Ebola Virus and Animals

As animal lovers, I think all of us that read about Spanish Ebola patient Teresa Romero‘s dog “Excalibur” being euthanized as a precaution from exposure to Ebola were disheartened. In the veterinary community, our pets are our family members. This disease has caused a lot of fear. I know we were all relieved that they decided to quarantine the U.S. Ebola patient Nina Pham’s dog Bentley for monitoring instead of euthanizing him as a precaution, and were happy to hear he is now safe at home.

Ebola virus, Photo CDC Cynthia Goldsmith

Ebola virus, Photo CDC Cynthia Goldsmith

There is not a confirmed source for Ebola currently, but is thought to be found in fruit bat populations. Humans initially may contract the disease by coming into contact with an infected animal (bat or primate) or infected fruit or meat (bushmeat), and then human to human transmission occurs via bodily fluids or fomites with infected fluid. Those caring for Ebola patients or in close contact are at highest risk.

In the current Ebola outbreak in West Africa, animals have not been found to be a factor in ongoing transmission. According to the Centers for Disease Control, the USDA, and the AVMA, pets are not considered to be at a significant risk for Ebola in the United States. This is probably because currently it is still considered low-risk for humans in the U.S. as well, so would be even lower risk for pets. But even in West Africa where Ebola is found, there are no current reports of dogs or cats actually becoming ill from Ebola. That being said, the above organizations are continuing to work to gather more information about Ebola and animals for veterinarians and the public.

There was a study written regarding the outbreak of Ebola in Gabon in 2001-2002. Over 400 dogs were screened for Ebola antibodies (many dogs were thought to have eaten infected dead animals because in this country dogs are scavengers), and approximately 25% of the dogs had detectable Ebola virus- IgG. This shows that these dogs were exposed to the virus. However, none of these dogs were symptomatic. Therein seems to lie the concern then about dogs harboring and transmitting the virus, even if they are asymptomatic. But, the dogs with positive antibodies against the virus tested negative for the disease. So the question is, when they are initially exposed, how long could they be shedding virus if at all? Currently only a few animal species (primates and humans) have demonstrated the ability to actually spread the Ebola virus.

As a vet tech, if you were to be encountered with the rare situation that an owner believed their dog to have Ebola, the best thing to do would be to notify the veterinarian immediately. The veterinarian should take a thorough history, acquire personal protective equipment, quarantine the dog, and contact the CDC and state veterinarian.

Please visit www.avma.org/ebola which includes information for veterinarians and a FAQ section for clients. There is also a link to the CDC page regarding Ebola and pets. You may also listen to this podcast by Dr. Ron DeHaven, the VP and CEO of the American Veterinary Medical Association regarding Ebola and Pets.

 

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Leptospirosis Review

October is Leptospirosis awareness month. Take a moment to review some facts about this zoonotic disease.

What is Leptospirosis? It is a disease caused by a spiral shaped Leptospira bacteria that can infect wildlife, domestic pets, and humans.  Many wildlife are carriers of the bacteria and do not have any clinical symptoms of the disease.

How is it transmitted? The bacteria are passed in the urine to water sources where they can live and reproduce. They can survive for a long time in water (especially stagnant water, ponds, or lakes) and wet soil. Animals become infected by drinking or swimming in water that is contaminated by the bacteria. It can enter the bloodstream through the mucous membranes or through a wound or cut.

Can it be prevented? Vaccinating dogs and livestock for leptospirosis is an important part of prevention, especially in areas where the disease is prevalent. Avoid stagnant water. Practice good hygiene and wash hands frequently- especially if there is contact that may have any urine on it.

What are the symptoms? The symptoms can resemble those of the flu virus. Fever, decreased appetite, vomiting, diarrhea, dehydration, weakness, and lethargy are some symptoms. Some dogs may have jaundice if the liver is severely affected. Bloodwork of a leptospirosis infected dog often has increased kidney and liver values. If a dog is suspected of having leptospirosis, make sure technicians handling the dog and the dog’s urine contaminated bedding, etc. wear gloves and protective clothing. The time between exposure and development of disease is usually 5 to 14 days, but can be as short as a few days or as long as 30 days or more. Cats seem to have some natural resistance and infection is rare in this species.

How is Leptospirosis treated? Treatment for leptospirosis involves supportive therapies including IV fluid diuresis and antibiotics. Leptospirosis is often treated with a combination of antibiotics including amoxicillin and doxycycline. The disease can be fatal, and the best chance for a good outcome is early diagnosis and treatment.

For more information about this disease, please visit www.leptospirosis.org and http://www.cdc.gov/leptospirosis/

 

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Review on Eye Testing

Veterinary technicians commonly perform or assist with ophthalmic examinations. This blog is a review on common eye tests and normal values.

A good eye exam begins with a thorough history and appreciating a patient’s signalment (age, male/female/spay/neuter status, breed). Some particular breeds may be predisposed to certain ocular diseases. Taking a good history may help the veterinarian make a proper diagnosis and treatment plan.

Eye tests should be performed in a certain order. The proper order for the most common ocular tests are Schirmer Tear Test (STT), Fluoroscein stain, and Intraocular pressures (IOP).

1)   Schirmer Tear Test- The STT tests for dry eye or kerratoconjunctivitis sicca (KCS). This is a decrease in tear production. A small piece of paper made for this test is inserted under the lower eyelid and held in place for 60 seconds. Normal tear production should be greater than 15 mm in 60 seconds. Most normal dogs will produce more tears than this but this is a guideline to follow.

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2)   Fluoroscein stain- This is a yellow dye which is applied to each eye to look for a corneal abrasion or ulcer. The abrasion or ulcer is seen when highlighting the stained eye with a fluorescent blue light.

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3)   Intraocular pressure (IOP) – This is the test for glaucoma. Glaucoma is increased pressures in the eyes. The pressure in the eyes is tested using a device called a tonometer (the most commonly used one is the TonoPen). A drop of proparacaine is applied to each eye to numb the surface of the eye. The tonometer is gently touched to the surface of the eye and a proper or good reading should be with less than 5% error. Normal values are less than 20 mmHg (typical normal range 10-20 mmHg). Again, this is only a basic guideline and should be interpreted based on the rest of the exam and clinical signs. A low pressure may be due to uveitis (inflammation). It is important to note: DO NOT put any pressure around the neck region while holding the pet for IOP. This can falsely elevate the readings.

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Rodenticide Toxicity

Anticoagulant rodenticide, otherwise most commonly known as “rat bait” poisoning, is a serious and potentially fatal toxicity that requires treatment. Coumarins such as warfarin and brodifacoum are the most commonly known examples. D-Con is a common rodenticide that pets ingest in the home in cases of toxicity.

Anticoagulant rodenticide is a vitamin K1 antagonist. Vitamin K is required for synthesis of clotting factors II, VII, IX, and X (2, 7, 9, and 10). Factor VII has the shortest half-life of these and will be depleted first.

Prothrombin time (PT) measures the extrinsic clotting system which contains factor VII and it becomes prolonged first.  Therefore, PT measurement is helpful in determining clotting status in a pet that may have been exposed to anticoagulant rodenticide. Platelet counts in these animals are usually normal. Any time there is a history of potential exposure or an animal is showing evidence of bleeding, coagulation should be checked.

Pets that have been exposed to anticoagulant rodenticide are at risk for bleeding. They may bleed spontaneously or if they receive an injury could bleed due to their inability to clot. They can bleed from anywhere and symptoms may include melena, epistaxis, bleeding from gums, blood in urine or vomit, lameness or joint swelling, etc. Clinical signs may be seen initially  within 4 to 6 days after ingestion.

If an animal is known to have recently ingested this toxin (within the last 8 hours), induction of emesis (vomiting) is recommended, followed by activated charcoal to prevent further absorption of the toxin, and supplemental Vitamin K 1 (phytonadione). It is given daily for 3 to 4 weeks. Vomit of this type of toxin is very commonly a green/blue color.

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Animals that are actively bleeding will need supportive care which may include IV fluid therapy and blood products to provide clotting factors in addition to the Vitamin K1 supplementation.

 

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Updates to VetTechPrep

We recently changed our program to reflect the new changes in the VTNE blueprint! The new categories you will find are:

Pharmacology, Surgical Nursing, Dentistry, Laboratory, Animal Care and Nursing, Diagnostic Imaging, Anesthesia, Critical Care, and Analgesia.

Take a quick 3 minute tour to see if VetTechPrep is right for you! http://www.vettechprep.com/tour.jsp

 

 

 

 

 

 

 

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Anesthesia Safety

To ensure a safe workplace for pets and employees, remember a few key points regarding anesthesia safety.

For General Anesthetic Procedures:

  • Always remember to ask for assistance when moving large pets from one place to another. Moving a heavy dog by yourself could cause you or the pet injury.
  • Patients that are recovering from anesthesia need to be closely monitored. Sometimes they may thrash around or make sudden movements and could injure themselves or others.
  • Watch for the swallowing reflex during recovery and remove the deflated endotracheal tube when the patient begins to swallow.

Anesthetic Gas Precautions:

The goal is to keep the amount of waste gas low in the hospital environment. When using gas machines and administering gas anesthesia:

  • Always perform a leak check prior to using the machine. Check the hoses, lines, and scavengers for any leaks and ensure that the soda lime canister is properly secured to the machine.
  • Make sure the the antesthesia machines receive regular service maintenance and keep record of the maintenance and service to the machines.
  • Make sure the scavenger for the waste gas is connected prior to turning on the machine.
  • When the machine is not in use, the machine vaporizer and oxygen should be turned off.  It should never be turned on unless the patient is connected to the machine. Oxygen can be used without connecting to the patient when blow-by oxygen is needed in emergency cases. Otherwise, a mask or connection directly to the ET tube is needed.
  • The endotracheal tubes should be the correct size for the patient. A tube that is too small puts a patient at risk of aspiration and causes anesthetic gas to leak out around the tube.
  • Inflate the endotracheal tube properly after placement but DO NOT OVERINFLATE. Ask for assistance if you are unsure how much to inflate the tube. If you overinflate the tube this could cause a tear of the trachea and could be life-threatening. Check for leaks after the patient is connected to the anesthetic machine.
  • When you turn the gas off after a procedure, leave the patient hooked up to oxygen for a couple of minutes. This will allow time for the anesthetic gas to pass out of the patient’s lungs and into the scavenger.
  • Make sure that the soda lime is changed regularly (every 12 hours of use or so), and keep a log of when it was changed.

If you are ever in doubt about how to properly hook up an anesthesia machine, or are unsure about cuff size, etc., ALWAYS ASK! Better to be safe and ensure that you are doing the right thing, and protecting yourself and your patients.

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Discussing Anesthesia With Clients

Dental Cleaning

One of the most common reasons owners neglect dental care or other procedures for their pet is fear of anesthesia. In fact, many owners have either had a negative experience surrounding anesthesia with a previous pet or with themselves, or have a friend who had a bad experience. Veterinary medicine has come a long way in terms of standards of care and many people do not realize how advanced our anesthesia protocols and procedures have become.

It is crucial to communicate with clients regarding the doctor’s recommendations and to communicate with them about their fears of anesthesia. Most owners don’t even know what anesthesia entails. They just think the pet goes to sleep and may never wake up. Tell them the precautions you take at your hospital to make sure that their pet is a good anesthesia candidate. They should have a full physical exam by the doctor and bloodwork to check their liver and kidney status prior to anesthesia.

HOW TO DISCUSS ANESTHESIA:

1) Tell the client about how long their pet will be under anesthesia. (i.e. Let them know that to clean their pet’s teeth and to perform the extraction will take about 30-45 minutes, or the spay should take about 15 minutes for the procedure but about 30 minutes total of anesthesia to include the shave and scrub the abdomen and get “Sophie” hooked up to the monitoring equipment.) Use the pet’s name when talking about these procedures.

2) Talk about the monitoring equipment when you mention it as above. Let them know you monitor the ECG and blood pressure. Let them know you constantly monitor their oxygenation and CO2 and keep record of their values. Discuss that you keep them on heat support so they stay nice and warm during the procedure and they will be on IV fluids to keep their blood pressure stable. They will have a tube placed in their trachea so that their airway is controlled. Sometimes it helps to give clients a tour of the surgery or anesthesia suites. It helps them to visualize where their pet will be and may help them to feel more confident.

3) Discuss specifics of anesthetic drugs. When they drop off the pet, let them know they will receive a pre-medication so they will be nice and relaxed and so you can get the IV placed and start the fluids. Depending on which anesthetics you use, let them know what recovery time is to be expected. Let them know that the anesthetic plan is tailored to each individual patient, and that the doctor will calculate the specific medications just for “Sophie”.

4) Do pre and post-op calls to the owner. Some people want to be called before and after while others just want to be called after. Ask them what they would like. It is always a relief to the client to know when the procedure is finished and hear that their pet is extubated and awake. Many times there are multiple procedures scheduled. It is helpful to give them an approximate time as to when their pet may be having their procedure. You don’t want them to call at 1 pm and wonder why their pet hasn’t had their dental yet. Keep open communication and if the procedure is pushed back due to an emergency, let them know! They should feel that their pet is a priority.

5) Tell them you will take great care of their pet. If there were to be any complications arrise they would be contacted immediately. Make sure to get a phone number and make sure they will be available at that number in case they need to be reached.

6) Ask them if they have any questions about anesthesia or the scheduled procedure. Make sure you answer all of their questions. If they have questions and you don’t know how to answer, have the doctor answer them. The doctor should go over the more serious risks of anesthesia or their procedure and discuss risk vs. benefit of the procedure to be performed. This is best done at the time of the physical exam.

 

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3D Printing for Pets

Recently, a feline “Cyrano,” a 9-year old male neutered cat developed bone cancer in his left hind leg. He had radiation therapy and the cancer was cured. However, due to the radiation the bone deteriorated.

Because Cyrano was a large cat at 26 pounds, amputation for him was not a great option.

Dr. Denis Marcellin-Little at North Carolina State University who has had more than 10 years of experience with 3D printing (also called additive manufacturing) took on the challenge of creating an implant for Cyrano. This is a way of making a 3-dimensional object from a digital model.

They chose to manufacture a cobalt chromium knee implant for Cyrano. This was a cutting edge option, as this type of implant or surgery had never been done before.

CT scans were taken of both hind legs to help get the images needed to produce the implant. A surgery team did 6 rehearsals to prepare for this surgery.  The actual surgery took 6 hours and went smoothly. The implant was a good fit and Cyrano began rehabilitation and is currently doing well.

courtesy of NC State University

courtesy of NC State University

Perhaps this procedure will open up many new possibilities for pets and humans alike.

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Golden Retriever Lifetime Study

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Retrospective studies have been helpful for bringing to light information about animal health that may have not otherwise been noticed. In the past few years, there have been many research articles that have focused on spaying and neutering health risks versus benefits. A recent study from U.C. Davis found a greater occurrence of hip dysplasia, cranial cruciate ligament tears and certain types of cancer in spayed or neutered golden retrievers as compared to intact counterparts. The research suggests that health risks are generally greater for dogs that were sterilized less than a year of age.  Golden Retriever Study

Now, the Morris Animal Foundation has recently launched a new study called the Golden Retriever Lifetime Study. This study aims to follow 3,000 Golden Retriever puppies through their lifetime, evaluating the many factors that may lead to certain diseases, especially cancer.

“Morris Animal Foundation’s Golden Retriever Lifetime Study is the largest and longest effort ever undertaken to improve the health of dogs. Over the next 10 to 14 years, observational data collected from 3,000 Golden Retrievers will help us learn how to prevent cancer and other diseases that take the lives of dogs too soon.” – Morris Animal Foundation

Please visit the link below to find out more about this study. To be included in the study, dogs must be purebred golden retrievers with a three-generation pedigree, younger than 2 years and healthy at the time their owners apply to participate. Owners must be 18 years or older and living in the contiguous United States.

Morris Animal Foundation Study Information Golden Retrievers

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Nodular Panniculitis

What is Panniculitis?

Panniculitis is a rare disease in which the fat layer beneath the dermis becomes inflamed. It can be caused by an infection with bacteria, fungi or other organisms, but it is more commonly a sterile nodular panniculitis (the descriptive term for an inflammation of the fat cells that does not involve an infectious agent). It is usually an idiopathic disease, meaning we don’t know what causes it. In some cases there may be a trigger such as a vaccine, trauma, Vitamin E deficiency, a drug reaction, or systemic autoimmune or infectious disease.

The inflammation in the fat layer causes bumps on the skin that can be soft or firm. The nodules can rupture and release a discharge that may resemble an abscess and be bloody or yellowish in color. These nodules are sometimes painful and most often appear around the head, neck, or abdominal region. Treatment involves corticosteroids, and in some cases antibiotics. It is helpful to culture these lesions to rule out the infectious agents as discussed above.  Vitamin E has been shown to be helpful in this condition. In chronic cases, cyclosporine may be the best option for control. In single lesion cases, surgical excision may be warranted.

Diagnosis

Skin biopsies and culture are the two keys to diagnosis. It is important to closely evaluate the pet’s history, such as recent drug administration, vaccines, or other concurrent illness like pancreatitis or autoimmune disease.

Predisposition

Dachshunds and German Shepherds seem to be predisposed, however, this condition can occur in any breed.

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