The Canadian Veterinary Journal La Revue Vétérinaire Canadienne

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July/Juillet 2017 The Canadian Veterinary Journal

Vol. 58, No. 07Vol. 58, La Revue vétérinaire canadienne

July/Juillet 2017 Volume 58, No. 07

Management of a tracheal intussusception in a dog

Fluoroscopic and endoscopic diagnosis of a lower esophageal ring causing foreign body impaction in a dog

Hemoabdomen secondary to high grade lymphoma

Retro-orbital and disseminated B-cell lymphoma in a yellow-collared macaw (Primolius auricollis)

Syndrome of inappropriate antidiuretic hormone secretion in a dog with a histiocytic sarcoma

Equine recurrent uveitis in western Canadian prairie provinces: A retrospective study (2002–2015)

Expected consequences of convenience euthanasia perceived by veterinarians in Quebec

Cardiovascular effects of constant rate infusions of lidocaine, lidocaine and dexmedetomidine, and dexmedetomidine in dogs anesthetized at equipotent doses of sevoflurane

Comparison of an online learning module to hands-on training in teaching a cautery disbudding technique for dairy calves including cornual nerve block application

Efficiency of medetomidine for epidural analgesia: Effects on isoflurane requirement and mean systemic arterial blood pressure in dogs

Canine oral papillomavirus outbreak at a dog daycare facility

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JULY/JUILLET 2017 Contents Table des matières

SCIENTIFIC RUBRIQUE SCIENTIFIQUE

CASE REPORTS RAPPORTS DE CAS 695 Management of a tracheal intussusception in a dog Manureva Lebreton, Eric Bomassi, Sebastien Etchepareborde 699 Fluoroscopic and endoscopic diagnosis of a lower esophageal ring causing foreign body impaction in a dog Hakyoung Yoon, Yeunhea Lee, Kidong Eom, Jaehwan Kim 703 Hemoabdomen secondary to high grade lymphoma 729 Cardiovascular effects of constant rate Carolina Azevedo, Stephanie Schleis Lindley, infusions of lidocaine, lidocaine and Annette Smith, Kellye Joiner, Peter Christopherson dexmedetomidine, and dexmedetomidine in dogs anesthetized at equipotent doses 707 Retro-orbital and disseminated B-cell of sevoflurane lymphoma in a yellow-collared macaw (Primolius auricollis) Rafael Moran-Muñoz, Alexander Valverde, J.A. Ibancovichi, Carlos M. Acevedo-Arcique, Kim Le, Hugues Beaufrère, Emily Brouwer, Sergio Recillas-Morales, Pedro Sanchez-Aparicio, S. Karlyn Bland, Sarah Wills, Shawn MacKenzie, Jorge Osorio-Avalos, Julio Raul Chavez-Monteagudo Heather Chalmers, Chantale Pinard, R. Darren Wood, Josepha DeLay, Dale A. Smith 735 Comparison of an online learning module to hands-on training in teaching a cautery 713 Syndrome of inappropriate antidiuretic disbudding technique for dairy calves hormone secretion in a dog with including cornual nerve block application a histiocytic sarcoma Charlotte B. Winder, Stephen J. LeBlanc, Anne-Charlotte Barrot, Agathe Bédard, Derek B. Haley, Kerry D. Lissemore, Marilyn Dunn M. Ann Godkin, Todd F. Duffield

ARTICLES BRIEF COMMUNICATIONS 717 Equine recurrent uveitis in western COMMUNICATION BRÈVES Canadian prairie provinces: A retrospective 742 Efficiency of medetomidine for epidural study (2002–2015) analgesia: Effects on isoflurane requirement Lynne S. Sandmeyer, Bianca S. Bauer, and mean systemic arterial blood pressure Cindy Xin Feng, Bruce H. Grahn in dogs 723 Expected consequences of convenience Ryota Watanabe, Yukihiro Fujita euthanasia perceived by veterinarians 747 Canine oral papillomavirus outbreak in Quebec at a dog daycare facility Dominick Rathwell-Deault, Béatrice Godard, Diane Frank, Béatrice Doizé Heather E. Lane, J. Scott Weese, Jason W. Stull

655 QUIZ CORNER TEST ÉCLAIR

CVJ / VOL 58 / JULY 2017 643 FOR PERSONAL USE ONLY

PRESENTS

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Case Studies 11 Case Studies from Dr. Norsworthy and various contributing authors

Notes Dr. Norsworthy’s notes from NAVC 2017 on Chronic Renal Disease in Cats & Hyperthyroidism

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JULY/JUILLET 2017 Contents Table des matières

FEATURES RUBRIQUES SPÉCIALES

LETTER TO THE EDITOR BOOK REVIEWS COURRIER DES LECTURES COMPTE RENDU DE LIVRES 647 A Revision of the Veterinarian’s Oath 702 Avian Medicine and Surgery in Practice: Karol A. Mathews Companion and Aviary Birds, 2nd edition Douglas Whiteside PRESIDENT’S MESSAGE 728 Saunders Handbook of Veterinary Drugs: LE MOT DE LA PRÉSIDENT Small and Large Animals, 4th edition 649 Advocacy is key Monica Rosati La défense des intérêts est essentielle 740 Reptiles and Amphibians, 2nd edition Troy Bourque Douglas Whiteside

651 VETERINARY MEDICAL ETHICS NOTICES ANNONCES DÉONTOLOGIE VÉTÉRINAIRE

716 Industry News 669 2016 CVMA ANNUAL REPORT Nouvelles de l’industrie RAPPORT ANNUEL 2016 DE L’ACMV 734 Index of Advertisers PRACTITIONERS’ CORNER Index des annonceurs LE COIN DES PRATICIENS 741 New Products 750 Is melatonin of value in cancer treatment? Nouveaux produits Experience with a case of feline mammary carcinoma 759 Classifieds Beverly Baxter Petites annonces

VETERINARY PRACTICE MANAGEMENT GESTION D’UNE CLINIQUE VÉTÉRINAIRE NEWS | NOUVELLES 753 Non-DVM wages and trends across Canada Salaires des employés non-vétérinaires 657 NEWS et tendances au Canada NOUVELLES Chris Doherty Heather Broughton, Isabelle Vallières

757 DIAGNOSTIC OPHTHALMOLOGY OPHTALMOLOGIE DIAGNOSTIQUE Lynne S. Sandmeyer, Marina L. Leis, Bianca S. Bauer, Bruce H. Grahn

Contributors

“Instructions for authors” are available online (www.canadianveterinarians.net). Les «Directives à l’intention des auteurs» sont disponibles en ligne (www.veterinairesaucanada.net).

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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 2017 Carlton Gyles, Guelph, Ontario L’Association canadienne des médecins vétérinaires 2017 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 : Jangi Bajwa, Burnaby, British Columbia AGRICOL, Biological Abstracts, Capsule Report, Current Contents — Agriculture, Bruce Grahn, Saskatoon, Saskatchewan Derwent Veterinary Drug File, EMBASE/Excerpta Medica, Myrna Milani, Charlestown, New Hampshire Index Veterinarius, Index Medicus, Quarterly Index, Science Citation Index, Small Debbie Stoewen, Ayr, Ontario Animal Practice, Veterinary Bulletin, Veterinary Reference Service, Veterinary Update. Tim Blackwell, Fergus, Ontario Assistant Editors/Rédacteurs adjoints Photo by/Photo de : Shutterstock Robert Friendship, Guelph, Ontario Greg Harasen, Regina, Saskatchewan Typesetting/Typographie Jacob Thundathil, Calgary, Alberta AN Design Communications Ron Johnson, Guelph, Ontario Richard Kennedy, Pincher Creek, Alberta Printed by/Imprimé par Shawn McKenna, Charlottetown, P.E.I. The Lowe-Martin Group Ottawa, Ontario Managing Editor/Directrice de la rédaction Heather Broughton, Ottawa, Ontario ISSN 0008-5286 Assistant Managing Editor/Directrice adjointe de la rédaction Stella Wheatley, Ottawa, Ontario Return undeliverable Canadian addresses to: Editorial Coordinator/Coordonnatrice de la rédaction 339 rue Booth Street Kelly Gray-Sabourin, Ottawa, Ontario Ottawa, Ontario K1R 7K1 e-mail: [email protected] Advertising Manager/Gérante de la publicité Laima Laffitte, Wendover, Ontario Subscriptions (2017). Annual: Canada $205 + applicable GST or HST; foreign $220 US; institutional $275. Express subscriptions available. Single issue/back issue: Published monthly by/ $25 each, institutional single issue = $50.00 + GST or HST, if applicable. (All prices Publication mensuelle de subject to change.) Missing issues will be replaced if the Subscriptions Office is Canadian Veterinary Medical Association 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 (2017). Annuel : Canada 205 $ + TPS ou TVH en vigueur; pays étranger 220 $ É-U; prix d’une institution 275 $. Abonnement express disponible. Anciens numéros (chacun) : 25 $, ancien numéro d’institution 50 $ + 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) ou (1-800-567-2862), 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 58 / JULY 2017 FOR PERSONAL USE ONLY Letter to the Editor Courrier des lecteurs

A Revision of the Veterinarian’s Oath Dear Editor, CANADIAN VETERINARIAN’S OATH I am writing this letter to invite comments from veterinarians “As a member of the veterinary medical profession, I solemnly swear and to ask the CVMA Council to consider making a change to that I will use my scientific knowledge and skills for the benefit of the Veterinarian’s Oath. The change I propose is the addition society. of “prevent and” relieve [animal suffering] to the Veterinarian’s I will strive to promote animal health and welfare, [ ] relieve Oath. Currently, The Oath reads “relieve [animal suffering].” animal suffering, protect the health of the public and environment, We teach and practice prevention of pain, illness, etc., which and advance comparative medical knowledge. is a very important part of veterinary medicine. With the addi- I will practise my profession conscientiously, with dignity, and in tion of “prevent” I believe the Oath will be more reflective of keeping with the principles of veterinary medical ethics. the expectations of veterinarians and what we strive to do. This I will strive continuously to improve my professional knowledge would apply to almost all animals as, for example, vaccination and competence and to maintain the highest professional and ethical is for prevention and preventive analgesia is stressed for all sur- standards for myself and the profession.” geries. There are many other situations in which we probably prevent more than we relieve. Following is the Canadian Oath — CVMA 2004 copyrighted in 2017, but dated 2004. Thank you

Karol A. Mathews, DVM, DVSc, DACVECC Professor Emerita, Emergency & Critical Care Medicine Department Clinical Studies, Ontario Veterinary College University of Guelph, Guelph, Ontario

Constructive and professional comments made in the spirit of intellectual debate are welcomed by the Editor. Writers are expected to be respectful of others and to ensure that letters are considerate and courteous. The Editor reserves the right to remove comments deemed to be inflammatory or disrespectful.

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Review/update your contact information and stay connected! Also, ensure that you add us ([email protected]) to your safe sender’s list so that our messages do not get blocked. Online Log on at www.canadianveterinarians.net and view your contact information. You can make changes directly online. Contact CVMA By e-mail at [email protected] or by telephone at 1.800.567.2862. We will confirm the e-mail address we currently have for you and make any necessary changes.

CVJ / VOL 58 / JULY 2017 647 FOR PERSONAL USE ONLY

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Advocacy is key La défense des intérêts est essentielle

he veterinary profession is relatively small but we have a a profession vétérinaire est relativement petite, mais nous T huge impact on society. Our voice as leaders in animal L avons un énorme impact sur la société. Notre voix est health and welfare, as well as environmental and public health, importante en tant que leaders au chapitre de la santé et du is important. Society needs to hear our voice. The CVMA bien-être des animaux ainsi que de la santé environnementale spends much time and resources trying to determine the best et publique. Par conséquent, la société doit entendre notre way to have our voice heard. The Association’s advocacy and voix et l’ACMV consacre beaucoup de temps et de ressources lobbying efforts are the key to the success of CVMA interests à déterminer la meilleure façon de faire entendre notre voix. and advancing the profession. Advocacy is one of the CVMA’s Les efforts de défense des intérêts et de lobbying sont essentiels strengths and directly supports its core competencies. In the afin d’assurer le succès des intérêts de l’ACMV et de faire past, the CVMA has focused on enhancing the image of the avancer la profession. Or, la défense des intérêts est l’une des profession and providing our members with benefits. Currently, forces de l’ACMV et elle appuie directement ses compétences and in the future, we will have a larger role to play with advo- fondamentales. Par le passé, l’ACMV s’est concentrée sur cacy, the promotion of the profession, and ensuring our voice l’amélioration de l’image de la profession et la prestation as veterinarians is heard. d’avantages à nos membres. À l’heure actuelle, et dans l’avenir, Our profession has difficulty with advocacy and lobbying. We nous aurons un plus grand rôle à jouer pour la défense des often struggle with advocacy activities because we are afraid of intérêts, la promotion de la profession et la représentation de la these being seen as self-promotion. We need to promote veteri- voix des médecins vétérinaires. nary medicine and animal health and welfare, not veterinarians. Toutefois, notre profession éprouve de la difficulté avec la Historically we have, on occasion, been too quiet on significant défense des intérêts et le lobbying. Nous éprouvons des doutes issues. This has been a problem particularly with controversial à l’égard de nos activités de défense des intérêts parce que nous matters and issues that do not have a clear consensus from our craignons qu’elles soient perçues comme de la promotion de la members or society. For example, issues such as transportation of profession. Nous devons promouvoir la médecine vétérinaire et le livestock, use of animals in entertainment and sport, and feline bien-être et la santé des animaux et non les médecins vétérinaires. declawing. During a strategic planning session a few years ago, Historiquement, nous avons parfois été trop silencieux sur CVMA Council directed committees to be more decisive with des enjeux importants et cette situation a créé des problèmes, position statements on controversial issues and to be more vocal. particulièrement pour les questions et les enjeux controversés pour We have also made a more concentrated effort to not only lesquels il n’y a pas de consensus clair au sein de notre société. Par advocate for the profession but to lobby government and policy exemple, des questions comme le transport du bétail, l’utilisation makers. We have always had an excellent relationship with des animaux dans le cadre de spectacles et de sports et le dégriffage the government. The CVMA is recognized as a leader and the félin. Il y a quelques années, durant une séance de planification voice of Canadian veterinarians. Recently, this relationship has stratégique, le Conseil de l’ACMV a demandé aux comités d’être become much more visible and significant. Several issues like the plus décisifs à l’égard des énoncés de position sur des enjeux importation of companion animals, antimicrobial stewardship, controversés et d’être plus vocaux. and transportation of food animals have all been reviewed in Nous nous sommes aussi efforcés de défendre non seulement la consultations with government. profession mais d’exercer des pressions auprès des gouvernements

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.

CVJ / VOL 58 / JULY 2017 649 FOR PERSONAL USE ONLY

The CVMA faces a challenge when it comes to lobbying. the biggest impact. We should encourage colleagues to develop It takes years to develop government networks and relation- relationships with policy makers in their own regions. Reach ships. CVMA representatives work constantly at fostering these out to government officials both elected and non-elected and relationships and are always looking for new opportunities. form relationships so they call on us for advice and leadership. A changing political landscape is a reality within which the Also take action to align ourselves with similar-minded NGO Association must work. Developing key networks within fed- groups. Having only one voice for the profession is a challenge. eral government is important. This highlights the importance Our profession is diverse and veterinarians will have different of the office being in Ottawa and close to government action. opinions based on experience, knowledge, and areas of practice. The CVMA also fosters relationships with non-governmental In order to promote veterinary medicine we must have a wide organizations (NGOs) that have similar core values and goals. range of networks. We must work closely with species interest Collaboration and networking with these groups are becom- groups and industry leaders. We need to engage all veterinarians ing increasingly more vital to achieving our goal of successful in all areas of clinical practice, public service, industry, and aca- LE MOT DU PRÉSIDENT DU MOT LE advocacy. The CVMA is lucky in that it has excellent relation- demia. Clearly, we will not always agree, but if we work to find ships with its international partners such as the American common principles and ideas we can move forward. Advocacy Veterinary Medical Association (AVMA), and the Federation is what we do. Our strength is the diversity of the profession. of Veterinarians of Europe (FVE). The AVMA participates in ■ several lobbying activities as well, and both associations benefit Troy Bourque from our combined efforts. As a profession, veterinary medicine needs to be more active at the local grass roots level. This is where I believe we can have

et des décideurs. Nous avons toujours entretenu d’excellentes En tant que profession, la médecine vétérinaire doit être relations avec le gouvernement. L’ACMV est reconnue comme plus active au niveau de la base. C’est à cet endroit que je crois un leader et la voix des médecins vétérinaires canadiens. que nous pouvons avoir le plus grand impact. Nous devrions Récemment, cette relation est devenue encore plus visible et encourager les collègues à développer des relations avec les importante. Plusieurs enjeux, comme l’importation des animaux décideurs dans leurs propres régions, à contacter les représentants de compagnie, l’antibiogouvernance et le transport des animaux gouvernementaux élus et non élus et à établir des relations destinés à l’alimentation ont tous fait l’objet d’un examen dans afin qu’ils puissent communiquer avec nous pour obtenir des le cadre de consultations gouvernementales. conseils et du leadership et aussi agir afin de nous aligner sur des Par ailleurs, l’ACMV doit relever des défis dans le cadre de ses organisations non gouvernementales ayant des buts semblables. activités de lobbying, car l’établissement de réseaux et de relations Il est difficile de parler d’une seule voix pour l’ensemble de avec le gouvernement nécessite plusieurs années. Les représentants la profession. Notre profession est diversifiée et les médecins de l’ACMV travaillent constamment pour entretenir ces relations vétérinaires ont des opinions différentes selon notre expérience, et nous sommes toujours à la recherche de nouvelles occasions. nos connaissances et nos domaines d’exercice. Pour promouvoir L’évolution constante de la situation politique est la réalité la médecine vétérinaire, nous devons posséder un vaste éventail avec laquelle l’Association doit composer et il est important de de réseaux. Nous devons travailler en étroite collaboration avec développer des réseaux essentiels au sein du gouvernement fédéral. les groupes d’intérêt des espèces et les leaders de l’industrie. Cela souligne l’importance de l’emplacement du bureau à Ottawa, Nous devons engager tous les médecins vétérinaires dans tous près des centres de décision du gouvernement. L’ACMV entretient les domaines de la pratique clinique, de la fonction publique, aussi des relations avec les organisations non gouvernementales de l’industrie et des universités. Clairement, nous ne serons pas (ONG) qui possèdent des valeurs et des buts semblables. La toujours d’accord, mais si nous travaillons afin de trouver des collaboration et le réseautage avec ces groupes deviennent de idées et des principes communs, nous pourrons progresser. La plus en plus cruciaux afin d’atteindre notre but d’une défense des défense des intérêts est notre mission. Notre force est la diversité intérêts fructueuse. De plus, l’ACMV est fortunée de posséder de la profession. ■ d’excellentes relations avec ses partenaires internationaux comme l’American Veterinary Medical Association (AVMA) et Troy Bourque la Fédération des vétérinaires d’Europe (FVE). L’AVMA participe aussi à plusieurs activités de lobbying et les deux associations profitent de nos efforts concertés.

650 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Veterinary Medical Ethics Déontologie vétérinaire

Ethical question of the month — July 2017 In modern livestock farming various metrics are used to measure animal productivity. Many of these production metrics are also considered indicators of animal welfare. Mortality rate is one metric used to judge both production efficiency and animal welfare on-farm. By extension, some use mortality rates during transport to judge the welfare of livestock during transport. Whereas livestock on a farm may die from a wide variety of causes including infectious disease, only fit and healthy animals are transported for sale. Therefore the reasons for transport deaths are seldom the same as the reasons for mortalities in the barn. Is transportation mortality an appropriate indicator for judging the welfare of livestock being transported? Question de déontologie du mois — Juillet 2017 Dans l’agriculture d’élevage moderne, divers paramètres sont utilisés pour mesurer la productivité de l’animal. Beaucoup de ces paramètres de production sont aussi considérés des indicateurs du bien-être animal. Le taux de mortalité est l’un des paramètres utilisés pour évaluer l’efficacité de la production et le bien-être animal à la ferme. Par extension, certaines personnes utilisent les taux de mortalité durant le transport pour évaluer le bien-être du bétail durant le transport. Tandis que le bétail à la ferme peut mourir en raison d’une diversité de causes, dont les maladies infectieuses, seulement des animaux aptes et en santé sont transportés aux fins de vente. Par conséquent, les causes de décès durant le transport sont rarement les mêmes que celles des mortalités se produisant à la ferme. La mortalité lors du transport représente-t-elle un indicateur approprié pour évaluer le bien-être du bétail qui est transporté?

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Address/Adresse :

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 parvenir 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.

CVJ / VOL 58 / JULY 2017 651 FOR PERSONAL USE ONLY Ethical question of the month — April 2017 Recent studies have shown that taking urban visitors on tours of carefully chosen and well-run livestock operations does not always produce a positive response regarding the care of farm animals. For example, when members of the public visit free stall dairy barns with robotic milking machines where cows are clean and comfortable with only rare cases of lameness and other “production diseases,” the response of the urban visitor is not always positive. Standard farm practices such as the removal of the calf at birth from its mother and the inability of cows to graze at pasture are considered both unnatural and disturbing to many urban visitors. Is educating the public regarding modern livestock production practices the correct approach to convincing the public that current industry practices ensure the welfare of farm animals? Question de déontologie du mois — Avril 2017 Des études récentes ont montré que l’organisation de visites guidées dans des exploitations d’élevage DÉONTOLOGIEVÉTÉRINAIRE soigneusement choisies et bien exploitées à l’intention des citadins ne suscite pas toujours une réaction positive à l’égard des soins des animaux d’élevage. Par exemple, lorsque des membres du public visitent des logettes laitières avec des systèmes de traite automatisée où les vaches sont propres et confortables et que seulement quelques rares cas de boiterie et d’autres «maladies de production» sont observés, la réponse du visiteur urbain n’est pas toujours positive. Les pratiques normalisées des fermes, comme la séparation du veau et de la mère à la naissance et l’incapacité des vaches de brouter dans les prés, sont considérées comme n’étant pas naturelles et dérangeantes pour de nombreux visiteurs urbains. L’éducation du public à propos des pratiques d’élevage modernes représente-elle l’approche appropriée pour convaincre la population que les pratiques actuelles de l’industrie garantissent le bien-être des animaux d’élevage?

An ethicist’s commentary on conflict between public view of animal welfare and experts his is by no means the first or only time in my career that in confinement? And to this question, science is not relevant.” T I have encountered major conflict between “expert” views Judging by her “huh,” I assume I did not make my point. of animal welfare and those of ordinary citizens. For example, Questions of animal welfare are at least partly “ought” ques- on one occasion, I was showing our laboratory animal facility tions, i.e., questions of ethical obligation. The concept of animal to a group of representatives from local humane societies. The welfare is an ethical concept to which, once understood, science facility was brand new and state-of-the-art. It was accredited by brings relevant data. When we ask about an animal’s welfare, the Association for Assessment and Accreditation of Laboratory or about a person’s welfare, we are asking about what we owe Animal Care International (AAALAC) and by implication, by the animal, and to what extent. A document called the CAST the National Institutes of Health (NIH). The facility was spot- report, first published by United States agricultural scientists in less; airflow and temperature were precisely controlled. The the early 1980’s, discussed animal welfare, and affirmed that the people from the Humane Society, however, saw it as far too necessary and sufficient conditions for attributing positive wel- sterile and austere. Clearly the standards were very different fare to an animal were represented by the animal’s productivity. across the different groups. A productive animal enjoyed positive welfare; a non-productive Something very similar is going on in the current case. And animal enjoyed poor welfare. I saw the very same thing while serving on the Pew Commission, This notion was fraught with many difficulties. First of all, the very first detailed study ever undertaken of intensive con- productivity is an economic notion predicated of a whole opera- finement agriculture and the ethical issues occasioned by such tion; welfare is predicated of individual animals. An operation, agriculture. When one discusses farm animal welfare with such as caged laying hens, may be quite profitable if the cages industry groups, one finds the same response — animal welfare are severely overcrowded, yet the individual hens do not enjoy is solely a matter of “sound science.” good welfare. Second, equating productivity and welfare is, to For example, one representative of the pork industry, testify- some significant extent, legitimate under husbandry conditions, ing before the Commission, answered that while people in her in which the producer does well if and only if the animals do industry were quite “nervous” about the Commission, their well, and square pegs, as it were, are fitted into square holes anxiety would be allayed were we to base all of our conclusions with as little friction as possible. Under industrial conditions, and recommendations on “sound science.” Hoping to rectify the however, animals do not naturally fit in the niche or environ- error in that comment, as well as educate the numerous industry ment in which they are kept, and are subjected to “technological representatives present, I responded to her as follows: “Madame, sanders” that allow for producers to force square pegs into round if we on the Commission were asking the question of how to holes — antibiotics, feed additives, hormones, air handling raise swine in confinement, science could certainly answer that systems — so the animals do not die and produce more and question for us. But that is not the question the Commission, more kilograms of meat or milk. Without these technologies, or society, is asking. What we are asking is, ought we raise swine the animals could not be productive.

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The key point to recall here is that even if the CAST Report definition of animal welfare did not suffer from the difficulties we outlined, it is still an ethical concept. It essentially says “what ETHICS MEDICAL VETERINARY we owe animals and to what extent is simply what it takes to get them to create profit.” This in turn would imply that the animals are well-off if they have only food, water, and shelter — something the industry has sometimes asserted. Even in the early 80’s, however, there were animal advocates and others who would take a very different ethical stance on what we owe farm animals. Indeed, the famous five freedoms articulated in Britain by the Farm Animal Welfare Council (FAWC) during the 1970’s (even before the CAST Report) represents quite a different ethical view of what we owe animals: The welfare of an animal includes its physical and mental *what the ﬂ ea! state and we consider that good animal welfare implies both fitness and a sense of well-being. Any animal kept by man, must at least, be protected from unnecessary suffering. Cats can get tapeworms The conflict between these two definitions cannot be resolved by appeal to empirical science. In fact, the nature of the science from just one ﬂ ea! one does is determined by which definition one adopts! To clarify: suppose you hold the view that an animal is well- Fleas can nd their way to indoor cats, too. And it only takes off when it is productive, as per the CAST Report. The role one ingested ea to transmit tapeworms. In a 2011 study, 34.5% of cats were found to be positive for of your welfare science in this case will be to study what feed, Dipylidium caninum tapeworms.1 bedding, temperature, etc. are most efficient at producing the most meat, milk, or eggs for the least money — much what Advantage Complete™ brings together four active ingredients animal and veterinary science does today. On the other hand, for control of eas, tapeworms, roundworms and hookworms. if you take the FAWC view of welfare, your efficiency will be constrained by the need to acknowledge the animal’s natural behavior and mental state, and to assure that there is minimal pain, fear, distress, and discomfort — not factors in the CAST $10 mail-in rebate on pet owners’ next purchase of Advantage® II Cat view of welfare unless they have a negative impact on economic when they buy Advantage Complete.™ productivity. Precisely the same sort of conflict is going on in the current case. What ordinary citizens consider good welfare for dairy cows is very different from what dairy scientists emphasize. While dairy scientists may expand the public’s view of dairy welfare, they cannot expunge the commonsense belief that cows ought to graze, and that calves should stay with mothers, any more than the public will believe that sows are better off in tiny gestation crates or cows should have their tails lopped off with garden shears! This is exactly what the Swedish public expressed in the 1989 farm animal welfare law, when the legislation granted cattle “the right to graze in perpetuity.” And when ordinary people learn that milk production entails separating the calf Advantage Complete™ from the cow at birth, they are not positively disposed towards Recommend Advantage® II for eas. the industry. Trust Profender® for tapeworms A far better strategy would be to develop a system, as has in and other internal parasites. fact been done, in which calves can nurse for part of the day. Similarly, cows should be given some access to pasture. While Like us on Facebook: /Bayer4vets 1Little S, Adolph C, Downie K, et al. (2015). High prevalence of covert infection with gastrointestinal helminths profits may suffer, it is better to act proactively than to wait for in cats. J Am Anim Hosp Assoc. 51(6):359-364. the inevitable coming of societal hammering. Rebate also valid on the following eligible individual product or co-packaged o er, if prescribed by the vet: Advantage Multi® for Cats & Advantage Complete™. Eligible products must be purchased in Canada between June 1, 2017, and December 31, 2018, through a licensed veterinarian. Bernard E. Rollin, PhD Ask your Bayer Sales Representative for more details. ©2017 Bayer Inc. ® TM see www.bayer.ca/tm-mc

CVJ / VOL 58 / JULY 2017 653

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Quiz Corner Test éclair

1. Azole antifungals are commonly used to treat systemic 1. Les antifongiques de type azole sont communément utilisés mycosis. Which of the following azoles best penetrates the pour traiter les mycoses systémiques. Lequel des azoles central nervous system (CNS)? suivants pénètre le système nerveux central (SNC)? A. Fluconazole A. fluconazole; B. Ketoconazole B. kétoconazole; C. Itraconazole C. itraconazole; D. Clotrimazole D. clotrimazole; E. Enilconazole E. énilconazole. 2. Which of the following is the most common reason for a 2. Laquelle des raisons suivantes est la plus commune pour un non-healing ulcer in a cat? ulcère qui ne guérit pas chez un chat? A. Improper formation of the epithelial basement membrane A. formation inappropriée de la membrane basale épithéliale; B. Mycotic corneal infection B. infection cornéenne mycosique; C. Feline herpesvirus type 1 infection C. infection à herpèsvirus 1 félin; D. Keratoconjunctivitis sicca (KCS) D. kératoconjonctivite sèche. 3. Concerning heartworm disease in dogs, which of the fol- 3. À propos de la maladie des vers du cœur chez le chien, lequel lowing statements is least accurate? des énoncés suivants est le moins juste? A. Thoracic radiographic findings include right ventricular A. Les radiographies thoraciques montrent un agrandissement enlargement and enlarged, tortuous pulmonary arteries. du ventricule cardiaque droit et des artères pulmonaires B. Eosinophilia and basophilia may be present on a complete tortueuses et augmentées de volume. blood (cell) count. B. L’hémogramme peut présenter une éosinophilie et une C. Glomerulonephritis results from antigen-antibody com- basophilie. plex deposition. C. La glomérulonéphrite résulte du dépôt du complexe D. Antigen tests detect antigen present in male heartworms. antigène-anticorps. E. Deep S waves on a lead II electrocardiogram are sugges- D. Les tests antigéniques décèlent l’antigène présent chez les tive of right ventricular enlargement. dirofilaires mâles. E. Les ondes S avec amplitude allongée sur un 4. A 2-year-old Quarter Horse is being evaluated for a swollen électrocardiogramme en dérivation II suggèrent un leg. Further examination reveals edema of one leg only, agrandissement du ventricule droit. which had an acute onset. Multiple firm nodules that follow the lymphatics are palpated. Which of the following is the most likely cause of these symptoms? A. Nocardia asteroides B. Dermatophilus congolensis C. Corynebacterium pseudotuberculosis D. Trichophyton equinum E. Mycobacterium tuberculosis

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5. An 8-month-old Holstein female is walking on her carpi. 4. On fait l’examen d’un Quarter horse âgé de 2 ans à cause No other abnormalities are found. What is the likely d’enflure à un membre. L’examen plus poussé révèle de diagnosis? l’œdème d’apparition soudaine dans un membre seulement. A. Laminitis Plusieurs nodules fermes le long des vaisseaux lymphatiques B. Radial paralysis sont palpables. Lequel des agents suivants est la cause la plus C. Pedal fracture probable de ces symptômes? D. Splints A. Nocardia asteroides; E. Sole abscesses B. Dermatophilus congolensis; C. Corynebacterium pseudotuberculosis; D. Trichophyton equinum; TESTÉCLAIR E. Mycobacterium tuberculosis. 5. Une vache Holstein âgée de 8 mois se déplace sur ses carpes. Aucune autre anomalie n’est rencontrée. Lequel des diagnostics suivants est le plus probable? A. fourbure; B. paralysie radiale; C. fracture du pied; D. suros; E. abcès de la sole.

(See p. 756 for answers./Voir les réponses à la page 756.)

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).

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NEWS | NOUVELLES

Nova Scotia Veterinarian Appointed 69th President of the Canadian Veterinary Medical Association Une vétérinaire de la Nouvelle-Écosse est nommée 69e présidente de l’Association canadienne des médecins vétérinaires he Canadian Veterinary Medical Association (CVMA) is Association canadienne des médecins vétérinaires (ACMV) Tdelighted to welcome Dr. Troye McPherson as its new L’ est heureuse d’accueillir la Dre Troye McPherson à titre de president. nouvelle présidente. Dr. McPherson, originally from Cape Breton, Nova Scotia, La Dre McPherson, qui est originaire du cap Breton, graduated from the Nova Scotia Agricultural College, the en Nouvelle-Écosse, a obtenu des diplômes du Nova Scotia Ontario Agricultural College, and the Ontario Veterinary Agricultural College, de l’Ontario Agricultural College et de College, University of Guelph. She began her career in west- l’Ontario Veterinary College de l’Université de Guelph. Elle a ern Canada at a mixed animal practice in Saskatchewan. entamé sa carrière dans l’Ouest canadien dans une pratique mixte Dr. McPherson was also the acting director of the Lakeland en Saskatchewan. La Dre McPherson a aussi été directrice par College Veterinary Technician program in Vermilion, Alberta, intérim du programme de techniques vétérinaires de Lakeland and an instructor in its agriculture program. She also worked for College à Vermilion, en Alberta, et instructrice de son programme the Canadian Food Inspection Agency in meat hygiene. d’agriculture. Elle a aussi travaillé pour l’Agence canadienne Dr. McPherson moved back to the east coast and she has d’inspection des aliments dans le domaine de l’hygiène des viandes. been a small animal practitioner with special interest in internal La Dre McPherson est ensuite retournée dans les Maritimes medicine and ultrasound for the past several years. où elle travaille maintenant depuis plusieurs années comme She is currently a member of the Nova Scotia Veterinary praticienne pour petits animaux et s’intéresse particulièrement à Medical Association (NSVMA) committee for RVT licen- la médecine interne et à l’échographie. sure and has served as the NSVMA president and its liaison Elle est actuellement membre du comité de la Nova Scotia to the Nova Scotia Provincial SPCA and Rabies Task Force. Veterinary Medical Association (NSVMA) pour l’agrément des TVA Dr. McPherson is the CVMA council liaison on the NSVMA et elle a occupé le poste de présidente de la NSVMA et a agi à titre and the CVMA representative to the Federation of Veterinarians d’agente de liaison auprès de la SPCA de la Nouvelle-Écosse et of Europe (FVE). du Groupe de travail sur la rage. La Dre McPherson est l’agente de “I am honored to be the president of the Canadian Veterinary liaison du Conseil de l’ACMV auprès de la NSVMA et représentante Medical Association,” says Dr. McPherson. “I look forward to de l’ACMV auprès de la Fédération des vétérinaires d’Europe (FVE). contributing to the voice of our profession and helping promote «Je suis honorée de devenir présidente de l’Association animal welfare and optimal care for animals, people and the canadienne des médecins vétérinaires», dit la Dre McPherson. environment.” «J’ai hâte de contribuer à la voix de notre profession et de In her spare time, Dr. McPherson enjoys hiking with her collaborer à la promotion du bien-être animal et des soins optimaux husband and their 5 border collies, and training her dogs in pour les animaux, les personnes et l’environnement.» agility and rally obedience; she has completed several dog train- Dans ses temps libres, la Dre McPherson aime faire de la ing courses in the United Kingdom. Dr. McPherson also enjoys randonnée avec son mari et leur cinq Border collies et dresser ses cross-country skiing, skijoring, and running. You can often find chiens pour l’agilité et le rallye-obéissance; elle a suivi plusieurs her in her “happy place” at her nephew’s farm cours de dressage de chiens au Royaume-Uni. La with her dogs. Dre McPherson aime aussi faire du ski de fond, Dr. McPherson will serve on the CVMA du skijoring et de la course à pied. Vous pouvez Council from July 2017 until July 2018. The souvent la trouver dans son lieu préféré à la ferme CVMA would also like to take this opportunity de son neveu avec ses chiens. to thank Dr. Troy Bourque for his dedication La Dre McPherson siégera au sein du Conseil and commitment while serving as president for de l’ACMV de juillet 2017 jusqu’en juillet 2018. the past year. L’ACMV aimerait aussi profiter de cette occasion pour remercier le Dr Troy Bourque de son dévouement et de son engagement pendant son mandat de président au cours de la dernière année.

Dr./Dre Troye McPherson

CVJ / VOL 58 / JULY 2017 657 FOR PERSONAL USE ONLY N Animal Welfare: Safeguarding the Five Animal Freedoms Animal Health Week — October 1 to 7, 2017 Protéger les cinq libertés afin d’assurer le bien-être animal Semaine de la vie animale — Du 1er au 7 octobre 2017

he Canadian Veterinary Medical Association has been run- Association canadienne des médecins vétérinaires organise Tning the Animal Health Week campaign for over 30 years L’ la campagne de la Semaine de la vie animale depuis plus de and this year we will emphasize the importance of Animal 30 ans et, cette année, nous désirons souligner l’importance du Welfare. The animals in our care are entitled to 5 basic freedoms bien-être animal. Les animaux confiés à nos soins ont le droit in order to survive and thrive. This year we want to showcase the de jouir des cinq libertés fondamentales afin de survivre et de importance of providing the animals we care for with the basic s’épanouir. Cette année, nous désirons souligner l’importance de elements all creatures require. procurer les éléments fondamentaux dont ont besoin les animaux During Animal Health Week, from October 1 to 7, 2017, confiés à nos soins. we are reminding animal owners that they are responsible for Durant la Semaine de la vie animale, qui se déroulera du 1er au meeting the needs of all animals in their care. This year’s theme, 7 octobre 2017, nous rappellerons aux propriétaires qu’ils ont la Animal Welfare: Safeguarding the Five Animal Freedoms, responsabilité de satisfaire aux besoins des animaux confiés à provides us with an opportunity to remind animal owners of the leurs soins. Le thème de cette année, Protéger les cinq libertés fundamental elements they are required to provide the animals afin d’assurer le bien-être animal, nous offre l’occasion de in their care to ensure them healthy and happy lives. rappeler aux propriétaires les éléments fondamentaux qu’ils doivent We’re reminding animal owners they can protect the Five procurer aux animaux confiés à leurs soins afin d’assurer qu’ils Animal Freedoms by: mènent une vie heureuse et en santé. • Providing proper nutrition Nous rappelons aux propriétaires d’animaux qu’ils peuvent – F reedom from hunger and thirst by ready access to fresh protéger les Cinq libertés animales en : water and a diet to maintain full health and vigor. • Fournissant une alimentation appropriée • Ensuring proper socialization – Prévenir la faim et la soif en fournissant de l’eau fraîche et – F reedom to spend time with or away from members of their des aliments afin d’assurer une santé vigoureuse. species as appropriate. • Offrant une socialisation appropriée • Providing adequate shelter – Donner la possibilité de passer du temps avec ou sans les – Freedom from discomfort by providing an appropriate membres de leur espèce en fonction de leurs besoins. environment including shelter and a comfortable resting • Procurant un hébergement adéquat area. – F ournir un environnement approprié qui comprend un abri et • Providing appropriate veterinary care une aire de repos confortable afin d’éviter l’inconfort. – F reedom from pain, injury or disease by prevention or rapid • Fournissant des soins vétérinaires appropriés diagnosis and treatment. – Favoriser l’absence de douleurs, de blessures ou de maladies • Allowing animals to exhibit normal behavior par la prévention ou un diagnostic et un traitement rapides. – F reedom to express normal behavior by providing sufficient • Permettant aux animaux de manifester un comportement space, proper facilities, and tools/accessories and not pun- normal ishing animals for carrying out undesired behaviors. – Promouvoir la possibilité d’exprimer un comportement normal en fournissant suffisamment d’espace, des installations adéquates ainsi que les outils et les accessoires nécessaires et en ne punissant pas les animaux lorsqu’ils manifestent des comportements indésirables. Célébrez la Semaine de la vie animale Nous invitons les équipes vétérinaires à célébrer la Semaine de la vie animale avec nous. Chaque année, les équipes considèrent que les expositions dans la salle d’attente sont la façon la plus populaire de célébrer la Semaine de la vie animale, suivies de près par les concours à l’intention de la clientèle. En plus de l’affiche officielle de la campagne, les articles suivants sont offerts afin d’inviter toute l’équipe vétérinaire à célébrer la Semaine de la vie animale : • Ballons biodégradables • Soucoupes volantes pour Fido; excellentes pour jouer avec les enfants et les chiens (nouveau)

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Celebrate Animal Health Week N We invite veterinary health teams to celebrate Animal Health Week with us. Each year veterinary teams rank waiting room displays as the most popular way of celebrating Animal Health Week, followed closely by client contests. In addition to the official campaign poster, the following items are available to engage your entire healthcare team and help celebrate Animal Health Week: • Biodegradable balloons • Fido friendly flyer frisbees; great for both child and dog play (new) • Cotton twill & trucker mesh caps (new) • Temporary tattoos • Pet rescue window decals (new design) • CVMA Activity Book “Big or Small, We Help Them All!” • Drawstring sports pack, which can be used for a variety of • Casquette de camionneur structurée en croisé de coton de activities like carrying sports gear or beach apparel qualité (nouveau) • Kid-friendly animal paper hat • Tatouages temporaires • T-shirts and V-neck pullover scrub shirts (both available in • Décalques de secours pour les fenêtres (nouveau design) men’s and women’s sizes — we’ve worked with our supplier • Album d’activités de l’ACMV «Petits et grands, ce sont nos to provide better-fitted apparel!). patients!» Place your order before the early bird deadline on July 21, • Sac à dos sport avec cordon qui peut être utilisé pour 2017 for a chance to win a $100 Subway gift card (enough transporter de l’équipement de sport ou des accessoires to treat the whole team to lunch!) and other fun prizes. de plage Placing your order online (instead of faxing or mailing it) at • Chapeau en papier pour enfants (www.canadianveterinarians.net) also gives you a chance to win • T-shirts et blouses chirurgicales avec encolure en V (disponibles a $50 Tim Horton’s gift card (treat your hard-working team to en tailles pour hommes et pour femmes — nous avons travaillé some delicious morning steam)! The last day to place your order avec notre fournisseur pour offrir des vêtements plus seyants!) for Animal Health Week materials is August 4, 2017. Placez votre commande avant la date hâtive du 21 juillet 2017 For additional information on Animal Health Week, pour courir la chance de gagner une carte-cadeau de 100 $ follow CVMA on Twitter (in English @CanVetMedAssoc chez Subway (assez pour sortir toute l’équipe à manger le midi!) and in French @Assoccanmedvet) and like us on Facebook et d’autres prix amusants. En plaçant votre commande en ligne (facebook.com/CanadianVeterinaryMedicalAssociation). Use (au lieu de l’envoyer par télécopieur ou par la poste) au (www. #AnimalHealthWeek for all your Animal Health Week social veterinairesaucanada.net), vous aurez aussi la chance de gagner media promotions. une carte-cadeau de 50 $ chez Tim Horton (gâtez votre équipe Our generous supporters travaillante le matin en lui offrant du délicieux café chaud)! La dernière journée pour commander des articles de la Semaine de Generous support of the 2017 Animal Health Week campaign la vie animale sera le 4 août 2017. is provided by Principal Plus Sponsor, Boehringer Ingelheim; Pour en savoir davantage sur la Semaine de la vie animale, Principal Sponsor, Petsecure; and Program Sponsors, Elanco, and suivez l’ACMV sur Twitter (en français à @Assoccanmedvet et iFinance Canada (Petcard). This month, we invite you to learn anglais à @CanVetMedAssoc) et aimez-nous sur Facebook more about our Principal Plus Sponsor, Boehringer Ingelheim. (facebook.com/CanadianVeterinaryMedicalAssociation). Servez- A message from Boehringer Ingelheim vous de #celebronslasva pour toutes vos promotions de la At Boehringer Ingelheim, we are passionate about animal health Semaine de la vie animale dans les médias sociaux. and we recognize the critical importance of serving animal health Nos généreux commanditaires needs globally, with a focus on prevention. We do this because La campagne 2017 de la Semaine de la vie animale est we know when animals are healthy, humans are healthier, too. généreusement appuyée par le commanditaire principal plus, One of the ways in which we contribute to animal welfare is Boehringer Ingelheim, le commanditaire principal, Petsecure, through the development of products that are a key component et les commanditaires de programme, Elanco et iFinance to providing adequate veterinary care. Our products focus on Canada (Petcard). Ce mois-ci, nous vous invitons à en apprendre 4 major areas of veterinary care: prevention of disease (vaccines), davantage à propos de notre commanditaire principal plus, pain mitigation (NSAIDS), parasiticides, and antimicrobials. By Boehringer Ingelheim. helping protect animals from disease, treat chronic conditions, assist with pain management, and keep them free of parasites, Un message de Boehringer Ingelheim animals are better able to exhibit normal behavior. Chez Boehringer Ingelheim, nous nous passionnons pour la santé We are committed to developing longer-term solutions to animale et nous reconnaissons l’importance critique de répondre ensure a healthy, sustainable future for animals and people. aux besoins en matière de santé animale à l’échelle mondiale en

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N In addition, Boehringer Ingelheim nous concentrant sur la prévention. Nous nous acquittons de cette tâche parce que nous is pleased to partner with a variety of savons que, lorsque les animaux sont en santé, les humains seront aussi en meilleure santé. groups and organizations committed to Nous contribuons au bien-être animal notamment en développant des produits qui the continued education of the veterinary représentent un élément clé dans la prestation de soins vétérinaires adéquats. Nos community, livestock owners and pet produits se concentrent dans quatre grands secteurs des soins vétérinaires : prévention owners on a range of topics including des maladies (vaccins), atténuation de la douleur (AINS), parasiticides et antimicrobiens. En animal welfare. contribuant à protéger les animaux contre les maladies, à traiter les affections chroniques, Our commitment extends to our work à appuyer la gestion de la douleur et à protéger les animaux contre les parasites, nous with industry associations to recognize leur permettons de mieux pouvoir manifester des comportements normaux. and support individuals who are making Nous sommes engagés à développer des solutions à long terme afin d’assurer un advancements in the area of animal wel- avenir durable et en santé pour les animaux et les personnes. fare. The Metacam® 20 Bovine Welfare De plus, Boehringer Ingelheim forme des partenariats avec divers groupes et Award recognizes and encourages those organismes voués à la formation continue de la collectivité vétérinaire, des propriétaires who research and practice animal wel- de bétail et des propriétaires d’animaux de compagnie sur un éventail de sujets, dont le fare and well-being. The Boehringer bien-être animal. Ingelheim Equine Canada Health & Notre engagement se poursuit dans notre travail avec les associations de l’industrie Welfare Award recognizes an individual or afin de reconnaître et d’appuyer les personnes qui réalisent des progrès dans le domaine organization that has contributed directly du bien-être animal. Le Prix pour la promotion du bien-être bovin MétacamMD 20 reconnaît to the improvement of horse health and et encourage les personnes qui effectuent de la recherche et exercent dans le domaine du welfare in Canada through years of hard bien-être animal. Le Prix Boehringer Ingelheim-Canada Hippique pour la santé et le bien- work and dedication. être du cheval reconnaît une personne ou une organisation qui a contribué directement We are also proud to bring together à l’amélioration de la santé et du bien-être des chevaux au Canada pendant des années animal health researchers, practitioners de dévouement et de travail ardu. and industry professionals from around Nous sommes aussi fiers de réunir les chercheurs en santé animale, les praticiens et les the world for an annual conference professionnels de l’industrie de toutes les régions du monde à l’occasion d’une conférence exploring topics related to farm animal annuelle explorant des sujets portant sur le bien-être des animaux de ferme. Le Forum well-being. The Boehringer Ingelheim d’experts Boehringer Ingelheim sur le bien-être des animaux de ferme s’est déroulé au Expert Forum on Farm Animal Well- Canada en 2015 et en 2016. Being was held in Canada in 2015 and Veuillez visiter notre site Web (www.boehringer-ingelheim.ca) ou parler à notre 2016. gestionnaire de territoire pour obtenir de plus amples renseignements. Please visit our website (www.boeh ringer-ingelheim.ca) or talk to your Boehringer Ingelheim territory manager for more information.

2017 SCVMA President’s Farewell Adieux de la présidente 2017 des ÉACMV can barely believe another school year has arrive à peine à croire qu’une autre année I gone by! Reflecting on the whirlwind of the J’d’université est terminée! En réfléchissant past year, I feel incredibly proud to be a part sur le tourbillon de la dernière année, je me sens of this profession and I’m so grateful to all who incroyablement fière de faire partie de cette put in countless hours (often behind the scenes) profession et je suis vraiment reconnaissante to enrich the academic experience of Canadian envers toutes les personnes qui consacrent veterinary students. d’innombrables heures (souvent dans les coulisses) At our March CVMA Committee Weekend, afin d’enrichir l’expérience universitaire des we talked about the importance of staying étudiants en médecine vétérinaire canadiens. inspired amidst the hard work, personal strug- Lors de la fin de semaine des comités de gles, and professional challenges we all face. For mars de l’ACMV, nous avons parlé de l’importance students, I think being involved in the Students de demeurer inspiré malgré le travail ardu, les of the Canadian Veterinary Medical Association difficultés personnelles et les défis professionnels (SCVMA) is one of the best ways to find that auxquels nous sommes confrontés. Pour les inspiration! Whether it’s attending the annual Elizabeth Hartnett étudiants, je crois que la participation aux Étudiants

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SCVMA Symposium, reading what other students are up to de l’Association canadienne des médecins vétérinaires (ÉACMV) N in the annual VetRap Student Newsletter and The Canadian est l’une des meilleures façons de trouver cette inspiration! Qu’il Veterinary Journal, getting a glimpse of life after vet school via s’agisse de la participation au Symposium annuel des ÉACMV, the annual New Graduate Survey report, or participating in de la lecture du bulletin étudiant annuel VetRap et de La Revue the Student Leadership Workshop (SLW), the SCVMA con- vétérinaire canadienne, d’un aperçu de la vie après l’école de nects us and helps us feel like part of something bigger. These médecine vétérinaire dans le cadre du rapport annuel sur le initiatives would not be possible without the hard work, plan- Sondage auprès des finissants ou de la participation à l’Atelier de ning, and organization of each college’s SCVMA committee leadership étudiant (ALE), les ÉACMV nous unissent et nous aident representatives, so I’d like to take this opportunity to thank à sentir que nous faisons partie d’un tout. Ces initiatives ne seraient our wonderful representatives for all of their amazing work this pas possibles sans le travail ardu, la planification et l’organisation past year. des représentants du Comité des ÉACMV dans chaque collège I’m so pleased the SCVMA is also engaging Canadian vet- et j’aimerais donc profiter de cette occasion pour remercier nos erinary students studying abroad. This year, we welcomed merveilleux représentants de leur travail exceptionnel au cours de 108 student affiliate members from 7 new international student la dernière année. affiliate schools. We are thrilled to hear about the great initiatives Je suis vraiment heureuse que les ÉACMV invitent organized by SCVMA chapters abroad, including poutine nights, aussi la participation des étudiants en médecine vétérinaire hoedowns, and Canadian Thanksgiving dinners! canadiens qui étudient à l’étranger. Cette année, nous avons I’d also like to thank the CVMA Council, Executive, and accueilli 108 étudiants affiliés provenant de sept nouvelles staff for all their support given to veterinary students, including écoles internationales affiliées. Nous sommes ravis de prendre assisting with our SCVMA Symposium, providing online infor- connaissance des excellentes initiatives mises en œuvre par les mation and resources, and offering support to new graduates sections des ÉACMV à l’étranger, dont des soirées à la poutine, as they move to the next phase of their professional veterinary des soirées country et des dîners de l’Action de grâce canadienne! journey. As we progress through our unique and varied career J’aimerais aussi remercier le Conseil de l’ACMV, l’exécutif et paths, I encourage you to stay active in our national veterinary l’ensemble du personnel pour tout le soutien accordé aux étudiants organization and take advantage of the incredible opportunities en médecine vétérinaire, y compris l’appui fourni lors de notre and services provided by the CVMA. If you would like to learn Symposium des ÉACMV, la communication de renseignements more, please browse the student section of the CVMA website, et de ressources en ligne et le soutien des finissants tandis qu’ils join the SCVMA Facebook group, or contact your college’s progressent à l’étape suivante de leur parcours vétérinaire. Tandis SCVMA Committee representatives — we love hearing from que nous suivrons nos cheminements de carrière uniques et variés, our fellow students. je vous encourage à demeurer actifs au sein de notre organisation I am sincerely grateful for the opportunity to have served as vétérinaire nationale et à profiter des occasions et des services your SCVMA president this year. It was an incredible learning incroyables fournis par l’ACMV. Si vous aimeriez en apprendre experience that impressed upon me the importance of having davantage, veuillez consulter la section étudiante du site Web de a strong, unified voice for the Canadian veterinary profession. l’ACMV, joignez-vous au groupe Facebook des ÉACMV ou contactez It was a privilege to be a part of the SCVMA Committee and les représentants du Comité des ÉACMV de votre collège — nous CVMA Council, and to meet so many caring and committed adorons avoir des nouvelles de nos camarades étudiants. students, veterinarians, and animal health professionals from Je suis sincèrement reconnaissante d’avoir eu l’occasion de across Canada and beyond. With such dedication, I have no vous représenter en tant que présidente des ÉACMV cette année. doubt that our profession’s future is in great hands. As my time J’ai vécu une expérience d’apprentissage incroyable qui m’a on the SCVMA Committee comes to an end, I’m ecstatic in communiqué l’importance d’avoir une voix solide et unifiée pour welcoming our incoming SCVMA president, Kira Moser from la profession vétérinaire canadienne. Cela a été un privilège de the University of Calgary — Faculty of Veterinary Medicine. faire partie du Comité des ÉACMV et du Conseil de l’ACMV et de Kira will lead a dedicated and capable Committee of student rencontrer tant d’étudiants, de vétérinaires et de professionnels de representatives from each of Canada’s 5 veterinary colleges, la santé animale compatissants et engagés de toutes les régions carrying on the proud traditions of the SCVMA. I wish all du Canada et d’ailleurs. Avec un tel dévouement, il ne fait aucun veterinary students and graduates an excellent year ahead! All doute que l’avenir de notre profession est entre bonnes mains. the best to you! Tandis que mon mandat au sein du Comité des ÉACMV tire à sa fin, je suis enchantée de souhaiter la bienvenue à notre nouvelle (by Elizabeth Hartnett, Ontario Veterinary College Class of 2018, SCVMA President, 2016/2017) présidente des ÉACMV, Kira Moser de la Faculté de médecine vétérinaire de l’Université de Calgary. Kira dirigera un Comité de représentants étudiants dévoués et compétents provenant de chacun des cinq collèges de médecine vétérinaire du Canada et poursuivra la fière tradition des ÉACMV. Je souhaite une excellente année à tous les étudiants et finissants en médecine vétérinaire et je vous offre mes meilleurs vœux de succès! (par Elizabeth Hartnett, promotion 2018 de l’Ontario Veterinary College, présidente des ÉACMV, 2016–2017)

CVJ / VOL 58 / JULY 2017 661 FOR PERSONAL USE ONLY N Meet the 2017–2018 Students of Rencontrez les représentants the CVMA (SCVMA) Committee 2017–2018 du Comité des Representatives! Étudiants de l’ACMV (ÉACMV)! arie-Anne Sirois, SCVMA arie-Anne Sirois, représentante des ÉACMV de la Faculté Mrepresentative from the Mde médecine vétérinaire (FMV) de l’Université de University of Montreal’s Faculté Montréal, est née et a grandi à Montréal, au Québec, et elle de Médecine Vétérinaire (FMV), a récemment déménagé à la campagne, dans la merveilleuse was born and raised in Montreal, municipalité de Saint-Hyacinthe, afin de suivre des études en Québec, and recently moved to the médecine vétérinaire. Après un an de travail avec un chien-guide, countryside, in the wonderful city Marie-Anne a découvert qu’il y a de nombreux différents types of Saint-Hyacinthe, to pursue her de personnes autres que les types classiques de personnes qui studies in veterinary medicine. After préfèrent soit les chiens ou les chats et elle est elle-même devenue 1 year of working with a seeing-eye une personne qui préfère les lapins. Elle s’est immédiatement dog, Marie-Anne discovered there passionnée pour la vie étudiante sur le campus et elle a été Marie-Anne Sirois are many different types of people élue au sein de l’association étudiante de la FMV (Association other than the classic “dog person” and “cat person,” becoming des étudiants en médecine vétérinaire du Québec ou AEMVQ), herself a “rabbit person.” She immediately became passionate d’abord comme coordonnatrice des affaires internes, puis comme about campus life and was elected to FMV’s student association coordonnatrice de la vie étudiante et, enfin, comme vice-présidente. (Association des Étudiants en Médecine Vétérinaire du Québec, Une fervente partisane des droits des animaux, Marie-Anne or AEMVQ), first as coordinator of Internal Affairs, then as est fondatrice de Végé Club, qui réunit tous les végétaliens, coordinator of Student Life and finally, as vice-president. A végétariens et futurs végétariens de la FMV et elle a ainsi créé une fervent animal rights supporter, Marie-Anne is the founder and collectivité grandissante qui organise, entre autres, des événements president of the Vege Club, bringing together all vegan, veg- comme une Action de grâce végétalienne. En raison de sa passion etarians and future-vegetarians from FMV, creating a growing et de son ambition, Marie-Anne a toujours une foule d’idées qui lui community, and organizing events such as vegan Thanksgivings, permettent de concevoir sans cesse de nouveaux projets! among many others. Her passion and ambition always leaves her Karie Bryenton, représentante du Comité des ÉACMV de overflowing with ideas and creating one project after another! l’Atlantic Veterinary College (AVC), a développé un grand amour Karie Bryenton, SCVMA et une immense appréciation pour les animaux de compagnie tôt Committee representative for the dans sa vie en tant qu’enfant unique qui possédait toujours des Atlantic Veterinary College (AVC), animaux de compagnie. Elle se passionnait pour le comportement developed a great love and apprecia- animal et elle s’est donc inscrite au programme de neuroscience tion for companion animals early in à l’Université Dalhousie, ce qui lui a permis d’acquérir un intérêt life as an only child who always had pour le bien-être des animaux de laboratoire. Après son diplôme de pets. Being passionate about animal premier cycle, Karie s’est rendu compte que ses intérêts s’étaient behavior, she later enrolled in the élargis aux animaux de toutes les tailles allant des grands animaux Neuroscience program at Dalhousie jusqu’à la volaille. Ces expériences ont confirmé la médecine University, during which time she vétérinaire comme étant la carrière rêvée de Karie et son admission gained interest in laboratory ani- à la promotion 2020 de l’AVC était vraiment un rêve devenu Karie Bryenton mal welfare. After her undergradu- réalité. Karie est fière de manifester son engagement envers un ate degree, Karie realized her interests expanded to animals of apprentissage global en tant que représentante du Comité des all sizes, as she truly enjoyed working on farms with animals ÉACMV et de représentante de la promotion de Cat Action, afin ranging in size from large animal to poultry. These experiences de manifester son engagement envers la réduction des maladies confirmed veterinary medicine to be Karie’s dream career path, et l’amélioration du bien-être de la population de chats féraux de which made her acceptance to AVC’s Class of 2020 truly a dream l’Île-du-Prince-Édouard. Elle est particulièrement fière de planifier come true. Karie is proud to be exercising her commitment to le Symposium 2018 des ÉACMV à l’AVC, car cet événement borderless learning as an SCVMA Committee representative, permettra de présenter l’exceptionnelle ambiance communautaire and as her class representative for Cat Action, exercising her de son école ainsi que des professeurs extraordinaires. Elle a hâte commitment to reducing disease and increasing the welfare of de rencontrer tous les participants au Symposium et elle souhaite PEI’s feral cat population. She is especially proud to be plan- une excellente année à tous les étudiants! ning the 2018 SCVMA Symposium at AVC, as it will showcase Katelyn Weaver, représentante des ÉACMV de l’Ontario her school’s fantastic sense of community and its incredible Veterinary College (OVC), est aspirante vétérinaire depuis son professors. She looks forward to meeting all the Symposium enfance. Son avenir laissait présager le travail auprès des animaux, participants, and wishes everyone a great year! car, toute petite, elle a élevé des animaux sauvages orphelins Katelyn Weaver, SCVMA representative for the Ontario dans sa table de chevet, elle a gambadé dans la ferme laitière Veterinary College (OVC), has been an aspiring veterinarian familiale et elle a assisté à la naissance de sa première portée since childhood. Whether it was raising orphaned wildlife in her de chiots en neuvième année. Katelyn a grandi dans la petite ville

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bedside table, running around on de Dorchester, en Ontario, et elle espère un jour posséder une N her family dairy farm, or delivering pratique pour petits animaux dans cette localité. Même si elle aime her first litter of puppies in grade 9, habiter dans une petite localité, Katelyn a eu la chance de voyager a future with animals was on the dans de merveilleux endroits à la recherche de rencontres uniques horizon. Katelyn grew up in the avec des animaux, dont la plongée avec des requins à la Grande small town of Dorchester, Ontario barrière de corail, le travail avec des kangourous et des wallabys and hopes to one day own a small dans le désert de l’Australie et la collaboration à des travaux de animal practice there. Although she recherche dans l’île Akimiski à la baie James, au Nunavut. Katelyn enjoys small-town life, Katelyn was s’investit beaucoup dans la protection des espèces fauniques fortunate enough to travel to beau- et domestiques et elle est excitée à propos des possibilités de tiful places seeking unique animal carrière qui lui réserve la médecine vétérinaire pour l’aider à faire Katelyn Weaver encounters including shark diving une différence. Katelyn a terminé son baccalauréat en sciences in the Great Barrier Reef, working with kangaroos and wal- avec spécialisation en biologie de conservation à l’Université labies in the Australian desert, and assisting with waterfowl Western Ontario (UWO) et elle est ensuite retournée à l’UWO research on Akimiski Island in James Bay, Nunavut. Katelyn pour faire une maîtrise en sciences en biologie. À l’achèvement de is heavily invested in wildlife and domestic species protec- sa maîtrise, Katelyn a travaillé comme biologiste de conservation tion and is excited about the career opportunities veterinary pendant trois années en se concentrant sur le gibier aquatique medicine provides to help her make a difference. Katelyn com- nord-américain et la protection des terres humides. Sa recherche pleted her Bachelor of Science with an honors specialization sur les cygnes a même fait l’objet d’un reportage à la série in Conservation Biology at the University of Western Ontario télévisée de TVO Striking Balance dans un épisode sur la Réserve (UWO) and later returned to UWO to complete her Master de la biosphère de Long Point en Ontario. En 2014, Katelyn a of Science in Biology. Upon completion of her MSc, Katelyn décidé de concrétiser son rêve et elle a présenté une demande worked as a conservation biologist for 3 years focusing on North à l’OVC. Elle entamera sa troisième année du programme de American waterfowl and wetlands conservation. Her swan médecine vétérinaire et elle n’a jamais été aussi heureuse. Katelyn research was even featured on TVO’s series Striking Balance in an aime participer aux activités de la collectivité de l’OVC et de la episode about Ontario’s Long Point Biosphere Reserve. In 2014, localité en général. Durant ses deux premières années à l’OVC, Katelyn decided to make her dream a reality and she applied to Katelyn a collaboré à la gestion de la campagne de financement OVC. She is now entering her 3rd year of her veterinary medi- communautaire Dog Jog de la fraternité professionnelle vétérinaire cine degree program and has never been happier. Katelyn enjoys Omega Tau Sigma et elle est fière de dire que l’événement a being involved in OVC’s community and the local community at permis de recueillir près de 25 000 $ pour appuyer l’OVC Pet Trust large. During her first 2 years at OVC, Katelyn helped head the au cours des deux dernières années! En tant que représentante Omega Tau Sigma professional veterinary fraternity’s Dog Jog sénior 2017–2018 des ÉACMV pour l’OVC, Katelyn est excitée Community Fundraiser and is proud to say they raised almost de présider la deuxième édition annuelle de l’Atelier de leadership $25 000 to support the OVC Pet Trust in the past 2 years! As étudiant des ÉACMV pour les étudiants en médecine vétérinaire the 2017/18 senior SCVMA representative for OVC, Katelyn is de l’Ontario. Katelyn est honorée de faire partie de l’initiative de excited to chair the 2nd annual SCVMA Leadership Workshop l’ACMV en vue d’offrir des occasions de leadership aux étudiants for Ontario veterinary students. Katelyn is honored to be part en médecine vétérinaire. of the CVMA’s initiative to bring student veterinarians leader- Kira Moser, représentante des ÉACMV de la Faculté de ship opportunities. médecine vétérinaire de l’Université de Calgary (UCVM), a Kira Moser, SCVMA representa- grandi à Tottenham, en Ontario, avant de déménager à Calgary, tive for the University of Calgary — en Alberta, à l’âge de 8 ans. Kira a passé la grande partie de Faculty of Veterinary Medicine son enfance dans la grange avec son cheval et avant d’entrer à (UCVM), grew up in Tottenham, l’université, elle a participé à des concours de saut à cheval, ce Ontario before moving to Calgary, qui lui a permis de développer une passion pour tous les animaux. Alberta when she was 8 years old. Elle a décidé de suivre sa passion et elle est déménagée vers le Kira spent most of her early days nord pour s’inscrire à un diplôme en santé animale à l’Université at the barn with her horse and dur- de l’Alberta à Edmonton. Après avoir passé deux étés excitants à ing her pre-university days she was travailler dans une clinique d’urgence pour animaux, Kira a décidé involved in show-jumping competi- qu’une carrière en médecine vétérinaire était le bon choix pour Kira Moser tions, through which she developed elle et elle est retournée à Calgary pour se joindre à la promotion a passion for all animals. She took this passion and moved north 2019 de l’UCVM. Dans ses temps libres, Kira aime faire du ski en to pursue an animal health degree from Edmonton’s University hiver et jouer à la balle molle en été. En plus de son rôle à titre de of Alberta. After spending 2 exciting summers working at an représentante au sein du Comité des ÉACMV, Kira siège au sein emergency animal hospital, Kira decided a career in veterinary du Comité de planification du week-end de bien-être et elle est medicine was right for her. She moved back to Calgary to join membre de l’exécutif de la Société étudiante de l’UCVM pour la the Class of 2019 at UCVM. In Kira’s spare time, she enjoys médecine d’urgence et les soins critiques. Kira est excitée à propos skiing in the winter and playing slo-pitch in the summer. In de l’occasion de représenter la voix des étudiants en médecine

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N addition to her role as an SCVMA Committee representative, vétérinaire à titre de présidente des ÉACMV cette année et elle a Kira is on the Wellness Weekend Planning Committee and an hâte de rencontrer un grand nombre d’étudiants lors du Symposium executive member of UCVM’s Student Veterinary Emergency 2018 des ÉACMV qui se déroulera en janvier à l’Atlantic Veterinary and Critical Care Society. Kira is excited about the opportunity College, à l’Île-du-Prince-Édouard! to represent the voice of Canadian veterinary students as the Shawna Ellis, représentante des ÉACMV du Western SCVMA president this year and is looking forward to meeting College of Veterinary Medicine (WCVM), est née à Montréal, many students at the 2018 SCVMA Symposium at the Atlantic au Québec, et a ensuite déménagé en Nouvelle-Écosse pour Veterinary College in Prince Edward Island this January! l’école secondaire. Après l’école secondaire, la famille de Shawna Shawna Ellis, SCVMA repre- est déménagée en Saskatchewan et elle s’est installée à Guelph sentative for the Western College afin de s’inscrire à un diplôme de premier cycle en biologie et en of Veterinary Medicine (WCVM), conservation de la faune à l’Université de Guelph. Même si Shawna was born in Montreal, Quebec then a toujours aimé les animaux et la faune, c’était sa fascination pour moved to Nova Scotia for high la médecine et la résolution de cas qui l’ont attiré vers une carrière school. After high school, Shawna’s en médecine vétérinaire. Shawna a passé l’été dernier à faire de family moved to Saskatchewan la recherche sur la façon dont les porcelets expriment la douleur. and she moved to Guelph to com- Shawna aime travaille avec les personnes et les animaux et, même plete her undergraduate studies in si elle fascinée par la médecine vétérinaire dans son ensemble, Wildlife Biology and Conservation son aspect favori est le lien humain-animal. Elle s’intéresse aussi at the University of Guelph. While vivement à la compréhension des Autochtones et des collectivités Shawna Ellis Shawna always loved animals and locales et à l’impact des animaux au sein de ces dernières. Shawna wildlife, it was her fascination with medicine and solving cases a passé du temps à travailler dans des réserves éloignées du nord that drew her to a career in veterinary medicine. Shawna spent de la Saskatchewan lors d’emplois d’été et, pendant ses études, last summer researching how piglets express pain. Shawna loves elle a travaillé auprès de résidents au logement vulnérable de working with people and animals and although fascinated Saskatoon dans le cadre de programmes de stérilisation. Durant by veterinary medicine as a whole, her favorite aspect is the l’été 2017, Shawna passera sept semaines en Afrique à travailler human-animal bond. She also has great interest in understanding avec la faune ainsi qu’à offrir des services vétérinaires dans des Aboriginal and local communities, and the impact of animals collectivités de la Tanzanie et du Madagascar. Shawna est excitée within them. Shawna spent time working in remote northern de représenter les Étudiants de l’ACMV au WCVM et elle désire Saskatchewan reserves during her summer jobs, and while in souhaiter une merveilleuse année à tous les membres des ÉACMV! school, she has worked with vulnerably housed Saskatoon residents through spay and neuter programs. During the summer of 2017, Shawna will spend 7 weeks in Africa working with Attention Practitioners wildlife as well as offering veterinary services to the communities in Tanzania and Madagascar. Shawna is excited to represent the Students of the CVMA at WCVM and wishes everyone in the You may not have the time, facilities, or experience to SCVMA a wonderful year ahead! write scientific articles for review by experts. But you have interesting and valuable experiences that are worth sharing. We encourage you to share by submitting articles to Practitioners’ Corner, The Canadian Veterinary Journal. Simply e-mail your article to Ms. Heather Broughton ([email protected]). We will edit to ensure the format is correct then we will publish your article in The CVJ.

664 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Announcement: New CEO and Annonce : Nouveau PDG et N Registrar Effective May 1, 2017 registraire à compter du 1er mai 2017 he Council of the College of e Conseil du College of Veterinarians of British Columbia TVeterinarians of British Columbia L(CVBC) est heureux d’annoncer que la recherche d’un nouveau (CVBC) is pleased to announce that the registraire a pris fin. search for a new registrar has concluded. Le 22 janvier 2017, le registraire et président-directeur général On January 22, 2017, current registrar (PDG) actuel, Larry Odegard, avait annoncé son intention de and chief executive officer (CEO) Larry prendre sa retraite, après quatre années passées au CVBC. À Odegard announced his plans to retire, ce moment, le Conseil avait prévu une recherche et une période after 4 years with the CVBC. At that de transition d’une longue durée. Le choix d’une candidate à time, Council had anticipated a lengthy l’interne a permis à M. Odegard d’aller de l’avant avec son projet search and transition period. The selec- de retraite. Nous lui offrons nos meilleurs vœux de succès dans tion of an internal candidate has provided Ms./Mme Luisa Hlus ses entreprises futures. an opportunity for Mr. Odegard to move À compter du 1er mai 2017, Luisa Hlus assumera les fonctions ahead with his retirement plans. We wish him all the best in his de registraire et de PDG et elle demeurera aussi l’avocate du future endeavors. CVBC. Effective May 1, 2017, Luisa Hlus will assume the role Mme Hlus a obtenu son diplôme de la Faculté de droit de of registrar and CEO, as well as remaining the CVBC’s legal l’Université de Victoria en 1990. Elle a exercé pendant plusieurs counsel. années dans les domaines de la défense d’assurance et du droit de Ms. Hlus graduated from the University of Victoria’s Faculty la famille avant de se joindre à la Law Society of British Columbia of Law in 1990. She practiced for a number of years in the à titre d’avocate. À la Law Society of BC, Mme Hlus a fait enquête areas of insurance defence and family law before joining the sur des plaintes d’inconduite professionnelle et des réclamations Law Society of British Columbia as a staff lawyer. At the Law d’un fond de compensation spécial, elle a administré des tutelles Society of BC, Ms. Hlus investigated professional conduct et elle a poursuivi des avocats lors d’audiences disciplinaires. complaints and special compensation fund claims, administered Plus récemment, elle a élargi ses horizons dans le domaine de la custodianships and prosecuted lawyers in discipline hearings. réglementation des professions autonomes en portant assistance More recently, she expanded her focus on the regulation of au College of Physicians and Surgeons of BC et au College of self-governing professions by assisting the College of Physicians Dental Surgeons of BC. En novembre 2015, Mme Hlus s’est jointe and Surgeons of BC and the College of Dental Surgeons of BC. au CVBC à titre de directrice des plaintes, de l’agrément et des In November 2015, Ms. Hlus joined the CVBC as the director services juridiques. En tant qu’avocate praticienne, elle a offert des of Complaints, Registration and Legal Services. As a practicing conseils juridiques et stratégiques. lawyer, she has provided legal and strategic guidance. Le Conseil est ravi que Mme Hlus continuera de diriger et Council is delighted that Ms. Hlus will continue to lead and de faire la promotion du CVBC en tant qu’organisme voué à promote the CVBC as an organization dedicated to regulating la réglementation de la profession vétérinaire en Colombie- the veterinary profession in BC in a fair and transparent manner. Britannique d’une manière juste et transparente.

The Practice Owners Economic Survey and Your Provincial Suggested Fee Guide Connection Le lien entre le Sondage économique auprès des propriétaires de pratique et votre guide tarifaire suggéré provincial he economics of practicing veterinary medicine in Canada a gestion financière des pratiques vétérinaires au Canada peut Tcan be divided into 2 eras; one era prior to and the other Lse répartir en deux époques : l’époque avant l’établissement after the establishment of Provincial Suggested Fee Guides. des guides tarifaires suggérés des provinces et l’époque après The era prior to the establishment of Provincial Suggested l’avènement de ces guides. Fee Guides consisted of having your receptionist call neighbor- Pendant l’époque avant l’établissement des guides tarifaires ing practices to find out what they were charging for a spay, suggérés des provinces, votre réceptionniste appelait les pratiques being unable to pay staff what they were worth, robbing Peter avoisinantes pour leur demander ce qu’elles facturaient pour

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N to pay Paul, and as for profitability… what profitability?? You une stérilisation, vous n’arriviez pas à verser à vos employés un get the picture. salaire correspondant à leurs compétences, vous preniez à Pierre Once Provincial Suggested Fee Guides were made available pour donner à Paul et la profitabilité… quelle profitabilité?? Vous to all practice owners, revenues increased almost immediately. comprenez sans doute... With increased profitability, practice owners were compensated Une fois que les guides tarifaires suggérés des provinces ont for their worth and able to appropriately pay their hardworking été distribués à tous les propriétaires de pratique, les recettes staff. Practices upgraded to modern medical equipment; enhanc- ont augmenté presque immédiatement. Grâce à une meilleure ing patient care and meeting owner expectations. Ultrasound profitabilité, les propriétaires de pratique ont été rémunérés machines, digital radiology, lasers and even CT scans were en fonction de leur travail et ils ont pu offrir une rémunération integrated into Canadian veterinary practices. Veterinary medi- appropriée à leurs employés travaillants. Les pratiques ont investi cine was on the move! It would be taking a step backward if dans de l’équipement médical moderne tout en améliorant les soins Provincial Suggested Fee Guides were no longer produced and aux patients et en satisfaisant aux attentes des propriétaires. Les distributed. The fee guides are produced annually based on data appareils à ultrason, la radiologie numérique, les lasers et même submitted by YOU in the Practice Owners Economic Survey. des tomodensitogrammes ont été installés dans les pratiques Without your valuable data, a statistically sound and defensible vétérinaires canadiennes. La médecine vétérinaire marchait vers document would not be possible. l’avenir! L’arrêt de la production et de la distribution des guides Another key puzzle piece is the CVMA’s Business tarifaires suggérés des provinces représenterait un pas en arrière. Management Program and its sponsors, Merck Animal Health, Les guides tarifaires sont produits annuellement en se basant sur Scotiabank, Petsecure, and IDEXX, who contribute financially to les données que VOUS avez soumises dans le cadre du Sondage assure that we, as practitioners, have an annual fee guide. One of économique auprès des propriétaires de pratique. Sans des the CVMA’s 3 strategic priorities is helping veterinarians achieve données utiles, il ne serait pas possible de publier un document “a successful career and a balanced life.” Although achieving this solide et sûr du point de vue statistique. state of balance may be considered a luxury by many practitio- Un autre élément clé est le Programme de gestion commerciale ners, it is more easily attainable in profitable practices. When de l’ACMV et ses commanditaires, Merck Santé animale, Banque you receive your next survey, consider the fact that without your Scotia, Petsecure et IDEXX, qui offrent une contribution financière survey results, and without the support of the CVMA and these afin d’assurer que nous, en tant que praticiens, aurons un guide generous sponsors, you and all Canadian veterinary practice tarifaire annuel. L’une des trois priorités stratégiques de l’ACMV owners would not have a fee guide! A scary thought! consiste à aider les médecins vétérinaires à obtenir «une carrière Let’s end on a “not so scary” note, veterinary medicine has prospère et une vie équilibrée». Même si l’atteinte de cet équilibre advanced and progressed in so many ways over the past 20 years peut être considérée comme un luxe par beaucoup de praticiens, il and with your help, and the continued support of our sponsors, est beaucoup plus facile de l’atteindre dans les pratiques rentables. we can all do our bit to ensure a bright future for the Canadian Lorsque vous recevrez votre prochain sondage, considérez le fait veterinary profession over the next 20 years! que, sans les résultats du sondage et sans le soutien de l’ACMV et de nos généreux commanditaires, vous et tous les propriétaires (by Frank Richardson, DVM, MBA) de pratique vétérinaire canadiens n’auriez pas un guide tarifaire! Une pensée terrifiante! To access the Provincial Suggested Fee Guides and other vet- Ne terminons pas sur une note si «terrifiante»!, car la médecine erinary economic reports, visit the CVMA’s Business Management vétérinaire a progressé de nombreuses façons au cours des vingt Program section of the CVMA website (www.canadianveterinar dernières années et, avec votre aide, et le soutien continu de nos ians.net/practice-economics/business-management). This section commanditaires, nous pouvons tous faire notre part afin d’assurer also includes Veterinary Practice Management articles and a Career un brillant avenir pour la profession vétérinaire canadienne au cours and Business Toolkit providing veterinarians easy access to pertinent des vingt prochaines années! online resources and information on personal financial management, veterinary business management and client management. (par Frank Richardson, D.M.V., M.B.A.)

Pour accéder aux Guides tarifaires suggérés des provinces et à d’autres rapports économiques vétérinaires, visitez la section du Programme de gestion commerciale de l’ACMV du site Web de l’ACMV (www.veterinairesaucanada.net/practice-economics/ business-management). Cette section comprend aussi des articles sur la Gestion d’une clinique vétérinaire et la trousse d’outils pour la carrière et les affaires qui offre aux vétérinaires un accès facile à des ressources et à des renseignements en ligne pertinents sur la gestion des finances personnelles, la gestion commerciale et la gestion des clients.

666 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Get your Free Monthly Global Digital Edition of Clinician’s Brief N Obtenez votre édition mensuelle numérique mondiale gratuite de Clinician’s Brief he Canadian Veterinary Medical Association (CVMA) Association canadienne des médecins vétérinaires (ACMV) Tworks hard to bring you new, relevant and exclusive member L’ travaille constamment pour vous offrir de nouveaux avantages, benefits, discounts and services. In many instances, the savings des rabais et des services pertinents et exclusifs. Dans de enjoyed more than cover the cost of your annual member- nombreux cas, les économies réalisées dépassent amplement le ship fee. coût de votre cotisation annuelle. The CVMA has 2 new, exclusive member benefits; Clinician’s L’ACMV offre deux nouveaux avantages aux membres exclusifs : Brief, and Plumb’s Veterinary Drugs. Aligned with CVMA’s Clinician’s Brief et Plumb’s Veterinary Drugs. La mission de values, the mission of Clinician’s Brief, and Plumb’s Veterinary Clinician’s Brief et Plumb’s Veterinary Drugs, qui correspond à celle Drugs is to provide small animal veterinary teams the tools they de l’ACMV, consiste à fournir aux équipes vétérinaires pour petits need to develop successful practices, build lasting client relation- animaux les outils dont elles ont besoin pour gérer des pratiques ships, and deliver gold-standard patient care. prospères, à établir des relations de longue date avec les clients As part of your CVMA member benefits, you’re entitled et à offrir des soins aux patients de calibre supérieur. to a free monthly Global Digital Edition of Clinician’s Brief Dans le cadre de vos avantages de membre de l’ACMV, vous or a discounted print edition. Some features and benefits of avez droit gratuitement à une édition mensuelle numérique Clinician’s Brief include: mondiale de Clinician’s Brief ou à un tarif réduit sur l’abonnement • Practical, relevant information on the latest veterinary medi- en version imprimée. Voici quelques-uns des avantages de cine topics. Clinician’s Brief : • Information is in a brief format for busy practitioners. • Des renseignements pratiques et pertinents sur les actualités • Ranked #1 most essential publication by small animal vet- en médecine vétérinaire. erinarians for 9 years. • Des renseignements présentés dans un format concis pour les • Access Clinician’s Brief anytime, anywhere — on your desk- praticiens à l’horaire chargé. top, tablet, or mobile. • La publication classée no 1 et comme étant la plus essentielle To request your free subscription, go to the CVMA Member par les vétérinaires pour petits animaux pendant neuf ans. Benefits and Services webpage and click on Clinician’s Brief • Vous pouvez accéder à Clinician’s Brief en tout temps et (member log-in required). n’importe où — sur votre ordinateur, votre tablette ou votre Also, with your CVMA member benefits, you can receive appareil mobile. a 30% online subscription discount to Plumb’s Veterinary Pour demander votre abonnement numérique gratuit, allez à la DrugsTM. Some features and benefits of Plumb’s Veterinary page Web des Avantages et services aux membres de l’ACMV et Drugs include: cliquez sur Clinician’s Brief (il faudra ouvrir une session). • Easy-to-use, digital resource for accessing veterinary drug De plus, dans le cadre de vos avantages de membre de information. l’ACMV, vous recevez un rabais de 30 % sur l’abonnement en ligne • Provides busy veterinarians with streamlined dosing informa- individuel ou de la pratique ou sur la version imprimée de Plumb’s tion reflecting the latest evidence-based recommendations Veterinary DrugsMD. Voici quelques-uns des avantages de Plumb’s combined with clinical expertise. Veterinary Drugs : • Plumb’s mobile app provides instant, offline access to drug • Une ressource numérique conviviale pour accéder à des dosing information, anywhere, anytime. renseignements sur les médicaments vétérinaires. Contact the CVMA at 1-800-567-2862 or (admin@cvma- • Fournit aux vétérinaires à l’horaire chargé des renseignements acmv.org) to obtain your CVMA member discount code you will posologiques structurés qui reflètent les dernières need to provide in order to benefit from the discount. recommandations fondées sur des données probantes ainsi Plumb’s Veterinary Drugs, and Clinician’s Brief are 2 more qu’une expertise clinique. of the CVMA benefits that can help position your practice on • L’appli mobile de Plumb’s vous fournit l’accès instantané et hors the forefront of veterinary medicine. ligne aux renseignements posologiques des médicaments, en tout temps et n’importe où. Contactez l’ACMV au 1-800-567-2862 ou par courriel (admin@ cvma-acmv.org) pour obtenir votre code de rabais de membre de l’ACMV dont vous aurez besoin pour profiter du rabais. Plumb’s Veterinary Drugs et Clinician’s Brief représentent deux autres avantages de l’ACMV qui peuvent aider à positionner votre pratique à l’avant-garde de la médecine vétérinaire.

CVJ / VOL 58 / JULY 2017 667 FOR PERSONAL USE ONLY Your CVMA membership means MORE...

INFLUENCE KNOWLEDGE ADVANCING YOUR ISSUES, YOUR CONCERNS KEEPING YOU CURRENT ON VETERINARY SCIENCE AND YOUR PROFESSIONAL INTERESTS. AND PRACTICE, RESEARCH, INNOVATION AND The CVMA looks at policy matters in terms of their potential impact on TRENDS TO ENHANCE YOUR CAREER DEVELOPMENT the profession. Our role as an advocate for animal welfare and veterinary AND LIFELONG LEARNING. medicine at the national level influences your access to critical drugs, contributes to the development of responsible animal welfare policies, The CVMA provides you with the latest news, information, and clinical and mitigates decisions that could adversely affect your delivery of veterinary non-clinical continuing professional development. Our role as a knowledge care, and fosters a wider appreciation of the role of veterinarians in the provider enables you to broaden your knowledge and skills and maintain One Health concept. your competence to the highest professional standards.

As a CVMA member you benefit from… As a CVMA member you benefit from…

• Engagement with Government and key stakeholders to influence policy • The Canadian Veterinary Journal decisions • Canadian Journal of Veterinary Research • International relations to provide the Canadian veterinary perspective • Clinician’s Brief™ (free global digital edition) • Media and public relations to provide balanced and trustworthy information • CVMA national convention and to promote veterinary professionals • CVMA Veterinary Summit • Position statements on animal welfare and national veterinary issues • CVMA National Issues Forum • Codes of practice for Canadian kennel and cattery operations, and for the • CVMA Emerging Leaders Program care and handling of farm animals • CVMA Canadian Veterinary Reserve • Member consultations and online discussions on key veterinary issues • Member e-newsletter ‘Online from 339’ • Pan-Canadian Framework for Professional Standards in Veterinary Oversight of Antimicrobial Use • CVMA online continuing education portal • VetFolio® online educational resources (subscription discount)

RESOURCES SAVINGS SUPPORTING OUR MEMBERS THROUGH EVERY PUTTING MONEY IN YOUR POCKET AND DELIVERING STAGE OF THEIR CAREER WITH ACCESS TO A RANGE MORE VALUE TO INCREASE YOUR PROFITABILITY. OF EXCLUSIVE PRACTICE TOOLS AND RESOURCES. The CVMA provides members access to professional resources, veterinary The CVMA uses its national purchase power and strategic partnerships economic reports, practice management solutions, client education so that you can benefit from discount rates and money-saving services. resources, and exclusive online content to support you and your practice team in the effective delivery of veterinary services.

As a CVMA member you benefit from… As a CVMA member you benefit from…

• MyVetStore.caTM - CVMA web store solution for clinics • Hotel discounts worldwide • NEW! MonerisTM preferred payment processing rates • National and Enterprise Rent-a-Car discounts • NEW! CVMA Petcard Program - financing options for your clients • The Personal Insurance home and auto group savings • Practice owner’s economic survey • Scotiabank® business banking and lending solutions • Individual practice diagnostic and valuation report • The CVJ classified ads discount • Provincial suggested fee guide • Staples Advantage™ business products • Associate compensation and benefits report • Adtel® telephone hold service and digital signage • Compensation report for non-DVM staff • Petro-Canada SuperPass™ fuel/diesel/car wash discount • Compensation report for DVMs outside private practice • WSAVA World Congress (registration discount) • Practice management articles and resources • WVA Congress (registration discount) • CVMA group insurance program • Plumb’s Veterinary Drugs™ (subscription discount) • CVMA mentoring program • NEW! GoodLife Fitness Corporate Discount • VetLaw Online™ legal advice column • NEW! HRdownloads™ discounts • CVMA Green Veterinary Practice and self-audit tool • Antimicrobial SmartVet mobile app • Veterinarian health and wellness resources For information about the many benefits and privileges • Early career DVM web resource hub of membership. • Guidelines for the successful employment of new veterinary graduates • Sedative, anaesthetic and pain management protocols posters • Guidelines for the legitimate use of compounded drugs in veterinary practice CANADIAN VETERINARY MEDICAL ASSOCIATION • Antimicrobial prudent use guidelines for beef cattle, dairy cattle, poultry and 339 Booth Street, Ottawa (Ontario) K1R 7K1 swine T • (800) 567-2862 • (613) 236-1162 • Therapeutic decision cascade poster F • (613) 236-9681 • Animal abuse resources for practitioners faced with this issue [email protected] • Preventive healthcare, nutritional assessment and client education tools and canadianveterinarians.net resources • Animal health week annual public awareness campaign

05/2017 FOR PERSONAL USE ONLY 2016 Annual Report of the Canadian Veterinary Medical Association Rapport annuel 2016 de l’Association canadienne des médecins vétérinaires

he CVMA is the national and international voice for ACMV est la voix nationale et internationale des médecins T Canada’s veterinarians, providing leadership and advocacy L’ vétérinaires du Canada et elle assure le leadership et la for veterinary medicine. défense des intérêts de la médecine vétérinaire. With 7287 members in 2016, the CVMA has reached its En 2016, l’ACMV comptait 7287 membres, ce qui représente highest ever membership number, an increase of over 7% from son effectif le plus élevé et une hausse de 7 % par rapport à l’année the previous year. Thank you to all the ongoing and new mem- précédente. Merci à tous les membres actuels et nouveaux pour bers for joining the CVMA and maintaining a strong national leur adhésion à l’ACMV et la promotion d’une voix nationale et and international voice for the profession. In addition, the internationale forte pour la profession. De plus, l’ACMV compte CVMA counts 7397 veterinary technicians and technologists as 7397 techniciens et technologues vétérinaires en tant qu’affiliés. affiliates. Thank you to the Registered Veterinary Technologists Merci à Technologues et techniciens vétérinaires agréés du Canada and Technicians of Canada (RVTTC) for the ongoing partner- (TTVAC) pour son partenariat qui fait partie intégrante du succès ship, which is integral to fostering a successful veterinary team. de l’équipe vétérinaire. The CVMA’s Core Competencies are National & Les compétences fondamentales de l’ACMV sont les Enjeux International Issues and Animal Welfare. A number of areas nationaux et internationaux et le Bien-être animal. Plusieurs support these core competencies, such as the CVMA’s journals, domaines appuient ces compétences fondamentales, comme the Annual Convention and the Student Symposium, Career & les revues de l’ACMV, le congrès annuel et le Symposium des Life Balance — including business management tools such as étudiants, une carrière et une vie équilibrée — incluant des outils the suggested fee guide, National Examining Board, veterinary de gestion commerciale comme les guides tarifaires suggérés, college accreditation, and Veterinary Technician Accreditation. le Bureau national des examinateurs, l’agrément des écoles de Animal Cruelty legislation: The CVMA has been advocat- médecine vétérinaire et l’agrément des techniciens vétérinaires. ing for the amendment of the Criminal Code to consolidate Loi sur la cruauté envers les animaux : Au cours d’une and modernize various offences against animals for the better bonne partie des vingt dernières années, l’ACMV a préconisé part of 20 years. In 2016, the Association supported the private la modification du Code criminel afin de consolider et de member’s Bill C-246 or Modernizing Animal Protections Act. moderniser les diverses infractions à l’égard des animaux. En Through a “grass-roots campaign” during the summer, the 2016, l’Association a appuyé le projet de loi C-246 émanant d’un CVMA encouraged its members to engage with their respec- député intitulé Loi sur la modernisation des mesures de protection tive Members of Parliament. Despite these efforts, the Bill was des animaux. Dans le cadre d’une campagne «à la base» durant defeated in the House of Commons with a vote of 198–84. l’été, l’ACMV a encouragé ses membres à contacter leurs députés The silver lining is that the federal government committed to fédéraux respectifs. Malgré ces efforts, le projet de loi a été défait review the current Act and engage in broad consultations in the à la Chambre des communes par un vote de 198 contre 84. process. The CVMA has liaised with the Liberal animal welfare Toutefois, le gouvernement fédéral s’est engagé à examiner la caucus and will be invited to a stakeholder initiative to discuss a Loi actuelle et à mener de vastes consultations dans le cadre de common strategy on how to modernize this outdated legislation. cet exercice. L’ACMV a effectué la liaison avec le caucus sur le Antimicrobial resistance: The CVMA has advocated for reg- bien-être animal du Parti libéral et elle sera invitée à une initiative ulatory and policy changes over many years. In 2016, the federal d’intervenants afin de discuter d’une stratégie commune sur la government started processing the following changes: Removing façon de moderniser cette loi désuète. growth promotion claims from pre-2004 approved medically Antibiorésistance : L’ACMV préconise des changements à la important antimicrobials (MIAs); increasing veterinary over- réglementation et aux politiques depuis de nombreuses années. sight over all MIAs (pre-2004 approved); increasing oversight En 2016, le gouvernement fédéral a entamé la mise en œuvre on importation of veterinary drugs (Own Use Importation) des modifications suivantes : l’enlèvement des allégations de and active pharmaceutical ingredients (APIs); facilitating access stimulation de croissance des antimicrobiens importants sur le to low-risk veterinary health products as additional tools for plan médical (AIM); le resserrement de la surveillance vétérinaire the maintenance of animal health and welfare; and introduc- de tous les AIM (approuvés avant 2004); l’accroissement de ing mandatory reporting of sales volume from manufacturers la surveillance sur l’importation des médicaments vétérinaires and importers to support antimicrobial use surveillance. In (importation pour utilisation personnelle) et des ingrédients preparation of the anticipated changes to be implemented in pharmaceutiques actifs (IPA); la facilitation de l’accès à des

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late 2017/2018, the CVMA, in collaboration with the Canadian produits de santé vétérinaire à faible risque à titre d’outils Council of Veterinary Registrars (CCVR) and with input from a additionnels pour le maintien de la santé et du bien-être animal; large group of stakeholders, drafted the document “Veterinary et l’introduction de la déclaration obligatoire des volumes de vente oversight of antimicrobial use — A pan-Canadian frame- des fabricants et des importateurs afin d’appuyer la surveillance work for professional standards for veterinarians.” The 2016 de l’utilisation. En préparation à ces changements dont la mise en CVMA Summit, with Dr. Troy Bourque as chair, provided for œuvre est prévue à la fin 2017–2018, l’ACMV, en collaboration discussion by all major groups involved. The Framework was avec le Conseil canadien des registraires vétérinaires (CCRV) et finalized at the end of 2016 and now provides a template of avec la rétroaction d’un vaste groupe d’intervenants, a rédigé le professional standards to be used by provincial and territorial document intitulé «Surveillance vétérinaire de l’utilisation des veterinary regulatory bodies when developing their own regula- antimicrobiens — Un cadre de travail pancanadien pour les tions, guidelines, or bylaws relating to veterinarians’ professional normes professionnelles régissant les médecins vétérinaires». RAPPORT ANNUEL responsibilities in providing oversight of use of antimicrobials Le Sommet 2016 de l’ACMV, qui a été présidé par le Dr Troy in all circumstances. Bourque, a permis aux groupes importants de participer. Le cadre In order to foster Antimicrobial Stewardship further, de travail a été finalisé à la fin de 2016 et il fournit maintenant the CVMA initiated a project to renew the 2008 CVMA un modèle de normes professionnelles que pourront utiliser les Antimicrobial Prudent Use Guidelines, add guidelines for organismes provinciaux et territoriaux de réglementation de la small ruminants and complete the Antimicrobial SmartVet apps médecine vétérinaire afin d’élaborer leurs propres règlements ou for antimicrobial prudent use in small animals. This project is lignes directrices portant sur les responsabilités professionnelles scheduled to be completed at the end of March 2018. des médecins vétérinaires pour la prestation de la surveillance With a financial contribution from the Canadian Food de l’utilisation des antimicrobiens dans toutes les circonstances. Inspection Agency (CFIA), the CVMA has also initiated a Afin de favoriser encore plus l’antibiogouvernance, l’ACMV a project on antimicrobial use surveillance in order to identify lancé un projet pour le renouvellement des Lignes directrices de baseline data and potentially later monitor antimicrobial use in l’ACMV sur l’administration judicieuse des antimicrobiens de large and small animals in an effective and efficient way. This 2008 afin d’ajouter des lignes directrices pour les petits ruminants project is in support of fighting antimicrobial resistance and et terminer les applis IntelliVet pour l’utilisation prudente des Canada’s related commitments to the World Organisation for antimicrobiens chez les petits animaux. L’achèvement de ce projet Animal Health (OIE) and the international community. est prévu pour la fin de mars 2018. Throughout 2016, the CVMA, in conjunction with the Grâce à la contribution financière de l’Agence canadienne CCVR, rolled out a monthly awareness campaign, alerting d’inspection des aliments (ACIA), l’ACMV a aussi entamé un veterinarians to the issue of antimicrobial use (AMU) and the projet pour la surveillance de l’utilisation des antimicrobiens afin upcoming regulatory changes. d’identifier les données de référence dans le but d’une surveillance Throughout the AMU regulatory process, the CVMA worked efficace éventuelle de l’utilisation des antimicrobiens chez les on the regulatory side with the CCVR, the Veterinary Drugs grands et les petits animaux d’une manière efficace. Ce projet Directorate, the CFIA, and the Public Health Agency of Canada. favorise la lutte contre l’antibiorésistance et les engagements Dog Importation: During its Annual Convention, the connexes du Canada envers l’Organisation mondiale de la santé CVMA hosted the first National Issues Forum, an event allow- animale (OIE) et la collectivité internationale. ing veterinarians to familiarize themselves with a national issue Au cours de 2016, l’ACMV, de concert avec le CCRV, a mis en and discuss it. The discussion took place on CVMA’s draft œuvre une campagne de sensibilisation mensuelle afin d’alerter Position Statement on Importation of Dogs into Canada. les médecins vétérinaires à l’égard de l’enjeu de l’utilisation des The resulting Position Statement was approved by Council in antimicrobiens et des modifications réglementaires prochaines. November and states: “The CVMA will support the importation Pendant le processus réglementaire en lien avec l’utilisation of dogs into Canada only once effective controls are in place that des antimicrobiens, l’ACMV a travaillé avec des spécialistes de mitigate the risk to Canadians and our resident animal popula- la réglementation du CCRV, de la Direction des médicaments tions from infectious disease… .” As a next step, the CVMA will vétérinaires, de l’ACIA et de l’Agence de la santé publique du consider furthering awareness on this issue with veterinarians Canada. and the public, and will lobby the government to take a lead on Importation des chiens : Pendant son congrès annuel, addressing this matter. l’ACMV a organisé le premier Forum sur les enjeux nationaux, un International relations: On an international level, the événement qui permet aux vétérinaires de se familiariser avec un CVMA represents Canada’s veterinarians as part of Canada’s enjeu national et d’en discuter. La discussion a porté sur l’ébauche government delegation to the OIE, as a member of the World de l’énoncé de position de l’ACMV sur l’importation des chiens Veterinary Association (WVA), the World Small Animal au Canada. L’énoncé de position qui en a découlé a été approuvé Veterinary Association (WSAVA), PANVET, the grouping of par le Conseil en novembre et stipule : «L’ACMV appuiera Federation of Veterinarians of Europe/American Veterinary l’importation des chiens au Canada seulement après la mise en Medical Association/CVMA, and as a member of the place de contrôles efficaces qui atténuent les risques présentés par International Veterinary Officers’ Coalition (IVOC). These les maladies infectieuses pour les Canadiens et les populations collaborations have resulted in joint Position Statements, engag- résidentes d’animaux...». Comme prochaine étape, l’ACMV ing with the WVA and the WSAVA in urging the United considérera une sensibilisation accrue des médecins vétérinaires

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Nations not to restrict the availability of ketamine, or tangible et du public à cet égard et des efforts de lobbying auprès du benefits to CVMA members such as access to WVA’s more than gouvernement pour qu’il prenne des mesures appropriées. 900 e-learning sessions, access to the Partners for Healthy Pets’ Relations internationales : Au niveau international, l’ACMV resource toolbox including tools on effective communication, représente les vétérinaires du Canada en tant que membre de marketing, etc., access to a template for use in the development la délégation du Canada auprès de l’OIE et de membre de ANNUAL REPORT ANNUAL of CVMA’s Mentorship Program, and free of charge Clinicians’ l’Association mondiale vétérinaire (AMV), de la World Small Briefs. Animal Veterinary Association (WSAVA), de PANVET, du CVMA in its leader and facilitator role: On behalf of its regroupement de la Fédération des vétérinaires d’Europe/ members, the CVMA is involved in 27 government agencies American Veterinary Medical Association/ACMV et en tant que and interest groups. The saying introduced by a former CVMA membre de l’International Veterinary Officers’ Coalition (IVOC). president still holds: “If you are not at the table, you may be on Ces collaborations ont donné lieu à des énoncés de position the menu.” The CVMA brings stakeholders together as needed conjoints, de concert avec l’AMV et la WSAVA, afin d’exhorter to discuss such matters as antimicrobial use (during the 2016 les Nations Unies à ne pas limiter la disponibilité de la kétamine, Summit) and engages with interested groups in the development ou à des avantages concrets pour les membres de l’ACMV, comme of Position Statements or responses to the government on new l’accès aux plus de 900 ateliers de cyberapprentissage de l’AMV, regulations, policies or guidelines. l’accès à la boîte à outils de ressources de Partners for Healthy Pets, The CVMA’s Annual Convention is Canada’s only national, dont des outils pour une communication efficace, le marketing, multi-species event providing an opportunity for veterinar- etc., l’accès à un modèle à utiliser dans le cadre de l’élaboration ians to learn and meet. The Summit, Presidents’ Meeting, du Programme de mentorat de l’ACMV et l’accès gratuit aux Provincial Forum, meetings with deans, registrars, the RVTTC, bulletins Clinicians’ Briefs. the Canadian Animal Health Institute, and alumni are held in L’ACMV dans son rôle de leader et de modérateur : Au nom conjunction with the Convention. de ses membres, l’ACMV a été active au sein de 27 organismes Thank you to the more than 600 volunteers, together with gouvernementaux et groupes d’intérêts. Le dicton introduit par the dedicated staff team, for providing their significant expertise un ancien président de l’ACMV est toujours valable : «Si vous and capacity to address animal health and welfare, and ecosys- n’êtes pas à table, vous pourriez être au menu». L’ACMV réunit tem issues on behalf of the profession. les intervenants au besoin pour discuter de questions comme The following report provides a summary of the main activi- l’utilisation des antimicrobiens (durant le Sommet 2016) et ties undertaken by the CVMA in 2016. interagit avec des groupes intéressés dans l’élaboration des énoncés de position ou de réponses au gouvernement sur de nouveaux règlements, politiques ou lignes directrices. Le congrès annuel de l’ACMV est le seul événement multi- espèces national du Canada qui offre des occasions d’apprentissage et de réseautage aux vétérinaires. Le Sommet, la rencontre des présidents, le forum provincial, des réunions avec les doyens, les registraires, TTVAC, l’Institut canadien de la santé animale et les anciens se tiennent lors du congrès. Merci aux plus de 600 bénévoles, de même qu’aux employés, pour leur expertise et leurs capacités considérables afin d’aborder la santé et le bien-être des animaux ainsi que les enjeux liés aux écosystèmes au nom de la profession. Le rapport suivant présente un sommaire des principales activités entreprises par l’ACMV en 2016.

Dr./Dre Nicole Gallant CVMA President 2015–16 Présidente de l’ACMV 2015–2016

Dr./Dr Troy Bourque CVMA President 2016–17 Président de l’ACMV 2016–2017

CVJ / VOL 58 / JULY 2017 671 FOR PERSONAL USE ONLY 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 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 evolves each year and takes into account financière globale d’une entreprise à l’Association. Le PCE the various programs and events that are corporately sponsored, évolue chaque année et il tient compte des divers programmes et allowing companies that support the CVMA in various aspects activités qui sont commandités par les sociétés et il permet à ces to get better recognition for their overall contributions. The dernières d’appuyer l’ACMV de diverses façons afin d’obtenir une RAPPORT ANNUEL 3 levels of sponsorship in 2016 were Platinum (. $80,000), meilleure reconnaissance de leurs contributions globales. Les trois Gold ($48 000–$79 999) and Silver ($27 000–$47 999). niveaux de commandite en 2016 étaient Platine (. 80 000 $), The CVMA would like to extend recognition to the follow- Or (de 48 000 $ à 79 999 $) et Argent (de 27 000 $ à 47 999 $). ing sponsors for their overall contribution to the Association L’ACMV aimerait reconnaître les commanditaires suivants pour for 2016: leur contribution globale à l’Association en 2016 : Gold: Merck Animal Health Or : Merck Santé animale Scotiabank Banque Scotia Virox Animal Health Virox Animal Health Silver: Hill’s Pet Nutrition Canada Inc. Argent : Hill’s Pet Nutrition Canada Inc. IDEXX Laboratories IDEXX Laboratories Merial Canada Inc. Merial Canada Inc. Petsecure Pet Health Insurance Petsecure assurance maladie pour animaux

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 animal

The Animal Welfare Committee (AWC) deals with a wide range Le Comité sur le bien-être animal (CBA) gère un vaste éventail of issues of concern to Canadian veterinarians and the public d’enjeux qui préoccupent les vétérinaires et le public canadiens with respect to the humane treatment of animals. Committee relativement au traitement sans cruauté des animaux. Les members include those from companion and food animal membres du comité proviennent de la pratique des animaux de practice, animal welfare research, wildlife and zoo animal compagnie et de la pratique des animaux destinés à l’alimentation, medicine, and laboratory animal medicine. Ex-officio mem- de la recherche sur le bien-être animal, de la médecine de la faune bers include those from the Canadian Food Inspection Agency et des animaux de zoo ainsi que de la médecine de laboratoire. (CFIA), Canadian Federation of Humane Societies (CFHS), Les membres d’office incluent ceux de l’Agence canadienne Ontario Veterinary Medical Association (OVMA), the Canadian d’inspection des aliments (ACIA), de la Fédération des sociétés Association of Laboratory Animal Medicine (CALAM), and the canadiennes d’assistance aux animaux (FSCAA), de l’Ontario Registered Veterinary Technologists and Technicians of Canada Veterinary Medical Association (OVMA), de L’Association (RVTTC). canadienne de la médecine des animaux de laboratoire (ACMAL) The AWC conducts extensive reviews of scientific and ethical et de Technologues et techniciens vétérinaires agréés du Canada dimensions of animal welfare issues of importance to veterinar- (TTVAC).

672 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY ians and the public. During 2016, the AWC proposed to CVMA Le CBA réalise des examens des dimensions scientifiques et Council revisions to existing Position Statements on: Castration éthiques des enjeux d’importance liés au bien-être animal qui sont of Piglets; Cutting, Reduction, or Removal of Healthy Teeth in importants pour les vétérinaires et le public. En 2016, le CBA Dogs; Partial Digital Amputation (Onychectomy, Declawing) of a proposé au Conseil de l’ACMV des révisions aux énoncés de Non-Domestic Felids and Other Carnivores Kept in Captivity; position suivants : Castration des porcelets; Coupe, réduction ou ANNUAL REPORT ANNUAL Devocalization of Dogs; Disbudding and Dehorning of Cattle; extraction des dents en santé chez les chiens; Amputation partielle Induced Molting of Poultry; Keeping of Native or Exotic Wild des doigts (onychectomie, dégriffage) des félidés non domestiques Animals as Pets; Partial Digital Amputation (Onychectomy or et d’autres carnivores gardés en captivité; Dévocalisation des chiens; Declawing) of the Domestic Felid; Tail Docking of Dairy Cattle, Enlèvement des bourgeons et écornage du bétail; Mue induite de la and Use of Thermocautery for the Treatment of Lameness in volaille; Garde d’animaux sauvages ou exotiques comme animaux Horses. The Position Statement of Ownership and Selection de compagnie; Amputation partielle des doigts (onychectomie of a Pet was rescinded and was replaced by a web information ou dégriffage) des félidés domestiques; Amputation de la queue resource for veterinarians and owners. des bovins laitiers et Utilisation de la thermocautérisation pour le During 2016 the AWC began work on new Position traitement de la boiterie chez les chevaux. L’énoncé de position Statements on Transportation of Dogs and Cats; The Use sur la possession et la sélection d’un animal de compagnie a of Animals in Competitive Sport; The Use of Animals in été révoqué et remplacé par une ressource d’information Web à Entertainment and Recreation; Marketing of Cull Dairy l’intention des vétérinaires et des propriétaires. Cows; Veterinary Reporting of Animal Abuse; the Use of Pain Durant 2016, le CBA a entamé des travaux sur de nouveaux Technologies in Animals (to replace Electro-Immobilization). énoncés de position : Transport des chiens et des chats; Utilisation During 2016, the AWC continued work on the revision of Code des animaux dans les sports compétitifs; Utilisation des animaux of Practice for Canadian Kennel Operations in consultation with dans les spectacles et les loisirs; Commercialisation des vaches AWC members and external stakeholders. laitières de réforme; Déclaration de la violence envers les animaux Working with AWC, CVMA communications disseminated par les vétérinaires; Utilisation des technologies douloureuses pour information via web news to veterinarians in Canada on the care les animaux (pour remplacer l’électro-immobilisation). Durant of compromised cattle. The CVMA convened a meeting of the 2016, le CBA a poursuivi son travail pour la révision du Code de Ad Hoc committee on compromised cattle during November pratiques recommandées aux chenils du Canada en consultation 2016 to discuss CVMA’s draft Position Statement. avec les membres du CBA et des intervenants externes. With the support of the AWC, the CVMA lobbied the federal En collaboration avec le CBA, le service des communications government in support of Private Member Bill C-246 including de l’ACMV a diffusé de l’information dans les nouvelles Web aux meeting with stakeholders, members of Parliament and the office médecins vétérinaires du Canada sur les soins du bétail fragilisé. of Minister of Agriculture. Letters expressing CVMA support L’ACMV a convoqué une réunion du Comité ad hoc sur le bétail were sent to Members of Parliament, veterinary species and fragilisé durant novembre 2016 afin de discuter l’énoncé de producer groups and CVMA members (requesting that they position de l’ACMV. actively engage their Members of Parliament). Avec le soutien du CBA, l’ACMV a exercé des pressions The CVMA was represented on the National Farmed Animal auprès du gouvernement fédéral afin d’appuyer le projet de loi Care Council (NFACC) Executive and Board and continues émanant d’un député C-246, y compris des rencontres avec to provide representation on the NFACC Code and Scientific les intervenants, les députés fédéraux et le bureau du ministre Committees as well as the Animal Care Assessment Program de l’Agriculture. Des lettres exprimant l’appui de l’ACMV ont Committees. Internationally, the CVMA was represented at the été envoyées aux députés fédéraux, aux groupes vétérinaires des Animal Welfare Committee meeting of the American Veterinary espèces, aux groupes de producteurs et aux membres de l’ACMV Medical Association (AVMA). Likewise the AVMA representa- (pour leur demander d’engager activement leur député fédéral). tive met with the CVMA’s Animal Welfare Committee during L’ACMV a été représentée au sein de l’exécutif et du conseil the March Committee Weekend. d’administration du Conseil national pour les soins aux animaux A number of animal welfare resources continue to be avail- d’élevage (CNSAE) et elle continue d’assurer une représentation able on the CVMA website including pain management post- au sein des comités des codes et des comités scientifiques ers; kennel and cattery codes, information on animal abuse ainsi qu’auprès des comités des programmes d’évaluation des and ownership and selection of a pet, and animal welfare news soins aux animaux. À l’échelle internationale, l’ACMV a été items and articles. représentée à la réunion du Comité sur le bien-être animal de l’American Veterinary Medical Association (AVMA). De même, le représentant de l’AVMA a rencontré le Comité sur le bien-être animal de l’ACMV durant la fin de semaine des comités de mars. Plusieurs ressources sur le bien-être animal continuent d’être disponibles sur le site Web de l’ACMV, y compris des affiches sur la gestion de la douleur, les codes pour les chenils et les chatteries, des renseignements sur la violence envers les animaux et sur la possession et le choix d’un animal de compagnie ainsi que des articles et des nouvelles sur le bien-être animal.

CVJ / VOL 58 / JULY 2017 673 FOR PERSONAL USE ONLY National Issues Enjeux nationaux

The National Issues Committee (NIC) considers a wide range Le Comité sur les enjeux nationaux (CEN) se penche sur un of issues of concern to the veterinary profession in Canada. vaste éventail d’enjeux qui préoccupent la profession vétérinaire During 2016 the NIC developed a new Position Statement on au Canada. Durant 2016, le CEN a élaboré un nouvel énoncé de Importation of Dogs into Canada. A review and revision of the position sur l’importation des chiens au Canada. Un examen et Position Statement on Veterinary Dentistry was undertaken with une révision de l’énoncé de position sur la dentisterie vétérinaire member discussion planned for 2017. a été entrepris et une discussion avec les membres est prévue The National Issues Forum was held for the first time in 2016 pour 2017. RAPPORT ANNUEL at the CVMA Convention with the aim of better informing Le Forum sur les enjeux nationaux s’est tenu pour la première and engaging members in the development and application of fois en 2016 lors du congrès de l’ACMV dans le but de mieux CVMA Position Statements for affecting change. The subject informer et d’engager les membres dans l’élaboration et of the 2016 Forum was Importation of Dogs into Canada. The l’application des énoncés de position de l’ACMV pour qu’ils event involved presentations from 3 panelists, discussion and aient un impact. Le sujet du Forum 2016 était l’importation des live polling, and was attended by 150 veterinarians. A high level chiens au Canada. Lors de l’événement, trois panelistes ont fait of support was expressed for CVMA’s new Position Statement des présentations qui ont été suivies de discussions et de sondages on the issue that was approved by Council in November 2016. en direct. Cent cinquante médecins vétérinaires étaient présents. A major focus of NIC deliberations continued to be antimi- Un haut niveau d’appui a été exprimé pour le nouvel énoncé de crobial stewardship and antimicrobial use surveillance given the position de l’ACMV sur cet enjeu et l’énoncé a été approuvé par changes to federal regulations expected during the next several le Conseil en novembre 2016. years. NIC drafted a response to the Minister of Health during Le CEN a continué de se pencher en grande partie sur August 2016 regarding the proposed regulatory changes that l’antibiogouvernance et la surveillance de l’utilisation des would enhance veterinary oversight of antimicrobial use in antimicrobiens compte tenu des modifications réglementaires animals. fédérales qui sont attendues au cours des prochaines années. Le The CVMA’s Veterinary Pharmaceutical Stewardship CEN a rédigé une réponse à la ministre de la Santé en août 2016 Advisory Group (VPSAG) completed the document “Veterinary concernant le projet de modification du Règlement qui porte sur oversight of antimicrobial use — A pan-Canadian framework le resserrement de la surveillance vétérinaire pour l’utilisation des of professional standards for veterinarians,” developed in col- antimicrobiens chez les animaux. laboration with the Canadian Council of Veterinary Registrars Le Groupe consultatif sur les produits pharmaceutiques (CCVR), and was used by CVMA communications as a basis vétérinaires (GCPPV) de l’ACMV a terminé la rédaction for monthly messages to veterinarians highlighting the key role du document «Surveillance vétérinaire de l’utilisation des veterinarians play in pharmaceutical stewardship. A revised antimicrobiens — Un cadre de travail pancanadien pour les draft document was presented to key stakeholders in late 2016 normes professionnelles régissant les médecins vétérinaires», including the National Farmed Animal Health and Welfare qui a été rédigé en collaboration avec le Conseil canadien des Council (NFAHWC) and the CCVR. The first document serves registraires vétérinaires (CCRV) et a été utilisé par le service the veterinary regulatory bodies as a template for professional des communications de l’ACMV pour communiquer des messages standards when developing their own regulations, guidelines or mensuels aux vétérinaires afin de souligner le rôle clé des médecins bylaws relating to veterinary professional responsibilities in pro- vétérinaires dans la gouvernance des produits pharmaceutiques. viding oversight in the use of antimicrobials in all circumstances. Une ébauche révisée du document a été présentée aux principaux In 2016, the CVMA completed an application to Agriculture intervenants à la fin de 2016, dont le Conseil national sur la and Agri-Food Canada (AAFC) for funding under the AAFC santé et le bien-être des animaux d’élevage (CNSBEAE) et le Agri-Marketing program to renew and enhance the Prudent Use CCRV. Le premier document servira de modèle pour les normes Guidelines for Food and Companion Animals. The proposed professionnelles à l’intention des organismes de réglementation project titled Renewal of CVMA Guidelines for the Prudent Use of de la médecine vétérinaire lors de l’élaboration de leurs propres Veterinary Anti-Microbial Medications was approved and will be règlements ou lignes directrices portant sur les responsabilités completed in 2018. In a separate initiative, the CVMA received professionnelles des médecins vétérinaires dans la surveillance funding from the CFIA to support an initial phase of a project de l’utilisation des antimicrobiens dans toutes les circonstances. on Antimicrobial Use (AMU) Surveillance in veterinary practices En 2016, l’ACMV a présenté une demande de financement to be completed in early 2017. auprès d’Agriculture et d’Agroalimentaire Canada (AAC), en The CVMA provided representation at meetings with the vertu du programme Agri-marketing d’AAC, afin de renouveler Canadian Animal Health Institute (CAHI), the Canadian et d’améliorer les Lignes directrices sur l’administration judicieuse Animal Health Products Advisory Committee (CAHPRAC), pour les animaux de compagnie et les animaux destinés à Canadian Global Food Animal Residue Avoidance Databank l’alimentation. Le projet proposé, qui s’intitule Renouvellement (cGFARAD); Canadian Council of Veterinary Registrars des lignes directrices de l’ACMV sur l’administration judicieuse (CCVR); Ad Hoc Committee on Veterinary Anti-Microbial des médicaments antimicrobiens vétérinaires, a été approuvé et

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Stewardship; National Farmed Animal Health and Welfare il se terminera en 2018. Dans le cadre d’une autre initiative Council (NFAHWC); Council of Chief Veterinary Officers distincte, l’ACMV a reçu des fonds de l’ACIA afin d’appuyer la (CCVO) Task Force on Dog Importation; and the American phase initiale d’un projet sur la surveillance de l’utilisation des Veterinary Medical Association (AVMA). antimicrobiens dans les pratiques vétérinaires qui sera achevé au The CVMA presented at the NFAHWC meeting on CVMA début de 2017. ANNUAL REPORT ANNUAL activities that support the National Animal Health Strategy. The L’ACMV a assuré une représentation à des réunions avec NIC continues to monitor the activity of the NFAHW Council l’Institut canadien de la santé animale (ICSA), le Comité and seeks opportunities to provide input on issues that are consultatif canadien sur la réglementation des produits de important to the veterinary community (e.g. disease surveillance, santé animale (CCCRPSA), la Canadian Global Food Animal Codes of Practice incorporation into provincial regulations, and Residue Avoidance Databank (cGFARAD); le Conseil canadien antimicrobial stewardship/resistance). des registraires vétérinaires (CCRV); le Comité ad hoc sur l’antibiogouvernance vétérinaire; le Conseil national sur la santé et le bien-être des animaux d’élevage (CNSBEAE); le Conseil canadien des médecins vétérinaires en chef (CCMVC); le Groupe de travail sur l’importation des chiens; et l’American Veterinary Medical Association (AVMA). L’ACMV a donné une présentation lors d’une réunion du CNSBEAE sur les activités appuyant la Stratégie nationale en matière de santé animale. Le CEN continue de surveiller l’activité du Conseil NSBEAE et il cherche des occasions de fournir de la rétroaction sur les enjeux qui sont importants pour la collectivité vétérinaire (p. ex., surveillance des maladies, intégration des Codes de pratiques dans les règlements provinciaux ainsi que l’antibiogouvernance et l’antibiorésistance).

Communications & Public Relations Communications et relations publiques

The CVMA received 82 media inquiries during 2016. This Durant 2016, l’ACMV a reçu 82 demandes de renseignements resulted in a number of interviews, including discussions on de la part des médias. Ces dernières ont donné lieu à plusieurs CVMA’s Position Statements on tail docking of dogs, marijuana entrevues, dont des discussions sur les énoncés de position de use in pets, and the risks of importing dogs into Canada. The l’ACMV sur l’amputation de la queue des chiens, l’utilisation de 2016 CVMA Convention in Niagara Falls saw successful media la marijuana chez les animaux de compagnie et les risques liés à coverage resulting in 3 print publication interviews and one l’importation des chiens au Canada. Le congrès 2016 de l’ACMV radio interview for the CVMA Summit. à Niagara Falls a obtenu une bonne couverture médiatique qui The CVMA continues to increase social media channel activ- s’est concrétisée par trois entrevues dans les médias imprimés et ity. By the fall of 2016, the CVMA’s Facebook page hit over une entrevue à la radio pour le Sommet de l’ACMV. 5000 likes and its combined English and French Twitter fol- L’ACMV continue d’accroître l’activité dans les réseaux lowers were over 8600. Its YouTube Channel featured the 2016 des médias sociaux. À l’automne 2016, la page Facebook de Animal Health video and testimonials from CVMA members. l’ACMV a atteint plus de 5000 J’aime et le nombre combiné de suiveurs de Twitter, en français et en anglais, s’élevait à plus de 8600 personnes. Son canal YouTube a présenté la vidéo de la Santé animale 2016 et des témoignages provenant de membres de l’ACMV. En 2016, l’ACMV a poursuivi sa campagne de sensibilisation sur Facebook et Twitter afin de promouvoir la valeur des soins vétérinaires auprès du public. Les mots-clics #VétérinairesPartenaires et #VetCareEverywhere ont été utilisés avec la série de messages sur les soins vétérinaires. La campagne de sensibilisation se poursuivra en 2017. En 2016, l’ACMV, en partenariat avec le Conseil canadien des registraires vétérinaires, a envoyé des messages mensuels à tous les vétérinaires par l’entremise de courriels, des médias sociaux et du site Web de l’ACMV, sous la bannière de Surveillance vétérinaire de l’utilisation des antimicrobiens au Canada : les règles vont changer…

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The CVMA continued an awareness campaign in 2016 on Facebook and Twitter to promote the value of veterinary healthcare to the public. The hashtags #VetCareEverywhere and #VétérinairesPartenaires were used with the series of veterinary healthcare statements. The awareness campaign continues into 2017. In 2016, the CVMA, in partnership with the Canadian Council of Veterinary Registrars, sent out monthly messages to all veterinarians through e-mails, social media and the CVMA website, under the banner of Veterinary Oversight of Antimicrobial Use in Canada: Regulations are Changing…We RAPPORT ANNUEL Want You Prepared. This was in response to the federal government’s announcement that new regulations would require veterinary oversight of the use of antimicrobials administered to food animals, including those administered in feed or water, Soyez prêts! Cette campagne a été déployée en réponse à l’annonce to be in place by the end of December 2016 (this date has since du gouvernement fédéral que la nouvelle réglementation exigerait been extended to the end of 2017). The messages were also la surveillance vétérinaire de l’utilisation des antimicrobiens shared with the provincial and territorial veterinary associations administrés aux animaux destinés à l’alimentation, y compris and regulatory bodies. ceux administrés dans les aliments ou l’eau, qui devra être mise The CVMA, in partnership with Merck Animal Health, en place d’ici la fin de décembre 2016 (cette date a depuis été declared March 2016 the first National Tick Awareness Month. reportée à la fin de 2017). Les messages ont aussi été partagés avec The campaign made available to clinics waiting room posters les associations provinciales et territoriales de médecins vétérinaires and ready-to-use, cut-and-paste social media posts. An exclusive et les organismes de réglementation. live webinar was also held on 2 consecutive days for western L’ACMV, en partenariat avec Merck Santé animale, a déclaré le Canada and eastern Canada, featuring renowned parasitolo- mois de mars 2016 le premier Mois national de la sensibilisation gist Dr. Michael W. Dryden. The webinar was archived until aux tiques. La campagne a distribué des affiches pour la salle May 31, 2016. d’attente des cliniques ainsi que des messages à couper-coller Animal Health Week (AHW) ran from October 2 to 8, 2016 pour les médias sociaux. Un webinaire exclusif a aussi été présenté with the theme, “Animal Health 1 Human Health 1 Planet en direct par le célèbre parasitologue Dr Michael W. Dryden Health = One Health.” Generous support of the campaign pendant deux journées consécutives pour l’Ouest canadien et was presented by the Principal Sponsor: Petsecure Pet Health l’Est du Canada. Le webinaire a été archivé jusqu’au 31 mai 2016. Insurance, and Program Sponsors: iFinance (Petcard) and La Semaine de la vie animale (SVA) s’est déroulée du 2 au Merial. A national news release was distributed the week prior 8 octobre 2016 sous le thème «Santé animale 1 Santé humaine 1 to Animal Health Week. In addition, targeted media pitches Santé de la planète = Une seule santé». Un soutien généreux were sent to various outlets across the country, resulting in de la campagne a été fourni par le commanditaire principal : 4 interviews. The Canadian Food Inspection Agency distributed Petsecure assurance maladie pour animaux, et les commanditaires 160 Animal Health Week posters through departments across de programme : iFinance (Petcard) et Merial. Un communiqué Canada and invited the CVMA to provide 2 presentations de presse national a été diffusé la semaine avant la Semaine de la during AHW. Photos from Animal Health Week events were vie animale. De plus, des communications ciblées pour les médias shared on the CVMA Facebook page and Twitter feed during ont aussi été acheminées aux divers réseaux au pays et elles se sont the campaign period. traduites par quatre entrevues. L’Agence canadienne d’inspection Mass e-mail and fax bulletins, social media updates, articles des aliments a distribué 160 affiches de la Semaine de la vie in provincial publications, information on the CVMA’s website, animale dans les diverses régions du Canada par l’entremise des and in the CVMA’s monthly eNewsletter continue to provide ministères et elle a invité l’ACMV à donner deux présentations members with relevant CVMA program updates and general durant la SVA. Des photos des activités de la Semaine de la vie veterinary news. animale ont été partagées sur la page Facebook de l’ACMV et sur le fil Twitter durant la campagne. Des bulletins de masse ont été envoyés par courriel et par télécopieur et des nouvelles dans les médias sociaux, des articles dans les publications provinciales, des renseignements sur le site Web de l’ACMV et le cyberbulletin mensuel de l’ACMV ont fourni aux membres des mises à jour sur les programmes pertinents et l’actualité vétérinaire en général.

676 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY 2016 CVMA Awards Prix 2016 de l’ACMV

The 2016 CVMA Awards Ceremony honored exceptional En juillet, la Cérémonie de remise des Prix 2016 de l’ACMV ANNUAL REPORT ANNUAL individuals of the veterinary community in July. Dr. Ernie a reconnu des personnes exceptionnelles de la collectivité Prowse, CVMA Small Animal Practitioner Award (Petsecure vétérinaire. Dr Ernie Prowse, Prix du praticien des petits Pet Health Insurance); Dr. Melodie Chan, CVMA Industry animaux de l’ACMV (Petsecure assurance maladie pour animaux); Award; Dr. Shawn Llewellyn, CVMA Humane Award (Merck Dre Melodie Chan, Prix de l’industrie de l’ACMV; Dr Shawn Animal Health); Dr. Larry Hammell, Merck Veterinary Award Llewellyn, Prix humanitaire de l’ACMV (Merck Santé animale); (Merck Animal Health); Animal Care Centre of Strathmore, Dr Larry Hammell, Prix vétérinaire Merck (Merck Santé CVMA Practice of the Year Award (Scotiabank); Dr. Bernhard animale); Animal Care Centre of Strathmore, Prix de la pratique Pukay, CVMA Life Membership; Ms. Elizabeth J. Knight, de l’année de l’ACMV (Banque Scotia); Dr Bernhard Pukay, CVMA Honorary Membership; and Dr. Sylvie Latour, Titre de membre à vie de l’ACMV; Mme Elizabeth J. Knight, CVMA President’s Award. The CVMA extends congratula- Titre de membre honoraire de l’ACMV; et Dre Sylvie Latour, Prix tions to Ms. Stacey Huneke who received the 2016 Canadian du président de l’ACMV. L’ACMV félicite Mme Stacey Huneke Registered Animal Health Technologist/Veterinary Technician qui a reçu le Prix du technologue en santé animale/technicien of the Year Award. The CVMA issued individual news releases vétérinaire de l’année 2016. L’ACMV a publié des communiqués on each award recipient, which resulted in 4 media requests for de presse individuels sur chaque lauréat qui se sont traduits par interviews. quatre demandes d’entrevues de la part des médias.

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 (The CVJ) and Canadian La Revue vétérinaire canadienne (La RVC) et la Revue canadienne Journal of Veterinary Research (CJVR) are the only national, de recherche vétérinaire (RCRV) sont les seules revues vétérinaires general or multi-species, peer-reviewed veterinary journals in nationales, à contenu général ou multi-espèces, évaluées par les Canada. The number of manuscripts submitted to The CVJ pairs au Canada. Le nombre de manuscrits soumis à La RVC en in 2016 was 286; the number submitted to the CJVR in 2016 2016 a été de 286; le nombre de manuscrits soumis à la RCRV was 86. Successful efforts are ongoing to reduce the backlog en 2016 a été de 86. Des efforts fructueux sont déployés afin of CVJ manuscripts; the time from submission to publication de réduire l’arriéré des manuscrits de La RVC; le délai entre le is currently just over 12 months. For CJVR the time for the moment de la soumission et la publication se situe actuellement same progression is 7.8 months. Both journals will continue to à un peu plus de douze mois. Pour la RCRV, le délai pour promote the relevance of journal articles to practice, and build cette même progression s’établit à 7,8 mois. Les deux revues demand for the knowledge delivered. continueront de promouvoir la pertinence des articles de revue A new cover designed in 2016 was launched with the January pour la pratique et de miser sur la demande pour les connaissances 2017 issue of CJVR. Also, regarding CJVR, a new associate publiées. editor, Dr. Faizal A. Careem, joined the journals team in the Une nouvelle page couverture conçue en 2016 a été inaugurée summer of 2016. avec la publication du numéro de Janvier 2017 de la RCRV. Both journals have introduced a plagiarism cross-check fea- De plus, à propos de la RCRV, un nouveau rédacteur associé, ture called iThenticate, which is incorporated into the Scholar le Dr Faizal A. Careem, s’est joint à l’équipe des revues à One online submission system. The CVJ had 2 articles that l’été 2016. were compromised last year due to plagiarism so this move was Les deux revues ont introduit une fonction de contre- deemed valuable for the future. vérification du plagiat appelée iThenticate, qui est intégrée dans The journals department sends an annual letter from the le système de soumission en ligne de Scholar One. La RVC a eu CVMA to the deans of Canadian veterinary schools on behalf of deux articles qui ont été compromis l’an dernier en raison du

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the editors. Editors are recognized by the schools for their work plagiat et cette mesure s’est donc avérée d’utilisation prometteuse with the journals in determining academic advancement/tenure. pour l’avenir. As a benefit to CVMA members, CVMA authors have lower Chaque année, le service des revues envoie une lettre aux publication fees for The CVJ and lower page charges for CJVR. doyens des écoles de médecine vétérinaire canadienne, de la part Advertising revenues, which had been on the decline for the last de l’ACMV, au nom des rédacteurs. Le travail des rédacteurs few years due to the pressures of the economy, have started to auprès des revues est reconnu par les écoles afin de déterminer rebound. Both journals will continue to strive toward a break- l’avancement et la permanence dans les universités. even budget. En tant qu’avantage aux membres de l’ACMV, les auteurs de Readers and CVMA members are reminded that all issues, l’ACMV profitent de tarifs de publication inférieurs pour La RVC except the most recent 6 months, of both The CVJ and CJVR ainsi que de frais inférieurs par page pour la RCRV. Les recettes are available to the public on the PubMed Central archive publicitaires, qui avaient connu une baisse au cours des dernières RAPPORT ANNUEL (www.pubmedcentral.com); a link is also available through années en raison des pressions économiques, ont commencé à the CVMA website (www.canadianveterinarians.net). CVMA se redresser. Les deux revues continueront de travailler en vue members can view the most recent 6 months of the journals on d’équilibrer le budget. 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 six derniers mois, de La RVC et de la RCRV sont disponibles au public dans l’archive de 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.

Conventions Congrès

The Canadian Veterinary Medical Association (CVMA) held L’Association canadienne des médecins vétérinaires (ACMV) a its 68th Annual Convention July 7–10, 2016 in Niagara Falls, tenu son 68e congrès annuel du 7 au 10 juillet 2016 à Niagara Ontario. This was the first time that the CVMA held its Falls, en Ontario. Il s’agissait de la première fois que l’ACMV Convention in this destination. Organized in collaboration tenait son congrès à cette destination. Le congrès annuel, qui with the Registered Veterinary Technicians and Technologists était organisé en collaboration avec Technologues et techniciens of Canada (RVTTC), the annual meeting attracted almost vétérinaires agréés du Canada (TTVAC), a attiré près de 1000 participants. 1000 participants. With over 35 speakers from Canada and the United States, Grâce à plus de 35 conférenciers provenant du Canada et des over 100 continuing education (CE) sessions were offered. For États-Unis, plus de 100 ateliers de formation continue ont été the 2nd year, the CVMA submitted the CE sessions for RACE offerts. Pour la deuxième année, l’ACMV a présenté une demande Approval. As a result, DVMs were able to earn a maximum of pour l’approbation des ateliers de formation continue par RACE. 28 CE hours from a selection of 134 RACE-approved hours. Par conséquent, les médecins vétérinaires pouvaient accumuler un The Convention provided an opportunity for many ancillary maximum de 28 heures parmi 134 heures de formation continue groups and organizations to hold meetings onsite including: the approuvées par RACE. RVTTC Board, the Christian Veterinary Missions of Canada, Le congrès a fourni l’occasion à de nombreux groupes et and Pet Secure. Two researchers from the University of Guelph organisations auxiliaires de tenir des réunions sur place, dont asked the CVMA to promote their study and to ask interested le conseil d’administration de TTVAC, Christian Veterinary candidates to sign up for onsite interviews. The response was Missions of Canada et Pet Secure. Deux chercheurs de l’Université positive and they filled all of the available spots. The Atlantic de Guelph ont demandé à l’ACMV de faire la promotion de leur Veterinary College and the Ontario Veterinary College held étude afin de demander à des candidats intéressés de s’inscrire offsite alumni receptions. à des entrevues sur place. La réponse a été positive et toutes les

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CVMA’s Professional Development Committee chose to sup- places ont été comblées. L’Atlantic Veterinary College et l’Ontario port the Niagara Falls Humane Society (NFHS) in recognition Veterinary College ont tenu des réceptions pour les anciens. of their help coordinating cadavers for the wet labs. They had Le Comité du perfectionnement professionnel de l’ACMV a table top that provided an opportunity to receive cash dona- a choisi d’appuyer la Société de protection des animaux de tions as well as products. The CVMA donated the leftover dog Niagara Falls (NFHS) afin de reconnaître sa collaboration pour ANNUAL REPORT ANNUAL leashes from the convention delegate bags, as well as a cooler la coordination des cadavres pour les laboratoires de travaux on wheels used to transport cadavers to the NFHS. In addition, pratiques. L’organisme a installé une table qui lui a donné the Waterloo-Kitchener Humane Society received a gift voucher l’occasion de recueillir des dons en espèces ainsi que des produits. for their support in securing cadavers as well. L’ACMV a fait don du surplus de laisses de chien destinées aux Kruuse donated the supplies for 2 labs and a large stock sacs des délégués ainsi que d’une glacière sur roues qui avait été of supplies were leftover. After consulting with the sponsor, utilisée pour transporter les cadavres à la NFHS. De plus, la the supplies were donated to Dr. Linda Bolton who works Société de protection des animaux de Waterloo-Kitchener a reçu with the Grey Bruce Aboriginal Qimmiq Team. This team of un chèque-cadeau pour son soutien pour l’obtention des cadavres. veterinarians, technicians and health care personnel volunteer Kruuse a fait un don de fournitures pour les deux laboratoires, to provide humane canine population control and community mais il restait un important inventaire de fournitures. Après education in remote and semi-remote First Nations communities consultation avec le commanditaire, les fournitures ont été in northern Ontario. données à la Dre Linda Bolton qui travaille avec l’équipe For the 3rd year, the CVMA Quest game was part of the Grey Bruce Aboriginal Qimmiq. Cette équipe de médecins mobile app to connect participants with each other and with vétérinaires, de techniciens et de bénévoles de soins de santé exhibitors/sponsors. In 2015, 40% of registered delegates played travaillent bénévolement pour offrir un contrôle sans cruauté de the game, whereas in 2016, 46% earned from one to 773 points la population canine ainsi que de l’éducation communautaire dans for app activities. For the first time, the CVMA took advantage les collectivités éloignées et semi-éloignées du Nord de l’Ontario. of the polling feature within the mobile app during the CVMA Le jeu de la Quête de l’ACMV s’est tenu pour la troisième Summit and the CVMA National Issues Forum. Both attempts année et il était intégré à l’appli mobile afin de relier les were successful. participants entre eux et avec les exposants et les commanditaires. The Saturday night “Mardi Gras” social event attracted En 2015, 40 % des délégués inscrits ont joué à ce jeu, tandis que, 210 delegates, and 67 exhibitors. There were diverse food en 2016, 46 % ont accumulé de 1 jusqu’à 773 points dans le cadre stations with local wine pairings. Entertainment included a des activités de l’appli. Pour la première fois, l’ACMV a profité de magician, 4 psychics, a caricaturist and DJ dance music. In la fonction de sondage intégrée à l’appli mobile durant le Sommet cooperation with the CVMA, Veterinarians without Borders de l’ACMV et le Forum sur les enjeux nationaux de l’ACMV. Les conducted a successful silent and live fundraising auction dur- deux tentatives ont été fructueuses. ing the social evening. L’activité sociale «Mardi Gras» du samedi soir a attiré The CVMA is grateful to the 45 sponsors of the Convention, 210 délégués et 67 exposants. Il y avait diverses stations especially the 3 Level 1 sponsors: Bayer Inc., Merial and Virox gastronomiques offrant des vins qui s’accordaient avec les mets. Animal Health. The exhibit hall was filled to capacity with over Les divertissements comprenaient un magicien, quatre voyants, 100 exhibiting companies. un caricaturiste et un DJ avec de la musique pour danser. En collaboration avec l’ACMV, Vétérinaires sans frontières a tenu un encan silencieux en direct réussi durant la soirée sociale. L’ACMV remercie les 45 commanditaires du congrès, particulièrement les trois commanditaires de Niveau 1 : Bayer Inc., Merial et Virox Animal Health. Le salon des exposants était rempli à pleine capacité et a présenté plus de 100 exposants.

CVJ / VOL 58 / JULY 2017 679 FOR PERSONAL USE ONLY Canadian Veterinary Reserve (CVR) Réserve vétérinaire canadienne (RVC) The mandate of the CVMA’s CVR is to provide veterinary La RVC a pour mandat de fournir des ressources vétérinaires surge capacity resources to first-responders in case of large-scale d’appoint aux premiers intervenants dans l’éventualité de emergencies involving animals, in order to address animal health situations d’urgence à grande échelle touchant les animaux and welfare. Typical first responders the CVR would assist are et afin de gérer les enjeux liés à la santé et au bien-être des the CFIA for foreign animal disease outbreaks and provincial animaux. La RVC porterait habituellement assistance à des emergency offices in case of civil emergencies involving animals. premiers intervenants comme l’ACIA pour les maladies animales With 288 reservists, the CVR meets the CFIA’s capacity exotiques et les bureaux de gestion des urgences provinciaux dans

RAPPORT ANNUEL requirements that are at 200. In 2016, the CVR conducted an le cas d’urgences civiles touchant les animaux. annual emergency call-up drill to test the timely responsiveness Grâce à ses 288 réservistes, la RVC satisfait aux besoins de of CVR members and the CVR management and administrative capacité de l’ACIA qui s’établissent à 200 réservistes. En 2016, la processes and procedure involved in executing a call-up. In total, RVC a organisé un exercice de mobilisation d’urgence annuel afin 213 CVR members were called up and 166 (78%) responded. d’évaluer la rapidité de la réponse des membres de la RVC et les Of the respondents, 103 reservists (62%) were available to serve. processus d’administration et de gestion ainsi que la procédure de The CVR was involved with the Public Health Agency of la direction de la RVC lors de l’exécution d’une mobilisation. Au Canada in the Beyond the Border project, coordinating emer- total, 213 membres de la RVC ont été mobilisés et 166 (78 %) gency preparedness and response of the USA and Canada, both, ont répondu. Parmi les répondants, 103 réservistes (62 %) étaient for humans and animals. As an outcome of this project, the disponibles à l’affectation. CVR is now hosting on its Web portal 16 online emergency La RVC a travaillé avec l’Agence de la santé publique du preparedness modules provided by the US Department of Canada dans le cadre du projet Au-delà des frontières afin Health and Human Services. de coordonner la préparation aux situations d’urgence et The CVR Advisory Board comprises representatives from the l’intervention aux États-Unis et au Canada, tant pour les humains Canadian Food Inspection Agency, Public Health Agency of que pour les animaux. À la suite de ce projet, la RVC hébergera Canada, Public Safety Canada, provincial registrars, Provincial maintenant sur son portail Web 16 modules de préparation aux Chief Veterinary Officers, Canadian Council of Emergency situations d’urgence fournis par le Département de la santé et des Management Organizations, Canadian veterinary colleges, services sociaux des États-Unis. Canadian Animal Health Institute, Canadian Animal Health Le Conseil consultatif de la RVC comprend des représentants Coalition, Veterinarians without Borders, non-governmental de l’Agence canadienne d’inspection des aliments, de l’Agence de organizations, the Canadian Veterinary Medical Association, la santé publique du Canada, de Sécurité publique Canada, and the Registered Veterinary Technologists and Technicians of des registraires provinciaux, des médecins vétérinaires en Canada. This structure ensures that key stakeholders are aware chef des provinces, du Conseil canadien des organisations of the capacity of the CVR and help facilitate the integration de gestion des urgences, des collèges de médecine vétérinaire of efforts in case of emergency. canadiens, de l’Institut canadien de la santé animale, de la Coalition canadienne pour la santé des animaux, de Vétérinaires sans frontières, d’organismes non gouvernementaux, de l’Association canadienne des médecins vétérinaires et de Technologues et techniciens vétérinaires agréés du Canada. Cette structure vise à assurer que les principaux intervenants sont au courant de la capacité de la RVC et aident à faciliter l’intégration des efforts advenant une situation d’urgence. 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 In 2016, the CVMA continued its benchmarking program En 2016, l’ACMV a continué d’offrir son programme that included valuable economic and practice management d’évaluation comparative du rendement qui comprenait des tools and resources such as provincial suggested fee guides, outils et des ressources utiles pour la gestion des finances et de compensation and benefits reports for associate veterinarians, la pratique, comme les guides tarifaires suggérés provinciaux,

680 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY non-DVM wage reports, provincial economic reports, and les rapports sur la rémunération et les avantages sociaux des individual practice reports. The data in these reports come vétérinaires salariés, les rapports sur les salaires des employés from the annual economic surveys the CVMA conducts in non-vétérinaires, les rapports économiques provinciaux et les partnership with the provincial veterinary medical associations rapports individuels des pratiques. Les données utilisées pour ces and program co-sponsors, Idexx Laboratories, Petsecure, Merck rapports proviennent des sondages économiques annuels réalisés Animal Health and Scotiabank. par l’ACMV en partenariat avec les associations provinciales de REPORT ANNUAL The CVMA and Association des médecins vétérinaires du médecins vétérinaires et les cocommanditaires de programme Québec en pratique des petits animaux (AMVQ) collaborated Idexx Laboratories, Petsecure, Merck Santé animale et la Banque to deliver the 2016 economic survey of small animal practitio- Scotia. ners in Québec. L’ACMV et l’Association des médecins vétérinaires du Québec In 2016, the CVMA published 6 veterinary practice manage- en pratique des petits animaux (AMVQ) ont collaboré pour la ment articles in The CVJ, which are also posted in the CVMA livraison du sondage économique 2016 auprès des praticiens pour website’s Business Management Program section. petits animaux du Québec. In Niagara Falls, Ontario, the 2016 CVMA Convention’s En 2016, l’ACMV a publié six articles sur la gestion Business Management track, “Future Directions in Veterinary commerciale d’une pratique vétérinaire dans La RVC qui peuvent Medicine,” consisted of 6 50-minute sessions. Dr. Adam Little aussi être consultés dans la section du Programme de la gestion discussed how harnessing technological advancements effectively commerciale du site Web de l’ACMV. opens up new ways to improve patient care while connecting À Niagara Falls, en Ontario, le volet sur la gestion commerciale with pet owners, and Dr. Caleb Frankel introduced the many du congrès 2016 de l’ACMV, «Orientations futures en médecine practical uses of technology in everyday veterinary medicine. vétérinaire», se composait de six ateliers de 50 minutes. Le Provincial veterinary medical associations’ representatives Dr Adam Little a examiné la façon dont une utilisation efficace attended the annual Economic Forum, held during CVMA’s des progrès technologiques permet de créer de nouvelles méthodes Convention, and were provided with the scheduling and deliv- pour améliorer les soins aux patients tout en établissant le contact ery of annual surveys and reports to all members. Participants avec les propriétaires d’animaux et le Dr Caleb Frankel a présenté obtained national data comparisons and discussed potential les nombreuses utilisations pratiques de la technologie dans la improvements to the program and its delivery. médecine vétérinaire quotidienne. Les représentants des associations provinciales de médecins vétérinaires (AMV) ont assisté au Forum économique annuel, qui s’est tenu durant le congrès de l’ACMV et où l’on a présenté un aperçu du calendrier et de la livraison des sondages et des rapports annuels à tous les membres. Les participants ont pris connaissance des comparaisons des données nationales et ont discuté des améliorations potentielles au programme et à sa mise en œuvre.

Health and Wellness of Veterinarians Santé et bien-être des médecins vétérinaires

In September 2016, the CVMA created a new Veterinarian En septembre 2016, l’ACMV a créé une nouvelle section du Health and Wellness Resources web section. The CVMA site Web sur la Santé et le bien-être des vétérinaires. Le Groupe Wellness Advisory Group researched and identified a collection consultatif sur le bien-être de l’ACMV a effectué des recherches of web-based resources to help veterinarians better understand et a identifié une collection de ressources Web afin d’aider les and manage their health and well-being. These resources are vétérinaires à mieux comprendre et gérer leur santé et leur bien- categorized under 3 key areas: Emotional and mental health, être. Ces ressources se classent dans trois grands domaines : Santé Physical health, and Veterinarian wellness. For easy access, a mentale et bien-être psychologique, Santé physique et Bien-être rotating banner pointing directly to the wellness entry page is des vétérinaires. Pour un accès facile, une bannière rotative permanently placed on the CVMA homepage. Resources con- pointant directement vers la page du bien-être a été placée de tinue to be added as they are identified. façon permanente sur la page d’accueil de l’ACMV. Des ressources Under the CVMA Insurance Program, employees enrolled in continueront d’être ajoutées au fur et à mesure qu’elles seront the group health benefits plan have access to professional referral identifiées. services and employee assistance services offered as an optional En vertu du Programme d’assurance de l’ACMV, les employés added benefit of the plan. inscrits au régime d’avantages sociaux de groupe ont accès à des The CVMA undertook a survey of provincial veterinary services professionnels spécialisés et à des services d’assistance aux associations and regulatory bodies to obtain information about employés offerts en tant qu’avantage supplémentaire du régime.

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their respective provincial member wellness programs, the types L’ACMV a effectué un sondage auprès des associations of services offered, the cost to offer such programs, and some provinciales de médecins vétérinaires et des organismes de aggregate usage statistics. The information received was com- réglementation afin d’obtenir des renseignements à propos piled and shared with the respondents. This action item was an des programmes de bien-être des membres provinciaux outcome of the 2016 Provincial Forum discussions and this issue respectifs, du type de services offerts, du coût de la prestation will be brought forward for further discussion again in 2017. de ces programmes ainsi que d’obtenir certaines statistiques A full-day Mind-Body Medicine workshop, presented by d’utilisation globales. Les renseignements reçus ont été compilés Dr. Allen Schoen, was offered as an add-on session to the 2016 et communiqués aux répondants. Cette mesure de suivi a découlé CVMA Convention program. The CVMA also made space des discussions tenues lors du Forum provincial 2016 et cette available for the Ontario Veterinary College AWAR2E research question a de nouveau été reportée en 2017 afin de tenir de group (Advancement of Wellness and Resilience in Research and nouvelles discussions. RAPPORT ANNUEL Education) to conduct on-site interviews to understand factors Un Atelier sur la médecine corps et esprit d’une journée affecting the mental well-being of veterinarians, with the goal complète, qui a été présenté par le Dr Allen Schoen, a été offert of developing training and other support programs for both comme atelier complémentaire dans le cadre du programme du veterinary students and practicing veterinarians. congrès 2016 de l’ACMV. L’ACMV a aussi réservé une place au groupe de recherche AWAR2E (Advancement of Wellness and Resilience in Research and Education) de l’Ontario Veterinary College afin de réaliser des entrevues sur place pour mieux comprendre les facteurs affectant le bien-être des vétérinaires dans le but de mettre au point de la formation et d’autres programmes de soutien pour les étudiants en médecine vétérinaire et les vétérinaires praticiens.

CVMA Web Store Program — “MyVetStore.ca” Programme de boutique Web de l’ACMV — «MaVitrineVétérinaire.ca»

In 2016, the CVMA added 16 member clinics to the CVMA En 2016, l’ACMV a ajouté 16 cliniques membres au Programme Web Store Program. Sales from month to month show a steady de boutique Web de l’ACMV. Les données mensuelles indiquent increase and some clinics have introduced the wellness plan une augmentation constante et certaines cliniques ont introduit billing module. Only clients who have registered have access le module de facturation pour le plan de bien-être. Seulement les to your web store; the web store is branded to your practice; clients que vous avez inscrits auront accès à votre boutique Web; la you control which products are available, pricing, and any/all boutique Web affiche le logo de votre pratique; vous contrôlez les prescription products and therapeutic diets; prices are auto- produits offerts, les prix ainsi que tous les produits sur ordonnance matically updated based on your markup over cost; unlimited et les diètes thérapeutiques; les prix sont automatiquement mis training and support are provided to staff. The CVMA Web à jour en fonction de votre majoration par rapport au coût; et Store Program is configured to meet the respective provincial une formation et un soutien illimités sont offerts aux employés. veterinary regulations and guidelines and is available to practices Le Programme de boutique Web de l’ACMV est configuré owned in whole/in part by CVMA members for whom CVMA de manière à satisfaire aux lignes directrices et aux règlements has negotiated the most favorable financial terms. MyVetStore.ca provinciaux respectifs et il est offert aux pratiques appartenant is powered by Acumenex. partiellement ou entièrement à des membres de l’ACMV et pour lesquels l’ACMV a négocié les conditions financières les plus favorables. MaVitrineVétérinaire est optimisé par Acumenex.

682 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Group Insurance Program Programme d’assurance de groupe

Professional Liability and Commercial “Protected Programme de responsabilité professionnelle et ANNUAL REPORT ANNUAL Self-Insurance” Program (PSIP) d’assurance auto-protégée commerciale In 2016, 1487 practices were insured, with 106 new policy loca- En 2016, 1487 pratiques étaient assurées et 106 nouvelles polices tions added. The PSIP model is the greatest selling feature and ont été ajoutées. Le modèle de l’assurance auto-protégée est le members save an average of 10% when joining. Participants are principal avantage offert et les membres économisent en moyenne provided comprehensive policies tailored to their specific busi- 10 % lors de la souscription d’une nouvelle police. On offre ness exposures and the proven rate stability differentiates the aux participants des polices complètes conçues spécifiquement CVMA program from competing products in the marketplace. pour répondre aux risques présentés par leur entreprise et c’est la stabilité éprouvée des primes qui distingue le programme de Employee Group Benefits Program (EGBP) l’ACMV de celui de ses concurrents. In 2016, participation increased by 15%. The EGBP offers flexible options for health and dental coverage, life insurance, Programme collectif d’avantages sociaux pour les accidental death and dismemberment, and disability. Optional employés wellness benefits such as professional referral and counseling En 2016, la participation a augmenté de 15 %. Ce programme services for insured members and family members, and busi- offre des options flexibles en matière de protection d’assurance ness assistance and coaching for the practice are also available. maladie et dentaire, d’assurance vie, d’assurance en cas de décès et Insured clinics benefit from the rate stability generated by de mutilation par accident et d’assurance invalidité. Des avantages spreading claims over the entire TotalGUARDTM/CVMA pool. facultatifs relatifs au bien-être, comme les services d’aiguillage Other insurance solutions available include: Affinity program, professionnel et le counseling pour les membres assurés et les veterinary student & graduate program, personal automobile, membres de la famille, ainsi qu’une assistance et un encadrement home and travel insurance. The CVMA Insurance Program is d’affaires pour la pratique sont également offerts. Les cliniques available exclusively to CVMA members. assurées profitent de la stabilité des tarifs assurée par l’étalement des réclamations sur l’ensemble du bassin TotalGUARDMD/ACMV. Les autres solutions d’assurance disponibles incluent : le programme Affinité, le programme d’assurance pour étudiants et diplômés et l’assurance automobile, habitation et voyage. Le Programme d’assurance de l’ACMV est offert exclusivement aux membres de l’ACMV.

Initiatives for Early Career DVMs Initiatives pour les vétérinaires en début de carrière

The CVMA has developed initiatives to support new veterinar- L’ACMV a élaboré des initiatives afin d’appuyer les nouveaux ians, help meet their personal and professional needs, and ease vétérinaires et de répondre à leurs besoins personnels et financiers their financial burden as they settle in their new profession. tandis qu’ils s’installent dans leur nouvelle profession.

Membership dues reduction Réduction de la cotisation A new fee structure adopted in 2016 provides new graduates Une nouvelle structure de cotisation adoptée en 2016 permet aux with a complimentary membership for the remainder of the finissants d’obtenir une adhésion gratuite pour le reste de l’année year in which they graduated. Individuals who maintain unin- au cours de laquelle ils ont obtenu leur diplôme. Les personnes terrupted membership after graduation throughout a consecu- qui conservent une adhésion ininterrompue après la fin des études tive 3-year period are eligible for a 75%–50%–25% tiered fee pendant une période consécutive de trois années sont admissibles reduction. Members in their first year following graduation à une réduction progressive de la cotisation de 75 %–50 %–25 %. also receive a complimentary Convention registration — a De plus, dans l’année suivant l’obtention du diplôme, les membres great opportunity to enhance their skills and knowledge at the ont droit à une inscription gratuite au congrès, ce qui représente CVMA Convention. une excellente occasion de perfectionner leurs compétences et leurs connaissances au congrès de l’ACMV. CVMA Mentoring Program In 2016, 36 mentors and 10 mentees were registered in the Programme de mentorat de l’ACMV program. This program is open to CVMA members. Profiles En 2016, 36 mentors et 10 mentorés étaient inscrits au of volunteer mentors are included in a roster on the CVMA programme. Ce programme est ouvert aux membres de

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website. Mentees can self-search a potential mentor and initiate l’ACMV. Les profils des mentors bénévoles sont inclus dans communication directly whenever they are ready to do so. A une liste affichée sur le site Web de l’ACMV. Les mentorés mentoring guide and FAQs are available online to help prospec- peuvent chercher eux-mêmes un mentor éventuel et initier la tive mentors and mentees. communication directement lorsqu’ils sont prêts à commencer. In July, the CVMA participated in a meeting to learn about Un guide de mentorat et une FAQ sont disponibles en ligne afin the Western College of Veterinary Medicine’s (WCVM) new d’aider les nouveaux mentors et les mentorés. Mentee Skills Building Program. The CVMA and WCVM En juillet, l’ACMV a participé à une réunion pour se renseigner are collaborating to further leverage these 2 programs and à propos du nouveau programme de création de compétences des strengthen the impact of mentorship efforts to benefit the mentorés du Western College of Veterinary Medicine’s (WCVM). profession. L’ACMV et le WCVM collaborent afin de mettre ces deux programmes à contribution ainsi que d’accroître l’impact de notre RAPPORT ANNUEL What Can’t Be Taught articles travail de mentorat pour renforcer la profession. A series of articles, written by members of the CVMA Emerging Leaders Network, provide insight into the first years in practice Articles Ce qui ne s’enseigne pas and offer some advice from someone “who’s been there.” Five Une série d’articles, rédigés par les membres du Réseau des articles were submitted and published in The CVJ in 2016. futurs leaders de l’ACMV, permet de jeter un coup d’œil sur les The articles were also posted on the member website in the premières années de pratique et offre des conseils provenant de Mentoring Resources section. personnes qui ont déjà vécu ces types de situations. Cinq articles ont été soumis et publiés dans La RVC en 2016. Les articles ont CVMA Emerging Leaders Program (ELP) aussi été affichés sur le site Web des membres dans la section des In its 7th year, the 2016 CVMA Emerging Leaders Program Ressources de mentorat. welcomed 34 participants from across Canada. The participants included 19 selected ELP candidates sponsored by CVMA/ Programme des futurs leaders (PFL) de l’ACMV VMAs; 5 students sponsored by CVMA, as well as the program Le Programme des futurs leaders 2016, qui en était à sa septième chair, and 8 paid participants. Once again, the program was année, a accueilli 34 participants de toutes les régions du Canada. facilitated by Dr. Rick DeBowes; after the program all par- Les participants incluaient 19 candidats du PFL commandités par ticipants had lunch with guest speaker, Dr. Jonathan Bloom, l’ACMV/AMV; cinq étudiants commandités par l’ACMV, ainsi who discussed reducing the fear in pets during veterinary visits. que la présidente du programme et huit participants payants. De The ELP is a highly interactive 8-hour workshop spread across nouveau, le programme a été animé par le Dr Rick DeBowes; 2.5 days during which participants gain insight into how best to après le programme, tous les participants ont déjeuné avec le lead themselves as individuals, how to communicate with those conférencier invité, le Dr Jonathan Bloom, qui a parlé des façons around them, and ultimately how this knowledge will better de réduire la peur des animaux de compagnie durant les visites prepare them to lead those around them. chez le vétérinaire. Le PFL est un atelier hautement interactif d’une durée de huit heures réparties sur une journée et demie Early Career DVM Resource Hub durant lequel les participants apprennent comment devenir de To support early career DVMs and help set them on the path to meilleurs leaders en tant que personnes, comment communiquer a successful career, the CVMA created a dedicated website sec- avec les personnes qui les entourent et comment ces connaissances tion containing useful information, tools and resources related leur permettront d’être mieux préparés à diriger les personnes to financial planning and budgeting, communications and autour d’eux. career development. Some examples of these tools and resources include student loan repayment estimators, a budgeting app Carrefour des ressources pour les vétérinaires en for mobile devices, guidelines for successful employment, and début de carrière instructional communications videos. Additional resources were Afin de mieux appuyer les vétérinaires en début de carrière et added throughout the year. de faciliter le lancement d’une carrière prospère, l’ACMV a créé une section réservée du site Web contenant des renseignements utiles, des outils et des ressources portant sur la gestion du budget et des finances personnelles, les communications et l’évolution de carrière. Ces outils et ces ressources incluent notamment des calculatrices pour le remboursement des prêts étudiants, une appli de budgétisation pour les appareils mobiles, des directives pour l’emploi des finissants et des vidéos éducatives sur la communication. Des ressources additionnelles ont été ajoutées pendant l’année.

684 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY VALUE OF MEMBERSHIP VALEUR DE L’ADHÉSION Membership Effectif

As the national professional association, the CVMA is a power- À titre d’association professionnelle nationale, l’ACMV est une

ful, unified voice for Canada’s veterinarians. Our strength is in voix puissante et unie pour les vétérinaires du Canada. Notre REPORT ANNUAL sharing veterinary science and knowledge, influencing policy force repose sur le partage de la science et des connaissances decisions that matter most to the profession, and providing vétérinaires, la capacité d’influencer les décisions politiques les services and resources to help meet the needs of veterinarians. plus importantes pour la profession ainsi que la prestation de In 2016, 7287 veterinarians and veterinary student members services et de ressources afin d’aider à répondre aux besoins des supported the CVMA’s work and leadership. vétérinaires. En 2016, 7287 vétérinaires et membres étudiants ont The CVMA is always looking to deliver more value to appuyé le travail et le leadership de l’ACMV. members to increase their profitability and professional suc- L’ACMV recherche toujours de nouvelles façons d’offrir plus cess. Members can take advantage of the broadest suite of ben- de valeur aux membres afin d’accroître leur rentabilité et leur efits available, including practice tools and resources, Position succès professionnel. Les membres peuvent profiter du plus vaste Statements and research, continuing education, powerful advo- éventail d’avantages offerts, dont des outils et des ressources cacy, and a wide array of discounts and savings on important pour la pratique, des énoncés de position et de la recherche, de products and services to help support veterinarians and the la formation continue, une puissante défense des intérêts ainsi practice team. qu’une vaste gamme de rabais et de réductions sur des produits Below are some of the member benefits and services that et des services importants afin d’aider à appuyer les vétérinaires were introduced in 2016. A full listing of all available member et l’équipe de la pratique. benefits is published in this issue of The CVJ (page 668). Voici quelques-uns des nouveaux avantages et services aux CVMA Online Education Portal: Powered by the World membres qui ont été introduits en 2016. Une liste complète de Veterinary Association, this global network of education tous les avantages aux membres est publiée dans le présent numéro resources from veterinary experts and top provider institutions de La RVC (page 668). from around the world offer over 600 free CE courses and over Portail d’éducation en ligne de l’ACMV : Optimisé par 450 paid courses to CVMA members. l’Association mondiale vétérinaire, ce réseau mondial de ressources Veterinarian Health and Wellness Resources: The CVMA de formation provenant d’experts vétérinaires et d’établissements created this new section on the CVMA website. There you d’enseignement internationaux de haut calibre offre plus de can find pertinent resources and information from numerous 600 cours de formation continue gratuits et plus de 450 cours sources to help support the personal well-being of veterinarians payants aux membres de l’ACMV. and veterinary students, with a focus on education, awareness Santé et bien-être des vétérinaires : L’ACMV a créé cette and prevention. nouvelle section sur le site Web de l’ACMV. Vous pourrez y Early Career DVM Hub: To help recent veterinary graduates trouver des ressources et des renseignements pertinents provenant on their path to a successful career, the CVMA has created a de plusieurs sources permettant de soutenir le bien-être personnel dedicated section of the website that contains resources compiled des vétérinaires et des étudiants en médecine vétérinaire tout en specifically to support early career veterinarians in the areas of insistant sur l’éducation, la sensibilisation et la prévention. financial planning and budgeting, communication, and career Carrefour des ressources pour les vétérinaires en début development. de carrière : Afin d’aider les diplômés récents à entamer une Career and Business Toolkit: This new web section of the carrière prospère, l’ACMV a créé une nouvelle section réservée business management program provides veterinarians easy access du site Web qui contient des ressources compilées spécifiquement to pertinent online resources and information on financial and afin d’appuyer les vétérinaires en début de carrière dans les practice management, human resources management, and mar- domaines de la gestion du budget et des finances personnelles, de keting and communications. la communication et de l’évolution de la carrière. Trousse d’outils pour la carrière et les affaires : Cette nouvelle section du site Web du Programme de gestion commerciale permet aux vétérinaires d’avoir facilement accès à des ressources et à des renseignements en ligne pertinents sur la gestion des finances et de la pratique, la gestion des ressources humaines et le marketing et les communications.

CVJ / VOL 58 / JULY 2017 685 FOR PERSONAL USE ONLY 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) represents over 1600 DVM students from the vétérinaires (ACMV) représentent plus de 1600 étudiants en 5 Canadian veterinary colleges. médecine vétérinaire dans les cinq collèges de médecine vétérinaire The successful, student-run 2016 SCVMA Symposium, du Canada. held January 15–16, 2016 at the Ontario Veterinary College in Le Symposium 2016 des ÉACMV, un événement réussi qui a Guelph, had 270 students in attendance. été organisé par les étudiants, a compté 270 participants étudiants The SCVMA conducted its annual New Graduate Survey, et s’est déroulé les 15 et 16 janvier 2016 à l’Ontario Veterinary RAPPORT ANNUEL gathering useful data for future veterinary graduates and the College à Guelph. profession. The survey report was published in The CVJ’s March Les ÉACMV ont réalisé leur sondage annuel auprès des issue and posted in the SCVMA website section. finissants afin de recueillir des renseignements utiles pour les The SCVMA received the annual VetRap student newsletter, futurs diplômés en médecine vétérinaire et la profession. Les featuring articles from each college, and 2 student e-newsletters. résultats ont été publiés dans le numéro de mars de La RVC et Throughout the year, the SCVMA Facebook group provides ils ont aussi été affichés dans la section des ÉACMV du site Web information updates. de l’ACMV. First-year students received CVMA-branded lab coats and Les membres des ÉACMV ont reçu le bulletin étudiant annuel name badges during each college’s welcome ceremony and the VetRap qui contient des articles provenant de chacun des collèges CVMA and Teacher of the Year Awards were presented at their ainsi que deux cyberbulletins étudiants. Pendant l’année, le groupe awards ceremony. Facebook des ÉACMV présentent aussi des mises à jour. In the fall at each college, a CVMA Council representative Les étudiants de première année ont reçu leurs sarraus et and the SCVMA Committee representative gave the CVMA des insignes d’identité affichant le logo de l’ACMV lors de One Voice presentation, introducing students to the CVMA la cérémonie d’accueil tenue à chacun des collèges et les Prix and led a current animal welfare or national veterinary issue de l’ACMV et les Prix de l’enseignant de l’année ont aussi été discussion. décernés lors d’une cérémonie de remise des prix. In the winter at each college, CVMA’s insurance partner, À l’automne, à chaque collège, un représentant du Conseil de Western Financial Group Insurance Solutions, presented l’ACMV et le représentant du Comité des ÉACMV ont donné la an overview of career insurance risks students may face and présentation Une voix de l’ACMV afin d’introduire les étudiants explained available insurance products and coverages. à l’ACMV et de mener une discussion sur une question de In 2016, the CVMA continued the international student l’heure portant sur le bien-être animal ou les enjeux vétérinaires affiliation program and had 3 participating schools, St. George’s nationaux. University — School of Veterinary Medicine; College of En hiver, à chaque collège, le partenaire d’assurance de Veterinary Medicine — Western University of Health Sciences; l’ACMV, Western Financial Group Insurance Solutions, a organisé and the School of Veterinary and Life Sciences — Murdoch une présentation sur l’assurance afin de donner aux étudiants un aperçu des risques d’assurance auxquels ils pourront faire face durant leur carrière et d’expliquer les divers produits et couvertures d’assurance offerts. En 2016, l’ACMV a poursuivi son programme d’affiliation des étudiants internationaux et elle comptait trois écoles participantes : École de médecine vétérinaire de l’Université St. George’s, Collège de médecine vétérinaire de Western University of Health Sciences et School of Veterinary and Life Sciences de l’Université Murdoch, pour un total de 58 membres affiliés étudiants en médecine vétérinaire. L’ACMV a introduit ce programme il y a quelques années à la demande du doyen d’un collège vétérinaire international et de ses étudiants canadiens. Le premier Atelier de leadership étudiant (ALE) des ÉACMV s’est tenu à la Faculté de médecine vétérinaire (FMV) de l’université de Montréal le 12 novembre 2016 et comptait près de 60 participants étudiants. Cet atelier interactif, qui était animé par Dr. Michele Guerin (right) presented the Ontario Veterinary College’s CVMA Award recipient, le Dr Rick DeBowes, s’intitulait : «Programmation du leadership Ms. Laura Omeljaniuk, with a commemorative plaque. expérientiel : La première étape pour tirer le meilleur de nous- La Dre Michèle Guérin (à droite) a présenté une plaque commémorative à Mme Laura Omeljaniuk, mêmes» et a offert des stratégies personnelles pour l’évolution de la récipiendaire du Prix de l’ACMV de l’Ontario Veterinary College. carrière qui peuvent ne pas être enseignées à l’école.

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University, totaling 58 veterinary student affiliate members. Groupe consultatif de liaison avec les étudiants The CVMA introduced this program a few years ago at the Le Groupe consultatif de liaison avec les étudiants de l’ACMV request of the dean of an international veterinary college and représente l’ACMV à chacun des cinq collèges de médecine his Canadian students. vétérinaire canadiens afin de renforcer le lien entre l’ACMV et ses The first annual SCVMA Student Leadership Workshop membres étudiants. Le groupe consultatif, qui se compose d’un ANNUAL REPORT ANNUAL (SLW), held at the University of Montreal’s Faculté de médecine professeur provenant de chacun des collèges, guide le représentant vétérinaire (FMV) on November 12, 2016, had almost 60 stu- du Comité des ÉACMV dans chaque collège et participe aussi dent participants. This interactive workshop, led by Dr. Rick à des initiatives annuelles de l’ACMV, dont la présentation DeBowes, titled, “Experiential Leadership Programming: The Une voix, la cérémonie des sarraus et le Symposium des ÉACMV. First Step in Being Our Best Selves,” offered personal and career development strategies students may not learn in school.

Student Liaison Advisory Group The CVMA Student Liaison Advisory Group (SLAG) represents the CVMA at each of the 5 Canadian veterinary colleges, strengthening the CVMA and veterinary student link. The SLAG, comprised of one faculty member from each college, guides their college’s SCVMA Committee representative and participates in annual CVMA initiatives including the One Voice presentation, lab coat ceremony, and the SCVMA Symposium.

Students of the CVMA participating in the canine abdominal ultrasound wet lab during the 2016 SCVMA Symposium held at the Ontario Veterinary College. Les étudiants de l’ACMV participant au laboratoire d’échographie abdominale canine lors du Symposium 2016 des ÉACMV tenu à l’Ontario Veterinary College.

The Ontario Veterinary College’s Class of 2020 wearing their CVMA branded lab coats. La promotion 2020 de l’Ontario Veterinary College portant le sarrau de l’ACMV.

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Policy and Advocacy Politiques et défense des intérêts The CVMA-Society of British Columbia Veterinarians Chapter La Section de l’ACMV-Society of British Columbia Veterinarians has expanded its committee structure to include an enhanced a élargi sa structure des comités afin d’inclure un Comité de Continuing Education (CE) Committee, and enhanced Editorial formation continue amélioré, un Comité de la rédaction amélioré Committee, and the new Animal Welfare Committee. et le nouveau Comité sur le bien-être animal. The CE Committee delivers excellent CE close to home. Le Comité de la formation continue offre une excellente We’ve increased the number of members of this committee formation continue dans la région. Nous avons augmenté le RAPPORT ANNUEL to also include a non-veterinarian industry person. The Fall nombre de membres de ce comité afin d’inclure une personne Conference, in response to member requests, will increase to non-vétérinaire de l’industrie. Notre Conférence d’automne, provide 15 CE hours, rather than 12, so members can earn their en réponse aux demandes des membres, sera élargie afin d’offrir required number of CE hours at one event. The Fall Conference 15 heures de formation continue, au lieu de 12 heures, afin que also consulted industry supporters personally in 2016 and as a les membres puissent accumuler le nombre requis d’heures de result will include a larger, better-placed trade show in 2017. formation continue à un événement. La Conférence d’automne We also began planning, in 2016, 2 regional CE sessions, both a aussi consulté personnellement les partenaires de l’industrie en sponsored and programmed by Cat Healthy. They are scheduled 2016 et, en conséquence, l’édition 2017 présentera un salon des for mid-May 2017 with one in Langley, to service the Metro exposants élargi et amélioré. En 2016, nous avons aussi commencé Vancouver and Fraser Valley veterinary communities, and la planification de deux ateliers de formation continue régionaux, one in Victoria, to service the Mid-Island and South Island qui sont tous deux commandités et élaborés par Cat Healthy. Ils communities. sont prévus pour la mi-mai 2017 et un atelier se tiendra à Langley The Editorial Committee, in 2016, partnered with the afin de desservir la région de Vancouver et des collectivités de la University of British Columbia’s (UBC) Animal Welfare pro- vallée du Fraser, et l’autre à Victoria, pour desservir les collectivités gram to include a regular column in the chapter’s journal written dans le centre et le sud de l’île. by UBC faculty. Also included are an RVT-written column and a En 2016, le Comité de la rédaction a aussi formé un partenariat Wildlife column. We continue to attract excellent contributions avec le programme de bien-être animal de l’Université de la expanding veterinarians’ interests and knowledge base. Colombie-Britannique (UBC) afin d’inclure une rubrique régulière The Animal Welfare Committee was struck, in principle, dans la revue de la Section qui sera rédigée par un professeur de in 2016, and issued its call for members (which garnered high l’université. On inclura aussi une rubrique rédigée par un TVA support at the Fall Conference). The Committee will set its et un article sur la faune. Nous continuons d’attirer d’excellents work plan and focus on topics that do not conflict with the articles afin d’élargir les intérêts et les connaissances des vétérinaires. CVMA Animal Welfare Committee activities, but are also not Le Comité sur le bien-être animal a été formé en principe constrained by national issues. en 2016, et il a lancé un appel pour recruter des membres (qui a recueilli un niveau de soutien élevé lors de la Conférence Science and Knowledge d’automne). Le comité s’apprête à rédiger son plan de travail et à We continue to attract renowned experts at both our Fall se concentrer sur des sujets qui n’entreront pas en conflit avec les Conference and our Delta Equine Seminar. In 2016, Chapter activités du Comité sur le bien-être animal de l’ACMV, mais qui members learned from these speakers: Dr. Marie Kerl on ne sont pas aussi limités par des enjeux nationaux. Emergency and Critical Care; Dr. Kenneth Martin on Pet Behavior; Dr. Peter Gordon on Neurology; Dr. Tammy Owens Science et connaissances on Pet Nutrition; with concurrent behavioral sessions from Nous continuons d’attirer des experts reconnus lors de notre Debbie Martin, LVT; and Dr. Tracy Turner and Dr. Joe Conférence d’automne et de notre Colloque équin de Delta. En Bertone on equine lameness and equine internal medicine. 2016, les membres de la Section ont fait l’acquisition de nouvelles connaissances auprès des conférenciers suivants : Dre Marie Kerl Practice and Economics sur les soins d’urgence et critiques; Dr Kenneth Martin sur le The Chapter continues to encourage member participation in comportement des animaux de compagnie; Dr Peter Gordon sur salary surveys and other economic reports done through the la neurologie; Dre Tammy Owens sur la nutrition des animaux de CVMA, and we promote these as a key benefit of membership. compagnie; ainsi que lors d’ateliers parallèles sur le comportement offerts par Debbie Martin, LVT; et Dre Tracy Turner et Dr Joe Bertone sur la boiterie équine et la médecine interne équine.

Pratique et finances La Section continue d’encourager la participation des membres aux sondages sur les salaires et d’autres rapports économiques réalisés par l’entremise de l’ACMV et nous faisons la promotion de ces programmes en tant que des avantages clés de l’adhésion.

688 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY SETTING STANDARDS Veterinary Technicians and Technologists ÉTABLISSEMENT DE NORMES Techniciens et technologues vétérinaires REPORT ANNUAL

The CVMA’s Animal Health Technologist/Veterinary Technician Le Comité d’agrément des programmes de technologie en Program Accreditation Committee (AHTVTPAC) is responsible santé animale et de techniques vétérinaires (CAPTSATV) est for accrediting veterinary technician training programs that responsable de l’agrément des programmes de formation des meet the minimum standards for educating and training quali- techniciens vétérinaires qui satisfont aux normes minimales pour fied personnel who may join the veterinary health care team. l’éducation et la formation d’un personnel qualifié qui pourra Graduates of such accredited programs benefit by having their faire partie de l’équipe de soins vétérinaires. Les diplômés de ces competence recognized and prospects for employment and programmes agréés profitent du fait que leur compétence est mobility enhanced and the veterinary team benefits from well reconnue et que leurs perspectives d’emploi et de mobilité sont trained technicians and technologists. améliorées et l’équipe vétérinaire profite de techniciens et de The CVMA maintains a reciprocity agreement with the technologues bien formés. American Veterinary Medical Association that allows for the L’ACMV maintient une entente de réciprocité avec l’American mutual recognition of our respective accreditation processes. Veterinary Medical Association qui permet la reconnaissance In 2016, site visits to Northern College, Vanier College, mutuelle de nos processus d’agrément respectifs. Oulton College and Seneca College took place. En 2016, des inspections ont eu lieu au Northern College, The 19 accredited programs in Canada are: à Vanier College, à Oulton College et à Seneca College. • Algonquin College, Ottawa, Ontario Les 19 programmes agréés au Canada sont les suivants : • Dalhousie University (formerly Nova Scotia Agricultural • Algonquin College, Ottawa (Ontario) College), Truro, Nova Scotia • Douglas College, New Westminster (Colombie-Britannique) • Douglas College, New Westminster, British Columbia • Georgian College, Orillia (Ontario) • Georgian College, Orillia, Ontario • Grand Prairie Regional College, Fairview Campus, Fairview • Grand Prairie Regional College, Fairview Campus, (Alberta) Fairview, Alberta • Lakeland College, Vermilion (Alberta) • Lakeland College, Vermilion, Alberta • Maritime Business College, Dartmouth (Nouvelle-Écosse) • Maritime Business College, Dartmouth, Nova Scotia • Northern Alberta Institute of Technology, Edmonton • Northern Alberta Institute of Technology, Edmonton, (Alberta) Alberta • Northern College, Haileyburg (Ontario) • Northern College, Haileyburg, Ontario • Olds College (sur le campus et téléapprentissage), Olds • Olds College (on-campus and distance learning), Olds, (Alberta) Alberta • Oulton College, Moncton (Nouveau-Brunswick) • Oulton College, Moncton, New Brunswick • Red River College, Winnipeg (Manitoba) • Red River College, Winnipeg, Manitoba • St. Clair College, Windsor (Ontario) • St. Clair College, Windsor, Ontario • St. Lawrence College, Kingston (Ontario) • St. Lawrence College, Kingston, Ontario • Saskatchewan Institute of Science and Technology, Saskatoon • Saskatchewan Institute of Science and Technology, (Saskatchewan) Saskatoon, Saskatchewan • Seneca College, King City (Ontario) • Seneca College, King City, Ontario • Université Dalhousie (anciennement Nova Scotia Agricultural • Thompson Rivers University (on-campus and distance College), Truro (Nouvelle-Écosse) learning), Kamloops, British Columbia • Université de Guelph, Campus Ridgetown (sur le campus et • University of Guelph, Ridgetown Campus (on-campus téléapprentissage), Ridgetown (Ontario) and distance learning), Ridgetown, Ontario • Université Thompson Rivers (sur le campus et • Vanier College, St-Laurent, Quebec téléapprentissage), Kamloops (Colombie-Britannique) • Vanier College, Saint-Laurent (Québec)

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The National Examining Board (NEB) is the first point of Le Bureau national des examinateurs (BNE) est le premier point contact for foreign-trained veterinarians wishing to practice de contact pour les vétérinaires formés à l’étranger qui désirent veterinary medicine in Canada. Passing the NEB exams and exercer la médecine vétérinaire au Canada. La réussite des examens obtaining a Certificate of Qualification (CQ) allows them to du BNE et l’obtention du Certificat de compétence (CC) leur apply for a license in any Canadian province. permet de présenter une demande de permis dans une province The NEB works closely with its counterparts in the United canadienne. States, namely the Educational Commission for Foreign Le BNE travaille en étroite collaboration avec ses homologues RAPPORT ANNUEL Veterinary Graduates (ECFVG) and International Council of aux États-Unis, notamment l’Educational Commission for Voluntary Agencies (ICVA), to ensure that the examination Foreign Veterinary Graduates (ECFVG) et l’International Council process is fair and relevant. of Voluntary Agencies (ICVA), afin de veiller à ce que le processus d’examen soit juste et pertinent. NEB Examination Process The NEB started administering the Preliminary Surgical Processus d’examen du BNE Assessment (PSA) for the Clinical Proficiency Exam (CPE) in Le BNE a commencé à administrer l’Évaluation chirurgicale 2016. This new step in the examination process is a mandatory préliminaire (ECP) pour l’Examen de compétences cliniques step for all candidates taking the CPE after January 1, 2017. It (ECC) en 2016. Cette nouvelle étape du processus d’examen has been developed to ensure candidates can demonstrate basic est obligatoire pour tous les candidats subissant l’ECC après le surgical techniques as a prerequisite for CPE registration. The 1er janvier 2017. Elle a été conçue afin d’assurer que les candidats first regular PSA sessions were offered at WCVM Saskatoon in puissent démontrer des techniques chirurgicales de base comme June and September and AVC in Charlottetown in October and préalable à l’inscription à l’ECC. Les premières séances régulières 21 NEB candidates took this new assessment in 2016. de l’ECP ont été offertes en juin au WCVM, à Saskatoon, et en In 2016 the NEB accepted applications from 258 new octobre à l’AVC, à Charlottetown, et 21 candidats du BNE ont candidates and issued 471 certificates of qualification (CQs) subi cette nouvelle évaluation en 2016. (338 Canadian students, 52 graduates from AVMA-accredited En 2016, le BNE a accepté des demandes provenant de veterinary schools, 81 graduates of non-accredited veterinary 258 nouveaux candidats et a émis 471 certificats de compétence schools). (CC) (338 à des étudiants canadiens, 52 à des diplômés des écoles de médecine vétérinaire agréées par l’AVMA, 81 à des diplômés d’écoles de médecine vétérinaire non agréées).

Members of the NEB evaluate an artificial skin sample for potential use in the NEB exams. Les membres du BNE évaluent un échantillon de peau artificielle en vue d’une utilisation éventuelle lors des examens du BNE.

690 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Veterinary College Accreditation Agrément des collèges de médecine vétérinaire

The CVMA, in collaboration with the American Veterinary L’ACMV, en collaboration avec l’American Veterinary Medical ANNUAL REPORT ANNUAL Medical Association — Council on Education, is accrediting Association — Council on Education, procède à l’agrément des university programs designed to educate students to become programmes universitaires conçus pour enseigner la médecine veterinarians. All Canadian veterinary colleges are AVMA/ vétérinaire aux étudiants. Tous les collèges de médecine vétérinaire CVMA-COE accredited. canadiens sont agréés par l’AVMA/ACMV-COE. In 2016 AVMA/CVMA-COE site visits were conducted at: En 2016, des inspections de l’AVMA/ACMV-COE ont été • University of Arizona réalisées dans les établissements suivants : • Tuskegee University • Université d’Arizona • Murdoch University (Perth, Australia) • Université Tuskegee • University of Pennsylvania • Université Murdoch (Perth, Australie) • Université de Pennsylvanie

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RAPPORT DES AUDITEURS INDÉPENDANTS

RAPPORT ANNUEL INDEPENDENT AUDITORS’ REPORT Aux membres de To the Members, L’Association canadienne des médecins vétérinaires: 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 statements of financial financière au 31 décembre 2016, et les états des revenus et dépenses, de position as at December 31, 2016, and the statement 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 financiers that are free from material misstatement, whether due to fraud or error. 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. Opinion Nous estimons que les éléments probants que nous avons obtenus sont In our opinion, the consolidated financial statements present fairly, in all suffisants et appropriés pour fonder notre opinion d’audit. material respects, the financial position of the Canadian Veterinary Medical Association as at December 31, 2016, and the results of its operations Opinion and its cash flows for the year then ended in accordance with Canadian À notre avis, les états financiers donnent, dans tous leurs aspects significatifs, accounting standards for not-for-profit organizations. une image fidèle de la situation financière de L’Association canadienne des médecins vétérinaires au 31 décembre 2016, ainsi que de sa performance financière et de ses flux de trésorerie pour l’exercice terminé à cette date, OUSELEY HANVEY CLIPSHAM DEEP LLP conformément aux normes comptables canadiennes pour les organismes Licensed Public Accountants sans but lucratif.

OUSELEY HANVEY CLIPSHAM DEEP LLP Ottawa, Ontario Experts-comptables autorisés April 13, 2017

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

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2016 2015

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568 184 674 759

INVESTMENTS 2 419 267 2 353 969 PLACEMENTS CAPITAL ASSETS 598 067 643 000 IMMOBILISATIONS

$ 3 585 518 $ 3 671 728

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717 013 905 041

NET ASSETS ACTIF NET Invested in capital assets 598 067 643 000 Investi en immobilisations corporelles Internally restricted net assets Actif net affecté d’origine interne Operational contingency 1 274 781 1 281 713 Éventualités opérationnelles Program contingency 995 657 841 974 Éventualités de programme Unrestricted — — Non affecté

2 868 505 2 766 687

$ 3 585 518 $ 3 671 728

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

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2016 2015

REVENUE REVENUS

RAPPORT ANNUEL Communications Program $ 61 462 $ 58 962 Programme de communications Professional development 547 756 458 130 Perfectionnement professionnel Journal — CJVR 87 391 85 603 Revue — RCRV Journal — CVJ 677 360 646 685 Revue — RVC Membership services 1 366 981 1 280 151 Services aux membres National Examination Board 1 529 545 1 383 455 Bureau national des examinateurs Canadian Veterinary Reserve 79 003 64 051 Réserve canadienne vétérinaire AHTVTP Accreditation 42 750 40 500 Accréditation TSA Secretariat 469 132 407 210 Secrétariat Students Program 76 308 71 328 Programme d’étudiants Special projects 155 966 111 135 Projets spéciaux Interest 45 987 43 130 Intérêts

5 139 641 4 650 340

Inter-departmental revenues Revenus entre services and administration allocations (231 333) (172 684) et frais administratifs

4 908 308 4 477 656

EXPENSES DÉPENSES Communications Program 204 162 192 444 Programme de communications Professional development 520 039 449 739 Perfectionnement professionnel Council and committees 318 684 328 376 Conseil et comités Journal — CJVR 96 053 82 660 Revue — RCRV Journal — CVJ 715 148 715 227 Revue — RVC Membership services 463 230 414 313 Services aux membres National Examination Board 1 493 704 1 346 916 Bureau national des examinateurs Canadian Veterinary Reserve 79 003 64 051 Réserve canadienne vétérinaire AHTVTP Accreditation 26 343 29 354 Accréditation TSA Secretariat 792 685 806 238 Secrétariat Students Program 130 794 125 977 Programme d’étudiants Special projects 197 978 164 871 Projets spéciaux

5 037 823 4 720 166

Inter-departmental expenses Dépenses entre services and administration allocations (231 333) (172 684) et frais administratifs

4 806 490 4 547 482

NET REVENUE (EXPENSE) FOR THE YEAR $ 101 818 $ (69 826) REVENUS (DÉPENSES) NETS POUR L’EXERCICE

694 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Case Report Rapport de cas

Management of a tracheal intussusception in a dog

Manureva Lebreton, Eric Bomassi, Sebastien Etchepareborde

Abstract — A 5-year-old Belgian Malinois dog was presented for evaluation of dyspnea of 1-month duration. Tracheal intussusception was diagnosed by tracheoscopy. Treatment consisted of surgical resection of the invaginated tracheal ring and the immediate cranial and caudal tracheal rings. The dog recovered uneventfully; complications included temporary emphysema after surgery. Seven months after surgery, the dog was still clinically normal. To the authors’ knowledge, this is the first report of a tracheal intussusception treated surgically in a dog.

Résumé — Gestion d’une intussusception trachéale chez un chien. Un chien Malinois âgé de 5 ans a été présenté pour l’évaluation d’une dyspnée d’une durée de 1 mois. L’intussusception trachéale a été diagnostiquée par trachéoscopie. Le traitement instauré consistait en la résection chirurgicale de l’anneau trachéal et des anneaux trachéaux crâniaux et caudaux immédiats. Le chien s’est rétabli sans incident; les complications ont inclus un emphysème temporaire après la chirurgie. Sept mois après la chirurgie, le chien était toujours cliniquement normal. À la connaissance des auteurs, il s’agit du premier rapport d’une intussusception trachéale traitée par chirurgie chez un chien. (Traduit par Isabelle Vallières) Can Vet J 2017;58:695–698

he causes of tracheal obstruction most commonly reported T in veterinary medicine include collapse, tumors, and tracheal foreign bodies. External trauma, complications relating to tracheostomy tubes and tracheal intubation can cause intraluminal stricture due to excessive granulation tissue (1,2). Tracheal intussusception is a rare condition in dogs and cats and there is only 1 report describing conservative treatment in a dog (3). The present study reports the diagnosis and treatment of a tracheal intussusception in a dog. Case description A 5-year-old Belgian Malinois dog was presented for evaluation of chronic dyspnea. Clinical signs, which had been present for 1 mo prior to presentation, included decreased exercise toler- ance with increased respiratory effort and episodes of cyanosis. At rest, the dog was asymptomatic. Before the onset of clinical signs the patient had been in an altercation with another dog. At the time of the altercation, the owners reported no external signs of trauma such as bleeding, hematoma, or wounds. Upon presentation, physical examination revealed a severe inspiratory dyspnea. Respiratory distress including tachypnea and cyanosis seemed to have been exacerbated by handling Figure 1. Tracheal intussusception represented by tissue opacification on cervical radiographs. Centre Hospitalier Vétérinaire, 29 Av. du Maréchal Joffre, 77100 Meaux, France. during the clinical examination. Stridor was audible. A focal Address all correspondence to Dr. Manureva Lebreton; e-mail: 3 cm 3 1 cm area of alopecia, without any wound or scar, was [email protected] noted on the ventral aspect of the neck. The clinical examina- Use of this article is limited to a single copy for personal study. tion was highly suggestive of an extra-thoracic airway dysfunc- Anyone interested in obtaining reprints should contact the tion. Initial differential diagnosis consisted of laryngeal disease CVMA office ([email protected]) for additional including laryngeal paralysis; inflammatory disease or neoplastic copies or permission to use this material elsewhere. disease; tracheitis; extraluminal mass compressing the pharynx,

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cranial RAPPORTCAS DE

Figure 2. Tracheoscopic view of stenosis induced by tracheal Figure 3. External visualization of the tracheal intussusception intussusception. after ventral surgical approach of the caudal trachea.

larynx or trachea; foreign body; nasopharyngeal polyp; abscess distal ring was invaginated into the proximal ring. Reduction of or hematoma of the pharynx, larynx or trachea. the intussusception was not attempted due to the deformation A direct laryngeal examination was performed under a light of the invaginated tracheal ring revealed by tracheoscopy. The plane of anesthesia to assess laryngeal function. The dog was trachea was incised caudal to the lesion in order to allow intuba- induced with midazolam (Midazolam; Aguettant, Lyon, France), tion in the caudal aspect of the trachea with a sterile endotra- 0.2 mg/kg body weight (BW), IV and propofol (Propovet; cheal tube (Figure 4). The lesion was then excised. The sterile Axience, Pantin, France) IV to effect. The examination of the endotracheal tube was removed and tracheal anastomosis was larynx was unremarkable. Thoracic and neck radiographs were performed with simple interrupted sutures (3-0 monofilament performed under anesthesia. Thoracic radiographs were unre- absorbable) encircling the cartilage rings in order to minimize markable. Neck radiographs revealed a 4-mm soft tissue opac- risk of postoperative stenosis (4,8,9). Three vertical interrupted ity in the lumen of the trachea at the level of the 6th cervical mattress sutures were added around adjacent tracheal rings to vertebra (Figure 1). relieve tension (Figure 5) (10). Upper respiratory endoscopy with a 5-mm flexible endoscope The dog’s recovery from surgery was uneventful. Postoperative was then performed to further explore the lesion in the trachea. treatment included oxygen, 3 L/min, by nasal tube. Weaning Examination of the trachea revealed severe stenosis in its cervical was possible within a few hours. Postoperative analgesia included portion, located 20 cm caudally to the laryngeal inlet (Figure 2). morphine (Morphine; Lavoisier, Paris, France), 0.2 mg/kg The tracheal lumen was restricted to a vertical slot of 3 mm BW, SC, q4h and carprofen (Carprieve; Bayer, Lyon, France), diameter surrounded by 2 cartilaginous pillars. Approximately 4 mg/kg BW, IV, q24h. Amoxicillin (Clamoxyl; Pfizer, Paris, 75% of the normal diameter of the tracheal lumen was con- France), 20 mg/kg BW, IV, q8h was administered for 48 h after stricted. It was possible to pass a 5-mm endoscope beyond the surgery. Upon discharge, medical treatment included carpro- lesion, demonstrating a normal tracheal diameter and appear- fen (Carprieve; Bayer), 4 mg/kg BW, PO, q24h for 10 d and ance immediately caudal to the lesion. No other abnormalities cefalexine (Rilexine; Virbac, Carros, France), 15 mg/kg BW, were identified such as tracheal rupture, pseudotrachea, or PO q12h for 7 d. pseudotracheal membrane. Based on these images, an intus- Twenty-four hours after surgery, a mild emphysema in the susception of a tracheal ring was suspected, without excluding ventral cervical region was palpable, without any associated a stricture due to excessive granulation tissue or an annular mass clinical signs. Five days after surgery, emphysema was completely compressing the trachea. In the event that there was an intus- resolved. Seven months after surgery, the owners reported that susception, the invaginated tracheal ring would likely have been the dog had regained a normal life and they did not agree to an damaged since tracheal rings are rigid and C-shaped cartilage endoscopic examination. and tracheoscopy do not show a fornix as expected. Due to the severity of the clinical signs, the location and the Discussion extent of the lesion, surgical management was recommended. External tracheal injuries are most often secondary to bite injury General anesthesia was maintained with isoflurane (Isoflo 100%; or road traffic accidents (2,11). The altercation with another Axience) in oxygen. Tracheal resection of the lesion including dog shortly before the onset of symptoms strongly suggests a 1 ring cranial and 1 ring caudal to the lesion was performed by traumatic cause, although it could not be proven. One case of an end-to-end method as previously described (4–7). Briefly, a trauma-induced tracheal stenosis was recently described in a ventral approach was taken (Figure 3). The lesion was located horse (1). The stenosis was associated with extensive scar tissue by a narrow space between 2 tracheal rings suggesting that the and deformation of 1 tracheal ring, without intussusception.

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cranial CASE REPORT CASE

Figure 4. Sterile tracheotomy caudal to the lesion.

cranial

Figure 6. Histology of the tracheal intussusception.

with submucosal neutrophilic, lymphocytic and histiocytic infiltrates, and multifocal areas of fibrous tissue as can be found in other inflammatory processes like tracheal collapse (13,14). It is difficult to understand the physiopathology of tracheal intussusception, which is a rare condition. To the authors’ Figure 5. Tracheal anastomosis after resection of the lesion. knowledge, only 1 case describing a similar lesion has been published (3). That case involved an 18-year-old male miniature poodle. The cause of the intussusception was unknown and Other causes were sought to explain tracheal intussusception as no history of trauma was suspected. The patient had a cough a congenital abnormality. Mawby et al (12) described a case of during the latter years of its life and diagnosis was made by local tracheal narrowing due to segmental tracheal dysplasia in tracheoscopy and computed tomography (CT). A 3-D recon- a mixed breed dog. The diameter of the intrathoracic aspect of struction CT showed that a segment of trachea at the level of the trachea was reduced to half the size of the cervical part. The the 6th cervical vertebra was displaced cranially and had invagi- tracheal narrowing was due to marked abnormal overlapping nated. Computed tomography would have helped to determine of the tracheal cartilage at the level of the trachealis muscle, if tracheal intussusception was present. However, CT was not causing a winding of the tracheal ring to itself (12). In our performed due to organizational constraints and the patient case, the resected tracheal rings were sent for histology to assess going into respiratory distress after recovery from anesthesia the possibility of congenital structural or cellular abnormality following tracheoscopy. So, immediate surgical management or signs of trauma. A “modified target sign” was present on was recommended. Tracheoscopy showed that the miniature histology images including 2 layers of cartilage corresponding poodle appeared to have had much less significant reduction to the invaginated portion surrounded by a C-shaped external in the airway diameter than the case presented here. Surgical tracheal ring (Figure 6). Histology confirmed the intussuscep- resection and anastomosis of the abnormal tracheal segment tion. There was no abnormality to explain this intussusception. was considered but was not performed due to the age of the Histological findings revealed non-specific signs of tracheitis dog and because the intussusception was well-tolerated. The dog

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was managed medically with amoxicillin and clavulanate potas- References sium, prednisolone, and theophylline for 4 wk, and recovered . 1 Barnett TP, Hawkes CS, Dixon PM. Tracheal resection and anastomosis partially with an intermittent dry cough (3). It is interesting after traumatic tracheal stenosis in a horse. Vet Surg 2015;44:265–269. that the intussusception affected tracheal rings at the level of the 2. Roach W, Krahwinkel DJ. Obstructive lesions and traumatic injuries of the canine and feline tracheas. Compendium 2009;31:E6. 6th cervical vertebra in those 2 cases; an area where the trachea 3. Kim JH, Park C, Moon SJ, Kang MH, Park HM. Incomplete tracheal is less accessible to external trauma as muscles, sternum and intussusception in a dog. Vet Radiol Ultrasound 2012;53:333–335. ribs protect the trachea (15). The cartilage of the tracheal rings 4. Hedlund CS. Tracheal anastomosis in the dog comparison of two end- to-end techniques. Vet Surg 1984;13:135–142. is thinner at the thoracic inlet, which may create a mechanical 5. Khan AM, Iqbal M, Saeed MA, Bashir IN. Experimental tracheal resec- weakness zone (15). Also, the direction of the intussusception tion and anastomosis in dogs. J Appl Anim Res 1999;16:87–91. is the same in both cases: the distal ring was invaginated into 6. Mutlu Z, Acar SE, Perk C. Treatment of a case of tracheal stenosis in a dog with tracheal resection and anastomosis. Vet Med Czech the proximal ring. As the diameter of tracheal rings decreases 2003;48:339–342. RAPPORTCAS DE progressively from cranial to caudal at the level of the thoracic 7. Hedlund CS. Tracheal resection and reconstruction. Probl Vet Med inlet, the direction of the intussusception seems logical (15). 1991;3:210–228. 8. Gibbons JA, Peniston RL, Raflo CP, Diamond SS, Aaron BL. A compar- Tracheal intussusception has not been described in the ison of synthetic absorbable suture with synthetic nonabsorbable suture medical literature for humans. Prolapse of the epiglottis into the for construction of tracheal anastomoses. Chest 1981;79:340–342. trachea is reported in children who have a concomitant swal- 9. Fingland RB, Layton CI, Kennedy GA, Galland JC. A comparison of simple continuous versus simple interrupted suture patterns for tracheal lowing dysfunction and gastroesophageal reflux disease (16,17). anastomosis after large-segment tracheal resection in dogs. Vet Surg Nasopharyngo-laryngoscopy is used to diagnose the prolapse. 1995;24:320–330. As the direction of the intussusception is different from tracheal 10. Demetriou JL, Hughes R, Sissener TR. Pullout strength for three suture patterns used for canine tracheal anastomosis. Vet Surg 2006;35: intussusception described herein, the tracheoscopic images are 278–283. completely different. A grading system is used depending on the 11. Jordan CJ, Halfacree ZJ, Tivers MS. Airway injury associated with cervi- degree of epiglottic and base-of-tongue prolapse. The severity cal bite wounds in dogs and cats: 56 cases. Vet Comp Orthop Traumatol 2013;26:89–93. can range from normal to complete obstruction of the pharynx 12. Mawby DI, Krahwinkel DJ, Donnell RL, Morandi F. Segmental tracheal by the base of tongue with no epiglottis visible (16,17). dysplasia in a mixed breed dog. Can Vet J 2006;47:1003–1006. In conclusion, this report describes an unusual case of inspi- 13. Marolf A, Blaik M, Specht A. A retrospective study of the relationship between tracheal collapse and brocnchiectasis in dogs. Vet Radiol ratory dyspnea in a dog, due to tracheal intussusception with a Ultrasound 2007;48:199–203. suspected traumatic cause. This case was managed surgically due 14. Tappin SW. Canine tracheal collapse. J Small Anim Pract 2016;57:9–17. to the severity of the clinical symptoms but medical manage- 15. Evans HE, De Lahunta A. Miller’s Anatomy of the Dog. 4th ed. St. Louis, Missouri: Elsevier Saunders, 2012:872. ment for a less severe case has also been described. The dog had 16. Yellon RF. Epiglottic and base-of-tongue prolapse in children: Grading a good clinical outcome and surgical resection of the affected and management. Laryngoscope 2006;116:194–200. trachea should be considered if clinical signs are severe enough 17. Yellon RF, Borland LM. Outcomes studies of epiglottic and base of tongue prolapse in children. Laryngoscope 2008;118:508–514. to warrant this. CVJ

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Fluoroscopic and endoscopic diagnosis of a lower esophageal ring causing foreign body impaction in a dog

Hakyoung Yoon, Yeunhea Lee, Kidong Eom, Jaehwan Kim

Abstract — A dog was presented because of regurgitation over a 3-day period. Radiographic examination revealed a bean-shaped filling defect and an annular narrowing at the level of the gastroesophageal sphincter. The contractile ring-like structure was sharply demarcated, and its appearance varied according to gastroesophageal distension. Endoscopic findings revealed lower esophageal ring and foreign body impaction.

Résumé — Diagnostic fluoroscopique et endoscopique d’un anneau œsophagien inférieur causant la surcharge d’un corps étranger chez un chien. Un chien a été présenté en raison de régurgitation pendant une période de 3 jours. L’examen radiographique a révélé un défaut en forme de haricot et un rétrécissement annulaire au niveau du sphincter gastro-œsophagien. La structure contractile en forme d’anneau présentait une délimitation marquée et son apparence variait selon la distension gastro-œsophagienne. Les résultats de l’endoscopie ont révélé un anneau œsophagien inférieur et la surcharge d’un corps étranger. (Traduit par Isabelle Vallières) Can Vet J 2017;58:699–702

enign esophageal stricture is a relatively uncommon but gographic findings and can be definitively identified at the B well-documented disease in dogs. The causative factors of gastroesophageal sphincter based on the appearance of a thin benign esophageal stricture are highly variable, with the main mucosal surface (4). While several diseases such as hiatal hernia, one being esophagitis that usually occurs during surgery. Other intussusception, masses, and strictures have been described at causes include chemicals, trauma, infectious agents, esophageal the gastroesophageal junction (1,6), esophageal ring has not foreign bodies, and gastroesophageal reflux (1,2). Acquired been reported in dogs. This is in contrast to human medicine, benign esophageal strictures, particularly those associated with in which it is one of the most common benign esophageal dis- ovariohysterectomy, have been the main focus of study in the eases, with well-documented imaging characteristics, diagnostic veterinary field for several decades (2,3), and variations of procedures, and treatment options. esophageal strictures, such as esophageal ring and web, have This report aimed to describe the fluoroscopic and endo- only been reported in human medicine (4). scopic features of esophageal ring that vary in appearance Esophageal ring is a condition that involves circumferential according to the degree of gastroesophageal distension and narrowing of the esophagus, especially around the gastroesopha- to enrich our current knowledge regarding the diagnosis of geal junction (5). Three types of esophageal rings, namely mus- esophageal ring that can cause foreign body impaction in dogs. cular (A-ring), mucosal (B-ring), and diaphragmatic (C-ring), have been documented. Muscular and diaphragmatic rings are Case description thought to be caused by normal smooth muscle contraction A 9-year-old intact male Pomeranian dog, weighing 2.1 kg, was or diaphragmatic crural pressure around the gastroesophageal presented with a history of foamy regurgitation over a 3-day sphincter. In contrast, mucosal rings, usually referred to as duration. Physical examination revealed only mild gingivitis, Schatzki’s rings in humans, are the most common esopha- without any other abnormalities. The dog was alert, and its respiratory rate and body temperature were 30 breaths/min and 37.9°C, respectively. Complete blood (cell) count (CBC) Department of Veterinary Radiology and Diagnostic Imaging, and serum biochemical findings revealed no abnormalities. College of Veterinary Medicine, Konkuk University 120, The dog had no history of surgery, and the owners had not Neungdong-ro, Gwangjin-gu, Seoul, Republic of Korea. noticed previous problems such as vomiting or regurgitation. Address all correspondence to Dr. Jaehwan Kim; e-mail: The owner reported that the dog had been regurgitating and [email protected] vomiting repeatedly after having eaten beans spilled on the floor Use of this article is limited to a single copy for personal study. 3 d before presentation. Anyone interested in obtaining reprints should contact the Thoracic radiographs were obtained (Titan 2000; Comed CVMA office ([email protected]) for additional Medical System, Seoul, Korea) using a routine procedure to copies or permission to use this material elsewhere. evaluate the upper gastrointestinal tract. A lateral-view image

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f f

RAPPORTCAS DE f

Figure 1. Right lateral thoracic radiograph of the dog. An oval Figure 2. Fluoroscopic images of the caudal esophagus. increased soft-tissue opacity is visible on the caudal mediastinal A — An oval, movable filling defect (f) of the contrast medium is region consistent with the caudal esophagus (arrow). visible. B and C — Sharply demarcated parallel lines are identified just caudal to the foreign body (arrows). D — Circumferential indentation of the caudal esophagus is noted on ventrodorsal image (black arrowhead). The small volume of contrast agent showed an oval increased soft-tissue opacity, 14 mm in diam- localized between the esophageal sphincter and diaphragmatic eter, around the caudal mediastinal region at the level of the hiatus (dashed arrows) was identified as a hiatal hernia (white arrowheads) upon endoscopy. Note that the variable appearance 10th thoracic vertebra (Figure 1). of the ring is due to variations in position of the foreign body Esophagography with fluoroscopic examination was carried and degree of esophagogastric distension and esophageal out using a fluoroscopic system (LISTEM diagnostic table; contraction. f — foreign body; St — stomach. LISTEM, Inchon, Korea) to identify the esophageal foreign body. With the dog in right lateral recumbency, a feeding tube was placed though a mouth gag. Ten milliliters of a 50:50 mix- (Polypectomy Snare; TeleMed Systems, Hudson, Massachusetts, ture of non-ionic iodinated contrast medium (Omnihexol 300; USA). Further endoscopic evaluation revealed a collapsed lower Korea United Pharmaceutical, Seoul, Korea) was slowly injected esophageal sphincter, with a diameter that allowed passage of through a 7-French feeding tube (JMS Feeding tube; Korea the tip of the endoscope into the stomach. As the stomach United Pharmaceutical) with fluoroscopic guidance. Esophageal distended with gas, the lower esophageal ring became gradu- motility, luminal diameter, and lower esophageal sphincter ally visible, with a thin white-pink mucosal surface. The ring, were observed (Figure 2). The presence of a filling defect was approximately 1 mm in thickness and 5 mm in diameter, was also noted. The esophagus was contracted well and had smooth eccentrically located at the ventral aspect of the caudal end of mucosal surfaces. At the level of the gastroesophageal sphincter, the esophagus. Parts of the foreign body were lodged on the a movable bean-shaped filling defect was identified, which was mucosal surface, with no evidence of inflammation. The cardia suspected to be a foreign body. Just caudal to the filling defect, a and fundus of the stomach were directly visible through the ring, well-demarcated circumferential narrowing of the lower esopha- which implied that the ring was located at the level of the lower geal sphincter causing stagnation of the contrast medium was esophageal sphincter (Supplementary file 2). observed. The appearance of this feature varied according to the The dog examined herein was diagnosed with a lower esopha- degree of gastroesophageal distension and esophageal peristal- geal ring with a small hiatal hernia and foreign body impaction sis. In addition, a small volume of contrast medium localized based on fluoroscopic and endoscopic findings. The owner between the lower esophageal sphincter and esophageal hiatus refused balloon dilation because the dog had never previously with an irregular gastric mucosal fold corresponding to a hiatal exhibited clinical signs of esophageal stricture and wanted to hernia (Supplementary file 1). Supplementary files are available maintain the dog on a liquid diet during the postoperative from the corresponding author. period. The dog recovered well, and the clinical signs had An endoscopy (FUJINON EVE 200; Fujinon, Tokyo, resolved at the follow-up 1 wk after endoscopic foreign body Japan) was done to remove the foreign body and identify the removal. lower esophageal stricture (Figure 3). Anesthesia was induced with propofol (Provive; Myungmoon Pharmaceutical, Seoul, Discussion Korea), 6 mg/kg body weight (BW), IV, and maintained In humans, a lower esophageal ring is the most common cause with 1.5% isoflurane (Foran solution; Choongwae Pharma of dysphagia even though most rings are asymptomatic; it is Corporation, Seoul, Korea) in 100% oxygen administered by observed in up to 14% of routine barium examinations in endotracheal intubation. The impacted foreign body, identified human medicine (7). Although it is a relatively common disease, to be a bean, was observed to be obstructing the residual esopha- its pathogenesis and etiology are not well-known and the causes geal lumen. It was removed using endoscopic snare forceps and exact location of lower esophageal rings are still discussed.

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of esophageal ring and the effect of ring diameter on the onset of clinical signs in dogs. Differential diagnoses for esophageal ring include peptic stricture caused by gastroesophageal reflux disease and esophageal web. Esophageal peptic stricture is generally observed at

the gastroesophageal junction, and usually exhibits an irregular, REPORT CASE thick, hemorrhagic mucosa, unlike the esophageal ring in the present case, in which there was a smooth mucosal surface with a thickness of only 1 to 2 mm and no evidence of inflammatory changes (4,5). Although esophageal web exhibits a few similarities with the esophageal ring, it is usually more eccentric, less annular-shaped, and limited to the cranial esophagus (9). Although, in the present case, the ring was more eccentrically located than that reported in the human literature (5,10), we Figure 3. Serial endoscopic images of the esophagus. A — impacted foreign body (FB) obstructing residual lumen of established the definitive diagnosis of esophageal ring and a ten- the esophagus. B and C — closed and open lower esophageal tative diagnosis of a mucosal ring based on its shape, location, sphincter with a small diameter (black arrows), respectively. presence of thin mucosal surface, and fixed ring size observed D — the esophageal ring is visible at the same level as that in images B and C, following inflation of the stomach. E — enlarged upon endoscopic and fluoroscopic evaluation. image of the esophageal ring demonstrates leftovers lodged Regardless of its type, diagnosis of lower esophageal ring is on the pink mucosal surface (arrowhead). F — the fundus of the challenging because of esophageal peristalsis as well as variable stomach (St), cardia (c), the edge of the mucosal ring (r), and the level of the diaphragmatic hiatus (dashed line) are visible through appearance of the ring, which depends on esophagogastric the mucosal ring. distension. Esophageal rings in dogs might be missed because ideal radiographic and endoscopic visualization require proper distension of both the esophagus and stomach (5). In the present case, the esophageal ring collapsed when only the A hiatal hernia inducing folding of the redundant esophageal esophagus was inflated, and it appeared to be a stenosis until mucosa is considered a significant factor affecting the occurrence the stomach was fully distended. Even in human medicine, the of lower esophageal rings (7,8). This hypothesis is supported accurate diagnosis of esophageal rings is challenging, because by the findings of a previous study (8), which reported a 97% the diagnostic accuracy and reproducibility of barium imaging incidence of hiatal hernia among human patients with lower with routine radiographs are much lower compared to those of esophageal ring included in that study. There is also a develop- real-time fluoroscopic evaluation (10). In our opinion, real-time mental theory that argues that the disease could be caused by a fluoroscopy with proper dilation should be performed in dogs congenital remnant of the mucosal ridge, which is not very likely with a suspected lower esophageal ring to obtain a definitive because most symptomatic patients reported in human medicine diagnosis. Furthermore, in order to establish a standard protocol were over the 40 y of age (5,7). There is also an inflammation and determine the proper imaging position for esophagography, theory that describes gastroesophageal reflux as the main cause large population studies are required to increase the detection of esophagitis and esophageal ring. However, a previous study rate of esophageal rings in dogs. (8) reported that only 28% of patients with lower esophageal In conclusion, we have described a lower esophageal ring ring had esophagitis. In the present case, similar to the findings causing foreign body impaction in a dog. Endoscopy and fluo- in human patients, a small hiatal hernia was identified with roscopic examination with proper dilation of the esophagogastric no evidence of esophagitis, upon endoscopic and fluoroscopic junction were effective in detection and diagnosis of the ring. evaluation. These findings, in combination with old age, are Lower esophageal ring should be considered as a differential similar to those in humans with esophageal rings. Therefore, diagnosis in cases in which dogs exhibit thin, circumferential this case suggests that the causes of esophageal rings in dogs and narrowing of the gastroesophageal junction on fluoroscopic humans might be similar. images. CVJ In human medicine, clinical signs including regurgitation, reflux esophagitis, heartburn, and dysphagia occured in cases in References which the diameter of the esophageal ring was less than 20 mm . 1 Thrall DE. Textbook of Veterinary Diagnostic Radiology. 6th ed. (4). These clinical signs worsen significantly in cases in which Amsterdam, the Netherlands: Elsevier Health Sciences, 2013:550–563. 2. Adamama-Moraitou KK, Rallis TS, Prassinos NN, Galatos AD. Benign the ring diameter is less than 13 mm (4). In the present case, esophageal stricture in the dog and cat: A retrospective study of 20 cases. although the ring diameter was only 5 mm, the dog showed no Can J Vet Res 2002;66:55–59. clinical signs until it swallowed the foreign body. This could 3. Vlasin M, Husnik R, Fichtel T, Rauserova L. Acquired esophageal stricture in the dog: A case report. Vet Med — Czech 2004;49:143–147. have been because the dog was a toy breed accustomed to 4. Smith MS. Diagnosis and management of esophageal rings and webs. consuming small-sized food. Moreover, the ring was located Gastroenterol Hepatol 2010;6:701–704. eccentrically at the ventral portion of the esophagus, which 5. Ott DJ, Gelfand DW, Wu WC, Castell DO. Esophagogastric region and its rings. Am J Roentgenol 1985;142:281–287. might have decreased its chances of causing food impaction. 6. Schwarz T, Johnson V. BSAVA Manual of Canine and Feline Thoracic Further studies are required to determine the clinical significance Imaging. Gloucester, England: BSAVA, 2008:200–212.

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. 7 DeVault KR. Lower esophageal (Schatzki’s) ring: Pathogenesis, diagnosis 10. Ott DJ, Chen YM, Wu WC, Gelfand DW, Munitz HA. Radiographic and therapy. Dig Dis 1996;14:323–329. and endoscopic sensitivity in detecting lower esophageal mucosal ring. 8. Müller M, Gockel I, Hedwig P, et al. Is the Schatzki ring a unique Am J Roentgenol 1986;147:261–265. esophageal entity? World J Gastroenterol 2011;17:2838–2843. 9. Fox E, Lee K, Lamb CR, Rest J, Baines SJ, Brockman D. Congenital oesophageal stricture in a Japanese shiba inu. J Small Anim Pract 2007; 48:709–712. RAPPORTCAS DE

Book Review Compte rendu de livre

Avian Medicine and Surgery in Practice: edition including husbandry and nutrition, diagnostic imaging, Companion and Aviary Birds, 2nd edition endoscopy, and oncology. The author also has included a glos- sary of abbreviations, and several appendices that encompass a Doneley B. CRC Press, Taylor and Francis Group. Boca Raton, robust formulary, reference intervals for commonly kept com- Florida, USA. 2016. 467 pp. ISBN: 9781-4822-6020-5. panion birds, and biological values for common companion $87.97 US. bird species. In addition to readily retrievable information, the chapters ver the past decade there have been numerous texts pub- are complemented by numerous practical color photographs, O lished on avian medicine and surgery, each with varying drawings, radiographs, and photomicrographs of cytologic degrees of depth of information and ease of use. The 2nd edition smears. These serve to further enhance the clinical descriptions. of Avian Medicine and Surgery in Practice: Companion and Aviary The information is presented in a succinct and logical manner Birds is an excellent blend of both features; readers can quickly in each chapter. access relevant and practical information, with additional refer- This textbook would be a valuable quick reference guide for ences listed at the end of each chapter which direct the reader to veterinary staff seeing predominately parrots in their clinical more detailed information on the subject matters. The second practice, as the information presented is very psittacine focused. edition comes only 6 years after the initial edition; however, Details on other companion bird species is not as in-depth. It is given the continuously rapid expansion of information in avian not designed to be a comprehensive avian medicine textbook; if medicine, its release is timely. The author’s extensive experience a wide variety of avian patients are seen then other avian medi- in clinical avian medicine of companion birds is evident as one cine textbooks may be more appropriate. For more in-depth reads through the various chapters. information on diseases or disorders, the clinician will need The book is well-organized into 30 chapters that range from to explore other resources; however, the author has numerous clinical anatomy and physiology, physical examination, clinical suggested references at the end of each chapter. Veterinary stu- techniques, supportive therapy, and differential diagnoses based dents will find the text to be a useful addition to complement on clinical signs and age, to chapters that outline diseases and their learning. disorders of the various organ systems. The last few chapters include incubation of eggs, pediatric medicine, analgesia and Reviewed by Douglas Whiteside, DVM, DVSc, DACZM, anesthesia, and surgery. The behavioral problems chapter is a DECZM (ZHM), Senior Staff Veterinarian, Calgary Zoo, Calgary, very good overview to approaching behavior in parrots. There Alberta. were several important additional chapters added to this second

702 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Case Report Rapport de cas

Hemoabdomen secondary to high grade lymphoma

Carolina Azevedo, Stephanie Schleis Lindley, Annette Smith, Kellye Joiner, Peter Christopherson

Abstract — A 10-year-old castrated male Labrador retriever dog was presented for evaluation of a right elbow mass. Mandibular lymphadenopathy was noted on physical examination. Following sudden death after discharge, a necropsy was performed. Cause of death was determined to be due to hemoabdomen secondary to high grade lymphoma.

Résumé — Hémoabdomen secondaire à un lymphome de haut grade. Un chien mâle Labrador retriever castré âgé de 10 ans a été présenté pour l’évaluation d’une masse au coude droit. Une lymphadénopathie mandibulaire a été observée à l’examen physique. Après une mort soudaine consécutive au congé, une nécropsie a été réalisée. La cause de la mort a été déterminée comme étant un hémoabdomen secondaire à un lymphome de haut grade. (Traduit par Isabelle Vallières) Can Vet J 2017;58:703–706

emoabdomen is characterized by the presence of free involving the right elbow with severe degenerative changes noted H blood within the peritoneal cavity, the cause of which in the opposite elbow joint. In addition, there were degenerative can be classified as traumatic or non-traumatic. In cases of changes in the scapulohumeral joints bilaterally. non-traumatic hemoabdomen, possible causes include intra- Physical examination findings included an 8-cm swelling abdominal neoplasia, coagulopathies, and intra-abdominal organ of the right elbow which encompassed the distal humerus and torsion (1). Neoplastic conditions that have been reported as proximal radius and ulna. Marked right forelimb lameness was a cause of hemoperitoneum in canine patients include splenic noted. The dog’s body condition score was 9/9. His mandibular hemangiosarcoma, splenic hemangioma, hepatocellular carci- lymph nodes were mildly enlarged bilaterally and his mucous noma, carcinomatosis (anaplastic adenocarcinoma of the abdo- membranes were pink and moist with a capillary refill time of men), splenic marginal zone lymphoma, as well as renal and less than 2 s. The abdomen was soft and non-painful on palpa- adrenal malignancies (1–7). However, hemoabdomen secondary tion with no palpable organomegaly or intraabdominal masses. to high grade lymphoma has not been previously reported in The remainder of the physical examination was unremarkable. the veterinary literature. Chest radiographs revealed a mild diffuse interstitial pattern and small mineralized opacities at the periphery of the lungs, Case description consistent with pulmonary osteomas. There was no evidence of A 10-year-old castrated male yellow Labrador retriever dog was gross metastatic disease. A complete blood (cell) count (CBC) presented for evaluation of right forelimb lameness. He had an revealed a mild normocytic normochromic anemia [HCT approximately 1.5-year history of a subtle limp on his front 36.4%; reference interval (RI): 38.7% to 59.2%]. Abnormal right limb due to severe osteoarthritis which was treated with biochemical findings included hyperproteinemia (79 g/L; RI: meloxicam, tramadol, chondroitin, glucosamine, and fish oil 5.5 to 77 g/L), hypoalbuminemia (28 g/L; RI: 30 to 48 g/L), supplements. One month before presentation his limp increased hyperglobulinemia (51 g/L; RI: 20 to 43 g/L), and hypocholes- significantly, leading to great difficulty with ambulation. The terolemia (3.0 mmol/L; RI: 3.42 to 8.68 mmol/L). Urinalysis owners noted a large mass in the region of the right elbow 3 wk revealed mild proteinuria, trace bilirubinuria, and minimally prior to presentation. Radiographs of the forelimbs were taken concentrated urine with a urine specific gravity of 1.014. by the referring veterinarian and revealed an osteolytic process Fine-needle aspirates of the right mandibular lymph node, left mandibular lymph node, right prescapular lymph node, and Auburn University Bailey Small Animal Teaching Hospital, the right elbow mass were taken and submitted for cytologic College of Veterinary Medicine, Auburn University, 1220 Wire analysis. Biopsies of the right elbow mass were taken with a Road, Auburn, Alabama 36849, USA. Jamshidi needle and were submitted for cytopathologic and Address all correspondence to Dr. Carolina Azevedo; e-mail: histopathologic examination. A sample of bone marrow was [email protected] aspirated from the left humerus and submitted for cytological Use of this article is limited to a single copy for personal study. analysis to evaluate for presence of multiple myeloma due to the Anyone interested in obtaining reprints should contact the elevation in serum globulin levels. While awaiting the results of CVMA office ([email protected]) for additional the cytology and bone biopsy, the patient was discharged with a copies or permission to use this material elsewhere. Fentanyl 100-mg transdermal patch (Apotex, Weston, Florida,

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Figure 1. Immunohistochemical staining of the spleen with Figure 2. Immunohistochemical staining of the lymph node CD79a antibody. with CD79a antibody.

USA) and a scheduled re-evaluation. The following day, the A complete necropsy examination was conducted. On gross patient was discovered dead by the owners at home. examination, an irregular, multilobulated, infiltrative, pale tan, Cytology of the left submandibular lymph node was consis- firm mass involving the proximal radius and ulna and surround- tent with lymphoid hyperplasia; with a population of mostly ing musculature was observed which abutted the elbow joint intermediate-sized lymphocytes. An intermediate cell lym- without crossing into the articular space. Hemoabdomen was phoma would be another consideration with these findings. observed upon entrance into the abdominal cavity. A single, Cytologic analysis of the right submandibular lymph node 11.0 cm diameter, multinodular to round, red-black, friable revealed lymphoid hyperplasia with increased numbers of mast blood-filled mass was present in the right limb of the spleen, cells. Evaluation of the right prescapular lymph node was consis- engulfed and adhered to the surrounding omentum. Similar tent with probable lymphoid hyperplasia with a predominance 0.5 cm up to 1.5 cm red-black masses were randomly dis- of intermediate sized lymphocytes in some areas; however, persed throughout the remainder of the spleen and the hepatic intermediate cell lymphoma could not be ruled out. Fine-needle parenchyma. aspiration of the right elbow mass and smears prepared from the Tissue samples collected from the spleen, mesenteric lymph biopsy sample revealed similar findings of a spindle cell popula- node, mandibular lymph node, prescapular lymph node, popli- tion which exhibited moderate anisocytosis and anisokaryosis teal lymph node, liver, and right elbow mass were fixed in 10% with large, variably sized nuclei, and prominent nuclei. The neutral buffered formalin and processed routinely. Sections cytologic appearance of these cells led to a probable diagnosis of (5 mm) were stained with haematoxylin and eosin (H&E). mesenchymal neoplasia. Cytologic analysis of the bone marrow Immunohistochemistry (IHC) was performed for identification aspirate showed mild evidence of antigenic stimulation with of CD79a, CD3, CD18, and cytokeratin. possible mild erythroid hyperplasia. Histopathology of the right elbow mass revealed a neoplastic Biopsy tissue contained an infiltrating, circum- population of spindle cells. These neoplastic spindle cells did not scribed, non-encapsulated mass of neoplastic polygonal or react with CD18 antibodies and were slightly immunoreactive spindle-shaped cells embedded in fibrocollagenous stroma. with cytokeratin, leading to a diagnosis of synovial cell sarcoma. Immunohistochemically, the neoplastic cells stained strongly Histopathologic examination of the spleen revealed sparse positive with vimentin antibody. Vimentin is present in cells lymphoid follicles and periarteriolar sheaths. The remaining of mesenchymal origin and in mesenchymal-derived tumors lymphoid follicles were moderately depleted with a reduction such as sarcomas, lymphoma, and melanoma. The neoplas- of up to 60% of lymphocytes, exposing the underlying reticu- tic cells also variably stained with CD18 antibody. CD18 lar matrix and reticuloendothelial cells. Histopathology of the is used as an immunohistochemical stain in joint tumors to ruptured splenic mass showed a marginally well-delineated, identify possible histiocytic sarcoma. It is highly expressed unencapsulated, expansile proliferation of neoplastic round cells in neoplasms of histiocytic origin, and CD18 may also be arranged in densely cellular sheets and supported by an incon- identified in other hematopoietic neoplasms. The neoplastic spicuous reticular matrix. Cells were fairly uniform, averaging cells did not stain immunohistochemically with MSA (mus- 12 mm in diameter with a nuclear to cytoplasmic ratio of 8:1. cle specific actin) antibody. Actin is used in joint tumors to Cells had a sparse rim of pale basophilic, often inconspicuous differentiate malignant fibrous histiocytoma. These staining cytoplasm and distinct cell borders. Nuclei were round to oval characteristics led to a histopathologic diagnosis of soft tissue to frequently indented with evenly dispersed, dense chromatin sarcoma. and 1 to 2 indistinct nucleoli. Ten mitoses were observed in

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10 contiguous 4003 microscopic fields and bizarre forms were differential diagnoses include intra-abdominal neoplasia, coagu- evident. Confluent areas of necrosis and many apoptotic cells lopathies, and intra-abdominal organ torsion. In this patient, the were scattered among the neoplastic proliferation. Neoplastic most likely primary cause was intra-abdominal neoplasia; how- lymphocytes exhibited strong, stippled to diffuse immunoreac- ever, the possible contribution of a concurrent disease process tivity with CD79a (Figure 1). The CD3 immunoreactive T-cells such as a coagulopathy cannot be ruled out as a coagulogram and CD18 immunoreactive macrophages were interspersed was not performed. REPORT CASE throughout the spleen. Microscopic evaluation of a mesenteric There are several previously reported primary neoplastic lymph node revealed that 90% of the normal lymph node causes of acute hemoabdomen. Amongst the most common parenchyma had been replaced by a population of neoplastic neoplastic causes of hemoabdomen is hemangiosarcoma. lymphocytes, similar to that described in the spleen. Neoplastic Hepatocellular carcinoma, carcinomatosis, renal and adrenal lymphocytes breached the capsule and extended out into the sur- malignancies, and low grade indolent lymphoma (specifically rounding perinodal adipose tissue. The neoplastic lymphocytes splenic marginal zone lymphoma) have also been reported as exhibited strong, stippled to diffuse immunoreactivity with neoplastic causes of hemoabdomen in canine patients (1–7). CD79a and did not maintain normal follicular arrangement In human medicine, non-Hodgkin lymphoma is recognized (Figure 2). The CD3 immunoreactive T-cells and CD18 immu- as a common cause of atraumatic pathologic splenic rupture noreactive macrophages were found interspersed throughout (14). In veterinary medicine, however, high grade large cell the lymph node, arranged with normal tissue distribution. lymphoma has not previously been reported as a cause of non- The appearance and topography of the observed neoplastic traumatic splenic rupture. Findings of this case report indicate lesions was not consistent with marginal zone lymphoma. non-traumatic splenic rupture can also occur secondary to high Microscopically, examination of the mandibular, prescapular, grade lymphoma. and popliteal lymph nodes did not reveal evidence of a neoplas- Another contributing factor to sudden death may have been tic population of lymphocytes. The histopathologic diagnosis of application of the transdermal fentanyl patch. Fentanyl is a the spleen and mesenteric lymph node was diffuse large B-cell mu opiate agonist used for control of pain. With transdermal lymphoma. Histopathologic analysis of the liver was consistent application, there is rapid dermal absorption with sequestration with hepatic congestion. of fentanyl in the stratum corneum. The fentanyl is subsequently slowly released from the stratum corneum into systemic Discussion circulation. Adverse effects associated with the transdermal Lymphoma is a common form of neoplasia encountered in patch include gastrointestinal upset, hypothermia, respiratory veterinary medicine; it constitutes 7% to 24% of all canine neo- depression, circulatory depression, and central nervous system plasms and 83% of all canine hematopoietic malignancies (8,9). depression. Severe adverse side effects are unlikely to occur at The classification of lymphoma in canine patients is based on the appropriate dose (15,16). However, prehension of the trans- anatomic location, histopathologic criteria, immunophenotypic dermal patch with oral or transmucosal absorption can result characteristics, stage, and substage (10). Anatomic locations in acute overdose (17). There was no evidence of transdermal include multicentric, gastrointestinal, mediastinal, cutaneous, patch ingestion in this case. ocular, hepatosplenic, renal, nasal, central nervous system, and There are several limitations to this case report due to its intravascular lymphoma. Several histopathologic schemes have retrospective nature and the lack of extensive diagnostic tests been developed for the characterization of animal lymphoid neo- prior to sudden death of the patient. Other differential diagnoses plasms based on morphologic, immunophenotypic, and geno- cannot be ruled out as causes of the patient’s sudden death or typic criteria. Most recently, the World Health Organization hemoabdomen. Specifically, an abdominal ultrasound, a coagula- (WHO) published the Revised European American Lymphoma tion profile, and thromboelastometry would have proved useful (REAL) of domestic animals classification scheme, which is the for more definitive evidence of the cause of death. Without more most generally accepted classification method. The REAL system extensive diagnostics and previous evaluation of the splenic classifies hematopoietic malignancies into unique disease entities parenchyma and peritoneal cavity, we cannot be absolutely cer- irrespective of organ of origin based on cellular morphology, tain that the high grade lymphoid malignancy observed in the cell lineage, architecture, and general biology which provides spleen was responsible for the patient’s sudden demise. some degree of prognostic indication (11–13). Lymphoma is In conclusion, this report describes a case of hemoabdomen subsequently staged based on degree of nodal or organ involve- most likely secondary to splenic rupture secondary to high ment and presence of concurrent clinical signs. In this case, grade diffuse large B-cell lymphoma with splenic involvement. histopathologic findings were consistent with high grade diffuse Only low grade indolent lymphomas affecting the splenic large B-cell lymphoma with neoplastic lymphocytes infiltrating parenchyma had previously been identified as a cause of non- the spleen and a mesenteric lymph node. This classification traumatic hemoabdomen in the veterinary literature. However, of high grade is particularly important when considering the although splenic rupture secondary to a high grade lymphoid splenic rupture and secondary hemoabdomen noted in this case. neoplasm had not been previously reported, this finding is not The cause of death in this patient was determined to be most surprising as hemoabdomen has previously been known to occur likely secondary to acute hemoabdomen. In previous literature, secondary to an array of benign and malignant etiologies. Due hemoabdomen has been associated with both traumatic and to the findings in this case, high grade lymphoma should also non-traumatic causes (1). In regard to non-traumatic causes, be considered as a differential diagnosis for hemoabdomen. CVJ

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References 10. Vail DM, Pinkerton ME, Young KM. Hematopoeitic tumors. In: Withrow SJ, Vail DM, Page RL, eds. Small Animal Clinical Oncology. 1. Brockman DJ, Mongil CA, Aronson LR. A practical approach to 5th ed. St. Louis, Missouri: Elsevier Saunders, 2013:608–678. hemoperitoneum in the dog and cat. Vet Clin North Am Small Anim 11. Vezzali E, Parodi AL, Marcato PS, Bettini G. Histopathologic clas- Pract 2000;30:657–668. sification of 171 cases of canine and feline non-Hodgkin lymphoma 2. Pintar J, Breitschwerdt EB, Hardie EM, Spaulding KA. Acute nontrau- according to the WHO. Vet Comp Oncol 2010;8:38–49. matic hemoabdomen in the dog: A retrospective analysis of 39 cases 12. Valli VE, Kass PH, Myint MS, Scott F. Canine lymphomas: Association (1987–2001). J Am Anim Hosp Assoc 2003;39:518–522. of classification type, disease stage, tumor subtype, mitotic rate, and 3. Aronsohn MG, Dubiel B, Roberts B, Powers BE. Prognosis for acute treatment with survival. Vet Pathol 2013;50:738–748. nontraumatic hemoperitoneum in the dog: A retrospective analysis of 13. Valli VE, Myrint MS, Barthel A, et al. Classification of canine malignant 60 cases (2003–2006). J Am Anim Hosp Assoc 2009;45:72–77. lymphoma according to the World Health Organization criteria. Vet 4. Evans K, Hosgood G, Boon GD, Kowalewich N. Hemoperitoneum Pathol 2010;48:198–211. secondary to traumatic rupture of an adrenal tumor in a dog. J AmVet 14. Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Med Assoc 1991;198:278–280. Systematic review of atraumatic splenic rupture. Br J Surg 2009;96: 5. Kosovsky JE, Manfra-Marretta S, Matthiesen DT, Patnaik AK. Results RAPPORTCAS DE 1114–1121. of partial hepatectomy in 18 dogs with hepatocellular carcinoma. J Am 15. Savides MC, Pohland RC, Wilkie DA, et al. The margin of safety of a Anim Hosp Assoc 1989;25:203–206. single application of transdermal fentanyl solution when administered 6. Stefanello D, Valenti P, Zini E, et al. Splenic marginal zone lymphoma at multiples of the therapeutic dose to laboratory dogs. J Vet Pharmacol in 5 dogs (2001–2008). J Vet Intern Med 2011;25:90–93. Ther 2012;35:35–43. 7. O’Brien D, Moore PF, Vernau W, et al. Clinical characteristics and 16. Martinez SA, Wilson MG, Linton DD, et al. The safety and effective- outcome in dogs with splenic marginal zone lymphoma. J Vet Intern ness of a long-acting transdermal fentanyl solution compared with oxy- Med, 2013;27:949–954. morphone for the control of postoperative pain in dogs: A randomized, 8. Kaiser HE. Animal neoplasms: A systemic review. In: Kaiser HE, ed. multicentered clinical study. J Vet Pharmacol Ther 2014;37:394–405. Neoplasms: Comparative Pathology in Animals, Plants and Man. 17. Schmiedt CW, Bjorling DE. Accidental prehension and suspected Baltimore, Maryland: William & Wilkins, 1981. transmucosal or oral absorption of fentanyl from a transdermal patch 9. Moulton JE, Harvey JW. Tumors of lymphoid and hematopoietic tissue. in a dog. Vet Anaesth Analg 2007;34:70–73. In: Moulton JE, ed. Tumors of Domestic Animals. 3rd ed. Berkeley, California: University of California Press, 1990.

706 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Case Report Rapport de cas

Retro-orbital and disseminated B-cell lymphoma in a yellow-collared macaw (Primolius auricollis)

Kim Le, Hugues Beaufrère, Emily Brouwer, S. Karlyn Bland, Sarah Wills, Shawn MacKenzie, Heather Chalmers, Chantale Pinard, R. Darren Wood, Josepha DeLay, Dale A. Smith

Abstract — A yellow-collared macaw was presented with unilateral left exophthalmia. The complete blood cell count and biochemistry revealed a heterophilic leukocytosis and elevation in liver parameters, respectively. A computed tomography scan showed a contrast-enhancing retrobulbar mass and hepatomegaly. Cytology of the liver was consistent with a round cell tumor, most likely lymphoma. The bird died after 2 months of palliative care. Postmortem examination confirmed a retro-orbital and disseminated B-cell lymphoma.

Résumé — Lymphome B rétro-orbital et disséminé chez un ara à collier jaune (Primolius auricollis). Un ara à collier jaune a été présenté avec de l’exophtalmie unilatérale gauche. La formule sanguine complète et la biochimie ont révélé une leucocytose hétérophile et une élévation des paramètres hépatiques, respectivement. La tomodensitométrie à l’aide d’une injection de milieu de contraste a montré une masse rétrobulbaire et une hépatomégalie. La cytologie du foie était conforme à une tumeur à cellules rondes, le plus probablement un lymphome. L’oiseau est mort après 2 mois de soins palliatifs. L’examen postmortem a confirmé un lymphome B rétro-orbital et disséminé. (Traduit par Isabelle Vallières) Can Vet J 2017;58:707–712

Case description had no prior relevant medical history. The macaw was fed a complete pelleted diet, supplemented with fruits and vegetables. 20-year-old female yellow-collared macaw (Primolius auri- On physical examination, the bird weighed 223 g and had collis) was presented to the Ontario Veterinary College A a body condition score of 3/5. There was evidence of feather Health Sciences Centre for an acute onset of left ocular swelling. damaging behavior throughout the plumage. There was left The owners reported that the bird had a decreased appetite for exophthalmia and associated peri-ocular swelling. Dazzle and 3 days prior to presentation. There was no sneezing, discharge, palpebral reflexes were present and the fundic examination was or irritation in the head region noted by the owners. The bird unremarkable. No abnormalities were detected in the right eye. Oropharyngeal examination revealed a small white plaque deep Health Sciences Centre (Le, Beaufrère, Wills), Department of within the choanal slit dorsal to the boney roof of the fossa choa- Clinical Studies (MacKenzie, Chalmers, Pinard), Department nalis, and the bird’s beak was found to be unexpectedly brittle of Pathobiology (Brouwer, Bland, Wood, Smith), Ontario when held open with a speculum. Hepatomegaly was suspected Veterinary College; Animal Health Laboratory (DeLay), on coelomic palpation and visual examination. A blood sample University of Guelph, Guelph, Ontario N1G 2W1. was taken from the right jugular vein and placed into EDTA and Dr. Le’s current address is Sydney Exotics and Rabbit Vets, heparin tubes, which were submitted for a complete blood (cell) North Shore Veterinary Specialist Hospital, 64 Atchison St, count (CBC) and plasma biochemistry analysis, respectively. Crows Nest NSW 2064, Sydney, Australia. Hematology revealed a moderate heterophilic leukocytosis [WBC 35.1 3 109/L, heterophils 28.4 3 109/L; reference Dr. Wills’ current address is Exotic Animal Care Centre, interval (RI) for Ara spp., no reference intervals available for Pasadena, California, USA. P. auricollis: WBC: 7 to 22 3 109/L] (1), and evidence of a left Dr. MacKenzie’s current address is Toronto Veterinary shift (band heterophils 3.86 3 109/L). A mild anemia (41%; Emergency Hospital, 21 Rolark Drive, Scarborough, Ontario RI: 47 to 55%) (1) with evidence of mild polychromasia [(5 to M1R 3B1. 10 per high power field (HPF)] was present. These findings were Address all correspondence to Dr. Hugues Beaufrère; e-mail: interpreted as indicative of inflammation and mild regenerative [email protected] anemia. Plasma biochemistry showed mild hypoproteinemia Use of this article is limited to a single copy for personal study. (30 g/L; RI: 34 to 42 g/L) (1). Also present were marked eleva- Anyone interested in obtaining reprints should contact the tions in activity of aspartate aminotransferase (AST; 1936 U/L; CVMA office ([email protected]) for additional RI: 124 to 378 U/L) (1), creatine kinase (3202 U/L; RI: 35 to copies or permission to use this material elsewhere. 355 U/L) (1), glutamate dehydrogenase (GLDH; 27 U/L; RI:

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Figure 1. Contrast CT-scan images of the head and body of a yellow-collared macaw (Primolius auricollis) with multi-organ B-cell lymphoma. Coronal (A) and transverse (B) sections of the head with a retrobulbar mass visible medial to the eye on the right side of the image (left side of the bird). Coronal (C), transverse (D), and sagittal (E) sections of the body illustrating hepatomegaly and multifocal, rounded, irregularly marginated hypoattenuating nodules with mild, non-uniform contrast enhancement. Scale bars depict size and boundaries of hepatic outline.

, 8 U/L) (1), and a mild elevation in bile acids (85 mmol/L; RI: , 71 mmol/L) (1). The GLDH elevation was consistent with hepatic necrosis and the mild bile acid elevation was consistent with mild liver dysfunction or post-prandial elevation. The specific source of the elevation in AST could not be determined as there was evidence of both muscle (CK) and hepatocyte (GLDH) injury. Computed tomography (CT) examination of the whole body was performed using a 16-slice helical scanner (GE Bright Speed; General Electric Healthcare, Milwaukee, Wisconsin, USA). The bird was sedated with midazolam (Versed; Roche Labs, Basel, Switzerland), 0.5 mg/kg body weight (BW) intra- nasally, mask-induced with isoflurane at 5% delivered with oxygen, and intubated with a 3 mm uncuffed endotracheal tube. Anesthesia was monitored with a Doppler unit placed on the Figure 2. A — Gross necropsy image of a yellow-collared superficial ulnar artery and with a capnograph. A 26 G intrave- macaw (Primolius auricollis) with multi-organ B-cell lymphoma nous catheter was placed in the right medial metatarsal vein to showing exophthalmia due to retrobulbar neoplastic infiltration. B — Gross necropsy image of a yellow-collared macaw facilitate the administration of iopamidol, a non-ionic contrast (Primolius auricollis) with multi-organ B-cell lymphoma showing agent (Isovue-300; Bracco Diagnostics, Monroe Township, hepatomegaly with rounded hepatic borders, mottling, and pallor New Jersey, USA), 2 mL/kg BW, IV, for contrast CT, which was of the hepatic surface, and irregular thickening of the hepatic capsule and adjacent mesentery. Compare to Figure 1. taken approximately 3 to 5 s after completion of the injection. Findings on the CT examination included a retro-bulbar mass of uniform density that occupied the infraorbital sinus and enhancement of the mass was noted. The liver was markedly caused distortion of the medial aspect of the left globe as well enlarged with multifocal, rounded, irregularly marginated as exophthalmia (Figures 1A, 1B). Mild heterogeneous contrast hypoattenuating nodules that had mild, non-uniform contrast

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Figure 3. A — Cytologic appearance (cytospin preparation) of a fine-needle aspirate from a cystic region of a hepatic mass in a yellow-collared macaw (Primolius auricollis) with multi-organ B-cell lymphoma. There are neoplastic cells with deeply basophilic cytoplasm and bizarre nuclear morphology (arrows), large foamy macrophages with prominent granules, heterophils, and red blood cells. Wright’s stain. Magnification 6003. B — Histologic appearance of the liver of a yellow-collared macaw (Primolius auricollis) with multi-organ B-cell lymphoma. There is a nodule of neoplastic cells (arrows) within the hepatic parenchyma. Hematoxylin and eosin. Magnification 2003. C — Histologic appearance of a retrobulbar mass in a yellow-collared macaw (Primolius auricollis) with multi-organ B-cell lymphoma. Empty arrow — detached retina (artefact); solid arrow — scleral ossicle; asterisks — neoplastic infiltrate. Hematoxylin and eosin. Bar = 500 mm. D — Immunohistochemical staining for MUM1 antigen in a section of small intestine with a serosal/ mesenteric neoplastic infiltrate in a yellow-collared macaw (Primolius auricollis) with multi-organ B-cell lymphoma. Strong nuclear and less pronounced cytoplasmic staining are visible in a large proportion of the neoplastic cells (left side of the image), as well as in scattered cells in the lamina propria of the small intestine (arrows). Bar = 50 mm.

enhancement (Figures 1C to 1E). These nodules distorted the The bradyarrhythmia occurred again, this time on recovery, and liver margins and displaced the ventriculus, proventriculus, was again unresponsive to an anti-cholinergic agent, atropine. and spleen caudolaterally to the left and the intestines cau- An electrocardiogram tracing was obtained but did not capture dally. While under anesthesia, a bradyarrhythmia with regular an appropriate sequence of bradyarrhythmia. occasional skipped beats was identified. Two doses of glycopyr- On cytology of the cytospin from the fluid obtained from rolate (Robinul; Baxter Healthcare, Deerfield, Illinois, USA), the right liver lobe, there were numerous large individual cells 0.02 mg/kg BW, IV, had no effect on cardiac rate or rhythm. with a round to angular shape exhibiting 4- to 5-fold anisocy- Anesthesia was therefore terminated prior to other diagnostic tosis, moderate anisokaryosis and with basophilic cytoplasm. procedures being carried out. Many cells were binucleate or trinucleate, and nuclei tended The bird was re-anesthetized in the same manner on the to be indented, bilobed, or angular with clumped chromatin. following day in order to obtain fine-needle aspirates of the Occasionally, satellite nuclei and nuclear molding were observed. retrobulbar and hepatic masses. The left and right liver lobes Additionally, there were frequent large vacuolated macrophages, were sampled percutaneously by direct visualization under the erythrocytes, and heterophils. Occasional mitotic figures were skin; aspiration of the right liver lobe produced 3 mL of fluid, noted. These findings were compatible with round cell neoplasia whereas aspiration of the left liver lobe resulted in only a cellular and mixed inflammation. Similar cell populations were noted on parenchymal aspirate. The retro-bulbar mass could not be safely the sample from the left liver lobe, but the large cells appeared sampled due to the small size of the bird and the location of the rounder, and had more deeply basophilic cytoplasm and a dis- mass dorsal to the palatine bone and medial to the jugal arch. tinct perinuclear Golgi zone. There was moderate anisocytosis

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and anisokaryosis with similar varied and atypical nuclear shapes plasmic staining with MUM1 (monoclonal mouse anti-human (Figure 2A). Some cells had prominent nucleoli. These findings MUM1 protein, clone MUM1p; Dako, Burlington, Ontario) were similarly interpreted as round cell neoplasia. was present in over 80% of the infiltrative cells in the liver and The owner elected palliative out-patient care, declining mesentery, as well as in scattered cells within the lamina propria radiotherapy for the ocular component of the disease and che- of the small intestine and spleen, used as the species control tis- motherapeutics. The bird was initially sent home on tramadol sue (Figure 3D). Additional tissue blocks from a macaw (species (Novopharm, Toronto, Ontario), 10 mg/kg BW, PO, q12h; not provided) and a Congo African grey parrot containing bursa, and meloxicam (Metacam, Boehringer Ingelheim Vetmedica. spleen, and thymus were subjected to the same IHC staining St. Joseph, Missouri, USA), 0.5 mg/kg BW, PO, q24h, to protocol for MUM1 antigen and appropriate positive staining provide pain relief. The meloxicam was discontinued and pred- was observed in lymphoid tissue in each case. There was no nisolone acetate (Rafter 8 Products, Calgary, Alberta), 0.2 mg/kg CD3 (rabbit polyclonal raised against the human antigen; Dako) RAPPORTCAS DE BW, PO, q24h, was administered once the cytological diagnosis immunoreactivity of the neoplastic cells; however, scattered was received. The bird continued to have a good quality of life, lymphocytes within the renal interstitium showed strong cyto- showing no clinical signs of illness, until 2 mo later when it died plasmic immunoreactivity to CD3, acting as a species-specific acutely at home. The body was submitted for necropsy. positive control for this stain. MHC II (clone TAL.1B5, mouse On external postmortem examination, pronounced exoph- monoclonal raised against the human antigen; Dako) staining thalmos of the left globe and mild periocular swelling were was also performed, but there was no reaction with lymphocytes noted (Figure 2A). On internal examination, the left retrobulbar in the species control tissue or with the neoplastic cells. Based on region contained a 7-mm diameter soft, homogenous tan mass. the histologic and cytologic appearance of the neoplastic cells, There was diffuse pallor of multiple organs (liver, thyroid glands, and the positive MUM1 and negative CD3 staining, a diagnosis and kidneys) and marked hepatomegaly with rounded borders of B-cell lymphoma was made. and an irregular mottled pattern (Figure 2B). Approximately 6 mL of clear yellow fluid was present in the coelomic cavity Discussion along with fibrinous adhesions between the coelomic viscera This case describes the clinical, advanced imaging, cytologi- and air sacs. Representative samples were fixed in 10% neutral cal, and histological findings associated with a retrobulbar buffered formalin, paraffin embedded, and sections stained and systemic B-cell lymphoma in a yellow-collared macaw. It with hematoxylin and eosin. The entire head, after removal of highlights the importance of a complete and thorough medical the brain, was placed in formalin to be sectioned after fixation diagnostic work-up and how the utilization of advanced imaging and decalcification. and fine-needle aspiration of the liver may provide a method of On microscopic examination, there was an infiltrative round obtaining a diagnosis in a non-invasive manner in an unstable cell neoplasm present within multiple organs. Infiltrating neo- patient. The infiltrative and extensive nature of the disease was plastic cells had morphologic features of lymphoma, including defined through contrast CT. This superior imaging modality, distinct cell margins, abundant eosinophilic cytoplasm, round as compared to radiography, enabled appropriate planning and central to eccentric nuclei, clumped chromatin and prominent staging of diagnostics in this patient. nucleoli. Many neoplastic cells had prominent perinuclear Ultrasound is a simple and non-invasive way to obtain imme- clearing, consistent with a Golgi zone. Neoplastic cells replaced diate assessment of the globe and its associated orbital structures approximately 90% of the hepatic parenchyma (Figure 3B) and in mammals. The anatomical re-enforcement of the avian globe were present in the kidney, spleen, ovary, gastrointestinal serosa, by the scleral ossicles diminishes the value of ultrasound to cloacal submucosa, air-sac membranes, adrenal gland, and bone diagnose and characterize retrobulbar diseases, though it can be marrow. Bone marrow from the tibiotarsus was 100% cellular, useful in identifying diseases of the posterior eye segment (3). with erythroid and granulocytic lineages admixed with large Exophthalmos is more prevalent in birds than buphthalmos and cells resembling those described above. The distribution of the indicates a retrobulbar space occupying lesion or an extension abnormal cells was patchy, encompassing 5% to 25% of the of a malignant ocular neoplasia (4,5). Due to the complexity bone marrow, depending on the field of view. Of the normal of the anatomy of the structures of the head, advanced imaging resident marrow cells, the population was approximately 70% is more effective in delineating the topography of such lesions erythroid. Maturation of resident marrow cells appeared syn- than are radiographs and ultrasound. While CT was the imaging chronous. Vascular invasion was not identified in the sections modality of choice in this case, MRI could have been performed examined. The left retro-bulbar mass (Figure 3C) was composed instead. While MRI has a superior soft-tissue resolution, CT was of neoplastic cells similar to those described previously and selected in this case as the scanning time is much shorter than did not appear to invade the globe or enter the cranial vault. for MRI, it does not require specific monitoring equipment Incidental findings included type-III atherosclerosis in the great that is MRI-compatible, and the MRI resolution may be low vessels and carotid and brachial arteries (2), a schwannoma in for small birds using a conventional 1.5 T MRI. An additional the pectoral muscle and mild multifocal hemorrhage within the advantage of the rapid scanning rate of the CT is that a whole- koilin layer of the ventriculus. The heart showed no histological body scan can often be performed, allowing identification of evidence of disease. lesions in other organ systems as was seen in our case (6–8). Immunohistochemistry was performed to further identify Lymphoma is commonly observed in avian species and typi- the neoplastic cells. Strong positive nuclear and weaker cyto- cally involves the liver, spleen, and kidneys (9–11), although

710 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY infiltration of the globe and adnexal tissue (5,12–15), skin (16), procedures. The cause of sudden death in this case was likely and intestines (17,18) has also been identified. It is notable that multifactorial, with hepatic neoplasia and ascites both contrib- many cases of retrobulbar neoplasia, including the case presented uting. The causes of ascites may include liver failure (clinical herein, are associated with lesions in other organ systems with hypoproteinemia and elevated liver enzymes), portal hyper- either metastasis to the globe or periocular areas (lymphoma, tension, chronic passive congestion, or a secondary effect of carcinoma, round cell tumor) or compression of the central neoplasia. Gastric hemorrhage may have resulted in the anemia REPORT CASE nervous system (teratoma) (4,5,19,20). This emphasizes the need identified on initial evaluation. The schwannoma noted in the to perform a thorough diagnostic work-up, especially when the pectoral musculature and the mild atherosclerosis are considered retrobulbar mass is challenging to access and sample. Computed incidental findings. The heart histologically showed no evidence tomography was useful in assessing the extent of lesions in the of disease, suggesting that the arrhythmia was due to a metabolic case described here, as well as in a similar case of retrobulbar disturbance and or structural damage to the cardiac conduction round cell tumor reported in a macaroni penguin (15). Our system that was not evident histologically. As the bird died at case differs from that in the penguin in that the macaw’s tumor home, examination of peripheral blood was not undertaken in was disseminated rather than localized, and diagnosis was order to determine whether the bird was leukemic terminally. achieved using in vivo hepatic cytology rather than at necropsy. In the case described here, the cytologic and histologic Differential diagnoses for a retro-orbital mass, in addition to appearances of the neoplastic cells were most consistent neoplasia, include retrobulbar granuloma (e.g., aspergillosis, with a B-cell lymphoma with plasmacytoid differentiation. mycobacteriosis, avian chlamydiosis, foreign body, and other Immunohistochemistry is frequently used in domestic small bacterial or fungal granulomatous inflammation), hematoma, mammal medicine to confirm and or identify the precise nature and trauma causing soft tissue swelling. Definitive diagnosis of lymphoid malignancies (26). Limitation exists when apply- requires additional testing including cytology or histopathology; ing mammalian IHC regimens to the evaluation of tissue from however, imaging can be used to direct sampling. pet avian species as no antibodies have been created specifically The presentation of birds with hepatic disease can be non- for immune-labelling of psittacine lymphocytes, and cross- specific and highly variable, thus confirming a diagnosis reactivity may be poor. It is thus essential to include a positive often requires a multi-modal diagnostic approach (21,22). control tissue, ideally from the same animal or at least from Hepatomegaly may be identified on palpation, or visualized the same species, as well as positive and negative controls in directly through the transparent abdominal wall if the liver a species for which the antibodies have been validated. While extends beyond the keel or suspected based on generalized coe- CD3 appears immunoreactive with a range of avian species lomic distension (22,23). Alterations in biochemical parameters (11,15,17,27), antibodies used routinely as B-cell markers and/or radiographic changes suggestive of liver disease need to on mammalian tissue; i.e., CD20 (rabbit polyclonal; Thermo be followed by liver biopsy or fine-needle aspiration to defini- Scientific, Burlington, Ontario), and CD79a (clone HM57, tively diagnose and characterize hepatic disease (22,23). mouse monoclonal raised against the human antigen; Dako), Humoral hypercalcemia of malignancy, more specifically, do not react with avian lymphocytes in our experience. Hence, elevated ionized calcium levels in association with lymphoma, B-cell lymphoma has rarely been reported in the avian litera- has been well-described in cats and dogs (24,25). This associa- ture in comparison to cases confirmed as being of T-cell origin tion has not been established in avian species; however, total (18,27–29). One case report in an umbrella cockatoo (Cacatua hypercalcemia was reported in 2 Amazon parrots (Amazona alba) describes a cutaneous lymphoma of B-cell origin based on amazonica and Amazona aestiva) diagnosed with malignant immunoreactivity with a rabbit monoclonal BLA.36 antibody lymphoma (17). As ionized calcium was not measured, the pres- (30). To the authors’ knowledge staining of avian lymphocytes ence of hypercalcemia of malignancy could not be confirmed. with this antibody has not been consistent or reliable, and thus Total blood calcium levels were normal in the macaw described was not attempted in this case. The use of MUM1 antibody in the current report. for the identification of late phase B-lineage lymphocytes Coelioscopic examination and guided biopsy techniques and plasma cells in avian species has not been reported to our under general anesthesia are well-described in the literature. knowledge, but in this case provided strong nuclear staining in This particular individual was deemed to be a poor surgical neoplastic and control tissues. MUM1 staining was present in candidate due to elevated hepatic enzymes, previously identified tissues from 3 species of psittacine birds, suggesting that this arrhythmias, prolonged anesthetic recovery, and the presence of antibody may prove useful in differentiating lymphocytes in a marked hepatomegaly causing a coelomic mass-effect. As well, various members of the family Psittacidae. the owner was reluctant to pursue more invasive procedures. Chemotherapy and/or palliative radiation has been reported Consequently, fine-needle aspiration of the liver was performed. as a treatment for neoplasia, especially for lymphoma, in birds Ultrasound guidance was not necessary as the liver was readily (10,31). The umbrella cockatoo diagnosed with B-cell lymphoma visible under the skin just caudal to the sternum, and the CT was successfully treated with vincristine and chlorambucil (30). had provided an excellent overview of hepatic size and shape. Due to the poor prognosis in the case reported here, as well as the Aspiration cytology can vary in sample yield and diagnostic reluctance of the owner to pursue intensive medical treatments, accuracy but in this case, with financial constraints and a poor chemotherapy or radiation therapy was not attempted. surgical candidate, the technique allowed confirmation of In conclusion, CT and fine-needle aspiration were used to diagnosis without the need to perform more invasive biopsy investigate a retrobulbar mass and associated hepatic disease in a

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yellow-collared macaw. This case illustrates how useful advanced 22. Lumeij JT. Hepatology. In: Ritchie B, Harrison G, Harrison L, eds. imaging can be for defining retrobulbar lesions, which are dif- Avian Medicine: Principles and Application. Lake Worth, Florida: Wingers Publishing, 1994:522–537. ficult to assess using more traditional diagnostic methods, and 23. Grunkemeyer VL. Advanced diagnostic approaches and current manage- shows that retrobulbar masses can be associated with disease ment of avian hepatic disorders. Vet Clin North Am Exot Anim Pract in other organ systems; thus emphasizing the importance of a 2010;13:413–427. 24. Savary KCM, Price GS, Vaden SL. Hypercalcemia in cats: A retrospec- thorough and systemic diagnostic work-up regardless of present- tive study of 71 cases (1991–1997). J Vet Intern Med 2000:184–189. ing complaint. CVJ 25. Messinger JS, Windham WR, Ward CR. Ionized hypercalcemia in dogs: A retrospective study of 109 cases (1998–2003). J Vet Intern Med References 2009;23:514–519. 26. Burkhard MJ, Bienzle D. Making Sense of lymphoma diagnostics in . 1 Hawkins M, Barron H, Speer BLB, et al. Birds. In: Carpenter J, small animal patients. Clin Lab Med 2015;35:591–607. Marion C, eds. Exotic Animal Formulary. 4th ed. St. Louis, Missouri: 27. Osofsky A, Hawkins MG, Foreman O, Kent MS, Vernau W, Lowenstine Elsevier, 2013:184–438. RAPPORTCAS DE LJ. T-cell chronic lymphocytic leukemia in a double yellow-headed 2. Beaufrère H, Nevarez JG, Holder K, Pariaut R, Tully TN, Wakamatsu N. Amazon parrot (Amazona ochrocephala oratrix). J Avian Med Surg Characterization and classification of psittacine atherosclerotic lesions 2011;25:286–294. by histopathology, digital image analysis, transmission and scanning 28. Malka S, Crabbs T, Mitchell EB, et al. Disseminated lymphoma of electron microscopy. Avian Pathol 2011;40:531–544. presumptive T-cell origin in a great horned owl (Bubo virginianus). 3. Gumpenberger M, Kolm G. Ultrasonographic and computed tomo- J Avian Med Surg 2008;22:226–233. graphic examinations of the avian eye: Physiologic appearance, patho- 29. Kelly TR, Vennen KM, Duncan R, Sleeman JM. Lymphoproliferative logic findings, and comparative biometric measurement. Vet Radiol disorder in a great horned owl (Bubo virginianus). J Avian Med Surg Ultrasound 2006;47:492–502. 2004;18:263–268. 4. Freeman KP, Hahn KA, Jones MP, Petersen MG, Toal RL. Unusual 30. Rivera S, McClearen JR, Reavill D. Treatment of nonepitheliotropic presentation of an Amazon parrot (Amazona species) with hepatocellular cutaneous B-cell lymphoma in an umbrella cockatoo (Cacatua alba). carcinoma. Avian Pathol 1999;28:203–206. J Avian Med Surg 2009;23:294–302. 5. Rodriguez-Ramos Fernandez J, Dubielzig RR. Ocular and eyelid neo- 31. Graham J, Kent M, Théon A. Current therapies in exotic animal oncol- plasia in birds: 15 cases (1982–2011). Vet Ophthalmol 2014;18:1–6. ogy. Vet Clin North Am Exot Med 2004;7:775–781. 6. Platt SR. Evaluating and treating the nervous system. In: Harrison G, Lightfoot T, eds. Clinical Avian Medicine and Surgery. Palm Beach, Florida: Spix Publishing, 2005:493–518. 7. Gumpenberger M, Henninger W. The use of computed tomography in avian and reptile medicine. Semin Avian Exot Pet Med 2001; 10:174–180. 8. Morgan R. Magnetic resonance imaging of the normal eye and orbit of a screech owl (Otus asio). Vet Radiol Ultrasound 1994:362–367. 9. Coleman C. Lymphoid neoplasia in pet birds: A review. J Avian Med Surg 1995;9:3–7. 10. Reavill DR. Tumors of pet birds. Vet Clin North Am Exot Anim Pract 2004;7:537–560. 11. Schmidt V, Philipp HC, Thielebein J, Troll S, Hebel C, Aupperle H. Malignant lymphoma of T-cell origin in a Humboldt penguin (Spheniscus humboldti) and a pink-backed pelican (Pelecanus rufescens). J Avian Med Surg 2012;26:101–106. 12. Schnellbacher R, Wilson S. What is your diagnosis? Lymphoma. J Avian Med Surg 2010;24:241–244. 13. Ramos-Vara JA, Smith EJ, Watson GL. Lymphosarcoma with plasmacytoid differentiation in a scarlet macaw (Ara macao). Avian Dis 1997; 41:499–504. 14. Nevarez J, Doo-Youn C, Tully T. What is your diagnosis? J Avian Med Surg 2011;25:231–233. 15. Woodhouse S, Rose M, Desjardins D, Agnew D. Diagnosis of retrobulbar round cell neoplasia in a macaroni penguin (Eudyptes chrysolo- phus) through use of computed tomography. J Avian Med Surg 2014; 29:40–45. 16. Burgos-Rodríguez AG, Garner M, Ritzman TK, Orcutt CJ. Cutaneous lymphosarcoma in a double yellow-headed Amazon parrot (Amazona ochrocephala oratrix). J Avian Med Surg 2007;21:283–289. 17. de Wit M, Schoemaker NJ, Kik MJ, Westerhof I. Hypercalcemia in two Amazon parrots with malignant lymphoma. Avian Dis 2003;47: 223–228. 18. Souza MJ, Newman SJ, Greenacre CB, et al. Diffuse intestinal T-cell lymphosarcoma in a yellow-naped Amazon parrot (Amazona Ochrocephala Auropalliata). J Vet Diagn Investig 2008;20:656–660. 19. López RM, Múrcia DB. First description of malignant retrobulbar and intracranial teratoma in a lesser kestrel (Falco naumanni). Avian Pathol 2008;37:413–414. 20. Schelling S. Retrobulbar teratoma in a great blue heron (Ardea herodias). J Vet Diagn Investig 1994;6:514–516. 21. Jaensch S. Diagnosis of avian hepatic disease. Semin avian Exot Pet Med 2000;9:126–135.

712 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Case Report Rapport de cas

Syndrome of inappropriate antidiuretic hormone secretion in a dog with a histiocytic sarcoma

Anne-Charlotte Barrot, Agathe Bédard, Marilyn Dunn

Abstract — A 7-year-old female neutered Bernese mountain dog was presented in a semi-comatose state. Based on serum hypo-osmolality with inappropriate urine hyper-osmolality and urine sodium excretion, the dog was diagnosed with a syndrome of inappropriate antidiuretic hormone secretion secondary to a histiocytic sarcoma. This report describes the first case of this syndrome in a dog with histiocytic sarcoma.

Résumé — Syndrome de sécrétion inappropriée d’hormone antidiurétique chez un chien avec un sarcome histiocytaire. Une chienne stérilisée de 7 ans, Bouvier bernois, est présentée dans un état semi-comateux. Basé sur une hypo-osmolalité sérique associée à une hyper-osmolalité urinaire et une excrétion sodique urinaire toutes deux inappropriées, un diagnostic de syndrome de sécrétion inappropriée d’hormone antidiurétique secondaire à un sarcome histiocytaire est posé. Ce cas est le premier cas de ce syndrome chez un chien avec un sarcome histiocytaire. (Traduit par les auteurs) Can Vet J 2017;58:713–715

ntidiuretic hormone (ADH), also known as vasopressin, is the right stifle revealed a large amount of purulent material. A normally secreted in response to an increase in osmolality Culture of the synovial fluid identified growth of Staphylococcus or decrease in arterial pressure or intravascular volume. However, aureus susceptible to amoxicillin/clavulanic acid. Following a ADH secretion is considerably more sensitive to small changes diagnosis of septic arthritis of the right stifle, the dog was treated in osmolality than to similar changes in blood volume. If the with amoxicillin/clavulanic acid (Clavaseptin; Vétoquinol, extracellular fluid becomes too dilute (hypo-osmotic), ADH Lavaltrie, Quebec) and meloxicam (Metacam; Boehringer secretion is inhibited. Vasopressin increases the reabsorption of Ingelheim, Burlington, Ontario) per os. water in the collecting ducts of the kidneys and increases the The dog’s owners reported marked weakness at initial presen- permeability of the medullary collecting ducts to urea. tation, but further investigations were declined due to financial Syndrome of inappropriate ADH (SIADH) secretion is concerns. Following discharge, the dog became weaker and defined as vasopressin secretion independent of plasma osmo- increasingly lethargic. lality. The SIADH is characterized by hypotonic hyponatremia One week after initial presentation, the dog developed muscle and urinary hyper-osmolality in a normovolemic patient with twitches and became semi-comatose. She was brought to her normal thyroid, renal, and adrenal functions. family veterinarian and received intravenous fluids for 2 d: 3 L In this article, the authors present a case of SIADH secondary of isotonic fluid (Lactated Ringer’s Solution; Baxter, Mississauga, to disseminated histiocytic sarcoma. Ontario) and 500 mL of 5% dextrose with 0.9% NaCl, IV. Physical examination revealed the dog to be thin and in a Case description semi-comatose state but well hydrated. Her right knee had A 7-year-old female neutered Bernese mountain dog was pre- significant fibrosis and mild joint effusion. A joint tap revealed sented in a semi-comatose state with a history of septic arthritis normal synovial fluid. Systolic blood pressure was normal at of her right stifle. The patient was up-to-date on vaccinations, 120 mmHg. A neurologic examination revealed an altered not routinely dewormed, and had no travel history outside of mental state. Quebec, Canada. The dog was evaluated for a non-weight- Prior to IV fluid therapy, complete blood (cell) count (CBC), bearing lameness of the right hind limb and a joint aspirate of serum biochemistry, urine and serum osmolalities, urinary

Small Animal Clinic, Veterinary Teaching Hospital, Veterinary Medicine, University of Montreal, 3200 rue Sicotte, Saint Hyacinthe, Quebec J2S 7C6 (Barrot, Dunn); Charles River Laboratories Preclinical Services, Seneville, Quebec (Bédard). Address all correspondence to Dr. Anne-Charlotte Barrot; e-mail: [email protected] Dr. Barrot’s current address is CHV St. Martin, 275 Route Royale 74370 St. Martin, Bellevue, France. 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. Results of complete blood (cell) count (CBC), serum biochemistry, and urine specific gravity on days 1 and 2 Reference range Day 1 Day 2 (am) Day 2 (pm) CBC Hematocrit 37% to 57% 34 34 34 Lymphocytes 1.3 to 4.4 3 109/L 0.38 — — Eosinophils 0 to 0.6 3 109/L 0.77 — — Biochemical values pH 7.35 to 7.45 7.44 7.42 7.38 2 HCO3 20 to 28 mmol/L 19.9 19.4 20.7 Sodium 143 to 154 mmol/L 130.3 131.7 138.2 Chloride 108 to 117 mmol/L 101.3 107.1 110.9

RAPPORTCAS DE Potassium 3.5 to 5 mmol/L 4.52 4.11 4.15 Urea 2.09 to 7.91 mmol/L 4.3 3.8 3.5 Creatinine 58 to 127 mmol/L 80 72 70 Albumin 29 to 39 g/L 1.8 — — Serum osmolality 290 to 310 mOsm/kg 270.6 Total T4 13 to 38 nmol/L 11 — — Baseline cortisol 30 to 230 nmol/L 16.3 — — Cortisol 2 h post-ACTH stimulation 150 to 330 nmol/L 145 — — Urine analysis Specific gravity 1.035 to 1.045 1.043 — — Urine sodium values 20 mEq/L 41.5 — — Urine osmolality 150 mOsm/kg of water 1365

sodium excretion, thyroid level, and an ACTH stimulation test were conducted. The results of these tests are summarized in Table 1. Mild normocytic, normochromic anemia, lymphope- nia, and eosinophilia were present. A severe hyponatremia with normokalemia was observed. Measured serum osmolality was hypo-osmolar. Fluid therapy was initiated, half maintenance rate [1 mL/kg body weight (BW) per hour] was administered as isotonic fluid (Lactated Ringer’s Solution) the other half with hypotonic fluid (5% dextrose with 0.9% NaCl), in order to slowly increase natremia. Hyponatremia and hypochloremia improved with fluid therapy, but the dog remained semi-comatose. Magnetic resonance imaging (MRI) of the head and neck revealed a large bilobed mass at the base of the brain that occupied 100% of the pituitary fossa and measured 2.1 cm in length 3 2.2 cm in height, and 3 2.2. cm in width (Figure 1). Following administration of gadolinium by the IV route, Figure 1. Sagittal T1 flair-weighted brain MRI image after the mass showed immediate homogeneous enhancement that IV gadolinium administration showing a large mass (arrow) remained homogenous but became more moderate within the completely infiltrating the sella turcica. solid portion of the mass. Enhancement became more concentrated within the cystic portions of the mass and peripherally at the subarachnoid level (which confirmed the extra-axial location lobe and tracheobronchial lymph nodes were enlarged, irregular of the mass). This extra-axial mass caused marked compression (nodular), and had a white discoloration. Significant fibrosis was of the adjacent cerebral structures, particularly both lobes of the noted around the right stifle joint. thalamus. Vasogenic edema was also noted. Upon microscopic examination, an invasive, poorly encap- Based on serum hypo-osmolality with inappropriate urine sulated, necro-hemorrhagic, densely cellular mass was noted hyper-osmolality and urine sodium secretion, excessive ADH next to the adenohypophysis (unaffected); it infiltrated the secretion from the pituitary mass was most likely responsible pars nervosa, extended into the meninges, white matter, and for the dog’s severe electrolyte abnormalities. Given the poor Virchow-Robin’s spaces, and dorsally displaced the hypo- prognosis, the owners opted for euthanasia and a necropsy was thalamus and thalamus. Edema was noted in the white matter. conducted. Cellular features (reniform nuclei and multinucleate giant Upon gross examination, a poorly delineated, mottled mass cells) were suggestive of a histiocytic sarcoma. As a similar mass of approximately 1.5 cm diameter was noted below the left replaced the parenchyma of the right middle lung lobe and the thalamus, displacing it upwards and to the left, resulting in an tracheobronchial lymph nodes, disseminated histiocytic sarcoma asymmetry between both hemispheres. The right middle lung was the final diagnosis.

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Discussion The prognosis for patients with SIADH depends on the ability to resolve the underlying cause. In this case, the prognosis Causes of hyponatremia with low plasma osmolality and nor- was poor, as it was secondary to metastatic neoplasia. movolemia are SIADH, myxedema coma associated with severe This case report has some limitations. Ideally, a thyroid panel hypothyroidism, antidiuretic drug administration, hypotonic should have been done to conclude that the dog suffered from fluid infusion, or psychogenic polydipsia (1). Although this euthyroid sick syndrome. The mechanism of inappropriate ADH REPORT CASE dog received fluids, it is unlikely that this small amount of secretion in this patient is unknown. Serum ADH concentration hypotonic fluid in a 33-kg dog resulted in the hyponatremia, was not measured due to cost. Intracranial disease may directly especially given the comatose state already present. The last stimulate the supraoptic or paraventricular nuclei to secrete 3 causes were excluded by the dog’s history. The decrease in ADH or it may alter the osmoreceptors to inappropriately stim- thyroxine (T4) was most likely secondary to a euthyroid sick ulate ADH secretion. Ectopic production of ADH by the tumor syndrome. Hypoadrenocorticism was excluded by an adreno- is also possible (15). In our patient, the most likely mechanism corticotropic hormone (ACTH) stimulation test. Given the is that the tumor stimulated the supraoptic or paraventricular electrolyte abnormalities and the serum and urine osmolalities, nuclei to secrete ADH. SIADH was strongly suspected. This report describes a new finding of SIADH in a dog with The syndrome of inappropriate antidiuretic hormone secre- disseminated histiocytic sarcoma with pituitary involvement. tion is characterized by the autonomous secretion of ADH with- CVJ out any volume or osmotic stimuli, and by the unique finding of impaired water excretion with a normal sodium excretion (2–4). References The diagnosis of SIADH requires that the following criteria 1. DiBartola SP. Disorders of sodium and water — Hypernatremia and be met: hyponatremia and hypo-osmolality, urinary hyper- hyponatremia. In: DiBartola SP, ed. Fluid, Electrolyte and Acid-base Disorders in Small Animal Practice. 4th ed. St. Louis, Missouri: Elsevier, osmolality (. 150 mOsm/kg of water, urine sodium concentra- 2012:45–79. tion . 20 mEq/L, normovolemia, normal renal, adrenal, and 2. Chastain CB. Syndrome of inappropriate antidiuretic hormone. In: thyroid function, and normal acid-base and potassium balance Silverstein DC, Hopper K, eds. Small Animal Critical Care Medicine. St. Louis, Missouri: W B Saunders, 2008:304–306. (2). An abnormally high serum ADH concentration does not 3. Robertson GL. Antidiuretic hormone. Endocrinol Metab Clin North need to be confirmed (2,5,6). Am 30;2001:1–15. In humans, SIADH is the most frequent cause of hyponatre- 4. Robertson GL. Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis. Am J Med 2006;119 (7A): mia. It has been reported in association with neoplasia, central S36–S42. nervous system disorders, administration of certain drugs, and 5. Brofman PJ, Knostman KAB, DiBartola SP. Granulomatous amebic even pulmonary disease (1–3). To our knowledge, SIADH has meningoencephalitis causing the syndrome of inappropriate secretion of antidiuretic hormone in a dog. J Vet Intern Med 2003;17: only been reported in 8 dogs prior to this report (5,7–12). 230–234. These cases have been attributed to neurologic disorders (1 dog 6. Ellison DH, Berl T. The syndrome of inappropriate antidiuresis. New with amoebic meningoencephalitis, 1 dog with hydrocephalus, Engl J Med 2007;356:2064–2072. 7. Fleeman LM, Irwin PJ, Phillips PA, West J. Effects of an oral vasopressin and 1 dog with hypothalamic tumors), to heartworm infection receptor antagonist (OPC-31260) in a dog with syndrome of inappro- (1 dog), to liver disease (1 dog), to aspiration pneumonia and priate secretion of antidiuretic hormone. Aust Vet J 2000;78:825–830. also classified as idiopathic (2 dogs) (5,7–12). To our knowledge, 8. Houston DM, Allen DG, Kruth SA, Pook H, Spinato MT, Keough L. Syndrome of inappropriate antidiuretic hormone secretion in a dog. this is the first report of SIADH in animals due to a pituitary Can Vet J 1989;30:423–425. tumor. 9. Kang MH, Park HM. Syndrome of inappropriate antidiuretic hor- Treatment of SIADH needs to address the underlying cause. mone secretion concurrent with liver disease. J Vet Med Sci 2012;74: 645–649. Until this can be done, supportive treatment using intravenous 10. Shiel RE, Pinilla M, Mooney CT. Syndrome of inappropriate anti fluids with the goal of correcting the hyponatremia is initiated. diuretic hormone secretion associated with congenital hydrocephalus The semi-comatose state observed in this patient was likely in a dog. J Am Anim Hosp Assoc 2009;45:249–252. 11. Rijnberk A, Biewenga WJ, Mol JA. Inappropriate vasopressin secretion explained by the severe hyponatremia; therefore, fluid therapy in two dogs. Acta Endocrinol 1988;117:59–64. was initiated. As hyponatremia had probably been present for 12. Bowles KD, Brainard BM, Coleman KD. Syndrome of inappropriate more than 48 h, care was taken to prevent central pontine antidiuretic hormone in a bulldog with aspiration pneumonia. J Vet Intern Med 2015;29:972–976. myelinolysis (2,13). Natremia should not increase with treat- 13. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med 2000;342: ment by more than 10 mmol/L, q24h (14). For that reason, 1581–1589. half isotonic and half hypotonic fluids were administered at a 14. Willard M. Therapeutic approach to chronic electrolyte disorders. Vet Clin Small Anim Pract 2008;38:535–541. maintenance rate and the serum sodium along with electrolytes 15. Onitilo AA, Kio E, Doi AAR. Tumor-related hyponatremia. Clin Med were closely monitored. Res 2007;5:228–237.

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Industry News Nouvelles de l’industrie

Western Financial Insurance Company renamed Petline Insurance Company Economical Mutual Insurance Company, one of Canada’s vides Canadian pet owners with comprehensive, veterinarian- leading property and casualty insurance companies, today recommended coverage for dogs and cats. announced the completion of its previously-announced acquisi- Petline will remain headquartered in Winnipeg, ensuring tion of Western Financial Insurance Company (WFIC) and its consistency of service in maintaining its industry-leading prod- flagship brand Petsecure from Desjardins Group. ucts, sales force, customer experience and relationships with Concurrent with the acquisition, WFIC changed its legal veterinarians, shelters and breeders. name to Petline Insurance Company (Petline). The brand name “This transaction is a step in our growth plan, which includes Petsecure remains the same. increasing scale and diversification through acquisitions,” said Bringing the market leader in the growing Canadian pet Rowan Saunders, President and CEO of Economical Insurance. insurance industry into the Economical family of companies is consistent with the strategy of Economical and its focus on Contact: Petsecure Pet Health Insurance, 300–600 Empress profitable growth, both organic and by acquisition. With net Street, Winnipeg, MB R3G 0R5; Phone: 204-942-2999; website: written premiums exceeding $50 million in 2015, Petline pro- www.petsecure.com

Unique bilingual portal provides news, information, continuing education and an opportunity to shape the industry for Canadian veterinary practitioners, technicians, students and other industry stakeholders There’s a new go-to veterinary resource on the Internet. An tion with a veterinary medical panel that includes Dr. Martha easy-to-navigate online portal that was created with the needs Winhall, BSc, DVM and Dr. Allan Corber DVM, DABVP. of the veterinary community in mind. A website designed to “Our goal is for CommuniVETTM to be a truly inclusive deliver content in a fresh, engaging way — and with a uniquely community, and to become the new go-to online ‘learning- Canadian twist: CommuniVET.com and-connecting’ destination for all members of the veterinary Exclusive continuing education content available on clinic team,” says veterinary medical panel advisor Dr. Martha CommuniVET.com includes webinars, online tutorials, inter- Winhall. “We hope that veterinary students and other animal active case studies, and highlights from veterinary conferences, health professionals will also accept our invitation to join us. among other things. To help promote a sense of connectedness The portal is so diverse that anyone in the animal health indus- and partnership among all stakeholders in the Canadian veteri- try can benefit from membership.” nary industry, CommuniVETTM also posts news about industry Because of the nature of content posted on CommuniVETTM, developments, produces video profiles of Canadian specialists access is restricted to registered members. Membership is free, and highlights noteworthy achievements in the veterinary com- and requires the completion of an application form, available munity. Members are also given the opportunity to help shape on at CommuniVET.com the animal health industry by participating in online surveys, and may at times be invited to participate in online discussion groups. CommuniVETTM was developed by a team of seasoned Contact: CommuniVet, 1800 Corbusier Blvd, Suite 138, Laval, professionals with a passion for animal health, in close collabora- Quebec H7S 2K1; website: www.communivet.com

716 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Article

Equine recurrent uveitis in western Canadian prairie provinces: A retrospective study (2002–2015)

Lynne S. Sandmeyer, Bianca S. Bauer, Cindy Xin Feng, Bruce H. Grahn

Abstract — The objectives of this study were to determine the demographics of horses with equine recurrent uveitis (ERU) presenting to the Western College of Veterinary Medicine and to describe and compare the prognosis of ERU in the Appaloosa with that in other breeds. Horses diagnosed with ERU by a veterinary ophthalmologist between 2002 and 2015 were included. Eye lesions were classified as mild, moderate, or severe based on clinical manifestations. Breed, age, severity, blindness, and final outcome were evaluated. Thirty-two horses fit the inclusion criteria; 62.5% were Appaloosas. Mean age at presentation was 12.13 6 4.6 years. Equine recurrent uveitis was bilateral in 93.6% of horses and was severe in 59.4% of eyes at presentation. Bilateral blindness was present in 59.4% of horses at last follow-up. Of 27 horses available for follow-up, 63% were euthanized due to ERU. No significant differences in age, severity, blindness, or rate of euthanasia were noted between Appaloosas and other breeds. The Appaloosa is at increased risk for ERU, which is a devastating ocular disease.

Résumé — Uvéite équine récurrente dans les provinces de l’Ouest canadien : étude rétrospective (2002–2015). L’objectif de cette étude consistait à déterminer les données démographiques des chevaux atteints d’uvéite équine récurrente (UER) présentés au Western College of Veterinary Medicine et de décrire et de comparer le pronostic de l’UER chez les chevaux Appaloosa avec celui des autres races. Les chevaux diagnostiqués entre 2002 et 2015 comme étant atteints de l’UER par un ophtalmologiste vétérinaire ont été inclus. Les lésions à l’œil étaient classées comme étant légères, modérées ou graves selon les manifestations cliniques. La race, l’âge, la gravité, la cécité et le résultat final ont été évalués. Trente-deux chevaux correspondaient aux critères d’inclusion : 62,5 % étaient des chevaux Appaloosa. L’âge moyen à la présentation était de 12,13 ans 6 4,6 années. L’uvéite équine récurrente était bilatérale chez 93,6 % des chevaux et était grave pour 59,4 % des yeux à la présentation. La cécité bilatérale était présente chez 59,4 % des chevaux au dernier suivi. Parmi les 27 chevaux disponibles pour le suivi, 63 % ont été euthanasiés en raison de l’UER. Aucune différence significative au niveau de l’âge, de la gravité, de la cécité ou du taux d’euthanasie n’a été signalée entre les chevaux Appaloosa et les autres races. Les chevaux Appaloosa présentent un risque accru d’UER, qui est une maladie oculaire dévastatrice. (Traduit par Isabelle Vallières) Can Vet J 2017;58:717–722

Introduction ing in blindness (1). Three clinical forms of ERU have been described: classic, insidious, and posterior (1). Classic ERU is quine recurrent uveitis (ERU) is a common condition the most common form and is characterized by active inflamma- with worldwide distribution, high prevalence, and is the E tory episodes followed by periods of minimal observable ocular leading cause of blindness in horses (1). It is characterized by inflammation. Insidious ERU is characterized by constant and chronic insidious or recurring bouts of inflammation of the subtle intraocular inflammation that does not typically manifest uveal tissue which leads to secondary changes ultimately result- as outwardly painful episodes. The clinical impression is that the insidious form is most commonly seen in the Appaloosa Department of Small Animal Clinical Sciences (Sandmeyer, and draft breeds (1). In posterior uveitis the inflammation is pre- Bauer, Grahn), Large Animal Clinical Sciences (Feng), Western dominately in the posterior segment, and this syndrome is most College of Veterinary Medicine, University of Saskatchewan, common in Warmbloods, draft breeds, and horses imported 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4. from Europe to the USA (1). Address all correspondence to Dr. Lynne Sandmeyer; e-mail: The pathophysiology of ERU is complex and not completely [email protected] determined. It is known to be an autoimmune disease; however, Use of this article is limited to a single copy for personal study. the mechanisms of the inciting cause and recurrence of inflam- Anyone interested in obtaining reprints should contact the matory episodes are not completely understood. The associa- CVMA office ([email protected]) for additional tion of Leptospira spp. with ERU is well-known but not fully copies or permission to use this material elsewhere. understood (2–12). It is theorized that for at least some horses,

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infection with Leptospira spp. may be the inciting cause of uve- considered to have mild ERU. Eyes with signs of mild ERU itis (2–5,12,13). The cells infiltrating the uvea of horses with and 1 or more of posterior synechia, cataract, vitritis, or uveal ERU are predominantly CD41 T-cells and a T-helper type 1 pigmentation changes (depigmentation or hyperpigmentation) (Th1)-mediated disease process is implicated (14–17). As ERU were considered to have moderate ERU. Eyes with secondary has an immune-mediated pathogenesis, it is possible that the glaucoma, phthisis bulbi, retinal detachment, and/or blindness genetic make-up of the individual plays an important role in due to sequela of ERU were considered to have severe ERU. determining the susceptibility to potential inciting infections, Breed, age, severity, final outcome, and causes of blindness as well as the development and severity of subsequent uveitis were evaluated. If final outcome was not recorded in the medi- episodes. Genetic associations for ERU have been confirmed in cal record, owners were contacted to arrange for re-evaluation,

ARTICLE both the Appaloosa and the German Warmblood horse breeds if possible, or to determine if the horse had been euthanized and remain under investigation (18–20). due to ERU. The frequency of ERU in the Appaloosa horse is report- Statistical analysis was completed using SAS Version 9.3 soft- edly much higher than in the general population and uveitis is ware (StataCorp, College Station, Texas, USA). Outcomes for thought to be more severe and more likely to cause blindness in Appaloosa horses were compared to the combined outcomes of this breed (2,11,21). Although the overall prognosis for ERU is other breeds due to low numbers in the latter group. Median thought to be poor, objective data are limited to few retrospec- age was compared using the Kruskal-Wallis test. The Fisher tive studies reporting the long-term visual prognosis for the exact test was used to compare the stage of ERU at presenta- disease (2,11,22). These studies originate in the northeastern tion, the probability of having 1 or 2 eyes with blinding ERU and southeastern United States and there are no objective data at presentation and at final outcome, and to evaluate the prob- originating in Canada. The objectives of this study were to ability of euthanasia due to the diagnosis of ERU. The number determine the demographics of horses with ERU presenting to of Appaloosa horses diagnosed with ERU was compared to a referral center in western Canada, and to describe and com- non-Appaloosa horses with ERU within the total equine hospital pare the prognosis of ERU in the Appaloosa horse with that in population at risk, and for each breed presenting with ERU other breeds. using the Fisher exact test. Relative risk of Appaloosa horses versus non-Appaloosa horses having ERU was calculated for the Materials and methods at-risk population examined by the ophthalmology service. The A search of the medical records of the Western College “at-risk” population was designated as horses $ 4 y of age as this of Veterinary Medicine (WCVM) at the University of was the youngest age of horse diagnosed with ERU. Saskatchewan was completed to identify all horses with a confirmed diagnosis of ERU between the period of 2002 and Results 2015. Diagnosis of ERU required complete ocular examina- Thirty-two horses fit the criteria of the study; 20 (62.5%) tion performed by a Diplomate of the American College of Appaloosa horses, and 12 (37.5%) other breeds consisting Veterinary Ophthalmologists (DACVO). Ocular examination of 4 Quarter Horse (QH)/QH-cross, 3 Thoroughbred (TB)/ in all horses included neuro-ophthalmic examination, fol- TB-cross, 2 Pony of the Americas (POA), 1 miniature horse, lowed by sedation with IV xylazine hydrochloride (Rompun; 1 Percheron, and 1 Hanoverian. For the Appaloosa, 13 were cas- Bayer, Toronto, Ontario), 0.5 to 1.0 mg/kg body weight (BW) trated males and 7 were female. In other breeds 7 were castrated and auriculopalpebral nerve blocks performed using 2 mL of males and 4 were female. Age at presentation ranged from 4 to a 2% lidocaine hydrochloride injectable solution (Bimeda- 23 y. Mean age at presentation was 12.13 (6 4.6) y. Median age MTC Animal Health, Cambridge, Ontario). Schirmer tear test at presentation was not significantly different between Appaloosa (Schirmer Tear Test Strips; Alcon Canada, Mississauga, Ontario), horses (12 y) and other breeds (11.5 y). rebound (Tonvet; Tiolat, Helsinki, Finland) or applanation For horses that were not euthanized immediately after tonometry (Tonopen XL; Biorad Ophthalmic Division, Santa diagnosis, clinical follow-up ranged from 1 to 9 y (mean: Clara, California, USA), and fluorescein staining (Fluorets; 3.81 6 2.97 y). Information on final outcome with respect to Bausch & Lomb Canada, Markham, Ontario) were completed euthanasia was available for 27 horses; 3 Appaloosas, and 2 other on all horses. Direct transilluminator, biomicroscopic (Osram breeds were lost to follow-up. Serological testing for leptospirosis 64222; Carl Zeiss Canada, Don Mills, Ontario or SL-14, Kowa, was completed on 3 horses; 1 Appaloosa for which the result Tokyo Japan) and indirect ophthalmoscopic (Heine Omega 200; was negative and 2 non-Appaloosa horses for which there was a Heine Instruments Canada, Kitchener, Ontario) examinations positive leptospirosis titer ($ 1:400). were completed following mydriasis with tropicamide 1% solu- During the period under study, 145 Appaloosa horses were tion (Mydriacyl; Alcon Canada, Mississauga, Ontario). presented to the WCVM for all reasons of a total 5091 equine Equine recurrent uveitis was confirmed if there was presence consultations, accounting for 2.8% of the clinic population. of active uveitis in addition to historical or clinical evidence Within the Appaloosa breed, horses presenting with ERU of previous episodes or continuous uveal inflammation. Eyes represented 20 of 145 (13.8%) total Appaloosa consulta- were classified as having mild, moderate, or severe ERU based tion examinations performed in the hospital. Twelve of the on recorded clinical manifestations. Eyes with conjunctival 4946 non-Appaloosa horses presented to the WCVM with ERU hyperemia, aqueous flare, miosis, and ocular hypotony (defined (0.24%). The odds ratio (OR) for an Appaloosa horse presenting as # 10 mmHg or 10 mmHg difference between eyes) were to the hospital for ERU compared to the total non-Appaloosa

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Table 1. Odds ratio for equine recurrent uveitis (ERU) in other breeds relative to the Appaloosa Total Odds Breed WCVM ERU ratio 95% CI P-value Quarter Horse 2359 4 0.011 0.003, 0.033 , 0.001 Thoroughbred 694 3 0.027 0.005, 0.094 , 0.001 Miniature horse 50 1 0.128 0.003, 0.847 , 0.017 Percheron 78 1 0.082 0.002, 0.532 , 0.001 Hanoverian 32 1 0.203 0.005, 1.370 , 0.130a ARTICLE Pony of the Americas 6 2 3.092 0.264, 23.257 , 0.211a Total non-Appaloosa 4946 12 0.015 0.007, 0.034 , 0.001

CI — Confidence interval. a The odds of the Appaloosa horse presenting for ERU was significantly greater than for the overall non-Appaloosa hospital population and for all other breeds presenting for ERU with the exception of the Hanoverian and Pony of the Americas.

Table 2. Severity of equine recurrent uveitis (ERU) in eyes at presentation Severe Severe Classification bilateral bilateral (eyes) Severe Moderate Mild (presentation) (LFUa) Appaloosa 22/40 (55%) 10/40 (25%) 8/40 (20%) 8/20 (40%) 11/20 (55%) Others 16/24 (66.7%) 4/24 (16.7%) 2/24 (8.3%) 6/12 (50%) 8/12 (66.7%) Total 38/64 (59.4%) 14/64 (21.9%) 10/64 (15.6%) 14/32 (43.8%) 19/32 (59.4%)

a LFU — Last follow-up.

Table 3. Blindness at initial presentation and last follow-up Horses Horses Horses Horses Eyes Eyes unilateral unilateral bilateral bilateral Blindness (initial) (LFU)a initial LFU initial LFU Appaloosa 21/40 (52.5%) 27/40 (67.5%) 9/20 (45%) 7/20 (35%) 6/20 (30%) 10/20 (50%) Other 15/24 (62.5%) 20/24 (83.3%) 3/12 (25%) 2/12 (16.7%) 6/12 (50%) 9/12 (75%) Total 36/64 (56.2%) 47/64 (73.4%) 12/32 (37.5%) 9/32 (28.1%) 12/32 (37.5%) 19/32 (59.4%)

a LFU — Last follow-up.

hospital population was 65.79 [95% confidence interval (CI): Blindness was most commonly associated with cataract 31.47 to 137.52; P , 0.001]. The odds of the Appaloosa (26 Appaloosa eyes; 11 other breed eyes), phthisis bulbi horse presenting to the WCVM with ERU were significantly (13 Appaloosa eyes; 4 other breed eyes), and glaucoma greater than that of other breeds diagnosed with ERU with the (11 Appaloosa eyes; 4 other breed eyes) (Figure 1). Other exception of the POA, and Hanoverian (Table 1). Appaloosa noted sequelae of ERU included lens luxation (5 Appaloosa horses represented 26 of 178 (14.6%) equine ophthalmology eyes: 3 other breed eyes), posterior synechia (13 Appaloosa consultations and 20/26 (76.9%) Appaloosas examined by the eyes, 8 other breed eyes), and retinal detachment as diagnosed ophthalmology service were diagnosed with ERU. Of the horses by indirect ophthalmoscopy (4 other breed eyes). All blind eyes examined by the ophthalmology service, the relative risk of an had more than 1 sequela of ERU. Appaloosa being diagnosed with ERU was 9.74 (95% CI: 5.44 A variety of treatments were employed including topical to 17.44; P , 0.0001). (diclofenac, flurbiprofen) and systemic (flunixin meglumine, At presentation, ERU was bilateral in 30 (93.6%) and uni- phenylbutazone, aspirin) non-steroidal anti-inflammatory medi- lateral in 2 horses, both of which were TB breed. Both of these cations, topical corticosteroids (prednisolone acetate, dexameth- TB horses were available for re-evaluation examination and asone), topical atropine, and topical antiglaucoma medications ERU was confirmed to remain unilateral 2 and 8 y after initial when indicated (dorzolamide, dorzolamide/timolol). diagnosis. The majority of eyes were classified as having severe Three Appaloosa horses and 1 non-Appaloosa horse had ERU at presentation and severe bilateral ERU was present in 1 eye enucleated due to severe ERU. Euthanasia due to ERU most horses at last follow-up (Table 2). There were no signifi- was the final outcome in 17/27 (63%) (9 Appaloosa; 8 other cant differences in severity at presentation or at last follow-up breed) horses. Nine horses were euthanized at the time of initial between the Appaloosa and other breeds. diagnosis. Median time to euthanasia for other horses was 3.5 y The majority of eyes (56.2%) were blind at initial pre- (0.5 to 8 y). One Appaloosa was euthanized for reasons other sentation (Table 3). At initial examination, 24 of 32 (75%) than ERU but was bilaterally blind at the time. No significant horses were blind in one or both eyes and this increased to differences existed in rate of euthanasia due to ERU between 28 of 32 (87.5%) horses at last follow-up. There were no sig- Appaloosas and other breeds. nificant differences between the Appaloosa and other breeds Of the 6 Appaloosa horses known to be alive to date, related to blindness in one or both eyes at presentation and last 2 are bilaterally blind and 4 remain visual in both eyes; these examination. horses have been followed clinically for 6 mo to 2 y. Of the

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Figure 1. Clinical manifestations of severe equine recurrent uveitis. Photographs of a — Phthisis bulbi in the right eye of a 16-year-old Appaloosa; b — Miosis, cataract, and posterior synechia in an 8-year-old Thoroughbred; c — Secondary glaucoma in a 19-year-old Quarter Horse; d — Miosis, cataract and posterior synechia in an 8-year-old Thoroughbred.

3 non-Appaloosa horses known to be alive to date, 2 are uni- (56.2% compared to 28.4%) as well as bilateral blindness on laterally blind, the other visual in both eyes. These horses have follow-up (59.4% compared to 28.9%) was also noted in our both been followed clinically for 2 to 8 y. study. Similar to previous reports, blindness was most commonly associated with cataract, phthisis bulbi, and secondary Discussion glaucoma (2,11). At last follow-up 87.5% of horses (85% The prevalence of ERU in our hospital population was much Appaloosa and 91.6% non-Appaloosa horses) were blind in at higher in the Appaloosa horse (13.8%) compared to other breeds least 1 eye. This is higher than previous studies which reported (0.24%) and the OR for the Appaloosa presenting for ERU 43.8% and 63.4% of horses blind in one or both eyes (2,11). was very high compared to the general hospital population. Bilateral blindness occurred in 50% of Appaloosa horses and These numbers must be interpreted with caution as ophthalmic 75% of non-Appaloosa horses examined. The proportion of examinations were not completed on all horses presenting to the bilaterally blind Appaloosa horses in our study falls within the hospital and it is likely that ERU was present and undiagnosed range of 39% to 58% reported previously (2,11). However, we in some horses in the general population. The relative risk for report a much higher frequency of bilateral blindness in non- a diagnosis of ERU in the Appaloosas examined by the oph- Appaloosa horses compared to the 35.7% and 8.3% reported thalmology service was 9.74, demonstrating ERU was much previously (2,11). more likely to be diagnosed in the Appaloosa than in other The retrospective nature of this study did not allow us to breeds examined. Of the 32 horses with confirmed ERU, the objectively and assuredly assign a diagnosis of insidious, clas- Appaloosas represented 62.5% of the ERU population which is sic, or posterior uveitis. Most horses presented with moderate much higher than 24% and 25% reported in previous retrospec- to severe forms of the disease and some had never been treated tive studies (2,11). for ERU prior to referral. The resulting clinical manifestations Our study found a higher overall frequency of bilateral may represent insidious uveitis, or a classic form which was disease (93.5%) compared to a recent retrospective (67.5%) undiagnosed and untreated. Additionally, posterior uveitis may (11). A higher proportion overall of blind eyes at presentation not have been recognized due to the severity of anterior segment

720 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY disease. Diagnosis of the form of uveitis would have required cate a lack of early recognition of the condition, delayed referral, earlier referral, and long-term management which was not pos- and therefore diminished therapeutic options and success. sible in many of our cases. Although our study shows that ERU is more common in There may be many reasons for the noted disparities in our the Appaloosa, we could not retrospectively make objective study compared to previous reports. The age at presentation was conclusions regarding the number and breed of horses with virtually identical to previous reports; therefore, this is unlikely insidious versus classic ERU. The clinical impression is that the to have played a role (2,11). However, geographic location, horse insidious form of ERU is more common in the Appaloosa than ARTICLE population, and hospital case load are potential factors that may in other breeds. The reasons for this difference are unknown have impacted our results. The number of horses in our study but may reflect different pathogeneses. Recent investigations is smaller compared to previous reports; however, our study using a candidate gene approach identified 3 genetic markers employed strict inclusion criteria for ERU. The study by Dwyer significantly associated with insidious ERU in Appaloosa horses et al (2) investigated the association of leptospiral seroreactivity (18). These included a single nucleotide polymorphism (SNP) and breed with uveitis and blindness. The inclusion criteria were within intron 11 of the TRPM1 gene on ECA1, an MHC class I not limited to cases with confirmed recurrent or continuous microsatellite (472-260), and an MHC class II microsatellite uveitis. Thus, it is possible that a number of horses, which may (eqMHC1) both located in intron 1 of the DRA gene on ECA20 not have had ERU as we have defined it, were included in that (18). The relative risk of ERU was 2 to 3 times higher with each study and direct comparisons of visual outcome may not be allele for the TRPM1 SNP (18). The TRPM1 gene is responsible possible. In the report by Gerding et al (11) 46.2% of horses for the Leopard complex (LP) spotting patterns for which the with ERU received cyclosporine implants as a therapy for ERU Appaloosa has been selected (30,31). Expression of this gene (11). This therapy has been reported to reduce recurrence of is reduced in the retina and skin of Appaloosa horses (30,31). uveitis episodes and improve long-term maintenance of vision Reduced expression in the retina of LP/LP horses is the cause in horses with ERU (23). These devices are recommended for of congenital stationary night blindness (CSNB); however, its horses with vision and lacking significant ocular conditions sug- role in pigmentation is not understood (30–32). The TRPM1 gestive of advanced ERU and are not recommended for horses gene may play a role in immune function as it is also known to with active, inflamed eyes that cannot be controlled with topical be expressed in human B- and T-lymphocytes, monocytes, and or systemic anti-inflammatory medications (23). Cyclosporine hematopoietic cell lines (33,34); however, these potential roles implants were not available at the WCVM until the later years have yet to be investigated in the equine species. of our study; however, most horses in our study would not Although overall numbers of POAs within the hospital have fit the criteria for implantation due to severity as 59.4% population were low (6), our data suggest that the POA may of eyes presented in the severe stage of disease. Additionally, the also be overrepresented for ERU. The POA is a breed developed insidious nature of the disease seen commonly in the Appaloosa in the United States with a foundation stallion that was an may limit the utility of this therapy in the breed. Although we Arabian/Appaloosa/Shetland pony cross; POAs have characteris- were unable to apply an ERU classification, Appaloosa horses tic LP spotting patterns. Other breeds with LP spotting include accounted for 62.5% of ERU cases in this series and it is pos- the Knabstrupper, Noriker, American miniature, and British sible many of these horses had the insidious form of the disease. spotted pony. Increased risk of ERU has not been reported in The association of Leptospira spp. with ERU is well-known, these breeds; however, it may be worth investigating along with particularly Leptospira interrogans serotype Pomona; however, the potential role of TRPM1 in ERU. Anecdotally, there is a this association is not completely understood. It is theorized suggested association between severity of ERU and extent of that for at least some horses, infection with Leptospira spp. is the roaning in Appaloosa horses. Unfortunately, phenotype with inciting cause of uveitis (2,4,5,12,13). Its role in chronic recur- respect to spotting patterns and roaning was not available for rences of the disease is debated, but likely involves interaction most horses in this study and thus, a relationship of phenotype with the immune system (16,17,24–28). Previous studies have and ERU could not be determined. reported an increased incidence of vision loss in seropositive Our data also suggest over-representation of the Hanoverian horses, particularly in Appaloosas (2,11). Leptospira interrogans breed for ERU. This warmblood horse breed, which originates in serotype Pomona was reported to be enzootic in the equine Germany, is known to have a high frequency of ERU in which population in Saskatchewan in 1979; however, recent surveys heredity has been shown to play a role (19,20,35). There is an are lacking (29). Testing for leptospirosis was minimal at our association between ERU and equine MHC class I haplotypes practice and thus, conclusions regarding the potential role for in the Hanoverian (35). In addition, genome wide association this agent in ERU in our equine population cannot be made. studies (GWAS) have identified a significant SNP on ECA20 Equine recurrent uveitis has been shown to have signifi- located close to the candidate genes IL-17A, and IL-17F. The cant personal, occupational, and economic impact (11). IL-17 cytokine is pro-inflammatory and is associated with cell Unfortunately, euthanasia was the most common final outcome damage during autoimmune disease including uveitis (15,36). for most horses in this study. This was higher (63%) than in This study demonstrates that ERU in western Canadian 1 previous report (14.9%) and may be related to smaller num- Prairie Provinces is a devastating ocular disease that is most bers of horses, increased incidence of blindness, and differences commonly bilateral, frequently results in bilateral blindness, in economic status and decisions made by owners in different and that euthanasia is a common final outcome. Most horses regions (11). Poor outcomes for this population may also indi- present to veterinary ophthalmologists at middle-age with

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advanced stages of disease which may limit therapeutic options binding protein is similar to the spontaneous disease. Eur J Immunol and effectiveness. Thus, early recognition of the disease and 2002;32:2598–2606. 17. Deeg CA, Pompetzki D, Raith AJ, et al. Identification and functional referral may improve outcomes. The Appaloosa, and possibly the validation of novel autoantigens in equine uveitis. Mol Cell Proteomics POA and Hanoverian are over-represented for ERU in western 2006;5:1462–1470. Canada. Future investigation of the association of ERU with 18. Fritz KL, Kaese HJ, Valberg SJ, et al. Genetic risk factors for insidious equine recurrent uveitis in Appaloosa horses. Anim Genet 2014;45: LP as well as genes involved in immune system function may 392–399. improve our understanding of the pathogenesis of this disease 19. Kulbrock M, Lehner S, Metzger J, Ohnesorge B, Distl O. A genome- in the Appaloosa horse. wide association study identifies risk loci to equine recurrent uveitis in German warmblood horses. PLoS One 2013;8:e71619. 20. Kulbrock M, von Borstel M, Rohn K, Distl O, Ohnesorge B. Occur

ARTICLE Acknowledgments rence and severity of equine recurrent uveitis in warmblood horses — The authors acknowledge Drs. Laura Field and Vanessa Holly A comparative study. Pferdeheilkunde 2013;29:27–36. 21. Angelos J, Oppenheim Y, Rebhun W, Mohammed H, Antezak DF. for their contributions to data collection and analysis. CVJ Evaluation of breed as a risk factor for sarcoid and uveitis in horses. Anim Genet 1998;19:417–425. References 22. Dwyer A. Visual prognosis in horses with uveitis. In: Proc American Society of Veterinary Ophthalmology Annual Meeting, Chicago, Illinois. . 1 Gilger BC. Equine recurrent uveitis. The viewpoint from the USA. 1998:22–23. Equine Vet J Suppl 2010;37:57–61. 23. Gilger BC, Wilkie DA, Clode AB, et al. Long-term outcome after 2. Dwyer AE, Crocett RS, Kalsow CM. Association of leptospiral sero- implantation of a suprachoroidal cyclosporine drug delivery devices in reactivity and breed with uveitis and blindness in horses: 372 cases horses with recurrent uveitis. Vet Ophthalmol 2010;13:294–300. (1986–1993). J Am Vet Med Assoc 1995;207:1327–1331. 24. Verma A, Artiushin S, Matsunaga J, Haake DA, Timoney JF. LruA and 3. Davidson MG, Nasisse MP, Roberts SM. Immunodiagnosis of LruB, novel lipoproteins of pathogenic Leptospira interrogans associated Leptospiral uveitis in two horses. Equine Vet J 1987;19:155–157. with equine recurrent uveitis. Infect Immunol 2005;73:7259–7266. 4. Wollanke B, Gerhards H, Brem S, Kopp H, Meyer P. Intraocular and 25. Verma A, Kumar P, Babb K, Timoney JF, Stevenson B. Cross-reactivity serum antibody titers to Leptospira in 150 horses with equine recur- of antibodies agains leptospiral recurrent uveitis — Associated pro- rent uveitis (ERU) subjected to vitrectomy. Berl Munch Tierarztl teins A and B (LruA and LruB) with eye proteins. PLoS Negl Trop Dis Wochenschr 1998;111:134–139. 2010:4;e778. 5. Wollanke B, Rohrbach BW, Gerhards H. Serum and vitreous humor 26. Parma AE, Santisteban CG, Villalba JS, Bowden RA. Experimental antibody titers in and isolation of Leptospira interrogans from horses demonstration of an antigenic relationship between Leptospira and with recurrent uveitis. J Am Vet Med Assoc 2001;219:795–800. equine cornea. Vet Immunol Immunopathol 1985;10:215–224. 6. Pearce JW, Galle LE, Kleiboeker SB, et al. Detection of Leptospira inter- 27. Lucchesi PMA, Parma AE. A DNA fragment of Letpospira interrogans rogans DNA and antigen in fixed equine eyes affected with end-stage encodes a protein which shares epitopes with equine cornea. Vet equine recurrent uveitis. J Vet Diagn Invest 2007;19:686–690. Immunol Immunopathol 1999;71:173–179. 7. Deeg CA, Ehrenhofer M, Thurau SR, Reese S, Wildner G, Kaspers B. 28. Deeg CA. A proteomic approach for studying the pathogenesis of spon- Immunopathology of recurrent uveitis in spontaneously diseased horses. taneous equine recurrent uveitis (ERU). Vet Immunol Immunopathol Exp Eye Res 2002;75:127–133. 2009;128:132–153. 8. Faber NA, Crawford M, LeFebvre RB, Buyukmihci NC, Madigan 29. Carpio MM, Iversen JO. A serological survey of Leptospira interrogans JE, Willits NH. Detection of Leptospira spp. in the aqueous humor serotype Pomona in Saskatchewan horses. Can Vet J 1979;20:127–130. of horses with naturally acquired recurrent uveitis. J Clin Microbiol 30. Bellone RR, Brooks SA, Sandmeyer L, et al. Differential gene expression 2000;38:2731–2733. of TRPM1, the potential cause of congenital stationary night blindness 9. Brandes K, Wollanke B, Niedermaier G, Brem S, Gerhards H. Recurrent and coat spotting patterns (LP) in the Appaloosa horse (Equus caballus). uveitis in horses: Vitreal examinations with ultrastructural detection of Genetics 2008;179:1861–1870. leptospires. J Vet Med Ser 2007;54:270–275. 31. Bellone RR, Holl H, Setaluri V, et al. Evidence for a retroviral insertion 10. Brem S, Gerhards H, Willanke B, Meyer P, Kopp H. 35 leptospira iso- in TRPM1 as the cause of congenital stationary night blindness and lated from the vitreous body of 32 horses with recurrent uveitis (ERU). leopard complex spotting in the horse. PLoS One 8. 2013;8:e78280. Berl Munch Tierarztl Wochenschr 1999;112:390–393. 32. Sandmeyer L, Breaux CB, Archer S, Grahn BH. Clinical and electro- 11. Gerding JC, Gilger BC. Prognosis and impact of equine recurrent retinographic characteristics of congenital stationary night blindness uveitis. Equine Vet J 2016;48:290–298. in the Appaloosa and the association with the leopard complex. Vet 12. Gilger BC, Salmon JH, Yi NY, et al. Role of bacteria in the pathogenesis Ophthalmol 2007;10:368–375. of recurrent uveitis in horses from the southeastern United States. Am 33. Perraud AL, Knowles HM, Schmitz C. Novel aspects of signaling and J Vet Res 2008;69:1329–1335. ion homeostasis regulation in immunocytes. The TRPM ion channels 13. Niedermaier G, Wollanke B, Hoffmann R, Brem S, Gerhards H. their potential role in modulating the immune response. Mol Immunol Detection of leptospira in the vitreous body of horses without ocular 2004;41:657–673. disease and of horses with ERU using transmission-electron microscopy. 34. Schmitz C, Perraud AL. The TRPM cation channels in the immune Deutsche Tierarzliche Wochenschrift 2006;113:418–422. context. Curr Pharm Des 2005;11:2765–2778. 14. Romeike A, Brugmann M, Drommer W. Immunohistochemical studies 35. Deeg CA, Marti E, Gaillard C, Kaspers B. Equine recurrent uveitis is in equine recurrent uveitis (ERU). Vet Pathol 1998;35:515–526. strongly associated with the MHC class I haplotype ELA-A9. Equine 15. Gilger BC, Malok E, Cutter KV, Stewart T, Horohov DW, Allen JB. Vet J 2004;36:73–75. Characterization of T-lymphocytes in the anterior uvea of eyes with 36. Korn T, Bettelli E, Oukka M, Kuchroo VK. IL-17 and Th17 cells. Annu chronic equine recurrent uveitis. Vet Immunol Immunopathol 1999;71: Rev Immunol 2009;27:485–517. 17–28. 16. Deeg CA, Thurau SR, Gerhards H, Ehrenhofer M, Wildner G, Kaspers B. Uveitis in horses induced by interphotoreceptor retinoid-

722 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Article

Expected consequences of convenience euthanasia perceived by veterinarians in Quebec

Dominick Rathwell-Deault, Béatrice Godard, Diane Frank, Béatrice Doizé

Abstract — In companion animal practice, convenience euthanasia (euthanasia of a physically and psychologically healthy animal) is recognized as one of the most difficult situations. There is little published on veterinary perceptions of the consequences of convenience euthanasia. A qualitative study on the subject based on interviews with 14 veterinarians was undertaken. The animal’s interests in the dilemma of convenience euthanasia was taken into consideration, strictly from the point of view of the physical suffering and stress related to the procedure. The veterinarian’s goal was to respect the animal’s interests by controlling physical pain. Most often, veterinarians made their own interests and those of the owners a priority when considering the consequences of their decision to perform or refuse convenience euthanasia.

Résumé — Conséquences attendues de l’euthanasie de commodité selon les perceptions des médecins vétérinaires au Québec. En pratique des animaux de compagnie, l’euthanasie de commodité (l’euthanasie d’un animal en bonne santé physique et psychologique) est reconnue comme l’une des situations les plus difficiles. Il y a eu peu de travaux publiés sur les perceptions vétérinaires des conséquences de l’euthanasie de commodité. Une étude qualitative sur le sujet basée sur des entrevues auprès de 14 médecins vétérinaires a été entreprise. Les intérêts de l’animal dans le dilemme de l’euthanasie de commodité ont été pris en considération, strictement du point de vue des souffrances physiques et du stress lié à l’intervention. Le but du médecin vétérinaire consistait à respecter les intérêts de l’animal en contrôlant la douleur physique. Le plus souvent, les médecins vétérinaires jugeaient leurs propres intérêts et ceux des propriétaires comme étant prioritaires lors de la considération des conséquences de leur décision de réaliser ou de refuser l’euthanasie de commodité. (Traduit par Isabelle Vallières) Can Vet J 2017;58:723–728

Introduction discussion and request for euthanasia are raised for healthy animals (convenience euthanasia), differences in the veterinarian’s ecisions on euthanasia are known to be ethically challeng- perception of the animal are seen with regard to their decision ing in both human and veterinary medicine (1–3). Similar D (accepting versus refusing to perform the procedure). to physicians, veterinarians are trained to examine patients, These perceptions were the basis for a previous study on the diagnose diseases, and develop treatment plans. When animals animal’s status in veterinary medicine as well as the moral duties are in the final stages of disease, discussion between veterinarians of veterinarians toward animals (5). The role and consideration and owners about euthanasia is recognized as the next step (4). If of each major stakeholder (veterinarian, owner, animal) in decisions to accept or refuse convenience euthanasia were identified as core elements leading to a better understanding of the conve- Sciences cliniques (Rathwell-Deault), Centre Hospitalier nience euthanasia dilemma. In 2013, the American Veterinary Veterinaire (Frank), Pathologie et microbilogie (Doizé), Medical Association (AVMA) (6) published euthanasia guide- Université de Montréal Faculté de médecine vétèrinaire, lines including an algorithm to help address the morality of the 1200 rue Sicotte, Saint Hyacinthe, Quebec J2S 7C6; Université decision. Despite this publication, moral duties of veterinarians de Montréal — Faculté de médecine, Montreal, Quebec concerning convenience euthanasia are still not clearly defined (Godard). within the profession. Address all correspondence to Dr. Dominick Rathwell-Deault; Consequences resulting from either performing or refusing e-mail: [email protected] to perform convenience euthanasia could shed light on ele- Use of this article is limited to a single copy for personal study. ments that veterinarians consider important for their choice. Anyone interested in obtaining reprints should contact the For example, which stakeholder (veterinarian, owner, or ani- CVMA office ([email protected]) for additional mal) would be considered? This type of approach is based on a copies or permission to use this material elsewhere. method of professional dilemma analysis (7). The veterinarian

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would think about convenience euthanasia, taking into con- Table 1. Perceptions of veterinarians who agree or refuse to a sideration the consequences of the procedure. The goal of this proceed with convenience euthanasia study, therefore, was to describe the veterinarian’s opinion on Negative perceptions when Negative psychological impact (n = 8) expected consequences of convenience euthanasia. veterinarians agree to proceed Contribute to dilemma/vicious cycle with convenience euthanasia (n = 4) Materials and methods Positive perceptions when Profitability for veterinary business veterinarians agree to proceed (n = 6) Methodological approach with convenience euthanasia Control of the situation by veterinarians In order to obtain maximal data, an inductive approach previ- (n = 3) ously described was used (5). Perceived consequences of conve- Good relationship with the owner/trust (n = 3) ARTICLE nience euthanasia were obtained via semi-structured interviews consisting of open-ended questions on perceived consequences Negative perceptions when Does not change the end result for veterinarians refuse to proceed the animal (n = 13) of accepting or refusing convenience euthanasia. The interview with convenience euthanasia Judgment and lack of respect from ended with a scheduled period of discussion on the topic. This the owner (n = 6) inductive approach allowed an understanding and knowledge Contributes to the animal overpopulation (n = 4) of the various responses (8). The interview guide available from Uncertainty about the future of the the corresponding author was pretested and modifications were animal (n = 3) deemed unnecessary. The research ethical committee of the Transfers the problem to other sources (n = 3) Faculty of Medicine at the University of Montreal approved Pressure related to the profitability of this study. veterinary business (n = 3) Positive perceptions when Influence on the public and social Consequences of convenience euthanasia veterinarians refuse to proceed education (n = 7) Analysis of perceived consequences following convenience with convenience euthanasia Influence during the choice of employment (n = 5) euthanasia was chosen to describe the dilemma. This method is a The number in brackets indicates the number of veterinarians with that known to help professionals analyze problematic situations (9). perception. Categories were not mutually exclusive. This type of assessment is a frequent tool used to understand dilemmas in terms of different potential outcomes (7). More specifically, this approach assesses which stakeholders (veterinar- seem low, the sample size matched information in the pub- ian, owner, or animal) and stakeholder interests were taken into lished literature on the average number of interviews required consideration, in this case by the veterinarian. for saturation of information in non-probabilistic studies (11).

Population studied and sampling Data analysis The population of veterinarians for this research was limited The primary researcher audio recorded all interviews and then to those in the province of Quebec. General practitioners and transcribed the data using a word processing system (MSWord; specialized veterinarians were both included in the sample to Microsoft, Redmond, Washington, USA). A manual coding achieve data saturation. Saturation establishes when to stop of verbatim established the preliminary list of codes (10,12). data collection in order to avoid a waste of time and money The researcher created codes to represent the main ideas of the and allows generalization of results for a given population (10). discourse sections. Similar ideas from different participants were Veterinarians who practiced convenience euthanasia and then grouped together. The first 4 interviews allowed comple- veterinarians who refused to practice convenience euthanasia tion of the manual coding. Next, a software analysis program for ethical reasons were recruited. Participating veterinarians (QDA MINER; Provalis Research, Montréal, Québec) was used were familiar with the topic of convenience euthanasia in their to complete coding of all interviews. The coding list was con- practice. tinously adjusted to reflect any new idea identified throughout In order to target a specific population of veterinarians, a the data analysis process. Internal validity and accuracy of the non-probabilistic sampling method was elected. Choosing the coding technique were assessed using counter-coding and inverse participants would likely result in a more efficient collection coding procedures (5,10). First, coding done by an indepen- of in-depth information about the consequences related to the dant research assistant was compared to the researcher’s coding decision of accepting or refusing convenience euthanasia. (counter-coding). Consistency level (percentage on agreement) Participants were recruited using a snowball method as was 89% (10,12). Next, inverse coding was performed to ensure described in other publications (5,9). Veterinarians not practic- that all interview excerpts represented by a code were appropri- ing convenience euthanasia were initially recruited followed by ately categorized. Coding results were shown to be accurate. veterinarians practicing convenience euthanasia. Analysis of the results was then undertaken. As recommended for qualitative research, no initial limit on number of participants was established. Recruiting and inter- Results views were discontinued when data analysis indicated saturation Veterinarians’ evaluation of expected of information. Data analysis was performed throughout the consequences of convenience euthanasia period of data collection. Fourteen participants were interviewed Veterinarians were invited by direct questioning to describe their for 30 to 45 min. Although the number of participants may perceived consequences of convenience euthanasia. Veterinarians

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were asked about both the possibility of accepting and refusing that they did not have a choice, even if they did not share the convenience euthanasia regardless of their choice in private prac- position of their facility on the subject: tice. Veterinarians identified 3 major stakeholders: the animal, “(…) I didn’t think that I would be obliged to do an act the owner, and the veterinarian. Their perceptions were classi- that I didn’t agree with. I didn’t think that they would fied in different categories depending on whether they resulted impose this on me. I think that now, the only thing that in positive (desirable) or negative (undesirable) consequences. I do control in those situations is to insist that every Categories were not mutually exclusive. All 14 veterinarians ARTICLE animal be adequately sedated before euthanasia, so that answered. The results are shown in Table 1. the animals do not feel the stress related to the act…. But aside from the sedation, my boss does not let me refuse Impact of convenience euthanasia decisions on euthanasia of a patient.… They want consistency of deci- animal overpopulation sions made within their clinic. They even met with me Most veterinarians (n = 13) thought that their decision on con- once because I had been asking clients questions about venience euthanasia in private practice did not change the end the reason why they wanted their animal euthanized and result for the animal (Table 1). An owner faced with refusal of I was offering other solutions.” convenience euthanasia would find the service at another facility or could arrange for the death of the animal in some other way. Some veterinary facilities have a policy in place declining all cases of convenience euthanasia. Five veterinarians interviewed “I am thinking about what would happen if we refused to chose to work in those facilities partly because of the existence euthanize the animal. What will the owner do? The owner of such a policy (category “Influence during the choice of will go to the SPCA and the animal will stay there. He will employment” in Table 1). Those veterinarians liked the fact that not be adopted by another family and we as veterinarians they would not be pressured from their employer to proceed think that we saved the animal’s life.” with convenience euthanasia. Responses showed that a practice Three veterinarians shared this opinion and considered not policy of consistently refusing requests of convenience eutha- only that the end result for the animal would not change, but nasia was very important for some veterinarians when choosing that the refusal to proceed with convenience euthanasia would a workplace. also transfer the dilemma to another facility (category “Transfers the problem to other sources” in Table 1). Psychological impact of clinical decisions on Opinions were divided concerning the impact of the refusal convenience euthanasia to proceed with convenience euthanasia on pet overpopulation. Eight veterinarians reported on the negative psychological Four veterinarians thought that refusal would contribute to impact of the decision to proceed with convenience euthanasia increase the overpopulation in animal shelters (Table 1). For (Table 1). others, decisions of convenience euthanasia made in private Some veterinarians (n = 3) proceeded with convenience practice would have no impact on the overpopulation problem euthanasia because they stayed in control of the situation, in shelters. particularly on the outcome for the animals (Table 1). These veterinarians would therefore not feel the discomfort associated “Here we participate in the spaying program for stray with abandonment or cruel killing of the animal elsewhere. One animals of our town. It has been proven that when a town veterinarian performed euthanasia to ensure that the animal traps and kills every stray animal in its territory, the popu- would be put down humanely. Three veterinarians described lation of stray animals just comes back to what it was in a their discomfort with the uncertainty of the animal’s safety if short period of time.” convenience euthanasia was refused (Table 1). Refusing convenience euthanasia could have consequences for the animal Financial impact of clinical decisions with (potential tragic outcome elsewhere) and the veterinarian’s regard to convenience euthanasia psychological health (guilt as a result of potential tragic out- Some veterinarians (n = 6) reported that euthanasia was a come elsewhere for the animal). These veterinarians felt that if profitable activity for veterinary enterprises (Table 1). When they proceeded with convenience euthanasia, they were able to veterinarians agree to perform convenience euthanasia, it creates control the situation and the future of these animals. From that a substantial income for their veterinary clinic: perspective, convenience euthanasia was partly beneficial for the veterinarian’s psychological health. “The owners are business men. They are very good veterinarians, but they also are business men. Their philosophy Concept of shirking responsibilities about convenience euthanasia is if we do not perform it Four veterinarians stated that they were in a vicious cycle cre- here, the client will go somewhere else and he will pay ated by convenience euthanasia (Table 1). These veterinarians elsewhere, so it is better if he pays here.” thought that the practice of convenience euthanasia did not During the interviews, 3 veterinarians declared being pres- include any element that would discourage current or future use sured by their employer to accept every request for convenience of this service by the animal’s owner. The ease of access for con- euthanasia (category “Pressure related to the profitability of venience euthanasia could even lead owners to repeat the experi- veterinary enterprises” in Table 1). These 3 veterinarians believed ence every time they chose to get rid of an undesirable animal.

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The indirect influence of convenience euthanasia on the was the only one that respected the owner’s autonomy. It did veterinarian’s perception of moral responsibility was also high- not judge the depth of the owner’s reflection nor the quality of lighted. In fact, some veterinarians felt that when they pro- motivations related to the demand. Agreeing to euthanasia was ceeded with convenience euthanasia, they encouraged owners the only option if they wanted to maintain a good relationship to consider euthanasia as an acceptable method to get rid of with their clients. Three veterinarians saw their decision to agree their animal. These veterinarians also made a link between con- to convenience euthanasia as an opportunity to create trust and venience euthanasia and the fact that owners were transferring a strong relationship with their clients (Table 1). They could not responsibility for their animals to the professional. They believed conceive of a situation in which the owner would show up at that owners were not aware of the amount and importance of the practice and ask for convenience euthanasia without having

ARTICLE responsibilities associated with adopting a companion animal. previously analyzed the situation. They also saw this situation Veterinarians felt that owners asking for convenience euthanasia as an opportunity to create a good reputation with regard to were choosing the least complicated option to “get rid of the the quality of service. animal” and associated responsibilities. They did not research other options to resolve the problem. Discussion Each consequence listed by interviewed veterinarians was classi- “Euthanasia shows a degree of cowardice because the owner fied to represent the defended interest (Table 1). In a utilitarian asks someone else to take responsibility for the healthy approach the assessment of the morality of an action is done animal. It is the only method that he has found.” by evaluating consequences for all stakeholders. An action is Some veterinarians took charge of the animal even when they deemed moral if the outcomes are more positive than negative refused to euthanize. In other words, refusal of convenience for all stakeholders (13). The minor role and consideration given euthanasia did not force the owner to take any responsibility. to the animal in the convenience euthanasia dilemma (5) made Therefore, in both situations, there was a shift of responsibility some veterinarians consider the procedure as a service that is not for the animal from the owner to the veterinarian. necessarily contrary to the animal’s interest. In fact, management of the animal’s suffering for the [Ordre des médecins vétérinaires “(…) I remember one case; it was a couple with a young du Québec (OMVQ), Quebec veterinary licensing body] is an child. They decided to adopt a great Dane puppy. Before essential criterion of good veterinary practice. adopting the dog, they should have gotten information Veterinarians are expected to take all possible measures about great Danes. It is a big dog and he will grow faster to reduce an animal’s physical suffering (the only regulated than the child. They came for convenience euthanasia aspect of the dilemma). The OMVQ does not recognize con- when the dog was 6 months old, because he was playing venience euthanasia as an action against the best interest of too roughly with the child…. A great Dane is not just healthy animals. Death is not a welfare factor taken into con- great, he is going to eat a lot and he will need to play a sideration (trustee of the OMVQ, personal communication, lot also. It is not a delicate breed; he will wag his tail and February 4th, 2010). Yeates (11) disagrees and states that whip everything around. We did find a new home for welfare assessment of an animal takes into consideration all this puppy, because I refused to euthanize him. But once of the animal’s interests. Presence and absence of positive and again, who was stuck with the problem? We were! This is negative elements and their repercussions in the animal’s life are what pisses me off and in the long-term it is burdensome. necessary for welfare assessment. Death of an animal removes People do not take their responsibilities. They unload their positive elements from the animal’s life and should therefore responsibilities onto someone else.” be considered when assessing animal welfare (11). Lack of discussion on recognition of the animal’s inherent value of life Education of the owner and relationship in the veterinary profession was noted during this analysis. between the owner and the veterinarian Veterinarians interviewed raised concerns about physical suf- Seven veterinarians believed that their decision to refuse con- fering and stress related to the euthanasia procedure but did venience euthanasia made a difference in the way owners saw not discuss any other concern regarding the animal’s interests. the dilemma even if ultimately the animal would be put down For most veterinarians, an evaluation of animal welfare that one way or another (category “Influence on the public and would take into consideration the animal’s interests other than social education” in Table 1). By refusing euthanasia, these vet- those related to physical suffering was difficult. As reported by erinarians were creating an opportunity to talk with the owner Fraser (14), there is no accepted scale for animal welfare. Many about the dilemma and to explain the situation as experienced criteria could be judged as essential by one evaluator and not by the veterinarian. The owner was then more aware of the by another. The animal’s welfare could therefore be judged as dilemma and this discussion brought about a reflection related poor by one person and good by another. Even if the evaluators to the issue. However, other veterinarians (n = 6) did not share are members of the same profession, evaluation could differ this opinion about provoking a discussion with the owner on greatly from one to another. It is therefore conceivable that convenience euthanasia. They believed that by doing so, the veterinarians were less inclined to evaluate other aspects of the veterinarian was showing judgment and a lack of respect for animal’s interest due to a lack of guidelines. The interests of the owner’s moral values (Table 1). The only respectful decision all major stakeholders (veterinarian, owner, or animal) were for them was to accept convenience euthanasia. This decision considered at the time of decision. Convenience euthanasia

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seemed the best solution for the majority of veterinarians with Yeates’ and Main’s publication on the topic (20). They interviewed. concluded that the veterinarian’s opinions on refusing euthanasia It is important to highlight that even if this vision of conve- were based mainly on justifications related to the animal. In nience euthanasia is shared by most of the veterinarians inter- other words, veterinarians who were refusing euthanasia justified viewed, cases of convenience euthanasia are still considered dif- their decisions on animal-based reasons primarily. The concerns ficult situations to manage mostly as a result of the discrepancy related to owners were also important, but they were taken between personal and professional perceptions of the animal. into consideration secondarily. In this study most veterinarians ARTICLE Because veterinarians are pet owners themselves, they may be interviewed were practicing convenience euthanasia, so the main uncomfortable with convenience euthanasia which may arise decision scheme was reversed. from the value they perceive of animals in general (4).The dis- For some veterinarians, convenience euthanasia is a humane comfort also seemed to lead veterinarians to question themselves method to stabilize the situation of companion animal over- about the dilemma. Veterinarians showed a willingness to change abundance. In this study, description of the veterinarian’s moral their way to evaluate the animal’s interest within the profession. responsibility toward animals was only possible in terms of Evaluation of the convenience euthanasia dilemma revealed management of the animal’s physical suffering and stress control the importance of multiple allegiances for veterinarians. On one during the procedure. Veterinarians were thus respecting their hand, the importance of the owner’s motivations to justify their oath and commitment toward animals when they performed request of convenience euthanasia was raised (5). Veterinarians convenience euthanasia. As concluded in the previous article during their education learn to analyze and choose the treatment related to this study (5), veterinarians decided about conve- to obtain the best outcome for animals. It is thus understandable nience euthanasia based on their analysis of the owner-animal that veterinarians for different reasons will agree to euthanize bond. As most owner-animal bonds seen in private practice were the animal rather than refuse in a particular medical situation from the anthropocentric point of view, the animal’s interests (15). However, by definition, cases of convenience euthanasia were barely taken into consideration. From that perspective, are unique in that the best interests of the animal are not taken most veterinarians believed that they were not active participants into consideration. At first glance, the decision concerning in the dilemma of convenience euthanasia. In fact, with their convenience euthanasia creates a situation in which the ani- pain management, they felt that their ethical duties toward mal’s interests are not respected. This fact creates a stressful animals were met. situation and a negative psychological impact on veterinarians. This study provides a description of the consequences of The second component deals with psychological stress within convenience euthanasia, but does not assess the prevalence of the the field of veterinary medicine. Publications show that the act reported facts within the entire population of veterinarians in of euthanasia is not an element causing stress for veterinarians Quebec. Fourteen Quebec veterinarians expressed their opinions (16,17). The origin of the psychological stress surrounding and therefore these cannot be extrapolated to the entire Quebec the convenience euthanasia dilemma seems to arise from the veterinary population or any other veterinary population in conflict between the prioritization of the animal’s interests Canada. Information on similarities and differences within and the willingness to satisfy the owner (18). Results from our Canadian veterinary practices is lacking. Evaluation of expected study confirm this evaluation of the psychological impact of convenience euthanasia consequences on a larger scale in Quebec convenience euthanasia. Stress surrounding the decision was requires a quantitative evaluation of the concepts described in also amplified by the pressure of profitability coming from the this article. A quantitative study is currently underway. owner of the veterinary facility (19). The goal of this study was to describe the veterinarian’s The evaluation of negative and positive perceptions of accept- perception of consequences related to the decision of accepting ing or refusing to perform convenience euthanasia adds another or refusing convenience euthanasia, as experienced in their day- perspective. Many outlined consequences were emotional states to-day practice. Analysis of the veterinarians’ responses brought experienced by veterinarians such as psychological stress, impor- to light many components of the dilemma and led to a better tance to feel in control of the situation, and discomfort regard- understanding of this issue. Decisions on convenience eutha- ing the animal’s future. Those emotional states would be inter- nasia in practice are taken by evaluating the consequences and preted as favorable to the veterinarian’s interests. The negative interests of the veterinarian and the client/owner. The animal’s psychological impact also suggested that veterinarians worried interests are evaluated strictly from a physical suffering point about the animal’s interests (absence of physical suffering). of view. Therefore, veterinarians are accomplishing their duty Owner interests prevailed when evaluating the financial aspect toward animals with regards to convenience euthanasia. and the data concerning the client-veterinarian relationship. Little information was collected on the animal’s interests except Acknowledgments for stress control during euthanasia and appropriate pain man- We thank all the participating veterinarians interviewed for agement for physical suffering. No one talked about the healthy sharing their time, experience, and expertise. We also thank animal’s interests to live. The animal’s welfare presented in this Mr. Philippe Aubert Côté for his work during the counter- analysis of consequences did not include any aspect other than coding process. Funding was obtained from the Fonds en santé those related to stress, and physical pain and suffering. All others des animaux de compagnie de l’Université de Montréal and the (e.g., the animal’s desire to live) were missing from their evalu- Association des Médecins Vétérinaires du Québec (animaux de ation of consequences. These results are partly in accordance compagnie). CVJ

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References 10. Miles MB, Huberman AM. Analyse des données qualitatives. De Boeck Supérieur, 2003. . 1 Rebuelto M. Ethical dilemmas in euthanasia of small companion ani- 11. Yeates D. Death is a welfare issue. J Agric Environ Ethics 2010;23: mals. Open Ethics J 2008;2:21–25. 229–241. 2. Lamarne P. Éthique de la fin de vie: acharnement thérapeutique, eutha- 12. Van der Maren J-M. Méthodes de recherche pour l’éducation. De Boeck nasie, soins palliatifs. La bioéthique en question. 1999, Paris, France: Supérieur, 1996. Édition Élipse. 128. 13. Singer P. La libération animale. 1993, Paris, France: Grasset, 1993:382, 3. Malherbe J-P. Sujet de vie ou objet de soins/Introduction à la pratique [8] de pl. de l’éthique clinique. Fides, ed. Montréal, Québec: Fides, 2007:471. 14. Fraser D. Understanding Animal Welfare: The Science in its Cultural 4. Tannenbaum J. Veterinary Ethics: Animal Welfare, Client Relations, Context. UFAW Animal Welfare Series. Oxford, UK: Ames, Iowa: Competition and Collegiality. 2nd ed. St. Louis, Missouri: Mosby, 1995: Wiley-Blackwell, 2008:x, 324. xv, 615. 15. Rollin BE. Animal Rights and Human Morality. 3rd ed. Amherst,

ARTICLE 5. Rathwell-Deault DG, Doizé B, Frank D. Conceptualization of conve- New York: Prometheus Books, 2006:400. nience euthanasia as an ethical dilemma for Quebec veterinarians. Can 16. Bartham DJ, Baldwin DS. Veterinary surgeons and suicide: Influences, Vet J 2017;58:255–260. opportunities and research directions. Vet Rec 2008;162:36–40. 6. Leary S, Underwood W, Anthony R, et al. AVMA guidelines for the 17. Bartham DJ, Baldwin DS. Veterinary surgeons and suicide: A euthanasia of animals: 2013 edition. 2013. Available from: https://www. structured review of possible influences on increased risk. Vet Rec avma.org/KB/Policies/Documents/euthanasia.pdf Last accessed May 3, 2010;166:388–397. 2017. 18. Batchelor CE, McKeegan DE. Survey of the frequency and perceived 7. Legault GA. Professionnalisme et délibération éthique: manuel d’aide à stressfulness of ethical dilemmas encountered in UK veterinary practice. la décision responsable. Sainte-Foy, Québec: Presses de l’Université du Vet Rec 2012;170:19. Québec. 2010:xv, 290. 19. Main DC. Offering the best to patients: Ethical issues associated with 8. Poupart EA. La recherche qualitative, enjeux épistémologiques et the provision of veterinary services. Vet Rec 2006;158:62–66. méthodologiques. Gaëtan Morin: Montréal, 1997. 20. Yeates JW, Main DC. Veterinary opinions on refusing euthanasia: 9. Dépelteau F. ed. La démarche d’une recherche en sciences humaines. Justifications and philosophical frameworks. Vet Rec 2011;168:263. Les presses de l’Université Laval (Laval, Québec) et De Boeck Université (Louvain-la-Neuve, Belgique), 2009:417.

Book Review Compte rendu de livre

Saunders Handbook of Veterinary Drugs: noting. Familiar alphabetical organization by drug name and Small and Large Animals, 4th edition other aspects from the 3rd edition that are carried over into the 4th edition, particularly important conversion informa- Papich MG. Elsevier, St. Louis, Missouri, USA. 2016. 900 pp. tion, compatibility charts, and drug and brand name indices ISBN: 9780-3232-4485-8. $88.44 CDN. are recapped but in this version easier to peruse. I like how the book doesn’t separate into small and large animal specific drugs he newest edition of this book has some notable features but rather incorporates the differences in pharmacokinetics, T compared with the previous version. The addition of a pharmacodynamics, and dosing variations with respect to certain few new drugs, more in-depth information on drug mechanism species captured under one umbrella. of action, indications and clinical use will please the reader Although the book is compact and easy to navigate, it lacks who is looking for more knowledge besides a dosing regimen. specific drug dosing references and does not represent a species Precautionary information, including Adverse Reactions and Side comprehensive veterinary pharmacology source. As stated in the Effects, Contraindications, Precautions and Drug Interactions preface the handbook is geared toward the veterinary student, remains an emphasized section with supplementary information technician, and busy general mixed animal practitioner, and with included in most drug categories. The inclusion of human medi- that in mind the handbook is a welcome guide. However, after cines in which veterinary uses may or may not have been identi- critically evaluating the subtle nuances between the editions, this fied is also considerably useful, specifically material located in author’s point of view doesn’t necessitate an immediate purchase Precautionary Information which emphasizes what the veterinar- if the 3rd edition is sitting on your shelf. ian needs to look for when owners self-diagnose and medicate. Additional appendices (information for pharmacists) and brand Reviewed by Monica Rosati, BSc, DVM, DVSc, Dip ACVAA, names added to the Listing of Drugs According to Functional and Staff Anesthesiologist at Mississauga Oakville Veterinary Emergency Therapeutic Classification table is definitely a highlight worth Hospital and Referral Services, Oakville, Ontario.

728 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Article

Cardiovascular effects of constant rate infusions of lidocaine, lidocaine and dexmedetomidine, and dexmedetomidine in dogs anesthetized at equipotent doses of sevoflurane

Rafael Moran-Muñoz, Alexander Valverde, J.A. Ibancovichi, Carlos M. Acevedo-Arcique, Sergio Recillas-Morales, Pedro Sanchez-Aparicio, Jorge Osorio-Avalos, Julio Raul Chavez-Monteagudo

Abstract — This study evaluated the cardiovascular effects of a constant rate infusion (CRI) of lidocaine, lidocaine and dexmedetomidine, and dexmedetomidine in dogs anesthetized with sevoflurane at equipotent doses. Treatments consisted of T1-Lidocaine [loading dose 2 mg/kg body weight (BW), IV, and CRI of 100 mg/kg BW per min] at m m 1.4% end-tidal of sevoflurane (FESEV); T2-Dexmedetomidine (loading dose 2 g/kg BW, IV, and CRI of 2 g/kg BW per hour) and FESEV 1.1%; and T3-Lidocaine-Dexmedetomidine using the same doses of T1 and T2 and FESEV 0.8%. Constant rate infusion of lidocaine did not induce any cardiovascular changes; lidocaine and dexmedetomidine resulted in cardiovascular effects similar to dexmedetomidine alone. These effects were characterized by a significant (P , 0.001) decrease in heart rate, cardiac output, cardiac index, oxygen delivery, and pulmonary vascular resistance index, and a significant (P , 0.001) increase in mean and diastolic arterial pressure, systemic vascular resistance index, pulmonary arterial occlusion pressure and oxygen extraction ratio, compared with baseline values. In conclusion, a CRI of lidocaine combined with dexmedetomidine produces significant cardiovascular changes similar to those observed with dexmedetomidine alone.

Résumé — Effets cardiovasculaires des infusions constante de taux de lidocaïne, lidocaïne et dexmédétomidine, et dexmédétomidine chez chiens anesthésier at équipotent doses de sevoflurane. L’objet de cette etude a été la evaluation des effets cardo-vasculaires de la perfusion à debit continue (CRI) de lidocaïne, lidocaïene et dexmédétomidine, et dexmédétomidine en chiens anesthésiés avec sévoflurane dans équipotentiel dose. Les traitemets consistèrent á T1-Lidocaïne [dose de charge de 2 mg/kg, IV, et perfusion à debit continue (CRI) de m 100 g/kg/min] en 1,4 % en fin d’expiration du sévoflurane (FESEV); T2-Déxmédetomidine (dose de charge de m m 2 g/kg, IV, et perfusion à debit continue (CRI) de 2 g/kg/h) et FESEV 1,1 % et T3-Lidocaïne-Dexmédétomidine en utilisant la même dose de T1 et T2 et FESEV 0,8 %. Perfusion à debit continue (CRI) de lidocaïne ne induit pas aucun échange cardio-vasculaire; lidocaïne et dexmédétomidine resulta dans effets cardio-vasculaires similaires a dexmédétomidine seule. Ces effets caracterices par significative décroissance (P , 0,001) en fréquence cardiaque, le débit cardiaque, index cardiaque, la libération de l’oxygène, pulmonaire indice de résistance vasculaire, et significative accroissement de la moyenne a la pression artériele diastolique (P , 0,001), indice de résistance vasculaire systémique, et l’extraction d’oxygène. En somme, la perfusion à debit continue (CRI) de lidocaïne produit significative échange cardio-vasculaire similaire à ceux observe en itilisant seulement dexmédétomidine. (Traduit par les auteurs) Can Vet J 2017;58:729–734

Department of Veterinary Anesthesia, Analgesia and Pharmacology, Faculty of Veterinary Medicine. Universidad Autónoma del Estado de México, Toluca, México (Ibancovichi, Moran-Muñoz, Chavez-Monteagudo, Osorio-Avalos, Recillas-Morales, Sanchez-Aparicio); Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario (Ibancovichi, Valverde); Anesthesia and Analgesia Department, Small Animal Veterinary Teaching Hospital, Faculty of Veterinary Medicine. Universidad Autónoma de Yucatán, Merida, Yucatan, Mexico (Acevedo-Arcique). Address all correspondence to Dr. J.A. Ibancovichi; 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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Introduction and Company, New Jersey, USA) was aseptically placed into the cephalic vein. Anesthesia was induced via facemask using aintenance of general anesthesia with inhalational anes- a vaporizer setting of 8% of sevoflurane (Sevorane; Abbott thetics allows for adequate control of anesthetic depth M Laboratories, Bogotá, Colombia) and a fresh gas flow of and a fast recovery. However, a major concern is the dose- 4 L/min. Dogs were orotracheally intubated and attached to dependent cardiopulmonary depression that occurs with higher a circle anesthetic rebreathing system (Fabius; Dragër Medical concentrations of inhalational anesthetics. The inclusion of an GmbH 23542, Lübeck, Germany), placed in lateral recumbency injectable analgesic and/or sedative and/or anesthetic drug allows and mechanically ventilated with intermittent positive-pressure a more balanced technique and may result in a sparing effect on ventilation (IPPV) to maintain eucapnia (35 to 40 mmHg end the minimum alveolar concentration (MAC) of the inhalational ARTICLE tidal CO ). Monitoring included end-tidal sevoflurane and anesthetic with a potential reduction in the dose-dependent 2 CO concentrations using a side-stream infrared gas analyzer adverse effects (1–4). 2 (Dräger Vamos; Dräger Medical GmbH) with the sampling Alpha 2-adrenergic agonists, such as dexmedetomidine and port attached between the endotracheal tube and the breathing medetomidine, have been included as part of balanced anesthetic system. The anesthesia monitor was calibrated each morning techniques in dogs and other species, due to their analgesic and using a calibration gas specifically designed for this purpose inhalational anesthetic sparing effects (2,4–11). Their profound (DOT-34 NRC 300/375M1014; Datex-Ohmeda Division, effects on the cardiovascular system at doses used commonly in Helsinki, Finland). Anesthesia was maintained with sevoflurane veterinary practice include a decrease in cardiac output, heart vaporized in 100% oxygen with a flow rate of 2 L/min and the rate, sympathetic tone, and an increase in afterload from increases end-tidal concentration (FE ) maintained at 2.8% while the in systemic vascular resistance, which may result in an increase in SEV instrumentation was completed. systemic and occasionally pulmonary pressures (11–18). These An isotonic fluid solution (Hartman Solution, HT, Pisa effects can be minimized and shortened when low doses are Agropecuaria, Mexico) was administered at a flow rate of administered in humans and dogs (2,5,7,10,14,18–21). 3 mL/kg body weight (BW) per hour through the cephalic cath- Lidocaine has been used intravenously as an analgesic during eter by use of an infusion pump (Colleague; Baxter Healthcare surgery and for its MAC sparing properties with minimal cardio- Corporation, Deerfield, Illinois, USA). An electrocardiogram vascular effects in dogs and horses (3,4,22–27). The cardiorespi- (lead II) for heart rate (HR) and rhythm was continuously ratory effects of a combination of lidocaine and medetomidine as monitored by placing electrodes at the level of the elbows a constant rate infusion (CRI) for balanced anesthesia have been and left patella, and a pulse oximeter probe attached to the determined in horses and included higher blood pressure, less dog’s tongue (BeneView T8; Shenzhen Mindray Bio-Medical inotropic support, lower inhalational anesthetic requirements, Electronics, Shenzhen, China). A 22-gauge catheter was asepti- and similar cardiac index when compared to a control group cally placed in the dorsal metatarsal artery and attached to a (6,28). The MAC sparing effects for isoflurane and sevoflurane of transducer (DTX plus DT 4812; Becton Dickinson Critical a combination of CRIs of lidocaine and dexmedetomidine have Care Systems, Singapore). The transducer was previously veri- been determined in dogs (29,30), but not the cardiopulmonary fied against a mercury manometer at 50, 100, and 200 mmHg, effects of these CRIs with sevoflurane. The purpose of this study and zeroed at the level of the manubrium for direct monitoring was to investigate if the benefits observed in other species from of arterial blood pressure [systolic (SAP), diastolic (DAP), and CRIs of lidocaine and/or dexmedetomidine combined with mean (MAP)]. Blood was collected and placed into lithium inhalational anesthetics are also present in dogs anesthetized heparin syringes (A-Line; Becton, Dickson and Company, with sevoflurane at equipotent doses. Our hypothesis was that Oxford, UK), for determination of pH, arterial partial pressure in sevoflurane-anesthetized dogs, a CRI of dexmedetomidine of carbon dioxide (PaCO ) and oxygen (PaO ), packed cell vol- with or without lidocaine is characterized by dexmedetomidine 2 2 ume, hemoglobin, bicarbonate, lactate, and glucose at the dog’s cardiovascular effects, compared with a CRI of lidocaine alone. corrected body temperature, using a blood gas analyzer (GEM Premier 3000; Instrumentation Laboratory, Warrington, UK). Materials and methods The gas analyzer was calibrated before each experiment by using Animals 2 aqueous buffered solutions containing precise concentrations

Three male and 3 female adult mixed breed neutered dogs, of CO2 and O2. 3.4 6 0.8 y old (mean 6 SD), weighing 18.4 6 5 kg were A 7-Fr 4 lumen 110 cm Swan-Ganz catheter (Arrow Balloon included in a prospective randomized crossover experiment with Thermodilution Set; Arrow International, Morrisville, North a 2-week washout period between treatments. Dogs were healthy Carolina, USA) was introduced through the jugular vein using based on medical history, physical examination, complete blood an introducer (Introducer kit; Arrow International) for deter- (cell) count (CBC), and serum biochemical analysis. The Animal mination of cardiac output (CO) by thermodilution (COM-1 Research Ethics Committee of the Universidad Autónoma de Cardiac Output Computer; Edwards Life Sciences, Irvine, Mexico approved this study (protocol # DCARM-1412). California, USA). The distal port of this catheter was connected to another pressure transducer and advanced into the pulmonary Anesthetic procedure and instrumentation artery using the characteristic pressure wave changes associated Food but not water was withheld for 8 h prior to each anes- with the right ventricle and pulmonary artery. The transducer thetic procedure. A 20-gauge catheter (BD; Becton Dickinson was connected to the distal port of the Swan-Ganz catheter,

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zeroed at the level of the manubrium to allow measurement of in the same concentrations of each drug as for the LID and mean pulmonary arterial pressure (MPAP) and pulmonary arte- DEX groups. These concentrations correspond to an infusion rial occlusion pressure (PAOP), and switched to the proximal rate of 0.05 mL/kg BW per min of any of the solutions. The

port for measurement of central venous pressure (CVP). For FESEV was decreased for each treatment to 1.4% for group CO determinations, 5 mL of dextrose (Dextrose 5%; Solution LID, 1.1% for group DEX, and 0.8% for group LID-DEX, DX-5; Pisa Farmaceutica, Mexico City, Mexico) iced to a based on MAC equipotent doses previously determined (30).

temperature of 1°C to 4°C was rapidly hand-injected into the A second set of measurements was completed after 45 min of ARTICLE proximal port of the Swan-Ganz catheter at end-expiration. At CRI administration. each measurement time, 3 consecutive measurements that were For recovery from anesthesia the CRIs and sevoflurane within 10% of each other were recorded and their average taken administration were discontinued. Upon return of reflexes and as CO (L/min). The thermistor on the Swan-Ganz catheter was spontaneous breathing, the dogs were disconnected from the used to measure core body temperature (T), which was main- anesthesia machine and extubated when a swallowing reflex was tained between 37.5°C and 38°C. Samples of mixed venous present. After recovery, dogs received carprofen (Rimadyl; Pfizer blood were anaerobically collected for gas analysis. Animal Health, Capelle a/d I Jssel, The Netherlands) 4 mg/kg BW, SQ, q24h for 2 d. All dogs were rehomed after this experi- Experimental protocol and measurements ment was completed.

The FESEV was adjusted to 1.8% after instrumentation and maintained for 30 min to establish baseline values for CO, Statistical analysis HR, CVP, SAP, DAP, MAP, and MPAP. From these values, the Statistical analysis was performed using Prism 6.0 computer following parameters were calculated: software (GraphPad Software; La Jolla, California, USA). The • cardiac index (CI) (mL/min per kg BW), CI = CO/BW; Shapiro-Wilk test was used for the assessment of normality. Data • stroke volume index (SVI; mL/beat per kg BW), were examined with a 2-way repeated measures analysis of vari- SVI = CI/HR; ance (ANOVA) to compare the effect of treatment with baseline • pulmonary vascular resistance index (PVRI; mmHg/mL and for comparisons between treatments. The Holm-Sidak test per min per kg BW) = [(MPAP — PAOP)/CI]; was used for multiple comparisons between means of treatments • systemic vascular resistance index (SVRI; mmHg/mL (32). Data are reported as mean 6 standard deviation (SD). per min per kg BW) = [(MAP — CVP)/CI]; Statistical significance was accepted at P , 0.05.

• oxygen delivery (DO2; mL O2/min per kg BW) = 3 Results (CaO2 CI)/100), where CaO2 (arterial oxygen content 3 3 1 in mL O2/dL) = (Hemoglobin Saturation 1.34) Baseline values for each of the 3 treatments were completed 3 (0.0031 PaO2); approximately 45 min after induction (Table 1). Following the • oxygen consumption (VO2; mL O2/min/kg BW) = dexmedetomidine CRI administration, HR, CO, CI, PVRI, 3 [(CaO2 — CmvO2) CI]/100, where CmvO2 (mixed and DO2 were significantly decreased with respect to base- 3 , venous oxygen content in mL O2/dL) = (Hemoglobin line in both the DEX and LID-DEX groups (P 0.0001) 3 1 3 , Saturation 1.34) (0.0031 PvO2); and and the LID CRI group; whereas MAP (P 0.0005), DAP 3 , , , • oxygen extraction ratio (ERO2; %) = (VO2/DO2) 100 (31). (P 0.0005), PAOP (P 0.0001), SVRI (P 0.0001), and , Each dog received 1 of the following 3 treatments on sepa- O2ER (P 0.0001) were significantly increased in both the rate anesthetic occasions, assigned by a randomization scheme DEX and LID-DEX groups with respect to baseline and the (http://www.randomization.com). T1-Lidocaine (LID)-loading LID group. All dogs receiving dexmedetomidine (DEX) showed dose of lidocaine (Lidocaína 2% Inyectable: Pisa, México), second-degree atrioventricular block in the first 20 min after 2 mg/kg BW, IV, followed immediately by a CRI of 100 mg/kg administration. BW per min; T2-Dexmedetomidine (DEX)-loading dose of Arterial blood gas values, lactate, and glucose were within dexmedetomidine (Dexdomitor; Orion Corporation, Espoo, normal range and not significantly different between groups. Finland), 2 mg/kg BW, IV, followed by a CRI of 2 mg/kg BW Mean and SD lower and upper values were 7.38 6 0.004 and per hour; and T3-Lidocaine-Dexmedetomidine (LID-DEX) 7.39 6 0.009 for pH, 35 6 1.0 and 37 6 1.2 mmHg for 6 6 6 at the same doses as T1 and T2. Loading doses were diluted PaCO2, 487 25 and 503 16 mmHg for PaO2, 22 1 and up to a final volume of 3 mL with sterile water and injected 23 6 2 mmol/L for bicarbonate, 1.0 6 0.1 and 1.1 6 0.1 mmol/L over 10 s. Treatments for the CRI were diluted into 60 mL for lactate, and 9.1 6 2.0 and 9.8 6 1.1 mmol/L for glucose. of saline (Saline 0.9%; Solution DX-CS; Pisa Farmaceutica) and delivered using a pump infusion device (Colleague; Baxter Discussion Healthcare Corporation). The solution for the LID group was In this study equipotent anesthetic doses of LID-DEX and DEX prepared by adding 6 mL of lidocaine 2% to 54 mL of saline, in combination with sevoflurane in dogs resulted in similar resulting in 2 mg of lidocaine per mL. For the DEX group, cardiovascular effects, characterized by significant increases 0.08 mL of dexmedetomidine 0.05% was added to 59.9 mL in SVR and MAP, with concomitant decreases in HR and of saline, resulting in 0.66 mg of dexmedetomidine per mL. CO, compared with an equipotent dose of LID combined For the LID-DEX group, 6 mL of lidocaine and 0.08 mL of with sevoflurane, which did not induce any alterations in dexmedetomidine were added to 53.9 mL of saline, resulting cardiovascular parameters. The cardiovascular effects in the

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Table 1. Baseline and 45-minute post-treatment cardiopulmonary parameters of 6 dogs anesthetized with sevoflurane and administered lidocaine (T1-LID), dexmedetomidine (T2-DEX), or the combination lidocaine-dexmedetomidine (T3-LID-DEX). Dogs were administered an IV loading dose of lidocaine, 2 mg/kg BW, followed by a CRI of 100 mg/kg BW per min (T1-LID and T3-LID-DEX), and an IV loading dose of dexmedetomidine, 2 mg/kg BW, followed by a CRI of 2 mg/kg BW per hour (T2-DEX and T3-LID-DEX). Data are expressed as mean 6 SD Parameters Baseline T1 T1-LID Baseline T2 T2-DEX Baseline T3 T3-LID-DEX 6 6 6 6 6 6 FESEV % 1.82 0.17 1.3 0.08 1.82 0.17 1.1 0.23 1.82 0.17 0.78 0.14 HR (beats/min) 112 6 11 115 6 13 116 6 14 68 6 6a,b 115 6 13 74 6 7a,b CO (L/min) 3.3 6 0.5 3.3 6 0.4 3.3 6 0.4 1.9 6 0.2a,b 3.4 6 0.5 2.0 6 0.2a,b CI (mL/min per kg BW) 178 6 27 178 6 22 179 6 23 103 6 11a,b 184 6 28 108 6 11a,b SAP (mmHg) 118 6 10 117 6 9 117 6 9 119 6 11 119 6 11 117 6 10 ARTICLE DAP (mmHg) 77 6 2 81 6 3 76 6 5 90 6 5a,b 77 6 5 91 6 6a,b MAP (mmHg) 90 6 2 92 6 2 89 6 6 98 6 3a,b 91 6 7 99 6 4a,b CVP (mmHg) 3 6 0.4 3 6 0.2 3 6 0.7 4 6 1.0 3 6 0.8 4 6 1.0 SVI (mL/beat per kg BW) 1.6 6 0.2 1.5 6 0.4 1.5 6 0.7 1.5 6 0.7 1.6 6 0.8 1.5 6 0.6 MPAP (mmHg) 14 6 0.4 14 6 0.5 14 6 0.8 15 6 0.7 14 6 1 14 6 0.4 PAOP (mmHg) 5.6 6 0.5 7.0 6 1.0 5.5 6 0.4 12.0 6 1.1a,b 5.7 6 0.6 11 6 0.7a,b SVRI (mmHg/mL per min per kg BW) 0.49 6 0.06 0.50 6 0.08 0.48 6 0.03 0.91 6 0.02a,b 0.45 6 0.03 0.88 6 0.03a,b PVRI (mmHg/mL per min per kg BW) 0.05 6 0.006 0.04 6 0.005 0.05 6 0.003 0.03 6 0.003a,b 0.05 6 0.002 0.03 6 0.003a,b 6 6 6 6 a,b 6 6 a,b DO2 (mL/min per kg BW) 30.3 1.5 29.3 2.0 30.5 1.6 19.9 2.0 29.6 1.1 20.5 1.7 6 6 6 6 6 6 VO2 (mL/min per kg BW) 5.0 0.4 5.0 0.5 5.0 0.4 5.4 0.4 5.0 0.4 5.2 0.4 6 6 6 6 a,b 6 6 a,b O2ER (%) 16.5 2.7 17.1 2.5 16.4 2.5 27.1 2.0 16.9 2.7 25.4 2.4 T (°C) 38.2 6 0.2 38.1 6 0.1 38.2 6 0.1 38.1 6 0.2 38.2 6 0.2 38.2 6 0.2 PCV (%) 41 6 1 41 6 0.8 40 6 1 43 6 1.5 41 6 0.5 43 6 2

a Significant difference from baseline. b Significant difference with respect to the LID group (P , 0.05).

LID-DEX and DEX groups are mostly related to the effects doses (, 1.2 mg/kg BW) followed by equal corresponding CRIs of DEX, which are induced in both conscious and anesthe- (mg/kg BW per hour) decreased HR to a maximum of 33%, tized dogs (2,5,7,9–12,17,20). Similar cardiovascular effects of whereas doses of 3 mg/kg BW and equal corresponding CRIs increased MAP and decreased HR and CO have been reported (mg/kg BW per hour) decreased HR by up to 62% (2,10,17). in horses anesthetized with isoflurane, receiving CRIs of LID- In our study, HR decreased by 39% in the DEX group, using medetomidine when compared to LID (6). In our study the a dose of 2 mg/kg BW and CRI of 2 mg/kg BW per hour. This decrease in CO from baseline in the DEX group (42%) and dose is equivalent to 4 mg/kg BW per hour of medetomidine LID-DEX group (41%) was due to a decrease in HR that was and the decrease in HR is similar to the 45% decrease induced of similar magnitude within each group, since CO = HR 3 SV, by that dose (7). The decrease in HR in the DEX-LID was less and SV was not affected by either treatment. Cardiac output (33%), and although not significantly different from the DEX was not affected in the LID group, similar to another study in group, it could have been less because LID has a vagolytic effect healthy dogs and dogs with subaortic stenosis administered doses under conditions of increased vagal activity, which results in an of up to 200 mg/kg BW per min (33). increase in the rate of discharge between the sinoatrial node and The effects of medetomidine and DEX on CO are dose- upper Bundle of His (36). Baseline HR did not change after related (7,10,11,17,21). In isoflurane-anesthetized dogs, administration of LID in the LID group, which is similar to medetomidine, which is considered half as potent as DEX for its results from other studies in dogs anesthetized with isoflurane or sedative and cardiorespiratory effects (34,35), caused a decrease sevoflurane (3,4,25,29,30), and has also been shown to increase in CO of 15%, 22%, 27%, 44%, 48%, and 61% with IV load- with LID (33). ing doses of 0.2, 0.5, 1.0, 1.7, 4, and 12 mg/kg BW, followed Pulmonary arterial occlusion pressure increased from base- by equal corresponding CRIs (mg/kg BW per hour), respectively line by 118% and 92% in in the DEX and LID-DEX groups, (7). Similarly, in isoflurane-anesthetized dogs, DEX caused a respectively. The SVRI followed a similar pattern, increasing by decrease in CO of 19%, 30%, and 58% with IV loading doses 119% and 125%, respectively. Similar findings are reported in of 0.5, 1.2, and 3 mg/kg BW, followed by equal corresponding other studies for these 2 variables in dogs and cats (10,17,37). CRIs (mg/kg BW per hour), respectively (10,17). In our study, The increase in PAOP is the result of a lower CO (38), whereas the approximately 40% decrease in CO from administering an the increase in SVRI is through direct vasoconstriction actions of IV dose of 2 mg/kg BW and CRI of 2 mg/kg BW per hour of alpha-2 agonists on the smooth muscle of blood vessels (39). In DEX in sevoflurane-anesthetized dogs is also in agreement with our study MPAP did not change, which is similar to other studies those studies. in halothane-anesthetized dogs and halothane-anesthetized sheep Heart rate is also affected in a dose-dependent manner by that received medetomidine (11,40), but PVRI decreased signifi- medetomidine and DEX in isoflurane-anesthetized dogs. In cantly in our study in the DEX and LID-DEX group, due to the general, lower loading doses followed by equal corresponding increase in PAOP. Other studies have also shown no significant CRIs (mg/kg BW per hour) of medetomidine (, 1.7 mg/kg changes in PVRI after medetomidine (40). Differences between BW) decreased HR to a maximum 36%, whereas higher doses vascular resistance of the pulmonary and systemic circulation (. 4 mg/kg BW) and equal corresponding CRIs (mg/kg BW have been attributed to the alpha-receptor density, which is lower per hour) decreased HR by up to 45% (7). For DEX, lower in the pulmonary than the systemic vasculature and may partly

732 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY explain the attenuated vasoconstrictor response of the pulmonary 3. Ortega M, Cruz I. Evaluation of a constant rate infusion of lido- circulation (41). Despite the observed cardiovascular effects of caine for balanced anesthesia in dogs undergoing surgery. Can Vet J 2011;52:856–860. alpha-2 agonists, their use has become more popular in healthy 4. Gutierrez-Blanco E, Victoria-Mora JM, Ibancovichi-Camarillo JA, patients undergoing surgery due to their potent analgesic and et al. Evaluation of the isoflurane-sparing effects of fentanyl, lidocaine, sedative effects. However, the cardiovascular effects of alpha-2 ketamine, dexmedetomidine, or the combination lidocaine-ketamine- dexmedetomidine during ovariohysterectomy in dogs. Vet Anaesth Analg agonists have not been thoroughly evaluated in dogs undergoing 2013;40:599–609. surgical stimulation, so it is not known if the changes and their 5. Uilenreef JJ, Murrell JC, McKusick BC, Hellebrekers LJ. Dexmedeto ARTICLE magnitude, as determined in this and other studies, are consis- midine continuous rate infusion during isoflurane anaesthesia in canine surgical patients. Vet Anaesth Analg 2008;35:1–12. tent in patients in whom sympathetic activity from nociceptive 6. Valverde A, Rickey E, Sinclair M, et al. Comparison of cardiovas- input is more likely to occur. One study demonstrated MAP to cular function and quality of recovery in isoflurane-anaesthetised be stable and within acceptable limits (99 mmHg) with HR of horses administered a constant rate infusion of lidocaine or lidocaine and medetomidine during elective surgery. Equine Vet J 2010;42: 49 to 68 beats/min in dogs undergoing soft tissue or orthopedic 192–199. surgery under isoflurane anesthesia, while receiving a CRI of 7. Kaartinen J, Pang D, Moreau M, et al. Hemodynamic effects of an 1, 2, or 3 mg/kg BW per hour of DEX after IV pre-medication intravenous infusion of medetomidine at six different dose regimens in isoflurane-anesthetized dogs. Vet Ther 2010;11:E1–E16. with 5 mg/kg BW (5). In another study in dogs undergoing 8. Kabukcu HK, Sahin N, Temel Y, Titiz TA. Hemodynamics in coro- ovariohysterectomy, medetomidine (1 mg/kg BW and a CRI of nary artery bypass surgery: Effects of intraoperative dexmedetomidine 1 mg/kg BW per hour) was administered after induction and administration. Anaesthetist 2011;60:427–431. 9. Rioja E, Gianotti G, Valverde A. Clinical use of a low-dose medetomi- before the start of surgery and decreased HR immediately after, dine infusion in healthy dogs undergoing ovariohysterectomy. Can Vet but increased steadily to baseline throughout surgery, whereas J 2013;54:864–868. CI did not change from baseline and during surgical stimula- 10. Pascoe P. The cardiopulmonary effects of dexmedetomidine infusions in dogs during isoflurane anesthesia. Vet Anaesth Analg 2015;42:360–368. tion, and SAP remained stable from baseline and only increased 11. Vickery RG, Sheridan BC, Segal IS, Maze M. Anesthetic and hemo- significantly during removal of the ovaries (9). dynamic effects of the stereoisomers of medetomidine, an alpha A decrease in CO has a direct effect on oxygen delivery 2-adrenergic agonist, in halothane-anesthetized dogs. Anesth Analg 1988;67:611–615. (DO2), since the latter is the product of the CO and CaO2. 12. Flacke JW, Flacke WE, Bloor BC, McIntee DF. Hemodynamic effects of dexmedetomidine, an alpha 2-adrenergic agonist, in autonomically Consequently, O2ER is also affected since it is the ratio of VO2 and DO . Decreases in DO and increases in O ER were shown denervated dogs. J Cardiovasc Pharmacol 1990;16:616–623. 2 2 2 13. Bloor BC, Frankland M, Alper G, Raybould D, Weitz J, Shurtliff in this and other studies when dexmedetomidine is used (10,17); M. Hemodynamic and sedative effects of dexmedetomidine in dog. however, if blood lactate concentrations remain unchanged J Pharmacol Exp Ther 1992;263:690–697. despite a decrease in DO and an increase in O ER, it should 14. Lawrence CJ, Prinzen FW, de Lange S. The effect of dexmedetomidine 2 2 on nutrient organ blood flow. Anesth Analg 1996;83:1160–1165. indicate that tissues can maintain aerobic metabolism, reflecting 15. Talke PO, Lobo EP, Brown R, Richardson CA. Clonidine-induced vaso- that CO is still adequate under these conditions. We did not constriction in awake volunteers. Vet Anesth Analg 2001;93:271–276. detect changes in lactate concentrations, despite a decrease in 16. Sinclair MD. A review of the physiological effects of a2-agonists related to the clinical use of medetomidine in small animal practice. Can Vet DO2 and an increase in O2ER. Similarly, lactate levels remained J 2003;44:885–897. unchanged in dogs undergoing surgery while receiving a CRI of 17. Lin GY, Robben JH, Murrell JC, Aspegrén J, McKusick BC, DEX or medetomidine (5,9). Despite affecting CO, the reduc- Hellebrekers LJ. Dexmedetomidine constant rate infusion for 24 hours during and after propofol or isoflurane anaesthesia in dogs. Vet Anaesth tion in blood flow caused by DEX has been shown in dogs to Analg 2008;35:141–153. preferentially affect the skin and spleen, whereas blood flow to 18. Congdon JM, Marquez M, Niyom S, Boscan P. Cardiovascular, heart, brain, liver, intestine, and kidneys remains well preserved respiratory, electrolyte and acid-base balance during continuous dexmedetomidine infusion in anesthetized dogs. Vet Anaesth Analg and above levels that induce underperfusion, which was also 2013;40:464–471. supported by unchanged lactate concentrations (14). 19. Aantaa R, Kanto J, Scheinin M, Kallio A, Scheinin H. Dexmedetomi In conclusion, the administration of DEX or the combina- dine, an alpha-2-adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery. Anesthesiology tion of LID-DEX produces significant hemodynamic changes 1990;73:230–235. resulting in decreased CO, HR, and increased SVR pressure 20. Aho M, Erkola O, Kallio A, Scheinin H, Korttila K. Dexmedetomidine and PAOP in dogs anesthetized with sevoflurane; however, such infusion for maintenance of anesthesia in patients undergoing abdominal hysterectomy. Anesth Analg 1992;75:940–946. changes were not associated with compromised tissue perfusion 21. Pypendop B, Verstegen JP. Hemodynamic effects of medetomidine in in research healthy dogs. the dog: A dose titration study. Vet Surg 1998;27:612–622. 22. Doherty TJ, Frazier DL. Effect of intravenous lidocaine on halo- Acknowledgment thane minimum alveolar concentration in ponies. Equine Vet J 1998; 30:300–303. This work was funded by the Mexican National Center for 23. Dzikiti TB, Hellebrekers LJ, Van Dijk P. Effects of intravenous lidocaine on isoflurane concentration, physiological parameters, metabolic Science and Technology (CONACYT). CVJ parameters and stress-related hormones in horses undergoing surgery. J Vet Med A 2003;50:190–195. References 24. Muir WW, Wiese AJ, March PA. Effects of morphine, lidocaine, . 1 Ilkiw JE. Balanced anesthetic techniques in dogs and cats. Clin Tech ketamine, and morphine-lidocaine-ketamine drug combination on Small Anim Pract 1999;14:27–37. minimum alveolar concentration in dogs anesthetized with isoflurane. 2. Pascoe PJ, Raekallio M, Kuusela E, McKusick B, Granholm M. Changes Am J Vet Res 2003;64:1155–1160. in the minimum alveolar concentration of isoflurane and some cardio- 25. Valverde A, Doherty T, Hernandez J, Davies W. Effect of lidocaine on pulmonary measurements during three continuous infusion rates of the minimum alveolar concentration of isoflurane in dogs. Vet Anaesth dexmedetomidine in dogs. Vet Anaesth Analg 2006;33:97–103. Analg 2004;31:264–271.

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26. Pypendop BH, Ilkiw JE. The effects of intravenous lidocaine admin- 35. Kästner SB, Von Rechenberg B, Keller K, Bettschart-Wolfensberger R. istration on the minimum alveolar concentration of isoflurane in cats. Comparison of medetomidine and dexmedetomidine as premedication Anesth Analg 2005;100:97–101. in isoflurane anaesthesia for orthopaedic surgery in domestic sheep. J Vet 27. Murrell JC, White KL, Johnson CB. Investigation of the EEG effects Med A Physiol Pathol Clin Med 2001;48:231–241. of intravenous lidocaine during halothane anaesthesia in ponies. Vet 36. Lieberman NA, Harris RS, Katz RI, Lipschutz HM, Dolgin M, Anaesth Analg 2005;32:212–221. Fischer VJ. The effects of lidocaine on the electrical and mechanical 28. Kempchen S, Kuhn M, Spadavecchia C, Levionnois OL. Medetomidine activity of the heart. Am J Cardiol 1968;22:375–380. continuous rate intravenous infusion in horses in which surgical 37. Pypendop BH, Barter LS, Stanley SD, Ilkiw JE. Hemodynamic effects anaesthesia is maintained with isoflurane and intravenous infusions of of dexmedetomidine in isoflurane-anesthetized cats. Vet Anaesth Analg lidocaine and ketamine. Vet Anaesth Analg 2012;39:245–255. 2011;38:555–567. 29. Acevedo-Arcique CM, Ibancovichi JA, Chavez JR, et al. Lidocaine, 38. Sheriff DD, Zhou XP, Scher AM, Rowell LB. Dependence of cardiac dexmedetomidine and their combination reduce isoflurane minimum filling pressure on cardiac output during rest and dynamic exercise in

ARTICLE alveolar concentration in dogs. PLoS One 2014;9:e106620. dogs. Am J Physiol 1993;265:H316–H322. 30. Moran-Muñoz R, Ibancovichi JA, Gutierrez-Blanco E, et al. Effects of 39. Willems EW, Valdivia LF, Saxena PR, Villalón CM. The role of several lidocaine, dexmedetomidine or their combination on the minimum alpha(1)- and alpha(2)-adrenoceptor subtypes mediating vasoconstric- alveolar concentration of sevoflurane in dogs. J Vet Med Sci 2014; tion in the canine external carotid circulation. Br J Pharmacol 2001; 76:847–853. 132:1292–1298. 31. Haskins S, Pascoe PJ, Ilkiw JE, Fudge J, Hopper K, Aldrich J. Reference 40. Celly CS, McDonell WN, Black WD. Cardiopulmonary effects of the cardiopulmonary values in normal dogs. Comp Med 2005;55:151–161. a2-adrenoceptor agonists medetomidine and ST-91 in anesthetized 32. Holm S. A simple sequentially rejective multiple test procedure. Scand sheep. J Pharmacol Exp Ther 1999;289:712–720. J Statist 1979;6:65–70. 41. Shaul PW, Magness RR, Muntz KH, DeBeltz D, Buja LM. Alpha 33. Nunes de Moraes A, Dyson DH, O’Grady MR, McDonell WN, 1-adrenergic receptors in pulmonary and systemic vascular smooth Holmberg DL. Plasma concentrations and cardiovascular influence of muscle. Alterations with development and pregnancy. Circ Res 1990; lidocaine infusions during isoflurane anesthesia in healthy dogs and 67:1193–1200. dogs with subaortic stenosis. Vet Surg 1998;27:486–497. 34. Kuusela E, Raekallio M, Anttila M, Falck I, Mölsä S, Vainio O. Clinical effects and pharmacokinetics of medetomidine and its enantiomers in dogs. J Vet Pharmacol Ther 2000;23:15–20.

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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

734 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Article

Comparison of an online learning module to hands-on training in teaching a cautery disbudding technique for dairy calves including cornual nerve block application

Charlotte B. Winder, Stephen J. LeBlanc, Derek B. Haley, Kerry D. Lissemore, M. Ann Godkin, Todd F. Duffield

Abstract — Disbudding and dehorning are common procedures on dairy farms. In a recent survey of Ontario dairy producers, 38% reported not using local anesthetic for these procedures. Use of pain control is important for both calf welfare and industry sustainability. Use of local anesthetic requires technical training, typically provided by a veterinarian, although online training videos also exist. Neither method has been studied for efficacy. Our objective was to compare an online module to hands-on training in teaching naïve participants (veterinary students) to effectively carry out a cornual nerve block and disbud a dairy calf. Participants were assigned to either an online or hands-on training group. Although no statistical differences were seen in success of the nerve block, online learners were less confident and had poorer technical skills. While online learning was surprisingly effective for a psycho-motor skill, best practices should include hands-on training.

Résumé — Comparaison d’un module d’apprentissage en ligne avec une formation pratique pour l’enseignement de la technique d’enlèvement des bourgeons par cautérisation pour les vaches laitières incluant l’application d’un bloc du nerf de la corne. L’enlèvement des bourgeons et l’écornage sont des interventions fréquentes dans les fermes laitières. Dans une étude récente auprès des producteurs laitiers de l’Ontario, 38 % ont signalé ne pas utiliser d’anesthésie locale pour ces interventions. Le recours au contrôle de la douleur est important pour le bien-être du veau et la durabilité de l’industrie. L’utilisation de l’anesthésie locale exige une formation technique, qui est habituellement fournie par un médecin vétérinaire, quoique des vidéos de formation en ligne existent également. Ni l’une ni l’autre des méthodes d’enseignement n’a été étudiée pour en évaluer l’efficacité. Notre objectif consistait à comparer le module en ligne à une formation pratique pour l’enseignement des participants non initiés (étudiants en médecine vétérinaire) afin de réaliser efficacement un bloc du nerf de la corne et d’enlever le bourgeon chez un veau laitier. Les participants ont été assignés au hasard à un groupe de traitement. Même si aucune différence statistique n’a été observée pour le succès du bloc nerveux, les apprenants en ligne manifestaient moins de confiance et avaient des compétences techniques inférieures. Même si l’apprentissage en ligne était étonnamment efficace pour une compétence psychomotrice, les meilleures pratiques devraient inclure une formation pratique. (Traduit par Isabelle Vallières) Can Vet J 2017;58:735–740

Introduction or destruction of the horn buds prior to this time. Although isbudding and dehorning are common and necessary polled sires are available for most dairy breeds, the overall use D practices on Canadian dairy farms, as having horned of such genetics is low (4) and reflects the recent introduction dairy cattle increases risk of injury to humans and cattle (1). and availability of this trait in commercial sires. Dehorning refers to the removal of the horn after attachment All disbudding or dehorning procedures are painful when of the horn bud to the skull, which occurs at approximately done without analgesia (1,5). Three-quarters of Ontario dairy 2 to 3 mo of age (2,3), and disbudding refers to the removal producers report performing these procedures themselves,

Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1 (Winder, LeBlanc, Haley, Lissemore, Duffield); Ontario Ministry of Agriculture, Food, and Rural Affairs, 6484 Wellington Road 7, Unit 10, Elora, Ontario N0B 1S0 (Godkin). Address all correspondence to Dr. Charlotte Winder; e-mail: [email protected] This project was funded by a Knowledge Translation and Transfer grant from the Agri-Food and Rural Link program of the Ontario Ministry of Agriculture, Food, and Rural Affairs — University of Guelph partnership. 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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while the remainder employ a veterinarian or veterinary tech- Materials and methods nician to disbud or dehorn (4). Frequency of use of pain con- Experimental methods were approved by the University of trol for these procedures by North American dairy producers Guelph Research Ethics Boards’ Certification of Ethical ranges from 15% to 40% (6–8), although more recent work Acceptability of Research Involving Human Participants in Ontario reported a higher rate of local anesthetic (62%) (REB#14SE037) and the University of Guelph Animal Care and non-ster oidal anti-inflammatory drug (NSAID) (24%) Services (AUP#3403). Calves in the study were housed on com- use (4). mercial farms as well as the university’s research farm. The study Painful procedures have been identified by dairy industry took place between June and August of 2015. stakeholders as key welfare issues (9). Beyond the individual

ARTICLE animal, these procedures have impact at the industry level, as Sample size consumers often emphasize “freedom from pain” as important Our goal was to have at least 16 participants per group, based (10). The veterinary profession has a moral obligation to pro- on an estimation of 90% success (10% rescues) in the hands-on mote animal welfare (11), and encouraging best practices for group, compared to 50% success (50% rescues) in the online pain management on-farm should be an important role of the group, with a standard deviation of 20%. This calculation food animal veterinarian. assumed 95% confidence and 80% power. The anticipated Cautery disbudding is the most commonly used method for dairy calves in North America, employed on 67% to 88% of success rate of the hands-on group was based on our group’s farms (7,8). Best practices for pain control involve administering experience with this type of training in year 4 of the DVM cur- both local anesthetic, commonly given as a cornual nerve block, riculum, whereas the anticipated success of the online group and an NSAID (2,3,12). A mandatory program (proAction) was difficult to estimate as there is no previous research in this which will be implemented by the Dairy Farmers of Canada area. We felt 50% success was generous for a psycho-motor skill in 2017, has animal care requirements that include use of pain being taught entirely online, with no practice opportunities. control for dehorning (13). While administration of an NSAID is uncomplicated, the Participation and study flow use of a cornual nerve block requires training in technique in Invitations to participate were sent to Year 1 and 2 students order to be successful. Typically, dairy producers learn this skill enrolled in the DVM program at the OVC, as well as summer one-on-one with their veterinarian. Other training methods students working at the OVC. Thirty-four students volunteered include published factsheets (14) and online training videos. A to participate in the trial. Participants were required to have had search of “dehorn calf” on “YouTube” showed dozens of short no experience watching or performing a cornual nerve block. videos demonstrating a variety of methods and techniques. To Twenty-one students were enrolled in the DVM program; the the authors’ knowledge, no training videos for disbudding or remainder were enrolled in other undergraduate or graduate dehorning technique or pain control application have been programs at the University of Guelph. studied for efficacy. These alternative methods of distributing Volunteers were allocated to 1 of 2 treatments: online information may provide additional resources for producers (n = 20) or hands-on training (n = 14). Students contacted trained by the traditional, one-on-one method, or may be used us by e-mail if they wished to participate; the first to contact as the sole resource for a producer who is unable or unwilling us was randomly assigned to either hands-on or online train- to acquire training through a veterinarian. ing, with the second volunteer assigned to the other group, Training in providing appropriate pain control for disbudding and so forth. Due to scheduling conflicts with the dates of or dehorning is also included in the curriculum for veterinary the hands-on training sessions, 3 participants were unable to medicine students. At the Ontario Veterinary College (OVC), attend their assigned date, and then were kept in the trial but practical training is provided in the final year for students in assigned to the online group. Hands-on training was done in both the Food Animal and the Rural Community Practice small groups of 2 to 4 participants by a Registered Veterinary streams. Dairy producers cite their herd veterinarian as being Technician (RVT) employed with the Ruminant Field Service influential in their disbudding or dehorning practices (4); there- at the OVC, experienced in providing similar teaching in Year fore, it is essential that veterinary students be comfortable not 4 of the DVM curriculum. Training followed a standardized only in conducting these procedures themselves, but also are protocol (available on request from the corresponding author), skilled in providing training to their clients when appropriate. whereby the RVT introduced the topic and demonstrated both With this in mind, the objective of our trial was to determine the cornual nerve block and disbudding technique on 1 calf if an online training module is as effective as hands-on, small (2 horn buds). Participants were then given a single horn bud group learning, for teaching naïve participants (veterinary each on which to practice, with as much help from the RVT as students) to successfully perform a cornual nerve block and required. disbud a dairy calf less than 8 wk of age with a small-diameter Online training participants were given access to an online thermal disbudding iron (Portasol; Elmira, Oregon, USA). Our training module developed to mirror the training protocol hypothesis was that online learning would be less effective than for the hands-on group. The training module included short hands-on training, resulting in poorer technique, slower time videos with audio explanations, pictures, and an optional quiz. to perform the procedure, and lower confidence in the students’ Participants were able to view the online module as many times ability to perform the procedure. as they wished before the evaluation day. The module can be

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Table 1. Mean rubric scores, time taken to completion of cornual Table 2. Univariable associations of rubric scores, time to nerve block and disbudding, and mean self-confidence scores completion, and self-confidence scores (1 to 5; 1 = very (1 to 5; 1 = very unconfident, 5 = very confident) for participants unconfident, 5 = very confident) with online training trained by online tutorial compared to those with hands-on training (hands-on training as the referent group) Online training Hands-on training Odds ratioa or 95% Confidence Variable Hazard ratiob P-value interval 95% 95% Mean Confidence Mean Confidence Theory and techniquea Variable score interval score interval Written score 4.7 0.06 0.9, 23.6 ARTICLE Handling score 0.2 0.02 0.03, 0.7 Theory and technique Block score 0.1 0.05 0.01, 1.0 Written score 4.8 4.7, 5.0 4.4 4.0, 4.8 Disbud score 0.1 0.05 0.01, 1.0 Handling score 3.1 2.7, 3.5 3.7 3.4, 4.0 Block score 2.3 1.7, 2.6 2.5 2.1, 2.9 Time to completionb Disbud score 2.7 2.4, 2.8 2.9 2.8, 3.1 Block application 0.5 0.04 0.2, 1.0 Disbudding 0.3 0.05 0.2, 0.7 Time taken Total 0.4 , 0.01 0.2, 0.8 Block time(s) 68 57, 77 51 41, 61 Disbud time(s) 69 50, 88 36 23, 49 Self-confidence scorea Total time(s) 126 100, 153 87 67, 106 Pre-evaluation 0.1 , 0.01 0.01, 0.4 Post-evaluation 0.6 0.48 0.2, 2.4 Self-confidence Change in score 4.4 0.04 1.0, 18.7 Pre-evaluation 3.2 2.9, 3.3 3.8 3.5, 4.1 Post-evaluation 4.3 3.8, 4.5 4.4 4.0, 4.7 a Odds ratio. Change in score 1.1 0.8, 1.4 0.5 0.2, 0.9 b Hazard ratio. accessed online from: https://bit.ly/disbudding (Articulate local nerve block. Exceptions were made if it was clear the Storyline 2; Articulate, New York, New York, USA). calf was avoiding flies. Rescued calves were then re-blocked by Evaluations occurred on 8 d, separate from training days, the RVT and the evaluation was continued. Rescues were also with between 2 and 6 students evaluated per day. Evaluations performed if any of the handling, restraint, or block techniques were held on both commercial farms (7 participants: 3 online, were considered to be unsafe for the calf or participant by the 4 hands-on) and the university farm (27 participants: 16 online, evaluator. Based on requirements from the Research Ethics 11 hands-on). At least 1 participant from each treatment was Board, participants were also informed of their right to stop present at each evaluation. One evaluator completed all assess- their participation in the study at any time if they wished. ments, and was blinded to the participants’ treatment group Participants who declined to complete the evaluation were also allocation. Each participant was evaluated separately, out of considered to have been unsuccessful in block administration sight and hearing of others. The evaluation was split into 4 sec- (rescued). tions: background knowledge, handling and restraint, nerve block application, and disbudding. Background knowledge was Statistical analysis assessed by a written quiz, which asked participants to identify All analysis was done using STATA13 (StataCorp, 2013. College the correct drug, volume, appropriate needle length and gauge, Station, Texas, USA). Descriptive statistics were reviewed, and and appropriate injection site. Evaluations of calf handling, univarible association with treatment group was conducted on block application, and disbudding used rubric scoring (avail- all potential explanatory variables. able on request from the corresponding author). Handling and Kaplan-Meir survivor function graphs were used to view dif- restraint score was based on correct application of the halter, ferences in time to task completion (nerve block application, choice of location to tie the calf, securing the calf’s head tightly disbudding iron application, and total time) between online and enough, and security of the quick-release knot. Cornual nerve hands-on trained groups. Univariable Cox-proportional hazard block technique score was based on correct location and the models were run for time to nerve block completion, time to number of needle insertions. Disbudding technique score was disbudding completion, and total time. The proportional hazard based on correct location and correct duration of application of assumption was assessed by the Kaplan-Meir graphs, a non- the disbudding iron on the skin. Time taken for blocking and significant test of non-zero slope, and by plotting Schoenfeld disbudding was also recorded, and this was done without the residuals over log of time. participants’ knowledge. Participants were asked to rate their As rubric scores (written quiz, handling, block technique, self-confidence in their ability to successfully block and disbud disbudding technique) and self-confidence scores were ordinal, a calf on a scale of 1 (very unconfident) to 5 (very confident), association with treatment group was assessed using ordered both before and after the evaluation. logistic regression. A non-significant Hosmer-Lemeshow good- A calf was considered to be inadequately blocked, and the ness of fit test was used to assess model fit. participant was immediately stopped (rescued), if the calf elic- Association between training group and an unsuccessful nerve ited any of the following behaviors during the first 5 s of the block (rescue) was assessed using Fisher’s exact test as only 4 res- application of the dehorning iron: head shake, ear flick, foot cues were performed, all having come from the online trained stamp, vocalize, rear, fall, kick, or tail flick. These have been group. Univariable exact logistic regression was used to examine validated as behavioral indicators of disbudding and dehorning the association between rescues and rubric scores (handling and pain (15–18) and were considered to indicate an inadequate block technique) to explore how well rubric scores compared

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1.00 1.00

0.75 0.75

0.50 0.50

0.25 0.25 ARTICLE 0.00 0.00 Proportion remaining uncompleted remaining Proportion uncompleted remaining Proportion 0 50 100 150 0 50 100 150 200 Time (seconds) Time (seconds)

Hands-on trained Online trained Hands-on trained Online trained

Figure 1. Kaplan-Meier survival function showing time to Figure 2. Kaplan-Meier survival function showing time to completion for administration of corneal nerve block for hands-on completion for disbudding iron application for hands-on trained trained participants (solid line) compared with online-trained participants (solid line) compared with online-trained participants participants (dashed line). (dashed line).

to a less subjective outcome (rescue). The more conservative P = 0.08). Block technique rubric score was therefore considered (1-sided P-value*2) P-values for these models are reported. A to be a valid measure of block efficacy. non-significant Hosmer-Lemeshow test was used to assess the fit of the model. Online versus hands-on training groups An increase in written score by 1 point tended to be associated Results with an increased probability of being in the online group Descriptive statistics (Table 2, OR: 4.7; P = 0.06; 95% CI: 0.9 to 23.6), while a Four participants were unsuccessful in providing an adequate similar increase in all other technical scores was significantly nerve block (rescued); 2 participants declined to complete the associated with decreased odds of having been trained online. cornual nerve block application, and 2 calves were rescued dur- An increase in handling score by 1 point was 5 times as likely to ing disbudding iron application (separate from the participants have been associated with training in the hands-on group, while who declined to complete the block). All 4 rescues were from a similar increase in block and disbudding technical scores was the online treatment group. associated with 10 times the odds of having been trained in the Descriptive statistics by treatment group are outlined in hands-on group (Table 2). Table 1. While written scores were higher for those in the A significant hazard ratio below 1 for the online group was online group (4.8 6 0.1) compared with the hands-on group seen for time to completion for all tasks (Table 2). The risk of a (4.4 6 0.2), those in the online group had lower scores for participant finishing in a given time was significantly less likely handling (3.1 6 0.2, online; 3.7 6 0.2, hands-on), block tech- if they were trained online. Those trained in the hands-on group nique (2.3 6 0.2, online; 2.5 6 0.2, hands-on), and disbudding were twice as likely to finish in a given time for cornual nerve technique (2.7 6 0.1, online; 2.9 6 0.1, hands-on). Online block application, and over 3 times as likely to finish in a given learners also took longer to perform all tasks. Application of the time for disbudding iron application (Table 2). The differences cornual nerve block took a mean of 68 s (6 5 s) for the online in time to completion for conual nerve block application and group compared with 51 s (6 5 s) for those trained hands-on. disbudding iron application are illustrated by the Kaplan-Meier Disbudding iron application took a mean of 69 s (6 10 s) for survival function graphs in Figures 1 and 2. online learners compared with 36 s (6 6 s) for participants A higher pre-evaluation confidence score was significantly trained hands-on. Consequently, total time was longer for online less likely to have come from an online trained participant; a learners (126 6 13 s) compared with hands-on (87 6 10 s). 1-point increase in score was associated with 10 times the odds Confidence scores for those trained online were 3.2 6 0.1 before of having come from a participant trained in the hands-on group evaluation, and rose to 4.3 6 0.1 after evaluation. Hands-on (Table 2). However, post-evaluation confidence scores did not trained participants had a mean confidence score of 3.8 6 0.1 differ between groups; this is explained by a 1-point increase in before evaluation; after evaluation this rose to 4.4 6 0.2. change in confidence score to be significantly associated with increased odds of having been in the online group (OR: 4.4; Validation of rubric scoring P = 0.04; 95% CI: 1.0, 18.7) (Table 2). Rubric scores were negatively associated with having been in the rescue group. For a 1-point increase in rubric score, odds of Discussion requiring a rescue were significantly lower for block technique While participants in this trial were veterinary students, we score (OR: 0.3; 95% CI: 0.03, 0.99; P = 0.04) and also tended hypothesize results to be no worse when extrapolated to dairy to be lower for handling score (OR: 0.3; 95% CI: 0.1, 1.2; producers. Our early year DVM students were likely much less

738 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY familiar with both cattle handling as well as injection technique, immediate feedback, and can use this to further refine technique compared to dairy producers or staff on dairy farms. We would or choose to seek additional help if not consistently successful. therefore expect motivated dairy producers’ success rates after Most dehorning or disbudding conducted on-farm is by cau- either form of training to be higher than that of our naïve tery (7,8), which requires application of a cornual nerve block, participants. in addition to NSAID administration, to provide adequate pain Differences in performance were seen between the 2 groups, control (16,18,19). While local anesthetic is inexpensive, lack of despite the hands-on group having only practiced their tech- familiarity with technique is likely an important barrier prevent- ARTICLE nique on a single horn bud. The only exception to the advantage ing more dairy producers from adopting use of this medication. of the hands-on group was the tendency of the online group to Readers are also reminded that the dispensing of these medica- perform better in the written quiz. Although all information tions for use by producers requires a valid veterinarian-client- from the online module was presented to the hands-on partici- patient relationship (VPCR); however, it should also be noted pants, online learners could go over this information at their that all dairy farms in Canada are required to have an ongoing own pace, and could review it as many times as they chose to. relationship with a licensed veterinarian, with a valid VPCR and This may have helped the online group to solidify their back- written prescriptions for any off-label drug use (13). ground knowledge. This trial showed hands-on training to be a highly effective Although rubric scoring was developed to improve con- method of teaching cornual nerve block and cautery disbudding sistency in scoring among participants, it is still somewhat technique, even when done with very limited practice opportu- arbitrary in design. We found a significant association between nities and naïve participants. Online learning may be suitable as likelihood of failure of the cornual nerve block and a lowered an adjunct to hands-on training, or as a resource to refresh the cornual nerve block technical score, which supports the use of skills of those who may not perform this task routinely. While our rubric scoring system as a valid measure of success. That online training is not recommended as a sole method of instruc- said, an effect of evaluation itself may have affected participants’ tion, in the absence of available hands-on training it may be a behavior (Hawthorne effect); we were required by our Research suitable alternative method. Ethics Board to inform participants that we would intervene during the trial if there was a danger of injury to either them- Acknowledgments selves or the calf. Consequently, a lack of our intervention may The authors thank Sarah Ferguson, Rachel Skippen (RVT), and have made apprehensive participants more confident that, if the study participants for their valuable contributions to this nothing else, they were not going to harm the calf. It is possible work. CVJ this effect was not equal between treatment groups. While there was no significant difference (P = 0.13) between References the online and hands-on groups with respect to unsuccessful 1. Stock ML, Baldridge SL, Griffin D, Coetzee JF. Bovine dehorning: cornual nerve blocks, the number of failures in the online Assessing pain and providing analgesic management. Vet Clin Food Anim group probably indicates an important difference which should 2013;29:103–133. be confirmed in a larger trial with the power to detect this 2. Disbudding and dehorning of cattle — position statement. Canadian Veterinary Medical Association [homepage on the Internet] c2010 difference. However, the success rate for the online-trained Available from: http://www.canadianveterinarians.net/documents/ group (75%) was still high, especially considering that this disbudding-and-dehorning-of-cattle Last accessed April 26, 2017. was the first cornual nerve block the participants had ever per- 3. Literature review on the welfare implications of the dehorning and disbudding of cattle. American Veterinary Medical Association [homep- formed. Differences in self-confidence prior to evaluation were age on the Internet] c2014 Available from: https://www.avma.org/KB/ seen between the 2 groups, with online learners rating their Resources/LiteratureReviews/Pages/Welfare-Implications-of-Dehorning- confidence significantly lower. This lack of self-confidence is and-Disbudding-Cattle.aspx Last accessed April 24, 2017. 4. Winder CB, LeBlanc SJ, Haley DB, Godkin MA, Lissemore KD, postulated to be a result of the lack of skill, but the opposite Duffield TF. Practices for the disbudding and dehorning of dairy calves might also be true. That is, online learners’ skill level may not by veterinarians and dairy producers in Ontario, Canada. J Dairy Sci differ from hands-on trainees, but a lack of confidence may 2016;99:10161–10173. 5. Stafford KJ, Mellor DJ. Addressing the pain associated with dis- result in a timid approach resulting in poorer evaluation scores. budding and dehorning in cattle. Appl Anim Behav Sci 2011;135: Online learners had a tendency to increase their confidence 226–231. score after evaluation, resulting in post-evaluation scores that 6. Hoe FG, Ruegg PL. Opinions and practices of Wisconsin dairy producers about biosecurity and animal well-being. J Dairy Sci 2006; did not differ between groups. This highlights the importance of 89:2297–2308. the hands-on nature of the evaluation for the online group, but 7. Fulwider WK, Grandin T, Rollin BE, Engle TE, Dalsted NL, Lamm also indicates that the disadvantage of being trained online was WD. Survey of dairy management practice on one hundred thirteen north central and northeastern United States dairies. J Dairy Sci not insurmountable; even practicing on a single horn bud was 2008;91:1686:1692. enough to substantially increase their confidence level. Online 8. Vasseur E, Borderas F, Cue R, et al. A survey of dairy calf manage- participants may take less time and be more proficient at the ment practices in Canada that affect animal welfare. J Dairy Sci 2010;93:1307–1315. technique with increasing practice attempts. In reality, producers 9. Ventura BA, von Keyserlingk MAG, Weary DM. Animal welfare would likely have multiple calves to disbud at one time, and it concerns and values of stakeholders within the dairy industry. J Agric is likely that their success after online training would improve Environ Ethics 2015;28:109–126. 10. Spooner JM, Schuppli CA, Fraser D. Attitudes of Canadian citizens after practicing on multiple calves. As evidence of block success toward farm animal welfare: A qualitative study. Livest Sci 2014; or failure is fairly obvious, producers will also receive almost 163:150–158.

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11. Whiting TL, Brennan SC, Wruck GC. The veterinary professional’s role 16. Faulkner PM, Weary DM. Reducing pain after dehorning in dairy in policing animal welfare. Can Vet J 2006;47:1065–1072. calves. J Dairy Sci 2000;83:2037–2041. 12. National Farm Animal Care Council. Code of Practice for the Care and 17. Stilwell G, de Carvalho RC, Lima MS, Broom DM. Effect of caustic Handling of Dairy Cattle. Ottawa, Ontario, Canada, 2009. paste disbudding, using local anaesthesia with and without analgesia, on 13. Dairy Farmers of Canada. proAction: Leading the way for sustainable behaviour and cortisol of calves. Appl Anim Behav Sci 2009;116:35–44. dairy farming; providing assurance to customers about farm practices. 18. Heinrich A, Duffield TF, Lissemore KD, Millman ST. The effect of Dairy Farmers of Canada, Ottawa, Ontario, Canada, 2015. meloxicam on behavior and pain sensitivity of dairy calves follow- 14. Factsheet: Dehorning of calves. Ontario Ministry of Food, Agriculture, ing cautery dehorning with a local anesthetic. J Dairy Sci 2010;93: and Rural Affairs [homepage on the Internet] c2009. Available from: 2450–2457. http://www.omafra.gov.on.ca/english/livestock/dairy/facts/09-003.htm 19. Duffield TF, Heinrich A, Millman ST, DeHaan A, James S, Lissemore Last accessed April 26, 2017. KD. Reduction in pain response by combined use of local lidocaine 15. Grøndahl-Nielsen C, Simonsen HB, Damkjer Lund J, Hesselholt M. anesthesia and systemic ketoprofen in dairy calves dehorned by heat

ARTICLE Behavioural, endocrine and cardiac responses in young calves undergo- cauterization. Can Vet J 2010;51:283–288. ing dehorning without and with use of sedation and analgesia. Vet J 1999;158:14–20.

Book Review Compte rendu de livre

Reptiles and Amphibians, 2nd edition pets seen in exotic animal practice, or in species found in small zoos or in a research setting. While there has been an Frye FL. CRC Press, Taylor and Francis Group, Boca Raton, update to amphibian diseases of significant importance such Florida, USA. 2016. 240 pp. ISBN: 9781-4822-5760-1. as Batrachochytrium dendrobatidis or B. salamandrivorans, there $35.16 US. is a lack of updates on clinical cases and explanations of a few diseases such as Inclusion Body Disease of Boids (Arenavirus), his self-assessment color review book is an update to ranaviral infections in turtles, or herpesviral or adenoviral infec- T the popular 1st edition that was published in 1995. The tions in lizards. However, this book is intended to be a comple- author, Dr. Frederic Frye, is widely considered to be one of ment, and not a stand-alone text, to the ever-growing body of the grandfathers of herpetological medicine. The 2nd edition medical literature on reptiles and amphibians, and as such it contains 232 short clinical cases of varying difficulty for the serves its purpose well. Most of the photographs and radiographs reader to work through featuring a combination of color photos, are of excellent quality; however, some of older photographs radiographs, photomicrographs, laboratory data, and questions. are dark and small, making it more difficult for the reader to A detailed explanation to the questions are found on the fol- sometimes identify a lesion. If a digital version of this book is lowing page. Thirty-two clinicians, in addition to Dr. Frye, available, then the ability to expand an image on a screen with contributed to the cases found within the book. good resolution would help with this problem. The book is purposefully laid out such that the cases appear This Self-Assessment Color Review of reptiles and amphib- in random order instead of being grouped by species, diseases, ians will appeal to a wide audience from experienced veteri- or organ system. This emulates the randomness of cases as they narians and herpetologists, to veterinary residents and interns may appear on a day-to-day basis in clinical practice. However, during their formal training, to veterinary students and amateur for those hoping to use the text as a quick reference guide, there herpetologists. Even experienced readers will be challenged to is a table of contents that broadly classifies the cases based on think broadly about disease processes and conditions, instead anatomy, disorders, or common conditions. In addition, the of jumping to a quick conclusion based on pattern recognition. Appendix lists both the common name and the scientific name of the species found within the book, and the index is cross- Reviewed by Douglas Whiteside, DVM, DVSc, DACZM, referenced by case number allowing the reader to quickly review DECZM (ZHM), Senior Staff Veterinarian, Calgary Zoo, Calgary, a disease or condition. Alberta. In general, the cases represent an excellent diversity of diseases, conditions, and species that would be encountered in

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New Products Nouveaux produits NEW PRODUCTS NEW Purina Launches Neurologic Breakthrough in Canine Nutrition Thousands of dogs with idiopathic epilepsy mulated with lower amounts of fat and higher proportions of protein may soon benefit from Purina’s introduction and carbohydrates than the traditional human ketogenic diet. “This of the first and only therapeutic diet indicated provides for a complete and balanced diet — which is important, given to help nutritionally manage dogs with this that epileptic dogs need to be on this specialized diet for the remainder condition as an adjunct to veterinary therapy. of their lives,” he explains. Purina® Pro Plan® Veterinary Diets NC Along with epilepsy, compromised brain glucose metabolism is a NeuroCareTM is formulated with medium significant factor in brain aging and cognitive dysfunction syndrome chain triglyceride (MCT) oil to help nutri- (CDS), a condition similar to Alzheimer’s Disease in humans.10 tionally manage dogs with epilepsy that are Canine CDS is believed to be significantly underdiagnosed; while also being administered anti-epilepsy drugs an estimated 14 percent of dogs aged eight and older are affected, (AEDs). The diet is enhanced with a unique blend of nutrients — only 1.9 percent are diagnosed.11 Key to the diagnosis is use of the eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), antioxi- “DISHAA” questionnaire that identifies signs of disorientation, dants and B vitamins, as well as MCT oil — to help nutritionally altered interactions, disturbances in sleep-wake cycles, house soiling, manage dogs with cognitive dysfunction syndrome (CDS). altered activity and anxiety. Idiopathic epilepsy is the most commonly diagnosed neurologi- In a randomized, double-blinded, 90-day study conducted by cal disorder in dogs.1 Unfortunately, the reality for many affected CanCog Veterinary Research, in which dogs diagnosed with CDS dogs — and owners — is living with debilitating, uncontrolled were fed a test diet containing 6.5% MCT oil and a unique blend seizures and/or unpleasant medication side effects. of nutrients, dogs improved significantly across all DISHAA cat- “More than two-thirds of dogs with epilepsy continue to have egories. This study, along with the RVC epilepsy study, provided seizures long-term, despite treatment,2 and 20–30 percent of the inspiration for the development of NeuroCare. affected dogs remain poorly controlled,”3,4,5 explains Jason Gagné, “Understanding brain chemistry and its role in the development DVM, DACVN, Director, Veterinary Technical Marketing for of debilitating conditions such as epilepsy and CDS is leading to Purina Pro Plan Veterinary Diets. Meanwhile, medications such important developments in therapeutic nutrition,” states Dr. Gagné. as phenobarbital and potassium bromide are commonly associated “It is our hope that NeuroCare can help thousands of dogs live with such side effects as polyphagia, weight gain, polydipsia, poly- significantly better lives.” uria, sedation, restlessness, lethargy and ataxia. The result: only four percent of veterinarians surveyed reported being either “totally” or References 1 “mostly” satisfied with current treatment options. . 1 2016 Veterinary Landscape Dashboard. Glucose serves as the primary fuel for the brain; however, brain 2. Arrol L, Penderis J, Garosi L, et al. Aetiology and Long-Term Outcome glucose metabolism is compromised in patients with epilepsy, cre- of Juvenile Epilepsy in 136 Dogs. Vet Rec. 2012;170:335. 3. Trepanier L, Schwark W, Van Schoick A, et al. Therapeutic Serum Drug ating a need for an alternate source of brain energy. According to Concentrations in Epileptic Dogs Treated with Potassium Bromide Dr. Gagné, adding ketones as an energy source for the brain is an Alone or in Combination with Other Anticonvulsants: 122 cases approach that has been used for decades in children with epilepsy;6 (1992–1996). J Am Vet Med Assoc. 1998;213:1449–1453. 4. Schwartz-Porsche D, Löscher W, Frey H. Therapeutic efficacy of however, the human “ketogenic” diet, which is high in fat and low phenobarbital and primidone in canine epilepsy: A comparison. J Vet in protein and carbohydrates, has yet to be shown to significantly Pharmacol Ther 1985;8:113–119. improve seizures in dogs as it does in humans.7 5. Podell M, Fenner W. Bromide therapy in refractory canine idiopathic epilepsy. J Vet Intern Med 1993;7:318–327. Fortunately, dogs can readily metabolize medium chain triglycer- 6. Neal EG, Chaffe H, Schwartz RH, et al. A randomized trial of classi- ides (MCTs) to produce ketones.8 Experts also believe that dietary cal and medium-chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia 2009;50:1109–17. MCTs may have direct antiseizure effects via blocking the Alpha- 7. Patterson EE, Munana KR, Kirk CA, et al. Results of a ketogenic food Amino-3-Hydroxy-5-Methyl-4Isoxazolepropionic Acid (AMPA) trial for dogs with idiopathic epilepsy. J Vet Intern Med 2005;19:421. receptors in the brain.9 8. Law TH, Davies ES, Pan Y, et al. A randomised trial of a medium-chain TAG diet as treatment for dogs with idiopathic epilepsy. Br J Nutr. 2015 A six-month randomized placebo-controlled, double-blinded Nov 14;114(9):1438–47. crossover study conducted in dogs with idiopathic epilepsy at the 9. Chang PS, Augustin K, Boddum K, et al. Seizure control by decanoic Royal Veterinary College in London, in partnership with Purina, acid through direct AMPA receptor inhibition. Brain. 2015;25:1–13. 10. Studzinski CM, Araujo JA, Milgram NW. The canine model of demonstrated for the first time that a diet with MCT oil can have human cognitive aging and dementia: Pharmacological validity of positive effects on reduction of seizure frequency when fed as an the model for assessment of human cognitiveenhancing drugs. Prog adjunct to veterinary therapy.8 Results included: Neuropsychopharmacol Biol Psychiatry. 2005 Mar;29(3):489–98. 11. Salvin HE, McGreevy PD, Sachdev PS, Valenzuela MJ. Under diag- • 71% of dogs showed a reduction in seizure frequency nosis of canine cognitive dysfunction: A cross-sectional survey of older • 48% of dogs showed a 50% or greater reduction in seizure companion dogs. Vet J. 2010;184:277–81. frequency • 14% of dogs achieved complete seizure freedom Contact: Nestle Purina, 2500 Royal Windsor Drive, Mississauga, ON Based on this information, Purina developed its NeuroCare diet, L5J 1K8; website: http://www.purinaveterinarydiets.com/default.aspx formulating it with MCT oil. Dr. Gagné notes that NeuroCare is for-

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Efficiency of medetomidine for epidural analgesia: Effects on isoflurane requirement and mean systemic arterial blood pressure in dogs

Ryota Watanabe, Yukihiro Fujita

Abstract — Five healthy beagle dogs anesthetized with isoflurane were administered medetomidine (a-2 adrenoceptor agonist) by the epidural route. Mean arterial pressure (MAP) and end-tidal concentration of isoflurane (ISO) were measured 1, 2.5, and 4 h after administration. Epidural administration of medetomidine reduced the isoflurane dose required to prevent changes in vital parameters following mechanical stimulation and maintained the MAP at a higher level compared to the control.

Résumé — Efficacité de la médétomidine pour l’analgésie épidurale : effets sur le besoin d’isoflurane et la tension artérielle systémique moyenne chez les chiens. De la médétomidine a été administrée à cinq chiens Beagle en santé anesthésiés à l’aide de l’isoflurane (agoniste adrénocepteur a-2) par voie épidurale. La tension artérielle moyenne (TAM) et la concentration de fin d’expiration de l’isoflurane (ISO) ont été mesurées 1 heure, 2,5 heures et 4 heures après l’administration. L’administration de médétomidine par épidurale a réduit la dose d’isoflurane requise pour prévenir des changements aux paramètres vitaux après la stimulation mécanique et a maintenu la TAM à un niveau supérieur comparativement au groupe témoin. (Traduit par Isabelle Vallières) Can Vet J 2017;58:742–746 dequate peri-operative analgesia is essential for early func- ing the pelvis, pelvic limbs, tail, perineum, abdomen and thorax A tional recovery from orthopedic surgery and for optimal (4). Although local anesthetics and opioids are the commonly patient care (1). Administration of analgesic drugs during administered agents in veterinary medicine, the primary media- surgery reduces the volatile anesthetic requirement and thus tors of spinal analgesia may also derive from endogenous norepi- prevents severe hypotension, which can lead to peri-operative nephrine at a-2 adrenoceptor subtypes A and B (5). Therefore, complications (2). a-2 adrenoceptor agonists are considered effective analgesic In veterinary medicine, a-2 adrenoceptor agonists are widely agents. This has been demonstrated in 2 previous studies in used to provide dose-dependent sedation, analgesia, and mus- which administration of medetomidine at 10 and 15 mg/kg cle relaxation (3). Medetomidine, which is classified as an body weight (BW) in cats and dogs, respectively (6,7), produced a-2 adrenoceptor agonist, is administered as anesthetic pre- an analgesic effect. This was tested in an awakened condition medication or for rescue analgesia and is given intramuscularly by the electrical stimulation method. In addition, a volatile or intravenously, particularly in small animals (3). However, anesthetic-sparing effect after injection of dexmedetomidine at medetomidine causes initial peripheral vascular constriction 0.5 to 6.0 mg/kg BW in dogs was also observed in another study and reflex bradycardia, followed by vasodilation, due to stimu- (8). In contrast, a study researching the synergistic effect with lation of the a-2 adrenoceptors in the central nervous system. an opioid, medetomidine, 5 mg/kg BW, injected by the epidural Administration of a-2 adrenoceptor agonists can therefore lead route in dogs found that this did not provide sufficient analgesia to a reduction in cardiac output or hypotension, even at clini- or reduce the inhalant anesthesia requirement (9). cally utilized doses (3). The minimum alveolar concentration (MAC)-blunting adren- Epidural administration of agents with analgesic properties ergic response (BAR) is the MAC that prevents an autonomic provides effective anesthesia and analgesia for procedures involv- response to a noxious stimulus. The MAC-BAR is usually higher than the MAC and it provides information to achieve an adequate level of surgical anesthesia that prevents autonomic Laboratory of Surgery II, School of Veterinary Medicine, Azabu adrenergic responses and movements in animals (10). University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara City, This study aimed to evaluate the isoflurane-reducing effect Kanagawa Prefecture, Japan. of epidural medetomidine following mechanical stimulation in Address all correspondence to Dr. Yukihiro Fujita; e-mail: anesthetized dogs. We hypothesized that epidural injection of [email protected] medetomidine produces volatile anesthesia-sparing effects and Use of this article is limited to a single copy for personal study. subsequently results in maintenance of a high systemic blood Anyone interested in obtaining reprints should contact the pressure. CVMA office ([email protected]) for additional The study was approved by the Institutional Animal Care and copies or permission to use this material elsewhere. Use Committee of Azabu University (protocol 140805-1). Five

742 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY BRIEF COMMUNICATION Concentration of isoflurane (%)

Time after administration (hours)

Figure 1. Airway concentration of isoflurane (ISO) following the epidural injection of saline (circles), 10 mg/kg medetomidine (triangles), and 20 mg/kg medetomidine (squares). Small shapes indicate individuals in each group, while large shapes with lines represent the mean of 5 dogs. Asterisks with the same numbers indicate a statistically significant difference (P , 0.05) between groups. intact male beagle dogs aged 78 to 82 mo [mean 6 standard of isoflurane (ISO; %) was measured from the distal endotra- deviation (SD), 80.4 6 1.1 mo] and weighing 9.5 to 12.8 kg cheal tube, and the heart rate [HR; beats per minute (bpm)] (10.9 6 1.4 kg) were used. Before experimentation, all dogs was measured via electrocardiogram lead II. were subjected to blood tests [complete blood (cell) count To ensure standardized conditions, hemoglobin saturation

(CBC), biochemical analysis, and electrolyte determination], estimated non-invasively with a pulse oximeter (SpO2) was thoracic and abdominal radiography, and general physical maintained between 95% and 100%, an esophageal tempera- examination. All dogs were confirmed to be in good to excellent ture probe introduced orally monitored temperature at 36.0°C health. Food and water were withheld from the dogs for 12 h to 37.0°C, and end-tidal partial pressure of carbon dioxide prior to experimentation. with mechanical ventilation was maintained between 35 and The dogs were pre-medicated with atropine sulfate (Atropine 45 mmHg. These parameters were monitored using a multi- sulfate injection 0.5 mg; Mitsubishi Tanabe Pharma, Osaka, parameter monitoring system (AM130 FUKUDA M&E, Tokyo, Japan), 0.025 mg/kg BW, SQ. Subsequently, anesthesia was Japan). Complete calibration using gas was performed at the induced with isoflurane (Isoflurane for Animals; Intervet K.K., start of the study and confirmed the range of error within 0.1% Tokyo, Japan) in 100% oxygen delivered via a mask. Anesthesia of the isoflurane concentration. In addition, before each experi- was maintained with isoflurane using a non-rebreathing anes- ment, it was confirmed that the baseline and 2.5% vaporizer thetic circuit, Bain coaxial system (Compos b Metran, Saitama, setup displayed on the monitor were 0.0% to 0.1% and 2.3% Japan). Dogs were orotracheally intubated with an endotracheal to 2.7%, respectively, without being connected to the dogs. tube and mean systemic arterial pressure (MAP; mmHg) was All dogs were administered lactated Ringer’s solution measured using oscillometry with the cuff positioned on the (Solulact; Terumo, Tokyo, Japan) at a rate of 3 mL/kg BW per proximal tail. The blood pressure cuff represented 40% to 60% hour, IV, through a 22-gauge catheter (Surflo; Terumo) posi- of the proximal tail’s circumference, the end-tidal concentration tioned in the cephalic vein.

CVJ / VOL 58 / JULY 2017 743 FOR PERSONAL USE ONLY COMMUNICATIONBRÈVE Heart rate (bpm) Mean arterial pressure (mmHg) Mean arterial pressure

Time after administration (hours)

Figure 2. Hemodynamic differences [A — mean arterial pressure (MAP), B — heart rate (HR)] between saline (circles), 10 mg/kg medetomidine (triangles), and 20 mg/kg medetomidine (squares). Small shapes indicate individuals in each group, while large shapes with lines represent the mean of 5 dogs. Asterisks with the same number indicate a statistically significant difference (P , 0.05) between groups.

After confirmation of anesthetic stability, which included ing the clamping of the 3rd metatarsal bone of the left limb to waiting for a period of 15 min during which there was no estimate deep pain using bone forceps at 1, 2.5, and 4 h after response to deep pain stimulation, the epidural injection was administration. The stimulated site was shaved pre-examination administered between the 7th lumbar and 1st sacral vertebrae to minimize the risk of hair-induced artifacts. The degree of with the dog in sternal recumbency. Correct spinal needle clamping was standardized by closing the first ratchet of bone (Terumo Spinal Needle; Terumo) placement in the epidural forceps in order to maintain the condition. A positive response space was confirmed by both the hanging drop and loss of resis- to the mechanical stimulus for the determination of ISO was tance methods. Dogs then received medetomidine (Domitor; performed as previously described in another study (10). The Nippon Zenyaku Kogyo, Koriyama, Japan), 10 mg/kg BW ISO was determined as the mean of the concentration of isoflu- or 20 mg/kg BW (diluted with 0.2 mL/kg BW sterile saline rane at which the dog did not demonstrate a positive response for the M10 and M20 groups, respectively), or sterile saline and a subsequent lower concentration tested positive. MAP and (0.2 mL/kg BW for the S group) as a control group, all admin- HR were measured 1 min before application of the mechanical istered by the epidural route. Lameness was estimated at the stimulus and were determined as the mean MAP and HR at end of each experimental procedure. If lameness was observed, which the dog did not demonstrate a positive response and a carprofen (Rimadyl Injectable; Zoetis Japan, Tokyo, Japan), subsequent lower concentration tested positive. 4.4 mg/kg BW, q24h, and buprenorphine (Lepetan injection; The ISO, MAP, and HR values were reported as mean 6 SD. Otsuka Pharmaceutical, Tokyo, Japan), 0.02 mg/kg BW, q8h, Statistical analyses were performed using a one-way analysis of were administered subcutaneously until lameness disappeared. variance (ANOVA) and post-hoc Tukey Kramer test. P-values The dogs were re-anesthetized according to the 3 different pro- , 0.05 were considered statistically significant. tocols with a washout period exceeding 7 d. The ISO values for the dogs in the S, M10, and M20 groups All mechanical stimulation procedures were performed with were 2.92 6 0.38%, 2.08 6 0.60%, and 0.88 6 0.99% at 1 h; the dog placed in the right lateral recumbency position. The 2.74 6 0.31%, 1.94 6 0.73%, and 1.08 6 0.36% at 2.5 h; ISO was determined by applying mechanical stimulation involv- and 2.64 6 0.30%, 1.94 6 0.75%, and 1.62 6 0.30% at

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4 h, respectively. Significant differences were observed between When these higher requirements were adopted, the expected the S and M20 groups at 1 h (P , 0.01), between the S and ISO would be approximately 1.9% to 3.8%, and this range M20 groups (P , 0.01) and M10 and M20 groups (P = 0.048) coincides with our results.

at 2.5 h, and between the S and M10 groups (P = 0.024), and Branson et al (9) found that medetomidine at 5 mg/kg BW BRIEF COMMUNICATION S and M20 groups (P , 0.01) at 4 h (Figure 1). administered in the epidural space of dogs did not produce The MAP values for the dogs in the S, M10, and M20 sufficient analgesic effect, as measured by the tail clamp test groups were 55.4 6 7.80 mmHg, 80.8 6 31.80 mmHg, (9). In contrast, 2 studies reported that medetomidine at and 113.6 6 13.92 mmHg at 1 h; 65.0 6 13.58 mmHg, 10 mg/kg BW in cats and at 15 mg/kg BW in dogs increased the 75.6 6 25.74 mmHg, and 95.2 6 11.78 mmHg at pain threshold (6,7). Moreover, Campagnol et al (8) found that 2.5 h; and 64.8 6 9.20 mmHg, 78.6 6 17.54 mmHg, and administration of dexmedetomidine, 1.5 to 6.0 mg/kg BW, had 79.0 6 12.41 mmHg at 4 h, respectively. Significant differences an isoflurane-sparing effect in dogs. Since dexmedetomidine is were observed between the S and M20 groups (P , 0.01), and approximately twice as potent as medetomidine, we could infer between the M10 and M20 groups (P = 0.031) at 1 h, and that this study examined approximately 3.0 to 12.0 mg/kg BW between the S and M20 groups at 2.5 h (P = 0.012) (Figure 2A). of medetomidine. Therefore, we assumed that an epidural The heart rates of the dogs in the S, M10, and M20 medetomidine injection exceeding 5 mg/kg BW was required to groups were 122.4 6 11.59 bpm, 105.4 6 18.28 bpm, provide an isoflurane-sparing effect against mechanical stimula- and 83 6 18.48 bpm at 1 h; 128.0 6 12.75 bpm, tion. Moreover, we estimated a higher dosage (. 15 mg/kg BW), 109.4 6 15.26 bpm, and 76.6 6 15.95 bpm at 2.5 h; and which has not been examined previously. 129.0 6 17.89 bpm, 108 6 18.33 bpm, and 91.4 6 17.05 bpm In the present study, epidural administration of medetomi- at 4 h, respectively. Significant differences were observed dine at 10 or 20 mg/kg BW decreased isoflurane requirements between the S and M20 groups at all time points (P , 0.01 at by 29.4% and 67.0% at 1 h, 29.9% and 60.0% at 2.5 h, and 1 h and 2.5 h and P = 0.015 at 4 h), and between the M10 and 28.8%, and 38.5% at 4.0 h, respectively. These reduction rates M20 groups at 2.5 h (P = 0.011) (Figure 2B). No dogs received may be comparable to that of morphine at 0.1 mg/kg BW analgesia after the procedure. (15). In the present study, the group administered medetomi- In the present study, despite the fact that all 5 dogs had a dine at 10 mg/kg BW experienced a similar isoflurane-sparing negative epidural pressure and loss of resistance during injection, rate as those in a previous study in which dexmedetomidine, only 1 dog had a high ISO (2.5%) at 1 h after administration 6.0 mg/kg BW, was injected by the epidural route (8). In addi- of medetomidine at 20 mg/kg BW. This ISO value was similar tion, similar to the previous study, the reduction rate in the to the ISO requirement with a saline injection (2.7%) and present study was dose-dependent. However, high-dose epidural higher than that following administration of medetomidine at injections of medetomidine, 20 mg/kg BW, have not been 10 mg/kg BW (2.1%). A previous study reported that 12% of reported. These findings may be explained by blockage of the 636 dogs undergoing hind-limb orthopedics surgery adminis- nociceptive pathway at the level of the spinal cord via activation tered bupivacaine by the epidural route showed persistent signs of the a-2 adrenoceptors. Systemic administration of medeto- of pain despite adequate anesthetic procedure (11). It may have midine also provides analgesia and has a volatile anesthetic- also been difficult to accurately identify the spinal needle insert sparing effect. Ewing et al (16) reported that medetomidine position in the dog with the 2.5% ISO in the present study, and at 30 mg/kg BW injected intravenously reduced the isoflurane this outlier could explain the insignificant difference between requirement by 47.2% (16). Therefore, epidural injection of the M10 and M20 groups at 1 h. medetomidine may have a greater volatile anesthetic-sparing Noxious stimulation is classified as electrical, thermal, effect with regard to hind-limb procedures than systemic admin- mechanical, or chemical (12). In the present study, we chose istration, even at a reduced dosage. In addition, the analgesic the mechanical stimulation method as a previous study revealed effects recorded in the present study persisted over 4 h; this was that this method could present similar results to the electrical longer than that reported for medetomidine at 30 mg/kg BW stimulation used to estimate MAC, and this method is reproduc- via intramuscular injection (17). ible surgically because it induces deep pain (13). The HR of the dogs in the M20 group was lower than that We adopted MAC-BAR rather than MAC as MAC-BAR is of the dogs in the S group at all time points, and in dogs in more suited to measuring an adequate level of surgical anesthesia the M10 group at 2.5 h. This may indicate that medetomidine that prevents autonomic adrenergic responses and movements was cleared from the cerebrospinal fluid (CSF) around the in animals (10). According to a previous report using sevo- spinal injection site and therefore had a similar effect to that of flurane, the MAC-BAR was 1.3 to 2.1 times higher than the systemic injection. Previous studies that administered medeto- MAC value. With isoflurane, the MAC is approximately 1.3% midine and dexmedetomidine by the epidural route showed to 1.4% in mongrel dogs (13). Therefore, the MAC-BAR of a similar HR-reducing effect, but reported a lower HR than isoflurane could be estimated at 1.69% to 2.94%. However, that in the present study (7,8). This discrepancy in HR rates the MAC-BAR of the control group herein was higher than our may be because the present study maintained a higher volatile surmised value. The study reported by Magnusson et al (14) anesthetic concentration than the previous 2 studies. Vesal indicated that beagle dogs needed a higher MAC of isoflurane et al (7) performed their study in conscious animals, while the in both young (2 to 3 y; 1.82 6 0.08%) and old (. 11 y; method of isoflurane concentration determination in the study 1.45 6 0.06%) than the values reported with mixed breeds (14). by Campagnol et al (8) was different from that herein since they

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excluded the changes in HR and MAP as nociception indica- 2. Brodbelt DC, Pfeiffer DU, Young LE, Wood JLN. Results of the con- tors. Therefore, in the present study, a higher concentration of fidential enquiry into perioperative small animal fatalities regarding risk factors for anesthetic-related death in dogs. J Am Vet Med Assoc isoflurane was required than that in the study by Campagnol 2008;233:1096–1104. et al (8) and since higher concentrations of inhalant anesthetic 3. Seddighi R. a-2 adrenoceptor agonists. In: Egger CM, Love L, result in vasodilation, HR may be increased to maintain the Doherty T, eds. Pain Management in Veterinary Practice. Ames, Iowa: Wiley Blackwell, 2014:93–103. MAP via the baroreceptor reflex. 4. Campoy L, Read M, Peralta S. Canine and feline local anesthetic and To confirm whether analgesia was due to the epidural effect analgesic techniques. In: Grimm KA, Lamont LA, Tranquilli WJ, alone, further studies should include an intramuscular injection Greene SA, Robertson SA, eds. Veterinary Anesthesia and Analgesia. 5th ed. Ames, Iowa: Wiley Blackwell, 2015:827–856. group and should measure medetomidine in CSF sampled from 5. Philipp M, Brede M, Hein L. Physiological significance of alpha(2)- the cisterna magna and in blood. A previous study reported that adrenergic receptor subtype diversity: One receptor is not enough. Am epidural administration of morphine in the lumbosacral space, J Physiol Regul Integr Comp Physiol 2002;283:R287–R295. 6. Duke T, Cox A-M, Remedios AM, Cribb PH. The analgesic effects of which reduces the halothane requirement for hind limbs against administering fentanyl or medetomidine in the lumbosacral epidural COMMUNICATIONBRÈVE an electrical stimulus, can also be performed for the forelimbs space of cats. Vet Surg 1994;23:143–148. (both 0.13 and 0.26 mL/kg BW injection groups) due to CSF 7. Vesal N, Cribb PH, Frketic M. Postoperative analgesic and cardiopulmonary effects in dogs of oxymorphone administered epidurally and adsorption and anterior movement (15). intramuscularly, and medetomidine administered epidurally: A compara- There are several limitations to the present study. First, the tive clinical study. Vet Surg 1996;25:361–369. number of dogs may have been insufficient to detect significant 8. Campagnol D, Neto FJT, Giordano T, Ferreira TH, Monteiro ER. Effect of epidural administration of dexmedetomidine on the mini- differences between the M10, M20, and control groups. The mum alveolar concentration of isoflurane in dogs. Am J Vet Res 2007; main reason why there were not significant differences in the 68:1308–1318. ISO reduction effect between groups S and M10 at 1.0 and 9. Branson KR, Ko JCH, Tranquilli WJ, Benson J, Thurmon JC. Duration of analgesia induced by epidurally administered morphine and medeto- 2.5 h may be due to the small sample size, despite the fact that midine in dogs. J Vet Pharmacol Therap 1993;16:369–372. there was an approximately 30% reduction in ISO effects at each 10. Yamashita K, Furukawa E, Itami T, Ishizuka T, Tamura J, Miyoshi K. time point. Second, we measured MAP using the oscillometric Minimum alveolar concentration for blunting adrenergic responses (MAC-BAR) of sevoflurane in dogs. J Vet Med Sci 2012;74:507–511. method in order to estimate systemic hemodynamics, although 11. Heath RB, Broadstone RV, Wright M, Grandy JL. Using bupivacaine measuring blood pressure using invasive techniques is superior to hydrochloride for lumbosacral epidural analgesia. Compend Contin measurements with a non-invasive technique. However, Koyama Educ Pract Vet 1989;11:50–55. 12. McKune CM, Murrell JC, Nolan AM, White KL, Wright BD. et al (18) reported a high correlation between direct and indirect Nociception and pain. In: Grimm KA, Lamont LA, Tranquilli WJ, blood pressure measurements with the same instrument as that Greene SA, Robertson SA, eds. Veterinary Anesthesia and Analgesia. used in the present study. 5th ed. Ames, Iowa: Wiley Blackwell, 2015:584–623. 13. Valverde A, Morey ET, Hernandez J, Davies W. Validation of several Medetomidine injection causes a 2-staged blood pressure types of noxious stimuli for use in determining the minimum alveolar change; elevation of blood pressure after administration and concentration for inhalation anesthetics in dogs and rabbits. Am J Vet subsequent hypotension (3). However, in the present study, Res 2003;64:957–962. 14. Magnusson KR, Scanga C, Wagner AE, Dunlop C. Changes in anes- epidural injection of medetomidine maintained the MAP at a thetic sensitivity and glutamate receptors in the aging canine brain. higher level than that in the control group. This may be due J Gerontol A Bio Sci Med Sci 2000;55:B448–454. to not only systemic absorption of medetomidine but also the 15. Valverde A, Dyson DH, McDonell WN. Epidural morphine reduces halothane MAC in the dog. Can J Anaesth 1989;36:629–632. reduction of isoflurane (that can cause severe hypotension). 16. Ewing KK, Mohammed HO, Scarlett JM, Short CE. Reduction of In conclusion, administration of medetomidine by the epi- isoflurane anesthetic requirement by medetomidine and its restoration dural route has a volatile anesthetic-sparing effect and maintains by atipamezole in dogs. Am J Vet Res 1993;4:294–299. 17. Vainio O, Vaha-Vahe T, Palmu L. Sedative and analgesic effects of the MAP at a higher level compared to the control; the effect is medetomidine in dogs. J Vet Pharmacol Ther 1989;12:225–231. potentially dose-dependent. CVJ 18. Koyama H, Fukushima R, Yoshii H, et al. Measurement of blood pressure using a new automatic-system of sphygmomanometer in dogs. Adv References Anim Cardiol 2002;35:41–47. 1. Berry SH. Analgesia in the perioperative period. Vet Clin North Am Small Anim Pract 2015;45:1013–1027.

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Canine oral papillomavirus outbreak at a dog daycare facility

Heather E. Lane, J. Scott Weese, Jason W. Stull

Abstract — This report describes an outbreak at a dog daycare facility where 13 of 52 dogs developed suspected canine papillomavirus (CPV) infection. Based on contact tracing, subclinical CPV shedding was speculated. Active surveillance, exclusion of animals with active or recent infection and cohort formation may have been effective in stopping the outbreak.

Résumé — Éclosion du papillomavirus oral canin dans une garderie canine. Ce rapport décrit l’éclosion dans une garderie canine où 13 des 52 chiens ont développé une infection suspectée par le virus du papillome canin (VPC). En se basant sur le retraçage des contacts, on a émis la supposition d’une excrétion subclinique du VPC. Une surveillance active, l’exclusion des animaux avec une infection active ou récente et la formation d’une cohorte ont pu être efficaces pour freiner l’éclosion. (Traduit par Isabelle Vallières) Can Vet J 2017;58:747–749

ospital acquired infections (HAIs) in human healthcare a considerable issue where investigation may be limited or there H settings are of great health and economic concern (1). is reluctance to report problems. Human HAIs have been associated with numerous factors, Canine papillomavirus (CPV) is a double-stranded, non- including weakened immune systems of patients, poor compli- enveloped, DNA virus. Papillomaviruses can be found in various ance of healthcare staff with procedures such as hand hygiene mammalian species, but are highly host-specific with numer- and high patient-patient interaction (2,3). While traditionally ous types identified in dogs (7). Infection can be transmitted the focus on HAIs is transmission within hospital environments, by direct contact with the papilloma(s) of an infected dog or it is increasingly clear that there can be a strong influence of the contact with the virus in the environment. The virus requires community, as patients who are admitted shedding a pathogen microabrasions to access the basal layer of the skin to establish (clinically or asymptomatically) can be important sources of an infection (8). It is not known if dogs need to have visible infection (4,5). Similar risk factors and transmission dynamics lesions to be infectious. After an approximately 4-week incu- exist in veterinary hospitals and settings such as dog daycares bation period (9,10), lesions of varying size and number may and boarding facilities, in which there may be mixing of animals become apparent, although subclinical infections are believed to from different origins. Concentrated populations, admission also occur. The most common presentation is the development of animals from diverse backgrounds, direct animal contact, of oral lesions (papillomatosis) in young dogs, but cutaneous and fomites, among other factors, can create an ideal environ- papillomatosis is also possible (9,10). ment for pathogen transmission (6). Little has been published In most cases, lesions are mild and result in little apparent on pathogen outbreaks and control measures in these animal discomfort or complications, and spontaneous regression typi- group settings. However, anecdotally, outbreaks in facilities cally occurs over 4 to 8 wk (10). However, severe clinical signs such as dog daycares are not uncommon and under-reporting is can be seen in some animals. In rare cases, lesions can be so severe that they create difficulty eating and drinking and can be a cause of respiratory obstruction (8). Department of Veterinary Preventive Medicine, College of A definitive diagnosis of CPV can only be obtained through Veterinary Medicine, The Ohio State University, Columbus, histopathology, polymerase chain reaction (PCR), immunohis- Ohio 43210, USA (Lane, Stull); Department of Pathobiology, tochemistry, in situ hybridization, or electron microscopy of Ontario Veterinary College and Centre for Public Health and biopsy samples. Additional diagnostics are needed to determine Zoonoses, University of Guelph, Guelph, Ontario N1G 2W1, the CPV type. Given the generally limited severity or long-term Canada (Weese). health consequences of CPV infection, relatively short duration Address all correspondence to Dr. Jason Stull; e-mail: of clinical signs, and typically self-limiting nature of the disease, [email protected] confirmatory testing is not often pursued. Several approaches Use of this article is limited to a single copy for personal study. have been suggested for treatment (e.g., surgical excision, vac- Anyone interested in obtaining reprints should contact the cination, antimicrobials); however, data on efficacy are lacking CVMA office ([email protected]) for additional due to limited study, the transient nature of lesions and concerns copies or permission to use this material elsewhere. about the use of antimicrobials when not indicated (7,8,11–14).

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Although CPV has been described since the 19th century, anecdotally frequently observed in dogs in group settings and is highly transmissible, little published information is available on disease occurrence (9). In 1 CPV outbreak in a dog breeding facility 10% (40/400) of dogs, all approximately 3.5 mo of age, were affected (15). Furthermore, limited information is available on best practices that can be implemented to prevent or control CPV transmission and resulting outbreaks. At the University of Guelph, Ontario Veterinary College, a dog daycare facility was established as a branch of the community practice program. Daycare dogs were kept separated from community practice patients, although there was a shared

COMMUNICATIONBRÈVE entrance and lobby. Procedural separation from veterinary practice patients included separate dedicated items, runs, and common use areas. At the daycare, dogs were managed as a Figure 1. Epidemic curve of suspected CPV cases in dog daycare facility (2011–2012). A — Active surveillance initiated. single group, allowed to directly interact with other attendees B — First cohort system put in place on December 13, 2011. and animal care attendants were responsible for monitoring the C — Existing cohorts consolidated February 21, 2012 and dogs. Common use toys and water dishes were available. Routine continued to April 1, 2012. environmental cleaning and disinfection practices, using accelerated hydrogen peroxide, occurred once daily. On September 6, 2011 an animal care attendant noted oral attended the daycare facility, ranging from 1 to 78 total visits lesions in a 9-month-old dog (D1) at the dog daycare facility. (mean 15 visits). During the outbreak period, 13 (25%) of these The dog was subsequently examined by a facility veterinarian dogs were diagnosed with suspect CPV infection: September and papillomavirus infection was presumptively diagnosed. The (n = 2), October (n = 1), November (n = 5), December (n = 4), dog was immediately excluded from the daycare facility until January (n = 1) (Figure 1). All suspect dogs had oral lesions; no free of oral lesions for 2 wk. On September 14, 2011 similar oral cutaneous lesions were reported. The ages of 7 of the suspect lesions were noted on another dog (D2) at the daycare facility dogs were known (range: 4 mo to 7 y; mean: 1.8 y; median: and were also diagnosed by a facility veterinarian as suspected 11 mo). The incidence rate for the 7-month outbreak period was papillomavirus infection. During a conversation with the owner 1.5 suspect CPV cases per 100 dog-days at risk (calculated using of D2, it was reported that these lesions had been present for the 11 incident cases identified after active surveillance was initi- approximately 3 to 4 wk. This dog was excluded from the facility ated and the dog-days at risk for this period determined from as per the previous dog. the attendance logs). Of the suspected dogs, 7 (54%) returned Following the 2 identified suspect cases of CPV and concern to the daycare facility after resolution of clinical signs (median: about likely transmission to daycare dogs from these cases, 40 d after exclusion; range: 29 to 85 d). Information was not an active surveillance program was established. Animal care available on additional details of cases, such as severity of ill- attendants performed daily oral and external evaluations on ness, breed, comorbidity and specific duration of clinical signs. all dogs at time of admission, with hand hygiene carried out Due to the continued case identification despite active sur- between oral examinations. If clinical signs of CPV infection veillance and immediate exclusion, effective December 13, 2011 were found (e.g., newly visible raised lesion in the oral cavity a cohort system was implemented. This involved the creation of or elsewhere) the affected dog was excluded from the daycare 10 cohorts (4 to 5 dogs per cohort) and each daycare attendee and not permitted to return until 2 wk after cessation of clini- was assigned to 1 of these cohorts based on dog-dog compat- cal signs (as determined by a veterinarian). A suspect CPV case ibility and planned attendance. Dogs only interacted with other was defined as a dog with clinical signs compatible with CPV dogs in their cohort and measures were taken to reduce indirect infection in the form of oral or cutaneous papillomatosis that contact between the different cohort members (e.g., water dishes was supported by examination by a veterinarian. All cases were and toys were changed between cohorts; common indoor and considered suspect as additional diagnostics (e.g., biopsy) were outdoor exercise areas were used by all cohorts). Due to logistics not pursued by clients. Electronic daily dog attendance logs were and decreasing daycare attendees, existing cohorts were consoli- kept for the daycare and subsequently reviewed to determine dated into 4 cohorts (3 to 10 dogs per cohort) that remained the population at risk and inform hypotheses for transmission from February 21, 2012 to March 30, 2012. within the facility. Contact tracing was conducted whereby During the outbreak, clients were provided an information dog attendance logs of all suspect CPV cases were reviewed to sheet about CPV, including how dogs become infected, clinical determine if they had contact with other affected dogs with an course and duration, general information about the outbreak at attempt to estimate an infectious period. the facility, and steps that were being taken to protect participat- The outbreak period was defined from September 6, 2011 ing dogs. Clients were asked to report observed signs in their to March 30, 2012 (the date of identification of the first CPV dogs consistent with CPV infection. On March 30, 2012 the case to an estimated 2 incubation periods after exclusion of outbreak was considered over as no new cases had been identi- the last case, respectively). In total, during the 7 mo, 52 dogs fied within 2 incubation periods.

748 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY

Despite the anecdotally frequent occurrence of oral CPV, secondary transmission and occurrence of an outbreak. Due to there are minimal publications on CPV outbreaks, manage- the nature of this outbreak and data available, the true effect of ment, and prevention. This may be due to the transient nature these measures on halting the outbreak cannot be determined.

and spontaneous regression of CPV clinical signs and minimum It is possible an agent other than CPV was responsible for the BRIEF COMMUNICATION severity in most of the infected animals. However, despite the lesions as confirmatory diagnostics were not pursued by the often minor severity of lesions, CPV is highly infectious, as clients; however, this seems unlikely as in the authors’ opinion documented in this outbreak and another study (15), can lead no other agents are consistent with the observed lesions and to severe disease in some dogs and therefore should be addressed outbreak. by prevention and response actions in canine group settings and As many veterinary clinics have dog daycare facilities as an veterinary facilities. added form of revenue, outbreaks within the hospital setting The origin of CPV in this outbreak cannot be established. could occur. Although most cases of CPV are mild and self- The index case (D1) could have become infected through con- resolving, it is highly infectious, potentially with subclinical tact with animals outside of the daycare (community acquired) shedding, and an outbreak in hospital patients could be severe. or through contact with an infectious dog or contaminated The incorporation of infection control practices aimed at CPV environment in the daycare facility. Due to the relatively long and similar pathogens is important for all clinics, especially those incubation period of CPV, any of these sources is possible. with multiple (potentially mixing) animal groups. CVJ Contact tracing based on electronic records and cohort assignments allowed evaluation of CPV transmission proper- References ties although there was high dog commingling during the first 1. Reed D, Kemmerly SA. Infection control and prevention: A review of hospital-acquired infections and the economic implications. Ochsner several months of the outbreak, making this evaluation difficult. J 2009;9:27–31. With 1 exception, all dogs that became infected had 1 or more 2. Sydnor ERM, Perl TM. Hospital epidemiology and infection control in CPV transmission opportunities within the daycare population acute-care settings. Clin Microbiol Rev 2011;24:141–173. 3. Ferguson JK. Preventing healthcare-associated infection: Risks, health- [present on the same day and time and with likely contact as care systems and behaviour. Intern Med J 2009;39:574–581. a dog incubating CPV infection, with this contact occurring 4. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance defi- approximately 1 incubation period (4 wk) before the onset nition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control of clinical signs]. The exception was D13 whose only contact 2008;36:309–332. with a previously infected dog in the facility occurred approxi- 5. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC mately 2 mo before developing clinical signs. This suggests that definitions for nosocomial infections. Am J Infect Control 1988;16: 128–140. an incubation period of greater than 4 wk may be possible, 6. Stull JW, Weese JS. Hospital-associated infections in small animal although other sources of infection cannot be excluded. For all practice. Vet Clin Small Anim 2015;45:217–233. other cases, transmission opportunities fell within the 4-week 7. Lange CE, Favrot C. Canine papillomatosis. Vet Clin North Am Small Anim Pract 2011;41:1183–1195. incubation period. 8. Sykes JE, Luff JA. Viral papillomatosis. In: Sykes J, ed. Canine Three cases could each be traced back to a single previously and Feline Infectious Diseases. St. Louis, Missouri: Elsevier, 2013: infected dog. If it is assumed these dog-dog interactions were 261–268. 9. M’Fadeyan J, Hobday F. Note on the experimental transmission of warts responsible for CPV transmission, dogs would have been infec- in the dog. J Comp Pathol Ther 1898;11:341–344. tious from 3 to 14 d prior to case identification (presumably 10. Chambers VC, Evans CA. Canine oral papillomatosis. I. Virus assay when clinical signs began). Subclinical shedding has not been and observations on the various stages of the experimental infection. Cancer Res 1959;19:1188–1195. described for CPV. Since indirect transmission, including 11. Lange CE, Tobler K, Schraner EM, et al. Complete canine papilloma- environmental contamination and additional external sources virus life cycle in pigmented lesion. Vet Microbiol 2013;162:388–395. of CPV cannot be excluded for these cases, this area deserves 12. Bredal WP, Thoresen SI, Rimstad E, Aleksandersen M, Nafstad PH. Diagnosis and clinical course of canine oral papillomavirus infection. further investigation. J Small Anim Pract 1996;37:138–142. There is limited information on the epidemiology of CPV 13. Yağci BB, Ural K, Ocal N, Hayardedeoğlu AE. Azithromycin therapy in group settings and utility of control measures to stop an of papillomatosis in dogs: A prospective, randomized, double-blinded, placebo-controlled clinical trial. Vet Dermatology 2008;19:194–198. existing CPV outbreak. In the outbreak reported here cohort 14. Weese JS, Giguère S, Guardabassi L, et al. ACVIM consensus statement formation, active surveillance, and exclusion of animals with on therapeutic antimicrobial use in animals and antimicrobial resistance. lesions may have been beneficial in decreasing case numbers J Vet Intern Med 2015;29:487–498. 15. Yhee JY, Kwon BJ, Kim JH, et al. Characterization of canine oral by decreasing direct and environmental exposure to the virus. papillomavirus by histopathology and genetic analysis in Korea. J Vet Early case identification (through active surveillance or client Sci 2010;11:21–25. reporting of clinical signs) can also be helpful in preventing

CVJ / VOL 58 / JULY 2017 749 FOR PERSONAL USE ONLY Practitioners’ Corner Le coin des praticiens

Is melatonin of value in cancer treatment? Experience with a case of feline mammary carcinoma

Beverly Baxter

mature, spayed female domestic shorthaired (DSH) cat melatonin supplementation for the entire duration and did not A weighing 5.8 kg was presented to my clinic in January 2015 report any other abnormal clinical signs. Histopathology was for evaluation of an upper left thoracic mammary mass, which declined at the third surgical intervention. was diagnosed as a poorly differentiated carcinoma. The cat had Twenty-four months after presenting for the initial mass multiple recurrences and surgeries and supplementation with (January 2017), the patient was presented for the fourth time oral melatonin. She survived for 2 years following the initial with an upper left thoracic/axillary subcutaneous mass. This visit. The details are as follows. mass was 8 cm across and irregular in shape, extending deep The subcutaneous mass was diffuse, 5 to 6 cm across, and had into the left axilla and feeling firm and lobular on palpation. a ropey texture. All lymph nodes palpated normally and survey The owners reported a transient period (24 h) of the cat being thoracic radiographs did not demonstrate any abnormalities. A off food 2 to 3 wk before presentation, with 1 episode of vomi- complete blood (cell) count (CBC) showed a mild lymphope- tion. The cat had maintained her weight to this point but she nia and blood biochemistry values were within normal limits. now weighed 5.3 kg. In addition to a mild leukopenia there was Mastectomy of the 2 upper left thoracic mammary glands was a mild increase in total serum protein. The mass was removed carried out under general anesthesia; post-operative recovery under general anesthesia and a drain was placed. A histopatho- was unremarkable. Histopathology revealed a poorly differenti- logical diagnosis of solid and tubular mammary carcinoma ated high grade mammary adenocarcinoma with intravascular was made. The cat had survived over 730 d since the initial and intra-lymphatic invasion. Referral for additional oncology diagnosis. management including chemotherapy was declined. However Feline mammary tumors (FMT) are reported to be the third the owners did elect to begin oral melatonin supplementation most common neoplasm in cats, after hemopoietic and skin (1) at 3 mg daily, administered in the morning. and there is an increased risk associated with being intact (2,3). In January of 2016 the cat was presented with a solitary Dorn et al (2) showed that neutering decreased the risk of devel- grape-sized focal subcutaneous mass in the same general area oping FMT 7-fold. Similarly, a controlled retrospective study but slightly more to the axilla. There were no other clinical showed that ovariohysterectomy decreased the risk of FMT or physical concerns. Pre-operative blood analysis revealed a 2.7-fold (95% confidence interval; 1.4 to 5.3, P , 0.0010) moderate leukopenia due to a neutropenia and lymphope- compared to intact felines and that relative risk was reduced by nia. A lumpectomy under general anesthesia was conducted 91% if the ovariohysterectomy was done by 6 mo of age and and histopathology diagnosed a metastatic tubular carcinoma 86% if done by 1 y of age (3). within an axillary lymph node. Recovery was without incident A breed associated risk may exist with DSH and Siamese and the owners did not report any further abnormalities until cats being overrepresented (4–6). The majority of FMTs are September 2016, when a 3rd subcutaneous mass in the region classified as carcinomas with metastasis frequently reported had developed. This mass appeared more invasive, was diffuse, (4–6). Feline mammary tumors are subtyped by both growth hard, not consistent in texture on palpation, and 6 to 8 cm in and histology. Tumors are graded I to IV using a tumor, node, size. Pre-anesthetic serum biochemistry values continued to be metastasis (TNM) system depending on tumor size and evi- within normal limits, but a leukopenia persisted. A mass removal dence of lymph node involvement or metastasis (5–7). Various was performed again. The owners had continued with the oral histological subtypes of FMTs including solid, tubular, papillary, tubulopapillary, complex, invasive micropapillary, squamous cell, Dr. Baxter is a practitioner at Baxter Animal Hospital in cribiform, and mixed have been described (5,8,9). The grade of Sudbury, Ontario. She is also a PhD student in the Biomolecular tumor can also be defined based on histology using modified Sciences program at Laurentian University in Sudbury, Ontario. versions of the World Health Organization (WHO) or Elston Address all correspondence to Dr. Beverly Baxter; e-mail: and Ellis grading systems (5,9) in which grade 1 (I) tumors are [email protected] well-differentiated, grade 2 (II) are moderately differentiated and Use of this article is limited to a single copy for personal study. grade 3 (III) tumors are poorly differentiated. A recent review Anyone interested in obtaining reprints should contact the by Zapulli et al (7) confirmed a relationship between tumor CVMA office ([email protected]) for additional size and survival time for felines with mammary neoplasms but copies or permission to use this material elsewhere. suggests that standardization in histological classification and

750 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY study methodology are required. For example, not all studies studies showing 100% of cats dying by 1 y after surgery (8) have reported significant findings for tumors , 3 cm which may and other studies demonstrating only 3% surviving to 2 y after be related to differences in accuracy and instrumentation (10). diagnosis (12). This patient’s primary mass also had micro blood

Further, while Castagnaro et al (8) demonstrated good predictive vessel and lymphatic invasion. The observation that the subject CORNER PRACTITIONERS’ value for tumor grades I and III but not for grade II, Seixas et al received daily melatonin treatment suggests that further studies (5) showed statistical significance between histological grade and on the possible benefits of melatonin might be useful. While overall survival using univariate analysis. it is not possible to determine from this single case whether Some factors used to determine prognosis in human patients, melatonin had any role, the paucity of randomized clinical tri- such as hormone responsiveness (estrogen or progesterone als of chemotherapeutic agents post-surgery and the high level receptor status) are not well-developed in veterinary medicine of side-effects from treatment suggests melatonin might bear (11). However, some studies have shown that unlike humans, consideration for further clinical trials with and without other feline mammary carcinomas do not display a high degree of therapeutics. Further, as Hughes et al (12) discuss, the role of positive steroid receptors (3,4,11,12). The absence of estrogen ovariohysterectomy in the incidence of feline carcinomas needs responsiveness in most feline tumors (11) seems at odds with to be considered since most FMT are estrogen receptor nega- the demonstrated protective effect of ovariohysterectomy (3). tive. It has been suggested that FMT may be a suitable model This case highlights a cat diagnosed with a poorly differenti- for human carcinomas but any comparison to women requires ated carcinoma; according to Seixas et al (5) only 3.1% of cats that future studies look at the separate incidence and prognosis with grade III mammary lesions survive to 2 y after presenta- in all feline molecular subtypes. A final note needs to recognize tion. The initial tumor size of 5 cm is in the expected range the dedication of this patient’s owners, who played a major role for a grade III tumor (8). The fact that the lymph node mass in her long survival. CVJ diagnosed 1 y after the removal of the original tumor was a different histological type may not be that unusual as involved Acknowledgments lymph nodes can display discordant results (42.9% of the time) compared to the primary tumor (11). I thank Robert Lafrenie, PhD, of Health Sciences North The primary recommendation for management of FMT is Research Institute and Laurentian University, Sudbury, Ontario surgical removal (4,13). It is not clear whether radical mastec- for his kind mentoring and review of the manuscript and the tomy has any benefit over more conservative surgical removal Irvine family for their permission to share the information in terms of survival (4,6). Cats with more aggressive disease as about this case. suggested by diagnosis with histological grade II and III tumors would appear to be candidates for adjunct therapy (6,13). References However, studies have failed to consistently demonstrate that 1. MacVean DW, Monlux AW, Anderson PS, Jr, Silberg SL, Roszel JF. Frequency of canine and feline tumors in a defined population. Vet surgery plus chemotherapy confers any beneficial effect in Pathol 1978;15:700–715. terms of survival (4,6,14). Managing the side effects of chemo- 2. Dorn CR, Taylor DOM, Schneider R, Hibbard HH. Survey of animal therapeutic agents in cats may be a substantial challenge (4,13). neoplams in Alameda and Contra Costa counties, California. Cancer morbidity in dogs and cats from Alameda County. J Nat Cancer Inst Other barriers to providing chemotherapy include financial 1968;40:307–318. means of the owner and patient personality and amenability 3. Overley B, Shofer FS, Goldschmidt MH, Sherer D, Sorenmo KU. to handling. Radiation therapy is not routinely recommended Association between ovariohysterectomy and feline mammary carcinoma. J Vet Intern Med 2005;19:560–563. for FMT (4). 4. Gimenez F, Hecht S, Craig LE, Legendre AM. Early detection, aggres- In this case, the patient received daily oral melatonin sive therapy — Optimizing the management of feline mammary masses. (3 mg/day) following removal of the original tumor. Melatonin J Feline Med Surg 2010;12:214–224. 5. Seixas F, Palmeira C, Pires MA, Bento MJ, Lopes C. Grade is an inde- is an indole amine hormone produced by pinealocytes and extra- pendent prognostic factor for feline mammary carcinomas: A clinico- pineal cells (15). Nocturnal secretions from the pineal gland pathological and survival analysis. Vet J 2011;187:65–71. provide a diurnal peak that mediates a number of biological 6. Amorim FV, Souza HJM, Ferreira AMR, Fonesca ABM. Clinical, cytological and histopathological evaluation of mammary masses in cats from effects including immunomodulatory, oncostatic, and anti- Rio de Janeiro, Brazil. J Fel Med Surg 2006;8:379–388. oxidant effects (15). Several studies have shown that women 7. Zappulli V, Rasotto R, Caliari D, et al. Prognostic evaluation of who do shiftwork or who regularly cross time zones (e.g., flight feline mammary carcinomas: A review of the literature. Vet Pathol 2015;52:46–60. attendants) involving frequent changes in their sleep/wake cycle, 8. Castagnaro M, Casalone C, Bozzetta E, De Maria R, Biolatti B, are at increased risk of breast cancer. The “melatonin hypothesis” Caramelli M. Tumour grading and the one-year post-surgical prognosis suggests that these disruptions in the normal circadian rhythm in feline mammary carcinomas. J Comp Pathol 1998;119:263–275. 9. Mills SW, Musil KM, Davies JL, et al. Prognostic value of histologic also disrupt the nocturnal emissions of melatonin (16) and that grading for feline mammary carcinomas: A retrospective survival analy- the loss of melatonin is related to increased risk of malignancy sis. Vet Pathol 2015;52:238–249. due to an inability to inhibit cyclooxygenase-2 activity which 10. Dorn CR, Taylor DOM, Frye FL, Hibbard HH. Survey of animal neoplasms in Alameda and Contra Costa counties, California. Methodology has been implicated in various malignancies including human and description of cases. J Nat Cancer Inst 1968;40:295–605. and feline breast carcinomas (17,18). 11. Brunetti B, Asproni P, Beha G, et al. Molecular phenotype in mammary This case illustrates a number of interesting points. The most tumors of queens: Correlation between primary tumour and lymph node metastasis. J Comp Pathol 2013;148:206–213. remarkable is the duration of the patient’s survival. The progno- 12. Hughes K, Dobson JM. Prognostic, histopathological and molecular sis for poorly differentiated carcinomas is very poor with some markers in feline mammary neoplasia. Vet J 2012;194:19–26.

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13. Cunha SCS, Corgozinho KB, Souza HJM, Silva KVGC, Ferreira AMR. 16. Stevens RG. Circadian disruption and breast cancer: From melatonin Adjunct chemotherapy with mitoxantrone for cats with mammary to clock genes. Epidemiology 2005;18:254–258. carcinomas treated with radical mastectomy. J Feline Med Surg 17. Wang J, Xiao X, Zhang Y, et al. Simultaneous Modulation of COX-2, 2015;17:1000–1004. p300, Akt and Apaf-1 signaling by melatonin to inhibit proliferation 14. McNeill CJ, Sorenmo KU, Shofer FS, et al. Evaluation of adjuvant and induce apoptosis in breast cancer cells. J Pineal Res, 2012;53:77–90. doxorubicin-based chemotherapy for the treatment of feline mammary 18. Millanta FG, Citi S, Della Santa D, Porciani M, Poli A. COX-2 expres- carcinoma. J Vet Intern Med 2009;23:123–129. sion in canine and feline invasive mammary carcinomas: Correlation 15. Jenwitheesuk A, Nopparat C, Mukda S, Wongchitrat P, Govitrapong P. with clinicopathological features and prognostic molecular markers. Melatonin regulates aging and neurodegeneration through energy Breast Cancer Res Treat 2006;98:115–120 metabolism, epigenetics, autophagy and circadian rhythm pathways. Int J Mol Sci 2014;15:16848–16884. LE COINLE DES PRATICIENS

Have Another Look at CJVR Avez-vous consulté la RCRV dernièrement? Members of the CVMA are entitled to receive the Canadian Journal Les membres de l’ACMV reçoivent un abonnement gratuit à la of Veterinary Research (CJVR) at no additional charge. The CJVR, Revue canadienne de recherche vétérinaire. On peut consulter la in the form of an interactive (portable document format) pdf, can RCRV, qui est présentée en format pdf interactif, sur le site Web be found on the CVMA member-only website (www.canadian de l’ACMV réservé aux membres (www.veterinairesaucanada.net/ veterinarians.net/publications-research-issue.aspx). publications-research-issue.aspx). Published by the CVMA, this quarterly, peer-reviewed journal is Publiée par l’ACMV, cette revue trimestrielle évaluée par les pairs Canada’s only national veterinary research publication. est la seule publication nationale de recherche vétérinaire au Canada.

Articles from the April 2017 issue of CJVR that might Les articles suivants du numéro d’avril 2017 de la be of interest to practitioners include: RCRV pourraient intéresser les praticiens : Application of direct polymerase chain reaction Application of direct polymerase chain reaction assays for Campylobacter fetus subsp. venerealis and assays for Campylobacter fetus subsp. venerealis and Tritrichomonas foetus to screen preputial samples Tritrichomonas foetus to screen preputial samples from breeding bulls in cow-calf herds in western from breeding bulls in cow-calf herds in western Canada on page 91 Canada à la page 91 Prevalence of small ruminant lentivirus and Prevalence of small ruminant lentivirus and Mycobacterium avium subsp. paratuberculosis Mycobacterium avium subsp. paratuberculosis co-infection in Ontario dairy sheep and dairy co-infection in Ontario dairy sheep and dairy goats on page 155 goats à la page 155

The CJVR, along with the monthly Canadian La RCRV, avec La Revue vétérinaire canadienne qui est Veterinary Journal, is also archived on PubMed Central publiée mensuellement, est aussi archivée sur PubMed (www.pubmedcentral.com) 6 months after publication. Central (www.pubmedcentral.com) six mois après la An interactive pdf of The CVJ is also available on the publication. member-only section of the CVMA website. Un pdf interactif de La RVC est aussi disponible dans la section réservée aux membres du site Web de l’ACMV.

752 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Veterinary Practice Management Gestion d’une clinique vétérinaire

Non-DVM wages and trends across Canada Salaires des employés non-vétérinaires et tendances au Canada

Chris Doherty

n the heels of a strong year for many veterinary hospitals près une solide année pour beaucoup de cliniques vétérinaires O across the nation, non-DVM staff are sharing in the Aau pays, les employés non-vétérinaires se partagent le butin spoils, with wage gains outpacing inflation. en obtenant des gains salariaux supérieurs au taux d’inflation. Data on non-DVM wages are collected through the pro- Les données sur les salaires des employés non-vétérinaires sont vincial Practice Owners Economic Surveys. Non-DVM staff recueillies dans le cadre des Sondages économiques provinciaux are grouped by job title, allowing for an accurate comparison auprès des propriétaires de pratique. Les employés non- between similar employees in different provinces. vétérinaires sont regroupés selon le titre du poste, ce qui permet However, comparing median hourly wage of non-DVM staff une comparaison fidèle entre des employés semblables dans les only tells half the story. The cost-of-living (COL)-adjusted différentes provinces. median hourly wage takes into consideration the variation in Cependant, la comparaison du salaire horaire médian des how much it costs to live in each province. For example, a family employés non-vétérinaires présente seulement un aperçu partiel living in Alberta is likely to have much higher monthly expenses de la situation, car c’est le salaire horaire médian ajusté au coût compared to one in Prince Edward Island, despite maintaining de la vie (CDV) qui tient compte de la variation du coût de la a similar standard of living; as such, we would expect hourly vie dans chaque province. Par exemple, une famille habitant wages to be higher in Alberta. en Alberta aura probablement des dépenses mensuelles de For the purposes of this article, the focus will be on the two beaucoup supérieures à celles d’une famille de l’Île-du-Prince- most populous staff groups: Registered Veterinary Technicians Édouard, malgré le maintien d’un standard de vie semblable, et (RVT)/Animal Health Technologists (AHT) and receptionists. on s’attendrait donc à ce que les salaires horaires soient supérieurs Table 1 outlines the median hourly wages and COL-adjusted en Alberta. median hourly wages for RVTs and AHTs in each province Pour les besoins du présent article, nous nous concentrerons sur Before adjusting for the cost of living, RVT/AHTs in Alberta les deux groupes d’employés les plus importants : les techniciens receive the highest wages, with a median of $22.00. In contrast, vétérinaires agréés (TVA)/technologues en santé animale (TSA) Nova Scotia had the lowest wage, with RVT/AHTs in this prov- et les réceptionnistes. ince earning a median of $16.75. Le tableau 1 indique les salaires horaires médians et les salaires Once adjusting for COL, however, the standings are dramati- horaires médians ajustés au CDV des TVA et des TSA dans cally altered. Newfoundland and Labrador moves into top spot, chaque province.

Dr. Doherty is a graduate of the Ontario Veterinary College and he works as an economic analyst for the Ontario Veterinary Medical Association. 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 Dr Doherty est diplômé de l’Ontario Veterinary College et travaille en tant qu’analyste économique pour l’Ontario Veterinary Medical Association. 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. RVT/AHT median hourly wage and COL-adjusted median hourly wage across Canada/Les salaires horaires médians des TVA/TSA et les salaires horaires médians ajustés au CDV au Canada RVT/AHT NL PEI NB NS ON MB SK AB BC TVA/TSA T.-N.-L. Î.-P.-É. N.-B. N.-É. Ont. Man. Sask. Alb. C.-B. Median hourly wages $20.00 $17.00 $16.84 $16.75 $18.00 $19.40 $19.00 $22.00 $21.00 Salaires horaires médians COL-adjusted median hourly wages $21.16 $20.54 $20.68 $19.53 $17.43 $20.82 $17.47 $16.54 $20.26 Salaires horaires médians ajustés au CDV

Registered veterinary technician (RVT)/Animal health technician (AHT); NL — Newfoundland and Labrador; PEI — Prince Edward Island; NB — New Brunswick; NS — Nova Scotia; ON — Ontario; MB — Manitoba; SK — Saskatchewan; AB — Alberta; BC — British Columbia./Technicien vétérinaire agréé (TVA)/Technicien en santé animale (TSA); 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.

National Median RVT/AHT Wage Inflation Adjusted RVT/AHT Wage Salaire médian national des TVA/TSA Salaire des TVA/TSA ajusté pour l’inflation Avant l’ajustement au coût de la vie, le TVA/TSA en Alberta $19.50 $19.20 recevait le salaire le plus élevé, avec une médiane de 22 $. Par $19.00 $19.00 $18.74 contraste, la Nouvelle-Écosse recevait le salaire le plus bas, car

GESTION D’UNECLINIQUE VÉTÉRINAIRE $18.39 $18.50 $18.16 un TVA/TSA dans cette province gagnait un salaire médian de $17.95 $18.00 $17.82 16,75 $. $17.50 $17.50 Cependant, après l’ajustement au CDV, le classement est $17.67 $17.00 modifié de manière spectaculaire. Terre-Neuve-et-Labrador ravit

$16.50 la première place, avec un salaire médian ajusté au CDV de 2012 2013 2014 2015 2016 21,16 $. D’autres provinces avec des coûts de la vie bas, comme la Nouvelle-Écosse, grimpent aussi au classement. Par contre, Figure 1. RVT/AHT national median hourly wages and inflation adjusted wages from 2012 to 2016./Salaires horaires médians l’Alberta dégringole avec un salaire médian ajusté au CDV de nationaux des TVA/TSA et salaires ajustés pour l’inflation de 16,54 $ en raison du coût de la vie élevé dans la province. 2012 à 2016. La figure 1 présente les cinq dernières années de croissance salariale pour les TVA/TSA. Le salaire médian national a grimpé with a COL-adjusted median wage of $21.16. Other provinces d’un peu plus de 1 % en 2016, passant de 19 $ à 19,20 $. with low costs of living, such as Nova Scotia, also climb the Même si cela semble peu de prime abord, signalons que, de rankings. Alberta, on the other hand, falls to a COL-adjusted 2012 à 2016, le salaire médian des TVA/TSA a augmenté de median wage of $16.54, due to the high cost of living in the 9,7 %. Par comparaison, l’inflation au Canada pendant la province. même période de temps a crû de 4,9 %, selon la Banque du Figure 1 shows the past 5 years of wage growth for Canada. Par conséquent, les salaires des TVA/TSA dépassaient RVT/AHTs. The national median wage climbed by just over significativement l’inflation, ce qui procurait un pouvoir d’achat 1% in 2016, from $19.00 to $19.20. While this may seem supérieur à ces employés non-vétérinaires. low at first glance, from 2012 to 2016, the RVT/AHT median Le tableau 2 indique le salaire horaire médian et le salaire wage has grown by 9.7%. By comparison, inflation in Canada horaire médian ajusté au CDV pour les réceptionnistes dans over the same time period has increased 4.9%, according to the chaque province. Bank of Canada. Therefore, RVT/AHT wages have significantly Comme pour la situation observée pour les TVA/TSA, l’Alberta outpaced inflation, leading to greater purchasing power for these possédait le salaire le plus élevé pour les réceptionnistes, avec un non-DVM staff. salaire horaire médian de 17 $. L’Île-du-Prince-Édouard affichait Table 2 outlines the median hourly wage and COL-adjusted le salaire le plus bas pour les réceptionnistes, avec une médiane median hourly wage for receptionists in each province. de 13,25 $. Similar to the situation experienced by RVT/AHTs, Alberta Cependant, de nouveau, l’ajustement au coût de la vie modifie was the highest paying province for receptionists, with a median le classement initial. Après l’ajustement au CDV, le salaire horaire hourly wage of $17.00. Prince Edward Island had the lowest médian de l’Alberta chute à 12,78 $, soit le plus bas au pays. Le wage, with receptionists earning a median of $13.25. salaire médian de l’Île-du-Prince-Édouard grimpe à 16,01 $, Once again, however, the adjustment for cost of living upends derrière celui du Nouveau-Brunswick et de la Nouvelle-Écosse. the initial rankings. After COL adjustment, Alberta’s median La figure 2 montre l’évolution du salaire médian national pour hourly wage falls to $12.78, the lowest in the country. Prince les réceptionnistes au cours des cinq dernières années. Au cours Edward Island’s median wage climbs to $16.01, behind only de la dernière année, les salaires des réceptionnistes ont augmenté New Brunswick and Nova Scotia. de 2,5 %, pour passer de 15 $ à 15,38 $. De 2012 à 2016, le Figure 2 shows the changes in the national median wage for salaire médian national a grimpé de 9,8 %, soit une hausse receptionists over the past 5 years. In the last year, receptionist remarquablement semblable à celle observée pour les TVA/TSA. wages grew by 2.5%, from $15.00 to $15.38. From 2012 to De nouveau, cette augmentation est supérieure au taux d’inflation 2016, the national median wage grew by 9.8%, remarkably close par une marge importante. to the wage gains experienced by RVT/AHTs. Once again, this Même si un TVA/TSA en Nouvelle-Écosse peut gagner un outpaces inflation by a wide margin. salaire bien en deçà d’un TVA/TSA en Alberta, le véritable

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Table 2/Tableau 2. Receptionist median hourly wages and COL-adjusted median hourly wages across Canada/Salaires horaires médians

des réceptionnistes et salaires horaires médians ajustés au CDV au Canada PRACTICE MANAGEMENT VETERINARY Receptionist NL PEI NB NS ON MB SK AB BC Réceptionniste T.-N.-L. Î.-P.-É. N.-B. N.-É. Ont. Man. Sask. Alb. C.-B. Median hourly wages $15.00 $13.25 $15.00 $13.80 $15.00 $14.50 $16.00 $17.00 $15.50 Salaires horaires médians COL-adjusted median hourly wages $15.87 $16.01 $18.42 $16.09 $14.53 $15.56 $14.71 $12.78 $14.95 Salaires horaires médians ajustés au CDV

NL — Newfoundland and Labrador; PEI — Prince Edward Island; NB — New Brunswick; NS — Nova Scotia; ON — Ontario; MB — Manitoba; SK — Saskatchewan; AB — Alberta; BC — British Columbia./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.

National Median Receptionist Wage Inflation Adjusted Receptionist Wage Salaire médian national Salaire des réceptionnistes pouvoir d’achat de ce salaire dans la province maritime est des réceptionnistes ajustés pour l’inflation significativement supérieur, après avoir tenu compte du coût de la $15.50 $15.38 $15.00 $15.00 vie. Il s’agit d’une considération importante pour les employés et $15.00 $14.71 les employeurs lors de l’examen des niveaux de rémunération des $14.50 $14.50 $14.53 $14.36 employés non-vétérinaires. Compte tenu des variations du coût de $14.00 $14.13 $14.00 la vie, il pourrait ne pas être suffisant d’offrir un salaire légèrement $13.50 supérieur à celui versé dans une province voisine. $13.00

2012 2013 2014 2015 2016 Notes : Les salaires horaires médians ont été déterminés à l’aide des Sondages économiques provinciaux 2016 auprès des Figure 2. Receptionist national median hourly wages and propriétaires de pratique. Il n’y a pas eu de Sondage économique inflation-adjusted wages from 2012 to 2016./Salaires horaires médians nationaux des réceptionnistes et salaires ajustés pour provincial au Québec en 2016. Le salaire médian ajusté au coût l’inflation de 2012 à 2016. de la vie a été déterminé en utilisant les données les plus récentes de Statistique Canada sur les dépenses moyennes des ménages, par province. Les dépenses moyennes des ménages ont ensuite été While an RVT/AHT in Nova Scotia may earn a wage well divisées par les dépenses moyennes des ménages du pays dans son below that of one in Alberta, the true purchasing power of ensemble afin de déterminer le ratio d’une province par rapport au that wage in the maritime province is significantly higher, after pays. Ce ratio a ensuite été multiplié par le salaire horaire médian accounting for the cost of living. This is an important consid- dans chaque province pour les TVA/TSA et les assistants non eration for both employees and employers, when examining agréés (tels que déterminés par les résultats de chaque sondage non-DVM compensation levels. Given the variations in cost of économique provincial respectif) afin de déterminer le salaire living, it may not be enough to simply offer a slightly higher médian ajusté au coût de la vie de chaque province. Les données wage than a neighboring province. sur l’inflation sont tirées de la feuille de calcul de l’inflation de la Banque du Canada. Notes: Median hourly wages were determined using the 2016 http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/ Provincial Practice Owners Economic Surveys. There was famil130a-fra.htm ■ no Provincial Economic Survey in Quebec in 2016. Cost- of-Living-Adjusted Median Wage was determined through use of the most recent Statistics Canada data on Average Household Expenditures, by Province. The Average Household Expenditure in each province was divided by the Average Household Expenditure of the nation as a whole, to determine the province to nation ratio. This ratio was then multiplied by the median hourly wage in each province for RVTs/AHTs and Non-registered Assistants (as determined by the results of each respective Provincial Economic Survey), to determine the Cost of Living Adjusted Median Wage in each province. Inflation data are taken from the Bank of Canada’s inflation calculator. http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/ famil130a-eng.htm ■

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Answers to Quiz Corner Les réponses du test éclair

1. A) Fluconazole is not highly protein-bound, enabling its penetra- 4. C) The correct answer is Corynebacterium pseudotuberculosis, tion into sites including the CNS, aqueous humor, prostate, the most common etiologic agent associated with ulcerative and urinary tract. Ketoconazole and itraconazole are highly lymphangitis. protein-bound, which limits their penetration into the CNS, C) La réponse exacte est Corynebacterium pseudotuberculosis, aqueous humor, prostate, and urinary tract. Clotrimazole is l’agent étiologique le plus fréquemment associé à la used as a topical antifungal. lymphangite ulcérative. A) Le fluconazole n’est pas fortement lié aux protéines, 5. A) The signs suggest both limbs are affected. The most common permettant sa pénétration dans les organes, incluant le reason for this posture is laminitis; bilateral presentation of système nerveux central, l’humeur aqueuse, la prostate et the other diseases is unlikely, especially in an 8-month-old le tractus urinaire. Le kétoconazole et l’itroconazole sont heifer. Bovine anatomy consists of fused and full-sized third fortement liés aux protéines, ce qui limite leur pénétration and fourth metatarsal bones, with no splints. Pedal bone dans le système nerveux central, l’humeur aqueuse, la fracture in medial claws often results in a cross-legged prostate et le tractus urinaire. Le clotrinazole est utilisé stance, and in lateral claws a wide-based stance. Signs of comme antifongique topique. radial paralysis are largely distal limb extensor deficits. 2. C) Answer A would be correct for a dog. Answer B would be cor- A) Les signes suggèrent que les deux membres sont atteints. La rect for a horse. Answer D is a common cause of ulceration raison la plus commune de cette posture est la fourbure; une in dogs. présentation bilatérale des autres problèmes énumérés est C) La réponse A serait la bonne pour un chien. La réponse B peu probable, spécialement chez une génisse âgée de 8 mois. serait la bonne pour un cheval. La réponse D constitue une L’anatomie bovine comprend un troisième et un quatrième cause commune d’ulcération chez le chien. os métacarpiens fusionnés et complets, sans os métacarpiens accessoires. Une fracture de la phalange distale de l’onglon 3. D) Antigen tests detect antigen from adult female worms, not médial résulte souvent dans une posture avec membres male worms. croisés et celle de l’onglon latéral dans une posture avec D) Les tests antigéniques décèlent l’antigène des vers adultes membres écartés. Les signes de paralysie radiale produisent femelles, non des vers mâles. des déficits des muscles extenseurs de la partie distale du membre.

quiz corner is generously sponsored by le test éclair est généreusement commandité par A: With trusted NOBIVAC® specialty vaccines, that provide demonstrated efficacy against specific pathogens, and offer unique features that set them apart in their category. www.nobivac.ca www.merck-animal-health.ca ® ® ® ® ® NOBIVAC LEPTO4 NOBIVAC LYME NOBIVAC INTRA-TRAC 3 ADT NOBIVAC 2-FeLV Nobivac® is a registered trademark of Intervet International B.V. Used under license. MERCK® is a registered trademark of Merck Canada Inc. © 2016 Intervet Canada Corp. All rights reserved.

NOBIVAC CVJ - Quiz Corner Answer ad.indd 1 2016-01-21 2:43 PM

756 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY Diagnostic Ophthalmology Ophtalmologie diagnostique

Lynne S. Sandmeyer, Marina L. Leis, Bianca S. Bauer, Bruce H. Grahn

History and clinical signs 10-year-old spayed female domestic shorthaired cat was A examined at the ophthalmology service at the Western College of Veterinary Medicine. This cat was presented for evaluation of pigmented lesions in the left iris. The menace responses, and palpebral, occulocephalic, direct and consensual pupillary light reflexes were present bilaterally. Schirmer tear test (Schirmer Tear Test Strips; Alcon Canada, Mississauga, Ontario) values were 16 and 21 mm/min in the right and left eyes, respectively. The intraocular pressures were estimated with a rebound tonometer (Tonvet; Tiolat, Helsinki, Finland) and were 13 and 25 mmHg in the right and left eyes, respectively. Fluorescein staining (Fluorets; Bausch & Lomb Canada, Markham, Ontario) was negative bilaterally. On direct examination there was brown Figure 1. Photograph of the left eye of a 10-year-old domestic discoloration of the left iris extending approximately 300° and shorthaired cat. mainly involving the peripheral iris. Biomicroscopic examination (Osram 64222; Carl Zeiss Canada, Don Mills, Ontario) revealed ing over time to become a diffuse lesion (1). The pigmented the darkly pigmented areas to be flat and the pigmentation to areas may be slightly raised and velvety in appearance. As diffuse extend into the iridocorneal angle involving the pectinate liga- iris melanoma progresses, the tumor invades deeper into the iris ments. Examination of the right eye was within normal limits. stroma and may lead to changes in pupil shape and mobility (1). Following topical application of 0.5% tropicamide (Mydriacyl; Benign melanosis may be congenital or acquired, and unilateral Alcon Canada, Mississauga, Ontario) indirect ophthalmoscopic or bilateral. These pigment spots are small clusters of normal (Heine Omega 200; Heine Instruments Canada, Kitchener, melanocytes on the surface of the iris and tend to have sharp Ontario) examination was completed and did not identify borders and remain superficial. Freckles are smaller spots, while abnormalities in either eye. A photograph of the left eye at pre- nevi are somewhat larger in area. These lesions can be congenital sentation is provided for your assessment (Figure 1). or acquired and tend to increase in number with age (2). Melanocytic tumors are the most common type of primary What are your clinical diagnosis, intraocular neoplasia in dogs and cats. Cats typically develop differential diagnoses, therapeutic plan, flat, diffuse tumors of the iris as described, while dogs typically and prognosis? develop raised, nodular lesions. In both species, infiltration of Discussion the iridocorneal angle in advanced disease leads to secondary The clinical diagnosis was diffuse iris melanoma in the left glaucoma. While canine uveal menanocytic neoplasia is typically eye. The differential diagnosis for pigmented iris lesions is benign in regard to systemic spread, feline diffuse iris melanoma benign melanosis or iris freckles/nevi. Diffuse iris melanoma is has the potential for metastasis and rates of 19% to 63% have a progressive pigmentation of the iris and is usually unilateral. been reported (3–6). The lymph nodes, lungs, liver, and spleen Pigmentation often develops in multifocal areas on the surface of are the most common sites; however, radial bone metastasis has the iris with these areas gradually increasing in size and coalesc- been reported in 1 cat (1,7). Definitive diagnosis of diffuse iris melanoma requires light microscopic examination of the affected uveal tissue. Uveal Department of Small Animal Clinical Sciences, Western College biopsy is rarely completed due to the invasiveness of the pro- of Veterinary Medicine, University of Saskatchewan, 52 Campus cedure. Thus, the clinical diagnosis of diffuse iris melanoma is Drive, Saskatoon, Saskatchewan S7N 5B4. based on the appearance and photographic documentation of Use of this article is limited to a single copy for personal study. progressive, expanding, and coalescing areas of hyperpigmenta- Anyone interested in obtaining reprints should contact the tion, with possible changes in pupil shape and mobility. When CVMA office ([email protected]) for additional cats present with small pigmented lesions, it is recommended copies or permission to use this material elsewhere. that serial photographs be taken over several months to years in

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order to document changes and progression of the lesions. Once the neoplasm, a mitotic index of . 7 mitoses in 10 high-power a clinical diagnosis of diffuse iris melanoma is made, however, (3400) fields, choroidal invasion, and increased E-cadherin and the question remains what is the most appropriate therapy. melan-A immunoreactivity of the tumor cells (5,6,8). Definitive treatment is currently limited to enucleation of Most of the current literature suggests that metastasis is more the globe as adjunctive therapy protocols have not been devel- likely to occur with more extensive tumors. Once tumor cells oped. Use of diode laser by a veterinary ophthalmologist to are within the filtration angle and scleral venus plexus there photoablate small, focal, iris lesions may be an option in very is greater potential for spread to distant organs. Therefore, early stages; however, the efficacy in preventing progression enucleation is justified based on an increased amount and of the tumor is not known and as the tumor is multifocal in size of pigmented areas, with spread of pigmentation into the nature, new lesions can be expected to form (1). The clinical iridocorneal angle. It is essential that an enucleated globe with dilemma is, therefore, determining the appropriate time to suspected iridal melanoma be submitted for light microscopic perform enucleation. Ideally, the clinician should be convinced evaluation to evaluate the extent of the neoplasia, which will in of the clinical diagnosis in order to avoid enucleation of an eye turn help determine the prognosis for the patient. with benign melanosis. Referral examination by a veterinary In this cat, pigmentation was confirmed on biomicroscopic OPHTALMOLOGIE DIAGNOSTIQUE OPHTALMOLOGIE ophthalmologist is recommended to help confirm the clini- examination to involve the pectinate ligaments and therefore cal diagnosis. Diffuse iris melanoma is slowly progressive and enucleation was recommended and completed. Light micro- although it is not known exactly when metastasis occurs in the scopic examination of the globe confirmed the clinical diagnosis course of disease, it is presumed to be in the latter stages. Thus of diffuse iris melanoma. The cat continues to do well; however, clinicians should avoid premature or unnecessary removal of a it is recommended that she be monitored closely for develop- healthy and visual eye. Nevertheless, the goal is to remove the ment of systemic disease that may be associated with metastasis. eye prior to development of metastasis. Staging with thoracic radiographs and abdominal ultrasound is not useful as these References modalities are not sensitive enough to reveal the miliary nature 1. Stiles JS. Feline ophthalmology. In: Gelatt KN, Gilger BC, Kern TJ, of tumor metastasis in distant organs. eds. Veterinary Ophthalmology. 5th ed. Ames, Iowa: Wiley-Blackwell, 2013:1477–1559. Several studies have attempted to correlate histopathologic 2. Martin CL. Anterior uvea and anterior chamber. In: Martin CL, ed. features of enucleated globes at various stages of disease with Ophthalmic Disease in Veterinary Medicine. London, UK: Manson metastasis (4–6,8). Unfortunately, metastasis of diffuse iris Publishing, 2005:298–336. 3. Wilcock BP, Peiffer RL. Morphology and behavior of primary ocular melanoma is rarely confirmed and may not be noted until melanomas in 91 dogs. Vet Pathol 1986;23:418–424. postmortem examination if this is completed. There is a strong 4. Kalishman JB, Chappell R, Flood LA, Dubielzig RR. A matched obser- correlation between the extent of local tumor infiltration and vational study in cats with enucleation due to diffuse iris melanoma. Vet Ophthalmol 1998;1:25–29. survival time (4). When enucleation is performed while the 5. Wiggans KT, Reilly CM, Kass PH, Maggs DJ. Histologic and immuno- tumor is still confined to the iris stroma affected cats survive as histochemical predictors of clinical behavior for diffuse iris melanoma. long as control cats (4). When enucleation is performed after Vet Ophthalmol 2016;19 Suppl 1:44–45. 6. Duncan DE, Peiffer RL. Morphology and prognostic indicators of ante- invasion of the ciliary body stroma, there is a progressively rior uveal melanomas in cats. Prog Vet Comp Ophthalmol 1991;1:25–32. poorer prognosis. Cats with glaucoma attributable to tumor 7. Planellas M, Pastor J, Torres MD, Peña T, Leiva M. Unusual presenta- infiltration have significantly reduced survival time compared tion of a metastatic uveal melanoma in a cat. Vet Ophthalmol 2010;12: 391–394. to control cats (4). Histopathologic features associated with 8. Day MJ, Lucke VM. Melanocytic neoplasia in the cat. J Small Anim Pract increased presumed metastasis include the presence of tumor in 1995;36:207–213. the scleral venus plexus, extrascleral extension, necrosis within

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X-Ray Digital & Analog Ultrasound VetAdvise.com ElectroSurgery & Laser Autoclave, Centrifuge & Microscope Procedure & Surgery Light Vital Sign Monitor All About Veterinarians IV Pump & Warmer 1480 Pemberton Avenue Consulting, Coaching, Valuations, Negotiations, Purchase / Sale North Vancouver, BC V7P 2S1 Phone (604) 446-9099 Anesthesia & Surgery Accessories www.fmsmeds.com Stainless Steel & Veterinary Table TERRY JACKSON, C.P.A. - C.G.A. Email: [email protected] Dental Unit & Dental X-Ray Phone: 604.939.2323 [email protected]

DOUGLAS C. JACK – Partner Experts in Autogenous Bacterins, and • Practice Management Agreements Swine Influenza Virus Vaccines • Incorporations • Employment Matters • Discipline Proceedings and Malpractice Defence • Buying and Selling a Practice ✓ High quality Autogenous Biologics P 416.367.6389 | TF 800.563.2595 F 416.367.6749 | [email protected] ✓ Licensed by the CFIA ✓ We make Vaccines for We make autogenous vaccines Bay Adelaide Centre, East Tower • Swine 22 Adelaide St W, Toronto, ON Canada M5H 4E3 • Poultry For more information, contact: Sam Mostafa Phone: 1-888-838-5223 Calgary | Montréal | Ottawa • Bovine Toronto | Vancouver e-mail: [email protected] Lawyers | Patent & Trademark Agents Borden Ladner Gervais LLP www.gallantcustomlaboratories.com is an Ontario Limited Liability Partnership. blg.com

760 CVJ / VOL 58 / JULY 2017 FOR PERSONAL USE ONLY FOR PERSONAL USE ONLY

Treating otitis externa just got easier.

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