The Big “C”: Your Best Friend Has Been Diagnosed With Cancer.

The Big “C”

Your Best Friend Has Been Diagnosed With Cancer.

            It is the veterinary visit we all dread. Your dog or cat has not been feeling well and you make an appointment with the veterinarian. The veterinarian tells you they are concerned that your pet may have cancer and recommends further diagnostics. You have the first dilemma. Do you have the additional diagnostics performed? What will it change? As an Internal Medicine Veterinary Technician I see this dilemma all too often. My personal experience has taught me that I am more comfortable with any decisions I make when I have more information.

            You elect to proceed with the additional testing. Generally the veterinarian will recommend chest radiographs and an ultrasound. Chest radiographs (x-rays) are done to see if there are any masses in the lungs which would indicate metastatic disease (spread of cancer for the original site to the lungs). Ultrasound is an excellent diagnostic tool that is non-invasive. If any abnormalities are noted, the veterinarian will generally recommend aspirates, either of an organ such as the liver or spleen or lymph nodes or a mass. Once the aspirates have been obtained the waiting begins. The aspirates are usually sent to a diagnostic lab for a pathologist to review.

            In an ideal situation, the veterinarian will call and tell you that the aspirates were normal and there is no evidence of cancer. However, in all too many cases the opposite is true. You get the devastating phone call that the aspirates came back as cancer. You go numb and wonder what will you do?

            Today we have more options than ever in the treatment of cancer in dogs and cats. This does not mean that treatment is the right option for you or your pet. This is a very personal decision and many, many factors may influence your decision. Some of the factors are:

1)      Type of cancer: Despite the many medical breakthroughs some cancers are very aggressive and do not have an effective treatment. Other cancers such as lymphoma can be very responsive to treatment.

2)      Age of your pet: With many cancers such as lymphoma we are seeing young dogs affected. While treatment is not limited to young dogs, some may find that they are less willing to put an older dog or cat through the stress surgery or chemotherapy.

3)      Temperament of your pet: Is your pet fearful or aggressive or are they the life of the party and a trip to the veterinarian’s office is the highlight of their week?  Treatment for any cancer generally involves weekly trips to the clinic for an exam and monitoring blood work.

4)      Finances: While treatments are more widely available they are not inexpensive. When you add up the cost of the chemotherapy, the recheck exams, weekly blood tests and other medications, the cost of treatment can be a deciding factor.

5)      Availability of treatment: Depending on the type of treatment recommended you may have to travel a long distance frequently or medically board your pet. Most commonly this is done with animals receiving radiation therapy.

     While these are not all of the factors you should consider they cover the basics. Everyone has an opinion but the decision is ultimately yours as the owner. Circumstances may change and you may find yourself making a different decision. As an owner of 4 dogs I have come to realize that I cannot treat them all the same. While two of my dogs would treat a weekly trip to the clinic as a holiday, the other two would be stressed and nervous from the moment we walked out the front door of the house. Their reactions to the same circumstances would definitely influence my decision on how to treat them.

     The key is to ask as many questions as you need to be sure that you fully understand your options.  A second opinion is never a bad idea, especially if you have reservations.  And a comfortable working relationship with you veterinary team (both primary and specialty care) will always make the process less stressful.

 

-Mary Meglaughlin

 

 

Happy Easter!

Here at the veterinary hospital, holidays don’t necessarily mean spending time with family and friends.  For us, a lot of our busiest times are during holidays and Easter is no exception.  While most people are aware that chocolate and candies are bad for our furry four legged friends, there are many more dangers to be aware of.  More than just the normal edible items found in our baskets on Easter morning can be catastrophic.

                We recently had a very sweet 10 month old lab mix named Gus at our facility.  Gus had not been feeling well and presented to the clinic for vomiting and lethargy.  Upon an ultrasound examination, it was determined that Gus had a gastrointestinal obstruction.  Some foreign material was lodged in his stomach preventing anything from moving through.

Gus was taken to emergency surgery that night and we were very surprised by what we found.  It turns out Gus had eaten a stuffed animal, but not just any stuffed animal.  He ate an entire stuffed bunny rabbit completely whole!  On top of that, Gus also chewed up and ate part of a teddy bear.  Gus may still be a baby, but it is important to have supervised play time with your pet and any toys.  Even animals that are older and have never eaten things in the past have still surprised us and their owners!

If you are ever in question over what your pet may have eaten, it is always best to call your regular veterinary hospital or Triangle Veterinary Referral Hospital if it is after hours, than to wait and see if they will be alright.  Depending on what was ingested, we may be able to induce vomiting or suggest other preventative treatments.  We hope everyone has a happy and healthy Easter!

 

-Kristen Schoen, RVT

Hurricane Sandy Relief

Visit us on Saturday, December 8th from 10am - 2pm for a pet portrait with Santa (Santa is being assisted by our own Dr Grafinger this year).  Just make a $15 donation, and have a wonderful keepsake! 

All proceeds benefit Hurricane Sandy relief efforts.  Call (919) 489-0615 to reserve a time slot, or just walk in on the day of.

A Special Student

 

 

-"Are you a vet student from NC State?"

-"No - I am just a high school student taking a gap year before university."

- "Really! I would never have guessed...."

 

            And thus my externship began at TVRH, and not once have I regretted my decision to spend a year under the guidance of Dr. Grafinger and his admirable team.  Spurred by my interest in biology and medicine, I began shadowing Dr. Grafinger in May 2012 during my senior year at Durham Academy.  Keen on learning how medicine and science are truly applied in the world around me, I viewed shadowing at the hospital as a way to explore the realms of emergency surgery while gaining work experience with animals and exposing myself to the atmosphere of an emergency hospital.  Barely eighteen and inexperienced in the field, I knew that to be granted such a special opportunity was rare and invaluable.  Dr. Grafinger took a risk by allowing someone as young and untrained as myself behind-the-scenes in such a hectic and unpredictable field, and, everyday, I hope that he and his team have not been disillusioned by their choice. 

            From the moment I began working with the vets and techs at TVRH, I have felt welcomed in every single way.  Rather than viewing me as an intrusion or burden, everyone at the vet has embraced my presence and demonstrated kindness, sincerity, and patience - qualities that I have found absolutely priceless.  Knowing their willingness to help me understand, I feel free to ask questions without the worry of being judged or criticized for my ignorance.  Even when procedures are so new to me that I am at a loss of questions, I have found that simply watching in silence can be the most valuable way to learn.  Thus, whether shadowing in surgery or helping to restrain an animal, I experience everything as though I were a student with a personal mentor; from the preparatory work of anesthetics and sterilization to the actual incisions and operations, I am continually exposed not only to various techniques and procedures, but also to the importance of teamwork and trust between colleagues, and the dedication and strength required to work under demanding conditions.

            By the time June arrives and it is time for me to leave, I will have learned so much more than anyone will ever realize.  Every day, I think to myself how thank you seem such empty and lifeless words compared to the gratitude I feel towards everyone at the vet, and I wonder how I will ever repay everything that I have received over this wonderful year.  Yet, for now, I will let myself relish every priceless moment I spend with TVRH because, thankfully, I know I still have many months ahead of me. 

           

 Submitted by: Simone Robinson

Vet Tech Week

We all come from different backgrounds, different places….but chances are we were the little kid who loved animals and were always trying to bring home another one, even the sick ones, because we wanted to make them better.  We are veterinary technicians, veterinary assistants, animal health care workers….whatever the title, we are caregivers.  We are the ones who care for your pets when they are in the veterinary hospital or clinic. 

Most people don’t really know what a veterinary technician does.  What you see is not necessarily what you are getting.  You may think we just hold animals, or take temperatures and weigh them…..but what goes on behind the scenes is what makes us who we are.  We are nurses, phlebotomists, anesthesiologists, surgery assistant’s lab technicians, x-ray technicians, pharmacists, client educators, nutritionists, cage cleaners, groomers, a warm touch when they are scared.  We often work long hours, staying late when we’re needed, we often think about our patients even after we’ve left work.  We are the ones who keep them healthy and nurse them back to health when they are sick or injured.  We get attached to them, we get excited when they get better and we are sad when they don’t. 

It doesn’t matter what part of veterinary care we are involved in, zoos, academia, research, small animal, large animal….. we all want what is best for them.  We all want to make a difference and help provide the best quality of life we can for our fuzzy friends and regardless of how many backaches, headaches, or heartaches we endure in our challenging job, this is still such a rewarding career.  We love what we do.  We take pride in our work and truly enjoy being caregivers for your pets.  We are veterinary technicians.

Michelle Schoepper RVT

 

Dr Grafinger's sea turtle adventure

 I was recently invited to NCSU school of Veterinary Medicine to perform surgery on a Loggerhead sea turtle rescued off the coast of North Carolina.   The sea turtle had a crushing injury to her carapace and a severely lacerated right front flipper.   Her carapace or shell injury was the likely result of a boat collision.  Her flipper laceration was secondary to becoming entangled in a crab pot line.  The turtle’s name is Nichols and she was rescued by the Karen Beasley SeaTurtle Rescue and Rehabilitation Center.

damaged right front flipper

damaged carapace

 

The Karen Beasley Sea Turtle Rescueand Rehabilitation Center (KBSTRRC) is a nonprofit organization staffed by volunteers lead by Jean Beasley, in Topsail Beach, NC. Their mission is to successfully rehabilitate and release injured or sick sea turtles from the wild.  Since 1996, 152 sea turtles have undergone successful rehabilitation at the center and have been released. Currently, the Karen Beasley Sea Turtle Rescue and Rehabilitation Center has the capability to treat and care for ~15-20 injured or sick sea turtles at one time.   They are currently transitioning into a new facility where they can house and treat many more injured turtles.  The facility is now under construction.

The most common sea turtle species found off the coast of NC include: Loggerhead (Carettacaretta), Green (Chelonia mydas), and Kemp’s Ridley (Lepidochelys kempi).

Kemp's Ridley

The Kemp’s Ridley is considered the world’s most endangered sea turtle, and has been listed as an endangered species since 1970.  An adult Kemp’s Ridley measures 24 to 28 inches (62-70 cm) in carapace length and weighs between 77 and 100 pounds (35-45 kg).  The Kemp’s Ridley is the smallest of the local N.C sea turtles.

 

 

Green

Green sea turtles are another endangered species found around the world.  They nest in significant numbers on the east coast of Florida, as well as NC. The green turtle is the largest member of the Cheloniidae family. An average adult female green turtle can have a three foot carapace length, and weigh close to300 pounds. The largest green sea turtle ever found was an adult male with a carapace length over 5 feet.

 

Loggerhead

Loggerhead sea turtles are the most prevalent species in NC waters and they are the most common species treated at the Karen Beasley Sea Turtle Rescue and Rehabilitation Center. While all other species of sea turtles found near the U.S. coastline are listed as endangered, the loggerhead is classified as threatened.  Adult loggerheads weigh up to 350 pounds when fully grown, with a carapace length of ~32 to 41 inches long (82-105cm).

        Sea turtles spend the majority of their life in the ocean, and only come ashore when they are nesting or sick/injured.   They are often injured by boaters, because sea turtles must surface to breathe.   In NC, boating injuries seem to be most prevalent in the late spring to early fall.  Female turtles migrate closer to shore to nest during this time.  Boating accidents frequently result in severe carapace or plastron fractures, flipper lacerations, head trauma, etc.   Turtles also frequently become entangled in fishing line, crab traps, rope and fishing nets, which can result in severe lacerations or even amputations of flippers.    

      Complete or partial flipper amputations were the most common forms of treatment for severe flipper lacerations in the past.   If the amputee is a male sea turtle, the prognosis for losing a rear flipper is better than losing a front flipper since they hold onto females during breeding. On the contrary, females are better off losing a front flipper since the rear flippers are essential for digging nests in the sand.   Female turtles can not dig a hole of appropriate depth with only one hind flipper.  It has been shown that navigation and swimming is not affected by the loss of one flipper.   

I have been involved in multiple surgical sea turtle procedures for KBSTRRC.  Shell or carapace fractures are treated by stabilizing the shell with stainless steel plates and screws.  Many times the broken shell becomes nonviable or necrotic and is debrided along with dead soft tissue.  Overtime the healing new shell and soft tissue fill-in the space.   Head injuries are also addressed by repairing associated soft tissue or applying bone plates to the skull.  I have also repaired or salvaged severe lacerations in these turtles instead of complete or partial amputations.   Primary repair of a severe flipper laceration gives the turtle the best chance of success once released in the wild to nest or breed.  It is probable the same turtle could have another injury to a flipper over time. 

I have reconstructed two flippers in Sea turtles in the past.  I repaired a near full thickness back flipper laceration on a Loggerhead turtle (Bunswick II) who was completely rehabilitated.  He was released approximately 1 year post-injury with nearly normal flipper function.    A partial amputation was performed on a Kemps Ridley sea turtle (Briggy) because the end of the flipper could be preserved.  However I used some of the viable skin to create a skin flap to reconstruct the remaining flipper.  He was rehabilitated and released nearly a year later as well.   Both cases were reported in the Journal of Zoo and Wildlife Medicine in 2009.  The journal discusses each case in more detail, and is listed below.

 

I recently repaired Nichols flipper laceration in the same manner as Brunswick II. His bones were pulled together with suture (Toggled) and then the soft tissue was repaired. My counterpart in surgery Dr. Roe debrided and cleaned his Carapace injury. The carapace wound will be allowed to heal by second intention (allow his body to repair the wound over time). Last report is he has been doing well. However, some of the sutures have loosened which toggled his bones back together. I suspect it will continue to stabilize with scar tissue over time, and hopefully he will be released as well. 

Simon and Grafinger viewing CT results

CT of flipper

Nichols after surgery

 

You can check on status of Nichols if you visit the www.seaturtlehospital.org website; just click on Nichols.   You can also review past histories of the other turtles rehabilitated (Briggy, Brunswick II, etc.).  Consider adopting a turtle and contributing to the sea turtle hospital by volunteering or making a financial donation.    They do wonderful work and continue to give each and every sea turtle a fighting chance. 

 

Mike Grafinger, DVM, DACVS

 

_________________________________________________________________________

 

J Zoo Wildl Med. 2009 Dec;40(4):744-51

Surgical repair of severe flipper lacerations in a loggerhead, Caretta caretta, and a Kemp's ridley, Lepidochelys kempii, sea turtle.

Church ML, Grafinger MS, Harms CA, Lewbart GA, Christian LS, Beasley JF.

Source

Department of Clinical Sciences, College of Veterinary Medicine at North Carolina State University, Raleigh, NC 27606, USA. dr.fauna@gmail.com

Abstract

A loggerhead, Caretta caretta, and a Kemp's ridley, Lepidochelys kempii, sea turtle were presented to the North Carolina State University, College of Veterinary Medicine for evaluation of distal flipper injuries. The goal for both animals at presentation was to preserve limb function and avoid complete amputation. A severe full-thickness flipper laceration was successfully reapposed in the first case, and a rotational flap was used to cover exposed tissue in the second case. Limb function was improved and complete amputations were avoided in both turtles.

 

Bake Sale!!

TRIANGLE VETERINARY REFERRAL HOSPITAL BAKE SALE TO BENEFIT PAWS4EVER!!

Please come and support our fundraising efforts for Paws4Ever and satisfy your sweet tooth at the same time!!!  We are raising money to donate to this wonderful organization!   We will sell a variety of yummy sweets at TVRH (608 Morreene Rd. Durham, NC) this Sunday September 30 from 9am until 3pm.  Please consider contributing to Paws4Ever and their goal of helping all animals in need!  The following items will be available for purchase:

COOKIES

BROWNIES

CUPCAKES

CHEESECAKE

PEANUT BUTTER BALLS

Please help support us in this great cause!!!!  Thank you in advance!

Paws4Ever will hold their 7^th annual Walk for Animal Protection on Saturday October 6, 2012 from 10am-2pm at Southern Village in Chapel Hill.  Please come visit us at our booth!

Not your everyday patient

Sadie lioness

Triangle Veterinary Referral Hospital had a wonderful opportunity to support an important organization last Friday.  One of our surgeons, Dr Mike Grafinger, and several of our support staff made a "house call" to the Conservators' Center in Mebane, NC.

The Conservators' Center is home to the largest collection of lions in the Southeast. Their 21 lions and 11 tigers attract visitors who are fascinated by these predaceous felines. Although most visitors are drawn to the Center for the thrill of seeing big cats up close, many leave talking about other species in their eclectic collection, which includes wolves, New Guinea singing dogs, lemurs, binturongs, servals, bobcats, jungle cats, and a lynx.

The lifeblood of the Center is a community of people committed to caring for almost 100 animals. With a very small staff, they depend on volunteers and interns to supply much of the labor; and on visitors, donors, and Lifetime Adopters to help fund their continuing growth. 
  
Sadie was originally part of a large number of big cats living at a breeding facility in Ohio. The facility had been repeatedly cited for a poor safety record, unsanitary conditions, neglecting to provide veterinary care, and other violations. After issuing close to 900 citations, the county's health department soon ordered the 14 lions and tigers to be removed - or euthanized, and the Center stepped in to help by providing a permanent home.   

Sadie had an infected mass on her chin that needed to be removed.  Dr Grafinger and his staff volunteered their time to help out;  what a unique opportunity for TVRH staff to be involved in this field surgery!

Sadie, anesthetized and closely monitored by technicians Beth, Bobby, and Dina

Sleeping well

After the tumor has been removed

Waking up after surgery

 If you'd like more information about the Conservators' Center, information about their animals, how to visit or volunteer, and how to support their important work, learn more at www.conservatorscenter.org  where you can read about the animals, sign up for a free e-newsletter, link to their Facebook pages (be sure to check out Arthur White Tiger's FB page, which is great fun to read), and find a way to get involved.

Dr Grafinger will be writing a blog submission about his experience with Sadie and  her surgery, so be sure to check back!

Older pets and arthritis

My pet has osteoarthritis?

All the medical advances in veterinary care and improvements in nutrition have resulted in our pets living longer lives.  We get to enjoy their company and unconditional love longer, but unfortunately with a longer life our beloved pets get to experience some of the consequences of older age.  One of the most common orthopedic problems seen in geriatric animals is arthritis. Arthritis (from Greek arthro-, joint + -itis, inflammation) is inflammation on a joint or multiple joints. So now you can tell your friends that you speak Greek!!! A joint is where two bones meet allowing motion (shoulder, elbow, carpus, among others). There are many different types of arthritides, which can be classified as inflammatory or non-inflammatory.  The most commonly seen in older pets is osteoarthritis (OA) or degenerative joint disease classified as a non-inflammatory arthritis. OA is commonly the result of loss of articular cartilage and damage to subchondral bone.  If you just learned that your pet has arthritis, please know that your pet is not alone. OA is the most common type of arthritis in people in the United States and is also the leading cause of disability.  Clinical signs associated with osteoarthritis include joint swelling, pain, stiffness when walking and lameness. With time, decreased joint motion due to pain and discomfort leads to a reduction on muscle mass (muscle atrophy) because of disuse. Use it or lose it! As your pet ages the water content of the cartilage decreases with reduction of proteoglycan content, with the loss of the structural framework the cartilage becomes more susceptible to damage. 

Fig. 1  End stage osteoarthritis in a canine elbow. 

Fig. 2  Normal elbow

 Fig. 3 Hip dysplasia and osteoarthritis present on both hips. 

 Fig. 4  Normal pelvis

How do I know that my pet has OA?

Watch your pet for any evidence of acute or chronic lameness (limping) such as difficulty standing, climbing stairs, reluctance to jump and stiffness when walking. Approximately 20% of dogs over 1 year old are estimated to be affected with OA. Cats also can have clinical signs as a result of arthritis, but they are masters at hiding pain so the condition is underdiagnosed in cats. 

How does my veterinarian diagnose OA?

Diagnosis is based on history, physical exam findings and radiographs of the affected joint(s). On physical examination the affected joint may be swollen, unstable, painful and may have decreased range of motion. Radiographic evaluation of the affected joint(s) is the most common screening tool used by veterinarians. Collecting joint fluid of the suspected joint and analyzing it under the microscope can also give you invaluable information that can help you localize the problem joint as well as rule out other problems that may be affecting the joint. Other advanced imaging that can be used to evaluate the joint are CT scan and MRI, but are not used as often due to added expense. Minimally invasive procedures such as arthroscopy can be used to explore the joint and rule out underlying disease leading to OA. 

How can I help my pet with OA?

Once your veterinarian definitively diagnoses OA on your pet, medical management should be implemented to improve your pet’s quality of life.

The five mainstays of medical management are:

Weight loss or weight management- Your pet may be obese because of inactivity, sometimes associated to the OA pain. Reduced weight decreases that stress and forces placed on the joints. A variety of commercial weight management diets are available to control the daily caloric intake of your pet while giving them the sense of satiety. Visit your veterinarian for diet recommendations. Weight management will require regular visits to your veterinarian (Doggy Weight Watchers, if you will) to monitor weight and diet.  

Nutritional supplements- Nutraceuticals are not marketed to diagnose, treat, or prevent disease, but are presumed to protect the cartilage and inhibit degradation of cartilage with positive effects in experimental and clinical trials. The most common nutraceuticals used are Glucosamine, Chondroitin, Methylsulfonylmethane (MSM), and Omega-3 Fatty Acids. Chondroprotectants include Adequan (Polysulfated glycosaminoglycan), sodium hyaluronate, and pentosan polysulfate.

Controlled regular exercise- Your pet should be rested during the initial onset of clinical signs. During the recovery period low impact regular exercise improves and maintains joint range of motion and muscle mass. Swimming is a great exercise since it helps joint motion without the added stress to the joints.  

Pain management- A multimodality approach to pain control should be followed when it comes to pain control on these patients. Pain management may include some or all of the following modalities depending on the severity of pain:

Veterinary non-steroidal anti-inflammatories such as Carprofen (Rimadyl^®), Deracoxib (Deramaxx^®), Etodolac (EtoGesic^®), Meloxicam (Metacam^®), Tepoxalin (Zubrin^®), Firacoxib (Previcox^®), are frequently used for pain control of orthopedic conditions. Potential side effects include vomiting, diarrhea, inappetence, anemia, and dark tarry stool. NSAID use can result in stomach ulcers, colitis, and can be toxic to the liver and kidneys. If any side effects are noted it is imperative that the medication is discontinued and to contact your veterinarian for further recommendations.

Tramadol is a centrally acting synthetic analgesic used to treat mild to moderate pain. Tramadol has been used as an alternative to pure opioid medications and also given in combination with a NSAID.  

Acupuncture may result in increase function and muscle strength by ameliorating pain in pets diagnosed with arthritis.

Amantadine is an antiviral medication used in people that may reduce the tolerance to other analgesic medications in animals. Typically it is used in combination with other pain medications because it is unknown if amantadine has any analgesic properties when given alone.

Just like in people, arthritis in animals is a condition that does not have a cure, but can be managed with a combination of exercise restriction, weight management, pain medications and neutraceuticals. Once your pet’s condition is not responsive to medical management other options may include stem cell therapy and total joint replacement. Stem cell therapy in animals holds promise, but further research is needed to confirm efficacy and results of treatment.

 

 Submitted by Dr Leonardo Baez

The dreaded "Cone of Shame"

We get it.  We really do.  That baleful look you give us when we say “Your pet will need to keep the e-collar on for 7-10 days.” Or “…..until the wound is healed.” Or “ …until the bandage comes off.”   Some of the many reasons we pass out the despised Elizabethan collar, aka “cone of shame”, “satellite dish”, “lampshade”….whatever term of endearment you chose, we all hate them.  We do not love putting them together. (FYI, watching first timers attempt assembly of an e-collar can provide for at least several minutes of amusement…)  We know what is going through your head when we present you with this lovely piece of plastic secured to your pets head with a white ribbon of gauze.  You are thinking, “How is he/she going to eat?”  “How will he/she fit in the crate?”  Or if you have experienced the displeasure of an e-collared dog in your house before, you might be thinking, “Oh no, the backs of my legs are about to take a beating!”  (Picture a 90 pound canine running up behind you and ramming your calves.)   

Unfortunately these stiff plastic leg bruisers are one of those necessary evil kinds of things.  We promise we aren’t passing them out just to make your life miserable for a couple of weeks.  We really do have your pets’ best interest in mind.  We make them don this head gear to keep us from needing to re-stitch a surgery site, or mend self inflicted wounds or tell you your pet’s eye has gotten worse because they have been rubbing it obsessively. We understand that e-collars are sometimes a huge inconvenience, however animals usually adapt quite well to wearing these “hats”, with the exception of those that just simply refuse, and we know that happens too.  Just try to stick it out and do the best you can to keep your little critter safe from themselves.  It is only temporary, and hey, you can take cute pictures of your furry family member looking pretty pitiful while they wear their collar!

 

Cayleb, my 90 pounder with an allergic reaction and corneal abrasion on his right eye.

 

 

Cayleb sporting his cone!  His eye was back to normal in 7 days.  We did have to bust out our super duper big crate for him to fit in with his e-collar, and of course watch out for the backs of our legs in our tiny living room!

Submitted by Michelle Schoepper  LVT

Help Team TVRH sponsor and build a fence with

the Coalition to Unchain Dogs!

Stop by our hospital and pick up one of these cute t-shirts, just a $20 donation to the Coalition to Unchain Dogs.