Fall is almost upon us and here at VRCC, we are ready for some cooler weather, warm blankets and pumpkin spice everything!

This issue of the VRCC newsletter highlights our Dermatology, Emergency, and Internal Medicine teams, and provides up-to-date information on upcoming events and news about the hospital.

Learn more about one of our Board Certified Dermatologists, Dr. Jeremy Bachtel.

The VRCC Emergency team discusses Wookie, a patient who came to see Dr. Debbie Van Pelt for a Addison’s disease.

Learn more about VRCC Internal Medicine in the Specialty Highlight section.

With cozy wishes this fall season,

Your VRCC Team

VRCC WELCOMES THE FALL SEASON!

FALL 2017 NEWSLETTER

3550 South Jason StreetEnglewood, CO 80110(303) 874-PETS (7387)www.vrcc.com

Dr. Jeremy Bachtel, clinical dermatologist at VRCC, was not always a veterinary dermatologist. Many years ago, he roamed the Arizona deserts in search of wildlife as a wrangler for the Arizona Game and Fish department. When not wrestling rogue alligators from backyards, he also served as a teaching ambassador to local schools, bringing live educational fauna to children of all ages. Fun fact: Dr. Bachtel’s worst injury was a bite on the nose from a bald eagle, requiring several stitches. He bears the scar to this day, and avoids bald eagles when possible.

Since moving to Colorado for his dermatology residency, he has stayed here at VRCC and has recaptured his love of the outdoors. You’ll often find him on the Colorado hiking trails outside of work, and perhaps enjoying a craft brew at the local pub thereafter. Comic-Con, the Estes Park Scottish festival, and the Renaissance Festival are also annual haunts, though he eventually returns home to the company of his cats, Steve and Steve.

In a professional capacity, Dr. Bachtel has published several research articles on veterinary therapeutics and has a particular acumen for the treatment of chronic ear infections and disease. He has also given several lectures regionally in the management of veterinary skin disease. As a board-certified veterinary dermatologist, Dr. Bachtel specializes in the management of allergy, otitis, and infectious and immune-mediated skin disease in all animals.

Specialty Highlight . . . Continues on page 2

STAFF HIGHLIGHT: DERMATOLOGYDr. Jeremy Bachtel, DVM, MS, Diplomate ACVD

The VRCC Internal Medicine department’s goal continues to be to work in partnership with referring veterinarians to provide excellent service and patient care to clients and patients. In conjunction with our 24-hour Critical Care & Emergency services, our Internal Medicine team provides the most well rounded and experienced care in the Denver Metro area.

We are excited to welcome Dr. Danielle Bayliss to our team! Dr. Bayliss attended veterinary school at Kansas State University, followed by a rotating Internship in Small Animal Internal Medicine and Surgery at Cornell University in Ithaca, NY. She then completed her Internal Medicine residency at Colorado State University. Dr. Bayliss practiced Internal Medicine at a referral and specialty hospital in Memphis, Tennessee for nine years prior to returning to her home state of Colorado to join VRCC. Dr. Bayliss has a Master’s degree in Clinical Sciences with an emphasis in feline infectious disease, and while she enjoys all aspects of Internal Medicine, she is particularly interested in interventional endoscopy and endocrinology. In her spare time, Dr. Bayliss enjoys spending time with her family and practicing aerial arts. In fact, she even owns an aerial arts studio in Memphis!

SPECIALTY HIGHLIGHT: INTERNAL MEDICINE

CONTINUING EDUCATION: HUDSON GARDENSVRCC is hosting our regional continuing education event on Wednesday, October 25th at Hudson Gardens in Littleton from 6pm - 10pm. Join us for an evening of learning at a beautiful venue! Current topics in veterinary specialty medicine will be discussed. Registration and dinner is at 6 p.m., lectures begin at 7 p.m. Come early to explore the Gardens. 3.0 CE Credits are available for this event. Registration is now open (space is limited to 100 DVMs). RSVP to Ruby Post at 303.874.2053 or rpost@vrcc.com.

Signalment: Wookie, 1 year old, neutered male, Husky mix History: Presents for emergency evaluation of progressively worsening lethargy of 4 days duration. Wookie has had diarrhea for 3 days and multiple episodes of vomiting of white foamy material over the past 24 hours. Today, he can barely stand and could not get up this morning.Physical examination: T = 99.5, P = 108 bpm, R = 30 breaths/min, body weight = 26.1 kg. Wookie was extremely weak and required assistance to stand. He was very subdued. Mucous membranes were pink, with CRT <2 sec. Pulses were weak but synchronous. Abdomen was soft and nonpainful. Rectal exam revealed scan feces. Emergency treatment and diagnostics:Blood pressure on presentation was 40 mmHg. A PIVC was placed and Wookie was bolused 500 ml of 0.9% NaCl IV over 10 minutes, after which BP increased to 72 mmHg. Initial PCV = 70% with total solids of 5.8 g/dl. Istat showed glucose = 93 mg/dl, BUN = 139 mg/dl, Na = 124 mmol/l, K = 7.9 mmol/l and Cl = 94 mmol/l. Wookie started having twitching episodes. Because of concern for hyperkalemia, he was administered regular insulin IV as well as a dextrose bolus. 2.5% dextrose was added to the 0.9% NaCl and continued at an aggressive rate of fluids. He was administered 5 mg of Dex SP IV once, as well as Famotidine and Cerenia IV and was maintained on IV fluids overnight. Because of concerns for potential of Addison’s disease, chemistry panel, CBC and ACTH stimulation were submitted. Monitoring and outcome:Overnight, Wookie ate and drank readily; no vomiting or diarrhea were noted. Blood pressure was stable between 104-136 mmHg. Wookie’s temperature had normalized; he was bright, alert, ambulatory and interactive. BUN was decreased to 40 mg/dl, creatinine decreased to 1.5 mg/dl, Na = 146 mmol/l, K = 4.7 mmol/l. Chemistry results confirmed elevated BUN, creatinine and potassium, and decreased Na/K ratio of 15. CBC confirmed elevated hematocrit and an absence of a stress leukogram. Both pre and post stimulation samples showed cortisol < 1 ug/dl, confirming the presence of Addison’s disease. Wookie was administered Percorten 57 mg IM and was started on oral prednisone at 5 mg once

daily. He was discharged to his owners care approximately 36 hours after presentation. Addison’s diseaseHypoadrenocorticism (Addison’s disease) is caused by a deficiency of glucocorticoid and/or mineralocorticoid production by the adrenal cortices. Causes can include idiopathic (likely immune-mediated), iatrogenic secondary to mitotane or trilostane therapy or rarely, adrenocortical destruction secondary to granulomatous disease, neoplasia or hemorrhage. Atypical Addison’s refers to a subset of patients in whom selective glucocorticoid deficiency is present (as demonstrated by low resting cortisol) but with normal electrolytes. The majority of these patients eventually develop concurrent mineralocorticoid deficiency. Most affected dogs present in young to middle age, although naturally recurring hypoadrenocorticism has been reported in dogs ranging from 2 months to 14 years. Female dogs are twice as likely to be affected. Genetic predisposition has been confirmed in Standard poodles and Bearded collies. Clinical symptoms in these patients commonly include lethargy/depression, anorexia, vomiting, weakness, weight loss and dehydration. Waxing and waning course is described in approximately 40% of patients. Laboratory findings often include hyperkalemia, hyponatremia, Na/K ratio <27:1, hypochloremia, azotemia, hypoglycemia and lack of stress leukogram. Dogs with atypical Addison’s will not demonstrate the aforementioned electrolyte abnormalities. Diagnosis of Addison’s disease is based on a high degree of clinical suspicion, with confirmation by a resting cortisol or ACTH stimulation test. Basal and post ACTH stimulation cortisol concentrations are <1 ug/dl in over 75% of dogs with hypoadrenocorticism.An Addisonian crisis is a medical emergency, necessitating aggressive therapy aimed at correcting hypovolemia and electrolyte abnormalities and providing an immediate source of rapid-acting glucocorticoid. Rapid infusion of large volumes (60-80 ml/kg/hr for 1-2 hours) of crystalloids, ideally 0.9% NaCl, will help to address the hypotension and

CASE STUDY: EMERGENCY & CRITICAL CARESpecialty Highlight . . . Continued

Internal Medicine welcomes another recent addition to our arsenal of state-of-the-art equipment: a new flexible scope. This scope allows us to retroflex above the soft palate in small dogs and cats in order to see disease in the nasopharynx including: foreign material, mites, masses, stenosis and rhinitis. In addition to the new scope, we still have our other scopes to perform upper GI endoscopy, male and female cystoscopy, rhinoscopy and bronchoscopy. We frequently utilize our on-site CT scanner for the work-up of nasal related problems.

We are very proud to announce that our lead Internal Medicine technician, Kari Walker, recently passed the specialty certification examination in Internal Medicine, and earned her VTS. She now joins the ranks of less than 100 other Internal Medicine Specialty Technicians across the US. Way to go Kari - we are so honored to have you on the VRCC team!

With the addition of Dr. Bayliss, we now have five board certified internists to accommodate more appointments and are able to care for more hospitalized patients. If you have questions about the services that we provide or would like to talk with one of our specialists about a case, Internal Medicine can be reached at 303-874-2055, or internalmedicine@vrcc.com. We look forward to assisting you in providing advanced critical care medicine to your clients and patients.

BATTLE OF THE VET HOSPITAL STARS

By: Dr. Debbie Van Pelt, DVM, MS, Diplomate ACVECC

Apex Dog and Cat Dentistry is excited to celebrate 10 years of excellence in dentistry and oral surgery with the VRCC! We are looking forward to our continued partnership with you and your clients. For any assistance, Dr. Beebe and the dentistry team can be reached at 303-810-6029 or dentistvet@me.com.

New VRCC doctor alert! We’d like to introduce Dr. Evan Lehman to the VRCC Emergency team. We have a new Radiation Oncologist that will be joining VRCC Oncology in early October, Dr. Katie Swift. Welcome to the team!

VRCC NEWSOctober 15 - 21 is National Veterinary Technician Appreciation week. Veterinary technicians are a vital part of our industry and do so much for our clients and patients. “THANK YOU!” to all Colorado veterinary technicians for all of your hard work!

VRCC was humbled by all of donations that came pouring in for disaster relief in Houston from hurricane Harvey. Our regional manager, Donna Wagner-Rago drove a large U-Haul (that was completely full!) out to Houston in early September to offer some much needed supplies for the people of Houston. Thank you to everyone who donated!

hypovolemia. This also helps to reduce serum potassium concentrations and increase renal perfusion.Hyperkalemia is often corrected by IV fluid therapy alone. However, for severe hyperkalemia resulting in significant arrhythmias (atrial standstill, significant bradycardia), intervention in the form of regular insulin administration (0.5 U/kg IV) and dextrose supplementation (as both bolus and as fluid additive) may be necessary. Alternatively, slow administration of NaHCO3 (1-2 mEq/kg over 15 minutes) or 10% calcium chloride (0.1 ml/kg over 20 minutes) can be cardioprotective. Administration of rapid acting glucocorticoid is important in stabilization of these patients. Dexamethasone sodium phosphate can be safely administered IV and will not interfere with ACTH stimulation tests results. Glucocorticoid administration can then be tapered to oral prednisone (0.2 mg/kg) over the next week. Unfortunately, no rapid-acting parenteral mineralocorticoid is currently available. Once a diagnosis of Addison’s disease is confirmed, administration of DOCP (Percorten) can begin. Wookie demonstrated clinical symptoms and initial preliminary lab work very suggestive of Addison’s disease. Prompt and aggressive intervention in these patients often results in dramatic improvement in a relatively short period of time, making treatment and diagnosis of Addisonian crisis extremely rewarding. We are happy to report that Wookie continues to do extremely well at home on his monthly Percorten injections and daily oral prednisone.

VRCC’s 6th annual Battle of the Vet Hospital Stars took place on Sunday, September 10th, and was a huge success! This annual, day-long event is filled with fun field-day games, team-work, crazy costumes, and camaraderie, all for a great cause! Thank you to all of the veterinary hospitals who competed in this year’s event! Battle would not have been possible without all of our sponsoring companies, a big “THANK YOU” goes out to all of them, especially our title sponsor: Royal Canin! A grand total of $15,738 was raised this year for PetAid Colorado through team entry fees, and a hospital fund-raising challenge. That brings the 6-year running total to an amazing $82,471!!!

We would also like to send a big congratulations to all of the winning hospitals! Our Grand Prize winner of the 2017 Battle was Columbine Animal Hospital! They not only get bragging rights and the coveted traveling trophy for the next year, but they also received a prize pack full of products

and donations from our company sponsors worth nearly $3,500. Brekke Veterinary Clinic placed 2nd, and Lone Tree Veterinary Medical Center took home third prize. Banfield of South Aurora’s “Hungry, Hungry Hippos” won the costume contest, and Louisville Family Animal Hospital won the hospital fund-raising challenge, raising $1,189!

For more information, visit the Battle of the Vet Hospital Stars Facebook Page, or visit www.vrcc.com/calendar-of-events/battle-of-the-vet-hospital-stars

The Handsome Wookie