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The Complete Journal for the Veterinary Health Care Team
CE Credit from Alfred State College, SUNY
Vol. 29 No. 7 | July 2008
FELINE MEDICINE AMY CAMPBELL, CVT, VTS (ECC) Measuring Success in the ICU
Nonobstructive Idiopathic FLUTD Urethral Obstruction in Male Cats
TOXICOLOGY BRIEF
Iron Toxicosis
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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, pet owners and breeders than any other. After 30 years of insuring pets around the world today Petplan insures over a million cats and dogs and is the only U.S. pet insurer to cover congenital and hereditary diseases with no dollar or time limits per condition. So join the Petplan family and give your clients the best protection money can buy.
All veterinary staff members receive up to a 15% discount. To find out how Petplan insurance can benefit your practice, jump onto the website at www.GoPetplan.com or call toll free 1.800.519.8099 to speak with a Licensed Pet Insurance Advisor. All coverage is subject to the applicable policy description, conditions, limitations, exclusions and all state and federal laws. Eligibility requirements apply. Use of the Petplan logo and brand name in the United States of America is under a license agreement between Fetch Inc and Petplan U.K . “Petplan” is the registered trademark of Petplan Limited, a wholly owned subsidiary of Allianz Cornhill Insurance PLC, a company registered and incorporated in the United Kingdom. Petplan policies in the United States are administered by Fetch Insurance Services, LLC and underwritten by American National Property And Casualty Company and American National General Insurance Company, rated A+ (Superior) by AM Best. © Fetch, Inc 04/07 PPAVF0208
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Editor’sLetter
The Complete Journal for the Veterinary Health Care Team
Vol. 29 No. 7
July 2008
EXECUTIVE EDITOR Hilda Guay 267-685-2435 | hguay@vetlearn.com MANAGING EDITOR Jill Greshes 267-685-2484 | jgreshes@vetlearn.com EDITORIAL Liz Donovan, Assistant Editor 267-685-2448 | edonovan@vetlearn.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 DiCindio, Senior Production Manager 267-685-2405 | mdicindio@vetlearn.com Elizabeth Ward, Associate Production Manager 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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Welcoming Dentistry and Equine Section Editors Over the next couple of months, you are going to see some new names in the pages of the journal. Jeanne R. Perrone, CVT, VTS (Dentistry), has been appointed Dentistry Section Editor, and DeeAnn Wilfong, BS, CVT, has been named Equine Section Editor. The role of the Section Editors is to acquire articles for publication in Veterinary DENTISTRY SECTION EDITOR Technician® on current topics in their given Jeanne R. Perrone, CVT, area of expertise. This will help us to keep VTS (Dentistry) you up-to-date about current trends in these areas. We plan to announce several other appointments within the next couple of months. Jeanne and DeeAnn were selected because of their exceptional contributions in their given fields. Jeanne is president of the Academy of Veterinary Dental Technicians. She became credentialed as a Veterinary Technician EQUINE SECTION EDITOR Specialist in Dentistry in 2006. She has been DeeAnn Wilfong, BS, CVT involved in veterinary dentistry for almost 16 years. From 2002 to 2006, she held several positions — dentistry technician, clinical coordinator, teaching assistant, and technician student supervisor — in the Dentistry and Oral Surgery Service at the University of Illinois Veterinary Teaching Hospital. Since August 2006, she has worked as a dentistry technician at Tampa Bay Veterinary Specialists in Largo, Florida. Jeanne also teaches dentistry in the veterinary technology program at St. Petersburg College in St. Petersburg, Florida. DeeAnn serves as president-elect of the American Association of Equine Veterinary Technicians. She has worked in equine specialty practice for almost 9 years. She was employed at the Littleton Large Animal Clinic in Littleton, Colorado, until 2005, after which she accepted a position in the internal medicine department at Rood & Riddle Equine Hospital in Lexington, Kentucky, and later in the anesthesia department at Oregon State University. DeeAnn recently returned to the Littleton Large Animal Clinic. The fields of veterinary dentistry and equine medicine have seen rapid growth and numerous changes over the past several years. Jeanne and DeeAnn will play an integral role in helping us keep you informed about advancements that are taking place in these areas. Welcome Jeanne and DeeAnn!
Hilda Guay, Executive Editor Veterinary Technician | JULY 2008
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Contents
The Complete Journal for the Veterinary Health Care Team
July 2008 Amy Campbell, CVT, VTS (ECC)
Tracy Powell
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Volume 29, Issue 7 For the benefit of those who wish to participate in the CE Program, the peer-reviewed CE articles contained in Veterinary Technician® meet the standards set by Alfred State College for 0.5 credit hour. Documentation will be issued by Alfred State College, a State University of New York (SUNY) College of Technology.
All clinical articles are peer reviewed.
COLUMNS 424 Toxicology Brief Iron Toxicosis Erin Freed, CVT
428 Equine Essentials The Use of Antifungals Jennifer L. Davis, DVM, PhD, DACVIM, DACVCP
392
Tech News — AIMVT Holds First Examination
FEATURE 396
Meeting the Challenge — A Talk with Amy Campbell, CVT, VTS (ECC) Liz Donovan As an emergency and critical care technician, Amy Campbell, CVT, VTS (ECC), is faced with the unique challenge of providing quality care in a fast-paced, often stressful setting. Read about how she maintains a positive outlook and why she is pursuing credentialing requirements for technicians in Massachusetts.
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ON THE COVER Amy Campbell, CVT, VTS (ECC), obtains blood pressure measurements on a dog.
See page 396 Photographed by Tracy Powell
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Merial-Vaccines_USE.qxp:VT
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Your knowledge. Our science. Their health. Circle 173 on Reader Service Card
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Contents
July 2008 409 Urethral
Obstruction
The Complete Journal for the Veterinary Health Care Team
Volume 29, Issue 7
DEPARTMENTS 385 Editor’s Letter 390 Information Page 392 Tech News 393 Industry Briefs 420 Author Instructions
Courtney Beiter, RVT, VTS (Anesthesia)
435 Tech Tips 439 Product Forum 440 Index to Advertisers 441 Market Showcase 442 Classified Advertising
CE ARTICLES 401
Nonobstructive Idiopathic Feline Lower Urinary Tract Disease Tonimarie Swann, BA, AAS, RVT Managing nonobstructive idiopathic feline lower urinary tract disease (iFLUTD) can be challenging because the disorder encompasses a variety of clinical signs. Treatment of iFLUTD may involve a combination of approaches — including environmental, dietary, and pharmacologic interventions — to help manage the patient’s clinical signs.
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Urethral Obstruction in Male Cats Courtney Beiter, RVT, VTS (Anesthesia) Urethral obstructions in male cats are fairly common emergencies, comprising about 10% of the feline cases seen in referral and emergency practices. Most patients require urethral catheterization to remove the obstruction.
Although iron is essential for the transport of oxygen, the presence of excess iron in the blood can lead to iron toxicosis. See page 424 388
JULY 2008 | Veterinary Technician
401 iFLUTD Correction — December 2007 Top 10 Nutritional Myths, by Mary Tefend On page 744, in the first paragraph under MYTH #1, the text reads: Veterinarians historically have recommended that owners never feed table scraps to pets. However, current research suggests that supplementing a commercial diet with fresh foods — meat and fresh vegetables — provides phytochemicals and other vital nutrients to facultative carnivores (i.e., dogs) and obligate carnivores (i.e., cats).1 The information was referenced to Remillard RL, Paragon BM, Crane SW, et al: Making pet foods at home, in Hand MS, Thatcher CD, Remillard RL, Roudebush P (eds): Small Animal Clinical Nutrition, ed 4. Topeka, KS, Mark Morris Institute, Walsworth Publishing Company, 2000, pp 163-182. However, the information should have been referenced to Wynn S: Alternative feeding practices. World Small Anim Vet Assoc World Congr Proc 2001.
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New VVectra New ectra™ ffor or CCats ats & KKittens ittens aand nd Ve VVectra ectra™ ffor or CCats ats ccontain ontain a ddual-action ual-action fformulation ormulation flfleas eas hhave ave nnever ever W bbefore efore eencountered. ncountered. Dinotefuran Dinotefuran iiss a 33rd rd ggeneration, eneration, qquick-kill uick-kill aadulticide. dulticide. PPyriproxyfen yriproxyfen iiss a ppotent, otent, 1W llong-lasting ong-lasting IIGR. GR. Together, Together, tthey hey provide yyour feline patients with monthh of protection against all stage stagess of fleas, and protection a full mont 1W Vectra is gentle enough re-infestation. against reinfestation. Vectra e to be used on 1 W kittens as a young as 8 weeks of age. The T space-age applicator is so un nique and easy to use, it’ unique it’ss W Vectra is also protected withh Bloodhound TTechnology patented. patented d. Vectra echnology that tra tracks acks every package from It’s a production ensure andd pro product authenticity..W It’s productio on to veterinary purchase to ens ure veterinary exclusivity an oduct authenticity giant leap leaap forward for your patients and your practice.
CContact ontact yyour our ssales ales rrepresentative epresentative rregarding egarding local local and and state state approval approval and and product product availability. availability. FFor or m more ore iinformation nformation oonn nnew ew VVectra ectra oorr ttoo oorder rder aany ny ooff tthe he VVectra ectra ffamily amily ooff pproducts, roducts, ccall all 8800-999-0297, 00-999-0297, visit visit summitvetpharm.com summitvetpharm.com or or contact contact your your Summit Summit VetPharm VetPharm or or Abbott Abbott Animal Animal Health Health representative. representative. Circle 127 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?
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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: $69 for one year, $126 for two years, $175 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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July 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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TechNews
Veterinary Technician Honored with Staff Recognition Award has been working as a senior veterinary technician in the cardiology department at the University of Missouri’s Veterinary Medical Teaching Hospital since 1997. At the university, Ed is responsible for teaching veterinary students, interns, and residents; performing cardiac ultrasound examinations; supervising the cardiac catheterization laboratory; communicating with clients; and assisting students and veterinarians with diagnostic and therapeutic procedures. In nominating Ed for this award, Deborah Fine, DVM, Ed’s supervisor in the cardiology department, noted that he not only rises to the challenge when facing additional duties but also thrives in an environment of increased respon-
sibility and continues to grow in expertise and knowledge. Congratulations, Ed!
Courtesy of the University of Missouri
H. Edward Durham, Jr., CVT, LATG, VTS (Cardiology), has been honored with the University of Missouri’s 2008 Chancellor’s Outstanding Staff Recognition Award in the category of technical services. This award is given to an individual who best reflects honor upon the university and the community through a combination of job performance, job-related personal qualities, relationships with associates, and ability to relate his or her work to the missions and values of the university. Ed, who is a frequent contributor to Veterinary Technician, was featured on our September 2006 cover. He was a founding member of the Academy of Internal Medicine for Veterinary Technicians and
H. Edward Durham, Jr., CVT, LATG, VTS (Cardiology), was the recipient of the University of Missouri’s Chancellor’s Award in technical services.
AIMVT Holds First Examination A
t this year’s American College of Veterinary Internal Medicine (ACVIM) Forum in San Antonio, Texas, 23 veterinary technicians became the first candidates for Veterinary Technician Specialist (VTS) certification in internal medicine. The Academy of Internal Medicine for Veterinary Technicians (AIMVT) tested applicants in one of three categories: small animal internal medicine, cardiology, or oncology. At next year’s examination, large animal internal medicine will be included as a category. While the examinees have to wait several weeks for their results, AIMVT’s charter members were granted VTS status at the ACVIM Forum. These individuals include the following: Steve Baker, LVT, RVT, VTS (SAIM) Cheryl Bohling, CVT, VTS (SAIM) Barbara Brewer, BA, BS, CVT, VTS (Cardiology) Susan Cox, RVT, VTS (SAIM) H. Edward Durham, Jr., CVT, LATG, VTS (Cardiology) Jane Ebben, RVT, VTS (LAIM) Tracy Elmes, LVT, VTS (SAIM) Lisa Estrin, BS, CVT, LVT, VTS (Oncology) Sheryl Ferguson, CVT, VTS (LAIM) Petra Guity, RVT, VTS (Cardiology) Diane Green, RVT, VTS (Oncology) Meri Hall, RVT, RLATG, VTS (SAIM)
Shari Hemsley, LVT, VTS (Cardiology) Laura Lien, BS, CVT, VTS (LAIM) Adrian Martin, LVT, VTS (Oncology) Linda Merrill, LVT, VTS (SAIM) Kristin Miguel, BS, RVT, VTS (LAIM) Anne Myers, AAS, RVT, VTS (Cardiology) Marika Pappagianis, BS, RVT, VTS (LAIM) Angela Randels, CVT, VTS (ECC, SAIM) Darlene Riel, RVT, VTS (SAIM) Beth Rogers, RVT, VTS (ECC, SAIM) Shirley Sandoval, RVT, VTS (LAIM) Rene Scalf, CVT, VTS (ECC, SAIM)
Jodi Schumacher, LVT, VTS (ECC, SAIM) Robin Sereno, BS, CVT, VTS (SAIM) Marianne Silva, BS, LVT, VTS (SAIM) Kathi Smith, RVT, LVT, VTS (Oncology) Rhonda South-Bodiford, RVT, VTS (SAIM) Michelle St. John, LVT, VTS (Cardiology) Melissa Supernor, CVT, VTS (SAIM) Judy Walton, CVT, VTS (Oncology) Ann Wortinger, LVT, VTS (ECC, SAIM) Kimm Wuestenberg, CVT, VTS (ECC, SAIM) Jean Young, LVT, VTS (LAIM)
According to Kimm Wuestenberg, CVT, VTS (ECC, SAIM), president of AIMVT, the process for VTS candidates is grueling, yet rewarding. “These individuals have a strong commitment to the veterinary profession,” says Kimm. “In order to obtain a VTS in internal medicine, a veterinary technician must prove that he or she has advanced skills and knowledge by going through the application process and taking a written examination. To maintain a VTS, the individual must prove that he or she has obtained a specified amount of continuing education (CE) by attending CE events, publishing articles, and lecturing. Through this process, the technician is able to truly understand disease states and pathophysiology, which allows him or her to provide the best possible care to patients. As technicians, we love animals and want to help them. The best gift that we can give the patients we care for is to push ourselves into being the best we can be in this rewarding career.” Congratulations to everyone who worked hard to make AIMVT a success!
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TechNews S TAT E N E W S OKLAHOMA At the annual Oklahoma Veterinary Medical Association conference in Tulsa last January, the Oklahoma Veterinary Technician Association (OVTA) elected its new board members: Tina Scantling, RVT (president); Elizabeth Rhodes, RVT (vice president); Nanette Wheatley, RVT (secretary); Debbie Reed, BS, RVT (treasurer); and Jackie Meeks, RVT (NAVTA representative). (Debbie was featured on the June 2008 cover of Veterinary Technician.) The OVTA also welcomed back Amy Born, RVT, from her military duties overseas. Amy was deployed in 2006 during her tenure as OVTA president but returned to Oklahoma in March. Finally, veterinary professionals and caring citizens alike were disappointed when the Pet Quality Assurance Act (House Bill No. 3192), which addressed the state’s puppy mill problem, failed to pass during the last Oklahoma legislative session. Plans are under way to reintroduce the bill during next year’s session. For more news from the OVTA, visit its recently updated Web site, which was designed by Paul Berg, at www.okvta.org. VIRGINIA The Virginia Association of Licensed Veterinary Technicians (VALVT) has announced the recipients of the following awards: Anne Lynch was named the Ursula Strider Memorial Veterinary Technology Student of the Year from Blue Ridge Community College (BRCC), Amy Michaux was named the Veterinary Technology Distance Education Student of the Year from the John Tyler Community College site of the BRCC Veterinary Technology Program, and Allyson Kirk was named the Northern Virginia Community College Veterinary Technology Student of the Year. The VALVT would like to wish the best of luck to all of the recent veterinary technology graduates in their future endeavors. For more information, visit the VALVT’s newly updated Web site at www.valvt.org.
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Developing Clinical Practice Academy Seeks Committee Members Organizing committee members are being sought for the formation of an Academy of Veterinary Technicians in Clinical Practice. The academy will be modeled after the American Board of Veterinary Practitioners. Following the guidelines established by the NAVTA Committee on Veterinary Technician Specialties (CVTS), a committee member must meet the following requirements: Be an active member of NAVTA Be a graduate of an AVMA-accredited veterinary technology program and/ or legally credentialed as a veterinary technician in the state or province of residence Have a minimum of 7 years of fulltime working experience in clinical practice Committee membership offers an excellent opportunity to gain recognition as an expert in clinical practice. Interested individuals who are willing to make the commitment to develop this academy can review the CVTS guidelines at www.navta.net (click on “Career Development”) and contact Danielle Buchanan at ddbuchan@ purdue.edu.
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. Tech News is compiled by VLS Assistant Editor Liz Donovan.
IndustryBriefs
Fort Dodge Animal Health Reintroduces ProHeart After a review by the FDA’s Center for Veterinary Medicine, Fort Dodge Animal Health has reintroduced ProHeart 6 into the US veterinary market. ProHeart 6 is an injectable heartworm preventative that provides 6 months of continuous protection from heartworm infection. Because this product is being returned to the market after a voluntary recall in 2004, Fort Dodge will implement a postmarketing surveillance initiative based on programs that are used to monitor the safety of human drugs. This effort will include comprehensive veterinarian training, pet owner education and consent forms, and specific requirements for the purchase and administration of the reformulated drug. For additional information, visit www.proheart6dvm.com.
Sharn Veterinary Launches New Web Site Sharn Veterinary has launched its new Web site (www.sharnvet.com), which was designed by Web development firm Magnetic. The site features streaming video, including training videos and video testimonials; dynamic tabbing to easily navigate product descriptions; technical support materials; and clinical information, including recent veterinary medical studies, articles, and papers. Based in Tampa, Florida, Sharn Veterinary offers state-of-the-art monitoring and critical care equipment and accessories designed specifically for use on animals. In addition to a series of high-end blood pressure and CO2 monitors, Sharn also carries a full line of multiparameter monitors to accommodate veterinary practices of all sizes and specialties.
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Quick Course Are Canned Foods Diluting the Power of Your Patients’ Therapeutic Food? For many pet owners, food is the language of love. A slice of cheese says I care about you. A dollop of canned tuna tells her she’s the only one. But for pets being fed therapeutic pet food, these extra foods can counteract the benefits of the therapeutic food and hinder the pets’ recovery—even if these “treats” come from another brand of canned pet food.
The Problem with Canned Foods Many well-intentioned clients feed their pets a dry Hill’s® Prescription Diet® pet food but also add a canned grocery store food for variety. In fact, 41% of
dog owners and 67% of cat owners feed their pets both dry and moist foods.1 The trouble is, feeding canned food that isn’t part of a pet’s recommended feeding regimen may disrupt the nutrient balance of the therapeutic food and reduce its effectiveness. Feeding these canned foods may provide excess calories and expose a pet to higher levels of minerals, which could actually exacerbate its medical condition. “One of the biggest problems with compliance is pet owners feeding an inappropriate moist food along with a therapeutic dry food
Adding a Food Can Cancel Out the Benefits of a Therapeutic Food 1,400 Hill’s® Prescription Diet® Feline k/d® dry
Intake in mg/240 kcal
1,200
Hill’s® Prescription Diet® Feline k/d® dry + Friskies® Fancy Feast®
1,000 800 600 400 200 0
Calcium
Phosphorus
Sodium
When a nontherapeutic canned food is added to a therapeutic dry food for a cat with renal failure, intake of calcium is tripled and intake of phosphorus and sodium is doubled, thereby reducing the beneficial effects of the therapeutic food.
Sponsored by Hill’s®, maker of Prescription Diet® pet foods
recommended by the veterinary team,” according to Dr. Philip Roudebush, Director of Scientific Affairs at Hill’s Pet Nutrition, Inc.
Make sure your
clients
understand that a therapeutic food must be fed exclusively. A Case in Point Consider the case of a 10 lb cat with renal failure that is currently fed Hill’s® Prescription Diet® Feline k/d® dry food. This therapeutic pet food has reduced protein to decrease kidney workload, lower levels of phosphorus to help slow disease progression, reduced sodium to minimize hypertension, and proper levels of calcium for older cats.2 What if the owner adds a can of Friskies® Fancy Feast® Flaked Fish and Shrimp Feast and removes the equivalent calories of the cat’s dry food? The cat’s calcium intake would triple, and his sodium and phosphorus intakes would double (see the figure to left). This essentially cancels out the benefits of feeding Hill’s Prescription Diet Feline k/d.2 If the owner fed the grocery store canned food only instead of the same number of calories of canned Hill’s Prescription Diet Feline k/d, the cat
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HOMEMADE TREAT RECIPES For clients who want to give their pets a treat, here are a few suggestions you can pass along.
Clients Depend on Your Nutritional Advice Owners who feed their pets therapeutic foods clearly want to do what’s right for their pets. Help them make the most of your nutritional recommendation by asking: • Do you feed dry and canned food? • Do you feed anything else with the food? • What kinds of treats do you feed your pet? • Do you measure the food you give (dry, canned, and treats)? • How much and how often do you feed your pet?
Explain to pet owners that diluting
the power of a therapeutic pet food could compromise their pets’ health. At the same time, underscore the importance of feeding therapeutic foods exclusively. Because most Hill’s Prescription Diet pet foods are available in both dry and canned forms, owners can still offer their pets variety without compromising your nutritional recommendation. For example, Hill’s® Prescription Diet® Feline i/d® and s/d® canned pet foods are now available in minced form for improved texture, which is especially important for pets with
Using canned food: 1. Shake the loaf of food out of the can. 2. Cut the loaf into ¼-inch thick slices, then divide each slice into bite-sized pieces. 3. Microwave treats on high for 2½ to 3 minutes. If using a conventional oven, place bite-sized pieces on an ungreased cookie sheet and bake at 350°F for 30 minutes or until crispy.
© biphoto, moodboard / Alamy
would receive seven times the calcium, six times the phosphorus, four times the sodium, and almost three times the protein.3
(Makes approximately two dozen treats)
Using dry food: 1. In a blender, grind 2 cups of dry food into a powder. 2. Pour powder into a mixing bowl, and gradually add 1 to 1¼ cups of water. 3. Shape into individual “cookies,” and flatten the dough with the back of a spoon. (The dough will not flatten like it does with standard “people cookies.”) 4. Place the treats on an ungreased cookie sheet, and bake at 350°F for 30 minutes or until crispy. Homemade treats should not exceed 10% of the pet’s total daily intake because heat alters the nutritional characteristics of the food. Baked treats should be stored in the refrigerator, never frozen. Discard leftovers after 5 to 7 days. This recipe may be used with any Hill’s® Prescription Diet® pet food except Canine and Feline a/d®, and Canine n/d® and s/d®. In these cases, the canned food can be rolled into balls and placed in the freezer to serve as a frozen treat.
health problems that can decrease appetite. The minced formula’s natural meaty texture, as well as the same precise nutrition as before, effectively complements the dry foods. Discuss with your clients the proper amounts of dry and canned food to feed each day.
REFERENCES 1. Habits & Practices Study, Pet Care Report, 2004. Data on file. Hill’s Pet Nutrition, Inc. 2. Allan TZ, Polzin DJ, Adams LG. Renal disease. In: Hand MS, Thatcher CD, Remillard RL, et al, eds. Small Animal Clinical Nutrition. 4th ed. Topeka, KS: Mark Morris Institute; 2000: 582-583, 587. 3. Comparison made using manufacturers’ published nutrient data.
This information has not been peer reviewed and does not necessarily reflect the opinions of, nor constitute or imply endorsement or recommendation by, the Publisher or Editorial Board. The Publisher is not responsible for any data, opinions, or statements provided herein.
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Meeting the Challenge A Talk with Amy Campbell, CVT, VTS (ECC)
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Liz Donovan Veterinary Learning Systems
Tracy Powell
RIAGING PATIENTS and consoling emotional clients in the fast-paced environment of emergency medicine can take a toll on even the strongest technician. According to Amy Campbell, CVT, VTS (ECC), the keys to avoiding burnout are maintaining a good sense of humor and continuing to challenge yourself. Amy works as an emergency and critical care technician at Tufts Veterinary Emergency Treatment & Specialties in Walpole, Massachusetts, where she strives to provide patients with the most advanced nursing care possible. In addition to her work at the hospital, Amy serves as president of the Massachusetts Veterinary Technician Association (MVTA). Through that role, she is pursuing state legislation that would require Massachusetts technicians to become licensed. Here, she tells us how she learned to meet the challenges of emergency and critical care, why education is important for technicians, and how the September 11 terrorist attacks inspired her to become involved in disaster preparedness.
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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 399.
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
©2008 Eli Lilly and Company CF00085R2
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Cover Story
How did you become interested in emergency and critical care? After I graduated from veterinary technology school in 1998, I was accepted into the Veterinary Technician Internship Program at The Animal Medical Center (AMC) in New York City. I went from living in a small town in Massachusetts to working in an enormous animal hospital in a large city. At The AMC, I had the opportunity to work in emergency and critical care, and I just loved the challenges of treating patients in that environment.
What types of challenges are unique to emergency and critical care? In the emergency care setting, technicians are required to think fast and make quick but calculated decisions regarding a pet’s care. When an animal presents to the clinic, I have about 30 to 45 seconds to talk to the owner, assess the animal, and then, based on my findings in that short period, decide whether the animal needs to be brought to the veterinarian for immediate treatment. However, one of the most difficult aspects of working in an emergency care setting is dealing with a variety of clients. Although emergency situations are very stressful for owners, they may have valuable information about what happened to the animal — if it collapsed suddenly or if there was a traumatic event — so being able to work with the client during triage is essential. Clients put a lot of money into their pet’s care and a lot of faith
AS in veterinary technology, Becker College, Leicester, MA (1998)
Professional Associations Academy of Veterinary Emergency & Critical Care Technicians (member), International Veterinary Academy of Pain Management (member), MVTA (president, former recording secretary), NAVTA, Veterinary Emergency & Critical Care Society
Why is specialization beneficial for technicians? Tracy Powell
Pets
JULY 2008 | Veterinary Technician
I have to remind myself that everything I’m doing is ultimately geared toward providing the animal with the best care. However, it is always difficult to deal with the very sad cases in which an animal needs to be euthanized. I think that having a sense of humor plays a big role in how I handle stressful situations. I also try to remain positive and remind myself that not all cases are devastating — there are a lot of good outcomes for every bad one.
I researched the Academy of Veterinary Emergency & Critical Care Technicians (AVECCT) and found that I met the requirements to apply for the annual examination. I became even more enthusiastic about specialization when I attended the 2004 International Veterinary Emergency and Critical Care Symposium (IVECCS). I was very impressed with the technicians who were specialized in emergency and critical care. I felt that they represented an extremely high standard of veterinary care. I submitted my application to AVECCT at the end of the year and was allowed to sit for the specialty examination. When I took the exam in 2005, I found it difficult but was amazed that all of the time I spent preparing and studying had paid off. Passing that exam was the biggest accomplishment of my career so far! Since I became specialized, new opportunities have presented themselves — I’ve been invited to lecture at IVECCS this September. It’s really exciting to be following in the footsteps of the professionals I admire and respect, and I hope that I’ll be able to inspire other technicians to seek specialization.
Education
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Working in an emergency care setting can be emotionally taxing. How do you maintain a positive outlook?
What prompted you to seek specialty certification in emergency and critical care?
V I TA L S TAT I S T I C S A M Y C A M P B E L L
Amy has two mixed-breed dogs: Storm (2 years old) and Sammy (13 years old).
into the team members treating the animal. I only have a short amount of time to convince the owner that I’m trustworthy and competent and that I have the animal’s best interests in mind.
It gives you a goal to work toward, and when you reach the goal, it opens doors professionally — you are able to lecture at conferences www.VetTechJournal.com
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COMFORTIS™ (spinosad) Chewable Tablets Brief Summary: Before using Comfortis chewable tablets, please consult the product insert, a summary of which follows: Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Dosage: Administer orally once monthly. Administer with food for maximum effectiveness. Recommended dose range is 13.5 – 27.3 mg/lb (30-60 mg/kg). Available in five tablet sizes for dogs ranging from 5 to 120 lbs. Dogs over 120 lbs should be administered the appropriate combination of tablets. Indications: COMFORTIS chewable tablets kill fleas and are indicated for the prevention and treatment of flea infestations (Ctenocephalides felis) on dogs for one month. Contraindications: There are no known contraindications for the use of COMFORTIS chewable tablets. Warnings: Not for human use. Keep this and all drugs out of the reach of children. Precautions: COMFORTIS chewable tablets are for use in dogs and puppies 14 weeks of age and older (see ANIMAL SAFETY). Use with caution in breeding females (see ANIMAL SAFETY). Use with caution in dogs with pre-existing epilepsy (see ADVERSE REACTIONS). The safe use of COMFORTIS chewable tablets in breeding males has not been evaluated. Adverse Reactions: In a well-controlled US field study, which included a total of 470 dogs (330 dogs treated with COMFORTIS chewable tablets and 140 dogs treated with an active control), no serious adverse reactions were observed with COMFORTIS chewable tablets. All reactions were regarded as mild and did not result in any dog being removed from the study. Over the 90-day study period, all observations of potential adverse reactions were recorded. Reactions that occurred at an incidence > 1% within any of the 3 months of observation are presented in the following table. The most frequently reported adverse reaction in dogs in the COMFORTIS chewable tablets and active control groups was vomiting. The occurrence of vomiting, most commonly within 48 hours after treatment, decreased with repeated doses of COMFORTIS chewable tablets. Percentage of Dogs (%) with Adverse Reactions
PERSONAL INTEREST
A “SMART” Plan for Animal Care During Emergencies
I
n 2006, Amy became a volunteer with the State of Massachusetts Animal Response Team (SMART) in the veterinary services sector. The veterinary services volunteers are responsible for the medical care of animals in the event of a disaster. Amy was inspired to serve as a SMART volunteer for a number of reasons. She was living in New York City during the terrorist attacks on September 11, 2001, and went to Ground Zero to assist in treating animals on the scene. She was impressed with the Veterinary Medical Assistance Teams (VMATs), which are deployed to provide veterinary care during disasters. A year later, while reading the September 2002 issue of Veterinary Technician®, Amy recognized the technician featured on the cover — Amy Breton, CVT, VTS (ECC) — as a former classmate at veterinary technology school; coincidentally, Breton had served on a VMAT deployed during the 9/11 rescue efforts. “After reading about Amy Breton’s involvement on the team, I knew I wanted to be involved in disaster response as well,” says Amy. Through her work as a SMART volunteer, Amy has learned to appreciate the importance of disaster preparedness. “The key to effective emergency response is being prepared. The need for disaster planning became clear during Hurricane Katrina. As the country observed, people are willing to sacrifice their lives for their animals. Therefore, it is the responsibility of those involved in disaster response to provide emergency assistance to people as well as their pets. Technicians are in an ideal position to volunteer for these organizations because, in emergency situations, there is a need for people who are knowledgeable about animal health care. Technician volunteers are able to not only assist the veterinarians but also offer emotional support to pet owners so that they feel comfortable leaving their animals in your care. No one wants what happened during Katrina ever to happen again.”
Month 1 Month 2 Month 3 COMFORTIS Active COMFORTIS Active COMFORTIS Active Chewable Topical Chewable Topical Chewable Topical Tablets Control Tablets Control Tablets Control (N=330) (N=139a) (N=282) (N=124) (N=260) (N=125) Vomiting 12.7 12.2 7.8 3.2 5.8 4.8 Decreased Appetite 9.1 5.0 2.8 1.6 1.9 0.8 Lethargy 7.6 5.0 3.5 4.0 1.2 0.8 Diarrhea 6.7 5.0 4.3 0.8 1.2 0.0 Cough 3.9 5.0 0.4 2.4 0.0 0.0 Polydipsia 2.4 1.4 0.7 0.0 0.4 0.0 Vocalization 1.8 0.0 0.4 0.0 0.4 0.0 Increased Appetite 1.5 0.0 0.4 0.8 0.4 0.0 Erythema 1.5 0.0 0.4 0.0 0.4 0.0 Hyperactivity 1.2 1.4 0.0 0.0 0.4 0.0 Excessive Salivation 1.2 0.0 0.4 0.0 0.0 0.0 a
This number (n=139) is less than the total number of dogs in the safety population for the active control group (n=140) because one dog joined the study late and was only dosed at Month 3. In US and European field studies, no dogs experienced seizures when dosed with COMFORTIS chewable tablets at the therapeutic dose range of 13.5-27.3 mg/lb (30-60 mg/kg), including 4 dogs with pre-existing epilepsy. Four epileptic dogs that received higher than the maximum recommended dose of 27.3 mg/lb (60 mg/kg) experienced at least one seizure within the week following the second dose of COMFORTIS chewable tablets, but no seizures following the first and third doses. The cause of the seizures observed in the field studies could not be determined. Animal Safety: COMFORTIS chewable tablets were tested in pure and mixed breeds of healthy dogs in well-controlled clinical and laboratory studies. No dogs were withdrawn from the field studies due to treatment-related adverse reactions. In a dose tolerance study, COMFORTIS chewable tablets were administered orally to adult Beagle dogs at average doses of up to 100 mg/kg once daily for 10 consecutive days (16.7 times the maximum recommended monthly dose). Vomiting was seen in 5 of 6 treated dogs during the first 6 days of treatment, usually within 2.5 hours of dosing. Treated females lost weight early in the treatment period, but their weights were similar to control dogs by the end of the 24-day study. COMFORTIS chewable tablets were not associated with any clinically significant changes in hematology, blood coagulation or urinalysis parameters; however, mild elevations in ALT occurred in all dogs treated with COMFORTIS chewable tablets. By day 24, ALT values had returned to near baseline levels. Phospholipidosis (vacuolation) of the lymphoid tissue, the long-term effects of which are unknown, was seen in all dogs treated with COMFORTIS chewable tablets. In a margin of safety study, COMFORTIS chewable tablets were administered orally to 6-week-old Beagle puppies at average doses of 1.5, 4.4, and 7.4 times the maximum recommended dose at 28-day intervals over a 6-month period. Vomiting was observed across all groups, including the control. Increased vomiting was observed at elevated doses, usually within 1 hour following administration. Vomiting at all doses decreased over time and stabilized when puppies were 14 weeks of age. The average daily and total weight gains of treated dogs were smaller than control dogs and were dose dependent. COMFORTIS chewable tablets were not associated with clinically significant changes in hematology, clinical chemistry, coagulation or urinalysis parameters. Phospholipidosis (vacuolation) of the lymphoid tissue was seen in some dogs in the 4.4X group and all dogs in the 7.4X group. The long term effects of phospholipidosis are unknown. Treatment with COMFORTIS chewable tablets was not associated with any other clinically significant adverse clinical observations, gross necropsy or histopathological changes. In a reproductive safety study, COMFORTIS chewable tablets were administered orally to female Beagles at 1.3 and 4.4 times the maximum recommended therapeutic dose every 28 days prior to mating, during gestation, and during a six-week lactation period. No treatment-related adverse effects were noted for conception rates in the dams, or for mortality, body temperature, necropsy, or histopathology findings for the dams or puppies. One dam from each treatment group experienced early pregnancy loss and one additional high dose dam aborted late term. The treated dams experienced more vomiting, especially at one hour post-dose, than the control dams. Puppies from dams treated at 1.3 times the maximum recommended therapeutic dose had lower body weights than puppies from control dams. Although puppy mortality between treated and control dams was not different, the puppies from the treated dams experienced more lethargy (4.4X group only), dehydration, weakness and felt cold to the touch (4.4X group only) than puppies from control dams. A pilot study without a control group was conducted to analyze milk from three lactating dogs treated with an experimental formulation of spinosad at 1.5 times the maximum recommended dose administered at day 28 of gestation and 24 hours prior to parturition. The data demonstrated that spinosyns were excreted in the milk of these dogs. Mortality and morbidity were greatest in puppies from the dam with the highest spinosyns level in milk. The spinosad milk: reference plasma exposure ratio calculated from this study ranged from 2.2 to 3.5. In well-controlled field studies, COMFORTIS chewable tablets were administered safely in conjunction with other frequently used veterinary products, such as vaccines, anthelmintics, antibiotics, steroids, flea and tick control products, anesthetics, NSAIDs, antihistamines, alternative/herbal remedies, shampoos, and prescription diets. Changes in hematology, clinical chemistry and urinalysis values were compared pre-and post-study and were unremarkable. Storage Information: Store at 20-25°C (68 -77°F), excursions permitted between 15 to 30°C (59 to 86°F). To obtain full product information please call 888-545-5973 or visit www.comfortis4dogs.com. NADA 141-277, Approved by FDA Manufactured for Elanco Animal Health, A Division of Eli Lilly & Co., Lilly Corporate Center, Indianapolis, IN 46285
and write articles for journals. Also, it has been my experience that practices want to hire specialized technicians because they are able to offer a higher level of focused, specialized care. In a state like Massachusetts, where technicians are not required to be credentialed, being specialized shows that you have a certain level of experience and education that sets you apart from other technicians who are not credentialed.
Tell me about your efforts to get credentialing legislation passed. After I returned to Massachusetts from New York, where technician licensure is required, I really wanted to help change our state’s Veterinary Practice Act. I became involved with the MVTA and served as recording secretary on the executive council. About 2 years ago, I ran for president and was elected. During my term, I’ve been concentrating on getting legislation passed that will require Massachusetts technicians to go to school and take the Veterinary Technician National Examination, which is administered through the American www.VetTechJournal.com
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On the Web! Want to know more about Amy? Send your question to editor@VetTechJournal.com, and you may see Amy’s answer in a future issue of our e-newsletter, TechTalk.
Association of Veterinary State Boards. Credentialing is important because it elevates the standard of care nationwide and regulates the profession to ensure that all technicians have a similar knowledge base and have met certain requirements. It is very beneficial to have consistency in the basic knowledge that is required of technicians. The process of changing the legislation is still very much in its infancy, but the MVTA is very dedicated and the legislation is very strong, so I’m hopeful that it will pass in the near future.
The
Perfect
What advice do you have for technicians who are entering the profession? No matter what stage you are in of your career, it’s important to continue to ask questions and challenge yourself so that you can improve your skills and the care that you provide to patients. Often, a case will come up in which an animal has a condition or a disease that I’m not familiar with, and I’m inspired to conduct research and learn more about it. I love having the ability to continue challenging myself on a daily basis.
Fate brought Amy and Storm together.
Storm
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Storm and her siblings find comfort with their mother, who was rescued in the aftermath of Hurricane Katrina. Amy Campbell
wo years ago, through an unusual coincidence, Amy’s work in emergency medicine and disaster response came together, inspiring her to adopt a special four-legged friend. While working the overnight shift at the hospital, Amy received a phone call from a local animal rescue volunteer who was traveling to Florida with several dogs that had been displaced after Hurricane Katrina. One of the dogs was giving birth, and the volunteer hadn’t even known that the dog was pregnant because it was severely emaciated. Amy gave the woman advice and soon forgot about the phone call. About 2 months later, Amy attended a disaster preparedness meeting for SMART volunteers (see box on page 399), during which she spoke with a fellow volunteer and mentioned the name of the hospital where she worked. The woman told Amy that she had recently called the hospital because one of the dogs she had been transporting after Hurricane Katrina began giving birth during the trip. When Amy told the volunteer that she was the technician who had spoken with her that night, the woman thanked Amy for her kindness. She said that the puppies were born healthy, were in Massachusetts, and were now available for adoption. Two days later, Amy brought home one of the puppies that she helped to save and — appropriately — named her Storm.
Tracy Powell
T
www.VetTechJournal.com
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CE Article #1
Nonobstructive Idiopathic
Feline Lower Urinary * Tract Disease
Tonimarie Swann, BA, AAS, RVT Feline Medical Center Pleasanton, California
F
ELINE LOWER URINARY TRACT DISEASE, also known as feline urologic syndrome, is a common disorder that encompasses a variety of clinical signs related to abnormal, painful voiding.1 Cats with lower urinary tract disease may have behavioral or neurologic problems or suffer from conditions such as urinary tract infection, calcium oxalate and struvite urolithiasis, or neoplasia.2 Idiopathic feline lower urinary tract disease (iFLUTD) refers to a group of diseases — without an understood underlying etiology — affecting the lower urinary tract.3
Nonobstructive iFLUTD, which is also referred to as feline idiopathic cystitis, is an inflammatory disease of the bladder. The term feline interstitial cystitis is used to describe chronic idiopathic cystitis.3 When a cat presents with signs of lower urinary tract disease, the technician should obtain a thorough history to help the veterinarian confirm a diagnosis of iFLUTD. If iFLUTD is diagnosed, the technician can help the owner implement the veterinarianprescribed treatment, which may include environmental enrichment, dietary modification, and — in severe cases — drug therapy.
and female cats, but the risk is higher for neutered or spayed cats when adjusted for age.2,4 Cats between 6 weeks and 16 years of age can develop iFLUTD; however, the average age at initial onset is 2 to 6 years.4,5 The disorder is not common in cats that are less than 1 year of age or greater than 10 years of age.2
Risk Factors
Neuroendocrine Disorders
Animals are at risk of developing iFLUTD if they spend all or most of their time indoors, are members of a multicat household, use a litterbox to urinate and defecate, eat primarily dry food, and are obese or have other comorbid conditions.2,4 The frequency of nonobstructive iFLUTD is similar in male
Abnormalities of both the central and peripheral sympathetic nervous systems have been identified in patients with iFLUTD.7 In addition, because of abnormalities in the hypothalamic–pituitary–adrenal axis of affected cats,4 cortisol fails to reduce the effects of increased sympathetic stimulation. Compared with healthy cats, affected cats have significantly decreased serum cortisol responses to adrenocorticotropic stimulation
*For information about the obstructive form of the disease, see “Urethral Obstruction in Male Cats” on page 409.
www.VetTechJournal.com
Pathogenesis Various mechanisms associated with the development of iFLUTD have been proposed, including neuroendocrine disorders, urothelium abnormalities, and stress.6
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and smaller adrenal glands.6,8 Therefore, affected cats may be more susceptible to stress (discussed below) and its effects on the bladder.
Urothelium Abnormalities It has been suggested that affected cats have a defective or deficient layer of glycosaminoglycans (GAGs) lining the bladder.9 The function of GAGs is to reduce the amount of urine solutes and proteins passing through the bladder epithelium, as well as to prevent crystals and bacteria from attaching to the bladder wall.9 If the GAG layer or urothelium is compromised, the bladder develops increased permeability,9 and damaging constituents of the urine can contact the sensory nerves and cause neurogenic bladder inflammation, leading to the clinical signs typically associated with iFLUTD.2
Stress
Stressors That Can Affect Cats Change in residence, number of other animals or people in the household, diet, feeding schedule, litter type, litterbox location, or litterbox cleanliness Disruption to the household routine (e.g., during holidays) Construction inside the home Weather changes Lack of toys, interaction with the owner, or places to hide, perch, and climb
Stress appears to be an important factor in the incidence of iFLUTD.10 It has been suggested that in affected cats, there is an increased stress response in the brain, causing an increased autonomic response that can affect the bladder.3 Patients with iFLUTD have significant increases in tyrosine hydroxylase immunoreactivity in the locus caeruleus (LC)7,11 and the paraventricular nucleus of the hypothalamus.12 A possible result of increased LC output is down-regulation of central and peripheral α2-adrenoceptors.7 Central α2-adrenoceptors are found in the LC, where they inhibit catecholamine release.13,14 Peripheral α2-adrenoceptors are found in the bladder mucosa, where they are believed to regulate blood flow.2 Desensitization of the central α2-adrenoceptors as a result of chronic stimulation and enhanced catecholamine release from the bladder has been reported15,16 and may strengthen the inflammatory response.2
Clinical Signs Regardless of the underlying cause, clinical signs associated with diseases of the lower urinary tract include hematuria, pollakiuria, dysuria, stranguria, and periuria.2 More than 50% of cats under 10 years of age with these clinical signs have iFLUTD.3 Most nonobstructive iFLUTD cases are self402
JULY 2008 | Veterinary Technician
limiting. Clinical signs can manifest suddenly but usually resolve within 3 to 7 days.9,17 However, approximately 50% of patients with nonobstructive iFLUTD will experience a recurrence of clinical signs within 1 year.4 In the early stages of iFLUTD, the pet may lick the skin in the area around the bladder.3 Crystalluria and urolithiasis may be present, but inflammation alone plays a large role in iFLUTD cases. On physical examination, a patient with nonobstructive iFLUTD will usually have a small and empty bladder, whereas a patient with obstructive iFLUTD will usually have a large and firm bladder, have abdominal pain, and resist palpation.18 If a client reports that his or her cat appears to be straining or constipated, veterinary staff should ask the client how much time has elapsed since urine was last observed in the litterbox. After obstruction has been ruled out, the patient can be evaluated for nonobstructive iFLUTD. It is important to note, however, that nonobstructive iFLUTD can progress to the obstructive form of the disease.18
Diagnosis Diagnosing iFLUTD involves ruling out other causes of lower urinary tract problems and behavior disorders causing inappropriate urination.3 Blood and urine tests should be conducted to identify electrolyte abnormalities or conditions such as kidney failure or urinary tract infection. Medical causes should be ruled out before behavioral causes can be diagnosed. Unlike patients with iFLUTD, cats with behavior-driven periuria do not have hematuria or dysuria, and voiding frequency does not wax and wane.18 In patients with iFLUTD, hematuria, crystalluria (which can also be found in healthy cats), and acidic pH may be observed on urinalysis.18 It is important to note that the leukocyte indicator on urine dipsticks is unreliable3; therefore, urine sediment should be examined microscopically. Cystocentesis is the optimal means of obtaining a urine sample to submit for culture.9 For information on performing a cystocentesis, see the box that appears on page 410 in “Urethral Obstruction in Male Cats.” To rule out the presence of uroliths, tumors, and diverticula, radiography or ultrasonography should be conducted.1 If available, www.VetTechJournal.com
FortDodge-Calicivax_USE.qxp:VT
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Everycat
needs calicivirus protection.
Everycat deserves CaliciVax.
Bivalent for broader protection against both traditional and emerging strains. The AAFP recommends calicivirus vaccine as a core antigen for all cats.1 Bivalent CaliciVax TM cross-neutralizes a broader range of strains than an older, first-generation vaccine.2 It’s the only vaccine labeled to protect against both traditional and emerging calici strains. And multiple combinations make it easy to update your protocol and customize protection for every patient. Contact your Fort Dodge Animal Health representative today and ask for the bivalent protection of CaliciVax.
1. 2006 American Association of Feline Practitioners Feline Vaccine Advisory Panel Report. JAVMA, Vol. 229, No. 9, Nov. 1, 2006. 2. Data on file, Fort Dodge Animal Health. Comparison among Fort Dodge vaccines.
©2008 Fort Dodge Animal Health, a division of Wyeth.
CaliciVax
™
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CE Article #1 Lower Urinary Tract Disease cystoscopy can allow visualization of these abnormalities.1 In patients with nonobstructive iFLUTD, treatment may include environmental enrichment, dietary modification, pheromone therapy, and pharmacologic intervention.2
sufficient number of toys available so that there is no need for cats to compete for them. Interactions between the owner and the cat may also help to reduce stress.20 An effort should be made to schedule a regular time for petting, brushing, and playing with the cat. At minimum, the owner should spend 10 to 15 minutes/day with each cat in the household.5,a
Environmental Enrichment
Dietary Modification
Because stress is believed to be an important factor in the development of iFLUTD, reducing environmental stressors (see box on page 402) may be beneficial.3,6 Technicians should educate clients about the association between stress and the clinical signs of iFLUTD. Indoor cats can exhibit stress because they must share their territory with other animals and humans in the household. To create an “environment of plenty,” it is important to provide at least one food bowl, water bowl, and litterbox for each cat in the house. In multilevel houses, these resources should be available on each floor and should be placed in quiet, low-traffic areas that cannot be accessed by other pets and children.19 Cats may also need a quiet place to relax, away from the other occupants in the house. A soft blanket kept under a bed or a cat bed placed in a closet or attached to a windowsill can provide a safe refuge. Because indoor cats have fewer opportunities to express their predatory instincts, they should be given climbing posts and toys that they can chase and catch.7 If multiple pets are living in the house, it is important to have a
Dietary modification is the most important component of long-term management of iFLUTD.21 Therefore, technicians should discuss the pet’s diet with the owner and review the dietary options available. Because the bladder of an animal with iFLUTD may have increased permeability, it is beneficial to increase the pet’s water intake directly (see box below) and provide canned (i.e., wet) food, which has a high water content. Feeding the pet a pH-neutral diet may also be beneficial.21 Prescription diets designed to dilute the urine and prevent crystal formation are available. Owners should be instructed not to add salt to the cat’s food to increase water consumption because this practice may increase the risk of urolith formation. Increasing salt intake can also increase blood pressure, which is a concern in iFLUTD patients with concurrent kidney problems.
Management
Tips to Increase a Cat’s Water Consumption Because some cats avoid drinking stale water, change the water in the cat’s bowl once or twice a day. Fill water bowls to the top. A large round bowl or shallow bowl may be preferred because it cannot tip over easily. Because some cats do not like the taste of tap water, provide filtered, distilled, or bottled water, or refrigerate tap water to improve its taste. Add a few drops of tuna juice to the cat’s water. Place ice cubes in the cat’s water. A drop of tuna juice or chicken broth can be added to the ice cubes before freezing. Because a cat may avoid drinking from a water bowl with an odor, keep the bowl clean. Stainless steel, ceramic, or glass bowls are less likely to harbor odor than plastic bowls. Because some cats prefer drinking water that flows from a faucet or fountain, schedule times to turn on the faucet in the sink or bathtub, or purchase a pet fountain. Feed the cat canned food, which has a high water content.
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Pheromone Therapy Feline facial pheromone is often used in conjunction with environmental enrichment to decrease stress in animals with iFLUTD.2 Pheromones affect the limbic system as well as the hypothalamus and alter the animal’s emotional state.22 Feliway (Ceva Santé Animale, Libourne, France), a synthetic analogue of the naturally occurring feline facial pheromone, was developed in an effort to decrease anxiety-related behaviors in cats.2 Feliway is available as a spray or room diffuser.2 It is marketed primarily as a means for decreasing spraying behaviors but may be useful in reducing the incidence of iFLUTD episodes,23 although such effects have not been reported.2 Because animals with iFLUTD are often anxious, use of the pheromone may decrease the response of the sympathetic nervous system.2 a For more information about healthy owner–pet interactions, visit www.vet.ohio-state.edu/indoorcat.
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The potential for an animal poison emergency is always there, so we are too. A pill bottle accidently knocked off a sink. Everyday things can quickly become a poison emergency for a pet. It’s the reason the ASPCA® Animal Poison Control Center is here 24/7/365 to support you with critical recommendations. As the only center in North America dedicated solely to animals, we have an experienced team of board certified veterinary toxicologists* on staff with the special expertise needed to save a pet’s life. Our exclusive AnTox™database of more than one million cases of animal poisonings also gives us immediate access to crucial case information. When potential danger turns into a real emergency, don’t hesitate. Call us.
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CE Article #1 Lower Urinary Tract Disease Drugs Commonly Used to Treat iFLUTD24 Drug Dose Analgesics (for use in acute cases) 0.01–0.02 mg/kg IM, IV, Buprenorphine or SC q8–12h Butorphanol 0.2–0.4 mg/kg IM, IV, or SC q8h (IV: use lower end of dose range) Fentanyl patch 25 µg/hr Drugs Affecting Bladder/Urethral Contractility Acepromazine 0.05 mg/kg SC q8h Bethanechol 2.5–5 mg PO q12h Phenoxybenzamine 2.5 mg PO q12h Prazosin 0.5 mg/cat PO q12h
Potential Side Effects — Sedation
Respiratory depression, bradycardia
Sedation, hypotension Salivation, vomiting, diarrhea Hypotension —
Analgesics/Anxiolytics (for use in chronic cases) Amitriptyline 5–12.5 mg PO q12–24h Sedation, weight gain, urine retention, urolith formation Buspirone 2.5–5 mg PO q12h Rare, but sedation or other neurologic effects Clomipramine 0.5 mg/kg PO q24h Sedation, anticholinergic effects 1 mg/kg PO sid Decreased food intake; vomiting and Fluoxetinea lethargy rare Westropp JL, Buffington CAT, Chew D: Feline lower urinary tract diseases, in Ettinger SJ, Feldman EC (eds): Textbook of Veterinary Internal Medicine, ed 6. St. Louis, Elsevier Saunders, 2005, p 1842.
a
Glossary Crystalluria_Excretion of crystals in the urine Cystitis_Inflammation of the urinary bladder Dysuria_Painful or difficult urination Hematuria_Presence of blood in the urine Periuria_Urination in inappropriate locations Pollakiuria_Abnormally frequent passage of urine Stranguria_Slow, painful discharge of urine because of urethral and bladder spasm; also called strangury Urolithiasis_Formation of calculi in the urinary tract Urothelium_Lining of the urinary bladder
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Pharmacotherapy Drug therapy may be indicated if the patient’s clinical signs do not improve following environmental enrichment, dietary modification, and pheromone therapy.2 Use of acute analgesics (e.g., butorphanol, buprenorphine, fentanyl), drugs that affect bladder/urethral contractility (e.g., acepromazine, phenoxybenzamine), and chronic analgesics/anxiolytics (e.g., amitriptyline, clomipramine) may be beneficial in managing clinical signs. Because stress is an important factor in the development of iFLUTD, the tricyclic antidepressant amitriptyline may be used to help manage severe, intractable cases.21 The drug may also reduce neurogenic inflammation in the bladder and decrease the discomfort associated with the disease.21 Limited data are available on the use of smooth and skeletal muscle antispasmodics to manage iFLUTD-associated urethrospasm, and it is unknown what role this type of spasm plays in producing the clinical signs of iFLUTD.17 In addition, use of NSAIDs, glucocorticoids, and prostaglandin analogues has
JULY 2008 | Veterinary Technician
not been shown to be effective in treating acute iFLUTD.24 Replacement of GAGs, such as pentosan polysulfate, has been used successfully to treat interstitial cystitis in humans, but the efficacy of current veterinary GAG preparations for treatment of iFLUTD has not yet been demonstrated.7 However, GAG replacements can be considered for treatment of severe cases in conjunction with other treatments.2 Theoretically, orally administered GAGs attach to the defective urothelium, leading to decreased bladder permeability and reduced neurogenic inflammation.2 Polysulfated GAGs and chondroitin sulfate have been used to treat iFLUTD, but such use is off-label, and the effectiveness of these treatments has not been documented.2 If clinical signs persist or recur after environmental, dietary, pheromone-based, and pharmacologic interventions have been implemented, the patient should undergo further diagnostics, including ultrasonography, contrast cystourethrography, and cystoscopy.
Conclusion The treatment of iFLUTD may involve a combination of approaches to help manage clinical signs and prevent recurrence. Technicians should educate clients about the treatment options available and suggest ways to implement environmental modifications that can reduce the pet’s stress, thereby helping to improve the quality of life for iFLUTD patients and maintain the human–animal bond.
References
1. Senior DF: Feline lower urinary tract disease. World Small Anim Vet Assoc World Congr Proc 2005.
2. Hostutler RA, Chew DJ, DiBartola SP: Recent concepts in feline lower urinary tract disease. Vet Clin North Am Small Anim Pract 35:147–170, 2005. 3. Forster-Van Hijfte M: Managing idiopathic feline lower urinary tract disease. Br Small Anim Vet Assoc Congr Proc 2006. 4. Chew DJ, Buffington CAT: Non-obstructive idiopathic/interstitial cystitis in cats: Thinking outside the (litter) box. World Small Anim Vet Assoc World Cong Proc 2007. 5. Barr MC: Feline lower urinary tract signs, idiopathic, in Tilley LP, Smith Jr FWK (eds): The 5-Minute Veterinary Consult. Baltimore, Lippincott Williams & Wilkins, 2004, pp 382–384. 6. Larson J: Feline Idiopathic Cystitis: A Pathophysiology Review. Accessed June 2008 at www.michvma.org/ documents/MVC%20Proceedings%202008/ Larson.pdf.
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Peer Reviewed 7. Chew DJ, Buffington CAT: Idiopathic/Interstitial Cystitis in Cats: Diagnosis and Management. Accessed June 2008 at www.chicagovma.org/pdfs/ceprograms/ IdiopathicInterstitialCystitis_01.pdf.
carbon dioxide response. Anesthesiology 80:1057– 1072, 1994. 15. Westropp JL, Kass PH, Buffington CAT: In vivo evaluation of alpha(2)-adrenoceptors in cats with idiopathic cystitis. Am J Vet Res 68:203–207, 2007.
8. Westropp JL, Welk K, Buffington CAT: Small adrenal glands in cats with feline interstitial cystitis. J Urol 170(6):2494–2497, 2003.
16. Petrovaara A, Kauppila T, Jyväsjärvi E, Kalso E: Involvement of supraspinal and spinal segmental alpha-2-adrenergic mechanisms in the medetomidine-induced antinociception. Neuroscience 44:705– 714, 1991.
9. Kalkstein TS: Idiopathic lower urinary tract disease, in Lappin MR (ed): Feline Internal Medical Secrets. Philadelphia, Hanley & Belfus, Inc., 2001, pp 223– 230.
17. Osborne CA, Lulich JP, Fruger JM, Polzin DJ: Idiopathic feline lower urinary tract diseases: Therapeutic rights & wrongs. World Small Anim Vet Assoc World Congr Proc 2003.
10. Little S: Idiopathic Cystitis in Cats: Diagnosis and Management. Accessed June 2008 at http://ftp. amvq.qc.ca/Notes/S-Little-Idiopathic-Cystitis-inCats.pdf.
18. Norsworthy GD, Grace SF: Lower urinary tract disease — Idiopathic, in Norsworthy GD, Crystal MA, Grace SF, Tilley LP (eds): The Feline Patient: Essentials of Diagnosis and Treatment, ed 2. Baltimore, Lippincott Williams & Wilkins, 2003, pp 325–330.
11. Reche AJ, Buffington CAT: Increased tyrosine hydroxylase immunoreactivity in the locus coeruleus of cats with interstitial cystitis. J Urol 159:1045, 1998. 12. Welk KA, Buffington CAT: Effect of interstitial cystitis on central neuropeptide and receptor immunoreactivity in cats. Res Insights Interstitial Cystitis Basic Clin Sci Symp 2003.
19. Overall KL: Feline elimination disorders, in Overall KL (ed): Clinical Behavioral Medicine for Small Animals. St. Louis, Mosby, 1997, pp 160–194.
13. Stevens CW, Brenner GM: Spinal administration of adrenergic agents produces analgesia in amphibians. Eur J Pharmacol 316:205–210, 1996.
20. Turner DC: The human–cat relationship, in Bateson P (ed): The Domestic Cat — The Biology of Its Behavior, ed 2. Cambridge, Cambridge University Press, 2000, pp 194–206.
14. Sabbe MB, Penning JP, Ozaki GT, Yaksh TL: Spinal and systemic action of the alpha 2 receptor agonist dexmedetomidine in dogs. Antinociception and
21. Sparkes AH: Feline lower urinary tract disease. World Small Anim Vet Assoc World Congr Proc 2006.
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CE Article #1 Lower Urinary Tract Disease 22. Pageat P, Gaultier E: Current research in canine and feline pheromones. Vet Clin North Am Small Anim Pract 33:187–211, 2003. 23. Gunn-Moore DA, Cameron ME: A pilot study using synthetic feline facial pheromone for the manage-
ABOUT THE AUTHOR
Tonimarie Swann,
BA, AAS, RVT
ment of feline idiopathic cystitis. J Feline Med Surg 6:133–138, 2004. 24. Buffington CAT: Feline lower urinary signs, idiopathic, in Côté E (ed): Clinical Veterinary Advisor: Dogs and Cats. St. Louis, Mosby Elsevier, 2007, pp 382–384.
Tonimarie was featured on the December 2007 cover of Veterinary Technician. She works as head technician at Feline Medical Center, an all-cat hospital in Pleasanton, California. Tonimarie and her husband, Chuck, have three FeLV-positive cats — Baloo (pictured with Tonimarie), Shawnee, and PJ. In her spare time, Tonimarie enjoys camping, fishing, and dancing.
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. Clinical signs associated with iFLUTD include a. hematuria. b. periuria. c. pollakiuria. d. all of the above 2. Which of the following statements regarding iFLUTD is true? a. The average age at initial onset of iFLUTD is between 2 and 6 years. b. Outdoor cats are more susceptible to developing iFLUTD. c. Stress is not associated with iFLUTD development. d. Female cats are most at risk of developing obstructive iFLUTD.
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5. Recent studies have shown that the pathogenesis of iFLUTD may involve a. decreased tyrosine hydroxylase immunoreactivity in the brain stem. b. increased bladder permeability. c. increased cortisol responses. d. decreased sympathetic stimulation.
3. Nonobstructive iFLUTD recurs within 1 year in approximately ___________ of patients. a. 10% c. 50% b. 25% d. 75%
6. Which of the following statements regarding iFLUTD management is false? a. Pharmacotherapy is the firstline treatment for iFLUTD. b. Pheromone therapy may be useful in reducing the number of iFLUTD episodes. c. It is beneficial to increase the affected pet’s water intake. d. Toys and climbing posts can be provided to encourage the affected pet to express its predatory instincts.
4. Clinical signs associated with nonobstructive iFLUTD usually resolve within a. 1 to 2 hours. b. 3 to 7 days. c. 2 to 4 weeks. d. 6 to 12 months.
7. Animals are at reduced risk of developing iFLUTD if they a. have a lean body condition. b. live among multiple pets in the household. c. eat primarily wet food. d. a and c
JULY 2008 | Veterinary Technician
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8. Environmental modifications that may help reduce an indoor cat’s stress include a. creating a hiding place for the cat in a closet or under a bed. b. placing an additional litterbox in a quiet, low-traffic area. c. attaching a cat bed to a windowsill. d. all of the above 9. To help increase the water intake of a cat with iFLUTD, it may be beneficial to a. add a drop of tuna juice to the cat’s water. b. add salt to the cat’s food. c. feed the cat only dry food. d. none of the above 10. The most important component of long-term iFLUTD management is a. drug therapy. b. environmental enrichment. c. pheromone therapy. d. dietary modification.
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CE Article #2
Urethral Obstruction in Male Cats
Courtney Beiter, RVT, VTS (Anesthesia) The Ohio State University
U
RETHRAL OBSTRUCTION is a potentially life-threatening emergency. Male cats are more prone to obstruction than female cats.1 When the urethra becomes partially or completely blocked, urine is unable to drain from the bladder, resulting in fluid, electrolyte, and acid–base abnormalities.2 Feline urethral obstruction is a relatively common condition, accounting for up to 10% of feline cases presented to small animal referral and emergency clinics.3,4
Etiology The urethra — the tubular passage through which urine is discharged from the bladder to outside the body — can become obstructed for several reasons. The urethra is longer and narrower in male cats than in female cats; therefore, male cats are more likely to develop an obstruction. The most common cause of obstruction is a urethral plug, which consists of mineral crystals (e.g., struvite, calcium oxylate), white blood cells, red blood cells, protein (mucus), and epithelial cells.5 The underlying cause of urethral plugs is unknown; however, plugs have been linked to struvite crystalluria — suggesting that diet may play a role — and idiopathic cystitis.6 Other causes of urethral obstruction include urethral edema and spasm associated with lower urinary tract inflammation and pain.7 Uroliths, neoplasms, and urethral strictures can also lead to urethral obstruction; however, they are reported less frequently than other causes.5
Clinical signs of urethral obstruction can vary depending on the severity and duration of the obstruction. Initially, the most common clinical sign is stranguria, which is sometimes mistaken by the owner as constipation.8 Affected cats may urinate frequently, strain to urinate, urinate inappropriately, and pass small volumes of blood-stained urine (hematuria).10 Lethargy, anorexia, vomiting, and other signs of systemic illness are also common.1 Signs of discomfort or pain caused by an inflamed urethra and increased bladder size include vocalization, inappetence, and hiding. Affected cats can be observed frequently
History and Clinical Signs Cats with a history of lower urinary tract diseasea — in particular interstitial cystitis — are at an increased risk of developing urethral obstruction.8 Some patients may have a history of obstruction.9 a For more information about feline lower urinary tract disease, see “Nonobstructive Idiopathic Feline Lower Urinary Tract Disease” on page 401.
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CE Article #2 Urethral Obstruction licking their genital region.10 Vomiting and lethargy may also be noted.1 In addition, the patient’s mucous membranes will be pale, and capillary refill time is prolonged.4 On abdominal palpation, the urinary bladder is often large and firm and cannot be expressed easily. Caution should be used when attempting to express a possibly obstructed bladder. If too much pressure is applied to the distended bladder, it can rupture. If bladder rupture is suspected, the goal is to immediately stabilize the patient so that the clinician can perform emergency surgery. If the urethral obstruction goes untreated for more than 24 to 48 hours, the resulting uremia can lead to hypothermia, bradycardia, tachypnea, altered levels of consciousness (including coma), and death.4
Diagnosis A common finding associated with urethral obstruction is a large, firm bladder on abdominal palpation. Urine should be collected for urinalysis, culture, and sensitivity testing.10 Blood work (i.e., complete blood count, serum chemistry profile, including serum potassium levels) should also be obtained. Serum potassium levels can be used to assess cardiotoxicity associated with hyperkalemia.10 An electrocardiogram (ECG) should be conducted to evaluate cardiac function and identify abnormalities consistent with hyperkalemia. Signs of hyperkalemia include diminished to absent P-waves, widened QRS complexes, prolonged PR intervals, and tall “tented” T-waves.11 These abnormalities, which most often appear on lead II tracings when serum potassium concentration is greater than 7 mEq/L, are the result of a raised (more positive) resting membrane potential that slows depolarization and exaggerates repolarization.12
Performing a Cystocentesis To perform a cystocentesis, a 22-gauge needle should be attached to a flexible IV extension set, 3-way stopcock, and large-capacity syringe (≥20 ml)a using aseptic technique. The needle should be inserted into the bladder through the ventrolateral wall at a 45° angle.11 It is important to properly insert the needle into the bladder wall to minimize trauma to the bladder.a Sanderson S: Urethral obstruction: Techniques to relieve obstruction and management of the patient. Proc 30th World Congr World Small Anim Vet Assoc 2005. a
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Abdominal radiographs can help determine the presence of cystic or urethral calculi. Identification of calculi (kidney stones) affects how an obstruction is treated. The presence of calculi can make it much more difficult to use a urinary catheter to remove the obstruction and can result in additional urethral trauma. If bladder stones are present, a cystotomy should be performed after the urethral obstruction has been removed and the patient is stable enough to undergo anesthesia. Voiding urohydropulsion is another method that can be used to remove bladder stones.13
Treatment Address Metabolic Abnormalities When treating cats with a urethral obstruction, it is important to quickly stabilize the patient’s vital signs and address metabolic abnormalities so that urethral catheterization can be performed to remove the obstruction. Administering IV fluids is the initial step in therapeutic management. Traditionally, 0.9% NaCl has been the fluid of choice because it does not contain potassium and has the greatest dilutional effect on hyperkalemia; however, a balanced electrolyte solution, such as Normosol-R, Plasmalyte 148, or lactated Ringer’s solution, can be administered as an alternative. Although these solutions contain some potassium, the concentrations are 5 mEq/L or less,14 which may also make the solutions effective in treating concurrent metabolic acidosis. Fluid rate and quantity should be determined based on the patient’s clinical signs and physical examination findings. Aggressive fluid therapy is indicated in patients that are markedly depressed or unresponsive. A shock dose of 60 ml/kg should be administered to these patients and titrated to effect.15 Hydration and cardiovascular status must be reevaluated after each bolus is administered. In patients with stable vital signs, the percent of dehydration should be used to calculate the fluid rate and quantity required to correct hydration status. If results of the serum biochemistry profile indicate a potassium concentration that is life threatening (>6 mEq/L),12 and/or if ECG findings suggest hyperkalemia, 10% calcium chloride at 0.1 mg/kg IV should be administered immediately to protect the heart from the effects of hyperkalemia.12 This dose should be given slowly over 5 to 10 minutes while monitoring the patient’s cardiac status on an ECG www.VetTechJournal.com
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CE Article #2 Urethral Obstruction Urethral Catheterization
Courtney Beiter, RVT, VTS (Anesthesia)
Anesthesia When vital signs are stable, urethral catheterization should be performed while the patient is under sedation or general anesthesia. Sedation is indicated in patients that are not stable enough for anesthesia. Moribund patients can be catheterized without any sedation. The anesthetic protocol should include a premedication, induction agent, and gas inhalant. The premedication provides sedation and reduces the amount of induction agent required. Acepromazine, a phenothiazine, can be administered at 0.03–0.1 mg/kg IV, IM, or SC for premedication.14
Feline patient with a catheter sutured in place.
Although doses at the low end of this range produce minimal cardiovascular effects, high doses can cause marked hypotension and reflex tachycardia; therefore, high doses should be used with caution in debilitated or hypotensive patients. Acepromazine may protect the heart against catecholamine-induced arrhythmias.a Acepromazine can be combined with buprenorphine at 0.006–0.01 mg/kg.16 Hydromorphone and fentanyl can also be combined with acepromazine. When given as a premedication, hydromorphone and acepromazine provide sedation and analgesia. Fentanyl, given as a constant-rate infusion, provides additional analgesia during catheter placement and allows for a decreased amount of inhalant to be used. Hydromorphone is administered at 0.025–0.1 mg/kg IV, IM, or SC.14 Fentanyl is given initially as a bolus dose of 2–5 mg/kg IV; a constantrate infusion of 1–5 mg/kg/hr is then initiated to maintain a level plane of sedation.14 Hydromorphone and fentanyl can cause respiratory depression at higher doses; therefore, debilitated patients should be given doses only at the low end of the range.14 The induction agent enables intubation of the patient for administration of inhalant anesthetic gas. Ketamine and diazepam, or
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propofol alone, can be used for induction.b Ketamine increases heart rate and contractility while maintaining blood pressure.c Diazepam produces minimal effects on the cardiovascular system and provides skeletal muscle relaxation.16 Ketamine at 4–6 mg/kg and diazepam at 0.3 mg/kg can be combined in the same syringe and administered intravenously to effect.d This combination should not be used alone in patients that are not stable enough for general anesthesia. If propofol is used for induction, the dose is 2–8 mg/kg IV administered to effect; 4 mg/kg is usually sufficient for induction of a premedicated patient.d The inhalant gas provides maintenance of anesthesia. Following induction, the patient is intubated and isoflurane or sevoflurane is administered. Blood pressure and heart and respiratory rates should be monitored closely during the administration of anesthesia. If insulin and dextrose were administered prior to anesthesia, blood glucose concentration should be tested every 4 hours.
Catheterization The area around the penis and prepuce is clipped and prepared using standard aseptic technique following induction and maintenance of anesthesia. A solution of sterile water and sterile lubricant is mixed at a 1:1 ratio, and two 20-ml syringes are filled with the solution. A sterile 3.5-Fr open-ended tomcat catheter is then attached to extension tubing and a 3-way stopcock, and one syringe of the sterile solution is attached to the stopcock. Prior to insertion in the urethra, the catheter should be filled with the sterile solution. Before the catheter is inserted in the urethra, the penis is extruded and extended dorsally until the long axis of the urethra is parallel to the vertebral column.16 The catheter tip is then seeded in the distal urethra, and the prepuce is pulled caudally to straighten the urethral flexure and facilitate passage of the catheter. The catheter is advanced slowly while the plunger of the syringe containing the sterile solution is pulsed at regular intervals. This process flushes the obstruction into the bladder. Once the catheter can be advanced easily through the urethra and all the sterile solution has been pulsed into and then aspirated from the bladder, the catheter is removed. A sterile indwelling 3.5- or 5.0-Fr urinary catheter should be inserted in the urethra and sutured in place. A closed urinary collection system is then attached to the indwelling urinary catheter for monitoring of urine output. McKelvey D, Hollingshead KW: The preanesthetic period, in Duncan LL (ed): Mosby’s Fundamentals of Veterinary Technology: Small Animal Anesthesia Canine and Feline Practice. Baltimore, Mosby, 1994, p 41. b Tindall B: Anesthesia for patients with cardiac disease, in Bedford PCG (ed): Small Animal Anesthesia: The Increased Risk Patient. Philadelphia, WB Saunders, 1991, p 77. c Lin HC: Dissociative anesthetics, in Thurmon JC, Tranquilli WJ, Benson JG (eds): Lumb & Jones’ Veterinary Anesthesia, ed 3. Baltimore, Williams & Wilkins, 1996, pp 241–296. d Thurmon JC, Tranquilli WJ, Benson JG (eds): Injectible anesthetics, in Lumb & Jones’ Veterinary Anesthesia, ed 3. Baltimore, Williams & Wilkins, 1996, pp 210–240. a
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Peer Reviewed Brief Summary of Prescribing Information
for conversion to a normal sinus rhythm. To decrease serum potassium concentration, a combination of regular insulin and dextrose can be administered. Insulin drives potassium into the intracellular space, and dextrose helps prevent hypoglycemia that may result from insulin administration. Regular insulin should be given at a dose of 1 U/cat.b Blood glucose concentration should be monitored every 4 hours after administration of insulin and dextrose. If glucose concentration decreases to 60 to 70 mg/dl or less, a dextrose constant-rate infusion should be initiated at the fluid rate already being administered. Dextrose 50% can also be administered without insulin to stimulate the release of endogenous insulin. The dose is 0.5 g/kg diluted 1:1 with NaCl or sterile water.5 The dextrose should be diluted 1:1 to decrease the osmolarity and should be administered with caution to avoid extravasation, since it can cause skin sloughing. Alternatively, sodium bicarbonate (1 mEq/kg given slowly over 10 minutes) can be used to drive potassium into the intracellular space. Administration of sodium bicarbonate may result in ionized hypocalcemia, hypernatremia, alkalosis, and seizures; therefore, its use should be restricted only to patients with severe hyperkalemia (potassium concentration >10 mEq/L) or acidemia (pH <7.1).
Remove the Obstruction Urethral catheterization is the method most commonly used to remove a urethral obstruction.1 If urethral catheterization cannot be performed immediately, or if the patient is too unstable or in too much pain, the urinary bladder can be emptied through cystocentesis b
Cooper E, VMD, MS, DACVECC: Personal communication, The Ohio State University Teaching Hospital, 2008.
Antiemetic
Prevention of Vomiting Due to Motion Sickness (minimum of 8 mg/kg) The following adverse reactions were reported during US studies for the prevention of vomiting due to motion sickness in dogs treated with CERENIA Tablets at a minimum of 8 mg/kg orally one time. Dogs may have experienced more than one of the observed adverse reactions.
CERENIA Tablets For oral use in dogs only CERENIA Injectable For subcutaneous injection in dogs only
Frequency of Adverse Reactions by Treatment
CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.
Placebo (n=195) Adverse Reaction
INDICATIONS: CERENIA (maropitant citrate) Tablets are indicated for the prevention of acute vomiting and the prevention of vomiting due to motion sickness in dogs.
Hypersalivation Vomiting1 Muscle Tremors Sedation/Depression Retching Flatulence
CERENIA (maropitant citrate) Injectable Solution is indicated for the prevention and treatment of acute vomiting in dogs. DOSAGE AND ADMINISTRATION: CERENIA Tablets and Injectable Solution are recommended for use in dogs 16 weeks and older. For Prevention of Acute Vomiting: Administer CERENIA Tablets orally at a minimum dose of 2 mg/kg (0.9 mg/lb) body weight once daily for up to 5 consecutive days. Administer CERENIA Injectable Solution subcutaneously at 1.0 mg/kg (0.45 mg/lb) equal to 1.0 mL /10 kg (1.0 mL /22 lb) of body weight once daily for up to 5 consecutive days. CERENIA Tablets may be used interchangeably with CERENIA Injectable Solution for once daily dosing for the prevention of acute vomiting. For Prevention of Vomiting Due to Motion Sickness: Administer CERENIA Tablets orally at a minimum dose of 8 mg/kg (3.6 mg/lb) body weight once daily for up to 2 consecutive days. Dogs should be fasted 1 hour prior to administration of CERENIA Tablets. Administer CERENIA Tablets 2 hours prior to travel. For Treatment of Acute Vomiting: Administer CERENIA Injectable Solution subcutaneously at 1.0 mg/kg (0.45 mg/lb) equal to 1.0 mL /10 kg (1.0 mL /22 lb) of body weight once daily for up to 5 consecutive days. WARNINGS: Not for use in humans. Keep out of the reach of children. In case of accidental ingestion, seek medical advice. Topical exposure may elicit localized allergic skin reactions in some individuals. Repeated or prolonged exposure may lead to skin sensitization. Wash hands with soap and water after administering drug. CERENIA is also an ocular irritant. In case of accidental eye exposure, flush with water for 15 minutes and seek medical attention. In puppies younger than 11 weeks of age, histological evidence of bone marrow hypoplasia was seen at higher frequency and greater severity in puppies treated with CERENIA than in control puppies. In puppies 16 weeks and older, bone marrow hypoplasia was not seen. PRECAUTIONS: CERENIA Injectable Solution is for subcutaneous injection only. The safe use of CERENIA Tablets and Injectable Solution has not been evaluated in dogs used for breeding, pregnant or lactating bitches, dogs with gastrointestinal obstruction, or dogs that have ingested toxins. Use with caution in dogs with hepatic dysfunction. Use with caution with other medications that are highly protein bound. The concomitant use of CERENIA with other protein bound drugs has not been studied in dogs. Commonly used protein bound drugs include NSAIDs and cardiac, anticonvulsant and behavioral medications. The influence of concomitant drugs that may inhibit metabolism of CERENIA has not been evaluated. Drug compatibility should be monitored in patients requiring adjunctive therapy.
1
Placebo (n=69)
Death during study Euthanized during study Diarrhea Hematochezia/Bloody stool Anorexia Otitis/Otorrhea Endotoxic Shock Hematuria Excoriation
CERENIA (n=206)
# dogs
% occurrence
# dogs
% occurrence
4 0 6 5 2 0 1 0 0
5.8 0 8.7 7.2 2.9 0 1.4 0 0
10 2 8 4 3 3 2 2 2
4.9 1.0 3.9 1.9 1.5 1.5 1.0 1.0 1.0
Other clinical signs were reported but were <0.5% of dogs. Adverse reactions seen in a European field study included ataxia, lethargy and injection site soreness in one dog treated with CERENIA Injectable Solution. Prevention and Treatment of Acute Vomiting In a US field study for the prevention and treatment of vomiting associated with administration of cisplatin for cancer chemotherapy, the following adverse reactions were reported in 77 dogs treated with CERENIA Injectable Solution at 1.0 mg/kg subcutaneously or 41 dogs treated with placebo: Frequency of Adverse Reactions by Treatment Placebo (n=41) Adverse Reaction Diarrhea Anorexia
# dogs
% occurrence
19 0 1 3 3 0
9.7 0 0.5 1.5 1.5 0
26 11 2 2 1 1
12.5 5.3 1.0 1.0 0.5 0.5
The following adverse reactions were reported during a European field study for the prevention of vomiting due to motion sickness in dogs treated with CERENIA Tablets at a minimum of 8 mg/kg orally once daily for 2 consecutive days. Dogs may have experienced more than one of the observed adverse reactions. Frequency of Adverse Reactions by Treatment Placebo (n=106) Adverse Reaction Vomiting Drowsiness/Lethargy/Apathy Hypersalivation Anxiety Trembling/Tremors Inappetence Mucus in stool
CERENIA (n=77)
# dogs
% occurrence
# dogs
% occurrence
1 0
2.4 0
6 4
7.8 5.2
Injection site reaction (swelling, pain upon injection)
0
0
3
4.0
Lethargy
1
2.4
2
2.6
CERENIA (n=107)
# dogs
% occurrence
# dogs
% occurrence
4 1 2 0 0 0 0
4 1 2 0 0 0 0
10 8 5 2 2 2 1
9 8 5 2 2 2 1
For a copy of the Material Safety Data Sheet (MSDS) or to report adverse reactions call Pfizer Animal Health at 1-800-366-5288. STORAGE CONDITIONS: CERENIA Tablets should be stored at controlled room temperature 20°-25° C (68°-77° F) with excursions between 15°-30° C (59°-86° F). CERENIA Injectable Solution should be stored at controlled room temperature 20°-25° C (68°-77° F) with excursions between 15°-30° C (59°-86° F). Use within 28 days of first vial puncture. HOW SUPPLIED: CERENIA peach-colored tablets are scored with a break line, and contain 16, 24, 60 or 160 mg of maropitant as maropitant citrate per tablet. Each tablet is marked with “MPT” and the tablet strength on one side and the Pfizer logo on the other. Each tablet size is packaged in blister packs containing 4 tablets per perforated sheet. CERENIA Injectable Solution is supplied in 20 mL amber glass vials. Each mL contains 10 mg of maropitant as maropitant citrate. US Patents: See US 6,222,038; US 6,255,320 NADA #141-262, NADA #141-263, Approved by FDA
Distributed by:
Pfizer Animal Health Div. of Pfizer Inc NY, NY 10017
Frequency of Adverse Reactions by Treatment Adverse Reaction
% occurrence
Not associated with motion sickness.
ADVERSE REACTIONS: Prevention of Acute Vomiting The following adverse reactions were reported during the course of a US field study for the prevention of acute vomiting in dogs treated with CERENIA Tablets at a minimum of 2 mg/kg orally and/or Injectable Solution at 1.0 mg/kg subcutaneously once daily for up to 5 consecutive days:
CERENIA (n=208)
# dogs
April 2007
Pfizer-Cerenia_USE.qxp:VT
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stops here CERENIA for motion sickness gives your canine patients the green light to travel. CERENIA is the first and only canine anti-emetic proven to prevent vomiting due to motion sickness, as well as treat and prevent acute emesis. So now you can give your patients complete vomiting control, whether theyâ&#x20AC;&#x2122;re on the road, at home, or in the clinic.
The safe use of CERENIA has not been evaluated in dogs used for breeding, pregnant or lactating bitches, dogs with gastrointestinal obstruction, or dogs that have ingested toxins. CERENIA is recommended for use in dogs 16 weeks and older. Use with caution in dogs with hepatic dysfunction. The most common adverse reactions noted during clinical studies were hypersalivation, drowsiness/lethargy, anorexia, and diarrhea. See page 413 for Product Information Summary.
Š 2008 Pfizer Inc.
All rights reserved.
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Printed in USA/April 2008.
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CE Article #2 Urethral Obstruction to help stabilize vital signs and to relieve discomfort (see box on page 410). Cystocentesis should be performed with caution because the bladder wall is friable and prone to tearing. Administration of a sedative prior to the collection procedure may be required in fractious patients or patients with severe pain. Detailed information on the catheterization procedure as well as sedation is provided in the box on page 412.
Postobstruction Care Medical Care Acepromazine (0.03 to 0.1 mg/kg IV q6â&#x20AC;&#x201C; 8h)14 can be administered following urethral catheterization to provide sedation and decrease urethral spasms. It can be administered with buprenorphine (0.006 to 0.01 mg/kg IV q6â&#x20AC;&#x201C;8h).16 Buprenorphine should be administered to provide analgesia. Buprenorphine solution can be administered orally and should be placed on the oral mucosa, where it has been shown to have excellent bioavailability. Following urethral catheterization, urine output should be measured every 4 hours to ensure that output equals 1 to 2 ml/kg/hr. IV fluids should be recalculated every 4 hours to match urine output plus the maintenance fluid rate for that individual patient. Packed cell volume and serum concentrations of total protein, electrolytes, blood urea nitrogen, and creatinine should be measured once or twice a day to assess hydration status and resolution of metabolic abnormalities. In some patients with significant azotemia, postobstructive diuresis often occurs as a result of medullary washout, osmotic diuresis, pressure necrosis, or antidiuretic hormone resistance. Diuresis should be suspected if urine output exceeds 2 ml/kg/hr. Diuresis can cause rapid dehydration and electrolyte depletion. Urine output of these patients should be monitored closely. Serum potassium concentration should also be measured regularly and potassium supplementation provided as needed. The urinary catheter should be left in place for 24 to 48 hours following urethral catheterization. Once urine output and results of blood and serum studies are normal, the catheter can be removed. A sterile urine sample for culture should be obtained from the urinary catheter just before removal. After the urinary catheter has been removed, the patient 416
JULY 2008 | Veterinary Technician
should be monitored closely during the next 24 hours to ensure that urination is normal.
Home Care Following discharge to the owner, a patient treated for urethral obstruction should continue to receive treatment with acepromazine at 0.5 mg/kg PO and buprenorphine at 0.01 mg/kg PO for 5 to 7 days to provide continued sedation and analgesia as well as to decrease urethral spasms. Antibiotics should be administered based on the results of culture and susceptibility testing of the urine sample obtained immediately prior to urinary catheter removal.
Long-Term Dietary and Environmental Management Long-term management should be geared toward decreasing the recurrence of interstitial cystitis, which may lead to another obstruction. Patients with a history of bladder or urethral stones should be placed on a urinary care prescription diet that keeps pH neutral to help prevent the crystals from returning. These patients can also benefit from increased water intake. They should have access to fresh running water. Although not ideal, water can be added to their canned food. Cats that are prone to cystitis need environmental enrichment. Scratching posts and toys can help increase their activity. They also need to be in an environment that has reduced levels of stress, and they need a quiet place for their food and litterbox.
Conclusion The short-term prognosis for cats treated for urethral obstruction is good when appropriate treatment and supportive care are provided as soon as an obstruction is suspected. Cats that have had one urethral obstruction are at increased risk for reobstruction. In addition, cats that develop urethral obstructions multiple times may require perineal urethrostomy to widen and shorten the urethra. This procedure should drastically reduce the chances of another obstruction from occurring; however, stones or calculi could possibly cause another obstruction. Acknowledgment: The author thanks Edward Cooper, VMD, MS, DACVECC, who is affiliated with The Ohio State University Veterinary Teaching Hospital, for his help in reviewing this article. www.VetTechJournal.com
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8 F WF CFFO B CFTUTFMMFS GPS more than 50 years. (And our patients canâ&#x20AC;&#x2122;t even read.)
Over 80,000 Copies Sold
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and everything in between. The 50th Anniversary Edition of the most trusted resource in veterinary medicine â&#x20AC;&#x201D; The Merck Veterinary Manual (9th Edition) â&#x20AC;&#x201D; has been extensively revised and updated with 400 additional pages, including:
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/PX UIFSF T B NBOVBM GPS QFU PXOFST UPP The Merck/Merial Manual for Pet Health delivers animal health expertise in everyday language that all pet owners can understand. Let pet owners know about this comprehensive resource; it can help them stay in touch with the health of their pets.
www.merckbooks.com Brought to you by an educational partnership between Merck and Merial Circle 192 on Reader Service Card
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CE Article #2 Urethral Obstruction References
1. Shaw D, Ihle S: Urinary tract disease and fluid and electrolyte disorders, in Small Animal Internal Medicine. Baltimore, Williams & Wilkins, 1997, pp 323–377.
Otic Suspension
2. Drobatz KJ: Critical care aspects of urethral obstruction. West Vet Conf Proc 2005. 3. Lawler DF, Sjolin DW, Collins JE: Incidence rates of feline urinary tract disease in the United States. Feline Pract 15(5):13–16, 1985.
Brief Summary Please consult the full package insert for more information.
4. Lee JA, Drobatz KJ: Characterization of the clinical characteristics, electrolytes, acid–base, and renal parameters in male cats with urethral obstruction. J Vet Emerg Crit Care 13(4):227– 233, 2003.
Indications Acarexx® (0.01% ivermectin) Otic Suspension is indicated for the treatment of adult ear mite (Otodectes cynotis) infestations in cats and kittens four weeks of age or older. Effectiveness against eggs and immature stages has not been proven.
5. The Ohio State University College of Veterinary Medicine: Unpublished data, Columbus, OH, 2002. 6. Sparkes AH: Feline lower urinary tract disease. World Small Anim Vet Assoc World Congr Proc 2006.
Precautions The safe use of Acarexx in cats used for breeding purposes, during pregnancy, or in lactating queens, has not been evaluated.
7. Hostutler RA, Chew DJ, DiBartola SP: Recent concepts in feline lower urinary tract disease. Vet Clin North Am Small Anim Pract 35(1):147– 170, 2005. 8. Bartges JW, Finco DR, Polzin DJ, et al: Pathophysiology of urethral obstruction. Vet Clin North Am Small Anim Pract 26(2):255–265, 1996.
Adverse Reactions In approximately 1% of 80 cats and kittens, pain associated with the pinna and vomiting were observed following treatment with Acarexx. Caution U.S. federal law restricts this drug to use by or on the order of a licensed veterinarian.
Courtney Beiter,
10. Senior DF: Urinary disorders, in Schaer M (ed): Clinical Medicine of the Dog and Cat. Ames, Iowa State Press, 2003.
“Urethral obstruction in male cats is a common emergency,” says Courtney. “Therefore, it is important for technicians who are working in small animal emergency and referral practices to know how to assess and treat these patients.” Courtney works in the emergency and critical care department at The Ohio State University Veterinary Teaching Hospital. She is currently writing a chapter on fluid therapy for an anesthesia book for technicians. Courtney and her husband, Joe, have a daughter, Makaila. They share their home with three dogs (Gus, Maddie, and Flegel) and three cats (Sydney, Daisy, and Rex).
11. Plunkett S: Urogenital and reproductive emergencies, in Emergency Procedures for the Small Animal Veterinarian. Philadelphia, Harcourt Publishers Limited, 2000, pp 224–225.
RVT, VTS (Anesthesia)
How Supplied Acarexx is packaged in two polypropylene ampules per foil pouch, which are packaged 12 foil pouches per display carton. Each ampule is filled to deliver 0.5 mL of 0.01% ivermectin otic suspension per ear. Storage Conditions Acarexx should be stored at temperatures below 86°F (30°C). Protect from freezing.
Acarexx is a registered trademark of IDEXX Laboratories, Inc. © 2006 IDEXX Pharmaceuticals, Inc.
IPI/ILS/BS/3
9. Bexfield NH: Urinary obstruction: Can’t pee, won’t pee. Br Small Anim Vet Congr Proc 2007.
ABOUT THE AUTHOR
12. Greene SA, Grauer GF: Renal disease, in Tranquilli WJ, Thurmon JC, Grimm KA (eds): Lumb & Jones’ Veterinary Anesthesia and Analgesia, ed 4. Ames, Iowa, Blackwell Publishing Professional, 2007, pp 915–919. 13. Ettinger SJ, Feldman EC (eds): Urolithiasis, urethroliths, and urethral plugs, in Textbook of Veterinary Internal Medicine, ed 6. St. Louis, Elsevier Saunders, 2005. 14. Plumb D: Veterinary Drug Handbook, ed 3. White Bear Lake, MN, Pharma Vet Publishing, 1999. 15. Kirby R, Rudloff E: Fluid and electrolyte therapy, in Textbook of Veterinary Internal Medicine. Philadelphia, Saunders, 2000, p 335. 16. Thurmon JC, Tranquilli WJ, Benson JG (eds): Preanesthetic and anesthetic adjuncts, in Lumb & Jones’ Veterinary Anesthesia, ed 3. Baltimore, Williams & Wilkins, 1996, pp 183–209. (text continues on page 422)
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Just one treatment of Acarexx with patented (0.01% ivermectin) Wisdom technology, DQG KH·V EDFN RQ D UROO ®
®
Acarexx® (0.01% ivermectin) is the first and only ivermectin otic suspension approved by the FDA for the treatment of ear mites in cats and kittens as young as 4 weeks old. It’s also the only one with patented Wisdom® technology, which finally makes it possible to deliver the superior efficacy of ivermectin safely. With just one treatment of Acarexx, the little patient will be back to his old tricks.
www.acarexx.com 7009 Albert Pick Rd. Greensboro, NC 27409
See Page 418 for Product Information Summary
© 2008 IDEXX Pharmaceuticals, Inc. • All rights reserved • 4794-02 • Acarexx and Wisdom are registered trademarks of IDEXX Laboratories, Inc. in the United States and/or other countries.
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Basic Guidelines for
g an Article for n i t i r W
Veterinary Technician
®
Getting Started Before you begin writing, contact our editorial office to make sure that an article on your particular topic is needed and that no other author is writing on the same subject.
How to Avoid Plagiarizing Keep in mind that when you are referencing a statement from a published source, the statement must be reworded so that it is different from, but has the same meaning as, the original statement. For example: Original source — Very young kittens (0 to 8 wk) are very susceptible to infection with FeLV. Cats older than 16 weeks are less likely to be infected, but cats of any age may acquire FeLV, particularly through prolonged contact. Plagiarism — Kittens that are 8 weeks of age or younger are very susceptible to infection with FeLV.1 Cats older than 16 weeks are not as likely to become infected, but cats of any age may acquire FeLV, particularly through prolonged contact.1
Updated February 2008
Acceptable rewording — Newborn kittens (≤8 wk of age) are more susceptible to FeLV infection than are adult cats; therefore, they have the greatest risk of infection if exposed to the virus.1 However, any cat that has prolonged contact with an FeLV-positive cat may contract the virus.1
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Format Manuscripts should be typewritten and double-spaced. The paper must be submitted electronically via email or on a disk compatible with Microsoft Word 6.0 or better. The paper should include headings where appropriate. The maximum length of manuscripts is 5,000 words. Shorter manuscripts are also welcome. Trade Names Trade names are generally not to be used in the text unless mention is essential and fair representation is made of all available products. Footnotes Any explanatory notes or personal communications should be footnoted using alphabetic superscripts within the text. Review Articles All review articles must be accompanied by a 10-question, multiple-choice quiz that tests the reader’s comprehension of the main points of the article. True/False questions should not be included. References All points discussed in the text of review articles and clinical columns must be documented by references cited with numbered superscripts in the text. References should be listed in order of citation in the text — not alphabetically. Journal articles, clinical textbooks, and conference proceedings are suitable references. Web sites are acceptable; however, only sites associated with legitimate, unbiased groups or organizations (e.g., universities, government organizations, reputable national associations) should be used.
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Veterinary Technicians
Keep uths ehea#lt1 hiny
with trum broad-spec n o ti c te pro †
PLAY a VITAL role in keepING cats protected.
You are the first person their owners see on each visit, and the last one they talk to. So it’s important for you to remind owners that one simple application of REVOLUTION (selamectin) each month can keep their cats protected from fleas, ear mites, hookworms,* roundworms,** and heartworms. A recommendation from you is all it takes to make the difference for your feline patients. 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. *Ancylostoma tubaeforme **Toxocara cati † 8 out of 10 broad-spectrum doses dispensed Revolution is a registered trademark of Pfizer Inc. Cats of the Revolution is a trademark of Pfizer Inc. ©2008 Pfizer Inc. All rights reserved. REV0408030 See page 422 for Product Information Summary.
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CE Article #2 Urethral Obstruction (continued from page 418) 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 FELIS PREVENTION OF HEARTWORM DISEASE CAUSED BY S $IROFILARIA IMMITIS AND THE TREATMENT AND CONTROL OF EAR MITE /TODECTES CYNOTIS INFESTATIONS 2%6/ S ,54)/. ALSO IS INDICATED FOR THE TREATMENT AND I CONTROL OF SARCOPTIC MANGE 3ARCOPTES SCABIEI 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 FELIS PREVENTION OF HEARTWORM DISEASE CAUSED BY S $IROFILARIA IMMITIS AND THE TREATMENT AND CONTROL OF EAR MITE /TODECTES CYNOTIS INFESTATIONS S 2%6/,54)/. IS ALSO INDICATED FOR THE TREATMENT AND CONTROL OF ROUNDWORM 4OXOCARA CATI AND INTESTINAL HOOKWORM I !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 $ IMMITIS AND WHILE THE NUMBER OF CIRCULATING MICROFILARIAE MAY S 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
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1. ___________ are the most common cause of urethral obstruction in male cats. a. Uroliths b. Neoplasms c. Urethral plugs d. Urethral strictures 2. Which of the following statements regarding the etiology of urethral obstruction is false? a. Although the underlying cause of urethral plugs is unknown, struvite crystalluria and idiopathic cystitis are thought to play a role. b. Urethral obstruction has been associated with urethral edema and spasm related to lower urinary tract inflammation and pain. c. In some cases, uroliths and neoplasms can cause urethral obstruction. d. Urethral strictures do not cause urethral obstructions in male cats. 3. Initially, the most common clinical sign of urethral obstruction in male cats is a. stranguria. b. inappropriate elimination. c. lethargy. d. hematuria. 4. On an ECG, which of the following is not a sign of hyperkalemia? a. diminished to absent P-waves b. prolonged PR intervals c. widened QRS complexes d. short PR intervals 5. When treating cats with urethral obstruction, ___________ has traditionally been considered the fluid of choice because it does not contain potassium.
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a. b. c. d.
Normosol-R 0.9% NaCl Plasmalyte 148 lactated Ringerâ&#x20AC;&#x2122;s solution
6. Following urethral catheterization, the urinary catheter should be left in place for ___________ hours. a. 8 to 10 c. 12 to 24 d. 24 to 48 b. 10 to 12 7. Feline urethral obstruction accounts for up to ________ of the feline cases seen in small animal referral and emergency practices. a. 3% c. 10% d. 12% b. 5% 8. Which of the following statements regarding urethral obstruction is false? a. Male cats are more prone to urethral obstruction than female cats. b. When urine is unable to drain from the bladder, fluid, electrolyte, and acidâ&#x20AC;&#x201C;base abnormalities occur. c. Cats with a history of lower urinary tract disease are less prone to developing urethral obstruction. d. In cats with urethral obstruction, a common physical finding is a large, firm bladder. 9. If the patient is not experiencing diuresis postobstruction, urine output should be ________ ml/kg/hr. a. 0.5 to 1 c. 1 to 3 d. 2 to 3 b. 1 to 2 10. Postobstructive diuresis can result in a. worsening of hyperkalemia. b. worsening of the azotemia. c. rapid dehydration and electrolyte depletion. d. none of the above www.VetTechJournal.com
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ToxicologyBrief
Iron Toxicosis
Erin Freed, CVT ASPCA Animal Poison Control Center Urbana, Illinois
I
RON, A HEAVY METAL, is the most abundant free iron enters cells of the liver, heart, and where it causes hepatic and myocardial trace mineral in the body.1–4 Although iron is essen- brain, damage by binding to cell membranes and tial for the transport of oxygen, the presence of ex- stimulates lipid peroxidation — in which free remove electrons from the lipid in cell cess iron in the blood can lead to iron toxicosis. The radicals membranes, resulting in cell damage.1,2,5,11,12 The occurrence of toxicosis also depends on most common cause of iron overdose is accidental inthe amount of iron already in the body.1,2 Angestion of iron-containing compounds; however, iat- imals that have a large amount of stored iron rogenic overdose via injection of agents to treat iron may develop signs of toxicosis even when the of iron ingested causes no problems in deficiency (e.g., iron dextran complex) is possible. level other animals.1,2 Iron-containing agents that animals may accidentally and Clinical Signs ingest include multivitamins, birth control pills, fertil- Toxicity Toxicity is not expected in healthy dogs and cats that ingest less than 20 mg/kg of elizers, and chemical hand and foot warmers.2,5 Pathophysiology Iron can exist in two different ionic states — ferrous (Fe2+) and ferric (Fe3+) — within the body. Although ferrous iron is more readily absorbed by the body, both forms can be absorbed if they are ionized.3,4,6 Metallic iron and iron oxide (i.e., rust) do not readily ionize; therefore, these forms are typically not problematic if ingested.1–4 After iron is ionized, most of it is absorbed by mucosal cells in the duodenum and upper jejunum. However, in cases of overdose, the entire intestinal tract may absorb iron.3,4,6,7 Absorption is also increased in the presence of vitamin C or a high-sugar diet.3,4,6,8 The iron is then transported across cell membranes to the blood, where it binds to transferrin,9 which is the primary iron transport protein.5 Transferrin is produced in the liver and is normally 25% to 30% saturated with iron.9 Most iron is transported by transferrin to the bone marrow for the production of hemoglobin. The body absorbs 2% to 15% of ingested iron, but only 0.01% is eliminated daily10; the remainder is stored in the liver, spleen, and bone marrow.1,2 When iron toxicosis occurs, transferrin becomes saturated so that the total serum iron (SI) concentration exceeds the transferrin ironbinding capacity; therefore, the amount of free circulating iron in the blood increases. This
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emental iron.1,2 Ingestion of 20 to 60 mg/kg of elemental iron may cause toxicosis with mild gastrointestinal (GI) signs.2 Ingestion of more than 60 mg/kg of elemental iron is considered potentially serious and may result in GI hemorrhage as well as metabolic acidosis and elevated liver enzyme values.2,4 Death may result if an animal ingests 100 to 200 mg/kg of elemental iron and does not receive treatment.1,2,4,8
Iron Salts and Their Content of Elemental Iron3,4,a Iron Salt Ferrocholinate Ferrous gluconate Ferric ammonium citrate Ferroglycine sulfate Peptonized iron Ferrous sulfate (hydrate) Ferrous lactate Ferric pyrophosphate Ferrous fumarate Ferric chloride Ferrous sulfate (anhydrous) Ferric phosphate Ferrous carbonate (anhydrous) Ferric hydroxide
% Elemental Iron 12 12 15 16 17 20 24 30 33 34 37 37 48 63
Williams RJ: Biomineralization: Iron and the origins of life. Nature 343:213–214, 1990. a
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Toxicosis can be characterized as peracute, subacute, or chronic. In peracute toxicosis, such as that occurring after an iron injection, clinical signs develop within minutes to a few hours after exposure. Signs are similar to those of an anaphylactic reaction and may include hypovolemic shock followed by sudden death as a result of vascular collapse.13 At the injection site, the skin may be discolored and edema may occur.8 Subacute toxicosis, such as that occurring after oral ingestion, can be grouped into four phases. During the first phase, signs develop up to 6 hours after exposure2 and include bloody vomiting and diarrhea caused by GI hemorrhage.4,6–8 In the second phase, which occurs within 6 to 24 hours of exposure, the patient’s condition appears to improve.2 During the third phase, which occurs about 12 to 96 hours after exposure,2 GI signs recur, along with shock, central nervous system depression, metabolic acidosis, liver failure, pulmonary edema, hemorrhage, or even death.4,6,7 Acute renal failure secondary to shock may also develop. Animals that survive this phase may enter a fourth phase 2 to 6 weeks after exposure.4,6 In this phase, gastric obstruction may develop secondary to gastric or pyloric stenosis.1,2,13 Chronic toxicosis occurs when iron is repeatedly ingested at low levels that individually do not have adverse effects. Long-term iron exposure may lead to the development of iron deposits in the liver, heart, pancreas, and adrenal and parathyroid glands. Death generally results from myocardial damage.12
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Diagnosis If a patient has ingested an iron salt–containing substance in amounts sufficient to cause toxicity, the veterinary staff should observe the patient’s clinical signs and measure the SI level and total iron-binding capacity (TIBC). Testing an animal’s SI concentration is the best method of confirming a tentative diagnosis of iron toxicosis.2 The SI test measures bound and free SI content, whereas the TIBC test assesses the total amount of iron that the transferrin can bind. SI testing should be conducted within a few hours of ingestion to obtain a baseline level. Testing should be repeated 4 to 6 hours after the first assays because SI levels may vary widely within the first few hours following ingestion.1 Normal ranges for SI and TIBC vary depending on the type of laboratory test used. The technician should check the range of the specific test to determine whether results are abnormal. Toxicosis can be confirmed if the SI value is greater than the TIBC value. If a patient has ingested radiopaque iron-containing tablets, it may be useful to obtain abdominal radiographs.4,6 Radiography should be conducted within a few hours of ingestion and then repeated after GI decontamination (discussed below).1,2,9,11 www.VetTechJournal.com
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ToxicologyBrief Calculating Ingested Iron Most products that contain iron include it as a salt compound. To calculate the amount of iron ingested, it is important to determine the amount of elemental iron (i.e., the amount of iron without a salt compound). The table on page 424 lists various iron salts and the percentage of elemental iron in each salt. For example, if a cat has ingested 10 tablets, each containing 32.5 mg of ferrous fumarate, the calculations would be performed as follows: To calculate the total amount of ferrous fumarate ingested, multiply 10 by 32.5, which equals 325 mg of ferrous fumarate. To calculate the amount of elemental iron ingested, multiply 325 by 0.33 (the factor that represents the percentage of elemental iron in ferrous fumarate; see table on page 424), which equals 107 mg of elemental iron. To calculate the amount of iron ingested per kilogram of body weight, divide 107 by the animal’s weight in kilograms.
Treatment If an animal has ingested less than 20 mg/kg of elemental iron, the veterinary staff should observe the patient and provide treatment based on clinical signs. If an animal has ingested more than 20 mg/kg of elemental iron, GI decontamination through induced vomiting or gastric lavage should be considered up to 1 to 2 hours after ingestion, unless the animal is already vomiting. Magnesium hydroxide may decrease the absorption of iron by transforming elemental iron into ferric oxide, which is not readily absorbed. Activated charcoal does not bind well to iron and is therefore not likely to be helpful in treating iron overdoses.11 GI protectants (such as misoprostol or sucralfate), along with an H2 blocker (such as famotidine, cimetidine, or ranitidine), may be administered. A proton pump inhibitor, such as omeprazole, can also be added, and intravenous fluid support — which helps manage shock and hypotension — can be offered. Electrolyte level and acid–base status should also be monitored in patients exhibiting clinical signs. Supportive care should be provided as needed.1,2,11 When the SI value is greater than the TIBC value or is above 300 μg/dl, excess iron must be removed from the blood. The drug of choice for this purpose is deferoxamine mes426
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ylate, an iron chelator. This agent is best given within the first 24 hours of exposure, at a rate of 40 mg/kg IM q4–8h or 15 mg/kg/hr IV.5 This hypotensive drug is excreted primarily by the kidneys. It should be infused slowly, and care must be taken when administering it to animals that are in shock or have renal insufficiency.8,13 Administering ascorbic acid after the gut has been cleared of iron increases the effectiveness of the drug.11 Use of deferoxamine mesylate will cause the urine color to become vin rose (i.e., deep red) if SI is elevated. Treatment is usually continued until the urine is no longer discolored, until clinical signs start to resolve, or until the SI value is less than 300 μg/dl.9,11 Patients should be monitored for at least 4 to 6 weeks after exposure for evidence of GI obstruction caused by scarring of the tract.1,2,4
Prognosis The patient’s outcome depends on the amount of iron ingested and how quickly the owner seeks medical attention for the pet. If signs do not develop within 6 hours of exposure, or if the patient receives early decontamination, the prognosis is good.5 The prognosis is guarded after signs have developed,1,2 but the prognosis is poor when the SI value is greater than 500 μg/dl and a chelator is not available.1,2
Role of the Technician Technicians should educate owners about the signs of iron toxicosis and instruct them to keep iron-containing products away from pets. However, if a product containing iron is ingested, the owner should immediately contact the hospital or an animal poison control center. When a client contacts the hospital to report that his or her pet has ingested a product containing iron, the technician should determine what type of product was ingested (e.g., multivitamins), how much the pet ingested (e.g., 10 tablets), and how much time has elapsed since the exposure. To help the veterinary staff calculate the amount of elemental iron ingested and administer the appropriate treatment, the client should bring the packaging that contained the ingested product (e.g., multivitamins, birth control pills, fertilizer). Although iron toxicosis occurs infrequently, the veterinary staff should be knowledgeable about how to manage affected patients. www.VetTechJournal.com
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References
1. Albretsen JC: Iron, in Plumlee KH (ed): Clinical Veterinary Toxicology. St. Louis, Mosby, 2004, pp 202–204. 2. Albretsen JC: The toxicity of iron, an essential element. Vet Med 101:82–90, 2006. 3. Goyer RA: Toxic effects of metals, in Klaassen CD (ed): Casarett & Doull’s Toxicology: The Basic Science of Poisons, ed 5. New York, McGraw-Hill, 1996, pp 715–716. 4. Greentree WF, Hall JO: Iron toxicosis, in Bonagura JD (ed): Kirk’s Current Therapy XII: Small Animal Practice. Philadelphia, WB Saunders, 1995, pp 240–242. 5. Hall JO: Iron, in Peterson ME, Talcott PA (eds): Small Animal Toxicology, ed 2. St. Louis, Elsevier, 2007, pp 433–437. 6. Hillman RS: Hematopoietic agents: Growth factors, minerals, and vitamins, in Hardman JG, Limbird LE, Molinoff PB, et al (eds): Goodman & Gilman’s The Pharmacological Basis of Therapeutics, ed 9. New York, McGraw-Hill, 1995, pp 1311–1340. 7. Liebelt EL: Iron, in Haddad LM, Shannon MW, Winchester JF (eds): Clinical Management of Poisoning and Drug Overdose, ed 3. Philadelphia, WB Saunders, 1998, pp 757–766.
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8. Osweiler GD, Carson TL, Buck WB, Van Gelder GA: Clinical and Diagnostic Veterinary Toxicology, ed 3. Dubuque, IA, Kendall/Hunt Publishing, 1985, pp 104–106. 9. Beasley VA: A Systems Affected Approach to Veterinary Toxicology. Urbana, IL, University of Illinois, 1999, pp 464–467. 10. Klaassen CD (ed): Casarett & Doull’s Toxicology: The Basic Science of Poisons, ed 6. New York, McGrawHill, 2001, pp 842–843. 11. Osweiler GD: Toxicology. Philadelphia, Williams & Wilkins, 1996, pp 188–191. 12. Hooser SB: Iron, in Ramesh CG (ed): Veterinary Toxicology: Basic and Clinical Principles. New York, Elsevier/Academic Press, 2007, pp 433–437.
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13. Howland MA: Risks of parenteral deferoxamine for acute iron poisoning. J Toxicol Clin Toxicol 34:491– 497, 1996.
ABOUT THE AUTHOR
Erin Freed, CVT “Understanding iron toxicosis can help technicians educate clients about this condition — owners may not realize that their pet is at risk if it ingests iron products,” says Erin, a veterinary technician at the ASPCA Animal Poison Control Center in Urbana, Illinois. Erin is pursuing a BAS degree in veterinary technology through the distance learning program at St. Petersburg College in St. Petersburg, Florida. She is also interested in holistic medicine. Erin is thankful for her family, which includes mom Kathy, dad Roger, sisters Amber and April, two cats (Babygirl and Dodger), and a dog (Buddy). www.VetTechJournal.com
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EquineEssentials
The Use of Antifungals
*
F
Jennifer L. Davis, DVM, PhD, DACVIM, DACVCP† North Carolina State University
UNGAL DISEASES are relatively rare in horses, but they can be life-threatening and are often extremely difficult to treat because the few available drugs may have poor bioavailability, induce severe toxicity, or be cost prohibitive. Veterinary technicians should be familiar with the different drugs used to treat fungal diseases in horses. This column provides a summary of drugs that are currently available. Griseofulvin The use of griseofulvin is limited to treatment of ringworm caused by Trichophyton equinum or Microsporum gypseum. Two convenient dosing forms (a bolus and a powder to be used as a top dressing in feed) are currently available for horses. Each dose of each form contains 2.5 g of drug, and a single daily dose for an adult horse is 5 mg/kg. Smaller doses (1.25 g) should be used for foals or ponies. The available veterinary formulations contain microsize particles of griseofulvin. In contrast, human formulations may contain ultramicrosize particles, which increase the surface area of the drug available for dissolution, thereby increasing drug solubility and bioavailability. These formulations can be used in veterinary species; however, the dose should be decreased by 50% to avoid toxicity. Griseofulvin should not be used in pregnant mares during the early stages of gestation because teratogenic effects, including ocular and skeletal malformations, have been reported.1 This drug has been given, without adverse effects, to mares in the later stages of pregnancy.
Azole Antifungals The azole antifungals include the imidazole ketoconazole as well as the triazoles, which include fluconazole, itraconazole, and voriconazole. The pharmacokinetics of these drugs have been studied in horses. Unfortunately, ketoconazole, which is inexpensive and readily 428
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available, is not absorbed following oral administration (30 mg/kg) in horses unless it is administered in a highly acidic vehicle, such as hydrochloric acid.2 Even when ketoconazole is administered in this fashion, the bioavailability is still low (around 23%2), and use of this drug is not recommended in horses. Of the antifungals studied in horses, fluconazole is among the most convenient to administer; affordable generic formulations are now available. A study of the pharmacokinetics of fluconazole in horses has shown that the bioavailability is approximately 100%, and no side effects have been reported, even with long-term administration.3 Fluconazole has been safely used in mares in the seventh and 10th months of pregnancy with no adverse effects on the fetus.4 The recommended dosing regimen involves a loading dose of 14 mg/kg PO followed by 5 mg/kg PO once daily.3 This regimen produces plasma and tissue concentrations greater than 8 µg/ml, which is sufficient to kill susceptible fungi, including the dermatophytes as well as Blastomyces, Candida, Coccidioides, Cryptococcus, Conidiobolus, and Histoplasma spp. However, fluconazole may be ineffective against Aspergillus spp, which are often highly resistant to the drug. The pharmacokinetics of itraconazole have been studied in horses,5 and the drug has been used to successfully treat equine fungal diseases. Two oral formulations of itraconazole are currently available in the United States: one is a capsule containing small, drug-coated spheres, and the other is an oral solution in which the drug has been complexed with cyclodextrins to improve solubility. The capsules have low and variable absorption (approximately 12%) in horses, and the spheres must be delivered intact — crushing them decreases bioavailability. The solution has better oral *Adapted from Davis JL: The use of antifungals. Compend Equine 3(3):128–133, 2008. †Dr. Davis discloses that she received a grant and speaking honorarium from Bayer Animal Health for a study related to enrofloxacin in cattle. This study is unrelated to antifungals.
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absorption (approximately 65%), but at the recommended dose of 5 mg/kg once daily, the 250-ml volume required for a 1,100-lb (500-kg) horse would be difficult for owners to deliver. Both formulations of itraconazole are cost prohibitive in many cases. Generic capsules are available but still expensive. To make dosing more affordable, many practitioners have tried using compounded formulations. Unfortunately, testing of the formulations as well as plasma samples from horses that have received them indicates that the drug concentration varies considerably in the formulations and that oral bioavailability is negligible. Therefore, compounded preparations of itraconazole should not be used in horses. The spectrum of activity of itraconazole is similar to that of fluconazole, with the exception that Aspergillus spp are typically susceptible to itraconazole, often with minimum inhibitory concentrations less than 0.06 µg/ml. To date, based on susceptibility and clinical use in horses, itraconazole is the recommended drug for treating aspergillosis. No adverse effects have been reported following administration of itraconazole to horses. In other species, itraconazole has been shown to inhibit cytochrome P-450–mediated drug metabolism in the liver, indicating potential drug–drug interactions in horses. In addition, in other species, concurrent administration of drugs that increase gastric pH (i.e., H2 antagonists [cimetidine, ranitidine], proton pump inhibitors [omeprazole, pantoprazole]) has been shown to decrease the bioavailability of itraconazole by inhibiting pH-dependent dissolution in the stomach; therefore, coadministration of these drugs in horses should be avoided. The newest azole antifungal to be studied in horses is voriconazole. The drug exhibits an oral bioavailability of approximately 100% and a long half-life, allowing oncedaily dosing.6 The spectrum of activity of voriconazole is broad, including Aspergillus and some Fusarium spp. Doses of 3 mg/kg PO q24h should be sufficient to treat aspergillosis, but higher doses (4 to 5 mg/kg) are probably necessary to treat infection with Fusarium spp. Voriconazole has excellent potential for use as an antifungal in horses; however, clinical experience is lacking, and the drug is currently too expensive for practical use.
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Amphotericin B Amphotericin B has been used in a limited number of horses, even though the pharmacokinetics have not been determined in this species. The use of this drug should be limited to patients with severe systemic fungal diseases because of potential irreversible nephrotoxicity. It is impractical to use amphotericin B in a field setting because it must be diluted in 5% dextrose and administered intravenously over a 60-minute period and because fluid preloading is recommended to help prevent renal damage. The serum biochemistry panel should be monitored www.VetTechJournal.com
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EquineEssentials frequently during the course of drug administration, and urine sediment tests should be conducted to monitor for early cast formation. Reported doses have ranged from 0.1 to 0.9 mg/kg IV q24–48h. Liposomal encapsulated formulations are available and have decreased toxicity, allowing higher cumulative doses to be used. However, these formulations are cost prohibitive, and their use has not been reported in equine medicine.
Other Antifungals Sodium or potassium iodide compounds have been used to treat fungal infections in horses and cattle for many years. The mechanism of action of these compounds against fungi and bacteria is unknown, and there is no in vitro evidence that these compounds are effective. In vivo, they are used to treat equine nasal fungal granulomas caused by Conidiobolus, Basidiobolus, and Pseudallescheria spp. It is recommended to begin therapy with intravenous 20% sodium iodide (125 ml q24h) for 3 days, followed by 30 g PO q24h for at least 30 days past resolution of clinical signs. Adverse effects (salivation, lacrimation, tachycardia, dry skin, anorexia, abortion, infertility) have been reported, particularly with intravenous dosing. Use of iodide compounds is not particularly effective as a monotherapy and should be combined with surgical excision, intralesional therapy, or use of other systemic antifungals. Lufenuron has also been studied as an antifungal in horses. It has been used successfully in an intrauterine lavage to treat fungal endometritis7; however, oral absorption is minimal, and systemic use of this drug is not recommended in horses.8 Terbinafine is an allylamine antifungal that has been used in humans and small animals to treat dermatophytosis and onychomycosis. Its spectrum of activity includes yeast and other systemic fungi, but its use in treating these infections has been limited. It has recently become generic and may be an affordable alternative treatment in horses, although the pharmacokinetics have not been studied in this species.
Ocular Antifungals One of the most common manifestations of fungal disease in horses is keratomycosis. Fungal infections of the cornea and the intraocu430
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lar structures can be vision threatening and are often difficult to treat. Natamycin is commercially available as a 5% ophthalmic suspension and has excellent activity against fungi that commonly cause keratomycosis, including Aspergillus and Fusarium spp as well as yeasts. Natamycin is expensive, has a tendency to precipitate with other medicine, and may sometimes block subpalpebral lavage catheters. Ophthalmic formulations of miconazole are not commercially available, but the drug can be compounded as a 1% solution and used topically in the eyes. Miconazole creams have been used in horses’ eyes by some practitioners; however, these creams may impair vision and should not be used in patients in which perforation of the cornea is likely, as the vehicles used can be irritating to the intraocular structures. Itraconazole can also be compounded for ocular use. Combining the drug with 30% dimethyl sulfoxide increases the corneal drug concentration but does not increase penetration of the drug into the anterior chamber, making this drug suitable for treating corneal surface and corneal stromal infections, but not for treating fungal endophthalmitis.9 The intravenous formulation of voriconazole has been studied for topical use in horses’ eyes. It penetrates well through an intact cornea, and aqueous humor concentrations reach greater than 2 µg/ml after topical application of 0.2 ml of 1% voriconazole every 4 hours.10 Higher concentrations of the drug or more frequent administration may result in signs of ocular irritation. Voriconazole is stable for up to 30 days when kept refrigerated in a well-sealed container. In cases that do not respond to traditional topical therapies, subconjunctival injection of amphotericin B has been used. The deoxycholate salt is diluted to a concentration of 0.5 mg/ml in sterile water (not saline). The injection volume is approximately 0.25 ml every other day. Amphotericin can be irritating to tissue, and some conjunctival inflammation or sloughing can occur.
References
1. Schutte JG, van den Ingh TS: Microphthalmia, brachygnathia superior, and palatocheiloschisis in a foal associated with griseofulvin administration to the mare during early pregnancy. Vet Q 19(2):58–60, 1997.
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EquineEssentials 2. Prades M, Brown MP, Gronwall R, Houston AE: Body fluid and endometrial concentrations of ketoconazole in mares after intravenous injection or repeated gavage. Equine Vet J 21(3):211–214, 1989. 3. Latimer FG, Colitz CM, Campbell NB, Papich MG: Pharmacokinetics of fluconazole following intravenous and oral administration and body fluid concentrations of fluconazole following repeated oral dosing in horses. Am J Vet Res 62(10):1606– 1611, 2001. 4. Taintor J, Crowe C, Hancock S, et al: Treatment of conidiobolomycosis with fluconazole in two pregnant mares. J Vet Intern Med 8(3):363–364, 2004. 5. Davis JL, Salmon JH, Papich MG: Pharmacokinetics and tissue distribution of itraconazole after oral and intravenous administration to horses. Am J Vet Res 66(10):1694–1701, 2005. 6. Davis JL, Salmon JH, Papich MG: Pharmacokinetics of voriconazole after oral and intravenous
ABOUT THE AUTHOR
Jennifer L. Davis,
DVM, PhD, DACVIM, DACVCP
7.
8.
9.
10.
administration to horses. Am J Vet Res 67(6):1070– 1075, 2006. Hess MB, Parker NA, Purswell BJ, Dascanio JD: Use of lufenuron as a treatment for fungal endometritis in four mares. JAVMA 221(2):240, 266–267, 2002. Scotty NC, Evans TJ, Giuliano E, et al: In vitro efficacy of lufenuron against filamentous fungi and blood concentrations after PO administration in horses. J Vet Intern Med 19(6):878–882, 2005. Ball MA, Rebhun WC, Trepanier L, et al: Corneal concentrations and preliminary toxicological evaluation of an itraconazole/dimethyl sulphoxide ophthalmic ointment. J Vet Pharmacol Ther 20(2):100–104, 1997. Clode AB, Davis JL, Salmon J, et al: Evaluation of concentration of voriconazole in aqueous humor after topical and oral administration in horses. Am J Vet Res 67(2):296–301, 2006.
“Compared with other species, horses have a limited ability to absorb many oral drugs,”says Dr. Davis. “Much of my research has focused on determining why absorption is so low in this species as well as trying to increase the number of drugs that are available to treat infectious diseases in horses.” Dr. Davis is an assistant professor of equine internal medicine at North Carolina State University College of Veterinary Medicine in Raleigh. When Dr. Davis is not working or tending to her horse, Chris, she enjoys traveling and photography.
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WE HAVE TURNED THE WHOLE WORLD OF PARASITE TREATMENT AND DISEASE PREVENTION INSIDE OUT.
FLEAS HEARTWORMS ROUNDWORMS
HOOKWORMS HOOK P WHIPWORMS WHIP
Prescription-only ription-o Advantage Multi® for Dogs (imidacloprid + moxidectin) Topical Solution: Proven-effective topical flea performance of imidacloprid, the active ingredient in Advantage®. 100% effective in the prevention of heartworm disease, as shown in clinical trials.1 Broad-spectrum control of intestinal parasites, including several larval stages.1 Advantage Multi® for Dogs (imidacloprid + moxidectin) Topical Solution CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. WARNINGS: For the first 30 minutes after application: Ensure that dogs cannot lick the product from application sites on themselves or other treated dogs, and separate treated dogs from one another and from other pets to reduce the risk of accidental ingestion. Ingestion of this product by dogs may cause serious adverse reactions including depression, salivation, dilated pupils, incoordination, panting, and generalized muscle tremors. In avermectin sensitive dogs, the signs may be more severe and may include coma and death. CONTRAINDICATIONS: Do not administer the product orally. Do not use this product (containing 2.5% moxidectin) on cats. HUMAN WARNINGS: Children should not come in contact with the application site for two (2) hours after application.
1. Freedom of Information Summary: NADA 141-251.
© 2008 Bayer HealthCare LLC, Animal Health Division, Shawnee Mission, Kansas 66201 Bayer, the Bayer Cross, Advantage and Advantage Multi are trademarks of Bayer. AM08419n
See Page 434 for Product Information Summary
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TechTips
TIP of the MONTH
Each published Tip of the Month contributor receives a Veterinary Technician® scrub top in addition to $50.
Foxtails, which are commonly found in backyards and recreational areas, can be extremely hazardous to pets, especially if the plant’s seeds are ingested. To help clients recognize this plant, I collected several stalks of foxtail and secured each one to a sturdy piece of paper with clear packaging tape. I then placed the visual aids in each examination room for the veterinarians and technicians to use when discussing the dangers of this plant with clients. Janet Kerr, RVT Sacramento, CA Reduce, Reuse, Recycle
At Your Fingertips
Many items that are typically used in a veterinary clinic can be recycled. After detaching used IV fluid bags from the solution set and emptying them of remaining fluid, we put them in our recycling bin. We also recycle syringe cases and pet food cans. It only takes a little extra time to help the environment. Emily Jax, CVT Apex, NC
To make it easier to microchip patients, I created prepacked kits that include the microchip syringe and the clinic’s relevant paperwork. In a separate bag inside the kit, I keep all of the materials (e.g., registration form, identification card, collar tag) that the client will take home. This way, we don’t have to waste time gathering all of the supplies. Melissa Rondez, RVT Fairfield, CA
We recycle empty laundry detergent bottles by using them as sharps containers. We affix a “hazardous materials” label to the bottle and secure the cap to the side of the bottle with tape. When the bottle is full, we attach the cap and tape it in place. The bottles are made of strong, durable plastic, so they are capable of safely holding used needles and glass slides. Terry Kennedy Springfield, PA www.VetTechJournal.com
The doctors in our mixed animal practice frequently perform surgery during farm calls. To save time and make sure that they have the necessary supplies, we prepare “kits” for them to take ahead of time. We put each doctor’s name on a large plastic Rubbermaid container, which is then filled with individually wrapped sterile supplies (e.g., surgical gown, gloves, instruments). After surgery, the doctor places everything back in
the container and exchanges it for a restocked “kit.” Elizabeth Hart, RVT Sidney, OH
The Air in There After changing an oxygen tank, I spray the connectors with soapy water. If bubbles form on the connectors, I know that there is an oxygen leak and that the connectors need to be tightened. Gloria Aguilar Ridgecrest, CA
?
TECH TIP CHALLENGE
$50 paid for each published response! In what ways does your clinic promote going “green”? Send submissions by August 15.
We pay $50 for each tip, question, or solution selected for publication. Submissions should not exceed 100 words and will be edited for length and clarity. Photos are welcome. Be sure to include your full name, address, and daytime phone number so that we can contact you. Videotape your tech tips and upload them to www.VetTechJournal.com/sharetechtip. We pay $100 for each Tech Tip video that we post on www.VetTechJournal.com. Tech Tips are compiled by VLS Assistant Editor Liz Donovan.
Veterinary Technician | JULY 2008
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TechTips
TECH TIP CHALLENGE
X-Ray Vision In the April issue, we asked what tips you have for storing radiographs for easy reference and handling. Here are some of your responses: A great way to organize x-ray folders is to use paint stir sticks, which can usually be obtained for free at a local paint store. We label the end of each stick with a letter of the alphabet and then insert the sticks between the appropriate envelopes (arranged alphabetically by the owner’s last name) so that the letters are visible. If the sticks break or become chipped, they can easily be replaced. Kathy Lizardo, RVT Yuba City, CA
To organize our radiographs, we arrange them in alphabetical order by the owner’s last name and store them in a used x-ray cabinet that we purchased. The cabinet is sectioned using lettered tabs, making it very easy to locate a radiograph. Large x-ray envelopes are kept on one side of the cabinet and small envelopes on the other side. We purge the files every 2 years to make space for new files. Robin Wright Fairborn, OH We use a numbering system to organize our x-rays before filing them. We label the first radiograph of the year as 001 and add the last two digits of the year (e.g., the first radiograph of 2008 was labeled 001-08). We then continue to number the radiographs chronologically throughout the year. We keep a log of each x-ray that is taken (including the x-ray number and the patient’s information), and we write the x-ray number in the patient’s file. Staci Westphalen Turlock, CA
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In our clinic, each radiograph is labeled with an identification number, the owner’s name, the patient’s name, and the date. The radiographs are then placed in an empty 14 × 17 film box that is labeled with the month and year that the radiographs were taken. The film boxes are stored on bookshelves with the open ends facing out. The information from each radiograph is also included in a notebook that we keep in the radiology suite. When radiographs are removed from the boxes for reference purposes, we use exposed films that are labeled “X-Ray Out” to mark the space. Lindsay Bumps, CVT Woodstock, VT
Lindsay Bumps
Robin Wright
Kathy Lizardo
To help us easily locate a patient’s radiographs, we attach adhesive letters that spell the owner’s last name along the edges of the x-ray envelope. We also attach labels to the x-ray that include the client’s name, the patient’s name, and the account number. As additional x-rays are taken of the same patient, we add a numerical sticker. Elizabeth Hart, RVT Sidney, OH
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Wet and wild doesn’t mean losing protection.
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ProductForum_July_VT:VT
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ProductForum Pet King Brands, Inc.
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Pet King Brands’ new Hoof ’n Hide enzymatic treatment line now includes Zymox Water-Resistant Topical Spray. This spray includes bioactive enzymes and provides large animals with long-lasting protection against microbes that cause bacteria and fungi. Although this product is recommended for use on large animals, it is also safe for small companion pets. 888-752-5487 䡲 www.petkingbrands.com Circle 101 on Reader Service Card
IDEXX Laboratories
Rhodococcus equi RealPCR Test IDEXX Laboratories has released a new IDEXX RealPCR test to help equine practitioners detect a potentially fatal form of pneumonia in foals caused by virulent strains of Rhodococcus equi. The test uses real-time polymerase chain reaction technology to detect the vapA gene, which is a marker for virulent R. equi. The test also detects avirulent strains of R. equi and is able to deliver results in 48 hours or less. 800-621-8378, option 1 䡲 www.idexx.com/requi Circle 102 on Reader Service Card
Medi-Dose, Inc./EPS, Inc.
Plastic Storage Bins EPS has expanded its line of storage and transport products to include plastic, stackable storage bins. The bins are molded from durable, lightweight polypropylene and feature rugged construction, making them able to withstand heavy-duty use. The bins are available in four sizes and a variety of colors.
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VetVision DRds SimonDR and Del Medical Systems Group collaborated on the design of this new digital high-resolution x-ray system. It features a 13-megapixel charge-coupled device sensor; three hard drives capable of storing over 20,000 images; easy-to-use WhiteCap image processing software; choice of a fixed, two-way, or four-way tabletop configuration; and a 400 mA anatomically programmed high-frequency generator. 800-835-3852 䡲 www.simondr.com Circle 104 on Reader Service Card
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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 408 and 409 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_July_VT:VT
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ProductForum The Greenies Company
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Spectrum Surgical has released newly designed starter and advanced eye packs. The starter pack includes curved tenotomy scissors, Bishop-Harmon forceps with teeth, a Barraquer wire eye speculum, and a Webster needle holder. The advanced pack contains the same scissors, forceps, and speculum as the starter kit in addition to a Castroviejo needle holder, chalazion forceps, and a microblade handle. Both kits are backed by a lifetime guarantee and are packaged in autoclavable cases that feature soft silicone pin mats and removable lids.
The Greenies Company’s pet pilling products now have a new package, recipe, size selection, and product name — Greenies Pill Pockets treats. The treats are made with real beef, chicken, or salmon, as well as high-quality proteins, antioxidant vitamins C and E, and other wholesome ingredients. The new formulation improves palatability to help increase successful pilling, and the redesigned package gives pet owners clear instructions on how to use the product, which improves client compliance in giving pets medication. The treats are available in several sizes and include two flavors for dogs — beef and chicken — and two flavors for cats — chicken and salmon.
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Spectrum Surgical Instruments
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Index to Advertisers For more information about products advertised in this issue, see the Reader Service Card inserted between pages 408 and 409.
Company
Animal Health Options ASPCA Bayer Animal Health Ceva Animal Health Fort Dodge Animal Health The Greenies Company Hill’s Pet Nutrition IDEXX Laboratories Lilly Merck Merial Petplan Insurance Pfizer Animal Health PurinaCare Insurance St. Petersburg College Summit VetPharm Veterinary Learning Systems Vetstreet Western Veterinary Conference
Product ProQuiet Animal Poison Control Center Advantage and K9 Advantix Advantage Multi for Dogs Feliway CaliciVax ProMeris Pill Pockets Hill’s Prescription Diet Pet Foods Prescription Diet Canine r/d Acarexx Comfortis Veterinary Manuals PureVax and Vet Jet Pet Insurance Cerenia Revolution Pet Insurance Online Veterinary Technology Program Vectra for Cats and Kittens TechTalk E-Newsletter Veterinary Technician® Is Now Free Practice Communication and Marketing Tool WVC 2009
Reader Service # 128 184
196 177 195 160
199 156 192 173 175 191 159 135 181 127
186
Page # 407 405 437 433, 434 Cover 3 403 Cover 4 411 394–395 Cover 2 (Canada only) 418, 419 397, 399 417 387 Cover 2 413, 414–415 421, 422 423 439 389 432 391 (US only) 425, 427, 429, 431 438
The following advertisers appear in our Market Showcase section, which begins on page 441. Alpine Publications MED I.D. Petknap, Inc. Veterinary Solutions WhereTechsConnect.com
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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.
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COLORADO – A brand-new, progressive small animal emer-
• Transfer opportunities and relocation
gency and critical care facility in Basalt seeks a full-time experienced veterinary technician to work rotating overnight and day shift positions. We are a small, multi-practice facility that operates 24/7. Our staff includes one board-certified and one board-eligible criticalist; a cardiologist; an ophthalmologist; a behaviorist; an acupuncturist; and two staff veterinarians. Previous experience in emergency and critical care, surgery, and anesthesia is preferred. Great benefits. Interested candidates, please contact our lead technician Renee Gerlock, CVT: call 970-618-2833 or email rgerlock@valleyervet.com.
That’s why we offer competitive salaries and generous benefits including: • Medical, dental and vision insurance • 401(k) retirement plan
• Exciting career advancement opportunities and specialty tech positions • Flexible scheduling These are just a few of the reasons why some of the nation’s top veterinary professionals consider joining VCA Animal Hospitals to be their smartest career move yet. Of course, working in one of VCA’s state-of-the-art facilities also has its advantages! Join us in one of our specialty hospitals and multi-doctor progressive practices. Come share your talent with our team and be a part of our family of over 1,800 doctors and 200 boardcertified specialists. We offer positions in 39 states and have more than 450 locations across the United States. Please visit us at www.vcapets.com. And feel free to contact us at (800) 216-8699 or talent@vcamail.com.
COLORADO Full-time head CVT position available immediately at our AAHA-accredited small animal/equine practice in Pagosa Springs. We are seeking an enthusiastic, self-motivated team player who enjoys variety in his/her work. Duties will include radiology, dentistry, surgical assistance, etc. Large animal experience preferred. Salary commensurate with experience; benefits, paid vacation, paid CE, and discounted veterinary services offered. Send resume to: San Juan Veterinary Hospital 2197 East Highway 160 Pagosa Springs, CO 81147 Fax 970-264-6202, Attn: Amy; or email amy@sanjuanvethospital.com.
CONNECTICUT – Skilled technician needed at threeALASKA – Experienced technician (license optional) veterinarian small animal hospital located outside
needed for busy 24-hour emergency hospital. Sightsee in beautiful Alaska on your days off! Competitive wages, health and dental insurance, paid vacation, and CE opportunities. Send resume to PET Emergency Treatment, 2320 East Dowling Road, Anchorage, AK 99507; or fax 907-274-5133. Visit www.petemergencytreatment.com.
Danbury. Utilize all your technical skills in our NEW, stateof-the-art facility with full in-house lab, digital x-ray, digital dental x-ray, ultrasound, etc. Friendly environment, excellent benefits. Salary commensurate with experience. Call 203-775-3679, or email resume to myvet@ BrookfieldAnimalHospital.com.
PLACE YOUR AD: VetTechClassifieds@vetlearn.com 442 JULY 2008 | Veterinary Technician
time 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 commensurate with experience and qualifications. Full benefits. Fax resume to 407-831-5434. Visit our website at www.kittydoctor.com.
FLORIDA – The SPCA Tampa Bay seeks a full-time CVT for our progressive animal shelter. Provide emergency and general medical care to sick and injured animals and assist veterinarian in day-to-day operations of the medical department. Excellent benefits; salary commensurate with experience. Job description available upon request. Send resume to SPCA Tampa Bay, Attn: Director of Operations, 9099 130th Avenue North, Largo, FL 33773; or email to Connie@spcatampabay.org. EOE.
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.
THE NEXT AVAILABLE ISSUE
is SEPTEMBER, which closes JULY 29 For information about ad placement, call Liese Dixon at 800-920-1695. www.VetTechJournal.com
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*Source: December 2007 BPA Statement
TECHNICIANS WANTED
TECHNICIANS WANTED
TECHNICIANS WANTED
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.
FLORIDA
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
Coral Springs Animal Hospital—primary care/multi-specialty/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
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 52422, or 267-685-2422 Fax 201-231-6373 • Email lcostantini@vetlearn.com www.VetTechJournal.com
area small animal practice seeks skilled, professional, self-motivated veterinary technician for full-time position. Technical skills will be fully utilized. Send resume to Tricia Hunt, practice manager: email TJHCVT@aol.com or fax 305-935-8730.
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:
FLORIDA – North Miami Beach/Aventura
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 fulltime. Contact Dr. Carter for an application and interview: 850-878-4799.
FLORIDA
Veterinary Technicians/Nurses We are a state-of-the-art small animal referral practice located in West Palm Beach. Our in-house veterinarians and consultants specialize in emergency and critical care, surgery, internal medicine, oncology, neurology, cardiology, radiology, and behavior sciences. We have a place for you, whatever your interests may be! Qualities required in our technicians and nurses include: • Clinical and interpersonal skills • Desire to directly assist with case management • Self-motivated and team-oriented • New graduates welcome! Excellent compensation adds to our quality working environment. Additional benefits include medical and dental insurance, 401(k), paid vacation, uniform reimbursement, CE, and discounted services for your pets! Please call Jennifer at Palm Beach Veterinary Referral & Critical Care Center: 561-434-5700; and/or send your resume, Attn: Jennifer: Fax: 561-296-2888 • Email: pbvrs@earthlink.net.
To place your classified or Market Showcase ad, contact us today! Veterinary Technician | JULY 2008
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ClassifiedAdvertising TECHNICIANS WANTED 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
TECHNICIANS WANTED GEORGIA – Veterinary technician needed for small animal practice in coastal Georgia. Benefits package includes insurance, 401(k), PTO, and CE allowance. Please contact Dr. Shireen Hamid: call 912-571-0040 or email thecritterdoc@hotmail.com. ILLINOIS – Veterinary Specialty Center is a state-of-the-art multidisciplinary specialty referral hospital located in the northern suburbs of Chicago. There are great opportunities for certified technicians and veterinary assistants to join our team. Our growing specialties include surgery, internal medicine, oncology, cardiology, nephrology, neurology, radiology/imaging, emergency and critical care, dermatology, physical therapy, behavior, and ophthalmology. We have an excellent work environment with outstanding compensation and benefits. For more information on these exciting and challenging opportunities, please contact: Evelyn Feekin Veterinary Specialty Center 1515 Busch Parkway, Buffalo Grove, IL 60089 Fax 847-459-1848 • Phone 847-459-7535 x312 or email at efeekin@vetspecialty.com.
GEORGIA Whether you live in this area already or are thinking about relocating, please consider a position with Georgia Veterinary Specialists in beautiful Atlanta. Due to recent facility expansion and an increasing number of motivated, skilled doctors, our hospital requires more technical coverage. We seek experienced, highly skilled technicians, assistants, and kennel assistants to join our 24-hour emergency/critical care/specialty referral practice. At GVS, we offer many specialty areas to utilize your skills and demonstrate your love for animals. You’ll receive excellent pay, a strong benefits package, 401(k), and paid vacation. Qualified candidates, please email resume, cover letter, and salary request to Human Resources at aflower@gvsvet.com, or fax to 404-459-0835. If you hope to practice where you and your skills will be valued… COME GROW WITH US!
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.
TECHNICIANS WANTED ILLINOIS Seeking a fulfilling and challenging career? Join Animal Emergency & Referral Center, one of the area’s fastest-growing veterinary centers, located in Chicago’s northern suburbs. AERC is a 24-hour emergency/critical care and specialty referral hospital, where board-certified specialists head each referral discipline: cardiology, imaging, internal medicine, neurology/neurosurgery, and orthopedic/soft tissue surgery. We seek experienced, energetic, skilled technicians to support our emergency/ICU and specialty departments. All of our talented and dedicated doctors and technical staff are committed to providing compassionate, progressive patient care and services 24/7. At AERC, we appreciate, encourage, and reward talent! We offer a competitive salary and benefits package, which includes health/dental/life insurance, uniform/CE allowances, 401(k), paid vacation/sick time, and no rotating shifts. Fax Sheri at 847-564-9604. Email srothschild@AERCenter.com. Visit us at www.aercenter.com.
ILLINOIS – 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. Qualified candidates, please email resume to mary.burke@vcamail.com; or fax 708-749-1716.
ILLINOIS – New facility! Incredible staff! The flexibility to enjoy your personal life! Sound too good to be true? Not at the Glenview Animal Hospital in Glenview! We need a technician to join our family. Customer-service–oriented first and foremost! Certification preferred; experience a plus. Fax or email resume to Missy: 847-724-4855; glenviewah@ glenviewanimalhospital.com.
When your advertising needs conflict with your desire to maintain anonymity, use our Confidential Forwarding Service! Whether you need to discretely replace a staff member, sell your practice, or advertise your professional availability, we have the tools to help! With CFS, interested parties send their inquiries to us and we mail, fax, or email them to you.
Call 800-920-1695 or visit www.VetClassifieds.com for more information! 444 JULY 2008 | Veterinary Technician
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TECHNICIANS WANTED
TECHNICIANS WANTED MASSACHUSETTS
SCHOOL OF VETERINARY MEDICINE INDIANA – The Veterinary Teaching Hospital at the Purdue University School of Veterinary Medicine is seeking veterinary technicians. Our challenging RVT positions will perfect your current skills and provide opportunities for professional growth, both clinically and academically. Candidates must be graduates of AVMA-accredited technology programs and licensable in Indiana within six months of hire. We offer competitive salaries and excellent benefits. The VTH includes both a large and small animal hospital, supporting laboratories, and other service facilities. We are dedicated to providing the highest quality routine veterinary care and specialized services in a hands-on training environment. You will enjoy a varied caseload and assist in the education of technician and veterinary students in areas such as: intensive care/ emergency medicine; soft tissue and orthopedic surgery; internal medicine; radiology; and others. Current openings are posted at www.purdue.edu/hr/Employment (click “Regular Staff Positions,” select “Basic Search,” then select “School of Veterinary Medicine Admin” under “Organization”). For more information, please contact Mrs. Dannell Smith: Veterinary Teaching Hospital, 625 Harrison Street, West Lafayette, IN 47907; Phone: 765-496-9585; Fax: 765-496-1166; Email: smithde@purdue.edu. AA/EOE.
LOUISIANA – Specialty and emergency veterinary hos-
pital seeks experienced technicians. We are a fully equipped 24-hour facility specializing in surgery, internal medicine, and oncology. We also offer physical rehabilitation and afterhours emergency and critical care. We are looking for motivated individuals who enjoy working in a fast-paced, team-driven atmosphere and who are dedicated to providing the highest standard of care. Our practice is located just 40 minutes from historic downtown New Orleans and the French Quarter. Come utilize your skills and expand your knowledge at our state-of-the-art facility. We offer a competitive salary and a comprehensive benefits package, including health, dental, and 401(k). Interested candidates: call Shelly Spotswood at 985-626-4862 or fax resume to 985-626-4852. Visit our website at www.lavrc.com.
MARYLAND
Technicians/Technician Supervisor Atlantic Veterinary Internal Medicine, in Annapolis and Towson, is currently hiring full-time registered or experienced veterinary technicians as well as an experienced technician supervisor. Both offices are part of the Chesapeake Veterinary Referral Center and are convenient to Baltimore, historic Annapolis, and Washington, D.C. Applicants should be compassionate, detail-oriented, and organized. We offer an excellent benefit package including health, dental, 401(k), and much more! Please call Kim Thomas at 800-788-2872 or fax resume to 410-224-2295. Visit our website at www.atlanticvetintmed.com to meet our doctors and staff.
MARYLAND – Our team-oriented, high-tech small animal hospital seeks a competent veterinary technician. Great pay and benefits. Send your resume/inquires to Dr. Esra Yavuz: Animal Medical Center, 142B North Bond Street, Bel Air, MD 21014; email esra@doctoresra.com; or fax 410420-9175. www.VetTechJournal.com
MARYLAND – Experienced veterinary technician needed for progressive, high-quality, state-of-the-art referral and emergency center. Located on 30 acres in Frederick. Great salary and working conditions. Fax resume and cover letter to 301-874-8880 or email jfinnegan@greenbriarpethospital.com. Visit our website at www.greenbriarpethospital.com. MARYLAND – Certified/registered technician or experienced assistant needed for a full-time position at our busy, four-doctor small animal practice. Olney-Sandy Spring Veterinary Hospital is a progressive, AAHA-accredited hospital where technicians are utilized to their fullest potential in the areas of surgical assistance, anesthesia monitoring, dentistry, radiology, laboratory, nursing care, and client education. Eligible candidates must be available weekday evenings and Saturdays and must have experience in a small animal hospital. Benefits include health insurance, paid vacation and CE, 401(k), and more. Send resume to Denise Sharp: fax 301-570-5121 or email petpalds@aol.com. Please visit our website at www.ossvh.com. MASSACHUSETTS – Seeking experienced full-time
veterinary technician to join our small community-oriented small animal/pocket pets practice. Must have excellent communication skills and enjoy working with the public. Health insurance, retirement plan, CE/uniform allowance, and generous vacation, personal, and sick time. No weekend, holiday, after-hours emergency, or night hours. Please send resume and cover letter to: Dr. J. Harrison, c/o Middlesex Animal Hospital, 668 Main Street, Reading, MA 01867; or fax 781-942-1313.
LOOK NO FURTHER. We’ve got your ideal job!
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
Come join the cutting edge! Vetcision is raising the bar on small animal medicine with a multi-million–dollar investment that will transform us from a surgery-only practice to a full-spectrum referral hospital. Our 19,000–sq. ft. world-class facility with the latest diagnostic and treatment technologies is within minutes of everything that historic Boston has to offer. You can expect to work in a progressive environment where innovation is the norm and career opportunities are unlimited, and you’ll have the freedom to make history in your field. Technician positions available in: • Small animal surgery • Internal medicine • Emergency and critical care Customer Care positions available: • Coordinators • Consultants Competitive salaries, excellent benefits — including generous paid vacation — and continuing education. Visit our website at www.Vetcision.com. Email your resume to careers@vetcision.com; or contact Berkeley O’Keefe: 293 Second Avenue, Waltham, MA 02454, or call 781-810-1010.
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ClassifiedAdvertising TECHNICIANS WANTED MICHIGAN – Small animal emergency/referral hospital in Kalamazoo is in need of another LVT. Board-certified surgeon and emergency/critical care specialist on staff. LVT duties will include anesthesia, surgical assistance, intensive care nursing, radiology, and clinical laboratory work. Full-time position with excellent salary and benefits. Send resume to Southwest Michigan Animal Emergency/Referral Hospital, 6039 South Westnedge Avenue, Portage, MI 49002; fax to 269-323-3636; or phone 269-760-4056. NEW JERSEY – RVT needed for busy, two-doctor, AAHAaccredited 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 973-7294092, attn: Diane; or email dvanlear59@yahoo.com. NEW JERSEY – Full- or part-time technician needed for sixdoctor practice in Morris Plains. We are a small animal/exotics practice with our own on-site ultrasound, chemotherapy, endoscopy. Duties include outpatient client communication, surgery, anesthesia monitoring, hospital treatments, and general nursing care. Includes some weekend/evening hours. Salary commensurate with experience. Send resume, Attn: Peggy, to Community Animal Hospital, 921 Route 53, Morris Plains, NJ 07950; email communityah@optonline.net; or fax 973-984-1855. Phone: 973-267-4220. NEW YORK – Licensed veterinary technician wanted for Rhinebeck Animal Hospital, located in the Hudson Valley. We are a progressive, fast-paced, seven-doctor pet hospital that cares for dogs and cats. New facility with advanced dental and anesthetic monitoring equipment. Tom: 845-876-6008; tom@rhinebeckanimalhospital.com. NEW YORK – Immediate openings for licensed veterinary technicians at progressive, seven-veterinarian, AAHA-accredited hospital located 30 miles east of Syracuse. Excellent salary and benefits, including health insurance and continuing education. Send resume to Frank Capella, DVM: Village Veterinary Hospital, 230 Genesee Street, Canastota, NY 13032; phone: 315-363-8700; fax: 315-363-1383; email: vvhmail@village vetcanastota.com; website: www.villagevetcanastota.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 full-service 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.
NORTH CAROLINA 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.
OHIO – RVTs needed for full-time, part-time, and weekend positions at MedVet Medical Center for Pets — a large, high-tech, high-energy, multi-specialty veterinary medical center in Worthington. Excellent pay and benefits. Don’t pass up this great career opportunity! Send resume, Attn: Human Resources: email employment@medvetohio.com, or fax 614-431-4419.
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TECHNICIANS WANTED 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
Registered Veterinary Technicians Needed Metropolitan Veterinary Hospital is in need of registered veterinary technicians to assist with our high-volume, state-of-the-art central hospital and referral center. We offer a wide range of services: internal medicine, surgery, neurology, ophthalmology, cardiology, and emergency and critical care. Primary responsibilities would include assisting with animal care, basic laboratory duties, diagnostic techniques, and surgical procedures, with a secondary function involving client contact, reception skills, and personal technical development. Candidates must be licensed RVTs in Ohio with a proven ability to function in a fast-paced environment. New and experienced technicians welcome. We offer competitive wages, health benefits, uniforms, paid time off, and a rewarding work environment. If you are interested in joining our team, please send your resume to: Metropolitan Veterinary Hospital, Attn: Human Resources 1053 South Cleveland-Massillon Road Akron, OH 44321; Fax 330-666-0519; or email to s.steen@metropolitanvet.com (subject: Registered Veterinary Technician).
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.
TECHNICIANS WANTED 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.
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
$1,000 Sign-On Bonus We are seeking experienced technicians and RVTs for our progressive, after-hours emergency hospital located in North Houston. Practice in a new, state-of-the-art facility with the highest standards of patient care. We offer a great work environment, an excellent salary/benefits package, uniforms, CE, flexible schedules, and a terrific support staff. This is veterinary emergency medicine at its best! $1,000 SIGN-ON BONUS! Send resume to hr@aeucc.com.
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WASHINGTON – Our well-equipped, five-veterinarian,
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.
UTAH – We are seeking skilled veterinary technicians with a perfect mix of technical and client service capabilities for a high-energy practice in the quaint 9th and 9th district in beautiful Salt Lake City. Our brand-new, state-of-the-art, AAHA-accredited facility is now open. Full-time positions are now available with very competitive wages, great benefits, and team-based work environment. Commitment to excellent patient care and client service a must! Highly motivated technicians who thrive in a fast-paced, challenging, and rewarding position may fax resumes with an intro letter to 801-328-9158 or email info@upcvet.com. www.uvhdc.com
VIRGINIA Seeking Experienced Veterinary Technicians 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 to join our growing AAHA-accredited practice. Our four-doctor/two-LVT small animal practice has great clients and a welltrained, 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.
www.VetTechJournal.com
TECHNICIANS WANTED
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 804-672-7200. 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 703-3684703 or call Dee/Dr. Smith at 703-330-8809. VIRGINIA – Lakeside Animal Hospital is seeking an energetic, experienced, full-time licensed/certified technician with a special interest in dentistry and/or anesthesia. We’re an AAHA-accredited three-doctor practice that sees companion animals and exotics. The ideal candidate is a motivated, detail-oriented team player who is enthusiastic about teaching senior and junior assistants and educating clients. Strong computer and multimedia skills desired. We offer a very competitive salary; signing bonus of $1,500; health and dental insurance; IRA; CE allowance; moving allowance; and substantial flextime. Interested technicians should call, email, or visit Lakeside Animal Hospital: 5206 Lakeside Avenue, Richmond, VA 23228; phone: 804-262-8697; fax: 804-266-0807; email: lakesideanimalhosp@yahoo.com. Attn: HR Manager Gina.
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 Busy, five-doctor practice that primarily sees small animals seeks full- or part-time LVT. Competitive salary, paid vacation, sick leave, health benefits, retirement plan, and CE and uniform allowances offered. Our clinic includes a well-equipped surgery suite with laser; ultrasound; endoscope; new digital radiography; organized pharmacy; and fully equipped in-house lab. Wenatchee is a beautiful city that sees all four seasons. We are located by the Columbia River, which offers parks, trails, and boating. Our valley also provides hiking, mountain biking, and skiing opportunities. Send resume to Angie at Cascade Veterinary Clinic 1201 Walla Walla Avenue Wenatchee, WA 98801; fax 509-663-5966; or email cascadevet@cascadevetclinic.com. Phone: 509-663-0793; website: www.cascadevetclinic.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.
WISCONSIN
Certified Veterinary Technician If you are a certified veterinary technician, this opportunity is for you! Pewaukee Veterinary Service — a busy, six-doctor AAHA-accredited small animal practice located in the great suburb of Pewaukee — is looking for full-time CVTs to join our technical team. We seek hard-working, career-minded individuals who want to practice high-quality medicine, have loads of compassion, and know what it is to be a real team player. We provide all the tools to help you succeed in your veterinary career with us, including truly state-of-the-art technology. We offer a great working schedule and highly competitive compensation package with generous benefits — you really can have it all! Email ckfeely@charter.net; fax 262-347-0780. Visit www.pewaukeeveterinaryservice.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.
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C L A S S I F I E D S ORDER FORM Please Place My Ad In ®
The Complete Journal for the Veterinary Health Care Team
C O N T I N U I N G E D U C A T I O N F O R V E T E R I N A R I A N S TM
for ____________ issues
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Pricing, Discounts, and Options Price per word (40-word minimum charge) $2.20
Single Ad Placement
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Add-On Options (one-time cost) $30 ❏ Early Internet Exposure — Place your ad on VetClassifieds.com 30 days before your first issue release date. ❏ Instant Internet Exposure — Your ad appears on VetClassifieds.com up to 7 weeks before your first issue release date. (one-time cost) $45 ❏ Confidential Forwarding Service — Direct inquiries to our attention; we send them to you via mail and/or email. (one-time cost) $40 ❏ Deluxe Package — Add a box border and bold contact information. Choose from six styles (see below). $50 ❏ Premium Package — Deluxe package plus your logo (email as high-resolution tiff, jpeg, or eps file). $100 Deluxe/Premium Package Style Sample (circle letter) A B C
D
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*First ad pays full price. Subsequent ads are eligible for one discount per ad, barring promotional specials. Percentage discounts are taken from total cost of ad.
Payment I will pay by (check one):
Check
Money Order
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) ______________________________________________ Fax (
) ______________________________________
Address_________________________________________________________________________________________________________ (credit card billing address if different from above)
Authorized Signature ______________________________________________________________________________________________ SPECIFICATIONS
ORDERING INFORMATION
• Counting Words: A new word is counted after every space. City, state, zip code, and phone/fax numbers are one word each. Email and Internet addresses are three words each.
Mail or fax order form and your ad to: Classified Advertising,Veterinary Learning Systems, 780 Township Line Road,Yardley, PA 19067 • Fax 201-231-6373 Email your ad and payment information to: VetForumClassifieds@vetlearn.com CompendiumClassifieds@vetlearn.com VetTechClassifieds@vetlearn.com CompendiumEquineClassifieds@vetlearn.com
• Payment: Include complete billing information with all orders. • Deadlines: No cancellation after the deadline date. All ads received after the deadline will be printed in the following issue of the appropriate journal(s).
For more information about classified advertising, call Liese Dixon at 800-920-1695 (toll-free) or 267-685-2491. For information about placing a display ad in Market Showcase, call Linda Costantini at 800-426-9119, ext. 52422 (toll-free), or 267-685-2422.
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