VOL UME 35 I S S UE 2
CANADIAN VETERINARY TECHNICIANS
A NATIONAL JOURNAL PUBLISHED BY THE ONTARIO ASSOCATION OF VETERINARY TECHNICIANS
CONTINUING EDUCATION • What is Intraosseous (IO) Catheterization?
D E D I C AT E D TO PROFESSIONALISM PUBLICATION MAIL AGREEMENT NUMBER 40034241 • PUBLISHED BY THE OAVT • Return Canadian undeliverable address to: OAVT, 100 Stone Rd W., Suite 104 Guelph, ON N1G 5L3
• You Should Laser That! • All About Oxygen Plus: Hands Down!, Meloxicam (Metacam), OAVT 2012 Conference Awards Nominations, Common Toxic Foods in the Small Animal Patient Part 2, Optimization of Ventral Tail Artery Catheterization in the Rat, Equine Physical Rehabilitation: An Overview, and more!
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Bayer, Bayer Cross and Profender are registered trademarks of Bayer AG, used under license by Bayer Inc.
Relax, it’s topical.
2011 Platinum Sponsors Making continuing education better & more accessible across Canada Bayer HealthCare Animal Health Division Hill’s Pet Nutrition Canada, Inc. Merck Animal Health Medi Cal/Royal Canin Veterinary Diet Pfizer Animal Health These companies are generously supporting a series of outstanding learning opportunities for registered veterinary technicians through OAVT. 34th Annual OAVT Conference & Trade Show February 16 - 18, 2012 Toronto, Ontario This meeting continues to expand and grow in stature, as the largest and best stand alone Registered Veterinary Technician/Technologist meeting in the world. Professionalism & Ethics Course Outstanding one-day CE courses offered during the year. Call the office for the date and location closest to you. TECHNEWS The quarterly national publication with three CE articles in each issue delivered directly to your door! Making information, education, industry news and career opportunities available to technicians - everyday and everywhere! www.oavt.org We applaud these companies for working closely with Canadian veterinary technicians and OAVT in the design and delivery of these exciting programs throughout 2011. EECI11663-01 / bsg111102-i01
Letter from the Editor............................................................................................................... 2 New CDC Study Based on Proprietary CAPC Data Links Incidence of Lyme Disease in Dogs to Increased Risk to Humans............................................................ 3 Safety Column: Hands Down!.................................................................................................. 4 Tech Tips and Tidbits................................................................................................................ 6 Pharmacology Column: Meloxicam (Metacam)........................................................................ 7 CE Article #1: What is Intraosseous (IO) Catheterization?............................................... 11 CE Article #2: You Should Laser That!.............................................................................. 15 CE Article #3: All About Oxygen...................................................................................... 21 Puzzle...................................................................................................................................... 25 Hill’s Pet Nutrition’s Drive Nutrition Sweepstakes................................................................... 25 TECHNEWS Winter 2011/2012 CE Quizzes................................................................... 27 Employment Ads..................................................................................................................... 30 Hill’s Pet Nutrition Launches New Pet Food for Hyperthyroid Cats........................................ 31 Submitting Articles to TECHNEWS...................................................................................... 31 Continuing Education Opportunities..................................................................................... 32 OAVT 2011 Conference Photos.............................................................................................. 33 OAVT 2012 Conference Awards Nominations........................................................................ 34 2012 34th Annual OAVT Conference..................................................................................... 35 Equine Physical Rehabilitation: An Overview......................................................................... 36 Common Toxic Foods in the Small Animal Patient Part 2....................................................... 38 Global News........................................................................................................................... 40 TECHNEWS Subscription..................................................................................................... 41 Canadians spend more time surfing the web than playing with their pets................................ 44 Optimization of ventral tail artery catheterization in the rat ensures timely collection of blood samples..................................................................................... 46 Did You Know?....................................................................................................................... 48
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Next Issue: Spring 2012 Deadline for Material: March 15, 2011 Distribution Date: April 15, 2011 TECHNEWS is a quarterly publication published by the OAVT.
Employment Ads: Please see Employment Ad Information on Page 30 For advertising information: Contact Cass Bayley: Tel. (519) 263-5050 Fax (519) 263-2936
• Editor - Cass Bayley (firstname.lastname@example.org) • Technical Editor - Shirley Inglis, AHT, RVT (email@example.com)
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 35 ISSUE 2
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RVT and Andria Gordon RVT. They both work at a small animal practice in Ontario and both really enjoy the addition of laser therapy to their practice and skill set. Light laser therapy is one of the newest medical advances in veterinary medicine so this article is timely and provides an excellent overview. CE Article #3 on page 21 is “All about Oxygen” and provides a solid overview on administering oxygen properly and monitoring oxygen deficiency when dealing with critically ill patients. Author Amy Breton CVT, VTS is with Veterinary Emergency and Specialty Care in Waltham, Massachusetts and is a Veterinary Technician Specialist in Emergency and Critical Care. E. Gwyn Rucker, RVT’s article on Equine Physical Rehabilitation is a review of the various therapies available including manual, hydrotherapy, cold laser and hyperbaric oxygen. This is an emerging field and Elizabeth’s article offers a well-rounded introduction for the avid reader.
Welcome to the Winter 2011 issue of TECHNEWS. This issue is full of outstanding articles and we applaud the many contributors that make TECHNEWS the best continuing educational journal of its kind. In the Safety Column author Christi Cooper RVT, CRSP (page 4) highlights how to find the right gloves for the right job and provides clarity on the choices available for hazard based glove selection.
providing a detailed introduction to this critical aspect of resuscitation medicine. Charlotte is Ontario based at OVC and has been a highly acclaimed speaker at the OAVT conference on many occasions.
Charlotte Donohoe RVT, VTS has authored CE Article #1 (page 11) on Intraosseous (IO) Catheterization
CE Article #2 (page 15) on You Should Laser That! is a well-presented collaboration between Beth Campbell
This is YOUR magazine and we welcome input from readers. Let us know what you would like to see in 2012 and we will source the best authors. Before you receive the spring issue, you can let your learning go LIVE by attending the OAVT Conference February 16 - 19 in Toronto. There is no better place to participate in hands-on learning. Review the program details at www.oavt.org See you there!
Cass Bayley Editor, TECHNEWS
TECHNEWS | VOLUME 35 ISSUE 2
New CDC Study Based on Proprietary CAPC Data Links Incidence of Lyme Disease in Dogs to Increased Risk to Humans BEL AIR, MD. (August 2011) – Using data from unique prevalence maps provided by the Companion Animal Parasite Council (CAPC, www.capcvet.org), scientists with the Centers for Disease Control and Prevention (CDC) have found that people in areas with a higher-than-average number of dogs with Lyme disease are at greater risk of contracting the disease. Researchers recently published their findings in a study, “Canine Serology as Adjunct to Human Lyme Disease Surveillance,” that cross-referenced data from the CAPC prevalence maps and U.S. national surveillance data on the occurrence of Lyme disease in humans. Results show that when few dogs in a given area test positive for Lyme disease, the risk to humans for contracting the disease is low. Conversely, the study also shows that the more dogs that test positive for the disease in a given area, the higher the risk of disease is to people. The prevalence maps, available exclusively from the CAPC, show the incidence of reported Lyme disease cases (see screen capture). Additional maps track the incidence of a variety of other parasite-borne diseases in both cats and dogs. Visitors to the CAPC website can search for canine or feline infection rate results by state, county and type of parasite.
“Veterinarians throughout the United States and our colleagues at IDEXX, VCA Antech and Banfield worked hard for many years to provide this incredibly compelling data, which essentially shows how tracking the incidence of Lyme in dogs allows researchers to predict possible outbreaks of the disease in humans,” said Susan Little, DVM, PhD, a director with the CAPC. “It is clear that public health benefits from our efforts and expertise.” Specific findings include: • Human Lyme disease incidence was effectively zero when the canine seroprevalence was <1.3 percent.
According to Little, the study’s findings underscore the importance of educating pet owners about the risks of parasite-borne disease to both pets and their families. The CAPC, guided by its mission to improve both human and animal health, is an objective and reliable source of information on parasites and zoonotic diseases for both pet owners and veterinarians. The prevalence maps are an essential tool in helping the nonprofit achieve its educational goals.
• Among 14 states with canine seroprevalence >5 percent, median annual human Lyme disease incidence was about 100-fold higher (24.1 cases/100,000 population) and positively correlated with canine seroprevalence.
“Veterinarians can find useful data and tools from the CAPC to help educate pet owners about parasite-borne diseases. This, in turn, allows veterinarians to play a central role in helping pet owners protect their pets and their families,” said Little.
“The prevalence maps and this study itself represent the strong industry collaboration that the CAPC creates,” said Little. “It is amazing when you realize that our pets are serving as sentinels, showing us where we are at risk for disease. It is a powerful demonstration of the strength and importance of the human-animal bond.”
About Dr. Susan Little Dr. Susan Little is a professor and the KrullEwing endowed chair in veterinary parasitology at the Center for Veterinary Health Sciences, Oklahoma State University, where she teaches veterinary parasitology and oversees a research program that focuses on zoonotic parasites and tick-borne diseases.
Screen Capture of the Prevalence Maps from www.capcvet.org The prevalence maps on the CAPC Web site (www.capcvet.org) allow viewers to search for the prevalence of parasite-born disease in either dogs or cats, by state, county and type of parasite. The maps are based upon data from two major national laboratories, which is then formatted in a county-by-county illustration of the prevalence of selected parasites and vector-transmitted diseases.
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The prevalence maps on the CAPC website include data for 2008, 2009 and 2010, presented in both absolute numbers and percentage of positive results. The maps combine data from two major national laboratories and format it in a county-by-county illustration of the prevalence of selected parasites and vector-transmitted diseases. The CAPC plans to expand the data it collects through its Partnership Program and make the information accessible to its partner practices in the near future.
About the Companion Animal Parasite Council (CAPC) The Companion Animal Parasite Council (www.capcvet.org) is an independent nonprofit 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.
M. Christi Cooper, RVT, CRSP is the Industrial - Agricultural Safety Officer for the University of Guelph. Her role focuses on worker safety issues at the satellite campuses and research stations across Ontario. Christi is a Canadian Registered Safety Professional (CRSP) and a RVT. She spent 16 years at the Veterinary Teaching Hospital (OVC) before switching to worker safety with the University’s Department of Environmental Health and Safety.
When it comes to gloves, there seem to be as many varieties as there are uses. They range from regular exam gloves to surgical gloves and specialty gloves (latex-free, talc free, brown gloves and chemotherapy gloves) to lead radiology gloves and leather gloves for handling wildlife, not to mention shoulder length gloves for large animal rectal exams as well as insulated gloves for work with liquid nitrogen. So, how do you choose the right gloves for the job? Preference according to style, fit and the need to prevent reactions can make selection of type and brand very personal. Close-fitting surgical gloves in the right style for the wearer is important (yes, there are different styles or shapes to the forms used for making
table 1 > Guide to Hazard Based Glove Selection Hazard
Degree of Hazard
Reinforced heavy rubber, staple-reinforced heavy leather
Rubber, plastic, leather, polyester, nylon, cotton
Sharp Edges Severe
Metal mesh, staple-reinforced heavy leather, Kevlar™, aramid-steel mesh
Leather, terry cloth (aramid fiber)
Mild with delicate work
Lightweight leather, polyester, nylon, cotton
Chemicals and fluids
Risk varies according to the chemical, its concentration, and time of contact among other factors. Refer to the manufacturer, or product MSDS. See section 188.8.131.52
Dependent on chemical. Examples include: Natural rubber, neoprene, nitrile rubber, butyl rubber, PTFE (polytetrafluoroethylene), Teflon™, Viton™, polyvinyl chloride, polyvinyl alcohol, Saranex™, 4H™, Barricade™, Chemrel™, Responder™, Trellchem™
Leather, insulated plastic or rubber, wool, cotton
Rubber-insulated gloves tested to appropriate voltage (CSA Standard Z259.4-M1979) with leather outerglove
Greater than 350°C
Up to 350°C
Nomex™, Kevlar™, heat-resistant leather with linings
Up to 200°C
Nomex™, Kevlar™, heat-resistant leather, terry cloth (aramid fiber)
Chrome-tanned leather, terry cloth
Up to 100°C
Cotton, terry cloth, leather
Thin-film plastic, lightweight leather, cotton, polyester, nylon
Lead-lined rubber, plastic or leather
Modified table taken from http://www.ccohs.ca/oshanswers/prevention/ppe/gloves.html November 10, 2011
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surgical gloves) and it may mean trying a few different samples to determine a favourite. Exam gloves come in a variety of materials and often tend to be looser fitting, which may be acceptable for the length of wear and the amount of tactile sensitivity required. Remember that gloves are to be used to provide protection against chemical or biological hazards and exposure to extreme temperatures, abrasions or lacerations. Table 1 provides a general guideline to describe appropriate hazard-based selection of gloves.1 No one glove material is appropriate for protection against all potential chemical
exposures as the permeation rate (rate at which the chemical seeps through the glove material) of the different glove types varies significantly with the chemical in question. Consultation of the material safety data sheets (MSDS), along with consideration of the usage, will provide guidance in determining an appropriate glove. The following links provide more detailed information regarding the proper selection of a glove material based on the specific chemical(s) being handled.1 • Ansell Chemical Resistance Guide: http://www.ansellpro.com/download/An sell_7thEditionChemicalResistanceGui de.pdf • Best Manufacturing Company’s Chemrest: http://www.chemrest.com
• Oklahoma State University’s Chemical Guide: http://www.ehs.okstate.edu/ hazmat/Gloves.htm Table 2 provides some basic information about selecting gloves suitable for various chemical applications.1 The following guidelines should be considered when using gloves: • Gloves should be inspected for damage prior to use. Any sign of deterioration, such as holes, tears or discoloration, should prompt immediate replacement of the gloves. • Gloves should be of an appropriate fit and thickness to allow for the required tactile sensitivity.
table 2 >
Characteristics, Advantages, Disadvantages and Uses of Selective Chemical Resistant Glove Materials Type
For Use With
Natural Low cost, good physical rubber properties, dexterity latex
Poor against oils, greases, organic solvents. May cause allergic reactions.
Bases, acids, alcohols, dilute aqueous solutions. Fair vs. aldehydes, ketones.
Natural rubber blends
Low cost, dexterity, generally better chemical resistance than natural rubber.
Physical properties often inferior to natural rubber. May cause allergic reaction.
Bases, acids, alcohols, dilute aqueous solutions. Fair vs. aldehydes, ketones.
Polyvinyl chloride (PVC)
Low cost, very good physical Plasticizers can be stripped. properties, average chemical resistance.
Average cost, average chemical Poor vs. chlorinated Oxidizing acids, alcohols, resistance, average physical hydrocarbons anilines, phenol, glycol ethers, properties, high tensile solvents, oils, mild corrosives strength, high heat resistance.
Nitrile Low cost, excellent physical Poor vs. chlorinated organic properties, dexterity solvents, many ketones Butyl
Strong acids and bases, salts, aqueous solutions, alcohols, oils, greases and petroleum products.
Oils, greases, aliphatic hydrocarbons, xylene, perchloroethylene, trichloroethane. Fair vs. toluene.
Good resistance to polar Expensive, poor vs. hydro- Glycol ethers, ketones, esters, organics, high resistance to gas carbons, chlorinated solvents aldehydes, polar organic and water vapour solvents
Polyvinyl Resists broad range of organics, Very expensive. Water alcohol good physical properties. sensitive, poor vs. light (PVA) alcohols, acids and bases.
Aliphatic and aromatic hydrocarbons, chlorinated solvents, ketones (except acetone), esters, ethers
Fluro- Good resistance to organic and elastomer aromatic solvents. Flexible. (Viton®)
Extremely expensive. Poor Aromatics and aliphatic hydrophysical properties. Poor vs. carbons, chlorinated solvents, oils, some ketones, esters, amines lubricants, mineral acids, alcohols.
Norfoil, Silver Excellent chemical resistance. Shield™, 4H™
Poor fit, stiff, easily punctures, poor grip.
Use for Hazmat work. Good for range of solvents, acids & bases.
Modified table taken from: http://www.ecu.edu/cs-admin/oehs/ih/Glove-Selection-Chart.cfm November 10, 2011
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• Gloves should be an appropriate length so as to provide adequate protection of the arm. • Gloves should be removed by pulling the gloves inside out to prevent exposure to any contaminants during removal. • Gloves are to be removed prior to touching computers or phones, opening doors or otherwise contacting items that would be expected to be free of contamination (either biological or chemical). • Wash hands thoroughly after removal of gloves. • Never re-use disposable gloves. • Re-usable gloves should be stored and maintained in such a way as to prevent exposure (e.g. in a Ziploc bag) and should be stored within the laboratory or work area. Manufacturer’s instructions are to be followed as applicable.1 The market is filled with options and competitors; price points are also a factor. However, the required protective factors need to be met. Many MSDSs will suggest types of gloves required and the protection time each affords the wearer against the hazardous material being used, so do your research and keep your hands protected!
references > 1. University of Guelph Lab Safety Manual www.uoguelph.ca/ehs
Syringe labels are helpful and can help you avoid medication errors It’s not rocket science, but labeling syringes certainly helps avoid confusion and potentially life-threatening mistakes. Commercial drug stickers are available, or just use coloured stickers found at an office supply or craft store, and write on abbreviations for the various drug after drawing up the medication.
How to help keep track of lumps Suggest to owners to have each lump evaluated by their veterinarian. Keep a line drawing of a dog’s body in each dog’s medical record. Sketch the lump, record the size based on measurements, and indicate the date if aspiration cytology was performed. This process makes short work of determining if this is a new lump or not. Note whether the veterinarian recommends aspiration cytology or biopsy, and whether the owner approved the procedure. This information can help with the decision regarding a possible referral to a specialist. Dogs with lumps in a difficult location may need advanced imaging to define tumour location, a specially trained surgeon to successfully remove the lump, or an oncologist to provide follow up chemotherapy.
Writing while performing dental prophylaxis While performing a dental prophy, your hands probably get messy and contaminated. In order to use a pen to make notes on the patient record, consider popping your pen down the finger of a rubber glove in order to keep the pen clean. Once you’ve finished with the procedure, discard the glove and you’ll have a pen that is bacteria-free. (Veterinary Medicine)
Euthansia tip For owner-accompanied euthanasias, consider attaching an extension set to the IV catheter. This will allow you to administer the solution without hovering over the pet, and allow the owner to be close to their loved one during the final moments. Be sure to use lots of flush to move the euthanasia solution through the IV line. (Veterinary Medicine)
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P H A R M AC O L O G Y C O L U M N
by Dr. Wendy Brooks, DVM, DipABVP (Educational Director, Veterinary Partner.com)
Meloxicam offers another unique feature that other veterinary NSAIDs do not: feline use. As much as having COX preferential NSAIDs has been a boon to canine practice, these same drugs did not offer pet cats any sort of safe relief. Cats are even more sensitive to NSAID side effects as a general rule and the quest for a feline NSAID is still on going; still, meloxicam has been approved by the FDA for use in cats for surgical pain so long as only one dose is given. In Canada, meloxicam injectable has been approved for use perioperatively and may be followed with up to 2 days of treatment with the oral suspension.
Brand name: Metacam Available for small animals in Canada in two strengths of oral suspension, two strengths of chewable tablets and as an injectable. Background Meloxicam is a member of the class of drugs known as NSAIDs (non-steroidal anti-inflammatory drugs), the same class as such common over-the-counter pain remedies as Advil (ibuprofen), Aleve (naproxen), Orudis (ketoprofen), and aspirin. Most NSAIDs cannot be used in pets due to the following unacceptable side effects: • Stomach ulceration and even perforation and rupture of the stomach can occur. This is not only painful but life threatening. • Platelet deactivation: platelets are the cells controlling the ability to clot blood and, as a general rule, it is preferable not to promote bleeding. We would prefer platelets to remain active and able to function should we need them. • Decreased blood supply to the kidney - this could tip a borderline patient into kidney failure. The veterinary profession has been in need of an NSAID that could effectively relieve pain without the above risks. The key appears to lie with the enzyme responsible for many inflammatory mediators: cyclo-oxygenase-2 (or COX-2).
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for pain management not only for pets but for humans as well. The introduction of COX-2 preferential NSAIDs has reduced stomach and intestinal side effects by 50% in humans and has made FDA approval of NSAIDs possible for pets. Meloxicam has only been approved in the U.S. for canine use since 2003 but has been available in Canada and Europe for years before. Meloxicam has been available in the U.S. for human use for many years.
A different but related enzyme, cyclooxygenase-1 (COX-1), is responsible for producing important biochemicals needed to maintain normal blood supply to the kidneys and GI tract. It had been previously impossible to inhibit cyclooxygenase-2 without also inhibiting cyclo-oxygenase-1, hence the side effects of previous NSAIDS. In 1997, Pfizer Animal Health released carporfen for dogs as the answer to this need. Carprofen is what is called a preferential cyclo-oxygenase-2 inhibitor. Carprofen does inhibit cyclo-oxygenase-1 slightly but, for the first time, it became possible to exert a different effect on each of these two enzymes. Meloxicam is a similar type of NSAID, preferentially inhibiting COX-2 over COX-1. This new ability to inhibit only the inflammatory COX proved to be revolutionary
Another use of COX preferential NSAIDs bears mentioning. There are many forms of cancer, in particular certain types of carcinomas (transitional cell carcinoma, possibly squamous cell carcinoma, and more) seem to exhibit COX-2 activity. This implies that these types of NSAIDs have anti-tumour effects separate from their anti-inflammatory effects and their use in the treatment of inoperable cancers is currently being explored. How this Medication is Used Meloxicam is generally given to control arthritis pain in dogs though can be given for many other painful conditions such as injuries, cancer, surgery, dental infections, and more. In dogs, it is typically given as a once a day in the form of a pleasantly flavored liquid or chewable tablet. The oral suspension comes with a special dosing syringe marked to show how much to give for the pet’s weight
(rather than in milliliters as most syringes are marked).
that all veterinary NSAIDs have potential to cause this reaction.
Meloxicam can be used in cats but with caution. The original oral solution of meloxicam was commonly dosed in drops from the bottle. Since the wrong dose of meloxicam can be dangerous for cats, it is important not to drop the drops directly into the cat’s mouth from the bottle as squeezing too strongly could easily deliver an overdose. There is currently a newer formulation at one third the strength of the original, which can be dosed more accurately with the included syringe. In cats, this product is given either as a single one time injection in association with surgery (its FDA approved use) or long term two to three times per week.
The most common side effects of meloxicam are nausea, appetite loss, vomiting or diarrhea. If any of the above are noted, meloxicam should be discontinued and the pet brought in for a liver enzyme and renal parameter blood test. In most cases, the reaction is minor and resolves with symptomatic relief, but it is important to rule out whether or not the patient has more than just a routine upset stomach.
Patients being considered for long-term meloxicam use should be evaluated with a complete physical examination and initial screening blood test to identify any factors, such as liver or kidney disease, that might preclude the use of this or any other NSAID. Side Effects The side effects of concern are the same with all NSAIDs: stomach ulceration, loss of kidney function, and inappropriate bleeding. These are dependent on the dose of medication used and on risk factors of the host (for example: an aged pet may not efficiently clear a dose of medication from its body leading to stronger and longer activity of the drug). There is also a an idiosyncratic reaction for NSAIDs that has received a great deal of press. An idiosyncratic reaction is one that is neither dose-dependent nor predictable by any apparent host factor; it simply happens out of the blue. This particular idiosyncratic reaction is a liver toxicity that is rare enough that it did not show up in any of the initial 400 carprofen test subjects, or in the U.K., and was not recognized until carprofen was used in over a million dogs in the U.S. after its release as the first NSAID. This reaction is reviewed below. While originally it was carprofen use that led to the recognition of this reaction, it is now felt
If a patient has borderline kidney function, NSAIDs should not be used as they reduce blood flow through the kidneys. It is also important that NSAIDS not be given to dehydrated patients because of this potential side effect. This is particularly true in cats. The hepatopathy side effect (usually occurs within the first 3 weeks of use). A carprofen reaction that has received attention is hepatopathy, a type of liver disease. Symptoms include nausea, appetite loss, and/or diarrhea as well as marked elevations (3-4 times higher than the normal range) in liver enzymes measured in the blood. The question of whether other veterinary NSAIDs share this reaction has arisen. At this time, it is generally felt that the hepatopathy idiosyncratic reaction is not unique to carprofen and should be of concern with any veterinary NSAID and this includes meloxicam. This reaction seems to be a canine issue only. Dogs with hepatopathy show improvement with support 5 to 10 days after discontinuing medication. It is important that the NSAID be discontinued and the patient evaluated in the event of upset stomach signs in case of this syndrome. Even though this is a rare syndrome (one in 5000), it can become life-threatening if ignored. Appetite loss or other intestinal signs do not necessarily indicate a hepatopathy but since they might, it is important not to ignore these signs should they occur. There is no way to predict which dogs will experience this side effect.
The hepatopathy reaction usually occurs in the first 3 weeks after starting carprofen but could theoretically occur later. All NSAIDs are removed from the body by the liver. If the patient’s liver is not working normally due to another disease or if the patient is taking other drugs that are also removed by the liver, it is possible to overwork the liver and exacerbate pre-existing liver disease. If there is any question about a patient’s liver function, another class of pain reliever should be selected. It is important to realize that COX-selectivity is not the sole factor in safety. In humans, the incidence of kidney function-related side effects was unchanged by the development of COX-2 preferential NSAIDs, such as meloxicam, and we expect the same is true with dogs. Still, these drugs have an excellent track record for safety. The important issue is to recognize risk factors for adverse reactions and take preventive steps (see the Concerns and Cautions section below). You might wonder how this is possible given the COX-2 selectivity and the answer is complex. While it is easy to think of COX-2 as the “bad” enzyme, COX-1 as the “good” enzyme, and COX selectivity as seeing that only the “bad” enzyme is suppressed, this kind of thinking would be a drastic over-simplification. In fact, COX-2 is important in activities involving the healing of stomach ulcers and other important processes. There is also a COX-3, of which very little is known, and studies show there may very well be a COX-4. Further, at higher doses, meloxicam and other COX-2 selective NSAIDs will lose their COX-2 selectivity and significantly inhibit COX-1 as well. As with all veterinary NSAIDs, periodic monitoring tests are important to check liver enzymes and kidney function, and to generally screen the patient’s health. Typically a schedule of every 6 months is recommended for dogs. There is no general consensus on what is appropriate for cats but because of feline sensitivity towards NSAIDs, monitoring is especially important. If you are using this product in a cat, be sure you understand what monitoring schedule your veterinarian is recommending for your specific pet.
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Interactions with Other Drugs Drugs of the NSAID class should not be used concurrently as the potential for the aforementioned side effects increases. For similar reasons, NSAIDS should not be used in conjunction with corticosteroid hormones such as prednisone, dexamethasone, etc. Pfizer recommends a 5 to 7 day rest period when changing from one NSAID to another. Aspirin poses an exception due to its strong platelet inactivating abilities so 10 to 14 days is recommended when switching to another veterinary NSAID from aspirin. Allow at least one week between prednisone and meloxicam. If meloxicam is used concurrently with phenobarbital, it is especially important that appropriate liver monitoring be performed. These two drugs interact such that neither may work well if they are used together. ACE inhibitors such as enalapril, benazepril, or captopril may not be as effective in the presence of meloxicam. (ACE inhibitors are used in the treatment of hy-
pertension or heart failure.) This is because ACE inhibitors depend on the dilation of blood vessels in the kidneys and such dilation can be interfered with by NSAIDs). Concerns and Cautions Meloxicam works as well when given on an empty stomach as when given on a full stomach. If a patient has had some upset stomach issues with meloxicam, these can often be minimized by administering the drug on a full stomach. Maximum effect is seen approximately 8 hours after administration of the oral product. When beginning a trial course of meloxicam, a response may take 3 or 4 days to show. If no response is seen in 10 days, meloxicam has failed and a different pain medication should be tried. If one NSAID fails, another may well work. Meloxicam should not be used in pregnancy or in lactation. Meloxicam should not be used in puppies under 6 months of age (safety has not been proven).
Meloxicam should be avoided, if possible, in patients with impaired function of the liver, kidney or heart. It should also be avoided in dehydrated patients and patients with known GI ulcers. ALWAYS SHAKE THE BOTTLE OF MELOXICAM BEFORE DRAWING UP THE DOSE For More Information The manufacturer of veterinary meloxicam, Boehringer Ingelheim (Canada) Ltd. (www.boehringer-ingelheim.ca), offers more information.
© 2012 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.
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No adjuvant or whole virus. Stimulates strong cell-mediated immunity1,2 essential for protection against FeLV infection.3 Excellent safety profile with more than 4.3 million doses administered in Europe since launch. Provides at least 13 months of protection to kittens as young as 8 weeks of age, as well as to cats previously vaccinated with killed-virus FeLV vaccines. Available in two convenient formats: 10 x 1 dose and 50 x 1 dose
1. Merial data on file. 2. El Garch, Hanane, Stephanie Richard, Fabienne Piras, Tim Leard, Hervé Poulet, Christine Andreoni, and Véronique Juillard. Feline leukemia virus (FeLV)-specific IFNγ+ T-cell responses are induced in cats following transdermal vaccination with a recombinant FeLV vaccine. Intern J Appl Res Vet Med, 2006, 4(2): 100-108. 3. Flynn, J. Norman, Stephen P. Dunham, Vivien Watson, and Oswald Jarrett. Longitudinal analysis of feline leukemia virusspecific cytotoxic T-lymphocytes: Correlation with recovery from infection. Journal of Virology, March 2002, 76(5): 2306-2315.
PUREVAX® is a registered trademark of Merial Limited © 2011 Merial Canada Inc. All rights reserved. VACS-09-1557-JAVFeLV (E) MERP-1124
Delivery of balanced electrolyte solutions and other intravenous fluids is a crucial aspect of resuscitation medicine. In many cases, illness or injuries to the veterinary patient cause hypotension and/ or hypovolemia; circumstances which lead to sub-optimal vascular access conditions. In the face of unobtainable vascular access, the IO route is an excellent choice for delivery of emergency drugs and resuscitative fluids. Access to the IO space is achieved through percutaneous placement of a cannula through the cortex of a long bone into the medullary cavity. A distinct advantage to IO fluid administration is the quick redistribution of fluids. Movement of IO fluid has been compared to delivery of fluid into the proximal vena cava due to its rapid redistribution.1 Fluids and medications delivered into the medulla of a long bone reach the intravascular circulation promptly which makes this method of access an excellent option during emergency situations. In addition, the IO route has the added advantage of rigidity in that the intramedullary cavity does not collapse in times of diminished circulation the way that peripheral vessels can. Delivery of fluids and medications via the intraosseous route is a concept that has been embraced for many years in human medicine. The discovery of the IO route as a means to deliver fluids into circulation was made in the early 1920s. Initially discovered using an animal model, the potential usefulness of this route was further investigated in the 1940s when a group of studies declared it a useful method of fluid delivery in pediatric patients. Throughout the ‘80s and ‘90s, IO access continued to be used in pediatric patients in whom intravenous (IV) access could not be established. Since that time, various health agencies and military organizations have come to recom-
CE Article #1 What is Intraosseous (IO) Catheterization?
mend IO access as a reliable means for fluid delivery in both pediatric and adult patients. In the emergency or pre-hospital setting in particular, it is widely accepted that if difficulty is encountered while obtaining IV access, precious time can be saved by instead placing an IO catheter.
IO catheterization can be performed using the simplest equipment, such as a hypodermic needle; or more specialized equipment, such as an injection gun or a drill. Historically, hypodermic, spinal and IO needles were used for IO cannulation, however, the last ten years have seen the development of several automated devices that may be used in veterinary as well as human patients.
Hypodermic needles are standard supply in all veterinary hospitals and as such may be the most readily available type of cannula
for IO catheterization. A potential drawback associated with hypodermic needles is the open lumen and the potential for obstruction by bony material during insertion through the cortex. Hypodermic needles are well suited as IO catheters in neonatal patients. Size will vary with operator preference, but 18-20 gauge needles work well with most neonatal patients. Bone marrow aspiration needles, spinal needles, or intraosseous catheters are more suitable for adult and large size patients when available. An advantage associated with bone marrow needles is the stylet or trocar that is seated within the lumen of the needle. The trocar helps prevent accumulation of a bone plug in the lumen of the needle during placement. The trocar/ stylet is removed once the catheter has been placed. Intraosseous catheters have the added bonus of two opposing fenestrations at the catheter tip; a feature which is valuable
Charlotte Donohoe, RVT, VTS (ECC) • My full time job: Emergency Referral Coordinator, Small Animal ICU, Ontario Veterinary College – since 1999 • My education: Bachelor of Arts degree in 1995 from York University. Major was psychology • Veterinary Technician Diploma in 1998 from Seneca College. • Veterinary Technician Specialist: Emergency and Critical Care - VTS (ECC) 2004. • When I am not working, I enjoy running, cycling, rock climbing and backpacking.
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if one side of the catheter is butted against the cortex of the bone. When using a hypodermic or bone marrow needle, the catheter is inserted into the medulla in the direction of the long axis of the bone. A gentle rotation is used in conjunction with manual pressure in order to pass the needle into the marrow. The catheter should be passed up to the hub, so that the hub is seated on the surface of the skin. The patency and appropriate placement of the catheter can be confirmed using a slow injection of heparinized saline flush (1 IU heparin/ml 0.9% NaCl). Resistance may be noted by the operator during the initiation of the catheter flush, but the injection should flow with little to no resistance subsequent to that.
The FAST1 (Pyng Medical) is a system that uses manual pressure to pass a catheter into the sternum in human patients. An adhesive patch is used to help landmark the appropriate insertion site on the patientâ€™s chest and a cluster of needles surrounding the stylet ensure appropriate depth. The Bone Injection Gun (BIG) (WaisMed Ltd) is an automatic device that uses a trigger released spring to advance the catheter through the skin and into the medulla of the bone. The BIG comes in two different sizes that are labelled for use in pediatric and adult patients. The pediatric device contains an 18g catheter that can be set to insertion depths between 0.5 and 1.5cm. The adult device consists of a 15g catheter and is set to a depth of 2.5cm. The BIG is typically used in the tibial plateau in human patients and has been found to be an equally effective device for placement of IO catheters in the proximal tibia of veterinary patients. An advantage associated with the BIG is that it typically achieves catheter placement faster than a manually driven device such as a bone marrow or hypodermic needle.
Location and Preparation
There are a number of sites that are suitable for IO catheter placement in veterinary patients. Deciding where to establish IO access involves consideration of a patientâ€™s age, size and health status. For example, in a pediatric patient, the trochanteric fossa of the femur may be the most palpable landmark and the easiest through which to gain access. In larger canine patients, the flat surface just medial to the tibial tuberosity is a popular site for IO access. The greater tubercle of the humerus is also an appropriate site for IO catheterization, but is slightly harder to identify as a landmark. Limbs affected by trauma, infection or pathological fracture are inappropriate sites for IO catheterization.
Several different tools are available for IO catheter placement in human patients. These may be used for veterinary patients where appropriate. Most of the automated devices place catheters perpendicular to the long axis of the bone in contrast to the traditional placement using a hypodermic or bone marrow needle.
The EZ-IO (Vidacare Corporation) is an automated tool that is similar to a small power drill. A stylet and catheter are loaded on to the end of the power driver. The catheter and stylet are advanced through the skin and the power mechanism is engaged to drive the stylet through the periosteum and into the marrow space. The process is completed rapidly once the user is familiar with the equipment.
Once a site for catheter placement has been selected, a large area surrounding the proposed site is clipped. The entire area must be aseptically prepared using a three stage surgical prep. To decrease any discomfort during placement, the periosteum should be numbed by injection of approximately 1ml of 1% or 2% lidocaine. Once the preparation is complete, the catheter is placed with strict adherence to sterile technique. The method of catheter placement depends on the catheter type and/or the device being used for placement. In the event that a catheter is being place manually, gentle pressure is applied to the catheter in addition to a slight rotary motion. Instruments whose stylets use a luer lock to remain attached to the catheter can be rotated gently in a clockwise direction to avoid loosening of the luer lock. Hypodermic needles and catheters
The catheter is advanced using gentle pressure in conjunction with a clockwise motion.
The catheter is seated firmly within the medullary canal. The stylet can be removed.
A Luer lock syringe is used to aspirate a sample immediately after the catheter has been placed.
Once placement has been confirmed, the catheter is secured using medical tape, padding and standard catheter bandaging materials. The patientâ€™s comfort is an important consideration when securing the catheter. Padding to cushion the hub of the needle is ideal, but securing the catheter is of utmost importance.
Device Assisted and Power Assisted IO Cannulation
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references > 1,2. Gelens, H. 2003. Intraosseous Fluid Therapy. Proceedings: Western Veterinary Conference 2003. 3. Mathews, K. 2006 Monitoring Fluid Therapy and Complications of Fluid Therapy in DiBartola, S. Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice. 377-391 St. Louis: Saunders
Troubleshooting difficulties with IO catheters is similar to investigating intravenous catheters. Inappropriate positioning of the catheter can lead to interruption of flow. If the catheter is against the wall of the cortex, the needle can be rotated slightly so that the bevel is moved away from that surface. Obstruction of flow can also be due to bone becoming lodged in the lumen of the catheter as it passes through the periosteum. This results in a bone plug. The plug can be removed by slowly flushing with heparinized saline.
whose stylets do not rely on a luer lock can be slightly rotated in a back and forth motion in conjunction with gentle pressure to advance the catheter. A slight give might be appreciated as the catheter passes through the cortex of the bone.
Fluids including blood products, analgesics and other medications (including emergency drugs) routinely delivered via intravenous therapy can be delivered safely via the IO route.
Catheter Related Complications
Bone marrow and blood may be aspirated through the catheter once it has been placed. It is more likely that immediate fluid resuscitation is required, however, and this may also be initiated as soon as the catheter is seated and the stylet (if any) is removed. Fluids may be delivered as per intravenous fluid guidelines. The volume and rate of fluid administration is similar to that encountered with intravenous fluid therapy. Catheter position can affect the flow rate of IO fluids. If the IO catheter is positioned right against the wall of the cortex, fluids may not flow freely into the marrow. Furthermore, if the catheter takes up bony material within its lumen during placement, it may become occluded. The tissue surrounding the bone should be evaluated as soon as continuous fluid infusion has been instituted. Routine investigation of the bandage and catheter site will alert the technician to any potential problems that may arise. If the IO catheter remains in place for any length of time (typically this is only until IV access is established), the site should be evaluated a minimum of once daily, twice daily being ideal. Providing the IO catheter is not a source of discomfort for the patient, this route can be used beyond the emergency phase of treatment. Typical use of the IO route is limited to between 12-24 hours. Most often, it is used only until the point at which intravenous access is obtainable. Although uncommon, it is possible to administer fluids at an intraosseous site for up to 3 days.2
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Complications are uncommon with the IO route of administration. Mild discomfort in veterinary patients during catheter placement is reported by some users, however, humans undergoing IO cannulation report that the discomfort is mild and brief when catheters are placed by experienced users. Having said that, it should be reiterated, that the periosteum is very sensitive. In order to minimize any discomfort, local anaesthetic should be injected prior to placement. Extremely high fluid rates and administration of cool fluids may also cause some degree of patient discomfort. In order to avoid this as a potential complication, fluids may be warmed and rates may be tailored to reflect patient comfort when possible. Incorrect placement of IO catheters may lead to nerve damage. Trauma to regional nerves may arise if landmarks are not correctly identified.3 Infection is another possible complication associated with IO fluid administration. As with intravenous fluid administration, complications may arise if catheters are placed without adherence to strict aseptic technique. Osteomyelitis is an infrequent, but serious complication associated with IO fluid therapy.
Summary Intraosseous cannulation is an excellent means of fluid delivery and medication administration in patients in whom achieving intravascular access is not possible. The IO
further reading > • Abrams-Ogg, A. 2003. Critical and Supportive Care in Pediatrics. Proceedings: Western Veterinary Conference 2003 • Gunn-Moore, d. 2006. How to Perform Intraosseous Fluid Administration in Neonates. Proceedings: WSAVA World Congress 2006 • Hartholt, K. et al. 2010. Intraosseous Devices: A Randomized Controlled Trial Comparing Three Intraosseous Devices. Prehospital Emergency Care 2010. 14:613 • Leidel, B. et al. Comparison of Intraosseous versus Central Venous Vascular Access in Adults under Resuscitation in the Emergency Department with Inaccessible Peripheral Veins. Resuscitation (2011). doi: 10:1016/j.resuscitation.2011.08.017 • Olsen, D. et al. 2002. Evaluation of the bone injection gun as a method for intraosseous cannula placement for fluid therapy in adult dogs. Vet Surg. 31(6): 533-40 • Su-Yin Ngo, A. et al. 2009 Intraosseous Vascular Access in Adults using the EZIO in an Emergency Department. Int J Emerg Med 2:155-160 • Waddell, L. 2002. Advanced Vascular Access Options. Proceedings: American College of Veterinary Internal Medicine 2002. • Weiser, G et al. 2011. Current Advances in Intraosseous Infusion – A Systematic Review. Resuscitation. doi:10.1016/j. resuscitation.2011.07.020
space maintains its structural integrity in the face of hypotension and hypovolemia and as such should be considered for delivery of emergency fluids and medications. Hypodermic needles, bone marrow or spinal needles, as well as intraosseous catheters can be placed manually into the medullary cavity of long bones. Automated devices are also available for use in veterinary patients. The trochanteric fossa of the femur is a popular site for IO catheterization in pediatric patients. In larger animals, the flat surface medial to the tibial tuberosity is one of the easiest sites to landmark. IO catheters should be placed using absolute aseptic technique, and should generally only be left in place until IV access is obtained. Fluids and medications used for IV delivery may also be used via the IO route.
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* With Intra-Trac® 3 ADT 1 ImpactVet Sales August 2010 2 B.bronchiseptica, parainfluenza and adenovirus type 2 For product information or technical support please call: 1-866-683-7838. Intervet Canada Corp., 16750 Transcanada, Kirkland, Québec H9H 4M7 Intra-Trac is the property of Intervet International B.V. and is protected by copyrights, trademark and other intellectual property laws. Merck Animal Health is a subsidiary of Merck & Co., Inc, Whitehouse Station, NJ, USA. MERCK is a trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA. Copyright © 2011 Intervet International B.V., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA. All rights reserved. INT001-10E-AD
Light laser therapy is one of the newest medical advances implemented in veterinary medicine. Though the technology is relatively new, the biostimulative properties of laser light were first discovered in 1966 by Endre Mester, who published the first scientific report of the stimulatory effects of nonthermal ruby laser light on the skin of rats.1 The first commercial laser appeared in the late seventies. Though therapy lasers have been used in Europe for quite some time, they have only been FDA approved in the USA in 20021 and shortly thereafter in Canada. Laser therapy has been used in human medicine for many years for physiotherapy and rehabilitation. Two common conditions receiving treatment with therapeutic lasers are carpal tunnel syndrome and rotator cuff tears. Therapeutic lasers are used in the veterinary practice today to treat a variety of chronic and acute conditions including but not limited to osteoarthritis, intervertebral disc disease, muscle strains and sprains, hot spots, burns, otitis, and lick granulomas. Laser therapy is non-invasive, easily applied, and an effective option to provide analgesia, reduce inflammation and increase the rate of wound healing in pets. What is a Laser? Laser is an acronym which stands for Light Amplification by Stimulated Emission of Radiation. A laser includes the following parts: an energy source (ie.
CE Article #2 You Should LaserThat!
power supply), a lasing medium (solid, liquid or gas), and a resonating cavity (mirrors)1. All lasers are classified according to their potential to cause damage to biological tissue. This relates directly to their laser output energy or power, the wavelength of the energy produced, the duration of the exposure beam and the cross sectional area of the laser beam at the point of interest. There are four classes of lasers. Class I lasers cannot cause any biological tissue damage – examples would include compact disc players or laser printers. Class II lasers have a wavelength of 400-700 nanometers (nm), and have the potential for optical hazard if
viewed directly or for a long period of time. An example of this class laser is a bar code scanner. Class III has two subdivisions: IIIa, and IIIb. Class IIIa lasers range from 1mW up to 5mW in power, and are not hazardous if viewed only momentarily by the unshielded eye. Class IIIb lasers do create a biological hazard if viewed directly, and also if the beam is viewed off of a reflective surface. The wavelengths of these lasers typically fall in the visible spectrum and they range in power from 5 milliWatts (mW) to 500 mW. Therapy lasers used today in veterinary practice fall into either the Class III or the Class IV categories. Class IV lasers
Beth Campbell, RVT has been a veterinary technologist for 11 years and worked in a number of small animal practices as well as a 24 hour emergency practice in the ICU. She is a graduate of the first Ridgetown College distance program class. She is currently working in a small animal practice in Toronto utilizing her new laser therapy training. She has recently added a rescue dog to her two cat family and is enjoying spending time with this amazing “Beauty”, seeing a new world through her eyes.
Andria Gordon, RVT spent ten years working in the corporate world before deciding to follow her passion and pursue a career helping animals. She graduated from Seneca College in 2010, and has been loving the tech life ever since. Andria works in a busy downtownToronto small animal practice where she’s been fortunate enough to gain exposure to laser therapy. She regularly treats canine and feline patients with laser therapy, in addition to her standard technician duties. Andria has a keen interest in canine behaviour and in her spare time, works part time as a dog trainer teaching people how to understand and train their dogs.
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also relaxes the musculature and increases the threshold of pain perception and activates acupuncture points.2,3
Laser Probes - Oblique
have an output power greater than 500 mW, and are divided into two groups: surgical and therapeutic.2 Surgical lasers cut while therapeutic lasers heal tissue. In this article, we’ll be addressing therapeutic lasers only. There are many makes and models of therapy lasers on the market. Various laser therapy units differ in how the laser light is applied. A laser set up will include either a hand piece such as a probe or a wand, or a soft flexible silicon array (a rectangular device that is strapped on the patient over the affected area to allow for hands-free treatment). Our experience has been in utilizing a Class IV laser with two different probe hand pieces – small for superficial treatments, and large for deep tissue treatments. How a therapy laser works There are four effects when photons are administered to tissue; reflection of the photons, absorption of the photons, transmission of the photons through the tissue or scattering of the photons.2 The goal of all laser therapy is to deliver an effective dosage of photons to the target tissues therefore achieving a positive physiological outcome. Laser therapy is also referred to as “photobiomodulation therapy” or “photostimulation therapy”. It is defined as the application of electromagnetic radiation within the red and infrared spectrum over injuries and lesions to stimulate healing and pain relief within those tissues. There is growing evidence supporting lasers influencing pain relief, wound healing, and inflammation. The mechanism of pain relief is thought to be due to several processes, such as increased secretion of serotonin, increased release of endogenous opiates, and blocked depolarization of C-afferent nerves. Laser therapy
In the case of wound healing, laser energy is absorbed by chromophores such as cytochrome c oxidase, in the mitochondria. This results in increased cellular metabolism and ATP production and stimulation of DNA and RNA formation which is followed by an increased expression of growth factors, cytokines and genes related to cell proliferation and migration. An increase in vascular activation has been seen following laser treatment to open wounds. This may be due to a local increase in temperature, which can influence cell membranes and ion exchange, and ultimately vascular tone.3 Laser light stimulates the production of fibroblasts. These fibroblastic cells are the building blocks of collagen which is the essential protein required for tissue repair. In the maturation phase of wound healing (the remodeling of scar tissue) lasers have been shown to enhance the organization of collagen fibers within wounds. Increased leukocyte and macrophage activity occurs at the site of the wound due to the stimulatory effect laser light has on the vascular system, and small capillaries are regenerated at a faster rate.2,3 Some studies have shown enhancement of the inflammatory response and increased production of growth factors such as transforming growth factor-ß. Immune system upregulation has also been demonstrated. Laser therapy has been shown to reduce inflammatory mediators like cyclo-oxygenase-2 (COX-2) and prostaglandin E. It promotes microcirculation by increasing vasodilation. By also promoting lymphatic flow, it therefore reduces inflammatory edema and inhibits the synthesis of inflammatory prostaglandin.3 Veterinary Applications of the Therapeutic Laser Laser therapy is being used in the veterinary practice to accelerate wound healing including surgical incisions, bite wounds, abscesses, punctures, and burns. It can play an important role in the treatment of many dermatological conditions including hot spots, lick granulomas, frostbite, pyoderma, and otitis. Laser therapy can also be beneficial in therapeutic treat-
ment of chronic musculoskeletal disorders such as osteoarthritis, degenerative joint disease, intervertebral disc disease, and spondylosis, as well as acute conditions such as fractures, ruptured ligaments, muscle strains and sprains. This list is not complete by any means, however represents a small fraction of usages in which laser therapy can be beneficial. Laser therapy is by no means a cure-all; it is typically used as an adjunct to traditional pharmacological approaches. For example, in cases of osteoarthritis, the patient might be prescribed an NSAID, with laser therapy used to further reduce inflammation and decrease pain. It can be used stand-alone in cases where the patient cannot tolerate a pharmacological approach or where the owner is unwilling or unable to administer medications. Because it is non-invasive, it can also be useful to manage pain and inflammation in cases where a surgical approach is not practical, either due to patient contraindications or owner consent. Key Laser Therapy Terminology There are several terms and principles a technician needs to understand in order to operate a therapeutic laser. The power of the beam the laser emits is measured in watts (W). Therapeutic lasers on the market today range up to 15 W. The frequency refers to the method in which the beam is delivered. It can be continuously delivered (called continuous wave) or pulsed in varying speeds (with the energy being delivered intermittently). The energy delivered by the laser is measured in joules (j). 1 joule = 1 Watts/second (W/s). The trend has been towards creating higher powered lasers which allow for relatively short treatment times. Determining the Patient’s Therapeutic Dose In order to successfully use a therapeutic laser, it is imperative that the correct dosage is determined and applied. In order to calculate the appropriate dose, several factors must be considered. Is it a superficial or deep tissue condition that we are treating? How large is the surface area and/or how large is the patient? Therapeutic doses for the majority of conditions fall into the 4-10j/ cm² range, according to the World Laser
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Therapy Association4. Patients with very thick hair coats, dark haired patients and overweight patients may require slightly higher dosages as the light is absorbed by the coat, or by tissues, muscle and fat. Similarly, underweight patients may require a slightly decreased dosage as there is less tissue for the beam to travel through. The good news is that the majority of therapeutic lasers on the market today do most of the work for you, with varying degrees of sophistication. Some of the more user-friendly models have the operator input several variables – patient weight, hair coat thickness, hair colour, body condition score, anatomical region, and the condition being treated – causing the machine to select the correct frequency, power and total dosage in joules. The patient’s progress is assessed at each treatment, and the technician may need to make adjustments in dosing dependent on the clinical results. Increasing the power or the treatment time will result in a higher energy output in joules. It is important to document the power, treatment time and total energy delivered in the patient’s medical record after each treatment. Laser Therapy Treatment and Documentation Protocol In Ontario, laser therapy can be administered by a technician as per the CVO Position statement entitled “The Practice of Complementary and Alternative Veterinary Medicine.”5 This provides a great opportunity for technicians to get in front of the client and demonstrate our knowledge and our value. At our practice, the patient is seen by the veterinarian for the presenting complaint and a treatment plan is established. As mentioned, often laser therapy is used as an adjunct to a conventional pharmacological approach. Because of the efficiency of the lasers on the market today, treatment time can take only minutes, and most laser systems are portable and can be moved into examination rooms. We have found it to be helpful for the owner to be present during the laser therapy. The owner provides comfort and security to their pet, and this is also a great time to collect information about the pet’s symptoms and progress at home. In the case of treating superficial conditions such as wounds, healing will be evi-
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dent visually: surface area of lesions may have decreased, scabs may be forming, hair regrowth could be evident, edema will have decreased and the colour of the wound may be returning to normal. We have found it helpful to photograph wounds at each treatment session, going so far as to measure the surface area, to track progress. This is not only beneficial in a large practice where multiple technicians and veterinarians are involved in a patient’s treatment, but it also helps clients to visually track their pet’s healing. In treating superficial conditions, the laser hand piece never makes direct contact with the skin; it is hovered above the wound and moved slowly but continuously in a cross-hatching pattern.
and moves around the skin and musculature throughout the treatment. If the patient will tolerate it, gentle passive range of motion exercises can be incorporated during therapy, allowing the beam to penetrate the affected area from all angles. In cases where there are arthritic changes in a limb, or in the case of an acute injury such as a torn cruciate ligament, we will typically incorporate treatment of the alternate limb or surrounding muscles into our therapy plan. Often when an animal is experiencing pain and inflammation in one area, they may compensate by overusing muscles and joints in another area. Patients with hip pain, for example, also benefit from the application of laser therapy at the lumbo-sacral junction.
Chronic muscular and joint conditions pose a greater challenge because the results of the laser therapy are not as immediately obvious. In these cases, we rely upon owner observations to give us an indication of the effect of the therapy. On the day of the first treatment, we collect baseline information about the pet’s current status, with the owner articulating specifically any challenges the pet is experiencing. For example, in the case of a dog with osteoarthritis:
Treatment Frequency Laser therapy is not an exact science and every patient will have an individualized response to treatment. There is therefore no magic formula that will determine exactly how many sessions are required, or precisely when a patient is likely to experience a positive response. Acute, superficial conditions respond much more quickly than chronic deep tissue conditions. In many cases an acute superficial condition may require as little as one treatment. Our biggest and most visible successes have been in cases of otitis. Of-
a. Is the dog grumbling when getting up or lying down? b. Is he slow to rise from a recumbent position? c. Is he having difficulty with stairs or getting in and out of the car? d. Is there any limping or altered gait? e. Is he no longer able or reluctant to jump on furniture? f. Is he restless or unable to maintain a comfortable position for long periods of time? We document this patient history and ask the owner to pay attention to these signs at home once the laser therapy has begun. At subsequent treatments, we are able to circle back to these questions and assess the effect of the therapy, making dosage changes as needed. In the case of treating musculoskeletal or joint disorders, we utilize a larger laser hand piece which contains a massage ball. This is applied directly to the skin,
Laser - Post-Op Cruciate
ten the pet will present with such inflammation that it is impossible to administer medication into the ear canal itself. We have seen cases where after a single laser therapy treatment, inflammation has been sufficiently reduced that the ear canal can then be visualized and medication can be delivered. It is important to set the appropriate expectation with the owner before beginning a course of laser therapy, especially in the case of chronic deep tissue injuries or conditions. Laser therapy has a cumulative effect so typically the more sessions the better the pet feels. For chronic conditions such as osteoarthritis, there are generally three treatment phases. The induction phase is the initial phase. Treatment is aggressive and is typically every other day until a response is noted. The degree of tissue abnormality and chronicity of the condition dictate the number of induction treatments required. Many patients show an improvement within 2-3 treatments during the induction phase. The initial response is due to the quick pain relieving effect of the therapy laser. Six induction phase treatments are average, but some patients may require as many as nine to twelve treatments. As treatments continue there is a cumulative long term reduction of inflammation. If a patient does not appear to be responding, it is always wise to re-investigate the dosage. As hospital personnel get accustomed to using a therapy laser, underdosing as well as poor therapy administration technique, can be the cause of an apparent lack of response.4 Next is the transition phase. In this phase, there is a gradual reduction in frequency of treatments required to maintain the clinical relief of symptoms that were achieved in the initial phase. This stage of the treatments is used as a bridge between the initial phase and the maintenance phase. For example, the initial phase of treatments may be reduced from one treatment three times a week to once weekly depending upon the pet’s response. The maintenance phase is the final phase of treatment. In the management of chronic degenerative conditions, typically continues for the remainder of the pet’s life. The goal of therapy is to maxi-
mize relief while minimizing the number of treatments. Generally, most chronic conditions can be maintained with one treatment every 3-4 weeks. Frequency is adjusted based upon the pet’s response to therapy. Because treatment response varies individually, it is important for the technician to collect regular feedback from owners and consistently refer back to previous treatment notes. Most laser therapy manufacturers have veterinarians on staff who have years of experience treating a wide variety of conditions with therapeutic lasers. These experts can be helpful resources in suggesting alternate dosing and frequency protocols. Our Experience with Therapeutic Laser Results It has been our experience that many owners cite the following observations in their pets after treatments with laser therapy: the pet is generally more active, can better navigate stairs, appears to have better range of motion, demonstrates a reduction in lameness, less restless and is sleeping more comfortably. In cases of patients with wounds/dermatological issues, clients have reported that their pet scratches less, has reduced inflammation, hair regrowth is rapid, and wounds quickly appear less red with scabs forming remarkably quickly. The list is a long one of the benefits seen with laser treatment and the above is just some of the responses and comments we have received from our clients. Safety Considerations Though laser therapy is very safe for both the patient and operator, there are some safety concerns and precautions that must be observed. The biggest safety concern is the eyes. Everyone within 5 feet of the laser should be wearing safety laser goggles or glasses, as light from the laser can cause retinal damage if it comes into direct contact with the eyes. Even reflected and refracted light from the laser beam be damaging. The patient’s eyes must also be protected from the laser. A thick towel or a small cloth made with black out material can be used to cover the patient’s head. There are also glasses for animals on the market especially designed for eye protection from laser light. Care must be taken in positioning to ensure the pet
is comfortable and is less likely to move around during treatment. Most hand pieces make it is easy to stop treatment if the patient moves unexpectedly. Laser light can reflect off shiny surfaces, therefore any metallic or reflective surfaces must be covered, and any shiny jewellery such as rings and watches should be removed. Signage must be placed notifying other personnel that laser therapy is ongoing in a particular area. Laser therapy has minimal effect on healthy cells or tissue (except the eyes, as mentioned), so if the beam comes in contact with the restrainer’s hand or other parts of the pet’s body, there is no danger.1,4 When applying laser therapy treatment around the head (ears, or oral cavity, for example) it is especially recommended that the technician has additional help to hold the patient still, minimizing the risk of movement. Especially with some of the higher powered therapy lasers, heat from the actual beam can be a concern. When used appropriately, the patient will feel a pleasant warming sensation. However, if the laser’s beam is not in constant motion, or is moving too slowly, the heat generated could be uncomfortable or could even burn the patient. It can be helpful to run your finger along the hair of the patient
Chester - Laser Goggles
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periodically as you are treating, to get an indication of the heat production. Black and very dark coated animals, especially, can become very warm quite quickly. For these animals it is recommended to spray the hair coat with water prior to beginning treatment. Contraindications There are a handful of situations in which laser therapy is contraindicated. The veterinarian and any technician treating the patient should be aware of the patient’s full medical history before beginning laser therapy. The biggest contraindication for laser therapy is cancer. If tumours have been diagnosed or are suspected, the affected area should not be treated with laser therapy. In our practice as a rule, we do not laser any lumpectomy patients where cancer is on the list of rule outs. Another contraindication is the growth plates of young animals, as these are still forming. Applying laser therapy near the growth plates can alter growth, and is not advised. Due to the fact that laser therapy increases circulation, active hemorrhage is another situation in which laser therapy should not be administered, as it could possibly lead to further hemorrhagic activity. Once the hemorrhage has stopped, it is safe to apply laser therapy. In our practice, we laser all of our post-surgical incisions; however in cases of excessive bleeding, we will wait 12-24 hours before administering treatment. Heart disease is another contraindication of laser therapy. The entire cardiac region should be avoided in any patient with a cardiac condition as laser therapy can alter neural function within the area. Other contraindications for laser therapy include the abdominal cavity, lumbar spine or pelvic area of a pregnant animal, any anatomical area that has been injected with corticosteroids within the past two to three days, and animals that are currently receiving photosensitive medications such as tetracycline or griseofulvin. To be clear, patients who have cancer, heart disease or growth plates that are forming may still undergo laser therapy,
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• J. Dais, Low Level Laser Therapy Position Paper for the CMTBC: An Examination of the Safety, Effectiveness and Usage of Low Level Laser Therapy for the Treatment of Musculoskeletal Conditions, July 2009 • Matsumoto, Mariza A, Ferino, RV, Monteleone, GF, Ribeiro, DA, Low-level laser therapy modulates cylco-oxygenase-2 expression during bone repair in rats, Lasers Med Sci (2009) 24:195-201 • Arp, Dennis. A Case Study: Healed Hotspot Turns Skeptic Around, Veterinary Practice News, March 2010. • Anders, Juanita J, Gueno, Stefano and Rochkind, Shimon, Phototherapy promotes regeneration and functional recovery of injured peripheral nerve, Neurological Research 2004, Volume 25, March, pp 233-238.
1. Turnér J, Hode L, The New Laser Therapy Handbook .Grangesberg, Sweden. Prima Books AB 2010. pp 69-142. 473-481 2. Riegal, Ronald J , Laser Therapy In the Companion Animal Practice: Mechanics and Protocols for Class IV Laser Therapy LiteCure LLC, 2008. pp 17-33 3. Kirkby, Kristin, “Laser Thearpy as a Modality in Canine Rehab, Small Animal Rehabilitation, NAVC Conference 2011, pp 1-3. 4. World Laser Therapy Association http:// www.walt.nu/dosage-recommendations. html 5. College of Veterinarians of Ontario Position Statement “The Practice of Complementary and Alternative Veterinary Medicine, June 10, 2009.
however not in the area where there is a contraindication as listed above. We use laser therapy on spay and neuter incision sites in puppies and kittens because we are treating a superficial condition (a surgical incision) and not impacting any growth plates. Similarly, a geriatric dog with an oral tumour could still be treated with laser therapy for arthritis in the hips, for example.
are still learning and adjusting with each case. Currently there is no standard training available.
Training for Administering Laser Therapy In our case, we performed an in-clinic training session with our laser therapy unit manufacturer. We also completed a 3+ hour online training through AIMLA (American Institute of Medical Laser Applications). The majority of our learning, however, has been hands-on through actually treating patients. When we added the laser to our practice we offered free therapy to a few “pilot” patients and tweaked our techniques (in terms of appointment flow, patient comfort and restraint, dosages, etc.), as we gained more experience. We also consulted several professionals with years of laser therapy experience; either through the laser therapy unit manufacturer that we use, or individuals we found on the Veterinary Information Network (VIN). We have benefited from their conference calls, webinars, and technique suggestions. We
Conclusion Laser therapy is a new and exciting development in the veterinary practice. There are a wide range of ailments that can be treated with laser therapy and the results are very promising. With a growing number of practices adding therapeutic lasers to their facilities, this new treatment modality represents a fantastic opportunity for patients and veterinary staff. Veterinary technicians find themselves at the centre of it and in a wonderful position, as we are the natural choice to administer the therapy. It is important for practitioners to educate themselves as there is currently a lack of clinical studies and a plethora of anecdotal reports, case studies and experimental evidence. It is anticipated that in the near future larger veterinary clinical studies will emerge to support the benefits and long term usage of laser therapy in treating companion animals. Understanding the potential clinical applications of laser therapy within the veterinary practice is key to providing the highest standard for care for our patients.
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Introduction As a technician you will likely be the first person to assess an animal’s condition. Any change in an animal’s breathing is an emergency. Owners may not understand the significance of this, and often mistake laboured breathing as “panting” or shallow breathing as “sniffing.” Administering oxygen effectively and understanding how to test and treat for oxygen deficiency is important when dealing with critical patients. Oxygen in the Body Oxygen is necessary for all normal metabolic processes involving cellular function in the body. Oxygen delivery to the body depends on three things: cardiac output, arterial oxygen content, and blood flow.1 Cardiac output is dependent on stroke volume and heart rate.1 Arterial oxygen content is a function of dissolved oxygen and hemoglobin saturation.1 Adequate blood flow ensures that there is enough hemoglobin and appropriate gas exchange. Oxygen is delivered to the cells in two forms: dissolved oxygen in arterial blood or attached to hemoglobin.2 The oxygen pathway is a six part process. The animal breathes in oxygen known as PIO2. This is transported to the pulmonary alveoli by the process of alveolar ventilation to determine the alveolar O2 partial pressure (PAO2).2 From the alveoli the oxygen is carried to the pulmonary capillary blood by a mechanisms known as pulmonary gas exchange which determines the arterial partial pressure (PaO2).2 The PaO2 is the principal figure in determining the arterial hemoglobin saturation (SaO2).3 The relationship between these two is known as the oxygen-hemoglobin saturation curve.3 Arterial oxygen content (CaO2) is a function of hemoglobin concentration and SaO2.3 Ultimately oxygen delivery to the tissues occurs because of the arterial oxygen content and cardiac output. Monitoring Oxygen Being able to determine the overall func-
CE Article #3 All About Oxygen
tion of a patient’s respiratory system in a quick and timely fashion is important. It is equally important to be able to determine if treatment to correct any respiratory dysfunction is helping to maintain adequate respiratory function in that patient. In general, any patient who appears to have some alteration in the respiratory status should receive oxygen until it is proven that it is not needed. In a clinical setting we can monitor the five parameters of adequate oxygenation: respiratory rate/ effort, mucous membrane colour, pulse oximetry, end tidal CO2 and blood gas.
Respiratory rate and effort is an easy parameter to monitor. If a patient is “breathing differently”, then it is important to look at the reason why. Determine the rate and assess the effort the patient appears to be putting into “breathing”. Signs of respiratory distress include but may not be limited to, any open mouth breathing in a cat, anxiety, restlessness (won’t lie down or stay down), extension of the head/neck, abducted elbows, and tachypnea. Normal respiration is characterized by concurrent outward movement of both the chest and abdomen during
glossary > CaO2 FiO2 PAO2 PaO2 PIO2 PvO2 SaO2 SpO2
Oxygen concentration of arterial blood Fraction of inspired oxygen in a gas mixture Alveolar partial pressure of oxygen Partial pressure of oxygen in arterial blood (gold standard to measure overall oxygenation) Partial pressure of inspired oxygen Partial pressure of oxygen in venous blood Arterial hemoglobin saturation Measures the oxygen saturation of hemoglobin (equipment is known as a pulse ox)
Amy N. Breton, CVT, VTS (ECC) - Amy is currently employed at the Veterinary Emergency and Specialty Center of New England in Waltham, Massachusetts as the Head Emergency Technician. 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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inhalation. If you notice prolonged inspirations, it may indicate upper airway obstruction.4 If you are noticing prolonged expiration it may indicate lower airway disease.4 Auscultation of the chest should occur if increased respiratory effort or rate are noted. Detection of wheezes, crackles, harshness or increased bronchial sounds will indicate respiratory distress and therefore a need for supplemental oxygenation. Along with respiratory rate and effort, mucous membrane colour is one of the easiest parameters to monitor and should be part of every physical exam. Though not completely accurate (because lighting, anemia or icterus hides the appearance of cyanotic membranes) any presence of cyanosis indicates a life threatening oxygenation issue which needs to be addressed immediately. Pulse oximetry (SpO2) is less invasive, and the equipment is significantly cheaper than that required to obtain a PaO2 measurement. A pulse oximetry machine measures the oxygen saturation of hemoglobin, which is a very insensitive measure of oxygenation. Normally animals should have a range from 98-100% on room air.5 The drawback to a pulse oximetry machine is that, at times, it is not very accurate. Patient movement, poor perfusion, hair, or any colour other than pink mucous membranes (icterus, cyanosis, anemia) can cause the reading to be inaccurate. However, the pulse oximetry machine continues to be a fairly quick and easy test to use to determine overall oxygenation. The SpO2 reading tends to follow the PaO2 reading.5 In general, a patient with a SpO2 reading of 96% equals a PaO2 reading of 80 mmHg and a reading of 91% estimates to about a PaO2 reading of 60 mmHg.5 Measuring end-tidal CO2 through capnography can be another way to assesses the overall health of the respiratory system, but is limited to patients that are intubated. The capnograph measures the amount of exhaled and inhaled carbon dioxide (CO2) during the respiratory cycle. Inspired and expired CO2 values change over the course of the breath cycle. Normal end-tidal CO2 is between 35-45 mmHg in dogs and cats.5 PaCO2 readings
are higher than end-tidal CO2 usually by 5-10 mmHg.5 Unfortunately, an accurate measurement of CO2 in a normal exhaled breath cannot be obtained, so end-tidal CO2 is reserved for intubated patients on ventilators or under anesthesia. Partial pressure of oxygen in venous blood (PvO2) is not very reliable and ideally should not be used.3 This is because the measurement depends on three components: cardiac output, oxygen consumption by the tissues and, to a lesser extent, arterial oxygen content.3 If there is a change in any of the three components then the PvO2 reading will be low, and creates diagnostic challenges. If you cannot obtain an arterial sample, then you should obtain a venous sample from the jugular vein or vena cava as these will often provide the most accurate results. Normal PvO2 measurements are above 40 mmHg.6 Most veterinarians will agree that a PvO2 below 30 mmHg is concerning and requires intervention, while a PvO2 below 20 mmHg is an emergency.6 Partial pressure of oxygen in arterial blood (PaO2) is still considered the goldstandard test when monitoring for overall oxygenation ability of a patient.7 It is not a measurement of how much oxygen is in the blood, but is the pressure exerted on the arteries by the dissolved oxygen molecules.7 Only a small percentage of oxygen is actually dissolved into a physical form that can be measured in plasma. Some blood gas analyzers will offer the reading as PO2. It is important to know if the sample was venous or arterial as the values are different and or the reading could be misinterpreted. Normal PaO2, at sea level, is between 80 and 110 mmHg.6,7 When PaO2 is less than 80 mmHg the patient is suffering from hypoxemia.6,7 Severe hypoxemia occurs with a PaO2 less than 60 mmHg.6,7 PaO2 is the most sensitive test of oxygenating ability and is also very reliable.6 Any small change in oxygenation will cause the PaO2 to change as well. Unfortunately, in order to obtain this measurement, you must obtain an arterial blood sample, which may not be possible in some patients. INTERPRETING THE BLOOD GAS VALUES FOR OXYGENATION Once a blood gas sample is obtained you
must interpret the results. While a patient may have a change in their respiratory pattern (shallow, heavy, etc.) it may not necessarily require oxygen. Conversely, many people have been fooled by a patient’s slow “normal” looking panting only to find out it was in great need of oxygen. PaO2/FiO2 Ratio: Once an arterial blood gas is obtained, you can then figure out the ratio of arterial oxygen pressure (PaO2) to fractional inspired oxygen (FiO2).8 The FiO2 is the amount of oxygen in a gas mixture (like room air). It is expressed as a number from 0 (0%) to 1 (100%), written either as a decimal or percentage.8,9 No matter what sea level the blood sample is drawn at, the FiO2 of normal room air is always 0.21 (21%).9 Most commercial oxygen machines keep the FiO2 at 40%. In general, the PaO2 should be approximately five times the FiO2.10 Therefore a patient under anesthesia on 100% oxygen should have a PaO2 of approximately 500 mmHg. Room air has a FiO2 0.21. Therefore a normal PaO2/FiO2 ratio is 476 (100/0.21). In general, a normal ratio is > 400. A patient with a ratio between 300-400 should be considered slightlymoderately hypoxic and oxygen should be provided until other tests are performed. A ratio of 200-300 indicates moderate pulmonary dysfunction and less than 200 is severe and requires significant support. While other parameters [eg. 1) The onset of respiratory distress must be acute, 2) known risk factors must be present, 3) evidence of pulmonary capillary leak that was not associated with increased capillary pressures and 4) evidence of inefficient gas exchange and evidence of inflammation] must be met, if a patient has a ratio less than 300, then the definition of acute lung injury may be applied.11 If the patient has a ratio of less than 200 (pending other parameters are met), then the patient may be suffering from acute respiratory distress syndrome.11 For example, the patient has a PaO2 of 59 mmHg on room air, the PaO2/ FiO2 (59/0.21) ratio is 281, which could lead to the patient being diagnosed as having acute lung injury. Alveolar-arterial Gradient (A-a gradient): The Alveolar-arterial gradient (A-a gra-
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dient), is a measure of the difference between the alveolar concentration of oxygen and the arterial concentration of oxygen.9 While it can be complicated to calculate, it takes CO2 into consideration and provides a method to compare lung function over time. The PAO2 is calculated by taking the pressure of the inspired air (760 mmHg at sea level), subtracting water vapour pressure (47 mm Hg) which is then multiplied by FiO2.5,9 In places with high altitude barometric pressure needs to be factored in place of the 760 mmHG at sea level.5 PaCO2 (value from your arterial blood gas) is divided by a “respiratory quotient” (which in a clinical setting is always 0.8) and subtracted from the first number. The formula looks like this: PAO2 = (760 - 47) x FiO2 - PaCO2/0.8 In animals breathing room air the A-a Gradient should be less than 10 mmHg (some texts suggest less than 15 mmHg), with greater than 25 mmHg being clearly abnormal and the pet definitely needs oxygen.5,12 As the FiO2 increases, so does the gradient which makes it hard to assess what is “normal”. Many animals are on supplemental oxygen which can cause the value to be greater than 25 and in animals on 100% oxygen the value could be as high as 100 mmHg. Patients who are hypoxemic due to hypoventilation alone should have normal A-a gradients so that hypoventilation can be ruled out as a sole source of hypoxemia in post-operative patients. Trends should be measured instead, which makes the A-a gradient a valuable way to follow a patient’s oxygenating ability over time. (See example 1 below)
HOW TO ADMINISTER Animals should be allowed to assume any position that provides them the most relief. Oxygen should be provided initially by the least-stressful route. Sedation should be considered in patients that are very stressed. Sedating a patient will calm them and decrease any hyperventilation that may have been occurring because of stress. Opioids are the drug of choice since most are reversible and allow for minimal effects on the cardiac and respiratory systems. Oxygen Hoods Oxygen hoods made from Elizabethan collars tend to be well tolerated in dogs, but not as much in cats. A hood can be made by covering 75% of the ventral aspect of an Elizabethan collar with plastic wrap.7 The Elizabethan collar should be 1 size larger than would normally be used for the patient. The oxygen tubing is placed along the inside of the collar and taped in place ventrally. FiO2 levels can get up to 60% oxygen very quickly and in many cases 80% using 1 L/10 kg body weight of oxygen.7 The oxygen hood is only for short-term use because humidity
will build quickly and may cause a panting patient to overheat. Oxygen Cages Oxygen cages are popular because they are convenient. The RVT can turn them on, put the patient in them and walk away. However, there are three main problems with commercial oxygen cages: 1. The length of time it takes for an oxygen cage to get up to 40% FiO2 is long and varies on size. Small oxygen cages (infant incubators) can be utilized for cats and FiO2 levels can get up to 40% very quickly, but larger oxygen cages can take anywhere from 15-40 minutes for the FiO2 to get to 40% (this is assuming the oxygen is at 10-15L/min).* 2. You also cannot work with your patient if they are in a cage. Every time the door is opened, the oxygen escapes and plummets the FiO2 to room air very quickly so the patient becomes dyspnic again. The patient experiences the change from an oxygen rich environment to- room air to -oxygen rich environment very quickly.
example 1 > PaO2 of 60 and PaCO2 of 65 with the patient on room air, the A-a gradient would be: PAO2 = 760-47 = 713 x 0.21 = 149.73 - 65/0.8 = 68.48. Then subtract PAO2 - PaO2 = 68.68 – 60 = 8.48 Normal value which suggests that hypoventilation, not parenchymal disease is responsible for the hypoxemia PaO2 of 112 and PaCO2 of 15 on room air the A-a gradient would be: PAO2 = 760-47 = 713 x 0.21 = 149.73 - 15/0.8 = 131. Then subtract PAO2 - PaO2 = 131 - 119 = 19 High and suggests that parenchymal disease is present and the patient could benefit from oxygen
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3. Cost. The cost of the cage itself is expensive as well as the cost of the oxygen. The oxygen cost can be up to 10 times greater than with other methods.7 Flow-By Oxygen This method can be effective, but usually only if the owners are there to administer it. The reason is simple: Pets don’t like to have air blown on their noses. Using face masks will certainly make flow-by oxygenation more effective, but they are poorly tolerated. It is important to remember to remove the diaphragm on the bottom of the oxygen face mask. Having a tight seal around the pet’s face will not allow for appropriate ventilation. The efficacy of this technique is still debated since it is unknown how much of the oxygen the animal actually intakes.6,7 The oxygen tubing must be less than an inch away from the animal’s nose in order for it to be effective.7 If it is more than an inch away much of the oxygen is likely dissipated into the room air surrounding the patient. Animals sometimes will tolerate this technique if an owner holds the animal and the oxygen line. Nasal Cannula This is a technique that is well tolerated by most dogs and cats. This consists of a
short human nasal cannula that has two sections of tubing coming from a small nose piece. There are three sizes: infant (cat and small dog), pediatric (medium sized dog) and adult (large dog > 25 kg). By using a few drops of proparacaine or lidocaine in each nostril, most patients will allow the tips of the cannula to be placed into the nostrils. The tubing is brought to the side of the nose and secured with staples or suture.7 The remaining tubing is brought behind a patient’s head and secured so it doesn’t flop in front of the face. Ideally a humidifier should be attached to this so that the nasal passages are kept as moist as possible. Oxygen rates depend on the patient. In general, a rate of oxygen is started at 50100 mL/kg up to a maximum rate of 5-6 L/minute.7 While it is known that this method provides at least a 40% nasal oxygen concentration, it is possible to administer too much oxygen causing them to be at risk for oxygen toxicity. Arterial blood gas should be checked at least once a day to ensure the patient is appropriately oxygenating. Nasal Catheters This is one of the most effective ways to provide oxygen to the patient. The technique was first developed in 1984 and was published in 1986. A red rubber tube(s) is placed into the ventral nasal meatus.7 It is then sutured/stapled to the patient’s nose and on the side of the face or on the bridge of the nose between the eyes.7 Generally 5fr catheters are used for cats/small dogs, 8fr is used for medium/large dogs. By using a few
drops of proparacaine or lidocaine in each nostril, some patients will allow the red rubber to be placed into the nostrils. Most patients will require some sedation. Measurement should be from the tip of the nose to the lateral canthus (nasopharyngeal). Marking the red rubber with a line will ensure correct placement. Flow rates are the same for the nasal cannula.7 Patients can have two nasal lines placed if the first is not improving the patient’s oxygenation status. A nasal line can be placed into the trachea via the nose.7 This is particularly useful in patients with collapsing trachea or laryngeal paralysis. For a nasotracheal catheter the tube is measured to the level of the thoracic inlet.7 The patient’s head should be held in an extended position to facilitate blind passage into the trachea. Oxygen into the trachea should be reduced by 50% than what would have been used for a nasal catheter.7 Oxygen being administered into nasal lines should always be humidified to avoid nasal passages drying out. With patients with head trauma, severe thrombocytopenia and nasal disease, nasal lines should not be used. Sneezing will elevate intracranial pressure. OXYGEN TOXICITY Oxygen toxicity is a very real concern for patients that require long term exposure of high concentrations of oxygen. The lung is the organ most vulnerable to oxygen toxicity and the associated damage is often severe and irreversible. A continuous FiO2 level of 33% at sea level (PaO2 of 255 mmHg) is considered the safe level for long-term exposure in people.3,5 Higher levels are generally tolerated well over short periods of time. Human patients suffering from oxygen toxicity report chest pains, coughing and severe effort to breathe. Acute lung injury generally follows. Studies performed in dogs describe symptoms that start with lethargy, restlessness and coughing.3,5 Eventually the signs progress to anorexia, dyspnea and eventually death.3,5 Studies have shown that dogs exposed to 100% oxygen survive an average of 2-5 days while dogs exposed to 75-80% oxygen lived to about 14 days.3,5 Interruption of the exposure to oxygen can also reduce its toxicity. Unfortunately the signs/
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(Source: Compendium of Veterinary Products, 12th edition, 2011)
CONCLUSION Understanding how to recognize respiratory distress may mean the difference between life and death for a patient. Being able to monitor and then effectively administer oxygen is imperative to the success of any respiratory patient.
Match up the common names with the scientific names of these canine parasites. Common name Scientific name 1. tapeworm a. Otodectes spp. 2. flea b. Dermacentor variabilis 3. whipworm c. Sarcoptes scabei 4. ear mite d. Mesocestoides corti 5. heartworm e. Toxocara canis 6. American dog tick f. Trichuris vulpis 7. sarcoptic mange g. Uncinaria stenocephala 8. roundworm h. Ctenocephalides spp. 9. brown dog tick i. Rhipicephalus sanguineus 10. hookworm j. Dirofilaria immitis Answers: 1d, 2h, 3f, 4a, 5j, 6b, 7c, 8e, 9i, 10g
symptoms of the patient often mirror the disease process that is causing the need for oxygen in the first place. Performing arterial blood gases and reducing oxygen rates is important to help decrease the chance of oxygen toxicity.
* Based on an in-clinic study of 3 oxygen cages of different sizes at the Veterinary Emergency and Specialty Center of New England. Study was performed by Amy Breton using a Hudson RCI Oxygen Monitor and a stopwatch.
references > 1. Otto C.: “Oxygen Uptake and Delivery”, IVECCS Symposium 2004 Proceedings 2. Guyton A., Hall J.: “Textbook of Medical Physiology”, W.B. Saunders Company, Philadelphia, 1996 3. Hopper, K.: “Clinical Considerations of Hypoxemia” ACVIM 2009 Proceedings 4. Rozanski E.: “Respiratory Distress: Diagnosis and Intervention”, IVECCS Symposium 2005 Proceedings 5. Clare M.: “Monitoring Oxygenation”, IVECCS Symposium 2007 Proceedings 6. Bersenas A.: “Oxygen Therapy”, Western Veterinary Conference 2007 Proceedings 7. Crowe D.: “Oxygen Therapy”, Atlantic Coast Veterinary Conference 2008 Proceedings 8. Haskins S.: Hypoxemia: When Oxygen Therapy Works, and When It Does Not, IVECCS Symposium Proceedings 2005 9. Martin L.: “All Your Really Need to Know To Interpret Arterial Blood Gases”, Lippincott Williams and Wilkins, Philadelphia, 1999 10. Hopper K.: “Assessment of Oxygenation”, IVECCS Symposium Proceedings 2005 11. DeClue A.: “Acute Lung Injury and ARDS: Pathophysiology and Interventions”, IVECCS Symposium 2007 Proceedings 12. Waddell L.: “Blood Gas Analysis” The Basics, IVECCS Symposium 2008 Proceedings
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Hill’s Pet Nutrition’s Drive Nutrition Sweepstakes has selected Laura Tschetter of Henderson Animal Hospital as the winner of a brand new Smart Car. The Drive Nutrition Sweepstakes called for veterinary technicians to register and then complete activities like: • Attending a Hill’s Martinis and Manicures event or Practical Nutrition in-clinic seminar • Making a call to the Hill’s Veterinary Consultation Service • Posting a photo of themselves with pets/clients and a Drive Nutrition flag to the online gallery • Answering educational nutrition trivia questions • Attending a veterinary technician lunch at a conference Laura’s entry was randomly selected out of 587,000 crowning her as the sole Canadian winner in the 2011 Drive Nutrition Sweepstakes. Two U.S. winners have already been selected from Arkansas and Pennsylvania.
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Clinical Nutrition to Improve Quality of Life® To learn more, contact your Hill’s Veterinary Account Manager, go to HillsVet.ca or call Hill’s Veterinary Consultation Service at 1-800-548-VETS (8387). Fritsch DA, Allen TA, Dodd CE, et al. A multicenter study of the effect of dietary supplementation with fish oil omega-3 fatty acids on carprofen dosage in dogs with osteoarthritis. J Am Vet Med Assoc. 2010;236:535-539. TECHNEWS 26 Roush JK, et al. Multicenter practice assessment of the effects of omega-3 fatty acids on osteoarthritis in dogs. J Am Vet Med Assoc. 2010;236(1):59-66. Roush JK, et al. Evaluation of the effects of dietary supplementation with fish oil omega-3 fatty acids on weight bearing in dogs with osteoarthritis. J Am Vet Med Assoc. 2010;236(1):67-73. 4 Renberg WC. Pathophysiology and management of arthritis. Veterinary Clinics of North America: Small Animal Practice 2005;35:1073-1091. 1 2 3
©2011 Hill’s Pet Nutrition Canada, Inc. ®/™ Trademarks owned by Hill’s Pet Nutrition, Inc.
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CE Article #1: All About Oxygen 1. Prolonged inspirations may indicate: a. Lower airway disease b. Heart failure c. Upper airway obstruction d. Diaphragmatic hernia 2. A patient with a PaO2 of 60mmHg is: a. Hypoxic b. Hypercapnic c. Hypotensive d. Breathing normally 3. After placing a nasal line you should administer the oxygen through: a. An anesthesia machine b. A humidifier c. Nebulizer d. A warming unit 4. The gold standard test at measuring overall oxygenation of the patient is: a. PvO2 b. SpO2 c. FiO2 d. PaO2
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5. The A-a gradient measures: a. The difference between alveolar concentration of oxygen and arterial concentration of oxygen b. The difference between venous concentration of oxygen and arterial concentration of oxygen c. The difference between alveolar concentration of oxygen and venous concentration of oxygen d. The difference between inspired oxygen concentration and arterial concentration of oxygen 6. A pulse oximeter measures: a. Percent of oxygen in the lungs b. Amount of oxygen in the air c. Oxygen saturation of cells d. Oxygen saturation of hemoglobin 7. The normal end tidal CO2 is: a. 15-25 mmHg b. 35-45 mmHg c. 55-65 mmHg d. 25-35 mmHg
8. Pending other parameters are met a pet with a PaO2/FiO2 ratio of under 200 could be suffering from: a. Acute lung injury b. Sepsis c. Acute respiratory distress syndrome d. Cushing’s disease 9. Your patient is on room air and has a PaO2 reading of 50 mmHg. The PaO2/ FiO2 ratio is: a. 238 b. 350 c. 430 d. 201 10. A method to deliver oxygen that is noninvasive where FiO2 levels can reach 60% quickly is: a. Nasal catheter b. Nasotracheal catheter c. Oxygen hood d. Flow-by oxygen
CE Article #2: Intraosseous Catheterization 1. Identify two reasons that make IO catheterization an excellent option for vascular access in the emergency setting. a. Inexpensive b. Intraosseous space doesn’t collapse c. Fluids delivered promptly into circulation d. b & c 2. Once an IO catheter is in place, which of the following additional circumstances might cause patient discomfort during fluid administration? a. Connecting fluid line b. Extremely high infusion rates c. Administration of body temperature fluids d. Extremely low infusion rates 3. Which of the following helps reduce the occurrence of complications? a. Ensure aseptic technique when placing IO catheter b. Avoid use of IO catheters in emergency situations c. Avoid clipping fur at catheter site (reduce skin irritation) d. Restrict use of IO catheters to feline patients only
4. Which site is frequently used for IO catheter placement? a. The tip of the olecranon b. The femoral head c. The tibial tuberosity d. The humerus 5. Which of the following are contraindications for IO catheter placement? a. Pathological fracture or trauma to area surrounding site b. Shock and head trauma c. Osteomyelitis d. a & c 6. Which two of the following may cause an obstruction of flow through an IO catheter? a. Catheter positioned against the cortex b. High blood pressure c. A bone plug d. a & c 7. Which of the following can safely be administered via an IO catheter? a. Sterile intravenous fluids b. Blood or blood products c. Emergency drugs (for CPR) d. All of the above
8. Which of the following points are potential complications associated with IO catheterization. a. Infection (osteomyelitis) b. Fluids remain in IO space c. Damage to local nerves d. a & c 9. Which hospital equipment shown below can be used to gain intraosseous access in compromised patients? a. 22g Vialon peripheral catheter b. 18-20g hypodermic needle c. Spinal needle d. b & c 10. Identify one advantage associated with the use of a catheter specifically designed for IO cannulation. a. Low cost b. Wide availability c. Strong material d. Fenestration on opposite surfaces of catheter end
CE Article #3: You Should Laser That! 1. Laser is an acronym which stands for: a. Light Amplification by Stimulated Emission of Radio waves b. Light Amplification by Stimulated Emission of Radiation. c. Light Abnormality by Stimulated Energy of Radiation d. Light Activation by Stimulated Energy Radiation 2. The power of the laser beam is measured in: a. Watts b. Joules c. Joules/cm² d. Watts/second 3. Today’s veterinary therapeutic lasers are: a. Class IV lasers exclusively b. Class III lasers exclusively c. Class III or Class IV lasers d. Class II, III or IV lasers 4. The following safety precautions should be taken when administering laser therapy: a. Shiny surfaces should be covered in the treatment area; shiny jewellery removed. b. Signage displayed indicating laser therapy is in progress. c. Special eye protection for the patient and any human in the room. d. All of the above.
5. The anti-inflammatory, pain relief, and wound healing properties of laser therapy can be helpful in treating many conditions seen in the veterinary practice. Which is NOT an example? a. Reduce the size of a cancerous tumour. b. Reduce the pain and swelling related to osteoarthritis c. Reduce the pain and inflammation associated with otitis. d. Speed the wound healing of a lick granuloma. 6. After surgery, the incision area is still bleeding actively. The best course of action as it relates to laser therapy would be: a. Recommend delaying laser treatment until the bleeding has stopped. b. Do not perform laser therapy on this patient after this surgery. c. Ice the wound, and then laser. d. Laser immediately as effects of the laser halt hemorrhagic activity. 7. Dark coated animals may absorb more heat from high powered lasers. Thus: a. Treatment time should be reduced b. Power should be reduced c. Both power and time should be reduced d. The treatment area should be sprayed with water prior to beginning laser therapy
8. In the case of an obese patient, the following is true regarding laser therapy dosing: a. The dosage in joules should be calculated based on lean body weight. b. The suggested dosage in joules may need to be increased. c. The suggested dosage in joules may need to be decreased. d. The dosage in joules should be calculated based on the patient’s actual body weight and treatment area. 9. The following is true regarding laser therapy treatment for osteoarthritis: a. Improvement can be seen after 2-3 treatments b. Improvement must be noted in the Induction stage before advancing to the Transition stage c. Every patient responds differently. There is no magic number of treatments before improvement is seen d. b & c 10. Laser light therapy stimulates: a. ATP and fibroblast production b. Cyclo-oxygenase-2 (COX 2) c. Prostaglandin E d. All of the above.
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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
• Website Only: $50.00 • Website and TECHNEWS (Members Rate): $50.00 first 20 words, $1.00 for each additional word • Website and TECHNEWS (Non-Members Rate): $75.00 first 20 words, $1.50 for each additional word
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
10829 (Nov 10, 2011) Vet Tech/Reception Third registered Vet. Tech required for a full-time position. Duties will include both reception and back office duties. Competance in IV catheterization, blood collection, intubation and patient monitoring required. Email cover letter and resume to Sandi@cocca.ca 10827 (Nov 10, 2011) RVT / AHT Compassionate tech required fulltime. Looking for good people skills, a sense of humour, and someone who wants to utilize a full range of their skills. Please contact Dr. Leslie Riley or Dr. Dick Weston. 905-727-3003. Fax 905-727-0057, or send email to firstname.lastname@example.org 10815 (Nov 3, 2011) Outstanding Receptionist Needed! We are looking for an exceptional receptionist to join our amazing team! We are a very busy, fast paced clinic in the east end of Scarborough. We pride ourselves on providing excellent service to our clients and first class medicine to our patients. For the right candidate we offer a generous CE allowance, full medical and dental benefits, uniform allowance and above average compensation. Interested? Please send a cover letter and resume to Michelle LeBlanc, Office Manager at email@example.com 10777 (Oct 18, 2011) Emergency RVT Part-time We require experienced RVT’s for Emergency shifts for 24/7 continuous care animal hospital.
Weeknights, weekends, holidays. Great team of professionals offering high quality caring service for our patients and clients. Please forward resume to: Dr. Daniel Mudrick, Clarkson Village Animal Hospital, firstname.lastname@example.org 10784 (Oct 17, 2011) Experienced RVT Feline Only Practice progressive feline medicine in a warm, friendly environment. Experience with compassionate feline care essential. Benefits, CE. Email email@example.com or fax (905) 665-3831. 10755 (Sep 28, 2011) Sales - Eastern Ontario UXR Inc. (Universal X-Ray Co of Canada) is a long-established company with a new team, vision, and product portfolio rocking big waves through a dynamic and personable team presence representing Best-inBreed digital radiography and laser technologies in the veterinary market across Canada. A diversified team, we are a respectful and encouraging crew who enjoys supporting new team members along the learning curve and celebrating successes as a team. We’re currently growing and need to add a great personality for a full-time Ontario sales position. Ideally, the candidate resides in the eastern GTA area. Candidates must come from a veterinary practice background with a commitment to customer service and spectacular people skills. Don’t be afraid of travel, it’s a large territory that requires coverage from Markham to the Quebec border. Mileage and expense accounts are part of the package along with a great salary and com-
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mission structure. If you have a winning character, take pride in your professional identity and an insatiable desire to learn new technologies, we want you. A top-notch handle of English is expected in all manners of communication and must be able to navigate computer operation and common programs. Additionally we expect our candidates to be creative enough to manage new situations through computer use and client interaction. Thinking on your feet and being a solutions provider are a critical component for a successful person in this role. We are delighted to receive your professional summaries through our Ontario Regional Manager, Carrie Morrison at firstname.lastname@example.org. Your time and efforts are greatly appreciated. Please understand that only candidates selected for continued review and evaluation will be contacted. 10754 (Sep 28, 2011) Veterinary Technician Required in Kelowna, British Columbia Full-time Animal Health Technician position available at Fairfield Animal Hospital in Kelowna, BC. Fairfield is a small animal practice with 24 hour emergency care. This is an overnight shift rotating 4 nights on, 4 nights off. We offer competitive salary with additional compensation for overnight shifts. Medical benefits, gym membership, uniform allowance and profit sharing are also offered. The successful applicant will be an Animal Health Technician who is able to work independently and as a team member. They must also be confident in their technical skills. Please send resumes attn: Kirsten Petersen, Fax: 250-860-8511, Email: Fairfield@shawcable.com
Hill’s Pet Nutrition Launches New Pet Food for Hyperthyroid Cats Hill’s Pet Nutrition announced the launch of Hill’s® Prescription Diet® y/d™ Feline Thyroid Health. Prescription Diet y/d is a daily, low iodine nutrition solution designed to manage hyperthyroidism in cats, and it is clinically proven to improve thyroid health in three weeks. Hill’s recently released results from three studies conducted to determine the impact varying iodine concentrations have in cat food. The studies revealed what levels of iodine are necessary to take a hyperthyroid cat and normalize them and those needed to ensure normal cats aren’t rendered iodine deficient. They concluded that if the iodine content can be kept below 0.32 ppm, hyperthyroidism in cats can be controlled through nutrition therapy alone. This is also dependent on pet owner compliance in providing the cat only Hill’s Prescription Diet y/d Feline Thyroid Health without interruption of outside iodine-rich dietary products. Through this effort, the cat’s thyroid levels can be kept in the normal range. For more information about Hill’s Pet Nutrition Inc. and Hill’s Evidence-Based Clinical Nutrition™ visit HillsPet.com or search for Hill’s Pet Nutrition on Facebook.
Submitting Articles to TECHNEWS We welcome your participation in the quarterly magazine, TECHNEWS, distributed nationally. In Ontario, articles submitted receive 2 C.E. credits and articles chosen for printing receive an additional 2 C.E. credits. Please contact your Provincial Association Registrar to determine your provincial C.E. values. Do not forget to include your return address information. Manuscripts should be submitted electronically either via email (address: email@example.com), CD/DVD-R or
USB stick in a format compatible with Microsoft Word 97 or better. Also send a hard copy of the article. • Articles should be no longer than eight pages of double-spaced type. • Avoid using trade names. • Feel free to include tables, boxes, diagrams, etc. • Include artist’s name if illustrations are used. • Footnotes should be used for any explanatory notes. Arrange alphabetically using superscripts (ex. a). • References: document all points reviewed by using numbered superscripts (ex. 3) in the text. Place references in the order they appear, not alphabetically. TECHNEWS is looking for articles from technicians that present current news and information. Articles should contain information on areas of interest to technicians,
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such as client education, clinical situations, lab procedures, nursing skills, neonatal care, research, exotics, large animal medicine, emergency procedures or anything else you feel is important to the continuing education of technicians. Articles received will be reviewed by the TECHNEWS editors and editorial committee. Controversial subjects will be prefaced by editorial commentary. The TECHNEWS editor reserves the right to make revisions in text when appropriate. Manuscripts may be edited for content, clarity and style. Feel free to contact the editorial office to ensure availability of a particular topic. Editorial correspondence for TECHNEWS: O.A.V.T. Editorial Submissions c/oThe Bayley Group P.O. Box 39 Hensall, ON N0M 1X0 Phone - 519-263-5050 Fax - 519-263-2936 Email - firstname.lastname@example.org
Investigate the provincial association’s web sites for details on other continuing education opportunities. Current as of: December 2011
2012 January 14-18 North American Veterinary Conference. Location: Orlando, FL January 26-28 OVMA - OVMA Conference. Westin Harbour Castle Hotel, Toronto - www.ovma.org January 28-31 Technician Symposium - 13th Annual Conference. Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA. Course Director: Susan Bryant, CVT, VTS (Anesthesia); Credits earned: 6 hours. Contact: Continuing Education Department • tel.: (508) 887-4723 • e-mail: vetCEinfo@tufts.edu • Web site: www.tufts.edu/vet/ce February 5 Monitoring the Anesthetized Patient and CPR Session. http://newsite.oavt.org/members/ continuinged.php
February 19-23 84th Annual Western Veterinary Conference. Location: Mandalay Bay Convention Center, Las Vegas, Nevada July 11-14 Canadian Veterinary Medical Association. 64th CVMA Convention “Learn à la Montréal” Best Medicine Practices – Timely Topics. Canine Foundations 2012 Seminars Canine Foundations is offering the following topics at Georgian College in 2012: • • • • •
Dog to dog aggression Canine emergency first aid Canine self defence Canine basic behaviour 101 Canine behaviour 102 Separation anxiety
Please visit the website at www.caninefoundations.com to register and learn more information.
OAVT 34th Annual Conference: Professionalism & Diversity February 16-18, 2012 International Doubletree Hotel, Toronto - 3 days of outstanding program with industry leaders Tracks Include: Practice management, pharmacology, nutrition, feline, communications, dental health, equine, hospice care, behaviour, dermatology, professionalism & ethics, and more! Sessions on: Hyperthyroidism, blood, cytology, parasite control, rehabilitation, anesthesia, bio-security, ultrasound, Toronto Zoo tour and much more! The program is designed by technicians and for technicians, providing the most comprehensive learning opportunity of the year!
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OAVT 2011 Conference Photos
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OAVT 2012 Conference Awards Nominations We are only a few months away from the OAVT conference. Each year, the OAVT presents a variety of awards to some outstanding members and contributors to the profession and association. Please read the descriptions below, and then nominate someone that you feel has earned one of these prestigious awards by faxing or emailing us your choices. Visit www.oavt.org to download the official form. 1. OAVT Veterinary Technician of the Year Nominees are Registered Veterinary Technicians who are currently OAVT Members in good standing. Nominees must display dedication to the humane medical treatment of all animals and excel in all aspects of their field. The nominee should be one who enhances the image and recognition of the Registered Veterinary Technician in the public or Veterinary Medical communities. 2. OAVT Merit Award Nominees are Technicians who are currently OAVT Members in good standing. Nominees should demonstrate a long standing history of community service and dedication at a regional, provincial and national level in any related association. The nominees should be those who promote and enhance the image of the members of the OAVT and the Veterinary Technology Profession. 3. OAVT Appreciation Award The Recipient of this award is a Company, Veterinarian or Sales Representative in the animal health community, who has demonstrated outstanding support and has contributed to the increased awareness of the veterinary technicianâ€™s role in the animal health community. 4. OAVT Veterinarian Award The recipient of this award is a Veterinarian in the animal health community, who has demonstrated outstanding support and has contributed to the increased awareness of the veterinary technicianâ€™s role in the animal health community.
Send in your Nominations!
And now, have your say! Nominate someone by visiting www.oavt.org to download the official form. Then send in the form to our address below by mail, fax, or email: Ontario Association of Veterinary Technicians 104-100 Stone Road West, Guelph, ON, N1G 5L3 Tel: 519-836-4910 | Fax: 519-836-3638 Email: email@example.com
OAVT Awards Reception & Dinner - Friday, February 17
Featured entertainer is Deb DiGiovanni, two-time Canadian Comedy Award winner, hugely popular on TV, radio & stage performance including her one-woman show. A rare opportunity to enjoy Deb up close & personal. This special event is included in the Conference registration but you must register in advance!
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Equine Physical Rehabilitation: An Overview by Elizabeth Gwyn Rucker, RVT
For their size, horses are extremely fragile creatures. As prey animals, their intended purpose in nature is to be a food source for predators. However, through domestication, this is no longer the case. Horses have become integrated into the “human world” as vehicles, athletes, and pets living an existence which in most cases, places them as a species, in an environment, discordant with their physiological constitution. It is due to this fact that horses are extremely susceptible to injury. The Oxford dictionary defines rehabilitation as “restore to effectiveness or normal life….restore to proper condition.”1 From the perspective of veterinary medicine, this encompasses everything post diagnosis and/or post surgical procedure. As veterinary technicians, this is where we can shine. Generally our profession is called upon for the aftercare and nursing
skills that are so beneficial in the rehabilitation process. The proper application of aftercare and rehabilitation procedures will make the difference in a horse’s quality of recovery. Through physical rehabilitation, we are aiding the horse in its already natural ability to heal itself. No longer are the “throw him out in a field and see what happens” or the “complete stall rest until healed” lines of thought acceptable. In fact those pieces of so called “advice” can do more harm than good and have ended the careers and even the lives of many horses. Yes, in some cases stall rest is necessary, generally in the acute phase of injury, but controlled movement, in the form of manual therapies and the increase of controlled movement as healing progresses is very important. Horses are built to compensate (remember - as a prey animal). If a horse shows physical weakness they will become vulnerable to predation; this is hardwired into their DNA. We need to look at the horse as a whole because the effects of a primary injury can lead to other structural
weaknesses. Conditions such as muscle atrophy, lack of coordination/proprioception, loss of bone density, and a weakened cardiovascular system, are important to address during the rehabilitation process, as well as treating the injury itself. Factors such as injury type, severity, location and patient’s behaviour must be taken into account when choosing which therapy or therapies to incorporate into an individual’s rehabilitation program. Each case is specific, so it is imperative that the rehab team, have a solid understanding of equine anatomy, physiology, kinetics, behaviour and rehabilitative processes in order to choose the most beneficial techniques and modalities. Here is a look at some of the therapies and rehabilitation options currently available to enhance the recovery process: Manual Therapies Manual therapies include stretching techniques, massage therapy, trigger point therapy and myofascial release to name just a few.
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Equine massage therapy has grown in popularity not only as a rehabilitation option but in injury prevention. When the muscles of the horse are not functioning properly, it is at risk of sustaining injury. When a horse has incurred an injury, it will place an excess load on the uninjured musculature putting these compensatory muscles and their associated structures at risk of sustaining injury and the cycle continues. Massage therapy addresses these scenarios through the release of stress points and muscle spasms, the breakdown of scar tissue and adhesions, an increase in circulation, tissue drainage, pain relief and an increase in the range of motion and flexibility in the target tissues.2
site of injury. The cold temperature provides an analgesic effect and the osmotic properties of the high salt content has a poultice-like effect useful for drawing out infection, as in the case of an abscess.6
Hydrotherapy The use of water can be beneficial not only as an adjunct to training and exercise but also as an aid in the process of recovery.
Cold laser therapy also improves blood circulation and vasodilation, stimulates nerve function, reduces inflammation and relieves acute and chronic pain.8 It is useful for a plethora of equine pathologies and can be used in the case of soft tissue, skeletal and nerve-related conditions.
Swimming pools are useful in maintaining cardiovascular function as well as providing an environment in which the horse is able to perform non-weight bearing movement. The gains of swimming are dependent on the horse’s swimming style. In the poor swimmer, the cautions will outweigh the benefits.3
The class 3B or class 4 level lasers are most appropriate for use in the equine as they offer the power required to penetrate into the deeper structures.
The water treadmill allows the horse recovering from a muscle, joint or tendon issue to exercise safely. With the ability to adjust the water depth to varying levels plus the allowance to create different levels of resistance, partial weight bearing movement can occur and cardiovascular function can be maintained.4 Hydrotherapy spas/tubs are used in the rehabilitation of lower limb injuries. Continuously circulating, cold (between 2-4 C)5 aerated, salt water achieves a reduction in inflammation by dispersal of the accumulated fluid from around the
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Cold Laser Therapy The light particles or photons emitted from the laser unit stimulate the mitochondria of the target cells causing an increase in ATP (cellular energy). When ATP production is increased, the target cells experience an accelerated rate of repair resulting in an increase in the speed, quality and tensile strength of tissue repair.7
Hyperbaric Oxygen Therapy Normal pressure at sea level is equal to 1 atmosphere absolute. In a hyperbaric chamber, horses are being treated at 1.5 to 3 times the pressure of 1 atmosphere. Under this pressure, increased oxygen is dissolved in the blood plasma with a higher delivery to all body tissues.9 This therapy has been proven for treatment in everything from wounds, soft tissue injuries and ostoemyelitis to laminitis, hypoxic conditions, EIPH (exercise induced pulmonary hemorrhage) and even infertility problems in stallions. Everything and anything that would be assisted from an increase in oxygen will benefit from hyperbaric oxygen therapy. It has also shown to potentiate the effects of antibiotic treatment.10
references > 1. The Oxford Dictionary of Current English. 7th Edition p.628. 1988 2. Bromiley, M.W., Equine Injury, Therapy and Rehabilitation. 3rd. Edition pp.8288. 2007. 3. Bromiley, M.W., Equine Injury, Therapy and Rehabilitation. 3rd. Edition pp.138-139. 2007 4. Bromiley, M.W., Equine Therapy and Rehabilitation. 3rd. Edition pp. 147148 .2007. 5. Bromiley, M.W., Equine Therapy and Rehabilitation. 3rd. Edition pp.144 6. www.foxfireequestrian.com 7. www.theralase.com 8. www.foxfireequestrian.com 9. Thomas, H.S., “The Future Has Arrived.”, www.equinechronicle. com>Health>EquineCare., 2008 10. Thomas, H.S., “The Future Has Arrived.”, www.equinechronicle. com>Health>EquineCare., 2008
Equine chambers are far and few between in Canada due to their cost but perhaps as scientific research intensifies and the beneficial results are accepted, this will change and hyperbaric oxygen therapy will become a popular treatment and rehabilitation option. Equine rehabilitation research is still in its infancy. With new information and treatment options coming forth at a rapid rate, this field is quickly beginning to expand. Horses today are required to perform above and beyond their “natural” capacity. Keeping them sound and in good health is of utmost importance. Due to the breakthroughs in equine rehabilitation in the last 10 years, horses sustaining, what were once career ending injuries, are now returning to competition or are at least able to enjoy a good quality of life.
P O I S O N I N G T OX I C O L O G Y C O L U M N
by Amanda Poldoski, DVM and Sherry Welch, DVM, DABT, DABVT
Some of the most common potential toxins encountered in the home, especially by dogs, are foods found in the kitchen. The following is the second of a two-part series summarizing potential clinical signs, mechanism of toxicity, and treatment recommendations, should exposure occur. Part 2 addresses bread dough, macadamia nuts, hops, and moldy food.
Unbaked Bread Dough Ingestion of unbaked bread dough containing yeast poses both mechanical and biochemical dangers to pets. The warm, moist environment in the stomach promotes yeast fermentation, resulting in expansion of the dough and production of carbon dioxide and alcohol (e.g., ethanol). Dogs may present with gastric bloat, gastric dilatation and volvulus (GDV), abdominal pain, vomiting, or unproductive retching. Clinical signs of ethanol toxicosis include ataxia, central nervous system (CNS) depression, coma, respiratory depression, hypoglycemia, and metabolic acidosis.1 Emesis should be induced early, provided the patient is asymptomatic. Cold water gastric lavage can also be helpful in decreasing further yeast fermentation; some pieces of dough may be recovered through a large bore tube. In severe cases, surgery may be indicated to remove a large mass of dough or correct GDV. Activated charcoal (AC) is not recommended as it does not reliably bind ethanol. Besides decontamination, treatment is symptomatic and supportive care including intravenous fluids (IVF); blood glucose and venous blood gas monitoring; supplementation of dextrose in IVF as needed; and nursing care if CNS or respiratory depression occurs.
Hops Humulus lupulus, commonly known as hops, is a plant used in the process of brewing beer. As home brewing increases in popularity, more dogs may be at risk for exposure. Hops plugs (which typically are dried) tend to be more toxic than hops pellets. The exact toxic principle is unknown, but may be related to essential oils, resins, phenolic compounds, or nitrogenous constituents within the plant. Clinical signs may occur rapidly and include malignant hyperthermia (with temperatures exceeding 105째F/40.6째C), tachypnea, panting, tachycardia, pain, anxiety, and vomiting.3 Disseminated intravascular coagulation (DIC) is possible secondary to severe hyperthermia. Death can occur within 6 hours without treatment. Any breed of dog may be affected, but breeds predisposed to malignant hyperthermia (e.g., greyhounds, Labrador retrievers, Saint Bernards, pointers, Dobermans, Border collies, English springer spaniels, and northern breeds) are at higher risk for toxicity. Early induction of emesis and administration of a single-dose of AC should be utilized in asymptomatic patients. In patients exhibiting clinical signs, gastric lavage (and administration of a single dose of AC) should be performed under sedation and intubation (to prevent aspiration). Treatment includes aggressive IVF, cooling measures, and supportive care. Dantrolene sodium may be used to reverse malignant hyperthermia. Patients should be monitored for 24-72 hours, or until signs resolve.
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references > 1. Powell LL. Bread dough. In Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology. Eds: Osweiler, Hovda, Brutlag, Lee. Ames, IA, 2011, pp. 411-415. 2. Liu D, Lee JA. Macadamia nuts. In Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology. Eds: Osweiler, Hovda, Brutlag, Lee. Ames, IA, 2011, pp. 441-444. 3. Duncan KL, Hare WR, Buck WB. Malignant hyperthermia-like reaction secondary to ingestion of hops in five dogs. JAVMA 210(1): 51-53, 1997. 4. Klatt CA, Hooser SB. Mycotoxins-Tremorgenic. In Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology. Eds: Osweiler, Hovda, Brutlag, Lee. Ames, IA, 2011, pp 451-456.
Macadamia Nuts These nuts are cultivated from Macadamia integrifolia trees which are commonly found in Hawaii and Australia. Ingestion of doses as low as 0.7 g/kg by dogs may cause clinical signs, though signs are typically noted at > 2 g/kg.2 Approximately 12 nuts weigh 1 ounce (28 g). Clinical signs tend to occur within 12 hours and may include hind limb weakness, ataxia, lethargy, tremors, joint pain, hyperthermia, vomiting, and abdominal pain. Signs tend to resolve within 24-48 hours. Mild elevations in serum triglyerides, alkaline phosphatase (ALP) and lipase may be noted and are likely related to the high fat content of the nuts. The toxin and mechanism of action are unknown and there is no specific antidote. Treatment includes early decontamination (emesis and administration of a single dose of AC), subcutaneous (SQ) fluids or IVF based on patient status, body temperature monitoring, anti-emetics, methocarbamol for tremors, and analgesics as needed.
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Moldy Food Ingestion of moldy food from the garbage or a compost pile puts dogs at risk for toxicity due to tremorgenic mycotoxins. These toxins may be found in moldy bread, pasta, cheese, nuts, or other decaying matter like compost. Clinical signs include vomiting, muscle tremors, hyperesthesia, agitation, ataxia, seizures, and hyperthermia secondary to tremor activity. Metabolic acidosis may occur and DIC is possible secondary to severe hyperthermia. Onset of clinical signs ranges from minutes to hours, with most occurring within 2-4 hours of ingestion.4 Signs may persist from hours to days, but typically resolve within 24-48 hours. Early induction of emesis and administration of a single dose of AC should be performed in asymptomatic patients. Gastric lavage may be helpful in symptomatic patients or if a large amount of material was ingested and emesis was ineffective. Treatment is symptomatic and supportive care including injectable methocarbamol for tremors, anti-emetics, anticonvulsants for seizures (e.g., phenobarbital, diazepam), and IVF to aid in cooling the patients and protect the kidneys from acute renal failure secondary to myoglobinuria from severe tremors and seizures.
Conclusion Veterinary professionals should be aware of common toxic foods, potential clinical signs, and basic treatments. Consultation with Pet Poison Helpline should be utilized if needed. Pet owners should be informed of these potential toxins and encouraged to restrict access to these items in order to prevent exposure. About Pet Poison Helpline
Pet Poison Helpline, a division of SafetyCall International, is a 24/7 animal poison control service based out of Minneapolis, MN. Pet Poison Helpline is available for pet owners and veterinary professionals who require assistance treating a potentially poisoned pet. The staff can provide treatment advice for poisoning cases of all species, including dogs, cats, birds, small mammals, large animals and exotic species. As the most cost-effective option for animal poison control care, Pet Poison Helpline’s fee of $35 per incident includes unlimited follow-up consultations. Pet Poison Helpline is available in North America by calling 800-213-6680. Additional information can be found online at www.petpoisonhelpline.com.
US - Pet GPS systems examined - An article in MIT Technology Review highlighted a number of pet-oriented GPS systems to help track and monitor pets. Tagg, consists of a device that fits into the collar your dog already has (provided it’s not a spiked or bejeweled one), plus a unit that rests in your home. Through your computer, you can set a virtual perimeter, a safe zone for your dog to wander. If he strays too far, you’ll get a text message alert. The device has a battery life of some 30 days and is water resistant; it’s intended for dogs (or cats) 10 pounds or heavier. For $200, you get all the necessary hardware, plus one year of the service. Global Pet Finder, Garmin, SpotLight, and Love My Pets all have models, with prices running up to around $700, depending on what level of military standard is sufficient for your own style of puppy surveillance. (Veterinary Advantage Weekly News)
Worldwide - Abbott’s online learning portal surpasses 20,000 registered veterinary professionals - Abbott Animal Health announced its online learning portal, AbbottAnimalHealthCE. com, has surpassed 20,000 users, who have earned a combined 39,145 continuing education credits through the site. Since the first CE modules went live in July 2009, individuals have registered from 28 countries. With longer workdays and fewer opportunities to travel, veterinarians and veterinary technicians have increasingly been turning to online continuing education opportunities to stay updated on the latest in veterinary medicine, including practice guidelines, client communication and case study reviews. AbbottAnimalHealthCE.com offers a total of 26 learning modules that are 30 minutes long in the areas of fluid therapy, diabetes and anesthesia. Each module incorporates video and audio, presented by an expert veterinarian, as well as downloadable tools and resources to help implement learning into everyday practice. After successfully completing a short quiz, the user can earn one hour of RACE-approved CE credit for each module. (Veterinary Advantage Weekly News)
US - Canine Vaccination - The American Animal Hospital Association (AAHA) has published updated canine vaccination guidelines. The guidelines were published in the September edition of the Journal of the American Animal Hospital Association (JAAHA) and can be found online at www.aahanet.org/Library/CanineVaccine.aspx. Canada - U of S International Vaccine Centre Celebrates Grand Opening - Canada’s capacity to prevent and fight infectious diseases got a major boost September 16, 2011 with the grand opening of the $140-million International Vaccine Centre (InterVac) at the University of Saskatchewan (U of S). InterVac is the largest facility of its kind in North America. The state-of-the-art vaccine research centre - one of the largest of its kind in the world - uses the most advanced technologies to develop vaccines against new and re-emerging infectious diseases safely and more quickly than ever before. “This stellar addition to our unique life sciences
Police say they are receiving complaints about people hunting from their vehicles. (CBC)
Canada - Shooting moose from vehicles lazy: RCMP - RCMP in Newfoundland and Labrador say they are receiving many complaints about dangerous hunters who aren’t bothering to get out of their vehicles or leave roads before taking a shot at a moose. Most hunters do things by the book, but some are trolling for moose on secondary highways and woods roads all around the province. Reports include stopping on the highway, erratic driving, driving without due care and attention, standing in the rear of half-ton trucks. The RCMP say that hunting from a vehicle is not only dangerous; it’s illegal under the Criminal Code and provincial laws. (cbc news)
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Super-big huggable protection against fleas and other parasites. Tasty little tablet.
Frank and Louie is an example of a Janus cat, named for the figure in Roman mythology with two faces on one head. The cat’s Massachusetts owner calls the face on the left Frank and the one on the right Louie. (Steven Senne/Associated Press)
US - Rare two-faced cat makes the record books: Massachusetts ‘Janus cat’ has reached the age of 12 - Frank and Louie the cat was born with two faces, two mouths, three eyes, and lots of doubts about his future. Twelve years after Marty Stevens of Worcester, Mass., rescued him from being put to sleep because of his condition, the exotic blue-eyed rag doll cat is not only thriving but has made it into the 2012 Guinness Book of World Records (which lists the cat’s name as Frank and Louie on its website, while other media are referring to him as Frankenlouie). He’s the longest-surviving member of a group known as Janus cats, named for a Roman god with two faces. The friendly, laid-back cat loves riding in the car and taking walks on a leash, though people who come up to pet him are usually shocked when they get closer. (The Associated Press) cluster is an important national resource that will advance development of the next generation of vaccines to protect animal and human health, while fostering international collaborations and partnerships to help prevent a global pandemic,” said U of S President Peter MacKinnon. Operating as part of the U of S’s Vaccine and Infectious Disease Organization (VIDO), the new containment level 3 InterVac facility provides specially designed facilities for scientists to safely conduct research into diseases such as tuberculosis, hepatitis C, HIV/AIDS, SARS, influenza, and prion diseases such as chronic wasting disease and mad cow disease. (www.vido.org) US - Vaccine tested to reduce feral cat population - According to CatChannel.com, a study performed by University of Florida researchers found that a single dose of the immunocontraceptive vaccine GonaCon controls fertility over multiple years in adult female cats. It is hoped that this research will lead to a nonlethal method of control for feral cat populations which is less expensive, labour-intensive, and invasive than current methods, such as surgical sterilization. Non-profit
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Dogs need protection from intestinal worms and heartworm, along with the one enemy their owners can actually see: fleas. Sentinel Flavor Tabs tastes like a treat making it easy for clients to administer with no residue. In a recent survey, 90.16% of topical users preferred Sentinel Flavor Tabs for ease of administration.1 That leads to better compliance. Recommend Sentinel; it’s hugsafe. For more information about Sentinel call 1-800-387-6325 or visit www.doghug.ca.
1. Data on ﬁle. Research conducted for Novartis Animal Health Canada Inc. 2010 ® Sentinel is a registered trademark of Novartis Animal Health Canada Inc. © 2011 Novartis Animal Health Canada Inc. ® Flavor Tabs is a registered trademark of Novartis AG – Novartis Animal Health Canada Inc., licensed user.
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Canada - Pet Product Industry Icon Rolf C. Hagen Dies - According to Pet Products International, Rolf C. Hagen, founder of Rolf C. Hagen Inc., died recently at his home in Montreal. Hagen died “suddenly yet peacefully,” according to an obituary in the Montreal Gazette. Hagen was born in 1932 in a small town north of Hamburg, Germany, as one of 10 children. After his schooling, he entered into an apprenticeship with a fish and pet food industry importer and exporter in Hamburg. He developed a network of industry contacts and moved to Montreal, where he founded the Hagen group of companies as a one-man, import-export operation in 1955. The company grew into a leading global manufacturer and distributor of pet care products. Hagen was inducted into the American Pet Products Association Hall of Fame in June 1999 and earned the Lifetime Achievement Award from the Pet Industry Distributors Association. (Veterinary Advantage Weekly News)
veterinary research organization Morris Animal Foundation funded the five-year study, which was published online in August in the scientific journal Theriogenology. Among the cats treated with GonaCon, 93 percent remained infertile for the first year, 73 percent remained infertile in year two, 53 percent in year three, 40 percent in year four, and 27 percent in year five. Although a permanent sterilant would be ideal, a long-acting contraceptive could be an effective tool for managing feral cat populations, especially where surgery is unavailable or impractical. US - Lasers help paralyzed dogs walk sooner after surgery - According to an AAHA Trends story, Florida veterinarians are saying that they are using lasers postoperatively to help paralyzed dogs walk sooner after surgery, according to
San Diego, media personality Dr. Marty Becker challenged veterinarians to build safe, credible and educational information for pet owners. More than 75 percent of pet owners use the Internet to access pet health information even before they pick up the telephone to make a veterinary appointment, Becker said in a presentation “The Internet is the most powerful tool of mass communication handed to human beings since the printing press, and [if ] we ignore this power, we miss this wave, at our own peril”. He challenged veterinarians to take back the role of educator by posting credible medical information online or recommending quality sites for pet owners. He called on veterinarians to capture client e-mail addresses to help facilitate communication through veterinary practice websites, e-mail alerts and patient updates. It is believed that most veterinary practices have just 20 percent of their clients e-mail addresses. Yet, e-mail remains an important gateway to foster quality communication between a practice and its clients, he said. Text messaging via cell phones offers another efficient way to remind clients about upcoming appointments or inform them about a case, Becker said. (Veterinary Advantage Weekly News)
a University of Florida news release. The dogs, paralyzed by intervertebral disc disease, are walking earlier after surgery than dogs not treated with laser therapy. The team conducted the first study ever that compares dogs with intervertebral disc disease treated postoperatively with lasers to dogs not treated with lasers. In the study, 34 dogs (75% were Dachshunds) came to the Small Animal Hospital unable to walk, with their diagnoses confirmed through MRI or CT scanning. Some of the dogs had lost the ability to feel deep pain in their back legs. Study results will help ease the surgery process for both owners and animals. (Veterinary Advantage Weekly News)
Canada - Beat the bugs: new biosecurity venture for Equine Guelph - Equine Guelph has received funding for Beat the Bugs, a new equine biosecurity venture. The program has been funded by the Agricultural Biosecurity Program, a Canadian federal-provincial-territorial initiative. From on-going cases of strangles to large outbreaks of EHV, it’s abundantly clear that infection control is a critical area for the equine industry, and one that typically receives little attention in the absence of an outbreak. The Beat the Bugs program will be launched in March 2012, and facilitate development of farm-specific biosecurity programs through workshops or a twoweek online program. The program is being developed by Equine Guelph with the cooperation of various academic and industry partners. More information can be found at http://www.equineguelph.ca
US - Expert challenges veterinarians to communicate with customers over the Internet - Recently at the CVC
Canada - Lost Iqaluit dogs now on Facebook: Bylaw officers to post lost pet photos and information to
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site - The City of Iqaluit has turned to Facebook to help reunite lost dogs with their owners. As many as 30 to 40 pets are lost each month in the capital of Nunavut. Rather than plaster posters and canvas neighbourhoods, Iqaluit users can join the Iqualuit Municipal Enforcement -Dog Pound group on the popular social networking site. By-law officers post mug shots of found animals and information about where and when officers picked up the dog. Owners have 72 hours to claim their pets before they’re put up for adoption or, in some cases, put down. A visit to the special Facebook page shows a lot of the lost dogs aren’t traditional Arctic breeds. (cbcnews) Canada - Calgary Opens Pet Morgue for Dogs, Cats Killed on Streets - Calgary is setting up a pet morgue where dogs and cats killed on the city’s streets can be identified by their frantic owners. In 2010, Calgary roads workers collected the remains of 483 cats and 46 dogs. Under the new program, the remains will be taken to an Animal Services Centre and stored for 10 days while workers search for licence tags, readable microchips or tattoos that could identify the owner. The centre will also have a website listing deceased pets and when they were found. Owners will be contacted and given a choice to have Animal Services cremate the remains or to arrange for a private cremation paid for by the family. (Canadian Press) US - Killers of police dogs face steeper penalties - New Jersey Gov. Chris Christie last month signed “Schultz’s Law,” legislation that increases the penalty of anyone convicted of killing a police canine or any dog involved in search and rescue. The law was enacted a day after a Camden County grand jury handed down an indictment against a man who killed a police dog, Schultz, by throwing him into oncoming traffic when he was apprehended by the canine. The prior law had a sentence of three to five years for killing a police dog, but now those convicted will face a minimum sentence of five years with no chance for parole, and can face fines of up to $15,000. (veterinarypartner.com)
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New Zealand - Goldfish found alive in ruins of New Zealand quake Two goldfish, named Shaggy and Daphne after characters from the animated TV show Scooby Doo, have become the smallest and hardiest survivors of the devastating February earthquake in Christchurch, New Zealand, that killed 181 people. The fish spent 4½ months - 134 days - trapped in their tank in the city’s off-limits downtown without anyone to feed them or even any electricity to power their tank filter before they were discovered and rescued. So how did they do it? Luckily for the fish, they live in a large, 100-litre tank. They had weeds to munch through. The fish may have gleaned some nutrition from eating algae growing on the tank’s rocks and walls. The naturally growing bacteria may have helped keep the water clean enough to sustain life. Then there’s the delicate question of their missing companions. There were six goldfish in the tank when the earthquake struck. By the time the survivors were found, no trace remained of three of the fish. A fourth was found floating in the tank. Goldfish are, after all, omnivores. The fish looked dull in colour but otherwise appeared fine. (The Associated Press)
US - Equine Health - The American Association of Equine Practitioners has developed guidelines for veterinarians who treat horses competing in athletic events other than racing. The document, “Clinical Guidelines for Veterinarians Treating the Non-Racing Performance Horse,” is available at www.aaep.org/white_papers.htm
Canadians spend more time surfing the web than playing with their pets New study offers troubling snapshot of pet health and wellness in Canada
TORONTO, June 15, 2011 – A new research study of the state of pet health and wellness in Canada has found that the choices owners are making about their pets’ nutrition and exercise could be affecting the length and quality of their pets’ lives. Canada’s Pet Wellness Report; a research study of 1,000 Canadian dog and/or cat owners and 100 veterinarians, by the Ca-
nadian Veterinary Medical Association (CVMA) in partnership with Hill’s Pet Nutrition, makers of Science Diet® brand pet food, provides a 360° snapshot of pet health in Canada, including exercise, nutrition, veterinary care, life stage (age)related needs and overall health status. The study revealed that pet owners are missing the visible signs of common health issues such as obesity and dental disease that are key to their pets living longer, healthier lives. “Overall, the research suggests that addressing the exercise, nutritional and
dental care needs of pets is key to enhancing pet health and wellness in the country,” says veterinarian and member of the CVMA Executive, Dr. Jim Berry. Internet and channel surfing overshadow pet exercise time According to the study, owners might not be making pet exercise a priority and as a result veterinarians are seeing the consequences: • On an average weekday, pet owners spend nearly twice as much time surfing the Internet (48 minutes) and three times as much time watching
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TV (79 minutes) as they do playing with/exercising their pets (25 minutes). • Even on the weekend, when pet owners might have more disposable time, they still spend an average of three times as much time per day watching TV (89 minutes) and far more time surfing the Internet (44 minutes) than playing with/exercising their pets (29 minutes). • Veterinarians believe that the majority of dogs (55%) and cats (70%) they see do not receive an adequate amount of exercise to maintain good health. “Pet owners need a better understanding of the health implications of inadequate exercise of their pets and the importance of basic decisions, such as what and how to feed them,” says Dr. Berry. “Otherwise their pets might be at risk for a range of broader health issues, such as heart disease, diabetes and mobility issues.” Dishing the Goods on Obesity The findings suggest pet owners also need to adjust how they evaluate what food to buy for their pets and how they feed them, since their choices could have weighty consequences: • When it comes to pet food shopping, veterinarians believe pet owners consider the price and best value offered by a pet food over the food’s ability to meet their pets’ health or life stagerelated needs. • Pet owners admit that they are nearly twice as likely to buy a pet food based on what their pet likes to eat (60%) vs. what will actually meet their health needs (33%). • Just two in 10 (18%) pet owners feed their pets the amount recommended on the pet food package and only 17% closely review the ingredient information. • Overall pet owners (44.5%) are most likely to feed their pets by “making food available to their pet(s) at all times”, which is more common among cat owners (57%) than dog owners (32%). Furthermore, the research indicates that
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veterinarians are seeing the consequences of poor decisions about pet nutrition: • Veterinarians (63%) are most likely to cite weight control as one of the most important things pet owners can do to increase the length and quality of their pets’ lives, yet only one in 10 pet owners proactively ask veterinarians about nutrition. • Veterinarians (65%) say overfeeding is by far the most common mistake pet owners make when feeding their dogs or cats. • Veterinarians say pet owners are often surprised when their pets are diagnosed as obese. Missing the Signs of Health Issues One of the most compelling findings from the study is that pet owners might be missing the obvious signs of health issues in their pets. Obesity and dental disease are the two most commonly diagnosed health problems dog and cat owners are surprised to learn about during veterinary exams. Meanwhile, veterinarians consider a pet’s weight, clean teeth and fresh breath among the best indicators of good overall pet health that pet owners can observe at home. Big Health Issues on the Prairies The research revealed that only half (51%) of dog owners and 58% of cat owners say their pets are in perfect health. Other pet owners claim their pets suffer from a range of health issues with weight problems near or at the top of the list for cats and dogs. One of the most surprising findings was the extent to which pets in Manitoba and Saskatchewan are the most likely to suffer from a host of health issues: • Cat owners on the Prairies were by far the most likely to say their pets are overweight (32.7% vs. national average of 19%) and to suffer from allergies (10% vs. national average of 2.8%), arthritis (6% vs. national average of 2.8%) and a dry coat/flaky skin (12% vs. national average of 7.5%). • Dog owners on the Prairies were by far the most likely to say their pets suffer from a poor/picky ap-
petite (11.6% vs. national average of 6%), digestive problems (11.6% vs. national average of 5.5%), dental disease (9% vs. national average of 4%) and low energy (9% vs. national average of 3.7%). • Pet owners on the Prairies are also the most likely to feed their pets canned/ wet food, table scraps, home-prepared food and raw meat. • Pet owners on the Prairies are also most likely to buy their pet food from a mass merchandise store. About the Research Canada’s Pet Wellness Report is based on the findings of an Ipsos Reid poll conducted between April 18 and April 27, 2011, on behalf of the CVMA and Hill’s Pet Nutrition. A sample of 1,043 pet owners from Ipsos’ Canadian online panel was interviewed online. A survey with an unweighted probability sample of this size and a 100% response rate would have an estimated margin of error of +/- 3.0 percentage points, 19 times out of 20. A survey of practicing Canadian veterinarians was also conducted using a sample provided by the CVMA. A survey with an unweighted probability sample of this size and a 100% response rate would have an estimated margin of error of +/- 9.6 percentage points, 19 times out of 20. The Canadian Veterinary Medical Association (CVMA), in partnership with Hill’s Pet Nutrition, developed Canada’s Pet Wellness Report to help educate Canadians about how proper exercise, love and attention, nutrition and veterinary care can all help ensure pets live long, happy and healthy lives. Canada’s Pet Wellness Report can be downloaded at www.Hillspet.ca, www. canadianveterinarians.net and www.facebook.com/ScienceDietCanada. For more information please visit www. harbingerideas.com/petreport. To arrange an interview with Dr. Jim Berry, please contact: Sarah Bush, Harbinger Communications, firstname.lastname@example.org 416-960-5100
Optimization of ventral tail artery catheterization in the rat ensures timely collection of blood samples Sarah Toupin, My Tran Trung, Sandra Brenton & Janna Cartier Pfizer Vaccine Research, Ottawa, Ontario, Canada
Accurate blood collection times are the cornerstone for reliable and repeatable study data. Our goal was to develop a ventral tail artery catheterization procedure that permitted obtaining multiple arterial blood samples from a rat immediately following intravenous (IV) administration via the lateral tail vein. Previously, blood samples at very early time-points were collected via the ventral tail artery using an individual needle and syringe at each time-point. However, this method was time consuming and the physiological responses of the rat while under anesthetic prevented the accurate collection of multiple successive blood samples. Despite numerous references of the use of a catheter for arterial blood collection, a detailed, in-depth description of ventral tail artery catheterization could not be found. Therefore, a non-invasive technique was developed to seat a catheter in the ventral tail artery immediately prior to IV injection via the lateral tail vein. This enabled collection of multiple rapid successive blood samples with minimal stress to the animals. Details of the ventral tail artery catheterization procedure as well as possible limitations associated with the technique will be presented.
Introduction Blood is most commonly collected from rats using a needle & syringe or surgically (e.g., cannulation or catheterization).
• Transfer the rat to a nose cone and place in dorsal recumbancy. Maintain anesthesia at minimum required level (e.g. 2-3% isoflurane).
• Disadvantages - Requires a sterile field, and extended anesthetic periods cause fluctuations in blood pressure, heart rate & respiration. We have developed a ventral tail artery (VTA) catheterization method to permit multiple arterial blood samples to be collected from a rat immediately following intravenous (IV) administration via the lateral tail vein.
• • • •
Methodology • Materials • Anesthetic chamber • Isoflurane vaporizer • Nose cone • Scavenging system • Warm water bottle, approx. 55-60ºC • Phosphate buffered saline (PBS; Sigma, St. Louis, USA) and/or sodium heparin (5U/mL; Sigma) • Isopropyl alcohol • 2x2 gauze, sterile • Sterile needle, 18 or 20G • Sterile 0.56” 24G catheters • Sterile injection cap • Flexible adhesive tape
Increase visualization of VTA Clean the tail with alcohol Cut down with sterile needle Catheter insertion • Extend and bend the tail and insert the catheter while maintaining a direct line with the VTA. A quick flash of blood will appear.
• Advance the catheter • Use a slight upward angle; ensure the tail is still bent. • • • •
Remove the stylet Place a cap on the catheter Tape the catheter in place Flush the catheter • Use either PBS or sodium heparin (200µL).
• Induction • Induce anesthesia with 3-5% isoflurane at flow rate of 1.5 L/min oxygen.
Needle and Syringe System • Advantage - Minimal use of anesthetic. Well suited for collection of single blood samples. • Disadvantage - Inefficient for collection of multiple samples (i.e., time). Surgical Preparations • Advantage - Well suited for collection of multiple samples.
Figure 1: Example of data obtained using a tail artery catheter for early time points.
Figure 2: Transverse sectional view of the rat tail: ventral artery (a) lateral veins (b, f ), vertebra (c), dorsal vein(d), skin (e), and tendon bundles (g). Adapted from WEIHE, W.B. The laboratory rat. In: Poole, T.B., ed. UFAW (Universities Federation for Animal Welfare)handbook on the care and management of laboratory animals. 6th Ed. Harlow, Essex: Longman Scientific and Technical, 1987: 309-330.
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1. Warming the tail.
• Recovering the rat post-bleed • Remove the tape and hold a gauze over the puncture site while removing the catheter. • Maintain steady pressure until bleeding stops. • Ensure the rat is recovering normally before returning it to the cage. Troubleshooting VTA cannot be visualized. • Warm the tail appropriately (water bottle is approx. 55-60ºC). • Use appropriate level of anesthesia • As blood pressure drops with extended periods of anesthesia, reduce the level of anesthetic as soon as the rat is immobile. Catheter advances next to the VTA and no blood is visualized. • Use anatomical landmarks • The VTA must be visualized before an attempt is made to introduce the catheter. Positioning your fingers over the lateral tail veins ensures the VTA is running down the centre of the tail. A flash of blood appears but, when advancing the catheter, blood flow stops. • Position is essential • The catheter may be in contact with the adjacent tendon bundles or the vertebra. If the catheter is dorsal to the VTA and next to the tendon bundles, it will advance but blood flow will eventually stop. • Correct the catheter’s placement • Attempt to reposition the catheter. Once multiple punctures sites are in one section of the VTA, it is
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2. Cut down with needle.
3. Insert the catheter.
nearly impossible to reposition. Remove the catheter and restart the procedure slightly higher on the tail. Excessive blood loss before the injection cap is attached. • Increase grip/occlude the VTA • Wrap flexible adhesive around the injection cap. Place a finger over the seated catheter to temporarily occlude the VTA. Blood flow will restart once pressure on the vessel is released.
4. Attach the injection cap.
Blood flow will not stop when the catheter is removed. • Apply pressure • Apply steady pressure while removing the catheter and until blood flow has stopped. • Monitor the animal • Do not return the rat to its home cage until blood flow has completely stopped and the rat is recovering normally.
5. Tape the catheter in place.
Summary • The major limitations encountered with this technique were finding the artery & properly positioning the catheter for blood collection. However, with practice this is easily mastered.
6. Tape catheter in place and then flush.
• The optimization of the VTA catheterization technique resulted in the more timely collection of multiple successive blood samples and a reduction in potential animal numbers needed. • Hence, it improved the efficiency of sample collection and study reliability. As presented at the 2011 CALAS conference in Toronto, Ontario Canada
7. A properly placed catheter.
Did You Know? Cattle handling tips for employees Animal handling expert Temple Grandin, PhD, spoke at the American Meat Institute (AMI) meeting about training employees to handle cattle in working facilities, whether at a feedlot or packing plant. Tips for animal handling in facilities included: Teach employees the principles of flight zones in cattle; teach employees about the point-of-balance of cattle, i.e., stand behind the shoulder to move an animal forward; discourage loud noises and yelling; move animals in small groups at a time instead of one large group; fill the crowd pen only half full for easier movement of a group of cattle; and get electric prods out of employees’ hands. Grandin also said alleviating stress, fear and distraction in working facilities would include: watching the ears of cattle to see what they are focused on; tying up back stops, especially if they are numerous in chute, to prevent balking; and notice rapid movements such as paper towels fluttering next to a chute or fans above chutes that are powered off but the blades are turning in the wind. (Drovers CattleNetwork)
Oh great, another banana joke Chimpanzees will “fake laugh” for the sake of social bonding, similar to the way people do. A study searched chimpanzee laughing and found that when one chimp laughed, other chimps will respond with a sound that didn’t match the full acoustic structure of real laugh, meaning they were actually faking it. The fake laughing was most likely to occur in newly formed colonies where chimps likely were not as familiar with each other. (veterinarypartner.com) Pet Pardons Gives Pets One Last Chance Pets are being saved from being killed in animal shelters through a Facebook application called Pet Pardons. The application connects foster volunteers who notify each other of dogs and cats scheduled to be euthanized at shelters. The application is estimated to have saved the lives of more than 2,000 pets already. (veterinarypartner.com)
The Guinness World Records 2012 Edition has named the dog with the longest ears. Harbor, an 8-year-old coonhound, has a left ear measuring 12.25 inches long and a right ear measuring 13.75 inches long. (veterinarypartner.com) Photo: Ryan Schude, Guinness World Records
EU Loses 20% of Farms in Seven Years There were fewer European farmers last year. Those producers were working more ground, as holdings consolidated into slightly larger operations. The European Union had 20% fewer farms in 2010 than seven years earlier. Those farms were working 2% less land, the EU’s statistical reporting agency Eurostat found. In 2010 there were just over 12 million agricultural holdings and an utilized agricultural area of 170 million hectares in the EU27, comparing 2010 with 2003. The average size of a holding was 14 hectares in the EU27 in 2010, compared with 12 hectares per holding in 2003. The agency was reporting from results of the EU’s 2010 census of agriculture. The survey is conducted every 10 years. (Feedstuffs) Three Dog Night A “three dog night” was once described by comedian Johnny Carson as a “bad night for a tree.” But the term originates with the Inuit tribes of Alaska, who measured nocturnal temperatures based on how many of their sled dogs they needed to serve as bed warmers.
Cats in the wild need to hunt and eat up to 20 small animals each day in order to survive, according to the Indoor Pet Initiative at The Ohio State’s College of Veterinary Medicine. Kittens begin to hunt alone at about 8 to 16 weeks of age.
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