KIBBLE IS A PUBLICATION FOR VETERINARY TECHNICIANS IN THE HEARTLAND FROM BLUEPEARL VETERINARY PARTNERS Your email will be used solely to send our newsletters and professional notifications. Medical Director: Jeffrey Dennis DVM, DACVIM Summer If you would like to receive Kibble via your email instead of by mail, please email Georgia Flood at [email protected]. 2011 KIBBLE MEDICAL DIRECTOR’S COLUMN So, Dr. Dennis, what’s with the name BluePearl? What is BluePearl Veterinary Partners? Three years ago, the owners of VSEC created a new business entity, subsequently named BluePearl Veterinary Partners. VSEC merged the business aspects of its practice with those of veterinary specialty practices in Tampa, Florida, and New York City to form the new company. The purpose of this merger was to take advantage of the numerous opportunities available to larger businesses, i.e. the reduction of duplicate business expenses, the financial advantage of negotiating better pricing for supplies and insurances through group purchasing, the sharing of veterinary community outreach projects and ideas, the introduction of staff training programs, and so on. Who owns BluePearl Veterinary Partners? BluePearl Veterinary Partners is wholly owned by the veterinarians who owned the original practices as well as veterinarian employees who have since bought shares in the new entity. Who manages BluePearl Veterinary Partners? Each of the member practices continues to manage its own operations and staff. There is no plan to franchise the practices as we recognize that each practice needs to reflect the needs and desires of the veterinary community it serves. Be assured that, the merger has not and will not change how VSEC operates, nor will it affect our dedication to service and patient care. Operations, pricing, and service at VSEC are not being directed by offsite management. Why the name change? Since the formation of the company three years ago we have been mulling over the advantages and disadvantages of changing our name. It has become apparent that, outside our own communities where our names are recognized, a common name among all the practices would serve us better within the veterinary industry and provide us more opportunities. Therefore, this year we adopted the new name, BluePearl. Are there any other changes planned? As a member of BluePearl Veterinary Partners, our mission remains unchanged, i.e., to partner with the veterinarians in the region, to promote and provide optimal healthcare and service to pets and their owners. As such our practice will remain locally focused, providing the community with comprehensive and compassionate specialty veterinary care. Jeff Dennis, DVM, ACVIM Medical Director Five Veterinary Technician Myths and Trade Secrets Revealed By Anonymous DECIDING TO TAKE A PAGE from the famous masked magician, I have decided to risk the wrath of my vet tech colleagues with this short exposé into the psyche of the vet technician. In this article I unveil five tricks, truths, and/or myths of the veterinary technician profession. 5 4 3 2 1 #5 Vet techs love all creatures great and small Truth: Most technicians know how to handle, care and treat the majority of domestic pets we are presented with. However, each of us has nightmares about having to handle one breed / species or another. For me it is birds… beady eyes, pointy beaks…shiver “get me out of here”. #4 Bribery is an excellent tool Trade secret revealed: Every clinic has a patient that only one person can handle. Tell me you haven’t heard someone make the comment: “Oh Cujo is here. Better go get Becky.” Then we all stand in awe as Becky skillfully handles the ferocious beast. What Becky has kept to herself (up until now) is that Cujo loves her because Becky spent weeks, or maybe even years, slipping the little monster doggy treats. #3 Men have a hard time in our field Myth: Behavior is behavior! If an animal is approached in a dominant manner, both men and women may be met with aggression. Some of the best technicians I know are male! #2 Veterinary technicians envy veterinary doctors Myth: I don’t envy DVMs in the least. The time I spend providing medical care, treatments and TLC to the patients I adore, DVMs are in the exam rooms talking to clients. Although I do enjoy conversing with our clients, when given the choice, my fuzzy friends win every time. #1 All veterinary technicians cry during sad animal movies: Truth: Alas, I cannot debunk this myth. We do indeed shed a tear (even on the inside) when our best friends are in peril. Ole Yeller, Bambi, Marley and Me, I am Legend, Charlotte’s Web. Rivers of tears have been shed while viewing these classics. It is our fate to shed a tear, or twenty, for our fallen friends. Do you agree? bluepearlvet.com 11950 West 110th St Overland Park KS 66210 913.642.9563 PURR-R-R-R-R Get to know our neurology tech Patient Monitoring PATIENT MONITORING IS THE MOST CHALLENGING and, dare I say, rewarding part of a technician’s job. In a previous issue we noted the role that pulse oximetry plays in evaluating patients for adequate oxygenation. In this edition, we present another convenient monitoring tool, capnography. Unlike pulse oximetry, the effective use of capnography requires a little more thought process. Ashlee Carlsen, RVT Neurology Technician Ashlee Carlsen is our neurology tech. She has been with us since 2008 and is a recent graduate of the Maple Woods veterinary technology program. She took a break from her duties to tell us a little bit about her job and herself: What is Capnography? Ashlee Carlsen, RVT What qualities make a great Neurology Technician neurology tech? Neuro techs should be empathetic and sympathetic, and should give 110 percent for every patient. I treat every patient as if it were my own pet. What about your job most excites you and interested you in the job? The cases we get to see are really interesting. For instance, when a dog comes in and cannot walk, we get to see it walk out of here after having surgery. It’s exciting and rewarding to see the family’s reaction. We also get to see special cases, such as animals with seizure disorders and dogs with disk disease. I also enjoy using the different diagnostic tools that a neurology service uses, such as CT scanning and MRI. And, of course, it’s also fun working with Dr. Brian Cellio. Measuring carbon dioxide: Carbon dioxide (CO2) is a byproduct of metabolism in the body. Carbon dioxide is produced in the tissues and transported through the blood stream to the lungs where it can be exhaled. The concentration of CO 2 in exhaled air indirectly reflects the concentration of CO2 in the blood. By measuring CO2 concentrations in exhaled air, information concerning the adequacy with which CO2 is being excreted from the body can be ascertained. Inadequate ventilation, displacement of the endotracheal tube in an anesthetized patient, severe lung disease, and reduced cardiac function or vascular perfusion are all reasons for abnormal CO2 readings in exhaled air. What is capnography? Capnography is the measurement of CO2 concentrations in inhaled and exhaled air. Most capnograph monitors continuously display the CO2 concentration as a waveform. Other monitors only provide the end-tidal CO2 concentration, i.e. the maximum concentration of CO2 in the exhaled gas which typically occurs at the very end of exhalation. Alarms warn the user when an abnormal reading occurs. How do you unwind at the end of the day? I am a runner. What keeps you up at night? A good movie or trying to finish a task at home that I could not get to during the day If you were given $10 million that you were required to give away, how would you spend it? I would make sure my family and my fiance’s family were taken care of. I would give some to the Crohn’s & Colitis Foundation of America and to various charities and churches. I would use some just for the fun of it! Outside of work, what do you consider yourself to be good at, and what are you a total mess at? I am good at cooking, but a mess when it comes to reading instructions. What is in your refrigerator right now? Grapefruit, eggs, asparagus, pudding cups and cheese sticks If you could choose anyone, with whom would you trade places for a week? Beth Moore, my fantastic Bible teacher. She inspires so many people. What was your first job? I was a waitress at a Chuck Wagon BBQ. Services Cardiology Kevin Christiansen DVM, DACVIM The yellow bars demonstrate exhaled CO2 concentrations. Capnography provides an objective measure of the patient’s ventilation and circulation. In this manner it is has an advantage over visual assessment of the adequacy with which a patient is breathing. Capnograph readings warn the user of a developing problem well before clinical evidence of a problem might be visualized. Early steps can then be taken to prevent injury to the patient. Rising CO2 concentrations in the blood alter neurologic and cardiovascular function ultimately leading to brain damage. How does it work? Carbon dioxide molecules absorb infra-red light. The greater the concentration of CO2 molecules present in a gas, the more light that is absorbed. By shining a beam of infra-red light across the gas to be sampled, a sensor on the other side of the sample can determine how much light has been absorbed. A microcomputer attached to the sensor computes the CO2 concentration. Inhaled and exhaled gases are sampled using either a sidestream or a mainstream analyzer attached to the end of the patient’s endotracheal tube. Dentistry Gary Modrcin DVM Emergency Medicine Richmond Aarstad DVM Sabrina Belshe DVM Shara Grauberger DVM Todd Odle DVM Jill Speicher DVM Amanda Stamper DVM Sonya Wesselowski DVM How do you read the waveform? Lower CO2 plateau / end tidal CO2 The CO2 waveform displayed on the capnograph represents different phases of the respiratory cycle. CO 2 concentration Time (seconds) Figure 1 A-B: End of the inspiratory phase when there is no CO2 being exhaled B-C: Exhalation upstroke when there is a rapid rise in CO2 concentrations as air starts to be exhaled from the lower airways and alveoli C-D: Expiratory plateau reflects the steady exhalation of CO2 from the pulmonary alveoli D: The highest concentration of CO2 occurs at the end of exhalation, termed the end-tidal CO2. Figure 3 shows lower CO2 in exhaled air due to: 1. A decrease in cardiac output causing less CO2 delivery to the pulmonary system 2. Hyperventilation causing excessive washout of CO2 beyond its collection in the alveoli 3. Pulmonary embolism obstructing blood flow to lungs 4. Leakage in the anesthetic circuitry Sloping Plateau/Prolongation of the expiratory upstroke (B-C) D-E: Inspiratory onset when the exhalation of CO2 abruptly ceases. Interpreting Abnormal Waveforms CO 2 concentration To interpret an abnormal waveform, consider how the steps in the respiratory cycle might be altered to cause the specific waveform abnormality Elevated Baseline CO2/ Rising CO2 plateau Time (seconds) Figure 4 reflects an inability to exhale quickly and completely due to interference of airflow 1. Partial obstruction to endotracheal tube or lower airways CO 2 concentration Absence of waveform Time (seconds) Figure 2 indicates the rebreathing of CO2 due to: 1. Insufficient new oxygen flow causing the patient to re-inhale exhaled gases 2. The soda lime is depleted thereby failing to remove CO2 from exhaled gases before the gas is inhaled again 3. The anesthetic machine is improperly hooked up 4. Hypoventilation resulting in the failure to exhale CO2 allowing concentrations to buildup in the alveoli 5. Incompetent expiratory valve interfering with the flow of exhaled gases 6. Incompetent inspiratory valve interfering with adequate new oxygen flow to patient CO 2 concentration Time (seconds) Figure 5 shows no CO2 is measured due to: 1. Dislodging of the endotracheal tube 2. Misplacement of the endotracheal tube (into esophagus) 3. Patient stops breathing Capnography can also be used to assess the effectiveness of CPR. Successful resuscitation would cause what was a low CO2 concentration, due to lack of cardiac output and ventilation, to suddenly rise excessively high as CO2 is again delivered to the pulmonary alveoli where it can be exhaled. As ventilation succeeds, CO2 levels will return to normal levels. Internal Medicine Lisa Cellio DVM, DACVIM Jeffrey Dennis DVM, DACVIM Brian Lucas DVM Crystal Hoh DVM, DACVIM Catherine Peace DVM Stephanie Pierce DVM, DACVIM Cheryl Wood DVM Neurology Brian Cellio DVM, DACVIM Oncology Heather Heeb DVM, DACVIM Surgery Candace Layton DVM, DACVS Steve Riley DVM, DACVS Trent Tuttle DVM, DACVS PCV vs HCT: What’s the Difference? WE ARE CERTAIN YOU KNOW the terms hematocrit (HCT) and packed cell volume (PCV). They are used, sometimes interchangeably, to describe a patient’s red blood cell indices. Both are meant to reflect the volume of blood that consists of red blood cells. But what do they mean? Are they the same? You will most commonly find the hematocrit reported on automated laboratory sample results. A hemotocrit is actually a calculation. It is based on the measurement of the amount of hemoglobin within, and the average volume of, the red blood cells present in a blood sample. It is not a direct measurement of this parameter. A packed cell volume also reflects the percentage of a blood volume that consists of red blood cells. It is not, however, a calculation. Blood infused into a small thin tube (interestingly called a hematocrit tube) is centrifuged to separate it into its cellular and fluid components. Using a comparison chart, the relative volumes of red blood cells packed into the bottom of the tube and the entire blood sample are visually estimated. Both hematocrits and packed cell volumes are expressed as percentages. A measurement by either parameter of 35% suggests that there are 35 mls of red blood cells within 100 mls of whole blood. Because of the varying methodologies it is uncommon for these two values to be exactly the same. Therefore, it is important to recognize that a difference will likely exist when monitoring a patient using both parameters. A low hematocrit or packed cell volume indicates anemia. Causes for anemia can include blood loss due to trauma or surgery, the immune destruction of red blood cells, or the lack of red blood cell production by the bone marrow. Higher than normal hematocrit levels or packed cell volumes are most commonly seen in patients suffering from dehydration or diseases that induce excessive red blood cell production by the bone marrow. A Natural High: How does catnip work? OILS ON THE LEAVES OF THE CATNIP plant (Nepeta cataria) appear to act as pheromones stimulating sensors in the cat’s nasal passages. This triggers nerves in the amygdala region of the brain inducing a feline behavior very similar to that noted in sexually active felines. Cats will rub up against the leaves, roll and vocalize. Interestingly, cats typically won’t respond to catnip until they reach sexual maturity (approximately 6 months of age). Not all cats will respond to catnip. It is believed to be an inherited trait. The response to catnip, when present, is transient, lasting 5 to 15 minutes. Continued stimulation of the affected sensory regions by the catnip oils likely induces a downgrading of the neurologic sensors inducing tolerance. After a period of non exposure, however, cats will again react to its presence. Catnip does not appear to be harmful to cats. Did you know that nondomestic cats such as lions and jaguars also react to catnip? BluePearl CE for Techs DATE TOPIC AND SPEAKER CONTENT CE HOURS AND LOCATION July 14 Canine and Feline Intestinal Parasites – the Old and New Melissa Andrasik RVT, BS • Real-time identification on “the big screen” • Zoonotic potential • Discussion of diagnostic options 7-8:30pm 1.5 hours CE BluePearl Meeting Room September CE Event - TBD Nov 10 Cytology for Technicians Melissa Andrasik RVT, BS Check the website for details, Kansas.bluepearlvet.com Collection methods: lymph node asp, fecal cytology, ear, etc. Proper handling and submission to yield usable results 7-8:30pm 1.5 hours CE Maple Woods Vet Tech Building Get the News Delivered to Your Inbox Eliminate the middle man – well, the postal workers – by signing up for future issues of Kibble via email by emailing Georgia Flood at [email protected]. We promise to use your email solely to send our newsletter and professional notifications. 11950 West 110th St Overland Park KS 66210 BluePearl’s newsletters are produced for the veterinary community with support from your Partners in Education: Abbott Animal Health, Antech Diagnostics, Boehringer Ingelheim, Hill’s Pet Nutrition, Novartis Animal Health, Pfizer Animal Health, Stokes Pharmacy, Virbac Animal Health, Webster Veterinary