Dogs

Arthritis is a complex condition involving inflammation of joints. It is very common, especially in older dogs.

There are many causes but, in general, the degree of arthritis is directly related to the age of the animal. Just as with us, the older a dog is, the stiffer the joints tend to be.

By far the most common form of arthritis is osteoarthritis (OA) which is perhaps better described as degenerative joint disease (DJD) since it is a progressive breaking down of the joint surfaces most commonly as a result of excessive wear and tear secondary to conditions involving joint mobility such as hip dysplasia and cruciate ligament rupture.

Although DJD is a progressive disease, early recognition, diagnosis and treatment of is very important in slowing the progress of the disease to ensure that dogs continue to live long and pain-free lives as far as possible.

At first, the signs are often subtle and many people think their dog is just getting old but, in fact, their dog can be in significant pain. Rarely will dogs cry out in pain with DJD. They have no idea that there are treatments available that can make them feel lots better and they don't have to suffer in silence. Ask yourself this; how would you know if someone (a person) close to you was suffering from arthritic pain? As a human, theu could tell you verbally, but unless they were lame or behaving oddly, it might not be obvious.

As responsible dog owners, we need to be looking out for the subtle developing signs of OA and so we have developed the questionnaire below as an aid to recognising if your dog is showing signs of arthritis.

Treatments for arthritis are varied, depending on the presenting signs and the individual dog. Sometimes, simple lifestyle changes (such as changes to exercise regimes and not having to go up and down stairs) can make huge differences. Ensuring your dog is not overweight is critical. Certain nutraceuticals can be helpful but beyond these, modern veterinary medicine has a large range of anti-inflammatory and analgesic (pain-killing) drugs available which can transform the quality of life for some dogs with arthritis.

I was told my neighbour's dog had died of chocolate poisoning. Can this be true?

Yes it can. Chocolate contains an alkaloid called Theobromine. This is a drug which is used as a diuretic, heart stimulant, vaso dilator, and also smooth muscle relaxant but it can be poisonous in excess.

Surely the dog would have to eat a huge quantity of chocolate for this to happen?

Not necessarily. Toxic doses are reported at around 100 mg/kg and fatalities at around 200 mg/kg. The amount of theobromine in chocolate depends on the type of chocolate.

Cooking chocolate and good quality dark chocolate contains between 15-20 mg/g whereas popular milk chocolate only contains about 1.5 mg/g.

Thus a small Chihuahua only weighing say a couple of kilos would have to eat less than 2 oz of good chocolate to potentially show signs of poisoning. Even a dog the size of Weimeraner could die if it ate say a couple of 200g bars of good quality or cooking chocolate.

What are the signs of chocolate poisoning?

Depending on the quantity actually eaten and the health status of the dog, sometimes no signs are apparent and the dog will be found dead from heart failure. This is particularly likely to happen in older dogs with cardiac problems. The usual signs are a thirst and urinary incontinence, vomiting, diarrhoea, panting, sometimes muscle spasms and seizures followed by coma and death. Excitability and a rapid, irregular heart beat are not uncommon.

What should I do?

If you have any suspicion that your dog has eaten an excessive quantity of chocolate, consult us without delay.

How soon do the signs occur?

It depends upon the quantity of theobromine actually ingested. One of the problems with chocolate poisoning is that signs are often delayed for more than 12 hours. Another problem is that once absorbed theobromine can sometimes remain active in the body for over 24 hours without being excreted. Death following ingestion of fatal doses typically occurs about 24 hours afterwards.

What is the treatment?

This depends on the clinical signs and the amount that may have been ingested. If the dog is presented to us early enough, simple emetics to make the dog sick may be all that are necessary. If there is doubt, we will administer activated charcoal which limits the absorption of the active principle, theobromine, from the gut. The charcoal may be repeated every four hours for 24-36 hours since one of the problems with theobromine is that it circulates in the bloodstream and can exercise its effects over a relatively long period. This effect has been shown to be shortened by repeated charcoal administration. In addition we will admit the dog and fluid therapy will be administered for at least 24 hours. Even if showing no signs it is essential that the dog is kept under close observation for at least 24 hours to check if there is any heart abnormality.

If chocolate is so poisonous to dogs, why are doggy choc drops sold as treats?

The amount of theobromine in chocolate products varies widely.

Milk chocolate has relatively small amounts and dogs would have to eat a lot of milk chocolate to poison themselves. Dog chocolate has even less and therefore is considered safe to use as treats in relatively small quantities.

Is it true that other products from the cocoa plant can be poisonous?

There have been recent reports of deaths involving dogs that have eaten cocoa shell garden products. These are used similar to bark as a mulching product. Cocoa powder itself can be hazardous if consumed as has happened in some cases.

I was totally unaware that dogs have dental problems. Is it common?

Dental disease is probably as common in dogs as in man and is probably just as painful. Dogs however do not have the same powers of communication of their discomfort and therefore until relatively recently a lot of dental problems have been overlooked in our pets.

Are the problems the same?

No. In man the most common problem is caries or decay which, due to the demineralisation (loss of calcium) from the enamel and the dentine results in painful infected cavities. In the dog decay only represents approximately 10% of dental problems, the majority of which are caused by periodontal disease.

What is periodontal disease?

This is simply infection in the tissues surrounding the tooth. Accumulation of tartar (calculus) on the teeth will cause the gums to recede around the base of the tooth. Infection soon follows and as a result of inflammation of the gums (gingivitis) they recede. Untreated infection then spreads into the tooth socket and ultimately the tooth loosens and is lost.

Is periodontal disease very common?

It is estimated that over 85% of dogs over three years old suffer from some degree of periodontitis, making it by far the most common canine oral disease.

What is tartar and can it be prevented?

The canine mouth is naturally a very unhygienic environment. It teems with bacteria. Many of these bacteria will breed on the surfaces of the tooth and form an invisible layer called plaque. Some of this is removed naturally by the dog’s tongue and chewing habits (particularly when young) but if allowed to remain the plaque thickens, becomes mineralised and is then visible as tartar (calculus). The tartar as it thickens presses on the gums which recede and the bacteria then result in gum infection (gingivitis). The gums gradually recede so that ultimately the socket is infected and the tooth is lost.

As the oral infection increases tonsillitis and pharyngitis can also occur. In addition, the bacteria are absorbed into the blood stream and can be carried to other organs. For example in older dogs heart infections are frequently due to bad teeth. Kidney and liver problems may also occur.

Can tartar be prevented?

Plaque in some dogs is mineralised much quicker than others. This depends on the individual. Special canine toys and ‘chew’ as well as feeding dry food does tend to reduce tartar build up, as does regular home care – cleaning. Today there are many products designed to reduce tartar in our dogs. (Please ask for a separate hand out).

Will feeding dry food remove tartar?

Once tartar has formed it will be necessary to remove it with a professional scale and polish under a general anaesthetic. However once removed dental home care goes a long way to prevent rapid re-occurrence.

What is involved with a scale and polish for my dog?

The tartar and more importantly invisible plaque has to be removed completely. For this a general anaesthetic will be necessary. If the patient is fairly elderly it will be prudent to carry out routine blood tests to establish that kidney and liver function are satisfactory. Sometimes antibiotic treatment is instituted before full dental prophylaxis is carried out. We will be happy to discuss this with you.

Under an anaesthetic scaling, both by hand and using ultrasonic cleaning equipment will remove tartar, both visible and also that which is accumulating below the gum line. It is this which causes gum recession. The teeth are then polished in order to try to prevent subsequent plaque build-up as much as possible. It may be necessary to carry out other procedures at the same time such as fillings, extractions etc. and sometimes special applications such as fluoride may be indicated to decrease tooth sensitivity and strengthen enamel.

These procedures will all be fully discussed either before hand or when you bring your pet in. We also ask for a contacting telephone number when you leave your dog so that we can discuss any additional work that may be indicated once under the anaesthetic.

Do I have to make an appointment for my dog to have a scale and polish?

Yes, we prefer to see the dog before an appointment is booked for dentistry. Then a general health check will be carried out and any laboratory tests arranged.

How can I prevent tartar accumulation after the procedure?

We will probably make an appointment for a check up a few days afterwards. Detailed instructions will then be given regarding home care. In the meantime it may be worthwhile getting your dog used to having his teeth brushed. Do this by using an old toothbrush dipped in his dinner or favourite food just to get him used to having the brush in his mouth. However we will explain the procedure of home care very fully and supply you with a useful leaflet.

Can I use human toothpaste?

Do not use human dentifrice on any account. These are foaming products and are not meant to be swallowed. They are universally resented by dogs.

Dental Home Care

Periodontal disease affects the structures surrounding otherwise healthy teeth.

It occurs in over 85% of dogs over three years of age. Home care involving regular cleaning of the teeth is the best way to prevent periodontal disease and thus the possible loss of many otherwise healthy teeth.

Consider how your teeth would look and feel if you failed to brush them every day. Your dog's teeth are really no different. Unless you regularly provide some form of dental care at home there is a very great possibility that periodontal disease will occur. Ideally it is preferable to train your dog to accept the procedure when a puppy but even elderly dogs can be trained to accept and even enjoy the procedure.

Dogs, unlike people, have a fairly long, flexible tongues and therefore it is not quite so important to brush the lingual, or inside, surfaces of the teeth since these are rubbed fairly vigorously by the tongue and consequently the build up of tartar on these tooth surfaces is considerably less than we experience.

How do I start to train my dog?

The procedure should be made as pleasurable as possible. For the first few days simply hold your dog as you normally do when petting him. Pet him particularly around the head and use treat rewards and lots of praise. Do this especially at your pet's meal time since for a healthy dog is the most pleasurable part of the day. You are going to utilise this to encourage dental home care compliance.

Your veterinary practice will supply a special toothbrush designed for use in your dog's mouth. Initially dip this in your pet's dinner or in some meaty titbit, for example pate, and brush this on the outside of the teeth holding the jaws shut and inserting the brush gently between the lips with the bristles against the teeth at an angle of approximately 45 degrees to the tooth and gum surface. Gently rub the bristles against both the teeth and the gums.

If necessary let the dog consume some of his meal in between brushing sessions.

Most people find their dogs will tolerate the cheek teeth being cleaned before they are happy to allow you to clean the front teeth or incisors. If you do have problems do not hesitate to contact the practice.

Once your pet is used to having the outside of the teeth cleaned in this way, it may be possible for you to venture into the mouth to clean the inside surfaces. To do this you have to hold the dog's head up as high as possible and then gently open his mouth. If you can hold a finger or your thumb pressed against the roof of the mouth, this will prevent him from shutting his mouth. However as previously stated this procedure is not as important as cleaning the buccal or outside surfaces of the teeth.

If you find you are unable to carry out these procedures, do not despair. Today there are special foods that have been formulated to help with tooth cleaning and there are also gels and other antiseptic solutions that can be applied on a daily basis. Please contact us.

Ear preparations are supplied in order to assist in clearing up your pet's ear complaint. The condition is not uncommon and there are a number of possible causes.

You will have been advised regarding the frequency of application but we thought it would be worthwhile just setting out the various steps in actual application of the medication. Please try to persevere with the treatment following the veterinary surgeon’s instructions even if an immediate improvement has been seen.

How do I apply the ear drops?

It is always useful if you can get someone to assist by holding your dog for you.

The head should be gently but firmly held and the ear flap pulled upwards to open the top of the ear canal as much as possible. Squeeze the prescribed number of drops into the upper part of the ear canal then gently but firmly massage the ear canal to allow the drops to disperse and to penetrate deep into the ear. With a piece of cotton wool or a piece of tissue on your finger wipe away any excess liquid and debris from around the ear.

DO NOT POKE ANYTHING DOWN THE EAR CANAL SMALLER THAN YOUR FINGER.

In other words, do not use cotton buds. The dog may move and you may as a result cause pain which will make it much more difficult for you to apply the drops next time.

When applying the drops note the colour and consistency of any discharge and if you are at all concerned contact us without delay.

If there appears to be an excessive growth of hair at the top of the ear canal try to gently pluck this in order to allow ventilation of the ear canal and penetration of the ear drops. Again, if in any difficulty, call us.

If you find it difficult to apply the medication sometimes a simple muzzle will take the dog’s mind off what is happening. If you contact us we can supply a suitable muzzle or alternatively one can be improvised from a piece of bandage or an old tie. We will gladly assist with a demonstration of how to apply this.

If you happen to own one of the flat faced, brachycephalic breeds, boxer, pug, peke etc., muzzling is more difficult, but techniques using a towel or in some cases, a special muzzle, can be effective. Please contact us.

Your veterinary surgeon will have discussed the frequency and application of the eye medication prescribed but it may be useful to have these notes as an aide mémoire.

Applying the Medication

• It is always useful to have someone to hold the dog for you if at all possible.
• Hold the head firmly but gently and tilt the nose upwards.
• Remove any dried discharge from the corners of the eye with a piece of cotton wool moistened with clean water.

Applying Ointment

If eye ointment has been supplied in a tube, do not point the nozzle directly at the eye. Gently part the lids between your finger and thumb and holding the tube with the nozzle parallel to the eye and approximately half a centimetre from the eye, gently squeeze a small amount of ointment across the already held open eye. Your dog will immediately close his eye. Gently stroke your fingers across the closed lids to disperse the ointment which will rapidly liquefy when in contact with the warm tears.

Applying Eye Drops

If a liquid has been prescribed the technique is, if anything, a little easier. The lids are parted as before and the nozzle is held vertically, approximately half a centimetre above the eye and one drop gently ejected on to the eyeball. Following this the procedure is exactly the same.

General Tips

Sometimes although only one eye is affected your veterinary surgeon will have advised you to apply the drops to both eyes. Please remember to apply the preparation to the unaffected eye first. It is also important to avoid touching the eye with any part of the nozzle of the eye preparation in order to reduce contamination as much as possible.

If you find it difficult to apply the medication, sometimes a simple muzzle takes the dog’s mind off what is happening and will be of great assistance. If you contact us we can supply a suitable muzzle or alternatively one can be improvised from a piece of bandage or an old tie. We will gladly assist with a demonstration of how to apply this.

If you happen to own one of the flat faced, brachycephalic breeds, boxer, pug, peke etc., muzzling is more difficult, but techniques using a towel or in some cases, a special muzzle, can be effective. Please contact us.

Many drugs in tablet form, licensed for use in dogs, have been specially formulated with palatability in mind. However, if the dog is at all suspicious, he is unlikely to eat the tablet voluntarily irrespective of how pleasant it may taste.

Can I train my dog to take tablets?

Yes, it is good foresight to train a puppy to accept tablets pushed down the throat. This is a useful technique to practice with a puppy using something pleasant like a vitamin tablet or a choc drop.

My dog has never had a tablet - how can I get them into him?

Try subterfuge to start! Most dogs readily accept soft centred chocolates even if they have never had them. Try giving him one or two and then give one with the tablet pushed into the centre. You may be successful. Make it a game and a lot of the problems will be solved. If necessary push the tablet disguised in the chocolate down the throat.

You say push the tablet down the throat. How do I do this?

Remember that dogs quickly learn when it is tablet time and will vanish from sight if given the opportunity. First catch the patient!

If possible try to get someone to help you to hold the dog. Depending on his size you may find it more comfortable supporting him on your lap if small or held between your knees if larger. Most people find it easier to approach from the side or behind when giving tablets.

Place one hand across the muzzle and insert a forefinger and the thumb gently into the space behind the canine teeth or fangs Then gently press the thumb on to the roof of the dog’s mouth. Provided you have sufficient strength and dexterity in your wrist to be able to cope with the dog’s head movement, this strategy usually effectively prevents the shutting of the jaws on your fingers.

It is most important that the gentle pressure on the hard palate is not reduced otherwise the mouth will clamp shut.

With the tablet in the other hand it can then be pushed as far down the throat as possible and if the jaws are then quickly closed and the throat stroked the tablet is usually swallowed.

I understand there are certain pill pushers. Can these be used?

There are certain devices on the market to help getting tablets into dogs. Some of these are reasonably effective but none are, in our experience, 100%. However it may be worth trying. If you would like to discuss this further please contact us.

Can I disguise the tablets with anything?

Yes, many people find that wrapping the tablet in butter or coating it in some favourite food or tidbit or using chocolates as already described will often do the trick. It should be remembered that there are certain tablets that you may have been directed to give on an empty stomach and care must be exercised then in the amount of food or tidbits allocated although one or two sweets in order to get the medication into the dog is preferable to no medication!

I get the tablet into the throat and follow all the instructions but frequently find it on the floor sometime later.

Even the most experienced of us have had this. If you are not sure that the tablet has been swallowed dripping a little water into the mouth with the aid of a syringe usually ensures that it is swallowed. Alternatively try gently pinching the nose and then stroking the throat.

Here at AlphaPet we are strong believers in preventative healthcare. Prevention is always better than cure! One of the most important things we can do to aid with this motto is to neuter dogs at an early age, if they are not being used for breeding.

In both dogs and bitches we recommend neutering from 6 months of age.  There is now plenty of evidence to show that this can be safely carried out in the bitch prior to their first season.

In bitches, the advantages of early neutering are:

• Removes the worry of coping with seasons (keeping her away from other dogs for 3 weeks out of every 6 months)
• No chance of pseudo-pregnancy (false pregnancy) after the seasons
• Reduced cancer risk. It has been proven that the more seasons they go through, the higher the risk of mammary tumours (cancer) in older age. Neutering prior to first season can significantly reduce the risk of these types of tumours.
• Eliminates the risk of pyometra - a severe and potentially fatal infection of the uterus.
• No risk of an unwanted litter of puppies

In dogs, early castration has the following benefits:

• Helps calm them down a bit but don't worry it will not change their personality! They will still be the same boy you know and love, just better at listening and learning, rather than running off after the girls!
• Helps reduce the risk of certain prostate conditions in older male dogs
• Removes the potential for testicular cancers, which are common in older entire male dogs.

In most cases the operations are done as a day patient surgery. They are admitted during the morning and go home the same evening.

We take pain relief seriously and both bitches and dogs will go home with additional pain relief for the first few days after surgery. They will need to take life easy for approximately 10 days after their surgery.

Post surgery we recommend close monitoring of your dog's weight, since a neutered animal's calorific needs are less than that of an entire animal and failure to monitor this can lead to weight gain.

For further advice please contact the surgery to arrange an appointment to discuss with a nurse or veterinary surgeon.

I have been told my dog is obese and must be put on a diet. Can this be true?

We are all very much aware of the problems that obesity causes in people. Heart, joint and breathing problems are the most common.

What is not so commonly known is the fact that the same problems can affect our pets if they are overweight, therefore it is always prudent to ensure that weight is lost if necessary.

What is obesity?

In man obesity is defined according to strict tables involving weight and height measurements. With dogs obesity is less precisely defined because of the diversity of body size and build. Consider a Whippet compared with a St Bernard or a Chihuahua and a Great Dane!

Therefore diagnosis is more subjective than with man. We can all readily spot the grossly obese dog belonging to another. Few of us would ever accept that our own dog was even a little overweight!

Pedigree animals are somewhat easier in that each breed has an optimum weight and simply weighing the dog will often establish whether it is obese.

With mixed breeds it is much more difficult.

Vets classify fat dogs as overweight, heavy, obese, and grossly obese. Categorising any dog depends sometimes on skin thickness measurements as in man but more usually on examination to determine whether individual ribs can be palpated. Overweight dogs have a slight excess of fat covering the ribs and have a discernible waist. If there is a heavy fat cover over the ribs and noticeable fat deposits in the lumbar region and at the base of the tail this would be classified as a heavy dog. When the ribs cannot be felt at all, there is a lot of fat over them and there is no waist the dog is OBESE. Grossly obese describes the dog with massive fat deposits present over the thorax, the spine and the base of the tail. The waist is absent and there is usually a sagging abdomen with obvious abdominal distension.

If my dog is overweight, will his behaviour have changed at all?

Many obese dogs are greedy. They will bolt their food and then ask for more. They will beg for food at family mealtimes. It will be noted that their activity is seriously reduced, they sleep instead of play and frequently will only walk for short distances. Other signs are difficulty in negotiating steps and stairs. They will often pant if forced to exercise more than absolutely necessary.

What is the cause of obesity?

Simple obesity is the accumulation of excess energy which is stored as fat. In other words the dog is receiving more calories then he needs for body maintenance and energy expenditure. There are many other causes of obesity such as glandular imbalances. Some breeds such as Labradors, Spaniels and Dachshunds tend to turn to fat very easily.

I had my dog neutered. Do you think this is what caused the problem?

There is some indication that neutering can increase the probability of obesity in later life. However it should be remembered that service dogs, e.g. Guide Dogs for the Blind, Hearing Dogs for the Deaf, Dogs for the Disabled, are all neutered but strict dietary control ensures that these animals are not obese.

I am sure my dog is not obese because he only eats a small quantity of food every day.

Obesity often develops insidiously. We think we are feeding our dogs only a small quantity of food but forget the odd sweet biscuit, the peppermint cream, the drink of milky tea when he goes to bed. We also forget that in comparison with us, if he happens to be a Papillon he is only a fraction of our weight so one sweet biscuit a day to him is probably equivalent to two or three packets a day to us.

What can I do?

To be told that a much loved pet is seriously overweight and can suffer health problems is always an initial shock. Compare the dog's weight with that when he was 12-24 months old. Weight should not have increased.

Positive thinking is imperative. Enlist the help of all members of the family. If you had been told your dog was suffering from a heart disease or kidney trouble you would know instinctively that this was serious. Obesity is just as serious and does require the co-operation of everyone in contact with the pet.

Do not be afraid of contacting the practice for advice. Weight will not come off overnight. Just like us it is a hard and often initially an unrewarding struggle. Be prepared to be patient and to persevere. Write down everything he gets in a day. Often you will be surprised at the sabotage that goes on, bread put out for the birds, the odd tidbit from an indulgent friend or neighbour. You have to be vigilant.

Above all, follow the professional instructions and the diet that has been prescribed. 

Once weight returns to an acceptable level you will be surprised at the years that seem to have been shed. It really is worth perservering. We will do all we can to help. Do not hesitate to contact our trained personnel.

Start off working in your enclosed garden, where it is safe for your dog to be off lead.

Walk around with your dog off lead, reward your dog every time they choose to come to you (treats, toys, praise etc) i.e. don’t try to recall them yet, let them choose to come to you.

Repeat this for several sessions, so the dog associates coming to you with something positive.

Now start calling your dogs name, give him a couple of chances to come to you but if he ignores you then go to him, stick a treat under his nose and lure him back to your start position. Touch his collar and then give the treat.

Occasionally put your dog back on the lead for a few steps and let him go and play again.

Repeat this for several sessions, initially working close to the dog and gradually increasing the distance between you and them.

Once your dog is recalling, you can add in a command word “come” or “here” are commonly used terms, but what ever you choose is fine, just keep it consistent.

Once you have 100% recall at home, take your dog somewhere quiet and enclosed outside. Use a long line or flexi-lead for back up control and repeat the above process from the start.

Finally start introducing other distractions, initially dogs that you know and trust and eventually working up to walking in a busy dog friendly park.

Once you are happy that you have good recall, work without the longline flexi-lead.

Remember to always carry some tasty snacks (or a suitable toy) as a reward, never punish your dog (even if it takes them ages to eventually recall) and keep the session short and try to finish on a good note when ever possible.

Long term, keep recalling your dog throughout the walk, reward and let them go and play again (this prevents the dog from getting wise to when you put the lead on it means “game over” for the walk.)

Boosters - Are they really necessary?

Primary (puppy) vaccination is essential if the major killer diseases that were rife only a relatively short time ago are not to once more become a scourge. However there is evidence today that some vaccine injections may not be essential.

If you have any concerns in this area please do not hesitate to discuss them with us. The problem is one of risk and benefits. There is no evidence that annual booster vaccination is anything but beneficial to the majority. To establish whether boosters are really necessary, blood tests are necessary which are usually more stressful and certainly cost more than a simple revaccination. Recently, published surveys have shown conclusively that omitting to re-inoculate against some of the major diseases can put pets at risk.

I would prefer my pet to have boosters only when necessary. Is this possible?

It is possible but the level of immunity against any of the inoculable diseases has to be established by individual blood tests (although there is currently no reliable blood test for Leptospirosis immunity). That immunity has to be boosted and cost factors have to be considered. The inoculation against a single disease is likely to cost as much as a multivalent vaccine and at present there is no scientific evidence that annual multivalent boosters actually cause harm. Obviously from your pet’s point of view it is preferable to receive one injection than a series. Also manufacturers have to submit evidence to the Veterinary Medicine Directorate (VMD) regarding the efficacy of all the components of the vaccine and the fact that the vaccine is safe before the product licence is issued.

Are there any other advantages of annual vaccination?

The annual booster appointment also involves a thorough health check – ears, eyes, heart and chest are all examined; dental, ear, heart and other problems frequently come to light during this examination and can be successfully treated because the condition has been detected early in its course.

As a result of the annual booster vaccination programme, major fatal diseases once common are now seldom seen. However, if you have genuine concerns and would prefer to have regular health checks and discuss revaccination of either all or some of the inoculable diseases please contact us and we will arrange this.