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Veterinarian Technician July 2007 (Vol 28, No 7) Focus: Medical Advances

On The Cover: "A Talk with Gerianne Holzman, CVT, VTS (Dentistry)"

by Andrea Vardaro Tucker

    As a college student in the late 1970s, Gerianne Holzman, CVT, VTS (Dentistry), knew that she wanted to work at a veterinary school. There was only one problem: Her state didn't have one. When the University of Wisconsin School of Veterinary Medicine's Veterinary Medical Teaching Hospital (VMTH) finally opened in 1983, Gerianne landed her dream job. Nearly 24 years later, Gerianne is still living her dream, working as a veterinary technician and coordinating the day-to-day activities of the VMTH's small animal surgery ward and feline kidney transplant program.

    Gerianne has achieved numerous successes in and beyond the school. She not only was elected secretary of the Wisconsin Veterinary Technician Association from 1983 to 1985 and president from 1988 to 1989 but also was chosen as the association's technician of the year in 1999. Her fourth-year veterinary students at the VMTH have selected her as distinguished technician of the year five times, and, in 2006, she became one of only 15 people in the world to earn the designation of veterinary technician specialist in dentistry. She also helped establish and continues to work in the VMTH's dentistry service.

    As the coordinator of the VMTH's cutting-edge renal transplant program, Gerianne gives us an insider's perspective on medical advances in the veterinary field and educational advances in the technician profession.

    Learn more about Gerianne's background and favorite hobby .

    When you first became a technician, did you think renal transplantation would ever be possible?

    I never really thought about whether transplantation would be possible. I graduated from the animal technician program of Madison Area Technical College (MATC) in 1978, the first year that the technician certification examination was offered in Wisconsin. The MATC technician program had only started in 1970, so we were learning as our instructors were learning about this new profession. We didn't even have computers back then; I wrote my term papers on a manual typewriter! Medicine, in general, is advancing quickly, and technology continues to develop at an even faster rate. Without the advent of the operating microscope, feline renal transplants probably would not be possible. It's amazing that we are now able to provide this service.

    How important is the transplantation program?

    Kidney transplants give cat owners an additional choice of treatment for a common feline medical condition, chronic renal failure. By the time most potential clients contact us, they've spent years treating their beloved pets with subcutaneous fluids, special diets, and other medications. Kidney transplantation usually serves as the last option to relieve a cat's suffering and, if successful, can add many healthy years to the patient's life.a

    Describe your role as coordinator of the program.

    It involves a lot of communication. I converse with referring veterinarians and potential clients; review all preoperative laboratory test results for transplant recipients with Jonathan McAnulty, DVM, MS, PhD, our transplant surgeon; and coordinate the surgery with the entire transplant team: surgeons, students, and operating room, anesthesia, critical care, radiology, and pharmacy staff. I also help select and, if necessary, name the donor cat. When the patient's family arrives, I give them information about Madison because we ask them to stay in town until, at least, the day after surgery. I also monitor the patient's status after discharge, which includes answering client questions, reviewing blood work results with our clinicians, and conveying medication changes to referring veterinarians.

    How do you typically find a donor cat?

    A donor can come from the recipient's family if its blood is a match and it is young and healthy. Otherwise, we obtain donors from facilities that raise animals primarily for research, so we know each cat's entire life history. These cats are young, healthy, and amazingly friendly. All members of the transplant team are encouraged to interact with the donors and help socialize them to their new environment because most have never left their birth facility. It's wonderful to watch them discover a whole new world.

    Walk us through a successful transplantation.

    We admit the donor cat the week before surgery and complete a full laboratory workup to confirm that it is in good health. On the day of the transplant, the donor's surgery begins in the morning and lasts about 2 hours. If the donor is not already spayed or neutered, this procedure is also done at the time of the kidney harvest. We also take one unit of blood from the donor for the recipient.

    The recipient's surgery begins in the early afternoon and lasts 4 to 5 hours. We usually leave the native kidneys in place so the cat has some kidney function in case the graft fails. Both the donor and recipient cats spend the night in the critical care unit, where they are closely monitored. The donor usually comes back to the surgery ward the day after surgery and is able to go to its new home with the recipient's family by the end of the week. One of our requirements is that the recipient's family must adopt the donor cat. Recipients generally stay in the hospital for a month postoperatively so we can monitor and stabilize the level of cyclosporine — the antirejection drug they receive for the rest of their lives — in their blood and ensure their blood kidney values have returned to normal.

    Your success rate is quite high.

    Currently, 80% to 85% of our patients survive surgery and are able to go home. This is a great statistic, but I always caution clients that statistics really don't matter if their cat doesn't survive. No matter how long patients live after surgery, it's heartbreaking for us when they die because a lot of time, effort, and emotion go into deciding to perform a transplant and to care for the patients in the hospital and at home. It takes a very special person to choose this procedure for their pet and to provide the extra care needed after surgery.

    We've performed 63 transplants on 61 patients. Our youngest recipient was 8 months old; the oldest recipient was 19 years old at the time of surgery and is still doing well approximately 1 year later. Our current longest survivor underwent the surgery more than 8 years ago and is now 18 years old. We've had patients come to us that were rejected at other transplant facilities. Although many of our recipients come from the Midwest, we've had patients from all over the country. One cat, Linus, came all the way from Singapore!

    Was Linus's transplant surgery successful?

    Yes, but the really interesting part was trying to get Linus and his donor, Pigpen, back into Singapore, which is a rabies-free country where any imported animals must spend at least 30 days in quarantine. This, of course, was not suitable for Linus because he had to be medicated twice daily and needed additional care. Linus and Pigpen spent an extra 2 weeks at our hospital while the owners went through all the bureaucracy to avoid the quarantine period. Despite the airline's last-minute requirement that Pigpen travel in the hold, both cats were fine on the plane, but once they got to Singapore, the authorities insisted that they go into quarantine. Finally, after some "discussion," both cats were allowed to go home.

    Do any other cases stand out in your memory?

    A couple of years ago, the owners of a cat named Milo purchased an RV to drive to our hospital because they didn't think Milo would tolerate a plane ride. The surgery went well, but Milo soon rejected the new kidney and it had to be removed. Thankfully, we obtained a second donor cat, and Milo underwent another transplant surgery, which was successful. After staying in Madison during the entire ordeal, Milo's owners welcomed both donor cats into their already full home, and Milo continues to do well. I found it incredible that these great owners spent a large amount of money to save their cat and had the emotional fortitude to continue after such a devastating setback. Exceptional clients like them make this job so special.

    You also serve as a teacher in the hospital. Did teaching come naturally?

    Many members of my family are teachers, but when I got my first students, I didn't know how to teach them what I'd been doing for 8 years, and it was frustrating. I looked to many clinicians for examples of how to teach and found that the patience and quiet demeanor of Eberhard Rosin, DVM, PhD, went much further in instructing the students than did other teaching styles. Dr. Rosin became my mentor and friend. The patient's best interest was at the heart of everything he did. Even after developing amyotrophic lateral sclerosis, also known as Lou Gehrig's disease, Dr. Rosin continued to teach by creating a manual for the students. He was an inspiration to all and a friend to many.

    What inspired you to become specialized in dentistry?

    Historically, dentistry has not been taught in detail to veterinary medical or veterinary technician students, yet periodontal disease is the number-one problem in dogs and cats. I helped establish the dentistry service at the VMTH to provide better service to our patients and clients and to expand my interests. The VMTH now hosts one of the few veterinary dental residency programs in the United States. With this background, joining the Academy of Veterinary Dental Technicians' organizing committee and becoming specialized in dentistry were logical steps. I still spend 1 full day a week in the VMTH dentistry and oral surgery department.

    What are some lessons you've learned that would benefit fellow technicians?

    Stick with the profession. Even if your current job is not your dream job, there are plenty of other clinics, hospitals, referral centers, pharmaceutical companies, and other employers of veterinary technicians. There are also numerous opportunities for growth within the veterinary technology profession if you're willing to work hard. The profession is continuing to evolve, and I encourage veterinary technicians to grow with their job and join local, state, and national organizations to keep abreast of changes. Don't give up!

    aMore information on the VMTH's transplant program can be found at www.vetmed.wisc.edu/dss/mcanulty/felinekidneytransplant/.

    NEXT: Preventing Iatrogenic Tracheal Trauma
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