Veterinary Technician | April 2008 by davidpsu

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The Complete Journal for the Veterinary Health Care Team

CE Credit from Alfred State College, SUNY

Vol. 29 No. 4 | April 2008

MARIANNE TEAR, MS, LVT Teaching by Example

BEHAVIOR Separation Anxiety in Dogs

CLINICAL NUTRITION Understanding Pet Food Labels Visit us at www.VetTechJournal.com

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Editor’sLetter

The Complete Journal for the Veterinary Health Care Team

Vol. 29 No. 4

April 2008

EXECUTIVE EDITOR Hilda Guay 267-685-2435 | hguay@vetlearn.com EDITORIAL Jill Greshes, Associate Editor Liz Donovan, Assistant Editor 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 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, Senior 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

780 Township Line Road • Yardley, PA 19067 PRESIDENT Derrick Kraemer

Inside the Highly Complex Animal Brain In the March issue of National Geographic, the article “Minds of Their Own — Animals Are Smarter Than You Think” discusses the complexities of the animal brain. According to the article, studies show that sheep can recognize more than 50 other sheep and 10 humans and can remember them 2 years later. The article also discusses how other animals show problemsolving skills. For example, chimpanzees can make their own tools, and octopuses block their dens with rocks. My rottweiler, Schultz, who passed away 2 years ago, was a great problem solver. When I first gave him a Kong toy filled with treats, he discovered that if he dropped the toy, the treats came out. He quickly became skilled at removing the treats. As soon as I would give him the Kong, he would throw it across the room — sometimes even hitting the TV — to get the treats out. One morning when I was taking a shower, the bathroom doorknob began to turn. Envisioning the shower scene in Alfred Hitchcock’s film Psycho, I pulled open the shower curtain. My heart was pounding in my chest. I tried to remind myself that it was unlikely that an intruder had entered the house because all the doors and windows were locked and a rottie was wandering around inside. When the knob stopped turning, I grabbed a towel and walked slowly to the door. I put my hand on the knob and cautiously opened the door, not knowing what to expect. On the other side stood Schultz, getting ready to try to turn the knob again with his mouth. Schultz’s funniest solution to a problem was his response to my new stove. I have a galley kitchen that is very small. The afternoon the oven was installed, Schultz really had to go out, but as soon as he saw his face reflected in the oven door, he stopped and wouldn’t go any farther. I tried coaxing him past the oven, but he wouldn’t budge. After several minutes, he suddenly turned around and started walking backwards until he had passed the oven. He concentrated so hard when he was walking backwards that he didn’t seem to notice his reflection in the oven door. After that day, as soon as he approached the oven, he would immediately turn around and walk backwards across the kitchen. Now that’s creative problem solving!

EXECUTIVE VICE PRESIDENT Ray Lender 267-685-2417 | rlender@vetlearn.com 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.

www.VetTechJournal.com

Hilda Guay, Executive Editor

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Contents

April 2008 204 Teaching by Example

The Complete Journal for the Veterinary Health Care Team

Volume 29, Issue 4 For the benefit of those who wish to participate in the CE Program, the peer-reviewed 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.

All clinical articles are peer reviewed.

Glenn Triest

COLUMNS 236 Clinical Nutrition Understanding Pet Food Labels

FEATURES 204

Not “Just” a Technician — A Talk with Marianne Tear, MS, LVT Andrea Vardaro Tucker In her new position as director of Baker College’s veterinary technology program, Marianne Tear, MS, LVT, has numerous opportunities to inspire her students. Read about what sparked her interest in becoming an educator and why she thinks it is so important to teach by example.

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Overview of Canine Separation Anxiety Katie Costello, RVT Dogs that suffer from separation anxiety may engage in behaviors such as inappropriate elimination, excessive vocalization, and destruction after the owner leaves the house. Technicians who are familiar with this behavioral disorder can educate owners about how to manage their pet’s anxiety.

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How Global Warming May Affect the Prevalence of Lyme Disease Laura McLain Madsen, DVM Researchers have been predicting that several factors — including global warming — will have a huge impact on the spread of infectious diseases, especially tick-borne diseases. Today, the prevalence of diseases such as Lyme disease is increasing in previously nonendemic areas.

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Carol Rosenfield, CVT

239 Equine Essentials New Treatment Modalities for Atrial Fibrillation M. Kimberly J. McGurrin, DVM, DVSc, DACVIM

256 Tech Life You Know You Have Been a Technician Too Long When… Ryan Jo Summers

ON THE COVER Marianne Tear, MS, LVT, and student Shannon Love examine slides under a microscope.

See page 204 Photographed by Glenn Triest

www.VetTechJournal.com

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U.S. Canine Positive Lyme Results. Available at: http://www.idexx.com/animal health/testkits/3dx/lymemap.htm. Accessed February 2, 2007. Conlon JA, et al. Efficacy of a nonadjuvanted, Outer surface protein A, recombinant vaccine in dogs after challenge by ticks naturally infected with Borrelia burgdorferi. Veterinary Therapeutics 2000;1:96-107. 3 Wikle RE, Fretwell B, Jarecki M, Jarecki-Black JC. Canine Lyme disease: One-year duration of immunity elicited with a canine OspA monovalent Lyme vaccine. Intern J Appl Res Vet Med 2006;4(1):23-28. 4 Chang Y, et al. Recombinant OspA protects dogs against infection and disease caused by Borrelia burgdorferi. Infection and Immunity 1995;63(9):3543-3549. 2

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Contents

The Complete Journal for the Veterinary Health Care Team

April 2008

Volume 29, Issue 4

216

Climate Change and Lyme Disease

DEPARTMENTS 193 198 200 226 242 245 246 247 248

Editor’s Letter Information Page Tech News Author Instructions Tech Tips Product Forum Index to Advertisers Market Showcase Classified Advertising

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Canine Separation Anxiety

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CE ARTICLE Understanding and Treating Diabetic Ketoacidosis Brandy Tabor, BS, CVT Animals with diabetes mellitus may develop diabetic ketoacidosis, a life-threatening metabolic disturbance that requires immediate diagnosis and treatment. Learn how technicians can play a crucial role in treating these patients.

This Month on the Web Visit the Conference Calendar at

www.VetTechJournal.com to view upcoming CE events. 196

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Watch the video Tech Tip

Proper Avian Restraint Only at www.VetTechJournal.com. www.VetTechJournal.com

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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 Technician® (ISSN 8750-8990) is published monthly by Veterinary Learning Systems, a division of MediMedia USA, 780 Township Line Road, Yardley, PA 19067. Copyright © 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 to Veterinary 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 800-4269119. POSTMASTER: Send address changes to Veterinary Technician, Veterinary Learning Systems, 780 Township Line Road, Yardley, PA 19067.

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April 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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Kills Adult Fleas

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Zhao X, Yeh JZ, Salgado VL, Narahashi T. Fipronil is a potent open channel blocker of glutamate-activated chloride channels in cockroach neurons. J Pharm Exp Ther 2004;310(1):192-201. 2 Ikeda T, Zhao X, Kono Y, Yeh JZ, Narahashi T. Fipronil modulation of glutamate-induced chloride currents in cockroach thoracic ganglion neurons. Neurotoxicology 2003;24:807-815. 3 Data on file at Merial. 4 McCall JW, Alva R, Irwin JP et al. Comparative efficacy of a combination of fipronil/(S)-methoprene, a combination of imidacloprid/ permethrin, and imidacloprid against fleas and ticks when administered topically to dogs. J Appl Res Vet Med 2004;2(1):74-77.

Circle 183 on Reader Service Card ®FRONTLINE is a registered trademark of Merial. ®ADVANTAGE is a registered trademark of Bayer Healthcare. ®K9 ADVANTIX is a registered trademark of Bayer Aktiengesellschaft. ©2007 Merial Limited, Duluth, GA. All rights reserved. FLE07ADSGRANDSLAMPG.

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TechNews

Researchers Link Cancer in Humans and Dogs M

an’s best friend may soon become a key to understanding cancer in humans. Cancer researchers at the University of Minnesota and North Carolina State University have discovered that humans and dogs share a genetic basis for certain types of cancer. Jaime Modiano, VMD, PhD, University of Minnesota College of Veterinary Medicine and Cancer Center, and Matthew Breen, PhD, North Carolina State University Center for Comparative Medicine and Translational Research, collaborated on the study. Their findings indicated that the specific genome reorganization that occurs in comparable human and canine cancers shares a common pathogenetic basis. The human genome contains 46 chromosomes, and the dog genome has 78. In the normal duplication of cells, these chromosomes can become rearranged or relocated. This process, known as translocation, can cause the cells to develop into cancer. “We found that the same translocation of chromosomes happens in dogs as in humans for the three blood and bone marrow cancers we studied,” states Dr. Modiano. Through studying dogs, Drs. Breen and Modiano discovered that the genetic changes that occur in dogs diagnosed with certain cancers of the blood and bone marrow, including chronic myelogenous leukemia, Burkitt’s lymphoma, and chronic lymphocytic leukemia, are virtually identical to genetic abnormalities in humans diagnosed with the same cancers. Studying certain cancers in dogs may provide insight into cancer risk factors, diagnosis, and prognosis in humans. Dogs are appropriate research subjects because they develop cancer spontaneously and because selective breeding has preserved the genetics of each breed. With the information gained from the study, Drs. Breen and Modiano will use grants from the National Cancer Institute to begin pinpointing risk factors for cancer in various breeds of dogs. The study was funded by the American Kennel Club Canine Health Foundation and the American Cancer Society.

Long-Time Veterinary Technician Educator Retires Manly Shults, LVT, an instructional support specialist at the State University of New York (SUNY) at Delhi, retired at the end of the school’s winter semester. Manly was an instructor at SUNY Delhi since the 1960s and was one of the first graduate veterinary technicians to teach other technicians. Among his many accomplishments, he was intricately involved in the licensing of veterinary technicians in New York State in the 1970s and the construction of the veterinary technology teaching facilities at SUNY Delhi, and he served as president of the New York State Association of Veterinary Technicians. 200

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“It has been a privilege to work with Manly,” says former colleague Dan Walsh, MPS, RVT, who now works as an instructional technologist at the Purdue University Veterinary Teaching Hospital. “He is one of the pioneers and visionaries in the profession of veterinary technology and veterinary technology education and has been a most giving and caring friend and teacher.” Manly’s contributions will be long remembered by his colleagues, former students, and other members of the veterinary profession.

Ann Johnson Becomes First Female President of WVC At the Western Veterinary Conference (WVC), held from February 17 to 21 in Las Vegas, Nevada, Ann Johnson, DVM, DACVS, was formally installed as WVC president, becoming the first woman to head the organization. Johnson, who will direct the activities of the 2009 conference, is chief of surgery at the University of Illinois and is recognized internationally for her work as a veterinary orthopedic surgeon and for her involvement in a clinical research program. Dr. Johnson currently serves as the American College of Veterinary Surgeons (ACVS) residency program facilitator and previously served as the chair of the ACVS board of regents. She has written numerous journal articles and coauthored several textbooks, including Small Animal Surgery and the Atlas of Orthopedic Surgical Procedures of the Dog and Cat, and was an editor of and contributor to the book AO Principles of Fracture Management in the Dog and Cat. Dr. Johnson has received several academic awards for distinguished teaching and research, including the University of Illinois Award for Excellence in Graduate and Professional Teaching.

Tell Us How You Celebrate National Pet Week Veterinary Technician® wants to know how your veterinary team promotes National Pet Week (May 4–10) in your clinic. Send us your story and/or photographs, and if we publish your submission, we will send you a free Veterinary Technician lunch bag! Send submissions to: Email: editor@VetTechJournal.com Fax: 800-556-3288

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TechNews S TAT E N E W S CALIFORNIA The California Registered Veterinary Technicians Association (CaRVTA) has named its new board of directors. The new officers are Pamela Maurer, RVT (president); Linda Lasky, RVT, VTS (ECC) (vice president); Cindy Hale, RVT (secretary); Nancy Ehrlich, RVT (treasurer); Sue Brodbeck, RVT (member-at-large); Jayne Camic, RVT (member-at-large); Sarah Okumura, RVT (member-at-large); and Nancy Ehrlich, RVT (legislative liaison). According to President Pamela Maurer, “This is a great leadership team that will be supporting the veterinary technology profession through combined efforts. We are working to make the profession a solid veterinary health care team through increased public awareness and improved nursing care and by broadening the skills, knowledge, and professionalism of technicians.” For more information on CaRVTA, visit its Web site at www.carvta.org. COLORADO The Colorado Association of Certified Veterinary Technicians (CACVT) announced that one of its members, Nichole Kelly, CVT, has recently earned recognition as a certified veterinary practice manager (CVPM) through the Veterinary Hospital Managers Association. “The process of becoming a CVPM has given me professional recognition and a great sense of accomplishment,” says Nichole in a recent CACVT newsletter. “I have also gained indepth knowledge of practice management and have a network of friends and other professionals to rely on for support.” Congratulations, Nichole!

See YOUR NEWS in the pages of Veterinary Technician®! Send story ideas to: Email: edonovan@vetlearn.com Fax: 800-556-3288

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To view upcoming meetings, visit our online Conference Calendar at www.VetTechJournal.com. To post a meeting, send your information to calendar@vetlearn.com.

Susan Cutter-Pedigo, MS, RVT, was named Indiana’s 2007 Veterinary Technician of the Year.

INDIANA The Indiana Veterinary Technicians Association (IVTA) has named Susan CutterPedigo, MS, RVT, its 2007 Veterinary Technician of the Year. Susan has been an active member of the IVTA since graduating from Purdue University’s veterinary technology program in 1999. Since that time, she served as IVTA recorder, president-elect, president, and past president, and she is currently serving as district representative. She has been instrumental in organizing a series of regional CE meetings called “By Techs, For Techs” in Columbus and Evansville and was recently a member of the Veterinary Practice Act Update Task Force. Susan was nominated by her employer, Ivan Rimstidt, DVM, who praised her qualifications and value to his practice. Clients and coworkers contributed letters of support, as did several members of the Purdue faculty. The Veterinary Technician of the Year award is based on the candidate’s service to the veterinary profession, the community, and the IVTA. OREGON On January 29, 2008, the Oregon Veterinary Examining Board (OVEB) approved a temporary rule that allows certified

veterinary technicians to earn all of their required 15 continuing education hours through interactive means (e.g., online). However, this rule will expire on August 2. Prior to this ruling, technicians were limited to only 7.5 hours of interactive continuing education. The ruling was enacted when technicians experienced difficulties in obtaining the additional 7.5 hours through attendance at seminars or workshops. After the rule expires, the OVEB will determine if a permanent rule is needed. For more information, contact the OVEB at 971-673-0224, or for a listing of courses that are approved for continuing education credit, go to www.aavsb.org. VERMONT We are deeply saddened to announce that Carolyn Ferris, a veterinary technician and member of the Vermont Veterinary Technician Association (VVTA), passed away on January 1, 2008, after a courageous battle with cancer. Carolyn worked as an elementary school teacher for more than 30 years. After she retired in 2003, she went back to school to become a veterinary technician. She earned a veterinary technology degree from Vermont Technical College and worked at the Berlin Veterinary Clinic in Montpelier, Vermont. Carolyn played an active role as a member of the VVTA. According to her peers, she helped with countless continuing education meetings and business meetings. She was always ready, willing, and able. “Carolyn also was one of the main people to demand that we do more during Hurricane Katrina,” states VVTA President Deb Glottmann. Carolyn will be missed by the veterinary community.

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Quick Course Glucosamine and Chondroitin Sulfate with ASU — Joint Health Beyond NSAIDs Sherman O. Canapp, Jr, DVM, MS, DACVS Veterinary Orthopedic & Sports Medicine Group, Ellicott City, MD Although NSAIDs are the cornerstone of osteoarthritis (OA) treatment in dogs, pet owners and veterinarians have continued to seek management options with fewer side effects that can improve long-term quality of life for patients with OA. A more progressive approach to OA management may include NSAIDs, weight loss, controlled exercise and physical therapy, environmental modifications, and the use of disease-

SYNOVIUM

AA Metabolites Leukotrienes, Prostaglandins (PGE2)

Leukocytes

modifying chondroprotective agents such as oral glucosamine hydrochloride–chondroitin sulfate (GC) products. Incorporating GC into a multimodal management plan can improve long-term joint function for patients with OA. A fairly recent addition to this family of agents is a GC product containing avocado/ soybean unsaponifiables (ASU) and green tea polyphenols (Dasuquin®, Nutramax

Macrophages Synoviocytes

Cytokines (IL-1β, TNF-α)

Inflammatory mediators (IL-1β, TNF-α, etc)

JOINT SPACE Proteoglycan destruction/loss Collagen breakdown Chondrocyte death Areas where GC-ASU has been shown to inhibit the OA process

Chemokines (IL-8, MIP-1β)

TIMPS Induce

Chondrocyte

CARTILAGE ECM

MMPs (collagenases)

Aggrecanases

COX-2 iNOS Cytokines PGE2 NO

Some of the agents involved in the pathogenesis of OA are illustrated here. Early OA changes may begin with synovitis, or inflammation of the joint capsule. Synovitis causes an influx of leukocytes into the joint space and release of inflammatory mediators (e.g., prostaglandins and cytokines) into the joint cavity. These inflammatory mediators adversely affect chondrocytes and the extracellular matrix of the cartilage. In vitro research using chondrocytes and synovial cells has shown that ASU, glucosamine, and chondroitin sulfate inhibit the pathways indicated. Administration of these agents may therefore help support cartilage health. (MIP-1β = macrophage inhibitory protein-1β; MMPs = matrix metalloproteinases; NO = nitric oxide; PGE2 = prostaglandin E2; TIMPs = tissue inhibitors of matrix metalloproteinase.)

Sponsored by Nutramax Laboratories, Inc.

Laboratories, Inc., Edgewood, MD). This product is produced to the industry’s highest quality standards. When administered to dogs and cats with OA, Dasuquin can serve as an important long-term option to help manage the chronic debilitating effects of this condition. How Does GC Work? Glucosamine is a glycosaminoglycan precursor used by chondrocytes, and chondroitin sulfate is the predominant glycosaminoglycan in the extracellular cartilage matrix. Administered together, these two agents act synergistically to modulate certain aspects of joint maintenance. They are also well absorbed after oral administration and have very limited side effects, even with long-term use. Studies have demonstrated some of the benefits of GC use in dogs. Administration of GC to dogs before experimental induction of synovitis resulted in decreased synovitis, associated bone remodeling, and lameness.1 Also, dogs with hip and elbow OA had improved pain scores and weight bearing after receiving GC,2 and administration of GC to dogs with experimental cruciate ligament injury was associated with potentially beneficial alterations in cartilage matrix metabolism.3 What about ASU? Avocado and soybean oils contain biologically active lipids known as ASU. These agents are thought to have antiinflammatory properties.4 An in vitro study using bovine chondrocytes showed that ASU decreased

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expression of the potent inflammatory mediators tumor necrosis factor–α (TNF-α), interleukin-1β (IL-1β), cyclooxygenase-2 (COX-2), and inducible nitric oxide synthase (iNOS) compared with chondrocytes incubated in control medium.5 These inflammatory mediators have a role in cartilage degradation (including proteoglycan destruction) and elsewhere in the pathogenesis of OA. ASU also stimulate synthesis of matrix components by increasing production of transforming growth factor–β (TGF-β), which is part of the extracellular matrix and is expressed by osteoblasts and chondrocytes. In a 2007 study, dogs given ASU for 3 months had higher levels of TGF-β in their joint fluid compared with control dogs.6 ASU have been shown to protect cartilage and/or improve joint function in several species,7–10 and when combined with a GC product, ASU complement the actions of the other agents without increasing side effects.10,11 In vitro studies also show a synergy between glucosamine and ASU, such that the combination of GC-ASU produces more favorable results than GC alone.10 Long-Term OA Management with GC-ASU Because GC-ASU has very few side effects or contraindications and is convenient to administer, long-term administration is generally well accepted by pets and owners. For severe OA pain, NSAIDs and/or alternative analgesic therapies are indicated to provide rapid pain relief and encourage mobility. But for mild to moderate pain or for longer-term control of OA pain and inflammation, appropriate nutraceuticals can complement other modalities, including intermittent NSAID therapy.12 In many cases, GC-ASU can be instituted alone or in conjunction with other therapies throughout the course of disease management to support long-term improvements in joint health and quality of life.

Although a recent study evaluated some methods for measuring pain in cats,13 this process is more difficult than in dogs, and there are currently no validated methods for measuring OA pain in cats. This creates a challenge for veterinarians trying to assess level of discomfort and response to therapeutic measures. Additionally, NSAIDs aren’t currently approved for treatment of OA pain in cats, so veterinarians trying to improve quality of life for these patients are somewhat limited by a lack of approved therapeutic options. A study being performed by Dr. Mila Freire Gonzalez, a research fellow at North Carolina State University College of Veterinary Medicine, is indicating that cartilage degeneration is very common in cats. In addition, her team has found that as many as 74% of all cats show radiographic evidence of degenerative joint disease (DJD) somewhere in the skeleton. A significant number of those cats also have impaired mobility. Fortunately, both GC and GC-ASU products are available for use in cats. Dr. Duncan Lascelles, director of the Comparative Pain Research Laboratory and the Integrated Pain Management Service at North Carolina State University College of Veterinary Medicine, employs various modalities for managing pain in cats, including physical therapy and nutraceuticals. He comments, “I’ve used Dasuquin extensively in cats, and it makes a marked difference. Over the past year, we have evaluated approximately 150 cats in detail for the presence of painful DJD. Many of those found to have painful DJD have received Dasuquin; I’ve seen these cats become more active with improved quality of life after taking Dasuquin.” Although data on the use of GC-ASU products in cats are limited, an in vitro study showed inhibition of PGE2 (an inflammatory mediator) in a model using feline chondrocytes.14 These findings might infer an antiinflammatory effect in feline joint disorders, but Dr. Lascelles cautions that it would be inappropriate to assume a direct connection between in vitro effects on cartilage and overall clinical improvement. “We know these cats improve clinically, but we can’t yet say why without more data,” Lascelles says.

References 1. Canapp SO, McLaughlin RM, Hoskinson JJ, et al: Scintigraphic evaluation of dogs with acute synovitis after treatment with glucosamine hydrochloride and chondroitin sulfate. Am J Vet Res 60(12):1552–1557, 1999. 2. McCarthy G, O’Donovan J, Jones B, et al: Randomised double-blind, positive-controlled trial to assess the efficacy of glucosamine/chondroitin sulfate for the treatment of dogs with osteoarthritis. Vet J 174(1):54–61, 2007. 3. Johnson KA, Hulse DA, Hart RC, et al: Effects of an orally administered mixture of chondroitin sulfate, glucosamine hydrochloride and manganese ascorbate on synovial fluid chondroitin sulfate 3B3 and 7D4 epitope in a canine cruciate ligament transection model of osteoarthritis. Osteoarthritis Cartilage 9(1):14–21, 2001. 4. Lippiello L, Nardo JV, Harlan R, Chiou T: Metabolic effects of avocado/soy unsaponifiables on articular chondrocytes. eCAM Advance access at http://ecam.oxfordjournals. org/cgi/content/abstract/nem132v1. 5. Au RY, Al-Talib TK, Au AY, et al: Avocado soybean unsaponifiables (ASU) suppress TNF-α, IL-1β, COX-2, iNOS gene expression, and prostaglandin E2 and nitric oxide production in articular chondrocytes and monocytes/ macrophages. Osteoarthritis Cartilage 15:1249–1255, 2007. 6. Altinel L, Saritas ZK, Kose KC, et al: Treatment with unsaponifiable extracts of avocado soybean increases TGF-β1 and TGF-β2 levels in canine joint fluid. Tohoku J Exp Med 211:181–186, 2007. 7. Kawcak CE, Frisbie DD, McIlwraith CW, et al: Evaluation of avocado and soybean unsaponifi-

10.

11.

12.

13.

14.

GC-ASU IN FELINE OSTEOARTHRITIS

able extracts for treatment of horses with experimentally induced osteoarthritis. Am J Vet Res 68(6):598–604, 2007. Cake MA, Read RA, Ghosh P: Modification of articular cartilage and subchondral bone pathology in an ovine meniscectomy model of osteoarthritis by avocado and soya unsaponifiables (ASU). Osteoarthritis Cartilage 8(6):404–411, 2000. Ameye LG, Chee WS: Osteoarthritis and nutrition. From nutraceuticals to functional foods: A systematic review of the scientific evidence. Arthritis Res Ther 8(R127):1–22, 2006. Au R, Au A, Rashmir-Raven A, et al: Inhibition of pro-inflammatory gene expression in chondrocytes, monocytes, and fibroblasts by the combination of avocado soybean unsaponifiables, glucosamine, and chondroitin sulfate. FASEB J 21(6):A736, 2007. Kettenacker RW, Griffin D: Safety profile evaluation of an equine joint health supplement containing avocado/soybean unsaponifiables (ASU), glucosamine, chondroitin sulfate and methylsulfonylmethane. Presented at the 15th Biennial AAVPT Symposium, Pacific Grove, CA, 2007. Beale BS: Use of nutraceuticals and chondroprotectants in osteoarthritic dogs and cats. Vet Clin North Am Small Anim Pract 34:271–289, 2004. Lascelles BDX, Hansen BD, Roe S, et al: Evaluation of client-specific outcome measures and activity monitoring to measure pain relief in cats with osteoarthritis. J Vet Intern Med 21:410–416, 2007. Punke JP, Au RY, Phan P, et al: Modulation of prostaglandin E-2 production in feline articular chondrocytes propagated in monolayer and dynamic microcarrier culture [abstract]. Presented at the ACVS Vet Symp, Chicago, IL, 2007.

This information has not been peer reviewed and does not necessarily reflect the opinions of, nor constitute or imply endorsement or recommendation by, the Publisher or Editorial Board. The Publisher is not responsible for any data, opinions, or statements provided herein.

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Cover Story

Not “Just” a Technician

A Talk with Marianne Tear, MS, LVT

Andrea Vardaro Tucker S A VETERINARY TECHNICIAN AND EDUCATOR, Langhorne, Pennsylvania Marianne Tear, MS, LVT, knows that the care technicians provide is vital to the health and well-being of their animal patients. Marianne cautions her peers and students to never refer to themselves as “just” technicians. She says, “When we downplay the importance of what we do, we allow others to do the same thing.” Marianne’s success shows that there is no limit to what veterinary technicians can achieve. Before she began teaching and inspiring veterinary technician students inside and outside the classroom, she worked as an assistant in a veterinary clinic and later at an emergency clinic while attending school to become a veterinary technician; interned at Abbott Laboratories in Waukegan, Illinois; and worked as staff manager of an emergency clinic. She served as Program Coordinator/Manager II at Wayne State University’s Wayne County Community College District veterinary technology program from 2000 until early this year, when she became program director of the veterinary technology program at Baker College of Clinton Township in Michigan. Marianne has authored two chapters in two separate veterinary technician review texts, coauthored an article in the Institute for Laboratory Animal Research Journal, and presented lectures at two conferences. Here, Marianne tells us about her career, her desire to improve the care that animals receive, and the inspiration she gains from teaching veterinary technology students. 204

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Cover Story Marianne discusses canine anatomy with (left to right) student Shannon Love, lab assistant Heather Bieke, and student Lauren High. The skeletal model, which is constructed of manmade materials, is supposed to depict a medium-sized dog.

How did you become interested in veterinary technology?

After graduating, I took a leave of absence from the emergency clinic to complete a 2½-month internship at Abbott Laboratories. When the internship was complete, I was offered the position of staff manager at Veterinary Emergency Service West. After several years, however, it was becoming difficult to work 16-hour shifts for 4 to 5 www.VetTechJournal.com

days a week. I wanted to stay in the field, but I needed a position with fewer physical demands. In January 2000, the director of Wayne State University’s Wayne County Community College District veterinary technology program asked me to assist with lab sessions 1 to 2 days a week because I had experience in emergency medicine and an understanding of biomedical research. I discovered that I thoroughly enjoyed instructing students. As staff manager at the emergency clinic, I was teaching one or two employees; at Wayne State, I got to work with about 40 students and help them to develop their skills and techniques. By August, I was working at the university full time.

V I TA L S TAT I S T I C S M A R I A N N E T E A R Education BA in biology, Wayne State University, Detroit, Michigan (1993); AAS in veterinary technology, Wayne County Community College District, Detroit, Michigan (1998); MS in biology, Wayne State University (2003)

Professional Associations Michigan Association of Veterinary Technicians (president-elect; past recording secretary), NAVTA (adviser for student chapter)

Family and Pets Marianne and her husband, Christopher, have a pug, Molly (5 years old); a shih tzu, Zach (8 years old); a 50-lb bull mastiff mix, Gehrig, after the baseball player (1 year old); an orange-and-white domestic shorthair, Dewy (about 10 years old); a black domestic shorthair, Morticia (about 9 months old); and two ponds full of fish. Veterinary Technician | APRIL 2008 205

Glenn Triest

After working in private practice, what made you decide to work in a university setting?

Marianne watches as student Lauren High checks a dog’s heart rate. Glenn Triest

While I was finishing up the coursework for my bachelor’s degree in biology, I saw a flyer for Michigan State University’s veterinary school, which sparked my interest in veterinary medicine. I started working at Center Line Veterinary Hospital in Michigan as a prerequisite for applying to veterinary school. At the hospital, I developed an interest in veterinary technology and only then realized that the veterinary technician plays an important role in strengthening the human–animal bond. The hospital’s owner, Harold Duchan, DVM, took me under his wing when I was an assistant and inspired me to always do my best. He later encouraged me to work at one of his emergency clinics, Veterinary Emergency Service East, because he thought that I would enjoy the pace and complexity of emergency medicine. Dr. Duchan believed that it was possible to be professional and still find joy in what you do. When I heard Nancy Shaffran, RVT, VTS (ECC), and Harold Davis, Jr., BA, RVT, VTS (ECC, Anesthesia), speak at a conference, I decided that I definitely wanted to become a technician. Their professionalism and passion for what they do were inspiring to me, especially the idea of using advanced nursing care to treat animals. Ms. Shaffran also asked one of the most thought-provoking questions during her talk: “Why do we put the animal’s name in quotes?” In other words, why do we treat animal patients like they are less important than human patients? Because of her comments, I realized that I wanted to spend my life ensuring that animal patients receive the same high-quality care I would want for members of my own family.

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Cover Story

Tell us about the work you performed at Wayne State University.

“I believe you should

challenge yourself,

even if it means moving outside your comfort zone.”

My main responsibilities included maintaining a working inventory, demonstrating the appropriate techniques, supervising the part-time assistants, and performing administrative duties. When one of the part-time faculty members had to stop teaching, I inherited the instructor’s course load. My new responsibilities included managing all laboratory sessions, conducting lectures, recruiting new students, advising students, supervising part-time faculty and laboratory assistants, and handling animal adoptions. I also coordinated the surgical rotation — I ensured that students attended their assigned session and that there were enough surgical candidates. I also supervised the students through their three rotations: anesthesia, surgical preparation, and surgical assisting.

What made you decide to leave Wayne State and accept the position of program director of the veterinary technology program at Baker College? After I spent more than 7 years at Wayne State, I realized that I wanted to advance my career further. I believe you should always challenge yourself, even if it means moving outside your comfort zone. I decided that it

was time for me to pursue other challenges, so the opportunity at Baker College just presented itself at the perfect time.

What new opportunities and challenges does your new position provide? Baker College is unique in that it offers its veterinary technology program coursework on several different campuses. Therefore, the program must be consistent throughout the college, but each campus also has to be responsive to the veterinary community it serves. It’s great to work in a collaborative environment, and I appreciate all of the support that I’ve received from my colleagues and the students. The program that I’m overseeing is very new — our first class graduates this spring. My primary responsibility is to ensure that every graduate passes his or her board exams and has the skill sets needed to be a vital asset to the veterinary community.

Why is this career path particularly rewarding for you? Watching a student advance his or her skills is one of the most rewarding aspects of my job. Typically, half the students who enroll in a veterinary technology program have little to no veterinary-related experience, whereas the other half already have

PERSONAL INTEREST

The Amazing Race

arianne has taken her skill as a technician and her passion for animals as far as Alaska, where she has volunteered her services to help perform prerace workups on the Iditarod sled dogs for the past 3 years. Every dog that runs in the Iditarod dogsled race must undergo a rigorous prerace workup that includes blood drawing and electrocardiography in a mobile clinic. Each dog musher can qualify up to 24 dogs, and more than 80 mushers typically enter the race each year. Jan Bullock, LVT, coordinates the entire process and uses a team of volunteer, credentialed technicians to perform the workups. Marianne got involved after reading about Jan and the program on the official Iditarod Web site. “Working with wonderful dogs and compliant owners from sunup to sundown is a wonderful experience,” Marianne says. “I could and do talk about the experience for hours on end. I’ve actually given a presentation on Marianne with a sled dog after running an the event at a major conference.” electrocardiogram during a workup.

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LYME DISEASE: You can’t ignore the signs.

LymeVax: The right choice for safe, effective protection. Urban sprawl. Expanding tick ranges.Warmer weather. More pets traveling with owners. Together, they make Lyme disease a growing, spreading threat for both people and dogs.1,2 Fortunately, LymeVax® is a whole-cell bacterin that induces an antibody response to multiple outer surface proteins. Unlike OspA-only vaccines, multi-antigen vaccines stimulate a wide array of immune responses. For more information on LymeVax, contact your Fort Dodge Animal Health representative today. 1. Centers for Disease Control and Prevention. Reported Lyme disease cases by state, 1993-2005. http://www.cdc.gov/ncidod/dvbid/lyme/ld_rptdLymeCasesbyState.htm 2. Reported positives from more than 1,400 veterinary clinics. Actual number of cases may be significantly higher. Data on file, Fort Dodge Animal Health.

LymeVax

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Off the Cuff What was the last movie you saw? Aliens — I’ve seen it more times than I can count, but I still love it. Are you a morning person or a night owl? I’m slowly turning into a morning person; my pug does not like to sleep in. What’s your favorite day of the week? Sunday. It’s our “stay in our PJs” day. The farthest I venture out is to the birdfeeders. What was your first pet? Cinderella, a Doberman pinscher–German shepherd mix I rescued when I was 5 or 6 years old. My mother made the mistake of telling me I could buy whatever I wanted with the $5 I got for doing extra chores. I told her I wanted a dog, but I think she was convinced I couldn’t get one for $5. The animal control officer took pity on me, though, and let me have Cinderella! 208

experience working in a veterinary clinic. It’s amazing to watch students who’ve never held a syringe before and then see them progress through the program until they can hold a syringe proficiently and can work adeptly in a veterinary clinic. The confidence they acquire while they’re learning is inspiring. Students who have some experience learn the “why’s” behind what they’ve seen done in the clinic. They also can in turn explain to their less experienced classmates what duties are performed in the clinic and share their experiences. I also love to hear about former students who are thriving in their career. I attended the Michigan Veterinary Conference this January, and several veterinarians who employ my former students approached me. The conversations always started with “You don’t know me, but my technician was one of your students” and ended with the veterinarians complimenting the quality of that technician’s work. My goal is to be able to take my pets into any clinic in southeastern Michigan and see one of my graduates working there as a technician. That way, I’ll know that my pets will receive the best care possible.

How do you inspire students to get involved with activities outside of the classroom? I encourage my students to get involved in the community by volunteering their time and services, and I try to lead by example. Telling students that community service is important isn’t as effective as inviting them to participate in an event with you. Most technicians I’ve met are empathetic and compassionate. They give so much of themselves both mentally and emotionally every day that it might seem like giving more in terms of volunteering is too draining. It’s actually the opposite — the positive feedback you get from those you are helping reinvigorates you. I also believe volunteering is an opportunity for us to let people know who we are and what we do. Each year, the Michigan Humane Society raises money through an event called the Mega March for Animals. Participants obtain pledges for themselves and their dog or cat to walk from Hart Plaza to Grand Circus Park in downtown Detroit and back.

APRIL 2008 | Veterinary Technician

Glenn Triest

Cover Story

Molly, Marianne’s 5-year-old pug, often comes to work with her.

When I worked at Wayne State, our staff and students registered as a group, and we ordered T-shirts with the college’s logo on the back. Events like this are important because they give students the opportunity not only to help a good cause but also to talk to the other pet owners about their future profession. When Hurricane Katrina hit, we couldn’t all travel to Louisiana to help out. So the students organized a T-shirt sale and collected more than $7,000 to send to the animal relief fund. The American Veterinary Medical Foundation matched the donation. The students took a feeling of helplessness and turned it into positive action.

What are your hopes for the profession? I hope that the profession continues to grow and that technicians gain the recognition that they deserve. I’d love to be able to answer the question “What do you do for a living?” with a simple “I’m a veterinary technician” and have the person know what I’m talking about and not say, “So you’re a veterinarian.” I’m positive, with the dedicated individuals we have in our midst, that it won’t be long before the public knows what a veterinary technician is and the important role that we play in providing the best care possible for pets. www.VetTechJournal.com

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Peer Reviewed

Overview of Canine

Anxiety

OGS WITH SEPARATION ANXIETY Katie Costello, RVT Town and Country Veterinary Hospital become distressed when they are left Warren, Ohio alone or separated from their owner. They may urinate or defecate inappropriately — even when they are house-trained — or engage in destructive behavior, potentially eroding the human–animal bond to such an extent that the owner may be considering relinquishing or euthanizing the pet. If an owner reports that his or her pet is misbehaving when it is home alone, the technician should obtain a thorough history to help the veterinarian rule out other conditions that could be causing the pet to behave inappropriately. If the pet is diagnosed with separation anxiety, environmental and behavioral modification, combined with drug therapy, can be used to manage the condition. Definition and Clinical Signs Separation anxiety is a behavioral syndrome in which a dog exhibits distress when it is unable to gain access to its owner.1,2 Often, a major change has occurred in the amount of time spent with the dog, such as when the

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owner returns to work after a period of illness or unemployment.3 Although dogs of any breed or age are at risk of separation anxiety, risk factors include history as a stray or shelter dog.3–5 Clinical signs of separation anxiety include housesoiling; destructive chewing; excessive Veterinary Technician | APRIL 2008 209

Separation

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vocalization, salivation, or licking; digging; trembling; vomiting or diarrhea; aggression directed at the owner upon his or her departure; and self-mutilation.6–8 Dogs with separation anxiety also commonly exhibit noise phobia or thunderstorm phobia.9,10 A dog’s anxiety may cause it to damage structures near exit areas in the home, such as doors or door frames; the dog may also destroy or defecate on the owner’s possessions, such as clothing or furniture.3,11 Some dogs with separation anxiety may display hyperattachment, remaining close to the owner while he or she is at home.9,12 These dogs exhibit signs of separation anxiety when they are unable to gain access to the owner or when they detect cues indicating that the owner is planning to leave (e.g., if the owner picks up car keys or a briefcase). Although some dogs become distressed even before the owner leaves, signs of separation anxiety usually begin within 30 minutes of the owner’s departure.3,11

Diagnosis In order for a veterinarian to diagnose separation anxiety, it must be distinguished from other possible medical causes. Therefore, a detailed patient history should be obtained, and a thorough physical examination should be conducted. If a pet urinates or defecates inappropriately, urinalysis and urine or fecal culture may be necessary to rule out urinary tract infection or gastrointestinal disease.3,13 A pet that is destructive may be engaging in exploratory chewing or compensating for a lack of stimulation.13 Videotaping the dog after the owner leaves may help to determine the extent of the problem or rule out other causes. When a dog is diagnosed with separation anxiety, the veterinary staff should discuss a treatment plan with the owner. It is important that the owner recognizes that when the pet exhibits undesirable behavior, it is not being spiteful but is anxious following separation from the owner.14

Treatment Management of separation anxiety requires an understanding of the factors triggering the undesirable behavior (e.g., identifying the departure cues that trigger the anxiety).3 Treatment involves both envi210

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ronmental and behavioral modification as well as pharmacotherapy.

Environmental Modification When the owner is at home, he or she should give the pet opportunities for social interaction and exercise; the dog should also be trained to rest or engage in play in a designated area, such as a room with a mat or bedding.11,14 Restricting the pet to a specific area can help reduce destructive behavior throughout the home.15 Whenever the pet enters the designated area, the owner should provide affection and offer the pet a variety of toys and treats so that the pet will be motivated to remain there.16 In addition, by offering the dog a reward whenever it rests or plays in the designated location, the area will become a “safe” place that the pet will choose to enter even when it is not alone in the house. Once the pet is settled in this “safe” area, the owner should begin to implement graduated departures (discussed below), in which he or she leaves the area and gradually extends the duration of time spent away from the pet; leaving a television on or playing music can also help to keep the pet relaxed while the owner is away.11 In some cases, keeping the pet confined in a crate while the owner is not at home may help to reduce separation anxiety. However, the pet must associate the crate with positive experiences, be relaxed and calm while inside the crate, and be acclimated to confinement (i.e., the pet should choose to enter the crate to rest or sleep, even when the owner is at home).17 However, if a dog has crate aversion, crating may increase its anxiety.3

Behavioral Modification Along with environmental modification, behavioral modification strategies such as systematic desensitization and counterconditioning should be used to decrease a pet’s anxiety. Because a pet will associate certain cues with the owner’s departure, such as the sound of keys being picked up, it may be helpful for the owner to desensitize the pet to these departure cues. During systematic desensitization, the owner exposes the pet to an anxiety-inducing stimulus at a low level of intensity, rewards the pet — using motivators such as treats or attention — when it exhibits relaxed behavwww.VetTechJournal.com

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HEARTGARD® Plus (ivermectin/pyrantel)

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the only heartworm preventive in a Real-Beef Chewable. Pet owners love to give it and dogs love to take it.

HEARTGARD Plus harnesses the irresistible power of real beef for heartworm prevention and the control of roundworms and hookworms in dogs. What dogs are getting: • The #1 veterinarian-recommended heartworm preventive1 • Treatment and control of common canine parasites (roundworms and hookworms) that can cause zoonotic disease in humans, including children • The real-beef taste dogs prefer 37:12 • The preventive owners prefer to give 3:1 over the next leading brand3 • The HEARTGARD Plus Guarantee of Satisfaction4 HEARTGARD is well tolerated. All dogs should be tested for heartworm infection before starting a preventive program. Following the use of HEARTGARD, digestive and neurological side effects have rarely been reported. For more information, please visit www.HEARTGARD.com. Circle 190 on Reader Service Card

When you want to protect, but worry about compliance, always recommend the only Real-Beef Chewable, HEARTGARD Plus.

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Peer Reviewed COMFORTIS™ (spinosad) Chewable Tablets Brief Summary: Before using Comfortis chewable tablets, please consult the product insert, a summary of which follows: Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Dosage: Administer orally once monthly. Administer with food for maximum effectiveness. Recommended dose range is 13.5 – 27.3 mg/lb (30-60 mg/kg). Available in five tablet sizes for dogs ranging from 5 to 120 lbs. Dogs over 120 lbs should be administered the appropriate combination of tablets. Indications: COMFORTIS chewable tablets kill fleas and are indicated for the prevention and treatment of flea infestations (Ctenocephalides felis) on dogs for one month. Contraindications: There are no known contraindications for the use of COMFORTIS chewable tablets. Warnings: Not for human use. Keep this and all drugs out of the reach of children. Precautions: COMFORTIS chewable tablets are for use in dogs and puppies 14 weeks of age and older (see ANIMAL SAFETY). Use with caution in breeding females (see ANIMAL SAFETY). Use with caution in dogs with pre-existing epilepsy (see ADVERSE REACTIONS). The safe use of COMFORTIS chewable tablets in breeding males has not been evaluated. Adverse Reactions: In a well-controlled US field study, which included a total of 470 dogs (330 dogs treated with COMFORTIS chewable tablets and 140 dogs treated with an active control), no serious adverse reactions were observed with COMFORTIS chewable tablets. All reactions were regarded as mild and did not result in any dog being removed from the study. Over the 90-day study period, all observations of potential adverse reactions were recorded. Reactions that occurred at an incidence > 1% within any of the 3 months of observation are presented in the following table. The most frequently reported adverse reaction in dogs in the COMFORTIS chewable tablets and active control groups was vomiting. The occurrence of vomiting, most commonly within 48 hours after treatment, decreased with repeated doses of COMFORTIS chewable tablets. Percentage of Dogs (%) with Adverse Reactions

ior after exposure to the anxiety-inducing stimulus, and gradually increases the intensity of the stimulus in small increments.18 For example, desensitization can be used if a dog becomes anxious when its owner picks up his or her keys. The keys should be picked up several times a day without the owner leaving. Initially, he or she should make as little noise as possible when picking up the keys, should command the pet to relax (this behavior must be taught before the owner can cue it), and should observe the pet’s reaction. If the pet exhibits a minimal response or no response, the owner should then gradually increase the noise level associated with picking up the keys until the dog does not exhibit anxiety when the owner picks up his or her keys normally. In counterconditioning, a response that is physiologically and behaviorally incompatible with the undesired response — in this case, anxiety — is induced.18 The owner can employ counterconditioning by playing one of the pet’s favorite games while picking up the keys and putting them down.17 Using counterconditioning with desensitization may achieve faster results.14 Use of punishment is not appropriate because it can induce further anxiety.7,11,14,a The owner should ensure that the pet receives rewards — such as affection, treats, or toys — only when it exhibits relaxed, calm behavior and not when the pet initiates physical contact or attempts to follow the owner.14 Graduated departures can be initiated while the dog is resting or playing with a toy in its “safe” area. When the pet is calm, the owner should leave the area. Then, he or she should return before the pet begins to exhibit anxiety. The duration of departure should be increased gradually.14 About 15 minutes before departure, the owner should withhold attention from the pet, which should be settled in its designated area and distracted with treats and toys that will engage the pet for a significant period of time. A hollow toy, such as a Kong toy (Kong Company, Golden, CO), can be stuffed with treats or the pet’s favorite foods (e.g., peanut butter, cheese) to keep the pet occupied. The owner should minimize

Month 1 Month 2 Month 3 COMFORTIS Active COMFORTIS Active COMFORTIS Active Chewable Topical Chewable Topical Chewable Topical Tablets Control Tablets Control Tablets Control (N=330) (N=139a) (N=282) (N=124) (N=260) (N=125) Vomiting 12.7 12.2 7.8 3.2 5.8 4.8 Decreased Appetite 9.1 5.0 2.8 1.6 1.9 0.8 Lethargy 7.6 5.0 3.5 4.0 1.2 0.8 Diarrhea 6.7 5.0 4.3 0.8 1.2 0.0 Cough 3.9 5.0 0.4 2.4 0.0 0.0 Polydipsia 2.4 1.4 0.7 0.0 0.4 0.0 Vocalization 1.8 0.0 0.4 0.0 0.4 0.0 Increased Appetite 1.5 0.0 0.4 0.8 0.4 0.0 Erythema 1.5 0.0 0.4 0.0 0.4 0.0 Hyperactivity 1.2 1.4 0.0 0.0 0.4 0.0 Excessive Salivation 1.2 0.0 0.4 0.0 0.0 0.0 a

This number (n=139) is less than the total number of dogs in the safety population for the active control group (n=140) because one dog joined the study late and was only dosed at Month 3. In US and European field studies, no dogs experienced seizures when dosed with COMFORTIS chewable tablets at the therapeutic dose range of 13.5-27.3 mg/lb (30-60 mg/kg), including 4 dogs with pre-existing epilepsy. Four epileptic dogs that received higher than the maximum recommended dose of 27.3 mg/lb (60 mg/kg) experienced at least one seizure within the week following the second dose of COMFORTIS chewable tablets, but no seizures following the first and third doses. The cause of the seizures observed in the field studies could not be determined. Animal Safety: COMFORTIS chewable tablets were tested in pure and mixed breeds of healthy dogs in well-controlled clinical and laboratory studies. No dogs were withdrawn from the field studies due to treatment-related adverse reactions. In a dose tolerance study, COMFORTIS chewable tablets were administered orally to adult Beagle dogs at average doses of up to 100 mg/kg once daily for 10 consecutive days (16.7 times the maximum recommended monthly dose). Vomiting was seen in 5 of 6 treated dogs during the first 6 days of treatment, usually within 2.5 hours of dosing. Treated females lost weight early in the treatment period, but their weights were similar to control dogs by the end of the 24-day study. COMFORTIS chewable tablets were not associated with any clinically significant changes in hematology, blood coagulation or urinalysis parameters; however, mild elevations in ALT occurred in all dogs treated with COMFORTIS chewable tablets. By day 24, ALT values had returned to near baseline levels. Phospholipidosis (vacuolation) of the lymphoid tissue, the long-term effects of which are unknown, was seen in all dogs treated with COMFORTIS chewable tablets. In a margin of safety study, COMFORTIS chewable tablets were administered orally to 6-week-old Beagle puppies at average doses of 1.5, 4.4, and 7.4 times the maximum recommended dose at 28-day intervals over a 6-month period. Vomiting was observed across all groups, including the control. Increased vomiting was observed at elevated doses, usually within 1 hour following administration. Vomiting at all doses decreased over time and stabilized when puppies were 14 weeks of age. The average daily and total weight gains of treated dogs were smaller than control dogs and were dose dependent. COMFORTIS chewable tablets were not associated with clinically significant changes in hematology, clinical chemistry, coagulation or urinalysis parameters. Phospholipidosis (vacuolation) of the lymphoid tissue was seen in some dogs in the 4.4X group and all dogs in the 7.4X group. The long term effects of phospholipidosis are unknown. Treatment with COMFORTIS chewable tablets was not associated with any other clinically significant adverse clinical observations, gross necropsy or histopathological changes. In a reproductive safety study, COMFORTIS chewable tablets were administered orally to female Beagles at 1.3 and 4.4 times the maximum recommended therapeutic dose every 28 days prior to mating, during gestation, and during a six-week lactation period. No treatment-related adverse effects were noted for conception rates in the dams, or for mortality, body temperature, necropsy, or histopathology findings for the dams or puppies. One dam from each treatment group experienced early pregnancy loss and one additional high dose dam aborted late term. The treated dams experienced more vomiting, especially at one hour post-dose, than the control dams. Puppies from dams treated at 1.3 times the maximum recommended therapeutic dose had lower body weights than puppies from control dams. Although puppy mortality between treated and control dams was not different, the puppies from the treated dams experienced more lethargy (4.4X group only), dehydration, weakness and felt cold to the touch (4.4X group only) than puppies from control dams. A pilot study without a control group was conducted to analyze milk from three lactating dogs treated with an experimental formulation of spinosad at 1.5 times the maximum recommended dose administered at day 28 of gestation and 24 hours prior to parturition. The data demonstrated that spinosyns were excreted in the milk of these dogs. Mortality and morbidity were greatest in puppies from the dam with the highest spinosyns level in milk. The spinosad milk: reference plasma exposure ratio calculated from this study ranged from 2.2 to 3.5. In well-controlled field studies, COMFORTIS chewable tablets were administered safely in conjunction with other frequently used veterinary products, such as vaccines, anthelmintics, antibiotics, steroids, flea and tick control products, anesthetics, NSAIDs, antihistamines, alternative/herbal remedies, shampoos, and prescription diets. Changes in hematology, clinical chemistry and urinalysis values were compared pre-and post-study and were unremarkable. Storage Information: Store at 20-25°C (68 -77°F), excursions permitted between 15 to 30°C (59 to 86°F). To obtain full product information please call 888-545-5973 or visit www.comfortis4dogs.com. NADA 141-277, Approved by FDA Manufactured for Elanco Animal Health, A Division of Eli Lilly & Co., Lilly Corporate Center, Indianapolis, IN 46285

For more information, see the American Veterinary Society of Animal Behavior guidelines on the use of punishment at www.avsabonline.org.

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The only FDA-approved monthly flea protection that kills fleas and comes in a chewable, beef-flavored tablet.

The most common adverse reaction recorded during clinical trials was vomiting. Other adverse reactions were decreased appetite, lethargy or decreased activity, diarrhea, cough, increased thirst, vocalization, increased appetite, redness of the skin, hyperactivity and excessive salivation. For product label, including important safety information, see page 212.

NEW Comfortis™ is the first and only oral flea protection approved by the FDA that kills fleas for a full month. Not only does it offer fast-acting, long-lasting flea protection, but Comfortis™ comes in a chewable, beef-flavored tablet that eliminates the messiness of topical flea treatments. To learn more about new Comfortis™, see your Lilly representative, distributor representative or call 1 (888) LillyPet. Available by prescription only. www.comfortis4dogs.com

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departure cues until the pet has become counterconditioned and desensitized to them. While the pet is playing or resting, the owner should leave the house. After returning home, the owner should withhold attention from the pet until it is calm and settled.14 Implementing environmental and behavioral modification strategies is time-consuming and requires that the owner be committed and patient. Boarding the pet or employing a pet sitter may be a temporary solution until a longterm treatment plan can be implemented.3

Drug Therapy Drug therapy is often used along with environmental and behavioral modification to reduce a pet’s anxiety and improve learning. When a pet’s anxiety is reduced, it may be more responsive to these therapies.12 Various drugs have been used to treat separation anxiety in dogs. The FDA has approved fluoxetine (1–2 mg/kg sid) and clomipramine hydrochloride (2–4 mg/kg q24h) for treatment of canine separation anxiety.2 Some behaviorists, however, recommend administering clomipramine hydrochloride at 1 to 3 mg/kg bid.13 Fluoxetine is a selective serotonin reuptake inhibitor; lethargy and anorexia are the most common side effects associated with its use.14 Clomipramine hydrochloride, a tricyclic antidepressant, inhibits serotonin reuptake and noradrenaline reuptake.12,19 The most common side effects associated with use of clomipramine hydrochloride in dogs are vomiting and sedation.20 Benzodiazepines (e.g., alprazolam, diazepam) are potent anxiolytics that can be useful in the short term at the beginning of therapy in severely affected dogs1; however, they often have a sedatory effect.12

Separation Anxiety Management Tips for Owners Avoid interacting with the pet until it is calm and relaxed, and provide rewards when the pet exhibits calm, relaxed behavior. To minimize anxiety-related destruction in the home, designate a “safe” area for the pet. Encourage the pet to remain in this area by providing toys and long-lasting treats. Withhold attention from the pet for at least 15 minutes before departure, and desensitize the pet to departure cues. Follow the veterinarian’s prescribed drug therapy regimen. If the pet is not responding to drug therapy, contact the veterinarian to discuss other treatment options. Avoid punishment, which can exacerbate the pet’s anxiety. 214

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Collars, diffusers, and sprays containing a synthetic form of the dog-appeasing pheromone that a mother dog produces to comfort her puppies can also be used to treat separation anxiety. This therapy does not appear to have any negative side effects.14,17

Conclusion Separation anxiety can affect puppies as well as adult dogs that previously did not exhibit behavior problems. Because significant changes in a dog’s life can lead to separation anxiety, owners who anticipate modifying their schedule or reducing the amount of time that they spend with the dog should implement these changes gradually, if possible.15 Without treatment, dogs with separation anxiety may be relinquished to shelters, abandoned, or euthanized21; therefore, technicians should ensure that owners are educated about treatment options. A treatment plan that combines pharmacotherapy with environmental and behavioral modification may manage the pet’s anxiety and help to strengthen the human–animal bond.

References 1. Simpson BS: Canine separation anxiety. Compend Contin Educ Pract Vet 22:328–339, 2000. 2. Sherman BL: Separation anxiety in dogs. Compend Contin Educ Pract Vet 30(1):27–32, 42, 2008. 3. Canine social behavior, in Beaver BV: Canine Behavior: A Guide for Veterinarians. Philadelphia, WB Saunders, 1999, pp 184–186. 4. Separation anxiety: Canine and feline, in Horwitz DF, Neilson JC: Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Canine and Feline Behavior. Ames, IA, Blackwell Publishing, 2007, pp 446–455. 5. Voith VL, Ganster D: Separation anxiety: Review of 42 cases. Appl Anim Behav Sci 37(1):84, 1993. 6. McCrave EA: Diagnostic criteria of separation anxiety in the dog. Vet Clin North Am Small Anim Pract 21(2):247, 1991. 7. Voith VL, Borchelt PL: Separation anxiety in dogs. Compend Contin Educ Pract Vet 7(1):42, 1985. 8. Schwartz S: Separation anxiety syndrome in dogs and cats. JAVMA 222(11):1528, 2003. 9. Flannigan G, Dodman NH: Risk factors and behaviors associated with separation anxiety in dogs. JAVMA 219(4):460–466, 2001. 10. Overall KL, Dunham AE, Frank DF: Frequency of nonspecific clinical signs in dogs with separation anxiety, thunderstorm phobias, and noise phobia alone or in combination. JAVMA 219:467–473, 2001. 11. Landsberg G: Diagnosing and treating canine separation anxiety. West Vet Conf Proc 2007.

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12. King JN: Pharmacological Management of Separation Anxiety. Accessed March 2008 at www.ivis.org/ advances/Behavior_Houpt/king/IVIS.pdf. 13. Calnon DJ, Landsberg GM, Rishniw M: Separation Anxiety in Dogs: Medical FAQs. Accessed March 2008 at www.vin.com. 14. Landsberg G: Separation anxiety — New approaches to therapy. West Vet Conf Proc 2008. 15. Fears and phobias, in Landsberg G, Hunthausen W, Ackerman L: Handbook of Behavior Problems of the Dog and Cat, ed 2. Philadelphia, Elsevier, 2003, pp 258–268. 16. Heiblum M: Separation anxiety in dogs. World Small Anim Vet Assoc World Congr Proc 2006. 17. Neilson JC: Challenging cases in separation anxiety. West Vet Conf Proc 2008.

ABOUT THE AUTHOR

Katie Costello,

RVT

18. Neilson JC: Fear of places or things, in Horwitz D, Mills D, Heath S (eds): BSAVA Manual of Canine and Feline Behavioural Medicine. Gloucester, England, British Small Animal Veterinary Association, 2002, pp 173–180. 19. Landsberg GM: Behavioral therapy for separation anxiety in dogs — An evidence based approach I & II. West Vet Conf Proc 2008. 20. King JN, Simpson BS, Overall KL, et al: Treatment of separation anxiety in dogs with clomipramine: Results from a prospective, randomized, double-blind, placebo-controlled, parallel-group, multicenter clinical trial. Appl Anim Behav Sci 67:255–275, 2000. 21. Overall KL: How to deal with anxiety and distress responses: Dogs. Atlantic Coast Vet Conf Proc 2001.

Katie works at the Town and Country Veterinary Hospital in Warren, Ohio. She is a member of the Society of Veterinary Behavior Technicians and founded K-9’s for Compassion, a Delta Society animalassisted therapy group. When she is not working, Katie enjoys scuba diving, hiking, and taking photographs. She and her husband, Sam, a veterinarian, have a daughter, Anastiya. Among the family’s eight dogs and five cats are five therapy animals. Katie is pictured with her beagle, Keebler, who used to suffer from separation anxiety.

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How Global Warming May Affect the Prevalence of

Lyme Disease

Laura McLain Madsen, DVM Central Valley Veterinary Hospital Salt Lake City, Utah

Clinical Signs N RECENT YEARS, there has been an increase than 90% of dogs that are seroposiin media reports about the potential effects of cli- tiveMore for Lyme disease have no clinical signs mate change, such as rising sea levels, hurricanes, or only mild clinical signs, such as self-limitlethargy, lymphadenopathy, lameness, or droughts, shrinking polar ice, and extinction of various ing fever.2 These signs can also be caused by other tick-borne diseases, making diagnosis wildlife species. Another possible, more insidious challenging.2 However, in some dogs, Lyme effect of global climate change is the expansion of the disease can cause more serious illnesses, such endemic range of disease vectors, including mosquitoes as renal disease (i.e., Lyme nephropathy) or Lyme nephropathy, characand ticks. In veterinary medicine, this may translate to polyarthropathy. terized by protein-losing nephropathy or renal failure, is more commonly seen in an increased number of cases of tick-borne diseases, such breeds as Labrador retrievers, golden such as Lyme disease, in geographic areas that were retrievers, and Shetland sheepdogs. It is thought that antigenâ&#x20AC;&#x201C;antibody complex deptraditionally thought not to harbor ticks. Therefore, plays a role in the development of technicians should educate owners about the increas- osition Lyme nephropathy.2,3 Compared to dogs, humans are more seriing prevalence of these types of diseases and monitor ously affected by Lyme disease, with only 10% patients for clinical signs of infection. of seropositive individuals remaining asympLyme Disease Transmission Lyme disease was first identified in 1975 in Lyme, Connecticut. The disease is caused by the spirochete Borrelia burgdorferi.1 B. burgdorferi has only been shown to be transmitted by ticks of the genus Ixodes. The main vectors are Ixodes scapularis (the deer tick or black-legged tick), which is found in eastern North America, and I. pacificus (the western black-legged tick), which is found in western North America. Ticks become infected with B. burgdorferi as larvae or nymphs by feeding on an infected host, such as a rodent, and then transmit the infection (i.e., borreliosis) as nymphs or adults while feeding on larger mammals (e.g., deer, dogs, humans).2

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tomatic.2 Affected humans may develop a skin rash, flu-like symptoms, joint pain, cardiac arrhythmias, and in rare cases, neurologic abnormalities (e.g., facial nerve paralysis, meningitis, multiple sclerosisâ&#x20AC;&#x201C;type polyneuropathies) and hepatic and ocular diseases.2

Prevalence Lyme disease is the most commonly diagnosed vector-borne disease in temperate zones of the northern hemisphere.1 The number of cases of Lyme disease in humans in the United States has steadily increased since 1991, when the disease was designated as reportable by the Centers for Disease Control and Prevention.4 From 2003 through 2005, more than 60,000 cases of human Lyme disease were reported www.VetTechJournal.com

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US Canine Positive Lyme Test Results

Reported positive Lyme test results collected from 2000 to July 2007 from more than 10,000 veterinary clinics, telephone surveys, and IDEXX Reference Laboratories.

to the agency,4 although obtaining exact statistics is complicated by factors such as underreporting and overdiagnosis of the disease.2,4 In the United States, Lyme disease is prevalent in several northeastern states (Connecticut, Delaware, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, and Rhode Island) and two states in the upper Midwest (Minnesota and Wisconsin); 95% of human cases occur in these endemic states.2,3 However, the range of endemic Lyme disease is expanding. Some of this expansion may be due to an increase in the deer population; a change in agricultural practices, leading to restoration of forested habitats; and an increase in human activities in wooded areas. However, the increased geographic range of Lyme borreliosis has also been attributed to global warming.1,2 www.VetTechJournal.com

500+ 251–500 101–250 1–100

Courtesy of IDEXX Reference Laboratories

Climate Change Global warming is a phenomenon of worldwide climate change due to human activities, including widespread deforestation and increased production of greenhouse gases — primarily carbon dioxide — from fossil fuel combustion. From 1920 to the present, the average global temperature has increased by 1.4°F or 0.8°C.5 Current research predicts that the global average temperature will increase by an additional 2.5°F to 10.4°F or 1.4°C to 5.8°C by the year 2100.5 Local temperature increases may be more or less than the average, with the United States predicted to experience temperature increases 30% above the global average.5 Although some locations may experience a local decrease in precipitation, a general increase is expected5; along with global warming, an increase in precipitation Veterinary Technician | APRIL 2008 217

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Peer Reviewed RECONCILE™ (fluoxetine hydrochloride) Chewable Tablets Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Indications: RECONCILE chewable tablets are indicated for the treatment of canine separation anxiety in conjunction with a behavior modification plan.

Ixodes scapularis, which is also known as the deer tick or black-legged tick, is one of the main vectors of Lyme disease in North America.

Contraindications: RECONCILE chewable tablets should not be used in dogs with epilepsy or history of seizures, nor given concomitantly with drugs that lower the seizure threshold (e.g., phenothiazines). RECONCILE chewable tablets should not be given in combination with, or within 14 days of discontinuing, a monoamine oxidase inhibitor. RECONCILE chewable tablets are contraindicated in dogs with a known hypersensitivity to fluoxetine HCl or other SSRIs. Observe a 6-week washout interval following discontinuation of therapy with RECONCILE chewable tablets prior to the administration of any drug that may adversely interact with fluoxetine or its metabolite, norfluoxetine. Human Warnings: Not for use in humans. Keep out of reach of children. In case of accidental ingestion seek medical attention immediately. Precautions: RECONCILE chewable tablets have not been clinically tested for the treatment of other behavioral disorders and are not recommended for the treatment of aggression. Studies in breeding, pregnant, or lactating dogs and in patients less than 6 months of age have not been conducted. Seizures may occur in dogs treated with RECONCILE chewable tablets, even in dogs without a history of epilepsy or seizures (see ADVERSE REACTIONS). RECONCILE chewable tablets have not been evaluated with drugs that affect the cytochrome P450 enzyme system and should be used with caution when co-administered with any drug that affects this system. Studies to assess the interaction of RECONCILE chewable tablets with tricyclic antidepressants (TCAs) (e.g., clomipramine) have not been conducted. The minimum washout period to transition dogs from TCAs to RECONCILE chewable tablets has not been evaluated. Data demonstrate that TCAs are cleared 4 days following discontinuation.1, 2

Adverse Reactions: In two North American field studies involving 427 dogs, the following adverse reactions were observed at a rate of ≥1% in dogs treated with RECONCILE chewable tablets (n=216): calm/lethargy/depression (32.9%), decreased appetite (26.9%), vomiting (17.1%), shaking/shivering/tremor (24%), diarrhea (21%), restlessness (16%), excessive vocalization (including whining) (13%), aggression (9%), otitis externa (6%), disorientation (5%), incoordination (5%), constipation (3%) and excessive salivation (3%). Other adverse reactions: Seizures: One of 112 dogs in the control group and three of 117 dogs that received RECONCILE chewable tablets experienced the serious adverse reaction of seizures during or up to 45 days after the end of the treatment period. One dog that was treated with RECONCILE chewable tablets experienced two seizures 10 days after the end of therapy and, despite escalating phenobarbital doses, died in status epilepticus approximately six months after the first seizure, In the second study, one of 99 dogs treated with RECONCILE chewable tablets and one of 99 dogs treated with the control tablet experienced the serious adverse reaction of seizures. Lastly, in a European multi-site study, one dog treated with a daily dose of 0.4 mg/kg for one month experienced one seizure one week after discontinuing therapy.

is expected to have a complex effect on the prevalence of tick-borne diseases, such as Lyme disease.

Weight loss: In field studies, a weight loss ≥5% (relative to pre-study body weight) was observed in 58 (29.6%) of dogs treated with RECONCILE chewable tablets and 24 (13.0%) of control dogs. No dogs were withdrawn from clinical studies due to weight loss alone. Dose reduction: Twenty dogs in the RECONCILE chewable tablet group and five control dogs required a dose reduction due to unacceptable adverse reactions, the majority intermittent and mild, generally anorexia, vomiting, shaking and depression. Lowering the dose eliminated or reduced the severity of these reactions in the RECONCILE chewable tablet group only, while resumption of the full dose resulted in a return of the initial adverse reactions in approximately half the affected dogs. One dog experienced recurrence of severe adverse reactions, which necessitated its withdrawal from the study. Additionally, two dogs required a second dose reduction of RECONCILE chewable tablets.

Expanding Geographic Range of Lyme and Other Tick-Borne Diseases Warming global temperatures can allow ticks to expand their range northward — and up to higher elevations — into areas that were previously too cold for them to survive. In addition, climate change can indirectly impact tick populations by affecting the populations of host species and the availability of suitable wooded habitats.6,7 For example, the white-footed mouse, a preferred host for tick larvae, is poorly adapted to cold weather; therefore, warmer temperatures could increase the mouse population.7 In addition, warmer temperatures resulting in an earlier spring and later autumn could allow ticks to complete their life cycle more rapidly. This may result in a greater tick population density and increased opportunities to transmit disease.1 Ticks are routinely carried north on migratory birds, and the deer tick is

Animal Safety: In a one-year laboratory safety study, dogs were dosed daily at 1, 4.5 and 20 mg/kg/day of fluoxetine in a gelatin capsule, corresponding to 0.87, 3.9 and 17.4 mg/kg/day of RECONCILE chewable tablets (the average ratio of fluoxetine AUC values for RECONCILE chewable tablets/fluoxetine capsule = 1.15). Three of five female dogs in the 20 mg/kg group died or were euthanatized during the first six months of the study. The high dose was decreased to 10 mg/kg/day (equivalent to 9.7 mg/kg/day of RECONCILE chewable tablets) for the last six months, and all remaining dogs completed the study. One dog in the 1 mg/kg group (0.87 mg/kg/day of RECONCILE chewable tablets) and two in the 20 mg/kg group (17.4 mg/kg/day of RECONCILE chewable tablets) experienced a seizure. Aggressive behavior, ataxia, salivation at dosing, hyperesthesia, nystagmus, thin body condition, weakness, lethargy, diarrhea and head tilt were noted in the high dose group. Anorexia, tremors, decreased pupillary light response, mydriasis, vomiting and decreased weight gain were observed in all treatment groups, although more frequently in the high dose group. All abnormal observations except decreased weight gain resolved by the end of a two-month recovery period. Evidence of phospholipidosis was noted in the lung, liver, adrenal glands, lymph nodes, spleen, retina and white blood cells of all groups, which resolved during the recovery period. Fluoxetine caused no marked or consistent effects on hematology, blood chemistries or urinalysis. Mild bradycardia was present in a dose-dependent manner in the two higher dose groups only. There were no effects noted on gross organ examination. To obtain full product information please call 888-545-5973 or visit www.reconcile.com NADA #141-272 Approved by FDA ©2007 Eli Lilly and Company REC005305-3P370CVBR1 1

Plumb DC. Amitriptyline. Veterinary Drug Handbook 5th Edition (Pocket Edition). Iowa State Press. Ames, IA. Page 39, 2002. Hewson CJ, et.al. The pharmacokinetics of clomipramine and desmethylclomipramine in dogs: parameter estimates following a single oral dose and 28 consecutive daily doses of clomipramine. J Vet Pharmacol Therap 21:214-222, 1998.

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Good dog There’s a new way to help a good dog overcome by separation anxiety. Approved by the FDA, Reconcile™ is a chewable, flavored tablet most dogs enjoy as a treat. Clinical trials show that taken once daily, Reconcile™, combined with a program such as the simple BOND™ behavior modification plan, can make a profound difference. Within eight weeks, 73% of dogs treated with Reconcile™ chewable tablets showed significant improvement as compared to behavior modification alone (51%). 42% of dogs showed improvement within the first week, which was significantly greater than with behavior modification alone (18%).

Find out how you can improve your prognosis for your clients’ pets. Contact us at www.reconcile.com or 1-888-LillyPet.

The most common adverse reactions recorded during clinical trials were calm or lethargy, reduced appetite, vomiting, shaking, diarrhea, restlessness, excessive vocalization, aggression and, in infrequent cases, seizures. For product label, including important safety information, see page 218.

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expected to expand its range north into Canada. White-tailed deer are suitable hosts, and rodents are suitable reservoirs. Therefore, the establishment of endemic tick populations in Canada is likely. Based on current projections of global warming, the tick’s range in Canada could expand measurably by the year 2020 and by up to 621.4 miles (1,000 km) by the 2080s.8 In North America, I. scapularis is expected to expand its range into such states as Georgia, Iowa, Michigan, North Carolina, and Virginia.9 The area of endemic Lyme disease in the upper Midwest has already expanded from a small area in northeastern Minnesota and northwestern Wisconsin southward to the Chicago area.10 I. scapularis has a complex 2-year life cycle.2 Ninety-eight percent of the tick’s life cycle occurs in the environment, not on the host; therefore, ticks are quite susceptible to moisture and temperature changes.6,9 I. scapularis is incapable of establishing endemic populations below the threshold of an average winter monthly temperature of 19°F (–7.2°C).9 This temperature threshold can be correlated with computer models of global warming to predict range expansion of the ticks in the next decades. Increased precipitation in the late spring and early summer is also associated with an increase in the tick population and, therefore, an increase in the prevalence of Lyme disease.6,7 In Europe, the primary vector of Lyme disease is Ixodes ricinus. This close relative of I. scapularis is also expanding its range

Glossary Endemic_Prevalent in a particular locale or region Polyarthropathy_Disease affecting multiple joints Protein-losing nephropathy_Disease of the renal glomeruli that results in loss of serum albumin into the urine Reservoir_Organism that serves as host for a pathogen to which it is immune Seropositive_Having antibodies against a particular infectious agent Vector_Organism (typically an insect or arthropod) that transmits a pathogen from one host to another 220

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as a result of climate change. It has been found as far north as Sweden and at higher altitudes, up to 4,265 ft (1,300 m) above sea level in the Alps. Concurrently, more cases of Lyme disease have been reported.1 Other disease vectors are also expanding their range, largely due to habitat change but perhaps supported by global warming. Amblyomma americanum, the lone star tick, can transmit ehrlichiosis as well as Borrelia lonestari, a putative agent of southern tick– associated rash illness, a human syndrome similar to Lyme disease. The lone star tick was once considered to be endemic only in the southern United States but has now become established as far north as Massachusetts and Michigan.11

Conclusion Scientists have forecasted that global warming and other environmental factors will increase the spread of Lyme disease and other tick-borne diseases. In North America, other tick-borne diseases of concern in small animal patients include ehrlichiosis (Ehrlichia canis, Ehrlichia chaffeensis, Ehrlichia ewingii), anaplasmosis (Anaplasma phagocytophilum, Anaplasma platys), Rocky Mountain spotted fever (Rickettsia rickettsii), cytauxzoonosis (Cytauxzoon felis), hepatozoonosis (Hepatozoon americanum), hemoplasmosis (Mycoplasma spp), babesiosis (Babesia spp), and bartonellosis (Bartonella spp).2,3,12 Technicians who work in traditionally nonendemic areas should be vigilant in monitoring for Lyme disease as well as other tick-borne diseases and should consider that patients with clinical signs may be co-infected with more than one type of tick-borne pathogen.2,3

References 1. Lindgren E, Jaenson TG: Lyme Borreliosis in Europe: Influences of Climate and Climate Change, Epidemiology, Ecology, and Adaptation Measures. Geneva, World Health Organization, 2006. 2. Littman MP: Canine borreliosis. Vet Clin North Am Small Anim Pract 33(4):827–862, 2003. 3. Littman MP, Goldstein RE, Labato MA, et al: ACVIM small animal consensus statement on Lyme disease in dogs: Diagnosis, treatment, and prevention. J Vet Intern Med 20(2):422–434, 2006. 4. Centers for Disease Control and Prevention: Lyme disease — United States, 2003–2005. MMWR Morb Mortal Wkly Rep 56(23):573–576, 2007.

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5. Pew Center for Global Climate Change: Global Warming Basics. Accessed March 2008 at www.pewclimate.org/global-warming-basics. 6. McCabe GJ, Bunnell JE: Precipitation and the occurrence of Lyme disease in the northeastern United States. Vector Borne Zoonotic Dis 4(2):143– 148, 2004. 7. Subak S: Effects of climate on variability in Lyme disease incidence in the northeastern United States. Am J Epidemiol 157(6):531–538, 2003. 8. Ogden NH, Maarouf A, Barker IK, et al: Climate change and the potential for range expansion of the Lyme disease vector Ixodes scapularis in Canada. Int J Parasitol 36(1):63–70, 2006.

9. Brownstein JS, Holford TR, Fish D: A climatebased model predicts the spatial distribution of the Lyme disease vector Ixodes scapularis in the United States. Environ Health Perspect 111(9): 1152–1157, 2003. 10. Jobe DA, Lovrich SD, Nelson JA, et al: Borrelia burgdorferi in Ixodes scapularis ticks, Chicago area. Emerg Infect Dis 12(6):1039–1041, 2006. 11. Dryden MW, Payne PA: Biology and control of ticks infesting dogs and cats in North America. Vet Ther 5(4):236–237, 2004. 12. Macintire DK: Diagnosis and Treatment of Common Tick-Borne Diseases. Accessed March 2008 at www.vin.com.

Laura is an associate veterinarian at the Central Valley Veterinary Hospital in Salt Lake City, Utah. She also serves on the editorial board of Veterinary Technician. Laura and her husband, Loren, share their home with two daughters, Bridget and Katelyn, and two pets: Leyla (a shepherd mix) and Clyde (a cat). Laura is pictured with Harry, her Norwich terrier, who recently passed away. In her spare time, Laura enjoys gardening, reading, and traveling.

ABOUT THE AUTHOR

Laura McLain Madsen, DVM

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Basic Guidelines for

g an Article for n i t i r W

Veterinary Technician

Getting Started Before you begin writing, contact our editorial office to make sure that an article on your particular topic is needed and that no other author is writing on the same subject.

How to Avoid Plagiarizing Keep in mind that when you are referencing a statement from a published source, the statement must be reworded so that it is different from, but has the same meaning as, the original statement. For example: Original source — Very young kittens (0 to 8 wk) are very susceptible to infection with FeLV. Cats older than 16 weeks are less likely to be infected, but cats of any age may acquire FeLV, particularly through prolonged contact. Plagiarism — Kittens that are 8 weeks of age or younger are very susceptible to infection with FeLV.1 Cats older than 16 weeks are not as likely to become infected, but cats of any age may acquire FeLV, particularly through prolonged contact.1

Updated February 2008

Acceptable rewording — Newborn kittens (≤8 wk of age) are more susceptible to FeLV infection than are adult cats; therefore, they have the greatest risk of infection if exposed to the virus.1 However, any cat that has prolonged contact with an FeLV-positive cat may contract the virus.1

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Format Manuscripts should be typewritten and double-spaced. The paper must be submitted electronically via email or on a disk compatible with Microsoft Word 6.0 or better. The paper should include headings where appropriate. The maximum length of manuscripts is 5,000 words. Shorter manuscripts are also welcome. Trade Names Trade names are generally not to be used in the text unless mention is essential and fair representation is made of all available products. Footnotes Any explanatory notes or personal communications should be footnoted using alphabetic superscripts within the text. Review Articles All review articles must be accompanied by a 10-question, multiple-choice quiz that tests the reader’s comprehension of the main points of the article. True/False questions should not be included. References All points discussed in the text of review articles and clinical columns must be documented by references cited with numbered superscripts in the text. References should be listed in order of citation in the text — not alphabetically. Journal articles, clinical textbooks, and conference proceedings are suitable references. Web sites are acceptable; however, only sites associated with legitimate, unbiased groups or organizations (e.g., universities, government organizations, reputable national associations) should be used.

Editorial Correspondence For topic availability and questions, contact: Hilda Guay, Executive Editor Email: hguay@vetlearn.com Phone: 800-426-9119, ext. 2435 Fax: 800-556-3288 Mail: VLS/Veterinary Technician 780 Township Line Road Yardley, PA 19067

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Photographs and Illustrations Submission of highquality photographs, slides, electronic images, or line drawings that help clarify the subject matter is encouraged. All original material will be returned to the author upon request. The publisher cannot be held responsible for original material, however, and authors are advised to keep duplicates of all original artwork. Electronic images should be provided as individual JPG or TIF files at a minimum size of 4 × 4 inches and a minimum resolution of 300 dpi. You must obtain written permission from the original source for any figures, diagrams, etc., that you do not own the rights to. For more detailed information about image submission, call 800-426-9119, ext. 2461. Ancillary Visuals Tables, boxes, sidebars, and diagrams that help to explain or clarify the text can be submitted with the manuscript. These items cannot be taken from other sources unless they are modified or written permission is obtained from the original source. A glossary should be provided for all review articles and clinical columns. Web Content Authors are encouraged to provide additional material (client handouts, additional tables or boxes, figures, short case reports, videos) for inclusion on VetTechJournal.com. Review and Approval All clinical articles will be reviewed by at least two acknowledged experts in the appropriate field of medicine. Controversial subjects will be clarified by editorial commentary. The Veterinary Technician® editorial staff reserves the right to make revisions in text when appropriate. All manuscripts are edited for content, clarity, and style. Authors are given an opportunity to review edited manuscripts before publication. Honorarium and Author Information The contact author receives an honorarium (the amount of which depends on the type and length of the article) in addition to 10 copies of the issue in which the article or column appears. Make sure to include your contact information and availability upon manuscript submission. Please also list your degrees and your affiliation and its city/state location.

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CE Article #1

Understanding and Treating

Diabetic Ketoacidosis

Brandy Tabor, BS, CVT Animal Emergency and Specialty Center Parker, Colorado

IABETIC KETOACIDOSIS (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient’s response to therapy, technicians should understand how this disorder occurs.

Pathophysiology DM is caused by a relative or absolute lack of insulin production by the pancreatic β-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non–insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, β-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body’s inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metabolic events can occur that lead to DKA. Predisposing disease processes (e.g., infecwww.VetTechJournal.com

tion, pancreatitis, heart disease), trauma, or exposure to a stressful situation (e.g., being boarded or relocated) can also lead to this condition. Normally, insulin suppresses hepatic glucose production during a state of hyperglycemia. In the absence of insulin, the liver continues to release glucose, exacerbating hyperglycemia. At the same time, cellular demand for glucose stimulates the release of glucagon from the pancreas. This hormone, together with the stress hormones cortisol, epinephrine, and growth hormone, triggers the liver to produce even more glucose and ketone bodies.1 When the production of ketone bodies exceeds the body’s ability to utilize them, they build up in the circulation, resulting in ketosis.2 Although acetone is chemically neutral, the other two substances (i.e., acetoacetic and β-hydroxybutyric acids) are acidic. Therefore, when these acids accumulate in the blood, they cause the blood pH to drop, resulting in metabolic acidosis.4 At the same time, the rise in glucose levels begins to cause osmotic diuresis.5 The renal tubular threshold for total reabsorption of ketone bodies and glucose is quickly exceeded, causing these substances to spill over into the urine for excretion.2 The negative charge of the ketones draws positively charged ions associated with electrolytes, such as sodium and potassium, into the urine to maintain a neutral state.2 Lack of fluid intake, combined with vomiting, diarrhea, and increased urine production, Veterinary Technician | APRIL 2008 227

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CE Article #1 Diabetic Ketoacidosis which commonly occur in patients with DKA, can cause an increased loss of electrolytes and fluid through the urine. This fluid loss can lead to dehydration and decreased tissue perfusion, while at the same time reduce the glomerular filtration rate (GFR), which can cause renal failure.2 As the GFR decreases, so does the patientâ&#x20AC;&#x2122;s ability to excrete glucose and ketones, both of which accumulate in the vascular space.2

Clinical Signs Patients that present with DKA may have been previously diagnosed with and treated for DM, or clients may have observed clinical signs of DM in their pet. Signs of DM include weight loss, polydipsia, polyuria, and polyphagia. Technicians should obtain a thorough patient history in case owners observed these signs but thought that they were unimportant.1,2 The questions that are asked of the owners should be phrased carefully, and leading questions should be avoided. Although the signs of DM precede the development of DKA, patients that develop this metabolic disorder are seriously ill. They may experience vomiting, anorexia, or lethargy, which are often caused by dehydration, electrolyte abnormalities, and acidemia.1 When a patient presents with vomiting and anorexia, it is likely that ketonemia, ketonuria, and metabolic acidosis have already developed; therefore, severe illness may occur within a week or less.2 On physical examination, the pet may present with a thin body condition, muscle wasting, dehydration, depression, unkempt haircoat, or hypothermia.1 Other signs of DM, such as cataracts in dogs or plantigrade stance due to diabetic neuropathy in cats, may also be noted.2 Plantigrade stance is characterized by walking

on the sole of the foot rather than on the toes, as dogs and cats typically do. Clinicians may detect ketone breath,2 which smells like acetone or nail polish remover. Patients with severe metabolic acidosis may also exhibit slow, deep Kussmaul breathing patterns.2

Diagnosis The four classic laboratory findings consistent with DKA are hyperglycemia, glucosuria, ketonuria, and metabolic acidosis.1 Therefore, if DKA is suspected, a complete blood count, full chemistry profile, urinalysis, urine culture, and blood gas analysis should be conducted.1,2 If possible, urine should be collected via cystocentesis. Urine reagent test strips that measure glucose and ketones should detect glucosuria and ketonuria.1 Since azotemia is a common finding in DKA patients, it is important to assess urine specific gravity before therapy is initiated. A dehydrated patient with a urine specific gravity of greater than 1.030 is most likely exhibiting prerenal azotemia, with normal kidney function. However, patients with a urine specific gravity of less than 1.020 may have primary renal failure.2 Evaluation of renal failure is important not only for fluid therapy but also for monitoring. For patients suspected of having oliguric or anuric renal failure, monitoring of urine output is crucial.2 A urine culture should also be conducted to detect a urinary tract infection, which can complicate treatment. The complete blood count most commonly reveals an elevation in packed cell volume and total protein, due to hemoconcentration caused by dehydration.1,2 Not surprisingly, blood chemistry findings will show an increase in blood glucose level. Although the average blood glucose level for a DKA patient is 500 mg/dl, readings may range Courtesy of H. Edward Durham, Jr., CVT, L ATG

(A) ECG from a healthy dog. (B) ECG from a dog with hyperkalemia. Although more dogs with DKA are likely to develop hypokalemia, the changes on an ECG are so subtle that the ECG would appear to be almost normal to the untrained eye. 228

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CE Article #1 Diabetic Ketoacidosis

Glossary Anuria_Lack of urine production Glomerular filtration rate_Kidney function test that estimates the filtering capacity of the kidneys Hemoconcentration_Increased concentration of red blood cells in the blood due to dehydration Hypotonic_Having lower osmotic pressure than a solution under comparison Ketonemia_Excessive amount of ketones in the blood Ketosis_Accumulation of large amounts of ketone bodies in the blood and tissues Oliguria_Reduced daily urine production Polydipsia_Excessive thirst manifested by excessive water intake Polyphagia_Excessive food ingestion Polyuria_Formation and excretion of large volumes of urine

from 200 to more than 1,000 mg/dl. Other abnormal findings may include elevated liver values, as well as increased levels of blood urea nitrogen, creatinine, cholesterol, and triglycerides.1 Decreased values for many electrolytes, including sodium, potassium, chloride, phosphorus, and magnesium, are also common.1 Electrolyte abnormalities may also be detected on a lead II electrocardiogram strip. For instance, the most common indication of hypokalemia on an electrocardiogram is a prolongation of the Q–T interval, with a lowering of the ST segment and a decrease in the T wave. Premature atrial and ventricular contractions may occur. Hyperkalemia, on the other hand, can result in a spiking of the T wave, a widening of the QRS interval, and a decrease in the P wave. Patients may exhibit bradycardia and ventricular arrhythmias.2 The anion gap, which measures the difference between unmeasured anions and cations, can be calculated from the chemistry panel and electrolyte results (see box below). An elevated anion gap can indicate ketoacidosis. There are other causes, however, of an increased anion gap, including ethylene glycol toxicity and renal failure.2 An elevated anion gap should be evaluated in conjunction with blood work results and the patient’s history to determine the cause of the increase. The anion gap in healthy dogs and cats ranges from 12 to 15 mEq/L, and most animals with ketoacidosis have an anion gap ranging from 20 to 35 mEq/L.2 Arterial blood gas analysis is necessary to document the degree of metabolic acidosis.1,2 The body’s buffering system may not be able to maintain a normal pH as the ketones build up in the circulation.2 A pH less than 7.0 can correlate with a grave prognosis.2 If the clinic has limited resources and an arterial blood gas analysis cannot be conducted, treatment can be initiated based on the presence of hyperglycemia, glucosuria, and ketonuria.2 Treatment of underlying disease processes is essential in order to successfully resolve DKA. For this reason, it is also beneficial to conduct an electrocardiogram, obtain thoracic and abdominal radiographs, and conduct an abdominal ultra-

Calculating the Anion Gapa Anion gap = [Sodium (mEq/L) + Potassium (mEq/L)] – [Chloride (mEq/L) + Bicarbonate ion (mEq/L)] Rose DB, Post TW: Metabolic acidosis, in Clinical Physiology of Acid-Base and Electrolyte Disorders, ed 5. New York, McGraw Hill, 2001, pp 583–585. a

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sonogram. These diagnostics may reveal heart failure, pancreatitis, or liver disease.

Treatment In patients with DKA, treatment should include the following steps in order of importance: Fluid therapy to restore fluid volume and enhance perfusion Insulin therapy to lower glucose and ketone concentrations while reversing metabolic acidosis Correction of electrolyte abnormalities The goal of treatment is for all parameters to return to normal over 36 to 48 hours.2

Fluid Therapy Rapid initiation of fluid therapy is a cornerstone of DKA treatment. Placement of a central venous catheter eliminates the need for frequent venipuncture to monitor blood glucose, electrolytes, and venous blood gases.5 It also allows central venous pressure to be measured to avoid overhydration. Fluid therapy is geared toward correcting cellular dehydration, poor tissue perfusion, and electrolyte abnormalities.5 Fluids can also decrease blood glucose levels, even without insulin, through dilution and by increasing GFR, which allows for increased secretion of glucose through the urine.5 However, fluid therapy alone cannot reduce the ketone concentration.2 The type of fluid chosen should be based on the patient’s electrolyte status.2 Since most patients with DKA have a deficit in total body sodium,2,5 a common fluid choice is 0.9% sodium chloride. Other fluid options include Normosol-R, Plasma-Lyte 148, and Ringer’s solution.2,5 Hypotonic fluids (e.g., 0.45% sodium chloride) usually do not provide enough sodium, and rapid infusion can result in cerebral edema, which can lead to coma.2,5 The use of buffer in the fluids is controversial.2 The volume and rate of fluids infused during the first 24 hours should be designed to correct dehydration, while supplying maintenance needs and replacing ongoing fluid losses from vomiting or diarrhea.2,5 There are several methods of determining dehydration, including assessing skin turgor, mucous membrane moisture, and urine specific gravity, as well as monitoring packed cell volume and total protein levels. Dogs and cats with DKA are typically 6% www.VetTechJournal.com

Estimating Replacement Fluids5 To estimate fluids to be infused in the first 24 hours: Maintenance fluid requirements = 55–65 ml/kg/day (Includes insensible losses of 20 ml/kg/day and urinary losses of 35–45 ml/kg/day) Plus Volume to correct dehydration: Body weight (kg) × % Dehydration (0.00) × 1,000 ml/kg = Fluid deficit (ml) Plus Estimated losses from vomiting and/or diarrhea The fluid volume is usually replaced over 24 hours. to 12% dehydrated.2 The amount of fluid to be infused can be calculated with the formula in the box above. The initial fluid rate is determined by the clinician based on many factors, including the presence of underlying diseases (e.g., congestive heart failure). If the patient is in shock during presentation, the clinician may choose to administer a crystalloid fluid bolus.6 Because of the high fluid rate required to correct dehydration, replace losses, and maintain normal requirements, the patient should be monitored closely for signs of fluid overload (e.g., nasal discharge, coughing, peripheral edema, ascites, increased respiratory rate and effort). After dehydration has been corrected, the fluid rate can be decreased to a maintenance rate that includes replacement of ongoing losses.2

Insulin Therapy Insulin therapy is crucial in treating patients with DKA. Insulin has the effect of lowering blood glucose, as well as reducing ketone concentration, which can improve metabolic acidosis. Insulin also decreases serum potassium levels by promoting potassium entry into the liver and skeletal muscle.7 The initiation of insulin therapy is often delayed to allow fluid therapy to correct dehydration and normalize electrolytes.2 The clinician should decide when it is best to start insulin therapy based on the individual patient. Regular insulin, which is short acting and has a fast onset of activity, is the only type of insulin that should be used in the initial treatment of DKA.5 Three protocols for insulin therapy exist: intramuscular insulin injections hourly, intramuscular or subcutaneous injections every 4 to 6 hours, and an insulin constant-rate infusion.2,5 Each protocol has advantages and disadvantages; therefore, the clinician should choose the protocol based on experience.5 A constant-rate infuVeterinary Technician | APRIL 2008 231

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CE Article #1 Diabetic Ketoacidosis sion is typically preferred.2,5 If the patient is dehydrated or has poor perfusion, intermittent intramuscular or subcutaneous insulin is not recommended. Insulin therapy should be administered in such a way as to lower the blood glucose gradually (50 mg/dl/hr) to 200 to 250 mg/dl over 6 to 10 hours.2 This slow, steady decrease prevents the osmolarity from changing too rapidly.2 Once the blood glucose level has reached 200 to 250 mg/dl, 2.5% to 5% dextrose should be supplemented in the fluids to avoid hypoglycemia while the ketosis resolves.2,5 The reversal of ketogenesis and the subsequent resolution of ketosis can take as long as 48 to 72 hours.2,5 Once the patient is able to eat and drink without vomiting, treatment with a longer-duration insulin, administered as twice-a-day injections, may be used.5

Electrolyte Supplementation One of the most common electrolyte abnormalities in patients with DKA is hypokalemia. Clinical signs of this imbalance include muscle weakness and cardiac arrhythmias. In cats, cervical ventroflexion can occur. Even if blood work reveals that potassium is normal, it should be anticipated that the concentration will drop rapidly as dehydration is corrected and as the potassium moves from the extracellular space into the intracellular space in response to insulin therapy and correction of the acidemia.2 Therefore, potassium chloride should be supplemented in the fluids.2,5 Potassium supplementation can be based on the potassium replacement scale (see table below) as long as the potassium supplementation does not exceed 0.5 mEq/kg/hr.2,5 Serum potassium levels should be reevaluated every 6 to 8 hours to allow for adjustments and to avoid oversupplementation.2,5 The patient’s serum phosphorus level may also decline after therapy is initiated for the same reason that the potassium level drops.2

Potassium Supplementation5,a Current Serum Potassium Level (mEq/L) 3.5–5.0 3.0–3.4 2.5–2.9 2.0–2.4 <2.0 a

Potassium Supplementation (mEq/L) for Fluid Therapy 20 30 40 60 80

Therapy must not exceed 0.5 mEq/kg/hr.

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Hypophosphatemia typically affects the hematologic and neuromuscular systems, resulting in hemolytic anemia, weakness, ataxia, and seizure activity if phosphorus levels fall to 1.5 mg/dl.2 Potassium phosphate can be added to fluids and given as a constant-rate infusion of 0.01 to 0.03 mmol/kg/hr.2,5 Serum phosphorus levels should be reevaluated every 6 to 8 hours and supplementation adjusted as necessary.2,5 Hyperphosphatemia can cause mineralization of tissue, iatrogenic hypocalcemia, and hypotension2,5; therefore, oversupplementation should be avoided.2,5 If potassium phosphate is added to the fluid regimen, the amount of potassium chloride should be adjusted to account for the additional potassium. Hypomagnesemia, which is also a common finding in patients with DKA, can be life threatening and cause refractory hypokalemia and cardiac arrhythmias. If the hypomagnesemia is mild, it can usually be resolved by administering a fluid that contains magnesium (e.g., Plasma-Lyte 148).5 However, if it is more severe (<1.2 mg/dl), it should be treated more aggressively with an infusion of magnesium sulfate or magnesium chloride.2,5

Monitoring Response to Therapy Careful patient monitoring, especially during the first 24 to 48 hours, is vital for successful treatment outcomes. Patients must be kept warm and dry, and they should be turned every few hours to prevent the formation of pressure ulcers. Since hematologic and physical parameters may change quickly, it is important for technicians to monitor the patient for any changes and to alert the clinician as soon as possible if any occur. Blood glucose levels should be checked every 1 to 2 hours until the level is less than 250 mg/dl. As soon as the level is reached, dextrose should be added to fluids to create a 2.5% to 5% dextrose solution in order to prevent hypoglycemia while insulin therapy continues.2,5 Serum electrolyte levels should be measured every 6 to 8 hours.2 When the serum sodium reaches 140 to 155 mEq/L, IV fluid should be changed from 0.9% sodium chloride to Ringer’s solution or lactated Ringer’s solution, both of which have a lower sodium content.2 Electrolyte abnormalities can be further monitored with lead II electrocardiogram strips. As insulin lowers the ketone concentration, the anion gap should return to normal, and www.VetTechJournal.com

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ketonuria will resolve. Total venous CO2 or arterial blood gases should be monitored every 6 to 8 hours. It is important to evaluate hydration status every 2 to 4 hours.2 Respiratory and cardiac auscultation should be normal, and mucous membranes should be pink and moist with a normal capillary refill time. Central venous pressure should remain below 10 cm H2O.2 Doppler blood pressure readings should remain within normal limits. A fasted pet should lose about 0.5% to 1.0% of body weight per day.2 Abnormal weight gain may indicate overhydration. Fluids should be adjusted as needed. Urine output should be monitored every 2 to 4 hours. Technicians should expect a minimum of 1 to 2 ml of urine/kg of body weight per hour.2 Lack of urine output within a few hours of initiating fluid therapy is a medical emergency, and the clinician should be notified immediately. Urine should also be checked for glucosuria and ketonuria. When patients are hypophosphatemic, packed cell volume should be checked daily for signs of hemolytic anemia.

Complications Complications of therapy for DKA include hypoglycemia, cerebral edema, hemolytic anemia, hypernatremia, hyperchloremia, hypokalemia, and hypophosphatemia.2 The best way to avoid these complications is with frequent reassessment of the patient’s electrolyte and blood glucose levels during the first 24 hours of treatment and then as the clinician deems necessary.2

Prognosis The prognosis for patients with DKA depends on response to treatment, the severity of the illness, and any underlying diseases that may exist.5 The high mortality rate seen with patients that develop DKA is most often associated with the underlying disease that caused the animal to develop DKA.2

ABOUT THE AUTHOR

Brandy Tabor,

BS, CVT

www.VetTechJournal.com

Role of the Technician Veterinary technicians play a crucial role in treating patients with DKA. The mortality rate increases in patients that are not intensely monitored.2 Technicians are responsible for alerting the clinician immediately of blood work results and monitoring the patient for signs of neurologic problems, aspiration pneumonia (if vomiting occurs), poor urine production, anemia, and overhydration, including nasal discharge, weight gain above expected, and changes in lung sounds, pulse quality, blood pressure, and mucous membrane color. The patient should be kept comfortable and taken to an appropriate area for voiding because any existing polyuria may not resolve immediately. Acknowledgment The author thanks Missy Jenkins, CVT, and Forest Burkhart, CVT, both of whom are affiliated with the Animal Emergency and Specialty Center in Parker, Colorado, for reviewing and gently critiquing the article.

References 1. Kerl ME: Diabetic ketoacidosis: Pathophysiology and clinical laboratory presentation. Compend Contin Educ Pract Vet 23(3):220–229, 2001. 2. Feldman EC, Nelson RW: Diabetic ketoacidosis, in Canine and Feline Endocrinology and Reproduction, ed 3. St. Louis, Saunders, 2004, pp 580–615. 3. Randels A: Diabetic ketoacidosis: Monitoring and management. Proc IVECCS Annu Conf:837–841, 2006. 4. Rose DB, Post TW: Hyperosmolar states: Hyperglycemia, in Clinical Physiology of Acid-Base and Electrolyte Disorders, ed 5. New York, McGraw Hill, 2001, pp 794–821. 5. Kerl ME: Diabetic ketoacidosis: Treatment recommendations. Compend Contin Educ Pract Vet 23(4): 330–340, 2001. 6. Rose DB, Post TW: Introduction to disorders of osmolality, in Clinical Physiology of Acid-Base and Electrolyte Disorders, ed 5. New York, McGraw Hill, 2001, pp 682–695. 7. Rose DB, Post TW: Potassium homeostasis, in Clinical Physiology of Acid-Base and Electrolyte Disorders, ed 5. New York, McGraw Hill, 2001, pp 377–378.

“Because diabetic ketoacidosis is a complex disease, it is important for veterinary technicians to understand its pathophysiology and the complications that may occur,” says Brandy, who works as a veterinary technician at the Animal Emergency and Specialty Center in Parker, Colorado. Her interests include patient care in the critical care setting.

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CE Article #1 Diabetic Ketoacidosis 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 fax (800-589-0036) your answers or participate online.

1. The anion gap measures the difference between a. measured anions and unmeasured cations. b. unmeasured anions and cations. c. unmeasured anions and measured cations. d. none of the above 2. In patients with DKA, the body’s buffering system may not be able to maintain a normal pH as __________ build up in the circulation. a. FFAs b. β-cells c. ketones d. none of the above 3. Of the three substances that make up the ketone bodies, which are acids? a. β-hydroxybutyrate and acetone b. acetone and lactate c. β-hydroxybutyrate and acetoacetate d. lactate and β-hydroxybutyrate

Go to www.VetTechJournal.com now to take this CE Test.

4. Which of the following are stress hormones that can contribute to DKA? a. epinephrine b. cortisol c. growth hormone d. all of the above 5. Most patients with DKA have a deficit in total body sodium; therefore, __________ is a common fluid choice. a. lactated Ringer’s solution b. 0.45% sodium chloride c. 0.9% sodium chloride d. Normosol-R 6. In patients with insulin-dependent DM, the body a. is able to produce insulin but is resistant to it. b. is unable to produce sufficient insulin. c. overproduces insulin. d. none of the above 7. In patients with non–insulindependent DM, the body a. is able to produce insulin but is resistant to it.

b. overproduces insulin. c. is unable to produce sufficient insulin. d. none of the above 8. The anion gap in healthy cats and dogs ranges from __________ mEq/L. a. 12 to 15 b. 15 to 20 c. 15 to 25 d. 20 to 35 9. Potassium supplementation should not exceed a. 0.5 mEq/lb/hr. b. 0.5 mEq/kg/hr. c. 0.5 mEq/lb/day. d. 0.5 mEq/kg/day. 10. In patients with DKA, the goal of insulin therapy is to lower blood glucose levels by 50 mg/dl/hr to 200 to 250 mg/dl in __________ hours. a. 4 to 8 b. 6 to 10 c. 10 to 14 d. 12 to 15

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ClinicalNutrition

Understanding

Pet Food Labels

Carol Rosenfield, CVT Alameda East Veterinary Hospital Denver, Colorado

includes the term “beef,” beef must represent at least 95% of the total weight of all ingredients (exclusive of water used for processing); however, if the product name includes a term such as “beef dinner,” “beef entree,” or “beef platter,” beef must represent at least 25% — but not more than 95% — of the total weight of all ingredients (exclusive of water used for processing).1 The PDP may also include the manufacturer’s name, the brand name, a product vignette, or a nutrition claim. If the PDP states that the product is “complete and balanced” — meaning that all required nutrients are present in the proper proportions and quantities — the manufacturer must be able to show proof of this claim in the nutritional adequacy statement (discussed later), which must appear on the information panel.

ELECTING THE APPROPRIATE pet food can be challenging for clients, who may be overwhelmed by the number of products available. In addition, not feeding the pet the appropriate amount or type of pet food can lead to such problems as obesity. Therefore, it is important that technicians know Panel how to read a pet food label in order to help clients Information The information panel lists all the ingrediselect the proper type of food for their pet and ents in the pet food. At the bottom of the information panel, the manufacturer’s name determine how much their pet should be fed. and address will usually be displayed. In The main pet food label components (i.e., product identification, net quantity statement, manufacturer’s name and address, list of ingredients) are established by the FDA.1–3 Some states develop their own labeling regulations; however, most states adopt labeling regulations that have been established by the Association of American Feed Control Officials (AAFCO),3 an advisory agency comprising federal and state regulators. Although the information listed on labels can differ among manufacturers, the packaging for canned and dry commercial pet food should contain a principal display panel (PDP) and an information panel.

Principal Display Panel The PDP must include the product name, a designator (statement of intent) that identifies the species for which the food is intended, and the net weight (i.e., the weight of the product, exclusive of the weight of packaging or other materials). The product name will often incorporate the name of an ingredient (e.g., chicken, beef). The percentage of this ingredient used in the total product is subject to regulations by AAFCO.1 For example, if a product name 236

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addition to the ingredient statement, the information panel must include feeding guidelines, a guaranteed analysis, and a nutritional adequacy statement.

Ingredient Statement The information panel on packaging for pet food sold in the United States must list each ingredient (e.g., chicken, chicken meal, corn, corn by-products) in an ingredient statement. No single ingredient can be given undue emphasis, nor can designations of the quality of the ingredients be included.4 However, different forms of the same ingredient (e.g., wheat bran, wheat flour) may be listed separately, making it appear that a certain ingredient represents a smaller portion of the food than it actually does.1 Because ingredients are listed in descending order based on predominance by weight, dry ingredients may be listed after moisture-rich ingredients.1

Feeding Guidelines In the United States, feeding directions written in common language must be listed on the label of pet food designated as complete and balanced for any or all life stages.1 www.VetTechJournal.com

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ClinicalNutrition The directions list suggested amounts to feed a pet per day, often based on the pet’s ideal weight and activity level. However, the feeding guidelines offer only general recommendations, and many animals will require more or less food than that recommended on the label.1

Guaranteed Analysis In the United States, pet food manufacturers are required to provide a guaranteed analysis on the label, which must include information regarding minimum percentages of crude protein and crude fat and maximum percentages of crude fiber and moisture.1 The exact amount of these nutrients in the product is not listed. For example, a pet food label claiming that the product has “minimum crude fat: 11%” cannot have less than 11% fat but may have more.4 When examining the guaranteed analysis, owners must also consider the moisture content of the product. Dry pet food often contains between 6% and 10% water, whereas canned pet food may contain up to 78% water.4 The amount of water in the food significantly affects the values listed in the guaranteed analysis.4 Pet food labels often indicate nutrient levels on an “as fed” or “as is” basis (which does not account for the amount of water in the product) rather than a “dry matter” basis. To compare nutrient contents in food with different amounts of moisture, the nutrient percentage should be

AAFCO Regulations on Nutritional Adequacy AAFCO has developed recommended standards for the nutritional content of pet food. For example, a pet food label’s nutritional adequacy statement may claim that the product is “complete and balanced for all life stages,” which means that the food has been formulated to provide complete and balanced nutrition for gestation, lactation, growth, and adult maintenance.1 AAFCO requires manufacturers to substantiate this claim using one of the following methods: 1. Formulate the product’s ingredients to provide levels of nutrients that meet a specific AAFCO nutrient profile (i.e., growth and reproduction or adult maintenance).1,3 2. Test the product per AAFCO feeding trial protocols, which involve feeding the product (or a “lead” member of a “family” of products) to dogs or cats under strict guidelines.3 The second method is preferred and is considered the most thorough and reliable.1,4 However, it is important to consider the fact that a pet food manufacturer can conduct feeding trials using either the named product or a similar product made by the manufacturer.3 converted into a dry-matter percentage.4 The dry-matter percentage is obtained by subtracting the moisture percentage listed on the label from 100% (e.g., dry food usually contains approximately 88% to 90% dry matter, whereas canned food usually contains about 22% to 25% dry matter).3 The remaining percentage indicates the amount of dry matter in the food. The dry-matter percentage of each ingredient in the food can be obtained by taking the listed percentage of one of the main nutrients and dividing that number by the percentage of dry matter.

Nutritional Adequacy Statement Since 1984, US regulations have required that all labels for pet food, except food prod-

Estimating Calorie Content5,a Example: Step 1: Multiply the crude protein percentage by 3.5.

Step 1: Crude protein 24% × 3.5 = 84

Step 2: Multiply the crude fat percentage by 8.5.

Step 2: Crude fat

Step 3: Add the percentages of crude protein, crude fat, crude fiber, moisture, and ash, and subtract the total from 100. This number represents the percentage of nitrogen-free extract (NFE), which is the carbohydrate portion of the product.

Step 3: Crude protein 24% Crude fat 10% Crude fiber 3% Moisture 10% Ash 5% Total = 52% (100 – 52 = 48)

Step 4: Multiply the NFE percentage from step 3 by 3.5.

Step 4: 48% × 3.5 = 168

Step 5: Add the results from steps 1, 2, and 4, and multiply the total by 10.

Step 5: Total = 337 Calorie content = 337 × 10 = 3,370 kcal/kg

10% × 8.5 = 85

To calculate crude protein and crude fat, the guaranteed analysis on canned products must be multiplied by 4.

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ClinicalNutrition ucts clearly designated as treats or snacks, contain a nutritional adequacy statement (see the box at the top of page 237).1 When a claim such as “complete and balanced for all life stages” appears on the label, the manufacturer must specify the method used to substantiate this claim (e.g., “complete and balanced for all life stages based on AAFCO feeding studies”).4

Other Label Claims Many pet food labels include terms such as “premium,” “superpremium,” “ultrapremium,” or “gourmet,” but these terms lack standard definitions and official regulatory standing.5,6 However, AAFCO does regulate the use of other descriptive terms on labels, such as “natural,” “light,” “lite,” “less calories,” “reduced calories,” “lean,” “less fat,” and “reduced fat.”4,6,7 According to AAFCO, “natural” can only be used to describe food or ingredients that are derived solely from plant, animal, or mined sources and that do not contain additives or processing aids that are chemically synthetic. Food labeled with the terms “light” or “lite” must meet specific metabolizable energy requirements, which may vary by state. The label on a product described as having “less calories” or “reduced calories” should provide the percentage of reduction in calories from the product of comparison and include a calorie statement.4,6 If a product is described as having “less fat” or “reduced fat,” the label must provide the percentage of reduction in fat from the product of comparison.4,6

Calorie Statement In 1994, new regulations from AAFCO were developed to allow pet food manufacturers to voluntarily include a calorie content statement on the label.4 If a calorie statement does not appear on the label, the food’s calorie content can be estimated using the steps outlined in the box at the bottom of page 237.

ABOUT THE AUTHOR

Carol Rosenfield, CVT

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Expiration Date Some pet food manufacturers include an expiration date or “Best If Used By” date on the product label. However, this information is currently not required.

Medical Claims Some pet food manufacturers claim that use of their products can aid in treating certain diseases. If manufacturers make these claims, the Center for Veterinary Medicine must ascertain that the claims are truthful.8

Conclusion The labels on packages of canned and dry commercial pet food provide information about the product’s ingredients and intended use. By understanding how to interpret the information provided, veterinary technicians can educate their clients and help them make informed choices among the many different types of pet food available on the market.

References 1. Hand MS, Novotny BJ (eds): Pet food labels, in Pocket Companion to Small Animal Clinical Nutrition, ed 4. Topeka, KS, Mark Morris Institute, 2002, pp 85–99. 2. 21 CFR chapter 1, part 501. Available at ecfr.gpo access.gov/cgi/t/text/text-idx?c=ecfr&tpl=%2 Findex.tpl. 3. Dzanis DA: Interpreting Pet Food Labels. Accessed March 2008 at www.fda.gov/cvm/petlabel.htm. 4. Case LP, Carey DP, Hirakawa DA, Daristotle L: Canine and Feline Nutrition: A Resource for Companion Animal Professionals, ed 2. St. Louis, Mosby, 2000, pp 151, 153–163. 5. Dzanis DA: Reading Dog and Cat Food Labels. Accessed March 2008 at petcaretips.net/ reading-pet-food-label.html. 6. Bren L: Pet Food: The Lowdown on Labels. Accessed March 2008 at www.fda.gov/fdac/features/2001/ 301_pet.html. 7. Wortinger A: History and regulation of pet foods, in Nutrition for Veterinary Technicians and Nurses. Ames, IA, Blackwell Publishing, 2007, pp 77–84. 8. Dzanis DA: Regulation of health claims for pet foods. Vet Clin Nutr 1:5–11, 1994.

Carol works as the operations manager of the Animal Lodge boarding and day care facility at VCA Alameda East Veterinary Hospital in Denver, Colorado. Her interests include animal nutrition and behavior. Carol has three daughters — Carrie, Kristie, and Shana — and four grandchildren — Bradley, Kirsten, Kylee, and Nick — as well as a deaf Australian shepherd named Skylar, which she trained using sign language.

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EquineEssentials

New Treatment Modalities for

Atrial Fibrillation

M. Kimberly J. McGurrin, DVM, DVSc, DACVIM University of Guelph Guelph, Ontario, Canada

TRIAL FIBRILLATION (AF), the most common clinically relevant arrhythmia in horses, is a potentially career-limiting condition.1–3 In high-level performance horses (e.g., racehorses) with AF, ability is drastically reduced. Restoration of sinus rhythm may allow return of the animal to its intended use. Traditionally, there have been limited options for managing AF in horses. Quinidine salts have been administered either orally or intravenously with relatively high efficacy.1–4 However, this agent has a number of potentially adverse effects. In addition, there have been no therapeutic alternatives for horses that fail to respond to the agent or cannot tolerate it. Investigations into new therapeutic modalities are ongoing. Flecainide and amiodarone are two pharmacologic options that are being considered.5 Electrical cardioversion is also being investigated.6,7

Arrhythmia In AF, the loss of coordinated wave fronts of electrical activity in the atria results in loss of both coordinated mechanical activity and atrial contraction.8 While the arrhythmia is present, the horse is incapable of achieving maximum cardiac efficiency. The loss of atrial function decreases cardiac output by up to 20%. In addition, the irregular ventricular rhythm results in variable cardiac fill, further reducing cardiac performance. Although sometimes paroxysmal (episodic), the arrhythmia is usually stable and remains present until treated.1–3

Prognosis In most horses with AF, there are no significant underlying cardiac abnormalities. There is mild valvular regurgitation in some cases.1,3 This is in contrast with humans, in whom underlying cardiac disease, including severe regurgitation and chamber dilation, is common.8 Therefore, restoration of sinus rhythm in horses should result in restoration of normal cardiac function. The arrhythmia tends not to recur (i.e., approxwww.VetTechJournal.com

imately 10% to 15% recurrence); therefore, no treatment is required beyond restoration of the sinus rhythm. This is different from humans, in whom recurrence is common even with a short duration of arrhythmia.8 For example, at the Ontario Veterinary College, stable sinus rhythm has been achieved in horses with long-standing (i.e., >3 years) AF.7

Treatment Traditional Therapy AF in horses has traditionally been managed through oral or intravenous administration of quinidine salts.1–4 A number of protocols have been developed. The efficacy of this agent is approximately 85%.1–3 A poorer prognosis for successful cardioversion in oldera horses, larger (i.e., >1,210 lb [>550 kg]) horses, and horses with long-standing (i.e., >4 months) AF has been reported.1–3 In addition, a number of adverse effects, ranging from mild (e.g., nasal edema, depression) to potentially life threatening (including development of additional dysrhythmia [e.g., torsades de pointes]), have been reported.1,4

Alternative Pharmacologic Strategies Pharmacologic options being evaluated include flecainide and amiodarone, both of which have been approved for treating human AF.5,8,9 Several years ago, flecainide was demonstrated to be effective in managing experimental equine AF of short (i.e., 15 minutes) duration,10 but the drug was recently demonstrated to be of only minimal efficacy for chronic AF in horses.5 Only *Adapted from McGurrin MK: Atrial fibrillation. Compendium 27(suppl 10A):36–40, 2005; reprinted with permission. a The age at which probability of success decreases has not been fully investigated.

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EquineEssentials one of 10 horses responded to therapy. Three horses developed tachycardia in excess of 100 bpm, and two horses developed potentially life-threatening dysrhythmias. Quinidine was subsequently used. The horses showed a favorable response to the quinidine, suggesting a limited benefit to using flecainide in such cases. Recently, oral flecainide was used successfully in one horse.11 Amiodarone, when administered intravenously, was shown in one study to be effective in four of six horses.12 Side effects were common. Three horses developed neurologic signs, and three developed elevated bilirubin levels.12 Several other agents are used in managing human AF8; however, their use has not been reported in horses.

Electrical Cardioversion

Electrical cardioversion is proving to be an

effective therapeutic option in managing AF in horses.

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Electrical cardioversion, in which an electrical shock is applied to the cardiac muscle to depolarize sufficient tissue to interrupt the arrhythmia and allow normal conduction to occur, has gained popularity in managing AF in humans (if restoration of sinus rhythm is desired).8 In human patients, the rate of AF recurrence is high, and studies have shown increased mortality with pharmacologic treatment of the abnormal rhythm. Therefore, there has been a trend toward treating the abnormal heart rate rather than the abnormal rhythm.8 Higher efficacy for restoration of sinus rhythm has been demonstrated with electrical compared with pharmacologic therapies in some human studies.8 Synchronized cardioversion enables the shock to be timed with the QRS complex to avoid delivery of shock during the T wave.8 Inappropriately timed shock delivery has a high risk of inducing ventricular dysrhythmia or fibrillation.8 Biphasic shocks, which deliver a positive followed by a negative waveform, are considered more effective than monophasic shocks, with lower energy levels required to achieve cardioversion.8 External cardioversion involves placing paddles or patches on the thoracic wall, followed by applying an electrical shock via a defibrillator. There is a report6 of successful transthoracic cardioversion using biphasic waveforms in one horse. This animal was placed under general anesthesia in dorsal recumbency with all limbs suspended, and paddles were placed over the atria with ultrasonographic guidance.6 Antiarrhythmic medications were also administered. The possible contribution of the antiarrhythmic medications to restoration of sinus rhythm cannot be eliminated.

APRIL 2008 | Veterinary Technician

Transvenous Electrical Cardioversion Cardioversion using intracardiac cathetermounted electrodes (transvenous electrical cardioversion [TVEC]) has been reported in humans.8 Higher efficacy at substantially lower energy levels is possible with TVEC compared with external cardioversion.8 This procedure has been adapted to horses.7,13,14 Purpose-designed cardioversion catheters (Rhythm Technologies, Irvine, CA) have been developed for use in horses. These 7.5-Fr catheters, which are 150 cm long, have a 9.5cm, 7-Fr coiled titanium wire electrode within a lumen along the length of the catheter. The lumen allows intracardiac pressure profiles to be obtained and used for guidance of catheter placement. These catheters have been evaluated with energy levels as high as 300 J. Catheters are placed through introducer catheters positioned in the right jugular vein. Echocardiography combined with invasive pressure monitoring is used to guide the placement of two catheters so that one is positioned with the cardioversion electrode in the left pulmonary artery and the other with the cardioversion electrode in the right atrium. The right atrial electrode gives direct access to right atrial tissue, and the left pulmonary artery electrode gives indirect access to left atrial tissue. This configuration allows the cardioversion shock to surround a major portion of the atrial tissue. Once catheters have been placed, general anesthesia can be induced. Pharmacologic agents that may either increase defibrillation threshold (e.g., antiarrhythmics such as lidocaine and acepromazine) or increase arrhythmia risk (e.g., dobutamine) should be avoided, as should other antiarrhythmic agents (e.g., quinidine, magnesium sulfate). The horse should be placed in lateral recumbency, and thoracic radiography should be used to confirm correct positioning of the cardioversion electrodes. The defibrillator should be attached to the cardioversion catheters through custom adapter cables, thus enabling the operator to be remote from the horse. This avoids risk of accidental shock to personnel. Cardioversion shocks should then be delivered using biphasic shocks synchronized to reach cardiac tissue on the R wave. A stepwise increase in shock energy (e.g., 50, 70, 100, 125, 150, 175, 200, 250, and 300 J) should be used until either cardioversion is achieved or a maximum energy of 300 J is reached. Energy levels higher than 300 J have not been evaluated in horses and thus cannot be considered safe. Carwww.VetTechJournal.com

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EquineEssentials dioversion catheters should be removed before recovery from general anesthesia. The clinical application of TVEC to performance horses (i.e., mainly standardbred racehorses) at the Ontario Veterinary College has achieved a 98% success rate with a mean cardioversion energy of 161.4 ± 6.7 J. The procedure has been applied as a first-line treatment as well as to horses that failed to respond to quinidine or in which quinidine caused unacceptable side effects. TVEC has also been applied successfully to a few horses with longstanding (i.e., 6 months to 7.5 years) AF. Adverse effects were limited to postanesthetic myopathy in two horses that had experienced a previous episode of exertional rhabdomyolysis (a condition in which skeletal muscles are damaged and release myoglobin into the bloodstream). Most (i.e., >80%) treated horses returned to performance at the same level as or a higher level than before development of AF.

Role of the Technician In managing equine AF, the veterinary technician’s role is to monitor the patient’s heart rate and rhythm as well as note any changes in behavior or signs of discomfort. The technician should alert the clinician to any abnormalities that occur during, or for several days after, treatment of AF.

Conclusion New therapeutic modalities for managing equine AF are currently under investigation. These new modalities may allow further options for horses that fail to respond to conventional treatment or may prove to be true alternatives to conventional management. Flecainide and amiodarone have been evaluated, and the results for flecainide have not been favorable.5 The agent does not appear to be as effective as quinidine, and adverse effects are not uncommon. Electrical cardioversion is proving to be an effective therapeutic option in managing AF in horses. The need for specialized equipment (i.e., echocardiograph, defibrillator) and general anesthesia may limit widespread application. TVEC has proven effective in treating quinidine-resistant AF, long-standing AF, and horses of various sizes (i.e., 825 to 1,386 lb [375 to 630 kg]). The energies required for successful TVEC (i.e., 50 to 300 J) are within the capacities of many commercially available biphasic defibrillators (maximum capacity: 360 J). The availability of new therapeutic modalities www.VetTechJournal.com

for managing equine AF gives practitioners alternatives. These modalities may be considered as further options in patients that fail to respond to conventional treatment or may become firstline treatments. The availability of alternatives may allow horses that were previously considered a loss to return to performance.

References 1. Deem DA, Fregin GF: Atrial fibrillation in horses: A review of 106 clinical cases, with consideration of prevalence, clinical signs, and prognosis. JAVMA 180:261–265, 1982. 2. Reef VB, Reimer JM, Spencer PA: Treatment of atrial fibrillation in horses: New perspectives. J Vet Intern Med 9:57–67, 1995. 3. Reef VB, Levitan CW, Spencer PA: Factors affecting prognosis and conversion in equine atrial fibrillation. J Vet Intern Med 2:1–6, 1988. 4. Muir 3rd WW, Reed SM, McGuirk SM: Treatment of atrial fibrillation in horses by intravenous administration of quinidine. JAVMA 197:1607–1610, 1990. 5. van Loon G, Blissitt KJ, Keen JA, et al: Use of intravenous flecainide in horses with naturally occurring atrial fibrillation. Equine Vet J 36:609–614, 2004. 6. Frye MA, Selders CG, Mama KR, et al: Use of biphasic electrical cardioversion for treatment of idiopathic atrial fibrillation in two horses. JAVMA 220:1039– 1044, 2002. 7. McGurrin MK, Physick-Sheard PW, Kenney DG, et al: Transvenous electrical cardioversion in equine atrial fibrillation: Technique and successful treatment of 3 horses. J Vet Intern Med 17:715–718, 2003. 8. Fuster V, Rydén LE, Asinger RW, et al: ACC/AHA/ ESC guidelines for the management of patients with atrial fibrillation: Executive summary; a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Circulation 104:2118–2150, 2001. 9. Trachsel D, Tschudi P, Portier CJ, et al: Pharmacokinetics and pharmacodynamic effects of amiodarone in plasma of ponies after single intravenous administration. Toxicol Appl Pharmacol 195:113–125, 2004. 10. Ohmura H, Nukada T, Mizuno Y, et al: Safe and efficacious dosage of flecainide acetate for treating equine atrial fibrillation. J Vet Med Sci 62:711–715, 2000. 11. Risberg AI, McGuirk SM: Successful conversion of equine atrial fibrillation using oral flecainide. J Vet Intern Med 20:207–209, 2006. 12. De Clercq D, van Loon G, Baert K, et al: Intravenous amiodarone treatment in horses with chronic atrial fibrillation. Vet J 172:129–134, 2006. 13. McGurrin MK, Physick-Sheard PW, Kenney DG, et al: Transvenous electrical cardioversion of equine atrial fibrillation: Technical considerations. J Vet Intern Med 19:695–702, 2005. 14. McGurrin MK, Physick-Sheard PW, Kenney DG: How to perform transvenous electrical cardioversion in horses with atrial fibrillation. J Vet Cardiol 7:109–119, 2005.

ABOUT THE AUTHOR

M. Kimberly J. McGurrin,

DVM, DVSc, DACVIM Dr. McGurrin is a clinician specializing in large animal medicine and cardiology at the Ontario Veterinary College, University of Guelph, in Guelph, Ontario, Canada. She says that “in horses with atrial fibrillation, modalities such as transvenous electrical cardioversion offer an alternative when quinidine therapy is inappropriate or has been unsuccessful.” In addition to her work in large animal medicine and cardiology, Dr. McGurrin is interested in equine performance medicine. When she is not working, she enjoys riding her show jumpers.

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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.

Courtesy of Brooklin-Page Bray

To commemorate a pet that has been euthanized at our clinic, we create a clay imprint of the animal’s paw to present to the owner. If the animal was a long time patient, we personalize the paw print by painting and decorating it. The owners always appreciate the gesture, and it makes them feel that their bond with our clinic is not broken despite the loss of their pet. The technicians at Babcock Hills Veterinary Hospital San Antonio, TX

Tidy Techs

piece of a rubber sticky mat inside each drawer to prevent the items from sliding around when the drawer is opened or closed. Heidi Farano New York, NY

To keep track of patients’ belongings (e.g., leashes, medications), I store them in clear, plastic, zippered bags that originally contained curtains I bought for my home. Each bag includes a hook, which I use to attach the bag to the outside of the patient’s cage. Kathy Daily, RVT El Dorado, KS

Catheter Commands

Kathy Daily, RVT

Sliding an IV catheter into place in an older or dehydrated patient can be difficult. If resistance is encountered, wait for the blood around the catheter to lubricate it. If the catheter is placed correctly in the vein, it will usually pass easily after a few seconds. Sandy Szalkiewicz Wauconda, IL

At our clinic, tools such as thermometers, bandage scissors, and nail trimmers are kept in drawers. We placed a 242

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To aid visualization when placing a urinary catheter in a female dog, I use a vaginal speculum made from a syringe case. To create the speculum, cut off the tip of a 3- or 5-ml syringe case and heat the cut end with a lighter. When the plastic

begins to melt, use your fingers to round the edges slightly (make sure that the edges are smooth before use). After the catheter is placed, the syringe case can be resterilized in an autoclave. Lara Angevine, CVT, RVT Longmont, CO Before I place an IV catheter in a patient with tough skin, I rub a small amount of sterile lubrication gel over the catheter site. This makes insertion and feeding of the catheter much easier. Amanda Baas, CVT Englewood, CO When an IV catheter is placed in a dog, we attach a microbore extension set to the end of the catheter using a T-connector. When we need to take the dog outside, we can unhook the fluid line without removing the entire bag. Jaclyn Lavy, RVT Casstown, OH www.VetTechJournal.com

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TechTips

TECH TIP CHALLENGE

Ticked Off In honor of Prevent Lyme in Dogs Month, we asked how you prefer to remove ticks. Here are some of your suggestions: Before removing a tick, hold an alcohol-saturated cotton ball directly on the tick for several seconds. The tick will lift its head, making it easy to remove the entire tick from the skin. Jody LeHew, RVT Cedar Rapids, IA To remove a tick, use tweezers or forceps to grab it close to the animal’s skin and pull on the tick just enough to cause tension. Maintain the tension for about 30 seconds. This usually fatigues the tick, making it easy to pull it off the skin without leaving the head behind. Andrea Carr, CVT Highland, MI Because ticks can carry Lyme disease, I instruct clients to never remove a tick from their pet’s skin with their fingers. I recommend firmly grasping the tick at the attachment area with forceps or tweezers and gently pulling it off, ensuring that the head is removed as well. The tick should then be placed in a jar of alcohol to kill it. When instructing clients on tick removal, I also remind them of the importance of administering monthly flea and tick preventatives. Dana Williams Mount Eden, KY Use the Tick Twister product (manufactured by H3D/O’Tom) to remove ticks. The device is placed under the tick and is twisted so that the tick can be lifted off the skin. The process is quick, easy, and painless for the patient. After removing the tick, I apply hydrogen peroxide to the animal’s skin to reduce swelling. Robin Manthei, LVT Malta, NY

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I remove a tick with a hemostat placed at a 90° angle to the tick’s head. Then, I soak the tick in alcohol or in a tick-control product to kill it. Lindsay Cosmi, CVT Colorado Springs, CO Before removing a tick, put on gloves to prevent the transmission of zoonotic disease. Part the animal’s fur around the tick, and squirt the tick with alcohol. Remove the tick with a hemostat, ensuring that the head is also removed, and squirt the tick again with alcohol to kill it. Adrienne Kruzer, AA, AAS, RVT Cleveland, OH

TECH TIP CHALLENGE

$50 paid for each published response! How do you store radiographs for easy reference and handling? Submitted by Maureen Owen, LVT, Fishers, IN. Send submissions by May 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 pay $100 for each Tech Tip video that we post on www.VetTechJournal.com. Tech Tips are compiled by VLS Assistant Editor Liz Donovan.

www.VetTechJournal.com

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ProductForum Nutramax Laboratories

Proviable Probiotic Products

OsteoChon, a unique, veterinarian-developed formulation of ingredients designed to support bone, joint, and cartilage development in foals and yearlings, is now offered in paste and powder forms. OsteoChon contains copper, zinc, and manganese for cartilage growth and health; hyaluronic acid, chondroitin sulfate, and silicon for primary joint health; and silicon, boron, and strontium for bone and cartilage strength, development, and density.

This line of veterinary-exclusive products is formulated to naturally support the intestinal health of dogs and cats. Proviable products contain seven species of probiotics, which are live microorganisms that benefit intestinal microbial balance when ingested, and two prebiotics, which are complex carbohydrates that stimulate the activity of the probiotics within the large intestine. Two formulations are available for dogs and cats: Proviable-KP paste and Proviable-DC capsules. The paste is sold in a graduated tube, and the capsules are sold in an 80-count carton. Combination packages are also available in two sizes: for cats and small dogs and for medium and large dogs.

877-786-9882 䡲 www.kinetictech.net Circle 101 on Reader Service Card

800-925-5187 䡲 www.nutramaxlabs.com Circle 102 on Reader Service Card

Kinetic Technologies

Bone and Joint Supplement

A VMA V Accr AVMA Accredited

Veter Veterinary TTechnology echn Degrees D egre

JAKKS Pacific

White Bites White Bites treats make it easy for clients to provide their dogs with regular at-home dental care. The treats, which contain Arm & Hammer baking soda to freshen breath, have a combination of chewy and abrasive qualities that aid in the long-term breakdown of plaque. JAKKS Pacific claims that these treats are specifically formulated with safety and digestibility in mind. This product is available in 4-, 8-, and 16-oz sizes.

• Associate’s Associate’s degree d egree

e n i l On

• Bachelor’s degree

310-455-6321 䡲 www.white-bites.com Circle 103 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 216 and 217 of this issue.

www.spcollege.edu/hec/vt w.spcollege.edu/hec/vt

St. Petersburg u g College urg

The product and service descriptions presented in Product Forum are provided by the manufacturers and are not necessarily endorsed by Veterinary Technician.

Veterinary Technician | APRIL 2008

(727) 27 7) 341-4SPC Excellence in education uccation i since i 1927

245

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ProductForum Meridian Animal Health

IDEXX Laboratories

Meridian Animal Health recently released a line of veterinarianexclusive products, including pharmaceuticals, therapeutics, supplements, parasiticides, and other pet care items. The company worked with a corporate advisory board made up of companion animal veterinarians, scientists, and university researchers to develop its products. Products that are currently available include liquid sutures and bandages; fly and mosquito spray for horses; natural flea, tick, and mosquito control for dogs and cats; natural calming agents for dogs; and natural joint therapy for dogs and cats.

IDEXX Laboratories now offers the SNAPshot Dx, an endocrinology analyzer for the IDEXX VetLab suite. The SNAPshot Dx analyzer enables veterinarians to conduct the following in-house SNAP tests within minutes: T4, to screen for and diagnose hypothyroidism, use with other preanesthetic tests to rule out heart impairment, and monitor medications; cortisol, to screen for Cushing’s syndrome and Addison’s disease and monitor long-term medications; and bile acids, to assess liver function, identify occult liver disease, detect possible portosystemic shunts, and monitor response to treatment.

866-374-0242 䡲 www.meridiananimalhealth.com Circle 104 on Reader Service Card

800-355-2896 䡲 www.idexx.com/snapshot Circle 105 on Reader Service Card

Companion Animal Products

SNAPshot Dx Analyzer

Index to Advertisers For more information about products advertised in this issue, see the Reader Service Card inserted between pages 216 and 217.

Company American College of Veterinary Internal Medicine Animal Health Options Fort Dodge Animal Health Hill’s Pet Nutrition Lilly Merial Nestlé Purina PetCare Company Nutramax Laboratories Schering-Plough Animal Health Sharn Veterinary, Inc. St. Petersburg College VetDent CE Associates Veterinary Learning Systems Vetstreet

Product 2008 ACVIM Forum ProQuiet LymeVax ProMeris Prescription Diet Canine r/d Comfortis Reconcile Frontline Plus Heartgard Plus RECOMBITEK Lyme Purina Veterinary Diets OM Overweight Management Canine Dry Formula Dasuquin Tri-Heart Plus Cardell Monitors Online Veterinary Technology Program New Dental Seminars Veterinary Technician® Is Now Free VetLearn.com Practice Communication and Marketing Tool

Reader Service # 198

Page # 221

127 177 195 136 156 193 183 190 175 171

222 207 Cover 4 Cover 2 212, 213 218, 219 199 211 195 234, 235

192 157 151 181 130

197 229, 230 223 245 215 243 Cover 3 224–225

186

The following advertisers appear in our Market Showcase section, which begins on page 247. Alpine Publications Auburn University College of Veterinary Medicine MED I.D. Petknap, Inc. Veterinary Solutions WhereTechsConnect.com

246

APRIL 2008 | Veterinary Technician

Dictionary of Veterinary Terms 7th Annual Veterinary Technician Course

161 162

BIPS Capsules X-Ray Identification System Pet Burial Bags World’s Best Dog & Cat Muzzle Job Source and Marketplace for Vet Techs

135 135 168 147 163

www.VetTechJournal.com

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MarketShowcase

free!

GET MORE EXPOSURE FOR ▲ Circle 161 on Reader Service Card

www.

ALL MARKET SHOWCASE PRINT ADS are placed on VetClassifieds.com for free! To place an ad, call Linda Costantini at 800-426-9119, ext 2422

VetClassifieds .com

World’s Best Dog & Cat Muzzle ▲ Circle 168 on Reader Service Card

THE NEXT AVAILABLE ISSUE

is JUNE, which closes APRIL 29

BONUS!

The durable, soft plastic Vetsol cat & dog muzzle goes on easily, is comfortable, and stays put! Great for exams, drawing blood, taking x-rays, and grooming.

Catheter Guards Save time and money by protecting your patients’ IV catheters.

VETERINARY SOLUTIONS PO BOX 16195, SEATTLE, WA 98116-0195

www.vetsol.com • becky@vetsol.com 858-232-0081 ▲ Circle 147 on Reader Service Card ▲ Circle 163 on Reader Service Card

Our

free Reader Service Program generates

highly qualified leads for your sales force!

www.VetTechJournal.com

FOR MORE INFORMATION OR TO PLACE AN AD, CONTACT LINDA COSTANTINI Toll-Free 800-426-9119, ext 2422 Phone 267-685-2422 • Fax 201-231-6373 Email lcostantini@vetlearn.com or VetTechClassifieds@vetlearn.com Veterinary Technician | APRIL 2008 247

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▲ Circle 162 on Reader Service Card

▲ Circle 135 on Reader Service Card

ClassifiedAdvertising TECHNICIANS WANTED

TECHNICIANS WANTED

ALASKA – Experienced licensed or unlicensed techni- growth. Great salary and benefits, including continuing edcian 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 Road, Anchorage, AK 99507.

CALIFORNIA – RVT (or RVT-eligible individual) wanted for progressive, service-oriented, ten-doctor practice in Corte Madera. A great opportunity for an energetic, selfmotivated team player to utilize his or her full range of skills. Full-time position with competitive salary and benefits package. Please contact Lani: fax 415-924-6235 or email lani.dacosta@sbcglobal.net.

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; email asgvets@asgvets.com; fax 818-507-9418; website: www.asgvets.com. CONNECTICUT – Five-doctor, veterinarian-owned, AAHA-

accredited hospital in Norwalk needs a technician. Work in a fun environment that promotes teamwork and personal

248 APRIL 2008 | Veterinary Technician

ucation at national meetings. Contact Dr. Michele Lamothe at 203-846-3495 or email brah@aol.com. Visit us at www. broadriveranimalhospital.com.

TECHNICIANS WANTED 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 - VETERINARY TECHNICIANS/NURSES We are a state-of-the-art small animal referral practice located in West Palm Beach. 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 www.VetTechJournal.com

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ClassifiedAdvertising TECHNICIANS WANTED

TECHNICIANS WANTED

GEORGIA – Consider practice in beautiful Atlanta. Whether

FLORIDA

*Source: June 2007 BPA Statement

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 $32,000–$44,000+ plus 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 Drive Coral Springs, FL 33071 Attn: Megan Kelly, Nurse Manager Phone 954-753-1800; Fax 954-343-0238

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 Drive, Miami, FL 33143 or fax resume to 305-665-2821, Attn: Brad, or call 305-665-2820 for more information. www.mvshospital.com

you are thinking about relocation or are already in this area, please consider a position with 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!

GEORGIA – Experienced veterinary technician wanted for small animal hospital in Douglasville. Technician and receptionist duties included. Part-time hours are 12–7, Monday, Thursday, and Friday. Salary commensurate with experience. Please call Bankhead Animal Hospital for more information: 770-942-9077.

HAWAII

Lead Technician Our progressive, six-doctor practice located in Kahului, Maui, needs an experienced veterinary technician. Join our light and fun work environment where a sense of humor is appreciated. Generous wage and benefits package includes vacation, health/dental/vision insurance, CE, 401(k), and attractive perks, plus assistance with moving expenses for the committed individual. Contact Kelly Heiman: call 808-893-2380; fax 808-893-2579; or email Kelly@centralmauianimalclinic.com.

T H E N E X T AVA I L A B L E I S S U E

is JUNE, which closes APRIL 29

reach over 18,300 paid subscribers* with your ad in Veterinary Technician classifieds. We also offer discounts for multiple ad placements, both in one journal and across our line of publications—Compendium, Compendium Equine, Veterinary Technician, Veterinary Forum, and Product Forum and Market News.

Classified Advertising LIESE DIXON Phone 800-920-1695 or 267-685-2491 • Fax 201-231-6373 Email VetTechClassifieds@vetlearn.com Market Showcase Display Advertising LINDA COSTANTINI Phone 800-426-9119, ext 2422, or 267-685-2422 • Fax 201-231-6373 Email lcostantini@vetlearn.com or VetTechClassifieds@vetlearn.com www.VetTechJournal.com

To place your classified or Market Showcase ad, contact us today! Veterinary Technician | APRIL 2008 249

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ClassifiedAdvertising TECHNICIANS WANTED

TECHNICIANS WANTED

ILLINOIS

Tired of fleas and fecals? Our small veterinary ophthalmology practice needs a full- or part-time technician. No weekend hours! New graduates and not-so-new retirees welcome. For more information, please call 630-964-7771, fax 630-964-0307, or email veterinaryvision@yahoo.com.

EXPERIENCED TECHNICIANS and CVTs WANTED

ILLINOIS Seeking a fulfilling and challenging career? Join Animal Emergency & Referral Center, one of the area’s fastest-growing veterinary centers, located in Chicago’s northern suburbs. AERC is a 24-hour emergency/critical care and specialty referral hospital, where board-certified specialists head each referral discipline: cardiology, imaging, internal medicine, neurology/neurosurgery, and orthopedic/soft tissue surgery. We seek experienced, energetic, skilled technicians to support our emergency/ICU and specialty departments. All of our talented and dedicated doctors and technical staff are committed to providing compassionate, progressive patient care and services 24/7. At AERC, we appreciate, encourage, and reward talent! We offer a competitive salary and benefits package, which includes health/dental/life insurance, uniform/CE allowances, 401(k), paid vacation/sick time, and no rotating shifts. Fax Sheri at 847-564-9604. Email srothschild@AERCenter.com. Visit us at www.aercenter.com.

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.

LOOK NO FURTHER.

We’ve got your ideal job! 250 APRIL 2008 | Veterinary Technician

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.

TECHNICIANS WANTED MASSACHUSETTS – Woburn Animal Hospital is seeking a highly motivated individual for an immediate opening at our state-of-the-art facility, where we provide top-quality care. The successful candidate will be an experienced veterinary technician with excellent interpersonal skills and the ability to multi-task in our busy, team-oriented veterinary practice. Please fax resume and cover letter to 781-9335785. No phone calls, please. MICHIGAN – Full-time LVT needed for our busy, twodoctor, AAHA-accredited small animal hospital with an interest in dentistry. Located in Ann Arbor, we have an excellent staff that is committed to teamwork and focused on high-quality, compassionate care for clients and patients. Our technicians are fully utilized; therefore, a license is required. Excellent pay and benefits. Fax resume to Westarbor Animal Hospital at 734-662-8151, or email shedding@tds.net.

Interested candidates, please contact Cathie Moses at 847-548-5300 or fax your resume to 224-656-5180. Email: sshogren@aetcenter.com.

MARYLAND – Experienced veterinary technician needed for progressive, high-quality, state-of-the-art referral and emergency center. Located on 30 acres in Frederick. Great salary and working conditions. Fax resume and cover letter to 301-874-8880 or email jfinnegan@greenbriarpethospital.com. Visit our website at www.greenbriarpethospital.com. MARYLAND

Technicians/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 website at www.atlanticvetintmed.com to meet our doctors and staff.

MASSACHUSETTS – Veterinary technician and techni-

cian 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.

MICHIGAN – Small animal emergency/referral hospital in Kalamazoo is in need of another LVT. Board-certified surgeon and emergency/critical care specialist on staff. LVT duties will include anesthesia, surgical assistance, intensive care nursing, radiology, and clinical laboratory work. Full-time position with excellent salary and benefits. Send resume to Southwest Michigan Animal Emergency/Referral Hospital, 6039 South Westnedge Avenue, Portage, MI 49002; fax to 269-323-3636; or phone 269760-4056. MICHIGAN – Enthusiastic part- or full-time LVT wanted for small animal practice in Kalamazoo. Utilize all of your skills performing anesthesia, radiology, laser surgery, dentistry, and more. Competitive salary plus benefits: CE, SIMPLE IRA, vacation, and more. Send resume to Oshtemo Veterinary Hospital, Box 346, Oshtemo, MI 49077; fax 269-375-4707; or email oshtemovet@sbcglobal.net. www.VetTechJournal.com

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ClassifiedAdvertising TECHNICIANS WANTED NEW JERSEY – Seeking motivated, responsible, and experienced technicians. We’re an AAHA-accredited practice with state-of-the-art equipment, including laser surgery; endoscopy; laparoscopy; digital x-ray; and in-house lab. Full-/part-time positions available. Salary commensurate with experience. Send resume to Tracy: fax 201368-9261 or email maywoodvet@aol.com. NEW JERSEY – RVT needed for busy, two-doctor, AAHA-accredited small animal practice in beautiful Sussex County. Must be a motivated self-starter and team player with proficiency in technical and client relation skills. Competitive salary; benefits include vacation/personal time, health insurance, uniforms, CE, 401(k). Fax cover letter and resume to 973-729-4092, attn: Diane; or email dvanlear59@yahoo.com.

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!

NEW JERSEY Red Bank Veterinary Hospital, a busy referral and emergency practice located at the Jersey shore, provides a great opportunity for advancement and continued training in all aspects of veterinary medicine. Come join our team of highly skilled technicians in our state-of-the-art, 58,000–sq. ft. facility! We have openings for general treatment technicians and in the exotics, oncology, critical care, and surgery specialties. RBVH also provides cardiology, dental, dermatology, emergency, internal medicine, neurology, ophthalmology, and physical therapy services. Competitive compensation and benefits packages. Credentialed or exam-eligible technicians preferred. Fax resume to 732-704-9504.

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-of-the-art equipment including high-speed fiberoptic 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,

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/Triage 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. medical insurance, and continuing education. Call Dr. Bill Freedman 201-313-7000.

NEW YORK – Bideawee seeks head LVT and LVTs for

full-/part-time positions at its Manhattan location to assist veterinarians in caring for resident animals and private clients’ animals. Salary commensurate with experience; excellent benefits package. Email cover letter/resume to greg.carastro@bideawee.org.

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 workweek, competitive salary, CE, medical, six paid holidays, 2 weeks vacation, 401(k)/profit sharing plans. Apartment available. NO night emergencies! Call Paul Staar 914723-1250.

NEW YORK

Technicians/Assistants Wanted The Center for Specialized Veterinary Care in Westbury is a state-of-the-art facility looking for experienced, motivated, compassionate LVTs, license-eligible technicians, and assistants. We are open 24 hours a day, 365 days a year. Departments include ICU, treatment, internal medicine, surgery, radiology, oncology, dermatology, neurology, and more. Sign-on bonus or contribution to moving costs for the right candidate! If you have the skills and compassion to make a difference in the life of a pet and want to earn a competitive salary and enjoy great benefits, then contact Toni Stovall at tstovall@vetspecialist.com or fax resume to 516-420-0122.

Place Your Ad Where It Will Get Noticed: www.VetClassifieds.com www.VetTechJournal.com

TECHNICIANS WANTED

NORTH CAROLINA North Carolina State University’s College of Veterinary Medicine is growing! The 110,000–sq. ft. Randall B. Terry Jr. Companion Animal Medical Center is scheduled to open in winter 2009. We are currently recruiting for the following positions: • Large Animal Hospital Manager, # 100180 • Large Animal Hospital Supervisor, # 44032 • Veterinary Emergency Technician Manager, # 44214 • Veterinary Technician, Registered, # RVT-0108 • Veterinary Assistant, # VA-0108 • Large Animal Attendant, # 100214 • Small Animal Patient Care Coordinator

Please visit the NCSU website at jobs.ncsu.edu for details about numbered positions and to apply online. Alternatively, you may fax resume and cover letter to Jim Brawley at 919-513-6225. NCSU is an equal opportunity/affirmative action employer and welcomes all persons without regard to sexual orientation. ADA contact: 919-515-3148

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ClassifiedAdvertising TECHNICIANS WANTED 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 Road, Akron, OH 44321 Fax 330-666-0519 or email to s.steen@metropolitanvet.com (subject: Registered Veterinary Technician).

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.

OREGON – Full-time CVT needed for two-doctor small

animal/exotics/wildlife practice where everyone’s opinions and input are valued. Located in beautiful Klamath Falls, we offer a competitive salary, attractive benefits, and a great work environment with fantastic clientele. Send resume to manager@everettveterinary.com or fax 541-884-7518.

PENNSYLVANIA – Rewarding full- or part-time posi-

tion available for a compassionate, experienced technician at Allergy, Ear, and Skin Care for Animals, a referral/specialty dermatology practice located in southern Bucks County’s Neshaminy/Langhorne area. Salary and benefits commensurate with experience. Fax resume to 215-354-9462, or email aesca@allergyearskincare .com. NO CALLS.

PENNSYLVANIA – Part-/full-time technician needed for

progressive, two-doctor small animal practice with excep-

252 APRIL 2008 | Veterinary Technician

TECHNICIANS WANTED

tional clientele. We offer a competitive salary and great benefits in a pleasant, team-based working environment. Mail resume to Chadds Ford Animal Hospital, 901 Baltimore Pike, Chadds Ford, PA 19317.

PENNSYLVANIA Certified veterinary technician wanted to join our team. Exeter Veterinary Hospital is a four-veterinarian, progressive, computerized, AAHA-accredited companion animal hospital east of Reading. Duties include, but are not limited to, in-house laboratory, radiology, surgery, dentistry, and client services. We are a well-equipped facility including an ultrasound, laser, endoscope, and complete dental room. Benefits package includes a retirement plan; uniform allowance; holiday, sick, and vacation pay; as well as continuing education. If interested, please contact Jenessa, staff manager, or Richard Rosato, hospital manager, at 610-779-2300 or fax resume to 610-779-3166.

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 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 website at: www.gwyneddvethospital.com.

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. SOUTH CAROLINA – Progressive, busy, one-doctor small animal practice in Sumter is seeking full-time CVTs, experienced technicians, assistants, and receptionists. We offer competitive wages, benefits, and major holidays off with no emergency work. Fax resume to 803469-6084. SOUTH CAROLINA – Licensed veterinary technician wanted for our busy, multi-doctor small animal clinic located in Bluffton, 10 minutes from beautiful Hilton Head Island. Candidate must be highly motivated, friendly, and willing to work in a fast-paced, demanding environment. Please send resume to Coastal Veterinary Clinic, 21 Buck Island Road, Bluffton, SC 29910, or fax 843-757-1114. TENNESSEE – Our 52-year-old, three-veterinarian small

animal practice in Nashville seeks two licensed or licenseeligible technicians to join us in our new 6,500–sq. ft. facility. We offer excellent benefits and a competitive salary for the individual who is the right fit for our practice. Please email your resume to RACManager@comcast.net.

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ClassifiedAdvertising TECHNICIANS WANTED TENNESSEE – We are growing again and have openings for two licensed or license-eligible veterinary technicians. Pet Emergency Treatment Service offers after-hours emergency care for dogs and cats in the Brentwood/Franklin area. We have one part-time and three full-time emergency doctors, six full-time LVTs, and other great support staff. We are next door to an established daytime surgery specialty practice. Excellent pay and benefits for the right candidate. Rotating schedule has large blocks of time off. Email your resume and inquiry to PETSEmergency@aol.com or call 615-554-7387.

TENNESSEE Our exclusively small animal practice located in Franklin — one of the most affluent counties in the U.S. and a suburb of Nashville — is seeking a full-time licensed or license-eligible technician. The ideal candidate is a diligent worker and a team player. Our practice provides dentistry, ultrasound, and surgery and is dedicated to client education and preventive medicine. We offer competitive pay and benefits, including CE, vacation/sick leave, uniform. Please fax resume: 615-778-0984.

TEXAS

Veterinary Technician The University of Texas Medical Branch at Galveston needs a full-time (40 hours/week) veterinary technician to provide technical expertise in all aspects of anesthesia; aseptic surgery support; pre- and postoperative care; and clinical and laboratory support services. Responsibilities will include administering treatments as directed by supervisors; anesthesia induction, maintenance and monitoring; surgical/veterinary record-keeping; operation, set-up, and maintenance of surgical equipment and the operating suite; radiograph exposure and development; sample collection and processing; and participating in daily rounds and health checks. High school diploma or equivalent plus 2 years of related experience required. AALAS certification (ALAT level), RVT, or equivalent preferred. Interested candidates should apply online at www.utmb.edu/hcm (Job Title: Veterinary Technician; Job ID #5031). UTMB at Galveston is an equal opportunity, affirmative action institution that proudly values diversity. Candidates of all backgrounds are encouraged to apply.

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. www.VetTechJournal.com

TECHNICIANS WANTED

TEXAS

VIRGINIA

$1,000 Sign-On Bonus

Experienced Veterinary Technicians Wanted

We are seeking experienced technicians and RVTs for our progressive, after-hours emergency hospital located in North Houston. Practice in a new, state-of-the-art facility with the highest standards of patient care. We offer a great work environment, an excellent salary/benefits package, uniforms, CE, flexible schedules, and a terrific support staff. This is veterinary emergency medicine at its best! $1,000 SIGN-ON BONUS! Send resume to hr@aeucc.com.

TEXAS – AAHA-accredited hospital in San Antonio seeks a technician with a minimum of two years’ experience; surgical experience a plus. Excellent salary potential based on experience. Great benefits. Send resume to office@ hillcountryanimalhospital.com, or fax 210-695-4919.

UTAH – We are seeking skilled veterinary 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 who 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 – Well-established, progressive animal hos-

pital in search of motivated LVT to join our talented team. Practice established in 1994, relocated to a brand-new 8,000–sq. ft. building in 2002. Located 5 minutes from beautiful historic Fredericksburg and an hour from Richmond and Washington, DC. Our state-of-the-art equipment includes sevoflurane, endoscopes, IDEXX work station, modern dental equipment, ultrasound, laser, digital x-ray, and physical therapy pool. Please contact Dr. Stephen McAuliff or Barb Cotton. Fax 540-891-4698 or call 540-891-1275.

VIRGINIA – We are looking for a full- or part-time LVT to join our growing AAHA-accredited practice. Our fourdoctor/two-LVT small animal practice has great clients and a well-trained, highly committed staff and we need another eager LVT to grow with us. Duties include providing nursing care, taking radiographs, monitoring anesthesia, assisting in surgeries, collecting and processing laboratory specimens, and giving routine vaccines. We offer boarding and grooming services, so your knowledge and skills will be put to good use. We offer highly competitive benefits, including paid vacation, continuing education, and insurance. Salary commensurate with skills and experience. Please contact Sherry Meier, Office Manager; Ross W. Moore, DVM; or Toni Connell, DVM: Independent Hill Veterinary Clinic, 13444 Dumfries Road, Manassas, VA 20110; call 703-791-2083; or email kirby13444@aol. com. Calls preferred.

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, state-of-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 Attn: Human Resources.

VIRGINIA – We are seeking a team-oriented, experienced, motivated licensed veterinary technician. Dumfries Animal Hospital is a five-doctor small animal and exotics practice located 15 miles south of the Beltway in northern Virginia. Come and share your commitment to patient care and client education with our team of four LVTs and six highly skilled veterinary assistants, along with the rest of our well-trained veterinary team. Our technicians are encouraged to utilize their technical skills daily. Duties include surgical and hospital patient care, anesthesia, dentistry, radiology, laboratory work, as well as exam room appointments. Hours are flexible with an occasional Saturday. We offer very competitive wages, health and dental insurance, vacation time, sick time, paid CE, license fees, a SIMPLE IRA, and an employee quarterly bonus program. Fax resume to Becky Ash at 703221-7225 or email dah01@earthlink.net. You may visit our website at www.dumfriesanimalhospital.com. VIRGINIA – Gayton Animal Hospital, our four-doctor, AAHA-accredited small animal practice in Richmond, seeks another full-time LVT. Our technicians are utilized as professionals and are encouraged to continue developing their skills and expertise. Our senior technician has been with us for 20 years and is a great source of training. We offer an excellent salary and benefits package, including health insurance, vacation and sick leave, uniform allowance, CE, pet care discount, and license and professional fees. Experienced technicians and new graduates are encouraged to apply. Submit your resume to Chris Shand, LVT, Gayton Animal Hospital, 9764 Gayton Road, Richmond, VA 23238; or fax 804-754-1063. VIRGINIA – Licensed veterinary technician needed for

busy Virginia Beach practice. Utilize your skills with laser, ultrasound, radiographs, laboratory techniques, and much more! Competitive salary and excellent benefits, including pet benefits, vacation, CE allowance, and health insurance. Contact Cathy at 757-481-2800; fax 757-496-2625; email greatneckvet@aol.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.

VIRGINIA – Small animal practice in Chesapeake seeking full-/part-time LVT. Technical skills fully utilized in modern, well-equipped facility. Caring, compassionate team player with organizational skills and experience desired. Excellent pay and benefits. Fax resume/references to Brentwood Veterinary Clinic at 757-485-1388 or email dpcleek@cox.net.

VIRGINIA – Experienced veterinary technician needed for well-equipped, two-doctor, small animal/exotics practice in Virginia Beach. Solid technical skills, good interpersonal skills, and team-player mentality required. Well-established clientele and cooperative, skilled, friendly staff. Providence Square Veterinary Clinic: phone 757-495-2961; fax 757495-6986; email chrysnz@aol.com. VIRGINIA – Licensed veterinary technician needed in beautiful Charlottesville! We have wonderful clients and a great staff and offer only the best medicine to our patients. Must be a team player and have an upbeat attitude. Flexible schedule and excellent compensation, including bonuses, retirement plan, health insurance, and CE. Email resume to cvilledogdoc@yahoo.com. 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 3–11, 254 APRIL 2008 | Veterinary Technician

TECHNICIANS WANTED

occasional Saturday AM shifts. Fax resume to 703-368-4703 or call Dee/Dr. Smith at 703-330-8809.

WISCONSIN – CVT position available for five-doctor practice.

WASHINGTON – Fast-paced, six-doctor, AAHA-accredited hospital located in Seattle is looking for a responsible, enthusiastic, full-time LVT or experienced assistant with lots of initiative who is committed to highquality animal care and superior client service in a teamoriented atmosphere. Benefits include health and dental insurance, 401(k), CE, uniforms, and more. Salary DOE. Contact David, technician supervisor: Elliott Bay Animal Hospital, 2042 15th Avenue West, Seattle, WA 98119; phone 206-285-7387; fax 206-285-9074; email dzajac@ elliottbayah.com. Visit www.elliottbayah.com.

WASHINGTON – Want to see your knowledge and skills utilized to their full potential? Interested in pursuing a career in emergency and critical care or surgery? Alpine Animal Hospital is a large, AAHA-accredited hospital in Issaquah (just east of Seattle) that offers 24-hour emergency care and an excellent day practice. We have ultrasound, endoscopy, digital radiology, and an ACVECC specialist and need new, energetic team members. We are looking for motivated licensed or experienced ER technicians and a licensed technician for daytime surgery support. This is a great opportunity to utilize your skills in a learning environment and work with our specialist, who works weekends! The ideal candidates are self-motivated, compassionate, skilled, fun, and great team players! Benefits: signing bonus, CE compensation, M/D/V, matched 401(k), license dues, pet benefits, vacation/sick days, uniforms, competitive salary, and relocation assistance (where applicable). Email resume to Allison Perkins, LVT at allison.perkins@vcamail.com or fax 425-391-7439.

WASHINGTON – Our well-equipped, five-veterinarian, AAHA-accredited facility in Lacey is hiring one or two fullor part-time LVTs. We are a fun-loving team that works to provide awesome patient care. Your skills will be fully utilized. Both new and experienced LVTs are welcome to apply. Contact Mayme Revel, Operations Manager: 360438-9623 or mtnviewvet@comcast.net. Check us out at www.mountainviewvet.com.

WASHINGTON – Licensed veterinary technician

needed for our rapidly growing small animal hospital. We are looking for a full- or part-time self-motivated team player who is interested in advancing his or her skills. We offer a 4/10 workweek, competitive wages, 401(k), medical benefits, and holiday/sick pay for fulltime employees. Please fax resume to 360-876-1482 or email hospital@kitsapvet.com.

Use ALL of your skills with laser, ultrasound, laparoscopy, echocardiography, 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.

Your Talent. Our Team. As the nation's largest network of veterinary hospitals and clinical laboratories, we know that our support staff and professionals are critical to our success. That's why we offer competitive salaries and generous benefits, including: • Medical, dental and vision insurance • 401(k) retirement plan • Generous discount for personal pet care • Continuing education opportunities • Transfer opportunities and relocation • Exciting career advancement opportunities and specialty tech positions • Flexible scheduling These are just a few of the reasons why some of the nation's top veterinary professionals consider joining VCA Animal Hospitals to be their smartest career move yet. Of course, working in one of VCA's state-of-the-art facilities also has its advantages! Join us in one of our specialty hospitals and multi-doctor progressive practices. Come share your talent with our team and be a part of our family of over 1,800 doctors and 180 board certified specialists. We offer positions in 38 states and have more than 450 locations across the United States. Please visit us at www.vcapets.com And feel free to contact us at (800) 216-8699 or talent@vcamail.com

WISCONSIN – Veterinary Specialty & Emergency Care

is looking for CVTs for its surgery and critical care services in our new 23,000–sq. ft. small animal emergency and referral center in Madison. We put an emphasis on teamwork and a healthy, happy work environment. Group health plan, 401(k), vacation/sick days, CE allowance. Experience preferred, but a positive personality is required. Send resume Attn: Barb Bachman: Veterinary Specialty & Emergency Care, 1848 Waldorf Blvd., Madison, WI 53719; fax: 608-845-2200; or email vsec@vetspecialtycare.com.

THE NEXT AVAILABLE ISSUE

is JUNE, which closes APRIL 29

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C L A S S I F I E D S ORDER FORM Please Place My Ad In ®

The Complete Journal for the Veterinary Health Care Team

C O N T I N U I N G E D U C A T I O N F O R V E T E R I N A R I A N S TM

for ____________ issues

Pricing, Discounts, and Options Price per word (40-word minimum charge) $2.20

Single Ad Placement

Available Discounts* ❏ Single ad placed in multiple issues (e.g., one ad placed for 2 months in Veterinary Forum) ❏ Single ad placed in multiple journals (e.g., one ad placed for 1 month each in Veterinary Forum and Compendium) ❏ Single ad in multiple journals for multiple months (e.g., one ad placed for 2 months each in Veterinary Forum and Compendium)

10% off 15% off 20% off

Add-On Options ❏ Early Internet Exposure — Place your ad on VetClassifieds.com 30 days before your first issue release date. (one-time cost) $30 ❏ Instant Internet Exposure — Your ad appears on VetClassifieds.com up to 7 weeks before your first issue release date. (one-time cost) $45 ❏ Confidential Forwarding Service — Direct inquiries to our attention; we send them to you via mail and/or email. (one-time cost) $40 ❏ Deluxe Package — Add a box border and bold contact information. Choose from six styles (see below). $50 ❏ Premium Package — Deluxe package plus your logo (email as high-resolution tiff, jpeg, or eps file). $100 Deluxe/Premium Package Style Sample (circle letter) A B C

*First ad pays full price. Subsequent ads are eligible for one discount per ad, barring promotional specials. Percentage discounts are taken from total cost of ad.

Payment I will pay by (check one):

Check

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Call for details regarding check or money order payments.

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Cardholder Name ______________________________________________ Contact Name ____________________________________ Clinic/Company __________________________________________________________________________________________________ Address ________________________________________________________________________________________________________ City __________________________________________________________ State ____________ Zip _____________________________ Telephone (

) ______________________________________________ Fax (

) ______________________________________

Address_________________________________________________________________________________________________________ (credit card billing address if different from above)

Authorized Signature ______________________________________________________________________________________________ SPECIFICATIONS

ORDERING INFORMATION

• Counting Words: A new word is counted after every space. City, state, zip code, and phone/fax numbers are one word each. Email and Internet addresses are three words each.

Mail or fax order form and your ad to: Classified Advertising,Veterinary Learning Systems, 780 Township Line Road,Yardley, PA 19067 • Fax 201-231-6373 Email your ad and payment information to: VetForumClassifieds@vetlearn.com CompendiumClassifieds@vetlearn.com VetTechClassifieds@vetlearn.com CompendiumEquineClassifieds@vetlearn.com

• Payment: Include complete billing information with all orders. • Deadlines: No cancellation after the deadline date. All ads received after the deadline will be printed in the following issue of the appropriate journal(s).

For more information about classified advertising, call Liese Dixon at 800-920-1695 (toll-free) or 267-685-2491. For information about placing a display ad in Market Showcase, call Linda Costantini at 800-426-9119, ext. 2422 (toll-free), or 267-685-2422.

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TechLife A Celebration of Technicians and Their Lives

You Know You’ve Been a Technician When...

TooLong

YOU CAN’T PET your own dog or cat without automatically peeking into its ears and eyes and checking its teeth for tartar.

YOU SEE AN ANIMAL and automatically start thinking of how to prepare it for surgery and how much fur you’ll need to shave off.

YOU PRACTICE new “hold” techniques on your pets in order to spend quality time with them.

YOU GIVE YOUR DOG A HUG and think its ears feel hot, so you immediately run for cotton swabs and a thermometer.

YOU HAVE AN OLD pair of jeans with holes in the knees, and you think to yourself, “Maybe I should just put them down.” YOU SEE SOMEONE walking a dog and immediately note the dog’s body posture, sex, known breed traits, and overall health condition.

YOU PET YOUR DOG and catch yourself checking the fit of its collar, even though you know that it fits perfectly fine. YOU SEE A CARTOON episode of a vet scene and immediately pick out at least a dozen things that are wrong. YOU CAN PLAY tic-tac-toe using the scratches and scars on your arms. YOU CAN CONNECT your scratches and scars and find interesting animal shapes in the patterns. Ryan Jo Summers Mills River, NC

256

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