Consultations, not guesswork.

A consultation includes a physical exam, and often involves interpretation of exam findings with other components of a pet's medical history (i.e. background, diagnostic test results, etc). Your pet's doctor will give you the medical information needed to understand the condition or disease, lay out all treatment options, and help guide you in making the best decision specific to your family and your pet.

Sometimes consultations involve discussions on matters that are not apparent on a physical exam. It can range from behavioral issues to nutrition consultations.

Let us help you avoid the rabbit hole of Google!

1. 1Previous medical records (email before appt or have us call for you prior to the appt!)
2. 2Vaccination history (especially for new puppy/kitten exam)
3. 3Fecal sample within 24 hours of appt (only for new puppy/kitten exam or if your pet is having diarrhea) — does not need to be refrigerated, but please store in a plastic bag or tupperware container.
4. 4Info on the medications your pet is taking (name, dosage, frequency)
5. 5What you’re feeding your pet (type of diet and amount)

Yes! We strongly recommend obtaining pet insurance. There is a certain amount of financial responsibility that pet owners must be ready to assume when they get a pet. It’s heartbreaking and stressful when your pet is sick and the situation can bring about more stress when there are limited financial means to provide your pet with all the treatments recommended by your veterinary team.

Pet insurance can be purchased at any stage of your pet’s life. The majority do not cover pre-existing conditions, so ideally the best time to obtain coverage is when you first bring your puppy or kitten home. However, we’ve had many clients purchase pet insurance when the pet is middle aged or a senior, and when they developed expensive but treatable diseases (ie. arthritis, cancer), it really helped!

Most companies have an annual deductible and request medical records before the policy begins or at the start of the policy. They will reimburse you after you pay for services, and they vary widely in coverage. The two companies that we trust and recommend are Trupanion and Healthy Paws. We have no affiliation, nor do we receive any compensation from any pet insurance company.

Additionally, there are websites that can be helpful for comparing and contrasting options:

• Pawlicy
• dvm360 — Pet insurance comparison chart
• Pet Insurance University

Heartworms are parasites that live in the dog's heart and are transmitted by mosquitoes. Although heartworm disease has not historically been a major problem in Los Angeles, it is becoming more common secondary to climate change and the increase in hurricanes. Heartworm disease is potentially fatal but easy to prevent with a monthly pill or injection. Dogs need to be tested for heartworms prior to starting these medications, then tested once a year. It is important not to miss any doses of your dog's monthly medication. Please ask your veterinarian about Proheart 12, Simparica trio, or Interceptor Plus.

In Los Angeles, fleas and ticks can be a year-round problem due to it never being extremely cold here! Aside from being irritating to dogs and their owners, fleas and ticks can transmit several serious diseases between dogs as well as from dogs to humans. Did you know that fleas have lead to a major typhus outbreak in humans recently?

Please ask your veterinarian which topical and oral products are effective.

1. 1Allergic skin disease is a widespread issue that is medically managed (unfortunately not cured) to decrease itchiness, manage secondary infections, and improve overall comfort.
2. 2Most commonly, pets can be allergic to flea bites (hypersensitivity to the flea saliva), something in the environment (such as molds, pollens, grass, and dust mite particles), or foods (primarily protein sources). Pets can and often do have multiple allergies added together to make them itchy. Allergies cause a break in the normal skin barrier, allowing bacteria to get in and cause infections. Allergies also cause inflammation, making the skin a perfect rich medium for bacteria and yeast to overgrow and cause worsening of skin infections.
3. 3To solve allergies, we must clear up the infection and remove the offending allergen(s) from the pet's world. Treating allergic skin disease can initially seem overwhelming since there are multiple options available for treatment. It can be hard to determine the underlying allergy because there is no simple test for food allergy and the skin lesion distribution is difficult to distinguish between food and environmental sometimes.
4. 4For treatment, we firstly always recommend keeping on flea prevention monthly since that is used as simple prevention. Next, we may recommend a food elimination diet or immune-modulating medication to help control the itch.
5. 5Additionally, there are some dogs that may have a hormonal imbalance or other disease condition that leads to signs that are similar to allergic skin disease but are actually not caused by allergies. We will recommend the appropriate testing if this is suspected.

1. 1To determine whether or not a food allergy or intolerance is causing the skin problems, a hypoallergenic diet is fed for a period of 8-12 weeks. When a pet is allergic to a diet, the allergy does not instantaneously resolve by switching to a new diet, hence it takes at least 8 weeks to see if it’s a true allergy. Since it can take this long to determine a food allergy, we often recommend immune-modulating medication at the same time to help with your pet’s comfort.
2. 2At the end of 8-12 weeks, if your pet’s skin condition has resolved, then we recommend "re-challenging" with the original diet for about 1-2 weeks to see if itching resumes (most clients do not opt for this as they are just happy that the problem has been corrected, but this is certainly an option that can be pursued). If we see recovery with the test diet and itch with the original diet, then food allergy is diagnosed and the pet is returned to either the elimination diet or another appropriate commercial food indefinitely.
3. 3Unfortunately, there is no other way to determine if a pet has a food allergy. Blood tests are often inaccurate for food but can be helpful with an environmental allergy.
4. 4The main concerns for feeding an elimination diet are as followed:

• It is important not to feed any other food, including table scraps (even food without a protein source), rawhide, chew toys, flavored chewable medications (these will need to be changed for unflavored tablets), vitamins, and other treats.
• If the pet needs to take oral medication and the owner is unable to pill the pet, we recommend giving the medication in the canned version of the same diet trial or vegan marshmallows to not negate the diet.
• All family members must be on board with the trial. There can be no slipping the dog other foods when no one is looking.
• It is probably best for all animals in the house to be fed the test protein so as not to have food-sharing issues.
• Itching must be managed during the trial in a way that the results of the trial are not foiled.
• Diet trials often span a season change period. If a dog has a pollen allergy and winter comes during the period of the diet trial, it may appear that the diet worked when, in fact, the seasons simply changed. This is one reason why diet challenge is important at the end, even if the pet is doing well, to determine if the diet has really been the main control mechanism.

There are so many options for pet foods and treats that it can become overwhelming! The pet food industry is not regulated by the FDA or anyone for that matter. There are a lot of buzz words on the packaging that attract people (ie. “organic”, “premium”, “all-natural”, “holistic”). As veterinarians, we always recommend a balanced diet for your pet.

The first step is to find a pet food that has an AAFCO label on it, which indicates that the food company has met the three important nutritional standards.

1. 1The diet is complete and balanced.
2. 2Make sure the correct life stage is intended. AAFCO-approved diets go through feeding trial requirements for growth, reproduction, and adult maintenance.
3. 3Identify that the label includes statements on how the food is complete and balanced - analysis of food or feeding trial evaluation of food.

For more information please visit these helpful websites:

• Tufts — Pet food decisions: how do you pick your pet's food?
• WSAVA — The Savvy Dog Owner's Guide to Nutrition on the Internet (PDF)
• WSAVA — The Savvy Cat Owner's Guide to Nutrition on the Internet (PDF)

This is difficult because the food label often overestimates how much you should be feeding your pet. Consequently, having an overweight pet is common and can lead to health concerns, including diabetes, arthritis, fatty liver disease, airway disease, etc. Please visit petnutritionalliance.org to calculate how much you should be feeding your pet.

We do not recommend feeding grain free diets. In 2019, the FDA published an updated study that linked grain free diets to the development of heart disease (dilated cardiomyopathy) in otherwise healthy dogs. Dilated cardiomyopathy (DCM) is a hereditary disease we normally diagnose in large or giant breed dogs such as Doberman Pinscher and Great Danes. But during the years 2014 - 2019, the FDA received increased reports of DCM in all different breeds, which sparked the investigation into grain free diets. Most of the diets associated with the reports of non-hereditary DCM have legume seed ingredients (eg. peas, lentils, etc.), high in their ingredient lists.

For more information regarding this, please visit:

• FDA — Investigation into potential link between certain diets and canine DCM
• FDA — Questions & answers on non-hereditary DCM in dogs

Consequently, we recommend diets that are grain based and are approved by the WSAVA (World Small Animal Veterinary Association — wsava.org). These include Wellness, Royal Canin, Hill's, Purina, Natural Balance, Nutro, Eukanuba, Honest Kitchen, Fromms, Iams, Just Food For Dogs, Fresh pet or Nom Nom Now.

The simple answer is no. Raw food diets are sold fresh, frozen, or freeze-dried and often sold on a bone and contain organ meat. There are multiple risks to feeding your pet a raw diet. These include nutritional imbalance and bacterial or parasitic contamination. These diets should especially not be fed in a household with an immuno-compromised person or children due to the risk of the raw food carrying harmful bacteria including Salmonella and Campylobacter. Additionally, the CDC and American Veterinary Medical Association support not feeding your pets a raw diet: AVMA — Raw pet foods policy FAQ

Yes, but we always recommend consulting balanceit.com or your veterinarian for additional help. It’s important that your home-cooking diet is well balanced and your pet is still receiving the essential minerals and vitamins in their food. There are other great sources for human grade food like Just food for Dogs, Nom Nom Now, Farmer’s dog or Ollie. We can also refer you to a board certified veterinary nutritionist for additional tips.

We are here for you if your pet has a behavioral issue! To name a few - separation anxiety, inappropriate urination, and aggression are common conditions we see in our dogs and cats. Please bring your pet with you during the consultation; this allows the veterinarian to thoroughly examine your pet and diagnose if there is an underlying medical condition contributing to the abnormal behavior. Our goal is to form a treatment plan that works best for you and your pet to improve or correct the bad behavior. This typically includes behavioral modifications, calming supplements, crate training and anti-anxiety medication depending on the severity.

Both trainers and behaviorists play important roles in helping our pets. A collaborative effort is the most conducive for an effective outcome.

Trainers

Dog trainers train dogs to perform specific tasks or actions. They also teach dogs not to do certain things. Some trainers will work with problem behaviors, even delving into the behaviorist side of things. However, if there are any underlying behavioral issues, a good trainer may refer you to a specialist.

Behaviorists

Diplomates of the American College of Veterinary Behavior (DACVB) are veterinarians who are specialists in the field. These specialists have completed a residency or training program in the discipline of veterinary behavioral medicine. Specialists in veterinary behavioral medicine have both the medical and behavioral knowledge to evaluate cases to determine if there is a medical component. Additionally, specialists determine which medication(s), if any, would be most appropriate as part of an integrated treatment program that includes behavioral modification plans appropriate to the individual patient.

Adaptil Pheromone Therapy: Collar, Spray, or Room Diffuser

ADAPTIL sends “comforting messages” to help puppies and dogs feel calm and relaxed in situations that may cause fear and anxiety.

Feliway Optimum Pheromone Therapy: Spray or Room Diffuser

FELIWAY is a cat specific therapy to help reduce common signs of stress in cats such as changes in household and conflicts between cats in the same household.

Zylkene Capsule Supplements

Zylkene helps balance reactions in some situations (travel, moving, adoption, over-grooming, meeting new people, loud noises, etc.) and helps animals maintain normal and relaxed dispositions. Zylkene may also open pets' receptivity to behavior-modification training.

ThunderShirt

Anxiety wraps are vest-like garments designed to calm anxious dogs. The vests work under the theory that pressure applied to the dog's torso causes a calming effect, similar to swaddling a crying infant or hugging a distressed person.

A great website to help pet owners recognize and address fear, stress, and anxiety in their pets: fearfreehappyhomes.com

Tips for a fear free vet visit: Fear Free vet visit tips