There is nothing quite like the jolt I feel when my CSC (receptionist) comes back to tell me that an emergency is on its way in, and that is especially true with rattlesnake bites being that they are so variable.  There are so many factors – known ones such as the size of the dog and location of the bite; possibly known ones such as the type of snake and time elapsed since the bite; and the unknown factors such as the amount of envenomation and the make-up of the venom. (Fortunately we only have one venomous snake in the Folsom area, but sometimes there is confusion with non-venomous bites).

One of the most important things we can do for our patients is educating their owners on the dangers of snake bites and what to do and even more importantly, what NOT to do.  First off, the timeliness of treatment is critical so it is crucial for the client to get to a hospital as soon as possible, and preferably one that has antivenin available if it ends up being needed.  Other than keeping the patient as quiet and calm as possible and (if applicable) keeping the bite site lower than heart level, they should not provide any first-aid.  They should not apply hot or cold compresses and absolutely not make any cuts, try to suck out the venom or place a tourniquet.

Antivenin is the only treatment that will slow, halt or reverse the effects of the venom.  Other than that we can provide supportive care to reduce the risk of shock with IV fluids and limit pain and the chance of infection.

In addition to educating clients about what happens AFTER a snake bite, we should be doing what we can to prevent things from getting to that point.  As the old adage goes, “An ounce of prevention”… yada yada yada.  There are more and more companies offering snake avoidance training.  We have hosted a “Rattlesnake Avoidance Training” day the past two years and our clients have greatly appreciated it and we’ve had more than a couple account of how their dogs responded (appropriately) even possibly preventing their “parents” from getting bitten. 

Well, I’m not quite sure what to expect for the rest of this season, but I do know that anytime we get a rattlesnake bite victim, I won’t need a Starbucks fix!

1. Introduce yourself with confidence with a warm, friendly smile and always use soft, calm speech.  If you approach a client with overpowering, firm speech then they will tend to back off and not trust you. Trust is the key to keeping a client’s nerves at ease.
2. Talk to your nervous client like you would talk to a good friend. Make them feel at ease and allow them to approach you with what is really making them nervous. If they don’t tell you, then ask them directly what is making them most concerned about the situation. I would stay away from mentioning “being nervous” because nobody really wants to be called nervous, use the words concerned or worried.
3. Address the issue that concerns them most first. A nervous client wants to know or wants an answer right away. If this isn’t possible then explain why it is not, and what you will do to find that answer as quickly as possible.
4. Assure them that their Pet is in good hands.  It’s amazing what these words will do.
5. Assure them that they aren’t the only one to go through this. Tell them it’s ok to be concerned, for this is a sign of a good Pet parent. I sometimes tell them a story about myself going through a similar situation and how I felt.
6. Make sure that you keep them super- informed of what is going on with their Pet.  A couple of hours can feel like 24 to a nervous client.
7. Nervous clients can quickly escalate to irate clients if they aren’t getting the outcome that they expected. Always explain all possible outcomes before they occur to avoid this.  Don’t sugar coat things just because the client is nervous – be honest and direct with the client’s concerns.  The worst possible scenario CAN happen.
8. And most importantly – do NOT get nervous yourself – this will make clients even more uneasy. I would be wide-eyed nervous if I had a fidgety, squirrely doctor talking to me about my precious little Pet.

Veterinary technician careers have expanded into many areas.  The government, private veterinary sector and various other industries have started to realize the huge knowledge base and skill set technicians have.  Veterinary technicians are hired in research, USDA/government, public health, animal control, zoos, wildlife centers, shelter/humane societies, meat packing plants, 4-H/FFA/Agricultural, herd health and production, artificial insemination labs and facilities, rehabilitation (human and animal), human/animal bond therapy, animal behavior, nutrition positions and the list goes on and on.

The question of whether or not veterinary technology positions are recession proof for your career goals can depend greatly on many things.  There is a need for credentialed veterinary technicians in many areas of the profession as mentioned previously.  Yes, the most obvious vet tech needs are in the food animal industry and in certain geographic areas, but there is still much opportunity in general practice as well. Just check out Banfield’s career page for evidence! This is great news for those individuals who have their hearts in their work and love the profession and what they do.  

Credentialed vet techs can add enormous value to the practices they work for.  By completing an AVMA accredited veterinary technology program and passing the Veterinary Technician National Exam, credentialed vet techs prove that they have the ability to perform lab work, assist in surgery, educate and relate to clients, take radiographs, do dental work and more! This gives veterinarians and hospital managers an advantage in hiring credentialed vet techs, since they have an almost guaranteed knowledge base and skill set.  Having this education can also give clients a sense of security knowing that their Pets are being taken care of by someone who has been formally educated in caring for Pets.

Clients have changed throughout the years. They are not just dependent on animals as a means for making a living, etc. Animals are a part of our families. Although some of the greatest need for credentialed vet techs is in large-animal practice, the growing popularity of Pets ensures that credentialed vet techs can find a career in small-animal practice. We depend on Pets to be there for us when we get home, when we are afraid, when we are alone.  Some of us depend on them for us to succeed in this world as being our eyes, our ears, our guardian angels.  Others depend on them as their partners at work (police dogs, search and rescue dogs, research animals, etc).  They are always there for us when we need them and because of these reasons and many more, we want to do everything we can do to make them happy, keep them safe and healthy, and be able to go that extra mile in times when they are sick, getting older or in times of need (broken bones, etc).  These things do not go away with the recession and neither does the compassion and love we have for our animals and Pets.

The veterinary technician career recession proof?  I say yes it is about as close as you can get!

Over the next few months, the BARK team will focus on the on the topic of Pet overweight and obesity.  They will be conducting additional research on this health topic by evaluating trends and identifying risk factors associated with Pet obesity.  Their aim is to use the findings to better equip doctors with concise, succinct reports that enhance risk communication with their clients.  Since the goal of evidence-based medicine is to enhance clinical expertise in concert with consideration of patient needs and client circumstances, the BARK team will develop evidence-based tools to provide to Banfield hospital associates. For instance, client talking points will be written to incorporate evidence that PetNurses can use to educate clients on the dangers of having an overweight Pet. To integrate with the rest of the veterinary community, this research initiative will also include publishing a Critically Appraised Topic (CAT) report, an exhaustive literature review (quarterly white paper) and results from these studies will appear in future blog postings on this site.

As a veterinarian, how are you addressing this epidemic in your clinic and how do you think we can address the under-diagnosis of overweight and obesity?  What questions do you have and want to see answered regarding this health topic?  How do you educate clients on the prevention of overweight/obesity in their Pets?  Post your inquiries here and we may pick yours to answer by leveraging our nationwide medical e-record database.

If you’d like to subscribe to the Banfield Applied Research and Knowledge (BARK) quarterly white paper, email us at bark@banfield.net and include SUBSCRIBE in the subject line.

1. Burkholder, W.J. and P.W. Toll, Obesity, in Small Animal Clinical Nutrition,4th edition, M.S. Hand, C.D. Thatcher, R.L. Reimillard, P. Roudebush, M.L. Morris, and B.J. Novotny, Editors. 2000, Mark Morris Institute: Topeka, KS. p. 401–430.
2. Hill, R.C., Conference on “Multidisciplinary approaches to nutritional problems”. Symposium on “Nutrition and health”. Nutritional therapies to improve health: lessons from companion animals. Proceedings of the Nutrition Society, 2009. 68(1): p. 98-102.
3. McGreevy, P.D., et al., Prevalence of obesity in dogs examined by Australian veterinary practices and the risk factors involved. Veterinary Record, 2005. 156(22): p. 695-702.
4. Lund, E., et al., Prevalence and risk factors for obesity in adult dogs from private US veterinary practices. International Journal of Applied Research in Veterinary Medicine, 2006. 4(2): p. 177-186.
5. Lund, E., et al., Prevalence and risk factors for obesity in adult cats from private US veterinary practices. International Journal of Applied Research in Veterinary Medicine, 2005. 3(2): p. 88-96.
6. German, A.J., The growing problem of obesity in dogs and cats. Journal of Nutrition, 2006. 136(7 Suppl): p. 1940S-1946S.

No other Iams foods are affected, and this recall is limited to Iams canned cat food in North America. The Procter & Gamble Company is recalling these specific lots because the product may contain insufficient levels of thiamine (Vitamin B1), an essential nutrient for cats.   Thiamine deficiency in cats can manifest with clinical symptoms including loss of appetite, salivation, generalized weakness, vomiting, weight loss, ventroflexion of the neck, ataxia, tremors, falling, circling and seizures. 

Diagnosis is made by history, physical examination, and response to thiamine supplementation.  Thiamine concentrations can be measured in whole blood (the sample must be frozen and protected from light during collection, storage, and shipment), or in food.   

Treatment requires thiamine, given either by injection or by mouth.  Recommended doses are 100 to 250 mg SC q 12 hrs or 2-4 mg/kg PO q 24 hrs.  Note that injections may sting, and rapid intravenous administration has been associated with anaphylaxis.     

Concerned pet owners who have purchased Iams ProActive Health canned cat and kitten foods with these codes should discard the product – please make sure the contents of the can are destroyed in such a way that no other pets can inadvertently eat the food. For further information veterinarians should call P&G at 800-535-8387.  Clients/Pet owners can call P&G at 877-340-8826.

The rat’s name was Newt and her owners loved her. I personally have never loved a rat, so this was all new to me.  We’d initially seen her for an abscess on her face.  I can’t tell you for certain what we actually diagnosed for Newt, but I know at one point we discussed an eye infection.  I can tell you that an eye infection does not make a rat cuter.  We eventually had to remove the eye in surgery.  I can also tell you with great certainty that a hairless rat does not get cuter when you remove an eye.

We had issues with keeping Newt warm post surgery.  I remember one of our PetNurses, Lesley, who isn’t particularly fond of rats, carrying Newt around the clinic tucked up next to a rubber glove full of warm water.  Again, this did nothing for the “cuteness” of Newt.  I found the whole thing strange.  Why so much effort for a rat?

Two surgeries and a lot of love didn’t do the trick and in the end the infection got the best of Newt.  I remember being astonished by the great lengths everyone was going to, just to save this one hairless, scarred little rat.  At one point, Newt’s parents even fashioned an Elizabethan collar out of a pop bottle in an attempt to keep Newt from ripping out her stitches.  That’s dedication.  I remember hearing the sadness in Newt’s parent’s voices when they called to tell us that she had passed.  They were grieving deeply.  It was right around that moment that I finally got it.  Newt wasn’t just a hairless, scarred rat to them, or maybe she was, but it didn’t matter.  She was family.  They cared about her and loved her, so when she needed help they provided all they could for her.  And so I learned something that October.  Treating Pets like family means all Pets, even the not-so-cute ones.  Because one man’s rat is another man’s Newt.

We found that the prevalence of tapeworms in cats is greater than the prevalence of fleas. This seems counterintuitive since tapeworms are transmitted when cats ingest fleas. This probably means two things – first, that cats probably remove most of their visible flea burden when they’re grooming (which makes it more difficult to diagnose flea infestation) and second, that flea control in cats is probably lower on most people’s list of priorities than ideal.

This is potentially important, as tapeworms are zoonotic. It’s no cause for alarm, as the prevalence of all the internal parasites (tapeworms, hookworms, whipworms and roundworms) is low, but it reinforces the point that year round flea, tick and worm prevention is extremely important.  It also should remind us of our responsibility as health professionals to discuss zoonotic diseases and how prevention can eliminate disease transmission with our clients.

Have you found the same thing out in practice and how do you approach the subject of regular parasite control? We’d love to get your feedback.

If you’d like to subscribe to the Banfield Applied Research and Knowledge (BARK) quarterly white paper, email us at bark@banfield.net and include SUBSCRIBE in the subject line.

People and their Pets share close living (and sleeping!) spaces. The recent 2009 H1N1 flu outbreak with reports of the virus found in people, dogs and cats demonstrates this closeness. Did you know that over three quarters of the emerging infectious diseases are zoonotic? ⁽¹⁾ However, as a recent survey revealed, most veterinarians in the United States aren’t encouraging client practices that could help to reduce zoonotic disease transmission. ⁽¹⁾ The survey also revealed that veterinarians consider it important to educate clients on zoonotic disease prevention, but only a small percentage initiate the discussion. The Centers for Disease Control and Prevention (CDC) provide on their “Healthy Pets Healthy People” website talking points, called Pet-Scriptions, to help veterinarians communicate strategies for zoonotic disease prevention with clients. Understanding whether there are young children or immunocompromised individuals in the family help veterinarians integrate zoonotic disease risk into their medical decision-making and client recommendations. In your own hospital setting, you can encourage frequent hand-washing and wearing gloves to handle feces and other biologic samples.

To help formalize the concepts into practice, the American Veterinary Medical Association launched the One Health initiative, which strives for an “establishment of closer professional interactions, collaborations, and educational opportunities across the health sciences professions, together with their related disciplines, to improve the health of people, animals, and our environment.” The most effective strategies for infectious disease prevention integrate the systems of medicine, veterinary medicine, and public health.

Veterinarians are essential partners in making One Health a reality. Did you know that it was a veterinary pathologist who linked a mysterious disease outbreak between humans and animals, which was later discovered to be West Nile virus ⁽²⁾! We want our clients and their pets to have long, happy lives together. When we talk about zoonotic disease, we are demonstrating our responsibility as health professionals and building trust with our clients. Sharing this information can strengthen both the client-veterinarian bond and the Pet-family bond!

What are the challenges for veterinarians in taking a bigger role in One Health? What are the opportunities? Please let us know what you think.

Further Reading:

• Childs, J.E. & Gordon, E.R. (2009). Surveillance and control of zoonotic agents prior to disease detection in humans. Mount Sinai Journal of Medicine, 76, 421-428.
• Kuehn, B.M. (2010). Human, animal, ecosystems health all key to curbing emerging infectious diseases. Journal of American Medical Association, 303(2), 117-124.

References:

1. Chomel, B.B. & Marano, N. (2009). Essential veterinary education in emerging infections, modes of introduction of exotic animals, zoonotic diseases, bioterrorism, implications for human and animal health and disease manifestation. Scientific and Technical Review, 28(2), 559-565.
2. Kahn, L.H. (2006). Confronting zoonoses, linking human and veterinary medicine. Emerging Infectious Diseases, 12(4), 556-561.

Despite the fact that strategies for prevention of periodontal disease are fairly straightforward, Pets still suffer from the disease. The most effective strategy is multi-faceted and includes teeth brushing at home, feeding of dental diets or treats, and dental prophylaxis performed by the veterinarian. However, client compliance with brushing is low and we’ve found that there’s a big gap between the number of Pets diagnosed with periodontal disease and those that actually receive dental prophylaxis. That gap can be as large as about 2/3 of all cats or dogs diagnosed with periodontal disease.

Why, despite the prevalence and impact of periodontal disease, are preventive strategies not fully implemented for Pets? Why are the behaviors that people have adopted around their own twice yearly dental care not standard for our Pets? Do Pets (especially cats) hide the pain that they may experience from periodontal disease from us?

As veterinarians do we recommend dental therapy less often than we should? Are there factors like anesthetic risk or cost of therapy that affect your discussion of the diagnosis or treatment with clients? What factors influence your recommendations? What factors affect your clients’ compliance?

We’d love to hear what you think!

Further reading:

• BARK’s White Paper on periodontal disease

What exactly does EBM mean to a practitioner? EBM is the conscientious and implicit effort to apply current best research evidence to medical decision-making. EBM should enhance clinical expertise in concert with consideration of patient needs and client circumstances.

For veterinarians, EBM is gaining momentum, but it is not widely employed in clinical practice. In addition to published research evidence, veterinarians still rely heavily upon textbooks, anecdotes, faculty expertise, and peer consultations. Depending on the clinical question, these may be the only resources to utilize, but they are often inadequate, outdated, and unproductive. Why has veterinary medicine been slower to adopt the practice of EBM? Is it because there is less rigorous, controlled research conducted and published in the peer-reviewed literature? These challenges create a gap between new knowledge and the practice of EBM in veterinary medicine.

How can the veterinary profession close the knowledge-to-practice gap? The gap represents a barrier to high quality care for individual patients. Where can veterinarians go to get evidence-based, synthesized information? Who teaches veterinarians how to incorporate it into clinical settings? The US Preventative Services Task Force (USPSTF) is well-known for providing physicians with recommendations and guidelines based on research evidence. According to their website, the USPSTF is “An independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.”

Could similar guidelines for preventive care and screening be developed for veterinarians? These guidelines would support the most efficacious screening for optimal pet care. The BARK (Banfield Applied Research and Knowledge) team is using Banfield’s large database to generate new knowledge, in addition to critically appraising existing knowledge from a variety of sources, to create preventive care and screening guidelines for the common diseases of middle-aged and senior pets.

Next month, BARK’s Research Medical Advisor Associate, Patrick Shearer, BVMS, PhD, will talk about periodontal disease. Please join us, post your comments, and engage in a discussion about what we know about the disease and how as veterinarians we can promote the highest quality evidence-based dental care for the pets that we see.

• Each month thereafter, the BARK team will blog about topics such as:
• EBM and evidence dissemination initiatives in the profession
• Strategies to best apply evidence in clinical settings
• Current and future research initiatives at Banfield

Let us know if you have ideas about questions or topics that are of interest to you, especially in relationship to evidence-based medicine and getting new knowledge to our patients!

Further Reading: Click on the links below for two articles on EBM that recently appeared in the Banfield Journal. The current edition of the Banfield Journal can always be viewed online at www.banfield.net/banfield-journal.

• Banfield Journal May-June 2009
• Banfield Journal July-Aug 2009