VetInfo Digest         May 1999

This Month:

Slow changes
Veterinary Hospital Staff Members
Focus on Certified Technicians
Quick Vet Check
When You KNOW Something is Wrong
Medication Advertisements
Gracie
Spring Thoughts

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Changes at VetInfo Digest

We are having problems moving the web site, so our plan to have a
subscriber area that is password protected is running behind. We still hope
to get this done soon. We hope to build a subscriber area with more
detailed information on medications, all of the issues of the VetInfo
Digest and more information on problems encountered more frequently in
specific breeds.

You support has enabled us to continue to make a great deal of information
available to the public on the World Wide Web. We appreciate your support
for our site very much and hope that you can tell your subscriptions are
helping people improve the lives of their pets all over the world. We get
emails several times a week thanking us for our effort. We can take only
part of the credit because we could not continue to provide this site
without your support. Thanks !

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Veterinary Hospital Staff, Part 2 Certified Veterinary Technicians

Certified Veterinary Technicians (CVT), also called Licensed Veterinary
Technicians (LVT), are licensed professionals, trained to provide nursing
care for pets and to run lab equipment properly. They are the most
under-appreciated staff members at veterinary hospitals because few clients
realize the extent of their training and the extent of their value to a
veterinary practice. The technicians at our practice have all been
dedicated professionals and all have provided a level of care to pets that
we might not have achieved without their help.

CVTs graduate from a two to four year course of college classes in most
cases. Some states allow certification of technicians who have met
experience and training requirements on the job. They must pass a licensing
exam in the state in which they work, in most states. There is a Veterinary
Technician National Exam (VTNE), which is also required by some states. It
is becoming customary to refrain from calling anyone in the hospital who is
not certified a technician.

If a state requires licensing it usually also requires that the license be
displayed. Look for the license!

Licensed or certified technicians are the "hands on" staff at most
veterinary hospitals. They may take the patient history, provide client
education, run the lab tests, monitor anesthesia, prep patients for
surgery, provide comfort to pets waking up from anesthesia or intensive
care in the hospital. In many hospitals the person who can provide the most
up-to-date information about how your pet really feels while it is
hospitalized is the hospital technician. The vet might be able to tell you
more about the disease process or what to expect during recovery from
surgery but the technician is a lot more likely to be able to tell you
whether your dog is comfortable in the hospital.

Technicians are often willing to patiently explain flea prevention,
heartworm disease, housebreaking strategies, vaccination protocols and all
the other routine things that veterinarians may not cover completely during
an office visit. Don't miss the opportunity to ask the questions you need
answers to just because the vet seems to be in a hurry that day. A good
technician will know the answer or at least know where to find it for you.
And most of them enjoy making sure that you really do understand what you
need to know before you leave the practice. They can tell you what the
monitoring procedures are
for surgery and what to expect when your pet needs to have X-rays taken.
Just ask.

Technicians are not allowed to make diagnoses or perform surgery. They can
administer medications or vaccinations under the supervision of a
veterinarian in most states. In many practices the technician will perform
many of the examination procedures such as taking the patient's weight,
temperature, heart rate and other vital signs. Lab tests such as heartworm
examinations and fecal examinations are usually performed by the technicians.

Veterinarians depend on their technicians to properly restrain pets during
physical examinations and procedures that may be uncomfortable for the pet.
If your veterinarian asks you to allow the technician to hold your pet, it
is best to comply. Veterinarians are sometimes sued by pet owners who are
bitten by their own pets during an exam, so it is becoming more and more
commonplace for veterinarians to insist that an assistant or technician
hold a pet for most procedures. I can not speak for all vets but I am most
comfortable when my technician is holding a pet. I know that she can
restrain the pet without much risk of harm to me or to the pet. This makes
most procedures go more
smoothly for me and for the pet.

Don't let a valuable resource for information go unused. Talk to the
technician at your vet's office and get an idea of how much they do know.
You will find that a licensed veterinary technician is a real professional
-- and that it is worth a little increase in fees to go to a hospital that
employs certified or licensed technicians to help with patient care.

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Quick Vet Check

A quick check on the quality of a veterinary hospital can be done simply by
asking for the records of your pet or pets. As far as I know, veterinary
hospitals are required to provide copies of veterinary records to clients,
on request, in all states. It is usually OK for a veterinary office to
charge for the cost of duplicating records but this should be a minimal fee.

Obtaining your pet's records does two things for you. It is always a good
idea to have a copy of the records on hand if you travel with your pet or
if your veterinarian does not work in a 24 hour a day veterinary hospital
and you may have to seek emergency help from an emergency clinic or other
facility. The other thing that it does is provide a glimpse into how
seriously your veterinarian takes record keeping or even how seriously he
or she is working to provide the best care for your pet. If the records
are not legible to you, then there is a good chance the staff in the
veterinary hospital can't read them, either.

If the records consist solely of financial information with no notes on
medical condition then your vet is not keeping adequate records or is not
providing you with copies of the entire record. If you can read the
records, look them over and see what your vet has written about
preventative care visits and about times when your pet was examined due to
an illness.

Can you understand from the record what the doctor thought the diagnosis
was and what treatments were given? If you can't easily tell what was done
it is likely that the vet's staff can't either. Keeping good records is a
necessary part of practicing medicine. It is just about the least fun of
the responsibilities facing vets, though A vet who works hard to keep
good records is probably likely to be making good diagnostic decisions,
too. After all, if a vet has legible records then it is more important to
make sure that what people read shows good patient care and good decision
making.

Like most things, this isn't a foolprood way to evaluate a practice but it
can be helpful --- and it really is a good idea to have a copy of your
pet's medical record, anyway.

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When You KNOW Something is Wrong....

There are times when you know for sure that something is wrong with your
pet but your vet will not be able to find a problem on physical exam or
through routine lab tests. This situation can be frustrating for both you
and your vet --- and potentially dangerous for your pet.

I learned very early in my career to listen to a client's intuition about
their pets. While I was still in veterinary school an older man brought a
sheltie in to the emergency services when I was on duty. He insisted that
something was seriously wrong with his dog. His reasoning was simple.
"Everyday since I have owned him, Lad has waited at the end of the driveway
for me until I come home from work. He didn't do that today so he has to be
really sick."

I couldn't find anything wrong with Lad. We even drew blood and checked his
hematocrit, total protein and white blood cell counts. Nothing was
abnormal. Lad was alert and seemed to be interested in looking around the
exam room. I was convinced that Lad just didn't feel like walking to the
end of the driveway today. Since I was still a student, one of my
professors also examined Lad. He couldn't find anything wrong with him,
either. But his owner insisted that something was wrong and asked if we
would keep Lad and observe his behavior tomorrow.

It was probably a good thing that Lad was in our hospital when it became
obvious what was wrong with him. This occurred about four in the morning
when I noticed that there was blood dripping from Lad's cage. He had thrown
up a large quantity of blood and it was everywhere. As we examined Lad now,
it was easy to make his gums bleed and his tears were a little red, too. A
phone call to Lad's owner to ask about the possibility that he might have
been exposed to a rat or mouse poison made his owner recall that he had
treated the silos with rodenticide. Lad had been accidentally poisoned when
he ingested some of this toxin.

Lad lived. He might not have if his owner had not been so convinced that
something was wrong. This taught me to listen to pet owner's opinions of
their pet's health very carefully. Twenty years of experience has taught me
to trust my instincts in some cases, too. There are owners who appear to
experience a form of hypochondria for their pets. Trying to figure out who
is worried for no reason and who has a legitimate concern can be really
difficult. I have sent pets home when I thought they were normal but when
they were actually ill. Sometimes their owners have ignored worsening signs
of these illnesses because they trusted me. No matter how good your vet is,
they don't know your pet as well as you do ---- trust your instincts and
ask your vet to recheck your pet or get a second opinion if you are sure
your dog or cat is ill. It might turn out that the results of this exam are
the same but at least it will be reassuring.

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Medication advertisements:

Veterinary medical advertisements have hit the airways and print media in
full force. I was really hoping that the manufacturers of the veterinary
products would not let their marketing divisions write the advertisements
unsupervised but that doesn't seem to be the case.

Novartis, the company that manufactures Sentinel (Rx) and Clomicalm (Rx)
has one ad that is often misunderstood and a second ad that I think is
irresponsible.

The first ad, for Sentinel, generates a lot of phone calls to our office.
At least a third of the people who call our office are convinced that
Sentinel prevents heartworms, all intestinal worms and kills both fleas and
ticks. I am not sure how this impression occurs but Sentinel does not have
any effect on ticks and it doesn't help with tapeworms, one of the
intestinal worms. It is a combination of milbemycin, the active ingredient
of Interceptor (Rx), the heartworm prevention medication and lufenuron, the
active ingredient of Program (Rx). Lufenuron prevents flea reproduction
but does not kill adult fleas. For many of our clients, this combination is
not effective enough for flea control and we prefer to use a heartworm
prevention medication in combination with Frontline Topspot when fleas and
ticks are a problem. Novartis is a good company overall and this
impresssion may not be their fault.

The second Novartis ad that I have just recently seen is for the medication
clomipramine (Clomicalm Rx). This is the medication that was recently
introduced for control of separation anxiety in dogs. This medication is a
major breakthrough for a tough condition to treat and deserves to be
considered by many clients as a aid in treating dogs with separation
anxiety. It is not very likely to work for this condition without some
attempt at behavioral modification, though. The print advertisements that I
have seen for Clomicalm really imply that dogs can be treated with
medication alone. Novartis is aware of the fact that this medication
should be used in conjunction with behavioral therapy but does not mention
that in the advertisement. This creates unrealistic expectations on the
part of owners and encourages veterinarians to try to appease clients by
providing the medication without the behavioral counseling. A big part of
the problem is that Clomicalm has come out before there is really a good
mechanism for delivering behavioral counseling to most pet owners. Most
veterinarians in practice today have little or no training in dealing with
behavioral problems. They are very reluctant to charge for counseling
services in the absence of training and so real behavioral counseling is
only available readily to a small number of veterinary clients. The
temptation to try to treat behavioral problems pharmacologically is very
strong in this situation and I think it is irresponsible of Novartis to
produce an advertisement encouraging that behavior, especially when the
available research does not appear to support the claim that clomipramine
will work well in the absence of behavioral training for pets with
separation anxiety.

I don't mean to pick on Novartis, because I am certain that there will be
similar advertisements from other companies as more pharmaceutical
companies market directly to the public. Be careful about accepting
advertising claims at face value.

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Gracie

Gracie came to our clinic wrapped in a towel, nearly unconcious, having
been hit by a car. A quick examination revealed a high probability that her
pelvis was broken. She was obviously in some pain. I placed an intravenous
catheter and began to run fluids. Pain relievers seemed to help her get
comfortable. I turned to the people who came in with her.

"Your cat has a broken pelvis and will need to be X-rayed to determine the
extent of the damage", I said.

"It's not our cat, Doc. It belongs to our neighbors. I am sure that they
would want you to take care of her, though. They're at Disney World for the
week," was the reply.

It is hard to describe how veterinarians feel when faced with a severely
injured patient whose owner is unknown or unavailable. How much care would
the owners want for their pet? How much can they afford? If the injuries
are severe enough to require an intensive recovery period, will this be
acceptable to the owners? There are a lot of questions, a pet that needs
immediate help and no answers.

We kept Gracie and took an X-ray. Fortunately, only her pelvis was broken.
It would be painful for a few weeks but then she would be OK. Cage rest
was the best thing for her and she didn't have anyone to go home to, so we
kept her.

Gracie is gray and white. My daughter named her on the first day in the
clinic, since no one knew what her name was supposed to be. She was six
years old at the time and chose the name because of her color. But it was
apparent after a few days that Gracie earned her name in another way.
Despite her injuries she was an incredibly nice cat. She accepted her
condition calmly -- and with grace. She had no voice but she opened her
mouth as if to meow a greeting whenever anyone stopped by her cage. Within
a few days, the staff was in love with her.

After a couple of weeks, we decided that it was pretty likely that her
owners weren't coming back for her. We called the folks who brought her in
and they gave us the owner's name and phone number. They assured us that
they had informed them that we had Gracie. We called the number. They
claimed not to own a cat. In an unusually desperate move, we drove by
their home to show them that Gracie was fully recovered and that we were
willing to let her go home without being paid. It wasn't a successful
mission. None of the other neighbors claimed Gracie, either.

Baggy, our resident clinic and outdoor cat was not willing to accept
another cat in his domain. The yard and clinic were going to have to be
off-limits for Gracie. We had four indoor cats. None of them seemed
enthused about us adding a fifth cat. We decided that it might be a good
idea for Gracie to live with my wife at vet school. She had an apartment
there where she could be the only cat, at least for a while. This worked
well for the first two years of Gracie's life with us.

It was a little tough on my wife, though. It turned out that Gracie may
have been a scientist in one of her nine lives. Her favorite pastime is
to find a high shelf with knick-knacks, books or other objects on it and do
gravity testing. She pushes the first object off the shelf and cocks her
head to one side to listen for the sound of it hitting the floor. Then she
leans way out over the edge with one eye down and one eye up, surveying the
effect of gravity on her object of study. She will do this as long as there
are objects to experiment with. It didn't take long for my wife's apartment
to have empty shelves and everything mobile stored in cabinets or on the
floor.

My wife did graduate from veterinary school. Her roommate didn't want to
take Gracie as she went off to her new job. So Gracie came home to live
with us. We were down to three cats at home now. It seemed like she might
fit in. Gracie had other ideas, though. She spent her time studying the
door, figuring out exactly how long it took to close when opened. Then she
carefully timed her runs at it to ensure that she made it outside at least
every other time.

Even if it had been OK with us for Gracie to live outside, it was not OK
with Baggie. He had been king of the yard for five years, successfully
running off every cat, dog, rabbit, mole and other creature that wanted to
live in his domain. He was a skilled fighter and he lived by the rule that
only the victor got to stay in the yard.

It only took a few seconds whenever Gracie got out for Baggie to appear and
to begin to stalk her. We would catch her and return her to the house
immediately.

Gracie was determined to live at least part of the time outside. She
learned that we would be chasing her right away, so she began to head for a
large tree in the backyard. One day the inevitable happened -- she got to
the tree first. Baggie got there a second later. They disappeared up the
tree in a mad rush. Soon Gracie appeared on a high branch, running out on
it with Baggie in hot pursuit. Gracie ran until the branch was so thin it
seemed impossible for it to hold her. Baggie sat at a thicker point
watching her. He wouldn't venture out further but he wasn't going to let
her back up the branch, either. Gracie managed to turn on her tiny
foothold. They stared at each other for at least ten minutes. Then Baggy
stood up and arched his back, confident that he was winning. In a
millisecond, Gracie took the opportunity to escape, running up the branch
and right through Baggie's legs. He almost rolled off the branch as his
head followed her path between his legs. He looked around to see if anyone
saw this humiliating incident. Gracie hit the ground running and
disappeared under our shed. Pulling himself together, Baggie followed her.
He couldn't fit under the shed, though. He waited again. Gracie crawled out
the other side and walked around the building to watch him from behind.

It never occurred to us that Gracie had the only weapon that Baggie
couldn't cope with -- she had an incredible sense of humor. She tormented
him for years. He never really gave up on stalking her and she never forgot
to stay one step ahead of him. She knew which culverts she could fit in and
he couldn't. She knew how far out on a branch to run and what she could
climb that he couldn't. We worried that one day he would finally catch her
and injure her. Gracie decided that she really didn't belong in the house
but she did want some break from Baggie at times. She took up residence on
our back porch. It was small but had a lot shelves. We only kept really
heavy items on them but she didn't seem to mind. She would sometimes go out
and sometimes come in the house, depending on her mood. She has been our
only real indoor/outdoor cat.

As Baggy got slower, Gracie ran from him at a more sedate pace. When he
couldn't climb as well, she stopped at lower branches. Over time, we
actually saw them sleep in the sun together a couple of times. Baggy never
really did accept her fully but she was the only cat that ever successfully
invaded his yard.

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Spring Stuff

Tick experts are predicting that this wil be a banner year for ticks. There
are only three products that work really well to control ticks:

Permethrin is a good tick killing ingredient, especially in the
concentrated formulas found in Defend (TM), ProTiCall (TM), Control (TM)
and some other products. It is not safe to use on cats and must be applied
at about 2 week intervals to control ticks well on dogs. This is only a
moderately effective flea control product, though.

Amitraz tick collars (Preventic TM) are effective for control of ticks on
dogs. They are toxic if ingested and dogs will chew on them. This is more
of a problem in multi-dog households, obviously. In our area they seem to
be effective for 6 to 8 weeks. Amitraz has no effect on fleas.

Fipronil (Frontline and Frontline Topspot TM) is effective for tick control
for both dogs and cats. It should be applied monthly for tick control. Its
effectiveness begins to wear off towards the end of the month for ticks but
stays high for fleas throughout the month.

Late spring and early summer are the times when we see most of our cases of
heat stroke in dogs. On the first really hot day of the year we almost
always see one or two cases of heat exhaustion / heat stroke and that trend
continues for the next few hot days, as well. Once summer really hits it
seems like most of our canine patients have figured out that it is too hot
to exercise hard. We rarely see heat related problems in cats, as long as
they stay out of clothes dryers.

Bee stings are a common problem in the late spring and early summer, too.
We see swollen faces or swollen legs from bee stings in both dogs and cats.
The swelling can be very rapid and extensive enough to be frightening. Most
of the time it will resolve in several hours but if your pet shows any sign
at all of difficulty breathing after a bee sting take him or her to the vet
right away. Pets do sometimes have anaphylactic shock reactions to bee
stings, just like people.

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Copyright: TierCom, Inc. This newsletter is authored by Michael Richards,
DVM., P.O. Box 476, Cobbs Creek, VA. Michal Justis is the web editor for
the VetInfo site.