Veterinary Technician | August 2009 by davidpsu

The Complete Journal for the Veterinary Health Care Team

Vol. 30 No. 8 | August 2009

CE Credit from Alfred State College, SUNY

Atypical Tech

A Talk with Stephanie Barnhill, MBA, RVT

Visit us at www.VetTechJournal.com

Care and Management of Diabetes Mellitus Three New Specialties New Wellness Campaign Launched

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Editor’sLetter

The Complete Journal for the Veterinary Health Care Team

Scrambling for Records

August 2009 EDITOR IN CHIEF Marianne Tear, MS, LVT

EDITORIAL STAFF Tracey L. Giannouris, MA, Executive Editor 267-685-2447 | tgiannouris@vetlearn.com Paul Basilio, Associate Editor 267-685-2421 | pbasilio@vetlearn.com Allyson Corcoran, Editorial Assistant 267-685-2490 | acorcoran@vetlearn.com VETERINARY ADVISER Dorothy Normile, VMD, Chief Medical Officer SALES AND MARKETING Boyd Shearon, Account Manager 913-322-1643 | 215-287-7871 | bshearon@vetlearn.com Joanne Carson, National Account Manager 267-685-2410 | 609-238-6147 | jcarson@vetlearn.com Russell Johns Associates, LLC Classified Advertising Market Showcase 800-237-9851 | vettech@rja-ads.com DESIGN Michelle Taylor, Senior Art Director 267-685-2474 | mtaylor@vetlearn.com David Beagin, Art Director 267-685-2461 | dbeagin@vetlearn.com Bethany Wakeley, Production Artist Stephaney Weber, Production Artist OPERATIONS Marissa DiCindio, Director 267-685-2405 | mdicindio@vetlearn.com Elizabeth Ward, Production Manager 267-685-2458 | eward@vetlearn.com Christine Polcino, Traffic Manager 267-685-2419 | cpolcino@vetlearn.com CUSTOMER SERVICE 800-426-9119, option 2 | info@vetlearn.com PUBLISHED BY

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

Our Mission VETERINARY TECHNICIAN is designed to support and actively promote the professional status and value of veterinary technicians and assistants in their own eyes, in the eyes of their colleagues and employers, and within veterinary medicine as a whole. 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 on our website.

www.VetTechJournal.com

I often wonder how many people would be able to produce the licensing status and vaccination records for their pets in an emergency. I am a licensed veterinary technician and I take great care of my animals, but I am terrible of keeping track of their records. When I worked in a clinic, I brought my pets into work and took care of them between other duties. Now that I work at a college, I take them to the veterinarian’s office at off-peak times. I don’t have set appointment times and I don’t have to worry about the client — me — not understanding shorthand, so complete records are not always kept. This has worked for me for more years than I would like to admit. All of that ended abruptly this past week, however. It had been a successful day in the classroom and my husband Chris and I were preparing dinner together. I hadn’t noticed anything wrong until my husband opened the garage door and let out a yelp. The door to the back yard had blown open and we had accidentally left the main garage door open as well. My pug, Molly, was waiting patiently in the garage, but my three boys had decided to run through the neighborhood. In a panic, I scooted Molly into the house and chased after my husband; I have never seen someone run so fast while wearing flip-flops. Gehrig and Brosius responded immediately to his summons, but Zach kept going. The situation turned into an ugly version of a relay as Chris passed the two large dogs to me while he chased after the shih tzu. As I carried the bullmastiff and pit bull back to the house — I of course forgot the leash — one of the neighbors stood on her front porch and yelled at me to leash my dogs if I am going to take them out. The woman’s daughter was crying, so I asked if she was okay. They ignored me and went into their house. Eventually Chris gathered Zach and brought him home, and we all sat down to rest, relatively unscathed. Twenty minutes later the police showed up. My neighbor had reported that Brosius — the pit bull — was roaming the streets, trying to attack her daughter. Thankfully, the child only had a minor scratch that could not be attributed to my dogs, but the police had to file a report anyway. Part of the report required the vaccination history for all of the dogs. I was able to do it in less than 10 minutes, but I had to tear my den apart in the process. If I had not been home, my husband would not have been able to find any of the records. We now have a dedicated file drawer for all of the animal’s medical files.

Glenn Triest

Vol. 30 No. 8

Marianne Tear, MS, LVT Editor in Chief

Veterinary Technician | AUGUST 2009

EditorialBoard Our Mission VETERINARY TECHNICIAN is designed to support and actively promote the professional status and value of veterinary technicians and assistants in their own eyes, in the eyes of their colleagues and employers and within veterinary medicine as a whole.

EDITOR IN CHIEF

Glenn Triest

Elaine Anthony, MA, CVT St. Petersburg College

Kimberly A. Baldwin, LVT, VTS (ECC) Cornell University

Marianne Tear, MS, LVT

Andrea Battaglia, LVT

Program Director Veterinary Technology Program Baker College of Clinton Township, Michigan

Cornell University

Tracy Blais, BS, CVT, MEd Mount Ida College

SECTION EDITORS

David Bolette, RVT, LATg University of Pittsburgh

BEHAVIOR Julie Shaw, RVT

Susan Bryant, CVT, VTS (Anesthesia)

Animal Behavior Clinic Purdue University

Tufts Cummings School of Veterinary Medicine

Mary Tefend Campbell, LVT, VTS (ECC)

DENTISTRY Jeanne R. Perrone, CVT, VTS (Dentistry)

Mindy A. Cohan, VMD

Tampa Bay Veterinary Specialists

Fort Washington Veterinary Hospital

EQUINE DeeAnn Wilfong, BS, CVT

Harold Davis, BA, RVT, VTS (ECC, Anesthesia) University of California, Davis

Littleton Large Animal Clinic Littleton, Colo.

Elizabeth Davis, DVM, PhD, DACVIM

NUTRITION Ann Wortinger, BIS, LVT, VTS (ECC, SAIM) Wayne State University

Kansas State University

Katherine Dobbs, RVT, CVPM, PHR interFace Veterinary HR Systems, LLC Appleton, Wis.

DeeAnn Wilfong

Tara Lang, BS, RVT Critter Communications, LLC Cape Girardeau, Mo.

Jeanne R. Perrone

Donna Letavish, CVT Michigan State University–East Lansing

Heidi Lobprise, DVM, DAVDC Pfizer Animal Health

Laura McLain Madsen, DVM

Julie Shaw

Ann Wortinger

Peter Olson

Marianne Tear

Central Valley Veterinary Hospital Salt Lake City, Utah

Rosandra (Rose) Manduca, DVM Miami Dade College

Alfred State College (CE Accreditation)

Melvin C. Chambliss, DVM Program Director

Kathleen M. Bliss, LVT, MALS Kelly Collins, LVT Tracey M. Martin, LVT

Betty A. Marcucci, MA, VMD VCA Burbank Veterinary Hospital

Trisha McLaughlin, CVT Newtown Veterinary Hospital Newtown, Pa.

Kathryn E. Michel, DVM, MS, DACVN University of Pennsylvania

Christopher Norkus, BS, CVT, VTS (ECC, Anesthesia) Ross University School of Veterinary Medicine Basseterre, St. Kitts, West Indies

Jody Nugent-Deal, RVT University of California, Davis

Kristina Palmer-Holtry, RVT University of California, Davis

Karl M. Peter, DVM Foothill College

Ann Rashmir-Raven, DVM, MS, DACVS Mississippi State University

Virginia T. Rentko, VMD, DACVIM Medway, Mass.

Nancy Shaffran, CVT, VTS (ECC) Pfizer Animal Health

Margi Sirois, EdD, MS, RVT Penn Foster College

P. Alleice Summers, MS, DVM Cedar Valley College

Correction The July 2009 CE article, “Managing the Veterinary Laboratory,” contained an error on page 24 in the second sentence under the “Quality Control” heading. The sentence should have read, “Reference laboratories normally run controls on their analyzers once each shift or after a certain number of samples have been processed.” We apologize for any confusion.

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. 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 ©2009 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: $49 for one year, $88 for two years, $126 for three years. Canadian and Mexican rates: $55 for one year, $102 for two years, $142 for three years. Foreign rate: $129 for one year, $219 for two years, $349 for three years. (All checks must be payable to Veterinary Learning Systems in US funds drawn on a US branch of a US bank.) Selected back issues are available for $8 each (plus postage). Reprints are available for all VETERINARY TECHNICIAN articles; call 800-426-9119. POSTMASTER : Send address changes to Veterinary Technician, Veterinary Learning Systems, 780 Township Line Road, Yardley, PA 19067.

AUGUST 2009 | Veterinary Technician

www.VetTechJournal.com

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Contents

The Complete Journal for the Veterinary Health Care Team

August 2009

Volume 30, Issue 8

Atypical Tech Stephanie Barnhill, MBA, RVT, does not draw blood, bandage surgical sites or even place catheters. Instead, she ﬁelds questions about everything from pet nutrition to canine rehabilitation. Read about her role in solving critical problems as well as her award-winning huskies. ©2009 Peter Olson

COLUMNS 14 Inside Behavior Diary of a Fearful Dog Julie Shaw, RVT

CE ARTICLE

Care and Management of Diabetes Mellitus Ann Wortinger, BIS, LVT, VTS (ECC, SAIM) Diabetes mellitus is a chronic endocrine disorder that can occur in dogs and cats. The veterinary technician’s commitment to help manage DM is repaid with a better quality of life for the patient. The peer-reviewed CE articles contained in VETERINARY TECHNICIAN meet the standards set by Alfred State College for 1.0 credit hour. Documentation will be issued by Alfred State College, a State University of New York (SUNY) College of Technology.

20 Peer Reviewed Advanced Imaging: Growing Your Options Denise M. Weber, RVT

36 Equine Essentials Geriatric Horses — Maintaining a Good Quality of Life Carreen McCarthy, CVT

42 Management Matters

Tech News Pet Insurance Center at DogTime ..........................................................35 Wellness Campaign Launched...............................................................35 NAVTA Announces Three New Specialties ............................................35

Final View Insatiable Hunger 48 4

AUGUST 2009 | Veterinary Technician

Saving the Planet Made Quick & Easy Katherine Dobbs, RVT, CVPM, PHR

DEPARTMENTS Editor’s Letter ............................................ 1 Editorial Board .......................................... 2 State News ............................................ 6 Tech Tips ..............................................12 Product Forum .....................................44 Market Showcase ..................................45 Classiﬁed Advertising ...........................46 Advertisers Index ............................... 47 www.VetTechJournal.com

Advertorial

Do You Know the 5 Ws of Preanesthetic Testing?

Who should have preanesthetic blood work?

What tests should you run as part of your preanesthetic testing protocol?

All patients, regardless of age, in order to screen for diseases, reduce risks during anesthesia and establish an individualized baseline

A comprehensive chemistry panel, including electrolytes and a full CBC, is necessary to determine the current health status of every patient undergoing anesthesia. And don’t forget total T4 for your senior patients.

When should you run preanesthetic blood tests? The same day as the anesthetic event because blood results can change quickly—especially glucose and electrolytes

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To learn more, sign up for our August Webinar, Preanesthetic Evaluation: Make No Compromises!, presented by Dr. Fred L. Metzger, at www.idexx.com/prean3. 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. © 2009 IDEXX Laboratories, Inc. All rights reserved. • 09-69182-00 All ®/TM marks are owned by IDEXX Laboratories, Inc. or its affiliates in the United States and/or other countries.

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CanadianNews

Canadian Veterinary Medical Association Appoints President Julie de Moissac, DVM, has been appointed successor to Diane Frank, DVM, DACVB, as the president of the Canadian Veterinary Medical Association (CVMA). Dr. de Moissac is the 61st national president of the organization. She assumed leadership at the CVMA’s Annual General Meeting in Montreal, Quebec, on June 3. After graduating from the Western College of Veterinary Medicine in 1986, Dr. de Moissac established a mixed animal practice near Outlook, Saskatchewan. She became a Saskatchewan Veterinary Medical Association (SVMA) councillor in 1995 and the SVMA president in 1998. She

then served a 3-year term on the Board of Directors of Prairie Diagnostic Services. “Becoming president of the Canadian Veterinary Medical Association is a truly humbling, yet exciting prospect,” says Dr. de Moissac. “The opportunity to work with and meet veterinarians from across this country is a once-in-a-lifetime privilege.” Dr. de Moissac has been a member of the CVMA for more than 23 years, ﬁrst as a council member and member of the Animal Welfare Committee, then as a member of the Executive Board. VT

Ontario Veterinary College Implements Hospital Information System The Ontario Veterinary College Teaching Hospital (OVCTH) is in the process of implementing Meditech, a commercially available hospital information system. The information system will help reduce costs and streamline the hospital’s administrative processes. OVCTH is the ﬁrst veterinary facility to implement the system. The total suite of applications being

implemented includes billing and accounts receivable, general ledger, accounts payable, ﬁxed assets, materials management, medical records, pharmacy, lab, imaging and therapeutic services (radiology information system), order entry, admissions, patient care inquiry (electronic view of the patient record), housing and bed management and scheduling. The sys-

Continuing Education OCTOBER

The Manitoba Animal Health Technologists Association Association n Conference, Trade Show and AGM — Oct. ct. 17 and 18 aat ipeg. For more Canad Inns Club Regent Casino Hotel in Winnipeg. hta t @mts.net information, visit www.mahta.ca or email mahta@mts.net CanWest Annual Conference 2009 — Oc Oct. O t. 17-20 at the Fairmont Banff Springs Hotel, Banff, Alberta. This his conference will offer courses for the entire animal health alt lth caree team. In addition to a variety of continuing education catioo sesca sions, learn about the latest in clinical knowledge, e, the h newest he

tem will also interface with the hospital’s ﬁnancial system and new picture archiving and communication system. “Between OVCTH staff, OVCTH administration, Hamilton Health Sciences, and Beacon Partners, there are approximately 20 people involved in the project,” says Steven Woodard, hospital information management coordinator. “We are also consulting with clinicians and members of Clinical Studies, OVC Information Technology Services, and University of Guelph Computing and Communications Services.” VT

technologic advances and the most effective ways to manage a vete veterinary inaryy practice. For more information or to register, visit www.c www.canwestconference.ca. c

Lifelearn Inc. Inc.: c.: Urinalysis — Oct. 24, Guelph, Ontario. Pac. Bak ke BS BSc, BSc c DVM, will present this program on urinalymela Baker, sis. The he empha emphasis e asi siss of this session will be on information and techniques that the pa p participant can apply in clinical practice. For more information n or to register, visit www.lifelearn.com. VT For more CE opportunities, visit www.caahtt-acttsa.ca and the Conference Calendar at www.VetTechJournal.com.

In our continuing efforts to bring the most relevant news to Canadian technicians, VETERINARY TECHNICIAN has teamed up with CAAHTT.

AUGUST 2009 | Veterinary Technician

www.VetTechJournal.com

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Cover Story

Atypical Tech

Stephanie Barnhill, MBA, RVT, does not have typical techAllyson Corcoran Editorial Assistant nician responsibilities. She does not draw blood, bandage surgical sites or even place catheters. Instead, Stephanie ﬁelds phone calls, the topics of which range from pet nutrition to canine arthritis rehabilitation, made by veterinary professionals across the United States and Canada. 8

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“I think it gives me an advantage, because I actually know my consumers. I know the type of things they’re looking for.”

Cover Story

A Typical Not-So-Typical Day For the past 8 years, Stephanie has worked as a senior veterinary consultation service (VCS) technician for Hill’s Pet Nutrition, Inc. Although Hill’s is a pet nutrition company, the consultation service will answer questions on almost any topic that the technicians and veterinarians are familiar with. Every work day, Stephanie sits at her desk, logged into a phone system and fields calls. When she receives one, Stephanie verifies the information of the caller, who must be a veterinarian or a health care team member, and sets up the case. Stephanie will then take down customer and patient history and triage the call. If the question requires a medical consult she will transfer the call to an on-staff veterinarian. “I can answer questions such as how many cups are in a bag of pet food or general nutrition questions,” Stephanie explains. It is important that she captures a thorough patient history to ensure accuracy because she then provides that information to one of the doctors before bringing them onto the call for a medical consultation. While fielding calls, Stephanie is as thorough as possible. “I type while I’m taking a call, so I try to get as much detailed information about the animal,” she explains. Before she transfers a call, the veterinarian quickly reviews the information so he or she can provide callers a quality consultation. If appropriate, food recommendations will be made at the end of the call. With numerous calls each day, Stephanie has a grasp of the most frequently asked questions. Mainly, Stephanie

fields calls about urinary tract disease, obesity, gastrointestinal disease and heart disease. She also learns from the calls. “There are more 30-lb cats than I realized,” Stephanie jokes. “Also, I learn how many diseases one poor schnauzer can actually have and still be alive — primarily diabetes, pancreatitis and hyperlipidemia. Schnauzers often form bladder stones. You name it; a schnauzer probably has had it.” To help break up the routine of endless calls, Stephanie is assigned to side projects, which also gives her the chance to get exposure to other departments. One of her side projects is quality control. If an account holder or a pet owner has concerns about a product, Stephanie will work with the regulatory and quality departments to verify food specifications such as the moisture, protein and fat levels. Doing so will ensure everything was within the company’s specification standards. In addition, Stephanie is working on a computer program that will allow computers in the consultation center to recognize certain account phone numbers and automatically populate account information when a call is received. She also is helping to organize a VCS leadership retreat. “We are planning interactive training focused on personal leadership, communication and life skills that benefit each of us individually and as a team,” Stephanie says.

Higher Education In May, Stephanie obtained her master’s degree in business administration. Although it may seem out of the ordinary for a technician to have an MBA, Stephanie

PERSONAL INTEREST

Showmanship or more than 20 years, Stephanie has shown her Siberian hus-

kies at regional and national dog shows. “Whether or not they do

well, we go for the camaraderie. It’s just fun to do, and my dogs do well enough to keep me involved,” she jokes. Stephanie enjoys dog Siberian huskies, Samoyeds and junior showmanship. Kohler

shows so much that she became an American Kennel Club judge for

Stephanie presents an award to Andrea Phillips.

www.VetTechJournal.com

Veterinary Technician | AUGUST 2009

Cover Story

hopes it will give her an advantage if or when she explores other job opportunities. “There are a lot of directions I could go and still be in the veterinary ﬁeld and the corporate ofﬁce. That’s what pushed me more toward a business degree,” she explains. “It will open doors if I go looking, but at the moment I’m content.” Should Stephanie become interested in changing jobs, she has many options, including product development or quality control. Because of her veterinary medicine background, Stephanie feels she is an asset to departments that may not typically employ technicians. “I think it gives me an advantage because I actually know my consumers,” Stephanie says. “I know the type of things they’re looking for. Plus, I hear all the things that clients really want as far as what marketing aspects actually will encourage them to commit. You get a feel for what the clients are looking for in marketing and product development.”

because there’s another phone call waiting to be answered or not enough staff members to answer all the calls that are coming in.” Stephanie admits missing daily interactions with puppies and kittens, but because she has nine Siberian huskies and three cats at home, she Stephen Smith Photography is not too far away from a clinic atmosphere. For any technician that is interested in a not-so-average job in the veterinary ﬁeld, Stephanie suggests “looking around and seeing what options are available that involve our degree, because there is quite a bit diversity out there — it’s just not well seen.” VT

V IT AL S T AT IS T ICS S T EPH ANIE B ARNHI LL

Stephanie did not always know she was going to work for a large pet nutrition corporation — the possibility just dawned on her one day after she realized she was tired of working in a clinic. “I worked in clinics for 10 years and I was burned out,” she explains. Stephanie spoke to an old contact who mentioned the possibility of working for a large corporation. She began to search for a new job and learned there was an opening for a short-term assignment at Hill’s. Stephanie found the job possibility interesting, but did not take it. Instead, a doctor from the veterinary consultation department called and asked Stephanie if she wanted to interview for an opening there. Stephanie explains that it was fate: “I was in the right place at the right time.” At first, the new corporate office surroundings took some getting used to. “Instead of running around like a chicken with its head cut off,” she explains, “I’m at a desk all day. It was a change from the type of job I was doing before.” The new job also brought a different kind of stress. “In the clinics, you’re bombarded with people dropping off pets or sick animals or being called in at 2 AM to fix something,” Stephanie explains. “Here, it’s a flashing light 10

AUGUST 2009 | Veterinary Technician

Jason Barnhill

Turning a New Leaf

Current Employment Senior veterinary consultation service technician, Hill’s Pet Nutrition, Topeka, Kan.

Education Associate of Applied Science — Veterinary Technology, Maple Woods Community College, Kansas City, Mo. (1994); Bachelor of Business Marketing, University of Phoenix (2006); Master of Business Administration, University of Phoenix (2009)

Professional Associations National Association of Veterinary Technicians of America (1994 to present); Kansas Veterinary Technician Association (1994 to present) www.VetTechJournal.com

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Microchips. Recovery. Giving Back.

TechTips

Courtesy of Chanae Piper

TIP of the MONTH

Each published Tip of the Month contributor receives a surprise gift in addition to $50.

To help organize our hospital, we cut up old cardboard boxes and tape them to the inside of the drawers to create custom organizers. We are able to organize catheters, gauze, syringes and much more. The dividers make ﬁnding things a lot easier. Chanae Piper, CVT Denver, Colo.

We often recommend Soft Paws as an alternative to declawing. The cats that live in the clinic wear Soft Paws and clients will comment on the “painted” nails, which gives us the opportunity to educate clients on alternatives to declawing. I even applied one of the Soft Paws nails to a client’s cat at no charge, so she could see how the product works. Lily Flanagan Grand Rapids, Mich.

It’s in the Bag

Courtesy of Beth Frey

Courtesy of Jeff Cheek

In our clinic, we have four otoscopes, each with different model numbers. To make sure the otoscopes are put back into the correct room, we labeled the head and base of each otoscope with the exam room number where they belong. Beth Frey West Chester, Pa.

Creature Comforts

At our clinic, we use three different colors of cards to mark the cages. White cards are for boarders and pets to be groomed, yellow cards for hospitalized patients and pink cards for surgical patients. This way, our staff can easily know why each animal is at the clinic. C. Guest Greer, S.C. We have a small clinic and space is limited, so I came up with a way to organize our Elizabethan collars (e-collars) and save space. I purchased hooks from a hardware store and installed 12

AUGUST 2009 | Veterinary Technician

When we intubate a patient, we use a piece of gauze to hold the tongue so we can get a better grip. Diane Chiorello Robbinsville, N.J. When patients present in shock and are hypothermic, they need help raising their temperature. When giving an intravenous (IV) fluid bolus, warm the fluids first. Typically, a 1-liter IV fluid bag takes about 1 minute to warm up in the microwave, but it is important to test the temperature before use. You also can keep fluid bags in an incubator. Angela Martin, LVT Ashburn, Va.

We make take-home samples of litter for our patients that have just been declawed. We ﬁll a large Ziploc bag with a soft cat litter such as Yesterday’s News for the cat to use for a few days after surgery. Rosanna Gestwicki Kalamazoo, Mich. When cleaning a foot wound, we place a diluted chlorhexidine solution in a tall Ziploc bag. We then place the patient’s foot inside the bag to clean and soak the wound. Using the bag helps prevent spills, reduces the patient’s stress and makes for an easy cleanup. Beth Stawicki, RVT Edison, N.J. When taking table top radiographs, 2.5-gallon Hefty OneZip bags work well to protect expensive digital radiograph cassettes from saliva, blood, urine and feces. The technicians at Kronenwetter Veterinary Care Mosinee, Wis. The technicians at Kronenwetter Veterinary Care

Everything in Its Place

them on an empty wall in the clinic. I then used a one-hole punch to make holes in the e-collars and organized them on the hooks according to size. Jeff Cheek, LVT Tacoma, Wash.

www.VetTechJournal.com

TechTips

How Convenient! Laminate any reusable charts, cage tags, etc. and write on them with a washable marker. This will save time on photocopying and paper. Brianne Hattum Regina, Saskatchewan, Canada When the clinic receives gratis things such as pens, scrub tops, etc. from our suppliers, I give them to technicians as a reward for a job well done. Brenda England Glasgow, Ky.

When we send a patient home with a pressure wrap after removing an intravenous catheter, we write the date and time when the wrap can be removed on a piece of tape and place it over the wrap. This way, the clients have no doubt when the wrap can be taken off. Jenny DeLorme Buffalo, Minn. We keep a daily checklist of duties to be performed, such as restocking, checking oxygen and vaporizer levels, record keeping, drug log, ﬁling radiographs, shipping blood work, etc. When the staff changes shifts, the checklist lets the next shift know what has been completed and what still needs to be taken care of. When a duty is performed, the staff member puts his or her initials next to that task. The checklist also helps us from

falling behind on equipment maintenance. Jennifer Walters Perry, N.Y. We keep a clear packing tape dispenser in the pharmacy. After applying the prescription label to a bottle or tube, we cover it with the clear tape to keep labels safe from greasy medications. Rhonda Poor San Antonio, Texas

Courtesy of Rhonda Poor

The pedals of cautery, laser and dental units can easily trap blood and debris, making them difﬁcult to clean. For easier cleanup, we place the pedal in a plastic bag. Wendi Martin, CVT Hainsport, N.J.

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Veterinary Technician | AUGUST 2009

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InsideBehavior

Diary of a

Fearful Dog O

ne aspect of the veterinary technician’s role in the treatment of Julie Shaw, RVT behavior problems is to observe behavior, including body language speciﬁc to anxiety and aggression, and then report his or her observations to the veterinarian. These observations can assist the veterinarian in determining the level of fear, anxiety, and aggression that the dog is exhibiting, as well as help the veterinarian determine an individualized treatment protocol. After the veterinarian has discussed the treatment option with the owners, the technician can work with them on implementing the prescribed protocol.

Jaunter, the fearful dog.

Living with Jaunter, an animal that has serious behavior challenges, has given me insight into what my clients may be experiencing on a daily basis. This insight has made it easier for me to empathize with clients and, therefore, has

Diary

Day 1

Day 2

I met Jaunter with his foster parent, and I was not surprised to find a terrified dog that vacillated between attempting to hide and frantically darting away. He seemed to completely shut down on the 3-hour car ride home, escaping into “learned helplessness.” However, I was committed to adopting him and trying to resolve his behavior issues. I reminded myself that, at work, I explain to owners that learned helplessness is when an animal does not believe he has any impact on his environment. He has “run out of options” and seems to disassociate from the situation. When we arrived home, I sat holding him on the patio. When I released him, he turned and ran directly into the swimming pool. He was so disoriented by fear that he did not notice the “big hole” in the ground. I scooped him out the pool, but when I released him, he immediately repeated the behavior. This time, he didn’t even attempt to swim, so I literally had to save him. In the house, he became so frantic that he ran into walls. I became concerned that he would seriously injure himself, so I put him in his crate for the rest of the evening. Fear level: 10

The next day, Jaunter met my children and my son’s service dog, “Hero.” Jaunter did not eat and would not take treats. I had to keep him on a leash so he wouldn’t frantically run into walls. Later in the day, he did investigate the yard a bit and did not fall into the pool. He completely ignored “Hero” but did notice the cats. Fear level :10

AUGUST 2009 | Veterinary Technician

Day 3 Jaunter began barking at anyone who entered the room, including the kids. When someone walked into the room, Jaunter dashed through the doggie door and began frantically barking and circling the swimming pool in an almost compulsive manner. In the evening, he sat with me on the couch and let my daughters pet him. There was a scuffle between Jaunter and Hero. Jaunter raised his lips in an offensive grimace as Hero passed my son Dylan. Hero immediately grabbed Jaunter by the neck, but no injuries occurred. I suspect the presence of Dylan was the trigger. Fear level: 10 www.VetTechJournal.com

InsideBehavior Diary Day 4 — Clonazepam Only 8:00 AM Jaunter remains frantic and hasn’t eaten for the fourth day. He will not even touch table food or canned dog food. He now growls when the children enter the room and raises his lips if he is beside me when Hero approaches. I immediately walk away from the situation to avoid him from developing an alliance with me. At times, he seems to want to approach people but still runs into the swimming pool. Fear Level: 10 9:00 AM I gave Jaunter 2 mg clonazepam orally. I will need to be careful and guarded with Jaunter while the clonazepam takes effect. Benzodiazepines can disinhibit aggression, especially when not given in conjunction with a selective serotonin reuptake inhibitor (SSRI).1 He may be more likely to defend himself rather than escape. I’ve posted a note on my door for others to knock softly and to only enter when I answer. Fear Level: 10 10:30 AM When I leave the office, I take Jaunter with me on the Gentle Leader, but he is very difficult to walk because he zig-zags back and forth frantically. He ran directly into a wall when a noise spooked him. He is still not taking treats from me and jumps at every sound and movement. Fear Level: 9 11:30 AM Jaunter has suddenly become ravenous and is walking around the office searching for treats. He dumped over the trash can and only jumped slightly from the noise. I can now walk him on the leash with less darting. He sniffed people as they walked past in the hallway and has begun slowly taking treats from people. I was able to condition him to the clicker, although he is not offering behaviors. Fear Level: 3 12:00 NOON It has been 3 hours since he received clonazepam. Twice when people walked by, Jaunter nipped/bumped them in the back of the knee. The question: Is this normal herding behavior, or is it an aggressive behavior? My first impression is that it is both. He played with a chew toy for the first time in the office. Fear Level: 2 2:00 PM Jaunter is resting after ransacking the office for food again. He now barks territorially when people walk past the office door. He also approached the door rather than backing away or hiding. I suspect he is becoming territorial since territorial aggression has a large fear component. I believe he is becoming less fearful but more aggressive, always a concern when using a benzodiazepine alone. He is now resting after searching all over the office for food. Fear Level: 2 www.VetTechJournal.com

3:00 PM Jaunter is sleeping next to the door. Fear Level: 2 4:30 PM It has been 7.5 hours since clonazepam was administered. Jaunter is now jumping at noises and has started darting frantically on walks. He is no longer taking treats. Clonazepam is reported to last 7 to 8 hours1 and that seems to be the case. Fear Level: 8

Day 5 — D.A.P. Collar Only 7:00 AM Jaunter refuses to eat or take treats, but he does seem better than yesterday morning. I suspect he is learning our routine. Predictability and consistency can decrease anxiety and together represent an environmental necessity for fearful animals. Fear Level: 8 8:00 AM Jaunter became fearful as we walked across the parking lot into the office. He is now as frantic as he was yesterday. I fitted the dog appeasing pheromone (D.A.P.) collar. Fear Level: 10 10:30 AM It is 2.5 hours after the collar was fitted and Jaunter is not taking treats but is sleeping quietly on the floor. He seems more relaxed. On our walk, he wouldn’t approach strangers but also did not attempt to run away. Fear Level: 7 11:30 AM The fire alarm in the building went off, and we had to evacuate. Jaunter sat on my lap outside and watched people attentively. He also greeted strangers in the hallway but still would not accept treats. Fear Level: 6 2:00 PM Seven hours after the collar was fitted, Jaunter was extremely relaxed, almost sleepy. I’ve seen no change in appetite but also no increase in aggressive behavior. Fear Level: 5

Day 6 — D.A.P. Collar and Clonazepam I am very pleased with the combination of the D.A.P. collar and clonazepam at 2 mg. Jaunter seems to have an overall decrease in anxiety and has been more attentive rather than reactive to his environment. Unfortunately, there is a drastic increase in anxiety 7 to 8 hours after receiving clonazepam. Dr. Luescher has prescribed fluoxetine at 20 mg q24h, and the first dose was administered. Fluoxetine, along with a benzodiazepine, seems to increase the duration of the benzodiazepine without disinhibting aggression.1 Dr. Luescher has also increased the clonazepam dose to 2 mg bid. Fear Level: 4 Veterinary Technician | AUGUST 2009

InsideBehavior

improved my ability to assist them with the prescribed treatment plan. When Jaunter was adopted from a rescue center, he was approximately 2 to 3 years of age and, according to his foster parent, shy yet affectionate. His early history indicated he had been kept in a kennel with little socialization. Genetics, lack of socialization, or poor socialization experiences along with conditioning are the usual causes of fearful behavior. With his history of little socialization and a possible genetic predisposition for fearfulness, it was assumed that Jaunter likely had serious fear issues. Apart from the fear, Jaunter was medically normal.

Fear is regarded as a normal response to a fear-provoking stimulus or event. Human medicine deﬁnes phobias as fears that are excessive and dysfunctional. Anxiety is an acute or chronic state of trepidation that something might happen or something desired or needed might not happen.2

Understanding Fear A fearful response may initially include defensive aggression or cowering, shaking, freezing, and dilated pupils, along with conﬂict behaviors, such as yawning, turning away, licking, or scratching. The tail may be low or tucked toward the

Diary Days 7 to 15 — D.A.P. Collar, Clonazepam, and Fluoxetine Mild, yet steady improvement was noticed. Fear Level: 3

Progression of Jaunter’s Fear Level 12

Clonazepam Only D.A.P. Collar Only

Day 16 — D.A.P. Collar, Clonazepam, and Fluoxetine

7 Weeks Jaunter has been in my life for 7 weeks. His fear level remains between 2 and 6, depending on the environmental stimuli. I have discovered that he is storm phobic and noise phobic. He seems to be equally afraid of people, regardless of sex, age, or stature, and I have yet to determine a desensitization hierarchy to address his fear of people. However, his quality of life has improved dramatically. When Jaunter feels safe, he is affectionate and loves to sit on our laps 16

AUGUST 2009 | Veterinary Technician

Fear Level

In addition to the D.A.P. Collar and clonazepam, fluoxetine at 20 mg q24h was continued. Jaunter’s fear level seems to remain at 3 to 5 when outside the house and around 2 to 3 when inside the house. He still growls when the kids enter my bedroom, but it is decreasing in intensity and duration. Once he recognizes the children, he enjoys their attention and petting. He still reacts strongly to strangers entering the house and runs out the doggy door to circle the pool. I am able to practice fastpaced heeling using the Gentle Leader. He will take treats from strangers in the house and in the office. I’ve found the best time to work with him is 4 hours after giving the clonazepam because there is such a dramatic increase in his appetite at that time. He has been eating better at home, although I’ve had to add canned food to his diet. I have been frustrated by the inability to progress with clicker training. Often, dogs that have not been socialized or trained have difficulty “learning to learn.” He has yet to understand that he can offer behaviors that earn a reward. I believe it will take much more time and patience. He has spent 3 years simply “surviving” in an overwhelming world. It will take time for him to feel safe enough to truly interact with instead of reacting to his environment. Fear Level: 3 to 5

6 4

Pronounced Polyphagia 2 0 8:00 AM

9:00 AM

10:00 AM

11:00 AM 12:00 PM 1:00 PM

2:00 PM

3:00 PM

4:00 PM

Time and lick our faces. He is a candidate for developing separation anxiety because of his angst personality, dependency on me, and history of multiple homes. His training also is showing signs of progress. I have been able to teach him to reliably target my hand on a verbal signal and will now utilize this behavior in mildly stressful situations (response substitution). The D.A.P. collar definitely decreased Jaunter’s overall anxiety and the benzodiazepine seemed to increase his confidence and appetite while the fluoxetine benefited him by not only adjusting his neurochemistry but also increasing the duration of the benzodiazepine. Jaunter will never be a “normal” dog, and I try to have realistic expectations for him. I treat him as I would a child who has suffered severe neglect or abuse and is, therefore, socially challenged. Jaunter will likely always require medication to cope with the world and help him continue learning new coping skills. If the day arrives that he can be weaned off medication, Dr. Luescher will instruct me on either slowly removing the SSRI or decreasing the benzodiazepine dose. Fear Level: 2 to 6 VT www.VetTechJournal.com

InsideBehavior

ground, the ears may be rotated back from the head, and the body may be leaning backward. Depending on the learning history and degree of fear, the animal may retreat from the stimulus, freeze because it feels unable to affect the situation, or attempt to defend itself against the stimulus.3 Fear often has a large conditioning component. Fearful reactions can be enhanced if the animal practices avoidance. The animal learns through repetition that the dangerous situation can be avoided through escape and the escape behavior is, therefore, reinforced. Behaviors learned through avoidance can be persistent because the animal does not learn that the situation it avoided was not harmful.

Training and Behavior Modiﬁcation Tools for Treating Fearful Animals Head Collars — Head collars, such as the Gentle Leader Head Collar (www.premier.com), are often necessary to gently redirect the dog’s head, eyes, and body away from the frightening stimuli while prompting an alternate response (response substitution). Clicker Training — Clicker training can be used during counter-conditioning, desensitization, and response substitution and to build general confidence in the dog. D.A.P. Collar — Dog-appeasing pheromone collars contain pheromones that help regulate behavior through the olfactory route. The collars diffuse a pheromone comparable with the appeasing pheromones produced by a lactating bitch.4 Calming Cap — The Calming Cap is designed to help decrease a dog’s anxiety level in stressful situations. The cap’s single-panel sheer fabric window makes the dog’s vision indistinct, thereby reducing the visual stimulus and enabling the dog to remain calm. Pharmaceuticals — Numerous medications can be prescribed and combined,1 including selective serotonin reuptake inhibitors (SSRI), such as fluoxetine; trycicylics, such as clomipramine; or benzodiazpines, such as clonazepam, alprazolam, and lorazepam. The animal also may learn that threatening behavior, such as growling, snarling, snapping, or biting, can cause the frightening stimuli to “leave.” The aggressive behavior is, therefore, conditioned. Over time, the animal’s conﬁdence level may increase as its aggressive behavior “works” and it becomes well accomplished at using the technique. Types of fear that can develop include: • Animate fears, such as fear of animals, humans, etc. • Inanimate fears, such as fear of objects, sounds, etc. www.VetTechJournal.com

• Situational fears, such as separation anxiety2 • A combination of the above The general principles for treating fears are described in the box Training and Behavior Modiﬁcation Tools for Treating Fearful Animals.

The Diagnosis Jaunter was diagnosed with both fear aggression and global fear by Andrew Luescher, DVM, PhD, DACVB, director of the Animal Behavior Clinic at Purdue University. Dr. Luescher believes that the world is a terrifying place for Jaunter, with the environment being rich in stimuli that can lead to anxiety and fear responses. Jaunter growled when people approached, although he never attempted to bite. In addition, he was in a constant and extreme state of anxiety. To Jaunter, danger seemingly lurks around each corner. He also suffers from speciﬁc fears and phobias, including fear of people. A diagnosis of fear aggression indicates that fear is the motivation for the aggression. Fear-aggressive dogs may attempt to defend themselves to varying degrees if they are unable to retreat from the frightening stimulus or stimuli. Global fear is a term used to describe an animal whose fear encompasses animate, inanimate, and situational fears. It is frequently impossible to determine all stimuli a globally fearful animal may react to.

The Treatment Plan Jaunter’s level of fear was to be rated and tracked on a scale of 1 to 10, with level 1 considered normal reactive behavior and level 10 considered frantic, “hysterical” behavior. There were several points that had to be considered when creating the treatment plan for Jaunter. First, identifying every stimulus that Jaunter was reacting to was not an option. His level of anxiety, even in a controlled environment, was rated 10. It was, therefore, impossible to avoid, reproduce, and control so many stimuli. Second, because Jaunter had inanimate fears, behavior modiﬁcation and clicker training were not applicable in the beginning phases of treatment. Counter-conditioning also was not possible because Jaunter refused treats and exhibited a constant high level of anxiety so that little learning could occur. A head collar was required to keep him from running away and inadvertently injuring himself. Jaunter likewise did not respond well to a calming cap. He seemed to become more fearful when he was unable to see danger approaching. Third, ﬂooding was an unavoidable constant occurrence. Jaunter’s world was rich with stimuli that elicited terror and (continues on page 41)

Veterinary Technician | AUGUST 2009

CHEWABLE TABLETS BRIEF SUMMARY: Before using PREVICOX, please consult the product insert, a summary of which follows: CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. CONTRAINDICATIONS: Dogs with known hypersensitivity to firocoxib should not receive PREVICOX. WARNINGS: Not for use in humans. Keep this and all medications out of the reach of children. Consult a physician in case of accidental ingestion by humans. For oral use in dogs only. Use of this product at doses above the recommended 2.27 mg/lb (5.0 mg/kg) in puppies less than seven months of age has been associated with serious adverse reactions, including death (see Animal Safety). Due to tablet sizes and scoring, dogs weighing less than 12.5 lb (5.7 kg) cannot be accurately dosed. All dogs should undergo a thorough history and physical examination before the initiation of NSAID therapy. Appropriate laboratory testing to establish hematological and serum baseline data is recommended prior to and periodically during administration of any NSAID. Owners should be advised to observe for signs of potential drug toxicity (see Adverse Reactions and Animal Safety) and be given a Client Information Sheet about PREVICOX Chewable Tablets. For technical assistance or to report suspected adverse events, call 1-877-217-3543. PRECAUTIONS: This product cannot be accurately dosed in dogs less than 12.5 pounds in body weight. Consider appropriate washout times when switching from one NSAID to another or when switching from corticosteroid use to NSAID use. As a class, cyclooxygenase inhibitory NSAIDs may be associated with renal, gastrointestinal and hepatic toxicity. Sensitivity to drug-associated adverse events varies with the individual patient. Dogs that have experienced adverse reactions from one NSAID may experience adverse reactions from another NSAID. Patients at greatest risk for adverse events are those that are dehydrated, on concomitant diuretic therapy, or those with existing renal, cardiovascular, and/or hepatic dysfunction. Concurrent administration of potentially nephrotoxic drugs should be carefully approached and monitored. NSAIDs may inhibit the prostaglandins that maintain normal homeostatic function. Such anti-prostaglandin effects may result in clinically significant disease in patients with underlying or pre-existing disease that has not been previously diagnosed. Since NSAIDs possess the potential to produce gastrointestinal ulcerations and/or gastrointestinal perforations, concomitant use with other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided. The concomitant use of protein bound drugs with PREVICOX Chewable Tablets has not been studied in dogs. Commonly used protein-bound drugs include cardiac, anticonvulsant, and behavioral medications. The influence of concomitant drugs that may inhibit the metabolism of PREVICOX Chewable Tablets has not been evaluated. Drug compatibility should be monitored in patients requiring adjunctive therapy. If additional pain medication is needed after the daily dose of PREVICOX, a non-NSAID class of analgesic may be necessary. Appropriate monitoring procedures should be employed during all surgical procedures. Anesthetic drugs may affect renal perfusion, approach concomitant use of anesthetics and NSAIDs cautiously. The use of parenteral fluids during surgery should be considered to decrease potential renal complications when using NSAIDs perioperatively. The safe use of PREVICOX Chewable Tablets in pregnant, lactating or breeding dogs has not been evaluated. ADVERSE REACTIONS: Osteoarthritis: In controlled field studies, 128 dogs (ages 11 months to 15 years) were evaluated for safety when given PREVICOX Chewable Tablets at a dose of 2.27mg/lb (5.0 mg/kg) orally once daily for 30 days. The following adverse reactions were observed. Dogs may have experienced more than one of the observed adverse reactions during the study. Adverse Reactions Seen in U. S. Field Studies Adverse Reactions

PREVICOX (n=128)

Active Control (n=121)

5 1 3 1 2 1 1

8 10 3 3 1 1 0

Vomiting Diarrhea Decreased Appetite or Anorexia Lethargy Pain Somnolence Hyperactivity

PREVICOX (firocoxib) Chewable Tablets were safely used during field studies concomitantly with other therapies, including vaccines, anthelmintics, and antibiotics. Soft-tissue Surgery: In controlled field studies evaluating soft-tissue postoperative pain and inflammation, 258 dogs (ages 10.5 weeks to 16 years) were evaluated for safety when given PREVICOX Chewable Tablets at a dose of 2.27 mg/lb (5.0 mg/kg) orally approximately 2 hours prior to surgery and once daily thereafter for up to two days. The following adverse reactions were observed. Dogs may have experienced more than one of the observed reactions during the study. Adverse Reactions Seen in the Soft-tissue Surgery Postoperative Pain Field Study Adverse Reactions

Firocoxib Group (n=127)

Control Group* (n=131)

5 1 1 1 1 1

6 1 1 0 0 0

Vomiting Diarrhea Bruising at Surgery Site Respiratory Arrest SQ Crepitus in Rear Leg and Flank Swollen Paw *Sham-dosed (pilled)

Orthopedic Surgery: In a controlled ﬁeld study evaluating orthopedic postoperative pain and inﬂammation, 226 dogs of various breeds, ranging in age from 1 to 11.9 years in the PREVICOX-treated groups and 0.7 to 17 years in the control group were evaluated for safety. Of the 226 dogs, 118 were given PREVICOX Chewable Tablets at a dose of 2.27 mg/lb (5.0 mg/kg) orally approximately 2 hours prior to surgery and once daily thereafter for a total of three days. The following adverse reactions were observed. Dogs may have experienced more than one of the observed reactions during the study. Adverse Reactions Seen in the Orthopedic Surgery Postoperative Pain Field Study Adverse Reactions

Firocoxib Group (n=118)

Control Group* (n=108)

1 2** 2 1 0 9 2

0 1 3 2 1 5 0

Vomiting Diarrhea Bruising at Surgery Site Inappetence/ Decreased Appetite Pyrexia Incision Swelling, Redness Oozing Incision A case may be represented in more than one category. *Sham-dosed (pilled). **One dog had hemorrhagic gastroenteritis.

POST APPROVAL EXPERIENCE: The following adverse reactions are based on voluntary post-approval reporting and are consistent with those reported for other cyclooxygenase inhibitory NSAID class drugs. The categories are listed in decreasing order of frequency by body system.

GASTROINTESTINAL: Vomiting, anorexia, diarrhea, melena, hematemesis, hematochezia, weight loss, nausea, gastrointestinal ulceration, gastrointestinal perforation, salivation. URINARY: Azotemia, elevated creatinine, polydipsia, polyuria, urinary tract infection, hematuria, urinary incontinence, renal failure. HEMATOLOGICAL: Anemia, thrombocytopenia. HEPATIC: Hepatic enzyme elevations decreased or increased total protein and globulin, decreased albumin, decreased BUN, icterus, ascites, pancreatitis. NEUROLOGICAL / BEHAVIORAL / SPECIAL SENSE: Lethargy, weakness, seizure, ataxia, aggression, tremor, uveitis, mydriasis, nystagmus. CARDIOVASCULAR / RESPIRATORY: Tachypnea. DERMATOLOGICAL / IMMUNOLOGICAL: Fever, facial / muzzle edema, pruritus, urticaria, moist dermatitis. In rare situations, death has been reported as an outcome of the adverse events listed above. INFORMATION FOR DOG OWNERS: PREVICOX, like other drugs of its class, is not free from adverse reactions. Owners should be advised of the potential for adverse reactions and be informed of the clinical signs associated with drug intolerance. Adverse reactions may include vomiting, diarrhea, decreased appetite, dark or tarry stools, increased water consumption, increased urination, pale gums due to anemia, yellowing of gums, skin or white of the eye due to jaundice, lethargy, incoordination, seizure, or behavioral changes. Serious adverse reactions associated with this drug class can occur without warning and in rare situations result in death (see Adverse Reactions). Owners should be advised to discontinue PREVICOX therapy and contact their veterinarian immediately if signs of intolerance are observed. The vast majority of patients with drug related adverse reactions have recovered when the signs are recognized, the drug is withdrawn, and veterinary care, if appropriate, is initiated. Owners should be advised of the importance of periodic follow up for all dogs during administration of any NSAID. EFFECTIVENESS: Two hundred and forty-nine dogs of various breeds, ranging in age from 11 months to 20 years, and weighing 13 to 175 lbs, were randomly administered PREVICOX or an active control drug in two field studies. Dogs were assessed for lameness, pain on manipulation, range of motion, joint swelling, and overall improvement in a noninferiority evaluation of PREVICOX compared with the active control. At the study’s end, 87% of the owners rated PREVICOX-treated dogs as improved. Eighty-eight percent of dogs treated with PREVICOX were also judged improved by the veterinarians. Dogs treated with PREVICOX showed a level of improvement in veterinarian-assessed lameness, pain on palpation, range of motion, and owner-assessed improvement that was comparable to the active control. The level of improvement in PREVICOX-treated dogs in limb weight bearing on the force plate gait analysis assessment was comparable to the active control. In a separate field study, two hundred fifty-eight client-owned dogs of various breeds, ranging in age from 10.5 weeks to 16 years and weighing from 7 to 168 lbs, were randomly administered PREVICOX or a control (sham-dosed-pilled) for the control of postoperative pain and inflammation associated with soft-tissue surgical procedures such as abdominal surgery (e.g., ovariohysterectomy, abdominal cryptorchidectomy, splenectomy, cystotomy) or major external surgeries (e.g., mastectomy, skin tumor removal ≤8 cm). The study demonstrated that PREVICOX treated dogs had significantly lower need for rescue medication than the control (sham-dosed-pilled) in controlling postoperative pain and inflammation associated with soft-surgery. A multi-center field study with 226 client-owned dogs of various breeds, and ranging in age from 1 to 11.9 years in the PREVICOX-treated groups and 0.7 to 17 years in the control group was conducted. Dogs were randomly assigned to either the PREVICOX or the control (sham-dosed-pilled) group for the control of postoperative pain and inflammation associated with orthopedic surgery. Surgery to repair a ruptured cruciate ligament included the following stabilization procedures: fabellar suture and/or imbrication, fibular head transposition, tibial plateau leveling osteotomy (TPLO), and ‘over the top’ technique. The study (n = 220 for effectiveness) demonstrated that PREVICOX-treated dogs had significantly lower need for rescue medication than the control (sham-dosed-pilled) in controlling postoperative pain and inflammation associated with orthopedic surgery. ANIMAL SAFETY: In a target animal safety study, firocoxib was administered orally to healthy adult Beagle dogs (eight dogs per group) at 5, 15, and 25 mg/kg (1, 3, and 5 times the recommended total daily dose) for 180 days. At the indicated dose of 5 mg/kg, there were no treatment related adverse events. Decreased appetite, vomiting, and diarrhea were seen in dogs in all dose groups, including unmedicated controls, although vomiting and diarrhea were seen more often in dogs in the 5X dose group. One dog in the 3X dose group was diagnosed with juvenile polyarteritis of unknown etiology after exhibiting recurrent episodes of vomiting and diarrhea, lethargy, pain, anorexia, ataxia, proprioceptive deficits, decreased albumin levels, decreased and then elevated platelet counts, increased bleeding times, and elevated liver enzymes. On histopathologic examination, a mild ileal ulcer was found in one 5X dog. This dog also had a decreased serum albumin which returned to normal by study completion. One control and three 5X dogs had focal areas of inflammation in the pylorus or small intestine. Vacuolization without inflammatory cell infiltrates was noted in the thalamic region of the brain in three control, one 3X, and three 5X dogs. Mean ALP was within the normal range for all groups but was greater in the 3X and 5X dose groups than in the control group. Transient decreases in serum albumin were seen in multiple animals in the 3X and 5X dose groups, and in one control animal. In a separate safety study, firocoxib was administered orally to healthy juvenile (1013 weeks of age) Beagle dogs at 5, 15, and 25 mg/kg (1, 3, and 5 times the recommended total daily dose) for 180 days. At the indicated (1X) dose of 5 mg/kg, on histopathologic examination, three out of six dogs had minimal periportal hepatic fatty change. On histopathologic examination, one control, one 1X, and two 5X dogs had diffuse slight hepatic fatty change. These animals showed no clinical signs and had no liver enzyme elevations. In the 3X dose group, one dog was euthanized because of poor clinical condition (Day 63). This dog also had a mildly decreased serum albumin. At study completion, out of five surviving and clinically normal 3X dogs, three had minimal periportal hepatic fatty change. Of twelve dogs in the 5X dose group, one died (Day 82) and three moribund dogs were euthanized (Days 38, 78, and 79) because of anorexia, poor weight gain, depression, and in one dog, vomiting. One of the euthanized dogs had ingested a rope toy. Two of these 5X dogs had mildly elevated liver enzymes. At necropsy all five of the dogs that died or were euthanized had moderate periportal or severe panzonal hepatic fatty change; two had duodenal ulceration; and two had pancreatic edema. Of two other clinically normal 5X dogs (out of four euthanized as comparators to the clinically affected dogs), one had slight and one had moderate periportal hepatic fatty change. Drug treatment was discontinued for four dogs in the 5X group. These dogs survived the remaining 14 weeks of the study. On average, the dogs in the 3X and 5X dose groups did not gain as much weight as control dogs. Rate of weight gain was measured (instead of weight loss) because these were young growing dogs. Thalamic vacuolation was seen in three of six dogs in the 3X dose group, five of twelve dogs in the 5X dose group, and to a lesser degree in two unmedicated controls. Diarrhea was seen in all dose groups, including unmedicated controls. In a separate dose tolerance safety study involving a total of six dogs (two control dogs and four treated dogs), firocoxib was administered to four healthy adult Beagle dogs at 50 mg/kg (ten times the recommended daily dose) for twenty-two days. All dogs survived to the end of the study. Three of the four treated dogs developed small intestinal erosion or ulceration. Treated dogs that developed small intestinal erosion or ulceration had a higher incidence of vomiting, diarrhea, and decreased food consumption than control dogs. One of these dogs had severe duodenal ulceration, with hepatic fatty change and associated vomiting, diarrhea, anorexia, weight loss, ketonuria, and mild elevations in AST and ALT. All four treated dogs exhibited progressively decreasing serum albumin that, with the exception of one dog that developed hypoalbuminemia, remained within normal range. Mild weight loss also occurred in the treated group. One of the two control dogs and three of the four treated dogs exhibited transient increases in ALP that remained within normal range. Made in Canada Marketed by: Merial LLC, Duluth, GA 30096-4640, U.S.A. 1-877-217-3543 U.S. Patent Nos. 5,981,576; 6,541,646; and 6,677,373 NADA 141-230, Approved by FDA

Designed for Dogs, approved for Surgery

As a class, cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, kidney or liver side effects. These are usually mild, but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including PREVICOX. Use with other NSAIDs, corticosteroids or nephrotoxic medication should be avoided. Refer to the prescribing information for complete details or visit www.previcox.com. ÂŽPREVICOX is a registered trademark of Merial. ÂŠ2009 Merial Limited, Duluth, GA. All rights reserved. PVX08NASURGTRADEAD. See Page 18 for Product Information Summary

For more information, please call Merial Customer Service at 1-888-MERIAL-1 (1-888-637-4251), or contact your Merial Sales Representative or Merial Sales Agent Representative.

Advanced Imaging: Growing Your Options To further their education and to raise the overall standards of care, today’s technicians should become familiar with these advanced imaging options.

nitially, the only imaging options veterinary professionals had for Denise M. Weber, RVT obtaining an image was radiography and its offshoots, such as myelography, upper gastrointestinal series with barium sulfate suspension, and intravenous pyelography — a radiographic study that uses soluble contrast medium. Unfortunately, because of the lack of contrast between tissue types, such as muscle and fat, as well as between air and fluid, radiographs produce a shadow of organs and reveal little about internal structures. When ultrasonography became available, it provided veterinarians with a better imaging alternative. With ultrasonography, sound waves directed at body tissues are reflected to a receiver and processed by a computer program to create an image. This makes it possible, for example, to actually see an intussusception or observe valvular movement and blood flow through the heart because organs, fluid, and air reflect sound waves differently. In addition, cystic and solid masses can be 20

AUGUST 2009 | Veterinary Technician

differentiated. With ultrasonography, the examiner can guide a biopsy needle accurately and obtain a biopsy specimen from a target organ or tumor. Endoscopy is another imaging option that provides full-color views of tissues within the body. In addition, endoscopy can help to identify such abnormalities as radiolucent foreign bodies, polyps, tumors, and ulcerations that cannot be distinguished on radiography or even ultrasonography. The clinician also can obtain a specimen without the need for invasive surgery. Although ultrasonography and endoscopy have improved the ability of veterinarians to make more accurate diagnoses, additional imaging options are needed so veterinary teams can approach a broader array of conditions using noninvasive methods. For example, when patients present with neurologic signs, veterinarians can generally reach an educated differential diagnosis based on the patient history and physical, neurologic, and laboratory ﬁndings. Using this information, the problem often can be pinpointed. In some patients, however, the differwww.VetTechJournal.com

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Figure 1. CT scan of the spine showing significant spinal cord compression because of disk herniation. CT allows visualization of the herniation in the spinal canal and can show how much of the spinal cord is compressed.

entials for clinical signs may not be readily apparent (e.g., it may not be clear as to whether clinical signs are related to a tumor or to an ongoing inﬂammatory process). In a patient suspected of having a brainstem mass, for example, the veterinarian can determine whether the mass is a tumor, granuloma, or abscess without performing an invasive surgical biopsy. Advanced imaging techniques enable veterinary professionals to answer clinical questions nonsurgically and then determine the appropriate treatment. Today’s owners demand a higher standard of health care for their pets.1 They now want and expect the clinician to

Figure 2. Axial image of a CT scan of a brain. Note the hyperintense lesions in the cranial vault.

determine what is causing their pet’s clinical signs. To meet these demands and provide better patient care, the veterinary team must keep pace with cutting-edge techniques. Computed tomography (CT) and magnetic resonance imaging (MRI) are, therefore, becoming more common.

Computed Tomography CT scanning is a type of imaging in which an x-ray tube and image receptor are rotated around opposite sides of the patient to produce a cross-sectional image. Radiography and myelography produce basic two-

Advantages and Disadvantages of Computed Tomography Pros

Cons

Myelography is often used in conjunction with CT imaging, which can be safer for the patient than myelography alone.8 When the two modalities are combined, the amount of contrast medium required may be reduced by up to 50%, which theoretically should reduce the risk for seizures following myelography. Because of the high sensitivity of CT and its ability to produce axial views, many lesions can be visualized without the need for myelography, thereby making the imaging process less invasive. CT also tends to be quicker, which may shorten the time the patient remains under general anesthesia. Because the gantry can tilt, CT can accurately scan such areas as the lumbosacral space.

One drawback of CT imaging is that it requires more expensive equipment than myelography does. Another disadvantage is that the patient is exposed to higher doses of radiation compared with other imaging techniques. Where the CT scanner is housed must be considered carefully as well. Because CT equipment produces radiation, the room in which scanning takes place must meet certain specifications. Inspection by a nuclear physicist and special licensing are required. In addition, the CT scanner generates a large amount of heat, requiring a separate air conditioning unit to prevent it from overheating.

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Veterinary Technician | AUGUST 2009

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Figure 3. (A) Sagittal T-2 weighted MRI image of the cervical spine of a dog with syringomyelia. Note the large hyperintense syrinx at C1-C3. (B) Dorsal T-1 weighted MRI image of a meningioma, determined because of the contrast enhancement and the dural tail.

dimensional views, but CT yields cross-sectional and longitudinal images and, using reconstructed computer data, can display the external and internal structure of organs.2 Patients undergoing CT are placed under general anesthesia to keep them from moving during the imaging process, which can take 10 to 15 minutes. The patient is positioned on a table within the unit that houses the rotating x-ray tube (gantry). As the tube moves around the patient, x-ray detectors acquire a series of projections that the computer recon-

Advantages and Disadvantages of Magnetic Resonance Imaging Pros MRI is sensitive at detecting intracranial lesions and is instrumental in identifying types of tumors. MRI also is sensitive to differences among soft tissue densities and appears to be more sensitive than other modalities to inflammatory processes within the target area.

Cons MRI is an expensive modality and may require substantial upgrades to a clinic’s physical plant.13 Nonferromagnetic objects, such as electrocardiograph leads, that are exposed to the magnetic field can induce electric currents and lead to excessive heating and burns.

AUGUST 2009 | Veterinary Technician

structs using a gray scale. The computer assigns these images to a matrix of pixels to be viewed on a monitor.3 As with myelography, a variety of spinal lesions can be detected with CT scanning. However, because CT allows the spinal column to be imaged from a transverse or axial view, considerably more detail can be visualized, and the lesions can be located more precisely. Like myelography, CT can show on which side a herniation has occurred, but unlike myelography it also can determine how much of the disk is on the ventral or dorsal ﬂoor and more accurately assess spinal cord compression (Figure 1). CT allows better visualization of spinal tumors, especially when an intravenous (IV) contrast medium, such as diatrizoate meglumine plus diatrizoate sodium, is used.4 Lytic bone lesions and end-plate irregularities, such as those seen in patients with discospondylitis, are easier to spot with CT imaging. CT also can provide images of the spinal cord itself, demonstrating such abnormalities as atrophy.4 Unlike radiography, CT can penetrate the skull to produce images of the brain (Figure 2), enabling veterinarians to deﬁnitively diagnose intracranial abnormalities, such as tumors and hydrocephalus. CT also shows other areas that are not easily visualized on standard radiographs, including the nose and sinus, middle ear, and periorbital region. Some severe adverse reactions to IV contrast media, such as iohexol and iothalamate meglumine, have been reported in both dogs and cats,5–7 so caution should be taken by both veterinarians and technicians when monitoring these patients. Supportive care should be provided as needed. www.VetTechJournal.com

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Magnetic Resonance Imaging MRI, another important tool for diagnosing neurologic and other disorders, works by measuring the magnetic differences in tissues caused by the activity of hydrogen atoms in the body. As with myelography and CT, the patient is anesthetized and placed inside a tube that houses a highfield−strength magnet. A series of radio waves are transmitted as short radiofrequency pulses in different imaging planes, or “slices,” through the patient’s body. Magnetic pulses excite the hydrogen atoms, aligning them along vectors (the Z axis). Radiofrequency pulses are then applied to cause the protons to move out of alignment with the external magnetic field. Next, the pulses are turned off, and a receiver coil is turned on to “listen” for the decay signal generated by the protons as they return to a lower energy state.9 The coil sends the data to a computer for processing into a visual image of each slice. Because specific tissues contain different amounts of water and fat, they display unique properties in a magnetic field. The hydrogen nuclei in soft tissues, which are mobile, emit signals that produce a pale gray image on the computer screen. The hydrogen nuclei of bone and calculi, which are less mobile, produce a darker gray image. Air has no hydrogen and produces no signal, causing it to appear black on images.10 MRI has had the greatest impact on imaging of the brain.

Glossary Computed tomography — imaging method that can create three-dimensional images from a series of two-dimensional radiographic images taken from a single axis of rotation. Fibrocartilaginous embolism (FCE) — obstruction caused when some material from a vertebral disc enters the blood supply to the spinal cord. Hydromyelia — dilatation of the central canal of the spinal cord because of an accumulation of fluid. Magnetic resonance imaging — imaging method that can show detailed contrast between soft tissues in the body. Myelography — imaging method that shows the passage of contrast material around the spinal cord and nerve roots. Syringomyelia — fluid-filled cavities in the substance of the spinal cord Ultrasound — imaging method that uses reflected sound waves to generate images of muscles, tendons and internal organs.

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Before the widespread use of MRI, brain lesions could only be diagnosed by history, neurologic examination, or process of elimination. Because it is more sensitive to soft tissue compared with other imaging techniques, MRI is better at detecting subtle intracranial lesions (Figure 3) and abnormalities in the nervous tissue itself, such as those seen in inﬂammatory processes. MRI is the method of choice for diagnosing syringomyelia or hydromyelia. Because of its sensitivity to tissue changes, MRI is instrumental in differentiating certain tumor types (e.g., glioma from meningioma). MRI also may reveal focal cord density changes in dogs severely affected by ﬁbrocartilaginous embolism.11 It is useful in diagnosing wobbler syndrome, a disorder often associated with type 2 disk disease, because MRI allows visualization of the ligaments around the affected area.12

Comparisons Although tumors often are visible on CT images, MRI shows tumors in much greater detail, especially when an IV contrast medium, such as gadolinium, is used. This medium does not cross the blood–brain barrier; the tumor takes it up through its vasculature. MRI also appears to be more sensitive to inflammatory processes within the target area.14 Compared with myelography and CT, MRI is the most expensive imaging method. However, MRI appears to have the fewest side effects because it does not expose the patient to radiation, and the contrast medium (if used) does not appear to cause any of the problems associated with agents used in other imaging procedures. Depending on the magnet used, the patient may be under anesthesia longer during MRI than during CT or myelography. Like the equipment for CT, the MRI magnet must be housed in a specially built room. Because the magnet is so high-powered, the anesthesia and monitoring equipment used in the imaging room must adhere to MRI-compatible specifications. Nonferromagnetic objects (e.g., electrocardiograph leads) within the magnetic field can induce electric currents, leading to heating and burns. Care must be taken when bringing any metal object into the MRI suite; the pull from the magnet can turn it into a projectile, which can injure the patient or staff or even damage the magnet itself.15 Metal objects inside a patient, such as BB pellets and surgical pins or screws, may distort the image or make it unreadable. Given the demand for a higher level of health care for pets, advanced imaging is necessary in veterinary medicine. It allows more accurate diagnosis, and when diagnoses are more accurate clients receive more realistic prognoses to facilitate decision making. VT Veterinary Technician | AUGUST 2009

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Acknowledgment The author wishes to thank Julie Ducote, DVM, DACVIM (Neurology), for her help and encouragement, as well as the doctors and staff at Animal Imaging, especially Susan Willenbrock, for their support and help in collecting the MRI images used in this article.

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References 1. Coe JB, Adams CL, Bonnett BN. A focus group study of veterinarians’ and pet owners’ perceptions of veterinarian-client communication in companion animal practice. JAVMA 2008;23(3):7:1072-1080. 2. Jackson S, Thomas R. Cross-Sectional Imaging Made Easy. Edinburgh, UK: Churchill Livingstone; 2004:3.3. 3. Hathcock JT, Stickle RL. Principles and concepts of computed tomography. Vet Clin North Am Small Anim Pract 1993;23(2):399-415. 4. Brawner WR, Hathcock JT. Neuroradiology. in: Slatter DH (ed). Textbook of Small Animal Surgery; ed 3. Philadelphia: WB Saunders; 2003:1118-1131. 5. Pollard RE, Pascoe PJ. Severe reaction to intravenous administration of an ionic iodinated contrast agent in two anesthetized dogs. JAVMA 2008;233(2):274-278. 6. Pollard RE, Puchalski SM, Pascoe PJ. Hemodynamic and serum biochemical alterations associated with intravenous administration of three types of contrast media in anesthetized cats. Am J Vet Res 2008 ;69(10):1274-1278. 7. Pollard RE, Puchalski SM, Pascoe PJ. Hemodynamic and serum biochemical alterations associated with intravenous administration of three types of contrast media in anesthetized dogs. Am J Vet Res 2008;69(10):1268-1273. 8. Bradley WG Jr, Seidenwurm DJ, Brunberg JA, et al, for the American College of Radiology. ACR appropriateness criteria: low back pain. Accessed October 9, 2008, at: http://www.acr. org/s_acr/bin.asp? CID=1205&DID=11801&DOC=FILE.PDF. 9. Berry CR. Anatomic and physiologic imaging of the canine and feline brain. In: Thrall DA (ed). Textbook of Veterinary Diagnostic Radiology. Philadelphia: WB Saunders; 1998:66-80. 10. Moore AH (ed). BSAVA Manual of Advanced Veterinary Nursing. Gloucester, U.K.: British Small Animal Veterinary Association; 1999:134-135. 11. Ueno H, Shimizu J, Uzuka Y, et al. Fibrocartilaginous embolism in a chondrodystrophoid breed dog. Aust Vet J 2008;83(3):142-144. 12. Dewey CW. Myelopathies: disorders of the spinal cord. In: Dewey CW (ed). A Practical Guide to Canine and Feline Neurology. Ames, Iowa: Iowa State Press; 2003: 277-336. 13. Bucsko JK. How not to design MRI suite. Radiology Today 2005; 6(24):36. 14. Kealy JK, McAllister H, The Skull and vertebral column. In: Diagnostic radiology and Ultrasonography of the Dog and Cat, ed 2. Philadelphia: WB Saunders; 2000:387-476. 15. Kanal E, Barkovich AJ, Bell C, et al. ACR guidance document for safe MR practices 2007. Am J Roentgenol 2007;188:1447-1474.

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ABOUT THE AUTHOR

Denise M. Weber, RVT Denise is a technician at the Center for Veterinary Specialty Care in Carrollton, Texas. Her interests include emergency and critical care nursing and advanced imaging.

Veterinary Technician | AUGUST 2009

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CE Article #1

Care and Management of

Diabetes Mellitus D

iabetes mellitus (DM) is There is no cure for DM, but — as with humans — it a chronic endocrine dis- can be controlled with insulin injections, diet, and exercise. order that can occur in The primary goal of treatment is to eliminate clinical signs dogs and cats. It is characterized by high blood sugar levels and long-term consequences, which requires substantial (hyperglycemia), increased appetite (usually with weight commitment from the owner. With appropriate therapy, loss), increased thirst, and increased urination. These signs most pets with DM can lead happy, comfortable lives. Loss of β-cell function is irreversible in dogs, and all occur because the pancreas is unable to produce enough dogs with DM are insulin-dependent (i.e., require daily insulin to meet the animal’s requirements.1, 2 Insulin is a hormone that enables cellular uptake of sugar insulin injections).4 Although most cats with DM are also (glucose) from the blood, which is then converted into energy. insulin-dependent, DM in some cats can be controlled by The glucose is stored as glycogen in the liver and muscle, and diet, weight loss (if obese), and oral hypoglycemic medicais used as an energy source. If the body lacks sufficient glyco- tions. Additionally, some cats with DM may regain normal gen because of DM, it will begin to convert glucose levels (euglycemia) and no longer fat into energy. require drug therapy, so cats under treatCauses When glucose is not taken up into ment should be monitored for hypoglythe cells, the glucose level in the blood cemia.1-3 The cause of DM is poorly Specifically, about 20% of cats with rises to abnormally high levels. The body understood and probably multifactorial. For most DM will become euglycemic after 4 to attempts to expel this excess glucose in patients the DM is considered 6 weeks of insulin treatment; signs will the urine, leading to increased urination idiopathic. DM in dogs and resolve, and insulin may be decreased or and hence increased thirst. The increased cats arises from damage to discontinued. Studies suggest that these appetite with weight loss is due to the the β cells of the pancreas. cats are in a subclinical diabetic state lack of energy in the cells and the use of Predisposing factors include: that becomes clinical when the pancreas fat to make up the deficit.1,2 Chronic pancreatitis is stressed by exposure to an insulinInfection Diagnosis and Treatment antagonistic disease or drug. Persistent Insulin-antagonistic Diagnosis of DM begins with a thorhyperglycemia causes a condition called diseases (e.g., Cushing’s ough physical examination and history “glucose toxicity,” which is potentially disease, pancreatitis, and of the pet’s health, especially recent eatreversible with correction of the hyperghyperlipidemia) and drugs ing and drinking behaviors. Blood tests lycemia.4 However, the owner should be (e.g., steroids) and urinalysis are needed to confirm the advised that the cat is at higher risk of Autoimmune disorders presence of DM and rule out any concurdeveloping DM again in the future and Obesity (only in cats, and rent diseases or infections. DM is often should be monitored accordingly. defined as greater than complicated by urinary tract infections, Once a pet is diagnosed with DM, its 15% over ideal body pancreatitis, other hormone disorders specific insulin requirements must be weight) (e.g., Cushing’s disease), infections, or a determined. There is a wide variety of Heredity build-up of chemical compounds called insulins available; the choice depends on Hormonal abnormalities.4 ketones in the body.1-3 Depending on the patient condition, species, and veterinarIn dogs, females are condition of the pet at presentation, hosian preference and experience. affected twice as often as pitalization may be necessary to correct Frequent phone contact between the males; in cats, DM occurs any metabolic problems and stabilize owner and the veterinarian or technician more often in males.1-3 glucose levels. is recommended at the outset to monitor

Ann Wortinger, BIS, LVT, VTS (ECC, SAIM)

AUGUST 2009 | Veterinary Technician

www.VetTechJournal.com

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Mometamax is the property of Intervet International B.V. or afďŹ liated companies or licensors and is protected by copyrights, trademark and other intellectual property laws. Copyright ÂŠ 2009 Intervet International B.V. All rights reserved.

1. Reeder CJ, GrifďŹ n CE, Polissar NL, et al. Comparative adrenocortical suppression in dogs with otitis externa following topical otic administration of four different glucocorticoid-containing medications. Vet Therap. 2008;9:111-121. 2. Rubin J, Walker RD, Blickenstaff K, Bodies-Jones S, Zhao S., Antimicrobial resistance and genetic characterization of ďŹ&#x201A;uoroquinolone resistance of Pseudomonas aeruginosa isolated from canine infections., Vet microbiol. 2008 Mar 4; [Epub ahead of print] SPAH-MO-96

See Page 28 for Product Information Summary

CE Article #1

Home Care Most pets with DM will require twice-daily injections of insulin for the rest of their lives. It is important to emphasize that the injections should be given at the same times each day, usually every 10 to 14 hours. Oral hypoglycemic medication may be effective for some cats with DM. There are five different classes of oral agents approved for treatment in humans in the United States, most of which work by stimulating pancreatic insulin secretion, enhancing tissue sensitivity to insulin, and slowing postprandial intestinal glucose absorption.4 Ability to administer oral medications, presence of working Î˛ cells, and cost limit the availability of these medications for pets.

the response to insulin therapy. Because the petâ&#x20AC;&#x2122;s insulin needs may vary because of changes in diet, exercise, and environmental factors, laboratory testing should be repeated periodically to ensure good glycemic control. Once control is achieved, evaluations should be performed every 3 to 6 months. 1-3

Insulin Dose The type of insulin and the daily dose are tailored to meet the needs of each animal. Other medications may be prescribed, depending on any concurrent conditions. The veterinarian will determine the initial dose of insulin while the patient is in the hospital. This may need to be adjusted once the patient has been home for 7 to 14 days because of differences in food and exercise. It typically takes 5 to 7 days for the patient to acclimate to a dose adjustment in insulin. Types of insulin are categorized by species and length of action. With regard to species, dogs respond well to recombinant human DNA insulin because their insulin amino acid sequence is very similar to that of humans.4 Canine insulin also is available, but can only be obtained through a veterinarian â&#x20AC;&#x201D; not through a pharmacy as with human insulin. In contrast, cats respond much better to bovine insulin than to recombinant human DNA insulin because of similarities between cat and cow amino acid sequences.1-3 However, the advent of human recombinant DNA insulin has made bovine insulin increasingly difficult to obtain, as very few manufactures cater to the veterinary market.5 Insulin glargine is gaining use in cats; this is a long-acting insulin analog with an amino acid sequence that has been altered compared with human insulin.5 Porcine-based insulins were preferred for many humans and most dogs before human recombinant insulin came into use. Porcine-based insulin has the same amino acid sequence as canine insulin and differs at only one site from human insulin. In terms of length of action, insulin is available in regular, neutral protamine Hagedorn (NPH), Lente, and Ultralente types. Regular is the shortest acting and is primarily used for hospital control of DM, as administration is typically every 4 to 6 hours. Ultralente is the longest-acting but least potent of the commercially available insulins. In addition, even though Ultralente is long acting, it still must be administered twice daily in most 28

AUGUST 2009 | Veterinary Technician

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Peer Reviewed

cats, and absorption is inadequate for controlling hyperglycemia in approximately 25% of cats treated.1-3 The dose of insulin also depends on such variables as insulin absorption from the subcutaneous space, circulating insulin-binding antibodies, scar tissue formation at the injection site, and concurrent disorders causing insulin resistance. Insulin absorption can be optimized by avoiding injection in the nape of the neck; the tissue there is thick and poorly vascularized. Instead, insulin should be given on either side of the spine from the point of the scapula to the hip bones in a zig-zag fashion to decrease the chance of administering the insulin in the same place on a routine basis. Not only does this help with absorption, but it also decreases the formation of scar tissue. If insulin is injected into scar tissue, absorption is very poor. The presence of insulin-binding antibodies varies with the patient’s species and the type of insulin used. They are estimated to occur in 5% of dogs and cats receiving recombinant human insulin and 45% of dogs receiving beef or porcine-based insulin.3 Concurrent drugs and disorders that may lead to poor glycemic control include agents that interfere with insulin (e.g., glucocorticoids), Cushing’s disease, estrus, chronic pancreatitis, renal insufficiency, oral and urinary tract infections, obesity, hyperthyroidism, acromegaly, and hyperlipidemia.3

Handling Insulin and Syringes Insulin must be stored in a cool, dark place; most people prefer to keep it in the refrigerator. The bottle should be mixed by rolling or swirling prior to withdrawal of the insulin into the syringe, but should never be shaken.1-3 Vigorous shaking of the bottle will fracture the delicate insulin crystals, inactivating them. Various syringes are available for injecting insulin, and insulin comes in a number of sizes and dilutions. It is important to make sure that the syringe is designed for the type of insulin being administered. For example, U-100 syringes should not be used with U-40 insulin. U-100 1/3-mL syringes have measurement marks further apart than do 1/2- or 1-mL syringes, which is an advantage for owners who have poor eyesight. Syringes and needles are disposable — i.e., single-use only — and should not be reused. An empty plastic liquid laundry detergent bottle with a cap that has been rinsed out makes a convenient disposal container for syringes. Owners can also purchase hazardous-waste containers from most pharmacies. It is extremely important that children do not have access to the syringes and needles. Insulin-induced hypoglycemia (from insulin overdose) usually occurs 2 to 6 hours after the injection, with the pet www.VetTechJournal.com

Glossary Euglycemia — normal concentration of glucose in the blood Fructosamine — a glycated protein serum complex that reflects average blood glucose concentration for the past 1 to 3 weeks Glycogenolysis — the splitting up of glycogen in the liver or muscle; yields glucose-1-phosphate Diabetic ketoacidosis — the overproduction and underutilization of ketone bodies; results in ketosis

becoming weak and ataxic. This may progress to seizure or coma. A blood glucose level that is signiﬁcantly below normal is an immediate threat to life and constitutes an emergency. Immediate reassessment of insulin requirements by the veterinarian is required.

Feeding When the diabetic patient is fed is as important as what is fed. The pet must be fed the recommended diet in the correct quantity at a regular time each day in conjunction with the insulin injection. Correct dietary management is critical. As a general rule, an animal with DM should be fed 2 to 3 times daily, prior to the injection of the insulin. If the insulin is given first and the animal refuses to eat, this could lead to hypoglycemia. The animal should always eat adequately before insulin is administered.1-3 Table scraps, treats, or any other food not prescribed by the veterinarian should not be allowed — including access to food for other pets in the house. The patient’s food should be consistent, both in ingredient content and nutrient source. Glycemic control is difficult to obtain if the composition or ingredient source of the food varies. Some commercial pet foods (especially grocery store brands) are produced from “open” formulas, which means that ingredients can vary from batch to batch depending on cost and availability. Semimoist diets and treats should never be fed, as they often contain simple sugars that act as humectants that bind water to prevent microbial growth, interfering with glycemic control.1-3 Studies have indicated that dogs with DM may benefit from fiber-rich formulas, as fiber may lower insulin requirements and blood glucose levels by slowing the release of the glucose from the digestive tract into the bloodstream, resulting in a steadier rise in the blood glucose level. Many cats with DM can benefit from a high-protein, low-carbohydrate diet. The choice of diet will be based on the pet’s weight, Veterinary Technician | AUGUST 2009

CE Article #1

glycemic control, and preference.1-3 Initially, it is more important for the patient to eat; the diet can be changed once the animal is stable and appetite has returned. The amount of food to be fed daily depends on the pet’s caloric requirements. This amount should not vary, as it will have a direct impact on insulin needs. Treats can still be given, but must be of a suitable type and calculated into the daily caloric requirements. If the pet is overweight, weight reduction is essential. Obesity decreases tissue responsiveness to insulin (both natural and injected), and can cause dangerous increases in blood glucose levels. There are no restrictions on the pet’s normal activity. However, it is important that exercise be moderate, regulated, and consistent to keep the insulin needs as consistent as possible.

Monitoring It is not recommended that the pet’s insulin dosage be changed based solely on blood or urine glucose levels monitored at home. Any changes in insulin dosage should be determined by the veterinarian based on laboratory tests performed

in the hospital. Insulin dosage does not need to be adjusted with each injection, and should not be changed without checking first with the veterinarian. The advent of monitoring devices that require only small amounts of blood has made it possible for many owners to perform home glucose monitoring using either the ear vein or lip margins. These devices are easy to use and provide a good indicator of glycemic control at home. If the owner is willing to perform such testing, monitoring in the hospital can be less frequent. Results should be sent to the veterinarian for interpretation and adjustment of the insulin dosage if necessary. However, the owner should be advised that home testing will not eliminate the need for periodic visits to the hospital.1-3 The biggest challenge to the veterinary team for monitoring DM is interpreting how changes in diet, activity, or stress affect test results. The blood glucose curve has long been the “gold standard” for management of insulin dosage in patients with DM. Hyperglycemia induced by stress, aggression, or excitement can negatively affect the curve, especially in cats. An alternative to hospital-generated blood glucose curves is to have the owner generate a curve at home using either an ear-prick or lip-prick technique. Feasibility depends on the pet’s stress level, the owner’s comfort level, and the affordability of monitoring supplies.5 Obtaining the blood level of fructosamine provides a direct indication of the pet’s blood glucose concentration during the previous 2 to 3 weeks. Fructosamine is a glycated protein, reflecting an irreversible, nonenzymatic, insulin-independent binding of serum proteins. These proteins have a circulating life span of 1 to 3 weeks. The higher the average blood glucose concentration is, the higher the serum fructosamine concentration will be.1, 2 This test is unaffected by short-term stress (e.g., car rides, time in the waiting room, blood collection), does not require prior fasting and can be performed at any time. An elevated serum fructosamine level shows that the pet has had a sustained elevation in blood glucose over a long period of time, and will likely need a change in insulin dose or type. A low serum fructosamine level indicates that too much insulin is being given and necessitates an adjustment in dose. It is helpful to test for serum glucose and serum fructosamine at the same time to compare the two results. This will help in interpreting the fructosamine findings. If the serum fructosamine and glucose levels do not “agree” (i.e., one is low and one is high), then home care should be evaluated and other factors that could affect glycemic control investigated. The Somogyi phenomenon should be suspected in the presence of clinical signs of poor glycemic control and a serum fructosamine level of less than 400 μmol/L. The Somogyi phenomenon results from a normal physiologic 30

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AUGUST 2009 | Veterinary Technician

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Heartworm prevention and much more. BayerDVM.com 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. © 2009 Bayer HealthCare LLC, Animal Health Division, Shawnee Mission, Kansas 66201 Bayer, the Bayer Cross and Advantage Multi are registered trademarks of Bayer. Revolution is a registered trademark of Pﬁzer Inc.

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1227 35299 M ltiT d

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3/13/09 10 49 10 AM

1CE CE Article #1 CREDIT

response to impending hypoglycemia induced by excessive insulin administration. Such a high dose of insulin can cause glucose counterregulation and transient insulin resistance. Hypoglycemia (blood glucose less than 65 mg/dL) stimulates hepatic glycogenolysis and secretion of blood glucose to elevate hormone values, most notably epinephrine and glucagons. This raises the blood glucose level, causing marked hyperglycemia within 12 hours of the glucose counterregulation. The dose of insulin that can induce the Somogyi phenomenon is variable and unpredictable. When tested at home, these animals will have high blood glucose levels at the time of the next injection, with 1 to 2+ glucose on the urine dipstick. If relying only on blood glucose values for insulin adjustment, the reaction to such results would be to increase the insulin dose, perpetuating the phenomenon until a hypoglycemic crisis is precipitated.1,2

Considerations and Complications Although DM can be controlled with insulin and diet, affected animals are more susceptible to other health problems. DM can predispose an animal to an increased incidence of infections (especially bladder infections), slow wound healing, cataracts, gastrointestinal problems, pancreatitis, and nervous system disorders.1-3 An intact female dog or cat with DM should not be bred, and neutering is recommended.6 It is extremely difﬁcult to control DM during pregnancy, and life-threatening problems can ensue. Complications resulting from DM and insulin therapy are common in both dogs and cats. The most common complications in dogs are blindness and anterior uveitis resulting from cataract formation; chronic pancreatitis; reoccurring infections involving the urinary tract, respiratory tract, and skin; hypoglycemia; and diabetic ketoacidosis (DKA).1-3 For cats, the most common complications include hypoglycemia, chronic pancreatitis, weight loss, poor grooming behavior, peripheral neuropathy of the hind limbs, and DKA.1-3

Cost The cost of caring for a diabetic pet is an important consideration. This will vary depending on the size of the pet and any additional health problems that may occur, as well as requirements for insulin, syringes, and blood tests. These factors should be discussed with the owner at the outset, as some owners may not be able to afford these expenses. Beyond the monetary cost, there is the time commitment required of the owner. Such a commitment may not be easy, but can be very rewarding for both the pet and the owner. 32

AUGUST 2009 | Veterinary Technician

Conclusion The veterinary technician’s commitment to helping with the management of a dog or cat with DM adds to the quality of the patient’s life and is paid back in years of companionship for the owner. Time spent with an owner who feels overwhelmed at the prospect of giving injections and performing home glucose monitoring can impart calm and conﬁdence, helping to ensure the best possible outcome for the pet. VT

References 1. Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. St. Louis: Saunders; 2004:496-577. 2. Bonagura JD, Bonagura J, Kirk RW, eds. Kirk’s Current Veterinary Therapy XII: Small Animal Practice, Philadelphia: W.B. Saunders; 1995:384-407. 3. Greco DS, Peterson ME, eds. Diabetes mellitus. Vet Clin North Am, 1995; 25(3)571-760. 4. Tilley LP, Smith FWK Jr. Blackwell’s Five-Minute Consult: Canine & Feline, ed 4. Ames, Iowa: Blackwell Publishing Professional; 2007:540,830,1174,121 8,1219,1322. 5. Nelson RW, Couto CG, eds. Small Animal Internal Medicine, ed 4. St. Louis: Mosby/Elsevier; 2009:767-795. 6. Tilley LP, Smith FWK Jr. Blackwell’s Five-Minute Consult: Canine & Feline, ed 4. Ames, Iowa: Blackwell Publishing Professional; 2007:370-377.

ABOUT THE AUTHOR

Ann Wortinger, BIS, LVT, VTS (ECC, SAIM) Ann, the nutrition section editor for VETERINARY TECHNICIAN, is program coordinator specialist for the veterinary technology program at Wayne State University/Wayne County Community College District and teaches courses in clinical pathology at the college.

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CE Article #1

Article #1 FREE CE Test The article you have read qualifies for 1.0 credit hour. To receive credit from Alfred State College, choose the best answer to each of the following questions. Take the test online at www.VetTechJournal.com.

1. Diabetes mellitus (DM) is a condition in which insufficient insulin is produced by the animal’s: a. liver. b. pancreas. c. kidneys. d. spleen. 2. In some cats, β-cell function may return after levels of _________ are normalized for a period of time. a. glucose b. blood pressure c. bilirubin d. phosphorus

6. As a general rule, an animal with DM should be fed_________ times daily, _________ the injection of the insulin. a. 1 to 2; after b. 2 to 3; before c. 1 to 2; before d. 2 to 3; after 7. Cats with DM have been found to benefit from a diet that is: a. high in proteins and low in carbohydrates. b. high in fiber. c. high in proteins and fats. d. low in fiber and high in carbohydrates.

3. How many days does it take for the patient to acclimate to a dose adjustment in insulin? a. 1 to 3 b. 5 to 7 c. 8 to 10 d. 15 to 30

8. Fructosamine has a circulating life span of: a. 1 to 3 weeks. b. 2 to 4 weeks. c. 5 to 6 weeks. d. 6 to 8 weeks.

4. Which of the following is not a factor that affects insulin requirements? a. Age b. Absorption in the subcutaneous space c. Circulating insulin-binding antibodies d. Scar tissue

9. The dose of insulin may need adjustment after the patient has been home for: a. 7 to 14 days. b. 1 to 3 days. c. 6 to 12 hours. d. 1 month.

5. Insulin-induced hypoglycemia usually occurs how long after the injection? a. 1 to 2 hours b. 2 to 6 hours c. 8 to 10 hours d. After 24 hours

10. Insulin causes most of the body’s cells to use glucose as energy or store it as: a. glycogen. b. phosphorus. c. fat. d. fructosamine.

Take this CE test for FREE! Go to www.VetTechJournal.com. 34

AUGUST 2009 | Veterinary Technician

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TechNews

ALEXANDRIA, Va. — The National Association of Veterinary Technicians in America (NAVTA) recently announced three new specialty academies for their members. In addition to their existing specialties in dentistry, anesthesia, internal medicine, emergency and critical care and behavior, NAVTA announced the following specialties: • Neurology subspecialty of the Academy of Internal Medicine for Veterinary Technicians (AIMVT), joining

the other subspecialties in small animal medicine, large animal medicine, cardiology and oncology. For more information, visit www.aimvt.com. • Academy of Veterinary Zoological Medicine Technicians, which was organized by a group of professionals to establish a high quality pool of specialized technicians. • Academy of Equine Veterinary Nursing Technicians, created to meet the needs of the equine veterinary com-

New Wellness Campaign SCHAUMBURG, Ill. — Twice-a-year pet wellness examinations and pet health insurance are the center of a new campaign sponsored by the AVMA and Fort Dodge Animal Health. “Pet Wellness Starts With a Plan” will be introduced to clinics during October, which is National Pet Wellness month. Approximately 15,000 veterinary clinics participate in National Pet Wellness and National Pet Wellness Month, which was ﬁrst launched in 2004 by the AVMA and Fort Dodge. For 2009, VPI Pet Insurance has joined as a campaign sponsor. The value and importance of twicea-year wellness examinations and disease prevention have been fundamental educational messages of National Pet Wellness since its inception. Educating clients about the value and importance of pet health insurance is new but equally important to the campaign’s mission. Studies have shown that, on average, clients with pet health insurance schedule more veterinary visits. Pet health insurance coverage is avail-

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able for routine wellness care, including vaccinations, diagnostics, heartworm and ﬂea and tick medications, as well as for unforeseen and potentially costly injuries, illnesses or accidents. Later this summer, clinics registered with National Pet Wellness will receive a free in-clinic education kit containing the following items: • Checklists that help identify the patient’s disease risk based on questions about behavior, environment, health history and other factors • Educational brochures that detail the three-part wellness plan • Lobby poster that informs clients about the three components of a comprehensive wellness plan and encourages them to ask veterinary team members for more information • Staff buttons to encourage clients to ask any team member about a wellness plan for their pet Veterinary staff who would like to participate in the National Pet Wellness educational campaign can register at VT www.NPWM.com.

Photo courtesy of NAVTA

NAVTA Announces New Veterinary Technician Specialties

(Left to right): Deborah Reeder, RVT (equine specialty); Amy Butzier, CVT (CVTS Chair and equine specialty); Bonnie Soule, CVT (zoological specialty); Sharon Kaiser-Klingler, RVT (equine specialty); and Linda Merrill, LVT (AIMVT-Neurology).

munity and to ensure the highest level of competency in its members. “The NAVTA Academies give veterinary technicians recognition for having advanced education, training and experience in an area of specialization,” said Amy Butzier, CVT, Chair of the NAVTA Committee on Veterinary Technician Specialties. For more information about NAVTA and the veterinary technician specialVT ties, visit www.navta.net.

Insurance Center at DogTime DogTime Media, the largest online entity in the $45.4 billion US pet market, has launched a comprehensive online pet insurance center. The center allows pet owners to compare different options using the Plan Comparison Grid, an interactive grid that compares plans side by side based on 10 criteria. The grid can be customized to compare just the plans that are relevant to a particular shopper’s needs. The website also offers guidance to pet owners through editorial content that explains key issues and concerns about pet insurance. VT Veterinary Technician | AUGUST 2009

EquineEssentials

Geriatric Horses —

Maintaining a Good

Quality of Life D

ue to advances in veterinary care and nutrition, Carreen McCarthy, CVT many horses are living into their twenties, thirties, or even forties. These animals fall into the category of a geriatric horse, deﬁned as a horse greater than 20 years old. A recent study indicates about 7.5% of the equine population consists of horses over 20

years of age.1 Consequently, more and more owners are seeking veterinary care for elderly horses. As veterinary technicians, we are important members of the veterinary team caring for these special equine patients.

General Care Elderly horses need special care and attention in order to provide them with a safe and comfortable environment. Subjects that we, as veterinary technicians, need to take into consideration when dealing with aged horses include: nutrition and feeding protocols, pasture environment, ambient temperature and grooming care, parasite control, dental care, common diseases of the geriatric horse, and euthanasia (see also Bentz AI, Bach C. Fare Thee Well: how to help owners (and yourself) deal with the death of a horse. Compendium Equine 2009; 4 (6): 267-273).

Picture courtesy of Katie Miller, CVT

Nutrition and Feeding Protocols

Figure 1. A geriatric horse with severe osteoarthritis of the carpal joints; the left front leg is more severely affected than the right front leg. Also note the poor hoof care. 36

AUGUST 2009 | Veterinary Technician

The most important component of caring for geriatric horses is maintaining their body condition. Older horses often lose weight due to poor dentition, disease, parasites or due to competition with other pasture mates. It is important to take older horses’ special needs into consideration to ensure they receive a well-balanced diet. An older horse may need special attention and supplemental feeding during months when there is less grass in the pasture. Geriatric horses also tend to suffer from osteoarthritis (OA), inhibiting them from grazing freely and thus reducing their intake of forage2 (Figure 1). It can be helpful to place hay in the pasture near the horses, so they may eat more easily. Sometimes the geriatric horse needs to be separated from the herd and fed in a stall to eliminate herd competition for food. It is important to note the overall body condition of an aged horse, and score the horse’s body condition (see The www.VetTechJournal.com

EquineEssentials

Equine Scale). Body condition scoring is based on a scale from 1 to 9: 1 is extremely emaciated and 9 is extremely overweight (Figure 2). Horses that are either too thin or obese are prone to develop secondary diseases, such as hepatic lipidosis, when inappetant due to any reason. This condition is caused by a decrease in caloric intake causing fat to mobilize and accumulate in the liver. Horses with hepatic lipidosis may show clinical signs of lethargy, weakness, anorexia, decreased water intake, and diarrhea. Treatment is aimed at correcting the negative energy balance in the horse. This usually consists of administering intravenous (IV) fluids, nutritional support, and correcting the underlying disease (e.g., neoplasia). In addition, older horses will generally lose body condition in the winter or summer months when grazing is sparse. A careful history and examination of the feedstuffs Figure 2. A 27-year-old gelding with thin body condition, including will help delineate the cause of the horse’s loss of body con- prominent withers, easily visible ribs, and bony pelvis. dition and identify ways to supplement energy intake. Aged horses may also have lost some of their teeth, have their place in the herd hierarchy and may be bullied by sharp edges on their teeth or a “wave mouth,” leading to an younger horses in the pasture. Therefore, it is a good idea impaired ability to chew hay, grain, or hay cubes. Specific den- to allow them time in the pasture alone or with another tal conditions are discussed below; however, frequent teeth older horse. This will eliminate stress on the horse and floating by a veterinarian will ensure good oral health and cor- allow them proper grazing time. Adequate pasture time is vital to minimize orthopedic issues and stiffness. rect any defects that may impact a horse’s ability to chew. Additional considerations include placing older horses in Because of an increased parasite burden in the geriatric horse, decreased digestive efficiency and compromised a pasture with a flat surface and monitoring weather condichewing ability due to lack of teeth, we need to take spe- tions; they often have significant OA and may have stiffness cial care when developing a feeding program for the aged and weakness in the hind-end, predisposing them to fall in horse. In general their feed should be palatable, easy to eat, slippery conditions such as severe rain, snow, or ice. and full of nutrients. Geriatric horses should be fed a senior diet giving small amounts of feed at a time. For example, Ambient Temperature and Grooming Care small feedings three times a day is ideal. Senior feeds offer Geriatric horses are more sensitive to extreme weather the horse increased protein, minerals, and vitamins. In conditions than younger horses.2 Older horses often have addition to the senior feed, a ¼ to hirsutism (an overlong haircoat) ½ cup of corn or vegetable oil may and are often not able to therGlossary be added daily as an extra source moregulate correctly. They may of calories. Older horses are prone also have areas of patchy sweatHirsutism — excessive growth of hair to weight loss, especially in the ing. Therefore, it is important to of abnormal or normal distribution colder months, and require more clip them, use blankets in colder calories to maintain their body weather, and to provide a cool Hyperhidrosis — generalized or condition. Soaked alfalfa cubes or environment during hot months. local excessive sweating pellets are also a good feed to offer To improve circulation, daily Occlusal — the grinding or biting older horses. Dengie hay is a good brushing is advisable. surface of teeth choice for older horses because it is less dusty, thereby minimizing Parasite Control Onchocerciasis — infestation with or any flare-ups of heaves, a disease Deworming and pasture mandisease caused by filarial worms that will be discussed later in this agement are important topics that Miosis — constriction of the pupil article. veterinary technicians can address with owners. Implementing an ACTH — adrenocorticotropic Pasture Environment effective deworming program is hormone As horses age, they often lose essential for proper barn managewww.VetTechJournal.com

Veterinary Technician | AUGUST 2009

EquineEssentials

The Equine Scale* 1 Poor — Animal is extremely emaciated. Spinous processes, ribs, tailhead, tuber coxae, and tuber ischii project prominently. Bone structure of withers, shoulders, and neck is noticeable; no fatty tissue can be felt. 2 Very thin — Animal is emaciated. There is slight fat covering over the base of the spinous processes; transverse processes of the lumbar vertebrae feel rounded. Spinous processes, ribs, tailhead, tuber coxae, and tuber ischii are prominent. Bone structure of withers, shoulders, and neck is faintly discernible. 3 Thin — Fat buildup is present about halfway on the spinous processes; transverse processes cannot be felt. There is a slight fat cover over the ribs. Spinous processes and ribs are easily discernible. Tailhead is prominent, but individual vertebrae cannot be visually identified. Tuber coxae appear rounded but are easily discernible; tuber ischii are not distinguishable. Bone structure of the withers, shoulders, and neck is accentuated.

Horse with a BCS of 2.5 to 3. Note the rib cage, tailhead, and pelvic areas.

4 Moderately thin — Negative crease can be seen along the back. Faint outline of ribs is discernible. Tailhead prominence depends on conformation; fat can be felt around tailhead. Tuber coxae are not discernible. Withers, shoulders, and neck are not obviously thin. 5 Moderate — Back is level. Ribs cannot be visually distinguished but can be felt easily. Fat around tailhead is somewhat spongy. Withers appear rounded over spinous processes, and shoulders and neck blend smoothly into the body. 6 Moderately ﬂeshy — Slight crease may be seen down the back. Fat over ribs is spongy, and fat around tailhead is soft. Fat is beginning to be deposited along withers, behind shoulders, and along neck.

8 Fat — Crease is seen down the back. Ribs are difficult to feel. Fat around tailhead is very soft. Areas along withers and behind shoulders are filled with fat, and neck is noticeably thickened. Fat is deposited along inner thighs. 9 Extremely fat — Obvious crease is seen down the back. Patchy fat appears over ribs. Bulging fat is seen around tailhead along withers, behind shoulders, and along neck. Fat along inner thighs may cause thighs to rub together. Flank is filled with fat.

7 Fleshy — Crease may be seen down the back. Individual ribs can be felt, but there is noticeable filling of fat between ribs. Fat around tailhead is soft. Fat is deposited along withers, behind shoulders, and along neck.

Horse with a BCS of 5.5 to 6. This would be considered an ideal weight, depending on how the horse is used.

Horse with a BCS of 8, which is considered overweight. Note the thick pelvic and tailhead areas, along with the sides of the neck.

*From Henneke D, Potter G, Kreider J, Yeates B. Relationship between condition score, physical measurements and body fat percentage in mares. Equine Vet J 1983;15:371-372.

AUGUST 2009 | Veterinary Technician

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EquineEssentials

Picture courtesy of Katie Miller, CVT

ment. Rotating dewormers ensures that various species and stages of parasites are killed. While geographic locations may differ in optimal deworming programs, deworming is generally recommended every 8 weeks. False negative results from fecal exams may be misleading, and while fecal egg counts are an important part of parasite control, they do not always detect encysted larvae, which can be detrimental to older horses. Using the proper larvicidal dewormer to kill encysted parasites and help maintain a good body condition in an older horse is important to overall good health of the horse. It is also important to remove manure routinely (e.g., once a week) and maintain a low stocking density of horses in the pasture.

Dental Care Some of the dental abnormalities that affect geriatric horses include tooth loss, wave mouth, sharp points, hooks and broken or infected teeth (Figure 3). Wave mouth occurs when there is substantial difference in the height of several teeth. It should be easily seen or palpated on a dental exam, especially if the horse is sedated and an oral speculum is used. Geriatric horses also may suffer from smooth mouth, a condition where the occlusal surfaces of the teeth are smooth. These dental abnormalities can cause poor body condition because the horse is not able to chew properly. Horses with dental abnormalities will often drop grain or hay from their mouths while chewing, also known as quidding. Dental exams and teeth ﬂoating should be performed on geriatric horses every 6 to 12 months to be able to correct these conditions if necessary.

Common Diseases of the Geriatric Horse The following overview addresses clinical signs, diagnosis and treatment of the six most common conditions affecting geriatric horses (see Box on page 40).

Pituitary Pars Intermedia Dysfunction (Equine Cushing’s disease) With an increasing number of aged horses in the population today, there has been an increased awareness of diagnostic testing and treatment for Pituitary Pars Intermedia Dysfunction (PPID), commonly called Equine Cushing’s-like disease. PPID is common in older horses and is caused by a malfunction of the pituitary gland, resulting in a tumor or enlarged gland.3 This leads to an increased secretion of pro-opiomelanocortin (POMC)derived peptides and ultimately to the clinical signs listed below. A unique and consistent clinical sign of advanced PPID is the long, curly hair coat that does not shed or www.VetTechJournal.com

Figure 3. Note the complete lack of upper incisors, missing lower incisor, and worn appearance of the teeth in this geriatric horse.

shed fully (hirsutism). Other clinical signs of horses with PPID include laminitis, muscle atrophy along the dorsum, fat accumulation, polydipsia, polyuria, secondary infections, lethargy, infertility, persistent lactation, hyperhidrosis, and metabolic abnormalities including hyperglycemia.3 Diagnosis is based on clinical signs and one of three tests: Dexamethasone-suppression test to assess cortisol response; serial measurements of ACTH, insulin, and dextrose; and thyrotropin-releasing hormone stimulation. However, none of these diagnostic tests are 100% accurate and while results are usually helpful, occasionally a false negative or false positive result can occur. Therefore, if the horse is older and exhibits these clinical signs listed above, PPID should be considered. Treatment is administration of pergolide PO q 24h for the remainder of the horse’s life. In addition, careful management is vital to maintaining the horse’s health, including clipping the haircoat and using a blanket during the winter months, and frequent trimming of the feet (e.g., every 4 weeks) (Figure 1).

Laminitis Another disease that occurs in geriatric horses is laminitis, also known as founder. Laminitis is an inﬂammation of the laminae, causing degeneration and necrosis of the hoof.4 Because laminitis can be due to a plethora of diseases, the cause of this disease is not yet clear and is an active area of research by many universities. Laminitis can be an acute or chronic condition. Examples of diseases associated with Veterinary Technician | AUGUST 2009

EquineEssentials

acute laminitis include ingestion of large quantities of grain, strangulating intestinal lesions, or mares with placental retention. Chronic laminitis may be caused by diseases such as PPID; geriatric horses with PPID may develop laminitis as a secondary complication and it may even be the ﬁrst indication that the horse has PPID. Clinical signs include lameness, depression, anorexia, and a horse’s reluctance to move or lift its feet to be cleaned. Increased pulsations in the digital arteries can be palpated or sometimes visualized. Depending on the severity of the condition, the horse may stabilize with treatment; however, euthanasia is often recommended in severe cases4 (see AAEP Guidelines for Recommending Euthanasia, www.AAEP.org). Treatment is directed at the primary disease causing laminitis (e.g., administration of pergolide to horses with PPID), supportive care and pain management. It is important to keep the horse comfortable and supportive treatment includes shoeing changes, deep bedding in the stall, and nonsteroidal antiinﬂammatory drugs (NSAIDs). Also, these horses seem to have a higher rate of foot abscesses, which must be treated aggressively. It is important in these cases not to mistake laminitis for abscess formation and vice versa. Laminitis in non-PPID horses is often associated with a degree of third phalanx (P3) rotation, while horses with PPID often do not have rotation or only minimal rotation of P3 (Bertone, J. Personal communication, Dec. 2008).

Heaves This disease is more appropriately known as Recurrent Airway Obstruction (RAO). A similar disease can occur in young horses and is known as Recurrent Airway Inﬂammation. It is a condition that can be acute or chronic and can affect a horse year-round or seasonally. Another form of the disease is actually worsened by outside exposure in the summer and on hot, humid days. Treatment includes keeping the horse inside in the heat of the day. This is commonly seen in the southeast United States, but is not limited to that region. Because a horse with Six Most RAO is reacting to an Common Diseases allergen in its environin the Geriatric Horse ment (e.g., dust), care should be taken to miniEquine Cushing’s/PPID mize exposure to dust Dental Disease and known offending Parasitism allergens. Providing adeLaminitis quate pasture time, minHeaves/Recurrent Airway imizing dusty bedding Obstruction and stalls, and soaking Uveitis hay before feeding are 40

AUGUST 2009 | Veterinary Technician

important steps to alleviate RAO in the geriatric equine patient. Clinical signs include: cough, tachypnea, dyspnea, ﬂared nostrils, wheezing, and a heave line, which is caused by increased exhalation and subsequent overdevelopment of external abdominal oblique muscles. Diagnosis is based on history, clinical signs, physical examination and diagnostic tests including transtracheal and bronchioalveolar lavage using an endoscope, radiographs, and blood tests. The most important part to controlling RAO is minimizing allergens and dust in the horse’s environment.

Uveitis Equine recurrent uveitis, also referred to as moon blindness, is one of the most common ocular diseases of the horse and the most common cause of blindness in equine patients.5 It is an immune-mediated disease characterized by periods of inflammation and inactive periods where inflammation may be difficult to discern. Clinical signs include photophobia, swelling and reddening of the conjunctiva, excessive tear production or discharge from the eye, corneal edema, and constriction of the pupil (miosis).6 Uveitis can be the result of trauma to the eye or caused by systemic disease including leptospirosis, brucellosis, onchocerciasis, strangles, equine influenza, or tooth abscessation.5 The diagnosis of uveitis includes a thorough ophthalmic exam and additional diagnostic tests, such as a CBC and serum chemistry panel. Treatment is based on the underlying clinical disease and use of topical and systemic antiinflammatory and antimicrobial medications to reduce intraocular inflammation and further damage to the eye. If the condition is chronic, sometimes surgical intervention may involve vitrectomy (removal of the vitreous) or a suprachoroidal cyclosporine implantation in which a cyclosporine disk is implanted under the scleral flap. It is important to treat uveitis quickly because recurrent episodes can lead to other chronic conditions such as adhesions between the iris and the lens, cataracts, retinal degeneration and, most importantly, blindness.

Euthanasia As always, the subject of euthanasia can be difﬁcult to discuss with an owner. Many times these horses have been members of the family for several decades. As veterinary technicians, we need to recognize the bond between owners and their horses and understand the loss they are feeling. We can help provide compassion and support at a time when they are needed the most.7 When the owner decides to euthanize his/her horse, some medical issues need to be taken into consideration. Whether the veterinarian chooses to use a needle or insert www.VetTechJournal.com

EquineEssentials

a catheter, it is helpful to clip the area over the jugular vein. As with any aged animal, these horses can be thin and it can be difﬁcult to locate the jugular vein. Due to the large size of these animals, disposal also can be a concern. The owner may choose to bury or cremate the horse. If burial is elected, the owner should contact local authorities because of possible restrictions in their township. Geriatric horses are treasured members of the owner’s family and have unique needs. When veterinary technicians understand the needs of these special horses, we can better educate the client and improve the lives of geriatric horses. VT

4. Linford, RL: Laminitis (Founder), in Smith, BP (ed): Large Animal Internal Medicine, ed 4, St. Louis, MO, Mosby Elsevier, 2009, pp1224-1227. 5. Equine Uveitis, in Aiello SE, (ed): The Merck Veterinary Manual, ed 8, Whitehouse Station, NJ, Merck & Co., Inc., 1998, pp 360-362. 6. Slater JD: Medical Nursing, in Coumbe, K (ed): Equine Veterinary Nursing Manual Oxford, UK, Blackwell Science Ltd, 2001, pp 249-283. 7. Bentz AI: The Geriatric Horse, in McCurnin DM, Bassert JM, (ed): Clinical Textbook for Veterinary Technicians, ed 7, Philadelphia, PA, Elsevier, 2009.

References

ABOUT THE AUTHOR

1. Part I: Baseline Reference of 1998 Equine Health & Management. Washington, DC: USDA:aphis, 1998; 7, 9, 12, 21, 44-46.

Carreen McCarthy, CVT Carreen is technician manager in the professional services center at Veterinary Learning Systems (VLS), publisher of VETERINARY TECHNICIAN, located in Yardley, Pa.

2. Ralston SL. Management of Geriatric Horses. Available at www.ker. com, October 2008. 3. McFarlane D: Pituitary and Hypothalamus, in Smith, BP (ed): Large Animal Internal Medicine, ed 4, St. Louis, MO, Mosby Elsevier, 2009, pp 1340-1344.

InsideBehavior

Diary (continued from page 17)

anxiety. When an animal is in such constant and complete distress, it is impossible for it to respond — rather, it simply reacts and is often unaware of the stimuli it is reacting to. There is little learning occurring, only a desire to “survive.” Technicians can explain this experience to clients by describing that it is comparable to having a very bright light shining in your eyes (i.e., the fear) but you are unable to see around or through the light. Until the light is dimmed (i.e., fear is decreased), you are unable to see what options and choices you have. Because of all these concerns, drug desensitization was the primary focus of the initial treatment plan for Jaunter. The goal was to decrease his fear to a level at which conditioning could occur, and over time, specific stimuli could be isolated and behavior modification techniques applied appropriately. Various treatment protocols can be developed by the veterinarian and centered around tools that are common in behavior modification (see box Training and Behavior Modification Tools for Treating Fearful Animals). Technicians should become familiar with the various tools that practitioners and behaviorists can implement in a behavior modification program. Ten months after adoption, Jaunter still requires clonazepam 2 to 3 times a day. On Dr. Luescher’s recommendation, www.VetTechJournal.com

I changed to trazodone at 100 mg sid to tid, as needed. Trazodone is almost always used as an adjunct to an SSRI and can be used as needed. It much less expensive than clonazepam. It is an axiolytic but also may have a mild sedation effect.5 Jaunter’s fear level remains between 2 and 4.VT

References 1. Crowell-Davis S. Veterinary Psychopharmacology. Blackwell Publishing, 2006. 2. Dodman N. Fear, Anxiety and Compulsive Behavior in Dogs. London: Professional Animal Behavior Associates; London, 2004. 3. Landsberg G, Hunthausen W, Ackerman L. 2003. Handbook of Behavior Problems of the Dogs and Cat, ed 2. London: Elsevier; 2003:162, 231-234. 4. Pageat P, Gaultier E. Current research in canine and ﬂine pheromones. Vet Clin North Am Small Anim Pract 2003;33:187-211. 5. Sherman B. Use of trazodone in veterinary behavior. 2009 ACVB/AVSAB Scientiﬁc Program.

ABOUT THE AUTHOR

Julie Shaw, RVT Julie is an animal behavior technologist at the Animal Behavior Clinic, Purdue University. She is president-elect and newsletter editor for the Society of Veterinary Behavior Technicians and is the behavior section editor for VETERINARY TECHNICIAN.

Veterinary Technician | AUGUST 2009

ManagementMatters

Planet Made Quick Easy Saving the

lmost everyone is going “green” these days, and you may be wondering how you can participate in the worldwide effort to reduce our impact on the Earth. There are many ways to create a veterinary practice that is more environmentally responsible while saving money at the same time.

Katherine Dobbs, RVT, CVPM, PHR

Begin With an Audit

in several convenient locations throughout the facility. Another example is the reduction of electricity use. It can be difficult for everyone to remember to turn out the lights in empty rooms, so motion-detecting lighting fixtures can help compensate for the human factor. However, that doesn’t mean that you shouldn’t tell the staff how they can help and hold them responsible for doing so. Conservation tasks should be mapped out in job descriptions and standard operating procedures, and the success — or failure — reflected in staff performance evaluations.

Before you go green, an audit can help determine where opportunities lie and how successful your efforts can be. Begin by identifying recyclable materials around the office, Shining a Light on Conservation including plastic, aluminum, glass and paper. Evaluate Lighting fixtures and bulbs should be a component of how much can be recycled and determine how these recy- green initiatives. Switch from incandescent bulbs to more clables can be easily separated for collection. Then, target energy efficient compact fluorescent bulbs. A construction the products that are abundant and easy to collect. Ask the or electrical contractor can help you determine if new bulbs local recycling handlers which matecan be installed in existing fixtures or rials can be recycled the most cost if it would be more sensible to switch effectively by considering the costs of out the entire fixture. collection, handling and processing. It is important to note that continuIt is helpful to know if you’ll receive ally lit signs can be an energy vacuum. If Use reusable jugs for spring or feedback, such as the amount of each you have a sign that must stay on, trade drinking water or purchase a water material you sent during a year, and if it in for an LED sign that can help save purifier that can turn your tap water into pure drinking water. items had to be removed from your colon your electric bill. lection because they weren’t recyclable. There may be ways in your commuSwitch to environmentally For example, some types of plastic and nity to “get off the grid” by using solar, friendly chemicals and cleaning glass are not recyclable. wind, or geothermal energy. supplies where appropriate.

Quiick k Hints

The Human Factor Admittedly, it is difﬁcult to change old habits. For a green initiative to be successful, the human factor must be considered. Additional tasks should require the least amount of time and energy expenditure. For example, recycling bins located around the back door of the facility will not get used as often as smaller recycling bins 42

AUGUST 2009 | Veterinary Technician

Buy office supplies that contain recycled components. Replace old appliances with energy- and water-efficient appliances for laundry, dishwashing, hot water heating, etc. Switch to email reminders and letters rather than paper reminders.

Beyond Paperless Some veterinary practices have gone paperless, while others have made an effort to minimize paper use. If your practice’s records are no longer in paper form, there may still be more ways to reduce paper use in your practice. Before hitting the print button, here is list of questions employees should ask themselves: www.VetTechJournal.com

ManagementMatters

• Is it necessary? Would it be appropriate to print one page or section instead of the entire document? Can I save it to my hard drive or a flash drive instead? • Have I used the Print Preview function to double-check that I am about to print what I actually need? Can I use a duplex feature to print on both sides of the page? • Can I use the second side of waste paper or the blank side of printed documents to turn into notepads for office use? Other ways the practice can reduce paper use include switching from a fax machine to a fax modem, where documents appear in an e-mail account instead of printing; scanning and emailing documents instead of passing around redundant stacks of paper; bringing laptops to meetings and using flash drives to save on printing reports for all who attend; establishing PINs to track employee printing and creating established protocols and policies that make paper conservation a necessity, such as what can be printed, how many copies are allowed. Remember to monitor and follow-up on your green efforts. Measure your progress to provide quantifiable results and comparisons. Ask employees how easily they are able to comply, and which initiatives seem to be most supported by the team. It also is important that management support the green

www.VetTechJournal.com

initiative in your practice. They should consistently voice their support to increase staff buy-in, and the entire management team should stand as role models for conservation efforts. Communicate these new initiatives to the team to instill this conservation effort in your practice culture and create a sense of pride for the organization.

For More Information: www.epa.gov/epawaste/conserve/tools/cpg/index.htm www.call2recycle.org www.Earth911.com www.energystar.gov www.greenseal.org www.epa.gov/epawaste/partnerships/plugin/index.htm

ABOUT THE AUTHOR

Katherine Dobbs, RVT, CVPM, PHR Katherine is the founder of the Veterinary Emergency and Specialty Practice Association (www. vespassociation.org). She has her own consulting firm, interFace Veterinary HR Systems, LLC. Contact her at ManagementMatters@sbcglobal.net.

Veterinary Technician | AUGUST 2008 43

0809_ProductForum_VT.qxp:VT

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Intervet/Schering-Plough Animal Health has introduced Nobivac Lyme, a vaccine that induces the production of highly specific antibodies that kill Borrelia burgdorferi (the causative agent of Lyme disease) by binding to outer surface proteins (Osp) A and C. Nobivac Lyme is administered by giving two doses subcutaneously, 2 to 4 weeks apart, with an annual booster thereafter.

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Canine Influenza Vaccine Intervet/Schering-Plough Animal Health has been granted a conditional product license by the USDA for the first vaccine against canine influenza virus. The vaccine is made from inactivated virus and has been demonstrated to reduce the incidence and severity of lung lesions as well as the duration of coughing and viral shedding. It may be given to dogs 6 weeks of age or older and can be given annually as a component of existing respiratory disease vaccine protocols to ensure more comprehensive protection. VT

908-298-4000 • www.intervetusa.com 44

AUGUST 2009 | Veterinary Technician

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Veterinary Technician | AUGUST 2009 45

ClassiﬁedAdvertising TECHNICIANS WANTED

TECHNICIANS WANTED

ALASKA – Full-/part-time LVT or veterinary assistant with 2 years’ experience wanted to join outgoing team at 24/7 AAHA-accredited emergency hospital in beautiful Anchorage. Emergency experience a plus. Technician interns welcome. Competitive wages, health and dental, paid vacation, CE. Assistance with traveling expenses available. Fax resume to 907-274-5133 or email akbmd@ clearwire.net. Visit www.petemergencytreatment.com.

FLORIDA – Two full-time technicians needed in Pensacola at multi-doctor practice that is currently pursuing AAHAaccreditation and will offer acupuncture next spring. Candidates must be self-motivated, hard-working, team-oriented, and dedicated to client service and patient care. Experience required; license/certiﬁcation preferred. Please email resume and three professional references to ksmith@navyblvd.com.

FLORIDA ARKANSAS – Busy, two-doctor AAHA-accredited hospital in Little Rock seeks a full-time CVT or state-certificate–eligible technician. A motivated team player will find an excellent opportunity for professional development at our well-established practice that continues to grow. We are semi-paperless and well-equipped with an in-house lab, ultrasound, and support equipment. There’s much to do in the capital city and numerous outdoor activities are a short drive away. We offer a competitive salary, vacation/personal time, health insurance, CE, and a profit-sharing plan. No emergency duty. Email Sarah at sarahcvt2008@yahoo.com or fax your resume to 501-225-2488.

FLORIDA – Miami Veterinary Specialists is a state-of-the-art referral practice that provides highquality, cutting-edge veterinary medicine. We are always seeking highly enthusiastic, self-motivated, experienced team players to join our fast-growing technician staff. New graduates welcome. Work to your fullest capability assisting our onsite board-certified specialists in: Ultrasonography • Computed Tomography (CT Scans) • Endoscopy • Fluoroscopy • Dermatology • Oncologic Surgery • Neurologic Surgery • 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, and digital radiography. The ability to think and handle responsibility is a must! Our benefits package includes a 401(k), CE, paid vacation, medical/dental insurance, pet discounts, and more. 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. For more information, call 305-665-2820 or visit www.mvshospital.com. FLORIDA – Experienced full- and part-time nurses needed at an established and recently expanded small animal emergency hospital, located only a few miles from the beach in sunny Jacksonville. Come enjoy a family-like atmosphere where our doctors are always willing to share knowledge and CE is available and encouraged. Our patient care is second to none! We are well-equipped with digital x-ray, ultrasound, vital scan monitor, Doppler blood pressure, StatSpin, full in-house lab, infusion pumps, endoscope, and much more. Competitive pay based on experience with generous beneﬁts package for full-time employees. Nights, holidays, and weekend hours required. Fax resume to 904-223-3084 or email to emergencypetcare@bellsouth.net.

AUGUST 2009 | Veterinary Technician

TECHNICIANS WANTED

Coral Springs Animal Hospital is always accepting applications from enthusiastic, motivated, compassionate, dedicated, quality-minded CVTs and 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 at our general/specialty/emergency/critical care facility, which is open 24/7. We are looking for individuals who want to utilize their veterinary nursing skills to the fullest. Technicians with the desire to work at a premium facility that has a great record of retaining excellent veterinary professionals 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, and discounted pet care. Drug-free workplace. Flexible scheduling. Please visit us and take a virtual tour of our brand-new 39,000–sq. ft. state-of-the-art facility at www.coralspringsanimalhosp.com. Please send resume to: Coral Springs Animal Hospital 2160 North University Drive Coral Springs, FL 33071 Attn: Shayne Gardner, Hospital Manager. Phone 954-753-1800 • Fax 954-343-0238.

FLORIDA Veterinary Technicians/Nurses We are a state-of-the-art small animal emergency/critical care and referral hospital located in West Palm Beach. Fueled by a dedicated team of professionals, our practice specializes in emergency/critical care, surgery, internal medicine, oncology, neurology, cardiology, radiology, and ophthalmology. 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 Specialists: 561-434-5700; and/or send your resume, Attn: Jennifer: Fax: 561-296-2888; Email: careers@palmbeachvetspecialists.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.

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.

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ClassiﬁedAdvertising TECHNICIANS WANTED

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PENNSYLVANIA – Busy companion animal practice productinfo@VetTechJournal.com. in Lancaster County seeks experienced full-time CVT to assist with basic procedures, provide emergency care, and perform other duties. Some evening/weekend hours. Competitive salary/beneﬁts. Send resume to 717-4644082 or mtbuchhholz1@comcast.net. Website: www. willowrunvetclinic.com.

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.

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, AAHAaccredited 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

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Veterinary Technician | AUGUST 2009 47

FinalView

Insatiable Hunger Submitted by the technicians at Animal Clinic, Inc., Grand Rapids, Mich.

4-year-old, 54-lb Siberian husky, 1 week away from whelping, came to our clinic because she was lethargic and not eating. On examination, palpation of the abdomen was painful. Radiographs revealed multiple fetuses and a large radiopaque density in the midabdominal area. The patient was taken to surgery for a cesarean section as well as an abdominal exploratory laparotomy and gastrotomy. One live puppy and three resorbed fetuses were removed from the uterus and the following contents were removed from the stomach: 36 rocks of various shapes and sizes, three 6-inch tubes of used pet toothpaste, two nylon leashes, a large metal bottle cap, a ball of baling twine, multiple pieces of glass, ﬁve nails, a rusty 4-inch bolt, a washer, fabric softener sheets, an intact wishbone, cellophane wrappers, folded paper, twigs, an 18-inch piece of cloth, a package of fuses, a rubber band, a 200-sheet box of tissues and numerous unidentiﬁable objects. Luckily, the patient recovered and the mother and puppy are doing well. VT

Do You Have a Unique Case to Share? Send us your interesting case with clinical images — radiographs and/or high-resolution photographs that help tell the story. Provide a 100- to 150-word description of what the images are showing, and include information about the animal’s recovery. We pay $75 per published case. Send submissions by email to editor@VetTechJournal.com, or mail to VLS/Veterinary Technician, 780 Township Line Road, Yardley, PA 19067. 48

AUGUST 2009 | Veterinary Technician

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