VOL UME 34 I S S UE 3
CANADIAN VETERINARY TECHNICIANS
A NATIONAL JOURNAL PUBLISHED BY THE ONTARIO ASSOCATION OF VETERINARY TECHNICIANS
D E D I C AT E D TO PROFESSIONALISM
CONTINUING EDUCATION • Gastric Dilatation & Volvulus: Diagnosis to Recovery • Dental Home Care • Congenital Heart Defects of the Dog and Cat
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
Plus: Gastrointestinal Decontamination of the Poisoned Small Animal Patient, Tech Tips and Tidbits, Social Media and Self-Directed Learning: What Veterinary Practices Need to Know, and more!
2011 Platinum Sponsors Making continuing education better & more accessible across Canada Bayer HealthCare Animal Health Division Hill’s Pet Nutrition Canada, Inc. Intervet Schering-Plough 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 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.
Letter from the Editor............................................................................................................... 2 Websites to Watch..................................................................................................................... 3 Thanks to Our Editorial Committee......................................................................................... 3 CE Article #1: Gastric Dilatation & Volvulus: Diagnosis to Recovery................................. 5 Correction................................................................................................................................. 8 CAPC Updates Parasite Management Guidelines, Control Recommendations.......................... 9 CE Article #2: Dental Home Care..................................................................................... 11 Top Pet Internet Searches........................................................................................................ 15 Orcas Feast on Baby Grey Whales........................................................................................... 15 CE Article #3: Congenital Heart Defects of the Dog and Cat........................................... 17 The Sharpest Mind in the Farmyard........................................................................................ 20 Let’s Start That Dog on a CRI................................................................................................. 21 Obesity in Horses Could be as High as in Humans................................................................. 24 World Small Animal Veterinary Association Develops Global Nutrition Guidelines................ 25 Gastrointestinal Decontamination of the Poisoned Small Animal Patient................................ 26 Puzzle...................................................................................................................................... 27 Continuing Education Opportunities..................................................................................... 28 CE Quizzes....................................................................................................................... 29 Tech Tips and Tidbits.............................................................................................................. 31 Employment Ads..................................................................................................................... 32 Submitting Articles to TECHNEWS...................................................................................... 33 Social Media and Self-Directed Learning: What Veterinary Practices Need to Know............... 36 Global News........................................................................................................................... 40 Interferon................................................................................................................................ 43 Did You Know?....................................................................................................................... 44
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Next Issue: Summer 2011 Deadline for Material: May 15 , 2011 Distribution Date: July 1, 2011 TECHNEWS is a quarterly publication published by the OAVT.
Employment Ads: Please see Employment Ad Information on Page 32 For advertising information: Contact Cass Bayley: Tel. (519) 263-5050 Fax (519) 263-2936
• Editor - Cass Bayley (email@example.com) • Technical Editor - Shirley Inglis, AHT, RVT (firstname.lastname@example.org)
The opinions expressed in this publication do not necessarily reflect the opinion of the Board of Directors nor the members of the Association.
TECHNEWS | VOLUME 34 ISSUE 3
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This spring issue of TECHNEWS is scheduled to arrive on your doorstep when the winter is a memory and the snow is long gone. However as I write this, we are in the midst of yet another Ontario blizzard but I remain hopeful that this too will pass! I am proud to say that I embraced winter this year, buying a pair of skis and hitting the slopes after a hiatus of longer than I care to remember. It was a perfect season to walk the dog and I worked those biceps with my friend George the shovel. This spring issue is full of great reading and just what you are looking for! The CE articles cover a wide range of topics: Gastric Dilatation & Volvulus (page 5), Dental Home Care (page 11) and
Congenital Heart Defects of the Dog & Cat (page 17). The CAPC Parasite Management Guidelines (page 9) details the Councilâ€™s recommendations and provides a useful reference. Another excellence resource is the Global Nutrition Guidelines (page 21) recently released from the World Small Animal Veterinary Association (WSAVA). An article on Gastrointestinal Decontamination of the Poisoned Small Animal Planet (page 22) offers a detailed overview of current recommendations. We salute our CE authors of this issue Amy Breton CVT, VTS (ECC) who is the Head Emergency Technician at Waltham, Massachusetts; Dr. Fraser Hale DVM, FAVD, DAVDC from the Hale Veterinary Clinic; Tanya Crocker RVT, VTS (SAIM) from Canada West Veterinary Specialists. All submissions for CE and general interest
articles are reviewed by the TECHNEWS Editorial Committee whom we are introducing for the first time on page 3. Their hard work and diligence in reviewing all submissions with Technical Editor Shirley Inglis RVT is what makes TECHNEWS the definitive and premiere journal for Canadian technicians! Take time after reading this issue to send us your thoughts, ideas for future issues, photos or stories from your neck of the woods! We encourage our readers to submit articles and take a proactive interest in the content of TECHNEWS. This is, after all, YOUR magazine!
Cass Bayley Editor, TECHNEWS
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Websites to Watch AVMA Video Promotes Animal Welfare Policy The American Veterinary Medical Association (AVMA) has released a new video promoting its policy on how to reduce pain for cattle during a common surgical procedure dehorning. Many breeds of cattle have horns, which are often removed early in life to protect other animals and producers from injury. The AVMA policy and this informational video offer guidance to help make this procedure as comfortable as possible for animals. AVMA policy recommends that, to reduce discomfort for the animal, dehorning be done at the earliest age practicable and that consideration be given to the use of local anesthetics (e.g., lidocaine) and nonsteroidal anti-inflammatory agents for pain control. The new video demonstrates the use of local anesthetic and disbudding (a dehorning technique applied to young calves), and helps educate producers and the general public about how pain management can improve an animals’ welfare. To see the entire video, visit http://www.avmatv.org/channel. cfm?s=68&c=551. (Veterinary Advantage News)
New website for Canine Influenza Protection Check out Intervet/Schring-Plough’s new website, doginfluenza.com, an informational source for CIV useful for both clinic staff and pet owners.
Apps Being Designed for... Cats? A New York Times article reports that a growing number of apps are being created for cats - not cat owners. (Do a YouTube search for “iPad and cats” or “cat plays with iPad” and you’ll see some amusing examples.) The apps do for pets what they generally do for people: help them fight boredom while also letting them look cool!Titles like App for Cats, Cat Game and Cat Toy are free, while Game for Cats starts free but can be upgraded by your cat for $1. (Veterinary Advantage)
Federally Reportable Diseases in Canada - 2011 This table lists the number of confirmed farmed herds or flocks affected by federally reportable diseases in Canada this year. The numbers are running totals, up until and including the last day of the previous month. Data on rabies and equine infectious anemia (EIA) are compiled separately, and are available via links on the same webpage. www.inspection.gc.ca/english/anima/disemala/rep/repe.shtml
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Thanks to Our Editorial Committee
Hearty thanks to our Editorial Review Committee for their continuing assistance reviewing the many articles submitted to TECHNEWS. Tine Curran AHT • Graduated St. Lawrence College • Worked as equine veterinary technician, Standardbred horse trainer, long time college faculty member. • Tine is the program coordinator of Georgian College’s Veterinary Technician program, currently teaching Anatomy and Physiology, Nutrition, Radiography. • She is married with 3 children aged 12-19, lives on a hobby farm with 2 horses, 3 goats, 2 cats, rabbit and toy poodle. Julie Lawerence, RAHT Julie graduated from the Olds College AHT program in 2000 after 10 years of working in the newspaper industry. She started at Calgary North Veterinary Hospital, a 24/7 primary care and emergency hospital, 8 years ago as an AHT working evenings in emergency medicine and now is the Assistant Manager. She has a 14-year-old Border Collie, Kayla, and a 14-year-old Torbi named Ali. Marg Brown, RVT, BEd, AdEd Marg has been involved in the education of technicians for over 30 years at Seneca College, King City Ontario as a technician, professor and coordinator. During that time she has been involved with the OAVT in various capacities. She also co-edits Mosby’s Comprehensive Review for Veterinary Technology and has contributed to chapters in other text books. She is currently residing in New York City with her husband where she is evaluating a component of a distance education course, coauthoring a text book, volunteering in facilitating English for immigrants, as well as being involved in an organization empowering young women. Of course she is also taking advantage of all that the city has to offer. She has a daughter beginning her PhD in child psychology.
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Introduction Gastric dilatation and volvulus (GDV), commonly known as bloat, is an acute life threatening condition, which is characterized by the malposition of the stomach when it rapidly fills with air and rotates. Gastric dilatation (the expanding of the stomach) and gastric volvulus (the twisting of the stomach without expansion) can occur separately, however, when they occur simultaneously the disease process to the body results in death if left untreated. Despite the first report of GDV in 1906, researchers have been unsuccessful in identifying a cause.3 Mortality rates range from 15-33%.13 While GDV can occur in many species (including cats and primates), deep chested and giant breed dogs are most commonly affected.6 Prompt recognition, rapid treatment and surgery are required to increase the chance of survival.
CE Article #1 Gastric Dilatation & Volvulus: Diagnosis to Recovery
Risk Factors Roughly 22% of giant breed dogs and 24% of large breed dogs will develop GDV in their lifetime.3 The Great Dane has the highest incidence (42.4%).3 The other most common breeds affected breeds are the Weimaraner, Saint Bernard, Gordon setter, Irish setter and the standard poodle.9 As these breeds get older, the risk of developing GDV also increases.3 Though there is no exact cause for GDV, many proposed risk factors could contribute. Exercise after a large meal, especially a meal of highly processed food or water, may be a risk factor.4 Dogs that were fed only one type of food appear to have an increase in risk, while dogs that were fed table scraps or canned food appear to have a lower risk.4 Despite the myriad of reports suggesting that it is food related, there has not been one definitive report showing a link between GDV and the types of food. Dogs that are male, geriatric, eating only one meal a day, eating too
quickly or having a raised food dish may all increase the risk to developing GDV.4 One published report showed that large breed dogs that ate quickly out of a raised food dish had a 20% increase in risk and giant breeds had an increase of 50%.3 Dogs that have developed GDV have been found to have increased gastrin concentrations.3 Gastrin is a hormone produced in the stomach that increases the release of gastric juice. In digestion, gastrin constricts the pyloric sphincter, causes esophageal spasming and slows the
rate of gastric emptying.3 This can lead to aerophagia and decreases the chance of vomiting with gastric dilatation.3 Other risk factors include a decrease in esophageal sphincter tone, myoelectric dysfunction and dogs that experience a delay in gastric emptying.3 Pathophysiology Most commonly during GDV the stomach rotates 90-270 degrees in a clockwise motion.7 Because the spleen is attached to the stomach by the gastrosplenic ligaments and vessels, the spleen will also
Amy N. Breton, CVT, VTS (ECC) is currently employed at the Veterinary Emergency and Specialty Center of New England in Waltham, Massachusetts as the Head EmergencyTechnician. Amy has 13 years of experience working as a certified veterinary technician. In 2001 she became boarded as a Veterinary Technician Specialist in Emergency and Critical Care.
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follow the stomach and will become displaced, if not twisted as well.3 Both air and fluid become entrapped within the stomach causing it to become enlarged. As the stomach fills with air, the caudal vena cava becomes compressed, leading to a decrease in venous return from the heart.1 A distended stomach can cause up to a 75% decrease in arterial flow to the gastric mucosa.8 Depending on the degree of rotation of the stomach, a partial or complete blockage of the portal vein may also occur.1 This may cause the liver or pancreas to become ischemic to some degree. With the rotation of the spleen it too may become ischemic. Pre-Surgical Treatment Patients that present with GDV usually have unmistakable signs. Signs include non-productive wretching, abdominal distention, abdominal pain, anorexia and restlessness. The stomach may be tympanic.8 Most patients will present in shock. Treatment of the shock is the first priority. Because the patient is in shock and usually has severe abdominal pain, intravenous (IV) catheter placement, IV fluid therapy and pain medication should be started before diagnostics. Oxygen should be administered because many GDV patients are in respiratory distress due to the enlarged size of the stomach pressing on the diaphragm.1 All vitals and parameters should be monitored including pulse, respiration rate, blood pressure, mucous membrane color and ECG. Many GDV patients experience ventricular arrhythmias.1 Fluid therapy should be initiated to help correct the shock. Most veterinarians usually treat shock with isotonic crystalloids first (Normosol, Lactated Ringer’s). Canine shock doses for isotonic crystalloids are 20-40 ml/kg given over 15 minutes and the feline dose is 10-20 ml/kg over 15 minutes.1 After the initial bolus is given the patient vitals should be reassessed (heart rate, respiration rate, dehydration status, blood pres-
sure, capillary refill time). Shock doses can be continued at 70-90 ml/kg over one hour in the canine and 35-50 ml/ kg over one hour in the feline.1 Colloids (hetastarch) can also be given and are the fluid of choice in many emergency clinics for the treatment of shock. Colloids are particularly useful in patients with poor perfusion because they are high molecular weight fluids that do not pass readily through the capillary membranes. Most veterinarians reach for colloids when crystalloids fail. Shock doses for colloids are 10-20 ml/kg in the dog given either rapidly or over 15 minutes and 10-15 ml/kg in the cat given over 15 minutes.1 Hypertonic crystalloids (7.5% NaCl) should be considered if there is no evidence of intra-abdominal hemorrhage and the patient is in severe shock.8 They work because they cause fluid to shift from the intracellular space to the extracellular space which improves venous return and cardiac output.14 It can be given at a rate of 4 ml/kg over two minutes, and treatment with hypertonic crystalloids should not exceed 1-2 hours.1 Pain medication should be administered immediately because it will, not only help alleviate the acute abdominal pain, but also it will help to reduce the stress of the animal. Once treatment of the shock has been initiated, further diagnostics can begin. A right lateral radiograph is the preferred diagnostic tool when ruling out GDV.1 A characteristic gas pattern is usually seen and can be described as a “shelf ” sign of tissues or a “boxing glove” of gas. Chest radiographs should also be taken to rule out aspiration pneumonia and metastasis. Initial bloodwork should be obtained prior to starting IV fluids (obtain blood at the same time catheters are placed) to ensure that values are those of initial presentation. With any patient suspected of ischemic disease, a blood lactate level should be obtained. Blood lactate values under 2 mmol/L are normal. In the case of gastric dilatation volvulus, levels greater than 6 mmol/L are associated with increased gastric necrosis. In 1999,
one study of 102 dogs with GDV found that only 58% of dogs survived with a blood lactate greater than 6 mmol/L, while 99% of dogs survived with levels less than 6 mmol/L.3 The study, however, did not evaluate the overall prognosis of patients who’s lactate decreased quickly once fluid resuscitation was initiated. It is thought that a patient who’s lactate normalized quickly after fluids have been started (even if the lactate is greater than 6 mmol/L) has a better prognosis than those that do not normalize. Other bloodwork that should be run includes a complete blood count, packed cell volume, total protein, coagulation profile, serum chemistry profile and electrolyes.6 Though it seems excessive, it is important to know whether any pre-existing disease exists and how decompensated the patient is. Since all GDV patients require surgery it is equally important to make sure that all electrolyte or other blood work abnormalities be rectified before the animal is placed under general anesthesia. Since disseminated intravascular coagulopathy (DIC) can occur whenever there is major change in the vascular system, all GDV patients are considered at risk, which is why it is important to check a coagluation profile. Once GDV has been diagnosed and therapy for shock has been initiated, gastric decompression should be performed. Gastric decompression helps to improve cardiac output and blood pressure by alleviating pressure on the vena cava and portal vein.2 There are two methods that can be used to decompress the stomach: orogastric and gastrocentesis. Placement of an orogastric tube is the fastest method which allows for the most decompression of the stomach. This method, however, generally causes more stress to the patient, and some patients may not tolerate it at all. A tube should be measured and marked from the point of the nose to the last rib.2 A role of tape should be placed in the mouth just behind the incisors with someone shutting the animal’s mouth on the roll.4 The tube is then advanced with slightly firm pressure and a twisting motion. Be careful not to apply too much force
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on the tube because you could cause an esophageal or gastric tear.2 Once you are in the stomach, contents should flow out of the tube into a bucket below the patient. If an orogastric tube cannot be placed, then a gastrocentesis should be performed. Once the gastrocentesis has been performed and air has been removed, orogastric decompression can be attempted again to remove more of the air and contents. Prior to surgery, broad spectrum antibiotics are usually given because of the risk of gastric necrosis and perforation.8 Steroids are considered controversial. To date, there has been no clinical evidence supporting high-dose steroid use in animals with shock (including in humans).1 Steroids can help to reduce resistance to infection and help to improve oxygen delivery to the tissue, which suggests that there may be some benefit to low-dose, but nothing has been proven.1 There are, however, plenty of well-documented adverse effects of steroids including gastric ulceration, immunosuppression and myocardial toxicity.16 Surgical Treatment Surgery is always recommended, because it is impossible to confirm whether the stomach is in correct anatomic position, that it is not necrotic or that the spleen is not thrombosed.1 Surgery should be performed once the animal is stabilized. Preanesthetic protocols vary and the individual patient should be assessed to determine what is appropriate. Phenothiazine tranquilizers (acepromazine) usually are not recommended because they can cause vasodilation and hypotension.6 Ideally, a benzodiazepine (diazepam) should be included in the preanesthetic protocol because it serves as a muscle relaxant and can help reduce anxiety by slowing down the central nervous system. Etomidate (usually used in conjunction with diazepam) is generally an appropriate choice, and is a good alternative to propofol or thiopental, because it helps maintain cardiac output.4 Other preanesthetic drugs include: buprenorphine, fentanyl, hydromorhopone and propofol. Propofol
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can cause vasodilation and respiratory distress and should be limited to those animals that have been stabilized.6 Once intubated, the patient should be monitored very closely which should include ECG, blood pressure, pulse oximetry and capnography. Mechanical ventilation may be required in order to maintain adequate oxygenation.6 During surgery, the stomach is repositioned and a permanent gastropexy is performed to prevent recurrence of GDV. The failure rate of gastropexy ranges between 3-8%.2 The goals of surgery should be to identify and remove any damaged or necrotic tissue, decompress the stomach, correctly position the stomach and then adhere the stomach to the body wall to prevent it from twisting again.4 Because the spleen is attached to the greater curvature of the stomach, a complete or partial splenectomy may be required if there appears to be necrosis or infarction.4 Removing the spleen does not prevent recurrence of GDV.9 It is imperative that intraoperative blood pressure be maintained at a mean arterial pressure of 80 mmHg.6 Surgery fluids generally include using a cystalliod at 10 kg/hr.1 If necessary, colloids can be administered in boluses (5-10 ml/kg Hetastarch IV) or at a continuous rate infusion (CRI).17 Hetastarch is generally not to exceed 20 ml/kg/day in dogs and 10-15 ml/kg in cats.16 When colloids are given, crystalloids should be decreased to avoid cardiac compromise or fluid overload. Using a CRI of certain kinds of pain medications may allow for a decrease in inhalant anesthesia and help increase blood pressure.6 However, because some medications can cause respiratory depression it is important to have mechanical or assisted ventilation ready if needed.6 By providing a CRI of an analgesic intraoperatively, most pets have a better recovery. If the patient is hypovolemic despite efforts (be sure that the patient is on an appropriate plane of anesthestia), blood pressure medications should be started. The most common cardiac arrythmias
that are seen post-operatively are ventricular premature contractions and ventricular tachycardia.2 Generally these are self-limiting and resolve in 2-4 days.2 The cause of the arrythmias include acid-base and electrolyte abnormalities, myocardial depressant factors and myocardial ischemia.2 Generally they are treated if the ventricular rate is greater than 160-180 beats per minute or the patient is clinical (pulses weak, shock is present or perfusion decreased).2 Most commonly the drugs of choice are lidocaine or procainamide. Prophylactic Gastropexy Due to the risk to some breeds, many owners are now opting for preemptive gastropexy. The gastropexy can be incorporated into the same procedure as a spay or castration, or when the abdomen is being explored or opened for another reason. With the advancement of surgery, laparoscopic and endoscopic gastropexy are now options for performing prophylactic gastropexy. Both offer less trauma and minimal risks compared to that of full abdominal surgery. The timing of the pexy does not seem to play a factor in whether the pexy will be a success. Currently there are no statistics stating the rate of overall succes with prophylactic gastropexy. Due to the limited amount of these procedures that have been done there are also limited statistics regarding the overall complications associated with these procedures. Post-Surgical Care No matter how stable a GDV patient was prior to and during surgery, all post-surgical patients should be given a guarded prognosis. Complications postoperatively include: sepsis, DIC, gastritis, cardiac arrythmias and ischemiareperfusion (I/R) injury. Gastic necrosis and perforation can occur up to five days post-surgery, especially if resection was performed.26 Due to the numerous complications which can occur, patients need to be closely monitored. All vitals need to monitored as well as electrolyte, acid-
base status and clotting times. Continuous ECG and blood pressure should be monitored along with all other vitals. Post-operative analgesia should be initiated before the patient is fully recovered to avoid excessive pain and stress to the patient. Pain medication should be multi-modal, such as a morphine, lidocaine and ketamine CRI. Generally metoclopramine is administered to help prevent ileus. Metoclopramide increases the lower esophageal sphincter tone, decreases pyloric sphincter tone, and increases gastric contraction.9 Gastric protectants (famotidine, cimetidine, ranitidine) may be used post-operatively.8 If patients experience vomiting post-operatively, an antiemetic should be considered.
Fluid therapy should be tailored to the findings of the bloodwork and the condition of the patient and should not be discontinued until the patient is able to take in fluids orally. If DIC is suspected, patients should be started on fresh frozen plasma to help replace clotting factors and antithrombin.6 If gastric resection occured, patients should continue on broad-spectrum antibiotics. Patients should eventually have food and water reintroduced about 12-24 hours post-surgery.8 The type of food that is reintroduced should be bland (void of high quantities of fat and sugar) and only a small quantity should be offered (a couple of tablespoons).8 Bland diets are commercially made, however boiled low fat chicken or hamburger and low
Our apologies - in the last issue (Winter TECHNEWS 2010, Volume 34, Issue 2) an error was inadvertently made in the Illustration portion of Cindy Stoate’s ‘Review of Basic Breathing Systems for Veterinary Anesthesia’ article. The text and illustrations didn’t match for Illustrations 1 and 2: the two illustrations were switched. Please see the correct information below:
Illustration 1: Aerial view of a carbon dioxide absorber with a standard ‘Y” circle system showing the flow of gases with A: inspiratory valve, B: expiratory valve, C: reservoir bag, D: APLV, E: scavenge hose, F: circle system
Illustration 2: Aerial view of a carbon dioxide absorber with a Coaxial F-circuit system showing the flow of gases with A: inspiratory valve, B: expiratory valve, C: reservoir bag, D: APLV, E: scavenge hose, F: F-circuit
fat cottage cheese/yogurt are also considered good alternatives. Eventually the animal can be weaned slowly back onto its regular diet. Typically patients are discharged when they are able to hold down food and water and when all cardiovascular signs are normal. Patients that are still experiencing cardiac arrhythmias may be discharged with medication and may be rechecked during suture removal. Conclusion Gastric dilatation and volvulus is an emergency that requires immediate care and surgery in order for the best prognosis to occur. Understanding how to care and treat patients will lead to a faster response when GDV does occur.
references > 1. Battaglia A: Small Animal Emergency and Critical Care for Veterinary Technicians, St. Louis, Saunders Elsevier, 2007. 2. Ettinger S, Feldman E: Textbook of Veterinary Internal Medicine, Philadelphia, W.B.Saunders, 2000 3. Winfield W, Raffe M: The Veterinary ICU Book, Jackson Hole, Teton NewMedia, 2002. 4. Fossum R: “GDV: Is There Anything New in Resuscitation and Surgery?”, IVECCS Proceedings 2007 5. Monnet E: “Gastric Dilatation and Volvulus: The Role of the Nurse”, British Small Animal Veterinary Congress Proceedings 2006. 6. Mazzaferro E. “Emergency Management of GDV”, Western Veterinary Conference Proceedings 2008 7. Waldron E. “Gastropexy in GDV Patients: Therapeutic and Prophylactic”, Atlantic Coast Veterinary Conference Proceedings 2007. 8. Plunkett S: Emergency Procedures for the Small Animal Veterinarian, 2nd edition, London, WB Saunders, 2000. 9. Wingfield W: Veterinary Emergency Medicine Secretes, Philadelphia, Hanley & Belfus Inc, 2001 13. Beck J, Staatz A, Pelsue D, Kudnig S, MacPhail C, Seim H. Monnet E.: “Risk Factors Associated With Short-Term Outcome and Development of Perioperative Complications in Dogs Undergoing Surgery Because of Gastric Dilatation-Volvulus 166 cases (1992-2003).” JAVMA, Vol 229, No 12, 2006 14. Davis H: “Nursing Management of the Hypovolemic Shock Patient.” Northeast Veterinary Conference Proceedings 2004. 16. Plump D: “Plumb’s Veterinary Drug Handbook”, Wiley-Blackwell, 2005. 17. Mazzaferro E.: “Vascular Access and Fluid Therapy... Providing the Best Support for Your Anesthetized Patient”, Western Veterinary Conference 2007 26. Brockman D.: “Gastric Dilation and Volvulus: Treatment and Post-operative Care”, World Small Animal Veterinary Association Proceedings, 2008.
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CAPC Updates Parasite Management Guidelines, Control Recommendations Council updates include Lyme disease, testing for regional vectors, and tapeworms
BEL AIR, MD. (December 3, 2010) – The Companion Animal Parasite Council announces changes to its General Guidelines for Parasite Prevention and Control. The new guidelines advocate for vaccination of dogs considered to be at risk against Lyme disease in regions of the country where Lyme disease is a concern. A second guideline advocates for yearly testing of regionally relevant vector borne diseases. Additionally recommendations for the treatment prevention and control of tapeworms have been strengthened. According to Mike Paul, DVM, executive director of CAPC, the changes to the Council’s guidelines and control recommendations are part of the council’s continuing commitment to provide veterinarians and technicians the most up-to-date information on canine and feline parasite control and prevention. “We are continually reviewing and evaluating all the guidelines and recommendations on parasitic infections of dogs and cats based on the latest science and practice information,” Dr. Paul says. “These latest changes have been thoroughly vetted by our board, which includes leading veterinary parasitologists and practicing veterinarians from across the country.” Following are the changes to the CAPC Guidelines: • Regarding Lyme Disease: In areas where Lyme disease is considered endemic, vaccination against Borrelia burgdorferi should be recommended for all dogs deemed at risk of the disease. • Regarding testing for regional parasitic diseases: In endemic regions,
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patients at risk should be tested annually for regionally relevant vectortransmitted pathogens. Following are the new recommendations for the prevention and control of tapeworm infections Tapeworm prevention recommendations: • Stringent adherence to controlling fleas and lice is required to prevent D. caninum in dogs and cats. • Prevention of predation and scavenging activity by keeping cats indoors and dogs confined to a leash or in a fenced yard will limit the opportunity for dogs and cats to acquire infection with Taenia spp. or Echinococcus spp. via ingestion of cysts in intermediate hosts. • To prevent zoonotic infections: In areas where Echinococcus granulosus is endemic, routine monthly deworming of dogs with praziquantel should be strongly considered. In areas where E. multilocularis is known to be present, treatment of dogs (and perhaps cats) every three weeks with praziquantel is recommended. Tapeworm treatment recommendations: • Treatment of infected animals to re-
move tapeworms should be instituted simultaneously with flea-elimination programs and predation prevention to avoid reinfection. Praziquantel, epsiprantel, and fenbendazole are approved for the treatment of tapeworm infections in dogs and cats. Praziquantel and epsiprantel are considered the treatments of choice because they are highly effective against D. caninum, the most common tapeworm of dogs and cats, as well as Taenia spp. Only praziquantel is labeled as effective against Echinococcus spp. (not labeled as effective in all formulations; check for specific label claims). For dogs, praziquantel is formulated with ivermectin and pyrantel pamoate to provide heartworm prevention and broad-spectrum internal parasite control. For cats, praziquantel is formulated with emodepside to provide broad-spectrum internal parasite control (check for specific label claims). Treatment of tapeworms in dogs and cats must be combined with appropriate husbandry modifications, such as effective flea control and prevention of ingestion of prey species; in the absence of these changes, reinfection is likely to occur.
“Veterinarians and technicians should feel confident in referring to the CAPC General Guidelines and recommendations in an effort to provide their patients with the most effective prevention from and treatment of parasitic infections,” Dr. Paul adds. “Following these peer-reviewed recommendations will help them provide the best care to their patients and ensure the long-term health and safety of their patients and clients.” The latest Guidelines and parasite treatment recommendations can be found at 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.
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YOU HEARD RIGHT. JUST ONCE-A-DAY FOR ONE WEEK!
As in your own mouth, there are two main components of oral health care for dogs and cats. There is what we, as veterinarians and technicians do once a year or so (professional dental care) and there is what the client does at home every day between professional treatments (dental home care). While it is the client who administers the home care, it is the veterinary practice that must train and equip the client for this job. Therefore, the veterinary dental team must understand home care inside and out in order to guide and assist the clients in setting up a practical and effective program for their pet.
CE Article #2 Dental Home Care
The purpose of home care is to maintain good oral hygiene to prevent the development or progression of periodontal disease and to maintain good gingival health. Why is Home Care Essential? The first thing to understand is that gingivitis and periodontal disease are caused by dental plaque (an invisible bacterial slime or biofilm) in contact with and below the gingiva. While tartar on the crowns of the teeth will harbour plaque, it is not the coronal tartar that is the enemy or the target of home care â€“ it is subgingival plaque and tartar that causes disease. To prevent subgingival plaque and tartar it is essential to prevent the accumulation of coronal plaque.
plaque is what causes disease; the tartar protects the plaque and makes it much harder to remove. If you prevent plaque accumulation/maturation, you will also prevent tartar formation. If your homecare strategy just prevents tartar formation without also targeting plaque, it will do little to prevent disease. I consider tartar prevention to be largely cosmetic rather than therapeutic.
Think of it this way; the bacteria in the plaque film are the soldiers against which we are fighting. Tartar is the fortress that the soldiers build to live and hide in. The
Following a professional dental cleaning the tooth surface is considered clean. Within hours, a film of salivary glycoproteins, known as the acquired pellicle,
starts to form on the exposed dental surfaces. In a few more hours, oral bacteria colonize this pellicle. This is the beginning of the development of dental plaque, which is a mixture of salivary glycoproteins, sloughed epithelial cells, white blood cells, food particles and bacteria. Immature plaque is a rather disorganized slime on the tooth surface. It is poorly attached, thin and aerobic and relatively easy to disrupt mechanically. If the immature plaque is left undisturbed, it becomes thicker, more organized and more firmly attached to the
Fraser Hale, D.V.M., FAVD, DAVDC - Hale Veterinary Clinic - In 1984, Dr. Fraser Hale graduated from Ontario Veterinary College and took an associate position at an American Animal Hospital Association practice in Toronto, ON. During five years there, he developed a special interest and gravitated towards dentistry. In 1988, he joined the American Veterinary Dental Society (AVDS) and started to attend continuing education programs on the subject. In 1989, Dr. Hale moved to Fergus, ON, to work as the small animal practitioner in a mixed practice. This practice had no dental equipment and no budget so he purchased the needed items out of pocket. Within three months, bonuses generated from the dental cases paid for the equipment and Dr. Hale was doing two to three dental procedures per day. In 1991, Dr. Hale began the Companion Animal Dental Certificate Series offered by the Ontario Veterinary College, taught by Dr. James Anthony. Dr. Hale also left general practice to begin a mobile veterinary dental referral service in which he would travel to hospitals with equipment to do in-house referral dentistry. In 1994, Dr. Hale became a fellow of the Academy of Veterinary Dentistry (the first in Ontario and only the third in Canada) and set up a stationary dental office at a practice in Guelph, ON. In 1997, he became a Diplomate of the American Veterinary Dental College (again, the first in Ontario and the third in Canada to become board certified). In 2003, Dr. Hale moved out of subleased space in a general practice to open Canadaâ€™s first dental-only veterinary facility. As well as being busy with his referral practice, Dr. Hale is frequently invited to speak to veterinary and technician groups as well as present at national and international conferences. He offers a wide range of continuing education programs at his practice, and he has published several articles and case reports in journals as well as textbook chapters. He is also a consultant on the Veterinary Information Network dental board. Dr. Hale has served and continues to serve on numerous committees in both the Academy of Veterinary Dentistry and the American Veterinary Dental College. In 2005, Dr. Hale was named Fellow of the Year by the Academy of Veterinary Dentistry and in 2010 was the recipient of the AVDS Hillâ€™s Pet Nutrition Research and Education Award.
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tooth surface. It starts to evolve into a highly complex society of co-operative and synergistic bacteria and protozoa. Aerobic bacteria live on the outer surface of this biofilm with anaerobes living in the deeper layers closer to the tooth surface. The mixed population of bacteria produces and secretes substances that act as a matrix, enhance adhesion and protect the residents of the biofilm from chemical and cellular antimicrobial agents. Bacteria in a biofilm are considered to be as much as 1500 times more resistant to antiseptics and antibiotics than the same bacteria would be in a monoculture. Mature plaque is 25% bacteria and 75% matrix. Using DNA probe techniques, it has been estimated that there may be as many as 1400 different species of microorganism living within the plaque film in a periodontal pocket. More than half of these organisms have never been cultured as they have such specific environmental requirements, they will only grow in the unique habitat of a periodontal pocket, not on a culture plate. Also, it has been found that organisms act physiologically very differently when part of a biofilm than they do when in culture media in the lab. These factors make culture and sensitivity testing of oral infections quite useless. Within as little as two days, undisturbed plaque can start to precipitate salivary minerals to form tartar. Now the plaque film is building its fortress and is going to be much harder to remove. The bacteria in plaque produce toxins, which cause inflammation of the gingiva. If left untreated, this gingivitis may progress to periodontitis (inflammation and destruction of the gingiva, periodontal ligament, alveolar bone and root cementum). To prevent gingivitis and periodontitis from developing and to maintain gingival health, plaque must be removed before it becomes organized and mineralized. In the wild, plaque is controlled by chewing through the hides of prey, and by eating raw, fibrous tissues such as heart and diaphragm. Feral dogs live for about six years and feral cats last for two to three years. Their mouths are designed to last this ‘lifetime’. As our pet cats and dogs
are living well into their teens and their diets offer little challenge to plaque, we must lend aid in the fight. Another factor in the high incidence of periodontal disease in pet dogs and cats is that many breeds (all short faced dogs and cats for instance) have significant anatomic deformities that dramatically increase the risk of developing periodontal disease. From the above, you can see that if the owners are not doing anything about plaque control at home on a daily basis, noticeable tartar and gingivitis may be back by the two-week recheck appointment. Home care refers to anything the owners are doing at home on a regular basis to control plaque and maintain periodontal health. In numerous studies, daily brushing of the teeth with a softbristled nylon toothbrush has been shown to be the most effective means of plaque control. It is the mechanical action of the bristles against the tooth surface that removes the plaque. Brushing also massages the gingiva, stimulating the gingival fibroblasts to produce more collagen thus firming and toning the gingiva. The rewards of having clients involved with home care are great. First and fore-
To start, you should never recommend a home care program to a pet that has not had a recent, very thorough oral examination (under general anesthetic). Home care can cause pain to the animal. If an owner tries to brush the teeth of a cat that has resorptive lesions, it will cause pain. If an owner tries to brush a tooth that has a crown fracture and exposed pulp, it will cause pain. If an owner tries to brush the teeth of an animal that has serious gingival inflammation, oral ulcerations, mobile teeth…, it will cause pain. If an owner brushes too vigorously or roughly, it will cause pain. If the animal’s early experience with home care involves pain, it will be very difficult to ever get this animal (or owner) to accept and enjoy daily home care, even after the painful conditions have been resolved. Home care can lead to a false sense of security. If an owner is brushing the crowns of the teeth daily, the crowns will remain clean and shiny. Therefore, at annual examination, you will see clean crowns and will be inclined to say that no further dental examination or treatment is required. However, there may well be problems brewing in an area that is not
One suggestion is to always perform a thorough oral examination (examine each tooth above and below the gum line and take whole-mouth dental radiographs) anytime you have an animal anesthetized for any reason whatever. Never squander an opportunity to look for problems and you will be amazed at what you find.
most, your patient benefits from better oral health. Secondly, your clients will become more aware of dental concerns and will actually start requesting more dental treatment. They will notice small problems early, when they are easily treated, rather that leaving them as surprises for you to find at vaccine time. The Dangers of Home Care As with any treatment or intervention, home care can be harmful to the pet and the owner and can be counterproductive if not approached in the proper manner.
only hard for the owners to brush, but also hard for you to examine with the animal awake. The problem could be a foreign-body induced periodontal pocket between the mandibular first and second molars, a caries lesion in the occlusal pit of the maxillary first molar, a previously formed periodontal pocket, a crown fracture or any number of problems. If you are not regularly anesthetizing your patients to do a thorough oral examination, you are going to miss these hidden problems un-
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til they become very advanced and obvious and the animal will have suffered in silence waiting for that to happen. So, home care is for pets with clean, healthy mouths and should never be used as a substitute for proper, professional care. What Home Care IS NOT • Home care is NOT a treatment for established disease. Home care is daily plaque control designed to maintain oral hygiene and prevent the development of gingivitis and periodontal disease. It does not remove tartar and it cannot reach into periodontal pockets. Therefore, home care should only be instituted AFTER appropriate professional treatment has established a clean and healthy mouth. Home care is then used in an attempt to maintain this healthy situation or to prevent the situation from deteriorating. • Home care is NOT a substitute for regular professional examinations and treatment. Since home care only cleans the crowns of the teeth and maybe 1 to 2 millimeters subgingivally, it will have little or no effect on established periodontal pockets. Home care is also only effective for those teeth (or tooth surfaces) the owner is able to reach. Therefore, even with home care, the animal should have regular professional examinations and treatments. I brush my own teeth 2-3 times a day and floss daily and I still see my hygienist and dentist every nine months. Never once have they told me that if I promise to brush every day that they don’t need to see me for a few years. At the end of each appointment they hand me a new brush, some floss and an appointment card for my next visit – no ‘ifs’, ‘ands’ or ‘buts’. • Home care is NOT an Over-theCounter concept. There is a dizzying array of home care products and aids available for your client to choose from. It can be confusing enough for us to figure out which products to use and when. Do not leave it up to your clients to decide for themselves which products to use or how to use them. For those animals that need home
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glossary > • Dental Plaque - An invisible bacterial slime or biofilm that forms on the tooth surfaces within hours of an oral hygiene procedure.
• Acquired Pellicle - A sterile film of salivary glycoproteins that forms
on the crowns of the teeth within minutes of an oral hygiene procedure
• Periodontitis - Inflammation and destruction of the gingiva, periodontal ligament, alveolar bone and root cementum
• Buccal Surface - The surface of the tooth in contact with the lining of the cheek pouch
• Lingual Aspect - The surface of the mandibular teeth in contact with the tongue
• Palatal Aspect - The surface of the maxillary teeth in contact with the palate
• Caries Lesion - Bacterial decay of the hard tissues of the tooth also known as a cavity
• Foreign-Body Induced Periodontal Pocket - A subgingival pocket
of periodontal disease caused by a foreign body such as a splinter of wood or bone trapped caught between the teeth or below the gum line
• Occlusal Pit - An invagination of the enamel and dentin on the grinding surface of a molar tooth.
care, take the time to discuss the situation with the owner and explain what they need to be doing. Listen to their thoughts and concerns, consider the animal involved and then customize a program based on the situation. And always keep each product’s limitations in mind – do not expect too much as there is no miracle product on the market and likely never will be. How to Institute a Home Care Program As indicated before, the first step in instituting a home care program is to ensure that the mouth is healthy and free of sensitive areas. This means a thorough dental examination under general anesthetic with whole-mouth intra-oral dental radiographs to assess and record oral health followed by appropriate treatment of all problems found. After healing, then you can have the owner start on the following steps. Some client-oriented information is available at www.toothvet.ca/dentalcare.html but some further detail is indicated. Home care is not something we do TO animals; it must be something we do
FOR them. It does not matter how motivated the owners are, if the animal is not a willing and enthusiastic participant, the program will fail. Therefore, we must train the animal to truly enjoy having its teeth brushed. If this is accomplished, the animal will request this attention and will give the owners grief if they try to skip a day. Teaching a dog to fetch a stick or shake a paw is like teaching a fish to swim. They are basically natural behaviours that we encourage with positive feedback. Having someone poke a toothbrush in their mouths is a very unnatural behaviour and so we must start with something the animal is already doing, reward that and then gradually shape the behaviour until it is what we want. When doing behaviour shaping or training of any sort, consistency is very important. The first step is to decide who in the family is going to be responsible for home care. Training should be done by one person. Once the program is up and running well, the job can be shared, but the training phase should be a oneperson job. In a perfect world, it would be the person who is the most motivated
or has the best relationship with the pet. However, sometimes the job defaults to the person who is consistently home every day. The next decision is when the brushing will happen. Dogs and cats are creatures of habit and like things to happen the same time each day. For many, late evening or just before bedtime works well as the pets are in a quiet mood and often looking for attention anyway. The third decision is where brushing will happen. The owner should do this in the same place every day, not only for consistency but also to ensure that all materials, including the rewards, are all close at hand. What follows are guidelines, not hard rules. Each program must be tailored to the home situation. In many homes, the pet will seek the owner’s company and attention by climbing on their lap or nudging their hand looking to be petted. In this situation, the animal is coming to the owner looking for something. It is the animal’s idea; the animal is initiating the interaction and this is ideal. At this time, the owner should get down at eye level with the animal and give it the attention it is seeking. The first step is to have the animal sit quietly while the owner strokes under the chin and mandibles, using lots of gentle praise. After ten seconds or so, the animal is given a reward (usually a food treat). It is important that the reward follows the behaviour within seconds for the animal to draw a connection between the two. Each day, the owner tries to increase the amount of time the animal sits quietly having its lower jaw massaged before getting the reward. When the animal is happy to sit for thirty seconds or so, the owner can start working on stroking and massaging the maxilla as well. They should go slowly, as animals are naturally very protective of their eyes. Next step is to gently and casually start manipulating the lips, pushing the upper
lip up, retracting the commissures of the lips caudally and the lower lip ventrally. This should be done without pulling on the whiskers or pinching the lips. After a few days of this, it should be possible to slip a finger (one without long nails) inside the mouth to start gently rubbing the teeth. Start with the anterior teeth (canines and incisors) and gradually work farther back in the mouth to massage the premolars and molars. It is not necessary to open the mouth or even lift the lips for this – it can all be done by feel. When the pet is comfortable accepting a naked finger rubbing along the buccal surface of the upper teeth, the finger can be wrapped in a gauze square, a bit of pantyhose or some other mildly abrasive material. The covered finger is again used to massage the teeth and gums, starting with the anteriors and day-by-day moving to the back teeth. If toothpaste is going to be used, now is the time to introduce it. Despite label claims, I view most veterinary tooth pastes as nothing more than flavouring. A study of human patients found that brushing without toothpaste was 98% as effective as brushing with paste. In other words, the mechanical action of the brush does 98% of the work. If the pet likes the flavour of the paste, it becomes part of the positive reinforcement and it can be a useful motivator. However, many clients report that their pet is so busy trying to lick the paste off the brush, they will not sit still for brushing and so the paste actually makes it harder to brush, not easier. Dogs with furry faces are inclined to get paste stuck in their facial fur and then this needs to be cleaned/combed out and this often makes the paste more trouble than it is worth. Certainly, if the pet does not like the paste, it will have a negative impact on the program and should be left out. To see if paste is going to help with the program or not, the owner should put some paste on the end of a finger and offer it to the animal. If the animal does not lick it off right away, the owner can dab a bit on the tip of the animal’s nose. The pet will lick it off and then will either want more or will turn away from it when the paste-laden finger is offered. If
the animal likes the paste, then try using it. If the animal does not like the paste you can try a different flavour. If the pet really does not like the paste, or likes it too much and will not sit still or gets it all gummed up in their fur, I would suggest skipping the paste altogether. The next step is to introduce the toothbrush. It should be a small, soft-bristled child’s or toddler’s brush. With the forefinger guarding the end of the brush, it is slipped into the buccal pouch under the upper lip and gently rubbed back and forth along the tooth at the gum line. Start with the anterior teeth and gradually work to the back of the mouth. The bristles of the brush are held at 45 degrees to the long axis of the tooth at the gum line and the brush used to sweep the crown and marginal gingiva to remove plaque and stimulate gingival fibroblasts. Owners should be cautioned about brushing too hard. They can practice on a ripe tomato. They should brush hard enough to dent the tomato’s skin but not hard enough to tear it. Some owners will complain that they cannot brush the back teeth because the pet keeps chewing on the brush. That is not altogether a bad thing. While the owner goes back and forth, the chewing action is brushing up and down and getting the bristles in between the teeth, almost like flossing. Once the animal is accepting of having the buccal surface of the upper teeth brushed, the owners can start to work on getting at the lower teeth and to the lingual and palatal aspects. This will involve opening the mouth. Approached gently, this is usually no particular challenge. If prior dental treatments have identified trouble areas, the owners should concentrate on these. After each training or brushing session, the pet is given a reward of some sort. This might be food, play, cuddles… whatever the animal will be motivated by. This is not a race or a competition. The animal sets the pace and determines how long is spent on each phase before moving to the next. If the owners try to progress too fast and evoke a negative re-
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sponse from the pet, that is what the pet remembers the next night and the game is lost. It is far better to go too slow than to go too fast.
non-compliant. These owners will have to be particularly patient and give the animal time to forget past negative experiences and learn new positive ones.
If the owners have made earlier attempts at home care without going through a gradual process of behaviour shaping, chances are it did not go well and the owners gave up because the animal was
Similarly, if the animal has been living with dental pain for sometime, the owners will have to proceed slowly to gain the animal’s trust and help them to learn that it no longer hurts to have their mouth handled.
If owners approach home care with enthusiasm, starting when their pet’s mouth is clean and healthy, follow the steps and take it slowly with lots of praise, affection and rewards, many animals will come to truly enjoy home care. Many owners claim their pets will not let them skip a day as they do not want to miss the attention and treats.
Top Pet Internet Searches
Have you ever wondered what your veterinary clients are searching for on the Internet? WebMD. com, a site for consumers that provides medical information, isn’t just for humans — the site also has pet health topics. Here’s a list of the top five petrelated searches of the year on WebMD.com: 1. What pets can and can’t eat 2. Pets in the bed 3. Is my pet normal? 4. Your pet and your personality 5. Top 10 dog poisons To help ensure that you’re the top source of pet health information for your clients, look for ways to broach these topics with them. It could be as simple as creating client handouts or asking a few specific questions during wellness exams. (Veterinary Economics)
Small groups of killer whales drive grey whale calves to waters of a certain depth, then attack and drown them. (John Durban/Vancouver Aquarium)
Orcas Feast on Baby Grey Whales
Up to a third of Eastern Pacific grey whale calves born each year are eaten by orcas that prowl the tip of the Alaskan Peninsula. The orcas, also known as killer whales, eat almost nothing but grey whale calves and yearlings for a month each spring, said a new study led by Lance Barrett-Lennard, a whale researcher at the Vancouver Aquarium and the University of British Columbia. The orcas stake out a key corner along the grey whales’ migration route between southern California and the Bering Sea. This is a place where they can stay in one place and the prey come to them.” The researchers found that groups of five or six orcas work together to separate calves from their mothers, who are about 50 per cent larger than the average orca and often put up a vigorous fight. If the orcas succeed, they drive the calf to waters about 20 to 40 metres deep and drown it. They pull on its pectoral flippers, they push on its head, roll it upside down, roll over its blowhole as it tries to breathe. The calf rarely lasts long. Finding the right depth ensures the massive feast won’t sink out of reach, as orcas can’t dive very deep. The researchers observed that the killer whales keep coming back for leftovers over the next five or six days, even though orcas don’t normally eat food unless it has been freshly killed. While it sounds like orcas eat a lot of grey whale calves, they probably have been eating the same proportion every year for so long that it doesn’t have a huge influence on the overall grey whale population. (cbc.ca)
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Protecting his heart is just the start.
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Nearly six months ago, I decided to make a change from working as head tech in our Internal Medicine department, a position I held for 8Â˝ years, and delved into the world of Cardiology. As Cardiology is a subspecialty of Internal Medicine, this would enable me to keep learning in one of my favourite fields, yet offer more focus than general Internal Medicine.
CE Article #3 Congenital Heart Defects of the Dog and Cat
At the advice of the cardiologist I work with, Dr. Marco Margiocco, in this article Iâ€™ve decided to cover 3 of the most common congenital heart diseases encountered in dogs: patent ductus arteriosus (PDA), pulmonic stenosis, and mitral valve dysplasia, the most common condition in cats. (Subaortic stenosis is another common congenital disease, but since it is not one we would try to correct using interventional cardiology I will not discuss it in this article.) To date, I have been involved in a few interventional cardiology procedures. One was a balloon valvuloplasty to correct pulmonic stenosis in a Boxer, and the other an ACDO placement in a 4 year old German shepherd with PDA. A congenital disease is a disease present at and existing from the time of birth.1 Congenital heart defects are more prevalent in dogs than cats. In 1992, Buchanan estimated the occurrence of heart disease in dogs to be 6.7 to 8.5 per thousand while in cats, estimates run at 2.0 per thousand.3 Congenital disease seems to be more common in purebred dogs and cats. The majority of evidence indicates that most congenital defects have a genetic basis, although outside environmental factors still have not been entirely ruled out.
figure 1 >
PDA (Patent ductus ateriosis) Poodle, Collie, Pomeranian, Maltese, Sheltie, Yorkshire Terrier, Bichon Frise, English Springer Spaniel, Cocker Spaniel, Keeshond Pulmonic Stenosis English Bulldog, Fox Terrier, Scottish Terrier, West Highland White Terrier, Miniature Schnauzer, Chihuahua, Samoyed, Miniature Pinscher, Labrador Retriever, Mastiff, Beagle
There is little information about breed predisposition in cats. In mitral valve dysplasia, it has been noted males are more frequently affected than females. Patent Ductus Arteriosus (PDA) The ductus arteriosus is a muscular blood vessel, which extends from the pulmonary artery to the aorta. In the fetus it allows blood to bypass the lungs due to the limited 5% to 8% amount required, which is just enough to help with pulmonary metabolism and growth. Lungs remain somewhat collapsed until birth. When they expand at birth, this causes an increase in PaO2 which then causes the musculature of the ductus to constrict and completely close within a few hours of birth.3 In a PDA, the ductal muscle is hypoplastic and therefore does not close completely. Most PDAs are a
Tanya Crocker, RVT, VTS (SAIM) is a 1996 graduate of the Veterinary Technician program at Ridgetown College of Agricultural Technology (now associated with the University of Guelph) in Ontario. She has worked at Canada West Veterinary Specialists (www.canadawestvets.com) for 10 years, specifically with the Internal Medicine service as coordinator for over 8 years and more recently as coordinator for the new Cardiology service. She was among the first graduates of the Small Animal Internal Medicine Specialty through the AIMVT. Outside of work she spends her time mountain biking and enjoying the West Coast lifestyle.
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funnel shape with the smallest end at the pulmonary artery. They are either described as a left to right or a right to left shunt. The most common is the left to right shunt as the right side of the heart (pulmonary side) has a naturally lower pressure than that of the left (systemic) side. This is also the PDA associated with the specific “machinery” murmur sound. Right to left shunts are not as common; interventional and surgical closure is contraindicated as the prognosis is generally poor. Depending on the size of the PDA, clinical signs or symptoms may or may not be exhibited. Dr. James Buchanan breaks the clinical signs down into four types of cases.5
figure 2 > • Type 1 (Small PDA) • Type 2 (Medium Size PDA) • Type 3a (Large PDA before Congestive Heart Failure)
• Type 3b (Large PDA plus Congestive Heart Failure) • Type 4 (Large PDA with Right-To-Left or Bidirectional Shunt)
Adapted from “ PDA from A to Z” by James Buchanan, WSAVA 2002
Type 1 essentially looks like a normal healthy puppy. They are asymptomatic, have a normal heart beat and pulse. Radiographs and the electrocardiogram (ECG) are normal even as they reach adulthood. The main signs are found on auscultation and echocardiogram. A continuous murmur (it does not fade in either systole or diastole) is present and occasionally a thrill is palpable at the left heart base. An echocardiogram (echo) shows the patent ductus and can be used to determine the flow direction and velocity. Type 2 has similar signs, just a little more pronounced. By the age of 1 year, signs are also more visible on radiographs with mild to moderate left heart enlargement, some mild increase in pulmonary vascular markings and increased R waves on ECG.
More pronounced differences come in the later stages, as with most disease processes. Type 3a may present with exercise intolerance; mitral regurgitation is now present, which creates a systolic murmur that may persist for days after the PDA is closed. Marked evidence of left heart enlargement is noted on radiographs prior to 6 months of age. R waves may be over 5 millivolts (mV) on ECG and marked changes are noted on the echo. In these cases, it is recommended to immediately proceed with PDA closure as life expectancy and prognosis becomes smaller with the threat of congestive heart failure (Type 3b). If left untreated, many patients will present in left heart failure. Up to 65% may die within their first year.5 Type 4 is less common and involves a right to left shunt.
Typically, PDA’s were closed surgically. This involved performing a thoracotomy and ligating the shunt. In the past 10 years however, interventional cardiology has quickly become more popular. While it requires more specialized equipment, the procedure is much less invasive. A small incision is made at the site of the artery where a catheter will be advanced. Recovery time is much shorter and easier - generally one to two days. The procedure involves performing an angiogram initially to determine ductus size and shape, and therefore the size of the occluder to be used. A transcatheter device is then advanced via the femoral artery and positioned fluoroscopically. Various devices are available, such as coils, vascular plugs and the Amplatz® Canine Duct Occluder (ACDO), one of the few appliances made specifically for
glossary > • ACDO - Amplatz® Canine Duct Occluder - A self-expanding device made of nitinol wire mesh used to close PDA in dogs
• Angiogram - Study of blood vessels and/or the blood flow within using a contrast agent, and usually fluoroscopy (a real-time x-ray)
• Balloon Valvuloplasty - An interventional procedure used to open a narrowed heart valve
• Congestive Heart Failure (CHF) - Noted as either left or right sided. The affected side of the heart fails to advance blood at a certain rate to either meet metabolic needs or to prevent pooling in the systemic (left) or pulmonary venous (right) circulation.
• Diastole - The phase following systole (contraction) when the heart fills with blood
• ECG - Electrocardiogram, also called an EKG (from the German Elektrokardiogramm), is an interpretation of the electrical activity of the heart
• Echocardiogram (Echo) - A sonogram (ultrasound) of the heart • Hypoplastic - An organ or tissue that is not completely developed, or is underdeveloped
• Interventional Cardiology - A branch of Cardiology, which involves
treating heart defects using various types of catheters. Not all defects are treatable using interventional cardiology.
• Shunt - A passage between two natural channels, especially blood vessels, formed anatomically or anomalously
• Systole - The phase of the cardiac cycle when the heart contracts • Thrill - A vibration felt on palpation, ie. when a grade v/vi heart mur-
mur is present you may also feel the vibration on the side of the chest. This is called a thrill.
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hypertrophy present and determine if there is an increase in right atrium size.
dogs. Surgery is still the best option when the patient is very small or the ductus is either too big or cylindrical in shape. Pulmonic Stenosis In pulmonic stenosis there is a narrowing in, above or below the pulmonary valve. This creates increased pressure in the right ventricle, which can also back up into the right atrium. The pressure created is usually proportionate to the severity of the obstruction. In many patients, no clinical signs are noted. Pulmonic stenosis is most commonly recognized upon auscultation during the physical exam. A murmur is noted at the left base of the heart. It can be of variable quality and may or may not be accompanied by a slightly exaggerated pulse of the jugular veins. Thoracic radiographs show evidence of the disease in moderate to severe cases. An echocardiogram is the best way to diagnose pulmonic stenosis. It allows the cardiologist to measure the severity of the stenosis, evaluate the degree of right ventricular
Correction of the stenosis can be performed by an interventional procedure called balloon valvuloplasty. In our procedure of a Boxer, we had to first perform an angiogram to rule out the existence of a coronary anomaly called the R2A (very important). When an R2A is present, the left coronary artery passes in front of the pulmonary trunk. It is contraindicated to balloon a dog with this anomaly as inflating a balloon could incur arterial damage. English and French Bulldogs and Mastiffs have also been described with this condition. During the procedure, catheters are inserted into the right carotid artery and the right jugular vein. An angiogram is performed to rule out R2A, and then another is performed to determine the required balloon size. Next, under fluoroscopic guidance, the balloon catheter is placed and inflated and deflated 2 to 3 times. Our Boxerâ€™s prognosis was good and she went home the next day. As it typically takes a few weeks for the valve leaflets to start working again, a recheck echo should be performed approximately one month after the procedure. Mitral Valve Dysplasia (MVD) MVD is the most common congenital disease of cats, and is seen predominately in males. Dogs are also prone (it ranks towards the end of the top ten list) and is most commonly seen in large breed dogs such as Great Danes, German shepherds and Mastiffs. It can be described as congenital, abnormally-formed mitral valve structures affecting any part of the mitral valve including: Balloon Valvuloplasty
references > 1. W.B. Saunders; Dorlandâ€™s pocket medical dictionary 24th edition.W.B Saunders Co, Philadelphia. 2. D David Sisson; Cardiovascular medicine in domestic animals (class notes), pg 273. 3. Mark D. Kittleson, Richard D. Kienle; Small Animal Cardiovascular Medicine. Mosby, Missouri 1998. pg 218 4. James W Buchanan, VIN [2002, online]. Patent Ductus Arteriosus from A to Z. Available: http://www.vin.com/ proceedings/Proceedings.plx?CID=WSAV A2002&PID=51377&Print=1&O=Ge neric [Accessed 26 February 2011] 5. Mark D. Kittleson, Richard D. Kienle; Small Animal Cardiovascular Medicine. Mosby, Missouri 1998. pg 222 6. Jonathan A. Abbott, DVM, Small Animal Cardiology Secrets. Hanley and Belfus, Philadelphia 2000. Pg 326
bibliography > 1. Stanley I. Rubin, Anthony P.Carr; Canine Internal Medicine Secrets. Mosby Elsevier, Missouri 2007. Pg 95-99 2. Jonathan A. Abbott, DVM; Small Animal Cardiology Secrets. Hanley and Belfus, Philadelphia 2000. Pgs 326-329 3. Fox, Sisson, Moise; Textbook of Canine and Feline Cardiology. W.B Saunders, Philadelphia 1988
deformed leaflets, adhesion(s) to adjacent structures, the thickening and elongation of chordae tendineae or abnormalities in the papillary muscles.6 The abnormalities typically result in mitral regurgitation which produces volume overload of the left heart. Chronic volume overload causes myocardial failure resulting in signs of congestive heart failure. Less commonly, MVD causes mitral valve stenosis. Apart from the systolic murmur typically heard with mitral regurgitation, patients may not have any signs of MVD until they are in left heart failure. Signs may include exercise intolerance, cough and dyspnea. An ECG may be normal or show evidence of chamber enlargement in the form of tall and wide P waves and tall R waves. Arrhythmias may also be present, most commonly atrial fibrillation. On radiographs, atrial enlargement is most commonly noted first. Ventricular enlargement shows up in the later stages of the disease.
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An echo would detect evidence of left-sided volume overload, showing up as a dilated left atrium and left ventricle. With the use of two-dimensional echocardiography, the abnormal structure is often visible while colour Doppler documents the regurgitation or the stenosis. The prognosis is variable for patients
with this condition. Some patients may be asymptomatic for years while others may develop signs of CHF early on. Most patients are medically managed with diuretics, ACE inhibitors and pimobendan, depending upon the severity of symptoms.
originally anticipated. I look forward to becoming more involved in this field and learning new procedures. Pacemaker placement and implantable loop recorders will be next on the list, and perhaps my next article?!
Conclusion Cardiology is so much more than I had
Special thanks to Marco Margiocco MS, DMV, Diplomate, ACVIM (Cardiology)
The Sharpest Mind in the Farmyard
When we look for examples of intelligent animals, certain species always leap to mind. Ourselves of course, and our close relatives the chimpanzees and other primates. Perhaps the cunning corvids – crows and scrub jays – with their prodigious memories and talent for deception. Dolphins and whales are pretty bright. Many would even agree that there is a sort of intelligence governing the behaviour of social insects like ants. But sheep? Sheep are just thick. Except that they aren’t. Over the past few decades, evidence has quietly built up that sheep are anything but stupid. It now turns out that the humble domestic sheep can pass a psychological test that monkeys struggle with, and which is so sensitive it is used to look for neurological decline in human patients. Laura Avanzo and Jennifer Morton of the University of Cambridge were interested in a new kind of genetically modified sheep. These animals carry a defective gene that in humans causes Huntington’s disease, an inherited disorder that leads to nerve damage and dementia. The hope is that the Huntington’s sheep could be a testing ground for possible treatments. For that to work, they reasoned, researchers will have to be able to track changes in the cognitive abilities of the Huntington’s sheep. So they decided to find out whether normal sheep could pass some of the challenging tests given to people with Huntington’s. If the sheep passed, that would mean that the Huntington’s sheep could be seen losing the ability as their disease progressed – and maybe regaining it if any treatments worked. So Avanzo and Morton put seven female sheep through a series of increasingly tricky challenges. In one test the sheep walked into a pen that contained two buckets, one blue and the other yellow, with some food in the blue one. Over the course of a few trials they learned what was going on and always went to the blue bucket. When the researchers put the food in the yellow bucket instead, the sheep changed
their behaviour accordingly. They also mastered a subtler game in which the food was still in one of the buckets but the clue to its location was the colour of a cone placed nearby, not the colour of the bucket itself. Next Avanzo and Morton stepped up the intellectual pressure, trying the sheep on intra-dimensional and extradimensional set-shifting. These tested the animals’ ability to shift their attention, something that requires a high level of mental control. In intra-dimensional set-shifting, the sheep still had to choose a bucket based on colour, but the set of colours was different: instead of blue and yellow, the choice was purple and green. Humans find this pretty easy. Extra-dimensional shifting is harder, as the sheep had to ignore the colour of the objects and instead focus on their shapes. In a touching piece of scientific understatement, Avanzo and Morton note that their decision to do these tests “was driven more by curiosity than expectation”. Humans and other primates can do set-shifting, but other large animals struggle with it – although researchers have persuaded mice and rats to do it. The task relies on the prefrontal cortex, a part of the brain that is much bigger in humans than other animals. Impressively, the sheep passed the tests, learning to attend either to different pairs of colours or to the objects’ shapes as necessary. As well as being good news for the study of Huntington’s disease, it’s one more step towards rehabilitating sheep’s reputation. It really is about time we stopped making fun of sheep. They can not only recognise each other’s faces, especially sheep they are socially close to – they can remember significant others for at least two years. They can also discriminate breeds, preferring to look at their own. What’s more, there is evidence that they can group plants by family and memorise the correct route through a maze. They have sophisticated social lives too: rams become long-term buddies and stick up for each other in fights. (New Scientist)
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Let’s Start That Dog on a CRI By Lori Williamson
Those three little letters lined up beside each other and spoken out loud can make for one intimidating word. Remember how those textbook questions in school set everything up so that all you needed to know was the rate? What about how to actually make the thing? How much drug should be used in what volume? Yikes. Sometimes it will be the technician’s responsibility to answer these questions. Not to worry; all that is needed are a few simple calculations and a plan. While there are different “recipes” for constant rate infusions, this article will outline two methods that utilize the patient’s specific drug requirement and administration time-line. Start with a list of items to have on hand: 250 ml bags of crystalloids, 150ml burette infusion sets, IV lines, IV extension sets, large syringes, needle lock connectors, and fluid pumps. Rates can be administered in ml/hr or drops/sec depending on what equipment is used. For drop/
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sec calculations, refer to the IV infusion set for the macro or micro drop factor. If the dose and drug strength are expressed in different units convert units to that of the dose1. To make the CRI you will need to know the weight in kg, the drug dose in mg and ml, the solution volume, solu-
tion strength, time over which to administer, and the rate. Case Example 1 (Table 1) A 6kg bichon frise has had an exploratory laparotomy and ileus is suspected. Administer metoclopramide at a constant
table 1 >
Metoclopramide CRI Time Drug Strength CRI Volume
24 hr 50mg/10ml = 5mg/ml 60 ml
Dose 1mg/kg/24hr (mass/strength)
(1 × 6) 24
= 6mg/day = 0.25mg/hr
Time × Dose ml/hr
24 × 0.05
CRI Strength (mass/volume)
Dose mg/day CRI Volume
CRI Rate1 (mass/strength)
Dose mg/hr CRI Strength
= 2.5 ml/hr
table 2 >
9ml/hr for 12 hours using 50mcg/ml fentanyl. What is the solution volume, drug volume, and solution strength?
Answer: The CRI will be made to a total volume of 108ml and will contain 21.6ml fentanyl. The solution strength is 10mcg/ml.
Drug Strength CRI Rate CRI Volume
12 hr 50mcg/ml 9ml/hr Time × Rate ml/hr
12 × 9
Dose 3mcg/kg/hr (mass/strength)
(3 × 30) 50
= 90mcg/hr = 1.8ml/hr
Time × Dose ml/hr
12 × 1.8
= 21.6 ml
Dose mcg/hr Rate ml/hr
CRI Strength (mass/volume)
rate of 1mg/kg/day2. Metoclopramide is labelled 50mg/10ml. Choose an appropriate volume to work with. What is the drug volume, solution strength, and rate to administer in ml/hr? Answer: The CRI will contain 1.2 ml metoclopramide and 58.8 ml crystalloid. The concentration is 0.1 mg/ml and the rate to administer over 24 hours is 2.5 ml/hr.
administered to the patient. Finally, the CRI will be “piggy-backed” onto the patient’s main fluid line using a needle lock connector. Case Example 2 (Table 2) A 30kg labrador retriever with pancreatitis requires a fentanyl CRI at a rate of 3mcg/kg/hr2. Administer at a rate of
The second example may be used when a specific rate per hour is desired. In order to ensure that the correct amount of drug per hour is administered, the drug volume and diluent must be in the same proportion to that of the drug dose and rate per hour; i.e.: dose/rate=drug volume/total volume, or (1.8ml/hr)/(9ml/ hr)=(21.6ml)/(108ml). This same concept can be applied to a CRI that is mixed into the primary fluids and the patient’s main fluid rate is to be used3. A 150ml burette set attached to an IV line would be ideal for case example 2. Again, make a little more than what is actually needed to account for what is lost in the line. Have the CRI prepared so that it can be ran immediately after giving an initial IV bolus of fentanyl. There are some other considerations to make when preparing a CRI. Remove
In case example 1, the formula rate=mass/ strength was used, however the formula rate=volume/time will result in the same answer. Knowing the solution strength will prove invaluable for those CRIs which require the rate to be decreased as the patient is weaned off. As mentioned in the example, the solution volume is an unknown quantity. Because of the small drug volume, a volume of 60ml was chosen and an inexpensive syringe and extension set was ran through a fluid pump as if it was a syringe pump. Another thing to be aware of is the dead space incurred by using IV lines and extension sets. In this example, after mixing the CRI and charging the extension set with solution, about 55 ml is left in the syringe meaning it will be empty before the 24 hours have elapsed. Perform a simple cross-multiplication to avoid this occurrence; i.e.: 1.2ml/60ml = X/65ml where X equals 1.3ml. 65ml are made at the same strength but only 60ml will be
Metoclopramide CRI using a portable fluid pump in a manner similar to a syringe pump. The line has been covered due to the light sensitivity of the drug.
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the calculated drug volume from a fluid bag before injecting drugs to ensure that the concentration is correct. Avoid making solutions with a very low concentration as this may result in a rate that is too high for the patient, such as a pediatric or a patient with heart disease. Attach a patient label to the CRI as well as a label detailing the contents. Know if the drug is light sensitive and what drug interactions exist. Since most patients receiving a CRI are already on fluids, decrease the main fluid rate accordingly to avoid fluid overload. Most importantly, the IV set
should be checked frequently to ensure that the line is running and the patient’s vital signs should be monitored closely. The methods for making constant rate infusions vary widely and the reader is encouraged to refer to other sources for more information. When using a standardized formula, follow each step through in a logical manner so that all the calculations make sense. You may find yourself excited rather than terrified the next time someone says, “let’s start that dog on a CRI.”
references > 1. Wanamaker, Boyce P and Kathy Lockett Massey. Applied Pharmacology for the Veterinary Technician. St. Louis: Elsevier Saunders, 2004. 2. Mathews, Karol A. Veterinary Emergency Critical Care Manual. Guelph: Lifelearn Inc., 2006. 3. Warren, Elizabeth. The VSPN Notebook. 2 Aug. 2002. Veterinary Information Network. 9 Nov. 2010. http:// www.vin.com/Members/CMS/misc
CRI Quick Quiz 1. A patient with a grade II/VI heart murmur will receive a CRI at 6 ml/hr. The main fluids are running at 55 ml/hr. What action should be taken? a. Monitor the patient`s respiration rate carefully b. Decrease the main fluids to 49 ml/hr c. Run the CRI in drops/sec to reduce the risk of fluid overload d. None since the heart murmur is low grade e. Both a. and b. 2. Portable fluid pumps can be used in a way similar to syringe pumps. a. True b. False 3. A 48.4 lb patient needs a CRI at a rate of 0.05 mg/ kg/hr. If the strength of the CRI is 0.1 mg/ml, what is the rate? a. 24 ml/hr b. 11 ml/hr c. 0.18 ml/min d. 0.18 drops/sec
6. If a volume to administer over a certain time period is known, why bother knowing the solution strength? Choose the most correct answer. a. It makes calculating a new fluid rate for a different dose easier b. It makes converting to drop/sec easier c. It makes logging the drugs easier d. None of the above 7. Which definition of dead space is the most correct? a. It is the distance between a patient`s catheter and the fluid pump b. It is the part of the fluid line where particles adhere to the plastic c. The amount of solution that can be delivered to the patient via gravity d. The amount of solution in a fluid line not administered to the patient 8. It is not possible to arbitrarily choose a rate to run a CRI at. a. True b. False
4. A cat needs to receive regular insulin at a rate of 0.1IU/kg/hr. What is needed to make the CRI? a. The patient`s most recent blood glucose level b. The amount of insulin in mg and 500 ml of D5W c. The amount of drug, the solution volume and strength, and the time d. A bag of crytalloids, an IV line, and a syringe pump
9. Which formula would be used to determine the drug volume? a. Mass of drug multiplied by the time b. Solution strength multiplied by the time c. Volume of drug per hour multiplied by the time d. Mass of drug divided by the solution volume
5. What is the strength of a 500ml solution that contains 2500mg of drug? a. 0.2 mg/ml b. 5 mg/ml c. 2.5 g/L d. 5% w/v
10. What is most important about administering CRIs? a. Making sure that all the calculations are correct b. Frequently checking on the patient and the IV set c. Knowing about drug interactions concerning the CRI d. Accurate labelling and record-keeping e. All of the above Answers: 1e, 2a, 3b, 4c, 5b, 6a, 7d, 8b, 9c, 10e
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Obesity in Horses Could Be as High as in Humans At least one in five horses used for leisure are overweight or obese. It’s a condition which can lead to laminitis and equine metabolic syndrome. The pilot study, carried out by The University of Nottingham’s School of Veterinary Medicine and Science, showed that rates of obesity among horses are likely to be just as high as they are among people. The results are published online in the journal Veterinary Record. Research carried out in Scotland has already shown a prevalence of obesity in pleasure riding horses but this is the first time a similar study has been done in England. Five hundred owners were sent questionnaires. None of them kept horses for breeding, livery, riding stables, or competition, so were all
classed as keeping their animals for leisure only. Of the 160 returned, one in five showed that their horses were either overweight or obese. Obesity is linked to a number of different diseases, including arthritis, laminitis and equine metabolic syndrome. Owners were asked about their perceptions of their horses’ body condition, and asked to score this from zero to five, with a score of more than 3 indicating overweight. The researchers then assessed the body condition of 15 randomly selected horses to see if the scores had under or overestimated the horse’s weight. They assigned an average score that was significantly higher for these horses; eight of the own-
ers had scored their horse at least one grade lower than the researcher had, indicating that the owners had underestimated their horses’ weight. On the basis of the researchers’ findings, the authors estimate that the true prevalence of overweight/obesity was likely to be 54% rather than the 20% indicated by the questionnaire responses. Increasing incidence of obesity is a multi-species problem, affecting both humans and their companion animals. The increasing incidence of obesity is a multi-species problem, affecting both humans and their companion animals. The study points out that veterinary professionals need to address this issue with their equine clients. (Science Daily)
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World Small Animal Veterinary Association Develops Global Nutrition Guidelines DUNDAS, ON (March 14, 2011) – In response to the growing need to help place the role of recommending small animal nutrition back into the hands of the experts –the World Small Animal Veterinary Association (WSAVA) has developed global nutrition guidelines. These guidelines are consistent with those produced by the American Animal Hospital Association (AAHA) last year, and are designed to increase worldwide awareness of nutrition as the fifth vital assessment. “Just as the WSAVA led a global effort to elevate pain to become the fourth vital assessment, we see the need to elevate a nutritional assessment to become the fifth vital assessment in a standard physical exam,” said Jolle Kirpensteijn, D.V.M., Ph.D., DACVS, DECVS, president of the WSAVA. “We believe a sound nutritional recommendation from a veterinarian is crucial, because pet owners are exposed to a myriad of nutritional myths that if acted upon can actually be harmful to their pets.” The evaluation of pet body temperature, pulse, respiratory and pain are long-standing vital assessments, but it is also important veterinarians and veterinary nurses/technicians work with their clients to ensure the pet is being fed a proper pet food. On a global scale, many pets are not receiving good quality complete and balanced meals. A lack of vital nutrients can lead to many forms of malnutrition, including obesity. The WSAVA Guidelines Development Committee met for a second time at the North American Veterinary Conference in Orlando, Fla. The group formulated a plan to build an alliance of global veterinary organizations to help healthcare teams and pet owners begin implementing the guidelines together on an international basis. These efforts will be coupled with the Veterinary Companion Animal Nutritional
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Consortium founded by AAHA of which WSAVA is a charter member. “Our team met for two full days during NAVC, and we are all very enthusiastic about the plans ahead for the WSAVA guidelines. We took the existing AAHA guidelines to use as a model, and will be working toward the mutual goal of making pet nutrition recommendations relevant worldwide,” said Lisa M. Freeman, D.V.M., Ph.D., DACVN, professor of clinical nutrition at Tufts Cummings School of Veterinary Medicine. “These guidelines are an important resource that global veterinary practices, pet food companies and all others invested in optimal small animal health can benefit from.” To help assimilate the WSAVA guidelines worldwide, the team’s next steps include working toward getting the guidelines published and encouraging other stakeholders to get involved. WSAVA’s hope is that global veterinary organizations will join forces with them to encourage veterinary healthcare teams and institutions in their respective geographies to make nutrition a routine part of their recommendation procedures. For more information about the World Small Animal Veterinary Association or the WSAVA Guidelines Development Committee, visit WSAVA.org. The World Small Animal Veterinary Association (WSAVA), which has just finished a year of celebrations to mark its 50th anniversary, embodies over 81 member associations representing more than 85,000 veterinarians worldwide. The WSAVA provides a program of global science and education for the veterinary care of small companion animals. For more information on WSAVA visit www.wsava.org CONTACT Dr. Walt Ingwersen Honorary Secretary of the WSAVA email@example.com
World Small Animal Veterinary Association Nutritional Assessment Guidelines Nutrition is critical because nutrients affect every living cell in the body; therefore the World Small Animal Veterinary Association (WSAVA) recognizes that nutrition for dogs and cats requires the same attention to detail as all other species cared for by our profession. Our companion animals are often fed a single source of nutrition, either pre made or homemade diets. Careful assessment of their nutritional needs must be taken into consideration in order to maintain optimum health and performance, be part of a treatment regime for a diseased state, or to maximize the quality of life in the patient with chronic disease. To emphasize that point, our goal is that a nutritional assessment and specific dietary recommendation be made on every patient on every visit. This will become known as the 5th Vital Assessment (5VA), following the four vital assessments of temperature, pulse, respiration and pain that are already addressed on each patient interaction. WSAVA will encourage every veterinary teaching institution in the world to begin to formalize this approach in their curricula as soon as possible. Routinely doing a brief screening evaluation of the nutritional status during history taking and the physical examination can be seamlessly performed as part of every patient exam. An extended evaluation would follow, if one or more risk factors is suspected or identified on screening. Nutrition related risk factors could include age, changes in appetite, activity level, abnormal physical exam findings, body condition score, unexplained weight change and disease status. Client compliance with nutritional recommendations offered by the veterinarian, veterinary nurses/technicians and their clinic team require everyone in the practice to believe in the critical importance of nutrition for their patients. A team approach to continuous nutritional education, implementation of appropriate protocols and focused client communication, utilizing these WSAVA Nutritional Guidelines, will be the key components to reach this 5VA goal.
Gastrointestinal Decontamination of the Poisoned Small Animal Patient By Amanda Poldoski, DVM (Veterinarian at Pet Poison Helpline; Justine A. Lee, DVM, DACVECC (Associate Director of Veterinary Services, Pet Poison Helpline)
In veterinary medicine, the first step in treating a toxicant exposure is generally decontamination of the patient. Decontamination is performed to limit absorption and promote elimination of the toxicant from the patientâ€™s body. For most substances, there is a narrow time frame in which decontamination can be effectively and safely performed. Obtaining a thorough history, time since exposure, and knowledge of the substance ingested are imperative when considering decontamination. Gastrointestinal (GI) decontamination generally involves induction of emesis and/or administration of activated charcoal (AC) with a cathartic. In certain situations, more aggressive decontamination using gastric lavage or even whole bowel irrigation (WBI) may
be indicated (particularly with certain dangerous toxins like calcium channel blockers or iron). Before initiating decontamination, several factors must be considered including: time since ingestion, underlying medical problems, symptoms, and type of toxicant. Finally, only appropriate emetics should be used. Clients should be appropriately educated on which emetics to use at home, and to only induce emesis following recommendations from veterinary professionals or an animal poison control helpline. The use of emetic agents will be reviewed further in a future article. Time frame: Induction of emesis is indicated for most toxicant exposures within 1 hour of ingestion. If several hours have passed since ingestion, the substance has most likely moved out of the stomach and emesis will be of little benefit.
Certain toxins are rapidly absorbed, potentially resulting in clinical signs within 15-30 minutes of ingestion. In these cases, induction of emesis at home is not recommended and is best performed after patient evaluation by a veterinarian. Examples include many human prescription medications like baclofen, selectiveserotonin reuptake inhibitor (SSRI) antidepressants, and benzodiazepine or non-benzodiazepine agents (e.g., sleep aids like zolpidem). Occasionally, there are some toxins that may remain in the stomach for several hours after ingestion, and delayed emesis induction (even up to 6 hours postingestion) may still be of benefit, provided the patient is asymptomatic. These include large wads of xylitol gum or ingestions of chocolate, grapes or raisins, blood or bone meal, iron tablets (which
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Medical concerns: Brachycephalic breeds (e.g., Boston terrier, Pug, Shih-Tzu, etc.) may be at higher risk for aspiration after vomiting. Emesis induction often may be more safely performed by a veterinary professional rather than at home by the pet owner. Patients with a history of laryngeal paralysis, megaesophagus, aspiration pneumonia, or upper airway disease should not have emesis induced due to high risk of aspiration pneumonia. Symptomatic patients: Patients that are already symptomatic (e.g., agitated, hyperthermic, tachycardiac, tremoring, seizuring, obtunded, etc.) or have a decreased gag reflex should not undergo emesis induction due to the increased risk for aspiration. As the patient is already symptomatic, the toxin is likely already absorbed, and further emesis is unproductive and potentially unsafe for the patient.
Match the drug name used to treat the disease or condition. (Source: North American Companion Animal Formulary, 9th edition, North American Compendiums)
Corrosive or caustic substance: Agents that can cause corrosive injury or burns to the skin and mucous membranes may cause further damage to the esophagus, oropharynx, and gastrointestinal tract (GIT) if emesis induction is performed. Examples include undiluted drain cleaners, toilet bowl cleaners, hydrochloric acid, concentrated sodium hypochlorite and lye products. With these substances, copious flushing should be initiated instead of emesis induction to help dilute product exposure.
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Hydrocarbons: Hydrocarbons (e.g., gasoline, kerosene, mineral spirits, motor oil, transmission fluid, tiki torch oil, furniture polish oil, etc.) are low viscosity liquids that can easily be aspirated into the respiratory tract, resulting in severe aspiration pneumonia. Induction of emesis is contraindicated in patients ingesting hydrocarbons. Activated Charcoal (AC): The goal of AC is to act as an adsorbent in the GIT and prevent systemic administration of the toxin. Dosing of AC is generally 1-5 g/kg orally, but dosing per label directions for specific products should be followed as concentrations of AC may vary. Administration of AC with a cathartic (often sorbitol) may be beneficial as far out as 6 hours post-ingestion, provided the patient is not at risk for aspiration. Multiple doses of AC are indicated every 4-6 hours for 2-4 doses when the toxin is a sustained-release product (e.g., Wellbutrin SR) or when the toxicant undergoes enterohepatic recirculation (e.g., carprofen). When giving multiple doses of AC, only the first dose should contain a cathartic to help promote excretion of the drug from the GIT; additional doses should not contain a cathartic due to the risk of hypernatremia. Finally, it is contraindicated to give AC to symptomatic patients that present late post-ingestion, when corrosive substances, hydrocarbons, or sources of salt (e.g., paint balls, homemade play dough) have been ingested; when AC does not reliably bind to the toxicant (e.g., heavy metals, alcohols, ethylene glycol, xylitol); or in patients that are dehydrated, hypovolemic,
Drug name 1. Isotretinoin 2. Fluconazole 3. Dobutamine HCl 4. Imidacloprid-Moxidectin 5. Bethanechol 6. Metoclopramide HCl 7. Potassium bromide 8. Clomipramine HCl 9. Methimazole 10. Docusate sodium
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 throughout North America for pet owners, veterinarians, and veterinary technicians who need treatment advice for poisoning cases of all species. Pet Poison Helplineâ€™s fee of $35 per incident is the most cost-effective option for animal poison control care. The fee includes free follow-up consultation for the duration of the case. hypernatremic, or have a potential GI obstruction. Conclusion: In veterinary medicine, the first line of therapy in treatment of the poisoned patient is decontamination. However, judicious and appropriate use of emesis induction and administration of AC is warranted, and veterinary technicians and staff should be well aware of the indications and contraindications.
Disease or condition a. Demodicosis b. Gastroesophageal reflux c. Epilepsy d. Feline acne e. Anxiety disorders f. Dilated cardiomyopathy g. Constipation h. Blastomycosis i. Hyperthyroidism j. Megaesophagus
Answers: 1d, 2h, 3f, 4a, 5j, 6b, 7c, 8e, 9i, 10g
may form a bezoar or concretion), foreign material, or medications that may delay gastric emptying (e.g., opioids, salicylates, etc.).
Investigate the provincial association’s web sites for details on other continuing education opportunities. Current as of: March 2011
2011 April 13 Hey, this shoe doesn’t fit! TAVM Lecture Series - Senani Retnayake, Hill’s Pet Nutrition. Putting yourself in someone else’s shoes, how to deal with clients and a discussion on how to work successfully with the full team. Location: Dave & Busters, near 407 & 400 area. www.tavm.org or contact 1.800.670.1702, ext. 12 or firstname.lastname@example.org April 15-17 Atlantic Provinces Veterinary Conference Location: the Halifax Marriott Harbourfront Hotel. Lectures for veterinarians, technicians, hospital managers and support staff. Sessions include GI diseases, dentistry, Lyme Disease, AIHA, leukemia and various behaviour topics. www.apvc.ca April 29-30 Cranial Cruciate Ligament Repair - Extracapsular Technique Radisson Hotel, Kitchener. For more details, visit www.focusandflourish.com
May 11 Dr. Kelly Mitchell on Internal Medicine TAVM Lecture Series. Location: Dave & Busters, near 407 & 400 area. www.tavm.org or contact 1.800.670.1702, ext. 12 or email@example.com May 13-18 50th Annual CALAS Symposium Toronto, ON June 3-5 Grey-Bruce Veterinary Association Conference Drs. Michael Ethier and Ameet Singh - “Exploring Emergency Medicine and Surgery”. Kincardine, ON. www.gbvaconference.com June 15 Avian and Exotic Species Medicine: What You Need to Know! Speaker: Michael Taylor, DVM, Veterinary Teaching Hospital, University of Guelph. An update on
new findings in the “exotic” species groups most commonly seen in companion animal practice in Ontario - small herbivores (rabbits, guinea pigs, chinchillas), ferrets as well as common pet birds and reptiles. Emphasis on how the comparative biology of these animals affects the way we interact with them and provide medical care. Practical examples will be used to illustrate current approaches and techniques for patient diagnosis and medical care. www.tavm.org or contact 1.800.670.1702, ext. 12 or firstname.lastname@example.org October 2-5 International Conference on Communications in Veterinary Medicine Pillar & Post, Niagara on the Lake, Ontario - A high energy communication boot camp for the whole veterinary practice team. ICCVM provides skills and ideas to put into practice immediately. An intimate and interactive opportunity to network and learn new perspectives from international speakers and delegates. www.iccvm.com / 519.263.5050
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TECHNEWS Spring 2011 CE Quizzes > SUBMIT BY MAIL:
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CE Article #1: Gastric Dilatation & Volvulus 4. When a dog is suspected of being 1. Gastric dilatation is: bloated what should you do first? a. The expansion of the stomach a. Take a radiograph b. The expansion & twisting of the stomach b. Place an intravenous catheter c. The twisting of the stomach c. Start setting up surgery d. The expansion, twisting and rupture d. Start gastric decompression of the stomach 2. Which of the following is never involved in the twisting motion of a GDV? a. Pylorus b. Spleen c. Kidneys d. Fundus
5. The best tool to diagnose if a patient has GDV is: a. A right lateral radiograph b. An ultrasound c. A left lateral radiograph d. A ventral/dorsal radiograph 6. Patients with GDV can suffer from: a. A necrotic stomach b. Disseminated intravascular coagulopathy c. Ischemia reperfusion injury d. All of the above
3. An orogastric tube used for gastric decompression is: a. Where you place a needle into the stomach to alleviate the air b. The fastest way to decompress the 7. The most common choice of fluids to stomach help treat shock in GDV patients is: c. Where you place a tube down into the a. Plasma esophagus to alleviate the air b. Hypertonic Saline d. The slowest way to decompress the c. Hypotonic Saline stomach d. Crystalloids
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8. Many patients present to the hospital with respiratory distress. This is because: a. The diaphragm may be ruptured b. There is usually a tumor in the lungs causing the bloat c. The stomach is so big it is pressing up on the diaphragm d. Dogs are never in respiratory distress with GDV 9. _____ serves as a muscle relaxant and can help reduce anxiety. a. Acepromazine b. Butorphanol c. Diazepam d. Fentanyl 10. When should you reintroduce food to a post-operative GDV patient? a. 36 hours post b. 12-24 hours post c. 1 hour post d. 48 hours post
CE Article #2: Dental Home Care 1. Starting with a clean tooth, deposits will accumulate on the crowns in the following order: a. Mature plaque, immature plaque, tartar, pellicle b. Immature plaque, pellicle, mature plaque, tartar c. Pellicle, tartar, immature plaque, mature plaque d. Pellicle, immature plaque, mature plaque, tartar e. Pellicle, mature plaque, immature plaque, tartar
3. While home care efforts have limits to the good they can do, there is no potential harm in starting a home care program, so you should always recommend home care for your patients, regardless of age or the state of their oral health. a. True b. False 4. Since owners brush their own teeth regularly, they already have the necessary skills to start brushing their pet’s teeth without any guidance from us. a. True b. False
2. The purpose of dental home care is: a. To maintain good oral hygiene to prevent the development or 5. When establishing a home care progression of periodontal disease and program, it is essential to incorporate to maintain good gingival health. a veterinary tooth paste. b. To remove minor accumulations of a. True calculus to treat the early stages of b. False periodontal disease. c. To avoid the need for annual 6. The acquired pellicle will accumulate professional dental examinations and on a clean tooth surface within: treatments. a. Seconds d. To manage periodontal disease in b. Minutes animals too old or too sick to undergo c. Hours general anaesthesia d. Days e. To prevent tooth resorption e. Weeks
7. Periodontal disease is caused by: a. Food stuck to the teeth b. Plaque c. Calculus d. Tartar e. Bad breath 8. While the bacteria within a periodontal pocket may be genetically identical to the same organisms grown in the lab, they behave physiologically very differently when in a plaque film. a. True b. False 9. Bacteria in a biofilm are much more resistant to antibacterial agents than they would be in a monoculture. a. True b. False 10. A good time for home care is: a. Just before breakfast b. Before leaving for work c. Upon returning from work d. During play time e. In the evening
CE Article #3: Congenital Heart Defects 1. A congenital disease is: a. Acquired after the age of 4 b. Present at birth c. Present only in purebred dogs and cats d. Present only in newborn, small breed dogs
cythemia and differential cyanosis c. Exercise intolerance, mitral regurgitation and an enlarged left heart d. Congestive heart failure, mitral regurgitation and exercise intolerance
8. An R2A anomaly is: a. The right coronary artery passes in front of the pulmonary trunk b. The left coronary artery passes in front of the pulmonary trunk c. The coronary artery is smaller than 5. The murmur for a PDA is described as: normal 2. The ductus arteriosus is: a. A holosystolic murmur d. A dance you did in the 80’s a. A vein that sends blood into the lungs b. “Machinery” or continuous murmur b. A section in the lung that allows c. “Shoes in a dryer” 9. As it progresses, MVD may show these blood to bypass d. There is usually no murmur detected symptoms: c. A bypass of the liver by the circulatory a. Dilated right atrium and ventricle system 6. Pulmonic stenosis is most commonly b. Exercise intolerance, cough, dyspnea d. A muscular vessel which allows blood diagnosed by: and possibly atrial fibrillation to bypass the lungs a. The owners noticing a severe exercise c. Ventricular tachycardia is the most intolerance common symptom 3. Right to left shunting is the most b. Auscultation during a physical exam d. MVD shows no symptoms common PDA. c. Syncope, respiratory distress and a. True cyanosis 10. Mitral valve dysplasia may be b. False d. It is only visible on echocardiogram medically managed with this and ECG combination of medications: 4. Type 3a PDA shows these most a. There is no medical treatment available common symptoms: 7. Pulmonic stenosis can be corrected b. Pimobendan, furosemide and antibiotics a. Mild left heart enlargement and using a balloon catheter. c. Diuretics, ACE inhibitors and increased R waves on ECG a. True pimobendan b. Right heart enlargement, polyb. False d. Herbal tea and regular massage 30
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Does your clinic provide grooming? If so, then turn these customers into new clients while their pets get pampered. While the pet is in-house, have a technician perform a courtesy physical exam and complete a ‘grooming physical exam report card’. The groomer can then report this information to the owner at pick-up, or the tech can phone the owner personally. You may be surprised at how often technicians will discover issues that result in the client consenting to a more in-depth exam or blood work by a veterinarian. Many clients will be happy that problems are detected early and that an appointment can be made for their pet right away. (Veterinary Ecomonics) Towel Warmer - Use a commercially available towel warmer to warm fleecy towels for your surgical and post-surgical patients. They cost less than $100 and are easy to use. (VeterinaryMedicine dvm360.cm)
Deodorize Anal Gland Odour Wipe a small amount of Speed Stick deodorant (Colgate-Palmolive) on to a piece of gauze and then wipe the anal gland area after expression. Presto! The smell disappears. (Veterinary Medicine journal) A Simple Trick to Remember to Remove IV Catheters - Wrap red Vetrap (3M) around placed intravenous catheters and use other colours for other types of bandages. Use the red colour to remind staff to remove the bandage and IV before the patient goes home. (Veterinary Medicine journal) Make Cheater Notes - Write clients’ kids’ names and birthdays on the inside of the medical record jacket. “Then you can ask, ‘Hey, how’s Katie doing? What is she now - 12?’” he says. “They’ll be so impressed that you ‘remembered.’ You’re reading it off the inside of the chart!”
Get Involved in Organized Medicine - Participating in local, provincial, and national associations will teach you collegiality. You’ll also develop a network of people you can call when you need advice and input, either medical or career-related. Remember to Give Clients What They Paid for - If a client pays for a radiograph or blood work, be sure to show the client the film or the lab results. The little old lady may not understand what you’re saying, but she’ll know you took the time to explain things to her, and she’ll tell others that your clinic is the best! (Veterinary Economics)
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The OAVT does not necessarily endorse any of the following employment opportunities or the interviewing/ hiring techniques implemented. There is a fee for placement of ads. Please see Job Ad Form online for further details. The OAVT reserves the right to edit as space allows.
placement of an employment ad > Placement of an employment ad within the TECHNEWS newsletter is for a one issue period, which also includes placement of the same ad upon the OAVT website at www.oavt.org/employment for a three month period or until the next issue ofTECHNEWS is published. • Ads may contain graphics as long as they are no larger than 3.5” x 2” at 300 dpi. All graphics for the web may be in colour format. • The OAVT reserves the right to edit any employment ads. • Charges for ad placement are outlined below. Any requested changes to an ad already placed will be treated as a new ad and billed. Advertisement Rates
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If you want to use graphics in employment ads, please refer to the following display ad rates: Full Page $1395.00* Half Page $895.00* Quarter Page $595.00* * Taxes not included in above mentioned rates PLEASE NOTE: All Employment Ads must be submitted on the OAVT website. Payment by Cheque/Money Order/VISA (payable to OAVT) may be mailed to: OAVT, Job Ad Placement Ontario Agricentre Suite 104, 100 Stone Road West Guelph, ON N1G 5L3
10402 (Mar 11, 2011) Receptionist Matthews Animal Clinic is currently recruiting for a full-time Receptionist to join our team. Our hospital offers veterinary care for the total well-being of our client’s pets. Since 1961 we have been providing a wide range of diagnostic, therapeutic, emergency, and surgical services to dogs, cats and pocket pets. The ideal candidate for this position will have excellent communication, interpersonal and problem solving skills along with the ability to multi-task, maintain an organized work area and work in a team environment. Our hospital expects that our clients will be treated with the utmost respect and compassion by all of our staff members, therefore strong customer service skills are considered an asset. Those with experience in a veterinary office setting or a graduate from the V.M.O.A program will be strongly considered. The fulltime position offers 40 hours per week as well as 1 - 2 Saturdays per month. The successful applicant must also be flexible with their schedule. We offer competitive compensation, extended health and dental benefits and the chance to truly utilize your skills and training. If you are interested in applying for this position, please submit a cover letter and resume to: Denise Jack, Clinic Administrator, email@example.com
is a must. In addition to a competitive salary, we provide uniforms and co-pay health benefits. Quinte Animal Hospital is located in Trenton, Ontario with just a short drive to upcoming Prince Edward County tourist attractions. To apply for the position, please email resumes to firstname.lastname@example.org or fax to (613) 392-0413. Resumes should be addressed to Dr. Olga Peck.
10397 (Mar 9, 2011) RVT Ouinte Animal Hospital is looking for a full-time RVT wih excellent technical and communication skills in small animal medicine. Our emphasis is excellence in medicine and client education and a team player
10388 (Mar 7, 2011) Veterinary Technician Wanted Full-time Veterinary Technician required for growing small animal hospital in Sarnia. Previous experience required. Please send resume to The Rapids Veterinary Hospital, 1403
10395 (Mar 9, 2011) Registered Veterinary Technician Heartland is looking for a motivated and professional Registered Veterinary Technician with a positive attitude to join our multi-species team. The ideal candidate should possess strong technical, communication and interpersonal skills and will be committed to providing excellent customer service. Duties will be shared between small animal in hospital care and large animal bovine and equine ambulatory services. Small animal on call requirements include one night per week and every fourth weekend. The successful candidate must be able to work well independently and equally as well as part of a team. Experience is preferred but not essential. Salary commensurates with experience. Interested candidates can forward their resume by e-mail to Mike Kucan, Business Manager (email@example.com).
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Michigan Ave, Sarnia, ON N7S 0B1 or firstname.lastname@example.org 10381 (Mar 7, 2011) Technician Full-time RVT required for two veterinarian small animal practice in Ottawa. Required for Monday to Friday full-time day shift - no evenings. Please email cover letter/resume to Dr Graham Johnson at email@example.com 10379 (Mar 7, 2011) AHT/RVT Wanted Full-time position for an AHT/RVT. Join a dynamic team in a hospital with modern technology for medicine and surgery. Need an enthusiastic person with people skills. Must be fully bilingual. Contact: Dre Andrée Lesage m.v, Fax: 819-643-3414, phone: 819-643-2868 10385 (Mar 6, 2011) Veterinary Technician River Grove Animal Hospital, Mississauga is hiring P/T Veterinary Technician, experience in AVI mark program, clinical experience is an asset. Send resume to: firstname.lastname@example.org
10384 (Mar 4, 2011) Animal Care Attendant We are looking for an experienced individual who will be responsible for animal care duties and hospital janitorial duties. This is a full-time position for the afternoon/early evening shift with alternating weekends. Salary is negotiable; CE and uniform allowance are provided. Send resume and cover letter, attention Beth Verge, to email: email@example.com or fax: 416-223-7676. Only candidates selected for interview will be contacted. 10372 (Mar 2, 2011) FT RVT Needed Immediately Looking for an awesome RVT for fulltime position covering maternity leave starting immediately in a modern progressive veterinary hospital in Trenton. Must have a winning personality, love dealing with pets and people. Lots of humour is a must. We demand a lot, but we give back more. Must be able to use computer comfortably and be a quick learner. Must have pleasant phone manners and great communication skills. Starting remuneration is above average. This position for the right person who wins our
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: firstname.lastname@example.org), 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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clients’ hearts will develop into full-time position. On-call schedule is one every 2-3 weeks, no Saturdays. Our on-call load is minimal. All we ask is a winning attitude, everything else we will teach and train. All enquiries are strictly confidential. Must be able to provide phone references. Email with your resume to email@example.com 10370 (Mar 1, 2011) RVT Are you a Registered Veterinary Technician interested in utilizing the full spectrum of your RVT skills? Do you want to develop an area of interest that would complement and strengthen our team? Then you want to consider joining our health care professional team! Queen West and Dundas West Animal Hospitals are looking for compassionate and client service driven RVT to join our dynamic team. CE allowance, dues, uniform allowance, etc. Salary to commensurate with experience and new grads are welcome. Our clinics are located in great communities and the hospitals are well established with state-of-the-art equipment. Interested applicants may
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
contact Patrick for more information at 416.815.8387 and/or forward a resume directly to email@example.com 10369 (Mar 1, 2011) Veterinary Technician Research TCP has an opening for a Veterinary Technician, full-time/one year contract. Reporting to the Supervisor, Technical Services the incumbent will provide specialized technical and clinical services to a variety of research projects. The successful candidate must be a graduate of a Veterinary Technician program, with RLAT (CALAS) preferred. E-mail or fax resumes to: firstname.lastname@example.org fax 647-837-5834 10368 (Feb 28, 2011) Part-time RVT Part-time RVT for Cats only clinic. Mondays and Wednesdays, to cover our full-time tech’s days off. Email resume to email@example.com fax 519-821-4928 10364 (Feb 28, 2011) Competent & Caring Full-time RVT This opportunity is exactly what you have been waiting for, what you were trained to do: to help pets, clients and your team members to achieve the highest standards of veterinary medicine in a caring environment. We are looking for a very good technician! Includes medical/dental benefits, C.E. Please send your resume to firstname.lastname@example.org. 10360 (Feb 25, 2011) RVT Lexington Rd. Animal Hospital has been serving the Kitchener-Waterloo area for 25 years and is a team oriented clinic with excellent support staff. We are looking for a compassionate and professional Registered Veterinary Technician to join our dedicated, skilled and friendly team. We pride ourselves on providing our clients with exceptional customer service and our patients with an unparalleled level of care. You must have strong technical and communication skills, a positive attitude and an obvious love for animals. We are a paperless practice, with digital radiography, dental radiography, ultrasound, and laser therapy. Our clinic hours are Monday to Friday 8-6:30 and Saturday 8:30 am to noon. After hours
and weekend emergencies are referred to the EVC. Please email cover letter and resume to Michelle Mathes, Manager, email@example.com 10350 (Feb 18, 2011) RVT - Full- or Part-time Emergency +/- Day After 23 years of high quality day clinic, now going 24/7. Looking for full- or part-time RVT’s who can work independently and within the team, help clients feel comfortable, with great technical skills. Primarily 8pm - 8am nights, 8am - 8pm weekends & holidays. firstname.lastname@example.org 10345 (Feb 14, 2011) Full-time RVT, Come Join Our Team! Come join Royal Ford Veterinary Hospital in Oakville! Full-time RVT required for our family oriented, two-veterinarian small animal practice. We are a compassionate, progressive, client service oriented hospital that practices high quality medicine and surgery. We offer a competitive compensation package including OAVT dues, CE, and excellent health benefits. Looking for a positive, friendly, outgoing team player with exceptional communication skills and technical expertise. Please fax your cover letter and resume to (905) 337-1882 or email it to Dr. Chris Catena at email@example.com. 10341 (Feb 11, 2011) Client Care Specialist New start-up AH is seeking P/T Client Care Specialist in Richmond Hill, ON. Our Client Care Specialists compassionately answer client questions, schedule and triage patient appointments, ensure safety/comfort in the wait area, and assist a doctor with pets as needed. Hours - some evenings and Saturdays as well. Please send resume and list of references to Dr. Sergiy Dariy at firstname.lastname@example.org 10335 (Feb 7, 2011) Veterinary Technician We are looking for a part-time to fulltime technician to work in our small animal clinic. Our patients are mostly cats and dogs, but we do furry exotics as well! Patient care, client relationships and communication skills are vital. Phone: 519-660-8048, Fax: 519-660-8690, Email: email@example.com
10330 (Feb 2, 2011) Emergency Hospital RVT High quality day hospital going 24/7. We need great RVT’s for weekends, nights, holidays- motivated to help and educate clients, full tech duties, reception work (more initially till the business grows), great care of patients. Need excellent communication skills - fluent in English. Full- or part-time. email firstname.lastname@example.org, or submit resume in person. Visit our website at www.clarksonvillagevet.com. 10329 (Feb 2, 2011) R.V.T. Required Position available for RVT. Must be a Registered Veterinary Technician, and member of the OAVT. Rabies and tetanus immunization required. Confidentiality of applications ensured. Respond to: email@example.com 10319 (Jan 27, 2011) Available - Full-time Position Full-time position available for a Registered Veterinary Technician in our busy, progressive companion animal clinic. We offer a competitive salary, OVMA benefits, uniforms, and CE. Resumes may be emailed to Coldwater Road Animal Clinic at firstname.lastname@example.org or snail-mailed to 8035 Hwy 12 W, Orillia, ON, L3V 6H2 10307 (Jan 19, 2011) Animal Care Attendant Full-time permanent Animal Care Attendant for animal hospital in Southwest Mississauga. Duties: patient care, hospital maintenance, reception, assisting with medical procedures. Good organizational skills and high energy required. Evening and nights (7:15 pm to 7:45 am) and weekend shifts (day and night coverage) Submit resume to 1659 Lakeshore Road West or e-mail email@example.com. Please no phone calls. 10304 (Jan 17, 2011) Part-time Receptionist We are looking for an enthusiastic team player to join our clinic who is willling to work in a busy environment. We are a progressive, well established clinic with over 25 years in dealing with both conventional and holistic medicine. We strive to make our days enjoyable at the same time working hard. If you are interested please forward your resume to: firstname.lastname@example.org, Fax: 416-285-7483
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10301 (Jan 14, 2011) Full-time RVT North Oakville Animal Hospital is looking for an experienced RVT to fill F/T position. CE allowance, health benefits and uniforms provided. Hours include morning and evening shifts on a rotational basis. Please email resume to Barb at email@example.com 10294 (Jan 12, 2011) Veterinary Receptionist/ Assistant Veterinary Receptionist/Assistant required for 20-25 hours per week, may increase. Duties include both reception and assistance. Strong communication skills and work as a team. Send resume to: firstname.lastname@example.org 10283 (Jan 6, 2011) RVT The Vaughan-Richmond Hill Veterinary Emergency Clinic is currently accepting applications for dedicated, enthusiastic RVTs to join our after-hours (overnights, weekends) emergency practice. Our modern facility has full in-house bloodwork capabilities, Surgivet monitoring equipment, digital radiography - just to name a few. If you think you would be an asset to an ER practice that values excellent technical skills alongside excellent interpersonal skills, a cheerful outlook, and the ability to approach our diverse caseload with competence, empathy, and a sense of humour, then you may be just the right fit. Emergency/critical care experience is preferred; however, special consideration may be given to exceptional candidates, including recent graduates. If you have always been the best at what you set your mind to, there is strong potential for long-term career opportunities . Competitive salary and benefits will be discussed at interview. Please submit your resume, along with cover letter, to email@example.com. All applications will be in confidence. 10282 (Jan 6, 2011) RVT The Ottawa Veterinary Hospital is an Ottawa based small animal clinic with a 24-hour emergency service. We are seeking full-time RVTs to join our dynamic team. Our growing and progressive team offers a challenging and positive environment whereby you can maximize your technical and client service skills. We offer competitive wages,
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health and dental benefits, CE, sick leave, shift premium and above all a positive and excellent learning work environment. Shift work required including nights, weekends, and holidays. We are in search of upbeat and outgoing professionals who possess excellent team playing and communication skills, and high quality patient care and client service. We have one full-time and one maternity leave/contract position available. Please send resume in confidence to: Sherry Philp, Head Technician, 613-725-5659, firstname.lastname@example.org 10281 (Jan 6, 2011) RVT The Bells Corners Animal Hospital is a small animal clinic located in Ottawa west. We are seeking a full-time RVT to join our dynamic team. We offer competitive wages, health and dental benefits, CE, sick leave and above all a challenging and positive work environment whereby you can maximize your technical and client service skills. We are in search of upbeat and outgoing professionals who possess excellent team playing and communication skills, and high quality patient care and client service. Please send your resume in confidence to: Joseph El-Farr, Managing Director, Bells Corners Animal Hospital, 613-725-5659, email@example.com 10278 (Jan 6, 2011) RVT A competent, compassionate, enthusiastic veterinary technician is required to join our team on either a full- or part-time basis. We are a small animal hospital which provides quality medicine in a friendly, supportive environment. Interested applicants please email resume to firstname.lastname@example.org or fax to 1-705-549-3731 10276 (Jan 5, 2011) Looking for Part-time RVT! Established 2 doctor practice in Newmarket looking for a part-time Registered Veterinary Technician to join our team. Successful candidate must be motivated and enthusiastic. Wage based on experience. CE/uniform allowance available. Please email resume to email@example.com or fax to (905) 895-9745. 10275 (Jan 5, 2011) Registered Veterinary Technician Full-time, overnight technician required for
a 24 hour hospital. Hospital is well established, recently expanded, technologically up to date, serving Brantford and area for over 55 years. Facility occupied by 8 veterinarians and 30 support team members. We strive to provide excellent care for pets, excellent service to clients and a happy working enviornment for our employees. We are not an emergency hospital, we just work around the clock. Salary: $18-20/hour + to start. Contact Angela Brown, RVT. fax: 519-756-2305, firstname.lastname@example.org 10270 (Jan 4, 2011) Full-time/Part-time VT/RVT Position Available We are looking for a compassionate and skilled individual to join our fast paced clinic. We are aiming to expand our client and patient care by finding more great team members. We boast a long list of exciting services including Orthopedics, Cancer care, Ultrasound, Digital Xrays (No stinky dip tanks or developer fluids here!!), a Dog and Puppy Daycare, Inhouse lab and many more exciting ways to exercise your skills. Students are welcome to apply but must be available for some daytime shifts. Resumes can be emailed to email@example.com 10258 (Dec 20, 2010) RVT Wanted Full- or Part-Time King Animal Clinic is looking for an addition to our team of 3 full-time technicians. The desirable candidate will be reliable and trustworthy and enjoy working with both people and animals. Position will include some reception duties and will be geared toward the candidateâ€™s personal interests and abilities. Strong motivation to learn and grow in your field is encouraged. Either full-time or part-time hours available for the right person. New grads welcome to apply. Competitive salary and health plan offered. Please send confidential resume to firstname.lastname@example.org. 10253 (Dec 15, 2010) Reception/Technician A new small animal practice in Bolton is looking for a suitable candidate for a fulltime position. Candidate should be able to multitask and confident in handling animals. Knowledge with Cornerstone will be an asset. Please forward you resumes to email@example.com. Only suitable candidates will be contacted.
and Self- Directed Learning: What Veterinary Practices Need to Know Lauren O’Leary, RVT CVPM
“The purpose of a business is to create a customer…who creates customers” - Peter Drucker What Clients Want: Clarity The internet is empowering people to learn more, through self-directed learning and learn it faster than ever before. Clients may come to us for a second opinion or are seeking a certain treatment or protocol for their pet but have never received a definitive diagnosis; they simply learned about it on the internet. Veterinary health care as we know it is changing. No longer will veterinary hospitals solicit clients to inform and educate them about their services; informed pet owners will search the web for a practice that meets their needs, within their chosen area. Many will have visited the clinic’s web site prior to choosing a hospital to look up the doctors online, to check out their stance on an ethical is-
sue, view from where they graduated, and where their interests lie within the field. A client can make contact from around the corner, or from around the world. No longer are closed doors with “employees only” signs appropriate. Clients want clarity. They want to see where their pet is going and how it will be treated, and with what protocol. What equipment is being used to monitor them? What are the credentials of the staff members attending to their pets? Wouldn’t you want to know the same for your pets? After all, our pets are like family. (AAHA Report 1995) One recent text sites, “After their physician, nurse or pharmacist – people are looking within their network for good advice on medical treatments. Some even list the advice from friends above that of their physician. Seventy six percent rely
on what others say, while only 15% rely on advertising. [Socialnomics, Erik Qualman (2009)] Within the veterinary health care industry, social media tools such as: breed club pages, client support groups, social networking sites, blogs, webinars, health education networks such as the Veterinary Information Network (VIN), Lifelearn, and Veterinary Support Personnel Network (VSPN), as well as video sharing sites like You Tube, are becoming increasingly popular. Clients may have been introduced to educational sites like Elluminate, Wimba and Moodle. They may have already used learning management systems sites like Blackboard while at school, so using these sites become a very natural adaptation for them. There are interesting phone apps specific to veterinary medicine including formulary and calculation programs
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which assist with drug doses, fluid calculations, conversions etc. (e.g. ‘A Vet Tool’). With the addition of programs like Skype and NetMeeting, we can keep in touch virtually with clients. Programs like Page Turner, SlideShare and Flickr can help us post virtual tours and photos demonstrating simple procedures to clients and to share event photos we are involved within the community. Search engines are expanding their reach and becoming increasingly more specific in focus with sites like Digg, Firefox, Reddit, Stumbleupon, and bookmarking sites like Delicious. Clinic websites can become increasingly more interactive with tools such as podcasts, web radio and video sharing devices. Online sites Zoomerang and SurveyMonkey help clinics to design and collect data from clients through surveys on their websites. Sites like Voki, Animoto, Audacity, Prezi, are also gaining in popularity. Check them out and see for yourself the tools that are available for your clinic to use, many that your clients are already using. These forums are changing the way veterinarians, their staff, and their clients learn, interact and communicate with each other. Client expectations are changing right along with these new modes of communication, this new method of bringing clients into community with us. People rely more heavily on the internet now than ever before. In fact, they make medical decisions, get support, and learn about disease conditions without even contacting a physician. (SarasonKahn 2008) With the advent of Web 2.0, clients can share what they learn with others around the world experiencing the same journey. Author Jane Sarasohn-Kahn states “The collective wisdom harnessed by social media can yield insights well beyond the knowledge of any single patient or physician”. Online forums allow clients to search, blog and learn about treatment regimes for the management of their pet’s diseases. They can access technical support sites from product manufacturers. They can come into community and support other pet owners facing the same struggles, such as pet loss, diabetes and cancer.
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When asked what they really want, clients will tell you plain and simple: they want clarity. They want to learn everything they can about their pets, their conditions and at their own pace. Doing so on the internet becomes one way to meet their needs. Shifting the Way We Think, Learn and Connect Social media is a shift in the way we think, learn, and connect with our clients, our staff and our community. Forums provided by social media networks are not giant bill boards for no charge advertising, nor are they simply vehicles for selling people more products. Social media is about sharing information and bringing clients and their pets into community with your clinic. Searching for information is empowering for them, and it is engaging their minds to learn all they can about their pets condition. It isn’t just a big pool of data. They want to share the experience with others, not have data dumped on them. They choose what they want to learn about, in the format they desire, through the venue of their choosing, be it Facebook®, a blog post, support group, or even Twitter®. In the past, learning required a physical classroom and a teacher. As web-based tools like Elluminate, Wimba, Blackboard, and Sakai have evolved, those wishing to learn online, can do so in their choice of environments: a synchronous (Instant Messaging, real-time) or asynchronous (blog post), whichever suits their needs.
chances are, so are your clients. Don’t make them work too hard, or they may choose someone else’s services. Monitor your online reputation using, “Google Alert” to crawl the web on your behalf, looking for recent postings, reviews or data about your clinic. Respond to reviews and ratings – be honest and forthright. Correct any misinformation, apologize to people who are upset or have concerns. Remember to be real; these things will happen to everyone occasionally. Within veterinary hospitals, we are already recruiting staff via postings on the internet using college and association websites and social media tools such as Linked In®, Monster.ca™ and vehicles like Craigslist™ and Kijiji™. In the meantime, privacy legislation allows us to check out potential staff members out by opening up their Facebook® page to see what they are really like when they let their hair down. This generation of learners has grown up online (Baird, Fisher 2005), surrounded by the digital world, and as a result have developed new ways of processing information. They are “hardwired” to simultaneously utilize multiple types of web-based participatory media. This is a technologically savvy generation of learners who have no concept of using a 26 volume set of encyclopedias.
What’s Web 2.0?
The Future The term Web 2.0 is associated with web Needs applications that facilitate participatory Integration information sharing, interoperability, user-centred In the future, we design, and collaboration on the World Wide Web. A will learn to listen Web 2.0 site allows users to interact and collaborate with each other in a social media dailogue as creators to our clients via (prosumers) of user-generated content in a virtual their chatter on community, in contrast to websites where users the internet. We (consumers) are limited to the passive viewing of will monitor our content created for them. Examples of Web 2.0 own presence on the include social networking sites, blogs, wikis, web. Have you ever video sharing sites, hosted services, performed a web search web applications, mashups and folksonomies. (Wikipedia) for your own practice? If you are having trouble finding your facility on the web,
Almost immediately following the introduction of Web 2.0, one very important area of our practices began to change: our libraries. This area within our practices may become entirely virtual, with no tangible books or journals; replaced with e-books, e-zines, and e-journals, all read on iPads™, Kindles™ or tablets. At the very least, they will be delivered digitally to our smart phones. Newspapers have already begun to see circulation rates declines with the advent of web-based news sites. These rapid changes in technology demand continual learning, unlearning, and relearning as people adapt to emerging innovations and developments. Technology is changing so rapidly we need continual training just to stay afloat. We need to integrate, but what does that look like and how does one go about integrating? One popular scenario has been to operate each of these social media functions through an area within your clinic’s website homepage. For client access, icons can be arranged which click right on to your Facebook®, Twitter®, LinkedIn® and YouTube® sites. You can also post a general interest pet blog that is linked to your clinic’s website enabling clients to see with which hospital the writer is affiliated. All of this can bond clients to your practice. Perhaps one of the biggest changes to our world is going mobile. Forget the desktop computer, most of these new social media forums have applications which run on clients’ and staff members’ phones. Most are web-based and require mobile browsers, hence the popularity of the Blackberry® and iPhones®, and now the iPad®. What is disturbing, however, about all this talk of technology, is the speed with which these progressions are made. How can our staff keep up with this pace of change? How much preparation and training will need to be done in order to increase the productivity of staff members with the advent of these tools? Will they significantly decrease the hours in a work day, or have they merely provided a way to take work with you, everywhere, with no escape? How much time will all this take? Where is the typical veterinary
hospital on this continuum of social media and its integration into veterinary practice? Unfortunately, the industry is all over the map, as everyone progresses at his or her own pace. It will take some time for hospitals and their clients to embrace this new culture of learning. Pace Yourself In 1967, a US senate subcommittee predicted that by 1985 US citizens would be working 22 hours a week with the advent of the new computer technology. (Swenson, 2007) No study needs to be referenced to determine how that projection turned out. Workloads have increased, stress has increased, ‘to do’ lists are longer, almost invariably due to these very technological advances that futurists were sure would be a godsend. To date, there are no longitudinal studies available on the affect of the social media boom on society and our self-directed learning. However, by virtue of our human nature, we are all about the next trend. In the long run, has each of these so called booms or trends benefited us? Has it benefited our environment and our living conditions, or just sold more consumer goods? Is Technology Really Progress?
“Few companies that installed computers to reduce the employment of clerks have realized their expectations... They now need more and more expensive clerks even though they call them ‘operators’ or ‘programmers.’” - Peter Drucker Progress continually gives us more options and advances at exponential rates. We have more technology, more laboursaving devices, more affluence, and more information than ever before, but we are stuck with human limits and 24 hour days. Progress has put us on a collision course with our limitations. (Swenson, 2003) If we listen to the rhetoric, technology is designed to make our lives simpler and easier, to save us time and money. Yet studies show more time than ever
is spent in front of a computer screen, and technology continues to be one of the most watched items on the stock exchange. When will our human expectations cease? The new, ‘bigger, better, faster’– has now become ‘smaller, mobile, and less expensive’. Technology used wisely, can be freeing. However, like anything in life, it can become allconsuming. We need to learn how to unplug and turn off, to protect our staff from overload and burn out. Daily, we see people walking and texting, surfing and tweeting, checking emails while they drive, and even while they develop x-rays. Lauded for their ability to multi-task, these people are not interacting with others, nor are they relaxing. Will social media benefit the important things in life long-term? Will it build relationships? Will it build our children’s ability to interact socially, or spell with proper English? Or will it take us backwards with all high tech and no high touch? Will phone calls to clients cease, only to become an email, or a tweet? How can we know? How can we see into the future? We can not, we can only be aware of the risks and benefits of these tools. Are There Benefits? Yes, clearly many hospitals are already seeing tangible benefits of the alliances formed through blogs and Facebook® pages for their clinic; there is a more intimate bond with their clients. Clients feel better-informed and they receive timely dissemination of information such as: alerts, food recalls, reminders, and invitations to events. Clinics are finding out very quickly what works and what doesn’t work for their clients, as clients have not been shy about speaking their minds, and giving feedback. On the upside, results are traceable if there is attendance at a posted event. What about return on investment? Many clinics will state that they feel they did not have to make a substantial investment of cash or time to get their programs up and running if they already had a presence on the web. Many of the programs and applications are free.
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Are There Risks? Most certainly! Cyber bullying, propaganda, spam, scams, false information, slander campaigns, privacy issues, tampering, hacking, and information overload – to name a few. Is there really a client-patient relationship based on web interaction? Can we charge for advice we give? Is it ethical to consult on the internet? All theses questions and many more will arise. Once something is out there posted on the worldwide web, it is out there forever. You can not take it back. Your only hope if misinformation is posted is to move into damage control mode. Answer honestly, correct mistakes and move on. What does it cost? Is it really free or is it costing us in terms of time staff are spending on manning sites, posting, blogging, checking and responding to emails and requests? Is it worth the effort? That remains to be seen, however at this juncture, one thing is true - clients certainly seem to think so! Action Steps for Clinics Embarking Upon a Social Media Campaign • Niche your market • Remember - it’s about referrals • Remember - overall database numbers are not important if no one comes back • It’s all about a relationship and building a community of learners • Clients will choose if that community leads to a booked appointment, or a sale • Listen to your clients and find out what they want or expect • Google yourself and your clinic – find out what clients are saying or not saying about you • Keep it simple • Have fun • Learn to integrate – there are programs to inter-connect applications. i.e. HootSuite • Share the love! Don’t have one person in control of all aspects of your social media • Designate different staff members to update different areas so the workload is shared Summary In summary, it was our goal to delve into how today’s veterinary team is coping with the steep learning curve that accompanies a foray into the realm of social media and self-directed learning. In the very near future, veterinary communication will be revolutionized by the integration of social media into all aspects of client education and patient care. This shift in the way we learn and educate our clients, our staff and our community will be a fundamental change within the very culture of those veterinary teams that choose to embrace it.
Conclusion The domain of social media is vast. Remember that everyone learns at their own pace, so go slowly. Better to master one area, gain confidence and move along, than to jump blindly into several areas at one time, not attend to them, or enjoy success in any of them. You will find champions on your team in certain
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areas: planning, execution, posting, updating. Don’t be afraid to celebrate successes, and discuss failures. Trial and error actually makes a good bedfellow for self-directed learning. Train, Train, and retrain. Integrate for ease of use, eliminating the need to access emails and posts at many different sites. Consider a software or application that does this for you for free, such as TweetBig. Check often for new applications and updates. This realm of social media is moving very quickly with new products being added daily. Remember also that different things motivate different people to learn, and people will naturally gravitate to a vehicle they can easily learn to manipulate, within their learning style. There is one overwhelming truth regarding social media - there is a desire to connect and to be in community with others which runs deeply within us all. If at first you don’t succeed, tweet tweet again!
Acknowledgements The author would like to thank Dr Pownall, of McKee Pownall Equine Services for his insight into the integration and effects social media on his practice. Lisa Yackel, CVPM Case Veterinary Hospital, Savannah Georgia, for sharing her insights into the affects of blogging in a veterinary practice and its effects on acquiring new clients and holding your own in a down economy. Brenda Tassava, CVPM Broad Ripple Animal Clinic, Indianapolis, Indiana for her vast amount of personal experience in taking something huge, and tying it all up with a neat little bow and making it simple for us all.
references > 1. Baird, Derek E. M.A., Fisher, Mercedes (2005) Neomillennial user experience design strategies: Utilizing Social Media to Support “Always On” Learning styles 2. Qualman, Erik, Socialnomics: How social media transforms the way we live and do business, 2009 3. Wen-ying Sylvia Chou, PhD, MPH; Yvonne M Hunt, PhD, MPH; Ellen Burke Beckjord, PhD, MPH; Richard P Moser, PhD; Bradford W Hesse, PhD, (2009). Social Media Use in the United States: Implications for Health Communication, Journal of Medical Internet Research, Nov 27 2009 doi: 10.2196/jmir.1249 4. Sarasohn-Kahn, Jane M.A., M.H.S.A., (April 2008) The Wisdom of Patients: Health Care Meets Online Social Media, Prepared for California Health Care Foundation, by THINK-Health 5. Swenson, Richard A. MD (2003) Overcoming Overload. Family Practice Management March 2003, Vol 10 No 3 76-77 6. The 1995 AAHA Report, A Study of the Companion Animal Veterinary Services Market, AAHA Press, 1995, Lakewood Colorado. Pg. 15 Pet Owner Research
US - Veterinary technicians receive positive occupational outlook - According to AAHA, the occupational outlook for veterinary technicians is “decidedly bullish,” using the U.S. Department of Labor’s Bureau of Labor Statistics and its occupational outlook handbook. With pet ownership on the rise, positions in the veterinary industry are firmly housed in the growth sector, according to the report. “Employment of veterinary technicians is expected to grow 36 percent over 2008-18 period, which is much faster than the average for all occupations,” the BLS report said. In particular, the increased spread of specialized and advanced veterinary care will create wider opportunities. Smaller class sizes in both 2- and 4-year veterinary technology graduating classes will translate to better prospects out of school for those new to the field. The Bureau has identified two venues where the competition is expected to remain high for the foreseeable future: aquariums and zoos. Stats show that the number of veterinary technicians in the United States increased ~24 percent, from 63,860 in 2005 to 79,200 in 2009. Meanwhile average annual salaries increased close to 15 percent, from $26,710 to $30,580 during the same period, AAHA reported. (Vet Advantage Weekly News)
Canada - Finesse to Power at Canada’s Outdoor Equine Expo - From dressage queen Jane Savoie to the mighty Clydesdales, the line-up at Canada’s Outdoor Equine Expo has finesse and power rolled up into one exciting event this June. Jane Savoie, one of the most recognized coaches in Olympic-level dressage, will bring the beauty and finesse of horses dancing dressage to her clinics at the Equine Expo. But when it comes to sheer power, Belgians, Percherons and Clydesdales are the musclemen of the equine world. They will be on display in full force in a variety of events and educational workshops under the watchful eye of draft horse expert, Jim Poole. For over 20 years, Jim Poole worked with and managed Budweiser Clydesdale Operations at Anheuser-Busch in St. Louis, MO. At Canada‘s Outdoor Equine Expo from June 10 to 12, 2011, Poole will share his expertise and anecdotes from a lifelong career with draft horse hitches and teamsters. Canada’s Outdoor Equine Expo will be held June 10 to 12 at the Iron Horse Equestrian Complex south of Milton, ON. For more information, visit www.EquineExpo.ca US - California bill gives technicians a seat on the state’s Veterinary Medical Board - San Diego - On Jan. 1, 2011, California joined 16 other states in assign-
US - New Bolton Center launching equine home nursing program - The University of Pennsylvania School of Veterinary Medicine launched Equi-Assist, an equine home-nursing program in December 2010. Believed to be the first program of its kind in the U.S., Equi-Assist will make clinical and post-hospitalization nursing services available to equine patients at a client’s home barn or lay-up facility. Equi-Assist will be limited to a 25-mile radius of the hospital, and the cost of care will be based on the length of the visit and the distance the technician must travel. There may be extra costs if there are specialized needs. The service will be performed by certified veterinary technicians with extensive equine experience plus additional training specialized to the home-care program. (dvmnewsmagazine.com)
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Super-big huggable protection against fleas and other parasites. Tasty little tablet.
NOAA scientists approach the young North Atlantic right whale they disentangled on Jan. 15 off the coast of Cape Canaveral, Fla. (Credit: With permission from EcoHealth Alliance)
US - Endangered right whale sedated, disentangled - U.S. wildlife scientists have successfully disentangled an endangered North Atlantic right whale using at-sea chemical sedation, marking the second time a “freeswimming” whale has been sedated to remove ropes from its body. The young female, born during the 2008-09 calving season and estimated at nearly 10 metres, was swimming off the coast of Florida on Christmas Day, 2010 when it was spotted by an aerial survey team. It was dragging fishing rope and wire mesh. Five days later, a team from the Georgia Dept of Natural Resources and Florida Fish and Wildlife Conservation Commission was able to remove 46 metres of rope. But an additional 15 metres remained wrapped through its mouth and around its flippers. So scientists with the National Oceanic and Atmospheric Administration (NOAA), along with state and non-profit group scientists, tracked the animal via satellite tag to see if it could shed the remaining rope on its own. When the whale still hadn’t disentangled itself by Jan. 15, the scientists moved in. Working off the coast of Cape Canaveral, they injected it with a sedative so they could safely move their boat close enough to cut the animal free. Before leaving the whale’s side, they also injected it with antibiotics to fight possible infection in its wounds. “Our recent progress with chemical sedation is important because it’s less stressful for the animal, and minimizes the amount of time spent working on these animals while maximizing the effectiveness of disentanglement operations,” Jamison Smith, of NOAA’s Fisheries Service, said in a release. NOAA continues to track the animal’s progress. Fishing gear removed from the whale was similar to what is used in the trap or pot fisheries for fish, crabs and lobsters along the midAtlantic, northeast U.S., and Canadian coasts. With an estimated 300 to 400 North Atlantic right whales left, the creatures are among the most endangered whales in the world. (cbc.ca)
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tant infections and the resulting increase in morbidity and mortality rates by “bringing together global political, scientific, industry, economic, intellectual property, policy, medical, and philanthropic leaders to develop creative incentives that will stimulate new antibacterial research and development,” according to a statement from the IDSA. A policy statement from the IDSA expresses concern that current antimicrobial development could be insufficient to counteract the increase in the prevalence of drug-resistant infections. (Vet Advantage Weekly News)
US - New guidelines for standards of care in animal shelters - “Guidelines for Standards of Care in Animal Shelters,” researched and written by 14 members of the Association of Shelter Veterinarians over two years, is now available. The Standards of Care begins with the Five Freedoms for Animal Welfare, originally developed as a basic creed for the care and husbandry of farm animals. The Standards note that the Five Freedoms have been applied to companion animals in other countries, and have even been used for laboratory animals. The Freedoms are: 1. Freedom from Hunger and Thirst; 2. Freedom from Discomfort; 3. Freedom from Pain, Injury or Disease; 4. Freedom to Express Normal Behavior; 5. Freedom from Fear and Distress. Also included in the Guidelines are: Effective population management requires a plan for intentionally managing each animal’s shelter stay that takes into consideration the organization’s ability to provide care; Tethering is an unacceptable method of confinement; and cages or crates intended for short-term temporary confinement or travel are unacceptable as primary enclosures and are cruel if used as such. (Vet Advantage Weekly News) ing a credentialed technician a seat on the state veterinary medical board. Bill AB 1980, changes the makeup of the California Veterinary Medical Board, adding an RVT to the four veterinarians and three public members sitting on the board. This collectively gives technicians a vote on regulations that affect the practice of veterinary medicine. It also means a technician will participate in disciplinary decisions the board makes against technicians. The bill also included title protection for credentialed technicians, clearly drawing a distinction between veterinary technicians and assistants. (Firstline) China & India - A cure for euthanasia? Humane organizations throughout the world can’t surgically sterilize homeless cats and dogs fast enough to control their numbers, and developing countries with dangerous feral dog populations—such as China and India—fare even worse. As a result, millions of dogs and cats are euthanized in shelters each year, and millions more are shot and poisoned around the globe. For
the past decade, humane organizations have pushed for a non-surgical alternative to traditional spay/neuter surgery—something cheaper and faster, such as a vaccine or a pill, that would allow them to reach many more animals with the same resources. Researchers have developed similar products for wildlife, but they have turned out to be ineffective or impractical for use in companion animals. Lack of funding and interest has slowed further progress. That may be about to change, thanks to a U.S. billionaire named Gary Michelson, who has announced $75 million in grants and prize money for the development of a single-use, nonsurgical sterilant for dogs and cats. (Science Now) US - AVMA supports antimicrobial development project - The AVMA and more than 20 other medical organizations have endorsed an initiative of the Infectious Diseases Society of America to support development of 10 new systemic antimicrobial drugs by 2020. The 10 x ‘20 Initiative is intended to combat the rising number of drug-resis-
US - Petfinder.com Foundation, Intervet/ Schering-Plough to distribute 1 million doses of flu vaccine - Petfinder.com Foundation is partnering with Intervet/ScheringPlough Animal Health, makers of the NOBIVAC Canine Flu H3N8 vaccine, to help local animal shelters and rescue groups take a leadership role in building community immunity against canine influenza virus (CIV). Up to 1 million doses will be distributed to Petfinder.com member organizations selected from those who submit grant applications for the vaccine. Each shelter and rescue organization awarded the grant will receive up to a four-month, two-dose supply of the vaccine. (Vet Advantage Weekly News) US - AVMA releases prescriptions, pharmacies FAQs - The American Veterinary Medical Association (AVMA) has released two new FAQs, one for pet owners and one for veterinarians, with answers to a number of frequently asked questions about veterinary prescriptions and pharmacies - including Internet pharmacies, according to a JAVMA news report. The FAQ for pet owners covers subjects such as the necessity of prescriptions, differences between brandname and generic drugs, and restrictions on the sale of some flea and tick products. The document offers reasons for pet owners to consider buying prescription drugs from a veterinary clinic rather than a pharmacy. The FAQ also discusses methods for determining whether an Internet pharmacy is reputable. The documents for pet owners and veterinarians both address the need for a veterinarian-client-patient relationship before a veterinarian can write a prescription. The FAQs note the AVMA recommendation that veterinarians comply with client requests for prescriptions to fill elsewhere. The FAQs are available at www.avma.org/issues/ prescribing (Vet Advantage Weekly News)
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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
Information • Interferon (Roferon, Intron A, Alferon N) • Brand Name: Roferon, Intron A, Alferon N • Available as injectable but commonly diluted into oral liquid Background The search for a general stimulant for the immune system has been on-going and no single product has emerged as efficacious. Products that are currently employed as immunostimulants include: vitamin C, echinacea (an herb), acemannan (an aloe derivative), levamisole (a dewormer), and many others. The interferons are what we call cytokines, meaning they are biochemicals secreted by cells of the immune system to regulate other cells of the immune system. There are several members of the interferon family classified according to the receptors. Interferon use in human medicine became much more common after genetic engineering technology enabled mass production of interferon proteins. Interferon alpha is strongly antiviral in its higher doses and is a more general modulator of the immune response in lower (dilute) doses. How This Medication is Used A bottle of injectable Roferon® contains 3 million units of interferon. When this bottle is diluted in saline appropriately to a dose of 30 units per mL, it is easy to see how the single 3 million unit vial can be used to make fairly large quantities of dilute oral solution. This translates into a reasonably priced product that can be prepared in any veterinary hospital. At the present time interferon alpha 2a made from Roferon is becoming scarce as Roche Pharmaceuticals has discontinued its man-
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Educational Director, VeterinaryPartner.com
ufacture. Interferon alpha 2b, called Intron A®, is more expensive but should work the same way. A feline recombinant product is available in Europe and its introduction to North America is highly anticipated. The oral preparation of dilute interferon is given once a day. The interferon enters the tonsils and lymph nodes of the throat as it is swallowed and exerts its immunostimulating effect there. Situations where dilute interferon alpha is commonly prescribed are: • Viral upper respiratory infections (especially in kittens) • Feline plasma cell stomatitis • Feline eosinophilic granulomas (especially lip ulcers) • Management of feline leukemia virus infection. • Management of feline immunodeficiency virus infection • Canine distemper infection • Systemic fungal infections (coccidioidomycosis, blastomycosis, histoplasmosis, aspergillosis) The low dose protocol was originally published giving interferon on alternating weeks (one week on medication and the next week off). This was because there was some concern that bone marrow suppression was possible with interferon as this had been seen in humans (albeit with higher doses). Since these fears were never realized, daily protocols have become more common. At higher doses (in the 10,000 unit range) interferon alpha is directly antiviral. The higher dose protocols are not commonly used because of expense, side effects potential, and eventual development of antibody production rendering the drug useless. Situations where these protocols have been used include treatment of: • Feline infectious peritonitis • Canine viral papillomas
Interferon has been used topically in the feline eye for herpes conjunctivitis. Side Effects The low-dose interferon protocol has not been associated with side effects, though since the preparation is made in saline, there is a possibly unpleasant salty taste. Giving the liquid mixed in food generally overcomes this issue. The high dose protocol may be associated with fever, joint pain, and flu-like symptoms (nausea, diarrhea, dry mouth, dizziness etc). In humans, bone marrow toxicities have been reported at higher doses. So far bone marrow issues have not panned out as a problem for pets but this was the origin of the initial alternating week protocols. Interactions with Other Drugs Interferon does not interact negatively with other drugs and is often combined with antibiotics and even anti-viral drugs. Concerns and Cautions • It is only the higher anti-viral protocols that have potential negative side effects (as noted above). • Commercially available interferons are human recombinant products. This means that as foreign proteins, they stimulate the pet’s immune system to react against them. After 3 to 7 weeks on the high dose protocols, antibodies against interferon may be produced, rendering them ineffective. © 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?
Full Moon Madness?
A study published in the Journal of the American Veterinary Medicine Association looked at emergency room intake over an 11-year period and found that emergency room visits increased 23 percent for cats and 28 percent for dogs during a full moon period. (Veterinary Partner)
Pets Forever - Colorado State University has a program that combines pre-veterinary students with elderly and disabled pet owners who need help keeping their pets at home. Students are responsible for walking dogs, scooping litter boxes and driving the home-bound owners’ pets to the vet’s office. The program, called Pets Forever, was created in 2008 and helps train students in the care of dogs in a home setting, while allowing the challenged pet owners to keep their pets when they otherwise may not have been able to do so. (Veterinary Partner) Pet ID Tags Can Be Scanned by Smartphone - Developer Dirk Van Vorris is manufacturing digital pet identification tags that can be scanned by any smartphone, according to Scripps Media. Once scanned, any information the pet’s owner put on the tag appears on the screen of the smartphone. The tag is limited to 3,500 characters but should leave plenty of room for contact information, so a Good Samaritan can return the pet to its owner. Tags run either $12.50 for a white tag or $14 for a colored tag. For more information, visit www.hightechtags.com. Dogs’ Social Traits Rub Off on Owners - Dogs make us better people. An Australian study reported in USA Today showed that people with dogs were more likely to gain trust, meet new people and help out neighbors than did people without pets. The same article reported that a different study of 128 children in New Mexico found that pre-teens who help care for dogs have higher self-esteem and empathy than those who did not have pet care responsibilities.
Only one-fifth of law enforcement officials have received formal training on recognizing animal cruelty - The ASPCA recognized three major obstacles law enforcement officers face when responding to animal abuse cases: 1. Cases are considered low priority by leadership 2. Law enforcement lacks staff with special knowledge in animal cruelty; and 3. No facilities exist for long-term impoundment of animals kept as evidence. The majority of officers polled (78 percent) believe dog and cat abusers are more likely to be involved in interpersonal violence or other violent crimes. (Veterinary Partner) Women Dominate Veterinary College Ranks - According to a WBNS-10TV feature, the AVMA reports that 80 percent of U.S. veterinary students are female. In 1970, by comparison, almost 90 percent were male. Researchers suggest that men are shying away from the field for several reasons: Incomes have been somewhat stagnant; personal autonomy is waning because of a proliferation of corporate practices; and, in the minds of at least some men, the growing presence of women might have eroded the profession’s prestige. (Vet Advantage Weekly) Dog and Cat Adoptions - Dog and Cat adoptions have increased while the number of pets given up has decreased. According to Pethealth Inc.’s look at the numbers from 850 animal welfare groups across the U.S. and Canada, the relinquishment of dogs declined 5 percent; 6 percent for cats. The killing of pets for population control decreased 10 percent for cats and 7 percent for dogs. Despite the struggling economy, adoptions rose slightly: Cat adoptions increased 3 percent in September 2010 over the same month a year ago; dog adoptions were up 2 percent. The company collects data from shelters that use its PetPoint software system.
Homes for Horses
The US has about 500-600 nonprofit and private organizations to take in and re-home unwanted horses. Many of them also provide feeding assistance programs in their communities. Rescue organizations are trying to prevent horses being sold to “kill buyers,” who send the animals to slaughterhouses north and south of American borders. (Veterinary Partner)
TECHNEWS | VOLUME 34 ISSUE 3
Send them home feeling better. Stop the vomiting. Right here, right now.
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Cerenia® is a registered trademark of Pfizer Products Inc., Pfizer Canada Inc., licensee.
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Help eliminate the pain of osteoarthritis for your patients. Dogs get the same kind of osteoarthritis (OA) joint pain and inflammation as people, but they typically hide it better. Talk to your clients about the symptoms of OA, and let them know about PREVICOX - it can help their dog live life to the fullest. In a study involving osteoarthritic dogs, 91% of owners indicated that their dogs’ symptoms improved on PREVICOX. 1
PREVICOX. Less pain for dogs. More relief for dog owners. Experience the PREVICOX difference for yourself... If your dog has been diagnosed with OA ask your Merial Technical Sales Representative if your dog qualifies for the free PREVICOX VetTech Trial.
1 Ryan W, et al. Clinical Effectiveness and Safety of a New NSAID, Firocoxib: A 1,000 Dog Study. Veterinary Ther. 2006 Summer;7(2): 119-126 PREVICOX® is a registered trademark of Merial Limited. © 2011 Merial Canada Inc. All rights reserved. PREV-11-1751-JATECH(E) MERP-2132