The NAVTA Journal Oct/Nov 2015

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Oct/Nov 2015

THE

NAVTA JOURNAL A Publication of the

National Association of Veterinary Technicians in America

in this edition‌ Golden Retriever Lifetime Study Dermatology 101 Killing Ourselves with Compassion Anesthesia Nerds Corner


National Veterinary Technician Week

THANK YOU

On behalf of more than 86,500 member veterinarians, the AVMA would like to thank our veterinary technicians for the passion they bring to this profession. Although we value veterinary technicians every day of the year, this week we especially honor the hard work you do to protect, promote, and advance animal health.

October 11-17, 2015 www.navta.net


You are navta!

THE

NAVTA JOURN AL

Oct/Nov 2015

A Publication of the

You Are NAVTA!

Now is the best time to renew your membership — so tell your colleagues about all the benefits of NAVTA membership, and join today!

Who are NAVTA members? Why NAVTA? The National Association of Veterinary Technicians in America (NAVTA) is made up of people just like you… people who want to make a difference in the lives of animals. NAVTA is a growing global network of: §§ Credentialed Technicians §§ Veterinary Technician Specialists §§ Assistants §§ Veterinarians §§ Practice Managers §§ Educators §§ Researchers §§ Industry Sales §§ Allied Industry §§ Students

NAVTA empowers you to succeed in your career. Together, we strengthen the veterinary technician profession.

NAVTA is a membership-based non-profit association that acts as the national voice of the veterinary technician profession. In addition to serving its members, NAVTA educates the allied industry and the general public about the veterinary healthcare team. NAVTA initiatives include: §§ Monitoring legislation that affects the veterinary technician profession on a national level §§ Continuing education and networking through state and local networks and student chapters §§ Celebrating National Veterinary Technician Week §§ Strengthening relationships with allied associations and NAVTA sponsors §§ Distributing technician demographic and salary surveys §§ Creating ongoing public relations campaign about the importance of credentialed technicians

National Association

of Veterinary Technic

ians in America

in this edition…

Golden Retriever Lifetime Study Dermatology 101 Killing Ourselves with Compassion Anesthesia Nerd s Corner

in this edition… President’s Message ....................................4

Member Updates ............................................6 Continuing Education: Controlled Substances: What Team Members Really Need To Know ........................................... 18 Continuing Education: Killing Ourselves With Compassion..................................... 26 Continuing Education: Dermatology 101: Increasing Efficiency and Enhancing Patient Diagnostics ................................ 32 Continuing Education: Updates on Pain Awareness & Management Across the Species Part 1 .......................................... 39 Industry News: “Golden” Veterinary Technicians Participate In Groundbreaking Canine Health Study ............................47 Disaster Response ................................... 51 Anesthesia Nerds Corner ..................... 53 Advertiser Index.......................................... 54

On the Cover

To learn more about what NAVTA can do for you, visit www.navta.net.

It is the third anniversary of the Morris Animal Foundation’s landmark Golden Retriever Lifetime Study. Our hats off to the veterinary technicians that have agreed to participate in this spectacular event.

Publication of the National Association of Veterinary Technicians in America

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NAVTA THE

JOURNAL

Letter from the president

President's Message

NAVTA Executive Director: Julie Legred, CVT Communications Director: Kara Burns, MS, M.Ed., LVT, VTS (Nutrition) P.O. Box 1227 Albert Lea, MN 56007 Phone: 888-99-NAVTA | Fax: 507-489-4518 info@navta.net | www.navta.net

Your career growth and development is one of our drivers and responsibilities. As your national professional organization, we are charged with offering you tools for success. In each of the Journal’s you are given three well-written articles, generated by your peers. Take a look at the authors and their credentials. Often times they have the same credentials as yours. PLUS, a number of the authors have advanced studies and certification in practice management, veterinary technician specialty, or business.

2015 NAVTA EXECUTIVE BOARD President: Dan Swenson, CVT President Elect: Rebecca Rose, CVT Secretary: Elizabeth Reed, BS, LVT, CCRA Treasurer: Beckie Mossor, RVT Member at Large: Mary Berg, BS, RLATG, RVT, VTS (Dentistry) Member at Large: Ed Carslon, CVT, VTS (Nutrition) Past President: Vicky Ograin, MBA, RVT, VTS (Nutrition) Commitee Chairs NAVTA SCNAVTA Chairperson & Board Advisor: Lori Renda-Francis, PhD, LVT NAVTA CVTS Chairperson: Margi Sirois, EdD, MS, RVT, LAT NAVTA State Representative Chairperson: Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM) NAVTA AVA Chairperson: Dennis Lopez, M.Ed., LVT NAVTA Exhibiting Representative : Virginia Rud, CVT, RVT THE NAVTA JOURNAL Editor in Chief & Website Coordinator Heather Prendergast, RVT, CVPM Associate Editor in Chief Kara Burns, MS, M.Ed., LVT, VTS (Nutrition) Editorial Board Josh Clark, MS, RVT Katie Larsen, DVM Ellen I Lowery, DVM, PhD, MBA Oreta M Samples, RVT, MPH, DHSc Jennifer Schori, MS, VMD Pat Telschow, BS, LVT Design Kalico Design | www.kalicodesign.com Printing and Fulfillment Boelte-Hall, LLC | www.boelte.com The NAVTA Journal Editorial Deadlines • Feb/Mar ‘16 edition: Dec 1(CE articles and case studies) and Dec 15 (all other content) • Apr/May ‘16 edition: Feb 1(CE articles and case studies) and Feb 15 (all other content) • June/July ‘16 edition: Apr 1(CE articles and case studies) and Apr 15 (all other content) • Aug/Sept ‘16 edition: July 1(CE articles and case studies) and July 15 (all other content) Opinions and statements in The NAVTA Journal are those of the authors and not those of NAVTA, unless so stated. NAVTA assumes no responsibility for, and does not warrant the accuracy or appropriateness of, recommendations or opinions of the authors or of any product, service, or technique referred to in The NAVTA Journal.

Fall is upon us, and the holidays are rapidly approaching. National Veterinary Technician Week will be celebrated the week of October 11- 17th, and we hope you have some phenomenal photos to submit for the next issue! We love to see the creative ideas our members have developed to bring attention to this special week. Nominations for the executive board are in! Soon, you will be receiving an email asking you to cast your vote. Please vote for your President-Elect and Member at Large. Your voice is important to us, and we cannot survive without you. The mission of NAVTA is to represent and promote the profession of veterinary technology. NAVTA provides direction, education, support and coordination for its members and works with other allied professional organizations for the competent care and humane treatment of animals. The volunteers that sit on the NAVTA Executive Board take an active role in leadership, on your behalf. The Committees and Executive Board work diligently, on a daily, weekly, and monthly capacity. They are busy, bringing to fruition the Mission, as volunteers, passionate about veterinary technology.

Published advertisements in The NAVTA Journal are not an endorsement of any product or service.

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The NAVTA Journal | Oct/Nov 2015

You are encouraged to write an article and begin building your creditability and career. You may be surprised at the advancement that can occur in the simple task of being published. Grab your bat (pen), and start swinging! Another incredible way to take action and move your career in a positive manner is to become an ACTIVE member in your local, state, and national professional organizations. Yes, “ACTIVE member.” Paying your dues and having a strong “voice” is important, however, for you to reap more of the benefits, ACTIVE participation is recommended, and builds your resume, confidence, networking, and leadership skills. We look forward to hearing from you in the form of updates, pictures of NVTW and articles for publication! –D an Swenson, CVT, President & Rebecca Rose, CVT, President Elect


smart is…

BROAD COVERAGE IN A SOFT CHEWABLE Protection against six parasites instead of only three.

TO ORDER, CALL YOUR DISTRIBUTOR REPRESENTATIVE OR CALL YOUR VIRBAC REPRESENTATIVE AT 1-844-4-VIRBAC (1-844-484-7222). Dogs should be tested for heartworm prior to use. Mild hypersensitivity reactions have been noted in some dogs carrying a high number of circulating microfilariae. Treatment with fewer than 6 monthly doses after the last exposure to mosquitoes may not provide complete heartworm protection. Please see full product label for more information or visit www.virbacvet.com.

* A. caninum. ** Prevents flea eggs from hatching; is not an adulticide.

© 2015 Virbac Corporation. All Rights Reserved. SENTINEL and SPECTRUM are registered trademarks of Virbac Corporation. Heartgard and the Dog & Hand logo are registered trademarks of Merial. 2/15 15336


NAVTA NEWS

Member Updates NAVTA State Representative Committee (SRC) leadership summits are underway, and the committee will continue to focus on bringing cohesiveness to our efforts on issues that matter to veterinary technicians throughout the nation. Please be sure to make use of the National Veterinary Technician Week toolkit www.navta. net/?page=nat_vet_tech provided by NAVTA as a resource for technician recognition in your region! Thank you once again for the tireless work you do, to advocate for each and every veterinary technician and the field of veterinary medicine. In the last issue, the National Association of Veterinary Technicians in America SRC shared the goals of improving communication between NAVTA and the state associations, aiding in developing leadership and association management skills among leaders, and providing opportunities and resources for state associations to serve their membership. These goals are directed at strengthening the veterinary technician profession through collaboration within the national network state level veterinary technician advocacy groups to achieve large, national scale goals. 33 representatives from 16 states and several VTS academies were present at the 2nd Annual NAVTA Veterinary Leadership Development Workshop held in Boston, in conjunction with the AVMA Convention. An initial survey of the attendees reinforced many common challenges for veterinary technician associations such as keeping the membership motivated, financial sustainability, and public/

professional awareness and recognition of veterinary technicians. Veterinary Technician leaders shared experiences and debated passionately on the future of the profession. The hottest topic of all among many important ones, were the topic of national credentialing standards. Is “veterinary technician” or “veterinary nurse” appropriate for our profession? The discussion not only surrounded the title itself, but also focused on credentialing and recertification requirements, professional responsibility, legislative changes, and acceptance and support by other medical professionals. The workshop served as a summit for leaders of the states, creating a collective force, moving towards the same goal. NAVTA is, and has been preparing key groundwork to bringing these large scale goals to fruition. We are extremely excited that the profession has gained momentum, and look forward to the accomplishments we will achieve as peers in this amazing field. Plans for future

– Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM) NAVTA State Representative Committee Chairperson

The NAVTA State Representative Committee (SRC) serves to support the veterinary technician profession by ensuring communication between NAVTA and state veterinary technician advocacy groups and supporting them in their missions. The SRC is continually looking for veterinary technician advocates to join the effort, whether it be through committee work or feedback. Please contact the SRC at statereps@navta.net and invite veterinary technician leaders to join us on Facebook at www.facebook.com/ groups/318542778312547/

Nebraska Veterinary Technician Association The Nebraska Veterinary Technician association (NVTA) is growing in numbers! We have increased membership and look forward to an exciting year ahead. We have a facebook page and a website to reach more technicians. www.nebraskaveterinarytechnicianassociation.com | www.facebook.com/NeVTF – Lisa Redington, LVT, NVTA President NAVTA NE State Representative

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The NAVTA Journal | Oct/Nov 2015


Oregon Veterinary Technician and Assistant Association The Oregon Veterinary Technician and Assistant Association (OVTAA) was able to send Tiah Schwartz, NAVTA State Representative, to the 2015 NAVTA Leadership Workshop held in Boston this past July. NAVTA State Representatives from all over the United States came together to discuss challenges facing state vet tech associations, and ways in which NAVTA can offer their support. It was a great opportunity to build relationships, brainstorm ideas and to set “SMART” goals. The OVTAA is looking for individuals who are interested in representing OVTAA in specific districts in Oregon. The purpose of selecting and utilizing district representatives is to help OVTAA grow as well as to promote OVTAA throughout the state. An OVTAA district organization may be created in any town or area of the state where there are three or more OVTAA members. Once that district has been determined, a district representative will be appointed by OVTAA Executive Board. We need your help in creating a strong

organization that will be felt across the state of Oregon; not just limited to the Portland area. Please let us know if you have interest in helping OVTAA grow by becoming a District Representative. Upcoming CE and volunteer events for September: • The OVTAA will be staffing a booth for the Oregon Veterinary Medical Association at the Oregon State Fair on September 6th • The OVTAA will be offering pet first aid at the “Strut Your Mutt” charity dog walk on September 12th. • Please join us for a webinar on “Triage” September 16th • Come help us wash dogs at the DoveLewis Dogtoberfest on September 27th • Please visit us on Facebook or our website at www.ovtaa.org for more information on these upcoming events! — Tiah Schwartz, Oregon NAVTA State Representative

Ohio Association of Veterinary Technicians The Ohio Association of Veterinary Technicians has been hard at work putting finishing touches on their yearly CE symposium, Discovery. Registration packets were mailed out on September 1st along with the yearly membership renewals. All information can be found on our website, www.ohiorvt.org, if you would like to register. The board has put together a great group of lecturers with timely and useful information for today’s technician. We’ve been fortunate to be able to include some great give-a-ways and even have thrown in a few surprises too. Hopefully we’ll see many of you there! Our new Facebook page is up and running, check it out and like us at The Ohio Association of Veterinary Technicians. A survey for veterinary technicians has been completed and is being sent out in an effort to gauge the profession in all

Caution Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Indications SENTINEL® SPECTRUM® (milbemycin oxime/lufenuron/praziquantel) is indicated for the prevention of heartworm disease caused by Dirofilaria immitis; for the prevention and control of flea populations (Ctenocephalides felis); and for the treatment and control of adult roundworm (Toxocara canis, Toxascaris leonina), adult hookworm (Ancylostoma caninum), adult whipworm (Trichuris vulpis), and adult tapeworm (Taenia pisiformis, Echinococcus multilocularis and Echinococcus granulosus) infections in dogs and puppies two pounds of body weight or greater and six weeks of age and older. Dosage and Administration SENTINEL SPECTRUM should be administered orally, once every month, at the minimum dosage of 0.23 mg/lb (0.5 mg/kg) milbemycin oxime, 4.55 mg/lb (10 mg/kg) lufenuron, and 2.28 mg/lb (5 mg/kg) praziquantel. For heartworm prevention, give once monthly for at least 6 months after exposure to mosquitoes. Dosage Schedule Milbemycin Oxime per chewable

Lufenuron per chewable

Praziquantel per chewable

Number of chewables

2 to 8 lbs.

2.3 mg

46 mg

22.8 mg

One

8.1 to 25 lbs.

5.75 mg

115 mg

57 mg

One

25.1 to 50 lbs.

11.5 mg

230 mg

114 mg

One

50.1 to 100 lbs.

23.0 mg

460 mg

228 mg

One

Body Weight

Over 100 lbs.

Administer the appropriate combination of chewables

To ensure adequate absorption, always administer SENTINEL SPECTRUM to dogs immediately after or in conjunction with a normal meal. SENTINEL SPECTRUM may be offered to the dog by hand or added to a small amount of dog food. The chewables should be administered in a manner that encourages the dog to chew, rather than to swallow without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole. Care should be taken that the dog consumes the complete dose, and treated animals should be observed a few minutes after administration to ensure that no part of the dose is lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended. Contraindications There are no known contraindications to the use of SENTINEL SPECTRUM. Warnings Not for use in humans. Keep this and all drugs out of the reach of children.

parts of Ohio. Results will be included in an upcoming newsletter and on our website. As the school year gets under way a member of our board will be visiting all the tech schools to spread the word about the importance of a strong state organization and the vital part they play. All new graduates will receive a complimentary membership for their first year. Local districts are also diligently planning advanced CE opportunities for their technicians as the year winds down. Updates for these meetings are posted on our Facebook page. We are looking forward to another great year with Discovery on the way and The Midwest Veterinary Conference coming soon. We would love to meet you in Ohio!

Precautions Treatment with fewer than 6 monthly doses after the last exposure to mosquitoes may not provide complete heartworm prevention. Prior to administration of SENTINEL SPECTRUM, dogs should be tested for existing heartworm infections. At the discretion of the veterinarian, infected dogs should be treated to remove adult heartworms. SENTINEL SPECTRUM is not effective against adult D. immitis.

–Christie Myers RVT

NADA #141-333, Approved by FDA © 2013 Novartis Animal Health US, Inc NAH/SSC/BS/1 1/14

Mild, transient hypersensitivity reactions, such as labored breathing, vomiting, hypersalivation, and lethargy, have been noted in some dogs treated with milbemycin oxime carrying a high number of circulating microfilariae. These reactions are presumably caused by release of protein from dead or dying microfilariae. Do not use in puppies less than six weeks of age. Do not use in dogs or puppies less than two pounds of body weight. The safety of SENTINEL SPECTRUM has not been evaluated in dogs used for breeding or in lactating females. Studies have been performed with milbemycin oxime and lufenuron alone. Adverse Reactions The following adverse reactions have been reported in dogs after administration of milbemycin oxime, lufenuron, or praziquantel: vomiting, depression/lethargy, pruritus, urticaria, diarrhea, anorexia, skin congestion, ataxia, convulsions, salivation, and weakness. To report suspected adverse drug events, contact Novartis Animal Health at 800-637-0281 or the FDA at 1-888-FDA-VETS. Manufactured for: Novartis Animal Health US, Inc. Greensboro, NC 27408, USA

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NA VTA NEWS

Member Updates Colorado Association of Certified Veterinary Technicians (CACVT)

Jason Lang, Anna, Brogren, Elizabeth Salan, Teressa Myers, Elizabeth Reed, Melody Quammen, Elisabeth Newell. (Absent: Rainy McDonald, Katherine Andrews)

CACVT would like to introduce the 2015-2016 Executive Board: President, Melody Quammen, CVT; President-Elect, Elisabeth Newell, CVT; Vice President, Jason Lang, CVT; Vice President-Elect, Anna Brogren, CVT; Secretary, Elizabeth Salan, CVT; Secretary-Elect, Elizabeth Reed, CVT; Treasurer, Teressa Myers, CVT; Treasurer-Elect, Rainy McDonald, CVT; Immediate Past President, Katherine Andrews, CVT CACVT held Board Orientation on August 23. Governing documents, board policies, general expectations, and attendance and performance evaluation markers were reviewed, discussed, and agreed upon. CACVT has put a great deal of effort into ensuring that the board is reflective of the vast geographic distribution of its constituents, as well as reflective of the array of positions that can be held by CVT’s within the industry. We are very excited about the commitment and professionalism of CACVT’s Board, and are looking forward to a positive and productive year. Strategic Planning will take place in early September. – Juliebeth Pelletier, CVT, Executive Director

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Wyoming Veterinary Technician Association The Wyoming Veterinary Technician Association is happy to announce that after a long year plus of work to reinstate our non-profit/ tax exempt standing we are now OFFICIALLY 501(c)(3) Federal Tax Exempt and are a Public Charity Status 509(a)(2) according to the IRS! This standing allows for contributions to be deductible under section 170 of the IRS Code. We are also able to receive tax deductible bequests, devises, transfers, or gifts under section 2055, 2016, or 2522, of the IRS Code. Several years ago the 501(c)(3) tax exempt status split into multiple subsections and somehow we missed the notification (common for associations without a permanent mailing address). Reinstatement has taken a lot of paperwork, volunteer time, and dedication, but we did it! It also involved revising our entire constitution and bylaws due to updates and requirements needed to ensure that our annual forms, among other things such as the annual Secretary of State filing the association is required to file, would be handled by the Executive Board for years to come in addition to other provisions the IRS

requires to be included in the constitution and bylaws for tax exempt status. Thanks to our diligent members who voted in the draft of the new constitution and bylaws at the annual Fall CE in September 2014 to get the bulk of the paperwork changes rolling and who will now be able to celebrate at the Fall CE this September 2015! Pretty good for a big state with the smallest population! The association could not have accomplished this without her help and knowledge. The association, sends out our sincere gratitude for all her hard work and perseverance. In other news we are proud to present this year’s Wyoming Veterinary Technician Scholarship award to Mackenzie Lowham. She was invited to the Annual CE conference held in Casper, Wyoming as a guest of the association. We encourage more Wyoming Resident students to apply next year. Applications and information can be found at www.wyvta.org –C ambria Harmon, LVT, CVT. NAVTA State Representative

South Carolina Veterinary Technician Association Our website is currently “under construction”. Please contact the board members at: SCAVT1@gmail.com if information is needed. Find us on Facebook at South Carolina Association of Veterinary Technicians. Upcoming conference (free registration for SCAVT members if registered by early October). Location: Wild Dunes, Charleston’s Island Resort. Date: Sunday, October 18, 2015 Register through SCAV: scav.org

The NAVTA Journal | Oct/Nov 2015

Please email the association if you are interested in joining the executive board! We are now having live web conference board meetings to limit traveling to meet face to face and to make it more convenient for all to attend. We would like to add pictures of our SCAVT members working with patients on the new website and also to our Facebook page. Please email pictures to SCAVT1@gmail.com. – Melissa P. Entrekin, LVT, VTS (ECC)


NA VTA NEWS

Florida Veterinary Technician Association (FVTA)

Melissa Siekaniec, CVT-VTS(ECC) delivers CE at the August FVTA Regional Meeting

The Florida Veterinary Technician Association (FVTA) has been staying busy with plenty of events over the past few months! We have held regional Association meetings with dinner and CE in St. Petersburg, Orlando, Cocoa, Fort Myers, and Gainesville! Topics presented include clinical pathology, nutrition, veterinary forensics, and CPR. These gatherings offer Florida CVTs a way to network, enjoy a meal together, and earn some face-to-face continuing education. We intend to continue rotating the regional meetings around the state to keep members engaged and well served by the Association!

Our Association newsletter is currently being provided quarterly; we include topical articles, AVMA accredited veterinary technology program updates, and even rescue or volunteer opportunities for veterinary technicians around the state. We hope to step up our mentoring process in order to encourage FVTA CVTs to work toward Veterinary Technician Specialist status in their area of interest. Many VTSs exist within our state association membership; connecting new or upcoming CVTs with them should help facilitate the process for interested individuals! We attend the quarterly Florida Board of Veterinary Medicine meetings in order to stay informed on current veterinary medical issues in our state, as well as to offer the BVM an update on what our Association has been up to. Next month we will participate in the Florida State Agricultural Response Team Advisory Board and Partners Meeting so we can bring members up to date with planning and preparedness efforts in the veterinary medical community.

The FVTA has also been continuing to work toward our professional goal of compulsory credentialing and title protection. Our focus is currently on a legislative approach that utilizes AVMA Model Practice Act language in an effort to establish state credentialing and regulation of veterinary technicians. To this end, we have begun consulting with lobbying professionals and the Florida Board of Veterinary Medicine. The FVTA also participated in the NAVTA/NAVC State and VTS Leaders Workshop held at the American Veterinary Medical Association annual conference. This workshop helped provide our Association with valuable agenda and goal setting principles, and helped familiarize us with what’s going on around the nation in other VTAs. We greatly appreciate the support and guidance offered by NAVTA as we seek to advance our profession in the state of Florida! –C arrie Jo Anderson, CVT FVTA President

New Hampshire Veterinary Technician Association NHVTA Board of Directors Chair Becky Gallant, BS, CVT, Treasurer Elizabeth Madison, CVT, NAVTA State Rep Ed Carlson, CVT, VTS (Nutrition) attended the 2nd annual NAVTA Veterinary Leadership Development Workshop was held at the AVMA Convention in Boston. Inspired by what we learned the board is working on SMART goals for our association. We would like to thank Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM) NAVTA State Representative Committee Chairperson, NAVTA, and NAVC for their work on this very informative event and look forward to similar events in the future! The CE committee is hosting a Sunday brunch lecture in September; “Conventional, Alternative, and Raw Diets” presented by Ed

Carlson, CVT, VTS (Nutrition). Thanks to the generous support of Hills Pet Nutrition this event is free to NHVTA members and to nonmembers for a small fee. The NHVTA will host a Technician Reception in the evening of Saturday, September 26 at the New England Veterinary Conference in Portland, Maine. Technicians from across New England networking with finger foods, a few adult beverages, and veterinary trivia games! What could be better? The NEVC has a great technician track this year starting on Friday with differential and urinalysis lectures and labs by Betsy Hensley, CVT. Followed on Saturday and Sunday with lectures by Ann Wortinger, CVT, VTS (ECC, SAIM, Nutrition)! Hope to see you there!

We will again be asking the Governor of New Hampshire to proclaim October 11 to 17, 2015 Veterinary Technician Appreciation Week in our state to coincide with National Veterinary Technician Appreciation Week. We believe increasing awareness of the important role veterinary technician’s play in veterinary medicine with the general public is essential to the continued growth of our profession. The Board of Directors is also working on something a bit different for the NHVTA, this year, to help our members celebrate! Watch our website and Facebook page for upcoming announcements! –E d Carlson, CVT, VTS (Nutrition) NHVTA State Representative to NAVTA

Publication of the National Association of Veterinary Technicians in America

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NAVTA NEWS

Member Updates New Jersey Veterinary Technician Association

Pictured Left: Nicole Knop, CVT, Owner and Operator of Zoom Room in Tinton Falls NJ, (center, back row) hosted the campers on site and taught them about owning and operating your own indoor dog gym. Her pets Tripod (left) and Rosie (right) gave live demonstrations on the equipment! Pictured Center: Christine Seminerio, CVT, and Joe Jenik, AVA, preparing to demonstrate safe and gentle feline restraint with DSH “Tulip”, and explain how the technician and assistant work together as a team. Pictured Right: Officer Michael Azzarello, CVT, NJSPCA Humane Law Enforcement & NJVTA Education Committee member, teaches the campers about animal law and what to do if animal abuse is suspected

What did you do this summer? We had a great summer on the Jersey Shore, but despite the draw of the surf and sand, we still made time to meet and make progress to finish up the transition of duties of past board members to present so we can begin moving forward on other projects for the NJVTA. After much coordination, all handoffs between people, banks, PO offices, AAVSB, you name it - have been completed. I wanted to recognize all present and past board members for their many hours after work meeting at various exits on the parkway to make this happen for technicians in NJ. We are all volunteer and transition takes lots of time to do it right. Thank you for your persistent efforts! In July, President Erika Ervin, CVT, and NAVTA State Rep Janet McConnell, CVT, represented the NJVTA at the 2nd Annual NAVTA Veterinary Leadership Development Workshop in Boston, Ma. We met many veterinary technician leaders from neighboring states and worked together during the daylong event to tackle issues facing the veterinary technician profession across the country. It was exciting to participate in these state level veterinary technician advocacy groups to achieve

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large national scale goals. We will be inviting these states to our NJ events and hope to have a regional CE for the tri-state area in the near future! Early August brought the Hambletonian Equine Conference to New Jersey and NJVTA was there to support technicians with a booth in the exhibit hall. CE was offered to veterinarians and technicians alike with a day-long wetlab followed by lectures expanded to two days this year. Robin Del Bove represented our association at her “all things technician” booth with NJVTA, NAVTA and VSPN materials. An evening of lovely weather and open air buffet concluded the meeting with dinner while watching the trotters at the Meadowlands Racetrack. Many stayed for the Hambletonian race on the Saturday following the conference. It was great to meet technicians from other states including PA and CT, as we hope to combine forces with some of our neighboring states in future CE opportunities. Summer is also camp season, and this year 15 members of the NJVTA (13 technicians and 2 assistants) participated in presenting

The NAVTA Journal | Oct/Nov 2015

at a career camp for our future members of the veterinary profession, called “Journey to Veterinary Careers”. This camp, given at the Brookdale Community College campus and developed by technicians Janet McConnell and Kim Calabrese, exposes children in grades 6 – 9 to a variety of careers working with animals over an entire week. This is our 6th season running the camp! Our roster of guest speakers include Veterinarians for companion and large animals, Technicians, Assistants, Specialists, Managers, a Veterinary Sales Representative from Purina, K-9 Police Officers from Tinton Falls, Humane Law Enforcement Officer, Seeing Eye Representatives, Wildlife Rehabbers, and a Zookeeper! We do 3 days at the college with presentations and furry (or scaled) guests, and then 2 days of field trips to on site locations. This year we visited Zoom Room, an indoor dog gym featuring agility, obedience and a variety of other training in Tinton Falls, followed by a trip to the Monmouth County SPCA in Eatontown for a look at shelter careers and a chance to meet many animals waiting for forever homes. The last day of camp is spent entirely onsite at Red Bank Veterinary Hospital, so the campers can get an up-close


NAVTA NEWS Registered Veterinary Technologists and Technicians of Canada real time feel for veterinary medicine in action, and conclude the camp with first aid training workshops with skills they can use for their own pets! This camp is very popular and we all enjoy sharing our passion for our careers working with animals! I am happy to share our camp syllabus with anyone interested in starting a similar summer adventure – contact janet.mcconnell@rbvh.net. Atlantic Coast Veterinary Conference The NJVTA is preparing for a booth presence at the Atlantic Coast Veterinary Conference, Oct 13th – 15th, 2015, and will also have NAVTA and VSPN representation. Since this great conference is right in our own backyard, it is the perfect venue for our board members to get lots of face to face time with the technicians and assistants in New Jersey! Come visit and celebrate National Veterinary Technician Week with us, share your thoughts on future CE events, or how the NJVTA can help you with your career! Information for the ACVC conference can be found at www.acvc.org Credentialing Committee Update From the NJVTA Credentialing Committee: we now have an all-time record of 518 credentialed technicians (CVT) on the membership roster; however not all are active. A reminder that once you earn your credentials they must be renewed every two years through submitting CE to NJVTA. Your credentials should only be used if they are active - 20 CE hours are required every two years. Visit www.njvta. com and click under membership & renewal for more information on renewing your credentials if you have let it lapse. Education Committee The NJVTA Education Committee was proud to receive a 3 year renewal for the Veterinary Assistant Program at Brookdale Community College in Collaboration with Red Bank Veterinary Hospital. The letter from the NAVTA Approved Veterinary Assistant Committee

stated that we received an extra year of approval since “the program continues to set the standard for the highest quality of veterinary assistant education in the United States” and “is a model for community college adult education programs”! We are very proud of this great accomplishment and would like to extend a big thank you to all the many CVT mentors that contribute to this program on a regular basis and to make it an exceptional program for our community. Information on this program can be found at www.brookdalecc.edu The Camden County College Veterinary Technology Program held their AVMA CVTEA site visit in March. The decision for full accreditation will be finalized by the CVTEA in October at their semi-annual meeting. The program enrollment is currently at 73 including 23 new applicants beginning in the fall. The new selective application process has proved to be a positive move for the program and students. Students must now complete prerequisite science and math courses prior to applying to the program. The new facility renovations have given the students the opportunity to experience their education in a setting which mimics the veterinary clinic exam room and surgical suite. The facility is also hosting a new Veterinary Exam Room Assistant pilot program which is in the process of applying for NAVTA certification. For more information, contact Peggy Dorsey, CVT, Director: PDorsey@camdencc.edu. Wishing you all a very meaningful National Veterinary Technician Week, and thank you for all you do! – J anet McConnell, CVT NAVTA State Representative for NJ

On July 14th and 15th, 2015 the RVTTC held their Annual General Meeting in conjunction with the CVMA Convention in Calgary, Alberta. This meeting is the RVTTC’s one time opportunity to meet face to face, with representatives from BCVTA, AAAHT, SAVT, MAHTA, OAVT and EVTA present, collaborating on the projects and issues facing RVTs in Canada. We are excited to share RVTTC have adopted the RVT Seal, developed by the OAVT, as a national symbol for RVTs. This seal will be utilized in a number of promotional items to identify and promote RVT’s and the quality of professionalism they provide. The RVTTC has elected a new executive for 2015-2016: RVTTC President Jody Carrick RVT from the OAVT, RVTTC Vice President Heather Quilty RVT from the EVTA and RVTTC Financial Officer Tina Douglas from the BCVTA. After an engaging strategic planning session the board is very eager with the organization’s direction and goals for 2015-2016. With one of our priorities this year; to focus on our members, our new CE portal has been launched to provide RVTTC members with an online venue to engage in a variety of professional education with continual new content available. The NEW RVTTC 2015 National Veterinary Technician Week poster was released at the CVMA Convention. National Veterinary Technician Week (NVTW) is held the week of October 11-17, 2015 to celebrate and provide public awareness of veterinary technicians. This is also an opportunity to inspire the veterinary team to highlight each other and share the benefits of their quality relationship and professional achievements together. What is your veterinary team preparing for NVTW? Share with us on Facebook! – Shannon Brownrigg RVT, RVTTC Executive Director

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NAVTA NEWS

Member Updates California Registered Veterinary Technician Association CaRVTA Holds Successful Strategic Planning Meeting The California RVT Association’s Executive Board held a strategic planning meeting facilitated by Dr. Peter Weinstein. The all-day session focused on short- and long-term goals for our Association including budget planning, new committees and increasing our membership numbers. The Board is currently working on new membership benefit offerings to help increase value for our members, and putting together a budget to allow CaRVTA to best serve its membership in new and exciting ways. We hope to share our progress in the Journal as we work towards our goals. CaRVTA RVT of the Year Award CaRVTA was proud to present our Third Annual RVT of the Year Award to Harold Davis! Harold is an amazing, groundbreaking technician. He is the ICU manager at the UC Davis Veterinary Medicine Teaching Hospital, and is a highly sought-after speaker and educator. CaRVTA’s RVT of the Year Award recognizes a technician who has contributed to the education and advancement of veterinary technicians, and Harold Davis certainly fits that description!

8th Annual UC Davis Back To School Technician and Assistant Conference CaRVTA continues to partner with UC Davis for the annual BTS Conference, held at the UCD Veterinary Medical Teaching Hospital. This is a fantastic educational opportunity for technicians and assistants. This year’s speaker list included CaRVTA Board member Jody Nugent-Deal, and RVT of the Year Award winner Harold Davis. With three tracks over 2 full days, there is something for everyone at this annual conference. Over 300 people attended in person, with an additional 100 via webinar. During the BTS Conference, CaRVTA also held its Annual Membership Meeting. Fundraiser for Nancy Ehrlich Scholarship Fund Last year CaRVTA announced the formation of the Nancy Ehrlich scholarship fund. This scholarship was established to provide need-based financial assistance for continuing education classes for CaRVTA members. This year we held a fundraiser at Sudwerk Brewing in Davis on the Saturday evening of the BTS Conference. This was a fun event, and will help CaRVTA provide financial assistance to RVTs needing CE credits in the future.

Legislative Advocacy CaRVTA continues to advocate for its members before the California Veterinary Medical Board (VMB) and the legislature. We have been working with the VMB to decrease the cost of the California RVT Law Exam from the current cost of $175 to something more reasonable for a typical technician salary. We are ensuring that the VMB is inspecting newly AVMA-approved RVT schools in California to be sure that they are meeting minimum standards for RVT education. Additionally, CaRVTA is helping assistants striving for their credential via the Alternate Route pathway to complete their work before the VMB eliminates the Alternate Route – we expect that elimination to occur sometime in 2017 or 2018. In the meantime, CaRVTA continues to assist alternate route candidates work with the VMB to get their applications approved which will qualify them to sit for the VTNE. We look forward to sharing our progress with you, including exciting new member benefit offerings, in future issues of the NAVTA Journal. –L iz Hughston, MEd., RVT, VTS (SAIM, ECC) CaRVTA NAVTA Representative

We Want to Hear Your News! In each edition of The NAVTA Journal we share state association, specialty academy, and SCNAVTA updates. Share news and photos about your group by emailing updates to editor@navta.net. (Photos must be supplied as jpg files at 300dpi)

The deadline for the Dec/Jan ‘16 edition is: Oct 15, 2015.

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The NAVTA Journal | Oct/Nov 2015


NAVTA NEWS

Massachusetts Veterinary Technician Association The annual CE conference will once again be held in Marlborough at the Best Western Royal Plaza Hotel and Trade Center on November 1st. It will feature 3 lecture tracks and two hands on labs.

MVTA Representatives at the NAVTA State and VTS Leadership Development Workshop (left to right, MVTA Treasurer Ed Carlson, CVT VTS (Nutrition), committee member Tracey Nowers, MA NAVTA Rep. Robyn Townsend, committee member Julianne Evenhus.

The MVTA is entering one of its busiest times of year! Not only are we busy planning our annual all day Continuing Education conference,we are also currently soliciting nominations for our upcoming biennial September elections! Any active member can nominate themselves, a friend or a colleague for one of the five positions open this fall: President, Vice President, Treasurer, Correspondence Secretary and Recording Secretary.

Additionally, we are also looking for nominations for the Technician of the Year award. The award will be presented at the conference banquet. This award was created to recognize a current MVTA member who has gone “above and beyond” to promote, support and advance the profession of Veterinary Technology. This summer we were lucky enough to have the national AVMA conference held in Boston. In addition to the great CE tracks, NAVTA held a State and VTS Leadership Development Workshop. It was a great time to meet other state association members and NAVTA leaders. We were able to brainstorm and work on some of our Association’s biggest issues. Representing Massachusetts was our current treasurer, Ed Carlson, committee members Julianne Evenhus, Tracey Nowers and myself. As discussed in our last NAVTA update, we are continuing our CE evening lectures

around our state. This is a way for the MVTA to reach out to our members in different areas and thank them for their membership. Through this vehicle we are trying to encourage participation and fresh ideas from members who may not be heard otherwise. It is also a way for our members to put a face with the names of our executive board members. Our last CE evening was our best turnout to date. Amy Breton, CVT, VTS (ECC) presented a lecture on July 16th entitled ‘CPR: Basic Life Support’ hosted by Blue Pearl –Massachusetts in Waltham, MA. We have hosted 3 of these lectures this year. With the positive feedback we have received, the CE committee is already planning on increasing this number next year and reaching out even further geographically, to our members. Our first lecture of 2016 is tentatively scheduled for the Cape Cod area. Additional information on all our upcoming events is available on our website, www. massvta.org –R obyn Townsend, CVT MVTA CE Committee member NAVTA State Representative

VTS Academy Updates Academy of Equine Veterinary Technicians AEVNT will be holding it’s next credentialing exam for accepted applicants in December at the AAEP/AAEVT Annual conference, which will be held in Las Vegas this year. AAEP/AAEVT is a great place to gain equine orientated CE for this specialty. The American Association of Equine Veterinary Technicians and Academy board members will be on site and available to answer ques-

tions throughout the conference. Letters of intent and inquiries for the 2016 application are now being welcomed in an effort to provide a longer mentor-ship time. For more information about the academy visit www.aaevt.org and search under the AEVNT tab.

– Sue Loly, LVT, VTS-EVN AEVNT Secretary

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NAVTA NEWS

SCNAVTA Updates Stanbridge College’s Veterinary Technician Program in Irvine, CA Vice President – Courtney Chipman; Courtney is taking the vet tech world by storm and is excited to combine her excellent people skills with her love of animals as a veterinary technician. Secretary – Erin Mertan; Erin has multiple years of experience working closely with exotics and pocket pets. She feels she has found her true calling and is eager to continue expanding her knowledge base. Public Relations – Vanessa Hubbard; Vanessa currently works in practice and also fervently dedicates her time to fostering and rehoming homeless pets. Her compassion for animals is a constant inspiration to her fellow council members and classmates. The newest addition to Stanbridge College’s challenging healthcare programs, the Associate of Science in Veterinary Technology degree, offers dynamic instruction in a clinical setting. The students develop diverse skill sets under instruction from accomplished veterinarians and registered veterinary technicians, while performing practiced abilities under instructor supervision both on and off campus. An ACCSC accredited college, Stanbridge students stand out because of their genuine compassion and determination to provide exceptional service to both patients and clients. The students are excited to team up with NAVTA and further strengthen the veterinary technician profession with their recently formed Stanbridge College Student Chapter of NAVTA. Since the first official meeting in May, the students have held two successful fundraisers, hosted an ice cream social and also currently have a peer support program in the works. Future plans include more fundraisers, creating NAVTA themed t-shirts for council members to wear at events, establishing a presence in social media, printing stickers to sell at events and possibly putting together a scholarship fund for veterinary technician students. In addition to monthly

14

SCNAVTA meetings, the council members are planning a formal networking event for students and local businesses to increase awareness of our program. Stanbridge College is pleased to introduce our SCNAVTA Council Members: Faculty Advisor – Victoria Llerena, BFA, RVT; Victoria has been working with animals since early 2006. She obtained her RVT license in early 2013 and is currently a veterinary technology instructor at Stanbridge College. Her special interests are internal medicine and emergency medicine, particularly endocrinology and pharmacology. President – Marissa Roos; Marissa has previously worked with the husbandry and behavior of marine mammals at the Long Beach Aquarium of the Pacific and currently volunteers for an exotic animal hospital. Marissa is leading our chapter by example with her distinctive professionalism and genuine compassion for both patient and client alike. She looks forward to furthering her education by attending veterinary school and devoting her skills to low-income, high-risk communities both local and abroad.

The NAVTA Journal | Oct/Nov 2015

Treasurer – Tina Emmerick; Tina brings her developed business administration skills to the table. Her innate ability to handle any high pressure situation will certainly make her a valuable RVT. Creative Consultant – Salena Sloan; Salena has years of experience working with both small and large animals. She looks forward to obtaining the official title of RVT and showcasing her extensive skill set in a busy practice! With a projected job outlook growth of 52% for 2010-2020 and the consistently increasing demand for quality, highly trained veterinary technicians, our chapter is passionate about our mission statement: “Striving to create a pawsitive future for animals!” – Erin Mertan Stanbridge College SCNAVTA Secretary


NAVTA NEWS

The Vista College Lubbock

The Vista College Lubbock student chapter of NAVTA has had an active 2014-2015 school year. In October 2014, we hosted a Halloween carnival on campus, where many families came out and enjoyed themselves, playing games and winning prizes. A portion of the proceeds from the event went to The Haven,

a local pet rescue organization. In May 2015, our chapter gathered donations and held a garage sale and partnered with Lubbock Animal Services to hold a microchipping clinic. The proceeds of the event were donated to Saving Grace Pit Bull Rescue. A raffle was also held in May for a KindleFire tablet, and a

portion of the proceeds went to Wildlife Rescue. Every June, the Science Spectrum hosts an event called Critterfest, where our local science museum is transformed into a zoo for the weekend, and this is one event SCNAVTA didn’t want to miss. We had a booth to inform people about animals, and to spread the word about veterinary technicians, and how cool a career it is. Upcoming events for our chapter include helping Saving Grace host a garage sale fundraiser, competing with other departments on campus to raise money for the National Heart Association’s heart walk, and organizing a blood drive for our community. – Jaime Wilks, Instructor

Macomb Community College Each summer the Veterinary Technician Program at Macomb Community College holds a Veterinary Career Academy for area high school students. This 4 day program is geared towards those students that are interested in learning more about careers working with animals. During the Academy students learn from our faculty, staff, and student volunteers and have a lot of hands-on opportunity to work with dogs and cats. They learn skeletal anatomy, how to make and stain blood smears, basic animal behavior and restraint, TPR, nail trimming, ear care, bandaging, work with various models and manikins, and a whole lot more. In addition, they learn about the various animal healthcare fields from those currently working in these professions. On the last day, they enjoy a field trip to see a local veterinary practice. This summer’s academy was held June 22-25 and was one of the most successful yet with close to 40 students attending. – Dr. Lori Renda-Francis, LVT SCNAVTA - Chairperson

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INDUSTRY NEWS

NAVTA Members Speak Out:

Benefits of Sedation vs. Manual Restraint Survey developed and analysis provided by Zoetis Inc.: Andrea Wright, DVM, MVSc, MBA, Outcomes Research Companion Animal Division; Eugene Bacon, Global Market Research; and Sharon Campbell, DVM, Companion Animal Division Veterinary Professional Services.

Dealing with frightened or aggressive animals is often all in a day’s work for veterinary technicians. While a bite or scratch is physically uncomfortable, what is often most distressing to us as technicians is that these dogs and cats are stressed and afraid when our goal is to help them feel better. In February 2015, NAVTA partnered with Zoetis to ask our members about the use of manual restraint and sedation and how it relates to the quality of care your patients receive—as well as to your job satisfaction. We would like to thank the 1,262 of you who participated in the survey. As promised, the results are reported in this article. Sedation vs. Manual Restraint On average, respondents are involved in 28 procedures requiring manual restraint or sedation each week with a range of 0 to 100. The survey defined forceful restraint as “physically restraining a dog or cat by one or more technicians without use of sedation for longer than a brief period of time.” Using that description, you reported being asked to forcefully restrain a dog or cat on average 11 times per week, ranging from 0-50 times. Additionally, 77 percent of you told us that at your practice, sedation is used in less than 50 percent of the procedures where it would be medically appropriate. Bites Happen According to the U.S. Department of Labor, veterinary technologists and technicians have a higher rate of injuries and illnesses than the national average. When working with scared or aggressive animals, they may be bitten, scratched or kicked. Injuries typically occur while the technologist or technician is holding, cleaning or restraining an animal.1 Your input to our survey confirmed this information: 83 percent reporting to have been injured while holding a dog or cat, but only nine percent reporting being injured when an animal was under sedation. Increasing Sedation = Increasing Satisfaction Nearly half (45 percent) indicated that you are currently

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very satisfied with your job, with 17 percent reporting being extremely satisfied. However, among the 31 percent of the total respondents who said they are somewhat satisfied, some pointed to their practice “not embracing low stress handling” as an area for improvement. In fact, 63 percent of those responding said that increasing sedation would improve their job satisfaction. You saw sedation instead of manual restraint as beneficial for a number of reasons: • Less stress on the cat or dog (92%) • Less stress on me and my coworkers (83%) • Increased efficiency (67%) • Improved medical outcomes (51%) Less Stress for All You told us that pets who are fearful or reluctant to be examined create a stressful situation not only for themselves, but also for you and for your colleagues. An Executive Summary published in the May 15, 2011, edition of the Journal of the American Veterinary Medical Association (JAVMA) summarizing a Bayer-sponsored “Veterinary Care Usage Study” confirms that the situation is stressful for owners as well. The study reported: “It became evident that cat owners found taking their animal to the veterinarian highly stressful for the animal and themselves. They indicated that their cats hid when the cat carrier appeared; aggressively, physically resisted being put in the carrier; cried during the car or bus ride to the veterinary clinic; showed signs of stress and fear in the waiting area, particularly when unfamiliar animals, especially dogs, were present; displayed physical signs of tension during the examination; and acted remote and unfriendly for several days after returning home.” The article further reported that 58 percent of cat owners and 38 percent of dog owners stated, “My pet hates to go to the vet.”2 Survey Respondents Said … Here are a few of the comments from fellow NAVTA members on why they support sedation protocols: • “Better patient care. You wouldn’t want someone doing that to your pet.”

The NAVTA Journal | Oct/Nov 2015


INDUSTRY NEWS

Sedation (Instead of Manual Restraint) Improves the Following

Less stress on the cat or dog

92%

Less stress on me and my coworkers

• “Improves animals’ behavior in the future. They don’t remember anything bad happening if we sedate the first time, and when we keep working with the animal, they sometimes improve to the point where several visits later we no longer need to sedate them.”

83%

Increased efficiency

67%

Improved medical outcomes

• “Less stress on owners.”

51%

11% Other (Specify)

• “Better long-term behavioral responses by repeat patients.” • “It is the right thing to do for the animals.” You also reported using sedation for a variety of procedures including exploring and repairing painful wounds or lacerations (68 percent); euthanasia (42 percent); exams with fractious animals (41 percent); radiology (40 percent); fracture stabilization (33 percent); and removing foreign bodies (28 percent). Interestingly, you reported that procedure type has more influence on the decision to use sedation than the benefit of sedation itself. When we looked deeper, relieving pain was commonly cited as the other influencer for each procedure.

Does not improve environment

5% 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of Medically Appropriate Procedures Using Sedation

23%

Under 10% 10 – 19% 20 – 29% 30 – 49% 50% or more

35%

12%

Conclusion The survey results clearly indicate that there is room for sedation for the fearful and aggressive animals you see each day. As advocates for our veterinary patients’ overall health, you can also be advocates to help improve their experience at your practice. Consider speaking with your veterinarians and other team members about how you can incorporate sedation to help make visits more pleasant for everyone involved—you, your colleagues, clients and, most importantly, the dogs and cats in your care.

12%

18%

Top Sedation Procedures Exploring repairing wounds or lacerations Euthanasia Exams with fractious animals Radiology Fracture stabilization Remove foreign bodies Clipping or shaving fractious animals

References

Declaws

1. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Veterinary Technologists and Technicians. http://www.bls. gov/ooh/healthcare/veterinary-technologists-and-technicians.htm. Accessed August 14, 2014.

Biopsies Minor dental procedures Anal sac abscesses Toe nail removals or trims

2. Volk JO, Felsted KE, Thomas JG, Siren CW. Executive summary of Bayer veterinary care usage study. J Am Vet Med Assoc. 2011; 238(10):1275-1282. doi: 10.2460/ javma.238.10.1275.

Other (Specify) Ear Exams Cystograms End of day procedures 0%

10%

20%

30%

40%

50%

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60%

70%

80%

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Veterinary Assistant

CONTROLLED SUBSTANCES: What Team Members Really Need to Know Mary L. Berg, BS, RLATG, RVT, VTS (Dentistry)

This Article is NOT RACE APPROVED. However, Veterinary Assistants can take the exam follwing this article at VetMedTeam.com and receive 1 CE credit that can be applied toward their AVA designation.

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Objective: After reading this article, participants will be able to describe how drugs are scheduled, record keeping and log requirements, inventory and security recommendations. Whether you are ordering and monitoring the controlled substance in your practice or administering these substances, it is important that you understand the rules and regulations. This knowledge will not only benefit you and your practice but protect you from potential problems. This is an opportunity to empower a technician with the knowledge to evaluate and improve the controlled substance handling within a practice. Technicians should take an active part in creating and activating good controlled substance protocols and vigilant in the enforcement of the protocol within their practice. Veterinary technicians and staff members should also be aware of team member’s performance and wellbeing in order to identify concerns regarding substance abuse and intervene quickly with compassion and empathy.

The NAVTA Journal | Oct/Nov 2015

Who is Responsible All licensed veterinarians that conduct any activities with controlled substance are required to be registered with the United States Drug Enforcement Agency (DEA). This includes individuals that purchase, stock, order, and prescribe controlled drugs (CS). The DEA does NOT require registration for a veterinarian that administers and dispenses as an agent of another veterinarian or veterinary hospital. In other words, an associate veterinarian or a relief veterinarian, are not required to register with the DEA. It is important to remember that registrations are to be maintained at the registered practice and must be readily available. The DEA and the State Boards of Veterinary Examiners are responsible for enforcement of the regulations. Some states, such as Missouri, require all licensed veterinarians who conduct any activities with controlled substances, including purchasing, stocking, ordering, prescribing and administering, must first obtain a state controlled substances registration. The sec-


Veterinary Assistant

ondary controlled substance registration may be issued by the BNDD (Bureau of Narcotic and Dangerous Drugs) or similar division, within the state. The guidelines further state, that if the veterinarian stocks controlled drugs at only one location, then only one registration is required. Additional registrations are not required unless he/she begin stocking controlled drugs at more than one location. For example, if the veterinarian stocks controlled drugs at two separate clinics, then he/she is required to have two separate state and federal controlled substance registrations. Every location where stocking takes place must be registered so that the BNDD (or similar division) and DEA are aware of the locations of controlled substance activities. Although the veterinarian must have a registration at a location where they practice and stock controlled substances, they may issue a controlled substance prescription anywhere in the state without an additional registration. It is in the veterinarian’s best interest to be aware of the controlled substance regulations within the state as well as the DEA.

Schedules of Drugs Drugs are scheduled based upon the degree of severity and risk of addiction and the schedules are set by the DEA. Schedule I drug would be those at the highest risk of addition. States can choose to change the schedule of a drug. For example, Tramadol is a schedule IV drug by DEA standards, however some states (Oregon) treat it as a schedule II drug, others as a schedule III. The schedule of the drug should be indicated on the bottle with a capital C and the Roman numeral corresponding to the schedule. Schedule I drugs such as heroin or cocaine are rarely used in veterinary practices. Examples of Schedule II drugs include Fentanyl, Hydrocodone, Morphine. Schedule III include Buprenorphine and Ketamine, Schedule IV include Buptrophanol, Diazepam, Phenobarbital and Schedule V drugs include preparations such as Codeine preparations. To determine how a drug is classified, visit http://www.dea. gov/druginfo/ds.shtml.

Purchasing The purchaser must have a DEA registration to purchase controlled substances. Controlled substances for use in a veterinary hospital can be purchased from a distributor or a pharmacy. If the drug is a Schedule II drug, a DEA Form 222 must be completed and filed with the DEA and kept on file by the purchaser and the supplier.

Record Keeping A record must be kept each and every time a controlled substance changes hands or is used on a patient. A proper paper trail that shows the path of the controlled substance from supplier to patient is essential and must be kept for at least two years. The DEA or state agency can inspect at any time without notice. The records must also be readily available should be requested by an investigator. Receipts of all purchases must be kept. Schedule III-V drug receipts can be kept in the same file. Schedule II drug receipts must have a DEA Form 222 attached and kept in a separate file from the others. It would be highly unlikely for a veterinary practice to have schedule I drugs.

Drug Logs It is required that drug logs be kept for each controlled substance. Controlled Substance Logs are available through AAHA, however

many practices choose to create their own logs. Most practice management software programs also include the capability to log controlled substances. When a practice creates their own logs it is important that all records for controlled substances include the following data: date of receipt, drug name, dosage form, strength, quantity received, name, address and DEA number of the supplier and recipient as well as the initials or name of all employees verifying receipt. AAHA (American Animal Health Association) accredited hospitals are required to keep log records in a bound book with a different book for each substance. However, the DEA does not require a bound book or a separate book for each drug. It is helpful to use a binder with dividers for each specific drug and concentration of the drug. They can be handwritten, typed or maintained electronically. Logs must be kept and be easily retrievable for inspection for two years.

For Ease of Record Keeping Each bottle or package is assigned a number when it is received into the practice. It is common to use the first letter of the drug and the number of the bottle and the year. For example: The third bottle of Ketamine purchased by the hospital in 2015 would be numbered K-3-15. It is important to write the number directly on the bottle with a permanent marker.

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Veterinary Assistant Controlled Substances, continued Tablets Start with inventory on hand 200 Add drugs purchased 2500 Total Quantity to Account For 2700 Drugs administered or dispensed 1200 Drugs transferred 25 Losses or thefts reported to DEA 5 Total Accounted For

1,230

Example of an audit on a controlled substance Each bottle then receives its own page in the log book. All of the information on the top of the log must be completed for each bottle or package. The first line of each page is completed on the date of arrival. In place of name and address – write beginning balance and the person creating this log initials the entry. Unfortunately, that means that each 1 ml vial of bupernorphine must be numbered labeled and have its own log sheet. It may seem tedious but it will protect the practice in the long run.

Inventories The DEA only requires a complete inventory every two years but it would be in the best interest of the practice to conduct inventory or audits on a more frequent basis. It is recommended that inventories or physical counts should be conducted on a weekly or monthly basis, and requires balancing beginning inventories with amounts purchased to amounts used and total on hand. The changes in veterinary medicine are leading to more and more prescriptions to be written as opposed to filling a prescription within the hospital. Prescriptions can only be issued to patients and must contain the following information: date, name and address of patient and owner, species, drug information (form, strength, quantity and directions for administering), the original ink signature of the veterinarian, DEA number and name and address of the veterinarian. It goes without saying that a prescription cannot be written for a

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human. Keep the prescription pads locked up and accessible only by those with access to the controlled substances. If the veterinarian writes a controlled substance prescription for the patient, a pharmacy can only fill a 30 day supply for Schedule III, IV or V drugs. These prescriptions can have up to five refills but after six months the veterinarian must write a new prescription for the drug. If the prescription is for Schedule II drugs, the prescription can only be filled for 30 days and must have a new prescription every 30 days.

Packaging Controlled substances that are dispensed to a patient must be packaged in childproof containers unless they are samples that are in DEA approved prepackaging containers. Controlled substances cannot be dispensed in envelopes, plastic bags and unapproved containers. Labeling – the dispensing veterinary practice staff must properly label all controlled substances. The labels must include the date of dispensing, name and address of the veterinarian, patient’s name, drug (name, strength, dosage form and quantity) and directions for administration. A warning label that states it is illegal to transfer the drug to anyone other than the patient for whom it was dispensed should be applied. All controlled substances dispensed must be documented in the patients chart. Copies of prescriptions to a pharmacy should also be placed in the chart. It is also advisable to keep a second copy of all prescriptions in a separate file. If a drug is unwanted or expired, the drug should be sent to reverse distributor and records must be kept for two years. Only contaminated drugs can be disposed of on site by the practitioner and a witness. If disposing of a drug in a tablet form on site, it is recommended to crush the tablet with a mortar and pestle and place the crushed drug in a sharps container. If the drug is a liquid, add it to kitty

The NAVTA Journal | Oct/Nov 2015

litter and disposing of it in the trash. The Environmental Protection Agency (EPA) does not recommended to flush the drug in the toilet or down a sink drain. Record the disposal of the drug on the log by stating the amount disposed of and method of disposal. Both individuals (the disposer and the witness) sign and date the log. Transferring of drugs among veterinarians is allowed but must have a transfer of controlled substances form for the supplier and the receiver. This form can be created in the hospital but it must include the pertinent information about both the supplier and the receiver. (Name, address, DEA Registration Number, drug, concentration and amount transferred) Any schedule II drugs require a DEA Form 222.

Security Controlled substances and prescription pads must be locked in a safe or cabinet with double locks. Two locks mean that the cabinet has two locks requiring two keys or that the cabinet is within another locked cabinet or room. It is also recommended that the cabinet be mounted or large enough to make removal from the premises difficult. Controlled substances should never be left out during the day. Perform background checks on individuals that have access to the controlled substances. Have an SOP (Standard Operating Procedure) in place that every individual in the practice reads and signs. Conduct regular training on controlled substances and have two individuals present at each use. Do not allow visitors access to the drugs and restrict the number of individuals with access to the drugs. Create a code word with external pharmacies if you are calling in a prescription. Review logs for falsifications and perform regular and random internal audits. Handling loss and/or theft – It is normal to have some loss in liquid controlled substance. This is due to the amount remaining in the hub of a needle. The DEA allows for ~10% loss in liquids. If the loss is significant (over 10%) or in a tablets and the clinic is unable to


Veterinary Assistant

account for the loss, a report must be made to the police, the DEA and the state board of Veterinary Examiners within seven business days. The DEA requires the completion of DEA Form 106 Report of Theft or Loss of Controlled Substances in the event of a loss. It is illegal for a veterinarian to prescribe drugs to a human or for themselves; doing so is a felony. It is also illegal for a veterinarian to supply controlled substances to animal shelters, animal control officers, and groomers if that drug is to be used as stock drug. Veterinary team members should be aware of the possibility of drug seeking by pet owners and the physical symptoms of addition. It is not uncommon for an owner to create a story about their pet to obtain drugs they then take themselves. These clients may call for frequent refills and may use the excuse of spilled bottles or having lost the medication.

Warning Signs of Substance Abuse Warning signs of substance abuse include secrecy, moodiness, abrupt changes in behavior, withdrawal from relationships, changes in appearance, financial stress, and disappearance of medications. The possibility that an individual is experiencing substance abuse can be difficult to address but remaining silent is just as serious. A team member’s substance use can result in a numerous problems for the practice and the individual. It could result in legal action if the substance abuse results in wrongdoing or inadequate patient care. In addition, the practice or individual could suffer from a loss of the license to practice, negative media coverage and loss of clients. It is important to remember to be sure to protect patient safety and professional standards as required by your state’s licensing board. The standards can usually be found on your state veterinary board’s website. Then, when the legal and ethical requirements are clear, you can focus on intervening with empathy and compassion.

The hierarchy of the practice must also be addressed. If the person suspected of drug use is a subordinate, it can be easier to comment and focus on the technical job performance and you may need to bring in a supervisor. It can be a difficult decision to bring this to the attention of a supervisor as it may damage your relationship with a co-worker. If the person suspected of using drugs is your supervisor, it may lead to fears about the loss of your job and worries about the well being of the practice. The concern about a fellow team member is complicated by both personal feelings and professional concerns. How do you open those delicate conversations with a coworker? This can be a very difficult conversation that must be opened with empathy and compassion. Begin the conversation with an inquiry about the individual’s well-being. You could start with “I’ve noticed you’re not yourself lately; you seem troubled and I’m worried about you. Is there anything I can do to help?” If the initial conversation does not resolve the issue each conversation may need to be more confrontational but still delivered with compassion. “I’ve noticed a change in your behavior and your job performance. I’m worried that this change may put a patient at risk. I have a duty to the patients so I need to ask if you are struggling with substance use. I can imagine that is difficult but I need to consider our patients so I’m asking you to seek professional help.” At this time lay out the steps that you and the individual need to take such as mandating time off for the employee, reporting to the state board and possible termination. Substance abuse is a major concern in our profession. It is important to know the regulations for controlled substances, take an active part in creating and activating good controlled substance protocols within your practice, be vigilant in the in enforcing those protocols and be aware of your team members in order to identify and intervene quickly with compassion and empathy.

References: Prendergast, H, Front Office Management for the Veterinary Team, 2nd ed; Elsevier 2013 www.dea.gov www.deadiversion.usodj.gov health.mo.gov/safety/bndd/doc/ vetguidelines.doc www.fda.gov/RegulatoryInformation/ Legislation/ucm148726.html www.aaha.org www.avma.org/KB/Resources/Reference/ Pages/dea-registration.aspx www.deadiversion.usdoj.gov/drug_chem_info/ tramadol.pdf www.dea.gov/druginfo/ds.shtml www.veterinaryteambrief.com - Signs and Symptoms of Possible Substance Use

About the Author: Mary L. Berg, BS, RLATG, RVT, VTS (Dentistry) Mary received her B.S. in Biology/Microbiology from South Dakota State University, her A.S. in Laboratory Animal Science from Redlands Community College, and her A.S. in Veterinary Technology from St. Petersburg College. She is a Charter member of the Academy of Veterinary Dental Technicians and received her Veterinary Technician Specialty in Dentistry in June 2006. Mary is currently serving as the treasurer of the AVDT and the American Society of Veterinary Dentistry. She is the past president of the KVTA and a member at large of the NAVTA board. Mary worked in research for over 22 years, specializing in products aimed at improving oral health of companion animals. She was the practice manager and dental technician specialist at Gentle Care Animal Hospital in Lawrence, Kansas for over 7 years and is currently the president of Beyond the Crown Veterinary Education, a veterinary dental consulting service.

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Veterinary Assistant

Controlled Substances Quiz 1. Which controlled substances must be logged? a. Phenobarbital b. Tramdol c. Telzaol d. All of the above

4. Which of the following drugs is considered a class II by the DEA? a. Telazol b. Butorphenol c. Tramadol d. Morphine

7. How often should controlled drug logs be balanced? a. Daily b. Weekly c. Monthly d. Yearly

2. Which agency oversees controlled substances? a. DEA b. FDA c. EPA d. All of the above

5. Which of the following are warning signs that a co-worker may be involved with substance abuse? a. Secrecy b. Moodiness c. Abrupt changes in behavior d. All of the above

8. How often does the DEA require an inventory to be completed on controlled substances housed within the veterinary practice? a. Monthly b. Yearly c. Annually d. Bi-annually

3. What should be done with expired controlled substances? a. Return to manufacture b. Send to a reverse distributor c. Dissolve in kitty litter d. T hrow into a biohazards bin to be incinerated

6. How many days of supply will a pharmacy fill a script for, when a veterinarian requests Tramadol? a. 30 days b. 60 days c. 90 days d. 120 days

9. Which of the following statements is true? a. DEA can inspect the practice unannounced, at anytime b. DEA cannot inspect the practice unannounced, at anytime c. DEA can inspect the practice at anytime, with an appointment d. DEA does not inspect veterinary hospitals 10. What form must be filled out and sent to a distributor, if schedule IV drugs are ordered? a. DEA form 222 b. DEA form 106 c. Both A and B d. No form is required for Schedule IV

This article is worth one continuing education credit and will be accepted for grading until Nov 1, 2017. To receive credit, please complete the quiz online at www.VetMedTeam.com. There will be a $5 fee for each quiz. *Due to updates and changes authorized by NAVTA, the online quiz may not be the same as the printed exam within The NAVTA Journal. Read each question thoroughly and answer it as it appears in the online exam. Please do not simply copy your answers from the printed version.

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The NAVTA Journal | Oct/Nov 2015


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THANK YOU!

The National Association of Veterinary Technicians in America extends their gratitude to HILL’SŽ for their continued support of National Veterinary Technician Week. Publication of the National Association of Veterinary Technicians in America

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Continuing Education

Killingwith Ourselves Compassion Crystal Schaeffer, RVT, BAS

Objective: After reading this article, the participant will be able to identify physical, cognitive, emotional, behavioral and environmental symptoms associated with compassion fatigue.

This program was reviewed and approved by the AAVSB RACE program for 1 hour of continuing education in jurisdictions which recognize AAVSB RACE approval. Please contact the AAVSB RACE program if you have any comments/concerns regarding this program’s validity or relevancy to the veterinary profession.

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The NAVTA Journal | Oct/Nov 2015

Compassion fatigue as an expression, emerged in the literature in the late 1980s.9 The term compassion fatigue is widely used to describe a “phenomenon whereby those working in a helping and caring relationship with others [humans and animals alike] – both professional careers and non-professional careers – may become traumatized as a result of the work they do.”9 Huggard (2014) identified veterinary medical professionals as being in the forefront of those suffering from compassion fatigue and career burn-out. Veterinarians and veterinary technicians who care for animals may face an increased risk for diminished self-efficacy, including burnout, moral distress with subsequent suicidal thoughts and actions, and compassion


Continuing Education

fatigue.13 In addition to burn-out, veterinary technicians can experience “moral distress, or an inability to act in a manner consistent with one’s personal and professional values due to institutional and other external constraints, as well as accompanying compassion fatigue, which is often characterized by a lack of emotional energy needed to care for patients.”9 A study performed by Crampton in 2012 compared two different populations of emergency medical technicians (EMT), in order to identify whether those working in urban areas experienced higher levels of compassion fatigue than those in rural communities. It was discovered that there was no significant difference in the populations, but the population of EMTs do experience mental stress in their profession, which results in subsequent compassion fatigue. The same concern may exist for veterinary technicians practicing within emergency/critical care situations, as well as general practice. This population may experience differing levels of mental distress, predisposing them to the development of professional burn-out with subsequent compassion fatigue. Career burn-out with compassion fatigue has been identified as a leading cause of suicide in veterinarians and veterinary technicians.13 In clinical practice, compassion fatigue has become an increasing concern for practice managers, doctors, clients, patients, and other members of the profession.4, 5, 7 In order to maintain the health of the profession Foote (2014) and Dulmus and Sowers (2012) identified that the veterinary medical profession needs to consider the risk factors that precipitate compassion fatigue amongst veterinary medical professionals and therefore contribute to the significance of compassion fatigue within the discipline. Simmons College (2014) reported that undereducated individuals may represent a high risk population for the development of work-related stress and subsequent CF. The classroom does not offer enough clinical experience. It becomes necessary to prepare veterinary professionals through information strategies, advanced

training techniques, and continuing education opportunities.6 Because of the high suicide rates of veterinarians and veterinary technicians, the researcher sought to add to the body of knowledge by examining the relationship between emergency veterinary technicians and veterinary technicians working in general practice, and the prevalence of compassion fatigue in emergency medicine compared to general practice. The chief purpose of this study was to examine the significance of compassion fatigue experienced amongst veterinary technicians working in an emergency facility and veterinary technicians working in general practice within Noah’s Animal Hospital(s), as well as to determine the level of knowledge associated with identification and coping strategies correlated with compassion fatigue. This knowledge would allow additional resources to be implemented at Noah’s Animal Hospital(s) to increase awareness of the risk factors related to compassion fatigue, in conjunction with the clinical manifestations of this phenomenon. By providing awareness of compassion fatigue within Noah’s Animal Hospital(s), the correlation to the profession may be identified and managed through advanced training, continuing education endeavors, and prevention strategies. The study identified veterinary technicians working in emergency medicine as having increased levels of compassion fatigue (75%), while general practice veterinary technicians showed a lesser degree of compassion fatigue (40%). The conclusions of this study support other studies within the literature regarding the prevalence of compassion fatigue in emergency (human) nurses. Hooper et al. (2010) and Kandolin (1993) identified a significant increase of compassion fatigue in nurses working exclusively within the emergency department(s) compared to nurses working in other departments. The researcher suggests that the risk factors identified within these studies (which include shift work, lack

of familiar support, and a constant, neverending stream of trauma cases) may also be applied to veterinary technicians working in emergency medicine. This study further identified that 75% of veterinary technicians working exclusively (>20 hours/week) in emergency/critical care experienced physiological signs of burnout with subsequent compassion fatigue. Veterinary technicians working exclusively (>20 hours/week) in general practice identified physiological signs of burnout and compassion fatigue far less than their emergency counterparts (30% burn out rate; 40% CF). These findings seem to support a previous study conducted in human medicine, in which Hooper et al. (2010) conducted research regarding compassion fatigue and emergency room nurses and nurses from three other specialty units. Findings of this study suggested a direct correlation of increased levels of compassion fatigue in nurses working in emergency medicine.8 Though emergency veterinary technicians have been identified as having an increased level of compassion fatigue in this study, it is important to note that 40% of veterinary technicians working in general practice were also identified has having experienced compassion fatigue. Foote (2014) points out that veterinary professionals are faced with many aspects of work that are out of their control. There is significant responsibility and risk associated with not having control over patient outcomes and dealing with clients who have emotional attachments to their pets.7 For decades now veterinarians and veterinary technicians have identified many sources of work – related stress. Veterinary technicians accept long work hours, including holidays and weekends. This commitment is often times taken for granted and underappreciated.7 Veterinary medical professionals (veterinarians and veterinary technicians) are expected to be available and “dedicate themselves to both the patients and the clients in what are often demanding and emotionally charged predicaments.”7 Foote (2014) identified key identifiers

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Continuing Education Compassion Fatigue, continued that may contribute to career burn out with subsequent varying levels of compassion fatigue to include: “…solving challenging and complex medical problems; administering anesthesia and performing surgical procedures; conveying important information accurately to clients; providing emotional support and guidance to clients; trying to cultivate client satisfaction; functioning in relationships with other staff [clinicians and veterinary medical support personnel]; performing euthanasia and being exposed to death and grief on a regular basis [particularly economic euthanasias]; and dealing with an unpredictable and often precipitous workload.” Dulmus and Sowers (2012) concede with Foote (2014), that many risk factors for compassion fatigue are present in animal-related professions including: performing/witnessing euthanasia, treating animal cruelty cases; limited financial resources on the part of the organization or owner; volumes of distressed clients and animals; the constant stream of unwanted sick animals; and conflict within the work place. Because animals themselves have varying levels of importance and use in the eyes of people and the law, those professionals who care for animals often find themselves in disagreement with others’ ideas and beliefs about “what is right” regarding care and stewardship of animals.4 Dr. Peter Huggard (2014) coined the concept “disenfranchised grief” as a precursor to veterinary compassion fatigue. The theory of “disenfranchised grief” refers to “…circumstances where, for one reason or another, an individual’s loss, [euthanasia or other], cannot or is not recognized by the person’s social group or wider society.”9 It may not just be experienced by individuals, a community may also suffer a ‘silent and secret’ grief. Veterinary professionals (particularly technicians) form a subgroup or culture within the community. Veterinary subgroups are at an increased risk of experiencing disenfranchised grief thus further

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contributing to the subsequent development of compassion fatigue.9 A predisposition towards stress in the clinical setting can also be attributed to specific personality traits. Veterinary technicians have a tendency towards heightened self-efficacy with a strong dedication to patients and owners. This subsequently leads to a strong work ethic, an increased vigilance in patient care, and an increased desire to achieve professionally within the realm of veterinary medicine.5 Elkins and Kearney (1992) have ironically identified that successful professionals exhibit similar characteristics. This personality subset has been linked with a medical predisposition towards stress-related illness.5 Clinical manifestations of compassion fatigue can be broad with varying degrees of severity and consequently may present slightly different in each individual.7 Foote (2014) summarizes signs of stress that coincide with compassion fatigue: Physical symptoms. Physical manifestations of compassion fatigue may include idiopathic musculoskeletal pains, tachyarrhythmias with subsequent secondary hypertension, general anxiety disorder with an increase predisposition to panic attacks and migraine headaches, and a decrease immune response leading to an overall increase in illnesses.7 Emotional symptoms. Emotional signs may include an acute on chronic depression with an overall decrease in self-efficacy. This emotional state can induce anxiety, worry, and unnecessary fear in the individual.7 Cognitive symptoms. Cognitive manifestations may include obsessive compulsive tendencies, poor memory with transient amnesia episodes that are triggered by an emotional crisis. This physiological state may worsen acute on chronic depressive inclinations and perpetuate anxiety induced attacks.7 Behavioral symptoms. Behavioral symptoms may manifest as passive or explosive

The NAVTA Journal | Oct/Nov 2015

anger and obsessive compulsive tendencies. These behaviors are damaging and may lead to a lowered self-esteem with worsening depression and anxiety.7 Environment symptoms. In the veterinary practice, environmental symptoms of stress may manifest as decreased job satisfaction with subsequent increases in internal and external conflicts with others in the workplace, absenteeism, decreased efficiency through recurring mistakes, and lack of follow-through with business objectives.7 The disregard and negligence of the clinical signs of compassion fatigue may lead to worsening of listed signs including a predisposition to suicide.13 Skipper and Williams (2012) conveys that a high suicide risk has been reported among veterinarians and veterinary personnel in comparison to the general population. Postulated causes of higher suicide risk within the profession [have included] “…depression, substance abuse, work-related stress, reluctance to admit psychiatric problems, and access to lethal drugs [and/or] familiarity with euthanasia.”13 The veterinary profession, particularly clinical medicine, requires adept interpersonal skills. Veterinary technicians must diligently monitor their emotional responses to conflict within the realm of patient care. This task may prove difficult and may trigger stress within the technician.11 McCulloch and Bustad (1983) have estimated that, for each of the “55 million animal visits to veterinarians each year, there were, on average, 1.7 people accompanying the animal, resulting in 100 million human contacts per year by the profession.”11 This number is expected to grow with the advent of veterinary medicine and the increase in human-animal bonds.2 With the increase in visits, so too, will the pressures exerted onto veterinary technicians (from the doctor, clients, as well as skills required for successful medicine). In advertently, escalations of burn-out and subsequent compassion fatigue may continue to rise.4, 7


Continuing Education

It is valuable for the profession to note that career burnout and compassion fatigue can affect both emergency and general practice veterinary technicians. Further research is needed to identify other precipitating causes, particularly in veterinary medicine, as a review of the literature did not find studies specifically associated with compassion fatigue and veterinary technicians. Previous studies on compassion fatigue in the human health care system establishes a need for further research in the animal medicine disciplines, more specifically veterinary technicians. Because research has supported the negative effects of compassion fatigue on human healthcare providers, as well as the lack of research associated with the effects of compassion fatigue on veterinary staff, there is a need for further study to identify the effects of compassion fatigue on veterinary personnel. This study also deduces that mental health education may aid in combatting compassion fatigue in the form of in-class room educational endeavors, in-practice continuing education, outsourced continuing education, and training opportunities. For veterinary technicians, “compassion fatigue is a relational phenomenon stemming from therapeutic connectedness with patients and families in need.”1 Fatigue, stress, sadness, addiction, suicide prevalence, and the associated decrease in morale and work performance, are all influenced by psychosocial factors that have traditionally been ignored in human and veterinary nursing, as noted by the 13% of veterinary technicians employed at Noah’s Animal Hospital(s) who indicated they did not feel comfortable approaching their leadership regarding feelings of burnout or compassion fatigue. These conditions not only impact retention of staff, but also may influence client satisfaction and patient safety. The researcher proposes that by addressing the real but unrecognized phenomenon of compassion fatigue in veterinary nursing within Noah’s Animal Hospital(s), the organization has the potential to influence both the “recruitment and retention”1 of highly effective veterinary technicians.

Ninety-three percent of respondents reported that they were cognizant of the concept or term ‘compassion fatigue’; 7% responded that they were not aware of the term compassion fatigue before this study. Sixty percent of the respondents that were not familiar with the term compassion fatigue, were credentialed veterinary technicians, 20% were certified veterinary assistants, and 20% were on the job trained veterinary assistants. The results of this study suggest further research regarding the effects of educational endeavors and compassion fatigue- based lecture in the classroom. Boyle (2011) concedes that “problems with compassion fatigue often emanate from a lack of basic communication skills. Strategies for talking with and supporting… families under stress, or for dealing with complex family scenarios, are seldom taught in basic nursing or veterinary technician programs.” Veterinary technology curriculum often lacks the basic tenant of emotional health, identified by Boyle (2011), including, but not limited to: • Identifying personal coping strategies • Developing caring communication styles • Establishing boundaries in relationships with families [and their pets] • Understanding family systems theory and identifying family norms • Re-framing ‘difficult’ interactions with individual clients and families • Resolving interpersonal relationship problems in the work setting • Coping with ethical conflict and dilemmas • Utilizing self-care strategies such as meditation and mindfulness “Continuing education programs that augment basic emotional-support competencies in the practice setting, patient rounds, and interdisciplinary team meetings that integrate the humanistic perspective into healthcare are excellent modalities for developing [the above listed] skills.”1 Practice managers, team leaders, and veterinarians that incorporate continuing education into the practice setting have the opportunity to supplement and

satisfy the emotional need of the veterinary technician staff. Encouraging a mental health component, in conjunction to technical/medical competencies at annual CE conferences may benefit the identified target population (ER veterinary technicians and to a lesser degree, but no less important, GP technicians) in identification and coping strategies associated with the development and prolongation of compassion fatigue. Ideologies that might be considered through an organizational perspective include: • CE allowance contingent upon mental health lecture attendance • In-house seminars incorporating healthy mindfulness exercises • Team teaching approaches that integrate self-learning and group presentation over compassion fatigue risk factors and treatment modalities • Reward programs that award team members for open dialogue with hospital leaders

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Continuing Education Compassion Fatigue, continued It is valuable for veterinary leadership to consider the multifaceted value that training endeavors offer. Enabling veterinary technicians to decrease compassion fatigue benefits not only individual technicians but also the practices which these technicians work and will “increase staff morale and productivity, encourage engagement in facility initiatives, reduced sick time, lower turnover rates, and higher patient and family satisfaction.”1 The study suggests an area for improvement for practice leadership to offer formal training covering career burnout and compassion fatigue. The study also recognizes that 90% of leadership had not offered training in this arena. Training endeavors should encompass risk factors, clinical manifestations, resource management, and in some cases mental health counseling. It is important to note that 57% of the target population would find benefit if the organization offered mental health counseling encompassing career burnout and compassion fatigue. In conjunction to training, leadership should also consider continuing education allotment towards healthy living techniques. This could take the form of in-house RACE approved CE or outsourced CE. The profession of veterinary medicine has rightfully identified CE requirements for medical modalities, but is only now catching up to the importance of healthy mindfulness for the caregivers. The researcher suggests a reimbursement program for technicians and veterinarians that offer evidence of mental health CE attendance as a way of rewarding and reinforcing the importance of their staffs’ mental health. There is value in identifying and acknowledging the higher predisposition for compassion fatigue within emergency medicine, as this may provide a starting point for immediate implementation of training and continuing education opportunities. The researcher further suggests that additional research be conducted on a national level and results compared to this study to identify if there is a prevalence of compassion fatigue within

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the profession as a whole, as well as to also identify factors related to compassion fatigue such as: risk factors, clinical modalities, and knowledge of coping strategies. References 1. Boyle, D. (2011). Countering Compassion Fatigue: A Requisite Nursing Agenda. Retrieved from: http://gm6.nursingworld. org/MainMenuCategories/ANAMarketplace/ ANAPeriodicals/OJIN/TableofContents/Vol-162011/No1-Jan-2011/Countering-CompassionFatigue.html 2. Burns, K. (2012). Veterinary visits increase slightly. Retrieved From: https://www.avma.org/ News/JAVMANews/Pages/120515e.aspx 3. Crampton, D. (2012). Comparison of PTSD and Compassion Fatigue Between Urban and Rural Paramedics. Retrieved from: https:// mycourses.spcollege.edu/d2l/common/popup/ popup.d2l?ou=11867&queryString=ou%3D1 1867%26type%3D1%26fk%3D25387%26m i%3D764888%26p%3D1%26un%3D1416 316297044&footerMsg=&popBodySrc=/d2l/ lms/email/frame_item_message_read.d2l&widt h=700&height=450&hasStatusBar=false&has AutoScroll=true&p=d2l_cntl_77a817991a114 5faa5b51f106369ce07_1 4. Dulmus, C. and Sowers, M. (2012). Social Work Fields of Practice (9) pp. 257-262 Hoboken, NJ: John Wiley & Sons 5. Elkins, A. and Kearney, M., (1992). Professional burnout among female veterinarians in the United States: J Am Vet Med Assoc 200 (5) pp. 604-609 6. Field Educator Simmons College (2014). Compassion Fatigue in Social Work Students. Retrieved from: http://fieldeducator.simmons. edu/article/compassion-fatigue-in-social-workstudents 7. Foote, D. (2014). Sustainable Futures for Veterinary Practice-Stress Management. Retrieved from: http://avpma.ava.com.au/ sites/default/files/AVPMA_website/resources/ Foote%20-%20Stress%20Management.pdf 8. Hooper, C., Craig, J., Javerin, D., Wetsel, M., Reimels, E., Anderson, C., (2010). Compassion Satisfaction, Burnout, and Compassion Fatigue Among Emergency Nurses Compared With Nurses in Other Selected Inpatient Specialties. Retrieved from: http://dx.doi.org/10.1016/j. jen.2009.11.027 9. Huggard, P. (2014). Caring for the careers: compassion fatigue and disenfranchised grief pp. 67-70. Retrieved from: http://assets.royalsociety.org.nz/media/Huggard.pdf

The NAVTA Journal | Oct/Nov 2015

10. Kandolin, I. (1993). Burnout of female and male nurses in shiftwork. Retrieved from: http://www.tandfonline.com/doi/ abs/10.1080/00140139308967865#. VRA2KXl0zug 11. McCulloch MJ, Bustad LK (1983). Incidence of euthanasia and euthanasia alternatives in veterinary practice In Katcher AH, Beck, AM, eds.New Perspectives on Our Lives with Companion Animals. Pp 366-369 Philadelphia, PA: University of Pennsylvania 12. Sanchez-Reilly, S., Morrison, L., Carey, E., Bernaki, R, O’Neil, L, Kapo, J., Periyakoil, V., and Thomas, J. (2013). Caring for oneself to care for others: physicians and their self-care J Support Oncology. Retrieved from: http://www. ncbi.nlm.nih.gov/pmc/articles/PMC3974630/ 13. Skipper, G., and Williams, J. (2012). Failure to Acknowledge High Suicide Risk among Veterinarians Journal of Veterinary Medical Education Volume 39, Number 1 14. Stamm, B. (2010). The Concise ProQOL Manual. Retrieved from: http://proqol.org/uploads/ProQOL_Concise_2ndEd_12-2010.pdf

About the Author: Crystal Schaeffer, RVT, BAS has been employed with Noah’s Animal Hospital in Indianapolis, Indiana for 13 years, and has spent the last 11 years strictly in critical care, trauma, and emergency medicine. She is a graduate from Cedar Valley College School of Veterinary Technology (AASVT degree). Crystal graduated with her BASVT degree from St. Petersburg College School of Veterinary Technology with a special interest in critical care/emergency medicine, research, and veterinary management. She is the Technician Director of Emergency Medicine, Assistant Practice Manager of GP, as well as the Director of Technician Development for Noah’s Animal Hospitals. She is the lead instructor and curriculum developer of IUPUI VACP (Indiana University Purdue University of Indianapolis Veterinary Assistant Certification Program). Professional affiliations include: AAHA (American Animal Hospital Association), NAVTA (National Association of Veterinary Technicians in America), and VECCS (Veterinary Emergency and Critical Care Society).


Continuing Education

Compassion Fatigue Quiz 1. Career burn-out with subsequent compassion fatigue has been identified as a leading cause of suicide in veterinarians and veterinary technicians. a. True b. False

6. Sixty percent of the respondents not familiar with the term compassion fatigue were: a. Credentialed veterinary technicians b. Certified veterinary assistants c. On the job trained veterinary assistants d. Veterinarians

2. What percentage of veterinary technicians working in emergency medicine have increased levels of compassion fatigue? a. 100% b. 90% c. 25% d. 75% 3. What percentage of veterinary technicians working in general practice have increased levels of compassion fatigue? a. 10% b. 40% c. 25% d. 15% 4. All of the following options may contribute to the development and prolongation of compassion fatigue in human ER nurses, except? a. Trauma cases b. Lack of familiar support c. Uncomfortable shoes d. Shift work

7. Veterinary technology programs often lack what major tenant that may predispose a technician to career burn out and compassion fatigue? a. Physical Health b. Emotional Health c. Spirituality d. None of the above 8. Practice managers, team leaders, and veterinarians that incorporate continuing education into the practice setting have the opportunity to supplement and satisfy the emotional need of the veterinary staff. a. True b. False

9. Advanced training endeavors encompassing risk factors, clinical modalities, and knowledge of coping strategies associated with compassion fatigue may benefit the practice by: a. Increasing staff morale and productivity b. Reducing sick time c. Decreasing staff turnover d. All of the above 10. Veterinary technicians that are aware of the existence of compassion fatigue, its risk factors, clinical signs, and coping strategies, provide higher patient and_______________. a. Family satisfaction b. Doctor satisfaction c. Fellow technician satisfaction d. None of the above

5. Which of the following may contribute to the development and prolongation of compassion fatigue in veterinary technicians? a. Economic euthanasia b. Unpredictable work load c. Cultivating client satisfaction d. All of the above

This article is worth one continuing education credit and will be accepted for grading until Nov 1, 2017. To receive credit, please complete the quiz online at www.VetMedTeam.com. There will be a $5 fee for each quiz.

*Due to updates and changes authorized by NAVTA, the online quiz may not be the same as the printed exam within The NAVTA Journal. Read each question thoroughly and answer it as it appears in the online exam. Please do not simply copy your answers from the printed version.

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Continuing Education

Dermatology 101:

Increasing Efficiency and Enhancing Patient Diagnostics

Missy Streicher, AAS, CVT, VTS (Dermatology)

Objective: After reading this article, participants will be able to obtain an accurate history, enhance current dermatology sampling techniques, and aid the veterinarian in diagnostics.

Prepping for Patient Dermatology Visits

This program was reviewed and approved by the AAVSB RACE program for 1 hour of continuing education in jurisdictions which recognize AAVSB RACE approval. Please contact the AAVSB RACE program if you have any comments/concerns regarding this program’s validity or relevancy to the veterinary profession.

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Glancing at the day’s schedule, Betsy the bulldog needs her ears checked and Sunny the golden retriever has a “hot spot”—again. In most practices, at least one patient will present daily with a skin issue.

When triaging patients, a technician is usually responsible for taking a TPR (temperature, pulse, respiration) while simultaneously obtaining a history from the owner based on the presenting complaint. The ability to take

The NAVTA Journal | Oct/Nov 2015


Continuing Education

a good history is helpful to the veterinarian because the information generates differential diagnoses before examining the patient. With dermatologic issues being so prevalent, taking an excellent dermatologic history is very important. Based on the history and physical exam, routine diagnostics should be recommended and performed. This provides excellent patient care, yields a definitive diagnosis of the type of secondary infection, creates a more defined list of the underlying cause, is good medicine, and is financially beneficial to the hospital by generating income from in house diagnostics. The hospital most likely has everything needed to complete these diagnostics. With practice, these can be done quickly by the technician enabling the veterinarian to spend more time discussing underlying cause(s) and therapeutic options with the owner. The laboratory items needed for an initial diagnosis are: microscope, glass microscope slides, cover slips, mineral oil, cotton-tipped applicators, scalpel blades (#10), Dif Quik or Wright’s stain, and Gram stain. These items will be used to collect what represents the minimal diagnostic database for dermatology that include skin scrapings, dermatophyte culture and skin cytology.

Allergies There are multiple types of allergies including atopy, food allergy, flea allergy, contact allergy and drug allergy. Atopy means “strange disease” and relates to allergies to environmental pollens, such as, grasses, trees, weeds, molds as well as house dust mites. Pruritus (itch) in dogs is a common sign of allergies and veterinary dermatologists frequently manage atopic patients as environmental allergies are not considered curable, but merely controllable. The act of scratching is commonly thought of as the rear foot contacting the body. However, licking, chewing, shaking head (ears), rubbing on furniture, and dragging the belly across carpet or rough surfaces are also signs of pruritus. Allergic dogs commonly have secondary infections which can also increase the pruritus level. The distribution pattern of pruritus along

with the history provides clues as to what type of allergy may be present. Combinations of allergic diseases are common, such as, atopy and flea allergy; atopy and food allergy; or the co-existence of all three problems with or without secondary complicating infections. When dogs first show signs of having an allergy, regardless of type, erythema (redness of the skin) is commonly noted when examining the pruritic areas. As the dog ages, their allergy symptoms become more severe and in the case of atopy, may start seasonally then become non-seasonal. Additionally, the dog usually suffers from more intense pruritus as a consequence of increasing the summation of allergens thus exceeding the pruritic threshold. Commonly, secondary infections enhance inflammation as another source increasing pruritus in addition to the allergy.

Secondary Dermatological Conditions To assess a potential secondary skin issue, look for signs of folliculitis (inflammation of the hair follicle). Examples of lesions associated with folliculitis are macules, papules, pustules, epidermal collarettes, crusts, excoriations, and alopecia. The three differentials of folliculitis are bacterial dermatitis, demodicosis and dermatophytosis. Malassezia pachydermatis (yeast) is often found in allergic patients, but does not have to be associated with a lesion. Ears, paws and face (particularly the lower lip margin) are areas often affected with Malassezia but can be found anywhere on the patient. A suspicion of secondary infection for a patient should be investigated if a dog previously responsive to steroid administration for the control of pruritus is now partially or non-responsive to steroid therapy. Referral to a veterinary dermatologist for long-term maintenance therapy may be warranted to manage the pet’s allergies to minimize severity and frequency of the allergic flare-ups and in turn controlling the infections.

Collecting Samples For folliculitis lesions, samples for the minimal dermatology data base are typically collected

“clean” to “dirty” starting with plucking of hairs for dermatophyte culture, next collect skin cytologies and lastly the skin scrapings. Skin scrapings are generally collected from the same affected areas as the dermatophyte culture and cytology samples. These scrapings leave a residue of blood and mineral oil after collection, which may make the other samples not as informative if collected after the scraping.

Obtaining a Culture for Dermatophytosis Ideally, a sample is collected for the presence of a dermatophyte (ringworm) when folliculitis and easily epilating hair are noted on a patient. Cost may be a limiting factor for this diagnostic test with bacteria being the most likely culprit of folliculitis. This diagnostic test may be postponed until a future visit; particularly if bacteria or yeast is found on skin cytology. If tasked with collecting a sample for a culture, pluck the hairs, crust and scale from the periphery or leading margin of a lesion as Dermatophytosis begins with a central lesion and migrates outward. The dermatophyte may resolve in the area it began, or at the center of the lesion, and a false negative may result if not collected from the appropriate area. The McKenzie toothbrush technique is recommended when trying to identify an asymptomatic carrier or rechecking a patient that antifungal treatment has been instituted to assess response to therapy.2 This is accomplished by using a sterile toothbrush and combing the animal nose to tail to collect hair and scale. If areas of folliculitis are noted, the lesional area should be sampled last to prevent the spread of potential contaminants to other parts of the body. If dermatophyte cultures are performed in the clinic, use sterile scissors to cut the tips of the toothbrush and gently apply to the dermatophyte media. If color change to dermatophyte media is noted, apply acetate tape to the colony and with the aid of lactophenol cotton blue stain to identify the type of dermatophyte present with the aid of mycology identification guides.1 Contaminant organisms may attribute for media color change making proper identification with a mi-

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Continuing Education Dermatology 101, continued

Allergy Type

Breed Predilection

Age

Distribution Pattern

Atopy

Terrier breeds Brachiocephalic breeds

6 months to 6 years With first symptoms noted between 1-3 years in approx‌

Paws/Legs Face Ears Axillae Inguinal

Less than 1 year Old age Can occur at any age

Same as atopic +/Perianal region

(allergies to grasses, Trees, weed, molds, dust Mites)

Retrievers (Golden and Labrador) German Shepherd Dogs Hounds (Basset, Beagle) Any Breed (purebred or mixed)

Food Allergy

Labradors Spaniels (Cocker, Springer) German Shepherd Dogs Any Breed (purebred or mixed)

Flea Allergy

Contact Allergy

Figure 1.

Any Breed

Any age; repeated and prolonged contact with offending allergen or chemical. Most rare

Dorso-lumbar region Tail head Caudal/medial thighs Inguinal Paws (interdigital spaces) Axillae Scrotum Inguinal region/belly Chin/muzzle

Common Signalment and Distribution Patterns

croscope necessary. Alternatively, the sample may be submitted to an outside lab at the onset of sample collection or after color change is noted on the media for identification of the dermatophyte organism. The type of dermatophyte present will help reveal the source so the cause can be controlled or eliminated as there is potential zoonosis. Microsporum gypseum is found in the soil, Microsporum canis is attributed to cats, and Trichophyton mentagrophytes is found in rodents.1

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GI issues (multiple bowel movements per day, loose stool, gaseous) Any age but may note seasonal exacerbations with increase of flea population noted

Short coated dogs Thinly haired regions

Pruritus of mouth after eating

Direct Impression Smear There are two techniques to collect skin cytology samples. First is a direct impression smear.2 (Figure 2) This is accomplished by pressing the slide against the skin. Although simple, there are a few ways to get a better diagnostic sample by altering technique. Hold the glass microscope slide in the middle to decrease the torque applied to the slide when pressing against the skin. This technique will decrease the likelihood for breaking the

The NAVTA Journal | Oct/Nov 2015

slide, which may result in cutting the patient or the person collecting the sample. Pinch up the area of skin that will be sampled and place the slide on the pinched up area with the contact area being toward the end of the slide. Make contact with the sample area by applying steady pressure and then swirling or dragging the slide across the region. If there is crust or scale present, a need to find out what is causing the lesion is maximally ideal. Using a side of the slide, gently lift the side of


Continuing Education

Figure 2.

Figure 3.

Direct impression smear—note that area of interest is held by pinching and the slide is held in the middle

Application of acetate Slide with new tape to interdigital space methylene blue stain prior to application of clear acetate tape

the crust (removing the entire crust may be painful to the patient) or scraping some of the scale away is beneficial for sample collection. Pustules easily rupture by using the same sampling technique as above. If the pustule does not rupture, consider using the corner of the slide to flick the top of the pustule allowing a disruption of its integrity and repeat the same sampling technique. Using a needle to rupture the pustule may cause unnecessary pain to the patient and possibly causing the skin to bleed obscuring the sample evaluation. Do not heat fix skin cytology samples as over heat fixing may cause artifact of how cells appear. Direct impression smears can be used for most skin cytology samples, but are particularly useful for exudative areas. Once the slide has air-dried, use Dif Quik stain (Wright’s stain) according to manufacturer’s recommendations. Using bibulous paper to blot the sample may give a false interpretation of results because of potential removal of sample onto the paper.

Tape Method The second technique for collecting skin cytology samples is by using clear acetate tape. The tape must be clear—if one cannot see though the tape, it will not be possible to assess the information from the tape preparation accurately with the microscope. Hold the tape by sticking the end on the middle or index finger. Stick the adhesive side to

Figure 4.

Figure 5.

Figure 6.

Acetate tape preparation after paper towel has been pressed to slide to eliminate excess stain. This slide is ready for immediate viewing with a microscope.

Skin cytology sample after staining with Dif Quik. The blue box indicates Malassezia pachydermatis; the yellow box a pair of cocci bacteria

the patient’s skin and apply pressure to area with the thumb of the hand that is holding the tape. Remove tape and then reapply to same or adjacent areas several times to increase chances of finding secondary infectious organisms. When collecting a sample from the paw, apply the tape to the interdigital spaces on both the dorsal surfaces and then the interdigital palmar/plantar surfaces with the same piece of acetate tape. (Figure 3) With tape preparation samples, there are two choices for staining to observe organisms. The simplest method is to draw into a syringe the stain from #3 of the Dif Quik and apply a small amount onto a microscope slide as demonstrated in Figure 4. After the skin cytology is collected, place the adhesive side onto the stain/slide. Using a paper towel, fold over the slide and gently press tape onto the slide. This helps the tape adhere to the slide while simultaneously squeezing out excess stain to improve ease of viewing on the microscope. (Figure 5) A second way is to dip the tape into stains #2 and #3 of Dif Quik by holding the tape with hemostats or a clothespin with tape to the end of the slide. Do not dip into the alcohol (#1) of the Dif Quik as this may remove the adhesive and the sample. The disadvantage to this technique is losing the tape sample in the stain container, but it can be eventually recovered. Once appropriately stained, place the tape on a slide, use the paper towel as previously described to apply

to a microscope slide. The advantage of the acetate tape preparation of cytology samples is that they are ready to read and do not require waiting for them to air dry. The downside of this collection method is it picks up hair, debris and creates many planes to focus and re-focus through on examination of the slide. Remember that a sample of the person’s skin that was collecting the sample is on the end of the tape in the form of fingerprints; so be mindful to read the sample in the middle of tape prep to insure that it is the patient that is being assessed and not the taker of the sample. Scanning the slide using the 10X objective allows appraisal of more likely areas to note organisms if neutrophils and proteinaceous debris are noted before proceeding to oil immersion (100X objective). Once an area has been selected, immersion oil will need to be applied to that point of the slide. If evaluating a tape preparation, immersion oil is applied directly on the tape. The microscope condenser should be moved all the way up or open to evaluate for Malassezia and bacteria (Figure 6). As long as an appropriate scan for suspect areas is performed followed by examination on 100X, viewing 15-25 HPF (high power fields) should be adequate to label the sample as NAF (no abnormal findings) or on a 0-4+ rating for pathological items that are present. To work in sync with the veterinarian, consider examining the same cytology samples with the clinician(s) several times

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Continuing Education Dermatology 101, continued a year to compare what would constitute a score of 0-4+ to standardize reference levels.

Ear Cytology Allergic otitis with the complication of secondary infection is common with atopic and food allergic animals which may be the only issue with that patient. Recurrent allergic otitis can be a source of discomfort for the patient and should be considered while collecting samples for ear cytology. Using a cottontipped applicator swab, collect material from both ears (even if only one ear is cited by the owner as being affected in the presenting complaint). Use a separate swab for each ear. To obtain the sample, gently swab a cottontipped applicator in each ear canal being careful not to lose sight of the tip of the applicator. Even though the otitis may be unilateral and the contralateral cytology sample does not reveal any infection, providing baseline documentation of both ears is important to maintain an accurate medical record and may demonstrate a developing problem which has not reached the magnitude of the contralateral ear. Additionally, a different type of infection than what was found in the affected ear may

be present so treating both ears the same without appropriate documentation based on cytology may be contraindicated. After collecting each ear swab, roll samples on to a glass microscope slide appropriately labeling each as left or right. Making two identical slides with material from each ear is recommended because if rod-shaped bacteria are noted, a second slide is prepared for the necessary Gram stain without having to cause potentially more discomfort to the patient by having to re-swab to take a second sample. Due to the usually waxy nature of the ear swab material, lightly heat fixing the slide by waving a flame source under slide without creating carbon residue or char is recommended as this melts the wax and allows the stain to penetrate the exudate better. This is usually accomplished by using a lighter or a Bunsen burner. After heat fixing, stain one of the ear slides using Dif Quik as done with the direct impression smear. Once the sample has air-dried, examine the slide on 10X followed by oil immersion (100X) as described in the reading of skin cytologies above to evaluate for presence of infection, such as, bacteria (rod or cocci) or yeast using the 0 to 4+ scale. If rod-shaped

Figure 7. Adult Demodex canis

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The NAVTA Journal | Oct/Nov 2015

bacteria are noted, the second slide that was previously made should now be heat fixed and Gram stained to identify if the rods are Gram positive or negative assisting the veterinarian in therapeutic options.

Skin Scrapes In addition to a patient noted to have any of the previously mentioned types of folliculitis lesions, dogs that also have comedones (blackheads), a history of steroid exposure (iatrogenic or with spontaneous hyperadrenocorticism), and dogs with short-hair coats seem to be more predisposed are suspect for Demodex mites, therefore; deep skin scrapes should be performed.1 First, place a heavy drop of mineral oil on a glass microscope slide. A new number 10 scalpel blade should be used for each patient because of potential for transfer of blood borne pathogens or diseases. Consider dulling the blade edge by running the edge across a metal surface like the edge of a stainless table. By dipping the blade in the mineral oil prior to scraping, the oil acts as a lubricant and a magnet of sorts to pick up the material of the scraping. Pinch the area of skin that is selected for the scraping because if Demodex are present, they are in the follicle and this will help bring the mites to the skin surface. After pinching, release the skin and use the non-dominant hand to spread the skin taut. Continuing to pinch the skin may act as a tourniquet allowing more scraping than necessary to see blood. This method will potentially cause more discomfort to the patient and put fingers in closer proximity to the scalpel increasing chances of a blade to finger mishap. Hold the blade perpendicular to the skin or slightly away from you. Scrape using steady light pressure in direction of hair growth ideally towards you in a small area to minimize discomfort for the patient and skin damage post sample collection. Continue to scrape until a small


Continuing Education

amount of blood is noted on the blade. Skin may bruise and appear to bleed, but stopping before blood is observed on the blade may result in a false negative scrape. Once blood is noted, give the area another pinch to create more capillary ooze and the use the scalpel blade to collect one last scrape in a sweeping or scooping motion to get as much oil, blood and skin debris as possible for the sample. Pick the microscope slide with oil on it up and swirl the material into the oil - rubbing the edge on the side of the slide to remove as much material from the blade. Placing a cover slip on top of the sample is advisable to enhance recognition of the borders and ensure that the entire area has been investigated. Although Demodex mites can be visualized on 4X, 10X is preferred as the mites, particularly the eggs, are more obvious and not as easily missed. The condenser should be lowered (as done with fecal samples) to allow for increased contrast. This is particularly helpful as the mites die and the skeleton/dead mites no longer are as refractive and bright light may obscure visualization. Dead mites are still considered positive scrapes when reassessing success of therapy with a demodicide. If folliculitis lesions are present in areas that may be difficult to scrape or are risky (because of proximity to the eye for example), hair may be plucked in the direction of hair growth and then placed in mineral oil. This technique may not yield as many mites as an actual deep skin scrape, but is still informative. If Demodex mites are present, note the quantity and life stage per slide obtained and also record location of the specimen acquisition. Noting the life stages (egg, larvae, nymph, adult) is important because when a dog is treated for demodicosis, it is an adulticide over several months. If juvenile stages are noted after previously only adults are present, then finding out why that occurs is important. Examples would be if the owner is giving medication as directed, or a young dog may grow out of his therapeutic dose, or other cause such as systemic disease. (Figure 7)

If Sarcoptic mange (scabies) is suspected, superficial skin scrapes are indicated. This endeavor is messy. Apply a generous amount of mineral oil to the suspect areas on the dog (margin of ear pinnae, hocks, elbows and lowest part of the ventrum) as these mites can move fast and the oil application can slow them down. Using a scalpel blade, remove the mineral oil that was placed on the skin by using long, broad strokes in the direction of hair growth and apply to a glass microscope slide. If crusts are present, scrape down to the “normal skin� which will not be normal due to inflammation and may bleed because of the crust removal even though causing the skin to bleed is not the objective of superficial skin scraping. Placing a cover slip on the sample, examine by scanning using the 10X objective with the condenser lowered as with the deep skin scrapes. Several slides may be required as Sarcoptes are notoriously difficult to find, but one Sarcoptes mite is considered diagnostic. Often, scabies is treated on index of suspicion (scabies incognito), but identifying them is gratifying and fulfills the diagnosis.

About the Author: Missy Streicher, AAS, CVT, VTS (Dermatology) Missy has been a Certified Veterinary Technician since 1993 and worked in a small animal hospital until 2000, when she began working for a private dermatology practice. In 2006, Missy moved to the Auburn University Small Animal Teaching Hospital and continued specializing in Dermatology. She sat on the organizing committee for the Academy of Dermatology Veterinary Technicians, which was accepted as a VTS by NAVTA in July of 2015.

In conclusion, technicians can collect and evaluate samples needed for the minimal database recommended for patients with dermatologic issues efficiently and effectively with practice. With skin and ear issues being seen routinely on receiving days, a technician may play a great role by evaluating the diagnostics performed thereby providing the veterinarian with a definitive diagnosis of infection type. Identifying the presence of mites allows for a more informed differential diagnosis for the underlying cause and potentially generates additional income for the hospital. References 1. Miller WH, Griffin CE, Campbell KL. Small Animal Dermatology, 7th ed. St. Louis, MO. Elsevier. Muller & Kirk. 2013 2. Hnilica, KA. Small Animal Dermatology A Color Atlas and Therapeutic Guide, 3rd ed. St. Louis, MO. Elsevier. 2011

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Continuing Education

Dermatology 101 Quiz 1. The three differentials for folliculitis are: a. Malassezia, bacteria, Demodex b. Demodex, dermatophyte, bacteria c. bacteria, pruritus, dermatitis d. Malassezia, bacteria, dermatitis

4. The affected areas in a patient exhibiting either food allergy or atopy are: a. lumbo-sacral region, ears, paws b. paws, ears, axillae c. face, lumbo-sacral region, caudal thighs d. elbows, hocks, pinnae

2. When evaluating a sample for Demodex mites, the condenser should be: a. down b. up c. m ites can be seen regardless of condenser location d. half-way between up and down

5. Atopic patients: a. Are rarely seen in most clinics b. are easily cured c. do not require long term therapy d. commonly have secondary infections

3. Cytology samples should be read to evaluate for Malassezia and bacteria using which objective lens(es): a. 10X, then 40X b. 10X only c. 10X, then 100X d. 40X, then 100X

6. To diagnosis infection and assess response to therapy a. Cytology samples are necessary (initial and recheck) b. The presence of Malassezia and bacteria can be diagnosed based on odor and appearance c. Is considered cured as long as the owner completes the prescribed treatment d. Initial cytology is only required

7. The type of allergy that should be suspected in dog less than six months of age: a. Flea Allergy b. Contact Allergy c. Food Allergy d. Atopy 8. Dermatophyte cultures should: a. Be checked daily during incubation b. Only be sent to outside laboratories c. Is the only diagnostic needed if skin scrapings are negative d. Should be collected in the center of a lesion since it begins centrally and spreads outward 9. Heat fixing a glass microscope slide is: a. not necessary b. may create artifact when interpreting cells present c. helpful when staining waxy material d. both b and c 10. To assess for the three differentials of folliculitis, the following diagnostics are needed a. skin scrape, acetate tape preparation, impression smear b. skin scrape, acetate tape preparation, dermatophyte culture c. dermatophyte culture, ear cytology, impression smear d. dermatophyte culture, ear cytology, skin scrape

This article is worth one continuing education credit and will be accepted for grading until Nov 1, 2017. To receive credit, please complete the quiz online at www.VetMedTeam.com. There will be a $5 fee for each quiz. *Due to updates and changes authorized by NAVTA, the online quiz may not be the same as the printed exam within The NAVTA Journal. Read each question thoroughly and answer it as it appears in the online exam. Please do not simply copy your answers from the printed version.

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The NAVTA Journal | Oct/Nov 2015


Continuing Education

Updates on

Pain Awareness & Management Across the Species

Mary Ellen Goldberg BS, LVT, CVT, SRA, CCRA Stephen Cital RVT, SRA, RLAT

This program was reviewed and approved by the AAVSB RACE program for 1 hour of continuing education in jurisdictions which recognize AAVSB RACE approval. Please contact the AAVSB RACE program if you have any comments/concerns regarding this program’s validity or relevancy to the veterinary profession.

Part 1

Objective: After reading this article, participants will be able to define and differentiate acute, chronic and neuropathic pain, and describe the benefits of multimodal pain management.

Pain has been called the “fourth vital sign” after body temperature, heart rate, and respiratory rate, and its potential presence should be evaluated in patients just as the other vital signs are.

The majority of this article was originally published in the NAVTA Journal Winter 2010 issue. So much exciting information about analgesia has been published since 2010 that we felt the need to update this article for references, dosages and adjunctive therapies. In part one of this article, we will discuss the fact that pain management needs to be applied to all creatures. While this article will briefly touch on certain topics involved in analgesia, it is not meant as an in-depth piece. Careful study of specifics for each species must be taken into account before proceeding with any analgesic therapy.

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.1 Pain motivates us to withdraw from potentially damaging situations, protect a damaged body part while it heals, and avoid those situations in the future.2 It is initiated by stimulation of nociceptors in the peripheral nervous system, or by damage to or malfunction of the peripheral or central nervous systems.3 Most pain resolves promptly once the painful stimulus is removed and the body has healed. However in certain circumstances pain persists despite removal of the stimu-

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Continuing Education Pain Management, continued lus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or pathology.4 For the purpose of this article we will describe pain as acute, chronic or neuropathic (maladaptive). Acute pain is a normal physiologic and usually time-limited response to an adverse (noxious) chemical, thermal or mechanical stimulus, associated with surgery, trauma, and acute illness and historically responsive to opioid therapy.5 Chronic pain is defined by the IASP (International Association for the Study of Pain) as “pain without apparent biological value that has persisted beyond the normal tissue healing time usually taken to be 3 months.”6 The classic example of chronic pain is osteoarthritis. Neuropathic pain is a type of pain, which is caused by tissue damage, or a single disease process isolated to a specific location without explanation for the dysfunction of the nervous system.7 Examples of neuropathic pain are phantom limb pain (e.g., onychectomy complications), complex regional pain syndrome, prolonged intervertebral disc disease, cancer, and chronic ear pain. Pain scoring first started with laboratory animals. In 1985 a behavioral paper was published by Morton and Griffiths looking into a metric to better define pain and create welfare standards for animals.8 Pain rating scales should include at least three requirements9:

VAS – a line with no markings is used, numbers are at each end 0 being no pain and 100 being worst. NRS – a number line with individual numerical markings (1-10) which are chosen as the score. SDS – numbers used to assign to descriptions that categorize different levels of pain intensity. Assessment of pain or distress may be based on many different criteria including: • Decreased activity • Abnormal postures, hunched back, muscle flaccidity or rigidity • Poor grooming • Decreased food or water consumption • Decreased fecal or urine output • Weight loss (generally 20-25% of baseline), failure to grow, or loss of body condition (cachexia) • Dehydration • Decrease or increase in body temperature • Decrease or increase in pulse or respiratory rate • Physical response to touch (withdrawal, lameness, abnormal aggression, vocalizing, abdominal splinting, increase in pulse or respiration) • Teeth grinding (seen in rabbits and farm animals) • Self-aggression • Inflammation

1. Minimal interobserver variability and observer bias.

• Photophobia

2. Ability to distinguish varying levels of pain intensity in a particular species and situation

• Objective criteria of organ failure demonstrated by hematological or blood chemistry values, imaging, biopsy, or gross dysfunction

3. Ability to detect the degree of “importance” of pain to the subject. Pain Scales can be visual analog scales (VAS); numerical rating scales (NRS) and simple descriptive scales (SDS).

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• Vomiting or diarrhea

When determining which analgesics should be used several factors need to be considered10: • What is the likely severity of pain, and what is its anticipated duration?

The NAVTA Journal | Oct/Nov 2015

• Which drug or drugs should be administered, and at what dose rates? • Are there any special factors that will influence the choice of analgesic, for example, the species of animal, any potential interactions with the particular research project, or any particular features of the current condition and the type of pain? • What facilities are available for management of the animal? What level of nursing care and monitoring of the animal is available? Can staff attend throughout a 24 hour period? Are there facilities for continuous infusion of analgesics?

Mechanism-Specific Definitions11 Clifford Woolf has proposed a clinically useful method of classifying pain that is based on the underlying physiology and pathophysiology of the specific type of pain: Nociceptive pain: transient pain in response to a noxious stimulus. Inflammatory pain: spontaneous pain and hypersensitivity to pain in response to tissue damage and inflammation. Neuropathic pain: spontaneous pain and hypersensitivity to pain in association with damage to or a lesion in the nervous system. Functional pain: hypersensitivity to pain resulting from abnormal processing of normal input. The mechanism-specific definitions of pain highlight the fact that the sensation of pain can represent normal protective mechanisms (nociceptive, inflammatory) to abnormal sensory processing (neuropathic, functional) in which pain itself becomes a disease. In veterinary medicine, inflammatory pain is routinely observed acutely (surgery, trauma) and chronically (osteoarthritis, cancer). Severe acute and chronic pains have components of neuropathic pain. The role of functional (central) pain in veterinary patients is less clear. Dr. Woolf further classified pain as Adaptive pain, which is defined as an appropriate hy-


Continuing Education

SPECIES-SPECIFIC BEHAVIORAL SIGNS OF PAIN : This chart is meant to display some of the different signs species may exhibit if in pain. Individuals may not show any of these signs or they show signs not listed. This is meant as a general guide.

Species

Vocalizing

Posture

Locomotion

Temperament

Dog

Whimpers, howls, growls

Cowers, Crouches; Recumbent

Reluctant to move; awkward, shuffles

Varies from chronic to acute; can be subdued or vicious; quiet or restless

Cat

Generally silent; may growl or hiss

Stiff, hunched in sternal recumbency; limbs tucked under body

Reluctant to move limb, carry limb

Reclusive

Primate

Screams, grunts, moans

Head forward, arms across body; huddled crouching

Favors area in pain

Docile to aggressive

Mice, Rats, Hamsters

Squeaks, squeals

Dormouse posture; rounded back; head tilted; back rigid

Ataxia; running in circles

Docile or aggressive depending on severity of pain, eats neonates

Rabbits

Piercing squeal on acute pain

Hunched; faces back of cage

Inactive; drags hind legs

Apprehensive, dull, sometimes aggressive depending on severity of pain; eats neonates

Guinea Pig

Urgent repetitive squeals

Hunched

Drags hind legs

Docile, quiet, terrified, agitated

Horses

Grunting, nicker

Rigid; head lowered

Reluctant to move; walk in circles “up & down� movement

Restless, depressed

Chickens

Gasping

Stand on one foot, hunched huddled

None

Lethargic, allows handling

Cows, Calves, Goats

Grunting; grinding teeth

Rigid; head lowered; back humped

Limp; reluctant to move the painful area

Dull, depressed; act violent when handled

Sheep

Grunting; teeth grinding

Rigid; head down

Limp; reluctant to move the painful area

Disinterested in surroundings; dull, depressed

Pigs

From excessive squealing to no sound at all

All four feet close together under body

Unwilling to move; unable to stand

From passive to aggressive depending on severity of pain

Birds

Chirping

Huddled, hunched

From excessive movement to tonic immobility depending on severity of pain

Inactive; drooping, miserable appearance

Fish

None

Clamped fins; pale color; hiding; anorexia

None unless forced; if a schooling fish; will separate itself from others

First sign to occur is anorexia; lethargic; stressed easily

Amphibians

None

Closed eyes; color changes; rapid respirations

Immobility; lameness

Anorexia; aggressive;

Reptiles

Hiss; grunting

Hunched; hiding; color change

immobility unless forced Anorexia; aggressive; lethargic; avoidance

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Continuing Education Pain Management, continued persensitive response to a potentially damaging stimulus that is responsive to medication or Maladaptive pain (commonly referred to as wind-up pain), defined as spontaneous hypersensitivity resulting from abnormal processing of a stimulus by the central nervous system (CNS), does not respond to treatment.12

Multimodal Analgesia Multimodal analgesia uses more than one method of pain management to cover the differing sensory and mechanisms of pain modulation. Multiple methods can actually reduce the amount of medications necessary to relieve pain, and can minimize uncomfortable side-effects. Benefits include13 1. More effective analgesia 2. Possible reduction of doses of one or more individual drugs 3. Fewer incidences of “breakthrough pain” Using combinations of different classes of analgesics may override some of the problems that can occur from differences in the speed of onset of action or duration of analgesia from various agents. Medications like opioids, NSAIDS, local anesthetics, alpha-2-agonists, ketamine, tramadol, gabapentin, amantadine and amitriptyline have shown synergistic effects when used in combinations. The following table is to be used as guidelines.

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It is always best to begin a medication at the lowest dose possible unless you have proven knowledge of how a certain species will react.

7. Bogduk, Nikolai; Merskey, Harold (1994). Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms (2nd ed.). Seattle: IASP Press. pp. 212.

References

8. Morton, D. B. and Griffiths, P. H. M. (1985) Guidelines on the recognition of pain, distress and discomfort in experimental animals and an hypothesis for assessment. Veterinary Record 116: 431-436.

1. International Association for the Study of Pain Retrieved 6 October 2009. This often quoted definition was first formulated by an IASP Subcommittee on Taxonomy Bonica, JJ (1979). “The need of a taxonomy”. Pain 6 (3): 247–252. 2. Lynn, B (1984) “Cutaneous nociceptors” in Holden, AV & Winlow, W The neurobiology of pain. Manchester, UK: Manchester University Press. p. 106. 3. Woolf, CJ & Mannion, RJ (1999) “Neuropathic pain: aetiology, symptoms, mechanisms and management”. The Lancet 353 (9168): 1959–1064. 4. Raj, PP (2007) “Taxonomy and classification of pain” in Kreitler, S; Beltrutti, D; Lamberto, A et al. The handbook of chronic pain. New York: Nova Science Publishers Inc. 5. McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc. 6. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 1986; 3:S1-S226.

The NAVTA Journal | Oct/Nov 2015

9. Karas, AZ; Danneman, PJ; Cadillac JM (2008) “Strategies for Assessing and Minimizing Pain” in Anesthesia and Analgesia in Laboratory Animals (2nd Ed). London: Elsevier Inc. p211. 10. Flecknell, P (1999) “Pain-assessment, alleviation and avoidance in laboratory animals” ANZCCART News 12 (4) December pp 1-10 pg 4. 11. Woolf CJ. Pain: Moving from symptom control toward mechanism-specific pharmacologic management. Annals of Internal Medicine 140:441-451, 2004. 12. Woolf CJ. Pain: Moving from symptom control toward mechanism-specific pharmacologic management. Annals of Internal Medicine 140:441-451, 2004. 13. Karas, AZ; Danneman, PJ; Cadillac JM (2008) “Strategies for Assessing and Minimizing Pain” in Anesthesia and Analgesia in Laboratory Animals (2nd Ed). London: Elsevier Inc. p205


Continuing Education

Table 1. Multimodal Analgesic Drugs for Dogs and Cats Drug

Dose

Species

Route

Dose Interval

Morphine

0.5-1.0 mg/kg

K-9

IM, SC, IV

q3-4 hr

0.05-0.1 mg/kg

Feline

IM, SC

q3-4 hr

0.2 mg/kg loading, IM

Comments Caution with IV administration: histamine release-give slowly

IM then continuous rate infusion

0.1-0.5 mg/kg/hr

K-9

CRI

0.05-0.1 mg/kg/hr

Feline

CRI

0.1 mg/kg preservative free

K-9/Feline

Epidural

1-5 mg in 5-10 ml saline

K-9

Intra-articular

Meperidine

3-5 mg/kg

K-9/Feline

IM, SC

q1-2 hr

DO NOT GIVE IV (Histamine release)

Methadone

0.1-0.5 mg/kg

K-9/Feline

IM, SC, IV

q2-4 hr

NMDA antagonist activity

Oxymorphone

0.05-0.2 mg/kg

K-9

IM, IV, SC

q3-4 hr

Minimal histamine release

0.03-0.05 mg/kg

Feline

IM, SC

q3-4 hr

Hydromorphone

0.1-0.2 mg/kg

K-9/Feline

IM, IV, SC

q2-4 hr

Fentanyl

5μg/kg +

K-9

IV

Infusion

Feline

IV

Infusion

q12-24 hr

Minimal histamine release. Hyperthermia may occur in cats

3-6 μg/kg/hr 2-3 μg/kg + 2-3 μg/kg/hr Fentanyl Patch 25 μg/hr

K-9: 3-10 kg

q1-3 days

50μg/hr

K-9: 10-20 kg

q1-3 days

75μg/hr

K-9: 20-30 kg

q1-3 days

100μg/hr

K-9: w> 30 kg

q1-3 days

25-50 μg/hr

Feline

≤ 6 days

6 hr to reach peak concentrations

Butorphanol (10 mg/ml)

0.1-0.2 mg/kg

K-9/Feline

K-9: q1 hr

Low oral bioavailability

10 mg/ml

0.2-0.4 mg/kg IV; then 0.1-0.2 mg/kg/hr

K-9/Feline

CRI

Pentazocine

1-3 mg/kg

K-9/Feline

IM, IV, SC

q2-4 hr

Nalbuphine

0.03-0.1 mg/kg

IM, IV, SC

12-24 hr to reach peak concentrations. Must supplement analgesia until blood levels are reached

Feline: q2-4 hr

K-9/Feline

IM, IV, SC

q2-4 hr

Buprenorphine 10-30μg/kg

k-9/Feline

IM, IV, SC

q4-10 hr

15-30 minute onset. Excellent buccal mucosa absorption in cats and dogs

Tramadol

K-9/ Feline

PO

q4-6hr

Nonscheduled μ agonist activity. Serotonin and norepinephrine reuptake inhibitor. NMDA antagonist at lower doses, GABA receptor inhibitor at high concentrations.

2-10 mg/kg start at 2-3mg/kg

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43


Continuing Education Pain Management, continued

Table 1. Contd. Drug

Dose

Codeine

1-2 mg/kg

Species

Route

Dose Interval

Comments

K-9

PO

K-9

IM, IV

q0.5-1.5 hr

5-20 μg/kg

Feline

IM, IV

q0.5-1.5 hr

1 μg/kg IV, then 1-2 μg/kg/hr

K-9/Feline

CRI

1-5 μg/kg

K-9/Feline

Epidural

2-5 μg/kg

K-9/Feline

Intra-articular

Xylazine

0.1-0.5 μg/kg

K-9/Feline

IM, IV

Yohimbine (Antagonist)

0.1 mg/kg IV; 0.3-0.5 mg/kg IM

K-9/Feline

IM,IV

Atipamezol (Antagonist)

0.05-0.2 mg/kg IV

K-9/Feline

Ketamine

0.5 mg/kg; IV then 0.1-0.5 mg/kg/hr

K-9/Feline

CRI

Amantadine

3-5 mg/kg

K-9/Feline

PO

q24 hr

Neuropathic pain

Amitriptyline

1.0 mg/kg

K-9

PO

q12-24 hr

Enhanced noradrenergic activity

0.5-1.0 mg/kg

Feline

PO

q12-24 hr

Gabapentin

5-10 mg/kg

K-9/Feline

PO

q12-24 hr

VDCC inhibitor; excellent for neuropathic pain or in addition as preanesthetic/postoperative analgesic

Acepromazine

0.025-0.05 mg/kg

K-9

IM,SC,IV

q8-12 hr

3 mg maximum total dose; used to potentiate or prolong analgesic drug effect. No analgesic benefit alone.

0.05-0.2 mg/kg

Feline

IM,SC

q8-12 hr

0.1-0.2 mg/kg

K-9/Feline

IV

q2-4 hr

0.25-1.0 mg/kg

K-9/Feline

PO

q12-24 hr

≤ 6.0 mg/kg

K-9

Perineural

q1-2 hr

≤ 3.0 mg/kg

Feline

Perineural

q1-2 hr

2-4 mg/kg IV, then 25-80 μg/kg/min

K-9

IV: CRI

0.25-0.75 mg/kg slow IV, then 10-40 μg/kg/min

Feline

IV: CRI

≤ 2.0 mg/kg

K-9

Perineural

q2-6 hr

≤ 1.0 mg/kg

Feline

Perineural

q2-6 hr

≤ 6.0 mg/kg

K-9

Perineural

q2-2.5 hr

≤ 3.0 mg/kg

Feline

Perineural

q2-2.5 hr

Medetomidine 2-15 μg/kg Dexmedetomidine

(1.0 mg/ml)

Diazepam

Lidocaine (1-2%)

Bupivacaine (0.25-0.5%) Mepivacaine (1-2%)

44

Sedation, mild analgesia, bradycardia, vomition

q0.5-1.0 hr

2-4 times the medetomidinedexmedetomidine dose Excellent for intraoperative CRI analgesia

Used to potentiate or prolong analgesic drug effect Onset: 10-15 minutes. Maximum dose: 12 mg/kg (K-9); 6 mg/kg (feline)

Excellent intra-operative CRI analgesia for both K-9 and feline

The NAVTA Journal | Oct/Nov 2015

Onset: 20-30 minutes. Maximum dose: 2 mg/kg (K-9 or feline)


Continuing Education

Short, CE and Poznak, AV. Animal Pain Churchill Livingstone Inc. New York, NY, 1992

References for Table 1 Fish RE, Brown MJ, Danneman PJ and Karas AZ. Anesthesia and Analgesia in Laboratory Animals, Academic Press, London, UK, 2008 Gaynor, JS, Muir, WW. Handbook of Veterinary Pain Management 3rd Edition, Mosby/ Elsevier Publishing, St. Louis, MO., 2015. Short, C.E. (Ed), Principles and Practice of Veterinary Anesthesia, Williams and Wilkins, Baltimore, 1987. Grimm KA, Lamont LA, Tranquilli WJ, Greene SA, Robertson SA. Veterinary Anesthesia and Analgesia: The Fifth Edition of Lumb and Jones. John Wiley and Sons, Ames, Iowa, 2015. Goldberg ME and Shaffran N. Pain Management for Veterinary Technicians and Nurses. John Wiley and Sons, Ames, IA. 2015 Egger, CM, Love L, Doherty T. Pain Management in Veterinary Practice, John Wiley and Sons, Ames, IA. 2014. Fox SM. Pain Management in Small Animal Medicine, CRC Press, Boca Raton, FL. 2014. Fox, SM. Chronic Pain in Small Animal Medicine, Manson Publishing LTD, London, UK. 2010. Spelts, K and Gaynor, J. “Pain Management Strategies� in Anesthesia for veterinary Technicians Editor Susan Bryant, Wiley-Blackwell Publishing, Ames, Iowa, 2010. Mathews, KA. Veterinary Clinics of North America: Small Animal Practice Update on Pain Management 38(6) Nov, Elsevier/Saunders Publishing, Philadelphia, PA. 2008. Tranquilli, WJ, Grimm, KA, Lamont, LA. Pain Management for the Small Animal Practitioner 2nd Edition Teton NewMedia, Jackson, WY 2004.

Hellebrekers, LJ. Animal Pain: A PracticeOriented Approach to Effective Pain Control in Animals Van der Wees Uitgeverij, Utrecht, The Netherlands. 2000. Sawyer, DC. The Practice of Veterinary Anesthesia: Small Animals, Birds, Fish and Reptiles. Teton NewMedia, Jackson, WY. 2008 Carroll, GL. Small Animal Anesthesia and Analgesia, Blackwell Publishing, Ames, Iowa. 2008

Part Two will continue in the Dec/Jan 2016 edition of The NAVTA Journal and will focus on commonly utilized pain medications in exotic and large animals species, as well as the nonpharmaceutical aspects of pain management.

About the Author: Stephen Cital RVT, SRA, RLAT Stephen became a Registered Veterinary Technician in 2009. Shortly thereafter, he obtained certification as a Surgical Research Anesthetist through the Academy of Surgical Research. Furthermore, he attained the designation of Registered Laboratory Animal Technician through the American Association of Laboratory Animal Science. Stephen is currently the chair for the organizing committee for the proposed Academy of Laboratory Animal Veterinary Technicians seeking Veterinary Technician Specialty status from NAVTA. His regular daytime position is an anesthesia technician and research interventionalist at Surpass Inc., as well as holding a relief position at the amazing Oakland Zoo. More recently he accepted a position at United Veterinary Specialty and Emergency to help develop and maintain training across multiple sites for staff in anesthesia and pain management. Currently, Stephen serves as director for the California Registered Veterinary Technicians Association and is the President Elect for the national Society of Laboratory Animal Veterinary Technicians.

About the Author: Mary Ellen Goldberg BS, LVT, CVT, SRA, CCRA Mary Ellen Goldberg is a graduate of Harcum College and the University of Pennsylvania in 1976. She worked at the Virginia Commonwealth University in the Division of Animal Resources as a Laboratory Animal Anesthesia and Analgesia Specialist for 15 years and has been the instructor of Anesthesia and Pain Management at VetMedTeam, LLC since 2003. Mary Ellen is also a Surgical Research Anesthetist certified through the Academy of Surgical Research. She is on the Organizing Committee for the Academy of Physical Rehabilitation Veterinary Technicians. Currently, she is a staff member at the Canine Rehabilitation Institute, as a Certified Canine Rehabilitation Assistant. (CCRA). Mary Ellen has written several books, and contributed to numerous chapters regarding anesthesia, pain management and rehabilitation. She has worked in various aspects of veterinary medicine from small animal and equine to mixed practice, coccidiosis research for a pharmaceutical company, zoo animal medicine and laboratory animal medicine. Mary Ellen is Executive Secretary for IVAPM since 2008.

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45


Continuing Education

Pain Management Quiz 1. Acute pain can be defined as: a. A normal physiological and usually timelimited response to an adverse stimulus. b. P ersistent pain that goes beyond a sudden noxious stimuli or normal tissue healing time c. A type of pain that is caused by tissue damage, or a single disease process isolated to a specific location without explanation d. A type of pain that rarely happens in most veterinary settings, but is caused by trauma, surgery or sudden disease processes. 2. Which is not an example of a type of pain scale? a. NRS b. VTS c. VAS d. SDS 3. Signs of pain in a dog do not include which of the following? a. Whimpers, cowers, shuffles b. Growls, cowers, is reluctant to move c. Shuffles, howls, crouches d. eats normally, plays, barks

4. Signs of pain in a dog do include which of the following? a. Silent, cowers, growls b. Growls, cowers, is reluctant to move c. Howls, crouches, plays d. Anorexic, carries limb, silent 5. Which is not a pain classifying term developed by Clifford Woolf? a. Inflammatory Pain b. Conformative Pain c. Nociceptive Pain d. Functional Pain 6. The benefits of Multimodal Analgesia include? a. Reduced doses of one or more individual medications b. Fewer incidences of breakthrough pain c. More effective pain control d. all of the above

7. Excellent pain relief that works directly at the site of injury by injection of specific medications is called? a. Local anesthetics b. General anesthetics c. Systemic anesthesia d. Partial anesthesia 8. Nociceptive cells and opioid systems have not been found in invertebrate species. a. True b. False 9. Pain scales should include all but which of the following? a. Ability to distinguish varying levels of pain intensity in a particular species and situation b. Ability to detect the degree of “importance” of pain to the subject c. Ability to prescribe the appropriate medication d. Minimal interobserver variability and observer bias 10. Which best describes the clinical signs of pain in rabbits? a. Silent, engaged with environment, eating normally b. Silent, hunched, withdrawn c. Grunting, active, eating well d. Silent, moving around cage, allows handling

This article is worth one continuing education credit and will be accepted for grading until Nov 1, 2017. To receive credit, please complete the quiz online at www.VetMedTeam.com. There will be a $5 fee for each quiz. *Due to updates and changes authorized by NAVTA, the online quiz may not be the same as the printed exam within The NAVTA Journal. Read each question thoroughly and answer it as it appears in the online exam. Please do not simply copy your answers from the printed version.

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The NAVTA Journal | Oct/Nov 2015

®


INDUSTRY NEWS

“Golden” Veterinary Technicians Participate In

Groundbreaking Canine Health Study As we reach the third anniversary of Morris Animal Foundation’s landmark Golden Retriever Lifetime Study, we asked veterinary technicians who have enrolled their own dogs to share their experience. We wanted to know how the study affects their personal and professional lives, as well as learn about the daily challenges they face as technicians and study participants.

Our Veterinary Technician Participants: Kathy Daily, RVT, El Dorado Animal Clinic, El Dorado, Kansas Kathy graduated from Colby Community College in Colby, Kansas, in 1974 and has been with El Dorado Animal Clinic for nearly four decades. Her Golden Retriever Lifetime Study Hero dog is Keeper, a 3-year old female. Keeper was enrolled in the study in March 2013, and is Hero #246.

Jamie Larsen, LVT, Brookside Animal Clinic, Kingsley, Michigan Jamie graduated from Baker College in Cadillac, Michigan, 11 years ago and has been working for Brookside Animal Clinic ever since. Her Golden Retriever Lifetime Study Hero dog is Elliot, a 4-year old male. Elliot was enrolled in the study in April 2013, and is Hero #332.

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INDUSTRY NEWS Continued from pg. 47 Why did you choose this career?

As a CVT/RVT, how do you think your perspective on the study may differ from owners who aren’t technicians?

work with animals. I was the weird kid out playing and cuddling with the animals any chance I had, while all the other kids were playing together.

Emma Sue is Elliot’s adopted sister. Emma is not enrolled in the study, however, she is an awesome supporter. She turned 9 this year and has almost every issue that Goldens are prone to except cancer. She has terrible allergies and hypothyroidism (Golden Retrievers are at an increased risk of developing both conditions). She is our smart and athletic Golden. Her favorite thing in the whole wide world is playing ball. We always joke that Emma got the brains and skills and Elliot could only handle beauty.

What’s unique about the practice you work for?

How did you first hear about the study?

How do you feel the veterinary technician’s role in the study supports the participating owners and veterinarians?

Kathy: We are a jack-of-all-trades practice;

Kathy: Gosh, I really don’t remember.

Kathy: Explaining to owners the details of

Jamie: Our practice is very small. We have one veterinarian, two veterinary technicians, a receptionist and an assistant. Because of this we are able to offer our clients and patients a very personal experience.

Jamie: Sarah, another technician at our of-

Kathy: Love of animals, and because

my daddy told me I couldn’t train horses all my life!

Jamie: I just knew I was always meant to

my boss will work on anything except skunks and rattlesnakes (but he used to!).

Tell us something special about your Golden Retriever(s). Kathy: Currently, I have Morgan, an

11-year-old foster failure. After fostering more than 175 Goldens, Morgan came and stayed. I know why he was in the pound. Ten years later, he is still jumping fences! Keeper, my hero, was purchased from a long-time internet friend. Keeper is the party girl. She will show up at a party with her red Solo® cups. She is a total tomboy. If she were human, she’d be the little girl with the coveralls on, and a frog in her pocket. She has passed her CCA [Noncompetitive Conformation Assessment Program], and is now competing in OB [Obedience]. Which, by the way, she thinks is also a party held in her honor.

Jamie: Elliot Gary George (named after my

dad, his grampy) is enrolled in the study. He is both the sweetest and most stubborn dog ever. I love him so much and can’t imagine life without him. I actually was there the day he was born. We did a cesarean section on his mom, Sassy. She had 14 puppies in her first and only litter.

Through professional publications? Through various Golden Retriever discussion boards? I knew, though, that as soon as Keeper was old enough, we would be doing this!

not “so much blood.” It takes that much to do everything we need to do.

sample draws, be it fecal, urine, blood, hair and nails. In my case, drawing the blood. Although, I do admit, I would rather someone else do the blood draw on my own dog. I am a wuss about my own dogs.

fice, read about it in one of our free veterinary magazines and said I should enroll Elliot in the study. He was only about 18 months when she read the article, and we got him enrolled right away.

Jamie: At our practice, we as technicians

and clients have.

Kathy: Just sorting out what goes where.

are the back-bone of the study. We are the ones educating the clients and running things behind the scenes.

What was the biggest hurdle What inspired you to for you and your clinic as become involved in the Golden you learned the process for Retriever Lifetime Study? a Golden Retriever Lifetime Kathy: While I’ve not lost a Golden to Study visit? cancer (knock on wood), many of my friends Jamie: Unfortunately I have lost way

too family members and friends to cancer. My mother is a survivor of breast cancer; she was diagnosed at the young age of 34. I basically was inspired to become involved because I am tired of seeing people and animals suffering and dying from this terrible disease and want to be a part of the cure.

What was your first impression about the Golden Retriever Lifetime Study? Kathy: Yes! A big high five for all! Jamie: I was very impressed with the study and it made me want to become as involved as I could be.

48

Kathy: I understand the blood draws. It’s

The NAVTA Journal | Oct/Nov 2015

Reading the directions, making sure you box things correctly.

Jamie: Collecting of stool and urine speci-

mens. It never fails that we have trouble getting one or the other. Everyone gets frustrated because it holds things up. Note from the Golden Retriever Lifetime Study Team: It can be helpful for the veterinary team to coach owners on how to collect urine and fecal samples at home. Picking up feces is simple, if you know which dog it came from! Urine collection can be more of a challenge, but sometimes owners are more successful at home because the dog is less nervous.


INDUSTRY NEWS

What do you enjoy about being part of this study? Is there something about it that you take particular pride in? Kathy: Simply that my boss, my dog, and myself may make a difference! Jamie: Knowing that I am doing everything I

can to do my part. I have high hopes that by the end of this we will have a better understanding of what is causing this horrible disease and how we can stomp it out. I love that Elliot and I are doing it together along with the other 3,000 dogs and their amazing families.

How much time do you spend with a client on a study visit? Kathy: About 30 minutes. The veterinarian spends about 45 minutes. Jamie: We typically spend 30 to 45 minutes with a client during a study visit.

What, if any, particular question(s) on the owner or vet questionnaire do you find particularly interesting and why? Kathy: Lifestyle and environment. I think that is probably critical.

Morris Animal Foundation is a nonprofit organization that invests in science to advance animal health. The foundation is a global leader in funding scientific studies for companion animals, horses and wildlife. Learn more at www.morrisanimalfoundation.org. Morris Animal Foundation’s Golden Retriever Lifetime Study is the largest and longest effort of its kind ever undertaken in the United States to improve the health of dogs. During a period of 10 to 14 years, observational data collected from our 3,000 Golden Retriever volunteers will help us learn how to prevent cancer and other diseases that take the lives of dogs too soon. Learn more at www.caninelifetimehealth.org.

Authors: Nancy Kay Clark, BSB/M, CVT Study Participants Manager, Canine Lifetime Health Project Morris Animal Foundation, Denver, Colorado When Morris Animal Foundation announced the beginning of the Golden Retriever Lifetime Study, Nancy Kay Clark became the first in line to participate. Nancy’s first American Eskimo Dog, Candy, developed two forms of cancer in her lifetime, so Nancy knows what it’s like firsthand to watch a beloved, four-legged family member suffer through illness, surgery and the hope of recovery. She became the first full-time member of the study team in 2010, and has enjoyed watching the study grow from its inception. Nancy lives in Parker, Colorado, with her husband (Rich), their American Eskimo Dog (Rocket Man!) and three kitties (Kameko, Luna Lovegood and Mae May). “The work I do at the Morris Animal Foundation honors the memory of all the animals who have touched my life.”

Kelly Diehl, DVM MS, DACVIM (SAIM) CVJ Science Writer, Morris Animal Foundation, Denver, Colorado Upon receiving her DVM from the University of Tennessee, Dr. Diehl completed an internship at the Animal Medical Center in New York and then a residency in small animal medicine at Colorado State University. After completing a 3-year NIH postdoctoral fellowship at National Jewish Health, Dr. Diehl joined the staff of the Veterinary Referral Center of Colorado as the co-owner of the internal medicine section. After 14 years, Dr. Diehl left private practice to pursue a career in medical communication. Fortunately for us, she now works with the Morris Animal Foundation team. Dr. Diehl lives in Colorado with her husband, two children, one cat, one box turtle, lots of fish, and one very lovable Labrador Retriever.

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49


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to Heartworms.

to Hookworms.

to rouNdworms. Say yES to

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The NAVTA Journal | Oct/Nov 2015

Of dogs showing a preference in two studies, all dogs preferred HEARTGARD Plus Chewables to TRIFEXIS® (spinosad + milbemycin oxime) beef-flavored chewable tablets; Executive Summary VS-USA-37807 and VS-USA-37808. Of dogs showing a preference in two studies conducted, all dogs preferred HEARTGARD Plus Chewables to SENTINEL® (milbemycin oxime-lufenuron) chewable tablets; Executive Summary VS-USA-37809 and VS-USA-37810. Of dogs showing a preference in two studies conducted, all dogs preferred HEARTGARD Plus Chewables to IVERHART PLUS® (ivermectin/pyrantel) beef-flavored tablets; Executive Summary VS-USA-37811 and VS-USA-37812. Of dogs showing a preference in two studies conducted, all dogs preferred HEARTGARD Plus Chewables to IVERHART MAX® (ivermectin/pyrantel/praziquantel) beef-flavored tablets; Executive Summary VS-USA-37813 and VS-USA-37814. Of dogs showing a preference in one study conducted, all dogs preferred HEARTGARD Plus Chewables to SENTINEL® SPECTRUM (milbemycin oxime/ praziquantel/lufenuron) beef-flavored tablet; Executive Summary VS-USA-37801. Opinion Research Corporation, Heartworm Prevention Medication Study, 2012. Data on file at Merial. Data on file at Merial.


Disaster Section Response Header

Improving The Federal Veterinary Disaster Response For State, Local Partners Becoming more nimble in emergency response and having a relationship with customers ahead of the event: those were the goals of a recent restructuring of the National Veterinary Response Teams (NVRT) that provide medical care for working and companion animals when state and local resources are overwhelmed in disasters. “Whenever our state and local partners need assistance, we want to ensure we can provide the appropriate response for their needs in the most efficient and flexible manner,” said Dr. Ty Vannieuwenhoven, Chief Veterinary Officer for HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR), Office of Emergency Management in

which the National Disaster Medical System and its NVRT are housed. “We also want the NVRT’s customers to know them personally before they are needed.” “To serve our state and local customers’ needs and our veterinary providers better, we wanted a re-envisioned approach to the federal veterinary response whether we’re providing support after disasters or during high-profile public events,” he explained. The new approach streamlines the team structure and could put providers in place faster after disasters. Before the restructuring, the nation had five 30-member teams dispersed across the country. The new structure

features a national team consisting of smaller teams of veterinarians and veterinary technicians aligned to the 10 geographic national emergency management regions. The NVRT is led by Dr. Robin Brennen Stupack. The structure includes an NVRT veterinarian who supports the ASPR regional coordination staff by representing the NVRT program for veterinary medical assessment, planning, and response with its jurisdictions within a region. “This effort aligns the NVRT members’ skills into units that can address specific preidentified areas of requirement in disasters,” Vannieuwenhoven said.

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chewables

CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: For use in dogs to prevent canine heartworm disease by eliminating the tissue stage of heartworm larvae (Dirofilaria immitis) for a month (30 days) after infection and for the treatment and control of ascarids (Toxocara canis, Toxascaris leonina) and hookworms (Ancylostoma caninum, Uncinaria stenocephala, Ancylostoma braziliense). DOSAGE: HEARTGARD® Plus (ivermectin/pyrantel) should be administered orally at monthly intervals at the recommended minimum dose level of 6 mcg of ivermectin per kilogram (2.72 mcg/lb) and 5 mg of pyrantel (as pamoate salt) per kg (2.27 mg/lb) of body weight. The recommended dosing schedule for prevention of canine heartworm disease and for the treatment and control of ascarids and hookworms is as follows: Dog Weight

Chewables Per Month

Ivermectin Content

Pyrantel Content

Color Coding 0n Foil Backing and Carton

Up to 25 lb 26 to 50 lb 51 to 100 lb

1 1 1

68 mcg 136 mcg 272 mcg

57 mg 114 mg 227 mg

Blue Green Brown

HEARTGARD Plus is recommended for dogs 6 weeks of age and older. For dogs over 100 lb use the appropriate combination of these chewables. ADMINISTRATION: Remove only one chewable at a time from the foil-backed blister card. Return the card with the remaining chewables to its box to protect the product from light. Because most dogs find HEARTGARD Plus palatable, the product can be offered to the dog by hand. Alternatively, it may be added intact to a small amount of dog food. The chewable should be administered in a manner that encourages the dog to chew, rather than to swallow without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole. Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes after administration to ensure that part of the dose is not lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended. HEARTGARD Plus should be given at monthly intervals during the period of the year when mosquitoes (vectors), potentially carrying infective heartworm larvae, are active. The initial dose must be given within a month (30 days) after the dog’s first exposure to mosquitoes. The final dose must be given within a month (30 days) after the dog’s last exposure to mosquitoes. When replacing another heartworm preventive product in a heartworm disease preventive program, the first dose of HEARTGARD Plus must be given within a month (30 days) of the last dose of the former medication. If the interval between doses exceeds a month (30 days), the efficacy of ivermectin can be reduced. Therefore, for optimal performance, the chewable must be given once a month on or about the same day of the month. If treatment is delayed, whether by a few days or many, immediate treatment with HEARTGARD Plus and resumption of the recommended dosing regimen will minimize the opportunity for the development of adult heartworms. Monthly treatment with HEARTGARD Plus also provides effective treatment and control of ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). Clients should be advised of measures to be taken to prevent reinfection with intestinal parasites. EFFICACY: HEARTGARD Plus Chewables, given orally using the recommended dose and regimen, are effective against the tissue larval stage of D.immitis for a month (30 days) after infection and, as a result, prevent the development of the adult stage. HEARTGARD Plus Chewables are also effective against canine ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). ACCEPTABILITY: In acceptability and field trials, HEARTGARD Plus was shown to be an acceptable oral dosage form that was consumed at first offering by the majority of dogs. PRECAUTIONS: All dogs should be tested for existing heartworm infection before starting treatment with HEARTGARD Plus which is not effective against adult D. immitis. Infected dogs must be treated to remove adult heartworms and microfilariae before initiating a program with HEARTGARD Plus. While some microfilariae may be killed by the ivermectin in HEARTGARD Plus at the recommended dose level, HEARTGARD Plus is not effective for microfilariae clearance. A mild hypersensitivity-type reaction, presumably due to dead or dying microfilariae and particularly involving a transient diarrhea, has been observed in clinical trials with ivermectin alone after treatment of some dogs that have circulating microfilariae. Keep this and all drugs out of the reach of children. In case of ingestion by humans, clients should be advised to contact a physician immediately. Physicians may contact a Poison Control Center for advice concerning cases of ingestion by humans. Store between 68°F - 77°F (20°C - 25°C). Excursions between 59°F - 86°F (15°C - 30°C) are permitted. Protect product from light. ADVERSE REACTIONS: In clinical field trials with HEARTGARD Plus, vomiting or diarrhea within 24 hours of dosing was rarely observed (1.1% of administered doses). The following adverse reactions have been reported following the use of HEARTGARD: Depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering, convulsions and hypersalivation. SAFETY: HEARTGARD Plus has been shown to be bioequivalent to HEARTGARD, with respect to the bioavailability of ivermectin. The dose regimens of HEARTGARD Plus and HEARTGARD are the same with regard to ivermectin (6 mcg/kg). Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of ivermectin administered at elevated dose levels (more than 16 times the target use level) than dogs of other breeds. At elevated doses, sensitive dogs showed adverse reactions which included mydriasis, depression, ataxia, tremors, drooling, paresis, recumbency, excitability, stupor, coma and death. HEARTGARD demonstrated no signs of toxicity at 10 times the recommended dose (60 mcg/kg) in sensitive Collies. Results of these trials and bioequivalency studies, support the safety of HEARTGARD products in dogs, including Collies, when used as recommended. HEARTGARD Plus has shown a wide margin of safety at the recommended dose level in dogs, including pregnant or breeding bitches, stud dogs and puppies aged 6 or more weeks. In clinical trials, many commonly used flea collars, dips, shampoos, anthelmintics, antibiotics, vaccines and steroid preparations have been administered with HEARTGARD Plus in a heartworm disease prevention program. In one trial, where some pups had parvovirus, there was a marginal reduction in efficacy against intestinal nematodes, possibly due to a change in intestinal transit time. HOW SUPPLIED: HEARTGARD Plus is available in three dosage strengths (See DOSAGE section) for dogs of different weights. Each strength comes in convenient cartons of 6 and 12 chewables.

The NVRT has numerous response capabilities in its toolkit. The teams can assess veterinary medical needs of the community following disasters, provide treatment for injured or ill small and large animals after disasters, supply veterinary care for sheltered, working or research animals, and conduct veterinary health screening at airports or other points of embarkation and debarkation. The importance of providing quality veterinary care during disasters has been long understood. What is today known as the NVRT began following Hurricane Andrew in 1992 with a vision shared by professionals in the American Veterinary Medical Association and the American Veterinary Medical Foundation and was incorporated into the federal emergency response the following year. Today, although several federal agencies support animals affected by disasters, under the federal Emergency Support Function 8, NVRT is the primary federal resource for treating ill or injured pets, service animals, working animals, laboratory animals, and livestock impacted by disasters. It aligns this support with the non-governmental organizations that provide many of the other needed services for animals post-disaster most of which are organized under the National Animal Rescue and Sheltering Coalition (NARSC). Most recently, the veterinary teams were part of the federal response to Hurricane Sandy in 2012, providing care in the damaged areas of Long Island and to the animals in the large disaster shelter in Brooklyn. NVRT members also provide care and treatment for working animals at special events, including the Fourth of July celebration, other events in Washington, D.C and the political conventions in 2012. States and local jurisdictions can learn more on requesting NVRT assistance by contacting ASPR Regional Emergency Coordinators located in each region. Their contact information is available online at www.phe. gov/Preparedness/responders/rec/Pages/contacts.aspx.

For customer service, please contact Merial at 1-888-637-4251.

®HEARTGARD and the Dog & Hand logo are registered trademarks of Merial. ©2015 Merial, Inc., Duluth, GA. All rights reserved. HGD14TR2015TRADEAD-5 (01/15).

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To learn more about the National Disaster Medical System’s National Veterinary Response Team, visit www.phe.gov/Preparedness/ responders/ndms/teams/Pages/nvrt.aspx.

The NAVTA Journal | Oct/Nov 2015


new Anesthesia Nerds Corner

Can You Pass This Test?

Anesthesia Leak Testing by Tasha McNerney BS, CVT

4.

Before any anesthetic event it is important for you (the awesome technician anesthetist!) to do a leak check to ensure the system can properly deliver anesthetic gas and oxygen as well as properly remove CO2 and anesthetic waste gases.

Fill the system by using the oxygen flush valve, fill the reservoir bag until the pressure manometer reads 20cmH2O, then stop. You can also turn on the flow of oxygen to fill the reservoir bag until the pressure reaches 20cmH2O.

1.

5.

With the correct anesthesia hoses and reservoir bag attached to the anesthesia machine, ensure that the machine is correctly connected to your oxygen source and waste gas scavenging system.

2.

Close the pop-off valve or occlude the quick release valve. The pop off valve prevents the inadvertent buildup of pressure in the system, and should remain open except during positive pressure ventilation.

3.

Occlude the end of the anesthetic delivery hose with your thumb or palm of your hand.

Hold pressure in the bag by continuing to occlude the end of the anesthetic delivery hose.

Resources:

6.

Watch the pressure manometer—it should remain steady at 20cmH2O for at least five seconds.

7.

CO2 scavenging system for leaks. Another common location for leaks is the connection and housing for the absorber assembly, which contains the absorbent for CO2. Soda lime granules on the gaskets can sometimes prevent a tight seal. Repair or replace components as necessary, then try again until the machine passes the leak test before connecting the patient to the anesthesia machine.

Open the pop-off valve to relieve the pressure in the system.

If the anesthesia machine failed the leak test, check the anesthesia delivery hose and reservoir bag for holes, and the scavenging/

1. Thurmon, J.C., Tranquili, W.J., and Benson, G.J. (1999) Equipment and Monitoring from Essentials of Small Animal Anesthesia and Analgesia. Pgs 239-251. Lippincot Williams & Wilkins. 2. http://www.peted4vetce.com 3. https://www.atdove.org/videos/Procedure/ Anesthesia-Leak-Test

Publication of the National Association of Veterinary Technicians in America

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The NAVTA Journal | Oct/Nov 2015


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