2013 Summer TECHNEWS

2013

|

VOL UME 36 I S S UE 4

PREMIER JOURNAL

FOR

CANADIAN VETERINARY TECHNICIANS

SUMMER

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 • The Essentials of In-Clinic Peripheral Blood Film Evaluation • Equine Obesity and the Healthcare Team • Alfaxalone (Alfaxan ) anesthesia - reflecting on the past year ®

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Career Spotlight: Stacey Huneke...............................................................................................4 Veterinary Clinic Responsibilities: Reporting Animal Disease to OMAF and MRA................... 5 The C.A.A.T. Dog Show and Family Fun Day........................................................................... 5 Pharmacology Column: Itraconazole (Sporonox)...................................................................... 8 Safety Column: H3N2 Dog Flu and Cats and Ferrets............................................................. 10 CE Article #1: The Essentials of In-Clinic Peripheral Blood Film Evaluation................... 11 Apps, Blogs & Websites to Watch........................................................................................... 18

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

Tech Tips and Tidbits.............................................................................................................. 19 CE Article #2: Equine Obesity and the Healthcare Team.................................................. 20 Employment Ads..................................................................................................................... 26

D E E

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Behaviour Column: For Pet Owners - How to Crate Train Your Dog...................................... 28 CE Article #3: Alfaxalone (Alfaxan® Anesthesia - Reflecting on the Past Year..................... 30 TECHNEWS Summer 2013 CE Quizzes.......................................................................... 34 Global News........................................................................................................................... 36 Puzzle...................................................................................................................................... 37 Submitting Articles to TECHNEWS...................................................................................... 37 Poisoning Column: Summer Toxins Dangerous to Dogs and Cats.......................................... 38

TECHNEWS

Continuing Education Opportunities..................................................................................... 41

The quarterly national publication with three

Did You Know?....................................................................................................................... 43

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: Fall 2013 Deadline for Material: August 1st, 2013 Distribution Date: September 30th, 2013 TECHNEWS is a quarterly publication published by the OAVT.

Employment Ads: Please see Employment Ad Information on Page 26 EECI 13263

For advertising information: Contact Laura Fanthome: Tel. (800) 675-1859 Fax (519) 836-3638

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

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

TECHNEWS | VOLUME 36 ISSUE 4

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Career Spotlight Stacey Huneke RVT Interviewed by the OAVT After graduating from Seneca College in 2001 and gaining my Registered status, I began working as an equine technician at thoroughbred farms, racetracks, and then equine surgeries before settling down at a mixed animal practice in 2006.

As a tech working with racehorses I did a lot of needling; pre-race treatments, fluid replacement after training or race days, antibiotic therapy, vaccines, and a little bit of microbiology, culturing swabs that were taken during upper airway endoscopy. I assisted with XRays, castrations (most of them standing), scoping airways and stomachs, joint prepping for injections and so on. It was really fast paced, focused work, and I enjoyed it a lot. The racetrack only runs about seven months a year so I started working in equine surgery.

At these referral hospitals there was a lot of catheter placement, and fluid therapy, bandage changes, inducing and recovering horses for surgeries ranging from, throat surgery to colic surgery as well as arthroscopy and closed castrations. Equine work is a physically demanding job, you have a strong back and great horsense.

I switched to working in a mixed animal practice because it is a little more ‘home-life’ friendly. You get to work more sensible hours and less weekends, and it runs throughout the year. In hospital I worked mostly with small animal surgeries, anaesthesia, nursing, and appointments. I also helped the equine vets on the road with x-rays, castrations, etc. I continued to work at two Standardbred race tracks taking pre-race TCO2 blood samples, I just couldn’t get away from the horses!

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Why I became an RVT: I was obsessed with animals as a child. In old photos of me, I am the one with the choke hold on whatever pet was unfortunate enough to find their way into my reach. I was also lucky enough to have parents who nurtured that obsession and worked hard to give me the opportunity to ride horses. Having been exposed to several species and learning to respect and care for them, I knew I had to work with animals ‘when I grew up’. In high-school I completed a co-op placement at our local veterinary clinic. I knew almost immediately I didn’t want to be a veterinarian. As an RVT you got to work with the animals, hands on. I felt I could make a real difference to their wellbeing as an RVT. This clinic had an RVT and I am grateful to her for taking me under her wing and teaching me about the profession and her career path.

After graduation I knew it was important to become Registered.

Becoming Registered would show employers and the public that I was serious about my profession. It would demonstrate that I was committed to continuing my education throughout my career, and recently, through our group insurance, the ability to be held accountable for my actions. A back injury forced me to modify my lifestyle and therefore modify my job. I could no longer lift dogs onto tables, or cat carriers off the floor. I was unable to assist with the large animal veterinarians with X-rays, castrations or lameness work ups. I reframed my position at the mixed animal practice away from large animal service to in office, small animal and clerical service. I was still plagued by chronic pain as well as the pain of feeling helpless at a job where I had once been so proficient. I had been contemplating a career change but could never commit to anything. It was always about the animals. I saw the job ad for the OAVT Member Services Manager and immediately thought, “This is it. This is what I’m supposed to do”. I was fortunate enough to obtain the job and as a veteran of the force, I can now advocate for all RVTs and work every day to make their lives on the front line better.

TECHNEWS | VOLUME 36 ISSUE 4

Veterinary Clinic Responsibilities for Reporting Animal Disease to the Ontario Ministry of Agriculture and Food and the Ministry of Rural Affairs (OMAF and MRA) On January 1, 2013, a new disease reporting regulation came into force under the Animal Health Act, 2009 that helps OMAFRA to better detect and monitor serious and emerging animal health hazards. Veterinary Technicians should be aware of the reporting regulations and can play an active role in reporting positive results for Immediately Notifiable Hazards to the Office of the Chief Veterinarian of Ontario (OCVO).

• Laboratories operating in Ontario must report information related to laboratory test positive results for hazards listed in the regulation as Immediately Notifiable Hazards and Periodically Notifiable Hazards. If an Ontario veterinarian or their client submits samples to a laboratory in Ontario that subsequently test positive for any of the Immediately Notifiable Hazards listed, it is the responsibility of the laboratory (not the submitting veterinarian), to notify the OCVO of those results immediately.

• However, if an Ontario veterinarian submits samples to a laboratory outside of Ontario that subsequently test positive for an Immediately Notifiable Hazard, the Ontario veterinarian is responsible for notifying the OCVO of those results immediately upon receipt from the non-Ontario laboratory. Only positive laboratory tests for listed hazards are to be reported by labs or veterinarians as above.

• Ontario laboratories reporting laboratory test positive results for Immediately Notifiable Hazards (or Ontario veterinarians reporting positive results from laboratories outside Ontario), must do so by e-mailing the required information to OCVO-Reportable-Notifiable@Ontario.ca. All emails sent to that address are automatically forwarded to the OMAFRA veterinarian-on-call in the Office of the Chief Veterinarian for Ontario.

Information needed when reporting a positive lab test for an “Immediately Notifiable Hazard” • The name of and contact information for the laboratory or veterinarian making the report.

• The name of and contact information for the person who submitted the specimen, as well as the veterinarian (if any) who requested the sample be submitted to the laboratory.

• The name of the Immediately Notifiable Hazard that is the subject of the report.

• The laboratory test(s) method(s) and result(s) providing information about the hazard, including information about serovars or subtypes of the hazard detected, if available.

• The date the sample or specimen was submitted to the laboratory.

• The laboratory case submission (number or identification) code.

• The location (municipal address) at which the specimen was taken or collected.

• Depending on the situation, the OMAFRA veterinarian-oncall may contact the reporting laboratory or veterinarian to discuss the situation to ensure that OMAFRA veterinarians understand the context of the situation correctly.

• The name and contact information for the owner and custodian of the animals involved.

• There is an OMAFRA veterinarian-on-call 7 days a week, 365 days a year, between the hours of 7 AM and 10 PM to assess such reports.

• The number of animals (by type) that were: a) at risk, b) clinically ill, and c) dead, in relation to the situation, at the time the samples were collected.

TECHNEWS | VOLUME 36 ISSUE 4

• The type, purpose and approximate ages of the animals involved.

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POSITIVE LAB FINDINGS OF IMMEDIATELY NOTIFIABLE HAZARDS TO BE REPORTED TO THE CHIEF VETERINARIAN FOR ONTARIO BY ONTARIO LABORATORIES (2013): African horse sickness African swine fever Aino virus infection Akabane disease Anaplasmosis Anthrax Avian chlamydiosis Avian encephalomyelitis Besnoitiosis Bluetongue Borna disease Botulism Bovine babesiosis Bovine cysticercosis Bovine ephemeral fever Bovine petechial fever Bovine spongiform encephalopathy Bovine tuberculosis Brucellosis Chronic Wasting Disease Classical swine fever

Contagious agalactia Contagious bovine pleuropneumonia Contagious caprine pleuropneumonia Contagious equine metritis Coxiellosis Dourine Duck hepatitis Egg drop syndrome Enterovirus encephalomyelitis Epizootic hemorrhagic disease Epizootic lymphangitis Equid herpesvirus 1 (neurologic) Equine encephalomyelitis western, eastern and Venezuelan Equine infectious anemia Equine piroplasmosis Foot and mouth disease Fowl cholera Fowl typhoid

Glanders Goose parvovirus infections Hantavirus Heartwater Hendra virus Herpesvirus of cervidae Ibaraki disease Infectious laryngotracheitis Influenza A Japanese encephalitis Listeriosis Louping ill Lumpy skin disease Nairobi sheep disease Newcastle disease Nipah virus Peste des petits ruminants Plague Pseudorabies Pullorum disease Rabies

Rift Valley fever Rinderpest Salmonellosis (sub-typed) Scrapie Screwworm Sheep and goat pox Small hive beetle Swine vesicular disease Theileriasis Tick-borne fever Tissue worm Trichinellosis Trypanosomiasis Tularemia Turkey viral rhinotracheitis Varroa mites (fluvalinate-resistant) Verocytotoxigenic Escherichia coli Vesicular stomatitis Viral hemorrhagic disease of rabbits Wesselsbron’s disease West Nile virus

HOW TO MAKE A REPORT TO THE CHIEF VETERINARIAN FOR ONTARIO: Effective January 1, 2013, the Reporting of Hazards and Findings Regulation under the Animal Health Act, 2009 requires that third party animal health laboratories and veterinarians in Ontario report findings of certain hazards to OMAFRA. Veterinarians are required to submit immediately notifiable reports only when they receive a positive lab result from a laboratory outside Ontario. Veterinarians are not required to provide periodic (annual) reports. There are no Ontario reporting requirements for animal owners, the general public or other types of businesses. Listed hazards relate to all animals except fish.

Information from the immediately notifiable reports will be used to assess how much risk the individual incident poses and whether follow-up is required. Information from the periodically notifiable (annual) reports will be used to identify new and emerging trends and to assess the need for future government programs.

Every call from a veterinarian reporting a serious risk will be assessed by an OMAFRA veterinarian. Veterinary reports of serious risk are expected to be rare. However, consider reporting • Unusually high mortality in a particular animal type or area • Possibility of a new and emerging hazard

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• Likelihood of affecting multiple • Potentially serious human health implications premises

IMMEDIATELY NOTIFIABLE HAZARDS

PERIODICALLY NOTIFIABLE HAZARDS

SITUATIONS OF SERIOUS RISK

Who Needs to Report

Laboratories; Veterinarians only when using laboratories outside of Ontario

Laboratories

Veterinarians

Content of Report

Laboratories – see Section 5 of the regulation*; Veterinarians – see Section 6 of the regulation*

See Section 14 of the regulation*

Provide the call centre representativewith your name, contact number and the nature of the report (for details see Section 20 of the regulation*)

How to Report

Email information to OCVO-Reportable-Notifiable@ontario.ca

Email information to OCVO-Reportable-Notifiable@ontario.ca

Call the Agricultural Information Contact Centre (AICC) at 1-877-424-1300

When to Report

Within 18 hours of becoming aware of a positive lab finding

Submit for previous calendar year by January 31

Veterinary reports of serious risk are due within 18 hours of becoming aware of the risk

TECHNEWS | VOLUME 36 ISSUE 4

The C.A.A.T. Dog Show and Family Fun Day! The Canadian Animal Assistance Team (C.A.A.T.) is holding their Annual Fundraising Event with the Country Paws Cares organization on Sunday, June 8 in Breslau, Ontario and Sunday, July 14 in London, Ontario. The “C. A. A. T. Dog Show and Family Fun Day” will feature our entertaining dog show with classes like “Dog with the Waggiest Tail”, “Most Distinguished Senior Dog”, “Dog – Owner Look-a-Like contest”, “Best Rescue”, etc. We will also have booths with items for sale, a barbeque lunch, pet portraits, nail trims, lots of fun events for dogs and all family members.

What does C.A.A.T. do?

The Canadian Animal Assistance Team is a registered Canadian charity whose mission is to improve the health/welfare of domestic animals in areas that have little or no access to veterinary services (either geographically or financially). It is hard to imagine not having the ability to provide for your pet’s most basic care. For many owners of pets in Canada, that lack of ability to provide these services is a reality. Many do not have any option without the help of organizations such as the Canadian Animal Assistance Team. We cannot provide what is needed without the help of our donors and sponsors. Please help us make a difference in the lives of the animals (and their people) in the communities that need our help.

C.A.A.T. Dog Show Participation Opportunities • Make it an event for your clientele, encourage your clients to participate as a group from your clinic!! Go to our Facebook page www.facebook.com/canadiananimalassistanceteam and share our event on your Facebook Pages and Websites.

• Make it an event for your vet clinic team - use this as a team-building event, bring your whole staff and their pets to participate in our classes!

• Give a financial donation to the Canadian Animal Assistance Team to assist with the upcoming 2013 animal health care projects. All donations of over $20 are eligible for a tax receipt for charitable donation.

• Participate in one of the dog shows with your dogs as an individual!

We invite you to become part of this fun-filled, family oriented, locally supported event for a very worthy cause. For more information on the Canadian Animal Assistance Team we encourage you to visit our website at www.caat-canada.org.

Christine Robinson, RVT, Executive Director Canadian Animal Assistance Team info@caat-canada.org

“Never doubt that a small group of thoughtful, committed people can change the world.

Indeed, it is the only thing that ever has.” ­ – Margaret Mead

TECHNEWS | VOLUME 36 ISSUE 4

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

I t r a cona zol e

( Sporonox )

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

Brand name:

How this Medication Works

Sporonox, Itrafungol Oral Solution (Vetoquinol)

Itraconazole works by inhibiting the fungal enzymes that produce ergosterol, an important component of the fungal cell wall. Without adequate ergosterol, the fungal cell becomes weak, leaky and ultimately dies.

Available in 100 capsules or as oral solutions Background The development of oral medications to be used in the treatment of invasive fungal infections has represented an immense medical breakthrough. With oral treatment available, human patients no longer require hospitalization several days a week for intravenous treatment of their disease; a more normal and productive lifestyle is now possible. Furthermore, the toxicity profiles of the newer oral drugs represents vast improvement over those of the injectables.

Ketoconazole was the first such oral antifungal drug but it had room for improvement regarding side effect potential. There were problems with nausea, liver toxicity, and feminization of male patients. Itraconazole was developed in answer to these concerns. Its potential for side effects is far lower, although its expense, unfortunately, was at first far greater. Generic medications have made this drug much more affordable in recent years.

Fungal infections for which itraconazole can be used include: • • • • • • • •

Dermatophytosis (ringworm) Malassezia/yeast dermatitis Blastomycosis Cryptococcosis (window washer’s disease) Histoplasmosis Aspergillosis Candidiasis Coccidiodomycosis (Valley fever)

Side Effects The chief reason for choosing itraconazole over other antifungal agents is to avoid side effects. While itraconazole users do not commonly experience side effects, it is important to be aware of what to watch for.

Side effects of concern are appetite loss, vomiting, and/or diarrhea. If they occur, medication should be discontinued and liver enzymes should be checked. Appetite loss in particular is felt to be an important sign of toxicity and

generally does not occur until itraconazole has been in use for over one month.

If an adverse side effect occurs, it is expected to resolve with discontinuation of the medication. After recovery, itraconazole can usually be restarted at a lower dose.

ADVISE CLIENTS TO NOTIFY THE CLINIC IMMEDIATELY IF THEY THINK THEIR PET MAY BE HAVING AN ADVERSE DRUG REACTION. Itraconazole should not be given to patients with known liver disease if possible.

In one research publication, an SGPT/ALT enzyme level of 250 IU/L was felt to be the highest tolerable level compatible with itraconazole use. Approximately 5-10% of dogs receiving standard doses of itraconazole will develop liver disease severe enough to warrant discontinuing the medication.

Interactions with Other Drugs The use of itraconazole in combination with the antacids Pepsid, Zantac, or cimetidine (Tagamet), omeprazole (Prilosec), (or with the antibiotic rifampin) will lead itraconazole to be less effective. If itraconazole must be used with these medications, it is recommended that at least 2 hours pass between the antacid administration and the administration of itraconazole.

Serious heart abnormalities have resulted when itraconazole was used with the antihistamine terfenadine (Seldane) or with the intestinal motility modifier cisapride (Propulsid). These medications should not be used with itraconazole.

The following heart medicines will be stronger in the presence of itraconazole and dosage may need to be reduced: amlodipine, digoxin, warfarin, or quinidine. A similar problem occurs with cyclosporine, an immune suppressant used in immune mediated disease, allergy, or after an organ transplant.

Concerns and Cautions Itraconazole Capsules work best when given with food.

The 100 mg itraconazole capsule is an inconvenient size for most animal patients. For this reason, it is common to have a compounding pharmacy make up a prescription as either capsules or flavored liquid in a size that fits the individual patient. There is one important caveat regarding going through a compounding pharmacy for itraconazole, and this regards

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TECHNEWS | VOLUME 36 ISSUE 4

the materials the pharmacy uses to make up formulations. Compounded itraconazole can be made up from the prescription product (either brand name or generic) or it can be made up from itraconazole available in bulk, which is usually much less costly. The bulk substance is not recommended as it is not as stable or available to the patient’s body as the prescription capsules. The capsules utilize special itraconazole-coated beads that are responsible for proper absorption. The compounding pharmacy must keep the beads intact in making their formulations.

More recently in Canada, a new oral liquid product called Itrafungol (by Vetoquinol) has been approved for feline use.

Itraconazole is able to penetrate most body tissues and thus fight fungal infections in most organs. It cannot penetrate, however, the blood/brain barrier and thus is useless in central nervous system fungal infections.

In such a situation, another closely related medication (fluconazole) would be helpful.

Fungal infections as a general rule are resistant to treatment and often months of therapy are needed. It is important not to discontinue treatment prematurely despite expense.

(An exception might be a Malassezia/yeast dermatitis, which frequently clears up in a couple of weeks.)

Itraconazole is dangerous if given in pregnancy. If a pet is pregnant, itraconazole should be avoided unless the fungal infection in question is potentially life-threatening.

Itraconazole should also be avoided in lactation as it will be delivered via milk to any nursing young.

It is important to give itraconazole with food for best absorption into the body.

© 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

H3N2 Dog Flu, and Cats and Ferrets (Excerpted from the Worms and Germs blog by Dr Scott Weese, DVM, DVSc, DACVIM, an associate professor in the Department of Pathobiology at the University of Guelph’s Ontario Veterinary College.)

The first true confirmed canine influenza virus (CIV) was the H3N8 canine flu that evolved from H3N8 equine flu. That’s the virus that spread to and amongst dogs in various parts of North America. The general consensus has been that only this strain should be called CIV, since it’s been the only true dog-adapted influenza virus that’s developed the ability to stay and circulate in the dog population.

More recently, another canine flu virus has emerged in dogs, this time a type H3N2 in Asia. H3N2 is a common human flu type, but birds are the ultimate reservoirs of all flu viruses, and based on the genetic relationship of H3N2 from dogs and birds, it’s thought that this virus came to dogs from birds.

Anytime a new infectious disease is encountered, it’s important to ascertain who/what it can infect. When H3N8 CIV emerged, it was shown that even though it came from horses, it was no longer adapted to readily infect horses. So, knowing a virus’ origin or typical infection trends can be useful but it doesn’t necessarily tell you the whole story.

Cats and ferrets are susceptible to many different types of influenza viruses, and are good species to look at when figuring out if a virus can spread to other domestic animals. A study in the recent edition of Influenza and Other Respiratory Viruses (Kim et al, May 2013) looked at transmission of H3N2 CIV between dogs, cats and ferrets.

Here are some highlights from the study: • All directly infected animals developed some degree of illness, with cats and dogs typically developing sneezing, coughing, increased respiratory effort and nasal discharge, and ferrets only developing sneezing.

• Cats could become infected by being in proximity to infected dogs or infected cat • Ferrets didn’t get infected when exposed to infected dogs.

• Ferrets did not develop disease after exposure to an infected ferret but 2/3 developed antibodies against CIV, meaning the virus had been transmitted, but not able to cause disease.

• Cats shed higher amounts of virus than ferrets.

• Dogs stopped shedding the virus by day 8 after infection. That’s not surprising since influenza shedding is short-term with H3N8 CIV. It shows that use of good infection control measures, particularly isolation, can be a key component of canine flu control.

So...

• Dogs with H3N2 CIV are potential sources of infection for cats and ferrets.

• Cats that are exposed to the virus can get sick and be sources of infection for other animals, presumably including dogs.

Cats may be another truly susceptible host for this virus.

• Ferrets seem pretty resistant to the virus. It probably takes fairly high level exposure for them to get infected and they are less likely to be of concern for subsequent transmission.

Interspecies transmission of flu viruses, and other viruses, is obviously an issue. Most of the attention is paid to the bird-pig-human cycle, for good reason. Birds are the reservoirs of all influenza virus variants; pigs are susceptible to both human and bird flu viruses and can act as a “mixing vessel,” and humans are the species we’re ultimately most concerned about. However, the potential for disease in pets, and for pets to be reservoirs of influenza for people or other animals, shouldn’t be neglected. I’ve frequently had discussions with colleagues in the medical and public health fields about the need for parallel companion animal surveillance when plans are made for emerging infectious disease surveillance and response (e.g. SARS, H1N1 flu, novel coronavirus). They typically respond with general enthusiasm, but interest and application aren’t the same, and actually getting plans in place to perform co-ordinated parallel surveillance hasn’t happened. Studies like this are just one more piece in the puzzle that indicates the need for broader surveillance and consideration of pets.

In that study, researchers infected dogs with CIV and kept them in close proximity to cats and ferrets, but without direct contact.

They also infected cats and ferrets to see whether they could transmit the virus to other cats or ferrets.

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CE Article #1 The Essentials of In-Clinic Peripheral Blood Film Evaluation Quality Control for Your In-House Analyzer Judith A.Taylor DVM, DVSc., DACVP (Clinical Pathology) Royal Canin Canada Introduction In practice, the complete blood count (CBC) is an integral part of the patient minimum data base. It may provide essential information regarding the etiology, severity, and duration of the disease process(es) affecting the patient. It is also used to monitor response to treatment and/or progression of disease. A review of a peripheral blood smear should be included as part of all patient hematological evaluations. Routinely combining results from an automated hematology analyzer, with findings from a blood smear assessment optimizes the detection of clinically relevant abnormalities.

While peripheral blood evaluations done at an external laboratory have the advantages of highly accurate and validated automated analyzers, dedicated trained laboratory technicians, quality assurance programs and the availability of clinical pathologists to review abnormal findings, not all clinics can rely exclusively on independent laboratory services and must periodically generate patient results in-clinic.

While performance of in-house analyzers has been evaluated and is generally reliable, inaccurate results may arise on abnormal samples (Becker, 2008). Evaluation of peripheral blood smears is an important means of detecting laboratory or specimen handling error. For this reason it is recommended that all automated hematological results should be substantiated by routine evaluation of a peripheral blood film (Becker, 2008).

There are many advantages to including inhouse peripheral blood film examinations as part of a routine patient laboratory assessment. Review of blood smears provides timely patient information and may expedite therapeutic intervention for critical patients before results are received from an external laboratory, or before sample processing is completed inclinic. Smear review allows for rapid serial monitoring of patient hemograms, and if repeated by the same technologist, results may be more consistent. In-clinic blood smears may be photographed for publication of case material. Finally, blood smear review provides in-house training material and opportunities for technical skill enhancement through the consistent and thorough practice at looking at blood smears.

A peripheral blood smear review is essential as a measure of quality control to confirm results from automated analyzers. Blood smear evaluation will detect qualitative and quantitative cellular abnormalities that are not identified by hematology analyzers. Atypical cells, intracellular inclusions, hemoparasites, cellular immaturity, poikilocytosis, and toxic changes may be missed in the absence of a blood smear assessment. Over- or under-estimated cell counts may arise from automated analysis of samples with extreme abnormalities in the leukon or erythron, or in the presence of macroor microcytes. Examination of a blood smear

will detect such discrepancies and avoid errors in patient care.

There are four basic components to the hemogram:

1. The erythron 2. The leukon 3. The platelets 4. Plasma protein Each part of the hemogram should be considered in a comprehensive, systematic manner.

With experience and practice, this takes relatively little time, especially in healthy patients.

The amount of time spent per smear will be dependent upon the presence and nature of the disease process and the experience and technical competency of the evaluator. Estimations of cell numbers and identification of morphological abnormalities will allow correlations with automated hematology results.

Results should be recorded in a concise, semiquantitative fashion using a standard format.

The time and emphasis placed on any individual parameter will be dictated by the individual case details. The evaluation of the hemogram is enhanced by familiarity with patient clinical history, physical examination findings, other clinicopathologic findings, treatment history, and ancillary tests such as imaging, serology, or microbiology, if available.

A 1984 graduate of OVC, Judy spent four years in small animal practice before returning to Guelph to complete postgraduate studies in clinical pathology. In 1997 she returned to OVC as Special Graduate Faculty in the department of Pathobiology. She became a diplomate of the American College of Veterinary Pathologists in 2000. She joined Medi-Cal Royal Canin in 2010 as a veterinary consultant, and her interests include hematopathology and cytology. Hobbies include gardening, skiing, biking, hiking, and showing dogs and horses. Judy lives in Guelph with her husband, their three children and assorted four-legged companions.

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Smear Preparation At least two good quality air-dried blood smears should be prepared at the time of phlebotomy for every patient undergoing a hematological evaluation regardless of where the blood is analyzed. This practice best preserves the blood cells prior to the onset of artifacts of storage time or transport conditions such as cell settling or aggregation, and cytoplasmic and nuclear swelling, shrinkage, or deterioration.

Storage of blood in EDTA may cause cytoplasmic vacuolation, cell swelling, or smudging of cells which may be difficult to distinguish from in-vivo toxic change.

Such artifacts may make cell identification Avoiding artifacts of morphology allows for the most accurate quantitative and qualitative assessment of all cell lines.

Smears should be labeled with patient identification and date. If an external laboratory service is used, one blood smear should be sent to the laboratory with the blood tube submission. The additional slides are kept for in-house evaluation.

Improperly prepared smears impede accurate assessment of the differential leukocyte count, platelet estimate and morphological evaluation of all cell lines. Good quality glass slides with a frosted end enable distinct labeling of the slide, and provide an area to handle the slide while avoiding contamination of the specimen. A small drop of blood 2-3 mm in diameter should be placed near the end of the clean, dry glass slide (Figure 1).

FIGURE 1

A second slide angled at 300 should be placed just ahead of the drop and pulled backwards just until contact is made with the blood. AS THE DROP OF BLOOD IS SPREADING along the contact surface, a quick, smooth forward motion with flat, even contact of the edge of the spreader slide results in a perfect “bulletshaped” smear with a symmetrical oval feathered edge. The slide should be immediately air-dried by rapid manual waving to preserve the cells properly. Prepared 12

smears should be kept away from specimens in formalin as exposure to the fumes alone will produce changes such as increased cytoplasmic basophilia with reduced cell detail. Air-dried and formalin-fixed specimens should be shipped in separate containers to the laboratory for this reason.

A well-made blood film has a thin, flat, uninterrupted surface with a translucent sheen.

It should cover ½ of the length, and ¾ of the width of the slide. The feathered edge is thin, symmetrical, and elliptical in shape, and the thickness of the smear should be consistent from tip to the butt. A monolayer area, just inside the feathered edge, is where cells should be well spread with no cell overlap or distortion of shape or size. This is where cells are the best preserved and counts should be conducted (Figure 2).

FIGURE 2

Evaluation of staining should be a part of smear quality assessment. Diff-Quik (Dade Behring, Deerfield, IL) , Wright’s Giemsa or other Romanowsky stains are suitable for routine use (Figure 3).

FIGURE 3

Excess stain precipitate on the slide will interfere with evaluation for inclusions such as Mycoplasma spp. and basophilic stippling. Slide fixation and staining should allow for crisp, clear nuclear and cytoplasmic membranes with minimal background precipitate. Cell staining should be uniform along the extent of a well-made blood smear and should be evaluated starting at low power and then at high dry magnification.

Smear Interpretation Initial scan using a low-power objective (4-10X) should cover the entire smear and will enable the identification of any hemoparasites (i.e. microfilaria), platelet clumping, and atypical cells.

Larger objects will be distributed towards the peripheral or feathered edges. This preliminary inspection should confirm adequacy of smear and stain quality. Detailed cell evaluation should then be conducted at higher power with the 40x (high dry) and 100x (oil immersion) lenses within the monolayer area of the smear.

The Erythron The erythrocytes or red blood cells (RBCs) are the most numerous cells on the blood smear in health. Evaluation of the size, shape, maturation, colour, saturation, density, distribution, and inclusions provides insight into the overall health and tissue oxygen delivery of the patient. Disorders of the red cells include anemia (decreased RBCs), polycythemia (increased RBCs), dysmaturation, enzyme abnormalities, and abnormal inclusions.

Distribution of the erythrocytes over the entire smear should be noted, but attention should be focused on findings within the monolayer area.

Cell morphology and intercellular adhesion may be affected by drying artifacts at the extreme ends of the smear. Individual red cells should almost touch, or be slightly separated in blood smears from healthy dogs and cats, respectively. Some rouleaux (red cells arranged like “stacks of coins”) is normal in horses and cats, and to a lesser degree in dogs (Figure 4).

FIGURE 4

Excessive rouleaux may be seen with some protein abnormalities such as hyperfibrinogenemia or hyperglobulinemia which makes the cells more adherent. Grape-like clusters or agglutination is indicative of immune hemolysis (Figure 5).

FIGURE 5

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The red cell surface is coated by antibody or complement resulting in irregular intercellular adhesion.

An initial low power scan of the blood smear will enable assessment of whether the red cells are decreased, normal, or increased in number. Moderate to severe anemia may result in a thin blood smear which stains pale pink when compared to the deep red of a smear from a non-anemic animal (Weiss, 1984). If anemia is detected, it is important to note if the anemia is regenerative or not. The presence of regeneration is indicated by the number of younger, larger, bluer erythrocytes (polychromatics) which have a higher RNA content, and by evaluation of the reticulocyte count (Figure 6).

FIGURE 6

The reticulocyte count is a part of the automated count or may be determined by manual staining of the smear with supravital stains such as New Methylene Blue (Figure 7).

FIGURE 7

For the manual reticulocyte count, two drops of blood are mixed with two drops of stain and left to incubate for ten minutes at room temperature. A blood smear is prepared from the mixture and then examined after air-drying, or may be counterstained with Diff Quik or Wright’s stain (Thrall, 2002). The number of reticulocytes per 1000 erythrocytes is enumerated and recorded as a percentage value.

The absolute reticulocyte number is obtained by multiplying the percentage by the absolute red cell count. In cats, there are two types

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of reticulocytes. Punctate reticulocytes have small focal reticulum and represent cells that may have been produced by the bone marrow within the last 2 weeks. Aggregate reticulocytes have more prominent reticulum in chains and clusters, and represent the most recent bone marrow response within the past 12 hours. The aggregate reticulocytes are the cells that should be counted for assessment of active bone marrow regeneration in cats.

Canine reticulocytes consist predominantly of the aggregate form.

The degree of bone marrow regeneration in response to anemia is species-dependent.

Polychromatic response is usually more pronounced for dogs than for cats. Horses do not release reticulocytes into peripheral circulation, and polychromatic responses in ruminants are low to absent compared to dogs and cats. The average number of polychromatic red cells should be recorded per oil field rather than using a “1+, 2+� value.

This semi-quantitative evaluation will enable determination of the appropriateness of the bone marrow response relative to the degree and duration of anemia. There is a lag time of about 2-3 days before accelerated bone marrow erythropoiesis becomes evident, with maximum response generally occurring by 7 days (Brockus, 2003). Other morphological findings with regenerative anemias may include overall larger red cells (macrocytosis) with more central pallor (hypochromasia) reflecting reduced hemoglobin content with accelerated erythropoiesis. There may be more variation in red cell size (increased anisocytosis) due to the heterogeneity of younger and mature cells in circulation.

The presence of nucleated erythrocytes (metarubricytes) should be recorded. An occasional metarubricyte is of little significance. However,in higher numbers, metarubricytes should be counted and reported as the number per 100 leukocytes as these are not an appropriate bone marrow response to anemia, especially in the absence of increased polychromasia. Low numbers of metarubricytes may be seen in some peracute hemolytic or blood loss anemias, with some toxicities (lead), iron deficiency, hypoxia, some tumours (hemangiosarcoma, leukemia) and splenic or bone marrow disorders.

Regenerative anemias are most often due to blood loss or red cell destruction (hemolysis).

Immune hemolytic anemia (IHA), Heinz body hemolytic anemia, infectious causes

(Hemobartonella, Babesia), microangiopathies, and neoplasia may be underlying causes.

Poorly regenerative anemias often accompany chronic inflammatory, metabolic, endocrine, and toxic disorders, some immune hemolytic anemias (aplastic anemia), and bone marrow diseases. Poorly regenerative anemia with small (microcytic), pale (hypochromic) red cells is typical of iron deficiency and should prompt a search for ongoing external blood loss in the patient (Figure 9).

FIGURE 8

FIGURE 9

High dry and oil field examination are used for detailed red cell morphologic assessment. Heinz bodies and Howell-Jolly bodies are the most frequently encountered red cell inclusions. Heinz bodies are denatured hemoglobin caused by oxidative damage to the red cells. They appear as small epicellular protrusions or knobs on the red cells. Due to the increased number of sulfhydryl groups in feline hemoglobin, small numbers are normal in cats (5-10%) (Brockus 2003, Thrall 2002).

Heinz bodies affecting greater than10-20% of feline erythrocytes may be associated with some diseases (hyperthyroidism, lymphoma, diabetes mellitus) (Brockus 2003). In dogs and cats Heinz bodies are often indicative of toxin ingestion (onions, zinc, acetominophen) (Mitchell, 2010). Heinz bodies are clear, colourless membrane defects, or stain the same as hemoglobin on Diff Quik-stained smears. They appear as small, dark blue inclusions on New Methylene Blue stained smears.

Howell-Jolly bodies are nuclear remnants seen in less than 1% of normal red cells, but

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increased numbers may be observed in regenerative anemias, or splenic dysfunction.

Erythrocyte inclusions such as mycoplasma, Babesia, and viral inclusions are uncommon but may be detected at high power, especially towards the peripheral edges of the smear (Figures 8,12).

Numerical and morphologic red cell indices aid in the assessment of the adequacy of the red cell mass and classification of any abnormalities like anemia. Consideration of the values for red cell count, hemoglobin, hematocrit, degree of regeneration (polychromasia and reticulocytosis), and indices such as the mean cell volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and the red cell distribution width (RDW) will help to confirm semi-quantitative and qualitative findings based on blood smear inspection.

These parameters must be compared to species, age, and in some cases, breed-specific reference intervals. For example, puppies under 2 months of age will have red cell parameters lower than adult values (hemoglobin usually around 100 g/L, Hct 0.30-0.35 L/L, plasma protein 50-55 g/L). Greyhounds generally have higher hematocrits (0.52-0.60L/L), hemoglobin, RBC counts and a trend towards higher MCV. (Shiel, 2007).

Abnormally shaped red cells such as ecchinocytes, acanthocytes, schistocytes and blister cells should be identified and recorded in a semiquantitative manner. Ecchinocytes may be an artifact of slow drying of the smear, or may be seen with dehydration or following venomous snake bites. Acanthocytes result from an altered cholesterol content of the red cell membrane and may seen with some tumours (hemangiosarcoma), or with some liver and splenic diseases (Figure 10).

FIGURE 10

Schistocytes or red cell fragments may be seen with iron deficiency anemia and intravascular red cell trauma that occurs within

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small vessels (microangiopathy) due to disseminated intravascular coagulation, or within vascular tumours or extreme tissue trauma, Blister cells are indicative of oxidative red cell damage.

The Leukon The leukocytes or white blood cells (WBCs) are the least numerous cell component in health, with a typical ratio of 1:500 to 1:1000 of white cells to red cells in most species. Evaluation of the numbers, size, distribution, maturation, and presence of inclusions or atypical cells should be conducted on each cell line. Findings may support underlying etiologies such as infectious, inflammatory, immune, neoplastic, and toxic (i.e. drug-induced) disorders. Disorders of the leukocytes include leukopenia (decreased WBCs), leukocytosis (increased WBCs),leukemia (neoplastic cells in circulation), dysmaturation and abnormal inclusions.

Blood smears from animals with leukemia which have markedly increased leukocyte counts will stain a deeper blue than smears from animals with leukocyte counts within the physiologic reference range.

Automated instruments cannot identify all cell types accurately. This is especially true in abnormal samples from clinically ill animals, or in aged blood samples where artifactual morphologic changes are present. Immature neutrophils (bands and younger), toxic changes, reactive or atypical lymphocytes, basophils, degranulated cells (vacuolated or “gray” eosinophils of Greyhounds), leukemic cells, and viral or other cell inclusions may not be detected unless the smear is manually reviewed.

The total leukocyte count should be estimated as low, normal or increased based on a low power scan. Estimates done per 10X objective field have been found to correlate fairly well to automated leukocyte counts with an average of 18-51 leukocytes per 10X objective field supporting a normal count in canine blood smears (Tvedten 1988).

A differential count should be conducted within the monolayer area. With the feathered edge positioned to the left, begin at the upper lateral edge and move in a straight line to the opposite lower edge of the smear. The leukocyte count is continued shifting slightly laterally along the bottom edge towards the butt of the smear and then returning to the upper edge (“castle pattern”) until 100 leukocytes are enumerated. Leukocytes are then carefully evaluated for toxic changes (Figure 11).

FIGURE 11

FIGURE 12

These morphologic abnormalities pertain mostly to neutrophils and represent disruption of cell maturation within the bone marrow and/or peripheral blood. Specifically, toxic changes include alterations in the cytoplasm (retention of ribosomes resulting in notable basophilia or “bluer” cells), vacuolation (dissolution of cytoplasmic granules), or rarer retained primary granules (prominent blue-pink granulation). Doehle bodies are retained intracytoplasmic aggregates of rough endoplasmic reticulum, the significance of which is very species-dependent (in cats and horses, this finding is minor compared to major significance in the dog) (Latimer, 2003). Nuclear changes are rarer and include karyolysis or nuclear swelling with decreased staining intensity of the nuclear chromatin resulting in lightly basophilic or pinker, smudged chromatin. Karyorrhexis (fragmented nuclei) may be an extreme toxic change or a part of the normal aging process. Abnormal cell size and altered nuclear size, shape, and segmentation are other indications of dysmaturation which may arise as a result of accelerated myelopoiesis due to increased peripheral demand for leukocytes, or due to disorderly marrow maturation.

Identification of band neutrophils may be problematic. Designation of cells as “band” neutrophils should be restricted to cells that have smooth, parallel sides (“horseshoeor U shaped”) and a less condensed, paler chromatin compared to their more mature segmented counterparts (Figure 13).

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cyte toxicity and immaturity these changes should disappear over time with resolution of the disease. The cytoplasmic basophilia may be the last feature to resolve upon patient recovery (Latimer, 2003).

FIGURE 13

FIGURE 14

Immature neutrophils denote a “left shift” or the earlier release of younger cells from the bone marrow. The left shift is described as “regenerative” or “degenerative” depending upon whether the number of immature cells (bands and younger) are fewer than, or exceed the number of mature segmented neutrophils, respectively. This finding is interpreted in light of the overall leukocyte count, the presence of toxic changes, and the clinical history of the patient. A degenerative left shift with leukopenia, neutropenia, and toxic change in a dog or a cat usually indicates an intense immune challenge warranting a guarded prognosis. A left shift is not specific to any one disease, and while it is seen most commonly with peracute sepsis or endotoxemia, it may also accompany any illness where there is significant tissue lysis (i.e. immune, toxic, ischemic, neoplastic and degenerative disorders).

Species differences in leukocyte dynamics must be taken into consideration. In cats and dogs with a good reserve of immature cells in the bone marrow, a degenerative left shift is encountered less frequently. When present in these companion animals, it indicates a more serious insult. Horses and cattle have less of a bone marrow granulocyte reserve and will develop a left shift more readily depending upon the nature of the antigen challenge.

When monitoring a patient with leuko-

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A stress leukogram is commonly encountered in clinical practice and is a non-specific finding which should be recognized and interpreted in light of the clinical case history.

It reflects release of endogenous corticosteroids, or administration of exogenous corticosteroids. A neutrophilic leukocytosis with lymphopenia, monocytosis and eosinopenia are the classic findings, but not all changes are present in every patient, The number of changes within the leukogram is somewhat species-dependent. For example, in the dog neutrophilia (without left shift and toxicity) is most commonly encountered, while in the cat lymphopenia is the most frequently observed stress-induced change.

Physiologic leukocyte increases may arise as a result of release of epinephrine in young, excited, healthy animals, Physiologic neutrophilia with counts up to 39 x 109 /L and lymphocytosis as high as 36 x 109 /L have been observed in healthy cats (Latimer, 2003). Lymphocytes in these cases are usually uniformly small, mature, and well- differentiated. Atypical blast cells in circulation may represent asynchrony of cell maturation and/or release due to intra- or extra- marrow disease (i.e. cats infected with Mycoplasma spp, feline leukemia virus, or feline parvovirus), They may also be identified in animals with leukemia (Figure 15).

FIGURE 15

Rarely animals with tumours in solid tissues will have cancer cells in circulation. If atypical cells are noted, assistance with cell identification should be obtained and smear review by a clinical pathologist should be requested. Mast cells are infrequently seen

in the peripheral blood and may be noted in cases of inflammatory disease (parvovirus infection, acute hemorrhagic pancreatitis, and severe hypersensitivities) or mast cell leukemia. Intracellular inclusions such as viral inclusions, rickettsial morulae, or bacteria are infrequently found (Figures 12, 14, 16).

FIGURE 16

The Platelets Platelets are the second most numerous cell in health with most domestic species having counts in the range of 200 to 1000 x 109/L. The role of platelets in the coagulation process is intuitive, but there is an increasing interest and awareness of their role in the inflammatory process as they are “micro -transporters” of many inflammatory cytokines such as platelet-derived growth factor and transforming growth factor. Disorders of platelets include thrombocytopenia (decreased platelets), thrombocytosis (increased platelets), megakaryocytic leukemia, dysmaturation and abnormal function or inclusions.

Estimates from a blood smear can be conducted during initial blood film examination. Beginning at the very tip of the smear, and moving along the long axis of the smear, platelets are counted in 10 consecutive oil immersion fields (100x) while traveling the entire length of the prepared film. The average number of platelets per oil field is multiplied by a factor of 15 to 20 to give an estimate of the platelets x 109/L. For dogs and cats, a minimum of 8-10 platelets is typical in normal animals (Thrall, 2002, Weiss, 1984).

An average of 8-29 platelets per oil immersion field supports a normal platelet count on canine blood films (Tvedten, 1988).

Evaluation of the size, distribution, maturation (younger cells are bluer and more granulated), and any inclusions (i.e. Ehrlichia platys) may provide an insight into underlying immune, infectious, neoplastic and thrombopathic disease processes. The younger or “shift” cells usually meet or exceed the size of the autologous red cells (Figure 18). Shift platelets are indicative of ongoing marrow thrombopoiesis. A low power scan of the smear will detect platelet clumping at the edges of the smear.

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If present, this finding could result in an artificial lowering of the observed leukocyte and platelet counts on the blood film. Automated cell counts often underestimate the true values of blood samples with micro- or macro-clotting. Feline and equine platelets tend to clump very readily upon blood collection. This occurs as a result of traumatic venipuncture, slow draw, or epinephrine release (think stressed cat!). Up to one-half to three-quarters of feline blood samples have erroneously low values. This can be avoided by clean venipuncture technique. Large feline platelets are often not counted in the platelet channel by automated instruments.

Low platelet numbers may be a relative or absolute finding. Thrombocytopenia as an artifact of in vitro clumping has no clinical relevance. Absolute thrombocytopenia may result from platelet consumption during prolonged or severe hemorrhage, sequestration within an enlarged spleen or neoplastic mass, peripheral destruction through immune targeting, or due to a lack of production as a result of intra-marrow disease. Increased platelet numbers may be seen in benign conditions such as anemia as a result of accelerated bone marrow cytokine stimulation. This is often referred to as “reactive thrombocytosis”.

An idiopathic asymptomatic macrothrombocytopenia (low platelet count with large size cells) in Cavalier King Charles Spaniels has been determined to have an autosomal recessive pattern of inheritance. Automated platelet counts underestimate the circulating platelet mass in dogs with large platelets (Tvedten, 2008). A microthrombocytosis (high numbers of smaller than normal platelets) is often seen with some anemias (possibly due to colony stimulating factors released in the marrow) and also in hypothyroid dogs. The pathogenesis of the latter mechanism is poorly understood.

Plasma Proteins Serum proteins include albumin and globulins. Albumin accounts for 35-50% of the total serum protein concentration in domestic species and 75% of the oncotic pressure of the blood. (Evans, 2003). Alpha and beta globulins include many transport molecules and acute phase reactant proteins. The latter proteins often increase with infection and inflammation. The immunoglobulins are secreted by B lymphocytes and plasma cells.

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Evaluation of serum or plasma protein is through measurement of total protein using a refractometer or, less frequently by separation into the respective components via serum protein electrophoresis and immunoelectrophoresis (Figure 19). Total protein measurement should be included with every hemogram.

Evaluation of the plasma proteins is critical in anemic patients. If the anemia is due to blood loss, the plasma proteins may be decreased depending on the duration of the bleed and concurrent disorders. With immune hemolysis, proteins may be normal to increased.

Hyperproteinemia may be a relative finding in dehydrated animals. Absolute increases in plasma protein may occur with immune disorders, inflammation, infection, and neoplasia, especially tumours of lymphocytes or plasma cells. Hypoproteinemia may be seen with hemorrhage, protein loss through kidney, intestinal or dermal diseases, body cavity effusions, or rarely through decreased synthesis as in end stage liver disease. Estimation of the albumin, globulins, and the A/G ratio may guide further investigation. For example, selective albumin loss suggests renal loss of the lower molecular weight protein whereas panhypoproteinemia is more consistent with gastrointestinal losses or hemorrhage. Inflammatory intestinal disease may present with an apparent selective albumin loss during mild or early protein leakage. As the enteric disease becomes more severe, loss of both albumin and globulins occurs. During chronic severe inflammation increased production of acute phase reactant proteins may mask ongoing globulin losses.

Conclusion Care should be taken with each blood sample to: 1. Prepare well made, air-dried stained and unstained smears.

2. Properly label all samples with relevant patient data.

3. Provide a thorough history for interpretation of the results.

4. Use a systematic approach to evaluate all parts of the hemogram including the erythron, leukon, platelets, and plasma proteins in a qualitative and semiquantitative manner.

references > 1. Becker M, Moritz A, Giger U. Comparative clinical study of canine and feline total blood cell count results with seven in-clinic and two commercial laboratory hematology analyzers. Vet Clin Pathol 2008; 37: 373-384.

2. Brockus CS, Andreasen CB. Erythrocytes.

In: Duncan & Prasse’s Veterinary Laboratory Medicine, Kenneth Latimer, Edward Mahaffey, Keith Prasse editors. 4rd Ed. Iowa State University Press, Ames, 2003; pp 3-45.

3. Evans EW, Duncan JR. Proteins, Lipids, and Carbohydrates. In: Duncan & Prasse’sVeterinary Laboratory Medicine, Kenneth Latimer, Edward Mahaffey, Keith Prasse editors. 4rd Ed. Iowa State University Press, Ames, 2003; pp.162-192.

4. Latimer KS, Prasse KW. Leukocytes. In: Duncan & Prasse’s Veterinary Laboratory Medicine, Kenneth Latimer, Edward Mahaffey, Keith Prasse editors. 4rd Ed. Iowa State University Press, Ames, 2003; pp 46-79.

5. Mitchell K, Kruth S. Immune-Mediated Hemolytic Anemia and Other Regenerative Anemias. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine.7th ed. St. Louis: Saunders Elsevier,2010: 761-772.

6. Shiel RE, Brennan SF, O’Rourke LG, McCullough M, Mooney CT. Hematologic values in young pretraining healthy Greyhounds Vet Clin Path 2007; 36;274-277.

7. Thrall M, Weiser G. Hematology. In: Laboratory Procedures for Veterinary Technicians. Charles M. Hendrix. 4th Ed. Mosby Inc. St. Louis Missouri, 2002; pp 29-74.

8. Topper MJ, Welles EG. Hemostasis. In Duncan & Prasse’s Veterinary Laboratory Medicine, Kenneth Latimer, Edward Mahaffey, Keith Prasse editors. 4rd Ed. Iowa State University Press, Ames, 2003; pp 3-45.

9. Tvedten H. Lilliehook I, Hillstrom A, Haggstrom J. Plateletcrit is superior to platelet count for assessing platelet status in Cavalier King Charles Spaniels. Vet Clin Pathol 2008; 37: 266-271.

10. Tvedten H, Grabski S, Frame L. Estimating platelets and leukocytes on canine blood smears. Vet Clin Pathol. 1988;17:4–6.

11. Weiss DJ. Uniform evaluation and semiquantitative reporting of hematologic data in veterinary laboratories. Vet Clin Pathol 13: 27-31, 1984.

TECHNEWS | VOLUME 36 ISSUE 4

ITCHING FOR A SOLUTION? ANALLERGENIC

HYPOALLERGENIC

SKIN CARE

SKIN CARE

HYDROLYZED PROTEIN

SMALL DOG

TECHNEWS | VOLUME 36 ISSUE 4 © ROYAL CANIN SAS 2013. All Rights Reserved. (Photo credit: G. Pelser)

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Apps,Blogs

&Websites

To Watch The Partners for Health Pets website (partnersforhealthypets.org/) offers tools and resources to enhance the delivery of preventive healthcare and communication with pet owners about the value of routine care. The website also provides an online survey tool that will help your practice uncover differences in opinions of your healthcare team and your clients with regard to preventive healthcare. Unique, real-time results will show you where more information and better communication are needed.

Is your practice interested in becoming a more cat-friendly practice?

You’ll find guidelines for pet owners and veterinary practices at The CATalyst Council’s website, catalystcouncil.org. You can watch and download video segments designed to help assist veterinary teams about ways to enhance feline visits to the veterinarian.

“Cool Cow” app launched by Purina Purina Animal Nutrition LLC introduced the Cool Cow app for smart phones, according to Agri-Marketing. The Cool Cow mobile app puts the tools dairy producers need to monitor and address heat stress at their fingertips. Research shows that cows can begin to show the effects of heat stress at a Temperature Humidity Index or THI of 68. Reproduction can be impacted at a THI of 55. Heat stress and an associated 10 percent to 35 percent milk production loss may cost a dairy producer $1.60 to $5.60 per cow per day. These losses can continue to mount when reductions in reproductive performance and increased days open are added into the equation. The mobile app features an easy-to-use heat stress calculator for inputting the current temperature and humidity readings. The temperature and humidity is then translated into a THI reading that shows the severity of heat stress, ranging from mild to extreme risk; providing dairy producers insight on the current conditions inside their barn. In addition to the heat stress calculator, the mobile app offers tips on mitigating heat stress from management to nutrition. The Cool Cow mobile app is available to download for Android.

Simple guidelines for veterinary blogs that work Does your practice want to reach potential customers/clients using an informative veterinary blog? Pam Foster, of Lifelearn, outlines a basic formula to achieve great results. Read more at: http://www.lifelearn.com/2012/05/simple-guidelines-for-veterinary-blogs-that-work/

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Dvm360 and Merck Animal Health have developed a Tick Control Toolkit.

This includes a special package of articles, tips, handouts, videos, and tools designed to make it easy for your team to educate pet owners about the importance of tick control and prevention.

The dvm360 social media marketing kit for tick control gives you pre-written Facebook posts and tweets (http://veterinarybusiness.dvm360.com/vetec/Parisitology+Center//Posts-and-tweetsabout-ticks/ArticleStandard/Article/detail/777785?contextCate goryId=49948) to educate your clients about the need for tick control and prevention.

A free iPad module on tick control for exam room education If you already have the dvm360 app for iPad, make sure you downloaded the latest update. Then, inside the app, click the tab labeled “Client Education.” You’ll find a module from dvm360 that’s designed to help facilitate conversations with clients in the exam room. Instruct clients on how to identify ticks, bust common tick myths, learn what types of ticks live where, and more.

If you don’t yet have the app, search for dvm360 in the iTunes App store.

New Hookworm and Cat Scratch Disease info sheets for owners available The Ontario Veterinary College’s Centre for Public Health and Zoonoses has recently posted two new client info sheets; one outlining details about Hookworms (and Cutaneous Larva Migrans), and also one about Cat Scratch Disease (CSD), caused by Bartonella henselae, commonly carried in the bloodstream of healthy cats. To read more about Hookworms, CSD and B. henselae, and many other zoonotic diseases, go to the Worms & Germs Resources page (wormsandgermsblog.com/ promo/services/).

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D​econtam mess-saver G​iving charcoal to patients is a messy job! Place a protective ‘trash bag coat’ on these animals by cutting a hole the size of the patient’s head in the bottom of the trash bag and carefully place the bag over the animal, draping it like a poncho. The patient’s head will be exposed but the rest of the body will be protected and clean. Remove the bag when you’ve finished the decontamination process. (Veterinary Medicine) Never forget blood in the centrifuge again Even on one of those busy, crazy days, you’ll never leave blood inside the centrifuge again. Use a sign enclosed in a plastic sleeve and sit this either on top of the centrifuge machine or Velcro it to the wall behind the machine. When the centrifuge is free of tubes, store the sign out of sight. FIRSTLINE For your clients: Tips to prevent pet theft According to the American Kennel Club, the rate of pet theft is on the rise. To avoid having a pet stolen, here are five tips to help prevent pet theft: • Don’t leave animals unattended or unleashed; • Properly identify your pet; • Keep your info up-to-date; • Spay and neuter your pets; • and Keep a recent photo of your pet: If your dog goes missing, use a recent photo to create fliers to distribute immediately. If you suspect that your pet has been stolen, call the police immediately and report the area where your pet was last seen. Microchipping can help with finding lost pets. The cost is low and allows pet owners to have the security of tracking their pets, as well as allowing animal control to identify and charge owners who abuse and neglect their pets and pet thieves. The problem of lost or stolen dogs can be greatly reduced if pet owners take precautions, such as implanting a microchip and keeping their tags updated. (veterinary advantage weekly news) To increase compliance for yearly vaccines and exams, try one or more of these tips 1. In this electronic age, consider sending handwritten reminder cards. Buy pre-made cards, check off what services need to be handled and add a personalized note or two. If you prepare them after each visit and then file them, it will make this chore easier.

2. Attach a ‘special’ time-sensitive saving to your reminders to draw in traffic.

3. Remind clients that since pets age more rapidly than humans; if one year equals 5-7 years of aging, as humans, we’d see our doctor at least once in that similar time period, shouldn’t their pet?

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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 25 of this issue!

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CE Article #2 Equine Obesity and the HealthcareTeam Kara M. Burns, ms, med, LVT, VTS (Nutrition) Academy of Veterinary Nutrition Technicians As is being seen in epidemic proportions in humans, cats, and dogs; obesity is also being diagnosed extensively in companion-animal horses. Because of this increase in prevalence in horses, the veterinary healthcare team has an even greater interest in weight loss and weight management. As with other species there are numerous risk factors that are associated with obesity. Obesity in horses has been associated with insulin resistance. Furthermore, obesity and insulin resistance have been linked to increased risk of laminitis (particularly the pasture-associated form of this disease). (Treiber, Kronfeld, et al, 2006; Carter, Treiber, et al, 2009) Also, overweight and obese horses have an increased risk for developmental orthopedic disease, osteoarthritis, and other skeletal and joint-related conditions. (Geor, 2010)

Assessment of Obesity in the horse

When implementing a weight management program, nutrition should be assessed and a nutritional recommendation made. Nutrition is the cornerstone to a weight management program and combined with exercise and owner education, the veterinary technician plays a key role in executing and managing the weight program designed for the obese horse.

The most widely utilized method for assessing overweight and obesity in horses is the evaluation of body condition using a 9-point scale.

Body-condition scoring (BCS) in horses is a subjective method of estimating a horse’s fat stores and is an important tool to help assess the nutritional status of the patient. (Becarova,2009; Henneke, 1983; Geor, 2010)

The definition of obesity in horses does not differ from the definition of obesity in cats and dogs. Obesity can be defined as an expanded mass of adipose tissue in the body.

Obesity is not just a cosmetic issue; it is a health issue.

The most common cause of obesity in horses is also the easiest to correct – overfeeding. The healthcare team is responsible for assessing the nu tritional practices of the horse owner.

First time horse owners, single-horse owners, and pony owners generally feed their animals too much. Ponies seem to be particularly susceptible to obesity, perhaps because their size renders them more easily overfed. (Foreman, 2010)

BCS measures subcutaneous fat deposition in six areas: 1. crest of the neck 2. withers 3. behind the shoulder 4. over the ribs 5. along the back 6. around the tailhead

Fat deposits may be asymmetric in distribution, thus the need to evaluate all six areas of the body on both sides. In the U.S., a score between 1 and 9 is assigned, while north of the border, the BCS scale is 1 through 5*. In both cases, 1 indicates emaciation, while 9 (U.S.) or 5 (Cdn), indicate extreme obesity. * The Ontario Ministry of Agriculture, Food, and Rural Affairs offer an Equine Body Condition Scoring Chart through their website http://www.omafra.gov.on.ca/english/livestock/horses/facts/98-101.htm.

The veterinary healthcare team should perform BCS and body weight evaluation regularly. Also, the owner should be educated as to how to perform BCS on their horse. Additional weight in any animal adds risk for a variety of disease conditions and can exacerbate existing disease conditions. Body weight is measured by use of a calibrated large-animal scale. However, weighing by scale is not always possible. In these instances weight can be assessed by utilizing weight tapes. Weight tapes estimate the horse’s weight using accurate body measurements of girth circumference and body length.

Lb/body weight = [heart girth(in)] 2 x length (in)/330 Kg/body weight = [heart girth(cm)] 2 x length (cm)/11,800

Kara M. Burns, MS, MEd, LVT, President, Academy of Veterinary Nutrition Technicians is a licensed veterinary technician originally from New England, now living in Kansas. She holds a master’s degree in physiology and one in counseling psychology. She began her career in human medicine working as an emergency psychologist. She also worked at Maine Poison Control as a poison specialist.

She then made the move to veterinary medicine and worked in small animal private practice and a small animal and avian practice.

Kara is the Founder and President of the Academy of Veterinary Nutrition Technicians, the tenth recognized specialty for veterinary technicians.

Currently, she works for Hill’s Pet Nutrition as the veterinary technician specialist working with the technician profession in all aspects.

Kara has authored many articles and textbook chapters and is an internationally invited speaker, focusing on topics of nutrition, leadership, and technician utilization.

She enjoys spending time with her wife Dr. Ellen Lowery and their children. The family also includes three horses, two sheep, 2 pugs, a French bulldog, 3 birds, 4 indoor cats, and assorted other critters!

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The formula above is considered most accurate when used on mature horses with a BCS in the range of 5 to 7. The healthcare team should also be advised that weight estimates based on heart-girth measurements do not account for variation caused by hydration state, pregnancy, and the weight of intestinal contents. (Geor and Harris, 2009; Becvarova, 2009)

Definition and Prevalence of Obesity Although a general definition or body condition score of obesity in horses and ponies does not truly exist, it has been accepted that horses with a BCS of 8 (fat) or 9 (extremely fat) are defined as obese. Animals with a BCS of 7 may be considered overweight if not obese.

Obesity in horses and ponies, as in other species, is caused simply by too many calories consumed and not enough calories expended.

Horses today are likely to be kept in stalls or small pens for much of the day, and may not require more than maintenance energy intake. Still, these horses may be fed more than the maintenance energy requirement, especially if grains, sweet feeds, and other high caloric density foods are added to the diet without first calculating the correct amount to be fed the individual horse. Obesity also may be a problematic in pasture-fed horses and ponies given unlimited access to pasture.

This is especially true in the spring and fall seasons, when pasture forage is plentiful and rich in energy.

Equine Metabolic Syndrome Obesity in horses is considered a risk factor for laminitis. One theory linking obesity with laminitis attributes the increased weight of the horse to increased load on the feet. (Geor and Harris, 2009; Geor, 2010) Nevertheless, the increased risk of laminitis in obese horses is undoubtedly related to the attendant insulin resistance. Associations among obesity, insulin resistance, and laminitis have been observed in horses, and has been termed equine metabolic syndrome. Other effects related to obesity include: • Impaired thermoregulation in hot weather • Reduced athletic performance • Increased risk of joint injuries

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Obesity and Inflammation Overall, obesity is considered to be a chronic inflammatory state, in part mediated by increased macrophage infiltration of adipose tissue. Recent studies in horses have also associated obesity with increased expression of inflammatory cytokines. Adipokines secreted by adipocytes and macrophages in adipose tissue include tumour necrosis factor-α (TNF-α), interleukins, leptin, adiponectin, resistin, and plasminogen-activator inhibitor type 1. Leptin provides information to the brain regarding the availability of fat stores in the body, promoting satiety and reduction in food intake when energy balance is positive or fat stores are plentiful. In horses, leptin concentrations have been found to vary with season, level of fitness, and gender. Also, a positive association between BCS and leptin has been documented. (Geor and Harris, 2009)

result in the loss of approximately 1 unit of BCS (approximately 20 to 25 kg for a light-breed horse) over a 4- to 6-week period. Body weight (via scale or weight tape) and BCS should be assessed regularly, at least every 2 to 4 weeks, during the weight reduction program to insure progress is monitored and the program amended as required.

4. Once the target weight and BCS have been reached, a weight management program should be implemented. The healthcare team should assess body weight and BCS monthly to ensure that the feeding program is appropriate to the current level of physical activity and other environmental influences (such as ambient conditions) on energy requirements.

Weight Management Programs with Horses Regardless of the species, weight management is a simple approach - eat less and exercise more. The healthcare team, specifically the veterinary technician, plays an integral part in the weight management of horses and in developing a weight management program with the veterinarian and the owner.(Geor, 2010) Weight management in horses involves the following: 1. Nutritional Assessment: • Assessment of the current feeding program • Assessment of housing • Assessment of feed provided to horse (including supplementary feed, hay, pasture quality, treats, time allowed for grazing) • Assessment of the amount of feed being given • Assessment of the water being provided – amount, quality, etc.

2. Assessment of exercise: • How many hours per week is involved in physical activity?

• Information on the activity level will form the basis for development of recommendations for physical activity.

3. Setting realistic weight loss goals and regularly monitoring progress. An effective weight loss regimen should

Key Nutritional Factors The first step in managing overweight or obese horses is calorie restriction. Trial and re-evaluation will be necessary to achieve the goal weight and BCS in individual horses.

The amount of food fed and the make-up of the food are two important points for the healthcare team to consider. In pasture-fed horses, it may be necessary to move the horse from pasture feeding to stalls to monitor dietary intake.

Restrictive grazing may be allowed. The following techniques allow the horse to graze while minimizing forage intake: • grazing muzzles (attached to a breakaway halter) • strip grazing behind other horses • mowing the pasture and removing clippings before allowing access • putting a deep layer of wood chips over a small paddock

21

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4

3

Negative crease along back. Faint outline of ribs can be seen. Fat can be felt along tailhead. Hip bones cannot be seen. Withers, neck, and shoulders not obviously thin.

MoDerAteLY tHin

Fat built up about halfway on vertebrae. Slight fat layer can be felt over ribs, but ribs easily discernible. The tailhead is evident, but individual vertebrae cannot be seen. The hipbones cannot be seen, but withers, shoulder, and neck are emphasized.

tHin

1 2

1

Score

3

Horse is emaciated. Slight fat covering over vertebrae. Backbone, ribs, tailhead, and hipbones are prominent. Withers, shoulders, and neck structures are discernible.

VerY tHin

Horse is extremely emaciated. The backbone, ribs, hipbones, and tailhead project prominently. Bone structure of the withers, shoulders, and neck easily noticeable. No fatty tissues can be felt.

poor

DeScription

Equine Body Condition Score

ILLUSTRATIONS BY ROBIN PETERSON, DVM; BASED ON TEXAS A&M UNIVERSITY BODY CONDITION SCORE

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Copyright 2006 The Horse; visit www.TheHorse.com

9

5

9

8

7

6

5

Obvious crease down back. Fat is in patches over rib area, with bulging fat over tailhead, withers, neck, and behind shoulders. Fat along inner buttocks may rub together. Flank is filled in flush with the barrel of the body.

eXtreMeLY FAt

Crease down back is prominent. Ribs difficult to feel due to fat in between. Fat around tailhead very soft. Area along withers filled with fat. Area behind shoulders filled in flush with the barrel of the body.

Noticeable thickening of neck. Fat deposited along the inner buttocks.

FAt

7

A crease is seen down the back. Individual ribs can be felt, but noticeable filling between ribs with fat. Fat around tailhead is soft. Noticeable fat deposited along the withers, behind the shoulders, and along the neck.

FLeSHY

May have a slight crease down the back. Fat on the tailhead feels soft.

Fat over the ribs feels spongy. Fat beginning to be deposited along the sides of the withers, behind the shoulders, and along the neck.

MoDerAteLY FLeSHY

Back is level. Ribs can be felt, but not easily seen. Fat around tailhead beginning to feel spongy. Withers are rounded and shoulders and neck blend smoothly into the body.

MoDerAte

higher energy and NSC content. Haylage is generally lower in NSC content when compared with hay, but is more palatable. The increase in palatability may cause higher total NSC intake. An NSC content less than 10% is recommended. Otherwise, the water-soluble carbohydrate content (sugars and fructans) can be considerably reduced by soaking the hay in clean water for 20 to 30 minutes before feeding. It is recommended to avoid feeding significant amounts of poorly digestible, highly silicated forages as it has been suggested that this may increase the risk of impaction colic.

Further information on hay, pasture maintenance, and water can be found at the Ontario Ministry of Agriculture, Food, and Rural Affairs website at: www.omafra.gov.on.ca/ english/livestock/horses/forages.html Some horses will not tolerate a grazing muzzle and for those that do tolerate the muzzle it is imperative that the horse has the ability to consume water. (Geor and Harris, 2009) Food for overweight and obese horses should be higher in fiber and lower in nonstructural carbohydrate (NSC) (starches, sugars, and fructans). Horses at maintenance require approximately 2.0% to 2.5% of their body weight as forage or forage plus supplement to meet daily nutrient requirements. To help restrict calories and encourage weight loss, grain and other concentrated sources of calories (such as commercial sweet feeds and feeds containing added fats) should be reduced in overweight horses or totally eliminated in obese horses.

The most crucial nutrient in any species is water. All animals should have access to fresh, clean water at all times. A 10% loss in total body water causes serious illness, while a 15% loss may result in death! Horses on average will drink 6 gallons of water per day. In conditions of extreme heat or stress this number increases to 25 gallons per day.

Technicians should remind owners that the more grain their horse eats the more water the horse will need.

Treats, whether carrots, apples, or commercially purchased treats, should also be eliminated or the amount calculated into the daily caloric allowance. Forage, in the form of hay or hay substitute (chop, chaff, or haylage), should be the primary or sole energy-provid-

24

ing component of the ration. In some areas, forage-based, low-calorie feeds complete with vitamins and minerals are available commercially; this type of diet offers convenience for the owner and may be used as a substitute for hay or fed as a component of the ration along with hay. (Geor, 2010) The veterinary technician should be fully involved in the weight management plan and educate owners on the plan and the risks to the horse should the weight management program not work. During the first month, hay should be provided at approximately 2% of current body weight per day with clients instructed to weigh the ration. These steps alone or with an increase in physical activity may result in some weight loss. However, with others, further reductions to hay at 1.5% of current body weight, and then 1.0 to 1.5% of target body weight, may be required. Continuous assessment and re-assessment are crucial throughout the weight management program. It is not recommended to decrease forage provision below 1.0% of body weight as this may result in unwanted behaviours such as wood chewing, ingestion of bedding, and coprophagy. It is also recommended that the daily food amount calculated be divided into multiple feedings (three to four) per day. (Geor and Harris, 2009) Grass hay that is mature (with visible seed heads and a high stem-to-leaf ratio) is higher in fiber and lower in energy and NSC and is appropriate forage for obese horses. Alfalfa hay or legumes are less desirable due to the

When feeding for weight loss, forage-only diets do not provide adequate protein, minerals, or vitamins. Consequently this lack of protein may result in loss of muscle mass rather than loss of fat. For those horses it is recommended to supplement the forage with a low calorie commercial ration balancer product containing sources of high-quality protein and a mixture of vitamins and minerals to balance the low vitamin E, vitamin, copper, zinc, selenium, and other minerals typically found in mature grass hays. It is important to remind the owners that products such as these are designed to be fed in small quantities (e.g., 0.5 to 1.0 kg daily). If needed this supplement can be mixed with chaff (hay chop) to increase the size of the meal and extend feeding time, which may alleviate boredom in animals provided a restricted diet.

When discussing weight management/ weight reduction programs with horse owners, several additional factors should be considered as approaches to extend feeding time and relieve boredom in the face of limited feed provision, the need for individual rather than group feeding, potential need for a change in the type of bedding, and potential use of pharmacologic agents or nutritional supplements that are purported to enhance weight loss or mitigate comorbidities such as insulin resistance.

Hay nets with small openings or double hay nets may be used to extend feeding time in horses. Mixing the feed with chaff or

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chopped straw is also a way to increase the size of the meal and encourage the horse to take longer to ingest the meal. For horses that may be housed with other horses, the obese horse may need to be separated to evaluate their intake. As mentioned above, horses in stalls may turn to ingesting their bedding when their daily calories are restricted. This behaviour substantially increases daily caloric intake and potentially increases the risk of colic. In this situation, use of shavings, paper, or other nonstraw alternatives for bedding is recommended.

Veterinary technicians can assist the veterinarian and the horse owner in maintaining the proper weight in horses. This is of utmost importance to the overall well-being of the animal. To make this happen a weight management program should be designed and implemented for the individual horse. An effective weight management program incorporated by the veterinary healthcare team should include the following: • Performing a nutritional history • Calculating amount to feed based on weight and BCS and target weight

• Begin a feeding regimen focused on the key nutritional factors above for weight management Restricting access to pasture, particularly during the growing seasons.

• Increasing physical activity to promote energy expenditure in horses without musculoskeletal injury and lameness • Ensuring a gradual transition to new diet • Follow up and monitor the horse’s body weight and body condition on a regular basis.

references > 1. Becvarova I, Pleasant RS, Thatcher CD. Clinical assessment of nutritional status and feeding programs in horses. Veterinary Clinics of North America, Equine Practice. Clinical Nutrition. Vol. 25, No. 1, April, 2009.

2. Carter RA, Treiber KH, Geor RJ, et al.: Prediction of incipient pasture-associated laminitis from hyperinsulinemia, hyperleptinemia, and generalized and localized obesity in a cohort of ponies. 7. 41, 2009, 171–178.

3. Foreman JH. Clinical approach to commonly encountered problems. Equine Internal Medicine, 3rd Edition. Reed, et al, eds. W.B. Saunders Company, 2010.

4. Geor RJ, Harris P. Dietary Management of the Obese Horse. In Current Therapy in Equine Medicine, 6th Edition. Robinson, Sprayberry, eds. W.B. Saunders Company, 2009.

5. Geor RJ. Aspects of clinical nutrition. Equine Internal Medicine, 3rd Edition. Reed, et al, eds. W.B. Saunders Company, 2010.

Henneke DR, Potter GD, Krieder JL, et al.: Relationship between body condition score, physical measurements and body fat percentage in mares.

Equine Veterinary Journal. 15, 1983, 371–372.

6. Treiber KH, Kronfeld DS, Hess TM, et al.: Evaluation of genetic and metabolic predispositions and nutritional risk factors for pasture-associated laminitis in ponies. J Am Vet Med Assoc. 228, 2006, 1538–1545.

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

• Ads may contain graphics as long as they are no larger than 3.5” x 2” at 300 dpi. All graphics for the web may be in colour format.

• The OAVT reserves the right to edit any employment ads.

• Charges for ad placement are outlined below.

Any requested changes to an ad already placed will be treated as a new ad and billed.

Advertisement Rates

• Website Only: $50.00 • Website and TECHNEWS (Members

Rate): $50.00 first 20 words, $1.00 for each additional word • Website and TECHNEWS (Non-Members Rate): $75.00 first 20 words, $1.50 for each additional word

The OAVT does not necessarily endorse any of the following employment opportunities or the interviewing/hiring techniques implemented. There is a fee for placement of ads.

Please see Job Ad Form online for further details. The OAVT reserves the right to edit as space allows.

11944 (May 10, 2013) Registered Veterinary Technicians Needed The Veterinary Emergency Clinic located near Yonge & Bloor is looking for experienced, dedicated and enthusiastic RVTs to join our team. This is an opportunity for you to participate in the practice of state-of-the-art veterinary medicine while working with a committed group of staff and board certified specialists. As a team member, you will be involved in all aspects of patient care. You will have the opportunity to utilize advanced skills in an environment that is committed to staff growth and advancement. Our new team members will be compassionate individuals who are able to work in a busy environment, have experience but are eager to learn, have high standards, an eye for detail and are able to work independently while maintaining good communication with other team members. This position offers an attractive salary(salary commensurate with experience), a shift premium for nights and weekends plus excellent medical and fringe benefits.

Please submit your resume to Claire Followes, RVT, Head Technician at cfollowes@vectoronto.com or fax to 416-9206185.

* Taxes not included in above mentioned rates If you want to use graphics in employment ads, please refer to the following display ad rates: Full Page $1395.00* Half Page $895.00* Quarter Page $595.00* * Taxes not included in above mentioned rates PLEASE NOTE: All Employment Ads must be submitted on the OAVT website.

11933 (May 8, 2013) Veterinary Technician/ Student Looking for a new graduate or technician student for summer employment (May to Sept), with the possibility of this turning into a full time position in the fall. The clinic provides a friendly learning environment, with 4 other full time RVT’s on staff.

Contact Dr. Marie McKibbin by phone at 519-371-1221 or owensoundvets@hurontel.on.ca

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

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T:3.375” S:2.125”

11923 (May 2, 2013) Part Time Technician If you are looking for a position in a well established hospital with an excellent clientele, then this is the opportunity for you. Our dynamic and growing team is seeking a motivated self starter who enjoys working in a bright, spacious, progressive environment with all the bells and whistles. Our hospital is open 7 days a week so flexibility in scheduling is important. Please email your resume to staff_wanted@ hotmail.com.

11919 (May 2, 2013) Veterinary Technician - full or part-time Upcoming maternity leave position available. Experience would be preferred, all resumes will be reviewed. Looking for a fun, hard working individual to join our team. Flexibility in shifts and times are also available- weekends, emergency work after hours, and weekday.

Please forwad resumes via email to jknights@ciaccess.com

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For Pet Owners - How to Crate Train Your Dog

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

The foundation for happy dog ownership lies in teaching good habits to your new family member, from the day they come home. One of the most useful bits of advice a veterinarian can suggest to their clients is in regards to effective crate or confinement training.

Puppy’s first visit should be scheduled with enough time to review house-training, socialization, crating and other important behaviour issues along with all of the necessary medical advice. Done properly, crate-training can make the difference between a happy adoption experience and chaos in the household. Here are some tips to pass on to clients…

1. When first bringing the puppy home, place food, treats, or chew toys in the crate to encourage the puppy to enter voluntarily.

Also, place bedding in the crate and encourage the puppy to use the crate for resting and sleep. This way the crate serves two functions – your puppy’s bed (crib) and your puppy’s play area (playpen). (See our article in last issue for more details).

2. The location of the crate is also important for achieving success. Choose a spot that the puppy would find appealing such as the kitchen or family room. Alternately, consider a second crate (or move the crate) to a room where the puppy might be more comfortable sleeping at night such as near to family members. Other canine family members may also provide comfort to the puppy by being in the same room. Dog appeasing pheromone (an Adaptil diffuser in the room or Adaptil spray on the bedding) may help the dog settle into the home faster.

3. If the puppy does not enter the crate voluntarily to nap, or play with its toys, schedule times to place the puppy in its crate. After play, exercise and an opportunity to eliminate, place your puppy in the crate with some treats, food-filled toys, chews and bedding and close the door. Although some puppies may immediately settle, vocalization and escape attempts can be expected at first.

As long as the puppy is not likely to cause itself any harm, the puppy should not be released from the crate until it has settled.

4. Many trainers will recommend a “mat exercise” to help puppies

learn to settle at a specific location on cue for valued rewards Mat and crate training can be combined by placing the training mat in the crate.

5. Each time the puppy is released from the crate, supervise closely and provide quality social and play time together. Then take the puppy back to the crate when supervision and social play is done times so that the puppy learns that there are times for it to nap and play on its own.

6. Do not leave the puppy in its crate any longer than it can control its bowel movements or urine. For times when the puppy might need to be left alone longer, arrange for a dog walker or use a larger pen or room for confinement training with a paper or potty area for elimination (see confinement without crating below).

7. After the evening meal, some additional play and a final opportunity to eliminate, place the puppy in its crate for the night.

Choose a location that is practical for you and comfortable for your dog. Depending on the puppy’s size and age it may be necessary to allow one trip outdoors during the night to eliminate for the first few weeks.

8. If your puppy is excessively anxious or will not settle in its crate, sometimes a change in the crate’s location or a different type of confinement (see below) might need to be considered.

Can I crate train an adult dog?

Crate training an adult dog may require more time and patience.

Consider where your dog might find it most desirable to sleep and use a scheduling approach to confinement. Find times throughout the day when your dog is ready to nap or play with feeding or chew toys and direct your dog into its crate for each of these “alone time” activities and a few valued treats as rewards. At first you might consider leaving the door open as long as your dog remains in the crate to nap or chew on its toys. Once your dog will readily enter the crate, begin to close the door for gradually longer periods of time and only release the dog when it is settled.

Confinement without crating Some dogs show extreme anxiety when confined. However it is essential that the dog learn to spend some time on its own. These dogs may adapt better to other types of confinement such as a pen, dog run, small room, or barricaded area (e.g. using a child gate). Any time your dog will need to be left alone longer than it can control (hold in) its elimination, use the larger area for confinement with paper or litter for elimination. Dogs that continue to show anxiety when confined may require the guidance of a behaviourist to determine if the anxiety is due to the confinement itself or due to some other underlying anxiety disorder.

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 behaviorist 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 behavior 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 4

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CE Article #3 ® Alfaxalone (Alfaxan ) Anesthesia - Reflecting on the Past Year Alfaxalone has been available to Canadian veterinarians for over a year now and I would like to share with you some of my observations about this interesting transition period.

These clinicians can’t wait for diazepam to become available once again so that they can return to their ketamine/diazepam induction protocols.

Small animal clinicians I have consulted with seem to fall into one of three camps: The members of the first group love Alfaxalone and have embraced it fully as a go-to induction agent. The second group dislikes it intensely. The third group have a bottle of Alfaxalone on their hospital shelves and have been looking at it warily, but they have not yet taken the plunge and administered it to any of their patients.

The third group may be struggling with the issues surrounding making changes to their anesthesia protocols because they simply don’t like change. They may also be hesitant and dismayed by the lack of information about Alfaxalone anesthesia if they are relying on American sources for their information. This is because Alfaxalone has not yet been released for use in the United States.

However, it has been in clinical use in the UK and “Down Under” for many years.

To some extent, practitioners’ experiences with and opinions about Alfaxalone have been influenced by the anesthesia protocols they’ve transitioned from in order to address the sudden and drastic injectable drug shortage imposed by Sandoz. Members of the Alfaxalone fan-club have witnessed and appreciated the rapid, predictable transition to unconsciousness along with the rapid awakening with minimal hangover that Alfaxalone brings to the veterinary anesthesia landscape. Generally, these practitioners have made the transition from propofol induction protocols and so the magnitude of the change has been minimal.

Clinicians who dislike Alfaxalone have complained about poor recoveries and patients “waking up” in the middle of a procedure.

I fall into the fan club category, though like many of you, I experienced some trepidation when I made my first forays into uncharted Alfaxalone waters. Who can blame us? We manage anesthetic risk in part by minimizing the unknowns we have to deal with, since we can’t always predict how our patients will respond to the anesthetic drugs we choose. So we use the same basic anesthetic drug protocol on all our patients. Not a bad strategy as long as the protocol we rely on has at least some built-in flexibility.

One of the reasons for the very different levels of enthusiasm about Alfaxalone is the contribution that ketamine induction makes to the whole anesthesia process. Ketamine is an analgesic. It also is cleared from the cir-

culation more slowly than either Alfaxalone or propofol. Thus, it provides background intra-operative analgesia and contributes to unconsciousness along with the inhalant anesthetic that is used for maintenance. If you take ketamine induction out of the equation and replace it with Alfaxalone, then you may have problems with pain control that result in rough recoveries. Alfaxalone will be pretty much cleared from circulation in 20 minutes or so (depending upon the dose you administer) and at that point, you are left with anesthetic gas along with your premedication drugs to keep your patient asleep and comfortable. Sometimes that may not be enough unless you adjust your inhalant anesthetic levels upward before the patient’s plane of anesthesia becomes too light.

If you do not make adjustments to your anesthetic protocols to address the absence of ketamine, you will become frustrated by the problems that pop up. However, the adjustments that need to be made are small and manageable. Practitioners who transitioned to propofol-based inductions have already been through this adjustment process which is why the introduction of Alfaxalone into their anesthesia protocols has been relatively smooth without any real noticeable difference. They have observed a few improvements with Alfaxalone substitution for propofol in that there is less respiratory depression and apnea at induction making the transition to inhalant anesthetic gas mainte-

Originally from Montreal, Dr. Nancy Brock obtained her DVM degree from the Ontario Veterinary College at the University of Guelph in 1982.

She practiced at Picton Animal Hospital in Eastern Ontario until 1984 and the London (Ontario) Emergency Clinic until 1985. She completed a residency in anesthesia and critical care at the University of California, Davis in 1988. In 1995, she became certified as a veterinary anesthesia specialist and is a Diplomate of the American College of Veterinary Anesthesiologists.

Based inVancouver British Columbia, Dr. Brock is a regular contributor and consultant for theVIN (Veterinary Anesthesia Network). She is also a clinical instructor of anesthesia at DouglasCollege’s AHT program in Coquitlam BC. As part of her anesthesia referral practice, Dr Brock provides veterinarians and their nursing staff with anesthesia assistance and expertise.

This assistance comes in the form of telephone consultation, in-clinic delivery of anesthesia to high risk or fragile patients and the training of veterinarians and technicians in advanced anesthesia techniques. She is also the author of a quick reference anesthesia publication entitled Veterinary Anesthesia Update for small animal practitioners.

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TECHNEWS | VOLUME 36 ISSUE 4

nance more seamless. Practitioners have also noticed less hypotension with Alfaxalone induction compared to propofol induction.

I have some advice for clinicians who have struggled with Alfaxalone use and yet remain open to ketamine and diazepam induction alternatives: 1. Consider “ketofol” for anesthetic induction Ketofol is a term coined in human anesthesia and refers to the combination of ketamine and propofol together for induction. Because less total propofol is needed to achieve good intubation conditions, ketofol reduces the severity and the incidence of respiratory depression and hypotension associated with propofol administration. So, it results in a smooth transition to inhalant maintenance.

In addition it establishes a ketamine analgesia background to supplement the poor to absent analgesia provided by inhalant agents.

For brief procedures this ketamine analgesia is sufficient to reduce pain in recovery. For longer procedures, this ketamine analgesia background can be sustained by its continued administration as a constant rate infusion (CRI) intra-operatively and even postoperatively if required.

2. Add local/regional blocks to your anesthesia protocols Just about every surgical procedure brings with it an opportunity to provide analgesia through the process of numbing the surgical site prior to or immediately after surgery.

This is a different approach to peri-operative analgesia by ketamine CRI. But it accomplishes the same goal of patient comfort in recovery and makes for very smooth awakening. One difference between the use of regional analgesia and the use of CRI analgesia is that the patients with regional analgesia wake up with less “hangover”, are clearheaded quickly after extubation and show an interest in food early on in recovery.

3. Revisit how anesthetic depth is being assessed.

I suspect that patients undergoing induction of anesthesia with Alfaxalone may be manifesting signs of a lighter plane of anesthesia that are being missed by anesthetists so that they seem to “suddenly wake up” when they are not supposed to. Two key signs of anesthetic depth are jaw tone and palpebral reflex. If your anesthetist assesses these two

TECHNEWS | VOLUME 36 ISSUE 4

vital signs every 5 minutes intra-operatively he/she will detect the subtle tightening of the jaw muscles and the return of a brisk palpebral reflex that announce a lightening of the anesthetic plane. At that point, upward adjustments to inhalant anesthetic gas delivery can be made in time and awakening can be avoided. Of course, this approach to anesthesia monitoring requires an actual anesthetist instead of someone who floats by and checks blood pressure every once in a while on their way to accomplishing other tasks. Generally, patients do not “suddenly wake up” though it may seem that way.

Why not simply go back to ketamine-based induction protocols once this annoying drugs shortage is over? Well, you certainly can do that. But you would be wise to consider familiarizing yourself with at least one non-ketamine dependent induction drug protocol since some of your patients may present for anesthesia with underlying disease that is intolerant of high doses of ketamine. The doses of ketamine in “ketofol” are relatively low compared to the amount of ketamine that is administered in com-

bination with diazepam or midazolam. So ketofol may be acceptable for this patient population. In some situations it may be wise to omit ketamine completely from the induction protocol.

Issues encountered during the injectable anesthetic drug shortage and the introduction of Alfaxalone on the Canadian veterinary scene has provided opportunities for insight into what is effective anesthesia. We have also been forced to evaluate how we manage change in our practices. Alfaxalone is not the last anesthetic drug that we will be introduced to in our careers. I suggest that we try to remember that anesthesia protocols are composed of component elements which influence each other. The earlier in the anesthesia delivery process that we introduce a new step or a new drug, the greater its influence and potential to dramatically change the way in which anesthesia unfolds - for better or for worse. Start planning for how you will deal with introducing the next “big thing” in anesthesia since it is only a matter of time before that happens.

Here is an excerpt about Alfaxalone from my anesthesia recipe book: Alfaxalone (alphaxalone) - brand name Alfaxan® • • • • • • • •

Steroid with anesthetic properties (but no steroid effects) Beneficial qualities: Minimal hypotension.

Minimal changes in heart rate.

Minimal respiratory depression.

No tissue irritation if administered peri-vascularly.

Suitable as an intramuscular sedative.

Excellent muscle relaxation providing ease of endotracheal intubation.

Undesirable characteristics: • Calculated volume may be impractical for sedation of larger patients (dogs).

• No preservative - contents of opened bottle should be discarded after initial use.

Indications: • Induction of anesthesia.

• Chemical restraint/sedation for non-painful manipulations such as diagnostic imaging, IV catheter placement and other short procedures

Dose recommendations: • 2 mg/kg IM for chemical restraint or anesthetic premedication.

• 1 to 3 mg/kg IV for induction of anesthesia.

How I administer Alfaxalone: Always premedicate before administering Alfaxalone for anesthetic induction.

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If you are administering Alfaxalone IM to cats, also administer glycopyrrolate 0.01 mg/ kg IM either at the same time or soon after.

Draw up 3 mg/kg as an induction dose for both cats and dogs. I usually end up administering 2 mg/kg but I like to have some extra leftover to top up as needed during the procedure.

Administer 0.5 mg/kg IV every 30 seconds until the patient fails to pull its foot back on toe pinch (or pulls back weakly).

As soon as the patient tolerates a face mask, deliver oxygen supplementation for the duration of the induction process.

You will likely administer about 1 to 3 mg/ kg total dose although a higher dose is safe and acceptable if needed. The dose will vary as a result of differences in premedication drugs/doses, the presence of acute illness, or advanced age.

If the patient has a pronounced cough at intubation, administer an additional 0.5 mg/kg Alfaxalone to help smooth the transition to inhalant.

Respiratory depression is always possible so be vigilant about monitoring your patient.

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Inducing Anesthesia with IV “ketofol” 1. Draw up 5 mg/kg of propofol and 5 mg/kg ketamine into the same syringe.

2.Administer 0.1 ml/kg of the above mixture IV as a bolus.

3. As soon as possible, place a face mask (with diaphragm removed) over the patient’s mouth and deliver supplemental oxygen. If the patient resists face mask placement, do not force it.The patient will likely readily accept the mask after receiving about 1 to 2 boluses of the ketamine and propofol mixture.

Concurrent use of ketamine along with propofol during induction reduces the necessary dose of propofol while providing a brief period of supplemental analgesia.

It also acts as a loading dose of ketamine prior to ketamine by CRI as long as infusion begins immediately after induction.

The contraindications to ketamine administration should be considered to apply to this combination of propofol and ketamine.

Because the stability of this mixture of two drugs has not been tested, do not store any remainder of the ketamine/propofol combination.

4. Wait 30 seconds and administer a further similar sized bolus.

5. Continue steps 2 and 4 until the patient’s head is down and resting quietly in a face mask. This will probably require between 2 and 5 bolus injections depending on the level of pre-anesthesia sedation, age and overall health status of the patient.

TECHNEWS | VOLUME 36 ISSUE 4

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33

CE Article #1: The Essentials of In-Clinic Peripheral

Blood Film Evaluation 1. A review of a peripheral blood smear should be conducted: a) On all clinically ill patients b) As part of the monthly in-house analyzer quality control c) Only for non-elective surgical patients d) As part of all patients undergoing laboratory analysis e) As part of geriatric wellness evaluations only 2. Which is the best method to preserve peripheral blood cell morphology following phlebotomy: a) Placing heparinized whole blood in the refrigerator prior to shipment b) Maintaining whole blood in EDTA at room temperature c) Heat fixation of peripheral blood smears made immediately upon collection d) As part of all patients undergoing laboratory analysis e) Rapid air-drying of peripheral blood smears made immediately upon collection 3. Which of the following morphologic changes seen in peripheral blood cells is not representative of transport or storage artifacts with EDTAanticoagulated blood? a) Erythrophagia b) Cell swelling c) Discrete cytoplasmic vacuolation d) Nuclear swelling e) Cell shrinkage

4. Which of the following statements is false regarding regenerative anemias? a) Metarubricytes are an appropriate response to anemia b) Polychromatic cell response to anemia is somewhat species dependent c) Polychromatic cells with increased RNA appear larger and bluer than mature erythrocytes d) Aggregated reticulocytes in cats represent the most recent bone marrow response to anemiasgeriatric wellness evaluations only e) A delay of about 2-3 days usually precedes bone marrow response to anemia 5. A “left shift” is a term denoting identification of which type of cells in circulation? a) Reactive (hyperchromatic) lymphocytes b) Lymphoblasts c) Band neutrophils and younger d) Vacuolated monocytes e) Hypersegmented neutrophils 6. Which of the following morphologic changes seen in peripheral blood cells is not representative of transport or storage artifacts with EDTA-anticoagulated blood? a) Erythrophagia b) Cell swelling c) Discrete cytoplasmic vacuolation d) Nuclear swelling e) Cell shrinkage

7. In peripheral blood samples with larger platelets or platelet clumping, the automated platelet count will likely be a) A true representation of platelet numbers b) Underestimated, especially in dogs c) Overestimated d) Underestimated, especially in cats e) Underestimated, especially in cats and horses 8. Hypoproteinemia is typically identified in all but which of the following disorders a) Blood loss b) Immune hemolysis c) Glomerular kidney disease d) Inflammatory bowel disease e) Body cavity effusions 9. Polycythemia refers to the following abnormality on the peripheral blood smear a) Atypical cells in circulation b) Increased number of erythrocytes in circulation c) Increased number of platelets in circulation d) Decreased number of leukocytes in circulation e) Increased plasma protein concentration 10. Which of the following statements is true regarding the finding of a degenerative left shift in a canine blood smear a) Denotes immature neutrophils in excess of segmented cells and is indicative of a serious antigenic challenge b) Is a typical response to a mild inflammation or infection c) May be seen as part of a stress leukogram d) d. Is frequently encountered when there is a physiologic leukocytosis e) Carries a favorable prognosis

CE Article #2: Equine Obesity and the Healthcare Team 1. Overweight and obese horses have an increased risk for: a) Developmental orthopedic disease b) Osteoarthritis c) Insulin resistance d) All of the above 2. Body-condition scoring (BCS) in horses is a subjective method of estimating a horse’s fat stores and is an important tool to help assess the nutritional status of the patient. a) True b) False 3. BCS measures subcutaneous fat deposition in ____ areas on the horse: a) Two b) Three c) Six d) Nine 4. 4. A weight management program for horses involves: a) Nutrition b) Exercise c) Goal setting and regular monitoring d) All of the above

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5. Obesity can be defined as an expanded mass of adipose tissue in the body. a) True b) False 6. Food for overweight and obese horses should be _____ in fiber and _____ in nonstructural carbohydrate (NSC). a) Lower in fiber and lower in NSC b) Higher in fiber and lower in NSC c) Lower in fiber and higher in NSC d) None of the above 7. First time horse owners, single-horse owners, and pony owners generally feed their animals too much. a) True b) False

9. When feeding for weight loss, forage-only diets typically do not provide adequate protein, minerals, or vitamins. This lack of protein may result in loss of muscle mass rather than loss of fat. a) True b) False 10. While on a weight management program, the following is true regarding treats: a) Carrots and apples can be fed free choice b) Treats can be given if the caloric amount is calculated into the daily caloric allowance c) Treats should never be given d) None of the above

8. The most crucial nutrient in any species is _____. a) Protein b) Carbohydrate c) Fat d) Water

TECHNEWS | VOLUME 36 ISSUE 3

CE Article #3: Alfaxalone (Alfaxan®) anesthesia -

reflecting on the past year 1. Ketofol is: a) A commercially available anesthesia drug preparation. b) Administered by the intramuscular route. c) Suitable only for canine patients. d) Prepared for individual patient use as it cannot be safely stored for prolonged periods.

2. The advantages of ketofol over propofol include: a) A short period of analgesia b) Reduced dose requirement for propofol c) Less respiratory depression than propofol alone d) All of the above.

3. Alfaxan administration: a) Is effective for oral sedation. b) Causes predictable and pronounced respiratory depression. c) As a negligible effect on the cardiovascular system. d) Should be administered as a rapid bolus IV to induce anesthesia.

4. Intramuscular Alfaxalone: a) Is contraindicated as it causes pain and tissue necrosis. b) Provides chemical restraint for 4-6 hours. c) Is contraindicated in cats. d) Is a useful tool for restraint of cats.

5. Analgesia via constant rate infusion causes less ‘hangover’ than regional analgesia. a) False b) True 6. The dose of Alfaxalone required for IV induction is reduced by prior premedication. a) True. b) False.

8. Ways of improving clinician satisfaction with Alfaxalone as an anesthetic induction drug include: a) Premedication. b) Titration c) Careful assessment of anesthetic depth. d) All of the above 9. Alfaxalone is contraindicated in patients receiving NSAIDs because Alfaxalone is a steroid. a) True. b) False.

10. Ketamine has analgesic qualities. a) True. b) False.

7. If you are unable to achieve intubation after you have administered 3 mg/kg IV Alfaxalone, you should: a) Administer more Alfaxalone until intubation can be achieved. b) Switch to mask induction to complete the induction process. c) Abandon anesthesia as this is a sign of impending problems. d) Begin a constant rate infusion of ketamine.

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35

Birds killed flying into Toronto buildings on display at ROM The exhibit is part of an annual public awareness campaign launched by the Fatal Light Awareness Program (FLAP). (Victor Ferreira/Canadian Press) A museum exhibit featuring the corpses of thousands of birds killed while travelling Toronto’s skies is meant to raise awareness of the perils facing the city’s feathered residents. More than 2,400 dead birds from 91 different species are on display at the Royal Ontario Museum. The annual exhibit was mounted in conjunction with the Fatal Light Awareness Program (FLAP), a group that argues reflective windows and other features of the city skyline pose grave threats to the avian population.

Global news Bioniche Life Sciences announced it has been granted $500,000 from the National Research Council of Canada Industrial Research Assistance Program (IRAP) to develop a second-generation vaccine for E. coli in cattle. (Animal Pharm) US - KENNEL COUGH - Cornell University’s Animal Health Diagnostic Center announced the availability of a diagnostic test for canine pneumovirus, a causative agent in kennel cough. The test is part of AHDC’s new canine respiratory panel, which tests for six viruses and two bacteria known to contribute to kennel cough.

(Feedstuffs)

36

Approximately a million birds are killed each year after colliding with city structures. Fatalities are attributed to reflective windows, which keep skies visible and fool birds into believing they have a clear path ahead of them. Unfortunately, the number of birds hitting buildings is not decreasing and the ROM is happy to support FLAP’s call to action,” he said.

Several of the birds on display belong to at risk species such as Canada warblers, whippoorwills, and chimney swifts. Other endangered birds include the kinglet species, ovenbirds, white-throated sparrows and ruby-throated hummingbirds are all common victims of collisions. Ruby-throated hummingbirds don’t lay many eggs and have a high mortality rate, and reflective glass exacerbates an already tenuous situation for the birds.

The latest exhibit is being mounted one

month after one of the city’s real estate giants found themselves in court over the issue of reflective glass.Cadillac Fairview was acquitted of a raft of charges after allegations that 800 birds died over a nine-month span in 2010 after colliding with windows at the company’s downtown properties. An Ontario judge cleared the company after ruling it had done due diligence in trying to rectify the problem, including applying film on windows. The ruling has opened the door to broader regulations governing the emission of reflected light, giving hope for the future. (cbcnews) Horse processing now legal in Oklahoma According to TheHorse.com, horse processing is legal in Oklahoma now that Gov. Mary Fallin has signed legislation reversing a 50-year-old law that made horse slaughter illegal in that state. Since 1963, horse slaughter for human consumption has been forbidden by Oklahoma state statute. Meanwhile, horse processing has not taken place anywhere in the United States since 2007 when a combination of legislation and court decisions shuttered the last remaining horse processing plants. Horse processing in the United States again became possible in 2012 when Congress passed and President Barack Obama signed legislation that did not specifically deny the USDA funding to carry out inspections at domestic horses processing plants. Since then, plant developments have been proposed in several states, but no U.S. horse processing plants are currently operating. Fallin said she signed the legislation in part because of the neglect of aged horses and the shipping of animals to foreign plants for slaughter “where they are processed in potentially inhumane conditions that are not regulated by the U.S. government.” (veterinary advantage weekly news) US - The American College of Veterinary Emergency and Critical Care (ACVECC) has approved nine veterinary hospitals and clinics in the U.S. to be provisionally designated as Veterinary Trauma Centers in a new initiative designed to improve treatment outcomes of animal trauma cases. (Newswise) Cost analysis shows veterinary wellness visits save pet owners in the long run Pet owners can save hundreds and even thousands of dollars on veterinary costs TECHNEWS | VOLUME 36 ISSUE 4

each year by taking pets to their veterinarian for routine examinations, according to Veterinary Pet Insurance Co, which sorted through its database of more than 485,000 insured pets to determine costs associated with the most common preventive canine and feline conditions in 2012. A cost analysis of common ailments that can be avoided through preventive care included: Dental care Average cost per pet to treat - $531.71 Average cost per pet to prevent - $171.82 Internal parasites Average cost per pet to treat - $179.93 Average cost per pet to prevent - $29.51

Definition

Term 1. dyspnea 2. hypertrophy 3. hypoxia 4. atalectasis 5. pathogenesis 6. bronchiectasis 7. metaplasia 8. pathognomonic 9. carina 10. bulla

External parasites Average cost per pet to treat - $180.67 Average cost per pet to prevent - $84.89 Infectious diseases Average cost per pet to treat - $678.24 Average cost per pet to prevent - $85.14 (using core vaccines)

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

Reproductive organ diseases Average cost per pet to treat - $531.98 Average cost per pet to prevent - $260.69

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.

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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 4

a) irreversible dilation of the bronchus caused by destruction of the airway wall b) transformation of cells from a normal to abnormal state c) ridge between the openings of the right and left main bronchi at the termination of the trachea d) increase in the size of cells in an organ or tissue e) distinctive for a pathologic condition; the clinical sign ‘names’ or indicates the pathology f) large cystic or bubble-like structure g) developmental process of a disease from its inception onward h) increased respiratory effort; difficulty breathing i) insufficient oxygen in tissue; insufficient oxygen in arterial blood leading to poor oxygenation of tissues j) absence of gas from all or a part of the lungs due to failure of expansion; collapse

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.

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37

POISONING COLUMN

Summer Toxins Dangerous to Dogs and Cats

By Lucy Miller, CVT, Pet Poison Helpline Summer brings many more opportunities for family pets to run and play in the outdoors.

The curious dog or cat may come across a number of every day items that have the potential to cause them serious harm. Pet Poison Helpline, an animal poison control based out of Minneapolis, gets tens of thousands of calls each summer from frantic pet owners about their poisoned four-legged friends. Accidental poisoning can occur within seconds: when a pet has licked the wet concrete where the ready to use (RTU) insecticide spray dripped, or licked the powder residue from a packet of pool shock (concentrated chlorine) after administration into a family pool. Understanding the toxicity risk of common items found in the yard, near the pool, or outdoor grill will be beneficial to everyone as summer approaches.

Grill/Oven Cleaners and Pool Shock Treatments: Active ingredients may include hydrochloric acid, concentrated sodium hypochlorite, and lye, all of which can be severely dangerous and damaging to the pet. When in doubt, the pH of the product should be assessed immediately to determine if the product is an acid (corrosive) or an alkali (caustic) chemical. The pet owner should be instructed to use tepid water to help irrigate the mouth (or affected area) for 15 minutes at home prior to bringing the animal to the clinic; this will help prevent further injury.

Note, appropriate protective gear should be worn prior to rinsing the skin, eyes, or mucous membranes (depending on where exposure occurred). Once presented to the veterinary clinic, immediate evaluation and further irrigation (e.g., for an additional 15 minutes) should occur. Emesis induction should never be performed with a corrosive or caustic substance,1 as it may result in further damage to the esophagus when vomited back up. Likewise, gastric lavage also is contraindicated because of the increased risk of perforation to the already damaged and weakened digestive tract. Treatment includes the use of gastric protectants (e.g., H2 blockers, sucralfate, proton pump inhibitors), analgesics, and soft canned food.

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Ready to use Yard Insecticides or Skin Repellent Sprays: RTU aerosolized yard sprays and mosquito sprays generally have a wide margin of safety, as these are typically low concentration permethrin(s). When in doubt, Pet Poison Helpline can help identify the active ingredient(s) and concentration(s) of the product. Ideally, one should attempt to obtain the Pest Control Products Act (PCP) number from container.

Small ingestions typically just result in hypersalivation and limited oral irritation. Larger ingestion may lead to gastrointestinal (GI) signs (e.g., vomiting). In general, a tasty snack (e.g., chicken broth, chicken soup, small amount of milk) can be offered to dilute the unpleasant taste from the mouth. While rare, more severe signs of persistent vomiting or diarrhea warrant anti-emetic therapy and fluid replacement [e.g., subcutaneous (SQ) or intravenous (IV)].

Charcoal Lighter, Tiki Torch and Citronella Fuels: These products commonly contain petroleum distillates or hydrocarbons. The very thin viscosity of this type of liquid enables them to be easily aspirated when ingested or when vomited back up. The aspiration risk outweighs the benefits of emesis, therefore emesis is never recommended with these products.1 The general rule is that toxins in the garage should not have emesis induction performed to prevent secondary aspiration pneumonia. Treatment includes decontamination (e.g., bathing the product off with a degreasing dish soap or flushing the product out of the mouth). Typically, these patients respond well to SQ fluids and a potent anti-emetic (e.g., maropitant).

Citronella Candles: These outdoor candles can result in GI signs (e.g., anorexia, vomiting, etc.) or even foreign body obstruction (FBO), depending on the amount ingested. With recent ingestion, emesis can be performed to prevent a waxy FBO. The use of activated charcoal is not warranted. Pa-

tients often can be monitored at home for any clinical signs. In general, the concentration of citronella or essential oil generally does not pose a risk to dogs.

Sunscreen: Sunscreens typically contain zinc oxide and forms of salicylates (aspirin-like compounds).

Zinc oxide is irritating to the GI tract and typically causes mild signs such as vomiting and diarrhea.2 Rarely, zinc toxicosis (heavy metal toxicity) can occur, but this is with massive or subacute ingestions. Salicylate toxicosis can result with sunscreen ingestion, but typically moderate amounts need to be ingested (depending on the strength of the aspirin). The four major systems affected are GI, respiratory, the central nervous system (CNS), and even the kidneys and liver. Clinical symptoms may include lethargy, vomiting, ataxia, hyperthermia, tachypnea, CNS depression, metabolic acidosis, and liver/renal compromise. Aspirin toxicity is a particular concern in cats, as they have altered glucuronidation (e.g., liver metabolism).3 Treatment includes antiemetics (e.g., maropitant), fluid replacement (SQ or IV), blood work monitoring, gastric protectants (e.g., H2 blockers, sucralfate), and symptomatic supportive care.

Cigarettes and Smokeless Cigarettes: Nicotine concentrations vary depending on the brand of cigarette (e.g., regular vs. light). Cigarettes butts may contain 5-7 mg of nicotine, whereas a cigarette may have as much as much as 30 mg. The newer electric cigarettes may contain 1-2 mls of a nicotine-containing solution, and also pose a toxic threat to pets. Also, electric cigarettes contain a battery in the chamber that is a potential corrosive risk if chewed into or swallowed. Clinical signs of nicotine toxicosis occur quickly (within 15 minutes to an hour), and can include GI signs (e.g., hypersalivation, vomiting), CNS signs (e.g., mydriasis, agitation or depression, ataxia, tremors, seizures, death), and even cardiopulmonary signs (e.g., tachycardia, hypertension, tachypnea, respiratory depression). Treatment generally includes TECHNEWS | VOLUME 36 ISSUE 4

antiemetics (e.g., maropitant), a single dose of activated charcoal with a cathartic, fluid therapy, blood work monitoring, anticonvulsants, and symptomatic supportive care. If the battery is suspected to be ingested, radiographs should be performed, and removal of the battery (e.g., by endoscopy or surgery) may be necessary. H2 blockers are contraindicated with nicotinine toxicosis, as an alkaline stomach environment promotes nicotine absorption.

Fireworks: Unused fireworks can result in toxicosis and thermal injury (from lit fireworks, causing burns on the face, lips, inside the mouth, or on paws). Clinical signs from ingestion of unused fireworks include GI signs (e.g., hypersalivation, vomiting, diarrhea, hematemesis), cardiac signs (e.g., tachycardiac), and miscellaneous other signs (e.g., hemolysis, hyperkalemia, methemoglobinemia, nephropathy, etc.). Heavy metal toxicosis or possible FBO from ingestion can also be seen, but is rare. At home therapy may include oral and dermal irrigation. The administration of charcoal is not warranted. Treatment generally includes gastric protectants, anti-emetics, blood work monitoring, and fluid therapy.

Glo sticks or glo jewelry: Children’s glow-in-the-dark jewelry typically contains dibutyl phthalate, which generally has a wide margin of safety. However, this liquid chemical is very bitter, resulting in profound clinical signs of drooling, pawing at the mouth, gagging or retching. As it is a mild irritant to the GIT, skin, eyes and mucous membranes, most cases can be managed at home with oral irrigation and offering diluted chicken broth or canned tuna water.

Once the oral cavity has been properly rinsed, the symptoms generally resolve.

Alcohol: Accidental alcohol poisoning can be seen in pets, and typically comes from atypical sources.

Sources include alcoholic drinks and baked goods. Rum-soaked cakes or other unbaked deserts may contain alcohol, which results in clinical signs of CNS depression, hypothermia, hypotension, seizures and respiratory failure. A profound hypoglycemia may be seen with alcohol poisoning in pets, and patients should have their blood glucose monitored frequently while hospitalized. Treatment includes IV fluids, dextrose, warming measures, and supportive care.

TECHNEWS | VOLUME 36 ISSUE 4

Propylene Glycol (PG): Propylene glycol is a chemical that is much safer than ethylene glycol, and is found in “petsafe” antifreeze products. It is often found in ice packs (found in summer picnic baskets) and are generally listed as ‘non-toxic.’ When ingested in large, toxic quantities, metabolic acidosis, liver damage and renal insufficiency are possible but generally rare. Clinical signs of propylene glycol toxicosis include CNS depression, weakness, ataxia and seizures.

Treatment includes emesis induction, if appropriate (although charcoal is not recommended), IV fluid diuresis, and supportive care.

Avocados: While many websites list avocado as poisonous to dogs, it generally has a wide margin of safety.

However, avocados are deadly to birds and ruminants. In dogs, the only risk is the avocado pit posing a FBO concern for dogs. Rarely, pancreatitis from this fruit’s high fat content may be seen.

Grapes/Raisins/Currants: This common picnic fruit is poisonous to dogs and results in Acute Renal Failure (ARF). The mechanism of action is not fully understood.

The amount ingested for the size of a pet is not a reliable gauge to base risk of clinical symptoms on. Clinical signs of grape or raisin toxicosis includes GI signs (e.g., anorexia, vomiting, diarrhea, uremic halitosis), renal signs (e.g., polyuria, polydipsia, oliguria, anuria, etc.), and CNS signs (e.g., lethargy). Treatment includes decontamination (e.g., emesis followed by one dose of charcoal), anti-emetic therapy, aggressive IV fluids (typically for 48 hours), daily monitoring of renal values, and urine output monitoring. In general, the prognosis is good if animals are treated before signs begin. However, once kidney failure has developed or oliguria/ anuria occurs, the prognosis is much worse.

Onions and Garlic: These plants from the Allium family result in oxidative hemolysis and damage to the red blood cells of dogs and cats. With onions, hematological changes can be seen with ingestions as low 5 g/kg in cats and 15-30 g/kg in dogs.4 Garlic is 5 times more toxic than onions. Clinical signs of Allium toxicosis include depression, GI signs (e.g., abdominal pain, diarrhea, etc.), pallor, tachycardia, tachypnea and icterus.

Evidence of hemoglobinuria, hemoglobinemia,

methemoglobinemia, and Heinz body anemia may be seen. Treatments include decontamination (e.g., emesis followed by one dose of charcoal) if a toxic dose is ingested, blood work monitoring (for anemia), fluid therapy (e.g., SQ or IV), antiemetics (e.g., maropitant), and symptomatic supportive care. Rarely, oxygen therapy and blood transfusions may be necessary in severe cases.

Xylitol: Nowadays, xylitol is frequently found in household food and consumer products, including sugar-free gums, sugar-free mints, nicotine replacement products, mouth washes, toothpastes, chewable vitamins, nasal sprays, baked goods, etc. Dogs ingesting toxic levels of xylitol experience a rapid rise in serum insulin levels and a subsequent drop in blood glucose. Higher doses can result in acute hepatic necrosis. This life-threatening hypoglycemia can be seen as early as 15 minutes post-ingestion. Clinical symptoms vomiting, collapse, diarrhea, lethargy, ataxia, tremors, seizures, in addition liver failure (e.g., elevated liver enzymes, etc.). Patients should only have emesis induction performed if their blood glucose is normal. Charcoal is not recommended with xylitol toxicosis. Treatment includes blood glucose monitoring, dextrose supplementation, IV fluids, hepatoprotectants (e.g., SAMe), and recheck blood work.

Conclusion: Make summer a fun time for your patients!

Educate your pet owners on what products to keep out of reach this summer. If you think one of your patients have ingested something toxic, immediate consultation with Pet Poison Helpline should be performed to evaluate toxicity and treatment. With prompt diagnosis, decontamination, and treatment, the prognosis is often good.

Acknowledgement: The author wishes to thank Justine A. Lee, DVM, DACVECC, DABT, Associate Director of Veterinary Services at Pet Poison Helpline for her input and review of this article.

Resource: Pet Poison Helpline, an animal poison control center based out of Minneapolis, Minnesota, USA, is available 24 hours a day, 7 days a week. Pet Poison Helpline provides treatment advice and recommendations relating to exposures to potential dangerous plants, products, medications, and substances, to veterinarians, veterinary staff and pet owners. There is a $39.00 per case consultation fee; however, all follow-up is complimentary. Pet Poison Helpline can be reached at 1-800-213-6680.

For further information regarding services, visit the PPH website at www.petpoisonhelpline.com or check out our iPhone app, Pet Poison Help, for more information.

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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!

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TECHNEWS | VOLUME 36 ISSUE 4

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 4

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Merck Animal Health, 42 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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TECHNEWS | VOLUME 36 ISSUE 4

Did You Know?

Study examines life expectancy of big dogs vs. little dogs According to LiveScience, big dogs apparently die younger mainly because they age quickly, researchers say. These new findings could help unravel the biological links between growth and mortality, the scientists added. Normally, across species, larger mammals live longer than their smaller counterparts; for instance, elephants can get up to 70 years old in the wild, while house mice reach only 4 years. Puzzlingly, within species, the opposite seems true -- in mice, horses and perhaps even humans.

Large breeds often die young compared with smaller ones, with a 155-pound (70-kg) Great Dane having an average life span of about 7 years, while a 9-pound (4-kg) toy poodle can expect to live up to 14 years. Researchers analyzed ages at death in 74 breeds, using data from more than 56,000 dogs that visited veterinary teaching hospitals. The scientists found that large breeds apparently aged at faster rates. Indeed, among dog breeds, an increase of 4.4 pounds (2 kg) in body mass leads to a loss of approximately 1 month of life expectancy. The investigators now want to follow the growth and health histories of a large number of dogs and pinpoint the leading causes of death for large dogs (veterinary advantage weekly news) Cat hypertension study seeking thousands of cats with kidney disease According to AAHA NEWStat, a large-scale clinical trial in the United States and Canada is now enrolling thousands of cats with kidney disease to see if they also have hypertension. The doubleblind, placebo-controlled trial, which is sponsored by a major animal health company and regulated by the FDA, is meant to find a treatment for hypertension in cats. Researchers hope the clinical trial will eventually lead to the first FDA-approved treatment for hypertension associated with kidney disease in cats. The treatment used in this clinical trial involves a liquid medication that researchers say is easy to administer. Veterinarians can contribute by referring clients who have cats with kidney disease to the clinical trial. Clients with cats that qualify for the study may be eligible for free study-specific care including study medication or placebo and free monthly exams, as well as monetary rewards. They might also receive funds credited to their accounts at referring family veterinarians, the clinical trial organizers said in a press release. Find more information about the clinical trial and its specific enrollment criteria, visit MyCatCanHelp.com or call (855) 254-3971.

Disease detection UK researchers at Writtle College, Chelmsford, are using wireless tracking sensors to record dairy cow movements to help discover if the animals are unwell before symptoms appear. The researchers are using small sensors attached to cow collars to record the behavior of the cows. Cutting-edge mathematical techniques are then employed to analyze the information in order to develop an early warning system for mastitis and lameness. (Animal Pharm)

TECHNEWS | VOLUME 36 ISSUE 4

AAHA offers new exam-room tool to promote, improve compliance The AAHA announced it is offering a new exam-room tool to help with compliance. Understanding Your Pet’s Health: A Visual Guide is an easy-to-use compliance and education guide which comes in the form of a flip book with laminated pages, connected with a single ring. Both the canine and feline sections are full of large, color photos and succinctly cover all major preventive health care topics, including: Vaccinations; Internal parasites; Weight management; Dental exams, cleanings, and radiographs; Pre-anesthetic blood work; Senior screenings; Pain management; Diagnostic imaging; and Ear disease. The helpful photos and simple language used throughout make this the perfect exam-room aid to use in discussions with clients about wellness topics and diagnostic tools. (veterinary advantage weekly news) Pet Loss Support Group Meets Monthly The OVC Health Sciences Centre is offering a Pet Loss Support Group to help support pet owners through the process of loss and grief.

This support group meets monthly and is for any OVC client whose pet is terminally ill or has died.

The group offers: • Emotional and moral support • A welcoming environment where you can talk about your loss and grieving.

• A place to remember and share stories about the life of your pet.

• Opportunities to connect with other bereaved pet owners and learn additional ways of coping with your loss.

Although the sessions are for pet owners to support one another, the OVC Health Sciences Centre’s clinical counsellor, Bojena Kelmendi, will be available to answer questions, provide suggestions, information and resources.

The group meets the first Thursday of each month from noon to 1:30 p.m. in the Animal Cancer Centre client lounge (adjacent to the waiting area).

For more information contact clinical counsellor, Bojena Kelmendi at bkelmend@uoguelph.ca.

Children’s book focuses on cats and critical thinking In the new children’s book, Fairminded Fran and the Three Small Black Community Cats, Dr. Linda Elder, educational psychologist and president of The Foundation for Critical Thinking introduces her readers to the growing plight of “feral cats,” while simultaneously introducing them to critical thinking as a transformative concept.

The book tells the story of Fran, a young girl who finds three, small, black cats living behind her school. Fran’s concern for the cats’ wellbeing compels her to find the best way to help. In the end, Fran must use her newfound knowledge to convince her classmates to understand feral cats by using critical thinking skills to make better choices. (veterinary advantage weekly news).

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1 Data on file. Hill’s Pet Nutrition, Inc. ©2012 Hill’s Pet Nutrition Canada, Inc. ®/™ TrademarksTECHNEWS owned by Hill’s Pet Nutrition, Inc. | VOLUME 36 ISSUE 4