When clients come into the clinic, they want to give you as much information as possible because they’ve come to you for answers. As a technician, it's important to be a sympathetic ear, but also to get the facts needed to help the doctor come up with a plan. I’ve been a veterinary technician for 20 years and worked in cardiology, internal medicine, oncology, and orthopedics for about 15 of those years. I’ve learned what works and what doesn’t when it comes to history taking and it starts before you enter the exam room.

The first step is making sure you have all the previous records from the client’s local veterinarian and any other specialty or emergency hospitals they’ve been to. Making a timeline of events is helpful when you have multiple sets of records, but the most important thing to look for is when did the problem begin. That gives you a good place to start your record reviewing. Although it’s important to know all the past pertinent history, you don’t need to include every detail, such as an ACL repair that happened 5 years ago when the pet is presenting to you for symptoms of Cushing’s disease.

The next items to look for are diagnostics that have already been performed and medications that have been prescribed. It’s best to know when these diagnostics took place and make sure the results of those tests are available to the doctor. It’s helpful to see what was already prescribed so you can confirm the medication with the client during the appointment. Keeping track of multiple medications can be overwhelming to clients so it’s helpful to have a list ready that you can confirm with them instead of the client coming up with a list on the spot.

For a client’s history, it is best to keep all of it in chronological order. Depending on the doctor, start from what’s currently going on and work backwards, or start at the beginning and move forward in time. Always use proper medication names, routes, times of administration, and use proper medical terminology. I like to write a history based on the records we’ve received before the appointment and then fill in the details with what the client tells me during their appointment. When it comes to specialty medicine, you need to know the story before entering the room because it’s hard to keep the client on topic if you don’t.

Once it’s time for the appointment to start, keep in mind that you need to be in charge of the conversation. Of course, you want to be kind and understanding, but you have a limited amount of time to get the information you need. Keeping a client on topic is hard when they care so much about their pet and want to share every detail about them. If the conversation train has gone off the rails, I find it helpful to say something like, “Let’s talk more about Olivia’s appetite changes” or “Can I interrupt you to talk more about Elliot’s cough? Have any medications helped so far?” to snap clients back to the present to continue telling me about the current issue. When discussing symptoms, you want to find out the frequency, duration, and severity. You also want to know what the clients tried on their own, like food or routine changes that might not have made it into medical records.

At the end of my time in the appointment, I let clients know what to expect next in terms of diagnostics and ask them what their goal is for the appointment. Depending on the department, it might not be obvious why the clients are there, especially in departments like internal medicine. It’s good to know what the client’s expectations are before the doctor enters the room. Once you have verbally given the veterinarian your history and answered any questions they have, it’s good practice to proofread the history you have written in the medical records. Make sure it makes sense and there are no spelling or grammatical errors. Days in any clinic are busy and you may forget details after the appointment. Make sure you have all the necessary information in the records before you move on to another task.

Writing a history takes effort before, during, and after the appointment. The technician is the strongest link between the client and doctor. If you put together a thorough history, you can feel proud that you helped your client get the answers they need to help their pet.

Articles

Obtaining a comprehensive but succinct initial history from clients can be a challenge, especially from worried clients.

In specialty medicine, histories start before the appointment

In this exclusive interview with dvm360, Mara Tugel, DVM, shares more on the research that was conducted for Zenrelia

Video interview with Mara Tugel, DVM 

Mara Tugel, DVM, veterinary technical marketing-companion animal therapeutics for Elanco, explained the research that was done prior to the approval of Zenrelia in the United States and Europe. 

Throughout the interview, Tugel provides a break down of the results for the 2 studies conducted within the United States and 1 in Europe to shed some light on how Zenrelia presented within those studies, the subjects, and just an overall view of the process for Zenrelia's approval, including a test comparing it to Apoquel. 

: As part of the European submission, we conducted a large clinical trial that was a head to head non-inferiority study with occlusitonib or Apoquel. This was done in client-owned dogs, and it was a blinded, masked, randomized study across 25 different clinical sites in Europe. What we found in that study was that once daily dosing of Zeneralia was as effective as Aqoquel dosed twice daily for 14 days and then once daily. Additionally, there were similar rates of adverse events between treatment groups, and that once daily Zenrelia dose helped minimize the opportunity for rebound pruritus, or that little bump in itch that we can see when the Apoquel doses decreased from twice daily to once daily. 

Finally, in the continuation phase of that study, we actually found really promising results for pruritus reduction and the potential to get dogs back to what we consider clinical remission or normal with a pruritus visual analog scale (PVAS) score of less than 2. So this is a PVAS score of less than 2, and that's really what dermatologists are starting to talk about as setting a new standard for treatment in dogs with atopic dermatitis in general.

Videos

During this interview with dvm360, Mara Tugel, DVM, provides more insight into the research conducted for Elanco's Zenrelia

The research behind Zenrelia

Tasha McNerney, BS, CVT, CVPP, VTS (Anesthesia), discussed her lecture on mechanical ventilation with general anesthesia in a dvm360 interview.

Utilizing mechanical ventilation

Tasha McNerney, BS, CVT, CVPP, VTS (Anesthesia), cofounder of Veterinary Anesthesia Nerds, was recently tasked with presenting a lecture on ventilation at dvm360’s 2024 Fetch Coastal conference in Atlantic City, New Jersey. The talk aimed to address lung physiology, mechanical ventilation, and various other ventilation modes, and when they will be the most beneficial to your patients.

A practicing technician at Mount Laurel Animal Hospital in New Jersey, McNerney discussed her lecture and the role of mechanical ventilation for cases in general anesthesia, in an interview with 

. The following is a transcript of the video:

Tasha McNerney, BS, CVT, CVPP, VTS (Anesthesia)

: Mechanical ventilation is something that I am pretty passionate about. It just kind of became a newer thing for me in the past year. Certainly, mechanical ventilation is not new. We've been doing this for years and years. I mean, in human medicine, we have people that that's their whole job, as respiratory therapists, right? And that's all they do, is ventilation. 

So we know that our [veterinary] patients under anesthesia, often—almost always—will hypoventilate. Now, there's different ways that we can do things. We can be the ventilator. We can do something called intermittent positive pressure ventilation, or we can utilize a ventilator. But then we look at really breaking the ventilator and the mechanical ventilator down even further. There's all these different kinds of ventilation modes and ventilation strategies we can use based on the patient in particular. So the same way that we create an individualized anesthetic plan, we can create an individualized ventilation plan that's going to make the most sense for that patient.

For more articles and interviews from Fetch Coastal, visit our 

Tasha McNerney, BS, CVT, CVPP, VTS (Anesthesia), discussed her lecture on mechanical ventilation for cases in general anesthesia in a dvm360 interview.

Planning for ventilation with general anesthesia

Photo: Нина Дроздова/Adobe Stock

In her lecture on feline diabetes, at the Fetch dvm360 conference in Atlantic City, New Jersey, Renee Rucinsky, DVM, DABVP, owner of Mid Atlantic Cat Hospital and Mid Atlantic Feline Thyroid Center, talked about methods for managing feline diabetes.

 Rucinsky began by explaining that the goals of treatment are not to create a perfect blood glucose level or to achieve the “textbook” blood glucose curve. Instead, the goals of treatment are to improve the glycemic control, patients’ clinical signs, and to improve the quality of life of the patient and the owner.

One treatment method that Rucinsky discussed was insulin therapy. The insulin that is most likely to put a cat into remission is Insulin Glargine, or percutaneous coronary intervention (PCI), explained Rucinsky. Insulin determir can also be utilized, she said. Unlike in dogs, felines only require 1 unit twice a day, regardless of their weight.

Administered in an appropriate dose, insulin, in combination with a diet change—which includes a reduction in carbohydrates, an increase in protein, and a strict calorie plan—has a high success rate for remission, lectured Rucinsky.

However, a drawback of insulin may include challenges with clients who may not administer the drug correctly. Moreover, issues with staff may arise, creating another drawback for using insulin as a treatment for diabetes. In her session, Rucinsky explained that front desk staff are often faced with critical decision making when clients call and ask for advice on a situation with their diabetic pets.

“…you're relying on [front desk staff] to make a decision, ‘do I get the technician?’ ‘Do I leave a note for the doctor?’ Maybe that person doesn't get a call back until 5 o'clock. So you have to train your staff to know [how to respond to] all these things… all that stuff makes insulin a potentially really, really scary drug,” emphasized Rucinsky.

During her lecture, Rucinsky also hinted at a potentially new insulin for cats that may be coming to the market in the future. She shared that the new product recently finished the pilot phase and is in the beginning stages of a pivotal clinical trial. The product would be a once-a-week insulin therapy for cats. Currently, there are 18 cats in the pilot trial, and of those, 40% have gone into remission on the drug, shared Rucinsky.

“I'm excited for this drug. It's been…really, really cool, and stay tuned on that, because for the cats that do require insulin, I think that might be a pretty cool option when it comes out,” said Rucinsky.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a new treatment option for felines with diabetes. This treatment works by blocking the reabsorption of glucose in the kidneys, leading to normal glycemia. In her lecture, Rucinsky explained that this treatment option should be used on cats with diabetes that are otherwise healthy.

Both Bexacat or Senvelgo SGLT2is are given once a day, do not need to go in the fridge, are mixed in the cat’s food, and are relatively palatable, said Rucinsky.

“The challenge with using SGLT2 inhibitors is that it's new, right? It's a new way of thinking about things. It's a completely different mechanism of action that we have to understand, and then we have a different way of monitoring as well. So you know, once we start these, they're not hyperglycemic at all. They're not going to get hypoglycemic. So how do we know if they've gone into remission?” inquired Rucinsky.

Patients taking SGLT2is should see a weight increase; less polyuria and polydipsia (PU/PD) polyphagia, blood glucose curves, fructose amine, glucosuria, and A1C. “Looking at ketonemia would be better,” explained Rucinsky, “blood ketones are going to be better than urine ketones.”

When using SGLT2is, it is crucial to measure patients’ ketones. Rucinsky highly recommended to veterinarians that do not have blood ketone meters in their hospital, to obtain one.

“Yes, you can do it on urine ketones, but it's better to do it on blood ketones. You're monitoring these guys with blood glucose anyway, you're already getting a blood sample. A handheld ketone meter looks just like your handheld glucometer, [and it’s only] $50. There's no reason for you not to have it in the hospital. It's not a different slide that you put in your AIDEX machine. It's not a whole other machine. If you send out blood ketones, that's great. You can do that, but you don't need that answer tomorrow. You need that answer today. So having a $50 piece of equipment seems like a no brainer,” emphasized Rucinsky.

Rucinsky R. Feline diabetes: What now? Treatment choices - diet, insulin, and SGLT2i. Presented at: Fetch Coastal; October 14-16, 2024; Atlantic City, NJ.

Renee Rucinsky, DVM, DABVP, discussed insulin therapy and SGLT2 inhibitors in her lecture at the Fetch dvm360 conference in Atlantic City

Treatment options for feline patients with diabetes

Whether or not pet owners should feed their dogs grain-free diets has been a hot topic in veterinary clinics nationwide. In her session, “Against The Grain: Where Do We Stand, Should We Still Be Afraid,” Danielle Conway, DVM, CVA, VSMT, CCRP, discussed the origin of the grain-free diet for pets, in addition to an overview of grains and their nutritional benefits.

“So, grain-free is growing, and it [will] continue to grow,” Conway said in her lecture. “It’s projected that, by 2032, [the grain-free pet food industry] will jump to reach $53.2 billion in the US alone.”

According to Conway, the grain-free pet food market saw a 4.8% growth in sales over the last 13 months and is expected to increase 6.4% from 2022-2032. She attributes this significant growth to a number of beliefs held by clients. Included in these theoretical benefits of grain-free diets are the fact that they’re more similar to ancestral diets, it lessens the risk of food allergies (and some pets have allergies to gluten), grain-free foods are more digestible, and they contain less carbohydrates.

Carbohydrates are 1 of the 3 main sources of energy. In veterinary medicine, dogs and cats do not require dietary carbohydrates (CHO), but they do require cellular glucose. Dogs are able to utilize as much as 65% dietary CHO, but cats can only use up to 40% dietary CHO. Conway notes that all grains are carbohydrates, but not all carbohydrates are grains.

Conway defined grains as the seeds or fruits of various food plants, including the cereal grasses and other plants. Grains can be divided into 2 classes: True grains (grasses) and pseudograins (non-grasses). True grains include wheat, barley, oats, rice, corn, millet, rye, and sorghum, and pseudograins include buckwheat and quinoa.

Although commonly confused gluten and grains are not the same. There are overlapping food items, but there are also grains that don’t have any gluten in them. “So, if you have a true gluten sensitivity or allergy, there are still grains that can be consumed safely that won’t trigger issues,” Conway explained. “I have seen this in clients with patients that, maybe, have a gluten sensitivity, [and] need to be avoiding gluten, not necessarily all grains.” She expressed that, while early signs indicate to this being applicable to veterinary medicine, more research is required.

Gluten itself is a protein mixture of glutenins and gliadins. Wheat, barley, rye, and triticale are examples of gluten. Conway cautions against operating in a world of absolutes regarding gluten. Not all grains are gluten-containing, and a lot of cases are closer to gluten sensitivities than true gluten allergies. She also admits that the line can be blurry and often confusing, and she still turns to the internet to double check whether specific grains contain gluten.

Conway shared that there are patients who test negative for celiac disease, despite still experiencing symptoms like bloating, diarrhea, and cramping after eating gluten. In these cases, the clinical signs do result following the removal of gluten from the diet. Zonulin, a protein responsible for breaking down tight junctions between intestinal cells, is increased upon exposure to gluten.

Conway debunks the increasingly common ancestral, raw-meat diet, which many owners believe is more similar to their dog’s ancestral and natural needs. This is not true. She explains that, not only are modern domestic dogs significantly different than wolves, but wolves themselves, in addition to only living to 6 years old in the wild, consume more than just meat. They have been found to forage and have shown attraction to grains in the stomachs of their prey. Separately, Conway concluded that more research is necessary to establish definitive proof that the anti-inflammatory diet is effective, despite the success of the Mediterranean diet.

What makes nutrition-based conversations so tricky?

Conway cites several reasons regarding why conversations about nutrition can be so difficult. First, she says that a lot of people feel very strongly about their pet’s nutrition, likening the subject to politics or religion, in the sense that it can be touchy. She also mentions the abundance of social media users that go viral, spreading misinformation about nutrition, despite falsely claiming to be experts. Other obstacles for nutrition conversations include confusing labels, mistrust of certain brands, hyperfixation on certain ingredients, and misunderstanding definitions. 

“When I train technicians how to have these hard conversations with clients, you almost need to approach with the same delicacy that you would when talking about religion or politics,” Conway said. “That’s how deeply and passionately a lot of people can feel about the food that they’re feeding [their pets], and there’s a lot of misinformation.”

Conway D. Against the Grain: Where Do We Stand, Should We Still Be Afraid? Presented at: Fetch dvm360 Conference; October 14-16, 2024; Atlantic City, NJ.

Information and opinions about the current state of grain-free pet diets were covered during a session at the Fetch dvm360 Conference in Atlantic City

Are grain-free diets becoming more common?

Susan Bohrer, DVM, CVA, CVFT, an integrative small animal practitioner and owner of Chi Dog pet meal service in Claremont, California, shared a holistic perspective on pet diets during a lecture at the 2024 Fetch dvm360 conference in Atlantic City, New jersey. During her talk on whole foods, she discussed different ways that individual foods affect patients, emphasizing that what works well for one patient may not be the best course of action for another.

According to Bohrer, Traditional Chinese Veterinary Medicine (TCVM) is comprised of 4 branches: acupuncture, herbal therapy, Tui Na (therapeutic massage), and food therapy. In learning TCVM, she became more interested in food therapy when she saw improvements in patients with chronic conditions such as pancreatitis, liver disease,and irritable bowel disease, as well as those with skin conditions and obesity, she said.

She then compared raw and cooked foods for canines and felines, from the perspective of holistic medicine. She noted that although cooked food is easier to digest than raw food, raw food is appropriate for some patients. “Raw is most suitable for healthy, strong dogs and cats because raw requires more energy (or Qi) to digest. This is why the young, active dog or cat with a good body condition thrives on raw food while the senior or sensitive dog or cat does not,” she said.

Bohrer noted that older dogs, young puppies and canines with sensitive stomachs may fare better with cooked food, rather than raw. She said cooked food can help strengthen the spleen and gastrointestinal (GI) microbiome in these pets.

A pet’s dietary needs may need to be amended as they age and their bodies change, Bohrer noted. She used the example of a dog that is on a raw diet for 10 years and is suddenly losing weight and having GI issues. “They won't eat that raw [food] that they previously loved. And the client is usually very committed to the raw, so they want their dog on it, and they're frustrated,” she said. “Why isn't this dog doing great on it anymore? So usually I'm just telling clients, ‘This is just, you're going to feed your dog differently.’”

Bohrer also educated attendees on the energetics of food, which is how an individual food affects the body. When a patient is imbalanced with too much heat, for example, therapy would be feeding cooling foods, and vice versa. Additionally, an internal dryness requires hydrating foods, she noted.

Warming foods, such as chicken , lamb, venison, oats and winter vegetables, are considered gentle foods in TCVM. Cooling foods such as turkey, rabbit, duck, barley, brown rice, and summer vegetables, are anti-inflammatory, and neutral foods are hydrating and include, for example, beef, port, salmon, eggs, potato, cauliflower], and carrots.

“So I always think about chicken and rice,” Bohrer said. “You know, the dog has GI upset. They go home. Client makes chicken and rice. They feel better [and are] looking good. They just needed a gentle chew tonic, right? It's just easy on the tummy. [The combination of] chicken and rice is always a version of, like, chicken soup, right?”

Seeing the benefits that food therapy brought to patients in practice, Bohrer began providing home cooking recipes to her clients. These recipes included food toppers for cats and easy, balanced meals for dogs. “Over and over I saw improvements as I brought in food therapy my patients. Especially for those chronic disease patients who were already on the recommended treatments,” she said.

Bohrer S. Healing with whole foods: TCVM food therapy, using real food not processed food. Presented at Fetch

A certified food therapist discussed holistic advantages to certain diets during a lecture at the 2024 Fetch Coastal conference.