The RVT Journal (formerly TECHNEWS) Spring 2014 by Ontario Association of Veterinary Technicians

SPRING 2014 VOLUME 37 ISSUE 3

THE

ASSOCIA TI O

REGISTERED VETERIN ARY TECHNICIAN

T VE

R T R

IN IC N AR Y T E C H

Proudly published by the Ontario Association of Veterinary Technicians (OAVT)

Focus on shelter Toronto RVTs Jenny Mykusz and Venessa Drakes volunteer at a TNR clinic. Read Where the wild things are…page 16

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Special to this issue: Focus on shelter: Shelters are full, and cats living on the street don’t always make suitable pets. Find out how Ontario RVTs are helping with local programs to get feral cat populations under control – with Trap-Neuter-Return (TNR) programs. Read Where the wild things are ........................................................................................................

Welcome to The RVT Journal (formerly TECHNEWS) Our team is working hard to bring Canadian RVTs all the great content you loved in TECHNEWS, with a new name, and a new look. Thanks for reading – and for joining us in celebrating the RVT profession!

Plus: Four things you need to know about dental x-ray installations in open treatment areas ............................................................................................

Thank you to the 2014 sponsors of OAVT’s annual conference! Your support makes continuing education better and more accessible across Canada. Thank you for supporting a series of outstanding learning opportunities for RVTs through the OAVT. Platinum Hill’s Royal Canin Bayer Zoetis

Gold Merial Silver The Personal

The 37th Annual OAVT Conference & Trade Show has been confirmed for February 26-28, 2015 at the Scotiabank Convention Centre in Niagara Falls.

The RVT Journal team Lynn Chudleigh (layout) Lisa McLean (editor-in-chief) Shirley Visser-Meier (technical editor) Thank you to our volunteer reviewers: Gemma Bell, Marg Brown, Tine Curran, Jill Gordon, Julie Lawrence The RVT Journal is a quarterly national publication with three CE articles in each issue delivered directly to your door! Making information, education, industry

news and career opportunities available to technicians - everyday and everywhere!

www.oavt.org

Regular columns:

Bronze Ceva Virbac P&G Pet Care Veterinary Purchasing

Thanks to our contributors this issue! Stephanie Allen, RVT Nancy Brock Wendy Brooks Tanya Crocker, RVT Sagi Denenberg Lynn R. Hovda Ned F. Kuehn Gary Landsberg Chris Robinson Rebecca Rose Bob Simpson Debbie Stoewen Stephanie Wills Colleen Wilson

Pro fe s s i o n a l i s m & E th i c s Reused pill bottles lead to formal complaint against RVT .....................

An e s th e s i a Anesthesia for canine dentistry and oral surgery ..................................

Beh a v i o u r Canine destructive chewing and digging ...............................................

Pha rm a c o l o g y Bethanechol ...........................................................................................

Vol u n te e ri n g Are you an adventurous RVT?.................................................................

Poi s o n i n g Methionine poisoning in dogs ................................................................

Fin a n c e How financial security planning can help answer your financial questions..................................................................................

Care e r Cultivate your career: grow gracefully leading by example ................... RVT R o u n d u p .............................................................................................

40 42

Continuing Education (CE) articles in this issue: CE1 CE2 CE3

CE article #1 – Mitral valve disease and the technician’s role in its management More than three quarters of small breed dogs over the age of eight acquire some type of valvular insufficiency such as Mitral Valve Disease (MVD). RVT Tanya Crocker outlines diagnosis and treatment – and how RVTs can help. ..................................................................................

CE article #2 – Canine nasal disease Learn the hallmark clinical signs of diseases of the nose in dogs. This in-depth look comes courtesy of Dr. Ned F. Kuehn ...........................................................................

CE article #3 – Compassion satisfaction: Flourishing in practice As veterinary caregivers, our hearts go out through sustained compassion -but our hearts can eventually give way to fatigue. Hear from Dr. Debbie Stoewen about the importance of positivity among RVTs .................................................

Don’t forget – RVTs can gain valuable CE credits by completing CE quizzes in The RVT Journal. Simply visit www.oavt.org for more details. Want to write CE articles for The RVT Journal? We are particularly interested in helping RVTs share their knowledge! Send your ideas to The RVT Journal technical editor Shirley Visser-Meier at Shirley@oavt.org.

Pro fe s s i o n a l ism & Ethics

Reused pill bottles lead to formal complaint against RVT By the OAVT complaints committee

RVTs face challenging situations and decisions every day. When an action is called into question, it may be reviewed by the OAVT Complaints Committee. This column aims to help RVTs learn from real situations about working within the boundaries and requirements of this demanding, self-regulated profession. For more information about filing or responding to complaints, visit www.oavt.org.

RVT told him that the clinic reuses pill vials.

6. That the Complainant believes that the

When the client pressed for more assurance

RVT’s actions demonstrate a lack of care

that the medication was still current-dated,

and a blatant disregard for animal

the RVT said she had an invoice from the

welfare.

compounding pharmacy, but she would not show it to the client. The RVT offered the

Decision:

client the opportunity to return the

The Complaints Committee decided that the

medication for a refund. The client declined

actions and conduct of this RVT did not

that offer, and decided to file a complaint

warrant a referral to the Discipline

instead.

Committee for determination of allegations

Allegations:

of professional misconduct or a referral to the

1. That the RVT intentionally or neglectfully

determination of incapacity. The Committee

dispensed expired medication to the

decided to strongly recommend that the

Complainant.

Respondent take the Professionalism and

Fitness

Practice

Committee

for

2. That the RVT knowingly (or neglectfully)

Ethics Course of Study being offered at

misinformed the Complainant that the

regular intervals by the OAVT. She was

A client requested a medication from his own

medication would expire in a month.

further advised to review Bylaw #2, Article 2

veterinarian. Since the client’s veterinary

3. That the RVT falsely advised the

- Professional Standards of the OAVT Bylaws

clinic did not have the medication in stock,

Complainant initially that she had

staff were able to refer him to a neighbouring

dispensed good medication in old pill

clinic. The second clinic told the client they

containers with a past due expired date

Reasons for decision:

had a one month supply of the medication

sticker on it.

In reaching its decision, the Committee

Complaint Summary:

Code of Ethics -- for her consideration.

that was leftover from another prescription.

4. That the RVT attempted to conceal an

considered the sanctions already imposed by

They told the client the medication would

error by providing assurances to the

the RVT’s employer. As it appears that both

expire “in about a month.”

Complainant that she had reviewed

disciplinary action and corrective measures

But after administering the first tablet to his

purchase invoices and had confirmed that

(in the form of the institution of new protocols

cat, the client noticed that the bottom of the

the medication was not expired.

at the RVT’s clinic) have been put in place and

pill vial stated that the medication had

5. That the Complainant believes that the

expired 9 months earlier. When the client

RVT’s

actions

were

spoke to the RVT about the expiry date, the

misleading, unethical and unprofessional.

4 The RVT Journal

intentionally

implemented, the Committee did not feel that the RVT was deserving of any actions beyond those outlined in the Committee’s decision.

CE CE articles help RVTs earn credits toward their RVT certification. Correctly answer the quiz associated with this article to earn one CE credit. www.technewsquizzes.ca/login.pl

ARTICLE #1

Mitral valve disease and the technician’s role in its management By Tanya Crocker, RVT, VTS (SAIM)

Cardiology is a specialty that requires a lot of communication. If you’re involved in the care of a cardiac patient, you need to ensure owner comfort, while also obtaining key information to optimize patient management. In this article you’ll find questions that may be asked during the initial encounter, as well as tips that will contribute to patient care and consistency – both with cardiac patients, and others in the hospital.

About Mitral Valve Disease valve leaflets with progressive loss of its Differential diagnosis mechanical properties leading to prolapse and (MVD) There are many causes for murmurs, some of Approximately 75 to 80 per cent of small breed dogs over the age of eight acquire some type of valvular insufficiency. Mitral valve disease (MVD) commonly affects small breed dogs, but it can also be acquired by larger breeds. Although MVD is one of the more common forms of heart disease encountered in small animal practice, it is not the most common cause of mortalityi. Table 1 Common breeds affected by MVD

Miniature and Toy Poodles Miniature Schnauzers Dachshunds Bichon Frises Pomeranians Cavalier King Charles Spaniels (CKCS) There are many names for MVD: Degenerative mitral valve disease (DMVD), myxomatous mitral valve disease, chronic valvular disease, valvular insufficiency and endocardiosis. All indicate a progressive disease of the connective tissue of the atrioventricular (AV) valves causing some or all of the following: thickening of valve leaflets, prolapse of valve leaflets, left atrial (LA) and left ventricular (LV) enlargement. The disease may also include progressive lengthening and possible rupture of chordae tendinae. Myxomatous degeneration can affect any of the four valves although the mitral valve has the highest incidence with the second highest occurrence being a combination of the mitral and tricuspid valves. The pulmonary and aortic valves are the least affected by degeneration.

regurgitation. Studies have shown a genetic predisposition in Cavalier King Charles Spaniels and Dachshunds.

Two studies have been done on families of CKCS and Dachshunds confirming that heredity is a major contributing factor in the transmission of degenerative mitral valve disease (DMVD)ii. It is polygenic, meaning multiple genes influence the trait. Research showed that parents diagnosed with early onset DMVD were more likely to produce offspring who also acquired early onset DMVD. Parents with later onset DMVD produced litters with a higher incidence of late onset themselves. Such findings show screening programs are essential in early detection and could eventually reduce the numbers of early onset DMVD in CKCS. Other factors such as diet, exercise and obesity were shown to play such a small role in the etiology that not much has been studied in regards to their influence on the disease.

Detection and diagnosis Auscultation of a soft heart murmur is one of the most common signs of DMVD in the early stages. The murmur will be heard best over the mitral area (the apex of the heart, also known as apical) on the left side of the chest. It can have different variations and they are not all uniform in how they present. Table 2 Murmur progression

A mid-systolic click, no murmur (third sound) A murmur with a mid-systolic click Intermittent Murmur heard with every heart beat

So how does it happen? Etiology of DMVD is unknown; the disease is characterized by progressive thickening of

6 The RVT Journal

which are normal: Physiologic murmur - this is common in athletes (both in humans and animals) Pregnancy Stress or recent exercise - both factors affect the intensity of the murmur or produce a murmur which would not be present at rest. Congenital diseases such as a mild aortic or pulmonic stenosis -- however these are left basilar murmurs! (Basilar, meaning the base of the heart, under the armpit).

How do we know? Echocardiography is the gold standard for murmur diagnosis. It provides the best information on valve morphology and function. It will also rule out congenital disease, physiologic murmurs, etc. As Mitral Valve Disease progresses, the risk of heart failure occurring increases. Heart disease does not mean heart failure. But you cannot have heart failure without heart disease present! The International Small Animal Cardiac Health Council System (ISACHC) scale is used in prognosis of heart disease. Table 3 ISACHC heart failure scale (International Small Animal Cardiac Health Council)

Class 1a - Asymptomatic with a murmur present and no heart enlargement Class 1b - Asymptomatic with a murmur present and heart enlargement Class 2 - Mild CHF, needs treatment, free from clinical signs at rest Class 3a - Severe CHF, clinical signs present at rest. Treatment at home is possible Class 3b - Severe CHF, clinical signs present at rest. Treatment in the ICU is necessary.

Mitral valve disease and the technician’s role in its management...continued

At this time there are no treatment options which halt or reverse the progression of the disease. Studies have shown pre-treating an asymptomatic patient with an angiotensinconverting enzyme (ACE) inhibitor does not improve survival time. Patients with a normal left atrium have a better prognosis. A normal left atrium would be approximately 1.2 times the size of the aorta. If a patient has an increased LA/AO ratio, they are at a higher risk of moving from a class 1 to class 2 on the ISACHC scale. Once congestive heart failure (CHF) occurs, ACE inhibitors do improve the quality and quantity of life.iii

The coughing patient

Early diagnosis is important, not only in breeding programs. It allows the veterinarian to optimize follow-up care by monitoring the LA/AO ratio and offering the best options in terms of what to treat or not to treat.

A regular log of resting or sleeping respiratory rates is the most important information a client can provide. It may be an indicator that a patient is going into heart failure. Sleeping or resting rates of a patient with heart disease should be 30-35 breaths per minute or lower. It is more representative to take the rate at home as the rate can typically rise to the mid 40’s due to the white coat effect.

Table 4.1 Signs and symptoms of the asymptomatic patient

No exercise intolerance or clinical signs Murmur is present, loudest at the left apex ECG - it is common to see a sinus arrhythmia Chest radiographs will be unremarkable with a normal vertebral heart score (VHS) Table 4.2 Signs and symptoms of the symptomatic patient

Increased respiratory rate and effort Difficulty sleeping Exercise intolerance Weight loss Decreased appetite Chest radiographs show cardiomegaly and evidence of left-sided congestive heart failure (LS-CHF) Many asymptomatic patients will not progress to CHF. Once congestive heart failure has occurred, treatment becomes mandatory. Diuretics (furosemide), ACE inhibitors (benazepril and enalapril) and an inodilator (pimobendan) are most commonly initiated. Status of the patient may also require the use of additional diuretics such as spironolactone and/or hydrochlorothiazide. Systemic hypertension may result in the addition of amlodipine.

A cough alone is not considered a clinical sign for CHF. The most important diagnostic tool in a coughing dog is chest radiographs. Geriatric small breeds are prone to respiratory diseases such as collapsing trachea and collapsing bronchi. These conditions present with a cough also, so chest radiographs are the only way to rule out respiratory versus cardiac disease.

Patient monitoring at home

Management of cases There are three important factors to managing these types of cases. A good history is the first step in management. Chronic cardiac cases require communication with the client(s) on a regular basis. Establishing a good rapport with both pet and owner at the initial exam can be very important. Consistency in how you perform the physical exam is also essential. Performing your physical exam identically on every patient allows you to pick things up that you may miss if every patient is examined differently. Finally, client communication or follow up is essential to monitoring how the patient is doing at home.

The physical exam Start with respiratory rate before handling the patient; if it is increased take a few readings over the course of the exam. Take note of: ❑ Increased effort - inspiration or expiration ❑ Flared nostrils ❑ Wet sounds, crackles on thoracic auscultation 7 The RVT Journal

❑ Mucous membrane colour, capillary refill time (CRT)

Noninvasive blood pressure (NIBP) The most common ways of obtaining NIBP are by Doppler and oscillometric devices. Doppler uses a change in the frequency emitted from ultrasound reflected from the circulating red blood cells or walls of the vessel to detect blood flow. This frequency is converted into an audible frequency. The oscillometric method inflates the cuff, then the microprocessor within the unit measures and averages the pressure oscillationsiv. The Doppler provides the most accurate measurement on patients with arrhythmias. As pulse strength can vary in many arrhythmic patients, due to type and number of irregular heartbeats, this irregularity may produce incorrect results with an oscillometric device. Therefore consistency is very important. The veterinarian needs to know if a reading of hypertension or hypotension is correct in order to treat the patient accordingly. The patient should be allowed to acclimatize to the testing area. Consider testing the patient in the owner’s vehicle if the patient typically becomes more anxious during long periods at the hospital. Note the cuff size and limb used as well as patient positioning. Ideally, the patient should be in lateral or sternal recumbency. If the patient will not lie down and standing is your only option, hold the paw up. The limb should be held at, or close to, the level of the right atrium.v Note positioning used in the record. A series of 5 to 7 consecutive readings are taken. The highest and lowest are discarded and the remaining are averaged. It is very important to use the correct size of cuff! Cats require a cuff 30% to 40% of limb diameter, and dogs require a cuff 40% of limb diameter. To find the correct fit you may use a measuring tape or use a cuff. Wrap it around the limb and note where the end meets. Fold the cuff in half at that point. This will be fifty percent of the cuff. Measure another cuff against it and you can approximate thirty percent and forty percent.

Mitral valve disease and the technician’s role in its management...continued

Auscultation Learning to auscult a murmur comes with time and listening to many patients, as well as knowing how to use both the diaphragm and bell functions on your stethoscope. The bell (the small side of a dual-sided stethoscope) is better for higher pitch sounds, such as gallops. If you have a Cardiology 2 stethoscope the bell function is accessed by applying more pressure whereas on an electronic stethoscope you press a button. Listening to patients in a quiet area of the hospital is a must. Quiet murmurs will not be heard in the middle of a busy treatment area! Questions to think of as you auscult may include the following:

✔ What is the heart and pulse rate? ✔ Is the patient tachycardic or brady-

✔

✔ ✔ ✔

cardic? Does the stressed cat have a heart rate of 120bpm or 240bpm? 240 represents a normal rate for cat in hospital, 120 represents a potential problem. Are pulses strong and synchronous or is there an arrhythmia? Are pulse deficits present? Are they weak or poor? Is there a murmur present? Where does it sound the loudest? What does it sound like? Can you feel the murmur when you place your hand on the chest? Is a gallop present? Do you hear crackles?

Taking a history

6. How is the appetite? 7. Has there been any increased drinking/urinating? With many of these questions if the owner answers "yes" you may ask the following: a. How long ago did the exercise intolerance/coughing/syncopal episodes start to happen? b. How long do the episodes last? c. In regards to syncope, are they limp or is there any "paddling" during an episode? Is the patient coherent? d. Does anything specifically cause the coughing/syncopal episodes/increased respiratory rate, i.e. during exercise, pet is stressed, only at night, or are the events at any time (even at rest)? e. How frequent are the episodes?

Radiographs As Mitral Valve Disease can be assessed by serial radiographs, ensuring correct positioning and technique will help the clinician effectively diagnose and monitor their patients. A few key points to remember would be:

❑ Cone down to include just the chest. "Chabdomens", "cat-o-grams" and such do not provide the best detail and it is not as safe for the operator. ❑ To effectively measure the vertebral heart score and monitor for signs of heart failure, the patient needs to be as straight as possible. An oblique view of the heart can make normal areas look abnormal and likewise can hide abnormal findings.

A detailed history provides the clinician with possible clues and could help with a diagnosis. The following are some questions you may ask the owner:

❑ Wear lead gloves, thyroid protectors,

1. Has the pet had any exercise intolerance or decreased energy level? 2. Have there been any episodes of fainting or collapse? 3. Has there been any coughing? 4. Has there been a change in the breathing pattern? 5. Is the pet on any medications? Note dose, frequency and when the pet last received any.

❑ Most patients may be safely and easily

dosimeters and lead gowns. Also, for your own safety, keep your hands out of the beam! placed on the table and held with various types of bean bags and tape for positioning allowing the operator to take the radiograph either behind a lead barrier or outside of the room. Sedation is also a tool to that can be safely utilized, even with cardiology patients.

8 The RVT Journal

Electrocardiograms (ECGs) Obtain ECGs with the patient in right lateral recumbency (reference values only apply to right lateral recumbency.) If the patient cannot tolerate lateral recumbency, an ECG can be obtained in any position, but the resulting ECG can only be interpreted in terms of rhythm analysis.

❑ A single lead ECG is of limited diagnostic value in many cases. Try to always acquire at least a 6-lead ECG. (Leads I, II, III, aVr, aVl, aVf). Ideally, try to also obtain chest leads if the machine has this option. ❑ Place clips distal to the elbows and stifles. If leads are placed on the chest, patient respirations and shivering will cause artifact on your ECG. ❑ Ensure good contact with either coupling gel or alcohol. ❑ Take your time to ensure the best quality tracing. It may take a few minutes before the patient calms down enough to get a measurable tracing. In conclusion, this article was written as a guide to help you become familiar with not only cardiac patients but also to consider how the methodology behind the most basic TPR can greatly assist you and your veterinarian in the provision of optimal care. Even after 18 years of practice there are things I learn on a regular basis, which really is the beauty of medicine and part of what makes this job so interesting. I hope I have provided a nugget or two of information that helps you. Full references for this publication are available at www.oavt.org.

Tanya Crocker Tanya is a 1996 graduate of the Veterinary Technician program at Ridgetown College of Agricultural Technology (now associated with the University of Guelph) in Ontario. She has worked at Canada West Veterinary Specialists (www.canadawestvets.com) for over 12 years. In addition to working in the ICU/Wards and other services, she was the service coordinator for Internal Medicine for over 8 years as well as coordinator for the Cardiology service for 3½ years. She was among the first graduates of the Small Animal Internal Medicine Specialty through the AIMVT. Outside of work she spends her time mountain biking and enjoying the West Coast lifestyle.

Anesthesia

Anesthesia for canine dentistry and oral surgery By Nancy Brock, DVM, Dip ACVA

Those of you working in private general practice know that dental procedures are some of the most frequent procedures requiring canine anesthesia. And they represent a significant source of income for small animal practices. So, it’s worth investing the time and energy in establishing dental anesthesia standard operating procedures (SOP) that are robust enough to ensure a positive outcome for every patient and minimize the incidence of adverse events. Think of a patient that leaves your hospital after a successful (i.e. uneventful) dental surgery as a walking advertisement for your practice’s high quality care. A robust dental anesthesia SOP needs to effectively address the unique challenges that dental surgery presents, such as: 1) Prolonged duration of sometimes unexpectedly

Pre-anesthesia evaluation:

Whenever possible, evaluate the extent of oral pathology in order to anticipate the degree of postoperative pain and the duration of anesthesia. You’ll need to be flexible though, as the full extent of oral pathology is often not determined until the patient is under anesthesia and dental radiographs have been performed. Be cautious about scheduling anesthesia and dentistry for a dog that is anorexic and losing weight. Weight loss and even anorexia are rarely caused by dental pain. So, it’s wise to look for another explanation for such symptoms before proceeding. A full investigation of the patient’s underlying health is highly recommended to avoid postoperative complications and poor recovery.

anesthesia,

2) Aged patients with concurrent diseases 3) Oral pain I believe that all patients undergoing dental procedures should be anesthetized with an endotracheal tube (ETT) secured in place to ensure a patent airway and prevent aspiration. This is a contentious issue that is currently being debated within the veterinary community. See www.avdc.org/dentalscaling.html. For a brief period, after the introduction of medetomidine as a veterinary sedative, I attempted to provide dental cleaning and oral radiography using sedation only. I quickly abandoned this practice as it presented too high a risk of injury to the dentist and the patient. The instructions that follow address the special anesthesia and analgesia challenges associated with canine dental procedures.

Anticipated problems: The following potential problems are associated with all anesthesia delivery: 1) hypotension, 2) hypoventilation, 3) hypothermia and 4) hypoxemia. Depending on the patient’s health status, duration of the procedure, support and the anesthesia drug protocol selected, these problems may be mild, moderate or severe. In addition, problems that are particular to dental/oral surgery need to be considered and planned for: 1) Tracheal and pharyngeal trauma due to repeated endotracheal tube motion 2) Post-extubation airway spasm and obstruction as a result of pharyngeal trauma and fluid accumulation

Premedication:

All patients undergoing general anesthesia benefit from premedication. Choose from among the following to facilitate IV catheter placement and handling: Acepromazine 0.05 mg/kg + butorphanol 0.2 mg/kg IM Acepromazine 0.05 mg/kg + meperidine 4.0 mg/kg IM Acepromazine 0.05 mg/kg + oxymorphone 0.05 mg/kg IM Note: Higher risk of vomiting Acepromazine 0.05 mg/kg + hydromorphone 0.05 mg/kg IM Note: Higher risk of vomiting (Dex)medetomidine 5 ug/kg IM can be substituted for acepromazine to achieve heavier chemical restraint. If an IV catheter can easily be placed without chemical restraint, consider butorphanol 0.1 mg/kg + midazolam 0.1 mg/kg IV.

Add atropine 0.02 mg/kg OR glycopyrrolate 0.01 mg/kg IM to the above protocols except when (dex)medetomidine sedation is chosen. Notice how the premedication options above do not contain anything to address pain. That is by design. Patients undergoing dental surgery are rarely in acute pain unless they have suffered a head injury. The purpose of premedication is to calm the patient and facilitate handling. Pain control comes afterward, once the patient is under anesthesia and can undergo dental nerve blocks. Opioids that are excellent analgesics are unfortunately poor premedication choices when the goal is to calm a patient.

3) Tracheal aspiration of fluid and solid material 4) Post-operative pain

Induction: Choose from the following:

5) Excess bleeding during maxillary tumour resection and

IV Alfaxan

6) Venous air embolism during use of dental drills.

IV propofol

10 The RVT Journal

IV pentothal

Anesthesia for canine dentistry and oral surgery...continued

Support:

IV ketamine + diazepam – preferred if intra-operative ketamine constant rate infusion (CRI) is planned

• Blood •

IV propofol + ketamine – preferred if intra-operative ketamine CRI is planned Mask induction presents no safety advantage compared to IV anesthetic induction. I discourage its use as it is resented by most patients especially those with facial or oral discomfort and exposes the anesthetist to unacceptable levels of waste anesthetic gas.

•

Maintenance:

Deliver sevoflurane or isoflurane by endotracheal tube. For maxillary resection, and anytime you are unhappy with the level of analgesia provided by dental nerve blocks, supplement inhalant anesthesia with your choice of opioid ketamine CRI or a combination of the two.

•

Monitoring: Part of the power of SOPs is that they instill a series of steps that ultimately become routine, ensuring that certain aspects of patient care are not accidentally omitted. In addition to a trained and attentive anesthetist, below are my standard monitoring SOPs:

•

pressure with either an oscillometric or Doppler-based monitor Temperature - either nasal or esophageal - you might be surprised at just how quickly and profoundly your patients become hypothermic Heart rate and rhythm via some form of continuous audio (ECG, pulse oximeter, Doppler sound) so that you don’t miss an episode of sudden bradycardia associated with vagal stimulation during dental manipulations. I also place an esophageal stethoscope before the other monitors are operational and as a back-up in case the audio disappears unexpectedly. Respiratory rate and rhythm - this requires keen powers of observation and a thorough knowledge of what is normal and what is abnormal when it comes to breathing patterns Verifying an intact ETT cuff seal by intermittently delivering a breath and listening for gas escaping around the mouth Blood loss assessment - keep a close eye on the amount of blood loss during maxillary surgery

11 The RVT Journal

Sometimes a patient needs to remain under anesthesia for longer than anticipated as a result of extensive dental pathology or difficulties with extractions. It is never a “bad” decision to complete the dental surgery in two separate visits. However, if a healthy patient is properly supported so that monitoring trends demonstrate a pattern of stable vital signs, this patient can remain under anesthesia for many hours. My record is 7.5 hours of anesthesia for a patient undergoing problematic dental surgery. The patient was well supported and monitored so that we were able to ascertain that vital signs were within normal limits and stable. What kind of support is required to provide these working conditions for the dentist? Heat supplementation to prevent hypothermia – ensure that the heat source has a thermostat and does not come in direct contact with the patient. Thermostats can fail though, so it is important to run your hands between the heat source and the patient to ensure that the proper amount of heat is being delivered. Accidental patient burning is painful and avoidable. It is also deleterious to a practice’s reputation. The accidental burns that I have heard of have involved some or all of the following circumstances: 1) failure or absence of a thermostat 2) direct contact between the patient at the heat source 3) prolonged contact with the heat source and 4) wet fur. IV fluid therapy should continue throughout the entire period of anesthesia but at a tapering rate to avoid iatrogenic fluid overload in the event of a prolonged surgical period. AAHA has recently published their fluid therapy recommendations: https://www.aahanet.org/PublicDocuments/F luid_Therapy_Guidelines.pdf

Anesthesia for canine dentistry and oral surgery...continued

The guidelines are well thought out and discourage a one-size-fits-all for fluid therapy during anesthesia. The hourly crystalloid fluid rate for dogs under anesthesia is 5 mL/kg/hour to be reduced during longer periods of anesthesia. Crystalloid alternatives are suggested when hypotension is refractory to fluid therapy.

Post-dentistry analgesia: A few recommendations to maximize your success with dental nerve blocks: • Perform dental blocks with bupivacaine

prior to all extractions. • Time the dental nerve block placement so

•

• •

Special instructions to avoid anesthesia-related complications: • Avoid harsh movement of the ETT during •

•

patient positioning. When changing the patient’s position, temporarily disconnect the ETT from the breathing circuit. This prevents tracheal trauma and accidental kinking of the ETT. Minimize the number of times you turn a patient over from side to side. I have a “1 flip” rule that I enforce in order to avoid hypotension that can occur when a patient is repositioned side to side. At the end of a dental procedure, while the patient is still unconscious, inspect the caudal pharynx with a bright light source to detect and remove particulate and fluid material from the throat before extubation. If you are concerned that material has traveled down the trachea, remove the ETT with the cuff partially inflated.

•

that at least 5 and preferably 10 minutes elapse before surgical manipulation starts. Placing a nerve block and then performing non-painful manipulations such as dental radiographs, charting or cleaning is a way to use up some of the time required for bupivacaine’s onset of effect. Do not dilute bupivacaine with lidocaine or saline as this will delay the onset and shorten the duration of the analgesia. 0.2-0.5 mL/site is my recommended volume of bupivacaine to instill. 2 mg/kg total dose (0.4 mL/kg of 0.5% bupivacaine) is an acceptable dose. At this dose, there is no need to dilute the bupivacaine and there is probably enough volume to permit a repeat of a block if it appears to be patchy or ineffective. Follow the nerve blocks with intraoperative injectable carprofen or meloxicam. These can be dispensed as home analgesia for 3 or more days post-

dentistry. Be sure to document effective urine concentrating ability by way of a urinalysis before prescribing NSAID medication to go home with the patient. • Systemic opioid use in combination with dental nerve blocks may predispose to post-anesthesia agitation or dysphoria after dental extraction surgery, but is appropriate after maxillary surgery. Note: The above approach to analgesia for oral surgery works well for all procedures except maxillary surgery: maxillary surgery is usually associated with underlying cancer and the surgical site cannot be rendered completely numb with local nerve blocks. So, systemic analgesia is required perioperatively and extending out a week or more after surgery.

recommends Do you know a dog or cat with motion sickness? Rumour has it, Elizabethan collars are a drug-free way to nip nasty nausea on car rides. Do you have a tip to share?

Email it to lisa@oavt.org.

Nancy Brock Dr. Nancy Brock obtained her DVM degree from the University of Guelph in 1982. She practiced at Picton Animal Hospital until 1984 and the London (Ontario) Emergency Clinic until 1985. She completed a residency in anesthesia and critical care at the University of California, Davis in 1988. In 1995, she became certified as a veterinary anesthesia specialist and is a Diplomate of the American College of Veterinary Anesthesiologists. Based in Vancouver, BC, Dr. Brock is a regular contributor and consultant for the VIN (Veterinary Anesthesia Network) and is also a clinical instructor at Douglas College’s AHT program in Coquitlam, BC. As part of her anesthesia referral practice, Dr Brock provides veterinarians and their nursing staff with anesthesia assistance and expertise via telephone consultation, the in-clinic delivery of anesthesia to high risk or fragile patients and the training of veterinarians and technicians in advanced anesthesia techniques.

12 The RVT Journal

Give your VIP*s the cleanliness they deserve

*Very Important Pets

Cleaners Dupont Neutrafoam Biosolve Plus

Disinfectants Biosentry 904 Clinicide Virkon & Virkon Tabs www.vetoquinol.ca

To protect VIPs that come into your clinic, no need to roll out the red carpet. Simply ensure that you have a good biosecurity protocol, and apply it every day.

Need more information? Consult your Biosecurity specialist: Vetoquinol!

Cover story

Where the wild things are Ontario TNR programs require TLC from dedicated volunteers By Lisa McLean

In 2008, Roxanne St. Germain set out to help a homeless cat near her workplace in Gormley, Ontario. She managed to trap the cat using an old raccoon trap, but when she tried to get help to spay the cat, the message she heard was consistent across the board: the cat would be put down because it was feral. Feral cats like the one St. Germain found have been born outside to lost or abandoned pets that were not spayed or neutered, and most have had little to no human contact. Others may have once lived in a home, but find themselves homeless and struggle to survive and try to adapt to life on the streets.

What is TNR? For many shelters around the world, TrapNeuter-Return (TNR) programs are the preferred solution to reducing the population of cats that cannot be tamed and placed in homes. TNR is a method of trapping unaltered feral cats, spaying or neutering them – as well as providing other care such as vaccinations – and then returning them to live out their natural lives in their colonies. When possible, adoptable cats and kittens are removed from the colony. Toronto has three clinics that offer free spay/neuter services as part of the city’s TNR program. TFCP is part of a group called the Toronto Feral Cat TNR Coalition that also

A perpetual cycle of breeding, fighting, and raising litters of kittens will lead to a drastically shortened life for the cats. St. Germain returned the cat she caught to the wild. She later retrapped it when she found a vet to help her. “The average feral cat is not adoptable, and shelters are full,” St. Germain says. “If you bring in a feral cat from outside, you would be on your own.” It’s a similar story across Ontario. The Canadian Federation of Humane Societies (CFHS) offers a low estimate that there are at least 100,000 homeless cats living in the

offers a trap loan program, and works with another member of the organization, Toronto Street Cats, that makes and distributes cat shelter structures and helps to source and distribute cat food that is occasionally donated to help offset volunteers’ out of pocket expenses. St. Germain says the program’s success lies largely with a team of dedicated volunteers who work tirelessly every day to no matter what the weather. “We want to get colonies on the radar, so we know where they are and we can help the colony, caretakers and community,” St. Germain says. “The cats know when the food comes out, and cats are ruled by their hunger. They need to be the ones to come to us.”

15 The RVT Journal

streets of Toronto alone. And with unsterilized female cats producing up to 25 kittens per year, the problem will continue to grow. Today, St. Germain is a board member with the Toronto Feral Cat Project (TFCP). She’s among the volunteers who lead a training program for colony managers and caretakers — volunteers who identify and feed feral cat colonies in their area and perform TNR. Volunteers are required to take workshops offered by TFCP to learn proper protocol before they can access services to help the cats.

While homeless cats can become a nuisance in some neighbourhoods, St. Germain says the most common obstacle is the lack of education among the public. St. Germain frequently encounters members of the public who are unaware that the cats they see on the street are homeless. A common myth is the cats are there because volunteers are feeding them, but St. Germain insists the cats are already there – feeding them keeps them healthy, and allows volunteers to schedule TNRs. “Cat overpopulation in Toronto is no bigger or smaller a problem than anywhere else in the world,” St. Germain says. “But in Toronto we’re doing something about it. We are slowly moving from reactive to proactive.”

Where the wild things are...continued

Bateman says like many shelters, the Guelph Humane Society is forced to assess the sociability of cats that are brought into the shelter. Keeping a feral cat in shelter presents more challenges because it’s stressful for the cat, and if the cat carries a disease, there’s danger in affecting other cats in the shelter. “Cats have a different nature and they’re more successful at producing homes outside – they can scrounge,” Bateman says. “They form social units. They don’t have a horrible life.”

Looking for numbers

For many shelters around the world, TrapNeuter-Return (TNR) programs are the preferred solution to reducing the population of cats that cannot be tamed and placed in homes.

The problem with cats Shane Bateman, Chair of the Guelph Humane Society (GHS) and veterinarian and Emergency/Critical Care clinician at the University of Guelph's Ontario Veterinary College (OVC), says part of the problem with cats is that for many families, cats are seen as less of a family member than dogs tend to be. He says families don’t pursue spay or neuter procedures unless cats are causing problems in the home. And if they run away or escape to live in the street, those unaltered former pets contribute to the overpopulation problem. “About 20 years ago we also struggled more with dog overpopulation,” Bateman says. “Today, dogs have a more prominent role in the family. And we have far too many cats than we have homes that want them.”

Bateman is leading the charge on the Guelph Cat Population Task Force, a new collaborative group bringing together stakeholders from a variety of viewpoints and disciplines. Bateman says TNR programs are one solution to cat overpopulation issues, but in order to implement any program that tackles the issue, community buy-in, government support and cooperation from the veterinary community are key. “Part of what makes our project somewhat unique is that the Guelph Humane Society has come to this challenge, and we’ve recognized it’s not just our problem, but a community problem,” Bateman says. Existing data about feral cat communities is largely unreliable, because much of it comes from the United States, where cold weather plays less of a factor. Likewise, there are stakeholders who claim feral cat communities can have a devastating effect on wild bird populations, but Bateman notes much of the research around bird models is based on theoretical and anecdotal evidence. Because Guelph is uniquely situated in a university community, the Guelph task force is inviting researchers of all disciplines to get involved. Bateman reports one obvious partner is the OVC, but he’s also bringing

16 The RVT Journal

wildlife biologists and social scientists into the fold, so the group can look at all angles. “How much do we recognize this as a community issue? What can we do with minimal impact on the cats? Animal welfare agencies strongly advocate TNR, and if that is truly the best approach, we need to work on producing data that demonstrates it,” Bateman says. Bateman says TNR programs require substantially more human resources, and their success is largely dependent on support from the local veterinary community. His group plans to launch a website that will put the issue to the Guelph community, and gauge community support for strategies that will contribute to managing cat overpopulation. “We hope with this project there will be less conflict and more cooperation, as we encourage stakeholders to see issues from other perspectives,” Bateman says. “If the Guelph community supports TNR, then the Guelph Humane Society will seek funding to begin addressing pockets of the city that have high percentage of cats not attached to homes.”

TNR: an RVT’s perspective Jenny Mykusz is an RVT working at the Toronto Humane Society (THS). Twice each month, she caps off her regular eight-hour shift with a second eight-hour shift, volunteering in the TNR clinic at THS. Mykusz became involved in volunteering for the TNR clinic three years ago, when a friend who volunteered was going on maternity leave. She says there’s valuable experience to be gained in volunteering. “A lot of feral cats aren’t used to humans. When there’s an angry cat to manage, I’m the one they come and get - you have to have nerves of steel,” Mykusz laughs “But mostly

Where the wild things are...continued

“A lot of feral cats aren’t used to humans. When there’s an angry cat to manage, I’m the one they come and get - you have to have nerves of steel.” they’re not angry, they’re petrified. They get super still. They don’t want you to look at them. I try to be quiet and respectful of their space.” Mykusz says RVTs can bring a lot to the fast pace of TNR clinics, where there are several volunteers and veterinary teams in place at one time. RVTs can be responsible for drug logs and paperwork, and can generally bring organization to the chaos. “RVTs have a lot to offer if they want to volunteer for TNR,” Mykusz says. “They can net and pre-med the cats, help with exams, prep the cats for surgery and monitor in surgery and recovery.” Mykusz adds one of her main roles (while premedicating) is in regulating the flow of animals into the surgical suite. “I have to make sure that I have enough animals sufficiently sedated to keep three surgeons busy. I also have to know how long each surgery will take and alternate between males and females to keep the animals moving through,” she says. Bateman too, suggests RVTs have a lot to contribute to the feral cat discussion. Whether it’s hands-on volunteering in clinics in their community, or helping to educate clients on best practices, he says RVTs have their finger on the pulse of what people who love animals think about these issues. “RVTs are enormously well positioned to be strong advocates for these kinds of studies and programs in their own communities,” Bateman says. “And when projects get started, their success always depends on knowledgeable people.”

The State of Spay-Neuter in Canada by the Numbers Canadian Federation of Humane Societies (CFHS)

$229 –

cost of adoption of a cat or kitten at Guelph Humane Society in Canadian dollars (includes sterilization, microchip identification implant, vaccinations, deworming, cardboard carrier, collar and identification tag, bath, 6 weeks Pet Insurance, taxes)

52 –

percentage of Canadians that acquire cats as strays, from friends and relatives, as giveaways, or from their companion animal’s offspring.

119,000 – low estimate of

19 –

percentage of Canadians that acquire cats from a pet store or breeder

number of cats taken in by Canadian shelters in 2012

2number million – of intact cats

25 –

in homes in Canada

percentage of Canadians that acquire cats from a humane society, SPCA or shelter.

100,000 – low estimate of the number of homeless cats living in the streets of Toronto

$547

25 –

number of kittens one unsterilized female cat can produce in one year

– percentage of cats entering shelters that have already been spayed/neutered

17 The RVT Journal

– cost of cat spay in Ontario in 2013 in Canadian dollars.

40,000 – low estimate of number of homeless cats in the Halifax Regional Municipality

Four things you need to know about dental x-ray installations in open treatment areas By Bob Simpson

In July 2012, the Ministry of Labour (MOL), published the “Veterinary Dental X-Ray Machine Installation” guidelines for the safe installation of dental X-ray systems. The guidelines are intended to help the workplace parties understand some of their obligations under the Occupational Health and Safety Act. As a 33-year veteran of the veterinary equipment business, here are some key insights I’ve picked up in my efforts to successfully install dental X-ray equipment in clinics.

1. Rejections are common

Andrea Jaskula (left) and Kelly Canham, RVT, use x-ray equipment at their clinic in Hamilton, Ontario.

Many veterinarians see their applications to install dental x-rays in open treatment areas denied. In April 2011, I contacted the MOL and asked why this was happening. The MOL replied that the applications all contained information that was not in conformance to the MOL guidelines. I was referred to an article in the OVMA’s FOCUS July/August 2007 magazine called SMILE! You Have Decided to Install a Dental X-Ray Machine! but was no further ahead with helping the veterinarians.

2. The guidelines are murky

Bob Simpson Bob Simpson is the owner of Canmedical, Veterinary Equipment Exchange Network, Canadian Radiographic, and C3 Contamination Control Corporation, and has 33 years experience in the veterinary equipment business. www.canmedical.ca

I started to dig deeper and discovered, with the help of the MOL, that much of it was subject to an individual inspector’s interpretation. I discovered that, as with many applications of legislation, what one inspector might deem acceptable, another may disagree with. The only way to get the approval process to work smoothly is to apply the rules in a way in which all the inspectors could relate. Door interlocks, for example, had to be defined, even though I could find no published the MOL definition for one. We

18 The RVT Journal

have had to learn what “engineered controls”(e.g. machine guarding, hazard controls) means, and how it is applied to veterinary clinics. Consulting a safety professional will greatly assist you.

3. It’s not the MOL’s job to educate you Keep in mind that the MOL's job is not to tell you how to make equipment installation work for your business. Their job is to approve or deny applications, and to monitor radiation sites and employee safety. Either the veterinarian or the company supplying the dental X-ray needs to make an application for approval based on the rules that are in place.

4. You have other options When your application is denied, clinics have other options. Some may wish to install the dental x-ray in their x-ray room, which is not always convenient, or they may build separate dental rooms, which can be cost prohibitive. Others, still, may opt to hire a safety professional to assist an equipment supply consultant, and help them navigate the approval system on their behalf.

ARTICLE #2

Canine Nasal Disease Ned F. Kuehn, DVM, MS, DACVIM (SAIM)

CE articles help RVTs earn credits toward their RVT certification. Correctly answer the quiz associated with this article to earn one CE credit. www.technewsquizzes.ca/login.pl

The hallmark clinical signs associated with diseases of the nose, paranasal sinuses, and nasopharynx are sneezing, nasal discharge (serous, mucoid, mucopurulent, mucohemorrhagic, hemorrhagic), reverse sneezing, obstructive nasal breathing, and soft cough or clearing of the throat (due to postnasal drip). These clinical signs are not necessarily limited to primary nasal disease as they may be seen with certain systemic and extranasal disorders. The wide varieties of disease that may be associated with nasal clinical signs are given in Table 1. The type of nasal discharge is not characteristic for any specific disease. Mucopurulent nasal discharge is most common and indicates bacterial colonization or infection secondary to an underlying disorder that has damaged the nasal mucosa. Primary bacterial infection is an exceedingly rare cause of rhinitis in dogs. Mucopurulent and serous discharges may be blood tinged as a result of mucosal erosion. Epistaxis usually results from an underlying nasal disorder causing erosion of a major blood vessel but also may be seen with systemic disorders such as coagulopathies, hypertension, vasculitis, or hyperviscosity syndrome.

Diagnosis The principal diseases associated with chronic nasal disease are sinonasal neoplasia, idiopathic lymphoplasmacytic rhinitis, and fungal rhinitis1 (Table 2). Clinical history and physical examination findings generally offer an indication of primary nasal disease as opposed to systemic or extranasal disease. Routine laboratory tests (complete blood count, serum chemistry panels, urinalysis), coagulation profile, blood pressure, and thoracic radiographs are important to rule out most of the systemic or extranasal causes of nasal discharge. Cytologic evaluation of nasal discharge is rarely helpful and not routinely suggested. Performing bacterial and fungal cultures of nasal discharge is not recommended because results are nonspecific and simply represent resident bacteria and fungi. Empirical antimicrobial treatment is not advised and merely delays definitive diagnosis. Any dog with nasal disease of greater than 2-week duration merits detailed diagnostic evaluation.

Diagnostic Imaging Diagnostic imaging studies are performed with the patient under anesthesia. Imaging studies often are essential in dogs with chronic rhinitis to help reach a diagnosis. It is critical that imaging studies be completed

before rhinoscopy or collection of intranasal samples so that blood from secondary hemorrhage does not obscure subtle lesions or affect the quality of diagnostic images. If dental disease is suspected, dental radiographs are recommended to evaluate teeth and surrounding structures. Radiographic images of the nose and sinuses may provide some insight but often do not reveal a specific cause of the nasal disease. Radiographs often lack sufficient resolution to identify or localize early nasal disease. Computed tomography (CT) is vastly superior to plain radiography of the nasal cavity2. Nasal CT provides a thorough assessment of the nasal cavities and paranasal sinuses and provides superior insight into the nature and extent of disease. Contrast-enhanced CT images are useful to distinguish between vascularized soft tissue and mucus accumulation. Because nasal CT clearly demonstrates the location and extent of nasal disease, it is often used to help guide postimaging rhinoscopic and biopsy procedures. The referenced articles here provide a comprehensive review of nasal radiography3 and nasal CT4, respectively. If routine diagnostic steps do not provide a cause for rhinitis, referral to an institution providing CT imaging is advised.

20 The RVT Journal

Rhinoscopy Rhinoscopy should be performed only after all imaging studies are completed and with the patient still under anesthesia. The nasopharynx is examined before the nasal cavity, because if hemorrhage is induced by examination of the nasal cavities, blood frequently pools in the nasopharynx and obscures visualization of this area. Retroflex nasopharyngoscopy is performed by turning a small flexible scope 180 degrees around the caudal margin of the soft palate to evaluate the caudal nares, dorsal soft palate, and nasopharynx. Anterior rhinoscopy may be limited by the size of the nasal cavity compared with the size of the scope, lesion location, and difficulty in visualizing intranasal structures because of mucus or hemorrhage. The convoluted nature of the nasal passages does not allow for evaluation of the entire nasal cavity, thus foreign bodies and neoplastic masses may be overlooked. Procurement of nasal specimens and biopsy of nasal tissue should be performed only after imaging and visual examinations are completed and while the patient is still under anesthesia. This author prefers to use nasal CT images to guide instrumentation for procurement of biopsy samples. During the biopsy procedure it is recommended that the dog be in sternal recumbency with the rostral end of the nose directed downward to

Canine Nasal Disease...continued

facilitate drainage of escaping blood away from the nasopharynx and oropharynx. Following biopsy, the tip of the nose remains positioned downward, and the oropharynx and cranial esophagus are suctioned to remove blood clots. Nasal lavage may be required to dislodge foreign material identified or suspected to be present within the nose. The rostral aspect of the nose should be directed downward while copious amounts of saline are flushed vigorously through the nostrils. The endotracheal tube cuff should be inflated to prevent aspiration pneumonia and the glottis should be surrounded with surgical sponges or gauze. Tissue samples are not submitted routinely for bacterial or fungal culture except when fungal plaques are detected5. To confirm a diagnosis of aspergillosis, a positive result on fungal culture should be supported by diagnostic imaging, cytologic, rhinoscopic, or histologic evidence of infection. Primary bacterial rhinitis is exceedingly rare in the dog, and almost all bacterial infections develop secondary to underlying primary nasal disease.

Nasal Neoplasia Nasal neoplasia is a very important cause of chronic nasal disease in middle-aged to older dolichocephalic and mesaticephalic dogs. Nasal neoplasia accounts for approximately 45% of all cases of chronic nasal disease in dogs. Tumours of epithelial origin (carcinomas) are most common and account for about 60% of primary nasal neoplasms. Approximately 98% of canine nasal tumours are malignant and primarily arise within the nasal cavity (Figure 1), although occasionally they originate in the paranasal sinuses (Figure 2). Nasal tumours tend to be invasive, with local to widespread destruction of nasal turbinates seen initially with invasion of septal,

cribriform, or facial bones observed later in the course of disease. Metastasis to regional lymph nodes or lung may occur in the late stages of disease. Clinical signs are related primarily to obstruction of airflow through the nasal cavities often associated with mucopurulent nasal discharge, epistaxis, sneezing, or sometimes reverse sneezing. Facial deformity or swelling, exophthalmia, or neurologic signs may stem from tumour destruction of facial bones or the cribriform plate. Facial pain and head shyness are seen rarely (unlike in fungal rhinitis). In some patients initial clinical signs may be very subtle, with unexplained onset of snoring, obstructive nasal breathing, and occasional reverse sneezing reported. Nasal CT images are far better than nasal radiographs for evaluating neoplastic disease and detecting bone destruction and neoplastic extension into surrounding structures. Nasal CT also is needed for staging the tumour, delineating tumour boundaries, and planning radiation therapy. Frequently nasal tumours cannot be visualized during rhinoscopy because of hemorrhage or because the origin is inaccessible. In these situations nasal CT studies provide direction and help to determine the location for blind biopsy sampling of the affected region of the nose. Radiation therapy is the treatment of choice for most nasal tumours, and a radiation oncologist or medical oncologist should be consulted. Surgery alone is ineffective, with survival times similar to those observed in untreated dogs. There is evidence suggesting that exenteration of the nasal cavity significantly prolongs the survival time in dogs with intranasal neoplasia that have previously undergone accelerated radiotherapy. Some nonsteroidal antiinflammatory drugs can reduce nasal tumour volume or slow tumour growth. Meloxicam or piroxicam therapy may induce clinical improvement in some patients

21 The RVT Journal

having nasal neoplasia, with reduction in epistaxis and obstructive nasal breathing for periods of 6 to 12 months (and occasionally longer).

Idiopathic Chronic Rhinitis (Lymphoplasmacytic Rhinitis) Idiopathic chronic rhinitis is identified in approximately 36% dogs having chronic nasal disease. The definitive cause of idiopathic chronic rhinitis remains undetermined; however, it is likely an aberrant innate and adaptive immune response to multiple precipitating factors6. Inhaled aeroallergens and irritants probably play a primary role in the development of this disease. There are some recent reports proposing that odontogenic infection may cause chronic lymphoplasmacytic rhinitis in some dogs. This disease syndrome typically affects middle to older aged dogs. Chronic unilateral or bilateral mucoid to mucopurulent nasal discharge often is present, although some dogs may have mucohemorrhagic discharge or epistaxis. Obstruction to airflow through the nose may occasionally result from excessive mucus within nasal passages or widespread turbinate mucosal edema. Chronic rhinitis is an exclusionary diagnosis as lymphoplasmacytic inflammation may be present with diseases such as nasal neoplasia, fungal rhinitis, or foreign body rhinitis. It is imperative that these diseases be thoroughly excluded before a diagnosis of idiopathic chronic rhinitis is entertained. Nasal CT is preferred over nasal radiographs because it greatly enhances the ability to define the extent and nature of disease and rule out other diseases that may be associated with lymphoplasmacytic inflammation. Nasal CT in dogs with

Canine Nasal Disease...continued

idiopathic chronic rhinitis may show lesions that are completely unremarkable or disclose unilateral or bilateral mild to moderate turbinate destruction with mucus accumulation within air passages and sinuses (Figure 3). Treatment of idiopathic lymphoplasmacytic rhinitis is extremely frustrating, with cure rarely achieved9. Although this is not a lifethreatening disease, owners of dogs so affected are often distraught at the petâ&#x20AC;&#x2122;s nasal obstruction or the need to clean up nasal discharge in the house. Allergen avoidance is rarely helpful; however, avoidance of secondhand smoke can substantially reduce signs in some dogs. Systemic or topical corticosteroids are seldom effective in controlling clinical signs and actually may worsen them. Antihistamine medications rarely are effective, but they occasionally slightly reduce the severity of nasal discharge. Long-term administration of antibiotics with immunomodulatory effects combined with nonsteroidal antiinflammatory agents can be helpful in some dogs.

Fungal Rhinosinusitis Fungal rhinosinusitis is an uncommon but important cause of nasal disease in the dog occuring in around 10-12% of dogs with chronic nasal disease. Aspergillus fumigatus is the most common cause of fungal rhinitis in dogs, but occasionally Penicillium spp., Rhinosporidium seeberi, and very rarely Cryptococcus neoformans may cause disease in dogs. Nasal aspergillosis is most commonly seen in generally in large mesaticephalic and dolichocephalic dogs. Sinonasal aspergillosis is a noninvasive disease in dogs with fungal hyphae confined to the surface of the mucosa and not within or below the surface mucosa7. The bony destruction seen with this disease

is not caused by the fungus itself but appears to result from the host inflammatory response due to an aberrant dysregulation of innate and adaptive immune responses. Systemic immunosuppression is not present in affected dogs. Local immune-dysfunction owing to imbalance between proinflammatory and antiinflammatory signals is likely involved in the pathogenesis of this disease6. Affected dogs often have copious unilateral or bilateral mucopurulent nasal discharge. The volume of nasal discharge is often less in dogs with primary fungal frontal sinusitis. Sneezing is common and may be accompanied by mild to severe epistaxis. Facial pain and depigmentation and ulceration of the nasal planum may be present (Figure 4). Facial distortion may be seen in advanced cases of fungal rhinitis if facial bones are breached. Nasal CT images (Figure 5A) along with rhinoscopy findings are noteworthy for the presence of dramatic turbinate loss within the nasal cavity. Frontal sinus involvement may be present and is characterized on CT by an irregularly marginated soft tissue attenuating density within the affected sinus (Figure 5BD). Mucosal thickening and bone remodeling of the affected sinus may also be seen. Diagnosis of nasal aspergillosis is confirmed by visualization of fungal plaques on nasal or sinus mucosa (Figure 6) and demonstration of branching septate hyphae on cytologic or histologic examination of samples from affected regions within the nose (Figure 7). Serologic tests positive for aspergillosis might support the diagnosis, although negative results may occur with extensive disease and positive results may occur in patients with other nasal disease. The prognosis after treatment of nasal aspergillosis is fair to good, but relapses are not uncommon, which necessitates retreatment. Treatment of nasal aspergillosis is best performed with topical antifungals 22 The RVT Journal

provided that the cribriform plate is intact. Topical therapy is more effective than orally administered antifungal agents, but multiple treatments are often required. When all topical treatments are considered together, approximately 46% of dogs have a successful first treatment and 69% respond successfully following multiple treatments8. The preferred topical treatment this author recommends is clotrimazole irrigation and depot therapy9. This procedure has an excellent success rate, shorter treatment time, and low patient morbidity. This author follows topical clotrimazole therapy with oral terbinafine for a minimum of 6 months of treatment10. Oral antifungal agents generally have lesser efficacy than topical therapy for Aspergillus infection, but are recommended if imaging demonstrates that the cribriform plate or orbital wall has been breached. The newer azole derivatives offer the best results. Voriconazole is a new-generation broadspectrum antifungal agent that is this authorâ&#x20AC;&#x2122;s preferred oral antifungal agent for sinonasal aspergillosis.

Foreign Body Rhinitis Grass awns can be a significant cause for chronic nasal disease in dogs living in certain geographic localities. Sticks, grass blades, nuts and miscellaneous plant material are other common causes for foreign body rhinitis.

Parasitic Rhinitis Parasitic rhinitis is uncommon with nasal mites (Pneumonyssus caninum), nasal nematodes (E. [Capillaria] boehmi) and fly larvae (Cuterebra spp.) occasionally encountered. Ivermectin, selamectin, or milbemycin are recommended for treatment of nasal mites. The treatment for nasal nematodes is not clearly defined, although

Canine Nasal Disease...continued

Table 1 Differential Diagnosis for Nasal Discharge, Sneezing, or Obstructive Nasal Breathing ivermectin or fenbendazole reportedly have been effective. Ivermectin with antiinflammatory doses of prednisone are recommended for Cuterebra larvae that cannot be physically removed.

Nasal Polyps Polyps within the nasal cavity are very rare in dogs. These are usually unilateral, although extension through the nasal septum may occur. Nasal CT findings are similar to that seen with nasal neoplasia. Rhinotomy is required for removal of the polypoid tissue and surrounding conchae. Recurrence 1 to 2 years later is possible.

Xeromycteria (Dry Nose) Xeromycteria (dry nose) can be unilateral or bilateral and is due to parasympathetic

neurogenic loss of secretions from the lateral nasal gland. The lateral nasal gland provides moisture to the lining of the nose, and moisture translocates over the surface of the nasal planum. Otitis media can lead to transient or complete loss of parasympathetic innervation to the lateral nasal gland because postganglionic parasympathetic innervation to the lateral nasal gland is via fibers coursing with the facial nerve through the petrous temporal bone. Clinically, patients have unilateral or bilateral hyperkeratosis and dryness of the nasal planum and mild thick nasal secretions within the nostril(s). Tear production is often normal as long as there is no damage to the preganglionic parasympathetic nerve proximal to the pterygopalatine ganglion. Successful treatment of the otitis media may lead to restoration of normal secretions from the lateral nasal gland.

Table 2 Recent 7 year retrospective study looking at clinical diagnosis after advanced diagnostic imaging in 185 dogs with chronic rhinitis referred to BluePearl Veterinary Partners â&#x20AC;&#x201C; Michigan. Clinical diagnosis in 185 dogs with nasal disease1

1) 2) 3)

Diagnosis

Number of cases

Percent of total cases

Neoplasia

832

45%

Idiopathic chronic rhinitis

37%

Fungal rhinosinusitis

10%

Nasopharyngeal stenosis

Foreign body

Xeromycteria

Undetermined

Hypertension

<1%

Nasal polyp

<1%

Traumatic remodeling

<1%

Dentigerous cyst

<1%

Osteomyelitis

<1%

The breed types that presented most frequently were 48 (26%) mixed breeds, 21 (11%) Labrador retrievers, 19 (10%) Golden retrievers, and 6 (3%) Jack Russell terriers. Carcinomas accounted for 61% and sarcomas for 38% of dogs with biopsy confirmed nasal neoplasia (n=62). Upon review of imaging studies, two dogs having a biopsy diagnosis of idiopathic chronic rhinitis were identified as most likely to have fungal rhinitis. This would change percent to 36% and 11% respectively.

23 The RVT Journal

Nasal and Paranasal Sinus Disorders Allergic rhinitis Bacterial rhinitis (Bordetella bronchiseptica, Pasteurella multocida) Ciliary dyskinesia Dental disease (fistula, tooth root abscess, retained broken tooth roots) Foreign body Fungal rhinitis (Aspergillus fumigatus, Penicillium spp., Rhinosporidium seeberi, Cryptococcus neoformans) Hyperplastic rhinitis (Irish Wolfhounds) Idiopathic chronic (lymphoplasmacytic) rhinitis Nasal polyps Nasopharyngeal stenosis Nasopharyngeal turbinates Neoplasia Nasal parasites (Pneumonyssus caninum, Eucoleus [Capillaria] boehmi, Cuterebra spp.) Odontogenic infection Oronasal fistula Palatine defects Trauma Extranasal Disorders Coagulopathies Cricopharyngeal disease Environmental agents (dusts, smoke) Esophageal stricture Hypertension Hyperviscosity syndrome Immunoglobulin A immunodeficiency Megaesophagus Oropharyngeal diseases Pneumonia Polycythemia Thrombocytopenia Vasculitis Viral rhinitis (canine distemper) Vomiting Xeromycteria

Canine Nasal Disease...continued

Figure 1 â&#x2013; Computed tomographic images of a dog with nasal adenocarcinoma. A CT image of the midregion of the nasal cavity. A homogenous destructive soft-tissue attenuating density is present within the right nasal cavity (note absence of turbinate structures). The nasal septum is deviated leftward and the mid-portion of the septal bone is lytic (arrow) with extension of disease into the adjacent right nasal cavity. B CT image at the same level but with contrast. There is contrast enhancement of the softtissue attenuating density indicating this is a tissue mass. C CT image for the same patient just rostral to the eyes. There is lysis of the vomer bone (angled arrow) and ventrolateral aspect of the right maxillary bone (horizontal arrow). The mass extends into and completely obstructs the nasopharyngeal meatus. D CT image at the same level but with contrast. The mass is contrast-enhancing and the borders of the mass can be clearly delineated.

Figure 2 â&#x2013; Computed tomographic images of a dog with right frontal sinus adenocarcinoma. A CT image at the midregion of the nasal cavity. The nasal cavity at this level is normal. B CT image of the same dog at the level of the frontal sinuses. A soft tissue attenuating structure is completely filling the right frontal sinus. C CT image at the same level but with contrast. The soft tissue structure in the right frontal sinus is contrast-enhancing (arrow at ventral margin of the mass) with a small amount of non-contrasting fluid ventral to the mass. D CT image at the caudal aspect of the frontal bone showing lysis and cortical thinning (arrow) due to the mass.

24 The RVT Journal

Canine Nasal Disease...continued

Figure 3 â&#x2013; Computed tomographic images of the midregion of the nose of a dog with lymphoplasmacytic rhinitis. A CT image in the midregion of the nose. Mucosal edema as seen with thickening of the turbinates and scattered soft-tissue attenuating material (mucopus) is present within both sides of the nasal cavity (left side more severely affected than the right at the level of this image). B Further caudal CT image shows a large amount of soft-tissue attenuating material (mucopus) admixed with air present bilaterally. The soft tissue material was not contrast-enhancing confirming the presence of fluid rather than tissue density. Figure 4 â&#x2013; Facial view photograph of an Old English sheepdog with chronic nasal aspergillosis. Dogs with nasal aspergillosis typically have copious mucopurulent nasal discharge. Dermal depigmentation and necrosis of the nasal planum is present in patients so affected with long-standing disease.

Figure 5 â&#x2013; Computed tomography images from dogs with sinonasal aspergillosis.

25 The RVT Journal

Canine Nasal Disease...continued

Figure 5 ■ Continued... A CT image of the middle region of the nasal cavity in a dog with nasal aspergillosis involving the right nasal cavity. The right nasal cavity is largely devoid of turbinate structures with scattered regions of softtissue attenuating densities (mucopus) present. The left nasal cavity has normal turbinate structures present. B CT image at the level of the rostral frontal sinuses in a dog with fungal sinusitis. There is a fungal plaque in the right ventrolateral frontal sinus (arrow in sinus) characterized by an irregularly marginated amorphous soft-tissue attenuating density along the frontal bone. Adjacent to the fungal plaque periostitis of the ventrolateral aspect of the right frontal bone is present (arrow outside of sinus). C CT image in another patient at the level of the mid-region of the frontal sinuses with bilateral fungal sinusitis. Within both sinuses the fungal plaques are seen as irregularly marginated amorphous soft tissue attenuating material. Mucosal thickening of the frontal sinuses

Figure 6 ■ Rhinoscopic view of fungal plaques within the nose of a dog having nasal aspergillosis.

bilaterally is present. Mild periostitis of the ventrolateral aspect of the left frontal bone is present. D CT image in another patient with fungal sinusitis. A large irregularly shaped heterogenous mass representing a fungal plaque is present in the right frontal sinus. Mucosal thickening of the right frontal sinus is present. A small fungal plaque is present in the dorsal aspect of the left frontal sinus (arrow). The structure is irregularly marginated and associated with mild periostitis adjacent to the fungal plaque. E CT image showing a meniscus in the right frontal sinus (lateral arrow in right sinus). A meniscus is consistent with fluid. Rather often the irregularly marginated amorphous soft-tissue attenuating densities seen with fungal sinusitis are confused as fluid within the sinuses (hence the correct diagnosis is missed). Note: Full references for this publication are available at www.oavt.org.

Figure 7 ■ Cytology of branching septate hyphae obtained from a fungal plaque in a dog with nasal aspergillosis.

Dr. Ned F. Kuehn

Off-white fungal plaques are observed on the nasal mucosa. Hyperemia of nasal mucosa, hemorrhage (ventral right 5 o’clock position) and necrosis (blackened area ventrally at the 6 o’clock position) is present.

There is high accuracy of cytologic samples when collection is done under direct endoscopic visualization. There is very low yield and a poor diagnostic value of samples demonstrating fungal hyphae when collected by blind swabs or preparations from samples of nasal discharge.

26 The RVT Journal

Dr. Ned F. Kuehn received his DVM from Michigan State University followed by a small animal internship at Louisiana State University and residency and MS degree in internal medicine at Purdue University. He has authored 50 scientific articles, clinical research abstracts and book chapters and has lectured to veterinary audiences worldwide. His areas of clinical interest are diseases of the nose in dogs and cats. Dr. Kuehn is currently Chief of Internal Medicine Services and Director of Internal Medicine Residency Training at BluePearl Veterinary Partners in Southfield, Michigan.

Hands up. Who prefers Milbemax?

Your clients need protection from worms all year round. Deworming 4 times a year with Milbemax® Flavor Tabs® helps to minimize overall parasite burdens in cats.† Prescribe Milbemax, a small tasty tablet that offers broad spectrum protection against 5 intestinal parasites.* † http://www.wormsandgermsblog.com/uploads/file/CPEP%20guidelines%20ENGLISH.pdf * Dipylidium caninum, Taenia spp., Echinococcus multilocularis, Ancylostoma tubaeforme, Toxocara cati. ® Milbemax is a registered trademark of Novartis AG – Novartis Animal Health Canada Inc., licensed user. ® Flavor Tabs is a registered trademark of Novartis AG – Novartis Animal Health Canada Inc., licensed user. © 2012 Novartis Animal Health Canada Inc.

Behaviour

Canine destructive chewing and digging Colleen Wilson BSc, DVM, Resident ACVB (Veterinary Behaviour), Gary Landsberg, BSc, DVM, DACVB, DECAWBM, Sagi Denenberg, DVM, DACVB, DECAWBM

Scavenging, chewing and digging behaviours are motivated by many factors including breed, sex, age, and “being a dog.” Some obvious examples are, a Yorkie with an innate desire to hunt and flush out rodents, a Beagle that is all nose, a Husky that likes to dig and find a cool place to lay down, and an intact male digging his way out of the yard to track down a neighbour’s dog in estrous. Young and adolescent dogs generally have more energy and may be more likely to engage in exploratory and oral play. Some may enjoy scavenging for food from counters, garbage Although digging may also be a form of play and exploration, dogs may dig to escape from confinement, to cool off, to bury items, or to access prey that might be underground – especially those dogs that are attracted to the odours or sounds of prey. cans, or even refrigerators to find items with appealing textures to chew on, or they may prefer digging a hole when alone in the yard. All of these behaviours may be “fun” for the dog, but not for the owners. Simply put, destructive behaviours may be a normal but unacceptable way for the dog to occupy its time. Some destructive behaviours may also be the result of anxiety, which will be discussed in another issue. Treatment for destructiveness requires that the owners first confirm that all of the dog’s behavioural needs are being met. By providing sufficient enrichment and proper supervision, most destructive behaviours can be successfully managed. A dog’s social needs should be addressed with regular sessions of play, exercise, and training. Object play, exploration, and feeding are also important components of the dog’s daily activities so that providing a bowl or two

of food a day may provide the calories but not the behavioural component of feeding (i.e. hunting and scavenging). For dogs that have a propensity to chew, greater oral stimulation can be provided by offering durable rubber toys filled with food, dental treats and toys, with appealing chew products stuffed into or attached onto the toy to extend chewing duration. When all needs have been effectively met, prevention may still be required when the dog cannot be supervised. Confinement into an area where the dog feels secure and comfortable (e.g. room, pen or crate) and has no access to your personal items or garbage may be the best option. During confinement, the dog should be provided with bedding, water and some food- and treat-filled toys. Alternately, food could be scattered or hidden throughout the room to prolong feeding and encourage exploration. If the room is large enough, try adding a basket of novel toys to maintain interest. As an alternative to confinement, it might be possible to prevent access to any site where the dog might destroy something by closing doors, putting up barricades, or using booby traps (e.g. motion detector sprays, alarms or aversive tasting substances). Although digging may also be a form of play and exploration, dogs may dig to escape from confinement, to cool off, to bury items, or to access prey that might be underground – especially those dogs that are attracted to the odours or sounds of prey. Undesirable digging can be prevented by accompanying the dog into the yard. However, if the dog is to be left alone outdoors, sufficient social enrichment should first be provided, and food and chew toys or scattered food should then be provided to keep the dog occupied. Providing shade, or allowing an acceptable area for digging, or

28 The RVT Journal

even a cooling pit, may be a successful option for some dogs. Some dogs will require housing in a secure, inescapable run or confinement area with shade, water, food and toys and perhaps even a small area for digging.

Simply put, destructive behaviours may be a normal but unacceptable way for the dog to occupy its time.

This article was co-authored with Dr. Colleen Wilson, BSc, DVM, Resident ACVB and mentored by Dr. Landsberg. Dr. Wilson provides an approved veterinary behaviour specialty training program at Osgoode Veterinary Services (osgoodevet. com). Dr. Landsberg practices veterinary behaviour, by referral, with Dr Sagi Denenberg, at the North Toronto Animal Clinic in Thornhill (northtorontovets.com). Both Dr. Landsberg and Dr. Denenberg are board certified diplomates of the American College of Veterinary Behaviorists and the European College of Animal Welfare and Behavioural Medicine.

Pharmacology

Bethanechol Chloride (Duvoid, PMS-Bethanecol) Dr Wendy Brooks, DVM, DipABVP (Educational Director, Veterinary Partner.com) Available as 5 mg, 10 mg, 25 mg, 50 mg tablets

We normally think of urination as a voluntary activity but in fact there is a great deal more to it. In order to urinate, the bladder’s detrusor muscle must contract – squeeze the bladder empty – while simultaneously the lower sphincter (a circular muscle that contracts to close an opening) must relax. These two activities must be coordinated or you will end up with the bladder squeezing against a

closed sphincter or a stretched (dilated) sphincter allowing passive leakage. The voluntary part is simply the when and where.

How this medication works

(peristalsis) in the intestine and stomach is a side effect, which can lead to diarrhea. Excess salivation and tear production can occur. Increasing the bladder’s detrusor muscle tone leads to a tighter bladder, which means less urine storage capacity and more frequent need to urinate.

Bethanechol chloride works by neurologically stimulating what are called muscarinic cholinergic receptors in the autonomic nervous system. (Think of the autonomic system as the part of your nervous system concerned with automatic functions such as muscle coordinations of the bladder and its sphincter.) By stimulating these nerve receptors, this medication is able to provide a stronger contraction message to the muscles those receptors control.

The coordination of these two muscles is disrupted by certain types of spinal injuries. The so-called upper motor neuron sign creates an increase in sphincter tone while lower motor neuron signs create a flaccid sphincter and a flabby bladder.

Bethanechol chloride works to strengthen the detrusor muscle’s contraction. If the lower sphincter is too tight from an upper motor neuron injury, this medication will help the bladder to contract harder to overcome it. If the bladder is flabby, this medication will help it regain some shape and strength so that it can empty in a controlled fashion rather than just leaking.

Concerns and cautions • Bethanechol should be stored at room

temperature. • Bethanechol is best given on an empty

stomach.

The most common side effects at normal doses are diarrhea, appetite loss, vomiting, and drooling. The other side effects listed above tend to involve overdosing. Atropine is considered an antidote.

Bethanechol should not be used in patients where urinary obstruction is an issue (bladder neck tumours, idiopathic cystitis with blockage or other actual blockage). There is no need to cause the bladder to contract against an obstructed outlet.

Side eﬀects

Interactions with other drugs

One has many muscarinic cholinergic receptors besides those in the bladder and these will also be stimulated by bethanechol chloride. Increased waves of involuntary action that force contents to move forward

If the patient’s urinary tract is not obstructed but has excess tone, it is helpful to combine bethanechol with a medication to relax the lower sphincter and urethra: diazepam or phenoxybenzamine.

Patients with stomach ulcers may secrete more acid while on bethanechol and should not receive this medication. Bethanechol is also considered contraindicated in hyperthyroidism, inflammatory bowel disease, epilepsy, asthma, low blood pressure, and certain heart rhythm disturbances.

© 2014 Dr Wendy Brooks, DVM, DipABVP and VIN, All rights reserved Editor's Note: Reprinted courtesy of Veterinary Information Network (VIN). VIN (www.vin.com) is the largest online veterinary community, information source and CE provider. The VIN community is the online home for over 30,000 colleagues worldwide. VIN supports the Veterinary Support Personnel Network (VSPN.org); a FREE online community, information source for veterinary support staff. VSPN offers a wide range of interactive practical CE courses for veterinary support staff -- for a small fee. Visit www.vspn.org for more information

29 The RVT Journal

Volunteering

Are you an adventurous RVT? By Chris Robinson, Executive Director, The Canadian Animal Assistance Team (CAAT)

style field hospitals – we take everything with us and set it all up when we arrive and take it all down when we leave.

Chris Robinson, CAAT Executive Director

Do you ever want to stretch your technical knowledge, learn from new challenges, learn about animals in different cultures and experience a different part of Canada or the world? You can do all of those things on a Canadian Animal Assistance Team (CAAT)

CAAT clinics are set up like M*A*S*H-style field hospitals – we take everything with us and set it all up when we arrive and take it all down when we leave. project. CAAT is a registered charity with project teams consisting of volunteer veterinarians, veterinary technicians, and assistants from all across Canada. CAAT Animal Health Care Clinics provide sterilization and vaccination programs to reduce the population growth, reduce the number of unwanted dogs and cats, and improve the general welfare of the resident animals. We provide these voluntary services in remote and under-served communities in Canada and internationally. Being a technician on a CAAT Animal Health Care Clinic stretches your technical knowledge base by making you work and think outside the box (or regular veterinary clinic). CAAT clinics are set up like M*A*S*H-

The diverse locations and situations can sometimes make you have to “think on your feet.” Hanging IV bags from hockey sticks duct taped to a ladder, hammering nails into a table leg to work for surgical tie anchors, or using PVC pipes to make tables tall enough for working on. Apart from your surroundings, learning to adapt to and work within the culture you are visiting is also something that is necessary. Being able to communicate with diplomacy and effectiveness with the members of the communities we serve is extremely important for building a relationship with the community that is necessary for longterm changes.

work long hours, have challenges put in front of them every day, and finish each day covered in undefinable fluids and dirt. What happens? Believe it or not, they form an amazing, cohesive, supportive, efficient team that works like clockwork within a day. They become new friends and colleagues. They take home memories, good and bad, from a unique experience only they share with each other. It is truly remarkable.

Since 2006, I have had the privilege of serving on many Animal Health Care Clinic projects for the Canadian Animal Assistance Team (CAAT). It is amazing, in giving my time and volunteering for these projects, what I have gained! I have learned that, despite appearances in some of the communities we visit, many people really love their animals – they just can’t do anything about their circumstances. The people often need the compassion too. I had confirmed, with absolute certainty, that animals are amazingly resilient and forgiving despite some pretty horrific odds. There is another extraordinary part of the experience that I have seen again and again. Imagine that you bring together a group of very diverse people (RVTs, vets and assistants) from all over Canada. They meet for the first time usually boarding a plane to a destination no one has been to before. They often stay in less than ideal accommodations and work in a less than ideal working environment. They

30 The RVT Journal

[About CAAT] The Canadian Animal Assistance Team (CAAT) is a group of veterinary technologists, veterinary assistants, veterinarians and people passionate about animal welfare, dedicated to providing veterinary medicine and humane education in support of needy animals worldwide. www.caat-canada.org and https://www.facebook.com/CAAT.Canada

CANINE ATOPY HAS MANY CAUSES.

Dogs with environmental allergies need diets designed for environmental allergies. Royal Canin Skin Care, Skin Care Small Dog and Skin Support have been clinically proven to reduce signs of itchiness and inflammation associated with non-specific and atopic dermatitis.

1, 2

Join the conversation #ItchyPetSeeYourVet

ÂŠ Royal Canin SAS 2014. All Rights Reserved. 1 Data on File; 2012 Clinical Trial. 2 Markwell PJ, Svoboda M, and Fray TR. Dietary Intervention Can Improve Clinical Signs In Dogs With Atopy. In: Proceedings of the WALTHAM International Science Symposium; 2003; Bangkok, Thailand: p. 21.

ARTICLE #3

Compassion satisfaction: flourishing in practice Part 1 Debbie Stoewen DVM, MSW, RSW, PhD

CE articles help RVTs earn credits toward their RVT certification. Correctly answer the quiz associated with this article to earn one CE credit. www.technewsquizzes.ca/login.pl

As veterinary caregivers, we are guided by compassion as well as an altruistic desire to improve the health and welfare of others, both human and animal. The degree to which we express authenticity, positive regard, and empathy in our work strongly influences the extent to which we are effective. Unfortunately, the more empathic we are towards those we care for, the more likely we are to internalize the distress of their circumstances. As our hearts go out through sustained compassion, our hearts can eventually give out from fatigue.1 Our hearts can become stressed. Not all stress, however, is bad. In fact, optimal stress is ideal. It produces exhilaration, high motivation, mental alertness, high energy, and sharp perceptions.2 All too often, however, stress can become excessive and threaten to overwhelm one’s sense of self-efficacy.2 Compassion stress can turn into compassion fatigue, and fatigue, which can affect anyone in the role of healer, helper, or rescuer, can deleteriously affect physical and mental health, professional competence and success, and vocational direction and development.3 There has been a growing focus on the pathological aspects of veterinary practice – aspects that can detract from the ability to offer the best we can to our clients, patients, and each other. Just as it is important to understand the aspects of practice that make us vulnerable, and take steps to manage the consequences, it is as – if not more – important to understand the aspects of practice that nurture and replenish us, and intentionally build these into our lives. As Radey and Figley (2007) state, “Our compassionate core requires us either to avoid negativity or to transform it.” 1 Fortunately for us, we can modulate the stress of negative events and consciously transfer this energy into satisfaction.1 It is time we place compassion stress, compassion fatigue, and the other negative consequences of veterinary practice into a broader context of positive veterinary medicine. In our work as caregivers, our goal should be to seek satisfaction – not avoid fatigue. Let’s adjust our perspective from one of avoiding negative consequences to one of promoting positive fulfillment. With a new outlook, compassion stress can be envisioned not as a risk for compassion fatigue, but as the potential for compassion satisfaction, that deeply rewarding sense of fulfillment that comes from helping others. Remember, stress at the right level – optimal stress – can be exhilarating, motivating and energizing. Compassion and the stress that accompanies it can benefit rather than harm those of us on the front lines; together they offer the opportunity to flourish in practice.

Compassion and flourishing As described by those who study the social psychology of compassion and flourishing, flourishing means “to live within an optimal range of human functioning, one that connotes goodness, generativity, growth, and resilience.’’4 In contrast, languishing means to live a life that is ‘‘hollow’’ or ‘‘empty.’’ 5 Flourishing caregivers provide highly competent and compassionate care, and experience high morale and work satisfaction, whereas languishing caregivers provide quite the opposite, and experience emotional stress, psychosocial impairment, limitations in daily activities, and lost workdays.1 Unfortunately, research has found that only one in five people in North America are truly flourishing.4

So we need to be asking some important questions. How can we turn the compassion we have for our patients and clients into momentum to flourish? How can we find and even create compassion satisfaction while working in the often emotionally-charged world of veterinary practice? And how can we balance the focus on pathology and how to minimize it, with a focus on altruism, compassion, resilience, success, and thriving?6 It is human nature to pursue activities that directly or indirectly take us to new levels of fulfillment. In the caring professions, the highest level of fulfillment is compassion satisfaction. So how can we set ourselves up to find compassion satisfaction – and flourish – in our chosen field of practice? The answer is simple: increase positivity.

32 The RVT Journal

The key to flourishing: Positivity Positivity is the quality or state of being positive. According to a conceptual model for understanding the origins of compassion satisfaction and compassion fatigue, based on the work of Barbara Fredrickson (1998), a social psychologist at the University of North Carolina at Chapel Hill and author of the book Positivity, along with Melissa Radey and Charles R. Figley, professors at the Florida State University’s College of Social Work, there are three interrelated ways of increasing positivity (see Figure 1).1, 7 These include increasing positive affect, stress management resources, and self-care that creates inspiration and happiness. Along with appropriate discernment and judgment, maximizing these three essentials increases

Compassion Satisfaction: Flourishing in Practice...continued

positivity, which culminates in compassion satisfaction. Let us take a look at each of these essentials and how they relate to one another.

Positive affect generates innovative ideas and interventions, enhancing the potential to help patients and clients, while negative affect – and the resulting lack of ideas and

Discernment and judgment

Resources Affect

Self-care

Compassion Satistaction

PositivityNegativity Ratio Compassion Fatigue

Fig. 1 Creation of compassion satistaction or compassion fatigue As found in Radey M, Figley CR. The social psychology of compassion. Clin Soc Work J 2007;35:207-214.

Three essentials: Affect, resources and self-care

interventions – restricts the ability to help. Positive affect provides an optimal environment to help others.

Affect is described as one’s range of feelings and attitudes.1 Affect refers to both your emotions and ways of looking at things, i.e. your perspective or interpretation of life. As explained by Radey & Figley (2007),

Resources refers to one’s intellectual, social, and physical capital1 – your assets and capacities. These resources promote your overall health and well-being. Physical health is one of your greatest resources. It is stamina and endurance. Social connection is vital. We are social beings who thrive in communities of belonging. Intellectual resources potentiate best outcomes in all directions. Together, your intellectual, social, and physical resources are critical in maximizing compassion satisfaction. You function at your best when all three are optimized.

“Positive affect, or positivity, includes feeling grateful and upbeat and expressing appreciation and liking. This is in contrast to negative affect, or negativity, which represents feeling contemptuous or irritable and expressing disdain or disliking. Unlike negativity, which narrows people’s behavioral urges toward specific actions that are life-preserving (e.g., fight, flight, reject, and isolate), positivity widens the array of thoughts and actions (e.g., play, explore, cooperate, interact, and greet) and generates greater flexibility and innovation.” 1

Positive affect along with intellectual, social, and physical resources are fundamental to flourishing and compassion satisfaction, but they are not possible without appropriate attention to self-care.1 It is vitally important to develop and maintain good discipline with self-care. Your body, mind, and spirit needs to be nourished to sustain and maintain both

33 The RVT Journal

your personal and professional well-being. It makes sense that in order to help others we must first help ourselves. Self-care is not optional. It is not only critical for your health and well-being – and your success – but also for the health and well-being of your patients and clients and the success of your practice. It is important to maintain adequate self-care throughout your career. There is a three-way reciprocal relationship between the three essentials: affect, resources, and self-care.1 Each influences the other. Positive affect can increase one’s physical, intellectual, and social resources and encourage self-care. Sufficient resources can increase the positivity of one’s affect and promote engagement with self-care. Good self-care can enhance one’s affect as well as one’s physical, intellectual, and social resources. The three are inextricably intertwined. Each contributes to your overall positivity, as reflected in the positivitynegativity ratio. In our work as caregivers, our goal should be to seek satisfaction – not avoid fatigue.

Altruism: Responding with good judgement Of importance, when engaging in any compassionate endeavor, the proper response and intensity of altruism engaged in needs to be ascertained.1 If you fail to discern and judge the appropriate extent to which you express altruism, you will likely over- or underrespond. Over- and under-response can disrupt the compassion reinforcing process, and instead of inspiring satisfaction, can contribute to fatigue. Good discernment and judgement is needed with your personal as well as professional relations.1 In every social situation, whether with family, friends, or

Compassion Satisfaction: Flourishing in Practice...continued

ASSOCIA T

R T R

Continuing to learn after achieving RVT status is essential for the individual and the advancement of the profession.

34 The RVT Journal

About CE articles: N

Pulling the entire model together, under the auspices of good discernment and judgment, your affect, ‘intellectual, social, and physical resources,’ and self-care influence one another reciprocally to result in a balance of positive to negative feelings, generating the positivity-negativity ratio, which will

Each of us can greatly enhance our capacity, proficiency, and competence to do and be what we intended to upon entering the profession, and in this way fulfill our personal as well as professional potential, if we focus on flourishing. When flourishing, we work in a manner that connotes goodness, generativity, growth, and resilience. When flourishing, we attain peak performance, the point where work becomes play. We can only flourish, however, when we set the compass due north – to compassion satisfaction. There are tangible steps each of us can take to increase the positivity ratio, improving both our personal and professional well-being as well as the service we provide to our patients, clients, and each other. If we equip ourselves with the appropriate skills and perspectives, our potential to experience compassion satisfaction expands exponentially. So the question to be addressed in the next article, Part 2 of Compassion Satisfaction: Flourishing in Practice, is this: How do we maximize the

There are tangible steps each of us can take to increase the positivity ratio, improving both our personal and professional wellbeing as well as the service we provide to our patients, clients, and each other.

Over the past twenty years, a ratio of at least a 3 to 1 theory of flourishing has been confirmed by studies in various settings.4, 8-10 This means that for those who flourish in their life’s work, they are far more likely to be able to identify three positive experiences for every one negative experience.1 Losada (1999), who studied the interpersonal dynamics among 60 business teams while they developed their annual strategic plans, identified 15 ‘‘flourishing teams’’ based on a positivitynegativity ratio of 5.6 to 1, correctly predicting these teams as significantly more productive.9 The ratio applies beyond the workplace. Gottman (1994), based on twenty years of research on marital relationships, concluded that unless a positive to negative ratio of 5:1 is maintained, couples will very likely divorce.10

This article proposes an alternate way of looking at compassion and empathic engagement – both essential to effective practice – not in the light of risks, but potential, and poses a paradigm shift from focusing on the risks for becoming fatigued to the potential to flourish in practice. Through drawing on research in psychology and social work, the concept of compassion satisfaction (a raison d'être for pursuing the work we do) is brought to the forefront, centering on a model rooted in positive psychology and expanded to incorporate the veterinary perspective.

Note: Full references for this publication are available at www.oavt.org.

T VE

Ultimately, the ratio of positive to negative affect is key in determining overall positivity.4 The positivity-negativity ratio is “the ratio of pleasant feelings and sentiments (or positive affect) to unpleasant feelings and sentiments (or negative affect) over time.” 1 In relation to compassion, the positivity-negativity ratio predicts when the ‘‘heart gives out.’’ 1 In understanding the potential to create either compassion satisfaction or fatigue, we need to understand how much positivity is enough to sustain us through the negativity.

positivity ratio to achieve compassion satisfaction and flourish in practice?

Flourishing’s magic number: The positivitynegativity ratio

determine whether you experience compassion satisfaction or compassion fatigue. With appropriate boundaries, increased affect, resources, and self-care can generate a higher positivity-negativity ratio, creating the optimal potential to experience compassion satisfaction, and as such, flourish in practice.

those at work, you are giving of your heart, and risk over- or under-extending yourself.

IN IC N AR Y T E C H

RVTs in Ontario can earn 1 Continuing Education (CE) credit by reading the CE articles in this publication and submitting successfully completed quizzes that correspond to CE articles. For more information about CE credits in Ontario, visit www.oavt.org.

Debbie Stoewen DVM, MSW, RSW, PhD As an entrepreneur, facilitator, and academic, Dr. Debbie Stoewen is committed to advancing the health and welfare of people and animals at the intersections of industry, academia, and civic society. As Pets Plus Us Care & Empathy Officer and the Director of Veterinary Services, she provides a fully accredited, evidencebased continuing education program called The Social Side of Practice for veterinarians and their teams across Canada. Compassion Satisfaction: Flourishing in Practice is one of the sessions in the CE module on Veterinary Wellness.

If you only see the boy and his dog, you’re missing something. You’re missing the eggs and larvae that dogs shed when they have fleas. Adult fleas only represent 5% of a flea infestation – the other 95% are eggs, larvae and pupae that hide in beds, carpets and floors. Sentinel prevents flea infestations by stopping the life cycle in its tracks, killing eggs and larvae before they become adults. Recommend Sentinel for flea control, heartworm prevention and intestinal worm protection, and you won’t miss a thing. For more information about Sentinel call 1-800-387-6325. © 2012 Novartis Animal Health Canada Inc. ® Sentinel is a registered trademark of Novartis Animal Health Canada Inc. ® Flavor Tabs is a registered trademark of Novartis AG – Novartis Animal Health Canada Inc., licensed user.

Poisoning

Methionine poisoning in dogs By Lynn R. Hovda, RPH, DVM, MS, Diplomate, ACVIM Director of Veterinary Services, SafetyCall International, PLLC and Pet Poison Helpline

eat the contents of an entire bottle. Dogs with undiagnosed liver, kidney or pancreas problems are more susceptible to poisoning and may even develop signs at normal doses. In these cases, the signs will be much worse than expected and last for a longer period of time.

How much is too much? Methionine products can be marketed specifically to prevent or decrease damage to lawns from dog urine.

Methionine is an amino acid prescribed by veterinarians for dogs and cats as a urine acidifier to treat or prevent urinary stones. The urine pH needs to be above 6.5 for it to be effective. Methionine is also present in many human and canine supplements sold in health food stores and online as capsules, chewable tablets, gels, and powder. It is not unusual for dog products, under a variety of trade names and formulations, to be found in farm and garden stores. These products are marketed specifically to prevent or decrease damage to lawns (i.e. brown spots with dead grass) from dog urine. Most contain 150 to 200 mg methionine/tablet, although a few contain 500 mg methionine/tablet, making it important to read the label on the container very carefully. Products for human use often contain 500 mg methionine or more/tablet. Poisoning in dogs is uncommon during most of the year, especially when used according to veterinary instructions. It becomes more of an issue in the spring and summer as people are tending to their lawns and gardens. Dogs are poisoned when fed too many tablets by overzealous, well-meaning owners believing â&#x20AC;&#x153;more is betterâ&#x20AC;? or when dogs accidentally

A determination of how much methionine is hazardous in dogs is difficult to establish. Doses of 100 mg/kg body weight (BW) are generally considered safe in healthy dogs with no underlying health problems. As this is only two 500 mg tablets in a healthy 10 kg (20 pound) dog, it is easy to see how consuming more tablets could be a problem. Anecdotally, weâ&#x20AC;&#x2122;ve had reports of a dog with suspected Any breeds with known hepatic abnormalities as well as those dogs with a history of pancreatitis, renal failure, or liver disease should be seen and evaluated as soon as possible by the veterinarian.

pre-existing liver impairment who developed signs at 52.5 mg/kg BW, while another dog developed ataxia at 200 mg/kg BW (four 500mg tablets in a 10 kg dog), and another showed signs of hepatic encephalopathy at 400 mg/kg BW (eight 500 mg tablets in a 10 kg dog). Other common signs include gastrointestinal distress, lethargy, muscle tremors, posterior tremors, and seizures.

What breeds are most at risk? An accurate history including the use of over the counter medications and herbal products is especially important when dealing with a suspected methionine poisoning. Any breeds

36 The RVT Journal

with known hepatic abnormalities as well as those dogs with a history of pancreatitis, renal failure, or liver disease should be seen and evaluated as soon as possible by the veterinarian. Serum chemistry including BUN, creatinine, liver enzymes, and diagnostic tests for pancreatitis should be performed. Older dogs, especially those who are predisposed to pancreatitis (especially those garbage loving Labradors) and animals on an acidifying diet should be monitored very closely. Metabolic acidosis occurs frequently, even in small overdoses, and blood gas analysis should be performed and monitored.

Treatment is supportive There is no antidote; treatment is supportive. Animals with signs of gastrointestinal distress generally respond to a bland diet. Emesis should be induced in those animals ingesting larger amounts and followed by a single dose of activated charcoal. General treatment includes IV fluids, gastrointestinal protectants such as omeprazole or famotidine, sedation if agitated, and anticonvulsant therapy (diazepam, phenobarbital) if needed. Animals with underlying problems will need to have those addressed and treated. Bezoars (large concretions of the product) may form following large amounts of chewable tablets so any dogs with continuing signs despite therapy will need an X-ray or endoscopic examination. The prognosis is quite good as long as treatment is early and underlying disease problems are recognized and treated appropriately. Animals with known liver disease, renal failure, or pancreatitis should not be given these tablets unless prescribed by a veterinarian. Owners should be cautioned to pay strict attention to the label and not give

Methionine poisoning in dogs...continued

Animals with known liver disease, renal failure, or pancreatitis should not be given these tablets unless prescribed by a veterinarian. their dog more tablets than recommended. As with other items, they should be kept in an area that is inaccessible to pets (definitely not on the kitchen countertop).

Regarding kittens A special note about cats: Kittens may be more susceptible to poisoning from methionine than adults. The use of methionine as a medication in kittens is not recommended unless prescribed and monitored closely by a veterinarian. They should not be allowed to eat adult cat food that has been treated with methionine. While poisoning in adult cats is rare, Heinz body anemia, hemolytic anemia, and methemoglobinemia are known sequellae. Other signs reported in cats include anorexia, ataxia, and cyanosis.

FURTHER READING Maede Y, Hoshino T, Inaba M, et al. Methionine toxicosis in cats. Am J Vet Res 1987;48(2):289-92. Villar D, Carson TL, Osweiler G, et al: Overingestion of methionine tablets by a dog. Vet Human Toxicol 2003;45(6):311-312. Pet Poison Helpline: ÂŽ

Pet Poison Helpline, an animal poison control center based out of Minneapolis, is available 24 hours, seven days a week for pet owners and veterinary professionals who require assistance treating a potentially poisoned pet. Staff provide treatment advice for poisoning cases of all species, including dogs, cats, birds, small mammals, large animals and exotic species. As the most cost-effective option for animal poison control care, Pet Poison Helplineâ&#x20AC;&#x2122;s fee of $39 per incident includes follow-up consultation for the duration of the poison case. Pet Poison Helpline is available in North America by calling 800-213-6680. Additional information can be found online at www.petpoisonhelpline.com.

Finance

How ﬁnancial security planning can help answer your ﬁnancial questions By Stephanie Allen

Working with a financial security advisor means you can combine the things that are important to you with products and knowledge that not only put you on the right track, but help you stay on track, throughout life’s changes.

The early years

Have you ever asked yourself any of these questions: How do finances affect my career, and why should I be thinking about it? What are my or my family’s goals? Where do I want to be later in life? How will I get there?

enough to meet your changing needs and based on solid insurance and investment solutions, you may get further and further off track over time.

When I began my career as a an RVT 20 years ago, finances, savings and insurance were not on my mind. Having a job at a great clinic, receiving a paycheque to pay the bills and student loans were my only concerns.

• Provide for your family in the event of your untimely death, disability, or critical illness

Today these concerns are still true for many, except there are higher student loans, pressure to find that great clinic and more stress to save money out of what’s left of your paycheque. As my career moved forward, I started to realize the need to plan for my future. Fortunately, I had my father’s advice and an understanding employer who was willing to help me with my goals. Without these two I would not be financially sound today and throughout my career.

Giving yourself a ﬁnancial head start It’s easier if you start early. But starting early doesn’t ensure you’ll reach your financial security goals. Without a financial security plan that’s tailored to your situation, flexible

A solid financial security plan can help you:

• Secure a comfortable retirement • Control your debt • Pay for your children’s education

Your 20s and 30s are likely to be the most demanding years of your life. By the time you add the costs of a home, car and student loan payments to the costs of raising children, you may think investing in your future is out of the picture. A good place to start is to protect what you already have – your family and your income. Younger couples, particularly those with children, and single parents are most in need of insurance coverage as they tend to have fewer assets and more debts. You also need to be covered because of the additional expenses associated with child care if something should happen to you.

• Secure savings for an emergency • Provide health coverage Any or all of these can affect your career, especially health and disability, as there are many dangers in a clinic. What would happen if you were injured and could not work? Even struggling with debt control, savings and retirement on your salary may seem all impossible, but a financial security plan can help. The first step to achieving your financial goals is creating a financial security plan that protects what you have and your plans for your future. Through your employer, you or your spouse may have a group plan; but that may not cover part of your personal plan and will only be temporarily available.

38 The RVT Journal

The sooner you take advantage of the advice available from your financial security advisor, the stronger you’ll finish.

It’s also a time to create savings habits that can last a lifetime. The amounts may be small, but putting aside a little bit on a regular basis can make realizing your dreams years from now a lot easier.

Starting later - tips Obligations in your 20s and 30s (and maybe your 40s too) have a way of sidetracking your financial security planning. Even if you have

not started any financial security plan it is not too late to create one. Now that your career is established and you have fewer major expenses, either because debts have been paid off or your children no longer require childcare, you may have more resources remaining at the end of the month to put towards a financial security plan. Before you build that addition to your home or make a luxury purchase, review your existing protection needs and your retirement goals. Are you going to retire when you want with the life style you desire?

The sooner you take advantage of the advice available from your financial security advisor, the stronger you’ll finish. Together, you can map out your integrated financial security plan to reach your goals and needs. Remember, even if you haven’t started planning at all, it’s not too late! There are higher student loans, pressure to find that great clinic and more stress to save money out of what’s left of your paycheque.

recommends Are your clients having a hard time helping their cat stick to its diet? Suggest they fill their cat's daily allotment in seven individual containers labelled with days of the week. When that day's container is gone, all members of the household will know kitty's reached her limit for the day. Do you have a tip to share?

Email it to lisa@oavt.org.

Stephanie Allen Stephanie Allen FSA, R.V.T., is a financial security advisor with Freedom 55 Financial, a division of London Life Insurance Company. She can be contacted at 519-352-6840, extension 364, by cell at 519-359-5901, or by email to Stephanie.allen@f55f.com.

Finishing strong Later in life, when you’d think it would be easier without the responsibilities for children at home, mortgages and maintaining a career, finances can get complicated. Take a breath and look at your financial security plan. Is it getting you where you wanted to be? Are you still on the right path? Are you able to continue to have a rewarding career as a vet tech?

The information provided is based on current laws, regulations and other rules applicable to Canadian residents. It is accurate to the best of the writer’s knowledge as of the date submitted for publication. Rules and their interpretation may change, affecting the accuracy of the information. The information provided is general in nature, and should not be relied upon as a substitute for advice in any specific situation. For specific situations, advice should be obtained from the appropriate legal, accounting, tax or other professional advisors.

Advertise with The RVT Journal The RVT Journal provides the single best direct route to more than 3,000 Registered Veterinary Technicians (RVTs), as well as technologists, hospital auxiliaries, affiliated industry partners and educational institutions in Canada. As the voice of Canadian RVTs, we welcome the opportunity to help you reach your audience.

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Career

Cultivate your career: Grow gracefully leading by example Rebecca Rose, AAS, CVT CATALYST Veterinary Practice Consultants, LLC

Have you ever stopped to take stock of how many of your colleagues have been in veterinary technology for one, two or even three decades? I, myself, have been a technician for nearly 30 years! Registered Veterinary Technicians (RVTs) are reinventing themselves and staying in the veterinary community longer, and if you want to rank among them, it is up to you to take the lead in your growth and professional satisfaction.

Self-assessment Attitude is everything. Ask yourself, what do I enjoy most about my job? How can I become more efficient at it? How can I be supported in or through professional growth? What time commitment is required to grow? What financial commitment is there? And, the most forgotten question of all, how will I benefit from growth? As your skills are refined you will naturally gravitate to certain passions and efficiencies. Once you have defined your area of interest, you should speak with your supervisor, manager or doctor about your desire to explore new advancements, educational opportunities and career options.

Be prepared Your managers may not realize all of the options available to you. It is your job to educate them on the ways a team can grow. Be prepared to discuss which skill you want to improve. Have materials in hand, examples of websites, research, time commitment and overall cost. Communicate the desired outcome – what do you hope to achieve? You’ll need to explain how pets, clients, and your workplace may benefit from your proposed skills development. Will there be an increase in client service? Will there be better patient care? How will the client benefit from your new knowledge? What’s the bottom line to the veterinary hospital? How will the added service be charged to the client? How will the

clinic recuperate its financial commitment to you? How will the veterinary team educate the clients on the new service you will be providing?

Example one: Expanding your knowledge in grief counseling Many technicians are exceptionally good at helping clients during the euthanasia of a family pet. Within the veterinary community we experience death ten times more often than our counterparts working in the human field. If you are compassionate and have great communications skills, you might consider pursuing more knowledge of grief counseling. Walk through some steps you might take to improve your knowledge of this area. You may wish to attend classes focusing on grief counseling, even if they are outside of the veterinary realm. You may consider speaking with a grief counselor at your local human hospital. Search for groups associated with hospice. View websites that emphasize care of pets during cancer treatment.

What are the benefits to the clinic? When you propose this plan to your supervisor, you may outline that your clinic’s clients will benefit from a technician who has increased awareness of empathy for the family, particularly with helping young children have a better first time experience with death. Having an RVT who specializes in

40 The RVT Journal

this area may also prompt the clinic to offer specialized services that would set the clinic apart. For example, when a pet is diagnosed with a terminal disease, the clinic may see value in being able to assign a specialized RVT to the case for communication of follow-up, helping to reschedule appointments, and to be present for euthanasia. That technician could also be available to offer phone consultations and guidance. Management may also wish to create a comfort room within the clinic to provide a relaxing space for families and pets.

What is the cost to the clinic? For this example, financial commitment on the part of the veterinary hospital may include a few added Continuing Educational (CE) classes. There are a number of ways to enhance your understanding of home pet hospice care and support. Plan on attending one of the Pet Loss and Grief Companioning Certificate courses offered by Pet Loss Professionals Alliance. Technicians may also take online classes or attend a local human hospice care program, or explore the International Association of Animal Hospice and Palliative Care. The clinic may also want to budget for a facelift to an exam room, if introducing a comfort room is part of your plan. Talk through with your management team the ways providing a “hospice service” may provide valuable experience and possible additional

compensation to your clinic. And, give some consideration for how you might track the cases you follow and show value to the client and family.

Example two: Developing your skills in dental hygiene In the case of a Dental Veterinary Technician Specialist, clients benefit when they receive the best possible care for their pet while the dental procedure is being performed.

What are the benefits to the clinic? Your clinic will benefit from your heightened technical skills, advanced radiology proficiency, increased dental anatomy, and greater synergy with your team. Plus, the clinic will have the added relief of communication with a veterinary technician specialist.

recommends What sage advice would you offer to newer veterinary technicians and assistants? VetTeamCoach is creating a new book for team members and students attending veterinary related programs. Contact Rebecca at CATALYST Veterinary Practice Consultants for more information rebeccarosecvt@gmail.com

What is the cost to the clinic? Think of all the things that may become an expense during the two years it will take to become a specialist. Be realistic. In addition to increased Continuing Education courses, the clinic may need to provide more time off for the technician for specialty training, testing, and associated fees. The clinic may also need to invest in new equipment such as dental instruments and dental x-ray equipment. When speaking to your manager, explain what you expect after you become a specialist. One technician in Minnesota explained she negotiated a raise even before she began the training. She was an asset that made her worth an additional $10,000 per year.

specialists. That equates to a salary increase of roughly $6,600 a year.

Paying it forward As you have consciously grown your career, you may wish to consider how you can become a mentor and pay it forward. Mentor/Mentee relationships are quite valuable and endearing. They provide you an opportunity to track your successes, outline your achievements, identify the road traveled and help someone else reach new heights. Remember, what comes around goes around. “Pay Forward” is a good concept.

A recent survey completed by the Veterinary Hospital Manager’s Association showed that Veterinary Technician Specialists, on average, were paid $3.30 per hour more than non-

Rebecca Rose, CVT CATALYST Veterinary Practice Consultants, LLC. Littleton, CO Ms. Rose currently owns her own business, Catalyst Veterinary Practice Consultants, LLC. She graduated from Colorado Mountain College in 1987 with an AAS in veterinary technology and became credentialed as a certified veterinary technician in the same year. AAHA Press recently updated her book, Career Choices for Veterinary Technicians; Opportunities for Animal Lovers. This one project opened up many opportunities. Over the years Rebecca has been honoured with many veterinary industry and academic awards. Rebecca’s diverse career includes working as a veterinary technician in a mixed animal practice, offering relief services throughout Colorado, being the first paid administrator to the Colorado Association of Certified Veterinary Technicians, managing two AAHA veterinary practices, and working with various industry leaders in an array of areas. She invites you to join her on her Facebook business page, Catalyst Veterinary Practice Consultants, LLC. You will see Rebecca finds great joy helping teams succeed.

41 The RVT Journal

Roundup Changes to Ontario Rabies Response Program

uncontrolled electricity. Reported symptoms for dairy cows include:

The Canadian rabies response program changed on April 1, 2014. CFIA will continue to oversee the laboratory sampling of samples while provinces will now be managing sample collection, handling and submissions. In Ontario, the Ministry of Health and Long-Term Care (MOHLTC) is investigating options for coverage of sample collection and submission, with the support of Ontario Ministry of Agriculture and Food (OMAF) and Ministry of Rural Affairs (MRA).

• • • • • •

The OAVT, MOHLTC, and OMAF and MRA have been in discussions identifying areas of the rabies control program that suit the skills and training of RVTs. For more information about changes to this program email Kirsti Clarida, RVT at kirsti@oavt.org

Farm groups launch uncontrolled electricity working group The Uncontrolled Electricity Agriculture Working Group is raising awareness about how uncontrolled electricity impacts farms. The issue of uncontrolled electricity affects all forms of livestock. Dairy cattle have been proven to be particularly sensitive to

Reluctance to enter milking parlour Reduced water or feed intake Nervous or aggressive behaviour Uneven and incomplete milkout Increased somatic count Lowered milk production

Practice for the Care and Handling of Pigs on March 6, 2014. The Code is available electronically at www.nfacc.ca/codes-ofpractice/pigs.

For more information visit www.farmfoodcare.org

Zoetis launches new online resource for emerging veterinary professionals Zoetis launched VETVANCE, a free web-based learning resource to arm veterinary students and recent graduates with indispensable tools and resources to support the future advancement of their careers. VETVANCE provides content on topics that may not be typically covered in a veterinary student’s core curriculum to help prepare students to handle the non-clinical aspects of the veterinary profession. Visit www.VETVANCE.com.

Smart Flow Sheet - new tool for small animal practitioners Smart Flow Sheet is the first electronic treatment sheet of its kind because it is optimized for an iPad. It brings the benefits of treatment reminders, automatic integrated billing and record keeping, and reduction of paper. As a cloud-based application, it allows access to all of your patients’ treatment plans in real-time from any device and from anywhere, in-hospital or out. Visit www.smartflowsheet.com.

New Code of Practice for the Care and Handling of Pigs released The Canadian Pork Council (CPC) and the National Farm Animal Care Council (NFACC) announced the release of the new Code of Farm & Food Care Ontario

42 The RVT Journal

Farm & Food Care Ontario

Joint obsolete pesticide and animal health medications collection in Ontario a success Ontario farmers returned more than 114,000 kilograms of obsolete pesticides and over 4,400 kilograms of animal health medications for safe disposal in 2013. The combined collection program was made possible through a unique partnership between CleanFARMS – a national industry-led agricultural waste stewardship organization – and the Canadian Animal Health Institute (CAHI). Ontario farmers were invited to participate at no charge, by dropping off their obsolete or unwanted agricultural pesticides and animal health medications to 31 ag-retail collection sites throughout the province in October for safe and environmentally responsible disposal. "This model of providing a simple, one-stop collection point for both pesticides and animal medications is a valuable service that we are pleased to offer to farmers," says Jean

Do you have news the RVT community can use? Email lisa@oavt.org to be included in The RVT Journal.

Szkotnicki, president of CAHI. The first animal health medication collection was piloted in 2009 and returned in 2013. After collection, all products are taken to a licensed waste management facility where they are safely disposed of through high-temperature incineration.

2012 National Animal Shelter Statistics Report The Canadian Federation of Humane Societies (CFHS) released its report on the 2012 national animal shelter statistics. A first-ofits-kind, the report is an accumulation of data from 102 shelters across the country and represents the best information about companion animals in Canadian shelters. To read the full report visit www.cfhs.ca

Toronto Zooâ&#x20AC;&#x2122;s polar bear cub has a Canmedical launched Veterinary Equipment Exchange Network (VEEN) name! With over 14,000 people voting in the 'Name the Cub' contest, a name has emerged as the favourite! "Humphrey" has been confirmed as the name for Toronto Zoo's male polar bear cub. The now almost four-month-old cub represents a heartwarming journey of survival, one where expert Toronto Zoo Wildlife Health and Wildlife Care staff worked around the clock to save a vulnerable species. Visit www.torontozoo.com/PolarBearCub/

SNAP Pro mobile device now available IDEXX Laboratories introduced the latest innovation in rapid point-of-care diagnostic testing, the SNAP Pro Mobile Device. SNAP Pro is an advanced point-of-care instrument that automatically activates SNAP tests, captures and saves images of the results and records invoice charges in the patient record. www.idexx.com

Registration open for West Texas A&M online course: Pharmaceutical use in cattle West Texas A&M University has opened registration for its online course on pharmaceutical use in cattle for the summer semester, which begins June 2nd, 2014. The instructor, Elaine Blythe, PharmD, is a certified online instructor and veterinary pharmacist to the National Veterinary Response Team (NVRT) and The AVMA's Veterinary Medical Assistance Teams (VMAT). Persons actively involved in the administration, distribution or sale of prescription and over-the-counter (OTC) pharmaceuticals used in food animals can benefit from comprehensive education on the therapeutic options for beef and dairy cattle. Students can use their drug knowledge base and skill set to collaborate with an attending veterinarian to maximize therapeutic outcomes, prevent drug-related problems and protect the wholesomeness of the food supply chain. Visit http://wtamu.edu/academics/veterinarypharmacy.aspx.

VEEN is a venue for veterinarians to buy and sell used veterinary equipment direct from other veterinarians who have surplus or unused equipment for sale. It can also be used to sell and relocate the entire contents of a veterinary practice anywhere in North America. Canmedical facilitates these transactions and produces market values for this equipment. Visit www.veencanada.com.

RVT promotion underway Toronto Zoo

Virbac awarded Seal of Acceptance for C.E.T. VeggieDent Chews Virbac Corporation announced it will now display the highly regarded Seal of Acceptance from the Veterinary Oral Health Council (VOHC) on their C.E.T. VeggieDent Chews. Both the small and regular sizes of the chews were awarded the Seal of Acceptance in September 2013 after the VOHC reviewed trial data. The seal was awarded to VeggieDent Chews for its ability to protect against tartar (calculus) build up on the teeth of dogs.

43 The RVT Journal

Bus Shelters never looked so good! The Ontario Association of Veterinary Technicians (OAVT) is promoting the work of Registered Veterinary Technicians with a public awareness campaign that includes six bus shelters throughout the GTA.

Help your patients get back to a normal life. The ONLY nutrition clinically tested to dissolve struvite stones in as little as 7 days1 2 and reduce the recurrence of FIC signs by 89%.

CHANGE THEIR FOOD. CHANGE THEIR WORLD. 1

Lulich JP, Kruger JM, MacLeay JM, et al. Efficacy of two commercially available, low-magnesium, urine-acidifying dry foods for the dissolution of struvite uroliths in cats. J Am Vet Med Assoc. 2013;243:1147-1153. Average 28 days in vivo study in urolith forming cats. Kruger JM, Lulich JP, Merrils J, et al. Proceedings. American College of Veterinary Internal Medicine Forum 2013. ®2013 Hill’s Pet Nutrition Canada, Inc. ®/™ Trademarks owned by Hill’s Pet Nutrition, Inc.

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