Veterinarian Referral Letter

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Department of Communication
Sciences and Disorders
College of Allied Health Sciences
University of Cincinnati
PO Box 670379
Cincinnati, OH 45267-0379
Animal Audiology Clinic & Bioacoustics Laboratory
Peter M. “Skip’ Scheifele, Ph.D., LCDR USN (Ret.), Director
David Brown, Ph.D., Assistant Director
Debbie Kemper, DVM, Audiology Clinic Attending Veterinarian
3202 Eden Avenue
119 French East Building
Phone (513) 558-8503
Fax
(513) 558-8500
Email: fetchlab@uc.edu
Web www.uc.edu/csd
Date:
Re: (Owner’s name and Pet’s Name) ____________________ Phone_______________
Dear Referring Veterinarian:
Your client has requested that his/her dog receive a hearing screening / comprehensive hearing assessment. The
results of the tests performed will not only tell whether the dog can hear but how well they can hear. If a hearing
loss is present, the test will, in most cases, delineate the nature of the hearing loss. Depending upon the request,
the dog will receive a general ear examination followed by either a hearing screening or a comprehensive hearing
assessment. The dog may be required to be sedated for this procedure. The dog will then be sent home or
referred for further imaging (under a different protocol). The report of auditory health will be provided to you and
your client.
Attached is a history form which is requried prior to booking the appointment. Your completion of this form will
provide us with important facts about the present health of this dog that will assist us in assessing the dog’s
hearing health. If required, you, as referring veterinarian will provide the sedation, either administered by you
or by the owner under your direction prior to arrival at the UC clinic. The dog will then simply lie on a small table
in either the sternal or lateral recumbant position and rest during the procedures. Both you and the owner will
receive a report on the state of the dog’s auditory health and any recommended follow-up activities necessary.
The owner/dog’s participation is voluntary and the owner may opt to withdraw this dog from the test at any time.
The owner has also been informed that he/she remains responsible for the dog’s health and behavior and that UC
will not be responsible for injuries to the dog or injuries or property damage caused by the dog.
REFERRING VETERINARIAN
Signed:________________________________
Date: ____________________
Printed Name: __________________________
If your client wishes to have OFFA certifications we have the forms at FETCV
H~LAB clinic. The test requires the dog to stay relatively still so consult with your client regarding the necessity for
sedation (a mild oral sedative). Sedation is not required nor desired for puppies.
UC FETCH~LAB Ver. 01 September 2009
Page 1
Department of Communication
Sciences and Disorders
College of Allied Health Sciences
University of Cincinnati
PO Box 670379
Cincinnati, OH 45267-0379
Animal Audiology Clinic & Bioacoustics Laboratory
Peter M. “Skip’ Scheifele, Ph.D., LCDR USN (Ret.), Director
David Brown, Ph.D., Assistant Director
Debbie Kemper DVM, Audiology Clinic Attending Veterinarian
3202 Eden Avenue
119 French East Building
Phone (513) 558-8503
Fax
(513) 558-8500
Email: fetchlab@uc.edu
Web www.uc.edu/csd
Referring Veterinarian History Page for Audiometric Evaluation
Date:
Owner Name: _____________________________________________ Phone ____________
Pet Name: _______________________________________________
Pet History:
Age: ________________ MALE / FEMALE SPAYED / NEUTERED
Weight: _____________ Color: ______________ Breed: _____________
Vaccinations: Please check all that have been given and date
___
Rabies
_______________________
Date Given
___
Distemper
_______________________
Date Given
___
Parvovirus
_______________________
Date Given
___
Adenovirus
_______________________
Date Given
___
Bordetellosis
_______________________
Date Given
Known allergies: _______________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Critical health history items:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Current medications or treatments that this dog is taking / undergoing:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
How will this pet be sedated for the hearing evaluation? (With what agent, amount, and when)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Referring veterinarian statement of authorization:
By signing this page I am acknowledging that this dog is a safe candidate for audiometric testing.
Signature: ____________________________________
Date: _________________
Printed Name: _________________________________
Dr. and/or Veterinary Clinic Name: ________________________________________________________
Address: _____________________________________________________________________________
_____________________________________________________________________________________
Phone: _________________________
FAX: ___________________________
Email: ___________________________________________
FETCH~LAB Billing codes and explanation
($60.00) = Hearing screening for puppies for the first (group of) three (3) puppies and $10.00 for each subsequent
puppy
($60.00) = Adult Dog Hearing screening includes ear exam repetitive click ABR.
($75.00) = Sonography with click DPOAE includes ultrasound and DPOAE testing.
($100.00) = Full Hearing Assessment Animal auditory brainstem response (ABR) includes the evaluation of both
ears and bone conduction (if necessary) and associated interpretation. A tone stimulus will be used to determine
approximate threshold as well as diagnostic significance (at higher intensities), selected frequency ABRs, and
DPOAE
($803.36) = MRI of Companion Animals is currently charged $803.36. This includes hardware setup (30 minutes),
monitoring of respiration and pulse (Small Animal Instruments, Inc), isoflorane anesthesia, anatomical T2 and T1
(pre and post Gd-DTPA contrast, 0.1 mMol/Kg) of brain (60-90 minutes on the Bruker 3T), data transfer and
archiving, burning to CD with E-Film autoplay software or as DICOM only (15 minutes) and sanitization after the
scan (30 minutes). - RSD
Assessing Hearing & Audiological Impairments Health in Dogs
Two types of hearing assessments are available from the Animal Audiology Clinic at the University of Cincinnati,
hearing screening and a comprehensive hearing assessment. Currently there are no universally accepted clinical
standards in the veterinary world that describe either of these procedures; therefore we are providing this to
describe our procedures.
Hearing Screening
A hearing screening is usually done to determine if a puppy/adult dog can hear or has a hearing problem. Most
often this procedure is requested by breeders, prior to registering and selling their dogs. The screening is a quick
and easy procedure that does not require sedation when done early. The first stage is to perform an otoscopic
examination of the ears. Most Clubs that utilize hearing screening as part of their registration, require an Auditory
Brainstem Response (also known as a Brainstem Auditory Evoked Response or BAER) test. This test requires using
very tiny subdermal needle electrodes placed in three (3) different locations on the dog’s head and a foam eartip
inserted into the ear canal of the ear being tested. The stimulus will be presented at a loud and soft level. This
quick screening is to provide information that the puppy is assumed to have normal hearing at birth.
Comprehensive Hearing Assessment
A comprehensive hearing assessment is conducted to determine the hearing health of any dog or to identify
specific hearing issues or to fit/tune K9 hearing aids. As with the hearing screening, there currently are no
standards for this assessment. Our assessment battery will determine the type and degree of hearing loss across
the frequency range from X to Z. It has three components: otoscopy, Distortion Product Otoacoustic Emissions
(DPOAE) and Auditory Brainstem Response (ABR). This protocol can only take a maximum of 120 minutes after
which the dog can go home. We require the dog to be sedated in order to get accurate results of these tests.
Otoscopy
A general ear examination to assess the canal for debris and to make sure that it is safe to place the ear tip in the
canal.
Distortion Product Otoacoustic Emissions (DPOAE)
The DPOAE is a test of cochlear function specifically the outer haircells. As shown in Figure 2, this is accomplished
by placing a probe in the ear canal and playing a number of pairs of tones into the ear. When the cochlea is
stimulated by a pair of tones it creates additional tones which are transmitted back into the ear canal and can be
recorded by a microphone. If the new tone (cubic distortion tone) is present above the background noise then that
portion of the cochlea is functioning normally. Absent DPOAEs can mean either a conductive or cochlea hearing
loss.
Auditory Brainstem Response (ABR)
The Auditory Brainstem Response or ABR is sometimes referred to in the literature as a Brainstem Auditory Evoked
Response (BAER) or Auditory Evoked Potential (AEP) test. Three subdermal needle electrodes are placed under
the skin on the dog’s head and a foam ear tip is placed in the ear being tested. A sound is sent to the ear and the
EEG waveform in response to that sound is recorded by the electrodes.
When being used to determine hearing ability, it is best to assess the system at various frequencies to determine if
there is hearing across the frequency range since we know that hearing loss can be present at any frequency,
especially in hearing loss due to noise or presbycuses. Frequency specific tone bursts are used to elicit a response
at each frequency tested. If a hearing loss is noted, then bone conduction testing will be done to determine the
type of hearing loss.
At FETCH~LAB all hearing screenings/assessments are always analyzed and confirmed by two (2) audiologists, an
animal bioacoustician, and a veterinarian.
DIRECTIONS TO UC FETCH~LAB
Please telephone Dr. Scheifele at: 513-504-3904 when you are close or on your way to the clinic so that we may
meet you at the French East building and arrange parking. You should pull up into the “turn-around” in front of
French East and I will come out to meet you. Then we will determine where you will park.
http://www.uc.edu/architect/documents/Logistics/logisticsbw_east.pdf
From the north or south via I-75
From I-75, take the Hopple Street exit (exit 3). (If you are traveling north, Hopple Street exits from the left lane)
Turn left off the exit on to Hopple Street.
As you cross the first intersection (Central Parkway), Hopple Street becomes Martin Luther King Drive.
Follow Martin Luther King Drive up the hill to Clifton Avenue.
to West Campus
ML King Drive borders the north edge of the West Campus.
Clifton Avenue borders the west edge of the West Campus.
To East Campus (Medical Center)
To get to the East Campus, follow King to Vine Street.
Turn left onto Vine, then turn right at Goodman Avenue.
From the west via I-74
Take I-74 east to I-75 south.
Take the Hopple Street exit (Exit 3).
Turn left off the exit on to Hopple Street.
As you cross the first intersection (Central Parkway), Hopple Street becomes Martin Luther King Drive.
Follow Martin Luther King Drive up the hill to Clifton Avenue.
To West Campus
ML King Drive King borders the north edge of West Campus.
Clifton Avenue borders the west edge of West Campus.
To East Campus (Medical Center)
To get to the East campus, follow King to Vine Street.
Turn left onto Vine, then turn right at Goodman Avenue.
From the north via I-71
From I-71 south, take the Taft Road exit (exit 3).
The exit places you on Taft Road, a one-way street heading west.
Taft Road becomes Calhoun Street as you near campus.
To East Campus (Medical Center)
Turn right on Jefferson Avenue.
Follow Jefferson until it crosses Martin Luther King Drive.
At MLK Drive, Jefferson Avenue becomes Vine Street.
From Vine, turn right on Goodman Avenue.
To West Campus
Stay on Calhoun until it ends at Clifton Avenue.
Turn right on Clifton Avenue.
From the south via I-71
Take I-71 north until it merges with I-75 just south of Florence, Ky.
Stay on I-75 after you cross the Ohio River.
From the left lane on I-75, take the Hopple Street exit (Exit 3).
Turn left off the exit on to Hopple Street.
As you cross the first intersection (Central Parkway), Hopple Street becomes Martin Luther King Drive.
Follow Martin Luther King Drive up the hill to Clifton Avenue.
To West Campus
ML King Drive borders the north edge of the West Campus.
Clifton Avenue borders the west edge of the West Campus.
To East Campus (Medical Center)
To get to the East Campus, follow King to Vine Street.
Turn left onto Vine, then turn right at Goodman Avenue.
From the east via US 50
From US 50 west, turn right on Taft Road.
Taft is a one-way street heading west.
Taft becomes Calhoun Street as you near campus.
To East Campus (Medical Center)
Turn right on Jefferson Avenue.
Follow Jefferson until it crosses Martin Luther King Drive.
At ML King Drive, Jefferson Avenue becomes Vine Street.
From Vine, turn right on Goodman Avenue.
To West Campus
Stay on Calhoun until it ends at Clifton Avenue.
Turn right on Clifton Avenue.
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