Veterinary Technician | May 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. 5 | May 2008

REBECCA ROSE, CVT Promoting Animal Welfare in the Community

PARASITOLOGY Educating Clients About Fleas EMERGENCY MEDICINE Adapting an Emergency Triage System from Human Medicine

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Milo before 5/10/07

Milo after 9/15/07

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GuestEditorial

The Complete Journal for the Veterinary Health Care Team

Vol. 29 No. 5

May 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

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

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AIMVT Aims for Excellence Kimm Wuestenberg, CVT, VTS (ECC), is passionate about promoting the veterinary technology profession. She has worked in general practice clinics as well as emergency and specialty hospitals and is a veterinary technician educator. Kimm became a Veterinary Technician Specialist (VTS) in Emergency and Critical Care in 2002. In June, she will earn a VTS certification in Small Animal Internal Medicine. Kimm currently serves as president of the Academy of Internal Medicine for Veterinary Technicians (AIMVT) and has been a member of several AIMVT committees, including the organizing committee and application committee. She shares her passion for promoting universal recognition of veterinary technicians as dedicated professionals who provide excellent care, demonstrate advanced skills, and play an essential role as members of the veterinary team. This year marks an exciting time for AIMVT. In June, we will conduct our first VTS examination — the culmination of 5 years of strategic development — thanks to the hard work and dedication of our organizing committee. We are thrilled by the number of applicants who are pursuing VTS certification in Internal Medicine in the subspecialties of Oncology, Cardiology, and Small Animal Internal Medicine; these applicants will be taking the June examination at the American College of Veterinary Internal Medicine conference in San Antonio, Texas. Although there was a shortage of Large Animal Internal Medicine applicants this first year, we are optimistic that the number of qualifying applicants in this subspecialty will increase next year. We are also optimistic that we will be able to offer a Neurology subspecialty in the near future. I was fortunate to be a member of the 2007 application committee and to review several of the Small Animal Internal Medicine applications. I was impressed with the advanced technical skills and knowledge of the applicants. I am proud that these highly skilled individuals aspire to be part of AIMVT, and I am looking forward to seeing these professionals become representatives of our organization. The veterinary technology profession is making dynamic changes through NAVTA — and its Committee on Veterinary Technician Specialties — and with the help of dedicated veterinary technicians. It is an honor to play a role in the transformation that is taking place. AIMVT intends to continue to set high professional standards and to award VTS certification in Internal Medicine to individuals who provide superior care, demonstrate advanced knowledge and skills, and are unconditionally dedicated to this rewarding career. For more information about AIMVT, visit www.aimvt.org.

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Contents

The Complete Journal for the Veterinary Health Care Team

May 2008

Volume 29, Issue 5

COLUMNS

For the benefit of those who wish to participate in the CE Program, the peerreviewed CE articles contained in Veterinary Technician® meet the standards set by Alfred State College for 0.5 credit hour. Documentation will be issued by Alfred State College, a State University of New York (SUNY) College of Technology.

290 Behavior Boot Camp

All clinical articles are peer reviewed.

The Technician’s Role in the Behavior Consultation

Rose, CVT, and her 266 Rebecca golden retriever mix, Tika

Julie Shaw, RVT

294 Case Report Dioctophyme renale Infection in a Labrador Mix Annette Morrison, VT, RLAT; Andrew S. Peregrine, BVMS, PhD, DVM, DipEVPC; and Alexandra Squires Bos, BVM&S

300 Equine Essentials Neonatal Candidiasis

FEATURES 266

Leading the Way — A Talk with Rebecca Rose, CVT Liz Donovan Rebecca Rose, CVT, explains how belonging to a professional association not only gave her networking opportunities but also changed her life.

272

Proposal for an Emergency Receiving and Triage System Adapted from Human Medicine Andrea Battaglia, LVT The Emergency Severity Index (ESI), a five-level triage system that uses numeric codes to classify patients, has been used in human emergency medicine. The author proposes a method of adapting the ESI system for use in a veterinary emergency hospital.

258

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Ontario Veterinary College, University of Guelph

Mike Arzt

Bradford G. Bentz, VMD, MS, DACVIM, DABVP (Equine)

294 Dioctophyme renale ON THE COVER Rebecca Rose, CVT, gives a presentation on behalf of the Gunnison Valley Animal Welfare League.

See page 266 Photographed by Mike Arzt

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Kills Adult Fleas

Kills Flea Eggs

Kills Ticks Kills Flea Larvae

FAST 3

Grand Slam. FRONTLINE® Plus contains two powerful active ingredients that kill ticks and fleas (adults, eggs and larvae) to provide extra protection for pets. • Fipronil kills adult fleas in multiple ways (by working on at least 3 different sites in their nervous system),1,2 kills ticks, and keeps killing all month long. • (S)-methoprene kills flea eggs and larvae to break the flea life cycle. That’s how FRONTLINE Plus eliminates existing infestations and protects pets against reinfestation.

LASTS4

FRONTLINE Plus also: • Aids in control of sarcoptic mange infestations. • Rapidly eliminates infestations of chewing lice. • Is approved for use on breeding, pregnant or lactating dogs and cats, as well as puppies and kittens 8 weeks of age and older.

To stop fleas and ticks, your recommendation counts.

For more details, visit www.FRONTLINE.com 1

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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Contents

May 2008 272

Emergency Triage System

The Complete Journal for the Veterinary Health Care Team

Volume 29, Issue 5

DEPARTMENTS 257 Guest Editorial 262 Information Page 264 Tech News 308 Tech Tips 310 Product Forum 311 Index to Advertisers 312 Market Showcase

282

CE ARTICLE

©CINHP / G. McCormack

Educating Clients About Fleas Sandra Rhodes, RAHT The cat flea, Ctenocephalides felis, is the most common ectoparasite of dogs and cats in North America. Infestation can result in flea allergy dermatitis — a skin condition caused by hypersensitivity to flea saliva — or skin trauma because of scratching by the pet. Technicians should understand the flea life cycle, recognize the clinical signs of infestation, and educate owners about preventatives as well as treatment options.

Visit our Conference Calendar at

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290

Behavior Consultation www.VetTechJournal.com

Courtesy of Newtown Veterinary Hospital

282

Educating Clients About Fleas

Gerald McCormack

Courtesy of Levittown Animal Hospital

313 Classified Advertising

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MAKE THE CONNECTION between OBESITY…

and the RISKS owners don’t see Have the SLENTROL conversation Research shows that clients who are told about the serious health risks associated with canine obesity are more motivated to take action.1 Don’t wait to have the SLENTROL conversation—your clients need you to tell them how to achieve a healthy weight for their dogs. SLENTROL is proven to help obese dogs achieve healthy weight, regardless of their past weight-loss history. With its phased approach, SLENTROL gives you the time to work with dog owners to develop the feeding and exercise habits that will maintain weight loss after treatment is completed. SLENTROL should not be used in cats, dogs receiving long-term corticosteroid therapy, or in dogs with liver disease. The most common side effect is vomiting. In addition, dogs may experience diarrhea, lethargy, or anorexia. The client should be made aware that if any of these signs persist for more than 2 days the dog should be re-evaluated. SLENTROL is not for use in humans under any circumstances. Additional information available at www.SLENTROL.com. Reference: 1. Data on file. Pfizer market research SL1007. Pfizer Inc, New York, NY. © 2008 Pfizer Inc. All rights reserved. Printed in USA/May 2008. SLE0108006

LESS WEIGHT. MORE LIVING. Circle 153 on Reader Service Card

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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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Vol. 29 No. 5

May 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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Ou Fr r R om ea de rs

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Required reading for our hospital training program.

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TechNews

Canine Blood Donor Program Launched T

he University of California–Davis (UC Davis) has launched a new community-based canine blood donor program — the largest program of its kind west of the Mississippi. More than 1,000 dogs will be screened during 2008 to develop a group of 200 to 400 regular donors, which will donate blood about 2 to 3 times per year to the blood bank at the UC Davis William R. Pritchard Veterinary Medical Teaching Hospital (VMTH). Before this program was established in February, UC Davis obtained blood for its canine patients from canine blood donors that lived at the hospital for several years. After that time, the donor dogs were adopted out. “Each year, the teaching hospital provides 200 to 300 transfusions for dogs to treat conditions ranging from surgical complications to kidney failure,” says Sean Owens, DVM, the blood bank’s medical director and head of the VMTH’s transfusion medicine section. “This

Danielle Carrade (left) and veterinary technician Dorian Lara of the new UC Davis animal blood bank process blood that is being stored at the bank.

See YOUR NEWS in the pages of Veterinary Technician®! Send story ideas to: Email: edonovan@vetlearn.com Fax: 800-556-3288 For meeting information, visit our online Conference Calendar at www.VetTechJournal.com. 264

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Karin Higgins/UC Davis

new donor program will allow us to develop a large, reliable source of blood products for our patients without maintaining a colony of donor dogs at the hospital.” To be eligible as a blood donor, a dog must be 1 to 8 years of age, weigh at least 55 lb, and have never been pregnant. Owners must live within 100 miles of UC Davis; however, the VMTH plans to establish a mobile blood bank that can travel to dog shows and other canine events to make donating more convenient. When a dog first visits the blood bank, it will be examined and screened for infectious diseases; in addition, a unit of blood will be drawn to determine the dog’s blood type. There are 13 different canine blood types; the preferred donor type is dog erythrocyte antigen 1.1 negative. To learn more about canine blood donation, contact the VMTH at 530-752-1393, ext. 421. For information about retired canine blood donors available for adoption, email caninebloodbank@gmail.com.

Veterinary technician Dorian Lara (left), transfusion coordinator for the new animal blood bank, draws about one pint of blood from Cider, a resident donor, who will soon be adopted. Cider is held by trainer and veterinary technician Dyne Hansing.

S TAT E N E W S PENNSYLVANIA AnimalScan, a magnetic resonance imaging (MRI) facility for pets, has opened in Easton, Pennsylvania. At this facility, which is the only one of its kind in the Lehigh Valley, veterinarians can use advanced MRI technology to quickly diagnose specific conditions in pets. “With our extensive background in MRI technology, we can now provide veterinarians and pet

owners with an incredibly effective diagnostic technique that was previously unavailable to them,” says Jim Stuppino, president of AnimalScan. A staff of trained veterinarians and certified radiologists oversee each MRI scan, which takes between 30 and 90 minutes, and work with outside veterinarians to interpret the image and make a diagnosis. For more information, visit www.animalscan.org.

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TechNews

Courtesy of Hill’s Pet Nutrition, Inc.

Oral solution for use in dogs only.

(Left to right) Dr. David Wadsworth, president-elect, WSAVA; Neil Thompson, president, Hill’s Pet Nutrition, The Americas; Dr. Hein Meyer, director of strategic initiatives, Hill’s Pet Nutrition, Inc.; Dr. Brian Romberg, president, WSAVA; and Professor Jolle Kirpensteijn, vice president, WSAVA.

Hill’s Pet Nutrition, Inc., and WSAVA Announce Initiative Hill’s Pet Nutrition, Inc., and the World Small Animal Veterinary Association (WSAVA) have announced a new financial initiative as part of their joint partnership aimed at providing better veterinary health care worldwide. Over the next 4 years, Hill’s will provide grants in total of more than $1.8 million to support the WSAVA’s activities promoting high-quality veterinary care. Through this initiative, Hill’s will be the exclusive Prime Partner of the WSAVA Congress for the next 3 years. In addition, the grants will support the WSAVA

Global Continuing Education Program; the WSAVA Renal Standardization Project, in collaboration with Bayer Animal Health; and the WSAVA Web site’s news bulletin. Hill’s will also continue to support award programs such as the WSAVA/Hill’s Excellence in Veterinary Health Care Award and the WSAVA/Hill’s Pet Mobility Award. The partnership between the two organizations was effective on January 1 and continues through December 31, 2011. To learn more about WSAVA’s programs, visit www.wsava.org.

AAEP Promotes Dental Care The American Association of Equine Practitioners (AAEP) has introduced a campaign to promote regular oral examinations for horses. The organization is urging equine practitioners to educate horse owners about the necessity of regular dental care. To assist with this effort, a variety of educational articles and resources about equine dentistry will be available on the AAEP Web site throughout 2008. In addition, equine practitioners can request free resources from the AAEP to promote equine dental care in the clinic. According to the AAEP, horses with periodontal

disease are prone to weight loss, colic, and bacterial infections. Therefore, mature horses should undergo an oral examination at least once a year, and horses 2 to 5 years of age should be examined twice yearly. “Routine dental maintenance is the easiest step an owner can take to prevent a more serious health problem from developing,” says Eleanor M. Green, DVM, DACVIM, DABVP, AAEP president. For information about the AAEP campaign, or to request educational or promotional resources, equine practitioners can visit www.aaep.org.

CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: SLENTROL (dirlotapide) Oral Solution is indicated for the management of obesity in dogs. CONTRAINDICATIONS: SLENTROL should not be used in cats. SLENTROL increases the risk of producing hepatic lipidosis during weight loss in obese cats. SLENTROL is not recommended for use in dogs currently receiving long-term corticosteroid therapy. Do not use in dogs with liver disease. WARNINGS: Not for use in humans. Keep this and all drugs out of reach of children. Adverse reactions associated with humans ingesting dirlotapide include: abdominal distention, abdominal pain, diarrhea, flatulence, headache, increased serum transaminases, nausea, and vomiting. SLENTROL may cause eye-irritation. If accidental eye exposure occurs, flush the eyes immediately with clean water. PRECAUTIONS: Safety in breeding, pregnant, or lactating dogs has not been established. Caution should be taken when considering any weight loss program in growing dogs, including treatment with SLENTROL. SLENTROL has not been evaluated in dogs less than 1 year of age. All dogs should undergo a thorough history and physical examination that includes laboratory tests to screen for underlying conditions. Pre-existing endocrine disease, including hyperadrenalcorticalism (Cushing’s disease), should be managed prior to use of SLENTROL. SLENTROL may produce a mild to moderate elevation in serum hepatic transaminase activity. If the elevation in alanine aminotransferase (ALT) activity is mild, continue SLENTROL and monitor as needed. If there is a marked elevation in ALT activity above the normal reference range or there is a simultaneous increase in aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transferase (GGT), or total bilirubin, discontinue treatment with SLENTROL. Elevations in hepatic transaminase activity usually decrease when SLENTROL is discontinued. The safety of SLENTROL use in dogs has not been evaluated beyond 1 year. ADVERSE REACTIONS: The adverse reactions associated with treatment with SLENTROL include vomiting, loose stools/diarrhea, lethargy, and anorexia. These adverse reactions were mainly observed during the first month of treatment or during the week after a dose increase. Vomiting was usually mild in severity, of short duration, and resolved with continued SLENTROL treatment. The SLENTROL-treated dogs generally had an increased frequency and duration of vomiting and diarrhea compared to the control dogs. The control dogs received corn oil. Adverse Reactions During Weight Loss: Percentage of Patients with Reported Signs Treatment

Control n = 88

SLENTROL n = 170

Vomiting Diarrhea Lethargy Anorexia Constipation Dehydration

21.6% 6.8% 3.4% 2.3% 1.1% 0%

24.7% 12.4% 9.4% 7.6% 2.4% 1.2%

In addition to the adverse reactions listed above, there were other abnormal findings. Many control and SLENTROL-treated dogs had dental disease, abnormal skin and ear findings, and lameness/arthritis. The incidence of these findings were similar in both control and SLENTROL-treated groups and most dogs had similar lesions noted pre-treatment. Two dogs in the SLENTROL treatment group developed corneal ulcers. One SLENTROL-treated and one control dog developed signs consistent with pancreatitis. One treated dog developed inappropriate urination and defecation and another treated dog developed polyuria and polydipsia. A 5-year-old Beagle with no medical history of seizures in the SLENTROL treatment group had a seizure on Day 52 of the study. The dog continued to receive SLENTROL until additional seizures occurred 11 and 12 days later. The investigator referred the case to a neurologist and the seizures continued approximately twice weekly. The neurologist found no lesions that support the causality of the seizures. A 5-year-old Dachshund developed a hepatopathy after 82 days of treatment and was withdrawn from the study for vomiting, increased hepatic enzymes, and anorexia. Vomiting continued for a few days after stopping treatment and the dog was hospitalized due to the anorexia. ALT activity levels continued to rise after all clinical observations resolved. During weight stabilization, vomiting (16.1%) and lethargy (4.8%) were the most frequent adverse reactions associated with treatment with SLENTROL. Other adverse reactions included diarrhea (1.6%), anorexia (1.6%), and ataxia (1.6%). In the post-treatment period, a 6 year old spayed female Chihuahua, was found dead by the owner 7 days after stopping dirlotapide therapy. The cause of death was not conclusive but did not appear to be related to the dirlotapide therapy. Some dogs treated with SLENTROL displayed a mild to moderate elevation in serum hepatic transaminase activity early in treatment that decreased over time while treatment continued. Hepatic transaminases generally returned to normal when treatment was discontinued (See Precautions for further information). Serum Chemistry Results: Percentage of Dogs Control n = 88 Serum Analyte ALT a > 120 IU/L AST b > 60 IU/L ALP c > 125 IU/L Cholesterol > 320 mg/dL

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Post e

Pre d

Post e

6.0% 4.8% 16.9% 9.6%

4.7% 3.5% 17.6% 14.7%

9.9% 9.2% 9.9% 4.6%

To report a suspected adverse reaction call Pfizer Animal Health at 1-800-366-5288. For a copy of the Material Safety Data Sheet (MSDS) for SLENTROL oral solution call 1-800-733-5500. STORAGE INFORMATION: Store in original container at room temperature 15° to 30° C (59° to 86° F). HOW SUPPLIED: SLENTROL is available in 20, 50 and 150 mL bottles containing 5 mg/mL of dirlotapide in solution. U.S. Patent No. 6,720,351 NADA #141-260, Approved by FDA Distributed by: Div. of Pfizer Inc NY, NY 10017

October 2006

Veterinary Technician | MAY 2008

Pre d 3.4% 0% 11.4% 14.8%

a ALT = serum alanine aminotransferase activity, b AST = serum aspartate aminotransferase activity, c ALP = serum alkaline phosphatase activity. Dogs with ALP activity > 325 IU/L were excluded from the study. d Pre = % of dogs with values above the laboratory reference range at pre-treatment. e Post = % of dogs with values above the laboratory reference range after 4 months of treatment.

820 600 000

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SLENTROL n = 170

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Cover Story

Leading the Way A Talk with Rebecca Rose, CVT Liz Donovan Veterinary Learning Systems

How did you begin your career in veterinary technology? I graduated from Colorado Mountain College in Glenwood Springs, Colorado, in 1987 and began working in a mixedanimal practice. However, I let my certification lapse when I started a family. Ten years later, when I returned to private practice, I retook the veterinary technician national 266

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Mike Arzt

OR REBECCA ROSE, CVT, her greatest achievement is Rebecca discusses pet that her two children are involved insurance with a client while Tika, her golden in leadership roles at their schools. retriever mix, stays close to her side. Certainly, in being leaders, they seem to be following in their mother’s footsteps. Rebecca began her career in veterinary medicine as a technician in private practice, left the profession for several years to raise a family, then became administrator of the Colorado Association of Certified Veterinary Technicians (CACVT), a position that opened the door to many opportunities to actively promote the profession. Currently, Rebecca works as a field educator for Veterinary Pet Insurance (VPI) while serving on the CACVT’s ethics committee and presenting lectures on the association’s behalf. She also represents technicians on the Iams Pet Wellness Council and runs a veterinary practice management consulting business from her home in Gunnison, Colorado, a small town of less than 6,000 people. To share the experience she has gained during her diverse career, she wrote a book titled Veterinary Technician Careers, which she hopes to publish next year. Here, Rebecca explains the benefits of networking, belonging to professional associations, and having pet insurance. examination. I tell people that story all the time — I highly recommend that technicians consider retaking the exam if they’ve been out of the profession for a long time.

You have held several positions within the CACVT. How did you first become involved with the association? In 1999, the CACVT’s executive members www.VetTechJournal.com

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Love brings people and pets together. Our recovery system helps them stay that way. Here at AKC Companion Animal Recovery (AKC CAR), we’ve made it our mission to recover as many missing pets as possible. By keeping our ID System microchips affordable, we increase the number of animals who can be found if lost. And we offer prepaid enrollment in our 24/7 recovery service with no annual fees or added charges. But our commitment to animal welfare doesn’t end there: a not-for-proﬁt organization, AKC CAR funds veterinary student scholarships, canine search and rescue grants and disaster relief efforts. To see how AKC CAR is making the world a better place for the animals we share it with, call us toll-free at 1-800-252-7894 or visit www.akccar.org/microchip.

Circle 155 on Reader Service Card

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Cover Story

What book are you currently reading? I often read several books at once, and I usually read nonfiction. Right now, I am reading The Seven Habits of Highly Effective People and Feelings Buried Alive Never Die. What is your favorite ice cream? Baskin-Robbins Pralines ’n Cream in a chocolate-coated waffle cone. What was your first job? When I was 13, I worked as a busgirl at a café in Gunnison. What’s your favorite refuge? Our house, which is on a mountain. I love sitting next to the fire pit that overlooks the valley and watching the sunset. That’s heaven! What is your favorite thing about yourself? My ability to adapt.

wanted to hire a part-time administrator to manage the association, and the Colorado Veterinary Medical Association (CVMA) planned to hire a part-time administrative assistant, so the two associations decided to combine the positions. I applied and was offered the job, which meant that I had to relocate to Denver. I was recently divorced, and my children were living with their father, so when I told my mother that I was considering moving to Denver by myself, I wasn’t sure if she would be supportive. But she said, “Rebecca, I think it’s a great move. I will bring the kids to stay with you on weekends, and I’ll help in any way I can.” After I had worked as administrator for a year, I was elected as president of the CACVT. I now serve as CACVT historian, and I communicate with the executive director, Denise Mikita, CVT, two to three times a week to give her input into projects she is currently working on. I also serve on the CACVT ethics committee. My involvement with the CACVT has taught me a great deal and created a wealth of opportunities that would not have existed had I not decided to serve as administrator. Accepting that position was the best decision I have ever made.

Mike Arzt

Off the Cuff

Rebecca and Tika check out the future site of Gunnison County’s first animal shelter.

Why should technicians join a professional association like the CACVT? As a member of an association, you have an opportunity to interact with colleagues who can serve as resources when you have questions about how to further your career. The networking opportunities are endless. Networking is an invaluable skill, and by becoming active in their state technician association, technicians will learn how to network and will be encouraged to grow professionally. To network effectively, I recommend that technicians step outside their comfort zone. For example, at an association event or continuing education class, a technician should sit with a group of people he or she doesn’t know and initiate a conversation. Technicians will likely find that their peers share their concerns and can offer valuable advice.

V I TA L S TAT I S T I C S R E B E C C A R O S E Award CVMA Veterinary Technician of the Year (2002)

Education

How can technicians benefit most from association membership?

AAS in veterinary technology, Colorado Mountain College, Glenwood Springs, CO (1987)

Pet Tika, a 5½-year-old golden retriever mix

Professional Associations CACVT (ethics committee chair, historian, past president, past CE committee chair, past administrator), CVMA (member), Gunnison County Animal Response Team (member), Gunnison Valley Animal Welfare League (member), NAVTA (past corresponding secretary), Veterinary Hospital Managers Association (member) Rebecca has two children, Zebulon, 19, and Tiana, 17. “Both of my children are active leaders among their peers,” says Rebecca. “I am very proud of their independence, open-mindedness, and calculated risk-taking. I cherish all of our time together.” Rebecca and her fiancé, Bob Weiss, plan to be married in June.

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Mike Arzt

Family

As a technician, if you are just paying your association membership dues and not actively participating, you are not reaping all the rewards that membership has to offer. An article published in the CACVT newsletter, called “Be Selfish, Volunteer,” discussed the irony of volunteering — the more you give, the more you receive. By serving a variety of roles in the association — from committee member to committee chair to secretary to president — you build a support system of veterinarians, technicians, and managers. Current or former members of the CACVT’s executive board would probably say that serving an active role in the association has had a profound impact on their career. www.VetTechJournal.com

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When I attended a leadership class for the CVMA, Jim Wilson, DVM, JD, who is one of the founding shareholders of VPI, gave a lecture on pet insurance. I spoke with Dr. Wilson after the lecture and mentioned that I was a technician and was very interested in learning about the benefits of pet insurance and how these plans benefit veterinary hospitals. He said that VPI was planning to hire a few technicians to serve as field educators, so I asked Dr. Wilson to have VPI contact me. Within a month, I was hired as a field educator.

What does your position as a VPI field educator entail? I communicate with staff at veterinary hospitals that are interested in learning more about VPI. I usually work from home, but the VPI office is located in Brea, California, so it’s really amazing that I can be in a little Colorado mountain town and integrate what I do into a huge office in California. A hospital manager can request a Webinar, which I’ll conduct from my computer. During the Webinar, I explain how pet insurance benefits the owner, the pet, and the veterinary hospital where the policyholder’s pet is receiving treatment. Unlike human health insurance companies, pet health insurance companies do not dictate how the veterinarian treats the patient. Any decision regarding treatment is made by the veterinarian and the pet owner.

How does pet insurance benefit the patient and owner? An owner with pet insurance is willing to spend more money on the animal’s treatment before making the decision to euthanize. VPI data show that insured pets visit a veterinary hospital three times more frequently than uninsured pets, increasing the opportunity to offer preventive care. VPI has been promoting annual wellness care and rewarding pet owners who take advantage of insurance reimbursements for annual care, like dental prophylaxes, vaccination titers, and heartworm prevention and testing. This is a great thing, because we all know that wellness care is imperative to a pet’s health. Proactive health care is a must for both humans www.VetTechJournal.com

and animals. I think we tend to be more reactive as a population in the United States, but preventive health care leads to a better quality of life.

You promote pet wellness as a member of the Iams Pet Wellness Council. Can you tell me about the council? The Iams Pet Wellness Council is a new initiative to promote pet wellness, and I am honored to be the only veterinary technician on the council. I work with several veterinarians to advise the IAMS Company about the importance of the relationship between nutrition and wellness.

How can technicians promote wellness care? Technicians play a very important client services role, so they are in an ideal position to promote wellness care. I recommend that technicians educate owners on the importance of PERSONAL INTEREST

A “Furry” Good Cause

lthough Rebecca’s many career responsibilities keep her busy, she still makes time to improve the welfare of stray and shelter animals. Rebecca is actively involved in the Gunnison Valley Animal Welfare League (GVAWL), a nonprofit animal-rescue organization that is planning to build Gunnison County’s first animal shelter. Last December, Rebecca traveled to Denver and met with managers at the city’s various animal shelters. She took tours of the shelters and photographed the interiors, including the kennels and surgical suites. She then gave a presentation to the GVAWL as well as the sheriff’s department and the city neighborhood services department. Rebecca has found some creative ways to raise funds for the shelter project. In January, at the Fur Ball — a fundraising event for the GVAWL — Rebecca took the stage as a member of the “Hairballs.”The Hairballs dress in discoinspired animal costumes and dance and lip-synch to animal-oriented songs, including “Who Let the Dogs Out?” and “Stray Cat Strut.” The Fur Ball event raised over $10,000. As of February 2008, the GVAWL had raised $138,066. The GVAWL hopes to begin building the shelter as soon as possible, but the organization will need to raise another $100,000 by July 2008 through grants, matching funds with the county and city, and generous donations. More information on the GVAWL, (left to right) Jane Tunendine; Rebecca Rose, CVT; Lara including how to submit donations, can Van Renselaar; DemaLou Coghill; Mike Callihan; and Phil be found at www.gvawl.org. Virdin perform as the Hairballs to benefit the GVAWL. Veterinary Technician | MAY 2008 269

Courtesy of Jan Badgley

How did the leadership and networking skills you developed lead to your position as a field educator for VPI?

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Introducing resQ from Bayer Animal Health ®

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wellness care at the first puppy/kitten visit and ensure that the owner has received information on topics such as behavior problems, microchipping, spaying and neutering, and pet health insurance.

As client educators, technicians can offer insight into clinic policies and procedures. How have you used your experiences to counsel technicians? In 2001, while I was working as a practice manager for a veterinary clinic, I helped to create an employee handbook, which is a vital tool for all veterinary hospitals. This inspired me to start my own consulting company, Red Valley Rose Consulting (www.rebeccarosecvt.com), to help veterinary practices create policy manuals for their employees. I meet with the clinic’s practice manager and other key employees and help them develop a customized policy manual. Having a policy manual is essential to ensuring that the practice runs smoothly and that the business policies are clearly defined. I have prepared articles for the CACVT newsletter on why a policy manual is important and how to put one together. In fact, that was one of the first topics that I lectured on.

What do you enjoy most about lecturing, and what other topics do you feel passionate about? I love to educate and to engage technicians and answer their questions. I have traveled across the United States talking about technician utilization, how technicians can become credentialed, and how the veterinary team can work most efficiently within the veterinary hospital. I also lecture frequently on behalf of the CACVT and VPI. Right now, I’m really passionate about educating technicians on the many different career options available to them. I’ve even written a book on this subject that I hope to have published next year.

What inspired you to write this book? In 2001, I worked with Carin Smith, DVM, to adapt her book — formerly called The Relief Veterinarian’s Manual — for technicians. Dr. Smith had also written a book on career choices for veterinarians, so at a conference in 2006, I met with her and discussed adapting that book for technicians. I’ve been in the veterinary technology profession for a long time, and I really love it. So I wanted to encourage technicians to find the career that best suits them. I started conducting research for the book last fall. Because I’ve worked in so many different careers in the field, I was able to include examples taken from colleagues and my own experiences. I am an advocate of veterinary technicians and the health care team, and I feel that when they know their jobs and they’re passionate about what they do, everybody succeeds.

What are your predictions regarding the future of the profession?

iMAX Blacck Label readerr

I think it’s going to skyrocket. I believe that the US Department of Labor’s projected growth of 41% by 2016 is accurate and that specialization will only increase the opportunities available. Because technicians can now become certified as practice managers, they are able to remove the practice management burden from the veterinarian. And more veterinarians are becoming specialized, so the skills of specialized technicians are in greater demand than ever before. Technicians have a unique set of skills that are vital to veterinary medicine, and if they promote themselves as professionals, the sky is the limit. 270

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www.VetTechJournal.com

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So I saw a

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and I ran towards it, breaking my

Just then, out of nowhere, I smelled a

four blocks away

and I booked it. By the time I took a break to use the I was lost. Fortunately, my vet recommended database made it easy to reunite with my even though I’m in the

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Proposal for an

Emergency Receiving and Triage System

Adapted from Human Medicine

Andrea Battaglia, LVT IKE HUMAN HOSPITALS, veterinary emergency hospitals Cornell University can be fast-paced, high-energy environments where the emer- Ithaca, New York gency staff must act quickly to assess patients and ensure that they receive the proper care within an appropriate time frame. Implementing an effective triage system takes a great deal of research and planning. In addition, all staff members must be thoroughly trained on how to use the system and must understand the importance of maintaining the system once it is established. Since so much of what is used in veterinary medicine, including medical techniques, equipment, and drugs, has been adapted from human medicine, it only makes sense that triage systems used in human medicine can be adapted and used effectively in veterinary settings.

Learning from Human Medicine One critical element of any emergency service is triage. The word triage is derived from the French verb trier, which means “to sort” or “to choose.”1 This term was initially used during times of war when massive numbers of wounded soldiers had to be quickly evaluated and sorted based on the severity of their injuries.1 Triage systems started being implemented in the United States during the 1960s, 1970s, and 1980s as physicians started working in group practices and began moving away from private practice and house call services.1 Because of these changes, hospitals began to see a dramatic increase in the number of patients coming into the emergency room, especially during evening hours and weekends.1 As a result, hospitals had to implement systems to more effectively triage the increased number of patients. In 1998, emergency physicians Richard Wuerz, MD, and David Eitel, MD, MBA, developed a five-level triage system, known as 272

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the Emergency Severity Index (ESI). The ESI uses numeric codes (level one to level five) to classify patients. The numeric codes correspond with the following categories: resuscitation, emergent care, urgent care, nonurgent care, and convenient care. Since this system was devised, it has continued to gain popularity in human emergency care.1 In 2003, the National Center for Health Statistics reported that about half the human emergency departments in the United States had implemented a three-level triage system (i.e., emergent, urgent, and nonurgent care), whereas the other half had implemented four- or fivelevel systems. The author’s experience includes working in a veterinary emergency hospital that used a three-level triage system. The hospital treated up to 60 cases/weekend. The author proposes a method of adapting the ESI system so that it could be used in a veterinary emergency hospital; however, it is unknown whether this system has ever been implemented in a www.VetTechJournal.com

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veterinary setting. In addition to describing the functions of veterinary technicians using an adapted ESI triage system, this article describes an approach to organizing this type of service and identifying how to properly classify animal patients based on the severity of their condition.

Defining the Emergency Service Before an emergency triage system can be implemented, the emergency clinic must establish what types of services it will offer on the basis of support staff skills and availability, equipment, diagnostic capabilities, and the surgical expertise of the veterinarians.a The emergency service must also consider the following: Will the hospital focus on certain species or provide at least immediate supportive care to all animals? Will it provide pets with routine health care (e.g., vaccinations, nail trims) during an emergency visit, or will it send clients to primary care veterinarians to support and maintain referral veterinarian relationships? Will it provide convenience euthanasia?

Categorizing Patients Based on the Emergency Severity Index With the ESI triage system, human patients are classified into one of five levels based on the severity of their condition. The following outlines how animal patients could be classified into the five levels. With veterinary patients, however, the owner’s emotional state and ability to handle the situation also must be factored into determining the pet’s acuity level.

Level One — Resuscitation The level-one or resuscitation category includes pets that arrive comatose or in respiratory and/or cardiac arrest. Immediate stabilization efforts are required. Updating the owner of the pet’s status within 5 minutes of resuscitation efforts is recommended. The owner must sign an emergency consent form, but lifesaving efforts often begin with the owner’s verbal authorization. a

The Veterinary Emergency and Critical Care Society offers guidelines that are intended to provide minimum standards for emergency and critical care facilities. For more information, visit veccs.org/guidelines.php.

www.VetTechJournal.com

Level Two — Emergent Care Pets that fall into level-two or emergent care status may have cardiovascular compromise, be in respiratory distress, have hypoglycemia, or be in a postictal state or seizuring. Most patients with trauma, toxicosis, or gastric dilatation–volvulus also fall into this category. Rapidly conducting an assessment and quickly obtaining a history are essential. The goal is to start treating this pet within 2 to 5 minutes. Longer waiting times may decrease the pet’s chance of survival. An emergency consent form must be signed by the owner before treatment is initiated. The emergency consent form should include an estimate of the cost of initial lifesaving therapies and an explanation stating that the estimate covers only the first 15 to 30 minutes of diagnostic and therapeutic care. Updating the owner about the pet’s status within 5 minutes of stabilization efforts is advised.

Level Three — Urgent Care Level-three or urgent care status indicates that the pet is in obvious mild discomfort and shows clinical signs that concern the owner. The patient’s temperature and pulse and respiration (TPR) rates or pain scale assessment (PSA) may or may not be within normal limits, but any abnormalities are not life threatening. Patients with small open wounds, inflammation of the skin of the ear, lameness, injury to a foot or footpad, and mild gastrointestinal disorders fall into this category. It is very important to identify the reason for the injury when obtaining a history because this will help determine the acuity level assignment. Any abnormalities related to trauma may quickly warrant reclassifying the patient at a higher level. The goal should be to treat a pet in this category in less than 2 hours. A longer waiting time could create undue stress for the owner and may cause the pet’s condition to worsen. The staff should maintain contact with the owner while he or she is waiting and provide updates on the pet’s condition. Periodic assessment of the pet’s condition is recommended.

Level Four — Nonurgent Care The level-four or nonurgent care situation is not life threatening, but the owner is anxious about a slight change in the pet’s behavior, appetite, or clinical signs related to a

Free download! Download a copy of the Emergency Receiving Questionnaire at www.VetTechJournal.com.

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chronic condition. The pet exhibits no obvious signs of stress or discomfort, appears normal during the initial assessment (which includes TPR and PSA), may have experienced a change in its environment (e.g., a move or a new pet or baby in the household), or recently underwent a procedure or surgery. Patients in this category may have internal or external parasites, dermatitis, or food allergies. The goal should be to treat this pet within 2 hours if possible, but longer waiting times most likely will not endanger the pet’s life. It is important that the staff maintain contact with the owner while he or she is waiting and provide updates on the pet’s condition as necessary.

Level Five — Convenient Care

Implementing an

effective triage system

takes a great deal of research and planning.

Patients classified as level-five or convenient care status often present during off-hours or weekends because an owner’s personal or work schedule does not allow him or her the time to establish a relationship with a primary care veterinarian. Often, these pets present without clinical signs. The owner may state that he or she is concerned about the possibility of ectoparasites or intestinal parasites, a small tumor, a chronic condition, or mild dermatitis. In some cases, a media-generated concern, such as a product recall, is cited as the reason for the visit. Sometimes, euthanasia falls into this category of care; therefore, the emergency hospital should decide whether it will provide convenience euthanasia as part of its services. In most cases, an owner with a patient in this category could be referred to a primary care veterinarian for care during regular business hours without compromising the pet’s health, especially if the emergency service is busy. These patients often can be triaged without undergoing a TPR evaluation and PSA. Taking a history usually includes the owner relating details of events not relevant to the original reason for presentation. In addition, owners may request to have their pet vaccinated while the patient is being examined. The emergency clinic should decide whether it will provide this type of service.

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pital has determined that it will modify the ESI or a similar system to receive and classify animal patients, all staff members must be trained on use of the system before it can be implemented. They must become familiar with the codes that are used and must understand the value and importance of maintaining the system once it has been implemented. The veterinary technicians who are working in an emergency environment can fulfill many roles during one shift, depending on caseload, support staff coverage, and ability. Each team member should have specific assigned responsibilities and understand that those assignments may change at any time. Having assigned responsibilities will encourage cooperation among all support staff members (including reception staff) and veterinarians. Constant communication, including updated information, about incoming and hospitalized patients is important for all emergency service staff. The emergency room supervisor or other designated manager should determine the specific roles of every technician, so this decision will vary by hospital. The assignments should be made based on the skills of the individual technician.

Emergency Triage Technician The emergency triage technician (ETT) should have more than 2 years of experience interacting with clients and treating critically ill or injured pets. This position requires a technician with high-level skills. This technician’s primary responsibility is to quickly assess (within 2 to 5 minutes, including taking a history) and assign a severity level to the patient. The ETT is responsible for notifying the veterinarians about which patients can safely wait for care and which ones must be treated immediately; therefore, the ETT must have excellent communication skills. In addition, the ETT must rapidly evaluate a volatile situation and determine whether it can be diffused or whether outside support services (e.g., law enforcement) are required.

Emergency Receiving Technician The emergency receiving technician (ERT) should have excellent technical and communication skills and be able to quickly initiate resuscitation efforts on critically ill or injured pets. The primary duty of the ERT is to assess the diagnostic and initial therapeutic needs www.VetTechJournal.com

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of outpatient and hospitalized pets, but the ERT may also assess an incoming emergency patient when the ETT is unavailable. This assessment includes placing intravenous catheters, setting up and starting intravenous fluid and drug therapies recommended by the veterinarian, and obtaining radiographs and blood samples for analysis. In addition, the ERT may assist the emergency treatment technician (ETXT) when time permits.

Emergency Treatment Technician As the primary caregiver of hospitalized patients, ETXTs should have excellent observation and communication skills and be able to quickly interpret findings on critically ill or injured pets. The ETXT’s principal duty is timely and efficient completion of treatments of in-house patients that are requested by the veterinarian. The ETXT also provides updates for owners when the veterinarian is unavailable and arranges and supervises owner visitations. The ETXT assists in receiving incoming patients when necessary but does not act as an ETT.

Factors to Consider When Implementing This Type of Triage System Communicating with the Owner by Phone Often, the initial contact with an owner experiencing an emergency with a pet is by phone. The hospital must decide if a veterinary technician or a receptionist will respond to these calls. Ideally, the individual handling these calls should be highly trained and knowledgeable about emergency medicine. The veterinary professional answering these calls must quickly obtain the following information: owner’s name, contact phone number, species and breed of pet, and primary concern. Providing the owner with advice over the phone about how to treat the pet is usually not recommended, even if the owner is persistent. The assessment of the pet’s condition would be based on an owner’s perception, not a trained veterinary technician’s or veterinarian’s observations; therefore, the advice could exacerbate the situation. Some obvious events may warrant giving advice. For example, if the owner calls and says that the pet has been locked in a car for several hours in the heat and is now having seizures, the veterinary professional can recommend cooling the pet by spraying cool (not cold) water on

the pet and setting the air conditioner on the highest setting while en route to the hospital. The veterinary professional who is answering the call should explain to the owner the best way to handle an injured pet to prevent the individual from being injured (e.g., using a sock for a muzzle) and to prevent further injury to the animal (e.g., placing the pet on a blanket during transport). It is important to supply information about the cost of the emergency visit and to explain what additional cost would apply if treatment is necessary. Any other information regarding the hospital’s payment policies, including the need for payment at the time service is rendered, should be provided at this time. It is important to document every call. In addition, all the information given by phone should be documented and consistent with hospital protocols and policies. Sometimes, an owner may be in contact with the hospital while en route and may be very distraught. An attempt to obtain the owner’s phone number and estimated time of arrival — but not detailed information — should be made. Additional details can be obtained when the owner arrives at the facility. The owner should be reassured that the team will be ready to assist the pet on arrival, and the owner should be reminded to drive carefully.

Emergency Technician Supplies Clean scrubs in case a change is needed Examination gloves Hemostats Roll of 1-inch tape Pen and highlighter Penlight Scissors Stethoscope Watch with a second hand

Organizing Patient Charts on the Basis of Severity The pet’s record, including the Emergency Receiving Questionnaire (see form on page 276), should be placed in an area designated for incoming charts in the order of the severity of the emergency. Bins for patient charts can be hung on a wall near the treatment area; this area should not be accessible to the public. The bins should be labeled with the ESI codes or a numeric system identifying which patient should be examined next. This system allows the veterinarian to prioritize duties quickly. The ETT should direct any questions about the pet’s status or history to the veterinarian immediately before leaving to receive other owners with pets.

Receiving Level-One and Level-Two Patients When an owner arrives with a pet that requires resuscitation or is in an emergent care status, the pet should be taken to the treatment area and the owner should immediately (text continues on page 278)

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EMERGENCY RECEIVING QUESTIONNAIRE Provided by

Date: ______________ Arrival time: ____________ Time received: ___________ ETT initials: _____________ Time examined by veterinarian: ____________________ Veterinarian’s initials: ______ Owner’s name:__________________________________ Pet’s name: _____________________________________ Species: ❏ Canine ❏ Feline ❏ Other: _________________ Breed: ______________________________________ Age: ________ Sex: ❏ Male ❏ Female ❏ Neutered/spayed

Reason for Emergency Visit Presenting complaint: ___________________________________________________________________________ Duration of illness or condition: ___________________________________________________________________

Patient History 1. How is the pet’s appetite? ❏ Normal ❏ Decreased ❏ Not eating Type of diet being fed: __________________ 2. Is the pet vomiting? ❏ No ❏ Yes If yes, describe appearance and frequency: ____________________________ 3. Does the pet have diarrhea? ❏ No ❏ Yes If yes, describe appearance and frequency: ______________________ 4. Is the pet urinating? ❏ No ❏ Yes If yes, describe: ❏ Normal ❏ Blood in urine ❏ Slow, painful urination 5. How is the pet housed? ❏ Indoors ❏ Outdoors ❏ Roams freely ❏ Always fenced in or leashed 6. List any medications currently being taken and why: _________________________________________________ ___________________________________________________________________________________________ 7. Was any over-the-counter medication given? ❏ Tylenol ❏ Aspirin ❏ Other: ___________________________ 8. Was the pet exposed to a toxin? ❏ No ❏ Yes If yes, describe: ________________________________________ 9. Have any changes in the pet’s environment occurred? ❏ No ❏ Yes If yes, describe: _______________________ 10. Other changes: ______________________________________________________________________________

Initial Assessment 1. Respiratory rate/ventilatory nature: ________ ❏ Eupneic (normal) ❏ Tachypnea (rapid breathing) ❏ Increased effort ❏ Dyspneic (out of breath) 2. Lung sounds: ❏ Clear ❏ Harsh ❏ Crackles ❏ Absent 3. Heart rate/pulse rate: ____ /____ Pulse quality: ❏ Normal ❏ Bounding ❏ Poor ❏ Weak ❏ Unable to palpate 4. Capillary refill time: ________ 5. Mucous membrane color: ❏ Pink ❏ Brick red ❏ Pale pink ❏ White ❏ Icteric (jaundiced) 6. Temperature (rectal/aural): _______ 7. Pain scale rating (1 = comfortable; 5 = painful): 1 2 3 4 5 8. Ambulatory: ❏ Yes ❏ No Lameness noted: _________ Other: _______________________________________ ____________________________________________________________________________________________ 9. Level of consciousness: ❏ BAR (bright, alert, reactive) ❏ QAR (quiet, alert, reactive) ❏ Lethargic 10. Behavior code: ❏ Red (caution) ❏ Yellow (normal behavior) ❏ Blue (very sweet disposition) Emergency Severity Index 1 Time assessment completed: _________

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(text continued from page 275)

We want to hear from you! If your emergency hospital currently triages patients using a similar four- or five-level system, please contact us at editor@VetTechJournal.com and let us know how successful the system is.

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be escorted into an area where the release form can be explained. As mentioned previously, the release form should include information about costs that may be incurred during the first 15 to 30 minutes. After the owner signs the form, resuscitation and/or other lifesaving therapies should begin. The hospital should develop a policy about whether an owner can remain with a pet during the initial resuscitation effort. Support staff commonly view owners as potential liabilities during resuscitation. However, allowing owners to be present may provide them with the necessary exposure to the process and help create an immediate trusting relationship with the staff. The owner’s presence may also avoid placing additional stress on a pet because it is not separated from its owner. If owners are allowed to be present during resuscitation, they must have a safe place to sit and be given an explanation of what will occur. Initial stabilization efforts should begin within 5 minutes of the pet’s arrival. Oxygen therapy should be administered via the flowby technique, or the pet should be intubated if it is in respiratory arrest. In addition, an intravenous catheter should be placed for the initial resuscitation. Fluid therapy and pain management also should be provided immediately after a decision is made about what treatment is required for the pet. If obtaining intravenous access is difficult, cutdown procedures should be implemented. Owners who are not present during resuscitation should be updated within 5 minutes by the ETT. An example of an owner update is as follows: “Mr. Jones, my name is ___________, and I am the emergency triage technician. The doctor is now assessing Fluffy’s condition. We have already placed an intravenous catheter into her vein that will allow us to provide her with the necessary supportive therapies. We have also given her medication to take away her pain. The doctor will speak to you about Fluffy as soon as possible. Do you have any questions? Can I offer you anything to drink? May I ask you a few questions at this time, if you are ready?” At this point, the ETT should obtain the patient’s history. Deviation from the Emergency Receiving Questionnaire is necessary

MAY 2008 | Veterinary Technician

when a pet arrives with an ESI level of one or two. If trauma is the cause of the visit, the time of occurrence and how the trauma occurred must be determined immediately. Other information that must be obtained immediately includes the presence of preexisting conditions, potential exposure to a toxin, length of illness, and current medications.

Receiving Level-Three to Level-Five Patients The initial greeting often takes place in the waiting area. The ETT should introduce him- or herself and quickly assess whether the pet needs assistance to be transported into the examination room and whether immediate stabilization is required. This process also gives the ETT an opportunity to evaluate other patients and owners in the waiting room. After the assessment, the ETT should escort the owner and pet into an examination room. Ideally, the patient’s history should be obtained in a private room to provide the owner with a comfortable environment where all questions can be answered honestly. If a private room is unavailable, an attempt should be made to isolate the owner and pet from other visitors in the waiting room. The technician should ask the owner the questions that are listed on the Emergency Receiving Questionnaire. This questionnaire should provide the ETT with a specific format to follow when performing an intake assessment. The ETT should assess the patient’s heart and pulse rates, pulse quality, respiratory rate, ventilatory nature, temperature, and mucous membrane color; in addition, the presence of lung sounds and the ESI code should be noted. The ETT should then explain the next steps, as determined by hospital protocol, to the owner. The explanation may be as follows: “Mr. Jones, Fluffy does not need immediate stabilization at this time. Dr. Smith will be in shortly to thoroughly assess Fluffy’s condition and discuss with you what Fluffy will need. You will have the opportunity to decide what you want us to do after we present all the information. I will return to reevaluate Fluffy and update you if the wait is more than 10 minutes. If you notice anything that changes or concerns www.VetTechJournal.com

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you about Fluffy’s condition, do not hesitate to tell the staff at the front desk immediately.” ABOUT THE AUTHOR

Andrea Battaglia, LVT Andrea is a section supervisor at the Cornell University Hospital for Animals in Ithaca, New York. She is also the author of the book Small Animal Emergency and Critical Care for Veterinary Technicians (2007). Andrea has three daughters — Audrey, Hannah, and Rhiana — as well as six dogs, six cats, a cow, and a mouse.

Conclusion Like human hospitals, veterinary emergency hospitals must establish an effective triage system to ensure that all patients receive proper care within an appropriate time frame. Although many aspects of veterinary medicine have been adapted from human medicine, it is unknown whether the ESI triage system has ever been adapted for use in a veterinary emergency hospital. Although the article presents a reasonable method of adapting this system to a veterinary emergency hospital, there are still numerous questions that must be answered: Can this system be effective in hospitals

Commentary Sally Powell, CVT, VTS (ECC) University of Pennsylvania The emergency receiving and triaging proposal is very interesting. Providing an estimate for stabilizing the pet and then having the client sign a consent form as soon as he or she arrives would allow the emergency staff to determine how committed the client is to treating the pet. This is definitely a benefit. I do, however, foresee some drawbacks to this process. The person who is explaining the charges may be put in a difficult position. Clients often have many questions regarding the severity of their pet’s injuries, and they do not have a clear idea of their pet’s prognosis. Furthermore, many clients are so distraught when they arrive that it is impossible for them to make rational decisions immediately. Having the client sign the form before the patient is stabilized might cause the client to make a rash decision. In order for the emergency staff to give the owner a realistic idea of the extent of the pet’s condition, the staff must first stabilize the patient and then perform a thorough physical examination. At the university hospital where I work, we have a different viewpoint on stabilization. We use initial stabilization as a teaching tool; therefore, in settings similar to ours, this part of the system would probably not be applicable. The article outlines how to quickly assess patients and then classify them into the different categories based on the severity of their condition. The author gives examples of possible patient presentations that would fall into each category. For level-two patients (emergent care status), I 280

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that treat an extremely high volume of emergency cases? What is the optimum number of patients that can be treated effectively using this type of triage system? Can patients be categorized quickly? Are there any drawbacks to modifying this system for veterinary hospitals? In order to determine if the human ESI system can be adapted and used to effectively triage animal patients, more research is necessary.

Reference 1. Gilboy N, Tanabe P, Travers DA, et al: Emergency Severity Index, Version 4: Implementation Handbook. AHRQ Publication No. 05-0046-2, May 2005. Agency for Healthcare Research and Quality, Rockville, MD. Accessed April 2008 at www.ahrq.gov/research/esi/esi1.htm.

would add the following presentations to this group: patients with altered mentation caused by increased intracranial pressure (not necessarily trauma), patients with massive hemolytic anemia (these patients are often cardiovascularly stable), and patients with acute glaucoma. Practices that implement this triage protocol would have to be large emergency facilities with many employees. Smaller practices would not be able to have three technicians dedicated to different assignments. If a smaller emergency hospital decides to implement this system, some of the technician responsibilities described may have to be combined. Also, I strongly advocate that all technical personnel be trained to perform all of the different assignments so that they can be rotated as needed. In addition, many supervisors or managers may not want to hire a trained technician for a triage receptionist position. One reason is that this individual will most likely require a higher salary, and the second reason is that the technician may feel that his or her skills are being underutilized. I think that receptionists who do not have a medical background can be effective as long as they are given extensive training and can rely on the veterinarians and technicians to answer any questions that they may have. Overall, the proposal was very thought-provoking, and the ideas described would probably be applicable to at least half of the practices that receive emergency veterinary patients. The practices that could not incorporate all of the proposed ideas might be able to incorporate some of them into their emergency facilities.

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CE Article #1

Fleas

Sandra Rhodes, RAHT Nanton Veterinary Clinic Nanton, Alberta, Canada

ORE THAN 2,000 SPECIES of fleas are recognized worldwide, including Ctenocephalides felis (the cat flea) and Ctenocephalides canis (the dog flea).1 In North America, the most common ectoparasite of dogs and cats is C. felis.1,2 Cat fleas are not host specific; they have been found to infest more than 50 different avian and mammalian hosts throughout the world, including cats, dogs, raccoons, and opossums.1,3 Infestation can result in skin trauma because of scratching by the pet. In addition, the pet may develop flea allergy dermatitis (FAD) — a skin condition caused by hypersensitivity to flea saliva.4–6 Fleas can also serve as vectors for Rickettsia typhi, Bartonella hensalae, and Mycoplasma haemofelis and as hosts for Dipylidium caninum.2,7 Because fleas are not always visible on a pet, infestation may not be apparent to the owner, especially if the pet is not scratching itself excessively or exhibiting skin conditions such as FAD. Technicians should understand the flea life cycle, recognize the clinical signs of infestation, and educate owners about treatment options and preventatives.

Characteristics and Life Cycle The flea is a wingless insect with a hard exoskeleton, a laterally flattened body, and a prominently enlarged third pair of legs that allow it to jump between hosts.4,5 Adult fleas are about 1/8 inch (3.2 mm) long and are medium-brown to black in color. Flea eggs, which are white, smooth, and oval, are slightly larger than 1/64 inch (0.5 mm) in size.1,4 Flea larvae are only 3/16 inch (4.7 mm) long and resemble worms.4 They have short, hair-like bristles and a brownish head. Flea eggs, larvae, and pupae can be found off the host3 — on surfaces such as bedding, carpet, or grass; however, fleas in the adult stage 282

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Gerald McCormack/Cook Islands Natural Heritage Trust

Educating Clients About

©CINHP / G. McCormack

In North America, the cat flea (Ctenocephalides felis) feeds on both dogs and cats. Adult fleas are only about 1/8 inch (3.2 mm) long.

spend most of their life on the host.4 Adult fleas require a host for a blood meal. They pierce the skin of the host with their mouthparts and suck the host’s blood. They are nonspecific in host selection. Although cat fleas prefer dogs or cats as hosts, they will move to a different host species, such as humans, if the preferred host is unavailable.5 On the host, female fleas feed and mate, laying up to 50 eggs/day.8,9 Once the eggs are laid, they fall off the host and land on surfaces such as carpet or bedding. The eggs will hatch in 2 days under optimum conditions (room temperature),4 producing larvae, which feed on the feces of adult fleas, on skin cells, and on organic matter in the environment. Larvae avoid direct light and burrow into carpet, bedding, cracks in the floor, grass, or decaying organic matter. They are susceptible to heat and desiccation.1 A relative humidity of at least 50% is required for successful development of larvae; exposure to a relative humidity below 50% is lethal at this stage.6 The duration of the larval stage varies according to temperature and environment (i.e., location and time of year) but is approximately 2 weeks, after which the larvae spin a cocoon and pupate.4,5 Pupae develop into adult fleas, but at cool temperatures, they can remain dormant in the cocoon for up to 12 months.4 Warm temperatures, body heat, or activities such as walking or vacuuming will stimulate them to emerge. The adult fleas will seek a suitable host and begin feeding as soon as one becomes available. Flea populations increase during spring and summer but are found year-round in North www.VetTechJournal.com

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America. Environmental temperatures less than 37.4°F (3°C) for several days will kill all stages of fleas.1,6 Adult fleas survive winter in northern temperate climates by living on hosts, including wild or domestic mammals. Eggs laid on the nesting site of a host will survive and develop into adults if the site is protected from the cold. Pets housed indoors offer the ideal breeding ground for flea survival during colder months.

pruritus, leading to excessive scratching and alopecia.4,6 Clinical signs associated with FAD may vary depending on factors such as presence of concurrent skin disease or degree of hypersensitivity. FAD should be differentiated from other dermatologic conditions, such as atopy, food allergy dermatitis, or mange.1 If FAD is diagnosed, it should be treated concurrently with the flea infestation because additional flea bites will prevent the skin from healing.

Clinical Signs Associated with Fleas Except for scratching, animals without FAD may exhibit few clinical signs of flea infestation, although severely infested hosts — particularly young animals — can develop anemia.6 Examination of the pet’s ventral abdomen and inner leg regions may reveal adult fleas moving or jumping along the skin surface, as well as the presence of flea dirt (i.e., feces), which resembles sprinkled pepper.6 When specks of flea feces are placed on a wet paper towel, they dissolve and turn red.2 Animals with FAD often suffer from intense

Treatment of Flea Infestation Pets that are infested with fleas may be treated with veterinarian-prescribed products that are administered topically, orally, or by injection.4 When a flea control regimen is recommended, technicians should determine whether clients are using any over-the-counter flea products and whether any of these products have been effective. Technicians should review administration instructions with the owner and instruct the owner to carefully read the label before administering the product,

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CE Article #1 Educating Clients About Fleas noting any cautions or contraindications. It is important to remind clients that many products that are formulated to treat fleas on dogs should never be used on cats or other species. Also, many products are administered according to the pet’s weight; therefore, it is important to weigh pets routinely. The products prescribed may contain insect growth regulators (IGRs), insect development inhibitors (IDIs), or insecticides.4 IGRs interrupt larval development by mimicking the juvenile growth hormone produced by fleas.10 IGRs are available as topical treatments applied directly to the pet’s coat every month.4 Generally, the topical formulations can withstand bathing; however, the owner should check the product label for specific instructions.4 IDIs prevent larvae from hatching from the egg.4,10 For example, the IDI lufenuron can be administered monthly to dogs or cats as a tablet or to cats as a food additive to suppress flea populations; it can also be administered to cats as an injection every 6 months.4 Some products combine an IGR with an insecticide to kill adult fleas, eggs, and larvae.6 Topical formulations, such as those containing the insecticides fipronil, imidacloprid, nitenpyram, selamectin, or spinosad, are applied directly to the pet’s skin to kill adult fleas. These compounds have a wider margin of safety than products containing cholinesterase inhibitors such as carbamates or organophosphates, which can pose health risks to pets, especially cats and young animals.4,6,10 However, in households with infants, young children, or pregnant women, human health professionals should be consulted before insecticides are used.

Diseases and Parasites Transmitted by Cat Fleas Cat fleas are vectors for transmission of diseases as well as hosts for parasites. For example, they can transmit diseases such as hemobartonellosis, which is caused by Mycoplasma haemofelis,7 or cat-scratch disease, which is caused by Bartonella henselae.2 Cat fleas also serve as the intermediate host for parasites such as Dipylidium caninum (the canine tapeworm).1,2,5 When flea larvae ingest tapeworm eggs, cysticercoids (i.e., tapeworm larvae) develop in the body of the flea, which in turn may be ingested by a dog or cat during grooming.1 Murine typhus, which is caused by infection with Rickettsia typhi or Rickettsia felis, can be transmitted by cat fleas to humans and small mammals.6 The disease is more prevalent along the southeastern, southwestern, and Gulf coasts of the United States, in areas inhabited by opossums, which are a primary reservoir for murine typhus.1,2

Environmental Management In addition to treating the pet, it is important that the owner implement indoor and outdoor control measures to effectively control fleas.

Indoor Controls After treatment for the pet is initiated, the owner should take steps to control fleas in the indoor environment. Flea populations are most dense in areas where pets sleep.6 Therefore, bedding and throw rugs should be washed in hot, soapy water. Human as well as pet bedding should be laundered once a week. Floors, carpets, and upholstered furniture should be thoroughly vacuumed daily.4 The owner should also vacuum along baseboards and other crevices.4 The upholstery in vehicles that have been used to transport flea-infested pets should be vacuumed. Vacuuming helps to remove not only adult fleas, eggs, and larvae but also pupae, which are resistant to insecticides, IGRs, and IDIs.3,4 A recent study11 revealed that vacuuming kills 96% of adult fleas and 100% of fleas in the pupal and larval stages. Insecticides that contain IGRs and have residual action can be used to control fleas indoors.4 If the flea problem does not resolve or if the infestation becomes severe, the pet owner should be advised to contact the veterinarian.

Outdoor Controls Outdoor flea populations are most prevalent in coastal areas and locations with moderate daytime temperatures and fairly high humidity.4 Outdoor controls involve removing organic debris (e.g., fallen leaves, wood piles), watering the lawn regularly, and trimming low-hanging vegetation to allow sunlight penetration, all of which can inhibit larvae development.4,6 The owner should also spray an IGR-containing insecticide in shaded or protected areas frequented by pets, such as crawl spaces, sheltered animal enclosures, or doghouses.4 It is usually not necessary for the owner to treat the entire lawn, since flea larvae generally cannot survive in areas where foot traffic is heavy or in locations with direct exposure to sunlight.4 Spraying insecticide outdoors may be (text continues on page 287)

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CE Article #1 Educating Clients About Fleas Flea Control Products a Product

Manufacturer

Active Ingredient(s)

Minimum Age/Weight

Route of Administration

Frequency b

Dogs Advantage Advantage Multi for Dogs Capstar

Bayer Animal Health Bayer Animal Health Novartis Animal Health

Imidacloprid Imidacloprid, moxidectin Nitenpyram

7 weeks 7 weeks/3 lb 4 weeks/2 lb

Topical Topical Tablet

Spinosad Fipronil, S-methoprene Fipronil Fipronil Imidacloprid, permethrin Lufenuron Metaflumizone, amitraz Permethrin

14 weeks 8 weeks 8 weeks 8 weeks 7 weeks 4 weeks 8 weeks 4 weeks

Chewable tablet Topical Spray Topical Topical Tablet Topical Topical

Revolution Sentinel Flavor Tabs

Lilly Merial Merial Merial Bayer Animal Health Novartis Animal Health Fort Dodge Animal Health Schering-Plough Animal Health Pfizer Animal Health Novartis Animal Health

Monthly Monthly Varies depending on severity of infestationb Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly

6 weeks 4 weeks/2 lb

Topical Tablet

Monthly Monthly

Vectra 3D

Summit VetPharm

7 weeks

Topical

Monthly

Virbac Long-Acting KnockOut Spray Virbac Pyrethrin Dip

Virbac Animal Health

Selamectin Milbemycin oxime, lufenuron Dinotefuran, permethrin, pyriproxyfen Permethrin, pyriproxyfen

6 months

Spray

Every 2 weeks

Virbac Animal Health

Pyrethrins, piperonyl butoxide, 12 weeks N-octyl bicycloheptene dicarboximide, di-N-propyl isocinchomeronate

Dip

No more than once every 7 days

Cats Advantage Advantage Multi for Cats Capstar

Bayer Animal Health Bayer Animal Health Novartis Animal Health

Imidacloprid Imidacloprid, moxidectin Nitenpyram

Topical Topical Tablet

Frontline Plus for Cats Frontline Spray Frontline Top Spot for Cats Program

Merial Merial Merial Novartis Animal Health

Fipronil, S-methoprene Fipronil Fipronil Lufenuron

ProMeris for Cats Revolution Vectra Virbac Pyrethrin Dip

Fort Dodge Animal Health Pfizer Animal Health Summit VetPharm Virbac Animal Health

Metaflumizone Selamectin Dinotefuran, pyriproxyfen Pyrethrins, piperonyl butoxide, N-octyl bicycloheptene dicarboximide, di-N-propyl isocinchomeronate

Comfortis Frontline Plus for Dogs Frontline Spray Frontline Top Spot for Dogs K9 Advantix Program Flavor Tabs ProMeris for Dogs Proticall

a b

286

8 weeks 9 weeks/2 lb 4 weeks/2 lb

Monthly Monthly Varies depending on severity of infestationb 8 weeks Topical Monthly 8 weeks Spray Monthly 8 weeks Topical Monthly 4 weeks (tablet), Tablet, suspension, Monthly (tablet 6 weeks (suspension or injectable and suspension), and injectable) every 6 months (injectable) 8 weeks Topical Monthly 8 weeks Topical Monthly 8 weeks Topical Monthly 12 weeks Dip No more than once every 7 days

See the product label for information on the specific flea stage affected. See the product label for information on the exact dosing frequency.

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unnecessary if the owner does not detect a significant number of adult fleas. To confirm outdoor flea infestation, the owner should walk through pet resting areas while wearing white socks pulled up to the knees. If fleas are present, they will jump onto the socks and be clearly visible.4 Because use of some flea control products outdoors may affect other species, such as butterflies, bees, and aquatic invertebrates,12 the owner should read the cautions on all products and carefully follow the application instructions on the label regarding the amount of product to use and the method of application.

Conclusion Flea infestation of pets is a common problem and can cause infected pets to suffer mild to severe discomfort because of itching and FAD. Sanitation of the indoor and outdoor environment, in conjunction with treatment of the pet, is an important element of flea control. Technicians should educate owners about the flea life cycle, the clinical signs associated with infestation, and the various preventatives and flea control products available, including indications and contraindications.

(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 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

Vacuuming kills

96% of adult fleas

and 100% of fleas in the pupal and larval stages.11

References 1. Fleas and flea allergy dermatitis, in Kahn CM (ed): The Merck Veterinary Manual, ed 9. Whitehouse Station, NJ, Merck & Company, 2005, pp 710–715. 2. Companion Animal Parasite Council: Ectoparasites: Flea Guidelines. Accessed April 2008 at www.capcvet.org. 3. Foil CS: Flea control update. West Vet Conf Proc 2003. 4. University of California Statewide Integrated Pest Management Program: Pests of Homes, Structures, People, and Pets. Accessed April 2008 at www.ipm. ucdavis.edu/PMG/PESTNOTES/pn7419.html. 5. Sloss MW, Kemp RL, Zajac AM: Veterinary Clinical Parasitology. Ames, Iowa State University Press, 1994, p 134. 6. Fleas and flea allergy, in Aiello SE, Mays A (eds): The Merck Veterinary Manual, ed 8. Whitehouse Station, NJ, Merck & Company, 1998, pp 632–637. 7. Lappin MR, Brunt J, Riley A, et al: Mycoplasma haemofelis and Mycoplasma haemominutum DNA in blood of cats and their fleas. Proc 21st ACVIM:929– 930, 2003. 8. Dryden MW: Understanding Persistent and Recurrent Flea Problems. Accessed April 2008 at www.vet. ksu.edu/DEPTS/dmp/personnel/faculty/pdf/Persistent. Recurrent.Flea.Problems.pdf.

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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

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CE Article #1 Educating Clients About Fleas

9. Dryden MW: Host association, on-host longevity and egg production of Ctenocephalides felis. Vet Parasitol 34:117–122, 1989.

postembryonic life stages of the cat flea, Ctenocephalides felis. Entomologia Experimentalis et Applicata 125(2):221–222, 2007.

10. Sousa CA: Fleas, Flea Allergy, and Flea Control: A Review. Accessed April 2008 at dermatology.cdlib. org/DOJvol3num2/fleas/fleas.html.

12. Pesticide Information Profile: Fenoxycarb. Accessed April 2008 at pmep.cce.cornell.edu/profiles/ extoxnet/dienochlor-glyphosate/fenoxycarbext.html.

11. Hink WF, Needham GR: Vacuuming is lethal to all

ABOUT THE AUTHOR

Sandra Rhodes, RAHT

Sandy works part time as an animal health technologist at Nanton Veterinary Clinic in Nanton, Alberta, Canada. She also volunteers at the Heaven Can Wait Animal Rescue Foundation in High River, Alberta, where she is helping the organization’s founder develop a spay/neuter initiative. Sandy and her husband, Michael, a veterinarian, have two children, Kathryn and Matthew, and a dog, Katie.

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. Which characteristic of the flea allows it to jump from host to host? a. a laterally flattened body b. a prominently enlarged third pair of legs c. short legs that allow it to move rapidly d. mouthparts that pierce the skin of the host 2. Adult fleas spend most of their life a. on the host organism. b. moving from one host to another. c. off the host organism. d. looking for a preferred host. 3. Which environmental temperature will kill all stages of fleas? a. <37.4°F (3°C) b. >39°F (3.9°C) c. 40°F (4.4°C) d. none of the above 4. Which of the following regarding larvae is false? a. A relative humidity of 50% is required for successful larval development.

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

b. The duration of the larval stage varies based on temperature. c. Larvae feed on the feces of adult fleas. d. Larvae need direct sunlight to develop. 5. At cool temperatures, flea pupae can remain dormant in the cocoon for up to ______ months. a. 4 b. 8 c. 12 d. none of the above 6. FAD is a skin condition characterized by a. hypersensitivity to flea saliva. b. scratching. c. alopecia. d. all of the above 7. In the United States, murine typhus is more prevalent along the a. Gulf coast. b. Atlantic coast. c. southeastern and southwestern coasts. d. a and c

8. A recent study revealed that vacuuming kills ______ of adult fleas. a. 95% b. 96% c. 99% d. 100% 9. To manage fleas outdoors, owners should a. water the lawn regularly. b. remove organic debris. c. cover sunlit areas. d. a and b 10. Which of the following regarding flea control is false? a. Bedding and throw rugs should be washed in hot, soapy water. b. Watering the lawn is discouraged if flea infestation is suspected. c. Low-hanging outdoor vegetation should be trimmed. d. The upholstery in vehicles used to transport infested pets should be vacuumed.

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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 287.

Comfortis™ chewable tablet 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 Comfortis™, see your Lilly representative, distributor representative or call 1 (888) LillyPet. Available by prescription only. www.comfortis4dogs.com

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BehaviorBootCamp

The Technician’s Role in the

Behavior Consultation

Julie Shaw, RVT PET’S BEHAVIOR PROBLEMS can erode the Purdue University human–animal bond, potentially leading to abanWest Lafayette, Indiana donment, relinquishment to a shelter, or euthanasia. However, veterinary technicians can offer valuable guidance when owners report that their pet is exhibiting behavior problems. A behavior consultation should be scheduled, during which the pet’s behavior can be evaluated and a systematic approach to treatment developed. Successful treatment of a pet with behavior problems is a team effort — involving the technician, the veterinarian, and the owner.

Julie Shaw, RVT Julie has been the senior animal behavior technologist at Purdue University’s Animal Behavior Clinic since 1999. She currently organizes and helps teach Purdue’s popular DOGS! course on behavior modification principles and techniques, lectures to veterinary professionals nationally and internationally, is the chairwoman of the organizing committee for the Academy of Veterinary Behavior Technicians, and is on the faculty of the Karen Pryor Academy. Julie received the 2006 NAVC Veterinary Technician Speaker of the Year Award and was named the 2007 Dr. Jack L. Mara Memorial Lecturer.

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When a pet presents to the veterinary clinic with behavior problems, the technician can educate the client about the various treatment options available, including behavior modification and pharmacotherapy. The veterinarian should establish a policy for the treatment of behavior problems so that a consistent protocol is always followed. Technicians cannot diagnose behavior problems or prescribe drugs; however, experienced technicians can play a vital role in patient triage by determining whether the behavior problem warrants further investigation by the veterinarian. To properly diagnose and treat a pet’s behavior problems, a behavior consultation with the veterinarian should be scheduled. If the client indicates that the pet’s behavior problems are severely eroding the human–animal bond, the veterinarian should be notified. The case should be considered a priority, and the behavior consultation should be scheduled as soon as possible.

Elements of the Behavior Consultation Obtain a History and Prepare the Client The technician can obtain the pet’s behavioral history from the client by telephone, or a history form can be mailed to the client, who should be instructed to re-

MAY 2008 | Veterinary Technician

Courtesy of Newtown Veterinary Hospital

Presentation

By building a rapport with the client, the technician can encourage compliance with treatment.

turn the completed form before the behavior consultation. The technician should ask the client about his or her postconsultation goals to ensure that the client’s expectations for the consultation are appropriate. In addition, the client should be informed of the clinic’s fee structure and any cancellation policies that may exist. The client should also be given instructions regarding what to bring to the consultation. For example, the technician may recommend that the client bring collars, leashes, and any other training tools that www.VetTechJournal.com

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help Make sure nothing ever comes . between them althy Keep utshhee#1 in

with pectrum broad-section prot †

To your clients, their cats are family. They count on you to safeguard this relationship. So why would you protect them with anything less than the #1 broad-spectrum parasite protection sold. With 70 million doses sold and 8 out of 10 doses dispensed, REVOLUTION® (selamectin) is the brand more veterinarians trust for their feline patients. Given once a month, it keeps their cats safe from fleas, ear mites, hookworms,* roundworms,** heartworms, and Heartworm Associated Respiratory Disease (H.A.R.D.). Prevention. It’s just better medicine. Visit us at catsoftherevolution.com.

Revolution is generally well-tolerated. In studies, <1% of cats and dogs experienced digestive upset. Approximately 1% of cats experienced temporary hair loss at the application site. Do not use in sick, weak or underweight animals. † 8 out of 10 broad-spectrum doses dispensed *Ancylostoma tubaeforme **Toxocara cati Revolution is a registered trademark of Pfizer Inc. Cats of the Revolution is a trademark of Pfizer Inc. ©2008 Pfizer Inc. All rights reserved. REV0308023

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BehaviorBootCamp 4OPICAL 0ARASITICIDE FOR $OGS AND #ATS #!54)/. 5 3 &EDERAL LAW RESTRICTS THIS DRUG TO USE BY OR ON THE ORDER OF A LICENSED VETERINARIAN ).$)#!4)/.3 2%6/,54)/. IS RECOMMENDED FOR USE IN DOGS WEEKS OF AGE AND OLDER AND IN CATS WEEKS OF AGE AND OLDER FOR THE FOLLOWING PARASITES AND INDICATIONS $OGS 2%6/,54)/. KILLS ADULT FLEAS AND PREVENTS FLEA EGGS FROM HATCHING FOR ONE MONTH AND IS INDICATED FOR THE PREVENTION AND CONTROL OF FLEA INFESTA TIONS #TENOCEPHALIDES FELISS PREVENTION OF HEARTWORM DISEASE CAUSED BY $IROFILARIA IMMITIS AND THE TREATMENT AND CONTROL OF EAR MITE /TODECTES CYNOTISS INFESTATIONS 2%6/,54)/. ALSO IS INDICATED FOR THE TREATMENT AND CONTROL OF SARCOPTIC MANGE 3ARCOPTES SCABIEII AND FOR THE CONTROL OF TICK INFESTATIONS DUE TO $ERMACENTOR VARIABILIS #ATS 2%6/,54)/. KILLS ADULT FLEAS AND PREVENTS FLEA EGGS FROM HATCHING FOR ONE MONTH AND IS INDICATED FOR THE PREVENTION AND CONTROL OF FLEA INFESTA TIONS #TENOCEPHALIDES FELISS PREVENTION OF HEARTWORM DISEASE CAUSED BY $IROFILARIA IMMITIS AND THE TREATMENT AND CONTROL OF EAR MITE /TODECTES CYNOTISS INFESTATIONS 2%6/,54)/. IS ALSO INDICATED FOR THE TREATMENT AND CONTROL OF ROUNDWORM 4OXOCARA CATI AND INTESTINAL HOOKWORM !NCYLOSTOMA TUBAEFORME INFECTIONS IN CATS 7!2.).'3 .OT FOR HUMAN USE +EEP OUT OF THE REACH OF CHILDREN )N HUMANS 2%6/,54)/. MAY BE IRRITATING TO SKIN AND EYES 2EACTIONS SUCH AS HIVES ITCHING AND SKIN REDNESS HAVE BEEN REPORTED IN HUMANS IN RARE INSTANCES )NDIVIDUALS WITH KNOWN HYPERSENSITIVITY TO 2%6/,54)/. SHOULD USE THE PRODUCT WITH CAUTION OR CONSULT A HEALTH CARE PROFESSIONAL 2%6/,54)/. CONTAINS ISOPROPYL ALCOHOL AND THE PRESERVATIVE BUTYLATED HYDROXYTOLUENE "(4 7ASH HANDS AFTER USE AND WASH OFF ANY PRODUCT IN CONTACT WITH THE SKIN IMMEDIATELY WITH SOAP AND WATER )F CONTACT WITH EYES OCCURS THEN FLUSH EYES COPIOUSLY WITH WATER )N CASE OF INGESTION BY A HUMAN CONTACT A PHYSICIAN IMMEDIATELY 4HE MATERIAL SAFETY DATA SHEET -3$3 PROVIDES MORE DETAILED OCCUPATIONAL SAFETY INFORMATION &OR A COPY OF THE -3$3 OR TO REPORT ADVERSE REACTIONS ATTRIBUTABLE TO EXPOSURE TO THIS PRODUCT CALL &LAMMABLEÂ&#x2C6;+EEP AWAY FROM HEAT SPARKS OPEN FLAMES OR OTHER SOURCES OF IGNITION $O NOT USE IN SICK DEBILITATED OR UNDERWEIGHT ANIMALS SEE 3!&%49 02%#!54)/.3 0RIOR TO ADMINISTRATION OF 2%6/,54)/. DOGS SHOULD BE TESTED FOR EXISTING HEARTWORM INFECTIONS !T THE DISCRETION OF THE VETERINARIAN INFECTED DOGS SHOULD BE TREATED TO REMOVE ADULT HEARTWORMS 2%6/,54)/. IS NOT EFFECTIVE AGAINST ADULT $ IMMITISS AND WHILE THE NUMBER OF CIRCULATING MICROFILARIAE MAY DECREASE FOLLOWING TREATMENT 2%6/,54)/. IS NOT EFFECTIVE FOR MICROFILARIAE CLEARANCE (YPERSENSITIVITY REACTIONS HAVE NOT BEEN OBSERVED IN DOGS WITH PATENT HEARTWORM INFECTIONS ADMINISTERED THREE TIMES THE RECOMMENDED DOSE OF 2%6/,54)/. (IGHER DOSES WERE NOT TESTED !$6%23% 2%!#4)/.3 0RE APPROVAL CLINICAL TRIALS &OLLOWING TREATMENT WITH 2%6/,54)/. TRANSIENT LOCALIZED ALOPECIA WITH OR WITHOUT INFLAMMATION AT OR NEAR THE SITE OF APPLICATION WAS OBSERVED IN APPROXIMATELY OF TREATED CATS /THER SIGNS OBSERVED RARELY Â&#x201D; OF TREATED CATS AND DOGS INCLUDED VOMITING LOOSE STOOL OR DIARRHEA WITH OR WITHOUT BLOOD ANOREXIA LETHARGY

SALIVATION TACHYPNEA AND MUSCLE TREMORS 0OST APPROVAL EXPERIENCE )N ADDITION TO THE AFOREMENTIONED CLINICAL SIGNS THAT WERE REPORTED IN PRE APPROVAL CLINICAL TRIALS THERE HAVE BEEN REPORTS OF PRURITUS URTICARIA ERYTHEMA ATAXIA FEVER AND RARE REPORTS OF DEATH 4HERE HAVE ALSO BEEN RARE REPORTS OF SEIZURES IN DOGS 3EE 7!2.).'3 $/3!'% 4HE RECOMMENDED MINIMUM DOSE IS MG SELAMECTIN PER POUND MG KG OF BODY WEIGHT !DMINISTER THE ENTIRE CONTENTS OF A SINGLE DOSE TUBE OR TWO TUBES USED IN COMBINATION FOR DOGS WEIGHING OVER POUNDS OF 2%6/,54)/. TOPICALLY IN ACCORDANCE WITH LABEL DIRECTIONS 3EE !$-).)342!4)/. FOR THE RECOMMENDED TREATMENT INTERVALS &OR CATS OVER POUNDS USE THE APPROPRIATE COMBINATION OF TUBES 2ECOMMENDED FOR USE IN DOGS WEEKS OF AGE AND OLDER AND IN CATS WEEKS OF AGE AND OLDER !$-).)342!4)/. ! VETERINARIAN OR VETERINARY TECHNICIAN SHOULD DEMONSTRATE OR INSTRUCT THE PET OWNER REGARDING THE APPROPRIATE TECHNIQUE FOR APPLYING 2%6/,54)/. TOPICALLY TO DOGS AND CATS PRIOR TO FIRST USE &IRMLY DEPRESS THE CAP TO PUNCTURE THE SEAL ON THE 2%6/,54)/. TUBE THEN REMOVE THE CAP TO ADMINISTER THE PRODUCT 0ART THE HAIR ON THE BACK OF THE ANIMAL AT THE BASE OF THE NECK IN FRONT OF THE SHOULDER BLADES UNTIL THE SKIN IS VISIBLE 0LACE THE TIP OF THE TUBE ON THE SKIN RELEASE THE HAIR AND SQUEEZE THE TUBE TO EMPTY ITS ENTIRE CONTENTS DIRECTLY ONTO THE SKIN IN ONE SPOT $O NOT MASSAGE THE PRODUCT INTO THE SKIN $UE TO ALCOHOL CONTENT DO NOT APPLY TO BROKEN SKIN !VOID CONTACT BETWEEN THE PRODUCT AND FINGERS $O NOT APPLY WHEN THE HAIR COAT IS WET "ATHING OR SHAMPOOING THE ANIMAL OR MORE HOURS AFTER TREATMENT WILL NOT REDUCE THE EFFECTIVENESS OF 2%6/,54)/. 3TIFF HAIR CLUMPING OF HAIR HAIR DISCOLORATION OR A SLIGHT POWDERY RESIDUE MAY BE OBSERVED AT THE TREATMENT SITE IN SOME ANIMALS 4HESE EFFECTS ARE TEMPORARY AND DO NOT AFFECT THE SAFETY OR EFFECTIVENESS OF THE PRODUCT $ISCARD EMPTY TUBES IN YOUR ORDINARY HOUSEHOLD REFUSE 3!&%49 2%6/,54)/. HAS BEEN TESTED SAFE IN OVER DIFFERENT PURE AND MIXED BREEDS OF HEALTHY DOGS AND OVER DIFFERENT PURE AND MIXED BREEDS OF HEALTHY CATS INCLUDING PREGNANT AND LACTATING FEMALES BREEDING MALES AND FEMALES PUPPIES SIX WEEKS OF AGE AND OLDER KITTENS EIGHT WEEKS OF AGE AND OLDER AND AVERMECTIN SENSITIVE COLLIES ! KITTEN ESTIMATED TO BE n WEEKS OLD KG DIED b HOURS AFTER RECEIVING A SINGLE TREATMENT OF 2%6/,54)/. AT THE RECOMMENDED DOSAGE 4HE KITTEN DISPLAYED CLINICAL SIGNS WHICH INCLUDED MUSCLE SPASMS SALIVATION AND NEUROLOGICAL SIGNS 4HE KITTEN WAS A STRAY WITH AN UNKNOWN HISTORY AND WAS MALNOURISHED AND UNDERWEIGHT SEE 02%#!54)/.3 $OGS )N SAFETY STUDIES 2%6/,54)/. WAS ADMINISTERED AT AND TIMES THE RECOMMENDED DOSE TO SIX WEEK OLD PUPPIES AND NO ADVERSE REACTIONS WERE OBSERVED 4HE SAFETY OF 2%6/,54)/. ADMINISTERED ORALLY ALSO WAS TESTED IN CASE OF ACCIDENTAL ORAL INGESTION /RAL ADMINISTRATION OF 2%6/,54)/. AT THE RECOMMENDED TOPICAL DOSE IN TO MONTH OLD BEAGLES DID NOT CAUSE ANY ADVERSE REACTIONS )N A PRE CLINICAL STUDY SELA MECTIN WAS DOSED ORALLY TO IVERMECTIN SENSITIVE COLLIES /RAL ADMINISTRATION OF AND MG KG IN THIS DOSE ESCALATING STUDY DID NOT CAUSE ANY ADVERSE REACTIONS HOWEVER EIGHT HOURS AFTER RECEIVING MG KG ORALLY ONE AVERMECTIN SENSITIVE COLLIE BECAME ATAXIC FOR SEVERAL HOURS BUT DID NOT SHOW ANY OTHER ADVERSE REACTIONS AFTER RECEIVING SUBSEQUENT DOSES OF AND MG KG ORALLY )N A TOPICAL SAFETY STUDY CONDUCTED WITH AVERMECTIN SENSITIVE COLLIES AT AND TIMES THE RECOMMENDED DOSE OF 2%6/,54)/.

SALIVATION WAS OBSERVED IN ALL TREATMENT GROUPS INCLUDING THE VEHICLE CONTROL 2%6/,54)/. ALSO WAS ADMINISTERED AT TIMES THE RECOMMENDED DOSE TO HEARTWORM INFECTED DOGS AND NO ADVERSE EFFECTS WERE OBSERVED #ATS )N SAFETY STUDIES 2%6/,54)/. WAS APPLIED AT AND TIMES THE RECOMMENDED DOSE TO SIX WEEK OLD KITTENS .O ADVERSE REACTIONS WERE OBSERVED 4HE SAFETY OF 2%6/,54)/. ADMINISTERED ORALLY ALSO WAS TESTED IN CASE OF ACCIDENTAL ORAL INGESTION /RAL ADMINISTRATION OF THE RECOMMENDED TOPICAL DOSE OF 2%6/,54)/. TO CATS CAUSED SALIVATION AND INTERMITTENT VOMITING 2%6/,54)/. ALSO WAS APPLIED AT TIMES THE RECOMMENDED DOSE TO PATENT HEARTWORM INFECTED CATS AND NO ADVERSE REACTIONS WERE OBSERVED )N WELL CONTROLLED CLINICAL STUDIES 2%6/,54)/. WAS USED SAFELY IN ANIMALS RECEIVING OTHER FREQUENTLY USED VETERINARY PRODUCTS SUCH AS VACCINES

ANTHELMINTICS ANTIPARASITICS ANTIBIOTICS STEROIDS COLLARS SHAMPOOS AND DIPS $ISTRIBUTED BY 0FIZER !NIMAL (EALTH $IV OF 0FIZER )NC .9 .9

have previously been used. It may be helpful for the client to bring the petâ&#x20AC;&#x2122;s favorite treats and to ensure that the pet will be hungry during the consultation so that it is motivated to respond to food rewards. If feasible, the client should videotape the pet while it is exhibiting behavior problems and bring the video to the consultation. If multiple pets in a household are exhibiting undesirable behavior, videotaping their interactions â&#x20AC;&#x201D; both with and without the owner present â&#x20AC;&#x201D; is also helpful. When a petâ&#x20AC;&#x2122;s behavior problems involve inappropriate elimination, the client can provide vital information about the petâ&#x20AC;&#x2122;s environment by bringing a diagram or photographs of the home, noting the location of windows and doors, favorite resting places of each pet in the household, and areas where housesoiling has occurred and where food/water bowls and litterboxes are kept. The technician can recommend a practical plan to help the client manage the petâ&#x20AC;&#x2122;s behavior until the consultation can be conducted. The client should be instructed to avoid punishment. If the pet is aggressive, the technician may recommend that the client avoid situations that trigger aggression. This measure can help to prevent the client from being injured by the aggressive pet. If separation anxiety is suspected, placing the pet in day care

Common Behavior Complaints and Recommendations Example 1 Complaint: My 12-week-old puppy is â&#x20AC;&#x153;dominant.â&#x20AC;? Recommendations:The technician should first ask the owner to clarify what he or she means by â&#x20AC;&#x153;dominantâ&#x20AC;? (e.g., the puppy is jumping on the children in the household and biting them). The technician can then recommended puppy classes in order to further evaluate whether the pet is demonstrating normal puppy behavior, which can be addressed in the puppy class, or atypical behavior, which should be addressed by the veterinarian. Example 2 Complaint: My dog barks all day. Recommendations: The technician should ask the owner to describe when the dog usually barks and whether there is a stimulus for the barking. If the dog is barking while the owner is home and accessible and the eliciting stimulus is the presence of squirrels in the neighborâ&#x20AC;&#x2122;s yard, the technician can recommend that the owner increase the number of opportunities for stimulation (e.g., walk the dog frequently, provide interactive toys such as a Kong) or limit the dogâ&#x20AC;&#x2122;s exposure to the squirrels by applying fog coating to specific windows in the home. The technician can also teach the owner how to modify the petâ&#x20AC;&#x2122;s behavior using response substitution techniques, such as â&#x20AC;&#x153;go to a matâ&#x20AC;? or â&#x20AC;&#x153;get a toy,â&#x20AC;? when a squirrel is present. If the client reports that the dogâ&#x20AC;&#x2122;s barking begins when he or she leaves for work and that the dog exhibits anxiety or aggression, a behavior consultation with the veterinarian should be scheduled to determine whether the pet has separation anxiety. Example 3 Complaint: My 5-month-old dog is defecating in the house. Recommendations: The technician should ask the owner whether the dog has been examined recently. If the pet has not recently undergone an examination, one should be scheduled. If the pet was recently examined and underwent a fecal analysis that uncovered no abnormalities, then the technician should ask the owner to describe when the accidents usually occur. If the accidents only occur in the dogâ&#x20AC;&#x2122;s crate after the owner leaves the house, the technician can suggest that the owner set up a video camera to document the petâ&#x20AC;&#x2122;s anxiety level when the owner is not home. After reviewing the video, the veterinarian and technician can determine whether a behavior consultation is needed.

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BehaviorBootCamp may be suggested as a temporary solution.

Develop the Treatment Plan The veterinarian will review the pet’s behavioral history, obtaining more detailed information during the behavior consultation, if necessary; rule out any medical problems that could be causing the pet to behave inappropriately; formulate a diagnosis; and develop a treatment plan that includes behavior modification and pharmacotherapy. Especially if the pet is aggressive, the veterinarian should make sure that the technician can work safely with the pet. During the behavior consultation, the technician can evaluate the pet’s trainability and its response to control behaviors (e.g., sit, down, stay, come). The technician can also set a foundation for the treatment prescribed by the veterinarian by beginning clicker training,a teaching the pet behaviors (e.g., go to a mat, lie down) that will be reinforced during behavior modification exercises, and desensitizing the pet to the use of a head collar or muzzle. It may be helpful for the technician to conduct these exercises while the pet is away from the owner to determine which behaviors have been inadvertently conditioned.

Review the Treatment Plan After the veterinarian develops a treatment plan, the client will often have questions about the plan and the pet’s diagnosis. The technician can serve as a valuable resource by doing the following: Explain the diagnosis to the client, and offer encouragement (e.g., by reassuring the client that the pet’s problem is not uncommon and is treatable). Advise the client of any potential side effects of the prescribed medication. Review the prescribed treatment plan with the client, emphasizing that treatment is a multistep process and that results may not be evident immediately. Demonstrate the prescribed training techniques (e.g., going to a mat, performing “down-stays”) — including the use of a

For more information on clicker training, see “‘Clicking’ with Animals — A New Clicker Training Certification Program” on page 108 of our February 2008 issue.

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training tools such as a head collar (e.g., Gentle Leader, Premier Pet, Midlothian, VA) — and give the client an opportunity to practice the techniques. By working closely with the client, the technician can build a rapport that will encourage client compliance with treatment and follow-up.

Conduct Follow-Up Follow-up may be conducted in person or through telephone or email communication or review of videotaped demonstrations of the owner applying the prescribed behavior modification techniques. Follow-up is crucial to the successful treatment of behavior problems, and the technician can support the client’s efforts by offering positive feedback, reviewing the elements of the treatment plan, and answering any questions related to the prescribed training and behavior modification techniques. If the client becomes frustrated, or if treatment does not seem to be effective, the technician can alert the veterinarian, who may decide to modify the treatment plan. During follow-up, it may be decided that the client requires more hands-on education. The technician may schedule one-onone training and behavior modification sessions with the client. These sessions could take place in the clinic or in the client’s home. One advantage to holding the sessions in the client’s home is that the technician can easily determine how to apply the techniques so that they are appropriate to the client’s lifestyle. In addition, by demonstrating the techniques in the client’s home, the technician can ensure that the client is able to apply them in the home environment.

Conclusion

Resources Books Hetts S: Pet Behavior Protocols. Lakewood, CO, AAHA Press, 1999. Landsberg G, Hunthausen W, Ackerman L: Handbook of Behavior Problems of the Dog and Cat, ed 2. London, Elsevier, 2003. Journal Articles Lane J: Understanding and improving client compliance. Vet Tech 24(12):850–853, 2003. Luescher AU, Flannigan G, Frank D, Mertens P: The role and limitations of trainers in behavior treatment and therapy. J Vet Behav Clin Appl Res 2:26–27, 2007. Luescher AU, Flannigan G, Frank D, Mertens P:The role and responsibilities of behavior technicians in behavioral treatment and therapy. J Vet Behav Clin Appl Res 2:23–25, 2007.

Successful treatment of a pet with behavior problems requires owner compliance with the veterinarian-prescribed treatment plan. By reassuring the client that the pet’s behavior problems are treatable, answering the client’s questions regarding treatment, and demonstrating training and behavior modification techniques, technicians can bond the client to the hospital and help maintain the human–animal bond. Veterinary Technician | MAY 2008 293

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CaseReport

Dioctophyme renale Infection in a Labrador Mix Annette Morrison, VT, RLAT University of Guelph Campus Animal Facility Guelph, Ontario, Canada

Andrew S. Peregrine, BVMS, PhD, DVM, DipEVPC Alexandra Squires Bos, BVM&S University of Guelph Ontario Veterinary College Guelph, Ontario, Canada

OSIE, a 2-year-old, 59.5-lb (27-kg) stray Labrador retriever mix from the Sarnia & District Humane Society, Ontario, Canada, was brought to the Ontario Veterinary College with a subclinical heartworm infection that had been diagnosed previously. At presentation, she was diagnosed with a number of common intestinal parasites, including Trichuris vulpis, Ancylostoma caninum, and Dipylidium caninum. She underwent treatment; however, 5 months later, it was noted that Rosie’s urine was ruddy brown in color. Urinalysis revealed that Rosie was infected with an unusual parasite. Presentation On physical examination, Rosie appeared to be healthy and demonstrated no obvious signs of illness. Because her urine was discolored, a midstream free-flow urine sample was collected and submitted for routine urinalysis, including sediment cytology, culture, and susceptibility testing. The collected urine was dark brown and cloudy. The urinalysis reagent strip (Multistix 10 SG, Bayer HealthCare) indicated a 3-plus result for blood. Sediment cytology per 400× magnification field revealed 500 to 600 erythrocytes, leukocytes in clumps, numerous squamous epithelial cells, occasional microfilariae of Dirofilaria immitis, and large numbers of ova of the

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Rosie, a Labrador retriever mix, was picked up as a stray in the Thames river area in Ontario, Canada.

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parasite Dioctophyme renale (also known as Dioctophyma renale). The culture results were negative for bacterial infection. The diagnosis of D. renale infection explained Rosie’s hematuria, and the free-flow urine sample did not indicate a bacterial infection; therefore, neither cystocentesis nor further urinalysis was conducted. D. renale, also known as the giant kidney worm, is the largest nematode known to infect domestic mammals.1 The only treatment for D. renale infection is surgical removal of the parasites. Therefore, a complete blood count (CBC), serum biochemistry, echocardiography, and abdominal ultrasonography were immediately scheduled to determine the severity of the D. renale infection and to assess the anesthetic risk associated with the concurrent heartworm infection. The results of the CBC indicated mild leukocytosis (leukocytes: 17.8 × 109/L [normal: 4.9 to 15.4 × 109/L]) characterized by mild lymphocytosis (lymphocytes: 5.3 × 109/L [normal: 0.8 to 5.1 × 109/L]) and moderate eosinophilia (eosinophils: 3.0 × 109/L [normal: 0.0 to 2.2 × 109/L]). The lymphocytosis suggested chronic antigenic stimulation, and eosinophilia has often been associated with parasitic infections; both findings were consistent with Rosie’s D. immitis and D. renale diagnoses. The total serum protein determined by refractometry was mildly increased at 85 g/L (normal: 55 to 74 g/L) and was confirmed on serum biochemistry, with a mild elevation in the globulin fraction of www.VetTechJournal.com

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52 g/L (normal: 21 to 42 g/L). These findings were also consistent with chronic antigenic stimulation by parasites. All renal function parameters were normal. In preparation for echocardiography and ultrasonography, Rosie was lightly sedated with 0.02 mg/kg of acepromazine and 0.2 mg/kg of butorphanol, administered intramuscularly. Rosie’s heart had normal morphology and good contractility; there was no dilation of the main pulmonary artery, and adult D. immitis parasites were only visible in the right pulmonary artery. Abdominal ultrasonography indicated that the right kidney was significantly enlarged, measuring approximately 10.2 cm in length, and had minimal normal architecture. A thin rim of normal cortex was present around the periphery, with worms visible within the renal pelvis. The left kidney appeared normal. Two additional worms were observed free in the abdomen, near the right kidney and the right lateral lobe of the liver. The urinary bladder had a marked amount of echoic sediment, likely

Indications: RECONCILE chewable tablets are indicated for the treatment of canine separation anxiety in conjunction with a behavior modification plan. 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.

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. 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.

Ontario Veterinary College, University of Guelph

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.

Ultrasonogram of the right kidney demonstrating multiple cross sections of parasites (*) and a longitudinal section of a parasite (+).

associated with the hematuria. Rosie’s prognosis was favorable because there was no indication of renal insufficiency, according to the blood work. Despite the subclinical heartworm infection, the cardiologist felt that Rosie would be a suitable 296

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50 µm

D. renale ova on urine sediment cytology (modified Wright’s stain, original magnification х400).

candidate for anesthesia. Surgery to perform a right nephrectomy and to retrieve two worms from the abdominal cavity was scheduled.

Surgery On the day of surgery, Rosie was administered cefazolin (22 mg/kg IV q6h) as a broad-spectrum antibiotic to minimize the risk of a systemic infection. She also received a course of oral cephalexin (30 mg/kg q12h). Rosie was sedated with hydromorphone and acepromazine; both drugs were administered at 0.05 mg/kg IM. An IV indwelling catheter was placed, and 2 ml of a 1:1 (volume:volume) ratio of ketamine (100 mg/ml) to diazepam (5 mg/ml) was administered IV to induce anesthesia. Immediately before the start of surgery, a morphine epidural (0.2 mg/kg) was administered at the lumbosacral junction (L7 to S1) as a preemptive analgesic. A surgical plane of anesthesia was maintained at 1.5% isoflurane with an oxygen flow rate of 500 ml/min. During surgery, Rosie’s blood pressure remained stable at 105/ 60 mm Hg. Anesthesia was uneventful. An abdominal incision was made from the xiphoid process to the pubis, and self-retaining retractors were placed to ease visualization of the abdomen. Two adult D. renale worms were located free in the abdomen. One was a female parasite. It was dark red in color, was approximately 100 cm in length and 10 to 12 mm in diameter, and was located between the right medial and right lateral liver lobes. The second worm was a male parasite. It was also www.VetTechJournal.com

Ontario Veterinary College, University of Guelph

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dark red in color, was approximately 30 cm in length and 3 to 5 mm in diameter, and was located between the diaphragm and the right lateral lobe of the liver. Female parasites can be distinguished from male parasites by their size and morphology. Female parasites are much larger than male parasites and do not have a copulatory bursa â&#x20AC;&#x201D; a fleshy, bellshaped structure at the posterior end of the male parasite.2 The two worms were gently removed from the abdomen without incident. The remainder of the abdomen was explored, and brown granulomatous tissue, subsequently shown to contain large numbers of D. renale eggs, was noted throughout the diaphragmatic and visceral surfaces of the liver, omentum, and mesentery. The left kidney appeared grossly normal, whereas the right kidney was markedly enlarged, vascular, nodular, and soft on palpation. Peritoneal tissue and fat were dissected from the capsule of the right kidney, and the right renal artery and vein were double-ligated using circumferential and transfixing ligatures. The ureter was similarly ligated at the level of the urinary bladder. The right kidney was removed en bloc, and the site was inspected for hemorrhage. The kidney was incised after removal from the surgical field, and three adult female D. renale parasites were found entangled in the dilated, thin-walled kidney. One female parasite was found occluding the proximal part of the associated ureter. The renal parenchyma was almost completely destroyed. Because the right nephrectomy and removal of the worms from the peritoneal cavity were uneventful and Rosie was to be adopted, a routine ovariohysterectomy was performed while she was anesthetized. The abdomen was lavaged, and the linea alba and subcutaneous tissue were closed using sutures in a simple, continuous pattern. The skin incision was closed using staples. Total anesthesia and surgery time was approximately 4 hours. Rosie was maintained on an IV drip (5 ml/min) of Plasmalyte A (Baxter Corporation, Deerfield, IL) for the duration of surgery and until she fully recovered from anesthesia. Immediately after surgery, Rosie was given an additional 0.5 mg/kg of morphine, divided into two sites, half administered IM and the other half administered IV. Oral cephalexin (30 mg/kg q12h) was continued postoperatively www.VetTechJournal.com

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Right kidney containing three female D. renale worms.

for 7 days. Rosieâ&#x20AC;&#x2122;s recovery was unremarkable, and she was discharged from the hospital after 3 days. The skin staples were removed 10 days after surgery.

Discussion D. renale infection occurs sporadically worldwide.3 Cases reported in North America appear to occur in localized enzootic areas where D. renale is prevalent in the mink population (the typical definitive host).3,4 The prevalence of D. renale infection in dogs is not well documented, but foci of infections have been noted in the Canadian provinces of Ontario, Manitoba, and Quebec and in the northern midwest region of the United States.1 Dogs and other carnivores appear to be atypical hosts in North America. However, in South America, particularly in Brazil, where fishing is an important economic activity, dogs appear to be the definitive host.5 The D. renale parasite has a complex life cycle, which may take up to 1 year to complete.4 In brief, fertile eggs are passed in the hostâ&#x20AC;&#x2122;s urine if adult female worms inhabit the kidney; in order for the eggs to be fertile, a male worm must also have been present. If an egg is deposited in water, the L1-stage (first stage) larva will develop within the egg; the rate of development depends on the water temperature.4 The egg containing the L1-stage larva is then ingested by an aquatic worm, Lumbriculus variegatus, in which the egg hatches. The larva molts twice, developing from L2-stage larva into L3-stage (infective stage) larva. Often, fish or frogs will ingest the

Glossary Hematuria_Presence of blood in the urine Hemoperitoneum_Presence of blood in the peritoneal cavity, the potential space between the visceral and parietal peritoneum Nematode_Unsegmented, cylindrical worm of the class Nematoda; also called roundworm Peritonitis_Inflammation of the peritoneum, the membrane that lines the inside of the abdomen and covers the organs

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CaseReport infective aquatic worm and become paratenic hosts, which aid in the transmission of a parasitic infection but in which there is no further development of the parasite. Definitive hosts, typically fish-eating mammals, become infected by ingesting the infective aquatic worm or a paratenic host. In the definitive host (e.g., mink), the L3-stage larva

penetrates the stomach or intestinal wall and typically migrates via the liver to the right kidney.3,4 It has been suggested that the close proximity of the right lobe of the liver and the right kidney to the stomach and duodenum may explain why the D. renale parasite often migrates to the right kidney.4 However, the parasite may not

Adapted from Anderson RC: Family Dioctophymatidae, in Nematode Parasites of Vertebrates: Their Development and Transmission, ed 2. Wallingford, United Kingdom, CABI Publishing, 2000, p 595; with permission.

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Illustrated by U.R. Strelive

Life cycle of D. renale. E = esophagus I = intestine K = kidney L = liver S = stomach UB = urinary bladder

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CaseReport always migrate to the right kidney and can remain free in the abdomen, as is often the case in dogs.4 In dogs, the prepatent period — the period between ingestion of infective-stage larvae and the earliest time at which eggs or adult parasites can be recovered from the dog — is approximately 135 days.3 The highest burden of worms in a dog was reported in Brazil, where a 2-year-old mongrel was observed with 28 worms free in the abdominal cavity and six worms in the right kidney.6 There have been isolated cases of D. renale infection in humans. However, D. renale eggs in dog urine cannot infect humans. Instead, just like infections in dogs, infections in humans are associated with ingestion of the L3-stage larva in an aquatic worm or paratenic host (e.g., uncooked fish). Diagnosis of D. renale infection is usually made by the discovery of characteristic amber, bipolar eggs with thick, pitted shells, 73 to 83 µm long and 45 to 47 µm wide, on urine cytology or by the discovery of the adult worms on abdominal ultrasonography. Since the parasite typically inhabits only the right kidney, the left kidney will compensate and signs of renal insufficiency often do not develop. Similarly, initial clinical signs (which may include hematuria, dysuria, and lumbar pain)1 may not be obvious and are commonly overlooked, as was the case with Rosie. If the parasites are free in the abdomen, there may be hemoperitoneum, peritonitis, or liver damage. Infection with the parasite will frequently not be diagnosed but may be found during a routine laparotomy or ovariohysterectomy or on necropsy.1 Dogs, particularly strays, living near lakes, streams, and other water sources are likely to be at the greatest risk of being infected because they may consume an infective aquatic worm or paratenic host. Preventive measures include not allowing dogs to consume raw fish or frogs or fish viscera from cleaned fish.

Conclusion In Rosie’s case, hematuria was the only clinical sign of D. renale infection. Animals tend to not exhibit discomfort in the same manner as humans, and subtle abnormalities in a dog’s behavior or appearance may go unnoticed. In retrospect, Rosie demonstrated www.VetTechJournal.com

signs — excessive shedding, slight bloating, and anxiety — that appeared to have been associated with the D. renale infection. Shortly after surgery, all three signs improved significantly. Because Rosie was a stray with an unknown history, it is not surprising that these signs were overlooked. Veterinarians and veterinary technicians must help clients understand the importance of regularly testing their dogs for all parasites that are prevalent in the area. Testing should include routine fecal analysis, heartworm testing, and possibly urinalysis if the dog is from, or has traveled to, an area where D. renale is endemic. Rosie was a stray from the Thames river area of Ontario, which is known by local veterinarians to be endemic for D. renale. Rosie was successfully treated for her heartworm infection and has been adopted. She is doing well in her new home (with author Annette Morrison), and every measure will be taken to ensure that she remains parasite-free. Acknowledgments: The authors thank the staff of the Ontario Veterinary College, University of Guelph, especially Lynne O’Sullivan, DVM, DVSc, DACVIM; Stephanie Nykamp, DVM, DACVR; Kristiina Ruotsalo, DVM, DVSc, DACVP; and Kevin Hogg.

References 1. Companion Animal Parasite Council: Urinary Nematode Guidelines. Accessed April 2008 at www.capcvet.org/?p=Guidelines_UrinaryNematode &h=0&s=0. 2. Phylum Nemathelminthes, in Olsen OW: Animal Parasites: Their Life Cycles and Ecology. New York, Dover Publications, 1986, p 516. 3. Measures LN: Dioctophymatosis, in Samuel WM, Pybus MJ, Kocan AA (eds): Parasitic Diseases of Wild Mammals, ed 2. Ames, Iowa State University Press, 2001, pp 357–364. 4. Anderson RC: Family Dioctophymatidae, in Nematode Parasites of Vertebrates: Their Development and Transmission, ed 2. Wallingford, United Kingdom, CABI Publishing, 2000, pp 595–603. 5. Nakagawa TL, Bracarense AP, dos Reis AC, et al: Giant kidney worm (Dioctophyma renale) infections in dogs from Northern Paraná, Brazil. Vet Parasitol 145(3–4):366–370, 2007. 6. Monteiro SG, Sallis ES, Stainki DR: Infecção natural por trinta e quatro helmintos da espécie Dioctophyma renale (Goeze, 1782) em um cão. Revista da Faculdade de Zootecnia, Veterinária e Agronomia Uruguaiana 9(1):95–99, 2002.

ABOUT THE AUTHOR

Annette Morrison, VT, RLAT Annette is the head veterinary technician at the University of Guelph’s Campus Animal Facility in Guelph, Ontario. Annette’s personal interests include veterinary medicine in developing nations. She and her children, Colin and Rachel, share their home with two dogs, Pyper and Rosie (the subject of this case report), and a cat, Levi. When she is not working, Annette enjoys hiking, camping, and gardening.

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EquineEssentials

Neonatal Candidiasis

Bradford G. Bentz, VMD, MS, DACVIM, DABVP (Equine) Hagyard Equine Medical Institute Lexington, Kentucky

ANDIDIASIS is an infection of the skin or mucous membrane(s) caused by any species of Candida. Case reports describing candidiasis in foals have been reported sporadically1–5; however, the epidemiology of equine neonatal candidiasis has not been described.

Lingual candidiasis in a foal.

Based on the few equine reports that exist, candidemia and disseminated systemic candidiasis appear to be relatively uncommon in foals. In humans, the incidence of these conditions may be associated with treatment and management factors that are more commonly related to neonatal intensive care. Risk factors identified for human neonatal candidiasis include preterm birth; low birth weight; disruption of cutaneous barriers; mechanical ventilation; prolonged umbilical catheter use; use of central lines; intravenous hyperalimentation; administration of fat emulsions, broad-spectrum antibiotics, H2-blockers, aminophylline, or corticosteroids; bacterial sepsis; disseminated intravascular coagulation; and preexisting fungal colonization of the trachea or gastrointestinal (GI) tract.6–8 Equine case reports that refer to Candida spp include a group of pediatric foals (i.e., 7 days to 6 months of age)1,2,4 with superficial infections and another group of younger foals (1 to 3 days of age) in which Candida spp were recovered from blood culture and/or joint fluid suggestive of a period of candidemia.3,5 The table on pages 304–305 summarizes the clinical findings of documented case reports for comparison. In a 6-year prospective study of human neonatal intensive care unit admissions, the overall incidence of invasive candidiasis was 300

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reported to be approximately 1.28%.9 Recovery of Candida spp from human neonatal cases reportedly includes Candida albicans (65.5%), Candida parapsilosis (15.5%), and Candida tropicalis (7%), with the incidence of non–C. albicans on the rise in neonatal intensive care units.9,10

Pathogenesis and Colonization Mucosal and skin colonization are reportedly of great importance in the pathogenesis of neonatal candidiasis, and a strong correlation exists between colonization of the GI tract and systemic disease.10 Colonization of the tongue in critically ill equine neonates is well recognized. However, colonization alone does not invariably lead to disease, and a number of risk factors that facilitate the ability of Candida spp to colonize and exhibit virulence have been proposed. Nearly 60% of healthy humans carry C. albicans as a commensal organism in the oral cavity, and 23% to 75% of healthy human volunteers had Candida spp in the small intestine, colon, or rectum.10 Most bloodstream isolates are found to be the same strains colonizing the GI tract, and recovery increases after hypoxia or parenteral treatment with endotoxin or dexamethasone.10 Up to 10% of human infants admitted to a nursery are *Adapted from Bentz BG: Neonatal candidiasis. Compend Equine 1(3):153–157, 2006; reprinted with permission.

www.VetTechJournal.com

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EquineEssentials Comparison of Signalment, Clinical Findings, Therapies, and Outcomes in Equine Case Reports Age

Number of Foals Reported

BroadSpectrum Antibiotics

Multiple Antibiotic Changes

Septicemia

Septic Arthritis

Respiratory Infection

Gross and Mayhew2

3–6 mo

—

McClure et al4

7 days– 5 mo

Unclear; presumably 8 of 8

Unclear

6 of 8

Lavoie and Harnagel3

24 hr

Yes

—

Unclear

Yes (Candida spp)

Yes

Reilly and Palmer5

Newborn– 3 days

4 of 4

3 of 4 (Candida spp in 1)

—

3.5 mo

Yes

—

Yes

Study

de Bruijn and Wijnberg1

colonized with Candida spp.10 Preterm birth is associated with numerous other risk factors in addition to colonization; therefore, preterm infants are at greater risk for local or disseminated disease. Colonization of the stomach is enhanced when the pH is greater than 3; thus antiulcer therapy may play a significant role in the colonization and pathogenesis of Candida spp infections of the GI tract.10,11 High-risk patients with compromised mucosal integrity from conditions such as enteritis or necrotizing enteritis are expected to be at risk for disseminated candidiasis.10,11 Colonization of immunosuppressed neonates may further predispose them to systemic candidemia or disseminated candidiasis. Nonperinatal nosocomial Candida spp infections are commonly traced back to the hands of humans working in intensive care units.10,12 C. albicans and C. parapsilosis are reportedly the most common isolates found on the skin and are the most common organisms associated with catheter-related infections in human neonates.10 Antimicrobial therapy may produce alterations in colonization density and in normal bacterial flora, thereby permitting commensal bacterial numbers to decrease and the density of Candida spp colonization to increase.

Systemic Disease Invasive neonatal candidiasis is usually caused by C. albicans infection, although infection with C. tropicalis, C. parapsilosis, or other isolates has been reported.8 The disease severity and susceptibility to antifungal agents appear to 304

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differ among species.8 Macroscopic “fungus balls” reportedly occur with C. albicans and C. tropicalis infections. These large, intertwined collections of pseudohyphae are associated with unusual presentations of neonatal invasive candidiasis, such as urethral obstruction, acute renal failure, hydrocephalus, or hemodynamic and embolic sequelae.8 Candida spp may invade nearly all tissues, including the retina, brain, heart, lungs, liver, spleen, and joints. End-organ invasion rates in human neonates with candidemia are as follows7: Meningitis (15%) Central nervous system abscesses and ventriculitis (4%) Endocarditis (4%) Enophthalmitis (3%) Renal abscesses (3%) Hepatic/splenic abscesses (1%) In foals, the overall mortality rate of candidiasis appears to be very high (see table above).

Diagnosis Diagnosing candidiasis is difficult for clinicians; conducting a blood culture is the standard diagnostic test. Despite a very high specificity of blood culture for candidiasis, the sensitivity of blood culture is poor.7 Increased organ involvement positively correlates with culture of Candida spp from the blood7; therefore, a positive culture may be associated with extensive organ involvement and a poorer prognosis. New molecular tests are being developed www.VetTechJournal.com

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EquineEssentials Involving Candida spp Fungal Plaques on Tongue

Antiulcer Therapy

Corticosteroid Administration

Diarrhea and/or Enteritis

—

2–4 of 8

—

Isolates Reported

Antifungal Therapy

Outcome

4 of 5

C. albicans C. krusei (2)

—

5 of 5 died

2 of 8

3 of 8

—

8 of 8

7 of 8 died

Yes

—

Yes

C. tropicalis

—

Died

3 of 4

—

C. albicans (4 of 4)

4 of 4

2 died and 2 survived (both received fluconazole)

—

Yes

C. glabrata

—

Died

to facilitate earlier and more accurate diagnosis of candidiasis. A β-glucan assay with 85% sensitivity and specificity has been developed to identify a major component of the fungal cell wall found in all clinically relevant species of Candida in the human neonatal intensive care unit. D-Arabinitol is a major metabolite of most Candida spp. Although both D and L isoforms of arabinitol are found in normal urine, an increase in the D-arabinitol:creatinine ratio is moderately sensitive (40%) and an increase in the D:L arabinitol ratio is both sensitive and specific (>90%) in diagnosing candidiasis using urine or blood.7 Polymerase chain reaction (PCR) amplification of a highly conserved 18S ribosomal RNA gene was found to be sensitive compared with culture in detecting candidemia.7,8 However, fungal PCR contamination (18% to 35%) limits the accuracy of a positive fungal PCR assay in patients with negative blood cultures.7 Ancillary cultures (e.g., tracheal wash, urine culture) cannot be reliably used to indicate neonatal candidemia.7

Treatment Therapy for invasive equine neonatal candidiasis includes the use of fluconazole, miconazole, and amphotericin B.5 For human neonates, fluconazole and amphotericin B reportedly exhibit reliable antifungal activity.7,13 Because a significant component of mortality due to candidiasis is delay in diagnosis and therapy, some investigators have advocated empiric antifungal therapy for immunocompromised human neonates. These decisions are www.VetTechJournal.com

based on clinical judgment and proposed risk factors, but at least one investigation has shown no benefit from empiric therapy.7 To help prevent disseminated candidiasis, empiric therapy has been used in critically ill equine neonates that exhibit colonization of the tongue. The benefit of such therapy is undefined. Amphotericin B is a polyene antifungal agent that binds to ergosterol, a sterol component unique to the fungal cell membrane, causing leakage of cytoplasm and fungal death.13 Although there are reports of the development of resistance in Candida krusei and Candida glabrata, treatment success with amphotericin B alone is reported, with doses ranging from 0.5 to 1.5 mg/kg.13 The duration of amphotericin B therapy is controversial, but most clinicians suggest a minimum of 14 days.13 Nephrotoxicity is a major consideration in its use, but toxicity in humans is generally reported to be mild and to resolve after cessation of therapy.13 Other concerns for the use of amphotericin B in adults relate to the potential for immediate adverse drug reactions, including fever, rigor, and chills.13 Lipid formulations of amphotericin B are available; they are efficacious in human neonatal patients and reportedly have a reduced potential for toxicity. However, conventional formulations of amphotericin B appear to be well tolerated in human neonates and are much less expensive.13 Flucytosine disrupts fungal DNA synthesis and has been used in combination with amphotericin B to treat candidiasis. The rationale for combination therapy is based on increased Veterinary Technician | MAY 2008 305

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Glossary Fungistatic_Having an inhibiting effect on the growth of a fungus Hydrocephalus_Abnormal accumulation of cerebrospinal fluid in the ventricles within the brain Nosocomial_Acquired during the treatment process Sequela_Medical condition that results from a prior disease

cerebrospinal fluid penetration of flucytosine compared with amphotericin B and proposed synergy between these two agents. Flucytosine is generally not recommended for use alone because Candida spp appear to rapidly develop resistance when the drug is used as monotherapy.13 Fluconazole is an azole antifungal agent that inhibits the fungal enzyme 14-α-sterol demethylase and prohibits ergosterol production.13 This drug readily penetrates cerebrospinal fluid, the brain, the liver, the spleen, and renal tissue13 and is excreted in the urine, making it an excellent selection for urinary tract candidiasis. Azoles are fungistatic but generally active against C. albicans, C. parapsilosis, C. tropicalis, and Candida lusitaniae.13 Intrinsic resistance to fluconazole has been observed in cases of C. krusei and C. glabrata infection.13 It is recommended that human neonates receive a loading dose of 10 mg/kg of fluconazole, followed by a maintenance dosage of 5 mg/kg/day for 28 to 42 days.13 Although other anti–Candida spp therapies (e.g., voriconazole, caspofungin) have become available and have potentially advantageous toxicity and sensitivity profiles, Candida isolates have reportedly been 100% susceptible to amphotericin B and 97.5% susceptible to azoles.9 It is unclear how the isolation rates of various Candida spp from humans and their relative sensitivities would compare with those from equine neonatal patients. Therefore, the current antifungal therapy for equine neonatal candidiasis must be based on extrapolation from human neonatal studies.

Conclusion At this time, therapy with amphotericin B (with or without flucytosine) or fluconazole alone is recommended to treat foals with candidiasis. However, clinicians and veterinary technicians should be familiar with all of the antifungal agents on the market as

ABOUT THE AUTHOR

Bradford G. Bentz, VMD, MS, DACVIM, DABVP (Equine)

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well as keep abreast of any new products that are in development. Equine-specific epidemiologic and clinical reports may be beneficial in ascertaining the best antifungal therapy for equine neonatal patients.

References 1. de Bruijn CM, Wijnberg ID: Potential role of Candida species in antibiotic-associated diarrhoea in a foal. Vet Rec 155:26–28, 2004. 2. Gross TL, Mayhew IG: Gastroesophageal ulceration and candidiasis in foals. JAVMA 182(12):1370– 1373, 1983. 3. Lavoie JP, Harnagel SH: Nonsurgical management of a ruptured urinary bladder in a critically ill foal. JAVMA 192(11):1577–1580, 1988. 4. McClure JJ, Addison JD, Miller RI: Immunodeficiency manifested by oral candidiasis and bacterial septicemia in foals. JAVMA 186(11):1195–1197, 1985. 5. Reilly LK, Palmer JE: Systemic candidiasis in four foals. JAVMA 205(3):464–466, 1994. 6. Johnsson H, Ewald U: The rate of candidemia in preterm infants born at gestational age of 23–28 weeks is inversely correlated to gestational age. Acta Paediatr 93:954–958, 2004. 7. Benjamin Jr DK, Garges H, Steinbach WJ: Candida bloodstream infection in neonates. Semin Perinatol 27(5):375–383, 2003. 8. Chapman RL, Faix RG: Invasive neonatal candidiasis: An overview. Semin Perinatol 27(5):352–356, 2003. 9. Roilides E, Farmaki E, Evoridou J, et al: Neonatal candidiasis: Analysis of epidemiology, drug susceptibility, and molecular typing of causative agents. Eur J Clin Microbiol Infect Dis 23:743–750, 2004. 10. Bendel CM: Colonization and epithelial adhesion in the pathogenesis of neonatal candidiasis. Semin Perinatol 27(5):357–364, 2003. 11. Linder N, Levit O, Klinger G, et al: Risk factors associated with candidemia in the neonatal intensive care unit: A case-control study. J Hosp Infect 57:321–324, 2004. 12. Reef SE, Larsker BA, Butcher DS, et al: Nonperinatal nosocomial transmission of Candida albicans in a neonatal intensive care unit: Prospective study. J Clin Microbiol 36(5):1255–1259, 1998. 13. Bliss JM, Wellington M, Gigliotti F: Antifungal pharmacotherapy for neonatal candidiasis. Semin Perinatol 27(5):365–374, 2003.

Dr. Bentz is an internist at the Hagyard Equine Medical Institute in Lexington, Kentucky. His professional interests include equine neonatology/pediatrics, neurology, antiviral therapy, and sport horse medicine. Dr. Bentz has two sons, Ian Bradford and Luka Anthony, and one daughter, Nicole Marie. In his spare time, he enjoys spending time with his children, playing guitar, hunting, and playing sports.

www.VetTechJournal.com

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TechTips

TIP of the MONTH Courtesy of www.outdoorsuperstore.com

When performing a dental prophylaxis, I find it difficult to position an overhead light to see inside the patient’s mouth. Instead, I use a head-mounted light (typically used for hiking or camping). It works well to show the “nooks and crannies” in the teeth. Teresa Earnheart, LVT Lawrenceville, GA Dental Do’s

Critical Care Cues

Our dental machine holds several sharp instruments on its front hangers. To reduce the risk of employee injury by one of these instruments, we cover each instrument with a 60-ml syringe case. The syringe cases are labeled so that they don’t get inadvertently thrown away when they are off the instruments. Lane Gilreath, RVT, and Julie Lowe, RVT Gainesville, GA

When an animal that is seizuring is admitted to the hospital, I place a “seizure watch” sticker on the cage and write the prescribed dose of Valium in milliliters. If the patient starts to have seizures, we can quickly administer the Valium without looking in the patient’s chart. Heather Pressdee, CVT Cheswick, PA

To prevent a dental elevator from being damaged when it isn’t being used, cover it with a 6-ml syringe case packed loosely with a small amount of cotton or gauze. Thomasina Cristobal Monterey, CA To make dental sealant easier to apply, we place the application tubes under the heating blanket that’s been placed over the patient. The heat causes the sealant to melt slightly. Mary May Madison, AL 308

Each published Tip of the Month contributor receives a Veterinary Technician® scrub top in addition to $50.

MAY 2008 | Veterinary Technician

I use puppy pads to line the cages of patients that are being treated for parvovirus. The pads more easily absorb vomitus and diarrhea, thereby cutting cleanup time in half. Anna Dyess Lehigh Acres, FL

By the Book I compiled basic information (e.g., vital signs, gestation periods, life span) about various exotic species that we rarely see at our practice. I wrote the information on index cards, laminated the cards, and then attached them to a key ring. We keep the cards in the treat-

ment area so that we don’t have to look up this information in a book when treating an exotic animal. Jennifer Simmons, LVT Leesburg, VA To encourage clients to prevent obesity in their dogs, our hospital compiled a book of local hiking trails that allow dogs. We also included photos of the staff’s dogs on the trails. The “Happy Trails” book is kept in our reception area for our clients to view. Encouraging clients and their dogs to exercise strengthens the human–animal bond as well as their bond with our practice. Christina Bouras Dover, NH We keep a notebook in our lab area by the microscope to record the results obtained from ear and fecal cytology samples. If a veterinarian or technician forgets to record the results in the patient’s chart, it is easy to look them up in the lab notebook. Jessica Menke, CVT, CVMRT Coon Rapids, MN www.VetTechJournal.com

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“The vet called it a foreign object. I just called it delicious.” Arabella Twinkletoes, age 1

DOGS WILL BE DOGS, THAT’S LIFE. EVERY SIX SECONDS A PET OWNER IS FACED WITH A $1,000 VET BILL. THAT’S LIFE TOO! Protect your clients and their pets by recommending Petplan® insurance — recommended by more veterinarians and pet owners than any other and for good reason. Clients insured with Petplan®: • receive full coverage for hereditary conditions • are reimbursed what their vet charges them, not what a benefit schedule dictates • are insured for chronic conditions for life So join the Petplan® family and give your clients the best protection money can buy.

The world’s largest and most trusted pet health insurance provider To arrange a free educational “lunch and learn” or to order materials for your practice jump onto the website at www.gopetplan.com or call toll-free 1.866.gopetplan (1.866.467.3875) Circle 197 on Reader Service Card All coverage is subject to the applicable policy descriptions, conditions, limitations, exclusions and all state and federal laws. Underwritten by American National Property and Casualty Company, rated A+ (Superior) by AM Best.

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ProductForum Merck/Merial

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This 1,300-page manual, geared toward pet owners, provides easyto-read information on numerous topics, from preventive care to the treatment of common diseases and disorders that affect companion animals, including dogs, cats, horses, birds, fish, and reptiles and other exotic species. This book can be recommended to clients who are interested in learning more about maintaining the health of their pet. Special sections cover topics such as emergency care and first aid; common diagnostic tests, including complete blood counts, bacterial cultures, biopsies, and urinalyses; zoonotic diseases; and common drugs used in pets. A portion of the proceeds from the sale of this manual, which is published on a not-for-profit basis, will be donated to the Embery Institute for Wildlife Conservation.

The American Association of Equine Practitioners has identified West Nile virus, Eastern equine encephalomyelitis, Western equine encephalomyelitis, tetanus, and rabies as the five diseases that should be included in a core vaccination protocol for adult horses. Fort Dodge Animal Health now offers West Nile-Innovator+ EWT — “The Mosquito Shot,” the only vaccine that protects against four of the five diseases — West Nile virus, Eastern equine encephalomyelitis, Western equine encephalomyelitis, and tetanus — in one vaccine. Fort Dodge also offers alternative combinations, such as the West Nile-Innovator+EW and West NileInnovator+VEWT, to ensure that patients receive the most complete protection for their geographic region. For previously vaccinated horses, the Mosquito Shot is labeled for a single dose annually and should be administered in the spring. Horses that have never been vaccinated against West Nile virus must receive two doses, 3 to 6 weeks apart.

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For more information about the products highlighted in this section, fill out and return the Reader Service Card inserted between pages 264 and 265 of this issue. The product and service descriptions presented in Product Forum are provided by the manufacturers and are not necessarily endorsed by Veterinary Technician.

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ProductForum Andersen Products

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Andersen Products has introduced the EOGas 4 Sterilizer with a 3½-hour, 122°F (50°C) cycle, which helps promote productivity for veterinary hospitals, laboratories, and commercial customers. Its unique dose of 100% ethylene oxide, combined with a substantially improved sterilization bag, allows fast and gentle sterilization. The EOGas 4 can sterilize expensive instruments, such as fiber-optic scopes, surgical sharps, and ophthalmic and orthopedic instruments, without damage.

Greenies introduces two new products. Greenies Senior canine dental chews offer preventive oral care for dogs age 7 or older. The chews are formulated with glucosamine and chondroitin to improve joint health and with antioxidants to boost and support the immune system. Greenies Lite dental chews offer the same preventive oral care benefit as Greenies dental chews, but with fewer calories. Both products have been given a seal of acceptance from the Veterinary Oral Health Council.

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Index to Advertisers For more information about products advertised in this issue, see the Reader Service Card inserted between pages 264 and 265.

Company Abaxis American Kennel Club American Veterinary Medical Association ASPCA Atlantic Coast Veterinary Conference Bayer Animal Health Ceva Animal Health Fort Dodge Animal Health The Greenies Company Hill’s Pet Nutrition Lilly Merial Petplan Insurance Pfizer Animal Health Sharn Veterinary, Inc. St. Petersburg College Summit VetPharm Veterinary Learning Systems Vetstreet

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Animal Poison Control Center 20th Annual Atlantic Coast Veterinary Conference resQ D.A.P. Diffuser, Spray, and Collar ProMeris Pill Pockets Oral Health Roundtable Prescription Diet Canine r/d Comfortis Reconcile Frontline Plus Pet Insurance Revolution Slentrol Cardell Monitors Online Veterinary Technology Program Vectra 3D Veterinary Technician® Is Now Free VetLearn.com Practice Communication and Marketing Tool

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196 195 160 136 156 193 183 197 198 153 151 181 127

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Page # 285 267 301 281 283 270, 271 279 Cover 4 Cover 3 Cover 2 (Canada only) Cover 2 (US only) 287, 289 295, 296 259 309 291, 292 261, 265 307 310 277 263 (US only) 320 302–303

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FOR MORE INFORMATION OR TO PLACE AN AD, CONTACT LINDA COSTANTINI Phone 800-426-9119, ext 2422, or 267-685-2422 Fax 201-231-6373 • Email lcostantini@vetlearn.com www.VetTechJournal.com

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ClassifiedAdvertising TECHNICIANS WANTED

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Critical Care Nursing Instructor The Department of Clinical Sciences, College of Veterinary Medicine, Auburn University invites applications for Instructor in Veterinary Critical Care Nursing in the Auburn University Critical Care Program. The individual selected will participate in all aspects of the Small Animal Teaching Hospital Critical Care Service and supervise the Intensive Care Unit (ICU). The selected candidate will be a certified veterinary technician and with a national reputation in critical care nursing and have extensive supervisory experience in an educational setting. A Masters degree or equivalent professional experience is required. Certification by the Academy of Veterinary Emergency and Critical Care Technicians (AVECCT) and eligibility for an Alabama State veterinary technician’s license is preferred. Responsibilities will include instruction and training of veterinary technicians and students in the DVM curriculum, staff scheduling, development of ICU protocols, coordination of ICU patient services, facilitating data collection for clinical research, and development of continuing education programs for veterinary technicians. A portion of the Instructor’s time will be spent as a team member of the veterinary ICU nursing staff on the clinic floor. Opportunities will be created for didactic and laboratory teaching and participation in management training opportunities. Review of applications will begin May 15, 2008 and continue until the position is filled. Applications should include: a letter of intent, a curriculum vitae, and names, mailing addresses, telephone numbers, and email addresses of three professional references. Please send inquiries to: Dr. Jim Wohl, Search Committee Chair, Auburn University, Department of Clinical Sciences, College of Veterinary Medicine, Auburn, AL 36849-5540. Telephone: 334-844-4690. Email: wohljam@auburn.edu; Please send applications to: Mrs. Amy Bylsma, Auburn University, Department of Clinical Sciences, Auburn, AL 36849-5540. Telephone: 334-844-8513. Email: bylsmaj@auburn.edu, with the original documents to follow by mail. For a complete description of this position, please see website: http://www.vetmed.auburn.edu/index.pl/employment.

Auburn University is an Affirmative Action/Equal Opportunity Employer. Minorities and women are encouraged to apply. The candidate selected for this position must be able to meet eligibility requirements to work in the United States at the time appointment is scheduled to begin and continue working legally for the proposed term of employment; excellent communication skills required.

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cian 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.

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ClassifiedAdvertising TECHNICIANS WANTED ARIZONA – Two career-oriented, full-time technicians needed for outstanding emergency and specialty hospital located in Tucson. Excellent benefits include health/dental, CE allowance, and paid time off. Fun-loving, friendly work environment with lots of Tucson sunshine!! If you’re tired of shoveling snow, visit www.southernazvets.com to download an application; email your resume to hr@southernazvets. com; or mail your resume to HR, 141 East Fort Lowell Road, Tucson, AZ 85705. CALIFORNIA – Experienced technician needed for

Humane Society Silicon Valley’s shelter hospital to provide medical exams, vaccinations, x-rays, blood draws, fecals, dentals, and other procedures. Improve quality of life and enhance adoptability of shelter guests through timely treatments and medical plans. Apply online at www.hssv.org; email jobs@hssv.org; or mail application/resume to HSSV, Attn: Human Resources, 2530 Lafayette Street, Santa Clara, CA 95050; fax: 408-988-2872.

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. COLORADO – Busy mountain practice in gorgeous Gun-

nison seeks full-time certified or experienced veterinary technician. Applicant should be skilled in anesthesia, nursing, radiology, lab work, dental care, and venipuncture. Work with our board-certified internal medicine specialist and a local orthopedic surgeon. We have a complete in-house lab, state-of-the-art anesthesia equipment, ultrasound, fiber optics, x-ray and dental x-ray, EKG, and a blood pressure unit. We emphasize individualized patient care. Compensation is commensurate with experience. Benefits include CE, uniform allowance, pet care discounts, health insurance stipend, and matching IRA. Gunnison is located in the Rocky Mountains and provides a wealth of outdoor recreational activities. Please contact Dr. Steffanie Jacobson, DVM, DACVIM: call 970-641-2460; fax 970-641-0817; email rockymountainvet@yahoo.com.

CONNECTICUT – Five-doctor, veterinarian-owned, AAHA-

accredited hospital in Norwalk needs a technician. Work in a fun environment that promotes teamwork and personal growth. Great salary and benefits, including continuing education at national meetings. Contact Dr. Michele Lamothe at 203-846-3495 or email brah@aol.com. Visit us at www. broadriveranimalhospital.com.

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 – The Cat Hospital of Orlando is seeking a fulltime veterinary technician with a commitment to excellent patient care. Applicant must be accomplished in phlebotomy, catheter placement, laboratory procedures, surgical support, and dental prophylaxis. Compensation is 314 MAY 2008 | Veterinary Technician

TECHNICIANS WANTED

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 commensurate with experience and qualifications. Full benefits. Fax resume to 407-831-5434. Visit our website at www.kittydoctor.com.

FLORIDA – Emergency Pet Care LLC, an off-hours small animal emergency hospital located in Jacksonville, is seeking a dedicated, passionate CVT to be our head treatment nurse. Responsibilities include: nursing duties, patient advocacy, inventory and equipment management, staff education, client management, and basic managerial responsibilities. We have a variety of “toys” to work with, including: digital x-ray, ultrasound, Doppler blood pressure, vital scan monitor, full in-house blood machines, endoscope, fluid/syringe infusion pumps, VetEd tablets, and Avimark software. Our doctors are always willing to share knowledge and CE is available and encouraged. Candidates for this full-time, salaried position must possess excellent communication skills, a professional work ethic, and a minimum of 4 years’ technical experience. We offer a generous benefit package, including CE, health benefits, and a flexible schedule in a thriving beach community. Nights, holidays, and weekend hours required. Mail resume, attn: Office Manager, to 14185-7 Beach Blvd., Jacksonville, FL 32250. FLORIDA – Veterinary hospital in Palm

Coast is seeking a full-time, experienced technician to join our team. Florida state licensure is preferred, but applicants with hands-on experience in a small animal hospital will be considered. Candidate must demonstrate proficiency in all skills necessary for basic patient care, anesthesia, radiography, and surgical assistance, such as placing IV catheters, anesthesia and intubation, venipuncture, surgical preparation and monitoring, restraint, assessment and triage, radiograph techniques, dental prophylaxis, client education, and general care of companion animals. Competitive salary and benefits for the right person. Qualified applicants please contact: Lynn Williams Safe Haven Veterinary Hospital 30 Lupi Court, Palm Coast, FL 32137 Email: LWilliams@safehavenvet.com Fax: 386-446-8317

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

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*Source: December 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

GEORGIA – Consider practice in beautiful Atlanta. Whether ified candidates, please email resume to lori.harris@ 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 – Full-time licensed/registered veterinary technician needed at our referral-only specialty practice in Atlanta. Board-certified specialists in internal medicine and surgery. Excellent benefits package: paid vacation, retirement plan, health insurance, competitive pay. No weekend work. Please email garmco@bellsouth.net for more information.

GEORGIA – Full-time licensed veterinary technician needed for growing small animal clinic. Great opportunity for a dependable, hard-working team player. Please contact Dr. Donita McElroy: Pet Med Plus, 2848 Holcomb Bridge Road, Alpharetta, GA 30022; call 770-993-7887; or fax 770649-1614.

ILLINOIS – Full-time positions available for CVTs at our fast-paced, 24-hour referral hospital in the Chicago area. The right candidates are energetic, detail-oriented, dependable self-starters. We offer a competitive salary and benefits package, including 401(k), company-sponsored CE, health insurance, paid vacation, and much more. Come join our team, where you will utilize all of your skills daily. Qual-

vcamail.com; or fax 708-749-1716.

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.

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

is JULY, which closes MAY 28 For information about ad placement, call Liese Dixon at 800-920-1695.

reach over 18,600 total qualified subscribers* with your ad in Veterinary Technician classifieds. We offer discounts for multiple ad placements, whether in one journal or 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 www.VetTechJournal.com

To place your classified or Market Showcase ad, contact us today! Veterinary Technician | MAY 2008 315

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TECHNICIANS WANTED

MAINE – Full-time veterinary technician position available 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.

at two-doctor small animal practice 30 minutes from Acadia National Park on Maine’s beautiful coast. Our hospital is well-equipped with modern, well-maintained equipment. We pride ourselves on offering current, high-quality medicine. Excellent pay and benefits. Come join our team and use your skills to your maximum potential! Contact Anne McArdle: Schoodic Animal Hospital, 2345 US Highway 1, Sullivan, ME 04664; phone 207-422-9999.

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

ILLINOIS EXPERIENCED TECHNICIANS and CVTs WANTED Are you a professional? We have full-time positions open for CVTs or experienced emergency and critical care technicians to become members of our team. Our hospital is a 24-hour emergency and treatment center that features specialty surgery, critical care, and internal medicine. Our team of veterinarians and technicians is here because they believe that emergency and critical care offers the opportunity to practice the highest level of veterinary medicine. Sound challenging? We think so! We are looking for technicians who have the desire to learn and want to expand their knowledge and acquire new skills in these specialty fields. We offer a competitive salary and complete benefits package.

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

ILLINOIS – State-of-the-art emergency practice in the heart of Chicago is seeking talented veterinary technicians to join our team of compassionate, care-oriented, adrenaline-fueled supertechs. There’s never a dull moment at Chicago’s only after-hours emergency service, open nights, weekends and holidays. Enjoy all that Chicago has to offer by day; practice by night. We offer a flexible schedule, competitive salary, comprehensive benefits package, and an environment focused on patient care. Contact Alice Murtas, Chicago Veterinary Emergency Services 3123 North Clybourn Avenue, Chicago, IL 60618 Phone: 773-281-7110; Fax: 773-281-7928 Email: alice@chicagoveterinaryemergency.com.

316 MAY 2008 | Veterinary Technician

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

Come join the Tufts team on our beautiful Grafton campus! Put your skills to work in our state of the art teaching hospitals where certification, education and experience are rewarded. Challenge yourself to excel in an environment that values Veterinary Technicians as essential team members.

VETERINARY TECHNICIANS • Small Animal Emergency and Critical care • Small Animal Medicine • Large Animal Medicine • Neurology • Anesthesia • Animal Care Attendants • Pharmacy opportunities Competitive salary and outstanding benefits package. Apply online or call the Human Resources Office for more information. Tufts University is an AA/EO employer and actively seeks candidates from diverse backgrounds.

Cummings School of Veterinary Medicine at Tufts University. (508) 839-7975

www.tufts.edu

MASSACHUSETTS Cape Animal Referral and Emergency Center (C.A.R.E.) is excited to offer a CVT/RVT the opportunity to grow with us in our newly formed oncology service. C.A.R.E. is seeking candidates who possess strong technical skills, a broad knowledge base, and the desire to become an integral part of the growth and development of the oncology service. Primary responsibilities will include supporting our board-certified oncologist with client relations, patient nursing, administration of chemotherapeutic agents, and client education regarding the treatment of cancer in companion animals. We offer a competitive salary, 100% paid medical benefits (full-time employees), CE reimbursement, paid vacation, uniform reimbursement, and personal pet benefits. C.A.R.E. is well equipped with all the state-of-the-art equipment that you would expect at a progressive referral and emergency facility. Our beautiful, cutting-edge facility is located on Cape Cod and is the only 24/7 referral and emergency hospital serving Cape Cod and the Islands. Our 10,000–sq. ft. facility contains our emergency service as well as veterinary specialists in surgery, internal medicine, oncology, ophthalmology, and cardiology. In addition, we are now proud to offer rehabilitation services and acupuncture to our patients. The C.A.R.E. team works hard and plays hard! If you share our love of veterinary medicine, please contact our nursing supervisor, Danielle Provost, CVT, at 508-398-7575 or email dprovost@carevet.net. You may also visit us at our website at www.carevet.net.

PLACE YOUR AD:

VetTechClassifieds@vetlearn.com www.VetTechJournal.com

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TECHNICIANS WANTED

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.

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.

Registered Veterinary Technicians Needed

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.

Full-time RVT wanted for family-oriented five-doctor animal hospital in Charlotte. Competitive salary and excellent benefits. Fax resume to 704-369-0789; email dpmanager@mallardcreekvet.com; or call 704-598-6525.

NORTH CAROLINA

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 YORK – Full-time LVT for busy, progressive small animal practice in central New York. Experience preferred but will consider new graduate. Familiarity with IDEXX VetLyte, LaserCyte, and VetTest a plus. Proficiency with anesthesia and lab work required. No emergency coverage; rotating weekends. We utilize our technicians to their full potential! Contact Dr. Marcia Ziegler-Alexander at mezdvm@aol.com.

NEW YORK – Licensed or license-eligible technician needed at six-veterinarian, AAHA-accredited, 24/7 fullservice hospital on the Upper East Side. Digital x-ray, ultrasound, VetScan, endoscope, laser surgery, and excellent technical support. Appointments 7 days/week. Competitive pay and benefits; flexible schedules. See website: www.parkeastanimalhospital.com. Fax or email resume: 212-355-3620; parkeast@aol.com. NEW YORK – Great opportunity for licensed or licenseeligible veterinary technician at Central Animal Hospital in Scarsdale, 30 minutes from NYC. We are a team-oriented, six-doctor/six-tech, AAHA-accredited small animal hospital with the latest equipment. Benefits: 4-day work-week, competitive salary, CE, medical, six paid holidays, 2 weeks’ vacation, 401(k)/profit sharing plans. Apartment available. NO night emergencies! Call Paul Staar 914-723-1250. 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.

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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

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.

OHIO

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 – Shaker Animal Clinic is seeking a lead veterinary technician who is registered in Ohio and has management experience. This individual must be a self-motivated, highenergy team player who is comfortable in a fast-paced environment. We are a dynamic, full-service small animal veterinary clinic with digital radiography, ultrasound, endoscopy, and I-131 therapy. Full-time employees are eligible for health insurance, paid vacation and holidays, and discounted services. Salary commensurate with experience. Please fax resume to our practice manager, Tiffany Westfall, at 216-561-3825; or email thooper@ shakeranimalclinic.com. No phone calls, please. 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 – Pennsylvania Veterinary Specialty and

Emergency Associates at Hickory Veterinary Hospital is looking for a CVT for our busy referral/emergency/general practice. Our facility is located in historic Plymouth Meeting, just 20 minutes northwest of Philadelphia. Our hospital is staffed by 15 technicians and 16 veterinarians — including a cardiologist, chiropractor, dermatologist, oncologist, radiologist, and specialized surgeons — as well as a competent, caring, and compassionate office and kennel staff. We are a well-established, growing, progressive, 24-hour AAHA-accredited hospital with state-of-the-art equipment and access to a local MRI facility. We are currently expanding our facility by 12,000 sq. ft., anticipating its completion by August 2008. If you are interested, please forward a resume to our hospital manager, Sharon Welsh: Pennsylvania Veterinary Specialty and Emergency Associates at Hickory Veterinary Hospital, 2303 Hickory Road, Plymouth Meeting, PA 19462; phone: 610-825-0402; fax: 610-828-8465; email: swelsh@hickoryvet.com.

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ClassifiedAdvertising TECHNICIANS WANTED PENNSYLVANIA – Full-time veterinary technician needed to join our three-doctor practice near Reading. We have a modern facility and a great staff that includes four licensed technicians. License and experience preferred but will consider others with related experience or education. Competitive wages and complete benefits package, including full employee health care coverage. Call Dr. Jim Priebe at 610-926-8866, or send resume to: Leesport Animal Hospital, 221 Hafer Drive, Leesport, PA 19533; fax 610-926-3860. PENNSYLVANIA – We are seeking the right certified veterinary nurse to join the team at Neffsville Veterinary Clinic, our six-doctor small animal practice in Lancaster. As an AAHA-accredited facility, we adhere to the highest standards of care. Our state-of-the-art hospital offers radiology, ultrasound, laser surgery, and more. The right candidate will have excellent communication skills, be highly motivated, and have the ability to work in a fast-paced, team-oriented environment. Responsibilities include surgical prep, administering and monitoring anesthesia, venipuncture, lab work, radiology, and treatment of hospitalized patients. NVC offers competitive salaries and excellent benefits, including health insurance, vacation, profit sharing, uniform allowance, continuing education, and a bonus program. Email resume to rick@neffsvillevet.com; mail to 2555 Lititz Pike, Lancaster, PA 17601; or fax to 717-569-4874. Phone: 717569-5381.

PENNSYLVANIA – Rewarding full- or part-time position 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 exceptional 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 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.

318 MAY 2008 | Veterinary Technician

TECHNICIANS WANTED 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 Professional Services Technician I Leading veterinary industry continuing education provider located in Yardley 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.

TECHNICIANS WANTED 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 – 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. 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. 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. 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.

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TECHNICIANS WANTED

TEXAS

VIRGINIA

clientele and cooperative, skilled, friendly staff. Providence Square Veterinary Clinic: phone 757-495-2961; fax 757495-6986; email chrysnz@aol.com.

$1,000 Sign-On Bonus

Technician 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!

Full-time, experienced technician wanted to join a great staff at our state-of-the-art facility in Leesburg. Position requires a hard-working, dependable, motivated, and cheerful person. Hours include afternoon shifts and some Saturdays. Full benefits package, including 401(k), health insurance, and paid leave.

Send resume to hr@aeucc.com.

Please contact Kelli Boswell: call 703-777-7781 (Monday-Friday 8–6, Saturday 9–12) or email kelli@noahvets.com.

TEXAS – Experienced veterinary technician

VIRGINIA

needed to join our established, AAHA-accredited practice. Located in northwestern San Antonio, we are a busy, full-service small animal hospital that provides complete patient care and boarding services. Technicians support six doctors through all phases of patient care and treatment. Email resume to spankratz@babcockhills.com or call 210-697-8581.

Experienced Veterinary Technicians Wanted

UTAH – We are seeking skilled veteri-

nary technicians with a perfect mix of technical and client service capabilities for a high-energy practice in the quaint 9th and 9th district in beautiful Salt Lake City. Our brand-new, state-of-the-art, AAHA-accredited facility is now open. Full-time positions are now available with very competitive wages, great benefits, and team-based work environment. Commitment to excellent patient care and client service a must! Highly motivated technicians 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

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 looking for a full- or part-time LVT VIRGINIA – We are seeking a team-oriented, experito 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.

VIRGINIA – Our busy small animal/exotics practice, located in the West End of Richmond, seeks a highly motivated, team-oriented LVT. We are offering a great benefits package that includes relocation assistance if needed. Contact our hospital administrator, Sonja Keefe, LVT, at 804672-7200. www.VetTechJournal.com

enced, 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 703-221-7225 or email dah01@earthlink.net. You may visit our website at www.dumfriesanimalhospital.com.

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

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

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

Technician Wanted Full-time, experienced technician wanted to join a great staff at our state-of-the-art facility in Leesburg. Position requires a hard-working, dependable, motivated, and cheerful person. Hours include afternoon shifts and some Saturdays. Full benefits package, including 401(k), health insurance, and paid leave. Please contact Kelli Boswell: call 703-777-7781 (Monday-Friday 8–6, Saturday 9–12) or email kelli@noahvets.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.

Veterinary Technician | MAY 2008 319

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ClassifiedAdvertising TECHNICIANS WANTED

TECHNICIANS WANTED

WASHINGTON – Experienced part-/full-time veterinary technician wanted for well-established, two-veterinarian small animal practice, where we emphasize client education. Excellent communication skills and attention to detail required. Current license preferred. A sense of humor is appreciated. Selected applicant will be an integral part of our animal healthcare team and will perform all aspects of small animal medicine, including dentistry, surgery, anesthesia monitoring, catheter placement, radiology, chemotherapy, etc. We offer a comfortable working environment and a flexible work schedule with competitive salary and benefits (including healthcare, paid vacation, continuing education, and licensing fees) plus an employer-sponsored SIMPLE retirement plan. Contact Alder Trail Animal Hospital: 5757 Highway 303 Northeast, Bremerton, WA 98311; phone: 360-377-3971; email: yeik@budsters.com.

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 – 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.

THE NEXT AVAILABLE ISSUE

is JULY, which closes MAY 28

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: 608-8452200; or email vsec@vetspecialtycare.com.

WISCONSIN – CVT position available for five-doctor

practice. 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.

To place an ad, email VetTechClassifieds@vetlearn.com, call 800-920-1695, or visit www.VetClassifieds.com.

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