2013 Spring TECHNEWS

2013

|

VOL UME 36 I S S UE 3

PREMIER JOURNAL

FOR

CANADIAN VETERINARY TECHNICIANS

SPRING

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 • Ulcers: A Pain in the Eye • Rabies • Cats, Carbs and Diabetes Plus: Help us help animals in need, Career Spotlight: Cindy Stoate, The benefits of crate training for puppies, Top 5 canine toxins of 2012, Doxycycline (Vibramycin) and more!

A Healthy Start to Life!

2013 Platinum Sponsors Making continuing education better & more accessible across Canada Bayer HealthCare Animal Health Division Hill’s Pet Nutrition Canada, Inc. Royal Canin Medi Cal Zoetis

2013 Conference Thank you letter ...........................................................................................2 Career Spotlight: Cindy Stoate.................................................................................................. 3 There are Many Ways You can Help us Help Animals in Need.................................................. 5 Pharmacology Column: Doxycycline - Vibramycin................................................................... 7 Safety Column: Hygiene Hypothesis - Fecal Exposure and Other Strange Musings................... 8 CE Article #1: Ulcers: A Pain in the Eye............................................................................ 10 CE Article #2: Rabies........................................................................................................ 14

These companies are generously supporting a

TECHNEWS Subscriptions.................................................................................................... 17

series of outstanding learning opportunities for

Tech Tips and Tidbits.............................................................................................................. 17

registered veterinary technicians through OAVT.

Apps, Blogs & Websites to Watch........................................................................................... 18 CE Article #3: Cats, Carbs and Diabetes........................................................................... 19

OAVT Conference 2013 This years conference was a great success.

Planning for the 2014 conference has already begun, and we cannot wait to see another successful year. Stayed tuned for details.

TECHNEWS Spring 2013 CE Quizzes............................................................................. 23 Employment Ads..................................................................................................................... 26 Behaviour Column: For Pet Owners - The Benefits of Crate Training for Puppies................... 28 Global News........................................................................................................................... 30 Puzzle...................................................................................................................................... 31 Submitting Articles to TECHNEWS...................................................................................... 31 Poisoning Column: Top 5 Canine Toxins of 2012................................................................... 32

TECHNEWS

Continuing Education Opportunities..................................................................................... 35

The quarterly national publication with three

Did You Know?....................................................................................................................... 37

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 2013.

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Next Issue: Summer 2013 Deadline for Material: May 1, 2013 Distribution Date: June 30, 2013 TECHNEWS is a quarterly publication published by the OAVT.

Employment Ads: Please see Employment Ad Information on Page 35 EECI13160

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• 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 3

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OAVT

CONFERENCE 2013 Dear Delegates, I would like to personally thank each of you for supporting the Ontario Association of Veterinary Technicians and the profession of Registered Veterinary Technicians through your attendance and participation at this year’s 35th Annual Conference and Trade Show. Without the support of delegates like you, we would be unable to accomplish the type of program that we offered this year.

Several attendees have praised the hard work and dedication of those responsible for producing and delivering this year’s conference and we owe everyone a very special thanks for making it happen.

The OAVT will continue to be on the leading edge with our content as well as our conference format. If you have any suggestions for future conferences, improvements on our last one, or would like to receive more information on ways in which you may participate more in the development of the OAVT conference, please do not hesitate to contact the office at oavt@oavt.org.

Warmest Regards,

Rory Demetrioff OAVT Registrar and Executive Director

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TECHNEWS | VOLUME 36 ISSUE 3

Career Spotlight Cindy Stoate

Anesthesiology

Interviewed by the OAVT pursuing continuing education opportunities. So this opportunity to further develop myself professionally, and support the advancement of our profession was welcomed.”

Cindy has worked in the area of anesthesia for the better part of twenty-five years. From a desire to expand her professional skills, she felt that pursuing the VTS (Anesthesia) credential was an ideal vehicle for the achievement of this. Cindy says it forced her to refine her current skill set, develop more advanced skills and study areas in a subject matter that had become a bit routine. The process also introduced her to other skills such as writing case reports, which was very educational and rewarding.

“I think it is easy to become stagnant in your profession by not pursuing continuing education opportunities.”

It was a combination of an interest in the sciences and a love of animals that introduced Cindy Stoate to the veterinary technician profession. During high school she spent some time volunteering in a clinic near her home to see if she would enjoy the work of a veterinary technician. She then pursued her diploma of Animal Health Technician at Centralia College of Agricultural Technology. At the time of her graduation there was no RVT status in Ontario. However, when the RVT status came into effect, she took advantage of the opportunity to advance her credentials through the VTNE exam. Cindy reflects “I think it is easy to become stagnant in your profession by not

TECHNEWS | VOLUME 36 ISSUE 3

Application to write the VTS (Anesthesia) exam was very challenging. It required a minimum number of hours of work experience in the field of veterinary technician and particularly the field of veterinary anesthesia, a case log with a minimum of fifty anesthesia cases completed that year, four complete anesthesia case reports, completion of approximately ninety Advanced Anesthesia skills (as supervised by a board certified Veterinary Anesthetist), two letters of recommendation and proof of attendance in forty hours of Continuing Education over the previous two years. Upon successful completion of the application the candidate would then study for a year to write a four hour exam to qualify for the VTS (Anesthesia) certificate.

After successful completion of the VTS (Anesthesia) exam the technician is then required to complete fifty hours of relevant continuing education every five years to maintain certification.

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This certification process required a great deal of motivation and willingness to study. Although a great deal of work, Cindy felt that the process alone was rewarding as it helped her to refine certain skills, gather more knowledge in Anesthesia and the management of cases before and after the anesthesia period.

Cindy currently works at the Ontario Veterinary College Health Science Centre (OVC) in the Anesthesia unit along with eight other highly skilled Veterinary Technicians, four faculty Anesthetists and two Anesthesia Residents. Her job is split into three main functions: 1) Performing anesthesia on the client cases. 2) Teaching anesthesia skills in the clinical environment to the 2nd, 3rd, and primarily 4th year veterinary students.

3) Maintaining the inventory and equipment in the anesthesia environment. The importance of this job relates to preparing the veterinary students to be proficient in and comfortable with performing anesthesia. Cindy thinks the students come to the clinic well prepared in the theory of anesthesia administration that they have received through their study lectures, and with basic technical skills they have acquired in teaching labs. One of her goals in her role as technician in the Anesthesia unit of the clinic is to help the veterinary students develop the technical skills required to complement their knowledge base, thus allowing them to perform efficient and effective, safe anesthesia. An additional goal Cindy feels is of equal importance, is to simply give the veterinary student the support and instill in them the confidence required when performing anesthesia, as this is sometimes a complicated and intimidating part of veterinary medicine.

agement a sense of organization and calmness that will provide the student with an environment conducive to learning. Having acquired the VTS (Anesthesia) credentials has also helped her to bring a new level of professionalism to the job from something as simple as refining the terminology she uses when teaching the students, to advancing her skill set when performing and instructing anesthesia.

Her advice to anyone thinking of pursuing this area of specialty in veterinary technology is to refer to The Academy of Veterinary Technician Anesthetists’ (AVTA) website (www.avta-vts. org) as it contains comprehensive and up to date information on what is required to qualify for certification. She also suggests that finding a mentor who has the VTS (Anesthesia) credentials can help in working towards this process. Mentors can also be accessed through the AVTA.

She hopes that her contribution to her work environment is reflected in her willingness to work hard and to keep up to date on the latest drugs, equipment and techniques that are being used and taught within the Anesthesia unit. Cindy thinks this helps to provide a smoother, safer and successful anesthesia.

She believes that when one exhibits knowledge and competence in what one is attempting to teach, then it will instill confidence in the student to take initiative knowing that someone is there to support them. She also tries to bring to the case man-

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TECHNEWS | VOLUME 36 ISSUE 3

There are Many Ways You can Help us Help Animals in Need The Canadian Animal Assistance Team (CAAT) is a registered Canadian charity that provides veterinary services for communities with little or no access to veterinary care (either geographically or financially). Our organization’s mission is to assist these communities with population control, disease prevention and humane education for basic animal care. The Canadian communities we visit are First Nation and Inuit communities that have approached our organization with the goal of making a long-term difference in the health and welfare of their animals.

Over the past 2 years, more and more veterinary hospital owners and their staff have expressed interest in assisting CAAT in its mission through raising awareness and/or support through funding. This interest has prompted us to launch our Memorial Card Program for veterinary hospitals.

Membership Card Program Our two-sided memorial card insert (for sympathy cards for clients) celebrates, honours and preserves the strong humananimal bond. Whether the memory is of a pet, a friend, or the human-animal bond, a CAAT memorial card is the perfect way to recognize that unique passion and connection. Every memorial card purchased helps CAAT achieve our mission to provide professional veterinary care where it is most needed at home and abroad.

TECHNEWS | VOLUME 36 ISSUE 3

To purchase CAAT’s memorial cards to have when needed to honour that special memory we ask for a donation to our charity (a minimum of $50 for 10 cards).

Tax receipts will be provided. To purchase cards, go to our website at www.caat-canada.org, select ‘get involved’, select ‘donate’, select ‘donate through Canada Helps’, under Fund/Designation select ‘general donation’, in the message box – enter the number of memorial cards (based on donation amount) and your mailing address. It is that easy!!

members and volunteers provide professional veterinary care where it is most needed, at home and abroad. Our volunteers help to provide the much-needed services during animal health projects in communities in need. We rely on the support of donors, members and volunteers to make

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these projects a reality. If you are giving a gift, please shop our Fundraiser Bookstore, where you can buy once, give twice. Here’s how it works, 25% of every purchase goes directly to CAAT and the work we do. So you get what you want, and give the gift of helping an animal, all at no extra cost.

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raising programs and help us to help those in need. Please pass on the links to our stores on your Facebook pages, websites, by email, etc. so others can choose to shop!

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First or second week of September for 7-10 days For more information on the Canadian Animal Assistance Team visit our website at www.caat-canada.org

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TECHNEWS | VOLUME 36 ISSUE 3

P H A R M AC O L O G Y C O L U M N gus of a smaller patient (especially a cat).

If the pill sits in the esophagus, it can cause enough irritation to eventually lead to a scar, causing difficulty swallowing. This can be prevented by following the pill with at least 6 cc of water or, better yet, using one of the liquid formulations.

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

Brand name: Vibramycin Available as oral syrup or suspension; 20 mg, 50 mg and 100 mg tablets; and 20 mg, 50 mg and 100 mg capsules.

bolism to complicate heartworm disease treatment so killing the Wolbachia prior to killing the adult heartworms is often included in the heartworm treatment protocol.

How this Medicine Works The tetracycline antibiotic family provides broad anti-bacterial protection by inhibiting bacterial protein synthesis. The mammalian host’s protein synthesis mechanisms are not affected because of basic differences in the shape of the cellular machinery (the ribosomes) used to translate RNA into protein.

Doxycycline has also proven useful in combating infections of methicillin-resistant Staph aureus (MRSA in humans) and methicillin-resistant Staph intermedius (MRSI in pets). These infections involve Staphylococci (bacteria) that are resistant to the drugs that Staphylococci have previously been predictably sensitive to.

Use of this Medication The body possesses many barriers through which antibiotics have difficulty penetrating (the nervous system, prostate gland, and eye are some examples or organs with special barriers). Infections behind these barriers can be difficult to treat. Doxycycline represents a modification of the basic tetracycline structure to enhance its ability to penetrate such biological barriers and to increase its duration of action. Though unable to reach adequate concentrations in the central nervous system, doxycycline is able to penetrate the prostate gland to treat infections there and can permeate cells to address intracellular parasites. Infectious agents for which members of the tetracycline family are especially helpful are, as mentioned, the intracellular ones including: • Mycoplasma haemofelis (agent of feline infectious anemia) • Borrelia burgdorferi (agent of Lyme disease) • Chlamydophila felis (an agent of feline upper respiratory infection) • Ehrlichia species (a tick-borne organism) • Mycoplasma species (in upper respiratory and urinary infections).

• Doxycyline has been used in the treatment of heartworm infection, not to kill the worms but to kill the Wolbachia bacteria carried by the heartworms. Wolbachia may increase the tendency for em-

TECHNEWS | VOLUME 36 ISSUE 3

Of course, there are plenty of less exotic bacteria against which doxycycline may be used. These include: Bordetella bronchiseptica (the chief agent of kennel cough) and bacteria of the genus Brucella.

Doxycycline also has properties by which it modifies immune-mediated diseases.

This immuno-modulating effect is separate from its antibacterial effects and is useful in treating such conditions as discoid lupus erythematosus, plasma cell pododermatitis, and other immune-mediated skin diseases.

Often doxycycline is combined with the B vitamin, niacinamide, to enhance results in such situations.

Side Effects Nausea and vomiting are the most commonly reported side effects of doxycycline in dogs and cats. If this side effect occurs, it is most easily managed by giving the medication with food. (Other members of the tetracycline class should not be given with food as food binds the drug and prevents its absorption into the body. With doxycycline this is effect is not considered significant.)

Drugs of the tetracycline class have potential to permanently stain teeth if given to immature animals. (It binds to calcium, which is needed for growing bones and teeth.) Doxycycline has the least potential for doing this.

The tablets have a particularly irritating pH should they become stuck in the esopha-

Certain types of urine dipstick tests can erroneously test positive for glucose in patients on tetracycline-type medications.

Interactions with other Drugs Antacids commonly contain calcium, which binds doxycycline in the GI tract. If these medications are used together, neither may be absorbed properly and the benefits of both are lost. Iron containing vitamin supplements produce the same problem. (Iron supplements are often used concurrently with doxycycline to treat feline infectious anemia. Administration of these two medications should be separated by a couple of hours or an injectable iron supplement may be employed.)

Nausea may result if doxycycline is used in combination with theophylline (an airway dilator). These two drugs might be used together to treat kennel cough.

Drugs of the tetracycline class may make digoxin (a heart medication) act stronger.

Concerns and Cautions Doxycycline oral suspension does not require refrigeration. Tablets and capsules should be stored away from light.

The reconstituted oral suspension is only good for 2 weeks. After that, it must be discarded.

Doxycycline does not kill bacteria; it merely curtails their ability to reproduce. For the invading bacteria to be killed, the host’s immune system must be active and effective.

This may not be the best choice medication for immune-compromised patients. © 2013 Dr Wendy Brooks, DVM, DipABVP and VIN, All rights reserved Editor’s Note: Reprinted courtesy of Veterinary Information Network (VIN). VIN (www.vin.com) is the largest online veterinary community, information source and CE provider. The VIN community is the online home for over 30,000 colleagues worldwide.

VIN supports the Veterinary Support Personnel Network (VSPN.org); a FREE online community, information source for veterinary support staff. VSPN offers a wide range of interactive practical CE courses for veterinary support staff -- for a small fee. Visit www. vspn.org for more information.

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SAFETY COLUMN

Hygiene hypothesis, fecal exposure and other strange musings (Excerpted from Dr Scott Weese’s ‘Worms and Germs Blog’)

Doug Powell, renowned for his food safety efforts and Barfblog (http://barfblog.com), often uses the phrase ‘don’t eat poop’, when it comes to food safety. I’ve stolen that line and use it a lot too when referring to zoonotic disease. However, over time, I’ve started to wonder whether that’s always the case.

I was giving a talk last week and the question of ‘how clean is too clean’ came up. It’s not the first time and I always have a tough time answering it these days. It relates to a few things, such as the hugely important role of our commensal bacterial population and the ‘hygiene hypothesis’.

While some people might be turned off by the concept, we are outnumbered by bacteria in our own bodies. We have ~10 bacterial cells in/on us for every one of our own cells. When you compare the number of bacterial genes to our genes, the difference gets even bigger. While those bacteria can cause disease, they are also critical for our health. We can’t live without them. The help our immune system develop and function. They help with digestion. The help us fight off harmful microorganisms. They produce vitamins and other compounds. They interact with us in ways that we don’t fully understand, and probably in ways we’ve never even thought about. We know clearly that the gut bacterial population plays a role in things like allergic diseases and there is increasing evidence of interaction between our intestinal bacteria and our brain.

A key part of our development is learning to how to live with our bacterial microbita and tolerate it. If our bodies recognized all bacteria as bad foreign invaders, we’d kill ourselves trying to kill them. Instead, we develop tolerance to these bacterial populations. Developing tolerance is a key aspect of healthy life and things that interfere with development of tolerance might set the scene for future diseases, particularly allergic and inflammatory diseases. That’s where the hygiene hypothesis comes in….are we now too clean?

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So, the concept that all bugs are bad is clearly wrong. Which bugs are good and how to live with the abundant microbial world in and around us is the tougher question to answer. Previous approaches to infectious diseases, based on ‘…find bacterium…must kill…” are too simplistic and potential harmful in some situations. There’s new research indicating that the best treatment for recurrent Clostridium difficile infection may be administration of feces from a healthy donor by enema. So, clearly exposure to feces is not always bad.

Back to the actual question (I was killing time on a plane as I wrote this so I had a chance to ramble on….). How clean do we want things to be, and can we be too clean? Does reduction in our exposure to microorganisms predispose us to various diseases, such as allergic and inflammatory diseases? The answer is presumably yes to both of those. However, what level of clean is good and what level is excessive?

In a hospital, we want clean…very clean. We have a highly susceptible population and lots of bad bugs in circulation. We want good attention to disinfection and thorough hand hygiene in hospitals, no doubt about it. But what about in the general population? Antibacterial soaps are not generally recommended for households because there’s no evidence they are needed and they might increase the likelihood of antibiotic resistance (since bacteria that become resistant to antibacterial agents in soaps can also be resistant to some antibiotics). We don’t need high level disinfection as a routine practice all over the house. At certain times and in certain areas, for sure. If you’re working with raw chicken, careful attention to hygiene and surface disinfection is important because of the high likelihood of exposure to some important pathogens. But do we need to be spraying disinfectants around the rest of the house on a routine basis (as some TV commercials indicate)? Probably not.

Being a germaphobe can be good, but maybe it can also be bad.

We need to think about the role of this complex and massive (yet still poorly defined) microbial population that lives with us.

How much exposure to bacteria from different sources is critical, especially in kids? How much is harmful? There has to be a middle ground and hopefully we’ll find it.

I’m not trying to say never wash your hands, just like I’d never say wash your hands after you touch anything, anytime. In certain locations (e.g. hospitals, food preparation areas) we need to pay extra attention to hygiene and disinfection. But what about the rest of the time? How do we find that balance? No one knows, but it’s a question to consider.

TECHNEWS | VOLUME 36 ISSUE 3

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Introduction

In small animal practice, corneal ulcers are a reasonably common presentation. They can be extremely painful, and if not appropriately managed, can become vision threatening. To understand the various types of corneal ulcers, a review of corneal anatomy is helpful.

The globe is comprised of the external fibrous tunic and the intraocular structures that allow vision. The fibrous tunic is divided into the opaque sclera and clear cornea. These two structures join at the limbus. The sclera makes up the majority of the globe and is composed of criss-crossing collagen fibres, fibroblasts and an external episclera, a dense, highly vascular, fibrous layer.

The cornea is the clear connective tissue layer at the front of the globe that allows light to enter and be focused on the retina to create an image. The cornea has four layers and is generally between 0.5 mm and 0.8 mm thick. The four layers are the epithelium, stroma, Descemet’s membrane and endothelium. The epithelium is nonkeratinised stratified squamous epithelium.

The stroma makes up the majority of the cornea (90%) and is comprised of keratocytes, collagen, and various ground substances that control its hydration.

The cornea and sclera have the same composition of collagen; however, the cornea’s clarity is due to the collagen being arranged in parallel layers. Descemet’s membrane is the basement membrane of the endothelium. The endothelium is a single layer of cells on the inner surface of the cornea and is a fluid pump that is mainly responsible for controlling corneal hydration and transparency.

Corneal Ulcers

A corneal ulcer occurs when there is damage to one or more of the corneal layers.

Ulcers are classified according to their

CE Article #1 Ulcers: A Pain in the Eye

By Sonia Maiorano, RVT, Vots Member

depth and cause. Most pets with corneal ulcers present with similar clinical signs.

These include squinting (blepharospasm), increased tearing (epiphora) or discharge, pawing/scratching of the eye, redness, and sometimes cloudiness of the cornea.

Presentation After obtaining the signalment, questions to ask the owner prior to booking the appointment are: • Is it one eye or both?

• When did the problem start?

• What do they notice their pet doing?

• Is there a discharge, and if so what colour is it?

• Is the eye a different colour, and if so what colour, and where is the colour?

Enter this information into a medical record so that it is available for the clinician to review and decide if the pet needs to be seen urgently.

Initial Exam Once the animal visits your clinic and is in a consultation room, prior to touching the pet, make some initial observations. Which eye seems to be affected? Is the animal holding the eye closed? Is there a discharge and what does it look like? Can you see any colour changes and localize where they are, e.g. eyelid, cornea, conjunctiva?

While you are doing this, take a clear and concise history from the owner. Go back over the same questions they were asked on the phone. Ask if they have applied any medications to the eye. If they have medicated, ask what products were used, how often they were applied and if they think it caused any improvement.

Following this, the next part of the examination is to perform the neuro-ophthalmological examination. A transilluminator is used to check the pupillary light reflexes.

Turn the lights in the room down low so it is easier to see any changes. Before you shine the light directly in one eye, stand back and shine it on both eyes. Can you see the tapetal (night shine) response from both eyes? This will identify if the pupils are the same size. Did both pupils dilate in the low light? Now check the direct pupillary light reflex. Bring the light up to one eye and watch the pupil. Does it constrict (miosis)? How much and how fast? Now move the light to the other eye. Is this pupil already constricted? This evaluates the indirect pupillary light reflex and tells you that when you shone the light in the other eye the light was perceived in the mid-brain and has caused the pupil in this eye to constrict. Remove the light to allow the pupil to dilate. Now repeat the direct pupillary light response test for this eye. Check the menace response. Does the animal blink?

Check the palpebral response. Do the lids

Sonia Maiorano is a graduate of Georgian College’s Veterinary Technician program. While enjoying her position in private practice for a number of years as an RVT, Sonia moved back to her home-town of Guelph, Ontario with her family and pets (furry and feathered!) and worked at the Ontario Veterinary College including the Ophthalmology department! There, she was able to develop her skills in ophthalmology in small animal, large animal and avian/exotics. She now works as an Ophthalmology Technician at the Animal Eye Clinic of Waterloo Region and is also a member of the Veterinary Ophthalmic Technician Society. Working with her mentor, Dr. Nick Whelan, BVSc, MVSc, MACVSc, Dip ACVCP, Dip ACVO, a Veterinary Ophthalmologist, she is constantly learning every day and enjoys working in a field that she loves! One of her goals related to this field is to work in conjunction with clients and patients on proofing homes when patients have lost their vision. During her spare time, if she is not car pooling her daughters to soccer, dance, or English riding, you can find her on the track with the Fergus Roller Derby League as one of the co-founders.

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close completely?

Now examine the eye. Look at the lids. Are they swollen? Can you see any discharge?

What colour and how much? Is the third eyelid elevated and what colour is it? Is the cornea clear? Can you see the iris and pupil? If it is not clear, can you see why?

With your finger, gently raise the upper Boxers commonly present with an indolent ulcer

This requires gently debriding of the cornea with a diamond burr to remove loose epithelial tissue.

eyelid and look at the conjunctiva on the globe (bulbar conjunctiva). Is it reddened or swollen and how much? If the blood vessels are inflamed, what do they look like?

Are they thick or thin?

If it is not contraindicated (i.e. if you believe there is an ulcer and it is very deep or has possibly perforated), perform a Schirmer tear test.

Check with your clinician if they also wish you to perform a fluorescein stain. If you perform a fluorescein stain, make note of the ulcer size and depth.

Keep in mind, all of the information needs to be entered into the history. Record keeping can be made easier if you follow a dedicated ophthalmology exam form to for eye cases.

Corneal Ulcers can be classified into three main categories: Grid keratotomy using slightly bent needle to encourage epithelial growth.

A contact lens is placed on cornea for protection in healing.

A temporary tarsorrhaphy is performed by temporarily and partially suturing the eyelids closed to help with healing.

This descemetocele is fluorscein-stained positive. This small diagnostic tool is extremely helpful in detecting the depth of an ulcer and it’s infection.

A conjunctival flap is placed over the descemetocele to encourage wound healing and save the eye.

In extreme cases like this one, sometimes an enucleation (removal of the globe) is the only option.

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1. Simple/uncomplicated: These can be acute and in dogs are often associated with trauma, lid/lash abnormalities such as entropion, distichiasis, ectopic cilia, foreign body or even a shampoo injury following regular grooming and the thickness of these ulcers are no more than 1/3 to ½ in stromal depth. In cats they are often associated with feline herpesvirus.

Once the initiating cause is removed this type of ulcer should heal quickly (within approximately 3 to 5 days).

Medical therapy should be as follows: Topical antibiotics applied every 6 to 8 hours to prevent a secondary infection. Cats also need a topical antiviral drop such as ganciclovir 3-4 times daily. If there is secondary uveitis (intraocular inflammation), a drop of atropine applied once daily can relax the intraocular ciliary muscle spasm and will also keep the pupil dilated (Note: cats do not like the taste of atropine as it is very bitter).

An NSAID (given orally or as an injection at time of the visit) in combination with an opioid, like tramadol, is effective in reducing inflammation and keeps the patient comfortable during the healing process.

An Elizabethan collar will prevent further self-trauma. Note: Do not use any type of systemic corticosteroids or topical steroidal medication to treat corneal ulcers. They will delay healing and can cause the corneal collagen to melt.

2. Indolent/Refractory Ulcers: These are usually seen in older dogs and Boxers. These initially present as a simple ulcer but never seem to heal and are usually

involve less than 1/3 to 1/2 of the stroma (stromal loss). This is due to an attachment problem between the epithelial cells and the anterior stroma. Treatment involves ulcer debridement (to remove loose epithelium) and a multiple punctate or grid keratotomy. Animals may need to be sedated for this procedure. For the keratotomy, the ophthalmologist uses a needle to make micro-punctures in the corneal stroma.

This will allow the corneal epithelium to grow down into the stroma and anchor the epithelium. After the grid is made, a soft contact lens is placed over the cornea for protection. The lids may be partially sutured together (temporary tarsorrhaphy).

Broad-spectrum bactericidal antibiotics are applied and an Elizabethan collar is assembled to prevent self-trauma.

Oral pain management (NSAID in combination with an opioid), topical EDTA (1%) or serum* and/or 5% hypertonic saline drops (to reduce corneal edema) may also be prescribed. EDTA and serum are used to help inhibit any bacterial or neutrophil collagenases that break down corneal collagen. Note that serum should not be used if a contact lens has been placed.

These ulcers should heal within 2 weeks. *Serum is made from spinning the patient’s own blood, separating, and freezing the serum in 0.3 mL alloquat syringes which are capped (do NOT cap syringes with needles).

3. Complex/Deep: There ulcers may have acute or chronic damage to the cornea, often from a trauma or an infection.

In some cases these can occur very quickly (over 24 hours), where the layers of the cornea appear to melt. These ulcers usually involve more than 1/3 to ½ of stromal loss.

Always assume these cases to be infected and treat as serious.

Where possible, a culture is gently taken (avoiding perforation of the eye) and submitted to identify the infection/bacteria.

If the entire stroma is lost down to Descemet’s membrane, this is referred to as a descemetocele. A descemetocele will not stain in the centre with fluorescein and can rupture at any time if left untreated.

If the route chosen is medical management, medication timing is much more intensive than that of a simple ulcer. Bactericidal antibiotic drops are given more frequently (every 1-2 hours) than in the ulcer scenarios described above. A broad spectrum drug is used, pending culture results. Mydriatic/ cycloplegic therapy is initiated which will allow the pupil to open and relieve ocular

11

pain. Serum and 2% EDTA are also prescribed.

Medical therapy is reasonable if the ulcer is 1/3 to 1/2 corneal thickness and does not look like it is melting. If there is no improvement over the next 24-48 hours, or the ulcer is deeper then surgery is recommended. The surgical procedures usually performed are a conjunctival graft or a corneal-conjunctival transposition. (A thin part of conjunctiva is isolated and then used to cover the graft, and is gently sutured into place on the cornea). A temporary tarsorrhaphy is then placed to keep the lids slightly closed to help with healing of the ulcer. Aggressive medical management follows until the patient’s cornea heals whereby the graft can be trimmed.

Note: It is essential that an Elizabethan collar is used to avoid self-trauma.

Conclusions:

Corneal ulcers are a very common clinical presentation in small animal practice.

Trauma, foreign body, dry eye and bacterial or viral infections can all be initiating causes of a corneal ulcer. The key to successful treatment is a good clinical exam, appropriate diagnostic testing, an appropriate treatment plan and owner compliance.

Many thanks to Dr. Nick Whelan, BVSc, MVSc, MACVSc, Dip ACVCP, Dip ACVO for his help with the writing of this article.

references > 1. Joan Dziezyc, Nicholas J. Millichamp.

Colour Atlas of Canine and Feline Ophthalmology, Elsevier 2004 2. Kirk N. Gelatt, Janice P. Gelatt. Veterinary Ophthalmic Surgery. Saunders Elsevier 2011 3. Kirk N. Gelatt. Veterinary Ophthalmology, Second Edition. Wiley-Blackwell 4. David J. Maggs, Paul E. Miller, Ron Ofri.

Slatter’s Fundamentals of Veterinary Ophthalmology Fourth Edition. Saunders Elsevier 2008 5. Sonia Maiorano, TECHNEWS Fall 2010, Volume 34, Issue 1

Glossary of Terms > Limbus – circular junction of the cornea and sclera.

Descemet’s membrane – the basement membrane of the corneal endothelium.

Blepharospasm – spasm of the orbicularis oculi muscle resulting in eyelid closure.

Epiphora – overflow of tears due to impaired drainage, excessive production, or both.

Tapetum – approximately semicircular, reflective layer of the choroid occupying up to the dorsal half of the fundus in many domestic species.

Miosis – constriction of the pupil.

Palpebral reflex (response) – eyelid closure in reaction to stimulation of the periocular skin.

Entropion – an introversion or rolling in of the eyelid.

Districhiasis – condition in which multiple cilia emerge from one meibomian (tarsal) gland orifice.

Ectopic cilia – hair/cilia protruding through palpebral conjunctiva. The cilia usually abrade the cornea, causing pain and ulceration.

Uveitis – inflammation of the iris, ciliary body or choroid in any combination.

Descemetocele – deep corneal ulcer characterized by sufficient stromal loss that there is exposure of Descemet’s membrane.

Cycloplegia (cycloplegic) – paralysis of the ciliary muscle induced to reduce pain due to ciliary spasm associated with anterior uveitis.

Mydriatic – pertaining to or characterized by dilation of the pupil.

Ten-plus things veterinarians can do now to increase cat visits “Since the Bayer Veterinary Care Usage Study III: Feline Findings confirms that better care for cats is key to veterinary practice growth, 2013 may turn out to be the ‘Year of the Cat’ on many veterinary calendars” said Cristiano von Simson, DVM, MBA, Director of Veterinary Technical Services at Bayer HealthCare LLC Animal Health Division, North America. “To help increase feline visits, Bayer HealthCare and the American Association of Feline Practitioners offer eleven practical tips.”

1. Find the un-served/under-served cats in your practice by asking about other household pets on every visit and tracking reminder compliance.

2. Educate cat owners on carrier use and transporting cats.

3. Make your waiting room as cat-welcoming as possible by establishing separate areas for dogs and cats and installing visual barriers, if possible.

4. Reserve one or more exam rooms for cats only.

5. Train all staff regularly in cat-friendly handling.

6. Review and refine feline exam protocols.

7. Talk through the exam with cat owners.

8. Use and dispense feline-friendly medications.

9. Send home an exam report every time.

10. Schedule the next exam before the cat leaves the practice.

11. Join AAFP and become a certified Cat Friendly Practice (http://catfriendlypractice.catvets.com/) For more information on the study results, go to www.bayerhealtcare.com

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TECHNEWS | VOLUME 36 ISSUE 3

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Rabies, also known as “hydrophobia”, is a preventable disease of the central nervous system.

Rabies is a zoonotic disease, and therefore, veterinarians, registered veterinary technicians, and others working with animals need to be especially vigilant about protecting themselves from this deadly virus.

Epidemiology and History in Canada

The rabies virus is distributed world-wide, with the exception of a few countries being labelled as rabies-free zones. These countries include Australia, Japan, New Zealand, and the United Kingdom1. The disease is most prevalent in Asia and Africa, with 95% of human deaths occurring in these areas2.

More than 55,000 people around the world die each year from rabies2.

The first recorded case of rabies in Canada occurred in the year 1819 in a person living in the province of Ontario3. Random outbreaks of the disease occurred in most of the provinces during the early 1900’s, and were largely attributed to domestic animals, particularly the domestic dog. In the mid20th century, another outbreak occurred, this time in Canada’s Arctic regions. Foxes (Alopex lagopus, Vulpes vulpes) and coyotes (Canis latrans) were the main vectors for the virus, spreading it to British Columbia, Alberta, Saskatchewan, and Manitoba.

The disease eventually migrated to Quebec, and then to Ontario, where it became enzootic in skunks and foxes3.

Virology and Transmission

Rabies is a Lyssavirus belonging to the Rhabdoviridae family. There are several different strains of the rabies virus present in Canada, including the Arctic Fox Strain, the Raccoon Strain, and the Bat Strain.

Despite being named after the species most commonly recognized as a reservoir of a particular strain, all strains of rabies are capable of infecting any type of mammal4.

CE Article #2 Rabies

By Tanya De Angelis, RVT

All rabies strains are zoonotic, meaning that the virus is transmissible from one species to another, including humans4.

Rabies is transmitted through the saliva of infected animals, most commonly through bite wounds5; however, it can also be spread by saliva entering through fresh wounds in the skin, or through contact with the mucous membranes. Felines are also known to transmit the illness through scratches1.

Human-to-human transmission is possible through corneal and organ transplantation, although this occurrence is rare5. In theory, infected humans can also transmit rabies to other people through bite wounds; however, there have been no documented cases of this occurring2.

The incubation period of the virus is typically three to eight weeks6, but can be even longer, depending on the site of entry and the amount of virus that has entered the wound. During the incubation period, the rabies virus makes its way from the entry wound to the surrounding nerve endings6.

It then travels via the nerves to the brain, where it rapidly multiplies in the neurons6, causing encephalitis2. From there, the virus travels to the salivary glands and appears in the saliva6, where it can then be transmitted to other animals or people.

Signs and Symptoms

Symptoms of rabies in domestic animals can often be vague and nonspecific6. Often times, clients will bring their pet into the clinic for veterinary treatment because it is

“just not doing right”6. Clients may have no idea that their pet could have rabies6, and that they and their family are now at risk of contracting the disease.

Three stages of clinical signs are observed in animals infected with rabies: the prodromal (prelude) stage, the excitative (furious) stage, and the paralytic (dumb) stage. The prodromal stage may be difficult to recognize as it may last only a few hours, but usually lasts for two or three days7. This stage is characterized by changes in behaviour and temperament6,7. Loss of appetite and a mild fever may also be associated with this stage7. Humans are at greatest risk of exposure to the virus during this stage6, and therefore, veterinary staff should be especially cautious when handling animals with these symptoms.

The excitative stage, which follows the prodromal stage, is usually easy to recognize.

During this stage, the animal may initially appear hyperactive or restless, and may chew or swallow unusual objects, such as rocks, sticks, or other non-food items7.

As the disease progresses, the animal becomes more irritable and aggressive, and may attack unprovoked. The animal may also bite itself; self-mutilation during this stage is very common7. The excitative stage typically lasts from one to seven days, but may be so short that the stage passes unrecognized7. Cases in which the excitative stage is dominant are referred to as “furious rabies”, where as cases in which the excitative stage is very short or absent are called

Tanya De Angelis, RVT graduated with Honours from the Veterinary Technician program at Seneca College in 2009 and became an RVT later that year. Tanya maintains a special interest in companion animal nutrition and parasitology. She is currently working at the Lincoln County Humane Society Animal Clinic and grooms dogs part-time at her home in Niagara Falls. Tanya has many four-legged companions, including several cats, a Shetland Sheepdog named Dexter, and a three-legged dog named Storm. In her spare time, Tanya enjoys various arts & crafts, reading comic books, cooking, and going swimming with Dexter.

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TECHNEWS | VOLUME 36 ISSUE 3

“dumb rabies”7.

The final stage is referred to as the paralytic stage, as the animal experiences progressive paralysis of its entire body7.

Excessive drooling, caused by paralysis of the pharynx and masseter muscles, is often the initial symptom of this stage7.

The animal may exhibit a slight protrusion of the tongue, and an inability to close its mouth. The animal loses its ability to swallow, making eating or drinking impossible. Following paralysis of the head and neck, the animal will experience paralysis of its limbs and the rest of its body7.

Death by respiratory or cardiac paralysis will occur soon after6.

Symptoms of rabies in humans are similar to those found in animals. The disease manifests itself in separate stages in humans as well. Following the incubation period, the first symptoms noticed are often comparable to those of influenza, including nausea, fever, headache, and generalized weakness8. A sensation of pain, itchiness, burning, prickling, or tingling (known as paraesthesia) may be present at the site of infection2. The symptoms of this first stage may last for several days, and is followed by inflammation of the brain and spinal cord. As in animals, the next stage of infection in humans in the excitative stage. During this stage, the infected person may appear hyperactive2, anxious, confused, or agitated8. The infection person may even experience hallucinations, insomnia, or other abnormal behaviours8. Hydrophobia may also occur during this stage, as swallowing becomes impossible due to spasmodic contractions

of the throat muscles1,7. Not all people infected with rabies will show symptoms of this stage; approximately 30% of humans will experience an excitative stage so short, that the disease appears to progress directly to the paralytic stage2. During this stage, the muscles become paralyzed, followed by coma, and eventually death caused by cardio-respiratory paralysis2.

Diagnosis & Treatment

Rabies is almost always fatal once clinical symptoms begin to present. As of June 2011, there have been only six people known to survive the virus without receiving pre- or post-exposure vaccination9. It is imperative that proper actions be taken immediately if you suspect that you have come into contact with the rabies virus in order to ensure survival.

There is currently no definitive ante mortem test for rabies in either animals or humans. It is difficult to diagnose rabies in humans based solely on clinical signs, as there are several other illnesses, including West Nile Virus and viral encephalitis that can be confused with rabies. Diagnosis in humans is typically made by sending samples of skin tissue or cerebrospinal fluid for testing, but these tests are not definitive. Unfortunately, the only diagnostic technique that is definitive in both humans and animals is examination of the brain tissue after death by fluorescent antibody test2,6.

The type of post-exposure treatment required will depend on the type of contact with the animal (Table 1). If you are bitten or scratched by an animal that is suspected

to be rabid, it is very important to immediately wash the wound with providineiodine or soap for at least fifteen minutes in order to remove as much of the rabies virus as possible1,2. You should then proceed to your nearest hospital or emergency care facility as soon as possible in order to seek medical attention, which consists of wound treatment, post-exposure rabies vaccination, and if indicated, administration of human rabies immunoglobulin (HRIG)2. These same instructions should be followed if a suspected rabid animal licks a fresh wound on your skin.

Veterinary professionals who have already received pre-exposure vaccination should also follow these steps, but will not receive HRIG, as it interferes with the immune system’s response to post-exposure vaccination7.

Post-exposure treatment of rabies is highly effective in preventing the disease if administered soon after exposure; however, if treatment is not sought and rabies develops, it is almost always fatal. Of the six people reported to have survived the disease, five had benefitted from an experimental treatment known as the “Milwaukee Protocol”, developed in 2004 at the Wisconsin Children’s Hospital by Dr. Rodney Willoughby9. The protocol involves putting the patient into a ketamine-induced coma in order to protect the brain while the patient’s immune system fights the disease. Unfortunately, the Milwaukee Protocol is far from a miracle cure for rabies; the protocol has been used at least 35 times around the world in an effort to save infected patients, but has only been successful in five cases9.

table 1 > Recommended pos t-exposure prophylaxis for rabies infection Category of exposure to suspect rabid animal

Post-exposure measures

Category I – touching or feeding animals, licks on intact skin (i.e. no exposure)

None

Category II – nibbling of uncovered skin, minor scratches or abrasions without bleeding

Immediate vaccination and local treatment of the wound

Category III – single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks, exposures to bats

Immediate vaccination and administration of rabies immunoglobulin; local treatment of the wound

Adapted from “Rabies Fact Sheet” by World Health Organization, 2011

TECHNEWS | VOLUME 36 ISSUE 3

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There is currently no treatment for animals that have developed rabies. Patients brought into the veterinary clinic that are suspected of having the disease should be euthanized6. The animal’s brain tissue should then be sent for diagnostic testing6, and the local office of the Canadian Food Inspection Agency (CFIA) should be notified. Patients that are up-to-date on their rabies vaccine and have been in contact with a rabid animal should be revaccinated and kept under observation for a period of three months6. Unvaccinated patients that have been exposed to the virus should be euthanized, but can be kept isolated under strict observation for signs of disease for a period of six months6.

Healthy dogs, cats, ferrets, horses, cattle, or other domestic mammals that bite a person are required to be quarantined at a veterinary office or humane society for a period of 10 days and observed for signs of rabies, regardless of vaccination history. It is not advisable to administer a rabies vaccine to the animal during the confinement period, as side effects from the vaccine can be confused with signs of disease10. Any sign of illness during quarantine should be evaluated by a veterinarian, and then reported immediately to the local health department10. If the animal develops symptoms of rabies, it should be euthanized, and its brain tissue sent for testing10. If the animal does not show any sign of illness during the 10 day confinement period, it is not considered to have been contagious at the time of the bite6. The animal can be released back into its owner’s custody, and the person bitten is not considered to be at risk of rabies.

How You Can Protect Yourself

There are several steps that veterinary technicians, veterinarians, and other animal workers can take in order to protect themselves from contracting rabies. The first and perhaps most important thing you can do to ensure your protection is to receive pre-exposure vaccination. A series of three vaccines are administered intramuscularly (typically in the upper arm) on days 0, 7, and 21. Pre-exposure vaccination is very effective, unlikely to cause adverse reactions11, and protects against all strains of the rabies virus. After you have been vaccinated, it is wise to have your serum titre levels checked annually to determine your immunity11. Booster vaccines may be required, as the duration of immunity will vary by individual11.

In order to protect yourself while working,

16

always obtain a patient’s vaccine history, especially for animals with neurological symptoms. Wear gloves when performing a necropsy or examining the oral cavity of a patient6. You can also protect yourself by properly educating clients:

• Encourage clients to ensure their

dogs, cats (including indoor-only cats), ferrets, and horses are up-todate with their rabies vaccinations • Discourage clients from keeping wild animals as pets (such as raccoons or skunks), and try to avoid handling wild animals brought into your clinic • Tell clients to avoid handling wild animals, especially those that appear tame, friendly or ill • Discourage clients from feeding stray or wild animals

Conclusion

Although there is a low prevalence of rabies in Canada, veterinary staff still need to be wary of this deadly disease. Rabies is almost always fatal, but can be prevented through pre-exposure vaccination, client education, and proper post-exposure medical treatment. If you come into contact with a rabid animal or an animal that you suspect is rabid, seek medical treatment and contact your local branch of the Canadian Food Inspection Agency without delay.

references > 1. Dr. Charlie Easmon, NetDoctor [2009, online]. Rabies. Available: http://www. netdoctor.co.uk/travel/diseases/rabies.htm [Accessed 26 July 2012] 2. Author Unknown, World Health Organization [2011, online]. Rabies Fact Sheet. Available: http://www.who.int/ mediacentre/factsheets/fs099/en/ [Accessed 26 July 2012] 3. Richard C. Rosatte; Rabies in Canada: History, Epidemiology and Control.

Canadian Veterinary Journal 1988 April; 29(4). Pages 362 – 365 4. Author Unknown, Rabies in Wild Animals [2012, online]. Available: http://www. health.gov.on.ca/english/public/program/ pubhealth/rabies/qa/rabies_wild.html [Accessed 26 July 2012] 5. Author Unknown, Centers for Disease Control and Prevention [2011, online].

How is Rabies Transmitted? Available: http://www.cdc.gov/rabies/transmission/ index.html [Accessed 27 July 2012] 6. Alleice Summers, MS, DVM; Common Diseases of Companion Animals. Mosby, Missouri 2002. Pages 259 – 261 7. Dennis M. McCurnin, DVM, MS, Dipl ACVS, Joanna M. Bassert, VMD; Clinical Textbook for Veterinary Technicians, 6th Edition. Elsevier, China 2006. Pages 335, 1146 – 1148 8. Author Unknown, Centers for Disease Control and Prevention [2012, online].

What are the Signs and Symptoms of Rabies? Available: http://www.cdc.gov/ rabies/symptoms/index.html [Accessed 28 July 2012] 9. Ferris Jabr; New Scientist [2011, online].

Rabies May Not Be the Invincible Killer We Thought. Available: http://www.newscientist.com/article/dn20593-rabies-maynot-be-the-invincible-killer-we-thought. html [Accessed 3 August 2012] 10. Author Unknown, Centers for Disease Control and Prevention [2011, online].

What to do with an Animal that has Bitten a Person. Available: http://www.cdc. gov/rabies/specific_groups/veterinarians/ person_bitten.html [Accessed 3 August 2012] 11. Author Unknown, Ontario Ministry of Natural Resources [2012, online].

Questions and Answers. Available: http://www.mnr.gov.on.ca/en/ Business/Rabies/2ColumnSubPage/ STEL02_168959.html [Accessed 3 August 2012]

TECHNEWS | VOLUME 36 ISSUE 3

Monthly Service Promotions Each month, plan to focus your client education on a particular service. Create fun information posters for your reception area bulletin boards and develop handouts to give to clients as they check out. Don’t forget to feature you monthly theme on your Facebook page!

Euthanasia Protocol Turn off lights in the hallway behind exam rooms when a euthanasia is performed. It will remind you to quiet down in order to not disturb clients during this emotional appointment. Turn the lights back on after they leave.

Inexpensive Protection To protect our portable Doppler from liquids such as scrub solution, blood, and urine, we cut a small opening for the cord in the end of a quart-size refrigerator storage bag and slip the bag over the unit. You can see the buttons easily, it doesn’t inhibit the sound, and the bag can be replaced easily and cheaply. (Veterinary Economics) Monthly Message Clients who struggle to remember their pets’ monthly heartworm preventive may appreciate it if you program their cell phone with a monthly reminder. After testing their pets for heartworm, program their phone before they leave the clinic. This should help boost heartworm preventive compliance!

Sterilization Savvy To help ensure consistency and accuracy with new employees who clean, wrap, and autoclave surgical instruments, consider creating an instrument binder. Take photographs of all of the instruments before and after they are wrapped in autoclave tubing. In a large binder with photo pages, label each instrument’s photos, including instructions on how to clean and wrap each instrument and whether it requires gas sterilization or autoclaving. Photo labels could also include the instrument’s cubby location code (e.g. B2): the letter corresponds to the cubby row and the number to the column. The binder also includes step-by-step pictures for folding surgical gowns.

TECHNEWS | VOLUME 36 ISSUE 3

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’.

Sign up for your subscription today see Page 23 of this issue!

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Apps,Blogs

&Websites

To Watch Pet website launches The US Centres for Disease Control and Prevention’s National Pet360, Inc. announced the launch of Pet360.com, a website for pet parents that brings together thousands of expert articles and resources, an active community of passionate pet owners and the largest online selection of pet supply brands to create the ultimate destination for pet parents. The site delivers each member a personalized experience based on their pets’ type, breed, gender, age, size and medical conditions. Pet360.com debuts with the following features: The Pet360 Library offers thousands of educational resources; The Pet360 Community is a place for members to meet others with similar pets, share their experiences and photos, ask questions, give advice, promote and support animal shelters and rescue groups and help raise awareness of the causes they are most passionate about; The Pet360 Shop provides members suggestions for food, treats, toys and medications; The Pet360 Safety Center alerts members when a brand or product they use has been recalled. For more information, watch the Pet360 Video or visit www.Pet360.com. (veterinary advantage weekly newsletter) Smart flow sheet™ A new tablet application would like to revolutionize the way veterinarians care about in-patients. The app includes treatment reminders, interactive whiteboard, built-in calculators, realtime sync, automatic medical records, picture/video capture, and much more. The Smart flow sheet™ is available for your iPhone, iPad, and iPod touch on the App store. http://www. smartflowsheet.com/ App Lets You Solve Disease Outbreaks At Home You may not be a disease detective, but now you can play one at home. The Centers for Disease Control and Prevention (CDC) has released a free app for the iPad called “Solve the Outbreak.”

It allows users to run through fictional outbreaks and make decisions: Do you quarantine the village? Talk to people who are sick?

The CDC says the app was designed in-house and says it is using social media to educate the public about diseases and to promote an appreciation for public health work. (CAHI clippings) App helps pet owners understand dog’s behaviour A new app called Dognition is challenging people to assess their dogs’ intelligence while contributing to scientific knowledge of dogs’ behavioural and cognitive patterns. Reported by Mother

18

Nature Network, Dognition encourages dog owners to take a survey about their pets’ behaviour, then play a series of games with their dogs that are designed to assess five dimensions of intelligence: empathy, communication, cunning, memory, and reasoning. Owners will gain a better understanding of their dogs’ behavioural tendencies and individual intelligence, but in the larger scheme of things, they will be providing valuable data that the scientific community can analyze to advance future studies, said the app’s designer, Brian Hare. Hare, an associate professor in evolutionary at Duke University and director of Duke’s Canine Cognition Center, said Dognition will help dog owners to gain a deeper understanding of what makes their dogs tick. (AAHA NEWStat) “Veterinarians on Call” a YouTube hit The YouTube video series “Veterinarians on Call,” sponsored by Zoetis Inc. (formerly Pfizer Animal Health), has recorded more than 550,000 views since its 2011 debut, the project’s production company reported. Look online for informative videos such as ‘Farmers raise cattle humanely, producing beef for America’, ‘Dr Turner welcomes piglets to the nursery’ and ‘Raising pigs with the best care, every day’. (Veterinary Practice News) Tools available for veterinarians to promote practice As part of the Partners for Healthy Pets mission, tools are available in the group’s Practice Resources Toolbox to enhance the delivery of preventive health care and veterinarians’ communication with pet owners about the value of routine care. The Practice Resources Toolbox includes The Opportunity Survey, Guidelines Implementation Tools, Communications Tools, Internet Marketing & Social Media Tools, Preventive Healthcare Plans Tools and Feline-Friendly Practice Tools. Visit the Partners for Healthy Pets online at partnersforhealthypets.org.

Top veterinary-related Facebook pages DVM Newsmagazine recently listed top veterinary-related Facebook pages to “Like”.

• Dr. Ernie Ward (http://Facebook.com/DrErnieWard/), “a veterinarian and practice owner, practice management consultant and media personality • American Veterinary Medical Association (http://Facebook.com/AVMAVets/) • Pawcurious (http://Facebook.com/Pawcurious/) Dr. Jessica Vogelsang is a veterinarian, popular pet blogger and lifestyle expert • Leo’s Pet Care (http://Facebook.com/leospetcare/) Dr. Greg Magnusson is a veterinarian and practice owner in Indianapolis, Ind. • CATalyst Council (http://Facebook.com/CatalystCouncil/) • Dr. Justine Lee (http://Facebook.com/doctorjustinelee/)

TECHNEWS | VOLUME 36 ISSUE 3

Cats are not small dogs when it comes to many diseases. Diabetes mellitus (DM) is no exception. Pathophysiology, risk factors, the usefulness of various insulin types, the issue of remission, and the importance of dietary management all differ between cats and dogs. This article explores the aspects of diabetes that are unique to cats, with an emphasis on recent findings and discussions involving diet, carbohydrates, and starch.

The Diabetic Difference Cats versus Dogs

–

Both the disease process and the potential for diabetic remission are key factors that differentiate this disease between the two species. Diabetes mellitus can be divided into two forms: • Type 1 or insulin dependent Diabetes mellitus (IDDM): This is characterized by an absolute insulin deficiency (ie non-functional pancreatic beta cells, which normally produce insulin), and life-long insulin treatment since remission is not possible. Most dogs (and a minority of cats) fall into this category. Insulin is the ONLY treatment option for dogs and some cats because the pancreas is no longer able to secrete insulin and oral hypoglycemic agents are not effective.1,2

• Type 2 or non-insulin dependent

Diabetes mellitus (NIDDM): This results in a relative insulin deficiency.

The majority of cats (85-90%) initially start out with this form. Unlike IDDM, patients with type 2 DM have sufficient beta cells within the pancreas, but they are dysfunctional.

1,2

Key features of NIDDM in cats include:

CE Article #3 Cats, Carbs and Diabetes: An Update on Diabetes Mellitus in the Feline

By Dr. Susan Kilborn, DVM, DVSc, VIMS

Impaired insulin secretion:

Impaired insulin secretion is a result of abnormal pancreatic beta cell function related to three factors: amyloid deposition in the pancreas, persistent hyperglycemia, and pancreatitis. Islet amyloidosis in cats is caused by accumulation of amyloid polypeptide, which is a hormone co-secreted with insulin by the pancreatic beta cells.

Islet amyloidosis is associated with a significant loss of beta cells in the pancreatic islets; however, the amount is usually insufficient to cause diabetes by itself.2,3 Hyperglycemia (high blood glucose) desensitizes glucose receptors on the pancreatic beta cells, leading to impairment of insulin secretion and worsening of the hyperglycemia. This is a reversible impairment which happens within a relatively short time period (weeks). Chronic hyperglycemia leads to glucose toxicity, which is an irreversible defect in insulin synthesis which happens over a longer period of time (months). Once glucose toxicity causes irreversible reduction of insulin secretion, a cat has Type 1 DM and will require life-long insulin treatment.2 Pancreatitis may contribute to pancreatic beta cell loss in some cases. Although many cats have significantly elevated feline pancreatic lipase immunoreactivity (fPLI or Spec fPL), this does not necessarily correlate with the degree of diabetic control.4

This study also suggested that many cats with diabetes will have concurrent pancreatitis regardless of the presence of any clinical signs. It may be worthwhile to consider a fPL as part of a minimum data base when first diagnosing a diabetic cat. Pancreatic adenocarcinomas can also result in DM and account for up to 19% of feline diabetics presented to referral institutions.1

Peripheral insulin resistance:

Cats with type 2 DM may also suffer from peripheral insulin resistance caused by: 1. Obesity, which leads to a decreased number (and binding affinity) of insulin receptors.2,5 2. Endocrinopathies or administered drugs which may create hormonal excesses that further decrease insulin sensitivity and result in diabetes. Glucocorticoids (either administered by the owner or due to hyperadrenocorticism), progesterone administration, hyperthyroidism, and acromegaly have all been associated with DM in cats.3,6 Acromegaly is excess growth hormone secretion caused by a pituitary mass. In a population of 184 diabetic cats studied in the United Kingdom, 29% were diagnosed with acromegaly based on elevated insulinlike growth factor (IGF-1) blood levels and presence of a pituitary mass found on brain imaging.7 Typical acromegalic appearance

Dr. Susan Kilborn received her DVM degree from the Western College of Veterinary Medicine. After 4 years of emergency and critical care practice in Winnipeg, she entered the DVSc program at the Ontario Veterinary College and became board certified in the American College of Veterinary Internal Medicine in 1995. After moving to Ottawa, Dr. Kilborn began receiving referral cases in medicine, initially with Alta Vista Animal Hospital, then through her self-owned Veterinary Internal Medicine Service (VIMS). She has a keen interest in companion animal nutrition and has been a consultant for Royal Canin Canada on the Technical Services Team since 2005.

Dr Kilborn has also served as an instructor and curriculum consultant in the Veterinary Technician program at Algonquin College, and really enjoys teaching students and being involved with the College.

TECHNEWS | VOLUME 36 ISSUE 3

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(facial and jaw enlargement, extremity enlargement) was not present in all of these cats, and insulin sensitivity was variable.

Given the significant prevalence of the disease in this population and sub-clinical presentation, cats should be screened for this disease by measuring serum IGF-1 if insulin resistance is suspected.

3. Illness or infections which increase the circulation of stress-induced hormones which are antagonistic to the action of insulin (i.e. glucagon, catecholamines). The most common sources of infection in cats include dental infections, dermatologic infections (abscesses, wounds, pyoderma), and infections of the urinary tract, including pyelonephritis.3

Confirmed Risk Factors for Diabetes Mellitus (DM) in Cats Multiple risk factors exist for the occurrence of DM in cats. See Table 1 for a summary, including what might be helpful for avoidance and mitigation of these risk factors.

Breed/genetics: Studies performed in Australia, New Zealand and the UK suggest that Burmese cats are at an increased risk. Studies in humans have identified several genes that predispose to obesity and/or DM, one of which is the melanocortin receptor 4 (MC4R) gene. A pilot study has identified a mutation in the MC4R gene in DSH cats. There was a significant difference between diabetic cats (homozygous for the mutation) and the control cats, suggesting that there may be a genetic aspect for predisposition to obesity and DM.8 Sex: Male cats are at greater risk than female cats. Males tend to gain more weight than females. High body fat percentage equates to insulin working less effectively; increased insulin levels contribute to exhaustion of pancreatic beta cells. Males tend to have lower insulin sensitivities even when lean, creating more of a disadvantage when they gain weight.5 Age: Cats are usually middle aged or older; older male cats appear to be at risk.

Obesity: Obesity will increase the risk of developing diabetes 3 to 5 fold in cats.

The glucose lowering effect of a given amount of insulin is reduced by more than half when body weight is increased by 44% in cats.9 In these very overweight cats, 67% of the individuals had insulin sensitivity which fell below the range reported for normal cats. The key message:

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obese cats are insulin resistant and cats with the largest percentage of body fat are the most insulin resistant.

Inactivity: Indoor confinement and low physical activity have shown to be independent risk factors for development of Type II DM in cats.1

Drugs causing insulin resistance:

It is historically well accepted that use of corticosteroids and progestagens may be associated with development of insulin resistance and DM. This assumption is confirmed in a study showing that repeated therapy with corticosteroids was a risk factor for development of DM in Burmese cats.1

Insulin Therapy in Cats Insulin therapy is required initially in the majority of cats to ensure rapid correction of glucose toxicity and reduce beta cell exhaustion. Longer acting insulins are the preferred choice for cats, as the duration of porcine lente insulin (Caninsulin®) (which is the first choice for dogs) may be too short in some cats to adequately reduce blood glucose levels over 12 hours.10 There are three types of long acting insulin to consider using in cats:

Glargine (Lantus®):

Insulin glargine is a human synthetic insulin analogue produced by recombinant DNA technology. This insulin forms microprecipitates which slow its absorption; consequently, it cannot be mixed or diluted with other insulins or solutions. Glargine is a clear insulin solution that does not require mixing or rolling; it should never be cloudy or hazy in appearance. Studies in diabetic cats suggest that a refrigerated vial of glargine is stable for 6 months. Some key points regarding glargine use in cats11: 1. Cats presented with diabetic ketoacidosis can be treated with glargine. When used intramuscularly or intravenously, glargine acts like regular insulin and can be used for initial therapy instead of regular insulin.

2. Glargine can be safely instituted at 0.5 IU/kg q12h. When evaluating the blood glucose curve using glargine, it is often more useful to assess pre-insulin glucose concentration rather than the lowest (nadir) glucose measurement.

3. It often takes 3–5 days for a good glucose-lowering effect to be seen in the curves, possibly because of the long duration of action and carry-over effect of glargine.

4. Some cats consistently have their nadir glucose concentration in the evening just before the next insulin injection, and less commonly, it occurs around the time of their morning injection.

Detemir (Levemir ®)

This is an insulin analogue like glargine, but it appears to be more consistently absorbed, perhaps because this insulin does not form a precipitate. The effect of detemir appears more predictable and consistent between cats than glargine, longer acting (mean of 13.5 hours), and doses of detemir for adequate blood glucose control are about 30% lower than for glargine.11 The use of detemir at a starting dose of 0.5-1 unit BID is a reasonable alternative for cats, especially if the duration of glargine is insufficient.11

Protamine Zinc Insulin (PZI):

PZI contains insulin combined with protamine and zinc to increase duration of action. PZI insulin made from both porcine and bovine insulins is no longer available.

Recombinant human protamine zinc insulin labelled for use in cats is currently only available in the US. Compounded PZI beef insulin is currently available in Canada (Summit Veterinary Pharmacy), and a compounded human recombinant PZI insulin is available through Chiron Compounding Pharmacy.

Remission in Cats Remission in cats is defined as normalization of blood glucose and fructosamine levels and resolution of clinical signs and glucosuria without anti-diabetic therapy.3 If the cause of beta cell dysfunction or peripheral insulin resistance can be corrected (such as discontinuing corticosteroids, resolution of obesity, treatment of pancreatitis), long term insulin therapy may not be required in many cats. If diabetes is detected early and hyperglycemia is corrected rapidly using insulin, this increases the likelihood for remission. Remission is much less likely to occur with the sole use of diet or oral hypoglycemic agents because blood glucose is rarely consistently reduced to allow for resolution of glucose toxicity.1,3 For many leading researchers in the area of diabetes, the clinical goal is remission and not simply control of clinical signs in diabetic cats.

Factors which affect achieving remission in feline diabetics include2:

TECHNEWS | VOLUME 36 ISSUE 3

1. Early diagnosis – cats will have more recoverable pancreatic beta cells.

2. Extent of damage to beta cells – some cats have progressed to Type I disease.

3. Effective insulin therapy to consistently maintain the blood glucose at < 12 mmol/L. 4. Diet: Low carbohydrate, high protein, and higher fibre diets aid in achieving remission.

5. Adequate monitoring: Home blood glucose monitoring is preferred as a lower stress aid in attempting to obtain reliable blood glucose values. Ensuring adequate control of blood glucose through frequent monitoring may assist in achieving remission.

5. Duration of therapy: Although cats can occasionally achieve remission after several years of therapy, most cats achieve remission within the first 16 weeks of instituting insulin therapy.

The predictors of remission in cats in-

clude higher age (possibly slower disease progression), higher body weight (indicating the importance of obesity and body weight control), and higher blood glucose at time of diagnosis.12 Cats in remission have been shown to have impaired glucose tolerance and occasionally impaired fasting blood glucose.2 Therefore, cats that no longer require insulin should never be considered “cured”. Although remission can last for years in some individuals, average remission times in a study of 90 cats were 114 to 151 days.12

Feeding the Cat with DM: Let’s Talk about Carbs Carbohydrates versus starch, and why should I care?

The term carbohydrate encompasses starch (the digestible form) and fibres (the non-digestible form). It is important to understand that it is the individual components of the term carbohydrate

that need to be considered when discussing control of DM. Figure 1 illustrates the breakdown of carbohydrate into its fibre and starch components. Starch is defined as a digestible complex carbohydrate (without total dietary fibres). The starch content of diets for diabetic cats is an important consideration because this nutrient has the greatest influence on post-meal blood glucose levels and insulin release.13 Fibre indirectly affects post-meal blood glucose by increasing the time for nutrient movement through the digestive tract. Increases in blood glucose after eating in cats may be limited by feeding lower starch diets with moderate increases in fibre content.13

Carbohydrate and Starch Source Non-rice carbohydrate sources have been associated with lower blood glucose and insulin levels in overweight cats. Ricebased diets produced significantly higher

table 1 > Risk factors for DM in Cat s Risk Factor

Description

Avoidance

Breed/Genetics

• Burmese cats are at increased risk • Study identified mutation in a gene in DSH cats

• Owner education and breeding programs • Future screening of the MC4R gene in cats

Gender

Males>females; likely related to lower insulin sensitivity and risk for weight gain

Client education; weight control and calorie intake restriction following neuter

Age

Cats > 7-8 years of age

Wellness programs designed to monitor risk factors. BCS/Body fat & biochemical screening from middle age onwards

Body Condition Score (BCS)

BCS > 3/5; increased risk in very obese (> 4 /5) cats

Client education; close monitoring of body weight at and post-neuter

Activity Level

Indoor, inactive cats are at risk

Client education - exercise is possible in indoor cats! (http://indoorpet.osu.edu)

Concurrent Drug Use

Corticosteroids (oral and Depo- Medrol®), progestagens

Corticosteroids are the most common associated drug cause of DM. Client education, close monitoring of cats receiving steroids, and use of alternate drugs in some cats are avoidance approaches

Concurrent Diseases

Infections of any type, hyperthyroidism, pancreatitis, inflammatory bowel disease, growth hormone excess (acromegaly), and hyperadrenocorticism

Client education and vigilance for infections (regular wellness monitoring, serum fPL, and urine analyses). Cats that show poor physiologic response to insulin or obvious insulin resistance should be tested for acromegaly.

TECHNEWS | VOLUME 36 ISSUE 3

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post-eating blood glucose values and insulin responses compared to other grains, including barley.14 Non-rice based carbohydrate sources (grains, barley) are slowly digested, thus reducing the need to release high amounts of insulin over a short duration of time.

Carbohydrates and Cats – A Consensus Statement In 2011, a consensus statement entitled ”Role of dietary carbohydrate in causing and managing feline obesity and diabetes mellitus” was presented at the ACVIM (American College of Veterinary Internal Medicine) annual forum (unpublished).

Included below are some of the questions that the consensus group discussed. All statements were referenced, and these can be obtained upon request of the author.

#1 - Are carbohydrates (CHO) digested and absorbed in cats?

YES. Cats can digest carbohydrates as

dogs do. There may be a maximal tolerance (~ 50 % of the dietary energy), and glucose clearance from blood may be slower depending on the starch source and amount.

#2- Are carbohydrates an essential nutrient in cats?

NO. Glucose can be synthesized from amino acids in cats.

#3 - Do dietary carbohydrates cause obesity in cats?

NO. Carbohydrates and dry diets are not

associated with obesity. Diet factors associated with obesity include higher fat, premium diet use, neutering, age, decreased activity, and unrestricted feeding. Higher carbohydrate diets were associated with reduced obesity risk in one citation.

#4 - Do dietary carbohydrates cause DM in cats?

Possibly, but not in all cats. High diet

carbohydrates (> 50 % of energy intake) were associated with higher blood glucose and insulin concentrations. There were no differences in insulin sensitivity with different diets. Risk for diabetes appeared increased if cats were fed either just canned or just dry diets, so the use of canned diets to reduce the risk of diabetes is unproven. Body condition score and obesity appear to be a large factor in assessing causation of DM.

#5- What diet is recommended when DM is already present?

Reduced carbohydrate diets, but there is no evidence to support specific CHO amount or type. Experts

22

agree that feeding concurrent illness or abnormality takes precedence.

Goals of Diet Therapy in Diabetic Cats3,13: 1. The majority of cats with DM are overweight and often initially require a weight loss diet. Following weight loss and return to an ideal body condition score or body fat measurement, cats benefit from a lower fat, moderate energy diet.

Providing higher levels of good quality protein helps maintain muscle mass and may assist with weight loss when required.

Carnitine supplementation in the diet can also help with weight loss.

2. Limit post-meal elevations in blood glucose. This can be achieved with dietary provision of low starch and higher protein levels. Because canned food tends to have lower starch content (starch is required in the manufacture of dry kibble), it is generally useful to feed cats a significant amount of canned diet.

3. Include soluble fibres such as psyllium and fructooligosaccharides in the diet.

Psyllium seed and husks have a gelling

references > 1. Rand JS, and Marshall RD. Diabetes mellitus in cats. Vet Clin Small Anim 2005; 35(1): 211 – 224.

2. Feldman EC. Diabetes mellitus in cats: Review of the condition and successful treatment strategies. In: Proc OVMA Conference, Toronto, ON. 2012.

3. Reusch C. Feline Diabetes Mellitus. In: Ettinger SJ, Feldman EC (eds). Textbook of Veterinary Internal Medicine, 7th edition.

St Louis, MO: Elsevier. 2010. pp. 17971800.

4. Forcada Y, German AJ, Noble PJM, et al.

Determination of serum fPLI concentrations in cats with diabetes mellitus. J Feline Med Surg 2008. 10(5): 480 – 487.

5. Biourge V, Nelson RW, Feldman EC, et al.

Effect of weight gain and subsequent weight loss on glucose tolerance and insulin response in healthy cats. J Vet Intern Med 1997; 11(2): 86 – 91.

6. Baral R, Little S. Endocrine Pancreatic Disorders. In: Little S (ed). The Cat – Clinical Medicine and Management, 1st edition. St Louis, MO: Elsevier. 2012. pp. 547- 567.

7. Niessen SJ, Petrie G, Gaudiano F, et al.

Feline acromegaly: an underdiagnosed endocrinopathy? J Vet Intern Med 2007; 21(5): 899 – 905.

effect on food within the stomach, which slows down the transit time from the stomach to the small intestines. This blunts the rise in blood glucose after eating.

4. Supplement the diet with antioxidants. High blood glucose contributes to insulin resistance and progressive pancreatic cell damage. This is partially due to increased intracellular oxidative stress.

Antioxidants may reduce this damage.

5. Feed a consistent diet at consistent meal times. Some cats may be all day nibblers, but it is important to offer only the calculated appropriate daily kcal requirement (no free feeding).

6. Feed appropriately for any concurrent diseases, such as pancreatitis, inflammatory bowel disease, or renal disease. This may involve feeding a canned diet that is lower in protein / phosphorus, or contains a novel protein or a limited number of protein and carbohydrate sources.

Current dietary recommendations for the diabetic cat are first and foremost: meet the requirements of the individual cat.

8. Forcada Y, Holder A, Jepson R, et al. A missense mutation in the coding sequence of MC4R (MC4R:c.92 C>T) is associated with diabetes mellitis in DSH cats. J Vet Intern Med 2011; 25(3): 681 – 682. (Abstr.)

9. Appleton DJ, Rand JS, and Sunvold GD. Insulin sensitivity decreases with obesity, and lean cats with low insulin sensitivity are at greatest risk of glucose intolerance with weight gain. J Feline Med Surg 2001; 3(4): 211 – 228.

10. Michiels L, Reusch CE, Boari A, et al.

Treatment of 46 cats with porcine lente insulin - a prospective, multicentre study. J Feline Med Surg 2008; 10(5): 439 – 451.

11. Rand JS. New Developments in the Management of Feline Diabetes. In: Proc ACVIM Forum, New Orleans, LA. 2012; pp. 573 - 574.

12. Zini E, Hafner M, Osto M, et al. Predictors of clinical remission in cats with diabetes mellitus. J Vet Intern Med 2010; 24(6): 1314 – 1321.

13. Fascetti A, Delaney SJ. Nutritional management of endocrine diseases. In: Fascetti A and Delaney SJ (eds). Applied Veterinary Clinical Nutrition, 1st edition. Chichester, UK: Wiley-Blackwell. 2012. pp. 289-300.

14. Appleton DJ, Rand JS, Priest J et al.

Dietary carbohydrate source affects glucose concentrations, insulin secretion, and food intake in overweight cats. Nutr Res 2004; 24(6): 447 – 467.

TECHNEWS | VOLUME 36 ISSUE 3

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CE Article #1: Ulcers: A Pain in the Eye 1) A refractory ulcer is usually associated with: a) Cats b) Older dogs c) Boxers d) Both B and C 2) Excessive tearing is commonly referred to as : a) Blepharospasm b) Edema c) Brachycephalic d) Epiphora 3) Questions to ask a client when booking an appointment for their pet with an ulcer would be: a) Is it one eye or both eyes b) Is there vomiting/diarrhea c) Is there a change in colour in the eye d) Both A and C 4) List the layers of cornea in order starting from the outer layer: a) Epithelium, Stroma, Descemet’s membrane, Endothelium. b) Descemet’s membrane, Endothelium, Stroma, Epithelium. c) Stroma, Epithelium, Endothelium, Descemet’s membrane. d) Endothelium, Stroma, Descemet’s membrane, Epithelium.

TECHNEWS | VOLUME 36 ISSUE 3

5) Which surgical procedure can be used for a corneal ulcer that is more than 1/3 to ½ in depth? a) Grid keratotomy b) Suture ulcer edges c) Conjuctival graft d) Both A and C

9) It is not advised to use systemic corticosteroids or topical steroids to manage corneal ulcers due to: a) Wound healing delay b) Increased corneal collagen melting c) A contact lens being placed d) Both A and B

6) Which diagnostic tests would be beneficial to perform during an initial exam of a suspected corneal ulcer: a) Tonometry b) Schirmer Tear Testing c) Fluorscein staining d) Both B and C

10) True or false: A descemetocele will NOT stain in the centre with fluorescein. a) True b) False

7) Corneal debridement is performed to: a) Culture a sample b) Gently remove loose corneal epithelium c) Apply topical anesthesia d) Learn ocular pressures 8) A temporary tarsorrhapy is: a) Suturing eyelids together permanently. b) Partially suturing eyelids together temporarily. c) Attaching the third eyelid to the upper eyelid. d) Suturing the conjunctiva to the eyelid.

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CE Article #2: Rabies 1. Rabies is a zoonotic disease capable of infecting any species of animal: a) True b) False 2. What type of virus is the rabies virus? a) Coronavirus b) Lentivirus c) Lyssavirus d) Parvovirus 3. Rabies can be transmitted to humans in the following ways: a) Through open wounds in the skin. b) Through bites or scratches from infected animals. c) From the virus coming in contact with mucous membranes. d) All of the above 4. The three stages of clinical signs associated with rabies are: a) Prodromal stage, excitative stage, paralytic stage. b) Incubation stage, prodromal stage, paralytic stage. c) Excitative stage, furious stage, paralytic stage. d) Incubation stage, prodromal stage, furious stage.

5. The excitative stage in animals can be recognized by: a) Loss of appetite b) Hyperactivity or aggression c) Limb paralysis d) Inability to swallow 6. If you are bitten by a patient that is suspected to be rabid, the first thing you should do is: a) Proceed to the nearest hospital or emergency care facility. b) Contact the Canadian Food Inspection Agency . c) Wash the wound(s) with soap or providineiodine for at least 15 minutes. d) None of the above

9. Pre-exposure rabies vaccines (for humans and animals) protect against all strains of the rabies virus. a) True b) False 10. You can protect yourself from rabies by the following methods: a) Encouraging clients to vaccinate their pets. b) Obtaining pre-exposure vaccination. c) Wearing gloves when performing an oral examination. d) All of the above

7. People who have received pre-exposure rabies vaccinations are still advised to seek postexposure treatment. a) True b) False 8. What is the protocol for healthy dogs, cats, ferrets, horses, or other domestic mammals that bite a person? a) Euthanize the animal and submit a brain tissue sample for rabies testing. b) Quarantine the animal for 10 days and observe for signs of rabies. c) The animal and person who was bitten should be vaccinated for rabies. d) Vaccinate the animal and keep it under observation for three months.

CE Article #3: Cats, Carbs and Diabetes 1. The main difference between canine and feline diabetic patients is: a) Cats generally experience NIDDM (Type 2), dogs almost always IDDM (Type 1). b) Cats generally experience IDDM (Type 1), dogs almost always NIDDM (Type 2). c) Dogs can generally achieve remission when they are diabetic. d) Cats never require insulin for therapy of diabetes.

2. According to the article, dietary carbohydrates cause obesity in cats. a) True b) False 3. The following are common causes of insulin resistance in cats, except: a) Obesity b) Infection, e.g. urinary tract infection c) Pancreatitis d) Renal failure 4. The following dietary alterations may assist in improving blood glucose control in DM, except: a) Reduction of starch b) High protein levels c) Feeding a dry diet only d) Fibre addition to diet

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5. Which of the following statements regarding cats receiving insulin during their initial therapy for diabetes mellitus is false? a) Oral hypoglycemic drugs are a successful alternative to insulin to treat diabetes in cats. b) Glucose toxicity is a major aspect of pathophysiology, so rapid reduction of hyperglycemia is necessary to reverse this. c) Insulin therapy may allow cats to achieve remission. d) Glargine is a long acting type of insulin that may be used in cats.

6. Circle the true statement (s) from the following: a) Cats rarely achieve diabetic remission. b) Dogs are generally treated with glargine insulin as the preferred insulin choice. c) Cats may become insulin dependent from prolonged hyperglycemia and beta cell dysfunction. d) Carbohydrate source (example - rice) is not important in feline diets when managing diabetes mellitus.

7. Which types of insulin is not used to manage diabetes in cats: a) NPH (Humulin) b) Glargine c) Detemir d) PZI insulin

8. The following are risk factors for DM in cats: a) Pancreatitis b) Receiving corticosteroid drugs c) Being a male d) All of the above 9. Pick the false statement regarding dietary goals in diabetic cats: a) Higher protein levels and inclusion of carnitine may assist in maintaining muscle mass and maintaining an ideal body weight. b) Starch is defined as the undigestible component of dietary carbohydrates. c) Non- rice carbohydrates sources may assist in reducing post-meal glucose elevations. d) Many cats are obese at the time of diagnosis and require a diet designed for weight loss.

10. If a diabetic cat goes into remission after treatment, this is most likely to occur within: a) 2 days b) 2 weeks c) 16 weeks d) One year

TECHNEWS | VOLUME 36 ISSUE 3

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11811 (Mar 4, 2013) RVT’S for HVEC Barrie Are you an RVT looking for a challenging career where you can make a difference daily? Do you want to work 1 shift, 2 shifts, 3 shifts or more? I’m sure you’ve answered yes to both of these questions, so the Huronia Veterinary Emergency Clinic in Barrie is the place for you!

Your future work environment is changing for the better and you’ll want to be a part of our team pool.

Utilize all of your technical skills, build rapport with our existing team and experience a diverse critical-care case load to challenge you personally and professionally. Competitive wages, CE and uniform allowances.

E-mail your resume to Damon Thompson, Hospital Administrator at: manager@hvecbarrie.com and come aboard now!

11797 (Feb 25, 2013) Technician Assistant Opportunity for technician assistant or equivalent. Established animal hospital requires additional staff.

Duties: animal restraint and cleaning. Need to be able bodied and hard working.

Please forward resumes to douglashopwood@hotmail.com or by fax to 613-737-7544 11787 (Feb 20, 2013) Veterinarian Technician We are a dynamic, well established small animal veterinary clinic in Richmond Hill, with 3 full-time veterinarians and 2 full time technicians. We are looking for a Veterinary Technician for a full time maternity leave position, with the possibility of staying on with us at the end of the maternity leave period. We require a caring, outgoing

person with excellent technical skills as well as excellent interpersonal skills to join our team. New grads welcome to apply. Please forward a covering letter and resume by email to vet.ad@hotmail.com.

11776 (Feb 12, 2013) Veterinary Technician Responsible for back office clinic maintenance, animal care, surgical preparation including catheterization, intubation and recovery. Compassion, ambition and desire to work in a team setting essential. Excellent communication skills required for exam room client education. Minimum 2 yrs experience required.

Please forward resumes via email to dr.rosely@avonleaanimalhospital.ca 11762 (Feb 5, 2013) VetAssistant/Receptionist We are looking for someone with experience who is capable of working in a busy environment, can multitask and has good communication skills. The right candidate will be working with the public as well as with our technicians performing different procedures.

We are a holistic and conventional clinic who offer a wide range of modalities, so the chance to learn is great.

Full time/part time hours Benefits included Please contact Chris or Anne by phone 416-757-3569 or by fax - 416-285-7483

TECHNEWS | VOLUME 36 ISSUE 3

T:3.375” S:2.125”

11759 (Feb 5, 2013) Experienced Versatile RVT Wanted We are looking for an experienced, self-reliant RVT willing to work at multiple animal hospitals in the Kingston/Napanee region.

Please forward resumes to; Dr. Mark de Wolde at drmad@ yourvet.ca 11733 (Jan 22, 2013) Veterinary Technician Part Time/Full Time Our dynamic and growing team is seeking a motivated self starter who enjoys working in a progressive hospital that offers laser surgery, digital radiography, laser therapy and all the other bells and whistles. We offer medical/dental benefits, above average salary commensurate with experience and a host of other perks and incentives. Our hospital is open 7 days a week so flexibility in scheduling is essential. Please email your resumes to staff_wanted@hotmail.com.

11714 (Jan 16, 2013) Veterinary Technician Full time veterinary technician needed at a small animal practice located in Simcoe, ON. We are a very busy clinic where technicians use their technical skills to the fullest. Looking for a compassionate, hard-working person with excellent communication skills. Please fax resume to: 519-428-3276 or e-mail at: qvh@kwic.com

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

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Recommend Sentinel for flea control, heartworm prevention and intestinal worm protection, and you won’t miss a thing. For more information about Sentinel call 1-800-387-6325.

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

For Pet Owners - The Benefits of Crate Training for Puppies

by Gary Landsberg DVM, DACVB, DECAWBM, Sagi Denenberg DVM, Colleen Wilson DVM

Caring for a new puppy can be overwhelming. Normal behaviours such as exploring, chewing and elimination can be upsetting to the owner and potentially dangerous to the puppy. Furthermore, these problems can quickly intensify with each repetition of the event. Therefore, when it comes to behaviour, prevention is always the best medicine.

reduce anxiety and improve comfort for the pet. In addition, when taking the pet along on outings or vacations, the crate can insure safety and prevent undesirable behaviours such as exploring, chewing, stealing or soiling.

As veterinarians and registered veterinary technicians we have a responsibility to provide guidance and resources that review normal and expected canine behaviour, as well as how to set up the household to succeed. A consistent and predictable environment, with consistent and predictable outcomes, can quickly teach the puppy what is desirable. With either supervision or confinement, problem behaviours can be prevented and punishment need not be employed.

Safety of the puppy is a primary concern since unsupervised investigation can lead to injury by chewing or ingesting nonfood items or getting into human food and garbage that are not safely secured.

From the owner’s perspective, another critical issue is the household damage that might be caused by chewing, soiling and exploration. Similarly, adult dogs may continue to chew leather apparel, climb onto furniture, house soil or enter rooms that are out of bounds if left unsupervised without confinement (or at least dog proofing). Crate training also limits access to stimuli that might incite barking when the owners are away from home, and insures that the pet has no opportunity to engage in undesirable behaviours such as jumping up, or biting at both owner arrivals and departures.

One of the best tools for prevention of undesirable behaviours is crate training.

A discussion of why and how to effectively and positively teach crate confinement should be a component of preventive counselling for each new puppy owner.

More than likely, there will come a time when being familiar with a crate serves everyone well. Whether for a trip by car or plane, boarding at a kennel, or even a short stay at the groomer or veterinary clinic, familiarity with a crate or cage can

One simple way to view crate training is to consider the analogy of a young child who might have similar requirements for supervision and safety, a crib is used for resting and sleeping and a playpen is utilized for “safe play” when direct supervision is not possible.

training a pet where to eliminate, what to chew and what rooms or furniture are permitted, the crate can be used to prevent soiling, and damage to the household at any time the puppy cannot be supervised. Once the crate becomes a secure and positive confinement area, most puppies will not soil in their crate unless left inside for an excessive period of time because most dogs instinctively eliminate away from their sleeping or eating areas.

The length of time a puppy should be left in a crate will vary depending on the age of the puppy.

With consistency, rewards and time, many puppies will learn to use their crates for security and comfort when chewing on a favoured toy, resting or even sleeping. The crate can also serve as a safe haven where the dog goes when anxious or want to be left alone. In fact, an excellent rule to teach young children is that “When Buddy is in his crate, he wants to be alone”. Studies have also shown that giving the puppy some time on its own after play and training sessions are done, can reduce the possibility of over-attachment issues that could lead to separation anxiety.

When the puppy is removed from confinement, desirable behaviours can be reinforced provided the puppy is adequately supervised. For example, while

Dr Gary Landsberg and Dr. Sagi Denenberg operate a behaviour referral practice, North Toronto Veterinary Behaviour Specialty Clinic in Thornhill, ON (northtorontovets.com). Dr. Landsberg is a board certified veterinary behaviourist and Dr. Denenberg has recently completed his residency requirements to sit for both the ACVB and ECAWBM examinations. Dr. Landsberg is also the mentor for the behaviour residency program of Dr. Colleen Wilson who sees referral behaviour cases at the Osgoode Animal Clinic (osgoodevet.com).

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TECHNEWS | VOLUME 36 ISSUE 3

Controlling canine urinary incontinence just got simpler.

With new PROIN™ Chewable Tablets, you have an easier way to help control female canine urinary incontinence due to urethral sphincter mechanism incompetence (USMI)—also known as urethral sphincter hypotonus. Here’s why.

• Chewable tablets for easy administration • Twice-a-day dosage for enhanced client adherence to your directions • Scored tablets in three strengths to provide accurate dosing • Highly palatable1 – liver-flavour that patients love • Proven efficacy of phenylpropanolamine hydrochloride in controlling USMI1,2 • 98.1% of clients surveyed during a clinical trial of PROIN Chewable Tablets were satisfied with the results2 Thanks to PROIN Chewable Tablets, controlling urinary incontinence is easy for your clients.

Visit www.virbac.ca to learn more.

© 2013 Virbac Canada, Inc. All Rights Reserved.

PROIN is a trademark of Pegasus Laboratories, Inc. and is used under license.

1. Multi-Centre, 28-day, Placebo-controlled, Clinical Field Study (PLI-CL001) Clinical evaluation of PROIN Chewable Tablets for the control of urinary incontinence in dogs due to sphincter hypotonus.

2. Multi-Centre, Open Label, Clinical Field Study (PLI-CL002) Clinical evaluation of the long-term effectiveness and safety of PROIN Chewable Tablets for the control of urinary incontinence in dogs.

0313

US - Dodge “So God Made a Farmer” spot most popular Super Bowl ad - According to ABC News, Dodge Ram’s Super Bowl commercial that featured the late radio broadcaster Paul Harvey’s tribute to U.S. farmers might have won the hearts and minds of viewers on Superbowl Sunday. The two-minute spot featured a series of stark photos of farmers at work. Along with a montage of still images, Harvey’s distinctive voice delivers the narration: his “So God Made a Farmer” speech, which he gave in 1978 at the National Future Farmers of America Convention. He died in 2009 at age 90.

Global news

US - Tornado missed veterinary hospital by 70 yards - A mere 70 yards separated the shattering punch of a tornado from a veterinary emergency clinic February 10th in Hattiesburg, Miss.

“It was so close that one of our side doors became unlocked,” Dr. John Mayfield, co-owner of the Animal Medical Center, told the VIN News Service. Six people were working at the hospital during the storm. A patient had arrived just before the twister. He was a severely injured dog that needed surgery after being eviscerated by another dog. The veterinary team saw the tornado when it came over the horizon. They retreated into an exam room, huddling with their patient holding cushions over their heads. The power went out.

“We just held him as the storm went over all of us,” Mayfield said. “Then we started back to work on him with headlights. He made it through surgery but died an hour

afterwards. We lost him to hypothermia.

He was so cold and all we had were hot water bottles to warm him up. It was a tough night to go through and then lose your patient.” Mississippi Gov. Phil Bryant said at least 63 people were injured and about 200 homes damaged or destroyed by a series of tornadoes that ripped through nine counties.

US - CATalyst Council concerned about commentary on recent study - A recent study and corresponding media reports have cast a negative light on cats by suggesting that they may be responsible for killing perhaps billions of birds and mammals, according to the CATalyst Council.

Dr. Brunt, executive director of the CATalyst Council and a feline practitioner in Maryland, expressed concerns that the study and corresponding articles may hamper the ability of shelters to place cats in adoptive homes. “We regret the fact that the articles written about the study have maligned cats as a whole, when in fact, the vast majority of the estimated destruction to wildlife was reportedly by feral or stray cats,” she said. “This works to discourage prospective cat owners from adopting one of the hundreds of thousands of healthy, enjoyable cats that are held in shelters across this nation.” The CATalyst Council offers the following observations: Responsible cat ownership is best supported by keeping your cat indoors; Support your local Trap, Neuter, Release (TNR) program and the development of other non-surgical ways to sterilize large numbers of animals; Remem-

Canada - Fredericton’s Tiny the cat meets weight-loss goal 30lb feline’s plight helped raise $10,000 for shelter - Tiny the cat has reached his vet’s goal weight of just over 17 pounds in just over a year, after tipping the scales at 30.2 pounds. He was dropped off at the Fredericton SPCA in a big box and weighed three times the size of an average domestic cat.

The attention generated by Tiny’s new regimen of diet and exercise helped raise $10,000 for the shelter. Tiny was officially adopted by his foster mom. (cbc.ca)

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TECHNEWS | VOLUME 36 ISSUE 3

Canada - 3 newborn polar bear cubs die at Toronto Zoo - Aurora, an 11-yearold female polar bear, gave birth to one female and two male cubs on Dec. 6, the zoo said in a news release on Dec. 10th.

One of the male cubs died shortly after it was born, and the two others died Dec 9th.

The zoo said it wasn’t clear how the second two cubs had died and that tissue samples will be analyzed. The zoo said that the silver lining in the deaths was that Aurora showed maternal instincts for the first time, after rejecting three cubs last year, only one of which survived. “The fact that Aurora was doing everything right this time is a huge step in the right direction,” said Maria Franke, the zoo’s curator of mammals. Polar bears are considered critically endangered, with between 20,000 to 25,000 wild polar bears worldwide — about 60 per cent of those in Canada. (cbc.ca)

Term

Definition

1. aerophagia

a) premature contraction of the ventricle that can be easily identified using an electrocardiograph b) inability of the heart to maintain adequate circulation c) difference in pressure between two chambers or systems; in BP it is the difference between the arterial and venous side of the capillary bed d) three or more ventricular premature complex beats in succession e) the difference between the SBP and the DBP; if the difference is great, the pulses feel bounding; if the difference is small, the pulses feel weak f) abnormally increased heart rate g) ventricular tachycardia with QRS complexes of different morphology h) swallowing of air i) electrocardiographic representation of ventricular depolarization of the heart j) electrocardiographic finding that suggests an epicardial injury current

2. ventricular tachycardia 3. QRS complex 4. ST-segment elevation 5. polymorphic ventricular tachycardia 6. ventricular premature beat 7. cardiac decompensation 8. pulse pressure 9. pressure gradient 10. tachyarrhythmia

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

ber that some of the killed mammals cited in the study are pests, including mice and rats, which reproduce quickly and pose a public health concern when their numbers are allowed to grow unchecked. (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@oavt.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,

TECHNEWS | VOLUME 36 ISSUE 3

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

31

POISONING COLUMN

Top 5 Canine Toxins of 2012

By Dr. Justine A. Lee, DVM, DACVECC, DABT Associate Director of Veterinary Services, Pet Poison Helpline

Pet Poison Helpline, an animal poison control based out of Minneapolis, recently released the top canine toxins from 2012. Make your pet owners aware of these common, dangerous household items in order to prevent accidental poisoning.

Top 5 Canine Toxicants: • Chocolate • Mouse and rat poisons (rodenticides) • Vitamins and minerals • NSAIDs • Cardiac medications (e.g., calcium channel blockers, betablockers, etc.)

Chocolate Chocolate contains methylxanthines (e.g., theobromine, caffeine) which can result in clinical signs of anxiety, agitation, gastrointestinal (GI) distress (e.g., vomiting, diarrhea), cardiotoxicity (e.g., tachycardiac, arrhythmias), and even neurotoxicity (e.g., tremors, seizures, etc.). Clinical signs can be seen at toxic ingestions of > 20 mg/kg of theobromine, while cardiotoxicity can be seen at > 40 mg/kg. Neurologic signs can be seen at > 60 mg/kg. With some of the kitchen toxins, they stay in the stomach for up to 6 hours, so with large xylitol wads of gum, massive ingestions of anything (that creates a bezoar), chocolate, grapes/raisins, it is ok to induce vomiting up to 6 hours out provided the patient is asymptomatic. Treatments includes decontamination, administration of multiple doses of

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activated charcoal, anti-emetic therapy, fluid therapy (e.g., intravenous or subcutaneous, depending on the stability of the patient), anxiolytics (e.g., acepromazine), beta-blockers (if tachycardiac), frequent walks (to prevent urinary reabsorption of methylxanthines), and symptomatic supportive care (e.g., electrocardiogram and blood pressure monitoring). As methylxanthines have a long half-life (e.g., 17 hours), treatment may be necessary for 2-3 days, depending on the severity of the clinical signs.

Mouse and Rat Poisons (Rodenticides) One of the most common mistakes seen in the field of veterinary toxicology is assuming that each green or blue rat or mouse poison is a long-acting anticoagulant (LAAC) rodenticide. Several different classes of rodenticides also exist, and are commonly mistreated with Vitamin K1 therapy inappropriately. Other types of rodenticides include bromethalin, zinc phosphide, and cholecalciferol rodenticides. Bromethalin works by uncoupling oxidative phosphorylation in the brain and liver mitochondria, resulting in cerebral edema (with clinical signs seen as ataxia, decreased mentation, tremors, seizures, etc.). Phosphide rodenticides result in the production of phosphine gas, which is toxic to humans also. When zinc phosphide combines with gastric acid (or the presence of food!), liberated phosphine gas is rapidly absorbed across gastric mucosa and distributed systemically, where it exerts its toxic effect. Clinical signs include severe GI signs (e.g., vomiting, bloat, abdominal pain, etc.), central nervous system (CNS) signs (e.g., tremoring, seizuring), and pulmonary signs (e.g., pulmonary edema, tachypnea, etc.). More importantly, emesis – whether intentionally induced or occurring due to clinical signs - can result in poisoning to the pet owner or the veterinary professional. Clinical signs of nausea and dif-

ficulty breathing have been reported in humans exposed to secondary phosphine gas. Treatment with an antacid (e.g., milk of magnesia, aluminum hydroxide, etc.) prior to emesis induction may help decrease the presence of phosphine gas.

Also, emesis induction should always be performed in a well-ventilated area (e.g., opening the car window if the patient vomits or inducing emesis outside or in a well-ventilated area). Cholecalciferols are the most deadly – and costly – to pets, as it results in severe hypercalcemia with secondary mineralization of the kidneys and soft tissues. This results in acute renal failure (ARF) and potentially chronic renal failure, and must be treated aggressively with IV fluid therapy, calcium monitoring, and administration of steroids, diuretics, and bisphosphonates. Lastly, first and second generation LAAC anticoagulants result in inhibition of Vitamin K epoxide reductase, resulting in inactivation of clotting factors II, VII, IX, and X. Clinical signs and elevation in clotting factors [prothrombin (PT) or activated partial thromboplastin time (aPTT)] are not seen for 48 hours.

Treatment includes decontamination, measurement of PT/PTT 48 hours postingestion, or prophylactic treatment with Vitamin K1 for a minimum of 4 weeks.

A recheck PT should be performed 48 hours after the last administered dose; if prolonged, an additional 2 weeks of Vitamin K1 therapy should be administered.

Vitamins and Minerals Vitamins and minerals contain 4 potential toxic ingredients: vitamin D, xylitol, iron, and calcium. Vitamin D – when ingested in toxic amounts (typically > 0.1 mg/kg) – can result in hypercalcemia and secondary ARF. Chewable, sugar-free vitamins often contain xylitol, and can result in severe toxicosis. Doses > 0.1 g/ kg of xylitol can result in clinical signs of hypoglycemia (e.g., lethargy, vomiting, malaise, ataxia, etc.) while doses > 0.5

TECHNEWS | VOLUME 36 ISSUE 3

g/kg can result in acute hepatic necrosis (e.g., icterus, melena, increased liver enzymes, etc.). Iron, which is found in very high levels in pre-natal vitamins, can result in severe GI signs and even organ damage/failure. Finally, oral calcium levels can transiently result in hypercalcemia.

Non-steroidal Anti-inflammatory Drugs (NSAIDs) NSAIDs are competitive inhibitors of prostaglandin synthesis (cyclooxygenase or “COX” inhibitors) and result in decreased prostaglandin, which is important for normal homeostatic function (including maintaining renal blood flow, maintaining mucous production in the stomach, etc.).1 Both veterinary and human NSAIDs can be toxic. Common prescription veterinary NSAIDs include carprofen, deracoxib, etogesic, previcoxib, etc. Common OTC human NSAIDs include active ingredients such as ibuprofen and naproxen sodium. With NSAID toxicosis, the GI tract, kidneys, platelets, and CNS can be affected. Cats and certain breeds of dogs (e.g., German shepherds) seem to be more sensitive to NSAIDs, and must be treated aggressively. With cats, GI signs are less likely to develop, and severe ARF is often more clinically seen. With dogs, GI signs secondary to upper GI ulceration (e.g., vomiting, diarrhea, melena, hematemesis, etc.) are more commonly seen initially, followed by secondary ARF. With NSAID toxicosis, it is important to keep in mind that each NSAID has a different toxic dose, margin of safety, half-life, and route of excretion. Pet Poison Helpline can be contacted to identify the specific NSAID and toxic dose ingested. Clinical signs of NSAID toxicosis include anorexia, vomiting, hematemesis, diarrhea, melena, abdominal pain, lethargy, malaise, uremic halitosis, dehydration, etc. Treatment includes decontamination, the use of activated charcoal (often multiple doses due to enterohepatic recirculation), GI protectants, aggressive IV fluid therapy (to help maintain renal blood flow), anti-emetic therapy, and symptomatic and supportive care. With high doses, anticonvulsants may also be necessary if CNS signs develop.

TECHNEWS | VOLUME 36 ISSUE 3

Cardiac Medications Certain cardiac medications include broad categories such as calcium channel blockers,2 beta blockers,3 and angiotensin-converting enzyme (or “ACE”) inhibitors.4 These medications are commonly used in both human and veterinary medicine to treat underlying cardiac disease or hypertension. Each category of cardiac medication has different margins of safety. Calcium channel blocker and beta-blocker toxicosis should be treated aggressively, as these two categories of medications have a narrow margin of safety. Toxicosis of these agents can result in myocardial failure, severe bradycardiac, and hypotension; untreated, cardiac output becomes reduced, and secondary severe hypoperfusion and ARF can potentially develop.2-3 With ACEinhibitors, severe overdoses can cause hypotension, dizziness, weakness, and hypotension.4 In general, there is a wider margin of safety with ACE-inhibitors, which are typically considered much safer. Pets ingesting small amounts of ACEinhibitors can potentially be monitored at home, unless they have underlying disease (e.g., kidney failure, cardiac disease, etc.). With ACE-inhibitors, ingestions > 10-20X a therapeutic dose are generally considered toxic, and can result in severe clinical symptoms (e.g., hypotension).4 Treatment for any cardiac medication includes decontamination (e.g., emesis induction, gastric lavage, activated charcoal administration), blood pressure monitoring, aggressive IV fluid therapy if hypotension is detected, and blood work monitoring. With severe toxicosis, the use of high-dose insulin therapy or intravenous lipid emulsion may be warranted as a potential antidote for calcium channel blocker toxicosis.2 Conclusion Treatment of the poisoned patient typically includes appropriate decontamination (e.g., emesis, administration of activated charcoal, if appropriate), along with symptomatic and supportive care. If you think your patient may have ingested something harmful, take action immediately.

About Pet Poison Helpline Pet Poison Helpline, an animal poison control center based out of Minneapolis, is the most cost-effective animal poison control center in North America, charging only $39 (USD) per call; this includes unlimited follow-up consultations. Pet Poison Helpline 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. Pet Poison Helpline is available in North America by calling 800-213-6680. www. petpoisonhelpline.com. Pet Poison Helpline also has an iPhone application with an extensive database of over 200 poisons dangerous to cats and dogs. The app, “Pet Poison Help” is available on iTunes for $1.99.

references > 1. Syring RS. Human NSAIDs. In: Osweiler G, Hovda L, Brutlag A, Lee JA, eds. Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology, 1st Ed. Iowa City: Wiley-Blackwell, 2010, pp.292-299.

2. Syring RS, Engebretsen KM. Calcium channel blockers. In: Osweiler G, Hovda L, Brutlag A, Lee JA, eds. Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology, 1st Ed. Iowa City: Wiley-Blackwell, 2010, pp. 170-178.

3. Engebretsen KM, Syring RS. Beta-blockers.

In: Osweiler G, Hovda L, Brutlag A, Lee JA, eds. Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology, 1st Ed. Iowa City: Wiley-Blackwell, 2010, pp. 155-163.

4. Adams CM. Angiotensin-converting enzyme (ACE) inhibitors. In: Osweiler G, Hovda L, Brutlag A, Lee JA, eds. Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology, 1st Ed. Iowa City: Wiley-Blackwell, 2010, pp.

131-135.

33

Give your VIP VIP*s the cleanliness they deserve

*Very Important Pets

Cleaners Dupont Neutrafoam Biosolve Plus

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

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

Need more information?

Consult your Biosecurity specialist: Vetoquinol!

Investigate the provincial association’s web sites for details on other continuing education opportunities.

2013 Nestle Purina Veterinary Symposium on Companion Animal Medicine The 2013 Nestle Purina Veterinary Symposium on Companion Animal Medicine, a Purina® sponsored event, will include lectures on how to use social media to promote preventive care, understanding how to feed cats for obesity prevention and weight management, and a few good tips on those troublesome chronic diarrhea cases. Use the link below to register to reserve your place at the 2013 Purina Veterinary Symposium on Companion Animal Medicine.

Toronto, Ontario - October 27th, 2013 http://www.dvm360storage.com/nestle-purina/2013-symposium/toronto.html

Featured Speakers

Wendy Myers - How to use social media to promote preventative care.

Debra Zoran, DVM, PhD, DACVM - Feline nutrition: Understanding how to feed cats for obesity prevention and weight management.

David Twedt, DVM, DACVM - Those troublesome chronic diarrhea cases - A few good tips.

Please register at least two weeks before the date of the meeting to allow enough time for the return of your confirmation postcard and event details. Web registrations will receive event details after clicking “submit.” All other registrations will receive event details approximately three weeks before the symposium. This course meets the requirements for 4 hours of continuing education credit in jurisdictions that recognize AAVSB’s RACE approval. The program, breakfast, and breaks are complimentary.

For additional information, please call 800-255-6864, ext. 3876 or e-mail abelcher@advanstar.com.

TECHNEWS | VOLUME 36 ISSUE 3

35

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Merck Animal Health, operating in Canada as Intervet Canada Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA. MERCK is a trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA. Copyright © 2012 Intervet International B.V., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA. All rights reserved.

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Did You Know?

Veterinary “pet peeves” discussed In a recent column for PetSide.com, Victoria Schade, a dog trainer, listed “vet peeves” (the things that owners do wrong in and around the exam room at the veterinarian’s office), following conversations with a veterinary technician and veterinarian. The listed included: Everything that relates to restraining your animal (“Restraint is probably the most unpleasant part of a vet visit for both you and your animal, and based on the feedback I received, it can be equally unpleasant for the techs and vets doing it”); Not paying attention when discussing post-treatment care; Animal that are poorly groomed or neglected; People who walk in without an appointment and demand immediate care; Arriving late for an appointment; Getting insulted if you’re asked to leave the room.(Veterinary Advantage Weekly News) Post-traumatic stress disorder acknowledged in military dogs While dogs are increasingly being employed to help returning veterans cope with post-traumatic stress disorder (PTSD), it appears that many returning military dogs can use some help as well. Dog trainers and specialists at Lackland Air Force Base in Texas who observed marked behavioural changes in dogs returning from war zones have acknowledged that military dogs can suffer from PTSD, according to the Los Angeles Times.

The Los Angeles Times tells the story of Cora, a 5-year-old dog who returned from months of detecting explosives in Iraq with PTSD symptoms similar to those found in humans. She went from a friendly, independent dog who followed orders well to an easily startled dog who lashed out at other dogs, required constant attention, and sometimes refused to follow commands.

Cora, and up to 10 percent of other military dogs, are prone to developing the same PTSD symptoms, according to the Times. They return home with frayed nerves due to their stressful experiences such as being around loud noises and sensing the fear and anxiety of their human counterparts.

According to the Times, up to half of returning military dogs with PTSD are simply too traumatized to keep working and will be retired. The remaining dogs will be retrained for further work with military or law enforcement organizations.

To read the full story, go to: http://www.latimes.com/news/nationworld/nation/la-na-military-dogs-20121126,0,1859286. story?page=1 (Newstat) Journal Scan: Why mixed-breed dogs need their own generic breed name. petMD.com lists top 10 warning signs of cancer in dogs and cats With May being Pet Cancer Awareness Month, educate your clients on the top 10 warning signs of cancer in dogs and cats: 1. Lumps and bumps 6. change of appetite 2. abnormal odours 7. coughing/difficulty breathing 3. abnormal discharges 8. lethargy and depression 9. changes in bathroom habits 4. non-healing wounds 10. evidence of pain 5. weight loss

TECHNEWS | VOLUME 36 ISSUE 3

Tornado Preparedness Tornadoes are terrifying and destructive—and they rarely give much warning. Encourage clients to create an emergency plan for their entire family, including pets, so they can stay safe during a tornado or severe storm. Following last year’s disaster that struck Joplin, MO, the experts at American Humane Association have put together a series of 10 tips to help before, during, and after a tornado.

Before a tornado: 1. Identify a tornado-safe area large enough for the entire family and pets—often a basement or the most interior room of the house on the bottom floor.

2. Practice getting the entire family to the tornado safe area quickly during calm weather.

3. Make the tornado-safe area pet-friendly by removing any dangerous items such as tools or toxic products.

4. Keep family and pet preparedness kits in the tornado-safe area or close by. Ensure that there’s a crate for every animal.

5. Know the pet’s hiding places and how to quickly and safely extricate them. Eliminate any unsafe hiding areas from which it may be difficult to remove the animal in a hurry.

During a tornado: 6. If an evacuation is possible, take the pets along. Take the pet preparedness kit and the pets’ identification.

7. If evacuation isn’t possible, take the entire family, including pets (both indoor and outdoor), to a tornado-safe room.

8. Put pets in crates or carriers in the safe room. If possible, place the crates under a sturdy piece of furniture.

After the storm has passed, use caution allowing your pets and other family members outdoors.

9. Exit only after the entire storm has passed.

10. Assess the damage before bringing pets outside.

11. Keep dogs on a leash and cats in a carrier.

12. Watch for objects that could cause injury or harm pets.

13. Allow pets to become reoriented. Familiar scents and landmarks may be altered causing your pet to become confused or lost.

14. Keep pets away from food, water, and other liquids that could be contaminated from the storm.

15. Keep pets away from downed power lines and debris.

Share these tips with your clients before the next big storm hits. You might help save a life or two. (Veterinary Economics)

37

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