Our skilled surgeons perform a variety of procedures. Contact us for more details.
From spay and neuter to orthopedic surgery and soft tissue surgery to emergencies, we perform a wide range of pet procedures. We also have access to an endoscopy specialist. Having your beloved companion undergo surgery can be stressful for both you and your pet. We do everything possible to make sure your pet's experience is filled with ease and comfort.
Even before surgery, your pet undergoes a thorough exam, including blood tests. We take into consideration your pet's age, breed and pre-existing conditions and develop an individualized anesthesia protocol for surgery.
When you drop your pet off for their procedure, you can feel confident knowing that we take all precautionary steps to ensure their health and safety. We carefully monitor your pet through various tracking equipment, body temperature blankets and specific anesthesia systems. Our registered veterinary technicians, who are trained to monitor your pet, are also present for the procedure to advise the rest of the team of their body's response to the surgery. Before you and your pet leave after their procedure, we will give you written post-operative care instructions and medication for post-operative pain management. If you have questions about your pet's upcoming surgery, please contact us at 416-245-8805.
Our veterinary team performs a range of surgical procedures, based on your pet's needs. With the help of our state-of-the-art diagnostic equipment and the years of experience of our staff, we've performed countless emergency and elective procedures. Some surgeries we perform are listed below.
Dogs sometimes develop problems of the anal sacs, the small glands that are located on either side of the anal opening. Owners may notice “scooting” along the floor or an odor that seems to come from the anus, even though there is no leakage of feces. At Richview Animal Hospital, we offer help for dogs with anal sac problems, with the anal sacculectomy procedure.
The anal sacs are small pouches on either side of the anal opening that function as a means to mark territory in canines. These glands contain oil and sweat glands that produce a strong odor. Generally, a small amount of the fluid is released when the animal defecates. However, the glands may become impacted with fluid, leading to troublesome symptoms. Tumors of the anal glands can also occur. In most cases, the extraction of the glands can be done by your veterinarian to release this fluid. The anal sacs can sometimes become impacted or infected, which can negatively affect the overall health of your pet. Anal gland problems generally occur in small dogs more often than large animals and can affect either sex. Antibiotics may be needed to clear up an infection of the anal glands.
“Scooting," or rubbing the hind area against the floor or carpet, can be a symptom of anal gland problems. Your dog may bite or lick the anal area constantly. You may notice a strong smell coming from the dog’s rear end. The animal may experience constipation or may show signs of discomfort when defecating. Chronic infection can lead to a painful abscess of the anal glands.
Frequent anal gland infection can lead to negative health effects. Your veterinarian may determine that the best course of action is to remove the anal glands to prevent further problems. In this procedure, a small incision is made in the area of the glands, and they are removed. The animal may be kept at the hospital for one or two days. Aftercare involves stool softeners for a period of time and the use of an e-collar to prevent tampering with the incision area.
There are certain problems that both people and pets can develop and one of these has to do with the bladder. Problems with the bladder can take many forms, ranging from trauma to infections and everything in between. In some cases, these problems may require surgery to be corrected. The prospect of bladder surgery can be scary for a pet owner to have to deal with. There is some important information that every pet owner should know about bladder surgery before moving forward.
There are numerous problems that veterinary clinics can diagnose when it comes to the bladder and not all of these are going to require surgery. Bladder surgery is not a decision that any doctor makes lightly. One of the most common reasons why a pet might need bladder surgery is to remove stones that might be present. Think about surgery for kidney stones in a person. Bladder surgery for stones in an animal is a similar issue. Furthermore, some animals might be having issues with incontinence. Bladder surgery can be used to help these problems as well. Bladder surgery is something that will be discussed thoroughly with the family before any decisions are made. We want all of our families to understand the process before making any decisions.
If a pet needs bladder surgery, several steps are needed. First, the family is going to be educated on all of the risks and benefits of the surgery. Next, the animal is going to be taken back to the operating room where anesthesia is given. This will allow the animal to sleep during the procedure without any pain being felt. Then, the operation will be performed. This will look different depending on the exact nature of the surgery. Finally, after the procedure, the pet is taken to the recovery area.
Animals sometimes think anything is edible, and they will try to consume bones, rocks, or any other foreign objects. However, this habit can cause an obstruction in their gastrointestinal systems. These blockages can cause serious health problems and can even lead to death. Veterinarians are trained to do enterotomy procedures, which involve an incision in the gastrointestinal system to remove offending objects. At Richview Animal Hospital, we perform surgical procedures, such as enterotomy, to help pets with these problems.
An enterotomy is a surgical procedure that involves making an incision into the intestines. This type of surgery is performed when x-rays and other testing confirms a gastrointestinal blockage. Enterotomy procedures are done routinely by veterinarians and generally have good outcomes. The risk of complication is low and usually involves infection of the incision, which can be managed effectively with antibiotics.
An enterotomy is generally used to remove foreign bodies that become stuck in an animal’s intestines, blocking normal intestinal function. Dogs, in particular, will ingest bones, rocks, pieces of rubber, pet toys, cloth, children’s toys, or any other unlikely item. These can become stuck in the narrow passageways of the intestines, preventing the passage of food and waste through the gastrointestinal system. Intestinal blockages can cause animals to become very ill and unable to feed normally. Surgery to remove foreign objects and restore normal gastrointestinal function is needed to prevent life-threatening consequences.
After surgery, the veterinarian will provide IV fluids, pain medications, and will carefully monitor the animal for any problems. When your pet is ready to go home, you will be given detailed instructions on feeding, acceptable activity levels, and medications for recovery. Generally, animals will begin eating normally after 24 hours. However, you should monitor your pet closely for vomiting, signs of pain, fever, or lethargy. Your veterinarian will discuss measures that will help to prevent your pet from experiencing the problem in the future.
If you live in the Etobicoke area and have a pet with severe eye problems, it might be time to consider a surgical procedure known as eye enucleation. The decision to have this surgery is serious because it has permanent consequences for your pet. In some cases, however, it might be the only way to save your pet's life. Richview Animal Hospital is here to help answer your questions about eye enucleation.
Eye enucleation is a surgery that removes the eyeball but leaves the eyelid and the structures surrounding the eyeball intact. Typically, this surgery is done when an eye is badly damaged, either through a serious accident or disease. When completed, the patient is left with an empty eye socket.
The surgery is only considered when the damage to the eye has become so great that the eye will never be able to function again. Typically, this means that no sight is expected to be recovered from the eye.
In the case of an accident, the eyeball is usually so badly damaged that it cannot recover and heal on its own. When this happens, it means that large parts of the eyeball are already missing, and the remaining tissue needs to be removed before it becomes infected or necrotic.
In the case of a disease such as cancer, tumors have grown through the eyeball to the point that the pet is in a lot of pain and cannot use the eye. This surgery is only considered if it is believed that the patient will never regain use of the eye. Usually, in this situation, the animal cannot see at all out of the eye by the time this type of surgery is considered.
In the short term, your pet will recover from this surgery much like any other major surgery. Your pet will be given pain medication, and the veterinarian will give you extensive directions on how to care for the wound. In the long term, nearly all animals adjust very well to only having one eye. Vision will only be slightly affected.
Your pet’s eyelids are a natural and effective protective system for their eyes. Dogs have a thick eyelid with extra fat and fur to protect them from external particulates entering them. Cats have both external and internal eye lid layers, that work as a system, for their protection. The key part to remember is that there are multiple layers involved with the eye lid structure, which involves skin, mucus membrane, muscle, as well as an extensive nerve network for sensitivity.
Unfortunately, the complexity of the animal eyelid also makes it prone to infection as there are more parts that can catch an external and unwanted particulate or become inflamed. And that in turn creates the noticeable eyelid infection. Animals are also prone to tumours in those areas, which in turn can create swelling and lumps.
There are five main tumour types that occur commonly, and dogs are very prone to them as their age progresses. In most cases, the tumour can be identified and removed with a surgical procedure when it is confirmed to be malignant. In many cases the tumours are benign and have no issue on the rest of the animal and their overall health. A minor cosmetic fix can be addressed but care should be taken when the tumour is large enough to cause a deformation of the eyelid if removed and it has no malignant effect. However, tumours grow over time, and even benign ones can begin to affect the animal’s ability to see and use their eyelid. So, every situation is frequently taken case by case. The five common tumours seen include:
• Adenomas (benign tumour)
• Adenocarcinomas (a tumour in a gland)
• Histiocytoma (benign tumour in the skin layer)
• Mastocytoma (mast cell tumour that tends to form as a lump)
• Papilloma (benign epithelial tumour)
As mentioned earlier, surgery is one method of tumour treatment. Another includes freezing the tumour and removing the deadened part. In many cases the tumour doesn’t usually return.
Some animals are far more prone to eyelid tumours simply due to their genetic disposition. For example, some dogs are not able to accommodate extensive exposure to sunshine without suffering reactions. Other types of dogs tend to have regular problems with their sebaceous glands. For any animal owner its simply smart preventative care to have regular checkups and ask a veterinarian for a closer look if something is found that looks out of the norm. In Etobicoke, Richview Animal Hospital is a great resource for eyelid problems and eyelid tumour examinations for your pet.
A pet emergency can be a frightening time. One of the most common reasons that pets end up in the emergency room is because the cat or dog has ingested a foreign body. Not only can this be painful for the pet, but it can cause a range of medical complications that can be fatal.
A foreign body can be anything that is not meant to be ingested by your cat or dog. For dogs, this commonly means pieces of a chewed up toy or a favorite human sock. Cats too can ingest foreign bodies. Usually, cats will eat a favourite toy or an enticing piece of string that becomes bound within their internal systems.
Unfortunately, when an animal ingests a foreign body it can lead to a range of medical complications. Foreign bodies are hard for the body to dissolve, so they often become lodged within various points of the digestive tract. Not only can this be painful, but it can prevent other food and matter from properly moving through the digestive system.
When the digestive tract is blocked, it can create a dangerous situation where the body is not absorbing the vitamins and nutrients needed, and dangerous bacteria are allowed to build up in the body. This can make your pet incredibly sick, and can eventually be fatal. The other concern with a foreign body is that it can become entwined with vital organs. Having a piece of string wrap around an organ can restrict blood flow, causing the organ to fail.
Using a range of diagnostic and surgical techniques, a veterinarian is able to help if your pet has ingested a foreign body. If your pet has recently ingested a foreign body, our veterinarians may want to closely monitor and examine your pet to see if he or she will pass the object naturally. If this is not possible, our veterinarians may take several diagnostic x-ray images to determine the location and severity of the blockage. If your pet is unable to pass the foreign body naturally, emergency surgery may be required. Our veterinarian will perform the surgery, extract the foreign body, and monitor your pet following the surgery to ensure that your pet is on the road to recovery.
When searching for a veterinarian for your pets, one of the things you should look for is a veterinary office that can provide laparoscopic surgery. This is a minimally invasive procedure that has been used with humans for years and is making its way into the animal world and transforming the way that pets have surgery.
Our veterinary care team can perform laporoscopic spays and gastropexies.
You might have noticed a pet walking around with only three limbs and wondered how it lost a limb, or perhaps your pet has been diagnosed with a condition that may require limb amputation. At Richview Animal Hospital, we understand how confusing and difficult this decision can be. Learn more about limp amputation below.
There are several reasons a pet may require limb amputation. The most common cause is cancer. Cancerous tumours can develop in any bone, including the bones of the legs. If the tumour is small and has not spread to other parts of the body, amputation may be the best option to remove it. Other conditions requiring limb amputation include severe trauma or injury to a limb, infections, and birth defects. In addition, we see many pets injured by cars from running into the street.
Limb amputation is a major surgery that is performed under general anesthesia. The affected limb is first shaved and prepped for surgery. Next, an incision is made through the skin and muscle, down to the bone. Most of the time, the entire limb is removed. In some cases, only part of the limb may be removed. The surgeon then closes the incision with stitches or staples.
After surgery, your pet will be taken to our recovery area, where they will be closely monitored. Most pets stay in the hospital for 1-2 days after surgery. It's important to discourage chewing or licking the amputation site after surgery. This can cause infection or bleeding. In addition, your pet will be given pain medication to keep them comfortable after surgery.
You can expect your pet to have a reduced activity level for 4-6 weeks after surgery. They may need help going up and down stairs, getting in and out of the car, or jumping on and off furniture. You'll be surprised that your pet can adapt quickly and will soon return to their usual self.
Some pets may need some additional support for mobility after losing a limb. This may include a wheeled cart, ramps, or special harnesses. Your veterinarian can help you decide what assistive device is best for your pet.
Mast cell tumors are horrifying, especially when you don't know much about them. At Richview Animal Hospital, we are here to help you through this difficult time and give your cat the best possible chance of recovery. Here's what you need to know about this type of cancer in cats.
Mast cell tumours are a type of cancer arising from mast cells, a type of white blood cell. These tumours can occur anywhere in the body, but are most commonly found in the skin or gastrointestinal tract. Mast cell tumours can be benign (non-cancerous) or malignant (cancerous); their behaviour can range from aggressive to relatively slow-growing.
Mast cell tumours are the most common type of skin tumour in cats, and they account for multiple intestinal tumours diagnosed in cats. While mast cell tumours can occur in any cat breed, they are most commonly seen in Siamese and related breeds.
If the mast cell tumour is on the skin, you may notice a lump or mass that appears suddenly. These tumours are often ulcerated or easily bleeding. If the tumour is in the gastrointestinal tract, your cat may vomit, have diarrhea, and refuse to eat.
Mast cell tumours can also release substances that cause systemic reactions, such as hives, wheezing, and difficulty breathing. These reactions are more likely to occur with malignant tumours or if the tumour has ruptured.
If you notice any of the above signs or symptoms, you must bring your cat to the veterinarian for an evaluation. Your veterinarian will likely recommend a tumour biopsy to determine if it is benign or malignant. Once a diagnosis is made, a treatment plan will be created that is best for your cat.
Treatment options for mast cell tumours vary depending on the type and location of the tumour, as well as your cat's overall health. Treatment options may include surgery, radiation therapy, or chemotherapy. Our veterinary team will work with you to find the best possible treatment plan.
Reproductive diseases and disorders are a serious matter for both humans and pets. One such condition, a uterine infection known as Piometra, can threaten the health and even the life of your female dog or cat. Here at Richview Animal Hospital, we care about your animals as much as you do. That's why we offer Piometra surgery to remove infected uterine tissue and save your beloved companion from danger.
Piometra is a bacterial infection of the uterus. Bacteria enter the uterus through the cervix, but only when the cervix is relaxed enough to be open, such as when your dog or cat is in heat. During this window of opportunity, bacteria make their way into the uterus, where over the next several weeks they produce an infection. You may recognize Piometra from certain telltale symptoms such as:
• A significant, abnormal vaginal discharge, which may contain pus and/or blood
• A swollen belly
• Vomiting and/or diarrhea
• Excessive thirst and urine production
• Pale gums
• Weight loss and lack of energy
If the cervix is still open when the infection strikes, the drainage of pus may allow the condition to go on for a longer period, but at least your pet is shedding toxins in the process. If the infection takes place behind a closed cervix, Piometra may resolve more quickly, but it will present an even more immediate threat to your pet's health.
Piometra is generally triggered by the interaction between bacteria and hormones, such as estrogen and progesterone. If your pet is receiving hormone therapy that includes these substances, she might be especially vulnerable to Piometra. Urinary tract infections can also lead to Piometra.
Piometra can make a dog or cat very sick, so surgery to remove the infected uterus is the preferred means of dealing with the problem swiftly and effectively. This procedure is similar to routine preventative spay surgery, but the illness of the animal makes it a more delicate and complicated operation. Our team will make an abdominal incision under general anesthesia, take samples of abdominal and urinary fluid for analysis, and then extract the uterus and ovaries, a procedure called ovariohysterectomy. We will provide antibiotics and recovery guidance to help your pet recuperate safely and completely.
It is our goal at Richview Animal Hospital to provide your pet with the best possible medical care. This is achieved by enhancing preventative, diagnostic and therapeutic medicine within a progressive and technologically advanced hospital. Because of our aim to provide your pet with the benefits of high quality health care, we are pleased to introduce radiowave technology to our surgical protocol. With this technique, we are able to offer your pet shorter anesthesia and post-surgical healing times. This procedure decreases post-operative pain and swelling, and allows for your pet to recover more quickly. Radiosurgery is used for feline and canine spay procedures and canine neuters.
• Post-operative pain is decreased - Radiowave surgery seals nerve endings as it cuts.
• Post-operative swelling is decreased - The low temperature of the radiowaves decreases the risk of tissue destruction.
• Less blood loss - As they cut, the radiowaves close off blood vessels.
• Risk of infection is decreased - Radiowaves vaporize bacteria. This makes sure that the incision area is free from possible infection.
• Quicker recovery - Because the degree of tissue destruction is decreased, healing and recovery is quicker.
• Safer than laser surgery - There are no safety hazards involved with radiowave technology.
• No burning of the tissue - Radiowave surgery does not burn the tissue.
A small micro fiber tip becomes energized by radiowaves. These ultra high frequency radiowaves interact with your pet's tissue in a specific and precise way. This results in a focused and accurate cutting technique, which decreases the amount of tissue destruction. Healing is rapid and the recovery process is increased. This technique additionally decreases discomfort and pain post-operatively.
• Spay and Neuter
• Tumor removal
• Skin tags
• Anal fistula
• Soft Palate
• Distachiasis (extra eyelashes)
Soft tissues are structures throughout the body that aren't bones. Some of the most common examples of soft tissues include muscles, ligaments, and tendons. These structures are found throughout the body in almost every location. When a pet injures their soft tissue, it often heals on its own; however, if the injury has caused the fibers to no longer be in contact, this healing process can no longer happen on its own. This is where the skills of a trained veterinarian who specializes in soft tissue repairs are necessary.
Soft tissue surgery refers to a variety of procedures that involve your pet’s internal organs, hernias, tumours, and other soft matter. In short, if it is not bones, joints, muscles, or nerves, it is considered soft tissue. Besides spaying and neutering, the most common reasons for soft tissue surgery are undesirable lumps or growths. Emergency repair of wounds, abscesses, or cysts are also common soft tissue surgeries.
Other issues that could require surgery include gastrointestinal distress, bile duct obstruction, hernias, ureteral stenting, and bladder stones. Our team has years of experience dealing with these types of issues. If soft tissue surgery is recommended, our staff will talk you through all of the options and answer any questions thoroughly before you make a decision.
The success of any surgery starts before the veterinarian even begins to operate. An accurate diagnosis can involve x-rays, ultrasounds, and bloodwork in addition to an external examination. Richview Animal Hospital takes care of all of these procedures on-site to maximize their accuracy and efficiency.
Animal anesthesiology is in many ways more complicated than its human equivalent. It is important to have staff on call around the clock who have both the expertise and commitment needed to do everything possible to keep your pet strong and stable going into surgery. Post-operative care is designed to maximize recovery and comfort for your pet. Our team wants you to stay informed as much as possible during each step along the way.
In the past, you may have considered sterilization surgery such as spaying or neutering an elective procedure aimed solely at reducing your household's animal population. While spay and neuter surgeries certainly do provide that significant benefit (both in your own home and for already-overburdened animal shelters), you may not realize the amazing health and wellness benefits they also offer.
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Sometimes, pets need surgery just like their human counterparts. When a pet needs surgery, this can be a scary prospect for the pet owners. One of the most common procedures that a trained veterinarian may have to perform is called a splenectomy
The spleen is not considered a vital organ; however, it still plays a critical role. The spleen is considered to be a part of the immune system. When the body develops an infection, it is the job of the immune system to clear out the invaders. The spleen is the garbage dump for all of the invaders the body kills during the course of an infection. It is also where the shells of dead red blood cells, white blood cells, and others are deposited. The spleen is responsible for collecting this debris and then filtering it out, eliminating it from the body. In this sense, the spleen plays an important role.
Sometimes, the spleen needs to be removed. One of the biggest reasons why a pet might need to have their spleen removed is that the spleen is growing too large. When the spleen grows to a large size, it is at risk of rupturing. If the spleen ruptures, this can lead to serious internal bleeding that might cause a pet to bleed to death. In order to prevent this from happening, it is important to remove the spleen early. This is where a trained veterinarian will play an important role.
Is your pet dealing with breathing issues? It may be associated with Brachycephalic syndrome. We meet many dogs and cats with this condition, and we are experienced in providing relief to our patients. If you have a breed that is prone to this ailment, give our team a call to find out how our veterinarians can help.
Brachycephalic is a term that describes breeds who are flat face. Dogs and cats with a flat face are popular because of their large eyes and appearance that is unique only to this type of condition. The same things that make them look cute like a flat face, narrow nostrils, and pushed up nose can also cause breathing problems. When this happens, it is called brachycephalic syndrome. There are many symptoms of this syndrome, ranging from eye issues, pet dental problems, and breathing conditions. For now, we will focus on the Stenotic nares.
Stenotic nares restrict how air flows into the nostrils. Stenotic nares can be dangerous as pets grow, if they experience shortness of breath through play, or overheats. This condition is hereditary, and there is nothing you can do to prevent it. However, it is important that your pet with Bracnycepnalic syndrome avoid strenuous exercises, and is kept at a healthy weight.
Your pet’s treatment plan will either be surgical, lifestyle changes, or both. If the condition does not cause too much discomfort, then the recommendation may be a healthy diet, weight loss, harness-style leashes, and possibly, medications and oxygen. If these treatments are not effective, then our veterinarian will need to surgically remove the nostril tissue that is blocking the airflow to help your pet breathe easier.
When a human has diabetes or a severely infected toe, doctors may recommend amputation. When a human loses a toe, it can cause issues with their balance, strength, and their gait. Toe amputation is also a common treatment in dogs. When a dog has their toe amputated, it can improve their quality of life.
There are a few common reasons where a veterinarian would recommend amputating your dog's toe.
Trauma: If your dog has been involved in an accident where his toe was injured such as being hit by a car or having something dropped on his toe, amputation may be necessary. If the veterinarian finds that the injury is too severe, the toe may need to be removed.
Tumours: If your dog develops a tumour on his toe, the veterinarian may recommend amputation. In most cases, removing the tumour is the safest and most effective treatment. This would avoid the dog going through expensive and painful cancer treatments.
Nail Bed Disorders: In some cases, veterinarians will recommend toe amputation for dogs with nail bed disorders. According to recent studies, nail bed disorders can result in cancerous tumours. Removing the toe before this can happen is the best preventative treatment.
The toe amputation procedure is not as serious as it may sound. Before the surgery, your pet would have preoperative tests to make sure that they are healthy enough for surgery. Next, your dog would be anesthetized, and the veterinary technician would remove the fur on the affected foot and then clean and sanitize the area. This will keep the incision from becoming infected. After the veterinarian amputates the toe, the veterinarian would suture the wound and wrap it in a bandage. In most cases, your dog will be able to go home the same day.
When you take your dog home, they may need to wear a cone for the first few days to keep them from biting at the stitches. You will need to keep your pet's wound dry and follow the veterinarian's instructions regarding their medications. Fortunately, your dog won't have much trouble compensating for their lost toe. It is much different than when a human has a toe amputated. You will need to take your dog back to the veterinarian two weeks after the surgery to have the stitches removed. By then, your dog should have made a full recovery.
If your pet is suffering from a foot or nail bed issue, please schedule an appointment with our team. If your dog requires a toe amputation, the sooner the procedure is performed, the better it will be for your dog. We can run the necessary test at our veterinary animal hospital to determine whether or not toe amputation is the best course of action.
Both dogs and cats can develop abnormal growths on their skin or inside their bodies that cause discomfort and may interfere with normal bodily function. An experienced veterinarian can diagnose these growths to determine how problematic they are and can remove these growths, when needed. At Richview Animal Hospital, we perform tumour removal for pets.
Some breeds of canines seem to be particularly susceptible to tumour development. Canines with short snouts, such as Pugs, Boxers, and French Bulldogs sometimes develop mast cell tumours. Lipomas and papillomas of the skin can occur that may require removal. More aggressive tumour such as lymphoma or osteosarcoma can occur, which may need more extensive treatment. A biopsy, a procedure in which a small piece of tissue from the tumour is excised to be examined under a microscope, allows veterinarians to determine what type of tumour is involved. Ultrasound and other tests may be needed to determine the extent of a tumour. Skin wounds that don’t heal or unexplained weight loss in your dog could be signs of serious illness and should always be evaluated by a veterinarian.
Most tumours turn out to be benign, and can be easily removed. However, mast cell tumours, squamous cell carcinoma, brain cancer, and breast cancer in cats can be a serious problem. Symptoms such as frequent vomiting or diarrhea, problems with mobility, or a distended abdomen should be investigated by your veterinarian.
Benign tumours can be removed, and the incision area generally heals without complication. Malignant tumours often grow quickly and can invade other tissues. For these tumours, removal of the primary tumour may be the first step toward helping the animal. If a growth is cancerous and has metastasized, additional treatment, such as radiotherapy or chemotherapy may be recommended.
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