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End of life decision making

Posted by Halifax Veterinary Hospital Blogging Team on Wed, Mar 21, 2018 @ 11:39 AM

pets_wide-af65d25cd6980441331f3eae6f52334d1aa7d74f.jpgPets quickly become a cherished member of the family and it can be hard to imagine life without them. However, part of life is aging and pets generally have much shorter lives than their owners. When the time comes to make a decision for your pet, it's never going to be easy. But you can move forward with peace of mind that you did the right thing if you follow certain signs and do the right amount of research. The day will be hard, but in the end, euthanizing your pet can be what's best for everyone involved. When considering whether euthanasia is the right direction for your family and your pet, think of the items in their life like a pyramid and use these tips to help you make the agonizing decision.

Emotional Aspects

The emotional involvement of your pet is at the top of the pyramid. It will help make a small portion of the decision. Ask yourself if your pet still has their dignity. Can they go to the bathroom on their own and eat alone or do they need help with some of the most basic items? Do they seem lax in their will to live or are they still looking for attention and acting like themselves? These emotional items will tell you a little more about what your pet might want if they could talk to you.

Social Elements

You know what your pet is like when they are healthy. How they act socially will tell you a lot about the direction you should take. Does your pet still engage with your family and play? Do they want to have pets and cuddles like they used to? Are they engaged with the other pets in your house if you have them? Pets who show some social engagement are healthier and in a better place than those who don't. If your pet is pulling back in a social way, they may be nearing the end of their time with you.

Pain Management

The bottom part of the pyramid is the largest portion and a big deciding factor as to what you need to do with your pet. You want your pet to be happy and healthy, but when they're not, you want to ensure that they aren't in any pain, if at all possible. Take a look at their mobility and hygiene. Are they able to keep clean like they used to and get around as needed? Are they safe or are they stumbling and stairs becoming a danger to them? Sometimes you can tell a pet is in pain because of the way they act and other times, they suffer silently. The best thing you can do when it comes to pain is consult with your vet. They are experts in the field and can tell you what your pet may be experiencing. The last thing you want is for your pet to suffer and if it is evident they are and there's no end in sight, you will know what to do.

Every pet is an individual and an important member of your family. No two pets are alike and there is no one right answer when it comes to the end of their life. If you are able to take a look at the emotional, social, and physical pyramid and fill in the gaps, you will better be able to come up with an answer that will give you peace of mind about the direction you take with your pet.

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Topics: pet resources, pet care, pet cancer, exotic pet care, dog care, cat care

The Danger of Essential Oils

Posted by Halifax Veterinary Hospital Blogging Team on Mon, Mar 05, 2018 @ 08:35 AM

christin-hume-505815-unsplash.jpgEssential oils are nothing new - they've been around for years, but more and more these days these essential oils are showing up in the news because of incidents regarding children. Children are at risk when it comes to ingesting essential oils, but so are pets!

If you use essential oils in your home, that's fine, but it's also important to keep your pets safe by following the rules below. These rules are primarily for essential oils.

Essential Oils Can Be Toxic

Aromatherapy for humans uses essential oils to create a relaxing atmosphere to calm people, take away headaches, reduce stress, etc. Unfortunately, if your pet gets into contact with these essential oils they can also become really sick. Make sure that if you use these oils at home that you keep your animals away from them. Pets should not lick, smell or eat these oils and they definitely shouldn't come into contact with them in terms of getting the oils on their feet, in their eyes, or on their skin.

Essential Oils Can Be irritants

As you probably know animals, especially dogs, and cats have a heightened sense of smell, more so than humans. Because of this some scents may become overpowering to them and cause irritations to the inside of their nose or eyes. Beyond just being able to smell better than humans do, dogs and cats have a more sensitive respiratory system than we do as well, which is why essential oils are NOT recommended around pets.

Pet Aromatherapy vs Human

If you visit your local pet shop or favorite online store you might see these pet aromatherapy products for pets, the pet variations are greatly diluted which does make them safer for animals. It's still a good idea to talk to your veterinarian though before using any oils on your pet. And never ever use these oils on open wounds, scratched skin, irritated skin, broken skin, etc.

Never apply human aromatherapy oils to your animal as these compounds can quickly be absorbed into the skin and go into the bloodstream to cause possible issues to your dog's organs.

Liquid Potpourri

Potpourri has long been touted as the perfect way to make your home smell nice. And while this is true, it can also lead to serious problems for your pets, especially when it comes to liquid potpourri which is made from essential oils and cationic detergents. These ingredients can cause chemical burns on the face, mouth or in the eyes. Not to mention the pure heat that comes from a pot of liquid potpourri can cause burns - or even death.

Keep your animals away from liquid potpourri and away from the stove or oven while it’s on. If your pet does accidentally come into contact with liquid potpourri, essential oils or any other type of harmful liquid, bath them immediately using a hand-safe natural dishwashing agent and call the veterinarian just in case.

While humans might find benefits in using essential oils, they are simply not made for pets, especially if they are not meant for pets or they are not diluted properly. If there ever comes a time when you want to try aromatherapy for pets on your animal, always make sure that you talk to your veterinarian first before using it on the animal.

Your veterinarian is more experienced and has more knowledge on this and therefore can offer a heads up on any issues you might see if you use the product, symptoms to look out for, and what to do in case of an emergency regarding your pet and these caustic liquids.

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Topics: pet resources, pet care, exotic pet care, vet halifax, dog care, animal hospital, Halifax vet, cat care

Five Keys to a Healthy Pet

Posted by Halifax Veterinary Hospital Blogging Team on Wed, May 17, 2017 @ 07:14 AM

download_8.jpgWhether it is to quit smoking, get more exercise or eat healthy. Many of us think of and treat our pets as part of their family – so it would make perfect sense to have a wellness plan for your pets. Here are five keys to ensuring the health of your pet.

There are many ways to keep your pet healthy, but to start you out – we have identified five areas that will help your beloved pet to live a long and happy life.

  1. Dental health. Dental disease is one of the most common problems found in pets. Your pet should have its teeth cleaned as advised by your veterinarian. When dental health is not addressed – it can lead to serious infections and the loss of teeth. Diseased teeth can also lead to other problems such as kidney and heart disease.
  2. Regular examinations. Remember – pets age faster than their humans. Just as you and your family members have regular physical exams, so should your pet. When illnesses are diagnosed early on – treatment will be less invasive as well as less expensive.
  3. Preventative healthcare. One of the most important responsibilities that come with being a pet owner is to provide preventative care for your animal. Vaccines given on a regular basis will help to keep your pet from contracting diseases from other animals, insects and from their surroundings. Your veterinarian will give you information on fecal testing and deworming as well as keeping your pet’s immunizations up-to-date.
  4. Healthy diet. Just as you are health-minded when it comes to your own diet – you should make sure that your pet is getting the nutrients he or she needs to stay healthy. No matter what type of pet you have – a healthy diet will lead to a healthy and happy pet. One of the most important things to keep your pet’s health at its optimum is to make sure they get plenty of water. They should have access to clean water at all times.

Your veterinarian will advise you what type of food is best for your particular pet – taking into consideration weight, age and mobility.

  1. Exercise. We all need exercise – and so does your pet. Physical and mental activity is important in order for your pet to stay alert and healthy. This is especially true if your pet is a dog. A dog needs to experience the smells, sights and sounds beyond their home or confines of your yard. Exercise for any type of pet is important to maintain a healthy weight. Obesity is a common health problem for many types of pets.

The best for our pets

We all want the best for our pets, and sometimes it can be costly. Your trusted veterinarian knows this and will find the most cost-effective way in which to offer services and advice to you for your pet. Your pet’s life will be extended when you provide the proper loving care that he or she needs and deserves.

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Topics: best vet, choosing a vet, dog care, cat care, exotic pet care, pet care, Halifax vet

Who’s going to care for your pet after you are gone?

Posted by Halifax Veterinary Hospital Blogging Team on Fri, Apr 14, 2017 @ 01:16 PM

download-2.jpegIn a lot of cases, pet owners assume that they – as humans, will outlive their trusted friend. But, that’s simply not always the case! In fact, in some instances your death might be unexpected, what happens then with your trusted friend? Its important that if you fall ill and become unable to care for your pets, or worse, you pass away, that you have someone who can provide, love and care for your loving animal. Here are a few options to consider for the future.

Emergency Caregivers – Temporary

Chances are if you love cats, dogs, or birds as much as we think you do, you probably have friends and family that also feel that way too. Consider talking to a handful of your friends and family and see if they would be willing and able to take your pet if anything should ever happen to you. This needs to be a person you trust fully, but also someone that can financially take on another mouth to feed and have the space for another animal. Never assume a friend or family member will be willing to step up for this role, have the discussion with them to ensure you can count on their commitment if needed.

Emergency Caregivers – Permanent

You also have the option, of course, to have your friends or family permanently take care of your pets. But, if you can't find someone close to you that you know personally, your next best step is to contact people in the pet field, such as Veterinarians. Sometimes they know of people that can take in animals if something has happened to their owner.

Make sure that you try to find alternative routes to finding a caregiver, either permanently or temporarily (for now), rather than taking them to the SPCA. Many shelters are nonprofit, or they rely on monetary donations – and even then, that’s never enough. They really do not have funds for caring for your loving pet indefinitely. Just look at how many animals there are already in shelters! They are already over populated as is.

No matter what option you choose to go with, either one of the options above, or another option entirely, always make sure that you note the plan for your pets in your will. That way everything will be finalized, and if anything should happen to you, you have definite plans for your pets. You can also set up a trust within your will and this will allow you to save up money on the side, and put it in the trust, so whoever takes over care of your animals, in the end, they will have the financial means to take care of your loved ones.

Your pets are like your kids. You probably wish you could have them forever or they could have you forever, but unfortunately, that's just not the way it works!

Some forethought on after life care will ensure your pet continues to be well loved and cared for if anything happens to you.

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Topics: best vet, cat care, dog care, exotic pet care, Halifax vet

Exotic Pets

Posted by Halifax Veterinary Hospital Blogging Team on Mon, Aug 22, 2016 @ 07:00 AM

Having a household pet will add value to your life in ways that you never imagined exotics.jpgpossible. The pet will keep you company when you are feeling lonely and liven you up as they play around the house with toys. Apart from companionship, there are also some health benefits that you can derive from pets. A study done at the University of Wisconsin-Madison revealed that having a pet at home can reduce the risk of a child developing allergies, for instance. This is based on the fact that exposure to pets at an early age triggers the child’s body to develop a robust immune system to counter the allergens. They can also bring a lot of joy to their owners, as they bring happiness and can improve your mental state. 

You may decide that you would like to own an exotic pet but here are a few important points to consider.

Chinchillas

Chinchillas are ranked among the softest and cutest pets in the world today. However, high temperatures can compromise their health, so you should ensure that the temperature in their enclosure does go above 75 degrees. Exposure to high moisture can harm their skin, and they should take several dust baths per week. Unlike other pets, such as cats, chinchillas do not like to be cuddled, and their diet should be balanced and in line with their nutritional requirements.

Rabbits

What is unknown to most people who buy rabbits is that they can seriously injure their backs if they kick hard or are dropped. Just like chinchillas, rabbits require a special diet plan that meets all their nutritional requirements. They also very active and require a lot of exercise, so they should be allowed to play and hop around the house during the day. Like chinchillas, they have a habit of nibbling things. You will also have to clean the litter box daily to prevent infections and maintain a high hygiene level inside the cage.

Budgerigar

This is a type of parakeet that has a small body structure and is very friendly. The bird gets accustomed to living and socializing with people at a young age and can bring a lot of joy to your life. As you walk around your home, you can train the budgie to perch on your body and to mimic some of the words that you say. The only downside is that they don't have limits when it comes to their bodily functions...so it is best to place a towel on your clothing before allowing a budgie to sit on your shoulder.

Guinea Pig

The guinea pig is an ideal choice for children who want a pet, but you aren't ready for a dog or cat. When happy, the guinea pig will love to play, and the sound of your fridge opening will often bring a squeak of delight, as they know where you keep the good food. Guinea pigs also have special diet requirements and need lots of vegetables that contain Vitamin C for healthy bones.

No matter what type of pet that you decide to keep, make sure that you provide the utmost care and attention, and always schedule regular vet appointments to keep your pet healthy.

Did you know we care for Exotic pets too, learn more.

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Topics: exotic pet care

Adrenal disease in Ferrets

Posted by Halifax Veterinary Hospital Blogging Team on Mon, May 16, 2016 @ 01:27 PM

Adrenal disease in ferrets can significantly impact their quality of life and even lead to the download.jpegdeath if left untreated. Knowing the root causes and common symptoms of the disease helps ferret owners ensure beloved furballs can lead long and joyful lives after diagnosis and treatment.

What is Adrenal Disease?
Put simply, this disease is the development of tumors in the adrenal glands. These glands are located in front of the kidneys and releases excessive levels of sex hormones. Adrenal disease can show up in three ways:

  • hyperplasia - an excessive growth in the tissue which has not yet impaired gland function
  • benign tumors - glands begin to lose functionality and health is impacted
  • carcinoma (malignant) tumors - gland is no longer functioning normally and gland rupture becomes a possibility, major health impacts

Signs of Adrenal Disease

Symptoms typically start to show after three years of age, but can appear as early as one year or as late as seven. Symptoms and severity can vary, but can include:

  • hair loss
  • reduced appetite
  • lethargy
  • sensitive skin - itching and scratching
  • increased smell
  • abdominal pain
  • increased grooming
  • aggressive sexual behavior 
  • increased urination (or difficulty in males)
  • swollen sex organs (particularly common in spayed females)

Causes of Adrenal Disease

While not definitive cause has been discovered, the most likely culprit seems to be early spaying/neutering. Many large breeding operations do so at around age 5 or 6 weeks. Waiting until after the ferret reaches sexual maturity greatly reduces the likelihood of it experiencing adrenal disease.

Another possible cause is an overabundance of light exposure. Ferrets require at least 12 hours of complete darkness within a 24-hour period - something they may not receive in a typical household full of electric lighting. The decreased melatonin production that results from excessive light access is thought to contribute to adrenal dysfunction.

Reduce Risk and Improve Treatment Outcomes

If you haven't yet acquired your ferret, source yours from a reputable breeder who postpones fixing until after your new companion has reached sexual maturity. Otherwise, make sure you are providing your ferret with plenty of darkness every day to help prevent adrenal disease.

As early as one year of age, begin routine adrenal tests to check for the disease before symptoms arrive. Treatment options are more flexible if the disease is caught in its early stages.

An implant known as Deslorelin is a great medication to treat the signs of adrenal glad disease but not the disease itself.  The implant’s effects last in the range of 8 to 30 months.  The Deslorelin implants are useful in the long term management of adrenal glad disease side effects and may be as effective as surgical management.  

Surgical removal of the adrenal tumor remains the only curative treatment however, due to age, health of medical conditions, it may not be the best option for your pet.  

Did you know we have a team dedicated to the care of exotic pets?  Learn more here…

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Topics: exotic pet care

Caring for a Pet Rat: What You Need To Know

Posted by Halifax Veterinary Hospital Blogging Team on Wed, Apr 13, 2016 @ 07:36 AM

 

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If someone says "rat" to you, your first thought may well be of the little guy dragging a slice of pizza that went viral recently. Or, you might even give more than a passing thought to European plagues of the middle ages. However, contrary to popular belief, a rat will spend as much time grooming as any domestic cat, and can be one of the most loving and rewarding animals to keep as a pet.

So is it a wild rat?

Although pet rats are closely related to wild rats, domesticated or fancy rats are easy to socialize, and will not spread disease. In fact, pet rats are available in a wide variety of coat and eye colors, from pink-eyed albinos to Siamese and Burmese colorings similar to those found in cats, and even rats carrying the charming rex and double rex genes, which can lead to curly coats and whiskers, or even no fur at all.

How do I keep it?

Rats are social creatures and like company, so it's best to get a friend for your new pet. Rats like to spend many hours grooming each other, and will snuggle together for warmth when they sleep, and they can get very lonely when kept on their own. You should aim for the biggest cage you can afford so that your rats have plenty of room, and they should have plenty of toys to keep them occupied - rats are very clever, and like puzzles and obstacles, such as tunnels, wood blocks, and even ropes for them to climb. Make sure they have a range of levels to explore, and hammocks to sleep in. Once socialized, your rats will like to come out of their cage and spend time with you. In terms of bedding, avoid sawdust and shavings as these can cause breathing problems.

What do I feed it?

Like us, rats have a tendency to enjoy things that are bad for them, so go easy on treats. A commercial rat mix supplemented with fresh vegetables such as kale and carrot will give your rat a balanced diet. Beware of mixes with too many nuts or seeds in, and if you have male rats, don't feed them too much protein, or any citrus fruits - both can be bad for their kidneys. Your rats will need constant access to fresh water.

What health problems should I be aware of?

A healthy rat will live for a little over two years, but just like us, they can develop health issues as they get older. Male rats can be prone to kidney problems, and female rats can be prone to tumors, both of which can be treated in many cases. Look out for problems with front paws, including holding food, as this can indicate more serious problems. Rats are also prone to respiratory ailments; your vet can advise on suitable antibiotic treatments. Also look out for mites and skin problems, which will need treatment with a specialist product developed for small animals.

Rats are bright, friendly and empathetic pets, perfect for adults and children; like all animals, make sure you have the time to care for and socialize them properly.

Interested in learning more about the care of exotic animals, click below.  

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Topics: exotic pet care

What Egg Binding is and How to Spot It

Posted by Halifax Veterinary Hospital Blogging Team on Thu, Apr 07, 2016 @ 05:04 PM

Egg binding is a relatively common problem in pet birds in which the bird is unable to pass an egg properly and it moves through her egg vent far too slowly, or not at all. This condition can cause serious harm to your pet bird and if left untreated, can even be life-threatening. Egg binding is a more common problem among smaller birds like songbirds, canaries, and finches because their eggs are proportionately larger compared to their bodies than eggs of larger birds.

Signs of egg binding include:shutterstock_15702574.jpg

  • Sudden loss of appetite
  • Depression
  • Lameness
  • Distended abdomen
  • Having trouble breathing
  • Sitting on the cage floor
  • Legs abnormally far apart
  • Overall weakness
  • Prolapse of the end of the reproductive tract out of the cloacal opening

If you’re worried that your pet bird is showing signs of egg binding or would like to learn more about the condition and preventing it, don’t hesitate to speak with us!

Risk Factors

The risk of egg binding is closely tied to your pet’s emotional, physical, and reproductive health. Here are a few conditions that can increase the risk of becoming egg bound:

  • Strong emotional bonds to their owner
  • Malnutrition, especially if their diet is low in protein or calcium (seed diets)
  • Low natural sunlight—these girls need vitamin D as much as you do!
  • A sedentary lifestyle—they need physical activity daily.
  • Advanced age
  • Having been egg bound before
  • Laying egg clutches too frequently

Prevention

While it’s impossible to bring the risk of egg binding down to zero, you can do a lot to make it highly unlikely. The best thing you could do is to make sure that your pet is happy and eating a nutritious diet. She should also be getting enough exercise, which could be as easy as encouraging her to play with more physically engaging toys, or may require a little one on one time.

Medical options for treating egg binding exist, too, and may be helpful for birds that are already prone to egg binding. Hormone therapy that stops egg laying is a common non-invasive method. Spaying is also possible, but is very risky so it is only an option of absolute last resort.

Treatment for Egg Binding

If your pet bird is showing signs of egg binding, you need to contact our veterinary office as soon as possible! The earlier that the condition is identified, the less painful and risky the treatment will be. We cannot stress this enough: do not try to treat egg binding yourself because it is easy to accidentally push the egg further up or even break the shell, which may cause internal lacerations.

The goal of treating an egg bound bird is simple: getting the egg out. This is much easier said than done because great care needs to be taken in order to not injure your pet bird. If caught early, noninvasive treatments like using a warm, high humidity environment or applying lubricant to your pet’s egg vent may be enough to get the egg out. However, if your pet bird has been egg bound too long or too severely, a veterinarian will need to treat her for shock and potential infection and perform more invasive procedures such as manually pushing the egg out, which is painful enough to require anesthesia. Abdominal surgery might even be necessary.  Learn more about our care for exotic pets.

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Topics: exotic pet care

Caring for a Pet Rat: What You Need To Know

Posted by Melanie Taljaard on Mon, Apr 04, 2016 @ 07:22 AM

If someone says "rat" to you, your first thought may well be of the little guy dragging a slicepet_rats.jpg of pizza that went viral recently. Or, you might even give more than a passing thought to European plagues of the middle ages. However, contrary to popular belief, a rat will spend as much time grooming as any domestic cat, and can be one of the most loving and rewarding animals to keep as a pet.

So is it a wild rat?

Although pet rats are closely related to wild rats, domesticated or fancy rats are easy to socialize, and will not spread disease. In fact, pet rats are available in a wide variety of coat and eye colors, from pink-eyed albinos to Siamese and Burmese colorings similar to those found in cats, and even rats carrying the charming rex and double rex genes, which can lead to curly coats and whiskers, or even no fur at all.

How do I keep it?

Rats are social creatures and like company, so it's best to get a friend for your new pet. Rats like to spend many hours grooming each other, and will snuggle together for warmth when they sleep, and they can get very lonely when kept on their own. You should aim for the biggest cage you can afford so that your rats have plenty of room, and they should have plenty of toys to keep them occupied - rats are very clever, and like puzzles and obstacles, such as tunnels, wood blocks, and even ropes for them to climb. Make sure they have a range of levels to explore, and hammocks to sleep in. Once socialized, your rats will like to come out of their cage and spend time with you. In terms of bedding, avoid sawdust and shavings as these can cause breathing problems.

What do I feed it?

Like us, rats have a tendency to enjoy things that are bad for them, so go easy on treats. A commercial rat mix supplemented with fresh vegetables such as kale and carrot will give your rat a balanced diet. Beware of mixes with too many nuts or seeds in, and if you have male rats, don't feed them too much protein, or any citrus fruits - both can be bad for their kidneys. Your rats will need constant access to fresh water, What health problems should I be aware of?

A healthy rat will live for a little over two years, but just like us, they can develop health issues as they get older. Male rats can be prone to kidney problems, and female rats can be prone to tumors, both of which can be treated in many cases. Look out, for problems with front paws, including holding food, as this can indicate more serious problems. Rats are also prone to respiratory ailments; your vet can advise on suitable antibiotic treatments. Also look out for mites and skin problems, which will need treatment with a specialist product developed for small animals.

Rats are bright, friendly and empathetic pets, perfect for adults and children; like all animals, make sure you have the time to care for and socialize them properly.  Did you know we have a team dedicated to exotic animals, including pet rats, learn more here.

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Topics: exotic pet care

Doing Our Best for our Fine Feathered Friends

Posted by Halifax Veterinary Hospital Blogging Team on Tue, Jan 05, 2016 @ 07:18 AM

Today is National Bird Day, a great day to focus on our feather friends.  

If you are a proud owner of a beautiful pet bird, then you know just how important it is to 10432461_10152472943827522_7872592545606370904_n.jpgmake sure they receive the right food and nutrients. Whether your beloved friend is a cockatiel, a parakeet, or even a glorious blue and yellow Macaw, their nutrition is of vital importance, so they can live long, happy, and healthy lives. Nowadays, healthy food options for pets and cats seem to be everywhere. You see organic and lean options for your furry friends at just about every pet or grocery store. But what about for your beloved bird? Which brands are right for them?

Finding the right balance and picking the right types of food for your bird can be more than difficult. It can be downright confusing. Unlike pets and cats, so many types of birds need different kinds of nutrition, so many that the average bird owner may not know where to turn. Sure, you could do hours of research making sure you're getting just the right kind of food for your specific breed, but who has time for that? Besides, isn't it better to let trained avian experts help you out?

That's where the folks at Harrison's Bird Foods have come to your rescue. Developed by Dr. Greg Harrison, a certified avian veterinarian with 34 years experience, he has created the perfect formula to give your flying friend all the vitamins and minerals they need. All of Harrison's Bird Foods are certified organic, and so complete nutritionally that they require little to no supplements.

Harrison's Bird Foods are now officially non-GMO verified, so you are guaranteed your pet is getting the most natural and fresh ingredients in their meals. They offer a variety of options, such as a special Recovery Formula, for poor sick and injured birds. Also they have formulated a special Bird Bread Mix, for those who like to give their birds little treats at mealtimes. And because this food is formulated by an actual certified and experienced avian veterinarian, Harrison Bird Foods also offers a diverse array of special health-related products, such as an Enzyme Mix to hep digestion, and a variety of Heal-x formulas for every possible need your feathered friend could possibly have.

So if you're looking to make sure your dear family pet gets the best care and nutrition they need, ask about Harrison's Bird Foods. Harrison's Bird Foods is so trusted by doctors that it is sold at local vets all over the world. So don't delay, and get the best food for your beloved bird today!

Contact us if you have other concerns about your Feathered Friends.

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Topics: exotic pet care