VetWrap Spring 2013 - DoveLewis | Emergency Animal Hospital

Volume 7 Issue 2
Spring 2013
Don't fear the reefer: know the signs and treatment
of marijuana ingestion and toxicity – see page 5

DVM Outreach
MeiMei Welker, DVM
Yet another wonderful Pacific Northwest
spring is here and my muddy yard and
therefore, muddy dogs, are happy to see
a little less rain. The bulbs popping up
everywhere is a sign that there are good
things to come. At DoveLewis we are
also looking forward to a lot of exciting
happenings in the coming months!
This year, DoveLewis celebrates its 40th
anniversary and we have not only survived
through the years, we have thrived. This
is in no small part due to the support
and continued trust of all the referring
veterinarians in the Portland metro and
Southwest Washington areas.
Our patient numbers are steadily climbing
and client satisfaction is at an all-time
high. We are constantly looking for ways
to improve and better serve the Portland
community as a whole.
Take the subject of sustainability for
example. In the past year, we worked
hard to achieve our Silver Certification for
Sustainable Business Practices through
the City of Portland. Most recently, we
instituted a new fax system that directly
faxes our case reports and discharge
instructions to referring practices,
Note from the desk of
the Chief Medical Officer
Lee Herold, DVM, DACVECC
An ounce of prevention (or education) is
worth a pound of cure. The good thing
about cycles is that they allow you to predict
what’s to come and be prepared. The
seasonal change to spring and summer will
bring us warmer weather, clearer days and
less rain. The bulbs are blooming and as the
weather warms, slugs come out in force. On
the hospital floor we will see higher numbers
of patients with tremorrgenic toxins. Most
of these tremorring patients will be dogs
with slug bait (metaldehyde) toxicity but
compost and mold ingestions are other
culprits. Warmer weather also means fleas,
which portend the arrival of larger numbers
of tremorring cats from permethrin toxicity.
For the hospital
that means it’s
time to break out
the apomorphine,
vomit buckets,
methocarbamol,
Most of these tremorring
patients will be dogs with
slug bait (metaldehyde)
toxicity but compost and
mold ingestions are
other culprits.
eliminating the need to waste paper by
printing them out first. As a result, each
patient will have an electronic file that
will include all of the paperwork from their
visit/stay at our hospital and any records
sent from their rDVM. This information
can then be accessed in one location
digitally during later visits—an option
that was not available to us previously.
This will not only help the environment
but will improve the quality of care and
service that we can provide to the patient,
client and our referring partners. If you are
interested in doing your part to participate
in sustainable practices and wish to
receive case reports via email instead,
please call or email us at 971.255.5904
or mwelker@dovelewis.org or Brian Stief,
Clinic Operations Manager at 971.255.5908
or bstief@dovelewis.org.
As always, any feedback, questions or
suggestions on how we can improve are
welcome. It is my goal to empower the
local veterinary community to take an
active role in moving DoveLewis forward
into the next 40 years! •
Contact Dr. Welker:
971.255.5904, mwelker@dovelewis.org
valium, activated charcoal, and lipid rescue
therapy. We at DoveLewis are prepared to
see these cases, but we will also continue
our annual crusade to educate the public
about keeping metaldehyde products
out of reach of pets, and to seek safe and
effective flea control products
from their veterinarians. Join us
in reminding your clients about
these seasonal hazards after all,
an ounce of education is worth a
pound of cure. •
Board of Directors
CEO
Ron Morgan
DoveLewis Emergency Animal Hospital
President
Adrianne Fairbanks, DVM
Pearl Animal Hospital
Immediate Past President
Mark Norman, DVM
Bethany Family Pet Clinic
Secretary
Scott Asphaug
Assistant U.S. Attorney
United States Attorney’s Office
Executive Committee Member
David Symes
Attorney, Ogletree Deakins
Finance Committee Chair
Michael Remsing
Dignified Pet Services
PVMA Representative
Jon Plant, DVM, DACVD
SkinVet Clinic
Board Personnel
Elizabeth Altermatt, DVM
Murrayhill Veterinary Hospital
Courtney Anders, DVM
Pearl Animal Hospital
Tim Munjar, DVM, DACVS
Veterinary Surgical Center of Portland
Julie Poduch
member at large
Steven Skinner, DVM, DACVIM
Oregon Vet Specialty Clinic
Kali Wilson, DVM
Forest Heights Veterinary Clinic
Lynette Xanders
Wild Alchemy
Mission Statement
DoveLewis, the Northwest’s Nonprofit 24–Hour
Emergency & ICU Animal Hospital, in association
with the regional veterinary community, provides
24–hour emergency, critical care, education and
community outreach.
Our highly–skilled professionals are dedicated to:
• Improving the condition of
animals needing emergency
and critical care.
• Strengthening the ties with,
and extending the reach of,
the veterinary community.
• Promoting the well–being of
animals and the human–animal
bond throughout the community.
DoveLewis Emergency Animal Hospital is recognized as
a charitable organization under Internal Revenue Code,
Section 501(c)(3). All donations are tax deductible as
allowable by law. Federal Tax ID No. 93–0621534.
Message from
the CEO
Recently, my wife and I decided to let one of
our dogs die. That might be a controversial
way to say it, but that is exactly the
decision we made. As sad as the situation
is, we are at peace with our decision—just
like we all want our clients to be when
faced with the choice of pursuing more
medical treatment or not. The dog we
decided to let go when her time comes is
Teddy, pictured with me.
The “back story” is that our two dogs are
pretty lucky that I work in the veterinary
industry! I’m not sure anyone else could
afford them. One is a diabetic pug named
Lucy who has an amazing personality and
Teddy, our wonderful Cairn Terrier who
has skin issues, several benign lumps,
Cushing’s-like symptoms (repeatedly) and
now, most unfortunately, lymphoma.
‘Lucy the Pug’ as we like to call her also
had bladder stone surgery, cataract
surgery (thank you, Dr. Kirshner), more
blood glucose curve tests than I can
count, a few scares that needed ICU
hospitalization, not to mention many other
miscellaneous ailments common to pugs!
We like to joke that our dogs might be
lemons, but they are our lemons and such
a great part of our family.
Like many of you, our
own pets seem to not just
mirror the medical needs
of the community at large
but seem to exceed the
norm—almost like it was
meant to be that they
are with us. For many in
the veterinary profession,
fostering or adopting pets in need is more
typical than atypical. It is reflective of
the compassion that flows through the
profession—the calling that led you to
veterinary medicine.
It is reflective of the
compassion that
flows through the
profession—the
calling that led you to
veterinary medicine.
Referring Partner Survey
Above: CEO Ron Morgan and his dog Teddy
Photo credit: Michael Jones Photography Studio
Just like our clients, we all have to make
some difficult decisions that may stop
short of pursuing every possible medical
option for our pets. Personally, we decided
not to start chemotherapy when nearly
13-year-old Teddy was diagnosed in
December. Although given just a few
months most likely to live without action,
we didn’t want to put her through even the
most basic of treatment not knowing for
sure the impact any of that would have on
her. She had been through
enough, we felt.
We chose, like many people,
to focus on making her
comfortable and giving her
as much fun and time as
possible. I have to admit, I
was concerned at first about
how people around us might
react to our decision not to treat Teddy. I
found, however, what I truly expected—a
compassionate, understanding, nonjudgmental
reaction from those at Dove
who knew our situation. This reaction is
what we hope all our clients feel!
As for Lucy, she has now passed the three
year mark since her diabetes diagnosis, so
we know the possibility of losing her as
well in the not-too-distant future. She has
received amazing care at DoveLewis in that
time, and we are diligent parents about her
diet, her insulin needs and routine. But we
know the clock is somewhat ticking.
So, we face the very real possibility of
losing both of our dogs in a relatively close
amount of time. It is so hard to imagine
the impact that will have on our family,
especially my younger daughter. Even
though she knows of these possibilities,
the reality will be something different.
While I wish 100 percent we were
not experiencing these things, going
through our pets’ illnesses has been so
eye opening for me. To experience what
so many others experience, to see our
medical team and support staff in action
as a client, to discuss our options as a
family, and to make decisions along the
way for Teddy’s and Lucy’s lives.
At the end of the day, I am no different
than any other client or any of you in that
respect. We all have to make personal
decisions about our pets. When we do,
I hope it brings us closer to our clients
and closer to understanding the emotions
they go through. That is what makes
this profession so great, an incredible
compassion for what your patients and
clients go through every day.
They don’t teach this in veterinary or tech
school. It just seems very engrained in
the DNA of most people in this profession.
So on behalf of all the Teddys and Lucys
in the world, thank you for helping make
lemonade out of the occasional, lovable
lemon. Life wouldn’t be as fun and
interesting without them!
Ron Morgan
DoveLewis CEO
We want to hear from YOU! Please take a moment to participate in our survey regarding
your experience with DoveLewis. The survey is short and will only take a few minutes of your time.
Your feedback is important to us and will help us better serve, and communicate with, the local
veterinary community. As a thank you for your participation, you will be entered into a drawing to
win a $100 Visa gift card. One winner will be drawn on May 1.
Take the survey anytime during the month of April at: dovelewis.org/rDVM-survey
Survey graphic by Connie Shu, The Noun Project
2 VetWrap Volume 7 Issue 2 Spring 2013 Cover photo by Avi Solomon
Spring 2013 Volume 7 Issue 2 VetWrap 3

Figure 1. Marijuana, one of the most common illicit drugs used.
Dove
Critical Transport
DoveLewis offers transportation service for critical
patients from your clinic direct to our hospital for $225.*
Critical transports are ideal for oxygen dependent
patients and those requiring continued treatments
and monitoring en-route.
Service includes:
• At minimum a DVM facilitating basic
supportive care during transport
• Basic supportive care includes
oxygen and continued IV fluids
For more information, please contact:
BRIAN STIEF, Clinic Operations Manager
971.255.5908, bstief@dovelewis.org
MEIMEI WELKER, DVM, Outreach DVM
971.255.5904, mwelker@dovelewis.org
* Available on a case-by-case basis. Additional treatment
outside of basic supportive care during transportation
may incur additional charges.
1945 NW Pettygrove, Portland | 503.228.7281 | dovelewis.org
Need to reach our medical staff?
Article
Don’t Fear the Reefer
Nathan Bodnar, DVM
Dietary indiscretion and resulting toxicities are some of the most
common emergencies in veterinary medicine. Each class, and
potentially each individual toxin, may present as a distinct
set of clinical signs. Marijuana is one of these toxins that can
be diagnosed based on the set of clinical signs.
Marijuana, also known as grass, hemp, Mary Jane, MJ, pot,
and weed, is one of the most common illicit drugs used and
thus, is potentially a very common toxicity. The frequency of
marijuana toxicity is most likely to increase with potential
decriminalization and increased medicinal use.
Marijuana is made from the dry leaves and flowers of the
hemp plant (Cannabis sativa). The active ingredient is delta
9-tetrahydrocannabinol (THC). THC is found in all parts of
the plant, but its concentration is highest in the flowers and
leaves. The average marijuana cigarette contains 150mg of THC.
Hashish, which is derived from resins of the flowering tops of the
plant, contains a higher concentration than the dry plant itself.
Hash oil is the most highly concentrated form of THC.
THC interacts will all major neurotransmitters in the brain including
norepinephrine, dopamine, serotonin, and acetylcholine and also
binds to specific receptors in the cerebellum and frontal cortex.
Marijuana is rapidly metabolized by the mixed function
oxidase system of the liver.
Between 65-90% is excreted through the feces, and thus
enterohepatic cycling is significant, while 10-25% is excreted
through the kidneys.
The LD50 has not been established in dogs. In rats the LD50
is 666-1000mg/kg; thus, marijuana appears to have a wide
safety margin.
Animals can be exposed to marijuana in several forms
including second hand inhalation of the smoke and oral
consumption. Dogs can also consume the dried plant
or cigarette directly. Dogs are especially likely to ingest
the marijuana when it is used in food products including
brownies, cookies, cakes and butter.
Clinical signs of marijuana intoxication mainly include:
neurological signs of depression/sedation, ataxia, disorientation,
hyperesthesia along with mydriasis, bradycardia, and urinary
incontinence. GI signs including vomiting are also often
appreciated in 30% of cases. Large exposure can lead to stupor,
hypothermia and hypotension.
The onset of clinical signs can range from five minutes to 96
hours, but the majority will occur between one to three hours
after ingestion. Clinical signs can last anywhere from 30 minutes
to 96 hours. THC is stored in the body’s fat deposits and thus,
can lead to prolonged clinical signs.
Marijuana intoxication can often be easily recognized by the
classic clinical signs of sedation, ataxia, hyperesthesia, and
urinary incontinence. Definitive diagnosis is usually achieved
through proper history with known ingestion. There are several
human urine drug screening kits that can test for THC but can
give false negatives in dogs. This is most likely due to different
metabolites in the dogs urine compared to humans.
Clinical suspicion should lead to further questioning of
the owner. It can be difficult to approach the subject, but
being straightforward and outwardly asking about possible
marijuana exposure is the best way. Owners often do not want to
confess about the possibility of marijuana due to concern of legal
ramifications. Veterinarians are not obligated to report marijuana
intoxications to the police, so some owners need to be reassured
that the police will not be involved. If owners are still reluctant
to divulge any information, discussing additional diagnostics
and cost involved to rule out other potential causes of the clinical
signs is often enough to get owners to admit to the possibility of
marijuana ingestion.
Treatment for marijuana ingestion/toxicity will depend on the
severity of clinical signs and the time since exposure/ingestion.
As with many toxicities, decontamination is the cornerstone
of treatment, including induction of emesis. Emesis induction
should only be performed if it is safe to do so. If the animal is too
sedate to protect its airway or is non-ambulatory, emesis should
not be performed. Activated charcoal also should only be given
if safe to do so. Repeated doses of activated charcoal should be
given due to the enterohepatic recirculation (every six to eight
hours for the first 24 hours). If it is not safe to induce emesis, other
decontamination options should be considered including gastric
lavage under anesthesia and enemas. Enemas can be very useful
to decontaminate a patient, as it is quick and simple to perform.
Activated charcoal retention enemas can also be used in patients
unable to receive oral charcoal. In addition to decontamination, IV
fluid diuresis will help to eliminate the metabolites of marijuana
throughout the kidneys.
Lipid therapy may also be beneficial in the treatment of
marijuana toxicities as it is fat soluble. Monitoring of the patient's
neurological status, heart rate, respiratory rate, and temperature
should be performed every two to four hours. Patients that are
very hyperesthetic/agitated should be kept in a dark quiet area to
help reduce external stimuli. Sedation with diazepam may also be
useful in these patients.
Prognosis for recovery is excellent. The rate of recovery is
dependent of the dose and the route of exposure. Animals with
exposure to second hand smoke usually recover within a few
hours. Animals ingesting small doses often recover completely in
12-24 hours. Ingestion of large doses may take 24-72 hours. •
References
Brown A, Mandell D. Intoxications: Illicit Drugs. Small Animal Critical Care
Medicine. 2009: 342-345
Donaldson C. Marijuana Exposure in Animals. Vet Med 2002; 97: 437-439
Janczyk P, Donaldson C, Gualtney S. Two Hundred and Thirteen Cases
of Marijuana Toxicoses in Dogs. Veterinary and Human Toxicology
2004; 46(1): 19-21
Call our dedicated DVM Backline:
971.255.5990 24 hours / 365 days Spring 2013 Volume 7 Issue 2 VetWrap 5

Fluid Therapy
Hospital Shuttle Service
for Referring Veterinarians
$35 ONE WAY $55 ROUND TRIP
We are happy to offer transport service to and
from our hospital to your practice for your clients’
convenience. Our service includes:
• Delivery of pet to your clinic for discharge
or continued care
• Pick up of stable patients from your clinic for
transport to DoveLewis for overnight care
• Pick up and drop off for all imaging services*
Shuttle Service is available:
7:30AM to 10:00PM, Monday through Friday
For more information, contact:
Brian Stief, Clinic Operations Manager,
971.255.5908, bstief@dovelewis.org.
MeiMei Welker, DVM, Outreach DVM,
971.255.5904, mwelker@dovelewis.org
Please call for hours and availability for shuttle service for imaging services.
A round trip fee is assessed for all imaging services.
Serviceable zip codes:
97006, 97005, 97008, 97034, 97035, 97201, 97202, 97203, 97204,
97205, 97206, 97209, 97210, 97212, 97213, 97214, 97215, 97216,
97217, 97218, 97219, 97220, 97221, 97223, 97225, 97227, 97229,
97230, 97232, 97233, 97236, 97238, 97239, 97266, 97267, 97294.
*Partial service: 97124, 97123 and 97007.
Dove O|N Monitoring—$220
Dove O|N includes exam, ER or ICU monitoring (as
determined by a DoveLewis veterinarian) with fluids,
pain management—antibiotics, or oral medications
as prescribed by the referring veterinarian (if indicated)
and patient status lab work (if necessary).
Packages are intended for stable patients.
Article
Ladan Mohammad-Zadeh, DVM DACVECC
Fluid therapy is a topic that we all learned from day one in
veterinary school. Although it is a fundamental part of many
of our therapies, it is far from a basic concept. This review of
fluid therapy will start with understanding fluid compartments,
osmotic and oncotic pressures, review the fluid types available
and the ‘when’ and ‘where’ of fluid therapy. Lastly, we will
review certain common scenarios in general practice and the
role of fluid therapy in those situations.
Fluid Compartments
Total body water (TBW) is comprised of 60% intracellular
space and 40% extracellular space. The extracellular space is
further divided into intravascular and interstitial (25% and 75%
respectively). There is a minute amount of space accounted for
in synovial, pericardial, pleural and peritoneal fluids. The major
cations in the intracellular space are K+ and Mg++. The major
anions are PO4- and protein. In contrast, the major cations in
the extracellular space are Ca++ and Na+ and the major anions
Cl- and HCO3-. The balance of fluid between the intravascular
space and the interstitium is governed by hydrostatic and
oncotic forces. The balance of fluid between intracellular and
extracellular compartments is governed by the osmotic effect of
Na+. This is true because membranes are virtually impermeable
to ions but allow water to move freely across membranes.
Important Terminology
Osmolality: A count of the total number of osmotically active
particles in a mass of solution (mOsml/kg).
Effective Osmole: Molecule that has the ability to exert an
osmotic force (i.e. can cause water pull). Typically these particles
are not freely moveable across membranes. These include Na+,
K+, and Glucose.
Ineffective Osmole: Molecules that do not exert an osmotic force.
Usually these particles freely move across membranes. They
include urea and HCO3-.
Tonicity = Effective Osmolality: This is the sum of the
concentrations of solutes which have the capacity to exert an
osmotic force across the membrane. Na+ is the main osmole that
affects water balance between the intracellular and extracellular
fluid. In practical terms, tonicity reflects Na+ concentration of a
fluid. The following is a commonly used equation for osmolality.
Eighteen and 2.8 are the molecular weight of the molecule
divided by 10 to get the correct unit conversion. The normal
serum osmolality is 290 – 310 mOsm/L. Cats may run on the
higher end of normal. The following equation is the calculation
for osmolality:
2(Na + K) +
BUN + Glucose
2.8 18
Calculating a patient’s osmolality can help estimate the degree
of intracellular dehydration. The higher the osmolality, the more
water will need to shift out of the intracellular space into the
extracellular space to compensate, resulting in intracellular
dehydration. Severe hyperosmolality can lead to neurologic
signs and weakness.
It is easy to confuse the terms osmolality and tonicity. It is helpful
to think in terms of tonicity representing the sodium content
and osmolality representing all of the effective osmoles in a fluid.
For example, 0.9% NaCl is both isotonic (154 mEq/L NaCl) and
iso-osmolar (308 mOsm/L). Five percent dextrose in water, D5W,
is hypotonic (0 mEq NaCl) but iso-osmolar (252 mOsm/L) because
of the dextrose concentration. For IV solutions that are meant to be
used over many hours to days, solutions must be iso-osmolar in order
to decrease the risk of phlebitis. For short term infusions however,
it is acceptable to infuse hyperosmolar solutions such as 7.5% NaCl
which is both hypertonic (1232 mEq Na/L) and hyperosmolar (2464
mOsm/L). Mannitol is unique because technically it is hypotonic, but
is hyperosmolar (1098 mOsm/L) and does cause fluid shifts out of the
intracellular and interstitial spaces. This is why it is primarily used to
treat cerebral edema.
Oncotic Pressure
Colloid osmotic pressure is the pressure exerted against the flow
of water out of the intravascular space. Hydrostatic force can be
seen as its opposite, that is, the pressure of water flow out of the
intravascular space into the interstitium. Colloid osmotic pressure
(COP) is synonymous with oncotic pressure. Albumin imparts
80% of the COP in the intravascular space. Thus, it is easy to
understand how hypoalbuminemia and the associated drop in COP
results in fluid shifts out of the intravascular space. Starling’s forces
describe the effect of hydrostatic pressure and oncotic pressure on
both the interstitial side and capillary side. It dictates the direction
of water in or out of the plasma space. In arterial capillaries, the
hydrostatic pressure is slightly greater than oncotic pressure,
favoring filtration, or movement of the water into the interstitium.
On the venous side, oncotic pressure is slightly higher favoring
fluid movement into the plasma space.
Fluid Therapy Plan
When you are deciding on a fluid therapy plan, it might be useful to
pose the following questions: Is fluid therapy indicated? What type
of fluid should be given? By what route should the fluid be given?
How rapidly should fluid be given? How much fluid should be given?
Assessing hydration is something we all do as part of our complete
physical exam. Determining the level of dehydration in our patients
is a combination of physical exam parameters (usually mucous
membrane and skin tent), history of losses or lack of water intake,
and lab parameters such as PCV/TS and urine specific gravity. Skin
tent is not a reliable indicator of interstitial hydration in pediatric
patients and geriatric patients. Levels of dehydration include: 5-6%
mild, 7-10% moderate, and 10-12% severe. A patient is clinically
moribund at a level of 15% dehydration.
To answer the question of what type of fluid should be given,
there are only a few major categories of fluid types to choose
from. Crystalloids are solutions containing electrolyte and nonelectrolyte
solutes capable of entering all body fluid compartments.
Within one hour of administration, two thirds redistributes into the
interstitium and one third stays in the intravascular space. Isotonic
fluids are meant for interstitial rehydration or maintenance. Hypotonic
fluids target intracellular rehydration. Hypertonic fluids are
meant for intravascular volume expansion or to create interstitial
volume dehydration. Most crystalloids, other than 0.9% NaCl and
0.45% NaCl/2.5% dextrose, are considered balanced solutions.
A balanced solution is buffered, isotonic and contains electrolytes.
Saline is an acidic fluid and when given in large volumes may
exacerbate underlying acidosis or delay normalization of pH.
Balanced crystalloids are buffered, making them more alkaline.
Other terms that are used to describe crystalloids are replacement
and maintenance. Replacement fluids contain an electrolyte profile
similar to extracellular space (higher Na+ and less K+), while
maintenance fluids have an electrolyte profile similar to intracellular
space (lower Na+, higher K+). The advantages of a maintenance
fluid type is that it decreases the Na+ load long term and
6 VetWrap Volume 7 Issue 2 Spring 2013 Spring 2013 Volume 7 Issue 2 VetWrap 7

Continued from page 7
decreases need for aggressive K+ supplementation. Indications for
use of a maintenance fluid type would include chronic renal failure
or rehydration of a dehydrated congestive heart failure patient.
Colloids are solutions containing molecules greater than
30,000 kDa. Two-thirds stay in intravascular space and one third
redistributes. The half-life of synthetic colloids ranges from a few
hours to a few days. Hetastarch, blood products, albumin, and
Oxyglobin are all examples of colloids. They are generally used for
oncotic support (e.g., hypoalbuminemia), or intravascular support
(e.g., refractory hypotension). Six percent hydroxyethyl starches are
the most common type of synthetic colloid available. The following
table lists the most commonly used 6% hydroxyethyl starches, the
base fluid and the molecular characteristics.
Colloid
Base Solution
Hextend LRS 670/0.75
Hespan 0.9% NaCl 450/0.7
Pentastarch 0.9% NaCl 200/0.5
Voluven
Vetstarch
0.9% NaCl 130/0.4
Ave Molecular weight/
Molar substitution
The first number represents the average molecular weight of
the particles in the solution. The second number represents the
molar substitution of hydroxyethyl starch per glucose. To reduce
intravascular hydrolysis of hydroxyethyl starch by amylase, the
amylopectin is hydroyxyethylated most commonly at carbon
position six. The number of hydroxyethyl groups per glucose unit
is defined as the molar substitution ratio. Why do we care about
these numbers? Larger molecular weight particles have a longer
half-life which is desired, but with higher molar substitution comes
an increased risk of coagulopathy (according to platelet function
assays and thromboelastography). While colloids have beneficial
properties, there are a few cautionary notes. Colloids in general
are not a good choice for interstitial rehydration. Large volumes
may interfere with platelet function. It is uncertain what the safe
maximum dose is per day. Extrapolating from human guidelines,
it is safest to not go beyond 40 ml/kg/day. Large volumes may
cause refractometer reading to falsely approach the total solids of
the colloid being used (e.g. Hetastarch = 4.2). Since colloids have a
high COP and stay mostly within the intravascular space, patients
Radiology Services
outpatient Services & FEES
Radiographs (two views and interpretation; no exam)........................$ 2 2 5 .0 0
Radiograph Interpretation (per case).................................................$37.00
Interpretation of digital or plain films by Dr. Lipman
Ultrasound..........................................................................................$318.00
Second Cavity Ultrasound (same patient)........................................$165.00
Echo / Single Organ Ultrasound.......................................................$250.00
Ultrasound–guided FNA*...................................................................$97.50
Ultrasound–guided Fluid Drainage*................................................$ 2 3 5 .0 0
Ultrasound–guided Fluid Aspirate*................................................. $49.50
Ultrasound–guided Fluid Cystocentesis*....................................... $39.00
*All Ultrasound-guided procedure pricing does not include sedation if necessary
on colloids must be monitored for volume overload. Remember that
COP is the primary determinant of oncotic strength. The following
table outlines some common fluid types in practice, its COP and
osmolarity. Interestingly, packed red blood cells have a very low
COP, but since the RBCs stay mostly within the intravascular
space, it is treated like a colloid in terms of dose and duration of
administration. Patients receiving blood products are at risk for
volume overload the same as when using other colloids.
FLUID COP OSMOLARITY
6% Hetastarch 32 mmHg 308 mOsm/L
Dextran70 61 mmHg 309
Oxyglobin 43 mmHg 300
Canine FFP 17 mmHg —
Canine pRBC 5 mmHg —
25% Human Serum
Albumin
5% Human Serum
Albumin
>200 mmHg 294
23 mmHg 300
LRS/NORM 0 273
25% Mannitol 1.3 mmHg 1372
Hypertonic Saline 0 2464
There are many routes of administration to consider when formulating
a fluid therapy plan. Oral administration is certainly the most
physiologically normal. If there is no contraindication to oral intake,
large volumes can be effectively administered and hypertonic and
calorie dense fluids can be given safely. Unfortunately, the oral route
is not good for rapid volume expansion and is not recommended as
sole use of rehydration if GI dysfunction is present. Subcutaneous
fluid administration is convenient, inexpensive and useful for at-home
therapy. The volume tolerated is dependent on SQ elasticity. It is less
effective for large dogs as not enough volume can be easily given.
Only isotonic, non-dextrose containing fluids are recommended
safe for use of this route. Intravenous is the preferred method of fluid
administration. The choice of peripheral or central venous placement
is guided by the number and type of fluids needed. Nearly any type
of fluid can be given through a peripheral catheter. In general, the
osmolality of the fluid being delivered should be iso-osmolar
so as not to induce phlebitis. This being said, short infusions
CT of Chest, Abdomen, Nasal or Brain............................................$ 8 7 9.0 0
(includes contrast, anesthesia & exam fee)
CT additional study (same visit).........................................................$325.00
CT Orthopedic (includes contrast, anesthesia & exam fee)................$ 9 14 .0 0
CT Ortho additional study (same visit)..............................................$ 6 2 5 .0 0
CT Lung Met Check (includes anesthesia and exam)........................$ 3 7 9.0 0
Phone consultations are welcomed!
Dr. Alan Lipman, DVM, DACVR ...................Phone: 971.255.5964
Diagnostic Imaging Coordinator:
Jen Langevin, CVT...................................................Phone: 971.255.5964
of hyperosmolar solutions can be given safely. From a practical
perspective, fluids containing more than 5% dextrose should
not be delivered through a peripheral vein for long term infusions.
Solutions with an osmolality less than 550 mOsm/L are safe to
deliver through a peripheral vein. Central veins tolerate higher
osmolality fluids such as parenteral nutrition. Intraosseus
administration is ideal for young or small/exotic animals. Sites
include: tibial tuberosity, trochanteric fossa of the femur, wing
of ilium, and greater tubercle of humerus. The advantage of an
IO catheter is that ANY fluid, including blood products, can be
delivered. The disadvantages include patient discomfort and
catheter maintenance. How fast fluids can be run in is dependent
upon the variables in Poiseulle’s law where Q is flow, P is the
pressure gradient on either side of the catheter, r is the radius of
the tube (catheter), n is the viscosity of the fluid going through
the tube and l is the length of the tube. In practical terms, a short,
large bore catheter most effectively delivers fluids.
Q = π Pr 4
8nl
How quickly fluids should be administered depends on a few
patient factors. Cats tend to be less tolerant of high volumes of
fluids compared to dogs. Moderate to severely hypothermic patients
do not have the normal vasomotor tone or cardiac contractility to
be able to tolerate boluses or high rates of fluids. The presence of
heart disease puts the patient at higher risk for volume overload
or failure. Pediatric patients have higher fluid requirements (70-
80 ml/kg/day), which should be taken into consideration when
formulating a fluid plan. Fluid type considerations include whether
the fluid is a crystalloid, colloid or hypertonic solution. Each of these
has a safe administration dose and administration duration. The
last consideration is your fluid therapy goal: Interstitial hydration or
intravascular volume expansion? The hydration deficit calculation
is helpful in determining the volume of fluid that should be given to
achieve rehydration. We try to achieve rehydration within 12-24
hours safely. Likewise, the free water deficit calculation is helpful
in determining the amount of free water needed to achieve from
intracellular rehydration. Unlike interstitial rehydration, intracellular
rehydration should be done no faster than to achieve a 0.5 mEq/hr
reduction in Na+.
Hydration deficit (liters) = % Dehydration x kg
Free water deficit (liters) = 0.6 x kg [patient Na+ – ideal Na+]
[Ideal Na+]
A bolus should be considered when rapid volume expansion is
desired. By definition, a bolus is rapid delivery of fluids (e.g., over
10-20 minutes). Unfortunately, because of how quickly crystalloids
redistribute, a one liter bolus set to 999 on a fluid pump is not a bolus.
Practical Fluid Therapy
Fluids in anesthesia. For routine surgeries, it is tempting to not want
to place a patient on fluids. However, there are some preoperative
conditions to consider: When PCV is greater than 50%, geriatric
patient, an azotemic patient. Even if the patient is well hydrated prior
to surgery, there are surgical conditions to consider. Open abdominal
surgery results in evaporative fluid loss and third spacing from
inflammatory infiltrates post-operatively. Evaporative loss is likely
less of a concern in elective orthopedic surgeries. Many induction
drugs are cardiovascular depressants, and gas anesthetics cause
vasodilation. Common anesthetic fluid strategies include 10 ml/kg/
hr or 10 ml/kg for the first hour, then 5 ml/kg. The latter would be
considered for elective orthopedic surgery on a well-hydrated patient
where there is little evaporative loss from the surgical site.
Fluids in CPR. It is tempting to give shock doses of fluids to a
patient that is in cardiac arrest. However, large volumes of fluid
may not be necessary and could be detrimental if the patient
survives. Manual chest compressions achieve a cardiac output
that is only 20% of normal and once the patient recovers they
could suffer from temporary systolic dysfunction. Renal function is
also impaired resulting in improper handling of fluids. Thus, large
volumes of fluid administered during CPR may lead to volume
overload and failure. A practical approach is to have fluids running
at a low rate (slow drip) as opposed to wide open during CPR. An
initial bolus should be considered if trauma or hypovolemia is a
contributing factor to the arrest.
Fluids in CHF. The hormonal influence of the renin-angiotensinaldosterone
system on CHF is too complex a topic to cover in
this article. There is undoubtedly an important role that RAAS
plays in fluid retention and electrolyte handling in a chronic
CHF patient. The answer to fluid therapy in a cardiac patient is
as complex as the pathophysiology itself. A patient with wellcompensated
disease will likely be less affected by RAAS. A
balanced crystalloid would be most appropriate for rehydration
of these patients. However, when a patient with a history of
decompensation requires fluid therapy, we are more concerned
about hormonal influence over Na+ handling. In this instance, a
hypotonic fluid or a balanced crystalloid would be appropriate.
However, hypotonic fluids are still not appropriate for boluses.
Fluids and Transfusions. Any citrate containing blood product
should not be run through the same line as calcium containing
fluid (LRS). If the PCV of the packed RBC unit is less than 70%,
it does not need to be diluted with NaCl. PCV of most units can
range 60-80%. The theoretic risk of delivering a unit with a high
PCV, is that it has a high viscosity and causes problems in the
line resulting in cell lysis. The recommended dose and rate of
administration of blood products is generally 10-20ml/kg over four
hours. However, this should be tailored to the patient’s needs and
lower doses should be used in cats.
Hypertonic saline has a high tonicity resulting in a fluid shift
from the interstitium into the intravascular space for rapid volume
expansion. The advantages are that small volumes result in big
effects, and it has been shown to increases cardiac contractility.
However, when used alone the effect is very short lived, about 10-15
minutes. This effect increases to 45 minutes when 'chased' with a
colloid. Hypertonic fluid therapy is not appropriate for dehydrated
patients, cardiac patients, renal patients or those who are already
hypernatremic. It is best utilized in the resuscitation for acute
volume loss of a previously euvolemic patient (e.g., hit by car or
hemoabdomen). Other potential uses would include resuscitation
of a patient that has pulmonary contusions where large volumes
of fluid may exacerbate already leaky capillaries in the lungs. The
dose for hypertonic saline is 3-5 ml/kg bolus over 10-20 minutes,
followed by 3 ml/kg bolus of colloid for longest lasting effect. It
is not to be given faster than 1-2 ml/kg/min as this may result in
bronchoconstriction and bradycardia. •
8 VetWrap Volume 7 Issue 2 Spring 2013 Spring 2013 Volume 7 Issue 2 VetWrap 9

Figure 1. Lizzy, pre-op, with a 10 x 14 cm irregular, ovoid, soft
tissue mass associated with the right antebrachium.
Figure 3. An ovoid skin incision was made around the base of the
mass, preserving grossly normal medial and lateral skin.
Figure 4. The mass originated from an irregular pedicle about 3 cm in
length starting from the deep fascia between the extensor carpi radialis
and digital extensor muscle bellies.
CAse Study
Surgical Debulking of a Large
Peripheral Nerve Sheath Tumor
Ashley A. Magee, DVM, DACVS
Lizzy, a 13-year-old spayed, female
retriever mix, presented to DoveLewis’
surgery department for evaluation and
possible removal of a large tumor on
the right forelimb. She was diagnosed
with a peripheral nerve sheath tumor
approximately 18 months prior via incisional
biopsy. The histopathology report
characterized the malignant neoplasm
as relatively low grade. No treatment was
elected at that time. From diagnosis to
presentation to DoveLewis, the mass
grew considerably and the skin had
become irritated and thin, and Lizzy had
begun to lick at the mass. A consultation
with an oncologist had been pursued
and surgical debulking recommended
since amputation was not considered
an option by Lizzy’s owners due to good
function of the limb, age, and lifestyle
considerations (she lives on a houseboat).
On examination, Lizzy was bright and
alert with a normal physical examination
other than a 10 x 14 cm irregular, ovoid,
soft tissue mass associated with the right
antebrachium (figure 1). The central 5 cm
of skin was erythematous, partially ulcerated,
and painful to palpation. No lameness
was noted. Recent CB, serum chemistry,
urinalysis and three view thoracic radiographs
were within normal limits.
After discussing their options and the
potential complications (failure to heal,
rapid regrowth of the mass, neurovascular
complications and anesthetic risks) of
debulking surgery, the clients decided to
go forward with the procedure. Lizzy was
admitted to the hospital for surgery. An
intravenous catheter was placed and she
was started on 5 ml/kg isotonic fluids
presurgically. Standard premedication
with hydromorphone 0.1 mg/kg and midazolam
0.2 mg/kg was given IV, along
with a perioperative dose of cefazolin IV
at 30 mg/kg. Preoxygenation was started
and pulse oximetry and electrocardiographic
monitoring begun prior to induction.
Lizzy was induced with propofol 5 mg/kg IV
to effect, intubated and placed on isoflurane
in oxygen for maintenance. Fluids were
increased to 10 ml/kg/hr. Lizzy was placed
in dorsal recumbency and a hanging limb
prep performed (figure 2). A brachial plexus
block was performed in standard fashion
using 2 mg/kg lidocaine and 0.5 mg/kg
bupivicaine for supplemental analgesia. The
patient was moved into the OR for surgery.
An ovoid skin incision was made around
the base of the mass, preserving grossly
normal medial and lateral skin (figure 3).
Hemorrhage was controlled with electrocautery
and ligation where appropriate. Sharp
Figure 2. Lizzy was placed in dorsal
recumbency and a hanging limb prep
performed.
dissection was used to free the mass from
underlying subcutis and fascia, ligating
larger vessels with 3-0 polyglyconate. The
mass originated from an irregular pedicle
about 3 cm in length starting from the deep
fascia between the extensor carpi radialis
and digital extensor muscle bellies (figure 4).
The pedicle and mass with attached fascia
and skin were removed en bloc and residual
grossly abnormal tissue removed. The area
was lavaged with a liter of warm saline then
gloves and instruments changed. The large
size and weight of the mass had effectively
stretched the surrounding skin to the point
that tension free longitudinal closure could
be performed with undermining alone. The
subcuticular layers were closed using 3-0
Maxon in a simple interrupted pattern. Skin
was closed with 2-0 polypropylene in a
simple continuous pattern. The limb was
placed in a soft padded bandage. The clients
declined submission of the mass for evaluation
of the tumor margins.
Lizzy recovered quickly and uneventfully from
surgery and was discharged to her owners
later that evening with oral pain medications
(tramadol and gabapentin). She was
rechecked at 48 hours, one week, and two
weeks post-operatively. The surgical wound
healed normally and Lizzy did not experience
any complications. Follow-up seven months
post-operatively revealed Lizzy had no gross
evidence of tumor regrowth and was otherwise
normal (figure 5).
Peripheral nerve sheath tumors are masses
arising from nervous tissue; the specific cell
origin is often not identifiable. They have variable
histologic characteristics of malignancy,
but often cause considerable local invasion
and have a low rate of distant metastasis. The
thoracic limbs are more commonly affected
in dogs. If associated proximally with a nerve
root, lameness is characteristic, but when
located more peripherally on the limb, lameness
may not be part of the clinical problem.
When associated with the spinal column,
lameness, muscle atrophy, and significant
neurologic dysfunction are often present.
When associated with a major motor nerve
such as the radial nerve, limb weakness or
dysfunction may be present before or after
resection of the mass.
Treatment consists of resection of the tumor
with wide margins. Amputation is often
required to obtain adequate margins and
due to resection of motor nerves to the limb
along with the tumor, making the limb nonfunctional.
In Lizzy’s case, amputation was
not considered a good option by her owners.
Because the mass was causing no neurologic
dysfunction, was located distally on the limb
below the major nerve trunks, and no metastasis
was detected on presurgical screening,
debulking was considered reasonable to
obtain significant palliation of the disease.
Residual neurovascular dysfunction was
discussed as a potential complication of the
surgery, along with wound healing complications
and aggressive return of the tumor.
These complications and the potential need
for later amputation or euthanasia should
complications be severe, should be discussed
with clients prior to performing palliative
debulking of a peripheral limb tumor.
Lizzy’s procedure was successful for several
reasons. At surgery, no direct association
with a major nerve trunk was found and
forelimb musculature was not invaded, leaving
these structures intact and preserving
her limb function. Similarly, the cephalic
vein and radial and median vasculature was
preserved, allowing for retained circulation to
the surgical site and optimal environment for
healing. The ability to obtain primary closure
of the wound was of
significant benefit;
the skin stretching
effect of the mass
provided grossly
normal skin for closure.
Skin stretching
techniques such
as presuturing for
several days prior to
surgery or creation of
a transposition flap
from brachial skin at
surgery are relatively
simple techniques
that could be
employed to help
create a tension-free
wound closure when
adequate skin is not
available.
In summary, tumor debulking can be
rewarding in select cases and patients
can have a satisfactory tumor-free interval
when more aggressive surgical methods
are not appropriate or desired by the client.
Tumor type, location and patient specifics
should be evaluated together to determine
the likelihood for success, and clients
should be well educated in the risks and
potential pitfalls of the procedure.
We would like to thank Lizzy’s owners
for allowing us to share her story, and the
Veterinary Cancer Referral Center and
Laurelhurst Veterinary Hospital for referral
of this patient. •
Figure 5. Lizzy, seven months post-op.
Suggested Reading:
Kent, M and Northrup, N. Nerve sheath
tumors. In Tobias, KM, Johnston, SA, eds.
Veterinary Surgery: Small Animal Vol 1 pp
547-548. Saunders, 2012
5K run/walk • Street Fair
Entertainment • prizes
NW 19th & Raleigh, Portland
Race starts at 9am
canine
co-pilots
welcome
$30 registration
Benefiting the
DoveLewis Stray Animal
& Wildlife Program
10 VetWrap Volume 7 Issue 2 Spring 2013
ORANGE PANTO
GRAY PANTONE

ten things
veterinary People
appreciate
when we are lucky
enough to get them...
1. Chairs, and sitting at work
in general (NICE)
2. Staff-only bathrooms
(so awesome)
3. Not getting attacked once in
a 24-hour period (rare)
4. Designated lunch time
(almost never)
5. “Regular office hours”
(see above)
6. Management training
(never enough)
7. Wearing jewelry, nice
clothes, and “impractical”
shoes (you know
the ones)
8. Saturdays and Holidays off
(exciting!)
9. Free food (very exciting!)
10. Manicured (or simply
not scratch-and-scabcovered)
hands
Education on demand for
all veterinary professionals.
On the Floor @Dove can help everyone in your
practice be more efficient, skilled and valued. Start
learning with unscripted HD videos, RACE-approved
lectures, articles and blogs featuring practicing
veterinary professionals at DoveLewis Emergency
Animal Hospital.
Sign up for less than $30/month to give your
entire practice access to www.atdove.org.
Are you a PVMA member?
Members receive one month free with annual
membership—contact us to sign up today!
now Offering
FREE CE
Credit
info@atdove.org
1.866.333.3319
Congratulations
Monica Maxwell, SPHR
Portland Business Journal
HR Leadership Award Winner!
Monica’s hard work and dedication to DoveLewis
have proved to be an invaluable combination.
We thank her for her exceptional contributions
to one of Oregon’s Most Admired Nonprofits!
Third Thursday
Grand Rounds
Technician lectures
brought to you
in partnership with
Stray Animal & Wildlife Program
Policy Reminder
FREE! Monthly CE Lecture
DoveLewis invites all doctors and support staff in the
community to attend our Third Thursday Rounds.
Doctors and technicians who attend receive one unit
of CE credit for each meeting. Rounds cover all topics in
veterinary medicine. DVM and technician topics alternate
monthly. A light meal will be served. Rounds are held on the
third Thursday of every month from 7:00PM–8:00PM in the
DoveLewis Community Room, 1945 NW Pettygrove in Portland.
PLEASE NOTE: THERE WILL BE NO THIRD THURSDAY ROUNDS IN OCTOBER
DUE TO THE DOVELEWIS ANNUAL CONFERENCE ON OCTOBER 21.
DVM Lecture
May 16, 2013: “Fever of Unknown Origin”
Erika Loftin, DVM, DACVECC
client Services Lecture
June 20, 2013: “Life at the Front Desk: Surviving
and Thriving on the Fault Line between Front and
Back When the Earthquakes Hit”
Brian Stief, Clinic Operations Manager
Register Online:
dovelewis.org/third-thursday-rounds
or RSVP: James Gabrio at 971.255.5937 or
jgabrio.dovelewis.org, at least two days before the event.
Spring is here —a time when we see an influx in strays and wildlife brought
to our hospital! Here’s a timely reminder of how our program works:
Hundreds of injured strays, lost pets and hurt wild animals come to DoveLewis from county shelters, Good Samaritan citizens,
police officers, and firefighters each year. We also regularly care for injured wildlife when the Audubon Society is closed in the
evening. DoveLewis never turns an injured stray animal away.
We try to find every injured stray’s owner by taking a snapshot of the animal and posting it on our Lost & Found Pet Database
on dovelewis.org, craigslist.org, and county websites. We scan for microchips and make attempts to quickly contact an owner.
If your client is missing a pet, please have them check our Lost & Found Database or have them call us at 503.228.7281.
Program Goals
1. Stabilize all stray animals unless we are unable to alleviate suffering, the animal requires extensive immediate emergency
surgery, or the animal has obvious end-stage disease with no likely owner contact.
2. Work with county organizations, Cat Adoption Team (CAT), and the Oregon Humane Society (OHS).
3. The Stray Animal and Wildlife Fund is a donor-supported community program. It is not uncommon for the cost of emergency
treatment for lost, stray, and wild animals to rise above $200,000 every year. DoveLewis works with all county shelters and
complies with their protocols regarding stray animals. We receive minimal reimbursement for emergency stray care from the
surrounding counties animal control agencies.
Powered by
Read more about the objectives of this program and our other community programs online at:
dovelewis.org/resources-for-veterinarians
12 VetWrap Volume 7 Issue 2 Spring 2013 Spring 2013 Volume 7 Issue 2 VetWrap 13

Figure 1. The rolled towel method can be used on brachycephalic
dogs to limit movement but still allows them to breath.
Tech Corner
Small Dog Handling
Leilani Baker, Technician Assistant
Nothing strikes fear in the hearts of veterinary staff like a
snarling Chihuahua in the lobby. I know many of us would
rather work with a large guard breed than a tiny ferocious one.
However, these small dogs are very popular, so many of them
come into our hospital daily. Here are some tips on how to make
the visit safe for vets, techs, tech assistants, as well as the tiny
canine patients themselves.
If immediate treatment isn’t necessary, take the time to get to
know the patient if he isn’t aggressive. Crouch at his level, face
your body sideways, don’t stare directly and speak in a friendly
and calm tone. Let the patient approach you instead of going
to it. When it’s time to take the patient for treatment, have his
owner walk with you to get the patient moving.
Aggressive dogs can be covered with a thick towel or blanket
and then picked up gently but securely since they can be quite
wiggly. Place them on a firm surface, expose their head if they
are snapping, and have another person put a stiff Elizabethan
collar on while you stop the head from swinging.
The collar must extend long enough past the dog’s muzzle to
avoid the applier’s fingers from being bitten. Elizabethan collars
are sometimes better than muzzles because they allow the dog
to breathe comfortably, are harder for a dog to pull off and still
allow us to visualize the mucous
Many little dogs can
be fine at the start
of the exam but will
bite if they become
uncomfortable with
a certain procedure
or experience minor
discomfort.
membranes. They are also easier
to place on a dog that is muzzle
savvy. Another option is using
a vinyl cat muzzle that covers
the whole head. These muzzles
do a great job of providing an
open airway while covering the
patient’s eyes. This often calms
them since they can’t see our
hands coming at them.
Figure 2. A muzzle will keep a dog calmer and help ensure handler safety.
AVAILABLE AT DOVELEWIS:
Vacuum Assisted
Wound Therapy
Vacuum assisted closure (VAC) is a type of therapy where
fluid is drawn from the wound for faster, more efficient healing.
This technique may be used over closed suture lines as well as
over open wounds (chronic or acute). For open wounds, VAC may
be a means to prepare the wound to close primarily or with a graft.
It may also be used to get a granulation bed healthy enough for
closure on its own. Due to the nature of cases seen at DoveLewis
(trauma and complex wounds) VAC is an advantageous form of
wound therapy management. This form of therapy is regarded as
financially favorable compared to conventional treatments in the
management of challenging wounds.
VAC can be employed for:
• Degloving wounds
• Chronic wounds or wounds in tough to treat locations
• Graft preparation and preservation
• Open fracture with skin defect
Key points regarding VAC wound
therapy at DoveLewis:
• Patients must be hospitalized a minimum of 2-3 days
during VAC wound therapy
• DoveLewis surgeon will always be involved in case
selection and treatment
• VAC is extensively used for dogs but is case dependent for cats
Surgery Team:
Coby Richter, DVM, DACVS
Ashley Magee, DVM, DACVS
Kristin Spring, BS, CVT, VTS
(ECC, Anesthesia), CVPP
Many little dogs can be fine at the start of the exam but will
bite if they become uncomfortable with a certain procedure or
experience minor discomfort. There is nothing wrong with using
a muzzle from the start with these dogs. Oftentimes the muzzle
will keep the dog a little calmer and help ensure handler safety.
Sometimes holding a small dog gently but firmly will suffice.
Do not scruff small dogs since they are not calmed by this
technique and often become more agitated. Simply restraining
them in your arms allows many procedures to be done by the
technician or veterinarian. When doing so, keep their muzzles
away from human faces to avoid being bitten. Also ensure
that their airway remains clear since many small dogs have
collapsing tracheas and some of them are brachycephalic.
Brachycephalic dogs need special consideration because for
them, breathing during regular activity often requires effort.
When they are stressed, such as during a vet visit, breathing
becomes even more difficult—they can actually become
cyanotic and collapse. Muzzles are often impossible to use on
these breeds, because some of them (like a pug) often have no
“muzzle” to place anything on. For these dogs you can roll a
towel lengthwise and place it around their neck. Just the extra
material on their short neck stops them from whirling around and
biting, but they are still able to breathe. Go slowly with stressed
brachycephalic dogs and give them a chance to catch their breath
between treatments.
With small dogs, minimum restraint is better than too much.
These little mites will often struggle to the point of hurting
themselves, or to the point of collapse. If they are becoming too
agitated take a break and give the dog a chance to calm down.
Ask the veterinarian if pharmacological restraint can be used.
See if someone else can switch with you because even excellent
handlers need a break too.
Hopefully these tips will make your next canine, mighty mite
treatment go smoothly! •
Reward Theory
{ Education rewards everyone it touches}
Knowledge you can put into practice
IDEXX Learning Center
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Join Providence at
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Love of Dove”
on June 9!
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you get from someone who’s
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14 VetWrap Volume 7 Issue 2 Spring 2013
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2/28/13 2:12 PM

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Volume 7 Issue 2
Spring 2013
Address Changed?
Want to switch to Email?
Contact James Gabrio
jgabrio@dovelewis.org or 971.255.5937