2010 Fall TECHNEWS

2010

|

VOL UME 34 I S S UE 1

PREMIER JOURNAL

FOR

CANADIAN VETERINARY TECHNICIANS

FALL

A NATIONAL JOURNAL PUBLISHED BY THE ONTARIO ASSOCATION OF VETERINARY TECHNICIANS

D E D I C AT E D TO PROFESSIONALISM PUBLICATION MAIL AGREEMENT NUMBER 40034241 • PUBLISHED

BY THE OAVT • Return Canadian undeliverable address to: OAVT, 100 Stone Rd W., Suite 104 Guelph, ON N1G 5L3

CONTINUING EDUCATION • Equine Squamous Cell Carcinoma: Can Also Be Found in the Eyes!

• The Role of the RVT in the Care and Management of Dogs with Acquired Heart Disease • Review of a Basic Anesthetic Machine Plus: Websites to Watch, Safety Column: Eye Wash Tips, Tech Tips and Tidbits, Global News, Poisoning Shorts: Ice Melts, The Veterinary Staff’s Role in Reducing Parasites, and more!

You have good reason to be concerned about the ongoing debate surrounding adjuvanted vaccines and the potential side effects resulting from the chronic inflammation they can cause in cats.

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1. Merial data on file.

2. El Garch, Hanane, Stephanie Richard, Fabienne Piras, Tim Leard, Hervé Poulet, Christine Andreoni, and Véronique Juillard.

Feline leukemia virus (FeLV)-specific IFNγ+ T-cell responses are induced in cats following transdermal vaccination with a recombinant FeLV vaccine. Intern J Appl Res Vet Med, 2006, 4(2): 100-108.

3. Flynn, J. Norman, Stephen P. Dunham, Vivien Watson, and Oswald Jarrett. Longitudinal analysis of feline leukemia virusspecific cytotoxic T-lymphocytes: Correlation with recovery from infection. Journal of Virology, March 2002, 76(5): 2306-2315.

2010 Platinum Sponsors Making continuing education better & more accessible across Canada Bayer HealthCare Animal Health Division

Letter from the Editor............................................................................................................... 2

Hill’s Pet Nutrition Canada, Inc.

Websites to Watch..................................................................................................................... 3

Intervet Schering-Plough Animal Health

OAVT 2011 Conference........................................................................................................... 3 Puzzle........................................................................................................................................ 3

Medi Cal/Royal Canin Veterinary Diet

Safety Column: Splish Splash, I gave Rover a bath and something jumped into my eye!............ 4

Pfizer Animal Health

Bacteria Facteria...................................................................................................................... 11

These companies are generously supporting a series of outstanding learning opportunities for registered veterinary technicians through OAVT.

CE Article #1: Equine Squamous Cell Carcinoma: Can Also Be Found in the Eyes!........... 7 CE Article #2: The Role of the RVT in the Care and Management

of Dogs with Acquired Heart Disease.......................................................................... 13

Hill’s Pet Nutrition Canada Inc. Launches Healthy Preventative Food.................................... 17 Pharmacology Column: Glipizide........................................................................................... 19

33rd Annual OAVT Conference and Trade Show February 17-19, 2011 London, Ontario This meeting continues to expand and grow in stature, as the largest and best stand alone Registered Veterinary Technician/Technologist meeting in the world.

Professionalism & Ethics Course Outstanding one-day CE courses offered during the year. Call the office for the date and location closest to you.

TECHNEWS The 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 We applaud these companies for working closely with Canadian veterinary technicians and OAVT in the design and delivery of these exciting programs throughout 2010.

O N TA R I O A S S O C I AT I O N O F V E T E R I N A RY TECHNICIANS D E D I C AT E D T O P RO F E S S I O N A L I S M

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CE Article #3: Review of a Basic Anesthetic Machine....................................................... 20 Poisoning Shorts: Toxicant Update: Ice Melts.......................................................................... 24 Continuing Education Opportunities..................................................................................... 25 TECHNEWS Fall 2010 CE Quizzes................................................................................. 27 Clinic of the Year Contest....................................................................................................... 29 Employment Ads..................................................................................................................... 30 Submitting Articles to TECHNEWS...................................................................................... 31 TECHNEWS Subscriptions.................................................................................................... 33 The Veterinary Staff’s Role in Reducing Parasites..................................................................... 34 Global News........................................................................................................................... 36 Tech Tips and Tidbits.............................................................................................................. 39 Did You Know?....................................................................................................................... 40

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Double page spread..................on request Full page........................................ $1395.00 Half page.........................................$895.00 Quarter page...................................$595.00 Insert..........................................on request Business Card.................................$295.00

Next Issue: Winter 2011 Deadline for Material: November 15, 2010 Distribution Date: December 15, 2010 TECHNEWS is a quarterly publication published by the OAVT.

Employment Ads: Please see Employment Ad Information on Page 30 For advertising information: Contact Cass Bayley: Tel. (519) 263-5050 Fax (519) 263-2936

• Editor - Cass Bayley (cass@bayleygroup.com) • Technical Editor - Shirley Inglis, AHT, RVT (shirley@naccvp.com)

The opinions expressed in this publication do not necessarily reflect the opinion of the Board of Directors nor the members of the Association.

TECHNEWS | VOLUME 34 ISSUE 1

Printed on recycled paper

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you can clip and provide to clients on preparing a plan for their pets in the event of a crisis.

For those of us who think of fall is the start of a new year, this is a great time to organize our plans for CE and this fall issue of TECHNEWS is chock full with three excellent CE articles to enjoy.

Christie Cooper’s regular column on Safety looks at eye wash stations with some practical advice for clinic managers and technicians.

There is an excellent article from Sonia Malorano RVT on equine opthalmology focusing on Squamous Cell Carcinoma

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(page 7) which will be of interest to many of our readers. We often receive requests for large animal CE and we hope that you find this article of great interest.

Dr. Walt Ingwersen’s article on the RVT’s role in the care and management of dogs with Acquired Heart Disease (page 14) offers insight into a team approach to coordinate care and offer support as the disease progresses.

Cynthia Stoate, RVT, VTS (Anesthesia) provides a review of the Basic Anesthetic Machine, an excellent refresher course for technicians at all levels. (page 21) On page 12 there is a short article that

We hope that you enjoy these articles and find them helpful. We are encouraged by the submissions from technicians across Canada as we make every effort to provide timely and useful articles on current areas of interest for our readers.

There is still time to enter the ‘”Clinic of the Year” Contest. This is a fun, easy way to salute your workplace and brag about your colleagues. We’d like to hear from YOU! Enjoy a beautiful fall!

Cass Bayley Editor, TECHNEWS

TECHNEWS | VOLUME 34 ISSUE 1

Friskies Cat Food Friskies brand of cat food (Nestlé Purina PetCare) recently equipped 50 cats with

Wahl Professional Animal Division Wahl Professional Animal Division introduced an upgraded website at www. wahlanimal.com. The new website boasts a new product wizard which directs users to the correct product needed for any grooming job. www.wahlanimal.com also offers product features and specifications along with low and high-resolution images for Equine, Large Animal, Professional Pet, Specialty Pet and Veterinary lifestyles.

OAVT 2011 Conference Highlights include: • Specialty tracks: equine, nutrition, critical care, feline and canine behaviour, dental, practice management • Sessions on bandaging, avian, biosecurity, large animal, rehabilitation and more • Wetlabs include: ultrasound, diagnostic techniques, dermatology, oncology • Vet Purchasing - on-site tour • Keynote Thursday followed by Welcome Reception in trade fair • Awards Reception and Dinner Friday

Visit www.oavt.org for more info!

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AAHA develops new nutritional assessment guidelines for dogs and cats The American Animal Hospital Association (AAHA) has developed a set of nutritional assessment guidelines to help veterinarians and team members properly assess and explain to clients the need for therapeutic diets. The guidelines break down nutritional assessment into “screening” and “extended” evaluations. Every pet is given a screening evaluation, and pets who show one or more nutrition-related risk factors then undergo an extended evaluation. The factors to be evaluated, as outlined in the guidelines, include the animal, diet, feeding management and environmental factors. AAHA noted that certain life factors, by themselves, may not call for an extended evaluation if the animal is otherwise healthy. The guidelines, which were made available through an educational grant from Hill’s Pet Nutrition, are available at AAHAnet.org/PublicDocuments/NutritionalAssessmentGuidelines. pdf. (dvmnewsmagazine)

Puzzle

Match up the common names with the scientific names of these equine parasites Common name

Scientific name

1. tapeworm

a. Gasterophilus spp.

2. lungworm

b. Onchocerca cervicalis

3. large-mouthed stomach worm

c. Oxyuris equi

4. common horse bot

d. Anoplocephala spp.

5. large strongyle

e. Parascaris equorum

6. neck threadworm

f. Draschia megastoma

7. pinworm

g. Trichostrongylus spp.

8. roundworm

h. Dictyocaulus arnfieldi

9. intestinal threadworm

i. Strongyloides spp.

10. hairworm

j. Strongylus vulgaris Answers: 1d, 2h, 3f, 4a, 5j, 6b, 7c, 8e, 9i, 10g

Saddle Ranch Productions Saddle Ranch Productions announced the launch of MyPetCARETV.com, a veterinarian supported online resource for pet owners. The site features instructional pet care videos, daily pet news, a social networking community, as well as a vet expert video response for the viewer generated questions of the week. (Business Wire)

small digital cameras to find out what cats do when left home alone. The findings, detailed in a new online publication called The Scratchington Post (www. friskies.com/scratchingtonpost), revealed that cats seek out sensory stimulation, taking special interest in computer and TV screens, screened-in porches and water. The Post also includes photos from the cat-cams with analysis by an animal behaviour scientist, findings from a cat owner survey and tips on how to provide cats with rich sensory experiences. (Pet Product News International)

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SAFETY COLUMN

With eyes stinging like crazy, where does a tech turn to for help?

Safety legislation across Canada requires the provision of eye wash stations when a hazard exists, expecting the employer to know when it is necessary – another good reason for knowing your WHMIS (Workplace hazardous Materials Information System) and how to use the information in the Material Safety Data Sheets (MSDSs).

The law is written so generically, and as a minimum standard, that it requires guidance to follow. For example, Ontario’s Occupational Health and Safety Act states: “where a worker is exposed to a potential hazard of injury to the eye due to contact with a biological or chemical agent, an eye wash fountain shall be provided.”1 Similarly, a quick-acting deluge shower may be necessary (in labs using acids, for example) where damage to the skin may occur from a substance.

Of course, astute clinic managers and owners are already likely taking precautions, not just because it’s required but because it’s the right thing to do. Yet even when good controls are in place – the use of goggles or safety glasses, face shields and safe work practices - accidental chemical exposures or instances where foreign bodies get past protection, can still occur.

M. Christi Cooper, RVT, CRSP is the Industrial - Agricultural Safety Officer for the University of Guelph. Her role focuses on worker safety issues at the satellite campuses and research stations across Ontario. Christi is a Canadian Registered Safety Professional (CRSP) and a RVT. She spent 16 years at the Veterinary Teaching Hospital (OVC) before switching to worker safety with the University’s Department of Environmental Health and Safety.

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Emergency showers and eye wash stations are a necessary backup to minimize the effects of accident exposure to chemicals. Currently there is no Canadian standard for the design or placement of eye wash stations or emergency showers. As a result, the American National Standards Institute (ANSI) Standard Z358.1-2009 “Emergency Eye wash and Shower Equipment” is generally used as a guide.2 So just what is required to meet the standard?

1. An eye wash should be located within

TECHNEWS | VOLUME 34 ISSUE 1

10 seconds of travel, and without requiring travel through doors or upstairs. ANSI notes that the average person can walk 16 to 17 metres (55 feet) in 10 seconds, but this does not account for the physical and emotional state of the person.

2. The activation of the eye wash needs to be effective – a one push start is ideal but not required by law - and provide a 15 minute flush for both eyes. With the fluid running, the injured person can hold their eyelids open and get relief.

3. A portable bottle with eye wash solution may allow for immediate flushing but can be very difficult for a person to use alone and of course, only allows one eye to be treated with the limited flush solution. The bottle may act as the initial flush while the user gets to a tap mounted or plumbed eye wash but cannot replace such a unit.

4. The nozzles of the eye wash stations need to be protected from airborne contaminants and most units are designed so that the removal of these covers does not require a separate motion by the user. Even the caps from syringe cases can act as nozzle covers and are easily lifted off by the water pressure when the eye wash is activated.

5. Wherever possible, tepid or warm water should be provided. As the water temperature gets progressively colder it becomes very difficult if not impossible to keep your eyes in the water.

6. A common design trap in many facilities is installing an eye wash station in a corner, conveniently tucked away but often in an area that also

Astute clinic managers and owners are already likely taking precautions, not just because it’s required but because it’s the right thing to do. Yet even when good controls are in place – the use of goggles or safety glasses, face shields and safe work practices - accidental chemical exposures or instances where foreign bodies get past protection, can still occur. becomes storage for extra equipment, unpacked boxes and the like. All of this may prevent easy access to the rinse solution. A tap mounted eye piece is acceptable, though a swing arm configuration (with a tempering valve to mix the hot and cold water) allows for quicker activation and use.

The Canadian Centre for Occupational Health and Safety further suggests that the emergency shower or eye wash station should: • be located as close to the hazard as possible • not be separated by a partition from the hazardous work area.

• be on an unobstructed path between the workstation and the hazard.

(Workers should not have to pass through doorways or weave through machinery or other obstacles to reach them.)

• be located where workers can easily see them - preferably in a normal traffic pattern.

• be on the same floor as the hazard (no stairs to travel between the workstation and the emergency equipment) • be located near an emergency exit where possible so that any responding emergency response personnel can reach the victim easily.

contamination will not occur • provide a drainage system for the excess water (remember that the water may be considered a hazardous waste and special regulations may apply). At the very least, a small hose may direct the fluid to a drain or basin, to avoid adding a slip hazard to the scenario!

• not come into contact with any electrical equipment that may become a hazard when wet, and • be protected from freezing when installing emergency equipment outdoors.2 Eye wash systems should be activated regularly, to ensure they remain in good working condition and are not blocked or corroding internally.

And of course, all personnel need to be shown the location of the eye wash and how to activate it so they are prepared to respond or assist a co-worker in an emergency.

references > 1. Occupational Health and Safety Act, of Ontario; Part III, section 124.

2. Emergency Showers and Eye Wash Stations; Canadian Centre for Occupational Health and Safety; http://www. ccohs.ca/oshlinks/

• be located in an area where further

TECHNEWS | VOLUME 34 ISSUE 1

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In the world of equine veterinary ophthalmology, the most common ocular neoplasia is the Squamous Cell Carcinoma (SCC). It is important to note that this neoplasia affects not only the eye, but can occur in other areas of the body. If left unchecked, SCC can lead to destruction of ocular tissues and possible blindness. Prior to diagnosing SCC, it is important to remember the anatomy of the eye and its related structures.

CE Article #1 Equine Squamous Cell Carcinoma: Can Also Be Found in the Eyes!

Anatomy The following paragraphs will review the anatomy of ocular structures affected by SCC. Eyelids The upper and lower eyelids of a horse comprise of skin, muscle, glands, cilia, and conjunctiva. This anatomy protects the eye by promoting tear film dispersal and controlling light intensity. There are three types of hair on the surface of the horse’s skin: a. Vibrissae – There are approximately 8 to 10 vibrissae surrounding the eyelids. These long individual firm hairs report sensation by cranial nerve (CN) V. If you touch the vibrissae, the eyelids will close. (It is therefore recommended to avoid touching the vibrissae while performing your ocular exam). b. Cilia – These hairs are located just above the eyelid margin. The eyelid cilia are fine and numerous in the upper eyelid, however, they are not present in the lower eyelid of the horse.

The cilia do provide tactility, however, their principle action is to limit the amount of light entering the eye and protect the cornea. c. Dermal Hair – These hairs cover the

surface of the eyelid. The area within 0.5 mm of the eyelid margin has few of these.

The eyelid contains several glands and the most prevalent one is the meibomian gland. These sebaceous glands are located within the eyelid margin and secrete the lipid layer of the tear film.

The eyelid muscles consist of: a. Orbicularis Oculi – this muscle encircles the palpebral fissure and close the eyelids; b. Levator Palpebrae Superioris – this muscle elevates the upper eyelid; c. Malaris Muscle – this muscle lowers the lower eyelid; d. Muller’s Muscle – this muscle gives tone to the eyelid margin

Conjunctiva The inner surface of the eyelids is covered by conjunctiva. The three main components of conjunctiva are: a. Palpebral conjunctiva – the pink tissue lining the upper and lower eyelids b. Bulbar conjunctiva – the pink tissue overlying the ocular globe c. Conjunctival Fornix – The area where the palpebral and bulbar conjunctiva join The conjunctiva also contains lymphatic follicles which contribute to the ocular immune responses.

Nictitan’s Membrane The third eyelid is located in the ventral medial aspect of the orbit and passively comes forward to cover the cornea if the

Sonia Maiorano, RVT is a VOTs Member (Veterinary Ophthalmology Technician Society Program), works in the Ophthalmology department of the Ontario Veterinary College Health Sciences Centre at the University of Guelph. She enjoys this area because of the diversity in learning, teaching and client communication in both large and small animal. Prior to joining OVC, she was in private practice for nine years.

She is a graduate with honours of the VeterinaryTechnician Program at Georgian College in Orillia, Ontario. Sonia lives in Guelph, Ontario, where she enjoys the peace and quiet of small town life. Her family includes her husband, two daughters, 3 dogs (including a meddling pug!), 3 cats, a cockatiel and a turtle. She hopes to get a horse in the next 2 years! She is the ophthalmology moderator and writer for VSPN and appreciates the opportunity to write this article for TECHNEWS.

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(excessive squinting), epiphora (excessive tearing) and enophthalmia (retraction of the globe). Ocular discharge is also commonly seen with cases of SCC. This discharge can be serous (clear tears) or become mucopurulent (infected).

Figure 1

Location With SCC, the location varies from the third eyelid (accounts for approximately ¼ of SCC found), the limbus (accounts for approximately ¼ of SCC found) or the eyelids. In order to determine the location and the disease itself, an ocular exam should be performed by a veterinarian or veterinary ophthalmologist.

globe is retracted within the orbit. The surfaces are encased with conjunctiva that contains mucous producing goblet cells. The base is composed of a lacrimal gland that produces some of the aqueous element of the tear film.

Types of SCC SCC can invade the epithelium of the upper and lower eyelids, the epithelium of the bulbar conjunctiva as well as the epithelium of the conjunctiva covering the third eyelid. There are four types of SCC: a. Papillomatous – the development of a papilloma where the connective layer multiplies into epithelium b. Plaque – the stratum spinosum multiplies within the epithelium c. Non-invasive SCC – cancerous changes to the epithelium’s basal layer are visible but are still contained within the epithelium d. Invasive SCC – cancerous changes occur beyond the epithelial layer to include the dermis; this is characterized by formations of whorls and keratinized foci on histological analysis of biopsies.

recognized that the occurrence of this disease increases with age (the mean being at the age of approximately 11 years).

Disease progression Constant and extreme exposure to ultraviolet radiation has been one belief to the development of SCC; therefore it has been noted that geographical areas of high altitude have increased rates of SCC. Clinical signs The patient may display clinical signs of discomfort or pain with the affected eye. These signs include: blepharospasm

Appearance Upper and Lower Eyelid SCCs of the eyelids first appear as ulcerated nodules on the eyelid margins (Figure 1). With time, these nodules get larger and spread along the palpebral margin.

The extent of the tumour can be easily underestimated as tumour cells can extend far from the margins seen on exam.

Bulbar Conjunctiva SCCs originating from the limbus are usually located at the lateral aspect of the eye (Figure 2). A fleshy, pink, and firm nodule commonly has a cobble-stone appearance. With time, this nodule can expand to include surrounding conjunctiva and cornea. Migration into the cornea is usually at the epithelial layer but some cases have demonstrated strictly corneal stromal involvement.

Figure 2

Breeds affected The breeds commonly affected by SCC are drafts (Belgians, Clydesdales, etc.), draft mixes, Appaloosas, and Painted horses.

Studies have shown that little to no skin pigmentation may play an important role in prevalence of this disease. It has also been

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Third eyelid SCCs of the third eyelid are usually located on the free margin of this eyelid.

A pink-coloured cauliflower mass protrudes from the medial canthus and can have an ulcerated appearance. If left without treatment, the mass will invade the entire third eyelid and migrate onto the surrounding conjunctiva in the medial canthus.

of the upper eyelid. A second nerve block, the frontal block, can also be done to ensure proper analgesia of the upper eyelid, especially if biopsies are to be taken.

Figure 4 - Direct Exam

All three locations of SCCs share the same histological appearance. It is important to ink the margin prior to sending off the biopsy in order to confirm clean margins following excision.

If metastasis occurs, it will migrate to the submandibular (regional) lymph nodes, thorax, sinus, and salivary glands.

Patient examination The patient may display signs of ocular discomfort or pain and therefore sedation should always be used to ensure safety of the patient and examiner. Choice of sedation is dependent on the general health status of the patient. Intravenous sedation is usually chosen for ease and the quick results. In addition to sedation, local ocular nerve blocks should be performed (Figure 3). The auriculopalpebral nerve block can be done in 3 locations: on the zygomatic arch caudal to the boney process of the frontal bone; caudal to the posterior ramus of the mandible; and dorsally to the highest point of the zygomatic arch. This block paralyzes the obicularis muscle, especially

Once time has been given for the nerve blocks to work (approximately 5 minutes), the exam begins by evaluating the patient’s head for symmetry, discharge, trauma, etc. A neurological ophthalmic exam, consisting of a dazzle reflex (response to light), menace response, direct and consensual pupillary light reflexes, should be done to document vision.

Other tests include the Schirmer Tear Test (measures tear production), tonometry (measures the intraocular pressures), and fluorescein stain uptake (verifies corneal ulcers) (Figures 4 & 5).

Questions that can be asked during the exam include: • What do you visualize upon examination of the upper, lower and third eyelid?

• Is the globe size normal?

• Is there any opacity in the lens?

• When performing the fundic exam (looking at the optic nerve and retina), is there anything abnormal?

The eye on a horse is much bigger than that of a dog or cat. Therefore the ocular structures can be better appreciated during an equine eye exam!

Treatment SCC of the Upper and Lower Eyelids A wedge resection of the affected tissue is required for removal of an SCC. This is done best with the patient in lateral recumbency under general anesthesia.

Although margins are difficult to achieve due to the limited amount of tissue to work with, adjunctive therapy to the remaining edges can be done to increase our chances of limiting recurrences. Adjunctive therapy can include cryotherapy, CO2 laser, or radiation therapy. If a large section of eyelid is affected, a blepharoplasty may be needed to reconstruct the eyelid; this procedure is best done by a veterinary ophthalmologist. If the entire eyelid margin is affected, brachytherapy (implantation of radiation beads) can also be done in certain facilities. Alternatively, injections of bacillus CalmetteGuérin (BCG) or cisplatin into the affected tissues can be done as a standing procedure under heavy sedation.

SCC at the Limbus If the tumour is relatively small, a keratectomy (excisional biopsy of the affected conjunctiva, limbus and cornea) can be performed under general anesthesia.

Preoperatively, bacitracin, neomycin sulphate and polymyxin B sulphate (BNP) ointment is applied. Systemic intravenous medications include flunixin meglumine and penicillin. Once the patient has been induced, the surgical area is prepped similarly to a third eyelid removal, however due to the patient being under a full general anesthetic, proparacaine is not a necessity. The patient is placed in lateral

Figure 5 - Indirect Exam

Figure 3

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recumbency and the procedure of carefully removing all the abnormal tissue is executed under the surgical microscope.

Postoperatively, a subpalpebral lavage system can be placed to facilitate drug administration, with use of antimicrobial treatment and systemic antiinflammatory drugs.

Adjunctive treatment options are recommended as clean margins cannot be determined at the time of surgery. These options include the use of cryotherapy which involves deep freezing of the affected area off, use of the CO2 laser which vaporizes tissues, or radiation therapy (Strontium probe application over the surgical site). All excised tissues should be sent off to the laboratory to have confirmation of SCC. SCC of the Third Eyelid If the growth is small, debulking or partial removal of the third eyelid can be done with surgery, followed by cryotherapy (which involves freezing the remaining margins of the third eyelid), and at home medical management. Complete removal of the third eyelid is usually performed in the hopes of clean margins and avoiding re-occurrence (Figure 6). However, if the growths are too big (limbal or third eyelid), it is recommended to perform an enucleation to ensure clean margins.

Preoperatively, the patient is given intravenous flunixin meglumine (NSAID) and a topical ophthalmic antimicrobial Figure 6

of BNP. A combination of penicillin and gentamicin can also be given intravenously for approximately an hour prior to surgery. Depending upon the size of the patient, the procedure can be performed with sedation and with the patient standing, or can be done under general anesthesia with the patient in lateral recumbency. With draft breeds, the risks and complications of general anesthesia and lateral recumbency are high and therefore, a standing procedure is usually elected. With a standing position, the patient is heavily sedated and the nerve blocks are administered. The eyelashes are trimmed with iris scissors, topical anesthetic ophthalmic solution (proparacaine) is placed in the eye and the eye is then prepped with diluted 1:25 povidone iodine solution. Two hemostat clamps are placed at the base of the third eyelid (Figure 7), which is then resected and cryotherapy is applied to the remaining edges (Figure 8).

Aftercare Depending upon the general use of the horse (pleasure, working, competitive?) owner aftercare is as follows: a. Avoid times of bright sunlight. Early in the morning or at dusk is best for less UV exposure; b. If this horse is pastured or can only be let our during the day, fly masks or a guardian type mask with eye coverings can be used to protect the horse from UV exposure and foreign body entry or damage (Figure 9);

Figure 7: Hemostat clamps applied to the third eyelid

Figure 8: The use of cryotherapy on the remaining edges

c. Schedule rechecks to monitor any regrowth (SCCs are known to become bilateral since both eyes are exposed to UV rays, plus a genetic component is also suspected with certain breeds). Be proactive about medication refills and monitor the eye for any changes in appearance.

Prognosis Several factors can impact prognosis. The

Figure 9: A good fly mask or a racing hood with an eye cover is a great way to protect the eye postoperatively from the elements.

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references >

ANOTHER INNOVATION FROM SUMMIT!

1. Brooks, Dennis E., 2002, Ophthalmology for the Equine Practitioner Teton NewMedia, Jackson, WY 83001 2. Maggs, David J., Miller, Paul E., Ofri, Ron, 2008, Slatter’s Fundamentals of Veterinary Ophthalmology, Fourth Edition Saunders Elsevier, St. Louis, Missouri 63146 3. Gelatt, Kirk N., 2007, Veterinary Ophthalmology Blackwell Publishing Professional, Ames, Iowa 50014 4. Bilger, Brian C., 2005, Equine Ophthalmology Elsevier Saunders, St. Louis, Missouri 63146 5. Hendrix, Diane V. H., 2005, Equine Ocular Squamous Cell Carcinoma Elsevier Inc., St. Louis Missouri 63146 6. Sandmeyer, Lynne, S., Breaux, Carrie B., Grahn, Bruce H., Diagnostic Ophthalmology May 2008, CVJ/Vol49

most important factor is having clean margins following excision. Another factor is limiting eyes and the surrounding tissues to UV exposure. Regular examination of the eyes and body by the owner and veterinarian can ensure early detection and removal of recurrences or potential new outgrowths of SCC. Conclusions Ocular neoplasia of the horse is a common issue in large animal veterinary medicine. With good communication between the referring veterinarian and ophthalmologist and a complete ocular exam, a great plan for disease treatment and reoccurrence prevention can be made and presented to the owner. The eye is only tolerant of a certain amount so it is important to ensure that plans are proactive from an owner’s, technician’s, referring veterinarian’s, and ophthalmologist’s point of view.

WHICH CAME FIRST? Unique chicken flavour coated tablets…designed to make treatment easier.

Summit Veterinary Pharmacy Inc. has developed a range of unique chicken flavour coated tablets designed to make treatment easier by using an appealing flavour.

• Chicken flavour in a coated tablet • Compounded to ensure consistent weight, shape, thickness and colour for your commonly-prescribed medications and strengths • HPLC potency tested prior to dispensing • Prescribed dose tablets provide consistency with each dosage unit • Minimizes the need to split tablets

SPECIAL THANKS A special thanks to Dr. Chantale L. Pinard, DVM, MSc, DACVO, Assistant professor in ophthalmology at the University of Guelph, Ontario Veterinary College for her insight, input, and reviews without which this article would not have been possible, and a thank you to Dr. Nick Whelan, BVSc, MVSc, MACVS, DDACVCP, DACVO, Associate professor in ophthalmology at the University of Guelph Ontario Veterinary College for his review and input.

Bacteria Facteria

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TECHNEWS | VOLUME 34 ISSUE 1

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CE Article #2 The Role of the RVT in the Care and Management of Dogs with Acquired Heart Disease Chronic health conditions (those having a progressive course that are managed rather than cured) present a unique challenge to the veterinary healthcare team – and a unique opportunity to showcase the team’s ability to coordinate care and offer support as the condition progresses from recognition and monitoring through to more advanced diagnostics and therapeutics.

Throughout, the foundation of care is based on client education and a robust veterinary-client-patient relationship (VCPR), of which the RVT plays an integral role, often representing the primary contact between the veterinary healthcare team and the pet owner.

An excellent example of this is acquired canine heart disease, 95% of which is either mitral valve disease (MVD) or dilated cardiomyopathy (DCM). They have a combined, overall incidence of 10% in the canine population, in other words, approximately 1 in 10 dogs in your practice have heart disease. Mitral valve disease is by far the most common, accounting for 75% of acquired canine heart disease with an incidence that increases with patient population age. Estimates indicate that it afflicts 25% of dogs over 7 years, 33% of dogs over 10 years, and 60% of Cavalier King Charles Spaniels over the age of 4 years. While less common in the overall dog population, DCM is over-represented in certain breeds, particularly the Doberman Pin-

scher, where 30-40% will develop DCM if given the time to do so.

A quick point of clarification between heart disease and heart failure to put the above figures into perspective: while all dogs having congestive heart failure (CHF) have underlying heart disease, not all dogs with heart disease have CHF. The reason is that the body has a tremendous capacity to compensate for varying degrees of organ dysfunction, the heart included. These compensatory mechanisms, while identifiable through diagnostics (see later), allow early heart disease to be clinically quiet, demonstrating no outward signs or symptoms of the internal changes taking place.

However, as a progressive condition with no cure, given appropriate time and no concurrent ailment that shortens life span, heart disease will progress from an asymptomatic or occult phase, to overt CHF with its dramatic clinical presentation and need for therapeutic intervention. As such, the term “early heart disease” usually refers to the asymptomatic phase of heart disease whereas “late” or “advanced heart disease” refers to dogs in which heart disease has progressed to CHF. Many good studies and the recent ACVIM Consensus Statement on Guidelines for the Diagnosis and Treatment of Canine Chronic Valvular Disease have defined therapeutic strategies that will improve both the quality and quantity of life for dog’s in CHF and are based on a triple therapeutic approach that includes a diuretic (furosemide or Salix™ by Intervet-Schering Plough), pimobendan (Vetmedin® by Boehringer Ingelheim Canada Ltd.), and an angiotensin converting enzyme inhibitor (ACEi) (ex. benazepril hydrochloride or Fortekor® by Novartis Animal Health Canada Inc., or enalapril or Enacard® by Merial Canada Inc., etc).

Unfortunately, there are no currently licensed products that have been shown

Dr. Walt Ingwersen is a 1982 graduate of the Ontario Veterinary College (OVC) where he returned to complete an internship and residency in small animal internal medicine resulting in his post-graduate Doctor of Veterinary Science degree and certification by the American College of Veterinary Internal Medicine as a specialist in the area of veterinary internal medicine. From 1987 to 1998, he was chief of veterinary internal medicine at a multi-person, general/specialty veterinary clinic on the east side of Toronto becoming its hospital director in 1993. In 1998, he changed career directions by becoming the first Canadian to act as editor of the Journal of the American Animal Hospital Association. Dr. Ingwersen also provides consulting services to the pet health industry, including the areas of microchipping, pet health insurance, and clinical pathology laboratory medicine. Since 2002, he has been a consultant to the Boehringer Ingelheim Canada Ltd., Vetmedica Companion Animal team joining them in a full-time capacity in 2004. He continues to provide internal medicine consultative advice, assisting veterinarians across Canada in making health care decisions and recommendations for the patients they treat. An active volunteer for provincial, national, and international veterinary medical associations, he is currently the Honorary Secretary and Editor for the World Small Animal Veterinary Medical Association.

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to be effective in delaying the onset of CHF when given during the asymptomatic phase of canine heart disease.

However, that does not mean that the veterinary healthcare team’s “tool chest” is empty. Instead, this is a classic example where a combination of early heart disease recognition, disease staging, disease monitoring, client education, and client follow-up can be instrumental in monitoring disease progression in an effort to maximize the symptom-free time of a pet with heart disease and allow for early therapeutic intervention when the transition from heart disease to CHF occurs.

This is where the RVT has a critical role to play.

Recognition of Heart Disease The RVT is often the first-line gatherer of patient-specific data, whether during a routine annual wellness examination or during preparation for an in-hospital interventional procedure requiring sedation and/or anesthesia. This generally involves the collection of a patient history, temperature/pulse/respiration (TPR), and a general physical examination (GPE), and is complemented by the patient signalment (species, breed, age, sex) and any additional data gathering that may be of relevance.

While the characteristic left heart base systolic murmur is an excellent biological marker/indicator of MVD in the middleaged to elderly, small-breed dog, similar overt markers are not always present for DCM. Either form of acquired heart disease can be complicated by concurrent respiratory disease, which is common especially in small-breed dogs, often resulting in clinical signs that can be shared by both system diseases (for example, cough and respiratory crackles on thoracic auscultation).

So, what aspect of the history and GPE can help confirm the presence of heart disease and/or differentiate between primary respiratory and heart disease?

History Always ask, as any sign or symptom that is out of the ordinary for the pet is relevant, although many are vague, nonspecific, and often attributed to old age.

Remember, old age unto itself is not a

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disease but it certainly seems to be complicated by disease(s)! Signs attributed to old age may in fact be attributed to significant underlying cardiopulmonary disease (respiratory compromise) and/or musculoskeletal disease (pain). Always explore these further with the owner.

With regards to differentiating between respiratory or cardiac disease when assessing breathing and/or coughing, a proper assessment is based upon sign description including duration, frequency, severity, and contributing factors. Consider the following hints: • Breathing: Dogs with progressive heart disease and/or impending CHF often demonstrate respiratory difficulty without exercise and during the night, evidenced by restlessness while trying to sleep. Their resting respiratory rate may also be elevated even at rest (see section on monitoring).

• Cough: A cardiac cough is generally soft and moist, not necessarily precipitated by exercise or excitement, more common following rest, has a relatively short duration (less than 6-8 weeks), and rapidly escalates in severity.

GPE A heart murmur is a tell-tale indicator of potential underlying heart disease. It is important to actually grade the heart murmur as severity does correlate with heart disease progression (see Table 1).

Aside from the characteristic heart mur-

mur, respiratory crackles can be shared by both cardiac and respiratory conditions as both results in small airway impairment.

The TPR can be very valuable in helping to differentiate between the two: • Temperature: Generally normal to low for cardiac disease versus low to elevated for respiratory disease, especially if complicated by a respiratory infection • Pulse: One of the compensatory mechanisms in heart failure is the sympathetic nervous system, which attempts, in part, to overcome a failing heart by increasing heart rate. As such, dog’s with clinically significant heart disease will have a rapid heart rate (140 or greater), which can be regular or irregular, if complicated by an arrhythmia (for example, atrial fibrillation). Slower heart rates or those demonstrating a sinus arrhythmia are more characteristic of signs related to respiratory disease.

• Respiration: While it can be elevated in both conditions, home monitoring can be very valuable in identifying disease progression (see later) Other Helpful Tips • Whether through auscultation or pulse palpation, the occurrence of one premature ventricular contraction (PVC) in an at-risk breed (i.e., Doberman pinscher) during a 3-5 minute period is highly correlated to occult DCM. As such, it pays to spend time on cardiac auscultation.

table 1 >

Heart Murmur Grading

Grade I/VI

Can only be heard in a quiet room after several minutes of listening

Grade II/VI

Soft but heard immediately upon auscultation

Grade III/VI

Low to moderate intensity

Grade IV/VI

Loud but without a palpable thrill

Grade V/VI

Loud but with a palpable thrill (hand placed on chest)

Grade VI/VI

Can be heard with stethoscope not directly on the chest wall

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table 2 >

Vertebral Heart Score Reference Values

Normal Dogs Boxers

8.5 – 10.7 10.3 – 12.6

Labrador Retrievers

9.7 – 11.7

Cavalier King Charles Spaniels

9.9 – 11.7

• Don’t forget to examine the jugular groove for a jugular pulse. A pulse seen in the thoracic inlet and radiating no more than 1/3 of the way up the jugular groove is considered normal. Anything more dramatic is correlated highly to right-sided heart failure, which may be due to MVD, DCM, pericardial effusion, or heart disease among others.

Heart Disease Staging Many different tests are available to help better define the presence and stage of MVD or DCM. These include chest radiographs, ECGs, and echocardiography.

All have their role and place yet none is as critical and cost-effective as thoracic radiographs, which are both useful in staging heart disease and are also the only way to diagnosis CHF (i.e., presence of pulmonary edema).

Heart disease usually progresses through several distinct stages over time, and have been categorized by various classification systems (by the Modified New York Heart Association, International Small Animal Cardiac Health Council, etc.). Suffice it to say, the asymptomatic phase of heart disease is divided into 2 stages and easily defined on thoracic radiography: 1. Heart disease present; no clinical signs; no cardiac changes 2. Heart disease present; no clinical signs; cardiac changes evident Clearly the latter indicates more advanced heart disease as the heart anatomy changes (cardiac remodeling) to accommodate and compensate for the underlying progression of the heart disease. Historically, assessments of cardiac size and shape were subjective (for example, the number of rib spaces, tracheal elevation,

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percentage of space in the chest cavity, etc.) and, while these are still useful, they are plagued with intra and inter-evaluator variability and bias. This has been largely resolved by the introduction of the Vertebral Heart Score (VHS), which generates an objective measure of a patient’s heart size and has been validated in multiple studies. See Figure 1 for a description on VHS methodology. Normal canine values are between 8.7 and 10.7 although species-specific values have been generated (see Table 2). Values greater than 11 are indicative that a cardiac cause for any respiratory signs displayed should be considered. Even if the patient is asymptomatic, an increase in cardiac size indicates that a more aggressive monitoring program should be implemented (see later).

Recently, a new blood test that helps stage heart disease has been made available through IDEXX Canada Corp. Termed Cardiopet™ NT-proBNP, the test assesses neurohormonal changes that accompany progressive heart disease and can help with differentiating cardiac from respiratory causes for respiratory signs.

Heart Disease Monitoring As heart disease is progressive, a monitoring program is critical in following disease progression to better predict the likelihood of impending CHF. This is usually done through a two-pronged approach: 1. In-clinic monitoring 2. At-home surveillance An in-clinic monitoring program is based on more frequent clinical re-assessments (beginning with every 6 months). Ideally, history, GPE, chest radiographs, and/or

laboratory testing can be repeated and reassessed to not only better quantify disease progression, but to also identify any concurrent ailments that may complicate or contribute to the underlying heart disease. These if appropriately treated, can help lengthen a pet’s asymptomatic phase.

The age-old adage that “an ounce of prevention is worth a pound of cure” applies well here, so encourage your client to embrace more frequent wellness examinations.

The same adage applies to the owner’s ability to gather valuable information through home surveillance, by identifying any unusual and persistent behaviour changes that may indicate impending CHF, including changes in respiratory rate and difficulty, increased frequency and severity of coughing, restlessness at night while trying to sleep, dramatic reductions in exercise tolerance, and bouts of fainting.

Pulmonary edema is the ultimate endresult signifying the transition from heart disease to CHF. It is not an all-or-nothing phenomenon that occurs from one moment to the next, but rather a progression over a relatively short period of time with the initial signs being subtle. A sentinel to this progression is respiratory rate and home-monitoring by the owner can be invaluable in identifying impending CHF. Have the owner measure their pet’s resting (ideally sleeping) respiratory rate 4 or 5 times per week. A normal respiratory rate is generally between 16-24 breaths per minute. An elevation of 25% or a rate greater than 30 breaths per minute that remains persistent and consistent indicates the need for clinic re-evaluation and/or a repeat thoracic radiograph. If confirmed to be emerging pulmonary edema, early therapeutic intervention can be initiated thereby preventing the progression to fulminate pulmonary edema and attendant respiratory embarrassment, which is more difficult and distressing to treat.

Client Education Many of the prior points have educational components to them. Other areas

15

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Measuring the Vertebral Heart Size

Checking for possible heart enlargement due to canine congestive heart failure is now as easy as 1-2-3.

1) Measure the lengths of the short and long axes of the heart on a right lateral chest radiograph.

2) Mark both of these lengths on the spinal column, starting from T4.

Count the corresponding number of vertebrae each measurement spans.

3) Add the two numbers together.

That value is the Vertebral Heart Size (VHS). VHS = S + L

For a healthy dog, the normal VHS should be less than 10.5-11.0. Values greater than 11.0 indicate possible heart enlargement due to congestive heart failure.

In dogs with congestive heart failure due to valvular insufficiency or cardiomyopathy, Vetmedin provides potent vasodilatation as well as direct positive inotropic effects. The results can be dramatic!

Choose Vetmedin.速 Choose life.

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16

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Figure 1: Vertebral Heart Score Methodology

to consider when developing an educational program for owners of dogs with heart disease include: Nutrition What we eat defines who we are, and this applies for our pets as well and can have a dramatic influence on both health and disease. Salt can be a cause for concern in dogs with heart disease as increasing levels of sodium result in water retention complicating or precipitating CHF. That being said, severe salt restriction, particularly if implemented too quickly, is also not ideal. As such, a good starting point is to ensure that the pet is on a premium quality diet designed for the appropriate life stage and that the owner avoids giving treats high in salt.

Lifestyle Exercise is good for both weight control and an opportunity for the owner to observe their pet’s behaviour for any indications of changes that may be reason for concern and veterinary intervention.

Follow-up Periodic phone re-assessment is helpful to address any maintenance issues that may come up. Often homecare for the dog being treated for CHF is a balance between breathing comfort and medication side effects (for example, frequency of urination and/or continence issues). Picking up on concerns can help fine-tune care that addresses both the pet’s and owner’s quality of life!

And remember, many of the animal health companies have supporting literature that are designed as client educational pieces that would nicely complement the educational efforts of the veterinary healthcare team. Ask your sales representative from companies providing product and/or services that address cardiopulmonary disease in dogs for more information.

Summary Acquired canine heart disease is common.

Its generally slow progression allows for many interventional opportunities that collectively can improve the pet’s qual-

references > 1.Atkins C, Bonagura J, Ettinger S, et al.

ACVIM Consensus Statement: Guidelines for the Diagnosis and Treatment of Canine Chronic Valvular Heart Disease. J Vet Intern Med 2009; 23:1142-1150.

ity and quantity of life. Recent research indicates the importance of quality of life for a pet owner: 86% of pet owners with dogs suffering from heart disease were willing to trade survival time for improved quality of life with 52% willing to trade 6 months. Key to maximizing quality of life is patient-specific data collection, monitoring, and education – for which the RVT is critically positioned within the veterinary healthcare team to drive excellence in patient care.

While even the best of care cannot prevent the progression of heart disease to CHF, it can help prevent a cardiopulmonary crisis!

Hill’s Pet Nutrition Canada Inc. Launches Healthy Preventative Food Hill’s Pet Nutrition Canada Inc. launched a brand new dry pet food product called Hill’s® Healthy AdvantageTM, a multi-benefit preventative food designed to help address canine and feline dental, weight, digestion, skin and coat, joint, urinary and immunity issues before they start. Healthy Advantage is available exclusively in Canada through veterinarians in Puppy, Puppy Large Breed, Kitten, Canine Adult and Feline Adult. Healthy Advantage contains a clinically proven kibble technology that scrubs teeth clean like a toothbrush reducing plaque and tartar buildup. The pet food also showcases a fiberenriched formula enhanced with L-carnitine, which helps maintain optimal body weight, build lean muscle and turn fat into energy; and natural glucosamine and chondroitin sulfate to provide the building blocks for healthy joints and cartilage. (Veterinary Advantage)

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17

N

EW

Hill’s Healthy Advantage veterinary exclusive pet nutrition ®

™

FIVE ESSENTIAL BENEFITS IN ONE PRODUCT DENTAL WEIGHT SKIN & COAT DIGESTION JOINT Contact your Hill’s veterinary account manager for information about a special initial product stocking offer ©2010 Hill’s Pet Nutrition Canada, Inc. ®/™ Trademarks owned by Hill’s Pet Nutrition, Inc.

P H A R M AC O L O G Y C O L U M N

Glipizide • Brand Name: Glucotrol • Available in 5 mg tablets Background Diabetes mellitus is an enormous problem in human medicine. There are hundreds of thousands of human diabetics who require treatment and there are research labs all over the world seeking ways to make life easier for the diabetic patient. This research spills over into veterinary medicine and can be helpful to our animal patients.

Human diabetic patients are classified as Type I (completely unable to produce any insulin) and Type II (unable to produce enough insulin). Type I patients do not respond to oral treatments to reduce blood sugar and they require insulin injections, whereas Type II patients may be able to respond to oral medications provided their pancreas has some remaining insulinproducing capacity. While it is not difficult to classify human patients, this is not so straightforward for animals. Diabetic dogs, for example are completely insulin dependent (analogous to Type I) and have no response to treatments other than insulin injections. Cats, on the other hand, are generally felt to fit into the Type II category, meaning some diabetic cats (perhaps as many as 30%) can actually make do with oral medications.

These oral medications work by causing the pancreas to release insulin more effectively (obviously if there is no insulin to release, this does not help). They also help increase tissue sensitivity so that smaller doses of insulin may have a greater effect.

Some cats will respond adequately to this treatment and thus avoid the use of insulin injections at home.

How this Medication is Used Typically, this is an oral medication scripted out to a pharmacy. It is given twice a day. Since no one knows if a cat will respond, monitoring for the first month or so

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by Dr Wendy Brooks, DVM, DipABVP (Educational Director, Veterinary Partner.com) is important. We recommend taking weekly blood sugar levels that will help us determine the dose of glipizide. Some cats will be partial responders and this partial response may or may not be adequate to control their diabetes. Some cats will respond at first but ultimately require insulin later on.

of glipizide and may be enhanced themselves when used in combination with glipizide: chloramphenicol, non-steroidal antiinflammatories, salicylates, and sulfa class antibiotics. Monoamine oxidase inhibitors such as selegiline may enhance the activity of glipizide as can the antacid cimetidine.

During treatment with glipizide, it is important for the cat to eat a low carbohydrate diet. This kind of dietary management is also helpful in treating diabetes mellitus and will help maximize the medication’s effect.

Concerns and Cautions • Pre-existing liver or kidney disease will predispose the patient to hypoglycemic reactions.

• If ketones are discovered in the patient’s urine, this is an indication that oral hypoglycemic treatments will not be useful. Only insulin can stop ketonuria.

• One of the most important cautions with the use of this medication is that by increasing the release of insulin, glipizide also increases the secretion of other proteins in the pancreas. It is generally abnormal protein deposition in the pancreas that caused the diabetes mellitus in the first place, thus the use of glipizide may lead to progression of pancreatic destruction. For this reason, we recommend glipizide as a last resort when insulin administration cannot be given or for a select few cats who are sensitive to insulin secretion.

Side Effects • Hypoglycemia (blood sugar dropping too low) will occur in some cats on this medication. This is one of the reasons why monitoring is so important. Hypoglycemia is reported to occur in ~15% of cats on glipizide.

• Nausea and appetite loss can occur in some individuals. Giving the medication with food is helpful. It is important to realize that appetite loss is a dangerous situation for a diabetic. It should be stressed to clients that they need to contact the clinic if the cat stops eating.

• Liver enzymes will elevate on diagnostic testing with the use of this medication. This does not appear to be a harmful problem but be aware of this reaction if there are elevated enzymes on a routine screening test.

If the cat’s liver enzyme elevations are accompanied by actual signs of illness, the medication should be discontinued. If the ALT enzyme becomes >500 IU/L, then the medication should be discontinued.

Interactions with Other Drugs The following drugs may enhance the effect

© 2010 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.

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Morbidity and mortality are known risk factors associated with veterinary anesthesia. One way to reduce their occurrence is to be familiar and confident

with the equipment you use. Anesthetic machines may look different from one another but they all have the same basic parts. When you are first introduced to a new anesthetic machine it is important to find out where all the different parts are located and how they work before you use it on your patient. This allows for a more efficient and safe procedure. Also, if you know how something works you can better solve any potential equipment problems and have an informed discussion with your service technician.

CE Article #3 Review of a Basic Anesthetic Machine

The best way to become familiar with the anesthetic machine is to follow the oxygen flow from the source, through the machine and to the patient. Although various medical gases are used with anesthetic machines, this article will focus on oxygen. Also, although newer generation anesthetic machines have developed into “work stations”1 consisting of ventilators, patient monitors and various other upgrades, this article will focus on the components of a basic anesthetic machine.

Oxygen Oxygen will be supplied to the machine generally by one of two methods, either by a cylinder of compressed gas attached directly or indirectly to the machine or by a reservoir located at a distance and piped to the location of the anesthetic machinea. Cylinders that attach directly to the machine are smaller cylinders of size “A” or more commonly size “E”. The cylinder is mounted on the anesthetic machine by a pin index safety system that incorporates holes in the cylinder valve and pins on the mounting yoke of the machine.1,2 Each medical gas has it’s own pin index pattern which prevents the wrong medical gas being mounted on any given yoke. For example, the pin

Figure 1: Oxygen Cylinder Mount with A: oxygen E cylinder, B: pressure reducing valve, C: oxygen yoke mount, D: pressure manometer.

index of a nitrous oxide cylinder cannot physically be mounted on the yoke for an oxygen cylinder.

The pressure inside an oxygen E cylinder can be as high as 2000 psi, which is too high for the infrastructure of the anesthetic machine and the patient. Components of the anesthetic machine that handle this elevated pressure are considered the high pressure system of the machine.2 The elevated pressure must be reduced and regulated through a pressure reducing valve (pressure regulator). This pressure reducing valve is located within the machine next to the mounting yoke and will reduce the pressure to 40 – 48 psi, allowing the oxygen to then be safely delivered into the anesthetic machine2.

The pressure reducing valve also regua. Cylinder sizes will vary from facility to facility and from one country to the next. The author has referenced cylinder sizes commonly used in her facility. Details for use of cylinders with yoke mounting and cylinders with mounted regulators will be similar.

Cynthia Stoate, RVT, VTS (Anesthesia) graduated from the Animal Health Technology program at Centralia College of Agriculture and Technology in 1982 and completed the RVT qualifications in 1991. After working in several small and large animal practices, including a year working in Australia, Cindy began her career at the Ontario Veterinary College Teaching Hospital in 1987. Cindy has worked in various units of the OVCTH but has primarily worked in the Anesthesia unit and has a particular affection for the feline population. Cindy is currently the Team Leader in the Anesthesia unit. One of Cindy’s most recent accomplishments was successfully completing the requirements for VTS (Anesthesia) certification in 2008. Interests include traveling, reading, gardening and quilting. Cindy shares her home with two adorable and handsome cats named Panda and Teddy.

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TECHNEWS | VOLUME 34 ISSUE 1

lates the pressure maintaining a consistent pressure as the volume of oxygen in the cylinder drops.1 Associated with the mounting yoke should be a pressure manometer, which measures the pressure in the cylinder. Because oxygen is a nonliquified gas the pressure in the cylinder will decrease as gas is withdrawn.1 Therefore, the volume of oxygen remaining in an E cylinder can be estimated by multiplying the psi on the manometer x 0.3 which will equal the liters of oxygen remaining for use (a full E cylinder holds approximately 650 liters).

Pressurized gas cylinders that attach indirectly to the machine are of larger sizes, such as “H” or “K”. The content of these cylinders also needs to be reduced in pressure utilizing a pressure regulator with a mounting nut thread specific to that gas, so that, as with the pin index of the smaller cylinders, the wrong gas cylinder won’t be mounted onto an oxygen regulator.2 Pressure regulators for these larger cylinders have a pressure manometer that indicates the pressure of the gas in the cylinder and an adjustable regulator to reduce the pressure delivered to the anesthetic machine to approximately 50 psi. The volume of oxygen remaining in a K cylinder can be estimated by multiplying the psi x 3.0, which will equal the liters of oxygen remaining for use (full K cylinder holds approximately 6770 liters). Oxygen is then delivered from the cylinder pressure regulator through high pressure hosing to the machine.

The second method of supplying oxygen to your machine is to have it piped into the machine by overhead piping from an oxygen reservoir such as a bank of large tanks with a manifold, a liquid oxygen storage tank or an oxygen concentrator.1,3 Piped oxygen is generally reduced in pressure at the source to 50 – 60 psi and does not have to go through a pressure reducing valve at the anesthetic machine.

If your machine utilizes only smaller cylinders, there should be a minimum of two cylinders on the machine for safety.

If your machine utilizes oxygen piped from a reservoir, the machine should also have at least one small cylinder mounted for emergency backup. On newer generation machines (those with small oxygen cylinder and a piped oxygen source), the

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slightly higher pressure of the piped oxygen will be utilized first to conserve the E cylinder for emergency back-up. However, E cylinders should always be closed when the machine is attached to a main reservoir to maintain this emergency source. The source of oxygen should be either closed or disconnected when an anesthetic machine is not in use, and any pressure that has built up in the machine bled out by either the oxygen flow meter or the oxygen flush valve.

Flowmeters Once the oxygen source has been identified and accessed, you then need to determine how to get it through the anesthetic machine to the patient. There is a pipeline system within the machine that delivers the oxygen from the pressure reducing valve to the flowmeter. This is known as the intermediate pressure system of the machine.2 The flowmeter consists of a plastic or glass tube with a float in the form of a ball or bobbin inside and a needle valve control knob at the base, which controls the flow rate of oxygen through the flowmeter and to the machine. The flowmeter also slightly reduces the pressure of the oxygen further. Components of the anesthetic machine beyond the flowmeter are considered the low pressure system of the machine.2 Gradations on most flowmeters are recorded in gradations of 100 ml/min for a flow rate below 1 L/min, and gradations of 1 L/min for flow rates above 1 L/min. Accuracy below 500 ml/min may be questionable and therefore many people do not set the oxygen flow rate below 1 L/min as a safety precaution. Newer designs of anesthetic machines may have two separate oxygen flow meters, the first one with gradations of 100 ml/min for flows less than 1 L/ min and the second one with gradations of 1 L/min for flows over 1 L/min, allowing for more accurate delivery at low flows. If a low flow or closed breathing system is to be used, monitoring oxygen concentrations delivered to the patient is then important.2 As the control knob at the bottom of the flow meter is opened oxygen flows up the tube and around the float. The float will rise within the tube. The higher the flow rate, the higher the float will rise in the tube. The flow rate is read from the middle of the ball or the top of the bobbin.

Sticky floats can occur from dirt or static electricity building up inside the tube and will result in an inaccurate reading of the flow rate.3 The float should be centered or rotating within the tube to demonstrate that it is not stuck against the inner wall of the flow meter. When the anesthetic machine is not in use and the pressure within the machine has been bled out, the flowmeter should be turned to the off position to prevent damage when oxygen is reintroduced into the machine at next use. Flowmeters only need to be turned off, not over-tightened.

Oxygen flow rates will be discussed in a future article on breathing systems.

Vaporizers Once the oxygen flow rate has been determined, the oxygen travels out the top of the flowmeter and through a back bar towards the vaporizer. There are a large variety of vaporizer designs available. In short, vaporizers come as either precision, or non-precision and either temperature-, flow- or backpressure-compensated or not. They are calibrated to a specific agent and are designed to be utilized within a specific location on the anesthetic machine, either in-circle or out-of-circle.

You should understand these aspects of your vaporizer and how to use it for safe anesthesia of your patient.

Once the oxygen has passed through the vaporizer the gases then travel through the low pressure piping system towards the common gas outlet (or known as the fresh gas port). From this point the decision needs to be made regarding what type of breathing system is going to be used on the patient. Due to the limited capacity of this article the different types of breathing systems will be discussed in a future article. However, components of the carbon dioxide absorber as part of the anesthetic machine for a rebreathing system will be discussed. References listed at the end of this article have detailed information on both vaporizers and breathing systems.

Carbon Dioxide Absorbers Carbon Dioxide (CO2) absorbers are utilized with circle breathing systems to reduce or eliminate rebreathing of the exhaled CO2. The absorber generally consists of a canister in a housing, a fresh gas

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Figure 2: Carbon Dioxide Absorber with A: canister, B: fresh gas inlet, C: unidirectional valves, D: inspiratory and expiratory ports, E: reservoir bag mount, F: adjustable pressure limiting valve, G: pressure manometer.

inlet, and an inspiratory and expiratory port for connecting the circle breathing hoses, inspiration and expiration unidirectional valves, a reservoir bag port, an adjustable pressure limiting valve (also known as the pop-off valve) and a pressure gauge (manometer). The arrangements of these components will vary between different designs of CO2 absorbers and will impact their function beyond the scope of this article.

Canisters come in various sizes and construction and it is important to be familiar with the unit you have to understand proper filling, installation into its housing and use to eliminate gas flow and leak problems. The canister holds the CO2 absorbent, most commonly soda lime or baralyme, which eliminates CO2 from the expired gases. Direction of gas flow through the canister, and subsequent utilization of the absorbent vary, but start where the exhaled gases first enter the absorbent.

The fresh gas inlet attaches to the common gas outlet of the anesthetic machine via a hose and directs the gases toward the CO2 absorber, or directly to the patient breathing system if CO2 absorbent is not being used.

The unidirectional valves are associated with the two ports that connect to the breathing system. These unidirectional valves direct the flow of gases in one direction and prevent backflow. The inspiratory valve opens on inspiration and closes

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on expiration, directing flow towards the patient through the inspiratory hose and preventing expired gases flowing back up the inspiratory hose. The expiratory valve opens on expiration and closes on inspiration. This allows expired gases traveling through the expiratory hose to enter the CO2 absorber and prevents gases flowing back through the expiratory hose towards the patient. Common unidirectional valves consist of a transparent dome cover over a seat with a disc sitting on top of the seat and a check valve restricting the flow of gases in one direction. As gases pass through the unidirectional valve in the controlled direction the disc should flutter on top of the seat indicating that the valve is functioning properly. If gases are forced back against an opposing unidirectional valve the disc should not flutter. Unidirectional valves should be observed throughout anesthesia to ensure that they are functioning properly.

A sticky inspiratory valve that does not flutter will reduce or eliminate fresh gas flow to the patient, and a sticky expiratory valve that does not flutter will obstruct outflow from the patient and create backpressure in the breathing system.

The bag port holds the reservoir bag and is most commonly situated between the expiratory unidirectional valve and the CO2 absorber.

The adjustable pressure limiting valve (APLV) is utilized to control the amount of expired gas that flow out the scavenge hose vs. remaining in the reservoir bag and recirculating with the fresh gases.

During spontaneous breathing the APLV is adjusted to maintain a small volume of expired gases in the reservoir bag allowing for evaluation of the frequency and depth of spontaneous breathing. The volume of gases in the bag should never create a pressure of more than 1 to 2 cmH2O during spontaneous ventilation.

During assisted or controlled ventilation the APLV is generally closed completely, or enough to create an inspiratory pressure sufficient for ventilation. This will direct ventilation to the patient, and the ventilator is designed with its own pressure limiting valve to release excessive pressure.

The pressure manometer is used to evaluate the pressure that is created in the pa-

tientâ&#x20AC;&#x2122;s breathing system either by spontaneous or controlled ventilation.

Scavenge Systems Since the volume of medical gas delivered to the patient usually exceeds their metabolic requirement, excess expired gases need to be evacuated from the breathing system on the anesthetic machine. This is accomplished with a scavenge system that connects to the APLV. Scavenge systems vary in design and function but are generally categorized as passive or active.

A passive scavenge system requires the ongoing flow of medical gases through the breathing system to direct the exhaled gases towards the APLV and out the scavenge hose. Exhaled gases can then either pass through a charcoal canister that will neutralize the exhaled anesthetic agent before being released into the room, or out into the atmosphere where dilution will make the anesthetic agent ineffective. Active scavenge systems still require the ongoing flow of medical gases through the breathing system to deliver the exhaled gases towards the APLV, but then incorporate a fan to draw gases away from the APLV and out into the atmosphere.

Oxygen Flush Valve The oxygen flush valve is commonly located next to the common gas outlet. This valve allows for oxygen to bypass the vaporizer and deliver a high volume (35 to 75 L/min)2 of oxygen to the common gas outlet, and subsequently to the breathing

Fig. 3 Scavenge Interface with A: block mount, B: waste gas in-ports, C: waste gas out-port to evacuation system, D: check valve, E: scavenge reservoir bag. Helps to organize multiple scavenge hoses to one source and control the draw of an active scavenge system.

TECHNEWS | VOLUME 34 ISSUE 1

system. Because of the high flow, and the high pressure that it produces, the flush valve should not be used on a pediatric breathing system connected to a patient, as this would create barotraumas to the patient’s lungs.2,4 Safety Devices and Alarms Various safety devices may be incorporated into your machine. For example, the unidirectional check valve. When positive pressure is created in the breathing system by either positive pressure ventilation or use of the oxygen flush valve, this pressure may be transmitted back to the anesthetic machine. This can impact the accuracy of the oxygen flow meter and the vaporizer and can also create leaks within the anesthetic machine. The unidirectional check valve will limit the impact of this high pressure.1 An emergency air-intake valve, if fitted onto an anesthetic machine, will open if gas flow in the anesthetic machine stops. This allows the patient to breath room air in the absence of gas flow.3 Various alarms may also be fitted onto your anesthetic machine. A low oxygen pressure alarm, or oxygen failure alarm, which indicates when the pressure of oxygen in the machine drops, is usually an indication of a problem with the source.

Machines can also be adapted with a high patient pressure alarm. This will alarm when the pressure in the patients breathing circuit reaches a preset limit indicating problems such as a kinked endotracheal tube or a closed pop-off.

Daily or Case-by-Case Checklist Once you are familiar with your machine it is not necessary to check all of these components daily. However, certain components should be checked on a daily basis, or more ideally, on a case by case basis. These would include the following: 1. Amount of oxygen available in your source as calculated in the paragraphs on Oxygen. Ensure that you have sufficient oxygen for the estimated length of procedure to be performed under anesthesia. Also en-

TECHNEWS | VOLUME 34 ISSUE 1

sure that you have an alternate source should your tank run dry or malfunction during a procedure.

2. Amount of liquid inhalant agent in the vaporizer. Different models of vaporizers have various methods of demonstrating the level of inhalant, but most commonly it can be noted through a glass window or tube located on the front of the vaporizer.

Ideally, the vaporizer should be full before beginning a case. However, if you are familiar with how long a certain level of liquid inhalant will last and are confident that you have enough, you can wait until the end of the day to fill vaporizer(s) to limit the exposure to personnel. Understanding how to fill the vaporizer you have is important to know before starting a case, should you need to refill the vaporizer during a procedure.

3. Viability of CO2 absorbent. The most reliable method of determining the viability of the CO2 absorbent is to measure the amount of CO2 in the inspired gases. However, not every clinic has the equipment to do this. There are a few other ways of determining the viability of CO2 absorbent but generally colour change and texture is the most common, plus temperature change. The CO2 absorbent will generally change colour to pink or purple, depending upon the agent you use, as it is expires. Unfortunately, the colour change occurs late when most of the absorbent is expired and the colour will change back to white when the machine is not in use. So noting white CO2absorbent when setting up your machine is not a guarantee. To avoid any confusion it is important to change expired CO2 absorbent at the end of a procedure, or at least hang a sign on the machine indicating the need to change the absorbent before next use. Most CO2 absorbent will be easy to crumble into a powder when it is fresh, but more likely to become brittle when it expires. We tend not to test this very often because it requires opening up the CO2 absorber canister more often, adding wear and tear to this component of the machine. Carbon dioxide absorbents generate heat

when functioning and therefore the outside of the CO2 absorber canister may feel warm to the touch when in use after a certain period of time.

4. Scavenge systems should be inspected to ensure proper attachment of the scavenge hose from the anesthetic machine to the appropriate scavenging destination, either an absorbing canister such as a charcoal canister (not to be confused with the CO2 absorber) or outside.

5. Pressure testing the breathing system should also be performed before a procedure starts. How to do this will be discussed in a future article. However, when pressure testing breathing hoses on a CO2 absorber it is a good time to also note the functioning of the unidirectional valves.

Understanding the design and function of the various components of the anesthetic machine, and performing routine tests prior to starting a case, will go a long way towards operator comfort and patient safety when anesthetizing an animal.

The author gratefully acknowledges the assistance of Dr. Melissa Sinclair for her assistance in reviewing this article.

references > 1. Dorsch J., Dorsch S., “Understanding Anesthesia Equipment Fourth Edition” 4th edition, Williams & Wilkins, 1999.

2. Hartsfield S., “Anesthetic Machines and Breathing Systems”, In: Tranquilli W., Thurmon J., Grimm K., “Lumb & Jones’ Veterinary Anesthesia and Analgesia ” 4th edition, Blackwell Publishing, 2007.

3. Alibhai H., “Anaesthetic machine and vaporizers”, In: Seymour C., Duk-Novakovski T., “BSAVA Manual of Canine and Feline Anaesthesia and Analgesia ” 2nd edition, BSAVA, 2007.

4. University of Florida, “Center for Simulation, Safety and Advanced Learning Technology”, http://www.vam.anest.ufl. edu/reviewhighpressure.html

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or hydrochlorothiazide are used to treat the hyperkalemia. Other recommended treatments include electrolyte, glucose and renal function monitoring.

The colder months are due; snow and ice are sure to follow.

A variety of ice melt products may be used to try and keep sidewalks and driveways safe.

House pets can accidentally be exposed to these types of products and experience potentially serious problems because of that exposure.

There are several common ingredients in most commercially available ice melt products, including sodium chloride, potassium chloride, magnesium chloride, calcium salts and urea. All can be irritating to the skin, varying from mild irritation to actual corrosive injury depending on the ice melt formulation. Owners should be instructed to wipe or rinse the feet if the pet should walk through areas where ice melts are being used.

Sodium Chloride Sodium toxicosis is possible after large ingestions of ice melts, salt, or rock salt.

A dose of 4 g/kg of sodium chloride can be lethal in dogs. Ingestion can cause gastrointestinal signs, PU/PD, hypernatremia leading to tremors, seizures,

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tachycardia and metabolic acidosis.

Treatment of acute sodium chloride toxicosis primarily involves administration of intravenous fluids and managing signs.

The fluid of choice is either half strength saline + 2.5% dextrose, or 5% dextrose in water. Acute hypernatremia can be corrected rapidly during the first 24 hours, and warm water enemas may be helpful in reducing the sodium level during this time period. For hypernatremia persisting for >24 hours (or hypernatremia that develops over several days, i.e. chronic hypernatremia), it is important to correct sodium slowly over a period of 48 to 72 hours in order to avoid cerebral edema.

The sodium should not be lowered at a rate of more than 0.5 mEq/L/hr. Sodium bicarbonate should be used cautiously, if at all, when treating acidosis as not to exacerbate hypernatremia.

Potassium Chloride Ingestion of this ingredient can cause severe irritation to the GI tract, including hemorrhage. Hyperkalemia can also occur, mainly in patients with renal insufficiency. Signs associated with hyperkalemia are vomiting/diarrhea, weakness, hypotension, and abnormal cardiac conduction. Treatment usually begins with dilution, as emesis is controversial.

Fluids (LRS or saline) and furosemide

Magnesium Chloride Hypermagnesemia can occur after icemelt ingestion. Hypermagnesemia can cause hypotension, hypophosphatemia, cardiac abnormalities (atrioventricular block, prolonged QT intervals, and bradycardia), weakness, and impaired neuromuscular transmission. Patients with renal insufficiency are more susceptible to developing hypermagnesemia. The LD 50 of magnesium chloride in rats is about 4,000 mg/kg. Dust from products containing magnesium may be irritating and can cause upset stomach. Treatment of magnesium salt ingestion is symptomatic and supportive. Emesis may reduce the amount absorbed if induced within two hours of ingestion. Calcium Carbonate and Calcium Magnesium Acetate: Acute ingestion of calcium salts is unlikely to increase serum calcium concentrations, because of the requirement of an acidic pH, parathyroid hormone, and vitamin D for absorption. The calcium carbonate and calcium magnesium acetate forms are irritants, and can cause gastritis, while the calcium chloride form is capable of causing severe irritation, including hemorrhage. Treatment is symptomatic and supportive including treatment for severe mucosal irritation with exposure to the calcium chloride form.

Urea Monogastric animals are not susceptible to urea poisoning but may exhibit increased blood ammonia concentrations.

Ruminants and large-bowel fermenters are susceptible because their intestinal microflora provides an ideal environment for the hydrolysis of urea, releasing carbon dioxide and ammonia. Ingestion of urea by dogs usually results in local irritation, and signs of hypersalivation, gastroenteritis, and abdominal pain. Less frequent signs include methemoglobinemia, weakness, and tremors. Managing urea ingestion in monogastric animals includes inducing emesis and monitoring electrolyte concentrations.

(ASPCA Animal Poison Control Veterinary e-newsletter)

TECHNEWS | VOLUME 34 ISSUE 1

Investigate the provincial associationâ&#x20AC;&#x2122;s web sites for details on other continuing education opportunities.

Current as of: August 2010

October 30-31 Guelph, ON Lecture: Lifelearn Live 2010 - Digital Radiography: Making Sense of the Technology and the Images (Lecture/ Lab) - Ontario Veterinary College www.lifelearn.com

Continuing Education Opportunities

2010 September 24-25 Guelph, ON Lecture: Module 1 - Fundamental Principles & Applications - Dr. Stephen Nykamp - www.lifelearn.com September 26 Edmonton, AB Lecture: Abdominal Radiology - Dr. Tim Spotswood, CARE Centre Animal Hospital - easav@edmontonvetinfo.com www.edmontonvetinfo.com

October 3 Guelph, ON Lecture: Advanced Cytology for Technicians - Dr. Pamela Baker, Seneca College - www.lifelearn.com October 3-9 Canada-Wide Canadian Veterinary Medical Association Animal Health Week www.canadianveterinarians.net October 10-16 Canada-Wide National Veterinary Technician Week

September 30 - October 2 Saskatoon, SK Saskatchewan Veterinary Medical Association 2010 Conference www.svma.sk.ca

October 19, 2010 Toronto, ON Lecture: Diabetes and Obesity in Dogs and Cats - Dr. Thomas Graves - Email: info@tavm.org, www.tavm.org

October 1-3 Dieppe, NB Eastern Veterinary Medical Association Fall Conference - In conjunction with the New Brunswick Veterinary Medical Association Conference - www.evta.ca

October 20, 2010 Toronto, ON Lecture: Fluid Therapy for the Veterinary Technician: Where, When & Why We Use Fluids - Toronto Academy of Veterinary Medicine Email: info@ovma.org, www.tavm.org

October 2-3 Winnipeg, MB Manitoba Animal Health Technologists Association 28th Annual General Meeting & Conference - www.mahta.ca

October 24 Calgary, AB Nestle Purina Veterinary Symposium on Companion Animal Medicine www.purinavets.com

October 3 Guelph, ON Anesthesia Lecture/Lab - Drs. Doris Dyson, Carolyn Kerr, Melissa Sinclair, Alexander Valverde - www.lifelearn.com

TECHNEWS | VOLUME 34 ISSUE 1

October 25 Edmonton, AB Lecture: Dermatology Pearls and Practice Pointers - Dr. Kinga Gortel easav@edmontonvetinfo.com www.edmontonvetinfo.com

October 31 - November 2 Napa Valley, California International Conference on Communications in Veterinary Medicine - Solage Calistoga www.iccvm.com November 5-6 Saskatoon, SK Saskatchewan Association of Veterinary Technologists Conference Email: conferences@svt.ca, www.svt.ca November 13-14 Ithaca, New York 27th Farriers Conference - For more information or questions, please contact the Office of Continuing Education at 607.253.3200. Email: amm36@cornell.edu www.vet.cornell.edu/education/ConEd.htm November 16 Toronto, ON Lecture: TAVM - Feline Medicine.

Email: info@tavm.org, www.tavm.org November 17 Toronto, ON Lecture: TAVM - Pet Feeding and Nutrition - An Overview with a Focus on Cats and Dogs. Email: info@tavm.org www.tavm.org November 17 Toronto, ON Lecture: Pet Feeding and Nutrition - An Overview with a Focus on Cats and Dogs - Dr. Jim Atkinson - University of Guelph - Email: info@tavm.org, www.tavm.org November 27-28 Guelph, ON Lecture: Surgical Opthalmology - Dr. Nick Welan - www.lifelearn.com December 3-5 Guelph, ON Lecture: Small Animal Endoscopy Module 1 - www.lifelearn.com

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TECHNEWS Fall 2010 CE Quizzes > SUBMIT BY MAIL:

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CE Article #1: Equine Squamous Cell Carcinoma: Can Also Be Found in the Eyes!

1. In equine ophthalmology, the most common neoplasia is: a. Squamous Cell Carcinoma b. Melanoma c. Melting Ulcer d. Lymphoma 2. Commonly affected horse breeds to this ocular disease are: a. Appaloosas b. Belgians c. Paints d. All the above 3. If SCC is found on the third eyelid, you cannot debulk surgically. a. True b. False

TECHNEWS | VOLUME 34 ISSUE 1

4. Where is the ocular squamous cell carcinoma most often located? a. Both b and d b. Limbus c. Periocular d. Third eyelid 5. Excessive tearing is called:

a. Blepharospasm b. Photophobia c. Epiphora d. Miotic

6. Where could SCC potentially metastasize to? a. Brain b. Skin c. Regional lymph nodes and salivary glands d. Ears

7. According to the readings, 9. The use of a fly mask for after care is to: what environmental factor a. Cover the loss of the is believed to be a cause of third eyelid/conjunctival SCC? graft a. Warm, humid b. Both c and d temperatures c. Protect the eyes from UV b. Exposure to UV solar d. Protect the eye from radiation damage by other c. Exposure to the cold elements damp temperatures d. Snow 10. To ensure margins are clean it is recommended 8. Treatment of limbal to: squamous cell carcinoma a. Use a scalpel blade to cut could involve: the third eyelid a. Surgery with a b. Apply cryotherapy on the keratectomy surrounding margins b. Surgery and use of c. Suture the eyelids shut cryotherapy d. Apply topical medication c. Surgery and radiation therapy d. Surgery with diode laser CO2 e. All the above 27

CE Article #2: The Role of the RVT in the Care and Management of Dogs with Acquired Heart Disease 1. When it comes to the incidence of acquired mitral valve disease (MVD) or dilated cardiomyopathy (DCM) in the dog population, which of the following statements is false? a. The overall incidence of MVD and DCM combined in the dog population is approximately 10% b. MVD and DCM occur more commonly in Cavalier King Charles Spaniels and Doberman Pinschers, respectively c. Acquired heart disease increases with age d. DCM occurs more commonly than MVD 2. Which of the following statements is false? a. All dogs with congestive heart failure (CHF) have heart disease b. Early heart disease is characterized as having no outward clinical signs c. Pulmonary edema and the onset of respiratory distress indicate early heart disease d. The tremendous compensatory abilities of the cardiovascular system allow significant heart disease to often go clinically undetected 3. Which of the following statements is true? a. At the first discovery of a heart murmur, heart disease should be aggressively treated with a combination of medications that includes ace inhibitors (ACEi), diuretics, and pimobendan b. More frequent monitoring programs are only beneficial for the canine patient that has progressed from heart disease to CHF c. ACVIM recommends the use of pi-

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mobendan as part of a triple therapy treatment protocol when canine heart disease progresses to CHF d. Treatment with an ACEi during asymptomatic (early) heart disease will delay the onset of CHF 4. Which of the following statements is true? a. Signalment is defined as patient information comprised of species, breed, sex, reproductive status, and age b. DCM is more common in some middle-aged large-breed dogs c. MVD is more common in older small-breed dogs d. All of the above

cardiac size on thoracic radiography b. A type of congenital heart condition c. A type of cardiac arrhythmia d. A method of assessing cardiac dysfunction via blood testing 8. Monitoring heart disease progression is best done by? a. More frequent in-clinic reassessments b. Owner observation for signs and symptoms of heart failure c. Monitoring resting respiratory rate by the owners at home d. All of the above

9. Which of the following would be an inappropriate recommendation for the dog with CHF? a. Control salt intact, including treats 5. Which of the following findings indib. As progressive heart disease often cate the likelihood of a cardiac rather results in weight loss, increase feedthan a respiratory cough on general ing when a heart murmur is first physical examination (GPE)? recognized to ensure the pet â&#x20AC;&#x153;bulks a. A soft, moist cough of short upâ&#x20AC;? ahead of more serious disease duration, often following rest, and c. Moderate or appropriate exercise regardless of exercise should be maintained and encourb. Honking, harsh cough of short duraaged for dogs with heart disease tion often made worse by exercise d. Encourage phone follow-ups, espec. Intermittent cough of long-standing cially if the owner has any concerns duration often made worse by exeror questions cise d. A cough that can only be elicited on 10. When it comes to heart murmur tracheal palpation grading, which of the following is correct?

6. Which of the following is unlikely to a. Severity is inversely proportional to be found on the GPE of a dog with the grade CHF? b. A grade III/VI murmur is the highest a. A cardiac murmur grade before a palpable thrill can be b. A slow, irregular heart rate felt c. Respiratory difficulty c. Most murmurs can be heard without d. A low temperature a stethoscope d. No specific grade of murmur is 7. What is VHS? directly tied to the transition from a. A method of objectively assessing heart disease to CHF

TECHNEWS | VOLUME 34 ISSUE 1

CE Article #3:Fall Review of aQuizzes > TECHNEWS 2010 CE Basic Anesthetic Machine SUBMIT BY MAIL: NEW! SUBMIT ONLINE:

Notes Please remember to send a selfVisit www.oavt.org/continuinged and click • An access code will be generated each time you choose a quiz. Record the addressed stamped envelope with your the Technews Quizzes button.

Havefloat ready: the anesthetic machine: 6. If the within aaccess flow- code - thisunidirectional 1. Small oxygen cylinders will enable youvalves, to quizzes so we can return them to you.

re-enter the site within 14 days you reservoir bagshould port, APLV a.

24 to 30 psi meter is not spinning, it and mounting yokes • username: First and last name You must have all answers correct in need to leave before completing the quiz. and a manometer. b. 40 to 48 psi may indicate that there incorporate a pin index order to receive your CE credit for the • password: First 4 letters of your last name • A score of 10/10 (100%) gas is required to quiz.

If you havethat any further questions d. Fresh inlet, unidirecc. 50 to 70(lowercase) psi is dirt or static safety system infollowed by your member # electricobtain one CE credit. Download and print or concerns regarding the quizzes tional valves, APLV and d. 70 to• 100 psi ity building up inside the cludes: e-mail: Required to have your results the certificate before exiting or taking please feel free to contact us. an exhaust fan. flowmeter tube, resulting a. Numbers on the cylinder and certificate sent to you another test.

Name ____________________________ 4. To calculate the number in an reading valve.

• province: The 2-letter code forinaccurate your • Please contact the OAVT office with any of the flow rate. questions. 9. Because of the high flow, b. Letters# on the mounting of liters ofprovince/state oxygen remainMember ________________________

and the high pressure that a. True yoke. ing in an oxygen E size is produced by the oxygen b. False c. Holes in the cylinder cylinder you multiply the valve, it should never valve and pins on the psi on the manometer by Pay by Credit Card: O Visaflush O Mastercard O I would like to subscribe or renew be used with a pediatric 7. Carbon dioxide absorbers mounting yoke. the following number: my subscription to TECHNEWS. Card # _________________________________________________ breathing system conreduce or eliminate red. Numbers and Letters on for onea.

0.03

Subscription costs are good year from when order received Exp. Date ______________________________________________ the (4 issues per year). ($39.55 with applicable taxes) nected to a patient. breathing of the following: cylinder valveCost: and $35.00 CDN b. 0.3 the (OAVT members exempt from TECHNEWS subscription fees.)

Name on Card _________________________________________ a. True a. Oxygen c. 3.0 mounting yoke. b. False b. Carbon dioxide d. 30.0 Amount Paid __________________________________________ c. Inhalant______________________________________________ anesthetic agent 2. The pressure inside an Address _______________________________________________ Signature 10. The best way to test d. All of the above.

5. The intermediate pressure Oxygen E size cylinder Phone (Home) _________________________________________ the viability of the CO2 system of the anesthetic can be as high as:

(Clinic) _________________________________________ Pay by Cheque 8. Components of the carbon machine consists of the a.

200 psi absorbent is to measure Cheques must be CDN funds, Make payable to ‘O.A.V.T.’ Fax ____________________________________________________ dioxide absorbers consist following: b. 1000 psi the amount of CO2 in the Mail this form to: TECHNEWS c/o OAVT Email of the following: a. The oxygen cylinder and c.

1200__________________________________________________ psi inspired gases. Alternate Ontario AgriCentre, Suite 104, 100 Stone Road West a. FlowON meter, the pressure reducing d. 2000 psiO RVT O AHT O VT O Other I am a(n): __________________ Guelph, N1Gvaporizer 5L3 Or Fax to: (519)methods 836-3638 of testing viabiland soda lime. valve. ity would be which one of b. Intermediate pressure b. The pipeline system from 3. The pressure reducing the following: systems, unidirectional the pressure reducing valve for an oxygen E a. Colour valves and an APLV. valve to the flowmeter. size cylinder reduces the b. Texture c. Canister in a housing, c. The pipeline system from pressure in the tank to the c. Temperature fresh gas inlet, inspiratothe vaporizer to the comfollowing pressure before d. All of the above ry and expiratory ports, mon gas outlet. allowing oxygen to enter

Clinic of the Year Contest!

TECHNEWS is pleased to introduce the 2010 ‘Clinic of the Year’ contest! We are looking for clinics and clinic teams that are burning trails, leading by example, thinking outside the box and re-writing the rules!

• Is your team progressive, compassionate, caring?

• Are you creating ‘best practices’ that other clinics could learn from?

TECHNEWS | VOLUME 34 ISSUE 1

• Is your clinic making maximum use of their technicians and providing a safe, creative environment where you can grow and learn?

• Is your clinic environmentally ahead of the curve and do you have the right tools in place to sustain these advances?

• Are there other ways that you are creating a winning team?

complimentary registrations for the OAVT February 2011 conference, two nights VIP accommodation at the Hilton London and a $250 cash prize. This clinic will be recognized at the OAVT Awards evening at the Hilton London.

We know there are some amazing clinics across Canada and we want to hear from you. One grand prize winner will be chosen November 15. An editorial with photos will run in the winter issue of TECHNEWS.

We encourage YOU to enter today! Send up to 500 words on what your clinic is doing that is special or why they are the BEST.

The winning team will receive two full

Other prizes will be announced in the next issue of TECHNEWS. Prizes will also be presented to the top five finalists.

Enter today: email rebecca@bayleygroup.com

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The OAVT does not necessarily endorse any of the following employment opportunities or the interviewing/ hiring techniques implemented. There is a fee for placement of ads. Please see Job Ad Form online for further details. The OAVT reserves the right to edit as space allows.

placement of an employment ad > Placement of an employment ad within the TECHNEWS newsletter is for a one issue period, which also includes placement of the same ad upon the OAVT website at www.oavt.org/employment for a three month period or until the next issue ofTECHNEWS is published.

• Ads may contain graphics as long as they are no larger than 3.5” x 2” at 300 dpi.

All graphics for the web may be in colour format.

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• Website Only: $50.00 • Website and TECHNEWS

(Members Rate): $50.00 first 20 words, $1.00 for each additional word • Website and TECHNEWS (Non-Members Rate): $75.00 first 20 words, $1.50 for each additional word If you want to use graphics in employment ads, please refer to the following display ad rates: Full Page. . . . . . . . . . . . . . $1395.00* Half Page. . . . . . . . . . . . . . $895.00* Quarter Page. . . . . . . . . . . $595.00* * Taxes not included in above mentioned rates PLEASE NOTE: All Employment Ads must be submitted on the OAVT website.

Payment by Cheque/Money Order/VISA (payable to OAVT) may be mailed to: OAVT, Job Ad Placement Ontario Agricentre Suite 104, 100 Stone Road West Guelph, ON N1G 5L3

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10019 (Aug 6, 2010) RVT/Technician Hastings Veterinary Hospital seeks RVT/Technician to cover a one-year leave: • We’re a warm group of 3 veterinarians, 2 technologists, 2 receptionists and 4 veterinary assistants.

• We’re looking for a vibrant, talented, outgoing technician to compliment our team!

• We have an in-house Vet Test, CBC machine, ultrasound unit, tabletop and digital dental X-ray machines. We utilize our team’s skills to their fullest.

• Hours average 35/week, including occasional weekend shifts.

• Please send Resume and Cover Letter to Valerie Dunbar: vadunbar@cogeco.ca.

10009 (Aug 4, 2010) RVT Position Available Kanata Animal Hospital has a 1 year maternity leave RVT position available starting in Nov / Dec 2010 with a possibility to stay on after.

We are a fully computerized and well equipped hospital. The ideal candidate will have strong technical skills, as well as an outgoing friendly personality. Our goal is to provide the best quality medicine with a focus on pain management in a caring and friendly work environment.

Benefits include a CE allowance and time off, RVT dues covered in full, extensive medical and dental health benefits 100% covered by employer and much, much more.

Salary is commensurate with experience. If you are interested in being part of a progressive and fast paced

hospital please send your resume to: animalhospitalhr@gmail.com or fax to 613-836-6974.

10003 (Aug 3, 2010) RVT South Windsor Animal Hospital is looking for a full-time RVT with excellent technical and communication skills. Fax resume to Kristi Wilson 519-969-6055 or call 519-969-7390.

10002 (Jul 29, 2010) RVT Wanted We are looking for an outgoing, energetic, people oriented individual.

Accepting resumes for part-time or full-time technician. We have small animal hospitals within ChathamKent. Please email your resume to: jknights@ciaccess.com 9998 (Jul 28, 2010) Veterinary Technician/ Assistant Veterinary assistant with reception responsibilities needed for our newly opened small animal hospital. The multi-tasking is a necessity. We are a small team and are located in a fast growing community of Milton. We’re looking for a friendly and personable team-player, who loves interacting with clients and their pets. We are striving to form lasting bonds with our clients and their pets. The hospital is well-equipped with digital x-ray and equipments. There is no grooming in our facility. We are going paperless and experience with AVImark/ cornerstone is an asset. The successful candidate should be flexible & willing to work every other weekend. If interested, please forward your resume to: loteym@gmail.com

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9996 (Jul 27, 2010) Animal Care Attendant F/T Animal Care Attendant needed for an emergency clinic. Must be able to work as part of a team and be able to effectively multi-task. Position involves some evenings and also weekend shifts.

Please reply to info@emergencyvets.ca.

9990 (Jul 27, 2010) RVT We are a progressive clinic which treats our animal clients with both holistic and conventional medicine. We are looking for an enthusiastic RVT to join our team who is willing to work in an environment where you will be able to use your skills that you have been trained for. Experience is an asset, as well as new graduates will also be considered. We offer competitive salary, CE and health benefits. Please e-mail to eyac@holisticpetvet.com. Fax to (416) 285-7483, East York Animal Clinic, 805 O’Connor Dr., Toronto, ON, M4B 2S7 9988 (Jul 21, 2010) Part-time RVT wanted Growing small animal practice with charming, small town atmosphere seeks outstanding P/T technician who loves to

use their skills. Must be compassionate and friendly with the ability to work well independently and also be a team player.

Evenings, Saturdays and holiday coverage initially with potential for growth. Competitive wages and dental/health benefits.

Please apply with resume to cah@cahvet.net.

9973 (Jul 13, 2010) RVT required immediately The Alta Vista Animal Hospital is a large Ottawa-based General Practice, Referral, and 24 hour Emergency hospital with a staff of 150+. We are seeking Registered Veterinary Technicians to join our dynamic group. We are looking for positive, upbeat, competent technicians who enjoy working in a team atmosphere. We currently employ approximately 50 technicians and 40 Veterinary Assistants. Our technicians work in specific departments including Emergency, Team Medicine, Internal Medicine, Specialty Surgery, ICU and Ophthalmology. We also have a Patient Care Department where our technician duties include tracking in-hospital patients, discharging surgeries and medical cases, and acting as a liaison between our Doctors and Clients. We offer: • Competitive wages

Submitting Articles to TECHNEWS We welcome your participation in the quarterly magazine, TECHNEWS, distributed nationally. In Ontario, articles submitted receive 2 C.E. credits and articles chosen for printing receive an additional 2 C.E. credits. Please contact your Provincial Association Registrar to determine your provincial C.E. values.

Do not forget to include your return address information.

Manuscripts should be submitted electronically either via email (address: cass@bayleygroup.com), CD/DVD-R or

USB stick in a format compatible with Microsoft Word 97 or better. Also send a hard copy of the article.

• Articles should be no longer than eight pages of double-spaced type.

• Avoid using trade names.

• Feel free to include tables, boxes, diagrams, etc.

• Include artist’s name if illustrations are used.

• Footnotes should be used for any explanatory notes. Arrange alphabetically using superscripts (ex. a).

• References: document all points reviewed by using numbered superscripts (ex. 3) in the text. Place references in the order they appear, not alphabetically.

TECHNEWS is looking for articles from technicians that present current news and information. Articles should contain information on areas of interest to technicians,

TECHNEWS | VOLUME 34 ISSUE 1

• Benefits (medical and dental) • Continuing education (CE) stipends, as well as the opportunity for inhouse CE • Vacation/sick/personal leave time • Opportunity for advancement (available positions are posted internally first before posting publically) Please apply directly to Lisa Hache, Director of Human Resources at lhache@avah.on.ca with a cover letter and resume.

9959 (Jul 6, 2010) Full-time Veterinary Reception Position A full-time receptionist position is available within a small animal veterinary practice in Ottawa. The position requires a person that is a team player, with a positive mature attitude and excellent customer service skills. The ability to multi-task and strong communication skills is essential. The lucky candidate must be able to work some evenings and some Saturdays. Preference will be given to applicants with experience in the animal health care field. We offer competitive wages, medical and dental benefits and so much more. Please Fax

such as client education, clinical situations, lab procedures, nursing skills, neonatal care, research, exotics, large animal medicine, emergency procedures or anything else you feel is important to the continuing education of technicians.

Articles received will be reviewed by the TECHNEWS editors and editorial committee. Controversial subjects will be prefaced by editorial commentary. The TECHNEWS editor reserves the right to make revisions in text when appropriate. Manuscripts may be edited for content, clarity and style. Feel free to contact the editorial office to ensure availability of a particular topic.

Editorial correspondence for TECHNEWS: O.A.V.T. Editorial Submissions c/oThe Bayley Group P.O. Box 39 Hensall, ON N0M 1X0 Phone - 519-263-5050 Fax - 519-263-2936 Email - cass@bayleygroup.com

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résumés to 613-746-2006, or e-mail to animalhospitalhr@gmail.com 9958 (Jul 5, 2010) Registered Veterinary Technician Full-time RVT wanted for three year old rapidly growing small animal hospital in Kanata Ontario. We are looking for a second RVT, to join our two veterinarians and support staff. We are fully computerized and have a wide range of diagnostics. Daily variety of surgery, dental, laboratory, and medical duties. Experience is an asset, but will consider new graduates. Call Dr. Stephen Liston, or Dr. Ann McKenna at 613-591-0966, or send resumes by fax to 613-591-0775, or by email to steveliston@sympatico.ca.

9956 (Jul 5, 2010) Receptionist Two full-time receptionist positions are required for a progressive, small animal hospital in Guelph. The successful applicants will be enthusiastic, self motivated and prepared to spearhead our customer service team. Experience in the veterinary or hospitality industry would be an asset. Qualified applicants please forward your resumes to mgemmill@cornellanimalhospital.com or fax to 1-519-763-7162 9952 (Jun 29, 2010) RVT Full-time or possible part-time RVT position available at our friendly 2 veterinarian/2 technician practice in Georgetown.

We are in a country setting but still within minutes to most major centers. We offer paid CE, OAVT dues, uniform allowance and health benefits. We require a self-motivated individual that takes pride in their work, possesses compassionate patient care and excels in client communication. If you are interested in joining a team that emphasizes high quality medicine and customer service then please submit your resume by fax 905-873-7422, email to info@terraglen.com or in person (attn: Dr. Boudreau).

9950 (Jun 29, 2010) Experienced Practice Manager Required VetStrategy is looking for an experienced Practice Manager to join our team. We

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have just taken over management of one of the GTAs largest practices, with a great support staff already in place. We need a former technician who has run other clinics to come on board and help us organize, co-ordinate, market and grow this latest addition to the nine-clinic VetStrategy family. We’re building a great team, with two operations directors and practice managers already on staff, so you will have colleagues and mentors to depend on. We have a structured, developed approach to running clinics, but we make sure that each clinic can “be themselves.” Your role would be to help our newest clinic “be themselves,” and at the same time help us make it even better! We offer high compensation, terrific learning opportunities, top-of-the-line benefits and an entrepreneurial culture where you can go as far as your skills and effort will allow. Please feel free to get in touch with us, and you can speak to us and some of the members of the team to see what it’s like to work with us! Please submit resumes to jobs@vetstrategy.com, and all applications will be considered confidential.

9949 (Jun 29, 2010) Veterinary Technician Veterinary Technician required for single vet well equipped practice-contact at 1-705-458-0633 or email cascon@rogers.com 9947 (Jun 28, 2010) Full-time RVTs Required!

VetStrategy is pleased to announce the addition of North Town Veterinary Hospital to its roster of practices. North Town is a 24-hour practice with a long tradition in Brampton. We are looking to dramatically expand our support staff by hiring multiple technicians for multiple shifts. We are equipped with the latest in equipment, including laser surgery, ultrasound, digital x-ray, computerized records and surgical tools. North Town has one of the largest client bases in the city, and as the only fully-staffed 24-hour clinic in Brampton, we are able to offer the best possible care. We are working to build one of the leading clinics in Ontario, and are willing to provide top-of-the-line compensation for the right candidates. If interested, please email jobs@vetstrategy.com

9940 (Jun 22, 2010) Registered Veterinary Technician North Town Veterinary Hospital is under new management and looking to add to our dynamic team of professionals! We are Brampton’s only 24 hour clinic, and we see one of the most diverse and exciting case loads in the city.

If you are looking for a fast paced, progressive environment with the latest in diagnostic equipment, this is the place for you. Put your skills to the test and come join our team! Full-time employees get full Health/Medical Benefits, paid CE, and are included in VETSTRATEGY’S city-wide Continuing Education.

Please e-mail: rebecca.lamont@ntvh.net, trish.parkin@ntvh.net 9934 (Jun 21, 2010) RVT Required We are looking for a mature, full-time efficient RVT at Springdale Animal Hospital in Brampton. Successful candidate will use all of their technical skills in surgery, anesthesia, dentistry, radiology, and most importantly - patient care. The candidate would also be expected to take on some managerial duties (scheduling, ensuring clinic cleanliness etc). We offer a competitive salary, OAVT dues and reasonable working hours in a relaxed environment with friendly long time staff. Email resume to valscorgie33@hotmail.com 9929 (Jun 16, 2010) Full-time RVT Wanted: Full-time experienced RVT for very busy animal hospital with high surgical and medical case load. Salary negotiable DOE. Full benefits, CE paid (required), uniform allowance, pay-for -performance bonuses, etc. Note some on-call is required, must be willing to relocate within 30 min of Espanola. Send resume with references to Espanola Animal Hospital, 138 Tudhope St., Espanola ON, P5E 1S6 or fax to 705-869-0092.

9926 (Jun 13, 2010) Veterinary Technician Seeking a self-motivated, cheerful and experienced vet tech to work at a progressive, one-vet animal hospital in Newmarket featuring digital x-ray and laser therapy. Full-time/part-time. Fax resume (905) 895-1723. Phone (905) 895-2278

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9925 (Jun 12, 2010) Registered Veterinary Technician Team orientated RVT must enjoy work, have a positive, caring attitude and a sense of humour! Small, friendly 3 DVM practice: computerized, modern, well equipped to enhance all your skills including anesthesia, radiology, dentistry, lab and client education. Orthopedics/ ultrasound/endoscopy by external consultants in-house. Flexible weekday/evening shifts. Uniform. Paid CE encouraged. email: drbennett@magma.ca 9920 (Jun 10, 2010) RVT Positive, friendly RVT with a great attitude wanted for a full-time position. If you love animals and want to be part of a team that values the animals’ needs above all, please contact us. We offer competitive salary, health and other benefits. Experience preferred but new grads with enthusiasm also welcome. Please fax resume to 519 434 0334.

9918 (Jun 9, 2010) Registered Veterinary Technician Small animal practice with 3 doctors.

Very client oriented. Applicant should be able to multi-task and be able to handle all aspects of veterinary medicine including: answering the phone, radiology, surgery, client communication, light house keeping duties, lab work. Contact Dawn Patterson at Cranberry Hill Animal Hospital, 33 Somerville Road, Kemptville, On., K0G 1J0 Tel: 613-258-5745 Fax: 613-258-7104 e.mail: staff@cranberryhill.ca 9915 (Jun 9, 2010) Pharmacy Technician Wanted Well-established pet hospital requires fulltime pharmacy technician. We are looking for a responsible individual, able to fill prescriptions, manage inventory, place an order for drugs and hospital supplies and also able to enjoy working with pets helping as a technician/assistant in down time. Please forward resumes to Dr. Sami Qureshi, fax: 519-756-2305, e-mail: beattie.petvet@rogers.com, www.beattieanimalhospital.com

Did You Know?

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Recommend Sentinel; it’s hugsafe.

For more information visit www.ah.novartis.com or call 1-800-387-6325. ® 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. © 2010 Novartis Animal Health Canada Inc.

TECHNEWS | VOLUME 34 ISSUE 1

TECHNEWS Subscriptions If you are not currently receiving all four TECHNEWS annual issues delivered direct to your door, now is the time to get your subscription! The Summer and Fall issues are full of outstanding continuing education articles and quizzes, interesting personal stories and practical ideas for your work. $39.55 per year includes shipping and is payable by credit card or cheque to ‘OAVT’.

Sign up for your subscription today see Page 27 of this issue!

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By Mike Paul, DVM, Executive Director, Companion Animal Parasite Council

Parasite…the very word is unpleasant. The reality is even more so. For most veterinary technicians and staff members, just visualizing an organism that invades another and feeds off it is enough to make them dislike these critters. Thank goodness there aren’t a lot of them, right?

Wrong! Unfortunately, parasites are not only common, they are widespread and have had millions of years to develop the characteristics that allow them to plague animals and humans worldwide. No animal, including man, seems to be safe from their invasion.

Fortunately, in our culture most parasites are well-known and, in recent years as a result of ongoing research and product development, they are relatively simple and straightforward to treat and prevent

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or control. So why are they thriving?

Why are our pets, and to a lesser degree society, so impacted by these organisms and the diseases they carry?

Again, we have knowledge of life cycles, we have agents that kill them and we have products that prevent or at very least control them. Why do they persist? I think there are three major reasons, all readily corrected.

First is a lack of awareness and understanding of the sometimes complex life cycles and environmental adaptations these animals have developed. Parasites have life cycles that ensure their spread by allowing for direct, as well as indirect, infection of hosts.

Second is a lack of awareness of the true potential for infection. Often we are reluctant to acknowledge that these parasites are present at some level in the animal population in virtually every region of North America.

Third is a false sense of security that parasite control products available are totally

effective and treat all stages of the parasite’s life cycle. “It won’t happen here; it won’t happen in our practice!”

It is important to realize that no product, no drug, no vaccine is 100 percent effective 100 percent of the time. We have come to expect nothing less and we get very close, but perfection still evades us. It also is extremely important to remember that certain life stages are not affected by some compounds. Parasite eggs can persist for incredibly long periods in the soil. Some stages can be totally unaffected by products developed to treat adult and pre-adult stages. That is why occasionally animals on preventives will still have parasites.

Climate change also plays a role. Temperature variations seem less predictable.

Why risk an exposure just to avoid two to four doses of a very safe medication?

Our environment is changing not only on a global level but on a minute level.

Our pets are no longer exposed to the extremes of temperature and humidity they once were. We air-condition and climate

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control our homes and therefore have reduced these extremes.

While some of the parasites we concern ourselves with were at one time very localized, animals are not. People relocate, travel and vacation more than in the past.

The nature of the human-animal bond has come to mean where we go, our pets go. Where they go, their parasites go.

Some regions once believed to be “heartworm free” now experience as many new annual infections as previously considered “high risk” regions. The profession’s attitude of benign neglect and wait-andsee has allowed a regional disease to become widespread.

And it’s not just heartworms we see expanding their impact. Roundworms occur everywhere, and the infection rate doesn’t vary much at all from region to region. Hookworms are similar and even whipworms, which are very persnickety about their humidity requirements, are turning up in other regions than traditionally considered typical whipworm country.

We know how hardy fleas are, and as our pets move into our climate-controlled homes and enjoy our landscaped lawns, they bring these pests into our homes.

Even cold, high altitude and arid regions are seeing that fleas are far more common than once believed. Various species of ticks have generally had pretty clear geographic distributions. Those ranges are expanding and with them the range of tick-transmitted diseases.

So how should technicians and staff members respond? The first step is to maintain an open index of suspicion.

Recognize that if you don’t have parasites on your list of concerns, you are quite simply wrong. Some members of the veterinary health team simply don’t believe their patients are at risk. In fact, they don’t even run tests to determine infection. But one thing is certain: If we don’t look for parasites, we won’t see parasites.

If we don’t test for heartworms or ticktransmitted diseases, we won’t find them.

That doesn’t mean they aren’t there.

A very important but often marginalized concern about parasites is their zoonotic potential. Companion animals live in

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increasingly close and intimate contact with people. A growing portion of our population is immune-compromised either as a result of diseases or the use of immunosuppressive drugs. In the United States, for example, it is estimated by the Centers for Disease Control that as high as 14 percent of the country’s population is infected with ascarids. That means that with nearly 40 million children under the age of 10, there are as many as 6 million children that have been infected with roundworms.

Fortunately, almost all infected children experience no clinical illness. If only 1 percent of those kids develop some sort of secondary manifestation, such as larval migrans, there are 60,000 of them in the U.S. alone. While we don’t know the incidence of disease that results from these infections, we can make some extrapolations.

Make it 0.1 percent and that figure is 6,000. Even .01 percent still leaves 600 children under 10 experiencing a roundworm-related disease. That doesn’t include the millions of people dealing with immune deficiencies from disease or drugs. The fact that these diseases may often go undetected and undiagnosed doesn’t mean they are not occurring.

We can’t prevent all of these cases. There are risks of exposure in playgrounds, sandboxes, and food supplies and we just can’t prevent everything. We can, however, control the spread in the pets that are seen by veterinarians on some regular basis. A monthly administration of an effective control will go a long way in reducing exposure and environmental contamination. Regular, properly conducted fecal examinations will confirm the success of monthly deworming and will also detect other parasites that might not be preventable.

and unwashed garden produce. Washing your hands thoroughly after working in the soil, reducing the risk of cats being a source, avoiding handling cat litter boxes -- all of these precautions are particularly important during pregnancy.

So what is your role in all of this? First of all, be informed. Become familiar with the CAPC guidelines for parasite control and prevention. Go to the CAPC Web site at www.capcvet.org and send your clients to www.petsandparasites.org Educate yourself on the parasites that impact dogs and cats. Learn how they are transmitted and how people can protect their families. Make use of the training materials and courses available and use the client education materials you can order online.

Make sure to use them to inform your hospital’s clients.

Second, be sure that fecal and blood diagnostics are always actively encouraged in every dog and every cat at least once a year.

Recommend and advocate for the use of prevention and control products that are effective against internal parasites, including heartworms ALL YEAR ROUND. Make sure pets are on flea and tick control products all year round.

Make sure your clients understand the reasons they should keep their cats indoors and control the activity of their dogs to further reduce exposure risks.

Finally, “Practice what you preach.” Start with your own pets and family and become an advocate for parasite control.

Your clients want quality care and that includes good advice. Make sure to remember that this is a quality of care concern.

Protect your clients and their families. It’s the right thing.

We know that Toxoplasmosis is of little concern in humans other than during pregnancy when the results can be devastating to a fetus. The incidence of human Toxoplasmosis is 9 percent. See the potential impact? The risk of Toxoplasmosis is significant. Given that there are no preventives and no vaccines currently available, the best control is education about hygiene, avoiding undercooked meats

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Israel - Animal Airways announced the launch of an Israel-based 24/7 international flight with veterinarian service and crew that speaks 10 languages. The company has subcontracted with Terminal4Pets to launch a full-time, global veterinarian support and guidance service. The service will allow families traveling with pets to access a veterinarian 24 hours a day, seven days a week, in ten languages. (JewishJournal.com) US - ATVs damaging fish habitat: DFO - Off-road vehicle enthusiasts that are driving their all-terrain vehicles through rivers and streams are damaging fish habitats and polluting waterways, according to the Department of Fisheries and Oceans. Federal fisheries officials are warning riders to stop endangering the fish. Atlantic salmon and brook trout are two species that spawn in the fine gravel of the rivers. When the ATVs cross the river, they crush the nests of the fish and also they release some toxic substances in the rivers. With the hot weather this summer, water levels in some areas are lower than usual. (CBC online news)

Global news Canada - New Brunswick salmon are having a difficult summer. The warm water and lower levels, particularly in the Miramichi River system, has caused hundreds of salmon to die. The New Brunswick All-Terrain Vehicle Federation launched a trails ambassador program mid-summer: fifty people with vests and logos to identify them, boost surveillance along trails and educate users. The plan follows harsh criticism of some off-road vehicle riders who wrecked public trails used by hikers and cyclists earlier this year.

(CBC online news)

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Canada - 6th Stampede Horse Dies After Fall - Six horses have died at the Calgary Stampede - four of them from the chuckwagon races - of various causes since the event began. Veterinarians euthanized a 6th horse, after it fell in the corner of the track with a breakdown injury to its right front leg. Six horses died at the Stampede in 2010: • Two suffered apparent heart attacks.

• One was put down after it broke its back in the saddle bronc event.

• One was euthanized after it suffered a shoulder injury in the chuckwagon races.

• Another died of undetermined causes.

Apparently, to lose six horses in one year is very unusual. (CBC online news)

US - HSUS gives little for pet care The Humane Society of the United States (HSUS) collected $86 million in 2008 and gave under $500,000 to organizations that actually care for cats and dogs, according to a Center for Consumer Freedom (CCF) analysis filed with the Internal Revenue Service. Almost $20 million was spent on ‘campaigns, legislation and litigation’, and more than $24 million spent on fundraising. CCF also noted that 41 HSUS employees were paid at least $100,000 and that HSUS Wayne Pacelle’s salary exceeded $250,000.

US - AAHA releases diabetes treatment guidelines - JAVMA News reported that the America Animal Hospital Association has released guidelines for the management of diabetes mellitus in cats and dogs. The first section of the guidelines covers diagnostic criteria and initial

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Help your canine patients remain healthy and active. Protect dog’s cartilage with Flexadin® is the first companion animal nutritional supplement that combines the benefits of: • Glucosamine and chondroitin: to help rebuild and restore cartilage structure • Harpagophytum procumbens (Devil’s Claw): to take advantage of a medicinal plant used to control pain which could help avoid the use of side-effect-causing anti-inflammatory drugs Flexadin® comes in chewable tablets with a taste dogs love.

Choose Flexadin® today! ® Registered trademark of Vétoquinol S.-A.

The evolution of articular support

www.vetoquinol.ca

Iraq - Baghdad police and veterinarians kill 58,000 stray dogs - The Baghdad government has assembled 20 teams of veterinarians and police shooters tasked with killing stray dogs following increased reports of dog attacks in the city. Since April, the teams have killed about 58,000 of the region’s strays, according to the Associated Press (AP).

With open-air markets and a bustling city scene beginning to return following the 2003 U.S.-led invasion of Baghdad, dogs are finding more food and having bigger litters. Officials say that attacks have increased steadily and children have been bitten and even killed.There are not believed to be any dog shelters in Baghdad, according to the AP. (Firstline)

assessment for diabetes. The bulk of the document addresses treatment for diabetes, with details about initial and ongoing treatment and monitoring of cats and dogs.

Other sections provide additional information about blood glucose concentration,

(Oscar the cat has full mobility in his hind legs thanks to two peg-like implants that have fused with his bone and are attached to artificial feet. (Jim Incledon/Associated Press)

UK - British cat gets bionic paws - A cat that had its back feet severed by a combine harvester has been given two prosthetic limbs in a pioneering operation by UK vet, Noel Fitzpatrick, a veterinary surgeon based in Surrey. The new feet are custom-made implants that “peg” the ankle to the foot. They are bioengineered to mimic the way deer antler bone grows through the skin. (veterinary advantage news + CBC online news)

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troubleshooting, and client education.

JAVMA published the guidelines in the May/June issue, and they are also available online at www.aahanet.org/resources/guidelines.aspx. (Veterinary Advantage) Australia - Dogs enjoy the first-ever canine concert - Tails were wagging outside the Sydney Opera House in Sydney, Australia, during a recent special concert designed for canine ears. Almost 1,000 dog lovers attended the free, 20-minute concert, although they couldn’t hear all of it.

The dog whistles and whale calls featured in the concert weren’t audible to people.

The concert, called Music for Dogs, was the brainchild of musician Laurie Anderson, who’s married to rock star Lou Reed of The Velvet Underground. Her inspiration: her rat terrier, Lolabelle. “She likes things with a lot of smoothness but with beats in them,” Anderson says. The effects of music on pets has long been debated.

However, the majority of studies tend to show that music has a calming effect on animals. Originally, the concert was going to only feature electronic noises played at a frequency too high for human ears. But in the end, Anderson decided to lower some of the octaves so that dog owners could enjoy the show too. The concert was part of Sydney’s Vivid LIVE Arts Festival that runs until June 20. (Firstline) Canada - Sidney Crosby namesake is RCMP dog - Students at Sidney Crosby’s former elementary school got to meet his furry, crime-fighting namesake in May.

Crosby the RCMP dog got a warm welcome at Colby Village Elementary School. (CBC)

Crosby, the RCMP dog, made a special visit to Colby Village Elementary School in Cole Harbour, N.S., to meet the students who named him. The Grade 6 students got to pet the 11-week-old German shepherd and take his picture. The other Crosby - the NHL star and Olympic hero - wasn’t there. The students won a national RCMP contest to name the new litter. The class received a plaque and a toy dog named after Justice, the first puppy from the RCMP’s breeding program to serve as a police dog. The RCMP said it received a record 9,125 entries for its national Name the Puppies contest this year. Submissions had to begin with the letter C and be only one or two syllables long. The students said they chose the name Crosby because it had national significance. The national police force has 135 dog teams for general investigations and 24 specialty dogs to detect drugs and bombs. (CBC online news)

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Try wrapping a small piece of Glad’s ‘Press n Seal’ around the capnograph connection to keep it dry during dentistries. This works well and is easy to remove and replace between patients. (Veterinary Medicine Journal)

Communication simplifies blood draws With fractious patients - or any patient that needs frequent blood draws - keep a note on the front of their files indication which location and technique for blood draw is best (ex. front left, on or off table, with or without owner present, shave area before blood draw). This way all team members will know what technique works best for each patient, and may avoid numerous blood draw attempts.

Tips for cats visiting the veterinary clinic

Here are a few tips to give to cat owners to ensure smoother vet visits:

• Leave your cat’s carrier out so that it becomes a den just like a dog’s crate

• Spray a synthetic pheromone, like “FELIWAY” in the carrier ~1/2 hour before traveling to the clinic

• Remain calm before you need to place your cat in the carrier

To coax a pet, especially some dogs, to take liquid medicine from a syringe is difficult. Encourage owners to coat the end of the syringe with dog or baby food.

As the dog eagerly licks the syringe end, the owner can squirt the medicine into the dog’s mouth.

• Take your cat on car rides in the carrier without going to the vet

• Don’t feed your cat before you travel in the car

except for treats used to entice the cat into the carrier (Veterinary Advantage)

OAVT Awards reception and dinner Friday February 18, 2011 Join your colleagues in celebrating the best in the industry in an evening that includes entertainment, great food and friends! Visit www.oavt.org to learn more.

TECHNEWS | VOLUME 34 ISSUE 1

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Did You Know?

Pets an “American Essential”

U.S. News and World Report recently came up with a list of “10 Things We Can’t Live Without” as a follow-up to an article on “21 things we’re learning to live without.” Pets were listed as an American essential. According to U.S. News and World Report: “While Americans have cut spending on themselves, spending on pet food, supplies, grooming, vet care and clothing (clothing?!) has been rising uninterrupted by about 5 percent per year. Industry officials attribute this to the ‘humanization’ of pets, which in turn has led many pet owners to close the ‘quality of life gap’ between their animals and themselves. The iWoof can’t be far behind.” Also on the list were portable computers; high-speed Internet access; smart phones; education; movies; TV; music downloads; booze; and coffee. (Veterinary Advantage)

Paws for a Snack Animal-shaped cookies originated in 1890s England, but the American manufacturer National Biscuit Company (Nabisco) displayed marketing genius in 1902 when the company put the now-familiar crackers in a small rectangular box made to resemble a circus cage and added a string to encourage parents to hang boxes as gifts to decorate Christmas trees. And what’s the favourite way to eat these cookies? The most popular order of dismemberment: back legs, forelegs, head and lastly the body. (veterinarypartner.com) Mammary Tumors 3x More Likely in Dogs Mammary tumors are three times more likely in dogs than breast cancer in women and are the leading tumor disease in female dogs. A spayed dog is less likely to get mammary tumors, and the age of the dog affects the survival period. A study at the Swedish University of Agricultural Sciences found that the two most common genes that cause breast cancer in women also increase the risk of springer spaniels getting mammary tumors.

Owners of female dogs should regularly check their females for lumps in their mammary glands, similar to women monitoring for breast cancer. (veterinarypartner.com)

Lasagna-Loving Cats Need Not Apply The Guinness Book of World Records has stopped listing animals in the “fattest” category, concerned that record-seeking owners will put their pets’ health at risk to be a record-holder.

AP Poll Shows Money a Major Consideration in Pet Care No surprise here - A recent Associated Press-Petside poll discovered that money is a consideration for the majority of people when dealing with the cost of health care for animals. The poll, conducted by GfK Roper Public Affairs & Media, found that while 62 percent of pet owners would likely get vet care if the bill was $500 or less, the percentage drops below half when the cost hits $1,000. The number drops to 35 percent if the cost is $2,000 and to 22 percent if it reaches $5,000. Only at the $500 level are dog owners (74 percent) more likely than cat owners (46 percent) to say they would likely seek treatment. In the higher price ranges, the two are about equally likely to seek vet care. (Veterinary Advantage)

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A Nest is Worth a Thousand Birds

Some birds make more than a thousand trips finding enough material to build their nests. Doves may spend only a matter of two to four days on nest building with twigs, while hawks will take months using sticks to build a nest. Hummingbirds use dandelion down, hair, feathers, spider silk, fine strips of bark and lint to make their nests. Martins and swallows build their nests out of mud, creating nest cups that cling under bridges and eaves. Orioles create a hanging nest by weaving together materials such as grass. Woodpeckers will create nests by excavating them, often using fresh wood-chip bedding. (veterinarypartner.com)

TECHNEWS | VOLUME 34 ISSUE 1

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