2012 Winter TECHNEWS by Ontario Association of Veterinary Technicians

2012

VOL UME 36 I S S UE 2

PREMIER JOURNAL

FOR

CANADIAN VETERINARY TECHNICIANS

WINTER

A NATIONAL JOURNAL PUBLISHED BY THE ONTARIO ASSOCATION OF VETERINARY TECHNICIANS

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

CONTINUING EDUCATION • Too Hot, Too Cold: Hyper- and Hypothermia • Pain Assessment and Management in the Cat • Feline Inflammatory Bowel Disease Plus: Technicians Needed from Nunavut to Botswana, Veterinary Dental X-Ray Machine Installation, Dominance, Alpha and Other Fallacies of Pack Leadership, Diphenhydramine - Benadryl, Equine News: Canine Flu - Risk to Horses, Holiday Hazards for Pets, and more!

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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. KJD-12-001 EECI12730-S01-01

Letters from the Presidents........................................................................................................ 2 Career Spotlight: Olivia Vandersanden...................................................................................... 3 2011 US Rabies Recap.............................................................................................................. 4 Technicians Needed from Nunavut to Botswana!...................................................................... 5 Pharmacology Column: Diphenhydramine - Benadryl.............................................................. 7 Safety Column: Veterinary Dental X-Ray Machine Installation................................................. 8 Safety Column: Health & Safety at Work: Prevention Starts Here Poster.................................. 9 CE Article #1: Too Hot, Too Cold: Hyper- and Hypothermia........................................... 11 CE Article #2: Pain Assessment and Management in the Cat............................................ 16 TECHNEWS Subscriptions.................................................................................................... 20 Apps, Blogs & Websites to Watch........................................................................................... 21 CE Article #3: Feline Inflammatory Bowel Disease........................................................... 22 Tech Tips and Tidbits.............................................................................................................. 25 TECHNEWS Winter 2012 CE Quizzes............................................................................ 27 Employment Ads..................................................................................................................... 29 Behaviour Column: Dominance, Alpha and Other Fallacies of Pack Leadership...................... 32 Global News........................................................................................................................... 34 Puzzle...................................................................................................................................... 35 Submitting Articles to TECHNEWS...................................................................................... 35 Poisoning Column: Holiday Hazards for Pets.......................................................................... 36 Equine News: Canine Flu - Risk to Horses?............................................................................ 38 Continuing Education Opportunities..................................................................................... 39 Did You Know?....................................................................................................................... 40

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Next Issue: Spring 2013 Deadline for Material: February 1, 2013 Distribution Date: March 15, 2013 TECHNEWS is a quarterly publication published by the OAVT.

Employment Ads: Please see Employment Ad Information on Page 35 For advertising information: Contact Laura Fanthome: Tel. (800) 675-1859 Fax (519) 836-3638

• Editor - Laura Fanthome, RVT, MES, BEd (lauraf@oavt.org) • Technical Editor - Shirley Inglis, AHT, RVT (Shirley@oavt.org)

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 36 ISSUE 2

Printed on recycled paper

CAAHTT

OAVT Dear Members: The OAVT Board of Directors is very excited to update our members on the developments about renewing our relationship with the Canadian Association of Animal Health Technicians and Technologists (CAAHTT). The OAVT Board of Directors (BOD) has been working very hard over the last four years to re-establish a working relationship with CAAHTT. We realize the importance of being part of a national association, and want to ensure that we have properly established the responsibilities and benefits associated with this affiliation. I have spoken before about how we are working on a formal agreement between both associations, which is an ongoing process.

have been committed to establishing a working relationship that will enable all the provinces to come together on common goals that are critical to the ongoing advancement of the profession. What we have done to try and ease this process is as follows: the OAVT has entered into a temporary membership with CAAHTT which enables us to be at their Board table for all discussions. We are actively involved in their “Affiliation Agreement Committee” which allows us to work directly on developing the formal agreement with the other committee members. Questions can be addressed immediately and work can continue without the formality of waiting for an official response from each BOD. Our goal is to have an Affiliation Agreement signed as soon as possible.

Developing this agreement has been a long and arduous venture. The first draft was prepared by the OAVT Board of Directors more than a year ago, and it has been discussed at length during every board meeting. Once the draft agreement was confirmed as comprehensive, we forwarded it to the CAAHTT board for their consideration. As with every agreement, many details needed a healthy discussion to ensure that all interests were adequately addressed.

The relationship between OAVT and CAAHTT is important to both associations, as we would like to see true national cooperation in order to represent Registered Veterinary Technicians and strengthen our profession across the country.

At this stage, everyone is committed to an agreement that will work for all provinces, including Ontario, to have a formally signed Affiliation Agreement. This means that there is still more tweaking of the draft agreement ahead of us. However, CAAHTT and OAVT

Sincerely,

We are looking forward to continuing to work together. Have a great Holiday.

October 19, 2012 Attention: CAAHTT Board Directors;

I would like to thank the whole CAAHTT board and OAVT for a cohesive union of vision and mission to make CAAHTT whole again. Now let’s continue to grow together as we propel forward as a truly unified national organization advocating all RAHTs, RVTs, VTs and AHTs across CANADA!!! Sincerely,

Elisabeth Zabori, BSc, RAHT CAAHTT President

Laura Sutton, RVT OAVT President

TECHNEWS | VOLUME 36 ISSUE 2

Career Spotlight Olivia Vandersanden

Zoo, Exotic, Wildlife Speciality

Interviewed by the OAVT survival and contributing to overall population growth. This is a huge asset when dealing with species at risk. The adult turtles however, are equally as important as the juvenile turtles. Turtles are very slow to heal, however they often do well under treatment. Injuries that a mammal would never be able to sustain, a turtle will often recover from beautifully. They are very prolific animals. Most often we see turtles that have been hit by cars. The treatment they receive is another area in which I am involved at the centre. Injuries we often see from collisions are fractures, broken jaws, shearing wounds of the carapace and head traumas. All admitted trauma cases are given pain meds, antibiotics and fluids upon arrival, and we then examine and triage them as necessary. Often, fractures are initially secured with bandage tape and super glue, and later the turtle is anaesthetized and has holes drilled into its shell with a dental drill to secure the fracture with wire.

I have been employed at the Kawartha Turtle Trauma Centre, a unique wildlife facility which deals exclusively with injured native Ontario turtles. It is a Turtle Hospital, but also plays an enormous role in conservation and education. Since seven of eight Ontario species of turtles are currently listed as species at risk, and less than 1% of eggs will reach adulthood; our conservation efforts are critical in preserving these amazing creatures. Every turtle’s contribution to future generations is crucial as so few of them make it to maturity. KTTC has recently begun a “head starting” program, which is a fantastic contribution to conservation in the turtle world. When a turtle is admitted to the centre, we immediately radiograph them to determine whether or not they are gravid. If they are gravid and in a healthy state, they are provided with a nesting box and are able to lay their eggs naturally. Sometimes they are induced to lay, and the eggs are then collected and carefully harvested in the lab to ensure a production of half males and half females (this can be done since sex is determined by temperature). Even female turtles that are deceased and are gravid will have their eggs harvested and can still be hatched. The “head starting” program helps young turtles reach a size where they are less vulnerable to predators and essentially gives them a “head start” on life, increasing their chances for

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Trauma cases with open wounds require our daily care. We flush and clean these wounds and bandage them to keep infection out. We do also see a variety of interesting cases such as aural abscesses, tumours, SCUD (septicemic cutaneous ulcerative disease), embedded fishhooks and more! I may also be asked to perform blood work and fecal analysis on patients which often yield interesting results. The world of reptile medicine is still fairly new and largely undocumented and so sometimes, we find ourselves in uncharted territory and are left to play the guessing game. Veterinary Technicians can play key roles in the conservation world and wildlife rehabilitation. Having a medical background is incredibly important when dealing with injured wildlife. Since turtles do not have the ability to express pain the same way we humans or other mammals do, it is crucial to have a medical team involved when dealing with trauma and other cases. At KTTC veterinary technicians are responsible on a daily basis for treatments which involve fluid therapy, bandage changes, administration of pain medication and antibiotics as well as general husbandry, running fecal analysis, urine analysis, radiography, blood collection and so much more. The work that we do at the Kawartha Turtle Trauma Centre is extremely rewarding. We may see only a tiny fraction of the turtles in the world, but to that tiny fraction we are making a tremendous difference, and that is enough to put a smile on my face every time I

head into work. When you have been treating an animal for weeks or even months, it is one of the best feelings to see that animal recover and be re-released into the wild. The world desperately needs wildlife rehabilitators as humans continue to heavily impact wildlife through the destruction of habitat, pollution, introduction of invasive species and much more. I feel that I am making a valuable contribution to the preservation of these creatures. I found myself working as an RVT at the Kawartha Turtle Trauma Centre the summer after I graduated from the Veterinary Technician Program at Seneca College. I had a special interest in wildlife and when the job posting appeared on the bulletin board at Seneca, I applied that same day. Dr. Sue Carstairs, my wildlife and exotics professor contacted me a few days later to say that I was hired for the job, providing the Canada Summer Jobs funding went through. I was away on a “Vet Nurses in the Wild” trip in South Africa for the month of May and I was checking my email as often as possible to see, if the funding had gone through. Finally, in my third week in Africa, I got the email confirming the job, and I was one of the happiest Technicians out there. A summer working with turtles -- how many people could say that? During that summer, I was also enrolled in the Advanced Wildlife Technician program run

by Dr. Carstairs at Seneca College following my passion in this area. This proved to be an absolutely amazing opportunity which opened my eyes to many other areas in which I could work as a Veterinary Technician. I am currently broadening my knowledge of wildlife by taking the Fish and Wildlife Technology program at Sir Sanford Fleming College. I also work parttime at the Riverview Park and Zoo, and still volunteer at the KTTC. Upon completion of this college program, I plan to apply to Veterinary school and become a Doctor of Veterinary Medicine. Becoming an RVT was an excellent way to ease into the field of Veterinary Medicine and it has left me wanting to further my education so that I can make even more of an impact on the Wildlife Rehabilitation world. I am thrilled with the path I have taken and the countless opportunities that have come my way from the decisions I have made. I see myself remaining in the wildlife rehabilitation field for the rest of my career.

conferences are now including very informative lectures on wildlife and exotics (the North American Veterinary Conference had some excellent wildlife talks this year) There are also copious amounts of textbooks available on wildlife and exotic animal medicine, and many organizations that one could join to play a further role in wildlife rehabilitation and conservation. Many of these organizations utilize technicians to a large degree. If you are looking for a career that is outstandingly rewarding, I would highly recommend looking into wildlife medicine. It`s a career that you can go home from every day with a big smile on your face and an enormous sense of accomplishment.

2011 US Rabies Recap Dr Scott Weese

There are so many ways to learn more about this field and to become involved. For technicians interested in this type of work, it is best to get a good knowledge and understanding of wildlife, which is much different than working with companion animals. Volunteering is also another way to get involved in a sector of veterinary medicine in which one is interested in entering. Jobs in this field are not always readily available, so it is a great idea to get your foot in the door at as many places as possible to broaden your possibilities for permanent employment. There are many courses available for those interested in wildlife, such as the Advanced Wildlife Technician Program at Seneca, the Wildlife Program offered at Northern College, the Wildlife Rehabilitators Course (to get your wildlife rehabilitators license). There are numerous workshops available and many veterinary

The annual US rabies surveillance report (http://www.wormsandgermsblog.com/uploads/file/ javma.pdf ) has been published in the September 2012 edition of the Journal of the American Veterinary Medical Association (Blanton et al 2012). There’s nothing really earth-shattering in it, but it’s a good overview of the rabies diagnoses in the US from 2011. It provides only a peek into rabies in wildlife (since only a small percentage of wildlife with rabies get diagnosed and reported) but numbers and trends in domestic animals, along with general wildlife data, provide useful information about the state of this virus in the US. There is also a good synopsis of Canadian rabies data in this report too: • • •

115 rabid animals were identified, with 92% being wild animals. There were three rabid livestock (two of which were horses) and six dogs and cats. No rabid raccoons were identified, continuing a trend started in 2009.

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Technicians Needed from Nunavut to Botswana! There are countless pet owners in many different parts of Canada and the world that want to do what is best for their pet but don’t have the knowledge of or ability to do so. The Canadian Animal Assistance Team (CAAT) specializes in helping these pet owners. We travel to communities with little or no access to veterinary care (either financially and/or geographically) and provide spay/neuter/vaccination clinics along with humane education. Our community members are always so grateful to have the opportunity to care for their pets. As each community member comes to us to have their pet receive veterinary care it is also an educational opportunity to discuss basic animal health and welfare.

As a member of a CAAT project, you are challenged to “think outside the box” and to rely on your most basic technical skills in very different working environments. Along with your valuable technical expertise, the other critical requirements for this work are passion, a sense of adventure and a positive outlook! It is very common, for those of us who have chosen the career path of working with animals, to find ourselves putting in long days to care for our patients. Why then, would we want to spend part of our vacation time doing the same thing and volunteering our time for it!?? The best way to understand

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why, is through the words of our dedicated team members! From Aliesha Timms Wilson, RAHT, British Columbia Team Member “I think the best way to sum up my reason for volunteering my time is that it allows me to help animals who wouldn’t otherwise receive the veterinary care that they need. It also gives me an opportunity to work with a wonderful set of Veterinarians, Animal Health Technologists and Assistants. It gives me a change from the normal routine of a Veterinary Hospital. We never know what to expect, but take the challenges as they come. I have made some really good friends through CAAT and hope to make more.” From Angela Watt, RVT, Ontario Team member “CAAT is an organization that represents helping animals, but it also helps the people that belong to those pets. I volunteer my time to help people better understand the life of their pet, and to be able to see the happiness in their eyes when they can do something for their furry friend they would never have been able to do otherwise. We are a group of people that come together from many different backgrounds, but for the same reason, to help those who need it. By donating our skills, our vacation time, and our ‘comfortable lives’, we can get the most amazing feeling back. The feeling of appreciation, of happiness, and of great respect is what the people of these communities give you. It is an experience beyond words. You receive kisses from the pets, and hugs from the families and the smile on your face can take you so much further in your own life. It is an experience I would never want to give back, and I want to keep going back for more!”

From Laura Sutton, RVT, Ontario CAAT Member “I like the adventure of a CAAT project. I get to go places that I’d never get to go to otherwise, meet people I’d never meet anywhere else, and do something good for the community I’m visiting, all while having an adventure of a lifetime! It doesn’t get much better than that. You never know who you are going to meet on a CAAT trip, but you are sure there will be no shortage of amazing people both volunteering as part of the team and within the community. I’ve made many great friends on CAAT projects, friends who I’m sure will last a lifetime. It’s easy to get wrapped up in our day-to-day practices and the stresses that go along with them. When I go away on a CAAT trip, it reminds me of why I became an RVT in the first place. Each member of the team is there to work hard, the clients that come in are so appreciative of us being there, and we are providing services to pets that would never receive veterinary care in any other way. You go back to basics and realize just how much you can do without all the bells and whistles of a vet hospital. And when you go back home, you have a whole new appreciation for things like monitoring equipment and unlimited gauze squares!”

From Sharon Townes, RVT, Nova Scotia Team Member “When I first learned about CAAT I was thankful for everything they have done in the past, and I wanted to be involved with everything that they do in the future (to help to reduce the numbers of unwanted dogs and cats

From Nicole Emery, RAHT, British Columbia Team Member “I wanted to volunteer for CAAT because I wanted to help and make a difference in the number of unwanted dogs and cats in our world. After my first CAAT project I had an overwhelming feeling of pride (because the work we did was amazing and truly made a difference), humility (being a part of such an amazing team of people all working towards the same goal), and addiction! I’m hooked.” Technicians are a very unique group of people! They all have important technical skills along with a great love of animals. Use those skills and that passion and join us!!! It is a tremendous opportunity to see new places, learn about animal health care in different cultures (even within Canada), help animals in need, and work with veterinary professionals from all across Canada. You will make new friends, both human and furry, and you will never forget the experience!!! and to help improve the lives of pets in communities that don’t have the luxuries that we do, and where the animals would otherwise be suffering). Since supporting CAAT, I have gained a deeper sense of awareness about the world around us, I was given the chance to travel to a place I would not normally go to, and I now have a new direction in which to focus my career as a dedicated veterinary technician.”

You must be a team member to be able to apply for projects. To become a member, go to www.caat-canada.org and click on GET INVOLVED. If you have further questions about membership email us at membership@caat-canada.org.

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TECHNEWS | VOLUME 36 ISSUE 2

P H A R M AC O L O G Y C O L U M N Diphenhydramine should not be used with additional tranquilizing medications. In animals that experience a hyperactivity reaction while taking metoclopramide (Reglan), this effect can be reversed with a dose of diphenhydramine.

by Dr. Wendy Brooks, DVM, DipABVP (Educational Director, Veterinary Partner.com) (for veterinary use only)

Brand name: Benadryl Available in 25 mg & 50 mg capsules, 12.5 mg chewable tablets, 50 mg tablets, oral elixir and syrup

mine. Patients with mast cell tumours experience chronic inflammatory symptoms due to circulating histamine. Antihistamines such as diphenhydramine may be helpful given long term.

Background Histamine is an inflammatory biochemical that causes skin redness, swelling, pain, increased heart rate, and blood pressure drop when it binds to one of many H1 receptors throughout the body. Histamine is an important mediator of allergy in people, hence a spectacular array of different antihistamines has proliferated. Histamine, perhaps unfortunately, is not as important a mediator of inflammation in pets, which means results of antihistamine therapy are not as reliable in pets.

Diphenhydramine has a strong antinausea side effect that makes it helpful in treating motion sickness.

Use of this Medication Diphenhydramine has several important effects and thus several uses. Most obviously, diphenhydramine is an antihistamine and it is used for acute inflammatory and allergic conditions such as: • Snake bites • Vaccination reactions • Blood transfusion reactions • Bee stings and insect bites • Diphenhydramine is frequently included in antihistamine trials for allergic skin disease. It is not one of the more effective antihistamines in this regard but its availability and inexpensive cost make it worth trying in many cases. Mast cell tumours are tumours involving cells that contain granules of hista-

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Diphenhydramine causes drowsiness in animals just as it does in people and can be used as a mild tranquilizer. When pet owners use diphenhydramine in a single dose or two to manage itching in pets, often the pet becomes drowsy and appears less itchy because he is too sleepy to engage in scratching or licking. This effect is different from actual itch relief, which typically requires a couple of weeks of use if it is going to occur. Side Effects With so many possible uses of this medication, it is difficult to separate out a side effect from a primary effect. Drowsiness is generally regarded as an undesirable side effect. At doses higher than the recommended dose, human patients complain of dry mouth and experience difficulty with urination. Interactions with other Drugs In the treatment of allergic skin disease, antihistamines are felt to synergize with omega 3 fatty acid supplements and, as a general rule for this condition, it is best to use these medications together.

Concerns and Cautions Be careful of oral liquids containing alcohol. These formulations should not be used in pets. It is important to realize that “Benadryl” is a brand name. It is easy for clients to try to save money and try to buy overthe-counter diphenhydramine and end up with an inappropriate product. To emphasize this point, refer to the products shown below. It seems like it would contain diphenhydramine but, in fact, it contains a combination of diphenhydramine and other medications, including a dose of acetaminophen that could be lethal to a pet. EDUCATE CLIENTS TO NEVER BUY OVER-THE-COUNTER MEDICATION FOR THEIR PET WITHOUT KNOWING EXACTLY WHAT THEY ARE SUPPOSED TO GET. A

A. This product contains a combination of medications with substantial potential for harm if given to a pet. B. This product contains only diphenhydramine, with no additional medications added.

© 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.

SAFETY COLUMN

Veterinary Dental X-Ray Machine Installation

(Issued July 2012 by Ontario Ministry of Labour)

Dental X-ray machines provide a valuable adjunct to modern veterinary care. In Ontario, the installation and use of these X-ray sources is regulated, in part, by Ontario Regulation 861 (X-ray Safety www.e-laws.gov.on.ca) under the Occupational Health and Safety Act. This Regulation sets out requirements relating to health and safety of workers exposed to X-ray. For example, before the installation or use of an X-ray machine, the employer must register his/her workplace and Xray sources with the Ministry of Labour’s Radiation Protection Service, and have the appropriate forms, application for review, and plan location drawings reviewed and accepted by the Ministry. In addition to general requirements in Regulation 861, section 16 has specific requirements relating to X-ray machines used for the diagnostic examination of animals. For example, where practicable, the dental X-ray machine should be installed or used in a room designed for the purpose of performing X-ray examinations of animals. In addition to the applicable general requirements of Regulation 861 and the specific requirements in section 16, where it is not practicable to have a dedicated Xray room, a dental X-ray machine may be installed and used in a general animal treatment room, only if the room meets all of the following conditions: 1. The dental X-ray machine must be permanently installed in the general treatment room with the exposure switch located in an area shielded from X-rays. The operator should stand outside the room (now used as a dental X-ray room) using the room walls as the protective shield. The labeled exposure switch can be mounted on a wall outside the dental X-ray room (similar to a light switch) or the switch can be on a cord long enough to permit the operator to remain in a shielded location (e.g., to leave the room). Hand-held, portable or stand-mounted dental units are not permitted in veterinary facilities. 2. All workers, including the veterinarian, must leave the dental X-ray room during exposures. Animals should be chemically and/or physically restrained or supported by

mechanical means during exposures. If it is absolutely necessary for someone to remain in the room to support or restrain an animal during an exposure, he or she must be provided with personal radiation protective equipment and dosimetry. 3. All access to the dental X-ray room must be controlled during the dental X-ray exposure by either door interlocks1 or visual control. The exception would be an operator standing at the doorway, “guarding” that access point. 4. The dental X-ray floor plan review, including the associated Form 2, must be designed to ensure that the X-ray beam is pointed only at barriers designed and approved for primary (main) beam exposure. Unlike larger veterinary radiographic X-ray machines, a dental X-ray machine can be pointed at room barriers other than the floor. The acceptable manner of directing the X-ray beam would be documented in written procedures. 5. Written policy and procedures must be developed, posted in the workplace, and all facility staff shall be instructed in dental X-ray safety procedures as they apply to their job function. Reference “Smile! You Have Decided to Install a Dental X-ray Machine” by Angela Cerovic. Focus magazine, July/August 2007, page 17. (http://www.ovma.org/). For additional information and forms, and to have your forms and plans reviewed contact: Radiation Protection Officer c/o Radiation Protection Service Ontario Ministry of Labour 81A Resources Road Toronto, Ontario M9P 3T1 (416) 235-5922 or Lothar.Doehler@Ontario.ca An interlock is an electrical switch. If a door is open or is opened during an X-ray exposure, the X-ray exposure will not start or, if started, would be terminated and will not restart if the door is closed. Typically, interlocks are connected in series with the exposure switch to interrupt the electrical power to the dental X-ray unit. A kitchen microwave oven door is an example of what is required; the oven will not start with the door open, and if the door is opened while the oven is operating, the oven will shut off.

Disclaimer This resource has been prepared to help the workplace parties understand some of their obligations under the Occupational Health and Safety Act (OHSA) and regulations. It is not legal advice. It is not intended to replace the OHSA or the regulations. For further information please see full disclaimer (http://www.labour.gov.on.ca/english/hs/hs_disclaimer.php).

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SAFETY COLUMN

Health & Safety

at Work:

Prevention Starts Here Poster

Health & Safety at Work Prevention Starts Here

Ontario’s Occupational Health and Safety Act gives workers rights. It sets out roles for employers, supervisors and workers so they can work together to make workplaces safer.

Call the Ministry of Labour at 1-877-202-0008 Report critical injuries, fatalities, work refusals anytime. Workplace health and safety information, weekdays 8:30am – 5:00pm. Emergency? Always call 911 immediately.

Find out more:

ontario.ca/healthandsafetyatwork © Queen’s Printer for Ontario Ministry of Labour ISBN 978-1-4435-8295-7 (PRINT) ISBN 978-1-4435-8296-4 (HTML) ISBN 978-1-4435-8297-1 (PDF) June 2012

Workers have the right to: • Know about workplace hazards and what to do about them. • Participate in solving workplace health and safety problems. • Refuse work they believe is unsafe.

Workers must: • Follow the law and workplace health and safety policies and procedures. • Wear and use the protective equipment required by their employer. • Work and act in a way that won’t hurt themselves or anyone else. • Report any hazards or injuries to their supervisor.

Employers must NOT take action against workers for following the law and raising health and safety concerns.

Employers must: • Make sure workers know about hazards and dangers by providing information, instruction and supervision on how to work safely. • Make sure supervisors know what is required to protect workers’ health and safety on the job. • Create workplace health and safety policies and procedures. • Make sure everyone follows the law and the workplace health and safety policies and procedures. • Make sure workers wear and use the right protective equipment. • Do everything reasonable in the circumstances to protect workers from being hurt or getting a work-related illness.

Supervisors must: • Tell workers about hazards and dangers, and respond to their concerns. • Show workers how to work safely, and make sure they follow the law and workplace health and safety policies and procedures. • Make sure workers wear and use the right protective equipment. • Do everything reasonable in the circumstances to protect workers from being hurt or getting a work-related illness.

Issued: June 1st 2012 for display in the workplace by October 2012 http://www.labour.gov.on.ca/english/hs/pubs/poster_prevention.php

NOTE: This poster is available in two versions: • the poster in PDF format; OR • Printed posters available from ServiceOntario Publications (https://www.publications.serviceontario.ca/ecom/). Ontario’s Occupational Health and Safety Act gives workers rights. It sets out roles for employers, supervisors and workers so they can work together to make workplaces safer.

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Improve Health and Safety: • Find out about your Joint Health and Safety Committee or Health and Safety Representative. • Talk to your employer, supervisor, workers, joint health and safety committee or health and safety representative about health and safety concerns. Workers have the right to: • Know about workplace hazards and what to do about them • Participate in solving workplace health and safety problems • Refuse work they believe is unsafe Workers must: • Follow the law and workplace health and safety policies and procedures • Wear and use the protective equipment required by their employer • Work and act in a way that won’t hurt themselves or anyone else • Report any hazards or injuries to their supervisor • Employers must NOT take action against workers for following the law and raising health and safety concerns. Employers must: • Make sure workers know about hazards and dangers by providing information, instruction and supervision on how to work safely • Make sure supervisors know what is required to protect workers’ health and safety on the job • Create workplace health and safety policies and procedures • Make sure everyone follows the law and the workplace health and safety policies and procedures • Make sure workers wear and use the right protective equipment • Do everything reasonable in the circumstances to protect workers from being hurt or getting a work-related illness. Supervisors must: Tell workers about hazards and dangers, and respond to their concerns Show workers how to work safely, and make sure they follow the law and workplace health and safety policies and procedures Make sure workers wear and use the right protective equipment Do everything reasonable in the circumstances to protect workers from being hurt or getting a work-related illness. Call the Ministry of Labour at 1-877-202-0008. Report critical injuries, fatalities, work refusals anytime. Workplace health and safety information: Weekdays 8:30am – 5:00pm. In an emergency: Always call 911 immediately. Find out more: ontario.ca/healthandsafetyatwork

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Introduction

Thermoregulation is the ability of an animal to maintain body temperature within certain boundaries, even when the surrounding temperature is very different. This process is one of the most important aspects of homeostasis. Pets may experience large changes in environmental temperatures and, while their bodies may first be able to regulate normal temperature, at some point the body may not be able to keep up with the demand. Certain diseases may also cause challenges to the body causing a failure of the body’s ability to thermoregulate. This failure can lead to either hypothermia or hyperthermia. As a veterinary technician you are likely to deal with the client and pet first and be responsible for performing the diagnostics, treatment and nursing care of these patients. Physiology

The body’s temperature is regulated almost entirely by a nervous system feedback mechanism which reports to the temperature-regulating centre located in the hypothalamus.1 There are three times as many heat-sensitive neurons than cold-sensitive neurons located in the hypothalamus.1 These neurons function as temperature sensors for the body.1 As the body comes in contact with cold stimulation, the heatsensitive neurons will increase their firing rate.1 Conversely, the cold-sensitive neurons will increase their firing rate when the body experiences heat stimulation.1 Ultimately it is these signals that will cause the body to lose or increase body heat.

CE Article #1 Too Hot,Too Cold: Hyper- and Hypothermia

Heat loss occurs from four main mechanisms: convection, conduction, radiation, and evaporation. In animals most heat loss occurs from convection (occurs from cooler circulating air moving over the body) and conduction (occurs from a pet lying directly on a colder surface).2 Pets can also experience heat loss through radiation (when cooler air disperses through the environment not forced) and evaporation (panting and sweat loss), though these are not as common. Ultimately, if the body needs to lose heat, vasodilation, sweating, panting and a decrease in chemical thermogenesis occurs.1 Heat production occurs from cellular metabolism, skin vasoconstriction, piloerection and voluntary muscle activity (shivering).1, 2 Piloerection allows for the hair to trap a layer of “insulated air” next to the skin which allows for a decrease of heat transferance.1 Shivering works by increasing muscle movement which allows for the body’s heat production to increase. When the body is cold, the hypothalamus will release thyrotropin-releasing hormone which acts to release thyroid-stimulating hormone from the pituitary gland.2 Thyroid-stimulating hormone, in turn, increases the re-

lease of thyroxine which works to increase the rate of cellular metabolism throughout the body.1 The liver is one of the largest organs in the body. Through cellular metabolism the more active the cells, the more they produce heat. Simply because of its size and therefore the number of cells involved, the liver helps to regulate the body’s heat.3 This is why liver failure pets may experience hypothermia.

Hyperthermia

A disease process or temperatures in the surrounding environment may cause the pet to no longer be able to thermoregulate. The pet’s temperature will increase to a point above normal (39.2°C / 102.5°F). There are two causes of hyperthermia: pyrogenic and nonpyrogenic.4 Pyrogenic hyperthermia is caused by inflammation or infection, while nonpyrogenic is caused by damage to the hypothalamus (e.g. tumour) or an alteration to the temperature-regulating centre itself.4 Certainly some forms of hyperthermia can be beneficial, as in the case of inflammation. When the core temperature increases above 41.1°C / 106°F neurological and organ dysfunction can occur.5 It is around this tem-

Amy N. Breton, CVT, VTS (ECC) is currently employed at the Veterinary Emergency and Specialty Centre of New England in Waltham, Massachusetts as the Head Emergency Technician. In 2003 she became boarded as a Veterinary Technician Specialist in Emergency and Critical Care. Amy is well published in over nine subjects, is an international speaker, has received numerous awards and is highly involved in her community. Amy lives in Massachusetts with her husband and wonderful furry kids.

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perature that the term heatstroke is applied due to the failure of systems which may occur. While temperatures above 41.1°C / 106°F can lead to neurological and organ dysfunction, it isn’t until the core temperature increases to 43°C / 109.4°F that the body experiences actual cellular death in the brain.6 There are two types of heatstroke: exertional and nonexertional.7 Exertional heatstroke occurs because a dog or cat will actively be playing, running or walking in an environment that is too hot for their body condition. Certain breeds, such as brachycephalic breeds, have a much lower tolerance for high temperatures compared to other breeds. Obesity and certain conditions, such as laryngeal paralysis and heart disease, may also play a factor in the pet’s inability to thermoregulate in hotter temperatures. Nonexertional heatstroke is caused by the pet’s inability to dissipate heat because of a decrease in airflow (closed car) or lack of shade or water. Generally if pets are provided shade, water and an environment with an adequate amount of circulating air, they will be able to thermoregulate appropriately. When temperatures exceed above 41.1°C / 106°F, the pet may experience central nervous system, gastrointestinal, cardiovascular, hepatobiliary, renal, hematologic and muscular dysfunction.4 While there is no set point at which each of these system fails, the higher the temperature and the longer the exposure results in more systems dysfunction and an increase in mortality rate. It is important to note that each pet responds differently. There are some dogs that may suffer little organ dysfunction with a core temperature of 43°C / 109°F, while others may experience life threatening hematologic and renal disorders. Heatstroke signs include incessant or noisy panting, collapse, inability to walk/staggering, altered mentation and/or gastrointestinal signs (vomiting/diarrhea). As temperature increases, swelling in the brain can occur leading to cerebral edema.4 Localized areas of intercerebral bleeding may occur.4 Pets may present with neurologic signs including seizures, nystagmus, anisocoria or they may be comatose. Gastrointestinal (GI) dysfunction occurs secondarily to ischemia and poor perfu-

sion during heatstroke.4 Some animals may experience GI signs even during mild hyperthermic episodes. Pets may experience hematachezia, melena, vomiting, hematemesis and GI sloughing. Initially during heatstroke, vasodilation and an increase in cardiac output occurs.8 Cardiac failure can occur because of the increased demands on the heart due to the increased metabolic demands and redistribution of blood flow, which leads to body-wide hypoxia.4 Myocardial ischemia, due to the hypoxia, can lead to ventricular arrhythmias which can lead to cardiac failure.8 One of the most life-threatening problems with heatstroke is the thermal injury to the renal system.4 Renal failure is initially caused by the decrease in cardiac output and renal vasoconstriction.8 This results in a decrease in renal perfusion causing tubular necrosis.8 Dehydration can also exacerbate renal failure. Liver and muscular damage occur from the hypoxia the pet experiences.8 Excessive heat can also cause injury to the hepatocytes leading to worsening liver failure.8 Even if a patient recovers from heatstroke, they may have permanent renal and liver damage which require lifelong treatment. As heatstroke progresses, pets may experience disseminated intravascular coagulation (DIC), systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS) and rhabdomyolysis. Disseminated Intravascular Coagulation DIC is a pathological process where the blood starts to coagulate throughout the whole body. The end result is that it depletes the body of platelets and coagulation factors, causing the body to be at risk for increased bleeding.9 Petechiae, ecchymosis and excessive bleeding are often noted with DIC. DIC is generally triggered whenever there is a major disruption in the intravascular system as is the case with heatstroke.4 When the endothelial cells are damaged, they expose substances that activate the clotting cascade. Eventually an unbalance occurs between clotting and bleeding, which is DIC. Systemic Inflammatory Response Syndrome The cytokines produced during an inflammatory response act as the mediators of

SIRS. SIRS can occur from hyperthermia alone (temperatures above 41.1°C / 106°F) if there is an inciting incident. SIRS is an inflammatory response of the entire body and can result in death. The diagnosis of SIRS can be made if the animal has two or more of the following criteria:10 • Heart rate: >160 bpm in the dog and >250 bpm in the cat or < 140 bpm in the cat • Respiratory rate: >20 bpm in the dog and >40 bpm in the cat • Body temperature: <37.8°C / 100°F or >39.7°C / 103.5°F • White blood cell count: >12,000 or <4,000 or > 10% bands Multiple Organ Dysfunction Syndrome Just as it sounds, it is the altered organ function of two or more organ systems. Organ dysfunction can occur during heatstroke or may occur because of a disease process causing hyperthermia. MODS may also occur due to complication from sepsis or SIRS.9 If MODS occurs in conjunction with SIRS, the prognosis becomes very poor.10 The number of organs involved decreases the chances of survival.10 Rhabdomyolysis Rhabdomyolysis is the rapid breakdown of muscle fibers due to traumatic injury to the skeletal muscles. In the case of heat stroke, this is due to muscle necrosis.4 The principal result is the release of muscle fiber contents, such as myoglobin, into the blood stream. Myoglobin is then circulated through the bloodstream and eventually through the kidneys where it blocks the structures of the kidneys causing acute tubular necrosis or kidney failure.

Treatment for Heatstroke

Initial stabilization should be aimed at decreasing the temperature to prevent further injury, restoring tissue perfusion and minimizing further neurologic injury.11 If an owner has called on the phone and reported signs of heatstroke, they should be instructed to pour cool (not cold) water over the pet and immediately transport to the closest veterinary hospital. Be sure to instruct the owner not to submerge the pet as it will not be able to breathe. Remember that not only how high the temperature was, but how long the pet was hyperthermic plays a role in how many complications the pet will experience. The goal of cooling is to reduce the temperature of the patient slowly as to cause

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the least amount of stress on the body as possible. A sudden drop in body temperature will cause further complications. If the body temperature is dropped too quickly, iatrogenic hypothermia can occur.4 Ice and cold water baths should be avoided because they can cause peripheral vasoconstriction. This causes blood to be forced back to the organs and causes the heat-sensitive neurons to fire more frequently.8 Because of cerebral edema, the temperature-regulating centre located in the hypothalamus may cause thermoregulation dysfunction and the pet may not have the ability to thermoregulate.4 If the temperature is dropped too quickly, the pet may not able to warm itself up due to the impaired temperatureregulating centre. The cooling end point should be 39.4°C / 103°F over 30 to 60 minutes.4 Cooling should be stopped at 39.4°C / 103°F to avoid iatrogenic hypothermia. There have been many reported methods on how to cool patients. Some of these include pouring rubbing alcohol on the pads, leaving a wet towel on the pet, cold water gastric lavage, cold water peritoneal lavage and cold intravenous fluids. There have been no reported real advantages to using any of these methods over noninvasive, peripheral cooling.4 It has been this author’s experience that anything other than hosing or pouring cool water on the pet causes the temperature to drop too quickly and iatrogenic hypothermia is more likely to occur. Studies have shown that dogs that experience iatrogenic hypothermia have a higher mortality rate.4 Oxygen supplementation improves tissue perfusion and decreases the risk of ischemia.8 Therefore oxygen should be provided because most patients experience some level of ischemia, hypoxia and/or dyspnea. This is particularly true in brachycephalic breeds because of the swelling in and around the throat. It is not uncommon that these breeds must be intubated or have an emergency tracheostomy performed because their airway has swollen shut from excessive panting. The most effective ways to administer oxygen are through the use of a face mask (removing the diaphragm to allow for panting) or an oxygen hood.12 Flow-by oxygen is generally ineffective and oxygen cages should be avoided because treatment cannot occur and the pet needs adequate circulating air to cool.12

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An intravenous catheter should be placed to help support cardiac output. Fluids should be used judiciously to avoid fluid overload. Large volumes of fluids may lead to the worsening of cerebral and/or pulmonary edema. When the catheter is placed, baseline bloodwork should be drawn at the same time. Minimally packed cell volume, total solids, blood glucose, electrolytes, venous blood gas and lactate evaluation should be performed immediately to assist in guiding fluid therapy.11 It has been shown that pets with hypoglycemia during the initial stages of heatstroke have a higher mortality rate.5 Patient temperature, heart rate and blood pressure should be monitored throughout fluid resuscitation.4 It is best to have the patient monitored on an ECG to look for any arrhythmias that may occur secondarily from the heatstroke. Colloids may need to be considered if the patient is hypoproteinemic or has a decreased colloid osmotic pressure.8 Plasma should be considered in patients suspected of having DIC. Albumin can be administered if the patient is hypoalbuminemic. The use of corticosteroids and NSAID drugs are usually contraindicated because of the decrease in GI integrity.4 These patients are typically at risk for GI ulceration and ischemic injury and administration of either usually causes worsening problems. Ultimately these patients require constant and intensive nursing care. If the patient is recumbent, the technician will need to lubricate the eyes, moisten the mucous membranes, turn the pet, keep the pet dry and free of bed sores and perform passive range of motion exercises. Ideally, unless DIC is present, a central line should be placed in these patients to monitor central venous pressures and for the administration of parental nutrition if needed later. A urinary catheter should be placed in down pets to keep them clean and dry. Pets should be monitored for GI signs and all vomiting and diarrhea should be noted. GI protectants, antiemetics and antidiarrheals should be considered in any heatstroke patient. Technicians should monitor for signs of DIC such as increased bleeding times, petechiae or ecchymosis. Even if the patient doesn’t have a urinary catheter, technicians should monitor urine output. This is easily done by using a non-absorbent litter for cats or catching the urine produced from dogs. A decrease in urine production may indicate kidney failure. It is equally important that technicians look for signs

of icterus in patients by monitoring gum colour, inspecting the colour of the sclera, pinna of the ear and underbelly of the pet. Throughout the pet’s hospitalization, blood work should be constantly monitored and treatment should be tailored to the pet accordingly. Clients should be informed that their pets are at risk for DIC and organ failure up 5 to 7 days post heatstroke.4

Hypothermia

Hypothermia can occur from a primary (cold environment) or secondary cause (temperature-regulating centre is impaired).5 Secondary hypothermia can occur even in a warm environment as in the case of chronic kidney failure patients. With mild hypothermia, the body’s response is to shiver, constrict vessels and increase chemical thermogenesis. At some point the body fails to keep up with the demands and these mechanisms become inactive. As a result, cardiovascular and organ dysfunction occurs. Mild hypothermia is defined by a core temperature between 32.2°C / 90˚F to 32.2°C / 99˚F, moderate hypothermia between 27.8°C / 82˚F to 32.2 / 90˚F and severe hypothermia <27.8°C / 82˚F.13 Initially the heart will produce a tachycardic response in an effort to keep up with the demand. Eventually a progressive bradycardia develops due to the decreased spontaneous depolarization of the cardiac pacemaker cells.2 When temperatures reach around 27.8°C / 82°F, the heart rate is usually half of what it is normally.2 Ultimately, this leads to a decrease in mean arterial pressure, respiratory rate, central nervous system, and cardiac output. When patients present with moderate hypothermia they may be stiff, reluctant to walk, depressed, semi-conscious or comatose.13 Heart arrhythmias may be present. Pets who present with severe hypothermia may be unconscious, nonresponsive and their pupils may be dilated.13 These pets may be experiencing ventricular fibrillation, take only 1-2 breaths per minute and clinically appear dead.13 There have been many human and veterinary doctors who have pronounced their patients dead when they were not, which is why it is important to warm the patient to ensure it is truly deceased. Hypothermic patients are at extreme risk for developing DIC, multiple organ failure and electrolyte abnormalities (particularly hypo- or hyperkalemia).2 Coagulation

times, blood chemistries and electrolytes should be monitored throughout the patient’s hospitalization stay.

Treatment for Hypothermia

If an owner has called recognizing the signs of hypothermia, you should instruct them to place a warm (not hot or wet) towel around the pet. The pet should be brought to the veterinary clinic immediately. It is important to instruct owners not place electric blankets or heat packs directly on the fur of the pet as these often result in burns. The technician team should prepare a warm area for the pet before it arrives so the pet can be placed on a warming surface rather than a cold table. Upon presentation at the clinic, rewarming the animal is the most important treatment. This is done by conduction and improving circulation through IV fluids. Intravenous catheters should be placed immediately and ideally warm (40˚C / 104˚F to 41.1˚C / 106˚F) IV fluids should be administered.13 Packed cell volume, total solids, blood glucose, electrolytes, coagulation times, venous blood gas and lactate evaluation should be performed to assist in guiding fluid therapy and stabilization of the patient. Patients should have an ECG attached while warming is occurring to watch for arrhythmias. As the tissues start to warm, vasodilation occurs causing the cold blood to circulate into the organs, which may initially decrease the core body temperature.13 While a patient should be rapidly warmed, there have been reports of severe shock and cardiac arrest during warming.2 A crash station should be ready and next to the patient during rewarming. In the cases of moderate or severe hypothermia, patients may require oxygen supplementation due to decreased ventilation. It has been recommended that patients in severe hypothermia have peritoneal lavage performed so that the core of the patient is warmed with the external body creating fewer demands on the body.2 The peritoneal lavage solution should be warmed to 40˚C / 104˚F to 45˚C / 113˚F. If these patients remain mentally dull after their core temperature has increased, they may have developed cerebral edema. Mannitol should be considered in these patients.13 Like hyperthermic patients, these patients require constant and intensive nursing

references > 1. Guyton A., Hall J.: Textbook of Medical Physiology: “Body Temperature, Temperature Regulation, and Fever”, WB Saunders, Philadelphia, 1996 2. Wingfield W., Raff M.: The Veterinary ICU Book: “Accidental Hypothermia”, Teton NewMedia, Jackson, Wyoming, 2002 3. Laberge M.: Thermoregulation, Gale Encyclopedia of Nursing and Allied Health, 2002, Accessed online: http://www.healthline.com/galecontent/thermoregulation (January 5, 2012) 4. Wingfield W., Raff M.: The Veterinary ICU Book: “Hyperthermia”, Teton NewMedia, Jackson, Wyoming, 2002 5. Serrano S.: “Heat Stroke and Hypothermia” International Veterinary Emergency and Critical Care Symposium Proceedings 2010 6. Khan V., Brown I.: “The effect of hyperthermia on the induction of cell death in brain, testis, and thymus of the adult and developing rat”, Cell Stress Chaperones. 2002 January; 7(1): 73–90 7. Flournoy W., Whol J., Macintire D.:, “Heatstroke in dogs: Pathophysiology and predisposing factors” Compen Contin Educ Pract Vet 25:410-418, 2003 8. Tabor B., “Heatstroke in Dogs”, Veterinary Technician Magazine (online) Vol 28, No 4, April 2007, Accessed online: http://www.vetlearn.com/veterinary-technician/heatstroke-in-dogs#top (January 5, 2012) 9. Grace P, Mathie R: Ischaemia-Reperfusion Injury, Blackwell Science; 1999 10. Campbell V: SIRS, Sepsis, MODS Demystified. International Veterinary Emergency and Critical Care Symposium 2005 11. Reineke E.: “Heatstroke and Hyperthermia”, International Veterinary Emergency and Critical Care Symposium Proceedings 2009 12. Crowe D.: “Oxygen Therapy”, Atlantic Coast Veterinary Conference 2008 Proceedings 13. Haldane S., McCullough S., Raffe M.: “Hypothermia”, Standards of Care, June 2003, Vol 5, No 5, Accessed online http://www.vetlearn.com/standards-of-care/hypothermia (January 6, 2012)

care. Ideally, unless DIC is present, a central line should be placed in these patients to monitor central venous pressures and for the administration of parental nutrition, if required. A urinary catheter should be placed in down pets to keep them clean and dry. Urine output should be monitored as organ failure is a concern. Bloodwork will need to be monitored throughout. These patients are at risk for developing hypoglycemia, hyperkalemia, DIC, and metabolic acidosis post-warming.13 It is important that these parameters are monitored for a minimum of 24 to 48 hours after normothermia has been achieved.13 Immune function can become impaired with hypothermia, so these patients are at a risk of developing secondary infections.5 Pneumonia may develop secondarily in these patients so watching for respiratory signs, such as coughing or increased effort, is important.13 More commonly, pulmonary edema may develop.13 Any changes in respiration should be noted immediately to a veterinarian and chest films should be taken.

may persist up to 72 hours after normothermia has been achieved.13 Blood pressure monitoring should occur several times a day even after patients are normotensive. Throughout the pet’s hospitalization, the pet should be constantly monitored and treatment should be tailored to the pet accordingly.

Conclusion As a veterinary technician you will likely encounter a patient who is experiencing hypo- or hyperthermia. You will need to communicate effectively and quickly to the client. Understanding the needs of your patient will allow you to provide the best nursing care possible. Since every second counts with these patients, it is important that treatment begins quickly and intensive nursing care is provided in order to ensure the patient’s best chance of survival.

Ideally patients should be on a continuous ECG, but if one is not available, an ECG should be checked several times a day to look for arrhythmias. Cardiac arrhythmias

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The Veterinary Oath has enshrined the veterinary healthcare team’s collective responsibility to “relieve pain and suffering” in the animals we care for, and this has now been expanded by the American Veterinary Medical Association to encompass prevention as well. A nobler calling does not exist when referring to animal care. Pain can be a terrible master that profoundly and negatively impacts on a patient’s quality of life. The importance of a team approach in its effective management is clearly supported by the literature and underscored by the finding that the number of RVTs within a practice positively correlates to the level of pain management practiced.1 However, despite our ongoing efforts and improvements as a profession, a pain incidence-pain treatment gap remains: that is to say pain occurs more frequently than it is treated, with one recent publication estimating that upwards of 6000 Canadian dogs and cats underwent elective surgical procedures on a monthly basis with inadequate pain management.2 There are many contributing factors to the “gap”, with many being addressed through innovation and education: myths are being revealed (e.g., yes – all animals do feel pain, they just exhibit it differently; no- inhalant anesthetics are not analgesics; no – pain is not protective, etc.), new therapies are being explored and licensed, and the recognition of pain as an illness have all precipitated great strides forward in the area of pain management for small animals.

CE Article #2 Pain Assessment and Management in the Cat: Meow or Meouch?

One of the persistent impediments to broader treatment of pain is its recognition. As our patients cannot verbalize their discomfort, it becomes our responsibility as part of the veterinary healthcare team to “look & listen” for non-verbal clues indicating the presence of pain and to assume the role of patient advocate. Considering the axiom “cats are not small dogs”, the following article explores the nuances of recognizing pain – both acute and chronic – in the feline species and general therapeutic strategies.

General Comments

As already mentioned, the cat is not a small dog – lighter and more agile, prone to spend less time directly with the owner and more “nap time”, overt behavioural changes consistent with pain are often misinterpreted as simply ‘slowing down’ due to aging. However, that is the foundation for feline pain assessment – changes in behaviour: loss of normal behaviour (e.g., grooming, eating, movement, agility/gait, social interaction, etc.) and gaining abnormal

behaviours (e.g., hiding, loss of litter box training, aggression when handled, local over-grooming, etc.). While true for both acute and chronic pain, this is of particular relevance to chronic pain and the owner is a critical diagnostic tool for assessing both the likely occurrence of pain and its response to treatment. As such, a good history and physical assessment for pain should accompany every patient assessment, regardless of presenting reason, and this is enunciated in the AAHA Practice Standards with regards to Pain Management.3 An additional point raised in the AAHA Practice Standards is that response to treatment is the gold standard for the diagnosis of pain, barring any contraindications. For acute pain, many causes are intuitively painful and this recognition has spawned such guiding principles as “treat predictable pain” and “we can’t always know that it does hurt but we can know that it doesn’t.” This brings in the relevance of “diagnostic anthropomorphism”. While we chuckle at times over the human qualities often attrib-

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

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uted to pets by their owners to explain a variety of good and bad behaviours, assessing for pain based on our own anticipated response given a similar clinical scenario is relevant – in other words, put yourself in the patient’s paws – if it were you, would this condition be painful? If yes, would it likely be significant enough to benefit from pain management? In the end, err on the side implementing pain management for those that can’t speak for themselves.

tic modalities and products with substantial evidence-based medicine to support their use. That is not to discount clinical experience in guiding treatment option or product selection, but based on the serious impact of pain on a patient’s quality of life, these should never be used as a mono-modal foundation for pain management and we should constantly be challenging ourselves with ”can we do better?”

A comment on pain assessment protocols – while there are many to choose from, none are scientifically validated in the cat. They need to be specific to either acute or chronic pain, and keep in mind that they are guides that should not pre-empt pain management (i.e., treat predictable pain) so much as guide it (e.g., duration, monoversus multimodal pain management, etc.). That being said, the key is to pick a method, become comfortable with its application and interpretation, and use it commonly and consistently. Some additional tools and comments will be made in the sections on acute and chronic pain.

The incidence of acute pain associated with the peri/postoperative period is 100%. Period. Table 1 provides a guideline as to the degree of pain associated with common feline clinical scenarios. While surgical technique and tools used (e.g., lasers) can help mitigate pain, they will never eliminate it. As such, implementation of pain management in the peri/postoperative period should be 100% - in other words, it should accompany every procedure. And not just in the immediate perioperative period but also into the postoperative period as pain does not magically disappear after 24 hours. Despite effective perioperative pain management, re-emergent pain due to premature analgesic withdrawal can be just as painful – and harmful – as no analgesic use at all, particularly for predisposing the patient towards allodynia or pathological pain (pain that persists despite the resolution of the inciting cause), a potential outcome of poorly treated pain. Therefore, the definition of pre-emptive pain management has been expanded to include not just the use of analgesics prior to the onset of

However, the previous paragraph does underscore a common theme – basing clinical decisions on evidence (well run clinical trials) -based medicine. There are many therapeutic products to choose from and the degree of supporting information regarding their efficacy and safety varies from true evidence-based medicine to eminence (opinion)-based medicine. Any treatment decision should be founded on therapeu-

Acute Pain

pain, but also for an appropriate duration of time postoperatively as well. As such, the current standard of care is for 2-4 days of post-operative pain management, which may need to be longer (and/or employ multi-modal analgesia) for more painful clinical scenarios, and this forms the basis for the recent publication by the Canadian Veterinary Medical Association of their “Examples of Anesthetic and Pain Management Protocols for Healthy Cats and Dogs; 2nd edition”.4 The foundation for acute perioperative pain management is multi-modal therapy, based on local anesthesia (where applicable), opioids, and non-steroidal anti-inflammatory drugs (NSAIDs). Don’t under-estimate the value of NSAIDs as they have both analgesic and anti-inflammatory properties – a powerful combination, especially when one considers that surgical pain always has a component of inflammatory pain due to the inevitable tissue trauma induced. Unfortunately, far too often real peri/postoperative pain is wrongfully dismissed or attributed to “recovery from anesthesia” and this raises the issue of pain recognition – how can we know pain is present and differentiate it from other potential clinical behaviours? To reiterate and build upon earlier comments: • •

Peri/postoperative pain incidence is 100% - treat predictable pain We can’t always know that it does hurt but we can know that it doesn’t

table 1 > Examples of Conditions and Expected Associated Levels of Pain Mild to moderate pain

Moderate pain

Moderate to severe pain

• Ovariohysterectomy • Castration • Removal of external, mobile masses • Some gingivitis • Some dental procedures • Cystitis • Otitis • Bite wounds and some lacerations

• Ovariohysterectomy (older, complicated) • Castration (some cats) • Minimally invasive surgical procedures, e.g., hernia repair • Exploratory laparotomy of a minimally inflamed abdomen and of an elective nature • Pancreatitis • Soft tissue injury • Enucleation • Some dental procedures • Orthopedic procedures

• Pancreatitis • Urethral obstruction • Exploratory laparotomy of an inflamed abdomen or for urgent cause • Orthopedic procedures

*Modified and reprinted with permission from Scherk, M. Experiences in Feline Practice: Incorportaing NSAIDs into analgesic therapy

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table 2 > Guidelines on the Postoperative Use of

Analgesics in the Cat

Minor Elective

• Neuters; dentals with significant inflammation; lacerations • mono-modal for 2 days Moderate Elective

• Declaw +/- sterilization; dental with extractions • mono-modal for 2-5 days Major Elective

• Extensive soft-tissue; orthopedic/joint invasion • MMA with background of NSAID + opioid • Duration dependant on degree and healing of surgical event Figure 01 > The 5 Faces of Pain in the Cat The Croissant This cat shows well controlled pain. The ears are pricked (upright) and forward, the eyes are not slanted. A horizontal line could be drawn through the centre of each eye. The back is minimally hunched and the cat appears bright and alert. This cat also displays a relaxed, tucked in leg posture, resembling a croissant.

The Humpy A cat with a hunched back, legs straightened often sitting quietly at the back of the cage may be in pain. This cat also has droopy ears and slanted half closed eyes. This posture is often seen after abdominal surgery.

The Squinty Cats with their heads down, ears “droopy” and eyes half closed and in a slanted position may be in pain. Note how a line drawn through the centre of the eyes makes a V shape.

The Flat-out Cats which are recumbent, tense or rigid may be in severe pain. This cat also has the facial expressions of pain: droopy ears and slanted half closed eyes.

The Untouchable Previously friendly and easy to handle cats that hiss, snarl or flinch or try to claw or bite in reaction to gentle pressure to a wound, or those that generally resent handling are probably in pain. A cat’s reaction can be expected to be proportional to the amount of pain being experienced.

*Reprinted with permission from Boehringer Ingelheim Canada Limited

As such, it is not a matter of should one treat but rather with what and for how long? This is where consistent and repetitive pain assessment can provide guidance, in concert with the information provided in Tables 1 and 2. So what should we use for pain assessment in the cat? A myriad of options exist but currently, none are validated for feline use. However, that is not to negate their value when used consistently and interpreted judiciously. Work done in laboratory animals (mice and rabbits; Grimace Scale) as well as human pediatrics, have correlated facial expression with the occurrence and degree of pain. A similar correlation has been explored in the feline and has recently been forwarded as the “5 faces of pain”, which is presented in Figure 1. While many of these facial expressions and postures may be seen immediately upon recovery from anesthesia, persistence beyond 2030 minutes should prompt close reassessment of the analgesic protocol employed. They can also be used as a discharge tool, to help guide the owner in assessing the comfort of their cat in the postoperative period while at home; emergence of facial expressions or body postures associated with pain should prompt a call to the veterinary clinic and a reassessment as to the need for additional analgesic support. These facial expressions are ideally put into context of the “bigger picture” – namely in context with the patient posture, behaviour, and response to gentle surgical site palpation. As such, the “5

faces of pain” marry well with the Colorado Acute Pain Scale, readily available through the International Veterinary Association of Pain Management website (www.ivapm. evetsites.net/refId,20467/refDownload.pml) Frequent monitoring and patient reassessment during hospitalization is the responsibility of the entire healthcare team – from kennel attendant to RVT to veterinarian. The RVT is uniquely positioned within the caregiver team to be the primary patient advocate based on their direct and frequent patient interaction, their trained understanding of feline behaviour and patient handling skills, and their intimate knowledge of the ramifications of untreated pain. Additionally, do not underestimate the therapeutic power of simple supportive care measures. This is now entrenched within the concept of multi-modal supportive care, which encompasses IV fluids, blood pressure monitoring, and maintenance of normothermia as a minimum. For those that have undergone an anesthetic and surgical procedure themselves, the comfort of the simple provision of warm blankets in the immediate post-anesthetic period cannot be over-stated. Combined with patient interaction, petting, a clean litter box, recuperative diets, etc., it ensures the groundwork for patient comfort is set and the inherent attendance to patient needs heightens the ability to identify the subtle nuances of feline pain behaviours. On a final note, also recognize that while acute pain associated with surgical procedures is well recognized, there are other commonly encountered sources of acute pain as well, including medical pain and some of these are highlighted in Table 1. Incorporating an analgesic strategy into the overall therapeutic protocol is critical to their successful management as well.

Chronic Pain

This is an area that epitomizes the fact that cats are not small dogs. Until recently, it was thought that cats simply were not prone to chronic osteoarthritic pain as are dogs. Behavioural changes were far too often dismissed as either old age, or overzealous anthropomorphism when it comes to loss of certain behaviours such as littertraining – “the cat must be mad at me.” However, when one looks at the various recent publications where the incidence of radiographic changes consistent with the occurrence of degenerative joint disease

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(DJD) was assessed in cats, it is quite likely that they may suffer from osteoarthritis more commonly than the dog, but simply display it differently. There are a number of potential explanations, some of which have already been covered (e.g., smaller, lighter, more agile, more sedentary, etc.) but another that complicates diagnosis is that cats generally get osteoarthritis bilaterally, limiting the ability to compare one limb against its contralateral mate and undermining the display of an overt limp. Bennet and Morton have done a number of seminal studies in this area, generating an inventory of the various behaviours potentially associated with overt osteoarthritis in the cat and then assessing their response, or not, to treatment. They have identified 4 main categories of behaviour that assist with patient assessment:5 Mobility levels (e.g., primarily jumping behaviour) 2. Activity levels (e.g., sleeping habits, playing, etc.) 3. Grooming habits 4. Temperament (e.g., social interaction, tolerance towards owners/ other animals) 1.

Their recommendations are for the owner to assess these behaviours for any change over time. For a more in depth inventory of associated behaviours, I refer the reader to their article but a simple visual aid that focuses on key behviours to assist clients in evaluating change over time can be found in Figure 2. Should there have been a consistent change over time, especially in multiple behaviours, then the diagnosis of chronic pain should be considered. A definitive diagnosis is often supported by additional diagnostics (e.g., general physical examination, radiography, etc.), with commonly affected joints of the skeletal system being hips, stifle, tarsus, and lumbosacral, the latter often associated with hind-end neurological abnormalities. This is an area where response to treatment becomes very relevant to the diagnostic process and, considering that inflammation is a common underlying pathophysiological process, a short trial course with a feline veterinary licensed NSAID may assist with diagnosis. Table 3 presents an example of a diagnostic approach to feline DJD.

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table 3 > Example Protocol for the Diagnosis of

Chronic Pain in the Cat

Recommend, gain commitment, and plan for routine preventative healthcare

• Encourage annual preventative healthcare visits and ensure pain assessment accompanies every visit Gather a complete history

• Recognize that feline pain is demonstrated behaviourally through the loss of normal behaviours and gaining abnormal ones • Query behaviour changes since last visit in categories of mobility (e.g., jumping), activity (e.g., sleeping, playing, etc.), grooming (e.g., hair coat, scratch post use, etc.), and temperament (e.g., social interaction, response to touch, etc.). Consider use of visual aid(s) to assist query (see Figure 2) Perform a complete general physical examination (GPE)

• Observe: gait for any obvious gait abnormalities (ensure firm floor provides firm footing) • General examination for evidence of under-grooming (e.g., tail head), over-grooming (e.g., over joint), abnormal nail wearing, and muscle mass loss • Musculoskeletal examination, assessing for joint thickening, crepitus, and reluctance to palpate. Gentle palpation of spine for any evidence of discomfort. Further diagnostics as warranted:

• CBC, biochemical profile, and urinalysis to assess for underlying metabolic disease that may be correlated with GPE findings or may impact on therapeutic protocols chosen • Sedation and radiography of suspect skeletal/joint abnormalities Response to treatment:

• Inventory behaviour changes as identified during history taking (see above) • If no contraindications, consider a 5-day trial of a feline veterinary NSAID licensed for musculoskeletal use • Assess response on Day 6 based on changes (if any) in altered behaviours identified in bullet #1 • If response is positive, diagnosis of clinically relevant chronic pain confirmed Once diagnosis of chronic pain has been made, establish an appropriate long-term therapeutic protocol based on:

• Surgical correction of musculoskeletal abnormality if applicable • Establishment and maintenance of ideal body weight • Nutritional therapy, including nutraceuticals and disease modifying agents (e.g., Omega-3 fatty acids, polysulfated glycosaminoglycans, etc.) • Pharmacological management – while NSAIDs are the foundation of degenerative joint disease treatment in all other species, currently there is no feline NSAID licensed for long-term use in Canada. In lieu of, guidance from published literature and Consensus Guidelines6 may provide relevant information • Additional adjunctive treatment (e.g., acupuncture, gabapentin, amantadine, opioids for breakthrough pain, etc.) • Salvage surgery (e.g., joint replacement, femoral head ostectomy, etc.)

Figure 2 >

Visual aid in identifying chronic pain in the cat

Painful Cat

Healthy Cat

Painful cats might use a chair to help them jump onto a table.

Painful cats play less frequently and spend more time sleeping.

Painful cats may be hesitant to climb stairs.

Painful cats may be hesitant to jump off a table.

*Reprinted with permission from Boehringer Ingelheim Canada Limited

Conclusions

There is no greater good that the veterinary healthcare team can provide to their patients than to identify and eliminate pain. While this is a lofty goal, closing the pain incidence-pain treatment gap is realistic and achievable, particularly based on our knowledge of pain behaviours and the growing availability of proven therapeutics. All we need to do is observe, ask, and listen. The RVT is in a key position to facilitate our profession’s ability to meet the Hippocratic Oath based on their central role within the veterinary healthcare team, their key liaison between the team and pet owner, and their frequent patient interactions – both during the office visit and the hospital stay. In essence, they are instrumental advocates towards achieving pain free clinics. Our patients are in good hands!

references > 1. Coleman DL, et al. Attitudes of veterinary nurses to the assessment of pain and the use of pain scales . Vet Rec. 2007;160:541-544. 2. Hewson CJ, et al. Perioperative use of analgesics in dogs and cats by Canadian veterinarians in 2001. Can Vet J 2006;47:352-359. 3. Hellyer P, et al. American Animal Hospital Association; American Association of Feline Practitioners; AAHA/AAFP Pain Management Guidelines. Rodan I, Brunt J, Downing R, Hagedorn JE, Robertson SA. J Am Anim Hosp Assoc. 2007;43:235-248. 4. Lemke KA, et al. Fundamental points in perioperative pain management & examples of anesthetic and pain management protocols for healthy dogs and cats: Edition 2. Canadian Veterinary Medical Association 2011. 5. Bennet D, et al. A study of owner observed behaviour and lifestyle changes in cats with musculoskeletal disease before and after analgesic therapy. J Fel Med Surg 2009;11:991-1004 6. Sparkes AH, et al. ISFM and AAFP consensus guidelines: The longterm use of NSAIDs in cats. http://www.isfm.net/toolbox/info_sheets/ NSAIDs_guidelines.pdf; last visited September 24, 2012

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

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Apps,Blogs

&Websites

To Watch CDC resource for veterinary health and safety The US Centres for Disease Control and Prevention’s National Institute for Occupational Safety and Health has launched a website entitled Veterinary Safety and Health (http://www.cdc. gov/niosh/topics/veterinary). It is designed to provide occupational health and safety (including infection control) information for people in the veterinary field, as well as people in zoos, animal shelters, kennels and other animal-contact situations. It’s largely designed to be a central resource to link to available information, combining a range of aspects from general occupational safety info to veterinary specific infection control, hospital design and related topics. Protecting Outdoor Workers from Tick Bites and Lyme Disease The Ontario Ministry of Labour presents information on Lyme Disease at: http://www.labour.gov.on.ca/english/hs/pubs/lyme.php Cat Friendly Nursing Care Guidelines New 2012 Feline-Friendly Nursing Care Guidelines - The American Association of Feline Practitioners (AAFP) and the International Society of Feline Medicine (ISFM) published new cat-friendly nursing care guidelines to help reduce feline stress during medical care. This slide show includes important tips from the guidelines and a link to the full guidelines. http://jfm.sagepub.com/content/14/5/337.full.pdf+html Smartphone-based veterinary heart monitor debuts Veterinarians and pet owners can now make phone calls, browse the Internet, and monitor animals’ hearts all from the same device. The first smartphone-based veterinary electrocardiograph (ECG) device has entered the market with the intention of providing a more portable and cost-effective way to monitor animal heart health. The heart monitor attaches to the iPhone and provides the phone with the ability to quickly read the electrical activity in an animal’s heart. The monitor, made by AliveCor, can read single-lead ECG waveforms from felines, canines and equines. The $199 (USD) device is a plastic case that is designed to attach to the back of the iPhone 4 and iPhone 4s. (Veterinary Advantage Weekly News)

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Pets Add Life Andrew Grantham, creator of the “Ultimate Dog Tease” video (quotable line: “The maple kind. Yeah.”), has collaborated with the American Pet Products Association’s Pets Add Life campaign for a new series of comedy videos. They’re at: youtube.com/petsaddlife. Updated Lifelearn Websites LifeLearn’s WebDVM4 platform now offers mobile-optimized websites, allowing pet owners to use their veterinarians’ websites more effectively on their smartphones. Websites using the WebDVM4 platform: • will now automatically recognize mobile devices and configure page layouts for better readability and navigation on a small touch screen, at no additional cost to subscribers. • Apple iOS, Android, BB and Windows Mobile • integrates with social media outlets • can bookmark and share information • advanced search engine optimization tools • easy-to-use content management system • integration with e=commerce and e-mail marketing systems • integrates with LifeLearn’s ClientEd Online service www.LifeLearn.com (DVM360.com) Two Blogs to Watch vetsbehavingbadly.blogspot.ca/2012/09/a-profession-indecline.html Veterinarians behaving badly - A sarcastic veterinary blog dedicated to all of the money grubbing vets out there who are fed up with the insanity of the American public. http://www.generationvet.com/ This is the story of a fictional veterinarian in Philadelphia. Besides having access to Amanda Brown, DVM’s Facebook, YouTube and Twitter pages from here, you can also contact her and creators Phil Barnes and Hillary Israeli directly at generationvet@gmail.com. Merck Manual App Unbound Medicine has launched the Merck Veterinary Manual mobile application for smartphones and tablets on all major platforms. The Merck Veterinary Manual offers information on the diagnosis, treatment and prevention of animal disorders and diseases. Powered by the Unbound platform, the app can be downloaded to iPhone, iPad, Android or BlackBerry devices for consultation anywhere that detailed information on companion, production, exotic and laboratory animals is needed.

One of the most common presenting complaints of patients to veterinary hospitals is gastrointestinal (GI) disease. Diarrhea and vomiting are common complaints from cat owners and are two of the most common signs in cats with inflammatory bowel disease.1-4 The main challenge to the veterinary healthcare team presented with such a case, is to help the pet owner to manage this potentially chronic problem. Inflammatory bowel disease (IBD) refers to a group of chronic, idiopathic gastrointestinal (GI) disorders characterized by histopathologic lesions of mucosal inflammation. IBD is considered the most common cause of chronic diarrhea and vomiting in dogs and cats. IBD is a generic term encompassing lymphoplasmacytic enteritis, lymphocytic gastroenterocolitis, eosinophilic gastroenterocolitis, segmental granulomatous enterocolitis (regional enteritis), suppurative enterocolitis and histiocytic colitis. The lymphoplasmacytic form is considered the most common type of IBD.3 More specifically to felines, the most commonly identified idiopathic inflammatory bowel disorders are lymphoplasmacytic enteritis, benign lymphocytic enteritis, and lymphocytic-plasmacytic colitis. The severity of IBD can range from mild clinical signs to life-threatening protein-losing enteropathies. Inflammatory infiltrates may involve the stomach, small bowel and colon. In cats, the stomach and small bowel are noted to be affected the most often.

Patient Assessment The most common clinical signs in cats with IBD are chronic vomiting, diarrhea, and weight loss.1-4 IBD is most often seen

CE Article #3 Feline Inflammatory Bowel Disease: Pathophysiology, Treatment Goals, & Nutritional Management

in middle-aged to older pets, although it has been documented in pets as young as 4 months. No breed or gender predilection appears to be evident. GI signs vary with the portion or portions of bowel affected. When the stomach and proximal duodenum are affected, vomiting tends to be the predominant clinical sign. Loose, fluid or steatorrheic stools are common when the small intestine is involved. Diarrhea manifested by tenesmus, mucus, and small stools has been associated to lesions in the colon. The clinical signs and symptoms associated with IBD are highly variable. Clinical signs may be intermittent or persistent. Clinical signs tend to increase in frequency and intensity as IBD progresses. Also variable is the presence of systemic signs. Certain animals may present with a history of lethargy, malaise, and inappetence; other patients

may present as alert and active upon examination. The frequency and character of the vomitus and stools are important to note. At times, vomiting will be related to food intake and the vomitus will contain food particles, while in other cases, animals may vomit only fluid or froth.1,3-6 It is important for veterinary technicians to question owners thoroughly about the appearance of the vomited material. Dark black or ‘coffee grounds’ type material is indicative of gastric ulceration or erosions. Also, diarrhea may be small or large bowel in origin and thus the colour of the stools should be evaluated to determine the presence of GI bleeding.1,3,5 When performing a physical examination on cats with IBD, technicians must remember that findings will vary among

Kara M. Burns, MS, MEd, LVT, President, Academy of Veterinary Nutrition Technicians is a licensed veterinary technician originally from New England, now living in Kansas. She holds a master’s degree in physiology and one in counseling psychology. She began her career in human medicine working as an emergency psychologist. She also worked at Maine Poison Control as a poison specialist. She then made the move to veterinary medicine and worked in small animal private practice and a small animal and avian practice. Kara is the Founder and President of the Academy of Veterinary Nutrition Technicians, the tenth recognized specialty for veterinary technicians. Currently, she works for Hill’s Pet Nutrition as the veterinary technician specialist working with the technician profession in all aspects. Kara has authored many articles and textbook chapters and is an internationally invited speaker, focusing on topics of nutrition, leadership, and technician utilization. She enjoys spending time with her wife Dr. Ellen Lowery and their children. The family also includes three horses, two sheep, 2 pugs, a French bulldog, 3 birds, 4 indoor cats, and assorted other critters!

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patients. Some patients may have no abnormalities. Other cats may present with weight loss and poor body condition and others may present with hemorrhage or hypoproteinemia. Upon palpation of the abdomen, some cats will have thickened loops of bowel. The veterinary technician should begin with taking a thorough history including: signalment, medication history, vaccination history, deworming schedule, medical history, exposure to toxins, etc. A very comprehensive nutritional history should also be taken including: feeding regimen, diet fed, type of diet (canned, dry, semimoist), feeding plan, household member responsible for feeding the cat, treats, toys, medication aids (pilling/medication aids). Another piece of the history should focus on the catâ&#x20AC;&#x2122;s environment, what enrichment if any is in the catâ&#x20AC;&#x2122;s environment, location and type of litterbox, other pets in the environment, etc. 1 It is important to listen to the pet owner and ask open ended questions when taking a history involving GI signs and symptoms.

Pathophysiology

The pathophysiology of inflammatory bowel disorders is not fully understood, despite a number of studies by veterinary and medical researchers. This fact alone is cause for frustration on the part of the owner and calls for empathy and compassion by the veterinary technician as the owner oftentimes feels at a loss for what is best for their cat. There appears to be no questioning that IBD is immune-mediated; however the pathogenesis of the various forms of IBD is poorly defined.1-5 Abnormal cytokine mRNA expression has been identified through intestinal biopsies in felines. Hypersensitivity is thought to be the primary pathway for the development of IBD. However, the underlying cause for hypersensitivity reactions is unknown. There have been two related theories put forth to explain the hypersensitivity reaction. The first suggests that patients suffering from IBD have developed a defect in the intestinal mucosal barrier. Subsequently, the loss of mucosal integrity results in increased gut permeability and hypersensitivity responses to antigens that typically have been tolerated. Alternatively, IBD may result from aberrant immunologic responses to luminal antigens. It has been theorized that defects in gut-associated lymphatic tissue (GALT) suppressor function may predispose patients to development of hypersensitivity to

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normally tolerated luminal antigens.4 These immunologic reactions may be triggered by parasites, pathogenic organisms, normal gut flora and dietary antigens. Inflammatory mediators are released in both of the aforementioned potential pathways. Further damage may result from these substances in the intestinal mucosal surface thus setting up a vicious cycle of inflammation and loss of barrier function. The pathogenetic pathway is most likely influenced by environmental (i.e., exposure to dietary antigens or GI parasites) and genetic factors that modulate disease expression. A potential genetic role is suggested as it appears that certain canine breeds (e.g., Basenjis, softcoated wheaten terriers) are predisposed for IBD.3-5 Mucosal inflammatory infiltrates and soluble factors are responsible for the clinical manifestations of IBD. Mucosal inflammation disrupts normal absorptive processes resulting in malabsorption and osmotic diarrhea. Gut permeability may be altered due to the leakage of fluid, protein, and blood into the gut lumen. Malabsorbed fats, carbohydrates, and bile acids result in secretory diarrhea. Inflammatory mediators may also trigger intestinal secretion and mucus production by goblet cells. Mucosal inflammatory infiltrates may alter intestinal and colonic motility patterns, a mechanism attributed to the influence of prostaglandins and leukotrienes on smooth muscle. Inflammation of the stomach and small bowel may stimulate visceral afferent receptors that trigger vomiting. Delayed gastric emptying associated with gastroparesis or ileus may exacerbate vomiting.1-3,5

Treatment

Dietary allergens may play a role in the cause of IBD in felines, so it makes sense that nutritional therapy might be beneficial. Dietary therapy should begin upon diagnosis of IBD and in cats with mild IBD; it may be the only therapy necessary to achieve resolution. However, the client must be educated in detail as to how nutrition plays a role in managing IBD and the importance of staying on the recommended food to avoid flare-ups of their cats IBD.

Key Nutritional Factors in Patients with IBD Water Dehydration is frequently encountered in patients suffering from IBD. Reduced water consumption is often intensified by fluid losses resulting from the vomiting and/or diarrhea the patient is exhibiting. Fluid balance in the patient should be

maintained through oral consumption of fluids. However, dehydrated patients and those with persistent vomiting may require parenteral fluid. Electrolytes As vomiting and diarrhea persist, serum electrolyte concentrations should be monitored regularly to allow early detection of abnormalities. A particularly common finding in patients with IBD is hypokalemia. Thus, foods containing 0.8 to 1.1% dry matter (DM) potassium are preferred. Potassium levels should be restored with intravenous potassium supplementation. Veterinary technicians need to keep in mind that affected patients often lose large amounts of sodium through diarrhea and, sodium deficits may be masked by dehydration.1,3 Energy Density and Fat Energy dense foods are preferred for managing patients with chronic enteropathies. Energy dense foods allow for the feeding of smaller volumes of food, thus minimizing GI distention and secretions. Unfortunately, energy dense foods are also usually higher in fat content. High-fat foods may contribute to osmotic diarrhea and GI protein losses, further complicating IBD. Consequently, the healthcare team should consider providing a food with moderate energy density (4.0 to 4.5 kcal/g DM) and fat levels of 15 to 25% DM), especially when introducing nutritional management. If tolerated by the animal, foods with higher fat levels can be gradually offered. Fiber-enhanced foods are usually lower in fat, thus providing a lower energy density versus highly digestible foods. It is recommended that the DM energy density of fiber enhanced foods for IBD be at least 3.4 kcal/g for cats. Fat content in fiberenhanced foods for cats with IBD is recommended to range from 9 to 18% DM. In normal cats it has been found that they can tolerate much higher concentrations of dietary fat as opposed to dogs.1,3 Protein Special attention must be paid to the potential of protein malnutrition in cats with IBD due to fecal losses through diarrhea. High biological value, highly digestible (â&#x2030;Ľ87%) protein sources are strongly recommended. Protein should be provided at levels sufficient for the appropriate lifestage for patients not experiencing excessive GI protein loss (35% for adult cats [DM]). Suggested protein levels for feline patients

being managed with hypoallergenic foods can have lower protein levels. Since dietary antigens are suspected to play a role in the pathogenesis of IBD, “hypoallergenic” novel protein elimination foods or protein hydrolysate foods are an acceptable course of nutritional management. As a result, it has been reported in some cases that elimination foods may be administered without pharmacologic intervention. The following are recommended for ideal elimination foods:

1. Avoid protein excess 2. Have high protein digestibility 3. Contain a limited number of novel protein sources to which the cat has never been exposed or contain a protein hydrolysate.1,3

Fiber Beet pulp, soy fiber, inulin, and fructooligosaccharides have been shown through in vitro fermentation to yield volatile fatty acids that may be beneficial in IBD involving the distal small intestine and colon. These are fermentable fibers that serve as prebiotics and cultivate the growth of beneficial bacteria such as Bifidobacterium and Lactobacillus spp. These fermentable fibers are recommended at rates of 1 to 5% DM in commercial products. Dietary fiber content may be increased to normalize intestinal motility, water balance and microflora. There are several physiologic characteristics of fiber that are beneficial to managing small bowel diarrhea. Insoluble fiber added at moderate levels (7 to 15% DM) increase nondigestible bulk, which buffers toxins, holds excess water and, provides intraluminal stimuli. This aids in reestablishing the coordinated actions of hormones, neurons, smooth muscle, enzyme delivery, digestion, and absorption. Fiber aids in the normalization of transit time through the small bowel, and in reestablishing normal peristaltic action. Veterinary healthcare team members must remember that increased fiber levels will reduce the energy density and digestibility of a food.

Cobalamin

Deficiencies in cobalamin (vitamin B12) have been recognized in cats with chronic enteropathies. These deficiencies may result in severe metabolic abnormalities such as increased serum methylmalonic acid and disturbances in serum amino acid levels. Because cats have increased cobalamin

turnover as a result of biliary excretion of cobalamin, they are at greater risk for cobalamin depletion. Additionally, cats unlike humans, lack cobalamin binding protein TC1, which facilitates long-term cobalamin storage. Hypocobalaminemia typically occurs when specific cobalamin receptors in the ileum are damaged as a consequence of inflammatory disease. Reduced cobalamin consumption and continuing GI losses increases the depletion in cobalamin. Veterinary technicians should monitor serum cobalamin in patients with chronic small intestinal disease. It is recommended that those cats found to have hypocobalaminemia (<300 ng/l) receive weekly subcutaneous cobalamin therapy (250 μg in cats) for four to six weeks or until serum levels return to the normal range. In specific instances, longer term maintenance may be indicated. If this is the case, once or twice monthly cobalamin injections should be administered with serum cobalamin levels and clinical signs being closely monitored.1,3

Therapeutic Nutrition Recommendation

Veterinary technicians should familiarize themselves with the key nutritional factors above and the various foods marketed for GI conditions. Hill’s® Prescription Diet® i/ d® Feline Gastrointestinal Health fits the profile above and allows for small portions to be fed multiple times a day while still achieving the proper nutrient intake. Also, this food has increased B-complex vitamins to help combat hypocobalaminemia. This food also allows for long term nutritional management of feline IBD. Purina Veterinary Diets® EN® Feline Gastroenteric® Formula also fits the profile of key nutritional factors for patients with IBD. Although the protein percentage on a DM basis is higher than necessary for an adult maintenance formula, the digestibility of this protein is high. Those patients that are suffering from IBD due to dietary allergens will benefit from nutritional management using Hill’s® Prescription Diet® z/d® Feline ULTRA allergen-free. This product contains one hydrolyzed animal protein source and a single highly digestible carbohydrate source. This limits the allergic response to dietary sources, thus limiting the signs and symptoms of IBD in the feline.

Pharmacologic Therapy

It is important that veterinary technicians familiarize themselves with pharmacologic

therapies used for treating and managing IBD in cats. Corticosteroids are looked to first when dealing with IBD. Cats with mild to moderate cases of IBD typically respond well to a prednisilone starting dose of 2 mg/kg a day PO (10 mg/cat/day for most cats). If biopsies have been obtained, begin 10 days after to allow time for the mucosa to heal. If improvement is noted after a two week recheck, this dose can be maintained for 2 to 4 more weeks. Typically at this point, the majority of cats are back to normal weight and are no longer exhibiting clinical signs. In this case, the corticosteroid dose can be weaned down to 1 mg/kg, PO (often 5 mg/ cat/day) for several months, with continued rechecks scheduled to assess weight, clinical signs, and diet. The goal of corticosteroids in feline IBD is to wean down to the lowest dose found to be effective, or in some instances discontinue the corticosteroid all together. It has been suggested that younger cats with IBD typically do not need to be treated as long as middle aged to older IBD cats.1,4,6 Methylprednisolone acetate can be used as a sole therapy or an adjunct therapy. It is reported that consistent control of signs in cats with moderate to severe symptoms are harder to control when methylprenisolone acetate is used alone. Veterinary technicians should note that use of methylprednisolone acetate should be reserved for situations where the owner cannot consistently give tablet or liquid preparations orally. Budesonide is a glucocorticoid that is a newer alternative for IBD management – especially when dealing with severe cases that are refractory to prednisolone, metronidazole, and dietary management or cannot tolerate corticosteroids. Typical dose for cats is 1 mg once per day.1,6 If combination therapy is warranted, metronidazole is the first choice to be used concurrently with prednisolone. Typically for IBD, a dose of 5 to 10 mg/lb BID is recommended.1,4,6

Summary

It is imperative that veterinary technicians familiarize themselves with IBD and the causes of this disease, and work with the entire healthcare team and patient owner to ease the signs and symptoms observed in cats presenting to the hospital.

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Veterinary technicians play an important role in monitoring IBD feline patients and their response to treatment. Technicians should be attentive in observing the following:

1. Corticosteroid– inadequate initial or long term maintenance dose

2. Moderate to severe IBD – failure to use ancillary medications

3. Failure of the healthcare team to rec-

ognize and treat a concurrent condition 4. Poor owner compliance 5. Treating only small intestinal inflammation when colitis is present as well 6. Failure to recognize and treat low body cobalamin levels 7. Failure to identify effective nutritional therapy Proper nursing care and owner education will assist the healthcare team in diagnosing and managing IBD and provide for the proper management of and improvement in the feline patient.

references > 1. Burns, KM. Gastrointestinal. In Small Animal Internal Medicine for Veterinary Technicians and Nurses. Merrill, L, ed. 2012, Wiley-Blackwell, Ames, IA. 2. Tams, T. Gastrointestinal Symptoms. In Handbook of Small Animal Gastroenterology 2nd Ed. Tams T. 2003, Saunders, St. Louis, MO 3. Davenport, DJ, Jergens, AE, Remillard, RL. Inflammatory Bowel Disease. In Small Animal Clinical Nutrition 5th Ed. Hand M, Thatcher, Remillard R, Roudebush P, Novotny B, eds. 2010, M.M.I., KS 4. Baral, RM. Diseases of the Intestine. In The Cat: Clinical Medicine and Management. Little, SE. ed. 2012. Elsevier, St. Louis, MO 5. Willard, MD. Disorders of the Intestinal Tract. In Small Animal Internal Medicine, 4th ed. Nelson, RW & Cuoto, CG, eds. 2009, Elsevier, St. Louis, MO. 6. Hall, EJ, German, AJ. 2008. Inflammatory Bowel Disease. In Small Animal Gastroenterology. Steiner, JM editor. Pp. 312-329. Schlutersche: Germany.

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Client Education Videos Spell out your hospital’s makeup policy right in the employee handbook Dress code. Most women know the difference between ‘daytime makeup’ and ‘nighttime makeup’. Daytime makeup is most appropriate, subtle is best. Tones that are flesh tone, and colours that are found in nature are best. Makeup tends to be trendy, and it is best for staff to be able to go with the flow, but the policy may want to state that staff look a step cleaner/better than clients that come in the practice. There may be obvious differences if the practice is in a rural setting versus a downtown urban setting. Lighter is best. (Shawn McVey, dvm360.com) Cover Rubber Stoppers With a Cap To keep the rubber stoppers on injectable medications clean after the bottles are opened cover the tops with 1-mL syringe casing caps (Veterinary Medicine) Minty Hands! Next time your hands are soiled with smells (e.g. anal gland and cat urine odours) that are reluctant to wash off, try washing your hands with a minty toothpaste. Works great! (Veterinary Medicine) Repurpose Your X-Ray Viewer Box If you now use digital radiography but still have light boxes throughout the hospital, consider using them as a dry-erase board! Tips on Hospital Designer (by Veterinary Architect Dan Chapel, AIA) • Ugly paint costs just as much as pretty paint colours so pick out a pleasing colour scheme. If you’re doing something big, hire a professional and do it right. • Edit your accessories. Clear the clutter, get rid of any decorative item that is smaller than a basketball • Take photos of your facility and look at them at home on your computer. You’ll then see it in a different light and will want to clean up things you walk by every day. Happy Birthday JoJo On the first of every month send out personalized “Birthday Gram” emails. The email could read, “Our records indicate that JoJo is having a birthday this month! Call today to schedule his complimentary birthday nail trim.” Patients usually inquire about other services or preventives that their pets need. The birthday nail trims will fill up your technician appointment calendar and won’t tie up the doctors. But most of all, the team members and your clients will love it. (Firstline)

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CE Article #1: Too Hot, Too Cold 1) The temperature-regulating centre is located in the: a) Medulla oblongata b) Parietal lobe c) Hypothalamus d) Prefrontal cortex

5) Neurological and organ dysfunction can occur at body temperatures greater than: a) 41.1°C b) 40°C c) 40.5°C d) 39.5°C

9) A major concern during rewarming of a hypothermic patient is: a) Severe shock and cardiac arrest b) Rhabdomyolysis c) Rebound hyperthermia d) Rebound hypothermia

2) Heat loss occurs because of these four things: a) Neurons, conduction, radiation, evaporation b) Convection, conduction, radiation, evaporation c) Convection, condensation, radiation, evaporation d) Convection, conduction, radiology, evaporation

6) One of the most life-threatening problems with heatstroke is: a) Diarrhea associated with gastrointestinal disturbances b) Acute liver failure c) Splenic hemorrhage d) Thermal injury to the renal system

10) Hypothermic patients are at risk for developing: a) Rhabdomyolysis b) Pneumonia c) Sepsis d) Pancreatitis

3) Heat production occurs from all of these things except: a) Cellular metabolism b) Skin vasoconstriction c) Convection d) Piloerection

7) Rhabdomyolysis occurs when: a) The blood starts to coagulate throughout the whole body b) Myoglobin is circulated through the bloodstream c) Organ function of two or more organ systems become altered d) Inflammatory mediators are excessively produced

4) One of the largest organs in the body involved in cellular metabolism is: a) Spleen b) Pancreas c) Kidneys d) Liver

8) One of the safest and most effective ways to cool a patient is through: a) Ice and cold water baths b) Cold water gastric lavage c) Noninvasive peripheral cooling d) Cold water peritoneal lavage

TECHNEWS | VOLUME 36 ISSUE 2

CE Article #2: Feline Pain & Management 1. Which of the following statements regarding the pain incidence-treatment gap is false: a) The occurrence of pain in small animals is more common than its treatment b) Is a fallacy as cats do not feel pain as other mammals do c) Is often due to the difficulty in assessing the presence of pain in cats d) Results in ~6000 Canadian dogs and cats per month undergoing elective procedures without adequate analgesic therapy 2. Which of the following is true with regards to pain in animals in general: a) Improperly treated pain can result in allodynia, or pathological pain b) Domestic animals have never been shown to perceive pain c) Inhalant anesthetics are powerful analgesics d) Certain procedures should not receive analgesics post-operatively to ensure the animal protects the surgical site 3. All of the following behaviours are commonly seen in cats with chronic pain except: a) Poor grooming b) Reduced ability to jump c) Overt and readily visible limb lameness d) Reluctance to play/interact 4. Which of the following best describes the use of pain assessment protocols: a) They should be specific to acute or chronic pain b) For acute pain due to surgery, they should be used as guides on type and duration of analgesics used, not to determine if analgesics should be used c) As there are multiple validated protocols available, any will work and can be used interchangeably between dogs and cats d) a & b above

5. Perioperative or acute pain management should encompass all of the following except: a) Pre-emptive analgesia and post-operative pain management b) Be given to every patient undergoing a surgical procedure c) Be restrictive to surgical procedures as medical conditions are not associated with pain d) Used in conjunction with supportive care. 6. With regards to implementing practice pain management standards, which of the following is false: a) Evaluation for pain should accompany every patient assessment b) Owner input should be excluded as it is biased by emotion and therefore misleading c) Response to therapy is the gold standard for diagnosing pain d) Therapeutic protocols should be based on evidence (study)-based medicine 7. With regards to the” 5 faces of pain in cats”, which of the following is false a) Is based on similar work done in mice and rabbits b) Is best put into perspective of the overall patient assessment by using it in combination with additional pain scales c) Has been discounted as it simply correlates to anesthetic recovery behaviours d) Can be a successful educational tool for discharge use in pet owners

8. Which of the following statements is false: a) Allodynia is the occurrence of pathological pain – pain that persists despite the resolution of the inciting cause b) NSAIDs are not useful as analgesics in the cat c) Pre-emptive analgesia encompasses the use of analgesics prior to the onset of pain as well as for an appropriate duration postoperatively d) The foundation for acute perioperative pain management is the use of local anesthetics, opioids, and NSAIDs 9. The reason that chronic pain is often missed in cats is/are: a) Cats are smaller and more agile, therefore better at hiding any underlying pain b) Cats tend to sleep more and have less interaction time with owners c) Joint disease in cats is generally bilateral, thereby mitigating an overt or obvious limp d) All of the above 10. When assessing the degree of pain for a given surgical procedure and the likely need for analgesic therapy, which of the following is true: a) Implementing analgesic therapy is dependent on pain assessment findings b) Should follow the adage “treat predictable pain” c) Would indicate that neutering a male cat does not require analgesic therapy d) Should avoid anthropomorphism as pain perception in animals is vastly different than in people

CE Article #3: Feline Inflammatory Bowel Disease 1. In cats, the most affected portion(s) of the GI tract are: a) Stomach b) Colon c) Small bowel d) a & c above 2. Which of the following is not a typical sign of IBD in cats: a) Vomiting b) Diarrhea c) Weight gain d) Weight loss 3. IBD is most often seen in which age range? a) Kittens b) Young adult c) Middle age d) None of the above 4. Loose, fluid, or steatorrheic stools are common when the _________is involved. a) Small intestine b) Large intestine c) Colon d) Stomach

5. A comprehensive nutritional history should include: a) Feeding regimen b) Diet fed c) Household member responsible for feeding the cat d) All of the above

9. Which of the following are fermentable fibers that serve as prebiotics and cultivate the growth of beneficial bacteria a) Soy fiber b) Inulin c) Both a & b d) Neither a & b

6. Dietary allergens may play a role in the cause of IBD in felines. a) True b) False

10. When specific cobalamin receptors in the ileum are damaged as a consequence of inflammatory disease, the following typically results: a) Hypercobalaminemia b) Hypocobalaminemia c) Fructooligosaccharidemia d) None of the above

7. Dehydration is frequently encountered in patients suffering from IBD. This is due to which of the following factors? a) Reduced oral water consumption b) Vomiting c) Diarrhea d) All of the above 8. Energy dense foods do not allow for the feeding of smaller volumes of food, and do not thus minimize GI distention and secretions. a) True b) False

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TECHNEWS | VOLUME 36 ISSUE 2

11615 (Nov 15, 2012) ICU & Neurology RVT’s Needed We are looking for dedicated and enthusiastic RVTs to join our ICU/ Critical Care and Neurology teams at the Veterinary Emergency Clinic. This is an opportunity for you to participate in the practice of stateof-the-art veterinary medicine while working with a committed group of staff and board certified criticalists and neurologists. As a team member, you will be involved in all aspects of patient care. You will have the opportunity to utilize advanced skills in an environment that is committed to staff growth and advancement. Our new team members will be compassionate individuals who are able to work in a busy environment, have experience but are eager to learn, have high standards, an eye for detail and are able to work independently while maintaining good communication with other team members. This position offers an above average hourly rate (salary commensurate with experience) plus a $2 shift premium for nights and weekends. Please submit your resume to Claire Followes, RVT, Head Technician at cfollowes@vectoronto.com or fax to 416-920-6185. 11613 (Nov 15, 2012) AHT/RVT PetFocus is growing! Full time AHT/ RVTs wanted to join our progressive organization in beautiful Nova Scotia. We provide a competitive salary, great benefits, and unique growth opportunities.

resumes to Melissa McKay, at melissa.mckay@petfocus.ca 11612 (Nov 15, 2012) Full Time Technician Needed! Ardiel Animal Hospital (Meaford, ON) needs a Full Time Veterinary Technician. Must be a team player and willing to utilize all of your skills. Some reception duties, weekend and on call rotation. CE and uniform allowance, Health and Dental Benefits! Please email (aah@bmts.com) or fax 519-5384906, resume and references. Attn: Connie 11610 (Nov 15, 2012) SENIOR RVT POSITION We are searching for an RVT with experience and leadership qualities to take on a position with significant responsibilities. This position is to commence in the Spring. Please contact Mark at: drmad@yourvet.ca 11600 (Nov 9, 2012) AFTER HOURS/ EMERGENCY 24 hour continuous care dog and cat hospital focusing on exceptional client service and nursing care. Heavy emphasis on analgesia, client education, smooth flow from day to night. We require competent tech for primarily weeknights, weekend and holiday day and nights. Full or part time. Please apply on-line to Dr.Daniel Mudrick or drop off resume in person to Clarkson Village Animal Hospital. www.clarksonvillagevet.com

Applicants should forward their

11598 (Nov 9, 2012) Kennel help and Groomer needed SwissRidge Kennels is looking for kennel help and a certified groomer. Please forward resumes via email to swissridgekennels@hotmail.com 11596 (Nov 8, 2012) Feline Only Durham Region Mature, experienced technician wanted full to part time, some evenings and Saturday mornings, no after hours. Friendly and supportive work environment, client-centreed practice with excellent patient care. Apply by fax (905) 665-3831 or email ksch@on.aibn.com. 11575 (Oct 29, 2012) Registered Veterinary Technician Wanted Friendly, Client oriented Technician wanted for 2 veterinarian practice in one of Torontoâ&#x20AC;&#x2122;s nicest Neighbourhoods. Health Insurance and continuing education. Please forward resume via email to info@torontopetvet.com 11564 (Oct 22, 2012) Registered Veterinary Technologists Our group of hospitals are constantly looking for high skilled RVTs for our dynamic team. Currently, we have two full time openings: 1. to work in a low stress environment doing elective surgeries/anaesthetics all day long. 2. to work hours between both of our premier animal hospitals performing strictly RVT duties Contact: Dr. Mark de Wolde drmad@yourvet.ca 613-583-6838 11563 (Oct 22, 2012) Outgoing F/T RVT required for busy hospital The Beaver Creek Animal Hospital in St. Thomas, ON is seeking to add a full time RVT to our team. We are a very busy, continuously expanding hospital with all the tools you need to succeed at your job such as digital xray, in-house lab, ultrasound, etc. Candidate must be outgoing, friendly, responsible and mature. We

offer competitive wages, medical and dental benefits, CE allowance, uniform allowance and many more perks. Qualified candidates can email their resumes to animalvet72@gmail.com or fax them to 519-637-1370 for consideration. 11546 (Oct 16, 2012) Full- Time RVT Wanted The successful applicant shall practice in a progressive veterinary health care environment that concentrates heavily on high quality veterinary care, including in-house diagnostics, radiology, dentistry, laser surgery, laser therapy, Rehabilitation, client communication/education and preventative health care. We place a high priority on life/work balance - we work hard during the week but have weekends off. We recently relocated to a brand new state of the art building. (Please visit our website for more info.) Salary based on experience with above average compensation packages. Please apply in writing to Connie Dagg, RVT, Practice Manager at cahvet@bellnet.ca. For additional information you may call 705-855-8869. 11511 (Oct 4, 2012) RVT Highbury North Pet Hospital in London is seeking a pleasant , organized , RVT with great communication skills and friendly demeanor who can work with a team and also has individual drive and initiative. You must be able to multitask, Avimark use is an asset and remuneration depends on experience. We include gym membership, break vouchers, CE, uniforms, pet insurance. We are a small, progressive, fun clinic so we cross train our technicians rotate through reception also. Contact : highburynorth@rogers.com or fax: 519-659-9102. Can drop of resume at 1570 Highbury Ave North. 11479 (Sep 27, 2012) Technician/Receptionist Brand new clinic in London seeking mature individual for full or part-time technician/receptionist position. Experience preferred, must be flexible and willing to work late night hours. Salary commensurate with experience, health benefits

package available. We do not perform declaws or any other cosmetic surgery and practice compassionate high quality medicine. We are looking for someone with integrity and the ability to work independently. Please forward CV to londonnorthvet@gmail.com 11466 (Sep 21, 2012) Receptionist - Full time Small animal hospital in Guelph requires a full time receptionist with excellent customer service skills. Please apply with resume to rcahtechs@rogers.com. 11445 (Sep 14, 2012) Registered Veterinary Technician The Veterinary Emergency Clinic located near Yonge and Bloor is currently looking for an RVT to join our team. This is an exciting opportunity to work in a fastpaced environment consisting of emergency, critical care (ICU) and specialty practices (incl. Internal Medicine/Oncology, Neurology, Surgery, Dermatology, Dentistry, Cardiology, Ophthalmology, and Anesthesia). If you are interested in becoming a critical part of a diverse team of professionals, including board-certified specialists, experienced veterinarians, RVTs and support staff, then the VEC is the place for you. We offer a competitive salary and comprehensive benefits plan for full time staff which includes life insurance, medical, dental and vision coverage plus an array of fringe benefits such as pet care and scrub allowance to name a few. Please forward your resume to the attention of Morgan Betts, Human Resources via e-mail at: hr@vectoronto.com or via fax: (416) 920-6185. Please note that the VEC hires only RVTs for nursing positions, if you are not a Registered Technician and would like to apply for the position of Animal Care Attendant please note ACA resume in the subject line or cover letter.

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11435 (Sep 12, 2012) Vet Tech, We are looking for you!! Are you an enthusiastic technician with excellent communication and technical skills? We are looking for a Vet Tech to fill a 15 month maternity leave position, starting October. Our clinic is located in the beautiful 1000 Island area in Gananoque. Our main focus is treating our patients and clients the way we want to be treated. If interested please contact Sam at 613-382-3429 or email us at ganvet@kos.net 11391 (Aug 28, 2012) Weekend Night On Call Technician Looking for a technician to care for our emergency patients on Saturday and Sunday evenings on call. Potential of full time hours with weekday shifts and weekend evenings. Please email jknights@ciaccess.com for further details. 11356 (Aug 13, 2012) Full Time RVT..use your training to the MAX! Greenboro Veterinary Clinic is looking for a full time RVT to join our team. Put your valuable skills to use in our 2 DVM, progressive, compassionate, very client-service-driven practice where technicians are responsible for sample collection, anesthesia, x-rays, primary patient care, and more. We offer competitive wages, CE/Scrub allowance and an excellent pet care plan. Submit resumes to Amanda Brown(Office Manager): officemanager@greenborovet.com

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B E H AV I O U R C O L U M N

Dominance, Alpha and Other Fallacies of Pack Leadership by Gary Landsberg BSc, DVM, DACVB, dipECVBM-CA, and Theresa DePorter DVM

Despite the fact that recent studies have re-evaluated hierarchy models and have modified our understanding of behaviour in the wild wolf, the concept of a hierarchal relationship amongst dogs and humans continues to be perpetuated. Today, veterinary professionals needs to know far more about canine behaviour than outdated strategies to ensure the proper balance of pack structure. In fact, recent research has clearly indicated that the following longstanding theory is more myth than fact: alpha wolves lead the pack, demand the high preferred resting areas, eat first and pin subordinates for social challenges – a cold, relentless management of hierarchy necessary for survival. Dogs descended from wolves so responsible family members must dictate pack leadership with the steadfast dedication of a wolf struggling for survival in the wilderness. If this theory is no longer considered true for wolves, then how can it be considered true for our dogs? Decades of observation by wildlife biologists of free-ranging wolf packs has revealed startling insight into the lives of these majestic canids. Seasoned leaders of wolf packs survey from near the back of the pack when travelling and in time of scarcity, the leaders allow the young to eat first. Wolf behaviour experts, such as

David Mech, have dedicated their lives to observing wolves in their natural state, and not only is there an absence of reports of wolves seeking high positions over the pack, nor a sign of a leader rousting a subordinate from a desired place, they report that submissive rolling is an appeasing behaviour offered by subordinates and rarely a pinning initiated by an alpha wolf. These students of wolf behaviour describe the role of the wolf leaders as parents – guiding, teaching and caring for their pack members. Dominance hierarchy theory training methods assume dogs are committed to a battle of supremacy and constant challenge with family members. This premise is wrong. Trainers and veterinarians advising families to take charge of the pack by eating first, walking through doors first, occupying a higher position and worst of all, pinning the dogs into submission are ignoring the current scientific research and subjecting the dog to unnecessary and sometimes cruel training methods. In reality, dogs have an intraspecies relationship and a pattern of behaviours with their human family members that are driven by a variety of motivations, including genetics, socialization, available resources, fear, conflicts, learning, behavioural pathology, and disease. Furthermore, application of scientifically-based principles of positive reinforcement, operant conditioning, classical conditioning, desensitization, and counter-conditioning programs have been shown to successfully teach dogs desirable behaviours and prevent behaviour

problems while enhancing the humananimal bond. During your next staff meeting consider reviewing Barry Eaton’s book, Dominance: Fact or Fiction, visit the American Veterinary Society of Animal Behaviour website (avsabonline.org) and read the position statements on dominance and punishment, or if you prefer a good movie….get popcorn and view ‘Fighting Dominance in a Dog Whispering World” (by Jean Donaldson and Ian Dunbar). Still not convinced? Review the David Mech article “International Wolf Centre” (Winter 2008 issue of Whatever Happened to the Term Alpha Wolf, www.wolf.org). Be sure everyone on your staff is clear: • Dogs are not pushing for dominance, trying to be in charge, or controlling family members • No one should recommend hanging, pinning, or rolling, ever • Recommendations about who eats first, walks in front and rests in the highest locations are myths with less value to your client than urban legends • Dogs who growl at the veterinary hospital are fearful and defensive – this is never dominance. Punishment never alleviates fear. • Punishment is always a last resort strategy for improving behaviour • Spring cleaning: clear out the old ideas, discard handouts on being in charge of your dog, and destroy any brochures from local trainers who perpetuate these myths • Schedule your next staff meeting titled: ‘Dogs learn best by positive reinforcement’ • Finally, be certain to only recommend trainers who understand learning principles and use positive reinforcementbased training.

Dr. Gary Landsberg is a veterinary behaviourist at the North Toronto Animal Clinic in Thornhill, ON (northtorontovets.com) and is mentor for three ACVB behaviour residents including Dr Sagi Denenberg who works with him at the North Toronto Animal Clinic (northtorontovets.com), Dr Colleen Wilson at th Osgoode Animal Clinic (osgoodevet.com) and DrTheresa DePorter at the Oakland Veterinary Referral Service in Michigan.

TECHNEWS | VOLUME 36 ISSUE 2

Just one premium C.E.T.® Dental Chew per day can help reduce gingivitis, plaque, calculus accumulation and halitosis — with excellent palatability. A recent clinical study published in the Journal of Veterinary Dentistry shows C.E.T. VEGGIEDENT™ Chews are effective in toy breed dogs and are easy to give. One chew a day was shown to: • Reduce calculus by 70% • Reduce plaque by 37% • Reduce halitosis Daily administration of a vegetable dental chew may play a significant role in the improvement of oral health over the long-term.1

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© 2012 Virbac AH, Inc. All Rights Reserved. C.E.T. and VEGGIEDENT are trademarks or registered trademarks of Virbac Corporation or one of its affiliated companies in the U.S. and Canada. 1. “Effectiveness of a Vegetable Dental Chew on Periodontal Disease Parameters in Toy Breed Dogs.” Journal of Veterinary Dentistry, 28 (4); 230-235, 2011.

US - Ohio Update - A year after the release and subsequent killing of dozens of tigers, lions, wolves and bears from a private compound in Zanesville, Ohio, the state is poised to become one the strictest in the keeping of exotic pets. Owners of such animals had until Nov. 5, 2012 to register their animals with the state’s department of agriculture, and a complete ban on owning such animals goes into effect Jan. 1, 2013. The few animals captured alive after the tragedy were sent to the Columbus Zoo and Aquarium, and later were ordered returned to the widow of the man who released the animals before killing himself. (veterinarypartner. com)

Global news

US - Injection-site Sarcoma Risk May be Less for Recombinant Vaccines, Study Finds - The recombinant class of vaccines might be less likely to induce injection-site sarcomas (IJS) in cats than inactivated vaccines, according to a study published in the Journal of the American Veterinary Medical Association (JAVMA). Researchers conducted the case-control study between 2005 and 2008, with a stated intent of comparing “associations between vaccine types and other injectable drugs with development of injection-site sarcomas in

cats.” Among the conclusions reached by researchers following the study were: Recombinant vaccines could potentially be less likely to induce sarcomas than inactivated vaccines, although neither type is risk-free; and other injectable drugs could potentially initiate sarcomas in felines, including long-acting penicillin and long-acting corticosteroids such as dexamethasone and methylprednisolone. (Veterinary Advantage Weekly News) Canada - Survey: Pet Shelters Typically Don’t Refer to Veterinary Clinic - About two-thirds of pet adoption shelters did not refer adopters to a specific veterinary clinic, according to a survey of about 10,000 new owners and reported by Veterinary Practice News. The poll of people who adopted pets from July 2011 to July 2012 was conducted by the Canadian animal wellness company Pethealth Inc. Despite the lack of a referral, 84 percent of adopters sought post-adoption veterinary care, 60 percent of whom took the pet to a veterinarian within a week. About 15 percent of adopters took their pet to a VCA Antech or Banfield hospital, while 6 percent went to an adjacent shelter and 79 percent traveled someplace else, such as to a private clinic. Of the 84 percent who sought veterinary care for

Multi-million dollar facility will help traveling pets and wild animals.

US - Airport to offer boarding, grooming and veterinary care services Over the years, air travel has become more accommodating to pets, from a dogfriendly airline and now to animal care facilities at John F. Kennedy International Airport in New York. A new $32 million facility that will provide kenneling, grooming, and other services for about 70,000 domestic and wild animals a year will be built at the airport. The facilities will use a building that is currently empty, as well as 14.4 acres of the grounds for the project. It will have kenneling and grooming services for dogs and cats, as well as a quarantine area for horses, an aviary, lawn space, a veterinary hospital and rehabilitation centre. Port Authority officials say it will create 190 jobs. Officials said the new setup would be larger than animal facilities that are currently in use at the airports in Los Angeles and Miami. (Firstline)

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Canada - Saskatoon SPCA Investigating Reports of Do-It-Yourself Surgery on Pets - The Saskatchewan SPCA has received reports from across the province of people performing do-it-yourself surgery on their pets. They are investigating five reports of dog owners using elastrator bands to neuter their male dogs, a practice usually found on the farm when castrating young bulls. Such owners may mistakenly assumee the practice is transferable, but it’s not because unlike bulls, dogs can lick and chew the area that’s under pressure, thus inflicting more damage. Some cases need emergency medical care to save their lives. The City of Saskatoon offers a subsidized spay-neuter program where low-income families can qualify for a pet surgery for a small fraction of the full price. (The Canadian Press)

Term

Definition

1. hypoalbuminemia 2. crystalloid 3. hetastarch 4. hypoproteinemia 5. hemolysis 6. precipitate 7. hemoglobinemia 8. acidemia 9. hypovolemia 10. hypoperfusion

a) a solid separated from a solution or suspension b) presence of free hemoglobin in blood plasma; indicates intravascular hemolysis c) a decreased amount of blood in the body, often resulting in life-threatening shock d) a solution that can pass through semi-permeable membranes e) a decreased blood pH (<7.35) f) decreased blood flow to tissues g) breakdown of red blood cells h) an abnormally low concentration of albumin in blood i) an artificial colloid used to expand blood volume j) abnormally small amounts of total protein in blood

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

their new pet, 44 percent arrived for a post-adoption checkup, 19 percent for routine wellness, 14 percent for vaccination, 6 percent for respiratory illness and 13 percent for other reasons. (Veterinary Advantage Weekly News)

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: shirley@naccvp.org), 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 Suite 104, 100 Stone Road West Guelph, ON N1G 5L3 Phone - (800) 675-1859 Fax - (519) 836-3638 Email - lauraf@oavt.org

POISONING COLUMN

Holiday Hazards for Pets

By Jessica Driscoll, CVT, Pet Poison Helpline and Justine A. Lee, DVM, DACVECC, Associate Director of Veterinary Services, Pet Poison Helpline

Candy, mistletoe, and tinsel, oh my! Holiday season is upon us once again and during this time of year calls to Pet Poison Helpline, an animal poison control centre based out of Minneapolis, Minnesota, peak! As pets explore new household objects such as holiday décor, foods, plants, and other holiday items and treats, they are more predisposed to accidental poisoning. The key to helping your clients maintain a safe household during this season is being aware of which holiday items pose a health hazard for pets. Listed below are some of the most notable holiday hazards. Plants Poinsettias: Debunk this myth – Poinsettias are barely poisonous! This favorite holiday plant has long been thought to pose a serious poisoning concern for pets. In fact, although ingestion of this plant may cause gastrointestinal upset (e.g., vomiting, drooling, diarrhea), it is highly unlikely to cause a serious or fatal toxicosis. If skin is exposed to the milky sap from the inside the leaves, dermal irritation (including redness, swelling, and itchiness) may also develop. Holly and Mistletoe: These common Yuletide plants typically cause abdominal pain, vomiting, and diarrhea, but rarely

cause a significant toxicity concern with small ingestions. If ingested, most pets lip smack, drool, and head shake excessively due to the mechanical injury from the spiny leaves. Rarely, a foreign body may result with massive ingestion due to the thick nature of the leaves. Wreaths: Florists have recently started to use the evergreen Japanese yews in wreaths (particularly popular in large wreaths found in barns or outdoors). All parts of this deadly plant contain cardiotoxic agents called taxines (taxine A and B). Clinical signs seen with yew poisoning include drooling, vomiting, weakness, difficulty breathing, life-threatening changes in heart rate and blood pressure, dilated pupils, tremors, seizures, coma and possibly death. Horses are very susceptible to yew poisoning, so make sure not to have these evergreens around the barn or pasture! Liquid Potpourri During the holidays, pet owners often use heated liquid potpourri products to fill their homes with the smell of evergreen, pumpkin, and winter spice. Unfortunately, these heated essential oils pose a threat – especially to cats - with an ingestion of this fragrant addition to the home. When these oils are heated,

they can easily cause burns for any pet as well as gastrointestinal irritation. Due to the altered liver glucuroindation metabolism in cats, our feline patients are especially sensitive to the corrosive cationic detergents found in these products. If ingested, liquid potpourri can cause severe burns to the mouth, esophagus, and stomach. These liquids can also cause severe skin irritation and should be thoroughly washed out of the fur to prevent secondary oral exposure from grooming. Because of the oily nature of liquid potpourri, patients should be bathed with a mild, gentle, degreasing hand-washing liquid dish soap (e.g. Dawn). Due to the serious health risks these products pose, it is safer to use other products such as plug-in air fresheners, scented candles, reed diffusers, and certain warmed scented waxes (although it is still best to keep these products out of reach too!) In addition, it is important to remind bird owners of the potential dangers of using aerosolized products in their homes. Due to their air sacs and unique anatomy, birds have highly sensitive respiratory tracts and therefore are particularly sensitive to airborne fragrances and other airborne products. Pet Poison Helpline encourages the avoidance of using any liquid potpourris, air fresheners, and other aerosolized products in homes with birds. Holiday Decorations Ornaments: Old-fashioned bulb lights can contain poisonous chemicals that may be dangerous to pets who chew the bulbs. Also, the glass or plastic surrounding bulb lights can pose a risk not only for gastrointestinal irritation, but potentially perforation, as well as oral injury. Tinsel and Ribbon: Although these items do not pose toxicity risk, they can cause a deadly linear foreign body when

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ingested. This is typically more of a concern with cats. If a pet ingests a long piece of tinsel, ribbon, thread, or string, advise the owners that it is best to bring the animal into the clinic immediately for an evaluation. Most importantly, if the pet owner sees the string hanging from the pet’s mouth or rectum, tell them not to pull it! As you are most likely aware, pulling on the string should only be done by a trained veterinary professional and never by the pet owner as this may cause a worsening of the placation of the small intestines or even septic peritonitis. Holiday Foods Raisins/Grapes/Currants: With all of the baked goods and “trail-mixes” that are around this time of year, it is important to remember that these items can contain raisins, grapes, or currants. Accidental ingestion can result in acute renal failure (ARF) and any ingestion should be taken seriously and treated aggressively. Alcohol: Alcohol can be found in surprising places, especially during the holidays. The most common sources of alcohol poisoning are not directly from liquors or drinks, but rather, from food sources such as rum-soaked cakes, alcohol-filled candies, and rising, unbaked bread dough. Alcohol toxicosis can result in severe obtundation, coma, hypoglycemia, hypotension, and hypothermia. In addition, intoxicated pets can experience seizures and respiratory failure (e.g., requiring intubation and ventilation). Chocolate/cocoa: The theobromine in chocolate and cocoa is a chemical that acts very similar to caffeine and is highly toxic to pets. This is a more common ingestion among dogs than cats and can lead to significant gastrointestinal upset e.g., vomiting, diarrhea, pancreatitis, etc.), cardiac signs (e.g., tachyarrhythmias, hypertension), and neurologic signs (e.g., agitation, tremors, seizures, etc). The darker or more concentrated the chocolate, the more theobromine it contains making semi-sweet chocolate, baker’s chocolate and dark chocolate the most dangerous. Milk chocolate contains a lower amount of theobromine than darker chocolates,

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but can still pose a risk if enough is ingested. White chocolate contains such a low amount of theobromine that it does not typically pose a poisoning concern; however, due to the sugar and fat content, pancreatitis may be a secondary sequela. Other toxic holiday chocolate threats include chocolate-covered raisins, espresso beans, or macadamia nuts hidden under the holiday tree. These pose additional risks due to the potential poisoning from the second food agent. Sugarless Gums and Candies: These products can contain xylitol which causes dose-dependent rapid hypoglycemia and acute hepatic necrosis. If xylitol toxicosis occurs, immediate action is recommended. If it is a recent ingestion and there is no risk for aspiration (e.g., symptomatic patient, brachycephalic breeds, etc), veterinary professionals can advise owners to induce emesis at home with a weight appropriate dose of hydrogen peroxide (for dogs only). Appropriate decontamination, blood glucose monitoring, liver function monitoring tests, intravenous fluid therapy, and supportive care may be necessary. Keep in mind that xylitol does not reliably bind to activated charcoal, and is not routinely recommended. Finally, additional, unusual sources of xylitol need to be ruled out, including mouth washes, toothpastes, mints, baked goods, sugar-free multivitamins, nasal sprays, etc. Fatty Meat Scraps and Bones: Fatty table scraps should not be given to pets, due to the risk for pancreatitis. Bones may pose a foreign body obstruction (e.g., esophageal, stomach, intestinal) or risk for gastrointestinal perforation. The best thing to do during the holidays is to educate your clients on common holiday dangers so they can pet-proof their home accordingly. If a pet owner suspects their pet has been poisoned, immediate veterinary attention is warranted. When in doubt, you can call or recommend the pet owner call, Pet Poison Helpline at 1-800-213-6680 or visit www.petpoisonhelpline.com. If you think your patients have ingested some-

thing poisonous, veterinary and toxicology experts suggest that it’s always easier, less expensive, and safer for your pet to be treated earlier, versus when he’s showing severe symptoms. Pet Poison Helpline has an iPhone application with an extensive database of plants, chemicals, foods and drugs that are poisonous to pets. A powerful indexing feature allows users to search for toxins and includes full-colour photos for identifying poisonous plants and substances. With a direct dial feature to Pet Poison Helpline, the app is called “Pet Poison Help,” and is available on iTunes.

About Pet Poison Helpline Pet Poison Helpline, an animal poison control centre based out of Minneapolis, is available 24 hours, seven days a week for pet owners and veterinary professionals that require assistance treating a potentially poisoned pet. The staff provides 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 $39 per incident includes follow-up consultation for the duration of the poison case. Pet Poison Helpline is available in North America by calling 800-213-6680. Additional information can be found online at www.petpoisonhelpline.com.

EQUINE NEWS

Canine Flu: Risk to Horses? Dr Scott Weese posted this blog report while attending the International Conference on Equine Infectious Diseases in Lexington, Kentucky. He attended an interesting discussion about canine and equine influenza.

pose a risk because they are carrying the normal equine flu, not the adapted canine version. So….

It’s well established that canine flu (A/H3N8) originated in horses and became established in dogs. Canine flu is closely related to, but different from, its equine parent. So, that raises questions about whether it’s able to go back into horses. It’s a relevant question since it has implications on what should be done with dogs that might have canine flu (or, in general, canine-horse contact, especially with performance horses).

If a dog has influenza that is known to be non-horse associated (typical canine flu) then there’s probably little concern for horses.

A study by Yamanaka et al (Acta Vet Scand 2012) looked at dog-horse infectivity of canine flu by putting infected dogs in a stall with healthy horses for 15 days. All dogs were sick and shedding canine influenza virus, but none of the horses got sick, shed the virus or mounted an antibody response. This study only involved 3 horse-dog pairs so we have to watch that we don’t go too far with the conclusions, but it suggests that while canine flu started off as horse flu, it has changed enough that infected dogs aren’t much of a risk to horses.

However, why take the chance? It seems logical to ban any dog with a suspected respiratory infection from horse barns. It also makes sense to ban dogs from barns with equine flu cases. It’s an easy, cheap, minimally disruptive and potentially useful flu control measure that might help reduce transmission of this important virus in both directions.

If a dog has influenza and there’s no clear dog link (or there’s a link with infected horses), it’s reasonable to assume that the dog could transmit the virus to horses.

But….. (yes, there’s usually a ‘but’ with infectious diseases)…. dogs are susceptible to the ‘normal’ equine influenza. It’s uncommon but dogs can be directly infected from horses with the classical equine H3H8 flu virus. In that situation, dogs might

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

Principals & Practice of Rehabilitation for Companion Animals Location: Northern College For more information, contact: Nancy Goudreault, RVT. Veterinary Sciences Coordinator goudreaultn@northern.on.ca

2013 January 24-26 OVMA Conference & Trade Show Location: Westin Harbour Castle, Toronto, Ontario www.ovma.org

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February 21-23 35th Annual OAVT Conference and Trade Fair Location: The London Convention Centre, 300 York Street, London, Ontario www.oavt.org February 21 & 23 OAVT Professionalism and Ethics (P&E) Workshop Location: The London Convention Centre, 300 York Street, London, Ontario May 4, 25, 26 Advanced Skills in Canine Rehabilitation: A Five Part Series Location: Delta Toronto Airport West, Mississauga, Ontario qualityceinc.com

Canine Foundations 2013 Seminars Canine Foundations is offering the following topics at Georgian College in 2013: • Canine Emergency First Aid • Basic Behaviour 101 • Canine Behaviour 102 • Canine Behaviour 103 • Dog to Dog Aggression • K9 Self Defence Please visit the website at www.caninefoundations.com to register and learn more information.

Did You Know? Cat Allergies More Common Than Dog Allergies for Humans While an estimated 10 percent of people are allergic to household pets, cat allergies are twice as common as dog allergies, according to the American College of Allergy, Asthma and Immunology. Among children, about one in seven between ages 6 and 19 prove to be allergic to cats. Contrary to popular belief, it’s not cat fur that causes those itchy, watery eyes. Most people with cat allergies react to a protein found on cat skin called Fel d 1. The reason that cat allergies are more common has to do with the size and shape of the protein molecule, rather than how much dander the animal sheds. The protein enters the air on bits of cat hair and skin, and it is so small and light – it’s about one-tenth the size of a dust allergen – that it can stay airborne for hours. Dog allergens don’t stay airborne the same way cat allergens do. The particle size is just right size to breathe deep into the lungs. (Veterinary Advantage Weekly News) FDA Approves Ingestible Device to Track Medication Use August 3, 2012 - The FDA has approved a kind of attachment for all types of pills, a tiny, harmless transmitter that will electronically register if a pill has been taken or not. It mixes with stomach acids and sends out a signal that the pill has been taken. (http://dia.bulletinhealthcare.com) Pet Tranquilizers While Flying May Cause Risk to Your Pet Few beliefs are as widespread and commonly held as the one that incorrectly suggests pets be tranquilized for an airline flight. That might be because many of us would prefer spending our time in the air asleep, and we figure our pets would prefer the same. But the fact is that tranquilizers increase the risk of flying for pets because the medication impairs the efficient functioning of an animal’s body at a time when such efficiency can be essential to keeping it alive. Tranquilizers are not routinely recommended for most flight-bound pets. If you think your animal is the exception, discuss the issue with your veterinarian. -- Dr. Marty Becker Parasites Prevented Poorly in Pets According to AAHA data, only ~50% of dogs and <4% of cats receive a monthly parasite preventative. (Firstline)

The study did find that veterinary visits for dogs were up 9.2 percent, but the feline decline has continued, with cat visits down 4.4 percent since 2006. The average number of veterinary visits per dog was 1.6 times per year, while the number of visits per cat was 0.7 times per year. (Veterinary Advantage Weekly News)

Increasing Popularity in Canine Sports Cause Risk of Injuries Dog sports such as agility and dock-diving have become more popular, with a result that injuries to canine weekend warriors are more common as well. The AKC Canine Health Foundation has launched an initiative to develop a better understanding of the proper conditioning, nutrition, training and rehabilitation of canine athletes. An upcoming series of free podcasts presents an expert lineup of veterinarians. More information is at www.akcchf.org/canineathlete. Smooth Over Your Exam Visits with a Form Download a useful form to ensure smooth exam room visits. Go to dvm360.com/treats to download a sample Exam room reference sheet and let the rewards - and better behaviour - begin! Use the form to gauge what your patients like and dislike in the exam room, waiting room and treatment areas. Keep it with your patient records and refer to it before each visit. (Veterinary Economics)

Pet ownership declines from 2006 to 2011 USA - The percentage of pet-owning households declined 2.4 percent over the last five years, according to a study of 50,000 pet owners conducted by the American Veterinary Medical Association (AVMA). The 2012 U.S. Pet Ownership and Demographics Sourcebook, revealed that the percentage of households owning dogs decreased 1.9 percent, while households owning cats declined 6.2 percent, although cats still outnumber dogs as pets. The recession is probably one of the big reasons for this decline.

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