July/Juillet 2015 The Canadian Veterinary Journal

Vol. 56, No. 07Vol. 56, La Revue vétérinaire canadienne

July/Juillet 2015 Volume 56, No. 07

Demographics of the Canadian dairy industry from 1991 to 2011

Autologous vaccination for the treatment of equine sarcoids: 18 cases (2009–2014)

Long-term prospective evaluation of intestinal anastomosis using stainless steel staples in 14 dogs

Antimicrobial dispensing by Ontario dairy veterinarians

Pharmacokinetics and bioequivalence of 2 meloxicam oral dosage formulations in healthy adult horses

Transient diabetes mellitus in a domestic ferret (Mustela putorius furo)

Hypertrophic osteopathy associated with hepatocellular carcinoma in a dog

Diode laser coagulation for the treatment of epistaxis in a Scottish fold cat

Glenoid dysplasia and osteochondritis dissecans in a cat

Successful resolution of a preputial prolapse in an alpaca using medical therapy

Clinical characteristics of horses and foals diagnosed with cleft palate in a referral population: 28 cases (1988–2011)

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JULY/JUILLET 2015 Contents Table des matières

SCIENTIFIC RUBRIQUE SCIENTIFIQUE

ARTICLES 741 Hypertrophic osteopathy associated with 701 Demographics of the Canadian dairy hepatocellular carcinoma in a dog industry from 1991 to 2011 Victoria D. Randall, Carlos Souza, Daniel Vanderhart, Sarah Boston Murray D. Jelinski, Stephen LeBlanc, Richard Kennedy 745 Diode laser coagulation for the treatment 709 Autologous vaccination for the treatment of of epistaxis in a Scottish fold cat equine sarcoids: 18 cases (2009–2014) Takuma Aoki, Hiroo Madarame, Keisuke Sugimoto, Hiroshi Sunahara, Yoko Fujii, Eiichi Kanai, Caitlin C. Rothacker, Ashley G. Boyle, Tetsuro Ito David G. Levine 749 Glenoid dysplasia and osteochondritis 715 Long-term prospective evaluation of dissecans in a cat intestinal anastomosis using stainless steel staples in 14 dogs Rebecca A. Schwarze, Cheryl A. Tano, Vincent W. Carroll Manuel Benlloch-Gonzalez, Eymeric Gomes, Bernard Bouvy, Cyrill Poncet 753 Successful resolution of a preputial prolapse in an alpaca using medical therapy 723 Antimicrobial dispensing by Ontario dairy veterinarians Jennifer H. Koziol, Misty A. Edmondson, Dwight F. Wolfe, Jenna E. Bayne David F. Léger, Nathalie C. Newby, Richard Reid-Smith, Neil Anderson, David L. Pearl, Kerry D. Lissemore, ARTICLE David F. Kelton 756 Clinical characteristics of horses and foals diagnosed with cleft palate in a referral 730 Pharmacokinetics and bioequivalence of population: 28 cases (1988–2011) 2 meloxicam oral dosage formulations in healthy adult horses Sarah D. Shaw, Tracy E. Norman, Carolyn E. Arnold, Michelle C. Coleman Melanie Vivancos, Jessica Barker, Sarah Engbers, Carrie Fischer, Jami Frederick, Heather Friedt, Joanna M. Rybicka, Tereza Stastny, Heidi Banse, 655 QUIZ CORNER Alastair E. Cribb TEST ÉCLAIR

CASE REPORTS RAPPORTS DE CAS 737 Transient diabetes mellitus in a domestic ferret (Mustela putorius furo) Alexis Duhamelle, Isabelle Langlois, Marion Desmarchelier

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JULY/JUILLET 2015 Contents Table des matières

FEATURES RUBRIQUES SPÉCIALES

PRESIDENT’S MESSAGE BOOK REVIEWS MOT DU PRÉSIDENT COMPTES RENDUS DE LIVRES 647 The CVMA and the veterinary profession 722 Tasks for the Veterinary Assistant, in Canada/L’ACMV et la profession 3th edition vétérinaire au Canada Donna Morley Jean Gauvin 736 Exotic Animal Formulary, 4th edition Ian Kanda 651 VETERINARY MEDICAL ETHICS DÉONTOLOGIE VÉTÉRINAIRE 755 Veterinary Technician’s Daily Reference Guide, 3rd edition 669 2014 CVMA ANNUAL REPORT Melissa Smith RAPPORT ANNUEL 2014 DE L’ACMV NOTICES ANNONCES SPECIAL REPORT RAPPORT SPÉCIAL 740 Industry News 693 The increasing risk of Lyme disease Nouvelles de l’industrie in Canada 744, New Products Catherine Bouchard, Erin Leonard, Jules Konan Koffi, Yann Pelcat, Andrew Peregrine, 762 Nouveaux produits Neil Chilton, Kateryn Rochon, Tim Lysyk, 765 Index of Advertisers L. Robbin Lindsay, Nicholas Hume Ogden Index des annonceurs

COMMENTARY 769 Classifieds COMMENTAIRE Petites annonces 700 Modest cost of veterinary services and goods to farmers in Canada NEWS | NOUVELLES Canadian Animal Health Institute

PRACTITIONERS’ CORNER 657 NEWS LE COIN DES PRATICIENS NOUVELLES 761 Anaplasmosis in a dog on Vancouver Island Heather Broughton, Isabelle Vallières Jennifer Kowalski, Diane Cruickshank, Malcolm Macartney

VETERINARY PRACTICE MANAGEMENT GESTION D’UNE CLINIQUE VÉTÉRINAIRE 763 A strong year in client numbers for much of Canada/Une année solide pour le nombre de clients dans une grande partie du Contributors Canada “Instructions for authors” are available online Chris Doherty (www.canadianveterinarians.net). 767 DIAGNOSTIC OPHTHALMOLOGY Les «Directives à l’intention des auteurs» OPHTALMOLOGIE DIAGNOSTIQUE sont disponibles en ligne Bianca S. Bauer, Lynne S. Sandmeyer, (www.veterinairesaucanada.net). Bruce H. Grahn

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The Canadian Veterinary Journal Editorial policy: All published articles including editorials and letters reflect the La Revue vétérinaire canadienne opinions of the authors and do not necessarily reflect the opinion of the publisher. Publication of an advertisement does not necessarily imply that the publisher agrees 339 rue Booth Street with or supports the claims therein. Ottawa, Ontario K1R 7K1 Politique de la Rédaction : Tous les articles publiés, y compris les éditoriaux et les Telephone: (613) 236-1162 lettres, représentent l’opinion de l’auteur et non pas nécessairement la position de Fax: (613) 236-9681 l’éditeur. E-mail: [email protected] La publication d’une annonce ne signifie pas nécessairement que l’éditeur est d’accord Website/Site Web: www.canadianveterinarians.net avec son contenu ou qu’il l’appuie. www.veterinairesaucanada.net Editor-in-Chief/Rédacteur en chef © C anadian Veterinary Medical Association 2015 Carlton Gyles, Guelph, Ontario L’Association canadienne des médecins vétérinaires 2015 Associate Editors/Rédacteurs associés Bruce Grahn, Saskatoon, Saskatchewan The Canadian Veterinary Journal is indexed or abstracted in: Wayne McDonell, Guelph, Ontario La Revue vétérinaire canadienne est indexée ou ses articles sont Feature Editors/Rédacteurs des chroniques résumés dans : Stephen Raverty, Abbotsford, British Columbia AGRICOL, Biological Abstracts, Capsule Report, Current Contents — Agriculture, Tim Blackwell, Fergus, Ontario Derwent Veterinary Drug File, EMBASE/Excerpta Medica, Andrew Allen, Saskatoon, Saskatchewan Index Veterinarius, Index Medicus, Quarterly Index, Science Citation Index, Small Animal Practice, Veterinary Bulletin, Veterinary Reference Service, Veterinary Update. Assistant Editors/Rédacteurs adjoints Robert Friendship, Guelph, Ontario Greg Harasen, Regina, Saskatchewan Photo by/Photo de : Shutterstock Jacob Thundathil, Calgary, Alberta Ron Johnson, Guelph, Ontario Typesetting/Typographie Richard Kennedy, Pincher Creek, Alberta AN Design Communications Shawn McKenna, Charlottetown, P.E.I. Printed by/Imprimé par Managing Editor/Directrice de la rédaction The Lowe-Martin Group Heather Broughton, Ottawa, Ontario Ottawa, Ontario Assistant Managing Editor/Directrice adjointe de la rédaction ISSN 0008-5286 Stella Wheatley, Ottawa, Ontario Editorial Coordinator/Coordonnatrice de la rédaction Kelly Gray, Ottawa, Ontario Return undeliverable Canadian addresses to: 339 rue Booth Street Advertising Manager/Gérante de la publicité Ottawa, Ontario K1R 7K1 Laima Laffitte, Wendover, Ontario e-mail: [email protected] Published monthly by/ Subscriptions (2015). Annual: Canada $195 + applicable GST or HST; foreign Publication mensuelle de $210 US; institution/agency $225. Express subscriptions available. Single issue/back Canadian Veterinary Medical Association issue: $25 each + GST or HST, if applic­able. (All prices subject to change.) Missing issues will be replaced if the Subscriptions Office is notified within 6 months (for requests within Canada) and 1 year (for requests from abroad) of the issue date. The publisher­ expects to supply missing issues only when losses have been sustained in transit and when the reserve stock will permit. Telephone (613-236-1162) or (1-800-567-2862) and fax (613-236-9681) orders accepted with a valid Visa or MasterCard number. Please advise the publisher of address changes promptly. Abonnements (2015). Annuel : Canada 195 $ + TPS ou TVH en vigueur; pays étranger 210 $ É-U; prix d’agence/institution 225 $. Abonnement express disponible. Anciens numéros (chacun) : 25 $ + TPS ou TVH en vigueur. Les prix sont sujets à changement sans préavis. Les numéros qui ne sont pas reçus seront remplacés si l’éditeur en est informée dans les 6 mois (pour les demandes venant du Canada) et 1 an (pour les demandes venant de l’étranger) suivant la date de parution. L’éditeur s’engage à remplacer les numéros manquants seule­ment lorsque les pertes ont été subies en transit et lorsque ses réserves le permettent. On peut payer son abonnement par téléphone (613-236-1162), par télé­copieur (613-236-9681) ou par carte de crédit (Visa ou MasterCard). Veuillez aviser le bureau de l’éditeur de tout ­changement d’adresse.

646 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY President’s Message Mot du président

The CVMA and the veterinary profession in Canada L’ACMV et la profession vétérinaire au Canada

uring my term as president of the Canadian Veterinary out au long de mon mandat de président de l’Association D Medical Association (CVMA), I had the opportunity to T canadienne des médecins vétérinaires (ACMV), j’ai eu la meet many veterinarians, from St. John’s to Vancouver. Many chance de rencontrer beaucoup de vétérinaires, de St. John’s à interesting discussions were had. I was surprised to find out that Vancouver. Nous avons eu une foule de discussions intéressantes the majority of veterinarians whom I met knew very little about et j’ai été surpris de constater que la majorité des vétérinaires the work accomplished by the CVMA. Most importantly, few rencontrés ne savaient à peu près rien du travail qu’effectue members and non-members know that the work accomplished l’ACMV. Mais, plus encore, très peu de membres et de non- by the CVMA staff and volunteers has a direct daily impact on membres savent que le travail qui est fait par tout le personnel their professional lives. et les bénévoles de l’ACMV a un impact direct sur leur vie So, for my last message, I decided to present some examples professionnelle de tous les jours. that illustrate the importance of the CVMA for Canadian vet- Alors, pour mon dernier tour de piste, j’ai décidé de présenter erinarians and the veterinary profession. quelques exemples afin de démontrer l’importance de l’ACMV I will not go into detail about member services, as most pour les vétérinaires canadiens et la profession vétérinaire. provincial associations offer similar benefits. However, some of Je ne m’attarderai pas trop longtemps sur les services aux the services offered are unique. The group insurance program membres, puisque la plupart des associations provinciales offrent is currently the best one offered to Canadian veterinarians and des services semblables. Cependant, certains des services offerts the rebates received when joining this program are generally sont assez uniques. Le programme d’assurance collective est greater than the CVMA membership fee. And what about the présentement le meilleur régime offert aux vétérinaires canadiens possibility of a personalized Web store for your practice? This et les rabais obtenus lors de l’adhésion à ce programme sont added value can help you re-launch your sale of pet food and généralement supérieurs à la cotisation à l’ACMV. Que dire de other products. Lastly, recent surveys have shown that the sug- l’offre d’une boutique en ligne personnalisée pour votre pratique? gested fee guides, the reports on compensation of veterinarians Une valeur ajoutée qui peut vous aider à relancer vos ventes de and on wages of non-veterinarians were appreciated by mem- diètes et de produits vétérinaires. Finalement, des sondages récents bers. I invite you to visit the CVMA website to see all the other nous ont permis de réaliser que les guides tarifaires suggérés, services that are offered to members. There is something for de même que les rapports sur la rémunération des employés everyone, for owners as well as employees. vétérinaires et non-vétérinaires, étaient appréciés par les membres. As you know, the practice of veterinary medicine is under Je vous invite à aller voir sur le site web de l’ACMV afin de provincial jurisdiction in Canada. However, many of the deci- constater tous les autres services qui vous sont offerts. Il y en a sions affecting the profession are made by federal and interna- pour tous. Autant pour les propriétaires que pour les employés. tional agencies. The CVMA is the national and international Comme vous le savez, la pratique de la médecine vétérinaire voice of Canadian veterinarians and it takes on a leadership relève de la compétence provinciale au Canada. Cependant, and advocacy role for veterinary medicine in Canada and beaucoup de décisions affectant la profession sont prises par on the international stage. Here are 2 examples of advocacy des organismes fédéraux et internationaux. L’ACMV est la voix work accomplished by the CVMA on behalf of all Canadian nationale et internationale des vétérinaires du Canada et elle assure veterinarians. le leadership et la défense des intérêts de la médecine vétérinaire.

Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des ­réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs.

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For more than 15 years, the CVMA has been active in the Autant au Canada qu’à l’international. Voici deux exemples qui fight against antimicrobial resistance (1). The CVMA has décrivent bien la défense des intérêts de tous les vétérinaires succeeded in showing various federal authorities that it is seri- canadiens par l’ACMV. ous about reducing the devastating impact of antimicrobial Depuis plus de 15 ans, l’ACMV est très active au chapitre de resistance. So much so that it is now considered an indispens- l’antibiorésistance. L’ACMV a réussi à démontrer aux diverses able partner by Health Canada, the Public Health Agency of autorités fédérales le sérieux de sa démarche pour diminuer les Canada, Agriculture and Agri-Food Canada and the Canadian effets dévastateurs de l’antibiorésistance. Tant et si bien qu’elle est Food Inspection Agency. The CVMA is present at meetings on maintenant considérée comme un partenaire incontournable par the federal framework for antimicrobial resistance. This means Santé Canada, l’Agence de la santé publique du Canada, Agriculture that the opinions of veterinary practitioners are always heard et alimentation Canada et l’Agence canadienne d’inspection des in those discussions. This is essential in order to avoid making aliments. L’ACMV est présente aux réunions portant sur le cadre

MOT DU PRÉSIDENTDU MOT decisions that do not take into account the reality of veterinar- d’action fédéral sur la résistance aux antimicrobiens. Ce qui signifie ians working in the field. que le point de vue des vétérinaires praticiens canadiens est toujours My 2nd example concerns the right of veterinarians to sell entendu lors de ces discussions. C’est essentiel, afin d’éviter des antibiotics. This prerogative could soon be questioned. Several prises de décisions qui ne tiendraient pas compte de la réalité des active stakeholders from the antimicrobial resistance camp regu- vétérinaires œuvrant sur le terrain. larly bring up the supposed conflict of interest that veterinar- Mon deuxième exemple porte sur le droit qu’ont les vétérinaires ians have when they sell antibiotics. In fact, according to them, de vendre des antibiotiques. Cette prérogative pourrait bientôt veterinarians have a stake in selling more antibiotics to improve être remise en question. En effet, plusieurs intervenants actifs dans their revenues. Therefore, these stakeholders pressure federal le milieu de l’antibiorésistance soulèvent régulièrement le supposé authorities to take away the right of veterinarians to sell anti- conflit d’intérêt qu’ont les vétérinaires en ce qui a trait à la vente biotics. The CVMA has defended and will continue to defend d’antimicrobiens. En effet, selon eux, les vétérinaires ont intérêt the right of veterinarians to continue to sell antibiotics. The à vendre plus d’antibiotiques afin d’améliorer leurs revenus. Par CVMA considers that these affirmations demonstrate a lack conséquent, ils font pression auprès des autorités fédérales afin que of respect toward veterinarians who protect animal and public les vétérinaires ne puissent plus vendre d’antibiotiques. L’ACMV health every day, and display an exceptional commitment and défend, et elle continuera de défendre, le droit des vétérinaires à strict oversight for the use of antimicrobials. The only winners continuer de vendre des antibiotiques. L’ACMV considère que of such a move would be companies and pharmacies of all types ces affirmations représentent un manque de respect à l’honneur (including online pharmacies) that have been trying for several et l’honnêteté des vétérinaires qui, tous les jours, garantissent la years to break through the veterinary market. santé animale et la santé publique pour la population canadienne, Our French colleagues were almost subjected to such regula- grâce à un engagement exceptionnel et à une supervision étroite tions. In 2013, the Health Minister of France wanted to enact de l’usage des antimicrobiens. Les seuls gagnants d’une telle a law that would have prevented veterinarians from selling mesure seraient les compagnies et pharmacies de tout acabit (dont antimicrobials. Ten thousand veterinarians took to the streets les pharmacies en ligne) qui essayent depuis des années de percer of Paris and, thanks to an unprecedented mobilization and the le marché vétérinaire. involvement of their national association, the Minister reversed Nos collègues français ont failli vivre une telle réglementation. his decision. En effet, en 2013, le ministre de la Santé de la France a voulu This is only the tip of the iceberg. We have been informed by promulguer une loi empêchant les vétérinaires de vendre des our American partners that large American retailers, which are antimicrobiens. Dix mille vétérinaires ont pris d’assaut les rues de also now established in Canada, are exerting pressure on various Paris et, grâce à une mobilisation sans précédent et à l’implication levels of the American government to prevent veterinarians from de leur association nationale, le ministre est revenu sur sa décision. selling any medications at all! The lobby groups have won the Et ce n’est que la pointe de l’iceberg. Nous avons été mis au first battle and an American law is now forcing veterinarians courant par nos partenaires américains que de gros détaillants to give a written prescription to all clients requiring medica- américains, qui sont maintenant aussi établis au Canada, tions. The client then decides if he/she wants to buy from the font pression auprès des différents paliers de gouvernement veterinarian or elsewhere. It is only a matter of time before these des États-Unis afin d’empêcher les vétérinaires de vendre des companies exert similar pressures on Canadian federal authori- médicaments, quels qu’ils soient! Ces groupes de pression ont ties and take this issue to court to advance their economic gagné la première bataille. En effet, une loi américaine oblige interests. dorénavant tous les vétérinaires à donner une ordonnance écrite These lobby groups will not stop working at the national à tous les clients qui ont besoin de médicaments. Par la suite, level and they will not hesitate to exert pressure on international le client décide s’il désire acheter ses médicaments chez son organizations like the World Health Organization (WHO), vétérinaire ou ailleurs. Ce n’est qu’une question de temps pour que the World Organization for Animal Health (OIE), the Food ces entreprises fassent des pressions similaires auprès des autorités and Agriculture Organization of the United Nations (FAO), fédérales canadiennes et aillent même en cour afin de faire valoir and World Trade Organization (WTO), to name only 4. These leurs intérêts économiques. organizations have the power to issue recommendations that Ces groupes de pression n’arrêteront pas leur travail au niveau could influence the practice of veterinary medicine in Canada. national et n’hésiteront pas à faire pression auprès d’organismes

648 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY

For all these reasons, the CVMA must continue to represent References and defend the interests of the profession and of Canadian vet- 1. Gauvin J. The CVMA and Prudent Use of Antimicrobials. Can Vet J erinarians on all national and international levels. 2014;55:809–812. Available from: http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4137919/ Last accessed May 12, 2015. ■ These are only a few examples of the work accomplished by PRESIDENT’S MESSAGE the CVMA to defend the interests of the veterinary profession and Canadian veterinarians. We count on the support of all Canadian veterinarians to continue to do this work well.

Jean Gauvin

internationaux comme l’Organisation mondiale de la santé (OMS), Ce ne sont que quelques exemples du travail qu’effectue l’Organisation mondiale de la santé animale (OIE), l’Organisation l’équipe de l’ACMV afin de défendre les intérêts de la profession des Nations Unies pour l’alimentation et l’agriculture et (FAO) et des vétérinaires canadiens. Nous comptons sur l’appui de tous et l’Organisation mondiale du commerce (OMC) pour n’en les vétérinaires canadiens afin de continuer à bien le faire. nommer que quatre. Ces organisations ont le pouvoir d’émettre des recommandations qui pourraient influencer la pratique de la Jean Gauvin médecine vétérinaire au Canada. Pour toutes ces raisons, l’ACMV doit continuer à représenter Renvoi et à défendre les intérêts de la profession et des vétérinaires 1. GAUVIN, J. «L’ACMV et l’utilisation judicieuse des antimicrobiens», Can Vet J, 2014, vol. 55, p. 809–812. Disponible au : http://www.ncbi. canadiens sur toutes les plates-formes, qu’elles soient nationales nlm.nih.gov/pmc/articles/PMC4137919/ Dernière consultation le 12 mai ou internationales. 2015. ■

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06/2015 FOR PERSONAL USE ONLY Veterinary Medical Ethics Déontologie vétérinaire

Ethical question of the month — July 2015 You recently joined a mixed animal practice that is an hour outside of a major metropolitan area. Many of the traditional livestock farms in the area are being purchased by suburbanites with significant off-farm income. They often keep a couple of horses or have a small goat herd or sheep flock. Your new employers are strug- gling to adjust to treating “farm” animals that are more closely tied to the emotional rather than the financial interests of the owners. Recently a horse with colic was seen by your colleague, treated with analgesics and the owners were instructed to walk the horse whenever it showed signs of colic. There has been little improvement over the past two days, the owners call several times a day to express their concerns and the senior partners continue to advise over the phone to keep walking the horse. You suggest it might be wise to refer this horse to a neighboring practice with more equine experience. Your employers are not in the habit of referring cases and are reluctant to invite in a competing practice. The horse is not improving. How should you respond? Question de déontologie du mois — Juillet 2015 Vous avez récemment commencé à travailler dans une clinique mixte qui se trouve à une heure d’un grand centre métropolitain. Beaucoup de fermes d’élevage traditionnelles sont en voie d’être achetées par des banlieusards ayant un revenu important en dehors de la ferme. Ils gardent souvent quelques chevaux ou ont un petit troupeau de chèvres ou de moutons. Vos nouveaux employeurs tentent de s’ajuster au traitement d’animaux «de ferme» qui font appel plus à l’attachement émotionnel qu’aux intérêts financiers des propriétaires. Récemment, un cheval souffrant de coliques a été examiné par l’un de vos collègues et traité à l’aide d’analgésiques. On a demandé aux propriétaires de promener le cheval lorsqu’il manifestait des signes de coliques. L’état du cheval ne s’était pas vraiment amélioré pendant deux jours et les propriétaires appelaient plusieurs fois par jour pour exprimer leur inquiétude et les associés principaux ont continué de conseiller, par téléphone, de promener le cheval. Vous suggérez qu’il serait peut-être préférable de recommander ce cheval à une pratique voisine ayant plus d’expérience avec les chevaux. Vos employeurs n’ont pas l’habitude de recommander des cas et ils sont réticents à l’idée d’inviter une pratique concurrente. L’état du cheval ne s’améliore pas. Comment devriez-vous répondre?

Responses to the case presented are welcome. Please limit your Les réponses au cas présenté sont les bienvenues. Veuillez reply to approximately 50 words and forward along with your limiter votre réponse à environ 50 mots et nous la faire par­ venir name and address to: Ethical Choices, c/o Dr. Tim Blackwell, par la poste avec vos nom et adresse à l’adresse suivante : 6486 E. Garafraxa, Townline, Belwood, Ontario N0B 1J0; Choix déontologiques, a/s du Dr Tim Blackwell, 6486, telephone: (519) 846-3413; fax: (519) 846-8178; e-mail: E. Garafraxa, Townline, Belwood (Ontario) N0B 1J0; [email protected]. téléphone : (519) 846-3413; télécopieur : (519) 846-8178; Suggested ethical questions of the month are also welcome! All courriel : [email protected]. ethical questions or scenarios in the ethics column are based Les propositions de questions déontologiques sont toujours on actual events, which are changed, including names, loca- bienvenues! Toutes les questions et situations présentées dans tions, species, etc., to protect the confidentiality of the parties cette chronique s’inspirent d’événements réels dont nous involved. modifions certains éléments, comme les noms, les endroits ou les espèces, pour protéger l’anonymat des personnes en cause.

Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des ­réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs.

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Ethical question of the month — April 2015 A long-standing client of your mixed animal practice passed away recently and his widow is moving to a nursing home where pets are not allowed. She requested that you find a suitable home for their 6-year-old Labrador retriever. You recently had to euthanize the 16-year-old shepherd-cross that belonged to a family that lives on a hobby farm. You call and enquire as to whether they would be interested in adopting the Labrador and they gladly accept. When they come to pick up the dog they are most grateful and explain that they had been unable to adopt a dog because no shelter or rescue association would provide a dog to a family that did not keep the dog in the house. They had resigned themselves to purchasing a dog from a breeder. This fam- ily’s dog has free access to a heated garage with a heated dog bed. You have taken care of this family’s pets and livestock for over a decade and find them exceptionally caring and attentive owners. You cannot believe that a shelter would deny a dog to such an excellent home. You contact a few shelters to enquire regarding their adoption policies and find that they only offer dogs to people who keep their pets in the house. There was

DÉONTOLOGIEVÉTÉRINAIRE a long list of additional restrictions some of which you also found unreasonable. Is it in the best interest of companion animals to have such stringent requirements regarding adoptions? Question de déontologie du mois — Avril 2015 Un client de longue date de votre pratique mixte est récemment décédé et sa veuve déménage dans un foyer de soins infirmiers où les animaux sont interdits. Elle vous a demandé de trouver un bon foyer pour leur Labrador retriever âgé de 6 ans. Vous avez récemment dû euthanasier le chien berger de race croisée âgé de 16 ans qui appartenait à une famille habitant sur une ferme d’agrément. Vous appelez la famille et vous lui demander si elle aimerait adopter le Labrador, ce qu’elle accepte avec joie. Lorsqu’elle arrive pour chercher le chien, elle est très reconnaissante et explique qu’elle ne réussissait à adopter un chien parce qu’aucun refuge ni association de sauvetage ne donnait un chien à une famille qui ne le gardait pas dans la maison. Ils s’étaient résignés à acheter un chien auprès d’un éleveur. Le chien de cette famille avait librement accès à un garage chauffé doté d’un lit chauffant. Vous soignez les animaux de compagnie et le bétail de cette famille depuis plus d’une décennie et vous trouvez que ce sont des propriétaires exceptionnellement compatissants et attentifs. Vous ne pouvez pas croire qu’un refuge refuserait un chien à cet excellent foyer. Vous contactez quelques refuges pour vous informer de leurs politiques d’adoption et vous constatez qu’ils offrent seulement des chiens aux personnes qui les gardent dans la maison. Il y avait aussi une longue liste de restrictions dont certaines vous semblaient déraisonnables. En va-t-il du meilleur intérêt des animaux de compagnie que les refuges imposent de telles exigences restrictives pour les adoptions?

An ethicist’s commentary on shelter reluctant to adopt Let me begin with a caveat: the vast majority of people work- to be a less than perfect home! In stark contrast to this inex- ing in animal shelters do not fit the description I am about to plicable attitude, my close veterinarian friend Brian Forsgren, present. Most are dedicated, selfless people who take it upon who has spent decades unselfishly serving a ghetto community themselves to rectify grievous social wrong. by providing affordable veterinary care, has repeatedly stressed, But in too many cases over the past 40 years, I have encoun- both in narratives and in his photographs, that these pets may tered an insufferable sanctimonious attitude on the part of a belong to people whose clothes are in tatters, but whose animals small number of those who have taken upon themselves the very are immaculate, well fed, and well cared for. As Brian tellingly real burden of dealing with the societal problem of unwanted puts it, who would be willing to say that a companion animal animals needing to be homed. According to this attitude, no means more to a rich person than to a poor one. home is good enough for the animals for whom they have Besides having to answer a battery of questions paralleling assumed responsibility. In one case, there was a prominent vet- what one might be required to answer for adopting a child, erinary oncologist employed at the Colorado State University a shelter sometimes consider an animal “unadoptable” for College of Veterinary Medicine and Biomedical Sciences who indefensible reasons. Foremost among these reasons are spuri- was attempting to acquire a dog from a shelter as a family pet. ous “behavior tests” administered by self-appointed “behavior He worked very long hours on numerous cancer patients for experts.” Failing these tests may amount to a death sentence for whom he effected unprecedented cures. After repeated home the animal. In one horrifying case I witnessed, a dog was moved visits, the shelter refused to place an animal with him, since from his kennel into a common area, growled at another male “he was not home enough.” I could not imagine a better owner dog, and was euthanized for being “overly aggressive.” with a nicer family! In 1978, I gave my first public speech on these issues. I I have encountered the same story in far too many shelters — argued that too many shelters protect the public from the ugly the self-appointed guardians of animal welfare seem to believe truth of their behavior, rather than the animals. In attendance that the animal is better off dead than placed in what they deem was Richard Avenzino, who had just taken over running the

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San Francisco Society for the Prevention of Cruelty to Animals are situations such as isolated and well-fenced rural properties (SPCA). He came up to me after my talk, shook my hand and where these dogs could live a good life while serving to protect

told me he had resolved not to let animals die under his aegis. people and property. Obviously such cases require a modicum ETHICS MEDICAL VETERINARY He served a wealthy and morally responsible community, and of common sense. No one should adopt an aggressive dog to a soon cut the euthanasia rate drastically. Shortly thereafter, he house regularly populated by small children, just as such a home was tapped to head the Maddie Fund, a billion-dollar bequest should not keep pistols and long guns, which are an “attractive devoted to end the killing of healthy animals. He recently nuisance,” in plain view or otherwise accessible to prying chil- retired, leaving an unparalleled legacy of animals saved from dren. Yet if managed appropriately these dogs can live well in a euthanasia. loving home while at the same time earning their keep. No one It is worth remembering that “the perfect home” is a mythic should choose death for another creature for anything but the construct by which real homes should not be judged. Such utmost compelling reasons, such as amelioration of intractable ridiculous criteria, as are described in the current case, are a suffering. travesty. No one with an ounce of sensitivity would affirm that a dog is better off dead than living in a home with access to a heated garage. Almost no one adopts aggressive dogs, yet there Bernard E. Rollin, PhD

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*Clinical significance unknown. 1. Silber H.E. et al. Population Pharmacokinetic Analysis of Blood and Joint Synovial Fluid Concentrations of robenacoxib from healthy dogs and dogs with osteoarthritis Pharm Res. 2010 Dec; 27(12):2633-45. 2. Pelligand L. et al. Pharmacokinetic/pharmacodynamic modeling of robenacoxib in a feline tissue cage model of inflammation.J Vet Pharmacol Ther. 2012 Feb; 35(1):19-32. 3. Brune K, Furst DE., Combining enzyme specificity and tissue selectivity of cyclo-oxygenase inhibitors: towards better tolerability?Rheumatology (Oxford) 2007 Jun; 46(6):911-9. ® Onsior is a registered trademark of Novartis AG; used under license. © 2014 Novartis Animal Health Canada Inc.

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Quiz Corner Test éclair

1. An 8-year-old golden retriever dies unexpectedly, with no 1. Un chien Golden retriever âgé de 8 ans meurt de façon premonitory signs of illness. At necropsy, the pericardial sac inattendue, sans signes prémonitoires de maladie. À la contains clotted and unclotted blood, and there is a soft, nécropsie, le péricarde renferme du sang coagulé et non dark red mass in the right atrium. The most likely diagnosis coagulé et il y a une masse molle de couleur rouge foncé for the atrial mass is which of the following? dans l’atrium cardiaque droit. Lequel des problèmes suivants A. Hematoma représente le diagnostic le plus probable pour cette masse B. Hemangiosarcoma atriale? C. Fibrosarcoma A. hématome; D. Rhabdomyosarcoma B. hémangiosarcome; E. Vascular hamartoma C. fibrosarcome; D. rhabdomyosarcome; 2. A 6-month-old cat is diagnosed with a tapeworm infesta- E. hamartome vasculaire. tion. Which of the following drugs is the most likely to be effective? 2. On diagnostique chez un chat âgé de 6 mois une infestation A. Fenbendazole par des ténias. Lequel des médicaments suivants est le plus B. Ivermectin susceptible d’être efficace? C. Praziquantel A. fenbendazole; D. Pyrantel B. ivermectine; E. Metronidazole C. praziquantel; D. pyrantel; 3. A 2-year-old, mixed-breed dog is being evaluated for an E. métronidazole. acute onset of ataxia, depression, polyuria, polydipsia, and vomiting. Urinalysis reveals an abundance of calcium oxa- 3. On fait l’examen d’un chien de race croisée, âgé de 2 ans, à late monohydrate crystals. A diagnosis of ethylene glycol cause de l’apparition soudaine d’ataxie, d’abattement, de poisoning has been made, but there is as yet no evidence polyurie, de polydipsie et de vomissements. L’examen de of renal disease. Which of the following is the most appro- l’urine révèle une abondance de cristaux de monohydrate priate treatment for this problem? d’oxalate de calcium. On établit un diagnostic d’empoison­ A. N-acetylcysteine nement par l’éthylène glycol, mais il n’y a pas encore de B. Vitamin K1 signes de maladie rénale. Lequel des traitements suivants C. Fomepizole est le plus approprié? D. Misoprostol A. N-acétylcystéine; E. Pralidoxime hydrochloride B. vitamine K1; C. fomépizole; D. misoprostol; E. hydrochlorure de pralidoxime.

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CVJ / VOL 56 / JULY 2015 655 FOR PERSONAL USE ONLY

4. Which of the following actions will prevent or minimize 4. Laquelle des actions suivantes préviendra ou diminuera le tissue damage following accidental perivascular injection dommage tissulaire à la suite de l’injection périvasculaire of thiopental in the horse? accidentelle de thiopental chez le cheval? A. Injection of bupivacaine solution into the area A. injection de bupivacaïne dans la région; B. Dilution of the area with three times the volume of saline B. dilution de trois fois le volume de saline dans la région; C. Injection of methylene blue into the area C. injection de bleu de méthylène dans la région; D. Alternation of cold and hot packs in the area D. alternance de tampons chauds et froids dans la région; E. Shock wave treatment of the area E. traitement par onde de choc dans la région. 5. Concerning bovine spongiform encephalopathy (BSE), which 5. À propos de l’encéphalopathie spongiforme bovine, lequel

TESTÉCLAIR of the following statements is false? des énoncés suivants est faux? A. High risk sources of the causal agent are affected cattle A. Les sources de risque élevé de l’agent étiologique sont brains, tonsils, and spinal cord. l’encéphale, les amygdales et la moelle épinière des bovins B. The human disease, thought to be contracted from cattle- atteints. derived food, has an incubation period of approximately B. La maladie humaine, que l’on croit être contractée par one week. la consommation de la viande de bovins, a une période C. Diagnosis is confirmed through histological examination d’incubation d’environ 1 semaine. of brain tissue. C. Le diagnostic est confirmé par l’examen histologique du D. In order to facilitate control, the feeding of most mam- tissu de l’encéphale. malian protein to ruminants is prohibited. D. Dans le but de faciliter son contrôle, il est interdit E. The disease belongs to a class known as transmissible d’alimenter les ruminants à l’aide de la plupart des spongiform encephalopathies. protéines mammaliennes. E. La maladie appartient à une catégorie connue comme une des encéphalopathies spongiformes transmissibles. (See p. 766 for answers./Voir les réponses à la page 766.)

Questions and answers were derived from Review Questions and Answers Les questions et les réponses sont extraites de Review Questions and for Veterinary Boards 2nd ed., a 5-volume series including Basic Sciences, Answers for Veterinary Boards 2nd ed., une série de cinq ­volu­mes qui Clinical Sciences, Small Animal Medicine and Surgery, Large Animal ­comprend Basic Sciences, Clinical Sciences, Small Animal Medicine and Medicine and Surgery, and Ancillary Topics, by kind permission of the Surgery, Large Animal Medicine and Surgery, et Ancillary Topics, avec publisher, Mosby–Year Book, Inc., St. Louis, Missouri. l’aimable permission de ­l’éditeur, Mosby–Year Book, Inc. de St. Louis (Missouri).

Editors Wanted Rédacteurs recherchés The Canadian Journal of Veterinary Research (CJVR) is looking for a La Revue canadienne de recherche vétérinaire (RCRV) est à la new editor. After a long and successful time at the helm, the current recherche d’un nouveau rédacteur. Après avoir occupé ses CJVR editor, Dr. Éva Nagy, is leaving. The Editorial Committee of fonctions pendant longtemps et avec grand succès, la rédactrice the CVMA is seeking an individual responsible for the peer-review actuelle de la RCRV, Dre Éva Nagy, quitte son poste. Le Comité process for scientific articles in the CJVR. A job description is avail- de la rédaction de l’ACMV est à la recherche d’une personne able by request ([email protected]). responsable du processus d’évaluation par les pairs pour la lecture des articles scientifiques de la RCRV. Une description de poste est The Editorial Committee is also seeking individuals interested in disponible sur demande ([email protected]). the position of associate editor for CJVR. An associate editor has a key role in allocating to peer reviewers various articles submit- Le Comité de la rédaction est aussi à la recherche de personnes ted to the journals for potential publication and in participating intéressées au poste de rédacteur associé pour la RCRV. Le in policy development as a member of the Editorial Committee. rédacteur associé joue un rôle clé lors la distribution, aux The success of the peer-review process and, thus, the credibility examinateurs, des divers articles soumis aux revues aux fins de of a journal are in large measure dependent on the selection of publication potentielle et il participe à l’élaboration de politiques appropriate individuals to review manuscripts. There is a vast en tant que membre du Comité de la rédaction. Le succès number of individuals with specialized knowledge in private du processus d’évaluation par les pairs et, en conséquence, la practice, research, academia and industry — the challenge is in crédibilité d’une revue dépendent en grande partie du choix des tapping into these resources for the peer review process. personnes appropriées pour réviser les manuscrits. Il y a un grand nombre de personnes possédant des connaissances spécialisées en If interested in these positions please contact the Journals’ staff at pratique privée et en recherche ainsi que dans les universités et 339 Booth St., Ottawa, Ontario K1R 7K1; tel: 613-236-1162 or l’industrie, et le défi consiste à mettre ces ressources à contribution 800-567-2862, ext. 124; or e-mail ([email protected]). lors du processus d’évaluation par les pairs. Si l’un de ces postes vous intéresse, veuillez communiquer avec le personnel des Revues au 339, rue Booth, Ottawa (Ontario) K1R 7K1; tél. : 613-236-1162 ou 800-567-2862, poste 124; ou par courriel ([email protected]).

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NEWS | NOUVELLES

Full Launch of the Lancement intégral du CVMA Mentoring Program Programme de mentorat

Now accepting requests for mentoring Nous acceptons maintenant relationships des demandes de mentorat he Canadian Veterinary Medical Association canadienne des médecins TAssociation (CVMA) is pleased to L’ vétérinaires (ACMV) est heureuse announce the full launch of its newly- d’annoncer le lancement intégral de son created mentoring program. Program par- nouveau programme de mentorat. La ticipation will provide individuals being participation au programme offrira l’occasion mentored (the mentees) opportunities to aux personnes mentorées (les mentorés) discuss their goals, concerns and challenges de discuter de leurs objectifs, de leurs with a trusted mentor. All mentors are préoccupations et de leurs défis avec un veterinarians and members of the CVMA. mentor de confiance. Tous les mentors sont “I would like to acknowledge our mem- des vétérinaires et des membres de l’ACMV. bers who responded to the CVMA’s call- «J’aimerais reconnaître et remercier out for mentors,” says Dr. Jean Gauvin, les membres qui ont répondu à l’appel CVMA president. “They are willing to de l’ACMV pour trouver des mentors», dit help support and guide a new generation of veterinarians and le Dr Jean Gauvin, président de l’ACMV. «Ces personnes sont give some of their time to help mentees settle into professional disposées à appuyer le soutien et l’orientation d’une nouvelle life.” génération de vétérinaires et à donner de leur temps afin d’aider les The CVMA Mentoring Program is now open to those wish- mentorés à s’installer dans la vie professionnelle.» ing to establish a mentoring relationship. CVMA members Le Programme de mentorat est maintenant ouvert aux personnes who are recent veterinary graduates, early career veterinarians qui désirent établir une relation de mentorat. Les membres de or Students of CVMA in their last year of study can register as l’ACMV qui sont des diplômés récents, des vétérinaires en début a mentee by completing a Mentee Profile Form and submitting de carrière ou des étudiants de l’ACMV dans leur dernière année it to the CVMA. Requests for mentoring relationships will be d’étude peuvent s’inscrire en tant que mentoré en remplissant un confidential. We encourage you to take advantage of this new «Formulaire de profil de mentoré» et en le soumettant à l’ACMV. Les opportunity. demandes de relations de mentorat demeureront confidentielles. For information about the program or how to register as a Nous vous encourageons à profiter de cette nouvelle occasion. mentor or a mentee, please consult the program information Pour en savoir davantage à propos du programme ou sur la posted on our website (www.canadianveterinarians.net) under façon de vous inscrire en tant que mentor ou mentoré, consultez les the Practice & Economics tab, or e-mail us (communications@ renseignements de programme qui sont affichés sur notre site Web cvma-acmv.org). (www.veterinairesaucanada.net) sous l’onglet Pratique et finances, ou envoyez-nous un courriel à [email protected]

Thank you to CVMA’s registered mentors Merci aux mentors inscrits de l’ACMV (listing as at June 3, 2015) (liste du 3 juin 2015) Allen, Dr. Dana — Guelph, ON Allen, Dr Dana — Guelph (Ont.) Aucoin, Dr. Melissa — Truro, NS Aucoin, Dre Melissa — Truro (N.-É.) Baxter, Dr. Beverly — Sudbury, ON Baxter, Dre Beverly — Sudbury (Ont.) Bell, Dr. Chris — Winnipeg, MB Bell, Dr Chris — Winnipeg (Man.) Buote, Dr. Phil — Edmonton, AB Buote, Dr Phil — Edmonton (Alb.) Cartwright, Dr. Dan — Fredericton, NB Cartwright, Dr Dan — Fredericton (N.-B.) Chalhoub, Dr. Serge — Calgary, AB Chalhoub, Dr Serge — Calgary (Alb.) Collis, Dr. Lisa — Edmonton, AB Collis, Dre Lisa — Edmonton (Alb.) Craig, Dr. Crystal — Dartmouth, NS Craig, Dre Crystal — Dartmouth (N.-É.) Dhillon, Dr. Jasmine — Edmonton, AB Dhillon, Dre Jasmine — Edmonton (Alb.) Dickinson-Mills, Dr. Elisha — Hampton, NB Dickinson-Mills, Dre Elisha — Hampton (N.-B.) Dowling, Dr. Patricia — Saskatoon, SK Dowling, Dre Patricia — Saskatoon (Sask.) Emery, Dr. Amanda — Lethbridge, AB Emery, Dre Amanda — Lethbridge (Alb.)

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N Fairles, Dr. Jim — Guelph, ON Fairles, Dr Jim — Guelph (Ont.) Forseille, Dr. Jocelyn — Edmonton, AB Forseille, Dre Jocelyn — Edmonton (Alb.) Hicks, Dr. Melanie — Moncton, NB Hicks, Dre Melanie — Moncton (N.-B.) Himann, Dr Maggie — Peterborough, ON Himann, Dre Maggie — Peterborough (Ont.) Hollingshead, Dr. Wayne — Ste-Clotilde de Horton, QC Hollingshead, Dr Wayne — Ste-Clotilde de Horton (QC) Kruzeniski, Dr. Steven — Granada, NL Kruzeniski, Dr Steven — Granada (T.-N.-.L) Kubic, Dr. Erika — Gander, NL Kubic, Dre Erika — Gander (T.-N.-.L) Leicht, Dr. Jonathan — Calgary, AB Leicht, Dr Jonathan — Calgary (Alb.) Lem, Dr. Michelle — Ottawa, ON Lem, Dre Michelle — Ottawa (Ont.) Lofstedt, Dr. Jeanne — Charlottetown, PE Lofstedt, Dre Jeanne — Charlottetown (Î.-P.-É.) McPherson, Dr. Troye — Dartmouth, NS McPherson, Dre Troye — Dartmouth (N.-É.) Pike, Dr. Leslie — Sydney, NS Pike, Dre Leslie — Sydney (N.-É.) Rotondo, Dr. Fran — Guelph, ON Rotondo, Dre Fran — Guelph (Ont.) Samson, Dr. Morris — Toronto, ON Samson, Dr Morris — Toronto (Ont.) Sauvé, Dr. Christopher — Edmonton, AB Sauvé, Dr Christopher — Edmonton (Alb.) Sherlock, Dr. Courtney — Eastern Passage, NS Sherlock, Dre Courtney — Eastern Passage (N.-É.) Welsman, Dr. Kathryn — Kamloops, BC Welsman, Dre Kathryn — Kamloops (C.-B.)

Farewell from SCVMA President Adieux de la présidente des ÉACMV he past year has been an incredible experience and I would ette dernière année a été une expérience incroyable et Tlike to thank all the Students of the CVMA for trusting me Cj’aimerais remercier tous les Étudiants de l’ACMV qui m’ont and allowing me the honor to represent you. Together, we are accordé leur confiance ainsi que l’honneur de les représenter. all shaping the future of our profession, and by making strong Ensemble, nous avons façonné l’avenir de notre profession et, en bonds within our own circle we will have an impact outside établissant des liens solides dans notre propre entourage, nous the circle. aurons aussi un impact à l’extérieur de ce dernier. The CVMA is really an amazing Association that strives to L’ACMV est vraiment une association incroyable qui travaille improve our profession every day. I’ve learned so much during en vue d’améliorer notre profession tous les jours. J’ai appris tant this process and from working with so many committed volun- de choses durant ce processus et en travaillant auprès de tant de teers. I would like to leave you all with this final thought; don’t bénévoles engagés. J’aimerais vous quitter en vous communiquant be afraid to be involved and take risks, this career is so broad. cette dernière pensée : n’ayez pas peur de participer et de prendre You can be the connection between animals, humans and the des risques, car cette carrière est tellement vaste. Vous pouvez agir environment. You can really make a difference. Don’t forget your en tant que lien entre les animaux, les humains et l’environnement. values, and as you all embark on your own journeys, don’t forget Vous pouvez vraiment faire une différence. N’oubliez pas vos to stay connected and up-to-date with your national professional valeurs tandis que vous entamerez votre propre cheminement Association, the CVMA! et assurez-vous de garder le contact avec votre association It has truly been a privilege to represent the Students of the professionnelle nationale, l’ACMV! CVMA and although I’m sad to leave my wonderful committee, Cela a vraiment été un grand honneur pour moi de représenter I am happy to introduce Justin Kristjansson, your 2015–16 les Étudiants de l’ACMV et, bien que je sois triste de quitter mon SCVMA president, and to allow him the opportunity to shine. merveilleux comité, je suis heureuse de vous présenter Justin Best of luck in your future pursuits! Kristjansson, votre président des ÉACMV 2015–2016, et de lui (by Guylene Kheirkhah, donner l’occasion de se distinguer. Université de Montréal, Je vous offre mes meilleurs vœux de succès dans vos projets Faculté de Médecine Vétérinaire, futurs! Class of 2017, 2014–2015 SCVMA President) (par Guylène Kheirkhah, Université de Montréal, Faculté de médecine vétérinaire, promotion 2017, présidente des ÉACMV 2014–2015)

Guylene Kheirkhah

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N Get to Know the 2015–16 Students Rencontrez votre Comité des of the CVMA Committee Étudiants de l’ACMV 2015–2016 he Students of the Canadian Veterinary Medical Association e Comité des Étudiants de l’Association canadienne des T(SCVMA) Committee represents the CVMA at all 5 Canadian Lmédecins vétérinaires (ÉACMV) représente les cinq collèges veterinary colleges, strengthening the links between the Association de médecine vétérinaire canadiens, afin de renforcer les liens entre and its student members. l’Association et ses membres étudiants. Justin Kristjansson, SCVMA representa- Justin Kristjansson, représentant des ÉACMV au Western tive at the Western College of Veterinary College of Veterinary Medicine (WCVM), est né et a grandi dans Medicine (WCVM), was born and raised in une région rurale du Manitoba et, dès un jeune âge, il a participé rural Manitoba and was involved in day-to-day aux activités quotidiennes de la ferme d’élevage de bovins de operations of his family’s beef cattle operation sa famille. Il a développé un intérêt précoce pour la médecine from a young age. An early veterinary interest vétérinaire en observant des protocoles de vaccination, le vêlage, stemmed from vaccination protocols, calving les vaches malades, les veaux, les chevaux et une rare césarienne. experiences, sick cows, calves, horses, and the Durant l’école secondaire, Justin a travaillé chez un éleveur de rare caesarean. During high school, Justin worked at a poultry volaille où il a participé à la gestion de la santé du troupeau, à breeder barn where he took part in flock health management, des programmes d’alimentation et d’éclairage ainsi qu’à de stricts feeding and lighting programs, and strict biosecurity protocols. protocoles de biosécurité. Immédiatement après l’école secondaire, Immediately following high school, Justin completed 2 years of Justin a achevé deux années d’un diplôme de baccalauréat en a Bachelor of Science degree with a major in biology at Brandon science avec une majeure en biologie à l’Université de Brandon. University. For 2 summers, he worked as a meat hygiene inspec- Pendant deux étés, il a travaillé comme inspecteur d’hygiène tor for the Canadian Food Inspection Agency, and was involved des viandes pour l’Agence canadienne d’inspection des aliments with pathology identification, national slaughter plant inspec- et il a travaillé à l’identification pathologique et au respect des tion standards, and gaining insight into the public health sector normes nationales d’inspection des abattoirs, ce qui lui a permis of veterinary medicine. After 2 years at Brandon University, he de découvrir le secteur de la santé publique de la médecine transferred into an Animal Science degree at the University of vétérinaire. Après deux années à l’Université de Brandon, il a Saskatchewan and after 3 years of undergrad, he was accepted transféré dans un programme de sciences animales à l’Université into the WCVM. A summer of beef cattle lameness research at de la Saskatchewan et, après trois années d’études de premier the WCVM and 2 summers of mixed-animal clinical experience cycle, il a été accepté au WCVM. Pendant un été, il a effectué de la in Glenboro, Manitoba, have greatly enhanced his understanding recherche sur la boiterie des bovins de boucherie au WCVM et, au of the broad scope of the veterinary profession. cours de deux autres étés, il a fait l’acquisition d’expérience dans Justin is involved in many organizations at the WCVM. He une clinique mixte à Glenboro, au Manitoba, ce qui lui a permis de was a first-year representative and then the bovine representa- grandement améliorer sa compréhension de la vaste portée de la tive for the Production Animal Club, as well as the junior vice- profession vétérinaire. president external of the Western Canadian Veterinary Students Justin participe à de nombreuses organisations au WCVM. Il Association (WCVSA). This position doubles as the junior a été représentant de première année, puis représentant bovin SCVMA representative, in which he assisted the senior SCVMA pour le Club des animaux d’élevage ainsi que vice-président representative with the planning and organization of the 2015 externe junior de l’association étudiante Western Canadian SCVMA “Prairie Zebras” Symposium. For the 2015–2016 Veterinary Students Association (WCVSA). Ce poste remplit school year, his 3rd year at WCVM, as the senior vice-president aussi la fonction de représentant junior des ÉACMV, où il a external of the WCVSA and as the president of the SCVMA, porté assistance à la représentante sénior des ÉACMV lors de la Justin looks forward to having the opportunity to represent planification et l’organisation du Symposium 2015 des ÉACMV Canadian veterinary students on the CVMA Council, ensuring «Zèbres des Prairies». Lors de l’année universitaire 2015–2016, that their needs and concerns are addressed. Continuing existing sa troisième année au WCVM, Justin sera vice-président externe student programs, such as the Symposium, as well as implement- sénior de la WCVSA et vice-président des ÉACMV, et il se réjouit ing new student opportunities, such as a student leadership pro- à la perspective d’avoir l’occasion de représenter les étudiants gram alternating among the colleges, are priorities for the year. canadiens en médecine vétérinaire au sein du Conseil de l’ACMV, Justin encourages all students to provide the SCVMA with their afin de veiller à répondre à leurs besoins et à leurs préoccupations. feedback on any aspect of their academic and professional lives. Les priorités de l’année consisteront à assurer la continuité des Noëlle Webb, SCVMA representative from the Atlantic programmes étudiants en cours, comme le Symposium, ainsi qu’à Veterinary College (AVC), grew up in Surrey, British Columbia, mettre en œuvre de nouvelles possibilités pour les étudiants, before moving to Nova Scotia at 9 years old. Like many, she comme le programme de leadership étudiant qui se déplacera wanted to become a veterinarian from a young age. Her curiosity d’un établissement à l’autre. Justin encourage tous les étudiants and passion about the diversity of the animal kingdom led her to à communiquer leur rétroaction au Comité des ÉACMV sur tout become fascinated with exotic and zoological medicine. Noëlle aspect de leur vie universitaire et professionnelle. is also interested in languages, which motivated her to take Noëlle Webb, représentante des ÉACMV de l’Atlantic Veterinary French and Spanish in high school. After high school, Noëlle College (AVC), a grandi à Surrey, en Colombie-Britannique, avant

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completed a 3-year double major in biology de déménager en Nouvelle-Écosse à l’âge de neuf ans. Comme N and German at Dalhousie University in beaucoup de jeunes, elle désirait devenir vétérinaire dès un jeune Halifax before being accepted into AVC’s âge. Sa curiosité et sa passion à propos de la diversité du royaume Class of 2018. In 2013, Noëlle spent the animal ont éveillé un intérêt pour la médecine exotique et zoologique. summer in Germany, further developing Noëlle s’intéresse aussi aux langues et elle a suivi des cours de her language skills. While studying at the français et d’espagnol à l’école secondaire. Après l’école secondaire, Ludwig Maximilians University in Munich, Noëlle a achevé une double majeure de trois ans en biologie et en she enjoyed learning from an amazing vari- allemand à l’Université Dalhousie avant d’être acceptée à la promotion ety of people. When she arrived at AVC, 2018 de l’AVC. En 2013, Noëlle a passé l’été en Allemagne afin de Noëlle was impressed again by the diversity of students and perfectionner ses compétences linguistiques. Pendant ses cours à staff. In 2015–16, Noëlle will also be the wildlife representa- l’Université Ludwig Maximilians de Munich, elle a aimé élargir ses tive for the Exotics/Lab/Wildlife Club and the secretary for the connaissances auprès d’un groupe de personnes incroyables. À Teaching Animal Enrichment Club. Noëlle feels grateful for the son arrivée à l’AVC, Noëlle a été de nouveau impressionnée par la wonderful experiences she’s gained by working 2 summers at the diversité des étudiants et du personnel. En 2015–2016, Noëlle agira Provincial SPCA in Halifax, volunteering for Hope for Wildlife, aussi comme représentante de la faune pour le Club des animaux and conducting parasitology research at Dalhousie and is look- exotiques, de laboratoire et de la faune et comme secrétaire du ing forward to the challenges and learning opportunities in the Teaching Animal Enrichment Club. Noëlle est reconnaissante des coming year, and wishes all her fellow students much success. expériences merveilleuses qu’elle a vécues pendant deux étés Kelsey Chapman, a student at the passés à travailler à la SPCA provinciale à Halifax, lors de son University of Calgary — Faculty of bénévolat auprès de Hope for Wildlife et de travaux de parasitologie Veterinary Medicine (UCVM), has been à Dalhousie. Elle se réjouit à la pensée de relever des défis et des surrounded by animals her entire life. occasions d’apprentissage au cours de la prochaine année et elle When she was young, her mother would offre ses meilleurs vœux de succès à ses camarades de classe. drop her off at a Jersey farm for daycare, Kelsey Chapman, une étudiante de l’Université of Calgary — lay her on a hay bail in her 101 Dalmatians Faculté de médecine vétérinaire (UCVM), a été entourée sleeping bag, and tuck in a bunny to keep d’animaux pendant toute sa vie. Lorsqu’elle était jeune, sa mère her warm. Kelsey spent most of her child- la déposait à une ferme de vaches Jersey comme garderie, la hood balancing school, riding, team sports, and competitive couchait sur une botte de foin dans son sac de couchage des swimming, and when she was old enough, she began volunteer- 101 Dalmatiens et plaçait un lapin sous son bras pour la garder au ing at the British Columbia SPCA and shadowing veterinarians chaud. Kelsey a passé la majeure partie de son enfance à jongler in her community. When Kelsey began her undergraduate degree école, équitation, sports d’équipe et nage compétitive et, lorsqu’elle in general sciences at the University of British Columbia, she a atteint l’âge requis, elle a commencé à faire du bénévolat auprès also took up modern pentathlon, a sport comprised of fencing, de la SPCA de la Colombie-Britannique et à suivre des vétérinaires horse jumping, swimming, and a combined run-shoot event. dans sa collectivité. Lorsque Kelsey a entamé son diplôme Upon moving to Calgary for her DVM degree, Kelsey decided d’études de premier cycle en sciences générales à l’Université to tone down the amount of time spent on sports in order to de la Colombie-Britannique, elle a aussi commencé à s’entraîner focus on veterinary medicine. She feels incredibly fortunate that pour le pentathlon moderne, un sport qui comprend l’escrime, le the UCVM has given her the opportunity to take on a variety of saut à cheval, la natation et une épreuve de tir à la course. À son jobs with large animals, from caring for dairy calves, to helping déménagement à Calgary pour son diplôme de D.M.V., Kelsey a with behavioral research on the bucking stock at the Calgary décidé de réduire ses activités sportives afin de se concentrer sur Stampede. The rewards of working with her high-spirited peers la médecine vétérinaire. Elle se sent incroyablement fortunée que drew Kelsey into becoming vice president of Events in the l’UCVM lui ait donné l’occasion d’occuper divers emplois auprès Calgary Association of Veterinary Students and, as of this year, des grands animaux où elle a pris soin de veaux laitiers et a porté Calgary’s senior SCVMA representative. Kelsey revels in mak- assistance lors de travaux de recherche comportementale sur la ing meaningful connections with all her veterinary peers, and ruade des bovins au Stampede de Calgary. Les récompenses du is delighted to continue being a part of the incredibly talented travail avec ses pairs enthousiastes ont incité Kelsey à devenir SCVMA team in the upcoming year. vice-présidente des événements de la Calgary Association of Jamie Freeman-Braganca, a student at the Ontario Veterinary Students et, cette année, représentante sénior des Veterinary College (OVC), was born in Brampton, Ontario, ÉACMV à Calgary. Kelsey adore établir des liens intéressants avec where she first set foot in a veterinary clinic as a co-op student. It tous ses pairs vétérinaires et elle est ravie de continuer de faire wasn’t long before the wagging of tails and the hustle and bustle partie de l’équipe extrêmement talentueuse des ÉACMV au cours of the clinic had her hooked. She knew then that she would be de l’année à venir. pursuing a career in veterinary medicine. Jamie was hired at Jamie Freeman-Braganca, une étudiante de l’Ontario the clinic where she worked for the remainder of high school. Veterinary College (OVC), est née à Brampton, en Ontario, où After high school, Jamie studied at the University of Guelph, elle a mis pied dans une clinique vétérinaire pour la première fois majoring in animal biology. During her studies, Jamie contin- en tant qu’étudiante dans un programme d’études coopératives. ued to learn her field by working in a pet store, small animal Il n’a pas fallu longtemps pour que les animaux affectueux et

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N clinics and volunteering in equine board- l’activité de la clinique séduisent Jamie. Elle savait dès lors qu’elle ing facilities, a beef operation and a turtle poursuivrait une carrière en médecine vétérinaire. Jamie a été hatchery. Her studies and the hours spent embauchée à la clinique et elle y a travaillé pendant le reste de gaining experience earned Jamie a spot in ses études secondaires. Après l’école secondaire, Jamie a étudié the OVC’s Class of 2018, also known as à l’Université de Guelph, et elle a obtenu une majeure en biologie the Ivory Owls. In the 2014–15 school animale. Durant ses études, Jamie a continué à s’instruire dans year, Jamie was the junior representative son domaine en travaillant dans une animalerie et dans une for the SCVMA at the OVC. This position clinique pour petits animaux et en faisant du travail bénévole dans allowed Jamie to meet veterinary students une pension pour chevaux, une exploitation de bovins ainsi qu’un from across Canada and to learn about common issues that cur- élevage de tortues. Grâce à ses études et aux heures passées rently face Canadian veterinarians. In the coming school year, à obtenir de l’expérience, Jamie a obtenu une place dans la Jamie is excited to take on the role of senior representative of the promotion 2018 de l’OVC, aussi connue sous le nom d’Ivory Owls SCVMA and chair of the 2016 SCVMA “The Elephant in the (chouettes d’ivoire). Pendant l’année 2014–2015, Jamie était Room” Symposium, which will be held at the OVC in January. représentante junior des ÉACMV à l’OVC. Ce poste a permis à In organizing this event, Jamie hopes to provide students with Jamie de rencontrer des étudiants en médecine vétérinaire de the opportunity to learn about some of the tough subjects of toutes les régions du Canada et de se renseigner à propos des veterinary medicine. Jamie also hopes to showcase what the enjeux communs vécus par les vétérinaires canadiens. Au cours OVC brings to the table when it comes to veterinary medicine de la prochaine année universitaire, Jamie est excitée d’occuper in Canada. la fonction de représentante sénior des ÉACMV et de présidente Hélène Rembeaux, SCVMA repre- du Symposium 2016 des ÉACMV «L’éléphant dans la salle», qui sentative from La Faculté de Médecine se déroulera à l’OVC en janvier. Lors de l’organisation de cet Vétérinaire (FMV), was born and raised in événement, Jamie espère fournir aux étudiants l’occasion d’aborder La Réunion, a small island located in the certains des sujets difficiles en médecine vétérinaire. Jamie Indian Ocean, east of Madagascar. Hélène, espère aussi présenter les atouts de l’OVC dans le domaine de la her younger brother, and her parents spent médecine vétérinaire au Canada. their weekends on the picturesque beaches Hélène Rembeaux, représentante des ÉACMV de la Faculté of La Réunion where she discovered what de médecine vétérinaire (FMV) de l’Université de Montréal, her island had to offer. La Réunion benefits est née et a grandi à La Réunion, une petite île située dans l’océan from the eco-diversity of its coral reef, which covers a large Indien, à l’est de Madagascar. Hélène, son jeune frère et ses portion of the island’s western cost. The tropical island hosts a parents passaient leurs fins de semaine sur les pittoresques plages variety of animals such as the white-tailed tropicbird as well as de La Réunion où elle a découvert tout ce que son île avait à offrir. the panther chameleon. As a child, Hélène was eager to learn La Réunion jouit de la biodiversité de son récif corallien, qui couvre about all the different types of animals that her island and its une grande partie de la côte ouest de l’île. L’île tropicale abrite surrounding waters harbored. Since then, she knew that she une variété d’animaux comme le phaéton à bec jaune ainsi que le wanted to become a veterinarian. When Hélène was 7, she caméléon panthère. Enfant, Hélène avait hâte de se renseigner moved with her family to Montréal, Quebec. When Hélène was à propos de tous les différents types d’animaux qu’abritaient 16 years old, she had the opportunity to travel to Hanuman Bay son île et ses eaux environnantes. Depuis ce temps, elle savait in Hawaii to train as a lifeguard. There, she was once more awed qu’elle voulait devenir vétérinaire. À l’âge de 7 ans, Hélène est by the bio-diversity and fragility of the tropics and her love of déménagée avec sa famille à Montréal, au Québec. À l’âge de animal science was rekindled. After CEGEP, Hélène was accepted 16 ans, Hélène a eu l’occasion de se rendre à la baie Hanuman à to study veterinary medicine in 2012 and she currently lives Hawaï pour s’entraîner comme sauveteur. À cet endroit, elle s’est with 2 roommates, their cats and her beloved rabbit Prunelle émerveillé plus d’une fois devant la biodiversité et la fragilité des in St-Hyacinthe, Quebec. After graduation, Hélène wishes to régions tropicales, ce qui a ravivé son amour pour les sciences complete an internship in exotic animal medicine and open a animales. Après le CEGEP, Hélène a été acceptée en 2012 au practice where she can treat small animals and exotic animals programme de médecine vétérinaire et elle habite actuellement native to her birthplace. Hélène became more involved with the avec deux colocataires, leurs chats et sa lapine adorée Prunelle SCVMA in her 2nd-year at FMV and helped organize the 2014 à St-Hyacinthe, au Québec. Après la fin du cours, Hélène désire SCVMA “LegenDairy” Symposium. She is now looking forward suivre un internat en médecine des animaux exotiques et ouvrir to representing FMV’s students as senior representative of the une pratique où elle pourra traiter des petits animaux et des SCVMA and to meet colleagues from across Canada! animaux exotiques provenant de sa terre natale. Hélène a accru sa participation aux ÉACMV lors de sa deuxième année à la FMV et elle a aidé à organiser le Symposium «Lait-gendaire» des ÉACMV en 2014. Elle a maintenant hâte de représenter les étudiants de la FMV en tant que représentante sénior des ÉACMV et de rencontrer des collègues provenant de toutes les régions du Canada!

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Tools for Your Practice: Take Full Advantage of CVMA Resources N Outils pour votre pratique : profitez pleinement des ressources de l’ACMV he CVMA has developed a range of practice tools and ACMV a mis au point un éventail d’outils et de ressources pour Tresources, including videos, guidelines, protocols, posters L’ la pratique, notamment des vidéos, des lignes directrices, des and best practices, to support you, your healthcare team and protocoles, des affiches et des meilleures pratiques, afin de vous your practice. These practice resources are a tangible benefit of appuyer vous, votre équipe de la clinique et votre pratique. Ces your CVMA membership and are intended to provide veterinary ressources pour la pratique sont un avantage concret de votre practitioners with knowledge and information to assist you in adhésion à l’ACMV et elles ont pour but de communiquer des your everyday work and enable you to deliver high quality vet- connaissances et des renseignements qui assistent les praticiens erinary care. Although some of the resources were developed for vétérinaires dans leur travail quotidien et leur permettent d’offrir particular areas of practice (companion animals, food animals, des soins vétérinaires de grande qualité. Même si certaines des equine) a number of them may be of relevance to all members. ressources ont été élaborées pour des domaines particuliers de la Throughout the year, each month we will focus on one spe- pratique (animaux de compagnie, animaux destinés à l’alimentation, cific tool to help you learn more about it and see how you can équidés), plusieurs d’entre elles pourraient être pertinentes pour use the practical information to make sound decisions in your tous les vétérinaires. day-to-day practice of veterinary medicine. Pendant l’année, nous examinerons un nouvel outil chaque mois afin que vous puissiez mieux le connaître et déterminer si CVMA’s Guidelines for the Legitimate Use vous pouvez utiliser ces renseignements pratiques pour prendre of Compounded Drugs in Veterinary des décisions sûres dans l’exercice quotidien de la médecine Practice vétérinaire. The CVMA, in consultation with a multi-member task force, created Guidelines for the Legitimate Use of Compounded Drugs Lignes directrices de l’ACMV sur la pratique in Veterinary Practice. These guidelines are intended to provide légitime des préparations magistrales de veterinary practitioners with information needed to make appro- médicaments priate professional decisions when considering whether or not L’ACMV, en consultation avec un groupe de travail, a créé les Lignes to use a compounded product to treat a patient. directrices sur la pratique légitime des préparations magistrales de Compounding drugs is a process that involves combining 2 médicaments. Ces lignes directrices visent à communiquer aux or more ingredients, at least one of which is a drug, to create a praticiens vétérinaires les renseignements requis pour prendre final product for dosing. This process is necessary and beneficial des décisions professionnelles appropriées lors de la considération in the treatment of veterinary patients but can harm animals d’une préparation magistrale pour traiter un patient. and the public and open veterinarians up to liability if not done La préparation de médicaments est un processus qui comporte properly. le mélange de deux ingrédients ou plus, dont au moins un est un The purpose of these guidelines is to summarize and clarify médicament, afin de créer un produit final pour la posologie. Ce existing legislation and policy regarding the compounding and processus est nécessaire et bénéfique pour le traitement des prescribing of compounded products patients vétérinaires, mais il peut faire du tort aux animaux et au Members can access the digital copy of these guidelines by public et les vétérinaires peuvent assumer une responsabilité si le opening a session on the CVMA website (www.canadianveteri cheminement approprié n’est pas respecté. narians.net) in the Practice & Economics section under Practice Le but de ces lignes directrices consiste à résumer et à clarifier Tools — Companion Animal or Food Animal. les lois et les politiques existantes concernant les préparations We hope you will find these guidelines useful! magistrales et l’ordonnance de préparations magistrales. Les membres peuvent accéder à l’exemplaire numérique de ces lignes directrices en ouvrant une session sur le site Web de l’ACMV (www.veterinairesaucanada.net) dans la section Pratique et finances sous Outils pour la pratique — Animaux de compagnie ou Animaux destinés à l’alimentation. Nous espérons que vous trouverez ces lignes directrices utiles!

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N The Perfect Pair: Partners in preventive veterinary care Animal Health Week — October 4 to 10, 2015 Des partenaires hors pair en matière de soins vétérinaires préventifs Semaine de la vie animale — Du 4 au 10 octobre 2015 he 2015 Animal Health Week will mark the 30th year the a Semaine de la vie animale 2015 marquera le 30e anniversaire TCanadian Veterinary Medical Association (CVMA) has run Lde cette campagne organisée par l’Association canadienne the campaign, and we want to emphasize that while medical des médecins vétérinaires (ACMV) et nous désirons souligner technology and veterinary care have advanced, the connection que, même si la technologie et les soins vétérinaires ont réalisé between the veterinary team and the client remains one of the des progrès énormes, le lien entre l’équipe vétérinaire et le most important facets of veterinary care. client demeure l’un des aspects les plus importants des soins With each passing year pets (and barn animals alike!) are vétérinaires. increasingly being considered members of the family. It’s with Chaque année, les animaux de compagnie (et les animaux de knowledge such as this that we celebrate the importance of ferme aussi!) en viennent de plus en plus à être considérés comme “The Perfect Pair: Partners in preventive veterinary care.” des membres de la famille. C’est pour reconnaître ce fait que nous During Animal Health Week, from October 4 to 10, 2015, célébrons l’importance des «Partenaires hors pair en matière de we’re reminding animal owners that they and their entire veteri- soins vétérinaires préventifs». nary team are important partners in ensuring optimal health for Durant la Semaine de la vie animale, qui se déroulera du 4 au their animal. The establishment of a close relationship between 10 octobre 2015, nous rappellerons aux propriétaires d’animaux an animal healthcare team and an animal (large or small) owner qu’ils sont, avec toute l’équipe vétérinaire, des partenaires can play a major role in laying the groundwork for a healthy, importants afin d’optimiser la santé de leur animal. L’établissement happy life for the animal. d’un lien étroit entre l’équipe de santé animale et un propriétaire We’d like to remind animal owners that: d’animal (grand ou petit) peut jouer un rôle majeur afin de jeter les • Animal owners and veterinarians are partners who work bases d’une vie heureuse et en santé pour l’animal. together to ensure animals stay healthy. Nous aimerions rappeler aux propriétaires d’animaux que : • Your veterinary team is there for you to discuss healthcare • Les propriétaires d’animaux et les vétérinaires travaillent options, and can help you make well-informed decisions ensemble afin de protéger la santé des animaux. about your pet’s medical care. • Votre équipe vétérinaire est là pour discuter avec vous des • Prevention is always better for pets and more cost-effective options de soins de santé et elle peut vous aider à prendre for pet owners. des décisions éclairées à propos des soins médicaux de votre • All pets should visit a veterinarian at least once yearly. animal de compagnie. Each year veterinary teams rank waiting room displays as the • La prévention est toujours préférable pour les animaux de most popular way of celebrating Animal Health Week, followed compagnie et elle est plus économique pour les propriétaires. closely by client contests. In addition to the official campaign • Tous les animaux de compagnie devraient visiter le vétérinaire poster, the following items will engage your entire healthcare au moins une fois par année. team and help celebrate Animal Health Week: Chaque année, les équipes vétérinaires considèrent que les • Balloons expositions dans la salle d’attente sont la façon la plus populaire • Temporary tattoos de célébrer la Semaine de la vie animale, suivies de près par • T-shirts (available in men’s and women’s sizes) les concours pour les clients. En plus de l’affiche officielle de la • V-neck pullover scrub shirts (available in a range of sizes) campagne, les articles suivants inviteront toute l’équipe vétérinaire • Pet rescue window decals à célébrer la Semaine de la vie animale : • CVMA activity book “Big or Small, We Help Them All!” • Ballons • Tatouages temporaires • T-shirts (disponibles en tailles pour hommes et femmes) • Blouses chirurgicales avec encolure en V (offertes dans diverses tailles) • Décalques de secours pour les fenêtres • Album d’activités de l’ACMV «Petits et grands, ce sont nos patients!» • Sac à dos sport (chaton) qui peut être utilisé pour toutes sortes d’activités et pour transporter de l’équipement de sport ou des vêtements de plage • Chapeau de papier pour enfants — Vache Placez votre commande avant la date limite du 10 juillet 2015 pour courir la chance de gagner une carte-cadeau de 100 $ chez Subway (assez pour sortir toute l’équipe à manger le

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• Paws N’ Claws Sports Pack (kitten), which can be used for a midi!) et d’autres prix épatants. La dernière journée pour placer N variety of activities like carrying sports gear or beach apparel votre commande d’articles de la Semaine de la vie animale est le • Kid friendly cow-themed paper hat 24 juillet 2015. Place your order before the early bird deadline on July 10, Un généreux soutien de la campagne de la Semaine de la 2015 for a chance to win a $100 Subway gift card (enough to vie animale 2015 est offert par notre commanditaire principal treat the whole team to lunch!) and other fun prizes. The last Petsecure assurance maladie pour animaux, le commanditaire day to place your order for Animal Health Week materials is de programme Plus IDEXX et les commanditaires de Programme July 24, 2015. iFinance Canada (Petcard) et Merial. Ce mois-ci, nous vous Generous support of the 2015 Animal Health Week cam- invitons à en apprendre davantage sur notre commanditaire de paign is provided by Principal Sponsor Petsecure Pet Health programme Plus, IDEXX Laboratories Inc. Insurance, Program Plus sponsor IDEXX, and Program spon- Depuis plus de 20 ans, les employés d’IDEXX à l’échelle du sors iFinance Canada (Petcard), and Merial. This month, we Canada travaillent pour offrir aux pratiques vétérinaires l’éventail invite you to learn more about our AHW Program Plus sponsor, le plus complet de services diagnostiques. Qu’il s’agisse d’un IDEXX Laboratories. laboratoire à la pratique ou d’un laboratoire de référence externe For over 20 years, IDEXX employees across Canada have — IDEXX procure les capacités de diagnostic convenant à chaque worked to offer veterinary practices the most comprehensive situation. range of diagnostic services available. Whether it is an in-practice En mettant à contribution la technologie et l’information en or external reference laboratory — IDEXX provides the right partenariat avec des professionnels médicaux spécialisés, IDEXX diagnostic capabilities in every situation. conçoit des solutions innovatrices pour aider les pratiques à By leveraging technology and information in partnership résoudre des problèmes médicaux complexes et à offrir les with advanced medical professionals, its innovative solutions meilleurs soins possibles tout en favorisant des liens solides et are designed to help practices solve complex medical problems durables avec les clients. and deliver the best possible care while fostering strong, lasting Voici quelques exemples des produits de pointe récemment bonds with clients. créés par IDEXX : Some examples of IDEXX’s recent ground-breaking products • Catalyst OneMD analyseur chimique interne et le test SNAPMD are: 4DxMD Plus fournit des résultats flexibles, exacts et en temps • Catalyst OneTM in-house chemistry analyzer and SNAP® réel aux propriétaires d’animaux. 4Dx® Plus Test deliver flexible, accurate, real-time results to • IDEXX Pet Health NetworkMD Pro offre des outils et des the pet owner. services en ligne pratiques pour aider à renforcer les relations • IDEXX Pet Health Network® Pro provides convenient d’affaires et les liens avec les clients. online tools and services to help strengthen business and • L’appli IDEXX VetConnectMD PLUS est le compagnon mobile client relationships. idéal pour les vétérinaires et les employés de la pratique • IDEXX VetConnect® PLUS app is the ideal mobile com- qui utilisent IDEXX VetConnectMD PLUS pour visualiser les panion for veterinarians and practice staff who use IDEXX résultats diagnostiques et les anamnèses des patients. VetConnect® PLUS to view diagnostic results and patient • Pet Health NetworkMD 3D a été créé par IDEXX pour fournir histories. des outils avancés pour la sensibilisation des clients à l’aide • Pet Health Network® 3D was created by IDEXX to provide d’animations anatomiques 3D, de radiographies et de vidéos advanced client education tools using vivid 3D anatomical éducatives sur les soins à domicile. animations, radiographs, and instructional home care videos. • PetDiseaseReport.com, le site de déclaration en temps réel • PetDiseaseReport.com, IDEXX Canada’s real-time pet dis- de maladies d’animaux d’IDEXX Canada, qui a maintenant ease reporting site, now has the ability to allow veterinarians la capacité de permettre aux vétérinaires de signaler et de to report and share their leptospirosis test results in addition partager les résultats de tests de la leptospirose en plus des to vector-borne disease test results. résultats des tests sur les maladies à transmission vectorielle. Research and development is at the heart of IDEXX’s com- La recherche et le développement se trouvent au cœur de mitment to partnering with veterinary professionals. As the pro- l’engagement d’IDEXX en vue de former un partenariat avec les fession continues to move to a preventive care model, IDEXX’s professionnels vétérinaires. Au fur et à mesure que la profession innovative solutions will be there to enhance the health and continue de se diriger vers un modèle de soins préventifs, les well-being of people, pets and livestock. solutions innovatrices d’IDEXX seront là pour améliorer la santé et le bien-être des personnes, des animaux et du bétail.

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N Around the Provinces Le tour des provinces Manitoba Veterinary Medical Association Manitoba Veterinary Medical Association (MVMA) (MVMA)

titre de présidente de la Manitoba Veterinary Medical À Association, je suis heureuse de partager certains faits saillants de notre travail avec nos collègues de toutes les régions du Canada. «Clarté» des tarifs vétérinaires La MVMA a commencé à rencontrer des représentants du gouvernement (des responsables de l’Office de la protection du consommateur et d’Agriculture Manitoba étaient présents) Dr./Dre Roxane Neufeld au printemps de 2014 concernant ce sujet. La réunion a été organisée par l’Office de protection du consommateur en réponse s president of the Manitoba Veterinary Medical Association, à des plaintes du public — et dans les médias — à propos des I am pleased to share some highlights of our work with col- A tarifs vétérinaires, particulièrement les tarifs pour animaux de leagues across Canada. compagnie. Veterinary fee “clarity” Durant les réunions du printemps, on nous a communiqués les The MVMA first began meeting with government (represen- trois grands domaines de préoccupation en rapport avec les tarifs tatives from Consumer Protection and Manitoba Agriculture vétérinaires : were in attendance) in the spring of 2014 regarding this matter. 1) Coût des services; The meeting was called by Consumer Protection in response to 2) Les clients ne comprennent pas les services vétérinaires qui complaints from the public — and through the media — about sont recommandés et les tarifs exigés; veterinary fees, with a focus on companion animal fees. 3) Les décisions prises par un vétérinaire après un examen initial During our spring meetings, we were told there were 3 main des services, sans que le client ne comprenne la hausse du areas of concern in regards to veterinary fees: coût et/ou sans obtenir l’autorisation du client pour prodiguer 1) Cost of services; les soins. 2) Clients not understanding the veterinary services being rec- Le gouvernement ne désirait pas réglementer les tarifs, mais ommended and the related fees; and il voulait plutôt assurer que la MVMA répondrait aux plaintes 3) Decisions being made by a veterinarian after initial review concernant la clarté et la transparence des tarifs (questions of services, without the client understanding the increase in 2 et 3). La MVMA a eu pour politique d’aborder les plaintes cost and/or without the client’s approval to proceed. relativement aux tarifs uniquement lorsqu’elles accompagnaient The government was not interested in regulating fees but in d’autres actes ou comportements qui étaient présentés au ensuring the MVMA would address complaints regarding fee Comité d’examen par les pairs (notamment une rupture des clarity and transparency (items number 2 and 3). The practice communications). Habituellement, la MVMA ne s’occupe pas of the MVMA has been to only address fee complaints when des conflits relatifs aux tarifs. Il semble que le gouvernement a coupled with other actions or behaviors that are brought to the l’intention d’accroître la protection du public en ce qui concerne la attention of the Peer Review Committee (namely a breakdown clarté et la transparence des tarifs vétérinaires en exigeant que la in communication). Typically, the MVMA does not become MVMA crée des règlements administratifs, dans le cadre d’une loi, involved in fee disputes. It appears the intention of the gov- pour appuyer ce comportement. ernment is to increase public protection related to clarity and Modification de la Loi sur la médecine transparency of veterinary fees by requiring the MVMA to create vétérinaire du Manitoba by-laws, through legislation, that support this endeavor. En raison du mandat du gouvernement concernant les tarifs Opening of Manitoba’s Veterinary Medical Act vétérinaires, la Loi sur la médecine vétérinaire du Manitoba fera With the government mandate regarding veterinary fees, it l’objet d’un examen au printemps de 2015. Au Manitoba, les means Manitoba’s Veterinary Medical Act will be opened in the vétérinaires n’ont pas le droit de se constituer en société. Depuis spring of 2015. In Manitoba, veterinarians are not allowed 2010, la MVMA demande que la Loi soit modifiée afin d’intégrer to incorporate. The MVMA has been requesting the Act be le langage requis pour permettre aux vétérinaires de se constituer opened to insert the required language to allow veterinarians en société. Donc, le côté positif de la «clarté des tarifs» sera qu’il to incorporate since 2010. So, the bright side of “fee clarity” is semble que l’amendement permettant aux vétérinaires de se it appears the amendment to allow veterinarians to incorporate constituer en société sera enfin intégré à la Loi. will finally be completed. La MVMA procède aussi à l’examen de la Loi où des The MVMA is also reviewing areas of the Act where change changements sont requis en portant une attention particulière à is required with a focus on the use and application of the term l’utilisation et à l’emploi du terme «membre» et à la réglementation “member” and the regulation of animal health technologists. des technologues en santé animale.

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Regulation of animal health technologists Règlementation des technologues en santé N In early 2014, the Manitoba Animal Health Technologists animale Association (MAHTA) approached the MVMA with a request Au début de 2014, la Manitoba Animal Health Technologists to change their members’ designation from “Animal Health Association (MAHTA) a approché la MVMA pour demander de Technologists” (AHT) to “Veterinary Technologists” (VT) as changer la désignation de ses membres en tant que «technologues the veterinary technologist designation is most commonly used en santé animale» (TSA) pour «technologues vétérinaires» (TV) car in Canada. As the designation “Animal Health Technologist” is la désignation de technologue vétérinaire est plus couramment defined in the Veterinary Medical Act, a review of the Act, as it utilisée au Canada. Vu que la désignation de «technologue en santé pertains to AHTs, was undertaken. animale» est définie dans la Loi sur la médecine vétérinaire, un During this review of the Veterinary Medical Act, it was iden- examen de la Loi, telle qu’elle se rapporte aux TSA, a été entrepris. tified that AHTs are members of the MVMA and the MVMA Durant cet examen de la Loi sur la médecine vétérinaire, il a is responsible for their regulation. Consequently, the MVMA été identifié que les TSA sont des membres de la MVMA et que la would need to undertake the regulation (including registration) MVMA est responsable de leur réglementation. Par conséquent, of AHTs in Manitoba. Currently, MAHTA fulfils the roles of la MVMA aimerait entreprendre la réglementation (y compris the regulatory and member service body for AHTs in Manitoba. l’enregistrement) des TSA au Manitoba. À l’heure actuelle, la The MVMA’s assumption of the regulation of animal MAHTA remplit la fonction d’organisme de réglementation et de health technologists has been paused due to the opening of the service aux membres pour les TSA du Manitoba. Veterinary Medical Act in the spring of 2015. Once any amend- La prise en charge de la réglementation des technologues ments to the Act are complete, the MVMA and MAHTA will en santé animale par la MVMA a été mise en suspens en raison determine how best to proceed with the required changes to de l’examen de la Loi sur la médecine vétérinaire au printemps de their respective governing documents as well as determining the 2015. Une fois que les modifications à la Loi seront terminées, responsibilities of each association. la MVMA et la MAHTA détermineront la meilleure façon d’aller MVMA leadership retreat de l’avant avec les changements requis pour les documents de réglementation respectifs ainsi que la détermination des In November of 2014, nearly 20 veterinarians, representing all responsabilités de chaque association. demographics, attended the 2014 MVMA Leadership Weekend. Key outcomes from this weekend included the identified oppor- Retraite du leadership de la MVMA tunities in 3 areas where our Association can work to improve. En novembre 2014, près de 20 vétérinaires, représentant toutes These opportunities are in the areas of professional image, mem- les régions démographiques, ont assisté à la fin de semaine du bership services, and membership engagement. Furthermore, leadership 2014 de la MVMA. Les principaux résultats de cette through an intense session of brainstorming, this group was able fin de semaine incluaient l’identification d’occasions dans trois to come together and redefine the MVMA’s Vision and Mission domaines où notre association peut apporter des améliorations. Statements. They are: Ces occasions touchent les domaines de l’image professionnelle, les services aux membres et l’engagement de l’effectif. De plus, Vision: dans le cadre d’une séance intensive de remue-méninges, ce We envision a society that embraces excellence in animal health groupe est parvenu à un consensus et a redéfini les énoncés de and welfare. vision et de mission de la MVMA. Les voici : Mission: Vision : As trusted leaders and advocates for the betterment and protection Nous avons pour vision une société qui favorise l’excellence en of animals and people in Manitoba, we provide regulatory gover- matière de santé et de bien-être des animaux. nance and empower our members to champion the art and science of veterinary medicine. Mission : Those who participated in the weekend activities, unani- À titre de leaders et de défenseurs de confiance pour la protection mously declared the weekend a success. Many felt it was defi- des animaux et des personnes du Manitoba ainsi que l’avancement nitely worth doing again. We all know that for success, we need de leurs intérêts, nous assurons une régie de la réglementation et to have a plan; and a Leadership Weekend is a great place to nous habilitons nos membres à être des champions de l’art et de la collectively come up with that plan. Now, it’s time for “the rub- science de la médecine vétérinaire. ber to hit the road” and move the plan into action. La fin de semaine a été déclarée comme un succès par tous (by Dr. Roxane Neufeld, President, ceux qui ont participé à ses activités. Beaucoup ont estimé qu’il Manitoba Veterinary Medical Association) valait la peine de renouveler l’expérience. Nous savons tous que pour connaître le succès, nous avons besoin d’un plan, et une fin de semaine du leadership représente une excellente occasion de mettre ce plan au point. Il est maintenant temps de passer aux actes et de mettre ce plan en œuvre. (par la Dre Roxane Neufeld, présidente, Manitoba Veterinary Medical Association)

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N Obituary Nécrologie Dr. Albert “Bud” Ings Dr Albert «Bud» Ings A man who walked softly while leaving a trail of gigantic foot- En mars, un homme qui parlait doucement pendant qu’il laissait prints across Prince Edward Island passed away in March with des traces de géant est décédé à l’Île-du-Prince-Édouard avec sa his family at his side. Dr. Albert “Bud” Ings died at the Kings famille à ses côtés. Le Dr Albert «Bud» Ings est décédé à l’hôpital County hospital at the age of 89. It would be easier to list the de Kings County à l’âge de 89 ans. Il serait plus facile d’énumérer things he didn’t do, and the people he didn’t know, than try to les choses qu’il n’a pas accomplies et les gens qu’il n’a pas connus, note such a list of achievements and friends. plutôt que de signaler la liste de réalisations et d’amis. A long-time veterinarian and politician, Ings still found Vétérinaire et politicien de longue date, Ings trouvait toujours time to be a fiddler, a founder and a family man. He was well le temps d’être violoneux ainsi que fondateur et homme de famille. known for driving his VW “bug” from farm to farm through Il était bien connu pour conduire sa Volkswagen Beetle dans l’est the rut filled roads in eastern Prince Edward Island during the de l’Île-du-Prince-Édouard durant les années 1950 et 1960 et il 1950s and 1960s and penned books about those rural visits that a écrit des livres à propos de ses visites rurales qui incluaient du included hot tea and biscuits. thé chaud et des gâteaux. “The Island has lost one of its best known vets,” wrote «L’Île a perdu l’un de ses vétérinaires les mieux connus», colleague Dr. Claudia Lister. “He was PEI’s answer to James a écrit sa collègue Dre Claudia Lister. «Il était la réponse de Herriot.” Ings established the Montague Veterinary Clinic in l’Île-du-Prince-Édouard à James Herriot». Ings a fondé la clinique 1967 and was elected Kings 3rd MLA in 1970. He was re-elected vétérinaire Montague en 1967 et il a été élu troisième député in 1974, 1978, and 1979. provincial de la circonscription de Kings en 1970. Il a été réélu en He served as minister of agriculture and forestry and minister 1974, 1978 et 1979. of health and social services in the Alex Campbell government. Il a occupé le poste de ministre de l’Agriculture et des Forêts “Bud will always be around in the memories of all the people et de ministre de la Santé et des Services sociaux dans le he knew and served,” wrote former PEI poet laureate Hugh gouvernement d’Alex Campbell. «Bud sera toujours présent dans MacDonald. le souvenir des personnes qu’il connaissait et qu’il a servies», a Ings helped establish the Atlantic Veterinary College (AVC), écrit l’ancien poète officiel de la Reine de l’Île-du-Prince-Édouard, the Queen Elizabeth Hospital, and was a charter member of the Hugh MacDonald. Garden of the Gulf Museum, the Montague Rotary Club, and Ings a contribué à la fondation de l’Atlantic Veterinary College was a Rotary Paul Harris Fellow. He served on the town coun- (AVC), de l’hôpital Queen Elizabeth et il était membre fondateur cil in Charlottetown, was a member of the Montague Legion, du musée Garden of the Gulf, du Club Rotary Montague et était and was a trustee of the Kings County Memorial Hospital and un fellow Rotary Paul Harris. Il a siégé au conseil municipal de the local school board. He was a member of the Prince Edward Charlottetown, a été membre de la Légion de Montague ainsi Island Centennial Commission and the Holland College Board qu’administrateur de l’hôpital Kings County Memorial et du conseil of Governors. scolaire local. Il était membre de la Commission du Centenaire de Ings was a member of Hillcrest United Church Choir and l’Île-du-Prince-Édouard et du conseil d’administration de Holland the Montague Male 8 Chorus, the Venerables senior drama College. group, and was a lifetime member of the PEI Fiddler’s Society. Par ailleurs, Ings était membre de la chorale de l’Église Ings was also an avid photographer and upon retiring penned Unie Hillcrest et de la chorale masculine Montague Male 8, du 2 award winning books about his travels as a vet and earned the groupe d’acteurs aînés Venerables et membre à vie de la société Order of Prince Edward Island in 2012. His book, Mud, Sweat des violoneux de l’Île-du-Prince-Édouard. Ings était aussi un and Tears, saw all proceeds from book sales donated to the PEI photographe enthousiaste et, à sa retraite, il a écrit deux livres Humane Society. primés à propos de ses voyages lors de ses tournées vétérinaires Ings was married to Connie Mair, who predeceased him, and et s’est mérité l’Ordre de l’Île-du-Prince-Édouard en 2012. Un has 3 daughters and 2 grandchildren. don a été fait à la Société pour la protection des animaux de He also received the Eugene Whalen Green Hat Award l’Île-du-Prince-Édouard de toutes les recettes tirées de son livre, (AVC’s highest award) and the Atlantic Award of Excellence in Mud, Sweat and Tears. Veterinary Medicine. Ings était marié à Connie Mair, qui l’a précédé dans la mort, et (Info from The Guardian) il avait trois filles et deux petits-enfants. Il a aussi reçu le Prix du chapeau vert d’Eugene Whalen (le plus grand honneur décerné par l’AVC) et le Prix d’excellence de l’Atlantique en médecine vétérinaire. (Renseignements d’après The Guardian)

668 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY 2014 Annual Report of the Canadian Veterinary Medical Association Rapport annuel 2014 de l’Association canadienne des médecins vétérinaires

he Canadian Veterinary Medical Association (CVMA) is Association canadienne des médecins vétérinaires (ACMV) T the national and international voice for Canada’s veterinar- L’ est la voix nationale et internationale des vétérinaires du ians, providing leadership and advocacy for veterinary medicine. Canada et elle assure le leadership et défend les intérêts de la The CVMA has close to 7000 members and 5800 affiliate médecine vétérinaire. L’ACMV compte près de 7000 membres veterinary technicians and technologists who are members of et de 5800 techniciens et technologues affiliés qui sont membres the Registered Veterinary Technologists and Technicians of de Technologues et techniciens vétérinaires enregistrés du Canada Canada (RVTTC). (TTVEC). For a small profession and a small association, collaboration Pour une petite profession et une petite association, la is essential. In 2014, the CVMA was proud to formalize col- collaboration est essentielle. En 2014, l’ACMV a été fière de laboration with 3 important stakeholders: formaliser une collaboration avec trois intervenants importants : Canadian Council of Veterinary Registrars (CCVR): The Conseil canadien des registraires vétérinaires (CCRV) : CVMA and the regulatory bodies have worked for many years L’ACMV et les organismes de réglementation travaillent depuis to establish a more formal collaboration among the veterinary de nombreuses années afin d’établir une collaboration plus regulatory bodies and with the CVMA. The registrars reworked officielle entre les organismes de réglementation vétérinaire et avec a proposal submitted in 2013 by a joint regulatory body/CVMA l’ACMV. Les registraires ont retravaillé une proposition soumise Task Force and drafted Terms of Reference for a Canadian en 2013 par un Groupe de travail mixte composé des organismes Council of Veterinary Registrars. During the 2014 CVMA de réglementation et l’ACMV et ils ont rédigé un mandat pour un Convention, these terms were signed by all regulatory bodies Conseil canadien des registraires vétérinaires. Durant le congrès and the CVMA. The CVMA representative holds a non-voting 2014 de l’ACMV, ce mandat a été signé par tous les organismes position on the CCVR. de réglementation et l’ACMV. Le représentant de l’ACMV occupe Registered Veterinary Technologists and Technicians un poste non votant au sein du CCRV. of Canada (RVTTC): To strengthen the ties of the veteri- Technologues et techniciens vétérinaires enregistrés du nary health care team, RVTTC (formerly called the Canadian Canada (TTVEC) : Pour renforcer les liens qui unissent l’équipe Association of Animal Health Technologists and Technicians de soins de santé vétérinaires, TTVEC (anciennement appelé [CAAHTT]) and the CVMA signed a Memorandum of l’Association canadienne des techniciens et technologues en santé Understanding during the 2014 CVMA Convention. This agree- animale [ACTTSA]) et l’ACMV ont signé un Protocole d’entente ment formalizes many of the collaborative activities that evolved durant le congrès 2014 de l’ACMV. Cette entente officialise bon over time and adds new opportunities. An ex-officio, non- nombre des activités de collaboration qui ont évolué avec le temps voting position has been reserved on the CVMA Council for an et elle prévoit de nouvelles occasions communes. Un poste d’office

Speakers from the 2014 Summit of Veterinary Leaders, which took place at the 2014 CVMA Annual Convention. Conférenciers du Sommet des leaders vétérinaires 2014 qui s’est déroulé lors du congrès annuel 2014 de l’ACMV.

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RVTTC representative and a reciprocal position has been made non votant a été réservé au sein du Conseil de l’ACMV pour un available on the RVTTC Board for a CVMA ­representative. représentant de TTVEC et un poste réciproque a été ouvert au The American Veterinary Medical Association (AVMA), the sein du Conseil de TTVEC pour un représentant de l’ACMV. Canadian Veterinary Medical Association (CVMA) and the L’American Veterinary Medical Association (AVMA), Federation of Veterinarians of Europe (FVE): Representing l’Association canadienne des médecins vétérinaires (ACMV) et 40 countries and over 330 000 veterinarians, the AVMA, la Fédération des vétérinaires de l’Europe (FVE) : Représentant CVMA, and the FVE have signed a Letter of Association. These 40 pays et plus de 330 000 vétérinaires, l’AVMA, l’ACMV et 3 groups will work together on animal health and welfare, public la FVE ont signé une Lettre d’association. Ces trois groupes health, trade agreements in relation to animal and veterinary travailleront ensemble pour améliorer la santé et le bien-être des matters, the advancement of veterinary education, the advance- animaux, la santé publique, les accords commerciaux se rapportant ment of veterinary science, and the promotion of the veterinary aux questions animales et vétérinaires ainsi que pour avancer RAPPORT ANNUEL profession. To date, the 3 parties agreed to joint positions on the l’enseignement de la médecine vétérinaire, de la science vétérinaire Global Control of Canine Rabies; Statement on The Essential et la promotion de la profession vétérinaire. Jusqu’à maintenant, Role of Veterinarians in Protecting Animal, Human, and the les trois parties ont se sont entendues sur les positions conjointes Public; Environmental Health — A Global Public Good; suivantes : Contrôle mondial de la rage canine; Déclaration sur Statement on Veterinary Education; The Role of Veterinarians in le rôle essentiel des vétérinaires dans la protection de la santé des Ensuring Good Animal Welfare; and Responsible and Judicious animaux, des humains et du public; Santé environnementale — Use of Antimicrobials. Un bien public mondial; Déclaration sur l’enseignement de la In 2014, the CVMA put a special focus on antimicrobial médecine vétérinaire; Le rôle des vétérinaires afin d’assurer un stewardship, an issue that the CVMA has been promoting bon bien-être animal; et L’utilisation responsable et judicieuse for over a decade. One event that caught much attention des antimicrobiens. was the CVMA’s Summit of Veterinary Leaders, chaired by En 2014, l’ACMV a concentré ses efforts sur la gestion Dr. Jean Gauvin. This Summit, under the title “Antimicrobial responsable des antimicrobiens, un enjeu dont l’ACMV fait la Stewardship: A New World Order,” was attended by over promotion depuis plus d’une décennie. Le Sommet des leaders 180 veterinarians. The Summit offered the opportunity to vétérinaires de l’ACMV, qui a été présidé par le Dr Jean Gauvin, learn from Canadian and international experts in the animal a été l’un des événements qui a attiré beaucoup d’attention. Plus and human health fields and provided a platform for animated de 180 vétérinaires ont assisté à ce Sommet, qui a été présenté discussions. The CVMA has continued to advocate for the sous le thème de «Gestion responsable des antimicrobiens : un regulated importation of active pharmaceutical ingredients, nouvel ordre mondial». Le Sommet a offert l’occasion de se the prohibition of own-use importation (OUI), or at least the renseigner auprès d’experts canadiens et internationaux dans establishment of a list of permissible products, and increased vet- les domaines de la santé animale et humaine et il fourni une erinary oversight of antimicrobials in livestock feeds and water. plate-forme pour la tenue de discussions animées. L’ACMV a Results of joint advocacy efforts with other stakeholder groups continué de préconiser la réglementation de l’importation des are expected in 2015. The CVMA provides Antimicrobial ingrédients pharmaceutiques actifs, l’interdiction de l’importation Prudent Use Guidelines for Beef Cattle, Dairy Cattle, Poultry pour utilisation personnelle, ou du moins l’établissement d’une and Swine. In 2014, the CVMA released the Antimicrobial liste de produits autorisés, ainsi qu’une supervision vétérinaire SmartVet mobile app to assist veterinarians with the prudent accrue des antimicrobiens dans les aliments et l’eau du bétail. use of antimicrobials when treating urinary tract infections in Les résultats des efforts conjoints de défense des intérêts avec companion animals. Another tool currently under development d’autres groupes d’intervenants sont attendus en 2015. L’ACMV is for canine pyoderma, to be followed by another for respira- fournit les Lignes directrices sur l’administration pour les bovins tory infections. laitiers, les bovins de boucherie, la volaille et les porcs. En 2014, The following reports provide a summary of the main activi- l’ACMV a lancé l’appli mobile IntelliVet pour aider les vétérinaires ties that were undertaken by the CVMA in 2014 for its members avec l’utilisation prudente des antimicrobiens lorsqu’ils traitent and, in many instances, for the profession at large. This would des infections des voies urinaires chez les animaux de compagnie. not have been possible to achieve without the contribution of Un autre outil actuellement en voie de développement servira à over 400 volunteers and a small, but dedicated team of staff. traiter la pyodermie canine et il sera suivi d’un autre ciblant les infections respiratoires. Jost am Rhyn, Chief Executive Officer, CVMA Les rapports suivants présentent un sommaire des principales activités qui ont été entreprises en 2014 par l’ACMV à l’intention de ses membres et, dans beaucoup de cas, pour la profession en général. Ces réalisations n’auraient pas été possibles sans la contribution de plus de 400 bénévoles ainsi que d’une petite équipe d’employés dévoués.

Jost am Rhyn, président-directeur général, ACMV

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Corporate Partnership Program (CPP) Programme de commandite par des entreprises (PCE)

The CVMA Corporate Partnership Program (CPP) is a compre- Le Programme de commandite par des entreprises (PCE) de ANNUAL REPORT ANNUAL hensive sponsorship program that was implemented in 2007 to l’ACMV est un programme de commandite complet qui a été better recognize a company’s overall financial contribution to the mis en œuvre en 2007 afin de mieux reconnaître la contribution Association. The CPP takes into account the various programs financière globale d’une entreprise à l’Association. Le PCE tient and events that are corporately sponsored, and allows companies compte des divers programmes et activités qui sont commandités that support the CVMA in various ways to receive better recog- par les sociétés et il permet à ces dernières d’appuyer l’ACMV de nition for their overall contributions. The 3 levels of sponsorship diverses façons afin d’obtenir une meilleure reconnaissance de in 2014 were Platinum (. $80 000), Gold ($48 000–$79 999) leurs contributions globales. Les trois niveaux de commandite en and Silver ($27 000–$47 999). 2014 étaient Platine (. 80 000 $), Or (de 48 000 $ à 79 999 $) The CVMA would like to recognize the following sponsors et Argent (de 27 000 $ à 47 999 $). for their overall contribution to the Association for 2014: L’ACMV aimerait reconnaître les commanditaires suivants pour Gold: IDEXX Laboratories leur contribution globale à l’Association en 2014 : Scotiabank Or : IDEXX Laboratories Silver: Hill’s Pet Nutrition Canada Banque Scotia Merck Animal Health Argent : Hill’s Pet Nutrition Canada Petsecure Pet Health Insurance Merck Santé animale Royal Canin Petsecure assurance maladie pour animaux Royal Canin

The following programs and activities underpin the CVMA’s Les programmes et les activités qui suivent servent de piliers aux core competencies and leadership initiatives in the areas of compétences fondamentales et aux initiatives de leadership de Policy and Advocacy, Science and Knowledge, and Practice l’ACMV dans les domaines des Politiques et défense des intérêts, and Economics. des Sciences et connaissances ainsi que de la Pratique et finances.

Policy & Advocacy National and international leadership efforts that advance the concerns and professional interests of members. Politiques et défense des intérêts Des efforts de leadership à l’échelle nationale et internationale qui font valoir les préoccupations et avancent les intérêts professionnels des membres. Animal Welfare Bien-être des animaux

The CVMA’s 2014 key initiatives for animal welfare included: En 2014, les principales initiatives de l’ACMV dans le domaine Position Statements: The CVMA Council approved du bien-être des animaux comprenaient notamment : Position Statements on Commercial Dog and Cat Breeding Énoncés de position : Le Conseil de l’ACMV a approuvé (formerly Puppy Mills), Euthanasia, Pest Control, and Tail des énoncés de position sur l’élevage commercial des chiens et Docking of Sheep. Under review are Position Statements on des chats (anciennement sur les usines à chiots), l’euthanasie, la the Devocalization of Dogs, Electroimmobilization, Forced lutte contre les animaux nuisibles et l’amputation de la queue Moulting of Poultry, Transportation of Pets on Airplanes, Use des moutons. Les énoncés de position sur la dévocalisation des of Animals in Science (formerly Use of Animals for Scientific chiens, l’électromobilisation, la mue forcée de la volaille, le Purposes). The CVMA is seeking input from stakeholders on the transport des animaux de compagnie dans les avions, l’utilisation Position Statements on Humane Slaughter, Humane Training des animaux en science (anciennement l’utilisation des animaux Methods for Dogs, and Mass Depopulation of Animals. The à des fins scientifiques) font maintenant l’objet d’un examen. Animal Welfare Committee (AWC) is developing a Small L’ACMV sollicite la rétroaction des intervenants sur les énoncés

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de position sur l’abattage sans cruauté, les méthodes de dressage sans violence pour les chiens et la dépopulation de masse des animaux. Le Comité sur le bien-être des animaux (CBA) travaille à l’élaboration d’un Code de pratiques pour les petits mammifères et à la finalisation du Code de pratiques recommandées aux chenils du Canada. Législation gouvernementale : Le CBA a continué de surveiller les divers projets de loi d’initiative parlementaire qui sont déposés afin d’aborder le besoin de réviser la législation fédérale sur la cruauté envers les animaux. Le CBA a préparé une lettre de rétroaction à la députée fédérale Isabelle Morin RAPPORT ANNUEL pour communiquer ses préoccupations concernant son projet de loi d’initiative parlementaire et les activités exclues (rodéo, production du bétail). L’ACMV a soumis une autre lettre au ministre de l’Agriculture pour exprimer ses préoccupations à propos du lent progrès de la modification de la réglementation sur le transport sans cruauté des animaux. Représentation au sein des comités des intervenants en Dr./Dre Michelle Lem matière de bien-être animal : L’ACMV a été représentée au sein du Conseil d’administration et de l’exécutif du Conseil national sur les soins aux animaux d’élevage (CNSAE). L’ACMV Mammal Pets Code of Practice and finalizing the revision of the a continué d’assurer une représentation au sein des comités des Code of Practice for Canadian Kennel Operations. codes et de la science ainsi qu’auprès des Comités du programme Government legislation: The AWC continued to moni- d’évaluation des soins aux animaux qui considèrent la vérification tor the various private member bills that are being tabled to de la mise en œuvre des codes. L’ACMV a fourni de la rétroaction address the need for updated federal animal cruelty legislation. au sondage et au rapport du Conseil national sur la santé et le The AWC prepared a feedback letter to Member of Parliament bien-être des animaux d’élevage (CNSBAE) relativement à la Isabelle Morin voicing concerns regarding her private mem- capacité de recherche en matière de bien-être animal au Canada. ber bill and the excluded activities (rodeo, livestock produc- Éducation et sensibilisation en matière de bien-être animal : tion). The CVMA submitted another letter to the Minister of Le CBA a soumis les articles suivants à La RVC aux fins de Agriculture to voice concerns about the slow progress of the publication (en anglais seulement) : Fitness for Transport Awareness, humane transport regulatory amendment. One Welfare — an Ethical Dilemma et Stressed Hogs. Les ressources Representation on animal welfare stakeholder committees: suivantes en matière de bien-être animal continuent d’être offertes The CVMA was represented on the National Farm Animal Care sur le site Web de l’ACMV : affiches sur la gestion de la douleur; Council (NFACC) Board and Executive. The CVMA contin- affiche sur la chirurgie esthétique; codes pour les chenils et les ued to provide representation to code and science committees, chatteries; renseignements sur la violence envers les animaux et as well as Animal Care Assessment Program Committees that des nouvelles et des articles pertinents sur le bien-être animal. are considering auditing code implementation. The CVMA On procède maintenant à la révision de l’affiche sur la gestion de provided input into the National Farm Animal Health and la douleur des grands animaux. À l’automne 2014, à la réunion Welfare Council (NFAHWC) survey and report on animal du CBA à la Faculté de médecine vétérinaire de l’Université de welfare research capacity in Canada. Calgary, la Dre Michelle Lem a donné une présentation aux Animal welfare education/awareness: The AWC submitted étudiants en médecine vétérinaire et aux professeurs sur son travail the following articles to The CVJ for publication: Fitness for avec les propriétaires d’animaux en marge de la société. Transport Awareness, One Welfare — an Ethical Dilemma, and Stressed Hogs. The following Animal Welfare resources continue to be available on the CVMA website: pain management posters; cosmetic surgery poster; Kennel/Cattery Codes; animal abuse information, and animal welfare related articles and news items. Work on a revised Large Animal Pain Management poster is in progress. During the fall 2014 AWC meeting at the University of Calgary, Faculty of Veterinary Medicine, Dr. Michelle Lem gave a presentation to veterinary students and faculty on her work with socially marginalized pet owners.

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National Issues Enjeux nationaux

The CVMA’s 2014 focus for the National Issues Committee En 2014, le Comité sur les enjeux nationaux (CEN) de l’ACMV ANNUAL REPORT ANNUAL (NIC) was on antimicrobial stewardship but numerous other s’est concentré sur la gestion responsable des antimicrobiens, files were also managed on behalf of members and the ­profession. mais de nombreux autres dossiers ont aussi été gérés au nom des Position Statements: The CVMA approved new Position membres et de la profession. Statements on Active Pharmaceutical Ingredients (API) for Énoncés de position : L’ACMV a approuvé de nouveaux Veterinary Use, and Veterinary Telemedicine, and revised the énoncés de position sur les ingrédients pharmaceutiques actifs positions on Antimicrobial Use in Animals, Microchip Animal (IPA) et la télémédecine et a révisé les positions sur l’utilisation Identification, and Veterinary Surgical Procedures. The CVMA des antimicrobiens, l’identification des animaux à l’aide d’une also approved a joint CVMA/AVMA/FVE position on the micropuce et les interventions chirurgicales. L’ACMV a aussi Global Control of Canine Rabies. The positions on Vicious approuvé une position conjointe de l’ACMV/AVMA/FVE sur le Dogs, Aquatic Veterinary Medicine, and Extra Label Drug Use Contrôle mondial de la rage canine. Les positions sur les chiens (ELDU) are under review. méchants, la médecine vétérinaire aquatique et l’utilisation Biologics: The NIC met with the Public Health Agency des médicaments en dérogation des directives de l’étiquette of Canada (PHAC) to further develop the veterinary practice (UMDDE) font l’objet d’un examen. exemption for the Human Pathogens and Toxins Regulations Produits biologiques : Le CEN a rencontré des représentants and followed up with the PHAC to finalize veterinary practice de l’Agence de la santé publique du Canada (ASPC) afin de exemption as per Canada Gazette I. The NIC studied Bill C-17 préciser l’exemption de la pratique vétérinaire en vertu du (Unsafe Drugs Act) to understand the implications for veterinary Règlement sur les agents pathogènes humains et les toxines et il practitioners. a effectué un suivi auprès de l’ASPC afin de finaliser l’exemption Therapeutics: In March 2014, the CVMA launched the de la pratique vétérinaire conformément à la Gazette du Canada. new mobile app Antimicrobial SmartVet. The Urinary Tract Le CEN a étudié le projet de loi C-17 (Loi visant à protéger les Infection tool was the first one loaded into the app. A working Canadiens contre les drogues dangereuses) afin de comprendre les group is developing the pyoderma content for the next tool. répercussions pour les praticiens vétérinaires. The CVMA was represented on the Ad Hoc Antimicrobial Produits thérapeutiques : En mars 2014, l’ACMV a lancé Stewardship Committee formed after the Antimicrobial la nouvelle appli mobile IntelliVet. L’outil pour les infections Stewardship Conference and on the AVMA Companion des voies urinaires a été le premier à être téléchargé dans l’appli. Animal Antimicrobial Stewardship Task Force. A Veterinary Un groupe de travail développe actuellement le contenu sur la Pharmaceutical Stewardship Advisory Group was struck to pyodermie pour le prochain outil. Par ailleurs, l’ACMV a été develop communication tools to highlight the key role veterinar- représentée au sein du Comité ad hoc sur la gestion responsable ians play in pharmaceutical stewardship. des antimicrobiens formé après la Conférence sur la gérance des Regulatory: The CVMA was represented on committees antimicrobiens ainsi qu’au sein du Groupe de travail sur la gestion addressing the Veterinary Drugs Directorate on the topics of responsable des antimicrobiens chez les animaux de compagnie ELDU, APIs and OUI. The CVMA renewed efforts to urge de l’AVMA. Un Groupe consultatif sur la gestion responsable des Health Canada to act on regulatory modernization to address produits pharmaceutiques vétérinaires a été formé pour élaborer regulatory voids related to API importation and OUI. The des outils de communication visant à souligner le rôle clé des CVMA drafted a response to the release of the Health Canada vétérinaires dans la gestion responsable des antimicrobiens. antimicrobial federal framework. Réglementation : L’ACMV a été représentée au sein de comités dialoguant avec la Direction des médicaments vétérinaires sur les sujets de l’UMDDE, des IPA et de l’importation pour utilisation personnelle. L’ACMV a renouvelé ses efforts pour exhorter Santé Canada à passer aux actes relativement à la modernisation réglementaire en vue de corriger les lacunes réglementaires liées à l’importation des IPA et à l’importation pour utilisation personnelle. L’ACMV a rédigé une réponse au lancement du cadre d’action fédéral de Santé Canada sur la résistance et le recours aux antimicrobiens. Salubrité des aliments et santé publique : L’ACMV a été représentée à la réunion des intervenants de la Canada Global Food Animal Residue Avoidance Databank (CgFARAD) pour aborder le besoin d’un financement durable à long terme du programme CgFARAD. Conseil national sur la santé et le bien-être des animaux d’élevage : L’ACMV a été représentée au sein de ce Conseil et

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Food Safety & Public Health: The CVMA was repre- elle a recherché des occasions de fournir de la rétroaction sur les sented at the Canada Global Food Animal Residue Avoidance enjeux importants pour la collectivité vétérinaire (surveillance des Databank (CgFARAD) stakeholder meeting to address the need maladies; intégration des Codes de pratiques dans les règlements for long-term sustainable funding for the CgFARAD program. provinciaux; gestion responsable et résistance des antimicrobiens). National Animal Health & Welfare Strategy Council: The L’ACMV a aussi présenté un exposé sur ses activités liées à CVMA was represented on this Council and sought opportuni- l’utilisation des antimicrobiens et à l’antibiorésistance lors du ties to provide input on issues important to the veterinary com- forum du CNSBAE. munity (disease surveillance; Codes of Practice incorporation Santé des écosystèmes : Nous avons continué de faire la into provincial regulations; antimicrobial stewardship/resistance). promotion des ressources pour une Pratique vétérinaire The CVMA made a presentation at the NFAHWC Forum on its écoresponsable de l’ACMV. antimicrobial use/antimicrobial resistance ­activities. Concept «Une santé» : L’ACMV a été interviewée par le RAPPORT ANNUEL Ecosystem Health: The CVMA’s Green Veterinary Practice bureau du vérificateur général concernant les enjeux liés aux resources continued to be promoted. règlements régissant les antimicrobiens au Canada. “One Health” concept: The CVMA was interviewed by the Office of the Auditor General regarding issues surrounding antimicrobial regulation in Canada.

Communications & Public Relations Communications et relations publiques

With 690 mentions tracked in the news and over 90 media Avec plus de 690 mentions retracées dans les nouvelles et plus de inquiries logged during 2014, the CVMA is the confirmed 90 demandes de renseignements de la part des médias enregistrées reliable source of veterinary information for Canadian journal- au cours de 2014, l’ACMV est la source fiable confirmée où les ists. Throughout the year, the CVMA proved to be a valuable journalistes canadiens obtiennent des renseignements vétérinaires. resource for journalists seeking knowledge and information on Pendant l’année, l’ACMV s’est avérée une ressource précieuse pour antimicrobial stewardship. The CVMA’s advocacy on the jerky les journalistes à la recherche de données et de renseignements treat issue was highlighted in the spring when the issue made sur la gestion responsable des antimicrobiens. La défense des headlines across the country. A successful media event was held intérêts de l’ACMV dans le dossier des gâteries Jerky a été during the CVMA Convention, giving the event and the profes- soulignée au printemps lorsque cet enjeu a fait les manchettes à sion added visibility in St. John’s, Newfoundland. l’échelle du pays. De plus, un événement médiatique réussi s’est 2014 was the first year of implementation in déroulé durant le congrès de l’ACMV, ce qui a the 3-year marketing plan established by Delta servi à rehausser la visibilité de l’événement et de Media’s Communications Audit. In accordance la profession à St. John’s, à Terre-Neuve. with the plan, messaging is being organized under Par ailleurs, 2014 a été la première année de the CVMA’s 3 leadership areas: Policy & Advocacy, mise en œuvre du plan de marketing de trois Science & Knowledge, and Practice & Economics. ans établi lors de l’audit des communications Selected content is being moved out from behind réalisée par Delta Media. Conformément au plan, the member restricted areas of the website to show les messages sont structurés en fonction des trois value to prospective members and the public. The domaines de leadership de l’ACMV : Politiques CVMA’s website and eNewsletter were enhanced et défense des intérêts, Science et connaissances and the volume of information shared via our social ainsi que Pratique et finances. Certains articles media channels increased. The CVMA’s number sont en voie d’être retirés des sections réservées aux of followers and fans on Twitter and Facebook membres du site Web afin de démontrer la valeur increased by over 30% and 55% respectively. A aux membres éventuels et au public. Le site Web YouTube Channel was also launched to provide a de l’ACMV et le cyberbulletin ont été améliorés space for sharing educational videos. et le volume d’information partagé par l’entremise “Our Role, Our Responsibility” was the slogan de nos médias sociaux a été élargi. Le nombre of the 2014 Animal Health Week campaign to de suiveurs et de fans de l’ACMV sur Twitter et promote veterinarians as responsible stewards of Facebook a grimpé de plus de 30 % et de 55 % the important medications that keep animals and respectivement. Un canal YouTube a aussi été lancé humans healthy. Animal owners were encouraged afin de permettre le partage de vidéos éducatives. to trust in their veterinarian, use antimicrobi- «Notre rôle, notre responsabilité» a été le slogan als safely, and keep their animals healthy. Four de la campagne de la Semaine de la vie animale industry partners (Program Plus Sponsor: IDEXX 2014 visant à promouvoir les vétérinaires en tant Laboratories and Program Sponsors: Petsecure que gestionnaires responsables des médicaments

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importants qui préservent la santé des animaux et des humains. On a encouragé les propriétaires d’animaux à faire confiance à leur vétérinaire, à utiliser les antimicrobiens de manière sécuritaire et à garder leurs animaux en santé. Quatre partenaires de l’industrie (commanditaire de programme Plus : IDEXX Laboratories et ANNUAL REPORT ANNUAL commanditaires de programme : Petsecure assurance maladie pour animaux Inc., iFinance [Petcard] et Banque Scotia) ont fourni du soutien à la Semaine de la vie animale. L’ACMV a communiqué aux membres des mises à jour sur les programmes de l’ACMV et des nouvelles vétérinaires générales dans le cadre d’envois de masse de bulletins par courriel et télécopieur, de mises à jour sur les médias sociaux, d’articles dans les publications provinciales, d’information sur le site Web de Mayor of St. John’s, Dennis O’Keefe. l’ACMV ainsi que dans le cyberbulletin mensuel. Des outils pour Le maire de St. John’s, Dennis O’Keefe. la pratique, comme ceux offerts dans le cadre de la collaboration de l’ACMV avec la Pet Nutrition Alliance, Partners for Healthy Pets et Soins des chats, ont aussi été mis en lumière. Pet Health Insurance Inc., iFinance [Petcard] and Scotiabank) provided support for Animal Health Week. Mass e-mail and fax bulletins, social media updates, articles in provincial publications, information on the CVMA’s website and in the monthly eNewsletter provided members with CVMA program updates and general veterinary news. Practice tools, such as those available through the CVMA’s involvement with the Pet Nutrition Alliance, Partners for Healthy Pets and Cat Healthy, were also highlighted.

Science and Knowledge Leading-edge research, education, news and information that enhances the lifelong learning and career development of members. Science et connaissances De la recherche, de la formation, des nouvelles et de l’information de pointe qui améliorent l’apprentissage continu et le développement de la carrière des membres. Journals Revues

The Canadian Veterinary Journal (CVJ) and Canadian Journal La Revue vétérinaire canadienne (La RVC) et la Revue of Veterinary Research (CJVR) are the only national, general or canadienne de recherche vétérinaire (RCRV) sont les seules revues multi-­species, peer-reviewed veterinary journals in Canada. The vétérinaires nationales, à contenu général ou multi-espèces, number of manuscripts submitted to The CVJ in 2014 was 336, évaluées par les pairs au Canada. Le nombre de manuscrits up from 325 in 2013; the number submitted to CJVR in 2014 soumis à La RVC en 2014 a été de 336, soit une hausse par was 108, close to the 109 of 2013. Efforts are ongoing to reduce rapport aux 325 soumissions reçues en 2013; le nombre de the backlog of CVJ manuscripts. The CJVR backlog will be manuscrits soumis à la RCRV en 2014 a été de 108, soit près des addressed with the installment of $15 000 approved by CVMA 109 soumissions reçues en 2013. Les efforts se sont poursuivis Council. The extra funds will be used to prepare additional afin de réduire l’arriéré des manuscrits de La RVC. L’arriéré de manuscripts for the online issues of CJVR; policy adjustments la RCRV sera corrigé à l’aide d’un financement de 15 000 $ will be made to prevent future backlogs. Both journals will approuvé par le Conseil de l’ACMV. Les fonds supplémentaires continue to promote the relevance of journal articles to practice serviront à préparer des manuscrits supplémentaires pour les and build demand for the knowledge delivered. numéros en ligne de la RCRV et des ajustements aux politiques The Editorial Committee is currently working hard to fill the permettront de prévenir des arriérés dans l’avenir. Les deux revues positions of one editor and 2 associate editors for CJVR. The continueront de promouvoir la pertinence des articles de la revue associate editor position for The CVJ was filled by Dr. Wayne pour la pratique et d’élargir la demande pour les connaissances McDonell in August, 2014. transmises.

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It was confirmed with the Canadian veterinary school deans Le Comité de la rédaction travaille actuellement en vue de that editors would be recognized by the schools for their work combler les postes d’un rédacteur et de deux rédacteurs associés with the journals in determining academic advancement/tenure. pour la RCRV. Le poste de rédacteur associé de La RVC a été The journals department created a letter from the CVMA to the accepté par le Dr Wayne McDonell en août 2014. deans on behalf of the editors. Il a été confirmé auprès des doyens des écoles de médecine As a benefit to CVMA members, CVMA authors will have vétérinaire canadiennes que les rédacteurs seraient reconnus par lower publication fees for The CVJ and lower page charges for les écoles pour leur travail auprès des revues afin de déterminer CJVR. Both journals will continue to strive toward a break-even l’avancement et la permanence dans les universités. Le service des budget. revues a créé une lettre de l’ACMV adressée aux doyens au nom During the 2014 March Committee meeting and strategic des rédacteurs. planning session it was noted that the journals are one of the En tant qu’avantage de l’adhésion à l’ACMV, les auteurs de RAPPORT ANNUEL most important member benefits for the CVMA. A redesign/ l’ACMV bénéficieront de tarifs de publication inférieurs pour reformatting of the news section of The CVJ was also discussed, La RVC et de frais réduits par page pour la RCRV. Les deux revues and was initiated in the fall and introduced with the May 2015 continueront de travailler en vue d’équilibrer le budget. issue; this activity was also suggested by the Delta Media report Durant la réunion de la fin de semaine des comités de mars completed in 2014. 2014 et lors d’une séance de planification stratégique, il a été Readers and CVMA members are reminded that all issues, signalé que les revues représentent l’un des plus importants except the most recent 6 months, of both The CVJ and CJVR avantages de l’adhésion à l’ACMV. Une refonte et un nouveau are available to the public on the PubMed Central archive format pour la section des nouvelles de La RVC ont aussi fait (www.pubmedcentral.com); a link is also available through l’objet de discussions et cette démarche a été entamée à l’automne the CVMA website (www.canadianveterinarians.net). CVMA et introduite dans le numéro de mai 2015; cette activité avait members can view the most recent 6 months of the journals on aussi été suggérée lors du rapport de Delta Media publié en 2014. the member-only section of the CVMA website. Nous rappelons aux lecteurs et aux membres de l’ACMV que tous les numéros, sauf pour les derniers six mois, de La RVC et de la RCRV sont toujours disponibles au public dans les archives PubMed Central (www.pubmedcentral. com); un lien est aussi disponible sur le site Web de l’ACMV (www.veterinairesaucanada.net). Les membres de l’ACMV peuvent visualiser les six plus récents mois des revues dans la section réservée aux membres du site Web de l’ACMV.

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Conventions Congrès

As a crucial Science and Knowledge pillar, the CVMA Le Comité du perfectionnement professionnel (CPP) de l’ACMV ANNUAL REPORT ANNUAL Professional Development Committee (PDC) oversees the pro- supervise l’élaboration du programme des ateliers de formation gram development for the continuing education (CE) sessions continue (FC) du congrès annuel de l’ACMV, car il s’agit d’un at the CVMA Annual Convention. Canada’s only multi-species pilier essentiel de la priorité Science et connaissances. En 2014, convention was held in St. John’s, Newfoundland and Labrador le seul congrès multi-espèces du Canada s’est tenu à St. John’s, in 2014 attracting 735 attendees. The CE sessions consisted of à Terre-Neuve-et-Labrador, et il a attiré 735 congressistes. a dental and orthopedic lab; a full–day practice management Les ateliers de FC comportaient un laboratoire dentaire et stream focusing on communication; and 36 concurrent sessions orthopédique; un volet d’une journée sur la gestion d’une pratique in the following streams: companion animal, bovine, equine, axé sur la communication; et 36 ateliers parallèles dans les volets animal welfare, shelter medicine, social media, and team well- suivants : animaux de compagnie, bovins, équidés, bien-être ness. Over 40 speakers from Canada, the United States and animal, médecine des refuges, médias sociaux et bien-être de overseas presented during the convention. l’équipe. Plus de 40 conférenciers provenant du Canada, des The 2014 convention evaluation received a 31% response États-Unis et d’outremer ont donné des présentations durant le rate. Results showed that the majority of respondents were congrès. companion animal practitioners with 15 or more years of expe- L’évaluation du congrès 2014 a obtenu un taux de réponse de rience. The 2 factors that contributed to their original decision 31 %. Les résultats ont démontré que la majorité des répondants to attend the CVMA Convention were the CE sessions overall étaient des praticiens pour animaux de compagnie possédant and the location. 15 années ou plus d’expérience. Les deux facteurs qui ont The majority of respondents attended 6 sessions per day contribué à la décision originale d’assister au congrès étaient les (the maximum possible) taking full advantage of the CE options. ateliers de formation continue et l’emplacement. In addition, they were very satisfied with the caliber of speakers La majorité des répondants ont assisté à six ateliers par jour and the length of sessions, and satisfied with the time for Q&A (le maximum possible) et ont pleinement profité des options de and the session chairs. formation continue. De plus, ils étaient très satisfaits du calibre For the first time, a video was produced to market and pro- des conférenciers et de la durée des ateliers ainsi que du temps mote the convention. This video featured then president-elect réservé aux questions et aux réponses et aux présidents des ateliers. Dr. Jean Gauvin and several PDC members. It was hosted on Pour la première fois, une vidéo a été produite pour faire la CVMA’s You Tube channel and had over 700 views. promotion du congrès. Cette vidéo a présenté le président désigné For the 2nd time, a mobile convention app was used onsite. du moment, le Dr Jean Gauvin, ainsi que plusieurs membres du However, a new module, the CVMA Quest, was added and CPP. Il a été hébergé sur le canal You Tube de l’ACMV et a obtenu introduced for the first time. In total, 21 activities allowed plus de 700 visualisations. participants to earn points (with pre-site and onsite questions) Pour la deuxième fois, une appli mobile du congrès a été allowing the top 3 scorers to win prizes. The CVMA Lounge, utilisée sur place. Cependant, un nouveau module, la Quête de in the Exhibit Hall, had a monitor displaying all participants l’ACMV, a été ajouté et introduit. Au total, 21 activités ont permis and their standing in the Quest. Activities ranged from ques- aux participants d’accumuler des points (avec des questions avant tions about St. John’s, to finding CVMA Council members, l’arrivée et sur place) et les trois concurrents ayant accumulé from exhibit specific questions to locating the mascot “Biscuit.” le plus de points ont remporté des prix. Le Salon de l’ACMV, qui était aménagé dans le Salon des exposants, comportait un moniteur affichant tous les participants et leur classement dans la Quête. Les activités comportaient des questions à propos de St. John’s, le repérage de membres du Conseil de l’ACMV ainsi que des questions portant sur les expositions et l’emplacement de la mascotte «Biscuit». La tournée des grands ducs «Havin’ a Time» sur George Street a attiré plus de 275 congressistes qui ont fait l’expérience des saveurs et des traditions locales et ont été baptisés au screech à titre de Terre-Neuviens honorifiques. Le Sommet des leaders vétérinaires 2014, qui a été présidé par le Dr Gauvin, a porté sur «La gestion responsable des antimicrobiens : un nouvel ordre mondial». Le sujet a suscité beaucoup d’intérêt et a attiré plus de 180 participants. Huit conférenciers, y compris un médecin en médecine humaine,

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The “Havin’ a Time” Pub Crawl on George Street attracted et des représentants de l’AVMA, de l’Organisation mondiale de 275 attendees who experienced local flavors and traditions and la santé animale (OIE), de l’Association mondiale vétérinaire were screeched in as honorary Newfoundlanders. (AMV) et de la Commonwealth Veterinary Association (CVA), The 2014 Summit of Veterinary Leaders, chaired by ont partagé leurs expériences et leur expertise. Durant le Sommet, Dr. Gauvin, focused on “Antimicrobial Stewardship: A New le Dr John Prescott, un bactériologiste vétérinaire à l’Ontario World Order.” The topic was of great interest attracting over Veterinary College, a dit qu’il croyait que le Canada vivait 180 participants. Eight speakers including a medical doctor, and une «occasion en or» pour améliorer la gestion responsable des representatives from the AVMA, the World Organization for antimicrobiens. Le Dr Prescott a recommandé la coordination Animal Health (OIE), the World Veterinary Association (WVA) d’un cadre de travail national et provincial pour lutter contre la and the Commonwealth Veterinary Association (CVA) shared résistance qui rassemblerait les vétérinaires en chef et les médecins- their experiences and expertise. During the Summit, Dr. John hygiénistes en chef dans un travail de collaboration afin d’éliminer RAPPORT ANNUEL Prescott, a veterinary bacteriologist at the Ontario Veterinary les échappatoires réglementaires et de mettre en œuvre un régime College, said that he believes Canada is in a “golden moment” de surveillance national global qui effectuerait un suivi exact de to improve antibiotic stewardship. Dr. Prescott recommended a l’utilisation des produits antibiotiques. coordinated national and provincial framework for countering resistance that would involve chief veterinary officers and chief medical officers working together, closing regulatory loopholes, and implementing a comprehensive national surveillance system that will accurately track the use of antibiotic products.

Emerging Leaders Program (ELP) Programme des futurs leaders (PFL)

The 2014 CVMA Emerging Leaders Program (ELP), in its Le Programme des futurs leaders (PFL) 2014 de l’ACMV, qui en 5th year of operation, had a total of 26 participants from across était à sa cinquième année, comptait un total de 26 participants Canada. The program was chaired by Dr. Melodie Chan, provenant de diverses régions du Canada. Le programme a été founder of this CVMA program and again leveraged the depth présidé par la Dre Melodie Chan, fondatrice de ce programme de of experience offered by our facilitator, Dr. Rick DeBowes l’ACMV, et a de nouveau mis à contribution la vaste expérience from Washington State University who has offered this type offerte par notre animateur, le Dr Rick DeBowes de l’Université of program around the world. Similar to last year’s program, d’État de Washington, qui a présenté ce type de programme Dr. DeBowes used an array of didactic and experiential learning partout dans le monde. Comme lors du programme de l’an approaches to help the participants gain insight into how best dernier, le Dr DeBowes a puisé dans un répertoire d’approches to lead themselves as individuals, how they communicate with d’apprentissage didactiques et expérientielles pour aider les

Emerging Leaders Program 2014 participants. Participants au Programme des futurs leaders 2014.

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those around them, and ultimately how this knowledge would participants à découvrir les meilleures façons de se comporter better prepare them to lead those around them. en tant que personnes, comment communiquer avec les autres The breakdown of participants included: 16 selected ELP personnes et comment ces connaissances pourraient mieux les candidates sponsored by CVMA/VMAs; 6 students sponsored préparer à diriger les personnes qui les entourent. by CVMA, 9 paid participants and the program chair sponsored La répartition des participants était la suivante : 16 candidats ANNUAL REPORT ANNUAL by the CVMA. sélectionnés pour le PFL et commandités par l’ACMV et les The comments received from the feedback survey were over- AMV; six étudiants commandités par l’ACMV, neuf participants whelmingly positive regarding both the content of the day, as payants et le président du programme commandité par l’ACMV. well as the facilitator; 96% of the respondents indicated that the Les commentaires reçus lors du sondage d’évaluation étaient program met or exceeded their expectations, and 100% of the essentiellement positifs concernant le contenu de la journée respondents rated Dr. DeBowes as a good or excellent facilitator. ainsi que l’animateur; 96 % des répondants ont indiqué que le programme avait satisfait à leurs attentes ou les avait surpassées et 100 % des répondants ont jugé que le Dr DeBowes était un bon ou excellent animateur.

Canadian Veterinary Reserve (CVR) Réserve vétérinaire canadienne (RVC)

The CVMA’s Canadian Veterinary Reserve’s mandate is to La Réserve vétérinaire canadienne de l’ACMV a pour mandat provide veterinary surge capacity resources to first-responders de fournir des ressources pour une capacité d’appoint pour les in the event of large-scale emergencies involving animals, in premiers intervenants dans l’éventualité de situations d’urgence order to address animal health and welfare issues. The reserve à grande échelle touchant les animaux, afin de gérer des enjeux was created in 2006. liés à la santé et au bien-être des animaux. La réserve a été créée The CVR consists of 474 members, with 245 of them having en 2006. received formal training. CVR members are practitioners from La RVC se compose de 474 membres, et 245 d’entre eux ont the 10 provinces, the Yukon and the Northwest Territories. reçu une formation officielle. Les membres de la RVC sont des praticiens provenant de 10 provinces ainsi que du Yukon et des AB = 77 BC = 68 MB = 24 NB = 15 NL = 2 NS = 18 NT = 1 ON = 114 QC = 111 PE = 10 SK = 32 YT = 2 Territoires du Nord-Ouest. The reserve was called up by the Canadian Food Inspection Alb. = 77 C.-B. = 68 Man. = 24 N.-B. = 15 T.-N.-L. = 2 N.-É. = 18 T.-N.O. = 1 Ont. = 114 QC = 111 Î.-P.-É. = 10 Sask. = 32 YK = 2 Agency (CFIA) in early December 2014 due to an avian influ- enza outbreak in the Fraser Valley of British Columbia. Overall, La réserve a été mobilisée par l’Agence canadienne 11 commercial premises (7 broiler breeder; 3 turkey; 1 table d’inspection des aliments (ACIA) au début de décembre 2014 en egg layer) were infected and 245 600 affected birds had to be raison de l’éclosion de l’influenza aviaire dans la vallée du Fraser culled: 155 CVR members responded to the call-up request, de la Colombie-Britannique. Dans l’ensemble, 11 établissements with 101 indicating that they would be able to serve for some of commerciaux (7 éleveurs de poulets à griller; 3 de dindons; 1 de the weeks between December 28, 2014 and March 1, 2015. In poules pondeuses) ont été infectés et 245 600 oiseaux affectés total 525 weeks of service were offered. In the end, because the ont dû être réformés : 155 membres de la RVC ont répondu outbreak could be contained by the CFIA, the CVR members à l’appel de mobilisation et 101 ont indiqué qu’ils pourraient did not need to be deployed. intervenir pendant quelques semaines entre le 28 décembre 2014 The CVR is attempting to partner with the Canadian Public et le 1er mars 2015. Au total, 525 semaines de service ont été Health Agency to obtain access to valuable online training offertes. En fin de compte, l’éclosion a pu être contenue par modules that are also utilized by the AVMA Veterinary Medical l’ACIA et il n’a pas été nécessaire de déployer les membres de Assistance Teams. la RVC. The CVMA is working with the provincial emergency man- La RVC tente de former un partenariat avec l’Agence agement offices and Chief Veterinary Officers to engage CVR canadienne de la santé publique afin d’obtenir l’accès à des members in provincial exercises. At the same time, it is hoped modules de formation utiles qui sont aussi utilisés par les équipes that involvement of CVR members in CFIA training opportuni- d’assistance médicale vétérinaire de l’AVMA. ties can be restarted. L’ACMV travaille avec les bureaux provinciaux de la gestion des urgences ainsi que les vétérinaires en chef afin d’engager les membres de la RVC dans le cadre des exercices provinciaux. Par ailleurs, nous espérons être en mesure de réinstaurer la participation des membres de la RVC dans les occasions de formation de l’ACIA.

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Practice and Economics Veterinary practice tools and resources that have been developed to support members and their healthcare teams. Pratique et finances Des outils et des ressources pour la pratique vétérinaire qui ont été conçus pour appuyer les membres et leurs équipes de soins vétérinaires. Business Management Gestion commerciale RAPPORT ANNUEL In 2014, the CVMA continued its unique benchmarking pro- En 2014, l’ACMV a continué d’offrir son programme gram that included valuable economic and practice management d’évaluation comparative du rendement unique en son genre tools and resources such as provincial suggested fee guides, com- qui comprenait des outils et des ressources pour la gestion pensation and benefits reports for associate veterinarians, non- d’une pratique, comme les guides tarifaires suggérés provinciaux, DVM wage reports, provincial economic reports and individual les rapports sur la rémunération et les avantages sociaux des practice reports. The data for these reports come from the annual vétérinaires salariés, les rapports sur les salaires des employés economic surveys that the CVMA conducts in partnership with non-vétérinaires, les rapports économiques provinciaux et les the provincial veterinary medical associations (VMAs), Idexx rapports individuels des pratiques. Les données utilisées pour ces Laboratories, Petsecure, Merck Animal Health and Scotiabank rapports proviennent des sondages économiques annuels réalisés who co-sponsor this program together with the CVMA. par l’ACMV en partenariat avec les associations provinciales de In 2014, the CVMA published 6 veterinary practice manage- médecins vétérinaires, Idexx Laboratories, Petsecure, Merck Santé ment articles in The CVJ: animale et la Banque Scotia qui cocommanditent ce programme • Associate salaries increase ... for half the provinces avec l’ACMV. • Provincial fees En 2014, l’ACMV a publié six articles sur la gestion • Results from the 2013 practice owners’ economic survey commerciale d’une pratique vétérinaire dans La RVC : • Non-DVM staff wages for 2013 • Les salaires des vétérinaires augmentent... pour la moitié des • Market share and veterinary practice management software provinces • How much does a vacation cost? • Tarifs provinciaux All of these articles can also be found on the CVMA website • Résultats du Sondage économique 2013 auprès des under the Business Management Program section. propriétaires de pratique For the Business Management track at the 2014 CVMA • Salaires des employés non-vétérinaires en 2013 Convention in St. John’s, Newfoundland, Dr. Bernadine Cruz • Part du marché et logiciels de gestion d’une pratique vétérinaire presented a full-day CE stream on “It’s not what you say but • Combien coûtent vos vacances? how” with topics covering great first impressions, communi- On peut aussi consulter tous ces articles sur le site Web de cating well when you don’t have time, communicating with l’ACMV, dans la section du Programme de gestion commerciale. seniors, how to talk to your boss, confidence, and target markets Pour le volet sur la gestion commerciale du congrès 2014 (boomers). Also, during the St. John’s Convention, the CVMA de l’ACMV qui s’est tenu à St. John’s, à Terre-Neuve, la offered its members free one-on-one business consultations with Dre Bernadine Cruz a présenté un volet de FC d’une journée Mr. Darren Osborne. sur «Ce n’est pas ce vous dites mais comment vous le dites» avec des Representatives from all provincial VMAs attended the yearly sujets qui portaient sur la façon de donner une excellente première Economic Forum hosted by the CVMA during the St. John’s impression, de bien communiquer quand vous n’avez pas le temps, Convention. Participants were de communiquer avec les aînés, comment parler à votre patron, given an overview of the com- la confiance et les marchés cibles (les baby-boomers). De plus, plexity of the scheduling and durant le congrès de St. John’s, l’ACMV a offert aux membres ses delivery of annual surveys consultations d’affaires individuelles avec M. Darren Osborne. and reports to all members. Des représentants de toutes les associations provinciales de Mr. Darren Osborne, CVMA’s médecins vétérinaires ont assisté au forum économique annuel economic consultant, presented organisé par l’ACMV durant son congrès à St. John’s. Les national data comparisons and participants ont pu constater la complexité du calendrier et de discussed ways for improving la production des sondages annuels et des rapports pour tous les the program and its delivery. membres. Darren Osborne, consultant économique de l’ACMV, a présenté les comparaisons des données nationales et a discuté des façons d’améliorer le programme et sa mise en œuvre.

Dr./Dre Bernadine Cruz

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Veterinary Wellness Bien-être des vétérinaires

There is a wealth of discussions on the topic of wellness in Le sujet du bien-être des médecins vétérinaires fait l’objet ANNUAL REPORT ANNUAL veterinary medicine and the CVMA continued to engage de maintes discussions et l’ACMV a continué ses activités through education and awareness. Four members served on the d’éducation et de sensibilisation. En 2014, quatre membres ont CVMA Wellness Advisory Group in 2014 to help move this siégé au Groupe consultatif sur le bien-être de l’ACMV afin de topic forward: réaliser des progrès à ce chapitre : • National listing of helplines, support services and resources • Une liste nationale des lignes d’assistance, des services et des for veterinarians available on the CVMA website. ressources de soutien pour les vétérinaires est disponible sur le • Wellness session at the 2014 CVMA Convention presented site Web de l’ACMV. by Dr. Jean E. Wallace, Ph.D., “Veterinarians and Animal • La Dre Jean E. Wallace, Ph.D., a présenté un atelier sur le Health Technician Wellness: The ups, the downs and main- bien-être lors du congrès 2014 de l’ACMV qui était intitulé taining momentum.” «Bien-être des vétérinaires et des techniciens en santé animale : • Editorial in the August 2014 CVJ by Dr. Carlton Gyles on les hauts, les bas et comment maintenir son élan». veterinarian suicides. • L’éditorial du numéro d’août 2014 de La RVC rédigé par le • CVMA participation in a survey from the Association of Dr Carlton Gyles portait sur le suicide des vétérinaires. American Veterinary Medical Colleges for the AAVMC 2015 • L’ACMV a participé à un sondage de l’Association of American Health and Wellness Summit. Veterinary Medical Colleges pour le Sommet 2015 de • What Can’t Be Taught; a new feature in The CVJ where l’AAVMC sur la santé et le bien-être. members share their experience on surviving their first year • Ce qui ne s’enseigne pas, est une nouvelle rubrique dans La RVC in practice, with the goal of helping new veterinarians cope où les membres partagent leur expérience sur la façon dont ils with stress as they transition to professional life. ont survécu à leur première année de pratique afin d’aider les • CVMA engaged with the International Veterinary Professional nouveaux vétérinaires à gérer le stress tandis qu’ils effectuent Wellness Network through its online community. la transition à la vie professionnelle. • L’ACMV a collaboré avec l’International Veterinary Professional Wellness Network par l’entremise de sa collectivité en ligne.

Group Insurance Program Programme d’assurance de groupe

The exclusive CVMA Group Insurance Program is designed Le Programme d’assurance de groupe exclusif de l’ACMV est for veterinarians and is overseen by the CVMA for the better conçu pour les vétérinaires et est supervisé par l’ACMV afin protection and service of members. d’assurer une protection et un service améliorés pour les membres.

Professional Liability and Commercial ‘Protected Programme de responsabilité professionnelle et Self-Insurance’ (PSI) Program d’«assurance auto-protégée» commerciale In 2014, the number of policies increased by 7% and the pro- En 2014, le nombre de polices a augmenté de 7 % et le gram grew to insure a total of 1476 practices. Overall, renewals programme a connu une croissance pour atteindre un total de for 2014 had a retention rate of 98%, which is quite exceptional. 1476 pratiques assurées. Dans l’ensemble, les renouvellements The PSI structure, the coverage enhancements (Legal Expense pour 2014 affichaient un taux de rétention de 98 %, ce qui and Cyber Liability coverage) introduced at the 2014 renewal, représente un rendement assez exceptionnel. La structure de and the proven rate stability comparison to competing products l’assurance auto-protégée, les améliorations apportées à la separate the CVMA Program from competitors. couverture (protection pour les dépenses juridiques et la cyber- responsabilité) introduites au renouvellement de 2014 ainsi que la comparaison éprouvée pour la stabilité des taux par rapport à

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Employee Group Benefits Program des produits concurrents distinguent le programme de l’ACMV The TotalGUARD/CVMA Employee Benefits Program offers de ceux de ses concurrents. a flexible choice of employee benefits including health and dental coverage, life insurance, accidental death and dismember- Programme collectif d’avantages sociaux pour les ment, and disability insurance. Insured clinics not only benefit employés from the rate stability generated by spreading claims over the Le Programme d’avantages sociaux TotalGUARD/ACMV offre entire TotalGUARD/CVMA pool, they also gain a competitive un choix flexible d’avantages sociaux qui comprend l’assurance advantage to help them attract and retain star employees. The maladie et dentaire, l’assurance vie, l’assurance en cas de décès ou Program also offers optional wellness benefits such as profes- de mutilation par accident et l’assurance invalidité. Les cliniques sional referral services and counseling for insured members assurées profitent non seulement de la stabilité des primes créée and their eligible family members, and business assistance and par la répartition des réclamations sur l’ensemble du groupe RAPPORT ANNUEL coaching for the employer’s organization. In 2014, the number TotalGUARD/ACMV, mais elles jouissent aussi d’un avantage of policies increased by 13%. concurrentiel pour les aider à attirer et à conserver les meilleurs Other insurance solutions available under the CVMA employés. Le Programme offre aussi des avantages optionnels Insurance Program include: de bien-être comme les services d’aiguillage professionnel et le Affinity Program (Individual Life, Child Dependent Life, counseling pour les membres assurés et les membres de la famille AD&D, LTD, Business Overhead Expense Insurance) admissibles ainsi qu’une assistance et un encadrement d’affaires Veterinary Student & Graduate Program (Individual Life, pour l’organisation de l’employeur. En 2014, le nombre de polices AD&D, LTD) a augmenté de 13 %. Les autres solutions d’assurance offertes en vertu du Programme Personal Automobile & Home Insurance d’assurance de l’ACMV incluent : Members continued to enjoy exclusive group rates and benefits Programme Affinité (assurance vie individuelle, assurance for their personal home and auto insurance as part of the CVMA vie pour les enfants à charge, assurance en cas de décès et de Group Insurance Program. In 2014, the number of new auto mutilation par accident, invalidité de longue durée, assurance and home policies more than doubled and increased by 69% pour les frais généraux d’entreprise). and 79% respectively. Programme d’assurance pour étudiants et diplômés (assurance Western Group Insurance Solutions administers the specialized vie individuelle, assurance en cas de décès de mutilation par CVMA Group Insurance Program and provides risk manage- accident, invalidité de longue durée). ment services for CVMA members across Canada. (In Québec, the administrator operates under HED, courtier en assurance, Assurance automobile et habitation individuelle inc.) The Personal Insurance Company provides auto and home Les membres ont continué de profiter de tarifs de groupe et insurance products exclusively through professional associa- d’avantages exclusifs pour leur assurance habitation et automobile tions. It is owned by The Desjardins General Insurance Group, individuelle dans le cadre du Programme d’assurance de groupe a wholly owned subsidiary of Desjardins Group. de l’ACMV. En 2014, le nombre de nouvelles polices automobile et habitation a plus que doublé, affichant des hausses de 69 % et de 79 % respectivement. Western Group Insurance Solutions administre le Programme d’assurance de groupe spécialisé de l’ACMV et offre des services de gestion des risques pour les membres de l’ACMV à l’échelle du Canada. (Au Québec, l’administrateur est exploité sous le nom de HED, courtier en assurance, inc.) La compagnie d’assurance La Personnelle offre des produits d’assurance automobile et habitation exclusivement par l’entremise des associations professionnelles. Elle appartient à Desjardins Groupe d’assurances générales Inc. et est une filiale en propriété exclusive du Groupe Desjardins.

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VALUE OF MEMBERSHIP VALEUR DE L’ADHÉSION Membership Effectif

Policy and Advocacy Politiques et défense des intérêts

The CVMA continued to provide national and international L’ACMV a continué d’assurer un leadership national et REPORT ANNUAL leadership on veterinary and animal health issues, and to rep- international à l’égard des enjeux vétérinaires et des questions resent the collective interests of the veterinary profession. The liées à la santé animale ainsi que de représenter les intérêts CVMA engaged in activities on behalf of members to influence collectifs de la profession vétérinaire. L’ACMV a participé à legislative and policy issues that may threaten the scope of des activités au nom des membres afin d’influencer les enjeux practice of veterinarians in Canada and the health of humans législatifs et politiques qui peuvent menacer la portée d’exercice and animals. For example: des vétérinaires au Canada ainsi que la santé des humains et des • Veterinary input in the development of national farm animal animaux, notamment dans les domaines suivants : welfare codes of practice • la rétroaction vétérinaire lors de l’élaboration des codes de • Research and formulation of veterinary and animal welfare pratiques nationaux sur le bien-être des animaux d’élevage; position statements • la recherche et la formulation d’énoncés de position sur la • Advocacy to influence federal legislation changes to close médecine vétérinaire et le bien-être animal; regulatory gaps • la défense des intérêts en vue d’influencer les modifications • Representation in global discussions in matters of food safety, législatives fédérales pour éliminer les lacunes réglementaires; drugs supply, labour mobility, education standards and global • la représentation dans les discussions mondiales sur des trade questions liées à la salubrité des aliments, l’approvisionnement • Media and public relations addressing national veterinary en médicaments, la mobilité de la main-d’œuvre, les normes issues and the treatment and welfare of animals. d’enseignement et le commerce mondial; In 2014, 6895 veterinarians and student members enjoyed • les relations publiques et les relations avec les médias touchant the wide array of programs, services and resources as a benefit of les enjeux vétérinaires nationaux ainsi que le traitement et le their membership. The CVMA uses its national volume purchase bien-être des animaux. power to help put money back in members’ wallets and deliver a En 2014, 6895 vétérinaires et membres étudiants ont profité wealth of practice tools, guidelines, best practices, resources and du vaste éventail de programmes, de services et de ressources information to support the delivery of high quality veterinary offerts dans le cadre de l’adhésion. L’ACMV met à contribution care and respond to the needs of its members. Here are some of son pouvoir d’achat de volume national pour aider les membres à the programs organized under the 3 leadership areas: réaliser des économies et offrir une foule d’outils pour la pratique, Science and Knowledge: includes The Canadian Veterinary de lignes directrices, de meilleures pratiques, de ressources et Journal, the Canadian Journal of Veterinary Research, an enriching d’information afin d’appuyer la prestation de soins vétérinaires scientific CE program at the CVMA Convention, the Emerging de grande qualité et de répondre aux besoins des membres. Voici Leaders workshop, timely advisories, and relevant news and quelques-uns des programmes organisés dans les trois domaines information. de leadership : Practice and Economics: includes provincial suggested fee Science et connaissances : comprend La Revue vétérinaire guides, associate and non-DVM compensation and benefits canadienne, la Revue canadienne de recherche vétérinaire, un reports, compensation reports for veterinarians in non-clinical programme de formation continue enrichissant au congrès de employment, specialized group insurance program, and practice l’ACMV, l’atelier des futurs leaders, des bulletins d’information management resources. opportuns et des nouvelles et des renseignements pertinents. Practice tools and support services: includes the Antimicrobial Pratique et finances : comprend les guides tarifaires suggérés SmartVet app, the Green Veterinary Practice resource, anesthetic pour les provinces, les rapports sur la rémunération et les and pain management protocols and posters, antimicrobial pru- avantages sociaux des vétérinaires salariés et des employés non- dent use guidelines, compounding guidelines, business banking vétérinaires, les rapports sur la rémunération pour les vétérinaires program, merchant payment processing service, telephone ‘hold’ occupant des emplois non cliniques, le programme d’assurance service, client education material and web resources, veterinary de groupe spécialisé et les ressources de gestion de la pratique. legal advice column and employment guidelines, to name a few. Outils pour la pratique et services de soutien : comprend, entre autres, l’appli IntelliVet, la ressource pour une Pratique vétérinaire écoresponsable, les protocoles et les affiches pour l’anesthésie et la gestion de douleur, les lignes directrices sur l’administration judicieuse des antimicrobiens, les lignes directrices pour les préparations magistrales, le programme de services bancaires commerciaux, le service de traitement des paiements pour les commerçants, le service de «mise en garde» téléphonique, du matériel pédagogique et des ressources Web pour les clients, une rubrique juridique vétérinaire et des lignes directrices sur l’emploi des finissants.

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Students of the Canadian Veterinary Medical Association (SCVMA) Étudiants de l’Association canadienne des médecins vétérinaires (ÉACMV)

The Students of the Canadian Veterinary Medical Association Les Étudiants de l’Association canadienne des médecins (SCVMA) represent over 1600 student veterinarians from the vétérinaires (ÉACMV) représentent plus de 1600 étudiants en 5 Canadian veterinary colleges. Over $80 000 was contributed médecine vétérinaire dans les cinq collèges de médecine vétérinaire from the CVMA’s operating budget to support student initia- canadiens. L’ACMV a contribué plus de 80 000 $ de son budget tives through the SCVMA program and to foster the relation- de fonctionnement pour financer les initiatives des étudiants dans ship between the CVMA and student veterinarians. le cadre du programme des ÉACMV et cultiver la relation entre The 2014 SCVMA Symposium was held January 9–11 in l’ACMV et les étudiants en médecine vétérinaire. RAPPORT ANNUEL Saint-Hyacinthe, Quebec, and was hosted by the students of la Le Symposium 2014 des ÉACMV s’est déroulé du 9 au Faculté de médecine vétérinaire. This student-led event was a 11 janvier à Saint-Hyacinthe, au Québec, et a été organisé par les huge success with over 350 students attending. étudiants de la Faculté de médecine vétérinaire de l’Université de The SCVMA conducted its annual New Graduates Survey to Montréal. Cet événement dirigé par des étudiants a remporté un gather useful information for future veterinary graduates and énorme succès et plus de 350 étudiants y ont participé. the profession. Results from the 2014 New Graduate Survey were Les ÉACMV ont réalisé leur Sondage annuel auprès des finissants published in the April 2015 edition of The CVJ. afin de recueillir des renseignements qui peuvent être utiles pour A variety of CVMA resources were produced for SCVMA les futurs diplômés en médecine vétérinaire et qui intéressent aussi members, including the annual VetRap student newsletter that la profession. Les résultats du Sondage 2014 auprès des finissants showcases articles from each of the 5 colleges, as well as 2 enews- ont été publiés dans l’édition d’avril 2015 de La RVC. letters dedicated to students. Throughout the year, the SCVMA Diverses ressources de l’ACMV ont été produites pour les section of the website and the SCVMA Facebook group provides membres des ÉACMV, notamment le bulletin étudiant annuel updated information. CVMA-branded lab coats and name badges were provided to first-year students during the Welcome Ceremony at each SCVMA Senior Representative college. The CVMA Awards and the Teacher of the Year Awards and 2014 Symposium were also presented at each college. Coordinator, Stéphanie Goulet, Again in the fall, the CVMA One Voice presentation was on the Birds of Prey Tour at hosted at each school to introduce students to the CVMA and Symposium 2014. to discuss a current animal welfare or national veterinary issue. La représentante sénior des A CVMA Council member and the SCVMA representative ÉACMV et coordonnatrice du delivered the presentation and facilitated the discussions. Symposium 2014, Stéphanie The CVMA’s group insurance partner, Western Financial Goulet, lors de la visite Group Insurance Solutions, hosted an Insurance Wine and des oiseaux de proie du Cheese presentation at each college. It is an opportunity to Symposium 2014.

The Ontario Veterinary College’s Class of 2018 Lab Coat Ceremony. La cérémonie des sarraus de la promotion 2018 de l’Ontario Veterinary College.

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VetRap qui présente des articles provenant de chacun des cinq collèges ainsi que deux cyberbulletins destinés aux étudiants. Pendant l’année, la section des ÉACMV du site Web et le groupe Facebook des ÉACMV ont présenté des mises à jour. Des sarraus affichant le logo de l’ACMV et des insignes ANNUAL REPORT ANNUAL d’identité ont été remis aux étudiants de première année durant la cérémonie d’accueil de chaque collège. Les prix de l’ACMV et les prix de l’enseignant de l’année ont aussi été décernés à chaque collège. De nouveau cette année, la présentation d’automne de l’ACMV «Une voix» a été organisée à chaque école afin d’introduire les étudiants à l’ACMV et de discuter une question de l’heure portant sur le bien-être animal ou les enjeux vétérinaires nationaux. Un membre du Conseil et un représentant des ÉACMV ont donné la présentation et animé les discussions. 2014–15 CVMA President, Dr. Jean Gauvin, presenting the CVMA Award to Richard Houle, Par ailleurs, le partenaire d’assurance de groupe de l’ACMV, a DVM student at FMV. Western Financial Group Insurance Solutions, a organisé Le président 2014–2015 de l’ACMV, le Dr Jean Gauvin, présentant le prix de l’ACMV à une présentation du midi à chaque collège. Cette conférence Richard Houle, un étudiant en médecine vétérinaire de la FMV. représente l’occasion de donner aux étudiants un aperçu des risques d’assurance auxquels ils pourront faire face durant provide an overview of insurance risks that students may face leur carrière et d’expliquer les divers produits et couvertures in their careers and to explain the various insurance products d’assurance offerts. and coverages available. Groupe consultatif de liaison avec les étudiants Student Liaison Advisory Group Les membres du Comité de liaison avec les étudiants de l’ACMV Members of the CVMA Student Liaison Advisory Group rep- représentent l’ACMV à chacun des cinq collèges de médecine resent the CVMA at each of the 5 Canadian veterinary colleges vétérinaire canadiens afin de renforcer le lien entre l’ACMV et and strengthen the link between the CVMA and its student ses membres étudiants. Le groupe consultatif, qui se compose members. The Advisory Group, which is comprised of one fac- d’un professeur provenant de chacun des collèges, fournit des ulty member from each college, provides guidance to SCVMA conseils aux représentants des ÉACMV à leur collège respectif. Les representatives at their respective colleges. Members also par- membres participent aussi à des initiatives annuelles de l’ACMV ticipate in annual CVMA initiatives at the veterinary colleges dans les collèges vétérinaires incluant la conférence «Une voix», la including the One Voice presentation, lab coat ceremony, and cérémonie des sarraus et le Symposium des ÉACMV. the SCVMA Symposium.

CVMA-SBCV Chapter Section de l’ACMV-SBCV

As the first chapter of the CVMA, the CVMA-SBCV Chapter À titre de première section de l’ACMV, la Section de l’ACMV- continues to flex its provincial muscle while maintaining its SBCV continue d’exercer des activités provinciales tout en place as part of the national team. The Chapter is the voice of conservant une place au sein de l’équipe nationale. La Section est veterinarians in British Columbia, sought after for comment, la voix des vétérinaires en Colombie-Britannique qui est consultée consultation, and information by the media, peers, stakehold- par les médias, les pairs, les intervenants et le public pour obtenir ers, and the public. des commentaires, des consultations ainsi que des renseignements.

Communications and consultation Communications et consultation The CVMA-SBCV Chapter is contacted by British Columbia Les médias de la Colombie-Britannique contactent la Section de media on animal and veterinary-related stories of importance l’ACMV-SBCV pour se renseigner sur des dossiers importants to British Columbians, such as raw pet food diets; West Nile touchant les animaux et les vétérinaires auxquels s’intéressent les Virus; and fire ants bites in dog parks. Other organizations citoyens de la Colombie-Britannique, comme les diètes composées turned to the Chapter for advice, such as British Columbia d’aliments crus, le virus du Nil occidental et les morsures de Ferries, which committed to consult with the CVMA-SBCV fourmis de feu dans les parcs à chiens. D’autres organisations on pet travel, and will credit that consultation. The Chapter consultent la Section pour obtenir des conseils, notamment is represented on the Provincial Animal Health/Public Health British Columbia Ferries, qui s’est engagée à consulter la Section Rabies working group, and was consulted on British Columbia’s ACMV-SBCV sur les déplacements des animaux de compagnie earthquake preparedness. et fera mention de cette consultation. La section est représentée

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Municipalities contact the CVMA-SBCV regarding animal au sein du Groupe de travail provincial en santé animale et en enquiries; industry partners rely on the Chapter for definitive santé publique sur la rage et elle a été consultée sur les préparatifs information. The CVMA-SBCV has strengthened its relation- d’urgence de la Colombie-Britannique en cas de tremblements ship with government veterinarians, reaching out to the Chief de terre. Veterinarian to publish a column in each issue of West Coast Les municipalités contactent la Section de l’ACMV-SBCV Veterinarian (WCV) magazine. The magazine itself continues to concernant des demandes de renseignements liées aux animaux be a well-read and relevant magazine providing current, mean- et les partenaires de l’industrie comptent sur la section pour ingful content for British Columbia veterinarians. Its periodic obtenir des renseignements définitifs. La Section de l’ACMV- WCV Monthly e-mail blasts also provide timely and relevant SBCV a renforcé ses liens avec les vétérinaires du gouvernement, information to members, and to Western College of Veterinary demandant au vétérinaire en chef de publier une rubrique dans Medicine (WCVM) BC-quota students, at their request. The chaque numéro du magazine West Coast Veterinarian (WCV). RAPPORT ANNUEL activities in this area fulfill the CVMA’s Policy and Advocacy Le magazine en soi continue de jouir d’un lectorat important et objective. c’est un magazine pertinent qui présente un contenu actuel et utile pour les vétérinaires de la Colombie-Britannique. Les envois Continuing education mensuels du WCV fournissent aussi des renseignements opportuns The CVMA-SBCV Chapter offered 2 well-attended continuing et pertinents pour les membres ainsi que les étudiants membres education events. The 43rd Annual Equine Seminar organized du groupe de la Colombie-Britannique au Western College of by the Equine Committee, held in Delta, featured Dr. Nicholas Veterinary Medicine (WCVM), qui ont demandé de recevoir la Frank, from Tufts University, speaking on Endocrine Disorders publication. Les activités dans ce domaine remplissent l’objectif of the Older Horse, and Dr. Hal Schott, from Michigan State de Politiques et défense des intérêts des l’ACMV. University, speaking on Fluid Therapy, Weight Loss, Urinary, and Hepatic Diseases. The Chapter’s 2014 Fall CE and Trade Formation continue Show, held in Richmond, featured Dr. Brigitte Brisson, Soft La Section de l’ACMV-SBCV a offert deux activités de Tissue Surgery; Dr. Nancy Brock, Anesthesia; Dr. Marnie Ford, formation continue qui ont rassemblé un nombre important Ophthalmology; Dr. James Montgomery, Medical Imaging; de participants. Le 43e Atelier annuel sur les équidés, qui a Dr. Charlie Pye, Dermatology; Dr. Kevin S. Stepaniuk, été organisé par le Comité des équidés, s’est tenu à Delta, et Dentistry, and lunch-and-learns featuring Dr. Liz Ruelle, How a présenté le Dr Nicholas Frank, de l’Université Tufts, qui a to Use the Cat Healthy Toolkit to Increase Your Feline Practice, traité des troubles endocriniens chez le cheval âgé, et le Dr Hal and Dr. Rebecca Ledger, Distinguishing Training Issues from Schott, de l’Université de l’État du Michigan, qui a abordé la Mental Health Disorders. Both CE events were financially suc- fluidothérapie, la perte de poids ainsi que les maladies urinaires cessful, and most veterinarians surveyed were likely to return et hépatiques. Le Salon d’exposition et les ateliers de formation next year. The activities in this area fulfill the CVMA’s Science de l’automne 2014 de la Section ont eu lieu à Richmond. On y and Knowledge objective. a présenté la Dre Brigitte Brisson, chirurgie des tissus mous; la Dre Nancy Brock, anesthésie; la Dre Marnie Ford, ophtalmologie; Chapter development le Dr James Montgomery, imagerie médicale; le Dr Charlie The Chapter Board has shown leadership in suggesting a fee Pye, dermatologie; le Dr Kevin S. Stepaniuk, dentisterie, et des review to address the needs of new graduates, and a review of causeries du midi qui ont présenté la Dre Liz Ruelle, Comment membership benefits to attract new members. The CVMA- utiliser la trousse de Soins félins pour élargir votre pratique féline, SBCV has been particularly involved in the establishment of a et la Dre Rebecca Ledger, Comment distinguer les problèmes de mentoring program, spearheading discussion with the WCVM, propreté des troubles de santé mentale. Ces deux événements de and it will continue to work with the WCVM and the CVMA formation continue ont été réussis sur le plan financier et la to develop the best mentoring program available. The Chapter plupart des vétérinaires interrogés ont dit qu’ils y retourneraient assists in the promotion of the fee guides, and the development l’an prochain. Les activités dans ce domaine répondent à l’objectif and promotion of position statements. de Science et connaissances de l’ACMV.

Évolution de la section Le Conseil de la Section a fait preuve de leadership lorsqu’il a suggéré une révision des cotisations afin d’aborder les besoins des finissants ainsi qu’un examen des avantages de l’adhésion afin d’attirer de nouveaux membres. L’ACMV-SBCV a été particulièrement présente dans l’établissement d’un programme de mentorat et elle a dirigé des discussions avec le WCVM et elle continuera de travailler avec le WCVM et l’ACMV pour élaborer le meilleur programme de mentorat possible. La Section collabore à la promotion de guides tarifaires et à l’élaboration et à la promotion d’énoncés de position.

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SETTING STANDARDS AHT/VT Program Accreditation ÉTABLISSEMENT DE NORMES Agrément des programmes de TSA/TV REPORT ANNUAL

The mandate of the CVMA’s Animal Health Technologist/ Le mandat du Comité d’agrément des programmes de technologie Veterinary Technician Program Accreditation Committee en santé animale et de techniques vétérinaires (CAPTSATV) (AHTVTPAC) is to identify the minimum standards for edu- consiste à identifier les normes minimales pour l’éducation et cating and training qualified personnel who may join the vet- la formation d’un personnel qualifié qui pourra faire partie erinary health care team and accredits education and training de l’équipe de soins vétérinaires et à agréer des programmes programs accordingly. The graduates benefit by having their d’enseignement et de formation en fonction de ces normes. Les competence recognized and prospects for employment and diplômés profitent du fait que leur compétence est reconnue et mobility enhanced, and the veterinary team benefits from well- que leurs perspectives d’emploi et de mobilité sont améliorées. trained technicians and technologists. L’ACMV maintient une entente de réciprocité avec l’American The CVMA maintains a reciprocity agreement with the Veterinary Medical Association qui permet la reconnaissance AVMA that allows for the mutual recognition of our respective mutuelle de nos processus d’agrément respectifs. accreditation processes. En 2014, le Conseil de l’ACMV a approuvé l’agrément des In 2014, the CVMA Council approved accreditation for the programmes à Vanier College et à Georgian College. programs at Vanier College and Georgian College. Les programmes de TSA/TV des établissements d’enseignement The AHT/VT programs of the following educational institu- suivants, soit 18 au total, sont actuellement agréés par l’ACMV : tions, 18 in total, are currently accredited by the CVMA: • Algonquin College, Ottawa (Ontario) • Algonquin College, Ottawa, Ontario • Douglas College, New Westminster (Colombie-Britannique) • Dalhousie University (formerly Nova Scotia Agricultural • Georgian College, Orillia (Ontario) College), Truro, Nova Scotia • Grand Prairie Regional College, Fairview Campus, Fairview • Douglas College, New Westminster, British Columbia (Alberta) • Georgian College, Orillia, Ontario • Lakeland College, Vermilion (Alberta) • Grand Prairie Regional College, Fairview Campus, Fairview, • Northern Alberta Institute of Technology, Edmonton (Alberta) Alberta • Northern College, Haileyburg (Ontario) • Lakeland College, Vermilion, Albera • Olds College (sur le campus et téléapprentissage), Olds • Northern Alberta Institute of Technology, Edmonton, Alberta (Alberta) • Northern College, Haileyburg, Ontario • Oulton College, Moncton (Nouveau-Brunswick) • Olds College (on-campus and distance learning), Olds, Alberta • Red River College, Winnipeg (Manitoba) • Oulton College, Moncton, New Brunswick • St. Clair College, Windsor (Ontario) • Red River College, Winnipeg, Manitoba • St. Lawrence College, Kingston (Ontario) • St. Clair College, Windsor, Ontario • Saskatchewan Institute of Science and Technology, Saskatoon • St. Lawrence College, Kingston, Ontario (Saskatchewan) • Saskatchewan Institute of Science and Technology, Saskatoon, • Seneca College, King City (Ontario) Saskatchewan • Université Dalhousie (anciennement Nova Scotia Agricultural • Seneca College, King City, Ontario College), Truro (Nouvelle-Écosse) • Thompson Rivers University (on-campus and distance learn- • Université de Guelph, Campus Ridgetown (sur le campus et ing), Kamloops, British Columbia apprentissage à distance), Ridgetown (Ontario) • University of Guelph, Ridgetown Campus (on-campus and • Université Thompson Rivers (sur le campus et téléapprentissage), distance learning), Ridgetown, Ontario Kamloops (Colombie-Britannique) • Vanier College, St-Laurent, Quebec • Vanier College, Saint-Laurent (Québec)

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National Exams Examens nationaux

The National Examining Board (NEB) is responsible for the Le Bureau national des examinateurs (BNE) est responsable administration, in Canada, of a 3-part veterinary licensing de l’administration, au Canada, d’un processus d’examen examination process. Completion of the exams is a requirement d’agrément vétérinaire en trois étapes. La réussite des examens to be eligible to apply for a license from any of the provincial est une exigence d’admissibilité pour présenter une demande de veterinary licensing bodies. Another role delegated by Council permis auprès d’un ordre professionnel provincial. Un autre rôle to the NEB is to evaluate university programs designed to edu- délégué par le Conseil au BNE est l’évaluation des programmes cate students to become veterinarians, as part of the AVMA/ universitaires conçus pour former les étudiants à devenir des RAPPORT ANNUEL CVMA-Council on Education (COE) accreditation program. vétérinaires, dans le cadre du programme d’agrément de l’AVMA/ ACMV-Council on Education (COE). NEB examination process Graduates of a non-accredited veterinary school are required to Processus d’examen du BNE complete all 3 parts of the NEB examination sequence in order Un diplômé d’une école de médecine vétérinaire non agréée doit to receive a Certificate of Qualification (CQ). A CQ is a prereq- achever les trois étapes de la séquence d’examens du BNE afin uisite to apply for a general license from any of the 10 provincial de recevoir un Certificat de compétence (CC). Le CC constitue veterinary licensing boards in Canada. une exigence préalable à une demande de permis auprès de l’un In 2014, the NEB accepted applications from 247 new can- des dix ordres vétérinaires provinciaux au Canada. didates and issued 450 CQs (323 Canadian students, 35 gradu- En 2014, le BNE a accepté des demandes provenant de ates from AVMA-accredited veterinary schools, 76 graduates of 247 nouveaux candidats et émis 450 CC (323 à des étudiants non-accredited veterinary schools, 16 American graduates from canadiens, 35 à des diplômés d’écoles de médecine vétérinaire AVMA-accredited veterinary schools). agréées par l’AVMA, 76 à des diplômés d’écoles de médecine The initial application to the NEB, and registrations for vétérinaire non agréées, 16 à des diplômés américains provenant all 3 NEB examinations, was moved to an online registration d’écoles de médecine vétérinaire agréées par l’AVMA). process during 2014. En 2014, un nouveau système d’inscription en ligne a été The NEB’s veterinary licensing process for graduates of instauré pour la demande initiale auprès du BNE ainsi que non-accredited veterinary schools is composed of the following l’inscription aux trois examens du BNE. examinations: Le processus d’agrément vétérinaire du BNE pour les diplômés • the Basic and Clinical Sciences Examination (BCSE); des écoles de médecine vétérinaires non agréées se compose des • the North American Veterinary Licensing Examination examens suivants : (NAVLE®); • l’Examen des sciences de base et cliniques (ESBC); • the Clinical Proficiency Examination (CPE). • l’Examen nord-américain d’agrément en médecine vétérinaire Graduates of an accredited veterinary school need only to (NAVLE®); pass one of the exams, the North American Veterinary Licensing • l’Examen de compétences cliniques (ECC). Examination (NAVLE), to receive a CQ. If such a candidate Les diplômés d’une école de médecine vétérinaire agréée requires more than 2 attempts to pass the NAVLE®, they must doivent uniquement réussir l’un des examens, l’Examen nord- also successfully complete the CPE. américain d’agrément en médecine vétérinaire (NAVLE), pour The BCSE is the first exam that graduates of non-accredited recevoir un CC. Si un tel candidat exige plus de deux tentatives veterinary schools must pass before being eligible to proceed pour réussir le NAVLE®, il doit alors aussi réussir l’ECC. to the NAVLE® and the CPE. In 2014, the NEB recorded a L’ESBC représente le premier examen que doivent réussir les total of 173 attempts on the BCSE by NEB candidates, includ- diplômés des écoles de médecine vétérinaire non agréées avant ing those with more than one attempt. In 2013, there were d’être admissibles à subir le NAVLE® et l’ECC. En 2014, le BNE 179 BCSE attempts by NEB candidates. a enregistré un total de 173 tentatives à l’ESBC par les candidats The NEB recorded a total of 613 attempts on the NAVLE® du BNE, incluant ceux avec plus d’une tentative. En 2013, il in 2014, during a 2-week testing window in April and a 4-week y avait eu 179 tentatives de l’ESBC par les candidats du BNE. window from mid-November to mid-December. In 2013, NEB Le BNE a enregistré un total de 613 tentatives au NAVLE® candidates had a total of 571 attempts. en 2014, durant une période d’examen de deux semaines en avril A total of 45 candidates appeared for the full Clinical et une période d’examen de quatre semaines de la mi-novembre Proficiency Examination (CPE) at exam sites in Canada in à la mi-décembre. En 2013, les candidats du BNE avaient réalisé 2014, compared to 52 in 2013. un total de 571 tentatives. Candidates who failed one to 3 sections during their attempt Un total de 45 candidats se sont présentés à l’Examen de at the CPE in full repeated approximately 79 sections during the compétences cliniques (ECC) intégral à des centres d’examen au course of 2014, compared to 93 sections in 2013. Canada en 2014, comparativement à 52 en 2013.

688 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY

In 2014, a total of 29 NEB candidates completed the CPE Les candidats qui avaient échoué de 1 à 3 sections durant leur in the United States compared to 46 in 2013. All were granted tentative à l’ECC intégral ont répété environ 79 sections au cours a Certificate of Qualification. de 2014, comparativement à 93 sections en 2013. En 2014, un total de 29 candidats du BNE ont terminé l’ECC Collaboration with exam providers in the aux États-Unis, comparativement à 46 en 2013. Ils ont tous ANNUAL REPORT ANNUAL United States obtenu un Certificat de compétence. Members or representatives of the NEB participated in meet- ings of its principal counterparts in the United States, including Collaboration avec les fournisseurs d’examen aux the Educational Commission for Foreign Veterinary Graduates États-Unis (ECFVG), which is part of the AVMA, as well as the National Des membres ou des représentants du BNE ont participé à des Board of Veterinary Medical Examiners (NBVME), which owns réunions avec leurs principaux homologues aux États-Unis, the NAVLE®. notamment l’Educational Commission for Foreign Veterinary CVMA members also participated in meetings held by the Graduates (ECFVG), qui fait partie de l’AVMA, ainsi que le ECFVG and the NBVME to prepare, review and validate exam National Board of Veterinary Medical Examiners (NBVME), qui content and procedures for all 3 exams. These activities ensure est propriétaire du NAVLE®. that they remain valid assessment tools. Les membres de l’ACMV ont aussi participé à des réunions tenues par l’ECFVG et le NBVME pour préparer, examiner AVMA/CVMA — COE Veterinary College Accreditation et valider le contenu et les procédures d’examen pour les trois The CVMA is a full, joint partner in the accreditation program examens. Ces activités veillent à assurer la validité de ces outils of the COE of the AVMA. When the COE confers accredita- d’évaluation. tion to a veterinary college in Canada, it is granted on behalf of the CVMA and the AVMA. The CVMA has a full, voting Agrément des collèges de médecine vétérinaire par representative on the COE, which usually meets twice a year l’AVMA/ACMV — COE at AVMA headquarters in Schaumburg, Illinois, to discuss and L’ACMV est partenaire à part entière du programme d’agrément decide upon policy and the accreditation status of colleges. géré par le COE de l’AVMA. Lorsque le COE confère l’agrément In 2014 AVMA/CVMA-COE site visits were conducted at: à un collège de médecine vétérinaire au Canada, il le fait au nom • University College Dublin de l’ACMV et de l’AVMA. L’ACMV dispose d’un représentant • Oregon State University College of Veterinary Medicine à part entière avec droit vote au sein du COE, qui se réunit • North Carolina State University College of Veterinary Medicine habituellement deux fois par année au siège social de l’AVMA • University of Minnesota College of Veterinary Medicine à Schaumburg, en Illinois, pour discuter et établir les politiques • Massey University Institute of Veterinary, Animal & Biomedical ainsi que le statut d’agrément des collèges. Sciences En 2014, des inspections de l’AVMA/ACMV-COE ont été • University of Utrecht réalisées dans les établissements suivants : • Virginia/Maryland Regional College of Veterinary Medicine • University College Dublin • Mississippi State University College of Veterinary Medicine • Collège de médecine vétérinaire de l’Université d’État de l’Oregon • Collège de médecine vétérinaire de l’Université d’État de la Caroline du Nord • Collège de médecine vétérinaire de l’Université du Minnesota • Institute of Veterinary, Animal & Biomedical Sciences de l’Université Massey • Université d’Utrecht • Virginia/Maryland Regional College of Veterinary Medicine • Collège de médecine vétérinaire de l’Université d’État du Mississippi

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RAPPORT ANNUEL RAPPORT DES AUDITEURS INDÉPENDANTS INDEPENDENT AUDITORS’ REPORT Aux membres de L’Association canadienne des médecins vétérinaires To the Members, : Canadian Veterinary Medical Association Nous avons effectué l’audit des états financiers ci-joints de L’Association We have audited the accompanying financial statements of the Canadian canadienne des médecins vétérinaires, qui comprennent l’état de la situation Veterinary Medical Association, which comprise the statement of financial financière au 31 décembre 2014, et les états des revenus et dépenses, de position as at December 31, 2014, and the statements of changes in net l’évolution de l’actif net et des flux de trésorerie pour l’exercice terminé à assets, operations and cash flows for the year then ended, and a summary cette date, ainsi qu’un résumé des principales méthodes comptables et of significant accounting policies and other explanatory information. d’autres informations explicatives. Management’s responsibility for the financial statements Responsabilité de la direction pour les états financiers Management is responsible for the preparation and fair presentation of these La direction est responsable de la préparation et de la présentation fidèle financial statements in accordance with Canadian accounting standards for de ces états financiers conformément aux normes comptables canadiennes not-for-profit organizations, and for such internal control as management pour les organismes sans but lucratif, ainsi que du contrôle interne qu’elle determines is necessary to enable the preparation of financial statements considère comme nécessaire pour permettre la préparation d’états that are free from material misstatement, whether due to fraud or error. financiers exempts d’anomalies significatives, que celles-ci résultent de fraudes ou d’erreurs. Auditors’ responsibility Our responsibility is to express an opinion on these financial statements Responsabilité de l’auditeur based on our audit. We conducted our audit in accordance with Canadian Notre responsabilité consiste à exprimer une opinion sur les états financiers, generally accepted auditing standards. Those standards require that we sur la base de notre audit. Nous avons effectué notre audit selon les normes comply with ethical requirements and plan and perform the audit to obtain d’audit généralement reconnues du Canada. Ces normes requièrent que reasonable assurance about whether the financial statements are free from nous nous conformions aux règles de déontologie et que nous planifiions material misstatement. et réalisions l’audit de façon à obtenir l’assurance raisonnable que les états financiers ne comportent pas d’anomalies significatives. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures Un audit implique la mise en œuvre de procédures en vue de recueillir des selected depend on the auditor’s judgment, including the assessment of éléments probants concernant les montants et les informations fournis the risks of material misstatement of the financial statements, whether due dans les états financiers. Le choix des procédures relève du jugement to fraud or error. In making those risk assessments, the auditor considers de l’auditeur, et notamment de son évaluation des risques que les états internal control relevant to the entity’s preparation and fair presentation financiers comportent des anomalies significatives, que celles-ci résultent of the financial statements in order to design audit procedures that are de fraudes ou d’erreurs. Dans l’évaluation de ces risques, l’auditeur prend appropriate in the circumstances, but not for the purpose of expressing an en considération le contrôle interne de l’entité portant sur la préparation et opinion on the effectiveness of the entity’s internal control. An audit also la présentation fidèle des états financiers afin de concevoir des procédures includes evaluating the appropriateness of accounting policies used and the d’audit appropriées aux circonstances, et non dans le but d’exprimer une reasonableness of accounting estimates made by management, as well as opinion sur l’efficacité du contrôle interne de l’entité. Un audit comporte evaluating the overall presentation of the financial statements. également l’appréciation du caractère approprié des méthodes comptables retenues et du caractère raisonnable des estimations comptables faites par We believe that the audit evidence we have obtained is sufficient and la direction, de même que l’appréciation de la présentation d’ensemble des appropriate to provide a basis for our audit opinion. états financiers. Nous estimons que les éléments probants que nous avons obtenus sont Opinion suffisants et appropriés pour fonder notre opinion d’audit. In our opinion, the consolidated financial statements present fairly, in all Opinion material respects, the financial position of the Canadian Veterinary Medical À notre avis, les états financiers donnent, dans tous leurs aspects Association as at December 31, 2014, and the results of its operations significatifs, une image fidèle de la situation financière de L’Association and its cash flows for the year then ended in accordance with Canadian canadienne des médecins vétérinaires au 31 décembre 2014, ainsi que accounting standards for not-for-profit organizations. de sa performance financière et de ses flux de trésorerie pour l’exercice terminé à cette date, conformément aux normes comptables canadiennes OUSELEY HANVEY CLIPSHAM DEEP LLP pour les organismes sans but lucratif. Licensed Public Accountants

OUSELEY HANVEY CLIPSHAM DEEP LLP Experts - comptables autorisés Ottawa, Ontario March 25, 2015

205 Catherine Street, Suite 200, Ottawa, ON K2P 1C3 — T 613 562 2010 — F 613 562 2012 — www.ohcd.ca

690 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY

CANADIAN VETERINARY MEDICAL L’ASSOCIATION CANADIENNE DES ASSOCIATION MÉDECINS VÉTÉRINAIRES

STATEMENT OF FINANCIAL POSITION ÉTAT DE LA SITUATION FINANCIÈRE AS AT DECEMBER 31, 2014 AU 31 DÉCEMBRE 2014 ANNUAL REPORT ANNUAL

2014 2013

CURRENT ASSETS ACTIF À COURT TERME Cash $ 471 921 $ 208 752 Encaisse Accounts receivable 158 986 184 976 Débiteurs Interest receivable 60 621 38 756 Intérêts à recevoir Prepaid expenses 73 215 56 239 Frais payés d’avance

764 743 488 723

INVESTMENTS 2 221 091 2 390 210 PLACEMENTS CAPITAL ASSETS 665 105 722 149 IMMOBILISATIONS

$ 3 650 939 $ 3 601 082

CURRENT LIABILITIES PASSIF À COURT TERME Accounts payable and accrued liabilities $ 98 506 $ 168 288 Créditeurs et charges à payer Government remittances payable 7 629 550 Remises gouvernementales à payer Deferred revenue 708 291 505 233 Revenus reportés

814 426 674 071

NET ASSETS ACTIF NET Invested in capital assets 665 105 722 148 Investi en immobilisations corporelles Internally restricted net assets: Actif nets affecté d’origine interne : Operational contingency 1 233 280 1 233 280 Éventualité opérationnelle Program contingency 938 128 971 583 Éventualité de programme Unrestricted — — Non affectés

2 836 513 2 927 011

$ 3 650 939 $ 3 601 082

APPROVED ON BEHALF OF THE BOARD AU NOM DU CONSEIL D’ADMINISTRATION

President Président

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CANADIAN VETERINARY MEDICAL L’ASSOCIATION CANADIENNE DES ASSOCIATION MÉDECINS VÉTÉRINAIRES

STATEMENT OF OPERATIONS ÉTAT DES RÉSULTATS FOR THE YEAR ENDED DECEMBER 31, 2014 POUR L’EXERCICE TERMINÉ LE 31 DÉCEMBRE 2014

2014 2013

REVENUE REVENUS

RAPPORT ANNUEL Communications Program $ 64 408 $ 59 211 Programme de communication Professional development 437 322 538 038 Perfectionnement Journal — CJVR 73 457 73 604 Revue — RCRV Journal — CVJ 598 921 651 179 Revue — RVC Membership services 1 299 209 1 292 362 Services des membres National Examination Board 1 255 138 1 245 693 Bureau national des examinateurs Canadian Veterinary Reserve 204 587 181 882 Réserve canadienne vétérinaire AHTVTP Accreditation 46 500 42 750 Agrément TSA Secretariat 424 243 360 287 Secrétariat Students Program 7 855 7 750 Programme d’étudiants Special projects 106 375 118 074 Projets spéciaux Interest 46 317 43 226 Intérêts

4 564 332 4 614 056

Inter-departmental revenues Revenus entre services and administration allocations (217 311) (206 591) et frais administratifs

4 347 021 4 407 465

EXPENDITURE DÉPENSES Communications Program 187 013 119 615 Programme de communication Professional development 405 514 477 293 Perfectionnement professionnel Council and committees 351 774 302 145 Conseil et comités Journal — CJVR 70 876 72 849 Revue — RCRV Journal — CVJ 702 124 683 399 Revue — RVC Membership services 447 239 464 422 Services des membres National Examination Board 1 283 078 1 191 380 Bureau national des examinateurs Canadian Veterinary Reserve 204 587 181 882 Réserve canadienne vétérinaire AHTVTP Accreditation 36 622 15 289 Agrément TSA Secretariat 739 219 735 580 Secrétariat Students Program 73 380 72 669 Programme d’étudiants Special projects 153 404 194 510 Projets spéciaux

4 654 830 4 511 033

Inter-departmental expenses Dépenses entre services and administration allocations (217 311) (206 591) et frais administratifs

4 437 519 4 304 442

NET REVENUE (EXPENSE) REVENUS (DÉPENSES) NETS FOR THE YEAR $ (90 498) $ 103 023 POUR L’EXERCICE

692 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Special Report Rapport spécial

The increasing risk of Lyme disease in Canada

Catherine Bouchard, Erin Leonard, Jules Konan Koffi, Yann Pelcat, Andrew Peregrine, Neil Chilton, Kateryn Rochon, Tim Lysyk, L. Robbin Lindsay, Nicholas Hume Ogden

Abstract — There is an increasing risk of Lyme disease in Canada due to range expansion of the tick vector, Ixodes scapularis. The objectives of this article are to i) raise public awareness with the help of veterinarians on the emerging and expanding risk of Lyme disease across Canada, ii) review the key clinical features of Lyme disease in dogs, and iii) provide recommendations for veterinarians on the management of Lyme disease in dogs.

Résumé — Risque accru de maladie de Lyme au Canada. Il existe un risque grandissant de maladie de Lyme au Canada en raison d’un élargissement de la portée de la tique vectrice, Ixodes scapularis. Les objectifs du présent article consistent à i) rehausser la sensibilisation du public avec l’aide des vétérinaires quant au risque émergent et grandissant de la maladie de Lyme au Canada, ii) examiner les principales caractéristiques cliniques de la maladie de Lyme chez les chiens et iii) présenter des recommandations aux vétérinaires pour la gestion de la maladie de Lyme chez les chiens. (Traduit par Isabelle Vallières) Can Vet J 2015;56:693–699 Lyme disease risk in Canada more advanced stages of the disease in dogs, although this is uncommon (3). yme disease (LD) is the most common tick-borne disease In Canada, the agent of LD is the spirochete Borrelia affecting human and dog health in North America and L ­burgdorferi sensu stricto, which is transmitted by the bite of Europe (1). In most human cases, LD presents as a non-specific ticks in the genus Ixodes. Ixodes scapularis, the blacklegged tick, flu-like illness frequently with a characteristic skin lesion known is the main vector in eastern and central North America and as erythema migrans (2). If left untreated, the disease can Ixodes pacificus, the western blacklegged tick, is the main vector progress to arthritic, cardiac, and neurological manifestations. west of the Rocky Mountains (2). In dogs, clinical disease is a less common outcome of infection Recent studies suggest that LD is an emerging health risk than in humans and usually presents as one or more of: fever, in southeastern and south central Canada, mostly due to the anorexia, depression, lethargy, lameness, joint swelling, arthri- increasing geographic range of I. scapularis (2,4–7). Ixodes tis, and lymphadenopathy. Nephropathy can also occur in the scapularis feeds on a broad range of animal species including rodents, birds, medium- and large-sized mammals, and reptiles, and also humans (8). Immature (larval and nymphal) ticks Public Health Risk Sciences Division, Laboratory for become infected by feeding on wild animal reservoirs (par- Foodborne Zoonoses (Bouchard, Pelcat, Ogden), and Zoonoses ticularly rodents such as the white-footed mouse, Peromyscus Division, Centre for Foodborne, Environmental and Zoonotic leucopus) and are capable of transmitting infection to humans or Infectious Diseases (Leonard, Koffi), Public Health Agency animals after they molt into nymphs or adults. The tick season of Canada, Saint-Hyacinthe, Quebec and Ottawa, Ontario; in Canada is typically from the spring snow melt to late autumn, Department of Pathobiology, University of Guelph, Guelph, although different life-cycle stages are active at different times Ontario (Peregrine); Department of Biology, University of of the year, and onset and end of activity can vary among years Saskatchewan, Saskatoon, Saskatchewan (Chilton); Department and localities. In most cases, ticks must attach and feed for 24 to of Entomology, University of Manitoba, Winnipeg, Manitoba 48 h before B. burgdorferi transmission occurs (9,10). (Rochon); Research Centre, Agriculture and Agri-Food Canada, In southern parts of the country, the incidence of reported Lethbridge, Alberta (Lysyk); Zoonotic Diseases and Special LD cases in humans has been increasing, particularly in south- Pathogens, National Microbiology Laboratory, Public Health ern parts of Ontario, Quebec, Manitoba, and in locations in Agency of Canada, Winnipeg, Manitoba (Lindsay). Nova Scotia. In 2004, there were an estimated 40 reported Address all correspondence to Dr. Catherine Bouchard; e-mail: human cases of LD in Canada (11); this number rose to [email protected] 682 reported human cases in 2013 (unpublished data). The Use of this article is limited to a single copy for personal study. incidence of clinical cases of LD in dogs in Canada is unknown. Anyone interested in obtaining reprints should contact the The seroprevalence of B. burgdorferi in dogs in Canadian prov- CVMA office ([email protected]) for additional inces ranged from 0.00% to 2.15% (average 0.72%) according copies or permission to use this material elsewhere. to a study in 2008 (12). It was assumed that 2/3 of positive

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Figure 1. Surveillance for Lyme disease risk areas, and tick vectors in eastern and central Canada based on different surveillance systems: A — Active surveillance sampling sites visited from 2003 to 2012: site locations that were sampled are delimited by grey lines (buffer of 25 km created around each site) and the sites with at least 1 I. scapularis tick found are represented following a colored gradient and quintile classification (darker areas indicating higher numbers of sites with ticks). B — The geographic distribution of I. scapularis ticks submitted from dogs based on the probable locations of acquisition, 1991 to 2012: the locations with ticks submitted are represented following a green gradient and quintile classification (darker green areas indicate higher numbers of locations with ticks submitted). C — The geographic distribution of I. scapularis ticks submitted from humans based on the probable locations of acquisition, 1991 to 2012: the locations with ticks submitted are represented following a brown gradient and quintile classification (darker brown areas indicate higher numbers of locations with ticks submitted).

694 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY SPECIAL REPORT SPECIAL

Figure 2. Lyme disease risk areas (hatched areas) where surveillance and research studies (risk mapping in BC: http://www.bccdc.ca/ NR/rdonlyres/A07283DB-A709-4494-BFD5-E2AB7ED2724C/0/Lyme_Disease_Risk_Areas_Map_BC_June_2013.pdf) suggest ticks and B. burgdorferi have become established. test results were associated with infections acquired in Canada, Peromyscus leucopus) (7,20); v) density of deer populations, rather than being travel-acquired in LD risk areas outside the which drives the density of local vector populations (21,22); country. The low seroprevalence in Canada [in LD risk areas in and vi) biodiversity of hosts and other community components the USA, seroprevalence is typically . 10% (13)] likely reflects affecting the B. burgdorferi transmission cycles (13,22,23). the early stage of emergence of LD in Canada in 2008. In Canada, humans and animals are usually exposed to tick This article focuses on i) the environmental drivers of LD, bites in deciduous woodlands, but also coniferous woodlands ii) the geographic distribution and variation of LD risk areas in in the Maritimes (Lindsay, unpublished data) and elsewhere in Canada, iii) the key clinical features and diagnostic options for the range of blacklegged ticks (24). Woodland habitats favor detection of LD in dogs, and iv) recommendations for treatment the survival of ticks by providing refuge from weather extremes, and prevention of LD in dogs. Veterinarians across the country suitable hosts, and a microclimate suitable for survival and can play an important role in raising public awareness about host-seeking (16). Host-seeking ticks climb woodland under- ticks and the pathogens they transmit. growth vegetation and stretch out their forelegs to better “sense” potential hosts. However, pets and humans can also be exposed Environmental drivers (albeit at lower frequencies) in urban and suburban settings According to previous Canadian studies, the pattern of LD (e.g., parks and gardens) due to ticks dispersed out of LD risk risk emergence and expansion is mostly shaped by the follow- areas in woodlands by migratory birds (so-called “adventitious” ing environmental drivers: i) introduction of I. scapularis and ticks). These ticks pose a low-level but geographically widespread B. burgdorferi by migratory birds (13–15); ii) climate conditions potential risk of exposure to LD-infected ticks. and climate warming that affect tick survival, activity, seasonal- ity, and development (16,17); iii) habitat conditions that are Geographic distribution of LD risk areas suitable for host and tick populations (13,18,19); iv) density Canadian studies have used analysis of active field and passive of B. burgdorferi reservoirs (e.g., the white-footed mouse, tick surveillance data to identify expansion of the geographic

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range of I. scapularis and emerging LD risk areas. Active field Table 1. Key clinical and diagnostic features to consider for surveillance involves collecting ticks directly from the environ- possible LD in dogs ment using drag sampling or capture of rodent hosts (11). Clinical features Description Passive tick surveillance involves collecting ticks submitted from i) Clinical signs consistent • Approximately 5% of dogs exposed animals or humans through participating veterinary and medical with LD to infected ticks develop clinical LD clinics (5,11). In Canada, LD-endemic areas are locations where • Most common clinical signs: fever, transmission of B. burgdorferi by resident populations of vector anorexia, depression, lethargy, sudden or recurrent lameness, joint swelling, ticks has been confirmed by active surveillance (25). The num- myalgia, arthritis, and ber of documented endemic areas in which I. scapularis is the lymphadenopathy vector has increased from 1 location in Ontario in the 1970s, to • Clinical signs appear 2 to 5 mo after 22 locations in 2014 in New Brunswick, Nova Scotia, Quebec, exposure RAPPORT SPÉCIAL Ontario, and Manitoba, although the extent of likely risk areas • Lyme nephritis, including immune- (i.e., locations where a field study has found ticks) is much wider mediated glomerulonephritis and ­protein-losing nephropathy, can occur (Figure 1A) (11). Based on field surveillance data from 636 loca- in later stages of the disease and more tions visited from 2003 to 2012, there are 3 regions with higher frequently in certain breeds of dogs a risk for LD across the country: i) southern Manitoba, ii) south- (i.e., Labrador and golden retriever) ern and eastern Ontario, and southern Quebec, and iii) parts of ii) Credible evidence of • Based on dog’s history of activity in Nova Scotia and southern New Brunswick (Figure 1A). More exposure to infected Ixodes locations where exposure to Ixodes tick(s) ticks is possible details on the methodology for active sampling and the level of effort can be found in published studies (6,11,26). iii) Positive laboratory tests • Most serological tests are not able to distinguish between active infection Passive tick surveillance from 1991 to 2012 indicates and exposure the likely locations where ticks were acquired by pet dogs • A ntibodies can be detected in dogs (Figure 1B) and humans (Figure 1C): a total of 16 288 I. scapu- between 3 and 5 wk after exposure to laris ticks were collected from dogs and 9715 ticks were col- infected ticks and serological tests can remain positive for months and even lected from humans. Ixodes scapularis ticks were found on dogs over a year after infection (30,35)b across Canada, from Newfoundland and Labrador to Alberta iv) Elimination of other • Many of the signs seen with LD could (Figure 1B). These maps show that the risk of dogs acquiring differential diagnoses b e due to other diseases [see algorithm I. scapularis ticks is similar to that for humans (Figure 1C) and in Littman et al (30)] corresponds mostly to locations in which active surveillance v) Response to treatmentc • A decision flowchart for Lyme positive has shown evidence of tick populations. However, because dogs dogs and treatment recommendations are particularly effective at acquiring adventitious ticks (19), can be found in Littman et al (30) and clinical veterinary medicine textbooks the geographic range of ticks collected in passive surveillance by veterinarians is wider than that of known reproducing tick a Less than 2% of seropositive dogs develop this disease with lameness reported in 9% to 28% of such cases (3); the conclusive involvement of B. burgdorferi has not populations (Figure 1B). Nevertheless, the regions with the been proven (37). highest risk of exposure to I. scapularis ticks for pets and humans b See further details in Diagnostic options section. c Some dogs with lameness due to other causes may respond to doxycycline are the southern parts of Manitoba, Quebec, and Ontario, and treatment due to the drug’s anti-inflammatory properties (30). parts of the Maritimes. In contrast, I. pacificus ticks are distributed widely through- The prevalence of B. burgdorferi is typically less than 10% in out southern and central British Columbia (27). However, for I. pacificus ticks found in southern British Columbia (2). several ecological reasons, the prevalence of B. burgdorferi in There is an estimated 5-year delay between I. scapularis host-seeking I. pacificus ticks is relatively low (2). As a result, population establishment and B. burgdorferi establishment in the probability of acquiring LD where I. pacificus ticks are southeastern Canada, but, due to particularities of the ecology the vector is much lower than the risk of acquiring LD where of I. scapularis, this delay may be as short as 1 y in south central I. scapularis is the vector. Canada (29). The percentage of infected ticks, therefore, is likely to increase with geographically variable rapidity in the years Geographic variation of LD risk following establishment of I. scapularis tick populations in the A range of landscape, climatic, and environmental factors south central and southeastern parts of Canada. have to converge for the co-existence of hosts, vectors, and transmission cycles of B. burgdorferi within a suitable habitat, Key clinical features of LD in dogs and outside these broad limits significant LD risk cannot occur Clinical signs (28). However, these generalizations can break down on a fine Unlike humans, infection of dogs by B. burgdorferi infrequently geographic scale producing areas of uncharacteristically high or results in clinical disease. Only about 5% of dogs develop clini- low environmental risk for LD. In Canada, the prevalence of cal signs of LD when exposed to B. burgdorferi (30,31); the most B. burgdorferi in I. scapularis ticks varies regionally but is usually common clinical signs in dogs are presented in Table 1. In other greater than 15% (sometimes reaching over 50%). Prevalence animals such as cats, horses, and cattle, serological responses to of infection may be less than 10% in locations where ticks B. burgdorferi have been detected but the spectrum of clinical and bacterium have only recently become established (29). disease is less clearly defined for these species (32–34).

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Diagnostic options only be initiated in dogs displaying clinical signs consistent In dogs, confirmation of clinical LD through laboratory testing with LD, with evidence of exposure to LD risk areas and sup- can be challenging (30,31,35); therefore, it is recommended that port from diagnostic laboratory tests (30) (Table 1). Treatment a LD diagnosis be based on 5 key criteria (Table 1). is also recommended in dogs with subclinical infections that are proteinuric. The standard treatment for LD in dogs is

The most common diagnostic test used to help confirm REPORT SPECIAL infection with B. burgdorferi is detection of specific antibodies antibiotic therapy such as doxycycline for a minimum of 1 mo to B. burgdorferi in serum. The serological assays are highly [10 mg/kg body weight (BW), PO, q24h] (31), although dogs sensitive and specific, although detection of antibodies cannot with presumptive Lyme nephropathy may require longer courses be used to differentiate active infection from previous exposure of treatment (30). In young dogs, amoxicillin at 20 mg/kg BW, to B. burgdorferi (30,31,35). Outcomes of serological testing PO, q8h for 30 d may be used (31). Dogs will usually respond need to be interpreted with care when the patient is from an to treatment within a few days, provided infection is detected area with low risk of exposure to B. burgdorferi-infected ticks, in the acute phase. However, in some cases, signs may return, as false positives are likely to occur in this situation, leading to and further treatment may be required (35,38). overdiagnosis (35,36). One of the most commonly used serological tests is the C6 Preventive measures enzyme-linked immunosorbent assay (ELISA) which detects Since there is great regional variability in LD risk across the IgM and IgG antibodies circulating in the blood, and does not country and within each province, preventive measures should cross-react with antibodies generated in vaccinated animals; be encouraged where appropriate; recommendations for tick C6 antibody responses typically occur 3 to 5 wk following control should take into account the observed timing of infes- experimental infection in dogs (31,35). A quantitative C6 assay tations on pets in your practice area. Depending on the dog’s is also available which measures the amount of antibody to activity and exposure to LD risk areas, pet owners should be the B. burgdorferi C6 peptide circulating in the animal tested; advised of the following preventive measures: declines in C6-specific antibodies following antibiotic treatment i) If possible, avoid high-risk areas during tick season (usually in dogs have been used as evidence of successful treatment in from spring snow melt to late autumn). clinically ill dogs (35,37). Other less-used serological tests ii) Check for ticks daily and promptly remove ticks after being include whole cell ELISA, immunofluorescent antibody assays in high-risk areas. (IFA), and Western blotting. Whole-cell ELISA and IFA can iii) Peridomestic risk of exposure can be lowered by using a give false-positive results, particularly when a dog has another number of landscape management practices (e.g., removal spirochete infection, an inflammatory condition or has previ- of leaf litter, reduction of vegetative cover, and exclusion of ously been vaccinated for LD (31,35,38). Western blot, which is wildlife using fences or other barriers) (39). commonly used in human medicine as a confirmatory test, has iv) Routine use of acaricides (topical and oral anti-tick prod- been used to differentiate natural infection and immunization ucts, collars) when regularly exposed to high-risk areas. response in dogs, but is more time consuming to complete and Some anti-ectoparasite products (e.g., those containing requires expertise to interpret, and therefore is not often used permethrin) are effective and safe for dogs but toxic for for standard diagnostic purposes in pets (31,35,38). cats. The efficacy and safety of available anti-tick products Other diagnostic testing that may or may not aid in clinical vary and should be taken into consideration when choos- LD diagnosis include, but are not limited to, polymerase chain ing an appropriate product for pets. Refer to the specific reaction (PCR), culture, complete blood (cell) count (CBC), safety and efficacy information available for each product biochemistry, and synovial fluid cytology. Multiple irregu- and always follow the instructions for use provided on the larities can be found on CBC and biochemical testing in dogs product label. with Lyme nephropathy. However, other than proteinuria, the v) Routine vaccination when animals are regularly exposed findings are highly variable and non-specific (35). Culture of to high-risk areas (available for dogs only); however, at B. burgdorferi from tissue or blood is the gold standard test for present, the benefits of vaccinating dogs for Lyme disease, confirming B. burgdorferi infection; however, it has low sensitiv- even in endemic areas, are debated (3). Some experts have ity, requires long incubation periods (up to 6 to 8 wk), and is concerns that since Lyme nephropathy has an immune- typically only used in research settings (30,31,35). The sensi- mediated pathogenesis, vaccination may increase the risk tivity and specificity of PCR testing in dogs are poorly defined of generation of immune complexes and thus the risk of and test performance characteristics in different diagnostic Lyme nephropathy in dogs predisposed to this condi- laboratories can vary. Also, PCR does not distinguish between tion (30,40,41). Multiple brands of vaccine to the outer viable and non-viable spirochetes (30,31,35). Contact your local surface proteins of Borrelia burgdorferi (OspA & OspC) animal health laboratory representative for more details on the are available for use in dogs; contact your pharmaceutical test performance characteristics for the different LD diagnostic representatives for specific safety and efficacy information testing options mentioned here. and recommendations. In conclusion, veterinarians are a potentially key source of Treatment recommendations information for the public on the risk of Lyme disease and ticks. According to the consensus statement of the American College Dogs are often more exposed to ticks than are humans, and of Veterinary Internal Medicine (ACVIM), treatment should sero-positive dogs are typically detected sooner and in higher

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­numbers than human LD cases in emerging LD risk areas Lambton, Grey Bruce and Northwestern Health Units in (42). Dogs may therefore be sentinels for early identification Ontario who provided field surveillance data as well as individu- of emerging LD risk areas, allowing prompt implementation als in Canadian universities, medical practitioners, veterinarians, of activities to prevent human infections. Veterinarians can, and the public who submitted ticks. CVJ therefore, play an important public health role in raising LD risk awareness. References Assessing risk in zones of emerging LD and endemic zones is . 1 Little SE, Heise SR, Blagburn BL, Callister SM, Mead PS. Lyme borreli- osis in dogs and humans in the USA. Trends Parasitol 2010;26:213–218. challenging. The combination of active and passive surveillance 2. Ogden NH, Lindsay LR, Morshed M, Sockett PN, Artsob H. The systems has revealed increasing risk of LD in south eastern and emergence of Lyme disease in Canada. Can Med Assoc J 2009;180: south central Canada. However, the risk of infection can vary 1221–1224. 3. Littman MP. Lyme nephritis. J Vet Emerg Crit Car 2013;23:163–173. greatly across these regions. Veterinarians can use this informa- 4. Leighton PA, Koffi JK, Pelcat Y, Lindsay LR, Ogden NH. Predicting RAPPORT SPÉCIAL tion, as well as practice data and travel history, to adequately the speed of tick invasion: An empirical model of range expansion for prevent/manage tick bites and LD cases in dogs. Information the Lyme disease vector Ixodes scapularis in Canada. J Appl Ecol 2012; 49:457–464. on regional, provincial, and federal public health organiza- 5. Koffi JK, Leighton PA, Pelcat Y, et al. Passive surveillance for I. scapularis tion websites (e.g., http://www.phac-aspc.gc.ca/publicat/ccdr- ticks: Enhanced analysis for early detection of emerging Lyme disease rmtc/14vol40/dr-rm40-05/index-eng.php) provides the most risk. J Med Entomol 2012;49:400–409. 6. Ogden NH, Bouchard C, Kurtenbach K, et al. Active and passive up-to-date information on LD risk areas in Canada. surveillance and phylogenetic analysis of Borrelia burgdorferi elucidate the process of Lyme disease risk emergence in Canada. Environ Health Persp 2010;118:909–914. Key points 7. Bouchard C, Beauchamp G, Nguon S, et al. Associations between Ixodes • There is an increasing risk of Lyme disease in Canada scapularis ticks and small mammal hosts in a newly endemic zone in southeastern Canada: Implications for Borrelia burgdorferi transmission. following the expansion of the tick vector I. scapularis in Ticks Tick-Borne Dis 2011;2:183–190. southeastern and south central Canada. 8. Tsao JI. Reviewing molecular adaptations of Lyme borreliosis spirochetes • Lyme disease can affect the health of both humans and in the context of reproductive fitness in natural transmission cycles. Vet Res 2009;40(2)36. doi: 10.1051/vetres/2009019. dogs — it is important that veterinarians be aware of 9. Schwan TG, Piesman J. Vector interactions and molecular adaptations of the risk of Lyme disease for their patients as well as their Lyme disease and relapsing fever spirochetes associated with transmission owners. by ticks. Emerg Infect Dis 2002;8:115–121. 10. Cook MJ. Lyme borreliosis: A review of data on transmission time after • Dogs are more likely to be bitten by ticks but less likely to tick attachment. Int J Gen Med 2015;8:1–8. develop clinical signs of Lyme disease when compared to 11. Ogden NH, Koffi JK, Pelcat Y, Lindsay LR. Environmental risk from humans. Lyme disease in central and eastern Canada: A summary of recent sur- veillance information. Public Health Agency of Canada. CCDR 2014: • Surveillance systems help to identify where the emerging 40–5. and expanding Lyme disease risk areas are. 12. Villeneuve A, Goring J, Marcotte L, Overvelde S. Seroprevalence • The prevalence of B. burgdorferi infection in ticks var- of Borrelia burgdorferi, Anaplasma phagocytophilum, Ehrlichia canis, and Dirofilaria immitis among dogs in Canada. Can Vet J 2011;52: ies across the country, being mostly greater than 15% in 527–530. I. scapularis ticks and less than 10% in I. pacificus ticks. 13. Bouchard C, Beauchamp G, Leighton PA, Lindsay R, Belanger D, • Prevention of Lyme disease is best accomplished through Ogden NH. Does high biodiversity reduce the risk of Lyme disease inva- sion? Parasit Vectors 2013; Jul 1;6:195. doi: 10.1186/1756-3305-6-195. avoidance of ticks; frequent checks for ticks with prompt 14. Scott JD, Lee MK, Fernando K, Jorgensen DR, Durden LA, removal of attached individuals, routine use of tick-bite Morshed MG. Rapid introduction of Lyme disease spirochete, Borrelia prevention products and potentially vaccination. burgdorferi sensu stricto, in Ixodes scapularis (Acari : Ixodidae) established at Turkey Point Provincial Park, Ontario, Canada. J Vector Ecol 2008; • Diagnosis of LD in dogs should be based upon clinical 33:64–69. presentation, history of exposure to ticks and/or LD risk, 15. Ogden NH, Lindsay LR, Hanincova K, et al. Role of migratory birds and diagnostic testing results; treatment should be restricted in introduction and range expansion of Ixodes scapularis ticks and of Borrelia burgdorferi and Anaplasma phagocytophilum in Canada. Appl to animals that present both clinical manifestations and Environ Microb 2008;74:1780–1790. diagnostic test results consistent with LD. 16. Lindsay LR, Mathison SW, Barker IK, McEwen SA, Gillespie TJ, Surgeoner GA. Microclimate and habitat in relation to Ixodes scapularis (Acari : Ixodidae) populations on Long Point, Ontario, Canada. J Med Acknowledgments Entomol 1999;36:255–262. 17. Ogden NH, Radojevic M, Wu XT, Duvvuri VR, Leighton PA, Wu JH. We thank our colleagues in provincial organizations who par- Estimated effects of projected climate change on the basic reproductive ticipated in the field and passive tick surveillance system (BC number of the Lyme disease vector Ixodes scapularis. Environ Health CDC, Alberta Health, Saskatchewan Health, Manitoba Health, Perspect 2014;122:631–638. 18. Lindsay LR, Mathison SW, Barker IK, McEwen SA, Surgeoner GA. Ontario Agency for Health Promotion and Protection, Institut Abundance of Ixodes scapularis (Acari : Ixodidae) larvae and nymphs national de santé publique du Québec and Laboratoire de santé in relation to host density and habitat on Long Point, Ontario. J Med publique du Québec, Université de Montréal, New Brunswick Entomol 1999;36:243–254. 19. Ogden NH, Barker IK, Beauchamp G, et al. Investigation of ground Agriculture, Aquaculture and Fisheries and New Brunswick level and remote-sensed data for habitat classification and prediction of Health, Nova Scotia Health and Wellness and Department of survival of Ixodes scapularis in habitats of southeastern Canada. J Med Natural Resources, Newfoundland & Labrador Department of Entomol 2006;43:403–414. 20. Rogic A, Tessier N, Legendre P, Lapointe FJ, Millien V. Genetic struc- Natural Resources), the Hastings & Prince Edward Counties, ture of the white-footed mouse in the context of the emergence of Lyme Chatham-Kent, Region of Peel, Niagara Region, County of disease in southern Quebec. Ecol Evol 2013;3:2075–2088.

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21. Bouchard C, Leighton PA, Beauchamp G, et al. Harvested white-tailed 33. Tuomi J, Rantamäki LK, Tanskanen R. Experimental infection of deer as sentinel hosts for early establishing Ixodes scapularis populations cattle with several Borrelia burgdorferi sensu lato strains; immunological and risk from vector-borne zoonoses in Southeastern Canada. J Med heterogeneity of strains as revealed in serological tests. Vet Microbiol Entomol 2013;50:384–393. 1998;60:27–43. 22. Werden L, Barker IK, Bowman J, et al. Geography, deer, and host bio- 34. Shaw SE, Day MJ, Birtles RJ, Breitschwerdt EB. Tick-borne infectious diversity shape the pattern of Lyme disease emergence in the thousand diseases of dogs. Trends Parasitol 2001;17:74–80.

islands archipelago of Ontario, Canada. Plos One 2014;9:e85640. doi: 35. Sykes JE. Lyme borreliosis. In: Sykes JE, ed. Canine and Feline REPORT SPECIAL 10.1371/journal.pone.0085640 Infectious Diseases. St. Louis, Missouri: Elsevier Saunders, 2014: 23. Ogden NH, Tsao JI. Biodiversity and Lyme disease: Dilution or ampli- 487–497. fication? Epidemics-Neth 2009;1:196–206. 36. Peregrine AS, Barker IK, Abrams-Ogg AC, Woods JP. Screening dogs in 24. Lee X, Coyle DR, Johnson DK, et al. Prevalence of Borrelia burgdorferi Ontario for Borrelia burgdorferi and Ehrlichia canis should be selective and Anaplasma phagocytophilum in Ixodes scapularis (Acari: Ixodidae) rather than routine. Can Vet J 2007;48:673. nymphs collected in managed red pine forests in Wisconsin. J Med 37. Levy SA, O’Connor TP, Hanscom JL, Shields P, Lorentzen L, Entomol 2014;51:694–701. Dimarco AA. Quantitative measurement of C6 antibody following 25. Laboratory Centre for Disease Control. Consensus conference on Lyme antibiotic treatment of Borrelia burgdorferi antibody-positive nonclinical disease, Health Canada, Guelph, Ontario, January 15–16, 1991. dogs. Clin Vaccine Immunol 2008;15:115–119. 26. Rochon K, Scoles GA, Lysyk TJ. Dispersion and sampling of adult 38. Krupka I, Straubinger RK. Lyme borreliosis in dogs and cats: Dermacentor andersoni in rangeland in Western North America. J Med Background, diagnosis, treatment and prevention of infections with Entomol 2012;49:253–261. Borrelia burgdorferi sensu stricto. Vet Clin North Am Small Anim Pract 27. Mak S, Morshed M, Henry B. Ecological niche modeling of Lyme 2010;40:1103–1119. disease in British Columbia, Canada. J Med Entomol 2010;47:99–105. 39. Piesman J. Strategies for reducing the risk of Lyme borreliosis in North 28. Reisen WK. Landscape epidemiology of vector-borne diseases. Annu America. Int J Med Microbiol 2006;296 Suppl 40:17–22. Rev Entomol 2010;55:461–483. 40. Levy SA, Lissman BA, Ficke CM. Performance of a Borrelia burgdor- 29. Ogden NH, Lindsay LR, Leighton PA. Predicting the rate of invasion feri bacterin in borreliosis-endemic areas. J Am Vet Med Assoc 1993; of the agent of Lyme disease Borrelia burgdorferi. J Appl Ecol 2013; 202:1834–1838. 50:510–518. 41. Klingborg DJ, Hustead DR, Curry-Galvin EA, et al. AVMA Council on 30. Littman MP, Goldstein RE, Labato MA, Lappin MR, Moore GE. biologic and therapeutic agents’ report on cat and dog vaccines. J Am ACVIM small animal consensus statement on Lyme disease in dogs: Vet Med Assoc 2002;221:1401–1407. Diagnosis, treatment, and prevention. J Vet Intern Med 2006;20: 42. Mead P, Goel R, Kugeler K. Canine serology as adjunct to human Lyme 422–434. disease surveillance. Emerg Infect Dis 2011;17:1710–1712. 31. Greene C, Straubinger RK, Levy SA. Infectious Diseases of the Dog and Cat. 4th ed. St. Louis, Missouri: Elsevier Saunders, 2012. 32. Butler CM, Houwers DJ, Jongejan F, van der Kolk JH. Borrelia burg- dorferi infections with special reference to horses. A review. Vet Quart 2005;27:147–156.

CVJ / VOL 56 / JULY 2015 699 FOR PERSONAL USE ONLY Commentary Commentaire

Modest cost of veterinary services and goods to farmers in Canada

Canadian Animal Health Institute

anadians enjoy the third lowest food cost after the USA Table 1. Breakdown of Statistics Canada farm operating expenses C and the UK. We spend 10% of the family budget on food for 2006 and 2011 at home, compared with 7% for the USA and 9% for the UK. 2006 2011 China in comparison spends 21%, while Russians spend 31% Category Census Census (1). The cost of veterinary services, (including medicines) in Purchases of herbicides, insecticides, fungicides, etc. 4.81 5.08 Canada’s food animal sector is relatively small but crucial to Total feed, supplements, and hay purchases 13.82 14.15 the supply of safe and wholesome food for both the Canadian Livestock and poultry purchases 14.07 11.76 and export markets. Veterinary services, drugs, semen, breeding fees, etc. 1.85 1.63 In the past 2 census periods, Statistics Canada has provided All fuel expenses (diesel, gasoline, oil, wood, natural 6.89 6.07 data on the cost of veterinary services as part of livestock farm gas, propane) operating expenses. Statistics Canada (2) defines the category Electricity, telephone and all other telecommunication “veterinary services” to include services, drugs, semen, breeding services 2.63 2.48 fees, etc. Comparing veterinary services with the other major Other 55.93 58.83 cost categories for food animal producing farms (Table 1), the cost of veterinary services was only 1.85% of the total farm busi- Table 2. Statistics Canada 2006 and 2011 data by province on ness operating expenses in 2006. In 2011, these costs dropped cost of veterinary goods and services as a percentage of total farm to 1.63% of the total operating expenses. operating expenses Veterinary services contribute the least to farm business % of total farm % of total farm expenses. Livestock and poultry purchases at 14.07% of total Veterinary services, drugs, operating expenses operating expenses costs and total feed, supplements, and hay purchase impact total semen, breeding fees, etc. for 2006 for 2011 costs more dramatically. Even fuel at 6.89% of the total farm British Columbia 1.47 1.38 business cost has over 3 times the impact on costs that veteri- Alberta 1.67 1.48 Saskatchewan 1.16 0.87 nary services and goods have. Of interest, the cost of fuel in the Manitoba 1.77 1.39 USA in 2011 was 4.8% of total farm production expenditures, Ontario 2.04 1.82 compared with 6.07% in Canada. Quebec 2.71 2.66 New Brunswick 1.43 1.40 Veterinary expenses were lower in 2011 than in 2006 in all Nova Scotia 1.80 1.74 provinces except Newfoundland (Table 2). Highest veterinary Prince Edward Island 1.37 1.30 expenses by percentage for both census periods were in Quebec Newfoundland and Labrador 1.01 1.38 and Ontario at 2.71 and 2.04, respectively. The lowest percent- age of costs was in Newfoundland where services are subsidized by the provincial government. References 1. Thompson D. Cheap Eats: How America Spends Money on Food. The Atlantic, March 8, 2013. Available from: http://www.theatlantic.com/ business/archive/2013/03/cheap-eats-how-america-spends-money-on- food/273811/ Last accessed May 5, 2015. 2. Statistics Canada. Available from: http://www5.statcan.gc.ca/cansim/ a26?lang=eng&retrLang=eng&id=0020044&paSer=&pattern=&stByV al=1&p1=1&p2=-1&tabMode=dataTable&csid Last accessed May 5, 2015.

Canadian Animal Health Institute, 160 Research Lane, Suite 102, Guelph, Ontario N1G 5B2. Address all correspondence to Lise Rodgers; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

700 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Article

Demographics of the Canadian dairy industry from 1991 to 2011

Murray D. Jelinski, Stephen LeBlanc, Richard Kennedy

Abstract — A retrospective study of the demographics of the Canadian dairy industry was conducted using data derived from Statistics Canada’s Census of Agriculture from 1991 to 2011. This longitudinal study shows that Canada’s dairy industry has undergone considerable consolidation. From 1991 to 2011, the number of dairy producers and dairy farms decreased by 48.9% and 61.9%, respectively. Furthermore, this trend in consolidation is likely to continue; nearly half (45.8%) of all dairy producers in Canada were $ 50 y of age in 2011. Not only will most of these producers be retired by 2021, but younger producers will also exit the industry for other reasons. These findings mirror what is occurring in Canada’s cow-calf industry, underscoring that supply-managed sectors experience demographic consolidation similar to non-supply managed sectors. These substantial changes will have ramifications for the veterinary profession. There will be fewer but larger farms, and the services and knowledge demanded of veterinarians will change accordingly, which has implications for food animal veterinary education.

Résumé — Démographie de l’industrie laitière canadienne de 1991 à 2011. Une étude rétrospective de la démographie de l’industrie laitière canadienne a été réalisée à l’aide de données dérivées de statistiques provenant du Recensement de l’agriculture de 1991 à 2011 de Statistique Canada. Cette étude longitudinale montre que l’industrie laitière du Canada a subi une consolidation considérable. De 1991 à 2011, le nombre de producteurs laitiers et de fermes laitières a chuté de 48,9 % et de 61,9 %, respectivement. De plus, cette tendance à la consolidation se poursuivra probablement; près de la moitié (45,8 %) des producteurs laitiers du Canada étaient âgés de $ 50 ans en 2011. La majorité de ces producteurs prendra non seulement sa retraite d’ici 2021, mais les jeunes producteurs quitteront aussi l’industrie pour d’autres raisons. Ces résultats reflètent ce qui se passe dans l’industrie d’élevage-naissage et soulignent le fait que les secteurs à offre réglementée vivent une consolidation démographique semblable à celle des secteurs qui ne sont pas à offre réglementée. Ces changements importants auront des répercussions pour la profession vétérinaire. Il y aura moins de fermes mais elles seront plus grandes et les services et les connaissances demandées évolueront considérablement, ce qui aura des conséquences pour l’enseignement de la médecine vétérinaire des animaux destinés à l’alimentation. (Traduit par Isabelle Vallières) Can Vet J 2015;56:701–708

Introduction census in 1666 (1), and 1871 marked the first year in which a census would be undertaken every 10 y (2). The first Census of survey involves sampling from a target population and Agriculture was conducted in 1896 and in 1956 Canada began then using the data to make inferences about the larger A administering a national Census of Agriculture every 5 y. Since population, whereas a census involves contacting every per- 1971, the Census of Agriculture and Census of Population have son within the target population. Canada conducted its first been conducted and linked, resulting in the creation of the Census of Agriculture-Population database. This hybrid database Department of Large Animal Clinical Sciences, Western College provides detailed information relating to the socio-economic of Veterinary Medicine, University of Saskatchewan S7N 5B4 characteristics of Canada’s farming population. (Jelinski); Department of Population Medicine, University The most recent census, completed in 2011, confirms that of Guelph, Guelph, Ontario N1G 2W1 (LeBlanc); Box 787, Canada’s agricultural sector is continuing a long-term trend Queen Charlotte, British Columbia V0T 1S0 (Kennedy). towards consolidation, that is, fewer producers, fewer farms, Address all correspondence to Dr. Murray Jelinski; e-mail: but larger operations. In fact, the number of Canadian farming [email protected] operations has been in a steady decline since 1946 (3). More Reprints are not available from the authors. recently, the number of farms has decreased by 10% in each of Use of this article is limited to a single copy for personal study. the last 3 census periods (3–5). Furthermore, the age structure Anyone interested in obtaining reprints should contact the of Canada’s livestock producers is such that the rate of consoli- CVMA office ([email protected]) for additional dation is poised to increase over the next 2 to 3 census periods; copies or permission to use this material elsewhere. nearly half of Canada’s farm producers were $ 55 y of age at

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the time of the last census (5). This workforce structure appears Table 1. Age distribution (%) of Canadian dairy farm operators in 2011 to apply particularly to farming; only a third of Canadians who were self-employed and working in a non-agricultural position Region were $ 55 y of age in 2011 (6). Age range Western Atlantic The retirement of nearly half of Canada’s producers is an (years) Canada Canada Ontario Quebec Canada event that has been foreshadowed since the 1960s. Following , 31 5.8 6.7 9.3 9.6 8.6 World War II, Canada, and most other industrialized nations, 31 to 40 13.3 13.4 15.5 17.3 15.7 experienced a sudden increase in the national birthrate. This 41 to 50 25.5 29.6 29.2 32.6 29.9 51 to 60 30.2 29.2 28.1 27.2 28.2 surge lasted for approximately 20 y (1946–1965) and created . 60 25.2 21.1 17.9 13.3 17.6 a ARTICLE what is colloquially known as the “Baby Boom” generation (7). Ratio 4.3 3.2 1.9 1.4 2.0 As of 2011, 30% of Canadians were baby boomers (46 to Total (n) 6065 1420 10 810 12 610 30 905 65 y of age), representing 42.2% of the working-age population a The ratio compares the proportion of producers . 60 y to those , 31 y of age. (15 to 64 y of age) (8). Over the next 2 decades, Canada will experience a major exodus of people from its workforce (9). As tors/farm (1 and $ 2); the operators’ age ranges (, 26 y, 26 to a result, Canadians can expect to see a slowing in the growth 30 y, 31 to 35 y, 36 to 40 y, 41 to 45 y, 46 to 50 y, 51 to 55 y, of its labor force until 2026, by which time the tail-end of the 56 to 60 y and . 60 y); and herd size (, 51, 51 to 100, 101 baby boom generation will have retired. to 200, 201 to 300, 301 to 500, and . 500 dairy cows and Consolidation in agriculture has implications for food animal replacement heifers . 1-year old). All the data underwent a veterinary medicine with respect to the supply and demand for “random rounding” procedure wherein StatsCan rounded the veterinarians, and the delivery of veterinary services. For much numbers in each sub-table to multiples of 5 to ensure that the of the latter half of the 20th century the veterinary profession data could not be associated with a particular farm. was concerned with a shortage of food animal practitioners In addition to the customized data, StatsCan’s online data- (10–14). More recently, reports from the United States sug- bases provided information on the number of dairy cows, dairy gest that the pendulum has swung towards an oversupply of operations, and the average number of dairy cows/farm for the food animal veterinarians (15–17). One of the factors cited for census years 1981 to 2011, inclusive (21). The accounting of this oversupply is consolidation within the livestock sectors. dairy heifers changed across census periods; therefore, only dairy Although larger operations are more likely to use veterinarians cow numbers (not heifers) were reported for these 3 datasets. for herd-level procedures such as pregnancy checking and bull In 1976, StatsCan estimated the number of “Beef cows” by breeding soundness examinations (18,19), the amount of vet- subtracting “Cows milking or to be milked” from “Total cows.” erinary contact time per animal decreases as herd size increases As a result, dairy herd size was understated because dairy farm- (19). This trend towards fewer veterinarians overseeing larger ers did not always classify dry dairy cows as “Cows milking or operations is evident within Canada’s poultry, swine, and feedlot to be milked;” this was corrected in future surveys. However, sectors. response errors in 1996 may have led to a slight overestimate of This report is a companion paper to a previously published the number of dairy cows and dairy farms, particularly in the study in which the demographics of the Canadian cow-calf sec- provinces having a low proportion of dairy operations. tor were described (20). The purpose of this study is to describe how the demographics of the Canadian dairy industry have Results changed over the last 20 y (1991 to 2011), with emphasis on The Canadian dairy industry has been consolidating for the changes in the age and number of dairy producers, number of last 5 census periods. Canada had 60 495 dairy producers in dairy operations, and herd size. 1991; 54 715 in 1996; 41 820 in 2001; 35 075 in 2006; and 30 870 in 2011. From 1991 to 2011, the number of producers Materials and methods decreased by nearly half (48.9%) and by 12% during the latest All data were derived from Statistics Canada’s (StatsCan) data- intercensal period (2006 to 2011). bases, which had been compiled from the last 5 Census of Table 1 is a cross-tabulation of the 2011 population of pro- Agriculture periods: 1991, 1996, 2001, 2006, and 2011. The ducers by geographical location and age range. Quebec had the customized data were cross-tabulated by 4 geographical regions greatest percentage of Canada’s producers (40.8%), followed (Quebec, Ontario, western Canada, and Atlantic Canada). by Ontario (35.0%), western Canada (19.6%), and Atlantic Western Canadian data were provided at the provincial and cen- Canada (4.6%). Nearly half (45.8%) of all dairy producers in sus agricultural region (CAR) level for the provinces of British Canada were $ 51 y of age; however, the producers’ age struc- Columbia, Alberta, Saskatchewan, and Manitoba. All other ture varied by region. Western Canada had the highest percent- data were provided at the provincial (Ontario and Quebec) and age of producers $ 51 y of age (55.4%), while Quebec had the regional levels (4 Atlantic provinces combined). The national lowest (40.5%). Included in Table 1 is the ratio of producers data were derived from the provincial and regional data. . 60 y of age to those , 31 y of age. Nationally there were StatsCan defined farm operators as persons responsible for 2 producers . 60 y old for every 1 producer , 31 y of age; in the day-to-day management decisions relating to the operation western Canada this ratio was 4.3:1. of the farm, with up to 3 operators per farm. These data were The time-series (Figure 1) shows how the age structure of stratified by operator gender (female/male); number of opera- Canada’s dairy industry has changed over the 5 census periods. At

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Age of producers , 31 years 31 to 40 years 41 to 50 years 51 to 60 years . 60 years ARTICLE Producers within each age category (%) Producers

Census year

Figure 1. Age distribution (%) of Canadian dairy producers for the census years 1991 to 2011. The number at the top of each bar is the ratio of older producers (. 60 years of age) to younger producers (, 31 years of age).

. 60

56 to 60

51 to 55

46 to 50

41 to 45

36 to 40

31 to 35

26 to 30

, 26

Figure 2. Population pyramids representing all Canadian dairy producers for the census years 1991 (blue) and 2011(green). Female producers are represented in the left panel, males in the right, and the middle y-axis is the age ranges for producers.

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Region Canada Quebec Ontario Western Canada Atlantic Canada ARTICLE Number of dairy cows by region

Census year

Figure 3. Number of dairy cows (excluding replacement heifers) by region and census year. Shaded area represents extrapolated data for the census years 2016 and 2021. All data were extracted from Statistics Canada’s online databases.

Region Canada Quebec Ontario Western Canada Atlantic Canada Number of dairy operations by region

Census year

Figure 4. Number of dairy operations by region and census year. Shaded area represents extrapolated data for the census years 2016 and 2021. All data were extracted from Statistics Canada’s online databases.

nearly every successive period the proportion of dairy producers population is a typical population pyramid characterized by a large in the 2 youngest age ranges has declined, while the proportion base of younger producers and an increasingly smaller number of producers in the 2 oldest age ranges increased. These trends of producers at each successive age bracket. In contrast, the 2011 are also captured in the ratio of old (. 60 y) to young (, 31 y) population forms an inverted pyramid comprised of a narrow producers. base of young producers and a large cohort of older producers. The overlapping population pyramids in Figure 2 show how The population pyramids provide a graphical representa- the age structure of the dairy industry changed from 1991 to tion of how the age structure of Canada’s dairy producers has 2011; all the age ranges are in 5-year increments, except for changed over the last 20 y, and also provide insight into when the very youngest and oldest ranges. Not only was there half as producers leave the industry. Presumably many of the produc- many producers in 2011 compared to 1991, but the population ers . 45 y of age in 1991 exited the industry by 2011 because ­structure changed dramatically for these 2 periods. The 1991 they had reached retirement age. However, producers appear to

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Region Canada Quebec Ontario Western Canada Atlantic Canada ARTICLE Average number of dairy cows per farm Average

Census year

Figure 5. Average number of dairy cows (excluding heifers) per herd by region and census year. All data were extracted from Statistics Canada’s online databases.

Herd size , 51 51 to 100 101 to 200 201 to 300 301 to 500 . 500 Number of dairy producers

Census year

Figure 6. Number of dairy producers in Canada by herd size (dairy cows and replacement heifers) and census year.

leave the industry for reasons other than retirement. In 1991, between 2006 and 2011, which is the smallest reduction in there were 15 615 dairy producers in the 26- to 35-year age herd size since 1976. Figure 3 also includes an extrapolation of cohort, but by 2011 this same cohort, now 46 to 55 y of age, the number of dairy cows to 2021, which is based on a con- had decreased by 31.6% to 10 685 producers. tinued steady decline of 3.4% per 5-year census period. This Figure 3 was derived from StatsCan’s online databases and, extrapolation suggests that Canada should have 930 000 and unlike the customized data, it only includes dairy cows, not 898 000 dairy cows by 2016 and 2021, respectively. replacement heifers. Generally, the number of dairy cows The decline in dairy farm numbers has exceeded that of the has been in a steady decline in every geographical location in dairy producers and cows (Figure 4). The number of farms Canada since 1976. The number of dairy cows decreased by reporting dairy animals decreased by 61.9% between 1991 26.9% between 1991 (n = 1 315 178) and 2011 (n = 961 700). (n = 39 077) and 2011 (n = 14 883). Although the decline in More recently, the Canadian dairy herd declined by 3.4% dairy operations appears to be slowing, there were 15% fewer

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Age of producers , 31 years 31 to 40 years 41 to 50 years 51 to 60 years . 60 years ARTICLE Number of dairy producers

Herd size

Figure 7. Number of dairy producers in Canada stratified by producers’ age and herd size (dairy cows and replacement heifers), as reported for the 2011 census.

dairies in 2011 compared to 2006. Based on continued consoli- fewer younger operators, fewer farming operations, and larger dation of 15% per 5-year period, the Canadian dairy industry operations. Furthermore, these trends show no signs of reversing can expect to have 12 650 and 10 750 dairies in 2016 and (22). Not surprisingly, a similar scenario has occurred within 2021, respectively. Canada’s dairy industry. For the period 1991 to 2011, there was Figure 5 shows how Canada’s average herd size (number of a substantial reduction in the number of dairy cattle (26.9%), dairy cows/herd) changed between 1976 and 2011. Prior to dairy producers (48.9%), and dairy farms (61.9%). Although 1996, dairy farms in Quebec and Ontario were larger than the the dairy industry has already undergone a considerable amount Canadian average, while western Canada had the smallest herds. of consolidation over the last 2 decades, this process continues. Since then, average herd size in western Canada has increased Nearly half of all producers were . 50 y of age in 2011, and by 242% (37 to 89 head), while average herd size in Ontario for every 1 producer , 31 y there were 2 . 60 y of age. If dairy and Quebec increased by 63% (38 to 62 head) and 37% (41 to producers are typical of the Canadian population, then most will 56 head), respectively. In 2011, the average dairy in Canada had retire from the workforce between the ages of 60 and 65. If this 65 dairy cows, excluding replacement heifers. assumption is correct, then nearly half of the dairy producers Unlike the previous figures that were based on the number identified in the 2011 census will no longer be farming by 2021. of dairy cows/herd, Figure 6 was generated from the custom- Although it took 20 y (1991 to 2011) for the number of ized analyses and hence herd size includes both dairy cows and producers in dairy industry to decrease by half, it is conceiv- replacement heifers . 1 y of age. From 1991 to 2011, the num- able that this number will decrease by half in the next 10 y ber of producers with dairies of , 51 head and 51 to 100 head (2021), thereby doubling the attrition rate of the previous 20 y. decreased by 64.8% and 52%, respectively. In contrast, there Furthermore, this pace of consolidation will probably continue was an increase in the number of producers with herds of 101 to until 2026, which is when the last of the baby boomers will 200 head (8.7%); 201 to 300 head (120.6%); 301to 500 head be in a position to retire. This trend can only be reversed by a (250.0%); and . 500 head (1000%; increased from 35 to massive influx of new dairy producers, which is highly unlikely. 385 producers). New automated technologies that assist management of dairy Figure 7 provides the breakdown of dairy producers by herds (e.g., robotic milking systems, activity monitors for estrus age range and herd size for the 2011 census year. Generally, detection, and in-line milk analyzers), will allow for more producers were evenly distributed by age across the vary- cows to be managed by fewer people. Furthermore, these same ing herd sizes. The notable exception was the smallest herds labor-saving tools may also displace the demand for traditional (, 51 head), which had the highest proportion (23.8%) of pro- veterinary services such as pregnancy diagnosis. ducers . 60 y old compared with 15% for the other herd sizes. Notwithstanding the demographics of the industry, dairy producers are relatively young compared to Canada’s beef cow- Discussion calf producers. A recent study found that at the time of the last Canada’s agricultural sector has undergone significant con- census (2011) 61.9% of Canadian beef producers were . 50 y solidation over the last 2 decades, leading to fewer operators, of age (20); this compares to 45.8% for dairy producers. Why

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the beef sector has a greater percentage of older producers com- progressive transfer tax to help maintain the price of quota at a pared to the dairy sector may be related to how these 2 sectors level that ostensibly all producers, large and small, could afford are managed. It has been hypothesized that supply management (29). This policy, however, met with limited success and eventu- of Canada’s dairy, poultry, and egg industries results in greater ally gave way to quota being capped at a price of $25 000/kg income stability, making these sectors more attractive to younger of butter fat/day. This cap has since been adopted by the producers (22). While this may partially account for the current 5 provinces that form the “All Milk Pool,” otherwise known as

differences in the age structure of the dairy and cow-calf indus- the “P5.” Member provinces of the P5 include Ontario, Quebec, ARTICLE tries, supply management alone may be unable to attract and New Brunswick, Nova Scotia, and Prince Edward Island. It is retain future dairy producers. A recent StatsCan study examined equivocal, however, as to whether the price cap has helped or 7 sectors of agriculture and found that the hog and dairy sec- hindered the industry. A recent econometric study of Ontario’s tors had the greatest proportional loss of producers , 40 y of dairy quota system found that producers with large-scale effi- age for the period 1991 to 2011 (22). This is salient because it ciency were more likely to buy quota; older producers were less confirms our finding that the loss of producers over the last 20 y likely to purchase quota; and those who had purchased quota is not solely related to producers leaving the industry due to old in the previous year were also more likely to purchase additional age. Rather, other socio-economic factors must be involved in quota in the current year (30). These findings indicate that the decision to sell the farm and exit the industry. High capital even within the constraints of supply management there is a costs and a limited supply of milk production quota represent drive towards increasing herd size. While the price cap may barriers to farm growth and entry into the dairy industry by new be slowing the rate of consolidation, it does not appear to be farmers and for business succession transfer at fair market values. arresting it. The pros and cons of supply management, particularly with The price of quota may also explain, in part, why the average respect to who benefits from this system, producers or consum- herd size in western Canada is increasing much more rapidly ers, is a topic of debate (23–27). Briefly, there are 3 pillars to than in Quebec and Ontario. The western provinces are not part Canada’s dairy supply management system: a quota system to of the P5 and hence there is no cap on the price of quota. As a control domestic milk production; the restriction of foreign result, the price of quota reflects supply and demand, which var- competition by limiting the import of dairy products; and the ies by province: British Columbia, $43 000; Alberta, $38 700; existence of provincial and national marketing boards that set Saskatchewan, $34 000; and Manitoba $26 550 (31). We specu- the price of milk paid to the producers (23). Opponents argue late that larger operations have a lower cost of production and that supply management creates a cartel that drives up the price hence have greater financial means to purchase quota, which of milk for consumers and limits Canada’s ability to export milk drives both the price of quota and consolidation. A free market to other countries. Supporters counter that supply management allows for quota prices to rise until it is either too expensive or ensures price stability for producers, resulting in an economi- enough sellers have been motivated to sell, leading to a reduc- cally viable industry that provides Canadians with a dependable tion in demand. Conversely, capping the price on quota removes supply of milk. price discovery from the market, which in turn constrains the Supply management ensures that the milk price paid to normal forces of supply and demand. This is particularly evi- Canadian dairy producers covers the full costs of production, dent in Ontario, Quebec, and the Atlantic provinces where the which ostensibly provides stability in the industry. Ideally, amount of quota offered for sale (supply) is only 2% to 10% of this stability should result in an industry comprised of small, what is being demanded (32). medium, and large producers. The data, however, show that The dairy industry forms an integral part of food animal there were 61.9% fewer dairies in 2011 than in 1991, and that veterinary practice, particularly in the provinces of Ontario there has been a disproportionately high loss in the number and Quebec. Therefore, ongoing consolidation in the dairy of smaller dairies (# 100 head). This loss in smaller dairies industry, driven by demographics and economics, will have has been offset by a steady increase in the number of larger a direct impact on food animal veterinary practice. Increased operations, which is reflected in the trend of increasing average consolidation means fewer but larger farms, which leads to a herd size. reduction in the number of veterinarians required to service this Canada’s decline in dairy farms closely mirrors what has industry. Not only will continued consolidation have an impact transpired in the United States. Whereas the number of dairies on the supply and demand for veterinarians and veterinary ser- in Canada decreased by 61.8% between 1991 and 2011, the vices, but it will also change what services are demanded. Data US experienced a similar decline of 58.4% between 1991 and from the beef sector show that increasing herd size is associated 2007 (28). As for the situation in Canada, the greatest loss with an increased uptake in herd level services (19). A similar in American dairies came at the expense of the smaller herds scenario will occur within the dairy industry, which will require (, 50 head). This underscores the premise that consolidation veterinary practitioners to evolve along with the industry. This appears inevitable, with or without supply management, and also has implications for veterinary teaching institutions, which that the main reason for the disproportionate loss in smaller need to adjust dairy curricula to meet the future demands of dairies is the drive by producers to capture economies of scale. the industry. We urge collaborative research among veterinar- One of the initial unintended consequences of controlling ians and economists, among others, to measure and project the milk production was an escalation in the price of milk quota. market requirements and opportunities for veterinarians in the In response, the Dairy Farmers of Ontario (DFO) instituted a Canadian dairy industry. CVJ

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References 17. Dall TM, Forte GJ, Storm MV, et al. Executive summary of the 2013 US Veterinary Workforce Study. J Am Vet Med Assoc 2013;242: 1. Statistics Canada. Canada’s first statistician. Available from: http://www. 1507–1514. statcan.gc.ca/about-apercu/history-historique/statistician-statisticien- 18. United States Department of Agriculture. Animal and Plant Health eng.html Last accessed May 22, 2015. Inspection Agency, Animal Health, NAHMS Beef Cow-Calf Studies, 2. Statistics Canada. About the Census of Agriculture — History. Available Beef 2007–08 Part II: Reference of Beef Cow-calf Management Practices from: http://www.statcan.gc.ca/ca-ra2006/about-apropos/history-histo in the United States, 2007–08. Available from: http://www.aphis. rique-eng.htm Last accessed May 22, 2015. usda.gov/animal_health/nahms/beefcowcalf/downloads/beef0708/ 3. Statistics Canada. The Daily, May 10, 2012, 2011 Census of Agricul­ Beef0708_dr_PartII.pdf Last accessed May 22, 2015. ture. Available from: http://www.statcan.gc.ca/daily-quotidien/120510/ 19. Waldner C, Jelinski MD, McIntyre-Zimmer. Survey of western dq120510a-eng.htm Last accessed May 22, 2015. Canadian beef producers regarding calf-hood diseases, management 4. Statistics Canada. The Daily, May 15, 2002, 2001 Census of Agriculture practices, and veterinary service usage. Can Vet J 2013;54:559–564.

ARTICLE — Canadian farm operations in the 21st century. Available from: http:// 20. Jelinski MD, Campbell J, Hendrick S, Waldner C. Survey of www.statcan.gc.ca/daily-quotidien/020515/tdq020515-eng.htm Last Saskatchewan beef cattle producers regarding management practices accessed May 22, 2015. and veterinary service usage. Can Vet J 2015;56:66–72. 5. Statistics Canada. 2006 Census of Agriculture, Farm data and farm 21. Statistics Canada. Census of Agriculture, selected livestock and poultry operator data. Available from: http://www.statcan.gc.ca/pub/95-629- data, Canada and provinces every 5 years, Table 004-0004. Available x/95-629-x2007000-eng.htm Last accessed May 22, 2015. from: http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng 6. Statistics Canada. Snapshot of Canadian Agriculture, Chapter 2. &id=0040004&tabMode=dataTable&srchLan=-1&p1=-1&p2=9 Last Available from: http://www.statcan.gc.ca/pub/95-640-x/2011001/p1/ accessed May 22, 2015. p1-02-eng.htm Last accessed May 22, 2015. 22. Beaulieu MS. Agriculture Division, Statistics Canada. Analytical Paper, 7. Statistics Canada. Generations in Canada. Available from: http:// Canadian Agriculture at a Glance, Demographic Changes in Canadian www12.statcan.ca/census-recensement/2011/as-sa/98-311-x/98-311- Agriculture. Catalogue no 96-325x-No.001. Available from: http:// x2011003_2-eng.cfm Last accessed May 22, 2015. www.statcan.gc.ca/pub/96-325-x/2014001/article/11905-eng.pdf Last 8. Statistics Canada. The Daily 2011 May 29, 2012, Census: Age and accessed May 22, 2015. sex. Available from: http://www.statcan.gc.ca/daily-quotidien/120529/ 23. Canadian Dairy Information Centre. Canada’s Dairy Industry at a dq120529a-eng.htm Last accessed May 22, 2015. Glance. Available from: http://www.dairyinfo.gc.ca/index_e.php?s1=cdi- 9. Statistics Canada. The Daily August 17, 2011, Study: Projected trends ilc&s2=aag-ail Last accessed May 22, 2015. to 2031 for the Canadian labour force. Available from: http://www. 24. Canadian Dairy Information Centre. Dairy Farming in Canada. http:// statcan.gc.ca/daily-quotidien/110817/dq110817b-eng.htm Last accessed www.dairyinfo.gc.ca/index_e.php?s1=dff-fcil&s2=farm-ferme&s3=nb May 22, 2015. Last accessed May 22, 2015. 10. Kingrey BW. Prospects in large animal practice. Can Vet J 1965;6: 25. Tamilia RD, Charlebois S. The importance of marketing boards in 215–219. Canada: A twenty-first century perspective. Br Food J 2007;109:119–144. 11. Carswell BL. The future of large animal practice: A veterinarian’s point 26. Royer A. The emergence of agricultural marketing boards revisited: of view. Can Vet J 1989;30:283. A case study in Canada. Can J Agric Econ 2008;56:509–522. 12. Bailey J, Hagele WC, Leung D, Lofstedt J, Radostits OM, Sandals D. 27. Lippert O. The Perfect Food in the Perfect Mess: The Cost of Milk in CVMA Task Force on “education, licensing, and the expanding scope Canada, The Fraser Institute, Vancouver, 2001. of veterinary practice.” Can Vet J 2002;43:845–854. 28. USDA NAHMS Dairy 2007, Part II: Changes in the U.S. dairy cattle 13. Radostits OM. Food Animal Veterinarians: An Endangered Species? Are industry, 1991–2007. Available from: http://www.aphis.usda.gov/ Too Few Veterinary Graduates Choosing Food Animal Practice? What animal_health/nahms/dairy/downloads/dairy07/Dairy07_dr_PartII. is the Problem? College of Veterinary Medicine Continuing Education, pdf Last accessed May 22, 2015. Kansas State University, Manhattan, Kansas. October 25 & 26, 2002. 29. Cairns A, Meilke K. Price ceilings on milk production quota values: 14. Andrus DM, Gwinner KP, Prince JB. Food Supply Veterinary Medicine Future or folly? Can J Agric Econ 2012;60:93–112. Coalition Report (2006) — Estimating FSVM demand and maintain- 30. Elskamp R, Hailu G. Do efficient dairy producers purchase quota? ing the availability of veterinarians for careers in food supply related Canadian Agricultural Trade Policy and Competitiveness Research disciplines in the United States and Canada. Available from: https:// Network (CATPRN). CATPRN Working Paper 2013–02. March www.avma.org/KB/Resources/Reference/Pages/Food-Supply-Veterinary- 2013. Available from: http://ageconsearch.umn.edu/handle/148901 Medicine-Coalition-Report.aspx Last accessed November 28, 2014. Last accessed May 22, 2015. 15. American Association of Bovine Practitioners. Summary opinion of the 31. Canadian Dairy Information Centre, Monthly milk quota exchange. American Association of Bovine Practitioner’s ad hoc Committee on Available from: http://www.dairyinfo.gc.ca/index_e.php?s1=dff- rural veterinary practice (May 20, 2011). Available from: http://www. fcil&s2=quota&s3=qe-tq Last accessed May 22, 2015. aabp.org/resources/pdfs/Summary_Opinion_of_the_AABP-Rural_Vet_ 32. The Milk Producer, June, 2014. Available from: http://www.travel Practice-5.19.11.pdf Last accessed May 22, 2015. press.com/subscription/IDEA/111514_070114_MP/DC8D1C26958A 16. National Research Council. Workforce needs in veterinary medicine. 1C32B82416AF1D7CCCE4/111514_070114_MP.pdf Last accessed Washington, DC: National Academies Press, 2012. May 22, 2015.

708 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Article

Autologous vaccination for the treatment of equine sarcoids: 18 cases (2009–2014)

Caitlin C. Rothacker, Ashley G. Boyle, David G. Levine

Abstract — The purpose of this retrospective case series was to assess the outcome of an autologous vaccination procedure on single and multiple sarcoid lesions, determine complication rate, and report owner satisfaction. Medical records (18 cases) from January 2009 through May 2014 were evaluated to identify horses undergoing the procedure. Signalment, number, size, anatomic location of lesions, and type of historical treatment were recorded. Follow-up was obtained via standardized owner survey, veterinary examination, and digital images. Data recorded and analyzed included ancillary therapies post-procedure, decrease in number and/or size of sarcoid lesions, sarcoid regrowth, complications, and owner satisfaction. There was a decrease in number of lesions observed by owners in 75% of cases and a decrease in size of sarcoids in 93.8% of cases. Clinical regression observed by owners was noted in 68.8% of cases. There were complications in 43.8% of cases and owner satisfaction in 75% of cases.

Résumé — Vaccination autologue pour le traitement des sarcoïdes équins : 18 cas (2009–2014). Le but de cette série de cas rétrospectifs était d’évaluer le résultat d’une procédure de vaccination autologue sur des lésions de sarcoïdes simples et multiples, de déterminer le taux de complication et de signaler la satisfaction des propriétaires. Les dossiers médicaux (18 cas) datant de janvier 2009 à mai 2014 ont été évalués afin d’identifier les chevaux subissant l’intervention. Le signalement, le nombre, la taille, l’emplacement anatomique des lésions et le type de traitement historique ont été consignés. Le suivi a été obtenu par un sondage standard auprès des propriétaires, un examen vétérinaire et des images numériques. Les données consignées et analysées incluaient des traitements auxiliaires après l’intervention, une baisse du nombre et/ou de la taille des lésions des sarcoïdes, la repousse des sarcoïdes, les complications et la satisfaction des propriétaires. Il s’est produit une baisse du nombre des lésions observées par les propriétaires et de la taille des sarcoïdes dans 93,8 % des cas. La régression clinique observée par les propriétaires a été consignée dans 68,8 % des cas. Il y a eu des complications dans 43,8 % des cas et les propriétaires étaient satisfaits dans 75 % des cas. (Traduit par Isabelle Vallières) Can Vet J 2015;56:709–714

Introduction along chains of lymph nodes (1,2). Sarcoids can be classified based on their clinical appearance and behavior. Whether arcoids are the most common skin tumor in the equid deemed occult, verrucous, nodular, fibroblastic, mixed or malig- population (1,2). Most tumors are benign, locally invasive, S nant, no significant distinctions have been noted histopatho- and fibroblastic; however, tumors can become large, ulcerate, logically between the classifications (3). Sarcoids often require and prevent proper use of equipment during athletic activity. treatment due to their location and discomfort to the animal. Rarely, in one form of the disease, the tumor cells can migrate Multiple modalities are described in the literature with no one treatment accepted as the gold standard (4). Department of Clinical Studies, New Bolton Center, School The pathogenesis of equine sarcoids has not been completely of Veterinary Medicine, University of Pennsylvania, 382 West elucidated. Bovine papilloma virus (BPV), however, has been Street Road, Kennett Square, Philadelphia, Pennsylvania 19348, strongly linked with equine sarcoids through the demonstration USA. of viral DNA in 73% to 100% of sarcoid samples analyzed, but Address all correspondence to Dr. Caitlin Rothacker; e-mail: has not been detected in other types of equine skin tumors or [email protected] equine papillomas (5). Typically, papilloma viruses are species- Use of this article is limited to a single copy for personal study. specific and the identification of BPV in equine sarcoids repre- Anyone interested in obtaining reprints should contact the sents an unusual case of inter-species infection (6). In 1 study, CVMA office ([email protected]) for additional BPV gene expression revealed the presence of the E5 protein in copies or permission to use this material elsewhere. 23 sarcoid samples analyzed and its absence from all non-sarcoid

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Table 1. Horses treated with the autologous vaccine procedure with no ancillary therapies Total Time to Veterinary Number tumor area Historical Complete Decrease Decrease follow-up confirmation Breed Age Gender of lesions (cm2) treatment regression in number in size (mo) of results ARAB 12 MC 1 15 YES NO NO YES 8 NO QH 13 MC 3 8 NO NO YES YES 28 NO WB 4 F 9 25 NO NO NO NO 2 YES QH 22 MC 1 6.25 NO YES — — 3 YES QH 8 MC 1 2 NO YES — — 12 YES TB 14 MC 1 50 YES YES — — 16 YES QH 14 MC 1 12.5 YES YES — — 17 NO ARTICLE ARAB 11 MC 1 12 YES YES — — 18 NO TB 13 MC 3 1.5 YES YES — — 39 YES WB 5 MC 3 16 YES YES — — 1 NO TB 20 MC 5 8 NO YES — — 12 NO

ARAB — Arabian; QH — Quarter Horse; WB — Warmblood; TB — Thoroughbred; MC — male castrated; F — female.

samples (7). The E5 protein is a transforming protein with The objective of this retrospective study was to assess the multiple modes of action. It promotes the down regulation of effect of an autologous vaccine procedure on single and mul- MHC class I molecules, thus allowing host immunosurveillance tiple sarcoid lesions, determine complication rate, and report to overlook infected cells (6,7). This protein is also thought to owner satisfaction. Favorable results would potentially provide aid in isolation of the infected cell and disruption of cell protein veterinarians an adjunctive modality to treat equine sarcoids, processing (6). specifically in cases with multiple lesions in anatomically chal- Transmission of BPV in equids is unclear. No intact virions lenging regions of the body where satisfactory surgical margins have been detected within equine sarcoids (6) and equids were are not possible. traditionally considered dead-end hosts. Recently, BPV DNA was detected in both the dermis and epidermis of equine skin, Materials and methods suggesting that equid to equid transfer may occur (8). Bovine Case selection papilloma virus DNA has also been found in face flies removed The medical records of all horses undergoing an autologous vac- from horses with sarcoid lesions (9). Stable management prac- cination procedure at the George D. Widener Hospital for Large tices may also contribute to the spread of the virus through Animals and the William H. Boucher Field Service section at the contaminated tack or pastures (5). University of Pennsylvania’s New Bolton Center, from January There is a genetic predisposition, with Thoroughbreds, 2009 to May 2014 were reviewed. Prior to implantation, all Quarter Horses, Arabians, and Appaloosas having an increased horses were required to have a biopsy with histopathology con- risk for sarcoid development (10,11). The presence of spe- firming the diagnosis of sarcoid. If multiple lesions were present, cific major histocompatibility (MHC) class II molecules has only 1 was chosen for biopsy and histopathology. been noted to increase the likelihood of sarcoid lesions in the Thoroughbred population (10). Greater than 70% of sarcoids Medical records review develop in horses , 4 y old (1). Sarcoids may be found any- The gender and breed distribution of all equine patients at where along the body, most commonly on the head, ears, and the George D. Widener Hospital from January 2009 through limbs (1,4,11). Sites of previous injury are reportedly predis- May 2014 were obtained. Data for the patients undergoing the posed to sarcoid development (1,2,11). autologous vaccination procedure included age, breed, gender, Treatment modalities include surgical removal, cryotherapy, number and size of lesions, anatomic location of lesions, and chemotherapy, interstitial brachytherapy, electrochemotherapy, type of historical treatment. Of the 18 horses undergoing this topical antiviral treatment, and topical herbal preparations procedure, follow-up data were obtained for 16 patients. (1,2,4,12–19). Immunotherapy has also been proposed with Follow-up was done by telephone conversation with the the use of Bacillus Calmette-Guerin (BCG) cell wall extract as owner using a consistent, standardized survey by a single author. an intralesional injection to induce an immunological response Owners were asked to subjectively evaluate the number and (16,17). An autologous vaccine that is based on the polym- size of current lesions. Where applicable, owners were asked to erization of antigenic tumor markers was reported to induce estimate the size of current lesions in centimeters. Complications complete remission in 19 of 21 horses after varying lengths of associated with the procedure and sarcoid regrowth at the time treatment (20). In 2008, Epsy (21) reported on an autologous of follow-up were recorded. Owner satisfaction was also recorded vaccination procedure performed in the field utilizing sarcoid as positive, negative, or indifferent. When possible, follow-up tissue frozen in liquid nitrogen and subsequently implanted into measurements were obtained by a veterinarian through physi- subcutaneous pockets in the neck. Complete tumor regression cal examination. Digital images of the lesions were obtained at was noted in 12 of 15 cases; however, no further results or larger the time of follow-up depicting the pre- and post-procedural case series have been published (21). appearance when possible.

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Table 2. Horses treated with the autologous vaccine procedure and ancillary therapies Total Time to Veterinary Number tumor area Historical Complete Decrease Decrease follow-up confirmation Breed Age Gender of lesions (cm2) treatment regression in number in size (mo) of results WB 7 MC 1 25 YES NO NO YES 5 NO WB 9 MC 2 16 YES NO NO YES 30 NO WB 19 MC 1 16 NO YES — — 2 YES WB 11 MC 1 32 YES YES — — 3 YES ARTICLE WB 18 F 2 6 NO YES — — 4 YES

WB — Warmblood; MC — male castrated; F — female.

Autologous vaccination procedure The procedure was performed according to the technique described by Epsy (21). The patient was restrained and sedated using a combination of detomidine hydrochloride (Dormosedan; Pfizer Animal Health, New York, New York, USA), 0.01 mg/kg body weight (BW), IV, and butorphanol tartrate (Torbugesic; Fort Dodge Animal Health, Fort Dodge, Iowa, USA), 0.01 mg/kg BW, IV. However in 2 cases, the patient was placed under general anesthesia to facilitate sarcoid debulking in a dif- ficult anatomic location (medial thigh and ventral abdomen). The sarcoid to be removed and surrounding skin were prepared by cleaning with 4% chlorhexidine gluconate (Betasept; Purdue Pharma, Stamford, Connecticut, USA) and rinsing with clean water. Using sharp dissection, the lesion was then debulked to approximately skin level, leaving the base in situ (Figure 1). If mild to moderate hemorrhage ensued, sterile 4 3 4 gauze squares Figure 1. Pre-implantation lesion located at the base of the ear. were used for compression at the site. The removed sarcoid was This was debulked and the autologus procedure was performed. sectioned into multiple small tissue cubes, measuring about 0.5 3 0.5 3 0.5 cm. Any superficial areas of gross necrotic tissue were removed from the cubes. The pieces were placed in sterile analyses were performed using STATA ICV 12.1 (StataCorp, gauze and submerged in liquid nitrogen for 7 to 10 min. An College Station, Texas, USA). Values of P # 0.05 were consid- area just ventral to the nuchal ligament, 10 cm long and 5 cm ered significant. wide, was clipped and aseptically prepared. Approximately 2 to 3 mL of 2% mepivicaine hydrochloride (Carbocaine-V; Pfizer Results Animal Health) was infused subcutaneously in 2 to 3 locations. Medical records review Stab incisions were created through the skin and subcutis using The autologous vaccination procedure was performed on a number 10 scalpel blade. Hemostat forceps were used to aid 15 geldings and 3 mares. The median age was 11 y (n = 15, in the creation of a pocket large enough to hold 1 to 3 cubes IQR: 8 to 14). A variety of breeds were represented including of sarcoid tissue. These were then placed subcutaneously in Warmbloods [n = 8 (44.4%)], Quarter Horses [n = 4 (22.2%)], each stab incision. The skin was closed over the implanted Thoroughbreds [n = 3 (16.7%)], Arabians [n = 2 (11.1%)], and sarcoid with 1 simple interrupted suture with a non-absorbable mixed breed [n =1 (5.6%)]. At this institution, during the same suture material. Phenylbutazone 20% (Phenylbutazone 20% time frame, 41.0% of patients were mares, 41.0% were geldings, Injection; Vet One, MWI Veterinary Supply, Boise, Idaho, USA), and 18% were stallions. Warmbloods represented 20.6% of the 2.2 mg/kg BW, was administered intravenously or orally after population, Quarter Horses 6.8%, Thoroughbreds 34.2%, and surgery in all cases for 1 to 2 d. No antimicrobials were used. Arabians 3.2%. Two horses were vaccinated in the field and 16 Signalment, number and size of lesions, anatomic location were vaccinated in hospital. of lesions, type of historical treatment, and follow-up data were Median number of lesions at presentation was 1.5 (n = 18, evaluated descriptively. Continuous variables were examined IQR: 1 to 3). Nine of the 18 horses had a solitary lesion and for normality using the Shapiro-Wilk test. As most parameters 9 had 2 or more sarcoids. In 16 of 18 (88.9%) cases, 3 or fewer were not normally distributed, data are presented as medians lesions were recorded. Median area of the presenting lesions was and interquartile ranges (IQR, 25th and 75th percentiles). 13.75 cm2 (n = 17, IQR: 6.25 to 16). Percentages were used to describe discrete data. The presence of Sarcoids were located on the head in 7 of 18 horses (38.9%), multiple initial sarcoids, the initial tumor area (cm2), the type the limbs in 5 of 18 (27.8%) and the body and trunk in 4 of of historical treatment, and the use of topical historical treat- 18 (22.2%). Two horses (11.1%) had lesions in multiple ana- ments were analysed by logistic regression, in order to identify tomic regions. Ten of 17 horses (58.8%) were treated histori- association with tumor regrowth or a decrease in tumor size. All cally prior to the autologous implantation procedure including

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topical bloodroot extract [Xxterra; Larson Laboratories, Fort Collins, Colorado, USA, n = 3 (30%)], topical Imiquimod [n = 1 (10%)], surgical debulking with intralesional cisplatin [n = 1 (10%)], and multiple modalities [n = 5 (50%)].

Long-term follow-up The median time to follow-up from the autologous implanta- tion was 10.5 mo (n = 15, IQR: 3 to 17.5). As reported by the owners, 12 of 16 (75%) horses showed an overall decrease in the

ARTICLE number of sarcoids with 15 of 16 (93.8%) having a decrease in size of sarcoids present. Complete regression was noted in 11 of 16 (68.8%) cases (Figure 2). Follow-up physical examination confirming owner findings was performed by a veterinarian in 5 of 18 cases. Digital images were provided to the author by owners for an additional 3 cases. Therefore, 8 of 16 (50%) cases available for follow-up had results confirmed secondarily to owner reporting. The cases available for follow-up were divided into groups based upon whether other post-procedural treatments were instituted or not. In 11 of 16 cases (68.8%) there was no other post-operative sarcoid treatment (Table 1). Veterinary examina- tion or digital images provided confirmation of owner-reported results in 5 of 11 cases belonging to this cohort. Of these horses, 6 of 11 (54.5%) had single lesions. Five of 6 (83.3%) regressed completely following autologous vaccination and the remain- ing horse had a decrease in size. The remaining 5 horses had . 1 lesion. Three of 5 (60%) horses had complete regression of Figure 2. Six month follow-up from the owner demonstrating all lesions while 1 of 5 (20%) had a decrease in size and num- complete regression with no ancillary therapy. ber (Table 1). Overall, in this cohort, 8 horses had complete regression with no further treatment following the autologous vaccination procedure. Discussion Post-procedural treatment was instituted in 5 of 16 (31.3%) The results of this retrospective case series are promising as 75% cases (Table 2). These included imiquimod (n = 4) and cisplatin of horses had a decrease in number of sarcoids, 93.8% had a (n = 1). Of these, 3 (60%) had complete regression of all sarcoid decrease in size of sarcoids, and 69% of horses had complete lesions while all 5 (100%) had decreases in size (Table 2). regression. Of the 11 horses in which the autologous vaccine Results were also examined based on the presence of absence procedure was performed with no post-procedural treatment, of historical treatment. Nine of 16 (56.3%) horses were treated 8 horses had complete regression of all sarcoids. Three of the historically prior to implantation procedure. In these cases, five patients with multiple lesions had complete regression of 6 of 9 (66.7%) completely regressed, and the remaining 3 horses all lesions without any other direct treatment. These findings had decreases in overall size of sarcoids. At the time of follow- demonstrate the ability of the autologous vaccine to cause a up, 3 of 16 horses (18.8%) had regrowth of 1 or more sarcoid decrease in the number and size of sarcoids in multiple areas lesions. All 3 cases belonged to the cohort of horses with histori- of the body with no other treatment. The 2 remaining cases of cally treated lesions. multiple lesions with no further post-procedural treatment were No statistical significance was found when analyzing the followed up at just 30 and 60 d post-procedure which may not associations between the presence of multiple initial sarcoids, be long enough to note significant change. the initial tumor area in cm2, the type of historical treatment, Many of the current treatment protocols for sarcoids rely on a and the use of topical historical treatments with tumor regrowth multimodal approach. It is also clear that biopsy or removal with or a decrease in tumor size. incomplete margins often causes aggressive regrowth of lesions Mild complications were noted in 7 of 16 cases (43.8%). (1,11). Reports of surgical excision alone vary dramatically The most common complication reported was swelling at the in success rate, ranging from 52% to 82% (1,4,11). Surgical site of implantation [n = 5 (71.4%)] followed by fever and a debulking followed by topical treatment with acyclovir has single abscess at the implantation site. All complications resolved resulted in complete regression in both nodular and mixed sar- with a short course of anti-inflammatory therapy. Overall, 12 of coids (14). In the present case series, 9 horses had single lesions. 16 (75%) owners were reportedly satisfied with the autologous With surgical debulking and the autologous vaccine procedure, vaccine procedure. The remaining 4 owners were indifferent 7 of 9 (77.8%) had complete remission thereby demonstrating to the procedure and outcome but were dissatisfied with the a benefit in utilizing the autologous preparation as an adjunct complications. therapy. Of the 9 cases unresponsive to historical treatment,

712 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY all 9 had decreases in size with 7 (77.8%) showing decreases in the debulked lesion and other lesions. The innate response number of lesions following the autologous procedure. consists of primarily non-specific phagocytic cells that both Treatment failure and regrowth of equine sarcoids are com- engulf antigen and release granules in an attempt to remove mon (4,12,14). The choice of initial treatment is often based an antigen. Soluble factors such as complement, acute phase on location of the lesion, the presence of multiple lesions, and proteins, and cytokines aid in cell signaling and phagocytosis cost/availability. It is noted anecdotally that sarcoids that do not (22). While the innate response has no antigenic memory, the respond to therapy can become problematic and unresponsive to acquired response consists of T-cells and memory B-cells that are ARTICLE ancillary therapies. While 3 horses in this series had regrowth, primed to recognize specific antigens. Vaccine technology relies all 3 had received historical treatment and thus most likely on creating a product that does not cause clinical disease but belong to a cohort of horses with more persistent lesions. In stimulates the production of memory B- and T-cells to prevent these cases, while regrowth of the original lesion had occurred, future infection (22). no new lesions were reported. There have been recent studies on the development of Complications were noted in 43.8% of cases but mostly vaccines to both prevent and aid in the treatment of cervical consisted of mild swelling at the site of implantation. Mild neoplasia, a disease in which 99.7% of tumors are positive complications are often associated with a variety of sarcoid for specific strains of human papilloma virus DNA (23,24). treatments (12,14,16,18). One horse developed an abscess at Papillomaviruses are unique in that development of cancerous the site of implantation. This was treated by the animal’s refer- lesions depends on negative regulation of cell cycle control as ring veterinarian and resulted in a small scar along the neck. well as immune evasion (24). A variety of therapeutic vaccines No inciting cause could be identified but the patient went on including protein based products, plant-derived products, to have complete remission of 2 lesions. DNA-based vaccines as well as bacterial and viral vectors have In the present study, Quarter Horses, Warmbloods, and been investigated with varying degrees of success. Combination Thoroughbreds represented the majority of cases. These findings therapy including traditional radiation therapy and a therapeutic reflect the genetic predisposition for sarcoids discussed in the vaccine was effective in a pre-clinical model (24) suggesting literature (1,4,11), as Quarter Horses do not constitute a high that a therapeutic vaccine is useful as an adjuvant to traditional percentage of the horses seen at this institution (6.8% of the therapy. Other work on a vaccine for HPV 16 demonstrated patient caseload). Geldings were overrepresented in this study, a strong immune response in the form of titers and cytokine as this institution recorded approximately equal numbers of production, but limited regression of tumors (23). These stud- mares and geldings in the same time frame. The median age ies were mimicked in work on sarcoid-bearing donkeys which at presentation (11 y) is likely related to a referral population were vaccinated with a virus-like particle containing the L1 and bias, as the initial onset of sarcoid lesions is widely accepted to E7 proteins; while a strong immunologic response was elicited, occur in younger animals ranging from 1 to 7 y old (1,2,6). The tumor regression was noted in only about half the donkeys (25). average age in this study is older than in most; therefore, these Immuno-modulation differs from traditional vaccine therapy cases may represent more aggressive lesions requiring referral in that it aims to stimulate a non-specific enhancement of the or lesions located in difficult anatomic locations where benign innate or acquired response (26). In the equine population, neglect is not a valid option. However, the anatomic distribution this has traditionally consisted of a variety of crude products of lesions in this case series reflects the most common areas of of bacterial, viral or plant origin (26). The proposed mecha- sarcoid occurrence in the general population. Multiple lesions nism relies on macrophage activation and subsequent cytokine are common in patients with sarcoids, ranging from 14% to release that increases phagocytic activity, antibody production, 84% of cases (11) which is reflected in this report as 46.7% of and lymphocyte cytotoxicity. In equids, immune-modulation horses had 2 or more sarcoids. has centered on the treatment of equine respiratory disease All initial follow-up was performed through conversation with complex. A recent systematic literature review examined stud- the owner; however, 5 horses were examined by a veterinarian ies on the use of Parapoxvirus ovis and Propionibacterium acnes for other medical reasons and the presence or absence of sarcoid as immuno-modulators for equine respiratory disease; overall, lesions was noted. All owners were asked to submit digital before favorable results in both the in vitro and in vivo work were noted and after images during the standardized survey. Owner reported with patients receiving these therapies showing improvement in findings were confirmed in half of the cases available for follow- recovery time (27). up by either veterinary examination or digital images. The use of The mechanism of action of these immuno-modulatory an owner survey has several limitations including placebo effect agents is largely unknown; however, clear success has been and subjectivity and a prospective, case-controlled study with demonstrated in equids suffering from chronic virus-associated bi-weekly tumor measurements would provide more accurate respiratory disease (27). In other species, in-depth in vitro work documentation for the regression of tumor lesions. However, has identified interleukin (IL)-16, a proinflammatory cytokine due to the extended geographic area this institution serves and secreted by activated T-cells, as a potential immuno-modulator the retrospective nature of the study, owner reporting was neces- in viral disease (28). In caprines, IL-16 may decrease the integra- sary in order to obtain long-term follow-up data. tion of caprine arthritis-encephalitis viral DNA into peripheral While the exact mechanism of the autologous preparation white blood cells (29). is unknown, we suspect the implanted tissue is acting as an Immuno-modulation represents a new front in both human immuno-modulatory agent to stimulate a host response against and animal medicine as a targeted means to treat both chronic

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viral disease and a variety of neoplasms. Future in vitro work is 14. Stadler S, Kainzbauer C, Haralambus R, Brehm W, Hainisch E, Brandt needed to support the use of the autologous sarcoid preparation S. Successful treatment of equine sarcoids by topical aciclovir applica- tion. Vet Rec 2001;168:187–190. utilized in this report. Larger case series or a prospective case- 15. Christen-Clottu O, Klocke P, Burger D, Straub R, Gerber V. Treatment controlled report may provide stronger evidence for the efficacy of clinically diagnosed equine sarcoid with a mistletoe extract (Viscum of this procedure. However, the clinical results, in combination album austriacus). J Vet Intern Med 2010;24:1483–1489. 16. Lavach JD, Sullins KE, Roberts SM, Severin GA, Wheeler C, with owner satisfaction and mild complications, make this an Lueker DC. BCG treatment of periocular sarcoid. Equine Vet J 1985; attractive therapy to aid in sarcoid treatment. CVJ 17:445–448. 17. Vanselow BA, Abetz I, Jackson AR. BCG emulsion immunotherapy of equine sarcoid. Equine Vet J 1988;20:444–447. References 18. Nogueira SA, Torres SM, Malone SD, Diaz SF, Jessen C, Gilbert S.

ARTICLE 1. Rees CA. Disorders of the skin. In: Reed SE, Bayly WM, Sellon DC, Efficacy of imiquimod 5% cream in the treatment of equine sarcoids: eds. Equine Internal Medicine. St. Louis, Missouri: Saunders Elsevier, A pilot study. Vet Dermatol 2006;17:259–265. 2010:710–713. 19. Théon AP, Wilson WD, Magdesian KG. Long-term outcome associ- 2. Pascoe RRR, Knottenbelt DC. Manual of Equine Dermatology. ated with intratumoral chemotherapy with cisplatin for cutaneous Philadelphia, Pennsylvania: WB Saunders, 1999. tumors in equidae: 573 cases (1995–2004). J Am Vet Med Assoc 2007; 3. Martens A, De Moor A, Demeulemeester J, Ducatelle R. Histopatho­ 230:1506–1513. logical characteristics of five clinical types of equine sarcoid. Res Vet 20. Kinnunen RE, Tallberg T, Stenbäck H, Sama S. Equine sarcoid tumour Sci 2000;69:295–300. treated by autogenous tumour vaccine. Anticancer Res 1999;19: 4. Taylor S, Haldorson G. A review of equine sarcoid. Equine Vet Educ 3367–3374. 2013;25:210–216. 21. Epsy BK. How to treat equine sarcoids by autologous implantation. 5. Chambers G, Ellsmore VA, O’Brien PM, et al. Association of bovine Proc Am Assoc Equine Pract 2008;54:68–73. papillomavirus with the equine sarcoid. J Gen Virol 2003;84:1055–1062. 22. Delves PJ, Roitt IM. The immune system. First of two parts. N Engl J 6. Nasir L, Campo MS. Bovine papillomoviruses: Their role in the Med 2000;343:37–49. aetiology of cutaneous tumours of bovids and equids. Vet Dermtatol 23. Van Poelgeest ME, Welters MJ, van Esch EM, et al. HPV16 synthetic 2008;19:243–254. long peptide (HPV16-SLP) vaccination therapy of patients with 7. Carr EA, Théon AP, Madewell BR, Hitchcock ME, Schlegel R, advanced or recurrent HPV-16 induced gynecological carcinoma, a Schiller JT. Expression of a transforming gene (E5) of bovine papil- phase II trial. J Transl Med 2013;11:88–102. loma virus in sarcoids obtained from horses. Am J Vet Res 2001;62: 24. Vici P, Mariani L, Pizzuti L, et al. Immunologic treatments for pre- 1212–1217. cancerous lesions and uterine cervical cancer. J Exp Clin Cancer Res 8. Brandt S, Tober R, Corteggio A, et al. BVP-1 infection is not confined 2014;33:29–44. to the dermis but also involves the epidermis of equine sarcoids. Vet 25. Ashrafi GH, Piujo K, Burden F, et al. Vaccination of sarcoid-bearing Microbiol 2011;150:35–40. donkeys with chimeric virus-like particles of bovine papillomavirus 9. Finlay M, Yuan ZQ, Burden F, et al. The detection of bovine type 1. J Gen Virol 2008;89:148–157. papillomavirus type 1 DNA in flies. Virus Res 2009;144:315–317. 26. Rush BR, Flaminio JB. Immunomodulation in horses. Vet Clin North 10. Meredith D, Elser AH, Wolf B, Soma LR, Donawick WJ, Lazary S. Am Equine Pract 2000;16:183–197. Equine leukocyte antigens; relationships with sarcoid tumors and lami- 27. Paillot R. A systematic review of the immune-modulators Parapoxvirus nitis in two pure breeds. Immunogenetics 1986;23:221–225. ovis and Propionibacterium acnes for the prevention of respiratory dis- 11. Bergvall KE. Sarcoids. Vet Clin Equine 2013;29:657–671. ease and other infections in the horse. Vet Immunol Immunopathol 12. Théon AP, Pascoe JR, Carlson GP, Krag DN. Intratumoral chemo- 2013;153:1–9. therapy with cisplatin in oily emulsion in horses. J Am Vet Med Assoc 28. Baier M, Werner A, Bannert N, Metzner K, Kurth R. HIV suppression 1993;202:261–267. by interleukin-16. Nature 1995;378:563. 13. Théon AP, Pascoe JR. Iridium-192 interstitial brachytherapy for 29. Nimmanapalli R, Sharmilla C, Reddy PG. Immunomodulation of cap- equine periocular tumours: Treatment results and prognostic factors in rine lentiviral infection by interleukin–16. Comp Immunol Microbiol 115 horses. Equine Vet J 1995;27:117–121. Infect Dis 2010;33:529–536.

714 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Article

Long-term prospective evaluation of intestinal anastomosis using stainless steel staples in 14 dogs

Manuel Benlloch-Gonzalez, Eymeric Gomes, Bernard Bouvy, Cyrill Poncet

Abstract — This prospective clinical study evaluated the use, complications, and clinical and ultrasonographic follow-ups of end-to-end intestinal anastomoses with skin staples in naturally occurring diseases in canine small and large intestines. Intestinal anastomoses were performed in 14 dogs and pre-, peri-, and postoperative data were recorded. Postoperative clinical and ultrasound evaluations were performed at regular intervals for 1 year. The mean time taken to construct the anastomosis was 5 min. There were no intraoperative complications. Hemorrhage and colonic stricture were the main postoperative complications. Staple loss occurred in 2 cases. Absence of wall layering and focal wall thickening were observed in all cases at each ultrasonographic follow-up. Hyperechoic fat was observed in all but 1 of the cases at month 1. Nine dogs were alive with normal digestive function at the end of the study. The skin stapler technique enabled rapid construction of consistent anastomoses with inexpensive stapling material.

Résumé — Évaluation prospective à long terme de l’anastomose utilisant des agrafes en acier inoxydable chez 14 chiens. Cette étude clinique prospective a évalué l’utilisation, les complications ainsi que les suivis cliniques et échographiques d’anastomoses termino-terminales utilisant des agrafes chirurgicales lors de pathologies naturelles du petit et gros intestins chez des chiens. Des anastomoses intestinales ont été réalisées chez 14 chiens et des données préopératoires, peropératoires et postopératoires ont été consignées. Des évaluations cliniques et échographiques postopératoires ont été réalisées à des intervalles réguliers pendant 1 an. La durée moyenne de la construction de l’anastomose était de 5 minutes. Il n’y a pas eu de complications peropératoires. L’hémorragie et le rétrécissement du côlon étaient les principales complications postopératoires. La perte de l’agrafe s’est produite dans deux cas. L’absence de couches de la paroi et un épaississement concentrique de la paroi ont été observés dans tous les cas à chaque suivi échographique. Le gras hyperéchogène a été observé dans tous les cas sauf un au mois 1. Neuf chiens étaient vivants avec une fonction digestive normale à la fin de l’étude. La technique de l’agrafeuse chirurgicale a permis la construction rapide d’anastomoses uniformes avec du matériel d’agrafage bon marché. (Traduit par Isabelle Vallières) Can Vet J 2015;56:715–722

Introduction time, with high levels of consistency and repeatability, reduced tissue trauma, and improved blood supply (1,3–7). Intestinal tapled intestinal anastomosis techniques include everting staplers come in various shapes and sizes, accommodating a triangulating end-to-end anastomosis (EEA) using a tho- S range of intestinal sizes (1). However, these instruments are racoabdominal (TA) stapler, inverting end-to-end anastomosis expensive and often several TA or GIA devices or cartridges are using a circular EEA stapler, and antiperistaltic side-to-side tech- needed for each anastomosis (1,3,5,7). When using circular EEA niques using gastrointestinal anastomosis (GIA) and TA staplers staplers, only 1 device is required but additional intestinal inci- (1,2). These techniques are safe alternatives to conventional sions are often necessary to accommodate the instruments (1,4). manual suturing techniques, considerably reducing surgical The use of a skin stapler for intestinal anastomosis was first described in 1990 by Fackler et al (8), who used stainless steel staples to appose the intestinal ends. Evaluation of the technique CHV Fregis — Surgery, 43 Av Aristide Briand, Arcueil 94110, in porcine and canine models showed a significant reduction France. in surgical time and a consistently high quality of anastomosis Address all correspondence to Dr. Manuel Benlloch-Gonzalez; irrespective of the experience of the surgeon or the presence of e-mail: [email protected] peritonitis (9–11). In addition to being inexpensive, the skin Use of this article is limited to a single copy for personal study. stapler technique provides a significant advantage, as only a Anyone interested in obtaining reprints should contact the single-use disposable skin stapler is required. CVMA office ([email protected]) for additional In 2000, Coolman et al (12) modified the original skin copies or permission to use this material elsewhere. stapler technique in dogs by creating an approximating, single

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layer end-to-end jejunal anastomosis rather than crushing and increased (. 0.7) short/long axis ratio were recorded (16). inverting the intestinal ends. The experimental jejunal anasto- Thoracic radiographs including opposite lateral and dorsoventral mosis model significantly reduced surgical time, gave similar projections were taken if neoplasia was suspected. healing characteristics, and showed no significant difference in Patients with dehydration or hypotension (systolic , 80 mmHg) mean bursting strength immediately after surgery and at 4 and were stabilized prior to surgery with intravenous lactated 21 d, compared with single-layer interrupted hand-sewn sutures Ringer’s (Fresenius Kabi, Sèvres, France) or 0.9% NaCl solu- (11). Experimental canine colonic anastomoses with skin staples tion [20 to 50 mL/kg body weight (BW) per hour] for the first resulted in a higher mean bursting strength immediately after 1 to 2 h. Infusion rates were then adjusted. surgery and at day 14 compared with single-layer interrupted

ARTICLE hand-sewn sutures (13). However, experimental models exert Surgeries non-physiologic increases in pressure across tissues and anasto- Trained surgeons (2 residents) performed the surgeries. Training motic lines and the clinical relevance of such tests is therefore consisted of a minimum of 3 intestinal anastomoses performed unknown (1). Although the skin stapler technique is reputed to on fresh cadaver dogs. A board-certified surgeon supervised the be safe for intestinal anastomosis in dogs (11), its use in clinical clinical procedures. situations and long-term follow-up have not been reported. To The dogs were premedicated with morphine hydrochloride date, only 1 series of small and large intestine anastomoses has (C.D.M Lavoisier, Paris, France), 0.2 mg/kg BW, SC, and been reported in 39 human patients, with no complications diazepam (Valium; Roche, Boulogne-Billancourt, France), (14). 0.25 mg/kg BW, IV. Anesthesia was induced with propofol The goal of this prospective clinical study was to evaluate the (C.D.M Lavoisier), 4 mg/kg BW, IV, and maintained with use, complications, and clinical and ultrasonographic follow-ups isoflurane (Baxter S.A.S., Maurepas, France) in 100% oxygen of end-to-end anastomoses with skin staples for the manage- via endotracheal tube. Lactated Ringer’s solution (Fresenius ment of naturally occurring diseases in canine small and large Kabi), 10 mL/kg BW per hour, IV, was given. Each patient intestines. received cefalexin (Rilexine; Sogeval, Laval Cedex, France), 30 mg/kg BW, IV, q90min during surgery from the time of Materials and methods induction. Intestinal anastomoses were performed as described Case selection by Coolman et al (12). Three full-thickness 3-0 absorbable stay Dogs requiring a single enterectomy procedure between sutures (Biosyn; Covidien, Elancourt, France) were placed at July 2010 and June 2012 were included. Dogs were excluded if 120° intervals around the intestine, with the first one placed a celiotomy had been performed within 15 d of presentation or at the mesenteric border. Tension was applied between 2 stay if any concomitant surgical procedure that could increase the sutures, and skin staples (4.8 3 3.4 mm) were placed at intervals risk of peritonitis (e.g., pyometra, prostatic abscess, cystotomy, of 2 to 3 mm using a skin stapler (Autosuture Royal 35 R single gastrotomy) was planned. Informed consent was obtained from use skin stapler; Covidien) between each of the stay sutures the dogs’ owners. (Figure 1). The suture line was tested for leaks as described previously (2). Additional skin staples were used if necessary. Preoperative assessment and care The site of the anastomosis was lavaged with warm saline solu- Signalment, body weight, presenting complaints, clinical find- tion and draped with omentum. In patients with suspected ings, and duration of clinical signs were recorded. A complete peritonitis, samples were submitted for bacteriological analysis. blood (cell) count (CBC), electrolytes, and serum biochemical Concurrent procedures were performed if needed and the celi- profiles were evaluated. otomy was closed in layers. Abdominal ultrasonographs and radiographs (2 orthogo- We recorded a description of the suspected intestinal lesion nal views) were evaluated by a board-certified radiologist. and any other abdominal anomaly, the presence of focal or gen- Ultrasound evaluations were performed on each dog using a eralized peritonitis, the site and length of intestinal resection, 5–8 MHz micro convex and a 14–8 MHz linear probe (Esaote the time required to construct the anastomosis (from the first Technos MPX, Genoa, Italy). Evaluation of the digestive tract intestinal stay suture to the last staple), the number of staples included wall thickness, luminal diameter, and luminal content used, and a description of concurrent procedures performed. (mucus, fluid, gas and alimentary patterns or foreign body) (15). Gastrointestinal motility was subjectively assessed as increased, Postoperative care normal (stomach and duodenum: 4 to 5 contractions/min; Post-operative analgesia was achieved with morphine chlorhy- jejunum: 1 to 3 contractions/min), decreased, or absent (15). drate (C.D.M Lavoisier), 0.2 mg/kg BW, SC, q4h, as necessary Wall layering was deemed altered if all 4 layers were visible but and carprofen (Zoetis, Paris, France), 4.4 mg/kg BW, IV or 1 or more had changes in relative echogenicity or thickness. PO, q24h once the dog started eating. Cefalexin (Sogeval), Absent wall layering was defined as loss of wall architecture (15). 20 mg/kg BW, IV or PO, q12h was continued in cases with The echogenicity of the mesenteric fat was classified as normal peritonitis. Critically ill dogs were hospitalized in the intensive or increased (focally or diffusely). The presence of abdominal care unit for evaluation and treatment. effusion was recorded and described as localized or generalized. Postoperative gastrointestinal function was monitored for Free gas was recorded as present or absent. Abnormal lymph gastric distension, frequency and character of emesis, diarrhea, nodes presenting irregular margins, altered echogenicity, and/or and bowel movements. Adequately hydrated patients were

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abdominal mass, and dehydration were the most common find- ings. The mean duration of signs prior to surgery was 14.4 d (range: 1 to 62 d). Laboratory findings included decreased red blood cell count (cases 1, 7, 12), increased white blood cell count (cases 1–3, 7, 8, 13), hypoalbuminemia (cases 1–3, 7), hypokalemia (cases 1,

3, 13), hypoglycemia (cases 1, 3, 13), increased aspartate ami- ARTICLE notransferase (AST) (cases 1, 3, 4, 6, 11, 12) and increased alkaline phosphatase (ALP) (cases 1, 3, 4, 6, 11, 12). In case 3, metabolic acidosis and increased blood urea nitrogen (BUN), creatinine, blood lactate concentration were identified. The illnesses diagnosed by ultrasonography are listed in Table 1. Absent intestinal motility was observed in 6 dogs (cases 1–3, 5, 6, 8). Free gas was observed in case 2. A localized increase in mesenteric fat echogenicity was seen in 7 dogs (cases 1, 2, 4, Figure 1. Intraoperative view showing the completed intestinal 6–8, 11). The cranial mesenteric lymph nodes were abnormal in anastomosis. Mucosa was not trimmed after intestinal resection. dogs 3, 7, 12, 14. Concomitant lesions included a splenic mass True appositional pattern was difficult to achieve, as the squared (case 12) and ovarian cyst with cystic endometrial hyperplasia shape of the closed staple tends to cause eversion of the intestinal edges. (case 3). Thoracic radiographs (cases 3, 4, 7, 9–12, 14) showed no detectable pulmonary metastases. administered lactated Ringer’s solution at a maintenance rate Preoperative care (44 to 66 mL/kg BW per day), until they were eating and drink- Intravenous fluids were administered to dogs 1 to 4, 6 to 8, ing without emesis. A highly digestible diet (Hill’s I/DTM) was and 13. Potassium chloride (30 mEq/L) or dextrose (0.5 g/kg BW) reintroduced 8 h after surgery and continued for 4 wk. Dogs was added to the maintenance fluids to correct hypokalemia and that were inappetent or had insufficient energy intake were given hypoglycemia (cases 1, 3, 13). Dog 3 had signs compatible with a high-energy liquid diet (Fortol, Intervet) via nasoesophageal compensated hypovolemic shock and was monitored in the inten- tube. The animals were hospitalized for at least 3 d before being sive care unit; maropitant citrate (Zoetis), 1 mg/kg BW, slow IV, discharged if they were free from complications. Surgical com- q24h, ranitidine (Zantac; GlaxoSmithKline, Marly-le-Roy Cedex, plications were recorded as minor (responding to conservative France), 2 mg/kg BW, slow IV, q8h, and cefalexin (Sogeval), treatment) or major (including life-threatening conditions or 20 mg/kg, IV, q8h, were administered. Creatinine, BUN, glucose, requiring a second surgical intervention, euthanasia, or leading electrolytes, and venous blood gas analyses were monitored every to death). 8 h until normalization. Surgery was performed after stabilization, usually within 4 to 12 h (24 h in case 3) of admission. Outcome A board-certified pathologist confirmed the histopathological Intraoperative findings diagnoses including presence or absence of neoplasia at the Intraoperative findings included focal severe intestinal wall surgical margin. Follow-up data included clinical and ultra- thickening compatible with neoplasia (cases 3, 4, 7, 11, 12, 14); sound examinations. Short-term follow-up examinations were focal hyperemic jejunum with moderate wall thickening and performed on days 3, 15, and 30 after surgery, and long-term multiple disseminated nodules bulging from the muscular follow-up examinations at 6 and 12 mo after surgery. The ultra- and mucosal layers associated with lymphagiectasia (case 9); sound examinations were performed as described previously with well-circumscribed fibronodular lesions at the ileocecal valve specific attention to the intestinal anastomosis. Wall thickness (case 10); un-reducible intussusception (cases 1, 8); intestinal was measured at the site of the intestinal anastomosis and an wall necrosis due to foreign body (cases 5, 6); intestinal wall adjacent healthy intestinal segment; the ratio of these 2 values perforation due to linear foreign body sealed with omentum was calculated to determine relative thickening. Abdominal (case 2); and strangulated jejunal obstruction with vascular radiographs were taken 1, 6, and 12 mo after surgery to deter- compromise due to adhesions associated with an uterine stump mine the number of staples remaining at the surgical site. abscess (case 13). Dog 4 had a 5-cm diameter adenocarcinoma that required partial dissection of the right lobe of the pancreas Results to achieve safe intestinal margins (6 cm) proximally. Animals The mean length of intestinal resection was 18 cm. Significant Fourteen dogs met the inclusion criteria (Table 1). The mean mesenteric fat was carefully cleared to enable straightforward age at the time of surgery was 6.7 y (range: 5 mo to 15 y). staple placement. The stapler proved difficult to manoeuvre The mean body weight was 15.7 kg (range: 5.3 to 39 kg). All for distal colonic anastomosis (case 11) due to the pubic bone. dogs presented with gastrointestinal disturbances: vomiting, Where intestinal exposure was limited, such as the ileocolic lethargy, anorexia, weight loss, pyrexia, and diarrhea (Table 1). junction or duodenal flexure, the duodenocolic ligament was On physical examination, abdominal pain, depression, palpable transected to enable full mobilization of the intestinal segment.

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utcome ied ied ood ood ood ood ood ood ood ood ood uthanized 8 mo mo 8 uthanized uthanized 1 mo mo 1 uthanized mo 1 uthanized E E surgery after surgery after G E surgery after O G G D D G G G G G G

ARTICLE emorrhage ypokalemia iarrhea iarrhea one one one one one one ollapse and death and ollapse ollapse and death and ollapse omiting enesmus, Stricture enesmus, omplications N Postoperative T H N c D H C C V N N D N N

7 0 5 8 8 1 5 0 0 2 5 5 5 1 taples used taples 1 Number of Number 2 1 1 s 1 2 1 2 3 1 2 2 3 2

.1 .2 .8 .2 .7 .1 .8 .2

.8 .1 .2 .5 2 4 4 3 4 7 6 4 4 5 3 2 3 5 nastomosis Time (min) of (min) a 1

9 8 4 0 0 5 4 0 9 2 2 8 0 7 cm) Length of Length resection ( 1 1 3 1 2 2 2 1 1 1 3 1

,5

4 4 0 5 2 9 8 5 3 6 6 4 0 0 cm) Length of lesion of ( 1 1 1

uodenal adenocarcinoma uodenal uodenal linear foreign body. foreign linear uodenal olon carcinoma olon hronic lymphoplasmacytic lymphoplasmacytic hronic clerosing nodules/chronic nodules/chronic clerosing llness leocolic intussusception leocolic ejunal lymphoma ejunal ejunal vascular compromise. vascular ejunal lymphoma ejunal ejunal intussusception ejunal ejunal leiomyosarcoma ejunal ejunal foreign body foreign ejunal ejunal foreign body foreign ejunal ejunal adenocarcinoma ejunal J Focal peritonitis Focal enteritis jejunal lesions) (xanthogranulomatous S cecal granulomatous inflammation C J peritonitis Generalied J I J J D J D J J I C

.5 .3 .5

.5

1.5 6 5 5 5 9 4 0 3 6 0 1 9 6 kg)

Weight ( 1 1 1 1 3 1 3 2 3

altese ixed avalier King Charles spaniel Charles King avalier spaniel ocker ane corso ane ernese mountain dog mountain ernese eagle reed ernese mountain dog mountain ernese asset artésian normand artésian asset asset hound asset rench bulldog rench hih tzu hih hih tzu hih ack Russell terrier Russell ack F M S C C B B B B B S B M C J

ender S S

S

S S M F M F M G M F F F M F F M F

.4

Summary of details of animals undergoing intestinal anastomosis with skin staplers skin with anastomosis details of intestinal Summary undergoing animals of ge (y) ge 5 9 0 1 1 4 4 9 1 6

A 1 1 1 1 1

3 1 2 4 5 6 7 8 9

Table 1. Table 1 10 11 2 12 5 13 14 1 spayed female — FS female; — F male; — M

Case

718 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY ARTICLE

Figure 2. Immediate necropsy view of dog 11. Stricture Figure 3. Longitudinal ultrasonographic image of the intestine formation at the colonic anastomotic site. Note the scar tissue showing absence of wall layering (white arrow) and focal covering the staples. accumulation of luminal gas centered at the enterectomy site (black arrows). The latter was also observed in a previous study (27) and was related to the reduced wall compliance of the enterectomy site.

There were 4 duodenojejunal (cases 2, 4, 7, 14), 6 jejunal next day with stabilization of cardiovascular parameters and a (cases 1, 3, 5, 9, 12, 13), 1 jejunoileal (case 6), 2 jejunocolic hematocrit of 39%. Dog 3 required intensive care immediately (cases 8, 10), and 1 colonic (case 11) anastomoses. The mean after surgery; intravenous 0.9% NaCl (20 mL/kg per hour) time required for construction of the anastomoses was 5 min. and colloid solutions (Fresenius Kabi), 10 mL/kg BW over 4 h, The mean number of staples used was 20 (Table 1). were administered to maintain adequate blood pressure (systolic Concurrent surgical procedures included ovariohysterectomy . 80 mmHg). Despite fluid therapy, hypotension persisted. (case 3), splenectomy (case 12), uterine stump excision (case 13), Blood analyses showed leukocytosis, thrombocytopenia, hypo- and mesenteric lymph node biopsy (cases 3, 7, 12, 14). A peri- glycemia, azotemia and increased lactatemia, ALT, and ALP. toneal drain (Blake silicone drain — flat, Ethicon) was used in Dobutamine (Baxter S.A.S.), 5 mg/kg BW per minute constant case 13. Samples were taken for bacteriological analysis from the rate IV infusion, oxygen, dextrose (0.5 g/kg BW, IV), and abscessed omentum (case 2) and free fluid (case 13). metronidazole (Sanofi-Aventis), 15 mg/kg BW, IV, q12h, were instituted. Decompensation continued with refractory hypoten- Postoperative data sion, oliguria, severe ventricular arrhythmias, and cardiac arrest Dogs 2, 7, 10, 11, 13 experienced minor complications (Table 1), 24 h after surgery. Dog 4 had prolonged prothrombin time which resolved with medical therapy and dietary management. (PT), activated partial thromboplastin time (aPTT), decreased Dog 13 required intensive care immediately after surgery due platelets, and serum fibrinogen, consistent with DIC that led to peritonitis and hypokalemia; peritoneal fluid, electrolytes, to collapse and death despite fresh blood transfusion 24 h after and hematology were analyzed regularly. Cefalexin (Sogeval), surgery. In cases 3 and 4, immediate postmortem examination 20 mg/kg BW, IV, q12h and metronidazole (Flagyl; Sanofi- revealed an intact anastomosis with no leakage. These deaths Aventis, France), 15 mg/kg BW, IV, q12h, were given to provide were considered to be unrelated to the surgical technique. In broad-spectrum coverage. Lactated Ringer’s solution (Fresenius case 11, rectal palpation revealed stricture at the surgical site Kabi), 50 mL/kg BW per day with potassium chloride (Fresenius 4 wk after surgery. The owner refused to continue therapy and Kabi), 30 mEq/L, and enteral feeding via nasoesophageal tube requested euthanasia. Immediate postmortem examination of were administered until complete recovery 2 d later. the anastomotic site showed extensive external and internal scar Four dogs experienced major complications including hypo- tissue narrowing the lumen and reducing compliance of the volemic shock (case 1), collapse, and death (cases 3 and 4), intestinal wall (Figure 2). Legs of the staples were occupying and intestinal anastomosis stricture (case 11). Dog 1 had a the intestinal lumen. rapidly falling peripheral hematocrit (21%) 12 h after sur- Enterococcus faecalis and Escherichia coli were isolated from gery. Hemorrhage around the anastomotic site was suspected cultures of cases 2 and 13, respectively. In case 2, the abscess was after ultrasound examination and guided abdominocentesis removed en bloc with the intestine. The postoperative CBC and (hematocrit of the sample 37%). Abdominal counterpressure clinical examinations showed no evidence of infection; cefalexin was applied and whole blood transfusion and oxygen therapy was discontinued 5 d after surgery. In case 13, metronidazole were administered. Clinical improvement was seen over the was stopped 5 d after surgery and cefalexin (20 mg/kg BW, PO,

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Table 2. Details of the sequential ultrasonographic follow-up of the intestinal wall thickness at the anastomotic sitea Follow-up 3 days 15 days 30 days 6 months 12 months Number of dogs 12 12 12 10 9 Wall thickness (mm) Range 6 to 12 (2.1 to 5.6) 5.5 to 8.2 (2.5 to 5.5) 5.5 to 7.5 (2.5 to 5.8) 5.5 to 6.8 (3.5 to 5.5) 5.5 to 7 (3.5 to 5.4) Median 7.73 (4.32) 6.7 (4.08) 6.5 (3.94) 6.27 (3.62) 6.1 (4.1) Wall thickness ratio Range 1.36 to 2.95 1.2 to 2.36 1.17 to 2.22 1.21 to 1.71 1.3 to 1.71 Median 1.84 1.72 1.58 1.46 1.48

ARTICLE a Intestinal wall thickness values of normal, adjacent intestinal segment are included in brackets.

q12h) was continued for 10 d. The mean duration of hospital- ple alignment and depth control with the skin stapler rely on the ization was 3.25 d. surgeon’s skill, as each staple is applied individually. Inexperience with the technique resulted in anastomotic dehiscence in 30% Follow-up of the cases in 1 study (13). This highlights the need for training Histopathological data were available for 9 dogs (Table 1). before applying the technique in clinical cases. In our experi- Tumor-free resection margins were achieved in all except ence, a short training period was sufficient to enable reliable case 11. Mesenteric lymph node biopsies were consistent with and consistent anastomoses, which was confirmed by the low metastases in dogs 3, 7, 12 and 14. rate of technical complications. The pubic bone hindered staple Mean follow-up time was 265 d. Five animals died or were placement in 1 case of low colonic anastomosis. Procedures in euthanized during the study (Table 1). Dogs 12 and 14 were the distal colon could be improved by using “pistol” type skin euthanized due to deterioration despite chemotherapy. The staplers with swivel noses that allow access to deeper, narrow owners confirmed normal digestive function in the 9 dogs that anatomical spaces, or pubic osteotomy to increase intestinal were alive at the end of the study. exposure (1,2). The surgical sites were visualized by ultrasound at each Unlike the B-shaped staples produced by circular or linear follow-up. Absence of wall layering (Figure 3) was observed devices, skin staples close in a square shape and are not hemo- over sequential examinations in all dogs except 2 that had static (1). The origin of the bleeding in case 1 was not deter- altered wall layering at 1 y. Focal wall thickening was present mined, but possible causes include inappropriate arcuate vessel in all cases at each follow-up but there was a sequential mild hemostasis or vessel laceration by a staple. Bleeding from the decrease in relative bowel wall thickness (Table 2). Hyperechoic staple line was reported in 2 cats after the use of circular EEA fat was observed in all dogs (n = 12) at day 3, in all but 1 dog devices for colonic anastomosis, which was resolved with blood at month 1, and had resolved in all dogs (n = 10) at month 6. transfusion (4). Iatrogenic vessel laceration can be avoided by Complete resolution of post-surgical pneumoperitoneum was gentle clearing of surrounding fat at the bowel ends to facilitate documented in all cases (n = 12) by day 15. Normal peristalsis accurate staple placement. Thorough inspection for evidence of was present in all dogs at each follow-up. Intestinal corruga- pulsatile bleeding from the anastomotic line is essential before tion was observed in dogs 9 and 13 at day 3 and had resolved closure. on day 15. Stricture formation following colonic anastomosis using Staple loss was observed in cases 5 (8/12 staples) and 7 (17/25 the skin stapler technique has not been reported previously staples) at the 6-month follow-up; no staples were seen in the (10,11,13,14). Stricture was reported in 20% of cases in a abdominal cavity or intestinal lumen. series of transrectal EEA in dogs and cats; no specific causes were identified (6). Colonic stricture may result from exces- Discussion sive tension, poor blood supply, adhesions at the level of the The use of a skin stapler with regular stainless steel staples was anastomosis, or inadequate postoperative management (1,2). effective for performing intestinal anastomosis in a population of Adequate blood supply to the anastomosis is vital: ligation of dogs with variable body weights and intestinal wall thicknesses, the cranial rectal artery in conjunction with colorectal resection and with various clinical conditions. The technique required and anastomosis has been associated with severe compromise inexpensive material, appeared to reduce surgical time, and of vascularity and necrosis of the distal colon and rectum (17). enabled consistent anastomoses with a low rate of complications. In dog 11 small perforating vessels from the caudal mesenteric The mean time required for anastomosis (5 min) was shorter and cranial rectal arteries required individual ligation along the than for hand-sewn interrupted anastomosis (range: 9.06 to resected intestine to preserve blood supply to the terminal colon 23.5 min) (12,13). Time reported for techniques using the GIA and rectum. Tissue handling or inadequate blood supply to tis- and/or TA devices (range: 7.7 to 18 min) included resection sues adjacent to the anastomosis may have induced transitory (5,7), which precludes comparison with our study. edema or congestion leading to impaired healing and stricture. Thoracoabdominal, GIA, and EEA devices fire 2 to 4 parallel Fibrous tissue proliferation seen in dog 11 may be explained staggered staple lines enabling consistent mechanically accurate by the absence of clean margins after tumor resection or the tissue apposition (1), unlike the disposable skin stapler. Even sta- high number of staples used that may have stimulated local

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­inflammation (18). Passage of solid feces has been demonstrated technique could explain the persistence of hyperechoic fat in to significantly decrease stricture formation by preventing the this study (30). healing anastomosis site from forming scar tissue across the The median relative wall thickening of dogs evaluated at 6 mo lumen (19). The laxatives administered to this dog induced (n = 10) and 1 y (n = 9) after surgery was 1.46 and 1.48 times formation of soft stool. the normal adjacent intestinal wall, respectively. Similar data Postmortem evaluation of the anastomotic site in dog 11 (1.4 times) were obtained for postoperative hand-sewn enterec- showed protrusion of the staple legs into the lumen with tomy wall thicknesses from 7 mo to 7 y (31). Despite this focal ARTICLE proliferation of thick fibrous tissue. Migration of staples into thickening, there was no evidence of significant luminal nar- the intestinal lumen and eventual excretion with the feces has rowing or impaired motility except in the dog that had colonic been suggested (20). Disappearance of staples was observed on stricture. radiography in 2 cases without consequences. The mechanism None of the visualized enterectomy sites had normal wall lay- of staple migration has not been elucidated and complications ering. Histological analyses on old healed intestinal anastomoses caused by the passage of the staples into the lumen cannot be (3.5 y) in humans have shown chronic inflammatory cells and excluded. Staples in GIA, TA, and EEA devices used for intes- muscular discontinuity with areas of intervening fibrosis (32). tinal anastomoses close to a height of 1.5 and 2.0 mm, whereas This finding is consistent with the previous long-term ultraso- skin staples used in this study close to a height of 3.4 mm (1). nographic study of enterectomy sites, which reported changes Discrepancy between the height of the staples and wall-thickness in the bowel wall architecture that persisted for up to 7 y (28). (2.1 to 2.5 mm) in this dog may have resulted in significant The inclusion of dogs with neoplastic lesions influenced the penetration of the staples into the lumen of the intestine con- number of postoperative deaths and reduced the length of post- tributing to obstruction and tenesmus. Intestinal obstruction operative follow-up, limiting the strength of our conclusions. secondary to staple exposure has been reported as a complication Intestinal anastomosis using a standard skin stapler with stainless of EEA in a dog (21). Caution is therefore recommended when steel staples proved effective when applied to elective and emer- using regular staples in thinner intestinal walls, particularly in gency surgeries. The technique enabled rapid construction of the colon, due to the risk of intraluminal staple exposure and consistent anastomoses with a single, inexpensive stapler. There subsequent intestinal obstruction. was no dehiscence and stricture formation was observed in 1 of Dehiscence is one of the most serious complications encoun- the 14 dogs. This surgical technique merits further investigation, tered in intestinal surgery with significant morbidity and especially with regard to the development of smaller staples for mortality rates (22–24). Dehiscence at the anastomotic site thinner intestinal walls. CVJ was not observed in this study, although some of the dogs had preoperative peritonitis, intestinal foreign bodies, postsurgical References blood transfusion, and/or low serum albumin concentrations, 1. Tobias KM. Surgical stapling devices in veterinary medicine: A review. Vet Surg 2007;36:341–349. all of which are risk factors for intestinal anastomotic leakage in 2. Brown DC. Small intestines. In: Tobias KM, Johnston SA eds. Textbook dogs (22–25). The absence of leaks in the present study com- of Small Animal Surgery. St. Louis, Missouri: WB Saunders/Elsevier, pares favorably with previous clinical series using hand-sewn and 2012:1513–1541. 3. Ullman SL, Pavletic MM, Clark GN. Open intestinal anastomosis stapled intestinal anastomosis, which reported leakage in 3% to with surgical stapling equipment in 24 dogs and cats. Vet Surg 1991; 16% (22–24,26) and 0% to 8.3% of cases, respectively (3–7). 20:385–391. Dehiscence was reported in 30% of the cases in an experimen- 4. Kudisch M, Pavletic M. Subtotal colectomy with surgical stapling instruments via a trans-cecal approach for treatment of acquired mega- tal canine model using the original skin stapler technique for colon in cats. Vet Surg 1993;22:457–463. colonic anastomosis, but these were attributed to initial unfa- 5. White RN. Modified functional end-to-end stapled intestinal anasto- miliarity with the technique (13). In experimental and clinical mosis. J Small Anim Pract 2008;49:274–281. 6. Banz WJ, Jackson J, Richter K, Launer DP. Transrectal stapling for studies using GIA and TA devices, leaks have been reported at colonic resection and anastomosis (10 cases). J Am Anim Hosp Assoc the intersection of the staple lines where the high number of 2008;44:198–204. accumulated staples might have compromised the integrity of 7. Jardel N, Hidalgo A, Leperlier D, et al. One stage functional end-to-end stapled intestinal anastomosis and resection performed by nonexpert the anastomosis and promoted partial necrosis (3,7,27). The surgeons for the treatment of small intestinal obstruction in 30 dogs. absence of superimposed staples with the skin stapler technique Vet Surg 2011;40:216–222. or a circular EEA device may reduce this risk. 8. Fackler ML, Breteau JPL, Sendowski ICP, Martin PDF. Perforating wounds of the abdomen by the modern assault rifle. J Trauma (China) Ultrasound examination of stapled intestinal anastomosis 1990;6:192–199 (suppl). has rarely been reported in dogs (7). In our study, hyperechoic 9. Howell GP, Morgans BT, Ryan JM, Cooper GJ. Assessment of the use fat persisted in 92% of the cases 1 mo after surgery. Sequential of disposable skin staplers in bowel anastomoses to reduce laparotomy time in penetrating ballistic injury to the abdomen. Ann R Coll Surg ultrasonographic features of normally healing hand-sewn enter- Engl 1991;73:87–90. ectomy and enterotomy sites showed resolution of hyperechoic 10. Wetherall AP, Howell GP, Cooper GJ, Taylor DE, Howell GP, Rice P. fat in 80% of the cases by day 10 after surgery (28). In a case Use of disposable skin staplers for bowel anastomosis to reduce lapa- rotomy time in war. Ann R Coll Surg Engl 1992;74:200–204. series of 30 dogs treated for intestinal obstruction with an 11. Edwards DP, Galbraith KA. Colonic anastomosis in the presence of end-to-end stapled anastomosis technique, hyperechoic fat fecal peritonitis using a disposable skin stapler. J Invest Surg 1998;11: was reported at day 3 in 2 dogs and was not evident on day 15 267–274. 12. Coolman BR, Ehrhart N, Pijanowski G, Ehrhart EJ, Coolman SL. (7). Hyperechoic fat is associated with inflammation, fibrosis, Comparison of skin staples with sutures for anastomosis of the small or scar tissue (29). The eversion tendency of the skin stapler intestine in dogs. Vet Surg 2000;29:293–302.

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13. Ang BK, Cheong D, Teh E, Teoh TA, Teoh TA, Tsang C. Skin stapled 24. Ralphs SC, Jessen CR, Lipowitz AJ. Risk factors for leakage following bowel anastomosis in a canine model. Singapore Med J 1999;40:81–83. intestinal anastomosis in dogs and cats: 115 cases (1991–2000). J Am 14. Fraser I. Intestinal anastomosis with a skin stapler. A safe and efficient Vet Med Assoc 2003;223:73–77. method in humans. Br J Surg 1994;81:665–667. 25. Tadros T, Wobbes T, Hendriks T. Blood transfusion impairs the healing 15. Penninck D. Gastrointestinal tract. In: Nyland TG, Mattoon JS, eds. of experimental intestinal anastomoses. Ann Surg 1992;215:276–281. Small Animal Diagnostic Ultrasound. 2nd ed. Philadelphia, Pennsylvania: 26. Weisman DL, Smeak DD, Birchard SJ, Zweigart SL Comparison of a Saunders, 2002:207–230. continuous suture pattern with a simple interrupted pattern for enteric 16. Nyman HT, O’Brien RT. The sonographic evaluation of lymph nodes. closure in dogs and cats: 83 cases (1991–1997). J Am Vet Med Assoc Clinical techniques in small animal practice. 2007;22:128–137. 1999;214:1507–1510. 17. Goldsmid SE, Bellenger CR, Hopwood PR, Rothwell JT. Colorectal 27. Kanemitsu K, Kawasaki K, Goto T, et al. Experimental comparison blood supply in dogs. Am J Vet Res 1993;54:1948–1953. of the stapled intestinal anastomotic techniques. Surg Technol Int 18. Ellison GW. End-to-end anastomosis in the dog: A comparison of 2009;18:98–102.

ARTICLE techniques. Compend Cont Educ Pract Vet 1981;3:486–494. 28. Matthews AR, Penninck DG, Webster CR. Postoperative ultrasono- 19. Yamane T, Takahashi T, Okuzumi J, Fujita Y. Anastomotic stricture graphic appearance of uncomplicated enterotomy or enterectomy sites with the EEA stapler after colorectal operation in the dog. Surg Gynecol in dogs. Vet Radiol Ultrasound 2008;49:477–483. Obstet 1992;174:41–45. 29. Penninck D. Gastrointestinal track. In: Penninck D, d’Anjou MA, 20. Coolman BR, Ehrhart N, Marretta SM. Use of skin staples for rapid eds. Atlas of Small Animal Ultrasonography. Ames, Iowa: Blackwell, closure of gastrointestinal incisions in the treatment of canine linear 2008:281–318. foreign bodies. J Am Anim Hosp Assoc 2000;36:542–547. 30. Ravitch MM, Canalis F, Weinshelbaum A, McCormick J. Studies in 21. Carobbi B, Foale RD, White RAS. Trichobezoar obstruction after intestinal healing: 3. Observations on everting intestinal anastomoses. stapled jejunal anastomosis in a dog. Vet Surg 2009;38:417–420. Ann Surg 1967;166:670–678. 22. Allen DA, Smeak DD, Schertel ER. Prevalence of small intestinal dehis- 31. Mareschal A, Penninck D, Webster CRL. Ultrasonographic assessment cence and associated clinical factors: A retrospective study of 121 dogs. of long-term enterectomy sites in dogs. Vet Radiol Ultrasound 2010; J Am Anim Hosp Assoc 1992;28:70–76. 51:652–655. 23. Wylie KB, Hosgood G. Mortality and morbidity of small and large 32. Shomaf M. Histopathology of human intestinal anastomosis. East intestinal surgery in dogs and cats: 74 cases (1980–1992). J Am Anim Mediterr Health J 2003;9:413–421. Hosp Assoc 1994;30:469–474.

Book Review Compte rendu de livre

Tasks for the Veterinary Assistant, and patient care; the latter topic earns 3 chapters to cover all 3rd edition areas for both companion small animals, pocket pets, and some large animals. Pattengale P, Sonsthagen T. Wiley Blackwell Publishing, Compared with the previous edition, most of the line draw- Ames, Iowa, USA, 2014. 656 pp. ISBN: 9781-1184-4078-0. ings have been replaced with black and white photographs $59.99 CDN. — this is especially helpful in the Animal Restraint section, although it is my opinion that “how to restrain” videos would uring the last decade, the description of a veterinary be a worthwhile future addition on the companion website. D assistant has evolved from an on-the-job trained layperson Answers for the most common questions associated with the performing a myriad of non-standardized and undefined tasks, tasks and procedures are provided, so that the assistant will to a more defined, respected, and pivotal member role of the be able to understand the “how” and “why” without having veterinary healthcare team. “Tasks for the Veterinary Assistant” to continually seek out a supervisor. A website containing the was created as an instruction and reference guide for the stan- tables, charts, and flashcards that are in the book is available for dardized North American training programs as well as for pupils quick consultation, although it does not provide any new mate- who are trained on the work site. rial. Rather disappointingly, the paper quality, thin cardboard Those who are interested in this career are made aware from cover, and spiral binding are as inferior as before and will not the opening page that this is a gratifying profession to work in withstand the rigors of daily use for very long. but that there are personal and professional standards that must In the current 3rd edition format, the authors have kept the be maintained and upheld in addition to the medical assistance content up-to-date with the ever evolving protocols, techniques, aspect. The roles of the various members of the veterinary and procedures of the veterinary field. Despite being a hefty team are clearly explained and defined. Topics are thoroughly tome, this book is worth having as it will be an invaluable aid explained in an easy to understand format, then broken down to those who train new employees, as well a useful reference into a “Preparation, Procedure, Follow-up” grid that provides guide for seasoned staff. a brief explanation as to the “why and how” for each particular procedure. Subsequent sections cover animal basics, anatomy, Reviewed by Donna Morley, VT, Clinique Vétérinaire de nutrition, restraint, laboratory and imaging, pharmacy, surgical Beaconsfield, 40-J St. Charles Blvd, Beaconsfield, Quebec.

722 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Article

Antimicrobial dispensing by Ontario dairy veterinarians

David F. Léger, Nathalie C. Newby, Richard Reid-Smith, Neil Anderson, David L. Pearl, Kerry D. Lissemore, David F. Kelton

Abstract — This questionnaire-based cross-sectional study was designed to capture the demographics of dairy practitioners in Ontario and to describe aspects of antimicrobial dispensing on-farm and over-the-counter by these veterinarians. The information collected revealed that the prescription status of a drug and the level of veterinary- client-patient relationship were important elements of dispensing policies. Over-the-counter dispensing records were incomplete, while only a small proportion of on-farm dispensing records contained pertinent information and directions as required by the Veterinarians Act. While respondents recognized that antimicrobial use in dairy herds could lead to resistance in cattle, few indicated that this was a significant public health issue. Veterinarians can play a key role in antimicrobial stewardship, part of which is the provision of complete written dispensing instructions to producers for antimicrobial use in dairy cattle.

Résumé — La distribution des agents antimicrobiens par les vétérinaires qui s’occupent des vaches laitières en Ontario. Cette étude en coupe transversale a été réalisée à partir de réponses recueillies d’un questionnaire qui ciblait les données démographiques des praticiens des fermes laitières de l’Ontario en plus de décrire les habitudes de dispense des doses d’agents antimicrobiens in situ par les vétérinaires ou en vente libre auprès des distributeurs. Cette information nous a permis de reconnaître que le statut de l’agent antimicrobien prescrit et le niveau de relation entre le vétérinaire-client-patient sont des éléments très importants de la politique de dispense. Les données concernant les agents antimicrobiens achetés sans prescription étaient incomplètes dans les points de vente et seulement une petite proportion des données internes à la ferme contenait les informations et les dosages tels que requis par la loi sur les vétérinaires. Les répondants reconnaissaient que l’utilisation des agents antimicrobiens chez les vaches laitières pouvait élever leur résistance à ceux-ci, mais peu d’entre eux mentionnaient que ceci engendrait une réelle inquiétude pour la santé publique. Les vétérinaires ont donc un rôle clé à jouer et ils devront être assidus en fournissant, par écrit, des instructions complètes sur les prescriptions d’agents antimicrobiens aux producteurs de vaches laitières. (Traduit par les auteurs) Can Vet J 2015;56:723–729

Introduction ers (4–8). Common elements among these guidelines include: the need for a valid veterinarian-client-patient-relationship oncerns regarding the potential public health impact of (VCPR); justifiable antimicrobial treatment and selection; the resistant bacterial infections of food-animal origin resulted C need for written (versus verbal) treatment protocols and dispens- in calls for more prudent use (1–3). This has in turn spawned ing records; the promotion of husbandry practices that will have the development of guidelines and policy recommendations a sparing effect on antimicrobial use; and on-going veterinary regarding the use of antimicrobials by veterinarians and produc- and producer continuing education regarding antimicrobial use and resistance. Antimicrobial drugs are used in the conven- Laboratory for Foodborne Zoonoses, Public Health Agency tional management of dairy herds (9,10); there was a lack of Canada, Guelph, Ontario N1G 5B2 (Léger, Reid-Smith); information on antimicrobial dispensing by veterinarians. The Department of Population Medicine, University of Guelph, purpose of the current study was to collect baseline information Guelph, Ontario N1G 2W1 (Newby, Reid-Smith, Pearl, on antimicrobial use in Ontario free-stall dairy herds in 2001. Lissemore, Kelton); Ontario Ministry of Agriculture and Food, Although not specifically tied to the issue of antimicrobial Elora, Ontario N0B 1S0 (Anderson). resistance, concerns associated with on-farm food safety have Address all correspondence to Dr. David F. Kelton; e-mail: contributed to the development of a quality assurance program [email protected] by the dairy industry. The Canadian Quality Milk (CQM) Use of this article is limited to a single copy for personal study. program is a HACCP (Hazard Analysis Critical Control Points)- Anyone interested in obtaining reprints should contact the based program that outlines best management practices linked CVMA office ([email protected]) for additional to the prevention of specific hazards, with a section specific to copies or permission to use this material elsewhere. managing drug use on farms to avoid residues in milk and meat

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(11). Industry initiatives like CQM and the Livestock Medicines The body of the questionnaire focused on aspects of anti- Education Program (12) are intended to encourage proper han- microbial use pertaining primarily to lactating cow treatments. dling and administration of drugs on-farm. Attitudes regarding antimicrobial use were investigated with Antimicrobials vary in their importance based on their abil- questions about dispensing policies and the veterinarian-client- ity to treat severe bacterial infections. The Veterinary Drug patient-relationship, factors influencing drug selection, the use Directorate has categorized animal antimicrobials according of written (pre-printed or written at the time of visit) on-farm to their importance to human medicine. It is noteworthy that protocols, drug-use information sources, the records associated ceftiofur, a 3rd generation cephalosporin, is in Category I (very with antimicrobial drug dispensing on-farm and over-the- high importance to human medicine), while penicillin-G is in counter, and the impact of antimicrobial drug use by the dairy

ARTICLE Category II (high importance) (13). Both of these antimicrobi- industry on antimicrobial resistance in dairy cattle and humans. als are commonly used in dairy medicine and their differences Questionnaire data were stored in a relational database should be considered when selecting antimicrobial drugs. (Microsoft® Access 2000). Descriptive analysis was conducted This study was the first of its kind at the time and had the using statistical software; Fishers exact test, Chi-squared, f-test following objectives: provide demographic information for dairy and t-test statistics (two-sided) were used to evaluate univariable practices and practitioners in the Province of Ontario; collect associations between demographic variables, and were considered data on factors that could influence antimicrobial selection, significant at P , 0.05 (SAS version 9.1.2; SAS Institute, Cary, dispensing and use; describe aspects of communications and North Carolina, USA). To assess associations between over-the- record-keeping associated with antimicrobial dispensing; and counter (OTC) dispensing policies for antimicrobials of different ascertain the attitudes regarding antimicrobial resistance in an prescription status) and the level of veterinarian-client-patient- animal health and public health context. relationship (VCPR), a mixed multivariable logistic regression model (PROC GLIMMIX) was created that controlled for extra- Materials and methods neous respondent and practice demographic factors. Given the Sampling frame small number of predictor variables of interest, all were admitted The population of interest for this study was veterinarians in to the full model. Spearman’s rank correlation coefficients were the province of Ontario who practice dairy medicine. A sam- examined for pairwise correlations among predictor variables pling frame of veterinarians (n = 340) was developed from a list . 0.7 to avoid collinearity between model covariates. Model of practices (n = 240) accredited as “Food-Producing Animal building was done manually through an iterative process in Mobile” by the provincial veterinary licensing body, the College which variables were retained based on evidence of confound- of Veterinarians of Ontario (CVO). The CVO registry did not ing, which was a substantive change (. 20%) in coefficients of categorize practices or members by species focus. Individual the explanatory variables of interest (antimicrobials of different veterinarians from these practices were identified using the prescription status and VCPR), based on a significance level CVO 2001 Directory. To further characterize the response of P , 0.05, and also if they were part of an interaction term. rate, veterinary practices were sub-categorized in the sampling Continuous variables (years in practice; percent time spent on frame as Dairy Intensive (practices with 1 or more veterinarians individual cow medicine; percent time spent on dairy practice; committed to full-time dairy practice, n = 48 practices) based number of dairy clients; and percent revenue from drug sales) on known practice profiles and the species focus of individual were examined for linear relationships with the outcome, OTC, practitioners (n = 117) within those practices. To limit design- by assessing quadratic terms and hierarchical dummy variables, based selection bias, in the form of non-response bias, all non- and also using a lowess curve. To account for a practice effect respondents were contacted with equal rigor through follow-up in the model, PracticeID was included as a random intercept. telephone reminders. Interactions among all terms in the main effects model were A questionnaire (described elsewhere, 14), designed to elicit examined for significant associations with OTC dispensing. information about antimicrobial use by dairy veterinarians, Finally, Chi-square tests were used to evaluate the questions was pre-tested by 12 practitioners and refined. On July 2, regarding the impact of antimicrobial drug use by the dairy 2001 questionnaires were mailed to 240 practices. There were industry on antimicrobial resistance, and these questions were no incentives in place to motivate participation. Over the dichotomized from the original 5-point scale (strongly agree to 6-month period following the initial mailing, practices with strongly disagree) into the following categories: strongly dis- non-respondents were contacted by telephone to remind those agree, disagree, and no opinion versus agree and strongly agree. practitioners to complete and submit their surveys. A Fisher’s exact test was used to evaluate potential associations The questionnaire was self-administered and contained between the opinion questions on the animal and human health 4 sections focusing on respondent and practice demographics, impacts of antimicrobial use in cattle and the frequency with antimicrobial dispensing considerations and communications, which a respondent was concerned about AMR in selecting an antimicrobial drug use, and opinions regarding antimicrobial use antimicrobial. and resistance. Practitioner demographic information included the veterinary school year of graduation, the proportion of Results total professional activity dedicated to dairy practice, and the Two hundred and sixty-four veterinarians remained in the amount of time spent on different aspects of dairy production sampling frame once those indicating dairy practice was “not medicine. a duty” were removed. The response rate was 47% (124/264).

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Table 1. Summary of respondent and practice demographics of a survey applied to 264 Ontario dairy veterinarians from 240 practices in July 2001 Number (%) of respondents 124 (47) Number (%) of respondent practices 83 (35) Median (range) years in practice 19 (0.25 to 50) Number (%) of OVCa graduates 117 (94) ARTICLE Number (%) of female respondents 11 (9) Number (%) of respondents practicing in each Ontario region: Southwestern 69 (56) Southeastern 33 (27) South-central 15 (12) Northern 7 (6) Number (%) of respondents, % professional time spent in dairy practice: . 75% 50 (40) 51% to 75% 34 (27) 26% to 50% 19 (15) 1% to 25% 21 (17) % respondents active in different aspects of dairy practice, and the average % (range) practice time spent on those activities: Individual cow medicine and surgery (ICM) 95 40 (0 to 100) Reproduction 98 38 (0 to 100) Milk quality and udder health 85 7 (0 to 30) Feeding and nutrition 72 6 (0 to 40) Replacement heifer management 73 4 (0 to 20) Facility planning 38 1 (0 to 10) Financial consulting 15 0.4 (0 to 15) Number (%) of respondent practices in practice size categories: , 26 farms/practice 24 (29) 26 to 50 farms/practice 24 (29) 51 to 75 farms/practice 15 (18) 76 to 100 farms/practice 10 (12) . 100 farms/practice 11 (13) Median (range) number of dairy herds per practice 45 (1 to 250) Median (range) percentage of practice herds milking: , 50 cows 59% (0 to 100) 51 to 100 cows 36% (0 to 100) . 100 cows 4% (0 to 29) Median % (range) herds per practice with free-stall barns 20% (0 to 83) Median % (range) gross practice revenue from drug sales 43% (1 to 100)

a OVC — Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.

Respondent demographics are summarized in Table 1. The variables with the exception of the percentage of professional response rate in each region was reflective of the provincial time spent in dairy practice, where most of the female respon- distribution of the dairy industry, with most respondents prac- dents (9/11) spent , 50% of their professional time engaged in ticing in either southwestern or southeastern Ontario (Table 1). dairy practice compared with 68% of males spending . 50% There were 83 practice locations: 42 in southwestern Ontario, of their time in dairy practice (Fisher’s exact test, P = 0.0006). 20 in southeastern Ontario, 15 in south-central Ontario, and The number of dairy clients per practice was evenly distrib- 6 in northern Ontario. The number of respondents per prac- uted across the other categories with 48% of respondents serving tice ranged from 1 to 5, but in most cases there was only 50 farms or less. There were no significant regional differences 1 (70%) or 2 respondents (18%) per practice. Seventy-three in the proportion of small, medium, and large herds across percent of the practices were categorized as dairy intensive and regions (f-test, 3 df, P . 0.05). Practices across the province 57% of the veterinarians in these practices responded to the indicated the majority of herds they attended milked 50 cows questionnaire. or less and a relatively small percentage of herds milked more Respondents to our questionnaire were Ontario dairy practi- than 100 cows (Table 1). Response rate to the question regard- tioners, predominantly male graduates of the Ontario Veterinary ing dairy practice gross revenue was 80% (99/124). Specifically, College with 11 to 24 y in practice (median time in practice = this questionnaire asked respondents to estimate the percentage 19 y). Eleven female veterinarians (9%) responded (Table 1). of their dairy practice gross revenue that was derived from drug There were no significant differences in the distribution of sales and professional fees; the median for this estimate was 43% female and male respondents among the other demographic (with an interquartile range of 15%).

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From the client-type profiles provided by respondents in terms of level of Veterinarian-Client-Patient-Relationship (VCPR), the overall median values were as follows: 80% “regu- lar clients” (farm visited every 2 to 8 wk), 15% sporadic clients (1 to 5 visits/y), and 0.5% rare clients (, 1 visit/y). A qualita- tive assessment of the data indicated within-practice variation among responses from multi-respondent practices; data, at the individual respondent-level indicated a higher frequency of OTC dispensing for both antimicrobials for regular clients (76% for

ARTICLE penicillin, 69% for ceftiofur), followed by sporadic clients (51% and 38%, respectively) and finally a very low frequency for rare clients (21% and 8%, respectively). For regular clients, most of the respondents indicated a policy of OTC dispensing for both antimicrobials, with 24% and 31% requiring some form of vet- Mean frequency score erinary consultation prior to dispensing penicillin or ceftiofur, Figure 1. Mean frequency scores and 95% confidence respectively. After removing “NA” (not applicable) responses, intervals for considerations in selecting an antimicrobial treatment in a lactating cow as provided by 124 respondents 25% and 32% of respondents indicated they would not dispense to the survey administered to 264 Ontario dairy practitioners penicillin or ceftiofur, respectively, OTC to any dairy producer, in July 2001. AMR — Antimicrobial resistance; Error bars while 20% and 7% indicated they would dispense these antimi- depict 95% confidence limits for the mean frequency scores (SAS, Proc Means). crobials without any form of veterinary consultation regardless of the level of VCPR. A mixed multivariable logistic regression model indicated Among different factors considered in choosing an anti- that OTC dispensing policy was associated with the type of microbial treatment for a lactating cow, a drug treatment’s antimicrobial being dispensed and VCPR client type, while efficacy for the given condition ranked the highest, in terms controlling for the other demographic confounders in the of mean frequency score (Figure 1). Having a label indication model. The odds of procaine penicillin G being dispensed OTC for lactating dairy cattle and the milk withdrawal time for the were 4.6 times greater compared to ceftiofur [95% confidence drug were reported to be the next most frequent considerations interval (CI): 2.5, 8.6; P , 0.0001]. Regular clients were in choosing an antimicrobial. Most indicated that potential 26.3 times more likely to receive antimicrobials OTC compared injection site lesions and antimicrobial resistance development to sporadic clients (95% CI: 10.9, 63.7; P , 0.0001), and the were only occasionally considered. Mean frequency scores for odds of OTC dispensing to sporadic relative to rare clients were veterinarian’s profit were low, with the majority indicating this 16.7 times greater (95% CI: 8.3, 33.3; P , 0.0001). Relative was never (72%) or only occasionally (22%) considered in to respondents with a percent time spent on dairy practice antimicrobial selection. , 26%, those with higher percentages of time spent in dairy Thirty-four respondents (28%) indicated they provided their practice were significantly more likely to allow OTC dispens- dairy clients with antimicrobial drug use protocols for lactating ing without requiring a veterinary consultation [26% to 50% cows. Several respondents commented that protocols were not time spent on dairy practice, odds ratio (OR) = 5.9; 95% CI: provided frequently, nor were they provided to all clients. In 1.4, 24.3; P = 0.01; 51% to 75% time spent on dairy practice, reporting how antimicrobial use instructions were provided to OR = 12.3; 95% CI: 3.6, 42.7; P , 0.0001; . 75% time spent dairy producers 88% of respondents indicated that they wrote on dairy practice, OR = 7.3; 95% CI: 2.2, 24.3; P = 0.001]. instructions for clients “often” or “always,” of those, 40% indi- The odds of OTC dispensing were 5.2 times greater among cated that they “always” left some form of written record. The respondents with less than 10 y in veterinary practice compared “other” forms of treatment instruction included written instruc- with their more experienced counterparts (95% CI: 2.2, 12.4; tions on the milk house white board, written instructions in the P , 0.001). herd book, or written treatment sheets and protocols. Regarding Respondents provided a ranking of the relative frequency with record quality, the information most frequently included in an which they consulted different sources of information regarding OTC record was the drug name (79%), the date (75%), and antimicrobial drug use in lactating cows. Continuing education amount dispensed (73%), but information about the case and seminars, veterinary journals, and pharmaceutical company treatment specifics, including residue avoidance instructions representatives were cited as primary information sources and were cited at frequencies , 20%. Twenty-seven percent of were ranked the highest, while the Internet was ranked the low- the veterinarians provided complete records when dispensing est. The second tier of information sources included veterinary on-farm; however, none of the respondents provided a complete colleagues, laboratory tests, and the Compendium of Veterinary OTC dispensing record. Products, followed by provincial government publication and There was a greater proportion of veterinarians (81%) who specialist advice. Among the lower ranking sources were the responded to our questionnaire who agreed to the question Veterinary Drugs Directorate (VDD), the gFARAD (global “Do you feel antimicrobial drug use, at the current levels within Food Animal Residue Avoidance Databank) system, and other the dairy industry, is a contributor to decreased antimicrobial sources (product labels and clinical experience). efficacy in dairy cattle” compared with those who did not

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agree (18%) (Chi-squared = 48, 1 df, P , 0.01). In contrast, Veterinarians should demonstrate an attitude of antimicro- 86% of respondents indicated some level of disagreement or bial stewardship in their dispensing policies, given their role as no opinion, compared with the proportion that agreed, to the a trusted advisor to producers. A survey of Ontario producers question asking whether antimicrobial use in dairy cattle could found that 99% of respondents ranked their herd veterinarian contribute to resistance in human medicine (Chi-squared = 64, as a primary source of advice on antimicrobial use and 96% 1 df, P , 0.01); of these, 27% indicated no opinion (data not identified their veterinarian as a primary retail source of antimi- shown). crobial products for their herd (14). Another study noted that ARTICLE 94% of producer respondents relied on veterinarians most in Discussion dealing with health management issues (19). A study involving The demographic statistics for veterinary respondents and South Carolina producers suggested that herd veterinarians are practices mirrored the distribution of dairy operations in the viewed as credible sources of information about antimicrobial province and regional milk production statistics for 2001 use and that a functional VCPR can influence attitudes of farm (15). In surveys conducted by the Ontario Veterinary Medical workers about the potential occupational hazards associated with Association (OVMA), median drug revenue for mixed and antimicrobial resistance on the farm (20). large animal practitioners, excluding equine specialists, was Implicit in the question about considerations in antimicrobial found to be 45.7% of total revenue (Darren Osborne, Director selections was that there was a presumptive diagnosis of a bacte- of Economic Research, OVMA, personal communication, rial infection, given the empirical knowledge of the clinician, and 2014) compared to the survey response median of 43% in this the need for antimicrobial treatment was justified; this question report. was not intended to solicit pharmacodynamic/pharmacokinetic The respondent demographics of the study population were considerations in drug selection (21) beyond efficacy of an anti- reflective of those of the source population of dairy veterinarians microbial for the given condition. Respondents indicated that thus minimizing non-response bias. The questionnaire design the potential for resistance development and veterinarian’s profit attempted to limit the potential for bias in responding by relying were rarely considered in selecting an antimicrobial, while efficacy, heavily on 5-point Likert scale questions, some with frequency labeled for use in lactating dairy cow, and milk withdrawal time scales (Never — Always), which appear to have minimized were the primary considerations, all of which are among the key this potential bias. The response distributions did not indicate elements of prudent antimicrobial use (6,7). the presence of significant positive skewing, central tendency, In this study, antimicrobial use protocol provision by veteri- acquiescence bias, or faking good (16). narians (28%) was similar to data from producer respondents The definition of a valid VCPR in the regulations under in Pennsylvania (21%) (22), Washington State (27%) (19), the Veterinarians Act of Ontario includes the elements that a and South Carolina (32%) (20), who indicated having written veterinarian has “sufficient knowledge” through “timely visits treatment plans in place (pre-printed or written at the time of to the premises,” that he/she believes that “the drug is prophy- visit versus verbal instructions only). A Wisconsin study showed lactically or therapeutically indicated for the animal,” and that that the use of written treatment protocols increased with herd the producer “has indicated a willingness to accept the advice” size, likely driven by a need for standardized procedures as the (17). Our questions regarding dispensing policies focused on number of farm personnel increased, and that 60% were written 2 antimicrobials; penicillin G (non-prescription) and ceftiofur by a veterinarian (23). Interviews with South Carolina producers (prescription) (18). We found that most of the responders revealed that while protocols were not available as formal writ- applied the concept of a valid VCPR in dispensed antimicrobi- ten documents, daily herd management still followed standard als. Our survey instrument did not establish the extent to which operating procedures developed through personal experience responses reflected clinic level policy or individual case-by-case (20). Our study also revealed that the majority of veterinarians dispensing behavior. Responses to this question did establish provided written instructions when dispensing antimicrobials that farm visit frequency and prescription status of an antimi- OTC and on-farm. However, record quality in terms of case crobial were used by veterinarians as discriminating factors in specific instructions was generally low, irrespective of dispensing determining the limitations on OTC dispensing. There was location, which could result in poor producer compliance and/ evidence of a policy shift to less OTC dispensing with a greater or improper antimicrobial use. While our findings indicated that requirement for consultation as the VCPR became more tenu- respondents may have deferred antimicrobial use instruction to ous. Multivariable models indicated that practice and individual the product label, the Ontario Veterinarians Act requires veterinar- demographic factors, generation of veterinarian and his/her ians to provide complete dispensing instructions to producers; time spent on dairy practice, may affect dispensing policy. some respondents may have assumed that the manufacturer’s Practitioners with , 26% of their time in dairy herds may be label information meets the requirements for providing directions applying a more cautious OTC dispensing policy, preferring to on use of the product. At the time of our survey, the Canadian dispense antimicrobials while on-farm. Less specialized prac- dairy industry was developing, but had yet to implement, the tices may not be destinations for producers to pick up drugs. Canadian Quality Milk (CQM) program (11), which included Younger dairy veterinarians may feel some level of intimidation a requirement that producers maintain treatment protocols and by demanding producers as they try to establish themselves in records under the guidance of their herd veterinarian (24). their practices and wanting to avoid confrontation over access Most respondents agreed that antimicrobial use in the dairy to drugs. industry could contribute to decreased efficacy in dairy cattle.

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These results are similar to those from a study reporting that practices and antimicrobial use. Additionally, other initiatives 74% of producers agreed that “antibiotics become less effective have resulted in a call to action by commodity and veterinary the more they are used” and a majority of producers (59%) organizations, and government agencies. New federal legislation agreed that antibiotic use in food animals could affect human on antimicrobial dispensing has been proposed (35). A recent health, but only 34% felt that a cow with an antimicrobial resis- policy paper published by the OMA has identified food-animal tant infection in the herd would pose a threat to farm workers agriculture as major users of antimicrobials and has made sev- (19). Interviews with South Carolina dairy producers revealed eral recommendations regarding how antimicrobials should be that 86% were not concerned about the potential for farm staff dispensed in this sector (36). Assuming there has been a shift to carry antimicrobial resistant organisms in relation to the in attitudes by policy makers toward greater antimicrobial stew-

ARTICLE overuse of antimicrobials on the farm (20). Most respondents ardship, it is speculated that there will be a trickle down effect to our survey did not believe that antimicrobial use in dairy to end users, veterinarians and producers. A follow-up study cattle had a public health impact. Furthermore, in selecting is warranted to collect current data in Ontario dairy herds in an antimicrobial, most of the respondents were not influenced order to assess if and how dispensing practices have changed by the potential for resistance development. However, 59% of since 2001. Washington State dairy producers agreed that antibiotic use in In general, respondents indicated the requirement for some food-producing animals could affect human health (19). Those form of consultation prior to dispensing penicillin or ceftio- in animal agriculture who disagree with this premise contend fur increased as the VCPR became more tenuous, and a shift that the greatest determinant of antimicrobial resistance in towards more restrictive dispensing policies was greater for ceft- humans is overuse/misuse by physicians. One assessment of phy- iofur than for penicillin. Most respondents frequently provided sician prescribing behavior found that 61% of prescriptions met written instruction when dispensing an antimicrobial and just with guideline recommendations, 10% were for the use of newer over half frequently added this information to the main clinic important narrow spectrum antimicrobials, and in 20% of cases medical record for that farm. None of the respondents provided antibiotics were not indicated (25). Educational interventions complete OTC dispensing records, whereas 27% provided com- aimed at curbing excessive or inappropriate prescriptions often plete records when dispensing on-farm. Potential antimicrobial focused on health economic outcomes, have met with varied resistance development was not a primary consideration in the success, and generally the net result has been modified prescrip- selection of an antimicrobial but there was general agreement tion profiles of subject physicians (26–29). Calls for restricted among respondent veterinarians that antimicrobial use in the use of antimicrobials in agriculture (30–32) and the need for dairy industry was a contributor to antimicrobial resistance veterinary leadership and education in developing strategies for in cattle. The majority disagreed that it could have a negative the preservation of antimicrobials (10) have motivated several impact on human medicine. As trusted advisors to producers, organizations to create prudent use guidelines (6,7), but there veterinarians play a key role in antimicrobial stewardship in remains little in the way of sustained veterinary and producer directing the appropriate use of these important drugs. education concerning antimicrobial use and resistance in a pub- lic health context. The Canadian Veterinary Medical Association Acknowledgments has published species-specific prudent use guidelines, which This project was supported by the Ontario Ministry of Agriculture ranked antimicrobial selection by their category of importance and Food, Food Safety Program and by the Laboratory for in human medicine, for various bacterial diseases. There is a Foodborne Zoonosis, Public Health Agency of Canada. We are need for additional research to better describe the potential grateful to the Ontario dairy veterinarians who participated in this public health impact of antimicrobial use on dairy farms. research project by responding to the questionnaires. We thank In the years since this study was conducted there have Andrea Rowe, Heather Aitken, Mary Lichti, Alison Mather, and been several initiatives [CgFARAD, CQM, Ontario Medical Betsy Varughese for their help with data management. We also Association (OMA) policy paper] that may have impacted cur- acknowledge and are grateful for the statistical support provided rent veterinary dispensing practices and attitudes. CgFARAD, an by William Sears. CVJ ongoing service that was active at the time of this study, provides information to veterinarians pertaining to the extra-label use of References drugs (ELDU) and the associated risks of violative residues (33). . 1 World Health Organization. The Medical Impact of Antimicrobial Use This program has provided limited advice on the potential for in Food Animals, Report of a WHO Meeting. Berlin, Germany. WHO/ antimicrobial resistance development/dissemination, thus it is EMC/ZOO/97.4 [Web Page]. 1997; Available from: http://whqlibdoc. less likely to have had a significant impact on the dispensing of who.int/hq/1997/WHO_EMC_ZOO_97.4.pdf Last accessed April 27, 2015. antimicrobials on dairy farms. On the other hand, the CQM pro- 2. World Health Organization. WHO global principles for the contain- gram, an on-farm food safety/quality assurance program, requires ment of antimicrobial resistance in animals intended for food. WHO/ producers to maintain drug inventory lists, log animal treat- CDS/CSR/APH/2000.4 [Web Page]. 2000; Available from: http://www. who.int/salmsurv/links/en/GSSGlobalPrinciples2000.pdf Last accessed ments, obtain veterinary prescriptions for ELDU and treatment April 27, 2015. protocols, and in turn increase awareness of the veterinarian’s 3. Avorn JL, Barrett JF, Davey PG, McEwen SA, O’Brien TF, Levy SB. role as a key advisor on drug use, including antimicrobials (34). Antibiotic resistance: Synthesis of recommendations by expert policy groups. WHO/CDS/CSR/DRS/2001.10 [Web Page]. 2001; Available The influence of prudent use guidelines, media, and vet- from: http://whqlibdoc.who.int/hq/2001/WHO_CDS_CSR_ erinary and industry literature may have modified dispensing DRS_2001.10.pdf Last accessed April 27, 2015.

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. 4 American Veterinary Medical Association. AABP/AVMA Judicious 20. Friedman DB, Kanwat CP, Headrick ML, Patterson NJ, Neely JC, Therapeutic Use of Antimicrobials in Cattle [Web Page]. 2014; Smith LU. Importance of prudent antibiotic use on dairy farms in South Available from: https://www.avma.org/KB/Policies/Pages/AABP- Carolina: A pilot project on farmers’ knowledge, attitudes and practices. Prudent-Drug-Usage-Guidelines-for-Cattle.aspx?PF=1 Last accessed Zoonoses Public Health 2007;54:366–375. April 27, 2015. 21. Erskine RJ, Wagner S, DeGraves FJ. Mastitis therapy and pharmacology. 5. Canadian Veterinary Medical Association. CVMA guidelines on the Vet Clin North Am Food Anim Pract 2003;19:109–138. prudent use of antimicrobial drugs in cattle [Web Page]. 2001; Available 22. Sawant AA, Sordillo LM, Jayarao BM. A survey on antibiotic usage in from: http://canadianveterinarians.net/ShowText.aspx?ResourceID=86 dairy herds in Pennsylvania. J Dairy Sci 2005;88:2991–2999.

Last accessed April 27, 2015. 23. Hoe FG, Ruegg PL. Opinions and practices of Wisconsin dairy pro- ARTICLE 6. Veterinary Drugs Directorate, HCGoC. Release of the Final Report of ducers about biosecurity and animal well-being. J Dairy Sci 2006;89: the Advisory Committee on Animal Uses of Antimicrobials and Impact 2297–2308. on Resistance and Human Health [Web Page]. 2002; Available from: 24. Dairy Farmers of Canada. Canadian Quality Milk — Reference Manual, http://www.hc-sc.gc.ca/dhp-mps/pubs/vet/amr-ram_backgrounder- On-Farm Food Safety Program [Web Page]. 2003; Available from: documentation-eng.php Last accessed April 27, 2015. http://www.dairyinfo.gc.ca/pdf/referencemanual.pdf Last accessed 7. FAAIR Scientific Advisory Panel. Policy recommendations. Clin Infect April 27, 2015. Dis 2002;34 Suppl 3:S76–S77. 25. Jelinski S, Parfrey P, Hutchinson J. Antibiotic utilisation in com- 8. Morley PS, Apley MD, Besser TE, et al. Antimicrobial drug use in munity practices: Guideline concurrence and prescription necessity. veterinary medicine. J Vet Intern Med 2005;19:617–629. Pharmacoepidemiol Drug Saf 2005;14:319–326. 9. Meek AH, Martin SW, Stone JB, McMillan I, Britney JB, Grieve DG. 26. De Santis G, Harvey KJ, Howard D, Mashford ML, Moulds RF. The relationship among current management systems, production, Improving the quality of antibiotic prescription patterns in general disease and drug usage on Ontario dairy farms. Can J Vet Res 1986;50: practice. The role of educational intervention. Med J Aust 1994;160: 7–14. 502–505. 10. Hady PJ, Lloyd JW, Kaneene JB. Antibacterial use in lactating dairy 27. Hux JE, Melady MP, DeBoer D. Confidential prescriber feedback and cattle. J Am Vet Med Assoc 1993;203:210–220. education to improve antibiotic use in primary care: A controlled trial. 11. Dairy Farmers of Canada. Canadian Quality Milk — The Program CMAJ 1999;161:388–392. [Web Page]. Available from: http://www.dairygoodness.ca/en/trade- 28. Stewart J, Pilla J, Dunn L. Pilot study for appropriate anti-infective and-industry/organization/programs/canadian-quality-milk/program. community therapy. Effect of a guideline-based strategy to optimize htm Last accessed April 27, 2015. use of antibiotics. Can Fam Physician 2000;46:851–859. 12. Livestock Medicines Education Committee, UoGRC. Livestock 29. McIsaac WJ, Goel V, To T, Permaul JA, Low DE. Effect on antibiotic Medicines Education Program [Web Page]. Available from: http:// prescribing of repeated clinical prompts to use a sore throat score: www.ontariolivestockmed.com/ Last accessed April 27, 2015. Lessons from a failed community intervention study. J Fam Pract 2002; 13. Veterinary Drugs Directorate, HCGoC. Categorization of Antimicrobial 51:339–344. Drugs Based on Importance in Human Medicine [Web Page]. 2009; 30. van den Bogaard AE, Stobberingh EE. Epidemiology of resistance to Available from: http://www.hc-sc.gc.ca/dhp-mps/vet/antimicrob/amr_ antibiotics. Links between animals and humans. Int J Antimicrob Agents ram_hum-med-rev-eng.php Last accessed April 27, 2015. 2000;14:327–335. 14. Leger DF. Antimicrobial use by free-stall dairy producers and veteri- 31. Lipsitch M, Singer RS, Levin BR. Antibiotics in agriculture: When narians in Ontario [MSc dissertation]. Guelph, Ontario: University of is it time to close the barn door? Proc Natl Acad Sci USA 2002;99: Guelph, 2009. 5752–5754. 15. Dairy Farmers of Ontario. Dairy Statistical Handbook 2004–2005 32. Singer RS, Finch R, Wegener HC, Bywater R, Walters J, Lipsitch M. [Web Page]. 2007; Available from: http://www.milk.org/Corporate/pdf/ Antibiotic resistance — The interplay between antibiotic use in animals Publications-DairyStatsHandbook.pdf Last accessed April 27, 2015. and human beings. Lancet Infect Dis 2003;3:47–51. 16. Streiner DL, Norman GR. Biases in responding. In: Streiner DL, 33. CgFARAD. [Homepage on the Internet] c2012. Available from: Norman GR. Health measurement scales — A practical guide to their http://www.cgfarad.usask.ca/home.html Last accessed April 27, 2015. development and use. 2nd ed. New York, New York: Oxford University 34. Canadian Quality Milk (CWM) website [homepage on the Internet] Press, 1995:69–82. c2014 Dairy Farmers of Ontario. Available from: https://www.milk.org/ 17. Government of Ontario. Veterinary Act, Regulation 1093. R.R.O. 1990, Corporate/Content.aspx?id=361 Last accessed April 27, 2015. Reg. 1093, s. 33 (1); O. Reg. 431/00, s. 7. R.R.O. 1990, Reg. 1093, s. 35. HC-VDD legislative changes. 33 (1); O. Reg. 431/00, s. 7. 1990. 36. Ontario Medical Association Policy Paper. When antibiotics stop work- 18. Compendium of Veterinary Products. CVP. Hensall, Ontario: North ing. Ont Med Rev 2013: March:27–43. Available from: https://www. American Compendiums Ltd., 2001. oma.org/Resources/Documents/Antibiotics03192013.pdf Last accessed 19. Raymond MJ, Wohrle RD, Call DR. Assessment and promotion of April 27, 2015. judicious antibiotic use on dairy farms in Washington State. J Dairy Sci 2006;89:3228–3240.

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Pharmacokinetics and bioequivalence of 2 meloxicam oral dosage formulations in healthy adult horses

Melanie Vivancos, Jessica Barker, Sarah Engbers, Carrie Fischer, Jami Frederick, Heather Friedt, Joanna M. Rybicka, Tereza Stastny, Heidi Banse, Alastair E. Cribb

Abstract — Meloxicam, a non-steroidal anti-inflammatory drug, is approved for use in horses in several countries, but an equine formulation is not available in North America. However, meloxicam is being used in an extra-label manner in horses in Canada. The purpose of this study, therefore, was to assess the bioequivalence of an approved oral meloxicam suspension (Metacam 15 mg/mL for horses; Boehringer Ingelheim Vetmedica GmBH, Ingelheim, Germany) from the European Union with human meloxicam tablets (Meloxicam 15 mg tablets; TEVA Canada, Toronto, Ontario) compounded with molasses to improve palatability and administration. The geometric mean ratios (GMR test/reference) and the 90% confidence intervals of the pivotal pharmacokinetic parameters (area under the curve and maximum concentration) were within the defined limits of 80% to 125% generally accepted for products to be considered bioequivalent. Therefore, use of human meloxicam tablets compounded with molasses would be expected to produce a similar clinical response in horses as the approved oral product from the European Union.

Résumé — Pharmacocinétique et bioéquivalence de 2 formulations de posologie orale de méloxicam chez des chevaux adultes en santé. Le méloxicam, un médicament anti-inflammatoire non stéroïdien, est approuvé pour utilisation chez les chevaux dans plusieurs pays, mais une formulation équine n’est pas disponible en Amérique du Nord. Cependant, le méloxicam est utilisé en dérogation des directives de l’étiquette chez les chevaux du Canada. Par conséquent, le but de la présente étude était d’évaluer la bioéquivalence d’une suspension orale approuvée de méloxicam (Metacam 15 mg/ml pour les chevaux; Boehringer Ingelheim Vetmedica GmBH, Ingelheim, Allemagne) de l’Union européenne avec celle des comprimés de méloxicam pour les humains (comprimés de 15 mg de méloxicam; TEVA Canada, Toronto, Ontario) préparés avec de la mélasse pour améliorer la sapidité et l’administration. Les ratios géométriques moyens (test RGM/référence) et les intervalles de confiance de 90 % des paramètres phamacocinétiques clés (secteur sous la courbe et concentration maximale) se situaient dans les limites définies de 80 % à 125 % généralement attendues pour des produits considérés comme bioéquivalents. Par conséquent, l’utilisation des comprimés de méloxicam pour humains préparés avec de la mélasse devrait produire une réponse clinique semblable chez les chevaux à celle du produit oral approuvé provenant de l’Union européenne. (Traduit par Isabelle Vallières) Can Vet J 2015;56:730–736

Introduction on the market in Canada approved for the horse. Aspirin is only on-steroidal anti-inflammatory drugs (NSAIDs) are used labelled for relief of pain and is not commonly used in the horses N for their anti-inflammatory, analgesic, antipyretic, anti- for significant pain or inflammation. Phenylbutazone is labelled thrombotic, and anti-endotoxic properties in a variety of clinical variously for pain and inflammation associated with osteoar- situations. Musculoskeletal disorders with mild to moderate thritis, myositis, and other musculoskeletal disorders in horses. pain and inflammation are among the most common indica- It is frequently used for chronic treatment of musculoskeletal tions for NSAID use in the horse (1,2). Phenylbutazone and disorders in horses because of its accepted efficacy, cost, and acetylsalicylic acid (aspirin) are the only oral NSAIDs currently availability as an oral formulation (3). However, ­phenylbutazone

Faculty of Veterinary Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada T2N 4Z6. Considered equal first authors (Vivancos, Barker, Engbers, Fischer, Frederick, Friedt, Rybicka, Stastny). Address all correspondence to Dr. Alastair Cribb; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

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Table 1. Pharmacokinetic parameters of oral meloxicam in horses from previously published studies (14,19,21). All results are reported as mean 6 standard deviation

Cmax Tmax AUC t1/2 Reference Product Conditions (ng/mL) (h) (ng*h/mL) (h) (19) Metacam® 15 mg/mL oral Fed horses 1730 6 610 3.4 6 1.2 7.76 6 1.992 solution for horses Not reported (Boehringer Ingelheim Nonfed 2580 6 580 1.5 6 1.07 Not reported Vetmedica GmBH) (fed 2 h post-dose) ARTICLE (21) Ilium® Meloxicam 30 Fed horses 915 6 117 2.62 6 1.88 11 281 6 3240 10.24 6 3.04 (Troy Ilium Pty Ltd) (14) 15 mg tablets crushed in Free choice hay; 1580 6 710 3.48 6 3.30 11 220 6 2000 5.25 6 1.40 15 mL molasses 1.5 kg grain twice daily (Caraco Pharmaceutical Labs)

Cmax — maximal concentration; Tmax — time of Cmax; AUC — area under the curve; t1/2 — half-life.

can be associated with significant gastrointestinal and renal influence the pharmacokinetics of oral meloxicam, so it may be toxicity (4–6). As a result, alternative NSAIDs for chronic pain that experimental or analytical differences are responsible for the in horses may be sought by veterinarians. apparent differences and the products may in fact be bioequiva- Meloxicam [4-hydroxy-2-methyl-N-(5-methyl-2-thiazolyl)- lent. However, if there are indeed significant differences between 2H-1,2-benzothiazine-3-carboxamide-1,1-dioxide] is a potent formulations, then the use of extra-label and/or compounded NSAID of the enolic acid class of oxicam derivatives and is a products should be approached with caution. preferential or selective inhibitor of COX-2 in many species, The goal of this study was to determine the bioequivalency including the horse (7–10). NSAIDs with preferential or selec- of human meloxicam tablets (Meloxicam 15 mg tablets; TEVA tive inhibition of COX-2 are thought to be associated with a Canada, Toronto, Ontario) compounded into a form suitable decreased incidence of gastroduodenal adverse events (11), but for administration to the horse compared with the approved the data to directly support this in species of clinical interest in equine product from the European Union (Metacam 15 mg/mL veterinary medicine are lacking. There are 2 studies assessing oral suspension for horses; Boehringer Ingelheim), at the recom- effects of meloxicam on the equine gastrointestinal tract, which mended dose of 0.6 mg/kg body weight (BW), PO, q24h. We provide some support for decreased gastrointestinal effects but used Metacam as the reference pioneer compound because the do not directly address the question of adverse effects during original pharmacokinetic-pharmacodynamic studies for dose routine clinical use (12,13). Regardless of the lack of definitive determination of meloxicam in horses (19) were carried out clinical data, there is a general perception amongst veterinarians with this product. that COX-2 selective compounds have an improved safety pro- The objective was to compare an oral product appropriate file related to the upper gastrointestinal tract and this influences for chronic use. The preference was to use a product already therapeutic decisions. approved for the oral route in a veterinary species. The oral small In the European Union and in Australia, meloxicam is animal meloxicam products available would require a volume approved for use in horses for the alleviation of inflammation not practical for oral administration in horses (approximately and relief of pain in both acute and chronic musculoskeletal 200 mL). There is no approved oral formulation for large ani- disorders. As a result, there has been considerable interest in the mals. However, generic human tablets are available in Canada. use of meloxicam in horses in North America (12–14), as well as As meloxicam is approved for use in humans and animals, as in other species for which it is not currently approved (15–17). the target patient population is a non-food animal, and as Anecdotal reports indicate that extra-label use of meloxi- there are no significant public health risks of using meloxicam cam in horses is occurring in Canada. The majority of pub- in this patient population, use of meloxicam tablets approved lished clinical studies with meloxicam have utilized either the for use in humans was deemed acceptable. Tablets are routinely Boehringer Ingelheim product (Metacam 15 mg/mL oral sus- compounded with molasses in equine practice to improve pension for horses; Boehringer Ingelheim, Vetmedica GmBH, palatability and have a formulation that can be administered Ingelheim, Germany) from the European Union (18,19) or the directly into the mouth with minimal loss of product. Therefore, approved product from Troy Pharmaceutical in Australia (Ilium in accordance with Health Canada Policy on Manufacturing Meloxicam 30; Troy Pharmaceutical, Smithfield NSW, Australia) and Compounding Drug Products in Canada (23), we elected (13,20–22). Pharmacokinetic studies of oral meloxicam in to use human meloxicam tablets compounded with molasses horses (using either commercially available equine products or [as previously reported (14)]. compounded human tablets) have shown considerable variabil- An alternative would have been use of the bovine intravenous ity in the reported parameters (Table 1). This suggests that the product, but it is not approved for oral dosing in cattle, would products may not be bioequivalent, but no head-to-head com- still benefit from compounding to improve palatability and oral parisons have been performed to address this question. Previous retention of product, and it is considerably more expensive than studies have shown that the feeding status of horses (18) can human generic tablets.

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This study tested the hypothesis that human meloxicam heparinized tubes. Samples were centrifuged at 1400 3 g for tablets compounded with molasses for administration were 5 min. Plasma was transferred into microfuge tubes, frozen at bioequivalent to a pioneer product from the European Union 280°C, and stored at 220°C until assayed. developed for oral use in the horse. Sample analysis Materials and methods Plasma samples were analyzed by use of validated high-­ Animals performance liquid chromatography (HPLC). The HPLC The study was carried out in accordance with the standards system was Shimadzu LC-10A series equipped with two of the Canadian Council on Animal Care and received ethi- LC-10AT VP pumps, an SIL 10A autoinjector, an SCL-10A

ARTICLE cal approval from the University of Calgary Animal Care VP system controller, SPD-10A UV-VIS detector and Class-VP Committee. The horses were determined to be systemically Chromatography Laboratory Automated Software (Shimadzu healthy on the basis of a physical examination, complete blood Scientific Instruments, 1998, Columbia, Maryland, USA), with (cell) count (CBC) and serum biochemical analyses completed a NovaPak 18 4-mm column (150 mm 3 5 mm) (WAT086344, 1 wk prior to initiation of the study. serial number: 11239232138 27; Waters Corporation, Milford, Eight horses (7 geldings and 1 mare) were used in this study. Massachusetts, USA). All routine chemicals were obtained Breeds included 3 Quarter Horses, 3 Thoroughbreds, and through VWR Corporation, Radnor, Pennsylvania, USA. 2 Hanoverians. The age of the horses ranged from 2.5 to 30 y The method was adapted from Dasandi et al (24). The extrac- (mean: 14.4 6 11 y). The mean weight was 526 6 57 kg (range: tion method was modified to improve the published recovery 444 to 575 kg). rate of approximately 35%. In a clean Eppendorf microcen- The horses were fed good quality grass hay throughout the trifuge tube, 500 mL of acetonitrile were added to 450 mL of study and had access to water at all times. The evening prior to equine plasma. After being vortexed for 10 s, 50 mL of 15% the initiation of the study horses were fed 2 flakes of grass hay perchloric acid was added. The samples were incubated for at 6 pm. Horses were not fed in the morning until 1 h post- 30 min at 4°C to allow protein precipitation. After centrifuga- dose. The horses then received free choice hay throughout the tion at 13 000 3 g for 5 min, the supernatant was transferred sample collection phase. to an injection vial and 50 mL were injected onto the HPLC system. The mobile phase consisted of a mixture of 85 mmol Experimental design sodium acetate buffer (pH adjusted to 3.3 with glacial acetic A two-period, two-way cross-over design was used. The horses acid) and acetonitrile (65:35 v/v), at a flow rate of 1 mL/min. were randomly assigned to 2 groups of 4. During the first Detection was at a wavelength of 355 nm. Under these condi- period, 1 group received meloxicam suspension (Metacam tions, meloxicam was eluted at a retention time of 8 min. 15 mg/mL oral suspension for horses; Boehringer Ingelheim The method was linear over the calibration range of Vetmedica GmBH; MXM-SUS) and the other group received 10 to 2000 ng/mL of meloxicam (Alfa Aesar; Ward Hill, meloxicam tablets (Meloxicam 15 mg tablets, TEVA Canada; Massachusetts, USA). Standard curves were accepted when the MXM-TAB). Following a wash-out period of 2 wk [. 103 the coefficient of determination exceeded 0.99. maximum reported half-life of 10.24 h (Table 1)] the horses The limit of quantification (LOQ) based on intra-day received the alternate product. and inter-day accuracy and precision was determined to be Meloxicam was administered orally to each horse. Tablets 25 ng/mL, with a limit of detection (LOD) of 10 ng/mL. The and suspension were administered in increments of 15 mg to LOD was established by the lowest evaluated concentration ensure accurate dosing of tablets (i.e., fractions of tablets were that still had a signal-to-noise ratio of at least 3 (concentrations not used). Therefore, the actual range of dose administered , 10 ng/mL were not tested). The LOQ was established as the was 0.56 to 0.62 mg/kg BW, with a mean and median of lowest evaluated concentration with a signal-to-noise ratio of 0.6 mg/kg BW. at least 10 and that had coefficient of variations for accuracy A mortar and pestle was used to crush the appropriate num- and precision that were , 20%. The intra-day accuracy (n = 5) ber of tablets to a fine powder for compounding. The powdered was 6 1% and the intra-day precision was , 6 2.2% except at drug was then added to 15 mL of molasses in a 60-mL catheter the lowest concentration of 25 ng/mL where it was 9.6%. The tip syringe and mixed in situ with a wooden stirring rod. Ten inter-day accuracy (n = 5) was 6 5% and the precision was milliliters (total of 25 mL) of molasses was layered on top and , 6 3.7%, except at the LOQ where it was 19.5%. Meloxicam the plunger was inserted. The same syringe was then used to recovery from plasma was 100% and it was stable in equine administer the drug. The MXM-SUS was administered using plasma for at least 30 d at 220°C. All samples were analyzed the manufacturer’s syringe provided with the product (equiva- within 30 d of collection. lent to a standard 20-mL syringe). Both the MXM-SUS and MXM-TAB were administered orally by inserting the syringe in Pharmacokinetic analysis

the mouth to the back of the tongue and depositing the drug. The maximal concentration of meloxicam (Cmax) and time of Each horse had a 14 g jugular catheter (Angiocath; Becton Cmax (Tmax) were determined directly from the graphical data Dickinson Infusion Therapy Systems, Sandy, Utah, USA) plots for each horse. The data obtained were subjected to non-­ placed prior to each dose. Blood samples (6 mL) were collected compartmental pharmacokinetic analysis. The area under the curve

at 0.5, 1, 2, 3, 4, 5, 8, 12, 18, 24, 36, and 48 h into lithium- (AUC0→LOQ and AUC0→∞) and the area under the first moment

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curve (AUMC0→∞) were calculated for each horse by use of the linear trapezoidal rule. The mean residence time (MRT0→L∞) was determined by dividing the area under the first moment curve by the area under the curve (AUMC0→∞/AUC0→∞). The terminal elimination rate constant (ke) was estimated from non-linear exponential curve fitting of the log-linear

terminal phase of the plasma concentration curve, using a ARTICLE

minimum of 3 points. The terminal elimination half-life (t1/2)

was calculated as ln(2)/ke. (ng/mL) Statistical analysis Descriptive statistics are reported as the mean 6 standard devia-

tion (SD). For comparison of Cmax, Tmax, AUC, t1/2, and MRT, a ratio-paired t-test (comparing a ratio of means) was performed. Meloxicam plasma concentration To compare the pharmacokinetic profile between 2 drugs, a two-way repeated measures (time and drug) analysis of vari- ance (ANOVA) was performed. Differences were considered Time (h) , significant when P 0.05. Figure 1. Plasma concentration-time curves for MXM-SUS According to Health Canada guidelines (25), 2 products are (closed circles) and MXM-TAB (open circles) following oral considered to be bioequivalent if the Geometric Mean Ratio administration in 8 horses. Plasma concentrations are expressed as mean 6 SD. The curves are significantly different (P = 0.02 (GMR Test/Reference) of the AUC0→LOQ and the Cmax, and for interaction in two-way repeated measures ANOVA). the 90% confidence interval (CI), determined after log trans- formation of the data, are entirely contained within the limits of 0.80 to 1.25 or 80% to 125%. This method is equivalent to a 2 one-sided test procedure with the null hypothesis of bio- Discussion inequivalence at a 5% significance level. The statistical analysis The extra-label use of approved drugs is always a concern to determine bioequivalence was carried out as described in the for the veterinarian, particularly if compounding is used to Health Canada Guidelines (25). facilitate administration. Ideally, the veterinarian wants to Statistical calculations were performed using Prism V. 6 know that the compounded drugs are behaving in a predictable (GraphPad Software; San Diego, California, USA) or using a manner in vivo and that the expected concentrations are being standard spreadsheet program. achieved. Unfortunately, this information is often not avail- able. Bioequivalence is the formal assessment of comparative Results pharmacokinetics of 2 different drug formulations and helps Plasma concentrations versus time for the 2 meloxicam formula- predict therapeutic differences between products. The lack of an tions are presented in Figure 1. There was a significant interac- approved meloxicam product for horses in North America means tion between time and formulation (P = 0.02), with a more that veterinarians must use a product approved in other spe- rapid increase in plasma concentration for MXM-TAB after cies in an extra-label manner if use of meloxicam is a clinically oral administration and subsequently lower concentrations in justified choice. The decision to compound the product is then the latter half of the curve. based on issues of route of administration, palatability, and ease Table 2 shows the summary of the results for the non-­ of administration. The purpose of this study was to determine

compartmental pharmacokinetic analysis. The Cmax for the MXM- if human meloxicam tablets (MXM-TAB) compounded in a SUS and MXM-TAB were not significantly different. However, formulation appropriate for use in the horse were bioequivalent

there was a significant difference in Tmax, with MXM-SUS having to an approved oral meloxicam suspension for horses available a longer Tmax compared to MXM-TAB. As shown in Figure 2, the in the European Union (Metacam; MXM-SUS). Human tablets plasma profiles were similar for most horses, while some showed (whether or not compounded) should not be administered to

a marked delay in reaching Cmax with MXM-SUS. Similarly, the horses intended for food. MRT0→∞ was significantly longer for MXM-SUS than for MXM- There was a significant difference in the pharmacokinetic TAB. Overall, the AUC0→LOQ for MXM-SUS was significantly profiles over time (a significant interaction between formulation larger than for MXM-TAB, but the difference between the means and time) between MXM-SUS and MXM-TAB (Figure 1). The was less than 10%. The terminal elimination half-life (t1/2) was MXM-TAB demonstrated a more rapid absorption, resulting not significantly different between the 2 formulations. in a higher initial concentration and lower concentrations in To formally assess the bioequivalence of the 2 formulations, the terminal phase. Although the terminal elimination half-life the 90% CI for the geometric mean ratios (GMR MXM-SUS/ should be considered an estimate because only the last 3 points

MXM-TAB) of the logarithmic values of Cmax and AUC0→LOQ could be used to estimate this parameter, there was no significant were determined. As shown in Table 3, the 90% CI of the GMR difference between the formulations. This is consistent with the were entirely contained with the limits of 80% to 125% for both expectation that metabolism and renal clearance of absorbed

the Cmax and AUC0→LOQ. meloxicam would be similar. There was no significant ­difference

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Table 2. Pharmacokinetic parameters (mean 6 standard deviation) of meloxicam suspension (MXM-SUS) and crushed meloxicam tablets (MXM-TAB) in horses (n = 8) after oral administration at 0.6 mg/kg BW. The Geometric Mean of the Ratios and associated ratio paired t-test P-value are shown Pharmacokinetic Geometric Mean parameter MXM-SUS MXM-TAB of Ratios P-value 6 6 6 Cmax (ng/mL) 667 196 708 164 1.08 0.11 0.42 6 6 Tmax (h) 5.5 4.1 2.5 0.8 0.55 6 0.30 0.043 6 6 AUC0→LOQ (ng·h/mL) 9131 2670 8373 2794 0.91 6 0.051 0.049 6 6 6 AUC0→∞ (ng·h/mL) 9297 2588 8406 2794 0.89 0.062 0.060 6 6 MRT0→∞(h) 11.1 1.6 9.6 1.33 0.86 6 0.069 0.033 6 6 6 t1/2 (h) 6.4 3.0 6.5 2.8 1.03 0.26 0.90 ARTICLE

Cmax — maximal concentration; Tmax — time of Cmax; AUC — area under the curve; t1/2 — half-life; MXM-SUS — meloxicam suspension; MXM-TAB — meloxicam tablets. (ng/mL) (ng/mL) Meloxicam plasma concentration Meloxicam plasma concentration

Time (h) Time (h)

Figure 2. Representative plasma concentration-time curves of MXM-SUS (closed circles) and MXM-TAB (open circles) in 2 individual horses illustrating the 2 different plasma concentration profiles observed.

Table 3. Geometric Mean Ratios (GMR) and 90% confidence The slower absorption of MXM-SUS in some horses intervals (shown as lower and upper limit expressed as %) determined by the Health Canada described method for (Figure 2) could be linked to either a decreased absorption rate determination of bioequivalence of oral formulations. Meloxicam because of the formulation or because the suspension was more suspension is considered the reference (R) product and crushed susceptible to interaction with the feed provided 1 h after dos- meloxicam tablets are considered the test (T) product. If the 90% CI (%) are fully contained between 80% and 125% of the GMR, ing. Administering drug to unfed horses, with feeding 1 h later, the products are generally accepted as bioequivalent was intended to reflect what may happen in clinical situations and to minimize the effect of food on absorption. Administering Pharmacokinetic Lower limit Upper limit parameter GMR (T/R) (%) (%) meloxicam to fed horses has previously been shown to delay absorption and reduce peak plasma concentrations, although C (ng/mL) 1.01 87 116 max it did not change over-all bioavailability (18). Given that oral AUC0→LOQ (ng·h/mL) 0.99 95 105 administration of meloxicam would be expected in clinical sce- (See Table 2.) narios requiring repeat administrations for sub-acute or chronic

conditions, the difference in Tmax, but with a similar Cmax, is in the Cmax (Table 2), but the Tmax for the Metacam oral suspen- unlikely to be of clinical significance. sion was significantly longer than for MXM-TAB. This suggests As shown in Table 2, the AUC0→LOQ, which is an overall that there was a delayed absorption of MXM-SUS compared assessment of drug exposure, was significantly different between to MXM-TAB. While it is not possible to calculate an absorp- the oral suspension and crushed tablets. The difference is small tion time from the data, the MRT was significantly longer for (less than 10%). It is not possible to determine absolute bioavail- the oral suspension, consistent with a delayed absorption (as ability in this study design (as it requires direct comparison of the terminal elimination half-lives were not significantly dif- oral to intravenous administration) nor to determine the specific ferent). These observations are consistent with the statistically cause of the differences between the formulations. However, significant difference between the plasma concentration-time one possible explanation is loss of drug during preparation and curves showing a more rapid increase in plasma concentrations administration. Mixing crushed tablets in molasses is a form with MXM-TAB. of compounding. A mortar and pestle was used to crush the

734 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY

appropriate number of tablets to a fine powder. The powdered product for horses. Veterinarians can expect to achieve a similar drug was then transferred to molasses in the syringe and mixed clinical response with human meloxicam tablets compounded in situ. It is possible that loss of small amounts of drug occurred in molasses as has been reported for the commercial product. in the process or remained in the catheter tip of the syringes However, further work is required to determine if meloxicam used to administer the drug. Avoidance of the latter drug loss is as effective as phenylbutazone in the treatment of muscu- was attempted by layering molasses on top of the mixed drug loskeletal pain and inflammation in the horse and if it has an

in the syringe, but it may still have occurred. improved safety profile, which would be required to fully justify ARTICLE To further assist in the determination of whether or not its extra-label and/or compounded use in select equine patients. the observed differences in pharmacokinetic parameters of the 2 formulations are likely to be clinically significant, a formal Acknowledgments assessment for bioequivalence was carried out in accordance This project was supported by the University of Calgary, Faculty with Health Canada Guidelines (25). The 2 pivotal parameters of Veterinary Medicine as part of a course in the second year of for bioequivalence are AUC0→LOQ and Cmax. To be considered the DVM program. The students all contributed equally to the bioequivalent, the GMR Test/Reference and the 90% CI should design and execution of the study and are considered equal first be within the limits of 80% to 125%. authors. CVJ In order to use AUC0→LOQ (area under the curve to the last measurable concentration), it is important to demonstrate References

that you have accounted for at least 80% of the AUC0→∞ (area 1. Lees P. Pharmacology of drugs used to treat osteoarthritis in veterinary under the curve until infinity or complete elimination of the practice. Inflammopharmacology 2003;11:385–399. 2. Valverde A, Gunkel CI. Pain management in horses and farm animals. drug, estimated from the terminal elimination phase). As seen J Vet Emerg Crit Care 2005;15:295–307. in Table 2, AUC0→LOQ accounted for over 98% of the AUC0→∞. 3. Soma LR, Uboh CE, Maylin GM. The use of phenylbutazone in the Further, it must be shown that there are no effects of sequence of horse. J Vet Pharmacol Ther 2012;35:1–12. 4. Lees P, Higgins AJ. Clinical pharmacology and therapeutic uses of administration or period administration. It was determined by non-steroidal anti-inflammatory drugs in the horse. Equine Vet J 1985; ANOVA that there was no significant period or sequence effect 17:83–96. (P . 0.10 in all cases), allowing comparison of the GMR using 5. Meschter CL, Gilbert M, Krook L, Maylin G, Corradino R. The effects of phenylbutazone on the intestinal mucosa of the horse: A the standard bioequivalence acceptance intervals. morphological, ultrastructural and biochemical study. Equine Vet J As shown in Table 3, the GMR and the 90% CI for both Cmax 1990;22:255–263. and AUC fell within the 80% to 125% range, formally 6. Read WK. Renal medullary crest necrosis associated with phenylbuta- 0→LOQ zone therapy in horses. Vet Pathol 1983;20:662–669. confirming that despite the minor differences in pharmacoki- 7. Engelhardt G, Homma D, Schlegel K, Utzmann R, Schnitzler C. Anti- netic parameters, crushed meloxicam tablets in molasses can be inflammatory, analgesic, antipyretic and related properties of meloxicam, considered bioequivalent to Metacam 15 mg/mL oral suspen- a new non-steroidal anti-inflammatory agent with favourable gastroin- testinal tolerance. Inflamm Res 1995;44:423–433. sion for horses. 8. Noble S, Balfour JA. Meloxicam. Drugs 1996;51:424–430. In a previous pharmacokinetic-pharmacodynamic (PK-PD) 9. Beretta C, Garavaglia G, Cavalli M. COX-1 and COX-2 inhibition in analysis, Toutain and Cester (19) reported median effective horse blood by phenylbutazone, flunixin, carprofen and meloxicam: An in vitro analysis. Pharmacol Res 2005;52:302–306. meloxicam concentrations of 130 ng/mL for increase in stride 10. Brideau C, Van Staden C, Chan CC. In vitro effects of cyclooxygen- length and 195 ng/mL for reduction in lameness scores in an ase inhibitors in whole blood of horses, dogs, and cats. Am J Vet Res induced-synovitis model. The time above the reported median 2001;62:1755–1760. 11. Radi ZA, Khan NK. Effects of cyclooxygenase inhibition on the gastro- effective concentrations for clinical effects of meloxicam in intestinal tract. Exp Toxicol Pathol 2006;58:163–173. horses are similar between the 2 products tested in this study 12. Little D, Brown SA, Campbell NB, Moeser AJ, Davis JL, Blikslager AT. (see Figure 1), suggesting that there will not likely be a dif- Effects of the cyclooxygenase inhibitor meloxicam on recovery of ischemia-injured equine jejunum. Am J Vet Res 2007;68:614–624. ference in the time period over which the drugs are clinically 13. D’Arcy-Moskwa E, Noble GK, Weston LA, Boston R, Raidal SL. Effects effective. of meloxicam and phenylbutazone on equine gastric mucosal perme- The C values reported here are lower than those previously ability. J Vet Intern Med 2012;26:1494–1499. max 14. Vander Werf KA, Davis EG, Kukanich B. Pharmacokinetics and adverse reported (Table 1), particularly the Cmax values observed by effects of oral meloxicam tablets in healthy adult horses. J Vet Pharmacol Toutain et al (18). The AUC values show less variability than Ther 2013;36:376–381. C between studies and the elimination half-lives are also 15. Kreuder AJ, Coetzee JF, Wulf LW, et al. Bioavailability and pharmaco- max kinetics of oral meloxicam in llamas. BMC Vet Res 2012;8:85. similar (Tables 1 and 2). The work of Toutain et al (18) clearly 16. Sinclair MD, Mealey KL, Matthews NS, Peck KE, Taylor TS, Bennett demonstrated an effect of food on absorption rate. Differences BS. Comparative pharmacokinetics of meloxicam in clinically normal in feeding regimens between the studies (feed always available horses and donkeys. Am J Vet Res 2006;67:1082–1085. 17. Lacasse C, Gamble KC, Boothe DM. Pharmacokinetics of a single versus fed 1 or 2 h after dosing) may affect the Cmax or feed dose of intravenous and oral meloxicam in red-tailed hawks (Buteo available may explain some of the differences observed between jamaicensis) and great horned owls (Bubo virginianus). J Avian Med Surg studies. Overall, the variation reported in previous studies and in 2013;27:204–210. 18. Toutain PL, Reymond N, Laroute V, et al. Pharmacokinetics of meloxi- the group of horses studied here suggests that there is consider- cam in plasma and urine of horses. Am J Vet Res 2004;65:1542–1547. able inter-individual variability, but no clinical significance has 19. Toutain PL, Cester CC. Pharmacokinetic-pharmacodynamic relation- been attached to this variability. ships and dose response to meloxicam in horses with induced arthritis in the right carpal joint. Am J Vet Res 2004;65:1533–1541. Human meloxicam tablets compounded with molasses were 20. de Grauw JC, van de Lest CH, Brama PA, Rambags BP, van Weeren PR. bioequivalent to the European Union approved Metacam In vivo effects of meloxicam on inflammatory mediators, MMP activity

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and cartilage biomarkers in equine joints with acute synovitis. Equine mps/compli-conform/gmp-bpf/docs/pol_0051-eng.php Last accessed Vet J 2009;41:693–699. May 20, 2015. 21. Noble G, Edwards S, Lievaart J, Pippia J, Boston R, Raidal SL. Phar­ 24. Dasandi B, Shivaprakash, Saroj H, Bhat KM. LC determination and macokinetics and safety of single and multiple oral doses of meloxicam pharmacokinetics of meloxicam. J Pharm Biomed Anal 2002;28: in adult horses. J Vet Intern Med 2012;26:1192–1201. 999–1004. 22. Raidal SL, Edwards S, Pippia J, Boston R, Noble GK. Pharmacokinetics 25. Health Canada. Guidance for Industry — Preparation of Veterinary and safety of oral administration of meloxicam to foals. J Vet Intern Med Abbreviated New Drug Submissions — Generic Drugs. Available from: 2013;27:300–307. http://www.hc-sc.gc.ca/dhp-mps/alt_formats/pdf/vet/legislation/guide- 23. Health Canada. Policy on Manufacturing and Compounding Drug ld/vdd-guide-ands-padn-eng.pdf Last accessed May 20, 2015. Products in Canada. Available from: http://www.hc-sc.gc.ca/dhp- ARTICLE

Book Review Compte rendu de livre

Exotic Animal Formulary, 4th edition a treatment plan. Fluid therapy recommendations, gavage feed- ing volumes, reference to abnormalities in bloodwork and more Carpenter J, Marion CJ, eds. Elsevier Saunders. St. Louis, are compiled in each chapter. The only major drawback is not Missouri, USA, 2013. 724 pp. ISBN: 9781-4377-2264-2. one of the editors, but more of the supportive data available to draw from. Each chapter is somewhat unpredictable as to what hen a veterinary practice sees exotics the most immediate can be found within. An example would be the cerebral spinal W mountain to overcome is the sheer number and variety fluid values charted in the rabbit chapter. This is an unexpected of taxon kept by pet owners. This is accomplished in large part find in its own right, but more so because the data aren’t avail- by expanding the clinic library of textbooks and with staff able to be presented in the other chapters. I would also like to training. Often simply known as “the Carpenter text” this book see the laboratory values presented in System International (SI) has quickly become an invaluable resource in our small animal units as opposed to the “Conventional” USA units. Most of the exotic’s practice. It does an excellent job of bringing together world is faced with endless writing of conversions throughout information from all the major groups of species you may come the margins. across in private pet practice. Near the end of the book Carpenter departs from the normal The Exotic Animal Formulary is laid out in a simple, easy format with a chapter on wildlife. It contains a hodgepodge of to reference manner. A quick flip through the tabs finds you to miscellaneous information on a variety of species and groups your chapter of choice. Chapter selection covers the 3 major of animals. While at certain times this may be helpful, it is an branches of exotic pets — birds, reptiles, and small mammals overextension past the realm of this book. This chapter does really well. Individual chapters for the small mammal species; not include a formulary for wildlife species, nor does it have sugar gliders, hedgehogs, rodents, rabbits, and ferrets offer a the strong supportive information you’ve come to expect from more complete reading for those species where information the previous chapters. Practitioners that treat wildlife will be is most available. Additional chapters for invertebrates, fish, reaching for other books for those patients. amphibians, miniature pigs, and primates provide additional All in all Carpenter’s 4th edition of Exotic Animal Formulary reference for clinicians faced with less common exotic patients. is a must have reference guide for any veterinarian treating exotic A most pleasant surprise is the finding of so much more infor- pets. It is also a good study guide for vets, AHT/RVT’s, and mation than simple drug dosages. For example, the bird chapter other veterinary staff looking to increase their familiarity with has 8 tables with hematologic and serum biochemistry values. the more exciting patients this career has to offer. If you were Biological and physical data such as incubation periods, wean- ever to be faced with the unrealistic expectation of only having ing ages, lifespan, and normal body weights are provided. Even one exotic textbook, the Exotic Animal Formulary would be a obscure data like intraocular pressures and urinalysis values are pretty decent choice. offered when available in the scientific literature. Values you just don’t expect to ever find documented normal ranges for. This is where there is a nice meld between this book and species-specific Reviewed by Ian Kanda, Animal Health Technologist, Park textbooks; which often reference this formulary. Included in the Veterinary Centre, 101 Broadway Blvd, Sherwood Park, Alberta Carpenter text are further tables to support the development of T8H 2A8.

736 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Case Report Rapport de cas

Transient diabetes mellitus in a domestic ferret (Mustela putorius furo)

Alexis Duhamelle, Isabelle Langlois, Marion Desmarchelier

Abstract — A 3.5-year-old spayed female ferret, fed a diet high in refined sugar, was referred for lethargy, polyuria, polydipsia, and polyphagia. Diabetic ketoacidosis was diagnosed. Treatment included insulin therapy and a low carbohydrate diet. Diabetes mellitus resolved 54 d later, and insulin therapy was discontinued. There has been no recurrence of the diabetes mellitus.

Résumé — Diabète mellitus transitoire chez un furet domestique (Mustela putorius furo). Une furette stérilisée de 3.5 ans, nourrie avec une diète riche en sucre raffiné, a été référée pour léthargie, polyuro-polydipsie et polyphagie. Un diagnostic de diabète acido-cétosique a été établi. Un traitement incluant une insulinothérapie et une diète faible en glucides a été mis en place. Le diabète s’est résolu après 54 jours et l’administration d’insuline a été arrêtée. Aucune récidive n’a été observée. (Traduit par les auteurs) Can Vet J 2015;56:737–740

3.5-year-old spayed female ferret weighing 802 g was 13.6 mmol/L (RR: 3.4 to 7.4 mmol/L) (2). Electrolyte disorders A referred because of a 2-week history of lethargy, polyuria, included hypokalemia (3.7 mmol/L; RR: 4.5 to 6.1 mmol/L) polydipsia, polyphagia, and a 2-day history of anorexia. The (2) a metabolic acidosis with a decreased blood pH (7.086; animal lived with 3 other ferrets, 1 of which had died of dia- RR: in cats, 7.310 to 7.462) (3) and a decreased bicarbonate betic ketoacidosis a month earlier (1). The ferrets’ diet consisted (9.2 mmol/L; RR: in cats, 14.4 to 21.6 mmol/L) (3). Dipstick entirely of processed cereals (Honey Nut Cheerios®); treats for urinalysis (Chemstrip 9; Roche Diagnostics, Mississauga, cats, dogs, and ferrets; candies and fruits, as all the ferrets had Ontario) performed on a free-catch sample revealed a marked stopped eating their regular ferret diet approximately 1 y prior glucosuria, ketonuria, proteinuria, and an increased leucocyte to presentation. A complete blood (cell) count (CBC) and serum presence. Abdominal ultrasonography was unremarkable. biochemical analysis, performed by the referring veterinarian 6 d A diagnosis of diabetic ketoacidosis was made based on the prior to presentation, had revealed hyperglycemia [25.3 mmol/L; clinical signs and laboratory findings. A concurrent urinary reference range (RR): 3.4 to 7.4 mmol/L] (2), hyperglobulin- tract infection was suspected based upon the proteinuria, the emia (46 g/L; RR: 20 to 31 g/L) (2), hyperalbuminemia (61 g/L; increased urinary leucocyte count, and the hyperglobulinemia. RR: 33 to 41 g/L) (2), and an increased packed cell volume The ferret was hospitalized, and intravenous fluid therapy (0.54; RR: 0.47 to 0.51) (2). was administered with 0.9% saline, 7.5 mL/kg body weight (BW) per hour, supplemented with potassium chloride at Case description 30 mEq/L. The fluid administration rate and the potassium Upon presentation, the ferret was lethargic, emaciated (body chloride supplementation were subsequently adjusted according score of 2/5), and dehydrated. A 2.5-cm diameter, cutaneous to repeated blood gas and electrolyte assessments. Cephalexin mass, adherent to underlying tissues, was observed at the end (Novolexin; Teva Pharmaceutical Industry, Toronto, Ontario), of the tail, and a 0.5-cm diameter, cutaneous, pedunculated 30 mg/kg BW, IV, q8h for 2 d and then 20 mg/kg BW, PO, soft-tissue mass was observed between digits 4 and 5 of the q12h was administered to prevent secondary bacterial infections right thoracic limb. Though the ferret had been anorectic for and to treat the potential urinary tract infection. The ferret was the past 48 h prior to presentation, blood glucose was elevated at offered a variety of foods for diabetic cats (canned and pelleted food OM Overweight Management® Feline Formula; Purina Department of Clinical Sciences, Faculté de médecine Veterinary Diets, Laval, Quebec; canned and pelleted food DM ­vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec Dietetic Management® Feline Formula; Purina Veterinary Diets; J2S 7C6. canned food Hill’sMD Prescription DietMD a/dMD Canine/Feline, Address all correspondence to Dr. Isabelle Langlois; e-mail: Streetsville, Ontario). [email protected] Blood glucose concentrations were measured every 2 h, using Use of this article is limited to a single copy for personal study. a handheld glucometer (Accu-Chek Active; Roche Diagnostic, Anyone interested in obtaining reprints should contact the Laval, Quebec). Blood was obtained from the ear vessels and CVMA office ([email protected]) for additional then processed immediately. Diabetes mellitus therapy was initi- copies or permission to use this material elsewhere. ated with Insulin Toronto (regular insulin) (Novolin®ge Toronto

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100 U/mL; Novo Nordisk Canada, Mississauga, Ontario), 0.1 U/kg BW, IM, diluted with 0.9% saline at 1 U/mL, IM, q1h for 10 h. The blood glucose concentration quickly decreased to values ranging between 3.7 mmol/L and 6.4 mmol/L. Ten hours after being admitted, the ferret remained anorectic and lethargic with a persistent acidosis (pH: 7.149; bicarbonate: 14.3 mmol/L). Sodium bicarbonate, 0.82 mEq/kg BW, diluted with 15 mL 0.9% saline 0, IV over 5 h, was administered once. Insulin Toronto was then administered SC q3h, but this pro- tocol failed to control the hyperglycemia, with glucose values ranging from 12.9 mmol/L to 29.7 mmol/L. Normalization of RAPPORTCAS DE blood glucose concentrations was then attempted by the admin- istration of porcine lente insulin (Caninsulin®; Intervet Canada, Figure 1. Follow-up blood glucose curves in the ferret. The first curve (diamonds) was generated 13 d after initial Kirkland, Quebec), SC, q12h, at progressive doses from 0.1 U admission; 0.8 U of porcine lente insulin was administered q12h to 0.8 U. When porcine lente insulin was administered at 0.8 U, (arrows). The second (squares) and third (triangles) curves 6 d after admission, the glucose nadir was approximately 8 to were generated 54 d after initial admission; in the second curve 0.8 U of porcine lente insulin was administered at 21h 12 mmol/L 4 h after injection. However, the pre-insulin blood (thick arrow); in the third curve no insulin was administered. glucose concentration was approximately 30 mmol/L. These The hatched area corresponds to the euglycemic range for results would be considered unsatisfactory in a cat (4), but the this species. ferret’s condition improved with the aforementioned insulin therapy. The metabolic acidosis (5 d after admission: pH: 7.23; bicarbonate: 19.3 mmol/L; and hypokalemia: 4.3 mmol/L) was continued according to the regular dosing schedule for the showed modest improvement (2). Further diagnostics, other first 12 h and was then stopped to monitor the effects on the than glucose measurements, were not performed due to the blood glucose concentration (Figure 1) which remained within owner’s financial constraints. The anorexia, ketonuria, and normal limits with and without insulin therapy. Based on these dehydration resolved within 3 d after admission. The ferret’s findings, insulin therapy was terminated (2). The serum bio- general appearance and attitude were back to normal on the chemistry, which included a blood glucose concentration, was sixth day of hospitalization. within normal limits. The differential diagnoses at this point The ferret was discharged 7 d following initial admission with included either a remission of the diabetes mellitus or the pres- instructions to the owner to continue the injections of porcine ence of an insulinoma. lente insulin (0.8 U, SC, q12h) and the oral cephalexin for 5 d. To check for the presence of an insulinoma, abdominal ultra- The ferret’s only diet was to be the pelleted food for diabetic sonography and a serum immunoreactive insulin analysis (Vita- cats (OM Overweight Management® Feline Formula; Purina tech Veterinary Laboratory Services, Markham, Ontario) were Veterinary Diets), as it was the animal’s preferred diet during performed 5 d after the insulin administration had ceased. The its hospital stay. Food was offered at the approximate time of serum immunoreactive insulin measurement had been previously each insulin administration, and the owner was instructed to validated in ferrets (5). Abdominal ultrasonography found no monitor the ferret for signs of hypoglycemia. abnormalities. A blood sample was taken following a 6-hour At the recheck examination 5 d after being discharged, fast. The blood glucose concentration which was measured with the ferret was bright and alert. She was eating well and had a laboratory analyzer (4.80 mmol/L; RR: 3.4 to 7.4 mmol/L) gained 68 g. Neither polydipsia nor polyphagia was reported. (2), insulin levels (35 pmol/L; RR: 33 to 311 pmol/L) Urinalysis did not reveal glucosuria, ketonuria, or proteinuria. (5), and insulin/glucose ratio (7.3 pmol/mmol; RR: 4.6 to Urine cytology demonstrated only rare leucocytes. A blood 44.2 pmol/mmol) (5) were all within normal limits. In order glucose curve was performed over 24 h (Figure 1) with the same to confirm the reliability of these results, 2 healthy ferrets were glucometer as previously used. The nadir of 9.4 mmol/L was also sampled for serum insulin levels and the insulin/glucose greater than that observed in well-controlled diabetic cats, and ratios were calculated. The insulin levels were 24 and 71 pmol/L, blood glucose concentrations exceeded 30 mmol/L for a total and the insulin/glucose ratios were 4.2 and 10.6 pmol/mmol, of 6 h (4). However, as the ferret was doing well clinically, and respectively. Based on the normal blood glucose concentration, the urinalysis was unremarkable, porcine lente insulin (0.8 U, insulin levels and ultrasound results in the affected ferret, an SC, q12h) was continued. insulinoma was ruled out as a cause of her clinical signs. Two months after the initial presentation, the ferret was pre- Ten months after the initial admission, the ferret was pre- sented to the emergency service for an acute episode of lethargy, sented for excision of the 2 cutaneous masses, located at the end weakness, and vomiting, starting 1 h after an insulin injection. of the tail and between digits 4 and 5 of the right thoracic limb. However, the clinical signs had resolved within 1 h after the The ferret had remained active with a good appetite, and she owner had placed maple syrup onto the ferret’s buccal mucosa. had gained 300 g. No clinical signs suggestive of hypo- or hyper- Upon arrival, the physical examination was normal. An acute glycemia were reported by the owner. A blood glucose concen- hypoglycemic crisis was suspected. The ferret was hospitalized tration, measured with the same previous glucometer after a to monitor her blood glucose concentration over 36 h. Insulin 4-hour fast, was within normal limits (3.8 mmol/L). Results of

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a pre-operative CBC and serum biochemical analysis, including maintain euglycemia on a high-protein, low-carbohydrate diet blood glucose concentration, were within normal limits. (19,20). In dogs, cats, and humans, it is believed that chronic ingestion of a high-carbohydrate diet may increase the demand Discussion on b-cells for insulin secretion leading to hyperinsulinemia, Spontaneous diabetes mellitus is uncommon in ferrets (6,7). Five b-cell exhaustion, and insulin resistance (19).

cases of spontaneous diabetes mellitus have been reported in fer- It is reported that spontaneous diabetes mellitus has a REPORT CASE rets, including 1 case in a black-footed ferret (Mustela nigripes) guarded-to-poor prognosis in ferrets (6,7). Blood glucose con- (1,8–11). One reference reports the anecdotal use of insulin to centration can be difficult to regulate in diabetic ferrets (6). To treat ferrets for persistent hyperglycemia (12). our knowledge, all ferrets reported with diabetes mellitus with In human medicine, a distinction has been made between ketoacidosis died or were euthanized (1,8,9,11). In examining Type-1 and Type-2 diabetes mellitus (13). Type-1 diabetes case reports of diabetes mellitus without an initial ketoacidosis mellitus usually occurs prior to or during adulthood and results in ferrets, only 1 animal had a severe ketoacidosis after 2 mo from the autoimmune destruction of b-cells. There is little or of porcine lente insulin therapy and was euthanized (11), while no insulin secretion which leads to a marked hyperglycemia another animal was successfully managed with insulin glargine and ketoacidosis. These patients depend on exogenous insulin injections (10). In our case, the ferret presented with ketoaci- for their survival (13). Type-2 diabetes mellitus usually occurs dosis and had the diabetes mellitus spontaneously resolve with later in life, and the endogenous insulin production is usu- insulin therapy and a high-protein, low-carbohydrate diet. To ally sufficient to prevent ketoacidosis (13). This classification our knowledge, this is the first report of non-iatrogenic, tran- remains unsatisfactory as it combines both an etiologic aspect sient diabetes mellitus in a ferret. (islet lesions) and a pathophysiologic status (insulin dependency) Remission may be observed in some diabetic cats after several (14). Therefore, another classification, based simply upon days to months of insulin therapy (16). Glucotoxicity has been pathophysiology with either lack of insulin secretion by b-cells reported in domestic cats. This phenomenon is described as or insulin resistance, has been used in veterinary medicine (14). an initially reversible suppression of insulin secretion which is Less commonly, hyperglycemia may be secondary to an excessive followed by an irreversible suppression. The proposed explana- glucagon secretion from a glucagonoma (15,16). tion for the suppression of insulin secretion is a drop in b-cell Lack of insulin secretion can be caused by various etiologies: density within the pancreas due to prolonged, elevated blood genetic predisposition, infectious, toxic, iatrogenic, or inflamma- glucose concentrations (16,21,22). It is suggested that glycemic tory damage of the pancreatic islets, or b-cell exhaustion because control with early insulin therapy could lead to a reversal of of chronic hyperfunction with insulin resistance (7,15,16). Most glucotoxicity and diabetic remission in cats (16). We speculate reported ferret cases involved iatrogenic diabetes mellitus sec- that a similar phenomenon may have occurred in this patient. ondary to a pancreatectomy (6,7). In 2 out of 4 diabetic ferrets Diet is an important component of therapy in diabetic in which histologic evaluation of the pancreas was done, signs of cats (16). Cats eating a high-protein, low-carbohydrate diet active pancreatitis were seen (9,11), including a marked decrease had greater reductions in both their blood glucose concentra- in the number of b-cells in 1 case (11) and the concurrent tions and their requirements for exogenous insulin (16,23). presence of an insulinoma in the other (9). Pancreatitis may be Furthermore, they were more likely to revert to a non-insulin- considered a consequence as well as a cause of diabetes mellitus dependent state (24). As an explanation, a high protein, low in the 2 aforementioned cases (9,11). In the present case, no carbohydrate diet would decrease the demand on b-cells to evidence of pancreatic inflammation or neoplasia was detected secrete insulin in cats (16). on ultrasonographic examination. However, histopathologic Blood glucose concentrations were measured with the same examination of the pancreas was not performed in the present portable blood glucose meter designed for use with human case and the absence of pancreatic disease cannot be verified. samples. This type of glucometer has been reported to underes- Risk factors for insulin resistance include genetic predisposi- timate blood glucose concentrations in ferrets (25). Therefore, tion, obesity, physical inactivity, diet, stress, endocrine disorders, the determination of blood glucose level with a laboratory or diabetogenic drugs (7,15,16). The 2 remaining diabetic analyzer is recommended when a low blood glucose concen- ferrets, in which histologic evaluation of the pancreas was tration is obtained with this type of glucometer (25). In the performed, did not have any evidence of pancreatic inflamma- present case, all results were normo- or hyperglycemic, and the tion or neoplasia. Adequate numbers of granules were detected use of this device did not preclude the diagnosis of diabetes within the pancreatic islet cells (1,10). This suggests that diabe- mellitus. tes mellitus was a result of either inadequate release of insulin or Transient diabetes mellitus may occur in ferrets. Further stud- peripheral insulin resistance. In the case presented here, 2 of the ies are required to investigate the effects of a high-carbohydrate owner’s ferrets, both fed a diet high in refined sugar, developed diet on the occurrence of diabetes mellitus and to examine the diabetes mellitus (1). We hypothesize this inappropriate diet possibility of a glucotoxity phenomenon in this species. CVJ may have been a major factor in the disease pathophysiology. One reference describes cases of diabetes mellitus in ferrets fed References a high-sugar diet (17). Ferrets are strict carnivores comparable . 1 Benoit-Biancamano MO, Morin M, Langlois I. Histopathologic lesions of diabetes mellitus in a domestic ferret. Can Vet J 2005;46:895–897. to cats and minks (18). It has been suggested that carnivorous 2. Quesenberry KE, Orcutt C. Basic approach to veterinary care. In: animals may have been selected for insulin resistance in order to Quesenberry KE, Carpenter JW, eds. Ferrets, Rabbits, and Rodents:

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Clinical Medicine and Surgery. 3rd ed. Philadelphia, Pennsylvania: 15. Monroe WE. Canine diabetes mellitus. In: Bonagura JD, Twedt DC, WB Saunders, 2012:13–26. eds. Current Veterinary Therapy XIV. 14th ed. St. Louis, Missouri: 3. DiBartola SP. Introduction to acid-base disorders. In: DiBartola SP, ed. WB Saunders, 2009:196–199. Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice. 16. Rand JS. Feline diabetes mellitus. In: Bonagura JD, Twedt DC, 3rd ed. St. Louis, Missouri: Elsevier Saunders, 2006:229–251. eds. Current Veterinary Therapy XIV. 14th ed. St. Louis, Missouri: 4. Bennett N. Monitoring techniques for diabetes mellitus in the dog and WB Saunders, 2009:199–204. the cat. Clin Tech Small Anim Pract 2002;17:65–69. 17. Lewington JH. Endocrine diseases. In: Lewington JH, ed. Ferret 5. Mann FA, Stockham SL, Freeman MB, Wagner-Mann C, Besch- Husbandry, Medicine and Surgery. 2nd ed. Philadelphia, Pennsylvania: Williford CL, Nachreiner RF. Reference intervals for insulin concentra- WB Saunders, 2007:346–379. tions and insulin: Glucose ratios in the serum of ferrets. J Small Exot 18. Vinke CM, Schoemaker NJ. The welfare of ferrets (Mustela putorius Anim Med 1993;2:79–83. furo T): A review on the housing and management of pet ferrets. Appl 6. Rosenthal KL, Wyre NR. Endocrine diseases. In: Quesenberry KE, Anim Behav Sci 2012;139:155–168. Carpenter JW, eds. Ferrets, Rabbits, and Rodents: Clinical Medicine 19. Rand JS, Fleeman LM, Farrow HA, Appleton DJ, Lederer R. Canine and Surgery. 3rd ed. Philadelphia, Pennsylvania: WB Saunders, 2012: and feline diabetes mellitus: Nature or nurture? J Nutr 2004;134:

RAPPORTCAS DE 86–102. 2072S–2080S. 7. Chen S. Pancreatic endocrinopathies in ferrets. Vet Clin North Am Exot 20. Miller JC, Colagiuri S. The carnivore connection: Dietary carbohydrate Anim Pract 2008;11:107–123. in the evolution of NIDDM. Diabetologia 1994;37:1280–1286. 8. Carpenter JW, Novilla MN. Diabetes mellitus in a black-footed ferret. 21. Zini E, Osto M, Franchini M, et al. Hyperglycaemia but not hyperlipi- J Am Vet Med Assoc 1977;171:890–893. daemia causes beta cell dysfunction and beta cell loss in the domestic 9. Phair KA, Carpenter JW, Schermerhorn T, Ganta CK, DeBey BM. cat. Diabetologia 2009;52:336–346. Diabetic ketoacidosis with concurrent pancreatitis, pancreatic beta islet 22. Nelson RW, Griffey SM, Feldman EC, Ford SL. Transient clinical dia- cell tumor, and adrenal disease in an obese ferret (Mustela putorius furo). betes mellitus in cats: 10 cases (1989–1991). J Vet Intern Med 1999;13: J Am Assoc Lab Anim Sci 2011;50:531–535. 28–35. 10. Hess L. Insulin glargine treatment of a ferret with diabetes mellitus. 23. Frank G, Anderson W, Pazak H, Hodgkins E, Ballam J, Laflamme D. J Am Vet Med Assoc 2012;241:1490–1494. Use of a high-protein diet in the management of feline diabetes mellitus. 11. Boari A, Papa V, Di Silverio F, Aste G, Olivero D, Rocconi F. Type 1 Vet Ther 2001;2:238–246. diabetes mellitus and hyperadrenocorticism in a ferret. Vet Res Commun 24. Bennett N, Greco DS, Peterson ME, Kirk C, Mathes M, Fettman 2010;34:107–110. MJ. Comparison of a low carbohydrate-low fiber diet and a moderate 12. Hillyer E. Ferret endocrinology. In: Kirk RW, Bonagura JD, eds. carbohydrate-high fiber diet in the management of feline diabetes mel- Current Veterinary Therapy XI: Small Animal Practice. Philadelphia, litus. J Feline Med Surg 2006;8:73–84. Pennsylvania: WB Saunders, 1992:1185–1188. 25. Petritz OA, Antinoff N, Chen S, Kass PH, Paul-Murphy JR. Evaluation 13. American Diabetes Association. Diagnosis and Classification of Diabetes of portable blood glucose meters for measurement of blood glucose Mellitus. Diabetes Care 2010;33:62–69. concentration in ferrets (Mustela putorius furo). J Am Vet Med Assoc 14. Rijnberk A. Endocrine panreas. In: Rijnberk A, ed. Clinical 2013;242:350–354. Endocrinology of Dogs and Cats. Dortrecht, The Netherlands: Kluwer Academic Publishers, 1996:95–118.

Industry News Nouvelles de l’industrie

Hill’s Pet Nutrition aids dogs rescued from acreage in Alberta Through the Hill’s Food, Shelter & Love® program, Hill’s Pet tinue to coordinate with the Red Deer organization to ensure Nutrition is donating a full supply of Science Diet® brand pet all future food needs for these animals are met. food to provide premium quality nutrition for a group of dogs “Like all of us who know the joy that comes from the loving recently rescued from inhumane conditions at an acreage in bond we share with our pets, the condition these dogs were liv- southern Alberta. ing in is truly shocking and deplorable,” said Frances Cheslo, The Alberta Society for the Prevention of Cruelty to Animals Hill’s Shelter Program Manager. “We at Hill’s are so pleased to seized more than 200 dogs near Milk River in what they are be a part of the effort to bring these innocent animals back to describing as one of the worst cases of neglect they have ever good health through superior nutrition so they can find the seen. The Alberta SPCA found the dogs (a mix of Huskies, loving homes they deserve.” Irish Wolfhounds, Malamutes and Komondors) chained up Since 2007, the Hill’s Food, Shelter & Love® has donated outside, emaciated and starving, with matted fur and a list of more than $10 million worth of Hill’s Science Diet® brand other injuries. The dogs are currently receiving medical care pet food to shelters across Canada, supporting the adoption and being spayed or neutered. The local animal welfare organi- of more than 200,000 cats and dogs. Additional information zations caring for them are asking for donations, foster homes on the Hill’s Food, Shelter & Love® program can be found on and volunteers. the Hill’s website. To request assistance during an emergency, To assist in the care of these rescued animals, Hill’s Pet shelters can contact [email protected] Nutrition has donated an initial shipment of 2,100 pounds of pet food to the Red Deer & District SPCA through the Hill’s Contact: Hill’s Pet Nutrition Canada Inc., Two Morneau Shepell Food, Shelter & Love® program, which will be distributed to Centre, 6th Floor, 895 Don Mills Road, Toronto, ON M3C 1W3; other local groups that are caring for the dogs. Hill’s will con- website: www.hillsvet.ca

740 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Case Report Rapport de cas

Hypertrophic osteopathy associated with hepatocellular carcinoma in a dog

Victoria D. Randall, Carlos Souza, Daniel Vanderhart, Sarah Boston

Abstract — A 9-year-old spayed female dog diagnosed with hepatocellular carcinoma and hypertrophic osteopathy was negative for additional lesions on computed tomography of the thorax and abdomen. Resection of the affected liver lobe resulted in resolution of clinical signs. This is the first case of hypertrophic osteopathy secondary to hepatocellular carcinoma.

Résumé — Ostéopathie hypertrophique associée à un carcinome hépatocellulaire chez un chien. Un carcinome hépatocellulaire et de l’ostéopathie hypertrophique ont été diagnostiqués chez une chienne stérilisée âgée de 9 ans mais était négative par tomodensitométrie pour des lésions additionnelles au thorax et à l’abdomen. La résection du foie touché a produit une résolution des signes cliniques. C’est le premier cas d’ostéopathie hypertrophique secondaire à un carcinome hépatocellulaire. (Traduit par Isabelle Vallières) Can Vet J 2015;56:741–744

9-year-old spayed female mixed breed dog, weighing Abdominal ultrasound revealed a well-defined heteroechoic A 23 kg, was presented to the Oncology Department of the 9 cm 3 7 cm lobular mass within the left aspect of the liver University of Florida for a liver mass previously identified on (Figure 1). This mass had multiple, irregular anechoic regions abdominal ultrasound by the referring veterinarian. One-month centrally causing distal acoustic enhancement. Color Doppler duration of decreased appetite and swelling in all 4 limbs were showed moderate vascularity within the peripheral aspect of the noted. mass. Additionally, multiple well-defined, hypoechoic nodules measuring up to 8 mm were identified within the left division Case description of the liver. A small volume of anechoic fluid was seen within On presentation the dog was bright, alert, and responsive. She the peritoneal cavity. Ultrasound-guided fine-needle aspiration was ambulatory, but very stiff upon walking. All 4 limbs were of the liver mass was inconclusive for neoplasia, with only mild painful to touch and had distal edematous swelling, extending hepatocellular atypia present. Cytology of peritoneal effusion from mid-tibia to mid-metacarpal and tarsal regions. The rectal showed a non-septic exudate with no evidence of neoplastic temperature was elevated at 39.9°C. Mucoid ocular discharge cells. and scleral hyperemia were noted in both eyes. The remainder Three-view thoracic radiographs revealed no intrathoracic of the physical examination was unremarkable. abnormalities. Radiographs of both the left and right tarsi Serum biochemistry showed elevations in alkaline phospha- revealed well-defined, smooth, mixed lamellar and columnar tase [470 U/L; reference range (RR): 8 to 114 U/L] and alanine osseous proliferation along the tibia, fibula, tarsal, and meta- aminotransferase (72 U/L; RR: 18 to 64 U/L). Complete blood tarsal bones bilaterally (Figure 2). Several smoothly margined, (cell) count (CBC) showed 11 anisocytosis and 11 target oval, up to 3.6 mm mineralized structures were noted just cells present. Results from the hematology indicated a mature proximal to the calcaneus tuber bilaterally. Moderate soft tissue neutrophilia (13.0 3 103/mL; RR: 2.7 to 8.9 3 103/mL). The thickening was present surrounding the tarsi and metatarsi. results of the urinalysis were unremarkable. These radiographic findings were consistent with hypertrophic osteopathy (HO) with possible fracture fragments of the osse- ous proliferation. University of Florida, Veterinary Teaching Hospital, Department Computed tomography (CT), with and without intravenous of Small Animal Clinical Sciences, PO Box 100126, 2015 SW positive contrast, was performed of the thorax, extremities, 16th Avenue, Gainesville, Florida 32610-0126, USA. abdomen, and pelvis. The only intrathoracic abnormality was Address all correspondence to Victoria Randall; e-mail: mildly enlarged sternal lymph nodes, which measured up to [email protected] 1.8 3 0.8 3 0.8 cm. A well-defined, lobular, heterogenous Use of this article is limited to a single copy for personal study. mass was seen within the left lateral liver lobe causing medial Anyone interested in obtaining reprints should contact the displacement of the fundic portion of the stomach. Multiple, CVMA office ([email protected]) for additional small, mineral attenuating foci were seen centrally within the copies or permission to use this material elsewhere. mass. Following intravenous contrast administration, multiple

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A B RAPPORTCAS DE Figure 1. Transverse ultrasonographic view showing a well- defined 9 cm 3 7 cm lobular mass within the left aspect of the liver, scant peritoneal effusion, and multifocal hepatic nodules.

marginal and central vascular structures were seen during the arterial phase. Heterogenous contrast enhancement of the mass similar to that of the surrounding hepatic parenchyma was seen during the portal venous and venous phases. Multiple, irregular, but well-defined fluid attenuating regions that did not con- trast enhance were seen within the central region of the mass. Multifocal hyper-attenuating, contrast enhancing splenic nod- ules were also seen. Computed tomography of the thoracic limbs included within the field of view, showed smooth, continuous, mixed columnar and lamellar periosteal proliferation along the Figure 2. Dorsoplantar views of the right (A) and left (B) tarsi showing bilateral well-defined, smooth, mixed lamellar and antebrachii proximal to the mid aspect of the humeri similar columnar osseous proliferation along the tibia, fibula, tarsal, to what was described on the radiographic images of the pelvic and metatarsal bones. limbs (Figure 3). Based on these imaging features, a diagnosis of HO was made and the patient was treated with Deracoxib (Novartis Animal Health US, Greensboro, North Carolina, had resumed. Repeat radiographs of the limb and thorax, along USA), 2 mg/kg body weight (BW), PO, q24h for 14 d. with abdominal ultrasound were offered, but were declined by Exploratory laparotomy was performed, revealing a nodular the client. mass confined to the left lateral liver lobe, 2 moderately enlarged hypogastric lymph nodes, and an area of the mesentery that Discussion appeared to be grossly thickened and irregular. A left lateral This report demonstrates resolution of clinical signs associated liver lobectomy was performed using a thoracoabdominal (TA) with suspected HO following surgical excision of a primary liver stapling device. The enlarged lymph nodes were excised and a tumor. Hypertrophic osteopathy is a rare disease characterized biopsy of the irregular area of the mesentery was performed. by periosteal proliferation along the diaphysis of long bones, Initial recovery was uneventful and the patient was discharged resulting in cortical thickening (1,2). It most commonly occurs 24 h later. Contact with the owner 7 d after discharge indicated bilaterally, and often in all 4 limbs, along an area of periosteum that the lameness had resolved and the dog was no longer receiv- that is not associated with tendon insertions or adjacent bones ing Deracoxib. (3,4). The clinical signs of HO typically include swollen limbs, Gross examination of the excised left liver lobe revealed lameness, lethargy, ocular signs, and pain on palpation of limbs an expansive, poorly demarcated mass with well-demarcated (5). Fever is often reported, and may be due to tumor-associated nodules. Histologically, the nodules contained a dense sheet of or immune-mediated pyrogenic cytokines (3,5). Regression of polygonal cells forming plates and cords separated by variable clinical signs has been reported to occur 2 wk after surgical exci- amounts of fibrosis. Mild anisocytosis and anisokaryosis were sion or treatment of the primary cause, with the bone lesions present with a mitotic index of 5 per 10, 4003 fields. Based regressing gradually over several months (1,4). on these histological findings, a diagnosis of hepatocellular car- The pathogenesis of HO is not well understood, and several cinoma (HCC) was made. The irregular portion of mesentery theories have been proposed (1). One theory suggests it may submitted for histopathology showed granulation tissue present. be due to increased poorly oxygenated blood flow to the limbs The lymph nodes were normal with no evidence of metastasis. producing local passive congestion (4,6). Poor tissue oxygenation Seven months after surgery, the owner stated that the dog stimulates proliferation of connective tissue, including the peri- continued to behave normally. The limbs were no longer swol- osteum and synovial membrane (4). This depression of blood len and the dog showed no evidence of lameness and was not flow has been theorized to be caused by a neural vascular reflex, receiving any analgesic medication. Normal appetite and activity originating in the thorax and carried by afferent vagal fibers.

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This theory has been supported by studies showing regression of clinical signs after performing a vagotomy (1,4). Hypertrophic osteopathy has been reported as developing secondary to both malignant and non-malignant diseases (7). The most commonly reported causes are primary and metastatic

lung disease; however, infections such as spirocercosis, dirofila- REPORT CASE riasis, and bacterial endocarditis have been reported (1,3–5,7,8); reports of abdominal tumors in the literature are less common (1,3–5,7,8). In this report, we describe a case in which hypertrophic osteopathy is present with no intrathoracic lesions, but instead a primary liver tumor. Hepatocellular carcinoma is the most common hepatic neoplasm in dogs (9,10). In humans, HCC is linked to hepatitis and cirrhosis, but in dogs and cats, the etiol- ogy is unclear (10,11). The prognosis for liver tumors is depen- dent on histology and morphology, and clinical presentation. There are 3 morphologic subtypes of HCC: diffuse, nodular, and massive (9). Massive tumors, defined as a solitary mass confined to a single liver lobe, tend to have a better prognosis due to their susceptibility tor surgical resection, compared with A nodular or diffuse tumors. Sixty-one percent of all canine HCC tumors have massive morphology (9–11). Right-sided liver tumors may have a poorer prognosis as the risk of intraopera- tive death increases due to hemorrhage and involvement of the caudal vena cava (10). In both dogs and cats with hepatic tumors that have a mas- sive morphologic appearance, surgical excision is the treatment of choice (10). In a study including 42 dogs, the median sur- vival time after surgical excision of a massive liver tumor was not reached due to most of the dogs being either still alive or dead from an unrelated cause (9,10). Local tumor reoccurrence after a liver lobectomy of a massive HCC is 0% to 13% in dogs (10). In summary, we described a patient which was diagnosed with HO secondary to HCC. Improvement of clinical signs occurred after surgical resection of the affected liver lobe. To our knowledge, this is the first report of HO secondary to a liver tumor in the dog. Acknowledgment The preparation of this publication was sponsored by the University of Florida’s Olive’s Way Fund. CVJ References 1. Cetinkaya MA, Yardimci B, Yardimci C. Hypertrophic osteopathy in a dog associated with intra-thoracic lesions: A case report and a review. Veterinarni Medicina 2011;56:595–601. 2. Thrall DE. Hypertrophic osteopathy. In: Thrall DE, ed. Textbook of Veterinary Diagnostic Radiology. 6th ed. St. Louis, Missouri: Saunders, 2013:344. 3. Salyusarenko M, Peeri D, Bibring U, Ranen E, Bdolah-Abram T, Aroch I. Hypertrophic osteopathy: A retrospective case control study B of 30 dogs. Israel J Vet Med 2013;68:209–217. Figure 3. Computed tomography of the left and right thoracic 4. Lenehan TM, Fetter AW. Hypertrophic osteopathy. In: Newton CD, limbs. A — Coronal view of left thoracic limb. B — Sagittal view of Nunamaker DM, eds. Textbook of Small Animal Orthopedics. 1st ed. right thoracic limb. Circumferentially surrounding the left and right Philadelphia, Pennsylvania: Lippincott Williams & Wilkins, 1985:603. proximal radius, ulna and humerus, there is smooth, continuous 5. Withers SS, Johnson EG, Culp WTN, Rodriguez CO, Skorupski KA, periosteal proliferation that transitions to discontinuous and Rebhun RB. Paraneoplastic hypertrophic osteopathy in 30 dogs. Vet Comp irregularly margined at the level of the right lateral humeral Oncol 2013; doi: 10.1111/vco.12026. epicondyle and transitions to cuboidal at the level of the left 6. Garrett LD. Paraneoplastic syndromes: What are they and why are they medial humeral epicondyle. important? Proc Annu Meet Coll Vet Intern Med 2004:439–441.

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7. Withrow SJ, Vail DM, Page RL. Paraneoplastic Syndromes. In: 10. Withrow SJ, Vail DM, Page RL. Cancer of the gastrointestinal tract. Withrow SJ, MacEwen EG, eds. Small Animal Clinical Oncology. In: Withrow SJ, MacEwen EG, eds. Small Animal Clinical Oncology. 5th ed. St. Louis, Missouri: Saunders, 2012:91–92. 5th ed. St. Louis, Missouri: Saunders, 2012:405–410. 8. Grillo TP, Brandão CVS, Mamprim MJ, de Jesus CMN, Santos TC, 11. Patniak AK, Hurvitz AI, Leiberman PH, Johnson GF. Canine hepatocel- Minto BW. Hypertrophic osteopathy associated with renal pelvis tran- lular carcinoma. Vet Pathol 1981;18:427–438. sitional cell carcinoma in a dog. Can Vet J 2007;48:745–747. 9. Liptak JM, Dernell WS, Monnet E, et al. Massive hepatocellular carci- noma in dogs: 48 Cases (1992–2002). J Am Vet Med Assoc 2004;225: 1225–1230. RAPPORTCAS DE New Product Nouveau produits

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744 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Case Report Rapport de cas

Diode laser coagulation for the treatment of epistaxis in a Scottish fold cat

Takuma Aoki, Hiroo Madarame, Keisuke Sugimoto, Hiroshi Sunahara, Yoko Fujii, Eiichi Kanai, Tetsuro Ito

Abstract — We report the case of a 4-year-old, castrated 4.2-kg Scottish fold cat with recurrent epistaxis that was unresponsive to medical therapy. Diathermocoagulation of the nasal mucosa with a diode laser controlled the epistaxis and there was no significant recurrence of epistaxis during 1 year of follow-up.

Résumé — Coagulation à la diode laser pour le traitement de l’épistaxis chez un chat Scottish Fold. Nous signalons le cas d’un chat Scottish Fold castré âgé de 4 ans d’un poids de 4,2 kg atteint d’épistaxis récurrente qui n’a pas répondu au traitement médical. La diathermocoagulation de la muqueuse nasale à l’aide d’une diode laser a contrôlé l’épistaxis et il n’y pas eu de récurrence de l’épistaxis durant le suivi d’un an. (Traduit par Isabelle Vallières) Can Vet J 2015;56:745–748

pistaxis in cats is caused by bleeding disorders, hyperten- We report a case of recurrent epistaxis in a young Scottish E sion (1), hyperviscosity syndrome (2), hamartomas (3), fold cat, and describe the bleeding site and its treatment with neoplasia, and infectious rhinitis; however, its prevalence is diode laser coagulation. low. In humans, especially children, recurrent epistaxis related to excessive low-grade inflammation of vessels and thin-walled Case description arterioles (4) and hereditary hemorrhagic telangiectasia (5) has A 4-year-old, castrated male, Scottish fold cat weighing 4.2 kg been reported. Although anterior epistaxis, such as bleeding was evaluated for mild sneezing and intermittent bilateral epi- from Kiesselbach’s plexus, is common in humans (6), the sites staxis preceded by right epistaxis without melena. The epistaxis of bleeding have not been reported in cats with epistaxis. had occurred occasionally from the time the cat was 1 year old, While recurrent epistaxis is treated with silver nitrate although the amount and frequency had been mild. Physical cauterization when the bleeding site has not been identi- examination revealed a grade 4/6 systolic heart murmur in fied in humans, this approach is not suitable in cats because the left parasternal region. The indirect systolic blood pressure of possible septal perforation; a severe complication (4,5,7). measured by Doppler was 237 mmHg when the cat was slightly However, electrocautery or diathermy with a pulsed dye (8), excited. A complete blood (cell) count (CBC) revealed leuco- neodymium:yttrium-aluminium-garnet (Nd:YAG) (9), argon penia [3780/mL; reference range (RR): 5500 to 19 500/mL], (10), or diode (11) laser may be attempted when the bleeding and serum biochemistry revealed an elevated creatinine level site has been identified. Chemical, electrical, diathermic, or laser (185.6 mmol/L; RR: 70.7 to 159.1 mmol/L). The prothrombin coagulation for epistaxis has not been reported in cats. time (8 s; RR: 8 to 11 s) and activated partial thromboplas- tin time (27 s; RR: 20 to 27 s) were normal. Tests for feline immunodeficiency and feline leukemia viruses were negative. Analysis of urine obtained by cystocentesis showed hematuria Laboratory of Surgery I, School of Veterinary Medicine, Azabu and proteinuria; however, the urine protein-to-creatinine ratio University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, (UPC) was 0.21. The urine specific gravity was 1.030. The Kanagawa 252-5201, Japan (Aoki, Sugimoto, Sunahara, Fujii); urine was not cultured. Echocardiography showed that the Laboratory of Veterinary Radiology (Kanai) and Laboratory of end-diastolic basilar septal thickness was 6.5 mm, and the left Small Animal Clinics (Madarame, Ito), School of Veterinary ventricular outflow tract velocity (2.52 m/s) was increased due Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, to systolic anterior motion of the septal leaflet; hypertrophic Sagamihara-shi, Kanagawa 252-5201, Japan. obstructive cardiomyopathy (HOCM) was diagnosed. The cat Address all correspondence to Dr. Takuma Aoki; e-mail: was prescribed benazepril (Fortekor; Novartis Animal Health, [email protected] Tokyo, Japan), 0.6 mg/kg body weight (BW) PO, q24h, for Use of this article is limited to a single copy for personal study. approximately 1 mo because hypertension was suspected as the Anyone interested in obtaining reprints should contact the cause of the epistaxis. CVMA office ([email protected]) for additional At 35 d after first presentation, computed tomography angi- copies or permission to use this material elsewhere. ography (CTA) was performed because epistaxis occurred up to

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Figure 2. Nasal submucosa. Irregularly shaped blood vessels with various wall thicknesses lined by a flattened mature endothelium (hematoxylin and eosin staining). Bar = 100 mm

Figure 1. Caudal rhinoscopy of the nasopharynx. Excessive and per hour constant-rate infusion (CRI), and isoflurane (1.5% to tortuous vessels were observed in the nasal mucosa. 2.0%) for maintenance of anesthesia. Lactated Ringer’s solu- tion (5 mL/kg BW per hour, IV) was given as a maintenance once or twice a week even though the cat’s indirect systolic pres- fluid. A diode laser (DVL-20; Asuka Medical, Kyoto, Japan) sure was decreased to 196 mmHg. The CTA did not reveal any was used to cauterize the nasal mucosa. A flexible 6-mm endo- abnormalities such as a mass, chronic rhinitis, or foreign body. scope (VQ TYPE 6092A, Olympus, Tokyo, Japan) was used to Nasal flushing samples were cultured, but no pathogens were visualize the excessive and tortuous vessels in the nasopharynx. detected. Real-time polymerase chain reaction (RT-PCR) tests A 400-mm bare optical fiber was guided to the abnormal ves- (IDEXX, Tokyo, Japan) on nasopharyngeal and conjunctival sels through the channel of the endoscope. The tip of the bare swabs for feline herpes virus, feline calicivirus, Chlamydophila optical fiber was partially peeled off and manually carbonated to felis, Mycoplasma felis, Bordetella bronchiseptica, and H1N1 coagulate the tissues by heat. Laser coagulation was performed influenza virus were all negative. The cat was prescribed bena- at 2.5 to 6.00 W output power and was continued until the zepril (0.6 mg/kg BW, PO, q24h) and amlodipine (Amlodin; abnormal vessels had disappeared (Figure 3). The tip of the fiber Sumitomo Dainippon Pharma, Osaka, Japan), 0.625 mg, PO, was re-carbonated when the carbonized substance was dropped q24h, because hypertension was again suspected. or burned off. If bleeding occurred from the vessels during laser At 58 d after first presentation, a rhinoscopy was attempted coagulation, it was arrested using the carbonated tip. The dura- because mild sneezing and epistaxis occurred approximately tion of the operation was 85 min, and the cat recovered from 2 wk after antihypertensive treatment. Caudal rhinoscopy anesthesia without complications. Fentanyl, 2 mg/kg BW per revealed excessive and tortuous vessels in the nasopharynx that hour CRI, was continued for 24 h for analgesia, and cefalexin bled easily (Figure 1). The region containing the abnormal (Laryxin; Toyama Chemical, Tokyo, Japan), 18 mg/kg BW, vessels was sampled for pathological investigation. Moderate PO, q12h, was prescribed as an antibacterial agent. Tramadol bleeding was arrested with cold saline. Microscopically, we (Toramal; Nippon Shinyaku, Kyoto, Japan), 0.1 mg/kg BW, PO, observed many irregularly shaped blood vessels of various wall q12h, was prescribed for analgesia for 3 d after surgery. The cat thicknesses lined by a flattened mature endothelium (Figure 2). had a good appetite and did not appear to have lost his sense of Prednisolone (Predonine; Shionogi, Osaka, Japan) was pro- smell, even immediately after surgery. Intermittent mild sneez- batively prescribed for 1 mo because vascular malformation ing and a small amount of epistaxis occurred during the 10 d was suspected. Prednisolone was started at 1.25 mg/kg BW, following laser treatment. Significant epistaxis had disappeared PO, q24h for 7 d, reduced to 1.25 mg/kg BW, q48h for 7 d, by the 1-year follow-up. and then continued at 0.625 mg/kg BW, q48h for 2 wk. The frequency of epistaxis decreased to once a month; however, the Discussion owner decided to stop administering prednisolone because of Although epistaxis is rare, it can be caused by bleeding disorders, its adverse effects: namely polyuria/polydipsia. hypertension (1), hyperviscosity syndrome (2), hamartomas (3), At 93 d after first presentation, diathermocoagulation was neoplasia, infectious rhinitis, lymphoplasmacytic rhinitis, and attempted with a diode laser via a caudal rhinoscopy. The cat foreign bodies in cats. In the present case, we did not detect was anesthetized with fentanyl (Fentanyl Injection; Janssen any mass, infection, or foreign body. The indirect systolic blood Pharmaceutical, Tokyo, Japan), 5 mg/kg BW, IV and propofol pressure was above the reference range and chronic kidney (Propofol; Mylan Seiyaku, Tokyo, Japan), 5 mg/kg BW, IV, for disease, which is common in cats, might be considered as the induction and fentanyl (Janssen Pharmaceutical), 5 mg/kg BW cause of the hypertension (12). However, hypertension does

746 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY CASE REPORT CASE

Figure 3. A — Rhinoscopy during diathermocoagulation with a diode laser. The arrow indicates the carbonated tip of the laser fiber. This procedure was performed until the abnormal vessels had disappeared. B — Rhinoscopy after laser cautery. The disappearance of the abnormal vessels was confirmed. not appear to be the cause because epistaxis was observed even Inflammation is suggested as an alternative explanation because when the cat was young and a “white coat hypertension” was prednisolone was slightly effective in treating the epistaxis and commonly observed in cats at the hospital (12). Indeed, the sneezing, although allergic or lymphocytic-plasmacytic rhinitis antihypertensive treatment did not resolve the cat’s epistaxis is rare in cats. Therefore, neovascularization due to chronic although medical control of hypertension might not have been low-grade inflammation might have been the cause of epistaxis sufficient. in this cat. Steroids might have been inadequate in this case, The owner requested a more detailed examination via rhinos- however, as they might have induced heart failure (14) and/or copy because she was distressed by the nosebleeds that occurred aortic thromboembolism (15) in a cat affected by HOCM. when her cat sneezed. In addition, the cat might require anti- In humans with both of the diseases described above, elec- platelet and/or antithrombotic therapy in the future because trocautery or diathermy is attempted when the bleeding site is he is affected by HOCM. The rhinoscopy revealed excessive identified, whereas silver nitrate cauterization is attempted when and tortuous vessels in the nasopharynx indicative of posterior the bleeding site has not been identified (4,5,7). In this cat, epistaxis, whereas anterior epistaxis, such as Kiesselbach’s plexus, silver nitrate cauterization might have been an option to arrest is common in humans (6). A biopsy was attempted despite the the nosebleeds because the bleeding sites during epistaxis were risk of severe hemorrhage. Fortunately, the moderate hemor- not identified, although excessive and tortuous vessels bleed eas- rhage that did occur was arrested by the use of cold saline. ily. Silver nitrate, however, particularly at high concentrations, Indeed, protracted hemorrhage was reported as an uncom- may cause severe complications, including septal perforation mon complication in dogs that underwent rhinoscopy-assisted (16). These side effects might be more severe in cats because biopsy (13). The cat had experienced recurrent epistaxis from they have a thinner nasal septum than humans. Therefore diode 1 y of age. Recurrent epistaxis is common in children, although laser coagulation was selected for use in this cat. This approach its causes have not been elucidated. Several case reports have appears to be suitable for cats with epistaxis because the fiber is shown that thin-walled arterioles and capillaries with a sur- very thin and can easily pass through the channel of even a small rounding inflammatory infiltrate are the prominent vessels, flexible endoscope, although many different types of lasers, such and neovascularization due to chronic low-grade inflammation as pulsed dye (8), Nd:YAG (9), and argon (10), are available to has been proposed as a mechanism of recurrent epistaxis (4). In arrest bleeding. Indeed, as has been reported in humans (11), addition, hereditary hemorrhagic telangiectasia characterized the diode laser induced sufficient diathermocoagulation in the by epistaxis and red-violet cutaneous lesions has been noted as abnormal vessels in the nasal mucosa of this cat. After diode a cause of epistaxis in humans, particularly children (5). In this laser coagulation, the cat’s epistaxis was resolved over the 1-year cat, the latter disease does not appear to have been the cause of follow-up period, which significantly improved the quality of epistaxis because pathological investigation did not reveal any life of both the cat and his owner. However, the procedure may signs of telangiectasia and cutaneous lesions were not detected. need to be repeated if epistaxis recurs.

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Although the diode laser is not a novel tool and is commonly 6. Mudunuri RK, Murthy MA. The treatment of spontaneous epistaxis: used for various bleeding abnormalities in veterinary practice, to Conservative vs cautery. J Clin Diagn Res 2012;6:1523–1524. 7. Spielmann PM, Barnes ML, White PS. Controversies in the special- our knowledge, this is the first report of successful laser coagula- ist management of adult epistaxis: An evidence-based review. Clin tion with a diode laser to treat epistaxis in a cat. Laser coagula- Otolaryngol 2012;37:382–389. tion with a diode laser can be considered a valid choice in the 8. Harries PG, Brockbank MJ, Shakespeare PG, Carruth JA. Treatment of hereditary haemorrhagic telangiectasia by the pulsed dye laser. treatment of epistaxis in cats; however, the near-circumferential J Laryngol Otol 1997;111:1038–1041. coagulation of the nasopharynx, as was observed herein, might 9. Werner A, Baumler W, Zietz S, Kuhnel T, Hohenleutner U, Landthaler be a cause of nasopharyngeal stenosis following scar tissue retrac- M. Hereditary haemorrhagic telangiectasia treated by pulsed neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1,064 nm). tion. In addition, the significance of the relationship between Lasers Med Sci 2008;23:385–391. epistaxis and abnormal vessels that was observed in this cat is 10. Lennox PA, Harries M, Lund VJ, Howard DJ. A retrospective study unclear because tortuous vessels are observed even in healthy of the role of the argon laser in the management of epistaxis second-

RAPPORTCAS DE ary to hereditary haemorrhagic telangiectasia. J Laryngol Otol 1997; cats. However, diathermocoagulation of these abnormal vessels 111:34–37. was effective in this cat. Further investigations are required 11. Fiorella ML, Lillo L, Fiorella R. Diode laser in the treatment of epi- to determine the relationship between abnormal vessels and staxis in patients with hereditary haemorrhagic telangiectasia. Acta Otorhinolaryngol Ital 2012;32:164–169. epistaxis, the appropriate interval between repeat procedures, 12. Brown S, Atkins C, Bagley R, et al. Guidelines for the identification, and the long-term benefits and possible side effects of laser evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med 2007;21:542–558. ­coagulation. CVJ 13. Lent SE, Hawkins EC. Evaluation of rhinoscopy and rhinoscopy- assisted mucosal biopsy in diagnosis of nasal disease in dogs: 119 cases References (1985–1989). J Am Vet Med Assoc 1992;201:1425–1429. 1. Littman MP. Spontaneous systemic hypertension in 24 cats. J Vet Intern 14. Ployngam T, Tobias AH, Smith SA, Torres SM, Ross SJ. Hemodynamic Med 1994;8:79–86. effects of methylprednisolone acetate administration in cats. Am J Vet 2. Ward DA, McEntee MF, Weddle DL. Orbital plasmacytoma in a cat. Res 2006;67:583–587. J Small Anim Pract 1997;38:576–578. 15. Schoeman JP. Feline distal aortic thromboembolism: A review of 3. Chambers BA, Laksito MA, Fliegner RA, McCowan C, Beck C, 44 cases (1990–1998). J Feline Med Surg 1999;1:221–231. Yates GD. Nasal vascular hamartoma in a domestic shorthair cat. Aust 16. Amin M, Glynn F, Phelan S, Sheahan P, Crotty P, McShane D. Silver Vet J 2010;88:107–111. nitrate cauterisation, does concentration matter? Clin Otolaryngol 4. Montague ML, Whymark A, Howatson A, Kubba H. The pathology 2007;32:197–199. of visible blood vessels on the nasal septum in children with epistaxis. Int J Pediatr Otorhinolaryngol 2011;75:1032–1034. 5. Fiorella ML, Ross DA, White RI, Sabba C, Fiorella R. Hereditary haemorrhagic telangiectasia: State of the art. Acta Otorhinolaryngol Ital 2004;24:330–336.

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748 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Case Report Rapport de cas

Glenoid dysplasia and osteochondritis dissecans in a cat

Rebecca A. Schwarze, Cheryl A. Tano, Vincent W. Carroll

Abstract — A 2-year-old Maine coon cat was presented for a right forelimb lameness. Computed tomography of the shoulder revealed a shallow glenoid, osteophyte deposition at the caudal humeral head and medial glenoid, and an intra-articular osseous body. This cat had glenoid dysplasia and osteochondritis dissecans of the glenoid.

Résumé — Dysplasie glénoïde et ostéochondrite disséquante chez un chat. Un chat Maine coon âgé de 2 ans a été présenté pour une boiterie de la jambe avant droite. Une tomodensitométrie de l’épaule a révélé un dépôt ostéophyte glénoïde peu profond à la tête humérale caudale et à la glénoïde médiale ainsi qu’un corps osseux intra- articulaire. Le chat avait une dysplasie glénoïde et une ostéochondrite disséquante du glénoïde. (Traduit par Isabelle Vallières) Can Vet J 2015;56:749–752

n this report we describe forelimb lameness, glenoid exci- Case description sion and osteophyte debridement via arthrotomy in a cat I A 2-year-old neutered male Maine coon cat, weighing 6.48 kg, with glenoid dysplasia and osteochondritis dissecans (OCD). was evaluated following a 9-month history of mild right fore- To the authors’ knowledge, this is the first report of glenoid limb lameness. When initially evaluated by the referring veteri- dysplasia and OCD in the scapulohumeral joint (SHJ) of a narian, there was no localizable lameness and the cat was started cat. Osteochondrosis (OC) is a focal disorder of endochondral on prednisone [1 mg/kg body weight (BW), PO, q24h] for a ossification, in which the articular cartilage of the epiphysis fails presumed immune-mediated polyarthritis. No improvement was to form subchondral bone due to a failure of matrix calcifica- noted and the cat was re-evaluated. Decreased range of motion tion or vascular invasion (1–3). This region of retained cartilage of the right elbow and shoulder was noted, and there was pain is susceptible to injury. Fissures may extend to the articular was on extension of each coxofemoral joint (CFJ). Orthogonal surface and result in the formation of a cartilage flap, referred radiographs of the right and left thoracic limbs and pelvis were to as OCD (1,4–10). Osteochondrosis has been reported in obtained and reviewed. The referring veterinarian noted signifi- humans, pigs, poultry, dogs, horses, cattle, cats, and rats and cant abnormalities of the right scapulohumeral joint (SHJ) and involves a multifactorial disease process (2,3,11–14). Suggested both CFJs, consistent with bilateral hip dysplasia, and referred risk factors include heredity, rapid growth, trauma, anatomic the cat for further diagnostics and treatment. conformation, and dietary imbalances such as an excess of cal- A physical examination indicated that the cat was apparently cium or vitamin D (1–6). Glenoid dysplasia is a developmental 3 healthy with a body condition score of 6 out of 9. A mild right anomaly of the scapula due to an incomplete ossification of the forelimb lameness was noted. Pain was elicited on right shoulder lower two-thirds of the bony glenoid and scapular neck, which flexion. Decreased range of motion and pain on extension of is typically unilateral and solitary (15,16). The cartilage remains each CFJ was noted. The remainder of the physical examination, intact, suggesting defective ossification (15). Shoulder injuries hematologic analyses and serum biochemical analyses, were all and disease in the cat are rare compared with the dog (17–19). within reference ranges. The patient was pre-medicated with buprenorphine (Hospira, Lake Forest, Illinois, USA), 0.01 mg/kg BW, IV. General anesthesia was induced with propofol (Hospira), 6 mg/kg BW, Affiliated Veterinary Specialists, 9905 South US Highway IV, and maintained with isoflurane in O2 with an anesthetic 17-92, Maitland, Florida 32751, USA (Schwarze, Tano); Idexx vaporizer. Right shoulder orthogonal digital radiographs were Laboratories, 3 Centennial Drive, North Grafton, Massachusetts taken and reviewed by a board-certified radiologist (EAF) on 01536, USA (Carroll). a diagnostic quality monitor (Dell UltraSharp U2410; Round Address all correspondence to Dr. Rebecca A. Schwarze; e-mail: Rock, Texas, USA) with image analysis software (ClearCanvas [email protected] Workstation V7.1 SP1; ClearCanvas, Toronto, Ontario). There Use of this article is limited to a single copy for personal study. were large osteophytes at the caudal aspect of the humeral head Anyone interested in obtaining reprints should contact the and medial aspect of the glenoid extending along the medial CVMA office ([email protected]) for additional aspect of the scapula (Figure 1). An intra-articular osseous body copies or permission to use this material elsewhere. (OB) was seen in the caudal aspect of the SHJ. The glenoid was

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Figure 2. Computed tomographic images of the right scapulohumeral joint of the cat in Figure 1, demonstrating the large bony proliferation arising from the medial margin of the Figure 1. Right lateral radiographic image of the scapulohumeral glenoid (thick arrow) and an intra-articular osseous body at the joint of a 2-year-old neutered male Maine coon cat which was caudal aspect of the glenoid (arrowhead). The humeral head (thin presented for a chronic right forelimb lameness. There are arrow) is a reference point. large osteophytes at the caudal aspect of the humeral head. An intra-articular osseous body is seen in the caudal aspect of the glenohumeral joint. The glenoid is flattened and irregular in shape. Patchy areas of sclerosis are seen within the proximal diaphysis/ metaphysis of the humerus. intra-articular caudal OB. Intra-operative evaluation of the SHJ revealed abnormal formation of the glenoid with ulcerations flattened and irregular in shape. Patchy areas of sclerosis were and eburnations of the glenoid articular surface. Grossly, there seen within the proximal diaphysis/metaphysis of the humerus; were no visible abnormalities of the humeral articular surface. absence of subchondral humeral head lesion was confirmed Partial removal of the large osteophyte on the medial aspect of radiographically. Computed tomography (CT) imaging of the the glenoid was done. The right glenoid and OB were submitted right shoulder was obtained using a 4-slice helical CT scan- for histopathologic evaluation. The joint was closed routinely. ner with a helical slice thickness of 1 mm (Toshiba Aquilion; The infraspinatus was reattached using a locking-loop suture. Tustin, California, USA). An additional series was performed The deep fascial incision, subcuticular tissue, and skin were of the right shoulder at 0.5 mm slice thickness. Imaging was closed separately. done with the patient in dorsal recumbency with the forelimbs Post-operative orthogonal radiographs were obtained, con- extended cranially and parallel to one another at the level of the firming removal of the large caudal intra-articular OB, glenoid, antebrachium and scapula. Images were reviewed (EAF) with and part of the medial osteophyte. Anesthetic recovery was the image analysis software using a bone setting (window with unremarkable. Postoperative pain management was initially 500 Hounsfield units, window level 2500 Hounsfield units). maintained with buprenorphine (0.01 mg/kg BW, IV/8 h), Computed tomography scans were evaluated using a systematic then (0.01 mg/kg BW, PO/8 h). The cat was discharged with approach and the following characteristics were noted: abnormal robenacoxib (Novartis, Greensboro, North Carolina, USA), formation and flattening of the glenoid, large bony proliferation 1 mg/kg BW, PO, q24h, and amoxicillin trihydrate/clavulanate arising from the medial margin of the glenoid, an intra-articular potassium (Zoetis, Kalamazoo, Michigan, USA), 62.5 mg, PO, OB at the caudal aspect of the glenoid, and patchy sclerosis q12h. Recommendations for the cat included restricted activity within the proximal aspect of the humerus (Figure 2). Recovery for 4 wk, followed by a gradual return to normal activity. from general anesthesia was uneventful and the patient was Samples of the glenoid and osseous body were fixed in 10% administered buprenorphine (0.01 mg/kg BW, IV) following neutral buffered formalin and processed by routine methods. extubation for pain management. Sections were stained with hematoxylin and eosin (H&E). The cat was admitted for right glenoid excision and removal Histopathological review indicated retained viable growth of the intra-articular OB. The cat was pre-medicated and general cartilage cores within trabecular bone, not exhibiting nor- anesthesia was induced as previously noted. Cefazolin (Westward mal endochondral ossification (Figure 3). Fragmentation, Pharmaceuticals, Eatontown, New Jersey, USA), 22 mg/kg BW, fibrillation, and clefting of the articular cartilage were noted IV/90 min, was administered at the start of surgery. A cranio- along the medial aspect of the articular surface of the glenoid. lateral approach to the right SHJ by infraspinatus tenotomy Additionally, retained growth cartilage was noted along the was performed by a board-certified surgeon (CAT) (20). An articular-­epiphyseal complex of the glenoid. The free osseous arthrotomy allowed excision of the glenoid and removal of the body was comprised of lamellar bone with an osteocartilagenous

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bone may be the result of a more advanced stage of osteochon- drosis or of sample submission. Osteochondritis dissecans results in clinical manifestations of the disease: signs of synovitis, lameness and secondary osteoar- thritis, or arthralgia due to synovial fluid contacting subchondral

bone or a displaced fragment (2,24,25). The fragment may be REPORT CASE displaced due to trauma, remain attached to cartilage, reattach to subchondral bone, or become calcified and tear loose (26). Osteochondritis dissecans fragments may be demonstrated on radiographs, CT, magnetic resonance imaging, or arthrography (25,27,30). Treatment options include conservative management or surgical debridement. In younger animals, conservative man- agement may be adequate if clinical signs are mild (31). Surgical Figure 3. Retained viable growth cartilage cores within options may include flap removal or debridement of cartilage trabecular bone, not exhibiting normal endochondral ossification not adhered to underlying tissues, followed by curettage, forage, (arrowhead). Hematoxylin & eosin, 3100. or abrasion of the underlying subchondral bone to promote defect reconstruction with fibrocartilage (12). matrix. These findings were consistent with OC/OCD of the Case reports of OC in the cat have been published. To date, glenoid. 2 cases of OC have been reported on the humeral head (OCD), Re-evaluation of the cat at 14 d revealed the cat was bright 1 on the patella, and 2 of the lateral femoral condyle (12,17,32). and alert with a moderate weight-bearing lameness with minimal The OCD of the humeral head was removed using a lateral right scapulohumeral crepitus and mild decreased extension. arthrotomy approach to the shoulder, which resolved the lame- At 1 mo the cat was active with no crepitus and motion was ness (12,19,33). Scapulohumeral joint injuries are not common apparently pain-free. A moderate weight-bearing lameness was in the cat. Scapulohumeral osteochondrosis (SH OC) also has noted. The shoulder extended to and flexed to normal limits. been reported in humans, dogs, and horses (17,28,34). In the At 1-year re-evaluation, no lameness or pain on range of motion dog SH OC is common along the humeral head and has a good was noted on physical examination. There was a 10° reduction prognosis with appropriate therapy; whereas in the horse, OC of in flexion and extension of the shoulder and crepitus was noted the SHJ has been reported along the caudal humeral head and at full flexion and extension. glenoid and is debilitating, with a poor prognosis for return to a racing career (31,34). In this report, a craniolateral approach Discussion to the scapulohumeral joint via infraspinatus tenotomy was In this report, the owner reported feeding a commercially used to allow for fragment removal and greater exposure to the available diet at the recommended amount, indicating dietary glenoid (20,35). imbalances were unlikely. The cat was in good body condition; The flattened or shallow appearance of the glenoid in the cat however, the cat’s breed may have suggested a faster rate of in this report is consistent with changes described in glenoid growth than other feline breeds. There was no reported occur- dysplasia (16). Glenoid dysplasia has been reported in humans, rence of trauma. Although multifactorial as previously discussed, dogs, and horses and radiographically appears as a flattened the pathogenesis of OC is not well understood; however, it has glenoid cavity (34–38). Radiographs and CT of this case showed been proposed that the earliest histopathological lesion of OC abnormal formation and flattening of the glenoid, which is con- is a focal necrosis of epiphyseal cartilage canals, resulting in sistent with dysplasia. These changes may result in instability or cartilage ischemia and failure of calcification during stages of secondary osteoarthritic changes (35,39). Glenoid dysplasia has development (2,7,8,21,22). Lesions may develop in multiple been reported to occur concurrently with hip dysplasia, and is locations; however, they often occur in bilaterally symmetrical believed to be congenital (16,33). sites, attributed to a symmetrical vascular pattern (1). Potential To the author’s knowledge, this is the first report of OCD of sequelae to OC lesions may include resolution via granulation the feline glenoid in conjunction with glenoid dysplasia. The tissue and subsequent intramembranous ossification, or mac- overall outcome was good with a reduction of lameness and roscopically, the formation of a subchondral cyst or fissures/ good range of motion of the SHJ. Feline OCD is uncommon. fragments (4,9,10,12). Additional investigation of the pathogenesis of feline OCD, In advanced stages, fissures or clefts may extend from this predominant locations, and outcomes following conservative site through the articular surface to create a flap or fragment management versus surgical repair is warranted because there known as OCD (23). The initial focal areas of chondrocyte are limited reports. Additionally, further investigation of the necrosis may be seen prior to or in combination with the later epidemiology, pathogenesis, and the association of glenoid macroscopic lesions of OC (4,7,21). In this case, the presence dysplasia with hip dysplasia is warranted. of retained growth cartilage within trabecular bone and the pres- ence of fragmentation, fibrillation, and clefting of the medial Acknowledgment glenoid articular cartilage are consistent with OC/OCD. The The authors thank Eric A. Ferrell, DVM, DACVR for radio- absence of observed necrotic cartilage cores within the trabecular graphic review and evaluation. CVJ

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References 21. Johnston SA. Osteochondritis dissecans of the humeral head. Vet Clin North Am Small Anim Pract 1998;28:33–49. 1. Ytrehus B, Carlson CS, Ekman S. Etiology and pathogenesis of osteo- 22. Laverty S, Girard C. Pathogenesis of epiphyseal osteochondrosis. Vet chondrosis. Vet Pathol 2007;44:429–448. J 2013;197:3–12. 2. Ekman S, Carlson CS. The pathophysiology of osteochondrosis. Vet 23. Whitehair JG, Rudd RG. Osteochondrosis dissecans of the humeral Clin North Am Small Anim Pract 1998;28:17–32. head in dogs. Compend Cont Educ Pract Vet 1990;12:195–204. 3. Tomlinson JL, Cook JL, Kuroki K, Kreeger JM, Anderson MA. 24. Weisbrode SE. Bone and joints. In: McGavin MD, Zachary JF, eds. Biochemical characterization of cartilage affected by osteochondritis Pathologic Basis of Veterinary Disease. 4th ed. St. Louis, Missouri: dissecans in the humeral head of dogs. Am J Vet Res 2001;62:876–881. Mosby-Elsevier, 2007:1067–1070. 4. Ytrehus B, Andreas Haga H, Mellum CN, et al. Experimental isch- 25. de Simone A, Gernone F, Ricciardi M. Imaging diagnosis-bilateral emia of porcine growth cartilage produces lesions of osteochondrosis. abnormal ossification of the supraglenoid tubercle and cranial glenoid J Orthop Res 2004;22:1201–1209. cavity in an English setter. Vet Radiol Ultrasound 2013;54:159–163. 5. Paatsama S, Rokkanen P, Jussila J, Sittnikow K. A study of osterochon- 26. Olsson SE, Reiland S. The nature of osteochondrosis in animals: dritis dissecans of the canine humeral head using histological, OTC Summary and conclusions with comparative aspects on osteochondritis bone labeling, microradiographic and microangiopathic methods. RAPPORTCAS DE dissecans in man. Acta Radiol Suppl 1978;358:299. J Small Anim Pract 1971;12:603–611. 27. Cogar SM, Cook CR, Curry SL, Grandis A, Cook JL. Prospective 6. Richardson DC, Zentek J. Nutrition and osteochondrosis. Vet Clin evaluation of techniques for differentiating shoulder pathology as a North Am Small Anim Pract 1998;28:115–135. source of forelimb lameness in medium and large breed dogs. Vet Surg 7. Carlson CS, Cullins LD, Meuten DJ. Osteochondrosis of the articular- 2008;37:132–141. epiphyseal cartilage complex in young horses: Evidence for a defect in 28. Vandevelde B, Van Ryssen B, Saunders JH, Kramer M, Van Bree H. cartilage canal blood supply. Vet Pathol 1995;32:641–647. Comparison of the ultrasonographic appearance of osteochondrosis 8. Ytrehus B, Ekman S, Carlson CS, Teige J, Reinholt FP. Focal changes lesions in the canine shoulder with radiography, arthrography, and in blood supply during normal epiphyseal growth are central in the arthroscopy. Vet Radiol Ultrasound 2006;47:174–184. pathogenesis of osteochondrosis in pigs. Bone 2004;35:1294–1306. 29. Vanbree H. Evaluation of subchondral lesion size in osteochondro- 9. Craig PH, Riser WH. Osteochondritis dissecans in the proximal sis of the scapulohumeral joint in dogs. J Am Vet Med Assoc 1994; humerus of the dog. J Am Vet Radiol 1965;6:40–49. 204:1472–1474. 10. Morgan JP. Osteochondritis in the proximal humerus of the dog. In: 30. Schaefer SL, Baumel CA, Gerbig JR, Forrest LJ. Direct magnetic Radiology in Veterinary Orthopedics. Philadelphia, Pennsylvania: Lea resonance arthrography of the canine shoulder. Vet Radiol Ultrasound & Febiger, 1972:341–345. 2010;51:391–396. 11. Morgan J, Wind A, Davidson A. Introduction. In: Hereditary Bone 31. Person MW. Arthroscopic treatment of osteochondritis dissecans in the and Joint Diseases in the Dog: Osteochondrosis, Hip Dysplasia, Elbow canine shoulder. Vet Surg 1989;18:175–189. Dysplasia. Hannover, Germany: Schlutersche GmbH &Co, 1999:1–19. 32. Butcher R, Beasley K. Osteochondritis dissecans in a cat? Vet Rec 12. Ralphs SC. Bilateral stifle osteochondritis dissecans in a cat. J Am Anim 1986;118:646. Hosp Assoc 2005;41:78–80. 33. Boswell JC, Schramme, MC, Wilson AM, May SA. Radiological study 13. Palierne S, Palissier F, Raymond-Letron I, Autefage A. A case of bilateral to evaluate suspected scapulohumeral joint dysplasia in Shetland ponies. patellar osteochondrosis and fracture in a cat: Clinical and histological Equine Vet J 1999;31:510–514. findings. Vet Comp Orthop Traumatol 2010;23:128–133. 34. Jenner F, Ross MW, Martin BB, Richardson DW. Scapulohumeral 14. Peterson CJ. Osteochondritis dissecans of the humeral head of a cat. osteochondrosis: A retrospective study of 32 horses. Vet Comp Orthop New Z Vet J 1984;32:115–116. Traumatol 2008;21:406–412. 15. Trout TE, Resnick D. Glenoid hypoplasia and its relationship to insta- 35. Mclaughlin R, Roush JK. A comparison of two surgical approaches to bility. Skeletal Radiol 1996;25:37–40. the scapulohumeral joint in dogs. Vet Surg 1995;24:207–214. 16. Taylor K, Kidwai AS, Armitage M, Fitzpatrick M, Griffith HJ. 36. Evans JP. Shoulder dysplasia in a Labrador. J Small Anim Pract 1968; Radiologic case study: Glenoid dysplasia. Orthopedics 2004;27: 9:55–58. 1315–1317. 37. Butterworth SJ. Shoulder dysplasia. In: Houlton J, Collinson R, eds. 17. Peterson CJ. Osteochondritis dissecans of the humeral head of a cat. BSAVA Manual of Small Animal Arthrology. Gloucestershire, UK: New Z Vet J 1984;32:115–116. BSAVA, 1994:154. 18. Scharf G, Steinbuchl S, Messmer M, Ohlerth S. Glenoid dysplasia and 38. Currarino G, Sheffield E, Twickler D. Congenital glenoid dysplasia. bicipital tenosynovitis in a Maine coon cat. J Small Anim Pract 2004; Pediatr Radiol 1998;28:30–37. 45:515–520. 39. Smith SP, Bunker TD. Primary glenoid dysplasia. J Bone Joint Surg [Br] 19. Ridge P. Feline shoulder arthroscopy using a caudolateral portal, a 2001;83-B:868–872. cadaveric study. Vet Comp Orthop Traumatol 2009;22:289–293. 20. Hohn RB. Osteochondritis dissecans of the humeral head. J Am Vet Med Assoc 1973;163:69–70.

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752 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Case Report Rapport de cas

Successful resolution of a preputial prolapse in an alpaca using medical therapy

Jennifer H. Koziol, Misty A. Edmondson, Dwight F. Wolfe, Jenna E. Bayne

Abstract — A 2-year-old intact male alpaca was presented for a post-breeding preputial prolapse of 5 days duration. The internal lamina of the prepuce was prolapsed approximately 6 cm and the exposed preputial epithelium was edematous and necrotic. Following 7 days of medical treatment, resolution of the preputial prolapse was achieved.

Résumé — Résolution réussie d’un prolapsus du prépuce chez un alpaga à l’aide d’un traitement médical. Un alpaga mâle intact âgé de 2 ans a été présenté pour un prolapsus du prépuce d’une durée de 5 jours après l’accouplement. La membrane interne du prépuce avait subi un prolapsus d’environ 6 cm et l’épithélium exposé du prépuce était œdémateux et nécrosé. Après 7 jours de traitement médical, la résolution du prolapsus a été obtenue. (Traduit par Isabelle Vallières) Can Vet J 2015;56:753–755

pon presentation of a young alpaca stud with a preputial U prolapse to the J. T. Vaughan Large Animal Teaching Hospital, a literature search was performed which yielded only 1 report of preputial prolapse in camelids (1). That case was managed by replacement of the prolapsed tissues and placement of a purse string suture in the preputial orifice. Extrapolating from bovine medical treatments of preputial prolapse, the stud in the present case was managed in a manner less likely to inter- fere with future breeding. Case description

A 2-year-old intact male alpaca weighing 59 kg was presented Figure 1. Prolapsed prepuce at the time of initial presentation. to J. T. Vaughan Large Animal Teaching Hospital for evalua- Approximately 6 cm of exposed tissue was present and the tion of a post-breeding preputial prolapse of 5 days duration. patient was able to urinate normally. Two months earlier, immediately following the alpaca’s first breeding, a preputial prolapse was treated successfully by the ment of the initial prolapse, the male bred a female by natural referring veterinarian with topical application of emollient oint- service without complication. Subsequent breeding of another ment and manual reduction of the prolapsed tissue. Following female several weeks after the natural service date resulted in a the initial injury, the owner was instructed to avoid use of the recurrence of the preputial prolapse. The referring veterinarian male for breeding for at least 2 mo. Two months after treat- was unable to reduce the prolapse and recommended that the owners keep the prolapsed preputial tissues lubricated with aerosolized vegetable oil or mineral oil. The prolapse persisted Department of Clinical Sciences, College of Veterinary for 5 d and tissue began to devitalize. The alpaca was referred Medicine, Auburn University, 1500 Wire Road Auburn, to the J. T. Vaughan Large Animal Teaching hospital for further Alabama 36849, USA. evaluation and treatment. Address all correspondence to Dr. Misty A. Edmondson; e-mail: Upon presentation, the alpaca was bright, alert, and respon- [email protected] sive with 6 cm of prepuce prolapsed beyond the preputial orifice The work described in this manuscript was performed at the (Figure 1). Superficial layers of the exposed preputial epithelium Auburn University College of Veterinary Medicine. were desiccated and necrotic, but no lacerations of the prepu- Use of this article is limited to a single copy for personal study. tial tissues were detected. All other physical parameters were Anyone interested in obtaining reprints should contact the within normal limits. During examination, a steady stream of CVMA office ([email protected]) for additional urine was observed from the urethral opening. The alpaca was copies or permission to use this material elsewhere. sedated with xylazine (Lloyd Manufacturing Shenandoah, Iowa,

CVJ / VOL 56 / JULY 2015 753 FOR PERSONAL USE ONLY RAPPORTCAS DE

Figure 2. Thick arrow indicates urine egress tube placed in the Figure 3. Brown gauze placed around the abdomen elevating lumen of the prepuce. Hollow arrow indicates the elastic tape the prolapsed tissue allowing for increased lymphatic and venous that has been placed over top of the stockinette and includes the drainage, resulting in a decrease in edema. entire length of the prolapsed prepuce and is adhered to the hair on the sheath.

USA), 33.2 mg, ketamine (Boehringer Ingelheim Vetmedica, after admission with instructions to monitor the animal closely St. Joseph, Missouri, USA), 333.2 mg, butorphanol (Pfizer, for recurrence, to seek re-evaluation at the J. T. Vaughan Large New York, New York, USA), 3.32 mg, intravenously to allow Animal Teaching Hospital 6 mo following discharge, and to further evaluation of the prepuce. The prolapsed preputial tis- avoid using the animal for breeding for 12 mo. The prognosis sue was edematous and friable with superficial necrosis of the for return to breeding soundness was guarded due to the risk of preputial epithelium and could not be manually reduced. The recurrence of the presenting problem. prolapsed tissue was gently cleansed with dilute povidine iodine scrub and water. An emollient mixture of 500 g of anhydrous Discussion lanolin, 60 mL of scarlet oil, and 2 g of tetracycline powder The sheath in alpacas is located in the inguinal region and is (2) was liberally applied to the prolapsed tissue. A 7.5 cm 3 flattened and triangular when viewed laterally. The prepuce is 3 mm semi-rigid plastic tube was placed in the preputial ori- adherent to the glans penis until 2 or 3 y of age. The prepuce fice, and the prepuce was covered with a 9-cm stockinette and has a well-developed muscular apparatus, consisting of the wrapped with compressive elastic bandage (Elasticon; Johnson cranial, lateral, and caudal preputial muscles that allow move- and Johnson, New Brunswick, New Jersey, USA) (Figure 2). A ment of the preputial orifice cranially during erection and mat- brown gauze sling was placed around the abdomen allowing ing behavior (4). Although multiple anecdotal reports by lay elevation of the prolapsed tissues. observers exist and preputial prolapse is described as a relatively Due to the history of recurring injury, the duration of pro- frequent incident in textbooks (4), only 1 previous case has been lapse, and the presence of devitalized tissue, the owner was given reported in the literature. A common sequel to chronic prolapse a poor prognosis for return to breeding and was presented with of the prepuce in other species is the formation of adhesions the following treatment options: i) continued medical manage- and abscesses, which can impair return to normal breeding ment, ii) reduction of the preputial prolapse and castration, and activity. The previous case report of a preputial prolapse in an iii) resection and anastomosis of the prepuce (3). The patient alpaca was managed by application of a purse string suture in was re-assessed the following day to determine viability of the preputial orifice (5). prepuce and feasible treatment options. The owners wished to This is the first such case presented to the Auburn University preserve the breeding integrity of the male, and medical man- Large Animal Teaching Hospital. The owner’s desire to maximize agement of the injury was continued. Treatments performed the potential for return to breeding soundness led to intensive during hospitalization included bandage changes and emollient medical management of the injury. A semi-rigid plastic tube application to exposed preputial tissue every other day until was placed in the preputial orifice to allow for urine egress. An manual reduction was achieved. Each treatment was carried emollient antiseptic ointment was used to prevent further desic- out under sedation with butorphanol, ketamine, and xylazine as cation of the tissue, treat possible infection of the affected area, previously described. By the 7th day of treatment, the prolapsed tissue was much less edematous and could be manually reduced and promote healing of the tissue. A stockinette was utilized to through the preputial orifice. No further bandages or retention keep the emollient in place and allow for application of pres- techniques were required as no further prolapse of preputial sure bandage. The pressure bandage, with the aim of reducing tissue was observed during the remainder of the alpaca’s hospi- edema, was placed using elastic tape with the compressive wrap talization. The alpaca was discharged to the owner’s care 10 d being placed the entire length of the stockinette and wrapped

754 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY tightly from the distal end of the prepuce proximally, anchor- (2). Another possibility is that there was incomplete separation ing the tape in the haired skin of the sheath. Finally, brown of the penis from the prepuce due to the younger age of the gauze was placed around the abdomen, allowing elevation of male and subsequent adhesion formation due to the traumatic the prolapsed tissues close to the body wall to promote venous release of the tissues during copulation. It is possible that during and lymphatic drainage of the edematous tissue. This type of initial coitus the adhesion was released leading to trauma and CASE REPORT CASE medical management is necessary to maintain the health of the subsequent prolapse of the tissue. CVJ prolapsed prepuce in cases where significant tissue trauma and devitalization do not allow for immediate manual reduction. References Furthermore, placement of a purse string suture in the sheath 1. Lin H, Walz P. Farm animal anesthesia: Cattle, small ruminants, camelids, pigs. Ames, Iowa: John Wiley & Sons, 2014. was not used in this case as this practice in bulls often leads to 2. Wolfe DF, Moll HD. Large animal urogenital surgery. Baltimore, Maryland: abscess formation and subsequent stenosis around the preputial Williams & Wilkins, 1999. 3. Tibary A, Rodriguez J, Sandoval S. Reproductive emergencies in camelids. orifice (2). While the reason for repeated prolapse of the tissue Theriogenology 2008;70:515–534. can only be speculated upon in this alpaca, bulls with poor con- 4. Cebra C, Anderson DE, Tibary A, Van Saun RJ, Johnson LW. Llama and alpaca care: Medicine, surgery, reproduction, nutrition, and herd health. formation of the prepuce and sheath appear to spontaneously St. Louis, Missouri: Elsevier, 2014. prolapse as a result of poor lymphatic drainage of the prepuce 5. Lane D. Preputial prolapse in an alpaca. Can Vet J 1999;40:260. caused by posthitis or repeated contusions during natural service

Book Review Compte rendu de livre

Veterinary Technician’s Daily Reference As with many texts, there is an electronic version, as well as a Guide, 3rd edition companion website. The website has the usual review and study materials, but also has 75 client education documents that can Jack CM, Watson PM, Valissitie Heeren V, eds. Wiley Blackwell, be edited. Ames, Iowa, USA, 2014. 908 pp. ISBN: 9781-1183-6350-8. As the authors point out, “patient care is at the heart of our (Paperback) $70.99. profession: this encompasses medical care, but also physical and mental comfort.” Discussions on pain control and pain scoring, he stated goal of this book is to help already trained and bedding, bandage and wound care, basic grooming, and tips on T licenced technicians throughout their work day. After feeding both the reluctant and over-excited eater are just some perusing this volume, I would argue that it could be of assistance of the topics that highlight this viewpoint. I personally enjoyed to anyone in the veterinary team. This book covers most areas of and bookmarked several “gems” that I had either forgotten or canine and feline veterinary medicine, from the basics of physi- had not previously come across as described in this book. My cal examination to more advanced and less frequently performed favorite diagram was of external bony palpation landmarks. My procedures such as bone marrow biopsy and chemotherapy. favorite table was 3 pages on pediatric physical examination. From dental care and taking radiographs, to basic and This was followed by a page on the process of normal labor and advanced calculations, it seems there isn’t much that hasn’t 2 pages on geriatric physical examination. been covered. Finding the information is easy, with a large table Regardless of the scope of your practice or your position on of contents, figure list, glossary, and list of abbreviations, index, the veterinary team, this reference has lots of useful information and list of references. Being a third edition, it is meticulously for a reasonable price. edited. Most photographs are black and white, but there is a color plate section included to enhance the visual effect. The anesthesia and pharmacology sections address some of the newer Reviewed by Melissa Smith, BSc, MSc, DVM, Small Animal agents available. Most of the information is laid out in tables Practitioner, Bellamy Harrison Animal Hospital, Moose Jaw, and charts. Skills and procedures are highlighted separately. Saskatchewan.

CVJ / VOL 56 / JULY 2015 755 FOR PERSONAL USE ONLY Article

Clinical characteristics of horses and foals diagnosed with cleft palate in a referral population: 28 cases (1988–2011)

Sarah D. Shaw, Tracy E. Norman, Carolyn E. Arnold, Michelle C. Coleman

Abstract — The objective of this case series was to characterize the population, case presentations, and outcomes of 28 equids diagnosed with cleft palate over a 25-year period. The incidence of cleft palate was 0.04%. The median age at presentation was 2 mo (range: 1 d to 3 y). Fifty percent of the animals were , 2 mo old, 21% were $ 2 mo but , 1 y old, and 29% were 1 y of age or older. Males and females were nearly equally represented. Short-term outcomes included euthanasia in 50%, surgical repair in 11%, supportive care in 4%, and no treatment in 32% of cases; 46% of the animals survived to discharge. Defects involving both the hard and soft palate and/or aspiration pneumonia generally had less favorable outcomes. Though cleft palate is rare in horses, it should be considered as a differential diagnosis in horses of all ages with nasal discharge, a cough, a history of recurrent respiratory infections, poor growth, or chronic submandibular lymphadenopathy. Endoscopic evaluation of the pharynx may aid in earlier diagnosis and prognostication for owners.

Résumé — Caractéristiques cliniques des chevaux et des poulains diagnostiqués avec une fente palatine dans une population de référence : 28 cas (1988–2011). L’objectif de cette série de cas était de caractériser la population, la présentation des cas et les résultats de 28 équidés diagnostiqués avec une fente palatine sur une période de 25 ans. L’incidence de la fente palatine était de 0,04 %. L’âge moyen à la présentation était de 2 mois (plage : 1 jour à 3 ans). Cinquante pour cent des animaux étaient âgés de , 2 mois, 21 % étaient âgés de $ 2 mois mais avaient , 1 an et 29 % avaient 1 an ou plus. Les mâles et les femelles affichaient une représentation pratiquement égale. Les résultats à court terme incluaient l’euthanasie dans 50 % des cas, la réparation chirurgicale dans 11 % des cas, des soins de soutien dans 4 % des cas et aucun traitement dans 32 % des cas; 46 % des animaux ont survécu au congé. Les défauts du palais dur et mou et/ou de la pneumonie par aspiration affichaient généralement des résultats moins favorables. Même si la fente palatine est rare chez les chevaux, elle devrait être considérée comme un diagnostic différentiel chez les chevaux de tous les âges avec un écoulement nasal, une toux, une anamnèse d’infections respiratoires récurrentes, une mauvaise croissance ou une lymphadénopathie sous- mandibulaire chronique. Une évaluation endoscopique du pharynx peut faciliter le diagnostic et la pronostication anticipés pour les propriétaires. (Traduit par Isabelle Vallières) Can Vet J 2015;56:756–760

Introduction lation (1). In a study of 608 congenitally deformed foals and fetuses, cleft palate was the most common craniofacial defect ongenital defects affect between 1% and 4% of foals (1). and was identified in 4% of this population (2). Cleft palate, or palatoschisis, is an uncommon congenital C Cleft palate is well-described in humans and most domes- defect affecting an estimated 0.1% to 0.2% of the equine popu- tic species, and has an estimated incidence rate of 0.6 per Department of Large Animal Clinical Sciences, Texas A&M 1000 domestic animals, which is similar to that in humans (3). University College of Veterinary Medicine and Biomedical The human literature describes cleft palates as defects of the pri- Sciences, 4475 TAMU, College Station, Texas 77843, USA. mary palate (the nares and lips) or the secondary palate (the hard and soft palate). In horses, cleft palate most commonly affects Address all correspondence to Dr. Carolyn Arnold; e-mail: the caudal half to two-thirds of the soft palate (1). These second- [email protected] ary defects result from a failure of midline fusion of the lateral Dr. Norman’s current address is Blue Ridge Equine Clinic, palatine processes. This fusion occurs in a rostral to caudal 55 Mint Spring Circle, Staunton, Virginia 24401, USA. direction at approximately day 47 of gestation in the horse (1). No funding was obtained to perform this study. The causes of cleft palate are poorly understood. Suggested Use of this article is limited to a single copy for personal study. causes in domestic species include genetic factors, environmen- Anyone interested in obtaining reprints should contact the tal, hormonal, and metabolic interactions, exposure to ionizing CVMA office ([email protected]) for additional radiation or teratogens, vitamin and mineral deficiencies, and copies or permission to use this material elsewhere. the administration of tranquilizers or corticosteroids during

756 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY pregnancy (4). Cleft palates in cattle and swine are associated discharge from the hospital. The proportion of Quarter Horses with the ingestion of toxic plants, including lupine species, wild that were admitted to the hospital during the study period and parsnip, poison hemlock, and the wild tobacco tree (1,4,5). In the proportion of Quarter Horses that were diagnosed with cleft cattle, cleft palates often present concurrently with arthrogry- palate were compared for statistical significance. posis (5). Cleft palates in cattle may be caused by an autosomal recessive trait, bovine viral diarrhea virus or akabane virus infec- Results tions, or selenium and manganese deficiencies (1,5). Case signalment ARTICLE The most common clinical sign associated with cleft palate Twenty-seven horses and foals and 1 miniature donkey foal with is dysphagia with bilateral nasal discharge of milk immediately cleft palates were presented to the Veterinary Medical Teaching after nursing (1,6). It is also common for foals to show clinical Hospital over a 25-year period (1988 to 2013). Fourteen animals signs of aspiration pneumonia, including coughing, abnormal were male, 13 were female, and 1 was a castrated male. The lung sounds, tachypnea, tachycardia, and pyrexia (1,6). Large median age at presentation was 2 mo (range: 1 d to 3 y). Fourteen defects involving the hard palate may be diagnosed with a thor- (50%) of the patients diagnosed with cleft palate at this referral ough oral examination, but definitive diagnosis is obtained via hospital were , 2 mo of age. Six patients (21%) were . 2 mo endoscopic evaluation of the nasopharynx (1,6,7). but , 1 y old. Eight patients (29%) were 1 y of age or older. Surgical repair is best suited for symmetrical defects that Quarter Horses were the most commonly represented breed. involve # 20% of the soft palate. Reported methods of correc- Thirteen Quarter Horses (46%) were diagnosed with cleft pal- tion for palatoschisis include a transoral approach, laryngotomy, ate. The proportion of Quarter Horses diagnosed with cleft pharyngotomy, and mandibular symphysiotomy. Complications palate was not significantly different than the proportion of including dehiscence of the palatal suture line, oronasal fistula Quarter Horses admitted to the hospital during the study period formation, mandibular osteomyelitis, instability of the man- (P = 0.81). Other cases included 6 Thoroughbreds (21%), dibular symphysis, lower lip dehiscence, incisional infection, 3 Arabians (11%), 2 mixed breed horses (7%), and 1 each of: hypoglossal nerve damage and chronic dysphagia are reported American Paint horse, American miniature horse, Tennessee to occur in up to 90% of attempted repairs (1,5–8,13). Failure Walking horse, and miniature donkey. of the repair is typically due to tension on the soft palate created by the lack of available tissue (5–7,13). Intensive post-operative History care is required to address associated aspiration pneumonia The presenting complaints of equids diagnosed with cleft palate and nutritional needs (4,6–11). Postoperative recommenda- included dysphagia with nasal regurgitation, persistent nasal tions include parenteral feeding or enteral feeding through a discharge, cough, aspiration pneumonia, submandibular lymph- nasogastric tube for 7 to 10 d to reduce irritation of the surgi- adenopathy, a history of pneumonia or respiratory infections, cal site. Broad-spectrum antimicrobial therapy is continued poor growth, wry nose, and colic. The most common present- for 5 d, but may be required for a longer time in animals with ing complaint was dysphagia with nasal regurgitation, seen in aspiration pneumonia (7). Due to the development of aspiration 17 horses (61%). Persistent nasal discharge, noted between pneumonia in all but the most mildly affected cases, conserva- feedings, was seen in 8 horses (29%). Six horses (21%) pre- tive management alone is rarely successful, and therefore, not sented with a cough. Three adult horses (11%) had a history of recommended (1,6). pneumonia or recurrent respiratory infections. Two horses (7%) Although cleft palate is a well-recognized condition, the had suspected aspiration pneumonia prior to presentation. One literature consists mainly of case reports and small case series (4%) 3-year-old horse presented with the sole complaint of a with limited information regarding case presentations and out- submandibular lymphadenopathy. One foal presented with wry comes in a population of both foals and adult horses (4,8–13). nose, and another with colic. Fifteen (53.5%) horses had more The purpose of this case series was to describe the presenting than 1 presenting complaint. Cases with multiple presenting complaints, diagnostics, comorbidity, treatments, and outcomes clinical complaints included: nasal regurgitation and aspiration of a diverse population of equids diagnosed with cleft palate. pneumonia (n = 3), nasal regurgitation and cough (n = 2), nasal regurgitation, cough, and poor growth (n = 1), nasal discharge Materials and methods and a history of pneumonia (n = 1), nasal discharge and cough This study was performed as a case series. Electronic medical (n = 1), nasal discharge and poor growth (n = 1), nasal regurgita- records at the Veterinary Medical Teaching Hospital at Texas tion and colic (n = 1), cough, multiple respiratory infections and A&M University from March 1988 to April 2013 were searched respiratory noise (n = 1), submandibular lymphadenopathy and for horses diagnosed with cleft palate based on keywords “pala- a history of pneumonia (n = 1), nasal discharge and a history toschisis” or “cleft palate.” Criteria for inclusion included avail- of pneumonia (n = 1), a palpable palatal defect and wry nose ability of the complete medical record and confirmation of the (n = 1), or nasal discharge and a deviated nasal septum (n = 1). palatal defect via endoscopic evaluation, or direct visualization at surgery or necropsy. Twenty-eight cases were included, rep- Diagnostics and comorbidity resenting 0.04% of all equine medical and surgical admissions Diagnosis of cleft palate was made via endoscopic evaluation to this hospital. The following information was extracted from of the nasopharynx in 26 (93%) cases. Two cases of cleft palate the records: signalment, presenting complaint, morphology of involving the hard palate were diagnosed via palpation of the the defect, diagnostics performed, treatment, and outcome until defect and were confirmed at surgery.

CVJ / VOL 56 / JULY 2015 757 FOR PERSONAL USE ONLY ARTICLE

Figure 1. Endoscopic image of the pharynx of a 3-year-old Quarter Horse mare with a midline soft palate defect.

Complete blood (cell) counts (CBCs) were performed on Figure 2. Transoral view of an extensive palatal defect involving both the hard and soft palate in a 2-day-old Quarter Horse filly. 9 (32%) animals. Abnormalities on CBC included leuko- The nasal septum is indicated by the black arrow. cytosis [20 300 cells/mL; reference interval (RI): 5400 to 14 300 cells/mL] in 1 foal, leukopenia (4900 cells/mL) in 1 foal, and hyperfibrinogenemia (14.7 to 26.5 mmol/L; RI: 2.9 to 11.8 mmol/L) in 4 foals. A normal leukogram was identified in 3 foals. Lateral thoracic radiographs were obtained for 9 (32%) cases. All 9 animals had radiographic abnormalities, ranging from mild cranioventral lung changes consistent with aspiration pneumo- nia, to severe lung consolidation with air bronchograms in the ventral lung. One 2-year-old filly had a mild interstitial and bronchial pattern with dorsocaudal distribution. Necropsies were performed on 9 animals (32%), in which 7 (25% of total cases) were confirmed to have pneumonia con- sistent with aspiration of feed material. In total, 12 horses (43%) were diagnosed with aspiration pneumonia; 9 (75%) of these were diagnosed antemortem. Euthanasia was elected in 8 of the 12 (67%) horses with aspira- tion pneumonia and in 7 of 16 (44%) horses without aspiration pneumonia.

Defect morphology Eighteen (64%) cleft palates were described as a midline soft pal- Figure 3. Endoscopic image of the pharynx of a 3-year-old Arabian stallion with an asymmetrical cleft palate. ate defect (see Figure 1). Five cases (18%) had a midline soft and hard palate defect (Figure 2). All 5 cases were , 1 y of age. Two horses (7%) had an asymmetrical soft palate defect (Figure 3). to severe bilateral palate hypoplasia. In the remaining 3 foals, Two horses (7%) had what was described as a bilateral soft pal- a mandibular symphysiotomy approach was used to repair the ate abnormality or soft palate hypoplasia. One case (4%) was palatal defects. Two foals had both soft and hard palate defects. classified as an unspecified soft palate defect. Dehiscence was noted after 8 d in 1 foal, while the other foal was lost to follow-up. The third foal had a soft palate defect and Short-term outcomes experienced a small degree of dehiscence at the cranial aspect Thirteen (46%) of the 28 animals were euthanized upon diagno- of the palatal repair 12 d after surgery; this foal healed with no sis of cleft palate. Three of 5 foals with hard palate involvement further interventions. were euthanized. One foal (4%) was discharged following supportive care with Surgery was attempted in 4 cases (14%), all of which were antibiotics to address bronchopneumonia and 1 filly (4%) died , 2 mo of age. One foal was euthanized during surgery due of colitis while awaiting surgery.

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Nine animals (32%) received no medical or surgical treat- animals that were younger at the time of diagnosis generally had ment and were discharged from the hospital. These cases had less favorable outcomes and more severe defects. neither clinical evidence of active aspiration pneumonia nor While cleft palate is often considered a differential diagnosis any significant clinicopathologic abnormalities where blood for nasal regurgitation of milk in foals, in this series 8 cases was analyzed. Surgical options were discussed with all owners (29%) were 1 y of age or older and 14 (50%) were , 2 mo of at the time of diagnosis but declined. All 9 of these cases had age. A recent retrospective case series found that of 55 horses

soft palate involvement only. diagnosed with cleft palate, 16.4% presented as athletic horses, ARTICLE 1 y of age or older (mean: 5 y; range: 1 to 14 y) (13). The most Discussion common clinical sign in those cases was abnormal noise originat- The incidence of cleft palate in this referral population was ing in the upper airway. The palatal defects in those horses were 0.04% based on all equine medical and surgical admissions located at the caudal edge of the soft palate under the epiglottis, during the study time period. This is a similar incidence to that and it was suggested that this small cleft defect may not interfere reported in a previous publication of cleft palate in domestic with athletic function in these cases (13). animals. Mulvihill et al (3) reported 331 cases with a cleft Foals , 2 mo of age were more likely to present with larger palate in a population of 684 650 domestic animals present- defects, especially involving those of the hard palate. Defects ing to 14 veterinary school clinics in North America (0.05% involving the hard palate were not diagnosed in any animal over incidence). 1 y of age. Nine of the 13 animals (69%) that were euthanized Males and females were nearly equally represented in this upon diagnosis were , 2 mo of age. Of these 9 animals, 7 had case series, with slightly higher incidence amongst males than evidence of concurrent aspiration pneumonia or systemic illness females. A gender difference is reported in the human literature, and 1 was diagnosed with a concomitant deviated nasal septum. in which isolated cleft palate has been reported more commonly Euthanasia was elected following discussions of medical and in females (3). Mulvihill et al (3) reported a larger number of surgical management. Decisions were based on poor prognosis cleft palates in female horses and cattle, but this was not statisti- or financial limitations. Conversely, horses diagnosed with cally significant. The number of cases with cleft palate in this cleft palate at . 1 y of age were more likely to be managed referral population was limited and likely to be insufficient to conservatively (75%) than horses , 1 year of age (15%). None demonstrate a clear gender bias. of these conservatively managed cases had involvement of the Cleft palate is often assumed to be a lethal congenital defect; hard palate, suggesting they had more modest palatal defects. however, 13 animals (46%) in this series survived to discharge, It is possible that horses diagnosed at a later stage in devel- 9 of which were discharged without intervention. This is simi- opment are more likely to have compensated for the defect, as lar to recent reports, with between 67% and 100% survival to supported in a recent publication by Barakzai et al (12). The discharge (12,13). Long-term outcomes were not available in authors of this study described a population of 15 adult horses most cases in this series based on the 25-year study period and with previously undiagnosed cleft palate. The outcomes in transient nature of horse ownership. However, 1 Thoroughbred these 15 cases were favorable; 2 horses had successful racing filly started race training and another continued to train. One careers, many were lightly ridden, and the survival rate was stallion with an asymmetrical soft palate defect continued to 100%. Upper airway and tracheal contamination with masti- breed mares. cated feed was common in the population of horses described The presenting complaints identified in these cases were by Barakzai et al (12), but was not associated with clinical signs numerous. The most common complaint was dysphagia with of lung disease other than coughing. Couetil and Hawkins (6) nasal regurgitation, but this was seen predominantly in foals also reported 3 horses diagnosed with cleft palate in adulthood , 2 mo of age. Persistent nasal discharge alone was the second with no clinical signs of aspiration pneumonia. In contrast, 3 of most common chief complaint at presentation and was only 8 (38%) horses . 1 y of age in our population were diagnosed seen in animals 2 mo of age or older. These complaints are with aspiration pneumonia based on physical examination well-described in the literature in association with cleft palate. findings and radiographic changes consistent with pneumonia. However, the clinical signs in some cases were nonspecific, such However, all 3 horses had mild changes and 2 were discharged as submandibular lymphadenopathy, intermittent cough, and without therapy. poor growth. Considering cleft palate as a differential diagnosis Many case reports and case series of cleft palate in the horse in horses of all ages with any of the clinical signs discussed is mainly focus on cases undergoing surgical repair and subsequent essential to making accurate diagnoses. outcomes (4,7,9–11). Given the preference for performing sur- Three animals 1 y of age or older had a history of respiratory gical repair prior to 6 wk of age, a case selection bias toward a infections as foals. Given the frequency of changes in horse own- younger population might exist in these studies (4,7,9–11). In ership, the true incidence of foal pneumonia in this population a series of 11 cases of cleft palate that underwent surgical repair, may have been greater than described here. Foals with clinical 9 (82%) were , 1 y of age (8). signs of pneumonia, especially those with pulmonary consolida- Surgery was attempted in only 4 cases in this equine popu- tions identified with thoracic radiography or ultrasonography, lation. Owners of horses diagnosed with cleft palate were are often diagnosed with Rhodococcus equi infection. Thorough informed of the likelihood of failure associated with surgical history gathering and endoscopic evaluation of the nasophar- repair, which may have influenced their decisions regarding ynx would aid in earlier diagnosis of cleft palate. In this series, surgical intervention. In addition, many animals had only mild

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clinical signs and owners possibly chose not to pursue surgery used for dorsal displacement of the soft palate and may warrant based on potential risks and complications. The animals that further consideration for the treatment of small, caudal, palatal underwent surgery in this population presented at 1 d, 13 d, defects in horses. 7 wk, and 1 y of age. Surgical repair was not possible in the Cleft palate is rare in horses, but should be considered yearling due to severe hypoplasia of the soft palate, and he was in horses of all ages with nasal discharge, cough, history of euthanized prior to anesthetic recovery. Survival to discharge recurrent respiratory infections, poor growth or submandibu- following surgery was 100%. However, surgical repair failed lar lymphadenopathy. Prognosis remains guarded for horses 8 and 12 d after surgery in the 1-day and 7-week old foals, diagnosed with cleft palate, with or without attempted surgical respectively. Unfortunately, both the 1-day and 13-day old repair. However animals with smaller defects appear to have

ARTICLE foals that underwent surgical repair were lost to follow-up and less co-morbidity, a lower incidence of pneumonia, and a lon- long-term follow-up beyond 6 wk was not available for the ger lifespan. In some cases, these animals may have careers as 7-week-old foal that underwent surgery. performance animals. CVJ It is recommended that surgery be performed in foals , 6 wk of age in order to optimize visualization of the defect, minimize References medical complications, and avoid airway contamination with 1. Gaughan EM, DeBowes RM. Congenital diseases of the equine head. solid food (1,7,9–11). Semevolos and Ducharme (11) report Vet Clin North Am Equine Pract 1994;14:273–289. complete healing of the cleft palate defect in 50% of cases after 2. Crowe MW, Swerczek TW. Equine congenital defects. Am J Vet Res 1985;46:353–358. 1 or more surgeries, but also report an 87.5% complication rate. 3. Mulvihill JJ, Mulvihill CG, Priester WA. Cleft palate in domestic ani- Repeated surgeries were not performed on any equid in this mals: Epidemiologic features. Teratology 1980;21:109–112. case series. Other studies have a lower success rate, consistent 4. Kirkham LE, Vasey JR. Surgical cleft soft palate repair in a foal. Aust Vet J 2002;80:143–146. with the findings of this case series, reporting palatal suture line 5. Oryan A, Shirian S, Samadian MR. Congenital craniofacial and skel- dehiscence and subsequent oronasal fistula formation in up to etal defects with arthrogryposis in two newborn male Holstein Fresian 90% of surgical cleft palate repairs (1,4,5,7–11). In contrast, calves. Comp Clin Pathology 2011;20:43–46. 6. Couetil LL, Hawkins JF. Respiratory Diseases of the Horse: A Problem- Murray et al (13) found that surgery was significantly associated Oriented Approach to Diagnosis and Management. Boca Raton, Florida: with survival. In that study, 13 of 26 horses that did not have CRC Press, 2013:132–135. surgery were euthanized, compared with 3 of 26 horses that had 7. Ducharme NG. Pharynx. In: Auer JA, Stick JA, eds. Equine Surgery. 4th ed. St. Louis, Missouri: Elsevier, 2012:569–591. surgery. However, despite this high survival rate, both complica- 8. Bowman KF, Tate LP, Evans LH, Donawick WJ. Complications of cleft tions and incomplete healing occurred in 65% of patients. The palate repair in large animals. J Am Vet Med Assoc 1982;180:652–657. reasons for the reported variations in complication rates and 9. Balstone JHF. Cleft palate in the horse. Br J Plast Surg 1966;19: 327–331. survival following surgery are unknown, but may be attributed 10. Jones RS, Maisels DO, DeGeus JJ, Lovius BBJ. Surgical repair of cleft to the number of surgeries per horse, the surgical approach, palate in the horse. Equine Vet J 1975;7:86–90. differences between inclusion criteria amongst studies, and 11. Semevolos SA, Ducharme N. Surgical repair of congenital cleft palate in horses: Eight cases (1979–1997). Proc Annu Convention AAEP case selection. Further studies are needed to more accurately 1998;44:267–268. identify prognostic indicators and factors associated with suc- 12. Barakzai SZ, Fraser BSL, Dixon PM. Congenital defects of the soft cessful repair of cleft palate. A recent case report described a palate in 15 adult horses. Equine Vet J 2013;46:185–188 13. Murray SJ, Elce YA, Woodie JB, Embertson RM, Robertson JT, laryngeal tie-forward procedure in a miniature pony diagnosed Beard WL. Evaluation of survival rate and athletic ability after nonsurgi- with cleft palate at 1 y of age (14). This procedure resulted in cal or surgical treatment of cleft palate in horses: 55 cases (1986–2008). advancement of the larynx, such that the defect was covered by J Am Vet Med Assoc 2013;243:406–410. 14. Charman R. Correction of pharyngeal and soft palate dysfunction the epiglottis, and subsequent resolution of the pony’s dysphagia associated with a cleft palate in a miniature pony using a laryngeal tie- and respiratory infections. This surgical approach is commonly forward. Aust Equine Vet 2011;30:63.

760 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Practitioners’ Corner Le coin des praticiens

Anaplasmosis in a dog on Vancouver Island

Jennifer Kowalski, Diane Cruickshank, Malcolm Macartney

n February of 2015, a 7-year-old, 33 kg, spayed female I Labrador retriever dog was presented to our hospital with a 1-day duration of decreased appetite, lethargy, and a stiff and stilted gate. She had vomited once the previous day and the owners mentioned that she may have ingested something from the garbage. This dog also had a history of acquiring several ticks within the previous 2 wk and that 2 ticks had been removed by the owners just prior to her examination. The Pacific deer tick, Ixodes pacificus, is commonly encountered on dogs in this area of Vancouver Island in 2 seasonal periods; a winter (January-February) spike and then throughout the summer (June through September). This dog had no history of travel off Vancouver Island. On distant examination, this dog had an obvious right hind leg lameness with a shifting of weight from this limb while walking. There were no obvious neurological deficits. Her tem- perature was 40.3°C, her heart rate was 170 beats/min, and her Figure 1. Blood smear showing morulae (cluster of bacteria) in a neutrophil. respiratory rate was normal. Her mucous membranes were pink and mildly tacky. There was no discernible pain or abnormalities on abdominal palpation. An orthopedic examination revealed Upon examination of the blood smear, it was readily apparent no obvious pain response on flexion or extension of any limbs, that there were cytoplasmic inclusion bodies (morulae, Figure 1) nor any obvious swelling of any joints. present in the neutrophils (seen in 27 out of 100 neutrophils Abdominal radiographs were taken and in-house complete counted). blood (cell) count (CBC) and serum chemistry were performed. A tentative diagnosis of anaplasmosis was made based on the The radiographs revealed spondylosis of several lumbar ver- history, clinical signs, and findings on the blood smear (1,2). tebrae but no other skeletal or soft tissue abnormalities were Treatment included doxycycline 300 mg, q12h for 14 d and detected. The chemistry panel was unremarkable with all prednisone 12.5 mg, q12h for 5 d, then q24h for 7 d. parameters within normal range. The CBC, however, revealed Serum was sent to Idexx Laboratory for a 4Dx SNAP test severe thrombocytopenia [18 3 109/L, reference interval (RI): which is an enzyme-linked immunosorbent assay (ELISA) 148 to 484 3 109/L] and the blood smear showed no plate- screening test for the presence of circulating antibodies to let clumping to skew this finding. There was a leukopenia Anaplasma phagocytophilum, A. platys, Ehrlichia canis, and (3.6 3 109/L, RI: 5.05 to 16.76 3109/L) with a notable lym- E. ewingii, Borrellia burgdorferi, and Dirofilaria antigen. The phopenia (0.24 3 109/L, RI: 1.05 to 5.19 3 109/L), an absolute results were negative for all organisms. Upon consultation with eosinopenia, and a normal neutrophil count (3.5 3 109/L, the reference laboratory, a real-time polymerase chain reaction RI: 2.95 to 11.64 3 109/L). The red cell count was normal (PCR) test for Anaplasma spp. DNA was performed on the (7.0 3 1012/L, RI: 5.65 to 8.87 3 109/L). same serum sample. This test was positive for Anaplasma DNA, thus confirming the tentative diagnosis. The patient improved significantly after a few days of therapy and had an uneventful McKenzie Veterinary Services, Victoria, British Columbia recovery. [Jennifer Kowalski (AHT), Diane Cruickshank (DVM), Malcom This case is similar in many respects to a previously docu- Macartney (DVM)]. mented case of anaplasmosis in a dog on Vancouver Island (3). Address all correspondence to Jennifer Kowalski; e-mail: Clinicians are reminded that screening tests for antibodies may [email protected] prove negative when animals present in the acute phase of ana- Use of this article is limited to a single copy for personal study. plasmosis which may last 7 to 14 d (2,4) and that laboratory Anyone interested in obtaining reprints should contact the confirmation for the presence of DNA may be required to con- CVMA office ([email protected]) for additional firm presence of the organism. There are several reports of dogs copies or permission to use this material elsewhere. that were positive by PCR but negative in tests for antibody to

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Anaplasma, including a recent report on 3 dogs from Saskatoon 2. Sainz Á, Roura X, Miró G, et al. Guideline for veterinary practitioners (5). In addition, there is a general sense that in many areas of on canine ehrlichiosis and anaplasmosis in Europe. Parasit Vectors 2015; 8:75. North America, including southern Vancouver Island, ticks are 3. Lester SJ, Breitschwerdt EB, Collis CD, Hegarty BC. Anaplasma phagocy- more prevalent and the incidence of tick bites in dogs appears to tophilum infection (granulocytic anaplasmosis) in a dog from Vancouver be increasing. Veterinarians are advised to be vigilant in testing Island. Can Vet J 2005;46:825–827. 4. Otranto D, Testini G, Dantas-Torres F, et al. Diagnosis of canine vector- for tick-borne diseases in dogs with a history of illness following borne diseases in young dogs: A longitudinal study. J Clin Microbiol tick exposure. Veterinary technicians viewing smears in-house 2010;48:3316–3324. need to be aware that the presence of inclusion bodies in neu- 5. Cockwill KR, Taylor SM, Snead EC, et al. Granulocytic anaplasmosis in three dogs from Saskatoon, Saskatchewan. Can Vet J 2009;50:835–840. trophils is a significant clue in the diagnosis of anaplasmosis. References 1. Kirtz G, Leidinger E. In-clinic diagnosis of canine anaplasmosis based on haematological abnormalities and evaluation of a stained blood smear. LE COINLE DES PRATICIENS Tierarztl Prax Ausg K Kleintiere Heimtiere 2015;43:101–106.

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Running Obsession Spreads — To Dogs! A new book recently launched — a guide to running with dogs. and balanced training in order to run, just like humans do. Given Running for Dogs is the brainchild of Toronto-based writer Olga my experience and research, I knew I could write a book that Zuberg and the Running for Dogs team, who’ve been research- would not only be easy to follow, but also more helpful than cur- ing the topic and organizing canine running competitions for rently available material”. Running for Dogs is the first such book over a year. Fitness with dogs has become very popular, and now to be aimed at ordinary pet dogs — entry-level canine runners. the much-needed guide is coming to life. Running for Dogs answers many common questions that dog The book is designed as an easy-to-follow guide to getting owners have: Is my dog a suitable running companion? How far started on running with dogs. In fact, the author found that it should my dog go? How do I start my dog on running? How takes only three runs for an average dog to pick up on running. do I prevent problems such as leash-pulling and jumping? And “I know how much dog owners love their pets, and that many much more… would do anything in their power to help them have fulfilling lives,” said Olga. “Unlike popular assumption, dogs do need a safe More information is available on www.blog.runningfordogs.com

762 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Veterinary Practice Management Gestion d’une clinique vétérinaire

A strong year in client numbers for much of Canada Une année solide pour le nombre de clients dans une grande partie du Canada

Chris Doherty

he number of active clients is, without question, one of the e nombre de clients actifs est, sans contredit, l’une des Tmost crucial metrics for any veterinary practice. Without L mesures plus importantes de toute pratique vétérinaire. a strong supply of clients, even the best run hospital will falter. Sans un nombre important de clients, même la clinique la mieux While the manipulation of fees, supply costs, and wages can gérée subira des ratées. Même si la manipulation des tarifs, des help a practice maximize profitability, the bottom line will coûts des fournitures et des salaires peut aider à maximiser la always be driven by how many pet owners are walking through rentabilité de la pratique, les résultats dépendront toujours du the front door. nombre de propriétaires d’animaux qui franchissent le seuil de Through the Annual Provincial Practice Owner’s Economic la porte. Surveys, the average number of active clients per full-time Dans le cadre du Sondage annuel provincial auprès des equivalent DVM can be measured in each of the provinces. For propriétaires de pratique, le nombre moyen de clients actifs par the purposes of this research, a full-time equivalent (FTE) is vétérinaire équivalent temps plein peut être mesuré dans chaque assumed to be 1750 hours worked per year. province. Pour les besoins de cette recherche, on suppose qu’un Table 1 outlines these averages from 2012 to 2014. The past équivalent temps plein (ETP) travaille 1750 heures par année. year was a strong one overall, with most provinces experiencing Le tableau 1 présente ces moyennes de 2012 à 2014. L’année growth in the average number of active clients per FTE. Led by dernière a connu une forte performance en général et la plupart New Brunswick, with a 20.6% increase, 5 provinces enjoyed des provinces ont connu une croissance du nombre moyen de higher average numbers of active clients in 2014 compared with clients actifs par ETP. Le Nouveau-Brunswick était en tête du those in 2013. Manitoba and Prince Edward Island had jumps peloton, avec une hausse de 20,6 % et, en 2014, cinq provinces of 8.9% and 7.4%, respectively, while Nova Scotia’s average ont affiché un nombre moyen de clients actifs supérieur à celui number of active clients per FTE climbed by 4.6%, and Alberta de 2013. Le Manitoba et l’Île-du-Prince-Édouard ont réalisé had a modest rise of 2.4%. des bonds de 8,9 % et de 7,4 % respectivement, tandis que le On the opposite side of the coin, however, Saskatchewan, nombre moyen de clients actifs par ETP a grimpé de 4,6 % en British Columbia, and Ontario all witnessed declines in the aver- Nouvelle-Écosse et que l’Alberta a affiché une hausse modeste age number of active clients per FTE. Ontario held the dubious de 2,4 %. honor of having the steepest downturn, with the number of Par contre, à l’envers de la médaille, la Saskatchewan, la clients falling by 7.1%. British Columbia’s average slipped by Colombie-Britannique et l’Ontario ont connu des déclins du 2.1%, and Saskatchewan’s by 1.2%. nombre moyen de clients actifs par ETP. L’Ontario a obtenu

This article is provided as part of the CVMA Business Management Program, which is co-sponsored by IDEXX Laboratories, Petsecure Pet Health Insurance, Merck Animal Health, and Scotiabank. Address all correspondence to the CVMA Business Management Committee; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. Le présent article est rédigé dans le cadre du Programme de gestion commerciale de l’ACMV, qui est cocommandité par IDEXX Laboratories, Petsecure Insurance, Merck Santé Animale et la Banque Scotia. Veuillez adresser toute correspondance au Comité de la gestion commerciale de l’ACMV; courriel : [email protected] L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des ­réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs.

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Table 1/Tableau 1. Average number of active clients per FTE DVM (1750 h)/Nombre moyen de clients actifs par vétérinaire ETP (1750 h) Year NF PEI NB NS ON MB SK AB BC Année T.-N.-L. Î.-P.-É. N.-B. N.-É. Ont. Man. Sask. Alb. C.-B. 2012 929 1023 1061 1012 837 953 933 900 921 2013 na/n.d. 1036 923 947 800 978 894 935 859 2014 1595 1113 1113 991 743 1065 883 957 841

NF — Newfoundland and Labrador; PEI — Prince Edward Island; NB — New Brunswick; NS — Nova Scotia; ON — Ontario; MB — Manitoba; SK — Saskatchewan; AB — Alberta; BC — British Columbia, na — not available./T.-N.-L. — Terre-Neuve-et-Labrador; Î.-P.-É. — Île-du-Prince-Édouard; N.-B. — Nouveau-Brunswick; N.-É. — Nouvelle-Écosse; Ont. — Ontario; Man. — Manitoba; Sask. — Saskatchewan; Alb. — Alberta; C.-B. — Colombie-Britannique, n.d. — non disponible.

Newfoundland & Labrador did not provide sufficient la distinction regrettable de connaître la plus grande baisse, responding practices in 2013 to report on average number of avec une chute de 7,1 % du nombre de clients. Par ailleurs, la active clients per FTE, and thus is listed as “na” in Table 1. moyenne de la Colombie-Britannique a affiché une baisse de While most provinces will relish these findings, it is impor- 2,1 % et celle de la Saskatchewan a diminué de 1,2 %. tant to note that these surveys were being completed just as the En 2013, Terre-Neuve-et-Labrador n’a pas fourni GESTION D’UNECLINIQUE VÉTÉRINAIRE price of crude oil began its plummet. As a result, the picture suffisamment de réponses des pratiques pour permettre un painted by the 2014 survey may be quite different from cur- rapport sur le nombre moyen de clients actifs par ETP et une rent reality, particularly in oil-rich provinces such as Alberta, mention «n.d.» est donc indiquée dans le tableau 1. Saskatchewan, and Newfoundland & Labrador. Given these Même si la plupart des provinces seront satisfaites de ces economic developments, some practices will find that they résultats, il est important de se rappeler que ces sondages ont été must work even more diligently to get clients into the building. effectués juste au moment où le prix du pétrole brut commençait One well-established method for retaining clients is through à chuter. Par conséquent, l’image reflétée par le sondage 2014 use of the telephone. By calling, staff members are able to pourra être très différente de la réalité actuelle, particulièrement actively engage clients and book an appointment time. Postcards dans les provinces dont l’économie repose sur le pétrole comme and e-mails are comparatively passive, and place the onus on the l’Alberta, la Saskatchewan et Terre-Neuve-et-Labrador. Compte client to contact the clinic to schedule an appointment. tenu de cette situation économique, certaines pratiques devront Another benefit to phoning clients is the ability to respond déployer des efforts encore plus diligents pour attirer des clients to any questions or concerns they may have. Without the à leur clinique. opportunity to immediately address them, clients’ queries Une méthode bien établie de conserver des clients se base may go unanswered; perhaps they are unsure as to why their sur l’utilisation du téléphone. En faisant un appel, les employés pet requires a physical examination. A postcard will do little peuvent engager activement les clients et prendre un rendez- to answer this question. Although more labor-intensive than vous. Les cartes postales et les courriels sont des méthodes plutôt mailings, the return on investment of calling clients due for passives et c’est le client qui doit communiquer avec la clinique reminders is typically higher as a result of a greater success rate pour prendre rendez-vous. in scheduling appointments. Un autre avantage de téléphoner aux clients est la capacité de The superiority of the telephone as a method of contacting répondre à des questions ou à des préoccupations qu’ils pourront clients is evidenced through research performed by Terra Shastri exprimer. Sans l’occasion de répondre immédiatement aux of the Ontario Veterinary Medical Association. In her analysis, préoccupations des clients, elles pourront ne pas être abordées et the number of clients booking an appointment in response to ils ne savent peut-être pas pourquoi leur animal de compagnie a a postcard was compared to the number booking as a result of besoin d’un examen physique. Une carte postale ne répondra pas a phone call (or voicemail if the client did not answer). A post- à cette question. Même si les appels aux clients représentent plus card or letter resulted in an average of 19% of clients booking de travail que les courriels, le rendement sera habituellement an appointment; a phone call garnered an average of 78.7% of supérieur parce qu’il se traduira par un meilleur taux de succès clients booking an appointment. pour la prise de rendez-vous. This year may prove to be a difficult one for some, particu- La supériorité du téléphone comme méthode de larly if the price of crude oil remains depressed, thus weighing communication avec les clients est confirmée par la recherche on provincial and national economies. The best defence against réalisée par Terra Shastri de l’Ontario Veterinary Medical these circumstances continues to be a good offence. Getting on Association. Dans son analyse, le nombre de clients prenant the phone and conveying the importance of veterinary visits to rendez-vous en réponse à une carte postale a été comparé au clients should be every practice’s game plan. Doing everything nombre de rendez-vous découlant d’un appel téléphonique (ou possible to keep active client numbers elevated will do more to d’un message sur la boîte vocale si le client n’avait pas répondu). help a practice weather difficult times than any other measure. Une carte postale ou une lettre a produit une moyenne de 19 % de clients qui prenaient un rendez-vous et un appel téléphonique Notes: Average numbers of active clients per FTE were deter- s’est soldé par une moyenne de 78,7 % de clients qui prenaient mined using the 2014 Provincial Practice Owner’s Economic un rendez-vous. Surveys. There was no Provincial Practice Owner’s Economic Cette année pourra s’avérer difficile pour certains, Survey in Quebec in 2014. Number of active clients per FTE particulièrement si le cours du pétrole brut demeure bas, ce qui

764 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY was determined by taking each practice’s reported number of resulting number of active clients per FTE was averaged among active clients, dividing by the total number of DVM hours all practices within a province, to determine the provincial aver- PRACTICE MANAGEMENT VETERINARY worked within the practice, and multiplying by 1750. The age number of active clients per FTE. ■

créera des pressions pour les économies provinciales et nationale. Notes : Le nombre moyen de clients actifs par ETP a été La meilleure défensive contre ces circonstances consistera à déterminé en se fondant sur les Sondages économiques passer à l’offensive. Toutes les pratiques vétérinaires devraient provinciaux 2014 auprès des propriétaires de pratique. En appeler leurs clients et leur communiquer l’importance des 2014, il n’y a pas eu de Sondage économique provincial auprès visites chez le vétérinaire. La mise en œuvre de tous les moyens des propriétaires de pratique au Québec. Le nombre de clients nécessaires pour protéger le nombre élevé de clients représentera actifs par ETP a été déterminé en prenant le nombre de clients la mesure qui permettra le mieux de traverser des moments actifs déclaré, en divisant ce chiffre par le nombre total d’heures difficiles. travaillées par les vétérinaires dans la pratique et en multipliant ensuite par 1750. La moyenne du nombre de clients actifs par ETP a ensuite été établie parmi toutes les pratiques d’une province afin de déterminer le nombre moyen de clients actifs par ETP à l’échelle de la province. ■

Index of Advertisers Index des annonceurs

Animal Health Laboratory, Laboratory Services Division...... 776 Jackson & Associates...... 776

Bayer...... 641, 644 Lebalab, Inc...... 659

Borden Ladner Gervais LLP...... 776 Merial Canada, Inc...... OBC.

Canadian Veterinary Medical Association...... 650, 654 Muskwa-Kechika Adventures...... 776

Concord Veterinary Supply...... 775 Practice One Consulting...... 776

Elanco...... 653, IBC Sensor Health Veterinary Diagnostics, Inc...... 776

Fresenius Kabi Animal Health...... 649 Universal Imaging...... IFC

Gallant Custom Laboratories, Inc...... 776 UXR, Inc...... 775

IDEXX Laboratories, Inc...... 642 Vetlink Employment Services...... 772

The participation of advertisers in the CVJ is an indication of their com- Le support des annonceurs démontre leur engagement pour mitment to the advancement of veterinary medicine in Canada. We l’avancement de la médecine vétérinaire au Canada. Nous vous encourage our readers to give their products and services appropriate ­encourageons à prendre ­connaissance de leurs services et ­produits. consideration. — Ed. — NDLR

CVJ / VOL 56 / JULY 2015 765 FOR PERSONAL USE ONLY

Answers to Quiz Corner Les réponses du test éclair

1. B) Hemangiosarcoma is a relatively common neoplasm in older C) Le fomépizole est le traitement reconnu pour les stades large breed dogs, and the right side of the heart is a common précoces d’empoisonnement par l’éthylène glycol. La site of origin. The description of the mass as soft and dark red N-acétylcystéine est utilisée pour traiter l’empoisonnement fits the typical gross appearance of hemangiosarcoma. Also, par l’acétaminophène. La vitamine K est utilisée pour traiter these neoplasms of vascular endothelial origin are prone to les patients exposés aux rodenticides anticoagulants. Le rupture, causing hemopericardium (cardiac tamponade) and misoprostol est un analogue de prostaglandine utilisé sudden death. pour traiter les expositions aux anti-inflammatoires non B) L’hémangiosarcome est un néoplasme relativement commun stéroïdiens et l’hydrochlorure de pralidoxime est utilisé pour chez les vieux chiens de grandes races et le côté droit inverser les problèmes cliniques associés aux intoxications du cœur est une localisation commune. La description d’organophosphorés. de la masse comme étant molle et de couleur rouge 4. B) Dil ution of the injectate with three times the volume of saline foncé convient à l’apparence macroscopique typique is the most effective treatment for extravasated thiopental. de l’hémangiosarcome. Aussi, ces néoplasmes d’origine None of the other actions listed will prevent tissue damage endothéliale vasculaire sont sujets aux ruptures, causant un following accidental perivascular injection of thiopental. hémopéricarde (tamponade cardiaque) et la mort subite. B) La dilution du produit injecté avec trois fois le volume 2. C) Praziquantel is the only anthelmintic available to be used de saline constitue le traitement le plus efficace contre against tapeworms. le thiopental extravasculaire. Aucune des autres actions C) Le praziquantel est le seul anthelmintique disponible pour énumérées n’empêchera le dommage tissulaire à la suite de utilisation contre les ténias. l’injection périvasculaire accidentelle de thiopental. 3. C) Fomepizole is the recognized therapy for early stage ethylene 5. B) The incubation period is very long. All other responses are glycol poisoning. N-acetylcysteine is used to treat acetamin- true. ophen poisoning. Vitamin K is used to treat patients exposed B) La période d’incubation est très longue. Toutes les autres to anticoagulant rodenticides. Misoprostol is a prostaglandin réponses sont vraies. analogue used to treat nonsteroidal anti-inflammatory drug (NSAID) exposures, and pralidoxime hydrochloride is used to reverse the clinical problems associated with organophos- phate intoxications.

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766 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Diagnostic Ophthalmology Ophtalmologie diagnostique

Bianca S. Bauer, Lynne S. Sandmeyer, Bruce H. Grahn

History and clinical signs 2-year-old, neutered male Australian shepherd cross dog A was examined at the ophthalmology service at the Western College of Veterinary Medicine (WCVM) for abnormal appear- ance of both globes. The dog was adopted as a stray dog 2 wk prior to examination and the new owners noted red eyes and visual deficits. Neuro-ophthalmic examination revealed absent menace and pupillary light reflexes in the right eye. A menace response was present in the left eye but the left direct and con- sensual pupillary light reflexes were incomplete. Palpebral and oculocephalic reflexes were present bilaterally. Schirmer tear test (Schirmer Tear Test Strips; Alcon Canada, Mississauga, Ontario) values were 28 and 20 mm/min in the right and left eyes, respectively. The intraocular pressures were estimated Figure 1. Distant photograph of a 2-year-old Australian with a rebound tonometer (Tonvet; Tiolat, Helsinki, Finland) shepherd cross dog. and were 5 and 8 mmHg in the right and left eyes, respec- tively. Fluorescein staining (Fluorets; Bausch & Lomb Canada, dysgenesis (MOD). A secondary uveitis was also present OU Markham, Ontario) was negative bilaterally. On distant exami- with the right eye more affected than the left. Microphthalmos nation bilateral moderate microphthalmia was noted (Figure 1). is a congenitally small eye. There is considerable variation in the Biomicroscopic examination (Osram 64222; Carl Zeiss Canada, extent of microphthalmia and the condition may be unilateral Don Mills, Ontario) of the right eye revealed moderate con- or bilateral. When unilateral, the degree of reduction of globe junctival hyperemia, microcornea, and mild corneal edema. size is usually obvious but mild decreases that are bilateral may The pupil was miotic and did not dilate following application not be so obvious. In milder forms the condition is compat- of 0.5% tropicamide (Mydriacyl; Alcon Canada) and moderate ible with vision but microphthalmos is often blinding when in aqueous flare was noted. Lenticular examination revealed mature combination with MOA (1). Merle ocular dysgenesis occurs in cataract. Biomicroscopic examination of the left eye revealed breeds affected by the merle gene [i.e., Australian shepherds, microcornea, mild conjunctival hyperemia, a large typical iris Great Danes, collies, and dachshunds including mixed breeds coloboma, and immature cataract. This pupil dilated only par- (2)]. The merle gene is a color dilution gene that lightens the tially following application of 0.5% tropicamide (Mydriacyl, coat color. The most severe ocular anomalies occur in homozy- Alcon Canada). Indirect ophthalmoscopic (Heine Omega 200; gous merles with abundant white hair coat involving the head Heine Instruments Canada, Kitchener, Ontario) examination region. The ocular abnormalities that occur with this condition could not be performed in the right eye due to the miosis and include: microphthalmos, microcornea, iridal abnormalities (col- lenticular opacification but was within normal limits in the left oboma, hypoplasia), asymmetric pupil size, shape, or position eye. Photographs of the right and left eyes following mydriasis (dyscoria and/or corectopia), persistent pupillary membranes, are provided for your assessment (Figure 2). lens abnormalities (microphakia, cataract, coloboma, luxation/ subluxation), scleral defects (coloboma, staphyloma) and retinal What are your clinical diagnosis, defects (detachment, retinal dysplasia). Affected dogs also have differential diagnoses, therapeutic plan, varying degrees of congenital deafness (3). Although the cause and prognosis? for this congenital anomaly remains unknown the embryogenesis Discussion of the ocular defect likely stems from a primary abnormality of Our clinical diagnoses were microphthalmos and multiple the retinal pigment epithelium (RPE) or outer layer of the optic ocular anomalies (MOA) OU consistent with merle ocular cup (4). In the Australian shepherd dog, the ocular disease is Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

CVJ / VOL 56 / JULY 2015 767 FOR PERSONAL USE ONLY

a posterior synechia, and they relax ciliary muscle spasm, which is a major factor in discomfort associated with uveitis (6). Topical anticholinergics can be used every 8 to 24 hours depending on the severity of the uveitis. Given the extent of the uveitis OD and to further evaluate the posterior segment, an ocular ultrasound was performed and revealed a complete retinal detachment. An enucleation, or an evisceration and prosthesis, was recommended to the owners given the lack of vision in this eye and high risk for continued severe uveitis with the development of secondary glaucoma. The owners initially declined surgery and the dog was treated with a topical steroid, prednisolone acetate 1% (ratioPREDNISOLONE; Teva Canada Limited, Toronto, Ontario) every 6 h OD and topical atropine sulphate 1% OPHTALMOLOGIE DIAGNOSTIQUE OPHTALMOLOGIE (Isopto-atropine; Alcon Canada) every 12 h OD. The left eye b was also treated with prednisolone acetate 1% every 12 h. Three weeks later the owners returned to pursue an evisceration and prosthesis for the right eye and the left eye was continued on prednisolone acetate 1% once daily indefinitely. Annual exami- nations with an ophthalmologist were recommended for the left eye for life to monitor for possible cataract progression or the recurrence of uveitis. A major differential diagnosis in cases of microphthalmia and MOA with or without uveitis is phthisis bulbi secondary to chronic uveitis or trauma. Phthisis bulbi, however, can be ruled out in this dog given the merle coat pattern and clinical signs OU. The prognosis for MOD depends on the severity of the condition. No treatment is necessary in mild cases; however, Figure 2. Clinical photographs of the right (a) and left (b) eyes when the lens is involved, medical and/or surgical treatment of a 2-year-old Australian shepherd cross dog. may be required. Affected dogs that have lenticular involvement with a normal posterior segment are candidates for phacoemul- sification and intraocular lens implantation. In many cases of inherited as a recessive trait with incomplete penetrance, while MOD, assessment by an ophthalmologist is recommended to the inheritance of the merle dilution is autosomal dominant fully evaluate the extent of the condition with the hopes for (5). Merle-merle breedings are, therefore, not recommended. maintaining vision and saving the globes long-term. Severe MOA with cataract can be accompanied by a pha- colytic uveitis due to leakage of damaged, cataractous lens References proteins into the anterior chamber. Clinical manifestations 1. Martin CL. Ophthalmic Disease in Veterinary Medicine. London, UK: of anterior uveitis include epiphora, conjunctival hyperemia, Manson Publishing, 2005. 2. Hendrix DV. Diseases and surgery of the canine anterior uvea. In: corneal edema, miosis, ciliary spasm causing pain, and photo- Gelatt KN, Gilger BC, Kern TJ, eds. Veterinary Ophthalmology. 5th ed. phobia with or without aqueous flare. The diagnosis of uveitis is Vol. 2. Ames, Iowa: John Wiley & Sons, 2013:1146–1198. based on the presence of the aforementioned clinical signs and 3. Gwin RM, Wyman M, Lim DJ, Ketring K, Werling K. Multiple ocular defects associated with partial albinism and deafness in the dog. J Am a low intraocular pressure. Uveitis should be treated with topi- Anim Hosp Assoc 1981;17:401–408. cal anti-inflammatory and anticholinergic therapy. Frequency 4. Cook CS, Burling K, Nelson EJ. Embryogenesis of posterior segment of administration of anti-inflammatories (topical NSAIDs or colobomas in the Australian Shepherd dog. Prog Vet Comp Ophthalmol 1991;1:163–170. steroids) should be every 6 to 12 h with the higher frequencies 5. Gelatt KN, Powell NG, Huston K. Inheritance of microphthalmia used in severe cases of uveitis. Topically applied anticholiner- with coloboma in the Australian shepherd dog. Am J Vet Res 1981;42: gics (1% to 2% atropine) are useful for 3 reasons: they reduce 1686–1690. 6. Brooks DE, Matthews AG. Equine ophthalmology. In: Gelatt KN, protein and cellular leakage from inflamed uveal blood vessels, ed. Veterinary Ophthalmology. 4th ed. vol. 2. Ames, Iowa: Blackwell they dilate the pupil which protects the eye from development of Publishing, 2007:1165–1274.

768 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY Classifieds Petites annonces Business Directory

Practice One Consulting

Practice Valuations  Practice Purchase Practice Sale  Practice Management

Dr. Frank Richardson, DVM, MBA Veterinary Management Consultant

P.O. Box 176 Phone: (902) 531-2617 Western Shore, Nova Scotia E-mail: [email protected] B0J 3M0 Fax: (902) 531-2618

DOUGLAS C. JACK – Counsel • Practice Management Agreements • Incorporations • Employment Matters • Discipline Proceedings and Malpractice Defence • Buying and Selling a Practice

P 416.367.6389 | TF 800.563.2595 F 416.361.2448 | [email protected] Scotia Plaza, 40 King St W Toronto, ON, Canada M5H 3Y4

Calgary | Montréal | Ottawa Toronto | Vancouver Lawyers | Patent & Trade-mark Agents Borden Ladner Gervais LLP is an Ontario Limited Liability Partnership. blg.com

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CVJ / VOL 56 / JULY 2015 769 FOR PERSONAL USE ONLY Business Directory

770 CVJ / VOL 56 / JULY 2015 FOR PERSONAL USE ONLY

PROTECT YOUR CAT FOUR TIMES A YEAR. Your clients and their pets deserve the best protection from intestinal worms all year round, but the risks aren’t always clear. New research sheds light on parasite prevalence across Canada and showed tapeworm to be among the most commonly found parasite in cats of any age1. Regular deworming is an important component to minimize the risks of parasite burdens in cats. Milbemax® Flavor Tabs®, are small tasty tablets that offers broad spectrum protection against tapeworm and other intestinal parasites.*

1 Villeneuve A, Polley L, Jenkins E, et al. Parasite prevalence in fecal samples from shelter dogs and cats across Milbemax®, Elanco and the diagonal bar are registered trademarks or trademarks the Canadian provinces. Parasites and Vectors, in press. owned by or licensed to Eli Lilly and Company, its affiliates or subsidiaries. ©2015 Eli Lilly and Company, or its affiliates * Dipylidium caninum, Taenia taeniaeformis, Echinococcus multilocularis, Ancylostoma tubaeforme, Toxocara cati. CACAFMIL00011

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