VetTechPrep Blog

One of the most common conditions seen in large breed dogs as they age is evidence of hip dysplasia. When you are taking a history for an exam appointment (especially for older pets), don’t forget to ask how they are getting around. Ask the owner if their pet is slowing down, reluctant to jump up, is less active, or is having problems getting up off the floor. Some owners assume that these symptoms are just part of aging (sometimes they can be); but if the pet is having trouble, the veterinarian should address these issues with the owner and discuss management of arthritis.

What is it? Canine hip dysplasia is a progressive and multifactorial disease. It is usually genetic and caused by abnormal formation of the hip joints. This malformation leads to muscle and ligament laxity which means that the hip joint is not properly held in place. The dyplasia leads to chronic inflammation and pain in the hips.

Symptoms can include:

• Difficulty rising from the floor (tile floors make it especially difficult)
• Difficulty laying down and getting comfortable
• Reluctance to use the stairs (going up or down)
• Not wanting to go for walks or chase the ball, etc.
• A bunny hop type of gait
• Sometimes the dog shifts weight on the pelvic limbs
• Reluctance to be brushed or pet in the hind end or crying out when handled or picked up
• Not being able to jump up anymore (often noted that they can’t jump into the car anymore)

Risks for hip dysplasia:

• Large and Giant breed dogs (smaller breeds like Bulldogs are also at risk)
• Obesity
• Sub-optimal diet
• Genetics (offspring of a dog that had hip dysplasia)

Diagnosis: Diagnosis is made by a combination of things. Physical exam and poor range of motion in the hips is suggestive; pain on hip extension, or Ortolani sign on exam (posterior dislocation) may also be seen with sedated exam. X-rays are very helpful in diagnosis. The head of the femur should be more than 50% covered by the acetabulum, poor coverage (<50%) in the hip joint is seen with dysplasia. The appearance of the joint can be affected by positioning. It is important to keep the legs parallel with the table and not frog-leg the patient for positioning. Because dogs with hip dysplasia are painful, sedation is often needed for good hip extension and positioning for x-rays. For younger dogs that are going to be used for breeding or owner is concerned about risk, Penn Hip evaluation can be performed under anesthesia to determine risk for future development of dysplasia based on hip laxity (best at 1 year of age, can be done as early as 16 weeks). OFA HIP x-rays are more subjective and based on a grading system (need to be at least 2 years).

Treatment: Treatment may range from controlled exercise, weight loss, and management with joint support medications (such as glucosamine and fatty acids)  or NSAID therapy. For more severe cases or those that cannot be controlled with medical management alone, surgical options include total hip replacement (with an artificial hip), femoral head osteotomy (to remove the head of the femur, usually for one hip), or triple pelvic osteotomy (for young high risk patients and performed between 6 to 12 months of age). Treatment depends up on each individual patient, pain level, and financial considerations.

Renal failure is one of the most common medical conditions veterinarians treat. Technicians are often needed to help facilitate those treatments and explain the treatments to the owners. This blog is a brief review on chronic renal failure, treatments, and long-term management goals.

1)      Overview: What is chronic renal failure? Chronic means that the kidney function has slowly decreased over time (months to years). It is a progressive loss of kidney function which cannot be cured. The kidneys are not able to properly filter waste products from the body. Typically the kidneys have lost more than 70% of functional capacity before clinical signs are seen. Symptoms may include polyuria and polydipsia, weight loss, poor haircoat, chronic or intermittent vomiting, and decreased appetite. Labwork typically shows azotemia (elevated BUN and creatinine which are the two renal values), dilute urine (low urine specific gravity due to the kidneys not being able to concentrate), elevated phosphorus, and sometimes anemia. The kidneys make erythropoetin (EPO a hormone which helps in production of new red blood cells). When kidney function decreases, so does EPO production, hence development of anemia.

2)      Management: The goal of treatments for CRF is to provide a quality of life for the patient for as long as possible. Medical management of chronic renal failure consists of several things.

• Fluid support for the kidneys is probably the most important treatment. This helps support hydration status. Often owners can be taught how to administer subcutaneous fluids to their pet (especially cats) once or twice weekly at home.
• Acid blockers such as famotidine (Pepcid AC) are very helpful. Pets in renal failure are at risk for ulceration in the gastrointestinal tract and should be on a daily acid reducer.
• Diet should be low in protein and phosphorus. There are various prescription diets in this category that may be used.  These diets reduce the workload on the kidneys and can help slow the progression of the disease.
• Blood pressure monitoring is crucial. Hypertension will develop in more than 20% of patients with chronic renal failure. High blood pressure can cause further renal damage, can cause blood clots, blindness (from retinal damage), and can lead to heart disease or other problems. Patients with hypertension need to be on medication to manage this problem.
• Iron supplements can be helpful in anemic patients. Blood transfusions are usually not helpful, as these are not beneficial long term, and the anemia is chronic in nature.
• If the phosphorus level is elevated, a phosphorus binder can be used to reduce this level. Elevated phosphorus can make the patient nauseous.
• Azodyl is a supplement that has been said to bind uremic toxins so that they are excreted in the intestine (an enteric dialysis). While there may be some controversy on benefit, many owners report an improved quality of life with this supplement.
• Sometimes other things are needed. CRF often leads to potassium depletion and a potassium supplement may be needed.

3) Ultimately, quality of life is what we always strive for. The goal is to keep the patient eating and minimize nausea. The veterinarian should provide education to the owner of things to watch for as the disease progresses so that they know what to expect in preparation for making end of life decisions. Treatments must be tailored to the individual patient.

Did you know that March was Pet Poison Prevention Month? As a veterinary technician, it is important to know common household toxins so you can inform owners of poisonous plants or chemicals which they may have in their home. Let’s do a brief review of common toxins which can be found in the home.

1) Antifreeze (Ethylene Glycol)- commonly kept in the garage, this toxin has a sweet taste and animals are drawn to it. Ingestion of this toxin can cause ataxia, vomiting, metabolic acidosis, sometimes seizures, and leads to acute renal (kidney) failure.

2)  Rodenticides (aka- “rat bait”)- Symptoms may vary depending on the active ingredient. Classically, the rat bait toxins contain anticoagulants. These inhibit vitamin K production and lead to uncontrolled bleeding. A prolonged Pro-Thrombin Time (PT) can be suggestive of this toxin. The PT may not elevated until more than 72 hours after the toxin ingestion, and the pet may not have clinical symptoms for 7 days or longer in some cases. Bruising or bleeding may be clinical signs.

3)  Prescription medications- very commonly owners accidentally drop a pill on the floor and the pet eats it. Tell owners to always open their pill bottles over a cookie sheet or other surface to prevent the pills from falling on the floor or bouncing off the countertop, especially elderly clients who take many medications and may have more difficulty handling their pills. Often, these medications include blood pressure pills which can be very toxic, especially to tiny pets. Drug toxicities are among the most commonly reported in small animal practice.

4) Foods- chocolate is a common one that most people know about. Chocolate contains theobromine and caffeine, which cause CNS stimulation (hyperactivity, restlessness, tachycardia, or seizures). Grapes and raisins are toxic in some pets and ingestion can cause acute renal failure. Xylitol is an artificial sweetener often found in sugarless gums or candies and causes severe hypoglycemia. It can be fatal. Avocados are toxic to birds. When Teflon pans are heated, chlorofluorocarbon fumes may be released into the air and can cause sudden death or respiratory distress in birds.

5)  Lawn pesticides- most of these chemicals can be toxic, so advise owners to only use pet friendly products and make sure they completely dry before the pet has access to the area. Also, snail bait is a major toxin and if ingested can cause seizures and death. (The snail and slug baits are usually metaldehyde based.)

6)  Poisonous plants- there are many of these. Major ones include Oleander, Sago Palm, and lilies. Lily plants specifically can cause acute renal failure, especially in cats. It is very useful to put together a list of common household toxins and use it as a client handout. Keeping clients informed may prevent their pet from being exposed to a deadly toxin.

Prevention is the key!

1)      Make the client understand why something is necessary. Whether it is compliance with giving medications at home, returning for follow-up bloodwork, or deciding to go forward with a dental cleaning, people are more apt and willing to comply when they understand exactly why these things are important for the health of their pet.

2)      Make it personal. Whether you are explaining a procedure or going over discharge instructions, use the patient’s name in the context. “It is really important that you return for labwork to check Charlie’s kidney function in two weeks.”

3)      Educate the client. Client handouts are very helpful. In the exam room, the client will only remember a small portion of what you explain to them. They will understand more if they have some materials to read after they get home.

4)      Instead of saying “estimate”, say “treatment plan”. It makes the client feel that this is a treatment plan for their pet, and not as focused on the financial aspect. It is important, however, that every client receive a treatment plan (estimate) for services before they are performed.

5)      Perform follow up calls. Call to check on the pet the following day after their visit. This is a good time to remind the client of follow up recommendations after they have had time to read their handouts and reflect upon their visit. Also, it shows that you care about their pet.

6)      Reminder calls for labwork are helpful. If the doctor recommends a follow up renal profile in 3 months, a call to let the client know that the pet is now due for the labwork will increase compliance. Everyone gets busy, and it is easy to forget a follow up without a reminder.

7) Empathize. Put yourself in the client’s position. Treat them how you wish to be treated when you are seeking care for your own beloved pets! This helps clients feel comfortable and thus makes them more compliant.

Veterinary technicians are commonly asked for tips on puppy potty training. This blog will give you some ideas and tips you may share with the owners of a new puppy!

1) Puppies will urinate or defecate after waking. They should be taken outside immediately when they wake. Puppies also eliminate shortly after eating. Feeding them on a schedule, and taking them out after they eat, will help to get them in the habit of going outside to do their business.

2) POSITIVE reinforcement is especially important. When the puppy urinates or defecates outside, the owner should give the puppy lots of praise, affection, and a treat is always a good idea. The puppy will pick up on the fact that their owner is happy when they go potty outside.

3) Young puppies often have accidents in the house while they are learning. Potty training is a process. Negative attention to accidents can set back the progress during training. It is best to ignore the accident unless they are caught in the act. The owner may clap their hands if they are caught in the act. The puppy should be immediately taken outside and then praised outside. The accident from inside can be soaked up or picked up and taken outside and placed on the lawn so the puppy senses that the elimination should take place outside.

4) An older puppy that “knows better” and has an accident in the house can be held in a submissive position on his side (see photo). This is a way of showing dominance over the puppy without direct punishment. Spanking or extensive yelling should be avoided at all times. The goal is for the new owner to bond with their puppy, and negative attention can be detrimental. The puppy is placed on his side, gentle pressure is placed on the neck while holding the legs that are on the floor side. The puppy may be held in this position next to his accident until he relaxes and submits. This is also an excellent way to appropriately discipline a puppy who bites or gets too rough, tears something up, etc.

5) Crate training can be very helpful. Puppies are less likely to soil in their own sleeping area. If they sleep in their crate or are crated while the owner is away, they should be let outside as soon as their crate is opened. A puppy should not be punished for an accident which happened while the owner was away.

6) A bell can be attached to the door area where the puppy goes out to eliminate. Before going outside ring or jingle the bell. Soon, the puppy will learn to ring the bell with his nose to notify the owner that he needs to go outside.

If a trained puppy begins to have accidents, is urinating frequently, there is an odor or discoloration to the urine, or if the puppy is having diarrhea, there may be a medical cause for the accident and they should seek veterinary care.