2010 Winter TECHNEWS by Ontario Association of Veterinary Technicians

2010

VOL UME 34 I S S UE 2

PREMIER JOURNAL

FOR

CANADIAN VETERINARY TECHNICIANS

WINTER

A NATIONAL JOURNAL PUBLISHED BY THE ONTARIO ASSOCATION OF VETERINARY TECHNICIANS

D E D I C AT E D TO PROFESSIONALISM

CONTINUING EDUCATION • Review of Basic Breathing Systems for Veterinary Anesthesia • Keep Them Stable Once They’re Off the Table • An Introduction to the Equine Lameness Exam

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

Plus: Transportation of Dangerous Goods (TDG) for Vet Techs, Hydroxyzine, Tech Tips and Tidbits, Poisoning Shorts, The Future of Zoonotic Parasite Management in Companion Animals, and more!

2011 Platinum Sponsors Making continuing education better & more accessible across Canada Bayer HealthCare Animal Health Division Hill’s Pet Nutrition Canada, Inc. Intervet Schering-Plough Animal Health Medi Cal/Royal Canin Veterinary Diet Pfizer Animal Health These companies are generously supporting a series of outstanding learning opportunities for registered veterinary technicians through OAVT. 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

EECIEECI-10716-S01-01 / bsg101129-s01-01

Letter from the Editor............................................................................................................... 2 Websites to Watch..................................................................................................................... 3 OAVT 2011 Conference........................................................................................................... 3 Safety Column: Transportation of Dangerous Goods (TDG) for Vet Techs............................... 4 CE Article #1: Review of Basic Breathing Systems for Veterinary Anesthesia...................... 7 Puzzle...................................................................................................................................... 13 Veterinarian ranks high in fastest growing professions in United States.................................... 13 CE Article #2: Keep Them Stable Once They’re Off the Table........................................... 15 Tech Tips and Tidbits.............................................................................................................. 19 CE Article #3: An Introduction to the Equine Lamenss Exam.......................................... 21 Continuing Education Opportunities..................................................................................... 24 CE Quizzes....................................................................................................................... 25 Poisoning Shorts...................................................................................................................... 27 The Future of Zoonotic Parasite Management in Companion Animals................................... 28 Employment Ads..................................................................................................................... 30 Submitting Articles to TECHNEWS...................................................................................... 31 Can you ask a pig if his glass is half full?.................................................................................. 34 9 out of 10 Pet Owners Would Give Up Date Night for Their Pets’ Medication & Well-being, According to New Grey Healthcare Group Study....................................... 35 Nutrition veterinary technician specialty announced............................................................... 36 Client information on Pet Preparedness................................................................................... 36 IDEXX Seeks Vet Participation for Feline Heart Study............................................................ 37 Hydroxyzine............................................................................................................................ 39 Global News........................................................................................................................... 40 Did You Know?....................................................................................................................... 44

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Next Issue: Spring 2011 Deadline for Material: March 15, 2011 Distribution Date: May 15, 2011 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 2

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a thorough look at controlling postoperative patients which will be of interest to technicians at all levels. In response to the many requests we receive for more equine related articles, we welcome Elise Wickett RVT who is the Head Technician at McKee Pownall Equine Services in Ontario. Elise’s CE Article 3 on “An Introduction to the Equine Lameness Exam” takes the reader through pre-exam preparations, and looks at passive and active examinations, Joint Flexion and Manipulation tests. This is a comprehensive overview for many readers who are now specializing in equine patients. We are pleased that all three CE articles are produced by RVTs and we are encouraged with the enthusiasm of TECHNEWS readers who submit photos, articles and ideas.

This issue brings together many excellent articles and outstanding contributors. We applaud the commitment of the TECHNEWS community to work closely with us in creating a publication that speaks to all Canadian technicians. With so many people turning to the internet for news and education, you will find information on websites to watch (page 3) and in the Calendar of Events (page 24) there are several on-line seminars and further resources listed.

Christie Cooper returns with a new safety article (page 4) on the transportation of dangerous goods which is a worthy read for all your work colleagues, so share this magazine! A Review of Basic Breathing Systems for Veterinary Anesthesia is CE Article 1 from author Cynthia Stoate, RVT VTS who is the Team Leader in the Anesthesia unit at OVC Teaching Hospital. We trust you will find this review helpful for your work. Lisa Randon RVT VTS is the author of CE Article 2 called “Keep them stable Once Their Off the Table” (page 15),

If you are looking for something hot to do in February, the program for OAVT’s 33rd annual conference is online at www.oavt.org. I hope that you are making plans now to come to London and make sure you register before the early-bird deadline of January 20th. The program committee has worked diligently to create two full days of outstanding lectures, workshops and wetlabs. The AGM and Awards dinner on Friday are two special reasons you will want to join your colleagues. See you there!

Cass Bayley Editor, TECHNEWS

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Abbott Animal Health adds to Online Education Abbott Animal Health is adding two features to its online education program: Master Certificates and the “My Dashboard” tracking tool (AbbottAnimalHealthCE.com). These new features will enhance the online continuing education experience and facilitate navigation and completion of the online education program. The Master Certificates add another level of recognition for users who successfully complete all modules within a series. They also demonstrate commitment to learning and improvement of patient care, signal the high level of expertise participants develop in each subject area, and provide a new means of proudly displaying continuing education accomplishments. Master Certificates are currently available for completion of the fluid therapy module series. Certificates for the anesthesia and the recently launched diabetes module series will follow. “My Dashboard” is a tracking tool that allows veterinarians and veterinary technicians to view snapshots of all modules and presenters, see their status toward completion of RACE-approved modules and identify dates when future models will be available, among other features. Nutritional Analysis If you’ve ever wanted to find out the nutritional analysis of foods/ products that do not show a ‘Nutritional Facts’ panel, this website is for you. http://www.nal.usda.gov/fnic/foodcomp/search. Nutrient Data Laboratory: Search the USDA National Nutrient Database for Standard Reference. Enter up to 5 keywords which best describe the food item. To further limit the search, select a specific Food Group.

OAVT 2011 Conference Highlights include: • Specialty tracks: equine, nutrition, critical care, feline and canine behaviour, dental, practice management • Sessions on bandaging, avian, 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 • AGM, Awards Reception and Dinner Friday

Visit www.oavt.org for more info!

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RxList Pill Identification Tool Having trouble identifying pills and capsules? Quickly identify drugs and medications using the RxList Pill Identifier Tool. http://www.rxlist.com/pill-identification-tool/article.htm American Humane to launch Animal Behaviour Resources Institute website The American Humane Association recently launched the Animal Behaviour Resources Institute website (http://abrionline.org), a free pet training and animal behaviour resource. The website features leading animal behaviour professionals in action through an extensive video library. It also includes podcasts, articles, and the latest research reports and news about animal behaviour and training. All the information on the website is based on scientific, evidence-based techniques and approaches as practiced by leading experts in animal behaviour. (Veterinary-advantage news) ACVIM Fact Sheets Did you know that the American College of Veterinary Internal Medicine (ACVIM) has created Fact Sheets for your clients? Check them out! (http://ow.ly/2laaO) Sample info: • Addison’s Disease • Brachycephalic Airway Syndrome • Cushing’s Syndrome • Tracheal Wash & Bronchoscopy • Diabetes Mellitus • Feline Immunodeficiency Virus (FIV) • Feline Asthma • Gastrointestinal Food Allergies • Megaesophagus • Immune Mediated Polyarthritis in Dogs • Prostate Disease • Hepatic Lipidosis in Cats • Steroid Therapy • And more! AAEP develops veterinary guidelines racehorse care The American Association of Equine Practitioners released guidelines for veterinarians who treat racehorses. The document, “Clinical Guidelines for Veterinarians Practicing in a Pari-Mutuel Environment,” promotes medical practices the AAEP believes place the appropriate emphasis on the health, safety and welfare of the racehorse. The central focus of the guidelines is the practice of administering medical treatment to a horse based on the entry date for its next race. All medical treatment of the racehorse should be based upon a veterinary diagnosis with appropriate time allowed for an evaluation following treatment to ensure the horse is recovered before it races again. Entry date should not be the primary factor when evaluating a horse’s need for medical care. The clinical guidelines are available at http://www.aaep.org/white_ papers.htm (veterinary advantage news) New website focuses on Vet Tech resources (U.S.) A comprehensive list of U.S. veterinary technician schools has been compiled and posted online by Vet Tech, a non-profit website devoted exclusively to providing students with an understanding of how to become a veterinary technician. The listing includes information on schools from 43 states, as well as a brief description of each and a link to its website. www.vettech.org The Wagging Tail Blog Banfield’s weekly professional blog covers a wide-range of topics from week to week, always staying relevant to the veterinary profession. Contributors include your peers, experienced vets and industry leaders. From the latest research to life balance tips, the blog has something to offer you! Visit http://thewaggingtailblog.com/

There is no “approved” or “standard” training. It can be performed online, from a CD or book, or through a live person - the choice is the employer’s.

SAFETY COLUMN

Dangerous goods cannot be mailed through Canada Post. Dangerous goods must be shipped via courier (e.g. Purolator) or by the employer’s own transport fleet. Even if shipping yourself via your own truck, the goods must be declared and paperwork filled out. All paperwork, both coming in and going out, must be retained for two years (Transport Canada requirement).

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.

The Transport of Dangerous Goods Act was passed in 1986. You see it in action daily on transport trucks and rail cars which post the little coloured diamonds (or placards). It regulates the transport of dangerous goods by motorized transport air, rail, marine, and road.

words, the regulations are “harmonized” worldwide, like customs declarations. There are also certain reporting requirements in case of a dangerous goods incident.

It was enacted to give some order to chaos in the event of an accident, so that emergency responders have some information about what was on the truck if it is rolled in a ditch. This differs from WHMIS, which was enacted to protect workers working with hazardous materials. While in the box on the road, it is TDG-regulated. When the box is opened in the lab, it is WHMISregulated. TDG is world-wide. The symbols and labels are the same in Gambia as Canada (due to influence of the Airline Pilots Association, among others). In other

Shippers, carriers, and receivers of dangerous goods must be trained and earn a certificate which can be produced for review by a Transport Canada or an MTO official (the fellows in the little green and white cars on Highway 401 and at weigh stations). The certificate is issued by the employer (not the training company) and must be current. For road transport, the training is good for 3 years. For air transport it is valid for 1 year. There is zero tolerance for not declaring dangerous goods for an air shipment.

Dangerous Goods are defined by regulation, slotting them into 9 classes, with corrosives and flammable liquids being by far the most commonly shipped materials. They do not match up exactly with WHMIS classes, but are close.

Consumers going to stores like Canadian Tire and taking dangerous goods home are exempt from the Act. This is why you can buy a propane tank for your BBQ yet not required to have the little certificates in your wallet. However, if you buy the same tank for the clinic and drive it to work on work business, then you are covered by TDG and must comply with all provisions (paperwork, packaging, placarding the vehicle, etc). This is why it is strongly encouraged that you have dangerous goods delivered and not pick them up yourself. There are some provisions for farmers taking pesticide sprayers down the road as well. They aren’t regulated the same as a truck full of pesticides delivering to the CO-OP store. Traffic incidents that occur while you are carrying dangerous goods may void vehicle insurance. Delivery carriers have an insurance rider to cover carrying dangerous goods. If you receive (sign for) dangerous goods of any kind (gasoline, lab chemicals, alcohol, radioisotopes, heat exchanger fluids, gas cylinders etc), or ship out dangerous goods (returns to Fisher Scientific, hazardous waste - sharps containers etc), then you need training and the certificate. Shipping Hazardous Waste a. Generators of hazardous waste must be registered with the Ministry of the Environment (MOE) and receive a “Generator Number”. The number is specific to a particular “site address” (it is on the paperwork the MOE sent confirming the registration) and the number and site address must match on any shipment. A “site” must be

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geographically connected – a one hundred acre parcel of land with many buildings can be one site – allowing shipment from any building. Two fifty acre parcels located 5 km apart require two registrations and two different numbers. b. Generators must also register their “wastes” by “waste class”. Each waste class will have a three digit code and a letter attached to it. There is also a description of the waste and sometimes the process - e.g., “waste lubricating oils from automobile servicing”. c. There should be paperwork on file from the MOE that gives you the generator number, site address, and a “schedule” listing all the waste classes for which the site is registered. d. You may only ship wastes which have been duly registered. Hazardous waste contractors should not take anything that isn’t registered.

out, he/she supplies the 6-part form. The generator (clinic) gets the top two copies, white and green. The white copy is sent to the MOE within 5 days. The clinic keeps the green. The carrier takes the other copies. He keeps one. He gives the others to the receiver. The receiver sends one to the MOE to match up with the white one you sent in, and sends a brown one to you to match up with the green one you kept; and the receiver keeps one on file. This system lets everyone know that the waste went to a receiver and wasn’t dumped down the drain. h. Manifests serve two purposes - one is tracking the waste from generator to receiver (Ontario law); the other is a shipping paper to comply with the Transportation of Dangerous Goods Act and Regulations (federal law). Because most of the time the material is “regulated” under TDG, the clinic person signing the manifest must have current training in TDG and have a certificate to show to a Transport Canada inspector if requested. In other words, it is not only shipments of “new” material that are regulated under TDG, but also wastes. The person signing the manifest is in the “hot seat” because he/she certifies by signing that the information on the form is true and correct. If there is a problem, the MOE and/or Transport

e. Each site must pay a $50 fee every year to MOE to stay registered. This is done on-line using the “HWIN” system of the MOE (www.hwin.ca) and a VISA card. Passwords are issued to employees of registered facilities.

useful contacts >

f. Each shipment of hazardous waste is entered into the HWIN system by MOE. There is a $5 charge for each manifest (shipping paper) and a tonnage charge for the amount of waste. Wastes that are sent for recycling may be exempt from the tonnage charge but there is still the $5 fee. MOE does NOT send a bill - you have to go online periodically and check and then pay the bill.

Some Online Safety Trainers:

g. The “manifest” is an important piece of paper that must be kept in a place where it can be retrieved. When a contractor comes to take the waste

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Canada will be at the signer’s doorstep. It is NOT the carrier’s responsibility to ensure that the information is true or correct - the carrier is relying on the shipper’s information. This point cannot be over-emphasized. Virtually every business today needs someone trained in TDG (and a backup for vacation, sickness, maternity leave) since dangerous goods are everywhere. This is a current requirement and not a “next year or when I get around to it” requirement. There are trainers all over Ontario. Transport Canada has a list of training organizations on its website. It’s possible that you could also piggy-back on a local organization’s training (ie. municipality, or a local company?) if they are giving it. The author wishes to acknowledge Jennifer Wesley, Laboratory Safety Officer at the University of Guelph for assisting in the development of this article.

Transport Canada provides a search engine listing TDG trainers across the country a http://wwwapps.tc.gc.ca/saf-sec-sur/3/train-form/search-eng.aspx

• Danatec: http://www.danatec.com/site/index.html • Ontario TDG Company: http://www.ontariotdgtraining.com/index. cfm?REFID=2501&gclid=CIKom5WN_aQCFYVrKgodfQLKgwh • YOW Canada: http://www.yowcanada.com/tdg_dangerous_goods_training.asp • TDG-WHMIS Compliance Center: http://www.tdgwhmis.com/

Provincial Ministries of the Environment British Columbia: www.gov.bc.ca/env Alberta: www.environment.alberta.ca Manitoba: www.gov.mb.ca/conservation Ontario: www.ene.gov.on.ca Nova Scotia: www.gov.ns.ca/nse/ Prince Edward Island: www.gov.pe.ca/eef Saskatchewan: www.environment.gov.sk.ca New Brunswick: www.gnb.ca/0009 Quebec: www.mddep.gouv.qc.ca/ministere/inter_en.htm Newfoundland and Labrador: www.env.gov.nl.ca/env

EARLY-BIRD REGISTRATION CLOSES JAN 20.

Make plans now to attend the 33rd annual conference and trade show in London! More than 60 industry leaders present an outstanding program designed specifically for veterinary technicians, Platinum Sponsors: with more than 1100 in attendance last year. This is YOUR conference ~ the place to learn and celebrate being a veterinary technician. The OAVT annual conference is the premiere opportunity of the year to meet colleagues, network with the industry, sample new products, learn new ideas and techniques that can have a dramatic impact on your work. Make plans now to expand your world at OAVT in February! Registration is now open at www.oavt.org 519.263.5050 / info@oavt.org Platinum Sponsors:

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This article is a follow up to the article “Review of a Basic Anesthetic Machine” previously published in TECHNEWS1. As noted in the previous article, morbidity and mortality are reduced if the person performing the anesthesia is familiar and confident with the equipment they are using. It is no less important to understand the breathing system being attached to the anesthetic machine. There are a multitude of different types of breathing systems available to use with inhalant anesthetic machines. This article will focus on the four most common to small animal veterinary anesthesia: Standard “Y” circle system, Coaxial F-circuit, Bain system and Ayres T-piece. Discussion will include function, set-up, pressure testing, flow rates and problem-solving. As with the previous article, “fresh gas” generally refers to oxygen +/- inhalant.

CE Article #1 Review of Basic Breathing Systems for Veterinary Anesthesia

Function Breathing systems are a series of tubes and bags that connect from the common gas outlet of the anesthetic machine1 to the endotracheal tube of the veterinary patient. These systems deliver oxygen and an anesthetic inhalant agent, remove exhaled gases and provide a way to assist or control ventilation if needed. Classifications There are differing opinions on how to classify breathing systems. The classifications usually reflect certain functions/characteristics of the breathing system such as2: • Is the system rebreathing or nonrebreathing? Rebreathing means to inhale previously expired gases, which may or may not have the carbon dioxide removed.3 This will be detailed further in this article. • Is the system open, semi-open/semiclosed or closed? This is regulated by the fresh gas flow rate and the adjustable pressure limiting valve (APLV) setting required to maintain an adequate volume of gases within the breathing system. • Is there absorbent to remove the carbon dioxide?

You should be familiar with these and other functions and how they inter-relate to better understand your breathing system and problem-solve it. This article will begin by reviewing a few of these characteristics and then applying them to the four breathing systems mentioned above. Rebreathing vs. Non-rebreathing systems Expired gases will include the carrier gas (generally oxygen), any inhalant anesthetic agent not metabolized by the patient, and carbon dioxide produced by the patient. Rebreathing means to inhale previously expired gases, which may or may not have the carbon dioxide removed3. Rebreathing can refer to exhaled gases that are sitting in the mechanical dead space

and the expiratory tube. These exhaled gases will not have the carbon dioxide removed, as they have not passed through a carbon dioxide absorbent. Dead space is the volume in the breathing system that is occupied by gases that are rebreathed without any change in composition. Mechanical dead space includes the space in the breathing system between the patient port end of the inspiratory tube and the patient’s mouth. This dead space includes the patient connection port of the tubing that adapts to the endotracheal tube and can include an endotracheal tube which is too long for the patient and is left protruding out of the mouth. At the end of an exhalation, the dead space is full of exhaled gases. As these exhaled gases in the dead space are not flushed forward in the breathing system by fresh gases, or are minimally diluted

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 would like to dedicate this article to her two adorable and handsome cats named Panda andTeddy, both of whom she had to bid farewell to this past summer.

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by turbulence from the fresh gas flow, the exhaled gas remaining in the mechanical dead space is the first bit of gas inspired on the next breath, leading to rebreathing of expired gases along with some fresh gas. Rebreathing also refers to breathing in exhaled gases that have re-circulated and mixed with the fresh gases entering the breathing system. The amount of rebreathing is determined by the fresh gas flow rate. The higher the fresh gas flow rate the more exhaled gases are pushed towards the APLV and eliminated through the scavenge system. The lower the fresh gas flow rate, the more exhaled gases are either directly re-inspired by the patient’s next breath, or recirculated and mixed with the fresh gases, depending upon the type of breathing system you are using. Any breathing system that allows the exhaled gases to re-circulate with the fresh gases requires a carbon dioxide absorbent to remove the carbon dioxide from the breathing system and prevent high percentages of inspired carbon dioxide. Having a fresh gas flow rate equal to or higher than the patient’s respiratory minute volume will reduce or eliminate rebreathing. Minute volume is the sum of all gas volumes exhaled in one minute. This is calculated by multiplying the tidal volume (the amount of gas exhaled in one breath, approximately 10-20 ml/kg/) by the respiration rate (average 10 breaths per minute), which equals a minute volume of approximately 200 ml/kg. Keeping in mind that exhaled gases also include any inhalant anesthetic agent not taken up by the body, we can then consider how this impacts the percentage of inhalant delivered to the patient in the breathing system. With a non-rebreathing system, all of the exhaled gases are evacuated through the scavenge system. So with a flow compensated vaporizer (which all of the modern vaporizers are) that is properly calibrated, and a non-rebreathing system, when you dial 2%, then 2% is delivered to and inspired by the patient. With a rebreathing system, the exhaled gases will contain inhalant anesthetic agent not metabolized by the body, at a lower percentage than was delivered from the vaporizer in the fresh gases. These exhaled gases, with a lower percentage of inhalant anesthetic agent, will mix with and dilute the percentage of inhalant anesthetic agent in the fresh gases. For ex-

ample, if the vaporizer is delivering 2% in the fresh gases to the patient, the patient initially inhales 2% anesthetic agent. The patient will uptake a portion of this anesthetic agent and then exhale perhaps 1.7% anesthetic agent in the exhaled gases. This 1.7% then recirculates and mixes with the fresh 2%, thereby diluting the percentage of anesthetic agent that is now being delivered to and inspired by the patient. One might wonder why you would choose to allow your patient to rebreathe exhaled gases. Exhaled gases are warmed and humidified by the body. When mixed with fresh gases, the exhaled gases will help to both warm and humidify the cooler, drier fresh gas. Rebreathing systems also tend to be a little more cost effective. Open vs. Closed systems Historically this terminology was simply a reflection of whether the APLV (if your breathing system has one) was fully open, partially closed or fully closed. However, technically this terminology has more to do with the fresh gas flow. With higher fresh gas flow rates that equal or surpass the patient’s minute tidal volume, the APLV will be left in an open position to allow elimination of excess gases not taken up from the patient. With lower fresh gas flow rates, the APLV will be partially closed to preserve a volume of gas within the breathing system sufficient enough to accommodate the patient’s tidal volume with each breath. If the APLV was left fully closed then all of the expired gas would recirculate with the fresh gas flow back to the patient. The fresh gas flow rate would only need to replace the volume that was taken up by the patient. Estimates of metabolic oxygen requirements in small animals are 2-7 ml/kg/ min. Clinically, most people use 10 ml/kg/ min as a safe “overestimate”. Hence, clinically the APLV could be fully closed if you were delivering just the volume taken up by the patient. However, having a partially-opened APLV would be required due to this small overestimation in metabolic need so that there is always adequate gas in the reservoir bag without any detectable increase in pressure within the system. Fully closed breathing systems can be dangerous to operate and need close observation by the anesthetist. These systems should ideally be used with a high patient pressure

alarm1. If the fresh gas flow rate exceeds the patient’s metabolic rate, with a closed APLV the volume of gas in the breathing system will increase and build up pressure against the closed APLV and subsequently build up pressure in the patient’s lungs. The high patient pressure alarm can be adjusted to alarm at a pressure that is low enough to not produce trauma to the patient’s lungs and soon enough to alert the anesthetist to open the APLV to release the pressure and adjust the fresh gas flow rate. In general, an open or closed system related to the APLV needs to be viewed in combination with the oxygen flow rates and whether it is rebreathing or non-rebreathing as outlined above. Carbon Dioxide Absorbent If the breathing system you are using utilizes a carbon dioxide absorber, then active carbon dioxide absorbent, as discussed in the last article1, will remove carbon dioxide from the exhaled gases prior to the exhaled gases recirculating with the fresh gases. Resistance Another characteristic of breathing systems that doesn’t impact classification, but should still be considered when using and understanding a breathing system, is resistance. Increase resistance of gas flow through the breathing system will increase the work of a spontaneously breathing patient and increase the consumption of energy by that patient. The resistance is usually associated with the level of fresh gas flow and the inner diameter of the breathing tubes and endotracheal tube. Resistance can also be affected by the length of breathing tube and changes in the path such as diameter changes or direction changes3. Although some patients benefit by a mild Positive End-Expiratory Pressure (PEEP) to keep lower airways open, the goal in most patients is to reduce the resistance within the breathing system as much as possible. Four types of breathing systems Standard “Y” circle system The standard “Y” circle system consists of two breathing tubes, one carrying inspired fresh gases to the patient and one carrying expired gases away from the patient. These two tubes are attached to the unidirectional ports of the carbon dioxide absorber canis-

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ter. At the other end the tubes are connected together by a “Y” piece. This “Y” piece is a 3-way connector which joins the inspired and expired tubes together and the third port is the patient connection port that adapts the tubes to the patient’s endotracheal tube or mask. A reservoir bag is also connected to the carbon dioxide absorber canister. The gases can then flow in a oneway, circular fashion through the inspiratory tube to the patient, out the expiratory tube away from the patient, through the carbon dioxide absorber and circle around to mix with the fresh gases coming into the system. The arrangement of the different components of a carbon dioxide absorber; fresh gas inlet, unidirectional valves and ports, reservoir bag port, APLV, will vary between manufacturers. The tubing, as with any breathing system, should ideally be corrugated to increase flexibility and limit kinking. Tubing of a clear material has the advantages of being lighter weight, absorbs less anesthetic agent, has lower compliance and aids in visualization of the inside of the tube for accumulation of moisture or debris3. The reservoir bag serves a variety of functions including3: a. Reserving exhaled gases for use during the next inspiration, allowing some rebreathing and more economical use of gases. b. Can be used for assisted or controlled manual ventilation. c. Allows for observation and evaluation of spontaneous respiration. d. Protects the patient from excessive pressure in the breathing system. The selection of size of reservoir bag is important. If the bag is too large it will be difficult to evaluate spontaneous breathing and to provide manual ventilation when needed. If the bag is too small there is a decreased safety margin for pressure increases in the breathing system and it may not provide a large enough reservoir. The reservoir bag should be ideally three to four times the patient’s tidal volume. Guidelines for selection of bag size in small animal anesthesia would be 1 litre for any patient less than 15 kg., 2 litres for any patient between 15 and 40 kg. and 3 litres for any patient greater than 40 kg. Reservoir bags are also available in 500 ml sizes for tiny patients.

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There have been various studies to determine the ideal fresh gas flow of various breathing systems. All of these studies have multiple variabilities. For the purpose of this article, fresh gas flow rates have been averaged. The oxygen-fresh gas flow rate, in a circle system, for the induction and recovery period, is 100 ml/kg/min. This provides a non-rebreathing flow that is critical for these periods of anesthesia for several reasons. During the induction period there is a small amount of residual gas or room air within the breathing tubes. When transferring a patient to the breathing tubes, the patient should receive 100% oxygen. This higher flow rate quickly pushes the residual gases/room air out of the tubing and replaces it with oxygen. Also during the induction period, when transferring from an injectable induction agent to an inhalant anesthetic agent, you want to ensure there is no dilution of the inhalation agent associated with rebreathing. After 5-10 minutes of the induction nonrebreathing flow rate, when the patient has transferred to the inhalant agent and is at a stable plane of anesthesia, the oxygen fresh gas flow rate can be reduced to 50 ml/kg/ min for the maintenance period. This is considered a partial rebreathing flow rate for this breathing system.

c. Many parts are difficult to clean d. The carbon dioxide absorber is expensive and bulky, and the absorbent can increase resistance to breathing. Absorbent may also not function correctly if not packed correctly in the canister. e. The tubing can be heavy for smaller patients f. Dead space tends to be slightly larger g. Moisture may accumulate in the breathing tubes There is also a mild increase in resistance during spontaneous respiration as the patient draws the gases through the unidirectional valves, creating more work for the patient. Coaxial F-circuit The F-circuit is slightly different in design from the standard circle system, but similar in function and use. The F-circuit is a coaxial design where the inspiratory tube runs inside the expiratory tube and only divert at the machine end to connect with the unidirectional valves. Connections to the unidirectional valves on the carbon dioxide absorber, along with a reservoir bag are the same as the standard circle system. Fresh gas flow rates are also the same as with the standard circle system.

During the recovery period, the nonrebreathing flow rate of 100 ml/kg/min should be utilized to flush all exhaled anesthetic agent away from the patient and out the scavenge, allowing the patient to recover from the anesthetic. If you were to use a rebreathing flow rate during the recovery period, some inhalant anesthetic agent would be rebreathed and prolong the recovery period.

A few advantages of the F-circuit are: a. Less mechanical dead space at the patient connection b. Lighter weight c. Less bulky tubing around the patient’s head d. As the exhaled gases travel over the inspiratory tube they will help to warm the inspired gases and humidify at the patient port. Oxygen flow rates are the same as for the standard circle system as is the selection of a reservoir bag size.

Advantages to the circle system are2,3: a. Lower fresh gas flow rates (economical and environmentally friendly) b. Length of the tubing can be adjusted to distance the anesthetic machine away from the patient and optimize patient exposure to the surgeon for various procedures c. Carbon dioxide is absorbed

Mapleson Systems Mapleson breathing systems are different in design and function in that there are no valves to direct the flow of gases and there is no carbon dioxide absorber. Fresh gas flows must therefore be higher to flush the exhaled carbon dioxide out of the system. Mapleson systems have been divided into five basic types, labeled A through E.

Disadvantages of the circle system include2,3: a. Multiple parts that need to be connected correctly for proper function b. Multiple connections that increase potential areas for disconnect or leakage

Advantages of the Mapleson systems are:4 a. The equipment is simple, inexpensive and relatively easy to use, clean and maintain b. They are light weight, less bulky and

easy to position c. There is generally less resistance to breathing with a Mapleson system than a circle system d. They do not require a carbon dioxide absorber or multiple, complex moving parts e. Minimal mechanical dead space is added f. The system allows the inspired concentration of anesthetic to be altered quickly Disadvantage of the Mapleson systems are: 3,4 a. Requires higher fresh gas flow rates, resulting in increased costs b. Higher flow rates may also decrease temperature of patient and dry patient airway c. Increased pollution due to higher flow rates required d. Anything that causes the fresh gas flow to drop presents a hazard for dangerous rebreathing Bain system The Bain system, a common breathing system used in veterinary anesthesia, is a modification of the Mapleson D system. It comes in two designs. The first one has the narrow fresh gas tube running alongside the wider expiratory tube. The second, more common design, is a coaxial system where the narrow tube carrying the fresh gas runs inside the larger corrugated tube that carries the exhaled gases away from the patient. Since the tube carrying the fresh gases is of narrow design and the oxygen flush valve delivers oxygen at an elevated flow rate, the oxygen flush valve should never be utilized with a Bain hose connected to a patient. The pressure of the oxygen flush leaving the end of the smaller tube will be increased and potentially cause trauma to the patient’s lungs4. The Bain system is ideally used with a metal header or mount to connect the Bain between the anesthetic machine and the patient. The inner tube of the Bain is attached to the fresh gas port of the anesthetic machine via a narrow flexible hose. The outer tube of the Bain carrying the exhaled gases attaches to the Bain mount. The Bain mount also holds the reservoir bag and has an APLV, +/- a manometer, that directs exhaled gases either into the reservoir bag or out the scavenge system. The Bain system can also be used without a metal header, by attaching an open-ended reservoir bag that dumps di-

rectly into the scavenge system. Intermittent Positive Pressure Ventilation is possible by partially or completely occluding the APLV or the open end of the reservoir bag. When using the Bain hose, fresh gases travel through the inner tube to the patient. During exhalation the expired gases are directed down the outer tube away from the patient. Continuous fresh gas flow prevents the exhaled gases traveling up the inner tube. During the pause between breaths, the continuous fresh gas flow coming through the inner tube pushes the exhaled gases further up the outer tube towards the reservoir bag and the APLV, thereby filling the patient end of the outer tube with fresh gas. During inspiration, the patient draws gases from both the inner fresh gas tube and the outer tube. The flow rate of the fresh gas determines how far up the outer tube the exhaled gases will be pushed and whether any exhaled gases will be inspired during the next breath, which would lead to rebreathing of both anesthetic agent and carbon dioxide. Another factor that determines the amount of rebreathing is the Inspiratory:Expiratory ratio. The longer the expiratory pause, the more time to push the exhaled gases away from the patient3. Fresh gas flow rates for the Bain system are generally 200 to 300 ml/kg/min for the induction and recovery period, providing a non-rebreathing system with the same advantages listed for the circle system. During the maintenance period, the fresh gas flow rate can be reduced to 130 ml/kg/min, providing a partial rebreathing system with slight clinically acceptable increases in PaCO2. Many manuals/texts state that flow meters are not accurate below 500 ml/min. However, it is common practice to not set the flow meter below 1 L/min, providing a larger safety margin for accidental adjustment of the oxygen control knob. Also, though most newer model vaporizers are flow compensated at low flows, older model vaporizers may not be accurate at flows as low as 500 ml/min. At a minimum flow of 1 L/min any patient less than 5 kg will essentially be on a non-rebreathing system throughout the procedure, which is not of concern. Advantage of the Bain systems in addition to those of Mapleson systems in general: a. Rebreathing will result in retention of heat and moisture

Disadvantages of the Bain systems are: a. If rebreathing is not extreme then normal End Tidal Carbon Dioxide (EtCO2) can be maintained, but it does increase the patient’s work in breathing. Depressed respiration can lead to increases in EtCO2. b. If the inner tube is cracked or broken (difficult to see) the whole system becomes a dead space. Integrity of the inner tube can be tested prior to use by setting the flow meter to a low flow then occluding the patient end of the inner tube. If the inner tube is intact the flow meter indicator (bobbin) should drop slightly3. Ayres T-piece The Ayres T-piece is a modified Mapleson E system when used without a reservoir bag, and a modified Mapleson F system when used with a reservoir bag. The system consists of a tube that connects directly between the patient and the scavenge system, with or without a reservoir bag at the non-patient end of the tube. The fresh gas enters the breathing tube close to the patient at a “T” junction with the breathing tube. Inspiration generally occurs from the fresh gas source, but if the inspiratory volume exceeds the fresh gas flow rate then gases can be inspired from the breathing tube. During the expiration pause the exhaled gases are pushed down the breathing tube away from the patient, similar to the Bain system. However, fresh gas flow rates 2 – 3 times the patient’s minute volume2 are required, making this system less economical. There is no carbon dioxide absorber, unidirectional valves or APLVs, therefore there is decreased resistance to breathing. The system can be used with or without an open ended reservoir bag. As with the Bain, intermittent Positive Pressure Ventilation is possible by partially or completely occluding the open end of the reservoir bag. The breathing tube and reservoir bag must be large enough to hold more than the patient’s tidal volume to prevent rebreathing. Leak testing All breathing systems can be leak tested, or pressure tested, in much the same manner. There are two ports through which gases are allowed to pass during normal operation: the end of the tube that connects to the patient’s endotracheal tube, and the APLV or open-ended reservoir bag. Both of these ports should be occluded for pressure test-

TECHNEWS | VOLUME 34 ISSUE 2

ing by holding your hand over the end of the breathing tube, and closing the APLV. Oxygen is then delivered into the sealed breathing system by either the oxygen flow meter, or the oxygen flush valve. Although the oxygen flush valve is not to be used on a Bain system connected to a patient, it is safe to use when pressure testing the system. Oxygen is delivered into the system until the pressure in the system reaches 20 cm H2O, as registered on the pressure manometer. At this point the oxygen delivery is discontinued and the manometer observed for a reduction of pressure in the system. If no reduction in pressure is noted then the breathing system is leak-proof. If a small reduction is noted then turn the oxygen flow meter up to 300 ml/min. If the pressure manometer stops dropping in pressure, or starts to increase in pressure, then this indicates the leak is small enough to consider it acceptable for safe use for both the patient and the person delivering the anesthesia. However, the cause of the leak in the system should be evaluated at a later time and not accepted long term. Common areas for leaks are punctures in the breathing tube or reservoir bag, loose or cracked unidirectional valves or carbon dioxide canisters and malfunctioning APLVs. This method of pressure testing will only detect leaks within the low pressure portion of the anesthetic machine, that which is beyond the fresh gas port. It will not detect leaks in the high or moderate pressure portions of the anesthetic machine, namely that which is upstream of the fresh gas port. Endotracheal tubes Endotracheal tubes (ETT) come in a variety of shapes, sizes and material. Red rubber, PVC and silicone are the most common materials. Following are some of the features of an ETT that should be considered when purchasing and utilizing. • Clear material makes it easier to visualize debris or obstructive material both during use and during cleaning. The PVC and silicone material aid in this, too. • Many ETTs come with a Murphy Eye. The Murphy Eye is an oval hole in the patient end of the ETT opposite the bevel opening of the tube. The Murphy Eye provides an alternate breathing path for the patient should the bevel opening become obstructed with debris or positioned against the inner wall of the trachea. • Cuffed ETTs are preferred for anes-

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thesia of most, but not all, veterinary patients. Cuffs come in two styles: high volume/low pressure and low volume/high pressure. High volume/ low pressure cuffs are preferred as the area of pressure created by the inflated cuff is spread out over a wider area and therefore less likely to damage the sensitive tissue of the inner trachea. Low volume/high pressure cuffs create a higher pressure at a narrower spot on the cuff which is more likely to cause tissue trauma. One can argue that the low volume/high pressure cuffs provide better protection for leakage of fluid past the cuff and into the lungs, however, if the ETT cuff is properly inflated and tested once placed in the patient, then this is not of concern with either type of cuff. Endotracheal tube cuffs should be pressure tested before use by inflating the cuff to a point were all wrinkles in the cuff are eliminated The inflated cuff is then left for at least one minute. The cuff should inflate evenly and not depress the lumen of the endotracheal tube. Any leak in the ETT cuff should be detected in this time period by a reduction in size of the inflated cuff3. The cuff is then deflated before induction. Once placed in the patient it is re-inflated as follows: a. With the APLV closed, oxygen is manually pushed into the patient’s lungs by compressing the reservoir bag to a pressure of 15-20 cm H2O. b. At the same time, inflate the ETT cuff and listen at the patient’s mouth for any oxygen leaking past the cuff. c. Inflate the ETT cuff only to a point where the leaking stops. This method should produce a cuff pressure less than 25 mmHg thereby not interfering with tracheal mucosal blood flow. Cuff pressures greater than 25 mmHg could potentially cause ischemic injury and potential tracheal stricture5. • When selecting an ETT size, it is best to intubate with the largest bore tube size possible without causing trauma, and an ideal length. The narrower the inner diameter of the tube, the greater the resistance to breathing it is for the patient. There are many recommended methods for determining the ideal diameter size of ETT for a veterinary patient: weight, distance measurement between nares (the distance between the nares should equal the width of the

ETT) and/or palpating the trachea. Each method comes with its own limitations. Practice and experience will be your best ally in selecting ETT sizes. It is recommended that when you select an appropriate ETT size, you also have at hand one size smaller and one size larger. The length of the ETT can be premeasured alongside the patient to ensure it is neither too short nor too long. The ETT should extend from the tip of the muzzle to the thoracic inlet. This will ensure that when securely tied to the patient the tube neither slips distally out of the larynx nor passes down one bronchi. Excessively long tubes that are left protruding out of the mouth will also increase dead space and resistance to breathing. • Endotracheal tubes can also be purchased with a reinforcing wire embedded in the wall of the tube in a spiral fashion. The advantage of this wire is that it helps to prevent kinking of the ETT during patient positioning that requires bending of the patient’s neck. Disadvantages of this type of tube are: a. They are expensive b. The tube cannot be shortened to adapt to the anatomy of the patient c. If the patient bites down on the tube a permanent obstruction of the tube may occur d. These tubes are so flexible that the stylet is required to aid with intubation e. They have a smaller internal diameter than standard ETTs of equal outer diameter therefore there is an increased resistance to breathing. Delivery of inhalant anesthesia via an ETT rather than a mask is recommended for the following reasons: a. A patent airway is maintained b. An ETT protects the airway from foreign material c. An ETT can provide positive pressure ventilation d. An ETT can facilitate tracheal or bronchial suction if necessary e. A correctly sized and placed ETT can reduce anatomical dead space5. Masks As with ETTs, masks come in a variety of material, shapes and sizes. Ideally, masks should only be used for oxygen delivery and not for mask induction. Mask induction leads to potential pollution of the environment and exposure to personnel. Masks

Review of Basic Breathing Systems for Veterinary Anesthesia Illustration 1: Aerial view of a carbon dioxide absorber with a standard â&#x20AC;&#x2DC;Yâ&#x20AC;? circle system showing the flow of gases with A: inspiratory valve, B: expiratory valve, C: reservoir bag, D: APLV, E: scavenge hose, F: circle system Illustration 2: Aerial view of a carbon dioxide absorber with a Coaxial F-circuit system showing the flow of gases with A: inspiratory valve, B: expiratory valve, C: reservoir bag, D: APLV, E: scavenge hose, F: F-circuit Illustration 3: Side view of a Bain breathing system attached to a mounting bracket, showing the flow of gases with A: mounting bracket, B: APLV, C: reservoir bag, D: fresh gas tube, E: scavenge hose, F: Bain system Illustration 4: Demonstrates the Bain breathing system used without a mounting bracket with A: an openended reservoir bag that can be connected directly to a scavenge hose Illustration 5: AyresT-piece without a reservoir bag with A: AyresT-piece, B: fresh gas tube, C: scavenge hose

Illustration 6: AyresT-piece with A: an open ended reservoir bag that can be connected directly to a scavenge hose

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references > 1. Stoate C., “Review of a Basic Anesthetic Machine”: “TECHNEWS”, Volume 34, Issue 1, Fall 2010, Ontario Association of Veterinary Technicians. 2. Hughes L., “Breathing systems and ancillary equipment”: Seymour C., Duk-Novakovski T., “BSAVA Manual of Canine and Feline Anaesthesia and Analgesia ” 2nd edition, BSAVA, 2007. 3. Dorsch J., Dorsch S., “Understanding Anesthesia Equipment” 4th edition, Williams & Wilkins, 1999. 4. Hartsfield S., “Anesthetic Machines and Breathing Systems”: Tranquilli W., Thurmon J., Grimm K., “Lumb & Jones’ Veterinary Anesthesia and Analgesia ” 4th edition, Blackwell Publishing, 2007. 5. Hartsfield S., “Airway Management and Ventilation”: Tranquilli W., Thurmon J., Grimm K., “Lumb & Jones’ Veterinary Anesthesia and Analgesia” 4th edition, Blackwell Publishing, 2007.

should be made of clear material for visualization of the patient’s airway during use plus for ease of cleaning. The mask should be of a size and shape that fits comfortably over the patient’s muzzle without either being obstructive to the patient’s muzzle or eyes, or so big as to increase dead space, thereby reducing the inspired oxygen concentration. If a mask is to be used for inhalant anesthesia delivery, then an airtight seal around the patient’s muzzle is necessary. Maintenance & cleaning of reusable supplies Endotracheal tubes should be rinsed with

water ,and then soaked in a cleaning agent that denatures protein (eg. Asepti-Zyme MultiTM). This will help break down any mucous or blood left in/on the tube. After soaking, the inside of the endotracheal tube should be scrubbed with a bottle brush and the tube rinsed with water inside and out. Flush masks with oxygen after use to help remove any residual gas odour that may permeate the material of the mask and be offensive to the next patient. Clean the mask between patients in the same manner as the endotracheal tubes. Rinse breathing tubes and reservoir bags with water after each use and hang to drain and dry. Clean-

Puzzle Match the generic drug name to the trade name for these human drugs used in veterinary medicine

Generic name

Trade name

1. Loperamide

a. Reglan®

2. Cefazolin sodium

b. Adriamycin®

3. Lorazepam

c. Imuran®

4. Metoclopramide

d. Imodium®

5. Metronidazole

e. Benadryl®

6. Doxorubricin

f. Ativan®

7. Azathioprine

g. Propulsid®

8. Diphenhydramine HCl

h. Ancef®

9. Mitotane

i. Lysodren®

10. Cisapride

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

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ing endotracheal tubes, masks and breathing tubes weekly in a soapy water solution and disinfectant (eg. Dynakil SQTM) is recommended. Be sure to rinse these supplies well as residual disinfectant solution can be irritating to airway tissues. Clean and disinfect supplies used on an infectious case immediately after use. If sterilization of any part of the breathing system is warranted, follow the manufacturer’s recommendations for sterilization. Conclusion Having confidence in the equipment and supplies that you use for anesthesia will provide confidence for the anesthetist and safety for the patient. Understanding the function, set-up and use of the various types of breathing systems, along with selection of the system most appropriate for your patient, will be helpful in providing such confidence. The author gratefully acknowledges the assistance of Dr. Melissa Sinclair, DVM, DVSc, DACVA, professor in anesthesia at the University of Guelph Ontario Veterinary College, for her review of this article and valuable input.

Veterinarian ranks high in fastest growing professions in United States Veterinarians are among the fastest growing professions in the United States, according to a recent report in Fortune magazine. The number of veterinarians is expected to increase by 36 percent between 2008 and 2018. The publication bases its conclusions on these data: • According to the 2009-2010 National Pet Owners Survey, 62 percent of U.S. households owned at least one pet in 2008, accounting for approximately 71 million households. • Pet care was one of the only sectors of the retail industry to grow during the recession. • The American Pet Products Association estimates that pet owners will spend almost $48 billion on their pets this year, $24 billion of which will be spent on medicine and veterinary care. Other occupations projected to grow rapidly within the next 10 years include nurses, network systems and data analysts, software and biomedical engineers, accountants and auditors. (dvmnewsmagazine.com)

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When dealing with postoperative patients, the most important thing for the anesthetist to remember is to rely on the patient’s response to stimuli in order to assess the patient’s recovery. The recovery of an anesthetized patient begins when all anesthetic drugs have been discontinued. Patient status is monitored regularly until the patient is conscious, and vitals have returned to normal. The following is a review of the important parameters to monitor in order to avoid morbidity commonly seen during the recovery stage.

Glycemic Control An adequate level of blood glucose is important for cerebral metabolism. A blood glucose of less than 60 mg/dL should be treated with an intravenous glucose infusion, (2.5-5% solution of 50% dextrose)5 or a bolus (50% dextrose always diluted 1:4 with saline)5 if hypoglycemia is severe enough. This is most commonly a problem in smaller dogs that have fasted, neonates, or patients with a glucocorticoid deficiency.1 Injuries A number of injuries can occur during the anesthetic period; some injuries to look for in a postoperative period are of the following: Swollen Feet Limbs may become swollen from being tied too tightly while on the operating table. Corneal Ulcers Anesthesia reduces the ability to blink and reduces tear formation, resulting in corneal ulcers. Apply optical lubricants to all anesthetized patients as a preventative. Tracheal Mucosal Injury Over-inflation of the endotracheal cuff, especially in cats, can cause problems.

CE Article #2 Keep Them Stable Once They’re Off the Table

If anesthetic time is prolonged, pressure necrosis can become an unfortunate consequence. The cuff should be deflated, moved slightly and re-inflated if time is of a concern. There are two types of endotracheal tubes. The older style is low volume, high pressure, and the newer type (used in human medicine) is high volume, low pressure. You should be able to look at the cuff and tell which type you have. The high volume, low pressure cuffs are bigger volume and look crinkled and wrinkly when deflated. The low volume, high pressure cuffs look flat and smooth when deflated. The intent of the high volume non-elastic cuff is to distribute a low pressure seal over a larger area of tracheal mucosa, making it less susceptible to injury.1 If you happen to have the high pressure cuffs, be sure to deflate and move the cuff by a centimeter or so every

30-45 minutes to be safe when used on cats and small patients. Joint Pain Older animals with arthritic joints may become very sore especially in the days following anesthesia due to stretching caused by positioning on the surgical table or surgical manipulation. Pulmonary Barotraumas Over-inflation of the lungs during anesthesia from manual or mechanical ventilation can occur. Leaving the pop-off closed when the patient is on a Bain system or circle system can also cause pulmonary over-pressurization.1 Seizures Seizures or seizure activity is occasionally seen in recovering animals. Seizures may

Lisa Randon, RVT, VTS graduated from St. Clair College in Windsor, Ontario in 1994. After receiving her RVT status, Lisa was hired by the Allandale Veterinary Hospital in Barrie, Ontario where she developed a love of anesthesia. In 2008, Lisa applied for a veterinary technician specialty (VTS) in Anesthesia. Lisa also visited the VRCC in Denver, Colorado, and Equine /Small Animal Surgical Facility in Texas, in order to complete her application. After passing the application she was invited to sit for the board exam and was successful in Chicago in Sept. 2009. Lisa traveled to St. Ann, Jamaica in 2009, to a non-kill shelter to anesthetize strays to be spayed and neutered. This was a career highlight for Lisa as it taught her to appreciate the technology and pharmaceuticals we have available to us in North America. Aside from small animal anesthesia, Lisa loves to spend time at the cottage, travel, read, alpine ski, golf, hike trails, play racquet sports but mostly loves to spend time with her family and her lovable head-of-the-household orange tabby cat, named “Opie”.

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be caused by hypoglycemia, the administration of ketamine, or due to procedures such as myelography or disorders such as epilepsy. Excitement, shown as paddling, is common with the use of pentobarbital, and is not seizure activity. Vocalization is often pentobarbital associated. Also, geriatric animals will vocalize from confusion. Seizures appear as twitching or uncontrolled movements of the head, neck and limbs and are often triggered by sound or touch. Any unusual twitching should be brought to the veterinarian’s attention. Treatment of seizures usually consists of intravenous diazepam (0.2-0.4 mg/kg) 4 Temperature (Hypothermia/Hyperthermia): This is extremely important to monitor, and the most common anesthetic complication. Hypothermia One of the most common postoperative complications that arise is hypothermia. This occurs in patients because their body cannot thermoregulate while under anesthesia. Almost all breeds with the exception of Nordic breeds (these breeds can actually become hyperthermic) will lose heat under general anesthesia. Small patients are at the greatest risk due to their body surface to mass ratio. Hypothermia is exacerbated in prolonged surgical procedures, especially those with an open body cavity or with use of cold irrigations. Many anesthetic drugs can act as a catalyst to heat loss, as can scrub solutions, cold surfaces, ambient operating room temperatures or room temperature intravenous fluids. Breed can also play a role. Hypothermia can interfere with homeostasis, and can potentially increase infection rates, and wound healing. The cardiovascular, immune, and CNS systems can also be affected. Anesthetized dogs have been shown to have a decrease in rectal temperature of 1.9 ºC in the first hour of anesthesia.² When using volatile inhalants, for every 1.8 ºC decrease in body temperature there is a 5% decrease in monitored anesthesia care (MAC) requirements. Mild hypothermia (min. 95º F or 35º C) can be minimized using warmed intravenous fluids, and protected warmed oat bags. Forced warming air instruments (convection-type warm air devices) are very effective in protecting against heat loss. The use of electrical heat-

This thermal burn was caused by an electrical heating pad. (Photo courtesy of Stephanie Frederick, RVT, Shawnee Animal Clinic Portsmouth, Ohio)

ing pads or hot water gloves is discouraged because of the potential for thermal injury. At least 60% of the body must be covered in order for re-warming to be effective.1 A body temperature of 32-34° C/90-94° F is associated with non-shivering thermogenesis. Animals will shiver if they can but at a lower temperature this may not happen. Postoperative shivering can be an effective way to increase body temperature, however it also increases metabolic oxygen demand of up to 400%! Shivering in the recovery period will also increase head and ocular pressures and increase bleeding. A body temperature of 28-30° C/82-86° F) will cause marked CNS depression. Atrial arrhythmias may occur, and hemodynamic parameters may be compromised. Aggressive re-warming in very cold patients should be avoided because peripheral vasodilatation may induce excessive hypotension in the face of a cold, depressed heart. Re-warming at this point should be limited to about 1° C/hr. Hyperthermia Dogs with thicker hair coats, that have being draped on the operating table for prolonged periods of time, can suffer from an increased core body temperature. Hyperthermia can also be caused by light levels of anesthesia, or the use of ketamine.1 Mild Hyperthermia (40º C/104º F) does not normally require treatment. Cell damage occurs above 42º C/108º F). Surface cooling techniques and removal of heat sources are effective techniques to reduce hyperthermia.

Malignant Hyperthermia can occur in dogs and cats but is rare. Volatile anesthetics and nondepolarizing agents such as Succinylcholine are potential triggers of malignant hyperthermia. Malignant hyperthermia is a hypermetabolic syndrome involving skeletal muscle characterized by hyperthermia, tachycardia, tachypnea, increased oxygen consumption, cyanosis, cardiac dysrhythmias, metabolic acidosis, respiratory acidosis, muscle rigidity, unstable arterial blood pressure, and death. There also may be electrolyte abnormalities, myoglobinuria, CK elevation, impaired blood coagulation, renal failure, and pulmonary edema. This syndrome has been reported in dogs (especially Greyhounds), cats, and horses. Dantrolene Sodium administration (2.510 mg/kg IV) is the specific and often effective antidote for this syndrome.1 Ventilation Poor ventilation is most often a concern in obese or brachycephalic patients. It is difficult for these patients to properly ventilate on their own in the postoperative period. Oxygen therapy may be required to assist these patients until they are awake. Atelactasis is another condition that can be a concern during the anesthetic recovery period. It is characterized by the collapse of lung tissue, preventing the respiratory exchange of carbon dioxide and oxygen. This condition may be caused by obstruction of the major airways and bronchioles, by pressure on the lung from fluid or by air in the pleural space. It is treated by suctioning the trachea to establish an

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Types of respiratory patterns to watch for in the postoperative period (Note: some patterns are abnormal and some are related to the administration of certain drugs) • Apnea: Absence of breathing • Apneustic: Prolonged pause after inspiration may be seen with dissociatives • Cheyne-Stokes: Periods of hyperventilation between periods of apnea • Dyspnea: Difficulty breathing, associated with a patient in distress • Gasp: Spasmodic inspiratory effort which ends abruptly. A gasp may indicate a severe hypoxia, or a terminal event. • Panting: Rapid movement of breathing. This is commonly seen with administration of opioids • Kussmaul: This breathing is deep, laboured and rapid. Usually this is seen with metabolic acidosis and diabetic acidosis.

open airway, positive-pressure breathing, and administration of oxygen. Cyanosis of the mucous membranes or a pulse oximeter reading of less than 90% saturation requires intervention with oxygen therapy. Patients that may be susceptible to having impaired oxygenation are: • Geriatric, obese patients • Brachycephalic breeds • Patients with CNS depression before anesthesia • Patients with pneumonia • Patients with cardiac disease • Patients recovering from a thoractomy, diaphragm repair If patients requires an oxygen cage be sure to include humidification (controlled environment of 75º F and 50% humidity). The oxygen flow rate should be adjusted to provide the patient with a concentration of 40-60% of oxygen. Sometimes a nasal catheter may be needed. In order to place one, instill a drop or two of 2% lidocaine into the nostril then wait a few minutes before introducing the lubricated rubber nasal catheter. Oxygen flow rates of 50-100 ml/kg/min should increase tracheal oxygenation to 40%.4 One must be careful not to induce oxygen toxicity.

table 1 >

Common Behavioural Responses to Pain in the Postoperative Period Behaviour

Dogs

Cats

Vocalization

Groan, whimper, growl

Groan, growl

Facial expression Glazed or fixed stare, ears back

Squinted eyes

Posture

Laterally recumbent or hunched

Sternal

Guarding

Limps, licks, chews surgical site

Activity

Restless or reluctant to move

Circling, restricted movement

Respiratory rate

May be increased and shallow

Heart rate

May be increased depending upon analgesic drugs given, ie. opioid

Pupil size

May be dilated

Blood pressure

Hypertension may be present in moderate to severe pain even if opioid has been administered

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Expressing the bladder during postoperative recovery

Positioning This is important in every patient but can be especially important in certain breeds. Cats tend to lay recumbent without any problems, however larger dogs, especially obese dogs, can have issues relating to atelactasis and ventilation. It is best to have these types of patients or breeds such as bulldogs lie in ventral recumbency. Instrumentation Some devices used to assist in monitoring include pulse oximeters, i-STAT® (handheld blood analyzer), glucometers, ECGs, blood pressure monitors ( Doppler or other types), thermometers, stethoscopes and fluid/syringe pumps. However it is important to always rely on instincts and your own examination of the patient, rather than to rely on any device. Occasionally a dog or cat will awaken suddenly, become disorientated, vocalize, paddle and appear incoherent. This sudden arousal can be due to pain or delirium. Delirium occurs in many non-premedicated animals. These patients usually calm down within 10 minutes, though it may be necessary to administer a low dose of acepromazine (0.03-0.05 mg/ kg IV). If pain is suspected during a rough recovery, analgesics should be administered intravenously. The goal of the anesthetist or the recovery technician is to provide adequate analgesia and sedation to allow the patient to be mobile, eat and sleep without discom-

Bair Hugger in use to prevent hypothermia

table 2 >

Severity of Pain Associated with Some Surgical Procedures Mild

Clipper burns, distended urinary bladder, eyelid procedures, superficial lacerations

Mild to Dental extractions, castration, ovariohysterectomy, Moderate aural hematoma Moderate Localized burns, corneal ulcerations, enucleation, to Severe onychectomy, mastectomy, abdominal surgery Severe

Burns, pancreatitis, total hip replacement, disc surgery, amputation, ear ablation, thoracotomy

fort, particularly during the first 12 hours post surgery. This doesn’t mean we have to be overzealous with pain medications as over usage of postoperative pain medications can contribute to a prolonged anesthesia which in turn can have significant side effects. Post-operative Bleeding Bleeding is not always easy to assess once the incision is sutured, but there are some parameters that can be monitored. Firstly, capillary refill time (CRT) is a good indication of perfusion. If a prolonged CRT is present, immediately check the pulse and blood pressure. A systolic pressure under 80 mmHg indicates hypotension and poor perfusion.4 Always look for petechia and obvious bleeding from surgical sites. Most healthy patients can tolerate a blood loss of 10% of their blood volume before significant hemodynamic changes occur. Losses between 20-30% are associated with blood pressure reductions. Greater than 30% loss will likely lead to hemorrhagic shock. If bleeding is excessive the patient will appear very sedated with little to no signs of arousal. Extubation Extubation is always performed after the patients regain the ability to swallow and protect their airways. The cuff is first deflated and the tube is deliberately removed. Assuring a patent airway after extubation is essen-

Cat with a bleeding disorder post-dental prophy

tial, particularly in patients that are brachycephalic. Possible post extubation problems include edema of the upper airway, laryngeal spasm, interference with the airway caused by the soft palate, and laryngeal paralysis. Regurgitation commonly occurs in brachycephalic breeds due to the decrease in esophageal sphincter pressure.1 It often happens in patients that have been in a head down position while in surgery. Regurgitation, unlike vomiting, will show no sign of retching. You will simply see fluid draining from the animal’s mouth. Removal of the material by suction is the best method. Re-intubation may be necessary if the tube has already been removed. This material may be aspirated into the lungs causing a pneuomonitis or local irritation to the esophagus.7 Cats with laryngospasm or laryngeal edema may breathe with an audible wheeze. They typically show exaggerated thoracic movements, gasping during IN-spiration only. If you observe this, check mucous membrane colour. If the cat is pink and Sp02 is greater than 90%, it will resolve on its own. If not, re-intubation and oxygen supplementation may be necessary. In the event of severe edema, the patient may benefit from a dose of furosemide and a cortiocosteroid to reduce swelling. Larygnospasm is easier to prevent than treat, therefore use lidocaine spray/ gel prior to intubation. Early extubation is recommended in cats so that the tube is removed before the laryngeal reflex returns. There are a number of other measures that can help to ensure a smooth and safe recovery. Emptying urinary bladders can help relieve discomfort. Also if using sound sensitive drugs, a quiet dark room can help with a smooth recovery. Pulse quality, mucous membrane colour and blood pressure should be monitored closely.

Also depending upon the case, it may be necessary to monitor blood gases, electrolyte abnormalities, glucose fluctuations, bleeding, and bruising. Expediting recovery from anesthesia can also include intravenous fluids to hasten renal and hepatic elimination, active warming, and reversal of agents/ analeptics for those who demonstrate slow recoveries. Extubation should occur at the time when the animal has recovered jaw tone and has the ability to swallow. Be careful NOT to pull the endotracheal tube too late as many patients will just suddenly awaken (especially if using propofol or reversing a drug) and the tube can be chewed. Although complications are uncommon good nursing is key during the recovery period, and the technician must be able to anticipate and respond to emergencies efficiently. It only takes a minute for a tragic event to happen. Human error can include inadequate history, inattentiveness or distraction along with faulty equipment. Remember, when in doubt don’t rely on instrumentation, but rather senses. Emergency care is ideally a team effort involving all hospital personnel. It is helpful to have “emergency dress rehearsals” from time to time. The author would like to acknowledge Dr. Anne Paquette for her assistance in reviewing this article.

references > 1. Lumb and Jones’ Veterinary Anesthesia and Analgesia Text Book, 4th edition, pp 497, 509-510, 553-554, 1042, 10431044, 2009 2. Aust Vet J 2004; 82: 65-68 T C Govendir. Evaluation of four warming procedures to minimize heat loss induced by anesthesia and surgery in dogs 3. Greene.S: Veterinary Anesthesia and Pain Management Secrets, Philidelphia, PA Hanley and Belfus, Inc. pp 113-119, 121-126, 139, 141-143, 149-153, 2002 4. Small Animal Manual Anesthesia, R. Paddleford, 2nd edition, pp 204, 231, 244, 1998 5. Veterinary Emergency and Critcal Care Manual, Karol Mathews, 1st edition pp281 1996 6. Small Animal anesthesia and Analgesia, Gwendollyn L. Carroll, pp 175, 2008 7. Small Animal Anesthesia and Analgesia, 2nd edition, McKelvey and Hollingshead; pp 242, 243, 246

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lung expansion and increasing respiratory effort and cardiac stress. In addition to placing a cuffed endotracheal tube, packing the posterior oral cavity with gauze, and using suction to prevent aspiration, fold several towels into squares, place these towels into layered piles, and then place the patient’s abdomen and thorax on top of the towel piles, allowing the patient’s neck and head to drop off the piles at a gentle downward angle. This downward slope of the head avoids fluid accumulation in the oral cavity and also avoids the dangers of whole body slanting or table tilting during anesthetic procedures. (Veterinary Medicine)

Distract a Cat

Next time you need to get a food bowl or litter pan out of that nasty kitty’s cage, use a food treat, toy, or laser pointer to momentarily distract him. Gender confusion Highlight the pet’s name in pink or blue to instantly recognize gender. Clients appreciate it when their pet is addressed correctly as ‘he’ or ‘she’. (Firstline) Keep ‘em warm If you use a circulating warm water blanket in surgery, place a clean towel under it for each surgery. Once the procedure has been completed, you’ve now got a warm towel to wrap the patient in for recovery.

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Treat Jar One way to help clients comply with an appropriate amount of treats is to suggest a treat jar, which can be especially effective in a multi-person household. Instruct clients to fill the jar with the number of treats allocated for the pet that day. When the jar is empty, that’s the end of the treats for the day. (dvm360)

Prevent aspiration during dentals without table tilting Table tilting is a common practice during veterinary dental procedures to help prevent the aspiration of fluid and debris. Unfortunately, the possible dangers of tilting an anesthetized patient head downward include gastroesophageal reflux that could lead to esophageal ulceration, scarring, and stricture and cardiopulmonary compromise that may result from abdominal organ pressure on the diaphragm, thus potentially reducing

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A portion of every general practice equine veterinarian’s caseload is handling lameness cases. The term ‘lame’ is defined by Saunders Comprehensive Veterinary Dictionary as “[the] incapab[ility] of normal locomotion; [or a] deviation from…normal gait.”1 Lameness may present itself in a horse as a subtle or minor change in its performance or attitude, or as a more obvious resting of a leg in an effort to relieve pain. Given this vast spectrum, determining the cause of lameness can be quite complicated and difficult. Unfortunately, the stakes are high. While lameness may cause but a minor ache that subsides with a few days rest, it may also develop into a chronic condition that significantly alters the life of a horse and threatens its career. Obviously, horses cannot talk to us to tell us where, why and how they are hurting. However, they can communicate, and the lameness exam is a veterinary medical team’s most effective way to ‘listen’ to a lame horse and to help relieve its pain. There are four general categories for classifying lameness2: 1. Supporting Limb Lameness: This type of lameness involves the limb when it is in the stance phase or when it is supporting weight. 2. Swinging Limb Lameness: This type of lameness involves the limb during motion. 3. Mixed Lameness: As the title suggests, this type of lameness involves both supporting and swinging limb lameness. 4. Complementary or Compensatory Lameness: This type of lameness occurs when pain in a limb causes uneven distribution of weight on another limb or limbs that then produces lameness in a previously sound limb. The Lameness Exam There are numerous steps involved in

CE Article #3 An Introduction to the Equine Lameness Exam

performing a thorough lameness exam. Given the challenges associated with diagnosing lameness, the leading idea of the lameness exam is to obtain as much information as possible in order to clarify both the cause and the type of lameness affecting the horse. Sometimes this means that what at first sight might have appeared to be a straightforward case of supporting limb lameness, for example, may upon closer examination turn out to be but one piece of a much more broad and complex problem. Revealing these types of connections is a central goal of the lameness exam. Obtaining a Detailed History As much as is possible, a detailed medical history should be obtained on every horse. Again, horses do not have the ability to speak to us about their injuries and their medical histories. However, it

is possible to gain this information from the horse’s caregiver. The key is to ask the right questions, for example: • How long the horse has been lame? • Has the horse been exercised during this time period? • If so, has the lameness worsened, improved, or stayed the same during exercise? • Was there a specific incident prior to the onset of lameness that may have been a contributing factor? • Has the horse been given any treatments, and if so, what were they and how did the horse respond? • When was the horse last shod, or trimmed? The answers provided to any or all of these questions can be extremely helpful in correctly identifying the cause and type of lameness affecting the horse. Ad-

Elise Wickett, RVT graduated from the Veterinary Technician program at the University of Guelph, Ridgetown College. An equine enthusiast from a young age, Elise has pursued her passion for horses through both traditional and non-traditional routes, spending time in Florida riding and training horses. These experiences solidified her interest in equine sport horse medicine and today she is the Head Technician specializing in podiatry and MRI at McKee Pownall Equine Services.

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ditionally, it can be very helpful to know the signalment and use of the horse. Research suggests that there may be a higher incidence of problems associated with specific breeds, ages and uses. Passive (Static) Examination After obtaining a medical history and other significant information, the next step in the lameness exam is to look at the horse. The horse is viewed at rest where conformation, behaviour and stance (i.e. how the horse is bearing weight) are assessed. The horse’s entire body should be checked for any abnormalities or conformational faults that may contribute to or be a result of lameness. Systematic palpation of the horse follows. Any signs of swelling, heat, muscle atrophy or lack of symmetry, abnormal calcification, and pain or tenderness should be noted. During this process, all four legs are carefully examined in order to elicit responses that indicate pain or discomfort. An important diagnostic strategy of the lameness test is to compare one side of the horse with the other in order to reveal asymmetries that might warrant further investigation. Although there may be an inclination to focus solely on the horse’s limbs, one must not forget to examine the entire horse since the cause of apparent lameness might be due to an ill-fitting saddle, or the result of discomfort in the mouth. Hoof testers are used in numerous locations on the foot to apply pressure to the hoof to determine areas of tenderness. “Many Hoof testers practitioners will (mpequine.com) concentrate on the front feet, as 70 to 80 percent of the horses weight will be supported by the front limbs.”3 If the horse is sensitive to the hoof testers, they may respond by moving their foot and leg away from the pressure. Importantly, if a horse moves – which could indicate sensitivity – it is imperative to attempt to reproduce this reaction in order to confirm the accuracy of the test. Occasionally a horse may move when pressure is applied by the testers, but the stimulus they are reacting to could be unrelated. This also holds true for palpation of other areas of the horse.

Active (Dynamic) Examination The objective of the active examination is to determine which limb or limbs might be bothering the horse and to what degree. During the active examination the horse is seen at all gaits on both hard and soft ground. The examiner should be looking for any or all of the following: • Head nod: when a sore forelimb is in the weight bearing phase of the stride, the horse may raise its head as a response to discomfort • Hip hike or hip drop: may indicate asymmetry of the stride in the hind end • General character of the horse’s stride, including stride length The advantage of working a horse on multiple surfaces is that each surface elicits different information: While soft surfaces can be helpful in exaggerating certain problems, thus making them more apparent, hard surfaces (such as asphalt) can be helpful in providing an opportunity to listen to the way the horse is moving as “usually, there is an obvious difference in the horse’s landing between the unsound and sound foot.”4 Certain types of lameness become more apparent on soft or hard ground, depending on the tissues involved. For example, foot soreness may become more apparent on firm footing. Lameness can be work induced and may only present itself in specific conditions. In these cases it may be necessary to evaluate the horse in the exact equipment and environment in which the lameness is most apparent. The opposite can also be true. Sometimes the freedom of moving without a rider, tack or harness causes the horse’s lameness to emerge. Whether under the influence of a rider, or moving freely by itself, the horse should be viewed while moving both on a circle (on a lunge line) from both directions, as well as in a straight line from the side, front and back. Much like a rider influences the movement of a horse while under saddle, the individual lunging and running alongside a horse also influences their movement. The handler thus plays an important role and, as such, should be both competent and adequately trained in

leading horses for lameness examination purposes. The technician should avoid restricting the horse’s head by loosely holding the lead as they run alongside the horse. This will also help avoid obstructing the examiners view. Ideally the technician-veterinarian team establishes a repeatable protocol for horse handling in order to help eliminate variables from compromising the quality of the examination. Additionally, the handler plays an important role in the veterinarian’s safety and ergonomics by squaring the horse up prior to flexions, keeping the horse’s head straight and keeping the horse’s attention while uncomfortable diagnostics are performed. The American Association of Equine Veterinary Practitioners (AAEP) has developed a grading system for evaluating lameness. The point of the system is to bridge the communication gap that often exists between doctors and clients as well among doctors themselves by providing a scale that is common to all parties. The AAEP guidelines explain the grading system this way5: 0. Lameness not perceptible under any circumstances. 1. Lameness is difficult to observe and is not consistently apparent, regardless of circumstances (e.g., under saddle, circling, inclines, hard surface, etc.). 2. Lameness is difficult to observe at a walk or when trotting in a straight line, but consistently apparent under certain circumstances (e.g., weight carrying, circling, inclines, hard surface, etc.). 3. Lameness is consistently observable at a trot under all circumstances. 4. Lameness is obvious at a walk. 5. Lameness produces minimal weight bearing in motion and/or at rest or a complete inability to move. Joint Flexion and Manipulation Tests Considered part of the active or dynamic portion of the lameness examination, the joint flexion tests are a series of targeted stress tests Flexion test used to assess the (mpequine.com) horse’s comfort

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level in specific anatomical areas. These tests are performed by having the veterinarian hold and flex each leg individually with the purpose of isolating specific joints. The leg is held in the flexed position for 30-90 seconds (depending on the joint) and then released, at which point the horse is asked to trot off in a straight line. (Think about squatting for 60 seconds, then immediately standing up and jogging â&#x20AC;&#x201C; that is what you are asking the horse to do.) Both the degree of discomfort caused, as well as the amount of time it takes for the horse to return to its normal movement are then noted. Occasionally a horse may display discomfort or resistance, not only to trotting after the flexion test, but to the flexion itself, which can also be indicative of a problem. It should be noted that some cases warrant further dynamic examination in the form of a neurological exam. Local Anesthesia or Diagnostic Nerve and Joint Blocks Local anesthesia or diagnostic nerve and joint blocks may be offered by the veterinarian as the next step in the lameness examination. There are certainly situations where this step is not pursued, but for the purposes of this article this option will be explained. The goal of the nerve and joint blocks is to further isolate and confirm where the pain that is causing lameness may be originating. This procedure consists of either a perineural or an intrasynovial injection of a local anesthetic agent (for example, lidocaine, mepivicaine, and bupivicaine). A perineural injection involves the deposition of anesthetic solution in close proximity to a nerve,6 whereas an intrasynovial injection involves injecting the anesthetic agent directly into the synovial structures. The injection site should be thoroughly cleaned with povidone iodine using a minimum of three 30-second scrubs for a perineural injection and a 3-5 minute scrub for an intrarticular injection. This is then followed by an alcohol rinse7. This aseptic site preparation is important to reduce the likelihood of infection. The clinician should inject the anesthetic agent in a systematic manner, beginning with the distal most point on the limb. After a period of 2-10 minutes (depending upon the anesthetic agent used and the location

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injected) the success of the block should be checked by assessing the skin sensation below the injection point. The horse is then evaluated again for lameness. If an improvement is observed, it may be concluded that the area that has been blocked or frozen is the location causing the problem. If an improvement is not observed then the clinician may suggest performing an additional block proximal to the first. Figure 1 outlines the specific perineural block locations and the anatomy they aim to target. In addition to these locations, there are numerous other intrarticular locations in both the fore and hind limbs that can also be anesthetized. Common locations include the distal interphalangeal (coffin) joint, metacarpophalangeal (fetlock) joint, carpal joints, tarsal joints and stifle joints. From an economic standpoint, this blocking procedure can be of great benefit to the client since, if successful, the veterinarian can direct diagnostic imaging to a specific area of the leg, rather

than the leg as a whole. While this is the ideal outcome, on occasion the horse fails to â&#x20AC;&#x2DC;block outâ&#x20AC;&#x2122; and wider scanning cannot be avoided. However, in cases where the horse fails to block out, we nevertheless learn where the problem does not exist, and this can be quite helpful in the diagnostic process. Conclusion The next possible step in assessing lameness is diagnostic imaging. Diagnostic imaging allows for the visualization of specific structures whose involvement may be implicated by the lameness examination. However, as imaging is a vast subject, its discussion will have to wait for another day. This article is a comprehensive introduction to both the steps involved in an equine lameness examination, and the concerns and considerations that arise when assessing lame horses more generally. The author would like to thank Dr. Aaron Barth for his support and editorial assistance and Dr. Melanie Barham for comments on an earlier draft of this article.

figure 1 > Palmar or Plantar Digital Nerve Block

Navicular bone Navicular bursa Cruciate/distal sesamoidean ligaments Distal superficial flexor and deep digital flexor tendons and sheaths Digital cushion Corium of the frog and sole Palmar aspect of the phalangeal joints Palmar third and solar aspect of the distal phalanx

Abaxial Sesamoid Perineural

Majority of pastern, foot and fetlock First, second and third phalanges Proximal and distal interphalangeal joints Laminae of the hoof Distal sesamoidian ligaments Extensor branches of the suspensory ligament Distal deep and superficial digital flexor tendons Distal common digital extensor tendon Portions of the fetlock joint

Low Palmar (Low Four Point)

Structures distal to and including the fetlock joint

High Palmar (High Four Point)

Majority of the metacarpal region

Suspensory Origin

Proximal suspensory ligament at its origin

mvm.massey.ac.nz or email mvm@massey.ac.nz

Investigate the provincial association’s web sites for details on other continuing education opportunities. Current as of: December 2010

Continuing Education Opportunities

2011 Conferences and Seminars

Saskatoon, SK. IWRC Member cost: $125, Non-Member cost: $159. Visit theiwrc.org Or call Kai at 866-871-1869 or email office@theiwrc.org

January 15-19 28th Annual NAVC AGM & Conference Orlando, Florida - Phone: 352-375-5672 Web: http://www.navc.com

March 24-27 AAHA & OVMA Conference Toronto - www.aahanet.org

February 8 & 9 Toronto Academy of Veterinary Medicine Subscription Lecture Topics include Intervertebral Disc Disease, Methicillin Resistant Staphylococcal Infections, Hypercalcemia, Anesthetic Morbidity and Mortality, Congenital Heart Disease. www.tavm.org or contact 1.800.670.1702, ext. 12 or info@tavm.org February 14-18 82nd Western Veterinary Conference WVC & Technician Program Mandalay Bay Convention Center, Las Vegas, Nevada. Phone: 702-739-6698 Email: info@westernveterinary.org Web: www.westernveterinary.org February 18 & 19 Ontario Association of Veterinary Technicians 33rd Annual Conference & Trade Show London Convention Centre & Hilton London www.oavt.org March 12-13 Full-day Wildlife Rehabilitation Seminar 8:30 - 5:30pm, University of SK Campus, Wildlife Rehabilitation Society of SK,

May 13-18 50th Annual CALAS Symposium Toronto - http://symposium.calas-acsal.org October 2-4 International Conference on Communications in Veterinary Medicine Outstanding interactive program for the full practice team with practical ideas and solutions. Explore communication skills that will have a dramatic impact on your clinic’s performance. Pillar & Post Hotel, Niagara on the Lake, Ontario. www.iccvm.com

Online Courses Massey University An AVMA-accredited veterinary school in Palmerston North, New Zealand that offers distance learning and post-graduate continuing education to veterinarians worldwide. Enrollments open in October 2010 for a number of courses that begin in February 2011, including: Canine and Feline Emergency Medicine; Dermatology for Small Animal Veterinarians; Canine and Feline Endocrinology; Veterinary Law; and Advances in Ruminant Nutrition for Veterinarians. For more information about the Master of Veterinary Medicine program and individual courses, visit

VetRadCE.com Provides AAVSB-RACE approved CE courses for veterinarians and veterinary technicians. Courses are written by experienced veterinary imaging professionals. They provide in-depth information and tips on a variety of imaging studies. Abbott Animal Health Launches New Fluid Therapy Online CE Featuring top specialists in the field including Dr. Bernie Hansen of North Carolina State University, Dr. Wayne Wingfield from Colorado State University, Dr. Steve Haskins of UC Davis, Dr. Rebecca Kirby of Milwaukee, and others, this CE is designed to increase veterinarians’ and technicians’ knowledge and confidence administering IV fluids. There are ten modules, each is approved by the Registry of Approved Continuing Education (RACE) for 1 continuing education credit for a total of 10 continuing education credits upon completing all 10 modules. The topics include fluid therapy basics, intro to fluid types, crystalloids and colloids in depth, fluid administration guidelines, catheter placement and care, IV fluids during anesthesia and surgery and interactive case studies. www.abbottanimalhealthce.com Veterinary Information Network VIN online CE courses have three main components. Real-time sessions are held for two hours weekly, from the VIN center. Course participants log in for a live session with the instructor(s). These sessions are logged for future study and to ensure participants unable to attend at the actual time of the session will have access to all materials from their course. In addition to the real-time sessions, each course has a library of course materials, including handouts, slide shows, and movies. Each course also has an interactive message board for an ongoing dialogue between participants and instructors on the course material. Daily Nutrition Matters Your career in veterinary medicine needs constant care and feeding, just like your canine and feline patients. Nestlé Purina wants to help you advance personally and professionally. If you are looking for a menu of pet nutrition information, register for Daily Nutrition Matters. The program also offers prizes and CE credits. http://www.purinavets.com/technicians

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CE Article #1: Basic Breathing Systems 4. The Murphy Eye of an endotracheal tube is lo- 7. Fresh gas flow through a circle breathing 1. Rebreathing refers to: system flows in the following fashion: cated at which point and serves which purpose. a. Breathing exhaled gases that are sitting in the a. In a To and Fro fashion. a. Located near the adapter to the breathing mechanical dead space and the expiratory tube. b. In a one-way, circular fashion as directed by tube and allows sampling of exhaled gases b. Breathing exhaled gases that have recircuthe unidirectional valves. b. Located on the cuff allowing for proper lated and mixed with the fresh gases enterinflation pressure. ing the breathing system. c. In one direction only, never returning to the patient. c. Located at the patient end of the endoc. Inhalation of previously expired gases, tracheal tube opposite the bevel opening, which may or may not have the carbon 8. When using a Bain hose of a coaxial design, which provides an alternate breathing path dioxide removed. the fresh gases travels from the fresh gas port for the patient should the bevel opening d. All of the above. to the patient through: become obstructed. a. The outer tube. 2. Minute volume is calculated by multiplying b. The inner tube 5. The Coaxial F-circuit is slightly different in the following two parameters: c. Through both tubes. design from the standard circle system, but a. Inspiratory and Expiratory time. similar in function and use. b. Tidal volume and respiration rate. 9. The Ayres T-piece is what type of Mapleson a. True c. Tidal volume and oxygen flow rate. breathing system: b. False d. Oxygen flow rate and respiration rate. a. Mapleson D system. b. Modified Mapleson E system when used 6. Average fresh gas flow rates for a circle 3. The reservoir bag serves a variety of funcwithout a reservoir bag. breathing system is: tions including: c. Modified Mapleson F system when used a. 100 ml/kg/min for induction and recovery a. Reserving exhaled gases for use during the with a reservoir bag. period, 50 ml/kg/min for the maintenance next inspiration, allowing some rebreathing d. b & c period. and more economical use of gases. b. 200 – 300 ml/kg/min for the induction b. Can be used for assisted or controlled 10. Advantages of a breathing system that aland recovery period, 130 ml/kg/min for the manual ventilation. lows some rebreathing of expired gases are: maintenance period. c. Allows for observation and evaluation of a. Exhaled gases can help to warm and huc. 700 ml/kg/min for the induction and spontaneous respiration. midify the cooler, drier freshly inspired gases. recovery period, 500 ml/kg/min for the d. Protects the patient from excessive pressure b. It is more economical. maintenance period. in the breathing system. c. It never requires a carbon dioxide absorber. d. 500 ml/kg/min at all times. e. All of the above. d. a & b.

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CE Article #2: Keep Them Stable 1. The drug of choice to treat Malignant Hyperthermia is: a. Diazepam b. Dilaudid c. Dantrolene d. Dexamethasone 2. Vocalization is often seen in the post operative period with: a. Diazepam use b. Acepromazine use c. Sevoflurane use d. Pentobarbital use 3. When using volatile inhalants, for every 1.8° C drop in core body temperature, there should be a decrease in what percentage of MAC to ensure that you don’t overdose the patient: a. 2% decrease in MAC requirements b. 7% decrease in MAC requirements c. 5% decrease in MAC requirements d. 0% decrease in MAC requirements

4. Leaving the pop-off valve open when a patient is on a Bain system can cause pulmonary over-pressurization. a. True b. False 5. Glycemic control is more of a concern in: a. Obese patients b. Patients with Cushing’s Disease c. Smaller fasted dogs and neonates d. Cats with kidney disease 6. Heat loss during the anesthetic period can affect: a. Homeostasis b. Cardiovascular and CNS systems c. Immune systems and infection d. All of the above 7. Atelactasis can be caused by: a. Sevoflurane b. Oxygen toxicity c. Low humidification in an oxygen tent d. None of the above

8. Re-warming a patient should be limited to 1° C/hr (slow) at which stage? a. Mild hypothermia (min 95° F) b. Moderate hypothermia (90-94° F) c. Severe hypothermia (82-86 ° F) d. Re-warming should always be slow 9. Regurgitation is commonly seen in the post operative period in: a. Rabbits only b. Brachycephalic breeds c. Cats d. Rabbits and brachycephalic breeds 10. This is commonly seen as a side effect with opioid administration: a. Apnea b. Cyanosis c. Panting d. Glucose fluctuations

CE Article #3: Equine Lameness Exam 8. The palmar digital nerve block: 5. If a left (front) carpus is noted to be 1. Compensatory lameness can be a. Numbs all anatomy below and swollen during the passive exam, to described as: including the front fetlock be complete, the active exam should a. Evasion of the bit causing inconsistent b. Is often the first block performed in include: contact with the rider the case of forelimb lameness a. Only circles to the left, felxion test b. Involves both supporting and c. Injection site does not require of the left front leg and movement swinging limb lameness thorough cleaning as it is not an evaluation on all surfaces c. Lameness in a previously sound limb intraarticular injection b. Circles in both directions, flexion tests due to uneven weight distribution d. Is often the first block performed in and movement evaluation at all gaits d. None of the above the case of hindlimb lameness on all surfaces c. Circles in both directions 2. What is a goal of the equine lameness d. No active exam needed, we know the 9. During the active exam the horse exam? shows shortness of stride on the right left carpus is the area of concern a. Obtain as much information as possible front on a hard surface at the trot. No b. Prescribe medication and treatment obvious lameness is seen at the walk. 6. During a joint flexion test: for the horse According to the AAEP scale, this a. The horse will stand quietly c. To perform diagnostic nerve blocks horse can be described as: b. The veterinarian palpates the leg d. All of the above a. 2/5 on the right front c. The handler waits until the horses b. 5/5 on the left hind leg is put back on the ground before 3. Hoof testers assess: c. Mildly unsound on the right front quietly walking off a. The quality of the hoof d. Unsound on the left hind d. The degree of discomfort caused to b. The horses sensitivity to unrelated the horse is assessed stimulus 10. To further localize the origin of the c. The temperature of the hoof lameness of the horse in question 9, 7. The AAEP: d. Areas of tenderness the veterinarian may wish to: a. Is the governing body of equine a. Take radiographs of the left hock practitioners 4. There are many variables to consider in b. Perform diagnostic nerve blocks on b. Provides a grading system for evaluating the active examination. These include: the left hind leg beginning at the lameness based upon a scale of 0-5 a. Surface, noise/sound origin of the suspensory c. A diagnostic tool used in lameness b. Quality of gait, handler interaction c. Perform diagnostic nerve blocks of examination c. Surface, direction of movement, the right front leg d. Is not a resource for equine weather d. Take radiographs of the right front leg veterinarians d. Both a & b

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New rat poison restrictions announced Children, pets and other animals will be protected by new rules restricting the use of rodent-control pesticides, Health Canada announced November 1, 2010. The new measures include: • Keep rodenticides in a tamper-proof bait station when used in areas accessible by children and pets. • Package rodenticides for consumers with a pre-baited, ready-to-use bait station. • Restrict certain rodenticides with high levels of toxicity and a long decomposition time to professional pest control operators or farmers. Manufacturers have until Dec. 31, 2012, to make the changes. Until then, consumers are advised to: • Read the safety precautions before using any rodenticide and use only as directed. • Store rodenticides away from food and out of reach of children. • Use gloves when handling rodenticides. • Place rodenticides in an area inaccessible to children, pets and nontargeted wildlife. • Use a closed bait station supplied with the rodenticide or buy one separately. • Wear gloves when disposing of dead rodents, and double-bag them before putting them into a garbage. (cbc online news)

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The Future of Zoonotic Parasite Management in Companion Animals Lack of awareness, diagnostics, compliance still place pets and people at risk by Mike Paul, DVM, Executive Director, Companion Animal Parasite Council

Whether dealing with horses, cows, cats or dogs, parasite prevention and control have always been a vital part of veterinary health care. Internal and external parasites have long been recognized as major health concerns for companion animals and their caregivers. Products from the worthless to the bizarre to the toxic have been used in the past to treat these conditions â&#x20AC;&#x201C; sometimes with detrimental effects to the patient and environment.

parasites. Heartworm disease, for example, has progressed from a once regional disease to the point that today it is recognized in nearly every province/state in North America. Zoonotic diseases, though not statistically common, continue to cause devastating disease in people. Increasingly, veterinarians are diagnosing vector-borne diseases that affect both animals and humans; protozoan infections, once thought uncommon, have become a significant risk to pregnant women and immune-compromised populations.

Modern parasiticides and preventives have been developed that are effective, well tolerated, economical and easy to apply and administer. When used as directed these products have been a great addition to the armamentarium of pet health care providers.

The main reasons for this persistent and growing problem are a lack of awareness and a lack of compliance. The products we have access to and the procedures we have are all effective. There is very little, if any, reason for any pet to become infected with heartworms or suffer from fleas or ticks; very little reason for internal parasites to plague animals; and almost no imaginable reason for any child to suffer the dire effects of a parasite they should never have been exposed to.

And yet, animals still suffer with heartworms, internal parasites and external

How will the science of parasitology respond? How will the

clinical practice be affected? What changes can we expect in this rapidly developing field of veterinary health care? It seems unlikely that new parasites will emerge. However, our shrinking world and the widespread movements of people and animals will likely lead to the addition of some heretofore exotic parasites to our list of concerns. The increasing closeness with which we live with our pets, and the fact that the boundaries between wildlife populations and humans have become blurred, have and will increasingly expose humans and domestic animals to parasites generally associated with wildlife. As a result, accurate diagnosis and the use of reliable, appropriate diagnostics remain vital. Once considered by many in practice as too time-consuming, fecal floatation by centrifugation will be defined as the standard of care and less consistent methods will be difficult to defend. New technologies that make use of serologic methodologies will become more widely applied. This will facilitate the diagnosis of protozoan diseases and

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perhaps internal worms. As we learn more about heartworm disease and why it is different in cats from dogs, we will undoubtedly see an increased emphasis on feline heartworm prevention. Over the years, manufacturers of parasiticides and heartworm preventives have done a fantastic job of developing highly safe and efficacious products. We can expect them to continue to develop new compounds that are specifically targeted to internal and external parasites. There will undoubtedly be greater emphasis placed on combination products that simplify treatment of and protection against internal and external parasites. The added simplicity and continued efficacy will facilitate compliance of the pet-owning public. In addition, medical/legal considerations and issues of liability and potential negligence will be of increasing concern. Inasmuch as we have a multitude of options available to us to protect pets and people, failure to offer the highest level of care and protection to every client will increase exposure to legal action by the courts and by licensing bodies. The stakes are simply too high. So what lies ahead for the veterinary practice? Every veterinary practice must place much greater emphasis and reliance on the science of parasitology and the role it plays in the business of veterinary medicine. It is the responsibility of the profession – and you the veterinarian – to protect our dog and cat patients, as well as their owners and families, from zoonotic parasites. You have the tools and talents to make it happen. By increasing the awareness of parasitic disease and the routine use of reliable diagnostics, compliance can be significantly improved. And along with greater compliance comes the improved health of our patients and reduced risk of zoonotic disease transmission to their owners, families and the public. For specific information on parasite control guidelines, visit the Companion Animal Parasite Control Web site at www.capcvet.org.

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CAPC & American Heartworm Society Sponsor Meeting on Heartworm Resistance Issues Roundtable of leading experts reviews science and perceptions of increased heartworm incidence The Companion Animal Parasite Council (CAPC) and the American Heartworm Society (AHS) convened a roundtable of leading veterinary parasitologists, companion animal veterinarians and other allied university and industry representatives recently to discuss scientific and clinical field observations related to the perceived loss of efficacy of heartworm products and possible resistance issues. The purpose of the meeting was to discuss three important issues: veterinary and pet owner compliance and its role in perceived loss of product efficacy; potential loss of product efficacy; and effective testing and treatment protocols. Attending the meeting were Drs. Mike Paul, Byron Blagburn, Dwight Bowman and Sharon Patton for CAPC; Drs. Matt Miller, John McCall and Tom Nelson for AHS; Dr. Ray Kaplan of the American Association of Veterinary Parasitologists; and seven others representing universities or private practice. Michael Paul, DVM, executive director of the Companion Animal Parasite Council, says this industry roundtable was instigated due to the clear frustrations expressed by veterinarians at the 2010 AHS symposium and many other practitioners who have experienced an increase in patients with heartworms. “There continues to be significant confusion among veterinarians and pet owners about heartworm resistance to conventional preventive products, perceptions about regional prevalence of heartworms, and the need for year-round administration of preventive products,” Paul explains. “We must acknowledge that something is occurring and we in the companion animal health care industry need to come together to scientifically evaluate and address these problem cases.” Wallace Graham, DVM, president of AHS, adds that all veterinarians and pet owners are encouraged to use existing approved heartworm products and protocols, which have been proven safe and effective. “We cannot overstress the need for strict compliance in the year-round administration of preventives for non-infected pets and testing and treatment for infected pets to most effectively deal with this situation until further information is received,” Graham says. Both CAPC and AHS hope that a consensus statement based on current scientific information and clinical observations will be forthcoming as a result of the roundtable meeting, and that this statement will provide further guidance in helping veterinarians provide the best, most effective care to their patients. The Companion Animal Parasite Council (www.capcvet.org) is an independent not-for-profit foundation comprised of parasitologists, veterinarians, medical, public health and other professionals that provides information for the optimal control of internal and external parasites that threaten the health of pets and people. Formed in 2002, the CAPC works to help veterinary professionals and pet owners develop the best practices in parasite management that protect pets from parasitic infections and reduce the risk of zoonotic parasite transmission.

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. • The OAVT reserves the right to edit any employment ads. • Charges for ad placement are outlined below. Any requested changes to an ad already placed will be treated as a new ad and billed. Advertisement Rates

• 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

10215 (Nov 15, 2010) Full-time Vet Tech We are a fun, fast-paced clinic looking for a full-time Vet tech that has a great attitude. We deal with small animals and exotics. Please send resumes to drkent@kingwestvets.com.

10206 (Nov 10, 2010) RVT We are looking for a full-time RVT to join our team. We offer a competitive salary, medical/dental benefits and CE. Please send resume to senanimalclinic@bellnet.ca or fax to 416-494-1218.

10214 (Nov 15, 2010) Guess Who’s Pregnant... Got your attention? Office Manager & RVT required full-time for a fastpaced client centered small animal hospital. Min 2 years (management) experience. Successful candidates will be self motivated, enthusiastic and enjoy a “family” environment. Forward Cover letter and resume mgmt@firthvet.com Attention: Nicole Zakharia, General Manager, FIRTH Veterinary Hospital, 4499 Wellington Road South, London, ON N6E 2Z8 or Fax: 519-681-4550 We look forward to meeting YOU!

10204 (Nov 9, 2010) Veterinary Technician Experienced Veterinary Techs/Assts (full- and part-time) - Thriving, friendly Toronto veterinary practice requires capable, confident and enthusiastic veterinary technicians and/or assistants to join our team in supporting our multi-doctor practice, providing compassionate and quality care to our patients and clients. Please forward your resume to andrea_bloorcourtvets@rogers.com or fax to 416.538.8465.

10212 (Nov 12, 2010) 2 Veterinary Technician and 1 Receptionist/ Secretary Small animal hospital is looking for 2 Veterinary Technicians and 2 Receptionists full-time/part-time in Ottawa. We have full Digital Radiography, in-house IDEXX Lab, Digital Ultrasound and computerized hospital management software. We are looking for experienced preferably or Fresh Vet tech graduate, and Receptionist. Veterinary Assistant may apply. We offer a very competitive and handsome salary. We also offer Health and Dental Plan. We are looking for enthusiastic and energetic personality. Please apply to smallanimalpractice@gmail.com.

10203 (Nov 9, 2010) Veterinary Technician Feline practice in Ottawa is looking for an outgoing person to join our team. Candidate must have a love of cats and be focused on excellent patient care and client education. Position is available immediately and includes good salary, health benefits, CE allowance and bonus. Reply to Sue at s_wood63@yahoo.ca. 10189 (Nov 1, 2010) Full-time Veterinary Technician New small animal hospital in Sarnia looking for mature, experienced veterinary technician for full-time employment. Management experience would be an asset. Please send resumes to rvethosp@hotmail.com or The Rapids Veterinary Hospital, 1566 McGee Street, Sarnia, Ontario N7S 2J4.

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10186 (Oct 28, 2010) Seeking Hospital Coordinator Fast paced veterinary clinic seeks a Hospital Coordinator to oversee day to day operations. We’re looking for a confident and organized individual who is proficient with: accounting, computers, and employee management. Tasks will also include inventory control, scheduling, and accounts payable/receivable. Please submit a cover letter and resume to: Dr. Luc Lavoie, cedarbraevetclinic@bellnet.ca, Fax: 416.431.3953 10164 (Oct 18, 2010) Full- and Part-Time RVT and Animal Care Attendant An experienced, highly qualified registered technician and wanted for both full- and part-time positions. Must be technically experienced and have exceptional client communication skills. Must have high acceptance rates for recommendations made to clients and be willing to work as part of our sales team. Excellent salary, medical / dental benifits,paid conference annually and OAVT dues and a great pet care benefits package. We are also seeking a very experienced Animal Care Atten-

dant. This position also has the potential to be part of the sales team if you have the right personnality and sales ability. Please e-mail your resume and references to patti.mccarragher@petvethospitals.ca 10155 (Oct 14, 2010) Receptionist We are a progressive clinic in which we practise both conventional and holistic medicine. We are looking for a team player who will be able to multi-task in a busy environment. Experience is an asset. We offer hourly wages and benefits. Please email resume to eyac@holisticpetvet.com 10152 (Oct 13, 2010) Registered Veterinary Technician, Brampton Animal Shelter A progressive Municipal Shelter requires a PT RVT to work a minimum of 24 hours per week. Duties include: health exams, vaccination, administering various treatments and euthanasia, temperament assessments and client education, place supply orders. Overseeing the running of the shelter in the absence of the Supervisor. Liaise with Veterinarians to determine treatment protocols. Various

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,

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shifts including weekends and holidays. Starting rate is $17 per hour with the possibility of full-time. Submit resumes to: stephanie.miller@brampton.ca 10149 (Oct 12, 2010) RVT We are looking for a full-time or part-time RVT for our progressive, fun loving small animal hospital in Kitchener. If you are interested please call us at 519-696-3130 and ask for Rebecca our Hospital Manager or forward your resume to fax: 519-696-3187, email: gvet29@gmail.com 10148 (Oct 12, 2010) Mixed Practice Veterinary Technician We are currently a solo practitioner, mixed practice. We are building a new clinic and looking to expand to two vets. The job is primarily small animal but will involve some farm animal lab work. We want: an independent worker who is also a team player; compassionate with animals; confident educating clients; aspiring to always learn new things. Resumes and/or interest can be sent to maxvc@sympatico.ca attention Dr. Bill.

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

10144 (Oct 6, 2010) R.V.T. Wanted The successful applicant shall practice in a progressive veterinary health care environment that concentrates heavily on high quality veterinary care, including in-house diagnostics, radiology, dentistry, laser surgery, laser therapy, client communication/education and preventative health care. We place a high priority on life/work balance - we work hard during the week but have weekends off. We recently relocated to a brand new state of the art building. (Please visit our website for more info.) A 12-24 month FT position (starting November 2010) with an excellent chance of permanent FT employment. Salary based on experience with above average compensation packages. Please apply in writing to Connie Dagg, RVT, Practice Manager at cahvet@bellnet.ca. For additional information you may call 705-855-8869. 10141 (Oct 5, 2010) Registered Veteriinary Technician Once upon a time, at a hospital in the kingdom of Orangeville, they longed for another RVT to join their royal family. The candidate they dreamed of would have to be energetic, personable, confident and technically proficient; and have the ability to multi-task and complete their tasks independently. The majestic RVT’s were very involved in educating clients, admitting and discharging patients, participating in scheduled examinations, processing in-house blood analyses and snap tests, calculating CRI’s and drug doses, and assisting in surgery. Shifts include days, evenings and a rotation of Saturdays. The clinic kingdom is fully computerized. Members of our royal family have OAVT dues and uniforms provided, and annual CE allowance. If you can make this story end happily ever after, please forward your resume to Debbie Barwick, Office Manager at dbarwick@dufferinvethospital.ca. 10133 (Oct 5, 2010) Registered Veterinary Technician Exclusive small animal practice (dogs and cats) in South Etobicoke is looking to hire a RVT. Position available to either a part-time applicant (daytime hours; no weekends) or an full-time applicant (no

weekends). Please submit a resume to lbac@bellnet.ca or fax to 416-251-0853. Attention Dr. Worthy. 10125 (Sep 28, 2010) Full-time RVT 90% Small Animal and 10% Equine practice - 1 Vet, 2 RVTs and Receptionist. Duties include surgical induction, anesthesia, dental prophys, minor treatments, blood collection, etc. Some reception duties so computer skills are an asset. This is a small friendly practice where we really know our clients! To contact us, fax resume to 613-732-4107, email sah@nrtco.net, or mail to Stafford Animal Hospital, 39638 Hwy #41, Pembroke, ON, K8A 6W4. 10117 (Sep 23, 2010) RVT The Veterinary Emergency Clinic located near Yonge and Bloor is currently looking for a RVT to join our team. This is an exciting opportunity to work in an established, fast-paced environment consisting of emergency, critical care (ICU) and specialty practices (incl. Internal Medicine/Oncology, Neurology, Surgery, Dermatology, Dentistry, Cardiology, Ophthalmology, and Anesthesia). If you are interested in becoming a critical part of a diverse team of professionals, including board-certified specialists, experienced veterinarians, RVTs and support staff, then the VEC is the place for you. We offer a competitive salary and comprehensive benefits plan for full-time staff which includes life insurance, medical, dental and vision coverage plus an array of fringe benefits such as pet care and scrub allowance to name a few. Please forward your resume to the attention of Claire Followes via e-mail at: hr@vectoronto.com or via fax: (416) 920-6185. Please note that the VEC hires only RVTs for nursing positions, if you are not a Registered Technician and would like to apply for the position of Animal Care Attendant please note “ACA resume” in the subject line or cover letter. 10107 (Sep 15, 2010) Technician Needed Full- and part-time positions available in small animal clinic in Ottawa. Hospital is well equipped with computerized medical records, digital dental rads, in house lab, etc... Position involves most aspects

of patient care including dentistry, surgery and client education. Extremely dedicated clientele. Competitive wages, incentive bonus, uniform and CE allowance, generous medical/dental benefits available to the right person interested in joining our team. Please send resume to app1029@gmail.com. 10106 (Sep 15, 2010) Full-time Vet assistant Full-time vet assistant/receptionist. Please call (613) 825-5001 or forward your resume to ltitcombe@sympatico.ca. 10103 (Sep 15, 2010) Veterinary Technician Full-time vet tech wanted. New grads welcome. Competitive salary, CE and health benefits offered. Contact office manager Tracy at tracycat1000@gmail.com or fax resume to 519 434 0334. 10093 (Sep 10, 2010) RVT wanted Our extraordinary team is looking for an enthusiastic, outgoing technician who loves caring for clients and patients. We value a technician who is committed to excellence, and is willing to help at all times. We practice by high humane and ethical standards, with superb anesthesia and analgesia. We provide a respectful, cooperative and high quality work environment. In addition, our technicians enjoy well above average wages, working great hours, continuing education and paid OAVT dues. You will truly get to use all of your technical, nursing & client communication skills everyday to help care for our patients & their families. If you’re an RVT interested in finding out more about this great career opportunity, please email clarksonvet@rogers.com or submit resume in person: 1659 Lakeshore Road West. 10092 (Sep 10, 2010) Customer Service / QC A professional well respected veterinary supply company is looking for the right person to provide customer service, sales support and quality control for importation of veterinary products. Must hold a Canadian university degree in science. Qualified person must be organized and able to work independently. E-mail resume for consideration to jlagerquist@centralsales.ca. Compensation based on experience.

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10091 (Sep 10, 2010) Full-time RVT A busy three doctor clinic is looking for a second daytime RVT. Monday through Friday, long weekends every other week, no Sundays. We are offering medical and dental benefits as well as a competitive wage. We are looking for a person who is comfortable with client education and communication. Other duties will include anesthetic monitoring, surgical assistance, dentistry, and digital radiography. New graduates welcome. E-mail resumes to bobbysyouruncle@hotmail.com. 10090 (Sep 9, 2010) Technician Full-time RVT needed for small animal practice in Barrie. We are a progressive small practice with two full-time veterinarians. We are located in the south end of Barrie. Shifts are mainly weekdays but also include every other weekend. Technicians receive OAVT conference and membership dues paid as well as a benefit plan. We offer competitive wages

based on experience and are looking for an individual who is confident in their technical skills. Please forward resumes to johnvt@sympatico.ca attn John. 10074 (Sep 1, 2010) Veterinary Technician Sales Opportunities Work with a veterinary clinical pathologist. This position offers an excellent way to increase your clinical knowledge while exploring your career in sales. Canadian Veterinary Imaging Inc. representative for Esaote Ultrasound, Fuji CR, Vetel DR and Heska Laboratory Equipment is looking for account managers in Ontario. Responsibilities will include product demonstration and account management. Current positions are open for the laboratory area for registered veterinary technicians. Please send your resume to admin@boothroyd.ca or call 905.702.7610, ext. 111. Compensation and bonuses will be commensurate with experience. Come join this growing team of professionals!

10031 (Aug 12, 2010) An Upbeat Registered Veterinary Technician needed Bells Corners Animal Hospital is an Ottawa based small animal clinic. We are seeking a full-time registered veterinary technician to join our dynamic team. Our growing and progressive team offers a challenging and positive environment whereby you can maximize all of your talents, technical and client service skills. We offer competitive wages, health and dental benefits, continuing education, sick leave and above all a positive and excellent learning work environment. Shift work is required including some Saturdays. We are in search of an upbeat and outgoing professional who possess excellent team playing skills, communication skills, and high quality patient care and client service. Two years experience is an asset. Please send your resume in confidence to: Joseph El-Farr, Managing Director, by fax: 613-725-5659 or e-mail: josephe@ottawavet.com. website: bellsvet.com

February: Dental Health Month Maximize your investment

Think about itâ&#x20AC;Ś A VetDirect mailing of 250 postcards to potential clients will cost you $200*. Assuming a realistic response from 5 clients who will call to book a dental prophylaxis, you could get a return on your mailing of more than 6x, and thereby maximize your investment on: your dentistry equipment your staffâ&#x20AC;&#x2122;s time and training * Price subject to change. Taxes not included.

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Can you ask a pig if his glass is half full? Experts from the university’s School of Agriculture, Food and Rural Development have shown for the first time that a pig’s mood mirrors how content he is, highlighting that pigs are capable of complex emotions which are directly influenced by their living conditions. Led by Dr. Catherine Douglas, the team has employed a technique to ‘ask’ pigs if they are feeling optimistic or pessimistic about life as a result of the way in which they live. In an experiment reminiscent of Pavlov’s dogs, the Newcastle team taught the pigs to associate a note on a glockenspiel with a treat - an apple - and a dog training ‘clicker’ with something unpleasant in this case rustling a plastic bag. The next step was to place half the pigs in an enriched environment - more space, freedom to roam in straw and play with ‘pig’ toys - while the other half were placed in a smaller, boring environment- no straw and only one noninteractive toy. The team then played an ambiguous noise - a squeak - and studied how the pigs responded. Dr. Douglas said the results were compelling. “We found that almost without exception, the pigs in the enriched environment were optimistic about what this new noise could mean and approached expecting to get

the treat,” she said. “In contrast, the pigs in the boring environment were pessimistic about this new strange noise and, fearing it might be the mildly unpleasant plastic bag, did not approach for a treat. “It’s a response we see all the time in humans where how we are feeling affects our judgement of ambiguous events. For example, if you’re having a bad day -feeling stressed and low - and you’re presented with an ambiguous cue such as your boss calling you into their office, the first thing that goes through your head is what have I done wrong? We call this a negative cognitive bias. But on a good day you greet the same ambiguous event far more positively, you might strut in expecting a slap on the back and a pay rise. “This ‘glass half empty versus glass half full’ interpretation of life reflects our complex emotional states, and our study shows that we can get the same information from pigs. We can use this technique to finally answer important questions about animal welfare in relation to a range of farm environments, for pigs and potentially other farm animals.” The research, funded by Universities Federation for Animal Welfare (UFAW) was presented at the organisation’s annual conference in York last month. Quality of life of our

farm animals is becoming increasingly important to consumers, scientists and government and the study is part of ongoing research at Newcastle to further our understanding of animal welfare and improve the lives of farmed stock. Sandra Edwards, professor of agriculture at Newcastle University and one of the UK’s leading experts in pig welfare, said the next step would be to refine and further validate the methodology so it could be used to help scientists determine what is really important to the pig for its well-being. “Historically, animal welfare research looked only at alleviating suffering. Now the UK industry itself is going beyond a minimum standard and funding research to explore measuring, and then promoting, quality of life,” she explained. “Although techniques exist to measure stress, in the past we haven’t been able to directly ask a pig if it is happy or not. Instead we have assessed production systems based purely on human perceptions and our best interpretations of behaviour. “Our research, for the first time, provides an insight into pigs’ subjective emotional state and this will help scientists and farmers to continue to improve the lives of their pigs in the future.” (Science Daily)

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9 out of 10 Pet Owners Would Give Up Date Night for Their Pets’ Medication & Well-being, According to New Grey Healthcare Group Study

help shape an expert-guided dialogue,” said Lynn O’Connor Vos, CEO, grey healthcare group. “Engaging owners online represents a significant opportunity to connect on their terms and become a more trusted source that understands their needs and wants.”

Pet owners in the US and Europe (UK, France and Germany) agree they are willing to give up personal luxuries for their pets, according to a Grey

Pet Owner Spending • Pet owners in the United Kingdom spend the most on their pets—more than $1,200 (USD) per year, compared to $864 (USD) in Germany, $799 (UDS) in France, and less than $900 (USD) per year in the US. • This disparity is explained by the fact that pet insurance is more common in the United Kingdom and Germany where nearly half of all pets are insured.

Healthcare Group study. Eighty-nine

percent of owners in the US and 91% in Europe would give up their vacation for a pet’s surgery, if it meant helping their pet. Not surprisingly given this level of dedication, nearly one in three (30%) of owners in both the US and Europe, view pets as children, while 3 in 5 (60%) owners consider pets very important for their overall happiness. Despite similar attitudes in the US and Europe, pet owners in Europe are more likely than US owners to spend Would you be willing to forego your vacation for your pet’s surgery? Would you be willing to give up date night to pay for your pet’s medication?

In both the U.S. and Europe, approximately 50 percent of money spent on pets is used on regular visits to veterinarians and preventative measures:

money on their pets health before their own. Where Pet Owners Turn for Information At least two-thirds of pet owners in the US and Europe turn to their vet or vet technician about their pet’s health. The second most popular source is online (59%). Interestingly, both vets and websites are the two most trusted information sources, while friends and family with pets ranks third at 33%. “It is not surprising that the study results show pet owners turn to websites as the second most popular source for information, but this represents a tremendous opportunity for pet care companies, along with the veterinary health care community, to

About grey healthcare group GHG (Grey Healthcare Group) is a global healthcare communications company, headquartered in New York, with offices in North America, Latin America, Europe, Asia and an animal health hub in Kansas City, Missouri. www.ghgroup.com.

Yes

Forego your vacation for your pet’s surgery

Give up date night to pay for your pet’s medication

What percentage of money spent is spent on each of the following? (Showing mean %, total must sum to 100%)

Regular visits / preventative exams, tests, surgeries, etc.

Preventative health items for your pet (e.g., vitamin supplements, medications specialty health food, etc.)

Emergency visits, exams, tests, surgeries, etc.

Travel with pet or kennel fees

Other

TECHNEWS | VOLUME 34 ISSUE 2

Nutrition veterinary technician specialty announced The National Association of Veterinary Technicians in America approves nutrition as tenth specialty. Just months after the National Association of Veterinary Technicians in America (NAVTA) announced its ninth specialty, clinical practice, the association has approved a 10th specialty: nutrition. As team members, veterinary technicians are already in an ideal position to talk to pet owners about the importance of nutrition. The Academy of Veterinary Nutrition Technicians’ (AVNT) goal is to further promote technicians as nutritional point persons by providing them with necessary skills and knowledge. “Nutrition is one area of veterinary medicine that affects every pet that comes into the hospital,” says Kara Burns, MS, Med, LVT, and chair of AVNT. “Every pet has nutritional needs, and a nutrition technician can focus on nutrition management that supports wellness and therapeutic care.” Like all other NAVTA academies, the AVNT will acknowledge veterinary technicians for achieving advanced education, training, and experience in their area of specialization, says Amy Butzier, CVT, VTS (Equine), and chair of the NAVTA Committee on Veterinary Technician Specialties. Butzier says she and the association are thrilled to see an increasing number of veterinary technicians seeking the new specialty. “It truly helps the entire veterinary health care team and the services we can provide,” says Butzier. (For more information on the AVNT, visit the academy’s website.) The NAVTA specialty academies now include: nutrition, clinical practice, dentistry, anesthesia, internal medicine, emergency and critical care, surgical, equine, zoology, and behavior. (Firstline)

Client information on Pet Preparedness The information below can be useful to hand out to clients Hurricanes, earthquakes, floods, tornadoes, wildfires and even man-made disasters have demonstrated to us all in recent years that a crisis can happen at any time, in any community. More than ever, it’s important to have a plan to ensure the safety of your pets. Here are some steps to get you started: Make a plan. Prepare for all possibilities, including that you may be away from home when disaster strikes. Get to know your neighbors, and be prepared to help each other out. Find out from local emergency operation agencies, shelters, veterinary organizations and your own veterinarian what the local emergency response plans are and what help they can provide for you and your pet. Keep ID on your pets. Most animals survive a disaster, but too many never see their families again. That’s because many pets aren’t equipped with a way to determine which pet belongs to which family. Pets should always wear a collar and identification tags. Better still is a permanent identification that can’t slip off, such as an imbedded microchip. Make sure one of the numbers on your pet’s ID and chip records is your cell phone, as well as a friend or relative living out of the area. That way, if you can’t get to your home phone, you can still be reached and reunited with your pet. Put your pet’s records in one easy-to-grab spot. Make a simple file with updated records of your pet’s vaccinations and other health records, as well as his license and microchip information, and details on his pet-health insurance provider. Include some good pictures of your pet with simple, uncluttered backgrounds, so if you need to make “lost pet” posters, you can. Put this material with the rest of your important papers in a place safe from fire or flood. Have carriers and restraints at hand. Advance warning won’t always occur of some disasters, such as earthquakes. But if you know a bad storm is on the way or a wildfire is in your vicinity, get your pet inside. Sturdy crates and carriers are “must-haves,” along with restraints, including comfortable box muzzles for dogs and soft face-shield muzzles and restraint bags for cats. While you may trust your pet to remain calm, it’s better to be prepared: An injured or scared pet may lash out in self-defense. Include your pet’s needs in your emergency kit. Always keep ample supplies on hand of your pet’s food, medications, litter and enough water to cover your pet as well as your human family members. (And rotate all supplies regularly.) A first-aid kit should cover your pet’s needs as well as your own -- and should include a compact first-aid guide geared to pets. If your pet eats canned food, don’t forget to throw in a spare can opener and a spoon. Disposable dishes and litter boxes can be useful as well. One of the best investments you can make when it comes to preparation is to know basic first aid for pets and people alike. For a directory of instructors in your area, check PetTech.net or ask your veterinarian for information. Excerpted from ‘Pet Preparedness’ by Dr Marty Becker and Gina Spadafori at veterinarypartner.com

TECHNEWS | VOLUME 34 ISSUE 2

Super-big huggable protection against fleas and other parasites. Tasty little tablet.

Dogs need protection from intestinal worms and heartworm, along with the one enemy their owners can actually see: fleas. Sentinel® (lufenuron/milbemycin oxime) Flavor Tabs® prevent flea infestations by breaking the flea life cycle at the egg and larval stages. If you prevent reproduction, there won’t be a nasty flea infestation to deal with. Sentinel Flavor Tabs tastes like a treat making it easy for clients to administer with no residue. That leads to

IDEXX Seeks Vet Participation for Feline Heart Study IDEXX Laboratories Inc. has launched a national field study on feline cardiac health to better understand the prevalence of feline heart disease and the profile of cats at risk. Unlike humans, where diet and lifestyle can be predisposing risk factors for heart disease, cats are believed to have genetic predispositions that can arise at any age, according to IDEXX. Heart walls thicken over time, affecting the heart’s ability to provide adequate oxygen to tissues and can lead to similar medical complications as those seen in some types of human heart disease. “This national study will aggregate experience so that we can begin to establish sensible recommendations for when and how often to test, as well as how to discuss heart disease with pet owners,” said Leif Lorentzen, DVM, said. “Most importantly, this study will help us determine the right time for pets to see a cardiologist.” IDEXX anticipates enrolling more than 3,000 general practice veterinarians in the study, which will continue through 2010. An online enrollment form is available at: idexx.com/knowcardio (Veterinary Advantage)

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better compliance. Recommend Sentinel; it’s hugsafe. For more information visit www.ah.novartis.ca or call 1-800-387-6325. © 2010 Novartis Animal Health Canada Inc. ® Sentinel is a registered trademark of Novartis Animal Health Canada Inc. ® Flavor Tabs is a registered trademark of Novartis AG – Novartis Animal Health Canada Inc., licensed user.

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No adjuvant or whole virus. Stimulates strong cell-mediated immunity1,2 essential for protection against FeLV infection.3 Excellent safety profile with more than 4.3 million doses administered in Europe since launch. Provides at least 13 months of protection to kittens as young as 8 weeks of age, as well as to cats previously vaccinated with killed-virus FeLV vaccines. Available in two convenient formats: 10 x 1 dose and 50 x 1 dose

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.

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

by Dr Wendy Brooks, DVM, DipABVP (Educational Director, Veterinary Partner.com)

Hydroxyzine (Atarax) • Hydroxyzine hydrochloride, Hydroxyzine pamoate • Brand Name: Atarax • Available in 10 mg, 25 mg, 50 mg & 100 mg tablets(hydroxyzine hydrochloride) and 25 mg, 50 mg, 100 mg capsules (hydroxyzine pamoate) as well as oral suspension

•

achieve relief with this medication. The enteric coating and small sized tablet make it a common first choice in an antihistamine trial. Mast cell tumours are tumours involving cells that contain granules of histamine. Patients with mast cell tumours experience chronic inflammatory symptoms due to circulating histamine. Antihistamines such as diphenhydramine may be helpful given long term, although hydroxyzine could also be used. Hydroxyzine has an anti-nausea side effect that makes it helpful in treating motion sickness. Hydroxyzine causes drowsiness in animals just as it does in people and can be used as a mild tranquilizer. Hydroxyzine is a member of the piperazine class of antihistamines. When different antihistamines are being tried and one appears ineffective, it is felt that the subsequent choice should be of a different class to avoid the likelihood of another failure.

Background Histamine is an inflammatory biochemical that causes skin redness, swelling, pain, increased heart rate, and blood pressure drop when it binds to one of many H1 receptors throughout the body. Histamine is an important mediator of allergy in humans, hence a spectacular array of different antihistamines has proliferated. Histamine, perhaps unfortunately, is not as important a mediator of inflammation in pets, which means results of antihistamine therapy are not as reliable in pets, particularly dogs, when it comes to itchiness. There are, however, numerous uses for antihistamines, including hydroxyzine, in veterinary medicine.

•

How this Medication is Used • Hydroxyzine has several important effects and thus several uses. Most obviously, hydroxyzine is an antihistamine and it is used for acute inflammatory and allergic conditions such as: • Snake bites • Vaccination reactions • Blood transfusion reactions • Bee stings and insect bites • The management of itchy skin • Hydroxyzine is frequently included in antihistamine trials for allergic skin disease. In such trials, several antihistamines are used sequentially in hoping to find one that was especially effective. Antihistamines in general are more effective in itchy cats than itchy dogs although many dogs

Side Effects • With so many possible uses of this medication, it is difficult to separate out a side effect from a primary effect. Drowsiness is generally regarded as an undesirable side effect. • At doses higher than the recommended dose, human patients complain of dry mouth and experience difficulty with urination. Animal patients experiencing a dry mouth may be observed drinking more water. Because of the difficulty with urination side effect, this medication and others with similar side effects should be avoided in patients with bladder neck tumours (such as the transitional cell carcinoma) or with prostate enlargement. • Fine tremors and even seizures have

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• • •

been reported in dogs taking this medication. Interactions with other Drugs • In the treatment of allergic skin disease, antihistamines are felt to synergize with omega 3 fatty acid supplements and, as a general rule for this condition, it is best to use these medications together. • Hydroxyzine should not be used with additional tranquilizing medications. • A newer antihistamine called cetirizine has become available. This medication represents an active form of hydroxyzine that does not cross the blood-brain barrier. This means that cetirizine would be helpful for a patient who has responded well to hydroxyzine but had an unacceptable level of drowsiness. Concerns and Cautions • When using an antihistamine to prevent an allergic reaction (such as a vaccine reaction) the antihistamine works best when given prior to the allergen. • THIS MEDICATION CAN CAUSE BIRTH DEFECTS IN PREGNANCY. IT SHOULD NOT BE USED IN PREGNANT PETS. • This medication will interfere with allergic skin testing. Withhold before allergy testing. © 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.

day of each month and focus on trends in animal welfare. (dvmnewsmagazine)

Global news

China - Pets dyed to look like pandas, ninja turtles or tigers It’s the latest fad in China, where pet ownership is rising in tandem with household income. But let your clients know that turning a pet into a tiger lookalike may be dangerous. The unregulated bleaches and dyes can be absorbed into the skin or ingested by the animal, triggering serious health repercussions. The transformation can take eight hours, and isn’t always about make-believe fun: Sometimes it’s done to pass a pet off as something he’s not to command a higher price at a pet store. According to a CNN story, a kitten with black-and-white tuxedo markings was bleached and dyed to look like a seal point Siamese for a higher sale price. The kitten had to have medical care after becoming ill from the dye. (veterinarypartner.com) Canada - Pethealth Inc. released new data on pet adoptions, relinquishments, euthanasias and adoption prices from nearly 850 animal welfare organizations in Canada and the United States. Here is what they found: • Owner relinquishments of cats and dogs declined 6 percent and 5 percent, respectively. • Animal shelter euthanasias of cats and dogs declined 10 percent and 7 percent, respectively. • The average adoption price for cats and dogs older than 1 year declined, while the price for dogs under 1 year remained stable. • Cat and dog adoptions in September 2010 increased 3 percent and 2 percent, respectively, over September 2009. The new PetPoint Report collects data from many shelters that use the PetPoint animal management software system. Reports will be published the third Mon-

Global - VPI lists top medical conditions requiring surgery for cats and dogs - Veterinary Pet Insurance Co. (VPI) recently examined its database of more than 485,000 insured pets to determine the top 10 dog and cat surgery claims submitted to the company last year. Top canine claims in order were: • Benign skin mass • Skin Abscess • Inflammation or pressure ulcer • Tooth extraction • Torn ACL or cartilage • Malignant skin mass • Cancer of the spleen • Cancer of the eyelid • Bladder stones • Cancer of the liver • Auricular hematoma Top feline claims were: • Tooth extraction • Skin abscess • Benign skin mass • Bladder stones • Cancer of the abdominal wall • Malignant skin mass • Multiple bite wounds • Cancer of the liver • Cancer of the mouth • Cancer of the nasal cavity According to VPI, the most common surgical claim for dogs on the list, benign skin mass, cost VPI policyholders an average of $999 per claim. The least common, auricular hematoma, cost an average of $296 per claim. For cats, the average per claim for the no. 1 condition requiring surgery on the list, tooth extraction, was $924, while the least common (cancer of the nasal cavity), cost an average of $927. Global - Rinderpest - The United Nations Food and Agriculture Organization announced that efforts to eradicate rinderpest, which has been prevalent in Africa, Asia and the Middle East, have succeeded. If confirmed, the virus will become the only one besides smallpox to have been wiped out by human efforts. (Animal Health SmartBrief ) US - WVC to reduce fees and increase focus on vet techs for 2011 - The Western Veterinary Conference announced that its 2011 Conference is featuring

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special reduced fees, new extras, and enhanced programming specifically for the 2011 Veterinary Technician Program. For more information, visit wvc.org Canada - Snakes found breeding in western Nfld. - Snakes are not native to Newfoundland, but a pregnant garter snake was recently found in St. David’s, southwestern Newfoundland. Introduced species, such as garter snakes, can cause problems. These red-sided garter snakes were photographed in ManiThey are known to eat meadow voles. toba. (CBC) On the island of Newfoundland, the meadow vole is a unique sub-species to the island, plus there is concern that an introduced animal may bring in disease to the province. Wildlife officials believe snakes may be arriving in the province on farm shipments, such as hay bales. Wildlife officials have been receiving reports of snakes on the island for more than a year. It’s unclear if the snakes will thrive on the island or make it to eastern communities. A number of introduced spe-

US - Dog Breeding Regulation - The “Puppy Mill Cruelty Prevention Act,” or Proposition B (Prop B) ballot initiative in Missouri was adopted November 4, 2010 by a narrow vote, with 51% of voters approving the measure. The initiative, carried to the ballot by The Humane Society of the United States (HSUS), with assistance from the American Society for the Prevention of Cruelty to Animals, limits commercial breeders to no more than 50 female breeding dogs and requires that those dogs be bred no more than twice every 18 months. It also increases living space for dogs, requires indoor housing with unfettered access to outdoor exercise yards, requires that dogs be fed daily and requires that dogs be examined annually by veterinarians. Missouri is said to be the largest dog breeding state in the US, with an estimated one of every three or four of puppies sold in pet stores in the US having been born in the state. (Feedstuffs.com)

21622 Technews-Jan2011.indd 1

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15/11/10 3:17 PM

When OVMA and AAHA collaborate, you receive the quality technician education and customer service that both conference are known for. Plus, you become part of the largest annual veterinary gathering in Canada. The conference offers education that supports your vital role in providing quality pet care, and it will help you enhance your skills, whether you are new to the field, experienced or working in a specialty area. Learn from your peers as well through networking opportunities available with other technicians from across Canada and the US.

AAHA & OVMA WelcOMe tecHniciAns tO AAHA/OVMA cOnference â&#x20AC;&#x201C; tOrOntO 2011 To register, visit aahanet.org/AAHAOVMAToronto2011 or call 800/883-6301. Complete course descriptions, interactive daily schedules and speaker bios are available online.

US - Equine piroplasmosis tally 409 by Oct 12, 2010 - According to Horsetalk, 409 horses in the United States have been confirmed with the parasitic infection equine piroplasmosis, as a result of an outbreak centered on Texas. The U.S. Department of Agriculture’s latest report to the World Organization for Animal Health said more than 2,300 horses have been tested for the disease as part of its ongoing investigation into the outbreak, first detected on a property in Kleberg County, Texas. Horses that have tested positive are in Texas, Alabama, Louisiana, Indiana, North Carolina, and Tennessee. Equine piroplasmosis is a blood-borne parasitic disease primarily transmitted to horses by ticks or contaminated needles. Mild cases of EP cause weakness and lack of appetite. Symptoms can include rough coats, constipation, colic, fever, anemia and low platelet counts. (veterinary advantage news) cies - moose in particular — have thrived in Newfoundland but the island is still free of skunks, porcupines and raccoons. (cbc online news) US - Whale snot, bat sex studies win Ig Nobel awards - The first documentation of fellatio in bats, the use of a remotecontrolled helicopter to collect whale snot and the finding that swearing can relieve pain won top honours at the annual Ig Nobel awards ceremony September 30, 2010. Not be confused with the Nobel Prizes, the Harvard University-based Journal of Improbable Research hands out the Ig Nobels annually. The Journal says the prizes are meant to celebrate research that first makes people laugh and then makes them think. The top biology prize went to a team of researchers led by Min Tan of the Guangdong Entomological Institute in Guangzhou, China. The team made headlines last year for showing that when female fruit bats performed fellatio on their partners while mating, the pair spent more time copulating. The Zoological Society of London’s Karina Acevedo-Whitehouse was part of a team that accepted the engineering prize for a system of collecting gases and mucus exhaled by whales. The team hung petri dishes from a helicopter and flew it over whales as they exhaled out their blowholes. The samples were used to study

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diseases the mammals might carry. The peace prize went to psychology researcher Richard Stephens of Keele University, North Midlands. He and his team found some volunteers were better able to withstand the pain from plunging their hand in a tub of ice water for as long as possible when they were asked to repeat a swear word of their choice compared with an inoffensive word. (cbc online news) US - Dog bite claims get chunk of insurance payouts - A report by the U.S.-based Insurance Information Institute shows close to one-third of liability claims paid in 2009 were for dog bites. According to the Insurance Information Institute, payouts for dog bite claims have risen by 30 per cent in the past six years. (IStock) In the U.S., dog bite claims amounted to $412 million in 2009, a rise of 6.4 per cent from 2008. The Insurance Bureau of Canada doesn’t track dog bite statistics. However, a spokesman for the bureau suggests that on a proportional basis, Canadian insurance companies would be facing a similar situation. According to the U.S. Centers for Disease Control, dogs bite nearly 4.7 million people in the U.S. each year, and nearly 900,000, half of them children, require medical attention. The rate of dog bite injuries is highest for children five to nine years old. Injury rates are higher for boys

than girls. More than half of the bites happen on the dog owner’s property. (cbc online news) US - Study says canine hip dysplasia may be underreported - A study comparing a University of Pennsylvania method for evaluating a dog’s susceptibility to hip dysplasia to the traditional American method has shown that 80 percent of dogs judged to be normal by the traditional method are actually at risk for developing osteoarthritis and hip dysplasia, according to the Penn method. The results indicate that traditional scoring of radiographs that certify dogs for breeding underestimate their osteoarthritis susceptibility. The results are of clinical importance to several populations, most notably veterinarians, breeders and pet owners. The two hip screening methods - the standard Orthopedic Foundation for Animals, or OFA model, and Penn Vet’s PennHIP model - were applied to a sample of 439 dogs older than 2 years. The four most common breeds included in the study were German shepherds, Labrador retrievers, golden retrievers and Rottweilers, all breeds commonly susceptible to hip dysplasia. According to Penn researchers, even if breeders were to selectively breed only those dogs having OFA-rated “excellent” hips -- the highest ranking but in some breeds, a very small gene pool, the study suggests that 52-100 percent of the progeny, depending on breed, would be susceptible to hip dysplasia based on the Penn Vet scoring method. (veterinary advantage news) UK - Technology has brought a change to the simple pet door, thanks to a microchip that recognizes only the cat or cats who are allowed through the door. The Pet Porte Smart Flap reads an implanted microchip to open the door as soon as the cat is a foot away, and holds the door open for a few seconds before locking to keep out other cats as well as wild animals looking for food. The manufacturer says the door can be programmed to work with up to 30 cats and can be locked to keep all cats contained when desired. Other automatic doors require a cat to wear a special collar. In the United Kingdom, more than 2 million cats have been implanted with the special microchip, and the door is a hit with cat owners. (veterinarypartner.com)

Did You Know?

Still Furry After All These Years Cats live a maximum of 27 years, with 15 years the typical life span. The two oldest cats on record were both tabbies. One, owned by a Mrs. Thomas Holway of the United Kingdom, died in 1939 at the advanced age of 36. The other, also from the U.K. and owned by a Mrs. Alice St. George Moore, lived to 34, dying in 1957. Downward Dog: The Kind Cats Like Yoga tunes may be just what your cat needs to relax, according to a study in Wales. The yearlong study focused on the reactions of cats exposed to meditation music vs. those who weren’t. Cats who listened to the calming music had a lower respiration rate and relaxed much more quickly than those who didn’t hear the music at all. Time for Meow-age Counseling One-third of married women believe their pets listen to them better than their spouses do, according to an Associated PressPetside.com poll. Among married men, 18 percent hold the same belief. (veterinarypartner.com)

If your clients are considering checking their shortnosed dog into cargo for their next trip by air, you might suggest they reconsider. U.S. airlines report that in the last five years, 122 dogs died in cargo, and half of those deaths were dogs of breeds were brachycephalic. Bulldogs died most often in transit, followed by pugs and French bulldogs. These breeds, bred for the round heads and flat faces, find it harder to breathe and harder to keep cool, both of which can have serious implications when flying.

World Veterinary Year Veterinary medical education got its start 250 years ago when the first veterinary medical college opened in Lyon, France. “World Veterinary Year” has been designated to bring attention and show appreciation to the veterinary profession. World Veterinary Year will launch internationally with an opening ceremony on Jan. 24, 2011 in Versailles, France. Secondhand smoke is a hazard to pets as well as people Shorter-nosed breeds are at greater risk for lung cancer, while longer-nosed breeds like collies and German shepherds are more likely to get nasal cancer. Dr. John Reif, a professor at the Colorado State University College of Veterinary Medicine and Biomedical Sciences, released the results in a podcast for the American Veterinary Medical Association. Previous studies had noted that cats exposed to second-hand smoke had double the risk of cancer compared to other cats. (Dr. Marty Becker and Mikkel Becker)

Buggin’ Out White is a bad color for wind turbines, according to a recent study. White attracts insects, which in turn attract birds and bats that are too often killed by the blades. Scientists tested different colors to see if the problems could be minimized, including white, light gray, dark gray, purple, sky blue and red. The best choice for not attracting insects? Purple. (veterinarypartner.com) Crate Expectations Crating or harnessing your pet in the car is an important safety measure for you, your dog and everyone else on the road. In a survey by AAA, nearly 60 percent of those polled admitted to having driven while distracted when their dog was in the car. Only 17 percent of respondents said they restrained their pet in a crate or with a seat-belt harness. An unrestrained 10-pound dog in a crash at 50 mph delivers 500 pounds of force on whatever the animal strikes; an 80-pound dog in a 30 mph crash delivers 2,400 pounds of force. (veterinarypartner.com) Besides humans and other primates, only some whales (including dolphins), elephants and European magpies are able to recognize themselves in a mirror. (Most children can’t until they’re about 18 months old.) (veterinarypartner.com)

The domestic cat is the only species of cat that can hold its tail vertically while walking. (CATalyst Council, Inc.)

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Introducing a new canine lepto vaccine shown to

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New NOBIVAC® Lepto4 is the only canine lepto vaccine that aids in the prevention of disease and mortality caused by the 4 key Leptospira serovars.* Safety, efficacy, and innovative vaccine programs. It’s what you get each and every time you use a NOBIVAC vaccine. And now with the addition of new NOBIVAC Lepto4, you get even more from our comprehensive line of NOBIVAC vaccines. Available as a stand-alone vaccine or in combination with DAPPv, NOBIVAC Lepto4 has been proven safe and well tolerated, as demonstrated in a 749-dog field study. When you support NOBIVAC Lepto4 or any of our other NOBIVAC vaccines, you also gain access to innovative one-of-a-kind programs such as the Afya Serengeti Project and Infovet®. Ask for more from your vaccines. Ask for NOBIVAC. Speak with your Intervet/Schering-Plough Animal Health representative today and ADD LIFE to your vaccine portfolio.

*L. canicola, L. grippotyphosa, L. icterohaemorrhagiae, and L. pomona. NOBIVAC and Infovet are registered trademarks of Intervet International B.V., used under license by Intervet Canada Corp. Copyright © 2010 Intervet Canada Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA. All rights reserved. NOB012-10E-AD

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