There is now a new kidney test available from IDEXX! Symmetric dimethylarginine (SDMA) is a new biomarker that can be used alongside the creatinine, BUN, and urinalysis to help diagnose renal insufficiency earlier on in the disease.


SDMA is a methylated form of arginine (an amino acid) that is released into the circulation when protein is broken down and it is excreted almost exclusively by the kidneys. It is a biomarker for kidney function and therefore is a good estimate of the glomerular filtration rate (GFR). This biomarker increases with the loss of 40% of renal function (as compared to creatinine which does not increase until 75% of the renal function is lost). SDMA is not affected by factors other than kidney function and is therefore very SPECIFIC.

So what happens if the SDMA is elevated and all other parameters are normal? Because it is a specific biomarker, it means that the animal tested is having early renal insufficiency. By using this SDMA test, it will allow for earlier intervention by prompting investigation to look for underlying causes of renal disease and help with earlier management (monitoring blood pressure and renal parameters, changing diet if warranted, use of renal protectant supplements, etc.)

If we know that renal insufficiency is occurring, we can potentially help to slow the progression. This new biomarker may be helpful in those cases where we are not quite sure if the patient is truly having underlying renal disease (dilute urine with normal renal parameters, weight loss cases, PU/PD symptoms, or even no symptoms but a dilute urine and negative culture for example).

Please take a moment to educate yourself about this important new diagnostic tool!

IDEXX Case Studies and Video about SDMA


We have heard a lot about compassion fatigue in the last year when it comes to the veterinary community. It is a very important topic to address if you work in the veterinary field.

What does Compassion Fatigue really mean? There are many definitions to what this means. In applying it to veterinary medicine, this is what it means for me.

Compassion fatigue is the exhaustion and burn-out that you can feel after repeated unfortunate situations which cause you stress and in which you feel responsible about an animal’s well being. 

Compassion Fatigue is something that most often affects caregivers. In our case, it centers around the constant care and attention that we give to animals. As we all know, being a veterinarian or veterinary technician does not always involve caring for cute and healthy puppies and kittens. We are faced with challenging cases day in and day out, sometimes encompassing traumas, death, or neglected animals. This starts to take a toll on those with a tender heart.


This is something that may affect you in general practice. Those who work in a shelter environment can especially be vulnerable to this. While I am in small animal practice, this can affect those on the large animal side as well.  Compassion fatigue can quickly lead to burn-out, which is very common in our profession. If you can recognize it and learn to manage it, it may help you in the long-run.

According to the Compassion Fatigue Awareness Project, if you think you might be suffering from this condition, you likely are. They suggest that awareness is the first step to healing. If you are aware, then you can take the appropriate steps to help yourself.

How can I deal with Compassion Fatigue? Whether a veterinarian or a veterinary technician, here are some things you can do:

  • Try to separate your personal life from your professional life. We all bring thoughts home from work, but if you are losing sleep over cases, this is an issue. New graduates tend to do this a lot. The longer you are in practice, the easier it will become to separate home life and work life. Reading non-veterinary material before bed helps. A good book can get your mind off work and help you to sleep easier.
  • Talk to someone. My husband is also a veterinarian, so this makes it good and bad for us. It is easy to vent as we both fully understand and can sympathize, but we tend to feed off of each other’s frustration. If my husband is in a happy mood and then I tell him about a bad case when I get home from work, then we are both upset, that doesn’t do him or us any good! So, I call my mom to vent. Find that person you can talk to about hard cases so that you can release it and move on.
  • Know that you cannot save the world.  As veterinarians or vet techs, we are obviously very caring individuals. We want to take on the burden of the world. I have to tell myself that I cannot love someone’s pet more than they do and I cannot hold myself responsible for those who are irresponsible.
  • My husband’s grandmother had a saying, “ Do the best you can; the angels can do no better.” You just do the best you can for each pet. They are the priority and it is our oath to prevent suffering. Even with difficult euthanasia situations, just remember you are allowing the pet to be at peace. This can be especially hard in shelter medicine when you constantly see cases of neglect or cruelty, or when healthy animals must be euthanized because there is no home for them and no more resources to continue to care for them. Remember you are there for the greater good. Without you, these pets would suffer.
  • Know that you will have good and bad days in practice. Focus on the good cases and the pets that you are able to help. Focus on those clients who are so appreciative of you and the care you give to their pets.

You are never alone! Please reach out for help if you find yourself having negative thoughts or need someone to talk to.

Veterinarians May Ignore Signs of Compassion Fatigue

JAVMA April 2015: Study: 1 in 6 veterinarians have considered suicide


It can be very intimidating or scary for owners to think about giving injections to their pets. With some encouragement and a good demonstration, the majority of pet owners will quickly become comfortable administering injections.

It is important that the owner receives handouts on diabetes, insulin, and administration. The information can be overwhelming, especially if they are apprehensive; they may forget some of what you tell them.

The doctor should go over diabetes with the owner, but technicians often give the insulin injection demonstration. Therefore, technicians should be familiar with insulin handling, and knowledgeable enough to answer basic questions about insulin and administration.


Key Points to Discuss with Owners of Diabetic Pets during Insulin Demonstration:

1) Never shake the insulin. Gently roll it prior to drawing it up in the syringe.

2) Keep the insulin refrigerated. If insulin must be taken out of the house, keep it on ice packs or in a cooler.

3) Always check, and double check, the amount of insulin drawn up prior to injecting. In the event the owner thinks too much insulin has given or if the pet got the insulin injection twice, medical attention should be sought immediately. (There are many scenarios where one family member gives the insulin, and then another family member didn’t know it was already given and the pet gets double dosed)  Have the owner keep a calendar and check off that the insulin was given and at what time to prevent any confusion, or in case they forget if they gave it or not.

4) NEVER RE-DOSE INSULIN. If you can’t remember if you gave it or not, or you are not sure if it went in (i.e. a wet spot on the fur), just give the next scheduled dose.

5) For pets that are on insulin every 12 hours (most pets get insulin twice daily), the injections should be given as close to 12 hours apart as possible. It is generally recommended that pets are fed twice a day and that insulin is given at mealtime. If the pet is not eating or only eats a little, typically it is best to give half of the regular dose and call the veterinarian for further guidance.

6) Monitor for signs of hypoglycemia (i.e. shaking, lethargy or weakness, stumbling, seizures, etc.). If signs occur, advise owners to give some Karo syrup orally if the pet is alert enough to swallow and call the hospital or have the pet seen immediately.

7) Explain the importance of follow-up visits to check a blood glucose curve or fructosamine level. This way the pet can have regulation monitored and the doctor can adjust the insulin if needed. The owner should NEVER adjust the insulin on their own.


Use a small vial of sterile saline to pretend it is the insulin vial. Gently roll the vial to show owner how to mix. Show the owner on the insulin syringe exactly where the units are and to which line or units to draw up their pet’s insulin. Have them look at the syringe after you draw it up.

Show them how to hold the pet (if applicable) and how to gently lift up on the skin and subcutaneous tissue to insert the needle (usually the scruff of the neck is easiest). The needle should be inserted to the hub and the insulin is injected. After injecting, the needle should be pulled straight out. The owner should purchase a sharps container for which to place used syringes, and insulin syringes should never be re-used. The site where the injection was given should also not be rubbed.

After you give the practice saline injection and show the owner how, have them practice with the saline a couple of times so that they will feel confident in giving the insulin at home.

Client Education on Diabetes Mellitus


In the recent JAVMA May 2015, there was an article regarding what is listed on the pet food label and what is actually in the food when tested. I was a bit shocked by the findings, however I am not surprised that there may be some degree of cross-contamination in pet food facilities (much like the label on human foods that states “made in a facility that processes peanuts.”)

However, according to the JAVMA article, “about 40 percent of dog and cat foods tested in a recent study (Food Control 2015; 50: 9-17), may have contained meats different from those listed on the product labels.” WOW! 40 percent is a huge number! The tests conducted by this study were based on DNA results of the animal products found in the pet foods.  Another reference was published by Laura Allred, PhD, who showed in her 2012 study that via ELISA testing 10 out of 21 commercial dog foods contained species that were not declared on the label or WERE MISSING SPECIES THAT WERE DECLARED! That’s right, that bag of dog food with chicken listed as the second ingredient may not even contain any chicken. To me, that is by far the worst.


What is the significance of this you may ask? Well, it may not be a huge issue if a pet gets a little bit of chicken, etc. even if it isn’t listed on the label, UNLESS that pet has a food allergy. We feed our own dogs limited ingredient diets although they don’t have food allergies, but we pay around $80 for a bag of dog food. That is a lot for a bag of food, and yes I expect what is listed on the bag to actually BE IN THE BAG! Apparently, the whole “you get what you pay for” scenario may not apply here.

The article does not list specific brands of food, and I will not go into my own opinion on food brands here, but I do hope that these findings will shed some light onto the deception that is occurring, even if it is not intentional. Better quality control should be occurring. The FDA focuses more on safety of products (don’t get me started on this either), so that while the system is supposed to ensure that the ingredients in the food are safe, the regulations of enforcing that what is actually in the food is matching the label falls to the wayside. So the food may be supposedly safe, but it is considered “food fraud,” according to John W. Spink, PhD, the director of the Food Fraud Initiative at Michigan State University.

Out of all type of food tested (dry food, treats, and wet food), wet food had the most added AND missing ingredients. It would be impossible to test DNA samples on every product, but perhaps in the future, the standards will be set higher to have better quality control.

Why you can’t trust pet food labels

Not all brands follow meat regulations: The Chapman Study

Recovering from Surgery

Recovering from Surgery

Veterinary technicians are often the first person of contact for pets during emergencies or post-operative in the hospital. Therefore it is critical that a veterinary technician can recognize the signs and symptoms of pain.  Pain management is an important part of patient care, and by implementing pain scoring in the monitoring of hospitalized patients, patients may receive the analgesia and attention they need.  Animals may be very stoic and pain can sometimes be difficult to assess. The following suggestions are meant to help with pain scoring in our pet patients. Some physical characteristics below such as panting or trembling may not be pain related but may be due to nervousness or other medical disease so these symptoms are to be interpreted based on the whole status of the patient.


General physical characteristics of pain may include (but are not limited to):

  • Vocalizing (crying, whining, etc.)
  • Inability to lay down or rest comfortably or not
    moving when awake
  • Increased panting, agitation, trembling,
  • Stiff gait or lameness
  • Hunched or abnormal posture or “praying”
  • Chewing or licking at a painful area
  • Depression/decreased responsiveness to the owner
  • Lack of self grooming in cats
  • Carrying tail in a low position
  • Decreased appetite
  • Urinating or defecating inappropriately because
    they don’t want to get up or posture
  • Attempts to bite at the owner or at a caregiver
  • Hiding

It is important to treat predictable pain which means that if an animal has a surgical procedure or has a medical condition that is known to be painful (such as pancreatitis or glaucoma), that analgesia is given regardless of whether the animal may “seem” painful (i.e. just because a pet is quiet does not mean they are not in pain). As a veterinary technician, look for physical characteristics of pain. Take the patient’s heart and respiratory rates. Tachycardia, tachypnea, or increased blood pressure may be seen when an animal is in pain (although these may not always be consistent; an animal that
is exhibiting painful behaviors but has a normal heart and respiratory rate is likely painful). The bottom line is that if you see characteristics of pain, notify the veterinarian so that the patient may be further assessed and appropriate analgesia may be administered.

AAHA/AAFP Pain Management Guidelines for Dogs and Cats



Anesthesia is routine in practice. However, it is important not to become complacent. All patients tolerate and react to anesthesia differently, and monitoring every patient closely is extremely critical.

IMG_0277IMG_0277IMG_0277This is Spunky. He is a 6-month old stray kitten that was brought in for a neuter and first FVRCP vaccination. He did well under anesthesia during his neuter and upon recovering was given his vaccine. A few minutes after receiving his vaccination, he acutely stopped breathing. Luckily the technician who was closely monitoring him was astute enough to recognize something was wrong. The doctor in charge immediately began chest compressions and ventilations as his heart had stopped and he was in cardiac arrest. Please take a moment to review CPCR technique.  Review on CPCR Technique

Cats rarely have vaccination reactions, but when they do, they are typically very severe and anaphylactic in nature. Spunky was given the appropriate medications including atropine, epinephrine, a small bolus of fluids, and was also given Dex SP since a vaccine reaction was suspected as the underlying cause. Luckily, Spunky’s heart began beating again and he has made a great recovery. It is very rare for a pet to survive cardiac arrest. The ones that do are typically the young and otherwise healthy patients and appropriate intervention is absolutely critical. Spunky did have cortical vision loss for about 3 weeks after this incident which is caused by temporary oxygen loss to the brain. He has now regained most of his vision, and he is a happy and playful kitten at home.

There are 2 lessons to be learned from this. First, it is best to not give vaccinations while a patient is under anesthesia. Unless the patient is extremely fractious or aggressive, it is best to just administer them on another day, or before they go home once they are completely recovered from anesthesia. Secondly, you can never let your guard down when watching patients under anesthesia- including before (after premedication), during, or after the procedure. Veterinary technicians are vital to helping watch the patients in the hospital and knowing what to do in an emergency situation truly is a matter of life or death!


dujoThis coming Saturday, May 30th at 1:00 EST, Dr. Mauricio Dujowich will present the topic “Veterinary Surgery-What to Expect” on the  Animal Airwaves Live call-in radio program on WUFT-FM.  The episode was prerecorded this week so there will not be a live call in section during the show.   Just as in people, many diseases as well as traumas experienced by pets require surgery for the best prognosis. Dr. Mauricio Dujowich, a veterinary surgery specialist, will discuss some of the more common situations requiring surgery, techniques now being used to treat various conditions, why a team approach to problem solving benefits animal patients and what pet owners should know if surgery is recommended for their pet. Listeners can also tune into the show online for live streaming during the broadcast:


To view upcoming and previous topics and to listen to past shows, visit the Animal Airwaves Live! 



Pets will lose about 75% of their renal function before azotemia is noted on the labwork. This is why staging is important to determine how far underlying renal disease has progressed, so that supportive measures and appropriate intervention can take place.

What is Chronic Kidney Disease?

Chronic renal disease is kidney disease that has been going on for months or years (longer term). This is different than acute renal failure which occurs suddenly and more severe (such as with antifreeze or lily toxicity). There are many possible causes of chronic kidney disease including:

  • Chronic bacterial infection
  • A defect of the kidneys at birth
  • Hypertension (high blood pressure)
  • Autoimmune disease (such as lupus, glomerulonephritis, or amyloidosis)
  • Infectious diseases (such as Lyme or Ehrlichia)
The intricate vasculature of the kidney is illustrated in this model.

The intricate vasculature of the kidney is illustrated in this model.

The kidneys contain thousands of nephrons (the functional unit of the kidney). The kidneys help to filter blood waste (from toxins, foods, cells, etc.), conserve water and electrolytes, and regulate calcium and Vitamin D levels. They also produce erythropoietin which helps the body to make new red blood cells.


Pets can have many symptoms, most commonly including decreased appetite, occasional vomiting, weight loss, and increased drinking and urinating.


Labwork often shows anemia of chronic disease (non-regenerative), elevated BUN and creatinine (azotemia), increased phosphorus, dilute urine, proteinuria.

Staging is helpful to determine severity of the renal failure. The International Renal Interest Society (IRIS) provides a helpful algorithm for staging renal failure in pets. IRIS Kidney Disease Algorithm

Tests to help determine the underlying cause of kidney disease include x-rays or ultrasound (to look at kidney structure and look for kidney stones), a renal biopsy in cases that are suspected autoimmune or congenital, urine culture and MIC, blood pressure, and urine protein:creatinine ratio.


Treatments can include diets limited in protein, phosphorus, and ash, phosphorus binders if the phosphorus is high, weekly (or more frequent) subcutaneous fluids for renal support, antacids (such as famotidine), and others. The treatment plan varies per patient and is tailored to each individual based on lab findings, stage of renal disease, underlying complications (such as hypertension), and clinical status.

IDEXX Advanced Diagnostics for Kidney Disease


Feel the Breeze!

"Pam" the dog feelin' the breeze!

“Pam” the dog feelin’ the breeze!

Simply put, it isn’t enough for a dog to live in a home with a yard. A yard to play in does not equal a “daily walk.” I am not saying it isn’t fantastic, because it is. I am just saying a daily walk and living in a home with a yard are not synonymous.

Often, clients come in with complaints of behavioral issues such as barking, fighting or dominance issues with other dogs in the home, or chewing up things around the house. The first question I always ask is, “How many walks does he/she get per day?” And most of the time there is silence because the answer is none. Or the response is, “None…but we have a backyard.”

Dogs still need to have their minds stimulated. They need to get out of the house and go for a walk, or a ride in the car, or have a pet play date.

When we as humans get home from work and are tired and ready to relax, the dogs are excited and happy to see us! They are ready to start their activities with us and be busy. Remember, they have likely been sleeping all day or just waiting for us to come home. Their whole world revolves around us. So as hard as it might seem to get up early for a morning walk, or to go for that evening walk after a long day, just commit to it for yourself and for your dog. It is good bonding time and frankly a necessity for the whole household!

It reminds me of a quote I recently saw, “To the world you may be just one person, but to one person (or dog in this case) you may be the world.” -Bill Wilson


What is Plague?

Plague is a disease caused by the bacterium Yersinia pestis. You may have recently heard about it in the news, as the first case of a dog to human transmission was reported in Colorado.

Dog Transmits Plague to Its Owner

Yersinia pestis photomicrograph, courtesy of NIAID

Yersinia pestis photomicrograph, courtesy of NIAID

How is it Transmitted?

Plague is most common in the Western to Mid-Western states, and is mostly seen where there is a high incidence of infected rodents such as prairie dogs. The bacteria are carried by fleas. When an infected flea bites an animal, the bacterium is transmitted and continues to spread in this manner, by the flea taking meals from infected animals and going on to the next. Dogs or cats running around outside chasing or eating vermin are at a higher risk of getting infected as the disease is transmitted through infected bodily fluids. Cats are very susceptible and are a more common source of infection in humans.


In humans, symptoms can include fever, chills, headache, weakness, coughing, enlarged lymph nodes (bubos or Bubonic form) and/or the development of pneumonia. The pneumonia form (Pneumonic plague) is the most contagious as it most often occurs from inhaling bacteria due to close contact with infected people or animals. Symptoms usually occur within 1-3 days after being exposed to the disease.

In cats, the most common presentation is high fever and abscessed lymph nodes (submandibular lymphadenitis). Cats can spread plague to humans through bites, scratches, contact with fluids ( it is not recommended to aspirate the lymph nodes if plague is suspected without proper protection), or infected fleas may be brought indoors via the cat or dog.

Contact your local health authorities about how and where to send tissue samples, and make sure to use proper protection if samples are taken from an animal.


Plague is treatable with antibiotics. However, late diagnosis can prove fatal, as the disease can be overlooked. The most common drugs used for treatment include doxycycline or gentamycin.

The CDC provides an excellent presentation on plague:

Centers for Disease Control Plague Training Module