Hyperthyroidism is the most prevalent feline endocrine disease, affecting about 10% of cats age 10 or older.

 It’s caused by a functional tumor of one or both thyroid glands that ignores the body’s regulatory mechanisms and produces excessive amounts of thyroid hormone. Most feline thyroid tumors are benign, but about 2% can be malignant.

Clinical signs include increased drinking, urination and appetite (polydipsia, polyuria and polyphagia, respectively), along with weight loss. Vomiting, diarrhea and behavioral changes (e.g. increased vocalization) can also occur.

Diagnosis is based on blood testing (baseline total thyroxine and sometimes free thyroxine) and consistent clinical signs. Treatment options include radioiodine, which is considered the treatment of choice,

 and surgical removal of the thyroid gland(s). Both are curative but involve significant up-front costs, so some owners opt for medication (methimazole) or a therapeutic diet, which can manage the problem but isn’t curative.

The good news? Most cats respond favorably to treatment. The not-so-good news? Clinical signs of hyperthyroidism resemble those of kidney disease, diabetes mellitus and even cancer, so early detection isn’t always straightforward. But veterinary technicians can play an important role at every step of the process, from diagnosis to long-term management.

Signs of hyperthyroidism are easily misinterpreted or missed completely. A pet owner whose senior cat starts drinking from water faucets may not realize this could indicate polydipsia. And a cat that suddenly eats voraciously may be dismissed as having a “healthy appetite.” 

Including thyroid hormone level testing as part of routine wellness screens in senior cats can increase the chances of early detection and prompt treatment. Also, when a middle-aged to senior cat is being examined, an astute veterinary technician can ask the right questions to help determine if the cat is showing subtle disease signs.

Owners who opt for medication may dread the idea of giving their cat a pill every day for life. Fortunately, veterinary technicians often have tried-and-true methods for medicating cats, and some of these easily translate to home care.

When all else fails, veterinary technicians can recommend other dosing options, such as transdermal formulations, compounded liquids and flavored chews. Technicians should recognize common side effects of methimazole (e.g. vomiting, anorexia, lethargy), so clients can be advised if issues arise. Technicians can also help clients navigate their cat’s transition to a prescription diet.

Technicians can spearhead client communications by following up after office visits or medication dosing adjustments, or fielding phone calls when owners have questions.

Hypertension and hyperthyroidism tend to target the same population of cats—middle aged to seniors.

 Blood pressure monitoring in at-risk cats is an excellent way to catch the condition early, before damage to organs, such as the eyes and kidneys, can occur.

Because cats with hyperthyroidism are considered at risk for hypertension, the American Association of Feline Practitioners recommends checking blood pressure during office visits for cats with hyperthyroidism.

Several portable devices are available for measuring indirect blood pressure in cats. It’s helpful to become familiar with the equipment at your practice, including how to use, maintain and calibrate the device.

Recheck exams aren’t just for drawing blood to recheck thyroid levels. These visits are an excellent opportunity to monitor weight gain, assess body condition score, and question the owner about improvements in drinking, urination and other disease signs.

Dr. Todd-Jenkins received her VMD degree from the University of Pennsylvania School of Veterinary Medicine. She is a medical writer and has remained in clinical practice for over 20 years. She is a member of the American Medical Writers Association and One Health Initiative.

Norsworthy GD, Carney HC, Ward CR. 2016 AAFP guidelines for the management of feline hyperthyroidism. 

Acierno MJ, Brown S, Coleman AE, et al. ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. 

Taylor SS, Sparkes AH, Briscoe K, et al. ISFM consensus guidelines on the diagnosis and management of hypertension in cats. 

Articles


It sure is, and here’s how veterinary technicians can play their part.


Is managing feline hyperthyroidism a team sport?

Whether you’re employed in a veterinary practice you’ve soured on, are relocating to a new town or are new to the industry, Tasha McNerney, CVT, CVPP, VTS (anesthesia/analgesia), and Tosha Zimmerman, CVT, shared advice for veterinary technicians at a recent 

“Acing the interview starts with the resume,” Zimmerman said. Make sure yours is succinct—one page, folks: “I’m advocating for one page,” McNerney said. "That’s it."

And double-check that your formatting looks OK. Some websites will give you an option to build your resume there (Indeed, for instance), but don’t trust the system to make it look good. Create, preview and then upload your resume on your computer, Zimmerman says; that way you can be sure it came out right.

Do you have an inappropriate name in your email address that you created when you were 15? It’s time to make a professional one.

“People are going to look at that,” Zimmerman warned—and judge accordingly.

 (how about at least 10 minutes?), and be on your best behavior from the time you’re in the door until you leave.

, said McNerney. No scrubs, unless you ask if it’s OK. “And please don’t wear your yoga pants,” she deadpanned. “Definitely no workout gear.”

Questions are a two-way street, of course. 

—and observe enough in a working interview or observation—to know whether the people you meet are the kind of people with the values you want in your workplace.

“Ask to speak to the staff,” Zimmerman said, and pepper them with questions about the practice and its culture. “’How late do you stay every day?’ ‘Why do you like working here?’ ‘Do you do team-building?’”

“You want to enjoy the time you're at work,” McNerney said. So, keep in mind that you're evaluating them as much as they're evaluating you.

Two veterinary technicians offer advice to fellow technicians who are looking for their next great job.

How to ace a veterinary technician job interview

Being a surgical nurse in a small animal practice is much more than the technical aspects of the job. It also involves caring for patients, clients, surgeons, teammates and yourself. Our surgical patients are usually pets that we have been caring for already and know well. You don’t connect only with your patients. Just as often, you connect with their owners to provide reassurance, sympathy, familiarity and confidence that their pet is receiving the best possible care.

But not every procedure is routine, and you can’t guarantee there won’t be risks with the various types of surgeries performed. With orthopedic surgery, for example, the primary concern is the weeks of at-home postoperative care and how the clients will adjust their daily life around their pet’s recovery. For emergency surgeries, where emotions often run high, detail and precision are imperative. Life-altering procedures, such as amputations or enucleations, also involve elevated emotions as well as concerns that must be addressed regarding the patient’s physical disability.

Then there are the technical aspects and making sure all the boxes have been 

 before surgery can proceed, from the exam and bloodwork to scheduling the day’s procedures, and on and on.

Before surgery, you need to ask yourself many questions: Is the right patient going under for the right surgery? Has the best anesthetic protocol for 

 individual patient been formulated? Is the patient is properly prepped for the procedure? Are the proper surgical supplies sterile and ready? Do you have all the supplies the doctor may want or need? Is the table set to the right height? Are the lights placed in the doctor’s preferred position?

During surgery, you must keep your patient at the safest and best anesthetic depth while paying close attention to your surgeon’s needs. If applicable, you must make sure you mark the right specimen to the right patient, and then send the right specimen to the right lab for the right test.

After the procedure, you must also ensure that the patients’ pain is being managed to the best of your ability. One of the primary concerns of a surgical nurse should be ensuring that you are providing the best possible pain management. Proper pain management is not only important for the patient during and directly after the procedure, but it’s equally important for the owner to feel their pet is pain free during recovery.

When the surgery is complete and the patient has recovered, you then reunite animal and owner. When all the stars align, the patient walks out sleepy but comfortable and the owner’s worries start to melt away. Not every day ends so nicely, of course, or even starts nicely. There are days when nothing goes as planned, or for whatever reason you or a coworker is having an off day. This profession is an emotional rollercoaster. As a surgical nurse, you are everything, and the only way to be everything is to have an amazing team of people you trust to support you and keep you smiling, and who enjoy all gross things you’re not allowed to talk about at the dinner table.

Ms. Bowdish is a surgery technician at Upper Arlington Veterinary Hospital in Upper Arlington, Ohio.

There are a million things to keep track of in this fast-paced position—all while keeping your patients alive and comfortable. 

Thoughts from a small animal surgical nurse

Editor's Note: dvm360.com and Firstline magazine asked practice manager Emily Shiver to answer your questions about life in practice for managers, technicians, assistants, client service representatives and more. Got a question for Emily? Email us at 

Veterinary teams are all feeling stress, anxiety and uncertainty on a daily basis. You have likely changed your entire work flow, including your team’s schedules. We are all feeling exhausted, scared and skeptical about the future. Here are 10 things you can do to help your team feel appreciated during these tumultuous times:

You may have seen this game circulating through social media. Download or create curbside bingo cards for your practice team, and offer prizes to the winners.

Provide breakfast, lunch or yummy treats for the team. Local restaurants and bakeries will surely appreciate the orders!

Have meetings at the beginning and end of each shift, and always ask for feedback. Your team has great ideas—use them!

Schedule meditation or yoga sessions. I bet some of you let out a chuckle just now, but I do this with my team and it is palpable when we don’t have our meditation session at lunch time to help us mentally prepare for the afternoon.

Set revenue goals and offer cash or gift card bonuses when those goals are reached.

Organize an ongoing potluck. Working seven days on and seven days off, our team has been pairing up and cooking lunch and dessert for one another. This has eliminated the stress for team members around having to bring or pick up their own lunch every day.

Write thank-you notes and place them around the practice for a nice surprise.

After a long day, don’t forget to tell your team “thank you”—use communication platforms like 

Give the gift of time. On the other side of this pandemic, award those who weathered the storm with an additional PTO day to use at their leisure.

Plan an “after-party” once all of this is over.

The sky is the limit when it comes to showing appreciation to your team, whose lives have literally been turned upside down over the past several weeks. Don’t forget to utilize your drug representatives to help you with some of these ideas, as many of them would be more than happy to send your team lunch or help you organize a prize for the bingo winner. Take care of your team, and they will take care of you!

Emily Shiver, CVPM, CCFP, is practice manager at Cleveland Heights Animal Hospital in Lakeland, Florida

Here are 10 ways to show your veterinary team how grateful you are for their hard work and dedication during the COVID-19 crisis.

Ask Emily: How can I help my team feel appreciated during the pandemic?

Stepping into the role of veterinary practice manager can be overwhelming. You’re suddenly responsible not only for yourself, but for a whole team of individuals. You’re likely trying to improve processes at the same time as you need to put out the normal fires that come with the territory. Your to-do list can seem unsurmountable, and you may feel obligated to work insane hours just to keep up.

When I was a new manager, I remember trying to do everything I could to keep my head above water. I wanted to prove myself. I often stayed late and woke up in the middle of the night to send a few emails—the job was on my mind most of the time. As you can imagine, this was not sustainable, and I started feeling burned out and needed to make some changes. Part of that change was prioritizing and letting go of nonurgent items—basic time management and self-preservation tactics.

Prioritization was clearly Step 1. There were certain items that couldn’t wait; upset clients were high on the list, along with technical systems issues. However, the items that came across my desk as urgent when they should have been addressed much earlier (for example, a tardy employee who’d been coming in late for several months and now needed an emergency performance improvement plan) could wait 24 to 48 hours. Part of this was helping the managers I oversaw. It was important that they understood what was and wasn’t urgent so they could better manage their own time and know when to involve me as well.

The next, and one of the hardest, tasks was to stop being tethered to my email and phone. At first, if I received a call from one of our doctors or saw a new email in my inbox, I stopped what I was doing and addressed it right then. Constantly diverting your attention elsewhere creates a significant decrease in your efficiency. It can feel like you’re on top of everything at all times, but you’re actually wasting huge chunks of your day refocusing. Also, when you can dive into a task with your full attention until it’s completed, you produce higher-quality work. The type of mindset it takes to audit medical records is completely different than the frame of mind needed to address employee relations issues. The longer you’re in one headspace, solving similar problems, the better you perform.

Setting reasonable goals was (and still is) a struggle. Being smart with your time also means knowing what can and cannot reasonably be accomplished in a day. I started a habit on Mondays to roughly set up my plan for the week. Each day, toward the end of the day, I would reassess the next day’s plan and adjust as needed. Everyone works at a different pace, but try to figure out how many “large” projects you can take on in a day, how much time you need to spend on catching up on emails, and how many smaller tasks you need to accomplish. It’s always wise to leave an hour or so for the unexpected as well.

I also began to realize that I was my own toughest critic. My own expectation of my output was far beyond what my organization expected. You want to wow your employer, but don’t do it at the expense of your own sanity.

4. Work on the toughest stuff when you have the most energy

When organizing tasks for the day, remember that everyone has a certain time of day where they’re most productive. Use this time to accomplish your least favorite tasks. For a lot of managers, these are the employee check-ins and reviews, the most important part of your responsibilities as a leader. Make sure to knock these out when you’re most energized, then you can take on the “easier” tasks when your mind is slowing down during the day.

New managers have a tendency to try to take on the world themselves without asking for help. Delegation, when done appropriately, can actually enrich your team’s abilities and add a sense of self-worth and responsibility for each employee. Employees want to feel helpful and want to be given higher-level tasks, and delegation can be key in accomplishing this. It’s important to find tasks that match the skillset and interests of each individual and to hand off tasks with trust (don’t hover), then check in periodically to see if they need your help. If mistakes occur, address them as they arise versus watching every move just in case an error happens. If you hover, your employees will feel mistrusted, and because you can’t be in all places at all times, the quality of everyone’s work is likely to suffer.

Lastly, but most importantly, give yourself time to reenergize—and encourage these healthy behaviors in your team as well. Part of managing your time is giving yourself mental breaks throughout the workday, in the evenings and on days off. Completely disconnecting mentally from work helps to recharge and keep alive that passion for your work. Take advantage of your paid time off and use this time to enjoy non-work-related hobbies and take care of your body—mentally and physically.

And don’t let me forget—congratulations, new manager. Your bosses clearly think you have what it takes to be a leader in your practice. Hopefully, these tips can help you work more purposefully, more efficiently and more happily.

Oriana Scislowicz, LVT, CCFP, PHR, SHRM-SCP, was a veterinary practice manager for many years before becoming senior HR specialist at Pharmaceutical Product Development.

Have you been promoted to veterinary practice manager? Once upon a time, I was in your shoes too. Here’s what I learned along the way that might help you as you step into your new role.

New managers: 6 tips for a great start

Loads of us practice managers are stuck in our ways. We're not breaking our habits year to year as part of the annual resolution package we outline for ourselves. We've followed the same old protocols for ages, doing things, for the most part, because we think they work just fine. These processes might work, but rarely do they work 

. (If they did, would you still be reading this?)

So why not spice your processes up? Why not try something new that could turn things around, enhance the customer experience and increase profits, all while making you feel like you crossed something off your New Year's list?

If you want to start fresh, do it with new clients. For starters, they've never seen your old ways. This puts you in the driver's seat for a new path to success. They are also a great audience for excitement.

Our practice is thrilled to have been in business for 40 years this year, but we try not to let age lead to comfort. We make a point to extend a great handshake to new customers, joining them on the other side of our front desk to greet their pets with enthusiasm and respect. This way we present as a young and spirited team but maintain the endurance of an old, wise one. Walking clients to their car, assisting with their pet's carrier or simply engaging in conversation is another delightful way to show them that you value their presence at your practice.

I recently took a flight home from Orlando on a “discount” airline. While I wasn't expecting much, I disembarked the flight rather impressed. One particular flight attendant seemed excited to see my 3-year-old son board the plane and went out of her way to ensure his comfort during the whole flight, checking in from time to time. This set them apart from other less friendly flights I‘ve been on in the last few years. When it comes to veterinary clients, I truly think most of them don't expect much of us. In their eyes, we're in the medical industry, but if my trip to Disney World showed me anything, that's not entirely true. We're in the 

 industry because we have direct contact with our clients, personally handling the issues they encounter and doing our best to make them right. It's just what that famous mouse does, except his “issue” is trying to deliver the most bang for your buck.

If you step back and look at your day-to-day routine, it's easy to see why a lot of us fail at our missions to have great veterinary practices. We commonly don't put our focus on what matters, forgetting that the pot at the end of the rainbow is those people on the other side of our front desks. A client recently told me that she was sick of her old veterinary clinic because she felt like a problem to them. A 

 I explained to her that when we are offered the opportunity to serve our customers, they become a part of our family. She said she ended up at our clinic because she saw the word “family” so many times in our online reviews. She read about how people had brought multiple pets over the decades to our practice because they felt like family.

So, if you want people in your clan, make every attempt to be as personal as possible (without being weird). Bend down to greet their children, quietly offering the parents a snack or an age-appropriate book (dollar stores have great, cheap options). While you're at it, learn that child's name and put it in the notes section of your management software with a brief description (little girl, dark hair, named Lyla). The next time you see the family, I assure you her mother will feel so special when you remember her daughter's name and ask her about her favorite color 

Another approach is to call a few days after a pet's visit and ask the owner if they had any questions they forgot to ask during their time with your team. You wouldn't believe how many people truly do have a question but felt like they would be annoying if they called. Email is also an easy way to accomplish this.

Try new little things all the time and see what works. Not every big thing has to cost big money. In fact, like the old saying goes, the best things in life are free. But, don't worry-they'll make you money in the long run!

Brent Dickinson is practice manager at Dickinson-McNeill Veterinary Clinic in Chesterfield, New Jersey.

How to make new veterinary clients happy and break out of your old habits all in one go.

Make your practice the happiest place on earth

It feels like service dogs, emotional support animlas (ESAs) and therapy dogs are everywhere you look these days. You see them in airplane cabins, in restaurants and in condos known for their strict “No Dogs Allowed!” policies. They're wearing little vests or tags to indicate their "helper" status.

Two questions spring to mind. First, are these animals really helping their owners and, second, what's the difference between these designations?

Let's tackle the first question first: Are they helping? Of course they are-in many ways. Dogs especially are incredibly versatile creatures. They can locate an escaped prisoner in the woods, guide a vision-impaired individual around a busy city, calm an individual in the throes of a severe panic attack and even 

. They can do all of this with a whimsical wag of their tail and an adorable cock of their head, causing us to fall head over heels in love with them.

Throughout history, dogs have been trained for important tasks as messengers, mine sweepers, scouts and sentries. They've protected households, helped hunt for food, warmed the beds of their owners (a “three-dog night” is a cold one!) and even served as flea traps to keep the pests off their noble owners (gross, right?). They have long been valued for the services they provide, and their usefulness continues today.

Many research articles demonstrate the health benefits of animals. One 

, published in 2003, found that when people pet dogs, both the animal and the person experience decreased blood pressure and increased oxytocin, endorphin and dopamine levels.

From the companion animal who greets a beloved owner at the door after a long day at work (or a 10-minute trip to the grocery store), to the emotional support animal prescribed by a mental health professional, to the service animal trained to provide a specific task for a person with a disability, dogs fulfill myriad duties for their owners. However, each of these groups is afforded different rights and has different responsibilities within the world of humans.

Every veterinary professional should have a clear understanding of the differences among these designations so they can guide and educate their clients.

 are pets. They're wonderful and live in the homes of lucky individuals in areas where they're allowed. They encourage activity via 

. They connect people in the community during outdoor activities. But companion dogs are generally not allowed inside businesses, and many apartment complexes and school dormitories ban pets altogether. And while many pet owners prefer calm, well-behaved companion animals, this is not a requirement-people can choose to own animals that are on the aggressive side (working with a veterinary behaviorist is recommended).

Therapy dogs (and other animls) used in animal-assisted interventions-such as being present during counseling sessions-must be well mannered, approachable by many kinds of people and able to be touched. They must be older than 1 year, free of parasites and used in goal-oriented, planned and structured interventions. These animals have neither the ADA rights afforded to service animals nor the public access or housing rights granted to ESAs. Animal-assisted interventions must be provided by licensed professionals.

 provide therapeutic support to people with a diagnosed mental illness such as anxiety, depression or post-traumatic stress disorder. These animals must be prescribed by a licensed mental health professional, and the prescription must state that 1) the individual has an impairment that substantially limits one or more major life activities and 2) the presence of the animal is necessary for the individual's mental health. These animals are present for the comfort of the owner and do not require any special training. The animal just needs to meet the needs of its individual owner.

ESAs do have more rights than companion animals but not as many as service animals, according to the Americans With Disabilities Act (ADA). ESAs are permitted with their owners in public areas with the permission of the venue. They may also fly with their owners in an airplane cabin. As written in the Fair Housing Amendments Act (FHAA), ESAs are permitted in housing regardless of the housing's pet policy. 

 are the other major group of helper animals. These dogs are selected for temperament and highly trained to meet the needs of an individual with a specified physical, sensory, psychiatric, intellectual or other mental disability. Training can take years to complete and cost upwards of $35,000. Service dogs are protected by Title II and III of the ADA and must comply with standards set by Assistance Dogs International, which include stringent testing requirements. These dogs are not to be touched when they are working (you've seen the warnings on their vests) and must be left to do their jobs. An enormous amount of time, training and bonding must be devoted to making a human-dog team work well together well.

These important designations are damaged when people try to manipulate them for their own purposes. Unfortunately, ESAs aren't well regulated at this time, and letters can be purchased online without the prerequisite mental health diagnosis, which can cause problems. Consider, for example, a dog owner who is moving into a new apartment with a no-pets policy who purchases a letter online for a couple hundred dollars to make his dog an ESA and thus able to live in the new place. When pet owners purchase letters like these for the sole purpose of being able to “take their dog anywhere” as a “service animal”-without understanding the ESA designation-they're misrepresenting the the "service" title and muddying the waters for those who legitimately need ESAs. 

It is incumbent on veterinarians and veterinary technicians to understand these designations and educate clients on this topic. If clients ever hint that they're going to order an ESA patch for their pet, ask them why. Offer to assist them in locating a licensed professional counselor who can perform a proper diagnostic exam to assess for need. If they insist that they don't need to see a mental health professional, then tell them the ESA designation doesn't apply to them.

Dogs are remarkable and provide for the needs of humans in a multitude of ways, especially as service dogs, emotional support animals and, yes, as pets at home. But making sure everyone understands the differences between these is crucial for the safety of all of us in the public sphere.

After 10 years working in the veterinary field as a veterinary assistant and trainer, Julie felt the call back to school to complete her education. Now, she's a professional counselor passionate about helping individuals and families achieve healthy functioning and is convinced that animals should be a part of that journey. Julie observed the power of the human-animal bond while in the veterinary field and has further witnessed the power of the presence of her own dog, Ed, in the counseling sessions she conducts.

Pets, emotional support animals (ESAs) and service animals have very different rights and responsibilities in veterinary clients lives. Take advantage of your opportunities to gently but firmly educate pet owners on what designations are appropriate for which animals and why its important not to blur the lines between them.

Cheat sheet: Service dogs, ESAs and pets

You walk into the treatment area after lunch, and the team is talking: “I can't believe he got a puppy! He's being hauled everywhere by that thing already. What was he thinking?” You keep walking and peek into the exam room window. Mr. Jones got a new chocolate lab puppy. You're not sure how old Mr. Jones is, but you think at least mid-70s. You know he isn't steady on his feet, and you remember more than one occasion on which you helped load him and his elderly dog into his old Ford truck. “Thank you kindly,” he would say with a smile. “We aren't as young as we used to be.”

‘Thank you for being with me today. With me and Joe.'

You're very fond of Mr. Jones. He's been coming into your clinic for as long as you can remember with his chocolate lab “Joe.” They'd became fixtures for a while, because Joe was coming in for cold laser therapy to help his aching hips when the anti-inflammatory medication Mr. Jones was faithfully giving just wasn't cutting it anymore.

“Neither of us move that well anymore,” Mr. Jones commented, rising slowly to take the leash from your hand after what would be the last treatment. “Can I get some of that laser therapy?” His eyes sparkled, and he laughed like it was the first-rather than the fifth-time he told you that joke. You remember the sadness that suddenly came over his face as he continued, “I think it's just about time.”

You were the technician assigned to help with Joe's euthanasia procedure. After completing the requisite paperwork, you looked up at Mr. Jones, his eyes welling with tears.

“Thank you for being with me today. With me and Joe,” he said. “My Ruthie-remember her?-she passed away last year. I think she'd be glad you're here with me. I know Joe is. Go see Ruthie, Joe, give her a kiss for me.”

Mr. Jones left your office wiping his face with a worn handkerchief. He asked to hug you goodbye before he left. You thought he'd never let go.

Mr. Jones' new puppy barks happily, and you're snapped back to reality. He smiles at you through the door and motions for you to come in.

“I'm so glad you're here! Meet Mr. Little Bit!” As you sit and talk to your elder-statesman client, you find out his house was just too quiet so he'd taken to going to the park for walks alone. “But no one spoke to me when I walked by myself like they did when old Joe was around. It was like I was invisible.”

He longed for interaction, he says, so he got Mr. Little Bit. Your heart melts as you listen. You can't fault his reasoning. He needed connection. He was lonely.

While Mr. Jones is fictional, I had a conversation like this with a client recently. He had a lab and replaced it with a labradoodle to deal with the excruciating loneliness he experienced daily in the time between the passing of his old companion and bringing home his new one. The problem was, he couldn't handle the new dog. I bet you've seen similar situations play out in your clinic.

People need connection, and our companion animals can meet many of those needs. As Mr. Jones stated, people were more willing to interact with him when he had a dog. People with pets are also more active, which keeps pet owners healthier longer. They're happy with the increased “feel-good” hormones and reduced cortisol. With retired and older pet owners, the dog gets the payoff of a companion almost every hour of the day. It's important for both the human and the canine companion. So how can you work to create a win-win for your elderly clients?

How to help an older pet owner manage a high-energy new pet

Be open to conversations about new pets when the elderly pet is failing.

 Gently ask older clients if they've considered what they're going to do when their pet passes. Some clients know they don't want another pet. Some aren't so sure. Let them know you'd be happy to set aside time to help them select an appropriate breed when the time is right. Normalize these conversations. Role-play with your veterinary team members how to start these conversations. Let your clients know that pets are a huge part of life, and ask how you can help them through the process.

 Create a brochure or printable item for clients with tips like, “Consider an older dog” or “Consider a smaller breed.” Mr. Jones would probably have loved a King Charles spaniel-loving, loyal, happy to please … and small.

 Provide pet owners with lists of dog walkers (some larger cities offer dog runners) as well as positive-reinforcement-based dog trainers. Look into doggie daycares in your area and ask them for senior discounts to account for these clients' fixed income as well as a new pet's need to be social and active.

 When you know an older client has a potentially difficult-to-handle dog, set reminders to call and check in with them. Offer support without judgment.

 Suggest they become foster parents until they're ready to adopt another companion. Many older clients become wonderful foster help as they find the perfect companion they didn't even know they were looking for!

 Post content about options after pet loss on your website and in social media. Again, seek to normalize the conversation.

 Suggest they join a grief sharing group for pet loss. They're popping up in cities near you. Not there yet? Reach out to mental health clinics and suggest they add one. The act of attending the group can help meet a need for community interaction.

Remember, these conversations are important

When a strong dog doesn't get the proper training, the pet can become too much for the owner. What happens when it's too much for the owner? These dogs may be rehomed, but often they wind up in shelters and the elderly owners find themselves alone and even more discouraged.

It's important that we seek to understand. While we may not think an adoption choice was a wise one, it's not ours to make. We can become part of a solution if we just take the time and forearm ourselves with talking points to take to our clients as the situations arise.

Remember this as well: If we're lucky, we'll all be old people with dogs one day-and we'll want to be understood as well.

After 10 years working in the veterinary field as a veterinary assistant and trainer, Julie Mullins has now felt the call back to school to complete her education. She completed her Bachelor's in Psychology and her Masters in Professional Counseling at Liberty University. She is passionate about helping individuals and families achieve healthy functioning and is convinced that animals should be a part of that journey. Julie observed the power of the human-animal bond while in the veterinary field and has further witnessed the power of the presence of her own dog, Ed, in the counseling sessions she conducts. Julie is also a grandmother, a runner, a business owner, a photographer and a lover of coffee, chocolate, wine and water.

How does your veterinary team help a client whos adopted a dog thats a little too much for them? Educate, support, and be kind.

When a new dog is too much for an older client

An anesthetist must understand how to use multiple pieces of equipment to perform their job properly, but the main tool of the trade is the anesthesia machine. To deliver oxygen efficiently, remove carbon dioxide and deliver appropriate concentrations of inhalant to the patient, it is paramount that the anesthesia machine be functioning properly.

This article describes how to test your anesthesia machine's pressure systems for potential leaks. Separate articles explain how to check the

The anesthesia machine's high-pressure system is where the pipeline and cylinder gas supplies are attached. It consists of the cylinders, hanger yoke, cylinder pressure gauge and regulator. Oxygen and other medical gases are supplied to the anesthesia machine through a central gas supply or by attaching the cylinder directly to the machine via the hanger yoke.

The larger cylinders typically are used for the central gas supply. They can be attached to the anesthesia machine by a single supply line or by a manifold that connects multiple cylinders at once. The regulator attaches to the cylinder through a gas-specific, threaded diameter index safety system 

. Malalignment of the threads or a loose connection can result in a leak.

The smaller cylinders attach directly to the anesthesia machine via a gas-specific, pin-indexed hanger yoke. 

A small washer, called a Bodok seal, must be placed around the yoke to form a tight attachment between the gas cylinder and hanger yoke 

. If the Bodok seal is not present, a leak will be heard when the cylinder is opened.

For anesthesia machines that are equipped with a double hanger yoke, both yokes should contain check valves, which prevent gas leaking from a cylinder with higher pressure to one with lower pressure. The valves also prevent gas leaks into the room of a vacant hanger yoke.

Hanger yokes in older anesthesia machines may not have built-in check valves. In this instance, a plug can be placed on the empty hanger yoke to prevent retrograde leaks.

 All cylinders should be tested immediately after being changed by slowly opening the valve in a counterclockwise direction to ensure that no leak is present from the regulator attachment.

How often should you check the pressure systems in your anesthesia machine? The

 should be checked whenever an oxygen cylinder is replaced. The intermediate and low-pressure systems need to be checked via negative-pressure and positive-pressure tests on a regular basis-at least monthly or whenever the breathing system is not leak checking properly.

 in your anesthesia machine should be checked before use with every patient.

The intermediate-pressure system in an anesthesia machine includes the pipeline inlet connections, pipeline pressure gauge (may not be present on all machines, especially portable ones), conduits from pipeline to flowmeter, conduits from regulator to flowmeter, flowmeter assembly and oxygen flush valve.

 Aside from the oxygen flush valve, the intermediate-pressure system is difficult to test for leaks because the components are upstream from the oxygen flow control valve (i.e. flowmeter). A negative-pressure leak test (described below) can be used to assess leaks in the intermediate-pressure system, but the flowmeter must be turned on and the oxygen cylinder turned off. 

The low-pressure system-where the oxygen and volatile anesthetic join together-includes the flow indicator within the flowmeter, vaporizer, low-pressure conduits and common gas outlet. Leaks in the low-pressure system may be difficult to recognize simply by listening. The best way to check for leaks in this system is to perform both negative-pressure and positive-pressure tests.

How to perform a negative-pressure leak test.

 This test assesses only the flowmeter, flush valve, vaporizer and conduit tubing between the intermediate- and low-pressure systems. It cannot be used to check any components of the breathing system.

Make sure the flowmeter and vaporizer are turned off. If the machine has a minimum mandatory flow, it must be turned off or disconnected from the oxygen source.

Remove the fresh gas inlet hose from the common gas outlet.

Attach a suction bulb to the common gas outlet and squeeze until it is fully collapsed 

. If the bulb remains collapsed for at least 10 seconds, then no leaks are present. If the bulb inflates, a leak is present. (Note that some anesthesia machines may require the suction bulb to be collapsed manually before attaching it to the common gas outlet.)

To test for internal vaporizer leaks, repeat the process with the vaporizer turned on (to the 0% position, if possible). Due to the capacity of the vaporizer, more than 10 seconds will be needed to assess the suction bulb. This test may not be sensitive enough to detect extremely small leaks within the vaporizer.

To complete the test, ensure that the vaporizer is turned off, remove the suction bulb and replace the fresh gas inlet hose to the common gas outlet.

If the anesthesia machine contains a check valve at the common gas outlet, then a negative-pressure leak test should be performed in conjunction with a positive-pressure leak test (

). A positive-pressure leak test will not detect a leak of the low-pressure components that are upstream from the check valve.

 The negative-pressure leak test is also known as the universal leak test because it can be used on anesthesia machines with or without a common gas outlet check valve.

How to perform a positive-pressure leak test. 

This test assesses only the flowmeter, vaporizer and conduit tubing between the intermediate- and low-pressure systems. It is not used to check any components of the breathing system. Perform this test with caution on anesthesia machines that contain a minimum mandatory flow option. Pressure that exceeds the prescribed limits can damage the flowmeter and other low-pressure components.

Make sure the flowmeter and vaporizer are in the off position. If the anesthesia machine contains multiple flowmeters, make sure they are all turned off.

Connect a pressure gauge to the common gas outlet 

. A sphygmomanometer can be modified with the appropriate connection for the common gas outlet.

Slowly turn on the flowmeter until the pressure gauge reads 30 cm H2O (22 mm Hg)

 use the oxygen flush valve for this test because the high pressure can damage the delicate anesthesia machine components.

Turn the flowmeter off and watch the indicator in the pressure gauge for movement:If the pressure remains constant, no leak is present. If the indicator begins to fall, the leak can be quantified by slowly turning on the flowmeter until the sphygmomanometer indicator stays at 30 cm H

O. The flow of oxygen that is needed to stop the indicator from moving represents the size of the leak. If less than 50 ml/min is needed to stop the leak, then the machine still passes this test.

 (Note: If the indicator continues to rise with the flowmeter turned off, this can indicate a leak through the flowmeter flow control valve or oxygen flush valve, as oxygen is continuing to be supplied to the common gas outlet.

 To test for internal leaks, repeat this test with the vaporizer turned on (to the 0%  position, if possible). If the anesthesia machine contains multiple vaporizers, turn on only one vaporizer at a time to 0%.

Repeat steps 4 and 5 for each vaporizer. It may be necessary to turn on the flowmeter       briefly to re-pressurize the system between vaporizers. The most common location for a vaporizer leak is the filling port.

If a leak is detected during either the negative- or positive-pressure test but it cannot be identified easily, then a trained professional should be called to service the machine. Their specialized professional equipment can be used to locate the exact position of the leak, which will help resolve the issue in a quick and efficient manner.  

Allen M, Smith L. Equipment checkout and maintenance. In Cooley KG, Johnson RA, Eds: 

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Darci Palmer became a veterinary technician specialist in anesthesia and analgesia in 2006. She holds the executive secretary position for the Academy of Veterinary Technicians in Anesthesia and Analgesia. Darci is an instructor for the Veterinary Support Personnel Network (VSPN) and an administrator for the Facebook group Veterinary Anesthesia Nerds.

Ensuring that all parts of your veterinary anesthesia machine are in good working order requires both preventive care and routine maintenance. Here's how to detect leaks in your machine's pressure systems.

Leaky anesthesia machine? How to check the pressure systems

	Excess gas exiting the pop-off valve of an anesthesia machine's breathing system is collected and diverted into the scavenging system. The scavenging system can be active or passive.

	An active scavenging system consists of a piped vacuum and duct system that carries the waste anesthetic gas (WAG) away from the anesthesia machine. The interface of an active scavenging system can be open or closed. An open interface does not contain valves and is open to the atmosphere, allowing both positive and negative pressure relief to occur spontaneously. This is considered the optimal design for patient safety.

	This article describes how to check the scavenging system of an anesthesia machine for leaks.

		Detailed instruction on how to check for leaks in the breathing and pressure systems of a veterinary anesthesia machine can be found 

	A closed interface consists of a knob that allows for adjustment of suction/vacuum, a collection bag, a positive-pressure relief valve and a negative-pressure relief valve (

). The collection bag on the scavenging system interface acts as a holding area for WAG coming from the anesthesia machine until it can be drawn properly into the scavenging system. The collection bag should be examined regularly to ensure there are no holes, especially around the neck of the bag. A collection bag that has a leak will act as a source of WAG contamination into the workplace.

Closed interface of an active scavenging system. (Photo courtesy of Darci Palmer, BS, LVT, VTS [Anesthesia & Analgesia])

	If suction/vacuum on the scavenging interface is set too low, then the WAG leaving the anesthesia machine may exceed the capacity of the scavenging collection bag. If the scavenging collection bag becomes too distended, the positive-pressure relief valve will open and allow WAG to escape into the room.

Using an anesthesia machine that is not working properly poses an unnecessary risk to both patients and personnel. Heres how to evaluate for leaks in your machines scavenging system.

Firstline May/June 2020