K I B B L E 1 0 2

KIBBLE IS A PUBLICATION FOR VETERINARY TECHNICIANS IN THE HEARTLAND FROM BLUEPEARL VETERINARY PARTNERS
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Medical Director: Jeffrey Dennis DVM, DACVIM
Summer
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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
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