1. General practice part 2

2. Lets talk about being an LVT:
What does LVT stand for?
What does it mean to be an LVT?
An LVT means a person is licensed as a veterinary technician by the board
They have a 2 year degree from an AVMA-accredited school
They took the VTNE and passed with a 70 or higher
Required to obtain 10 hours a year of CE (roll over of 10)
No more than 2 hours from office management
No more than 4 hours from online
American veterinary medical association

3. Review of types of supervision:
Direct supervision: supervision of a person by a veterinarian who is physically present on the premises
General supervision: supervision of a person by a veterinarian who is readily available to communicate with the person
Immediate supervision: supervision by a person who is within audible and visual range of both the animal patient and the person under supervision
Direct: The veterinarian is on the property (not right there directly with the technician)
General: The veterinarian is available by phone
Immediate: The veterinarian is right there with the technician and the patient

4. Supervision requirements for LVT’s:
Under direct or immediate supervision:
Suture close existing surgical skin incision and skin laceration
Induce anesthesia
In dogs and cats, extract loose teeth or dental fragments with minimal periodontal attachment by hand without the use of an elevator
Administer rabies vaccine
Euthanize (only under immediate supervision)
Unlicensed person under immediate supervision of a veterinarian or LVT may: Suture close existing surgical skin incision and skin laceration, Induce anesthesia, Draw blood and take samples for the purpose of testing and diagnosis
For rabies vaccine administration: the vet has to have a client patient relationship first

5. Opening task as a veterinary technician (Exam room tech)
Check on any hospitalized patients
This will include obtaining vitals/feeding/medicating/cleaning kennel/walking the patient
Opening the exam rooms
This includes making sure they are stocked and clean
Making sure everything is stocked for appointments (ex. Vaccines)
Surgery technicians will set up for surgery (you will touch base on this later when you take surgery)
Checking messages
Printing out call back list

6. Daily task for a veterinary technician: (Exam room tech)
Running exam rooms
Obtaining vitals and a thorough history
Restraining for the doctor
Pulling up/administering vaccines
Performing diagnostic testing (vena puncture, UA, radiographs, fecals)
Filling medications/going over discharge instructions
Invoicing charges

7. Running a wellness appointment
Step 1: Always read the file
Step 2: Enter the lobby with a smile and retrieve the patient
If large dog, obtain a weight if it has not been done (scale is usually in lobby)
Step 3 &4: Obtain vitals in the exam room while obtaining the patient history
When questioning the client, only ask open-ended questions
Example: Don’t ask- Is he eating and drinking?
Instead: ask- How is his appetite?
Once you get information over their health, you can move on to what vaccines they are due for
MAKE SURE THERE ARE NO HEALTH CONCERNS EVEN IF IT IS A WELLNESS EXAM
Open-ended can not be answered with yes or no. This causes them to give us a better history
Sometimes they will come in for vaccines and they are not healthy. We can not vaccine if the animal is sick

8. SOAP: Subject: this is where you put the patient history
Objective: This is where you write out vitals or physical abnormalities
Assessment: Diagnoses or condition of patient
Plan: The plan of action for this patient
Do you know what part Technicians fill out?
The doctor fills out their exam findings in the Objective
Vaccines administered will go in the Plan

9. Vaccines for dogs/cats
Step 5: Go over required vaccines and optional
Even if they have never received a specific vaccine, go over it anyway. You never know if they will want it this time
Required vaccines for cats:
FVRCP
RABIES
Optional: FELV
Required vaccines for dogs:
DAPP/DHPP
Optional: Leptospirosis, Bordetella, Influenza
You also don’t know if they never received it because they were not educated on the importance of it

10. Explaining vaccines How do you go over vaccines with a client?
This is one of the biggest struggles new veterinary technicians have
You do not want to overwhelm them!
Example: I see Bruce is due for his Distemper parvo vaccine. Did you have any questions over what this is for?
Once this has been established, you can then move on to the next step:
Would you be interested in the Leptospirosis vaccine? It is not a required vaccine, but is highly recommended
This will then lead to explain what Leptospirosis is
Breaking it down for the owners is the key. Especially if it is their puppies first visit

11. Canine core vaccine: DAPP/DHPP
D: distemper
H: hepatitis/Adenovirus
P: parainfluenza
P: parvo
Leptospirosis can be added in as well(DHLPP)
This is started at 6-8 weeks of age and administered every 3-4 weeks until 16 weeks of age
Remember the 1st 2 vaccines are not valid

12. Canine Distemper vaccine:
What to say: “Canine Distemper is serious and highly contagious disease caused by a virus that attacks the respiratory, GI, and nervous system of dogs. It is spread through sneezing or coughing from infected animal. They can also contract it through sharing bowls with infected animals. Wild life, such as Raccoons and Skunks can be carriers as well. If they were to contract this disease, there is no cure and they would require extensive treatment.”
“This vaccine is usually in a combination vaccine and is given starting at 6-8 weeks of age. It is then boosted every 3-4 weeks until they are 16 weeks of age. This way they will have full immunity before they are a year old.”
Upper respiratory: Discharge from eyes and nose, coughing, fever
GI: Diarrhea, vomiting
Neurologic: Twitching and paralysis
Remember infected animals can shed this virus for months

13. Canine Hepatitis vaccine:
What to say: “Canine Hepatitis is the next portion of the combination vaccine. It is a highly contagious viral infection that causes inflammation of the liver. Other organs can be affected as well. Although, this is not related to human version of Hepatitis, it is still very painful for infected dogs. It is spread in the feces, urine, blood, saliva, and nasal discharge of infected dogs.”
Canine Parainfluenza:
What to say: “ The next portion of the combination vaccine is canine parainfluenza. It is an upper respiratory virus that could contribute to a more severe upper respiratory infection”
Other organs include: Kidneys, spleen, lungs, and the eyes
There is no cure
C/S: vomiting, jaundice, stomach enlargement, pain around the liver

14. Canine Parvovirus vaccine:
What to say: “The last portion of the combination vaccine is Canine Parvovirus. This is a highly contagious virus that affects all dogs, but unvaccinated dogs and puppies less than 6 months are at the most risk. The virus attacks rapidly dividing cells so that is why younger dogs are more susceptible. You will see GI systems, such as severe bloody diarrhea. This could lead to severe lethargy and dehydration. Puppies can contract it through direct contact or through fecal-oral route and it can live in the environment for over a year. If your dog contracts Parvovirus, they will need veterinary care right away.”
No cure
The only way to kill it in the environment is with bleach

15. Canine Bordetella vaccine:
What to say: “Canine Bordetella is a highly communicable bacteria infection that causes severe coughing. It is the primary cause of kennel cough. The coughing tends to sound very harsh, similar to a whooping sound. Dogs can contract it through close contact with infected animals. This is recommended for any patient who visits dog parks ,boards or goes to the groomer. Most boarding facilities and groomers require this vaccine.”
“This is given at 6-8 weeks of age. It is given yearly or every 6 months depending on the requirements of boarding/grooming facilities.”
Optional vaccine

16. Canine Leptospirosis vaccine:
What to say: “Leptospirosis is a bacteria infection that can lead to liver and kidney failure. The bacteria is passed through urine of wild animals and can be found in standing water or soil. It is a zoonotic disease which means humans can contract it as well. Dogs do not have to come in contact with an infected animal to contract the bacteria.”
“It is given at 12 weeks of age and is boosted one time 3-4 weeks later. It is then given yearly. It can be added into the Distemper/parvo combination.”
Optional vaccine

17. Canine Rabies vaccine:
What to say: “Rabies virus is a viral disease of mammals that invades the nervous system. It is most often transmitted through the bite of a rabid animal. This virus not only affects animals, but humans as well. This vaccine is required by law.”
“It is given starting at 12 weeks of age. It is then a yearly vaccine. If the patient has been given 2 consistent rabies vaccines (exactly 1 year apart, they can qualify for a 3 year vaccine the following year).”

18. Feline core vaccines: FVRCP
FVR: Feline viral rhinotracheitis
C: Calicivirus
P: Panleukopenia
This is started at 6-8 weeks of age and administered every 3-4 weeks until 16 weeks of age
Feline viral rhinotracheitis (Feline herpes)
Panleukopenia (Feline Distemper/Parvo)
Feline vaccines (DOVE 7 minutes)

19. Feline viral rhinotracheitis/Calicivirus
What to say: “These two viruses are highly contagious upper respiratory infection. They are seen in both vaccinated and unvaccinated cats year-round. It will be much worse for unvaccinated cats. They are passed through direct contact or through nasal droplets. Although they cause similar upper respiratory signs, Feline viral rhinotracheitis (also known as Feline herpes) causes corneal ulcers and Feline Calicivirus cause ulcerative stomatitis. Once infected with these viruses, cats may have flair ups year-round when not vaccinated.”
“This vaccine is a combination vaccine and is given starting at 6-8 weeks of age. It is then boosted every 3-4 weeks until they are 16 weeks of age. This way they will have full immunity before they are a year old.”
Feline viral rhinotracheitis (Feline herpes): Corneal ulcers
Feline Calicivirus: Ulcerative stomatitis

20. Feline Panleukopenia vaccine:
What to say: “The next portion of the vaccine is Feline Panleukopenia. It is a virus that attacks developing cells so that is why younger cats are more susceptible. It causes GI, upper respiratory symptoms and some neurologic symptoms.
“This vaccine is part of the combination vaccine and is given starting at 6-8 weeks of age. It is then boosted every 3-4 weeks until they are 16 weeks of age. This way they will have full immunity before they are a year old.”
Essentially this disease could cause their brains to not fully develop, REMEMBER Cerebellar hypoplasia: Cerebellum is smaller due to cell destruction in the brain

21. Feline Leukemia vaccine:
What to say: “Feline Leukemia is an immunosuppressive disease. The virus attacks cats' immune systems. They can contract it from other infected cats through direct contact (most common is through grooming). They can also contract it from their mothers through nursing. This virus makes them very sick because their immune system is weakened and they are more prone to secondary infections. There is no cure for this infection.”
“It is given at 8 weeks of age and is boosted one time 3-4 weeks later. It is then given yearly. Even if your cat is indoors, its still a good idea to at least have this vaccine done every year for a couple years.”
Remind them about the kitten getting out and being exposed.
Also remember we test at 8 weeks of age, before we vaccinate for the virus.

22. Feline immunodeficiency:
What to say: “This virus attacks the cat's immune system. It is mainly contracted through cat bite wounds. Stray intact cats tend to be the main carriers. Although, we do not vaccine for it, it is recommended to have any cats with an unknown history tested.”
“This test is in a combination snap test with Feline Leukemia. The cat must be 6 months of age though to get accurate results due to protection from their mother.”
Remember FELV test for an antigen and FIV test for an antibody
antigen=active infection, antibody=exposure to infection

23. Communicating with the doctor
Once you have obtained a history and gone over vaccines with the client, you then communicate with the doctor.
This important because the client may have declined or had additional questions over something that only the doctor could go over.
A big one is blood work. You as the technician usually will go over the importance of blood work, but a lot of times the owners will want to speak with the doctor.
Do you know why we do recommend blood work?
This would include any abnormalities the owner mentioned or any abnormal vital signs.

24. Next step for a wellness exam
Help the doctor examine the patient
Present estimate/Treatment plan
Pull up all vaccines
Be prepared to hold for the doctor
Diagnostics: heartworm/felv/fiv testing or blood work
If any of these diagnostic are positive or indicate something abnormal, the doctor will go over the results
Some blood work is sent off to a laboratory facility. The result should come back by the next day

25. Educate clients on their options for heartworm and flea prevention
This is very important!!!
This will depend on their age, weight, and diagnostic test results
It also depends on what your hospital currently has. You want to try and promote the preventions your hospital has. These are also the preventions your doctors trust so you should trust them as well.
Can you guys name heartworm preventions?
Can you guys name flea preventions?
What about the combination ones?
Heartworm Testing (DOVE) 5 mins
Remember you can’t give certain heartworm preventions to patients who are positive (Trifexis is a NO GO)

26. Flea preventions: Advantage (imidacloprid)- once a month spot-on
Sentinel: (Lufenuron)-oral in dogs; injectable in cats
Frontline (fipronil) - once a month spot-on
Revolution (Selamectin) – once a month spot-on
Comfortis (spinosad) - once a month ORAL tablet
Bravecto (fluralaner) – 3 month oral tablet; CNS paralysis and death
Nexguard (Afoxolaner) – once a month chewable

27. Heart worm preventions:
HEARTGARD/IVERHEART (Ivermectin/pyrantel pamoate)
SENTINEL (Milbemycin oxime+lufeneron)
REVOLUTION (Selamectin)
ADVANTAGE MULTI/PROHEART 6
Moxidectin
ProHeart: Q 6 month injectable
TRIFEXIS (Milbemycin oxime + Spinosad)

28. Finishing the exam right!
Make sure that all charges are in correctly with vaccine numbers (Rabies requires a tag number)
You also need to make sure these numbers are added into the medical record with the route and location the vaccine was administered
The last step is to discharge the patient
Go over any medications/heartworm/flea prevention
Help the client back to the lobby
Schedule their recheck if needed (Healthy exams should be good for a year)
This last part will let the client know that you care about their pets health!!!!
You the vaccine information in the plan area of the SOAP
New Client Orientation (DOVE) 1 min

29. Don’t forget to clean the rooms between each patient…
This will include sweeping the floors/mopping
Wiping down the tables
Cleaning any tools that were used or replacing them
This helps reduce the spread of disease and makes the room more welcoming and presentable
If there was a sick patient in the exam room, the room can be shut down to patients that could potentially contract something
Ex: Dog with upper respiratory, only place cats in the room the rest of the day
Cleaning Exam Rooms (DOVE) 2 mins
The exam room reflect what the clients will think is happening in the treatment area
Mopping is last to help with disease control

30. Running a sick patient exam
First step: find out what their primary/chief complaint is
Obtain a thorough history (know their vaccine status)
Obtaining vitals
Know what is normal and what is abnormal
Remember some diseases can be spread by fomites! Be aware for your safety and other patients
Wear PPE if needed
Clean rooms thoroughly afterwards
Mark rooms as needed

31. Communicating with the doctor
This is very important!!!
Details will help the doctor rule out certain diseases
Can you name some diseases that we vaccinate for?
The goal is to ask all the right questions so the doctor does not have to ask those additional questions
Let the doctor know if you see abnormalities
Any nasal discharge/epistaxis/crust
Abnormal vitals
If the patient seems lethargic/nauseous
If vitals are abnormal, make sure you tell the doctor

32. Next step for a sick patient exam
Help the doctor examine the patient
Present estimate/Treatment plan
MAKE SURE YOU GET A SIGNITURE!!
Sick patient visits can be expensive and include a lot of different diagnostic testing
Diagnostic testing could include:
Blood work
Radiographs
Parvovirus testing/Fecal/UA/Skin scrape
This all depends on the chief complaint

33. Outpatient care for the patient
Once the doctor has gone over their diagnosis, it is up to you to finish the appointment
Fill medications for their specific condition
Make sure medication has patients name, clinic name, clinic address, clinic phone number, doctors name, expiration date, date it was prescribed, refills
Make sure instructions are clear for the owner
Go over any discharge instructions/medications with the owner
You might need to administer first dose of medication
Filling Prescriptions (DOVE) 1 min

34. Don’t forget call backs for any patients who were discharged
These are done for patients who were discharged the day before
The technician uses the computer system/patient charts to get a through history
This lets them know what the patient was seen for (chief complaint)
This lets them know what medications the patient was sent home with
Once the technician speaks with the owner, they must document the entire conversation in the computer system for that specific patient
ITS ALL ABOUT COMMUNICATION