Veterinary Technician | October 2009 by davidpsu

The Complete Journal for the Veterinary Health Care Team

Vol. 30 No. 10 | October 2009

CE Credit from Alfred State College, SUNY

Best You Can Be

A Talk with Heidi Reuss-Lamky, LVT, VTS (Anesthesia)

ALI & ARDS A To Extract or Not to Extract? Correction of a PDA Golden Ophthalmic Rules Visit us at www.VetTechJournal.com

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Editor’sLetter

The Complete Journal for the Veterinary Health Care Team

Remembering the Past

October 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 Christine Polcino, Traffic Manager 267-685-2419 | cpolcino@vetlearn.com CUSTOMER SERVICE 800-426-9119, option 2 | info@vetlearn.com PUBLISHED BY

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

Our Mission VETERINARY TECHNICIAN is designed to support and actively promote the professional status and value of veterinary technicians and assistants in their own eyes, in the eyes of their colleagues and employers, and within veterinary medicine as a whole. Indexing: VETERINARY TECHNICIAN ® is included in the international indexing coverage of Index Veterinarius (CAB International), Focus On: Veterinary Science and Medicine (ISI), SciSearch (ISI), and Research Alert (ISI). Article retrieval systems include The Genuine Article (ISI) and The Copyright Clearance Center, Inc. Yearly author and subject indexes for VETERINARY TECHNICIAN are published in December on our website.

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Raise your hand if you remember administering Biotal as an induction agent. As I was looking through the articles in this month’s issue, I was reminded of my first solo anesthesia induction, maintenance, and monitoring. The patient was a less-than-friendly schnauzer who bit me as I administered her premedications. We had high school students to help with the kennel and serve as assistants, but rowdy dog restraint was not one of their strong suits. At the time, our clinic was considered progressive because we used butterfly catheters to administer the Biotal. We would then flush the line, cap it, and tape it to the patient’s leg—no fluids were administered unless there was sufficient blood loss. We used red rubber endotracheal tubes and had to blow air through them to make sure we didn’t miss a wayward mucus plug during cleaning. After the patient made it to the surgery table, there was no perioperative monitoring. If your clinic was lucky, you had an esophageal monitor. For those of you too young to remember, an esophageal monitor is an esophageal stethoscope attached to a speaker. You could hear the heartbeat and lung sounds from the next room as you got the next patient ready. Just for the record, they are still available, relatively cheap, and I continue to love them. There was also no postoperative pain regimen. The thought at the time was that the animal needed to feel a little pain so it wouldn’t move around and tear out its sutures, causing more damage. Please forgive me, but I did repeat that line of reasoning more than once. Now, we embrace balanced anesthesia and preemptive pain management. We routinely monitor blood pressure, pulse oximetry, capnography, blood gas, and more, and our endotracheal tubes are blissfully clear. The skill set for veterinary technicians has grown exponentially in the past 25 years—we can even specialize in anesthesia and learn the finer points of the field to keep our patients safe. As someone who has been through some of the technologically limited times, I often wonder where we will be and what we will be able to do in another 25 years!

Glenn Triest

Vol. 30 No. 10

Marianne Tear, MS, LVT Editor in Chief

Veterinary Technician hopes you had a wonderful National Veterinary Technician Week! Veterinary Technician | OCTOBER 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.

Glenn Triest

EDITOR IN CHIEF

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, MI

Andrea Battaglia, LVT Cornell University

Tracy Blais, BS, CVT, MEd

SECTION EDITORS

Mount Ida College

BEHAVIOR Julie Shaw, RVT

David Bolette, RVT, LATg 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, CO

Elizabeth Davis, DVM, PhD, DACVIM

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

Kansas 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, WI

Jeanne R. Perrone

Tara Lang, BS, RVT Critter Communications, LLC Cape Girardeau, MO

Donna Letavish, CVT Michigan State University

Heidi Lobprise, DVM, DAVDC

Julie Shaw

Alfred State College (CE Accreditation)

Melvin C. Chambliss, DVM Program Director

Douglas J. Pierson, VMD, MPS 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, MA

Nancy Shaffran, CVT, VTS (ECC) Margi Sirois, EdD, MS, RVT Penn Foster College

P. Alleice Summers, MS, DVM Cedar Valley College

Marianne Tear Ann Wortinger

Peter Olson

Pfizer Animal Health

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

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.

OCTOBER 2009 | Veterinary Technician

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B:8.25” T:8” S:7”

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K9 Advantix® is for use on dogs only. © 2009 Bayer HealthCare LLC, Animal Health Division, Shawnee Mission, Kansas 66201. Bayer, the Bayer Cross, K9 Advantix and Advantage are registered trademarks of Bayer.

Job #: 1227-38194 Size: 2 Publications:

Version: A Veterinary Technician 10/1/09 IO#11164

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Trim Size:

8” x 10.75”

Studio Artist:

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Bleed Size:

8.25” x 11”

Art Director:

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New packaging for Advantage® Topical Solution and K9 Advantix® will arrive in clinics this fall! New packaging features will make it easy for you to educate your clients.

Contents

The Complete Journal for the Veterinary Health Care Team

October 2009

Volume 30, Issue 10

Best You Can Be Heidi Reuss-Lamky, LVT, VTS (Anesthesia), enjoys days full of twists, turns, and challenging cases in her position at a specialty hospital. Read about her passion for anesthesia and how she stays sharp in the ever-changing landscape of veterinary technology.

10 COLUMNS 22 Dental Checkup To Extract or Not to Extract? Annie Mills, LVT, VTS (Dentistry)

CE ARTICLE

Acute Lung Injury & Acute Respiratory Distress Syndrome Amy Breton, CVT, VTS (ECC) Acute respiratory distress syndrome and acute lung injury are two syndromes unique to the respiratory system. Technicians have an important role in alerting veterinarians to any changes in respiratory status. 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.

32 Peer Reviewed Correction of a Canine Left-to-Right Shunting Patent Ductus Arteriosus Connie K. Varnhagen, PhD, RAHT

40 Management Matters Compassion Fatigue: The Cost of Caring Katherine Dobbs, RVT, CVPM, PHR

Tech News Reader Survey: Animals and Responsibilities Contribute to Job Satisfaction ................................................................16 Rabies Cases Among Cats on the Rise ....................................................20 Golden Ophthalmic Rules .....................................................................21

DEPARTMENTS Editor’s Letter ............................................. 1 Editorial Board ........................................... 2 State News ............................................ 6

Final View Shish Kebab

Statement of Ownership ....................... 8

Classiﬁed Advertising ...........................46

October 2009 | Veterinary Technician

Tech Tips ..........................................9, 38 Product Forum .....................................42 Advertisers Index ............................... 43 Market Showcase ..................................45

www.VetTechJournal.com

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Dr. Steve Haskins Dr. Elizabeth Martinez

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

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ALABAMA The Alabama Veterinary Technician Association’s 2009 Fall CE Conference will be held on Nov. 7 at the Jefferson State Community College’s Jefferson Campus. Eight hours of CE will be offered. Tentative topics include dermatology, the future of veterinary technology, client relations, rehabilitation, 3-year rabies vaccine schedule, separation anxiety, and practice law. There will also be an optional dental wet lab, which will include cleaning, charting, and disease recognition. Check-in and on-site registration will begin at 7:30 AM. Program hours will run from 8:00 AM to 5:00 PM, and lunch will be provided. For more information, visit www.alabamavettech.com. VT

CALIFORNIA The CVC Technician Program in San Diego will take place Nov. 7–9 at the San Diego Convention Center. Topics include blood pressure measurement, physical exams, radiography, endoscopy, anesthesia, practice management, and more. For more information, visit www.cvcwest.com. COLORADO The Colorado Association of Certiﬁed Veterinary Technicians (CACVT) offers its appreciation for the efforts of technicians, assistants, client service individuals, and volunteers. CACVT recognizes that the efforts of the entire team provide a wonderful atmosphere for taking care of the animals that affect people’s lives. CACVT asks that technicians pause and recognize all the good work they do. Also, CACVT recently hosted two events. The Spotlight Conference on dentistry and anesthesia was held on Sunday, Oct. 11. On Wednesday, Oct. 14, CACVT was at the Bel-Rea Open House celebrating with the largest technician program in Colorado. Please contact Denise Mikita, MS, CVT, at info@cacvt.com for more information. KANSAS The Kansas Veterinary Technician Association (KVTA) was fortunate to send 6

OCTOBER 2009 | Veterinary Technician

three executive board members to the NAVTA Leadership Conference which was held in conjunction with the CVC in Kansas City. Kara Burns, MS, MEd, LVT; Bridget Keesling, RVT, BS; and Cheryl Hermann, BA, RVT, participated in a motivational speech, “Succeed In the Box, Changing Company Culture,” presented by Rick Grandinetti. The executive board members also discussed association legal issues with John Thomas, PA. As a result, KVTA is now working on incorporating the organization, ﬁling a 501(c)6 with the IRS, and purchasing liability insurance. KVTA would like to thank NAVTA and Hill’s Pet Nutrition for sponsoring this educational and inspiring workshop and Karla Capper, RVT, for setting up and working at the promotional booth. KVTA would also like to congratulate Stephanie Barnhill, MBA, RVT, for appearing on the cover of the August issue of VETERINARY TECHNICIAN. Stephanie has been a member of KVTA for 15 years. Congratulations, Stephanie! NEW MEXICO The New Mexico Registered Veterinary Technician Association (NMRVTA) welcomed eight new technicians who passed the veterinary technician national exam in June. Congratulations to all! The state now has 127 registered veterinary technicians. The association also hosted a Picnic

in the Park for Central New Mexico Community College veterinary technician students. Delicious food and fun were had by all, including four-legged friends. In other news, NMRVTA hosted its annual conference and meeting on Oct. 17, which featured 8 hours of continuing education. Topics included a NAVTA presentation; an AAEVT equine presentation; and a surgery preparation, physical therapy, and oncology speaker, among others. NORTH CAROLINA The 14th Annual North Carolina Veterinary Conference takes place Nov. 6–8 at the Raleigh Convention Center. Technician-speciﬁc topics include communication skills for veterinary technicians, emerging infectious diseases, tick-transmitted infections, pain management, equine emergencies, and more. For registration information, visit www.ncveterinaryconference.com or call 919-513-6259. TEXAS The Texas Association of Registered Veterinary Technicians (TARVT) is currently holding elections for positions on their 2010 executive board. Positions that need to be ﬁlled are vice president, president-elect, secretary, treasurer, and associate representative. For more information, visit the TARVT Web site at www.tarvt.org or contact the election coordinator, Cindy Dittmar, RVT, at cindyd@tarvt.org. VT

Get the Word Out! Do you have state association or other local news to share? Send your state’s goings-on to Allyson Corcoran, editorial assistant, at acorcoran@vetlearn.com. Photos are always welcome and encouraged. www.VetTechJournal.com

Cat owners listen to their cats. Listen to your cat owners. Cats and their owners agree: a topical dewormer beats a pill any day. In fact, nearly 90% of cat owners prefer topical drops to pills or tablets.* So listen to your cat owners. Choose the only feline dewormer that treats and controls roundworms, hookworms and tapeworms with the ease and convenience of a topical application: ProfenderÂŽ Topical Solution. *From a survey of 736 cat owners. Data on file.

Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. Children should not contact application site for twenty-four (24) hours. See Page 8 for Product Information Summary

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STATEMENT OF OWNERSHIP, MANAGEMENT AND CIRCULATION (Required by 39 U.S.C. 3685) 1. Title of Publication: Veterinary Technician, 2. Publication Number: 8750-8990, 3. Date of Filing: October 1, 2009, 4. Frequency of Issue: Monthly, 5. Number of Issues Published Annually: 12, 6. Annual Subscription Price: $49, 7. Complete Mailing Address of Known Ofﬁce of Publication: Veterinary Learning Systems, 780 Township Line Road, Yardley, Bucks County, PA 19067, Contact Person: Christine Polcino, Telephone: 267-6852419, 8. Complete Mailing Address of Headquarters or General Business Ofﬁce of the Publisher: Veterinary Learning Systems, 780 Township Line Road, Yardley, PA 19067, 9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor—Publisher: Derrick Kraemer, Veterinary Learning Systems, 780 Township Line Road, Yardley, PA 19067; Executive Editor: Tracey Giannouris, 780 Township Line Road, Yardley, PA 19067; Managing Editor: Paul Basilio, 780 Township Line Road, Yardley, PA 19067, 10. Owner: Veterinary Learning Systems/MediMedia USA, 780 Township Line Road, Yardley, PA 19067, 11. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or More of Total Amount of Bonds, Mortgages or Other Securities: None, 12. Tax Status – Has Not Changed During Preceding 12 Months, 13. Publication Title – Veterinary Technician, 14. Issue Date for Circulation Data Below: July 2009, 15. Extent and Nature of Circulation—15a. Total Number of Copies (Net Press Run) - Average Number Copies Each Issue During Preceding 12 Months: 33,099, Actual Number Copies of Single Issue Published Nearest to Filing Date: 8,597, 15b(1) Paid/Requested Outside-County Mail Subscriptions Stated on Form 3541 - Average Number Copies Each Issue During Preceding 12 Months: 9,772, Actual Number Copies of Single Issue Published Nearest to Filing Date: 4,024, 15b(3). Sales Through Dealers and Carriers, Street Vendors, Counter Sales, and other Non-USPS Paid Distribution - Average No. Copies Each Issue During Preceding 12 Months: 0, Actual No. Copies of Single Issue Published Nearest to Filing Date: 0, 15c. Total Paid and/or Requested Distribution - Average No. Copies Each Issue During Preceding 12 Months: 9,772, Actual No. Copies of Single Issue Published Nearest to Filing Date: 4,024, 15d(1). Free Distribution by Mail (Samples, Complimentary, and Other Free): OutsideCounty as Stated on Form 3541 - Average No. Copies Each Issue During Preceding 12 Months: 21,131, Actual No. Copies of Single Issue Published Nearest to Filing Date: 3,213, 15d(4). Free or Nominal Rate Distribution Outside the Mail - Average No. Copies Each Issue During Preceding 12 Months: 0, Actual No. Total Copies of Single Issue Published Nearest To Filing Date: 0, 15e. Free Distribution - Average No. Copies Each Issue During Preceding 12 Months: 21,131, Actual No. Copies of Single Issue Published Nearest to Filing Date: 3,213, 15f. Total Distribution - Average No. Copies Each Issue During Preceding 12 Months: 30,903, Actual No. Copies of Single Issue Published Nearest to Filing Date: 7,237, 15g. Copies not Distributed - Average No. Copies Each Issue During Preceding 12 Months: 2,196, Actual No. Copies of Single Issue Published Nearest to Filing Date: 1,360, 15h. Total - Average No. Copies Each Issue During Preceding 12 Months: 33,099, Actual No. Copies of Single Issue Published Nearest to Filing Date: 8,597, 15i. Percent Paid - Average No. Copies Each Issue During Preceding 12 Months: 32%, Actual No. Copies of Single Issue Published Nearest to Filing Date: 56%, 16. This Statement of Ownership will be printed in the October 2009 issue of this publication. 17. I certify that the statements made by me above are correct and complete: Derrick Kraemer, Publisher.

TechTips

Courtesy of Heather Riggs, CVT

TIP of the MONTH

So that all of our staff members have quick access to important phone numbers, we typed up wallet-sized lists, laminated them, and have given everyone a copy so they always have the list with them. Lori Sheppard Christiana, PA

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

We are always busy filling prescriptions and sometimes forget how much water to add to specific medications. To help us remember, we marked a 20-cc syringe for each type of medication with a line of red tape and then labeled the syringe cases. They are kept by the sink in the pharmacy so we just have to grab the syringe for the medication we are filling and refer to the fill line. Heather Riggs, CVT Provo, UT

How Convenient!

Instead of dispensing surgical glue directly from the bottle, I apply a new 22-gauge needle to the bottle tip before each use and dispense the glue directly from the needle tip. Dispensing glue from the narrow tip of the needle allows for more precise application and creates less mess. Amy Early, LVT Virginia Beach, VA

When a feral cat is dropped off in a Havahart trap for a spay or neuter, we leave the cat in the trap and use a large blanket to squeeze the cat to the back of the cage. After the cat is in position, we can give an intramuscular anesthetic injection without anyone having to handle the cat. Carol Murphy Christiana, PA

To avoid wasting sample cups for running clean cycles through our electrolyte machine, we use the plastic cap that protects the hub of a sterilization needle as a disposable cup for cleaning ﬂuid. This cuts back on waste and is an easy way to recycle our extra plastic waste. Kelli Hertel and Scott Snow Evansville, IN

Diagnostic Dilemmas We use a pair of nail trimmers to break a microhematocrit tube to check total protein levels. It is safer than breaking a glass tube with your ﬁngers. Jean Vick Edenton, NC To improve communication among our staff members, we made cage cards that indicate what a patient needs. We have different cards that say things like fecal sample needed, urine sample needed, seizure watch, or caution. This helps prevent us from missing tests or important information. Sarah DeYoung, LVT Grand Rapids, MI

Courtesy of Sarah DeYoung, LVT

We always have a charged digital camera on hand in the hospital. We use the camera to document interesting cases and surgeries, especially the strange things we remove from patients. We also like to take pictures of our patients when their owners dress them up and post the pictures on our Web site with the owners’ permission. Lisa Hogue Apex, NC

Courtesy of Julie Todd, CVT

Courtesy of Kelli Hertel and Scott Snow

At our clinic, we draw up heparinized ﬂush into syringes and have them ready to use in a cup. Each one is labeled and the cup is dated. Julie Todd, CVT Bozeman, MT

(continues on page 38)

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Veterinary Technician | OCTOBER 2009

Cover Story

Best You Can Be A Talk with Heidi Reuss-Lamky, LVT, VTS (Anesthesia)

ÂŠ 2009 Peter Olson

More than 25 years ago, Heidi Reuss-Lamky, LVT, VTS (Anesthesia), Allyson Corcoran Editorial Assistant became a veterinary technician, and she has never looked back. Through the years, Heidi has seen her profession constantly change and evolve. Watching the profession grow, she knows that there is one key factor to being a successful, skilled technicianâ&#x20AC;&#x201D;continuing education (CE).

OCTOBER 2009 | Veterinary Technician

www.VetTechJournal.com

Cover Story

Every day is a Surprise

Bark Backwards from Ten

An ever-changing caseload is a fact of life at Heidi’s job. At the specialty clinic where Heidi works, she spends most mornings with patients during appointments and her afternoons assisting with surgery. Heidi explains that working in a specialty clinic means every day is a surprise. “Some days we’re cracking a chest to perform a lung lobectomy and excise lung bullae,” says Heidi, “and the next day we may have to place a cystostomy tube or repair an abdominal wall hernia on a kitten that weighs less than one pound.” Working in the specialty ﬁeld is not only full of surprises but also very rewarding for Heidi. She has been involved with specialty medicine for 16 years, and feels fortunate to be in a situation where she continues to gain knowledge. “I found my niche working with board-certiﬁed surgeons in the veterinary specialty environment. My job continues to challenge me, even after all these years,” she explains. “I get a lot of satisfaction from continually learning new things.” With her fast-paced days full of twists, turns, and challenging cases, Heidi realizes that it’s not the right job for everyone. “You need a special type of personality to work in a facility like this,” she explains. “Some people may perceive it as stressful, but I don’t consider it stress because I’m having too much fun!”

As a surgical technician, one of Heidi’s more important responsibilities is anesthesia. She has always been fascinated with anesthesia and had the opportunity to focus on it when she began working in the surgery department at her ﬁrst specialty clinic in 1993. Heidi remembers that anesthesia monitoring was a somewhat rudimentary process in the early ’90s compared to today’s techniques. “Back when I started, all we had was an EKG machine and an esophageal stethoscope to monitor patients undergoing complex surgical procedures,” she explains. “It just shows how far we’ve come. Nowadays, we have these multiparameter monitors that display temperature, blood pressure, EKG, pulse oximetry, and end-tidal CO2. You can get very accurate moment-to-moment information on the anesthetized patient. Whether I anesthetize a routine or critical case, access to advanced technology allows me to do a much better job.” In the past, Heidi has written articles about monitoring anesthesia and explains that having a complete understanding of the capabilities of your equipment is vital because, “as an anesthetist you are only as good as your interpretation of the data, which also impacts your assessment of that patient.”

The Best You Can Be Heidi understands the importance of CE because she has experienced the constant changes in the ﬁeld. “I have to keep learning because I always want to be the best that

A L W AY S L E A R N I N G

Remembering the Basics hen she worked in private practice, Heidi admits that she felt like a broken record. “I would talk to clients about fleas, vaccines, and intestinal parasites; it was the same thing day in and day out,” she says. However, Heidi continues to work at a local small animal hospital Courtesy of Heidi Reuss-Lamky, LVT, VTS (Anesthesia)

1 day a month to keep abreast of the latest topics and information pertinent in general practice. “In my current surgical position I don’t have the opportunity to read stool samples or keep up-to-date with the newest flea products and vaccine protocols,” Heidi explains.

Heidi’s dogs expertly pose in her backyard. (Left to Right) Bull, Arielle Moon, Madigan (foreground), Atom, Ava Marie, Lexa and Gryf (who passed away on August 6, 2009).

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Veterinary Technician | OCTOBER 2009

Cover Story

I can be at whatever I do,” she says, and CE gives her that opportunity. She hasn’t missed a surgery conference since 1994, because, “CE is the key to keeping up with all the new technologies and the latest techniques,” she says. Another way Heidi strives to be her best is through specialization. In 2004, she obtained her veterinary technician specialty in anesthesia. Heidi explains that she pursued this specialty because she has always been passionate about providing the safest anesthesia and best pain management she can for the patients under her care. “Pursuing specialization in anesthesia truly has made me a much better anesthetist,” she says, but she admits it was a difficult process. Because Heidi worked mainly with surgeons and not with a boardcertified anesthesiologist, she attended every anesthesia lecture she could and read countless books on the topic to learn as much about it as possible. In addition to her work in the practice, Heidi is also on the Credentialing Committee of the Academy of Veterinary Technician Anesthetists (AVTA). When she initially joined the committee, she really looked forward to reading the applications. “Many of the applicants worked with boardcertified anesthesiologists and used different anesthetic protocols and techniques that I was unaccustomed to,” Heidi

says. “At ﬁrst I felt a bit like a Peeping Tom. It was like peeking through the window of a world that I never experienced, and it was very enthralling.” After years of evaluating AVTA applications from across the country, Heidi still enjoys it because she likes to see the various techniques used at different private practices, research institutions, and universities. Heidi advises technicians who are interested in specializing to put themselves in the right environment that will enable them to concentrate on their chosen ﬁeld. She thinks that if technicians love their career but feel there is more they want to accomplish, then specializing may be an interesting and worthwhile pursuit for them. In addition to attending CE events, Heidi stays sharp by lecturing at major conferences across the United States and Canada. “I really enjoy lecturing,” she says. “When I was in high school, I was on the forensics team. Who’d have thought that a high school class would become so useful later in life?” Whether she is instructing another technician at work or lecturing at a conference, Heidi gets a lot of satisfaction out of passing along knowledge. “I love utilizing all of the tools in my advanced skill set,” she says. “But I get just as

PERSONAL INTEREST

Teaching Dogs New Tricks n her free time, Heidi enjoys gardening, English horseback riding lessons, traveling, reading, and watching her husband Bryan train with their dogs for Frisbee competitions. He coordinates a routine to music and tosses the Frisbee to the dog in various ways for the dog to catch. Heidi explains that

Courtesy of Heidi Reuss-Lamky, LVT, VTS (Anesthesia)

her dogs often jump off Bryan’s chest, knee, and back to catch the flying disc. “In my opinion, it’s the most entertaining canine sport out there,” Heidi says.

To see a video of Bryan in action, visit http://www.vettechjournal.com/frisbeevideo.

OCTOBER 2009 | Veterinary Technician

www.VetTechJournal.com

Cover Story

Become a

S TAY I N G F O C U S E D

MICROCHIP

Calling All Surgical Techs

SPECIALIST!

eidi is currently working on getting the Academy of Veterinary Surgical Technicians (AVST) petition approved by NAVTA. If approved, the academy would focus on:

Advanced knowledge of anatomy and physiology Knowledge of sophisticated orthopedic and soft tissue surgical procedures, including potential complications Knowledge and care of specialized surgical instruments (including various sterilization methods) Care and maintenance of surgical equipment (e.g., nitrogen-powered drills and arthroscopic and laparoscopic equipment) Principles of infection control and asepsis Diagnostic imaging methods and techniques Postoperative care (e.g., wound management, coaptation, and rehabilitation) Client education

VETERINARY TECHNICIAN® and Bayer Animal Health have teamed up to create an online CE course on microchipping for veterinary technicians. In this free RACE-approved course, you’ll learn everything you need to know to become a microchipping expert: Benefits of microchipping pets Microchipping technology and implantation techniques

Currently, Heidi and the rest of the AVST organizing committee, which includes Teri Raffel, CVT; Gerianne Holzman, CVT, VTS (Dentistry); Susan Holland, LVT, VTS (Anesthesia); Amy Weiss, BS, LVMT, CAHT; Danielle Browning, LVMT; Kim Schmidt, CVT; and Tanya Niles, LVT, are waiting to hear back from NAVTA as to whether their recently amended petition will be accepted. “My fingers are crossed that NAVTA will embrace our latest effort and, hopefully, we can still get provisional recognition this year,” Heidi says.

Veterinary Technician | OCTOBER 2009

The best way to explain the advantages of microchipping to clients How to market microchipping effectively in the practice And much more!

To find out more about this new CE course, visit vettechjournal.com/microchipping

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Cover Story

much satisfaction from seeing somebody do something that I taught them. Spreading the knowledge of what I’ve learned and seeing someone else succeed makes me feel good.”

Looking Toward the Future Being a veterinary technician can be a demanding job, but Heidi wants technicians to feel they can still have career longevity. “It would be nice to have people graduate from a veterinary technology program and feel that they can eventually retire in this profession, but I know it doesn’t happen often. Nonetheless, I sure am going to give it a try!” When Heidi looks toward the future, she hopes that the term “veterinary technician” may one day become a household word. “I want to be able to say ‘I’m a veterinary technician,’” she explains, “and have people not only understand what it means, but also say their child wants to be a veterinary technician someday, too.” VT

VITAL STATISTICS HEIDI REUSS-LAMKY

...with Vetstreet

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 Education Certificate of completion in Veterinary Technology, Michigan State University College of Agricultural Technology, East Lansing (1984).

• Educate your clients at their convenience—and yours

Current Employment Oakland Veterinary Referral Services—Specialty Referral & 24-Hour Emergency Hospital, Bloomfield Hills, MI; St. Francis Animal Hospital, Macomb, MI.

Associations National Association of Veterinary Technicians in America; Academy of Veterinary Technician Anesthetists (member of credentialing committee); Michigan Association of Veterinary Technicians (past president); future president of the Academy of Veterinary Surgical Technicians (if approved by NAVTA.) Veterinary Technician | OCTOBER 2009

Visit Vetstreet.com to learn more and sign up for a FREE webinar. 15

Salary and Skills Survey

Survey Says...

Animals and Responsibilities Contribute to Job

Satisfaction

eterinary technicians who have the most responsibility and the most contact with patients reported higher levels of job satisfaction, according to a survey conducted by MediMedia Research. The email survey of VETERINARY TECHNICIAN readers found that technicians who were very satisfied with their current position also tended to earn a higher hourly wage than those who were not satisfied, but money played a smaller part than other key factors in the amount of satisfaction derived from a career in veterinary technology. “If you find satisfaction in your job, you tend to be a more attentive employee, and attentive employees tend to

Paul Basilio Associate Editor

Technicians who are very satisfied give higher ratings to the key drivers of satisfaction Key Drivers of Overall Satisfaction (mean rating) Day-to-day animal contact

Job responsibilities

Self-fulfillment

Work environment

Salary

10 9.97

Mean rating (0–10)

8.91

8.50

8.36 7.61 6.45

6.63 5.95

5.49 4.52

0 Very satisfied

All other respondents

OCTOBER 2009 | Veterinary Technician

www.VetTechJournal.com

Salary and Skills Survey

Few technicians are not satisfied with their role

On average, licensed technicians earn more than unlicensed technicians

Respondents Currently Not Satisfied

Mean Hourly Wage

100

98% $15.02

Hourly wage ($)

Percentage

$17.07

Not satisfied

All other respondents

Licensed

Not licensed

Technicians who are very satisfied with their role tend to make higher wages

The vast majority of technicians would recommend becoming a technician to family and friends

Mean Hourly Wage by Licensed Veterinary Technicians (mean wage)

Would Recommend Becoming a Veterinary Technician (percentage selected) 100

84%

$15.56 Percentage

Mean hourly wage ($)

$17.01

16% 0

Very satisfied

All other respondents

make more money,” said Marianne Tear, MS, LVT, editor in chief of VETERINARY TECHNICIAN. “The survey found that several factors, including self-fulﬁllment, determined job satisfaction. Technicians have stopped waiting for someone else to tell them they’re doing a good job. We’re starting to take ownership and tell ourselves that we’re doing good work.” www.VetTechJournal.com

Yes

Respondents ranked the key drivers of overall job satisfaction on a scale of 1 to 10, and the response from satisfied technicians was virtually unanimous—day-to-day animal contact was by far the most important factor in determining the level of job satisfaction for technicians. Animal contact was followed, in order, by job responsibilities, self-fulfillment, work environment, and, finally, salary. Veterinary Technician | OCTOBER 2009

Salary and Skills Survey

While a vast majority of technicians are interested in obtaining certification, many are not currently working toward this goal Certification Interest Level Interested and currently working toward certification

38%

Interested but not currently working toward certification

47%

Not interested 15% 0

100

Percentage

“We tend to think that we want more money,” Tear said, “but it never ranks up there in what makes us happy. We want to take care of the animals first, then we want to have as much responsibility as possible. I call it the ‘technician gene.’ If you have it, you have to take care of every sick or injured animal you see, and then you go to work and say ‘I can do that, that, and that—and also that.’ When I see students that have those characteristics, they’re usually the ones that are going to be fantastic when they go to work in clinics.” One interesting result from the survey was that 47% of respondents said they were interested in certification, but were not currently working toward that goal. “I know it’s difficult because people have a lot going on in their lives,” Tear said, “but I would recommend that technicians who are interested in certification look at online certification programs and see if there’s something there that they can work toward. If technicians submit that as one of their goals to their employer, there may be a chance that they could get some form of reimbursement for completing the program.” There are several online certification programs for veterinary technicians, such as St. Petersburg College, Penn Foster College, and Blue Ridge Community and Technical College. The survey found that technicians are carrying out more technical duties than in the past. More than 90% of respondents said they drew blood, placed IV catheters, performed 18

OCTOBER 2009 | Veterinary Technician

in-house diagnostics, and obtained radiographs. More than 80% of respondents served as a surgical assistant and administered anesthesia. “I like that,” Tear said. “When I started out in this profession you would be lucky if 60% or 70% of technicians drew blood. Across the board, we are deﬁnitely getting more of the technical duties.” Some of this can be attributed to new techniques that are being used to educate veterinarians, Tear said. “In tech school, we learned about the importance of working with the veterinarian from the ﬁrst day,” she explained. “Now some of the veterinary schools are doing a better job of stressing the importance of technicians to veterinary students. When those veterinary students graduate, most of them can’t imagine life without a technician.” More than 1,300 technicians responded to the email survey. Although the samples are large, they are not probability samples and, as a result, may not be representative of all veterinary technicians. Therefore, the results may not be generalizable. VT

Lucky Winner!

Congratulations to Sherri Watson of Mohave Valley, AZ. Survey respondents were entered into a drawing for a new iPod, and Sherri was the lucky winner. Happy listening!

www.VetTechJournal.com

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TechNews

SCHAUMBURG, IL—Reported cases of rabies in the United States dropped in 2008, but veterinarians and public health ofﬁcials warn that an increase in the number of reported cases in cats poses a health risk to both animals and people. There were 6,841 reported cases of animal rabies in the United States and Puerto Rico in 2008 according to a report issued by the Centers for Disease Control and Prevention (CDC) and published in the Sept. 15, 2009, issue of JAVMA. The number represents a 3.1% decrease from the 7,060 rabies cases in animals reported to the CDC in 2007. There were two cases of rabies in humans in 2008, up from one case reported in 2007. According to the CDC report, rabies continues to affect wildlife much more than it does domestic animals. Wild

Her Eartip Says It All. Feral cats are eartipped as part of Trap-Neuter-Return protocols. Learn more at alleycat.org/Veterinarian.

Rabies Cases Among Cats on the Rise

animals, especially raccoons, bats, skunks, and foxes, accounted for 93% of all rabies cases reported in 2008, the report states. More work needs to be done, however, when it comes to controlling rabies in pets, especially cats and dogs. Cats led the list of domestic animals with reported cases of rabies in 2008. According to the CDC report, there were 294 reported cases of rabies in cats last year, up about 12% from the 262 reported cases in 2007. In 2008, there was a total of 75 dog-related cases, down from 93 in 2007. Jesse Blanton, MPH, an epidemiologist at the CDC, said cats have more interaction with wildlife, where they are prone to being bitten by a rabid animal, and they aren’t getting the vaccinations they need. “The CDC’s general belief is that people are doing a good job vaccinating their dogs, but not their cats,” Blanton said. “We have controlled canine rabies through the vaccination of domestic dogs, so we know that vaccinating works.” The belief that cats aren’t getting their necessary shots is supported by data from an AVMA report that indicates 36.3% of US cat-owning households did not visit a veterinarian in 2006. The report, US Pet Ownership and Demographics Sourcebook, indicates that 17.3% of dog-owning households did not visit a veterinarian in 2006. The simple act of vaccinating a pet, Blanton said, provides protection to the animal and the humans with whom it may come in contact. Veterinarians can vaccinate dogs and cats, and advise clients on the recommended or required frequency of vaccination needed. Rabies remains a threat worldwide, killing more than 55,000 people every year, according to the World Health Organization. VT Source: American Veterinary Medical Association

W W W. A L L E Y C AT. O R G

Education

Advocacy

Action

OCTOBER 2009

www.VetTechJournal.com

TechNews

Golden Ophthalmic Rules By Paul Basilio Associate Editor LAS VEGAS—Eye examinations can be a rewarding and useful addition to general practice, but veterinarians need the right equipment to properly evaluate the eye. Fortunately, an increasing number of veterinarians are purchasing ophthalmic supplies compared with 10 years ago, but there is still room to improve, said Kerry L. Ketring, DVM, DACVO, of the All Animal Eye Clinic in Cincinnati, Ohio, who spoke at the Western Veterinary Conference about the golden rules generalists need to follow for basic, worthwhile eye examinations.

External Examination Tools “Rule #1: You have to have the right equipment,” Ketring said, adding that a bright light source and magnifying loupes are essential for an external examination of the eye. “You’d be amazed at what you see when you shine light on the subject.” The older you get, he joked, the more magnification you need for your loupes. “I keep one pair in the exam room and one in my tackle box for [tying] flies.” According to Ketring, purchasing loupes with the highest magnification is not necessary. At 5× magnification, Ketring said, working distance becomes critical, adding that using loupes with 5× magnification means “you have to be on top of your subject, and your depth of field is affected. I think 2.5× or 3× is fine.”

Tonometry Ketring warned against looking at a patient’s eye and saying, “‘That looks hard.’ That’s a pet peeve of mine. Concrete walls look hard—eyes cannot. www.VetTechJournal.com

You have to measure the pressure.” Ketring said the Tono-Pen Vet is preferred by veterinary ophthalmologists because of its precision and ease of operation. It calculates the average of four valid taps on the cornea and displays the mean intraocular pressure and standard deviation. When using tonometry to screen patients’ eyes, he recommended that veterinarians refer to a list of breeds predisposed to certain eye diseases. “It’s good medicine,” Ketring explained. “It allows you to develop the skill of measuring pressure while helping local breeders become aware of eye problems in their puppies.” But false-elevated pressure readings are possible, Ketring added, especially when examining the eyes of unruly dogs that require restraint. False-low pressure readings, however, are not possible.

Ophthalmoscopy Ophthalmoscopes are used to evaluate the clear media in the eye, Ketring said. “It’s easy,” he explained. “You can use it to evaluate the entire clear media, the fundus, and the anterior segment. All you do is set the ophthalmoscope on 0 diopters, stand an arm’s length away from the animal, shine the light in its eye, and the light reﬂects off the posterior segment.” The problem some veterinarians run into, Ketring explained, is not dilating the patient’s pupil before examination. “I don’t care what the manufacturers say—when you’re looking at the fundus, you will see twice as much if you dilate the pupil,” he said.

Traumatic Ulcers According to Ketring, humaninduced traumatic ulcers are overdiag-

nosed in veterinary medicine. The only case he has seen in 31 years involved a woman who had long ﬁngernails and poked the eye of her rottweiler when it jumped up as the woman was petting it. “Have you ever tried to poke a dog in the eye?” he asked. “You can’t do it. You’re not fast enough. “I’m not saying [traumatic ulcers] don’t exist, but you can miss the primary diagnosis if you let the client convince you that the problem is a result of trauma,” Ketring said. “The majority of ulcers are associated with keratoconjunctivitis sicca, exposure keratitis, lid disease, and degenerative diseases of the cornea, such as indolent ulcers in dogs.”

Breed Incidence The American College of Veterinary Ophthalmologists and the Canine Eye Registration Foundation have compiled a breed list of many eye diseases, which can be beneficial for veterinarians to keep on hand. Golden retrievers, for example, are predisposed to ectopic cilia. “If a young golden retriever comes in with periodic tearing or recurring ulcers, it’s either mild entropion or ectopic cilia,” Ketring said. “You know the age, you know the breed, and you have the diagnosis. You just need to find the hair in its eye. “I am convinced that if a certain breed walks through your door and you look at the list to find out what diseases that breed [can have], you can immediately come up with a short list of differentials,” Ketring added. “Ralph Waldo Emerson said, ‘People only see what they are prepared to see.’ He should have been an VT ophthalmologist.” Veterinary Technician | OCTOBER 2009

DentalCheckup

Extract Not to Extract? A

s veterinary professionals, our goal is to provide exceptional patient care. Continuing education is imperative to remain current in the varied disciplines of veterinary medicine. One of these disciplines, dentistry, has long been overlooked in the care of veterinary patients. There has been a glaring lack of emphasis on both routine preventive oral care for animals and the advanced tooth-saving procedures that are commonplace in modern human dentistry.1 However, in recent years, great strides have been made in dental care, and advanced techniques are being used to save teeth as an alternative to extraction. As current practitioners strive to provide quality dental care for their patients, they should bear in mind that exodontics is an area of dentistry that should not be overused.2

By Annie Mills, LVT, VTS (Dentistry)

OCTOBER 2009 | Veterinary Technician

It is in the patient’s best interest for owners to be wellinformed about the alternative therapies that can be used to stop the progression of, and in some cases, reverse the effects of, periodontal disease. Several alternatives will be presented here, as well as the procedure for determining whether teeth should be salvaged or extracted. A majority of veterinary dental experts believe that patients with stage 4 periodontal disease would beneﬁt from extraction.2 A complete evaluation of the tooth or teeth in question is imperative when considering a treatment plan. A thorough examination integrates several different methods and tools to gather information about the patient’s dental health. Perhaps the most important method is digital dental radiography, an integral part of veterinary dentistry3 (Figures 1–4). When each tooth is considered a separate www.VetTechJournal.com

DentalCheckup

entity, there are 42 separate potential decisions to be made concerning a dog with a full set of teeth.4 Information to be gathered for each tooth includes mobility, structural normality, furcation involvement of multirooted teeth, and pocket depth.1 In addition to a complete evaluation, there are other factors to consider when deciding between salvage or extraction. The relative importance of the tooth (“strategic” versus “nonstrategic” teeth) plays a part as well, as retention of a canine or carnassial tooth may be more signiﬁcant than retention of an incisor or smaller premolar.3 The owner’s level of commitment to providing adequate home care and regular professional therapy, along with the pet’s tolerance and temperament, are also important components in the decision-making process. When a patient is presented for a dental cleaning—or “prophy”—and has progressed beyond gingivitis to periodontitis, the treatment plan will not be a simple “prophy,” but will also involve periodontal therapy. Seldom is a “dental cleaning” solely preventive in nature. Typically, there is additional salvage work to do. The term periodontal therapy is much more accurate and more professional for these procedures.3 Advances in periodontal treatment include new approaches in professional prophylaxis, root surface

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therapy, perioceutic application (doxycycline), pocket reduction and gingival flap preparation, osseous regeneration and augmentation (guided tissue regeneration [GTR]), and bone grafts.4 Some or all of these techniques can be performed in general practice with the right tools and training. These techniques will be discussed briefly here, but should be researched further before being integrated into the dental program of the general practitioner. A thorough cleaning above and below the gumline is imperative in the prevention of periodontal disease. Ultrasonic scaling, in conjunction with hand instrumentation, is the first step in the treatment process. Complete probing and charting of each tooth should also be an integral part of the professional prophylaxis. Root surface therapy or root planing should be performed on teeth with pockets ≥5 mm. Root planing is the process whereby residual embedded calculus and portions of the necrotic cementum are removed from the roots to produce a clean, hard, smooth surface that is free of endotoxins.2 If the pocket is ≤5 mm, closed-root planing can typically be effective. Any pockets deeper than that require raising a gingival flap to expose the area for scaling, a procedure that is known as open-root planing.3

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Veterinary Technician | OCTOBER 2009 23

DentalCheckup

Figure 1. Advanced periodontal disease in which there is more than 50% bone loss.

Figure 2. Retained root tip.

Figure 4. Unerupted first premolar causing a dentigerous cyst.

Figure 3. Retained root tip.

Perioceutics are now available and allow the application of doxycycline directly into the sulcus or periodontal pocket. Once in place, the gel releases doxycycline at higher levels than systemic doses. Doxycycline, like other tetracycline products, also has an anti-collagenolytic effect, which can moderate the destructive processes of periodontal disease.2 It also conditions the pocket and allows the regrowth of periodontal tissue, which improves attachment, thereby reducing the pocket depth. Pocket reduction can also be achieved by performing apically repositioned ﬂap surgery. This technique is used to decrease pocket depth in areas with deep infrabony pockets and facilitates better self-cleaning of affected areas. 24

OCTOBER 2009 | Veterinary Technician

It was once believed that when periodontal tissue was lost, it was gone for good. However, new techniques in the regrowth of this tissue, first used in human dentistry, have made their way into veterinary practice. Veterinary dentistry has benefitted greatly from the expertise that developed in human dentistry. The theory of regeneration focuses on allowing the correct cells to grow into the defect first—osteoblasts to recover bone loss and periodontal cells to bridge from bone to tooth. With the placement of some sort of barrier in the void, this therapy aims to keep the faster-growing alveolar mucosa and gingival connective tissue out of the defect, while encouraging growth of the periodontal ligament and bone.3 Bone grafting is a technique used to regenerate bone around periodontally affected teeth that have bone loss. An autologous bone graft or synthetic implant material is placed into the defect following open debridement and root planing of the infrabony pocket. Client compliance with www.VetTechJournal.com

DentalCheckup

Figure 5. Fractured maxillary fourth premolar with pulp exposure.

Figure 6. Fractured mandibular premolar, in which the majority of the tooth is gone.

follow-up and home care is extremely important in order for this procedure to be successful. Endodontics is another alternative therapy to tooth extraction. Endodontics is the branch of veterinary dentistry that deals with the diagnosis and treatment of the pulpal tissues of the tooth. When a patient is presented with a fractured or discolored tooth, it must be treated endodontically or extracted (Figures 5 and 6). In most cases, endodontic treatment is preferred over extraction to maintain the integrity and function of the tooth. Endodontic procedures include root canal, pulp capping, and vital pulpotomy. Most general veterinary practices do not perform endodontic procedures, but this should be one of the recommendations offered to the owner. A referral to a veterinary dentist must be offered to the owner in order to provide the best care to the patient. Usually fractured or discolored teeth can be observed on the initial exam. At this point, referral can be discussed. If the pathology is discovered during a dental cleaning and exam, referral may still be offered and performed at a separate time. There are also instances in which extraction is the only appropriate treatment. It is important to note that in most cases, extraction is a surgical procedure to be performed only by a veterinarian. One indication for extraction would be persistent or retained deciduous teeth. If a practitioner identiďŹ es an adult tooth erupting and the deciduous tooth is not exfoliating naturally, it is necessary to extract the deciduous tooth.2 Interceptive orthodontics is described as extraction of deciduous teeth when the mandible or the facial maxillary structures are not developing appropriately and a malevolent interlock exists, interfering with normal jaw development. Supernumerary teeth are extracted when they cause crowding or interfere

with occlusion and periodontal health.2 Other indications for extraction include nonvital or fractured teeth with pulp exposure, when root canal therapy is not possible or declined by the owner, diseased teeth where the periodontium cannot be restored, and teeth that have structural damage for which restoration is not feasible. Additionally, teeth involved with, or surrounded by oral neoplasia, teeth in a fracture line that interferes with bone fracture healing, impacted or embedded teeth, and retained roots should also be extracted. To extract or not to extract is a question that, at one time or another, faces all veterinary professionals who perform dentistry. The answer is not always clear but, with the development of newer alternative therapies, unnecessary extraction can now be avoided. The general practitioner can signiďŹ cantly improve their dental program by learning and implementing the techniques discussed here. VT

www.VetTechJournal.com

References 1. Mitchell P. Small Animal Dentistry. St. Louis, MO: Mosby; 2002. 2. Holmstrom SE, Frost P, Eisner ER. Veterinary Dental Techniques. Philadelphia: WB Saunders; 2004. 3. Lobprise H, Wiggs R. Common Dental Procedures. AAHA Press; 2000. 4. Harvey C, Emily P. Small Animal Dentistry. St. Louis, MO: Mosby; 2002.

ABOUT THE AUTHOR

Annie Mills, LVT, VTS (DENTISTRY) Annie is a technician at All Pets Dental in Weston, FL. She is originally from Michigan and has been a licensed technician since 1983. Annie received her VTS in dentistry in 2008.

Veterinary Technician | OCTOBER 2009 25

CE Article #1

Acute Lung Injury & Acute Respiratory Distress Syndrome

cute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are two syndromes that are unique to the respiratory system. ALI is an inflammatory disorder of the lungs, and the most severe forms are known as ARDS. In the past 20 years, veterinary medicine has given recognition to both syndromes. Unfortunately, the mortality rate remains around 99–100%.1 For patients to have a chance at survival, early detection is imperative and treatment must be aggressive. Technicians have an important role in alerting veterinarians to any changes in respiratory status and ultimately initiating treatment on patients. In 2007, veterinary-specific definitions were created for ALI/ARDS to provide consensus for diagnostic criteria.2 Five veterinaryspecific diagnostic criteria were identified, with four of the criteria being required and the fifth being strongly recommended.2 The onset of respiratory distress must be acute and known risk factors must be present.2 The other three criteria are evidence of a pulmonary capillary leak that was not associated with increased capillary pressures, evidence of inefficient gas exchange, and evidence of inflammation.2

Amy Breton, CVT, VTS (ECC)

No matter how the syndromes develop, it is known that ALI/ARDS can occur when there is a serious injury to the lung. Both syndromes develop secondarily from an overzealous inflammatory response, which usually occurs within 24–48 hours after the onset of the injury or acute illness.6 The release of cytokines and other inflammatory mediators cause neutrophils and T-lymphocytes to quickly migrate to the site of insult, causing the area to become overwhelmed.7 The final stage (end stage) of ARDS results in the lungs becoming cobblestone in appearance, with severe fibrosis and pulmonary edema occurring.8

No matter how the syndromes develop, it is known that ALI/ARDS can occur when there is serious injury to the lung

Pathophysiology The exact triggering mechanism of ALI/ARDS is not completely understood in human medicine, and even less research on the subject has been conducted in veterinary medicine. Dogs have been used as research models for human studies, which allows some insight into the syndromes.3 It is unknown if cats develop ALI and ARDS in a similar manner to dogs.4 Many researchers suggest that ALI/ARDS does exist in the cat, but not by the standards which currently deﬁne the syndromes. This could possibly be because common risk factors (such as sepsis, pneumonia, and nonfatal thoracic trauma) occur less in cats.5 26

OCTOBER 2009 | Veterinary Technician

Measuring Oxygenation

The major difference between ALI and ARDS is the degree of hypoxia.7 To determine whether your patient is in ARDS or ALI, you must first obtain an arterial blood gas sample. Appropriate handling of the sample is important to avoid pre-analytical errors. If you are not using pre-filled heparin syringes, you must ensure that you obtain an appropriate sample amount to avoid heparin dilution (sodium heparin 1:1000 units/mL).9 You must also avoid exposing the sample to air. The sample should be run as soon as possible, otherwise it should be placed on ice and run within 1–2 hours.10 Arterial samples are most commonly taken from the dorsal pedal or femoral arteries. Once a sample is obtained, the ratio of arterial oxygen pressure (PaO2) to fractional inspired oxygen (FiO2) must be calculated. If a patient has a ratio <300 (and if the patient meets the other criteria), then the definition of ALI may be applied.7 If the patient has a ratio of <200, then the patient may be suffering from ARDS.7 The FiO2 is the amount of oxygen in a gas mixture (similar to room air).8 It is expressed as a number from 0 (0%) to 1 (100%), written either as a decimal or percentage.11 No matter what altitude the blood sample is drawn at, the FiO2 of normal room air is always 0.21 (21%).8 www.VetTechJournal.com

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PaO2 is the partial pressure of oxygen in arterial blood and is measured in mm Hg. Some blood gas analyzers will offer the reading as PO2. In that case, it is important to know if the sample was venous or arterial or the reading could be misinterpreted. Normal PaO2, at sea level, is between 80 and 110 mm Hg.8 When PaO2 is <80 mm Hg, the patient is suffering from hypoxemia.8 Severe hypoxemia occurs with a PaO2 of <60 mm Hg.8 Therefore a normal PaO2/FiO2 ratio is 476 (100/0.21). If an arterial blood gas is performed and the patient has a PaO2 of 59 mm Hg on room air (21%), the PaO2/FiO2 ratio is 280, which could lead to a diagnosis of acute lung injury. Once an arterial blood gas is performed, chest radiographs should be taken. While CT scanning may lead to more accurate images of the pulmonary parenchyma, it serves as no greater a diagnostic tool than a radiograph.5 On film, bilateral alveolar infiltrates will be seen in most cases.5 Since there are other diseases that cause alveolar infiltrates, it is important to complete a thorough workup as well as obtain an accurate history from the owners.

Causes The exact risk factors for dogs and cats are ill deﬁned, but the list of potential risk factors is vast. Any major change in the respiratory system or major trauma can set the body up for ALI or ARDS.12 Risk factors are generally categorized into two groups: pulmonary or extrapulmonary. Some pulmonary risk factors include: direct trauma to the lungs, pneumonia, and noncardiogenic pulmonary edema (e.g., electrocution, head trauma).5,13 Extrapulmonary risk factors include: sepsis, systemic inﬂammatory response syndrome (SIRS), viral infection (parvovirus), smoke inhalation, multiple blood transfusions, peritonitis, and pancreatitis.5,13 The most common risk factors for dogs include sepsis and pneumonia. Cat risk factors include systemic infection, neoplasia, acute pancreatitis, pulmonary disorders, and sepsis.14,15

Signs and Symptoms All ALI/ARDS patients present with or develop severe respiratory distress. Patients are often severely lethargic, collapsed, or completely unable to walk. Generally these patients have poor perfusion. Upon auscultation, crackles may be detected. Rarely is coughing a symptom.16 Orthopnea may be observed.17 Besides the noncardiogenic pulmonary edema, pulmonary hypertension can occur from vasoconstriction. This may lead to right ventricular dysfunction of the heart. Due to the severe hypoxemia that these patients face, many patients end up in multiple organ failure (multiple organ www.VetTechJournal.com

Glossary Alveolar infiltrates—where liquid enters the alveoli, which are the sacs of the lungs where gas is exchanged. Capnography—monitoring the amount of exhaled CO2 in order to determine if the patient’s ventilation status is normal. Central venous pressure—the pressure of the blood coming from the right atrium of the heart. Chemosis—swelling around the iris which may indicate fluid overload. Cytokines—small secreted proteins which help to mediate an inflammatory response. Diuretic—a drug used to increase urine formation and output. These drugs help promote the removal of excess fluid in the body. Hypoxemia—decrease of dissolved oxygen in arterial blood causing the patient to have breathing difficulties. Orthopnea—a condition where breathing is difficult and the patient must be allowed to sit or stand in order to breathe with less effort. Pancreatitis—inflammation of the pancreas. Peritonitis—inflammation of the peritoneum, which is the lining that covers the walls and organs. Vasodilator—a drug that decreases blood flow resistance and therefore lowers blood pressure. Vasopressor—a drug that increases cardiac output and supports blood pressure.

dysfunction syndrome [MODS]).16 In dogs, ALI/ARDS leads to a high rate of bacterial pneumonia, aspiration pneumonia, or sepsis.16 Disseminated intravascular coagulopathy (DIC) may also occur from the severe changes to the vascular system.16 Hypoalbuminemia can be seen, and in humans, can be seen as a potential precursor to developing ARDS.18 In veterinary medicine, death occurs from the myriad complications.

Treatment The gold standard treatment for all species is oxygen supplementation and organ perfusion.5 Technicians play a crucial role in treating these patients. Stress should be minimized to any animal in severe respiratory distress.19 Restraint, in most cases, should be minimal. Even the most aggressive dog tends to be less aggressive when it is unable to breathe. Some cats will become more fractious and Veterinary Technician | OCTOBER 2009

CE Article #1

By the Numbers – Key Parameters for ALI/ARDS FiO2 0.21 (21%) = Fractional inspired oxygen Normal room air PaO2 Partial pressure in arterial blood

80–110 mm Hg = Normal range

SpO2 Pulse oximetry

98%–100%*

PvO2 Partial pressure in venous blood

40 mm Hg = Normal ≤30 mm Hg = Of concern ≤20 mm Hg = Emergency

PaO2/FiO2 ratio

476 = Normal ≤300 = Consider ALI ≤200 = Consider ARDS

*At sea level.

require immediate sedation so that you can safely work with them. Animals should be allowed to assume any position that provides them with the most relief. Oxygen should be provided initially by the least stressful route.20 Oxygen hoods made from Elizabethan collars tend to be well tolerated in dogs, but not as much in cats. Oxygen hoods tend to provide quick relief, and FiO2 levels can get up to 60% oxygen very quickly.21 Small oxygen cages can be used for cats, and FiO2 levels can reach 40%, but take upwards of 25 minutes for the FiO2 to reach a level greater than 40%.21 You also cannot work with your patient if it is in a cage. The efﬁcacy of ﬂow-by oxygen is still debated since it is unknown how much of the oxygen the animal actually takes in. The oxygen tubing must be inches away from the animal’s nose in order for it to be effective.21 Since most animals do not tolerate air blowing in their faces, this technique is most effective if the owners are present to help hold their pet and oxygen line.21 Longterm oxygen therapy can include the use of oxygen cages, nasal oxygen lines, or a mechanical ventilator. It is imperative to constantly assess oxygenation in ALI/ ARDS patients. In a clinical setting we can monitor the four parameters: mucous membrane color, partial pressure of oxygen in venous blood (PvO2), PaO2, and pulse oximetry (SpO2).11 The goal in administering oxygen should be to maintain an adequate PaO2 while allowing for the lowest FiO2 possible (room air 0.21).11 Mucous membrane color is one of the easiest parameters to monitor and should be part of every physical exam. Though not completely accurate (because light28

OCTOBER 2009 | Veterinary Technician

ing, anemia, or icterus can hide the appearance of cyanotic membranes), any presence of cyanosis indicates a life-threatening oxygenation issue which needs to be addressed immediately.11 PvO2 is not very reliable and ideally should not be used.11 If you cannot obtain an arterial sample, then you should obtain a venous sample from the jugular vein or vena cava as these will often provide the most accurate results.11 Normal PvO2 measurements are above 40 mm Hg.11 Most agree that a PvO2 below 30 mm Hg is concerning and requires intervention, while a PvO2 below 20 mm Hg is an emergency.11 Partial pressure of oxygen in arterial blood (PaO2) is still considered the primary test when monitoring for overall oxygenation ability of a patient.11 PaO2 is the most sensitive test of oxygenating ability and is also very reliable.11 Any small change in oxygenation will cause the PaO2 to change as well.11 Unfortunately, in order to obtain this measurement, you must obtain an arterial blood sample, which may not be possible in some patients. SpO2 is less invasive, and the equipment is significantly less expensive than that required to obtain a PaO2 measurement. A pulse oximetry machine measures the oxygen saturation of hemoglobin, which is a very insensitive measure of oxygenation.11 Normal animals should have a range from 98%–100% on room air. Patient movement, poor perfusion, hair, or any color other than pink mucous membranes (icterus, cyanosis, anemia) can cause the reading to be inaccurate.11 The SpO2 reading tends to follow the PaO2 reading. In general, a patient with a SpO2 reading of 96% equals a PaO2 reading of 80 mm Hg and a reading of 91% estimates to about a PaO2 reading of 60 mm Hg.11 In veterinary medicine, intravenous fluid therapy plays an equally important role in managing ALI/ARDS. One of the greatest challenges with ALI/ARDS patients is maintaining adequate organ perfusion and function. In human medicine, there is still much debate on whether aggressive fluid therapy is a benefit.3,12 Many argue that by restricting fluids, and perhaps adding diuretics, you can help reduce pulmonary edema and therefore improve gas exchange.22 In veterinary medicine, the choice of treatment continues to be the use of crystalloids, however, in human medicine, some doctors advocate the use of colloids. Since perfusion must be maintained, then the choice of fluids remains the clinician’s decision. Ideally, central venous pressure (CVP), colloid osmotic pressure, and blood pressure should be monitored to ensure adequate perfusion. If CVP cannot be monitored, then clipping the hair from the jugular veins and looking for jugular distension should be www.VetTechJournal.com

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done.23 Technicians need to monitor for early signs of fluid overload. Increase in respiratory rate, chemosis, or nasal discharge should be noted.23 If appropriate, diuretics may be administered. Although antibiotics are indicated when bacterial pneumonia has been diagnosed, many human and veterinary doctors advocate the use of antibiotics even without such a diagnosis since the chance of a secondary infection is high.3 The veterinary staff caring for an ALI/ARDS patient should be constantly looking for signs of sepsis or other infection. Signs include development of a fever, increases in white blood cell count, decreases in blood glucose increases in heart rate and respiration rate. Alerting the veterinarian to changes in the patient’s status is important to diagnose sepsis early. Despite intensive research with steroids as a treatment for ARDS in the last 20 years, no benefits have been proven.24 This continues to be another source of controversy in both human and veterinary medicine. The use of vasopressors and vasodilators remains controversial and depends on the patient’s overall condition.3 It is imperative that patients maintain adequate perfusion to the organs, so it would seem that vasopressors are indicated. Unfortunately many patients suffer from pulmonary hypertension, and when they are given a vasopressor, it is likely that hypertension will only increase, possibly causing a worsening of edema.3 All parameters must be evaluated and all risks must be factored in before attempting any new treatment. Nutritional support must be considered as well in patients that are hospitalized more than 48 hours. Both ALI and ARDS cause an increase in resting energy expenditure and an increased protein consumption.25 This is particularly true for patients experiencing sepsis. Providing nutritional support to these patients early in their disease course is essential in order to minimize weight loss and provide adequate energy for metabolic support.25 Ventilators are considered one of the primary treatments in human medicine.5 Unfortunately in veterinary medicine, they are expensive and not regularly found in most hospitals. As the disease progresses, animals have a harder time breathing. This is because the lungs become stiff, causing them to need increasingly higher pressures to inflate the lungs to a specific volume. One study in 1994 of 41 ventilated dogs showed that 56% of them developed either pneumonia or a pneumothorax.25 Unfortunately, the use of mechanical ventilators is poorly documented in cats. Despite the use of mechanical ventilators as a primary treatment choice in human medicine, in veterinary medicine they are rarely used due to the expense and the poor www.VetTechJournal.com

prognosis that ALI and ARDS offer. If available, they are a treatment of choice. A technician is often the first one to notice changes in a patient’s condition and is usually the one caring for the patient. All ALI and ARDS patients must receive intensive nursing care. Vitals (i.e., heart rate, respiration rate, mucous membranes, temperature) must be constantly monitored. Patients should be reassessed every hour or two depending on their status. Ideally, all patients should be on a constant ECG and have blood pressure and CVP monitored throughout.26 All ALI/ARDS patients should have a central line and urinary catheter placed. It is important that fluid intake and excretion is monitored for changes in hydration status. If possible, ALI/ARDS patients should have an arterial line placed to allow for more frequent arterial blood gas measurements and arterial blood pressures.26 If the patient is recumbent, it is important to ensure that the patient is rotated to help prevent fluid buildup on one side. Patients should have their eyes lubricated if they are not properly blinking.27 In veterinary medicine, the diagnosis of ALI or ARDS is a devastating one that requires intensive nursing care and monitoring. Early diagnosis and aggressive treatment will provide the best chance of survival for our patients. VT

References 1. DeClue A, Cohn L. Acute respiratory distress syndrome in dogs and cats: a review of clinical findings and pathophysiology. J Vet Emerg Crit Care 2007;17(4):340-347. 2. Wilkins P, Baumgardner J, Otto C, et al. Acute lung injury and acute respiratory distress syndromes in veterinary medicine: consensus definitions: the dorothy russell havemeyer working group on ALI and ARDS in veterinary medicine. J Vet Emerg Crit Care 2007;17(4):333-339. 3. Russell J, Walley K. Acute Respiratory Distress Syndrome: A Comprehensive Clinical Approach, New York. Cambridge University Press; 1999. 4. Silverstein D. Acute respiratory distress following trauma: catching your breath. Proc 2004 IVECCS. 5. King L. Textbook of Respiratory Disease in Dogs and Cats. St. Louis. Saunders Elsevier; 2004. 6. Randhawa R, Bellingan G. Acute lung injury, Anaesthesia & Intensive Care Medicine Journal. 2007;8(11):477-480. 7. DeClue A. Acute lung injury and ARDS: pathophysiology and interventions. Proc 2007 IVECCS. 8. Haskins S. Hypoxemia: When oxygen therapy works, and when it does not. Proc 2005 IVECCS. 9. Baldwin K. Blood gas analysis and sample handling. Proc 2005 ACVC. 10. Schoeffler G. Arterial blood gas interpretation. Proc 2004 Northeast Vet Conf. 11. Hopper K. Assessment of oxygenation. Proc 2005 IVECCS. 12. Wingfield W, Raff M. The Veterinary ICU Book. Jackson, WY. Teton NewMedia; 2002. 13. Palmer J. Ventilatory therapy and acute lung injury. Proc 2005 IVECCS. 14. Shaw S. Practical tips for dealing with respiratory distress in dogs

Veterinary Technician | OCTOBER 2009

CE Article #1 and cats. Proc 2008 West Vet Conf. 15. Mazzaferro E. Feline lower airway disease: current concepts in acute management. Proc 2004 IVECCS. 16. Tilley L, Smith FWK. The 5-Minute Veterinary Consult Canine and Feline. Baltimore. Lippincott Williams and Wilkins; 2000 17. Cote E. Clinical Veterinary Advisor Dogs and Cats. St. Louis. Mosby Elsevier; 2007. 18. Dubois M, Melot C, Orellana-Jimenez C, et al. Albumin administration improves organ function in critically ill hypoalbuminemic patients: a prospective, randomized, controlled, pilot study, presented at Taipei Veterinary General Hospital in September 2006. 19. Drobatz K. The technician’s role in the approach to respiratory distress. Proc 2004 ACVC. 20. Biddinger B. Assessment and monitoring of pleural diseases, Proc 2007 ACVIM Symp.

21. Crowe T. Oxygen therapy: techniques and monitoring. Proc 2004 IVECCS. 22. Matthay M, Ingbar D. Pulmonary Edema. New York. Marcel Dekker Inc.; 1998. 23. Devey J. Fluid therapy and lung disease. Written for California Veterinary Specialists, San Marcos, CA; 2007. 24. Savel R, Goldstein E, Lehman H, Kupfer Y. Methylprednisolone infusion in early severe ARDS. American College of Chest Physicians CHEST Journal. 2007;132(3):1096-1097. 25. Powell L. Ventilator-induced pneumonia. Proc 2006 IVECCS. 26. Adamantos S. Monitoring and supporting cardiopulmonary function in the critical patient. Proc 2007 Brit Sm Anim Vet Cong. 27. Damon M. Monitoring and nursing management of the ventilator patient. Proc 2006 IVECCS.

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. The mortality rate of ARDS in veterinary patients is a) 25–30%. b) 50–75%. c) 5–10%. d) 99–100%.

6. The FiO2 of room air is always a) 0.10. b) 0.21. c) 0.34. d) 0.41.

2. The definition for diagnosing a patient with ALI or ARDS includes all except a) an acute onset must be present. b) known risk factors must be present. c) evidence of efficient gas exchange. d) evidence of inflammation.

7. If a patient has been diagnosed with ARDS, what will you likely see on a chest radiograph? a) neoplasia b) bilateral alveolar infiltrates c) an enlarged heart d) a pneumothorax

3. Normal PaO2 at sea level is between a) 60 and 90 mm Hg. b) 80 and 110 mm Hg. c) 120 and 140 mm Hg. d) 160 and 190 mm Hg.

8. Oxygen should always initially be given a) by face mask. b) by placing the animal in an oxygen cage. c) the least stressful way possible. d) by an oxygen hood.

4. Arterial blood gas samples should be run a) in 3–4 hours. b) immediately. c) within 24 hours. d) does not matter when they are run. 5. After you obtain an arterial blood gas, you must calculate a) PaO2 /FiO2 ratio. b) FiO2 /PaO2 ratio. c) PvO2 /FiO2 ratio. d) PvO2 /PaO2 ratio.

OCTOBER 2009 | Veterinary Technician

9. To monitor a patient’s overall oxygenation ability we can monitor a) PaO2. b) mucous membrane color. c) SpO2. d) All of the above. 10. ______ is considered the primary test when monitoring for overall oxygenation ability of a patient. a) PaO2 b) SpO2 c) Mucous membrane color d) None of the above

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Correction of a Canine Left-to-Right Shunting

By Connie K. Varnhagen, PhD, RAHT

Patent Ductus Arteriosus Scrappy, a 5-year-old, 27-kg, neutered Labrador retriever, presented to the Calgary Animal Referral and Emergency (CARE) Centre in Calgary, Alberta, Canada, for mild exercise intolerance. The owner reported that the normally active dog was “slowing down” and panting excessively even after mild exercise. History The patient was the runt of its litter, was rejected by its dam, and was hand-fed for the first 5 days. A presumed innocent heart murmur was detected on auscultation at the puppy’s first veterinary examination. At approximately 6 months of age, the patient began experiencing chronic small intestine diarrhea and weight loss. Over the next 30 months, the dog was diagnosed and treated for giardiasis, coccidiosis, small intestinal bacterial overgrowth, borderline exocrine pancreatic insufficiency, and lymphocytic plasmacytic inflammatory bowel disease. Also at approximately 6 months of age, the patient developed a nonseasonal pruritus and dry, brittle haircoat. Atopy was diagnosed from punch biopsies. At the time of presentation at the CARE Centre, the patient’s chronic diarrhea was being well maintained on a hypoallergenic diet and the atopy was moderately maintained with cool baths with antipruritic shampoos and topical treatment of occasional skin infections.

Evaluation Physical examination revealed a precordial thrill, a grade V/VI continuous murmur with the point of maximal intensity over the left heart base and exuberant femoral and gingival membrane pulses. No heart arrhythmias were noted, heart rate was 60 bpm (normal: 70-120), and capillary reﬁll 32

OCTOBER 2009 | Veterinary Technician

time and mucous membrane color were normal. Lung sounds were normal on auscultation. Based on the physical examination, the differential diagnosis included patent ductus arteriosus (PDA) or another type of arteriovenous fistula. Right lateral and ventrodorsal (Figure 1) thoracic radiographs revealed cardiomegaly with left atrial and ventricular enlargement and a prominent pulmonary artery bulge. Electrocardiography (ECG; Figure 2) demonstrated a tall R wave (greater than 4.0 mV in lead II compared with a normal parameter of 3.0 mV), indicative of left ventricular enlargement, and normal sinus rhythm. Echocardiography was performed and was definitive for a left-to-right shunting PDA (Figure 3). The diameter of the PDA at the pulmonary artery was 4.8 mm. Color Doppler also revealed mild to moderate mitral valve insufficiency with at least two jets. Trivial aortic, tricuspid, and pulmonic valve insufficiency were also apparent. M-mode measurements confirmed the ECG finding of an enlarged left ventricle (left ventricle internal diameter of 6.39 cm at diastole and 4.70 cm at systole compared with normal parameters of 4.2 cm at diastole and 2.8 cm at systole for a normal dog at the same weight1) and demonstrated moderately reduced left ventricle contractility. The left atrium and pulmonary artery also were moderately enlarged. A complete blood count (CBC) revealed low normal RBCs (561/μl, reference range: 550–850), mild leukopewww.VetTechJournal.com

M.R. O’Grady; with permission

Peer Reviewed

M.R. O’Grady; with permission

Figure 2. ECG tracing, Lead II (5 fine lines vertically = 1 mV; 25 fine lines horizontally = 1 second). Normal R-wave height should be 3.0 mV.

Figure 1. Ventrodorsal thoracic radiograph. The heart is enlarged, taking up five ribs (compared with a normal heart size of four ribs), with a large left atrium and ventricle and a large pulmonary artery bulge (arrow).

nia with marginally low numbers of lymphocytes (900/μl, reference range: 1200–4500) and monocytes (200/μl, reference range: 300–1000), low granulocytes (2600/μl, reference range: 3500–12,000), and marginally low numbers of platelets (196,000/μl, reference range: 200,000–500,000). A complete biochemistry proﬁle revealed a marginally low total protein of 5.3 g/dL (reference range: 5.4–8.2), with a low globulin of 1.7 g/dL (reference range: 2.3–5.2). All other parameters were within normal limits.

Therapy To promote arterial vasodilatation and reduce afterload on the left ventricle, enalapril maleate, 0.5 mg/kg BID, was

Figure 3. Color Doppler of PDA from transverse section through the heart base. The blue color represents flow through the pulmonary artery; the green color represents the PDA jet causing turbulent flow from the higher pressure aorta, through the ductus arteriosus, and into the lower pressure pulmonary artery. LA = left atrium, RV = right ventricle, RA = right atrium, PA = pulmonary artery, PDA = patent ductus arteriosus, AO = aorta.

prescribed. Occlusion of the PDA with an Amplatz canine duct occluder (ACDO) was advised (Figure 4). The procedure was performed at the Ontario Veterinary College by M. Lynne O’Sullivan, DVM, DVSc, DACVIM (Cardiology), assistant professor of clinical studies, with Michael O’Grady, DVM, MSc, DACVIM, assisting. Because of the PDA, the patient was assessed as an American Society of Anesthesiologists (ASA) Class III, Moderate risk.2 Premedication consisted of 2 mg hydromorphone HCL administered IM. Following preoxigenation, the patient was induced with propofol at 60 mg and diazepam at 6 mg, administered to effect. A 10-mm endotracheal tube was inserted and the patient was maintained (text continues on page 36)

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Veterinary Technician | OCTOBER 2009

Peer Reviewed

Patent Ductus Arteriosus Patent ductus arteriosus (PDA) is the most common congenital cardiac defect in dogs and is caused by an incomplete closure of the fetal ductus arteriosus. Female dogs are more commonly affected and a genetic link has been suggested in many breeds.3–6 The ductus arteriosus is an arterial shunt between the pulmonary artery and the aorta that allows fetal circulation to bypass the lungs. Resistance from the fluid-filled developing pulmonary vessels in the fetus prevents blood from flowing from the pulmonary artery into the lungs. Instead, the blood flows through the ductus arteriosus and into the aorta. With respiration following birth, pulmonary resistance drops and blood flows into the lungs instead of through the ductus arteriosus. Decreased maternal prostaglandins, coupled with endogenous vasoactive and prostaglandin-inhibiting substances, are thought to support vasoconstriction within the ductus arteriosus.7 The ductus closes over during the first hours to days following birth.4–6 In PDA, the ductus arteriosus fails to close, remaining patent. Most commonly, circulation through the ductus arteriosus flows from the higher pressure aorta to the pulmonary artery (left-to-right shunting).4–6 Less commonly, pulmonary hypertension leads to circulation from the pulmonary artery to the aorta (right-to-left shunting).4–6,8,9 In left-to-right shunting PDA, a certain amount of blood recirculates through the pulmonary system and back through the left side of the heart. This results in volume overload in the pulmonary circulatory system and in the left atrium and ventricle. This in turn leads to increased pressure and hypertrophy of the affected structures.4–6 Left-to-right shunting PDA is categorized into four types, according to severity of the symptoms and clinical features:5,6 Type 1, small PDA: the animal is asymptomatic and the PDA may be identified at a puppy wellness exam. A continuous murmur may be appreciated over the left heart base. No other findings are apparent.5,6 Type 2, medium PDA: the animal is still generally asymptomatic. A continuous murmur is appreciated at the left base and apex and a precordial thrill can be felt at the left heart base. Peripheral pulses (particularly the femoral and gingival membrane pulses) may be hyperkinetic or bounding. Changes in the cardiac silhouette may be noted on radiograph, including left heart enlargement and arterial bulges. The R wave in the ECG may be slightly taller than normal. The Type 2 PDA will also be apparent in a color Doppler echocardiograph (Figure 3).5,6 Blood flowing in a vessel toward the 34

OCTOBER 2009 | Veterinary Technician

transducer will be red and blood flow away from the transducer will be blue. Thus, blood returning to the heart in the pulmonary artery will be one color and blood leaving the heart through the aorta will be another color. Blood flow across the PDA will be turbulent, with blood flowing in multiple directions. The resulting color Doppler image will be green. Type 3A, large PDA: the animal may present for reduced exercise tolerance. The continuous murmur and thrill are easily appreciated and a systolic murmur may be present due to mitral valve regurgitation. Pulses are exuberant and the gingival pulse is easily visualized. Radiographic changes include marked left-sided heart enlargement and a prominent aortic bulge (Figure 1). The R wave in the ECG is markedly high (Figure 2). The PDA is easily visualized in a color Doppler echocardiograph.5,6 Type 3B, large PDA with congestive heart failure: the animal will have all the symptoms and clinical features of the Type 3A PDA, but also will present with dyspnea and poor body condition. Clinical findings of congestive heart failure may include pulmonary edema and atrial fibrillation.5,6 Surgery or occlusion is used to correct a left-to-right shunting PDA; without surgery, up to 65% of affected dogs die within the first year.10 Surgery consists of a thoracotomy and ligation of the ductus arteriosus. Surgery is typically successful and has a low surgical mortality rate of 2%–8%.5,6,10 Occlusion of the ductus arteriosus through transcatheter insertion of embolization coils is much less invasive than thoracic surgery and also has a low mortality rate.5 Embolization coils do not completely occlude the PDA, however, and a number of cases have been reported in which the coils have migrated out of the ductus arteriosus.11 Recently, a human device to occlude vessels and heart structures has been used to occlude a PDA in a dog.12,13 Based on initial success, a canine version was created that has two discs to block off the PDA from both the pulmonary artery and the ductus arteriosus sides of the PDA.14 The Amplatz canine duct occluder (ACDO) has been successfully placed in dogs ranging in weight from 3.8 kg to 32.3 kg with PDA types ranging from asymptomatic Type 1 to Type 3A/B associated with mild congestive heart failure.14 The transcatheter insertion procedure for inserting the ACDO is only slightly more complicated than coil placement. Although the database of cases is small, there have been very few reports of device migration, and no reports of mortality associated with occlusion with the ACDO.14 www.VetTechJournal.com

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M.R. O’Grady; with permission

Peer Reviewed

on 2 L O2 and 1.5% isoﬂurane. Plasmalyte was administered via IV catheter at a surgical rate of 150 mL/hour. To treat bradycardia (induction HR = 50 bpm), glycopyrrolate RV the at 0.14 mg was administered IV. During the procedure, patient also received 2 mg hydromorphone IV and, at the end of the procedure, received 3 mg meloxicam IV. The procedure consisted of making an incision into the left femoral artery to feed the angiographic catheter and RA PA deployment device. Angiography and transesophageal echocardiography were used to measure the diameter of the ductal opening. Then, a guiding catheter was fed through the femoral artery, into the aorta, and through the ductus arteriosus to the main pulmonary artery. The ACDO with a guide wire was fed through the catheter (Figure 5). The pulmonic side of the occluding disk was deployed in the pulmonary artery and then retracted to rest against the wall of the pulmonary artery at the opening of the ductus arteriosus. The rest of the device was then deployed within the ductus arteriosus. After testing the stability of the ductal occluder and performing a last angiogram to determine

Although PDA correction is usually accomplished at a much younger age than 5 years, Scrappy has a high probability of enjoying a normal life span. complete PDA occlusion, the guide wire was unscrewed from the device and the wire and catheter were removed from the femoral artery. The femoral artery was ligated circumferentially using 2-0 absorbable sutures. The incision was closed using 3-0 absorbable sutures in a simple continuous pattern on muscle and subcutaneous layers, and 2-0 polypropylene nonabsorbable sutures in a simple interrupted pattern on the skin. The patient was recovered and administered aceproma36

OCTOBER 2009 | Veterinary Technician

M.R. O’Grady; with permission

Figure 4. Amplatz canine duct occluder.

Figure 5. Angiogram showing no flow across the Amplatz canine duct occluder.

zine at 0.6 mg postoperatively to reduce anxiety. After an uneventful night, the patient was released to the owner the next morning.

Outcome The patient’s recovery from the procedure was unremarkable. The owner reported an increase in energy and no complications from the procedure. At a 6-month follow up, the patient still panted excessively with exercise but showed no clinical signs of cardiac disease. Right lateral and ventrodorsal thoracic radiographs revealed the ACDO in place. Cardiac ultrasound demonstrated no flow across the ductus arteriosus and only trivial mitral and aortic valve insufficiency. M-mode measurements indicated minor reverse remodeling of the heart (left ventricle internal diameter had reduced to 5.11 cm at diastole and 4.50 cm at systole). To assist with continued reverse remodeling of the heart, the dog was continued on enalapril maleate, 0.5 mg/kg BID, which reduces the amount of circulating angiotensin II and aldosterone, both of which are profibrotic to the heart. Although PDA correction is usually accomplished at a much younger age than 5 years, Scrappy has a high probability of enjoying a normal life span. VT Acknowledgments: The author acknowledges the support of David L. Wright, DVM, Director, Distance Learning Veterinary Technology Program, San Juan College, Farmington, NM; Michael www.VetTechJournal.com

Peer Reviewed

Glossary Cardiac afterload—the amount of pressure placed on the left ventricle as it ejects blood into the aorta. Cardiac impulse—palpable movement of the chest wall in response to heart beat. Cardiac remodeling—change in the shape and/or size of a chamber of the heart. Cardiomegaly—enlarged heart. Color Doppler—Doppler ultrasound of flow transformed by a computer into colors reflecting direction of flow of blood through a vessel or chamber. Congestive heart failure—the heart’s pumping action is not sufficient to adequately perfuse body tissues. Contractility—the heart’s ability to contract. Ductus arteriosus—fetal vessel that allows blood flow from the pulmonary vein to the aorta, bypassing the lungs. Echocardiography—ultrasound of the heart. Hypertrophy—enlargement of the heart muscle. Mitral valve—heart valve between the left atrium and ventricle (bicuspid valve). M-mode—time motion mode of echocardiography that is used to examine thickness and contractility. Murmur—abnormal heart sound. Occlusion—obstruction or closure of an opening. Precordial thrill—palpable vibration along the chest wall in response to heart beat. Thoracotomy—surgical incision into the thorax. Transesophageal echocardiography— echocardiography accomplished by passing the probe down the esophagus to the level of the heart. Valvular insufficiency—failure of the heart valves to close completely, allowing blood flow through the valve. Vasodilatation—dilation of the blood vessels.

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R. O’Grady, DVM, MSc, Diplomate ACVIM (Cardiology), Ontario Veterinary College, Guelph, Ontario; Cameron Friesen, DVM, Friesen Veterinary Services, Edmonton, Alberta; and Samantha Crosdale, DVM, Herbers Veterinary Services, Sherwood Park, Alberta, in helping to prepare and review this case report. This report was completed as part of a course requirement for the San Juan College Distance Learning Veterinary Technology Program.

References 1. Cornell CC, Kittleson MD, Della Torre P, et al. Allometric scaling of m-mode cardiac measurements in normal adult dogs. J Vet Intern Med 2004;18:311-321. 2. McKelvey D, Hollingshead KW. Veterinary Anesthesia and Analgesia, 3rd ed. St. Louis: Mosbey; 2000. 3. Patterson DF. Epidemiologic and genetic studies of congenital heart disease in the dog. Circ Res 1968;23:171-202. 4. Goodwin J. Congenital heart disease. In: Miller M, Tilley L eds. Manual of Canine and Feline Cardiology. Philadelphia: WB Saunders; 1995:271-293. 5. Buchanan J. Patent ductus arteriosus. In: Cote E ed. Clinical Veterinary Advisor: Dogs and Cats. St Louis: Mosby; 2007: 820822. 6. Buchanan JW. Patent ductus arteriosus: Morphology, pathogenesis, types and treatment. J Vet Card 2001;3:7-16 7. Bonagura JD. Patent ductus arteriosus. In: Tilley LP, Smith FWK Jr eds. Blackwell’s 5 Minute Veterinary Consult, 4th ed. Hoboken: Wiley-Blackwell; 2007:1038-1039. 8. de Reeder EG, Gittenberger-de Groot AC, van Munsteren JC, et al. Distribution of prostacyclin synthase, 6-keto-prostaglandin F1 alpha, and 15-hydroxy-prostaglandin dehydrogenase in the normal and persistent ductus arteriosus of the dog. Am J Pathol 1989;135:881-887. 9. Brown R, Rockett A. Right-to-left shunting PDA & secondary polycythemia. Vet Tech 2008;29:538-543. 10. Eyster GE, Eyster JT, Cords GB, et al. Patent ductus arteriosus in the dog: Characteristics of occurrence and results of surgery in one hundred consecutive cases. JAVMA 1976;168:435-438. 11. Saunders AB, Miller MW, Gordon SG, Bahr A. Pulmonary embolization of vascular occlusion coils in dogs with patent ductus arteriosus. J Vet Intern Med 2004;18:663-666. 12. Smith PJ, Martin MWS. Transcatheter embolisation of patent ductus arteriosus using an Amplatzer vascular plug in six dogs. Small Anim Pract 2007;48:80-86. 13. Achen SE, Miller MW, Gordon SG, et al. Transarterial ductal occlusion with the Amplatzer vascular plug in 31 dogs. J Vet Intern Med 2008;22:1348-52. 14. Nguyenba TP, Tobias AH. Minimally invasive per-catheter patent ductus arteriosus occlusion in dogs using a prototype duct occluder. J Vet Intern Med 2008;22:129-134.

ABOUT THE AUTHOR

Connie K. Varnhagen, PhD, RAHT Connie is a professor in Edmonton, Alberta, Canada at the University of Alberta and an animal health technologist at the General Veterinary Hospital.

Veterinary Technician | OCTOBER 2009

TechTips (continued from page 9)

When inducing a patient to vomit, it is useful to have the patient vomit into a large litterbox. Vomitus can be examined quickly for the contents and is easier to clean up. Katie Hastings Grosse Ile, MI

examination and surgery room, we turned to Velcro. Apply a piece of self-adhesive Velcro to the wall and another piece to the back of the pen or calculator. No more annoying string or missing pens or calculators! Dee Brown Kitchener, Ontario, Canada

When conducting a SNAP heartworm antigen test (IDEXX Laboratories), I use a simple trick to remember how much blood and conjugate to use: • Blue has 4 letters (4 drops of blue conjugate solution) • Red has 3 letters (3 drops of blood) Michelle Blackwell Randolph, MA

Expired intravenous ﬂuids can be used as hot water bottles, after food coloring has been added to avoid confusion with unexpired bags. The staff at Salisbury Animal Hospital Salisbury, MD

Everything in Its Place Our staff was constantly losing pens and calculators. To ensure pens and calculators were available in each 38

OCTOBER 2009 | Veterinary Technician

Throughout the hospital, we have file holders on the walls that are labeled for different uses (e.g., refile, sick/surgery, check-in, medication, unfinished doctor’s charts). It is easy to place a file in the appropriate holder so files are not left on the counters. Sandee Gummo, LVT Buffalo, NY For referencing sequential radiographs we place a round, colored sticker on the radiograph and a matching one on the envelope next to the date it was taken. The sequence of colors correlates to the sequence in a rainbow, beginning with red and ending with violet. Instead

Courtesy of Lisa Powers, LVT

To keep our clinic tidy, we use inexpensive silverware dividers in each of our examination rooms. We have a slot for various items such as nail clippers, fecal loops, eye tests, and instruments. The dividers help us ﬁnd things more efﬁciently. Nicole Roberts Pearland, TX

Our emergency clinic uses hardware storage bins to keep syringes and needles handy. The bins are clear and are clearly labeled. The compartments keep the items tidy, and we know exactly where things are kept. The staff at the Niagara Veterinary Emergency Clinic St. Catharines, Ontario, Canada

Courtesy of the staff at the Niagara Veterinary Emergency Clinic

Courtesy of the staff at Salisbury Animal Hospital

To keep small surgical patients warm, we slightly heat the surgical scrub and the ﬂuid bag in an infant baby wipe and bottle warmer. The warmer has a spot for wipes where we put our scrub solution and a spot for a bottle where we put 250-mL ﬂuid bags. Danielle Apthorp Chesterland, OH

To better organize our endotracheal tubes, we made a board with expandable pen holders for the tubes. The different-sized tubes ﬁt and stay neat, organized, and easily accessible. Lisa Powers, LVT Rocky Mount, VA

Courtesy of Dee Brown

Warming Up

of having to examine each and every radiograph closely to determine the date, the color sequence allows a much more efﬁcient way of choosing the radiograph to examine. Julie Squibb Lively, Ontario, Canada

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TechTips

Courtesy of Melissa Thomas

We apply stickers to our surgery patients’ Elizabethan collar. We have a wide variety of stickers for cats and dogs, and we use sticker letters to spell out the pet’s name. We purchase the inexpensive stickers from a stationery store. Our clients really love the personalization and think it is thoughtful. Melissa Thomas Harmony, PA

Courtesy of Bethany Darling, CVT

Client Care

We find that clients often forget to bring in stool samples for their pets’ annual visit. Rather than skip the care protocol or lose revenue, we send home a fecal container with a label of the pet’s name. The client pays for the fecal flotation test at the time of the office visit, and when they bring back the container, the staff knows to which pet the container belongs. Bethany Darling, CVT Oregon, WI

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© 2009 Bayer HealthCare LLC, Animal Health Division, Shawnee Mission, Kansas 66201 Bayer, the Bayer Cross and resQ are registered trademarks of Bayer. PetLink and design are trademarks of Datamars S.A.

MC09591n

ManagementMatters

Compassion Fatigue The Cost of Caring

eterinary medicine is often more than just a career—it is a calling. It attracts compassionate, caring individuals who want to help ill or injured animals. Because of the nature of companion animal medicine, we often find ourselves helping families through suffering and sorrow. However, we do this caring work for others who are in emotional and physical pain at a cost to ourselves, the “cost of caring,” also known as compassion fatigue. Compassion fatigue can damage us and the work we do. Teams affected by compassion fatigue may contribute to a toxic work environment by becoming dispirited and cynical at work, making clinical errors, and losing a respectful tone toward clients and patients. We pay a price personally, as the work of caring becomes more difficult for us to maintain and tolerate. The veterinary practice also pays a price as compassion fatigue in team members leads to higher levels of absenteeism and turnover, excessive amounts of workers compensation claims, changes in coworker relationships, an inability of teams to work well together, aggressive behavior toward clients, unhealthy competition among the team, lack of flexibility, and rampant gossip. It is no surprise that compassion fatigue leads to increased attrition as professionals drop out of the veterinary industry. Compassion fatigue is characterized by a deep physical and emotional exhaustion and a pronounced change in the worker’s ability to feel empathy for patients, loved ones,

Katherine Dobbs, RVT, CVPM, PHR

OCTOBER 2009 | Veterinary Technician

and coworkers. It is marked by a loss of satisfaction in the career. It attacks the very core of what brought us to this vocation; our empathy and compassion for others. Compassion fatigue doesn’t stop at the end of a shift. It can seep into our home lives and affect non-work relationships. We may experience withdrawal, decreased interest in intimacy, mistrust, isolation from others, overprotection as a parent, projection of anger or blame, intolerance, loneliness, and increased interpersonal conﬂicts. Compassion fatigue affects us on many levels, and it must be fought on different levels as well. To minimize the effects of compassion fatigue and combat the personal symptoms, you must make time to take care of yourself. Try to explore or rediscover activities that bring you happiness and also allow you to step out of the caregiver mode. Learn to make yourself a priority for at least a part of every day. It is helpful to map a transition routine for the end of your workday that helps put the stresses of work behind you and allows you to come home with a refreshed, positive outlook. This could be as easy as listening to your favorite music on the drive home, stopping by a tranquil park for a few moments, immediately playing with a pet after coming through the door, or anything that helps the transition between work and home life. Because compassion fatigue lives at work, it must be fought on that battleﬁeld as well. The actions you take will www.VetTechJournal.com

ManagementMatters

not only help you, but provide relief to the entire team. This can make the organization more emotionally healthy, more productive, and more profitable. Compassion fatigue must be acknowledged. This means you need to talk openly about compassion fatigue with your coworkers and supervisors. New hires should be informed about this emotional issue that they may encounter, and team members should take compassion fatigue assessment tests on a regular basis. Staff meetings and other team communications should openly discuss compassion fatigue and its main symptoms, so everyone can recognize the enemy. When a crisis occurs, a trauma case arrives, or a longtime patient dies, recognize the effect this has on the team members and provide a safe place for them to talk about their feelings. Form a buddy system so everyone has someone to talk to and provide encouragement. One of the weapons we have against compassion fatigue is the satisfaction we get from our work. We can derive pleasure from doing the work well, and this helps minimize the effect that compassion fatigue has on us. It also helps us return each day to perform the work we For More Information: are called to do. Figley CR, ed. Treating It is important to look Compassion Fatigue. at specific stressors and Routledge; 2002. satisfiers in our work as Mathieu F. Transforming technicians. Based on Compassion Fatigue into a survey published in Compassion Satisfaction: Top Compassion Fatigue in the 12 Self-Care Tips for Helpers. Animal-Care Community WHP; 2007. by Charles R. Figley, Mathieu F. Running on Empty: PhD, the top stressors Compassion Fatigue in Health and satisfiers affecting Professionals. WHP; 2007. daily work are:

One of the weapons we have against compassion fatigue is the satisfaction we get from our work.

Figley CR, Roop RG. Compassion Fatigue in the Animal-Care Community. Humane Society of the United States; 2006.

www.compassionfatigue.org www.interfacevethr.com www.VetTechJournal.com

Stressors for Technicians Difﬁcult or noncompliant clients Problems with coworkers Not enough time

Satisfiers for Technicians Helping and healing animals Working as a team Thankful clients From this survey data, it is obvious that there are stressors facing technicians every day and that most of them have nothing to do with the animals in our care. If we can have more positive relationships with our clients, we will experience more job satisfaction. If we work as a team, minimizing conflict and distributing the work load evenly, we will experience more satisfaction from helping and healing animals. These are solid objectives that we and our practices can aim for by learning how to communicate better with both pet owners and coworkers. We will all benefit from reducing compassion fatigue in our professional and personal lives. VT

ABOUT THE AUTHOR

Katherine Dobbs, RVT, CVPM, PHR Katherine is the president of interFace Veterinary HR Systems, LLC. She is a compassion fatigue specialist and presents workshops and lectures on the topic. Contact her at ManagementMatters@sbcglobal.net.

Veterinary Technician | OCTOBER 2009 41

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Veterinary Technician | OCTOBER 2009 43

ProductForum Vetericyn, Inc.

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Veterinary VeterinaryTechnician Technician||OCTOBER AUGUST 2009 45

ClassiﬁedAdvertising TECHNICIANS WANTED

TECHNICIANS WANTED

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.

FLORIDA - Veterinary Emergency Referral Center is currently accepting applications for experienced and certified veterinary technicians for full-time surgery, emergency and overnight shifts. VERC is a 24-hour emergency and referral hospital offering cardiology, critical care, surgery and ophthalmology specialties. VERC provides a state-of-the-art, educational and friendly working environment with competitive salary and benefits. Interested applicants can call, mail or fax their resume to Cat Grantham, Office Manager. Veterinary Emergency Referral Center 4800 North Davis Highway Pensacola, FL 32503 850-477-3914; Fax 850-477-3916 website: www.vetemergencycenter.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

VETERINARY TECHNICIAN POSITION The Veterinary Specialty Center Emergency and Critical Care Services is in partnership with a state-of-the-art multi-specialty referral hospital located in the northern suburbs of the Chicago area. We are searching for talented, caring and experienced veterinary technicians. Our team-oriented approach to patient care offers the highest possible quality of care to our patients. Our creative business plan provides for an excellent work environment with outstanding compensation, profit sharing and benefits.

Send resume attention Evelyn Feekin Email: efeekin@vetspecialty.com or fax 847-459-1848

INDIANA – Full-time registered veterinary technician wanted for busy, five-doctor, AAHA-accredited small animal hospital in Elkhart. Must be a team player, have excellent organizational skills, take interest in continuing education, show motivation, and be able to multi-task. We are wellequipped with ultrasound, an in-house lab, and surgical support equipment. We offer competitive wages and benefits. Email resume to: animalcareer516@yahoo.com. MARYLAND – Head technician for high-tech small animal hospital in Laurel, Maryland. Must be experienced, certification a plus but not required. Flexible schedule, paid health plan, paid retirement plan, paid vacation, excellent salary. Fax resume to Dr. Brenner at: 301-725-2483 or email: drbb0165@aol.com. Web site: www.Brenvet.com

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

Find your job online www.vetclassifieds.com 46

OCTOBER 2009 | Veterinary Technician

FLORIDA 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

NEW JERSEY – Technical supervisors wanted. We have immediate placement, and future opportunities for growing specialty and ER/Trauma hospital in New Jersey. Looking for candidates who have good communication, management, training and technical skills to ﬁll our weekend, training and other management positions. Check out why we are becoming the employer of choice by going to: www.northstarvets.com for more details on position and how to apply.

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

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ClassiﬁedAdvertising TECHNICIANS WANTED

TECHNICIANS WANTED

CONTINUING EDUCATION

PENNSYLVANIA – Valley Veterinary Hospital is seek- VIRGINIA – Licensed veterinary technician. We are ing a certiﬁed/registered technician for a full-time position at our three doctor small animal practice. Candidate must be highly motivated, friendly, and willing to work in a fastpaced, demanding environment. Duties included, but are not limited to, in-house laboratory, radiology, surgery, dentistry, and providing nursing care. This position includes shifts on the weekends and the evenings. The hospital is equipped with an in-house lab, digital radiography, endoscopic, and ultrasound equipment and a computerized medical records system. We offer an excellent salary and beneﬁts package including paid health insurance. Fax resume: (610) 935-8116, or email: vvhgwenn@ comcast.net.

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@uvhdc.com www.uvhdc.com

growing! Full-time position available for a personable, energetic, and motivated individual. 6,400 square foot facility, multi-doctor practice (6), digital x-ray, and all new in-house lab equipment. We strive to practice high caliber medicine in a personalized and compassionate environment. Practice associated with two full-time groomers and a professional trainer. Centrally located between Richmond and Washington, D.C. If you are interested in joining our team, contact us with resume and references - attention Ashley, White Oak Animal Hospital, 10 Walsh Lane, Fredericksburg, VA 22405, or call: (540) 374-0462, or email: woah@woahvets.com.

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.)

Mid-South Regional Conference 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

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Looking to hire technicians? Place your ad in Veterinary Technician, the complete journal for the veterinary health care team. It is a must-read for technicians and the entire staff for practical information used every day. Advertising options to fit your budget. Choose from print, internet, or both…

Contact Trish O’Brien to schedule your marketing plan – we are here to assist! Call: 800-237-9851, ext. 237 or email: vettech@rja-ads.com

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Veterinary Technician | OCTOBER 2009 47

FinalView

Golden Retriever Shish Kebab Submitted by the emergency staff of Midwest Veterinary Referral and Emergency Center, Blaine, MN

iscuit, a 2-year-old, neutered golden retriever, presented to our emergency center after impaling himself on a ½-inch thick piece of rebar while running through his owner’s garden. His owners had to use power tools to cut the rebar from the ground before bringing Biscuit into the emergency center. On presentation, Biscuit was bright, alert, responsive, experiencing minimal pain, and not in shock. He had approximately 4 inches of rebar protruding from the base of his tail and 16 inches of rebar protruding from the entry point in his right inguinal region. After administration of pain medication, radiographs were taken and revealed that the rebar was bent about 90 degrees and had penetrated the skin in the inguinal region, passed through the pelvic canal, and exited through the perianal region. Our emergency staff could not cut the thick rebar in order to facilitate removal, so we called the local ﬁre department for help. After technicians anesthetized and positioned Biscuit, three ﬁremen used bolt cutters to sever the rebar at the entry point in the caudal-ventral abdomen area. The rebar was then removed from the exit point at the base of the tail using a slow, twisting motion. Because there was no resistance in extraction, the veterinarian continued to remove it using this motion. The wound was surgically explored and, fortunately for Biscuit, there was minimal internal damage. The rebar had passed through the right inguinal canal and left all major structures in the area (e.g., bladder, pelvis, femoral artery, colon, and sciatic nerve) intact and undamaged. The wound was thoroughly lavaged with sterile saline, then debrided, and two Penrose drains were placed. Biscuit went home the following evening with antibiotics, pain medication, and a new nickname—Biscuit the VT shish kebab retriever. He has since made a complete recovery.

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 300-word description of what the images are showing, how the case was treated, and the animal’s recovery. We pay $75 per published case. Send submissions by e-mail to editor@VetTechJournal.com, or mail to VLS/Veterinary Technician, 780 Township Line Road, Yardley, PA 19067. 48

OCTOBER 2009 | Veterinary Technician

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Score a free laptop!

Just score your senior preanesthetic protocols.

Win me!

Note: For this quiz, animals 7 years or older are considered seniors. 1. I run my preanesthetic profiles on the same day as the surgery for the most up-to-date results because things can change quickly and I may need to adjust my procedures. a. Always b. Sometimes c. Rarely d. Never 2. I run my preanesthetic profiles on a fasted blood sample for the most accurate results. a. Always b. Sometimes c. Rarely d. Never 3. I add a complete blood count (CBC) to senior preanesthetic profiles to assess for possible anemia, bleeding disorders and inflammatory disease prior to every anesthetic event. a. Always b. Sometimes, depends on patient c. Rarely d. Never 4. I run a full chemistry profile (minimum of BUN, creatinine, total protein, ALT, ALKP, GLU, ALB, AMYL, Ca, PHOS, CHOL, GLOB and TBIL) for every senior patient to screen for organ dysfunction and assess hydration status. a. Always b. Sometimes, depends on patient c. Rarely d. Never

5. I add electrolytes to every senior preanesthetic profile to assess hydration status and screen for abnormalities so that I can choose the best possible fluid therapy for my patients. a. Always b. Sometimes, depends on patient c. Rarely d. Never 6. I add a T4 to every senior preanesthetic profile to evaluate thyroid function prior to a surgical event. a. Always b. Sometimes, depends on patient c. Rarely d. Never 7. I add a urinalysis to senior preanesthetic profiles to detect possible diabetes or early renal disease. a. Always b. Sometimes c. Rarely d. Never

To enter: 1. Circle your answers. 2. Go to www.idexx.com/prean3 to score your test. (You’re eligible to win regardless of your score.) 3. Fax this completed quiz, including your practice name and address, to 1-207-556-6772 by November 13, 2009. 4. Be entered to win an HP laptop with a 2.0 GHz Intel® Pentium® T4200 dual-core processor. 5. For full contest rules go to www.idexx.com/preanrules.

My Score is 0-9

Let us help.To set up a free, full-staff training (we’ll even provide lunch) call 1-800-355-2896.

10-17 You may need a refresher. To set up a free, full-staff training (we’ll even provide lunch) call 1-800-355-2896. 18-21 You’re doing a great job!

Score your test at www.idexx.com/prean3 Please complete information and fax to 1-207-556-6772 to be eligible to win.

Practice Name ___________________________________________________________ Practice Phone _____________________________________________ Address __________________________________________________________________________________________________________________________ Name of Participant _______________________________________________________ Position __________________________________________________ E-mail ___________________________________________________________________________________________________________________________

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