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VET TECH PRESS Northern Virginia Community College Veterinary Technology Program - SPRING 2014 Compassion Fatigue by Jessica Sanderson In veterinary medicine, caring is an intricate act that innervates your every action. Care must not be paid only to patients and clients, but also to our colleagues. To show this level of care and compassion regularly, a sacrifice is wrought from an individual. We spend our days in veterinary medicine giving love to injured animals, hugs to grieving owners, and last embraces to dying pets. We are the sponge that absorbs every disgruntled word, every frustrated cry, and every exasperated sigh. Compassion fatigue is the result of caring so much for others that we have forgotten to care for ourselves. Compassion fatigue easily preys upon individuals in care-giving professions, such as those of the veterinary field. Those of us attracted to these positions, come ingrained with the idea that other’s needs are more important than our own. We are the perfectionists, and are generally conscientious on the whole. Pre-dispositions such as these are a perfect set-up to be let down. A sense of hopelessness and negativity takes up residence where consideration and kindness once dwelled. As our reserves deplete, compassion fatigue develops into a very real problem. There is no time to stop in veterinary medicine, and recognizing this issue can become a major obstacle to healing. The burn of compassion fatigue can feel similar to an aching back and tired feet at the end of a long shift. It is not a simple task to separate the heart-sore feelings of euthanizing a pet that was under your care for years, from the endless frustrations of work. Compassion fatigue begets a cycle of destruction that must first be recognized in order to be healed. This complex issue has a very real set of symptoms. Individuals discover that they bottle up emotions, give in to compulsive behaviors, start to isolate themselves from others, have trouble sleeping, are prone to nightmares, voice complaints, have issue with administration, mentally and physically are worn down, and find no pleasure in activities outside. Compassion fatigue is very real and very common in the veterinary field. Many people do not even realize how much it is already affecting them. In order to continue on our journey, sometimes we must stop and replenish our inner reserves. Many times compassion fatigue will be mistaken for the normal rigors of our profession, but the normal rigors should not linger or bleed into the rest of our lives. Allowing your spirit to burn out hinders your ability to be the best caretaker and diminishes your strength to persevere in the presence of disease, disability, and discomfort. We are the soldiers of our own battlefield. We must arm ourselves daily to survive the struggles. Remember, you do not struggle alone, give comfort and support to those in the trenches with you. In this issue: Natural Remedies (page 2) Post-op Rehab (page 3) Senior Pets (page 4) Cat Care (page 4-5) ER Readiness (page 5) Student Gloria Rittgers sits with a patient during recovery from an anesthetic procedure at Northern Virginia Community College. Photo by Jennifer Smith 1 Alternative Veterinary Therapies Advocate For “Natural-Minded” Clients and Your Patients by Gray Akers The term “natural” is in everywhere; superfoods abound in the grocery store, acupuncture and homeopathy are becoming household words, holistic eateries are booming industries, and more frustrated pet owners are turning to home remedies and complementary medicine to treat their pets for a variety of preventative and therapeutic pursuits. As veterinary professionals, it is up to us to understand and empathize with clients’ concerns, record thorough histories and educate clients on the proper use of supplements and natural remedies, and above all, regard these herbal and complementary therapies as potent medicines with strong pharmacologic properties to be used with caution and respect. Client compliance is a constant struggle for veterinary professionals, and in most cases a team effort from all facets of the veterinary staff is one’s best bet in making a client feel listened to, understood, and respected. Widespread supplemental therapies such as glucosamine and chondroitin for joint health, fatty acids for integument and immune support, and amino acid and plant-based liver supplements such as Denosyl (containing SAM-E) still meet resistance from some veterinarians and their staff. Such attitudes are harmful to the veterinary community as a whole, and they should be countered by a caring staff that acknowledges their clients’ beliefs and validates their perspective but also offers scientific and evidencebased medical advice for the benefit of their pet. In so doing, the pet owner will feel more trusting and inclined to engage with the veterinary team openly without fear of criticism. With a cooperative, trusting client, it is up to the veterinary staff to take and record pertinent, thorough medical histories that take into account all aspects of the animal’s lifestyle, conditions, and behavior. With an incomplete history recorded by the technician or veterinarian, such an interaction may be missed and the animal may experience significant adverse effects. Asking a client specifically about their pet’s possible regimen of herbs, vitamins, or supplements leaves little room for such mistakes. In the case of clients medicating their pets without input from a veterinarian, dosage or administration frequency of certain herbal or natural products may be significantly divergent from medical guidelines, possibly resulting in overdose or sensitivity toxicities. Oftentimes it takes a proactive, well-rounded veterinary team to ask the right questions and ensure that the most accurate, thorough history is being recorded regarding a patient. It could be the difference between a successful or a failing treatment. Natural therapies are growing in popularity and show no signs of losing steam. Although some alternative therapies practiced by these clients may be misguided, harmful, or ineffective, the veterinary staff must acknowledge their clients’ perspective to cultivate a mutually respectful relationship that facilitates meaningful client education and compliance. Complementary therapy is possibly a contentious issue in modern veterinary medicine, but through appropriate communication and self-education, it need not be a hindrance to a pet patient’s optimal medical care. Household Toxicities in Dogs and Cats Foods Colby, the dog, enjoying nature. Photo by Jennifer Smith Chocolate Caffeine Xylitol Ethanol Garlic Onion Grapes Raisins Complied by Lisa Resnick Plants Lillies Azaleas Rhododendrons Sago plant Oleander Other Rodenticides Prescription and OTC drugs 2 Alternative Veterinary Therapies The Importance of Post-Operative Rehabilitation for Canines by Bernadette Walker Post-operative rehabilitation for dogs is an integral part of a patient’s recovery. To maximize and maintain the benefits of many surgical procedures, postoperative physical therapy has become a vital component to the patient’s healing process. When a patient is recovering from an orthopedic surgery, healing times may vary depending on the procedure and the patient’s comfort level. Success of the surgery, patient age and weight, and client compliance all may affect the patient’s progress. It is important to emphasize to clients that they are a vital part of their pet’s post-operative rehabilitation process. Clients are often instructed during the first few days after their pet’s surgery to administer pain medications, apply cold or warm compresses, assist in mobility, and sometimes provide gentle massage. Encouraging a client to play an active role with their pet’s recovery can be a wonderful bonding experience and helps speed the healing process. Depending on a patient’s condition or type of surgery, patients may begin a formal post-operative rehabilitation program within 2 weeks following a surgical procedure. Rehabilitation programs often begin with a detailed evaluation and progress examination of the patient. Treatment plans are usually established on the patient’s current condition, past activity levels, and mobility goals for the future. Once a treatment plan is in place, rehabilitation may include a combination of hands-on techniques and therapeutic exercise programs that specifically address pain reduction, promote tissue healing, strength training, greater mobility/range of motion, and overall functional improvement. Benefits of Post-Operative Rehabilitation Pain and swelling, patient comfort Decrease in pain and swelling Pain medication may be used at a minimum or not at all Progress after severe orthopedic surgery or neurologic injury Less pain Increase in mobility Faster More complete Less healing complications Improved muscle function Increased muscle strength Increased range of motion Recovery time Overall muscle function, strength, and range of motion Chart by Bernadette Walker Two main concerns of post-surgical procedures are pain control and loss of mobility/range of motion. Rehabilitation programs are specifically designed and implemented to address these concerns along with other issues that arise in the healing and recovery process. The goals of treatment are often patient specific and may change during the course of treatment based on the needs of and the progress of the patient. Pet outpatient Brenna receives laser and acupuncture treatment at Veterinary Surgical Centers. Photo Courtesy of Jameswalkerstudios.com. Innovative technology includes therapeutic lasers, ultrasound and electrical stimulation machines to facilitate tissue healing to decrease pain and swelling. These technologies are often combined with specialized hands on techniques such as massage therapy, underwater treadmill sessions, and individualized therapeutic exercise programs to restore a patient’s mobility, strength and function. Post-operative treatment plans differ in length also depending on the patient’s progress, generally lasting from 4 to 7 weeks. Goals of a post-operative rehabilitation treatment plan fluctuate from week to week during a program and are patient-specific. Each week offers its own benefit and challenges for the patient. However exercises and treatment sessions overlap to ensure a balanced program. Client communication is a major component in the post-operative rehabilitation process. Educating the client of the importance of regular therapy and athome care all influence the patient’s recovery and overall benefit of a rehabilitation program. In addition, most patients who are discharged following a rehabilitation program go home with an exercise program to continue on the path to a complete recovery with goals to maintain an optimum, active, and healthy lifestyle. 3 Client Education On the Subject of Senior Pets by Megan Jensen No matter how many times they say to us “they will never grow old,” pets will age. Whether it’s realizing one’s own mortality or that the once energetic puppy has slowed and greyed, owners hate to admit that their pets won’t be around forever. So how do we, as veterinary health care providers, help our clients deal and come to terms with the subject of an aging pet? First, we have to define what a senior pet is. We NOVA Veterinary Technology student Katrin Ventocilla with her dog Sophie. Photo by Michael Robinson all know the trick of multiplying an animal’s age by seven to get their approximate age in human years, but how do we rationalize this number and make it diagnostic? Studies show that an average dog or cat is considered middle aged at 7 to 8 years of age, and that this is the ideal time to start thinking about preventative senior care. But owners commonly say, “He doesn’t seem to be sick or painful. Why do I need to start thinking about bloodwork now?” We should expect these comments and then help owners think about the importance of creating a diagnostic baseline for their pets or aiding in diagnosis of a disease before it becomes physically symptomatic. Secondly, how can a clinic further raise client compliance of preventative care? Once clients understand the importance of preventative care during their appointments, we can provide them with pre-made senior pet care packets. These packets should include in depth and easy-to-understand information, addressing the importance of blood cell counts (CBCs), serum chemistry profiles, fecal floatations, blood pressure screenings, and urinalysis. Other important information that should be included in the senior packet is information on weight management, the importance of dental hygiene, common signs of aging, and early disease warning signs. It may help clients to better understand their pets’ health if it is described in human medical terms. Lastly, hospital personnel can give priority care to senior pets and their owners by creating preventative care programs that clients can sign-up for on either an annual or biannual basis. Create a list of services that can be packaged and discounted. This rewards clients for completing this preventative health care screening. Clinics can also reward these exceptional clients with discounts on routine dental cleaning and other therapeutic treatments. Since the key to immortality has not yet been discovered, aging is something to which everyone can relate. It is our job to make sure our clients are accurately and fully informed on their pet’s life-stage status. By making the client-veterinary relationship more cohesive and team-oriented we can enhance the qual- Have We Seen Your Cat Lately? by Kierianne Knollman “Have we seen your cat lately?” This is a simple and easy question for not only our receptionists to ask but our veterinary staff as well. Clients don’t bring their cats in for various reasons including, but not limited to: “Oh, he’s just a cat, he seems healthy to me,” “My cat doesn’t go outside so why does he need a Rabies vaccine?” “The cat gets really car sick,” “The cat isn’t really ours. We just feed him, because he lives outdoors and is a neighborhood cat.” These statements all show the clients lack of knowledge regarding the health of the animal and who has true ownership of them. Each jurisdiction is different, but in most cases if a client is feeding a cat, even if it is a stray it can be considered legal animal ownership. Therefore, that owner needs to comply with pet ownership law, in- cluding providing medical care. Rabies vaccination is required by law for both dogs and cats in the state of Virginia. As veterinary professionals we need to bring to the owner’s attention that keeping their cat indoors will keep it safer. Even if cats are kept inside away from several dangers it does not mean it is not at risk for certain diseases brought in by other pets and people. The cat will still be at risk for other disease states that are species-specific. According the Humane Society for the United States, in 2012 there were 95.6 million cats owned in the U.S. Three times as many cats were not seen by a veterinarian than dogs, says the American Association for Feline Practitioners, (Continued on page 5) 4 Client Education Cotton, the cat receiving acupuncture. Have We Seen Your Cat Lately? (Continued from page 4) and the American Animal Hospital Association. They are under the impression that indoor cats are less susceptible to illness, and the owner’s will only bring the patient in to the vet if they are exhibiting any signs of illness. As we all know, cats are incredibly adept at hiding illness. Owners need to be informed that bringing in their cat at least once every year can catch disease states and problems early. Ways for veterinary staff to encourage cat owners about bringing in their pets for veterinary visits can include sending out reminder emails for existing patients, asking the owner if there are any other pets that they would like us to set up an appointment for, or leaving out educational literature about the importance of preventative and maintenance health visits for the feline pets. Posting information on the walls of the veterinary hospital and on the practice website about the importance of preventative medicine in our cats Photo by Mary Aller, DVM. can also help our clients make informed decisions about the need to have their cat seen. We have to remind owners that routine visits, vaccinations, and examinations are to prevent and detect problems early, to avoid suffering, further disease complications, and more expensive treatments down the road. The most important point for veterinary staff to impress upon clients is the overall, long-term health of the pet and peace-of-mind for the owner. We want to build client compliance so we can better assist the client, and help our patients. Are You Ready... Is Your Hospital Prepared for an Emergency? by Jenny Carr For the average veterinary practice, life-threatening emergencies such as cardiopulmonary arrest are not on the forefront of everyone’s mind. But, if a patient were to arrest or have a life-threatening emergency, would your hospital be prepared to help save that patient’s life? It takes a well-prepared, well-trained, and organized hospital to quickly and properly perform lifesaving procedures. All staff should know where the cart is located and where items are inside the cart. The cart or portable toolbox should be checked every shift change to ensure all supplies are there. Drugs should also be checked on a regular basis to ensure they have not expired. The drawers should be labeled on the outside as to their contents. A well-trained veterinary staff is critical in helping patients in the emergent situation. Hospital staff should work as a team in times of emergency and everyone should know their roles. In an emergency, there should be a team leader guiding and directing the staff. This will usually be a veterinarian directing Drugs To Be Kept In CRASH Cart Mandatory Atropine Epinephrine Lidocaine Sodium Bicarbonate Recommended Dopamine Dobutamine Norepinephrine Vasopressin Glycopyrrolate technicians to intubate, give drugs, etc.. If the doctor steps away for any reason, a licensed veterinary technician should take over that leadership role. Assistants can obtain supplies, document drugs given and times, and hold the patient in proper position. The front staff helps by taking care of the waiting client family. Hospitals should run mock practice codes to help staff work as a team and understand roles during an emergency. Doctors and veterinary technicians should also be knowledgeable on how to properly and safely use a defibrillator.. Emergency drugs should be precalculated and kept on the monitoring sheet before an anesthetic procedure. A properly trained staff that can work as a knowledgeable team in emergency procedures will have a better chance of achieving a successful outcome. People trust veterinarians to take care of their pets. Pets are rarely seen as just “pets,” but instead viewed as family members and friends. The best way a hospital can take care of these furry family members is to be prepared to help them in a time of crisis. If a hospital is well-stocked with emergency supplies, wellorganized with a well-trained and knowledgeable staff, they have a better chance of saving a pet patient’s life. Naloxone Diphenhydramine Mannitol Furosemide Propofol Propranolol Doxapram Terbutaline Heparin Flumazenil Calcium Gluconate Nitroprusside Acepromazine Complied by Jenny Carr 5 The Northern Virginia Community College Veterinary Technology Program graduating class of 2014 would like to thank their families, friends, teachers and clinics for all their help and support in preparing the next generation of Licensed Veterinary Technicians to enter the field of veterinary medicine. Thank you all! NOVA Veterinary Technology On-Campus Program 2014 Graduates (not in photo order) Gray Akers, Crystal Bailey, Jennifer Carr, Stacie Craddock, Allison Craig, Jessica Del Toro, Sara Doan, J Forte, Kristin Hakala, Katherine Hall, Jessica Hansen, Breanna Hargbol, Ed Hickey, Megan Jensen, Danielle Kinsey, Kierianne Knollman, Laura Koch, Natalie Lalande’, Nicole Latane’, Ian McCabe, Sarah McKinney, Kristen Mitchell, Pamela Pasch, Anjali Raj, Lisa Resnick, Gloria Rittgers, Cailey Roeske, Julia Roop, Jessica Sanderson, Jill Sites, Jennifer Smith, Mark Speth, Rachel Stephens, RosaLena Tabacchi, Marc Taylor, Katrin Ventocilla, Malcolm Vernem, Magdalena Voelker, Bernadette Walker, Samantha Wooten Assistant Dean and Associate Professor Tregel Cockburn, DVM Distance Learning Program Head and Prof. Mary Aller, DVM, MS Professor Leslie Sinn, DVM Assistant Professors and Instructors Amy Laubinger, DVM and Paige Geier, DVM Bonnie Webster, LVT and Diane Schrenzel, LVT Admin. Assts Linda Karol and Deborah Fulton Chief Editor: Jennifer Smith Assistant Editors: Jessica Del Toro, Ed Hickey, Pamela Pasch, Cailey Roeske, Anjali Raj, Julia Roop, Samantha Wooten Northern Virginia Community College Veterinary Technology Department, Loudoun Campus 21200 Campus Drive LA Building Sterling, VA 20164 703-450-2525 [email protected]