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Walter Brown, BS, RVTg (right) meets Adam Christman, DVM, MBA, dvm360® chief veterinary officer (left) in an embrace before delivering his keynote address.  

 Conference in Charlotte, North Carolina, veterinary technician Walter Brown, BS, RVTg, took the stage for a lively keynote address on bizarre cases in the emergency room (ER), because according to him, “you never know what you’re going to get.” He shared real-life anecdotes and paired his expert knowledge with humor for an interactive lecture on triaging, stabilizing, and treating these ER patients. 

Here are 2 of the case studies he presented:

In this clinical case, local college fraternity brothers who were at a pool party with their German shorthaired pointer, arrived at the ER. The dog drank a significant amount of saltwater and ingested beef jerky, and Brown discovered it was experiencing saltwater intoxication, or hypernatremia. This consists of increased values outside the sodium reference range which is 140-150 mEq/L for canines and 146-157 mEq/L for felines. With hypernatremia, “Either you have an excess in salt, meaning you ate a lot of things that are salty, or you can have what we call free water loss,” explained Brown. The clinical signs include seizures, comas, potential permanent neurological damage.

Brown said that fluid needs must be taken into consideration when treating hypernatremia patients experiencing shock and/or dehydration. Those with chronic hypernatremia (> 48 hours) must be treated slowly to reduce rapid cell volume expansion which can cause swelling. “Depending on how long this hypernatremia has been going on, you don’t want to lower the sodium too fast. When you lower the sodium too fast, you have these neurological damages.” Sodium levels should be corrected slowly at a rate of 0.5 to 1 mEq/L/hr.

The formula to calculate free water deficits = ([current [Na]p ÷ target [Na]p] – 1) x (0.6 x body weight in kg). "This is the amount of water you want to replace to the patient. And this allows you to lower that sodium level to where it needs to be,” said Brown. He added that water may be supplemented intravenously (as D5W) or orally on an hourly basis for alert patients. Free water replacement by itself will not correct dehydration or hypovolemia as free water replacement does not have the sodium required for this. Most patients are supplemented with 0.9% NaCl intravenous fluids.

Case #2: Anticoagulant Rodenticide Toxicity

Three southern ladies came to the ER that suspected their 3 Rat Terriers ingested rat poison. The dogs were involved in a barn hunt game and succeeded at getting into the poisoning, rather than finding the rats, suffering from anticoagulant rodenticide toxicity. This can result in secondary coagulopathies by depleting coagulation factors II, VII, IX and X (Vitamin-K dependent factors). The clinical signs include lung and body cavity bleeding (though bleeding in other areas can be seen), and there also may be areas of petechia and ecchymosis. Brown shared, “A lot of times owners don’t know until 2 or 3 days after when they start seeing these clinical signs.”

To treat anticoagulant rodenticide toxicity, if the ingestion is known with 4 hours and no contraindications, emesis can be induced. “I often don't suggest owners to do hydrogen peroxide, unless they are safe to do it, and I've seen a lot of owners do hydrogen peroxide and [it] causes [the dog] to aspirate and then we have more problems.” At the clinic, these treatments can be used for emesis at the following levels: apomorphine: 0.03mg/kg IV or 0.04mg/kg IM (dogs); 3% hydrogen peroxide: 1 to 2 ml/kg PO (dogs); xylazine: 0.44mg/kg IM or SC (cats).

Additionally, activated charcoal (1-4g/kg PO) should be administered to absorb remaining rodenticide. It is most effective within an hour of ingestion. It can be paired with can foods so patients are inclined to consume it. Sodium sulfate (250mg/kg in dog and cats) or 70% sorbitol solution (1-2ml/kg) can be administered via cathartic.

Forty-eight hours after ingestion, a Prothrombin Time (PT) should be accessed for all patients if no vitamin K has been received. “The PT measures the extrinsic coagulation pathway and includes factor VII which has the shortest half-life, this means the PT will be prolonged before the activated partial thromboplastin time (aPTT) and before the development of clinical signs,” said Brown.

After 48 hours, if the PT is prolonged with no clinical signs of bleeding, the patient should be started on oral vitamin K for a 4-week period and monitored for signs of secondary bleeding. A PT should be rechecked 48 hours following the last dose of vitamin K. If the PT is still prolonged, vitamin K should be supplemented for another 2 weeks with a follow up PT, according to Brown. 

Brown W. Oh hell to the no! Bizarre cases in the ER! Presented at Fetch dvm360

 conference; Charlotte, North Carolina. March 24-26, 2023.

Articles

Fetch Charlotte keynote speaker Walter Brown, BS, RVTg, highlights interesting ER case studies from a veterinary technician perspective 

Not-so-ordinary ER cases you should know 

According to Fetch Charlotte faculty member Kate Boatright, VMD, it's most important to remain non-judgmental when discussing finances with clients. In this 

interview, she provides further advice on this subject she covered at her lecture. 

The following is a partial transcript of the video.

: I often will ask clients early in the conversation, if they've expressed some financial concerns, I'll say, "What's your budget today?" Because for me, I don't care if you [have] $200 or $2,000. But I do care if I spend all your money on diagnostics and have nothing left to treat your pet with.

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In this dvm360® interview, Kate Boatright, VMD, shares expert insight on how to compassionately broach this topic

How to discuss finances with clients

 interview, Fetch Charlotte faculty member Laura Gaylord, DVM, DACVIM (Nutrition), owner/founder of Whole Pet Provisions, PLLC, presents insight into why the incidence of copper storage-related hepatopathies has increased in recent years. She also shares how the Association of American Feed Control Officials is addressing this concern. 

: There also was a change in the types of supplements that were put in pet foods going back about 15, 20 years ago, I believe. And that has made a copper source that's very highly bioavailable in pet foods compared to what was used prior to that. Another concern is ingredients, maybe the ingredients we're using going into pet foods have more copper than we thought.

In this interview, Fetch Charlotte faculty member Dr Laura Gaylord sheds light on this hot topic that was the focus of her lecture

An update on copper concerns in pet foods

Jan Bellows, DVM, DAVDC, DABVP, FAVD, for his keynote presentation at the Fetch Charlotte Conference.

Jan Bellows, DVM, DAVDC, DABVP, FAVD, has been specializing in veterinary dentistry for almost 50 years, but for those who are not as confident, Bellows shared his top hacks for simplifying dental cases for any veterinary professional. In his keynote presentation at the Fetch 

 conference in Charlotte, North Carolina, sponsored by Basepaws, Bellows presented in alphabetical style with tips that start with the letter A, all the way to Z.

Here’s a highlight of some points Bellows made in his keynote:

Do not waste time with finger toothbrushes.

Bellows said, “The 2 wipes that I recommend are the Oral Cleansing Wipes by Addison Biologics and the Vetradent wipes.” Successfully brushing a pet’s teeth is a struggle for many clients and Bellows recognizes this struggle. He stated, “Tooth brushing is a great idea. It's the gold standard, but virtually no one can pull it off.” Bellows also mentions that most of the time tooth brushing is not a Fear Free experience for the pet. Dental wipes offer a gentler experience and Bellows recommends giving a high value treat afterwards.

Bellows stated that rubber toothbrushes that fit on your finger are a waste of time for dental health. “All you are doing is pushing the plaque around and not removing any plaque. So don't waste your time on this.”

Bellows stated that he uses ventilators for every procedure and that they are particularly helpful for the anesthesia portion of the procedure. He recommends using the Digicare Animal Health ventilators.

“Vet methadone is for animals that you got to do painful procedures, if you are going to take out teeth, it’s fabulous. They go down so easily they come up, and it really helps them with pain.” After using methadone, Bellows advises attendees that close monitoring must follow. Adverse events usually happen in the cage after a procedure, so it is important to monitor the patient during this time.

Check out all of Dr Jan Bellows’ tips in select print issues of our 

Jan Bellows, DVM, DAVDC, DABVP, FAVD, shared tips for making any dentistry case easier with hacks presented in alphabetical style at the Fetch Charlotte conference

Dental hacks to make every case more manageable

Walter Brown, RVTg, VTS, ECC, believes that his first love was veterinary medicine. After growing up around animals, Brown expressed a passion for veterinary medicine, which his mother encouraged. However, after entering a rebellious phase in his life he put veterinary medicine on the back burner to pursue a different career. Once he rediscovered his love for veterinary medicine and learned about the different career opportunities, Brown began his career as a veterinary technician.

To learn more about Brown, the future of his career, and his upcoming keynote address, check out his Q&A style interview with 

What inspired you to become a technician?

The biggest thing that inspired me to become a veterinary technician is at a young age being surrounded by so many animals. My grandmother lived on a large property and she would have a number of different hunting dogs in the area that would be dropped off to our house. She had a ton of cats, chickens, cows, and just being there as a kid and being around these different animals, I think is what grew my love for veterinary medicine. Like all kids, I want to be a veterinarian and my mother really pushed me hard to be a veterinarian and as a kid, right, being pushed by your mom, what's the next thing you do? Rebel.

I was in [my college] band [and] I was in the movie 

. During that process, [my college] lost their accreditation so I had to follow my second love, which again, was always my first love. I was just a rebellious person as a teenager. Going into veterinary medicine, I learned that there were different avenues of veterinary medicine and what sparked my interest the most was Veterinary Technology, and I followed that career path up until college where I had an opportunity to become a veterinary technician or go to veterinary school and I chose to be a veterinary technician.

What will you be discussing in your keynote?

We're actually going to do something a little fun for the keynote address, without giving too much away. I think for a lot of time, this year or for the past couple of years, we focused a lot on burnout, passion, compassion, fatigue, wellbeing, and I think we did a great job of addressing all of those different things [in] 2020, 2021, and 2022, during the pandemic, which was definitely needed.

I would like to focus more on educating and moving to the veterinary technician needle. So I thought it'd be cool to actually go over some cool cases that I've seen in the ER that really happened and kind of go through those cases and explain to the veterinary technicians and even the veterinarians that will be in the room our role as veterinary technicians and kind of give them a quick down and dirty to these different cases, why it happened, what it what makes sense about it, how we treat it and just kind of go through it really, really quickly. I think it'd be fun just going through cases and getting some education about veterinary medicine. I like to have fun with different lectures or whatnot.

What does being a keynote speaker mean to you?

Oh, man I'll be honest with you when I got the word, it was one of those AHA moments of like, wait, this is happening, and it was really one of the greatest things that happened. I think it really meant the most to me coming from the 

 crew because I remember when I received my first message from [Dr Adam Chrisman] and it was like ‘hey, love what you do. Thank you for being an advocate’ and it was like, wow, like this is a major conference and major group of people reaching out. People who know me, the comedy that I do or whatnot, all my veterinary technician family will tell you the one thing about Walter [is he] keeps it honest and he's going to tell it like it is kind of deal but also be genuine with it.

For the veterinary technician family to support me, the 

 family, and all the veterinary technicians that follow the Fetch conference because it was amazing the last conference I did, the rooms were packed, and it was just an amazing feeling. So, to have so many veterinary technicians rooting for me and being a part of this and having 

, who kind of gave me my start, be the next group of folks to say ‘hey you’re the next keynote speaker’, it just means a lot to me. I just want to tell you all thank you and I can't wait to have a great time and party hard with the veterinary technician family in Charlotte.

Is there something that you are looking forward to as your career advances?

I think what I look forward to is passing the baton. If there's one thing I would like everyone to know is we get caught up in veterinary medicine being a marathon of different things that we're trying to achieve, whether it's moving the industry forward, veterinary technicians trying to get better pay, recognition, helping with burnout, getting over to burnout, you know, and we've looked at this thing as a marathon and we can't look at it that way, or we're gonna burn ourselves out. It's a relay race and we got to know when to pass the baton.

I tell technicians all the time, Walter won't be here, skinnigolive won’t be here all day but I want to make sure I inspire someone where I can pass you the baton to do that. I encourage them and get on your TikTok, be funny, get on Facebook [because] you never know when it's your time to break out. I want to make sure I pass the baton, whether it's educational, whether it's inspiring them to be [a] social media content creator, whatever it may be, to inspire them to be the next person up. I'm here for that.

Meet our day 3 keynote speaker Walter Brown, RVTg, VTS, ECC

Q&A with a keynote: Walter Brown, RVTg, VTS, ECC 

 readers! For those who are currently enjoying all the learning at Fetch Charlotte, we hope you are having a fun and education time. For those not in Charlotte, do not worry because throughout the weekend, we will be sharing our conference coverage here at dvm360.com!

As we prepare our conference coverage, here is what was popular this week on dvm360.com:

 is excited to share that our very first continuing education 

 of The Vet Blast Podcast is now available! Thanks to our friends at Elanco, Adam Christman, DVM, MBA, sat down with Susan E. Little, DVM, PhD, DACVM (Parasitology) to talk all this tapeworm. 

 this week that its 3-month-year old Andean bear twin cubs have ventured out from their hidden den to meet guests at the zoo for the first time since they were born in December 2022.

 by the DEA is warning the public about the trafficking of fentanyl mixed with FDA-approved veterinary sedative xylazine, creating a higher risk of users suffering from a fatal drug poisoning.

, Natalie Marks, DVM, CVJ, president at Marks DVM Consulting, gave a little inside look at her upcoming lecture at this weekend’s Fetch Charlotte Conference.

The American College of Veterinary Ophthalmologist officially 

 registration for the 14th annual National Service Animal Eye Exam Event. The event will take place throughout May in nearly 200 cities across the United States Canada, Puerto Rico, and Hong Kong.

? You are in luck because we just launched the dvm360 TikTok account! You can check out our account 

 for laughs and lessons on all things veterinary medicine.

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