March 2015

Henry Schein AcquisitionGlobal F.A.S.T. Using Ultrasound in Dog and Cats as an Extension of Your Physical ExamEducation Events Across CanadaForkless Plates for TTAHematology Sample Handling TipsManitoba, Meet Julie

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In this issue:

gaining market share for our animal health diagnostics partners, including Abaxis, Inc. and Heska Corporation.” “The partnership with Henry Schein Animal Health will represent an important step for the scil animal care organization,” said Dr. Jaissle. “Henry Schein Animal Health understands that the veterinarian is the source of credible clinical information in the animal health industry. Focusing on and educating veterinary professionals has been the key to scil’s

success for nearly 20 years. We are excited to fi nd a partner that shares our passion for expanding the important diagnostic solutions that veterinarians provide to their customers.”

For the full press release please visit: www.scilvet.com

MELVILLE, N.Y., Jan. 19, 2015 /PRNewswire/ -- Henry Schein, Inc. (NASDAQ: HSIC), the world’s largest provider of health care products and services to offi ce-based dental, animal health and medical practitioners, an-nounced today that it will acquire scil animal care company GmbH, a distributor of animal health laboratory and imaging diagnostic products and services to veterinarians primarily in North America and Europe.

“The partnership with Henry Schein Animal Health will represent an important step for the scil animal care organization,”

Founded in 1998 with headquarters in Viernheim, Germany, scil animal care sells, services and supports laboratory diagnostic and imaging solutions to veterinarians in the United States, Canada, Germany, France, Italy, the Netherlands and Spain, with a distribution presence in 25 additional countries. In addition to the selection of products it offers customers, scil animal care provides product installation and training, loaner and repair services, as well as a broad array of educational programs. Among scil animal care’s more than 200 employees are 32 veterinarians, 26 equipment specialists and more than 70 sales representatives. Dr. Hartmut Jaissle, who has served as Chief Executive Offi cer of scil animal care since May 2012, will continue to lead the business. Dr. Jaissle became a licensed veterinarian in 1991, and transitioned from clinical practice to the business of animal health in 1995 with subsequent positions at

Colgate-Palmolive Company, Aesculap AG and B. Braun Melsungen AG. Dr. Jaissle and the scil animal care employees will become part of Henry Schein’s global Animal Health business. “We look forward to expanding Henry Schein’s Animal Health equipment capabilities in North America and Europe with the addition of scil animal care’s specialty diagnostics distribution business, a critical element to help veterinarians provide high-quality care and increase practice revenues,” said Stanley M. Bergman, Chairman of the Board and Chief Executive Offi cer of Henry Schein. “We will be delighted to welcome the scil animal care employees to Team Schein. The scil animal care professionals will enhance our Animal Health business’s equipment sales and support capabilities, representing our key supplier partners and introducing veterinarians to important diagnostic options. This will be a signifi cant step forward in expanding our diagnostics product category and

Henry Schein To Acquire scil animal care company

“I’m excited to be part of such a passionate industry”

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pathology messaging

Global F.A.S.T.Using Ultrasound in Dog and Cats as an Extension of Your Physical ExamBy: Dr. Greg Lisciandro, DVM, Dipl. ACVECCPart 1- A.F.A.S.T.

Since the landmark translational FAST validation study by Dr. Soren Boysen, we have developed the target-organ approach, the abdominal fl uid scoring system to better characterize the meaning of a positive FAST exam, the thoracic FAST (TFAST), and most recently the application of lung ultrasound called Vet BLUE (Veterinary Bedside Lung Ultrasound Exam). We have suggested the use of the following acronyms, AFAST (Abdominal FAST), TFAST (Thoracic FAST), and Vet BLUE, with a T3 to better clarify their applications which include Trauma, Triage and Tracking (T3) thus avoiding the onslaught of confusion acronyms in human medicine. When all 3 formats are used together we refer tothe exam as Global FAST (GFAST). GFAST3 is a format thatchanges the mindset of traditional abdominal ultrasoundand echocardiography. Global FAST may prove in emergent situations more helpful ruling in and ruling out important conditions potentially missed by using only one or the other of these traditional formats. Moreover, Vet BLUE screens for lung conditions not evaluated by either traditional exam.

KEY POINT: Standardizing terminology is important to prevent confusing acronyms; and Global FAST is a new comprehensive ultrasound format that provides important emergent information differently from the traditional approaches of complete abdominal ultrasound and echocardiography.

Abdominal FAST or AFASTSchematic of the AFAST3 (Abdominal) Ultrasound Exam:

This material is reproduced with permission of John Wiley & Sons, Inc, Focused Ultrasound Techniques for the Small Animal Practitioner, Wiley ©2014The AFAST3 sites (right lateral recumbency is preferred but left lateral is acceptable and either lateral recumbency is safer than dorsal recumbency [not recommended]).. To the right of the pictorial labeled A) is a translational depiction on an abdominal radiograph of a dog. The AFAST3 should always be performed in a standardized counter- clockwise manner as follows: 1) Diaphragmatic-Hepatic (DH) View also used to image the pleural and pericardial spaces 2) Spleno-Renal (SR) View also used as a window into the retroperitoneal space 3) Cysto-Colic (CC) View and 4) Hepato-Renal (HR) View which completes the AFAST3 exam. The HR view in higher-scoring dogs and cats is often a favorable site for abdominocentesis. All AFAST3 views are performed in the longitudinal (sagittal) orientation because it is easier to appreciate the anatomy of the respective target organs and less confusing especially for the novice sonographer. Importantly, Boysen et al. showed that when comparing longitudinal (sagittal) to transverse views, they matched 399/400 times.

KEY POINT: Keeping it simple by fanning through only longitudinal orientation expedites the learning process. AFAST3-applied Fluid Scoring System:

The AFAST3-applied fl uid scoring system is defi ned as follows (4-point scale): abdominal fl uid score (AFS) of 0 (AFS 0) means negative at all 4 views to a maximum score of AFS 4 means positive at all 4 views. Low-scoring AFS1 and 2 dogs are considered major injury, small volume bleeders, unlikely to become anemic from

FAST (acronym) stands for Focused Assessment with Sonography for Trauma was developed in the 1990s by trauma surgeons for use in the trauma bay at triage for detecting indirect evidence for intra-abdominal injury through the detection of free fl uid (black sonographic triangulations that are unlikely to represent any normal structures). What is often failed to be mentioned is that the formats were also used by trauma surgeons as an extension of the physical examination to detect complications well before human patients were often overtly clinical since ultrasound exceeds the sensitivity of physical examination, vital signs, laboratory fi ndings and radiography for many conditions (bleeding, infection [septic effusions], non-septic effusions).

the intra-abdominal bleed if no pre-existing anemia and no other bleeding sites.

High-scoring AFS 3 and 4 dogs considered major injury, big or large volume bleeders, likely to become anemic from the intra-abdominal bleed thus helps

predict the need for blood transfusion and surgery depending on patient subset.

Reproduced with Permission Lisciandro, et al. JVECC 2009; 19(5):426-437.JVECC 2011;20(2);104-122.

Use of Serial AFAST3 Exams and Determining the AFS:The use of serial AFAST3 and serial application of the abdominal fl uid score is imperative to maximize information and improve sensitivity of the exam including searching for fl uid, assessing the abdominal fl uid score (0-4), and evaluating the presence or absence of the urinary bladder. The author performs 4-hour post-admission serial AFAST and AFS in all stable patients (sooner if unstable); and serial FAST exams are standard of care in human medicine (American College of Emergency Physicians Guidelines [2001]). The use of the AFAST3 and AFS is helpful in trauma, non-trauma and tracking of bleeding dogs and cats; and for monitoring non-hemorrhagic effusions.

KEY POINT: Serial FAST ultrasound exams increase Sensitivity (in other words not missing free fl uid) and allow you to re-score (AFS) and evaluate for the presence of the urinary bladder (indirect urine output, and ruling out urinary bladder rupture).

AFAST3 is a Cerebral Exam, Not just Fluid-positive, Fluid-negative:The Diaphragmatico-Hepatic (DH) View is loaded with information that is readily appreciated during the minutes it takes to perform the AFAST3 including volume status, gallbladder fi ndings, liver fi ndings, and its use for pleural and pericardial effusions. The Spleno-Renal (SR) View is unique since it interrogates both the abdominal cavity and retroperitoneal space with target-organ interrogation of the left kidney and spleen. The Cysto-Colic (CC) View lends itself to suspecting urinary bladder pathology. The colon is a tricky structure that can cause mistakes by the air-fi lled colon appearing like bladder stones, the fl uid-fi lled or fecal-fi lled colon like masses. The CC View is the most common AFS-positive site in low-scoring AFS 1 and AFS 2 dogs (and cats) by directing the probe toward the table top into the “CC pouch” where the urinary bladder is immediately against the ventral abdominal wall. The Hepato-Renal (HR) View is completes the AFAST3 format and is this called the “Home Run Site” because in high-scoring dogs and cats the view will likely have abundant fl uid amenable to abdominocentesis. Since ultrasound cannot sonographically characterize free fl uid, sampling is necessary with fl uid analysis, including cytology and chemistry analysis. The HR view is nicknamed by the author the “big lie” since routinely the right kidney and liver are not directly imaged but rather the probe is place in the mid-section umbilical region and directed in the most gravity-

dependent “HR Pouch” for the detection of free fl uid. In cases in which the right retroperitoneal space is of interest, then the author will interrogate the target-organs as a 5th AFAST3 view. It has not been determined what clinical importance of routinely performing the AFAST3 5th view is (low yield or high yield or if the left retroperitoneal space is adequate without the right retroperitoneal space since they are in such close proximity).

Clinical Indications/Applications of AFAST3:Blunt trauma, penetrating trauma, collapse, apparent collapse, undifferentiated hypotension, respiratory distress (since there are non-respiratory look-a-likes [hemoabdomen, cardiac tamponade, anaphylaxis, high fever, and others]), post-interventional at-risk bleeding (surgery, percutaneous procedures, laparoscopy), Post-interventional at-risk peritonitis (surgery, percutaneous procedures, laparoscopy); and patient monitoring during fl uid resuscitation and during hospitalized care.

*The use of AFAST3 should be simply stated as an “extension of the physical exam” for nearly ALL dogs and cats that are abnormal. FAST3 formats (AFAST3 and its applied fl uid scoring system [AFS], TFAST3 and Vet BLUE) should be adopted as BASIC “screening tests” just as we have been trained to perform minimally basic blood tests (so-called Quick Assessment Tests [PCV/TS, serum character, BUN, Creatinine, Blood Glucose, and ALT]).

About the Author:Dr. Greg Lisciandro DVM, Dipl. ACVECC, Dipl. ABVP is a passionate proponent of the use of Focussed Assessment with Sonography for Trauma (“FAST”) ultrasound techniques in veterinary medicine.He is a member of the ACVECC Education Guidelines Committee that is currently developing a Veterinary Advanced Trauma Life Support curriculum; and continues to publish novel clinical research involving uses of ultrasound; and been invited to write several book chapters on the use of AFAST3, TFAST3, Vet BLUE (Veterinary Bedside Lung Ultrasound Exam) and other abbreviated ultrasound exam formats. Dr. Lisciandro may be reached at FastSavesLives@gmail.com and at www.FASTvet.com

Join us for Continuing Education all across Canada

Basic Ultrasound April 11 & 12, 2015 Ottawa, ON

Dental Radiology & Positioning April 12, 2015 Toronto, ON

Scan Only Ultrasound April 12, 2015 Ottawa, ON

Introduction to TPLO April 25, 2015 Calgary, AB

Basic Ultrasound April 25 & 16, 2015 Winnipeg, MB

Scan Only Ultrasound April 26, 2015 Winnipeg, MB

F.A.S.T. Ultrasound May 3, 2015 Calgary, AB

Pearls of Liver/Spleen Ultrasound May 23 & 24, 2015 Halifax, N.S.

MSK Ultrasound May 31, 2015 Victoria, BC

Repairs of Common Conditions of the Hind Limb June 13 & 14, 2015 Edmonton, AB

F.A.S.T. Ultrasound June 14, 2015 Halifax, N.S.

Dental Radiology & Positioning

Basic Ultrasound

Scan Only Ultrasound

Introduction to TPLO

F.A.S.T. Ultrasound

Basic Ultrasound

Scan Only Ultrasound

MSK Ultrasound

Pearls of Liver/Spleen Ultrasound

Watch for part 2 of Dr. Greg Lisciandro's F.A.S.T. series: Thoracic F.A.S.T. in the next issue of

*References available upon request

Repairs of Common Conditions of the Hind Limb

F.A.S.T. Ultrasound

HematologySample Handling Tips

Needle Size22 gauge or larger bore needles are ideal.Small bore needles result in a greater likelihood of cell damage (hemolysis) and clotting activation. Platelet clumps and hemolysis can lead to low RBC and HCT results. Try to avoid butterfl y catheters as they can cause slow transfers as well.

Careful Sample TransferThe sample needle and EDTA tube top should be removed prior to sample transfer unless a direct collection method is used. Carefully express the sample so blood runs down the side of the tube. This should reduce cell damage caused by passing through the needle a second time and the turbulence from spraying into the tube which causes cellular damage and clotting activation.

Blood Sample to EDTA RatioIt is crucial to fi ll the EDTA tube properly. The ratio of anticoagulant to blood sample is very important. For small patients such as cats, kittens, and exotics, use tubes such as microtainers or Sarstedt Microvette 100/200 tubes when the sample volume is small. Attention must be paid to proper fi ll lines. Improper ratios result in cell morphology changes, falsely lowered HCT, RBC counts, platelet clumping, etc.

Sample MixingAfter EDTA tube has been adequately fi lled, it is vital that the sample be mixed immediately.Invert the tube 20-30 times (at least 2 minutes) to ensure that all the EDTA mixes with the blood. Inadequate mixing may result in clotting activation and platelet clumping. It is very important to thoroughly mix directly before testing also. Roll the vials in your hands and gently invert at least 20 times to thoroughly mix.

Clotted SamplesIf clotting is a possibility due to prolonged draw or delayed sample transfer, check prior to proceeding with the analysis. A clotted sample should never be introduced into an automated system. To check for clots put two stick applicators into the sample and immediately pull them out. Any clots or strands that adhere to them suggest this sample should be discarded and a fresh draw used.

We’ve all been there. You run your CBC and the results aren’t quite what you expected. Often the fi rst assumption is that your in-house hematology analyzer isn’t working correctly. But did you know that technical service logs show many times it is actually the sample itself that is the problem. Follow these tried and true sample handling tips to make the most of your CBCs.

Forkless Plates for TTA Webinar

Dr. Barnhart will take us through the science behind this technique, and the benefi ts in terms of less complications, less inventory and overall better outcomes for the patients. The webinar will fi nish with an opportunity for questions/comments. 1 CE credit is pending approval.

About Dr Matthew D. Barnhart, DVM, MS, DACVS:

Matthew D. Barnhart, DVM, MS, DACVS, is a Veterinary Surgery Specialist as well as the Specialty Leader for MedVet. He has been on staff at MedVet Columbus since 1999.His practice is focused on orthopedics and neurosurgery, particularly cranial cruciate ligament injury

treatment, joint replacement and arthroscopic surgery. Dr. Barnhart is a pioneer of veterinary orthopedics in the state of Ohio. He was the fi rst to perform such innovative procedures as tibial plateau leveling osteotomy (TPLO), tibial tuberosity advancement (TTA), sliding humeral osteotomy (SHO) and minimally invasive fracture and joint surgeries.

In addition to his appearances on ONN, NBC 4 and WBNS 10-TV, Dr. Barnhart’s work in small animal surgery has been widely published in peer-reviewed journals, including the Journal of the American Veterinary Medical Association and Veterinary Surgery.

Dr. Barnhart is frequently invited to lecture nationally and internationally on such veterinary orthopedic topics as cranial cruciate ligament rupture pathophysiology, fracture treatment and medical management of osteoarthritis.

Click here to register or call 1.866.382.6937 and ask for Andrea.

Please join us and learn some new tips and tricks to update the TTA surgeries you are already performing. Dr. Matthew D. Barnhart DVM MS DACVS who authored a paper based on a clinical study of 125 dogs in 4 TTA treatment groups will lead the webinar and teach us how to use forkless plates.

Join us on April 10, 2015 at 12PM EDT for this free, informative webinar

Manitoba, Meet Julie

Central Canada meet Julie, scil animal care company’s newest addition. She will be supporting Veterinarians in Manitoba and Saskatchewan for all their diagnostic needs. To make your appointment call us today at 1.866.382.693. We are here to support you!

“I’m excited to be part of such a passionate industry”

What do you want to see in the next issue of scilful Vet Solutions?

Interested in submitting an article or an idea? Please email us at infoca@scilvet.com

We Want to Hear from You!

Central Canada meet Julie, scil animal care company’s newest addition. She will be supporting Veterinarians in Manitoba and Saskatchewan for all their diagnostic needs. To make your appointment call us today at 1.866.382.693. We are here to support you!

“I’m excited to be part of such a passionate industry”

scil animal care company131 Saunders Rd, Unit 5

Barrie, ON L4N 9A7T: 1.866.382.6937 F: 705.726.9202

www.scilvet.com