VOL UME 35 I S S UE 1
CANADIAN VETERINARY TECHNICIANS
A NATIONAL JOURNAL PUBLISHED BY THE ONTARIO ASSOCATION OF VETERINARY TECHNICIANS
D E D I C AT E D TO PROFESSIONALISM PUBLICATION MAIL AGREEMENT NUMBER 40034241 • PUBLISHED BY THE OAVT • Return Canadian undeliverable address to: OAVT, 100 Stone Rd W., Suite 104 Guelph, ON N1G 5L3
CONTINUING EDUCATION • • •
Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats Getting the Cat to Come Back: Feline Friendly Practice Tips Case Study: Feline Lymphoma
Plus: More on PPE (Personal Protective Equipment), Working at the Toronto Centre for Phenogenomics, Common Toxic Foods in the Small Animal Patient Part 1, My Zookeepers Diary, and more!
Comfortable in their own skin. Fleas can be a real irritation – for dogs and cats. But they don’t have to be. advantage® provides fast and effective flea treatment and control – killing fleas on contact, breaking the life cycle and killing adults before they can lay eggs. Locked into the skin’s lipid layer, advantage® works without fleas having to bite. And it keeps working even when pets get wet. Proven to be safe and effective so you can recommend advantage® with confidence. Guaranteed. Like all Bayer Parasite Solutions products, advantage® fits into your parasite prevention protocols. To start your patients on the path to good health, contact your Bayer representative for an advantage® PetPak™. Visit BayerParasiteSolutions.ca.
Proven. Bayer, Bayer Cross, advantage and PetPak are trademarks of Bayer AG, used under license by Bayer Inc.
2011 Platinum Sponsors Making continuing education better & more accessible across Canada Bayer HealthCare Animal Health Division Hill’s Pet Nutrition Canada, Inc. Merck Animal Health Medi Cal/Royal Canin Veterinary Diet Pfizer Animal Health These companies are generously supporting a series of outstanding learning opportunities for registered veterinary technicians through OAVT. 34th Annual OAVT Conference & Trade Show February 16 - 18, 2012 Toronto, Ontario This meeting continues to expand and grow in stature, as the largest and best stand alone Registered Veterinary Technician/Technologist meeting in the world. Professionalism & Ethics Course Outstanding one-day CE courses offered during the year. Call the office for the date and location closest to you. TECHNEWS The quarterly national publication with three CE articles in each issue delivered directly to your door! Making information, education, industry news and career opportunities available to technicians - everyday and everywhere! www.oavt.org We applaud these companies for working closely with Canadian veterinary technicians and OAVT in the design and delivery of these exciting programs throughout 2011. EECI-11439-01 / bsg110626-s01-01
Letter from the Editor............................................................................................................... 2 Small Dogs are Big.................................................................................................................... 3 Websites to Watch..................................................................................................................... 3 Letter to the Editor................................................................................................................... 3 Safety Column: More on PPE (Personal Protective Equipment)................................................ 4 Veterinarians Without Borders Aims to Make Rabies History................................................... 6 Puzzle........................................................................................................................................ 6 Data Reveal Cats Need Better Protection Against Roundworm & Heartworm.......................... 7 Poisoning Toxicology Column: Common Toxic Foods in the Small Animal Patient Part 1........ 8 Merck Announces New Name for its Animal Health Division.................................................. 9 CE Article #1: Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats............................................................................................. 11 My Zookeepers Diary.............................................................................................................. 20 CE Article #2: Getting the Cat to Come Back: Feline Friendly Practice Tips.................... 23 CE Article #3: Case Study: Feline Lymphoma................................................................... 27 TECHNEWS Fall 2011 CE Quizzes................................................................................. 31 Working at the Toronto Centre for Phenogenomics................................................................ 33 Employment Ads..................................................................................................................... 36 Submitting Articles to TECHNEWS...................................................................................... 37 Global News........................................................................................................................... 38 TECHNEWS Subscriptions.................................................................................................... 39 Tech Tips and Tidbits.............................................................................................................. 41 Continuing Education Opportunities..................................................................................... 42 OAVT 34th Annual Conference: Professionalism & Diversity................................................ 42 Pharmacology Column: Maropitant Citrate (Cerenia)............................................................. 43 Did You Know?....................................................................................................................... 44
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Next Issue: Winter 2011 Deadline for Material: November 15, 2011 Distribution Date: December 15, 2011 TECHNEWS is a quarterly publication published by the OAVT.
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The opinions expressed in this publication do not necessarily reflect the opinion of the Board of Directors nor the members of the Association.
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Dr. Susan Little has provided the CE article Getting the Cat to Come Back: Feline Friendly Practice Tips (page 23) with excellent tips on how the veterinary team can expand and improve their feline client base. Dr. Little will be a featured speaker at the OAVT conference in February for more feline education! Laura Thomas is a registered sonographer since 1992 and working in veterinary medicine since 1998 as the Ultrasound Education Manager at Vet Novations. She has provided the CE article on Feline Lymphoma with a comprehensive overview and excellent images to assist the reader. Alison Weller, RVT submitted an interesting article on her experience in taking the Zoological Animal Technology (ZAT) program at the Alberta Business and Education School (page 20). We greatly appreciate Alison’s work in submitting this article and salute her quest for learning! Madeline Harvey, RVT provides an article on Working at the Toronto Centre for Phenogenomics on page 33. This article will be of particular interest to technicians in research and a good read for all technicians!
“I recently received a summer edition copy of the OAVT journal. It is a very robust journal with lots of interesting topics certainly providing something for everyone in your membership. I am sure that the OAVT must receive many compliments for such a professionally compiled journal.” - Pete Mosney, IDEXX Laboratories
These late August days are showing hints of autumn and that’s why I love being a Canadian so that I can fully enjoy the changing seasons! This issue of TECHNEWS will arrive in your mailbox before the leaves change colour and in time to make a few goals for fall - more walks with the dog, more time with our animals! This is a dynamite issue full of great reading which we hope you will fully enjoy. Christi Cooper provides some excellent information on Personal Protective Equipment (page 4) which is so important in this profession. She provides a great overview from head to toe. Take a moment to review the current details on the Rabies Campaign on Page
6 which makes it easy for you to get your clinic and colleagues involved. This is important for all Canadians and RVTs can definitely make a huge impact. A revealing article on Common Toxic Foods (page 8) offers the first in a twopart series from Amanda Poldoski, DVM and Sherry Welch, DVM - we appreciate their time to provide this important information. The CE articles in this issue provide a great span of knowledge. Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats (page 11) looks at the lack of comprehensive treatment guidelines, stressing that proper and prompt diagnosis of UTI is required to make informed treatment decisions. The guidelines provided in this article will assist readers with optimal management of UTIs in dogs and cats.
Our Jack Russell terrier was slightly on the pudgy side (perhaps more than slightly) and after discussing with the RVT at my local clinic we decided to cut out all snacks of any kind. This was 6 months ago and she has lost 4 pounds, has the zip back in her life and much more energy - just from cutting out snacks! This really drove home the fact that nutrition is so key to longevity and health and I really appreciate this clinic working with me (and cheering us on!) in identifying where we were slipping up and how to correct our mistakes. The OAVT Conference Planning Committee is busy putting the final pieces together for an outstanding program in February. We feel confident that this is the best program ever and you will find exactly what you are looking for - more than 55 sessions created by and for technicians. Join us February 17 & 18 in Toronto!
Cass Bayley Editor, TECHNEWS
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Letter to the Editor I would just like to share some positive feedback regarding one of the articles in the summer TECHNEWS issue. I would like to thank Alison R. Weller for her article on the Naked Mole-Rat. I found it fascinating and was very pleased to finally read an article pertaining to the research side of veterinary technology. I would also like to thank TECHNEWS for printing the article. I hope this is a new trend, and that more techs in my field will share their knowledge. Thank you! Nicole Hague BSc (Hon) RVT RLAT Research Technician London Health Sciences Centre London Regional Cancer Program
Websites to Watch Novartis launches new atopic dermatitis website
Novartis Animal Health launched a new website (www.atopica.com) to provide information on the causes, symptoms, diagnosis and treatment of skin problems affecting dogs, such as canine skin allergies and atopic dermatitis. The website, which is the central part of an awareness campaign sponsored by Novartis Animal Health, aims to support veterinarians in the diagnosis and management of canine skin allergies such as atopic dermatitis. Tools available on the new website include presentations from experts and guidance for vets on how to talk to pet owners about the long-term management of atopic dermatitis, a guide to diagnostic techniques and a one-minute atopic dermatitis test.
Information Sheets for Owners
Go to the website www.wormsandgermsblog.com (Resources page) to find Information Sheets specifically for kids, for veterinarians, for physicians and for public health personnel. Topics include: • Animals: Dogs, Cats, Turtles, Hamsters, Rabbits, Pet Birds, Reptiles
Small Dogs are Big
Smaller-breed dogs are becoming more popular. According to Banfield, The Pet Hospital, Chihuahuas now represent 8% of Banfield’s patient population. From 2000 to 2010, this number has grown 116%. Shih Tzus are up 87% during that period as well. Labrador Retrievers dropped nearly 2% in the rankings over the 10-year period and German Shepherds are down 40%. Banfield suggests increased apartment or condo ownership with little to no yard space and the desire for pets that require less space may be driving the change among younger dog owners. An older population of suburban dog owners may be focused more on travel or downsizing and therefore smaller dogs may be more desirable. See below:
Top 10 Breeds • Lab Retriever - 10.1% • Chihuahua - 8% • Shih Tzu - 5.8% • Yorkshire Terrier - 5.4% • Pit Bull - 4.7% • German Shepherd - 3.5% • Mixed Breed - 3.4% • Dachshund - 3.3% • Maltese - 3.1% • Standard Poodle - 3.1%
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• Diseases: Rabies, Giardia, Toxoplasma, Leptospira, Clostridium difficile, Cryptosporidium, MRSA, MRSP, Slamonella, Ringworm, Campylobecter • Other topics: Litter Boxes, Sandboxes, Cat Bites, Raw Meat, Petting Zoos, Needlestick injuries All information sheets found on this page can be freely downloaded, printed and distributed. The authors only request that the website (www.wormsandgermsblog.com) is acknowledged as the source.
A website to remember if you have clients moving to the US...
Pet owners searching for the perfect veterinarian in the U.S. need look no further than the AVMA’s new website: MyVeterinarian.com. The site provides pet owners with detailed information about veterinary practices across the country. Pet owners head to MyVeterinarian.com type and type in their zip code – if they’re looking for a veterinarian in a specific geographic area – and a list pops up with everything they need to know: The veterinary clinic’s name, address, phone number, and business hours. The site even includes medical services provided, the species of animals served, and the names of the veterinarians on staff. Practices can choose to include a link to their website and a map to show the exact location of the clinic. Pet owners can also search the site for specific health and pet-care related topics, such as what clinics might offer dermatologic or behaviour services, or where boarding and training are available.
What kind of protection do we need in our profession? Let’s start at the top. Facial protection prevents exposure of mucous membranes of the eyes, nose, and mouth to infectious materials.1 Eye (and face) protection is critical for work with many chemicals (e.g. liquid nitrogen, cleaning agents, etc) when diluting or spraying, for the biohazards faced in dentistry or lancing abscesses, during laser ablations and wound flushing and especially important for the delivery of chemotherapeutic agents. All eye and face protection in Canada sold as safety products should meet the CSA Z94.32002 Industrial Eye and Face Protectors, and must bear permanent identification of the manufacturer on the product, so that they can be contacted to ensure that the product meets the standard. (Note that products that meet the American National Standards Institute (ANSI) standards Z87.1-89 and Z87.1A-91 for eye and face protection may not meet the CSA standard). You will want to review the information provided through WHMIS (Workplace Hazardous Materials Information System) training, and also refer to the information provided by the manufacturers in material safety data sheets (MSDS) to ensure the type of protection chosen is appropriate. A face shield or goggles worn with a surgical mask provide adequate facial protection during most veterinary procedures that generate potentially infectious sprays and splashes.1 Safety glasses are designed to protect against impact and do not provide significant splash protection. Therefore safety glasses should only be worn in cases of light work not involving significant volumes of liquids. Goggles are to be worn when there is a risk of splashing a hazardous material. Indirect vented goggles are preferred.2
M. Christi Cooper, RVT, CRSP is the Industrial - Agricultural Safety Officer for the University of Guelph. Her role focuses on worker safety issues at the satellite campuses and research stations across Ontario. Christi is a Canadian Registered Safety Professional (CRSP) and a RVT. She spent 16 years at the Veterinary Teaching Hospital (OVC) before switching to worker safety with the University’s Department of Environmental Health and Safety.
As I write this I’m enjoying a hot summer evening – barefoot and loving it! In fact, I was barefoot all day, but then I didn’t work today – being off while recovering from a touch of surgery. The wonderful staff at Guelph General Hospital took excellent care of me. It was interesting to note that the operating room nurses and doctors wear eye protection combined with their surgical masks, everyone wears low heeled comfortable shoes and, with heightened infection control practices, (GGH is currently struggling with a Clostridium difficile outbreak) imagine the number of gloves they must go through! 4
Not all products are created equally, and in an article for Canadian Occupational Safety Magazine online, Anne McGlone from the Eastman Chemical Company walks us through the various materials that are available in order to make the best possible choices for safety glasses in regards to clarity, impact, heat and scratch resistance. In short, products such as newer-generation tetramethyl cyclobutanediol (TMCD) have a balance of properties that will last longer for use, over the old standby of cellulosics and polycarbonates, which performed poorly in terms of strength, heat resistance and optical clarity when exposed to common cleansers, over the long term. At times, a face shield may also be desirable to protect facial skin from splashes – again, depending on the materials, volumes, and methods or procedures being followed. The requirement for eyewear specific to the use of lasers is detailed in CSA Standard Z386-08 Safe Use of Lasers in Health Care Facilities, where it reminds us that the protection must be appropriate to the make, model, performance specifications and the location of use of the laser and conditions of use of the eyewear. This standard requires that “veterinary technicians must play an active role in promoting laser safety within the veterinary practice. They may serve as laser safety officers (LSOs) in the practice situation and actively participate in educational activities.”3 Guidance is also available for the protection necessary in the delivery of chemotherapeutic agents (e.g. vincristine, vinblastine, cisplatin, doxorubicin, etc.) from the Prevention Guide – Safe Handling of Hazardous Drugs, available at http://www.irsst.qc.ca/en/-irsst-publication-prevention-guide-safehandling-of-hazardous-drugs-cg-002.html
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Assistance for performing a face and eye protection assessment at your workplace can be found appended to the University of Guelph’s Safety Policy 851.05.03 Eye and Face Protection, available on line at http:// www.uoguelph.ca/ehs/sites/uoguelph.ca.ehs/ files/05-03.pdf Noise-induced hearing loss is one of the most preventable occupational injuries encountered. I covered this topic fairly thoroughly in the Fall 2008 issue (Volume 30, Issue 1), in the column ‘Can you hear what I hear? Hearing protection may consist of ear plugs or ear muffs depending upon the amplitude and frequency of the noise. For most provinces, hearing protection must be worn in areas where the eight hour time weighted average noise level is greater than 85 dB.2 While the typical vet practice will not have nearly the noise levels like those experienced in factories or on construction sites, there are still some loud sounds to be aware of. The high pitch of ultrasound units and in cage washing areas, the piercing levels reached by barking dogs (while you are doing kennels, cleaning the runs or feeding), the squealing pigs at feeding times and even roosters crowing can all reach noise levels where hearing protection should be worn. When I have tested the noise levels of dogs in kennels and in pig barns, results have often reached over 100 decibels. Of course, it is not a consistent level, so the length of exposure should be factored in here. Where staff spend more than 15 minutes, regularly, in such a noisy environment, hearing protection is recommended. A general rule of thumb is, if you have to raise your voice to make yourself heard (over background noise) when speaking to the person next to you, you should be wearing hearing protection. Additionally, in the provinces of British Columbia, Saskatchewan and Manitoba, a hearing testing surveillance program (audiometric testing) must be put in place where there are established noise exposure issues, and records kept on file. Other provinces may not require testing, but protection is still specified or implicit in the general duty clause (to take all precautions to protect a worker). Please check the legislation for your jurisdiction. When it comes to foot protection, there are legislated requirements of some sort in
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every jurisdiction. Several provinces, including B.C., PEI, Nova Scotia and New Brunswick mention protection against slippery or wet locations. Quebec and Manitoba address protection from corrosive substances and Saskatchewan requires protection when a worker is at risk from a heavy or falling object or where the worker may step on a sharp object. And most provinces also have a general clause specifying that foot protection be required according to the hazard, which leaves what is needed open to interpretation. Typically, in our profession our feet face crush hazards from equipment and patients, wheels on carts, gates, chemicals, biohazards contained in blood and feces, sharps and some slippery scenarios. Footwear should be suitable for the specific working conditions (e.g., rubber boots for farm work) and should protect personnel from both trauma and exposure to infectious material.1 While not commonly worn in the equine industry, footwear with protective toe caps should be worn for all work with large animals in veterinary-related scenarios (i.e. practice, research, etc). Unlike going riding at a stable, we are not always familiar with the large animal patient, who is often in pain, or will at least be made uncomfortable as we take TPRs, use needles or manipulate sore joints. Currently, lightweight composite materials are available for the protective cap (not just steel), that meet CSA Standard Z195-02 Protective Footwear4. Even the popular slip on style Blundstones® are now available with protective toe cap options. The biosecurity needs of farm calls continue to require the big black overboots we wore in college, the type that can be scrubbed and disinfected when leaving each facility. Swine barns and other specialty facilities may require that you change entirely, and wear what they provide. Closed toe footwear (and closed heels as well) should be worn in labs, kennels, surgery and for treatments, due to the type of work performed. Professional “nursing” Crocs® are available, without any holes in the upper of the shoe, and of course many styles can be found that surround the whole foot. There really is no place for sandals (or high heels) in the clinic. Fortunately, nonslip soles are a very common attribute of many types of safety footwear. Disposable shoe covers or booties add an extra level of protection when heavy quantities of
infectious materials are present. Promptly remove and dispose of shoe covers and booties when leaving contaminated work areas.1 In general, personal protection is …personal. Involving staff in choosing the style of protection goes a long way towards acceptance and compliance in use. Ideally, goggles and safety glasses should not have to be shared and replacements should be available in the event they get scratched or the material becomes opaque. If foam plugs are used as hearing protection, they should be changed regularly, and it is recommended to change the foam rims on ear muffs annually. There are an abundance of companies providing safety gear, from the big names like North and 3M, available through distributers like Fisher Scientific, Vet Purchasing, Safety Today and Tenaquip, to smaller companies with products available at hardware stores. Sometimes you get what you pay for, (please don’t buy safety gear at dollar stores) but being informed enough to ask the right questions is important too. There you have it, personal protection from head to toe, leaving hand protection (gloves) and respiratory protection to be covered (pardon the pun) in the future editions.
references > 1. Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel; National Association of State Public Health Veterinarians, http://www.nasphv.org/ Documents/VeterinaryPrecautions.pdf 2. Laboratory Safety Manual, University of Guelph, available at http://www. uoguelph.ca/ehs/sites/uoguelph.ca.ehs/ files/lab-safety-manual-fall-2008_0.pdf 3. CSA standard Z195-02 Protective Footwear, http://www.csa-international. org/product_areas/occ_health_and_ sports_safety/footwear/Default. asp?language=english 4. CSA standard Z386-08 Safe Use of Lasers in Health Care Facilities http://legislation.ccohs.ca/legislation/ documents/stds/csa/clshc08e.htm; CSA Z94.3-2002 Industrial Eye and Face Protectors, available at https://www.rkb. us/standarddetail.cfm?standard_id=139
Veterinarians Without Borders Aims to Make Rabies History
For many Canadians, paying for their pet’s rabies vaccine is the only time that rabies crosses their mind. Thanks to widespread animal vaccination programs, human rabies is now extremely rare in Canada. Yet over 55,000 people die from rabies every year – most of them children in Africa and Asia. This is an astounding rate of one person every ten minutes. The good news is that the global rabies problem is solvable and Veterinarians without Borders/Vétérinaires sans Frontières – Canada (VWB/VSF) wants to raise awareness of this disease to make rabies history. The most common source of human rabies is linked to uncontrolled rabies in dogs. The key to eradication means developing comprehensive programs that include sustainable animal vaccination and control as well as providing access to education and treatment. To date, VWB/VSF has raised and dispersed over $150,000 towards rabies prevention projects around the world, and is working to stop rabies in countries including Cambodia, Guatemala, India PDR, Malawi and Uganda. VWB/VSF is calling on Canadians to help raise awareness about the global rabies issue. The organization’s fourth annual Rabies Campaign, running throughout the month of September, will help raise funds to support international rabies prevention programs. World Rabies Day is on September 28, 2011. “The funds raised during the campaign go directly to supporting our various rabies prevention programs and in the last three years we have seen what’s possible. We just wish we could reach out to more communities in need.” said Dr. Erin Fraser, Managing Director, VWB/VSF.
Drug name 1. Clemastine fumarate 2. Epsiprantel 3. Dirlotapide 4. Maropitant 5. Vitamin K1 6. Vancomycin HCl 7. Furosemide 8. Gabapentin 9. Fluoxetine HCl 10. Glycopyrrolate
Disease or condition a. Motion sickness b. MRSA (I) infection c. Pulmonary edema d. Allergic rhinitis e. Seizure disorders f. Obesity g. Sinus bradycardia h. Tapeworms i. Obsessive-compuslive disorders j. Toxicosis, anticoagulant poisoning
Answers: 1d, 2h, 3f, 4a, 5j, 6b, 7c, 8e, 9i, 10g
Match the drug name used to treat the disease or condition:
(Source: North American Companion Animal Formulary, 9th edition, North American Compendiums)
Generous Canadian veterinary practices raised over $22,000 during last year’s Rabies Campaign and the organization is hoping to raise even more money this year. Participating in the Rabies Campaign is easy! Visit the VWB/VSF website (www.vwb-vsf.ca) to see how you can get involved and Help Make Rabies History!
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Data Reveal Cats Need Better Protection Against Roundworm & Heartworm Lack of compliance in use of preventives cited as No. 1 reason for more infected felines BEL AIR, Maryland (June 22, 2011) – Extensive data collected by laboratories for IDEXX, ANTECH, and Banfield Pet Hospitals in 2010 reveal that cats need better protection from heartworms and roundworms, according to the Companion Animal Parasite Council (CAPC). The comprehensive results of the combined national sample data can be found on interactive maps on the CAPC website, www.capcvet.org, and allows the viewer to search for canine or feline infection rate results by state, county and type of parasite. Nationally for roundworms, 6 percent of 780,000 fecal samples from caredfor cats contained the eggs of the feline roundworm, Toxocara cati. For the 4 million cared-for canine fecal samples that were examined, the national average was 2.9 percent containing the eggs of Toxocara canis. There were only four states – Alaska, Arizona, California and Nevada – where a higher percentage of dogs were infected with roundworms than cats.
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For heartworm, there was a higher percentage of cats positive for heartworms than dogs in every state except for Arkansas, Louisiana, Mississippi, Oklahoma and Texas. For the 250,000 feline samples and 5 million canine samples, the national averages were 2.7 percent of cats being positive and 1.2 percent of dogs testing positive. In general, three out of every 100 cats tested was positive for heartworm antigen, a good indicator that these positive cats have living heartworms in their lungs, according to the CAPC. Feline antigen data should be considered with caution because cats are more likely to be tested only when ill, but surveys utilizing other detection methods have revealed similar prevalences. The numbers from these maps suggest that heartworm preventives with broadspectrum internal parasite control are reducing the worm populations in dogs, but that cats are not receiving the same protection. These data strongly support the CAPC recommendation that all pets, both cats and dogs, be protected annually throughout the United States against heartworm, intestinal parasites and ectoparasites. According to the CAPC, every veterinary clinic’s parasite prevention motto should be every pet, all year long.
Additional information and frequently updated research on parasite infections of canines and felines can be found on the CAPC website at www.capcvet.org.
The Companion Animal Parasite Council (www.capcvet.org) is an independent not-for-profit foundation comprised of parasitologists, veterinarians, medical, public health and other professionals that provides information for the optimal control of internal and external parasites that threaten the health of pets and people. Formed in 2002, the CAPC works to help veterinary professionals and pet owners develop the best practices in parasite management that protect pets from parasitic infections and reduce the risk of zoonotic parasite transmission.
P O I S O N I N G T OX I C O L O G Y C O L U M N
by Amanda Poldoski, DVM and Sherry Welch, DVM, DABT, DABVT
Some of the most common potential toxins encountered in the home, especially by dogs, are foods found in the kitchen. The following is the first of a two-part series summarizing potential clinical signs, mechanism of toxicity, and treatment recommendations, should exposure occur. Part 1 will address chocolate; grapes, raisins, and currants; xylitol; and onions and garlic.
Possibly the most well-known toxic food in veterinary medicine, chocolate contains methylxanthines (e.g., theobromine and caffeine) which cause dose-dependent signs including vomiting, diarrhea, agitation, hyperthermia, tachycardia, muscle tremors, and seizures. Pancreatitis is also a potential concern, especially with large ingestions. The darker the chocolate, the higher the concentration of methylxanthines in the product. A 20 kg dog would need to ingest approximately 14 oz of milk chocolate, or 4.5 oz of semi-sweet, or 2 oz of unsweetened chocolate to cause moderate signs of toxicity (e.g., agitation, tachycardia). Emesis may be induced even several hours after ingestion, provided the patient is asymptomatic, as chocolate tends to remain in the stomach for quite some time. Multiple doses of activated charcoal (AC) are recommended as methylxanthines undergo enterohepatic recirculation. Treatment includes decontamination and supportive care including IV fluid therapy (IVF), frequent walks (to prevent reabsorption of methylxanthines from the urine across the bladder wall), sedatives for agitation (e.g., acepromazine), beta-blockers for persistent tachycardia or hypertension (e.g., propranolol), methocarbamol for tremors, and anticonvulsants for seizures, as needed.
Grapes, Raisins, and Currants
Ingestion of grapes, raisins, or currants can cause acute renal failure (ARF) in dogs. Anecdotal reports also exist regarding cats and ferrets developing toxicity, but exposure among dogs appears to be more common. Early signs can include vomiting, diarrhea, anorexia, and lethargy. Azotemia may develop within 1-3 days post- ingestion. While some ounce/kg toxic doses have been proposed, none have been published in peer-reviewed veterinary literature to the authorsâ€™ knowledge. As a result, any exposure should generally be considered potentially problematic. Emesis may be induced up to 6 hours post-ingestion as grapes and raisins tend to remain in the stomach for hours. A single dose of AC may be given following emesis induction. Following decontamination, treatment includes baseline lab work [including CBC, chemistry, urinalysis (UA)], aggressive IVF, anti-emetics, blood pressure and urine output monitoring, and supportive care. Renal values should be monitored daily during hospitalization and re-evaluated 2-3 days after discharge. If azotemia is absent after 2-3 days of IVF, the prognosis is excellent.
This natural, sugar-free sweetener is found in many chewing gums, mints, pudding and gelatin snacks, oral rinses, toothpastes, and OTC supplements (e.g., multivitamins, fish oils, etc.). The xylitol content of these products can vary widely depending on brand and flavor. In dogs, ingestion of > 0.1 gram/kg can cause acute hypoglycemia (within 10-15 minutes). Larger ingestions, generally > 0.5 gram/kg, can result in acute hepatic necrosis and hepatic failure.1 Due to the potential for rapid onset of hypoglycemia, emesis should only be induced by a veterinary professional provided the dog remains normoglycemic. Activated charcoal does not reliably bind xylitol, therefore its use is not recommended. Treatment includes monitoring of blood glucose and hepatic values, supplementation of dextrose in IVF, hepatoprotectants [e.g., S-adenosylmethionine (SAMe)], as needed. Hepatic values should be re-evaluated 2-3 days after discharge.
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references > 1. Dunayer EK, Gwaltney-Brant SM. Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs. JAVMA 229(7):1113-1117, 2006. 2. Cope, R.B. Allium species poisoning in dogs and cats. Veterinary Medicine 2005;100:562-566. 3. Lee KW, Yamato O, Tajima M, et al. Hematological changes associated with the appearance of eccentrocytes after intragastric administration of garlic extract to dogs. AJVR 2000; 61(11):1446. 4. Hill AS, O’Neill R, Rogers QR, et al. Antioxidant prevention of Heinz body formation and oxidative injury in cats. Am J Vet Res 2001; 62:370-374.
Merck Announces New Name for its Animal Health Division
Boxmeer, the Netherlands, June 29, 2011 – Merck’s animal health division, formerly known as Intervet/Schering-Plough Animal Health, announced that effective today it will begin using the new name, Merck Animal Health.
Onions and Garlic
These foods can result in both gastroenteritis and oxidative damage (resulting in a Heinz body anemia). Both dogs and cats are susceptible to onion and garlic toxicosis, but cats and Japanese breeds of dogs (e.g., Akita, Shiba Inu) tend to be more sensitive. Ingestion of > 5 grams/kg of onion in cats, and > 15-30 grams/kg in dogs can cause clinical hematological changes.2 Garlic is considered to be about 5 times as potent as onion.3 Clinical signs of anemia (e.g., lethargy, pallor, tachycardia, weakness, etc.) may not be noted for several days, but can occur sooner with a large ingestion. Treatment focuses on early decontamination (inducing emesis followed by a single dose of AC) and supportive care for anemia and gastroenteritis. Antioxidants such as ascorbic acid, Vitamin E, and N-acetylcysteine (NAC) can be used but have not been shown to provide any protective effects in cats.4 Blood work (e.g., packed cell volume, blood smears, CBC, etc.) should be monitored every 1-3 days as needed, depending on case severity, as anemia can persist for about 3 weeks.
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Veterinary professionals should be aware of common toxic foods, potential clinical signs, and basic treatments. Consultation with Pet Poison Helpline should be utilized if needed. Pet owners should be informed of these potential toxins and encouraged to restrict access to these items in order to prevent exposure.
About Pet Poison Helpline
Pet Poison Helpline, a division of SafetyCall International, is a 24/7 animal poison control service based out of Minneapolis, MN. Pet Poison Helpline is available for pet owners and veterinary professionals who require assistance treating a potentially poisoned pet. The staff can provide treatment advice for poisoning cases of all species, including dogs, cats, birds, small mammals, large animals and exotic species. As the most cost-effective option for animal poison control care, Pet Poison Helpline’s fee of $35 per incident includes unlimited follow-up consultations. Pet Poison Helpline is available in North America by calling 800-213-6680. Additional information can be found online at www.petpoisonhelpline.com.
“The name change reflects Merck’s commitment to animal health and its complementary role to the overall business,” said Raul Kohan, President of Merck Animal Health. “We are unwavering in our commitment to veterinarians, producers, pet owners and society as a whole. Merck Animal Health is a global leader in the research, development, manufacturing and sale of veterinary medicines and vaccines, with a strong presence in biologics and pharmaceuticals. The division generated global sales of $2.9 billion in 2010. Merck values the diversification that Merck Animal Health brings to its portfolio, and sees growth opportunities in the business that can be leveraged across both animal and human health. The company intends to capitalize on Merck Animal Health’s broad and innovative portfolio going forward, and to develop the unit into a best-in-class global animal health leader.
Urinary tract disease is a common reason for use (and likely misuse, improper use, and overuse) of antimicrobials in dogs and cats. There is a lack of comprehensive treatment guidelines such as those that are available for human medicine. Accordingly, guidelines for diagnosis and management of urinary tract infections were created by a Working Group of the International Society for Companion Animal Infectious Diseases. While objective data are currently limited, these guidelines provide information to assist in the diagnosis and management of upper and lower urinary tract infections in dogs and cats. 1. Introduction Urinary tract disease is commonly encountered in dogs and cats and accounts for significant use (and presumably also overuse and misuse) of antimicrobials. Improper therapy can lead to a variety of patient health (e.g., failure to resolve infection), economic (e.g., need for repeated or prolonged treatment), public health (e.g., antimicrobial resistance) and regulatory (e.g., antimicrobial use) concerns. In human medicine, antimicrobial use guidelines such as those developed by the Infectious Diseases Society of America (IDSA) are widely respected and provide excellent guidance to physicians on management of various infectious diseases, including urinary tract infections (UTIs)1,2. Such guidelines can be directly
CE Article #1 Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases
used or form the basis of hospital-level antimicrobial use guidelines. The impact of national or international guidelines is difficult to assess, but implementation of antimicrobial use guidelines at the hospital level has been shown to significantly improve antimicrobial prescribing practices, either alone or as part of a broader antimicrobial stewardship program3-5.
This document contains guidelines developed in 2010 by the Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. During the course of guideline development, it became abundantly clear that there are significant limitations in objective, published information. Accordingly, recommendations
Authors • • • • • • • • • • •
J. Scott Weese - Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada N1G 2W1 Joseph M. Blondeau - Clinical Microbiology, Royal University Hospital and University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8 Dawn Boothe - College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA Edward B. Breitschwerdt - College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA Luca Guardabassi - Department of Veterinary Disease Biology, Faculty of Life Sciences, University of Copenhagen, 1870 Frederiksberg C Copenhagen, Denmark Andrew Hillier - College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA David H. Lloyd - Department of Clinical Sciences, Royal Veterinary College, North Mymms, Hertfordshire AL9 7TA, UK Mark G. Papich - College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA Shelley C. Rankin - School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA John D. Turnidge - Division of Laboratory Medicine, Women’s and Children’s Hospital, North Adelaide, SA 5006, Australia; University of Adelaide, Adelaide, SA 5000 Jane E. Sykes - Department of Medicine and Epidemiology, University of California, Davis, Davis, CA 95616, USA
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are based on available data, whenever present, along with expert opinion, considering principles of infectious diseases, antimicrobial therapy, antimicrobial resistance, pharmacology, and internal medicine. Corresponding guidelines for human medicine were evaluated, with careful consideration of the abundant differences between species. As with all guidelines, these should be interpreted as general recommendations that are reasonable and appropriate for the majority of cases. The Working Group acknowledges the variability between cases, and these guidelines should not be considered as standards of care that must be followed in all circumstances. Rather, they should be considered the basis of decision-making, with the potential that different or additional approaches may be required in a minority of cases. Further, while these guidelines are designed as international guidelines, appropriate for all jurisdictions, the Working Group realizes that regional differences (e.g., antimicrobial resistance rates, antimicrobial availability, prescribing regulations) exist. 2. Simple Uncomplicated Urinary Tract Infection Simple uncomplicated UTI is a sporadic bacterial infection of the bladder in an otherwise healthy individual with normal urinary tract anatomy and function. The presence of relevant comorbidities (e.g., diabetes mellitus, urinary or reproductive tract conformational abnormalities) or 3 or more episodes per year indicates complicated or recurrent UTI, respectively, as are discussed below. Clinically significant infection implies the presence of a clinical abnormality and is characterized by dysuria, pollakiuria, and/or increased urgency of urination along with the presence of bacteria in urine2. These clinical signs are not pathognomonic for infection and can also be caused by noninfectious conditions. Additionally, bacteria can be present in the urine in the absence of clinical signs (covert bacteriuria/subclinical bacteriuria). Therefore, the clinician must interpret the clinical evaluation, gross and cytological appearance of the urine,
and bacterial culture results in parallel to determine the likelihood of a clinically significant UTI. 2.1. Summary of Recommendations for Uncomplicated UTIs 2.1.1. Diagnosis of Uncomplicated UTIs Proper and timely diagnosis is critical for management of UTIs. Proper diagnosis allows for determination of both the need for antimicrobials and optimal drugs. As discussed above, clinical signs are nonspecific and should not be used alone for diagnosis of UTI. Rather, the presence of clinical abnormalities should indicate the need for further testing. Sediment analysis alone is inadequate for diagnosis of UTIs because of problems regarding the variable quality of interpretation, stain contamination, and false positive results from bacteriuria in the absence of clinical infection. Hematuria and proteinuria are often present with a UTI, but they are nonspecific and may be caused by noninfectious conditions. The presence of pyuria and bacteriuria does, however, provide supporting evidence of a UTI. Sediment analysis is a useful adjunctive measure to consider in conjunction with clinical signs and culture results. All individuals performing analysis should be proficient at the technique, ideally through formal training and ongoing education and quality control. Complete urinalysis, including urinespecific gravity, urine glucose level determination, and examination of the sediment for crystalluria is considered a minimum database for evaluation of suspected UTI and may be helpful to investigate underlying causes of infection, if present. Aerobic bacterial culture and susceptibility testing should be performed in all cases, to confirm the presence of infection, identify the presence of resistant bacteria that may not respond to initial therapy, to help differentiate reinfection
from relapse should a UTI return, and to provide the clinician with guidance regarding the most common bacteria causing UTI in their practice and local susceptibility patterns. Cystocentesis should be used for sample collection. Catheterized samples can be evaluated for culture but cystocentesis samples are preferred. Free-catch (midstream voiding or manual expression) samples should not be used. It is imperative that a quantitative culture be performed. Urine samples for culture and susceptibility testing should be refrigerated immediately after collection and submitted to the laboratory as quickly as possible. Results of samples that take 24 hours or more to reach the laboratory should be interpreted with caution because of the potential for both false positive and false negative results, particularly if a urine preservative was not used. Testing of refrigerated samples greater than 24 hours old is acceptable if samples contain a urine preservative; otherwise, retesting is recommended. The use of specific urine transportation tubes is recommended, provided they are appropriate for the volume of urine that is collected. The use of new or alternative techniques or materials intended to facilitate successful culture such as inoculation of â€œurine paddlesâ€? in clinics is a reasonable alternative to traditional sample collection approach to try to optimize bacterial recovery. The preferred approach is for paddles to be inoculated in clinics and promptly submitted to a diagnostic laboratory for incubation and subsequent testing. The use of traditional culture methods in clinics may be a reasonable alternative to submission to outside laboratories. In-clinic testing can minimize the impact of sample deterioration that occurs between sample collection in the clinic and processing at the laboratory and can be cost-effective for screening purposes. However, bacterial isolation should only be attempted in clinics with appropriate laboratory facilities, proper equipment, proper biosafety level 2 (BSL-2) contain-
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ment and waste management, and adequately trained individuals. Quantitative culture should be performed. Incubation of urine paddles in the clinic can be performed, but this approach has the same biosafety requirements as incubation of culture plates. Identification and susceptibility testing must only be performed if there is adequate biocontainment and properly trained staff. Only protocols that include reference strains for quality control testing and have been standardized by an appropriate organization (i.e., Clinical and Laboratory Standards Institute (CLSI), European Union Committee on Antimicrobial Susceptibility Testing (EUCAST), or equivalent) should be followed. If culture is being performed to screen samples and send isolates (on plates, paddles, swabs, or any other approach) to a diagnostic laboratory for subsequent testing, clinicians must contact their laboratory to determine if those items will be accepted. In all cases in which isolates are shipped, regional regulations must be followed regarding shipment of bacteria. If a veterinary clinic is unable to satisfy BSL-2 containment and properly ship isolates, the use of these techniques is discouraged. The advantage of quantitative culture techniques lies in the availability to determine the level of bacterial growth (colony counts), which can be used in interpreting the relevance of results. For samples collected by cystocentesis, any level of bacterial growth may be significant, although samples from a UTI typically contain ≥103 colony forming units (CFU)/mL6. The colony count and the identity of the organism isolated should be considered in all situations. Small numbers of minimally pathogenic skin commensals (i.e., coagulase negative staphylococci) likely represent contamination. For samples collected via catheter, bacterial counts ≥104 CFU/mL in males and ≥105 in females are typically considered significant. Samples with lower counts
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table 1 >
Summary of First-line Antimicrobial Options for UTIs in the Dog and Cat Infection Type
First-line drug options
Guided by culture and susceptibility testing, but consider amoxicillin or trimethoprim-sulfonamide initially
Antimicrobial therapy not recommended unless high risk for ascending infection. If so, treat as per complicated UTI
Start with a fluoroquinolone, with re-assessment based on culture and susceptibility testing
should be interpreted with caution and ideally repeated prior to treatment to confirm the same organism can be demonstrated. Samples obtained in male dogs by catheterization are usually adequate so long as proper sterile technique was performed to obtain the sample. Positive cultures obtained from catheterized female dogs should be confirmed with a cystocentesis unless medically contraindicated. Although it has been suggested that bacterial counts of greater than or equal to 105 CFU/mL in dogs and 104 CFU/ mL in cats are significant for free-catch samples6, the potential for high-level contamination is present and therefore results from free-catch samples are not considered diagnostic. Cystocentesis should be performed to confirm positive culture results from free-catch samples, unless medically contraindicated. Susceptibility testing should be performed according to accepted standards, such as those published by the CLSI or EUCAST, or another internationally recognized public standard. The interpretive criteria for susceptibility testing and breakpoints for systemic infections also apply to UTIs. Those drugs for which urinary tract-specific breakpoints have been provided are limited to ampicillin or amoxicillin in dogs (≤8 µg/mL),
amoxicillin-clavulanate in dogs and cats <8/4 µg/mL), and nitrofurantoin. 2.1.2. Treatment of Uncomplicated UTIs Antimicrobial therapy is indicated in most cases while awaiting culture and susceptibility results to relieve patient discomfort. In most situations, initial therapy should consist of amoxicillin (11-15 mg/kg PO q8h) or trimethoprim-sulfonamide (15 mg/kg PO q12h) (Tables 1 and 2). Amoxicillin/clavulanic acid (12.5–25 mg/kg PO q8h) is an acceptable option but is not recommended initially because of the lack of evidence regarding the need for clavulanic acid and the desire to use the narrowest spectrum that is possible while maintaining optimal efficacy. Veterinarians should be aware of the pathogen and antimicrobial resistance trends among urinary pathogens isolated from patients in their clinic. Reports of resistance rates from other institutions or broader surveillance programs can provide some information but it is not a replacement for clinic-level information. Changes in local resistance patterns for urinary pathogens should be monitored. As baseline resistance rates of the most common organisms to a first-line drug increase, consideration should be given to changing the empirical drug choice.
table 2 >
Antimicrobial Treatment Options for Urinary Tract Infections in the Dog and Cat Drug Dose
Amoxicillin 11–15 mg/kg PO q8h
Good first-line option for UTIs. Excreted in urine predominantly in active form if normal renal function is present. Ineffective against beta-lactamaseproducing bacteria.
Amikacin Dogs: 15–30 mg/kg IV/IM/SC q24h Cats: 10–14 mg/kg IV/IM/SC q24h
Not recommended for routine use but may be useful for treatment of multidrug resistant organisms. Potentially nephrotoxic. Avoid in animals with renal insufficiency.
12.5–25 mg/kg PO q8h (dose based on Not established whether there is any advantage over amoxicillin alone. combination of amoxicillin+clavulanate)
Not recommended because of poor oral bioavailability. Amoxicillin is preferred.
Cephalexin, 12–25 mg/kg PO q12h Cefadroxil
Enterococci are resistant. Resistance may be common in Enterobacteriaceae in some regions.
Cefovecin 8 mg/kg single SC injection. Can be repeated once after 7–14 days.
Should only be used in situations where oral treatment is problematic. Enterococci are resistant. Pharmacokinetic data are available to support the use in dogs and cats, with a duration of 14 days (dogs) and 21 days (cats). The long duration of excretion in the urine makes it difficult to interpret post-treatment culture results.
5 to 10 mg/kg q24h PO
Enterococci are resistant.
2 mg/kg q12-24h SC
Approved for treatment of UTIs in dogs in some regions. Enterococci are resistant.
Chloramphenicol Dogs: 40–50 mg/kg PO q8h Cats: 12.5–20 mg/kg PO q12h
Reserved for multidrug resistant infections with few other options. Myelosuppression can occur, particularly with long-term therapy. Avoid contact by humans because of rare idiosyncratic aplastic anemia.
Ciprofloxacin 30 mg/kg PO q24h
Sometimes used because of lower cost than enrofloxacin. Lower and more variable oral bioavailability than enrofloxacin, marbofloxacin, and orbifloxacin. Difficult to justify over approved fluoroquinolones. Dosing recommendations are empirical.
Doxycycline 3–5 mg/kg PO q12h
Highly metabolized and excreted through intestinal tract, so urine levels may be low. Not recommended for routine uses.
Enrofloxacin 5 mg/kg PO q24h (cats) 10–20 mg/kg q24h (dogs)
Excreted in urine predominantly in active form. Reserve for documented resistant UTIs but good First-line choice for pyelonephritis (20 mg/kg PO q24h). Limited efficacy against enterococci. Associated with risk of retinopathy in cats. Do not exceed 5 mg/kg/d of enrofloxacin in cats.
Imipenem- 5 mg/kg IV/IM q6-8h cilastatin
Reserve for treatment of multidrug-resistant infections, particularly those caused by Enterobacteriaceae or Pseudomonas aeruginosa. Recommend consultation with a urinary or infectious disease veterinary specialist or veterinary pharmacologist prior to use.
Marbofloxacin 2.7–5.5 mg/kg PO q24h
Excreted in urine predominantly in active form. Reserve for documented resistant UTIs but good First-line choice for pyelonephritis. Limited efficacy against enterococci.
Meropenem 8.5 mg/kg SC/IV q 12 (SC) or 8 (IV)h
Reserve for treatment of multidrug-resistant infections, particularly those caused by Enterobacteriaceae or Pseudomonas aeruginosa. Recommend consultation with a urinary or infectious disease veterinary specialist or veterinary pharmacologist prior to use.
Nitrofurantoin 4.4–5 mg/kg PO q8h
Good second-line option for simple uncomplicated UTI, particularly when multidrug-resistant pathogens are involved.
Tablets: 2.5–7.5 mg/kg PO q24h; Oral Excreted in urine predominantly in active form. Suspension: Cats: 7.5 mg/kg PO q24h Dogs: 2.5-7.5 mg/kg PO q24h
Trimethoprim- 15 mg/kg PO q12h - Note: dosing sulfadiazine is based on total trimethoprim + sulfadiazine concentration
Good first-line option. Concerns regarding idiosyncratic and immune-mediated adverse effects in some patients, especially with prolonged therapy. If prolonged (>7d) therapy is anticipated, baseline Schirmer’s tear testing is recommended, with periodic re-evaluation and owner monitoring for ocular discharge. Avoid in dogs that may be sensitive to potential adverse effects such as KCS, hepatopathy, hypersensitivity, and skin eruptions.
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Objective data regarding the prevalence of resistance that indicates a need to change initial therapy is lacking; however the Working Group considers 10% to be a reasonable standard. Accordingly, if baseline resistance rates to a given drug from non biased sample collection exceed 10%, the drug chosen for initial therapy should be changed to another of the recommended initial choices. Care should be taken when determining rates. Decisions should be based on cultures from an appropriate patient population (i.e., animals presented for simple uncomplicated UTI). If culture data are biased towards animals with refractory or recurrent infections, then the baseline prevalence of resistance in the uncomplicated UTI population could be overestimated. Therefore, determination of this prevalence should involve a comparable population of primary uncomplicated UTIs and should involve the use of proper breakpoints. If culture and susceptibility testing indicates the presence of an isolate that is resistant in vitro to initial therapy but there has been apparent clinical response, maintaining the current treatment is acceptable provided a follow-up urinalysis, including culture, is performed after treatment has been completed to ensure resolution of infection.
knowledges the likelihood that a shorter treatment time (â‰¤7 days) may be effective. Accordingly, in the absence of objective data, 7 days of appropriate antimicrobial treatment is reasonable. Clinical trials supporting shorter durations for treatment of UTIs in dogs and cats are strongly encouraged. There is currently insufficient evidence supporting the use of other adjunctive treatment measures (e.g., cranberry extract) for uncomplicated UTIs in animals. 2.1.3. Monitoring Response to Treatment of Uncomplicated UTIs There is no indication for measures beyond monitoring of clinical signs. Provided the full course of antimicrobials is administered correctly, there is no evidence that intra- or post-treatment urinalysis or urine culture is indicated in the absence of ongoing clinical signs of UTI.
If culture and susceptibility data indicate that the isolate is not susceptible to the chosen antimicrobial and there is a lack of clinical response, then therapy with the original drug should be discontinued and treatment with an alternative drug begun. Factors that should be considered when choosing the antimicrobial include the susceptibility of the bacterium, potential adverse effects, and issues regarding prudent use of certain antimicrobials and antimicrobial classes. More detailed discussion regarding drug selection is provided below under Complicated UTI.
3. Complicated Urinary Tract Infection A complicated UTI is an infection that occurs in the presence of an anatomic or functional abnormality or a comorbidity that predisposes the patient to persistent infection, recurrent infection, or treatment failure7. In humans, the concurrent presence of prostatitis, urinary calculi, a neurogenic bladder, pregnancy, diabetes mellitus, or immunocompromising disorders also defines a complicated UTI7, and it is reasonable to apply this to companion animals. An identifiable abnormality is not always present, because of the difficulty diagnosing some anatomical, functional, metabolic, or other abnormalities. Recurrent UTIs, as defined by the presence of 3 or more episodes of UTI during a 12-month period8, also indicate complicated infection.
Adequate evidence regarding duration of treatment is lacking, precluding the ability to make a specific recommendation for treatment duration. Typically, uncomplicated UTIs are treated for 7â€“14 days. However, the Working Group ac-
Recurrent UTIs can more loosely be defined as reinfection or relapse. While definitive determination of relapse versus reinfection is difficult (or often impossible), consideration of whether reinfection or relapse is most likely is important.
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Reinfection is recurrence of a UTI within 6 months of cessation of previous, apparently successful treatment and isolation of a different microorganism. If the same bacterial species is present, genotyping is ideal to determine whether the same strain is present; however this is uncommonly available. Evaluation of antimicrobial susceptibility pattern can be helpful, although unrelated organisms can have the same susceptibility pattern and changes in susceptibility can occur in individual strains. Therefore, evaluation of susceptibility pattern is useful but not definitive. Relapse is recurrence of a UTI within 6 months of cessation of previous, apparently successful treatment and isolation of an indistinguishable organism from the one that was present previously, which is presumably because of failure to completely eliminate the pathogen. In general, relapses tend to occur earlier than reinfections (i.e., within weeks rather than months) and are characterized by a period of apparent bladder sterility during treatment. It should be recognized that isolation of the same bacterial species, even if the same antimicrobial susceptibility pattern is present, does not definitively indicate that the organism was not successfully eliminated, since reinfection with the same strain or a phenotypically (or even genotypically) indistinguishable strain cannot be ruled out. A refractory infection is similar to a relapse except that it is characterized by persistently positive results using culture during treatment (despite in vitro susceptibility to the antimicrobial), with no period of eliminated of bacteriuria during or after treatment. 3.1. Summary of Recommendations for Complicated UTIs 3.1.1. Diagnosis of Complicated UTIs General principles of diagnosis, as discussed for simple uncomplicated UTI, apply for complicated UTIs. A diagnosis of recurrent UTI should never be based on clinical signs or urine sediment exam-
ination alone. Bacterial culture and susceptibility testing should be performed in all instances to confirm recurrent UTI. Efforts must be made to determine any underlying factors that could be associated with recurrence or relapse. A complete blood cell count, serum biochemical profile, urinalysis, imaging and, if deemed appropriate, endocrine testing should be performed. A complete physical examination, including rectal palpation and examination of the vulva, is required. Referral to a specialist in internal medicine or surgery (particularly in females) should be considered to further investigate underlying causes (e.g., cystoscopy). If an underlying cause cannot be found and corrected, it is possible therapy will ultimately be unsuccessful. Client compliance with previous antimicrobial treatment should be investigated. This is particularly important in cases where relapse is suspected. If cystotomy is being performed, culture of a bladder wall biopsy as well as any uroliths that might be present is recommended9. 3.1.2. Treatment of Complicated UTIs If the clinical condition of the patient permits, consideration should be given to waiting for culture results before starting therapy. If treatment must be initiated immediately for patient care reasons, a drug should be selected from those recommended for initial treatment of simple uncomplicated UTI. Where possible, the drug class used should be different from that used to treat the prior UTI(s) (i.e., if amoxicillin was used initially, start treatment with trimethoprim-sulfadiazine). After treatment has been initiated, continued treatment should be based on the results of culture and susceptibility testing. Preference should be given to drugs that are excreted in urine predominantly in an active form. Classes of drugs that are not predominantly excreted in urine in active form (e.g., macrolides) should be avoided. Referral or consultation with specialist to determine the appropriate approach is reasonable.
The susceptibility test will typically use the S/I/R classification (Susceptible, Intermediate, and Resistant). If resistant, treatment is likely to fail and the drug should not be prescribed. If susceptible, there is a greater likelihood of clinical success (resolution of clinical signs of UTI) using normal treatment regimens; however factors such as drug absorption, drug excretion, drug inactivation, biofilm, necrotic debris, the presence of foreign materials, development of drug resistance during treatment, inducible resistance, laboratory error, and various comorbidities can impact on the success of an individual treatment. The use of drugs reported as intermediate is appropriate in situations when the drug is physiologically concentrated at the target site or if the dosage can be increased. If treatment was initiated before culture, susceptibility results were available, and the isolated organism is resistant to the antimicrobial that was initially chosen, a change to a more active drug based on susceptibility testing should be made. If more than one bacterial species is identified on initial culture, the relevance of the each organism should be considered, based on the bacterial counts and the pathogenicity of the organisms. For example, when present in a mixed infection, anecdotal evidence suggests that infection by Enterococcus spp. will often resolve when the other organism is successfully treated. Ideally, antimicrobial therapy should be directed against both organisms. In some instances, an antimicrobial effective against both organisms will not be available. Combination therapy that would be potentially effective against both organisms should be considered. In some situations, a reasonable drug or drug combination may not be available. Targeting therapy towards the organism perceived as the most clinically relevant is a reasonable approach, provided there is no evidence of pyelonephritis or underlying disease that increases the risk of systemic or ascending infection with an organism otherwise of limited primary pathogenicity.
There is no supporting evidence for administration of other drugs (e.g., clarithromycin) for the purpose of breaking down bacterial biofilm. There is no supporting evidence that direct instillation of antimicrobials, antiseptics, or DMSO directly into the bladder via a urinary catheter is effective for treatment of recurrent UTIs. These compounds are quickly flushed out of the bladder when the animal urinates and may be locally irritating. Any underlying causes should be managed appropriately, whenever possible. Evidence supporting the duration of therapy for complicated UTI does not exist. Typically, 4 weeks of treatment has been recommended. The Working Group agrees that it is likely that shorter courses of appropriate treatment might be effective in some or all situations. In the face of insufficient data supporting a shorter course of therapy, 4 weeks of treatment is a reasonable recommendation. In animals with a nonrecurrent but complicated UTI (e.g., diabetic animal with a first instance of UTI and whose infection would have been classified as uncomplicated if the comorbidity was not present), shorter-term therapy may be more reasonable. 3.1.3. Monitoring Response to Treatment Urine culture should be considered 5â€“7 days after initiation of therapy, particularly in patients with a history of relapsing or refractory infection, or those considered at high risk for ascending or systemic infection. Any bacterial growth during treatment indicates potential treatment failure and should prompt immediate re-evaluation. Referral or consultation with a specialist is recommended. Urine culture is recommended 7 days after cessation of therapy in all cases. (If the patient was treated with cefovecin, the prolonged excretion of the drug must be considered. Optimal timing of sampling in such cases is unclear, but testing 3 weeks after the last dose may be reasonable.) If a positive urine culture
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is obtained after treatment, more indepth investigation of predisposing factors for relapse or reinfection should be performed. Referral should be strongly considered. Unless there is clear evidence for the reason for failure, retreatment without any other investigation is not recommended. If no signs of disease are present, these cases should be managed as described for subclinical bacteriuria. If there is lack of clinical response to treatment or if clinical signs of UTI recur after apparently successful treatment, the animal should be managed again as described above, with particular emphasis on determination of underlying causes. Referral is strongly recommended. 3.1.4. Preventive Measures There is insufficient evidence to recommend use of either pulse (intermittent) or chronic low-dose therapy for prevention of UTIs. The effect of these practices on emergence of resistance should be considered. There is anecdotal evidence that a small percentage of animals with severe clinical signs may require such an approach, but only after thorough evaluation for underlying causes, ideally by a specialist in small animal internal medicine. Although there may be some theoretical benefit for the administration of urinary antiseptics such as methenamine (methenamine hippurate), there is currently insufficient evidence available to assess the effectiveness of these treatments in animals. There is currently insufficient evidence to support the administration of other adjunctive therapies to prevent recurrent infections. Although there is some evidence for a benefit of nutritional supplements (e.g., cranberry juice extract) for this indication in humans, the evidence is not strong and some studies have shown no effect10-13. Currently, there are no data to support the benefits of these measures in veterinary medicine. When effective in people, dietary supplements may help to prevent but not treat UTIs. When selecting cranberry-based treatments, one should be aware of the variability in quality and potency of over-the-counter products and, based on human stud-
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ies and in vitro work, should choose an extract that has a higher concentration of proanthocyanidins, the antioxidants thought to be responsible for antibacterial effects. 4. Subclinical Bacteriuria Subclinical bacteriuria is the presence of bacteria in the urine as determined by positive bacterial culture, in the absence of clinical and cytological evidence of UTI. 4.1. Summary of Recommendations Treatment may not be necessary in animals that have no clinical signs of UTI and no evidence of UTI based on examination of urine sediment. In some circumstances, treatment may be considered if there is concern that there is a particularly high risk of ascending or systemic infection (e.g., immunocompromised patients, patients with underlying renal disease) or that the bladder may be a focus of extraurinary infection. Diagnosis and management of the underlying cause is critical and treatment should not be used as a replacement for proper diagnosis and management. The presence of multidrug-resistant bacterium does not represent, by itself, an indication for treatment. Anecdotal information suggests that multidrugresistant organisms will sometimes be replaced with susceptible organisms if treatment is withheld, and then treatment with routine antimicrobials may be more practical if decolonization is desired or if clinical disease develops. 5. Urinary Catheters UTI and subclinical bacterial colonization of the bladder are commonly identified in dogs with indwelling urinary catheters14,15. Differentiating these two is important because the approach to management of infection versus colonization is different. 5.1. Animals with Urinary Catheters: No Clinical Signs of Infection Culture for diagnosis of the presence of bacteria in urine is not recommended in
the absence of clinical signs consistent with an active infection. It is not necessary to treat catheterized animals with bacteriuria in the absence of clinical or cytological evidence supporting the presence of an infection. Prophylactic antimicrobial therapy for prevention of UTI in catheterized animals is never indicated. 5.2. Animals with Urinary Catheters: When Urinary Catheter is Being Removed There is no evidence supporting the need to culture the catheter tip at time of catheter removal since catheter tip culture results are not predictive of development of catheter-associated UTI16. There is also no evidence supporting routine culture of urine after catheter removal. However, culture of the urine (ideally collected by cystocentesis after catheter removal) may be reasonable in patients in which the risk and implications of UTI are high (e.g., recently obstructed male cat with at high risk for reobstruction). Clinical monitoring and cytological examination to detect a potential UTI are preferred to urine culture in a patient with no signs of UTI. There is no indication for routine (prophylactic) antimicrobial treatment following urinary catheter removal in an animal with no clinical or cytological evidence of active UTI. 6. Animals with a Urinary Catheter and Signs of a UTI UTI should be suspected in catheterized animals exhibiting clinical signs of infection. However, such patients may not be easily identified. As such, infection should be suspected in all cases of fever of unknown origin or bacteremia with an unknown focus. Infection should also be suspected when there are gross or cytological (i.e., hematuria, pyuria) abnormalities. Urine culture should always be performed if infection is suspected. If a catheter must remain in place and signs of UTI are present, the catheter should be replaced and a urine sample collected through the new catheter for culture.
Several milliliters of urine should be withdrawn to clear the catheter and discarded prior to obtaining the sample for culture. When possible, catheters should be removed and urine sampled by cystocentesis after an appropriate period of time has passed for the bladder to fill with urine. Less ideal is a sample collected from the urinary catheter prior to removal, in which case positive cultures should ideally be confirmed with a subsequent cystocentesis sample. In all instances, cultures should be quantitative. Urine culture should never be performed from the collection bag. Culture of the catheter tip after removal is not recommended. Treatment is more likely to be successful if the catheter can be removed. The costbenefit of removing or retaining the catheter should be considered in the context of management of the UTI and the patientâ€™s underlying disease condition. Treatment should be selected and administered as per recommendations for primary uncomplicated UTI or complicated UTI, as appropriate based on a prior history of UTI and the presence of ongoing comorbidities or risk factors. If the patient has not had recurrent infections, the catheter has been removed and no relevant comorbidities are presented as a simple uncomplicated UTI is indicated. Otherwise, patients should be managed as complicated UTIs. 7. Upper Urinary Tract Infections (Pyelonephritis) 7.1. Diagnosis Culture and susceptibility testing should always be performed. Cystocentesis samples should be used for culture whenever possible. If cystocentesis is not possible because of the presence of little urine in the bladder, a sample obtained by urinary catheter is acceptable, but not ideal. Positive cultures should be confirmed by a subsequent cystocentesis sample, whenever possible. Other general principles of diagnosis, as described under Simple Uncomplicated UTI, apply.
Interpretation of susceptibility data should be based on antimicrobial breakpoints for serum rather than urine concentrations. If multiple organisms are isolated, the suspected relative relevance of these should be considered. This assessment would include the bacterial species and colony counts, as is discussed above. 7.2. Treatment Treatment should be initiated immediately, while awaiting culture and susceptibility results. Initial treatment should involve antimicrobial drugs known to have local or regional efficacy against Gram-negative Enterobacteriaceae, based on the predominance of those organisms in pyelonephritis. If regional data are supportive, treatment with a fluoroquinolone excreted in urine in the active form (e.g., not difloxacin) is a reasonable first choice. If ascending infection is suspected, urine culture results obtained for diagnosis of lower UTI might be the basis of initial therapy. If the upper UTI results from hematogenous spread, initial therapy should be based on cultures of blood or the infected site, whenever available. While treatment will be started before culture results are available, the culture and susceptibility data should be reviewed when results are received. If combination therapy was initiated and the isolate is susceptible to both drugs, one might be discontinued if supported by evidence of clinical response. If resistance is reported to one of the drugs, that antimicrobial should be discontinued. A second drug to which the isolate is susceptible should be substituted if the patient has not responded sufficiently; substitution is not necessary if patient response has been sufficient. If resistance is reported to both antimicrobials and clinical evidence of improvement is not evident, antimicrobial treatment should be changed to a drug to which the offending organism is susceptible in vitro. Consultation with a specialist is indicated with multidrugresistant organisms. Treatment of 4â€“6 weeks is often recommended. A shorter duration of therapy might be effective; however there is currently inadequate evidence to provide objective recommendations, and 4â€“6 weeks of treatment is recommended at this time.
7.3. Monitoring Therapy Urinalysis and culture should be performed 1 week from the start of treatment because of potential severity of disease and long treatment duration. If the same organism is isolated, one should consider adding an antimicrobial to which the organism is susceptible in vitro, if possible. Consultation with a specialist is recommended. If polymicrobial infection was present initially and only 1 organism remains, consultation with a specialist is recommended to determine the relative clinical relevance of the isolates and treatment plan. Treatment should not necessarily be changed because it is possible that the primary pathogen has been eliminated and changing therapy could result in regrowth of that organism. Culture is recommended 1 week after cessation of therapy to ensure elimination of infection. 8. Multidrug-Resistant Infections Multidrug-resistant pathogens, including various Enterobacteriaceae, staphylococci, and enterococci, are becoming increasingly problematic. Multidrug-resistant pathogens may be harder to treat because of limited drug choices. There are public health concerns with regard to the potential for zoonotic transmission of resistant pathogens. Additional concerns result from the increasing pressure to use antimicrobials in animals that are critically important in human medicine. Addressing the globally increasing issue of antimicrobial resistance is complex and difficult. Because of the high incidence of antimicrobial use in UTIs of dogs and cats, veterinarians must be cognizant of the role of inappropriate treatment in the emergence and dissemination of multidrug-resistant pathogens. At the same time, the Working Group believes that prudent (and therefore rare) use of certain drugs in the treatment of canine and feline UTIs would constitute a miniscule fraction of overall use of these critical drugs. As such, use of critically important antimicrobials in companion animals can be justified as long as their use is prudent and proper, based on culture and susceptibility data as well as pa-
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tient care and welfare reasons. In particular, the use of drugs such as vancomycin, carbapenems, and linezolid is not justified unless the following criteria are met. 1. Infection must be documented based on clinical, culture, and cytological abnormalities. The use of these drugs for the treatment of subclinical infection is not supported. 2. Resistance to all other reasonable options and susceptibility to the chosen antimicrobial must be documented. 3. The infection must be potentially treatable. The use of critical drugs in situations where there is little realistic chance of elimination of infection (e.g., failure to remove the underlying cause) is not supported. 4. Consultation with someone with expertise in infectious diseases and antimicrobial therapy must be obtained to determine whether there are any other viable options and whether treatment is reasonable. 9. Conclusions Urinary tract disease is a common reason for antimicrobial therapy in dogs and cats. Proper and prompt diagnosis of UTI is required to allow for informed treatment decisions to be made, and careful scrutiny of patient history, clinical signs, urinalysis results, as well as culture and susceptibility data, is required for optimal case management. Successful treatment should not only involve elimination of the clinically apparent infection, it should also do so while minimizing the risks of complications such as struvite urolithiasis, ascending or systemic infection, recurrent infection, or development of antimicrobial resistance. While there are major limitations in available data, including a complete lack of published efficacy studies for dogs and cats, these comprehensive practice guidelines will assist with optimal management of UTIs in dogs and cats. Acknowledgments The guideline development meeting was supported by an unconditional educational grant from Bayer Corporation USA. The authors thank Dr. Jodi Westropp for her review of the guidelines. Copyright © 2011 J. Scott Weese et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. SAGE-Hindawi Access to Research, Veterinary Medicine International, Volume 2011, Article ID 263768, doi:10.4061/2011/263768
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references > 1. L. E. Nicolle, S. Bradley, R. Colgan, J. C. Rice, A. Schaeffer, and T. M. Hooton, “Infectious diseases society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults,” Clinical Infectious Diseases, vol. 40, no. 5, pp. 643–654, 2005. 2. J. W. Warren, E. Abrutyn, J. Richard Hebel, J. R. Johnson, A. J. Schaeffer, and W. E. Stamm, “Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women,” Clinical Infectious Diseases, vol. 29, no. 4, pp. 745–758, 1999. 3. S. Deuster, I. Roten, and S. Muehlebach, “Implementation of treatment guidelines to support judicious use of antibiotic therapy,” Journal of Clinical Pharmacy and Therapeutics, vol. 35, no. 1, pp. 71–78, 2010. 4. T. A. Metjian, P. A. Prasad, A. Kogon, S. E. Coffin, and T. E. Zaoutis, “Evaluation of an antimicrobial stewardship program at a pediatric teaching hospital,” Pediatric Infectious Disease Journal, vol. 27, no. 2, pp. 106–111, 2008. 5. N. R. Toth, R. M. Chambers, and S. L. Davis, “Implementation of a care bundle for antimicrobial stewardship,” American Journal of Health-System Pharmacy, vol. 67, no. 9, pp. 746–749, 2010. 6. J. W. Bartges, “Diagnosis of urinary tract infections,” Veterinary Clinics of North America – Small Animal Practice, vol. 34, no. 4, pp. 923–933, 2004. 7. R. Orenstein and E. S. Wong, “Urinary tract infections in adults,” American Family Physician, vol. 59, no. 5, pp. 1225– 1234, 1999. 8. X. Albert, I. Huertas, I. I. Pereiró, J. Sanfélix, V. Gosalbes, and C. Perrota, “Antibiotics for preventing recurrent urinary tract infection in non-pregnant women,” Cochrane Database of Systematic Reviews, no. 3, Article ID CD001209, 2004. 9. I. S. Gatoria, N. S. Saini, T. S. Rai, and P. N. Dwivedi, “Comparison of three techniques for the diagnosis of urinary tract infections in dogs with urolithiasis,” Journal of Small Animal Practice, vol. 47, no. 12, pp. 727–732, 2006. 10. C. Barbosa-Cesnik, M. B. Brown, M. Buxton, L. Zhang, J. Debusscher, and B. Foxman, “Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial,” Clinical Infectious Diseases, vol. 52, no. 1, pp. 23–30, 2011. 11. R. G. Jepson and J. C. Craig, “Cranberries for preventing urinary tract infections,” Cochrane Database of Systematic Reviews, no. 1, Article ID CD001321, 2008. 12. E. A. Opperman, “Cranberry is not effective for the prevention or treatment of urinary tract infections in individuals with spinal cord injury,” Spinal Cord, vol. 48, no. 6, pp. 451–456, 2010. 13. D. A. Wing, P. J. Rumney, C. W. Preslicka, and J. H. Chung, “Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study,” Journal of Urology, vol. 180, no. 4, pp. 1367–1372, 2008. 14. L. J. Bubenik, G. L. Hosgood, D. R. Waldron, and L. A. Snow, “Frequency of urinary tract infection in catheterized dogs and comparison of bacterial culture and susceptibility testing results for catheterized and noncatheterized dogs with urinary tract infections,” Journal of the American Veterinary Medical Association, vol. 231, no. 6, pp. 893–899, 2007. 15. J. Ogeer-Gyles, K. Mathews, J. S. Weese, J. F. Prescott, and P. Boerlin, “Evaluation of catheter-associated urinary tract infections and multi-drug-resistant Escherichia coli isolates from the urine of dogs with indwelling urinary catheters,” Journal of the American Veterinary Medical Association, vol. 229, no. 10, pp. 1584–1590, 2006. 16. S. D. Smarick, S. C. Haskins, J. Aldrich et al., “Incidence of catheter-associated urinary tract infection among dogs in a small animal intensive care unit,” Journal of the American Veterinary Medical Association, vol. 224, no. 12, pp. 1936–1940, 2004.
Antimicrobial Stewardship in Agriculture & Veterinary Medicine Conference
October 31 - November 2, 2011 - Toronto Marriott Airport www.antimicrobialcanada.com
By Alison Weller, ACT, RVT, RMLAT, ZAT Veterinary Technologist, University of Toronto, Mississauga
Have you ever felt you wanted to learn more? Go back to school, or take a course that interested you? Well…I have…a few times. It seems I have this incessant need to constantly learn. I finish one course/program, have a short break, get bored and move onto another. I’m dubbed a “perpetual student” by my family and friends. A few years ago, I felt that “bug”. Through readings, I heard about a few college programs that taught subjects on zoological science. After a Google search, I found a course in Canada that could be done either in person in Alberta, or by correspondence, was offered by the Alberta Business and Education School (ABES www.abes.ca), and partnered through the Northern Alberta Institute of Technology (NAIT), called the Zoological Animal Technology (ZAT) program.
When I began this program back in 2004, I was working in an animal facility that only housed mice and rats. I then moved to the University of Toronto that used exotic animal species, and was hooked even more! I realized the ZAT curriculum was just not for a “keeper” at a zoo, but could be used at any animal-based organization – even at my current position at the University of Toronto Mississauga.
know where I would end up, but knew I would enjoy the journey. My journey finally ended in October 2010, when I completed my 6 week practicum at the Toronto Zoo. I give many thanks to all the staff at the Toronto Zoo who helped me complete the course requirements,
How many of us have dreamed to work at a zoo? It has been a highlight for me at any age to go to a zoo and see all the different animal species, and learn their biology and behaviour. I have also had the pleasure to volunteer under Dr. Suzanne MacDonald from York University, observing her behaviour work for a number of years – a great opportunity that started me on the path at the Toronto Zoo. It has taken me 6 years to complete this program, through full and part-time employment, and with a pause to complete my RMLAT. When I began, I didn’t
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moving me around to some of the different zoogeographical regions, the Nutrition centre, the Horticulture department, and the Animal Health Centre. My home “base” was in the AMERICAS area. I had asked to work with a wide variety of species. This included various reptiles, amphibians, insects, birds, fish, cute and furry mammals, and some even deemed “dangerous” species, such as the polar bears, jaguars, poisonous snakes, and my beloved arctic wolves. Daily tasks included husbandry of these animals – preparing diets, feeding, cleaning cages/exhibits – as well as involvement in various enrichment techniques, keeper feedings with the public, as well as extensive involvement in our area’s “Meet the Snake and Polar Bear Keeper” talks. I realized that to be a great keeper, one needs to be part spider monkey, pro-baseball pitcher, Einstein, and Superman. Well, I tried my best.
I had some exciting moments (touching an awake rattlesnake and Komodo dragon, helping to train the newest otter to integrate with the other two residents, helping to build an exhibit for poison frogs), as well as some scary moments. One in particular stands out: On my second day, our male polar bear “Inukshuk” thought he could ram the bars and get through them to eat me. He was outside watching me cleaning his pen inside the holding building. He charged at the metal screening, then BANG! and stopped about 60 cm away from me. I could feel his breath on my face. He stormed away unsatisfied after a few seconds, as I was trying to swallow my heart that was in my throat. Ah, the memories…
Baby Snapping Turtle
I will cherish always all these memories and new friendships. I hope you enjoy some of the many photos I thought best captured my great time at the zoo. This was a long journey for me, and I’m kind of sad it’s over. My only question is: What’s next?
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No compromise. No regrets.
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No adjuvant or whole virus. Stimulates strong cell-mediated immunity1,2 essential for protection against FeLV infection.3 Excellent safety profile with more than 4.3 million doses administered in Europe since launch. Provides at least 13 months of protection to kittens as young as 8 weeks of age, as well as to cats previously vaccinated with killed-virus FeLV vaccines. Available in two convenient formats: 10 x 1 dose and 50 x 1 dose
1. Merial data on file. 2. El Garch, Hanane, Stephanie Richard, Fabienne Piras, Tim Leard, Hervé Poulet, Christine Andreoni, and Véronique Juillard. Feline leukemia virus (FeLV)-specific IFNγ+ T-cell responses are induced in cats following transdermal vaccination with a recombinant FeLV vaccine. Intern J Appl Res Vet Med, 2006, 4(2): 100-108. 3. Flynn, J. Norman, Stephen P. Dunham, Vivien Watson, and Oswald Jarrett. Longitudinal analysis of feline leukemia virusspecific cytotoxic T-lymphocytes: Correlation with recovery from infection. Journal of Virology, March 2002, 76(5): 2306-2315.
PUREVAX® is a registered trademark of Merial Limited © 2011 Merial Canada Inc. All rights reserved. VACS-09-1557-JAVFeLV (E) MERP-1124
There is no question that feline medicine has grown steadily in popularity since the 1970s when the first feline-only practices were established. Today, organizations such as the American Association of Feline Practitioners (AAFP; www.catvets.com), the Cornell Feline Health Center (www.vet.cornell. edu/fhc), the International Society of Feline Medicine (www.isfm.net), the Winn Feline Foundation (www.winnfelinehealth.org) and the Feline Advisory Bureau (www.fabcats.org) provide funding for feline health research and continuing education for veterinarians and cat owners. Cats have now surpassed dogs as the most popular companion animal in many countries. In the United States, there are over 93 million pet cats compared with over 77 million pet dogs.1 One-third of households own at least 1 cat, and the average number of cats per household is 2.45. Canadians own 8.5 million cats compared with 6 million pet dogs.7 About 35% of Canadian households own at least 1 cat and the average number of cats per household is 1.76. However, some alarming statistics about feline veterinary care have been published in the United States. In 2006, only 64% of cats visited a veterinarian compared with 83% of dogs.4 Between 2001 and 2006, the number of feline veterinary visits declined by over 10% despite an increase in the number of owned cats. In addition, pet owners spend half as much on veterinary care for cats compared with dogs. The reasons for the decline in feline veterinary care are multiple and complex.6 They include issues such as: • Difficulty getting the cat to the veterinary clinic • A low level of owner awareness of cats’ basic medical needs • Difficulty recognizing subtle signs of
CE Article #2 Getting the Cat to Come Back: Feline Friendly Practice Tips
illness • The perception that cats are able to take care of themselves • The low perceived value of cats, since most cats are acquired for free • Owner discomfort and stress associated with experiences at the veterinary clinic Veterinary teams which treat cats can benefit from an understanding of the unique nature of cats as well as the physiologic and behavioural responses to stress experienced by this species. Cats are bonded to their home environment and seldom leave it by choice. Being forced into a strange environment makes a cat uncertain about its safety and causes
anxiety and distress. Cats prefer to avoid danger and confrontation by running away or hiding, strategies that are not easy to employ during veterinary visits. Young kittens rarely experience anxiety at veterinary visits, but it may become apparent as the cat matures. Implementation of approaches to create a cat-friendly practice environment and use of respectful handling techniques will improve welfare and veterinary care for cats as well as make working with cats more rewarding for the veterinary team. In addition, health care tailored to the various feline life stages improves early recognition and treatment of problems, thereby improving feline health and welfare and preserving the human-animal bond.11
Dr. Susan Little (DVM Diplomate, American Board of Veterinary Practitioners Certified in Feline Practice) received her BSc from Dalhousie University (Nova Scotia, Canada) in 1983 and her DVM in 1988 from the Ontario Veterinary College, University of Guelph. She has been in feline practice since 1990 and achieved specialty board certification in Feline Practice in 1997, re-certifying in 2006. She is part owner of two feline specialty practices in Ottawa, Canada. She serves on the board of the Winn Feline Foundation, and is a feline medicine consultant for the Veterinary Information Network (VIN). Dr. Little also serves as a consultant for IDEXX Laboratories and Fort Dodge Animal Health.
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How to encourage more feline veterinary visits: 1. Provide cat-friendly transportation information 2. Make your facility cat-friendly 3. Understand respectful handling of cats 4. Tailor health care to feline life stages Reducing the stress associated with veterinary visits starts at home; habituation to the carrier and the car should start early in the cat’s life. AAFP has published a position statement on the transport of cats that contains useful information.9 Each cat should travel to the veterinary clinic in its own carrier; it is unsafe to allow a cat to move freely inside an automobile. Placing more than one cat in a carrier is unwise as redirected aggression can occur in fearful situations. Solid sturdy carriers that open at the front and top or with easily removable tops are preferred. Softsided carriers can be used as long as they have adequate ventilation; however they collapse easily, are more difficult to clean, offer minimal protection, and are often difficult to get a cat out of. The carrier should provide the cat with an enclosed, safe feeling; coated wire carriers or cagetype carriers should be covered to provide privacy. Feliway® can be sprayed on a towel and placed in the carrier about 30 minutes before the cat is put inside. Various other tips can help desensitize cats to carriers, such as leaving the carrier out in the home so that it is familiar, feeding the cat in or near the carrier, placing catnip or toys in the carrier, training the cat to enter the carrier on command for a reward, and acclimating the cat to the car and carrier with occasional short trips that are not to the veterinarian. Travel should be on an empty stomach; this helps prevent motion sickness and makes the cat more interested in treats while at the clinic. In some cases, medications
such as maropitant may be used for motion sickness. Sedatives or tranquilizers should be avoided when possible as the cat may be injured because it is unstable and may not be properly monitored during transportation. If sedation must be used, benzodiazepines such as alprazolam are preferred (1/4 to 1/2 of 0.25 mg tablet BID, start one day before travel). Once at the clinic, the owner should be welcomed with visible signs that the staff care about cats, such as posters, photos of staff and clients’ cats, cat products and cat-specific information. Veterinary staff who interact with cats and their owners should be knowledgeable about general cat care, behaviour, handling, medical and surgical needs, and cat breeds. The clinic can hold special educational events or ‘clinics’ for diabetes education, obesity prevention and treatment, kitten kindergarten, etc. A separate waiting area or even separate appointment times for cats are appreciated. Cat-friendly waiting areas are quiet with softer lighting. Tables or shelves should be provided so that carriers can be placed off the floor. Ideally, owner and cat would be placed into an examination room as soon as possible. Waiting in this normally quieter environment is preferable to a busy reception area. Minimizing wait times helps reduce stress for both cat and owner. Once in the examination room, the clinician should spend time taking a history and talking with the owner while allowing the cat to adjust and venture out of the carrier on its own if possible. Remember that cats are very sensitive to sights, sounds (voices, equipment, door bells, etc.), smells (perfumes, disinfectants, alcohol, etc.) and touch. Attention should be paid to these details to reduce anxiety. No rule says all cats must be ex-
‘Understand that most cats are pessimists – they assume the worst will happen. Try not to confirm it for them.’ - Kim Kendall
amined on a stainless steel table; many cats are more comfortable remaining in the carrier (with the top removed), or being examined on a lap, on the floor, on a shelf or even on the scale after being weighed. Cat-friendly exam table surfaces are made of non-slip materials, such as rubber mats. When possible, allow the cat to remain on the towel or bedding that came with the carrier. A Feliway® plug-in diffuser should be placed in waiting areas, examination rooms and in areas of the clinic where cats will be housed. Security is important; ensure that any escaped cats cannot get out of doors or windows. Respectful feline handling is a critical component of successful feline practice.8 Gone are the days when difficult cats are handled with large gloves or ‘scruffed.’ The key to successful handling is an understanding of feline behaviour. Most of the undesirable behaviours exhibited by cats in veterinary clinics are induced by fear. Physical confrontation is the last resort for most cats; their efforts are first focused on avoidance and escape. The more control the cat has during the visit, the less forceful and aggressive the handling, and the more patient the approach, the better the outcome. Many anxious cats can successfully be examined with the use of a towel to cover the head; reducing sight of unfamiliar people and places can reduce fear. Avoid making sounds that mimic hissing, such as ‘shushing’ sounds. Cats should be approached calmly and talked to quietly. Avoid direct eye contact as ‘staring’ is considered confrontational. Minimal restraint is the best approach for cat handling; make use of techniques such as allowing the cat to stay in the bottom half of the carrier. Always start with the least invasive procedures and progress to those more likely to be stressful later in the appointment. Owners are more likely to return for regular visits if they feel the veterinarian and clinic staff are skilled and respectful when handling cats. Caging for cats in the clinic should be in a ward separate from dogs. As well, cages should be placed so that cats cannot see one another. Cage materials should de-
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crease sounds and maintain heat, features that are not consistent with metal structures. Ideally, vertical space and hiding places should be provided with a shelf, as well as placement of a box or even the cat’s own carrier in the cage. The cage should have enough room to place the food and water as far as possible from the litter box. Feliway® can be sprayed on towels or bedding 30 minutes before use. Since cats evolved in desert environments, ambient temperatures somewhat above the typical human comfort zone are desirable. This can be provided with bedding for insulation and burrowing. Feline health care and counseling of cat owners on wellness and prevention varies by life stage. The AAFP/AAHA guidelines defined 6 life stages with associated health care guidelines:11 1. Kitten: birth to 6 months 2. Junior: 7 months to 2 years 3. Prime/Adult: 3-6 years 4. Mature: 7-10 years 5. Senior: 11-14 years 6. Geriatric: 15+ years Annual health examinations are considered the minimum standard by AAFP and AAHA. More frequent examinations are recommended for senior and geriatric cats as well as those with chronic medical conditions (e.g., diabetes mellitus, chronic renal disease). Changes in health can occur quickly in these patients although the signs may not be readily apparent to owners. Educating owners about the subtle signs of sickness can lead to more frequent visits, better communication and more timely diagnosis and treatment. As well, prevention and earlier detection of disease can save money in the long run. Pet health insurance should be encouraged as it allows for optimal treatment decisions. The 10 subtle signs of sickness: 1. Inappropriate elimination 2. Changes in interaction 3. Changes in activity 4. Changes in sleeping habits
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references > 1. 2009-2010 APPA National Pet Owners Survey, Greenwich, CT, 2010, American Pet Products Association, Inc. 2. Curtis T: Environmental enrichment for cats, Comp Contin Edu Pract Vet 29:104, 2007. 3. Ellis SLH: Environmental enrichment: Practical strategies for improving feline welfare, J Feline Med Surg 11:901, 2009. 4. Flanigan J, Shepherd AJ, Majchrzak S et al: U.S. pet ownership & demographics sourcebook, Schaumburg, IL, 2007, American Veterinary Medical Association. 5. Herron ME, Buffington CA: Environmental enrichment for indoor cats, Compend Contin Educ Vet 32, 2010. 6. Lue TW, Pantenburg DP, Crawford PM: Impact of the owner-pet and client-veterinarian bond on the care that pets receive, J Am Vet Med Assoc 232:531, 2008. 7. Perrin T: The Business Of Urban Animals Survey: the facts and statistics on companion animals in Canada, Can Vet J 50:48, 2009. 8. Rodan I, Folger B. Respectful handling of cats to prevent fear and pain: American Association of Feline Practitioners, http://www.catvets.com/professionals/guidelines/position/, 2009. 9. Rose C, Rodan I, Levy J et al. Transport of cats: American Association of Feline Practitioners, http://www.catvets.com/professionals/guidelines/position/, 2010. 10. Stella JL, Lord LK, Buffington CAT: Sickness behaviours in response to unusual external events in healthy cats and cats with feline interstitial cystitis, J Am Vet Med Assoc 238:67, 2011. 11. Vogt AH, Rodan I, Brown M et al: AAFP-AAHA: Feline life stage guidelines, J Feline Med Surg 12:43, 2010.
5. Changes in food and water consumption 6. Unexplained weight loss or gain 7. Changes in grooming 8. Signs of stress 9. Changes in vocalization 10. Bad breath
stressors (e.g., lack of sufficient resources, visitors, changes in diet, changes in routine, conflict with other cats, etc.) can induce physical signs of illness in otherwise healthy cats, such as anorexia, vomiting or diarrhea.10 Indoor cats need adequate numbers of ‘resources’ - hiding places, elevated resting places, food and water stations, scratching posts, litter boxes and stimulating toys.2,3,5
During examinations, asking questions in an open-ended manner will gather more information. Checklists can be used to ensure no areas of inquiry are missed. The body weight and body condition score or body mass index should be determined and recorded at every opportunity, even if a cat has been presented only for grooming or a nail trim. Since cats are so good at hiding signs of illness, baseline laboratory testing is valuable and allows for detection of trends at future visits.
In conclusion, all veterinary clinics can incorporate principles of cat-friendly practice to encourage more frequent feline visits and more satisfied cat owners. As Dr. Barbara Stein famously said, ‘Cats are not small dogs.’ Given the decrease in feline veterinary care, now more than ever, veterinary teams must understand the unique nature of cats and their needs.
The home environment is critically important in wellness and veterinary staff should be trained to ask questions that uncover pertinent information and counsel clients about enriched environments. An indoor-only life style decreases the risks of trauma and infectious diseases, but welfare may be compromised and illness induced by a stressful or sterile environment. Recent research has shown that
Resources 1. Feline Advisory Bureau/International Society of Feline Medicine Cat Friendly Practice: http://www. isfm.net/catfriendlypractice/publications.html 2. CATalyst Cat-Friendly Practice: http://www.catalystcouncil.org/resources/ health_welfare/cat_friendly_practices
HE’S NOT J U S T G E T T I N G O L D E R HE’S ONE OF
M I L L I O N S O F AG I N G P E T S
WHO KNOWS WHAT ALZHEIMER’S DISEASE MIGHT FEEL LIKE.
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This article originally appeared in The Canadian Journal of Medical Sonography, 2011, Volume 2, Issue 1, and is reprinted here with permission from the Canadian Society of Diagnostic Medical Sonographers and Andrew John Publishing Inc. Abstract A 6 year old, neutered male, domestic, longhaired cat presented with extreme lethargy, anorexia and weight loss. The blood panel demonstrated elevated levels of creatinine, urea, sodium and potassium. The animal tested positive for Feline Leukemia Virus. An abdominal ultrasound was ordered and the kidneys were markedly echogenic, with mild pyelectasia. A fine needle aspirate of the kidney was done and it demonstrated large abnormal lymphocytes. The diagnosis of renal lymphoma was made and the owner decided to euthanize. Introduction Feline leukemia virus (FeLV) is associated with many illnesses related to immunosupression in cats. This virus has an association with development of neoplasia such as leukemia, lymphoma and lymphosarcoma. In a cat, it can be the cause of severe clinical syndromes that are all associated with depression of the immune system.2 FeLV is a retrovirus, which means it is in the same family as Feline immunodeficiency virus (FIV) and the human version, Human immunodeficiency virus (HIV). Retroviruses are species specific1, so there is no worry about humans contracting FeLV. FeLV is transmitted through the saliva of an infected cat. Transmission can be through biting, grooming, sharing food and water dishes or sharing litter boxes. When a cat is infected, other cats in the home are at a greater risk of infection. The virus can also be transmitted through the mammary glands or the placenta. In most cases, an infected cat suffers from a chronic wasting disease marked by anemia, lethargy, and anorexia.2 Once exposed to
CE Article #3 Case Study: Feline Lymphoma
FeLV, some cats will have a sub clinical infection and develop immunity to the virus. Unfortunately, other cats become persistently infected raising the probability of the development of a neoplasia.
Normal Feline Kidney
liver is involved, the animal often presents with anemia and jaundice. Renal involvement presents with uremia in many cases.
The virus has many different presentations. Approximately 30% of FeLV-infected cats will develop cancer. Usually, the cancer is in the form of tumours of lymphocytes or red blood cells, and includes lymphosarcoma, lymphoid leukemia, myeloid leukemia, and erythremic myelosis.4
As previously stated, cats with FeLV are susceptible to immunosuppression which in turn predisposes the cat to many infectious diseases like peritonitis and infectious anemia. With such a variable presentation of FeLV, any cat that presents with illness should be tested for the virus. A positive diagnosis will shape the investigation and the treatment.
Abdominal lymphosarcoma usually presents with a bowel obstruction or malabsorption and there is often involvement of the mesenteric lymph nodes. When the
Case Study A 6.5 year-old, domestic, longhaired cat presented to a veterinary clinic with extreme weight loss, lethargy and anorexia.
Laura Thomas works as the Ultrasound Education Manager for Vet Novations based in Barrie, ON. She has been a registered sonographer since 1992 and has been scanning with the Veterinary community since 1998. Laura is currently working on her Masters in Ultrasound through Charles Stuart University. Her research foundation will be in Veterinary ultrasound education. She hopes to begin her thesis in the fall of 2012. Laura can be reached at email@example.com.
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Figure 1: Measurement for the renal pelvis is taken at the renal crest
Figure 2: Long axis measurement of the kidney
Figure 3: Extremely echogenic cortex
Figure 4: Subcapsular fluid or subcapsular lymphoma infiltrate
Figure 5: Ill defined mass medial to the cranial pole of the right kidney. Note the reactive omentum on the ventral lateral surface
Figure 6: Gall bladder seen with minimal sludge, the liver appears heterogeneous.
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The cat was a feral cat that had been rescued and domesticated by his owners. The early clinical history is unknown. The cat was administered intravenous fluid on admission with no urine output. Blood work revealed marked abnormalities, with the most significant being: extremely high urea at 46.4 mmol/L (normal range 5.7-12.9 mmol/L), creatinine > 212 mmol/L (normal range 71-212 mmol/L) and the cat tested positive for FeLV. Both the sodium and the potassium were abnormal. The blood panel abnormalities and decreased urine output indicated renal disease. An abdominal ultrasound was performed. The bladder was identified with a catheter visible. Both the left and the right kidney were abnormally large: 6.2 cm and 5.9 cm (Figure 2) respectively when a normal range is quoted at 3.8 cm - 4.4 cm.3 The cortices were hyperechoic and there were subtle parenchymal changes (Figure 3). Subcapsular effusions or subcapsular lymphoma exudate was demonstrated surrounding both kidneys (Figure 4). Bilaterally the renal pelvis had a measurable amount of fluid (0.31 cm). There is normally no fluid visible in the renal pelvis. Adjacent to the cranial pole of the right kidney, there was an ill-defined, hypoechoic mass that measured 3.0 x 2.6 x 2.6 cm and there was reactive omentum surrounding the cranial aspect of the mass (Figure 5). The liver was heterogenous in echotexture. The gallbladder contained a minimal amount of sludge (Figure 6). The spleen, pancreas, left adrenal and bowel appeared normal. The right adrenal was not identified. These findings confirmed suspicion of renal involvement. A fine needle aspirate was performed on a kidney and the result was diffuse infiltration of large abnormal lymphocytes indicating renal lymphoma. The mass adjacent to the cranial pole of the right kidney was a regional lymph node. The lymph node was infiltrated at all levels with the abnormal lymphocytes. The animal was euthanized. Conclusion The estimation is that 1-2% of healthy cats are infected with FeLV.4 Kittens are very susceptible to the virus up until they are four months old. Outdoor cats are more
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susceptible than indoor cats and multiple cat households are also at a greater risk. Some cats that have FeLV can live for years but if there is any presentation of disease the treatment should be aggressive. Lymphosarcomas can be treated with chemotherapy and prednisone. The human antiviral drug AZT has been used with some success, but as in humans it can have toxic side effects. Efforts should be made to isolate the infected cat and treat them accordingly. There are immunizations available but none produce complete protection. With immunization there appears to be an increased incidence of the development of a fibrosarcoma at the injection site. It is estimated one in 5,000-10,000 vaccinated cats a year will develop a vaccine related tumour.4 Research is underway to determine the tumour cause(s). Current theories are: abnormal reactions to the adjuvant in vaccines, genetic predisposition, and/or infections with another virus.4 At present, the recommendation is to only immunize cats already exposed to the virus, or cats living in a high risk environment. Glossary7 • Erythremic myelosis: a neoplastic process involving the erythropoietic tissue, characterized by anemia, irregular fever, splenomegaly, hepatomegaly, hemorrhagic disorders, and the presence of numerous erythroblasts in all stages of maturation in the circulating blood • Myeloid leukemia: Cancer of the blood forming tissue like bone marrow and the lymph nodes • Pylectasia: Dilation of the renal pelvis • Anechoic: the literal translation is “without echoes”. So an anechoic structure has no echoes at all. (Sometimes people say echolucent; this is incorrect and it comes from the x-ray term radiolucent.) • Echogenic: describes a region of the ultrasound that is filled with echoes. This can be used to describe the comparison of the echogenicity as in a structure is “more echogenic”. • Echogenicity: term used to describe the brightness of the echo on the image. The echo that is produced by the interface itself is a represented by the
strength of the signal received by the transducer, which is demonstrated by the brightness. Assessing the echogenicity on its own and in comparison to adjacent structures is the basis of a large part of the ultrasound exam. Heterogeneous: term is opposite to homogeneous; also a descriptive term describing the texture of the anatomy. Heterogeneous is mottled and complex in appearance. Inhomogeneous is a term that has been made up and it is incorrect but used synonymously with heterogeneous. Homongeneous: descriptive term used to describe the actual texture of a structure. When a structure is homogeneous it is smooth and the texture is similar throughout. Hyperechoic: term used to describe an area of bright echoes. Hypoechoic: term used to describe an area with that is darker. The echoes are weaker. Other terms to describe this appearance are echopenic or echo poor. Isoechoic: term used to describe when one structure has the same echogenicity as another.
references > 1. D’Anjou, M.A., Penninck, D.,(2008). Atlas of Small Animal Ultrasonography. Iowa: Blackwell Publishing. 2. Merck.(1986). The Merck Veterinary Manual, sixth edition. Merck & Co., Inc. Rathway, NJ., U.S.A. 3. Mattoon, J.S., Nyland, T.G.,(2002). Small Animal Diagnostic Ultrasound, second edition. Philadelphia: Saunders. 4. Nash, H (1997-2010). Feline Leukemia Virus: A Cause of Immunodeficiency in Cats [Electronic Source]. Drs. Foster & Smith Inc. Educational Staff 5. (www.epa.gov/economics/children/basic_info/glossary.html 6. (http://www.answers.com/topic/erythremic-myelosis#ixzz1JEnpgR49 7. Chris Harrington RTNM, R. R. (2009). Sonography Principles and Instrumentation. Winnipeg, Manitoba: The Burwin Institute for Diagnostic Medical Sonography.
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CE Article #1: Antimicrobial Use Guidelines 4. Ciprofloxacin is a good drug choice 1. What is the purpose of developing for treating canine pyelonephritis. and distributing these comprehensive a. True guidelines? b. False a. To assist in the diagnosis and management of upper and lower urinary tract infections in dogs and 5. What drug would be a good choice to use while awaiting culture results cats of an uncomplicated UTI? b. To improve antimicrobial a. Trimethoprim-sulfa prescribing practices b. Amoxicillin-clavulanic acid c. To be part of a broader c. Amoxicillin antimicrobial stewardship program d. a and c d. All of the above 2. The presence of pyurina and bacteruria provides supporting evidence of a UTI. a. True b. False
6. Prophylactic use of antimicrobials is recommended for all catheterized animals. a. True b. False
3. A colony count of ≥103 in a cultured cystocentesis sample would not be considered significant. a. True b. False
7. A urine culture should be performed 5-7 days after therapy initiation for all UTIs. a. True b. False
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8. Sample collection should ideally be made by what method? a. Free catch (mid-stream voiding) b. Cystocentesis c. Catheterization d. Free catch (manual expression) 9. Diagnosis of an uncomplicated UTI can be made by clinical signs (dysuria, pollakiuria, and/or increased urgency of urination and presence of bacteria in urine) alone. a. True b. False 10. A complicated UTI occurs in the presence of: a. 3 or more episodes of UTI in 12 month period b. Urinary calculi or pregnancy c. Diabetes mellitus or an immunocompromising disorder d. a and c e. All of the above
CE Article #2: Getting the Cat to Come Back 1. All but one of these are felt to be reasons for the recent decline in feline veterinary care: a. People believe cats take care of themselves b. Many believe cats are easily replaced, ie. low value c. Cats are healthier now than ‘when we were kids’ d. Owners find it difficult to take the cat to the veterinary clinic 2. Senior and geriatric cats should visit the clinic once a year. a. True b. False 3. Hospitalized feline patients would appreciate the following cage features: a. Stainless steel cage, a towel and a kitty litter box b. A hiding place, warm bedding c. Close proximity to other cats and dogs d. A nice small cage with the litter box, food and water all in a row
8. Cats are clever at hiding sickness. 4. To avoid motion sickness, the Query clients regarding changes following drug can be used before travel: to all but one of these health a. Dirlotapide parameters: b. Maropitant a. Food and water consumption c. Ipecac b. Grooming and vocalization habits d. Apomorphine c. Weight d. All of the above 5. During a physical examination on a cat, it is best to start with the 9. According the AAFP Guidelines, an stressful procedures first and follow eight year old cat is a ‘senior’. up with the least invasive at the end. a. True a. True b. False b. False 6. To make a cat feel at ease, shushing sounds and direct eye contact should be avoided. a. True b. False 7. Enrichment for indoor cats could include: a. High resting places b. Interesting toys c. Scratching posts d. All of the above
10. In multiple cat households, when transporting more than one cat to the hospital, place two cats per carrier in order to provide comfort along the way. a. True b. False
CE Article #3: Feline Lymphoma 1. According to the article, approximately how many cats infected with Feline Leukemia Virus (FeLV) will develop cancer in their lifetime? a. 60% b. 80% c. 10% d. 30% 2. If the virus attacks the kidney the presentation is often: a. Bloody urine b. Uremia c. Painful kidneys d. Frequent urination
4. If a female cat is infected with FeLV, there is a strong chance that her kittens will be infected as well. a. True b. False 5. How does FeLV spread? a. Through the saliva of the infected cat b. Through sharing food c. Through sharing litter boxes d. All of the above 6. According to the article, if a cat tests positive for the virus it will likely become active in their seventh year. a. True b. False
3. If lymphosarcoma has infiltrated the bowel, the cat will likely present with: 7. If your cat has been immunized for a. Bloody stools FeLV, they are completely protected b. Hyperbilirubinemia from the virus: c. Bowel obstruction or malabsorption a. True b. False d. Tachycardia
8. When a cat is infected with FeLV: a. The cat often suffers from a subclinical infection b. The cat will immediately develop peritonitis c. Anorexia will develop within the first week d. The cat will experience episodes of panting 9. A small percentage of immunized cats have developed: a. Lymphosarcoma b. Leukemia c. A fibrosarcoma at the injection site d. Mast cell tumour 10. Young kittens are more susceptible to the feline leukemia virus. They should be protected from potential carriers up to about four months. a. True b. False
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Working at the Toronto Centre for Phenogenomics By Madeline Harvey, RVT
I’ve always loved science and, in particular, learning about and working with animals. In high school when I decided that I wanted to become a veterinary technician, I knew little about what it would be like to work in a research environment. It wasn’t until I took the laboratory animal course in college that I learned about a career in comparative medicine. Working as a technician in research can be exciting and rewarding. You are an important part of the scientist’s team. In my role, I ensure that protocols are followed and that the mice under my care are healthy and do not suffer unnecessarily. I enjoy working in research because I have the ability to make sure the animals I am responsible for are treated properly. Also, I’m helping scientists improve medicine for both humans and
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animals. This is why I think working as a veterinary technician in research is a great career choice. What initially intrigued me about research is that it makes it possible to work with animals and help people at the same time. As a veterinary technician in research, you not only ensure that the animals under your care are provided with medical attention and respect, you also help advance discoveries in human medicine. After college, I worked in small animal practice for a couple of years before deciding to begin my career in research at the Toronto Centre for Phenogenomics (TCP). TCP is a mouse research facility that supports medical and behavioural research. It opened in the fall of 2007, and was formed through the collaboration of four member hospitals: Mount Sinai Hospital, The Hospital for Sick Children, University Health Network and St. Michael’s Hospital. The facility can hold up to 180,000 mice.1
The Centre studies the functions of genes, works on identifying genes for complex human diseases and produces new mouse models of human disease. One method for doing this is through the creation of transgenic mice. These mice are used in the study of diseases that have genetic origins, e.g. cancer. As a TCP technician, I work with transgenic mice as well as other types/strains. Each scientific investigator chooses to use a certain type of mouse based upon the needs of the research being conducted. As a veterinary technician, it is my responsibility to ensure that the mouse receives the proper care and any additional care that may be required due to the genetic background of the mice. For example, some mice are bred to have neurological deficiencies. These mice may not be able to balance normally. Special housing requirements and food may need to be provided to ensure the safety and welfare of these mice. A flat bedding versus corncob bedding may be chosen
sidebar > The main responsibility of one of the technicians at TCP is the maintenance of the sentinel program. Sentinel mice are placed on each rack in a room and are exposed to soiled bedding from each cage on their rack. After a minimum of 12 weeks of exposure, the mice are euthanized and tested for bacteria, viruses and parasites. The sentinel program reflects the health status of the mouse colonies in specific rooms through comprehensive routine testing. Each rack is tested on a quarterly basis which helps in the early detection of a possible outbreak. TCP is a specific pathogen free (SPF) facility which means that identified pathogens are tested for and not permitted within the facility. The maintenance of the sentinel program takes a lot of time and is very costly to maintain. The technician running the sentinel program must work with the technicians in the TCP breeding colony to ensure enough mice are generated to keep sentinel mice stocked for every rack. Other daily tasks involved in the maintenance of the sentinel program include preparing sentinel cages for the mice. Many pathogens are transmissible by exposure or the ingestion of feces. The preparation of a sentinel cage allows the sentinel mice to be exposed to any possible pathogens carried by the research mice. To prepare a sentinel cage, a small amount of soiled bedding from each cage on their rack is placed into a sentinel mouse’s cage. This is performed at each time cage change. A technician also routinely tests research cages by taking fecal samples from randomly selected cages. These fecal samples are sent to a lab where and tested for specific bacteria and viruses. After the sentinel mice have been euthanized, the technician collects and organizes the samples from the mice and prepares them for testing by an outside laboratory. Some procedures such as necropsy/pathology are done at TCP. If a result comes back positive for a pathogen, additional testing is completed to confirm if the original result was a true or false positive. If a positive test result is confirmed, additional testing may involve testing some of the research mice and the immediate separation and/ or quarantine of the affected rack in the room. Technicians at TCP also provide technical assistance on a variety of research projects, including mouse handling and restraint, anesthesia, performing surgical procedures, blood, fluid, and tissue collection, oral dosing, injections, and providing treatments as required. TCP technicians are also involved in the training of new staff and research personnel.
to help with balance. A moist food may be chosen instead of a hard pellet diet because the mouse may have trouble balancing while holding a hard pellet. These are some of the things that I need to consider when working with certain strains of mice. Preventing Disease One of the time-consuming but important aspects of my job is helping to prevent and contain potential disease outbreaks. While working with a large number of mice, mouse diseases can quickly spread throughout a colony if preventative measures are not in place. At TCP a lot of work, time and money go into ensuring that outbreaks are prevented and contained as much as possible. TCP is a barrier facility. This means that there is always a barrier between the person handling the mice and the mice themselves. This helps prevent disease outbreaks. Other precautions taken are wet showers, dry air showers, the donning of protective equipment (hat, mask, scrubs, gowns, gloves, designated shoes and shoe covers), sterilization of equipment and the use of laminar flow or biological safety cabinets. Mice at TCP are housed in many rooms; each room can contain a maximum of 960 cages. Scientists, referred to as “principal investigators,” may keep their mice in one room or several rooms, depending upon the size of their mouse colony and the microbial and viral status of their mice. A Mouse House Mice are housed in vented cages that sit on a vented rack. The cages are about the size of a shoebox and rectangular in shape. The cages are placed on racks that allow each cage to get its own air supply. There are many advantages to each cage having its own air supply, e.g. the prevention of the spread of disease transmitted by pathogens through the aerosol route. This method of air supply also reduces ammonia levels by drying any soiled bedding. On the vented rack, the air is hepa filtered and air changes 65 to 80 times per hour. The exhaust from these air changes is exhausted to ducts that bring the air out of the building. Most mice eat a standard rodent pelleted diet although some studies may require some mice to eat a special dietary. Water is provided from a common source through an automated watering system via a sipper valve. Each room contains supplies for the mouse’s care such as extra food, bedding, cages, cage card holders, special diets or supplements and medical supplies. The Breeding Colony The maintenance of the in-house breeding colony is another major responsibility for the technicians at TCP. At the facility, there are two rooms that are used for breeding wild type mice. A wild type mouse is a general term used to describe a mouse that is not a mutant or genetically modified. Specifically, the types of mice housed in the breeding colony are of certain strains, such as CD-1 and C57BL/6. CD-1 mice are an outbred strain and are a general multi-purpose model, typically used for safety and efficacy testing, aging, as surgical models and in transgenic production. C57BL/6
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in the mouse’s ear by removing some of the tissue. The pattern correlates to a numbering system that helps to identify mice individually. One method is not better than the other. It is normally up to the investigator and/or technician to choose a preferred method. • Tissue samples are also normally removed at the time of identification. They are usually taken from the ear or tail and sent to the investigator who will determine if the mouse holds a gene of interest.
mice are an inbred strain, are also a general multi-purpose model, typically used for diet-induced obesity, transgenic and knockout model production, safety and efficacy testing and immunology. Choosing an inbred vs. an outbred strain would be determined by the experiment’s needs. A strain is defined as inbred when it has been mated brother x sister for 20 or more generations, thus making inbred strains genetically identical (also referred to as isogenic). Outbred strains are defined by having some genetic variation. These strains are maintained by random breeding.” Technicians at TCP are responsible for maintaining this colony and ensuring that appropriate numbers of mice are generated so that the technician can fulfil investigators mouse orders. The maintenance of the breeding colony for an investigator’s transgenic mice is another responsibility for technicians at TCP. This is similar to maintaining a wild type breeding colony. When working to maintain transgenic mice lines, the technician regularly works closely and directly with the research personnel. The types of duties involved in maintaining a breeding colony of transgenic mice include: • Plug Checks: When mice breed, the semen from the male forms a “plug” or hardened ball in the vagina that prevents the semen from leaking out, thus ensuring a greater chance of fertilization. This plug can remain in the
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female for up to 24 hours. Checking for this plug from breeding females can help you determine if mating has occurred although it does not guarantee pregnancy. • The technician will also keep track of new litters born, the number of pups and the number of males and females. This information will be sent to the research personnel so he or she can determine if breeding for a certain strain (genotype) should continue. This determination is made based on the needs of the experiment. The investigator may need more mice for an upcoming experiment or may decide to hold off on breeding because enough stock mice (mice that are not breeding) have been born. • Once pups are a minimum of two weeks old, the technician can ear tag or ear notch the mouse pups. Ear tagging is the insertion of a metal tag (similar to an earring) with a number on it. Since each ear tag has a specific number each mouse can be easily individually identified. Another method of mouse identification is the ear notch numbering system. Through the use of an ear notch punch, different patterns can be made
For More Information To learn more about research animals and working as a technician in research, a great resource is the Canadian Council on Animal Care website at www.ccac.ca. This council provides guidelines on the ethical treatment of animals in research. The website also has job postings and a training area that has many articles pertaining to the care and treatment of animals in research. One of the benefits of working as a technician in research is the opportunity for further certification and continuing education. This certification is organized through the Canadian Association for Laboratory Animal Sciences (CALAS). CALAS provides resources and testing that allows technicians to be certified as registered laboratory animal technicians. The registration exam consists of a written, oral and practical exam. Prerequisites to write this exam, a diploma from a veterinary technician course and at least 12 months employment in an animal health research facility prior to examination.2 The study material for this course covers many important areas pertaining to the research environment. It includes learning about the importance of cleaning, disinfection and sterilization, the animal facility, the history of comparative medicine, the types of animals used in research and more.
references > 1. http://phenogenomics.ca/about/index.html 2. http://www.calas-acsal.org/index.php?Itemid=106&id=24&option=com_content&task=view
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10645 (Aug 5, 2011) Full-time RVT wanted Progressive two-veterinarian hospital in the Meadowlands of Ancaster requires full-time RVT. Minimum 1 year experience. Commitment to client relationships and education are a must. Please fax resume to (905) 304-5091. 10642 (Aug 3, 2011) Veterinary Technician Wanted Full-time night technician required for a 24 hour Hospital. Hospital is well-established, technologically updated, serving Brantford and area for over 55 years. We strive to provide excellent care for pets, excellent service to clients and happy working environment for our employees. We are a full-service facility that goes around the clock, not an emergency hospital. Salary $18-$22 per hour plus other benefits. Contact Angela at firstname.lastname@example.org or fax resume at 519-756-2305. 10629 (Aug 2, 2011) Registered Veterinary Technician Wanted New Listing. Opportunity to work in a 2 veterinarian companion animal hospital in one of Toronto’s best neighborhoods. Please fax resumes to 416-4833513 or email email@example.com. 10623 (Jul 26, 2011) Receptionist Client-oriented, two-veterinarian practice needs a second full-time receptionist. Experience or veterinary receptionist certificate required. Forward cover letter and resume to firstname.lastname@example.org 10607 (Jul 18, 2011) Vet Technician RVT needed, 20-30 hours per week.
New grads welcomed. Weekend availability preferred. Full-time possible. Send resume to email@example.com or 519-966-5751 ext. 28. 10549 (Jun 20, 2011) Veterinary Technician We are seeking an enthusiastic and self-confident registered veterinary technician for full-time employment commencing August 2011. We offer in-house lab, digital xray, laser surgery. Alliston is a growing community centrally located. Submit your resume to firstname.lastname@example.org. 10540 (Jun 10, 2011) Veterinary Technician Wanted Full-time night technician required for a 24 hour hospital. Hospital is well established, recently expanded, technologically updated, serving Brantford and area for over 55 years. We strive to provide excellent care for pets, excellent service to clients and happy working environment for our employees. We are full-service facility that go arround the clock but not an emergency hospital. Salary $18 -$22 per hour plus other benefits.Contact Angela, fax 519-756-2305, or e-mail email@example.com 10538 (Jun 9, 2011) Registered Veterinary Technician Well-established small animal clinic 30 minutes south of Ottawa requires a personable, client oriented, self motivating, technically capable RVT for a full-time position. Clinic has 3 veterinarians, 2 technicians, 1 veterinary assistant, 1 receptionist and office manager. Contact Dawn Patterson, 33 Somerville Rd, Kemptville, On., K0G 1J0 E.Mail firstname.lastname@example.org Fax: 613-258-7104
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Submitting Articles to TECHNEWS We welcome your participation in the quarterly magazine, TECHNEWS, distributed nationally. In Ontario, articles submitted receive 2 C.E. credits and articles chosen for printing receive an additional 2 C.E. credits. Please contact your Provincial Association Registrar to determine your provincial C.E. values. Do not forget to include your return address information. Manuscripts should be submitted electronically either via email (address: email@example.com), CD/DVD-R or
USB stick in a format compatible with Microsoft Word 97 or better. Also send a hard copy of the article. • Articles should be no longer than eight pages of double-spaced type. • Avoid using trade names. • Feel free to include tables, boxes, diagrams, etc. • Include artist’s name if illustrations are used. • Footnotes should be used for any explanatory notes. Arrange alphabetically using superscripts (ex. a). • References: document all points reviewed by using numbered superscripts (ex. 3) in the text. Place references in the order they appear, not alphabetically. TECHNEWS is looking for articles from technicians that present current news and information. Articles should contain information on areas of interest to technicians,
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such as client education, clinical situations, lab procedures, nursing skills, neonatal care, research, exotics, large animal medicine, emergency procedures or anything else you feel is important to the continuing education of technicians. Articles received will be reviewed by the TECHNEWS editors and editorial committee. Controversial subjects will be prefaced by editorial commentary. The TECHNEWS editor reserves the right to make revisions in text when appropriate. Manuscripts may be edited for content, clarity and style. Feel free to contact the editorial office to ensure availability of a particular topic. Editorial correspondence for TECHNEWS: O.A.V.T. Editorial Submissions c/oThe Bayley Group P.O. Box 39 Hensall, ON N0M 1X0 Phone - 519-263-5050 Fax - 519-263-2936 Email - firstname.lastname@example.org
Canada - 2nd police dog killed in Metro Vancouver - Another police dog has been killed in Metro Vancouver – the second in 24 hours to die while on duty. The two-year-old dog named Bear died instantly when it was hit by a car late July 12 while chasing a burglary suspect across the Lougheed Highway in Maple Ridge. Ridge Meadows RCMP Staff Sgt. Mike Bhatti said the death of the dog was hard on the officer involved. “They’re partners. They go to all calls together. (sic) They’re a team and I’m sure the dog handler is quite upset.” said Bhatti. RCMP arrested one person in connection with the robbery, but several other suspects got away. Earlier that morning, RCMP police service dog Bo was killed when the cruiser driven by his handler hit another vehicle and slammed into a power pole. (cbc.ca/news)
UK - Animal Health Research - The Global Strategic Alliances for the Coordination of Research on the Major Infectious Diseases of Animals and Zoonoses (STAR-IDAZ) was recently launched. STAR-IDAZ is funded by the European Commission and coordinated by the UK’s Department for Environment, Food and Rural Affairs (Defra). Bringing together thousands of scientists from research organizations across five continents, as well as the pharmaceutical industry and international animal health bodies, the network seeks to improve coordination of research activities to improve the control of the major current challenges and future disease outbreaks. (Business Wire) US - Equine Lameness - Cornell University’s Department of Biomedical Engineering has developed a batteryoperated ultrasound system that horses can wear inside leg wraps designed to help heal their legs. The UltrOZ Elite System, which provides up to 6 hours of ultrasound therapy, is being marketed by ZetrOZ, a business spinoff from the Department. (wbng.com)
Canada - Pet, business licencing cuts suggested for Toronto - Eliminating pet licensing, streamlining business licensing and outsourcing animal care are among the latest round of suggestions on how the city can reduce expenditures as mandated by Mayor Rob Ford. The city released a report by auditor KPMG July 11th that looks into which services provided by the municipal licensing and standards division can be modified or eliminated. The review found that none of the services provided by the licensing department could be classified as “core.” Core services are those that are legally mandated or considered essential to the functioning of the city. As a result, the city should consider eliminating licensing of pets as “few cats and most dogs are never licenced,” according to the report. Pet licensing nets the $660,000, the report said. The city could also cut back on the level of service for animal emergency services, and lower the standards for wildlife call responses and collecting dead animals, the report suggests. It will be debated by council’s municipal standards and licensing committee later in July. Toronto is faced with a looming $774-million budget shortfall. In the spring, the city kicked off a comprehensive review of all city services, how they are provided, and the fees people pay for them. (cbc.ca/news)
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Super-big huggable protection against fleas and other parasites. Tasty little tablet.
US - Egg Industry, Humane Society (HSUS) Propose Cage Laws - Threatened with a series of state laws cracking down on cramped cages, the egg industry said it would agree to seek federal regulation to improve conditions for egg-laying hens. In an unusual move, the United Egg Producers announced the effort in a joint appearance with the Humane Society of the United States. The egg group represents 95 percent of the egg-laying hens in the United States. The two groups are proposing that Congress write and pass legislation to phase-out cramped cages over several years and gradually require what they call “enriched” cages. Those cages would give hens more space, perches and scratching areas that would allow them to express natural behaviors. The proposed legislation would also require companies to indicate on egg cartons how their hens were treated, with phrases such as “eggs from caged hens” or “eggs from free-range hens.” The proposal comes after laws requiring better hen conditions were passed in AZ, CA, MI and OH. Animal welfare groups were gearing up to propose additional standards in Washington state and Oregon. They believe that working together to create a national standard is far superior than a patchwork of state laws and regulations that would be cumbersome for their customers and confusing to consumers. The more-cramped conventional cages are now used by more than 90 percent of the egg industry. Under the proposed legislation, egg producers would invest $4 billion over the next 15 years to phase them all out. The egg industry’s move could set a precedent for other food producers. The pork industry criticized the deal, citing concerns that something similar would be expected of them. (Associated Press) US - Non-pharmacist veterinary technicians may now dispense prescription drugs in retail operations - A new law, Senate Bill 2080, allows drug dispensing by certified vet techs who have met academic and certification requirements set forth by the state board of pharmacy. Veterinary retail facilities must also receive a permit from the state pharmacy board in order to operate, according to the law. A valid veterinarian-client-patient relationship will be required for any drugs dispensed under the new classification. The law was passed April 25, 2011.
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Dogs need protection from intestinal worms and heartworm, along with the one enemy their owners can actually see: fleas. Sentinel Flavor Tabs tastes like a treat making it easy for clients to administer with no residue. In a recent survey, 90.16% of topical users preferred Sentinel Flavor Tabs for ease of administration.1 That leads to better compliance. Recommend Sentinel; it’s hugsafe. For more information about Sentinel call 1-800-387-6325 or visit www.doghug.ca.
1. Data on ﬁle. Research conducted for Novartis Animal Health Canada Inc. 2010 ® Sentinel is a registered trademark of Novartis Animal Health Canada Inc. © 2011 Novartis Animal Health Canada Inc. ® Flavor Tabs is a registered trademark of Novartis AG – Novartis Animal Health Canada Inc., licensed user.
TECHNEWS Subscriptions If you are not currently receiving all four TECHNEWS annual issues delivered direct to your door, now is the time to get your subscription! Year-round, issues are full of outstanding continuing education articles and quizzes, interesting personal stories and practical ideas for your work. $39.55 per year includes shipping and is payable by credit card or cheque to ‘OAVT’.
Sign up for your subscription today see Page 31 of this issue!
US - Marathon swims deadly
for polar bear cubs - Polar bears forced to swim longer distances because of diminished sea ice off Alaska’s coast may be paying a price in lost cubs, according to a U.S. study. The study reviewed data from female polar bears in the Chukchi and southern Beaufort seas that wore GPS collars and took swims of at least 50 km between 2004 and 2009. Eleven were mothers with cubs. In six cases, dependent cubs survived the swim when they were spotted again two months to a year later. But five cases, cubs could not be located after the longdistance swim. Cub survival rate was higher for bears that were not recorded taking longdistance swims. (cbc.ca/news)
US - Dogs and cats don’t raise child’s allergy risk - A young child’s chances of developing a pet allergy is no higher, if you have a cat or dog in your home, according to researchers from the Department of Public Health Sciences, Henry Ford Hospital. In fact, researchers said, children often may be protected. According to a VIN News Service article, a common concern of parents of young children is whether keeping a pet at home might raise their allergy risk. A team monitored a group of children from the day they were born through to adulthood. The children and their parents were regularly contacted regarding their exposure to dogs and cats. When 565 of them reached the age of 18 years, blood samples were taken and tested for antibodies to cat and dog allergens. The scientists found that exposure to a specific pet during the child’s first year of life was the key exposure period. In some groups, this exposure was, in fact, protective. Young adult males who were exposed to dogs during their first 12 months of life had a 50 percent lower risk of becoming sensitized to dogs compared to young adult males who had no dog in the house during the same period. Adult males and females were much less likely to be sen-
Russian city limits pets to 1 dog, 2 cats In an attempt to control rabies, one governor is placing strict limits on pet ownership. According to an article in The Moscow Times, Governor Yevgeny Savchenko of Belgorod infuriated pet owners by banning all residents from walking dogs outside their homes and limiting residents to one dog and two cats per household. Now, dog owners will only be allowed to walk their pets in two designated areas. As a result, thousands of dogs will be crowded into the city’s walking grounds at any given time.The head of the Belgorod city department for veterinary inspection says limits on pets were necessary because some owners keep dozens of animals in unsanitary conditions, causing neighbours to complain about the stench of urine and waste. Some veterinarians in Belgorod praised the ban as an opportunity to limit pet owners who bear no responsibility for their pets. The governor’s office pointed to rabies fears for the pet ban. A total of 3,927 people went to the doctor after animals bit them in the first 10 months of last year, compared with 4,065 in 2009. A total of 263 rabies cases were registered in the region last year, including 89 wild animals (mostly foxes), 85 dogs, and 72 cats. (Firstline)
sitized to cats if they lived with a cat in the house during their first 12 months of life, compared to peers who did not have a pet cat during the same period. (veterinary advantage weekly news) US - ACVO/Merial National Service Dog Eye Exam Event has record turnout - The American College of Veterinary Ophthalmologists (ACVO) announced record breaking results from the 4th Annual ACVO/Merial National Service Dog Eye Exam Event. With the help of more than 200 volunteer board certified veterinary ophthalmologists throughout the U.S. and Canada, 4,000 service
US - Cat obesity study provides insight - A collaborative team of researchers has shown that adding moisture to a cat’s diet slows down the rate of weight gain. This finding, at least in part, appeared to be driven by increased activity. This research was conducted at the WALTHAM® Centre for Pet Nutrition. In a series of studies conducted in partnership with the University of Aberdeen, WALTHAM® scientists found that cats fed a dry diet with a total of 50 percent moisture had a slower rate of weight gain and were more physically active than those cats fed the dry diet alone containing 10 percent moisture. This is the first time a hydrated diet has been associated with a lower rate of weight gain and increased physical activity in cats. (veterinary advantage weekly news)
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animals were examined during the event, an increase of 25 percent from last year. Guide dogs, handicapped assistance dogs, detection dogs, search and rescue dogs and other service animals including horses and even a service donkey received free sight saving exams. As part of the program, a team of ACVO doctors hosted a Service Dog screening event at Lackland Air Force Base (AFB) in San Antonio, Texas at the Department of Defense Military Working Dog Center. Approximately 150 Transportation Security Agency (TSA) dogs and military working dogs were screened. (veterinary advantage weekly news) Canada - Successful Adoption in Canada Fuels Global Interest in Needle-Free Injection - Officials with AcuShot report the successful adoption of needle-free injection within western Canada’s pork industry is helping fuel global interest in the technology. Needlefree injection uses high velocity and pressure to create an opening, seven to ten times smaller than that of a conventional needle, to instantaneously force the veterinary compound being administered through the skin. Both Manitoba and Saskatchewan currently offer incentives to encourage the adoption of needle-free injection. There has been recent interest from American producers as they have grave concerns over the spread of PRRS, plus increased sales to South Korea because of the foot and mouth disease outbreak there. (CAHI Clippings) Canada - On an average weekday, Canadian pet owners spend nearly twice as much time surfing the Internet (48 minutes) and three times as much time watching television (79 minutes) as they do playing with/exercising their pets (25 minutes). The statistics come from Canada’s “Pet Wellness Report,” a research study of 1,000 Canadian dog or cat owners and 100 veterinarians conducted by the Canadian Veterinary Medical Association.
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You know your clients go to the Internet for veterinary information, so guide their website choices by offering your trusted website recommendations on your discharge sheet. This way, you know clients are reading credible websites when they surf.
Smile for the camera!
Take a before and after photo of each patient’s teeth and send the photos home as part of an educational handout. The difference in the pet’s teeth is night and day, and clients realize the money spent really improved their pet’s health. Display the most dramatic before and after results to clients who aren’t quite sold on dental cleanings for their pets. (Veterinary Economics)
Top 10 ways to use email at your clinic
Prioritize what you do with patients. Because some patients get fractious, it’s probably better to withdraw a blood sample before performing the nail trim. And trim the front claws before the rear, as if time runs out, the front claws are more likely to be overgrown than the rears.’ (Veterinary Medicine)
1. Reminder notes 2. Educational info 3. Appointment reminders and confirmation 4. Pre- and post-operative instructions 5. ‘Welcome to our practice’ mailings 6. Announcement of new services 7. Client satisfaction surveys 8. Thank you notes for referrals 9. Practice newsletters 10. Birthday cards
When greeting clients for the first time, a good way to bond with them is to ask them why they named their pet as they did. Everyone loves telling that story!
When syringe-feeding your cat patients, tie on a baby bib to catch any drips and spills. Take a photo for the client - they’ll love it!
Investigate the provincial associationâ€™s web sites for details on other continuing education opportunities. Current as of: August 2011
2011 October 2-5, 2011 International Conference on Communications in Veterinary Medicine - Pillar & Post Hotel, Niagara on the Lake - Special OAVT member rate available -www.iccvm.com October 15-18, 2011 CanWest Veterinary Conference Banff Springs Hotel, Banff, Alberta - www.canwestconference.ca October 22 & 23, 2011 Manitoba Animal Health Technologists Association - MAHTA 29th AGM & Conference Canada Inns Club Regent Casino Hotel, Winnipeg, Manitoba www.mahta.ca October 31 - November 3, 2011 Antimicrobial Stewardship in Canadian Agriculture and Veterinary Medicine Toronto Airport Marriott Hotel - www.antimicrobialcanada.com
2012 January 26 - 28, 2012 OVMA - www.ovma.org February 17 & 18, 2012 34th Annual OAVT Conference & Trade Show Doubletree International Airport Hotel, Toronto. Full program details available on website in mid September. www.oavt.org
OAVT 34th Annual Conference: Professionalism & Diversity February 16-18, 2012 International Doubletree Hotel, Toronto - 3 days of outstanding program with industry leaders Tracks include: Practice management, tech-centered practice, pharmacology, nutrition, feline, communications, dental health, equine, hospice care, behaviour, dermatology, professionalism & ethics, and more! Sessions on: Hyperthyroidism, blood, cytology, parasite control, rehabilitation, anesthesia, bio-security, ultrasound, Toronto Zoo tour and much more! The full program will be available in September. The program is designed by technicians and for technicians, providing the most comprehensive learning opportunity of the year!
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P H A R M AC O L O G Y C O L U M N
by Dr. Wendy Brooks, DVM, DipABVP (Educational Director, Veterinary Partner.com)
• Brand Name: Cerenia Available in 16 mg, 24 mg, 60 mg, and 160 mg tablets; and as injectable Background While strong nausea-controlling drugs in injectable form have been available for dogs for some time, oral medications have been lacking. Until recently, efforts were largely confined to the oral use of metoclopramide which is rather short acting, and meclizine, which is not approved for use in dogs. In 2008, Pfizer released maropitant citrate, a strong anti-nausea medication for dogs that could be given once a day. Vomiting occurs when the vomit center of the brain stem is stimulated. It may be stimulated a number of ways: via the brain, as in motion sickness or through emotional input; via the chemoreceptor trigger zone in the brain stem, as when nauseating toxins are detected in the bloodstream; directly, as in dietary indiscretions; or a combination of any of the above. An important molecular step in initiating vomiting involves the binding of a material called substance P to a structure called the NK-1 receptor. This lock and key binding occurs in both the vomit center and in the chemoreceptor trigger zone. Maropitant citrate mimics the structure of sub-
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stance P and binds the NK-1 receptors so that they cannot bind substance P, thus making stimulation of the vomit center extremely difficult. How This Medication is Used Maropitant is used once a day in dogs to control nausea. It can be given as a shot or as a tablet. The dose is higher for motion sickness versus for treatment of disease-related nausea. For the former, maropitant can be given two days in a row and for the latter for 5 days in a row. Side Effects Side effects are uncommon with the use of this medication, but the most commonly noted side effects were: drooling, drowsiness, diarrhea, and appetite loss. Interaction with Other Drugs The risk of experiencing the above side effects is increased when maropitant is combined with other drugs that are highly blood protein-bound in the circulation. Common drugs that meet this criterion are phenobarbital, non-steroidal anti-inflammatory drugs (NSAIDs), and thyroid hormone supplements. Concerns and Cautions • Note that the dosage recommended
for a one-time control of motion sickness is much higher than that for longer term nausea relief, as in the treatment of a disease. Maropitant has not been tested for safety in puppies less than 16 weeks of age. Maropitant is for use in 5-day courses. After 5 days, the dog should come off maropitant for the 6th day but can start a new 5-day course on the 7th day. For motion sickness, maropitant can be given 2 days in a row. Do not give this medication wrapped in a treat that may upset your pet’s stomach. Minimize fatty treats as they work against the effectiveness of the medication. Maropitant may not be appropriate for dogs with liver disease. Maropitant has not been evaluated in pregnant or nursing dogs and is not approved for use in cats. Some feline studies have been performed and the drug has been used by many in cats without adverse effect.
© 2011 Dr Wendy Brooks, DVM, DipABVP and VIN, All rights reserved. Editor’s Note: Reprinted courtesy of Veterinary Information Network (VIN). VIN (www.vin.com) is the largest online veterinary community, information source and CE provider. The VIN community is the online home for over 30,000 colleagues worldwide. VIN supports the Veterinary Support Personnel Network (VSPN.org); a FREE online community, information source for veterinary support staff. VSPN offers a wide range of interactive practical CE courses for veterinary support staff -- for a small fee. Visit www.vspn.org for more information.
Did You Know?
Pet Insurer Lists Top 10 Most Expensive Pet Health Conditions
Keeping Tabs on Tabby Cats
As many cat owners know, tabby is not a breed of cat but the pattern of the cat, no matter its colour. There are five tabby patterns. For non-cat cognoscenti, here is an easy way to spot the different tabbies, according to Cat Daily: 1. The classic tabby has bold, swirling patterns on its sides that resemble a marble cake. 2. The mackerel tabby has narrow, branching stripes on its sides and spine that resemble a fish skeleton. 3. The spotted tabby has round, oval or rosette-like spots, small or large, on its sides. 4. The ticked tabby has neither stripes nor spots but is instead marked by individual hairs highlighted with alternating light and dark bands of hair. 5. The patched tabby is distinguished by a tortoiseshell pattern. Tabbies all share a pencil-thin line shaped like an M on their foreheads. The marking has been interpreted as a blessing from the Virgin Mary or from the prophet Mohammed, who is said to have loved tabbies. Others link the marking to “Mau,” the ancient Egyptian word for cat. (veterinarypartner.com)
Fancy or ‘Phobe? An ailurophile is a cat fancier, a lover of cats. Don’t like cats? Then you’re an ailurophobe, defined as someone who hates or fears cats. (veterinarypartner.com)
Recent data from Veterinary Pet Insurance Co. (VPI) revealed that $1,000 veterinary bills may be more common than expected. In 2010, VPI policyholders submitted nearly 14,000 claims with an average treatment cost exceeding $1,000. VPI analyzed its database to find that the majority of its most expensive claims were the result of just 10 conditions. The conditions were: • Torn knee ligament/cartilage (average cost per claim $1,578) • Intestinal – foreign object ($1,967) • Stomach – foreign object ($1,502) • Intervertebral disc disease (IVDD) ($3,282) • Stomach torsion/bloat ($2,509) • Broken leg/plate ($1,586) • Laryngeal paralysis ($2,042) • Tumor of the throat ($1,677) • Ear canal surgery ($1,285) • Ruptured bile duct ($2,245). While surgical treatment for a cruciate repair occurred with the greatest frequency, the condition with the highest average cost per claim was IVDD, for which pet owners paid an average of $3,282 in 2010. According to DVM Newsmagazine’s 2009 State of the Profession survey, veterinarians estimate the average dollar amount at which most clients would opt to stop treatment of a sick or injured animal at $1,451. Of the top 10 most common costly claims, only ear canal surgery falls beneath the average survey limit, thus illustrating the value of pet health insurance as a way to manage unexpected pet health expenses. (veterinary advantage weekly news)
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