Cushing’s disease: an update!

By Doreen M. Houston DVM, DVSc, Diplomate ACVIM(Internal Medicine)

Since I graduated in 1980, veterinary medicine has ex-panded in knowledge and diag-nostic capabilities. As a result of increased awareness and screening, canine Cushing’s

disease (hyperadrenocorticism or HAC) is being diagnosed (and over diagnosed) in a large number of dogs. What do we really know about canine Cushing’s disease? What clinical sign(s) are pathognomonic and which are suggestive of the disorder? How is Cushing’s best diagnosed, treated, and monitored? What happens if we elect not to treat? The answers to these questions follow.

In about 85-90% of dogs, Cushing’s disease is caused by bilateral adrenocortical hyperplasia as a result of a pituitary tumour (adenoma or carcinoma) producing too much adrenocorticotrophic hormone (ACTH), which causes the adrenal gland to overproduce steroid hormones. Pituitary dependent hyperadrenocorticism (PDH) affects primarily older, female, small breed

Evans syndrome: breaking down IMHA and ITPBy Amy Breton, CVT, VTS (ECC)Veterinary Emergency & Specialty Center of New England

Immune-mediated hemolytic anemia (IMHA) can occur due to primary (idiopathic) or secondary (virus, bacteria, parasite) causes. Approximately 60-75% of dogs develop primary idiopathic IMHA rather than secondary. In both primary and secondary IMHA the immune system destroys red blood cells prematurely, faster than the rate at which new ones can be produced. It is not known what triggers this inappropriate antibody production in primary IMHA but it is thought that antibodies may bind to two different red blood cells, which in turn, cause the cells to clump together.

Immune-mediated thrombocytopenia (ITP), also known as Evans syndrome and by the acronym IMP, occurs due to primary (idiopathic) or secondary (e.g. drug reaction, neoplasia) causes. While IMHA involves

Cushing’s disease continues on page 6

InsideWinter 2013 issue

Vol.5, No.1

Return undeliverable Canadian addresses to3662 Sawmill Valley DriveMississauga, Ontario L5L 2P6Publications Mail Agreement #41262570

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Terrilee Robinson and Fergus. Celtic Creatures Veterinary Clinic, Sydney, NS.

3 Life of a Vet Tech

8 The role of the technician in forensics

10 Reptile and amphibian husbandry basics

11 Training Tips

12 SAVT News

13 Industry News

13 Canadian Vet Tech Update

14 Continuing Education Calendar

14 CVMA News

A neWsmAgAzine for AnimAl HeAltH tecHnologists And VeterinAry tecHniciAns

ER Triage continues on page 4

ER triage: the vet tech’s role HALIFAX, NS – In emergency medicine, it is rare that a patient presentation follows a standard SOAP format: Subjective, Objective, Assessment, and Plan. ER physicians and techs do not have time to write down a history, or give detailed dictations about a physical before instituting treatment. So their thinking must be a little different, explained David Liss, RVT, VTS (ECC), speaking at the Atlantic Provinces Veterinary Conference. He said the immediate concerns are identifying patients that need care immediately, and then rapidly instituting life saving measures that are proven to reduce morbidity and mortality.

Triage Mr. Liss said that knowing what is coming in is half the battle. Telephone triage tips include recommending a visit to the veterinary hospital, providing limited

Evans syndrome continues on page 7

Dr. Doreen Houston with grandson Bennett

f10705CLIENT: P&G ACC. MGR: Bree PROD. MGR: Sharlene

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A neWsmAgAzine for VeterinAry tecHnologists And tecHniciAns

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I was born into a family that loves animals, so I came by my current hobby naturally. We had a raven named Wonderful flying around the house when I was a kid, and innumerable other strange critters that my mother took care of for the natural history museum in San Francisco.

I began working with wildlife as a rehabilitator in Connecticut, where I obtained my first licence. I brought my interest with me to Saskatchewan in 2001, and quickly connected with the Western College of Veterinary Medicine (WCVM). They were skeptical that songbirds could be rehabilitated, but decided it was worth trying as an alternative to euthanizing otherwise healthy orphaned birds.

It has grown from that day forward, including several years appealing to the governments for permits before finally being approved in 2005. That year, I took in 20 animals. By the summer of 2009, it was clear I needed to access funding. I incorporated and created Living Sky Wildlife Rehabilitation (LSWR), obtaining federal charitable status in order to access donations and grants.

The numbers continue to grow: 2010 saw 159 admissions; 2011 had 222 animals come in, and in 2012 we had over 325. I have a large number of volunteers as the demands are far beyond my ability as one individual. In 2012, I hired a part-time employee to provide care during the day while I am at work.

The growth of the provincial Wildlife Hotline, run by the Wildlife Rehabilitation Society of Saskatchewan, has contributed significantly to the visibility of wildlife rehabilitation in the province. I re-started this organization in 2006 with a group of other dedicated folks interested in supporting Saskatchewan wildlife. I have had to step back from the provincial organization with the increased responsibility of running LSWR, but I remain involved in organizing the trainings in the spring.

Each year is a new experience, and an opportunity to learn and grow my skills. I often wish I had the official training of a vet tech behind me, so I am very happy I have so many wonderful techs as volunteers!

This is a short version of my day in mid-summer:5:30 a.m. – Roll out of bed - put on raccoon outfit and gloves. Mix formula. Remember heater, towels, bottles, and other supplies. Try to only wake one at a time to feed them, but this is impossible because they all crawl out and start screaming. Feed one while scratching the others to reduce the decibel levels. 6:15 – Danyelle arrives and starts cleaning the duck tubs while the ducks are swimming. 6:45 – Raccoons are finally done! Change cloths, wash up, and prepare baby bird formula. Check on foxes and replenish food/water.7:00 – Wake up each bird, one at a time; weigh, clean, feed. Check weight for gain from yesterday. Make note to tell Shelagh to feed more or monitor this one today. 7:30 – Danyelle’s leaving. She got most of the ducks done, and there are only 2 tubs left. Finish the ducks and continue to weigh, clean, and feed birds while letting ducks have some extra swim time. Feed skunks and outside ducks.

8:30 – Shelagh arrives – YEAH!! Brief her on what’s changed since she left yesterday at 7pm: (We got in a new batch of ducklings that need mealworms; the Grackle lost weight; the finch is ready for the flight cage; I saw the crows picking at their food.)9 a.m. – Ready and off to work for a few hours.12 p.m. – Pick up 2 nestlings from the vet college; Shelagh examines, weighs, gets them set up in their new nest. Ralph is swimming ducks for the noon swim. Feed raccoons again; check feeding charts; feed birds that are due; grab myself a bite to eat upstairs and dash back to work (late, as usual these days).5 p.m. – Get crickets at the pet store – we got in a Barn Swallow this afternoon. The vet college has more birds to pick up. Oh, and the shipment of 20,000 mealworms has arrived at the bus depot.6:00 – Finally get home with supplies and more critters. Shelagh is madly swimming ducks as the volunteer had to cancel for tonight. I take over ducks and let her intake the new arrivals, feeding birds in between other tasks. Haley shows up with another duckling – that makes 56 now in 8 tubs. New duckling is admitted, examined, stuffed with mealworms, swum, and put in with 4 others from yesterday. Monitor how they get along; yes, the newbie is being accepted sufficiently. Keep feeding birds. Time to feed raccoons…. Put Haley to work for a bit, swimming ducks.7 p.m. – Poor husband asks how many are staying for the supper he is making (he takes over all household duties while I go crazy in the spring and summer. We would not eat if he did not shop and cook for us). Keep swimming ducks, cleaning tubs, and feeding birds. Shelagh escapes for the night. Feed skunks, foxes, and outside ducks.8:00 – Supper is ready. Do a quick round of feeding, then wash up and spend 15 minutes sitting (aaaahhhh). Time’s up, and its back to work feeding birds again. 9:00 – Start swimming ducks again…. Keep up with hungry birds, and clean cages for the night.9:30 p.m. – Sharon arrives (phew!) and helps clean and feed birds for the night.11 p.m. – Cages are clean, birds are fed, and I get to turn out the lights so the birds go to sleep. Prepare raccoon formula, change, and feed raccoons while nodding off….Clean up, and prep for the morning. Sharon takes off.12 a.m. – Crawl upstairs, clean up, and sink into bed.

Some might call me crazy, and they’d be right. But the opportunity to give these animals a second chance is worth all the time and energy. The joy of watching an animal run or fly free, realizing and enjoying their freedom is overwhelming, knowing they would otherwise be dead.

Ms. Shadick is always in need of volunteers, and the province desperately needs more rehabilitators. Please consider taking the Basic Wildlife Rehabilitation Course on March 30/31, 2013 (www.theiwrc.org), and enjoy the exhilaration of providing an animal a second chance. Feel free to contact her at jshadick@sasktel.net for more information or to volunteer.

Jan Shadick, Licenced Wildlife Rehabilitator, Living Sky Wildlife Rehabilitation

“Some might call me crazy” – a day in the life of a wildlife rehabilitator

Life of a Vet Tech

Winter 20134

Nursing observations Nursing interventions (with DVM order as needed)

1. Fluid balance* Mucous membrane colour, feel, CRT, skin tent, sunken eyes?

Administer fluids, increase rate, decrease rate, change fluid therapy plan as needed

2. Oncotic pull* Skin texture, edema, chemosis

Nutrition, colloid support, massage if edema present

3. Glucose* Weakness, lethargy, hypo/hyperglycemia

Administer insulin, dextrose support, monitor blood glucose levels

4. Electrolytes* Collapse, weakness, hypoventilation, ECG changes, hypo/hyper Na, K, Cl, Mg, PO4, Ca

Administer antidotes or supplement as needed, monitor patient reaction, ECG

5. Oxygenation and ventilation*

Ventilation, RR, character, orthopnea, cyanosis

Administer oxygen, supplement ventilation

6. Mentation* BAR, QAR, depressed, obtunded, stuporous, responds to verbal/painful stimuli, coma

Treat underlying disease process, administer diuretics if increased ICP suspected

7. Blood pressure* Hypo, hypertension, tachycardia (prompt to perform a BP)

Fluids, vasopressors, recheck BP at regular intervals

8. HR, rhythm, contractility*

HR, pulse quality, MM, CRT, mentation, temperature

Various medicaments, recheck BP, perfusion parameters

9. Albumin* Hypo/hyperalbuminemia None specific10. Coagulation* Tendency to bleed, primary /

secondary coagulation deficit-bleeding from catheter sites, ecchymoses /petechiae, gingival bleeding, harsh lung sounds, joint pain

Use smaller gauge catheters, avoid large vessels, only “good sticks”

11. RBC/Hgb concentration*

MM, CRT, HR, RR, pulse quality

Monitor transfusions and patient reaction

12. Renal function* UOP, BUN, creatinine, USG, signs of fluid overload

Monitor renal values, UOP measurements regularly

13. Immune status, Abx dosage, WBC count

Careful maintenance of invasive devices, nosocomial infection prevention (gloves, washing hands), properly administering medications), institute effective protocols to minimize colonization, protecting rectal thermometers, swabbing ports before injection, using as many one-time-use items as possible.

14. GI motility/ mucosal integrity*

Vomiting, diarrhea, anorexia, hematemesis, melena, hematochezia, tenesmus

Administer medicaments as prescribed, observe for as-piration, keep patient clean/dry

15. Drug dosages/ metabolism

Pediatric, geriatric pets, patients with liver/kidney dysfunction, various medications change meta-bolism (CYP450 inhibitors)

Use drug charts to assess compatibility

16. Nutrition* Poor BCS, muscle wasting, history of anorexia, GI signs (V or D)

Administering parenteral/enteral nutrition, tempting to eat, patience, not force-feeding, creating food aversion

17. Pain control* Patients crying out, shivering, hiding, tachycardic, febrile, hypertensive, tachypneic, aggressive, submissive, attention-seeking

Assessing pain using scoring systems, objective/subjective criteria, PRN orders, re-assessing after analgesic medications given

18. Nursing care/ patient mobilization*

Recumbent patient, neuro-logic, orthopedic patient

Walks, PROM, recumbent care, eye/ear care

19. Wound care/ bandage care*

Patient with bandage present Bandage changes/checks

20. Tender loving care*

Talking, petting, sitting with patients, providing owner visits, familiar toys, other items

information about possible disease processes, providing accurate directions to the hospital, advising of possible wait times, and cautioning them to be careful if their pet is in pain.

Once the animal arrives and a brief history is taken, it should be determined whether the case is critical or not. Triaging is a rough categorizing of patients, identifying which patients should be seen immediately, within hours, within days, or those patients that have expired.

Triage levels

Primary survey: TPR + ABC’s + Mentation + BPTotal physical response provides a rectal temperature, heart or pulse rate, respiration rate and effort, and often MM/CRT parameters. Mr. Liss said that adding mentation as a parameter “gets us to think that patients in shock may not be receiving adequate cerebral perfusion and be obtunded.” He added that blood pressure is mandatory on every critical patient.

Airway assessment checks for dyspnea that may be caused by upper or lower airway obstruction or pleural effusion. The rate and character of an animal’s breathing should be checked, and auscultated for wheezes/crackles. Circulation assessment involves pulse quality, assessment of both the femoral and distal pulses, and auscultation for any murmurs.

Assessment of an animal’s mentation will provide information on whether they are alert, responsive to verbal and painful stimulation, or unconscious. He noted that if the patient has a derangement in one of these parameters, they might be in shock. Signs of shock include tachycardia, bradycardia, hypothermia, hypotension, hypertension, obtundation, and tachypnea.

After all of this information has been assessed and processed the veterinary technician proceeds to diagnostics and treatments to evaluate minimum database, fluid therapy, and analgesics.

The minimum database is a collection of tests aimed at figuring out whether the patient is going to crash quickly. The database often includes blood glucose, BUN, venous blood gas, electrolytes, lactate, and PCV/TS.

Fluid therapyThe goal of fluid therapy is to increase effective circulating volume to maximize organ perfusion. Fluid options include crystalloids (e.g. lactated Ringer’s solution, Plasma-Lyte, 0.9% NaCL, or buffered solutions), colloids (e.g. Hetastarch, Dextran), and hypertonic solutions (e.g. 7.5% NaCL).

If a patient has a perfusion deficit (e.g. tachycardia, weak pulses, hypotension, or normotension with tachycardia), they will need a bolus. If a patient receives a fluid bolus, and they are not responding well, all parameters should be re-checked.

Analgesic therapy Analgesics that are best used in the acute care setting are the opioid medications. Withholding pain medication until the patient is more stable is not necessary. The pure mu opioid medications have very few side effects and are regarded as cardiovascularly-sparing at published doses.

EvaluationMr. Liss concluded by saying that once the patient has received its first set of interventions, it is time to see if they worked. The evaluation step involves both medical and nursing models to reduce morbidity and mortality. While the medical side involves re-running lab work, ordering additional diagnostic tests, etc., the nursing model will focus on the patient, not the disease, to see if interventions are effective. CVT

ER Triage continued from page 1

Critical: Causing death within minutes Respiratory emergenciesCardiac emergenciesLife-threatening hemorrhage

Emergent: Causing death within hours ShockHemorrhageSevere sepsisUrethral obstructionsCompromised trauma patients (w/o hemorrhage)Intractable vomiting

Urgent: Causing death within days Untreated infectionsDehydration

Non-urgent: No risk of immediate death Self-contained clean woundsDermatological problems

Dead: Self-explanatory

Nursing observations and interventions in critical patients

*can be assessed or performed directly by technicians and reported to the veterinarian.

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Nursing observations and interventions in critical patients

Winter 20136

dogs such as the Miniature Poodle, Dachshund, Boxer, Boston terrier, and Beagle. Adrenal tumours (ATs) affect primarily large breed, female dogs.

Clinical SignsOnly one is really pathognomonic for the disorder and that is calcinosis cutis. If present, it is highly likely the dog has Cushing’s disease. On the other hand, the following clinical signs may or may not be related to the disorder: •Polyuria, polydipsia, polyphagia•Panting•Pendulous abdomen (redistribution of body fat, muscle catabolism, thin

skin, big liver)•Hair thinning and hair loss •Muscle weakness•Lethargy•Skin hyperpigmentation, comedones, bruising•Facial nerve palsy•CNS disturbance with larger tumours (e.g. seizures, behavioural change)•Recurrent infections•Reproductive abnormalities (clitoral hypertrophy, testicular atrophy, anestrus)•Predisposition to proteinuria (microalbuminuria in association with

systemic arterial hypertension can lead to secondary renal disease)

DiagnosisThere is a need to have a high index of suspicion, based on clinical signs, before screening a dog for HAC. Ensure the dog is not on any form of steroid medication. Findings on CBC, biochemistry, and urinalysis may include: •Neutrophilia, eosinopenia, and lymphopenia•Elevated serum alkaline phosphatase (SAP), cholesterol, ALT, glucose

(lots of reasons other than HAC for these changes) • Inappropriate (<1.025) urine specific gravity (USG) on first morning sample

Although a number of screening tests are available, the ACVIM Consensus group in 2012 recommended the Low Dose Dexamethasone Suppression (LDDS) as the test of choice; it is diagnostic in approximately 95% of cases. A baseline serum cortisol sample is collected, 0.01-0.015 mg/kg dexamethasone sodium phosphate is administered, and serum cortisol samples collected at 4 and 8 hours post dexamethasone administration. In normal dogs, cortisol suppresses to < 1.0 ug/dl or < 30 mmol/L at 8 hours. Dogs with HAC are more resistant to steroid suppression; lack of adequate suppression at 8 hours is diagnostic for Cushing’s disease. Some dogs with pituitary-dependent HAC may exhibit suppression at 4 hours followed by escape at 8 hours, thus it is critical to obtain both the 4- and 8-hour samples.

Other screening tests •Urinary cortisol-creatinine ratio test – many false positive results •Measurement of 17OHP – no longer recommended•Adrenocorticotropic hormone (ACTH) stimulation test – used to diagnose

iatrogenic Cushing’s disease (dog receiving steroids who becomes Cushingoid), to monitor response to therapy, and to diagnose Addison’s disease (hypo ACTH)

Differentiating tests to know if PDH or AT•High dose dexamethasone suppression test (0.1-1 mg/kg IV)•Measurement of endogenous ACTH •Abdominal ultrasound, CT, or MRI of the adrenal and/or pituitary gland

Treatment with mitotane (Lysodren®) or trilostane (Vetoryl®) Don’t treat based on abnormal lab results if there are no clinical signs! Prior to initiating therapy, recommend that the owner monitor and record water consumption and appetite over a 3-5 day period in the home environment. The treatments recommended should result in a drop in water consumption to approximately 60 ml/kg/day (in dogs with PU/PD) and may result in a drop in appetite. It is critical the owner be aware when these changes occur and call immediately. Any vomiting, diarrhea, or listlessness should also prompt a call.

Mitotane (Lysodren®)This drug causes destruction of the cortisol-producing areas of the adrenal gland. The goals of therapy are to eliminate clinical signs and have the pre- and post-ACTH plasma cortisol values within the normal resting range

(< 4.0-6.0ug/dl) or < 100 nmol/L). The induction dose is 25 mg/kg PO q 12 hours (50 mg/kg/day) until the owner reports changes in water consumption or appetite as above. This generally takes 7-28 days (average 12). An ACTH stimulation test is performed at this time, or if no changes are noted by the owner, every 7 days until the basal and post ACTH cortisol concentrations are within the desired range. It is important to maintain daily contact with the owner. The maintenance dose is 50 mg/kg/week (divided into 2-3 doses [e.g. Monday, Thursday, and Saturday]).

Note: If any side effects are detected or if low basal or post-ACTH cortisol concentration develops after the initial treatment period, stop the Lysodren®, and check electrolytes and renal values. Most often, physiologic dosages of prednisone (0.2 mg/kg) are needed until serum cortisol returns to the basal reference range. If adverse clinical signs were caused by a low circulating cortisol concentration, maintenance dosages of mitotane can usually be restarted in 2-4 weeks.

Trilostane (Vetoryl®)Trilostane is a synthetic, orally active steroid analogue that competitively inhibits 3β hydroxysteroid dehydrogenase, the enzyme that is critical for synthesis of cortisol. The European label directions (2-10 mg/kg once daily) differ from North American ones (2.2-6.7 mg/kg/day). Several endocrinologists recommend starting at 1 mg/kg q 12 hours and titrating upward depending on response to therapy.

Administer trilostane for 10 days and then perform an ACTH stimulation test. Regardless of whether the dog is on once a day or twice a day trilostane, the ACTH stimulation test is performed 4-6 hours post-pill. If the serum cortisol is > 50 and < 200 nmol/L (2-7 µg/dl) and the dog is clinically improved, continue with the same dose. If the dog is still showing dramatic clinical signs of HAC and if post ACTH cortisol concentration is markedly elevated, increase the dose by 25%. Don’t change the dose if the dog is clinically doing well. If the dog is not well or the serum cortisol is < 50 nmol/L (< 2µg/dl), stop the trilostane and provide supportive care. Repeating the ACTH stimulation test 14 days later will confirm if the dog is Addisonian or not. If not, a lower dose of trilostane (50-75% of previous dose) is recommended.

MonitoringThe ACTH stimulation test and electrolytes, BUN, and creatinine should be performed at 3-4, 6, and 12 weeks and then every 6 months (as with Lysodren). Make sure the owner has given trilostane the day the ACTH stimulation test is performed! The goal is to have the post ACTH stimulation value between 40-150 nmol/L.

Why choose trilostane over mitotane?• Intolerance or fear of mitotane •No induction protocol with trilostane• It is a daily drug, which some owners prefer vs. trying to remember which

days to give Lysodren•Longer survival time reported with trilostane (708 days with trilostane vs.

662 days with mitotane in one study but really not a significant difference)

BUT…it is more expensive than mitotane, must be given more frequently, and can have similar side effects!

The risks of not treating include:•Euthanasia (owners do not tolerate dogs urinating in the house)•Problems regulating diabetes mellitus•Thromboembolism• Increased incidence of infections•Systemic hypertension•Glomerular nephropathy

Prognosis: Most do well for another 2-4 years.

This article is based on a presentation given by Dr. Houston at the NBVMA/EVTA Conference held in Dieppe, NB. CVT

The CE quiz on this article is available for completion online at www.k2publishing.ca

Cushing’s disease continued from page 1

Winter 2013 7

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the destruction of red blood cells, in ITP there is increased destruction of platelets by the body’s own immune system, at a rate faster than they are produced in the bone marrow.

Immune-mediated hemolytic anemia (IMHA)IMHA can affect both dogs and cats, but typically middle-aged dogs are more susceptible. In dogs that have secondary IMHA due to disease, spayed females are more commonly affected. There is some evidence of genetic predisposition in Cocker Span-iels and Miniature Schnauzers. Roughly 60% of dogs with IMHA will also experience ITP (Evans Syndrome).

The pet typically presents with signs of anemia, including weakness/collapse, lethargy, dull/depressed mentation, pale/white mucous membranes, bounding pulses, heart murmur, and tachycardia. As large quantities of red blood cells are broken down, bilirubin is released into the blood stream, which may overwhelm the liver, causing some patients to become icteric.

The diagnosis of IMHA relies heavily on bloodwork. On a complete blood count (CBC) 95% of dogs will have spherocytes (small, spherical red blood cells). Agglutination of the red blood cells usually occurs. A CBC should always be submitted to an outside laboratory.

The Coombs’ test, also known as a direct antiglobulin test (DAT), offers a more conclusive diagnosis for IMHA, as it detects antibodies that are attached to the red blood cells. A series of dilutions takes place until agglutination occurs.

The complications of IMHA are vast. These include throm-bocytopenia, disseminated intra-vascular coagulation (DIC), thromboembolism, gastrointestinal ulceration, renal failure, and refractory anemia. Throm-bocytopenia can occur because of ITP or because of platelet consumption. The exact physiology of why ITP occurs concurrently with IMHA is unknown.

Treatment first includes dealing with any initial problems caused by the anemia. This may include oxygen supplementation and/or red blood cell transfusion. There

are valid concerns that transfusing a patient may worsen the IMHA, therefore patients should not be transfused until they have a packed cell volume (PCV) of 20-22%. If patients with a PCV greater than 22% are transfused there is an increased risk of thromboembolism.

Fluid therapy is important, and stabilization of patients is usually done through the use of crystalloids. Maintenance of tissue perfusion is equally important, even when it results in further lowering of the hematocrit. Fluids are also important in maintaining renal perfusion and helping to deal with the high levels of circulating bilirubin. Patients experiencing disseminated intravascular coagulation should receive fresh frozen plasma.

If the pet is experiencing primary IMHA, immuno-suppressive drugs are given along with gastrointestinal protectants to prevent GI bleeding. Corticosteroids (prednisone, prednisolone) are the primary drugs used for helping to suppress the immune system. Response to corticosteroids is reflected by a rising hematocrit, adequate reticulocytes, reduced spherocytes, and reduced agglutination of the red blood cells.

Azathioprine is a purine (mimics DNA and RNA) analogue immunosuppressive drug that is commonly combined with prednisone therapy. Since it is commonly used with prednisone, its efficacy alone is unknown. Azathioprine is low-cost and well tolerated in dogs,

Evans syndrome continued from page 1

Winter 20138

making it an attractive choice as an additional line of defence.In humans intravenous immunoglobulin (IVIG) is considered a first line

treatment and is used in cases where prednisone doses are dangerously high or are ineffective. There are several studies showing evidence that IVIG competitively inhibits the binding of canine IgG making it effective for IMHA. Unfortunately due to expense, periodic limited availability, potential increased risk of thromboembolic disease, and the concern of a hypersensitivity reaction to the human product, it is usually not the first choice of treatment in animals.

Lastly, both cyclosporine (Atopica™) and danazol (Danocrine®) have been used to treat IMHA as secondary line medications. Cyclosporine is generally well tolerated in dogs, but rare gastrointestinal signs can occur as a side effect which resolve after the drug is discontinued. The efficacy of danazol is not supported by any published reports and is rarely used, perhaps because it can be hepatotoxic in dogs.

Immune-mediated thrombocytopeniaWhile not as common as IMHA, ITP occurs in dogs and less commonly in cats and is more common in middle-aged females.

Clinical signs include petechial hemorrhage, ecchymoses, melena, hematuria, retinal hemorrhage, and epistaxis. A worsening of the signs occurs in patients with severe thrombocytopenia (<10,000 platelets/µL).

A diagnosis is performed by obtaining a platelet count. While a low in-house platelet test may suggest ITP, it is best to send a CBC for a manual platelet count. A platelet count of less then 30,000 in addition to a low mean platelet volume (MPV) is highly suggestive of ITP.

The biggest complication of ITP is DIC. Coagulation times should be checked and patients should be monitored for signs of excessive bleeding, petechiae, and ecchymoses.

Treatment is similar to that of IMHA. While transfusing with red blood cells is done to prevent life-threatening anemia in IMHA patients, the transfusion of platelet rich plasma or whole blood is not as common.

Unfortunately platelets are extremely fragile and, if transfused, the patient’s immune system will often destroy new platelets within hours.

Patients with ITP are treated with corticosteroids (prednisone, prednisolone) and other adjunctive therapies may also be added (azathioprine, cyclophosphamide, danazol, cyclosporine). Vincristine may be added to the therapy because it interferes with some immune system effects on the platelets and also helps to mature megakaryocytes into functional platelets more quickly.

Nursing careUpon initial presentation these patients may require oxygen supplementation. Blood transfusions may be needed and will require diligent monitoring for any signs of a blood transfusion reaction including urticaria, vomiting, collapse, fever, shaking, or panting.

Physical exams should occur minimally every eight hours and include a heart rate, pulse rate, respiratory rate and effort, mucous membrane colour, capillary refill time, rectal temperature, and neurological status. If there is any change from normal parameters, the veterinarian should be notified. Because patients are at risk for DIC it is important to look for early signs, which include excessive bleeding after venipuncture sticks and/or petechiae on the gums, pinna, or abdomen of the pet.

It is important that IMHA patients have their blood pressure monitored minimally every 8-12 hours. If the mean arterial pressure falls below 60 mmHg, the kidneys and other organs are not being appropriately perfused, putting the pet at risk of organ failure.

Ultimately the patient’s condition may change quickly depending on the progression of the disease. It is imperative that appropriate nursing care is provided to them to allow for the best prognosis.

This article is based on a presentation given at The Veterinary Emergency and Critical Care Society Conference in San Antonio, TX. CVT

The CE quiz on this article is available for completion online at www.k2publishing.ca

SAN ANTONIO, TX – Animal cruelty is any action or lack of action that results in unjustifiable or unnecessary suffering, illness, injury, or death of an animal. Veterinarians and veterinary technicians need to have an understanding of local animal cruelty laws so they can respond appropriately and assist the investigators and prosecutors in the potential case, explained Melinda Merck, DVM, presenting at the Veterinary Emergency and Critical Care Society Conference.

Every veterinary hospital should have a standard operating procedure (SOP) to handle and report suspected abuse cases. All staff should be trained on the SOP and the animal cruelty laws and practice act affecting reporting of suspected abuse. The SOP should include several key components, including agency(s) responsible for abuse investigations including all contact information; name of head cruelty officer in the area including cell number for emergencies; ‘after hours’ contact and reporting/response protocol; and protocol for handling the animal after the report. Dr. Merck said the key is to establish a relationship early with the investigating agency/officers and the prosecutors.

Documenting history in a potential abuse caseThings may not always be what they appear to be when examining a victim of animal cruelty. The suspicion of non-accidental injury should be raised when there is significant discrepancy between the history provided and the clinical findings. Suspicion should also be raised when explanations are vague, inconsistent, or contradictory. Questions should be asked to determine who had access to the animal (including other animals), what the animal had access to, when and where the event occurred, and how and why it happened. Environmental details should include whether the animal had access to the outdoors, if it was allowed outside unattended, and if and how it was confined. For strictly indoor animals, the layout of the home is needed

including the presence and location of stairs. Specific information about where the animal was found, what was present around the animal (such as blood or other bodily fluids), and the initial symptoms of the animal are also necessary. In addition, a history should be obtained regarding the food the animal eats, how often it is fed, and when the animal last ate or drank and/or last had access to food or water. Dr. Merck stressed the importance of noting the owner’s behaviour; they may be apathetic, uneasy, angry with routine history questions, embarrassed, or their responses may be generally inappropriate to the situation.

Full documentationFull documentation of all the findings should be recorded when examining an animal. This includes written and photographic and/or video documentation. A complete physical exam should be conducted, including blood work, fecal samples, and radiographs. After treating the animal, it is vital to document the process of the animal’s recovery including weight gain and by repeating appropriate tests.

Any evidence related to a crime must follow a chain of custody, in which the evidence is accounted for at all times. All evidence must be labelled with the date and time, description of the item, where it was collected from, and the person who collected it. The container should be sealed with tape with the examiner’s initial and date across the seal. All evidence should be kept in a locked cabinet with restricted access. If the evidence is transferred to another person, location or laboratory, this must be noted with time and date, the purpose of the transfer, and a signature obtained from the recipient.

Crime scene investigation and evidence collectionClean tools should be used for collecting evidence, and paper envelopes or bags used to package most of the evidence. Plastic bags should not be used

The role of the technician in forensics

Forensics continues on page 10

More than 85% of dogs and cats over the age of 1 year

have signs of periodontal disease.* Periodontal disease hurts!Talk to your veterinary team about dental health.

*Verhaert, Wetter (2004), Kyllar, Witter (2005)

Does Your Pet Have Periodontal Disease?

Winter 201310

because moisture can compromise the integrity of the sample. If an item is wet it may be wrapped in paper (butcher, roll craft paper) and then placed in the paper bag/envelope, then sealed with tape, dated and signed with the collector’s initials.

Often the environment holds the key to what happened to the animal or contains vital information that is pertinent to the investigation and the ultimate prosecution of the case. The scene must be recorded in situ for later analysis using photography and/or videography keeping a photo log. It is important to show any weakness, limping, injury, or vocalizing. In starvation cases it is also valuable to show the animal’s response when offered food or water. Photos and videos taken by others should be collected to analyze along with the physical exam findings. The housing of the animal, condition of the food and water bowls, and the contents of each should be noted. It should be determined from the owner what food the animal normally eats, and when it last ate and drank water, because this will be crucial in poisoning cases when comparing to the stomach contents. Any items that show evidence of being chewed on as well as any rope or chain used to tether the animal should be collected; knots and the weight of the chain are both significant pieces of evidence. Findings of blood should be recorded, noting the location and the quantity by taking measurements of the bloodstain.

Animal DNA forensic testing, parentage verification, sex determination, species identification, and mitochondrial DNA testing are all available.

Dr. Merck said that the location of any bodily fluids such as vomit, urine, or feces should be noted and collected for possible DNA, toxicology, or parasite analysis. The feces need to be inspected for foreign material, and after impound, the first bowel movement should be collected and inspected for clues to what the animal had recently ingested.

Further investigations include looking for possible poisons, evidence of any weapons, bullets, and shell casings, burns, and medications. Papers related to the animal including veterinary invoices, adoption papers, kennel licence, and rescue licence should also be collected, if possible. Any toys, brushes, or property that can be linked directly to the animal through DNA testing may help provide clues to the crime.

Entomology CollectionMaggots can aid in determining the time and location of death, and provide DNA and toxicology evidence. Other insects are forensically important such as beetles, which feed at different times post mortem. A sample of all insects, pupae, and pupa casings on the body should be collected noting the location on the body they were found. If there is a mass of maggots, then a temperature of the mass must be taken by inserting a thermometer in the centre.

The entomologist will also need photographs of the animal and the environment it was found in. They need to know if there were any unhatched eggs on the body and the location, the position of the body when found at the scene, and if the body was in direct sunlight or under shade. Dr. Merck concluded by saying that animal forensics is a complex field of

medicine, and one that involves a wide variety of expertise. The veterinary technician educated in the complexities of the field can have an important role to play in solving cases of animal cruelty, making an important contribution to a quickly evolving and cutting-edge field of veterinary medicine. CVT

For more information, please go to www.veterinaryforensics.com.

Reptile and amphibian husbandry basicsTORONTO, ON – Reptiles and amphibians, often referred to collectively as herps, are increasing in popularity as pets, and they are more commonly seen in veterinary practices today. As companion animals, they deserve proper care from the owners and the veterinary team. These taxa have some notably different biology than mammals, which leads to a lot of misconceptions, misinformation, and potentially fatal mistakes by owners as well as inexperienced veterinary staff, explained Christina Miller CAHT, RLAT, BSc (Ag. Env. Sci.), speaking at the Ontario Association of Veterinary Technicians Conference. Most health problems in captive reptiles and amphibians are caused by poor husbandry, so understanding the basic principles is key when evaluating them in the veterinary practice.

Understanding ectothermyHerps are mostly heterothermic ectotherms; they rely on the environment to maintain thermal homeostasis, whereas endotherms rely on their metabolism to maintain their body temperature.

Ectotherms employ behavioural adaptations to maintain the preferred body temperature by moving between areas of different temperature in the environment. They may also alter their body posture in order to increase or reduce exposure to sunlight. Ectotherms will also employ physiological thermoregulation, such as lightening the body colour to reflect heat, and some frogs can alter their skin mucous secretions to increase or decrease their evaporative heat loss. Endotherms (mammals and birds), conversely, control body their temperature mainly through physiological processes (i.e. sweating when too warm, shivering when too cold).

The enclosureSize, dimensions, and material are the key features of the enclosure. Very active animals need more space relative to their size compared to less active species. Arboreal animals need space to climb, whereas a fossorial animal needs space to burrow. Different cage materials are appropriate for different species and environmental conditions. Mesh or screen walls may trap toes if the mesh is too fine, and may be difficult to

maintain at a consistent temperature and humidity (but mesh walls offer an excellent exercise surface). Glass and acrylic are better insulators than screen, but some animals obsess over escaping through the transparent barrier. Wood is an excellent insulator, but it is difficult to disinfect.

Heating in captivityThe temperatures needed by an animal in captivity are very species-specific. A “preferred optimum temperature range” (POTR) exists for every species, which is a range of body temperatures that the animal fluctuates within to achieve a “preferred body temperature” (PBT). A general rule of thumb is that there should be at least an 8°C difference from the warm side of the enclosure to the cool side so that the animal can thermoregulate properly. Heliothermic ectotherms obtain their body heat from a radiant source – in nature this is the sun; thigmothermic ectotherms obtain their body heat from a surface pre-heated by the sun. Many species use a combination of heliothermy and thigmothermy in the wild. To monitor the enclosure’s temperature gradient, a minimum of two thermometers is necessary to ensure that the gradient is within safe and appropriate limits. Heating devices should never be in direct contact with the animal, but instead placed outside the enclosure, or inside covered with a secure grill. Lighting in captivityMost diurnal herps require broad-spectrum lighting that includes ultraviolet A and ultraviolet B radiation, which are wavelengths found in natural sunlight, broad-spectrum fluorescent bulbs, halogen bulbs and to a lesser degree, incandescent bulbs. It has been demonstrated that reptiles provided with UVA light generally do better in captivity, with increased levels of natural activities, greater reproductive success, and better appetites.

UVB light converts provitamin D3 in the skin to the active form of vitamin D3, which is needed to regulate calcium uptake from the diet. Ultraviolet B may also serve to disinfect the skin of external parasites, possibly in semiaquatic animals that may be constantly exposed to aquatic pathogens, but also spend a significant amount of time basking. It is produced by the sun, and by broad-spectrum fluorescent bulbs.

Forensics continued from page 8

Reptiles continues on page 12

Winter 2013 11

In-clinic formal puppy classes designed for weekly visits are an excellent idea. But unless the clinic has a designated person interested in behaviour and training, it can be challenging to design a successful recurring weekly format that gets regular participation. Often, when clinics begin offering regular puppy classes, the initial interest and participation is great, but the novelty can wear off once the first group gets older, and recruiting new clients can be challenging. There are some alternate options to introducing puppy classes to the clinic environment that take little time to prepare and encourage staff confidence and client participation.

To begin, consider which type of classes can be realistically supported through your clinic. If this is a new venture, the most successful approach is to start by offering a monthly “Puppy Party” or “Puppy Primer”, with the intention of possibly progressing to a weekly format of classes depending on client demand and staff interest. Monthly “Puppy Parties” are simple to organize and can provide an opportunity for clients with puppies up to the age of 4 months to drop in just for the experience. Formal “puppy classes” imply registration and commitment for consecutive weeks, which can be a deterrent for some.

“Puppy Parties” are typically hosted for a 1-2 hour time slot one evening a month and have one to three staff members hosting the event. They are not designed to teach obedience or formal manners, but rather focus on exposure and desensitization to various experiences. These puppy parties do not have a formal itinerary but encourage each guest to visit a controlled social area and when ready, move from one designated training station to another station (2–5 minutes each), ending back in the monitored play area. One staff member will be answering group questions and offering general guidance and interpretations of the play behaviours while the other assistant staff will take individual puppy families through their circuit stations. Attendees can drop in at any time throughout the party and leave after 30-40 minutes without feeling obligated to stay when the puppy is exhausted or over stimulated. Gentle encouragement to depart on a good note instead of pressing through for the full duration will support the intention of a healthy and happy experience.

The training station rotation is similar to “circuit training” at the local gym; a few minutes will be spent on exposing the pup to being on the exam table, then move to experiencing standing inside the empty grooming bath tub, continuing to the weigh scale station, then into a closed recovery cage, and so forth. This is simply an opportunity to allow the puppy to be exposed to unsure footing, noises, scents, and routines without the anxiety that may be associated with clinic visits. Of course, healthy treats, toys, and praise should be added at each station with appropriate timing and application. More invasive routines can be added with confident puppies at the coach’s discretion; gentle restraint and release, imitating nail trimming routines, “pilling” the puppy with a small treat, brushing their teeth with a finger toothbrush, hearing the clipper sounds, feeling and smelling the alcohol on a front leg, and many other options. The pet owners are then encouraged to repeat the circuit again, and where appropriate, imitating the experiences at home on a daily basis.

In-clinic puppy parties allow clients to experience fun and relaxed times with their pups while building a relationship with the clinic by

becoming familiar with the clinic’s staff and philosophy. They provide a unique opportunity that training centres and kennel clubs are unable to duplicate, encouraging referrals and support from the training community. For consideration, the clinic may select a qualified “guest trainer” to be featured each month if training isn’t a service that is currently offered through the clinic. Hosting a qualified “guest trainer” provides an opportunity for the clinic staff to learn what current techniques, tools, and training applications are practiced locally. It may also provide an opportunity to educate trainers in proper coaching regarding veterinary services, including current vaccination protocols and deworming practices in their region. The trainer will learn more about you and your veterinary practice and ideally feel confident about referring clients to your clinic.

Puppy classesWeekly puppy classes can take a similar approach with the circuit station rotations if there are enough training assistants to ensure safety in each encounter. Initially, the group is toured through the stations without their puppy’s participation and given a demonstration of what is expected to happen for the 2-5 minutes until a signal is given to rotate to the next station. Assistant trainers or competent participants are placed at stations that require spotting or to act as a stranger (possibly wearing a white lab coat) to give approved treats to the participating pups. Each puppy family begins simultaneously at separate stations and is given the opportunity to explore the area and desensitize their puppy, taking advantage of the imprinting age and building confidence that may have a positive impact for a lifetime.

Typical puppy classes that do not have circuit style encounters are more common and easier to host when only one instructor is available. However, they tend to focus primarily on informal obedience, “manners” and corrections, overlooking the importance of imprinting exposure and opportunities during the sensitive period of development. Since obedience commands and leash skills may be introduced successfully at any age, puppy classes for ages under 4 months should aim to avoid duplication and to coach owners through the process of healthy social experiences, desensitization, and recognizing normal canine body language.

Leanne Barker, RAHT, CMT, CPDT, CCTPresident, Canadian Canine Training Corp.Train@CanadianCanineTraining.comSherwood Park, AB – 780-416-5050 – 1-877-PRO-4DOG

Leanne has been training animals, owners and trainers, full time, for 18 years and is considered a reliable consultant in the field of animal behaviour. She is a Registered Animal Health Technologist, Certified Master Trainer, and Certified Professional Dog Trainer. Leanne presents at dog training and industry related conferences and seminars across North America and Japan.

Puppy party plans and classes

Training Tips

Winter 201312

SAVT NewsBy Nicole Wood, RVTSAVT President-Electpresident.elect@savt.ca

Our 28th Annual Conference was held November 2-4 at the Travelodge in Saskatoon, Saskatchewan. The weekend included a vast range of talks, a heated panel discussion on Raw vs. Kibble diets, interesting abstract presentations, and 13 different hands-on wet labs. The conference opened Friday night with a wine and cheese social where all 250 registrants were given their first opportunity to take in the tradeshow, featuring 29 booths.

On Saturday, talks resumed after a wholesome breakfast and informative keynote address given by Jolene Watson, RVT. The day continued with a diverse range of topics including Anesthesia Equipment 101, Care of the Geriatric Horse, Animal Learning Theory (How Animals Learn), New Technology in Calf Vaccinations – Intranasal Vaccines, and The Use of Therapeutic Laser In Veterinary Medicine, just to name a few. Our AGM was held during the lunch hour break where we adopted a new life insurance program that is now offered to all SAVT Members. Attendees also voted on the new and improved look of our logo.

The evening was capped off with the Awards Banquet. Congratulations to all of the registered veterinary technologists who celebrated their 5, 10, 15, 20, 25 and 30 year anniversaries!

Also a big congratulations to the 2012 award recipients: Veterinarian of the Year – Dr. Shawn Haas, Lakeland Vet Clinic in North Battleford; SAVT Appreciation Award – Ruth Black, Veterinary Medical Centre at the WCVM in Saskatoon; SVMA Technologist of the Year – Abigail Culleton, Regina Human Society; Conference Appreciation Award – Carol Polland, Hills; SAVT Student Bursary recipients – Brittany Turnbull, Kelsey Campus, and Kylee Wiens, Lakeland campus. Of the Canadian Association of Animal Health Technologists and Technicians (CAAHTT) awards, Michele Moroz received the Sandy Hass Appreciation Award and Lois Ridgway the CAAHTT Recognition Award.

An evening of being thoroughly entertained by the band “Gongshow” was followed the next day by wetlabs, abstracts, and the panel discussion on Sunday morning at the Veterinary Medical Center – Western College of Veterinary Medicine. Wetlabs included Bovine Advanced Handling, Introduction to Clicker Training, Cytology, Heart of Animal Care (Holistic Energy Medicine), and Dental Radiography.

The SAVT would like to give a huge thank you to the conference committee who worked very hard to make this years’ conference a huge success. We saw the election of our new 2013 board members: Darlene Ford, Financial Officer; Taunia Sawatzky, Member at Large; and Paula Mason, Member at Large. I’m looking forward to a great year of working with them as well as our returning members Cindy Toy, President; Melanie Browning, Past President; and Patricia Perrin, Secretary.

We have an exciting and busy year ahead of us and I encourage everyone to keep an eye on our website www.savt.ca to see what we have in store!

Important points of consideration when lighting a reptile or amphibian enclosure: •Never allow a glass or plastic barrier to occlude the broad-spectrum light•Most bulbs are effective at a distance of less than 30 cm (12”) from the

basking spot (but read the manufacturer’s recommendations). However, because bulbs may also produce small amounts of harmful UVC radiation near the bulb’s surface, a minimum distance of 10 cm (4”) has been suggested

•Screen or mesh covers or enclosures will physically block some UV from reaching the animal. If mesh or screen is between the broad-spectrum bulb and the animal, ensure that the herp can get relatively close to the bulb, or add a reflector to increase local UV irradiance

•Always ensure that the animal can choose a location as a refuge from UV light exposure

•Vary the photoperiod you provide according to the natural habitat of the herp

•Select a bulb according to the animal you have, and the type of enclosure you are usingo Linear fluorescents are suitable for enclosures with a lot of floor

space, as well as for long animals that have a large body area that needs UV exposure

o Compact fluorescents are limited in their “spread” but have a greater relative irradiance closer to the bulb, so they are more suitable for small enclosures

o Mercury vapour lamps (flood or spot bulbs) are only suitable for very large enclosures. They produce a fair amount of heat as well as visible light, UVA and UVB

•Replace the light every 6-12 months, or according to the manufacturer’s recommendations. The UV output of a bulb decreases over time, even if the bulb is still producing visible light

•Although the UVB output on the package is relative, consider using “high output” bulbs (with an 8.0 or 10.0 rating) with desert species, and mid-range output bulbs (5.0) with forest species. Low output bulbs (2.0) are probably useless in terms of UVB output.

Water in the enclosureWater should be kept clean and ideally free of chemical additives. It should be presented in a way that the animal is accustomed to; some will only drink water droplets off of vegetation or from moving water sources. Aquatic species should have their water quality monitored regularly.

HumidityMost animals should be provided with humid microhabitats to aid in skin shedding and maintaining hydration. These can be simple (a plastic container with entry hole, filled with damp paper towel or sphagnum moss), or fancy commercial versions.

SubstrateSubstrate, the medium covering the cage floor, comes in two broad categories: particulate (made up of many small particles, such as sand or earth) and non-particulate (made of up large pieces, such as paper towels, newspaper, or carpet). The abrasiveness of the substrate must be considered, especially for amphibians due to their delicate skin. As well, accidental ingestion must be avoided; it is necessary to consider whether the substrate is small enough to be eaten accidentally. If ingested, will it pass through the digestive tract or will it definitely cause an impaction? Some substrates are great media for microbe growth and can quickly become a “biohazard”; full substrate changes should be part of a cleaning schedule in conjunction with spot cleaning. Finally, the substrate should allow natural behaviour such as burrowing if the animal is fossorial, as this allows the animal to feel secure, and acts as a form of environmental enrichment.

Environmental enrichmentEnvironmental stimuli can be used to enhance the captive environment in order to reduce stress behaviours and encourage natural behaviours. A minimum of two hides spots per animal, one in the cool end and one in the warm end of the gradient, are necessary. Hides should be just large enough for the animal to enter, turn around and exit, and more than one entry/exit is even better. Horizontal hiding are for terrestrial animals and vertical hides for arboreal animals. Plants (fake or live), rocks, branches, etc. can help mimic the natural habitat, making the environment more interesting. CVT

Reptiles continued from page 10

Winter 2013 13

NAVTA announces new interim Executive DirectorThe National Association of Veterinary Technicians in America (NAVTA) is excited to announce that the executive board has appointed two valued and respected veterinary technician leaders to head up the organization.

Julie Legred, CVT, is a staunch supporter and leader in many technician arenas and has agreed to transition NAVTA to the next level; the NAVTA executive board has named her the new interim Executive Director.

Kara Burns, MS, Med, LVT, is a former NAVTA Technician of the Year and is one of the most widely respected technicians in the country; she has been selected as the new interim Communication Director.

NAVTA is a nonprofit organization that represents and promotes the veterinary technician profession.

For more information, visit www.navta.net.

Stowaway pelican from Maryland makes port call in TampaAn injured pelican that landed on a cruise ship on December 27 was treated at BluePearl Veterinary Partners specialty and emergency hospital in Tampa. According to the Hillsborough County Animal Services officer that brought the injured pelican to the veterinary clinic, the pelican injured itself by flying into part of the ship’s superstructure after it had landed on the ship.

Doctors from BluePearl Veterinary Partners avian and exotics medicine

team treated the bird for dehydration and after a physical examination determined the bird has a minor wing injury that required rehabilitation. The pelican was transferred to the Suncoast Seabird Sanctuary where it will receive rehabilitation treatment.

Equine Guelph declares 2013 - “Colic Prevention” year!Equine Guelph kicks off 2013 by announcing a new eWorkshop designed to help horse owners understand colic and take preventative measures to reduce the risk of this #1 horse killer by following good stable management practices. This eWorkshop will include:• Identifying risks factors associated with colic• Understanding different types of colic• Detecting early signs and symptoms of colic• Assessing your management plan • Developing preventative strategies• Implementing practical ways to reduce colic risk

In addition to funding from Standardbred Canada, investment in this project has been provided by Agriculture and Agri-Food Canada.

For more information visit www.equineguelph.ca.

By Karen TousignantPublisher

We are excited to announce that, starting with this issue, most of the provincial vet tech associations across Canada will now be distributing Canadian Vet Tech newsmagazine directly to their members! This will enable us to work more closely with the associations and will lead to many new opportunities to meet the needs of veterinary technicians and technologists.

We’ve had very enthusiastic feedback from vet techs on our online Continuing Education (CE) quizzes. Canadian Vet Tech CE quizzes are approved for 1 CE credit per quiz by all of the associations in Canada. That means you can earn up

to 3 CE credits per issue of Canadian Vet Tech, or a total of 12 CE credits per year simply by completing the quizzes associated with the 3 CE articles in each issue of the magazine. CE quiz articles are easy to identify since they always begin on the front cover and include a CE symbol at the end of the article title.

As an avid animal lover, I would like to pay tribute to a very special dog. Yukon is the canine companion of a friend of mine, and sadly he recently was diagnosed with canine lymphoma. Although the prognosis for Yukon is not a positive one, he and his owner have exemplified the human-animal bond. Yukon’s life can be celebrated as a happy one, filled with the love that every dog deserves.

Please e-mail your comments and suggestions to karen@k2publishing,ca.

REGISTER ONLINE TODAY TO HOLD YOUR SPOT: www.theiwrc.orgWant to register by phone?Call 866-871-1869 or email office@theiwrc.org

Where: University of Saskatchewan Campus

When: March 30-31, 2013

Cost: IWRC Members $125* Non-members $159* *USD

Intensive Basic Wildlife Rehabilitation CourseEducation and Resources for Wildlife Conservation Worldwide

The International Wildlife Rehabilitation Council will offer a Basic Wildlife Rehabilitation Course in Saskatoon this March for those looking to add to their formal wildlife rehab education. The IWRC is a non-profit organization that offers training and support to professional wildlife rehabilitators—from large non-profit organizations to individual home rehabilitators.

Description: An introductory course with lecture topics that include: intro to wildlife rehab, basic anatomy and physiology, calculating drug dosages, handling and physical restraint, thermoregulation, stress, basic shock cycle, initial care and physical examination, nutrition and associated diseases, standards for housing, zoonoses, euthanasia criteria and release criteria.

Includes a half-day lab to practice techniques in: gavage (tube-feeding), physical restraint, intramuscular and subcutaneous injections, physical exams, limb immobilization and weighing. 15 Continuing Education Units

Hosted by WRSOS Wildlife Rehabilitation Society of Saskatchewan

Industry News

Canadian Vet Tech Update

Winter 201314

Canadian Veterinary Medical Association NewsBy Tanya FryeCVMA Communications Manager

Review and revision of the CVMA Code of Practice for Canadian Kennel Operations The Animal Welfare Committee has begun a review and revision of the 2007 CVMA Code of Practice for Canadian Kennel Operations. Among the issues that will be considered in the review are tethering of dogs, time spent out of confinement, and kennel requirements for home breeding operations versus commercial kennel operations.

Development of Humane Slaughter Position StatementThe Committee has begun the development of a Humane Slaughter position statement, and it is currently gathering background information and scientific references, as well as consulting with experts in the field of humane slaughter practices. Once the draft Position is developed, it will be sent to CVMA members for consultation to help finalize the position.

New and revised Position Statements approved by Council•Revised Complementary and Alternative Veterinary Medicine and

Castration of Horses, Donkeys, and Mules Position Statements were approved by Council in November 2012.

•New – Capture of Wild Animals for the Pet Trade Position Statement was also approved by Council: “The Canadian Veterinary Medical Association (CVMA) is opposed to the capture of wild animals to be kept or sold as pets.”

For further information on the all CVMA position statements, please visit the website www.canadianveterinarians.net.

Companion Animal Prudent Use Guidelines under developmentThe Companion Animal Prudent Use Guidelines are under development. The CVMA Working Group has completed the general principles and the UTI section. Work has begun on the canine pyoderma section. The adaptation of the Guidelines into a web application for tablets and smartphones is being planned.

Updated list: recognized Radio Frequency Identification Products (2012-11-1)A review process has been established by the National Companion Animal Coalition (NCAC) to assess the conformity of radio frequency identification (RFID) products and processes with the revised Canadian standard for electronic (microchip) identification of companion animals. Only those RFID products that have been submitted for review and have been deemed in conformity with the Canadian standard will be recognized as suitable for companion animal identification. Find the updated list on the CVMA website under the Publications section – Other resources.

CVMA Council meeting held in OttawaThe CVMA Council met on November 24 and 25, 2012, in Ottawa, to make policy decisions with a focus on the CVMA’s 2013 Program Plan and Budget. Council welcomed the following new members on board, Emily Vellekoop (representing all student veterinarians of Canada), Dr. Berney Pukay, representing all CVMA members in Ontario, and Ms. Michelle Moroz, representing CAAHTT in an ex-officio, non-voting capacity. The CVMA would like to thank Ms Crystal Riczu, past SCVMA President, for her active involvement at the Council table.

Canadian Veterinary Reserve (CVR) enters three-year agreementOn October 11, 2012, the CVMA entered into a three-year CVR funding agreement with the Canadian Food Inspection Agency (CFIA). The government contribution to this CVMA program is exclusively for foreign animal disease emergency preparedness. Given the absence of funding for civil emergency preparedness, the CVMA is looking at alternatives for maintaining the civil emergency preparedness of Reservists, such as existing online courses versus in-person training and participation in national and provincial exercises. The CVR currently consists of 474 members, of whom 245 have been trained.

Just around the corner! 2013 CVMA Convention in Victoria, BCThe CVMA, in partnership with its provincial host, the CVMA-SBCV Chapter, invite you to join us in Victoria, British Columbia, from July 10 to 13, 2013, for the CVMA Convention. Take part in a unique four-day convention and experience Canada’s ONLY national multi-species event. Go to the CVMA website, under Convention to view the preliminary Scientific Program.

February 1-3Winnipeg, MbThe Central Canadian Veterinary Conferencewww.mahta.ca

February 13ConCord, on A Variety of Topical Issuesinfo@tavm.org www.tavm.org

February 13-14onlineLaboratory Animal Scienceswww.bioconferencelive.com

February 17-21las Vegas, nVWestern Veterinary Conferencecarolyn@wvc.orgwww.wvc.org

February 21-23london, onOntario Association of Veterinary Technicians Conferenceoavt@oavt.orgwww.oavt.org

MarCh 6ConCord, on Making the Most of Cytology and Blood Film Evaluationinfo@tavm.org www.tavm.org

MarCh 14-17phoenix, aZAmerican Animal Hospital Association Conferencewww.aahanet.org

MarCh 30-31saskatoon, skIntensive Basic Wildlife Rehabilitation Courseoffice@theiwrc.orgwww.theiwrc.org

april 10ConCord, on Review of the Anesthesia Machineinfo@tavm.org www.tavm.org

april 17-20louisVille, kyNorth American Veterinary Dermatology Forumwww.aavd.org

april 19-21haliFax, nsAtlantic Provinces Veterinary Conferenceeprowse@eastlink.cawww.apvc.ca

May 3kitChener, onRehabilitationinfo@focusandflourish.comwww.focusandflourish.com

May 4Mississauga, onCanine Rehab – Rehab for the Neurologic and Hospitalized Patientanne.behnan@gmail.comwww.qualityceinc.com

May 4-7Winnipeg, MbCanadian Association for Labora-tory Animal Science Symposiumhttp://calas-acsal.org

May 15ConCord, on Separation Anxietyinfo@tavm.org www.tavm.org

May 25Mississauga, onCanine Rehab – Hip Rehabilitationanne.behnan@gmail.comwww.qualityceinc.com

June 12-15seattle, WaAmerican Congress of Veterinary Internal Medicine Forumwww.acvim.org

June 15Mississauga, onCanine Rehab – Putting It All Togetheranne.behnan@gmail.comwww.qualityceinc.com

July 10-13ViCtoria, b.C.Canadian Veterinary Medical Association Conventionscunningham@cvma-acmv.orgwww.canadianveterinarians.net

septeMber 11ConCord, on Infectious Diseases and Infection Controlinfo@tavm.org www.tavm.org

noVeMber 9ConCord, on eMarketinginfo@tavm.org www.tavm.org

noVeMber 13ConCord, on Veterinary Radiology in Today’s Small Animal Practiceinfo@tavm.org www.tavm.org

Continuing Education Calendar

Email your meeting announcement to shelagh@k2publishing.ca

Protection shouldextend to allmembers of thefamily.

A simple, easy to administer Interceptor flavoured tablet provides protection against four of the most common internal parasites.Interceptor prevents heartworm disease and treats and controls roundworm, hookworm and whipworm.

Interceptor is a tasty Flavor Tab®, it won’t rub off, wash off or get licked off.

Interceptor is also approved for puppies two weeks of age, pregnant females, and all breeds of dogs including collies.

Protect against common intestinal nematodes any time of the year with Interceptor 12-pack.

® Registered trademark of Novartis Animal Health Canada Inc. ™ Trademark of Novartis AG – Novartis Animal Health Canada Inc., licensed user.© 2012 Novartis Animal Health Canada Inc.

Visit www.ah.novartis.ca or call 1-800-387-6325 for more information.

Interceptor® reduces the risk of zoonotic transmission.

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If you only see the boy and his dog, you’re missing something.You’re missing the eggs and larvae that dogs shed when they have fleas. Adult fleas only represent 5% of a flea infestation – theother 95% are eggs, larvae and pupae that hide in beds, carpets and floors. Sentinel prevents flea infestations by stopping the lifecycle in its tracks, killing eggs and larvae before they become adults. Recommend Sentinel for flea control, heartworm preventionand intestinal worm protection, and you won’t miss a thing. For more information about Sentinel call 1-800-387-6325.

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