Ultimate Teacher's Guide for VetCheck in the Classroom | Supporting education in veterinary client communication.

VetCheck in the Classroom - Teacher's Guide

This guide includes:

Standards

This guide correlates with the following veterinary nurse and technician standards:

Students will

Discussion questions

1. Understanding complaints

2. Improving compliance

3. Dealing with Dr. Google

4. Reducing the stress of a vet visit

Activities for students

Objectives:

Materials:

Activity 1: Speaking vet to a layperson

  1. This activity is done in groups of 4 or more.
  2. Each team divides into two groups - 1 group will be the educators, the other group will be the interviewers.
  3. The educators will find a layperson and ask them for 5 minutes of their time to explain fleas, ticks, or worms.
  4. The interviewers will determine 5 important questions about the same topic to determine the level of comprehension. Sample questions may include:
    • Where do pets pick up fleas?
    • How can you tell if a pet has fleas?
    • How do you treat for fleas?
    • Why is it important to treat for fleas?
    • Why may you still see fleas after you have treated your pet?
  5. Resources: VetCheck flea, tick or worm handout

Activity 2: Role play

  1. This activity is done in groups of 4 or more.
  2. Each team divides into two groups - 1 group will represent a vet nurse or technician, the other group will be the client.
  3. The veterinarian has just advised the client that the pet needs a dental prophylaxis.  When the nurse goes to make the booking, the client says they will think about it.
  4. The vet nurse group are to workshop some important points to help explain the importance of a dental.
  5. The client group are to workshop the common reasons for why customers do not proceed with dentals.
  6. The groups both then come together to role play their responses.
  7. Resources: VetCheck Dental care handout, Dental health handout

Activity 3: Chinese whispers

  1. This activity is done in 1 or 2 large groups positioned in a circle
  2. Each participant has the chance to explain a mock health condition and give treatment instructions. Students can choose a topic from the VetCheck suite of handouts to help them detail a condition, cause, signs, management and a fictional treatment plan. The first student then explains this to the person next to them. That person then explains it to the person next to them and so on.
    • Example: Fred has been diagnosed with stifle arthritis, which is an irreversible inflammatory condition of the joints. This is due to old age wear and tear. As there is no cure, we must manage the inflammation and pain and try to slow the progression of the disease. The vet has recommended a course of pentosan.  This course of injections is weekly for 4 weeks. Expect improvement by the end of the course. Call us if you noticed any lethargy, pale gums or bleeding.
  3. The last person in the group will recite what they have heard and will be compared against what the first participant explained.
  4. Resources: VetCheck arthritis, hot spots, dry eye, anal gland problems, fleas, ticks, barking

Activity 4: Vet translation

  1. This activity is done in pairs
  2. Students are asked to translate a veterinarian's veterinary practice management record to help the customer understand what the veterinarian has discussed with them.
  3. Students must answer the questions that the client has for each case
  4. Students are to write a pet health summary based on the veterinary practice management record in VetCheck and email it to the teacher. Here are some sample VetCheck summaries

Case 1

Fifi presented with diarrhea. It is chronic and appears to be progressing. The high volume & low frequency suggests that the diarrhea is small intestinal in origin, as does the absence of fresh blood, mucus, and tenesmus, which are the cardinal signs of large bowel diarrhea in small animals. The chronic small bowel diarrhea accompanied by weight loss is most suggestive of a small intestinal malassimilation syndrome, possibly with protein loss into the feces.
General pathophysiologic mechanisms such as non gatrointestinal diseases or maldigestion or malabsorption or SIBO
DfDx’s for this problem
Inflammatory bowel disease:
Lymphocytic/plasmacytic enteritis and eosinophilic enteritis are most common: produce diarrhea by osmotic and exudative mechanisms. Hypoalbuminemia is consistent with these diseases due to increased loss and/or malabsorption.
Lymphangiectasia: Hypoalbuminemia is also consistent with this disease due to protein loss. Diarrhea is not always seen with this disease, but when it occurs is primarily osmotic and associated with fat malabsorption in particular.
Intestinal neoplasia: A diffuse intestinal lymphoma, in particular, can result in malabsorption due to infiltration of the mucosa with neoplastic cells. The infiltrate impedes nutrient absorption and may make the mucosa “leaky”. A focal neoplasia (e.g. lymphoma or adenocarcinoma) can produce partial obstruction (see SIBO above). Hypoalbuminemia may be seen with neoplastic diseases due to transmucosal loss.
Small intestinal bacterial overgrowth (SIBO)

Other considerations:
Food allergy or intolerance: would still be a consideration as 2.5 weeks is not sufficient to adequately assess response to dietary change (allergy may require 6 weeks); wouldn’t commonly expect hypoalbuminemia with these differentials.
GI parasites: These would seem unlikely now given the absence of a response to a broad- spectrum anthelmintic. Whipworms usually cause signs of colitis (no evidence for), and rarely an Addison’s-like disease, which is not supported in this dog. One consideration is still giardiasis, which can be difficult to diagnose and difficult to treat. However, the treatments instituted already would have been expected to be effective against giardia. Likewise, we don’t expect hypoalbuminemia with giardiasis – although the hypoalbuminemia could be resulting from something besides GI disease.

Initial Plan to address this problem:

  • Regular worming regime
  • Repeat folate & cobalamin: especially now, following antibiotic treatment (Drug A, bid, PO for 10 days). Is there any indication of change?
  • Repeat TLI: just to be sure we can rule out EPI, which is a treatable disease. A single value could always be in error.
  • Repeat CBC, Panel and UA: These values are now several weeks old and things may have changed. This will also help rule out non-GI causes of diarrhea, such as liver or renal disease.
  • Imaging – recommend abdominal ultrasound as the most sensitive method to evaluate thickness of the intestinal mucosa, look for abdominal masses, and examine mesenteric lymph nodes for increased size. Since IBD and alimentary lymphoma are important DfDx, this may be best non-invasive way to look for compatible lesions. However, both of these diseases can, at least initially, produce very subtle lesions that might not be detected.
  • Future consideration: in order to make a Dx, we may ultimately need to biopsy intestine, either via endoscope or laparotomy.

Case 1 questions from the client:

Case 2

{a} General pathophysiologic mechanisms
Hypoalbuminemia can be caused by 3 general mechanisms:
1. Decreased production - liver disease (there is currently little evidence for liver disease).
2. Increased loss via the:
• Gastrointestinal tract
• Kidney (especially glomerular disease; a protein-losing nephropathy)
• 3rd space – lost into a cavity such as chest or abdomen (e.g. due to
vasculitis)
3. Decreased intake (chronic malnutrition)
{b} Mechanisms most likely in this case:
There is currently little evidence for liver disease. However, a more sensitive function test like bile acids would be necessary to address more carefully.
GI loss is supported by history of diarrhea and weight loss with DfDx’s as for problem #1. Protein-losing enteropathies are classically associated with panhypoproteinemia due to loss of both albumin and globulin.
Loss into urine: a urinalysis should be performed to exclude the contribution of urinary tract losses to the low albumin in this dog.
3rd spacing: There is no evidence or history of fever, edema or ascites as might be expected with pleuritis or peritonitis; no inflammatory leukogram or thrombocytopenia as might be seen with vasculitis.
Decreased absorption of protein could be contributing to the hypoproteinemia. However, even dogs with EPI and severe malassimilation most commonly have normal serum protein due to production by the liver.
{c} DfDx
{d} Initial Plan (P)
  Perform CBC, Biochem panel and bile acids. Repeat panel in a month to see if hypoproteinemia is worsening or otherwise changed.   Perform a UA to rule out protein-losing nephropathy (renal disease). Measure and document food intake over the week and report back.

Case 2 questions from client:

References

https://www.vetmed.wsu.edu/docs/librariesprovider16/docs---diagnostic-challenge/soap-examples/syspath-1.pdf?sfvrsn=2