Committed to Highly Critical Care
With just a couple dozen veterinary dialysis centers available nationwide, Cummings School of Veterinary Medicine operates a unique service for animals in need of this specialized treatment.
A well-rounded veterinary technician with 25 years of experience, Carolyn Tai, CVT, oversees Cummings School’s dialysis center, located in its Foster Hospital for Small Animals.
Fueled by an interest in animals, Tai jumped at an opportunity to volunteer at the St. Louis Zoo while earning a B.S. in biology at the University of Missouri in St. Louis. She liked it so much that she landed a position and worked there for 10 years, handling many different species.
Tai left the Zoo due to an illness in her family and started working as a veterinary technician. She has worked at Cummings School for 12 years, with the last two years primarily in dialysis, a rare service in the veterinary field.
“I like to challenge myself, so a little while after working here, I heard about veterinary technician specialties,” she explains. Tai earned Veterinary Technician Specialist (VTS) certification in both Emergency and Critical Care in 2013 and Internal Medicine in 2021. She worked in both the Intensive Care Unit or the Emergency Room until the School’s dialysis service reached a need due to staffing shortages.
Armed with some training and part-time work filling in, Tai jumped in. “I always loved it because it’s interesting and different and it is highly critical care, which I’ve always enjoyed.” After splitting time with another dialysis technician, Tai assumed full-time responsibilities as the only dialysis technician just before the pandemic began.
“And, unfortunately, our dialysis service has gotten a lot busier in the last two years,” Tai acknowledges, pointing out that because they do therapeutic plasma exchange, it would be more appropriate to call it an extracorporeal therapy service, which addresses immune mediated diseases and toxicities. Dialysis is a treatment in response to kidney failure.
“In the last year we’re now offering hemoperfusion for toxicities and we’re doing a study on removing inflammatory mediators using a cytokine filter.”
The demand for services has resulted in three consecutive years of increases for Cummings School. Over the last nine months, they have seen 35 patients and administered 67 sessions.
Tai expects the demand will continue. “We’re expecting a bad leptospirosis season this year,” she laments. A bacterial disease, leptospirosis is spread through the urine of infected animals and some patients who contract it require dialysis for treatment. (Learn more about protecting animals from leptospirosis).
The unique set of skills Tai possesses enable Cummings School to operate more efficiently despite space and staff limitations.
"Dialysis is an extension of critical care and most of the patients that we’re caring for require intensive monitoring, as well as creative thinking," Caroyln Tai, CVT
A patient that was recently on a ventilator and simultaneously receiving dialysis would usually require more than one technician, but with Tai’s ECC training, she managed the patient from all aspects.
“Working in the critical care unit, you need to know how to multitask,” she explains, “Especially as a learning institution and a teaching hospital. You must remember that an animal may not be limited to just one disease process.
“For instance, an animal that is diabetic could develop heart failure, or have liver disease or kidney disease, so you have to consider all its ailments.”
For this reason, all Cummings School internal medicine residents are required to learn dialysis as part of their residency.
Tai is always on call with the resident and a faculty member. “Our current [Urology/Nephrology] Fellow Emmanuelle Butty, med. vet., DACVIM (SAIM), will soon join our faculty, which we're really excited about,” Tai beams. Mary Labato, V83, DACVIM, oversees the operations, including residents’ training.
Every other year, a Veterinary Dialysis Academy is operated by the Veterinary Nephrology Society. The 18-month course certifies residents to run dialysis, according to Tai. The course is popular among veterinary residents and critical care residents also enroll in the Academy to learn about this aspect of veterinary medicine. Labato is among the Society members who serve as the academy’s instructors.
“I work with and train the Internal Medicine residents to set up the extracorporeal (dialysis) circuits for the course. We use a fake patient, a stuffed dog that we put food coloring in, so the residents can see the food coloring get removed by dialysis,” Tai explains.
As for her next challenge, Tai recently learned of a new academy run by the American Society of Veterinary Nephrology and Urology. She is hoping that if a VTS for nephrology and urology is developed, she would love to do it.
While contemplating her next educational pursuit, Tai is excited that Cummings School is expanding its services. She estimates that intermittent hemodialysis accounts for approximately 60 to 70 percent of their cases. However, she points out that over the last few years “more published studies have referenced therapeutic plasma exchange for immune-mediated disease processes,” Tai declares, mentioning the rise she’s seen in cases of immune-mediated hemolytic anemia (IMHA) dogs, and immune thrombocytopenia (ITP) dogs.
Using therapeutic plasma exchange for either ITP or IMHA is gaining popularity, and Cummings School has offered that option, as well as hemoperfusion. A recent purchase of a hemoperfusion pump could enable toxicity patients to skip a day or more of treatment in the hospital.
“Previously, even with therapeutic plasma exchange, a patient probably would have had to be in the hospital for three days, but with the hemoperfusion she may be able to go home as early as one day, possibly two,” she contends.
Another new machine that Cummings School is hoping to obtain would enable it to treat patients that are in the range of 2–10 kg (4–22 lbs). “It’s called CARPEDIEM and we'll be able to put small animals on it, such as cats, ferrets, or exotic species,” Tai shares. “We’re excited about the possibility of adding these new therapies.
Do you have a passion for taking care of pets and the people who love them? Are you looking for a collaborative work environment where you can learn, teach, and grow? Cummings School of Veterinary Medicine is hiring Veterinary Technicians for our Foster Hospital for Small Animals at Tufts University and our Large Animal Hospital. Our team of professionals works hard and smiles more. Join us. Learn more and apply.
Department:Foster Hospital for Small Animals