The Complete Journal for the Veterinary Health Care Team
CE Credit from Alfred State College, SUNY
MICHELLE MILLER, BS, CVT Improving Quality of Life for Cancer Patients
NUTRITION Managing Obesity in Dogs and Cats Rhodococcus equi Infection in Foals
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Vol. 29 No. 1 | January 2008
WEIGHT MANAGEMENT
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Editor’sLetter
The Complete Journal for the Veterinary Health Care Team
Vol. 29 No. 1
January 2008
EXECUTIVE EDITOR Hilda Guay 267-685-2435 | hguay@vetlearn.com EDITORIAL Jill Greshes, Associate Editor Liz Donovan, Editorial Assistant 800-426-9119 x2446 | editor@VetTechJournal.com VETERINARY ADVISERS Dorothy Normile, VMD, Chief Medical Officer Beth Thompson, VMD, Medical Director SALES AND MARKETING Joanne Carson, National Account Manager 267-685-2410 | 609-238-6147 | jcarson@vetlearn.com Boyd Shearon, Account Manager 913-322-1643 | 215-287-7871 | bshearon@vetlearn.com Linda Costantini, Sales Representative 267-685-2422 | lcostantini@vetlearn.com Ray Lender, Executive Vice President 267-685-2417 | rlender@vetlearn.com DESIGN Michelle Taylor, Senior Art Director 267-685-2474 | mtaylor@vetlearn.com David Beagin, Art Director 267-685-2461 | dbeagin@vetlearn.com PRODUCTION Marissa Kuchta, Production Manager 267-685-2405 | mkuchta@vetlearn.com Elizabeth Ward, Production Coordinator 267-685-2458 | eward@vetlearn.com CIRCULATION Barbara Horan, Circulation Specialist 267-685-2440 | bhoran@vetlearn.com Gina Donnelly, Customer Service Supervisor 800-426-9119 x2 | info@VetTechJournal.com PUBLISHED BY
780Township Line Road •Yardley, PA 19067 PRESIDENT Derrick Kraemer Indexing: Veterinary Technician ® is included in the international indexing coverage of Index Veterinarius (CAB International), Focus On: Veterinary Science and Medicine (ISI), SciSearch (ISI), and Research Alert (ISI). Article retrieval systems include The Genuine Article (ISI) and The Copyright Clearance Center, Inc. Yearly author and subject indexes for Veterinary Technician are published in December.
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Ringing In the New Year — With a New Look! I’m sure that as soon as you picked up this issue of Veterinary Technician®, you noticed the journal’s new look. When I first got together with the art director, Michelle Taylor, and my art designer, David Beagin, to discuss the redesign of the journal, I told them that there were three things I wanted to accomplish. My first goal was to change the cover image so that it reflected the vital role that technicians play in the field of veterinary medicine. I wanted the image to be more clinical or technical, rather than a portrait. So this year, on the cover, I plan to show technicians in their professional environment doing what they do best — everything from treating patients to administering drugs to conducting tests to educating clients. I thought that this was a necessary step in helping to elevate how technicians are perceived within the profession. There are so many technicians who are striving to better the profession, and they deserve recognition for their professional accomplishments. I’ve conducted surveys and polled readers, and the feedback that I’ve consistently gotten is that most readers feel that the journal content is really good and is at the appropriate level. So although I’ve kept the conContact us! tent of the articles basically the same, my second goal was to update the We want to hear what you think look of the pages and make the jourabout our new design. Go to nal more reader-friendly. One of the www.VetTechJournal.com and things that David did was to colorclick on “Do you like our new code the different sections. For exlook?” to post your comments. ample, continuing education articles have a dark purple bar at the top of the page and peer-reviewed columns have a burgundy bar. This will make it easier for readers to search for a particular article. Many technicians have told me that the journal is their main source of news. So my third goal was to expand some of the departments, such as Tech News and Product Forum, to give readers more up-to-date information on pertinent current events and new products. As the journal continues to grow, this new design will give us the flexibility to continue to make necessary changes. I want to thank Michelle and David for pouring their hearts into this project. I think it really comes through on the pages. I hope that you like the new design. Enjoy!
Hilda Guay, Executive Editor Veterinary Technician | JANUARY 2008 1
Contents
The Complete Journal for the Veterinary Health Care Team
January 2008
Volume 29, Issue 1
COLUMN
For the benefit of those who wish to participate in the CE Program, the peerreviewed CE articles contained in Veterinary Technician® meet the standards set by Alfred State College for 0.5 credit hour. Documentation will be issued by Alfred State College, a State University of New York (SUNY) College of Technology.
48 Equine Essentials
All clinical articles are peer reviewed.
Rhodococcus equi Pneumonia Debra Hembroff, AHT
16 Compassion Counts
Peter Beck
Summit 20 Expert on Pet Food
FEATURES 16
Compassion Counts — A Talk with Michelle Miller, BS, CVT Liz Donovan
20
Veterinary Learning Systems’ Expert Summit on Pet Food: Part One Leading clinical nutritionists, nutrition industry experts, and veterinary professionals share their thoughts on nutrition and commercial pet food and discuss such topics as addressing owner perceptions and misconceptions, educating veterinary professionals, and reading pet food labels.
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JANUARY 2008 | Veterinary Technician
ON THE COVER Michelle Miller, BS, CVT, shows how to position a patient for radiation treatment. The basset hound, Edith, belongs to Michelle’s coworker, Leslie Elks, CVT.
See page 16 Photographed by Peter Beck
www.VetTechJournal.com
YOU KNOW how sensitive cats can be. WE KNOW Contains core antigens recommended in AAFP Guidelines. 5
pure, non-adjuvanted feline vaccines. We know the last thing you want is post vaccinal inflammation at the injection site – so why risk exposing cats to adjuvants? With non-adjuvanted PUREVAX® feline vaccines, you can: • Provide protection and reduce the potential risks associated with adjuvants1,2 • Safely vaccinate kittens as young as 6 weeks of age3,4
1 Macy
DW. The potential Role and Mechanisms of FeLV Vaccine-Induced Neoplasms. Seminars in Vet Medicine and Surgery (Small Animal) 1995;10(4):234-237.
• Effectively protect cats with different lifestyles
2 Day MJ, Schoon HA, Magnol JP, et al. A kinetic study of histopathological
changes in the subcutis of cats injected with non-adjuvanted and adjuvanted multi-component vaccines. Vaccine 2007; 25:4073-4084. 3 Data on label. 4 As young as 8 weeks recommended for vaccination with PUREVAX Feline
Rabies and 9 weeks recommended for vaccination with PUREVAX Recombinant Feline Leukemia. 5 Richards JR, Elston TH, Ford RB, et al. The 2006 American Association of Feline
Practitioners Feline Vaccine Advisory Panel Report. J Am Vet Med Assoc. 2006;229(9):1405-1441. ®PUREVAX is a registered trademark of Merial. ©2007 Merial Limited, Duluth, GA. All rights reserved. PUR07PBCOREAD2.
Ask your Merial Representative about PUREVAX brand products, the only complete line of non-adjuvanted feline vaccines available. To order Merial vaccines, contact your Merial Sales Representative or call 1-888-Merial-1 (1-888-637-4251). For more information visit www.merial.com. Circle 173 on Reader Service Card
Your knowledge. Our science. Their health.
Contents
The Complete Journal for the Veterinary Health Care Team
January 2008
Volume 29, Issue 1
28 Managing
Tell us how you like our
NEW LOOK. Go to
Obesity
www.VetTechJournal.com to post your comments. See page 1
Richboro Veterinary Hospital, Richboro, PA
DEPARTMENTS 1 2 8 14 51 53 55 56 57 64
Editor’s Letter Information Center Tech News Program Notes Tech Tips Product Forum Index to Advertisers Market Showcase Classified Advertising Picture This!
CE ARTICLES 28
Managing Obesity in Dogs and Cats
38
The Anatomy of the Liver and How It Functions Amy N. Breton, CVT, VTS (ECC) Diseases affecting the liver can lead to serious complications. Learn how the liver functions and how to test for and treat common hepatic diseases.
4
upp Jordan Schr
Dana Call, RVT, VTS (ECC) With the proper weight loss program, obesity in pets can be successfully managed. Technicians can help clients implement a diet and exercise regimen to promote weight loss and keep pets healthy.
JANUARY 2008 | Veterinary Technician
51 Tech Tip of the Month www.VetTechJournal.com
With your help, we’re protecting pets in more ways than ever before. Thanks to the veterinary community, Merial has contributed more than $2 million in cash and product in just two years to help care for pets in need. With your support, we’ll keep providing for deserving pets nationwide.
To learn how you can contribute, please visit www.PawsToSavePets.com.
®FRONTLINE, HEARTGARD and the Dog & Hand logo are registered trademarks, and TM“Paws To Save Pets” and the Paw & Blue Ribbon logo are trademarks, of Merial. ©2007 Merial Limited, Duluth, GA. All rights reserved. MER-ADS7P2SPTRADEAD.
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InformationCenter
The Complete Journal for the Veterinary Health Care Team
How to Contact Us Want to submit a manuscript? Check on your subscription? Send feedback?
Editorial Office VLS/Veterinary Technician 780 Township Line Road Yardley, PA 19067 Editorial Comments Phone: 800-426-9119, ext. 2446 Email: editor@VetTechJournal.com Fax: 800-556-3288 Submissions Please make sure that your contact information (full name and credentials [if applicable], mailing address, email address, and daytime phone number) is listed clearly on all submissions. Please follow up on submissions if you have not received an acknowledgment from our editorial office within 4 weeks. Manuscript Inquiries and Submissions Phone: 800-426-9119, ext. 2435 Email: hguay@vetlearn.com Fax: 800-556-3288 all other Editorial Submissions Phone: 800-426-9119, ext. 2446 Email: editor@VetTechJournal.com Fax: 800-556-3288 Tech Tip Videos Visit www.VetTechJournal.com/ sharetechtip to upload your video.
Circulation and Subscription Inquiries If you are moving, please notify us 6 to 8 weeks in advance to ensure uninterrupted service. Send us your current mailing label with your old address and the effective date of change. For address changes, subscriptions, and other matters, please contact us by: Phone: 800-426-9119, option 2 Email: info@VetTechJournal.com Fax: 800-589-0036 Web: www.VetTechJournal.com Advertising and Sales Joanne Carson Phone: 267-685-2410 Email: jcarson@vetlearn.com Boyd Shearon Phone: 913-322-1643 Email: bshearon@vetlearn.com Linda Costantini Phone: 267-685-2422 Email: lcostantini@vetlearn.com Classified Advertising Liese Dixon Phone: 800-920-1695 Email: VetTechClassifieds@vetlearn.com Web: VetClassifieds.com
Art Inquiries Phone: 800-426-9119, ext. 2461 Email: dbeagin@vetlearn.com
Our Mission Veterinary Technician is designed to support and actively promote the professional status and value of veterinary technicians and assistants in their own eyes, in the eyes of their colleagues and employers, and within veterinary medicine as a whole. Veterinary TechnicianŽ (ISSN 8750-8990) is published monthly by Veterinary Learning Systems, a division of MediMedia USA, 780 Township Line Road, Yardley, PA 19067. Copyright Š 2008 Veterinary Learning Systems. All rights reserved. Canada Post international publications mail product (Canadian distribution) sales agreement number 40014103. Return undeliverable Canadian addresses to MediMedia, PO Box 7224, Windsor, ON N9A 0B1. Printed in USA. No part of this issue may be reproduced in any form without written permission from the publisher. Periodicals postage paid at Morrisville, PA, and at additional mailing offices. Subscription rate: $46 for one year, $83 for two years, $119 for three years. Canadian and Mexican rates: $55 for one year, $102 for two years, $142 for three years. Foreign rate: $66 for one year, $119 for two years, $166 for three years. (All checks must be payable toVeterinary Learning Systems in U.S. funds drawn on a U.S. branch of a U.S. bank.) Selected back issues are available for $8 each (plus postage). Reprints are available for all Veterinary Technician articles; call 800-426-9119. PoSTMaSTER: Send address changes toVeterinaryTechnician,Veterinary Learning Systems, 780 Township Line Road, Yardley, PA 19067.
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JANUARY 2008 | Veterinary Technician
Vol. 29 No. 1
January 2008
EDITORIAL BOARD Elaine Anthony, MA, CVT Kimberly Baldwin, LVT, VTS (ECC) Andrea Battaglia, LVT Dawn Bennett, DVM Tracy Blais, AS, BS, MEd, CVT Kathy Bliss, BS, LVT David Bolette, RVT, LATg Susan Bryant, CVT, VTS (Anesthesia) Melvin C. Chambliss, DVM Mindy Cohan, VMD Christina A. Cornelius, LVT Elizabeth G. Davis, DVM Harold Davis, JR., BA, RVT, VTS (ECC, Anesthesia) Katherine Dobbs, RVT, CVPM Cheryl Holloway, RVT Tara Lang, BS, RVT Pepi F. Leids, DVM Donna Letavish, CVT Heidi Lobprise, DVM Rosandra (Rose) Manduca, DVM Betty A. Marcucci, VMD, MA Tracey M. Martin, LVT Laura McLain Madsen, DVM Trisha McLaughlin, CVT Kathryn E. Michel, DVM, MS Christopher Norkus, BS, CVT, VTS (ECC, Anesthesia) Jody Nugent-Deal, RVT Kristina Palmer-Holtry, RVT Karl M. Peter, DVM Ann Rashmir-Raven, DVM, MS Virginia Rentko, VMD Nancy Shaffran, RVT, VTS (ECC) Julie Shaw, RVT Margi Sirois, EdD, MS, RVT P. Alleice Summers, DVM Mary Tefend, MS, LVT, VTS (ECC) Kelly Towne-Collins, AAS, LVT Ann Wortinger, LVT, VTS (ECC) Any statements, claims, or product endorsements made in Veterinary Technician are solely the opinions of our authors and advertisers and do not necessarily reflect the views of the Publisher or Editorial Board.
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ASPCA_Use.qxp:Bayer Advantage Ad_USE
12/13/07
2:12 PM
Page 3
The potential for an animal poison emergency is always there, so we are too. A pill bottle accidently knocked off a sink. Everyday things can quickly become a poison emergency for a pet. It’s the reason the ASPCA® Animal Poison Control Center is here 24/7/365 to support you with critical recommendations. As the only center in North America dedicated solely to animals, we have an experienced team of board certified veterinary toxicologists* on staff with the special expertise needed to save a pet’s life. Our exclusive AnTox™database of more than one million cases of animal poisonings also gives us immediate access to crucial case information. When potential danger turns into a real emergency, don’t hesitate. Call us.
ORDER A FREE MAGNET Visit www.aspca.org/freemagnet for your free ASPCA Animal Poison Control Center magnet − an easy way to keep our emergency number handy. For information on our online Toxicology CE courses, visit www.apcc.aspca.org. No animals were harmed during the production of this ad.
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*American Board of Veterinary Toxicology www.abvt.org
TechNews
Technicians Needed in Homeland Security and Emergency Response by Liz Donovan
Colorado Veterinary Medical Reserve Corps
R
Rescue responders can be called to help with local emergencies. This volunteer is treating one of about 95 cats that were seized from an unventilated garage.
ecent catastrophic events — from natural disasters to terrorist attacks to local emergencies — have led to increased awareness about disaster preparedness, emergency response, and homeland security. To advocate the importance of disaster preparedness, medical professionals in both human and animal health are being trained to serve on emergency response teams. Several programs are available to help veterinary professionals obtain specialized training that will prepare them to use their clinical skills to help animals in an emergency or disaster.
Medical Reserve Corps Seeks a Few Good Technicians The Medical Reserve Corps (MRC), a community-based network of volunteers dedicated to public health and emergency response, is currently seeking veterinary technicians and other professionals to volunteer their services. On November 1, 2007, JAVMA reported that there was a lack of veterinary health care team members on MRC units across the country. Technicians can help fill this void in their community by becoming involved in emergency response.
“Trained staff who are able to assist in animal evacuations and emergency response are very much needed,” says Capt. Robert Tosatto, RPh, MRC director. “Technicians can help by providing triage care, general veterinary care, and evaluation and decontamination services.” According to JAVMA, MRC units in various states have been formed to specifically address animal health and safety, leading other MRC units to request the assistance of veterinary professionals. “Before an emergency, it is incredibly important for pet owners to be prepared. We have learned that lesson from Hurricane Katrina and the southern California wildfires. The technician’s role in making sure that pet owners have emergency plans for their animals is very important,” says Tosatto. Veterinary professionals interested in learning more about the MRC should visit www.medicalreservecorps.gov. The Web site includes a searchable database of MRC units across the United States and contact information for each unit. If your area does not have a local MRC, Tosatto recommends contacting your local health department about
Chemical Combination in Pet Food Proves Lethal by Liz Donovan Last spring, more than 100 brands of pet food from several manufacturers were recalled after the food was linked to kidney failure in dogs and cats. Preliminary study results indicate that a combination of two chemicals was the likely cause of the kidney failure, which resulted in the deaths of hundreds of cats and dogs. The FDA originally attributed the illnesses to the presence of melamine — an industrial chemical used in the production of certain resins and fertilizers — in the pet food. Experts determined that the melamine was added to wheat gluten and rice protein to artificially el8
JANUARY 2008 | Veterinary Technician
evate the food’s protein content. New data, however, suggest that a combination of melamine and cyanuric acid — a chemical used in swimming pools and hot tubs to slow the breakdown of chlorine in the water — contributed to renal failure in animals that ate the food. At the annual meeting of the American Association of Veterinary Laboratory Diagnosticians (AAVLD), veterinary toxicologist Birgit Puschner, PhD, announced results from a study that she conducted with colleagues at the University of California–Davis California Animal Health and Food Safety Laboratory. The study showed that when ad-
ministered separately, neither melamine nor cyanuric acid demonstrated observable effects on renal function in cats; however, the combination of the two chemicals seriously affected renal function. “The results of this study demonstrate that a single oral exposure of cats to melamine and cyanuric acid can result in acute kidney failure,” said Puschner. When combined, melamine and cyanuric acid form fan-like crystals in the renal distal tubules and collecting ducts of dogs and cats. These crystals hinder renal function, leading to renal failure. These data match those of an AAVLD www.VetTechJournal.com
TechNews
starting one. “The more professionals we have to assist in an emergency situation, the better,” Tosatto says.
The Colorado Veterinary Medical Reserve Corps conducts personal protective equipment training for its members.
“This program teaches technicians how to prevent and treat disease and explains what their role would be in a natural disaster,” says Dan Walsh, LVT, MPS, who is currently a student in the program. “It also gives technicians a stepping stone for increased knowledge and additional academic resources. It shows the career opportunities available to them outside of private practice, including areas that constantly battle the possibility of disease, such as biosecurity and homeland security.” The program is a cooperative effort of the Purdue School of Veterinary Medicine, Purdue Homeland Security Institute, Indiana Board of Animal Health, Indiana State Police, and Indiana Department of Homeland Security. For more information, visit www.biosecurity center.org/article.php?vetHomelandProgram.
Nonpolarized
survey that examined nephrotoxicity cases from a 2-month period. JAVMA reported that the cyanuric acid may have been a co-contaminant formed by “incomplete reactions during melamine production,” according to Wilson Rumbeiha, associate professor at the Michigan State University Diagnostic Center for Population and Animal Health. To read the proceedings of the AAVLD meeting, visit www.aavld.org and click on “Annual Meeting.” The pet food recall began on April 15, 2007. The last recall was announced on August 22, 2007. www.VetTechJournal.com
Polarized
Dalen Agnew, DVM, PhD, DACVP, Michigan State University
Purdue University now offers a Veterinary Homeland Security Certificate Program for veterinary professionals who are interested in becoming involved in animal health emergency response. The graduate-level distance-learning program was recently granted national certification by the USDA’s Animal and Plant Health Inspection Service based on its adherence to National Animal Health Emergency Management System guidelines. The guidelines, which were designed to help responders deal with animal health incidents, promote four areas of emergency management: prevention, preparedness, response, and recovery. Participants in Purdue’s program must complete nine courses; the content is delivered online or by CD. The topics include swine disease, rabies, anthrax, and plague. “Our lectures hit on all animal-related events, whether they are natural disasters or intentional crimes,” says Marianne Ash, director of biosecurity and preparedness planning at the Indiana State Board of Animal Health and adjunct professor at Purdue. “We focus on biosecurity and disaster preparedness using scientific methods to meet the growing demand for homeland security.”
Colorado Veterinary Medical Reserve Corps
Purdue Offers Veterinary Homeland Security Certificate Program
Photomicrographs(400хmagnification)ofthekidneysofa9-year-oldmalecat.Thehematoxylin–eosinstained sections show tubules in varying stages of necrosis, degeneration, and regeneration. These tubules contain necrotic debris, protein, and aggregates of crystals forming radial plates or coarsely granular clumps typical of melamine–cyanuric acid crystals. The crystals are birefringent when exposed to polarized light. Veterinary Technician | JANUARY 2008 9
TechNews
aaHa Turns 75
Preparing for National Pet Dental Health Month T
his February, in honor of National Pet Dental Health Month, Hill’s Pet Nutrition is challenging veterinary health care teams to make pet dental care a priority. To support this initiative, Hill’s is cosponsoring “Pets Need Dental Care, Too,” an awareness program that encourages veterinary professionals to talk with clients about the importance of scheduling regular dental examinations and providing routine dental care at home. To help clinics implement a dental awareness program, Hill’s will provide free National Pet Dental Health Month kits. Each kit contains a guide of suggested outreach activities, information on Hill’s-brand pet food designed to help control plaque and tartar, and “Pets Need Dental Care, Too” brochures, window clings, and temporary tattoos. Health care teams can show off their creative ideas for promoting dental health by entering the nationwide “Pets Need Dental Care, Too” Pet Dental Awareness Contest. Participants will be judged based on creativity, clinic activities, and community outreach used to promote dental health during the month of February. The winning health care team will receive $1,000 to improve their work environment, a membership to the American Veterinary
Dental Society (AVDS), and a 1-year subscription to the Journal of Veterinary Dentistry. To enter, teams must submit a completed entry form (included in the “Pets Need Dental Care, Too” kit), along with photographs, illustrations, and examples of materials and activities that were used in the campaign. Entries will be accepted from March 1 to March 31, 2008. For more information on the contest, or to order a “Pets Need Dental Care, Too” kit, visit www.petdental. com or call 877-552-1550. National Pet Dental Health Month is also sponsored by the AVMA, the AVDS, the Academy of Veterinary Dentistry, the American Veterinary Dental College, and the Academy of Veterinary Dental Technicians.
Before
after
Glenn Davenport and Shaker Veterinary Hospital, PC
Brook Niemic, DVM, DAVDC, FAVD
Patricia Dominguez, LVT, VTS (Dentistry), delivers a presentation on dental health awareness at the Shaker Veterinary Hospital in Latham, New York.
offering clients before-and-after photographs of their pet’s dental cleaning is one way to promote regular dental prophylaxis.
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JANUARY 2008 | Veterinary Technician
The American Animal Hospital Association (AAHA) will celebrate its 75th anniversary at this year’s annual conference. To mark this anniversary, AAHA plans to change its yearly conference schedule so that the event is held from Thursday through Sunday. This will minimize the amount of time that attendees need to be away from their practice. This year’s conference will be held on March 27 to 30 in Tampa, Florida, and will include more than 280 hours of continuing education designed for the entire practice team. Areas of study designed for technicians will include behavior, canine rehabilitation, dermatology, emergency medicine, infectious diseases, monitoring, oncology, pain management, and professional development. For more information, or to register for the conference, visit tampa2008.aahanet.org or call 800-883-6301. AAHA was established in 1933 to promote high-quality standards in private practice. Since that time, AAHA has grown to serve approximately 6,000 veterinary health care teams internationally. It has awarded accreditation to 3,000 teams that have met its strict standards for high-quality practices. AAHA also publishes Trends magazine and the Journal of the American Animal Hospital Association. In 2005, AAHA published AAHA Dental Care Guidelines for Dogs and Cats, and in 2007, it worked with the American Association of Feline Practitioners (AAFP) to develop AAHA/AAFP Pain Management Guidelines for Dogs and Cats. For more information about AAHA, visit www.aahanet.org.
For meeting information, visit our online Conference Calendar at www.VetTechJournal.com.
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PREVICOX® (firocoxib)
HAPPY DOGS. HAPPY CLIENTS. TM
Imagine how you’d feel if you were the owner of a dog with OA. The helper that trampled your flower beds and dug up your borders – in short, made gardening worthwhile – can’t even come out to play. Your client might think it’s old age, but if it’s osteoarthritis, PREVICOX and you can make a big difference in both their lives. Give your clients the change they’re looking for, and your patients the relief they need. Dispense PREVICOX.
FOR THE CONTROL OF PAIN AND INFLAMMATION ASSOCIATED WITH OSTEOARTHRITIS IN DOGS.
In one study, 97% of owners were satisfied with PREVICOX.2
As a class, cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, kidney or liver side effects. These are usually mild, but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including PREVICOX. Use with other NSAIDs, corticosteroids or nephrotoxic medication should be avoided. Refer to the prescribing information for complete details or visit www.previcox.com. 1
2
Ryan WG, Moldave K, Carithers D. Clinical effectiveness and safety of a new NSAID, firocoxib: a 1,000-dog study. Vet Ther 2006;7(2):119-126. Data on file at Merial.
®PREVICOX is a registered trademark, and ”HAPPY DOGS. HAPPY CLIENTS.” is a trademark, of Merial. ©2008 Merial Limited, Duluth, GA. All rights reserved. PVX08CNPORCHAD.
TM
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CHEWABLE TABLETS For oral use in dogs only. CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. DESCRIPTION: PREVICOX® (firocoxib) belongs to the coxib class of non-narcotic, non-steroidal anti-inflammatory drugs. Firocoxib is a white crystalline compound described chemically as 3-(cyclopropylmethoxy)-4-(4-(methylsulfonyl) phenyl)-5, 5-dimethylfuranone. The empirical formula is C17H20O5S, and the molecular weight is 336.4. The structural formula is shown below:
PHARMACOKINETICS: The absolute bioavailability of PREVICOX (firocoxib) is approximately 38% when administered as a 5 mg/kg oral dose to fasted adult dogs. Firocoxib is rapidly cleared from the blood via hepatic metabolism and fecal excretion (CLsystemic = ~0.4 L/hr/kg). Despite a high level of plasma protein binding (96%), firocoxib exhibits a large volume of distribution (Vd k of total drug = ~4.6 L/kg) and a terminal elimination half life of 7.8 hours (%CV = 30%). The oral drug absorption process is highly variable among subjects. Co-administration of PREVICOX with food delays drug absorption (Tmax from 1 to 5 hours) and decreases peak concentrations (Cmax from 1.3 to 0.9 mcg/mL). However, food does not affect the overall oral bioavailability at the recommended dose. INDICATIONS: PREVICOX (firocoxib) Chewable Tablets are indicated for the control of pain and inflammation associated with osteoarthritis in dogs. DOSAGE AND ADMINISTRATION: Always provide Client Information Sheet with prescription. Carefully consider the potential benefits and risks of NSAIDs (including PREVICOX) and other treatment options before deciding to use PREVICOX. Use the lowest effective dose for the shortest duration consistent with individual response. The recommended dosage of PREVICOX (firocoxib) for oral administration in dogs is 2.27mg/lb (5 mg/kg) body weight once daily. The tablets are scored and dosage should be calculated in half tablet increments. PREVICOX Chewable Tablets can be administered with or without food. CONTRAINDICATIONS: Dogs with known hypersensitivity to firocoxib should not receive PREVICOX. WARNINGS: Not for use in humans. Keep this and all medications out of the reach of children. Consult a physician in case of accidental ingestion by humans.
For oral use in dogs only. Use of this product at doses above the recommended 2.27 mg/lb (5.0 mg/kg) in puppies less than seven months of age has been associated with serious adverse reactions, including death (see Animal Safety). Due to tablet sizes and scoring, dogs weighing less than 12.5 lb (5.7 kg) cannot be accurately dosed. All dogs should undergo a thorough history and physical examination before the initiation of NSAID therapy. Appropriate laboratory testing to establish hematological and serum baseline data is recommended prior to and periodically during administration of any NSAID. Owners should be advised to observe for signs of potential drug toxicity (see Adverse Reactions and Animal Safety) and be given a Client Information Sheet about PREVICOX Chewable Tablets. For technical assistance or to report suspected adverse events, call 1-877-217-3543. PRECAUTIONS: This product cannot be accurately dosed in dogs less than 12.5 pounds in body weight. Consider appropriate washout times when switching from one NSAID to another or when switching from corticosteroid use to NSAID use. As a class, cyclooxygenase inhibitory NSAIDs may be associated with renal, gastrointestinal and hepatic toxicity. Sensitivity to drugassociated adverse events varies with the individual patient. Dogs that have experienced adverse reactions from one NSAID may experience adverse reactions from another NSAID. Patients at greatest risk for adverse events are those that are dehydrated, on concomitant diuretic therapy, or those with existing renal, cardiovascular, and/or hepatic dysfunction. Concurrent administration of potentially nephrotoxic drugs should be carefully approached and monitored. NSAIDs may inhibit the prostaglandins that maintain normal homeostatic function. Such anti-prostaglandin effects may result in clinically significant disease in patients with underlying or pre-existing disease that has not been previously diagnosed. Since NSAIDs possess the potential to produce gastrointestinal ulcerations and/or gastrointestinal perforations, concomitant use with other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided. The concomitant use of protein-bound drugs with PREVICOX Chewable Tablets has not been studied in dogs. Commonly used protein-bound drugs include cardiac, anticonvulsant, and behavioral medications. The influence of concomitant drugs that may inhibit the metabolism of PREVICOX Chewable Tablets has not been evaluated. Drug compatibility should be monitored in patients requiring adjunctive therapy. The safe use of PREVICOX Chewable Tablets in pregnant, lactating or breeding dogs has not been evaluated. ADVERSE REACTIONS: In controlled field studies, 128 dogs (ages 11 months to 15 years) were evaluated for safety when given PREVICOX Chewable Tablets at a dose of 5.0 mg/kg orally once daily for 30 days. The following adverse reactions were observed. Dogs may have experienced more than one of the observed adverse reactions during the study.
Adverse Reactions Seen in U. S. Field Studies Adverse Reactions Vomiting Diarrhea Decreased Appetite or Anorexia Lethargy Pain Somnolence Hyperactivity
PREVICOX n=128
Active Control n=121
5 1 3 1 2 1 1
8 10 3 3 1 1 0
INFORMATION FOR DOG OWNERS: PREVICOX, like other drugs of its class, is not free from adverse reactions. Owners should be advised of the potential for adverse reactions and be informed of the clinical signs associated with drug intolerance. Adverse reactions may include vomiting, diarrhea, decreased appetite, dark or tarry stools, increased water consumption, increased urination, pale gums due to anemia, yellowing of gums, skin or white of the eye due to jaundice, lethargy, incoordination, seizure, or behavioral changes. Serious adverse reactions associated with this drug class can occur without warning and in rare situations result in death (see Adverse Reactions). Owners should be advised to discontinue PREVICOX therapy and contact their veterinarian immediately if signs of intolerance are observed. The vast majority of patients with drug related adverse reactions have recovered when the signs are recognized, the drug is withdrawn, and veterinary care, if appropriate, is initiated. Owners should be advised of the importance of periodic follow up for all dogs during administration of any NSAID. CLINICAL PHARMACOLOGY: Mode of action: PREVICOX (firocoxib) is a cyclooxygenase-inhibiting (coxib) class, non-narcotic, nonsteroidal anti-inflammatory drug (NSAID) with anti-inflammatory and analgesic properties. There are two main cyclooxygenase enzymes, COX-1 and COX-2, and a newly discovered third enzyme, COX-3, which has yet to be fully characterized.1 Cyclooxygenase-1 (COX-1) is the enzyme responsible for facilitating constitutive physiologic processes, e.g., platelet aggregation, gastric mucosal protection, and renal perfusion.2 It also is constitutively expressed in the brain, spinal cord, and reproductive tract.3 Cyclooxygenase-2 (COX-2) is responsible for the synthesis of inflammatory mediators, but it is also constitutively expressed in the brain, spinal cord and kidneys.4, 5, 6 Cyclooxygenase-3 (COX-3) is also constitutively expressed in the canine and human brain and also the human heart.7 Results from in vitro studies showed firocoxib to be highly selective for the COX-2 enzyme when canine blood was exposed to drug concentrations comparable to those observed following a once daily 5 mg/kg oral dose in dogs.8 However, the clinical significance of these findings has not been established. EFFECTIVENESS: Two hundred and forty-nine dogs of various breeds, ranging in age from 11 months to 20 years, and weighing 13 to 175 lbs, were randomly administered PREVICOX or an active control drug in two field studies. Dogs were assessed for lameness, pain on manipulation, range of motion, joint swelling, and overall improvement in a non-inferiority evaluation of PREVICOX compared with the active control. At the study’s end, 87% of the owners rated PREVICOX-treated dogs as improved. Eighty-eight percent of dogs treated with PREVICOX were also judged improved by the veterinarians. Dogs treated with PREVICOX showed a level of improvement in veterinarian-assessed lameness, pain on palpation, range of motion, and owner-assessed improvement that was comparable to the active control. The level of improvement in PREVICOX-treated dogs in limb weight bearing on the force plate gait analysis assessment was comparable to the active control. PALATABILITY: PREVICOX Chewable Tablets were rated both convenient to administer (97.2%) and palatable to the dog (68.5%) by owners in multi-center field studies involving client-owned dogs of various breeds and sizes. ANIMAL SAFETY: In a target animal safety study, firocoxib was administered orally to healthy adult Beagle dogs (eight dogs per group) at 5, 15, and 25 mg/kg (1, 3, and 5 times the recommended total daily dose) for 180 days. At the indicated dose of 5 mg/kg, there were no treatment-related adverse events. Decreased appetite, vomiting, and diarrhea were seen in dogs in all dose groups, including unmedicated controls, although vomiting and diarrhea were seen more often in dogs in the 5X dose group. One dog in the 3X dose group was diagnosed with juvenile polyarteritis of unknown etiology after exhibiting recurrent episodes of vomiting and diarrhea, lethargy, pain, anorexia, ataxia, proprioceptive deficits, decreased albumin levels, decreased and then elevated platelet counts, increased bleeding times, and elevated liver enzymes. On histopathologic examination, a mild ileal ulcer was found in one 5X dog. This dog also had a decreased serum albumin which returned to normal by study completion. One control and three 5X dogs had focal areas of inflammation in the pylorus or small intestine. Vacuolization without inflammatory cell infiltrates was noted in the thalamic region of the brain in three control, one 3X, and three 5X dogs. Mean ALP was within the normal range for all groups but was greater in the 3X and 5X dose groups than in the control group. Transient decreases in serum albumin were seen in multiple animals in the 3X and 5X dose groups, and in one control animal. In a separate safety study, firocoxib was administered orally to healthy juvenile (10-13 weeks of age) Beagle dogs at 5, 15, and 25 mg/kg (1, 3, and 5 times the recommended total daily dose) for 180 days. At the indicated (1X) dose of 5 mg/kg, on histopathologic examination, three out of six dogs had minimal periportal hepatic fatty change. On histopathologic examination, one control, one 1X, and two 5X dogs had diffuse slight hepatic fatty change. These animals showed no clinical signs and had no liver enzyme elevations. In the 3X dose group, one dog was euthanized because of poor clinical condition (Day 63). This dog also had a mildly decreased serum albumin. At study completion, out of five surviving and clinically normal 3X dogs, three had minimal periportal hepatic fatty change. Of twelve dogs in the 5X dose group, one died (Day 82) and three moribund dogs were euthanized (Days 38, 78, and 79) because of anorexia, poor weight gain, depression, and in one dog, vomiting. One of the euthanized dogs had ingested a rope toy. Two of these 5X dogs had mildly elevated liver enzymes. At necropsy all five of the dogs that died or were euthanized had moderate periportal or severe panzonal hepatic fatty change; two had duodenal ulceration; and two had pancreatic edema. Of two other clinically normal 5X dogs (out of four euthanized as comparators to the clinically affected dogs), one had slight and one had moderate periportal hepatic fatty change. Drug treatment was discontinued for four dogs in the 5X group. These dogs survived the remaining 14 weeks of the study. On average, the dogs in the 3X and 5X dose groups did not gain as much weight as control dogs. Rate of weight gain was measured (instead of weight loss) because these were young growing dogs. Thalamic vacuolation was seen in three of six dogs in the 3X dose group, five of twelve dogs in the 5X dose group, and to a lesser degree in two unmedicated controls. Diarrhea was seen in all dose groups, including unmedicated controls. In a separate dose tolerance safety study involving a total of six dogs (two control dogs and four treated dogs), firocoxib was administered to four healthy adult Beagle dogs at 50 mg/kg (ten times the recommended daily dose) for twenty-two days. All dogs survived to the end of the study. Three of the four treated dogs developed small intestinal erosion or ulceration. Treated dogs that developed small intestinal erosion or ulceration had a higher incidence of vomiting, diarrhea, and decreased food consumption than control dogs. One of these dogs had severe duodenal ulceration, with hepatic fatty change and associated vomiting, diarrhea, anorexia, weight loss, ketonuria, and mild elevations in AST and ALT. All four treated dogs exhibited progressively decreasing serum albumin that, with the exception of one dog that developed hypoalbuminemia, remained within normal range. Mild weight loss also occurred in the treated group. One of the two control dogs and three of the four treated dogs exhibited transient increases in ALP that remained within normal range. STORAGE: Store at room temperature, between 59°–86° F (15°–30° C). Brief periods up to 104° F (40° C) are permitted. To request a Material Safety Data Sheet (MSDS), call 1-877-217-3543. HOW SUPPLIED: PREVICOX is available as round, beige to tan, half-scored tablets in two strengths, containing 57 mg or 227 mg firocoxib. Each tablet strength is supplied in 10 count and 30 count blister packages and 60 count bottles. For customer service, please contact Merial at 1-888-637-4251. 1
PREVICOX (firocoxib) Chewable Tablets were safely used during field studies concomitantly with other therapies, including vaccines, anthelmintics, and antibiotics. POST APPROVAL EXPERIENCE: The following adverse reactions are based on voluntary post-approval reporting and are consistent with those reported for other cyclooxygenase inhibitory NSAID class drugs. The categories are listed in decreasing order of frequency by body system. Gastrointestinal: Vomiting, anorexia, diarrhea, melena, hematemesis, hematochezia, weight loss, nausea, gastrointestinal ulceration, gastrointestinal perforation, salivation. Urinary: Azotemia, elevated creatinine, polydipsia, polyuria, urinary tract infection, hematuria, urinary incontinence, renal failure. Hematological: Anemia, thrombocytopenia. Hepatic: Hepatic enzyme elevations, decreased or increased total protein and globulin, decreased albumin, decreased BUN, icterus, ascites, pancreatitis. Neurological / Behavioral / Special Sense: Lethargy, weakness, seizure, ataxia, aggression, tremor, uveitis, mydriasis, nystagmus. Cardiovascular / Respiratory: Tachypnea. Dermatological / Immunological: Fever, facial / muzzle edema, pruritis, urticaria, moist dermatitis. In rare situations, death has been reported as an outcome of the adverse events listed above.
®PREVICOX is a registered trademark of Merial. ©2008 Merial Limited, Duluth, GA. All rights reserved. PVX08CNPORCHAD.
2
3
4
5 6 7
8
Willoughby DA, Moore AR and Colville-Nash PR. COX-1, COX-2, and COX-3 and the future treatment of chronic inflammatory disease. Lancet 2000;355:646-648. Smith, et al., Pharmacological Analysis of Cyclo-oxygenase-1 in Inflammation. Proc. Natl. Acad. Sci. USA, Pharmacology 1998; 95:13313-13318. Jones CJ and Budsberg SC. Physiologic characteristics and clinical importance of the cyclooxygenase isoforms in dogs and cats. JAVMA 2000;217(5):721-729. Zhang, et al., Inhibition of Cyclo-oxygenase-2 Rapidly Reverses Inflammatory Hyperalgesia and Prostaglandin E2 Production. JPET 1997; 283:1069-1075. Jones and Budsberg, pp. 721-729. Zhang, et al., pp. 1069-1075. Chandrasekharan NV, Dai H, et al. COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/ antipyretic drugs: Cloning, structure and expression. Proc. Natl. Acad. Sci. USA, 2002;99(21):13926-13931. Data on file.
Merial Limited 3239 Satellite Blvd. Duluth, GA 30096-4640 U.S.A. 1-877-217-3543 U.S. Patent Nos. 5,981,576; 6,541,646; and 6,677,373 NADA 141-230, Approved by FDA
TechNews
Surgical Specialty in the Works Veterinary technician specialty academies have opened the doors for technicians to advance in their profession and be acknowledged for their specialized training. According to the Veterinary Emergency and Specialty Practice Association, technicians who are involved in surgery may soon join the ranks of technicians specialized in dentistry, emergency and critical care, anesthesia, and — beginning with the first exam this June — internal medicine. Kevin Benson, CVT, is working to organize a committee for the prospective surgical veterinary technician specialty academy. “This specialty academy would provide surgical tech-
nicians with better education, the opportunity to increase their pay, and more choices for advancement in their profession,” says Kevin. The academy would be designed to expand technicians’ knowledge of surgery-based procedures, increase public awareness of the importance about technicians in the surgical suite, create a higher level of skill in the surgical team, and offer advanced surgical continuing education geared toward technicians. Candidates interested in joining the organizing committee must meet the following requirements: 䊳
Be a NAVTA member
Have graduated from an AVMAaccredited program and/or be legally credentialed to practice in their state, province, or country 䊳 Be recognized as exceptionally qualified in the field of surgery 䊳 Have a minimum of 7 years’ experience, with no less than 75% of that time devoted to surgery 䊳
If you have the above qualifications and would like to help start a veterinary technician specialty academy in surgery, contact Kevin Benson at KBenson@vetcision.com. Kevin plans to submit the application to NAVTA by April.
NaVTa announces Changes NAVTA has announced major changes to its management team, effective this month. Patrick Navarre, BS, RVT, will no longer act as executive director, and Carlene Decker, BS, CVT, will be leaving the management team. Patrick has been involved with NAVTA since its first organizational
meeting in 1981. He accepted the position of executive director in 1993. Carlene, who joined the association’s management team in 1993, has served as NAVTA president, vice president, president-elect, and past president. She also worked as editor of The NAVTA Journal and will con-
tinue to hold this position after the transition. As of press time, NAVTA had not yet filled the vacant positions but had announced that the executive board will ensure that the transition occurs quickly and smoothly. For more information, visit www.navta.net.
ARIZONA The Veterinary Health Care Team of Arizona (VHCTAz) recently honored the Arizona Animal Wellness Center in Gilbert as the veterinary health care team of the year for 2007. The team, which includes nine technicians, four receptionists, and two veterinary assistants, was nominated by Parva Bezrutczyk, DVM, of the Arizona Animal Wellness Center, based on their high professional standards. The team was selected for the award because of its ability to work as a close-knit family while providing exceptional care to the center’s clients. In her nomination letter, Dr. Bezrutczyk stated,“Our team is committed to meeting and exceeding the expectations of every person they interact with every day. They are proud that they can practice in a profession that makes www.VetTechJournal.com
Field of Dreams Photography
S TAT E N E W S
The veterinary staff at the arizona animal Wellness Center in Gilbert was honored as the veterinary health care team of 2007 by the Veterinary Health Care Team of arizona.
a difference in the lives of our clients and their pets.” Congratulations to these professionals for this achievement! The VHCTAz awarded certificates of recognition to nine additional health care teams: VCA Phoenix West Animal Hospi-
tal, Eye Care for Animals,Veterinary Specialty Center of Tucson,Anthem Pet Medical Center, Sunrise Pet Clinic, DC Ranch Animal Hospital, the Humane Society of Southern Arizona, McQueen Veterinary Clinic, and Prescott Animal Hospital, PC. Veterinary Technician | JANUARY 2008
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ProgramNotes
®
Veterinary Technician
CE Seminar Hilda Guay
By Liz Donovan Veterinary Learning Systems
V
Liz Donovan
ETERINARY TECHNICIAN was proud to help members Elaine Anthony, MA, CVT, and Julie RVT, presented lectures, as did Vickie technicians expand their knowledge through its Shaw, Byard, CVT, VTS (Dentistry). Edward Robin6th annual CE Seminar, which was held last fall in son, VT, AAS, BA, presented the wet lab. Ulster, New York; Detroit, Michigan; and Dallas, Behavior Julie Shaw, senior animal behavior technoloTexas. The program, titled “Perfecting Practical gist at Purdue University, gave three lectures Skills,” attracted more than 300 technicians and vet- on behavior, including the keynote lecture, tierinary health care staff. The events were made possi- tled “Shooting the Client Is Not Politically CorUsing Behavior Modification Techniques ble with generous support from Bayer Animal Health. rect: to Change Client Behavior.” During this lec-
Hilda Guay
Julie Shaw, RVT, served as the keynote speaker for the event.
With seven lectures and one wet lab, the program was designed to provide opportunities for all members of the veterinary health care team to enhance their knowledge and skills. Each lecturer at the seminar was a current leader in veterinary technology with extensive experience in presenting world-class continuing education. The lectures included practical tips — in the areas of behavior, dentistry, cytology, urinalysis, and parasitology — that could be applied immediately in the veterinary practice. The 2-day seminar offered 12 hours of continuing education credit. Veterinary Technician editorial board member and frequent contributor Margi Sirois, EdD, MS, RVT, served as program chair for the event. Editorial board
Pamela Hensley (left) spends time after a dentistry session getting pointers from Vickie Byard, CVT, VTS (Dentistry). 14
JANUARY 2008 | Veterinary Technician
ture, Julie discussed the importance of communicating with clients. “Technicians spend an enormous amount of time educating, counseling, communicating, and modifying the behavior of the humans in their exam rooms,” she stated. She gave technicians essential information, illustrated by scenarios, about shaping the behavior of clients to improve compliance. In her second lecture, “Puppies Gone Wrong … And Right Again!,” Julie discussed a new way of thinking about the dominance theory. “The dominance theory has been overused and has led to complications in the relationship we have with dogs,” she explained. Julie discussed alternative reasons why puppies can become aggressive (e.g., genetics, poor socialization, inconsistent owner interactions) and described risks and warning signs of potential behavior problems. Through the use of videos and case examples, Julie discussed successful and unsuccessful treatment plans. In Julie’s third lecture, titled “Behavior Modification: Getting It Right,” she discussed common behavior modification techniques, including counterconditioning, response substitution, and desensitization. Videotaped behavior modification sessions were used to demonstrate these techniques. www.VetTechJournal.com
Dentistry Vickie Byard, inpatient supervisor and dentistry coordinator at Rau Animal Hospital in Glenside, Pennsylvania, and president-elect of the Academy of Veterinary Dental Technicians, presented two lectures on dentistry. Her first lecture, titled “Dental Radiology: Are Intraoral Radiographs Really Necessary?,” provided an overview of the importance of radiography in veterinary dentistry. During the lecture, Vickie cited statistics that indicated that radiography performed on dental patients with obvious clinical findings revealed additional pathology in 50% of dogs and 53.9% of cats. She also addressed the financial benefits of having a dental radiography unit in the clinic, and she gave technicians examples of practical radiographic techniques that can be used to obtain diagnostic-quality images. Vickie also gave a detailed lecture on the importance of toothbrushing and promoting periodontal prophylaxis in the clinic. In the lecture, titled “Toothbrushing to Marketing: Veterinary Dentistry Topics You Can Chew On!,” she discussed ways that technicians can promote regular dental cleaning by easing clients’ fears about anesthesia and by showing clients at-home cleaning techniques. Vickie also offered suggestions on creating a multimedia dentistry marketing plan for the clinic.
Cytology and Urinalysis
Edward Robinson, a Bayer wet lab administrator and a veterinary technician educator, presented the wet lab, which focused on centrifugal fecal flotation. In the lab, titled “Advanced Fecal Examination Procedures,” he explained that the most current method recommended to perform inclinic fecal examination is centrifugal flotation. Technicians had the opportunity to examine various types of intestinal parasites, including Giardia oocysts.
Megan Ferris, LVT, (left to right) Tammy Nopper, LVT, and Sarah Wells, LVT, participate in the fecal wet lab. www.VetTechJournal.com
Elaine anthony, Ma, CVT, answers an attendee’s question.
Look for dates and locations for the 2008 CE Seminar in an upcoming issue, or visit www.VetTechSeminars.com.
Parasitology
Hilda Guay
Elaine Anthony presented lectures on urinalysis and cytology. Elaine has more than 20 years’ experience as a veterinary technician lecturer, is
a veterinary nutritional consultant for Nestlé Purina PetCare Company, and works part time at a veterinary internal medicine clinic. She is also a veterinary technician educator and a frequent contributor to Veterinary Technician. In her urinalysis lecture, titled “Microscopic Examination of Urine Sediment,” Elaine described various cells, casts, crystals, and miscellaneous components that are commonly seen in an analysis of urine sediment from dogs and cats. She also explained techniques for conducting the microscopic examination. “All staff members should follow the same standard protocol when collecting, processing, and examining urine samples,” Elaine stated. In addition, Elaine presented “Examination of Cytology Specimens,” a 11/2-hour lecture on practical cytology. She emphasized the importance of performing a cytologic evaluation and discussed terminology that should be used when describing cell types. She also explained how to differentiate inflammatory cells from neoplastic cells and how to determine whether the neoplastic cells are malignant or benign.
Hilda Guay
ProgramNotes
The Veterinary Learning Systems’ staff took time to interact with attendees during breaks and after sessions. The feedback was overwhelmingly positive. Many participants said that they could not wait to take the information that they learned and use it in their clinic. Thank you to everyone who attended this successful event, and we look forward to seeing you in 2008! Veterinary Technician | JANUARY 2008 15
Peter Beck
Compassion Counts A Talk with Michelle Miller, BS, CVT by Liz Donovan Veterinary Learning Systems
‘‘C 16
ANCER IS A SCARY WORD,” says Michelle Miller, BS, CVT. “That’s why the technician’s role in helping clients cope with their pet’s illness and make an educated decision is critical in veterinary oncology.” Helping clients select an individualized treatment protocol designed to improve their pet’s quality of life is just one of Michelle’s many responsibilities as an oncology/radiation therapy senior technician at the University of Minnesota Veterinary Medical Center (VMC), where she also treats cancer patients undergoing chemotherapy and radiation therapy. Here, she tells us about the influence of human medicine on veterinary oncology and discusses her plans to promote the veterinary technology profession.
JANUARY 2008 | Veterinary Technician
www.VetTechJournal.com
Cover Story
Before I became a technician, I worked for many years in marketing and event planning. I was able to travel all over the country, but I realized that my corporate career wasn’t fulfilling. I loved animals, so I decided to take a job as a receptionist at a local veterinary clinic. I fell in love with veterinary medicine right away, and I never once looked back. In 2002, shortly after I accepted the receptionist position, I decided to further my new career by pursuing a degree in veterinary technology. I graduated from St. Petersburg College in St. Petersburg, Florida, in 2004 and then completed a 1-year internship at The Animal Medical Center in New York City, where I spent time in the oncology and radiation therapy departments learning about different cancer treatments and chemotherapy drugs. I knew then that oncology was a perfect fit for me. In 2005, I moved to Minnesota to work in VMC’s oncology and radiology departments.
What made you choose the field of oncology? Early in my career, I worked with a boardcertified internal medicine veterinarian who treated patients with chemotherapy. I found that I was really interested in internal medicine, cytology of cancer cells, and oncology in general, so I read everything I could find about veterinary oncology.
What is new in the field of veterinary oncology and, specifically, radiation therapy? As more and more information about veterinary oncology is available, pet owners are becoming better informed about cancer treatment options and are more willing to treat their pets. We have learned a great deal from human medicine and now use that information to treat companion animals. Veterinary oncologists have access to cancer drugs that were previously only used in human medicine. Now that these drugs are more affordable, many more people are able to treat their pets. Radiation therapy is also making great advances as technology gets better. VMC recently purchased a linear accelerator for more advanced radiation treatments. We used to have an outdated cobalt-60 radiation therapy unit, so the new unit has www.VetTechJournal.com
Off the Cuff What is your favorite television show, and why? I love Dancing with the Stars for its energy and entertainment and 24 for its suspense. If you were a crayon, what color would you be? Brown, because it represents being natural and down to earth. What one word would you use to best describe yourself? Driven. What are your personal goals for this year? My goal is to run two marathons. I run 25 to 30 miles a week, and I usually run one marathon a year, but I’ve never done two in one year! increased the standard of care. The linear accelerator can treat patients faster than the previous unit, and they experience fewer side effects.
Describe your work at VMC. There are five technicians who work in the oncology and radiology departments. Each week, we usually treat about 50 patients and rotate among different areas. For example, one week, I’ll work in chemotherapy, administering the chemotherapy drugs and preparing notes for the client when the patient is discharged. The next week, I’ll help administer radiation therapy. I also spend a week receiving new patients and educating their owners about veterinary oncology and treatment protocols. I’ll spend the fourth week spreading my time among the other
V I TA L S TAT I S T I C S M I C H E L L E M I L L E R Education BS in public health, Mankato State University, Mankato, MN (1996); AS in veterinary technology, St. Petersburg College, St. Petersburg, FL (2004)
Professional associations NAVTA, Minnesota Association of Veterinary Technicians, Veterinary Cancer Society
Pets Michelle has two domestic shorthaired cats, Noel (6 years old) and Missy (5 years old), and a 6-month-old yellow Lab, Apple (pictured on opposite page with Michelle).
Peter Beck
How did you become involved in veterinary technology?
Veterinary Technician | JANUARY 2008 17
three areas to help the other technicians care for patients. We have a unique arrangement at VMC because patients spend all day at the facility while they undergo chemotherapy or radiation therapy.
How important is client education in helping to treat cancer patients? Client education and communication are extremely important to the technician’s role in oncology. A large part of our job involves giving our clients the right resources, supporting their decisions, and educating them to the best of our ability. We explain to clients that in veterinary medicine, the approach to treating cancer is different from that in human medicine. We can’t always cure cancer, but we’re trying to improve the animal’s quality of life, and we really focus on that goal at VMC. Working in the oncology field can be very emotional. Many pet owners feel guilty. They have a difficult decision to make as to whether they should treat their pet. Technicians serve as the clients’ “sounding board,” so they are an invaluable resource on the oncology health care team.
What hopes do you have for the profession? I would love to see technicians be respected and recognized for their accomplishments. I’m on a committee that is working to have technicians added to Minnesota’s Veterinary Practice Act, which I think will play a huge part in getting technicians the pay and respect that they deserve. One of my roles on the committee is getting the word out to the public about what technicians do and what the practice act is. Circle 182 on Reader Service Card
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JANUARY 2008 | Veterinary Technician
Cover Story
I also want technicians to get the best education available and be indispensable to veterinarians.
Michelle demonstrates how to administer chemotherapy.
What are your professional goals? I’m currently working toward a specialization in internal medicine (oncology), and I’ll be taking the test in June 2009. I’m so excited about the specialization process – I love the challenge of each case log I write and each new procedure I perform. I’m learning more about what I love!
What is your greatest accomplishment?
Peter Beck
So far, my greatest accomplishment is becoming a technician. I feel so fortunate that I got into this profession. I love going to work every day, and I love my patients and clients — I think there is something to be said for that. I still have far to go, though. There are so many things I want to do. I just want to do as much as I can to become more involved in, and more dedicated to, the profession. PERSONAL INTEREST
ne of Michelle’s passions is her involvement with Basic Animal RescueTraining (BART), a nonprofit organization that teaches rescue volunteers how to provide first aid to domestic animals in emergency situations. BART was founded by Janet Olson, DVM, whose husband was one of several firefighters who responded to a fire at a home in New Brighton, Minnesota. The home belonged to a firefighter, whose 13-year-old German shorthaired pointer, named Bart, was trapped inside. When Bart was rescued, he was unresponsive and had suffered smoke inhalation.The fire department did not have the proper resources or experience in animal rescue, and Bart died. After the tragedy, Dr. Olson founded the BART organization in Bart’s honor. “Bart’s story makes me cry every time I think about it,” says Michelle. As part of her work
O
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with BART, she trains firefighters and other firstresponder personnel on safe animal restraint and handling and the proper use of rescue and safety equipment, such as muzzles, on animals. In 2007, BART began expanding to a national level. Michelle offered her insight from the training program so that a federal program could be formed. “BART is such a great program,” says Michelle. “Being involved in this program is important to me because it gives me a special experience that is similar to what I see between cancer patients and their owners. I love to see the strong bond that people have with their pets and the lengths to which people will go to save their animals. It’s something that I don’t think a lot of people get to see on a regular basis.” For more information on BART, visit basic animalrescuetraining.org.
BART photo, courtesy of Rich Schmitt
Honoring the Memory of Bart
Michelle gives a presentation on the proper use of rescue and safety equipment.
Veterinary Technician | JANUARY 2008 19
EXPERT SUMMIT ON
PET FOOD PART ONE
Julie Churchill, DVM Assistant clinical professor University of Minnesota
Leighann Daristotle, DVM, PhD Manager of scientific communications P&G Pet Care
Kathryn E. Michel, DVM, MS, DACVN Associate professor of nutrition Chief, section of medicine The University of Pennsylvania
Sean Delaney, DVM, MS, DACVN* Senior executive vice president Chief scientific and medical officer Director of special projects Natura Pet Products, Inc. *When this roundtable was held, Dr. Delaney was assistant clinical professor at the University of California–Davis.
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VETERINARY LEARNING SYSTEMS, publisher of Veterinary Technician®, assembled a group of professionals — including clinical nutritionists, nutrition industry experts, veterinarians, a veterinary technician/clinical instructor, and an FDA director — to emphasize the importance of pet nutrition, not only in treating certain diseases but also in helping to maintain health. In part one, the discussion focuses on addressing owner perceptions and misperceptions, educating veterinary professionals about nutrition, and reading pet food labels.
www.VetTechJournal.com
Lisa M. Freeman, DVM, PhD, DACVN
Phil Roudebush, DVM, DACVIM
Professor Department of clinical sciences Tufts Cummings School of Veterinary Medicine
Director of scientific affairs Hill’s Pet Nutrition
Dottie Laflamme, DVM, PhD, DACVN
Mary B. Tefend, MS, LVT, VTS (ECC)
Senior pet nutrition scientist Nestlé Purina PetCare Global Resources
Clinical instructor Auburn University
Daniel McChesney, PhD
Karen Todd-Jenkins, VMD
Director Office of surveillance and compliance Center for Veterinary Medicine FDA
Staff veterinarian Veterinary Learning Systems
Veterinary Technician | JANUARY 2008 21
Pet Food Summit — Part One
ADDRESSING OWNER PERCEPTIONS AND MISPERCEPTIONS Kathryn E. Michel, DVM, MS, DaCVN, Moderator: In regard to commercial pet foods and companion animal nutrition, what are some of the areas that generate the most concern and/or confusion for pet owners? Dottie Laflamme, DVM, PhD, DaCVN: I think confusion stemming from a lack of understanding about ingredients is probably the most common concern I hear about. There are lots of different questions that arise, but they all stem from a lack of understanding about the ingredients — where they come from and why they’re used. We need to provide an understanding about ingredients and why they’re used, what they are, how their safety is assessed, and related issues. This could help clear up some of the most common concerns about commercial pet food.
“The pet nutrition industry is one of the most dynamic that practitioners encounter, yet they fail to recognize that.” Phil Roudebush, DVM, DaCVIM
Julie Churchill, DVM: Ironically, veterinarians are often uncomfortable in their ability to evaluate or discriminate among products, possibly because of a lack of education. Yet pet owners are quite comfortable in making nutrition decisions, but these decisions are often based on misinformation or misperceptions that they’ve found on the Internet. Mary B. Tefend, MS, LVT, VTS (ECC): The Internet can cause confusion for owners because some clients will, for example, Google “homemade pet food diets.” Then they will create a diet for their pet using this information. When I access these sites myself, I find that they were created by individuals with no veterinary background. The client 22
JANUARY 2008 | Veterinary Technician
doesn’t know this. They believe that the information is true because it’s on the Internet. Karen Todd-Jenkins, VMD: Before the Internet, there weren’t as many resources for pet owners, so they were more likely to consult their veterinarian about food choices for their pets. Now some veterinarians probably feel that we have less influence in this area because owners have so many other sources of information. So, in looking to the future, we have to use more Web-based tools to reach clients and convince them that we’re a reliable source of information. We also have to better understand the choices ourselves so we can make solid recommendations.
EDUCATING VETERINARY PROFESSIONALS ABOUT NUTRITION Michel: Veterinary health care professionals need to recognize the importance of nutrition and understand the role that it plays in the overall wellness and care of their patients. That being said, what are some of the problems that veterinary professionals encounter? Laflamme: Veterinarians remain the number one cited source of information about nutrition and pet care for owners. However, there is some perception that veterinarians don’t know about nutrition, and this perception is partly correct because nutrition training for veterinarians is highly variable across the country. Some schools offer several courses in nutrition and have boarded nutritionists, and other schools provide no nutrition training. Some years ago, the American College of Veterinary Nutrition hired the AVMA to conduct a survey, and the findings indicated that veterinarians perceived this lack of training, recognized it, and wanted to get better nutrition education. We still have a dichotomy in which veterinarians are the number one source of nutrition information for pet owners and, yet, what is their source of nutrition information? Veterinarians need to have the tools to address the issues, understand what the issues are, and provide solutions. Tefend: Working with veterinary students, I have found that many of them don’t understand how to read a pet food label. For exwww.VetTechJournal.com
Pet Food Summit — Part One
ample, they fail to realize that ingredients are listed by weight. So usually in canned food, for instance, water is listed first. Students think that the greatest percentage of canned food is water and don’t understand that it is the predominant ingredient by weight. So the second ingredient listed might be, by percentage, the main ingredient on a dry basis. Teaching veterinary students how to read a pet food label would be beneficial because they will be educating clients about pet food and nutrition. Lisa M. Freeman, DVM, PhD, DaCVN: So the key is to train veterinary professionals while they are still in veterinary school so that they are able to read pet food labels, knowing what the ingredients are and being knowledgeable about how pet food is regulated. Each vet school should have a boardcertified nutritionist to provide nutrition training for students. Tefend: If every school had a nutritionist and from the very beginning taught nutrition concepts, then when students entered their clinic year, they would better understand the differences among pet food products. Phil Roudebush, DVM: The pet nutrition industry is one of the most dynamic that practitioners encounter, yet they fail to recognize that. In the past 3½ years, more than 1,000 pet food products have been introduced in the US market alone, along with a handful of new nutrition-related drugs. But practitioners don’t understand the enormity of this industry. They need to spend some time and energy understanding it. When I was a student, the leading cat food in America was Puss ’N Boots, and if I still thought that today, I would be grossly misinformed. More than one new pet food product is introduced every day — day in and day out, year after year. For those of us in industry, it’s very difficult to keep up with all of the new products. Laflamme: That’s an interesting observation in light of the fact that the nutritional needs of dogs and cats really haven’t changed. Yet so many new products are being introduced. Veterinary health care professionals need to start by understanding the nutritional needs www.VetTechJournal.com
of dogs and cats and the individual factors that affect those needs, so that they can select appropriately from the available pet foods. It can be a real challenge. Churchill: In veterinary education, we’ve underemphasized the importance of nutrition and its role in wellness and maintaining health. We seem to have a love affair with treatment. And veterinarians have a higher comfort level with the “therapeutic diets” or using nutrition in the role of therapy but underemphasize its importance in maintenance and wellness.
“Working with
veterinary students, I have found that many of them don’t understand how to read a pet food label.” Mary B. Tefend, MS, LVT, VTS (ECC)
Todd-Jenkins: There’s a lot of information available. But as a veterinarian, I want to know what things I should be looking for. When I assess product information and numerous ingredients are listed and I’m trying to compare six different diets, it would help if I knew specifically what makes one diet better than another one. I think clients come into the office with the same questions. They’re just flooded with all this information. Some of the sources are reliable, but many of them are not. For us to be able to make recommendations and to help clients with nutrition choices for their pets, we need to know what to look for when comparing diets side by side. Sean Delaney, DVM, MS, DaCVN: The presumption is that there are significant differences among foods. I would argue that there are a lot of good foods, so it becomes challenging if we’re discriminating among foods for healthy animals. How do you distill and filter information? Unless there’s a specific Veterinary Technician | JANUARY 2008 23
Pet Food Summit — Part One
known disease state or preventive strategy we’re trying to employ, it is challenging for a veterinarian, even a veterinary nutritionist, to discriminate. Obviously, that scenario is different for therapeutic diets, but for most patients, that’s the challenge. Daniel McChesney, PhD: When veterinary health care professionals are asked, “What should I feed my pet?,” many tell clients to read the label on the can, and if it indicates that the food was subjected to AAFCO feeding trials or nutritional profiles, then nutritionally it’s fairly equal, regardless of the brand. Is that a true and useful statement?
Veterinary professionals need to obtain diet histories for all their patients to establish a pattern of diets that are associated with healthy pets and diets that are associated with pets that aren’t doing quite so well. Freeman: I echo those comments. I generally recommend a food made by a well-known, reputable company and one that has undergone AAFCO feeding trials, but there are limitations to feeding trials. A nutritional adequacy statement gives a lot of information because it tells if the food is complete and balanced. We’re seeing more commercial foods that are not complete and balanced, yet they appear to be according to the package label.
“For us to be able to make recommendations and to help clients with nutrition choices for their pets, we need to know what to look for when comparing diets side by side.” Karen Todd-Jenkins, VMD
Laflamme: A diet can meet nutritional profiles established by AAFCO or be subjected to animal feeding tests, both of which substantiate nutritional adequacy. There can be a significant difference in the meaning of these two claims. Anyone can create a pet diet — either canned or bagged — and sell it to owners without the diet ever being fed to a dog or cat. That scenario would fall within the regulations of “formulated to meet the profile.” Animal feeding tests, performed according to AAFCO standards, are certainly a great level of assurance, but even that, in my opinion, is probably a minimum level. Those studies identify gross nutritional deficiencies. But we’re formulating diets that we anticipate to be fed for years — sometimes the lifetime of a pet — and you have to look at an AAFCO feeding trial as an important component, but only one component. You also have to look at the history of the company and the research that it does. 24
JANUARY 2008 | Veterinary Technician
Churchill: But even trained veterinary health care professionals sometimes have difficulty understanding the label because the language is legalese — it’s cumbersome and frequently difficult to read. It may be on the side of the package or in very small print.
READING PET FOOD LABELS Michel: The importance of reading product labels has been brought up several times. Therefore, an important step would be to teach veterinary professionals how to read labels. They in turn can educate their clients on how to read a label. What does a label tell you about the product? Does the label provide enough information? McChesney: Feeding instructions are often on the package, but sometimes, if owners followed those instructions, they would actually be providing inadequate pet nutrition. In addition, most people don’t measure the food in cups. So I think that most owners don’t feed their pet the proper amount as specified by the directions on the package. Freeman: I believe that critical information on the label is how many calories are in the food. In addition, providing useful units of measure, not per kilogram but per cup or per can of food, is important. www.VetTechJournal.com
Pet Food Summit — Part One
Delaney: There is a lot of debate within the industry, which I think is the best way to put it, about how useful calorie listings are. However, I do think that most nutritionists would say that having some calorie information on the label would help more than hurt. McChesney: A lot of products say they are reduced calorie, reduced fat, or low fat, but the claim is actually based on that particular product. For example, if product X started with 2,000 calories, a reduced-calorie diet must be less than the initial 2,000 calories. However, if another brand also claims to be reduced calorie but started with 3,000 calories, the caloric intake would be substantially higher than that found in product X. Delaney: I had a client who said, “I can’t get my dog to lose any weight on this reducedcalorie food.” We checked the packaging, and the food had 500 calories per cup, reduced from 600 calories. It was reduced in comparison with the company’s normal product, but for those who are not aware,
most foods are about 300 to 400 calories per cup, so it became obvious why the reduced-calorie diet was not very effective. Leighann Daristotle, DVM, PhD: We have gone full circle because if a reduced-calorie claim is on a product, it still needs to be the veterinary health care professionals who educate the client as to the meaning of that claim. Even if the food is a complete and balanced diet — and we’ll assume that most of what’s on the shelf is — the client should not make a choice simply because a food has the fewest calories, as it may not be the appropriate diet for that particular pet. Laflamme: Veterinary professionals should develop an inventory or list of foods that are sold in their area because there are a lot of good national foods, but there are also some good regional foods. By completing dietary histories on all patients and then considering additional pertinent information from the pet food manufacturers, veterinary professionals can identify a number of different foods that
The summit provided veterinary and industry experts with an opportunity to exchange ideas and expertise.
www.VetTechJournal.com
Veterinary Technician | JANUARY 2008 25
Pet Food Summit — Part One
they feel confident recommending in different price categories to meet the financial capabilities of all their clients. Most owners want the best value. They want good-quality nutrition, but they also want it at an affordable price and a convenient location. Roudebush: Although most consumers don’t look at product labels, members of the veterinary health care team should be able to read and understand product labels.
“In veterinary education, we’ve underemphasized the importance of nutrition and its role in wellness and maintaining health.” Julie Churchill, DVM
Freeman: Owners should check whether the label indicates that the diet is complete and balanced for the appropriate life stage. Veterinary health care professionals also need factual information about ingredients. There’s so much misinformation about ingredients on the list. For example, lamb listed as the first ingredient is sometimes perceived as better than a by-product, which has become a frightening term to some people. Yet some labeling might list the first ingredients as beef heart, beef liver, or beef lung without the word by-product.
Look for part two of our Expert Summit on Pet Food in our February issue.
Delaney: It seems that the industry has made many attempts to get rid of that term, even by renaming it protein co-products. What is amusing to me are people who are strong advocates of raw food diets and foes of by-products saying, “I have this great source of beef liver or beef heart.” Daristotle: Consumers may not understand that most of the macro-ingredients in commercial pet food are indeed by-products of the human food industry, not be-
26
JANUARY 2008 | Veterinary Technician
cause they are bad for anyone but because of food preferences. Roudebush: My grandfather and father grew up on farms, and when an animal was slaughtered, all of it was used. There were no by-products. We have gotten away from that practice. Michel: Is there anything that should be added to the label? Roudebush: Calorie information should be mandatory, not voluntary. Tefend: Another tool on the label would be a better guaranteed analysis. There’s a maximum and a minimum indicated, but the label doesn’t say how much nutrient is actually in a can. The exact amounts aren’t listed. Delaney: I would add two things to the label. The first would be an 800 number or another method of contacting the manufacturer in case there are questions. Also, I would add proximate analysis, meaning the protein levels and then, by difference, the carbohydrate level. Being able to calculate and compare that information can be useful. For example, if an animal is prone to hyperlipidemia, with this information you could identify whether a food is high in fat. Arming veterinarians and veterinary technicians with the ability to convert proximate analysis to an energy basis would be a good filtering tool. Even if veterinary professionals recommend a specific brand, within that brand there could be considerable variation in the nutrient profile. For example, with Fancy Feast, the fat level among different flavors can range from 25% up to 55%. That’s a huge difference from a physiologic point of view. Todd-Jenkins: That’s a good point. How much fat is too little or too much, and how much protein is too much or too little? Veterinarians and veterinary technicians need some type of quick reference guide: If the label specified grams of fat or grams of protein, that information could help veterinarians make a decision in selecting a diet. www.VetTechJournal.com
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CE Article #1
Managing
Obesity in Dogs and Cats By Dana Call, RVT, VTS (ECC) Oklahoma State University–Oklahoma City
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Patient Assessment Patient History Obtaining a thorough patient history is the first step in evaluating the nutrition status of a pet. The history should include signalment (i.e., species, breed, age, weight, sex, reproductive status), activity level (i.e., active or sedentary), and environmental factors (e.g., only pet in household, fed by one person or numerous individuals). For patients that are above optimal weight, the information obtained from the history may help to indicate if the weight gain is related 28
JANUARY 2008 | Veterinary Technician
Richboro Veterinary Hospital, Richboro, PA
LTHOUGH NUMEROUS factors may contribute to the development of obesity in pets, overfeeding and underexercising are the two most significant causes.1 With the proper weight loss program, obesity can be successfully treated. Client compliance is also essential to the program’s success. to a medical condition. For example, conditions such as ascites, edema, hyperadrenocorticism, and heart disease may cause weight gain, increased girth, or exercise intolerance.1 To detect weight problems early, each patient should be weighed during every office visit and the weight should be recorded in the patient’s medical record.
Diet History In addition to obtaining a patient history, it is essential that the technician obtain a diet history. A thorough diet history can www.VetTechJournal.com
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help determine exactly what the pet is being fed and what factors should be considered when creating a weight loss plan. If possible, owners should be given a diet history form to fill out before the visit. By filling out the form at home, the owner will be more likely to remember to list all foods, including table scraps and treats, that he or she gives the pet. The diet history form should include questions about the type of food being fed as well as the quantity and frequency (e.g., whether the pet is fed only at mealtimes or is fed free choice). The client should indicate the exact amount of food, in standard (8-oz) cups, that is being fed to the pet. The technician should make sure that the owner is correctly measuring commercial dry food in 8-oz cups. Many owners do not know how much food their measuring scoop holds. It is also important to question the owner about supplements, foods that are fed with medications, table scraps, and treats. In addition, the form should indicate whether the pet is being fed a nutritionally balanced homemade diet, and if so, what ingredients are being used and in what quantity.
Physical Examination Before creating a weight loss program, a complete physical examination should be performed to determine the patient’s health status. A complete blood count, serum chemistry profile, thyroid hormone panel, and urinalysis may be ordered to help the veterinarian rule out a medical condition as the cause of the weight gain. Following the physical examination, the pet’s body condition score (BCS) should be determined. BCS is a semiquantitative method used to determine whether a patient is at optimal weight or is underweight, overweight, or obese. It involves visually assessing the patient’s body condition and physically palpating the patient’s ribs. Palpating the patient will ensure that the assessment is accurate, especially if the pet has a long or thick haircoat. The five-point scalea and the nine-point scale are the two most commonly used BCS systems.2,3 When using the five-point scale, 1/5 indicates that the patient is emaciated, 3/5 is ideal, and 5/5 is grossly obese.2 aTo
download a BCS chart using the five-point scale, visit www.VetTechJournal.com and click on Free Downloads.
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CE Article #1: Managing Obesity When scoring a patient using the nine-point scale, 1/9 is emaciated, 5/9 is ideal, and 9/9 is grossly obese.2 Although either scoring system can be used, the practice should select one system so that the patient is evaluated consistently every time. Another method of estimating body fat is to obtain the patient’s morphometric measurements.b For this method, a measuring tape (graduated in centimeters) is used to measure different parts of the animal’s body.3 There are two sets of measuring points: one for cats and one for dogs. Once the measurements are obtained, an equation is used to convert the morphometric measurements into estimates of percent body fat.3 BCS is often preferred over this method because morphometry requires complex calculations and numerous measurements that can be difficult to obtain. Before creating a weight loss program, the pet’s relative body weight (RBW) should be determined. To obtain RBW, the patient’s current body weight is divided by its optimal body weight.3 Animals that have a RBW of 1.00 or 100% are considered to be at their optimal weight.3 A RBW of less than 1.00 indicates that the patient’s weight is less than optimal.3 RBW values of 1.10 and 1.20 indicate that the patient falls into the overweight or obese category, respectively.3 Several sources can be used to help estimate a patient’s optimal body weight. The best method of obtaining optimal weight is to check the patient’s medical record and locate a recorded adult weight and BCS that were obtained when the animal was classified as being at optimal weight.3 If a BCS is unavailable but the patient’s weight is indicated in the file, then a close estimate would be the patient’s weight at the time it Possible Causes of Obesity reached adult age.3 Most cats Abnormal feeding behaviors and small-to-medium-breed dogs reach optimal body Advanced age weight when they are a year Certain endocrine disorders (e.g., hypothyold. If a dog’s weight history roidism, hyperadrenocorticism)1 is unavailable, the American Kennel Club has weight listDecreased activity level ings that are categorized by Diet composition and palatability breed and sex.3 However, the Genetic predisposition American Kennel Club only provides information about Increased caloric intake purebred dogs, not mixed Living environment (e.g., more than one breeds. Once the patient’s person feeds the pet) optimal weight has been established, a weight loss proSex and reproductive status gram can be created.
Creating A Weight Loss Program After it has been determined that a pet is overweight or obese, treatment options, including changes in diet and physical activity, should be discussed with the client. Any medical conditions and deficiencies noted during exercise must be considered when developing a weight loss protocol. It is important to keep in mind that changes in diet to achieve weight loss may be an additional challenge in animals with medical conditions (e.g., diabetes mellitus, renal compromise). bFor more information about morphometric measurements, see Burkholder WJ, Toll PW: Obesity, in Hand MS, Thatcher CD, Remillard RL, Roudebush P (eds): Small Animal Clinical Nutrition, ed 4. Topeka, KS, Mark Morris Institute, 2000, pp 401–430.
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JANUARY 2008 | Veterinary Technician
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CE Article #1: Managing Obesity
owners should be instructed to use an 8-oz scoop to measure dry food.
Glossary
Body condition score Semiquantitative method of evaluating body composition, commonly using a nine-point or five-point scale, to determine whether an animal is at optimal weight or is underweight, overweight, or obese Hepatic lipidosis Abnormal accumulation of lipids in the liver, causing severe disease in cats Kilocalorie (kcal) Unit of heat equal to 1,000 calories Morphometry Measurement of form
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anorexia Lack or loss of appetite
Nutritional Requirements and Intake Adjustments Dietary therapy is the foundation of weight management in companion animals.4 Dogs and cats are believed to require more than 50 nutrients to maintain good health and quality of life5; therefore, an animal’s intake of essential nutrients should be considered when creating a weight loss program. Weight gain and obesity result when the animal’s daily consumption of calories exceeds its daily energy expenditure over time.3 Therefore, a patient’s energy requirement should be determined before initiating any changes in food intake. Energy requirement can be calculated using one of several methods. The box on page 34 explains how to properly calculate metabolizable energy requirement. Once the animal’s energy requirement is established, the number of calories being consumed should be compared with the number of calories needed for weight loss. The calorie content of all food, including treats, should be determined.3 Feeding a nutritionally balanced diet that provides 60% to 70% of the calories necessary to maintain current body weight usually results in adequate weight loss.1 After the
JANUARY 2008 | Veterinary Technician
veterinarian assesses the patient’s blood work and physical examination findings, he or she will be better able to determine if the patient’s current commercial diet is adequate or if the patient would benefit from a prescription weight loss diet. In cats, calorie restrictions should be conservative so that the cat is not fed less than 60% of its daily energy requirement at the start of the dietary adjustment.6 Technicians must tell cat owners to make sure that their cat continues to eat while the dietary changes are being implemented. Some cats may develop anorexia because of stress or attempts to change their food type.6 Because of the risk of hepatic lipidosis, cats cannot go longer than 48 hours without food.
Physical Activity Weight loss programs that rely on calorie reduction alone may fail to help the patient lose weight. Exercise is the best method of ensuring that the energy expended is greater than the number of calories consumed.3 Overestimation of energy requirement based on current body weight and relatively low levels of daily exercise may stifle weight loss. Slowly introducing physical activity during weight loss has many www.VetTechJournal.com
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CE Article #1: Managing Obesity benefits, including regulating food intake and building muscle (lean tissue). Because exercise requires energy, dietary restriction combined with exercise forces the body to use fat stores for energy.3 For pets that are sedentary, the duration and intensity of exercise should slowly be increased as endurance improves. The owner should set a goal of 20 minutes of exercise 3 to 5 times a week.1 The exercise program should be determined by the physical capabilities and health of the pet and should be deemed safe and tolerable.3,6 Swimming can sometimes be advantageous for pets with osteoarthritis or cardiopulmonary disease. More calories per minute can be burned by swimming than by walking; therefore, the same number of calories can be expended in less time.3 Increasing a cat’s level of physical activity is challenging. Some cats can be trained to walk on a leash, although indoor cats may be reluctant to do so. Providing motorized play units and “fishing rod” toys may encourage a cat to play. In addition, offering feeding toys or placing the pet’s food bowl in different areas of the house may entice the cat to move around.4 Use of play rewards may lead the pet to initiate play and exercise interactions.
Implementing a Weight Loss Program
Free Download! A Diet History Form can be downloaded at www.VetTechJournal.com
Weight reduction protocols should be tailored to the individual patient. Slow transitions may yield greater long-term benefits. To help decrease begging, the technician can suggest that the owner offer more frequent meals while reducing overall daily food intake.7 Another way to discourage begging is to encourage the owner to keep the pet out of the kitchen while meals are being prepared and eaten.1 The technician can also suggest alternatives to table scraps or high-calorie treats. Air-popped popcorn, unflavored rice cakes, baby carrots,7 or cereals such as Cheerios or shredded wheat squares are possible substitutes.c While the pet is participating in the weight loss program, the owner should be encouraged to keep a food diary that details cA Heintz, DVM; J Lee, DVM: Personal communication, Wedgewood Pet Clinic, Oklahoma City, Oklahoma, 2007.
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every food item, including treats and table scraps, consumed by the pet. Low-calorie treats can be given as long as they do not exceed 10% of the pet’s total caloric intake.8 Owner compliance is essential to weight loss in a pet. Therefore, technicians should counsel clients about the numerous health benefits that their pet will receive by losing excess weight. Some of the benefits include increased longevity,9 maintenance of body condition, reduced risk of musculoskeletal disorders, and improved glucose tolerance.4 The veterinarian should review the diet plan with the owners. The technician can then provide a BCS chart, a measuring cup, an exercise plan, and nutritional information on diets and treats. To monitor progress, staff members should encourage the owner to bring the pet to the clinic for monthly assessments.8 Monitoring the patient’s progress is essential and requires staff involvement.
Patient Monitoring A weight loss goal of 1% to 2% of body weight per week is recommended for most pets. A balance between effective gradual weight loss and minimal loss of lean body
Calculation of Metabolizable Energy (ME) Requirementa adult Dogs at Maintenance K = 99 (inactive) 132 (active) 160 (extremely active) K х Body weight (kg)0.67 = ME requirement Example: ME requirement of an active 10-kg (22-lb) dog: 132 х (10 kg)0.67 = 617.4 kcal of ME/day adult Cats at Maintenance Sedentary house cats: 50 kcal/kg х Wkg Moderately active house cats: 60 kcal/kg х Wkg Extremely active house cats: 70 kcal/kg х Wkg Example: ME requirement of a moderately active 4-kg (9-lb) cat: 60 kcal х 4 kg = 240 kcal of ME/day a Adapted from Case LP, Carey DP, Hirakawa DA, Daristotle L: Energy balance, in Canine and Feline Nutrition: A Resource for Companion Animal Professionals, ed 2. St. Louis, Mosby, 2000, pp 375–388.
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CE Article #1: Managing Obesity tissue is optimal. Owners should be informed that weight loss in pets requires a lifelong commitment. It may take several months for a pet to lose weight. If weight loss is not evident during regular assessments, modifications in diet and exercise may be required. Slight reductions in body weight or BCS represent success; therefore, the owner should be congratulated for complying with the program.10
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Conclusion Implementing a weight loss program in the clinic can improve patient care and longevity. Technicians can encourage compliance by sharing obesity prevention strategies with clients and recommend methods to reduce food intake as pets reach maturity and are neutered or spayed.3 They should also weigh patients at every visit and assess BCS. Owners who understand the importance of keeping their pet’s weight at an optimal level can work with the staff to keep their pet healthy.
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References 1. Case LP, Carey DP, Hirakawa DA, Daristotle L: Obesity, in Canine and Feline Nutrition: A Resource for Companion Animal Professionals, ed 2. St. Louis, Mosby, 2000, pp 303–330. 2. Remillard RL: Obesity: A disease to be recognized and managed, in Ettinger SJ, Feldman EC (eds): Textbook of Veterinary Internal Medicine, vol 1. St. Louis, Elsevier– Saunders, 2000, pp 76–78. 3. Burkholder WJ, Toll PW: Obesity, in Hand MS, Thatcher CD, Remillard RL, Roudebush P (eds): Small Animal Clinical Nutrition, ed 4. Topeka, KS, Mark Morris Institute, 2000, pp 401–430. 4. German AJ: The growing problem of obesity in dogs and cats. J Nutr 136(7 Suppl):1940S–1946S, 2006. 5. Campbell KL, Corbin JE, Campbell JR: Companion Animals: Their Biology, Care, Health, and Management. Upper Saddle River, NJ, Prentice Hall, 2005, pp 168– 211. 6. Wills JM, Simpson KW (eds): The Waltham Book of Clinical Nutrition of the Dog and Cat, ed 1. Boston, ButterworthHeinemann, 1994, pp 131–145. 7. Kaplan H, Gurven M: The Natural History of Human Food Sharing and Cooperation: A Review and a New Multi-Individual Approach to the Negotiation of Norms. Preliminary Draft. Prepared for the Conference on the Structure and Evolution of Strong Reciprocity, Santa Fe Institute, Santa Fe, NM, March 9–11, 2001; cited with permission (Gurven M).
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8. Yaissle JE, Holloway C, Buffington CA: Evaluation of owner education as a component of obesity treatment programs for dogs. JAVMA 224(12):1932–1935, 2004. 9. Kealy RD, Lawler DF, Ballam JM, et al: Effects of diet re-
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Peer Reviewed striction on life span and age-related changes in dogs. JAVMA 220(9):1315–1320, 2002. 10. Delaney SJ: Identify At-Risk Patients When Battling
ABOUT THE AUTHOR
Dana Call, RVT, VTS (ECC)
Obesity in Companion Animals. Accessed December 2007 at www.dvmnews.com/dvm/DVM+InFocus/ Identify-at-risk-patients-when-battling-obesity-in/ ArticleStandard/Article/detail/162668.120.
“Obesity is a debilitating condition that has many side effects and can cause many secondary medical conditions,”says Dana. “It is also one of the few conditions that the veterinary team will face that is preventable and curable with time, patience, and effort.”Dana is a staff veterinary technician and instructor at Oklahoma State University–Oklahoma City. She also works as a senior emergency and critical care technician at the Veterinary Emergency and Critical Care Hospital in Oklahoma City. She and her husband, Jim, have three sons and a daughter. Dana appeared on our February 2007 cover with Oreo (pictured), who unfortunately passed away in October.
Article #1 CE Test The article you have read qualifies for 0.5 credit hour. To receive credit from Alfred State College, choose the best answer to each of the following questions. Either mark the answers on the postcard inserted in this issue of Veterinary Technician and fax (800-589-0036) or mail the card to us, or participate online.
Take this CE Test online at www.VetTechJournal.com
1. Which of the following would not be asked on a diet history form? a. Is the pet fed any supplements? If so, what kind? b. Does the pet show aggression when other pets in the household are being fed? c. Is the pet fed any food when given medications? d. How many individuals in the family give food to the pet? 2. As part of the medical evaluation, the veterinarian may order a __________ to rule out a medical condition. a. thyroid panel b. complete blood count c. urinalysis d. all of the above 3. Which of the following is not a method of obtaining a BCS? a. 3-point scale b. 5-point scale c. 9-point scale d. none of the above www.VetTechJournal.com
4. When measuring commercial dry food, owners should be instructed to use a standard cup, which is a. 4 oz. b. 6 oz. c. 8 oz. d. 10 oz. 5. Which of the following is false? a. Cats that go longer than 48 hours without eating are at risk of developing hepatic lipidosis. b. Obtaining morphometric measurements is the most common method of obtaining a BCS. c. A weight loss protocol should be tailored to the individual patient. d. A measuring tape (graduated in centimeters) should be used to obtain morphometric measurements. 6. In regard to RBW, a value of __________ is considered optimal. a. 0.10 b. 1.00 c. 1.10 d. 1.20
7. A nutritionally balanced diet that provides __________ of the calories necessary to maintain current body weight usually results in adequate weight loss. a. 60% to 70% b. 65% to 75% c. 75% to 85% d. 80% to 90% 8. Which of the following is considered to be a cause of obesity? a. genetic predisposition b. neutering c. hypothyroidism d. all of the above 9. For most pets, a weight loss goal of __________ of body weight per week is recommended. a. 1% to 2% b. 2% to 3% c. 3% to 4% d. 4% to 5% 10. More calories can be burned per minute by __________ compared with __________. a. swimming; walking b. walking; swimming c. walking; running d. a and c Veterinary Technician | JANUARY 2008 37
CE Article #2 amy N. Breton, CVT, VTS (ECC) Veterinary Emergency and Specialty Center of New England Waltham, Massachusetts
The Anatomy of the Liver and How It Functions
C
ERTAIN DISEASE PROCESSES can cause liver failure; therefore, it is crucial that technicians understand not only how the liver functions but also how to test for the presence of and treat various liver diseases. Technicians who can conduct the different tests used to diagnose liver disease play a key role in client education and are able to provide better care for their patients.
bacteria. The hepatic artery supplies the remaining 20% of the blood to the liver. This blood, which is rich in both oxygen and nutrients, supports the high metabolic activity of the hepatocytes. The hepatocytes secrete hormones and bile, a yellowish-green digestive liquid. The bile is carried through channels of increasing size to the gallbladder and the common bile duct, which leads to the duodenum, where the bile is released.4
Physiology Anatomy The liver, a brownish-red, friable organ, is the largest gland in the body. It is located in the cranial abdomen and is shaped to fit around neighboring structures â&#x20AC;&#x201D; for example, its caudal surface is concave (to fit around the stomach), and its cranial surface curves with the diaphragm.1 Most of the liver is encased in peritoneum. The liver consists of six lobes.2 The lobes are separated into tiny hepatic lobules, which help filter blood through the liver.3 The hepatic cells (i.e., hepatocytes) line the lobules and radiate toward a central vein.3 As an animal ages, its liver atrophies; therefore, the liver in young animals weighs more than the liver in adult animals.1 The liver has a unique venous system called the hepatic portal system, which receives both oxygenated and deoxygenated blood.4 All products of digestion are filtered through the liver,4 and approximately 80% of the blood that flows into the liver enters via the portal vein and originates from the stomach and intestines.3 The hepatocytes are nourished by this blood, which is rich in nutrients but not in oxygen.3 As the blood enters the lobules, plasma flows across the hepatocytes and filters into the central vein; the blood then travels from the central vein into the hepatic vein and eventually into the caudal vena cava.5 As the blood is filtered through the liver, it passes through Kupffer cells, which help to remove 38
JANUARY 2008 | Veterinary Technician
Bile plays an important role in digestion, and bile production is one of the main functions of the liver. Bile consists primarily of bile salts, water, and bile pigments such as bilirubin (which is created when old red blood cells break down) and biliverdin.3 Bile salts enhance the absorption of fatty acids and some fat-soluble vitamins, such as vitamins A, D, E, and K.3 Without bile salts, vitamin deficiencies can occur. One of the most important functions of bile is to emulsify fat so that it can be broken down by digestive enzymes in the gut.6 The liver also plays an important role in carbohydrate metabolism; in a process called glycolysis, the liver metabolizes carbohydrates by converting excess glucose into glycogen, which is then stored.7 Stored glycogen is converted back into glucose and released into the body to supply energy.7 The entire process (glycogenolysis) is controlled by the hormone glucagon, which is produced byÎącells in the islets of Langerhans in the pancreas. When glucagon is released, glycogenolysis begins. Patients with liver failure may have decreased glucose levels. The liver also plays a vital role in deamination, in which amino acids are broken down by removal of an amino group. Because excess amino acids cannot be stored, they are converted into enzymes or energy by various tissues in the body. The discarded amino group, however, is converted into ammonia and then www.VetTechJournal.com
into urea or uric acid, which is excreted safely through renal filtration.1,3 Animals with liver failure may have increased levels of ammonia and decreased levels of blood urea nitrogen. The liver also synthesizesα- andβ-globulins, which transport lipids and fat-soluble vitamins throughout the body.3 Prothrombin is one of the most important α-globulins produced by the liver. Factor X — an enzyme that requires vitamin K for synthesis — and calcium ions help convert prothrombin into thrombin.3 Prothrombin and thrombin are necessary for coagulation. If the liver is damaged, the body’s ability to coagulate blood may be affected. In addition to synthesizing globulins, the liver helps to synthesize lipoproteins, phospholipids, and cholesterol and aids in fat metabolism by oxidizing fatty acids at a high rate.3 It also helps to convert carbohydrate molecules into protein molecules and fat,3 which is then transported by the blood back into the adipose tissue, where it is stored and may be used for energy.3 The liver stores many substances, including iron and vitamins A, D, and B12.3 It also helps destroy damaged red blood cells and foreign substances (e.g., drugs),7 alters toxins such as alcohol by detoxifying them, and excretes toxins in bile. The liver is the primary organ involved in drug and toxin metabolism. The liver plays a role in thermoregulation by helping to produce heat and maintain body temperature through cellular metabolism (i.e., the more active the cells, the more heat they produce).
Disease Processes Certain disease processes can cause liver failure. To maintain high-quality patient care, it is important to conduct diagnostic tests to diagnose liver problems. If any of the following diseases or conditions is present, liver disease should be suspected. Although any inflammatory disease can affect the liver, the condition usually must be severe (e.g., anaphylactic shock, systemic inflammatory response syndrome, pancreatitis). Because a large amount of blood is filtered through the liver, any change in the circulatory system could affect the liver. Severe anemia can result in hypoxia, thereby affecting the liver.8 When the blood supplied to the liver is not appropriately oxygenated, the liver can be damaged. If the liver www.VetTechJournal.com
Amy N. Breton, CVT, VTS (ECC)
Peer Reviewed
is damaged because of injury or disease, it may not be able to store vitamins sufficiently, including vitamin B12, which is needed for hemoglobin production. Because the liver helps to regulate glucose, liver disease should be suspected when a patient presents with hypoglycemia. Shock can lead to liver damage. In dogs, the liver and gastrointestinal tract are the main body structures affected by shock.9 In cats, the main organ affected by shock is the lungs.9 In cats with anorexia, hepatic lipidosis is a major concern. Triglycerides accumulate in the blood, overwhelming the liver and potentially causing severe liver dysfunction. When petechiae or ecchymoses are observed on a patient, liver involvement should be suspected. Because the liver plays a vital role in coagulation, bleeding under the skin indicates that the body’s clotting ability may be jeopardized. To determine if there are any signs of hemorrhage, each patient should undergo a complete physical examination, including inspection of the mucous membranes, sclera, and inguinal areas.
Liver in a dog with hepatic neoplasia. Note the nodules present.
Diagnostic Testing Serum Chemistry Profile The most common laboratory tests conducted to evaluate the liver are those that measure the level of specific enzymes, such as alkaline phosphatase (ALP), aspartate aminotransferase (AST),γ-glutamyltransferase (GGT), and alanine transaminase (ALT). An elevation in the level of any of these enzymes usually indicates liver damage resulting from trauma or disease. Veterinary Technician | JANUARY 2008 39
CE Article #2: The Liver Increased levels of other blood components, such as ammonia and bilirubin, may also be indicative of liver disease. In addition, urinalysis and coagulation testing can be used to determine whether the liver is functioning properly.
Oral solution for use in dogs only.
CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: SLENTROL (dirlotapide) Oral Solution is indicated for the management of obesity in dogs. CONTRAINDICATIONS: SLENTROL should not be used in cats. SLENTROL increases the risk of producing hepatic lipidosis during weight loss in obese cats. SLENTROL is not recommended for use in dogs currently receiving long-term corticosteroid therapy. Do not use in dogs with liver disease. WARNINGS: Not for use in humans. Keep this and all drugs out of reach of children. Adverse reactions associated with humans ingesting dirlotapide include: abdominal distention, abdominal pain, diarrhea, flatulence, headache, increased serum transaminases, nausea, and vomiting. SLENTROL may cause eye-irritation. If accidental eye exposure occurs, flush the eyes immediately with clean water. PRECAUTIONS: Safety in breeding, pregnant, or lactating dogs has not been established. Caution should be taken when considering any weight loss program in growing dogs, including treatment with SLENTROL. SLENTROL has not been evaluated in dogs less than 1 year of age. All dogs should undergo a thorough history and physical examination that includes laboratory tests to screen for underlying conditions. Pre-existing endocrine disease, including hyperadrenalcorticalism (Cushing’s disease), should be managed prior to use of SLENTROL. SLENTROL may produce a mild to moderate elevation in serum hepatic transaminase activity. If the elevation in alanine aminotransferase (ALT) activity is mild, continue SLENTROL and monitor as needed. If there is a marked elevation in ALT activity above the normal reference range or there is a simultaneous increase in aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transferase (GGT), or total bilirubin, discontinue treatment with SLENTROL. Elevations in hepatic transaminase activity usually decrease when SLENTROL is discontinued. The safety of SLENTROL use in dogs has not been evaluated beyond 1 year. ADVERSE REACTIONS: The adverse reactions associated with treatment with SLENTROL include vomiting, loose stools/diarrhea, lethargy, and anorexia. These adverse reactions were mainly observed during the first month of treatment or during the week after a dose increase. Vomiting was usually mild in severity, of short duration, and resolved with continued SLENTROL treatment. The SLENTROL-treated dogs generally had an increased frequency and duration of vomiting and diarrhea compared to the control dogs. The control dogs received corn oil.
Alkaline Phosphatase ALP is an enzyme in the biliary duct cells of the liver. ALP levels in plasma increase because of bile duct obstruction, intrahepatic cholestasis, or infiltrative diseases of the liver.8
Aspartate Aminotransferase AST is an intracellular enzyme that aids the transfer of amino groups during conversion from amino acids to α-oxoacids.8 AST levels increase when hepatocytes degenerate or undergo necrosis; they may also increase after a patient takes medications, such as antiseizure drugs, or after a traumatic injury (e.g., being struck by an automobile). AST and ALT levels are related to the number of damaged hepatocytes; however, the damage may be reversible.8
γ-Glutamyltransferase
Adverse Reactions During Weight Loss: Percentage of Patients with Reported Signs Treatment
Control n = 88
SLENTROL n = 170
Vomiting Diarrhea Lethargy Anorexia Constipation Dehydration
21.6% 6.8% 3.4% 2.3% 1.1% 0%
24.7% 12.4% 9.4% 7.6% 2.4% 1.2%
GGT, an enzyme found in the bile ducts, is usually tested in conjunction with ALP in order to rule out cholestasis. When GGT testing is conducted in conjunction with ALP testing, it has been shown that the diagnostic value of these tests is improved compared with either test alone.8
In addition to the adverse reactions listed above, there were other abnormal findings. Many control and SLENTROL-treated dogs had dental disease, abnormal skin and ear findings, and lameness/arthritis. The incidence of these findings were similar in both control and SLENTROL-treated groups and most dogs had similar lesions noted pre-treatment. Two dogs in the SLENTROL treatment group developed corneal ulcers. One SLENTROL-treated and one control dog developed signs consistent with pancreatitis. One treated dog developed inappropriate urination and defecation and another treated dog developed polyuria and polydipsia. A 5-year-old Beagle with no medical history of seizures in the SLENTROL treatment group had a seizure on Day 52 of the study. The dog continued to receive SLENTROL until additional seizures occurred 11 and 12 days later. The investigator referred the case to a neurologist and the seizures continued approximately twice weekly. The neurologist found no lesions that support the causality of the seizures. A 5-year-old Dachshund developed a hepatopathy after 82 days of treatment and was withdrawn from the study for vomiting, increased hepatic enzymes, and anorexia. Vomiting continued for a few days after stopping treatment and the dog was hospitalized due to the anorexia. ALT activity levels continued to rise after all clinical observations resolved. During weight stabilization, vomiting (16.1%) and lethargy (4.8%) were the most frequent adverse reactions associated with treatment with SLENTROL. Other adverse reactions included diarrhea (1.6%), anorexia (1.6%), and ataxia (1.6%). In the post-treatment period, a 6 year old spayed female Chihuahua, was found dead by the owner 7 days after stopping dirlotapide therapy. The cause of death was not conclusive but did not appear to be related to the dirlotapide therapy. Some dogs treated with SLENTROL displayed a mild to moderate elevation in serum hepatic transaminase activity early in treatment that decreased over time while treatment continued. Hepatic transaminases generally returned to normal when treatment was discontinued (See Precautions for further information).
Alanine Transaminase ALT is an enzyme in hepatocytes. When a cell is damaged, ALT enters the bloodstream. ALT levels increase dramatically in patients with acute liver disease; however, an elevated ALT level does not necessarily indicate liver damage. A patient can have normal fluctuations in ALT levels throughout the day.10 Certain drugs, such as corticosteroids, as well as hepatic injury (e.g., resulting from being struck by an automobile) can also cause an increase in ALT levels.10
Albumin Albumin, which is synthesized in the liver, is a major protein found in plasma. It is responsible for maintaining colloid osmotic pressure and helping to prevent plasma loss from the capillaries. Patients with chronic liver disease can have decreased albumin levels.11 By themselves, tests measuring albumin levels cannot determine the degree of liver damage; however, these tests can be used as an additional diagnostic tool.
Serum Chemistry Results: Percentage of Dogs Control n = 88 Serum Analyte ALT a > 120 IU/L AST b > 60 IU/L ALP c > 125 IU/L Cholesterol > 320 mg/dL
SLENTROL n = 170
Pre d
Post e
Pre d
Post e
3.4% 0% 11.4% 14.8%
6.0% 4.8% 16.9% 9.6%
4.7% 3.5% 17.6% 14.7%
9.9% 9.2% 9.9% 4.6%
Ammonia
a ALT = serum alanine aminotransferase activity, b AST = serum aspartate aminotransferase activity, c ALP = serum alkaline phosphatase activity. Dogs with ALP activity > 325 IU/L were excluded from the study. d Pre = % of dogs with values above the laboratory reference range at pre-treatment. e Post = % of dogs with values above the laboratory reference range after 4 months of treatment.
Ammonia levels in the blood increase when the liver is not able to convert ammonia into urea. Elevated ammonia levels may indicate the presence of a liver shunt or hepatitis.12
To report a suspected adverse reaction call Pfizer Animal Health at 1-800-366-5288. For a copy of the Material Safety Data Sheet (MSDS) for SLENTROL oral solution call 1-800-733-5500.
Bilirubin
STORAGE INFORMATION: Store in original container at room temperature 15° to 30° C (59° to 86° F).
Bilirubin — a product of the breakdown of hemoglobin — undergoes conjugation, a process in which the liver makes bilirubin water soluble. In patients with liver damage, conjugation may not occur, causing total bilirubin levels to increase (hyperbilirubinemia). Total bilirubin, the total amount of bilirubin detected in the blood, includes conjugated and unconjugated bilirubin. Some conditions, such as bile duct obstruction or
HOW SUPPLIED: SLENTROL is available in 20, 50 and 150 mL bottles containing 5 mg/mL of dirlotapide in solution. U.S. Patent No. 6,720,351 NADA #141-260, Approved by FDA Distributed by: Div. of Pfizer Inc NY, NY 10017
820 600 000 October 2006
40
JANUARY 2008 | Veterinary Technician
www.VetTechJournal.com
SLENTROL W ORKS —
TAKE UP TO 20% OFF
AVERAGE WEIGHT LOSS OF 3% PER MONTH SLENTROL provides a medically appropriate approach to weight loss with steady and dependable results —97.8% of dogs that completed a 4-month study lost weight. Mean weight loss was 11.8%1 SLENTROL works by decreasing appetite and reducing food intake SLENTROL should be used as part of an overall weight-management program that includes a nutritionally balanced diet and exercise
Individual results will vary. Of the 141 dogs completing the study, maximum body weight loss was 29.5%; 1 dog lost no weight and 2 gained weight to a maximum of 1.8%.1 SLENTROL should not be used in cats, dogs receiving long-term corticosteroid therapy, or in dogs with liver disease. The most common side effect is vomiting. In addition, dogs may experience diarrhea, lethargy, or anorexia. The client should be made aware that if any of these signs persist for more than 2 days the dog should be re-evaluated. SLENTROL is not for use in humans under any circumstances.
For more information,See please visit www.SLENTROL.com Page 40 for Product Information Summary
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Reference: 1. Data on file. 1962C-60-03-671 (addendum). Pfizer Inc, New York, NY.
© 2007 Pfizer Inc. All rights reserved.
Printed in USA/August 2007
LESS WEIGHT. MORE LIVING.
CE Article #2: The Liver hemolytic anemia, can cause increases in total bilirubin levels.12 Direct bilirubin includes only the portion of bilirubin that has undergone conjugation. If the direct bilirubin level is normal and the total bilirubin level is high, then it is likely that the patient has excessive unconjugated bilirubin (e.g., hemolysis). However, if the direct bilirubin level is high, then the patient has excessive conjugated bilirubin, potentially signaling the presence of a condition such as neoplasia or gallstones.12
agnostic testing should be conducted to rule out liver disease.
Blood Urea Nitrogen
Radiography
Blood urea nitrogen may be decreased in patients with advanced liver disease because they are not able to convert nitrogenous waste products into urea.
Radiography is a useful tool but does not usually provide a diagnosis. For example, hepatomegaly can often be observed on a radiograph; however, a tumor originating from the liver rarely can be seen on a radiograph. If neoplasia is suspected, it is important to obtain left, right, and ventrodorsal chest views to look for metastases.
Coagulation Tests It is important that abdominal taps, multiple venipunctures (especially those involving the jugular veins), and cystocentesis are not performed until the patient’s clotting times are checked and are within normal limits.
Prothrombin Time Prothrombin is anα-globulin needed for the coagulation of blood. The prothrombin time (PT) test is performed to assess the extrinsic pathway of the coagulation cascade. Liver disease should be suspected in any patient that has a prolonged PT; however, a prolonged PT does not specifically indicate the presence of liver disease, and a normal PT does not indicate the absence of liver disease.
Imaging Abnormal results on certain blood tests usually indicate that a patient has some type of liver damage. Although some diseases can be ruled out after test results are obtained, the cause of liver damage cannot usually be determined by blood tests alone. Imaging can be used to reveal tumors, obstructions, or other abnormalities.
Ultrasonography Ultrasonography can also be used as a diagnostic tool when managing a patient with liver disease. Gallbladder obstructions, tumors, bile duct obstructions, and lipidosis can often be diagnosed with ultrasonography. Ultrasonography can distinguish between solid and fluidfilled masses; however, it cannot yield a definitive diagnosis. It is important that a qualified ultrasonographer — ideally, one who is board certified — conduct the test. For example, finding a liver shunt (portosystemic shunt) in a small puppy can be difficult even for a highly trained individual.
Activated Partial Thromboplastin Time Thromboplastin is a clotting factor that converts prothrombin into thrombin. The activated partial thromboplastin time test assesses the intrinsic pathway of the coagulation cascade to determine how long it takes a patient’s blood to clot. PT and activated partial thromboplastin time tests are generally conducted at the same time.
Urinalysis Urinalysis should be conducted to determine whether bilirubin is present in the urine (i.e., bilirubinuria). Trace amounts of bilirubin are normal in a concentrated urine sample from a dog, but such findings are abnormal in a cat.9 If bilirubinuria is evident, additional di42
JANUARY 2008 | Veterinary Technician
Serum Protein Electrophoresis Serum protein electrophoresis is used to measure the levels of different types of proteins. This test is useful for evaluating patients that have abnormal results on liver function tests because it allows a direct quantification of multiple serum proteins, such as total protein, albumin, and α-, β-, and γ-globulins. Different liver diseases can cause elevations in different globulins.4
Biopsy Ultrasound-Guided Fine-Needle Aspiration Fine-needle aspiration biopsy can be a very useful diagnostic tool; however, it is associated with an increased risk of complications bewww.VetTechJournal.com
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cause patients with liver disease may have clotting abnormalities and may hemorrhage. Fine-needle aspiration biopsy can also be performed “blindly,” without ultrasonography. However, samples obtained blindly are often of poor diagnostic quality. Because the liver plays a role in the coagulation cascade, it is important to rule out any clotting problems before obtaining a sample. Little to no sedation is generally needed to perform the biopsy procedure; however, patient movement may result in liver laceration and retrieval of an inadequate sample. Certain diseases or types of neoplasia can be diagnosed using this method; however, the sample obtained does not always yield a diagnosis. A percutaneous needle can also be used to obtain a biopsy sample. The sample obtained using a percutaneous needle is larger than that obtained using a fine needle but can also be nondiagnostic.
Laparoscopic Compared with needle biopsy, laparoscopic biopsy can be used to obtain a larger sample of the affected area of the liver, and the laparoscope provides a better view of the liver than does ultrasound imaging. Laparoscopic biopsy is more invasive than ultrasoundguided fine-needle aspiration biopsy; therefore, patients are placed under general anesthesia. However, just as with needle biopsy, it is important to ensure that the patient does not have any clotting problems before laparoscopic biopsy is performed.
Treatment Once a diagnosis has been made, a treatment plan should be formulated. Because there are many treatment options available for patients with liver disease, it is important that clients be informed of and understand these options. Even if the pet’s overall prognosis is good, some clients may decide to forgo treatment because it can be expensive and timeconsuming; other clients may choose to euthanize their pet if it requires long-term care or extended hospitalization. The overall treatment goal for a patient with liver disease is to provide supportive care. During treatment, it is also important to manage complications associated with liver failure, such as gastrointestinal ulceration, anemia, infection, ascites, edema, and coagulopathy.9 Because infection is always a potential complication www.VetTechJournal.com
of liver disease, antibiotics may be used as a preventative. When caring for a patient with liver disease, the technician should frequently monitor all vital systems (e.g., cardiovascular, respiratory, neurologic). Because the technician likely spends the most time with the patient, he or she can alert the veterinarian to early signs of complications. It is also important for the technician to thoroughly evaluate the patient during monitoring. For example, if the color of a patient’s mucous membranes is not checked regularly, the technician may not recognize that anemia has developed. In addition, the color of a jaundiced patient can change hourly, and it is important to notify the veterinarian if any changes occur. Aggressive fluid therapy is one of the most important treatment options when managing a patient with liver disease. Fluid therapy helps to improve hepatic circulation and prevent complications such as disseminated intravascular coagulation, shock, or renal failure.9 Often, 0.45% sodium chloride is used to help prevent sodium retention and portal hypertension.9 Colloids such as hetastarch may be used to help restore oncotic pressure. Electrolyte levels should be monitored, and fluid adjustments should be made accordingly. Ascites may need to be drained in order to in-
Glossary anisocoria Change in pupil size ascites Accumulation of fluid in the abdomen Cholestasis Cessation of the flow of bile from the liver Coagulation cascade Sequence of enzymatic reactions leading to blood clot formation Extrinsic pathway Pathway that is initiated by tissue thromboplastin (factor III) and involves calcium ions and factor VII Gland Group of cells that excrete a substance Hemolysis Destruction of red blood cells Hepatomegaly Enlargement of the liver Intrinsic pathway Pathway in which factors VIII, IX, XI, and XII are activated by exposure to subendothelial collagen or foreign substances Keto acids Organic acids containing a ketone group and a carboxylic group Neoplasia Formation of a tumor Peritoneum Abdominal lining Veterinary Technician | JANUARY 2008 43
Compliance WHAT FEEDS YOU?_____________________ . Let’s face it, pet owners love to give their dogs treats. But when you prescribe a therapeutic diet for a pet, giving the wrong treats can compromise compliance. That’s why we’ve developed a line of healthy, palatable canine treats to complement our therapeutic diets. So you can keep them on track by helping pet owners treat responsibly.
Compliance has never tasted so good. 1-800-222-VETS www.purinavets.com | user name: purinavets | password: nutrition
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crease comfort and ease breathing. When treating a patient with liver disease, proper nutrition is essential. During the initial treatment stages, the patient may not be allowed any food by mouth. Patients that appear nauseous or are vomiting should not be fed. However, in patients that require long-term care, nutritional needs must be considered. A feeding tube may be placed if an animal is unwilling to eat.12 A feeding tube allows for controlled, effective feedings compared with force-feedings using a syringe. Technicians can encourage the patient to eat by offering it a variety of foods or hand-feeding it. Because patients with certain liver diseases require special diets, the veterinarian should be consulted before any feedings are initiated. In patients with diseases such as feline hepatic lipidosis, nutrition plays a crucial role in recovery.9 Certain treatments may be necessary if a patient experiences complications associated with liver disease. For example, mannitol and furosemide may be used to help reduce cerebral edema, which may develop in patients with severe liver disease. Technicians should immediately notify the veterinarian of anisocoria or changes in neurologic status. If a patient develops coagulopathy, freshfrozen plasma may be given. A technician may also be the first person to notice petechiae on the patient.
Follow-Up Often, patients are discharged from the hospital even though they remain slightly jaun-
diced or have elevated levels of liver enzymes. In some cases, it may take months for a patient’s liver to fully recover; therefore, rechecking blood work and/or performing ultrasonography can ensure that treatment is continuing to be effective. Occasionally, a patient may be readmitted to the hospital if its condition worsens. Technicians should educate owners about signs indicating that a pet’s condition has worsened; for example, technicians can explain that the owner can look for signs of jaundice by checking the color of the pet’s mucous membranes and sclera. If the pet becomes lethargic, develops anorexia, begins vomiting, suffers from diarrhea, or exhibits worsening jaundice, the owner should ensure that the pet receives immediate medical attention.
Prognosis Some patients recover quickly from liver disease. Within 24 hours, an animal’s condition can change drastically — an animal that is very jaundiced and lethargic can become alert and exhibit no jaundice. However, some animals experience severe complications from liver disease, potentially resulting in a wide variety of sequelae. Patients with acute liver failure generally have a good prognosis if the disease is diagnosed early and treatment is started immediately.9 Patients with chronic liver disease, however, have a variable prognosis. Patients with neoplasia may have a favorable outcome if complete resection is possible and chemotherapy is started early. However, the
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CE Article #2: The Liver prognosis is guarded in most patients with hepatic neoplasia.9
Conclusion Technicians should know how to test for the presence of and treat various liver diseases and should be able to recognize complications in affected patients. If a technician understands how liver disease affects a patient, he or she can notify the veterinarian about important changes in the patient’s condition.
References
5. Aspinall V, O’Reilly M: Introduction to Veterinary Anatomy and Physiology. Edinburgh, ButterworthHeinemann, 2004. 6. Bowen R: Secretion of Bile and the Role of Bile Acids in Digestion. Accessed December 2007 at www.vivo.colostate.edu/hbooks/pathphys/ digestion/liver/bile.html. 7. Aspinall V: Essentials of Veterinary Anatomy and Physiology. London, Elsevier, 2005. 8. Dial SM: Clinicopathologic evaluation of the liver. Vet Clin North Am Small Anim Pract 25(2):257– 273, 1995.
1. Dyce KM, Sack WO, Wensing CJ: Textbook of Veterinary Anatomy. Philadelphia, WB Saunders, 1987.
9. Wingfield WE, Raffe MR: The Veterinary ICU Book. Jackson Hole, WY, Teton NewMedia, 2002.
2. Rosenfeld AJ: Liver, in The Veterinary Medical Team Handbook: The Team Approach to Veterinary Medicine. Ames, IA, Blackwell Publishing, 2007.
10. Hall RL: Laboratory evaluation of liver disease. Vet Clin North Am Small Anim Pract 15(1):3–19, 1985.
3. Hole J: Essentials of Human Anatomy and Physiology, ed 5. Dubuque, IA, William C. Brown, 1995.
11. Lehrer JK: Medical Encyclopedia: Albumin-Serum. Accessed December 2007 at www.nlm.nih.gov/ medlineplus/ency/article/003480.htm.
4. Dyce KM, Sack WO, Wensing CJ: Textbook of Veterinary Anatomy, ed 3. Philadelphia, WB Saunders, 2002.
12. Tilley L, Smith F: The 5-Minute Veterinary Consult: Canine and Feline, ed 2. Philadelphia, Lippincott Williams & Wilkins, 2000.
ABOUT THE AUTHOR
Amy N. Breton, CVT, VTS (ECC)
“Understanding how the liver functions is essential for technicians,” says Amy, who works in the emergency room at the Veterinary Emergency and Specialty Center of New England in Waltham, Massachusetts, and runs her own behavior consulting service. She and her husband, Joe, have two dogs, one cat, one rabbit, and a tank full of fish.
Article #2 CE Test The article you have read qualifies for 0.5 credit hour. To receive credit from Alfred State College, choose the best answer to each of the following questions. Either mark the answers on the postcard inserted in this issue of Veterinary Technician and fax (800-589-0036) or mail the card to us, or participate online.
Take this CE Test online at www.VetTechJournal.com
1. Which of the following is not a main liver enzyme typically measured in patients with liver disease? a. AST c. bilirubin b. ALP d. GGT 2. Direct bilirubin contains only the portion of bilirubin that has undergone __________ a. hemolysis. b. deamination. 46
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c. systemic inflammatory response syndrome. d. conjugation. 3. Albumin is synthesized in the liver and is responsible for maintaining a. coagulation. b. colloid osmotic pressure. c. plasma proteins. d. production of bile. 4. Trace amounts of __________ are not typically found in a cat’s urine. a. bilirubin b. white blood cells c. granular casts d. protein
5. __________ can be used to diagnose the presence of a liver shunt. a. Radiography b. Ultrasonography c. Serum protein electrophoresis d. Fine-needle aspiration biopsy 6. __________ is a major concern in cats that are not eating. a. Hepatic lipidosis b. Shock c. Inflammatory disease d. none of the above (continues on page 50)
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Veterinary Technician Specialists: Taking It To The Next Level NaTIoNaL CoNFERENCE oF
VETERINaRY TECHNICIaN SPECIaLTY aCaDEMIES MaRCH 28–29, 2008 • TaMPa , FLoRIDa in cooperation with aaHa! Tampa 2008
Qualifies for 15 CE hours Meets CE requirements for veterinary technician specialty certification Sponsored in part by Pfizer Animal Health and Hill’s Pet Nutrition
2008 Program HIghlights AVECCT Donna Oakley, CVT, VTS (ECC) Transfusion Support of the Bleeding Patient Recent Advances in Canine and Feline Blood Compatibility Blood Transfusion: Monitoring for Adverse Events Angel Rivera, CVT, VTS (ECC) An Introduction to the Concept of Immunoneuroendocrine Exhaustion Severe Sepsis: Do the Current Human Guidelines Have a Place in Veterinary Medicine? Hypovolemic Shock
AVTA Susan Barbour, CVT, LAT, VTS (Anesthesia) Preanesthetic Evaluation in Small Animals Cardiovascular Monitoring Respiratory Monitoring Sharon Kaiser-Klingler, RVT, VTS (Anesthesia) Balanced Anesthesia for the Small Animal Patient Blood Gas Analysis in Small Animal Anesthesia Exotic Animal Anesthesia in Private Practice
AVDT Susan Berryhill, BS, RVT, VTS (Dentistry), and Jeanne Perrone, CVT, VTS (Dentistry) Monitoring the Dental Patient … It’s Not “Just a Dental”! Charting Every Dental Patient: A Case-Based Approach to Accurate Charting What’s New in Dentistry? How Is the “Human Side”Influencing the Care We Provide? Gerianne Holzman, CVT, VTS (Dentistry) Endodontics for the Veterinary Technician Orthodontic Therapy for Malocclusions The Whys and Hows of Prosthodontic Treatment
A JOINT PRESENTATION BY Academy of Veterinary Emergency & Critical Care Technicians Academy of Veterinary Technician Anesthetists* Academy of Veterinary Dental Technicians* Academy of Internal Medicine Veterinary Technicians* in partnership with VLS, publisher of Veterinary Technician® *Provisional recognition from the Committee on Veterinary Technician Specialties (CVTS) of NAVTA
AIMVT Lisa Estrin, BS, CVT, LVT Rescue Me: What’s Up with Rescue Protocols for Lymphoma? Diagnostic Imaging in Oncology Radiation Therapy: A Ray of Hope Angela Randels, CVT, VTS (ECC) The Ins and Outs of Fluid Therapy Electrolyte Imbalances Addison’s Disease: Why Does It Get Missed?
For program details visit us at www.ncvtsa.org
EquineEssentials
Rhodococcus equi Pneumonia By Debra Hembroff, aHT Calgary, Alberta, Canada
F
OAL PNEUMONIA, particularly that caused by Rhodococcus equi (also known as Corynebacterium equi), is a devastating disease that can become endemic to some breeding facilities. Technicians with a basic understanding of R. equi pneumonia and the environmental factors necessary for R. equi to thrive and spread can help clients develop husbandry practices that aid in the prevention of this disease. Causative Agent R. equi is a robust, soilborne, gram-positive, facultative, intracellular bacterium that is widespread within the environment. Optimal environmental growth is achieved at 86°F (30°C), and the organism’s simple nutritional needs are easily met by common barnyard manure, such as that of swine, cattle, poultry, and horses.1 R. equi is commonly considered the most deadly respiratory pathogen to infect foals. All horse facilities are likely to be contaminated with this pathogen to some degree; however, healthy horses develop immunity to it by the time they reach maturity.1 Several strains of R. equi exist, but the strain that carries virulence-associated protein A has been found to be particularly pathogenic.2 During the first 12 weeks of a foal’s life, as its immune system develops, ingestion of low concentrations of R. equi likely stimulates the production of natural immunity.1 However, R. equi can replicate exponentially within the intestines of immunologically naive foals, ultimately increasing contamination of the environment. This is likely the reason why some breeding facilities become heavily contaminated by R. equi.1 Exposure to heavily contaminated dust, particularly through inhalation, can overwhelm a foal’s
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developing immune system, allowing infection to occur. This is a particular risk in foals exposed to the virulent form of R. equi, which invades only the macrophages of the lung tissue, creating isolated abscesses that initially develop slowly. In this way, R. equi effectively “hides” itself from the developing immune system of the foal. Diagnosis can be difficult during the early stages of the disease because the foal is initially able to compensate for the loss of lung function and shows few (if any) clinical signs.3,4 R. equi pneumonia is most commonly diagnosed in foals aged 6 to 12 weeks, highlighting the fact that the foal is especially susceptible to infection during the first few weeks of life.1
Clinical Signs R. equi infection is initially suspected on farms where several foals between 4 and 6 weeks of age develop low-grade fever and cough. As mentioned above, the pathogen enters and infects the alveolar macrophages of the lungs, and affected foals develop chronic suppurative bronchopneumonia with extensive abscessation. The lung infection develops slowly and, in some instances, is complicated by diarrhea or colic as a result of concurrent R. equi intestinal infection.3,4 Once clinical signs appear, a foal’s condition often worsens so rapidly that the foal can be critically ill before barn staff are aware of the illness; therefore, careful early monitoring is essential.1 Common clinical signs include fever, increased respiratory effort and bronchial sounds, coughing, and wheezing. Respiratory rates may increase to more than 40 breaths/min.1 Clinical signs of R. equi pneumonia are very similar to those of other respiratory diseases, and a number of diagnostic tests are available to help veterinarians make a definitive diagnosis. www.VetTechJournal.com
EquineEssentials Diagnosis Complete blood count, fibrinogen concentration, serologic study, and radiography can all be used to diagnose respiratory diseases in foals. However, a definitive diagnosis of R. equi pneumonia requires bacterial culture or polymerase chain reaction amplification, combined with cytologic examination of tracheobronchial aspirate.3
Treatment Although R. equi is susceptible to a wide variety of antimicrobial agents, effective treatment can be difficult. The large abscesses created by R. equi are encased with thick, caseous material that forms a barrier to many antibiotics. However, some lipidsoluble antimicrobials, such as erythromycin and rifampin, are able to penetrate this caseous barrier. For this reason, the combination of erythromycin and rifampin has been described as the treatment of choice for R. equi infection.3 When an affected foal is identified, it should be immediately isolated and treated, contaminated manure should be removed from the environment, and stalls and equipment should be disinfected. Any other foals on the property should be considered especially at risk for infection and carefully monitored. Attempts to predict the likelihood of exposure based on barnyard cultures have had mixed results because R. equi can be isolated on affected and unaffected farms.5 To complicate matters further, R. equi thrives in soil, which constitutes a large part of the equine environment and is exceptionally difficult, if not impossible, to disinfect.
Prevention R. equi infection is endemic on some farms and sporadic on others, but fortunately, it does not occur on most, despite widespread environmental distribution.3,4 Although researchers have found most barnyards to be contaminated with R. equi, they have not been able to definitively predict areas of increased virulence.4,5 Because foals spend a lot of time lying down or exploring (sniffing) their environment, they are likely to inhale bacteria-laden dust. Therefore, young foals, especially those up to 4 to 6 weeks of age, should be considered vulnerable. Neonatal foals may become infected in the www.VetTechJournal.com
first few days of life. As research continues into developing a vaccine that is compatible with the developing immune system of very young foals, the following are commonly recommended prevention strategies: Minimize the risk of infection. Infected foals can shed up to 10,000 organisms per gram of manure.1 Practicing good hygiene (i.e., removing manure), decreasing population density, avoiding the use of dusty loafing pens, and foaling during cold seasons (when the organism remains frozen in the ground) can help protect developing lungs.1,3 䊳 Recognize and treat infection at an early stage. R. equi pneumonia is often not recognized until it is well advanced; initially, affected foals are often bright, alert, and vigorous and are sucking well. It is important to critically assess the condition of foals by conducting a thorough physical examination as often as twice weekly on farms with enzootic problems.1,2 Accurate records of information such as temperature, pulse, respiratory rate, and even behavior can be essential tools in the early identification of sick animals. For example, even a sign as subtle as unusual shortness of breath after mild exertion warrants closer evaluation of a foal’s respiratory health status. 䊳
Glossary Bronchopneumonia Acute inflammation of the walls of the bronchioles, with varying amounts of pulmonary consolidation due to spread of the inflammation into peribronchiolar alveoli and the alveolar ducts Caseous Cheeselike Facultative Able to survive under varying environmental conditions Gram stain A method for differential staining of bacteria that is useful in bacterial taxonomy and identification and in indicating fundamental differences in cell wall structure; gram-positive organisms stain purple–black, and gram-negative organisms stain pink Passive immunization Temporary immunization conferred by the introduction of specific antibodies or lymphocytes from a donor (e.g., from a mare to a foal via colostrum) Suppurative Forming pus Virulence The disease-evoking severity of a pathogen
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Implement passive immunization. Vaccination of pregnant mares to increase foals’ passive immunity derived via colostrum has been found to be ineffective.6 Hyperimmune plasma can be used to boost the immune system of foals in endemic areas, but this treatment is expensive and time-consuming and may not supply complete protection. Therefore, if used, passive immunization with hyperimmune plasma should be combined with other preventive strategies.3,7
Conclusion Several pathogens can cause pneumonia in foals. R. equi pneumonia, one of the most deadly forms of foal pneumonia, all too often has a significant economic impact on breeding facilities because of its high mortality rate, the loss of athletic potential in affected foals, and the expense of treatment. A basic understanding of the virulence and life cycle of R. equi will help the veterinary team work with clients to prevent the spread of this deadly pathogen.
ABOUT THE AUTHOR
Debra Hembroff, AHT
References 1. Wright B: Rhodococcus equi Pneumonia of Foals. Accessed June 2007 at www.omafra.gov.on.ca/ english/livestock/horses/facts/90-056.htm. 2. Jain S, Bloom BR, Hondalus MK: Deletion of vapA encoding virulence associated protein A attenuates the intracellular actinomycete Rhodococcus equi. Mol Microbiol 50(1):115–128, 2003. 3. Giguère S: Rhodococcus equi Pneumonia. Accessed June 2007 at www.ivis.org/proceedings/ AAEP/2001/91010100456.pdf. 4. Hondalus MK: Rhodococcus equi: Pathogenesis and Virulence. Accessed June 2007 at www.ivis. org/proceedings/AAEP/1997/Hondalus.pdf. 5. Martens RJ, Takai S, Cohen ND, et al: Prevalence and Virulence of Rhodococcus equi in Sick Foals and Soil of Horse-Breeding Farms in Texas. Accessed June 2007 at www.ivis.org/proceedings/ AAEP/1999/53.pdf. 6. Cohen ND, Chaffin MK, Martens RJ: How to Prevent and Control Pneumonia Caused by Rhodococcus equi at Affected Farms. Accessed November 2007 at www.ivis.org/proceedings/ AAEP/2002/910102000295.PDF. 7. Lunn DP: Practical Foal Vaccination Strategies. Accessed June 2007 at www.ivis.org/proceedings/AAEP/1997/Lunn.pdf.
Debra, a stay-at-home mom, teaches and volunteers on the Veterinary Support Personnel Network. She also is a frequent contributor to Veterinary Technician. She lives in Calgary, Alberta, Canada, with her partner, Wayne, and their son, Christopher. The family shares its home with a rosella parakeet, two cats, and, of course, a horse.
The Liver (continued from page 46) 7. An important part of managing a patient with liver failure is a. frequently walking the patient. b. providing soft bedding. c. thoroughly evaluating the patient during monitoring. d. checking the patient’s packed cell volume and total solids frequently. 8. What fluid can be used to help prevent sodium retention and portal hypertension? a. lactated Ringer’s solution 50
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b. 0.45% sodium chloride c. Normosol-R d. hetastarch 9. Which of the following statements is true regarding patients with acute liver failure? a. Patients can have a good recovery if treatment is started immediately. b. Liver values are always elevated on blood work. c. Owners should be given a guarded prognosis despite
early intervention. d. If the animal is jaundiced, the prognosis is poor. 10. __________ may be given if a patient develops coagulopathy. a. Packed red blood cells b. Fresh-frozen plasma c. Heparin d. Hetastarch
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TechTips
TIP of the MONTH
Each published Tip of the Month contributor receives a Veterinary Technician® scrub top in addition to $50.
Jordan Schr
upp
At my clinic, if we find parasites or other abnormalities when studying a sample under a microscope, we photograph or videotape the finding by placing a digital camera lens against the lens of the microscope. We then show the picture or video to the pet’s owners to help explain why their pet needs treatment.
ugh as seen thro (red arrow) g g e n a d n rrows) a ites (black a Sarcoptic m e. a microscop
Tricks of the Trade After surgery, the gauze knot used to hold endotracheal tubes is often difficult to untie because the gauze is wet and sticky. We use a pair of rat-toothed forceps to grasp one side of the knot, which then comes apart easily with a gentle pull. Yvonne Baden, RVT Toledo, OH Trimming the nails of a nervous or fractious dog can be difficult, so we involve three technicians. We lay the patient on its side on a table. One technician holds the front legs, and another technician holds the back legs. The dog will usually relax and allow the third technician to trim its nails. Desirae Koenig, LVT Bennet, NE At our hospital, we had a patient that needed gastric lavage. Because our hospital rarely performs this procedure, we did not have a suction tip available. Instead, www.VetTechJournal.com
we used the proximal end of an IV line (the part that is inserted into the IV bag) to perform the lavage. Cassie Fay Boulder, CO
“Cath” and Carry We place a small piece of a straw on each side of a catheter before taping the catheter in place. It is then easier to cut off the tape when the catheter is removed. Jill Tally Greenville, IL I work at an emergency clinic where patients are frequently discharged with catheters that need to be removed in several days. We wrap the catheter with Vetrap and a piece of white tape. Then, using a permanent marker, we write the date that the catheter was last flushed and capped so that the client and the referring veterinarian know when to remove the catheter. Amanda Waldon, LVT Jackson, TN
Jordan Schrupp, CVT Detroit Lakes, MN Warm and Fuzzy At my clinic, I create warming bags using fluid bags that are about to expire. I inject a small amount of food coloring into the bag so that staff know which bags are for heating only. The bag can be warmed to the desired temperature in the microwave and then placed under a patient’s blankets. This method is inexpensive, and the bag can be sprayed with disinfectant before it is used for another patient. Michelle Williams, RAHT Victoria, British Columbia, Canada To keep a patient’s temperature from dropping during a long surgery, I give the patient warm IV fluids by wrapping a heated fluid bag around the IV line. I also place a heated fluid bag on the Y-shaped piece of the anesthesia machine so that the patient breathes warm air. Cheryl Owens, RVT Roseville, CA Veterinary Technician | JANUARY 2008 51
TechTips
TECH TIP CHALLENGE
“Scratch” Me If You Can In the October issue, we asked what tips you give clients whose cat won’t use a scratching post. Here are some of your responses: To encourage cats to use a scratching post, I recommend that clients buy a slanted cardboard post and cover it with catnip daily. Cats prefer cardboard posts because they are able to shred them. If a cat is scratching furniture, I suggest that the client put the post near the furniture. Danielle Witmer Lancaster, PA To make a scratching post more enticing to a cat, I suggest that clients apply catnip spray to the post. If the cat continues to scratch the furniture, I recommend temporary nail caps as an alternative. Erin Miles Plantation, FL
?
TECH TIP CHALLENGE $50 paid for each published response! What is the best way to remove ticks? Deadline for responses: February 15.
Answers to our Tech Tip Challenge or other Tech Tip submissions should be sent to: Email: editor@VetTechJournal.com Fax: 800-556-3288 Mail: VLS/Veterinary Technician, 780 Township Line Road, Yardley, PA 19067 We pay $50 for each tip, question, or solution selected for publication. Submissions should not exceed 100 words and will be edited for length and clarity. Photos are welcome. Be sure to include your full name, address, and daytime phone number so that we can contact you. Videotape your tech tips and upload them to www.VetTechJournal.com/sharetechtip. We will pay $100 for every Tech Tip video that we post on www.VetTechJournal.com. Tech Tips are compiled by VLS Editorial Assistant Liz Donovan.
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At our hospital, we instruct clients to provide a post that is at least 3 feet tall because cats like to stretch when they scratch. We also recommend posts that are made from wood, carpet, or rope because cats seem to prefer those materials. Amanda Sontag, LVT Norfolk, VA We instruct clients to offer a variety of scratching posts, including those made from sisal, cardboard, wood, and carpet, to determine their cat’s preference. We also suggest that clients sprinkle catnip on the post and place it in an area that their cat prefers. Elissa Curtin Sammamish, WA
Warm and Fuzzy (cont.)
A Hair-Raising Tale
To help prevent hypothermia, especially in dental patients, we hook two circulating heating pads together: one pad is placed under the patient, and the other pad is placed on top of the patient. Each pad can be hooked into either end of the heating unit motor. The water circulates from the heating unit through both pads and back to the heating unit. Jamie Drown, LVT New Hampton, NH
Before cleaning or administering medicine in a dog’s ears, I use small hair clips to attach the ears to the top of the head. I then have a free hand to stabilize the patient’s head. Julie Squibb Lively, Ontario, Canada
Julie Squibb
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ProductForum Unotron
Andis
Washable DataEntry Devices
Lighted Hair Dryer
Unotron’s line of waterand dust-proof computer equipment is able to withstand contact with liquids and can be completely submerged. Unotron’s products, which include wireless and standard mice, keyboards, and smartcard readers, can be cleaned with soap and water and can withstand the hospital-grade disinfectants that are used in veterinary practice settings. 972-438-8900 䡲 www.unotron.com Circle 101 on Reader Service Card
Spectrum Surgical
Preowned Equipment Spectrum Surgical is now offering preowned certified equipment for veterinary practices. The equipment includes pneumatic and battery-powered handpieces and attachments, rigid and flexible endoscopes, video equipment, and complete tower systems. Spectrum services all makes and models of power equipment, air hoses, rigid and flexible endoscopes, and video equipment. The company also offers free equipment evaluations for mail-in repair. All preowned certified equipment is tested and inspected for quality and comes with a full warranty. 800-444-5644 䡲 www.spectrumsurgical.com Circle 102 on Reader Service Card
For more information about the products highlighted in this section, fill out and return the Reader Service Card inserted between pages 24 and 25 of this issue. The product and service descriptions presented in Product Forum are provided by the manufacturers and are not necessarily endorsed by Veterinary Technician.
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Andis has introduced the ACM-5 Illuminator, the grooming industry’s first illuminated hair dryer. The dryer is equipped with 12 light-emitting diodes, which are designed to cast ultrabright white light to improve visibility and prevent overdrying. The unit comes with an 8-foot cord and incorporates tourmaline and ionic technology. The company claims that ions emitted by tourmaline crystals seal the hair’s cuticle layer and eliminate frizz for smoother, silkier hair and that the ionic technology dries hair faster by breaking apart water molecules. The dryer produces 1,875 watts of power and includes four heat settings and air speeds. 800-558-9441 䡲 www.andis.com Circle 103 on Reader Service Card
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ProductForum Nylabone Products
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Pet Chews
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Nylabone offers a variety of edible and nonedible products that do not contain any ingredients that could be harmful to pets. Currently available products include durable and flexible nonedible chews, Nutri Dent dental chews, Healthy Edibles wholesome chews, Prime Choice edible snacks, and Vida certified organic treats.
Royal Canin now offers the Recovery RS, a highly palatable complete and balanced diet designed to assist in the management of dogs and cats with or recovering from a critical illness. The Recovery RS diet offers high energy density and is enriched with antioxidants and omega-3 fatty acids. The texture of the Recovery RS product is designed to facilitate feeding by syringe and through enteral feeding tubes.
800-631-2188 䡲 www.nylabone.com Circle 104 on Reader Service Card
800-592-6687 䡲 www.royalcanin.us Circle 106 on Reader Service Card
ImproMed
Customer Satisfaction Survey ImproMed has announced that its Infinity software now interfaces with VSurv from Animal Care Technologies. VSurv, a fully automated online customer satisfaction survey, will allow veterinary practices to better serve their clients by giving practices the ability to create their own survey questions or choose from a preexisting list of professionally designed queries. 800-357-3182 䡲 www.impromed.com 䡲 Circle 105 on Reader Service Card
If you bought certain recalled Diamond Pet Food Products in 2005, you may be entitled to a payment from a legal settlement. Legal Notice From The United States District Court For The Eastern District Of Tennessee At Knoxville
A settlement has been reached in a class action lawsuit about certain Diamond Pet Food products. The settlement provides for an amount of up to $3.1 million to pay consumers who purchased recalled Diamond Pet Food products, and to compensate dog owners whose dogs were injured by eating Diamond Pet Food products. WHO'S INCLUDED? You are a Class Member if you bought recalled Diamond Brand or Country Value Brand Pet Food product in 2005, and did not return the food for a refund. You are additionally a class member if your dog was injured or if you incurred a veterinary bill as a result of your dog eating Diamond Brand Dog Food. WHAT IS THIS CASE ABOUT? The lawsuit has alleged that Diamond Pet Foods initiated a recall of certain products in December of 2005, and that certain consumers have not received a refund for recalled food. The lawsuit also alleges that certain dog food manufactured by Diamond contained aflatoxin and that dogs were injured and/or their owners incurred veterinary bills because of the food. Diamond denies that the plaintiff is entitled to the relief sought. The settlement is neither an admission of wrongdoing nor an indication that Diamond violated any laws. A court has not made any findings as to which side is right in the case. The settlement is designed to resolve the case. WHAT DOES THE SETTLEMENT PROVIDE? Diamond has agreed to create a settlement fund of up to $3.1 million to pay for valid claims and for attorneys' fees, costs, and expenses as may be established by the court. The settlement agreement, available at the website, describes the details of the settlement. The settlement provides that consumers who purchased recalled dog food and did not already return it for a refund may receive money, provided the class member establishes that he or she purchased recalled Diamond Dog Food and did
not return it. Additionally, the settlement fund provides that class members who submit a valid claim showing that their dog was injured or that they incurred a veterinary bill as a result of Diamond Dog Food will be entitled to a payment for veterinary expenses. The settlement also provides that Diamond will pay attorneys’ fees, costs, and expenses incurred in this lawsuit. HOW DO YOU ASK FOR A PAYMENT? Call the number listed below or go to the website to obtain a claim form, or send a request to the address below and a notice and claim form will be sent to you. If you believe you are a class member, fill out the claim form and mail it to the address below. All claims must be postmarked by April 15, 2008. WHAT ARE YOUR OTHER OPTIONS? If you don't want to be legally bound by the settlement, you must exclude yourself by March 16, 2008 or you will not be able to sue Diamond about these claims ever again. If you exclude yourself, you will not get any money from the settlement. To exclude yourself, you must send a letter by mail stating that you want to be excluded. You must include your name, address, telephone number and signature. You must mail your request to: Diamond Pet Food Settlement, c/o The Garden City Group, Inc., P.O. Box 9214, Dublin, OH 43017-4614. If you stay in this settlement class, and you wish to object to the settlement, you must notify the court of your intent to object by February 26, 2008. The website explains how to exclude yourself or how to object to the settlement. The court will hold a fairness hearing on March 26, 2008 at 1:30 p.m. to consider whether to approve the settlement and a request for attorneys’ fees by the lawyers representing the class members. The lawyers representing class members are requesting a fee of $465,000.00, and expenses of $10,735.00 from the settlement fund. This is only a summary of the settlement agreement. To learn more about the settlement, call toll free 1-800-960-6651, go to the website, and/or write to Diamond Pet Food Settlement, c/o The Garden City Group, Inc., P.O. Box 9214, Dublin, OH 43017-4614.
1-800-960-6651
www.RecalledPetFoodSettlement.com
ProductForum IDEXX Laboratories
Sharn Veterinary
Avian Health Profile
Cardell Multiparameter Monitor
The Avian Health Profile, a panel of six of the most commonly used chemistries for the diagnosis of disease in avian species, is now available. The Avian Health Profile runs on the IDEXX VetTest chemistry analyzer, which offers speciesspecific reference ranges for budgerigars, cockatoos, cockatiels, canaries, conures, macaws, and parrots. The profile includes albumin, aspartate aminotransferase, calcium, glucose, total protein, and uric acid, as well as a calculated parameter for globulin. The company states that the flexible single-slide testing capability of the VetTest analyzer allows users to add tests to the panel and perform single-test follow-up. 800-355-2896 䡲 www.idexx.com/ahp Circle 107 on Reader Service Card
The Cardell Model 9405 is a compact multiparameter unit that offers blood pressure, pulse oximetry, electrocardiogram (ECG), carbon dioxide, respiration, and temperature monitoring and incorporates Oridion Microstream capnography, Cardell MAXNIBP blood pressure technology, and Nellcor OxiMax all-digital pulse oximetry. The unit offers manual, automatic, and stat modes for monitoring animals ranging from cats to horses and comes with 12 cuffs in six sizes, three FilterLine sets, a Nellcor lingual sensor, and a three-lead ECG set. 866-447-4276 䡲 www.sharnvet.com/products.html Circle 108 on Reader Service Card
Index to Advertisers For more information about products advertised in this issue, see the Reader Service Card inserted between pages 24 and 25.
Company Animal Health Options ASPCA Fe-Lines, Inc. Fort Dodge Animal Health The Greenies Company Hill’s Pet Nutrition Merial
NCVTSA Nestlé Purina PetCare Company Novartis Animal Health Pfizer Animal Health Sharn Veterinary, Inc. St. Petersburg College US District Court
Product Reader Service # ProMotion 128 Animal Poison Control Center 184 Sticky Paws Cat Deterrent Products 182 Promeris 195 Greenies dental chews 160 Prescription Diet Canine r/d 132 Prescription Diet Canine t/d Merial EDU 129 Previcox 180 PureVax 173 WVC Technician Symposium www.PawsToSavePets.com 183 2008 National Conference of Veterinary Technician Specialty Academies Purina Veterinary Diets 171 Sentinel Simplicef 191 Slentrol 153 Cardell Monitors 151 Online Veterinary Technology Program 181 Diamond Pet Food Products Settlement Notice
Page # 29 3 18 Cover 4 (US only) 27 Cover 2 (US only) Cover 2 (Canada only) 33 11, 12 7 Cover 3 5 47 44–45 Cover 4 (Canada only) 30, 31 40, 41 35 53 54
The following advertisers appear in our Market Showcase section, which begins on page 56. MED I.D. Petknap, Inc. Veterinary Solutions
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BIPS Capsules X-Ray Identification System Pet Burial Bags World’s Best Dog & Cat Muzzle
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MarketShowcase
The next available issue is MARCH, which closes JANUARY 30
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Phone 267-685-2422 or 800-426-9119, ext 2422 • Fax 201-231-6373 • email lcostantini@vetlearn.com 56 JANUARY 2008 | Veterinary Technician
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ClassifiedAdvertising TECHNICIANS WANTED
TECHNICIANS WANTED
ALABAMA – Technicians wanted for busy AAHA-accredited hospital in beautiful northeast Alabama. Applicants must have experience in a technician capacity at a veterinary hospital or be a recent graduate of a veterinary technology program. We offer digital radiography, ultrasound, laser surgery, orthopedics, and much more. Team members enjoy such benefits as BC/BS, paid time off based on hours worked, healthy pet benefits, and a family-oriented environment. Must be available and willing to work evenings, weekends, and holidays. Visit our website at www.amcvets.com. Please send cover letter and resume to: Tech, PO Box 2414, Anniston, AL 36202 or email bonniediehl@amcvets.com.
COLORADO – Experienced certified veterinary technician
ALASKA – Experienced licensed or unlicensed technician needed for busy emergency hospital open evenings, weekends, and holidays. Have your days free to see the sights of Alaska. Competitive wages, health and dental insurance, vacation pay, and continuing education opportunities. Send resume to PET Emergency Treatment, 2320 East Dowling Rd., Anchorage, AK 99507.
CALIFORNIA – Excellent career opportunities for compassionate, skilled veterinary technicians in our state-ofthe-art, AAHA-accredited, multispecialty referral hospital. We are currently seeking experienced critical care/emergency and surgical technicians to join our team. RVT/VTS and anesthesia experience a plus. Salary commensurate with experience. Benefits include health insurance, CE, 401(k). Contact Mary Rattray at 818-244-7977. Send resume to Animal Specialty Group, 4641 Colorado Blvd., Los Angeles, CA 90039. Web site www.asgvets.com; email asgvets@asgvets.com; fax 818-507-9418.
or equivalent is needed for a growing mixed animal practice. An ideal candidate will have a great attitude, a teachable spirit, and a strong work ethic. Must be a team-oriented self-starter as well as proficient in all technical skills. Park County Animal Hospital is located in Fairplay, which is close to several world-class ski resorts. This is a full-time position with excellent benefits. Fax cover letter and resume to 719836-2011 or call 719-836-1717; email kerrymadole@ hotmail.com.
CONNECTICUT – South Wilton Veterinary Group in Wilton, an AAHA-certified practice, needs motivated technicians. Our award-winning facility treats dogs, cats, birds, and exotics. Five doctors, including a board-certified avian specialist. Full- and part-time available, morning and afternoon shifts. Rotate weekends and holidays. Receive competitive salary and benefits. Email cover letter and resume to kmauro@southwiltonvet.com or fax 203-834-9999. CONNECTICUT – Head veterinary technician needed for three-DVM small animal hospital located 1 hour from NYC near beautiful Candlewood Lake. Utilize all of your skills while you help us transition into our new, state-of-the-art, 8800–sq. ft. hospital. Management responsibilities if desired. Excellent compensation. Phone 203-775-3679, fax 203-775-9496; www.BrookfieldAnimalHospital.com.
DELAWARE – Certified and/or experienced technicians needed for multiple part-time (4 to 6 hours) shifts at new
CALIFORNIA – Registered veterinary technicians needed veterinary imaging center in New Castle County. MUST be for busy AAHA-certified emergency clinics. We have digital x-ray, ultrasound, endoscopy and a full in-house lab. We offer medical and dental insurance, vacation and uniform allowance. Excellent opportunity to use and expand your technical skills! Must be available nights, weekends and holidays. Recently certified is OK. We have locations in Garden Grove and La Habra. Email or fax inquiries and resume only. NO calls. emyers@er4yourpet.com; fax 309-413-6111.
CALIFORNIA – Full-time technician needed for modern small animal clinic with an ocean view. Excellent pay and benefits including vacation, continuing education and health insurance. Fax resume 949-499-4698 or call 949-4994190.
CALIFORNIA – Are you looking to improve your current skills and gain new ones in an exciting, team-oriented environment? Adobe Animal Hospital in Los Altos is looking for veterinary technicians and assistants to join our team of 20 doctors and over 100 support staff at our 24-hour, AAHA-accredited facility. With dedicated ICU, surgery, and client-relations technicians, the staff prides itself on working in a collaborative atmosphere as a complete medical team. The state-of-the-art facility includes an in-house laboratory, ultrasound, endoscopy, and digital dental radiography (expanding to all digital radiography soon). Our patients are mainly small and exotic animals. We offer competitive wages with pay differentials for weekends, swing, and grave shifts and great benefits, including health, dental, paid vacation, flexible spending, CE allowance, uniform allowance, employer-matched 401(k), and very generous discounts on health care, food, and supplies for your pets. The ideal candidates are professional, self-motivated, and interested in advancing their skills working in a vibrant team environment with other technicians and doctors. Licensed or experienced candidates are preferred, but all interested applicants are encouraged to email resumes to adobeanimal@comcast.net. For more information, visit www.adobe-animal.com.
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proficient in IV catheter placement and have a strong anesthesia background and sound ability to monitor patient vitals. This position could lead to full-time employment and — for the right individual — the opportunity to manage an anesthesia team. Please fax resume to 610-918-9938.
TECHNICIANS WANTED
FLORIDA – MIAMI VETERINARY SPECIALISTS is a state-of-the-art veterinary referral practice with multiple board-certified specialists on site. MVS practices high-quality, cutting-edge veterinary medicine. MVS is looking for highly enthusiastic, self-motivated, experienced team players to join our fast-growing technician staff. Work to your fullest capability with our specialists assisting in: Ultrasonography • Endoscopy • Oncologic surgery • Neurologic surgery • Dermatology • Fluoroscopy • Orthopedic surgery • Soft tissue surgery • Internal medicine • 24-hour emergency care • And much more Specialized duties include: patient monitoring (including anesthesia), ICU and critical care, surgical prep, sterility assistance, specialized diagnostics and treatments, radiography, and the ability to think and handle responsibility. Benefits include: 401(k), CE, paid vacation, medical/dental insurance, pet discounts, and more. New graduates welcome. Interested veterinary technicians, please apply in person: Miami Veterinary Specialists, 8601 Sunset Dr., Miami, FL 33143 or fax resume to 305-665-2821, Attn: Brad, or call 305-665-2820 for more information. www.mvshospital.com
For information about AD PLACEMENT, call LIESE DIXON at 800-920-1695 FLORIDA - VETERINARY TECHNICIANS/NURSES We are a state-of-the-art small animal referral practice located in West Palm Beach, Florida. Our in-house veterinarians and consultants specialize in emergency and critical care, surgery, internal medicine, oncology, neurology, cardiology, radiology, and behavior sciences. We have a place for you, whatever your interests may be!
Qualities we require in a technician/nurse include the following: • Clinical as well as interpersonal skills • Desire to directly assist with case management • Self-motivator and active team member • New graduates welcome! Excellent compensation adds to our quality working environment. Additional benefits include medical and dental insurance, 401(k) retirement plan, paid vacation, uniform reimbursement, CE, and discounted services for your own pets! The greater West Palm Beach area is a growing, pleasant region of Florida with a comfortable climate. With magnificent beaches lining the Atlantic coast and one of the largest wilderness areas in the United States, outdoor recreational activities abound. Just a short drive to Miami Beach will bring you to the multicultural center of south Florida. Two hours north will take you to the Orlando area where you will find a number of theme parks and the Kennedy Space Center.
If interested, please call and/or fax your resume to our HR Director, Jennifer, at Palm Beach Veterinary Referral & Critical Care Center at 561-434-5700. Fax: 561-296-2888 • Email: pbvrs@earthlink.net Veterinary Technician | JANUARY 2008 57
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TECHNICIANS WANTED IDAHO Take your skills in another direction by joining our team of veterinary professionals! Pets Best Insurance is looking for a veterinary technician to work in the claims department at our national headquarters in Boise. Responsibilities will include communicating with customers in all 50 states and assisting in record interpretation. Work 8-5, Monday to Friday, with a competitive wage and benefit package. If you enjoy client communication and education, then this job may be perfect for you. Check out our website at www.petsbest.com, then email your resume to jhight@petsbest.com.
VETERINARY TECHNICIAN WANTED
Come join our team! New Graduates Welcome Florida Veterinary Specialists, located in Tampa, is accepting applications from full-time CVTs or experienced technicians to join our growing hospital. Benefits include paid vacation; holidays; health, dental, and disability insurance options; 401(k); CE allowance; uniforms; and professional discounts on pet care. For more detailed information, contact Shirley Sabin at 813-933-8944 or email shirley.sabin@fvs.com. For more information about our hospital, visit www.fvs.com.
ILLINOIS EXPERIENCED TECHNICIANS and CVTs WANTED
(352) 392-2235 ext. 5428 recruiter@vetmed.ufl.edu.
FLORIDA Coral Springs Animal Hospital, a primary care/multispecialty/critical care/emergency facility, open 24 hours/day, is always accepting applications for enthusiastic, motivated, compassionate, dedicated, quality-minded AHTs and CVTs or similarly experienced technicians without a degree. New graduates are encouraged to apply. We practice professional, excellent veterinary medicine and surgery with the highest degree of ethics and integrity. We are looking for individuals who want to use their veterinary nursing technical skills to the fullest. Technicians with the desire to work at a premium facility that has a great record of retaining excellent veterinary nurses are encouraged to apply. Salary is commensurate with experience but will range from $28,000–$40,000+ and shift pay differentials. We also have a generous benefits package that includes health and dental insurance, paid vacation, paid sick or personal days, paid holidays, CE, uniform allowance, retirement plan with employer matching, bonuses, discounted pet care. Drug-free workplace. Four-day workweek. Please visit our website at www.coralspringsanimalhosp.com. Please send resume to: Coral Springs Animal Hospital 1730 University Dr. Coral Springs, FL 33071 Attn: Megan Kelly, Nurse Manager Phone 954-753-1800; Fax 954-343-0238
FLORIDA – Veterinary technician needed for small animal
practice in Tallahassee. Located in a great university community close to the Gulf Coast. Salary and benefits for full-time. Contact Dr. Carter for an application and interview: 850-878-4799.
FLORIDA – Pensacola. Outgoing CVT needed for small
animal practice with an emphasis on dentistry and surgery. Health, IRA, bonus, uniforms, CE, sick leave, paid vacation, and relocation allowance are available. Contact Dr. Ashley at 850-479-2222; email drashley@mchsi.com; www.cordovaamc.com.
GEORGIA - TECHNICIANS WANTED Consider practice in beautiful Atlanta. Whether you are thinking about relocation or are already in this area, please consider a position with the Georgia Veterinary Specialists. At GVS, you will find many specialty areas to utilize your skills and love for animals. We seek experienced, highly skilled technicians, assistants, and kennel assistants to join our 24-hour emergency, critical care/specialty referral practice. Along with recent facility expansion and the ever-increasing number of motivated, skilled doctors, our hospital requires more technical coverage. You'll find excellent pay, strong benefits package, 401(k), and vacation. Qualified candidates, please submit a resume, cover letter, and salary request to Human Resources: aflower@gvsvet.com or fax 404-459-0835. If you hope to practice where you and your skills will be valued... COME, GROW WITH US!
Are you a professional? We have full-time positions open for CVTs or experienced emergency and critical care technicians to become members of our team. Our hospital is a 24-hour emergency and treatment center that features specialty surgery, critical care, and internal medicine. Our team of veterinarians and technicians is here because they believe that emergency and critical care offers the opportunity to practice the highest level of veterinary medicine. Sound challenging? We think so! We are looking for technicians who have the desire to learn and want to expand their knowledge and acquire new skills in these specialty fields. We offer a competitive salary and complete benefits package.
Interested candidates, please contact Cathie Moses at 847-548-5300 or fax your resume to 224-656-5180. Email: sshogren@aetcenter.com.
ILLINOIS -
Twenty-four–hour emergency/ critical care and specialty referral hospital in Chicago’s northern suburbs seeks experienced technicians for emergency/critical care and specialty departments. Seeking a rewarding and challenging career? Animal Emergency and Critical Care Center is emerging as one of the area’s fastest-growing veterinary centers. Board-certified specialists head up each discipline of the specialty referral practice: internal medicine, cardiology, surgery, neurology/neurosurgery, and imaging. A team of talented and dedicated emergency doctors completes our professional staff. All are committed to providing cutting-edge care 24/7. We are a high-energy, high-performing organization providing a learning environment for energetic, dedicated technicians. Fax Sheri at 847-564-9604. Email srothschild@aercenter.com. Competitive salary and benefits package
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perform daily animal health–related, veterinary medical assistant functions, provide perioperative care to animals, induce and maintain anesthesia in a wide variety of lab animal species, and perform surgical and maintenance-related functions of the department. The veterinary technician will also assist clinical veterinarians in maintaining the health surveillance program, to include such tasks as routine phlebotomy for serologic examination and necropsy of animals. Must be certified veterinary technician/animal health technician with a bachelor’s degree in biological sciences. AALAS certification at the laboratory animal technician (LAT) level or certification/eligibility at the laboratory animal technologist (LATG) level desirable. Send resume and cover letter to: Angeles Tenorio, Rush University Medical Center, 600 S. Paulina, Suite 403, Chicago, IL 60612 or apply online at www.jobsatrush.com. EOE M/F/D/V
INDIANA – We are looking for a full-time registered veterinary technician; 25% in the clinic, 75% in the rehabilitation center. We are a four-veterinarian small animal hospital with state-of-the-art equipment for rehabilitation, including swimming pool, underwater treadmill, EStem, digital CR, ultrasound, blood analyzer, and more. Benefits include training and certification program for canine rehabilitation, holiday pay, paid vacation and sick days, retirement plan, personal pet discount, allowances for continuing education, uniforms, and medical insurance. A competitive salary with no after-hours emergency duty. Position starting January 2008. We are located in West Lafayette, 1 hour northwest of Indianapolis, 1.5 hours southeast of Chicago, and 10 minutes from Purdue University. Call 765-463-7877 or email pvppms@insightbb.com. You can visit our websites at petsandvetsaspartners.com and petmedspaandrehab.com.
MARYLAND – Certified/registered technician or experienced assistant needed for a full-time position at our busy, four-doctor small animal practice. Olney-Sandy Spring Veterinary Hospital is a progressive, AAHA-accredited hospital where technicians are utilized to their fullest potential in the areas of surgical assistance, anesthesia monitoring, dentistry, radiology, laboratory, nursing care, and client education. Eligible candidates must be available weekday evenings and Saturdays and must have experience in a small animal hospital. Benefits include health insurance, paid vacation and CE, 401(k), and more. Send resume to Denise Sharp: fax 301-570-5121 or email petpalds@aol.com. Please visit our website at www.ossvh.com.
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ILLINOIS - Veterinary Specialty Center is a state-of-the-art multidisciplinary specialty referral hospital located in the northern suburbs of Chicago. There are great opportunities for certified technicians and veterinary assistants to join our team. Our growing specialties include surgery, internal medicine, oncology, cardiology, nephrology, neurology, radiology/imaging, emergency and critical care, dermatology, physical therapy, behavior, and ophthalmology. We have an excellent work environment with outstanding compensation and benefits. For more information on these exciting and challenging opportunities, please contact: Evelyn Feekin Veterinary Specialty Center 1515 Busch Parkway, Buffalo Grove, IL 60089 Fax 847-459-1848 • Phone 847-459-7535 x312 or email at efeekin@vetspecialty.com.
TECHNICIANS WANTED
MARYLAND Veterinary Technician Supervisor Atlantic Veterinary Internal Medicine, in Annapolis and Towson, is currently hiring full-time registered or experienced veterinary technicians as well as an experienced technician supervisor. Both offices are part of the Chesapeake Veterinary Referral Center and are convenient to Baltimore, historic Annapolis, and Washington, D.C. Applicants should be compassionate, detail-oriented, and organized. We offer an excellent benefit package including health, dental, 401(k), and much more! Please call Kim Thomas at 800-788-2872 or fax resume to 410-224-2295. Visit our Web site at www.atlanticvetintmed.com to meet our doctors and staff.
Maryland - Experienced veterinary technician needed for growing, state-of-the-art referral and emergency center located in Frederick. Fax resume and cover letter to 301-874-4963 or email jessicafinnegan@comcast.net. Visit our website at www.Greenbriarkennels.com.
MASSACHUSETTS – Veterinary technician and technician assistant needed for three-doctor practice located in Boxborough. Country setting with easy access to Routes 2 and 495. Seeking individuals with excellent client/coworker communication skills and high standard of patient care to work in exam, surgical, and treatment areas. Rotating schedule includes weekend and evening hours. Competitive compensation; benefits available. Contact Karen at 978263-0995 or fax resume to 978-263-8912.
MASSACHUSETTS – Rapidly growing, three-doctor small animal hospital in Chelmsford is seeking an experienced, motivated team player to join our technician staff. Full-time position with benefits. Salary commensurate with experience. Please fax resume to Chelmsford Animal Hospital at 978-256-4965.
NEW JERSEY – NEW state-of-the-art hospital opening February 2008! This is your chance to really make a difference. Seeking happy, motivated, enthusiastic technicians. Check us out at www.barnsidevethospital.com or email vetbythesea@ barnsidevethospital.com for employment brochure. Howell – central shore area – farms and the beach!
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ClassifiedAdvertising TECHNICIANS WANTED NEW JERSEY – Licensed or experienced technician wanted for small animal practice in Edgewater. We practice high-quality medicine for upscale clientele who consider their pets to be part of the family. We use state-ofthe-art equipment including high-speed fiber-optic dental unit, dental radiographs, video otoscopy, electrocautery, Doppler and oscillometric blood pressure, pulse oximetry, and ECG and offer on-site ultrasound and endoscopy. We are looking for someone who is motivated, dedicated, has good communication skills, and is willing to continue to learn. Competitive salary, retirement plan, medical insurance, and continuing education. Call Dr. Bill Freedman 201-313-7000. NEW YORK – Licensed veterinary technicians. Bideawee seeks licensed veterinary technicians for its Manhattan location to work with veterinarians in providing care to our resident animals in the adoption center and to private client animals. Send cover letter/resume to greg.carastro@bideawee.org or fax 212-532-4210.
NEW YORK – Licensed veterinary technician wanted for Rhinebeck Animal Hospital, located in the Hudson Valley. We are a progressive, fast-paced, seven-doctor pet hospital that cares for dogs and cats. New facility with advanced dental and anesthetic monitoring equipment. Tom: 845-876-6008; tom@rhinebeckanimalhospital.com.
TECHNICIANS WANTED
TECHNICIANS WANTED
RECRUITING VETERINARY TECHNICIANS WHO WANT TO BUILD A CAREER AND ADVANCE IN THEIR AREAS OF SPECIALTY Cornell University Hospital for Animals is growing and needs veterinary technicians interested in expanding their knowledge and skill levels in the areas of:
Anesthesia Critical Care Equine Farm Animal Outstanding salary, individualized orientation, mentor program, tuition reimbursement, technician CE, health and dental insurance. If you have an AVMA-approved degree in veterinary technology, have/are eligible for New York State licensure, and have experience in a fast-paced environment, send cover letter and resume to:
Ms. Kimberly Baldwin, LVT, VTS (ECC) Manager of Nursing Services Cornell University Hospital for Animals Box 35 CVM, Ithaca, NY 14583-6401 Check our website: www.vet.cornell.edu/hospital.
NEW YORK
EMERGENCY/CRITICAL CARE TECHNICIANS Come to the heart of New York City and work in the renowned Animal Medical Center with world-class veterinary specialists and technicians in a state-of-the-art facility. The AMC is one of the nation’s largest facilities for animal care, research, and education with over 50,000 visits annually. Ninety veterinarians representing all specialties comprise the professional staff, providing a progressive, stimulating, and rewarding environment 24 hours per day. The Department of Critical Care and Emergency Medicine includes dedicated specialists, residents, emergency doctors, and technicians providing patient care at the highest level. We are looking for talented, motivated technicians to join this exciting group in the ICU or Emergency Service. An interest in learning and teaching is essential. Professional development is encouraged. Requirements: graduate of an AVMA-accredited veterinary technician program with a current NYS license or permit for veterinary technology. Experience in critical care or AVECCT certification is preferred. Salary ranges from $21-$27/hr plus shift differentials. We offer competitive benefits including medical/dental insurance and more. Various shifts and work week configurations are available. Please apply via email at careers@amcny.org, or fax 212-758-8157. For more information about the AMC and opportunities we offer, visit www.amcny.org. EOE
NEW YORK – Veterinary technician licensed or licenseeligible wanted for a three-doctor practice on eastern Long Island. We are a compassionate and caring staff who work well together in a great work environment. Candidate will be allowed to practice a full range of technician duties in a well-equipped state-of-the-art hospital. Competitive salary with excellent benefits. Call Julie at 631-324-7900 or fax resume to 631-324-9433. NEW YORK – Great opportunity for licensed or licenseeligible veterinary technician at Central Animal Hospital in Scarsdale, 30 minutes from NYC. We are a team-oriented, six-doctor/six-tech, AAHA-accredited small animal hospital with the latest equipment. Benefits: 4-day work week, competitive salary, CE, medical, six paid holidays, 2 weeks vacation, 401(k)/profit sharing plans. Apartment available. NO night emergencies! Call Paul Staar 914-723-1250. NORTH CAROLINA – Come enjoy the “Land of Waterfalls” in Brevard as a certified veterinary technician in a well-established small animal practice. Applicant must be licensed or license eligible. Competitive salary/excellent benefits. If you are interested in a career working with a highly motivated, energetic team, please send your resume to: PO Box 181, Brevard, NC 28712 or call 828-884-3647.
OHIO – The Veterinary Referral Clinic & Emergency Center in Bedford Heights is looking for full- or part-time registered (or eligible) veterinary technicians to work in the emergency center and specialty hospital. $2,000 Sign-on bonus when hired for our busy emergency center! We offer an outstanding wage with shift differential; comprehensive medical and dental health insurance; 401(k)/profit sharing; paid vacation; sick, personal, and holiday time off; uniform allowance; pet care discounts and allowances; and compensation for continuing education and license fees. Please contact Kathy George, Hospital Administrator, at KGeorge@nvanet.com or fax resume to 216-831-5980.
60 JANUARY 2008 | Veterinary Technician
OHIO
Registered Veterinary Technicians Needed Metropolitan Veterinary Hospital is in need of registered veterinary technicians to assist with our high-volume, state-of-the-art central hospital and referral center. We offer a wide range of services: internal medicine, surgery, neurology, ophthalmology, cardiology, and emergency and critical care. Primary responsibilities would include assisting with animal care, basic laboratory duties, diagnostic techniques, and surgical procedures, with a secondary function involving client contact, reception skills, and personal technical development. Candidates must be licensed RVTs in Ohio with a proven ability to function in a fast-paced environment. New and experienced technicians welcome. We offer competitive wages, health benefits, uniforms, paid time off, and a rewarding work environment. If you are interested in joining our team, please send your resume to: Metropolitan Veterinary Hospital, Attn: Human Resources 1053 South Cleveland-Massillon Rd., Akron, OH 44321 Fax 330-666-0519 or email to s.steen@metropolitanvet.com (subject: Registered Veterinary Technician).
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Professional Services Technician I Leading veterinary industry continuing education provider located in Yardley, Pennsylvania, is seeking a Professional Services Technician. The Professional Services Technician will be responsible for answering incoming or placing outgoing calls, emails, or faxes to provide technical product support on pharmaceuticals, biologics, and other animal health products as per client contracts. This includes market research and guarantee claim data collection, entry, and processing. The technician will be responsible for performing technically accurate and timely reporting of adverse events by following contractual standard operating procedures. The preferred candidate, who may or may not be a licensed/certified veterinary technician, must be a detail-oriented team player with the ability to communicate technical subjects to colleagues, peers, and external clients. The individual must have exceptional communication and interpersonal skills and the ability to multitask. Strong computer skills using MS Office are required. This position offers a competitive compensation plan, health benefits, and matched 401(k). Please send cover letter and resume, which must include salary requirements, to Attn HR: email jobs@medimedia.com or fax 267-685-2952. EOE.
Gwynedd Veterinary Hospital and Emergency Service is a busy 24-hour medical care and referral facility with a 16-doctor and 30-technician team providing comprehensive care and ER services, located 45 minutes northwest of Philadelphia. We have two board-certified specialists on our staff who regularly perform endoscopy, ultrasound, and orthopedic surgery. Our clients appreciate the excellent patient care delivery that we offer, including digital radiography, in-house coagulation testing, multilumen catheterization, capnography, and TPN. Salary is commensurate with experience. Your colleagues are talented and focused on quality patient care using the latest techniques and medications. We offer a flexible schedule and excellent benefits.
Please fax resume to 215-699-7754 Attn: Cindy Lorenz Email: gwyneddvethosp@comcast.net Visit our Web site at: www.gwyneddvethospital.com.
PENNSYLVANIA - We are a specialty/ referral/emergency and critical care practice located in Valley Forge. We have a brand new 18,000–sq. ft. facility with state-of-the-art diagnostic and therapeutic equipment. We offer a competitive salary, multiple health care packages, CE compensation, 401(k), personal pet discounts, and a generous amount of vacation time. Three-to 4-day work schedule for the emergency service and 4- to 5-day work schedule for specialty. University level medicine in a fun and relaxed environment. Contact Julie Banyacski, CVT, VTS (ECC), at 610-666-1050 or fax 610-666-1199.
PENNSYLVANIA Experienced technician needed for 24-hour fullservice emergency AAHA-accredited veterinary practice located in the beautiful Pocono Mountains, 90 minutes from New York City or Philadelphia. We are a six-doctor small animal and exotics clinic with a strong surgical and orthopedic background, currently seeking night and overnight technicians. Weekends are a must. Person must be self-motivated, a team player, and possess great people skills. Competitive salary, continuing education, and benefits offered based on experience.
Visit our hospital at www.creaturecomfortsvet.net. Call Liz after 4 PM at 570-992-0400; fax resume to 570-992-4713, Attn: Liz; or email lmbccvs@hotmail.com.
PENNSYLVANIA – Full- or part-time veterinary technician position available for a compassionate team player at our busy, five-doctor, AAHA-accredited small animal practice in Wyomissing. Experience preferred; salary/benefits commensurate with experience. To join our team, call 610-3722121 or fax resume to 610-372-0903. TEXAS – The Animal Emergency Center of West Houston, the fastest-growing AAHA-accredited emergency center in the country, is currently looking to hire compassionate, confident, motivated, team-oriented, and experienced nurses for full-time positions in our state-of-the-art facility. Potential candidates should show a willingness to learn, love to interact with people, have good typing skills, and have knowledge of Microsoft Word and Excel. Candidates should be able to multitask and be willing to work nights, weekends, and holidays. We offer very competitive wages (to be determined with experience) and benefits (health insurance, vacation, sick time, CE, license fees, uniform allowance, etc.). Interested candidates can email their resumes to aecwh.aecwh@hotoffice.net or fax to 832-593-8388.
TECHNICIANS WANTED TEXAS – Highly respected emergency/critical care veterinary hospital in Austin seeks an energetic technician with an open mind for learning who is looking for mentorship and to build technical skills. We are a progressive, emergency-only hospital with state-of-the-art equipment, owned and operated by a board-certified emergency/critical care veterinarian. Great team atmosphere with excellent compensation, benefits, and matching 401(k). Must be able to work overnights, weekends, and holidays. Please fax resume to 512-331-6121. TEXAS – Seeking veterinary technician for our busy, fourdoctor, AAHA-accredited practice in northwestern San Antonio. Use your skills in a fun atmosphere. We need motivated self-starters who enjoy educating clients and giving quality care to patients. No night emergency hours. Great health plan. Fax resume to 210-697-8337, Attn: Sara.
UTAH - We are seeking skilled veteri-
nary technicians with a perfect mix of technical and client service capabilities for a high-energy practice in the quaint 9th and 9th district in beautiful Salt Lake City. Our brand-new, state-of-the-art, AAHA-accredited facility is now open. Full-time positions are now available with very competitive wages, great benefits, and team-based work environment. Commitment to excellent patient care and client service a must! Highly motivated technicians that thrive in a fast-paced, challenging and rewarding position may fax resumes with an intro letter to 801-328-9158 or email info@upcvet.com www.uvhdc.com
VIRGINIA Experienced Veterinary Technicians Wanted. The LifeCentre for Veterinary Emergency & Specialty Care in Leesburg has full-/part-time licensed technician positions available in our emergency/critical care and internal medicine departments. We are seeking skilled, experienced, compassionate individuals to meet the expanding needs of our emergency and specialty practice located in northern Virginia. Our group recently moved into a brand-new, stateof-the-art, 18,300–sq. ft. facility that was designed from the ground up as a referral hospital. The facility has all the toys, including CT, digital radiography, ultrasound, in-house lab equipment, telemetry, and new MRI machine on site. We offer the ability for the right individuals to join our team and be challenged and appreciated by the doctors, staff, and clients. We offer competitive pay ($1,500 signing bonus) and benefits, including health insurance, 401(k), CE allowance, moving allowance, vacation, and personal paid leave. Please email your resume to: LeesburgLVT@aol.com or fax to 703-777-3396 Attention: Human Resources.
To place an ad, email VetTechClassifieds@vetlearn.com, call 800-920-1695, or visit www.VetClassifieds.com. www.VetTechJournal.com
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ClassifiedAdvertising TECHNICIANS WANTED Virginia ~ Experienced emergency veterinary technicians wanted...
Are you tired of the same old daily routine? Would you like the opportunity to participate in progressive veterinary medicine? The Regional Veterinary Referral Center in Springfield is looking for experienced technicians to work in our emergency and critical care department. Successful candidates should possess technical expertise, strong client relation skills, and an intense desire to learn and grow in their job experience. This position offers a competitive salary with benefits and continuing education opportunities. We also have a great staff and working environment. If you feel that you would enjoy the challenge of progressive veterinary medicine, please call: Lynn Chiappane or Sue Mordi at 703-451-8900 or fax resume to 703-451-3343.
TECHNICIANS WANTED
TECHNICIANS WANTED
VIRGINIA – Seeking highly motivated and responsible licensed veterinary technician to join Veterinary Internal Medicine Practice in Manassas. Applicant must be a team player, hard working, and willing to work in a fast-paced environment. Great benefits package. Starting salary $35,000/year. Available position: Monday–Friday 3:00–11:00 occasional Saturday AM shifts. Fax resume 703-368-4703 or contact Dee/Dr. Smith at 703-330-8809. VIRGINIA – Centreville Animal Hospital is a small animal practice with a family-friendly environment. We are a seven-doctor, AAHA-accredited practice expanding our state-of-the-art facility and need a new licensed veterinary technician to help us grow. Our fully utilized current staff of four LVTs is very team oriented and always works to provide the best care possible. The position offers competitive salary and benefits. Please contact us at taylordvm03@ yahoo.com or 540-230-9030. We are located in Centreville, VA 20121.
WASHINGTON – Licensed veterinary technician for small animal practice. Four- and 5-day shifts per week. One Saturday per month. Two doctors, two technicians, four assistants per shift. Come join the fun with quality people practicing exemplary medicine. Marine View Veterinary Hospital, Des Moines. Contact Dr. Felts at mvpetdocs@earthlink.net
WASHINGTON – Alpine Animal Hospital in Issaquah is looking for a new, energetic team member. We're a large AAHA-accredited hospital, just east of Seattle, that offers 24-hour emergency care with our excellent day practice, including ultrasound, endoscopy, digital radiology, and an AVECCT specialist. We need an LVT to work with our day practice in surgery—a great opportunity to utilize your skills in a learning environment and work with our specialist! The ideal candidate is self-motivated, compassionate, skilled, fun, and a great team player! Benefits: signing bonus, competitive salary, CE compensation, MDV, matching 401(k), license dues, pet benefits, vacation/sick days, uniforms. Send resumes to Allison Perkins, RVT. Fax 425-391-7439 or email allison.perkins@vcamail.com. WISCONSIN – CVT position available for five-doctor practice. Use ALL of your skills with laser, ultrasound, laparoscopy, echocardiology, and more. Excellent pet benefits, vacation, CE allowance, health insurance. For more information, contact Melinda at 920-434-1010, or send resume to Animal Hospital of Howard, 635 Cardinal Lane, Green Bay, WI 54313.
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PICTURE TH!S
Dr. Stephen Comer
A Quacky Image This radiograph was taken of an adult boxer that presented for possible ingestion of a rubber duck. The owners reported that the dog had been playing with the duck when it mysteriously went missing.We induced vomiting and found a rubber crab, but no duck, in the vomit.The owners stated that the crab had been missing for some time.We took radiographs, including the one here, which revealed the missing duck. The owners opted to wait in case the duck was able to pass on its own.We never received an update, but we’ll never forget those radiographs!
Submitted by Dr. Stephen Comer, Sara Beebe, and the staff of the animal Emergency Hospital, Grand Rapids, Michigan.
Treasure Hunt
Patricia A
. Wright, C VT
In November 2006, a 6-year-old neutered bull terrier presented with a history of pica and foreign body surgery. He had a 1-week history of anorexia, straining to defecate, and vomiting. Radiographs (right) revealed a foreign body in his stomach and distal jejunum. During surgery, this“treasure chest”(below), weighing 1.6 lb, was removed. The dog recovered well.
Do You Have a Unique Image?
Patricia A. Wright, CVT
Send us your interesting, extraordinary, or even amusing images. They can be radiographs, cytology slides, photographs, or any type of unique image. Provide a brief description of what the image is showing, along with your name and contact information.We pay $50 per published image. Send submissions by Email: editor@VetTechJournal.com Mail: VLS/Veterinary Technician
780 Township Line Road Yardley, PA 19067 Submitted by Patricia a. Wright, CVT, Saugus animal Hospital, Saugus, Massachusetts.
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JANUARY 2008 | Veterinary Technician
www.VetTechJournal.com
PRACTICAL DENTISTRY FOR TECHNICIANS Wednesday, February 20, 2008 2 to 6 pm Mandalay Bay Convention Center Expanding Your Dental Services with Dental Radiology Dr. Brook Niemiec Top Ten Dental Therapies in Small Animal Medicine Dr. Jan Bellows Jump-Start Your Prevention with Oral ATP Paul Camilo Dental Cleaning: Instrumentation and Technique for Technicians Thomas Koenig
©2007 Merial Limited, Duluth, GA. All rights reserved. OVT08PBWVCSYMAD
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