An Ounce of Prevention

Parasite prevention medications, along with vaccines, have extended the lifespan of our companion animals. A hundred years ago, cats and dogs were primarily outside animals- because who would want to sleep in bed with someone who is flea bitten and tick infested that poops wriggling worms?

This millennium, thankfully, we have safe and effective medications that prevent infections with intestinal parasites that can infect humans, kill disease carrying ticks and itch inducing fleas, and prevent fatal heartworm disease.

 

Heartworm

The first time I saw the consequences of heartworm disease was during my emergency internship. I walked into the hospital ward to find the walls covered in blood and my fellow intern looking pale and shaken.

One of our patients had been admitted for having trouble breathing secondary to heartworm disease, and during the night the inflammation had eroded into large blood vessels and the poor dog had coughed out most of his blood volume before dying. Horrifying- especially since this was preventable. 

Heartworm is transmitted by the bite from mosquitoes that are infected with heartworm larva (Dirofilaria immitis). The larvae mature under the skin of the dog, then migrate through the tissues of the dog into the circulation and end up in the blood vessels of the lungs and heart.

The incidence has been increasing in Massachusetts as in the rest of the country, likely due to warmer weather, a huge number of bats dying from White-nose syndrome, and with the influx of disease from dogs brought up from the southern US.

Yearly blood testing for this disease is recommended. It takes up to six months after infection for the heartworm test to be positive, as the test is for the antigen (protein) found in the adult female heartworm. Infection is prevented by using a year-round, monthly heartworm prevention medication such as Sentinel.

Heartworm infection in dogs is fatal over time if left untreated. Death occurs by heart failure, bleeding into the lungs, worm embolism, or secondary kidney damage. Treatment is expensive and has significant risks; year round prevention is much safer for your dog and less expensive than treatment. Even more exciting- the same heartworm prevention medication also controls hookworm infection and removes infection with roundworms and whipworms. Major prevention gold.

 

Ticks

Ticks in the Concord area are epic, as my son would say- last spring I saw a dog with well over 50 ticks embedded under the fur of his hind legs (he is a long dog, and clearly the ticks were unimpressed by the topical preventative applied to the front end). Ticks are spider-like parasitic insects that feed by biting their host and feeding on blood. They are attracted to the smell, warmth and vibration of an animal passing nearby. When they bite and suck blood, and especially when they detach after their blood meal, ticks will regurgitate part of their stomach contents into their host. This is how tick borne diseases- Lyme, anaplasma, ehrlichia, Rocky Mountain Spotted Fever, and babesia- are transmitted.

In our practice in West Concord, a high percentage of dogs test positive for Lyme and anaplasma. While these diseases will not transmit directly from the dog to you, you are in the same environment as your dog and precautions are advised. Monthly year-round tick prevention is recommended- the black legged (deer) tick, which transmits Lyme disease, quests for a blood meal year- round.

A hard frost does not kill ticks, and ticks continue to be active in certain environments, like the woods, and find warmer microenvironments in the leaf litter where they wait for a meal.

Our practice recommends the monthly oral product Nexgard, which works well in our patient population.

 

Fleas

Fleas are thankfully not as common as ticks in Concord, but infestations with resistant fleas are becoming very common in the South. Fleas are small dark insects that look like tiny bugs quickly running through the fur. Fleas bite through the skin and drink blood, and cause itching which can be very intense in a flea allergic pet.

Flea dirt (which is the stool from fleas) looks like small black specks that turn red when moistened, since flea dirt is composed of digested blood. The adult fleas that are seen are only the tip of the iceberg- each adult female lays 50 eggs a day, which hatch into maggot-like larvae.

Once fleas are in the house, intensive frequent vacuuming and washing of bedding, furniture and carpeting are necessary to control the infestation. The adult fleas have to be prevented from feeding (which they need to do to lay eggs) by treating every pet in the house with a preventative. The eggs hatch over a period of three months, so even if the adult fleas are killed more adults will appear. Prevention is best in the form of monthly year-round medication. We recommend the monthly oral product Nexgard. I have never seen fleas in a dog on flea prevention.

We are lucky to be living in a time when parasites- hopping, squirming, biting- do not need to be accepted as the cost of living with pets. Heartworm/intestinal parasite prevention and flea/tick prevention should be part of your basic pet routine. The alternative is gross at best, and life threatening at worst.


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Dr. Astrid Kruse graduated from Tufts University Cummings School of Veterinary Medicine in 2003. After completing a year long rotating small animal medicine and surgery internship, she joined the staff at a large general practice hospital on the North Shore, where she enjoyed forming long term connections with her patients and clients. She is happy to be a part of the team at Domino Veterinary Hospital in Concord, MA. Her special interests include dog and cat internal medicine, preventative health care, rabbit and guinea pig medicine, soft tissue surgery, and dentistry in all species.

Worms are Yucky- Pet Parasite Prevention

Yesterday a cat came into our practice for vomiting- the presence of squiggling spaghetti like worms in her vomit prompted the anxious visit. Because roundworms eggs can infect humans, and there were small cute children in the exam room, we had a tense and stressed conversation about zoonotic disease (diseases that pass from animals to humans) and parasite treatment and prevention.

Dogs and cats, especially cats that go outside and hunt, are exposed to intestinal parasites that can make them sick and that can also be transferred to humans. Decades ago, there were few medications for parasites, and dogs and cats stayed outside the house to ensure they didn't infest their owners. Now, with pets in the house and often in the bed, preventing infection is essential for both pet and human health. Thankfully safe and effective medications, both for the treatment of existing infections and the prevention of new ones, are available.

Puppies and kittens are often born with worms, which can pass through the placenta and through their mother’s milk.

All dogs and cats should be dewormed several times as infants. Stool samples need to be checked in addition, because the basic broad spectrum deworming medication can’t treat every single type of parasite. More specific medications are used to treat infections like coccidia, giardia, or tapeworm. Stool samples can come back “negative”- meaning no parasites seen- even if a pet is infected with worms because adult female worms need to be laying eggs at the time that the stool is produced for there to be eggs in the sample. 

In humans, the worms do not complete their life cycle as they do in their normal host. After being ingested through contaminated soil, food or dirty hands, roundworm larva travel through the body, especially through lungs, the nervous system and eye. Unsurprisingly small children are most at risk because of their questionable personal hygiene habits. Hookworms are transmited from soil, or sand, and travel underneath the skin, leaving itchy tracks. 

Our patient, the worm spewing cat, was given a deworming medication to rid her of the current infestation of worms. She will start on a monthly topical medication to prevent future infections. And the cute little girls living with their pet cat, who probably play in the dirt and don’t wash their hands like a surgeon, are protected too.


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Dr. Astrid Kruse graduated from Tufts University Cummings School of Veterinary Medicine in 2003. After completing a year long rotating small animal medicine and surgery internship, she joined the staff at a large general practice hospital on the North Shore, where she enjoyed forming long term connections with her patients and clients. She is happy to be a part of the team at Domino Veterinary Hospital in Concord, MA. Her special interests include dog and cat internal medicine, preventative health care, rabbit and guinea pig medicine, soft tissue surgery, and dentistry in all species.

Do I REALLY Need to Brush my Dog's Teeth?

Yes. Do you need to brush your own teeth? Yes- unless you want the sticky biofilm that is plaque forming a nasty fuzz over your teeth, causing odor (halitosis!) and laying the groundwork for infection. A biofilm like plaque is composed of millions of bacteria that stick to each other and surfaces with a slimy matrix, and never a good thing to have in your body.

Plaque mineralizes to tartar within 24-48 hours, which can’t be removed by just brushing and needs to be scaled off.

Dogs and cats have teeth very similar to human teeth, susceptible to the same diseases- the only difference in human teeth and dog/cat teeth is the shape. Cats, which are pure carnivores, have fang teeth for grasping their prey and very sharp pointy premolars and molars, made for slicing their juicy prey into meat chunks small enough to be swallowed.

Dogs also have fang teeth for grasping, but their premolars are less sharp and pointy and some of their molars are flattened. This pointy tooth shape is why cats and dogs don’t really chew and crush their kibble. Humans have more flat grinding tooth surfaces because we are an omnivorous species (except for bleeding heart vegetarians like me).

After the final baby (deciduous) teeth fall out at 6 months, cats and dogs have their permanent teeth for the rest of their life- unless they become so rotten that they fall out, are knocked out by significant trauma, or are extracted surgically for having a dead root, a fracture (and root canal is not an option), immune tooth resorption, or most commonly severe infection of the surrounding bone and soft tissue (periodontal disease).

Infection and inflammation in the mouth give nasty oral bacteria access to the bloodstream, infecting distant organs like the kidneys and heart valves.

If properly cared for, the permanent teeth can stay healthy, pain free and functional for life. And if well cared for, there will not be an abhorrent, nauseating, obnoxious mouth odor that frightens houseguests and small children.

Dental home care’s goal is to remove plaque before it turns into tartar, and before bacteria can infect the gums, bones, and soft tissues surrounding the tooth. Plaque also stimulates the immune response in cats that causes tooth resorption. What does home care look like? Daily tooth brushing. Feeding diets and treats that are clinically proven to help reduce tartar and plaque (with the VOHC seal)- think apple, not fudge! 

Tooth brushing is the most effective tool for decreasing plaque buildup before it mineralizes to tartar in 24-48 hours. Brush your dog's and cat’s teeth, if at all possible (meaning if you will be pulling back a bloody finger stump we can look at other suboptimal options) every day with a finger toothbrush and toothpaste. Try to make the experience pleasant by slowly working up to brushing the entire mouth, being patient and gentle, and rewarding with petting or a treat.

The teeth with the most tartar deposition tend to be the upper premolars (in the back of the mouth). Consider putting your pet’s toothbrush next to yours so that tooth brushing becomes a routine. Don’t share the same toothbrush, obviously, no matter how deep the love goes, but it can be a helpful visual cue.

You can also try feeding VOHC approved treats (VOHC stands for Veterinary Oral Health Council, which puts its seal on products that have clinical trials proving their effectiveness). For a full list of treats go to www.VOHC.org- Greenies are usually well liked (and are available at the office). Please remember that treats do have calories and that you may need to reduce the amount of calories from regular meals. You can consider using Hill's Prescription T/D diet for a dry kibble option- the kibble are large with cross hatched fibers that help remove plaque from the teeth.

For dogs, you can also try HealthyMouth, a water additive (VOHC seal) with all natural ingredients that is helpful in reducing plaque and tartar if your dog is happy to drink it. Please be wary of any "miracle" sprays for dental disease that are sold at pet stores with no VOHC seal- these have not been evaluated for efficacy and often do nothing for oral overall health. If it's too good to be true, it is probably too good to be true! Do not give your dog bones, antlers, cow hooves, rocks, ice, or hard plastic Nylabones to chew on. These commonly cause broken teeth- if the pulp is exposed, a broken tooth needs to have a root canal or be extracted.

Despite your best care efforts, most dogs, especially small breeds and greyhounds, and many cats will need regular dental cleanings under anesthesia to scale off tartar and radiographs (Xrays) to check for disease at the tooth roots. Just like you, who brush hopefully twice daily and floss, still need to see a hygienist to clean up, pets are no different. A healthy mouth is a key component in having a comfortable quality of life, a bloodstream free of nasty oral bacteria, and kissability. Smooch!


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Dr. Astrid Kruse graduated from Tufts University Cummings School of Veterinary Medicine in 2003. After completing a year long rotating small animal medicine and surgery internship, she joined the staff at a large general practice hospital on the North Shore, where she enjoyed forming long term connections with her patients and clients. She is happy to be a part of the team at Domino Veterinary Hospital in Concord, MA. Her special interests include dog and cat internal medicine, preventative health care, rabbit and guinea pig medicine, soft tissue surgery, and dentistry in all species.

Healthy Mouth in a Healthy Body

It’s surprising that we accept a rotten smell from our dog’s and cat’s mouth and dismiss it as harmless doggie breath or tuna breath. That smell, which in a human makes us recoil, indicates disease in a pet. Kidney failure and advanced diabetes can cause changes in breath odor, but most often bacterial infection along the gums and bones surrounding the teeth is the culprit. 

Teeth should be white and shiny. Tartar forms when plaque, which is a biofilm of bacteria, mineralizes in 24-48 hours. Plaque is easily removed by brushing daily. Certain treats, dry foods, and water additives can also help to reduce plaque and tartar.

Look for the VOHC (Veterinary Oral Health Council) seal on a product, which means it has been clinically tested and proven to be effective.

Chewing on hard objects can cause teeth to break, which is painful. If the pulp is exposed, the tooth will get infected and eventually develop an abscess (infection with pus) at the root. In dogs, the big upper premolar all the way in the back of the mouth is the most likely tooth to fracture. Cats more often fracture their upper canine (fang) teeth. A broken tooth with pulp exposure requires extraction or a root canal and crown to treat.

Do not give your pet bones, hard plastic chew toys, antlers, hooves or ice to avoid broken teeth!

Gums should be a healthy uniform pink, even at the gum line. Red puffy gums indicate inflammation and infection. Bacteria from the mouth, which are a nasty bunch, gain access to the blood stream and the rest of the body through the inflamed gums, and cause heart valve problems, liver and kidney disease, and other issues that affect wellbeing and longevity. Daily brushing to remove plaque, and addressing tartar through a professional dental cleaning as needed, is important to keep gums and the rest of the body healthy.

Just as humans visit the dental hygienist every 6 months or so, dogs and cats need regular professional veterinary dental care to remove tartar and address potential periodontal pockets in the gums or bone loss around teeth from infection. Because no pet will hold still to have every surface of every tooth scaled- including the area under the gums- and not swallow or inhale the bacteria laden water, general anesthesia is used. Thankfully modern anesthesia is very safe, and certainly safer than having a chronic mouth infection.

Breath should be fresh- minty is unrealistic, unless your pet actually eats mints, which isn’t advised. But healthy teeth, healthy gums and a clean pain free mouth are attainable!


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Dr. Astrid Kruse graduated from Tufts University Cummings School of Veterinary Medicine in 2003. After completing a year long rotating small animal medicine and surgery internship, she joined the staff at a large general practice hospital on the North Shore, where she enjoyed forming long term connections with her patients and clients. She is happy to be a part of the team at Domino Veterinary Hospital in Concord, MA. Her special interests include dog and cat internal medicine, preventative health care, rabbit and guinea pig medicine, soft tissue surgery, and dentistry in all species.

What it Really Means if your Pet is Overweight

Over a third of pets are overweight. Our pets don’t have to hunt for their food, and mindless snacking is easy when food is available all the time. Exercise, especially in the winter months, is in short supply. Not enough dogs get the opportunity for regular long walks or off leash romps with friends in the park which they need.

Cats lounge expertly, and need time and motivation to engage in hunting behaviors with a laser mouse or feather toy (moving their eyes while watching us doesn’t burn many calories). Many of us human caregivers show our love through food.

 

Obesity leads to increased risk of painful arthritis and orthopedic injuries, cancer, breathing problems, skin issues, and diabetes among other maladies.

 

Grooming challenges are common- I frequently see fat cats with matted fur and dandruff past their missing waists, and sometimes worse things crusted around their hind ends, because reaching around and cleaning that far is too hard! Chunky dogs develop moist skin folds that are predisposed to infection. Studies in many species show that obesity leads to a shorter lifespan. 

Cats and dogs should tuck in at the waist, and the ribs should be easily felt but not seen in most breeds. Losing excess weight and fat in pets means increasing calorie output (exercise) while decreasing calories taken in.

Pet foods have quite variable calorie counts, and each individual pet has different caloric needs depending on activity level, age, breed, and other factors. Cats can become very ill with fatty liver disease if they are forced to lose weight too quickly.

Your veterinarian can help you determine if your pet is overweight, help determine the goal weight, and give you guidance on type and amount of food to feed for a longer and healthier life!


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Dr. Astrid Kruse graduated from Tufts University Cummings School of Veterinary Medicine in 2003. After completing a year long rotating small animal medicine and surgery internship, she joined the staff at a large general practice hospital on the North Shore, where she enjoyed forming long term connections with her patients and clients. She is excited to join the team at Domino Veterinary Hospital in Concord, MA! Her special interests include dog and cat internal medicine, preventative health care, rabbit and guinea pig medicine, soft tissue surgery, and dentistry in all species.

Intestinal Parasite Prevention

Medications to Prevent Yucky Stuff on the Inside

 

Our dogs live in a different world than us- unless you are crawling through grasses, sniffing hind ends, and licking things with an interesting odor. Dogs are exposed to all sorts of insects and parasites that we clothed, shod, upright and comparatively clean adult humans are not.

Some canine parasites are species specific and only infect dogs and wild canids, while others can also infect humans and in particular small children who often practice questionable hygiene. (I am the mother of small children and can attest to this, despite proper parenting- our handwashing song is sung to the Row Row Row your Boat tune: “Wash wash wash your hands, bacteria can be mean- E. coli, typhoid, salmonella, get those hands all clean.”) Parasite prevention medications help reduce the risk of illness to both our furry friends and their human families.

 

All dogs should be on monthly parasite control medication to keep them and their human families healthy. “Dewormers” are found in most monthly heartworm prevention medication for dogs.

 

Milbemycin (in Sentinel and Interceptor) is effective in controlling roundworms, hookworms and whipworms; pyrantel (found in Heartgard) is effective against roundworms and hookworms. All these worms can cause diarrhea, abdominal cramping, and poor health in dogs, as well as anemia in the case of hookworms, which sink their 6 sharp teeth into the intestinal lining and drink blood. 

Humans are infected with hookworm by skin contact (like when walking barefoot) with contaminated soil or sand containing microscopic hookworm eggs, which survive for months in soil. The hookworm larva puncture and travel under the skin, causing itchy and unsightly worm migration tracks before eventually dying.

Humans are infected with roundworms through accidental ingestion of contaminated soil (fresh eggs are not infective)- the eggs can remain infective for years. The larva become confused in the “wrong” host (they wanted to be a dog or cat!) and travel around the body. In some people, especially children, the worms cause illness as they migrate through organs including the liver and lungs, and cause blindness if lodged in the human eye. According to the CDC, 14% of humans in the US have antibodies showing infection with roundworms.

Whipworms rarely infect humans. Picking up stool quickly, and washing hands before eating are good prevention strategies in addition to monthly parasite control medication for pets.

Heartworm is transmitted by mosquito bites. Mosquitoes feed on a dog or wild canid that is infected and suck up tiny larval worms. When the infected mosquitoes then bite another dog, the infective larval stage is transmitted.  The larvae mature under the skin of the dog, and migrate through the tissues of the dog into the circulation and end up as long, spaghetti-like worms in the blood vessels of the lungs and heart.

The heartworm disease incidence has been increasing in Massachusetts, along with the rest of the country, which is likely due to warmer weather, a huge number of bats dying from White-nose syndrome, and with the influx of the disease from rescue dogs brought up from the southern US. Heartworm infection in dogs is fatal over time if left untreated.

Death occurs by heart failure, bleeding into the lungs, worm embolism, or secondary kidney damage. Treatment is expensive and has risks; year-round prevention is much safer for your dog and better for the wallet. Rarely, heartworms infect humans but do not complete their life cycle- the dying larva will form a benign circular lesion in the lung which unfortunately looks like lung cancer or tuberculosis on scans, leading to invasive testing.

Humans are susceptible to infection with other related filarial worms, primarily found in Africa, that cause elephantiasis (lymphatic filariasis), river blindness, and eye worm (loa loa).

In sum: Ensure your dog is on a monthly year-round heartworm preventative that has deworming medication built in. Check with your rescue/shelter/breeder that your puppy has been dewormed every 2 weeks before bringing home the cute furry bundle, and follow up with appropriate deworming treatments at your vet.

Always pick up your dog’s stool (and promote “pick up after your pet” public health regulations). Wash your hands before eating or touching your mouth. And remember to wash your hands after touching humans or objects humans have touched, since fellow Homo sapiens carry many more germs that are dangerous to you than a well looked after dog!


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Dr. Astrid Kruse graduated from Tufts University Cummings School of Veterinary Medicine in 2003. After completing a year long rotating small animal medicine and surgery internship, she joined the staff at a large general practice hospital on the North Shore, where she enjoyed forming long term connections with her patients and clients. She is excited to join the team at Domino Veterinary Hospital in Concord, MA! Her special interests include dog and cat internal medicine, preventative health care, rabbit and guinea pig medicine, soft tissue surgery, and dentistry in all species.

Lyme Disease in Dogs in Massachusetts

Signs in dogs: lethargy, fever, limping, protein losing kidney disease/failure

Prevention: flea/tick prevention (chewable Nexgard), Lyme vaccination, daily tick checks, avoiding tick infested environments (tall grasses, fields, woods)

 

Lyme disease is caused by infection with the Borrelia burgdorferi bacterium. The infection is transmitted by the bite of a black legged tick (deer tick). Although previously it was thought that if a tick were removed within 24 hours infection could not occur, it is now believed that Lyme infection can occur within hours.

 
 

Dogs do not develop the classic bulls eye rash after being bitten and it can take 1-4 months after being bitten by an infected tick for dogs to show signs of Lyme Disease.

 
 

Cats are not thought to develop Lyme disease; other non-human animals sickened by Lyme infection are horses, cattle, and small rodents and rabbits. 

Most dogs are able clear the Lyme organism and, although blood antibodies show previous infection, there are no signs of disease. Some dogs develop fever, lethargy, or limping from joint inflammation. Other dogs develop kidney disease (Lyme nephritis), caused by damage to the kidneys’ filtration unit by the immune response to Lyme, that allows protein to leak through. These dogs show no clinical signs of kidney damage until they develop kidney failure months or years later- this is why blood testing (and, if Lyme positive, urine testing) are so important for Lyme surveillance. This kidney disease, while medically manageable in the early stages, is not curable.

Dogs are resistant to the neurological and heart manifestations of Lyme disease that occur in humans. Canine patients that show clinical signs of Lyme or have a high C6 antibody level, or abnormal levels of protein in the urine, are treated with a course of an antibiotic. The infection is not always permanently cleared from the body by the immune system or with antibiotics, because the Lyme organism can hide within the body and from the immune system.

 
 

Preventing infection requires a multi pronged approach in a high risk area for tick disease such as Massachusetts. An effective flea/tick product should be used every month year round, because black legged ticks bite even during the winter. I have seen ticks on dog patients all through the winter, except when a thick blanket of snow is keeping pets and pet parents snuggled by the fire.

 
 

The monthly chewable Nexgard is very effective at preventing ticks from attaching long enough to transmit disease and is the product we recommend at Domino Veterinary Hospital in Concord, MA. Some patients may need a tick collar (Scalibor, Seresto) in addition, if they go into tick heavy environment (such as walks in the woods or tall grass), to give additional protection.

Lyme vaccination is a great tool in addition to tick control- this vaccine is given yearly and helps the immune system inactivate Lyme both inside the tick’s gut and in the dog’s body. Keeping dogs out of areas that are tick infested- high grasses, fields, woods- especially during the peak feeding season is helpful. Environmental control of ticks including spraying pesticides is an option but comes with possible risks. Tick tubes decrease local tick populations by giving mice, which are part of the deer tick’s life cycle, nesting material that is toxic to ticks.

All dogs at Domino have their blood tested yearly for tick diseases. A large number of dogs in this area test positive for Lyme and other tick borne diseases (predominantly anaplasma, occasionally ehrlichia). The Concord Massachusetts area’s beautiful hiking trails and open spaces that keep the dog population so active, lean, and happy are infested with ticks.

 
 

Over a 5 year course in Middlesex county, 691,400 positive Lyme tests in dogs were reported by Idexx, one of the two big veterinary labs.

 
 

It's important to protect your dog by using effective flea/tick prevention, checking them for ticks daily, keeping them (and yourself) away from high tick areas, as well as considering vaccination. 

Unfortunately ticks and all the diseases they carry are a growing concern. As a pet owner it is becoming more and more important that you have a preventive routine in place to keep your pet (and yourself and your family) free of tick related illness so they can live a healthy and happy life.


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Dr. Astrid Kruse graduated from Tufts University Cummings School of Veterinary Medicine in 2003. After completing a year long rotating small animal medicine and surgery internship, she joined the staff at a large general practice hospital on the North Shore, where she enjoyed forming long term connections with her patients and clients. She is now excited to join the team at Domino Veterinary Hospital in Concord, MA! Her special interests include dog and cat internal medicine, preventative health care, rabbit and guinea pig medicine, soft tissue surgery, and dentistry in all species.