Andrew J. rosenfeld

Veterinary Medical TeamHandbook

Veterinary medicine is a dynamic field allowing team members growth in every

aspect of the science and profession. In a single day, a team member may be

involved in administrative, emergency and critical care, internal medicine, surgical,

and radiological teams. With increasing expectations of quality care and technology,

team members’ knowledge and responsibilities are growing at an exponential rate.

The Veterinary Medical Team Handbook is designed as a training resource for

veterinarians, technicians, and staff. Coverage ranges from administrative tasks and

client communication to common diseases, disorders, and procedures. The aim is

to increase the staff’s ability to detect and manage health problems and to enable

the team to be more effective communicators with each other and with clients.

Two accompanying CD-ROMs contain training modules and interactive case studies

for further learning and practice.

✔A valuable training guide for veterinary practices and hospitals.

✔Designed for easy reference with abundant bullet points, algorithms, lists,

and key point boxes.

✔Covers common diseases, disorders, and procedures, as well as administrative

tasks and client communication.

✔ Includes two CD-ROMs with training modules and interactive case studies.

About the AuthorAndrew J. Rosenfeld, DVM, Diplomate ABVP, is the founder and president of Veterinary Team Education Course. He lectures frequently on topics in emergency medicine, small animal anatomy and physiology, and cardiology. He has practiced small animal critical care and emergency medicine for 16 years and served as hospital director of Paradise Valley Emergency Animal Clinic in Scottsdale, Arizona, for 3 years. Previously, Dr. Rosenfeld was director of technical education for the Pet’s Choice family of veterinary hospitals and specialty practices and adjunct professor at Mesa Community College and Arizona State University.

relAted titlesBlackwell’s Five-Minute Veterinary Practice Management Consult Lowell Ackerman 978-0-7817-5984-7

Tasks for the Veterinary Assistant Paula Pattengale 978-0-7817-4243-6

Veterinary Technician’s Daily Reference Guide Candyce M. Jack, Patricia M. Watson, and Mark S. Donovan 978-0-7817-3202-4

Veterinary Medical Team

Handbook

Ro

senfeld

Veterinary Medical Team Handbook

rosenfeld_fullcover.indd 1 6/15/07 10:10:05 AM

The Veterinary Medical Team Handbook

The Team Approach to Veterinary Medicine

The Veterinary Medical Team HandbookThe Team Approach to Veterinary Medicine

Andrew J. Rosenfeld DVM

Diplomate, American Board of Veterinary Practitioners Canine and Feline

Andrew J. Rosenfeld, DVM, Diplomate ABVP, is the founder and president of Veterinary Team Education Course. He lec-tures frequently on topics in emergency medicine, small animal anatomy and physiology, and cardiology. He has practicedsmall animal critical care and emergency medicine for 16 years and served as hospital director of Paradise Valley EmergencyAnimal Clinic in Scottsdale, Arizona, for 3 years. Previously, Dr. Rosenfeld was director of technical education for the Pet’sChoice family of veterinary hospitals and specialty practices and an adjunct professor at Mesa Community College andArizona State University.

©2007 Blackwell PublishingAll rights reserved

Blackwell Publishing Professional2121 State Avenue, Ames, Iowa 50014, USA

Orders: 1-800-862-6657Office: 1-515-292-0140Fax: 1-515-292-3348Web site: www.blackwellprofessional.com

Blackwell Publishing Ltd9600 Garsington Road, Oxford OX4 2DQ, UKTel.: +44 (0)1865 776868

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Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted byBlackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive,Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of pay-ments has been arranged. The fee codes for users of the Transactional Reporting Service is ISBN-13: 978-0-7817-5759-1/2007.

First edition, 2007

Library of Congress Cataloging-in-Publication Data

Rosenfeld, Andrew J.The veterinary medical team handbook: the team approach to veterinary medicine/Andrew J. Rosenfeld.—1st ed.

p. ; cm.Includes bibliographical references and index.ISBN-13: 978-0-7817-5759-1 (alk. paper)ISBN-10: 0-7817-5759-2 (alk. paper)1. Veterinary medicine—Handbooks, manuals, etc. I. Title.[DNLM: 1. Veterinary Medicine—Handbooks. 2. Animal Diseases—nursing—Handbooks. 3. Animal Technicians—

Handbooks. SF 748 R813v 2007]

SF748.R67 2007636.089—dc22

2006036123The last digit is the print number: 9 8 7 6 5 4 3 2 1

Dedicated to Lisa, Lauren, and Jillian, who act as my center,my practicality, my imagination, and my world

Preface ixCD-ROM Instructions and Contents xi

Section 1The First Two Days on the Job

Chapter 1 Basic Terminology 3Chapter 2 Vaccines, Heartworms, and Their

Terminology 7Chapter 3 Elective Procedures 15Chapter 4 Safety and Restraint 25Chapter 5 Obtaining an Adequate and Precise

History 33Chapter 6 The Medical Record and the 30-Second

Triage Examination 39

Section 2Anatomy and Physiology—The Science behindthe Diseases

Chapter 7 Physical Exam 51Chapter 8 Skeletal System 63Chapter 9 Teeth and the Oral Cavity 87Chapter 10 Gastrointestinal System 103Chapter 11 Respiratory System 129Chapter 12 Cardiovascular System 147Chapter 13 Urogenital System 173Chapter 14 Liver 193Chapter 15 Exocrine and Endocrine Pancreas 207Chapter 16 Thyroid Gland 217Chapter 17 Adrenal Gland 223Chapter 18 Reproduction 235Chapter 19 Integument 249Chapter 20 Eyes and Ears 273

Section 3Clinical Diagnostics—The Science behind theDiagnostics

Chapter 21 Complete Blood Count 293Chapter 22 Organ, Hormonal, and Drug Level

Clinical Pathology 309Chapter 23 Urinalysis and Fecal Clinical

Diagnostics 337Chapter 24 Electrocardiogram 353Chapter 25 Radiology, Ultrasound, and Endoscopy

Techniques 365

Section 4Understanding the Concepts of Disease andTreatment

Chapter 26 Pharmacology 379Chapter 27 Toxins and Poisons 397Chapter 28 Fluid Therapy 409Chapter 29 Anesthesia 419Chapter 30 Shock 435Chapter 31 Cardiopulmonary Cerebral

Resuscitation (CPCR) 453

Appendix 461Glossary 487Index 505

vii

Contents

Veterinary medicine is a dynamic field, allowing all teammembers growth in every aspect of the science and profes-sion. It is the only medical profession that allows a medicalteam member to be part of surgical, radiological, emergencymedicine, internal medicine, and surgery teams all in oneday. With increasing expectations of quality care and tech-nology, a team member’s knowledge and responsibilities aregrowing at an exponential rate.

This book is dedicated to that veterinary team that worksas one unit to

● focus the doctor’s attention where the hospital needs himor her most,

● utilize the staff to their fullest potential,● increase staff satisfaction and loyalty as well as decrease

employee turnover,● increase revenue by becoming more effective communi-

cators and increasing their ability to sense health prob-lems and deal with upset clients, and

● turn the veterinary technician field into a profession thatcan be financially and professionally rewarding.

This book is intended to be used as a training and inter-active resource to help train the medical team to be a re-source for the veterinarian, the patient, and the client.

How to Use This Book

Each section of this book is divided into sections. The sectionsare broken down into the following: The First Two Days on theJob, Anatomy and Physiology—The Science behind theDiseases, Clinical Diagnostics—The Science behind theDiagnostics, Understanding the Concepts of Disease and Treat-ment, and the Appendix. The overall goal of this book is to

● give the paraprofessional the education and tools to dis-cuss and understand the different disease, diagnostic, andtreatment processes that may be required;

● serve as a quick reference source for the paraprofessionalon general practice subjects; and

● reinforce the concepts of each section with interactiveclinical cases in a PowerPoint format.

Using this book either as a simple resource or as a part ofa formal training program will help refine the skills of thestaff and make them greater resources within the hospitalteam.

Acknowledgments

Thanks to the following professionals who reviewed thebook: Dr. Curt Coffman, Fellow of the Academy ofVeterinary Dentistry, Aid Animal Dental Clinic, Scottsdale,Arizona; Dr. Kimberly Coyner, DVM ACVD, DermatologyClinic for Animals, Phoenix, Arizona; Dr. Sharon Dial,DVM ACVP (Clinical and Anatomic Pathology), associateresearch scientist, Department of Veterinary Science andMicrobiology at University of Arizona, Tucson, Arizona;Victoria M. Lukasik, DVM, Diplomate ACVA, SouthwestVeterinary Anesthesiology, and assistant research scientist,Radiology, University of Arizona College of Medicine,Phoenix, Arizona.

Thanks also to Stephen Bistner, DVM DACVO, Ply-mouth, Minnesota, and Jeffrey Bowersox, DVM ACVO,Wilmington, Delaware, for editing support and images.

Special thanks to Caron Cann, who has been my profes-sional sounding board and a compass for me while I finishedthis project.

ix

Preface

The goal of the interactive CD-ROMs is to practice the keyconcepts of each section of the book. The CD-ROM is splitinto two programs.

The first CD-ROM is meant for practice with the firsttwo sections of the book with special focus on:

● Auscultation Trainer—Reviews basic concepts of aus-cultation and allows team members to practice auscultinghearts with different murmurs in case formats.

● Section I Cases—Helps the team member apply basicconcepts of nomenclature, lesion position, and obtaininga medical history and understanding the concepts of sur-gery, vaccination, and heartworm prevention.

● Section II Cases—A slightly more advanced programoutlining and testing concepts of basic anatomy andphysiology, diseases, clinical diagnostics, and communi-cation with clients about the cardiac, renal, liver, and pan-creatic organs.

The second CD-ROM contains advanced rounds for themedical team focusing on physical examination, clinical di-agnostics, and treatment concepts. Topics contained on theCD-ROM are:

● EKG Trainer and Case Rounds—This section reviewsthe basic concepts of the electrical rhythm of the heart,step-by-step protocols on how to evaluate an EKG, andhow recognize basic arrhythmias.

● Emergency Triage Trainer—The program takes themedical team through two emergency cases that enter thehospital at the same time; the team has to evaluate whichanimal is more of an emergency at each step of the eval-uation.

● Toxin Rounds—This program takes the medical teamthrough toxin and poison ingestion cases and focuses oncommon physical symptoms and clinical diagnostics as-sociated with common poison ingestion.

● Complete Blood Count Rounds—This program showsthe medical team how to evaluate a complete blood countfocusing on red blood cell morphology, white blood cellchanges, and platelet estimation on the blood film.

● Fluid Rounds—This section takes the medical teamthrough how to evaluate the patient for dehydration, de-termine fluid need, and practice fluid calculation.

To Load the CD

Both CD-ROMs contain self-loading narrated PowerPointbased programs that work on any computer (PC orMacintosh). Both contain large files and will take 3 to 5minutes to load. Simply place the CD-ROM into your CD-ROM drive and allow the program to load. The program willthen instruct you on how to navigate through each program.

To Navigate in the PowerPoint Environment

Once in the PowerPoint environment, you will be able tonavigate through each slide by clicking on selected tabs tomove forward, answer a question, evaluate a heart rhythm, ormake choices where to go in the program. To fully enjoy thisprocess, please follow these guidelines to navigate in thisenvironment.

1. When the program begins, you get a Macro Warning.These programs contain commands called “macros” thatallow the participant to move throughout the environ-ment, listen to sound files, and view image files con-tained on these CDs. These are not meant to affect yourcomputer or its ability to function. In order to use theCD-ROMS you will need to select to activate the macrosin this presentation.

In order to view this program properly, please selectEnable Macro and click Okay. The program will thenload and run normally.

xi

Veterinary Medical Team Handbook Interactive CD-ROM

2. When selecting a tab, make sure that the mouse arrowhas changed to a small hand before left clicking themouse button. This will select the proper tab, and willnot move you one slide forward in the program.

Correct way—The mouse has gone from arrow to hand,showing you are selecting the proper tab.

Incorrect Way—In this image the arrow has not changedinto the hand, and clicking the mouse will move the pro-gram forward one slide only.

3. When using the mouse, you inadvertently click or usethe dial to move one slide forward. If you do inadver-tently move to the next slide and are out of place, simplyright click the mouse, which will bring up the followingoptions:

By right clicking the mouse, the following options be-come available, please highlight Previous and click withthe left mouse button. This will move you back one slidespace.

4. There is no narration for the slide. On occasion,PowerPoint may not initiate the narrative sequence. Torestart the narration process, simply click the left mousebutton once.

Finally—The programs are meant as fun exercises to rein-force the concepts of the book. At no time does the program,the book, or the author suggest that the medical team is re-sponsible for diagnosis, prognosis, or treatment of the patient.

xii CD-ROM Instructions and Contents

Section 1

The First Two Days on the Job

This section is for the new employee who has an active interest in learning the fundamentals of being a part of the veterinaryteam. It is a training manual that outlines what all team members should know on the first 2 days on the job.

Introduction

As with the study of any science or profession, there is a lan-guage and terminology unique to this knowledge; veterinarymedicine is no different. Understanding the basics of veteri-nary terminology is a critical aspect of becoming an excel-lent team member and will better serve your clients and pa-tients. Many clients will use terminology that they pick upfrom other hospitals, the Internet, or human medicine, and ifa team member does not fully understand what the client isasking for, miscommunication and poor client service canoccur. For example, consider the following situations.

● A client calls and informs you that their pet needs tocome in for “an allergy injection.” This could refer to asteroid injection for allergies or an allergen vaccine for apet that has been skin tested for allergies.

● A client comes in and requests that “their pet needs to beput to sleep.” In most cases this suggests that their pet isto be euthanized, but clients use this terminology to askfor sedation for a pet that may need to be groomed or thatis going on a car trip.

● A client brings their male cat in for a “spay.” If the sex ofthe animal is not quickly determined, the cat may beprepped and possibly surgically set up for an ovariohys-terectomy.

All these situations sound amusing, but they have oc-curred in everyday clinical settings. Therefore, it becomesthe veterinary professional’s responsibility to understand andeducate the clients so that they can make an informed choice.

Directional Terminology

To properly describe a lesion, injury, or other problem, thefirst thing that must be mastered is the directional terminol-ogy that helps locate the problem on the pet’s body (Figure1.1). To systematically do this, we create a series of planesthat split the pet into sections. The most important plane wedeal with is the median plane that splits the pet into twosymmetrical halves.

Once this plane is established, we compare where a bodypart or injury falls in relation to the proximity of the medianplane. For example, the forelimb of a dog is illustrated in

Figure 1.2. Each toe or finger is closely related to our fin-gers and toes. The first digit, which represents our thumb, isthe dog and cat’s dewclaw, a small digit that does not directlyhave a function in weight bearing and is often removed whenthe animal is young (3–4 days old).

The first digit is closest to the medial plane of the animaland hence we say that the first digit is the most medial. Theother digits are farther away from the medial plane from thefirst digits and hence we refer to these digits as being lateralto the first digit.

Therefore, the third digit is medial to the fifth digit andlateral to the first and second digits, and the fourth digit ismedial to the fifth digit and lateral to the first, second, andthird digits.

Also, we must be able to inform the medical team wherea region, mass, or injury lies in relation to its position on thelimb. Hence the closer the area of concern lies to the body,the more proximal it is. The farther away the injury or arealies from the body the more distal it is said to be. In the il-lustration in Figure 1.2, the wrist is proximal to the toes, orthe toes are said to be distal to the wrist. This directional ter-minology refers only to limbs.

When discussing the main torso of the animal’s body, wedefine areas closer to the spine as having a dorsal positionto regions that are closer to the pet’s sternum and belly,which have a ventral position. Hence a dog’s ears are gener-ally dorsal to their eyes, or the eyes sit more ventral to thecanine’s ears.

Further directional terminology occurs when we explainwhere the body part lies in its relation to the head or tail.Body parts that lie closer to the head of the pet are cranialin their position, whereas body parts that are closer to thetail are caudal in their location. Thus a pet’s ears are cranialto their shoulders, or their shoulders are caudal to the ears.

For a review, see Figures 1.3 and 1.4.

History Terminology

Taking a good medical history is one of the chief focuses ofthis book and will be discussed in detail in Chapter 5.However, there are certain abbreviations that are used in tak-ing an accurate history and relaying this information to themedical team. Some abbreviations used in taking the ani-mal’s history are as follows:

3

Chapter 1

Basic Terminology

3

● C: coughing● S: sneezing● V: vomiting● D: diarrhea● PD: polydipsia (increased thirst)● PU: polyuria (increased urination)● BM: bowel movement ● Anorexia: not eating● Lethargy: depressed/decreased energy and activity

Terminology of the Physical Exam

There is specific nomenclature that is also used in dis-cussing the pet and aspects of the pet’s body system basedon the physical exam. To properly communicate with themedical team, the team member must have an understandingof this terminology. Although we will discuss the physicalexam in detail in Chapter 5, there are medical abbreviationsthat are commonly used to describe an animal properly.

Cat description abbreviations include

● DLH: domestic long hair,● DMH: domestic medium hair, and● DSH: domestic short hair.

There are many abbreviations for physical examinationnomenclature, as well. For mentation (how the pet presentsmentally), the abbreviations are as follows:

● BAR: bright, alert, and responsive● QAR: quiet, alert, and responsive● Depressed: animal is not active or normally responsive to

stimuli● Comatose/obtund: animal is not responding to any stim-

uli, severe depression without consciousness

For the baseline parameters of overall health the termsused are as follows:

● T: temperature● P: pulse● R: respiration● MM: mucous membrane● CRT: capillary refill time● Hydration

Abbreviations for the body systems are as follows:

● CV: cardiovascular system (heart and vascular system)● Resp: respiratory system (trachea, bronchi, and lungs)● Abd: abdomen● LN: lymph nodes● MS: musculoskeletal system● E-E-N-T: eyes, ears, nose, and throat● Neuro: neurologic system● Int: integumentary system (skin)● Uro: urogenital system (reproductive organs)

4 Section 1: The First Two Days on the Job

Figure 1.1. Descriptive terms. (Courtesy of Anatomy of Domestic Animals, 7th Edition. Pasquini, Chris, and Pasquini, Susan. SudzPublishing, Pilot Point, Tx 1989. Used with permission from Sudz Publishing.)

Disease Terminology

When obtaining a thorough history and understanding theconcerns of the client, it is important to define the onset andprogression of the pet’s disease. In these cases, the followingterms are used to help define these parameters.

● Acute onset of disease refers to a disease entity that hasaffected the patient rapidly as the patient went from goodhealth to illness in a short period of time.

● Chronic onset of disease refers to a disease entity that a pa-tient has been dealing with over longer periods of time. Symp-toms can worsen or stay the same during the duration of theillness, but the patient is still affected over the long term.

● Progressive disease refers to disease entities that haveworsening symptoms over time. Both acute and chronicdisease can have progressive symptoms.

Pharmacological Terminology

When dispensing medication to an animal there are specificabbreviations and terms that apply to the route by which thedrug is given, how often it is given, and to what part of theanatomy it is applied. Understanding these terms is extremelyimportant because a mistake can produce serious side effects.

DosingThe abbreviations used for dosing, particularly the frequencyof administration of medication per day, are as follows:

● EOD: every other day● SID: once per day ● BID: twice per day ● TID: three times per day ● QID: four times per day ● PRN: as needed ● ETD: every third day● q: normally written in lowercase case, q translates to

every (i.e., q 8 hrs means every 8 hours).

See examples of using this terminology in clinical set-tings next.

Anatomical Abbreviations for Ears and EyesWhen dealing with the eyes and ears, specialized abbrevia-tions allow us to determine which ear or eye is to be treated.

Example 2: Your veterinarian asks you to assist her infilling a prescription for 500 mg aspirin. The chart in-dicates the following instructions: Give one (1) tabletq 12 hours PRN. This translates to “Give one tabletevery 12 hours as needed” (for pain, limping, or forwhatever the disorder indicated).

Example 1: You are a part of a busy medical team.Your doctor has talked with Mr. Doe about his dogRufus at length. Rufus is on phenobarbital. Mr. Doeleft a message for the doctor that Rufus is still seiz-ing and asks what he should do about the medication.The doctor leaves you the following message: “Pleasecall John Doe about Rufus. Instruct him to increaseRufus’s phenobarbital from 1–25 mg tablet SID to1–25 mg tablet BID by mouth (PO). If the seizing con-tinues, I will need to see Rufus.” This message indi-cates that you need to instruct Ms. Doe to increaseRufus’s phenobarbital from 1–25 mg tablet 1�/day to1–25 mg tablet 2�/day by mouth.

Chapter 1: Basic Terminology 5

Figure 1.2. The forelimb of a dog. (Courtesy of Anatomy ofDomestic Animals, 7th Edition. Pasquini, Chris, and Pasquini,Susan. Sudz Publishing, Pilot Point, Tx 1989. Used with permis-sion from Sudz Publishing.)

The following abbreviations are used for eyes:

● OD: right eye ● OS: left eye ● OU: both eyes

The following abbreviations are used for ears:

● AD: right ear● AS: left ear● AU: each ear

A good way to remember the letter combination is that itwas once thought that people who shook hands with theirleft hand were thought to be “sinister.” Hence s means left.

Administration RoutesThe way a drug is administered to the animal also has itsown abbreviations.

● IV: intravenous–in the vein (typically done through an in-travenous catheter)

● IM: intramuscular–in the muscle● IN: intranasal–in the nose● IC: intracardiac–in the heart (rarely done)● IT: intratracheal–in the throat (or intratracheal tube)● PO: per os–by mouth● SQ: subcutaneous–under the skin

It is very important to never fill a prescription or give amedication without full knowledge of the drug, the drug’sfunction, and any potential side effects or drug interactions.If there is ever a question on a prescription or concern re-garding the route or the dosing of a medication, the prescrip-tion should not be filled until all questions are discussedwith a veterinarian. Pharmacology will be discussed com-prehensively in Chapter 26.

CD-ROM 1 reviews material presented in this chapter.Please try the cases for Section 1 (The First Two Days on theJob) to help reinforce the information presented here.

6 Section 1: The First Two Days on the Job

Figure 1.3. Cranial/caudal and dorsal/ventral nomenclature.

Figure 1.4. Lateral/medial nomenclature.

Although many diseases will be discussed in depth in subse-quent chapters, all members of a medical team will need tohave knowledge of specific diseases, vaccines, and heart-worm prevention from the first day on the job. Every prac-tice and medical team has a slightly different approach totheir vaccine recommendations, how often the vaccinesshould be administered, and how to discuss the vaccineswith the client. It is important to get an understanding ofhow your medical team approaches this topic; however, thissection will help provide a basic overview of vaccinationprinciples and nomenclature.

Canine Vaccines

There are generally two schedules of vaccines given to ca-nines in a general practice, the schedule for the puppy andthe schedule for the adult. The puppy is generally vaccinatedthree to four times over the first 6–16 weeks of life to helpboost long-term immunity for many juvenile and adult dis-eases. The adult vaccine is generally an annual booster tohelp maintain the animal’s immunity to specific diseases

throughout its life. The types of vaccines given can vary butin general they are as discussed next.

DHPP Also known as DA2P, the DHPP vaccine is generally givensubcutaneously three to four times in the juvenile phase(6–16 weeks) every 2–4 weeks and is then repeated annually.It can be given in conjunction with other vaccines (coronavirus/leptospirosis). The diseases that are vaccinated for arecanine distemper, hepatitis, parainfluenza, and parvo virus.

Canine Distemper Virus Canine distemper virus(CDV; see Chapter 11), the D in DHPP,is a highly infectious upper respiratory virus that can cause

● severe high body temperature (fever),● anorexia,● depression,● lethargy,● coughing,● sneezing,● sinusitis, and● neurologic signs.

Fifty percent of the time CDV enters the central nervous sys-tem, causing seizures, coma, and death.

Key Points in Discussing Distemper Virus withClients● Distemper virus is an upper respiratory illness that is

commonly found in large kennel facilities with younganimals, such as a pound or animal control facility.

● The infection will start as a severe upper respira-tory infection causing loss of appetite, depression,runny purulent (pus) ocular and nasal discharge,and fever.

● Fifty percent of the time the virus will infect thecentral nervous system producing seizures, muscu-lar tremors, coma, and death.

● If the animal begins to exhibit neurologic symp-toms, the animal's prognosis is generally poor.

● A full set of vaccinations as a puppy and regularadult vaccines is very protective against the virus.

There are some basic points to raise when discussingvaccines with clients.

● Vaccines are killed or weakened bacteria or virusesthat are injected into a healthy animal to help it de-velop immunity to a specific disease.

● In order for vaccines to be effective, the pet mustbe in good health with a normal immune system.

● No vaccine is 100% effective, and if the animal isexposed to enough of the infectious agent, they canstill become ill. However, in some cases, the vac-cines generally can help reduce the capacity of amicroorganism to cause disease (virulence).

● Vaccines will not prevent the disease in an alreadyinfected animal.

● Although rare, any vaccine can produce an allergicreaction, and there is no way to tell if an animalwill have a reaction to a vaccine until the vaccine isgiven.

● Vaccine reactions can occur in the first minutes tohours after inoculation.

7

Chapter 2

Vaccines, Heartworms, and Their Terminology

7

Canine Hepatitis VirusCanine hepatitis virus, the H (or A in DA2P) in DHPP, is anadenovirus that produces a life-threatening infection of theliver, causing

● depression,● anorexia,● yellowing of the gums, whites of the eyes and skin (jaun-

dice),● vomiting, and● diarrhea.

ParainfluenzaParainfluenza, the first P in DHPP, is a flu virus causingupper respiratory and or pneumonia.

Parvo Virus Parvo virus (CPV; see Chapter 10), the second P in DHPP,is a severe viral disease of juveniles (8 weeks–18 months ofage) that lives in the environment through exceptional coldand heat for years. The virus attacks the cells of the intestinethat absorb water and food. The animal is unable to properlyabsorb food and water causing the following

● Massive diarrhea and vomiting (often bloody).● Anorexia. ● Severe life-threatening dehydration.● Massive whole body infection (sepsis). The virus tem-

porarily decreases the white blood cell population in thepet. The animal is then open to massive infections fromany bacterial source.

Corona VirusCorona virus (CV) is a weak gastrointestinal virus that causesmild vomiting and diarrhea. The vaccine can be given subcu-taneously with DHPP or by itself.

LeptospirosisLeptospirosis is a spiral bacteria (spirochete) that can causean acute kidney or liver disease and can affect blood cellpopulations. As the infection occurs, the animal’s ability toremove toxins from the body is impaired producing signs of

● depression,● anorexia,● vomiting,● diarrhea,● profound dehydration, ● yellowing of the gums, whites of the eyes, skin (jaun-

dice),● vomiting blood (hematemesis),● frank blood in the stool (hematochezia), and● nose bleeds (epistaxis).

This vaccine can be given subcutaneously by itself or withthe DHPP vaccine. This is one of the most common vaccinesto produce an allergic reaction in the pet.

Canine RabiesRabies is a debilitating and lethal viral infection of the cen-tral nervous system that is spread through the saliva and biteof an infected animal. Rabies can be spread by wildlife(skunks, raccoons, bats, foxes, coyotes, etc.). All dogs in theUnited States are required to be vaccinated. Generally, thejuvenile vaccine is given subcutaneously or intramuscularly.The adult vaccine is then boosted after 1 year and then re-peated every 1–3 years depending on how prevalent rabies isin the geographic region (endemic). Rabies is also infec-tious to humans (zoonotic).

BordetellaThe Bordetella vaccine protects against infectious tracheo-bronchitis (kennel cough; see Chapter 11). Bordetella causesa mild upper respiratory/sore throat complex for which vaccineis administered two to four times per year through an intranasalvaccine or once a year through a subcutaneous vaccine.

Lyme DiseaseLyme disease is an intracellular parasite (Borrelia burgdor-feri) that is spread by a tick bite and occurs in specific geo-graphic regions of the United States (New England andother regions). It produces acute lameness, fever, anorexia,and occasionally heart disease. This vaccine is given intra-muscularly in endemic regions of the country.

Feline Vaccinations

As with the canine, there are two set schedules for vacci-nation: one for the kitten and one for the adult. However,vaccine recommendations are currently undergoing a dra-matic reexamination due to potential long-term reactions tospecific vaccines (see below), and many hospitals and med-ical teams have very different recommendations for their

Key Points in Discussing Parvo Virus with Clients

● Parvo virus is an illness of the gastrointestinal sys-tem that is found in large numbers in the environ-ment. The virus is very hardy and able to livethrough temperature extremes for years.

● The infection temporarily destroys the cells that ab-sorb food and water, so the pet cannot properly di-gest and absorb it. This produces severe vomitingand diarrhea, often with blood.

● The virus also temporarily decreases the pet’s whiteblood cell population making them very suscepti-ble to infection.

● These pets dehydrate and become severely infectedleading to a life-threatening state.

● Although the vaccine does not always prevent a petfrom contracting parvo, the more vaccinations thepet has received usually decreases the virulence ofthe disease.

8 Section 1: The First Two Days on the Job

vaccine schedule. However, the general vaccines for cats arediscussed below.

FVRCPThe FVRCP vaccine is generally given subcutaneously threetimes in the juvenile phase (6–16 weeks) every 2–4 weeksand is then repeated every 1–3 years. The diseases that arevaccinated for are feline viral rhinotracheitis, feline calicivirus, and feline panleukopenia virus.

Feline Viral RhinotracheitisFeline viral rhinotracheitis (the FVR in FVRCP) is a felineherpes virus that produces a mild to moderate upper respira-tory infection generally in young kittens. As with other her-pes virus in all species, the animal can overcome the infec-tion and then be reinfected with the virus at other points inthe pet’s life related to stress, the animal’s health status, andother factors. The signs of the disease are

● coughing,● sneezing,● watery ocular discharge,● squinting,● fever,● anorexia, and● corneal ulceration.

Feline Calici Virus (FCV)Feline calici virus (FCV), the C in FVRCP, is an upper res-piratory virus generally of the young cat or adopted cat. Itproduces signs of

● coughing,● sneezing,● watery ocular discharge,● drooling from the mouth,● anorexia, and● ulcers of the tongue.

Feline Panleukopenia Virus Feline panleukopenia virus (or feline parvo virus; FPV), theP in FVRCP, is often called feline distemper. However, fe-line panleukopenia is a parvo virus. As with the canine formof the disease, it produces a severe viral juvenile disease (8weeks–18 months of age) that attacks the cells of the intes-tine that absorb water and food. The pet is unable to properlyabsorb food, causing massive diarrhea and vomiting (oftenbloody), anorexia, and severe life-threatening dehydration.The disease has a high mortality rate in cats.

Feline RabiesJust as with the canine form, feline rabies is a debilitatingand lethal viral infection of the central nervous systemspread through the saliva and bite of an infected animal.Rabies vaccination and licensing in cats can be required de-pending on state law. Generally, the juvenile vaccine is given

subcutaneously or intramuscularly. The adult vaccine is thenboosted after 1 year and then repeated every 1–3 years de-pending on how endemic rabies is in the state. Rabies is alsoinfectious to humans (zoonotic).

Feline Leukemia Virus Feline leukemia virus (Felv) is an incurable, potentially lethal,viral disease that infects the cat’s white blood cells, causing aninability of the white blood cells to reproduce and protect thebody from infection. Cats can carry the disease for yearswithout showing infection and can spread the disease overlong-term exposure to other cats through cat fights, groom-ing, eating from the same food bowls, or sexual intercourse.Signs and onset of the disease can be extremely variable de-pending on where the viral disease begins to show itself.

Acute Felv Disease (Disease of Sudden Onset)Respiratory disease causes an acute precipitation of whiteblood cells and fluid of the body building up within the chestcavity producing signs of

● shortness of breath,● open mouth breathing,● bluing of the gums, whites of the eyes, tongue,● abdominal breathing, and● death

Feline leukemia virus can invade the central nervous sys-tem producing (although rarely)

● seizures,● fever,

Key Points in Discussing Feline Leukemia withClients● There is no link between human leukemia and the

feline leukemia virus.● Outside or inside/outside cats are the most at risk.● Cats spread the disease from cat fights/bites,

chronic exposure (over months to years) to infectedcats through grooming and eating out of the samefood bowl, sexual coitus.

● Cats can carry the disease and be infectious foryears without any physical symptoms.

● Most vaccines are about 70% effective, and catsthat do roam outside should be tested annually.

● Vaccines will not prevent the disease in an alreadyinfected animal, so if there is a concern with Felv,that cat should be tested prior to initial vaccination.

● Although rare, the vaccine can make the cat de-pressed, lethargic, and grumpy for a few days afterthe vaccination, similar to our reaction to a humanflu shot.

● Feline leukemia vaccine does have some potentiallong-term side effects of concern (see below).

Chapter 2: Vaccines, Heartworms, and Their Terminology 9

● depression,● coma, and● death.

Chronic Felv Disease (Disease of Slow Onset)With chronic disease, signs can be dependent on which bodysystems the virus infects; however, general signs are

● weight loss,● anorexia,● severe dental disease,● diarrhea/vomiting (if the intestinal system is affected),● poor abilities to heal,● muscle wasting, and● poor hair coat.

Feline Infectious PeritonitisFeline infectious peritonitis (FIP) vaccine protects against aviral disease of the corona virus family that produces a fatalinflammatory disease of the abdomen and chest. The virusinteracts with white blood cells of the body, producing mi-croscopic clumps of white blood cells and virus on tissue.These nests of inflammatory cells cause organ damage anddisease on the tissue level. The disease is most common inyoung and stray cats. The disease produces signs of

● anorexia,● lethargy,● weight loss,● depression,● fever,● accumulation of fluid in the abdomen (ascites),● accumulation of fluid in the chest (pleural fluid), which

presents as— shortness of breath,— open mouth breathing,— bluing of the gums, whites of the eyes, tongue,— abdominal breathing, and— death.

Feline Immunodeficiency VirusFeline immunodeficiency virus (FIV) is an incurable viraldisease that can attack any system in the cat’s body, causinga chronic wasting disease or an acute life-threatening epi-

sode. The disease usually affects the cat’s immune systemand then secondarily will affect other body systems. Thevirus can cause a wide variety of signs.

Respiratory disease presents with

● chronic nasal discharge,● chronic ocular discharge (eyes),● trouble breathing,● increased respiratory rate,● open mouth breathing, and● collapse.

Gastrointestinal disease presents with

● severe gingivitis,● ulcers in the mouth and tongue, ● chronic vomiting,● chronic diarrhea,● weight loss, and● nonresponsiveness to medication.

Neurologic disease presents with

● seizure,● aggression, and● fever of unknown origin.

Potential Side Effects of Vaccination

Short-Term Reactions: Allergic and AnaphylacticReactionsThere are a few basic concepts that must be understoodwhen discussing and monitoring allergic reactions in pets.

● Any medication, whether vaccine or medicine, whetherinjectable or oral, can produce an allergic reaction in ananimal.

Key Points in Discussing FIV with Clients ● FIV is in the same family of viruses as HIV.● There has never been a reported case of humans

contracting FIV from a cat.● Cats can carry the disease and be infectious for

years without any physical symptoms.● Outside or inside/outside cats are the most at risk.● Cats spread the disease from cat fights/bites,

chronic exposure (over months to years) to infectedcats through grooming and eating out of the samefood bowl, and coitus.

● There is a vaccine available, however at this time,its ability to promote protection is still under inves-tigation.

● Any cat that has been vaccinated for FIV will showpositive on the FIV screening test, making it im-possible to differentiate a cat that has been vacci-nated from one that has been infected.

Key Points in Discussing FIP with Clients● Outside or stray cats are the most at risk.● Currently it is unknown exactly how the disease is

spread.● The virus belongs to a large family of viruses; the

exact virus type within the family is so far un-known. Therefore there is no absolute test for FIP.

● FIP vaccine is given through an intranasal vaccine,typically for animals that are at risk.

10 Section 1: The First Two Days on the Job

● There is no way to tell if any pet given a medication forthe first time will have a reaction.

● The allergic reactions in the dog and the cat manifestthemselves with completely different symptoms.

● Allergic reactions are uncommon.● Allergic reactions are generally mild; however, mild al-

lergic reactions can precipitate into more severe reactionsif the pet is not treated in a timely fashion.

● The allergic reaction can take place in the first few min-utes after injection or several hours after exposure.

● Although unlikely, animals may show a first-time allergicreaction to a medication or a vaccine they have neverbeen exposed to previously. It is not impossible for a dogto start to show a mild allergic reaction on its first rabiesvaccination.

● Typically, patients produce allergic reactions after beingexposed to a vaccine or medication for a second or thirdtime. This is not usually due to a change in the manufac-turer of the vaccine (see below) but can be because thepet has built up a small allergic response to the vaccineover time.

Canine Allergic Reaction When administering puppy vaccines, remember that the puphas had very limited or no exposure to previous vaccinations,so allergic reactions to vaccinations are always possible andshould be discussed with the client prior to the vaccine beinggiven. The reaction is caused by the body responding to thechemical or metal components of the vaccine that are respon-sible for stimulating an immune reaction in the body. Thesechemicals or portions of microscopic metal that produce animmune response are called an adjuvant. This immune re-sponse stimulates the white blood cells of the body to capturethe deactivated or killed infectious agents and produce im-munity against the specific disease. With an allergic reaction,the body is overreacting to the adjuvant with a release of asubstance called histamine, which regulates the allergic re-sponse. The most common vaccine to produce an allergicreaction is the leptospirosis vaccine; however, any vaccinemay stimulate a reaction in a given animal. Common symp-toms of a mild allergic reaction (see Figure 2.1) are

● swollen face,● swollen eyes,● itchy muzzle,● hives, and● red ears, abdomen, armpits.

There are rare occasions when severe reactions, called ana-phylactic reactions, can occur. Anaphylactic reactions canbe an acute problem where an oversensitized animal will gothrough a massive allergic reaction. However, it is importantto know that a mild allergic reaction can lead into a severeanaphylactic reaction if not properly treated or recognized.Signs of an anaphylactic reaction are

● respiratory noise when breathing, ● breathing (rasps breathing pattern),

There are some very basic points to raise when dis-cussing an allergic reaction with the client. Withyoung animals that have not been exposed to a spe-cific vaccine before,

● inform them that allergic reactions are very rareand usually mild problems, but they can occasion-ally occur;

● review symptoms of a possible allergic reactionand stress to the client that they should be aware ofwhat to look for in the next 12–24 hours;

● make sure the owner has emergency contact num-bers for your hospital or a local emergency clinic ifany signs are noted;

● if signs are noticed, the animal should be seen im-mediately to prevent a mild allergic reaction fromgetting worse; and

● inform the client that if a pet shows sensitivity to aspecific vaccine, steps can be taken in the future toprevent the pet from having repeat incidence ontheir next vaccination.

With older animals that have been repeatedly ex-posed to the same type of vaccinations

● always check the chart and with the client to ensurethat there has been no previous history of vaccinereaction; and

● check to see if there has been any concern regard-ing even mild changes in the pet's health prior tovaccination. If so, inform the veterinarian imme-diately.

Chapter 2: Vaccines, Heartworms, and Their Terminology 11

Figure 2.1. Image of a canine allergic reaction. Note theswollen lip and skin around the nose. This type of reaction canoccur minutes to hours after vaccination.

● shortness of breath,● vomiting,● slow heart rate,● poor pulse quality,● weak to nonresponsive, and● cold.

Anaphylactic reactions are life-threatening emergencies thatmust be dealt with immediately or the pet may die. Sincesome anaphylactic reactions can precipitate from mild aller-gic reactions, all clients must be informed of what to do ifthey are concerned their pet is having a reaction to medica-tion (see below).

Feline Allergic ReactionsAs with most situations, cats react very differently fromdogs when responding to an allergic reaction. Although catswill occasionally have mild to severe reactions to vaccinesand medication, their symptoms can be quite different. Catscan show any of the following symptoms.

● depression● lethargy● reddening of the ears and mucus membranes● profuse vomiting● dehydration● weak pulse● collapse

The most common vaccine to produce mild symptoms of de-pression and lethargy is the feline leukemia vaccine, whichcan produce mild flu-like symptoms of soreness, lethargy,and change in attitude (grumpiness) in some cats.

What To Do When a Vaccine Reaction OccursVaccine reactions are generally mild and reported by theowner usually in the first 12–24 hours after the vaccination.Since the animal is not in the hospital, there is no way toassess the patient’s stability over the phone. Therefore, itis recommended that the client be rechecked immediately ei-ther by the hospital or the emergency clinic.

If the client is hesitant to have their pet seen, it is impor-tant to inform them that even a mild allergic reaction canprecipitate into a more severe problem if the pet is notchecked and the reaction is not halted. If the client is stillhesitant to have their pet seen,

● the doctor should be consulted immediately; ● at no time should over-the-counter medication ever be

suggested to a client without a veterinarian’s recommen-dation;

● the chart should be documented with the highlights of thephone conversation and that an allergic reaction to a vac-cine has occurred; and

● the folder or the top sheet of a chart (usually a patient’smedical problem log) should be labeled with a bright

sticker or highlighter to indicate that the patient has ahistory of allergic reactions to a specific medication orvaccine.

If a Pet Had a Vaccine Reaction in the Past Every hospital team handles patients with a history of vac-cine reactions differently; however, some basic tenets oftreatment are that the pet receive a dose of antihistamine30–120 minutes prior to the vaccination. The antihistaminehelps to block the release of the histamine producing the al-lergic reaction. The medication can be given orally by theowner or in an injection at the hospital.

The pet is then vaccinated and then must be monitoredfor a few hours after the vaccination for any signs of an al-lergic reaction. Often the pet can be hospitalized for the day;however, if owners are reluctant to leave the pet, a recom-mendation should be made that the pet and owner stay withthe pet in the hospital for 30–60 minutes after the vaccina-tion should be made. This allows the veterinarian the abilityto assess that there is no obvious reactions in that time anddischarge the pet. The owners must also be aware that theseanimals still need to be closely monitored with owner super-vision for the next 12–24 hours and any changes reportedimmediately to the hospital.

Long-Term Reactions There can be some long-term concerns from vaccinationsthat are also tied to the animal’s response to the adjuvant. Aswith allergic reactions, there is no way to determine if an an-imal will have a long-term reaction until the vaccine isgiven. Overall, the owner should be aware that these reac-tions are extremely rare and the probability that these reac-tions would occur is very small in comparison with a muchlarger probability of a pet getting a disease if the animal isnot properly vaccinated.

A sterile abcessation at the vaccine site (vaccine knot) ap-pears as a small knot that is noticeable over the vaccinationsite, especially after rabies vaccination. Most of these knotsare a small, nonpainful mass or nodule of chronically in-flamed tissue (granuloma) that occurs and disappears in14–28 days. On a few occasions, these knots can develop aclear or purulent (pus) fluid accumulation and becomelarger. These are extremely rare, but if noted, the abscessesmay need to be lanced and drained.

Injection site sarcoma is a malignant destructive cancerthat has been associated in response to exposure to the adju-vant of feline leukemia and, more rarely, feline rabies vac-cine. It occurs in less than 0.1% of all cats vaccinated.However, without advanced diagnostics or surgical excision,an injection site–induced fibrosarcoma and a vaccine knotare impossible to distinguish. Therefore, all swellings orlumps in cats should be carefully monitored, especiallyaround vaccine sites.

In some practices, the vaccines are given in differentanatomical locations so that the medical team can monitorany reactions to each specific vaccine. For example, FVRCP

12 Section 1: The First Two Days on the Job

vaccine will be given subcutaneously over the right shoul-der, avoiding the midline, and as distal as possible. Felv willbe given subcutaneously in the left hind leg. Rabies vaccinewill be given subcutaneously in the right rear leg. Thus themedical team can be able to monitor each specific site andknow what vaccine was administered there.

Vaccine Side Effect Concerns

The concerns with long-term side effects from vaccines areradically changing the recommendations of what vaccina-tions should be given and how often they should be admin-istered. It is very important to discuss with the medical teamwhat the hospital’s recommendations are for vaccines, andtheir time table, before discussing any vaccinations withclients. Constructing a simple vaccine schedule for dogs andcats can become a useful resource for new employees. Anexample of a vaccine schedule is seen in Table 2.1.

Heartworm Disease

Note that a complete discussion of heartworm disease iscovered in Chapter 12. Heartworm disease is a parasitic in-fection of a bloodborne parasite, Dirofilaria immitis (seeFigure 2.2). The disease is spread by mosquitoes, which feedon infected dogs and cats. The mosquitoes pick up larvalheartworms (microfilaria), which they in turn inject into anuninfected animal the next time they feed.

● The parasite is injected into the tissue, and over the next3–6 months it migrates through the tissue to the bloodsupply and to the right heart.

● There the worms mature and reproduce, causing an ob-structive heart disease in the right heart and lung fields(see Figure 2.2).

● The disease can be asymptotic initially (especially in fe-lines), but as the infection worsens, the right side of theheart begins to obstruct and potentially fail.

● The infection affects dogs and cats (rarely) in mosquito-endemic regions, along the Atlantic and Gulf coasts, and

other parts of the United States. Outside, unprotected an-imals are at the highest risk.

Common Signs in Medical HistoryIn canines the disease produces a chronic progressive dis-ease. In felines, the disease can be asymptotic until the petenters acute cardiac failure. Common medical complaintscan be

● sudden death (cats),● weakness/lethargy/collapse,● decreased ability to exercise,● coughing (rare in cats),● shortness of breath,● weight loss, and● fluid buildup in the abdomen (ascites) with formation of

obstructive right heart disease in severely affected animals.

Common Points in Physical ExaminationPhysical signs depend on heartworm burden, length of dis-ease, age of the pet, and other underlying disease conditions.Signs are species dependent.

In canines, patients may present with a mild to worseningcough. In severe cases animals may be unable to exerciseproperly. There may be evidence of a right tricuspid murmurwith increased lung sounds. The pet may be coughing upblood.

Key Points in Discussing Potential Long-TermVaccine Side Effects with Clients● Just as with allergic reactions, there is no way to tell

if a vaccine will produce a long-term side effect untilthe vaccination is given.

● The possibility of formation of a vaccine-induced sar-coma occurring is less them 0.1%.

● The vaccine's protection for exposed or at-risk ani-mals far outweighs the possibilities of long-term sideeffects.

● The owners should monitor the vaccine sites for thenext 2–4 weeks and report any changes or concernsthat they note immediately.

Chapter 2: Vaccines, Heartworms, and Their Terminology 13

Table 2.1 Feline vaccination schedule.

Vaccines Kittens Adults Recommendations

Felv Vaccinated at Vaccinated every Given in left hind 12 and 16 3 years leg.weeks of age Recommended for

inside and out-side or outsidecats only.

Cats should be tested for FELVannually.

Rabies Vaccinated at Vaccinated at Given in right hind 16 weeks 1 year and leg.of age then every Per state law, all

3 years cats must be vaccinated andlicensed.

FVCRP Vaccinated at Vaccinated every Given over the 8, 12, and 3 years shoulder blades.16 weeks

FIP Not recom- Not recom- Only given onmended at mended at request of this time. this time. owner.

FIV Not recom- Not recom-mended at mended at this time. this time.

FVCRP, Feline viral rhinotracheitis, calici virus, panleukopenia virus; FIP,feline infectious peritonitis; FIV, feline immunodeficiency virus.

In felines, pets may not show any physical signs until thepet is in cardiovascular failure or death.

DiagnosisDiagnosis is largely based on screening patient blood for an-tibodies against the adult heartworm. In canines, there aremany excellent in-hospital tests to determine potential expo-sure. In feline patients, there are tests available throughmany of the outside animal health laboratories.

PreventionAnnual to biannual heartworm testing and routine heart-worm prevention (every month to every 6 months dependenton the product) can greatly reduce the chance of heartworminfection for pets living in endemic regions.

CD-ROM 1 reviews material presented in this chapter.Please try the cases for Section 1 (The First Two Days on theJob) to help reinforce the information presented here.

There are some basic points to raise when discussingheartworms with the client.

Disease● Heartworm disease is a bloodborne parasite infec-

tion that is spread by mosquito bites.● The disease is endemic in warm climates where

there are active mosquito populations.● However, specific geographic regions are more en-

demic for the disease (i.e., northeast and southeastcoastal states, Texas, and parts of the Midwest).

● The disease is transmitted by the mosquito thatfeeds on a currently infected animal and then bitesan unaffected pet.

● The mosquito injects a small larval form of the par-asite into the tissue, which over 4–6 months mi-grates into the right heart and lung fields.

● There the parasite begins to reproduce and becomeobstructive to the heart and lungs.

Physical Signs● In the canine, pets generally develop a persistent

worsening cough that can develop into weakness,inability to exercise, and collapse in severe cases.

● In feline heartworm disease, the worm loads can bemuch less, with infections having only a few wormsevident. Physical symptoms are mild to nonexistentuntil the feline enters a cardiovascular shock/crisis.

Clinical DiagnosticsAlthough there are many diagnostic tests used to diag-nose and confirm the extent of heartworm disease, theinitial clinical test is a simple blood test that evaluatesthe pet's blood for the presence of antibodies againstthe adult heartworm. Many of these tests can be run ina few minutes within the hospital setting.

ControlThrough annual to biannual heartworm testing andplacing the pet on heartworm prevention, the pet ishighly unlikely to develop the disease. The preventa-tives are monthly tablets that kill any of the larval par-asites that the pet comes in contact with.

14 Section 1: The First Two Days on the Job

Figure 2.2. Image of multiple lung fields. Note the high num-ber of adult heartworms in the incised lobe. These worms becomeobstructive to the heart and lungs, producing a severe cardiac andrespiratory disease.

This chapter will focus on discussing basic elective proce-dures with the client. Although approaches and types ofelective surgical procedures vary from hospital to hospital,the basic concepts of each will be covered along with somekey points regarding how to approach discussing surgerywith the client.

As with all components of veterinary medicine, surgeryalso has its own terminology and special terms. An overviewof these surgical terms follows.

● Ovariohysterectomy (OVH), or spay, refers to a com-plete removal of the ovaries and uterus from a female pa-tient. After the procedure, the female is unable to repro-duce or have heat cycles and has a much lower chance ofdeveloping infections of the uterus (pyometra) or havingmammary tumors in later life.

● Orchidectomy/castration, or neuter, refers to a com-plete removal of both testicles of a male animal, render-ing the pet unable to reproduce and decreasing secondarysex characteristics (i.e., aggression, voice change, terri-tory marking, etc.).

● Feline onchyectomy, or declawing, refers to the removalof the claws and fingertips (third phalanx) in a feline.These procedures are typically done on the forelimbs ordone on all four legs to prevent the pet from scratchingand damaging its environment.

● Feline tendonectomy refers to an alternative surgicalprocedure to declawing where a small section of tendonsthat flex and exteriorize the claws is removed. This pro-cedure prevents cats from extending their claws, butleaves the nail and fingertip intact.

● Dental prophylaxis is a thorough dental cleaning, oralexamination, gingival examination, and polishing of thepatient’s mouth. With severe disease, dental x-rays can betaken and tooth extractions or advanced procedures (i.e.,root canal) can be performed.

When discussing surgery with the client, there are twomain topic groups. The first is what the client should knowabout anesthesia and surgery before the procedure. How todiscuss anesthetic procedures with the client will be coveredlater. The discussion of surgery should focus on

● the goals of the procedure,● how the procedure is physically done, and

● any contingencies that would make the procedure morecomplicated.

The second part of the discussion outlines what the clientneeds to monitor after surgery. This is usually discussed atthe time of discharge and should be done both verbally andwith written instructions for the client to take home so theclient may reread the information at a later time.

Besides specific concerns that need to be discussed witheach procedure, general comments about monitoring inci-sions and incision care should always be reviewed with theclient at the time of discharge.

The Ovariohysterectomy

An ovariohysterectomy (OHE), or spay, is a complete re-moval of both ovaries and the uterus to the cervix. Once the

Discussing Monitoring the Incision Site with theClient● The incision site should be checked daily for

swelling, draining, heat, or any evidence of incisionline breakdown. If there are any changes noted, thehospital should be notified immediately.

● The incision site may have some mild, firmswelling after the first week, which is usually local-ized over where the last suture knot was placed.This swelling will disappear as the sutures are ab-sorbed over the next 4–6 weeks.

● The animal should not be bathed and the incisionshould not be allowed to get wet.

● If absorbable suture is used to close the skin, theclient should be informed that the suture will dis-solve on its own, but the incision should be checked10–14 days after the procedure.

● If nonabsorbable suture is used, the incision shouldbe checked between postoperative days 10 and 14and the sutures removed when the incision hashealed.

● If the pet is bothering or licking the incision at anytime, the hospital should be contacted and a Busteror Elizabethan collar placed on the pet to keep theanimal away from the incision.

15

Chapter 3

Elective Procedures

15

pet is placed under anesthesia, the abdomen (belly) is shavedand surgically prepped with an antiseptic/antibacterial soapand then rinsed with alcohol to reduce hair and bacterialload. The surgical boundaries are then covered with steriletowels (draped), and an incision is made into the abdominalwall. The ovaries are first located and exteriorized; theirblood and nerve supplies are tied off with an absorbable su-ture (ligated). The procedure is repeated with the otherovary (see Figure 3.1).

With both ovaries freed from their blood supply, theuterus is exteriorized and ligated just above the cervix. Theuterus with its ovaries is then completely removed from theabdomen (Figure 3.2).

The abdominal wall is closed with three separate suturelayers: first the muscle wall is closed with absorbable suture,then the subcutaneous tissue is closed with absorbable su-

ture, and lastly the edges of the skin are brought together.The incision is then cleaned, and animal is moved into therecovery area (see Figure 3.3).

If the female animal is in heat or pregnant at the time ofsurgery, the procedure will be more complicated because theuterus is larger and has an increased vascular supply.Animals that are in heat can still be attractive to malesand must be kept separated from any male animal untilsigns of heat disappear. If the patient is accidentallybred, the internal sutures could break down and the petcould begin to bleed internally.

After this procedure, the patient will not be able to repro-duce or go into heat. An animal is spayed to prevent heat andpregnancy but also to reduce the risk of mammary tumorsand disease of the reproductive tract in middle-aged to olderfemales (see Chapter 18).

16 Section 1: The First Two Days on the Job

Figure 3.1. Image of the ventral abdomen (belly) shaved and cleaned in preparation for surgery (a). An incision is made in the middleof the abdomen (b). The abdomen is then explored (c), isolating the uterine horns and exteriorizing the ovaries and ovarian pedicle (d).The pedicle is then double-ligated (tied) with absorbable suture and the ovary and uterine horn exteriorized.

A B

C D