Veterinary Technician | September 2009 by davidpsu

The Complete Journal for the Veterinary Health Care Team

Vol. 30 No. 9 | September 2009

CE Credit from Alfred State College, SUNY

Never-Ending Ann A Talk with Ann Wortinger, BIS, LVT, VTS (ECC, SAIM)

Emesis â&#x20AC;&#x201D; Is It for Your Patient? Canine Uveitis Feline Inappropriate Elimination TechTalk Wins Award Visit us at www.VetTechJournal.com

With the introduction of the first vaccine for canine influenza,

only the love is contagious. Now you can provide your patients with more comprehensive protection against respiratory infection. Love is not the only thing in the air. Canine influenza virus (CIV) has been confirmed in dogs across 30 states and the District of Columbia, and its prevalence is rising.1 And because most dogs are naive to the virus, virtually every naive dog exposed will become infected.2 CIV is highly contagious and sometimes deadly. Clinical signs associated with CIV can be confused with kennel cough making accurate diagnosis difficult. Now you can broaden the respiratory protection you currently offer to patients with the addition of the first vaccine for canine flu, Canine Influenza Vaccine, H3N8. Canine Influenza Vaccine, H3N8 —a killed virus vaccine from Intervet/Schering-Plough Animal Health—significantly decreases clinical signs of disease and reduces viral shedding, and its safety has been confirmed in a study involving more than 700 dogs.3

Notice: This product license is conditional. As with all USDA conditionally licensed products, data submitted to the USDA supports a reasonable expectation of efficacy. Safety was established in trials involving more than 700 dogs.

So while CIV, like love, can be easily spread and hard to identify, it no longer has to be so overwhelming. To learn more, contact your Intervet/Schering-Plough Animal Health representative, visit www.doginfluenza.com, or call our technical services team at 800-224-5318.

References: 1. Syndromic surveillance data of Cynda Crawford, DVM, PhD, University of Florida, and Edward Dubovi, PhD, Cornell University. 2. Key facts about canine influenza. CDC Website. Available at: http://www.cdc. gov/flu/canine. Accessed May 1, 2009. 3. Data on file, Intervet/Schering-Plough Animal Health. Copyright © 2009 Intervet International B.V. All rights reserved. SPAH-VC-284:9412

Editor’sLetter

Vol. 30 No. 9

September 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

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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.

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Living the Oath When you get this issue, September will be half over and October — and National Veterinary Technician Week — will be looming large on the horizon. This year, my goal for celebration is to take a harder look at the veterinary technician oath and make sure I am living up to my promise. If I were to grade myself based on the oath, I would say I am doing B– to C+ work, which leaves a lot of room for improvement! I am active in my state association and a proud, card-carrying member of my national organization. If you call me in the middle of the night to tell me there are puppies or kittens that need hand-rearing, I’ll be there. I volunteer at low-cost vaccination clinics, work with a local rescue group and run in charity races that help our local zoo. But am I “aiding animals and sociVeterinary Technician’s Oath ety” to the best of my ability? I solemnly dedicate myself Sometimes I get tired and crabby and In aiding animals and society just don’t want to talk, so when the perBy providing excellent care and services for animals, son in the checkout line sees my scrubs By alleviating animal suffering and starts asking questions about what And by promoting public health. I do, sometimes I give short answers. I get annoyed by silly questions and I accept my obligation to practice My profession conscientiously downright incorrect comments, such as And with sensitivity, adhering to “My doctor told my pregnant daughter The profession’s Code of Ethics, to get rid of her cat so her baby will And furthering my knowledge be healthy.” You can insert your own And competence through a Commitment to lifelong learning. favorite old wives’ tale here. I admit that I don’t always have the time or energy to correct them. Sometimes I’m in a hurry, my kids need me or I just don’t want to argue. So I give a strained smile, nod, grab my bags and fume the entire way home. That type of attitude doesn’t help anyone. I’m not aiding, I’m not practicing my profession conscientiously and I’m certainly not adhering to the profession’s Code of Ethics. I can’t single-handedly change the world — or even my community — but I can strive to change the outlook of one well-meaning but uninformed person. If I do that consistently, I might truly affect the life of one animal, by strengthening the human–animal bond for the pregnant woman who wanted to keep her cat but didn’t have all the facts. I might be able to keep one more animal out of the shelter. And if we all helped just one more animal, collectively, we might be able to change the world. Wishing you all an early “Happy National Veterinary Technician Week!”

Glenn Triest

The Complete Journal for the Veterinary Health Care Team

Marianne Tear, MS, LVT Editor in Chief

Veterinary Technician | SEPTEMBER 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 Program Director Veterinary Technology Program Baker College of Clinton Township, Michigan

Andrea Battaglia, LVT Cornell University

Tracy Blais, BS, CVT, MEd SECTION EDITORS

Mount Ida College

David Bolette, RVT, LATg

BEHAVIOR Julie Shaw, RVT

University of Pittsburgh

Animal Behavior Clinic Purdue University

Susan Bryant, CVT, VTS (Anesthesia) Tufts Cummings School of Veterinary Medicine

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

Mary Tefend Campbell, LVT, VTS (ECC)

Tampa Bay Veterinary Specialists

Mindy A. Cohan, VMD

EQUINE DeeAnn Wilfong, BS, CVT

Fort Washington Veterinary Hospital

Littleton Large Animal Clinic Littleton, Colo.

Elizabeth Davis, DVM, PhD, DACVIM Kansas State University

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

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

Katherine Dobbs, RVT, CVPM, PHR

DeeAnn Wilfong

interFace Veterinary HR Systems, LLC Appleton, Wis.

Jeanne R. Perrone

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

Donna Letavish, CVT Michigan State University–East Lansing

Heidi Lobprise, DVM, DAVDC

Julie Shaw

Ann Wortinger

(CE Accreditation)

Melvin C. Chambliss, DVM Program Director

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

Rosandra (Rose) Manduca, DVM Miami Dade College

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) Margi Sirois, EdD, MS, RVT Penn Foster College

P. Alleice Summers, MS, DVM Cedar Valley College

Pfizer Animal Health Peter Olson

Marianne Tear

Alfred State College

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

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.

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Contents

September 2009

The Complete Journal for the Veterinary Health Care Team

Volume 30, Issue 9

Never-Ending Ann Ever since Ann Wortinger, BIS, LVT, VTS (ECC, SAIM), was a child, she knew she wanted to be an animal doctor — even before she knew it was an actual profession. It took her a little while before she realized that she actually wanted to be a technician.

16 COLUMNS 22 Peer Reviewed A Veterinary Technician’s Guide to Canine Uveitis

CE ARTICLE

Sondra Biggs, BS, RVT

Emesis — Is It for Your Patient?

28 Peer Reviewed

Jo Marshall, CVT Veterinary staff need to respond quickly in life-threatening situations and be able to evaluate and recognize instances where induction of emesis may be contraindicated or pose additional health concerns to the animal, staff and owners.

Feline Inappropriate Elimination: How to Get Owners to Treat, Not Euthanize

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.

42 Management Matters

Jennifer Dwiggins, BS, RVT

New Sheriff in Town Katherine Dobbs, RVT, CVPM, PHR

Tech News Ten-Year Program Shows Imidacloprid Highly Effective ........................10 TechTalk Wins Grand Award .................................................................11

DEPARTMENTS Editor’s Letter ............................................. 1 Editorial Board ........................................... 2

Final View

Tech Forum .......................................... 6

Mystery Growths

Tech Tips ..............................................12

State News ............................................ 8 Advertisers Index ............................... 43 Product Forum .....................................44 Market Showcase ..................................45

48 4

SEPTEMBER 2009 | Veterinary Technician

Classiﬁed Advertising ...........................46 www.VetTechJournal.com

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Your knowledge. Our science. Their health.

TechForum

I read Marianne Tear’s Editor’s Letter, “Congratulations on Your New Son” (May 2009, page 1), and jumped for joy. About 5 years ago, I had an English bulldog named Wally that was diagnosed with a chemodectoma, a benign tumor near the heart-base region. The specialist gave him 1 to 3 months to live. We tried chemotherapy and kept him comfortable with steroid therapy, and Wally ended up living for another year and a half. During Wally’s treatment, I became depressed. During that time, a man came into my clinic with three small pit bull puppies. One of them fell as she was trying to crawl over a baby gate, which caused a hairline fracture of her femur that required a cast. During her treatment I fell in love. The man agreed that the puppy would have a great home with me and that she would get the care she needed, so I took her home and named her Kanga. I did not know anything about pit bulls at the time, so I researched the breed and learned a lot. Kanga likes other dogs that she knows, but can be aggressive to unfamiliar dogs. She loves all people, however, and she adores children. I have never bonded with a pet like this before. She is my heart. A short time after I adopted Kanga, hurricane Katrina hit the Gulf Coast. So many people and animals needed help, so I offered to take in 10 dogs that

Send Us Your Letters Email: editor@VetTechJournal.com Mail: VETERINARY TECHNICIAN 780 Township Line Road Yardley, PA 19067 All letters submitted to VETERINARY TECHNICIAN are subject to editing and editorial discretion as to whether they will appear in Tech Forum. 6

SEPTEMBER 2009 | Veterinary Technician

Courtesy of Sonya Schuler, CVT

Pit Bull Puppy Love

Kanga sleeping. people had surrendered. Some were pit bulls and some were mixes, and we gave them the medical attention they needed. These dogs were evaluated and eventually found permanent homes. After hurricane Katrina, I began taking care of a couple of dogs at a time, and eventually founded a small pit bull rescue. Pit bulls are my passion, but I hear the same question about the breed every day: “Why would you help those dogs?” I use those open-ended questions as an opportunity to educate people about the breed. It saddens me when I hear that pit bulls are often the first dogs to be euthanized in shelters because of the reputation of their breed. We need more responsible and educated pit bull owners, but it is difficult to find people that want to help the breed.

Sonya Schuler, CVT Bethlehem, Pa. Sunrays Pit Bull Rescue

New Beginnings I have been a licensed veterinary technician for 2 years and currently work at a large referral clinic, but I am searching for something new. Are there other positions where a technician can use his or her degree? Is teaching an option, or does that require more schooling?

Curious Technician Marianne Tear responds: It sounds cliché, but there is virtually no limit to what a veterinary technician can do. The ﬁrst thing to do before you

make any big change is determine what it is about your current situation that you don’t like. I worked in a busy clinic for many years and got to the point where I was emotionally exhausted. I wasn’t burned out; I later learned that I had compassion fatigue. Teaching is an option as well, but it is important to prepare yourself to deal with students, their questions and their issues. If clients are causing you dissatisfaction at your current position, then dealing with students may not be the right direction. Think of technician education as client education on steroids. Patience and a willingness to explain “why” are essential. You also have the option of applying to work at a smaller clinic. Many small clinics are able to focus on different aspects of veterinary medicine that you may enjoy, such as reproduction medicine, canine athletics, physical rehabilitation, cats or rescue animals. You also can start your own business. Pet sitting and doggie daycare are viable options for many technicians. Being a licensed technician can lend credibility to your business and set you apart from others in the same market. You also can make time for yourself. So many of us make our work our worth; we don’t separate who we are from our job. Don’t get me wrong: I am a technician. However, I don’t measure my success by any of the jobs I do. I try to measure it by the number of animals I help, the number of students I positively impact and so on. If I concentrated on the animals I couldn’t help or the students I wasn’t able to motivate, I wouldn’t be able to get out of bed. Make your own joy and take time to be silly. I know that my neighbors think I am crazy, but on exceptionally stressful days I run around the backyard with my dogs. It is hard to take yourself too seriously when you are covered in mud and dog slobber. VT www.VetTechJournal.com

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OVC Health Sciences Centre Appoints Associate Dean The Ontario Veterinary College (OVC) has announced the appointment of Sherri L. Cox, DVM, MBA, as associate dean, administration and chief operating ofﬁcer of the OVC Health Sciences Centre. According to Dean Elizabeth A. Stone, DVM, MS, DACVS, chairperson of the search committee, “Dr. Cox was instrumental in taking the primary health care initiative from vision to reality. With this continuing level of professionalism and expertise, I am conﬁdent that she will work enthusiastically and collaboratively with OVC faculty, staff and students to ensure that all facets of our OVC Health Sciences Centre are successful.”

Dr. Cox is a recent DVM graduate from OVC and also has an MBA from the College of Management and Economics at the University of Guelph. She will use her 20 years of organizational experience to focus on strategic and immediate operational needs for the OVC Health Sciences Centre. The Health Sciences Centre’s goal is to integrate animal, human and ecosystem health. Dr. Cox believes that, “together, we can build an exciting future for the OVC Health Sciences Centre. We will all share in the success as we create a global model for the improvement of health for animals, people and the environment.” VT

Canadian Veterinary Medical Association Releases Code of Practice for Canadian Cattery Operations Following in the footsteps of its Code of Practice for Canadian Kennel Operations, the Canadian Veterinary Medical Association (CVMA) has released its Code of Practice for Canadian Cattery Operations.

Similar to other codes of practice, it is voluntary and can be used as an educational tool by cat breeders, current and prospective cat owners and animal welfare groups. It also can be used as a practical standard by those interested

Continuing Education NOVEMBER LifeLearn, Inc.: Blood Smear Evaluation — No Nov. ov 1 15. 5 valuation oof Guelph, Ontario. Sessions will focus on evaluation peripheral blood smears, with an emphasis sis on identiﬁsi b discussed cation of abnormalities. Topics that will be ation of preinclude “basophil boot camp” and identiﬁcation cursors, toxic changes and common morphologic l gic changes lo mons mo nstrated by ns of erythrocytes. Clinical cases will be demonstrated all p pho hoPamela Baker, BSc, DVM, using high-quality digital photomicrographs, and participants will evaluate ssamples am on, proper on p using double-headed microscopes. In addition, is is smearing technique will be practiced, with dis discussion

in the promotion of sound care, management and welfare practices related to the care and breeding of cats. The code of practice covers many topics, including the selection of a cat, housing and accommodation, care and supervision, behavioural needs, transportation, education, emergencies and euthanasia. The guide is a result of the work of professionals in the ﬁeld and is available from the CVMA’s website at canadianveterinarians.net VT

of selection of the best technique for abnormal samples. nts should have at least a basic working knowlParticipants edge ed g of of blood bloo cell identiﬁcation. For more information, visit www.l l www.lifelearn.com. SAVT 25 th Anniversary Conference, Saskatoon, Saskatchewan Saskatch chew ch wan — Nov. 13–15, TCU Place. A block of hotel roomss at the Hilton Hil ilto to Garden Inn will be reserved for conference delegates,, b but demand is always high so plan your accommodations accommodation n early. 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.

SEPTEMBER 2009 | Veterinary Technician

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Ask your distributor or Abbott sales representative for details. Stay tuned for future CE modules covering blood glucose monitoring!

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Cover Story

In It for the Long Haul In an exhausting and demanding profession, Ann has figured out a way to maintain longevity. For other technicians to achieve the same longevity, Ann suggests they find an area they enjoy and pursue it: “Don’t assume that the only job is in a small animal practice, in a large animal practice or wherever you currently work. There are lots of other options. Whether it is nutrition, behavior, integrating different vaccine schedules into a clinic, surgery or anesthesia, technicians should find something that they like and pursue it.” Finding something she likes is exactly how Ann started a nutritional support service at a private practice where she worked for 13 years. She was interested in nutrition and wanted to expand on her interest by incorporating it into the practice. “It was something that I wanted to do,” she says. “I told my practice manager that it was something I wanted to try. I already had the computer codes, price scale and everything all set up, so all the manager needed to do was say ‘yes.’” Ann encourages technicians to explore and excel in their areas of interest. She explains that technicians need to present themselves as effectively as possible. If a technician is unhappy in their current situation, Ann says, “complaining isn’t going to help. If you don’t like something, think of a solution and present it to your employer.”

“Crocheting is stress management for me. I can’t crochet with tense hands because it ruins the work,” she says. “The volume of crocheting I do can reﬂect my stress level. During one stressful year, I made afghans for my kids, nieces and nephews — everybody got an afghan!” If Ann’s husband comes home and ﬁnds her weeding the garden in the summer or watering the houseplants in the winter, it’s a sign that it may be best to leave her be for awhile because she probably did not have a good day. Although Ann has found her own personal stress relievers, she still admits to experiencing some degree of burnout in her long career. But Ann learned how to address it. “I can’t say I avoided it,” she explains. “I learned to work around it, and I changed the situation. I didn’t let it control me.” VT

VITAL STATISTICS ANN WORTINGER

through blood work and telling me which organs are being affected is very rewarding,” she explains.

Stress Factor To help alleviate work-related stress, Ann has many relaxation outlets. After a stressful day, She can be found weeding in her garden or crocheting afghans for everyone she knows.

Education Bachelor’s in Interdisciplinary Studies, Wayne State University, Detroit, Mich. (2008); Veterinary Technology Degree, Michigan State University, East Lansing (1983); Master’s candidate in Nutrition and Food Science, Wayne State University, Detroit, Mich. (2009).

Publication “Nutrition for Veterinary Technicians and Nurses,” Blackwell Publishing (2007); more than 30 peer-reviewed articles in Veterinary Technician, AAHA, NAVTA, Tech News and Veterinary Forum.

Michigan Association of Veterinary Technicians; National Association of Veterinary Technicians in America; Veterinary Emergency Critical Care Society; Academy of Veterinary Emergency Critical Care Technicians; Academy of Internal Medicine for Veterinary Technicians; Association of Veterinary Technician Educators

Family For 128 hours over 17 weeks, Ann is responsible for teaching her students how to properly conduct five diagnostic procedures that the American Veterinary Medical Association requires: complete blood count, blood chemistry, urinalysis, tests for endo- and ectoparasites and microbiology.

SEPTEMBER 2009 | Veterinary Technician

Todd, in-it-for-the-long-haul-too spouse of 25 years; Scott, 23, soon to be a student at Wayne State University (WSU), Detroit, Mich.; Bill, 18, student at WSU.

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A Veterinary Technician’s Guide to

Canine Uveitis T

he uvea is the vascular component of the eye and consists of the iris, ciliary body, and choroid. The uvea and its components are responsible for producing aqueous humor and maintaining the blood–ocular barrier, as well as for supplying nutrients to the retina and helping to eliminate waste products. The uvea also includes the muscles that regulate the constriction and dilation of the pupil. Uveitis, the inflammation of the uveal tract of the eye, is one of the most commonly diagnosed eye conditions and causes of blindness.1 Inflammation of the uveal tract causes a breakdown in the barrier between the eye and the blood supply. This allows white blood cells and other inflammatory proteins to leak from the vasculature into the eye. This will often cause the eye to have a hazy, cloudy look, and blue irises may even change to yellow as a result of inflammation of the iris2 (Figure 1).

Sondra Biggs, BS, RVT

Anatomy of the Eye The eye contains three chambers, all of which can be affected by uveitis: The anterior chamber includes the space between the cornea and the iris; the posterior chamber consists of the space between the iris and the lens; and the posterior segment consists of the space between the lens and the retina. Additionally, there are three layers that compose the eye: Sclera — the white part of the eye that helps the eye to hold its shape. Choroid — the portion between the sclera and the retina. Retina — the lining in the back of the innermost portion of the eye; responsible for collecting light in the rods and cones for transport to the brain, which creates vision. 22

SEPTEMBER 2009 | Veterinary Technician

Clinical signs Dogs affected by uveitis may demonstrate signs of pain and be photophobic. Diagnosis of uveitis is made after a thorough eye examination that includes vision testing, a Schirmer tear test, fluorescein staining, direct and indirect pupillary light responses, and an intraocular pressure measurement when possible. This is relevant because the increased outflow of aqueous humor inside the eye will cause an initial drop in eye pressure, and a measurement of less than 10 mm Hg is indicative of uveitis.3 The presence of aqueous flare also is characteristic of uveitis. In one study, approximately 86% of dogs with uveitis presented with aqueous flare.1 Aqueous flare occurs when the blood– aqueous barrier is compromised and is visualized when a small, direct beam of light creates a “headlights-in-the-fog” effect in the anterior chamber. This is known as the Tyndall effect2 (Figure 3). Uveitis will commonly cause the iris to undergo ciliary spasm and become miotic. Ciliary spasm can be very uncomfortable and can cause blepharospasm and increased tearing. Conjunctival hyperemia is another common condition seen with uveitis and is noted by redness in the white part of the eyes.

Pathology Uveitis can be acute or chronic and bilateral (both eyes) or unilateral (one eye) (Figure 2). Its cause can be either ocular or systemic, and both unilateral and bilateral uveitis can have a systemic root. Treatment of uveitis and the possible underlying disease is essential for the preservation of comfort and vision (See Sequelae of Uveitis.). www.VetTechJournal.com

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Figure 1. Right eye of a husky diagnosed with leptospirosis. The iris appears yellow. There is episcleral injection and aqueous flare due to severe anterior uveitis.

Causes

Figure 2. Both eyes of a husky showing the difference between the right eye with uveitis and the left eye that is unaffected.

mediated uveitis involve stabilizing the blood–ocular barrier, providing comfort, maintaining vision, and minimizing inflammation. Treatment often includes topical NSAIDs or corticosteroids, as well as mydriatic agents that dilate the pupil. The most common topical NSAIDs include flurbiprofen and diclofenac.2 Topical corticosteroids, such as dexamethasone and prednisolone acetate, are used because of their ability to penetrate the cornea into the anterior chamber of the eye.2 Hydrocortisone does not achieve a therapeutic level in the aqueous humor due to its inability to efficiently penetrate the cornea.2 Systemic NSAIDs and corticosteroids may be used when topical medications cannot successfully control the uveitis. Systemic corticosteroids should be used with caution because of the potential to exacerbate possible infectious causes of uveitis. In some immunemediated cases where systemic and topiSequelae of Uveitis cal NSAIDs and corticosteroids fail, an immunosuppressive drug such as azaChronic recurrence thioprine may be used to control uveitis.3 Posterior synechiae However, careful monitoring of a com(adhesions of iris to the plete blood count should be performed lens) to detect a decrease in white blood cells, Anterior synechiae red blood cells, and platelets.1 Topical (adhesions of the iris to atropine ointment or solution is the most the cornea) common mydriatic and cycloplegic. Glaucoma Atropine relaxes the pupillary muscles, Cataracts relieves ciliary spasm, provides comfort, Lens luxation stabilizes the blood–ocular barrier, and reduces infiltration of inflammatory cells Blindness into the eye.

There are myriad causes for canine uveitis, both infectious and noninfectious. Because of this, an extensive medical history and diagnostic evaluation are necessary to investigate possible systemic causes. This should start with a complete physical examination and a detailed history, as well as a complete blood count and biochemistry proﬁle.2 Further infectious disease testing should be performed based on individual history and geographic location (See Causes of Canine Uveitis and Questions for Owners). In one study, 102 dogs with uveitis were examined, and 25 were diagnosed with metastatic neoplastic disease.1 For this reason, chest radiographs and abdominal ultrasound can be valuable tools when identifying possible causes of uveitis.

Treatment Treatment of uveitis is dependent on the cause. Whenever possible, the underlying disease should be treated. Systemic antibiotic treatment is recommended with the diagnosis of leptospirosis and tickborne illnesses such as ehrlichiosis, Rocky Mountain spotted fever, and Lyme disease. Unfortunately, an underlying condition cannot be identiﬁed in some cases of uveitis. These cases are presumed to be idiopathic or immune-mediated through process of elimination. In one study, 58% of dogs with uveitis were diagnosed with idiopathic or immune-mediated uveitis.1 The goals of treatment for idiopathic and immune24

SEPTEMBER 2009 | Veterinary Technician

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We Reclaimed Our Time, Giving It Back to Those Who Need It Most—Our Patients ❝Selecting LabREXX ultimately led to us being able to practice better medicine for our clients.❞

t’s a typical afternoon at your practice, the phone is ringing off the hook, surgery patients are in recovery, and you’re in a mad dash to complete the morning outpatient procedures. Somewhere in the midst of all this, you also need to complete the day’s lab requests. You’re searching for the test code book in hopes of finding the tests the doctor requested when you hear the call that the courier is here to pick up your lab samples. In a hurry, you shuffle through the lab req forms, scribble in some names, check off some boxes, and hope that the sample tubes are correct.

Gina Toman Seaside Animal Care Calabash, NC

The Problem Technicians are responsible for a million and one things each day, and somehow the lab pickup sneaks up on us and we find ourselves unprepared. Inevitably, the lab forms don’t get filled in correctly, patient information is incomplete, and the wrong tests end up being performed. The result? Clients are charged inappropriately, leaving us with two possible outcomes: One, a staff member is faced with making that uncomfortable call to the client to inform him or her of the missed billing, or two, the clinic is left to pick up the lab charges for those tests that were performed incorrectly as a result of our human error. At Seaside Animal Care, we made the commitment to becoming paperlight and embraced technology to improve our workflow—but we still used handwritten, carbon-backed lab requisition forms. As a team leader, I spent my day looking through books to find specific tests for the doctors or on the phone with the reference lab to check prices and sample requirements. If I was lucky, I had time to enter codes and prices into the computer. Otherwise, I had to hope that my fellow team members entered the information correctly. Then there was the hassle of periodic price changes that I had to keep up with when the new price sheets came out. All of this kept me from what I do best: caring for my patients.

The Search To alleviate the burden, we decided to look for a software solution. As a team leader, I wanted a program that my fellow technicians could pick up without a lot of training. Adding a program that worked with our existing software was the key to a seamless transition in getting rid of the paper-based forms. In addition, staff handwriting had been an issue in the

past, so the software had to generate the entire requisition form. We also found that lab results came back with incorrect information and looked so unprofessional that we couldn’t present the written results to the client. Even worse, we had to put off clients when we selected the wrong test code and the lab needed extra time to run the correct test. I also wanted the software to capture charges and update those charges in accordance with the updates from the reference lab. Finally, I needed the results to upload instantly into the patients’ charts—no more missing the receipt of a fax or relying on scanned-in faxed results.

The Solution What I found was a free software that had been right under our noses all along—IDEXX LabREXX®. LabREXX not only met my requirements but exceeded my expectations: ➤ Requisitions are completely computer generated and feature a unique bar code, ensuring that the tests you want are the tests being run. ➤ Charges are captured, and because it works with our existing software, invoice items are created automatically and reflect our pricing protocols. ➤ Names are correct, including doctor, client, and patient names, and test selection is always species appropriate. ➤ E-mail alerts can be set up to inform doctors that results are available. ➤ It’s easy to check test status or add tests via the VetConnect portal. VetConnect also permits us to e-mail the LabREXX results directly to clients, remaining true to our paper-light philosophy. In addition, LabREXX organized Seaside’s most commonly used tests, making it fast and convenient to select the tests we run most frequently. Test results transfer directly into the patient’s chart, freeing staff so they (and I) can devote more time to patient care. In fact, I estimate we’ve added at least 30 minutes of productive time to our day by adopting LabREXX. At the end of the day, selecting LabREXX allowed Seaside to stay true to our practice philosophy and ultimately led to us being able to prac■ tice better medicine for our clients. LabREXX software is available online at VetConnect.com and through leading practice management software such as Cornerstone, AVImark, and ImproMed.

Visit www.vetlearn.com/labrexxpromo for more information about IDEXX LabREXX electronic test request forms or to set up LabREXX. You’ll also be entered for a chance to win a gift card! ADVERTORIAL

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Figure 3. The Tyndall effect in a dog. Aqueous flare is visualized when a small, direct beam of light creates a headlights-in-fog effect in the anterior chamber and is known as the Tyndall effect.

Figure 4. Corneal edema and ciliary flush in a dog.

The Impact on the Veterinary Technician

dogs to carry urine on their fur, personnel that come in contact with a dog that is possibly infected with leptospirosis or other zoonotic diseases should wear gloves and practice frequent hand washing. Recognition of uveitis and its potential causes is important for protection of human health as well as for providing total care of the patient. Educating clients about uveitis can often be difﬁcult because of the many causes and extensive treatments needed to control the condition. Untreated uveitis can be devastating to the patient’s eyes and well-being. The veterinary technician must be aware of the potential effects of uncontrolled uveitis and have the ability to accurately and conﬁdently relay that information

Uveitis may have multiple infectious causes. Therefore, veterinary personnel should be aware of the zoonotic potential of animals presenting with this condition. Leptospirosis, for example, is one of the most common zoonotic diseases in the veterinary ﬁeld. Although uveitis is an unusual condition to be associated with leptospirosis, the potential for infection should be considered on presentation, and proper precautions should be taken.4 The veterinary technician often is responsible for the care of dogs with uveitis and with assisting the veterinarian throughout diagnosis. Leptospirosis is spread through an infected dog’s urine. Since it is not uncommon for these

Causes of Canine Uveitis1,5 Bacterial Brucella canis Leptospira spp Septicemia or bacteremia of any cause Rickettsial Rickettsia rickettsii (Rocky Mountain spotted fever) Ehrlichia canis Borrelia burgdorferi (Lyme disease) Fungal Blastomyces spp Coccidioides spp Cryptococcus spp Histoplasma spp

SEPTEMBER 2009 | Veterinary Technician

Algal Prototheca spp Parasitic Dirofilaria immitis Leishmania spp Toxoplasma spp Viral Adenovirus (canine infectious hepatitis) Distemper Herpesvirus Rabies

Noninfectious Immune-mediated or idiopathic uveitis Lens-induced uveitis (cataracts) Uveodermatologic syndrome (called Vogt-Koyanagi-Harada syndrome in humans) Hyperlipidemia Hypertension Pigmentary keratitis in the golden retriever Trauma Ulcerative keratitis Primary neoplastic disease (ocular melanoma) Secondary neoplastic disease from another site in the body (i.e., systemic lymphosarcoma)

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Questions for Owners Does your dog eat any raw meat? Does your dog eat or have access to any cat feces? Does your dog swim in lakes or streams? Is your dog current on vaccinations? What vaccines does your dog receive? Any recent travel? Any vomiting or diarrhea? Any changes in appetite or weight? Any change in energy? Any coughing or sneezing? Any difficulty breathing? Any change in drinking? Any change in urination? Any other signs of illness? Does your dog have any other known medical conditions?

to the client. Technicians should be able to clearly and accurately describe the clinical signs that owners should look for, as well as the importance of following all medication and treatment regimens. Some cases of canine uveitis are incurable but can be controlled depending on the underlying cause.

Conclusion Canine uveitis often can be a subtle and frustrating disease. Consideration of the potential causes is necessary to control the condition. Long-term medication may be required for proper control. Clinic staff should remain aware of the possible zoonotic risks and take the proper precautions to protect themselves. Client education is essential for treatment of uveitis, and it is often up to the veterinary technician to educate clients about the importance of medicating and controlling uveitis. When uveitis is controlled, it is possible to provide these dogs with comfort as well as preserving long-term vision. VT

Glossary Anterior chamber — the front-most portion of the eye, the space between the cornea and iris Anterior uveitis — inflammation of the iris and ciliary body Aqueous humor — fluid in the anterior chamber that helps the eye keep its shape. It is constantly being made by the ciliary body and drained out through the iridiocorneal angle. Blepharospasm — squinting; contractions of the orbicularis oculi muscles Choroid — vascular tissue between the retina and sclera Ciliary flush — hyperemia of the bulbar conjunctiva usually associated with intraocular inflammation Conjunctiva — transparent membrane covering the outer surface of the eyeball and inner surface of the eyelids as one continuous membrane Cycloplegia — paralysis of the ciliary muscles of the eye Episclera — outermost layer of the sclera Hyperemia — congestion of the conjunctival blood vessels Hyphema — red blood cells in the anterior chamber Hypopyon — white blood cells, or pus, in the anterior chamber Miosis — pupil constriction Mydriasis — pupil dilation Panuveitis — inflammation of the entire uveal layer Posterior chamber — the rear-most chamber of the eye, the space between the lens and the retina Posterior uveitis — inflammation of the choroid Sclera — fibrous outer wall of the eye Uvea — from the Latin word uva or grape; consists of the iris, ciliary body, and choroid Uveitis — inflammation of the uveal tract

References 1. Massa KL, Gilger BC, Miller TL, Davidson MG. Causes of uveitis in dogs: 102 cases (1989-2000). Veterinary Ophthalmology 2002;93-98. 2. Johnsen DA, Maggs DJ, Kass PH. Evaluation of risk factors for development of secondary glaucoma in dogs: 156 cases (19992004). JAVMA 2006;1270-1274. 3. Gelatt KN. In: Essentials of Veterinary Ophthalmology. Baltimore: Lippincott Williams & Wilkins 2000;201-215. 4. Townsend WM. Canine and feline uveitis. Vet Clin Small Anim 2008;323-346. 5. Townsend WM, Stiles J, Krohne SG. Leptospirosis and panuveitis in a dog. Veterinary Ophthalmology 2006;169-173.

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ABOUT THE AUTHOR

Sondra Biggs, BS, RVT Sondra has worked at Veterinary Eye Centers in Austin, Texas, for 2 years. She graduated with a bachelor’s of science degree in veterinary technology with an emphasis in ophthalmology from Mercy College, Dobbs Ferry, N.Y., in 2006. Sondra also has a strong interest in internal medicine.

Veterinary Technician | SEPTEMBER 2009

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Feline Inappropriate Elimination: How to Get Owners to Treat, Not Euthanize

eline inappropriate elimination occurs when a cat fails to use its litterbox either to urinate or defecate. Inappropriate elimination is different from urine marking. When a cat is marking, it will generally back into a vertical surface with its tail held straight up and twitching, and then spray urine. A cat with inappropriate elimination will void a large amount of urine on a horizontal surface.1 A cat that urinates or defecates outside of its litterbox should be seen by a veterinarian to determine whether the cause is a medical illness or a behavioral problem. Only after a medical condition is ruled out can behavioral problems be considered.2 This article is intended to help technicians and technologists educate owners about inappropriate elimination and how it can be successfully treated.

Jennifer Dwiggins, BS, RVT

Owner Education Can Prevent Euthanization An estimated 97,000 cats are euthanized every year because of behavioral problems,2 and inadequate litterbox use is one of the leading reasons cats are relinquished to shelters. When a cat is ﬁrst adopted, veterinary staff need 28

SEPTEMBER 2009 | Veterinary Technician

to educate the owners on acceptable litterbox use (i.e., the litterbox is used every time the cat urinates or defecates). Veterinary staff also can help establish a healthy human– animal bond between owners and cat by teaching the owners what normal cat behavior is and how to properly care for a cat. The better the owners are educated, the better chance the cat will have a long, healthy life.3 The owners may not always consider inappropriate elimination to be a problem. They may think their cat has stopped using the litterbox in order to “spite” them and, therefore, may not bring up the issue when they come to the clinic.2 Owners may even be embarrassed that their cat is eliminating inappropriately. Technicians need to help establish communication between the owners and their cat to help owners understand that their cat may need help dealing with a stressful environment.4 There is always a reason for inappropriate elimination and it is the responsibility of technicians and technologists to ask the right questions to help determine whether the cat is having medical or behavioral problems, and how the problem should be treated. www.VetTechJournal.com

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Medical Causes of Inappropriate Elimination Often a cat will urinate or defecate outside of the litterbox, even in front of the owners, to express that it does not feel well. There are several medical conditions and diseases that can cause this improper behavior. If the condition is diagnosed and treated, the cat typically will resume using its litterbox. If the illness remains undetected and untreated, and the cat continues to eliminate inappropriately, it is possible for such behavior to become habitual. When this occurs, behavioral modiﬁcations become necessary and the veterinarian may decide that behavioral modiﬁcation drugs are needed after the illness has been detected.4

Patient History Is Key A number of conditions — urinary tract disease, diabetes, renal insufﬁciencies, irritable bowel disease, constipation, and colitis — can contribute to inappropriate elimination of both urine and feces. A thorough patient history is an important component in helping a veterinarian determine whether a medical condition is the cause of inappropriate elimination (for a sample list of history questions, visit www.VetTechJournal.com). When taking a patient history, the technician should ask owners if they have noticed any of the following: An increase in the cat’s water intake Larger than usual urine clumps in the litterbox Smaller than usual urine clumps in the litterbox The cat frequently entering the litterbox The cat vocalizing in the litterbox The cat straining or staying in the litterbox longer than usual A change in the odor of the urine

ing to urinate, frequent visits to the litterbox, or licking at the urogenital region. Blood in the urine (hematuria) can also be a sign of dysuria. When urination is no longer voluntary, it is classiﬁed as urinary incontinence.5

It is the job of veterinary technicians and technologists to take an accurate and thorough history using both speciﬁc and open-ended questions. Feline Lower Urinary Tract Disease Feline lower urinary tract disease (FLUTD) is very common, especially in indoor cats that eat dry food, live in a multicat household, or are obese.6 Cats with this disease may have urinary tract infections, crystals in their urine, or behavior or neurologic problems. Another form of this disease is idiopathic feline lower urinary tract disease

The technician also should ask about stool: Consistency Amount Color Change in the odor Presence of blood Change in diet or medication

Urinary Tract Disease Urinary tract disease is a common cause of inappropriate elimination in cats. Signs of urinary tract disease include polyuria, anuria, dysuria, hematuria, and urinary incontinence. Frequent urination of normal or large amounts of urine (polyuria) may indicate renal disease, hyperthyroidism, or diabetes.5 Many times owners will notice increased drinking along with polyuria. In the case of anuria, the inability to urinate, the build up of metabolic wastes results in uremic poisoning. Anuria is often seen with a urinary blockage or at end-stage renal disease. Painful or difﬁcult urination (dysuria) is characterized by strainVeterinary Technician | SEPTEMBER 2009

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(iFLUTD), also known as idiopathic cystitis, for which there is no known cause. Some clinical signs owners should watch for are hematuria, polyuria, dysuria, and anuria.5 This condition affects more than 50% of cats 10 years and younger that exhibit these signs.6 Inflammation of the bladder has been shown to contribute to iFLUTD. Unlike an obstructed bladder, which is distended and painful on presentation, the iFLUTD bladder is small because the cat is frequently urinating small amounts. It is still possible for the bladder of a cat with iFLUTD to become obstructed. It has been shown that high stress can bring on a case of iFLUTD in a cat6; therefore, technicians need to educate owners about ways to reduce stress in their cat’s life. A cat with iFLUTD that lives in a multipet household would benefit from access to a low-traffic area that cannot be entered by other pets and children. The cat should have its own food, water, and litterbox, so it does not have to compete or fight with other cats to gain access. Owners need also to spend at least 15 minutes each day with the affected cat because interaction with owners has been shown to decrease stress in cats.7,8 Diet also can be a contributing factor with iFLUTD, and this is another topic technicians need to discuss with owners. Cats with iFLUTD need more water in their diet and benefit from canned food.6 A flowing 30

SEPTEMBER 2009 | Veterinary Technician

pet water fountain also can encourage water consumption in some cats. It is important for technicians to explain to owners that, although the cause of iFLUTD is unknown, treatment options are available.6

Arthritis Arthritis can be a cause of inappropriate elimination. If a cat has problems moving about, it may not want or may not be able to go to the litterbox if it is farther away, up on another piece of furniture, or requires going up or down stairs. The cat may have problems if the litterbox has high sides that prevent the cat from getting in and out of the litterbox easily. Arthritic cats will need several low-sided litterboxes throughout the house. Under-the-bed sweater boxes are inexpensive and work well.5 If arthritis occurs in the lumbar spine, hips, or knees, the cat may experience pain when it positions to urinate or defecate. Because this happens in the litterbox, cats may conclude that getting into the litterbox makes them hurt and, to avoid pain, they avoid the litterbox.

Cognitive Dysfunction As a cat gets older, it may exhibit signs similar to Alzheimer’s disease in humans. This is called cognitive www.VetTechJournal.com

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dysfunction in animals, and there is currently no deﬁnitive diagnostic test for this condition. Cognitive dysfunction may affect elimination if the cat cannot remember where its litterbox is, or it may forget to go to the litterbox. In this case, it is necessary to provide the cat with more litterboxes in different areas of the house, placed near where the cat spends most of its time. Some cats may also need to be taken to the litterbox sporadically throughout the day. Vision may also decrease in elderly cats. A night-light near the litterbox may be helpful.3

Behavioral Causes of Inappropriate Elimination Once medical illness has been ruled out, the next step is to determine the behavioral reasons behind the inappropriate elimination, and there are many. Cats can have problems with types of litter, types of litterboxes, and litterbox locations. Anxiety and stress, as well as age and senility, also can cause inappropriate elimination. New experiences can alter where the cat eliminates.3 Multicat households can be a source of stress or aggression for an individual cat as well.7 Conﬁnement of one or more cats may determine which cat is

the culprit, but it does not address the underlying behavior problems.

Type of Litterbox Cats are very particular by nature, and especially so when it comes to their litterboxes. Cleanliness is of utmost importance. Litterboxes need to be scooped at least daily if using a clumping litter, and the litter should be replaced at least once a month. Nonclumping litter should be changed no less than 2 times a week. At the time of litter change, the litterboxes need to be washed with a mild soap and water, or just water. Harsh chemicals or disinfectants should not be used because those strong odors can cause the cat to avoid the litterbox.3 In a multicat household, there should be at least one litterbox for each cat, plus one. Size also matters. The box should be large enough for the cat to turn around in comfortably, approximately 1.5 times the length of the cat, from the tip of the nose to the base of the tail. Many commercial litterboxes are not large enough. Large plastic storage containers, such as under-the-bed sweater boxes, work well. Keep in mind that elderly cats and

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kittens may have trouble with litterboxes with high sides. The sweater boxes also work well for these cats. Covered litterboxes are often purchased because they help decrease the spread of litter and odor, but they are not always considered cat friendly. Strong odor can build up within the enclosure and act as a deterrent to the cat. In a multipet household, covered litterboxes also create an environment where one cat or dog can trap the other cat inside the litterbox. If a covered litterbox is used, it should have two entrances. If a litterbox is being created by using a plastic container and it still needs to be covered, cardboard boxes make adequate covers.1

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Location of Litterbox Litterbox location also is very important. The location of the litterbox must be appropriate for the cat from its point of view. A cat will need its litterbox in a private, but conveniently located area.9 A litterbox that is in the basement, next to the furnace or washer/dryer, or on cold ﬂooring is not desirable for most cats. A litterbox in the basement may be too far to travel for kittens or elderly cats. Also, if the litterbox is next to the furnace or washer/dryer and the appliance starts while the cat is urinating or defecating, the noise may frighten the cat and it will not want to return to that litterbox. In multicat households, the litterboxes need to be spread around the house and not contained in a central location. This will prevent a dominant cat from patrolling the litterbox area and attacking any of the other cats that may try to use it.1

Type of Litter The type of litter used can deter a cat from using the litterbox. Determining the right kind of litter depends on the cat. Most cats prefer a ﬁne-grain, clumping, unscented cat litter. Clumping litter helps to decrease the odor and if scooped daily, provides the cat with the cleanliness it desires. Because a cat’s sense of smell is much stronger than that of humans, it can be put off by scented litters or nearby air fresheners. Some cats prefer materials for litter that owners usually would not consider using: potting soil, sand, leaves, and carpet squares. Once a litter material is found that the cat seems to accept, it is best to stay with it.9

Vetstreet uses the latest technology to help you bridge the gap between client and practice. Now you can: • Provide private pet health websites for every client • Increase compliance through automated services • Create a competitive online store • Educate your clients at their convenience—and yours

Controlling Pain and Stress Technicians also need to consider what to do when a cat starts to behave inappropriately. Recently declawed, neutered, or spayed cats may experience pain while in the litterbox and learn to associate that pain with the litterbox. In this case, the pain needs to be controlled ﬁrst. If eliminating the pain does not work, then a new litterbox might need to be purchased and placed in a new location.1 Anxiety and stress can also cause inappropriate eliminawww.VetTechJournal.com Veterinary Technician | SEPTEMBER 2009

Visit Vetstreet.com to learn more and sign up for a FREE webinar. Veterinary Technician | SEPTEMBER 2009

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nicians, so the questions the technicians ask may determine whether or not a cat is euthanized or surrendered. Technicians need to encourage owners and give them hope. It also is the job of the veterinary professional to be an advocate for the pet. The bond between the pet and owner is strong and, if broken, is difﬁcult to repair. The stronger the attachment between owner and pet, the more likely the

Anxiety and stress can also cause inappropriate elimination. owner will try to understand and work to resolve the cause of the inappropriate elimination. Likewise, the more owners are educated on the causes of inappropriate elimination, the more understanding they may have of the problem and the better the cat’s chances are of getting treatment. There is a cause — or several causes — for inappropriate elimination, and with a thorough history and proper diagnostics, veterinary technicians can help resolve the source of the problem. VT

References

tion. A recent move, a new baby, a new pet, and visitors can all be stressors. Even holiday decorations can be upsetting to a cat. In these cases, veterinarians might decide to use anxiolytic drugs, such as buspirone or amitriptyline. A cat should never be punished when it eliminates inappropriately, as this will only cause fear and anxiety and make the situation worse. An enzymatic cleaner can be used to clean the soiled areas to prevent the cat from returning to that area.5

The Technician’s Role It is the job of veterinary technicians and technologists to take an accurate and thorough history, using both speciﬁc and open-ended questions. A client may often overlook inappropriate elimination for months or even years. The sooner inappropriate elimination is identiﬁed and dealt with, the better chance the cat has to resolve any problems it may be having.4 Owners are often more comfortable talking to veterinary tech34

SEPTEMBER 2009 | Veterinary Technician

1. Crowell-Davis SL. The litterbox blues. Compend Contin Educ Vet 2007;29:34-37. 2. Peterson N. All things considered: “educating cat owners.” Veterinary Technician 2006;27(11):702-708. 3. Crowell-Davis SL. Cognitive dysfunction in senior pets. Compend Contin Educ Vet 2008;30:106-110. 4. McCurnin DM, Bassert JM. Clinical Textbook for Veterinary Technicians, ed 6. St Louis: Elsevier; 2006:409,412-416. 5. Eldredge DM, Carlson DG, Carlson LD, Gifﬁn JM. Cat Owner’s Home Veterinary Handbook. ed 3. Hoboken, NJ: Wiley Publishing; 2007:371,381,539. 6. Swann T. Nonobstructive idiopathic feline lower urinary tract disease. Veterinary Technician 2008;29(7):401-408. 7. Turner DC. The human–cat relationship In: Bateson P, ed. The Domestic Cat—The Biology of Its Behavior, ed 2. Cambridge University Press; 2004:194-206. 8. Curtis TM. Preventing behavior problems in cats. Compend Contin Educ Vet. 2006;28(2):119-134. 9. Catanzaro TE. Promoting the Human-Animal Bond in Veterinary Practice. Ames, IA: Iowa State University Press; 2001.

ABOUT THE AUTHOR

Jennifer Dwiggins, BS, RVT Jennifer received both an associate’s and a bachelor’s degree of science from Purdue University, West Lafayette, Ind., and has been an RVT since 2007. She is currently the head technician at Pets and Vets as Partners, a small animal practice in West Lafayette. She is pictured here with her adopted cat Oliver, who was surrendered by his previous owner for inappropriate elimination. Jennifer also has four other cats and two guinea pigs. www.VetTechJournal.com

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CE Article #1

– Emesis Is It for Your Patient? R

apid induction of emesis may be the best method of limiting absorption and preventing continued exposure in potentially harmful or life-threatening ingestion situations. Veterinary staff need to respond quickly in these situations and be able to evaluate and recognize instances where induction of emesis may be contraindicated or pose additional health concerns to the animal, staff, and owners. This article is a primer on what concerns need to be evaluated before reaching for an emetic agent.

Jo Marshall, CVT

Breed and Species Concerns Most cats, dogs, ferrets, and potbelly pigs can be safely induced to vomit.1,2 Brachycephalic breeds that may have anatomical concerns, such as an elongated soft palate, are candidates for sedation and gastric lavage rather than emesis. Rabbits, ruminants (e.g., sheep, cattle, llamas, goats), horses, and birds cannot safely have emesis induced, and rodents (e.g., chinchillas, rats, gerbils) are anatomically unable to vomit.3

Risk vs. Benefit

SEPTEMBER 2009 | Veterinary Technician

What Was Ingested Caustic or corrosive substances such as undiluted drain cleaners, toilet bowl cleaners, hydrochloric acid, concentrated sodium hypochlorite, and lye products can result in further burns and corrosive injury to the stomach, esophagus, and mouth when vomiting occurs after ingestion. Gastric lavage also is contraindicated in these ingestions because of the increased risk of perforation to the already damaged and weakened digestive tract. Keep in mind that if damage occurred going down, it will occur on the way back up. When ingested, fragrance oils and liquid potpourri can cause burns to the oral cavity, pharynx, and esophagus. Fragrance oils are cationic detergents in various concentrations. The more concentrated the product, the greater the burns and corrosive damage. Burns can be seen with concentrations of 7.5% and higher, but with cats, concentrations as low as 2% have resulted in corrosive ulcerations.4 Pets can walk through spilled fragrance oil, getting it on their feet and hair. These instances of dermal exposure quickly become oral exposures as the animal begins to self groom to remove the oily substance. Cats tend to be at the greatest risk for exposure to these products. Many of the essential oil products contain terpenes. Once absorbed, terpenes are metabolized in the liver by glucuronidation. Cats are unable to eliminate compounds through glucuronidation because they lack the glucuronyl transferase enzyme.2

When ingested, fragrance oils and liquid potpourri can cause burns to the oral cavity, pharynx, and esophagus.

Does the risk of inducing emesis outweigh the beneﬁts? Inducing emesis can result in the aspiration of gastric content and potential injury to the stomach and esophagus. If the ingested substance poses in minimal to no risk when left to pass through the digestive tract, the beneﬁt of inducing emesis would be limited and, therefore, not recommended. Altered mentation or underlying medical conditions may prevent safe induction of emesis. Animals that are unconscious, seizing, or laterally recumbent pose a greatly increased risk of aspiration with emesis. Animals in a state of agitation or extreme excitability can become further stimulated when attempts are made to induce emesis, and this may potentiate seizures. Animals with underlying medical conditions or seizure history require careful evaluation of the risk associated with exacerbation and worsening preexisting concerns with 36

induced emesis. Patients that are already vomiting should never be given an emetic agent without veterinary guidance.

Contraindications to Emesis Induction Hydrocarbons and petroleum distillates, such as gasoline, mineral spirits, and furniture polish oils, are of products that can pose an aspiration risk when ingested. The very thin viscosity of this type of liquid enables them to be easily aspirated when a patient vomits. The aspiration risk outweighs the beneﬁts of emesis and, therefore, emesis is not recommended. www.VetTechJournal.com

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Zinc, calcium, and aluminum phosphides are the active ingredients in many of the commercially available mole and gopher baits. Induction of emesis needs to occur quickly because of the rapid onset of symptoms. Ingestion of phosphides produces a toxic phosphine gas in the moist, acid environment of the stomach.1 Phosphine gas exposure poses significant health risks for staff and owners. Dogs being transported to the clinic after ingestion of this rodenticide often vomit in the car and owners may be exposed to the gas. Owners should be advised to transport their pet in a ventilated car after administration of an aluminum hydroxide or calcium carbonate antacid preparation.1 Induction of emesis and a physical examination need to be performed in a well ventilated area or outdoors to prevent inhalation of phosphine gas by staff. Vomitus generally has a telltale garlic or rotten fish odor to it. Xylitol is a sweetener frequently used in low-sugar or no-sugar products and may be used in combination with aspartame or other sugar/alcohols. Common products that contain xylitol are sugar-free gums, sugar-free mints and numerous dental hygiene products. Xylitol ingestions in dogs need to have emesis immediately induced because of the rapid onset of signs. Dogs ingesting concentrated xylitolcontaining products experience a rapid rise in serum insulin levels and subsequent drop in blood glucose. This drop in blood glucose is dose-dependent and may occur within 15 minutes of ingestion. Clinical signs often occur very quickly and include vomiting, diarrhea, lethargy, ataxia and seizures as well as potential long-term effects on the liver. Pharmaceutical ingestions (especially ingestions of large quantities of medications) that do or do not have typical veterinary use, can result in significant, rapidly occurring life-threatening signs. Examples of these signs are central nervous system (CNS) excitability, changes in blood pressure and heart rate, respiratory depression, sedation, and seizure activity. Many of the pharmaceutical ingestions need to have emesis induced within 10 minutes to prevent significant signs from occurring simultaneously with vomiting. After an emetic agent has been administered, there is generally a 10 to 15 minute period before emesis is actually achieved, and the status of the patient may rapidly deteriorate during that time.

Considerations in Choosing an Emetic Agent The list of methods used to induce emesis in animals is broad and varying. Many home remedies are used without success and have the potential of causing further concerns. Emetics can work by causing local gastric irritation, stimulation of the CNS or a combination of irritation and CNS stimulation.5 Regardless of the emetic used, all work best if www.VetTechJournal.com

Glossary Antiemetic — a medication given to prevent or stop vomiting Aspiration — the act of breathing or inhaling a substance into the respiratory tract and lungs Brachycephalic breed — a breed of dog or cat that has a short, pushed-in face and broad head Cationic detergent — a class of detergents that has a positive ionic charge. Concentrations above 7.5% have corrosive potential. Chemoreceptor trigger zone (CRTZ) — area of the brain located in the medulla oblongata that both initiates and controls the act of vomiting Contraindicated — a condition or factor that increases the risks involved when using a drug or a medical procedure Corrosive — a substance that will damage or destroy tissue with contact Emesis — the act of vomiting Emetic agent — a drug, product or object used to induce emesis Glucuronidation — process of metabolism of drugs, pollutants and hormones that occurs in the liver. Process renders the substance more water soluble to allow elimination from the body in urine. Glucuronyl transferase — the enzyme responsible for glucuronidation Hydrocarbon — organic compound consisting entirely of hydrogen and carbon. Generally have very low viscosity properties Hypernatremia — excessively high sodium level. Pharmaceutical — a substance designed or intended for use in the diagnosis, treatment or prevention of disease Phosphine gas — a highly toxic, colorless gas produced by the chemical reaction that occurs when phosphides come into contact with moisture. Gas production is enhanced in the acidity of the stomach. Phosphine gas affects lungs, brain, kidneys, heart, and liver. Xylitol — a non-sugar sweetener frequently added to sugarless gums, mints and dental products. It is highly toxic to dogs.

Veterinary Technician | SEPTEMBER 2009

CE Article #1

there is food in the patient’s stomach. If the animal has not eaten within the last 2 hours, a small snack is recommended before administration of the emetic agent.2 Emetic agents often are not effective if an antiemetic (e.g., ondansetron) has been previously administered. Methods that are not recommended to induce emesis include digital induction of emesis, syrup of ipecac, liquid soaps, dry mustard powders, and salt. Digital induction of emesis or forcing a foreign object down a pet’s throat often results in physical injury to the throat and soft palate, and a high likelihood of the individual being bitten in the process. Historically, syrup of ipecac has been recommended for use in rapid induction of emesis. However, its cardiotoxic potential and tendency to result in prolonged vomiting, lethargy and diarrhea, have caused syrup of ipecac to fall out of favor in routine management of poisoned patients.7,8 Soaps, mustard powders, and table salt are not reliable as induction agents and in addition, salt may result in hypernatremia in the patient.

Hydrogen peroxide solutions with concentrations of greater than 3% have the potential of being corrosive to the gastrointestinal mucosa and should never be used. Recommended emetic agents include hydrogen peroxide, apomorphine hydrochloride and xylazine hydrochloride.4 Hydrogen peroxide (H2O2) works by local irritation of the oropharynx and gastric lining, which results in a gag reﬂex. It is usually recommended for oral administration by the pet owner when timely transportation to a veterinary clinic is not possible. A 3% hydrogen peroxide solution is recommended. It is dosed at a rate of 1–5 ml/kg and is administered orally. The maximum dose should not exceed 10 ml for a cat and 50 ml for a dog.6 Use of hydrogen peroxide from an unopened bottle is recommended. Hydrogen peroxide deteriorates after it has been opened and can lose efﬁcacy as an emetic over time. Once H2O2 is administered, the pet should be gently walked. If emesis does not occur within a 10 to 15 minute time frame, the dose may be repeated once. Adverse effects associated with the use of H2O2 as an emetic agent include irritation to gastrointestinal tract, gastric dilatation-volvulus in dogs, and aspiration risk. 38

SEPTEMBER 2009 | Veterinary Technician

Hydrogen peroxide solutions with concentrations of greater than 3% have the potential of being corrosive to the gastrointestinal mucosa and should never be used. Cats have reportedly developed gastrointestinal ulcerations with administration of 3% concentrations and judicious use, if at all, of H2O2 is recommended in cats. Apomorphine hydrochloride is a centrally acting emetic agent and in many circumstances is considered the emetic agent of choice for dogs in a clinical setting. Administration results in stimulation of the chemoreceptor trigger zone, quickly followed by emesis. Apomorphine may be administered IV, IM or subconjunctivally. Dosing for IV administration is 0.03–0.04 mg/kg, for IM administration is 0.04–0.08 mg/kg and subconjunctival dosing is 0.25 mg/ kg.6 When using apomorphine tablets for subconjunctival administration, tablets or portions of the tablet are crushed and added to a few drops of water in a syringe. This solution is then instilled directly into the conjuctival sac. Once emesis is achieved, the conjunctival sac should be flushed well with water or saline to remove apomorphine residue. Adverse effects associated with apomorphine administration are prolonged emesis and ocular irritation. These may be limited with subconjunctival administration and subsequent flushing of the conjunctival sac. Overdose of the drug results in prolonged emesis, respiratory and cardiac depression, CNS depression or excitement. Reversal of CNS and respiratory concerns may be done with naloxone, but reversal will not have an effect on prolonged emesis.6 Apomorphine should not be used with ingestions of medications that result in compounding of respiratory or CNS depression symptoms or with antidopaminergic drugs that prevent emesis from occurring. Apomorphine hydrochloride has at times been difficult to obtain but can generally be obtained from compounding pharmacies. Xylazine hydrochloride is a reliable, centrally acting emetic agent used primarily in cats. A dose of 0.44 mg/kg is administered intramuscularly to cats with anticipated emesis occurring in 3 to 5 minutes.6 Xylazine does not reliably produce an emetic response when used in dogs. Adverse effects associated with xylazine use include bradycardia, sedation, tremors, and respiratory depression. Overdoses of xylazine result in hypotension, cardiac arrhythmias, respiratory depression, and CNS depression. Clinical signs can be reversed with yohimbine or atipamezole.6 Xylazine hydrochloride should not be used in cats that have ingested medications or products that may result in compounding of bradycardia, respiratory depression, sedation, or CNS depression symptoms. Induction of emesis can be a valuable tool in limiting and preventing continued exposure to ingestion of potentially harmful substances. However, emesis needs to be perwww.VetTechJournal.com

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formed only after a thorough physical evaluation of the pet and appropriate evaluation of time of exposure and potential risks involved are considered. Once this evaluation has been completed, the veterinary team can conﬁdently move forward with the safest course of treatment and potential decontamination method. Pet Poison Helpline (PPH) is an animal poison control center that provides treatment advice and recommendations relating to exposures to potential dangerous plants, products, medications, and substances, to veterinarians, veterinary staff and pet owners 24 hours a day, 7 days a week. There is a $35.00 per case consultation fee. PPH is located in Bloomington, Minn. The PPH number is 800-213-6680. For further information regarding services, visit the PPH website at www.petpoisonhelpline.com. VT

References 1. Pet Poison Helpline Case Database: Unpublished data, Bloomington, MN, 2004 – 2009. 2. Gupta R. Veterinary Toxicology, Basic and Clinical Principles. New York: Elsevier;2007. 3. Bihun C, Bauck L. Basic anatomy, physiology, husbandry, and clinical techniques. In: Quesenberry K, Carpenter JW, eds. Ferrets, Rabbits, and Rodents, ed 2. St Louis: Saunders; 2004:289-290. 4. Plumlee KH. Clinical Veterinary Toxicology, St Louis: Mosby, 2004. 5. Battaglia, AM. Small Animal Emergency and Critical Care for Veterinary Technicians, ed 2. St Louis, MO, Saunders, 2007, pp 356-367. 6. Plumb, DC. Plumb’s Veterinary Drug Handbook, ed 6. Ames, IA, Blackwell Publishing, 2008. 7. Rosendale, ME. Decontamination Strategies, in: Poppenga RH, Volmer PA, eds. The Veterinary Clinics of North America, Philadelphia: WB Saunders Co, 2002; 311-316. 8. Krenzelok EP, Vale JA. Gastrointestinal Decontamination, in Brent J, Wallace KL, et al, eds. Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient, Philadelphia: Elsevier Mosby, 2005; 53-59.

Acknowledgments: The author wishes to thank Lynn Hovda, RPh, DVM, MS, DACVIM, Director of Veterinary Services at Pet Poison Helpline, for her input and review of this article and Justine Lee, DVM, DACVECC, for her editing expertise and input.

ABOUT THE AUTHOR

Jo Marshall, CVT Jo works at the Pet Poison Helpline in Bloomington, Minn. Her professional interests include toxicology and emergency and critical care along with animal behavior and training.

Clinical Expertise at Your Fingertips Your most comprehensive source for trusted information, including: Web-exclusive content, including video Tech Tips and downloadable forms and handouts FREE accredited CE, available when yyou ou aaree Thousands of journal articles State and national news TechTalk E-Newsletter Discussion Board Classified ads

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. When a pet has ingested a potentially dangerous substance, the goal of inducing emesis is to a. give the owner something to do. b. prevent further ingestion. c. limit absorption and prevent continued exposure. d. hospitalize the pet. 2. A patient should not be induced to vomit if the a. patient is already vomiting. b. patient is a rat. c. patient is unconscious. d. all of the above. 3. Ingestion of a corrosive product can result in a. tissue burns and necrosis. b. constipation. c. the inability to vomit. d. minimal concerns. 4. Cats are more sensitive to ingestions of liquid potpourri because a. they are unable to metabolize and eliminate essential oils containing terpenes. b. they lack the glucuronyl transferase enzyme. c. they encounter these products more frequently than dogs. d. both a and b. 5. Phosphine gas forms rapidly when zinc, calcium, or aluminum phosphides are ingested and a. combine with the moisture and acid in the stomach. b. the pet is induced to vomit. c. the pet is administered an antacid product. d. both a and c.

6. Recommended emetic agents include a. salt, syrup of ipecac and 7% hydrogen peroxide. b. 3% Hydrogen peroxide, apomorphine hydrochloride and xylazine. c. hydrogen peroxide, salt and apomorphine hydrochloride. d. apomorphine hydrochloride, xylazine and syrup of ipecac. 7. The chemoreceptor trigger zone is a. the act of initiating vomiting. b. the CNS control center that regulates emesis. c. an area of the liver. d. located in the kidney. 8. Flushing the conjunctival sac after use of apomorphine hydrochloride is recommended to a. lubricate the eye. b. prevent ocular irritation. c. prevent protracted emesis. d. Both b and c. 9. To induce emesis in cats, xylazine HCL is administered a. IM. b. subconjunctivally. c. SQ. d. IV. 10. All emetic agents work best when a. the animal has an empty stomach. b. a small meal has been offered and administering ondansetron. c. no antiemetic has been administered and a small snack has been fed recently. d. the animal has been given ondansetron.

Take this CE test for FREE! Go to www.VetTechJournal.com. 40

SEPTEMBER 2009 | Veterinary Technician

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ManagementMatters

New

Sheriff in Town T

here are two types of new managers: those who are new to the team, and those who are part of the team but new to management. Both types of managers face unique challenges, and each one will have to earn his or her title.

Katherine Dobbs, RVT, CVPM, PHR

New to the Team Even if you have management experience, you may not have experience with this particular team, so it is important to forget what you think you know and learn about your new team. Managers and staff need to earn each other’s respect, and this requires one-on-one interaction. Before diving head ﬁrst into the fray — and certainly before suggesting any changes — get to know each person by arranging individual meetings.

Getting To Know You What are three things you like about working here?

Ask each person some revealing questions (See Getting To Know You), then share a little about yourself, allowing them to ask questions as well. This small investment of your time can help you begin to form bonds, and the answers you uncover will help prioritize needed changes in the practice. Realize that the team will be more impressed with your concerns and less impressed with your credentials or experience. If you also happen to be new to veterinary medicine or that particular type of practice, you’ll need to spend some time learning about the facility’s operations. Put on some scrubs and dive in alongside the team to observe and ask questions, if appropriate. Give equal time to all areas of the practice. People want to know that their boss understands the job they do, so get on the ﬂoor and learn.

The days of being

“one of the gang” are gone and friendships may need to be adjusted.

What would you change if you could? What are three things you do well? What part of the job would you like to learn next? What are some qualities that are important to you in a manager? Are there any other positions within the practice that you would enjoy? Is there anything about me you would like to know?

SEPTEMBER 2009 | Veterinary Technician

New to Management Even if you know your team, pinning a sheriff’s star on your chest will change things — for you and them. Whether you are being promoted to the management position or taking on a supervisory role, it can be a difﬁcult transition. The days of being “one of the gang” are gone and friendships may need to be adjusted. You can remain friends with people you supervise as long as you recognize the new boundaries. Being on the management team requires you to be impartial and objective — there is no room for playing favorites. The goal is not to be liked; the goal is to be respected. That respect can be earned when you demonstrate that you can be a fair, consistent and supportive boss. There are continuing education courses that focus on practice management, and having an experienced mentor can be key to www.VetTechJournal.com

ManagementMatters

If a coworker is now suddenly your boss, it is important to realize that he or she has chosen to make this big career move, and your best response is to be supportive.

your success. Invest time and energy to learn how to be a good manager, and through your contributions you can make your practice more successful.

The Team’s Perspective If you are on a team with a new manager, you may feel skeptical — particularly if you had issues with the previous manager. It is important to give the new manager a chance, or at least the beneﬁt of the doubt. Be open and honest with your communication. Speak with him or her often, but not about him or her to other teammates. After all, this new person may help you reach your career potential. If a coworker is now suddenly your boss, it is important to realize that he or she has chosen to make this big career move, and your best response is to be supportive. If you feel annoyed, perhaps you need to examine why. Is this a position you wanted but perhaps lacked the experience or motivation to pursue? It is likely that other opportunities can be found or created in the future. Do not begrudge someone else for making the move. In the end, everyone should focus on the goals of the VT practice, and what is best for the entire team.

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.

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Contact Trish O’Brien at vettech@rja-ads.com or call 800-237-9851, ext. 237 Veterinary Veterinary Technician Technician | SEPTEMBER | AUGUST 2009 45

ClassiﬁedAdvertising TECHNICIANS WANTED

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CALIFORNIA – Opening for a registered veterinary technician in El Centro, California. The applicant must have a current California license and should be bi-lingual (Spanish). Fax resume to: 760-353-6451.

PENNSYLVANIA – Busy companion animal practice 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.

FLORIDA 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 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.

SEPTEMBER 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.

PENNSYLVANIA Gwynedd Veterinary Hospital and Emergency Service is a busy 24-hour medical care and referral facility with a 16-doctor and 30-technician team providing comprehensive care and ER services, located 45 minutes northwest of Philadelphia. We have two board-certified specialists on our staff who regularly perform endoscopy, ultrasound, and orthopedic surgery. Our clients appreciate the excellent patient care delivery that we offer, including digital radiography, in-house coagulation testing, multilumen catheterization, capnography, and TPN. Salary is commensurate with experience. Your colleagues are talented and focused on quality patient care using the latest techniques and medications. We offer a flexible schedule and excellent benefits. Please fax resume to 215-699-7754, Attn: Cindy Lorenz. Email: gwyneddvethosp@comcast.net. Visit our website at www.gwyneddvethospital.com.

TENNESSEE – Nashville Humane Association located in Nashville, Tennessee is hiring a full-time, licensed technician to work on ROVER our mobile spay/neuter clinic. We are looking for a LVT who can provide the highest quality of care to our surgical patients while providing exceptional client service. NHA offers a competitive compensation package, including paid health insurance, vision plan, simple IRA with company contribution, vacation and personal days, paid CE classes, and much more. Only Certiﬁed LVT or RVT need apply. If interested please send resume to jbeach@nashvillehumane.org or fax to 615-352-4111.

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.

For classified advertising information, email

vettech@rja-ads.com

Position to fill? Service to promote? Call C ll your classifi l ified d advertising d ti i representative today!

Contact Trish O’Brien to place your ad today. Call 800-237-9851, ext. 237 or email vettech@rja-ads.com. www.VetTechJournal.com

ClassiﬁedAdvertising TECHNICIANS WANTED 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

The Complete Journal for the Veterinary Health Care Team

VIRGINIA – Part-time/full-time LVT wanted. We are looking for a full-time or part-time licensed veterinary technician to join our growing AAHA practice. We are a four doctor, two LVT practice with great clients and a welltrained, highly committed staff. Your duties will include providing nursing care, taking radiographs, dentals, monitoring anesthesia and assisting in surgeries. You will also be responsible for collecting and processing laboratory specimens and giving routine vaccines. We offer highly competitive beneﬁts including paid vacation, continuing education and insurance. Salary will be commensurate with your skills and experience, and new graduates are welcome. Please contact Sherry Meier, Ofﬁce Manager, at Independent Hill Veterinary Clinic, 13444 Dumfries Road, Manassas, VA 20112, 703-791-2083, or via email: kirby13444@aol.com. (Your best bet is to call.)

CONTINUING EDUCATION

Mid-South Regional Conference

HAVE YOU HEARD THE NEWS?

November 13, 14, 15, 2009 Harrah’s Casino and Convention Center (formerly the Grand Casino and Convention Center) Tunica, Mississippi. Conference will feature topics on Ophthalmology, Dermatology, Oncology, Orthopedics, Infectious Diseases and Immunology, Spay/Neuter Techniques, Practice Management and VLE principals. Technician Track, November 14, 2009 Physical Therapy/Rehab, Emergency/Critical Care, Spay/Neuter & Shelter Med Topics, Parasitology. For more information and registration form, contact: Lee Hughes, Executive Director Memphis/Shelby County Veterinary Medical Association 901-754-1615 Lmhughes@bellsouth.net

For classified advertising information, email vettech@rja-ads.com. www.VetTechJournal.com

Veterinary Technician Market Showcase and Classified Advertising sections deliver your product, service or opportunity to thousands of potential buyers and responders each issue. Every ad is also featured on vetclassifieds.com for even greater marketing exposure. Contact Trish O'Brien to create a marketing plan or to schedule your classified ad – we are here to assist! Call: 800-237-9851, ext. 237 or e-mail: vettech@rja-ads.com

Veterinary Technician | SEPTEMBER 2009 47

FinalView

Mystery Growths Submitted by Emily Schreib, LVT, Walworth Animal Hospital, Walworth, N.Y.

aintball, a 6-year-old, spayed domestic shorthair, was brought to our clinic for a second opinion. On presentation, Paintball was breathing like a brachycephalic dog and had odd growths on her face, but was otherwise healthy. The growths appeared when Paintball was about 1 year old. A FeLV/FIV test came back negative. The growths had spread along the ears and on the inside and outside of the nose and appeared to occlude the nares. The gingival tissue also contained lesions and growths, but they did not prohibit her from eating. Biopsies were taken of the ear, nostril and gingival tissue. The results showed melanocytomas with osseous metaplasia. This interested the pathologist, who had not seen this osseous metaplasia in cats before. The case was referred to the oncology department at the Cornell University College of Veterinary Medicine, where the results were conﬁrmed. No similar cases were found. Other than sounding like a pug and the gremlin-like appearance she sports, Paintball continues to live a VT happy life!

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

SEPTEMBER 2009 | Veterinary Technician

www.VetTechJournal.com

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When it comes to protecting g their best friends from harmful parasites, your clientts rely on your expertise as a veterinary technician. Recommend K9 Advantix ®. K9 Advantix ® protects dogs mo ore than Frontline® Plus by repelling and killing ticks, ﬂea as and mosquitoes. It also repels biting ﬂ ies and kills lice.

K9 Advantix is for use on dogs only. © 2009 Bayer HealthCare LLC, Animal Health Division, Shawnee Mission, Kansas 66201 Bayer, the Bayer Cross and K9 Advantix are registered trademarks of Baye ayerr. aye Frontline is a registered trademark of Merial.

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