thescalpel oct09.pdf

NEWSLET TER OF THE TORONTO ACADEMY OF VETERINARY MEDICINE VOL. 25, #4 OCT. 2009

The Scalpel

SEMINARSUpcoming

HOSPITAL PERSONNEL SERIES

Wednesday November 11Electrocardiographic Interpretation

Sponsor:

Continuing Education

For complete SEMINAR INFORMATION turn to page 10 & 11

Continuing EducationGet out your calendars and markdown the Subscription Series &Hospital Personnel Series Seminarscoming up nextmonth .... page 10-11

A New Era Begins atthe Toronto VeterinaryEmergency HospitalA profile of a brand new compre-hensive emergency facility .... page 3

Responsible DogOwnership InitiativeLocal Toronto event part of nation-wide campaign for responsible dogownership ............................. page 5

A Case StudyWhat’s your diagnosis? .......... page 9

In the NEWSInteresting and fun news snippetsregarding our favourite four-legged friends ..................... page 17

In this

ISSUE

nears completion of its fourth session,the program which started out as a jointventure of the College of Veterinarians ofOntario (CVO), the Ontario VeterinaryMedical Association (OVMA) and theOntario Veterinary College (OVC),continues to evolve. VSTEP, now a notfor profit corporation with a board ofdirectors consisting of proportionalrepresentation from each of the threenoted organizations, has provided train-ing and remediation to 146 internationalveterinary graduates seeking to upgradetheir skills and knowledge in an effort tosuccessfully pass the challenging system ofNorth American Veterinary Licensingexams.Each spring when the DVM under-

grads leave the OntarioVeterinary CollegeVSTEP participants begin their intensivelearning campaign which includes some450 hours of lectures and practicallaboratories delivered over a sixteen weekperiod. Each year the program strives to

SUBSCRIPTION SERIES

Tuesday November 10

Practice Management

Sponsor:

Veterinary Skills Training& Enhancement Program

Dr. Alec Martin

s the Veterinary Skills,Training & Enhance-ment Program (VSTEP)A

GuestCOLUMN

Continued ... Veterinary Skills on page 16

TheScalpel OCT09 20pgs R4:The Scalpel 10/19/09 11:31 AM

NEWSLETTER OF THE TORONTO ACADEMY OF VETERINARY MEDICINE THE SCALPEL 3

In 1974,Dr.AveryGillick established theMorningside Animal Clinic and 35 yearslater, along with his partners Carl Porter,JoanneCockshutt andMitchell Gillick a newera has begun with the birth of the TorontoVeterinary Emergency Hospital (TVEH).Officially opening its doors on October 5th,the TorontoVeterinary EmergencyHospitaloffers a wide array of services in a warm,pleasant and comfortable environment. Youwill find this new facility at 21 Rolark Drive,just steps away from the intersection ofBirchmount and Ellesmere. It is a remark-able building from the outside alone and yet,the interior of the building was unlike any-thing I had ever seen.

This has been a 4 year project for Dr.Gillick and his partners, colleagues and staff.

From finding the “perfect” location to zon-ing and design, theywanted everything to beexactly right. They consulted with 3 differ-ent architects from theU.S., finally choosingone from Colorado called Animal Arts. An-imal Arts specialize exclusively in the designof small animal veterinary hospitals and an-imal shelters. Their architecture is awardwinning and they seemed to appreciate theneeds and feel of what was needed for thenewTVEHbuilding. One of their architectsis a former AHT and this only helped tomeld the structural necessities with designideas. From day one it has been about phi-losophy for this group. They wanted thisbuilding to reflect the hospitals philosophieson pet-centered practices. They have a fluidand seamless approach, using a teamof spe-cialists who work together on each case toestablish the best possible medical care foreach individual patient. For this reason,every space had to be open,practical and ac-cessible. There were considerations that hadto bemade due to the sheer size of the build-ing. TVEH is 16,500 square feet and creat-ing a harmonious work environment in aspace this large required a lot of thought,creativity and ingenuity. Animal Artsworked in conjunctionwith a local architect,Nino Rico, who did the exterior revamp(they kept the original exterior walls but didcompletely gut the building), interiorcolours and ensured that at the end of theday, the entire building met code.

As you enter the building your eyesquickly notice the beautiful photographs onthe walls. Large colourful portraits of dogsand cats all done by a photographer namedMarcia Leeder line the walls. There is anessence captured through these photos thatcreates a welcoming feeling from the mo-ment you enter. The reception area is spa-cious with ample seating, a coffee station offto one side and a children’s play nook. Oneof the things that I noted throughout mytour was the attention to detail, and I meanevery detail. The chairs in the reception areaare extremely comfortable and “roomy.” Ilearned fromDr.Gillick that these are no or-dinary chairs! They are used in weight lossclinics, designed to hold people of generousproportions and each chair can handle

700lbs. No wonder they felt so cozy!We began our tour with the 10 exam

rooms. That’s right…TEN. Each one waslarge, equipped with lots of cupboard spaceand a fold down table tomaximize the floorspace.

The“smaller”exam roomswere nothingof the kind, and they just got bigger fromthere.

A noticeable absence was the traditionalcomputer station on each counter top. Thispractice will be “paper light,” the veterinari-answill havewriting tablets whichwillmakeit much easier for everybody. It also enablesthem to spend a lot more time facing theclient and patient instead of the computerscreen. Some of the rooms have beenequipped with dimmer switches to accom-modate ophthalmology exams.

The reception desk has an intake area foradmitting patients and a separate dischargearea which is close to another door exitingstraight into the side parking lot. There is avisiting room near the reception desk forboth visiting and saying good bye. This“comfort” room ensures privacy and an in-timate setting for families with both two andfour legged members to share momentswithout interruption. It has been set up closeto the side exit enabling a quick and privatedeparture when and if necessary.

The largest of the exam rooms is largerthan most treatment areas! It has beenequipped with underground plumbing sothat, in the future, it could potentially be setup to accommodate rehab equipment.There are windows everywhere and the nat-ural light is a true benefit in this building.Theymade a commitment to ensure that allanimal holding areas would have natural

EDITOR’S NOTE: We are proud tohighlight the accomplishments of ourmembers. Should you wish to share astory about your clinic or activity,send us an email.

Senani Ratnayake, BSc RVT

Continued on page 6

is the newsletter of theToronto Academy ofVeterinary Medicine

EditorJennifer Day

ContributorsAlec Martin • Senani Ratnayake

Rob Jones • Krista NelsonBrandon Hall

For additional copies contact:Toronto Academy ofVeterinary Medicine

c/o OVMA420 Bronte Street South, Suite 205

Milton, Ontario L9T 0H9

905-875-0756 • 1 800 670-1702

www.tavm.org

All rights reserved. E. & O. E. October 2009Published by: Gawenda & Company

For Advertising Information call 416-485-0103.

The Scalpel

ANew Era Begins at the TorontoVeterinary Emergency Hospital



Local Initiative BringsAwareness toResponsible DogOwnership in Canada

Through an invitation from CKCMedia Contact Sonny Allinson, one ofmy technicians and I took part in theCanadian Kennel Clubs’ responsibledog ownership initiative on September26, at Trinity Bellwoods Park inToronto. While the event in Torontowas considered the flagship event in thecampaign, support was widespreadwith Mayors of cities from severalprovinces proclaiming the day onbehalf of the event.

The responsible dog ownershipinitiative (RDOG) included the weekbeginning September 19 and thesecond National RDOG DAY on theSaturday. RDOG DAY is supportedby a growing list of like-mindedorganizations and is intended toencompass all dogs and dog ownersacross Canada. It was supported inlocal communities by Responsible DogOwnership Groups (RDOG's) throughtheir local initiatives which embracedthe need for education, supportingresponsible dog ownership in Cana-dian communities.

The Canadian Kennel Club iscommitted to the furthering ofresponsibility for the ownership ofdogs in Canada. As experienced andknowledgeable dog enthusiasts, theysupport the dog-owning public byeducating owners in the responsibili-ties associated with bringing a dog intothe home. By evaluating readiness fora new dog, determining the breed thatis right for an owner, integrating thedog into the home through adviceon health, training and canine goodcitizenship, CKC members providethe support, advice and guidanceto families inter-

Rob Jones, DVM

Continued on page 7

Responsible dog owners enjoy the day at Trinity Bellwoods Park, in Toronto.

Canadian Kennel Club’s media contact Sonny Allinson with responsible dog owners



A New Era Begins at the Toronto Veterinary Emergency Hospital

light, it is wonderful, not to mention envi-ronmentally friendly!

Almost all of the exam rooms have backdoors so that staff can quicklymove into thepharmacy, lab and triage areas.The hospitalis based on a hub system. The hub on themain floor is an open central triage areawith computer work stations and prepareas. Off this area is a surgical suite, labo-ratory, digital radiography suite, dog ward,cat ward, large dog ward (with runs) andwalk out for those quick trips outside (hey,when you gotta go…). Most importantly,separated by glass, is the ICU. The ICU isequipped with gadgets and gizmos forthe nerdiest of veterinarians. A portableultrasound is among the many pieces ofequipment on the ready for any case thatcomes in. It has its own runs and cages andwill be staffed by 2 RVT’s at all times.

Perhaps this is a good time to introduceyou to the staff of TVEH. There are fouremergency veterinarians, all partnerswithin the emergency department. Dr.’sNorman Nasser, Jocelyn Kean, KristaNelson and Jason Donohoe have 34 yearsof emergencymedicine experience amongstthem,making for a pretty exceptional team!Dr.Michael Ethier is a new addition to thereferral service and will be joining TVEHas a critical care specialist having achievedboarded certification through the Ameri-can College of Veterinary Emergency andCritical Care. Dr.’s Avery Gillick, KatrinaSmith and Wendy Foster make up theInternal Medicine team. Dr.’s Carl Porter,Mitchell Gillick and Joanne Cockshutt arethe surgical team.Having somany boardedspecialists is an asset and they round outtheir combined knowledge with their indi-vidual experiences and special interests.Last but not least is Dr. Colleen Mitchellwho is in charge of all diagnostic imagingin the hospital. She is board certified by theAmerican College of Veterinary Radiolo-gists and is the only veterinary radiologistin the GTA! All of these specialists areon-call and available to the emergencyteam anytime. On a separate note, Dr.Mitchell’s services are available to all vet-erinarians. She routinely reads radi-ographic films and digital images forveterinarians across Canada and she also

performs ultrasounds on an out-patientbasis (you can contact the hospital formoreinformation on these services).

There is a window in the ICU that over-looks another room, the isolationward.Toooften we see isolation wards tucked away ininaccessible locations when we know thatthese patients are usually some of thesickest and most critical. In this facility theisolation ward has windows on three walls,ensuring that these patients are not forgot-ten. It has a separate ventilation system androom for cats and dogs of all sizes. It also hasa little treatment area of its own whereprocedures and medicating can beperformed.

Down the hall are the staples of anypractice.The kitchen is complete with dish-washer and ample storage space while nextdoor is one of two laundry rooms in thehospital!

Where do you go fromhere?Well, up ofcourse! We take the elevator to the secondfloor.

We step out into an open concept prepand recovery area.There is a large treatmentarea, another hub, with cages, open recov-ery bays, computer work stations and sur-gical prep tables.One corner of the room isset up for endoscopy. Off the hub you findan array of rooms and equipment – a sec-ond digital radiography suite across fromanultrasound suite.Here wemeet Dr. ColleenMitchell working with two top-of-the-lineultrasoundmachines.Next doorwe find theCTControl Roomand through thewindow

we see a brand new CT machine. Lookingat themachine I wonder how on earth theygot it into the room but, as we enter, myquestions are answered.TheCTwas loweredinto the second story room using largecranes through a metal hatch in the ceiling(I wish I had seen THAT)! The leaded doorto this roomweighs an incredible 750lbs, thewhole thing is definitely a sight to behold.

A set of double doors opens into a hall-way that seems to go forever.This is surgery.There are four large operating rooms for atotal of five surgical suites in the hospital.

There is Altro flooring throughout. It isa non-skid/slip, easy to clean, electrostati-cally neutral flooring with natural antisep-tic properties. There are windows betweenthe hallway and the suites but also, betweenthe suites themselves. It makes for a brightspace that feels open as you can see every-thing and everybody at once. Pass-throughdrawers line the hallway and we see arthro-scopic equipment in the largest of the suitesas we near the end of the hall.At this endwefind a separate room for laundry and packprep. There is another room as well that isstrictly for storage of surgical related sup-plies. I notice another one of those“details.”Every area of the hospital has its ownmop/pail closets. This ensures that nothingis transferred between different areas of thehospital. So simple, So Smart!

We exit the hallway through anotherdoor and pass more storage rooms as we

Continued from page 3

Continued on page 14



ested in canine companionship.Currently the RDOG initiative

boasts national supporters beyond theCKC, including: Canada Post, CanadaSafety Council, CFHS, CVMA, DLCC,Banned Aid Coalition, ResponsibleDog Owners of Canada, plus officialCKC partners such as IAMS, Petsecure,Eukanuba, BMO and BFL Canada Risk& Insurance Services Inc.

Our role was to provide first aidadvice for the assembled dog owners,and act as a representative of theveterinary community. As well asaddressing any questions from the dogowners in attendance, we alsoprovided a display of a recommendedcanine first aid kit, as well as some takehome material. As the weather was

cooperative, the event was wellattended. The primary attraction forthe attendees was the RDOG Walk ofSupport, in this case a circuit of TrintyBellwoods Park by the attendees andtheir dogs. Media attention from CityTV at the beginning of the event alsoallowed the message to get across.

To further promote the theme of re-sponsible dog ownership, the CKC wastesting dogs for their Canine GoodNeighbour program. This involvedevaluating each dog’s temperamentand encourages owners to have a richerrelationship with their dogs. Theprogram also enhances communityawareness of responsible dog owner-ship and the numerous benefits associ-ated with dog ownership.

Also in attendance at the event wererepresentative from Iams, a display of

the CKC indigenous Canadian dogbreeds, The Responsible Dog Ownersof Canada, Petsecure, and representa-tives of the City of Toronto’s By-lawEnforcement Officers.


Local Initiative BringsAwareness to Responsible DogOwnership in Canada

Rob Jones, DVM



10-year-old male neutered EnglishBull-dog presented to the Morning-

side Animal Clinic with a three-day historyof anorexia, lethargy, stertor and what theowner originally described as vomiting.The owner noted that the vomiting alwaysseemed to be followed by gagging andcoughing. Upon further questioning, thegastro-intestinal signs were thought to bemore consistent with regurgitation (post-prandial expulsion of undigested food, lackof abdominal effort). Upon examination,vital signs were within normal limits, how-ever the dog was estimated to be roughly 5% dehydrated. He had bilateral muco-pu-rulent nasal discharge and chest soundswere found to be increased bilaterally onauscultation which was thought to be dueto referred sounds from the upper respira-tory tract. Since his last visit he had lost 3

kg. The patient was admitted for hospital-ization and supportive care which includedI.V. fluids, antibiotics and gastro-protectantdrugs and further diagnostics wereperformed.

Lab-work performed revealed the following:• Total protein 75.3 (50-74) g/L• Globulin 41.3 (16-36) g/L• Alk Phos 206 (12-118) U/L• Chloride 101 (102-120) mmol/L• A thyroid profile waswithin normal limits.• Urinalysis was within normal limits, aswas the CBC except for a very minor

thrombocytosis 447 (170-400).

Abdominal x-rays were within normallimits, except for two small uroliths inthe bladder lumen. Three view chestradiographs were obtained (see below).

What is the likely diagnosis? What aresome of the diseases that are associatedwith this condition? What furtherdiagnostics should be performed?What is the prognosis andwhat aresome of the possible sequelae?

... See page 12

What is your Diagnosis?Case

STUDYDr. Krista Nelson

A



Practice ManagementSPEAKER: Shawn G.McVey,MA, MSWCEO, Innovative Veterinary Management Services

Shawn can pack a room at any conference wherehe speaks, largely because he is willing to share realworld experiences both good and bad, to bring theconcepts home to his audiences. His advice andsuggested remedies are practical, not just theoreti-cal. This lecture will be divided into 5 sections:Toxic Work (managing your stress); Fierce Conver-sations; Coaching to Strengths; Progressive Leader-ship; and Money and Medicine (getting clients toaccept your fees).

SPONSOR: Pfizer Animal Health

Tuesday, November 10

2009SEMINARS

S U B S C R I P T I O N S E R I E SSPEAKER BIOGRAPHY:

Mr. McVey completed his grad-uate studies in Political Social Workand Behavioural Science and pur-sued a career as a Psychotherapistand Program Director in humanpsychiatric facilities in 1991. Mr.McVey is the owner of InnovativeVeterinary Management Solutions(IVMS), a boutique consulting busi-ness that specializes in improvinghealth care delivery systems and cor-recting workplace culture. Mr. McVey is the former CEO of EyeCare for Animals, a Phoenix, Arizona based veterinaryophthalmology company that holds 24 practices throughout theUnited States. Mr. McVey is the founder and co-owner of Vet-erinary Specialists in Private Practice (VSIPP), an annual con-ference that provides continuing education for Specialists andAdministrators who deliver specialty medicine to the public. Heis a graduate of VMI (Purdue’s Veterinary management Insti-tute), a Trustee andDirector of the Helping Pet’s Foundation andis the first non-veterinarian to be named to the Board of Direc-tors of the American Animal Hospital Association.Mr.McVey isa member of the Editorial Advisory Board of Veterinary Eco-nomics and firstLine Live magazines and has been namedSpeaker of the year at both NAVC and theWVC.Mr.McVey lec-tures to international audiences in and out of veterinary medi-cine approximately 50 times per year.

Mark your calendars for these exciting continuingeducation seminars. As always, seminars are held

at Dave and Busters in Concord.

2009SEMINARS

Dave & Busters, Concord, SouthEast corner of Hwy’s 400 & 7120 InterchangeWay, Concord, ON. L4K 5C3

(905) 760-7600



SPONSOR: IDEXX Laboratories

SPEAKER BIOGRAPHY: Dr. Lynne O’Sullivan

• Graduated fromDVMprogramat the Atlantic VeterinaryCollege, University of PrinceEdward Island, 1998

• Small Animal Internship atOntario Veterinary College,University of Guelph, 1998-1999

• Residency and DVSc in cardiol-ogy at the Ontario VeterinaryCollege, University of Guelph,1999-2003

• Board certified in Cardiologyby ACVIM in 2003

• Has been a faculty member at the Ontario Veterinary Collegesince 2003

• Research interests include: echocardiographic assessmentof systallic and diastolic function, dilated cardiomyopathy,mitral valve disease and therapeutics.

ElectrocardiographicInterpretationSPEAKER: Lynne O’Sullivan,DVM, DVSc, DACVIM(Cardiology), Ontario Veterinary College

Electrocardiography is essential in the evaluationof small animals with arrhythmias or abnormali-ties of heart rate, and inmonitoring the anestheticpatient. Veterinary technicians play a central rolein the acquisition of the electrocardiogram (ECG)and in patient monitoring, therefore the ability tounderstand basic ECG principles and to interpretan ECG are invaluable skills. The utility of and in-dications for an ECG will first be considered. Thetechnique of acquiring an ECG and the principlesunderlying the generation of the ECG will bereviewed, along with technical tips for achievinghigh quality tracings. The normal movement ofelectricity through the heart (the anatomy andfunction of the normal cardiac conductionsystem) and how this relates to the findings on anormal ECG will be discussed. Finally, clinicallyrelevant rate and rhythm disturbances in smallanimals will be discussed by working through aseries of ECG cases that will be provided. Asystematic approach to interpreting ECGs will beused. Cases may include bradyarrhythmias (slowrhythm disturbances) such as sinus bradycardia,heart block, sick sinus syndrome, and atrial stand-still, and tachyarrhythmias (fast rhythm distur-bances) such as ventricular prematurecontractions, ventricular tachycardia, supraven-tricular premature contractions, supraventriculartachycardia, and atrial fibrillation. The recognitionof ECG abnormalities, the clinical relevance of theECG findings, and basic treatment principles willbe highlighted.

HOSPITAL PERSONNEL SERIESWednesday, November 11



A diagnosis of acquiredmegaesoph-agus was made based on the survey ra-diographs. Megaesophagus is classifiedas either congenital, acquired secondary,or acquired idiopathic. Some condi-tions associated with acquired second-arymegaesophagus includemyastheniagravis, hypoadrenocorticism, SLE,polymyositis and lead intoxication. Hy-pothyroidism is currently not thoughtto be a significant related disease. Inorder to identify any associated under-lying conditions, further diagnostic testswere performed including:

1. ACTH Stimulation test:• Resting 85 nmol/L (28-124 nmol/L)

• Post 579 nmol/L (28-550 nmol/L)

These results show an exaggeratedresponse of the adrenal glands and arenot consistent with hypoadrenocorti-cism.

2. Acetylcholine Receptor Antibody testwas also found to be within normallimits at 0.15 nmol/L (0.0-0.6),which

would rule out myasthenia gravis.Other diagnostics recommended

were an ANA, serum lead levels andupper G.I. endoscopy but the ownersdid not wish to pursue further evalua-tions. A tentative diagnosis of idiopathicmegaesophagus was made.

The dog responded well tointravenous fluids and antibiotics andmultiple, daily elevated feedings.He was discharged to the owners forcontinued supportive care and iscurrently stable after several months.

DISCUSSION

The exact pathology associated withidiopathic acquired megaesophagusremains unknown, although it is specu-lated by some sources that esophagealdilation is related to an abnormality inan afferent neural pathway.

The majority of cases of adult-onsetmegaesophagus are deemed to beidiopathic. Any underlying conditionsthat are identified should be treated.In these cases, the treatment andmanagement of the cases are mainlysupportive and can be labour intensivefor the owners.

Prokinetic drugs such as metoclo-pramide and cisapride are commonlyused, but in most cases do not help toincrease esophageal motility, as roughly80% of the canine esophagus iscomposed of striated muscle andresponds poorly to the aforementionedmedications. These drugs may increasethe tone of the lower esophagealsphincter, which might decrease refluxfrom the stomach, however could alsoexacerbate the regurgitation and reten-tion of fluid and food that remains inthe esophagus.

More recently some clinicians havesuggested the use of bethanecol,a cholinergic agent which hopefullymight help increase esophagealmotility.

The mainstay of management isrelated to feeding multiple smalldigestible (either in a slurry ormeatball

form), in an elevated or uprightposition. Maintaining the pet in anelevated position for 10-15 minutespost-prandially can also help to decreaseepisodes of regurgitation. In somecases, the placement of long-termfeeding tubesmay be of benefit inmain-taining nutrition.

Retention of fluid and food in theesophagus can result in esophagitis.Gastro-protectants such as Sulcrate canbe used for supportive care.

The most common complication ofmegaesophagus is aspiration pneumo-nia, which can significantly decrease theprognosis, should it occur concurrently.Owners should be advised that clinicalsigns of coughing, dyspnea, lethargy,pyrexia and/or a muco-purulent nasaldischarge requires immediate attention.Confirmation of pneumonia should bebased on thoracic radiographs and willgenerally require intensive IV antibiotictherapy.

The prognosis for idiopathicacquired megaesophagus remainsguarded to poor and owners shouldbe made aware of the associatedcomplications and the accompanyingclinical signs. Owners should beprepared to commit a significantamount of time inmanaging these casesat home.

References:Boria PA,Webster CRL, Berg J: Esophageal achalasiaand secondary megaesophagus in a dog. CanVet J2003;44:232-234.

Gelberg HB: Alimentary System. In McGavin MD,Zachary JF (eds): Pathologic Basic of Veterinary Dis-ease, 4th ed. Philadelphia, Mosby Inc., 2007, pp 321-322.

Jergens AE: Diseases of the Esophagus. In Ettinger SJ,Feldman EC (eds): Textbook of Veterinary InternalMedicine, 6th ed. Philadelphia,WB Saunders, 2005,pp 1304-1306.

Washabau RJ: Gastrointestinal motility disorders ofdogs and cats. World Small Animal Veterinary Associ-ationWorld Congress Proceedings 2005.

Webb AA, Taylor SM,McPhee L: Focal myastheniagravis in a dog. CanVet J 1997: 38: 493-495.

What’sYourDiagnosis:Continued from page 9

Animal BehaviourConsultantsBehavioural Assessments

of Problem DogsFocusing on Canine Aggression

and Anxiety

Kerry Vinson, B.A. (Psych), Certificates in Canine Behaviour Problems

Krista Nelson, DVMTorontoVeterinary Emergency Hospital21 Rolark Drive, Toronto416-247-8387



encounter a very important room in the hos-pital. The central IT room. There are 75computer work stations in the hospital and17km worth of cables and wires runningthroughout to enable the whole system(which can even be accessed remotely)! Thehospital even has a wi-fi network set up sothat all staff blackberries actually transferonto the hospital system as you enter thebuilding. Staff can page veterinarians in thehospital directly on their blackberries whenthey are in the building and as they exit thebuilding, it automatically disconnects fromthe system. I see a small room full of blue ca-bles and amonitor onwhichwe see live-feedvideo of the reception area and parking lot.There are 7 security cameras, both internaland external. They enable staff to view areasof the hospital from anywhere in the build-ing. Being a 24 hour facility, security was amajor concern. At 11pm, all hospital doorslock automatically. When an emergencycomes in after hours, they simply press a

button inside the main double doors andstaff can view the door before allowing entry.It is also a benefit for staff to be able to viewthe exterior perimeter of the building beforetaking a dog out for a midnight stroll. Thelocks on the doors throughout the buildingare similar to those youwould find in a hotel.They use a key card system.Every staff mem-ber has a key card and staff members willhave different levels of access. The cards canhelp keep people in, or out! You can evenlock doors with the cards. Interestingly, thissystem has programs built in that actuallyrecord which cards have been used at whattimes. You can actually track who went inand out of each door and when. From amanagement standpoint, this can be quitehandy. It is quite a state-of-the-art systemandwill hopefully keep everybody, includingthe patients and clients, safe and sound.

In this last hallway we find the doctorsand administrative offices. 10 cubicles enablethe veterinarians to have their own spacewhile being able to interact as necessary.Theco-operative philosophy of this practice is

built on the ability of each veterinarian andtechnician from each specialty towork cohe-sively – the offices are designed to enable thisbehaviour. Next door is the administrativeoffice. The practice has a hospital managerand CEO, Sandra Kent who works closelywith Jade LeMasurier (office manager) andBrandonHall (communicationsmanager) tokeep the 52 staff members, patients andclients happy!

The protocol for patients in the hospitalis that, after initial recovery post-procedure,they go downstairs where they can be closelymonitored by the critical care/ICU team.Thechemopatients are the exception to this rule.With their suppressed immune-systems itwas decided that they will be contained tothis ward,with other chemopatients, to sim-ply reduce their risk of exposure.

I was thrilled to find out, as an RVTmy-self, that there are 8 RVTs in ICU, 5 in ER, 2in surgery, 2 in IM, 1 in radiology and afloater. They are encouraged to completespecialty training and all are being cross-trained so that no area will be short staffedunder any circumstance. In total there are 52staff members in this hospital and most arefrom the core staff of the original Morning-side facility. For this reason, the original flowand unity are being enhanced and builtupon, they are definitely not starting fromscratch! Staff at all levels are encouraged tomeet new skill levels and are paid accord-ingly. They also receive benefits accordingly,everything from holidays to veterinary careallowances for staff pets are designed to growas you do!

Logging onto the clinic website,www.tveh.ca you encounter the followingmessage.Dedicated to providing multi-specialty andemergency services.Committed to education and communica-tionwith pet owners and primary veterinarycare teams.Focused on individual patient healthcare.Skill, care and knowledge when you need it.

It is a reassuring message and speaks tothe philosophy of the place and its people.

On behalf of the Toronto Academy ofVeterinaryMedicine I would like to wish Dr.Gillick and his colleagues continued successin their new home under their new name…the TorontoVeterinary EmergencyHospital.

Good luck and BestWishes!

A New Era Begins at the Toronto Veterinary Emergency Hospital




Wednesday Sept. 16My Pet is In Shape ... Round Is aShape!

SPEAKER: Bob Clement,BA, BEd, DVM,

SPONSOR: Medi-cal® Royal CaninVeterinary Diet

If you were unable to attend the Sept. 16Hospital Personnel Series Lecture, here

is a summary of what you missed.

SeminarREVIEW

SUMMARY:

Depending on the reference source the incidenceof obesity in dogs and cats inNorthAmerica varies from25-40 %. It is a world wide problem and parallels theproblem of obesity in the human population. Whenpolled during the presentation the overwhelmingmajority admitted that weight loss was not a priority ofthe veterinary clinics of their experience.

Excess weight is clearly a risk factor for many clin-ical problems – orthopedic disorders, endocrinopathies,cardio-respiratory disease , incontinence, cancer – andhas been proven to decrease life span by up to 15%.It compromises our efforts to assess our patientsphysically, chemically and with imaging techniques.It complicates anaesthesia, surgery and medical man-agement.

Furthermore white adipose tissue has been foundto be the largest endocrine organ of the body producinginflammatory mediators. It is not only a risk factor fordisease but a disease in its own right.

The presentation addressed strategies to createrecognition for the need for weight loss and thelanguage necessary to come to a “ yes” decision to thebenefit of the pet. In addition avoiding obesity in thefirst place was emphasizedwith educating the pet ownerabout body condition scores, measurement of food,allowing for treats and factoring in appropriate exercisefor the growing pet.

Weight loss diets coupled with weight lossprograms were discussed with emphasis on the part-nership between the pet owner and the clinic and theneed formonitoring, problem solving and positive sup-port.

Veterinary clinics advocate for the pets that can’tspeak for themselves. The opportunity to impact on thequality and longevity of life is huge.



improve the quality of course materialsover previous sessions and the goalremains to help international veterinarygraduates secure employment in theirprofessional field.

When an international veterinarygraduate lists “VSTEP” as part of theireducation experience, it is worthwhileunderstanding that 95% of VSTEPinstruction is provided by active orrecently retiredOVC faculty.The balanceof the instruction comes from active orrecently retired practitioners. Approxi-mately 100 hours of the program arededicated to bovine, ovine and equinemedicine.The balance of the coursema-terial stresses companion animals.

Pathology instruction includesanatomical and clinical componentsdelivered using classroom lectures,clinical pathology and necropsy labsand participants are invited to attendnormally scheduled pathology roundsat the OVC. Instruction is either lecturestyle or case-based. An ability to recog-nize and describe lesions of commondisease problems, formulate a list ofdifferential diagnoses, develop an effi-cient diagnostic plan, interpret testresults and perform basic laboratoryprocedures including a post mortemform key components of this module.

Radiology provides instruction onthe principles of radiology, radi-ographic safety and techniques.Through in-class presentations, practi-cal lab experiences, web-based studyand the review of modern text books,participants learn to recognize normaland abnormal radiology of the respira-tory, cardiovascular, gastrointestinal,urinary and musculoskeletal systems.

The Pharmacology/Pharmacy/Tox-icology module stresses rational drugtherapy through an integrated under-standing of drug factors, host factors

and disease factors, with emphasis onclinically relevant properties of selectedmajor drug classes commonly used inveterinary practice. Topics include anintroduction to clinical pharmacology,general therapeutics and therapy oforgan systems. The Pharmacy compo-nent stresses prescribing rules andconventions and this year saw the addi-tion of six hours of clinical Toxicology.

The Anesthesia module includeslectures, labs, and case-based problemsolving providing instruction inmodern regional and general anesthet-ics. Included in the material presentedis care and use of equipment includinginhalant anesthetic machines andmulti-parameter monitoring equip-ment, techniques for catheter place-ment and endotracheal intubation,selection and dosages of pre-medica-tions, maintenance anesthetics andfluid therapy and the management ofpatient recovery and anestheticemergencies. Multiple live animal labsprovide opportunities to put classroomlearning into practice.

Surgery instruction is delivered usingclassroom lectures, DASIE suturing labsand live animal labs where each partici-pant ultimately performs two canineovariohysterectomy surgeries.Proper pa-tient preparation, instrumentation,drap-ing and suturing are taught andpracticed.Woundmanagement, surgicalconditions of the abdomen and urogen-ital tract are stressed in detail and generalprinciples of oncologic, orthopedic andspinal conditions of the dog and catround out the learning experience.

Companion Animal Medicineconstitutes a significant component ofthe programwith participants receivinginstruction in the disciplines ofdentistry, ophthalmology, dermatology,urology, neurology, gastroenterology,cardiology, hepatology, endocrinology,oncology, pediatrics and geriatrics.

Preventive medicine fundamentals anda series of actual case based interactivesessions are used to stress practicalapplications of these disciplines. Liveanimal labs teaching proper examina-tion techniques in dermatology,ophthalmology and neurology are usedto emphasize classroom learning.

Modeled and developed by the sameinstructors that brought Clinical Com-munication Skills training to the DVMundergraduate program, VSTEPprovides its participants with the samein-class lectures, videotaped simula-tions, self reflection and feedback frompeers and coaches. The result is aninternational veterinary graduate betterprepared to handle the nuances ofcommunicating with today’s NorthAmerican veterinary clientele.

This year saw the addition of livesimulated client encounters requiringthe VSTEP participant to collect ahistory, develop a list of differentialsand get agreement from the client on adiagnostic plan based on a fee estimate.

VSTEP graduates have securedpositions as practicing veterinarians inlarge urban centres (Toronto, Chicago,New York, Detroit, Miami, San Diego,Honolulu) small urban centres (Wind-sor, Brantford, Brampton, RichmondHill, Saskatoon, Jersey City, London,Barrie, Lethbridge, Chatham, Rich-mond) and smaller rural communities(Southampton, Keswick, Port Elgin,Watford, Cavan Hills, Gananoque,Pembrooke, Ripley).

If you would like to learn moreabout VSTEP, please contact eitherAlec Martin or Jennifer Thurtellat (519) 767-6564 or by [email protected] [email protected].

Veterinary Skills Training & Enhancement Program


E. Alec Martin DVM, ProgramManager,Veterinary Skills Training & Enhancement Program100 Stone RoadWest – Suite 204, Guelph, Ont. N1G 5L3Phone: (519) 767-6564 Website: www.vstepontario.org



“San Diego Zoo's new panda cub is a boy”The Associated Press, Sept. 3rd, 2009

SAN DIEGO – The panda cub born at the SanDiego Zoo nearly a month ago is a boy.

The zoo said the yet-to-be-named cub'smother briefly left the den Thursday, allowingveterinarians to examine the 2.8-pound babypanda for the first time.

Senior zoo veterinarian Geoff Pye says thecub is healthy and starting to show its black-and-white markings. He says the cub hasreached its "initial cute stage" and is "very rolypoly."

The tiny cub's birth on Aug. 5 attracted somuch traffic to the zoo's Web site that the on-line Panda Cam camera feed crashed. The zoo'sblog also went down for a period.

“Defend your bulbs from garden pests”The Star.com, Sept. 9th, 2009

Bulbs are perfect self-contained packages forgardeners. They're equipped with everythingnecessary to make flowers grow and bloom.Problem is, that makes them a prize for preda-tors, too.

"The perfect lunch box," said Leonard Perry,an extension professor with the University ofVermont. "Put them in the ground this fall andI guarantee you the plant pests will come."But there are ways tominimize animal damage,and it begins by not underestimating your ene-mies. Squirrels, chipmunks, rabbits, deer,mice,voles, moles and the many other critters thatfeast on flower bulbs are crafty. Observant, too."Just the fact you're disturbing the earth is a tip-off," Perry said. "These guys are curious. They'llknow something is going on and come to in-vestigate. Once they discover the newly plantedbulbs, they'll assume it's food for getting themthrough winter and there you go. So much forany spring flower displays."

Deer and rabbits like grazing on the tenderstems as they surface in early spring. Squirrels,chipmunks, voles and moles, among others,often dine underground. That requires design-ing a bulb defence in layers.

Here are some proven deterrents. For bestresults, use them in combination:– Pest-resistant bulbs. Tulips are deer magnetsbut other, less appetizing bulbs are ignored, saidBecky Heath, co-owner of Brent and Becky'sBulbs in Gloucester, Va. "In populated areas,where hunting is dangerous and there are no

natural predators, deer have become brazen,going right up to the front door to eat some-thing in a pot on a porch," she said. "Chooseplants that either taste bad or are (naturally)poisonous." Inter-planting daffodils or alliums,both deer-resistant bulbs, among the more de-lectable tulips also can be effective.– Fencing,wire covers, cages and other barriers.Voles, moles and chipmunks are notorious fortunnelling their way to bulbs, shrubs and treeroots. "Put a wiremesh cage around themwhenyou plant," Perry said. Fencing is expensive, butit will keep deer out of the garden. Build themat least twometres high, however, since deer areexcellent jumpers. An electric fence is anothergarden option.– Unpleasant smells and flavours. "We put bulbsin a plastic bucket and spray them with some-thing that tastes nasty (but) that's not necessar-ily poisonous," Heath said. "Let the spray dryand then plant the bulbs. For insurance, weoften spray the ground when the new shootsbegin to emerge."Many such repellents are soldand most come with strict guidelines for theiruse. "We usually get people to check with theirlocal extension agent to see what's allowed ineach area," Heath said.

Lights, sprinklers and barking dogs.Motiondetectors attached to water sprinklers and spot-lights can be effective. "A tethered dog oftenworks," Perry said. "But it doesn't take long fordeer to learn the length of the tether and ignoreit."Other ideas:

Try planting closer to the house or givingbulb-eating animals a distant, alternative gar-den of their own.

Shooting and poisons are the ultimate sanc-tions, but both comewith safety concerns: Bothrisk injury or damage beyond the intended tar-get.

"I don't like using poisons even if you don'thave kids or pets," Perry said. "They can worktheir way into the food chain and get into edi-bles. I'd much rather use biological controlssuch as burying bulbs with something unappe-tizing like ground-up shells."

Trapping is yet another alternative, althoughmany communities have rules against relocat-ing wild critters. Check with city hall beforemaking any moves.

Successfully controlling animal pests aroundthe yard will depend on your timing, methodsand resolve. Be aware that what may haveworked previously for you or a neighbour maynot work again. "Use a few different things indifferent areas to stay ahead of the game," Perrysaid.

“Vet says Edmonton elephant Lucy should-n't be moved”TheStar.com, Sept. 14th 2009

EDMONTON – Edmonton's Valley Zoo saysan independent veterinarian has ruled thatmoving the city's lone elephant could threatenthe animal's life.

The vet, Dr. James Oosterhuis, says Lucy hasbreathing problems that would make travelperilous.

The city released the opinion ahead of a visitthis week by game show host Bob Barker.He and other celebrities, including WilliamShatner, have argued that Lucy's isolated exis-tence is tantamount to torture.

They are urging that she be sent to liveamong elephants in a refuge in the UnitedStates.

Lucy is 34 – the average lifespan for such an-imals is 45 years.

“’Lonely cat lady' is not so catchy,”Globe andMail, Sept. 14th, 2009

Whatmakes a crazy cat lady? Is it the number ofcats, the amount of cat-hair-covered sweaters sheowns, or simply the intensity of devotion be-tween female and feline?

A new documentary explores the world offour CCLs (crazy cat ladies) and explodes someof the uglier stereotypes that cling to thesewomen like the faint stench of cat urine.

The appropriately titled Cat Ladies, whichwill air in Ontario on TVO Sept. 23, 27 and 30,documents the lives of Margot, a receptionistwhose life revolves around her three cats; Diane,a former banker who shares her home with 123felines and fears that her life is slipping out ofcontrol; Sigi, who pursues cat rescuing with thegrim determination of a soldier; and Jenny, 35-year-oldwomanwith 17 animals who is fightingthe siren call of full-fledged cat-ladydom.

It's an emotional story about solitude andlove, but it's also a tale of the nasty undercurrentof misogyny that runs through our culture.

"The stereotype is so dismissive," directorChristie Callan-Jones says. "I was surprised attheir feistiness, their independence. They choseto buck social trends. I thought it would end upbeing this film about sad lonely women but it'sreally not.These women aremore thanwho youthink they are."

"Most people would never know I have a catproblem," Jenny says. Indeed, as an attractivewoman with a successful career as a real-estateagent, she is themost outwardly "normal" of thebunch. She has friends, she has hobbies - she justalso has a whole lot of cats.

The significance of that is not lost on her. "Ihave this sickness where I need to take care ofsomeone, and I don't have a husband and kidsto take care of. I've always only hadmy animals,"says Jenny,who grew upwith an alcoholic fatherand learned early on to take solace in the con-stancy of felines. "These guys take care of me byletting me take care of them."

Almost by definition, being a cat lady meansthat a woman has chosen to shun the socialnorms of marriage and childbearing,whichmaybe one reason why society so harshly judges thefur-covered.While the moniker crazy cat lady issometimes used fondly or humorously,when ex-

In theNEWS

Continued on next page



amined, it's a clear example of feminist backlash.Throughout sexual maturity, women are re-

ferred to in feline terms - from sex kitten tocougar, and of course there's the popular vulgarslang for female genitals.Onlywhen they step outof line are females referred to in canine terms, asbitches.Women are expected to identify a bit withcats, but there's an invisible line that, whencrossed, triggers the cat-lady stigma. Tellingly,there's no corresponding crazy dog man (orwoman) stereotype.

"It's this idea about male appreciation," pro-ducer Jeanette Loakman says. "Dogs are faithful,and they're obedient. If you have a lot of catsyou're uncontrollable and unpredictable. You'renot going to be obedient."

For the most part, the women profiled in thedocumentary are incredibly self-aware.

At first blush,Margot seems like a cheerful ec-centric. She collects shedwhiskers in a special boxand unabashedly shares that she once had adream about breastfeeding her cats. But then adarker truth emerges. Adopted into a high-achieving family as a toddler,Margot says she al-ways felt different. "My cats, that's what savedme.... They accepted me for who I was."

In a heartbreakingmoment of candour late inthe film, she says, through a tight smile: "I thinkthat a lot of people don't know that I'm as lonelyas I am."

ForDiane, the cat-rescuing habit spiralled outof control after she was laid off from her profes-sional career. "I used to be a business person.NowI'm a cat lady," she says. "It's not good," she adds,recounting how she's given up friends and travel.Echoing Margot, she says, "It saves the cats but itdoesn't save me."

Of the four women, Sigi is the most militantand least apologetic about her cat-collectingways,to the dismay of her neighbours in Kitchener-Waterloo, Ont., who can't use their backyardwithout being assailed by the odour of hundredsof cats. She'd like to adopt out the animals, shesays - but only so she could bring another 100 intoher house.

"I think I'm a lot more sane than the peoplethat can handle leaving a cat out in themiddle ofwinter to freeze to death or starve to death," Sigisays. "I think that's crazy."

“Toronto woman may face animal crueltycharges after cat falls 22 storeys”680NEWS, Setpt 2nd, 2009

Toronto - Cruelty charges are being consideredagainst a Toronto cat owner after the animalsurvived a 22-storey fall from an apartmentwindow.

The cat, Layla, sustained two broken legs inthe fall this past June, but a Toronto HumaneSociety official alleges the owner refused to gether medical help.

It's alleged that the cat's owner took her to avet, but balked at paying for surgery to fix herlegs and repeated calls from the vet went unan-swered.

Cruelty officer Jerry Higgins said it took twocourt-ordered warrants and two weeks to get

possession of the cat, with help from police.Layla will be well enough to leave hospital in

a day or so, and the Humane Society will try tofind her a good home at ground level.

“‘If zoo gets giant pandas, beavers out ontheir tails,”TorontoStar.com, Sept. 24th, 2009

A Toronto Zoo with no beavers?Senior zoo staff are warning that Canada's

iconic animal might have to be banished if thezoo board single-mindedly pursues the dreamof obtaining giant pandas from China.

The zoo's management committee recentlyvoted to make it a priority to obtain a pair ofpandas for long-term display. It suggested the$15 million cost for a panda pavilion might bedrawn from plans to redevelop the zoo's north-ern sector.

Trouble is, that's where Canadian animals areto be displayed.

Pulling $15 million out of the $33.8 millionbudget for the northern sector project meanssomething else would have to be cut, says a re-port from acting chief executive officer PeterEvans.

"It is very likely that in order to accommo-date the reduced budget, exhibits such as thegrizzly bear and beaver and otter would be elim-inated, and the Canadian Wilderness Orienta-tion Centre would need to be reduced in scope."

If the zoo wants pandas badly, the reportsuggests, the board should increase the budgetby $15 million and try to raise money else-where.

The issue will go to the next meeting of thezoo's board on Oct. 2.

Zoo chair Raymond Cho said he'd like tohave pandas but cautioned that all factors haveto be weighed.

"We have to be very, very careful," Cho said."I don't think we should give up Canadian ani-mals."

He noted there's no guarantee the Chinesegovernment will let Toronto have a pair, anyway,and the price could be too steep. Over a decade,the costs of keeping pandas would probably ex-ceed the extra revenues they bring in, the analy-sis says. Including a pavilion, the net cost couldbe as much as $19 million over 10 years.

There are other costs in the short term. Theboard's fundraising committee wants to send adelegation to China at a cost of $63,000. And itrecommends spending $20,000 on a lobbyist

“Clyde's Outback adventure”,TheStar.com, Sept. 17th 2009

HOBART, Australia–A cat named Clyde wasreunited with his owner yesterday after a mys-terious three-year odyssey in which the long-haired Himalayan strayed 3,800 kilometresinto the Australian Outback.

Ashleigh Sullivan, 19, said she had given uphope of ever finding Clyde after he vanishedwhen he was about 1 year old from her familyhome near Hobart city in Australia's islandstate of Tasmania.

"I'm positive he remembers. He's not actinglike he's suddenly appeared somewhere and isfrantic," Sullivan said as she tearfully held hercontented cat.

A nurse found Clyde wandering at a hospi-tal in the remote Queensland state town ofCloncurry and cared for him for four monthsbefore taking him to a local vet as she was leav-ing town and could not take the cat with her.The vet, Donna Weber, traced Clyde's ownerfrom an identification microchip that wasimbedded under the cat's skin.

But no one has a clue how Clyde managedthe 300-kilometre sea journey across the BassStrait from Tasmania off mainland Australia'ssoutheast coast, and then more than 3,200kilometres overland to Cloncurry, deep in thearid interior of the Outback.

An animal transport company returned thecat to Hobart for free – flying the feline most ofthe way.

"It's pretty special to have him back." Sulli-van said. "I'm overwhelmed."

“Government to rethink petting farms ad-vice after children hospitalised with E.coliinfection”MatroNews.ca, Sept. 20th, 2009

LONDON - The British government says it willreview guidelines for petting farms after anE.coli outbreak at a farm in southeast England.

The Department of Health said in a state-ment Sunday that it has asked advisers to reviewguidelines for visitors to open farms in the lightof the outbreak.

The Health Protection Agency says there are64 cases of E.Coli 0157 linked to a GodstoneFarm in Surrey.Nine children are in hospital andtheir condition is described as stable.

Health officials do not currently adviseagainst touching animals but suggests anyonevisiting a farm wash their hands thoroughly af-terwards. Godstone Farm is closed last week andthree other farms have also since closed.

E.Coli can cause diarrhea, vomiting andmaylead to kidney failure.

“Cat alive in the rubble 4 weeks after fire,”TheStar.com, Sept. 10th, 2009

FRANKLIN, Ohio – A woman's pet cat hasbeen found alive, buried beneath debris 26 daysafter an Ohio fire.

Sandy LaPierre says she assumed 1-year-oldSmoka had died from the Aug. 10 fire inFranklin, about 30 miles (48 kilometres) northof Cincinnati. The blaze broke out in a buildinghousing a flower shop and LaPierre's second-floor apartment.

A demolition company moved in to teardown what was left of the building the day afterthe fire. A crew from Stark Wrecking Co. cameback Sept. 4 to clear away the rubble and foundSmoka's head sticking out from under 16 feet(nearly 5 metres) of debris.

LaPierre says her female cat lost a lot ofweight and has been gobbling down food tomake up for it. She says Smoka has some diffi-culty walking but otherwise seems OK.


thescalpel oct09.pdf

Documents