2012 Spring TECHNEWS by Ontario Association of Veterinary Technicians

2012

VOL UME 35 I S S UE 3

PREMIER JOURNAL

FOR

CANADIAN VETERINARY TECHNICIANS

SPRING

A NATIONAL JOURNAL PUBLISHED BY THE ONTARIO ASSOCATION OF VETERINARY TECHNICIANS

CONTINUING EDUCATION • Canine Hemangiosarcoma - Diagnosis and Treatment Options

D E D I C AT E D TO PROFESSIONALISM PUBLICATION MAIL AGREEMENT NUMBER 40034241 • PUBLISHED BY THE OAVT • Return Canadian undeliverable address to: OAVT, 100 Stone Rd W., Suite 104 Guelph, ON N1G 5L3

• The Activated Clotting Time in Veterinary Practice • An Introduction to the Concept of Veterinary Hospice Care© Plus: Online Resource is the Leading Authority on Parasites, Take a Fresh Breath, Metoclopramide (Reglan), OAVT’s 35th Annual Conference, Equine News, Common Feline Poisons to Avoid!, Handling Foals, and more!

Introducing Canine

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2012 Platinum Sponsors Making continuing education better & more accessible across Canada Bayer HealthCare Animal Health Division Hill’s Pet Nutrition Canada, Inc. Merck Animal Health Royal Canin Medi Cal Pfizer Animal Health These companies are generously supporting a series of outstanding learning opportunities for registered veterinary technicians through OAVT. 35th Annual OAVT Conference & Trade Show February 21 - 23, 2013 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 2012.

EECI12208-S01-01

Letter from the Editor............................................................................................................... 2 Online Resource is the Leading Authority on Parasites.............................................................. 3 Safety Column: Take a Fresh Breath.......................................................................................... 4 Pharmacology Column: Metoclopramide (Reglan).................................................................... 7 CE Article #1: Canine Hemangiosarcoma - Diagnosis and Treatment Options................... 9 CE Article #2: The Activated Clotting Time in Veterinary Practice................................... 13 CE Article #3: An Introduction to the Concept of Veterinary Hospice Care©.................. 17 Puzzle...................................................................................................................................... 19 OAVT’s 34th Annual Conference ........................................................................................... 20 Employment Ads..................................................................................................................... 23 Submitting Articles to TECHNEWS...................................................................................... 25 Equine News........................................................................................................................... 26 Poisoning Toxicology Column: Common Feline Poisons to Avoid! ......................................... 28 TECHNEWS Spring 2012 CE Quizzes............................................................................. 30 Global News........................................................................................................................... 32 Tech Tips and Tidbits.............................................................................................................. 34 Apps and Websites to Watch................................................................................................... 35 Continuing Education Opportunities..................................................................................... 36 Handling Foals ....................................................................................................................... 38 Did You Know? ...................................................................................................................... 40

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Next Issue: Summer 2012 Deadline for Material: May 15, 2012 Distribution Date: July 1, 2012 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 35 ISSUE 3

Printed on recycled paper

Welcome to the Spring edition of TECHNEWS! We have some superb content ready for your consumption in this great issue and we hope you enjoy all of it! Christi Cooper’s final article in her series of personal protective equipment focuses on respiratory hazards and provides some excellent advice on the selection of respirators for work. (page 4). The first CE article (page 9) is on Canine Hemangiosarcoma - Diagnosis and Treatment Options by author Geri Higginson MSc, RVT. The article focuses on splenic and cardiac hemangiosarcoma tumours. Our second CE article (page 13) is from Karol Mathews DVM and Teresa Cheng DVM on the Activated Clotting Time in Veterinary Practice. The cost and simplicity of the ACT test makes it

valuable in veterinary practice and this article provides an excellent overview. An Introduction to the Concept of Veterinary Hospice Care© is CE article #3 on (page 17) by Ann McClenaghan, BS, CVT. This very emotional subject is becoming increasingly important within veterinary medicine and Ann provides clarity for greater understanding so that we can better assist our clients. Shirley Inglis, RVT provides a snapshot of the February OAVT conference with some great take-away points she heard from presenters including Jayne Takahashi, Heather Lowe, Katherine Dobbs, Alison Moore and Karol Mathews. We received some very positive comments from delegates and the work has already begun for the 35th annual conference in 2013. If you have ideas on topics and speakers that you would like to hear, please let us know now! TECHNEWS readers provide excellent input with great ideas and we look forward to hearing from YOU!

Enjoy spring, get ready for summer and have a great time with this issue of TECHNEWS!

Cass Bayley Editor, TECHNEWS CE Article 3, Volume 34 Issue 3 - Cogenital Heart Defects by Tanya Crocker Question 6: ‘Pulmonic stenosis is most commonly diagnosed by...’ This question was removed from the online quiz system due to a challenge in the wording of the question. Any quizzes completed online will be reviewed and changes will be made if question 6 was marked incorrectly. Anyone who submitted the quiz by mail and did not receive a credit because number 6 was marked ‘incorrect’ should contact the OAVT.

TECHNEWS | VOLUME 35 ISSUE 3

Online Resource is the Leading Authority on Parasites The Nonprofit Companion Animal Parasite Council (CAPC) Celebrates 10-year Anniversary with Redesigned Website, www.CAPCVet.org The newly redesigned website, www.CAPCVet.org, from the nonprofit Companion Animal Parasite Council (CAPC) is a one-stop resource on parasites for veterinarians and technicians. The website provides comprehensive data and visuals that support hospital teams as they work to keep pets and families safe from the risks that parasites pose. The CAPC reintroduces the website to mark its 10-year anniversary. “We know that the vast majority of veterinarians read and refer to the CAPC guidelines, which are the industry standard. So, we made this popular information easier to access and much more visual with rich media content,” said Christopher Carpenter, DVM, MBA, executive director of the CAPC. “We’ve improved the navigation tools, added new and dynamic content and, most importantly, significantly upgraded our prevalence maps.” The online CAPC parasite prevalence maps are a first for the industry and help veterinarians educate clients about the incidence of tick-borne disease agents, intestinal parasites and heartworm disease. The new maps provide localized and timely parasite information. To find local conditions, visitors simply select parasite and disease categories, choose dogs or cats and then click on a state and county to get parasite updates on their region of interest. The CAPC updates the maps monthly.

About the Companion Animal Parasite Council (CAPC) The Companion Animal Parasite Council (www.capcvet.org) is an independent nonprofit 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.

Visitors to www.CAPCVet.org will also find new expert articles and various resources, from video to brochures for purchase, designed to keep them apprised of the latest industry data and help them educate clients about parasites and the diseases they carry. To prevent infections, the CAPC continues to recommend that pet owners administer parasite control medication to dogs and cats year-round, which often requires a monthly application, and seek regular veterinarian checkups so that pets may be tested and treated for any external or internal parasites that doctors find.

About the CAPC Founded in 2002, the nonprofit CAPC (www.CAPCVet.org) is an independent council of veterinarians, veterinary parasitologists and other animal health care professionals established to foster animal and human health, while preserving the human-animal bond, through recommendations for the diagnosis, treatment, prevention and control of parasitic infections. The CAPC brings together broad expertise in parasitology, internal medicine, public health, veterinary law, private practice and association leadership.

TECHNEWS | VOLUME 35 ISSUE 3

SAFETY COLUMN

Take a

Fresh Breath

Christi Cooper, RVT, CRSP, CHSC is the Agricultural and Veterinary Safety Officer for the University of Guelph. Her role focuses on worker safety at the university, especially for the Ontario Agricultural and Ontario Veterinary Colleges. Christi holds a certificate in Volunteer Program Management, and is certified to conduct ISO 19011 and OHSAS 18001 audits.

Let’s talk about respiratory protection in this final article in the series of personal protective equipment, or PPE. Respiratory hazards, like other hazards in the workplace, must first be identified, evaluated, and controlled. There are steps outlined in the CSA Standard Z94.4-11 (RSO 2011): Selection, Use, and Care of Respirators on how to go about conducting a hazard assessment and selection of a respirator for non-bioaerosol workplace contaminants. This process is different for work with bioaerosols (e.g. biohazardous gas, vapour or particulates), and professional assistance should be sought when choosing respiratory protection for safe work with biohazardous agents that can cause serious or lethal human disease or adverse health effects. The key points for selection of respirators for work with non-bioaerosol contaminants: • Identification of the hazard(s) and its physical state, • Measure or estimate the concentration of the hazard, • Identify an appropriate exposure limit for each airborne contaminant and if there is an applicable health regulation or substance-specific standard for the contaminant,

• Determine if there is oil present and • Determine if the contaminant can be absorbed through or is irritating to the eyes. Such assessments must be completed again when the nature of the hazard changes.1 The processes and contaminant exposures must then be considered, including whether exposures are routine or nonroutine (i.e. only from malfunctions in equipment or processes and spills), the period of time the worker needs to wear the respirator, physical demands made upon the worker during that time, and the conditions such as temperature and relative humidity. Measurement or estimation of the concentrations of gas / vapour or particulate to which persons might be exposed must be done by a qualified person who uses air sampling methods, mathematical modeling or experience from similar circumstances. Sampling for workplace exposure levels is another whole topic and beyond the scope of this article.1 The Health and Safety Handbook for Veterinary Hospitals, available from the Ontario Veterinary Medical Association, provides an overview of measurement and control in “Chapter 2: Waste Anesthetic Gas”.2 As in the case of controlling all hazards, the first level of control is by engineer-

ing methods, such as general ventilation. Rooms need to be dedicated for use by design, with the appropriate number of air exchanges to meet facility design standards such as ASHRAE (American Society of Heating, Refrigerating and Air Conditioning Engineers). These standards outline the range of air exchange rates for surgeries, laboratories, treatment and office rooms. After engineering controls, the next level of control is administrative or procedural controls, such as the use of local supplied exhaust (i.e. fume hoods and active scavenge systems). Another example of administrative controls is scheduling - deciding who is involved in the procedure. Prudence dictates the need to plan who will be involved in your more hazardous procedures and keep the volunteers, high school co-op students and the pregnant staff out of harm’s way. The use of a respirator should be considered when permanent engineering controls are inadequate or non-functional e.g. for an emergency spill, when the exposure is not controlled such as in mass production of a chemical or when engineering and administrative controls are not practical3 -it’s tough to get a patient into a fume hood! Clinics and other veterinary facilities should have procedures in place to keep exposures to a minimum – for example, have good air exchanges in areas where chemicals are used such as the prep area and surgical suite, and use an active scavenge system. Additionally, disposable respirators will provide relief when nuisance levels of the hazards are encountered. Care is required when selecting respirators for contaminants that exist as particles and vapours. Generalizations about the contaminant phase are based on the American Conference of Governmental Industrial Hygenists (ACGIH) threshold limit value(TLV) listings or the regulation in your jurisdiction. Low vapour pressure contaminants with a TLV listed only as mg/m3 are assumed to exist in the particle phase and would require a particle filter. Contaminants with TLV’s listed in both ppm and mg/m3 are generally found in the vapour phase, and would require chemical protection in the filter

TECHNEWS | VOLUME 35 ISSUE 3

or cartridge. Mixtures of contaminants in workplace air suggest that filters with aerosol and vapour removing capabilities would be required. Professional advice and assistance is essential for proper respirator selection and for correct, confident use of the recommended respiratory protection.4 Respirator Types There are several types of respirators that are appropriate for use in a clinical or laboratory setting, the choice depending on the exposure associated with the work being performed. They are: filtering face piece (FFP) or disposable “mask”, the elastomeric air purifying respirator, with absorbing cartridges and possibly pre-filters for large particles such as dusts – available in half-face or full face, if eye protection is also required, and the powered air-supply respirator (or PAPR). This discussion will concentrate on the disposable “dust” mask respirator, as the

most commonly used for large particles in short term and low exposure or nuisance level concentrations – these respirators are often simply referred to as an “N95”. These disposable respirator masks, that meet National Institute for Safety and Health (NIOSH) standards, have at least a 95% filtration efficiency for the most penetrative size of particles, those measured to 0.03 µm.4 There are actually several types of disposable dust masks or respirators approved by NIOSH. Disposable respirators are divided into nine types, grouped by protection type for the process or material worked with and the efficiency rating, by percentage. These types are: • N-- Not Oil Resistant, • R – Oil Resistant and • P –Oil Proof, with 95, 99 and 100% ratings. Don’t be surprised if you actually find yourself wearing an R95 respirator – they

are all rated for protection from particles or droplets, first and foremost. The N, R and P designations refer to the filter’s oil resistance as described in Table 3, below. Selection of the appropriate respirator will depend on the nature of the workplace atmospheric hazard, physical characteristics of the workplace, the physical demands of the task, and the capabilities and limitations of the respirators available. Respirators are to be chosen and maintained with appropriate fit-testing and monitoring according to Canadian Standards Association (CSA) Standard Z94.4-11 (RSO 2011): Selection, Use, and Care of Respirators. The various styles of disposable respirators fit differently – these masks are not “one size fits all”. According the CSA Standard, staff should be fit tested every 2 years as a minimum, to ensure a proper fit, application, knowledge and use, even when using the disposables and more fre-

table 3 > Oil Resistance Ratings of Repository Protective Masks Oil Resistance

Rating

Description

Not Oil Resistant N95

Filters at least 95% of airborne particles

N99

Filters at least 99% of airborne particles.

N100

Filters at least 99.97% of airborne particles

Oil Resistant R95

Filters at least 95% of airborne particles

R99*

Filters at least 99% of airborne particles

R100*

Filters at least 99.97% of airborne particles

Oil Proof P95

Filters at least 95% of airborne particles

P99

Filters at least 99% of airborne particles

P100

Filters at least 99.97% of airborne particles

*No NIOSH approvals are held by this type of disposable particulate respirator.5

TECHNEWS | VOLUME 35 ISSUE 3

quent when circumstances change such as introduction of a new hazard, the worker experiences weight loss / weight gain, a change in facial features or a return to work from a leave of absence. Respirator manufacturers may conduct or be able to recommend someone to conduct fit testing, or try contacting your local hospital or university safety department. All disposable respirators are designed to be used for short exposures or when only nuisance quantities of non-toxic particulates are generated from the material(s) or process being used. This includes use for when staff members who are more sensitive to smells, but there is negligible chemical hazard. For example , a disposable respirator with a layer of charcoal, such as the 3M 8577 R95, will provide short term protection and relief from the organic vapours when filling anesthetic machines , using bone cements, or cautery fumes, when performed in an area with good general ventilation. For situations where the air contains unacceptable concentrations of vapours or fine air-borne particles, or for longer term use, either an air-purifying (cartridge style) or supplied-air respirator is to be used. Employees who require air-purifying or supplied-air respiratory protection should be medically evaluated to ensure they are physically fit for the stresses associated with longer term respirator use. Exposures to hazardous splashes or infectious droplets should also be prevented and protection for the eyes in the form of goggles or a face shield may be necessary. Brands There are a number of NIOSH approved respirator manufacturers on the market including 3M, North, Moldex, Willson, Gerson and only NIOSH approved respirators should be used. When a successful fit test has been achieved with one product or style, there is no guarantee that a fit will be achieved with another manufacturer’s product or model; fit testing is specific to the particular respirator and only that respirator should be used by the worker.

Respirator Care and Storage Depending on the reason for use, disposable masks may be able to be reused up to about 40 hours of exposure, until soiled or damaged, it is difficult to breathe through due to surface particles or until the chemical being protected against can be smelled through it. Disposable respirators used in working with zoonoses or infectious agents are always single use only and must be disposed of immediately following removal. NEVER share a disposable respirator – these are personal use items! Non-disposable respirators must be cleaned between users, if shared. Respirators are to be stored such that they do not accumulate dust, and cannot absorb the chemical they are being used to protect the wearer against. Store a respirator in a sealed plastic bag, or in a clean dry place (staff locker?). Never write on the respirator, but label the bag or box it is stored in with the name of the user. When being used, detection of an odour through the respirator is confirmation that the respirator is either not providing a good fit or that the filtering capability, including any cartridges, have expired.3 In order to provide adequate protection, a respirator must be suited to the hazard, properly fitted, worn correctly, properly stored and maintained. In order to provide protection, the respirator must form a seal with the face of the wearer. This requires the wearer to be clean shaven (at least within 24 hours)1 and to ensure that long hair or glasses do not interfere with the respirator. A Workplace Respiratory Protection Program should be in place to consolidate the required due diligence initiatives when reliance is placed on this critical piece of personal protective equipment. Respirators are worn when the workplace atmosphere is known to be contaminated and protection is required for every breath. Respirators that don’t fit provide no protection! A word of caution about respirator use and pregnancy; all research regarding protective factors of respirators has been conducted using average healthy persons as the model. Disposable respirators with protection against nuisance level

organic vapours and elastomeric respirators with organic vapour cartridges have been worn by pregnant staff but there has been no scientific testing to-date on the unborn fetus. Whenever possible, it is strongly recommended that pregnant personnel avoid expsoures such as involvement with inhalant anesthetics, from induction to post recovery. The Center for Disease Control provides excellent information regarding N95 respirators and surgical masks at the NIOSH Science Blog, found at http:// www.cdc.gov/niosh/blog/nsb101409_respirator.html . 3M provides more information in the form of a Technical Data Bulletin, number 174, entitled Respirator Protection for Airborne Exposures to Biohazards on their website at http://mws9.3m.com/mws/ mediawebserver.dyn?6666660Zjcf6lVs6E Vs66S2tkCOrrrrQ-

references > 1. CSA Standard Z94.4-11 Selection, use and care of respirators; available for purchase at http://shop.csa.ca/en/canada/respiratoryprotection/z944-11/invt/27016392011/ 2. Health and Safety Handbook for Veterinary Hospitals, (2008) Ontario Veterinary Medical Association; available from the OVMA at www.ovma.org 3. University of Guelph Lab Safety Manual, found at http://www.uoguelph. ca/ehs/programs/lab-safety 4. University of Guelph Safety Policy 851.05.06 Respiratory Protection Programs, found at www.uoguelph.ca/ ehs/sites/uoguelph.ca.ehs/files/05-06.pdf 5. NIOSH-Approved Filtering Facepiece Respirators, available on-line at http:// www.cdc.gov/niosh/npptl/topics/respirators/disp_part/ 6. NIOSH Science Blog; N95 Respirators and Surgical Masks; accessed on-line at http://www.cdc.gov/niosh/blog/ nsb101409_respirator.html 7. 3M Technical Data Bulletin, (2009); Respirator Protection for Airborne Exposures to Biohazards; 174; available at http://mws9.3m.com/mws/mediawebserver.dyn?6666660Zjcf6lVs6EVs66S2t kCOrrrrQ-

TECHNEWS | VOLUME 35 ISSUE 3

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)

Brand name: Reglan Available in 5 mg & 10 mg tablets (oral suspension exists but is famous for unpalatable taste to pets). How This Medication Works One of the stomach’s most important functions is to grind the food we eat into a fine slurry that passes freely through the intestines. A strong rhythm of contraction is necessary to effect this grinding, and this rhythm creates the stomach’s motility. Motility disorders are common and may be chronic (of long duration) or of sudden onset. When motility is reduced in the stomach, food pools there and creates a sensation of nausea and bloating. In some cases, bile refluxes from the intestine back into the stomach, causing irritation and more nausea. Metoclopramide normalizes stomach contractions so that food and bile can pass in the correct direction. An additional effect of metoclopramide is helpful in the control of nausea. There is a biochemical barrier separating the brain and central nervous system from the blood stream so that only certain biochemicals can cross over. This partition is called the blood-brain barrier. Metoclopramide is able to cross the blood-brain barrier and act on the brain directly to control the sensation of nausea. Metoclopramide thus helps the vomiting patient by normalizing stomach motility and acting directly on the brain to reduce the sensation of nausea.

TECHNEWS | VOLUME 35 ISSUE 3

How this Medication is Used Signs of nausea in pets include: • Loss of appetite • Vomiting • Drooling • Loud stomach or intestinal sounds • Chewing motions Metoclopramide can be used to control nausea in any situation except in the event of stomach or intestinal obstruction. If a motility problem is suspected (a classical history would include vomiting food many hours after eating), metoclopramide should also be helpful. If a motility disorder extends beyond the stomach (for example, a colon motility disorder might lead to constipation), metoclopramide is not expected to be helpful. METOCLOPRAMIDE IS BEST GIVEN 20 MINUTES BEFORE A MEAL. Side Effects Side effects are rare with metoclopramide but generally stem from the ability to penetrate the blood-brain barrier. Animals predisposed to seizures (i.e., epileptics) may experience seizures, although this should not be a problem for normal animals. Some animals experience drowsiness and others will experience marked hyperactivity. Hyperactivity can be reversed with a dose of Benedryl (diphenhydramine). Constipation has been reported as a side effect in some individuals. This is not a common side effect. If you suspect your pet is having an adverse reaction to metoclopramide, dis-

continue the medication and inform your veterinarian. There is another motility modifier called cisapride (Propulsid) that may be a good alternative. This medication does not cross the bloodbrain barrier and hence does not have the behavioral side effects that metoclopramide can, but it also does not reduce the sensation of nausea by this additional mechanism either. Interactions with Other Medications Metoclopramide should not be used with phenothiazine tranquilizers such as acepromazine if there is any potential for seizures in the patient. Both medications serve to lower the threshold to seizures. Propantheline bromide (Pro-Banthine), which is used to treat some cardiac arrhythmias, will inactivate metoclopramide. Narcotic analgesics may negate the effects of metoclopramide. Cautions and Contraindications In patients who have a rare adrenal tumor called pheochromocytoma, the use of metoclopramide can induce dangerously high blood pressure. If stomach obstruction is suspected in a patient, it is best not to encourage motility and some other anti-nausea drug is preferred. Metoclopramide crosses the placenta and into milk and is probably best avoided in pregnant or nursing mothers.

© 2012 Dr Wendy Brooks, DVM, DipABVP and VIN, All rights reserved. Editor’s Note: Reprinted courtesy of Veterinary Information Network (VIN). VIN (www.vin.com) is the largest online veterinary community, information source and CE provider. The VIN community is the online home for over 30,000 colleagues worldwide. VIN supports the Veterinary Support Personnel Network (VSPN.org); a FREE online community, information source for veterinary support staff. VSPN offers a wide range of interactive practical CE courses for veterinary support staff -- for a small fee. Visit www.vspn.org for more information.

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Hemangiosarcoma (HSA) is a malignant sarcoma which originates from endothelial cells and has a widespread metastatic behaviour1. Although it can arise in any vascularized area, it is most commonly found in the spleen, right atrium of the heart and subcutaneous tissues in the dog. Comparatively, human vascular endothelial tumours (known as angiosarcomas), are rare and often associated with previous radiation treatment sites or are found on the heads of elderly patients2. HSA typically affects middleaged to older, large breed dogs, with German shepherds, standard poodles golden retrievers, and Labrador retrievers reported as high risk breeds1-3. Some studies report that it is responsible for approximately 50% of all splenic tumours and 3% of skin tumours in the dog. This article will focus on splenic and cardiac hemangiosarcoma tumours as they are more likely to be the cause of an emergent presentation at the veterinary clinic. While most dogs with this disease will die within 6 months of diagnosis due to metastatic spread, it is important to note that many can still enjoy a good quality of life following surgery and chemotherapy despite the poor prognosis.

CE Article #1 Canine Hemangiosarcoma - Diagnosis and Treatment Options Patient Presentation

Dogs with a large ruptured splenic hemangiosarcoma mass may become acutely weak or collapse due to hypotensive shock from massive hemorrhage. The owners may report that, historically, there had been intermittent episodes of inappetance, lethargy, or a distended abdomen that resolved within 1-2 days3. It has been theorized that these episodes are due to smaller bleeds that are subsequently reabsorbed from the peritoneum. Physical examination of these dogs at presentation may reveal a cranial abdominal mass, an abdominal fluid wave, and pale mucous membranes with prolonged capillary refill times. They may also be tachycardic and have poor peripheral pulses4. Dogs with a right atrial HSA mass may present with a history of lethargy, exercise intolerance, weight loss, and respiratory distress. Physical exam findings may include muffled heart sounds (due to pericardial effusion), tachycardia, weak or thready pulses, pale mucous membranes, dyspnea, and ascites4.

Patients presenting with signs consistent with splenic or cardiac hemangiosarcoma should be immediately triaged to assess their health status. Many may benefit from immediate IV fluid boluses due to shock if the tumour is actively bleeding at the time of presentation. A blood sample for (at minimum) a PCV and total solids should be collected prior to fluid initiation. These results will serve as a baseline measurement for the fluid resuscitation and to determine if any blood products are required. Flow-by oxygen and analgesics may also be of benefit for some patients. Once the patient is deemed hemodynamically stable, further diagnostics may be pursued.

Etiology

The etiology of hemangiosarcoma is unknown; however, some studies show evidence that there may be dysregulation of pathways controlling blood vessel development (angiogenesis) at the molecular level3. The abnormal blood vessels produced by the tumour are weak and prone to leaking, leading to possible rupture and subsequent blood loss as they grow. Tumour cells are

Geri Higginson MSc, RVT received her 4 year BSc (Zoology) degree from Victoria College, University ofToronto in 1993 and RVT diploma from Seneca College in 1998. In 2007, she completed her MSc degree at the Ontario Veterinary College, University of Guelph, investigating the effect of diet on avian coagulation. She has worked at the Ontario Veterinary College since 1998, working both with Avian & Exotics department and presently, with the Oncology Service. Geri loves to travel, having spent time in Asia, SE Asia, and the Middle East. She is also actively involved with running and triathlon groups in the Guelph area.

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disseminated throughout the body from these abnormal vessels via the bloodstream as well as through the seeding of body cavities from the rupture of masses. Histologic confirmation is required for a definitive diagnosis of HSA as it can be difficult to distinguish between a hematoma and hemangiosarcoma on gross examination or with abdominal ultrasound. See Figure 1 for a histologic example of a dog’s spleen with hemangiosarcoma. Grossly, HSA lesions may vary in size and number, but are typically friable, blood-filled and poorly circumscribed 3, 5. Figure 2 shows evidence of hemorrhagic clots first evident upon incision into the abdominal cavity. Figure 3 shows the enlarged spleen exteriorized with 2 distinct masses located near the head and tail of the organ. Figure 4 shows the same spleen now removed from the dog. These splenic masses were confirmed to be hemangiosarcoma based on histologic diagnosis.

Diagnosis/Staging The recognized staging system for hemangiosarcoma is as follows: Stage I – dogs with a tumour less than 5cm and which is confined to a primary site such as the spleen (ie. not ruptured) Stage II – dogs with a tumour greater than 5cm, with or without rupture

Figure 1: Canine splenic hemangiosarcoma, 400x magnification. This tumor is composed of plump spindle cells forming irregular vascular channels with a classic sponge-like architecture. Photo courtesy of Dr. Andrew Vince.

Figure 2: Courtesy of Dr. Sarah Boston.

Stage III – dogs with a tumour greater than 5cm that has ruptured, with or without local spread into adjacent tissues such as the liver or omentum, and has distant metastasis (ie. To the lungs)3, 5. At the time of presentation, most dogs are likely a stage II or III, unless the mass is an incidental finding on examination for an unrelated issue. Diagnostic tests to stage the extent of disease present in suspected hemangiosarcoma patients should include complete bloodwork (CBC/biochemical profile +/- coagulation profile), three view thoracic radiographs (right and left lateral, ventrodorsal views), abdominal ultrasound +/- abdominocentesis and echocardiography. Typical sites of hemangiosarcoma metastasis include the liver, omentum, mesentery and lungs1-5. Dogs with evidence of gross metastasis at the time of staging have a poorer prognosis and surgery for these patients in the emergent setting is a palliative procedure only. The presence of metastasis may also affect owner expectations of their dog’s survival time and quality of life and subsequently may alter the chosen treatment plan. Anemia and thrombocytopenia may be present on the hemogram, with schistocytes or acanthocytes noted in peripheral blood smears3. The serum biochemistries may show evidence of hypoalbuminemia and hypoglobulinemia; prolonged prothrombin (PT) and activated partial thromboplastin time (aPTT) may be detected on coagulation profiles3. Abdominal and pericardial effusions from hemangiosarcoma will be serosanguineous and usually will not clot. Unfortunately, cytology of the effusions may not be helpful as tumour cells can be difficult to locate due to dilution by normal red blood cells. If detected, affected cells may have prominent multiple nucleoli, be multinuclear and may appear plumper than normal3.

Figure 3: Courtesy of Dr. Sarah Boston.

Three view thoracic radiographs should be obtained to rule out the presence of metastatic pulmonary nodules. Preliminary radiographs will also serve as a baseline measurement of disease progression if treatment is initiated. Abdominal ultrasounds are preferred over abdominal radiographs due to potential loss of detail in the radiographs from ascites. Ultrasonic examination of the rest of the abdomen may rule out the presence or absence of metastases in other organs. An echocardiogram of dogs presenting with pericardial effusions may detect a mass in the right atrium; blood clots, however, can also exhibit a similar mass-like effect. Unless the dog presents at a veterinary referral hospital with an on-site cardiologist, a cardiac assessment may not even be available at the time of presentation. A recent retrospective study assessed the presence of concurrent splenic and right atrial masses in dogs with hemangiosarcoma4. Results showed that dogs with hemoabdomen (due to splenic mass rupture) rarely had a concurrent right atrial mass (8.7%); intraabdominal metastasis instead was more common. However, dogs presenting with pericardial effusions and a cardiac mass showed a concurrent splenic mass in 29% of cases4. This suggests that the latter cases may have a primary cardiac HSA with subsequent metastatic spread to the abdomen.

Treatment Options and Prognosis

Treatment options for HSA patients include surgery alone, surgery followed by chemotherapy or chemotherapy alone. Surgery alone has been associated with survival times of 19 to 86 days 3,5. Surgery followed by chemotherapy for either splenic or cardiac HSA presentation prolongs survival typically up to 6 months, with the 12 month survival time in less than 10% of cases3. Chemotherapy on its own (even if appropriate drug and dosing protocols are

Figure 4: Courtesy of Dr. Sarah Boston.

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applied) provides a limited response with often a quick recurrence of the initial presenting signs. The treatment plan is often dependent on the patient’s overall health status at the time of presentation, the availability of surgery and/or adjuvant chemotherapy to follow the surgery (ie. owner proximity to treatment centres), the owner’s own emotional and financial considerations, as well as the personal experience and recommendations of the attending clinician. Surgery A complete splenectomy and removal of any metastatic lesions (such as liver or omental masses) would be required for any splenic HSA case. Palliative surgery options for primary cardiac HSA would involve a pericardiectomy to release the effusion around the heart, allowing heart function to normalize3, 4, 6. Surgical resection of right atrial masses is possible in some situations but due to an overall poor prognosis for long term survival, a pericardiectomy followed by adjuvant chemotherapy is more commonly recommended to owners6. Chemotherapy Chemotherapeutic agents are incorporated into the treatment of hemangiosarcoma to minimize and/or delay the onset of metastatic disease. Presently, the standard of care chemotherapy recommended for hemangiosarcoma in dogs is either single agent doxorubicin or doxorubicin in combination with other chemo drugs. Doxorubicin is used extensively in treatment regimes for humans with soft tissue sarcomas7. Although there have been various drug combinations previously evaluated for HSA (such as vincristine/cyclophosphamide/ doxorubicin; cyclophosphamide/doxorubicin; vincristine/cyclophosphamide/methotrexate), there appears to be little improvement to survival times from combination protocols with doxorubicin versus doxorubicin on its own3, 7-10. Protocols not containing doxorubicin seem to have limited efficacy in improving survival times beyond what is found with surgery alone8. Metronomic or antiangiogenic chemotherapy is a more recent oral chemotherapy protocol that specifically targets tumour vasculature development rather than the actual tumour cells11-13. The chemo drug cyclophosphamide has been shown in some studies to increase endothelial cell death (whereas the goal of other dosing is to tar-

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get tumour cells) when given in a continuous low-dose regime. Non-steroidal antiinflammatory drugs (NSAIDs), such as piroxicam and meloxicam, are also utilized in metronomic protocols as there is some evidence that inhibition of cyclooxygenase (COX) enzymes (mechanism of action for NSAIDs) can alter components of endothelial cell formation and growth factor production11. Other drugs, such as etoposide and doxycycline, may also be included in some metronomic protocols. Many oncologists are now including metronomic chemotherapy in conjunction with the standard doxorubicin protocols or will follow up with metronomics once the doxorubicin protocol is completed.

area (BSA) in square metres based on the patient’s body weight. For hemangiosarcoma, doxorubicin is administered IV every two to three weeks at a dose of 30mg/ m2 for 6 treatments. The cardiotoxic dose for doxorubicin is listed as 240mg/m2 total dose8 (ie. a cumulative total not greater than 240mg/m2 over the 6 treatments). Ideally, most patients (particularly if there is a breed predilection for cardiac disease and/or evidence on physical exam of cardiac concerns) will have, at minimum, an assessment of their heart’s contractility to determine suitability for doxorubicin administration. Monitoring of cardiac contractility throughout doxorubicin treatments is also recommended.

Metronomics is also an alternative treatment option for owners who choose not to treat with conventional chemotherapy. Although this protocol is generally well tolerated by the majority of patients, gastrointestinal toxicity and hepatic/renal concerns related to NSAID use, along with the development of sterile hemorrhagic cystitis from cyclophosphamide metabolism are possible side effects. At this time, there is little published research on the efficacy of metronomic use in the dog but it is an active area of investigation.

Chemotherapy treatments are usually initiated at the time of suture/staple removal (10-14 days post surgery). Presently, there is an ongoing trial at the Ontario Veterinary College Health Sciences Centre comparing doxorubicin administration given immediately post operatively (less than 72 hours post surgery and with histologic confirmation of hemangiosarcoma) versus the standard wait period. The purpose of the study is to assess if there is a longer survival time and any significant post-operative complications for HSA patients administered a more aggressive doxorubicin dosing schedule than the standard protocol.

Chemotherapy Dosing While chemotherapeutic drugs should always be given at the maximally tolerated dose and dose intensity, doses may need to be tailored to the individual patient based on their CBC results and any adverse reactions after previous treatments. Chemotherapeutic agents kill rapidly dividing cells and as such, cannot discriminate between normal cells and tumour cells. Due to their high cell turnover rates, the gastrointestinal tract and bone marrow are commonly affected4-16. Side effects can include nausea, anorexia, vomiting, diarrhea and myelosuppression. Although some toxicity may become immediately evident, symptoms will usually develop 3-5 days posttreatment. Medications to prevent nausea, vomiting and diarrhea should be sent home with clients so that they may initiate treatment at home as necessary. Future doses may need to be decreased if the patient suffers from significant toxicity after their first treatment. Aside from gastrointestinal and bone marrow toxicities, doxorubicin can also cause cardiotoxicity resulting in congestive heart failure in 20% of cases8. Most chemotherapy agents are dosed on the body surface

Chemotherapy Administration When administering chemotherapy, it is very important to be aware of specific nuances for each individual drug including routes of administration, contraindications, side effects, and general safety concerns. As doxorubicin can cause potential anaphylactic reactions in some patients, prophylactic use of diphenhydramine prior to administration is highly recommended15,17. Doxorubicin is also a tissue vesicant, resulting in severe sloughing of the surrounding tissue if the drug is administered perivascularly15,17. The severity of the tissue damage may even require the amputation of the affected limb17. Due to this concern, doxorubicin must only be administered through a well placed indwelling catheter. It is standard practice in our clinic to use a 2” 20g IV catheter in most patients if possible. Flushing with a minimum of 10ml of 0.9% sodium chloride will ensure the patency and correct placement of the catheter. If there is any question of its patency, the catheter should be removed and another vein utilized for the treatment.

references >

Figure 5: Chemo administration

Doxorubicin should be administered slowly IV (ie. 1ml/minute). For ease of administration, our clinic routinely uses a 19g butterfly needle and 3-way luerlock stopcock as an administration set into the catheter (with the doxorubicin syringe and a 10ml sodium chloride flush attached). This allows the administrator to deliver small volumes of drug followed by small volumes of flush, ensuring slow administration and increasing the safety of the whole procedure (Figure 5). Flushing the administration set greatly reduces the risk of a chemo spill in situations where the patient may struggle and the butterfly needle becomes dislodged from the catheter end. Some very anxious or aggressive patients may even require sedation for doxorubicin treatments to ensure the safety for all those involved with their treatments. Health care providers involved with the preparation or administration of chemotherapeutic agents are known to be at risk from exposure to these agents via inhalation, ingestion, or topically through direct skin contact or accidental injection14,18. It is clear that strict safety protocols must be followed with the use of chemo agents in both the clinic and at home by the client to reduce exposure concerns. This will include use of protective gowns, gloves, goggles, masks during intravenous chemo treatments and at minimum, the use of gloves during oral chemotherapy administration in the clinic and at home by the owner.

Patient Monitoring Post Treatment

During/

Restaging of hemangiosarcoma patients (with thoracic radiographs and abdominal ultrasounds) is recommended during their chemo protocol as well as every 2-3 months after completion to monitor for any progression of disease. Some owners may wish to discontinue further chemotherapy treatments at the time of detection of metastasis whereas others may elect for further surgery and/or a change in the chemo protocol if possible.

1. Sorenmo, KU et al: Chemotherapy of canine hemangiosarcoma with doxorubicin and cyclophosphamide. Journal of Veterinary Internal Medicine 1993; 7: 70-376. 2. Hillers, KR et al: Effects of palliative radiation therapy on nonsplenic hemangiosarcoma in dogs. Journal of the American Animal Hospital Association 2007; 43: 187-192. 3. Thamm, DH: Miscellaneous Tumours â&#x20AC;&#x201C; Hemangiosarcoma. In Withrow, SJ, Vail DM eds. Small Animal Clinical Oncology, 4th ed. St. Louis, Saunders Elsevier, 2007, 785-792. 4. Boston, SE et al: Concurrent splenic and right atrial mass at presentation in dogs with HSA: a retrospective study. Journal of American Animal Hospital Association 2011; 47: 336-341. 5. Hammond, TN et al: Prevalence of hemangiosarcoma in anemic dogs with a splenic mass and hemoperitoneum requiring a transfusion: 71 cases (20032005). JAVMA 2008; Vol 232: February 15, 553-558. 6. Weisse, C et al: Survival times in dogs with right atrial hemangiosarcoma treated by means of surgical resection with or without adjuvant chemotherapy: 23 cases (1986-2000). JAVMA 2005; Vol 226: Feb 15, 575-579. 7. Sorenmo, KU et al: Efficacy and toxicity of a dose-intensified doxorubicin protocol in canine hemangiosarcoma. Journal of Veterinary Internal Medicine 2004; 18: 209-213. 8. Teske, E et al: A randomized controlled study into the efficacy and toxicity of pegylated lipsome encapsulated doxorubicin as an adjuvant therapy in dogs with splenic hemangiosarcoma. Veterinary and Comparative Oncology 2011; 9: 283-289. 9. Sorenmo, KU et al: Canine hemangiosarcoma treated with standard chemotherapy and minocycline. Journal of Veterinary Internal Medicine 2000; 14: 395-398.

Conclusion

Hemangiosarcoma is a highly metastatic neoplasm with a poor long term survival prognosis in dogs with splenic and cardiac masses. It is important that as part of the veterinary team, RVTs are familiar with this type of cancer, its presenting signs and potential treatment options. Despite the poor prognosis for long term survival, hemangiosarcoma patients deserve to en-

10. Ogilvie, GK et al: Surgery and doxorubicin in dogs with hemangiosarcoma. Journal of Veterinary Internal Medicine 1996; 10: 379-384. 11. Lana, S et al: Continuous low-dose oral chemotherapy for adjuvant therapy of splenic hemangiosarcoma in dogs. Journal of Veterinary Internal Medicine 2007; 21: 764-769. 12. Chun, R, Thamm, DH: Targeting angiogensis and tumour vasculature. In Withrow, SJ, Vail DM eds. Small Animal Clinical Oncology, 4th ed. St. Louis, Saunders Elsevier, 2007, 262263. 13. Teicher, BA et al: Antiangiogenic agents potentiate cytotoxic cancer therapies against primary and metastatic disease. Cancer Research1992; 52: Dec 1, 67026704. 14. Oncologic Nursing Society: Patient and provider safety with the infusion process. ONS 33rd Annual Congress, Philadelphia, 2008. 15. Chun, R et al: Cancer chemotherapy. In Withrow, SJ, Vail DM eds. Small Animal Clinical Oncology, 4th ed. St. Louis, Saunders Elsevier, 2007, 92-118. 16. Morris,J, Dobson, J: Small Animal Oncology. Blackwell Science Ltd., Oxford 2001, 39-46. 17. Crump, KT. Veterinary Cancer Society [Internet]: Veterinary oncology â&#x20AC;&#x201C; Cancer and chemotherapy. Spring Valley (Calif ); c2009 [modified 2010 Feb 3; cited 2010 April 15]. Available from: http://www.vetcancersociety. org/ 18. MacDonald, V: Chemotherapy: Managing side effects and safe handling. Canadian Veterinary Journal. June 2009: Vol 50: 665-668. Other related references: 19. Higginson, G: Chemotherapy: safe administration and quality of life concerns. TECHNEWS Summer 2010; 33: 7-11.

joy a high quality of life for what time they have remaining with their families. Owners must always be made aware of all their options and will depend on their veterinary team to provide them with knowledgeable advice and realistic expectations.

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The activated clotting time (ACT) has traditionally been used as a test to assess the coagulation status of patients with conditions such as rodenticide toxicity, vitamin K deficiency, snake envenomation, haemophilia, hepatic failure and disseminated intravascular coagulation (DIC). In these conditions the ACT is markedly prolonged and associated with a history and clinical signs with (or potentially associated with) hemorrhage. As a single reagent assay, the simplicity and rapidity with which the results can be obtained are the advantages of ACT. The cost, in addition to the simplicity of this point-ofcare test, makes it valuable as a trending tool in any veterinary practice to monitor progress of therapy1. We have also identified the utility of the ACT as a screening test for inflammation2. The early awareness of a pathologic inflammatory process, which may be occult, prompts identification of a cause and subsequent early therapeutic intervention.

CE Article #2 The Activated Clotting Time in Veterinary Practice Ultimately, this may allow prevention of its progression to syndromes carrying a poorer prognosis such as DIC and multiple systemic organ dysfunction syndrome (MODS). C-reactive protein (CRP), an acute phase protein (APP), can be measured to identify and monitor an inflammatory process; however, this is not a point-of-care test, is frequently performed in batches and therefore, reporting is delayed, and is expensive. The ACT test has good biological correlation with the CRP and has the advantage of assessing the patient’s overall progress with respect to their inflammatory and/or coagulopathic conditions2. This monitoring would either confer a great expense, or would not be a financial option with other hemostatic tests.

The ACT is not meant to replace the prothrombin time (PT) or activated partial thromboplastin time (aPTT), which are frequently required for specific diagnosis, but as an inexpensive screening and trending test. The PT examines the extrinsic or tissue factor and common coagulation pathways with prolonged values indicating a possible deficiency of FII, FV, FVII, FX, or fibrinogen3. The PT is frequently performed to detect acquired clotting disorders including vitamin K factor deficiency or antagonism, hepatic disease, and DIC4. The aPTT screens for deficiencies and inhibitors within the intrinsic or contact activation and common coagulation pathways. Prolonged values indicate a possible deficiency of FII, FV, FVIII, FIX,

Karol Mathews DVM, DVSc, DACVECC, Professor Emerita • DVM, OVC, 1980 • DVSc Surgery, OVC, 1986 • Diplomate American College of Veterinary Emergency & Critical Care, 1993 • Service Chief - Emergency & Critical Care Medicine, OVC 1989-2009 • Currently: Professor Emerita, OVC • Chair WSAVA Global Pain Council • President-elect International Veterinary Academy of Pain Management •

Honours & Awards 1999 CVMA Small Animal Practitioner of the Year 2002 ACVECC Scientific Achievement – Pain Management in the Critically Ill 2002-2004 Presidential Distinguished Professor Award, University of Guelph 2009 Ira M Zaslow, VECCS award for Distinguished Service Author and co-author of 70+ refereed journal articles, and many book chapters Editor of Veterinary Emergency & Critical Care Manual 1st & 2nd editions (Lifelearn Inc) National and International speaker

Teresa Cheng, DVM, MSc, Dip. ACVECC During her training under Dr. Karol Mathews, Teresa’s MSc study focused on the relationship between inflammation and coagulation. Of particular interest to her was to see if inflammation altered the results of the common coagulation assays and also to investigate the utility of the ACT as a trending tool in ICU patients. Currently, Teresa is working as a criticalist in her home town of Vancouver, British Columbia at Canada West Veterinary Specialists and Critical Care Hospital.

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FX, FXI, FXII, prekallikrein (PK), high molecular weight kininogen (HMWK), or fibrinogen3. The aPTT should detect all factor-dependent coagulopathies with the exception of a FVII deficiency. The details of these tests and their shortcomings can be obtained elsewhere1.

Coagulation and Inflammation

A brief overview of this topic is presented as a basis for understanding the utility of the siliceous earth ACT test system described here, its correlation with the CRP in inflammatory conditions, and as an explanation for the dynamics of this test. Inflammation increases platelet numbers5. Inflammation also activates secondary hemostasis through several mediators. The outcome of inflammation-induced activation of coagulation is the formation of thrombin with subsequent fibrin clot development. A direct measure of inflammation can be obtained by measurement of CRP, which can dramatically increase in dogs when induced by any inflammatory focus6. In general, APPs increase in response to inflammation and tissue destruction and remain elevated pending resolution of the underlying inflammatory process. Physiologically, CRP is found in only low levels in health, has a short halflife, and is the fastest (reaching peak concentrations within 24 hours) reacting APP signaling the onset of inflammation with a rapid decline following the cessation of an inflammatory stimulus7. These properties not only facilitate detection of inflammation, but also trend the progression of the underlying disease and evaluate the effectiveness of supportive therapy. C-reactive protein is not a major APP in the cat and therefore considered to be a poor marker of inflammation in this species.

Figure 1: Shows small magnet in tube

Activated Clotting Time

The ACT has been used in veterinary practice for many years8 and was based on the original bedside coagulation test proposed by Hattersley in 19669. It assesses the time for a fibrin clot to form in fresh whole blood, after contact activation of factor XII. The specific tubes required for the test were produced by the Becton Dickinson Company (BD, Franklin Lakes, NJ, USA) and contained an inert siliceous earth compound (Celite®, Celite Corporation, Lompoc, CA, USA) as the activator for factor XII in formation of the fibrin clot. However, after many years of using the BD ACT tube in both human and veterinary practice, the manufacturer discontinued production because of a reduction in demand and difficulty sourcing the raw compounds. We mention this because the currently available ACT tubes are part of a system: Acetylyke™ system, Helena Laboratories, Beaumont, TX, USA. At the Ontario Veterinary College, two types of tubes are used: C-ACT™ and MAX-ACT™ tubes. C-ACT™ tubes contain celite and require 2mL blood, while the MAX-ACT™ tube contains three coagulation initiators (celite, kaolin and glass beads) and are designed for maximum contact activation of factor XII and require 0.5mL blood. Both tubes also contain a small magnet (Figure 1) which rotates in the blood when in the Actalyke incubator (Figure 2). When the clot forms, the magnet sticks in the clot which is sensed by the machine. It is this time that is digitally displayed. In human medicine, the ACT is used extensively for anticoagulation monitoring during cardiac bypass surgery, coronary angioplasty, dialysis, and therapies for thromboembolic diseases10. The incubator system digitally displays the time to full clot. This does not require examining the tube every 10 seconds and therefore allows the tester more freedom to focus on other aspects of patient care rather than the ‘test system’, which in many instances was the human axilla. While the tubes are designed for the incubator system, they can also be incubated in the human axilla in a

Figure 2: Actalyke Incubator

Figure 3: Tube must remain vertical

similar fashion to the BD tubes; however the MAX-ACT™ tube must remain vertical (Figure 3) to allow the small volume of blood to remain in the bottom of the tube with the activator. The ACT evaluates dysfunction within the intrinsic and common coagulation pathways with clot formation signifying the endpoint of the assay. The ACT [siliceous earth tube] requires a phospholipid surface to mediate the process of coagulation provided by the patient’s own platelets allowing it to be an indicator of a patient’s global state of coagulation10. Although moderate thrombocytopenia (50 x 109/L) has not been shown to prolong ACT, severe thrombocytopenia (<10 x 109/L) and qualitative platelet abnormalities are thought to influence ACT outcome. However, clinical observation has noted a normal ACT in some dogs with platelet counts <10 x 109/L. Newer point-of-care analyzers with the ACT option do not utilize the patient’s platelets. Instead there are added phospholipid reagents, stabilizers, and buffers. These multi-reagent ACT assays produce results that offer no additional information from aPTT11. Assays for both PT and aPTT are routinely performed on platelet-poor plasma and do not consider the significant interaction of in vivo platelets on clot formation12. The ACT is also sufficiently sensitive to distinguish hypercoagulable disorders10, which frequently occur initially in some conditions prior to the onset of hypocoagulation. As an example, caution is required when interpreting ACT following surgical trauma. There is a tendency for ACT to accelerate due to surgically- induced release of thromboplastin13. Therefore, trending is essential as the ACT moves from a shortened time (hypercoaguable) through normal range and into a prolonged time. The temperature at which the ACT test is performed is important and must be consistent in your clinic. The process of coagulation is highly dependent on the tempera-

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ture at which fibrin polymerization and platelet aggregation and adhesion occurs12, therefore, the ACT results can be variable when conducted over a range of temperatures. Acceptable heating sources include heat blocks14, waterbaths, the human axilla15 and the specific incubator in the Actalyte™ system, where the temperature can be set to a specific number [eg. 38.4°C at the Ontario Veterinary College OVC)]. It is essential that normal ACT values be established for each test system. The time for ACT using the MAX-ACT™ tube will differ from that using the C-ACT™ tube, and incubation in the waterbath at 37°C differs from the human axilla and the Actalyke incubator. Established reference ranges for the specific test system can be utilized but the system selected must be used consistently as this will reduce the variability that occurs when different contact activants and heat sources are used [BOX1]. The ACT protocol currently employed at the OVC is summarized in Box 1. The ACT reported is the time of first visual clot formation. This time usually corresponds to complete clot formation, however it may occasionally represent a partial clot. The subjectivity of time to visual clot formation can be a source of error with the inability to identify partial clots yielding erroneously prolonged coagulation times9. Conversely, when utilizing ACT for anticoagulation monitoring, an increased variability has been reported when the coagulation times are greatly prolonged. A cut-off point of 300 seconds has been the suggested value beyond which the accuracy of ACT as a guide for therapeutic anticoagulation dosing is reduced. This limitation may be of little clinical consequence as that degree of prolongation is well above the normal reported ranges in both veterinary and human patients.

Box 1. Ontario Veterinary College ACT Protocol Collect whole blood sample:

Sample collection remains an important source of error for hemostatic assays and proper technique is imperative. Atraumatic blood collection is essential. a. Avoid excess pressure in the syringe. Pull the plunger gently and allow blood to flow slowly. Excessive negative pressure on the syringe collapses the vessel and reduces/stops blood flow and results in a traumatic blood collection. b. Blood collected via venipuncture, or from an IV catheter at the time of placement, are both acceptable. c. Blood must be collected using a syringe TECHNEWS | VOLUME 35 ISSUE 3

table 1 > Reported ACT Reference Ranges for

MAX-ACTa and C-ACTb Tubesd

Species

Method

(number of animals in study)

Range (sec) Mean

Collection Site

MAX-ACT

Feline (32 normal catse)

37°C water 55-85 bath

Juglar

Canine (47 normal dogse)

37°C water 55-80 bath

Juglar

Canine (13 normal dogsf)

37°C heat- 65-90 ing block

Juglar

Canine (13 normal dogsf)

Axilla

70-105 94.5

Juglar

Canine (13 normal dogsf) Canine (20 normal dogs)

Incubatorb Incubatorb

78-110 93-108

Juglar Saphenous Vein

Canine (20 normal dogsg)

Axilla

85-105

Saphenous vein catheter

Canine (20 normal dogsg)

Incubatorb

95-115

Saphenous vein catheter

C-ACT

Helena Laboratories, Beaumont, Texas. These tubes contain kaolin, celite, and glass beads. Actalyke incubator, Helena Laboratories. c Helena Laboratories. These tubes contain celite. d Each institution should establish its own reference range specific to the ACT protocol and instrumentation used. e See AM, Swindells KL, Sharman MJ, et al. Activated coagulation times in normal cats and dogs using MAXACT tubes. Aust Vet J 2009;87:292-295. f Normal range established at the Ontario Veterinary College, University of Guelph, Ontario, Canada. Blood from a single sample was used for three incubation techniques. g Normal range established at the Ontario Veterinary College. a

as the C-ACT™ and MAX-ACT™ tubes do not have a vacuum. d. Prior to collection from an indwelling catheter [arterial line or jugular catheter – not a peripheral IV catheter] i. Flush the a-line with 1.0mL, from a syringe containing 2mL 1U/mL, heparinized saline, with immediate withdrawal of 2mL blood, OR ii. Flush the jugular catheter (pediatric as described in i above; adult catheter 3-4 mL from a 6mL hep saline syringe, withdraw 3-4mL blood) iii. Fill the syringe, to mix the withdrawn blood with the heparinized saline, which is capped for re-injection within 30 seconds. iv. Another needle and syringe are used to obtain the amount of blood required for the test and other tests that may be required, directly from the catheter. The blood should flow easily into the syringe. If there is difficulty, abort the attempt and try

another vessel. ‘Traumatic’ collection will give erroneous results. v. Immediately, remove the needle and place the 0.5 ml or 2mL blood directly into the ACT tube when timing is begun (Figure 4). vi. The heparinized blood is then replaced via the catheter to avoid

Figure 4

references >

Figure 5

iatragenic blood loss where frequent sampling will be necessary. Flush the catheter.

Key Points for the ACT

• Keep the tube upright to maintain the activator in the bottom of the tube at all times [Figure 1] • For 0.5-mL tubesa: • Swirl gently for 10 revolutions (Figure 5). • Axillary, water bath, or heating block method: - Place tube in: human axilla [tucked up high with only a shirt interface, keeping tube as upright as possible (Figure 5); OR a 37°C water bath; OR a 37°C heating block. - Examine the tube at 60 seconds, and every 10 seconds thereafter for clot formation (Figure 6). Continue incubation be tween examinations. Jiggle the tube, if the magnet is still free (moves), it is not clotted. The blood must remain in the bottom of the tube with the activator and magnet otherwise this small volume of blood will stick to the sides of the tube (Figure 7) reducing the volume of blood in the bottom of the tube. Once the magnet does not move, tip the tube to 45° - 90° (Figure 6) to ensure there is no movement of blood and it appears clotted, then tip 180° to confirm clot. • Incubator methodb: Tap the tube two or three times before placing it in the incubator to prevent the magnet from sticking prematurely and producing invalid results. The incubator should be set at 38.4°C.

1. T Cheng, KA Mathews, Wood D. The link between inflammation and coagulation: influence on the interpretation of diagnostic laboratory tests. Comp on Continuing Education. Feb 2011Vetlearn.com. 2. T Cheng, KA Mathews, RD Wood, ACG Abrams-Ogg. Relationship between assays of inflammation and coagulation: a novel interpretation of the activated clotting time in dogs. Can J Vet Res 2009 Apr;73(2):97-102. 3. Taylor LJ. Laboratory management of the bleeding patient. Clin Lab Sci 2003; 16(2):111 – 114. 4. Chee Y, Greaves M. Role of coagulation testing in predicting bleeding risk. Hematol J 2003; 4(6):373 – 378.

Figure 6

Figure 7

For 2-mL tubesc: • Tip the tube back and forth to mix the activator with the blood. • Place the tube horizontally in the axilla, the incubator, or upright in a 37°C water bath or heating block. Examine the tube at 60 seconds and every 10 seconds thereafter, for clot formation, by tipping the tube 90° and observe for movement of blood.

5. Peng J, Friese P, Wolf RF, et al. Relative reactivity of platelets from thrombopoietin and interleukin-6 treated dogs. Blood 1996; 87(10):4158 – 4163. 6. Murata H, Shimada N, Yoshioka M. Current research on acute phase proteins in veterinary diagnosis: an overview. Vet J 2004; 168:28 – 40. 7. Ceron JJ, Eckersall PD, Martinez-Subiela S. Acute phase proteins in dogs and cats: current knowledge and future perspectives. Vet Clin Pathol 2005; 34(2):85 – 99. 8. SW Bateman, KA Mathews, ACG Abrams-Ogg, JH Lumsden, IB Johnstone, TK Hillers, RA Foster. Evaluation of point-of-care tests for diagnosis of disseminated intravascular coagulation in dogs admitted to an intensive care unit. J Am Vet Med Assoc 1999; 215:805-810. 9. Hattersley PG. Activated coagulation time of whole blood. J Am Med Assoc 1966; 196(5):150 – 154. 10. Aucar JA, Norman P, Whitten E, et al. Intraoperative detection of traumatic coagulopathy using the activated coagulation time. Shock 2003; 19(5):404 – 407. 11. Tseng LW, Hughes D, Giger U. Evaluation of a point-of-care coagulation analyzer for measurement of prothrombin time, activated partial thromboplastin time, and activated clotting time in dogs. Am J Vet Res 2001; 62:1455 – 1460. 12. Schreiber MA. Coagulopathy in the trauma patient. Curr Opin Crit Care 2005; 11:590 – 597. 13. Gravlee GP, Whitaker CL, Mark LJ, et al. Baseline activated coagulation time should be measured after surgical incision. Anesth Analg 1990; 71:549 – 553. 14. AM, Swindells KL, Sharman MJ, et al. Activated coagulation times in normal cats and dogs using MAX-ACT tubes. Aust Vet J 2009;87:292-295. 15. SW Bateman, KA Mathews. Comparison of axillary and heating block methods of activated clotting time (ACT) in dogs. JVECC 1999; 9:79-82.

agulation system, we must consider the influence of inflammation on coagulation assays and therefore, the interpretation of the results of these assays. The cost of managing patients with inflammatory and coagulopathic conditions is high and utilizing the ACT for optimizing patient care is an approach to reduce diagnostic costs.

Conclusions With the existing evidence to support a highly integrated inflammatory and co-

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Mention the word hospice and the term alone evokes varying degrees of emotion in people. If this is a service that you have had the opportunity to be involved with personally it can stir up some powerful emotions and feelings. And, depending on the circumstances, it can either conjure up peaceful and grateful feelings or a negative and adverse reaction. Either way, the reaction is often strong. Human hospice has been called the “final act of compassion” and finds its roots traced back to Europe during the medieval times. By definition, the word comes from the Latin word hospitum, to host or hospitality.1 Hospice is a philosophy of care that provides comprehensive, loving support for patients with terminal illnesses that have progressed beyond a doctor’s expectation of cure. Hospice care helps the patient to live with dignity, in comfort and peace, surrounded by their loved ones, as they approach the end of their lives. The hospice philosophy teaches that death is a part of life and does not always involve suffering and struggle. Hospice neither hastens or postpones death and seeks to reduce the suffering involved in the dying process for both the dying patient and her or his loved ones. Having its foundation in religion, monks and nuns

CE Article #3 An Introduction to the Concept of Veterinary Hospice Care©

provided shelter and care for the poor, orphaned, sick and dying. Monasteries and convents initially were seen as a place for the weary traveler to rest. In 1905, the Irish Sisters of Charity opened St. Joseph’s Hospice in Hackney, East London. The mission of this facility was to care for the terminally ill. The modern hospice concept was defined and developed by Dame Cicely Saunders, a physician, R.N. and social worker, who began working with dying patients in the 1940’s. In the 1960’s Dame Saunders founded the first modern hospice, St. Christopher’s Hospice in London, England. Dr. Saunders believed that people continue to live very meaningful lives even when they are dying and that a loved one can be inspired to dedicate themselves to something of meaning in their memory.2 The hospice movement in the United States has its roots in the pioneering work of Dr. Saunders. In 1969, Dr. Elisabeth Kubler-Ross brought

the subject of death and dying out into the open with her groundbreaking and bestselling book, On Death and Dying, a book based on interviews with dying patients. Dr. Kubler-Ross identified five stages of grief: denial, anger, depression, bargaining and acceptance. Dr. Kubler-Ross’s trailblazing work enhanced the hospice movement. The first hospice in the United States was the Connecticut Hospice opened in 1974. Four years later, the U.S. Department of Health, Education and Welfare cited hospice as a viable concept of care for terminally ill people and their families providing humane care at a reduced cost.3 In the early 1980’s, U.S. Congress created legislation establishing Medicare coverage for hospice care. The Medicare Hospice Benefit was made permanent in 1986 and today most states also provide Medicaid coverage. This coverage allowed the movement

Ann P. McClenaghan, BS, CVT is a certified veterinary technician with over 23 years experience working in small animal practice. She has an Associate’s degree in Veterinary Technology from Harcum College and a Bachelor’s degree in Business Administration from Philadelphia University. Ann is a long time member of several veterinary professional organizations and served on the Board of Directors for the Pennsylvania Veterinary Technicians Association (PVTA). Ann was an instructor for seven years at Manor College in the Veterinary Technology Program and served as the program’s Education Coordinator. She is also a published author on the topic of veterinary palliative and hospice care and most recently co-authored a chapter in the Veterinary Clinics of North America: Volume 41 Number 3, May 2011, for Palliative Medicine and Hospice Care. She continues to teach others by presenting educational workshops for fellow veterinary technicians, staff, and pet owners about veterinary palliative and hospice care, grief support, and animal nature assisted therapy. Ann is also a member and Tester/Observer for Therapy Dogs Incorporated. She shares her life with her husband Charlie, their cat Lucy, and two dogs, Rusty and April.

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to grow with more hospices forming around the country. Hospices quickly grew from volunteer-based units into health care companies with paid staff and quality practices. Once people learned of the benefits of hospice care, more chose this care for themselves or their loved ones.

The Hospice Movement in Veterinary Medicine

Eric Clough, VMD and his wife, Jane Clough, RN, BA, VNA presented “Helping Clients Say Good-bye: Hospice Care for Pets” at the AVMA Convention in Baltimore, MD in 1998. This was a landmark conference for many veterinary professionals who had been providing pet hospice care and didn’t know it. Dr. Clough, a New Hampshire based veterinarian, became interested in his wife, Jane’s work as a human hospice administrator. Dr. Clough noticed that by using the human hospice philosophy of focusing on quality of life, providing pain relief and comfort as well as home care, his clients were more satisfied with their experience – even though the end result was the same. Dr. Clough said, “Hospice care gives you the opportunity to say goodbye to your pet. The underlying philosophy is not about treatment, but to make the animal comfortable and provide them with a kind death.”4 Soon the veterinary community began to see an emergence of the veterinary hospice care movement. In 2000, at the AVMA Annual Convention, Utah, Dr. Alice Villalobos, led a talk about the emerging veterinary hospice movement she termed “Pawspice”. Dr. Villalobos spoke about her many years of experience in veterinary oncology and the difference incorporating “Pawspice” care has made to her clients and the clients referred to her. Shortly after, in 2001, the AVMA established Veterinary Hospice Care Guidelines. These were reviewed and updated in 2007. The First International Symposium on Veterinary Hospice Care was held in 2008 at UC Davis. This was a first attempt at gathering professionals from different areas of healthcare to discuss this emerging new specialty of veterinary hospice. During that same year, Valarie Hajek Adams, a veterinary technician (CVT) from Wisconsin, USA, formed a 501c3 non-profit foundation, Healing Heart Foundation, Inc., to sponsor programs that honour the spirit of the human-animal bond. The first program the HHFI launched was Healing Heart Pet Hospice. This program is modeled after the human hospice standard in

that veterinarians are in place as medical directors and veterinary technicians do home health care under their direction. Other professionals such as mental health counselors are consulted or called as necessary. In 2011, the first veterinary palliative and hospice care textbook was published titled, Veterinary Clinics of North America: Small Animal Practice. Palliative Medicine and Hospice Care. Additionally, the AVMA updated the Veterinary Hospice Guidelines addressing a number of issues associated with providing hospice care and stated: “Although veterinarians and their staff also benefit from veterinary hospice by assisting in the respectful closure of each unique human-animal bond, hospice services provided by veterinarians are time consuming and require a considerable commitment to the medical needs of the patient and to the emotional needs of the client. Not all veterinarians are in a position to offer these services. Veterinarians or veterinary hospitals that are unable to offer hospice care should be prepared to refer clients to another veterinarian who can offer these services. Referring this activity does not infer that excellent care is not being delivered by the referring veterinarian, but provides more options for the client desiring to access veterinary hospice.”5

The Principles: Hospice and Palliative Care In Veterinary Medicine

Palliative care, (from the Latin palliare, to cloak), is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients. Palliative medicine is appropriate for patients in all disease stages, including those undergoing treatment for curable illnesses and those living with chronic diseases. In hospice care, it is an approach that improves the quality of life of patients and their families facing the problems associated with a life-threatening illness. Palliative care is comfort care that treats the whole patient – mind, body and spirit. Taken from the human model, palliative care is usually provided by a team of experts, including doctors, nurses and social workers. Chaplains, various therapists, nutritionists, pharmacists and others may also be part of a palliative care team. Every hospice patient receives palliative care, but not every patient receiving palliative care is a hospice patient. The veterinary hospice care model is afforded different options for care. Hospice may be provided through hospitalization,

but most frequently is provided in the pet’s home. Like human hospice, pet hospice and palliative care is best provided with a team approach coordinating a plan of care that falls within the family’s beliefs and goals for the pet. Hospice care is not for every pet or owner. Veterinary hospice care is not an alternative to euthanasia but a type of care that may precede it.6 Dr. Alice Villalobos cautions the veterinary profession to be vigilant against owners going too far. Her Quality of Life Scale has set a standard that many veterinary hospices utilize in practice.7 Criteria for veterinary hospice care are closely modeled from human hospice in that: • The patient has a life expectancy of 6 months or less • Doctors feel further treatment is futile since the patient is not improving • Owners who have opted not to pursue treatment

Aggressive Treatments/Diagnostics vs. Palliative Care and Hospice

When deciding to pursue aggressive treatment or certain diagnostic testing for a terminally ill animal, the veterinary practitioner must ask themselves the following questions and consider the answers carefully before moving forward.8 • Will the treatment change the outcome? • Will the treatment cause pain or harm to the pet? • Will the treatment improve the quality of life for the pet? • Will knowing the test results make a difference in the outcome for the pet or family?

The Benefits of Veterinary Hospice Care

Palliation allows the terminally ill pet to function more comfortably so as to enjoy as much of their normal routine as possible, interacting with their family in their own surroundings. Life is just better when its pain free! The bond between owner and pet deepens and takes on new meaning during the hospice care journey. Owners and their families will benefit emotionally, perhaps spiritually and often physically from having veterinary support to assist on this journey. While euthanasia might be a consideration at some point, it often does not have to be the first choice for many terminally or chronically ill pets. For the veterinary professional, providing

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veterinary palliative and hospice care to clients and their pets opens the door for economic and spiritual growth and can be very rewarding for the veterinary technician who feels this calling. Following in the steps of the human hospice care model, often it is the veterinary technician who is directly involved with patient care, teaching the owner palliative care techniques and medication administration. The veterinary technician serves as the medical liaison between the owner and attending veterinarian. Both veterinarians and technicians providing pet hospice care should know their state or province’s scope of practice by familiarizing themselves with their practice act. Being part of the end of life journey with an owner and their pet is a very enriching experience for all of those involved, especially the veterinary technician. Providing veterinary hospice care as an additional service will generate income and expand the client base of a practice. Offering this compassionate end of life care, dignifies the profession by further honouring the bond we share with our pets. Most importantly, the veterinary profession now has the ability to say to many families of pets with a life limiting or terminal illness, “We now have another option for you” instead of having to say, “I’m sorry, there’s nothing more that can be done”.

©**Reprint, copying, emailing, scanning without written permission from author strictly prohibited** Permission granted to TECHNEWS magazine for a one time non-internet, hardcopy only publication of this article 03/18/12 Ann P. McClenaghan, BS, CVT P.O. Box 1014 Willow Grove, PA 19090 USA Email: cm2am@aol.com

references > 1. Abington Memorial Hospital, Home Care Hospice Training Manual. Fall 2002. p.1 2. Brown, Gordon. 2008. Courage: Portraits of Bravery in the Service of Great Causes. New York: NY. Weinstein Books. p. 183 3. National Hospice & Palliative Care Organization (NHPCO). http://www.nhpco.org/i4a/pages/index. cfm?pageid=3285 4. Clough, E. And J. Clough. 1998. Lecture. “Helping Clients Say Good- bye: Hospice Care for Pets”. Proceedings for FasTrack To a Better Practice, Baltimore, MD: AVMA Convention. 5. Guidelines for Veterinary Hospice Care. April 2011. American Veterinary Medical Association, Schaumburg, IL. http:// www.avma.org/issues/policy/hospice_ care.asp 6. Clough, E. And J. Clough. 1998. Lecture and Proceedings. “Helping Clients Say Good- bye: Hospice Care for Pets”. Proceedings for FasTrack To a Better Practice, Baltimore, MD: AVMA Convention. p. 20. 7. Villalobos, Alice and Laurie Kaplan, MSC. 2007. Canine and Feline Geriatric Oncology: Honoring the HumanAnimal Bond. Ames, IA: Blackwell Publishing Professional pp. 304-305. 8. Clough, E. And J. Clough. 1998. Lecture and Proceedings. “Helping Clients Say Good- bye: Hospice Care for Pets”. Proceedings for FasTrack To a Better Practice, Baltimore, MD: AVMA Convention. p. 23.

bibliography > 1. Abington Memorial Hospital, Home Care Hospice Training Manual. Fall 2002. 2. Brown, Gordon. 2008. Courage: Portraits of Bravery in the Service of Great Causes. New York: NY. Weinstein Books. pp. 179-207. 3. Clough, E. And J. Clough. 1998. “Helping Clients Say Good- bye: Hospice Care for Pets”. Proceedings for FasTrack To a Better Practice, Baltimore, MD: AVMA Convention, pp. 19-43. 4. Downing, Robin. 2000. Pets Living with Cancer: A Pet Owner’s Resource. Colorado: AAHA Press, pp. 81-103. 5. Guidelines for Veterinary Hospice Care. March 2007, April 2011.

American

Veterinary Medical Association, Schaumburg, IL. http://www.avma.org/issues/ policy/hospice_care.asp 6. Gaynor James S. and William W. Muir III. 2002, 2009. Handbook of Veterinary Pain Management, 2nd. Edition, St. Louis, MO: Mosby, Inc. An affiliate of Elsevier Inc. pp. 2-12, 57-77, 505-600. 7. National Hospice & Palliative Care Organization (NHPCO), 1700 Diagonal Rd., Suite 625, Alexandria, VA 22314, www.nhpco.org. http://www.nhpco.org/ i4a/pages/index.cfm?pageid=3285 8. Shearer, Tamara S. Guest Editor. Veterinary Clinics of North America: Small Animal Practice. Palliative Medicine and Hospice Care. Volume 41. Number 3. May 2011. Philadelphia, PA: W.B.

(Source: North American Companion Animal Formulary, 9th edition, 2010)

Saunders Co. A Division of Elsevier, Inc.

Match up the human trade names with the comparable veterinary trade names. Human Trade Name Veterinary Trade Name 1. Cleocin a. Atopica 2. Eldepryl b. Reconcile 3. Buprenex c. Metacam 4. Neoral d. Antirobe 5. Diprivan e. GastroGard 6. Prozac f. Vetergesic 7. Mobic g. Cartrophen-Vet 8. Prilosec h. Anipryl 9. Pitocin i. Oxytocin 10. Elmiron j. PropoFlo

9. Shearer, Tami. 2002, 2009. “Hospice and Palliative Care.” In Handbook of Veterinary Pain Management, 2nd. Edition, by James S. Gaynor and William W. Muir III. St. Louis, MO: Mosby, Inc. An affiliate of Elsevier Inc., pp. 589-600. 10. Villalobos, Alice and Laurie Kaplan, MSC. 2007. Canine and Feline Geriatric Oncology: Honoring the HumanAnimal Bond. Ames, IA: Blackwell Publishing Professional pp. 277-333.

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

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OAVT’s 34th AnnualConference

Using Alternative Medicine Modalities in Equine Practice (Dr Alison Moore) •

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34th Annual

This year’s conference in Toronto hosted more than 1100 full delegates including 300 student delegates. The three day conference provided an outstanding CE program which was extremely well received by the delegates. The evaluations are carefully reviewed and provide a foundation for building the next program. Our roving reporter Shirley Inglis RVT provides some key take-away notes from a few sessions ~

Communication Summit (Jayne Takahashi and Heather Lowe) •

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Communication creates an impression of: - our level of care - our knowledge, expertise, competency - our ability to be trusted Something to keep in mind when you have a communication challenge: remain curious; be non-judgmental. How we communicate with each other is ultimately how we communicate with our clients. Veterinarians essentially conduct 160,000 interviews in their lifetime, yet they have had little training in communication skills It is a basic human need to be Heard, Understood and Acknowledged

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Core communication skills include: - open-ended inquiry - reflective or active listening - empathic statements - non-verbal cues Advised to start appointments with open-ended questions (except emergencies), as it saves asking them lots of questions and you pick up what is important to the client. How? What? When? Who? Use ‘Why’ cautiously as it may seem accusatory. Reflective listening is an attitude as much as a skill. In team medicine situations, to reduce repetition, the vet tech and vet can exchange information in front of the client (who can participate). Empathy does not equal sympathy. Empathy is stepping inside someone’s shoes, while sympathy is expressing pity. You can still be empathetic and not agree. State the obvious. Practice by starting with one interaction a day. Don’t respond to a client question with an answer. Respond with more questions. Speed of speaking is ~125-150 words/ minute; however one can listen at ~750-1200 words/minute. Therefore, we tend to lose focus when listening. Performance reviews should be seen as ‘career planning sessions’, not a grilling of past shortcomings. If you are uncomfortable looking clients in the eyes, look between the eyebrows. 80% of decisions are based on emotion. The wider the lens, the better the view. Most important thing in communication is to hear what isn’t said.

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Chiropractic integrates well with medical therapy, although currently a disconnect exists between the two modalities. The most important cause of loss of horses in performance disciplines is due to musculoskeletal injury and lameness, especially the back. Owners turn to Complementary and Alternative Veterinary Medicine as they don’t want their horse(s) to be dependent on medications, partially due to fear of positive drug testing at track or competitions. Women are more likely to use complementary therapies.

Where does the money go? (Katherine Dobbs) • • •

15-25% of practice income is never invoiced. To improve this stat, have the practice manager post missed charges. Institute multiple check points. Consider creating an auditor position.

The Wounded Patient: Managing the Wound and the Pain Things You May Not Think of (Karol Mathews) • • •

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Buprenorphine takes 30 minutes to work. Don’t confuse sedation with analgesia. EMLA (lidocane) cream is great for use before inserting IV and urinary catheters. Trend body temperatures using both the axilla and rectum. They vary 1-1.5C. Once you know the variation, you can just use the axilla (less invasive). Use alpha 2 agonists only in healthy animals (ex. quill removals). Don’t use NSAIDs for pregnant or lactating dogs, nor puppies. Neonates (0-2 weeks) - use fentanyl (less sedative). They have a lower opioid requirement. Flush wounds with room temperature shower water (ie. skip the expensive saline). For wounds, use raw honey (centri-

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fuged off the cone). Do not use fluorquinolones unless you know the infection is a gram negative rod.

Learning to Live in the Moment: Assisting the Pet Caregiver with Anticipatory Grief (Ann McClenaghan) • •

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Grieving is a process, not an illness. It doesn’t last just a day. Death is transforming and life changing. One never really resolves one’s grief. We reconcile ourselves to it. If we don’t acknowledge the significance of death, we don’t acknowledge the significance of life. (Dr Alan Wolfelt) Anticipatory grief is real. Acknowledge it. Thanatology = the study of death, dying and bereavement.

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11051 (Mar 27, 2012) Veterinary Assistant Multi doctor, multi technician practice looking for a veterinary assistant. Duties will include veterinary assistance, ward care and reception. Responses to rfox@cogeco.net general info at baycitiesanimalhospital.ca 11030 (Mar 19, 2012) FULL TIME - WE ARE ADDING AN RVT TO OUR TEAM Busy position in 3 doctor practice located in south Mississauga. Duties include anaesthetic induction, surgical assistant, dental prophy & digital dental radiographs, Idexx lab onsite, client visits, client education and patient care. Must be self-motivated, highly organized and have excellent communication ability. New grads welcome to apply. Group benefits, OAVT membership and conference paid annually. Call Bonnie Machin, CVPM, 905-826-1881, fax resume and cover letter to 905-826-7442 11027 (Mar 15, 2012) Veterinary Technician Wanted Exciting news! We are expanding our 24hr./7days a week facility plus opening a new Hospital in the Hamilton-Wentworth area. Recently we have increased ratio to one tech per vet plus extras. More technicians are required. We strive to provide excellent patient care, excellent service to clients and are AAHA accredited. This is a great opportunity for technicians to utilize all their skills in a fast paced, highly technical and modern facility. This facility include laser surgery, digital x-rays, digital dental, ultrasound, etc. We are looking for motivated individuals who

want to be part an exceptional team while at the same time be rewarded with a good quality of life and wages. Contact: Angela Brown at beattie.petvet@rogers.com, fax 519756-2305 11021 (Mar 12, 2012) Veterinary Technician or Veterinary Assistant Highbury North Pet Hospital in London seeks a registered veterinary technician or a veterinary assistant with formal training or experience to fill in for a mat leave, then to add to our team as a permanent position to the right candidate. All our wonderful staff are cross trained and very friendly, professional, dedicated, capable of serving clients and patients in all areas of the hospital. Remuneration dependent on experience and education and includes pet insurance, gym membership, break vouchers, uniform and CE allowances. Please e mail your resume and cover letter with references to highburynorth@rogers.com, fax to 519-659-9102 or deliver in person to 1-1570 Highbury Ave North, London ATT: Michelle or Dr Chin 11016 (Mar 9, 2012) Technician/RVT Needed We’re seeking a dynamic RVT/technician to join our outstanding team! Please email your Resume and cover letter, to Valerie Dunbar at vadunbar@cogeco.ca, or drop it off at Hastings Veterinary Hospital, Creekside Centre, 9E Tuftsville Road, Stirling, ON. (www.hastingsvet.ca, or visit us on Facebook).

11011 (Mar 7, 2012) FT & PT Registered Veterinary Technicians The VEC South has opportunities for RVTâ&#x20AC;&#x2122;s to work in an exciting 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 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 provide a challenging and supportive work environment with excellent opportunities to continuously develop your knowledge and skills for career advancement. The VEC provides on-site training for new grads. 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. Please forward your resume to the attention of Morgan Betts, Human Resources via e-mail at: hr@vectoronto.com or via fax: (416) 920-6185. Please note that the VEC hires RVTs only 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. 11010 (Mar 7, 2012) Veterinary Assistant/Technician We are within 30 minutes of Toronto, Brampton, Mississauga and Guelph and are looking for a Veterinary Assistant/ Technician. Responsibilities include working in treatment, surgery and reception areas where we strive to create an enjoyable, fun working environment. You should be a self starter, team player, with strong communication and interpersonal skills. The hours required may be FT or PT based on a mutually agreeable schedule. We are a flexible organization that understands the need to successfully balance work and family obligations. Working knowledge of Avimark would be an asset. Salary based upon experience with CE and health benefits available. New graduates welcome. Email cover letter and resume to info@terraglen.com or fax 905-873-7422. 24

11007 (Mar 5, 2012) RVT or VT Needed We are seeking an Energetic, Motivated, Experienced, Professional Full/ Part Time Vet Tech for our growing private practice. Must be good with Pets and their People. Full technical skills are required and previous Surgical and Dental experience a must. Knowledge of Avimark is a plus, but not essential. Competitive wages (based on experience), CE and benefits. New Grads are Welcome. If you enjoy working in an upbeat fun environment please contact us at 905-822-1644 or email your cover letter and resume to info@mcclearyanimalhospital.com. 11004 (Mar 5, 2012) Veterinary Technician Required Full Time/ Part Time (Day and night) veterinary technicians required for a progressive, high quality, full service 24 hours veterinary hospital in HamiltonWentworth area. Focus is on excellent pet care and service to our clients in a team based environment. Lots of opportunity helping in medicine and surgery. Competitive salary and benefits. Please forward your resume to fax 519-7562305 or e-mail beattie.petvet@rogers.com. 10985 (Feb 20, 2012) Reception/Technician Seeking dynamic positive team player for a busy full service clinic in London. Experience preferred but not mandatory. Position is 3/4 reception with some light technician duties as well. Benefits include health insurance, CE, uniforms, etc. Contact jaguarwoman66@yahoo.ca with resume, no phone calls please. 10984 (Feb 20, 2012) Office Manager Looking for experienced office manager/ lead receptionist for well-established practice. Minimum 3 years experience, Salary commensurate with experience. Please forward CV to ronna62@yahoo.ca in confidence. 10977 (Feb 14, 2012) Practice what you were taught 24 hour continuous care small animal hospital, requires full or part time experienced RVT. Weeknight, weekend and holiday, day or night, rotating 12 hour shifts with occasional weekday shift for

full time. Digital x-ray, on site lab, great team to work and learn with. Top concern is pets and clients, emphasis on pain control, nursing care. Please email clarksonvet@rogers.com. 10956 (Feb 7, 2012) Full Time Animal Care Attendant Needed! North Town is a progressive, fast paced 24 hour hospital specializing in emergency care and routine veterinary services. We are looking for an experienced ACA to join our amazing team of support staff. This position is a full time overnight position. For the right candidate we offer competitive wages, uniform allowance, benefits and a fantastic CE program. Interested applicants please submit a cover letter and resume to Emily - emily@ northtownvethospital.com. 10952 (Feb 6, 2012) Registered Veterinary Technician We are a busy small animal hospital in Richmond Hill looking for a full time RVT to join our team. We need a friendly, motivated person with excellent technical and communication skills to complement our well-established practice. We offer competitive wages and health/dental benefits. Please e-mail your resume and covering letter to vet.ad@hotmail.com. 10933 (Jan 31, 2012) Veterinary Technician Required Burlington Animal Hospital, located in Burlington, Ontario and Kingsway Animal Hospital located in Hamilton, Ontario are looking for a full time Registered Veterinary Technician to join their teams. This position would involve working at both locations until September 2012 and would thereafter be a full time position in Burlington. The ideal candidate would have strong client communication skills, a team medicine approach, and leadership qualities. We offer competitive salary, extended health benefits and continuing education allowances. Please submit your application to danyliwj@associatevets.com.

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10928 (Jan 20, 2012) RVT/VT New after hours veterinary hospital looking for experienced full- and part-time technicians to join our team. Please email cover and resume to Scott Whyte and Pam O’Connell at poconnellrvt@kingston.net 10914 (Jan 10, 2012) Emergency/After Hours + some weekdays Looking for full- or part-time experienced technician for 24 hours continual care small animal hospital - dogs and cats only. Primarily after hours - weeknights, weekends, holidays, + occasional weekdays if full time. Great skills with clients, competent tech skills, efficient, team worker. Please email clarksonvet@rogers.com. Thank you. 10903 (Jan 4, 2012) RVT Small animal hospital. Your skills will be utilized in, but not limited to anesthetic & surgical prep/assistance, digital imaging, labratory procedures, ultrasound, etc. We are open 7 days/ week and operate on a schedule of 10 hour shifts, 4 days on 4 off. Shared rotation of after hours treaments and after hours emergency on call. Benefits and continued education offered. Contact Pamela Yurick, vetme@live.ca, fax 807-344-8210 or mail 1160 Oliver Rd. Thunder Bay, ON P7B 7A4

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© 2012 Novartis Animal Health Canada Inc. ® Sentinel is a registered trademark of Novartis Animal Health Canada Inc. ® Flavor Tabs is a registered trademark of Novartis AG – Novartis Animal Health Canada Inc., licensed user.

Submitting Articles toTECHNEWS 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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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

T:3.375” S:2.125”

EQUINE NEWS

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Horse 360 app Promotes Equine Health to Owners World-renowned Australian horseman Clinton Anderson is partnering with a brand new iPhone 4 application, Horse 360, which features in-depth 3D anatomical diagrams and activities to help horse owners better understand their animals and communicate with their veterinarians. (Veterinary Advantage Weekly News)

QUA990656E

….and another resource for Equine Infection control California equine event biosecurity document - In response to the large and high-profile equine herpesvirus outbreak that occurred summer 2011,

AAEP seeking veterinarians for cases in laminitis study The American Association of Equine Practitioners Foundation is calling on veterinarians to volunteer information about naturally occurring cases of laminitis for the first study of The Laminitis Research Project. The Laminitis Research Project unites veterinarians and horse owners in a collaborative effort to uncover new information about the causes, prevention and treatment of laminitis. Researchers coordinating the first study in the project series, A Case-Control Study of Pasture- and EndocrinopathyAssociated Laminitis (PEAL) in Horses, are currently seeking cases from practicing veterinarians in the United States and Canada. This study is supported by the Foundation and by Prascend® (pergolide mesylate), manufactured by Boehringer Ingelheim Vetmedica, Inc. By identifying risk factors associated with this form of the disease, researchers hope to develop strategies for management and prevention, as well as identify priorities for future laminitis research. To sign up, visit the study website at www.vetmed. tamu.edu/laminitis. Participating AAEPmember veterinarians may also enroll in the study by contacting the Dr. Michelle Coleman, the study coordinator, at mcoleman@cvm.tamu.edu or (979) 219-3523. (Veterinary Advantage Weekly News)

Obesity demands more.

S:9.375”

AAEP Urges Utilization of Biosecuity Guidelines During Breeding Season The American Association of Equine Practitioners urged those involved in the breeding management of mares and stallions to reduce the risk of venereally transmitted diseases by utilizing the association’s “Biosecurity Guidelines for Control of Venereally Transmitted Diseases.” Developed in 2011 by the AAEP Infectious Disease Committee, the guidelines focus on controlling the transmission of equine arteritis virus (EAV), contagious equine metritis (CEM), and equine herpesvirus-3 (EHV-3). The guidelines provide recommendations for developing a biosecurity program for horses at a breeding facility, including the pre-breeding care of stallions and mares and protocols for natural breeding and artificial insemination. The biosecurity guidelines, along with the AAEP vaccination guidelines, are available at http://www.aaep.org/ images/files/BioGuidelinesContofVenTransDis.pdf.

the California Dept of Food and Agriculture has published a Biosecurity Toolkit for Equine Events (http://www. cdfa.ca.gov/AHFSS/Animal_Health/ Equine_Biosecurity.html). It’s a comprehensive document that covers a wide range of measures to reduce the risk of disease transmission.

Input to Canada’s New Equine Code of Practice Needed Canada’s National Farm Animal Care Council (NFACC) is conducting a second survey to gain further stakeholder input as it revises Canada’s official Equine Code of Practice which serves as the national understanding of equine care requirements and recommended best practices. The NFACC is overseeing a multi-year project to renew the Codes of Practice for several farm animal species, including horses. Each species has a lead organization responsible for facilitating their individual Code’s development. Those involved in equine sports, medicine and industry are encouraged to provide input through this survey. To complete this 10 minute survey, visit www. nfacc.ca/codes-of-practice/equine and click on survey. (Equine Canada)

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Bayer, Bayer Cross, K9 advantix and PetPak are trademarks of Bayer AG, used under license by Bayer Inc. TM, Bayer HealthCare LLC, used under license by Bayer Inc.

P O I S O N I N G T OX I C O L O G Y C O L U M N

Common Feline Poisons to Avoid! by Justine A. Lee, DVM, DACVECC, Associate Director of Veterinary Services, Pet Poison Helpline

Curiosity killed the cat, but satisfaction brought him back. Due to the curious nature of cats, it’s often harder than it looks to pet-proof one’s home adequately. Even the most experienced cat owner can still have common household poisons lying around. Make sure to educate clients on the common feline poisons commonly seen by Pet Poison Helpline, an animal poison control center based out of Minneapolis, MN, USA.

Human and Veterinary Medications Approximately 40% of calls to Pet Poison Helpline are due to cats inappropriately ingesting human or veterinary drugs. Cats have difficulty metabolizing certain drugs due to their altered glucuronidation (i.e., liver metabolism), especially as compared to dogs and humans. Common OTC drugs like ibuprofen and naproxen are non-steroidal anti-inflammatories (NSAIDS), and are deadly when ingested by cats. Even veterinary NSAIDs – particularly the chewable, canine tablets – pose a huge threat as well. When ingested, NSAIDS can result in severe, acute renal failure (ARF) and gastrointestinal injury/ ulceration. Likewise, one Tylenol (e.g., acetaminophen) tablet can be fatal to a cat. Untreated, it can cause severe methemoglobinemia, Heinz body anemia, dyspnea, cyanosis, a swollen face, liver failure and death. Cats also seem to like the taste of certain antidepressants (e.g., Effexor), which may contain an attractive smell or flavor in the coating. When ingested, selective serotonin reuptake inhibitor (SSRI) antidepressants can result in severe agitation, mydriasis, tachycardiac, tremors, and seizures. With any accidental medication ingestion, immediate veterinary care is imperative.

Lilies The common Lily plant (from the Lilium spp. and Hemerocallis spp.) is often found in gardens, floral arrangements, or as fresh cuttings. These beautiful, fragrant flowers are know as the common Easter lily, tiger lily, Japanese show lily, stargazer lily, rubrum lily, and day lily. All parts of the plant, including the pollen, are toxic to cats, and result in severe ARF. As little as 1-2 leaves or petals can result in ARF, and clinical symptoms are typically seen within hours. Clinical signs include early onset vomiting, depression, and anorexia, which progresses to acute anuric renal failure in 1-3 days. Clinicopathologic testing reveals severe azotemia, epithelial casts (12-18 hours postingestion) on urinalysis, proteinuria, and glucosuria. Treatment includes aggressive decontamination and IV fluid therapy for approximately 48 hours. While rarely performed in veterinary medicine, the use of peritoneal or hemodialysis has been successful in anuric renal failure cases. With treatment, the prognosis is good if treatment is initiated early and aggressively. Adequate decontamination (with emesis induction and activated charcoal) is of the utmost importance. If fluid therapy is initiated within 18 hours, the overall response to therapy is good. However, if treatment is delayed beyond 18-24 hours, or anuria has already developed, the prognosis is grave.

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Glo Sticks / Jewelry During certain holidays (e.g., Halloween), glo sticks and glo jewelry may be more readily available. These contain dibutyl phthalate (often nicknamed “DBP”) inside, which is the clear to yellow, oily liquid that has a very bitter taste. When a cat bites into these products, the DBP can leak out from the glo stick, and result in profuse drooling, gagging, pawing at the face, and retching. DBP can also result in irritation to the skin and eyes, resulting in a burning or stinging sensation or even corneal ulceration. As cats are fastidious groomers, they end up ingesting more and more as they groom the DBP off their fur. Thankfully, the chemical itself isn’t very “toxic,” but can result in pretty dramatic clinical signs. Most of these cases can be treated at home. First, the cat should be safely removed from the area, and any remaining DBP liquid should be cleaned up immediately. Next, the bitter taste of DBP can be flushed out of the mouth by offering the cat milk, canned tuna water (not oil!) or chicken broth. Lastly, a bath may be necessary (or at least a thorough wipe down) to remove any remaining DBP. Household Cleaners Exposure to household cleaners accounted for approximately 6% of feline-related calls to Pet Poison Helpline. Many cat owners don’t realize that some common household cleaners like kitchen and bath surface cleaners, carpet cleaners, toilet bowl cleaners and even laundry detergents can be toxic to cats. Symptoms can include profuse drooling, difficulty

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breathing, vomiting, and even organ damage. Cleaning products should be stowed out of any cat’s reach to prevent exposure. When using these products in the household, cats should only be reintroduced back into the cleaned areas after the products have completely dried. Pyrethrins and Pyrethroids: Pyrethrins and their synthetic derivative, pyrethroids, are commonly found in premise and topical insecticides (e.g., permethrin, cyphenothrin, bifenthrin, cyhalothrin, etc). The diluted amount found in premise sprays and topical flea sprays and shampoos is typically <1%. Toxicity from exposure to these low-concentration products is highly unlikely. That said, cats are significantly more sensitive to pyrethrins than dogs. While a precise toxic dose for cats is not well established, products containing greater than a 5-10% concentration of pyrethrins may lead to systemic toxicity. The application of canine spot-on pyrethin/ pyrethroid based insecticides (typically ~40% concentration) to cats is the primary cause of feline pyrethrin toxicity. Cats that groom dogs following recent spot-on applications are also at high risk for toxicity. Dogs are rarely at risk for systemic toxicity from routine or accidental exposure to pyrethrins. Dogs are more likely to suffer a dermal paresthesia reaction secondary to a concentrated spot-on product. Signs of systemic toxicity include hyper-

salivation, vomiting, hyperexcitability, twitches, tremors, dyspnea, weakness, disorientation, and seizures. Tremors are extremely responsive to injectable methocarbamol and less responsive to benzodiazepines. Seizures may be controlled with phenobarbital or general gas anesthesia. Dermal decontamination is crucial but should be performed after stabilization. This should be performed with a liquid, degreasing dish soap (e.g., Dawn, Palmolive). Supportive care including the monitoring and maintenance of hydration, body temperature, and blood glucose levels are necessary. Signs may persist for 1-4 days, depending on the animal. The prognosis is excellent with aggressive treatment. Conclusion These common feline toxins are readily available throughout a pet owner’s home, and veterinary professionals must be aware of the underlying mechanism of action, importance of decontamination, and overall treatment of toxicosis. With rapid decontamination, the prognosis is often much improved. With delayed treatment, along with the development of clinical signs, the prognosis may be poorer. Cat owners should be appropriately educated on how to cat-proof their house. About Pet Poison Helpline Pet Poison Helpline, a division of SafetyCall International, is a 24/7 animal poison control service based out of Minneapolis, MN. Pet Poison Helpline is available for pet owners and veterinary professionals who require assistance treating a potentially poisoned pet. The staff can provide treatment advice for poisoning cases of all species, including dogs, cats, birds, small mammals, large animals and exotic species. As the most cost-effective option for animal poison control care, Pet Poison Helpline’s fee of $35 per incident includes unlimited follow-up consultations. Pet Poison Helpline is available in North America by calling 800-213-6680. Additional information can be found online at www.petpoisonhelpline.com.

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CE Article #1: Canine Hemangiosarcoma 1. Hemangiosarcoma: a) Is a benign tumour b) Is only associated with previous radiation sites c) Is most commonly found in large breed, middle aged dogs d) Originates from abnormal endothelial cell development e) c & d 2. Which of the following describes a Stage II hemangiosarcoma: a) An intact primary tumour, less than 5cm in size b) A ruptured tumour with metastasis c) A primary tumour less than 5cm with metastasis d) A ruptured tumour greater than 5cm 3. Where does hemangiosarcoma typically metastasize to? a) Liver, lungs, brain b) Lungs, liver, omentum c) Brain, liver, omentum d) Omentum, liver, stomach

4. What areas of the body are most immediately susceptible to chemotherapy drugs? a) Bone marrow and skin cells b) Hair follicles and gastrointestinal tract c) Bone marrow and gastrointestinal tract d) Hair follicles and skin cells

8. Metronomic chemotherapy: a) Targets tumour cells b) Targets tumour vasculature development c) Includes NSAIDs d) b & c e) a & c

5. Why should diphenydramine always be given with doxorubicin? a) To prevent tissue sloughing b) To prevent anaphylaxis c) To help with drug absorption d) To reduce GI side effects

9. Splenic hemangiosarcoma patients a) Statistically have approximately 6 months survival post surgery only b) Receiving chemo drugs in combination with doxorubicin are proven to have longer survival times c) Statistically may have approximately 6 months survival following surgery and doxorubicin chemotherapy d) Should not have a splenectomy

6. Why is a well-placed IV catheter very important for doxorubicin administration? a) It is a tissue vesicant and can cause sloughing if given perivascularly b) Perivascular injections can cause an anaphylactic reaction c) It improves the patient’s response to the chemotherapy d) It will cause fewer GI side effects 7. The cardiotoxic dose of doxorubicin is: a) 30mg/m2 b) 180mg/m2 c) 240mg/m2 d) None of the above

10. Common presenting signs for dogs with hemangiosarcoma do not include: a) Respiratory distress and muffled heart sounds b) Distended abdomen and tachycardia c) Injected mucous membrane colour and bradycardia d) Lethargy and weak pulses

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CE Article #2: Activated Clotting Time 1. The activated clotting time is only used as a test 5. Which of the following can be used as a point-of- 8. The 0.5mL MAX-ACT tube must remain upright to a) Ensure that the magnet remains at the side of the care test to monitor a patient’s inflammatory state to assess the coagulation status of patients tube to facilitate clot formation a) PT a) True b) Ensure the activator prevents a clot b) aPTT b) False c) Ensure the blood does not stick to the side of the c) ACT tube d) CRP 2. The siliceous earth based ACT test requires the d) Ensure a platelet phospholipid layer e) All of the above addition of specific activators for clot formation e) Facilitate incubation of the patient’s blood 6. When performing the MAX-ACT which of the a) True 9. According to the ‘Reported ACT Reference Range’ following must be standardized when trending b) False table, the time to normal clot formation is individual patients a) the shortest with incubation in the axilla a) Incubation method 3. The ACT evaluates dysfunction within the b) the shortest with incubation in 37°C water bath b) Interval between testing a) Intrinsic and common coagulation pathways c) the shortest in the Actalyke incubator c) Venipuncture site with clot formation signifying the endpoint of d) longer with the 37°C water bath than the axilla d) Sampling technique the assay method e) All of the above b) Extrinsic pathway as it activates Factor VII with e) longer for cats than dogs with the 37°C water bath subsequent clot formation 7. Atraumatic blood collection is essential. Which of c) Extrinsic and intrinsic pathways involving all 10. The ACT can be influenced by: the following is correct: factors leading to clot formation a) test temperature a) Rapid aspiration of blood into the syringe d) Common pathway only making it a specific test b) patient temperature improves test results for clot formation c) patient platelet count b) Avoiding excess pressure in the syringe, allow e) All of the above d) test method blood to flow slowly into the syringe e) a, c, and d c) Increased negative pressure on the syringe main4. Inflammation has been documented to be closely tains vessel patency associated with the coagulation system. Which of d) Blood collection from the jugular vein guarantees the following tests is the preferred test to measure an atraumatic blood collection the degree of inflammation: e) None of the above a) ACT b) PT c) aPTT d) CRP e) None of the above

CE Article #3: Intro to Veterinary Hospice Care© 1. Hospice is: a) The “final act of compassion” b) Not a place but a philosophy c) A medical facility d) None of the above e) a & b 2. Hospice’s roots traced back a couple of hundred years ago to: a) United States b) China c) Europe d) None of the above e) a & b 3. Hospice care helps the patient to: a) Live with dignity b) Live in comfort and peace c) To be surrounded by their loved ones, as they approach the end of their lives d) All of the above e) None of the above 4. Which statement(s) are true about the Hospice philosophy: a) Hospice care is for every patient b) Neither hastens or postpones death c) Seeks to reduce the suffering involved in the dying process for both the dying patient and her or his loved ones d) All of the above e) b & c

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5. The following woman was a pioneer in the human hospice movement: a) Margaret Thatcher b) Florence Nightingale c) Dame Cicely Saunders d) Hilary Clinton e) None of the above 6. Palliative care is comfort care that treats: a) Only certain areas of the body b) The whole patient – mind, body and spirit c) Only the mind d) None of the above e) a & c 7. Pet hospice and palliative care is best provided: a) By a non-veterinary professional b) Outside of the owner’s beliefs and goals for the pet c) a & b d) With a team approach coordinating a plan of care that falls within the family’s beliefs and goals for the pet. e) None of the above 8. Which of the following statements are true: a) The veterinary hospice care model is afforded different options for care. b) Hospice may be provided through hospitalization, but most frequently is provided in the pet’s home. c) Every hospice patient receives palliative care, but not every patient receiving palliative care is a hospice patient. d) All of the above e) a & c

9. Which of the following statements are false: a) Veterinary hospice care is an alternative to euthanasia b) Veterinary hospice care involves a lot of diagnostic testing and aggressive treatments c) Veterinary Hospice care is for every pet with a life limiting illness d) All of the above e) None of the above 10. Regarding the benefits of Veterinary Hospice Care, the following statements are true: a) Owners and their families will benefit emotionally, perhaps spiritually and often physically from having veterinary support to assist on this journey. b) Providing veterinary hospice services will not generate income and expand the client base of a practice. c) While euthanasia might be a consideration at some point, it often does not have to be the first choice for many terminally or chronically ill pets. d) All of the above e) a & c

Global news

Canada - New University of Guelph Facility to Advance Public Health, Zoonoses Research - (December 2011) The University of Guelph opened a new research facility to help prevent and control emerging animal related diseases that threaten public health.

American and three international championships. But Kate’s win at the world’s most famous dog show was completely unexpected. Kate was set to tour around the United States for several few weeks before returning home to her family in Sherwood Park. (CBC News)

Based at the Ontario Veterinary College (OVC), the new laboratories will support investigations by researchers in U of G‟s Centre for Public Health and Zoonoses (CPHAZ). Scientists will use state-of-the-art equipment to address new or re-emerging zoonotic diseases such as the H1N1 flu virus, bird flu, E. coli O157:H7 and West Nile virus. The Centre for Public Health

US - Ceva partners with Leader Dogs for the Blind - As part of its strategic mission to extend its commitment to the bond between animals and humans, Ceva Animal Health announced it is sponsoring a guide dog. Ceva has partnered with Leader Dogs for the Blind to support a black female Labrador puppy appropriately named “Ceva.” This is the first time in its 73-year history that the Leader Dogs for the Blind organization has connected with a companion animal pharmaceutical company to promote its life-changing programs. (Veterinary Advantage Weekly News)

US - Hyperbaric oxygen chamber explosion - A company that billed itself as manufacturing the “safest, most advanced and most reliable chambers in the world” is asking users to stop operating its hyperbaric oxygen chambers following a fatal explosion in Ocala, FL. In a letter to customers, Lexington, Ky.-based Veterinary Hyperbaric Oxygen offered “sincere condolences” to those impacted by the Feb. 10 explosion at the Kentucky Equine Sports Medicine & Rehabilitation Center (KESMARC). KESMARC employee Erica Marshall, 28, was killed along with a horse inside the chamber that exploded. A female intern working nearby in the center sustained injuries. The letter asked users of its chambers to shut down until investigators can pinpoint the cause of the explosion. Local media have reported that a horse inside the hyperbaric oxygen chamber kicked off a protective cover over its shoes. (Veterinary Advantage Weekly News) US - Sherwood Park Poodle wins at Westminster - A poodle owned by a Sherwood Park veterinarian and breeder has won top honours at the world-renowned Westminster Dog Show 2012 in New York City. Kate Winsit, a 2½ -year-old standard poodle, won best of her breed at the show on Monday, defeating two of the top dogs in the United States. Owner Dr. Elly Holowaychuk has raised poodles for more than 27 years with great success — her dogs have won 65 Canadian, 35

Worldwide - Pfizer Equine supports World Vets in Nicaragua - Pfizer Equine has donated vaccines to World Vets to support an ongoing equine project in Granada, Nicaragua. The project is focused on the 6,000 working horses that live in the immediate area and have little access to veterinary care. Granada is unique in that horses are still the most common way to move heavy materials, especially for the construction industry. The World Vets team of 12 volunteers treated and vaccinated over 400 horses during the week of the project. (Veterinary Advantage Weekly News) US - Bill Gates - A voice of reason for Modern Agriculture - The Microsoft founder is an advocate for agriculture, championing the use of technology and modern agriculture to alleviate hunger throughout the world. He has called for a ‘digital revolution’ to combat hunger by increasing agricultural productivity through satellites and genetically-engineered seed varieties. He believes it is possible for small farmers to double and in some cases even triple their yields in the next 20 years, while preserving their land. Gates’ foundation has committed $2 billion for farmers over the years, and just

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announced $200 million in new grants to finance research on a new type of drought-resistant maize, a vaccine to help livestock farmers and a project training farmers. He feels that investments in agriculture are the best weapons against hunger and poverty. He defends the use of GMOs in the developing world and large-scale farm land investments by foreign states in the developing world - both seen as highly controversial by many. (Drovers CattleNetwork) and Zoonoses involves more than 40 U of G scientists, as well as government and industry collaborators. They investigate a variety of infectious diseases, including food-borne diseases and diseases affecting companion animals, food animals and wildlife. (University of Guelph ‘Feedblitz) US - Feline intakes, euthanasia down in shelters - Feline intakes and euthanasia in animal shelters continue to trend downward, according to the latest PetPoint report. The report, showed that intakes of cats declined 6 percent and euthanasia of cats decreased 4 percent in November 2011 compared to the year-ago period. Owner surrender and stray cat intakes declined year over year by 5 percent and 9 percent, respectively, while adoptions and returns to owners increased by 2 percent and 5 percent. Petpoint postulates that the increasing return of lost cats to their owners suggests more cat owners are using appropriate methods of pet identification, such as microchips and external ID tags. (Veterinary Advantage Weekly News)

US - Cat Friendly practices in pilot program see revenue increase - A pilot program transforming “ordinary” veterinary practices into “more cat-friendly practices” saw the bestperforming and most engaged practices achieve an increase between 14 percent and 33 percent in feline revenue after only a few months of participation, according to the CATalyst Council. Practices participating in the pilot program compared revenue and feline invoices from the same time period (May through September) during the previous year (2011 vs. 2010). Preliminary results of the “Cat Friendly Practice Makeover” were released at last month’s annual board and sponsor meeting of the CATalyst Council in San Francisco. (Veterinary Advantage Weekly News) Worldwide - UK Pet Population Shifts, Dog Population Declines and Pet Obesity on the Rise - The role of ‘man’s best friend’ is shifting to other animals outside of the dog population, and pet owners are also now dealing with fatter dogs and cats. The proportion of households in the UK owning a dog has dropped, particularly large dogs (those heavier than 23kg), which experienced a decline from 2.8 million to 1.8 million during 2006 through 2011. This number fell by over 200,000 in 2011 alone. UK pet owners turning their attention to lowcost and low-maintenance pets such as cats, and even reptiles. (Euromonitor International)

A Burmese python is wrapped around an American alligator in Everglades National Park, FL. (Lori Oberhofer/National Park Service/Associated Press)

US - Large numbers of mammals living in Florida’s Everglades are being wiped out by massive pythons, a phenomenon scientists fear could disrupt the food chain and upset the ecosystem, says a new study. The finding is based on the fact that roadside sightings of mammals such as raccoons, opossums, bobcats are down significantly in areas where pythons and other large constrictor snakes live, according to the study published Monday in the Proceedings of the National Academy of Sciences. The snakes are not native to the Everglades and many are likely dumped there by people who bought them as pets but turned them loose after they grew too big to keep at home. It’s believed others escaped from pet shops during hurricane Andrew in1992 and have been reproducing ever since. (CBC News)

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US - Rising (U.S.) Dog, Cat Ownership Buoys Pet Sector - Anemic growth of American consumers’ per capita disposable income during the recent economic downturn did not adversely affect dog and cat ownership—or the pet sector’s bottom line—according to a February 2012 special report by Santa Monica, Calif.-based market research firm IBISWorld.

Directions to the emerg clinic Owners will sometimes drive straight to your clinic if their pet experiences an emergency. Consider installing a mailbox that will hold directions (including the phone number) to the emerg clinic so that no more valuable time is wasted. Don’t forget to keep it well-stocked. Convenient Location for Eye Lubricant To keep eye lubricant for anesthetized patients handy, attach a magnetic clip to the anesthesia machine and then clip the lubricant in it. No more searching through drawers to find those small tubes. Double Gloves Use double gloves when expressing anal glands. After expressing the glands, remove the first glove. Then clean the patient’s bottom with a baby wipe and spray with a pet deodorizer/perfume. Once completely finished, remove the second glove. Look ma, nice clean hands! And these tips gleaned from a piece on Emergencies by Dr. Scott Shaw, DVM, DACVECC Cats that are in heart failure are hypothermic. So if you see a dyspneic cat with a temperature >38C, think respiratory disease. If its temperature is <38C, think heart failure. The type of fluid you choose in an emergency seldom matters, except in animals with heart failure or severe hypochloremia Wounds aren’t always what they seem, especially in patients with impalement injuries. Stick wounds require aggressive exploration as they can leave a long track of debris that can quickly lead to sepsis. Migrating foreign bodies can be trouble, particularly porcupine quills. A single quill left behind may end up in the brain, lung, or pericardium—several days to months after the porcupine encounter. So do your best to find and remove them all. Age is not a disease. While age-related diseases exist, an ill older animal may live quite awhile if the disease is managed appropriately.

Despite the slow-down in growth, the American Pet Product Association reported the number of dogs and cats owned as pets rose from 163 million in 2007 to 180 million in 2011. Dog and cat ownership is expected to rise 2.2 percent this year to 184 million. IBISWorld expects revenue from pet stores, groomers and boarders, veterinarians and sales from online suppliers to total $51.6 billion in 2012. They also forecast demand for pet products and services to grow through 2017 as per capita disposable income grows. Food production, breeding, insurance and funerals are listed as some areas of potential growth. Pet boarding businesses posted the highest growth in the sector with an annualized rate of 4.1 percent, according to the report. Pet store revenue grew at an annualized rate of 2.8 percent. The report also stated online sales of pet food and supplies—especially premium foods and pharmaceuticals—have increased since 2007. Veterinarian services saw slow growth, but those businesses that managed costs well had positive revenue growth, the report stated. (Pet Product News International.com) US - Increase in veterinarians per practice - According to a recent JAVMA News article, the number of veterinarians per practice has increased “noticeably” in recent years. For all private practices combined, the mean number of fulltime–equivalent veterinarians per practice increased from 2.08 in 1999 to 2.44 in 2009, according to the AVMA Biennial Economic Survey. For companion animal-exclusive practices specifically, solo practices are now less common than practices with more than three veterinarians. Many companion animal practices have even more veterinarians, and many have multiple locations. Meanwhile, the biggest corporate practices, Banfield Pet

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Hospital and VCA Antech Inc., continue to expand. Business considerations and veterinarian preferences, not the increase in the supply of veterinarians, seem to be the primary factors contributing to the growth in practice size. However, it has yet to be determined what effect, if any, the weakening demand for veterinary services might have on the trend toward larger practices. (JAVMA News)

Matilda, the resident cat of New York’s Algonquin Hotel, has been banned from the lobby, ending a feline tradition that began in 1932. (Richard Drew/Associated Press)

US - NYC hotel’s famous feline banned from lobby - One of the hotel’s favourite traditions is the succession of cats that have had free run of the place for 80 years. But that tradition has ended. The New York Post reports that city health inspectors have banned the current cat, Matilda, from roaming the lobby. The city department of health says pets are not allowed in areas where food is served. And the Algonquin serves food in the lobby. The Post says Matilda is now on a leash behind the check-in desk or out of sight on a higher floor. The blue-eyed cat took up residence winter 2011. She’s the 10th Algonquin cat since 1932.

Apps and Websites to Watch Merial launches second wave of smartphone app Merial has expanded its smartphone presence with a second HEARTGARD Dose Reminder App available to Android users, and has improved the HEARTGARD app for iPhone users.The app allows pet owners to set individual reminders for each of their dogs and users can now share accounts from one phone to another. Pet owners can also use their camera phone to assign a picture to monthly reminders, and custom dog barks can be added to reminders too. The app also allows pet owners to select if they have purchased a 6- or 12-dose pack of HEARTGARD. On the last reminder it will direct them to call their veterinarian for a refill and display their veterinarian’s contact information for easy access. Pet owners can download the Android version of the app via the Android Market™. iPhone users can download the app through iTunes or through the App Store on their phone. (Veterinary Advantage Weekly News). Nutrition app Doggie Dietician is an iPhone application developed by Dr. Sheri Cone to help dog owners improve their dog’s diet. Doggie Dietician walks pet owners through a series of questions to determine how much to feed a pet, then makes specific diet recommendations. The app also offers a database of dog breeds and their ideal weight; the caloric count of dog foods and treats; a list of toxic foods to avoid; and more. Dogsandticks.com, the online authority on ticks and tick-borne illnesses, is now an even greater resource for veterinarians and their clients. The website has been redesigned to include new educational tools for pet owners, such as maps showing the incidence of tick diseases, a risk assessment for dogs and information on a wide range of ticks and the diseases they carry. The refreshed site also incorporates several interactive features to engage and inform visitors about tick-borne illness. For complete details go to idexx.com. Also by Idexx: IDEXX Laboratories, Inc. announces the launch of a new web-based resource for veterinary practices that wish to establish consistent protocols for a higher standard of patient care and improved client experiences. STEPs, Simple Tools for Effective Protocols at idexx.com/steps, helps practice managers or owners better manage change with a complete set of tools for staff training, protocol implementation, pet-owner education and gauging progress. For complete details, go to idexx.com.

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Investigate the provincial association’s web sites for details on other continuing education opportunities. Current as of: March 2012

Nestle Purina Veterinary Symposium series in 2011 (Sponsored by Nestle Purina) If you missed the Purina Symposium series in 2011 you can now attend online! Go to http://www. purinavetsymposium.com/ to register and view presentations.

2012 May 4-6 PABA (Professional Animal Behavious Association) Location: Thornborough Hall, University of Guelph, Guelph, Ontario July 10, 2012 12:00-1:00pm CST Toxins in your Garage Poisonous to Small Animals Speakers: Justine A. Lee, DVM, DACVECC Ahna G. Brutlag, DVM, MS I Hour of RACE approved CE Register at www.petpoisonhelpline.com/ veterinarians/webinars

July 11-14 Canadian Veterinary Medical Association. 64th CVMA Convention “Learn à la Montréal” Best Medicine Practices – Timely Topics.

Dr. Bryon Blagburn, MS, PhD: Emerging Issues in Heartworm Health Available on demand. www.heartwormwebinar.ca

November 6, 2012 12:00-1:00pm CST Kitchen Toxins Dangerous to Pets Speakers: Justine A. Lee, DVM, DACVECC Ahna G. Brutlag, DVM, MS I Hour of RACE approved CE Register at www.petpoisonhelpline.com/ veterinarians/webinars.

Canine Foundations 2012 Seminars Canine Foundations is offering the following topics at Georgian College in 2012:

November 9-11 The Communication Summit for the Veterinary Practice Team A Communication Boot Camp that will take your practice to the next level in customer relations, teamwork and patient care. Location: Hockley Valley Resort, Ontario www.iccvm.com 1-888-527-3434 for more details.

• • • • • •

Dog to dog aggression Canine emergency first aid Canine self defence Get Fit with Your Fido Canine basic behaviour 101 Canine behaviour 102 Separation anxiety

Please visit the website at www.caninefoundations.com to register and learn more information.

2013 February 21-23 35th Annual OAVT Conference and Trade Fair Location: The London Convention Centre, 300 York Street, London, Ontario

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Handling Foals by Nettie Barr Canadian Natural Horsemanship Inc.

throughout the entire process we are imprinting. A common concern is that the mare will be aggressive towards the handler. This can be true in some cases; therefore, it is important that the owner has established an understanding of trust and respect with the mare prior to breeding and foaling.

Do not put your head above the foals head as shown in this picture. It is not uncommon for foals to throw their head up reactively.

At birth a foal is fully developed, nourished, and neurologically mature, to soon be on its feet and run from danger. Their senses are fully functional. Some horse handlers believe foals to be frail, and are concerned about handling the foal at birth. There are proven advantages to the technique of imprinting, where the foal is handled at birth and desensitized. Early imprinting facilitates easier handling of foals, yearlings, and later for training under saddle. Imprinting can only occur within the first few hours after birth. Any handling that occurs after the first few hours is considered training. Generally when using the technique of imprinting, at three days of age, foals are halter broke, able to handle, and pick up their feet. It is important that when you are imprinting you do not come between the mare and the foal. We allow the mare to smell and lick her foal

Always be aware of the mare and her body language. If you are present at the birth, the mare likely accepts you as you have the scent of the foal, afterbirth, etc. It is not uncommon for the mare to be somewhat “pinny eared”. This is not always a sign of aggression. Horses also pin their ears when they are feeling unconfident or unsure.

dler to first halter the mare. If possible allow the mare to be present, rather than tying her up. I encourage you to introduce yourself to the mare and allow her to smell you. Once handling the foal, periodically continue to allow the mare to smell you. If it is comforting to the mare, give her some attention and rub her. This will give her more confidence as you now have the scent of the foal on you. If the foal is difficult to catch, avoid cornering and trapping. If time allows, wait for the foal to nurse and then approach and firmly catch the foal. Do not use the “gotcha” approach. If time is of the essence and you must catch the foal, avoid grabbing too hard. Place one hand at the chest area to prevent forward movement and place the other behind to prevent the foal from backing away. Only be present with your hands; apply pressure only when the foal attempts to move away. When the foal relaxes be sure to release the pressure. Using this technique, the foal quickly learns to avoid pressure he/she must relax.

Read the mare’s body language. This allows you to handle the foal safely and effectively. Always let the mare see and smell the foal. As Veterinary Technicians, unfortunately you do not have the opportunity to establish this trust and respect with the mare. It is important to enter the pen as though you are not on a mission. Give the mare a chance to relax with you present. Avoid consistent, direct eye contact. Keep your body language quiet. Listen to and read the mare’s body language. Ask the owner if the mare is accepting and respectful before approaching the foal. If you are unsure, it is not incorrect to ask the han-

Do not take the foal immediately away from the mare. Handle the foal as closely to the mare as possible. This keeps both the mare and foal more relaxed and confident with you in their space. Allow the foal to nurse periodically as they tire quickly. Allowing the foal to nurse brings the foal and mare back to a state of relaxation. If possible, these handling sessions should be frequent and short.

Rub in the area you are asking the foal to pick up their foot. Then begin with phase one applying fingertip pressure.

When the foal lifts the foot, let the foot rest in your hand. In time ask the foal to keep the foot in your hand for longer periods of time.

For your safety, consider your body position. Remember the horse’s blind spots directly in front and behind the horse. Avoid having your head above their head as it is common for foals to quickly and

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can also use a butt rope. For safe and effective communication, the ropes should be on the same side you are on; that is, if leading on the left side, the lead shank (or horseman string) is in your left hand, the butt rope is in your right hand. Be sure to teach both the left and right side of the horse.

Stand off to the side, rather than directly in front of the horse. Comb the rope through your hands slowly applying more tension on the rope. The second the foal moves forward, release rewarding the slightest try. Notice I use the horseman string rather than a lead shank which may be too heavy for a young foal.

reactively bring their heads up. Rub; do not pat. When handling foals, your hands are present, not grabbing or holding. The foal quickly learns to not lean into pressure. This is important to horse owners and handlers, as foals are very responsive and light. Rough or inexperienced handling can create heavy, nonresponsive, and more reactive horses. Early learning is very powerful, and has a lifelong impact on the foal. Leading When teaching horses to lead, have slow hands to ask and quick to release. Offer support with your hand behind the foal’s butt, slowly increasing the pressure. The instant the foal responds, release! You

A foal at birth is neurologically mature enough to soon be on their feet.

When the foal learns to give to pressure you no longer require the butt rope. You can then begin teaching the foal to lead from pressure with the halter and lead shank. Lead off from the side rather than straight in front, ‘combing’ the rope through your hands, slowly adding more pressure. Reward the slightest try. As the foal develops an understanding, you can increase the number of steps. There is a formula for teaching: first we want to develop an understanding, then quality, and then quantity. Picking up Feet Position yourself at a 45 degree angle from the front feet. Whether you are picking up the front or the hind feet, stay in close. Rub the area with open hands you will be applying fingertip pressure. Then begin applying pressure using phase 1 which is very light fingertip pressure. Slowly increase the pressure till the foal picks up the foot or shows a try. Immediately release the pressure, and rub again open handed. Build this understanding

Allow the foal to nurse throughout handling.

Be present with one hand on the butt if the foal backs, and the other in the chest area should the foal want to move forward.

to where the foal understands to pick up his foot. I do not ask at the chestnut, particularly with colts or stallions as this is the area that in play, they nip at one another. When the foal lifts his foot let it rest in your hand. If the foal resists and tries to take his foot back, remain present in your hold, but do not grab too tightly. Move along with the foot, trying not to give the foot back until the foal relaxes. Build an understanding where the foal can leave his foot up for longer periods. Common Foal Handling Mistakes: • Anthropomorphism (attributing human qualities to the foal). • Starting too heavy. • Not rewarding the slightest try. • Too much excitement or noise. Keep your body language calm. • Too fast. • Not considering the mare being part of the process. • Allowing other horses in the pen creating interference and confusion. • Allowing too many people creating interference. Too many handlers. • Do not have an agenda. Work with the horse rather than your agenda. • Be flexible, be a lateral thinker.

Nettie Barr, Canadian Natural Horsemanship Inc. Canadian Natural Horsemanship Inc. has been developed to effectively reach the needs of equine enthusiasts. Its goals are to reach all levels of horsemen or horsewomen to develop safer, affordable, informative, step by step, user-friendly techniques that apply for all disciplines of horsemanship. The personal approach of Nettie Barr takes into consideration the confidence and dignity of both horse and handler, creating a relaxed and positive atmosphere for learning. Setting people and horses up for success with lasting results has been the focal point and strength of her approach. For more information, visit www.canadiannaturalhorsemanship.com

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Did You Know? ACVO®/Merial® National Service Dog Eye Exam scheduled for May 2012 For the month of May 2012, the American College of Veterinary Ophthalmologists (ACVO) is launching the fifth annual ACVO/Merial National Service Dog Eye Exam Event to help service animals such as guide dogs, handicapped assistance dogs, detection dogs and search and rescue dogs. More than 200 board certified veterinary ophthalmologists throughout the United States, as well as Canada and Puerto Rico, are estimated to provide free sight-saving eye exams to thousands of eligible service animals. Registration for service animal owners and handlers begins April 1, 2012 at www.ACVOeyeexam.org. Since the program launched in 2008, more than 10,500 service animals have been examined. In addition to dogs, other service animals including horses and even a service donkey received free sight saving exams. (Veterinary Advantage Weekly News) Natural Selection Why, in a room full of people, will a cat invariably make a beeline for the one person in the room who hates or is allergic to cats? Cats don’t like eye contact from strangers -- they find it intimidating. When a friendly cat wanders into a room, he’ll notice that all the people who like cats are looking at him. So he heads for the one who he thinks is being polite -- the person who isn’t looking at him. The cat doesn’t realize that the person isn’t looking because he doesn’t want the cat near him. It’s just a little bit of cross-species miscommunication. (veterinarypartner.com)

table 1 > Top 10 in 2011 Top dog breeds1

Top 10 dog names2

Top 10 cat names2

Top 10 bird and exotic names2

1. Labrador retriever

Bella

Charlie

2. German shepherd

Bailey

Max

3. Beagle

Max

Chloe

Baby

4. Golden retriever

Lucy

Oliver

Sunny

5. Yorshire terrier

Molly

Lucy

Buddy

6. Bulldog

Buddy

Shadow

Jack

7. Boxer

Daisy

Smokey

Angel

8. Poodle

Maggie

Tiger

Daisy

9. Dachshund

Charlie

Bella

10. Rottweiler

Sophie

Tigger

Coco

Stay active at work to help prevent cancer Workers who remain on their feet during the day are less likely to be diagnosed with cancer, a new study shows. A recent news release from the American Institute for Cancer research (AICR) stated that 49,000 cases of breast cancer and 43,000 cases of colon cancer occurring annually in the US were the direct result of a lack of physical activity. Furthermore, sedentary working conditions increased cancer risks independent of physical activity outside of work, the AICR says. These findings prompted the group to recommend that employees remain active and upright as much as possible during their workdays. (Veterinary Economics)

The annual gross revenue for the average veterinarian increased by $93,311 for each credentialed veterinary technician employed.-AVMA report on veterinary practice business measures 2009.(October issue, Texas Veterinarian)

• The oldest living cat verified by Guinness World Records was Creme Puff, who lived to age 38. • The oldest-known dog was Bluey, an Australian cattle dog who lived to be 29.

Not all cats like catnip Not all cats like catnip. The ability to appreciate the herb is genetic, with slightly more cats in the fan club than not. These hard-wired preferences aren’t immediately apparent, though, since kittens under the age of three months don’t react to catnip at all. Among those cats who do like catnip, you’ll find two basic kinds of reactions: Your cat may seem to become a lazy drunk, or a wired-up crazy. Credit a substance called “nepetalactone,” which is found in the leaves and stems and causes the mood-altering behavior. (veterinarypartner.com)

Everyone needs a vacation, even Britain’s royal horses, who are given a three-week vacation every year. They go to the beach, where they get to gallop freely on the sandy shores and swim in the ocean. (veterinarypartner.com)

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