May/Mai 2017May/Mai The Canadian Veterinary Journal

Vol. 58, No. 05 Vol. 58, La Revue vétérinaire canadienne

May/Mai 2017 Volume 58, No. 05

Complications and risk factors of castration with primary wound closure: Retrospective study in 159 horses

Treatment rates for injectable tiamulin and lincomycin as an estimate of morbidity in a swine herd with endemic swine dysentery

Information needs, sources, and decision- making by hatching egg and broiler chicken producers: A qualitative study in Alberta, Canada

Congenital nuclear cataracts in a Holstein dairy herd

Ovarian carcinomatosis in a dog managed with surgery and intraperitoneal, systemic, and intrapleural chemotherapy utilizing indwelling pleural access ports

Femoral head ostectomy and medial patellar ligament desmotomy to treat a pregnant miniature horse with coxofemoral joint luxation and upward fixation of the patella

Frontal and caudal maxillary sinus lipoma in a horse

Idiopathic glaucoma in an 11-year-old crossbred mare FOR PERSONAL USE ONLY

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MAY/MAI 2017 Contents Table des matières

SCIENTIFIC RUBRIQUE SCIENTIFIQUE

ARTICLES CASE REPORTS 466 Complications and risk factors of castration RAPPORTS DE CAS with primary wound closure: Retrospective 493 Ovarian carcinomatosis in a dog managed study in 159 horses with surgery and intraperitoneal, systemic, Mickaël P. Robert, Ronan J.J. Chapuis, and intrapleural chemotherapy utilizing Claire de Fourmestraux, Olivier J. Geffroy indwelling pleural access ports 472 Treatment rates for injectable tiamulin and Matthew P. Best, Angela E. Frimberger lincomycin as an estimate of morbidity in a 498 Femoral head ostectomy and medial patellar swine herd with endemic swine dysentery ligament desmotomy to treat a pregnant Krysia Walczak, Robert Friendship, Egan Brockoff, miniature horse with coxofemoral joint Amy Greer, Zvonimir Poljak luxation and upward fixation of the patella 482 Information needs, sources, and decision- Elsa K. Ludwig, Christopher R. Byron making by hatching egg and broiler chicken 503 Frontal and caudal maxillary sinus lipoma producers: A qualitative study in Alberta, in a horse Canada Elsa K. Ludwig, Christopher R. Byron, R. Michele Anholt, Margaret Russell, Tom Inglis, Kevin K. Lahmers, Marcos P. Santos Darko Mitevski, David Hall 488 Congenital nuclear cataracts in a Holstein STUDENT PAPER dairy herd COMMUNICATION ÉTUDIANTE Stephanie Osinchuk, Lyall Petrie, Marina Leis, 508 Idiopathic glaucoma in an 11-year-old Fritz Schumann, Bianca Bauer, Lynne Sandmeyer, crossbred mare Kayla Madder, Fiona Buchanan, Bruce Grahn Daniella Rizzo

441 QUIZ CORNER TEST ÉCLAIR

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MAY/MAI 2017 Contents Table des matières

FEATURES RUBRIQUES SPÉCIALES

PRESIDENT’S MESSAGE BOOK REVIEW LE MOT DU PRÉSIDENT COMPTE RENDU DE LIVRE 433 Let’s answer the “Why?” 481 Current Therapy in Avian Medicine and Une réponse au «Pourquoi?» Surgery Troy Bourque Lynn Smart-Ridgway

437 VETERINARY MEDICAL ETHICS NOTICES ANNONCES DÉONTOLOGIE VÉTÉRINAIRE 497 New Products SPECIAL REPORT Nouveaux produits RAPPORT SPÉCIAL 471 Index of Advertisers 459 Lessons learned from the evolution of Index des annonceurs terrestrial animal health surveillance in Canada and options for creating a new 518 Classifieds collaborative national structure Petites annonces V. Wayne Lees, Cameron Prince

VETERINARY PRACTICE MANAGEMENT NEWS | NOUVELLES GESTION D’UNE CLINIQUE VÉTÉRINAIRE 511 Bouncing back across the board: Results of 443 NEWS the 2016 CVMA Practice Owners Economic NOUVELLES Survey/Rétablissement généralisé : Heather Broughton, Isabelle Vallières résultats du Sondage économique 2016 de l’ACMV auprès des propriétaires de pratique Chris Doherty

515 DIAGNOSTIC OPHTHALMOLOGY OPHTALMOLOGIE DIAGNOSTIQUE Lynne S. Sandmeyer, Jerome Gagnon, Bianca S. Bauer

Contributors

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

CVJ / VOL 58 / MAY 2017 429 FOR PERSONAL USE ONLY

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 : Andy Allen, Saskatoon, Saskatchewan 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.

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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 so economic reports, practice management solutions, client education 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.ca™ - 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 • VetLaw Online™ legal advice column • 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

03/2017 FOR PERSONAL USE ONLY

PRESENTS

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I So ea y! FOR PERSONAL USE ONLY President’s Message Le mot du président

Let’s answer the “Why?” Une réponse au «Pourquoi?»

eterinarians are often asked why? Why is there a need for n demande souvent pourquoi aux médecins vétérinaires. V better stewardship regarding antibiotic use? Why are we OPourquoi avons-nous besoin d’une meilleure antibio­ spending a lot of resources and effort in increasing the oversight gouvernance? Pourquoi consacrons-nous de vastes ressources of antimicrobial use in animals? The threat of antimicrobial et investissons-nous des efforts importants pour accroître la resistance (AMR) is obviously driving this, but we are also surveillance de l’utilisation des antimicrobiens chez les animaux? not the only profession utilizing antibiotics. Why do we need La menace de l’antibiorésistance représente évidemment le increased oversight of prescribing and dispensing? Why do we moteur de cette initiative, mais nous ne sommes pas non plus need to show that we are using antimicrobials appropriately in la seule profession qui utilise des antibiotiques. Pourquoi avons- animals? International and national pressure, as well as public nous besoin d’une supervision accrue de la prescription et de la pressure and perceptions are all determining factors. distribution des médicaments? Pourquoi devons-nous démontrer If compared, the issue of antimicrobial resistance in veteri- que nous utilisons les antimicrobiens de manière adéquate chez nary medicine versus human medicine, the veterinary field has les animaux? La pression internationale et nationale ainsi que la relatively fewer issues. While AMR is already a huge issue in pression et les perceptions du public représentent tous des facteurs human hospitals, it is of increasing concern in veterinary medi- déterminants. cine. However, both fields of medicine use the same important En comparant la médecine vétérinaire et la médecine humaine, antibiotics and there exists a risk of misuse creating resistance. nous constatons que le domaine de la médecine vétérinaire The biggest issue for veterinary medicine is that 70% to 75% présente relativement moins de problèmes. Cependant, même of all antibiotics given to animals is through livestock feed si l’antibiorésistance représente déjà un enjeu énorme dans les without veterinary oversight. There is much emphasis on food hôpitaux humains, elle suscite des préoccupations grandissantes en animals and the use of antimicrobials in feed; however, use in médecine vétérinaire. En effet, les deux domaines de la médecine companion animal practice where pets are in close contact with ont recours aux mêmes antibiotiques importants et il existe un their owners is also important. Small animal practitioners are risque de mauvaise utilisation créant de la résistance. L’enjeu more likely to prescribe Class 1 and 2 antibiotics, which are the le plus important en médecine vétérinaire est que de 70 % à most important to human medicine. Veterinarians need to be 75 % de tous les antibiotiques sont administrés aux animaux accountable in all areas of veterinary practice. dans les aliments sans supervision vétérinaire. On a beaucoup The Pan Canadian Framework document on veterinary insisté sur les animaux destinés à l’alimentation et l’utilisation oversight of antimicrobials, published by the CVMA last year des antimicrobiens dans les aliments, toutefois, l’administration addressed what the Association felt oversight of prescribing and en pratique des animaux de compagnie, où les animaux sont en dispensing of antimicrobials should look like. The document contact étroit avec leurs propriétaires, est aussi importante. Les did not, however, address the important issue of surveillance. praticiens pour petits animaux prescriront le plus probablement Surveillance means more than the surveillance of resistant bacte- des antimicrobiens de classe 1 et 2, ceux qui sont les plus ria; it includes the collection of data on the use of antimicrobi- importants en médecine humaine. Or, les médecins vétérinaires als. With funding from the Canadian Food Inspection Agency, doivent assumer la responsabilité de leurs actes dans tous les the CVMA is working on ways of gathering information on domaines de la pratique vétérinaire. antimicrobial use in large and small animal practices. Le document du Cadre de travail pancanadien sur la The Association held a workshop in late February with surveillance vétérinaire des antimicrobiens, qui a été publié par approximately 50 stakeholders. The workshop looked at how l’ACMV l’an dernier, a présenté le projet de l’Association pour un

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 / MAY 2017 433 FOR PERSONAL USE ONLY

antimicrobial use data might be collected from veterinarians, to show the international community that Canada is serious veterinary practices, and places were antimicrobials are dis- about addressing the AMR threat. pensed. The major goal of the workshop was to create consensus The CVMA has long been promoting pharmaceutical stew- and identify the most relevant and easy-to-collect data as part ardship. In particular, we published Prudent Use Guidelines of a prescription-based antimicrobial use surveillance program in 2008 and are currently undertaking a project to review and for small and food animals. Over 40 leaders of the veterinary renew those guidelines. The federal government is supporting community, covering 9 different areas of practice including small this project with funding through Growing Forward 2. We have animal, food animal, equine, and aquaculture were all commit- also lobbied the federal government to continue moving forward ted to finding solutions. The group explored major challenges in a timely manner with regulatory and policy changes that will to collecting data, including dispensing differences in various improve antimicrobial stewardship. provinces, veterinary and client confidentially, and the differ- Part of belonging to a profession is being stewards of that pro- ences in veterinary practice management software. There were fession. Members protect the profession from threats that will LE MOT DU PRÉSIDENT DU MOT LE significant challenges identified; however, the resolve from the damage the integrity of the profession. Antimicrobial resistance veterinarians to address those obstacles was remarkable. and the way antibiotics are used in animals is a threat to the One of the first questions this group explored was “Why?” integrity of the veterinary profession. We need to take action Why collect data on antimicrobial use? The collection of antimi- when there are obstacles to being good stewards. We must crobial use data will support the federal government framework remain accountable to society to maintain our social contract on AMR. One of the pillars of that framework is surveillance. and the right to use antimicrobials. ■ But this is also being done to support the Canadian commit- ment to the World Organisation for Animal Health (OIE) and Troy Bourque

programme de surveillance de la prescription et de la distribution l’utilisation des antimicrobiens? La collecte des données sur des antimicrobiens. Le document n’a pas cependant abordé l’utilisation des antimicrobiens appuiera le cadre de travail du l’importante question de la surveillance. La surveillance signifie gouvernement fédéral sur l’antibiorésistance. L’un des piliers de plus que la surveillance des bactéries résistantes, car elle comprend ce cadre de travail sera la surveillance. Mais ce travail est aussi la collecte de données sur l’utilisation des antimicrobiens. Grâce à réalisé afin d’appuyer l’engagement canadien envers l’Organisation un financement de l’Agence canadienne d’inspection des aliments, mondiale de la santé animale (OIE) et pour démontrer à la l’ACMV travaille afin d’élaborer des méthodes de collecte des collectivité internationale que le Canada envisage sérieusement données sur l’utilisation des antimicrobiens auprès des pratiques la menace de l’antibiorésistance. pour grands et petits animaux. Signalons que l’ACMV travaille à la promotion de la À la fin février, l’Association a tenu un atelier auquel ont gouvernance des produits pharmaceutiques depuis longtemps déjà. assisté environ 50 intervenants. L’atelier s’est penché sur la façon Plus particulièrement, nous avons publié des Lignes directrices dont les données sur l’utilisation des antimicrobiens pourraient sur l’administration judicieuse des antimicrobiens en 2008 et être recueillies auprès des médecins vétérinaires, des pratiques nous travaillons maintenant en vue de réviser et de mettre à vétérinaires et des endroits où les antimicrobiens sont distribués. jour ces lignes directrices. Le gouvernement fédéral appuie Le but majeur de cet atelier consistait à dégager un consensus ce projet grâce à des fonds provenant de Cultivons l’avenir 2. et à identifier les données les plus pertinentes et les plus faciles Nous avons aussi exercé des pressions auprès du gouvernement à recueillir dans le cadre d’un programme de surveillance de fédéral afin de continuer d’aller rapidement de l’avant pour la l’utilisation des antimicrobiens sur ordonnance administrés aux modification des règlements et des politiques qui amélioreront petits animaux et aux animaux destinés à l’alimentation. Plus l’antibiogouvernance. de 40 leaders de la collectivité vétérinaire, provenant de neuf Une des responsabilités de l’appartenance à une profession différents secteurs de la pratique, dont les petits animaux, les consiste à devenir des intendants de cette profession. Les membres animaux destinés à l’alimentation, les équidés et l’aquaculture, ont protègent la profession contre les menaces qui porteront atteinte à tous travaillé en vue de trouver des solutions. Le groupe a exploré son intégrité. L’antibiorésistance et la façon dont les antibiotiques les défis liés à la collecte des données, notamment les différents sont utilisés chez les animaux représentent une menace à l’intégrité modes de distribution dans les diverses provinces, la confidentialité de la profession vétérinaire. Nous devons agir lorsqu’il se présente liée aux médecins vétérinaires et aux clients ainsi que l’éventail des obstacles à notre bonne intendance. Nous devons demeurer de logiciels pour la gestion d’une pratique vétérinaire. Des défis redevables envers la société afin de respecter notre contrat social importants ont été identifiés, mais la détermination des médecins et de conserver le droit d’utiliser les antimicrobiens. ■ vétérinaires à surmonter ces obstacles était remarquable. L’une des premières questions que ce groupe a explorées était «Pourquoi?» Pourquoi devons-nous recueillir des données sur Troy Bourque

434 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY FOR PERSONAL USE ONLY

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Ethical question of the month — May 2017 The use of animals for testing new pharmaceutical products that may prove effective in the treatment or prevention of serious human diseases is considered acceptable by a large proportion of Canadians, as well as citizens of many other countries. This is in contrast to the use of animals for testing the safety of cosmetics. Testing of cosmetics in animals is banned in all 27 countries in the European Union but is still performed in Canada. Is there an ethical basis for the continued testing of beauty products on animals in Canada? Can a veterinarian in good conscience work in laboratories performing this type of testing? Question de déontologie du mois — Mai 2017 L’utilisation des animaux pour les essais de nouveaux produits pharmaceutiques qui pourraient s’avérer efficaces dans le traitement ou la prévention des maladies humaines graves est considérée acceptable par une grande proportion de Canadiens ainsi que par les citoyens de beaucoup d’autres pays. Cette situation contraste avec l’utilisation des animaux pour des tests d’innocuité des cosmétiques. Les tests de cosmétiques sur les animaux sont interdits dans les 27 pays de l’Union européenne, mais ils sont toujours réalisés au Canada. Existe-t-il des fondements éthiques pour poursuivre les tests des produits de beauté sur les animaux au Canada? Un médecin vétérinaire peut-il travailler en toute conscience dans des laboratoires qui effectuent ce type de tests?

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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.

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 / MAY 2017 437 FOR PERSONAL USE ONLY

Ethical question of the month — February 2017 Several niche marketing programs forbid the use of antimicrobials in livestock production. This creates problems for producers and for the animals they care for. These niche marketing programs require that if an animal is treated with an antibiotic, it must be identified and removed from the niche marketing program. This creates an incentive for producers to “wait and see” if an animal can resolve an infection on its own. Regardless of the outcome, there is unnecessary suffering associated with the delay in treatment. This violates both the husbandry ethic as well as public expectations. If the stockperson eventually treats the animal, it seldom responds as well as it would have if the treatment has been given in a timely manner. Individual animals treated with an antimicrobial can be difficult to market. Irregular marketing of treated animals is time-consuming and often less profitable. As a result, “no antibiotic” marketing schemes have the potential to create negative effects on animal welfare. Can veterinarians be associated with no antibiotic niche programs and still adhere to their oath to prevent unnecessary animal suffering? DÉONTOLOGIEVÉTÉRINAIRE Question de déontologie du mois — Février 2017 Plusieurs programmes de marketing de créneau interdisent l’utilisation des antimicrobiens dans la production du bétail. Cela crée des problèmes pour les producteurs et les animaux dont ils s’occupent. Ces programmes de marketing de créneau exigent que, si un animal est traité à l’aide d’un antibiotique, il doit être identifié et retiré du programme de marketing de créneau. Cette situation incite les producteurs à attendre pour voir si un animal peut vaincre l’infection de lui-même. Sans égard au résultat, il se produit des souffrances inutiles lorsque l’on retarde le début du traitement, ce qui est contraire à l’éthique d’élevage ainsi qu’aux attentes du public. Si le préposé au bétail traite finalement l’animal, il répond rarement aussi bien que si le traitement avait été administré plus rapidement. Les animaux individuels traités à l’aide d’un antimicrobien peuvent être difficiles à commercialiser. La commercialisation irrégulière des animaux traités est longue et souvent moins rentable. Par conséquent, les programmes de commercialisation «sans antibiotiques» ont le potentiel d’avoir des effets négatifs sur le bien-être animal. Les vétérinaires peuvent-ils être associés à des programmes de créneau sans antibiotiques et toujours respecter leur serment de prévenir les souffrances inutiles des animaux?

An ethicist’s commentary on prudent use of antibiotics in livestock production The pre-Socratic philosophers devoted a great deal of attention and as a result of the fact that such indiscriminate use inevitably to trying to understand the nature of reality. Among these think- drives the evolution of resistance to these powerful drugs. ers were Parmenides and Heraclitus, who espoused diametrically As one who has served both on the Pew Commission, study- opposed views. Parmenides affirmed that if we truly understood ing the consequences of the industrialization of agriculture, reality, we would realize that it was ultimately unchanging — that and on the World Health Organization commission charged change is an illusion. Heraclitus, on the other hand, argued that with setting guidelines for rational use of antibiotics, I have reality was constantly changing, metaphorically articulating his encountered modern day examples of Cratylus-like extensions view as “one cannot step in the same river twice.” So far, so good. affirming that one should not use antibiotics for any purpose in Unfortunately, as is often the case, Heraclitus had disciples animals, including treating disease. who carried his ideas one step too far. Prominent among these In response to such an extreme position, my colleagues individuals was Cratylus, who affirmed that “one cannot step attempting to regulate excessive antibiotic use have univocally in the same river once,” which makes no sense whatsoever. affirmed that it is part of our moral obligation to the animals A similar dynamic of carrying good ideas to absurdity is readily we raise and care for not to let them suffer. Any traditional evident throughout our culture. Freud is not responsible for the agriculturalist, raised in the ethic of animal husbandry, would excesses of the Freudians, nor Marx for the Marxists. be shocked and horrified at the suggestion that we allow the The implicit notion here is “zero tolerance.” This notion has animals to suffer from treatable diseases. been responsible for a great deal of mischief. Some years ago, Some years ago, in this column, I debated the organic zealots one of the Colorado school districts announced a policy of “zero who refused to use antibiotics to treat highly painful foot rot tolerance for weapons in schools.” A second grade child brought in cattle, even if the animals were removed from the food sup- an orange to school along with a fruit knife packed by her ply well after the government prescribed clearance period. As mother to peel it. She was thrown out of school and suspended! far as I’m concerned, such behavior has everything to do with This demonstrates that Cratylus is alive and well. marketing and nothing whatever to do with rational use of By the same token, those who question the excessive use of antimicrobials. antibiotics as a method of growth promotion, or as a way of Indeed, if the general public became aware that conspicuous forcing farm animals into harmful environments that grossly denial of antibiotic use was not rationally based, but rather was violate their natures and harm their welfare in major ways make a self-righteous marketing tactic resulting in considerable suf- a powerful point, both from the standpoint of animal welfare, fering, the zealots would not fare well.

438 CVJ / VOL 58 / MAY 2017 VETERINARY MEDICAL ETHICS

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1. A 6-year-old shih-tzu presents with polyuria, polydipsia, 1. Une chienne Shih-tzu âgée de 6 ans souffre de polyurie, de alopecia, and a pot-bellied appearance. She has been receiv- polydipsie, d’abattement et présente un abdomen distendu. ing daily oral prednisolone for the past 8 months. Results Depuis 8 mois, elle reçoit quotidiennement de la prednisolone of an ACTH response test are as follows: baseline cortisol, par voie orale. Les résultats d’un test réponse à l’ACTH sont 15 nmol/L (reference range: 15 to 110 nmol/L), and post- les suivants : cortisol initial de base, 15 nmol/L (étendue de ACTH cortisol, 24 nmol/L (reference range: 220 to référence : 15 à 110 nmol/L), cortisol post ACTH, 24 nmol/L 550 nmol/L). The most likely diagnosis is which of the (étendue de référence : 220 à 550 nmol/L). Lequel des following? diagnostics suivants est le plus probable? A. Iatrogenic hyperadrenocorticism A. hyperadrénocorticisme iatrogène; B. Hypoadrenocorticism B. hypoadrénocorticisme; C. Hyperadrenocorticism resulting from a pituitary tumor C. hyperadrénocorticisme résultant d’une tumeur D. Hyperadrenocorticism resulting from an adrenal tumor hypophysaire; E. A sex-steroid-secreting adrenal tumor D. hyperadrénocorticisme résultant d’une tumeur surrénalienne; 2. Which of the following is true regarding feline immunode- E. tumeur surrénalienne sécrétant un stéroïde sexuel. ficiency virus (FIV)? A. It is most prevalent in kittens younger than 4 months 2. Lequel des énoncés suivants est vrai à propos du virus de of age. l’immunodéficience féline? B. Ocular disorders are not associated with FIV. A. Il est le plus prévalent chez les chatons âgés de moins de C. Chronic and recurrent infections are common. 4 mois. D. Cats start to exhibit clinical signs within 48 hours of B. Les problèmes oculaires ne sont pas associés au virus infection. de l’immunodéficience féline. E. Most infections occur via transplacental transmission. C. Des infections chroniques et à répétition sont communes. D. Les chats commencent à démontrer des signes cliniques 3. Which of the following is INCORRECT regarding rabies? dans les 48 heures suivant le début de l’infection. A. Clinical signs usually occur within 2 to 8 weeks of exposure. E. La plupart des infections se produisent par transmission B. Virus is shed in saliva only after clinical signs start. transplacentaire. C. Death occurs 3 to 10 days after the onset of clinical signs. D. A direct fluorescent antibody test on brain or salivary 3. Lequel des énoncés suivants est INCORRECT à propos de la gland is the test of choice. rage? E. Vaccination is protective. A. Les signes cliniques se manifestent de 2 à 8 semaines après l’exposition au virus. 4. Which of the following is the most likely diagnosis for a B. Le virus est libéré dans la salive seulement après l’apparition horse with a history of anorexia, depression, hyponatremia, des signes cliniques. and exogenous administration of glucocorticoids? C. La mort se produit de 3 à 10 jours après le début des signes A. Adrenal insufficiency cliniques. B. Diabetes insipidus D. Une réaction d’immunofluorescence directe sur l’encéphale C. Goiter ou la salive est l’épreuve diagnostique de choix. D. Cushing’s disease E. La vaccination offre une protection adéquate.

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5. Which of the following is NOT an appropriate review when 4. Lequel des diagnostics suivants est le plus probable chez un a sudden increase in the incidence of coliform mastitis cheval qui présente une anamnèse d’anorexie, d’abattement, occurs? d’hyponatrémie et d’administration de glucocorticoïdes A. Feed delivery relative to milking time exogènes? B. Culture of all cows with grossly normal milk and elevated A. insuffisance surrénalienne; somatic cell count B. diabète insipide; C. Udder preparation procedures by parlor staff C. goitre; D. Manure removal from barns and re-bedding frequency of D. maladie de Cushing. stalls 5. Laquelle des procédures suivantes N’EST PAS appropriée E. Administration protocol for Escherichia coli bacterins

TESTÉCLAIR lorsqu’une augmentation soudaine dans l’incidence de mammite à coliforme se produit? A. présentation de la nourriture relativement à la traite; B. culture de toutes les vaches ayant du lait macroscopiquement normal et une numération élevée des cellules somatiques; C. procédures de préparation du pis par les préposés du salon de traite; D. enlèvement du fumier des étables et mise en place fréquente de litière dans les enclos; E. protocole d’administration de bactérines d’Escherichia coli. (See p. 502 for answers./Voir les réponses à la page 502.)

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 N

CVMA Council Update Mise à jour du Conseil de l’ACMV he March Council meeting was part of the annual CVMA a réunion de mars du Conseil a fait partie de la fin de semaine TCommittee Weekend at which 68 participants represented Lannuelle des comités de l’ACMV à laquelle 68 participants ont the CVMA’s standing committees namely the Animal Health représenté les comités permanents de l’ACMV, notamment le Comité Technology/Veterinary Technician Program Accreditation d’agrément des programmes de technologie en santé animale et Committee (AHTVTPAC), Animal Welfare Committee de techniques vétérinaires (CAPTSATV), le Comité sur le bien-être (AWC), Editorial Committee, National Examining Board animal (CBA), le Comité de la rédaction, le Bureau national des (NEB), National Issues Committee (NIC), and the Professional examinateurs (BNE), le Comité sur les enjeux nationaux (CEN) et le Development Committee (PDC). The CVMA is proud of the Comité du perfectionnement professionnel (CPP). L’ACMV est fière support of over 600 volunteers who help to serve and represent du soutien de ses plus de 600 bénévoles qui contribuent au service the profession. et à la représentation de la profession. The CVMA Council, consisting of representatives from all Le Conseil de l’ACMV, qui se compose de représentants de provinces, student veterinarians, veterinary colleges and vet- toutes les provinces, des étudiants en médecine vétérinaire, des erinary technicians, welcomed the following new members: facultés de médecine vétérinaire et des techniciens vétérinaires, Dr. Christiane Armstrong (British Columbia), Dr. Chris a accueilli les nouveaux membres suivants : Dre Christiane Bell (Manitoba) and Dr. Karin Machin (Western College of Armstrong (Colombie-Britannique), Dr Chris Bell (Manitoba) Veterinary Medicine/University of Calgary Faculty of Veterinary et Dre Karin Machin (Western College of Veterinary Medicine/ Medicine/Ontario Veterinary College). Council also welcomed Faculté de médecine vétérinaire de l’Université de Calgary/Ontario 2 guest speakers: Dr. Harpreet Kochhar, Chief Veterinary Veterinary College). Le Conseil a aussi accueilli deux conférenciers Officer of Canada and associate vice-president, Canadian Food invités : Dr Harpreet Kochhar, vétérinaire en chef du Canada et Inspection Agency (CFIA) and newly appointed as Canada’s World vice-président associé de l’Agence canadienne d’inspection des Organisation for Animal Health (OIE) delegate, and Dr. Manisha aliments (ACIA) et délégué du Canada récemment nommé auprès de Mehrotra, director, Veterinary Drugs Directorate (VDD). l’Organisation mondiale de la santé animale (OIE), et la Dre Manisha Strategic planning: The CVMA conducts its priority area Mehrotra, directrice, Direction des médicaments vétérinaires (DMV). strategic planning in a 4-year cycle. The CVMA’s priorities Planification stratégique : L’ACMV effectue sa planification are National & International Issues, Animal Welfare, and A stratégique des domaines prioritaires selon un cycle de quatre ans. Successful Career, A Balanced Life. This year, Council partici- Les priorités de l’ACMV sont les enjeux nationaux et internationaux, pated in a Strategic Planning Session on A Successful Career, A le bien-être animal et une carrière prospère, une vie équilibrée. Balanced Life and discussed such matters as business and finan- Cette année, le Conseil a participé à un atelier de planification cial management, veterinary wellness, and mentorship. A survey stratégique sur une carrière prospère, une vie équilibrée, et a discuté of approximately 140 selected veterinarians, conducted prior to des questions comme la gestion commerciale et financière, le bien- the session, provided additional input in this needs assessment. être vétérinaire et le mentorat. Un sondage réalisé auprès d’environ During the upcoming CVMA Summit, scheduled for July 13 140 médecins vétérinaires choisis, qui a été effectué avant l’atelier, during the 2017 CVMA Convention in Charlottetown, Prince a fourni des renseignements additionnels pour cette évaluation des Edward Island, participants will be discussing the “Uber” of besoins. veterinary practice, followed by a National Issues Forum entitled Durant le Sommet de l’ACMV à venir, qui est prévu le 13 juillet Is Alternative Medicine No Longer an Alternative? Building on durant le congrès 2017 de l’ACMV qui aura lieu à Charlottetown, à l’Île-du-Prince-Édouard, les participants discuteront de l’«Uber» de la pratique de la médecine vétérinaire, qui sera suivi d’un Forum sur les enjeux nationaux intitulé «La médecine parallèle est-elle toujours parallèle?» en misant sur ce thème, le Conseil prévoit entreprendre une planification stratégique élargie en 2017 afin d’aborder les nouvelles réalités de la profession et de déterminer les façons dont l’ACMV peut mieux représenter et desservir la profession dans ce nouveau contexte. Surveillance vétérinaire de l’utilisation des antimicrobiens — Un cadre de travail pancanadien pour les normes professionnelles régissant les médecins vétérinaires : Ce cadre de travail, qui a été élaboré par l’ACMV en collaboration avec le Conseil canadien des registraires vétérinaires (CCRV), fournit un modèle pour les normes professionnelles qui seront utilisées par Dr./Dr Harpreet Kochhar Dr./Dre Manisha Mehrotra les organismes provinciaux et territoriaux de réglementation de la

CVJ / VOL 58 / MAY 2017 443 FOR PERSONAL USE ONLY

N this theme, Council is planning to undertake broader strategic médecine vétérinaire lorsqu’ils élaboreront leurs propres règlements planning in 2017 to address new realities in the profession and ou lignes directrices portant sur les responsabilités de la profession how the CVMA can better represent and serve the profession in vétérinaire dans la supervision de l’utilisation des antimicrobiens. Un such a new context. sommaire et le cadre de travail ont été distribués à tous les membres Veterinary Oversight of Antimicrobial Use — a Pan- de l’ACMV en janvier 2017. Canadian Framework of Professional Standards for Surveillance de l’utilisation des antimicrobiens : L’antibio­ Veterinarians: This Framework, developed by the CVMA in résistance représente une priorité de l’Organisation mondiale de collaboration with the Canadian Council of Veterinary Registrars la santé (OMS), de l’OIE, des Nations Unies, du G20, du G7, du (CCVR) provides a template of professional standards to be used gouvernement fédéral canadien et de la profession vétérinaire. by provincial and territorial veterinary licensing bodies when L’utilisation prudente et la réduction appropriée de l’utilisation des developing their own regulations, guidelines, or bylaws relating antimicrobiens sont importantes pour la santé et le bien-être du to the responsibilities of the veterinary profession in providing public et des animaux. L’utilisation prudente des antimicrobiens est oversight in the use of antimicrobials. An Executive Summary aussi importante pour le commerce international et la société en and the detailed Framework were distributed to all CVMA général. members in January 2017. Grâce à une contribution financière de l’ACIA, l’ACMV travaille à AMU surveillance: Addressing antimicrobial resistance l’élaboration d’une collecte quantitative des données sur l’utilisation (AMR) is a priority for the World Health Organization (WHO), des antimicrobiens pour les pratiques pour grands et petits animaux. the OIE, the United Nations, the G20, G7, the Canadian federal Le 28 février et le 1er mars, l’ACMV a organisé un atelier préliminaire government and the veterinary profession. Prudent use, and as qui a réuni plus de 50 intervenants. L’atelier avait pour objectif much as appropriate, the reduction of antimicrobial use (AMU) d’engager les intervenants et de discuter d’un ensemble minimum de are important for the health and welfare of the public and ani- données et de la façon dont ces données pourraient être recueillies. mals alike. Prudent AMU is important for international trade Selon la disponibilité des fonds et la rétroaction du gouvernement and a requirement by society in general. fédéral, les prochaines étapes pourraient inclure un sondage afin With a funding contribution from CFIA, the CVMA is d’établir les données de référence qui mèneront à la création d’un working on the development of quantitative AMU data col- système de surveillance ayant pour but de réduire l’utilisation des lection for large and small animal practices. On February 28 antimicrobiens. and March 1, the CVMA hosted a preliminary workshop that Lignes directrices sur l’administration judicieuse des brought together over 50 stakeholders. The objective of the antimicrobiens : L’ACMV a amorcé le renouvellement de ses workshop was to engage stakeholders and discuss a minimum Lignes directrices sur l’administration judicieuse des antimicrobiens data set and how such data could be collected. Depending on pour les animaux destinés à l’alimentation de 2008 et elle poursuit the availability of funding and input by the federal government, la rédaction de ses Lignes directrices sur l’administration judicieuse the next steps may include a survey to establish baseline data des antimicrobiens pour les petits animaux. On prévoit que ces leading to a surveillance system, the goal of which would be the travaux seront finalisés d’ici mars 2018. Avant le début des travaux reduction of antimicrobial use. des experts en la matière, on procédera à une consultation des Antimicrobial Prudent Use Guidelines: The CVMA intervenants afin d’identifier leurs besoins. started with the renewal of its 2008 Food Animal Prudent Use Communication sur l’utilisation des antimicrobiens : L’AC MV Guidelines and is continuing the development of online Small poursuit sa campagne de sensibilisation mensuelle ciblant les

Dr. Ken Andrews (PhD) facilitates the CVMA’s Strategic Planning Session. Le Dr Ken Andrews (Ph.D.) anime une séance de planification stratégique de l’ACMV.

444 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY

Animal Prudent Use Guidelines. This work is scheduled to be médecins vétérinaires et elle insistera davantage sur l’utilisation des N finalized by March 2018. Before subject matter experts begin antimicrobiens chez les petits animaux. their work, stakeholders will be consulted to identify their needs. Évaluation nationale de l’OIE : L’ACIA se prépare à une AMU communication: The CVMA is continuing its évaluation par l’OIE de l’exécution des services vétérinaires monthly AMR Awareness Campaign targeting veterinarians canadiens. Cette évaluation servira à déterminer la capacité and will add some emphasis on AMR in small animals. vétérinaire du Canada du point de vue de la réglementation fédérale OIE country assessment: The CFIA is preparing for an et provinciale ainsi que de la préparation aux situations d’urgence evaluation of the performance of Canadian veterinary services by et de la pratique vétérinaire. L’inspection de l’OIE s’est déroulée du the OIE. This evaluation will assess Canada’s veterinary capacity 13 au 31 mars 2017. Quelques pratiques vétérinaires pour grands from the federal and provincial regulatory perspective, as well et petits animaux ont été choisies au hasard par l’équipe d’inspection as the perspective of emergency preparedness and the veterinary aux fins d’évaluation. Le rapport et les recommandations de l’OIE practice. The OIE site visit took place from March 13 to 31, sont attendus à l’été 2017. L’ACMV a participé à la séance de 2017. A few large and small animal veterinary practices were formation de l’OIE et a porté assistance à l’équipe de l’ACIA qui se selected randomly by the site visit team for assessment. The préparait à cette évaluation. OIE report and recommendations are expected in the summer Importation des chiens : L’énoncé de position de l’ACMV, of 2017. The CVMA participated in the OIE training session qui a été approuvé par le Conseil en novembre, a été distribué à and assisted the CFIA task team preparing for this assessment. la collectivité vétérinaire. L’ACMV planifie des démarches auprès Importation of rescue dogs: The CVMA’s position state- du gouvernement sur cette question et elle mettra au point une ment, as approved by Council in November 2016, has been campagne d’information ciblant les vétérinaires et le public. distributed to the veterinary community. The CVMA is planning Loi fédérale sur la cruauté envers les animaux : Après la advocacy steps with the government on the issue and develop- défaite du projet de loi C-246, l’ACMV a continué de rencontrer ing an information campaign targeted at veterinarians and the l’auteur du projet de loi, le député fédéral Nathaniel Erskine-Smith, public. afin de discuter des étapes suivantes. M. Erskine-Smith a expliqué Federal animal cruelty legislation: Following the defeat que, lors de son examen futur de la loi sur la cruauté envers les of Bill C-246, the CVMA continued to meet with the Bill’s animaux, le gouvernement cherchera des arguments basés sur author, Member of Parliament (MP) Nathaniel Erskine-Smith, des données scientifiques. Le Parti libéral, sous la direction de to discuss next steps. Mr. Erskine-Smith explained that in its la députée fédérale du Québec Alexandra Mendes, a formé un future review of the animal cruelty legislation, the government caucus de 23 députés libéraux pour considérer les modifications will be looking for evidence-based arguments. The Liberal party, requises à la loi sur la cruauté envers les animaux. Ce caucus under Quebec MP Alexandra Mendes, has established a caucus invitera l’ACMV à discuter de la future loi sur la cruauté envers les of 23 liberal MPs to consider the changes needed for future animaux. L’ACMV envisage aussi une réunion avec le bureau de la animal cruelty legislation. This caucus will invite the CVMA to ministre de la Justice. discuss the future animal cruelty legislation. The CVMA is also Code de pratiques recommandées aux chenils : Le CBA considering a meeting with the office of the Minister of Justice. termine l’ébauche d’une révision du Code. Les principales sections Kennel Code: The AWC is completing the draft revision of portent sur l’environnement des animaux (logement et installations); the Code. The key sections are Animal Environment (accom- les aliments et l’eau; les pratiques d’élevage; le transport; modation, housing and handling facilities); Food and Water; l’euthanasie; les annexes; et la bibliographie. Le Code servira de Husbandry Practices; Transport; Euthanasia; Annexes; and guide pour tous les exploitants de chenils et sa publication est References. The Code will serve as a guide for all kennel opera- prévue vers la fin de 2017. tors. The Code is scheduled to be released later in 2017. Premières nations : Un groupe de travail établi par le Conseil de First Nations: A task force struck by the CVMA Council l’ACMV a entamé des pourparlers avec Vétérinaires sans frontières has started talks with Veterinarians without Borders (VWB) to (VSF) pour identifier comment l’ACMV pourrait porter assistance identify how the CVMA could assist in improving the accessi- afin d’améliorer les services vétérinaires au sein des collectivités des bility to veterinary services within First Nations and Northern Premières nations et du Nord. L’ACMV a prévu la tenue d’un atelier communities. The CVMA has provided VWB with a venue for de VSF de 13 h 30 à 18 h 30 le vendredi 14 juillet 2017 durant a workshop on Friday, July 14, 2017, 1:30–6:30 pm during the le congrès de l’ACMV. L’atelier facilitera l’identification des enjeux CVMA Convention. The Workshop will aid in identifying the et des lacunes dont l’on doit tenir compte lors de la formulation issues and gaps that will be taken into account when formulating d’une stratégie. L’atelier s’insère parfaitement dans le programme a strategy. The workshop ties nicely into the CVMA’s morning de formation continue matinal de l’ACMV qui abordera des enjeux continuing education (CE) program addressing such issues comme les soins vétérinaires à distance dans les collectivités rurales as Remote Veterinary Care in Rural Canadian Communities, canadiennes, des cliniques vétérinaires gérées par les étudiants et Student Run Veterinary Clinics, and Accessible Veterinary Care. des soins vétérinaires accessibles. Canadian Veterinary Reserve (CVR): The CVR has Réserve vétérinaire canadienne (RVC) : La RVC a entamé une embarked on a recruitment campaign and has added 65 reserv- campagne de recrutement et a ajouté 65 réservistes au cours des ists over the past few months, reaching a total number of 278; derniers mois, pour atteindre un total de 278 réservistes. L’objectif the aim is to reach a total of 300. The CVR was involved with visé est de 300 réservistes. La RVC a travaillé avec l’Agence de the Public Health Agency of Canada (PHAC) in the Beyond la santé publique du Canada (ASPC) dans le cadre du Projet

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N the Border project, coordinating emergency preparedness and par-delà la frontière afin de coordonner la préparation aux situations response in the United States and Canada, for both humans d’urgence et les interventions aux États-Unis et au Canada, tant pour and animals. As an outcome of this project, the CVR is now les humains que pour les animaux. Dans le cadre de ce projet, la hosting 16 online emergency preparedness modules provided RVC présente maintenant 16 ateliers de préparation aux situations by the US Department of Health and Human Services free of d’urgence qui sont offerts en ligne et fournis gratuitement par le charge. The CVR held its annual call-up drill in March, which ministère de la Santé et des Services humains des États-Unis. La involved CFIA and Emergency Management British Columbia. RVC a tenu son exercice annuel de mobilisation en mars auquel The drill tested the response of reservists and the operational ont participé l’ACIA et l’organisation de gestion des urgences de la readiness of the CVR. Colombie-Britannique. L’exercice a mis à l’épreuve la réponse des Transportation of Dogs and Cats: Council approved the réservistes et la préparation opérationnelle de la RVC. revised position statement as follows: Transport des chiens et des chats : Le Conseil a approuvé “The Canadian Veterinary Medical Association (CVMA) l’énoncé de position suivant comme suit : strongly recommends that if dogs and cats are to be transported by «L’Association canadienne des médecins vétérinaires (ACMV) a conveyance that it is done in a manner that ensures the safety, recommande vivement que les chiens et les chats soient transportés security, health and welfare of the animal and the public safety.” dans un mode de transport qui assure la sécurité du public et protège Animal Health Technology/Veterinary Technician Program la sécurité, la santé et le bien-être de l’animal.» Accreditation: Council approved the extension of accreditation Agrément des programmes de technologie de la santé to the Seneca College Veterinary Technician Program in King animale et des techniques vétérinaires : Le Conseil a approuvé City, Ontario and the Oulton College Veterinary Technician le prolongement de l’agrément du Programme de techniques Program in Moncton, New Brunswick. vétérinaires de Seneca College à King City, en Ontario, et du Students of the CVMA (SCVMA): The SCVMA hosted its Programme de techniques vétérinaires d’Oulton College à Moncton, annual Symposium at the University of Calgary. Approximately au Nouveau-Brunswick. 200 students attended. The post-Symposium survey indicated Étudiants de l’ACMV (ÉACMV) : Les ÉACMV ont organisé leur a satisfaction rate of 97%. The 2018 SCVMA Symposium will Symposium annuel à l’Université de Calgary. Environ 200 étudiants be held on January 19–20 at the Atlantic Veterinary College. y ont participé. Le sondage après le Symposium a indiqué un taux de The first SCVMA Leadership Workshop took place at the satisfaction de 97 %. Le Symposium 2018 des ÉACMV se tiendra Faculté de médecine vétérinaire in November 2016 and was les 19 et 20 janvier à l’Atlantic Veterinary College. attended by almost 60 students. The next SCVMA workshop is Le premier Atelier de leadership des ÉACMV a eu lieu à la scheduled for November 2017 at the Ontario Veterinary College. Faculté de médecine vétérinaire de l’Université de Montréal en This Leadership Workshop serves as a precursor to the CVMA’s novembre 2016 et près de 60 étudiants y ont assisté. Le prochain Emerging Leaders Workshop, which takes place annually during atelier des ÉACMV est prévu pour novembre 2017 à l’Ontario the CVMA Convention. Veterinary College. Cet atelier de leadership sert de précurseur à CVMA Awards: Council selected the following winners of l’Atelier des futurs leaders de l’ACMV qui se déroule chaque année the 2017 Awards: durant le congrès de l’ACMV. • Small Animal Practitioner Award: Dr. David Condon Prix de l’ACMV : Le Conseil a choisi les lauréats suivants pour • Merck Veterinary Award: Dr. Stephen LeBlanc les Prix 2017 : • Humane Award: Dr. Anne McDonald • Prix du praticien des petits animaux : Dr David Condon • Practice of the Year Award: Mona Campbell Centre for • Prix vétérinaire Merck : Dr Stephen LeBlanc Animal Cancer • Prix humanitaire : Dre Anne McDonald • Life Membership: Dr. Jeanne Lofstedt • Prix de la pratique de l’année : Mona Campbell Centre for • RVL Walker Award: Ms. Elizabeth Hartnett Animal Cancer The Awards Ceremony will take place during the upcoming • Titre de membre à vie : Dre Jeanne Lofstedt Convention in Charlottetown, on July 13, following the CVMA • Prix RVL Walker : Mme Elizabeth Hartnett Annual General Meeting. La cérémonie de remise des prix se déroulera le 13 juillet, durant CVMA Convention: The 2017 CVMA Convention will le prochain congrès à Charlottetown, après l’Assemblée générale take place from July 13–16 in Charlottetown, Prince Edward annuelle de l’ACMV. Island. The Convention will offer 7 wet labs and over 100 ses- Congrès de l’ACMV : Le congrès 2017 de l’ACMV se déroulera sions facilitated by over 40 speakers. The CE is again approved du 13 au 16 juillet à Charlottetown, à l’Île-du-Prince-Édouard. Le by the Registry of Approved CE (RACE) administered by the congrès offrira sept laboratoires de travaux pratiques et plus de American Association of Veterinary State Boards in which most 100 ateliers animés par plus de 40 conférenciers. De nouveau, la Canadian licensing bodies are members. formation continue a été approuvée par le Registry of Approved See you in Charlottetown! Continued Education (RACE) qui est administré par l’American Association of Veterinary State Boards dont sont membres la plupart (by Jost am Rhyn, CEO, CVMA) des organismes de réglementation du Canada. Au plaisir de vous rencontrer à Charlottetown! (par Jost am Rhyn, PDG, ACMV)

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CVMA’s Emerging Leaders Program N Programme des futurs leaders de l’ACMV ast summer I was lucky to be one of 34 participants in the été dernier, j’ai eu la chance de faire partie des 34 participants LCVMA’s Emerging Leaders Program (ELP) at the CVMA’s L’ au Programme des futurs leaders (PFL) de l’ACMV (ELP) annual Convention in beautiful Niagara Falls, Ontario. I would lors du congrès annuel de l’ACMV tenu dans la splendide ville de like to start by thanking Virox Animal Health for sponsoring this Niagara Falls, en Ontario. J’aimerais d’abord remercier Virox Animal workshop. It is a wonderful addition to the CVMA Convention, Health pour sa commandite de cet atelier. C’était un merveilleux and your generous sponsorship is invaluable. ajout au congrès de l’ACMV et votre généreuse commandite est Over the course of this 8-hour, 2-day workshop, Dr. Rick très appréciée. DeBowes, professor of Surgery and director of the Professional Pendant cet atelier de huit heures réparties sur deux journées, Life Skills Program at Washington State University — College le Dr Rick DeBowes, professeur de chirurgie et directeur du of Veterinary Medicine, highlighted some veterinary practice Programme de compétences professionnelles essentielles au challenges and guided participants on how to overcome these Collège de médecine vétérinaire de l’Université d’État de challenges by applying leadership and teamwork concepts. Washington, a mis en lumière quelques-uns des défis de la pratique Dr. DeBowes has also practiced in private small animal medicine vétérinaire et a informé les participants sur les façons de surmonter and academic equine practice settings. He is a frequent speaker ces obstacles en mettant en application des concepts de leadership at various leadership programs, and was a co-founder of the et de travail d’équipe. Le Dr DeBowes a aussi exercé la médecine American Veterinary Medical Association (AVMA) Veterinary vétérinaire en pratique privée pour petits animaux et la pratique Leadership Conference (VLC) and a series of other interactive équine en milieu universitaire. C’est un conférencier fréquent à leadership education experiences for health care teams. divers programmes de leadership et il a été cofondateur de la The CVMA ELP gives participants tools to effectively cope Veterinary Leadership Conference (VLC) de l’American Veterinary with veterinary practice challenges as part of a professional medi- Medical Association (AVMA) et d’une série d’autres expériences cal team, and to help find a good work/life balance. éducatives interactives sur le leadership à l’intention des équipes Through presentations, videos and interactive activities, de soins de santé. Dr. DeBowes takes the focus off the profession’s medical aspect, Le PFL de l’ACMV donne aux participants les outils afin de gérer and shifts it to workplace communication. My favorite part efficacement les défis de la pratique vétérinaire au sein d’une équipe of this experience was the interactive group activities, as they médicale professionnelle et d’atteindre un bon équilibre travail-vie. highlighted the importance of effective communication strategies Dans le cadre de présentations, de vidéos et d’activités when approaching problems. The lessons learned in this work- interactives, le Dr DeBowes, au lieu d’insister sur l’aspect médical shop would benefit any veterinarian, whether a recent graduate de la profession, examine la communication en milieu de travail. or an experienced practitioner. Ce que j’ai le mieux aimé de cette expérience? Les activités de

2016 Emerging Leaders Program participants. Des participants à l’édition 2016 du Programme des futurs leaders.

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N

CVMA Council members mingle with ELP attendees. Les membres du Conseil de l’ACMV rencontrent des participants du PFL.

This year the 2017 CVMA ELP will be held July 13–14 groupe interactives, car elles soulignaient l’importance de stratégies at the CVMA Convention, in beautiful Charlottetown, efficaces de communication pour la résolution de problèmes. Les Prince Edward Island. Any CVMA or Registered Veterinary leçons apprises dans cet atelier seront utiles à tous les médecins Technologists and Technicians of Canada (RVTTC) member vétérinaires, qu’il s’agisse d’un diplômé récent ou d’un praticien is welcome to register for this fantastic workshop. CVMA chevronné. members who graduated within the past 10 years are encour- Cette année, le PFL 2017 de l’ACMV se tiendra les 13 et aged to apply for full event sponsorship to attend. Sponsored 14 juillet au congrès de l’ACMV, dans la splendide ville de participants receive travel to and from Charlottetown, 2 nights’ Charlottetown, à l’Île-du-Prince-Édouard. Les membres de l’ACMV accommodation at the Delta Prince Edward Hotel, an 8-hour ou de Technologues et techniciens vétérinaires agréés du Canada workshop with Dr. Rick DeBowes and a complimentary 2017 (TTVAC) sont invités à s’inscrire à cet atelier exceptionnel. Les CVMA Convention registration (value $645). Up to 2 sponsored membres de l’ACMV qui ont obtenu leur diplôme au cours des participants will be selected per province. dix dernières années sont encouragés à présenter une demande For more information, testimonials from past participants, pour une pleine commandite afin d’assister à l’événement. Les or to register or apply for sponsorship, please visit the CVMA participants commandités recevront le transport aller-retour à website (www.canadianveterinarians.net/science-knowledge/ Charlottetown, deux nuitées à l’hôtel Delta Prince Edward, un atelier emerging-leaders-program)! de huit heures avec le Dr Rick DeBowes et une inscription gratuite au congrès 2017 de l’ACMV (valeur de 645 $). Jusqu’à deux (by Traci Henderson, SCVMA representative, WCVM) participants seront choisis par province. Pour en savoir davantage, lire des témoignages d’anciens participants ou vous inscrire ou présenter une demande de commandite, veuillez visiter le site Web de l’ACMV (www.veterinaires aucanada.net/science-knowledge/emerging-leaders-program)! (par Traci Henderson, représentante des ÉACMV, WCVM)

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SCVMA New Graduate Survey Report: Class of 2016 N Rapport sur le sondage auprès des finissants des ÉACMV : promotion 2016 he Students of the Canadian Veterinary Medical Association es Étudiants de l’Association canadienne des médecins T(SCVMA) annually survey recent Canadian veterinary Lvétérinaires (ÉACMV) effectuent un sondage annuel auprès college graduates and report on current Canadian veterinary des finissants des écoles de médecine vétérinaire du Canada workforce conditions. This year’s survey response rate was 43% et présentent un rapport sur les conditions de travail pour les (n = 146), with 87% of respondents being female. Please note, professionnels vétérinaires au Canada. Le taux de réponse au some respondents did not answer every question. sondage de cette année a été de 43 % (n = 146) et 87 % des répondants étaient des femmes. Veuillez noter que certains Demographics répondants n’ont pas répondu à toutes les questions. Figure 1. Graduating College (n = 144). 50 Données démographiques Figure 1. École d’obtention du diplôme (n = 144).

40 50

30 40

20 30

10 20

0 10 AVC OVC FMV WCVM UCMV

0 Figure 2. Where respondents primarily grew up (n = 144). AVC OVC FMV WCVM UCMV

Figure 2. Milieu dans lequel les répondants ont surtout grandi 10% (n = 144).

14% On a Farm Acreage 10 % Town or City 14 % 76% Ferme Terrain de plusieurs acres Ville ou village

76 % On a Farm — 14 respondents Acreage — 21 respondents Town or City — 109 respondents

Employment data Ferme — 14 répondants The employment data collected showed that 98% (n = 143) Terrain de plusieurs acres — 21 répondants Ville ou village — 109 répondants of respondents have been employed since graduation and the 3 respondents’ reasons they are not working in the veterinary Données sur l’emploi field since graduation are that 1 is furthering their education Les données recueillies sur l’emploi ont montré que 98 % (masters, PhD), 1 isn’t working because of children and 1 (n = 143) des répondants travaillaient depuis la fin du cours et, decided to take a break. parmi les trois répondants qui ne travaillaient pas dans le domaine vétérinaire depuis la fin des études, un répondant poursuivait ses études (maîtrise, doctorat), un répondant ne travaillait pas pour des raisons de famille et un répondant a décidé de prendre une pause.

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N Figure 3. If you are working in the veterinary field, did you Figure 3. Si vous travaillez dans le domaine vétérinaire, secure this position before graduation? avez-vous obtenu ce poste avant la fin du cours?

140 140

120 120 117 117 100 100

80 80 78 81 78 81 60 60

40 40

29 29 20 23 25 20 23 25

0 0 Yes No Yes No Yes No Oui Non Oui Non Oui Non 2016 2015 2014 2016 2015 2014

In 2016, 84% of respondents (n = 140) secured their position En 2016, 84 % des répondants (n = 140) ont obtenu leur before graduation, 73% (n = 107) in 2015 and 76% (n = 106) poste avant la fin du cours, 73 % (n = 107) en 2015 et 76 % in 2014. (n = 106) en 2014. Figure 4. Are you still working in the position you accepted Figure 4. Occupez-vous toujours le poste que vous avez following graduation (n = 139)? accepté après la fin du cours (n = 139)?

5% 5 %

Yes No Oui Non

95% 95 %

Yes — 132 respondents Oui — 132 répondants No — 7 respondents Non — 7 répondants Among the 7 veterinarians no longer working in the position Parmi les sept vétérinaires qui n’occupaient plus le poste qu’ils they accepted before graduation, 3 did not like their employer, avaient accepté avant la fin du cours, trois répondants n’aimaient 1 did not like the position, and 3 found better jobs. pas leur employeur, un répondant n’aimait pas le poste et trois avaient trouvé un meilleur emploi. Figure 5. Successful search methods used in securing current employment (n = 149). Figure 5. Méthodes de recherche qui ont été fructueuses pour Number of trouver l’emploi actuel (n = 149). Method respondents % Nombre de CVMA/The Canadian Veterinary Journal Méthode répondants % 13 9% classifieds ACMV/Petites annonces de La Revue 13 9 % Provincial veterinary medical association vétérinaire canadienne 37 25% classifieds Petites annonces des associations 37 25 % Networking 23 15% provinciales de médecins vétérinaires Internships 32 21% Réseautage 23 15 % Internet searches 0 0.0% Internats 32 21 % Worked there as an undergraduate 25 17% Recherche Internet 0 0,0 % Other (please specify) 19 13% J’ai travaillé à cet endroit pendant mes études 25 17 % Some of the other methods used in securing current employ- Autre (veuillez préciser) 19 13 % ment were e-mails from the colleges, a partner worked at the clinic, a classmate’s recommendation, dropping off resumes, and Certaines des autres méthodes utilisées pour trouver un emploi positions were secured there during 4th-year rotations. étaient des courriels provenant des écoles, un partenaire travaillait à la clinique, la recommandation d’un camarade de classe, la remise en curriculum vitæ et des postes qui étaient obtenus lors des rotations de quatrième année.

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Figure 6. Please rate your level of satisfaction with your Figure 6. Veuillez évaluer votre niveau de satisfaction à l’égard N current position (n = 139). de votre poste (n = 139).

70 70

60 64 60 64

50 54 50 54

40 40

30 30

20 20

10 12 10 12 9 0 9 0 0 0 Very satisfied Satisfied Neutral Dissatisfied Very Très satisfait Satisfait Neutre Insatisfait Très dissatisfied insatisfait

Very satisfied — 39% Très satisfait — 39 % Satisfied — 46% Satisfait — 46 % Neutral — 9% Neutre — 9 % Dissatisfied — 6% Insatisfait — 6 % Very dissatisfied — 0% Très insatisfait — 0 %

Figure 7. What is your current employment type? Employment Type 2016 (n = 139) 2015 (n = 106) 2014 (n = 106) Government 3 respondents (2%) 1 respondent (1%) 0 respondents (0%) Internship/residency 30 respondents (22%) 12 respondents (11%) 21 respondents (20%) Private clinical practice 103 respondents (74%) 92 respondents (87%) 78 respondents (74%) Industry/commercial 1 respondent (1%) 0 respondents (0%) 3 respondents (3%) Other 2 respondents (1%) 1 respondent (1%) 4 respondents (4%)

Figure 7. Quel est votre type d’emploi actuel? Type d’emploi 2016 (n = 139) 2015 (n = 106) 2014 (n = 106) Gouvernement 3 répondants (2 %) 1 répondant (1 %) 0 répondant (0 %) Internat/résidence 30 répondants (22 %) 12 répondants (11 %) 21 répondants (20 %) Pratique clinique privée 103 répondants (74 %) 92 répondants (87 %) 78 répondants (74 %) Industrie/milieu commercial 1 répondant (1 %) 0 répondant (0 %) 3 répondants (3 %) Autre 2 répondants (1 %) 1 répondants (1 %) 4 répondants (4 %)

Respondents were asked approximately how many hours On a demandé aux répondants le nombre approximatif d’heures per week they work and the average was 45 hours per week. travaillées par semaine et la moyenne était de 45 heures par Respondents were also asked how many full-time and part-time semaine. On a aussi demandé aux répondants combien de veterinarians work at their practice and the average number of vétérinaires à temps plein et à temps partiel travaillaient à leur full-time veterinarians per clinic was 4 and the average number pratique et le nombre moyen de vétérinaires à temps plein par of part-time veterinarians per clinic was 1. clinique était de 4 et le nombre moyen de vétérinaires à temps partiel était de 1.

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N Figure 8. Please indicate the percentage breakdown of time Figure 8. Veuillez indiquer le pourcentage de temps que vous spent treating these species (n = 138). consacrez à ces espèces (n = 138). Species Time % Espèce % du temps Poultry 1% Volaille 1 % Birds and caged birds 2% Oiseaux et oiseaux en cage 2 % Bovine — Beef 3.5% Bovins — bœufs de boucherie 3,5 % Bovine — Dairy 12% Bovins — bovins laitiers 12 % Bovine — Veal 0.5% Bovins — veaux 0,5 % Petits ruminants 1,5 % Small ruminants 1.5% Gibier d’élevage 0 % Farmed game 0% Chiens 47,5 % Dogs 47.5% Équidés 14,5 % Equine 14.5% Félidés 39,5 % Feline 39.5% Porcs 1 % Porcine 1% Autre 8,5 % Other 8.5% Autres espèces 3 % Other species 3% On a demandé aux finissants s’ils suivaient le même Graduates were asked if they are following the same career cheminement de carrière qu’ils avaient prévu au moment de path they intended upon graduating from veterinary college l’obtention du diplôme et 90 % (n = 124) ont répondu oui et and 90% (n = 124) responded yes and 10% (n = 14) responded 10 % (n = 14) ont répondu non. Les raisons pour lesquelles no. The reasons 10% of respondents are not following the same 10 % des répondants ne suivaient pas le même cheminement career path are their interests changed during veterinary stud- de carrière étaient que leurs intérêts avaient changé durant le ies, there weren’t many jobs in the original field, personal life cours vétérinaire, qu’il n’y avait pas beaucoup d’emplois dans le changes, and they started in a different field and realized they domaine prévu, des changements dans la vie personnelle et qu’ils were happy. avaient commencé dans un domaine différent et ont réalisé qu’ils Figure 9. In which province or territory are you presently y étaient heureux. employed? Figure 9. Dans quelle province ou territoire travaillez-vous Number of actuellement? respondents Province/Territory (n = 137) % Nombre de répondants Alberta 23 16.8% Province/Territoire (n = 137) % British Columbia 16 11.7% Alberta 23 16,8 % Prince Edward Island 2 1.5% Colombie-Britannique 16 11,7 % Manitoba 2 1.5% Île-du-Prince-Édouard 2 1,5 % New Brunswick 2 1.5% Manitoba 2 1,5 % Nova Scotia 5 3.6% Nouveau-Brunswick 2 1,5 % Nunavut 0 0% Nouvelle-Écosse 5 3,6 % Ontario 42 30.7% Nunavut 0 0 % Quebec 27 19.7% Ontario 42 30,7 % Saskatchewan 12 8.8% Québec 27 19,7 % Newfoundland and Labrador 1 0.7% Saskatchewan 12 8,8 % Terre-Neuve-et-Labrador 1 0,7 % Northwest Territories 0 0% Territoires du Nord-Ouest 0 0 % Yukon 0 0% Yukon 0 0 % International 5 3.6% International 5 3,6 % In these provinces, 61% of respondents (n = 127) work in an urban practice and 39% in a rural practice. Dans ces provinces, 61 % des répondants (n = 127) travaillent dans une pratique urbaine et 39 % travaillent dans une pratique rurale.

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Income and compensation data Données sur le revenu et la rémunération N Figure 10. Mean annual salary ($CDN) by province. Figure 10. Salaire annuel moyen ($CAN) par province. (n = number of respondents) (n = nombre de répondants) British Columbia (n = 16) $73,375.00 Colombie-Britannique (n = 16) 73 375,00 $ Ontario (n = 42) $61,338.33 Ontario (n = 42) 61 338,33 $ Alberta (n = 21) $60,166.67 Alberta (n = 21) 60 166,67 $ Saskatchewan (n = 11) $59,727.72 Saskatchewan (n = 11) 59 727,72 $ Quebec (n = 30) $47,783.33 Québec (n = 30) 47 783,33 $ International (n = 5) $58,200.00 International (n = 5) 58 200,00 $ Manitoba (n = 2) $71,500.00 Manitoba (n = 2) 71 500,00 $ New Brunswick (n = 2) $55,000.00 Nouveau-Brunswick (n = 2) 55 000,00 $ Nova Scotia (n = 5) $60,000.00 Nouvelle-Écosse (n = 5) 60 000,00 $ Newfoundland and Labrador (n = 1) $142,000.00 Terre-Neuve-et-Labrador (n = 1) 142 000,00 $ Prince Edward Island (n = 1) $24,000.00 Île-du-Prince-Édouard (n = 1) 24 000,00 $ Figure 11. Compensation method. Figure 11. Modes de rémunération. Number of % of respondents Nombre de Compensation method respondents (n = 138) % des répondants Mode de rémunération répondants (n = 138) Straight salary 83.3% 115 Salaire fixe 83,3 % 115 Base salary plus a percentage 16.6% 23 of your gross earnings or billings Salaire de base plus un pourcentage de vos revenus bruts ou des montants 16,6 % 23 Income based on a percentage 0% 0 facturés of your gross earnings Revenu basé sur un pourcentage de vos revenus bruts 0 % 0 Figure 12. Average student debt upon graduation ($CDN) according to the veterinary college and graduation year. Figure 12. Dette étudiante moyenne à la fin du cours ($CAN) (n = number of respondents by college). selon la faculté de médecine vétérinaire et la promotion. (n = Debt nombre de répondants par faculté). 2016 2015 2014 Dette AVC $91,590 n = 18 $101,454 n = 11 $140,421 n = 19 2016 2015 2014

FMV $32,930 n = 28 $19,687 n = 24 $31,220 n = 25 AVC 91 590 n = 18 101 454 n = 11 140 421 n = 19 OVC $54,950 n = 39 $43,184 n = 33 $55,133 n = 30 FMV 32 930 n = 28 19 687 n = 24 31 220 n = 25 UCVM $70,550 n = 8 $74,083 n = 12 $51,446 n = 13 OVC 54 950 n = 39 43 184 n = 33 55 133 n = 30 WCVM $50,190 n = 42 $47,111 n = 27 $50,500 n = 26 UCVM 70 550 n = 8 74 083 n = 12 51 446 n = 13 WCVM 50 190 n = 42 47 111 n = 27 50 500 n = 26

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N Figure 13. Professional benefits offered in addition to base Figure 13. Avantages professionnels offerts en plus du salaire salary. de base. Number of Nombre de % of respondents % des répondants Benefits respondents (n = 133) Avantages répondants (n = 133) Primes pour le travail sur appel ou After-hours/on-call premiums 42.8% 57 42,8 % 57 en dehors des heures normales Cell phone 27% 36 Téléphone cellulaire 27 % 36 Clothing allowance 44.4% 59 Allocation vestimentaire 44,4 % 59 Continuing education fees 79.7% 106 Frais de formation continue 79,7 % 106 Continuing education travel expenses 42.8% 57 Dépenses pour les déplacements liés 42,8 % 57 Disability insurance 24% 32 à la formation continue Dental insurance 52.6% 70 Assurance invalidité 24 % 32 Health insurance 60.2% 80 Assurance dentaire 52,6 % 70 Life insurance 25.6% 34 Assurance santé 60,2 % 80 Malpractice insurance 66.9% 89 Assurance vie 25,6 % 34 Payment of licensing fees 81.2% 108 Assurance pour faute professionnelle 66,9 % 89 Payment of fees for voluntary Paiement des frais de permis 81,2 % 108 38.3% 51 professional association membership Paiement de la cotisation d’une Pension 8.3% 11 association professionnelle à adhésion 38,3 % 51 volontaire Profit sharing 3% 4 Fonds de retraite 8,3 % 11 Retention 0.8% 1 Partage des profits 3 % 4 Sick leave/compassionate leave 36.1% 48 Rétention 0,8 % 1 Vehicle allowance/transportation Congé de maladie ou pour des raisons 24.8% 33 36,1 % 48 expenses personnelles Other (please specify) meal Allocation pour un véhicule ou 3% 4 24,8 % 33 allowances pet insurance dépenses pour le transport Autre (veuillez préciser) 3 % 4 repas assurance maladie pour animaux

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Other information Autres renseignements N Figure 14. Number of graduates who are currently members Figure 14. Nombre de diplômés qui sont actuellement membres of professional organizations other than their provincial d’organisations professionnelles autres que leur organisme de regulatory body (n = 132). réglementation provincial (n = 132). Number of Nombre de Organization respondents Organisation répondants American Animal Hospital Association (AAHA) 22 American Animal Hospital Association (AAHA) 22 Association des médecins vétérinaires du Québec 10 Association des médecins vétérinaires du Québec 10 Canadian Veterinary Medical Association (CVMA) 113 Association canadienne des médecins vétérinaires (ACMV) 113 Ontario Veterinary Medical Association (OVMA) 36 Ontario Veterinary Medical Association (OVMA) 36 None 7 Aucune 7 Other 25 Autre 25 Other organizations: Association of Veterinary Anaesthetists (AVA) n = 1 Autres organisations : American Association of Equine Practitioners (AAEP) n = 8 Association of Veterinary Anaesthetists (AVA) n = 1 American Association of Bovine Practitioners (AABP) n = 4 American Association of Equine Practitioners (AAEP) n = 8 Canadian Association of Bovine Veterinarians (CABV) n = 2 American Association of Bovine Practitioners (AABP) n = 4 Atlantic Bovine Practitioners Association (ABPA) n = 1 Association canadienne des vétérinaires bovins (CABV) n = 2 Ontario Association of Bovine Practitioners (OABP) n = 2 Atlantic Bovine Practitioners Association (ABPA) n = 1 Ontario Association of Swine Veterinarians (OASV) n = 1 Ontario Association of Bovine Practitioners (OABP) n = 2 American Association of Swine Veterinarians (AASV) n = 2 Ontario Association of Swine Veterinarians (OASV) n = 1 American Veterinary Medical Association (AVMA) n = 3 American Association of Swine Veterinarians (AASV) n = 2 Western Canadian Association of Bovine Practitioners (WCABP) American Veterinary Medical Association (AVMA) n = 3 n = 1 Western Canadian Association of Bovine Practitioners (WCABP) n = 1 Association Vétérinaire Québécoise de Médecine de Refuge Association vétérinaire québécoise de médecine de refuge (AVQMR) (AVQMR) n = 1 n = 1 Ontario Association of Poultry Practitioners (OAPP) n = 1 Ontario Association of Poultry Practitioners (OAPP) n = 1 American Holistic Veterinary Medical Association (AHVMA) n = 1 American Holistic Veterinary Medical Association (AHVMA) n = 1 Association des médecins vétérinaires praticiens du Québec Association des médecins vétérinaires praticiens du Québec (AMVPQ) (AMVPQ) n = 1 n = 1 Respondents indicated the top 3 challenges they faced Les répondants ont indiqué les trois principaux défis auxquels (n = 130); the following challenges were among the most ils ont dû faire face (n = 130); les défis suivants étaient ceux frequently mentioned (listed in order of prevalence): qui étaient le plus fréquemment mentionnés (indiqués en • Lack of confidence ordre de prévalence) : • Schedule that is overloaded or difficult to manage • Manque de confiance • Work-life balance • Horaire surchargé ou difficile à gérer • Communication with clients or difficult clients • Équilibre travail-vie • Lack of experience • Communication avec les clients ou les clients difficiles • Manque d’expérience The 2016 New Graduate Survey Report was written by Mélissa Gohier from the Faculté de médecine vétérinaire (FMV). Le Rapport sur le sondage auprès des finissants 2016 a été rédigé par Mélissa Gohier de la Faculté de médecine vétérinaire (FMV) de l’Université de Montréal.

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N 2017 CVMA Convention Congrès 2017 de l’ACMV Charlottetown, July 13–16 Charlottetown, du 13 au 16 juillet Unleash Your Potential! Libérez votre potentiel! he 2017 CVMA Convention is less than 2 months away, but e congrès 2017 de l’ACMV aura lieu dans moins de deux mois, Tyou can still take advantage of the early bird savings up until Lmais vous pouvez toujours profiter du tarif de l’inscription hâtive June 2. The Convention, July 13–16, offers over 128 RACE- jusqu’au 2 juin. Le congrès, du 13 au 16 juillet, offrira plus de approved continuing education (CE) credits so you can earn up 128 crédits de formation continue approuvés par RACE pour vous to 27 credits. Top-notch speakers from Canada and the United permettre d’accumuler jusqu’à 27 crédits. Des conférenciers de haut States have been invited to speak. Here’s a few who you don’t calibre provenant du Canada et des États-Unis ont été invités. En want to miss. voici quelques-uns que vous ne voudrez pas manquer. Dr. Alex Reiter, a diplomate of the American and European Le Dr Alex Reiter, diplomate des Collèges dentaires vétérinaires Veterinary Dental Colleges, will give 6 dentistry lectures. He will américain et européen, donnera six conférences sur la dentisterie. Il look at perioperative considerations relating to patient manage- se penchera sur les considérations péri-opératoires se rapportant à ment prior to, during, and after anesthesia. He will review the la gestion du patient avant, durant et après l’anesthésie. Il passera diagnosis and treatment of stomatitis in cats, focusing on thera- en revue le diagnostic et le traitement de la stomatite chez les chats, peutic strategies that work. Further, he will provide information en se concentrant sur les stratégies thérapeutiques efficaces. De about closed and open tooth extraction, as well as management plus, il fournira des renseignements à propos de l’extraction de of extraction complications. Dr. Reiter will also discuss the dents ouverte et fermée ainsi que de la gestion des complications diagnosis and treatment of maxillary and mandibular fractures liées à l’extraction. Le Dr Reiter discutera aussi du diagnostic et and adjacent soft-tissue injuries and discuss the most commonly du traitement des fractures maxillaires et mandibulaires et des recognized oral tumors, and staging of the dogs and cats with blessures des tissus mous adjacents et il parlera des tumeurs orales les plus fréquemment reconnues ainsi que des stades des tumeurs orales chez les chiens et les chats. Le dernier atelier se penchera sur les efforts de reconstruction pour les patients durant le traitement de lésions orales congénitales, traumatiques ou néoplasiques. Le Dr Alastair Cribb, professeur de pharmacologie clinique à la Faculté de médecine vétérinaire de l’Université de Calgary, examinera la compréhension actuelle de la pharmacologie clinique des anti-inflammatoires non stéroïdiens (AINS) et des médicaments connexes. Il communiquera les progrès récents au niveau de la biologie des cyclooxygénases et des prostaglandines et il abordera aussi la

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Dr./Dr Alex Reiter Dr./Dr Alastair Cribb Dr./Dr Karri Beck

oral tumors. The final session will look at reconstructive efforts pharmacodynamique et la pharmacocinétique des AINS telles made for patients during treatment of congenital, traumatic or qu’elles se rapportent à leur usage clinique chez les animaux de neoplastic oral lesions. compagnie. Il passera également en revue les données probantes Dr. Alastair Cribb, professor, Clinical Pharmacology, actuelles pour l’usage et le choix des AINS chez les animaux de University of Calgary Faculty of Veterinary Medicine, will compagnie et se penchera sur l’efficacité et les effets indésirables. review the current understanding of the clinical pharmacol- L’atelier examinera les différences importantes entre les AINS qui ogy of nonsteroidal anti-inflammatory drugs (NSAIDs) and peuvent aider le clinicien à prendre des décisions rationnelles pour associated drugs. He will share important recent advances in un patient individuel. Et, dans un troisième atelier, il présentera une the biology of cyclooxygenases and prostaglandins and the introduction à la médecine de précision personnalisée en pratique pharmacodynamics and pharmacokinetics of NSAIDs relevant des animaux de compagnie. to their clinical use in companion animals will be addressed. He Les Drs Sandra McConkey et Hans Gelens, tous deux de will also review the current evidence for the use and selection l’Atlantic Veterinary College, examineront l’utilisation judicieuse of NSAIDs in companion animals, covering both efficacy and des antibiotiques qui est requise dans le monde actuel de adverse effects. The session will address important differences l’antibiorésistance croissante. Leurs conférences discuteront between NSAIDs that may aid the clinician in making rational l’utilisation rationnelle des antibiotiques chez les patients petits decisions for an individual patient. And in a 3rd session, he animaux à l’aide d’un format interactif axé sur des cas cliniques. will provide an introductory look at personalized and precision Des ateliers de dermatologie seront donnés par la Dre Karri medicine in companion animal practice. Beck qui travaille dans deux hôpitaux spécialisés de la région Drs. Sandra McConkey and Hans Gelens, both with the de Toronto. Elle se penchera sur diverses maladies de la peau à Atlantic Veterinary College, will look at the insightful use of médiation immunitaire qui sont observées tellement rarement en antibiotics that is required in today’s world of increasing anti- pratique générale qu’elles sont souvent oubliées. Le traitement microbial resistance. Their talks will discuss the rational use of des maladies de la peau à médiation immunitaire nécessite antibiotics in small animal patients using an interactive clinical souvent le recours à des médicaments immunosuppresseurs tels case-based format. que des stéroïdes, de l’azathioprine, du chlorambucil et de la Dermatology sessions will be given by Dr. Karri Beck who cyclosporine. Un deuxième atelier portera sur la reconnaissance works out of 2 referral hospitals in the greater Toronto area. She des diverses tendances de réaction et des différentiels potentiels, will look at a variety of immune-mediated skin diseases that de l’investigation diagnostique et des options de traitement pour are seen so infrequently in general practice that they are often les patients félins allergiques. La dermatite atopique canine sera overlooked. Treatment of immune-mediated skin disease often présentée ainsi que diverses options de traitement. involves the use of immunosuppressive medications such as Il ne s’agit-là que de quelques-uns des conférenciers du steroids, azathioprine, chlorambucil and cyclosporine. A 2nd ses- programme du congrès 2017. Et le congrès de l’ACMV ne portera sion will focus on recognizing the various reaction patterns and pas uniquement sur les ateliers de formation continue. Il y aura potential differentials, diagnostic work-up and treatment options une foule d’occasions de réseauter et de reprendre contact avec for allergic feline patients. Canine atopic dermatitis will be pre- des collègues ainsi que le Salon des exposants qui présentera sented with various treatment options. de nouveaux produits et services. L’Atlantic Veterinary College These are just a few of the speakers in the 2017 CVMA (AVC) organisera une réunion des anciens le vendredi 14 juillet Convention program. And the CVMA Convention isn’t just à l’AVC. Pour commencer la journée du samedi du bon pied, les about CE sessions. Opportunities to network and reconnect congressistes sont invités à participer à la course folle Merial ou à with colleagues abound as well as an exciting Exhibit Hall la séance de yoga, qui seront tous deux suivis d’un petit déjeuner showcasing new products and services. The Atlantic Veterinary continental. La journée prendra fin lors d’un party de cuisine de College is holding a reunion for its alumni on Friday, July 14 at l’Île-du-Prince-Édouard longuement attendu au restaurant Lobster

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N the college. To kick-off Saturday, July 15, attendees are invited on the Wharf. Des délicieux fruits de mer et des artistes locaux to participate in the Merial Fun Run/Walk or yoga session with sauront divertir les participants! a continental breakfast afterwards. The day will end with the Si vous avez des non-membres dans votre clinique, ils voudront much anticipated PEI kitchen party at the Lobster on the Wharf peut-être considérer cette offre spéciale. Inscrivez-vous à une restaurant. Delicious seafood and local entertainers promise a adhésion de six mois (du 1er juillet au 31 décembre 2016) à moitié fun evening for all! prix et profitez du tarif de membre pour l’inscription au congrès. If you have non-members in your clinic, they may want to Cela représente un rabais de 150 $ sur le tarif de l’inscription et consider this special offer. Sign up for a 6-month regular mem- l’adhésion de six mois à un tarif réduit de 50 % par rapport à la bership (July 1–December 31, 2016) at half price and enjoy cotisation annuelle régulière. Composez le 1-800-567-2862 pour the member rate for your general Convention registration. communiquer avec l’ACMV et profiter de cette promotion d’adhésion! That’s a $150 savings on your registration fee and a half-year Pour en savoir davantage à propos du congrès, veuillez visiter le membership at 50% off the regular annual dues amount. Call site Web (www.veterinairesaucanada.net). 1-800-567-2862 to join the CVMA and take advantage of the membership promotion! For more convention information, visit the website (www.canadianveterinarians.net).

To All Members of the Canadian À tous les membres de l’Association Veterinary Medical Association canadienne des médecins (CVMA) vétérinaires (ACMV) Notice of the Annual General Meeting Avis de l’Assemblée générale annuelle of the CVMA de l’ACMV ll members of the CVMA are invited to participate in ous les membres de l’ACMV sont invités à participer à Athe Annual General Meeting (AGM), taking place in the Tl’Assemblée générale annuelle (AGA) qui aura lieu le jeudi Harbourview Rooms at the PEI Convention Centre (18 Queen 13 juillet de 12 h à 14 h 30 dans les salles Harbourview du PEI Street) in Charlottetown, PEI on Thursday, July 13 from Convention Centre (18 rue Queen) à Charlottetown (Î.-P.-É.), durant 12:00 am to 2:30 pm, during the 2017 CVMA Convention. le congrès 2017 de l’ACMV. Immédiatement après l’AGA, l’ACMV Immediately following the AGM, the CVMA will hold its annual tiendra sa cérémonie annuelle de remise des prix. Awards Ceremony. Nota : Note: Même si tous les membres de l’ACMV ont accès à des sièges Although all CVMA members have access to theater seating dans l’amphithéâtre à l’AGA, un repas sera servi uniquement aux at the AGM, only those with a meal ticket can be provided personnes qui ont obtenu un billet de repas à l’avance. Pour obtenir with a lunch. To obtain a meal ticket, please go to our online un billet de repas, veuillez vous rendre au site d’inscription en ligne convention registration site (www.canadianveterinarians.net/ au congrès (www.veterinairesaucanada.net/science-knowledge/ science-knowledge/annual-convention-registration) and sign annual-convention-registration) et inscrivez-vous à l’AGA. up for the AGM.

458 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY Special Report Rapport spécial

Lessons learned from the evolution of terrestrial animal health surveillance in Canada and options for creating a new collaborative national structure

V. Wayne Lees, Cameron Prince

Introduction Why is an effective surveillance system anada has a long history of strong terrestrial animal health important to Canada? C surveillance and disease control programs based upon There are 2 major functions of any effective animal health officially designated, federally reportable, and notifiable diseases surveillance system: i) to quickly identify any new or emerging (1). These diseases pose a major threat to animal health, human disease before it spreads too far, so that it can be brought under health, and our trade in food animal products. In a large country control as soon as possible; and ii) to monitor diseases already with diverse ecological and production systems, it is a challenge present, to evaluate if Canada’s control measures are effective. to create a collaborative approach to the rapid identification, An effective surveillance system underpins our ability to: characterization, and response to new and emerging diseases or • trade in live animals and agricultural products internationally, to production-limiting diseases that are not currently listed in • protect the public from zoonotic diseases and related food- federal regulations. borne illnesses, Designing a formal, coordinated, national surveillance system • improve animal welfare through timely disease control, and for these diseases has been the subject of a great deal of effort • protect the economic well-being of producers. over the last 35 years. The Canadian Food Inspection Agency In recent years, Canada has experienced incursions of significant (CFIA), in collaboration with the Public Health Agency of disease threats, including: bovine spongiform encephalopathy Canada (PHAC) and 12 other partner organizations, recently led (BSE), West Nile virus, highly pathogenic avian influenza, a project to develop and pilot test a system for the early warn- H1N1 influenza in swine, porcine multi-systemic wasting ing of emerging and zoonotic diseases that may pose a threat syndrome, and porcine epidemic diarrhea. In addition, active to Canada. Known as the Centre for Emerging and Zoonotic ongoing control programs have been mounted against rabies, Disease — Integrated Intelligence and Response (CEZD-IIR), chronic wasting disease, and bovine tuberculosis affecting cattle the project was funded under the federal Canadian Safety and and wild cervids. Security Program (CSSP), which supports initiatives to enhance An effective One Health approach to animal health surveil- the security of Canadians. Another initiative, the Canadian lance is essential to protect farmed animals, wildlife and humans. Animal Health Surveillance System (CAHSS), has been pro- This will require a new, more integrated approach to surveillance posed to link the various existing surveillance networks across than we have seen in the past. It will not take the form of one the country. massive system; rather, the technology is now in place to utilize a To determine how these initiatives best fit into the current more distributed network of systems whereby data and collective animal health framework in Canada, it is important to first wisdom are shared between animal and human health partners understand the evolution of previous efforts to create a national, in government, industry, and academia. It is our opinion that collaborative surveillance system. This report documents the the major stumbling block will be to establish an enduring col- evolution of animal health surveillance in Canada between laborative model for funding and governing the system — one 1980 and 2015 and offers a comparative look at 3 international that can persist despite changing priorities and issues of the day. models. Recommendations are offered for consideration when Our past experience gives us the foundation upon which to build designing future national animal health surveillance systems. a truly collaborative, national terrestrial animal health system.

Box 471, Oak Lake, Manitoba R0M 1P0 (Lees); 3359 Drew Henry Drive, Osgoode, Ontario (Prince). Address all correspondence to Dr. Wayne Lees; e-mail: [email protected] The views expressed are those of the authors, based on their personal experiences in the Canadian animal health system. Wayne Lees has worked in veterinary practice and in the Surveillance Unit of the CFIA. He recently retired as Chief Veterinary Officer for Manitoba. Cam Prince has over 35 years of experience in the management and delivery of food safety and quality inspection and audit systems. He was formerly Vice President of Operations and Inspection Modernization at the CFIA. Although this article is being published as a Special Report, it has been peer-reviewed. 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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The evolution of animal health This was a first attempt to provide a national forum for major surveillance stakeholders to comment on disease control efforts and to share animal disease information. However, because it was an annual Canada has an extensive, well-trained cadre of private veteri- forum, it lacked the immediacy needed when dealing with new nary practitioners, a very good diagnostic veterinary laboratory or emerging diseases. The CAHCC annual conference was dis- system, and well-developed animal health institutions at the continued in 2005 and was replaced in 2011 by the National federal, provincial, territorial, and academic levels. These sys- Farmed Animal Health and Welfare Council (NFAHWC) tems perform very well for monitoring animal diseases that have Annual Forum. already been identified and for which disease control programs have been developed. Canada’s efforts to eradicate bovine Canadian Animal Health Coalition (CAHC) tuberculosis and brucellosis are perhaps the best examples of The highly structured format of the CAHCC annual meeting

RAPPORT SPÉCIAL strong federally led programs that were carried out for more and packed agenda offered limited ability for in-depth com- than half a century, for the benefit of animal health and human ment and further analysis. To overcome this, in 2002 a number health alike. However, as these programs achieved their goals, of the major producer groups and some provinces formed the the Canadian Food Inspection Agency (formerly the Health Canadian Animal Health Coalition to create a stronger voice of Animals Branch, Agriculture Canada) scaled back on its in influencing the direction of animal health programs. The on-farm presence, and the 3-way direct contact between farmer, Coalition has since evolved into an association of industry veterinary practitioner, and regulator was weakened. This trend groups who have managed a number of important projects to has continued with further program adjustments at the federal advance Canada’s animal health system. These include: studies level, with the result that the informal “over the fence” conversa- on the economic impact of foot-and-mouth disease; a pilot tions that used to alert officials to new or unusual diseases no project on zoning at West Hawk Lake on the Manitoba-Ontario longer took place. border; models for the control of Johne’s disease; coordination The establishment of a coordinated, comprehensive national of emergency management systems among governments and approach to animal health surveillance for emerging diseases has producer groups; contributions toward the development of been in development for many decades in Canada. This paper animal welfare codes of practice (3). provides an overview of the various organizations, committees, and councils that have been or continue to be part of the pro- Canadian Animal Health Network (CAHNet) cess. As we look to the future, it is important to understand the In 1996, an Animal Disease Symposium brought together over efforts that have gone before. 100 participants from federal and provincial governments, vet- erinary colleges, private practice, and producer organizations to Canadian Animal Health Consultative Committee forge a new alliance for animal disease surveillance in Canada, During the 1980s, the federal government was the lead agency the Canadian Animal Health Network or CAHNet (4). This for animal health disease surveillance and control in Canada. network was led by the Animal Diseases Surveillance Unit at the Most of the provinces had a provincial veterinarian, but his/her CFIA and was charged with coordinating a response to diseases role in managing animal health programs was not as active that fell outside the traditional federal mandate. as that of today’s provincial and territorial Chief Veterinary The Canadian Animal Health Network was to be an informa- Officers. Many of the provincial veterinarians were pathologists tion broker for new and emerging diseases in Canada, to support and directors of their provincial veterinary diagnostic laborato- both animal health and public health objectives. The network ries. As such, they played a valuable role in identifying new or sponsored monthly national teleconferences with provincial emerging diseases found in diagnostic specimens delivered to chief veterinarians and veterinary laboratories, and published a the laboratory. These case reports were often shared through semi-annual bulletin that highlighted new and ongoing animal newsletters, teleconferences, or diagnostic pathology confer- health issues (5). Though still largely an informal approach, ences but there was no formalized alert mechanism for national CAHNet did facilitate important and timely national discus- information dissemination. sions about newly emerging diseases, such as West Nile Virus To improve national dialogue on the direction of the national incursions across the country, and the spread of post-weaning animal health programs, in the 1970s the Health of Animals multi-systemic weaning syndrome (PMWS) in swine. With the Branch of Agriculture Canada (which is now part of the reallocation of staff and resources, CAHNet was disbanded after CFIA) established the Canadian Animal Health Consultative operating for 6 years. Committee (CAHCC), which held an annual open meeting of the major stakeholders in Canada (2). Akin to the annual meet- Canadian Animal Health Surveillance Network ing of the US Animal Health Association, it included representa- (CAHSN) tives from federal, provincial, and territorial animal diagnostic Initiated in 2004 and originally funded as a 4-year project laboratories and disease control programs, academics, veterinary sponsored by Defence Research and Development Canada (now associations, producer associations, public health representatives, the Centre for Security Sciences), the Canadian Animal Health and international observers. Over the course of the 2- to 3-day Surveillance Network (CAHSN) included partners in federal annual meeting, updates were given on all of the major federal and provincial animal health departments and diagnostic labo- disease control and food inspection programs and proposals. ratories, the Public Health Agency of Canada, university animal

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health diagnostic laboratories, and the Canadian Cooperative National Farmed Animal Health and Welfare Wildlife Health Centre (now known as the Canadian Wildlife Council (NFAHWC) Health Cooperative), the university-based network of wildlife About the same time that CAHSN was in development, there diagnostic pathologists and epidemiologists (6). were attempts to develop an overarching animal health strategy CAHSN’s goals were to:

for Canada. The Council of Chief Veterinary Officers (CCVO), REPORT SPECIAL • Establish a network of animal health diagnostic laboratories comprising federal/provincial/territorial (FPT) Chief Veterinary (federal, provincial, and academic) that would enhance Officers, began to take a much more active role in this process. Canada’s diagnostic surge capacity for testing for foreign With support from FPT assistant deputy ministers (ADMs) of animal diseases; agriculture, the CCVO partnered with the major livestock and • Establish a framework for combining disease intelligence from poultry commodity organizations to create the initial National across Canada to detect emerging disease threats; Farmed Animal Health and Welfare Council (NFAHWC). The • Coordinate disease response in a timely manner; and Council was to be an advisory body reporting to the FPT ADMs • Support these goals through a common information tech- on major issues of animal health and welfare policy and strate- nology platform based on the Canadian Network for Public gic direction. In a similar fashion, the Council’s livestock and Health Intelligence (CNPHI) architecture. poultry industry representatives were to report to the national The Canadian Animal Health Surveillance Network did achieve commodity organizations. Rounding out participation in the some very important accomplishments during its 4 years of Council were representatives from the Council of Chief Medical active development. The network of veterinary diagnostic Officers of Health, the Public Health Agency of Canada and laboratories across the country was significantly strengthened academia. as facilities and equipment were upgraded, common diagnostic Since its inception in 2010, the Council has played a signifi- protocols were established, and staff training was supported. cant role in promoting strategic thinking in animal health and The link between federal, provincial, and academic diagnostic welfare. One of its early reports, “Surveillance in a time of transi- laboratories was further enhanced when data sharing agreements tion in farmed animal health,” articulated a number of observa- and a common data platform were put in place. tions and recommendations to improve the nation’s animal health However, the original concept of having CAHSN act as the surveillance system (8). The report identified problems with the unifying national (as opposed to simply federal) diagnostic, current surveillance system in terms of a lack of leadership and and epidemiological umbrella organization that would collect, coordination, which led to the inability to easily detect trends or collate, and analyze surveillance data from across Canada and emerging diseases. There was also a lack of understanding among create early warning intelligence was never fully realized. The stakeholders about the value of surveillance. Recommendations project funding ended just as the surveillance piece was coming were proposed under 2 major headings: leadership and organi- to the fore. Efforts to create an ongoing, self-sustaining, not- zation, and technical enhancements. A national collaborative for-profit style governance structure did not gain widespread corporate structure was proposed that would coordinate the acceptance as many of the partners were facing significant surveillance systems across the country under a board of directors financial constraints. In the end, the CFIA agreed to sponsor who were overseen by the CCVO. Technical enhancements were a minimalist approach to CAHSN, maintaining the labora- proposed that would strengthen CAHSN’s role in data manage- tory network component, especially as it related to support- ment and analysis for known and emerging diseases of animal ing diagnostic and surveillance capacity for federally named health or veterinary public health significance. diseases of interest. A significant legacy of CAHSN was to raise In 2012, the Council published a progress report on Canada’s awareness of the need for a national collaborative surveillance capabilities in anticipation and agri-intelligence (9). The report network that could coordinate response to new or emerg- noted that although stakeholders received a large amount of ing diseases among the multiple tiers of the animal health animal health information, very little of it was in the form of infrastructure. agri-intelligence. Those surveyed agreed that agri-intelligence could proactively identify opportunities and avoid or reduce Canadian Regulatory Veterinary Epidemiology the impact of adverse events, but that the intelligence had to be Network (CRVE-Net) customized for various users. The Council encouraged further The Canadian Regulatory Veterinary Epidemiology Network development of the agri-intelligence capacity of the federal (CRVE-Net) is based at the Atlantic Veterinary College in government and encouraged industry and provincial/territorial Charlottetown, PEI. Established in 2009, the CFIA has contrib- stakeholders to participate in the development of this capac- uted funding “to support the continuation of CRVE-Net’s work ity. The report also noted that the industry-led initiative to in linking Canada’s 5 veterinary colleges to develop expertise in monitor health of swine across Canada through the Canadian veterinary epidemiology risk analysis, surveillance, modelling, Swine Health Intelligence Network (CSHIN) was a significant and modern tools to enhance knowledge to address terrestrial development that employed novel techniques using social and aquatic animal diseases of importance to Canada” (7). This media to gather disease information directly from producers was a significant first step to create a formal partnership between and veterinary practitioners. This information was analyzed and the veterinary colleges and the CFIA involving research into distributed to the members, and was recognized as an innovative diseases of regulatory interest. early warning system for swine diseases.

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The NFAHWC has continued to advance the notion of a Provincial Animal Health Surveillance Networks national animal health surveillance system as part of a national In the past, the heart of most provincial animal health surveil- animal health system. Surveillance and intelligence systems go lance systems centered on the veterinary diagnostic laboratories. hand in hand, with each providing the other with continuous This network of laboratories served as a very good early warning feedback. At the 2014 NFAHWC Annual Forum (10), a num- system to the presence of a new disease, but they did not have a ber of initiatives were reported to be proceeding simultaneously, formal way of amassing clinical data from the field to measure including: its impact. Various provinces have developed their own surveil- • Work is continuing on development of a disease prioritiza- lance networks, but the provincial resources available to conduct tion and categorization tool that will help clarify what new surveillance vary greatly across the country. Perhaps the most or emerging diseases should command CFIA involvement. well-developed system is Quebec’s RAIZO network (12), which • The CEZD-IIR project is developing tools to generate animal links producers, practitioners, veterinary diagnostic laboratories, RAPPORT SPÉCIAL health intelligence from open source information, with the and disease investigation specialists. Other provinces, such as view to bolster Canada’s capacity to identify early warning Ontario and Alberta, have developed surveillance networks for signals for emerging diseases. some species, but structure, function, and capacity in this area • Work is proceeding to develop a sustainable model of gov- differ significantly from province to province. ernance for the overarching “network of networks,” which has been described as a loosely affiliated distributed system Public Health Network of networks that are based on key principles, rather than one The pan-Canadian Public Health Network (PHN) was estab- that is centrally controlled. This initiative since evolved into lished following the Severe Acute Respiratory Syndrome (SARS) the Canadian Animal Health Surveillance System (CAHSS) outbreak in 2005 to develop policy advice and collaborative which is further discussed below. infrastructure to address important public health threats. It Although it does not presently operate disease surveillance comprises the FPT Chief Public Health Officers, senior gov- and control programs itself, the National Farmed Animal Health ernment officials, academics, health professionals, and non- and Welfare Council has emerged as an important organization government organizations. It is governed by a 17-member for undertaking collaborative policy analysis and creating policy Council that provides advice to the FPT Deputy Ministers of recommendations for industry and government organizations Health. Steering committees provide operational coordination alike. among the jurisdictions in 3 key areas: Healthy People and Communities; Communicable and Infectious Disease; and Canadian Animal Health Surveillance System Public Health Infrastructure (13). (CAHSS) While this structure works well for human health surveil- The CAHSS is a network of networks, backed by the lance, especially for monitoring the annual outbreaks of human NFAHWC, which links many existing government and non- influenza through its FluWatch network (14), the organiza- government animal health surveillance networks that have tional differences between human health and animal health collectively and voluntarily agreed to collaborate (11). Each are significant. There are no equivalents in human health to network is independently governed and self-funded, but is the animal industry stakeholders, such as the food animal and linked through CAHSS by a common vision to create an inte- poultry producer associations. To be effective, any animal health grated animal health surveillance system in Canada. A Directors surveillance system must include these organizations as primary Group, drawn from the participants, establishes priorities and partners. initiates activities, and is supported by a Champions Group, who provide strategic direction and higher level support. Several International models federal employees in CFIA and AAFC have been dedicated to There are several international models of animal health sys- provide operational support to CAHSS. tems worth examining to see if they hold value in a Canadian The approach taken by CAHSS is a significant step forward context. Each has a different approach to governance, ranging in the evolution of a national animal health surveillance system. from primarily industry-led to primarily government-led, and By recognizing the diversity of existing networks and by work- something in between — a collaborative industry-government ing towards achieving common goals, this approach is most approach. Here are some examples of different models that likely to succeed in a country such as Canada. Creating these could be considered. synergies, the interests of domestic animal, wildlife, and public health officials, producer groups, and academia can be served Animal Health Ireland collectively through a One Health methodology. Animal Health Ireland is an industry-led, not-for-profit part- The next logical step in this process will be to create a gov- nership (15). Its purpose is to develop control programs for ernance and funding model that is more permanent and stable. endemic production-limiting diseases, such as bovine viral Excellent progress has been made based on the goodwill of the diarrhea and mastitis. Government does play an advisory role, participants, but as people and priorities change over time, but the organization is funded and operated mainly by industry. CAHSS support is vulnerable to the shifting focus of the issue This structure works well for diseases that are well-recognized, of the day. This can put at risk the long-term viability of this endemic, and have their primary impact on economic produc- type of voluntary system. tion. As the programs are led by farmers with advice from

462 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY government, they are more likely to be implemented in the Implications for future field. However, this system has limitations in dealing with new surveillance efforts or emerging diseases that may require a rapid, non-voluntary, Canada’s animal production systems are diverse and regionally regulatory response. based, so it is not surprising that the animal health systems The Animal Health and Welfare Board of (including surveillance systems) that have evolved reflect that REPORT SPECIAL England diversity. Some of these are based on geographic region (e.g., provincial boundaries); others are more national in scope but Members of this Board are nominated by industry but appointed focus only on one species. Because animal health systems are by the English government (16). The Board reports directly to structured and funded in a way that is significantly different the Ministers on strategic advice related to animal health and from those in public health, it has been difficult, if not impos- welfare, and has a role in monitoring the regulatory framework. sible, to design a one-size-fits-all surveillance and intelligence- The Board is primarily advisory in nature, and does not operate gathering system for the entire country. It is clear that a new, disease surveillance or control programs itself. collaborative model must be developed. The primary advantage of this system is the direct access to It is within this context and evolution that initiatives, such senior levels of government. To some, this may appear to be attractive at first glance, but in our context it would tend to as CEZD-IIR and CAHSS, must be considered. CEZD-IIR subvert the established policy-making framework. Canada’s will add intelligence analysis and early warning alert capacity to system of vetting policy proposals through producer groups the Canadian animal health system. This capacity may exist in and the civil service does provide a great deal of opportunity for other systems for some species, for some provinces, or even in consultation and refinement. Finding a system that is responsive the personal networks of some experienced individuals, but there and yet inclusive should be our goal. is no overarching intelligence gathering and analysis capacity that currently exists in Canada. The Canadian Animal Health Animal Health Australia Surveillance System shows promise for linking the networks, Animal Health Australia (AHA) is an interesting model that may tools, and capabilities that currently exist, but to be useful it hold value for Canada, as it seeks to balance federal, state, and must serve the needs of its primary clients — animal and human industry interests. Funded equally by federal and state govern- health experts in governments, academic institutions, and animal ments, and industry partners, this independent not-for-profit producers. As it develops further, the next step should be to company operates over 50 animal health programs for a number create an operational and independently funded program under of species (17). Its priorities are to: manage and strengthen the the National Farmed Animal Health and Welfare Council. This emergency management system; enhance preparedness and would be a positive move towards developing a more formal, response capacity among stakeholders; strengthen biosecurity collaborative, integrated surveillance system. and animal welfare; and deliver value to its members. Animal Lessons for the future Health Australia has developed strategies for enhancing bios- ecurity and animal welfare, the AusVetPlan emergency response Whatever national animal health structure is adopted, there are manuals, biosecurity manuals, and created a disease alert system. a number of lessons that can be learned from previous efforts to What is attractive about this model is its inclusiveness. build surveillance and intelligence-gathering capacity in Canada. Because it includes both layers of governments and producer These are the first principles upon which any future national groups, this model might work well for Canada’s diverse agri- animal health system must be based. cultural sectors. Its tripartite funding model as a not-for-profit corporation means that it is not controlled by any one entity; Build strength from diversity therefore, collaborative solutions must be found. In addition The diversity of animal health systems should be viewed as a to policy advice, AHA manages a truly impressive suite of pro- strength rather than a weakness. Resilience is built through grams ranging from controlling indigenous diseases to designing diversity — if one system fails, another steps in. For example, an biosecurity measures and to creating emergency management early warning signal that may be missed by a provincially based plans. system may be picked up by a species-based one. Therefore, any Canada has taken a step in this direction with the creation future early warning system must cast its net widely and build of the National Farmed Animal Health and Welfare Council. on the capacity of the other systems that are already in place. It uses a similar funding approach and includes a wide variety of expertise on its board. However the Council has been lim- Collaboration is key ited thus far to a policy advisory role. If the Animal Health There are simply too many diverse systems of agriculture in Australia model holds value, the next logical step would be Canada to impose a one-size-fits-all approach to animal health to create a not-for-profit corporate entity, and venture into and surveillance programs. There are also marked regional and the realm of program design and implementation, perhaps sectoral differences in the capacity to fund and implement ani- beginning with surveillance. The CAHSS model is a step in mal health programs. Balancing these interests requires a truly this direction, but it currently lacks the independent funding collaborative approach to finding outcome-based solutions. A and corporate governance structure seen in the Animal Health recent report on the small-scale food production and processing Australia model. sector in Manitoba used such a collaborative approach to focus

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on identifying and achieving common outcomes that would under a common vision. This is an encouraging development, benefit all (18). One recommendation from that report was to as building within this framework will ultimately strengthen all create a common organizational structure where all interests participants. Further expansion of the Council’s existing policy could be represented. Our NFAHW Council is the beginning of advisory role to include hands-on operational capacity will be such an organization for animal health and welfare in Canada, critical to advancement. but its role could be expanded to actually operate programs. Conclusion Personal networks remain important “Those who cannot learn from history are doomed to repeat it.” Because Canada’s animal health regulatory and surveillance This quote was first attributed to the Spanish philosopher community is relatively small, the informal networks that have George Santayana and was later immortalized by Sir Winston been developed have been quite effective at detecting new or

RAPPORT SPÉCIAL Churchill. As we seek to build an animal health framework for emerging issues as long as there has been some way to share that the future, let us not ignore the lessons from the past. information, such as via a teleconference. Regular teleconfer- The framework for the future must be collaborative — a true ences among the key players have been a central component stand-alone partnership between governments and industry, of all of the surveillance systems that have evolved over the with stable funding and visionary leadership. We believe that last 3 decades. Efforts to formalize, codify, and summarize this the Animal Health Australia model holds the most promise for information in a report are useful as an adjunct, but they do not Canada. The NFAHW Council is an important first step in this replace these essential personal contact networks. direction, but its roles must be expanded, its funding secured, National coordination requires dedicated and its independence guaranteed. personnel and financial resources over a longer term Acknowledgments In the past, effective networks have functioned on the basis of This paper is based in part on the authors’ contribution to Part 1 goodwill, but the commitment of the partners dwindles when of the report “CEZD-IIR Preliminary Sustainability Options,” resources become tight. To move beyond this requires a signifi- prepared by TDV Global. We wish to thank James Dunlop of cant investment in dedicated human and financial resources. TDV Global and Harry Gardiner of the CFIA for their helpful The CAHSN laboratory network was successful at improving suggestions. CVJ the national surge capacity for diagnosing foreign animal dis- eases, but it required a sizeable commitment of federal funds for References laboratory improvements along with the provincial commitment . 1 Canadian Food Inspection Agency. Terrestrial Animal Diseases. [Online] to upgrade training and certification. When the federal funding [Cited: May 16, 2016.] Available from: www.inspection.gc.ca/animals/ terrestria-animals/diseases/eng/1300388388234/1300388449143 Last ended, some provinces struggled to meet their ongoing costs. It accessed February 28, 2017. appears that a 3- or 4-year window of funding may not be suf- 2. Inch C. The Canadian Animal Health Network. Can Vet J 1997;38: ficient to develop and establish a new system. Stable, long-term 621–627. 3. Canadian Animal Health Coalition. [Online] [Cited: May 16, 2016.] funding is necessary to support any national network. Available from: www.animalhealth.ca Last accessed February 28, 2017. 4. Lees W, Kellar J, Dore A, Power C, Inch C. Canadian Animal Technical issues are hurdles that can be Health Network — CAHNet. Proc 9th Symp Int Soc Vet Epi Econ, Breckenridge, Colorado, USA 2000:464. overcome 5. Bowman QP, Arnoldi JM. Management of animal health emergencies The diversity of surveillance systems across Canada creates techni- in North America: Prevention, preparedness, response and recovery. Rev cal hurdles for epidemiologists who must collate and analyze data Sci Tech Off Int Epiz 1999;18:76–103. 6. Kloeze H, Mukhi S, Kitching P, Lees VW, Alexandersen S. Effective in order to monitor disease trends across regions and across spe- animal health disease surveillance using a network-enabled approach. cies. There has been some progress in standardizing information Transbound Emerg Dis 2010;57:414–419. systems, but this has been slow. These problems may be difficult, 7. University of Prince Edward Island. Canadian Regulatory Veterinary Epidemiology Network (CRVE-Net). [Online] [Cited: May 30, 2016.] but they are not insurmountable. For instance, with the advent of Available from: http://cver.upei.ca/news/announcement-canadian- smart phone technologies, new opportunities arise for coupling regulatory-veterinary-epidemiology-network-crve-net Last accessed real-time surveillance with in-depth analysis. Technological issues February 28, 2017. 8. National Farmed Animal Health and Welfare Council. Surveillance in a should not be seen as insurmountable — they are just speed time of transition in farmed animal health. Willis N, ed, 2011. [Online] bumps that slow advancement. Rather, it is the lack of leadership [Cited: July 20, 2016] Available from: http://www.ahwcouncil.ca/pdfs/ and vision that will completely derail progress. reports/surveillance/NFAHW%20Council%20Surveillance%20in%20 a%20Time%20of%20Transition%20in%20Farmed%20Animal%20 Health%20Final.pdf Last accessed February 28, 2017. Success will depend on strong leadership from 9. National Farmed Animal Health and Welfare Council. Anticipation those with a vision and agri-intelligence: Progress report of the NFAHW Council. 2012. [Online] [Cited: July 20, 2016] Available from: http://www.ahwcouncil. Central to creating a national system is leadership. Without ca/pdfs/anticipation/Anticipation%20and%20Agri-intelligence%20 leadership from key individuals who carry a vision — and with- progress%20report%20Nov%202012%20rev.pdf Last accessed out the backing of strong champions who enable that process February 28, 2017. 10. National Farmed Animal Health and Welfare Council. Forum 2014 — there will simply be too many hurdles. The recent leadership Proceedings. 2014. [Online] [Cited: June 1, 2016] Available from: of the NFAHW Council has brought together many partners http://www.ahwcouncil.ca/forum/2014 Last accessed February 28, 2017.

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11. CAHSS website [Online] [Cited September 6, 2106.] Available from: 16. Animal Health and Welfare Board of England. [Online] [Cited: May 11, https://www.cahss.ca Last accessed February 28, 2017. 2016.] Available from: https://www.gov.uk/government/groups/animal- 12. RAIZO website. [Online] [Cited: May 31, 2016.] Available from: http:// health-and-welfare-board-for-england-ahwbe Last accessed February 28, www.mapaq.gouv.qc.ca/fr/Productions/santeanimale/maladies/RAIZO/ 2017. Pages/raizo.aspx Last accessed February 28, 2017. 17. Animal Health Australia. [Online] [Cited: May 11, 2016.] Available 13. Pan-Canadian Public Health Network. [Online] [Cited: May 31, 2016.] from: https://www.animalhealthaustralia.com.au/ Last accessed

Available from: http://www.phn-rsp.ca/index-eng.php Last accessed February 28, 2017. REPORT SPECIAL February 28, 2017. 18. Lees V. Wayne, chair, Small Scale Food Manitoba working group. 14. Public Health Agency of Canada. FluWatch. [Online] [Cited: Jun 1, Advancing the small scale, local food sector in Manitoba: A path for- 2016.] Available from: http://healthycanadians.gc.ca/publications/ ward. 2014. [Online] [Cited: May 11, 2016.] Available from: https:// diseases-conditions-maladies-affections/fluwatch-2015-2016-08- www.gov.mb.ca/agriculture/food-and-ag-processing/pubs/small-scale- surveillance-influenza/index-eng.php Last accessed February 28, 2017. food-report.pdf Last accessed February 28, 2017. 15. Animal Health Ireland. [Online] [Cited: May 11, 2016.] Available from: http://animalhealthireland.ie/?page_id=499 Last accessed February 28, 2017.

CVJ / VOL 58 / MAY 2017 465 FOR PERSONAL USE ONLY Article

Complications and risk factors of castration with primary wound closure: Retrospective study in 159 horses

Mickaël P. Robert, Ronan J.J. Chapuis, Claire de Fourmestraux, Olivier J. Geffroy

Abstract — Castration with primary wound closure reportedly has lower complication rates and shorter recovery periods compared to castration with second intention healing. However, little is known about risk factors associated with complications using primary wound closure. Medical records of 159 horses castrated and having primary wound closure were reviewed. Main short-term complications were: scrotal hematoma in 12 horses (7.6%), signs of colic in 6 horses (3.8%), fever in 4 horses (2.5%), and peri-incisional edema in 3 horses (1.9%). As for long- term complications, 24 out of 105 (23%) horses sustained some form of edema. One horse was euthanized because of a suspected inguinal abscess. Among tested parameters, horses aged 3 to 6 years old and French trotters appeared to be more at risk of developing complications. Intraoperative ligation of the cremaster muscle and use of electrocautery prevented complications. Overall, client satisfaction was excellent (98%).

Résumé — Complications et facteurs de risque de la castration avec fermeture des plaies par première intention : étude rétrospective chez 159 chevaux. La castration avec fermeture des plaies par première intention a un taux de complications plus faible et une période de convalescence plus courte que la castration avec cicatrisation par seconde intention. Cependant, on en sait peu sur les facteurs de risque associés aux complications en utilisant la technique de fermeture des plaies par première intention. Les dossiers médicaux de 159 chevaux castrés de cette façon ont été examinés. Les complications à court terme sont les suivantes: hématome scrotal chez 12 chevaux (7,6 %), signes de coliques chez 6 chevaux (3,8 %), fièvre chez 4 chevaux (2,5 %) et de l’œdème péri-incisionel chez 3 chevaux (1,9 %). En ce qui concerne les complications à long terme, 24 sur 105 (23 %) chevaux ont présenté un certain degré d’œdème. Un cheval a été euthanasié à cause d’un probable abcès inguinal. Parmi les paramètres testés, les chevaux âgés de 3 à 6 ans et les Trotteurs Français semblent être plus à risque de développer des complications. En outre, la ligature peropératoire du muscle crémaster et l’utilisation du bistouri électrique semblent prévenir les complications. Dans l’ensemble, la satisfaction des clients était excellente (98 %). (Traduit par les auteurs) Can Vet J 2017;58:466–471

Introduction wound closure under general anesthesia has been performed for more than 40 y (6). Lower complication rates and shorter astration is probably one of the oldest veterinary surgical recovery periods have been reported with this technique com- procedures and the most frequently performed surgery in C pared to those healing by second intention after scrotal incisions equine practice (1,2). Despite its routine character, more com- (3,7). However, little is known about the risk factors associated plications develop following castration than any other elective with complications and about the long-term follow-up of horses surgical procedure, some of them being life-threatening (3). It is gelded using this technique. also the most common cause of malpractice claim against equine The objectives of this retrospective study were to: i) report surgeons in North America (4,5). Castration with primary the short- and long-term complications in 159 horses castrated by a primary closure technique at the equine clinic of ONIRIS; Oniris — CISCO, Site de la Chantrerie, CS 40706, 44307 ii) identify risk factors associated with these complications; NANTES Cedex 03, France. iii) document overall client satisfaction regarding castration Address all correspondence to Dr. Mickaël P. Robert; e-mail: with primary closure. [email protected] Dr. Chapuis’ current address is Western College of Veterinary Materials and methods Medicine, University of Saskatchewan, Saskatoon, Canada. Medical records review Use of this article is limited to a single copy for personal study. The records of all horses that were castrated using a primary Anyone interested in obtaining reprints should contact the closure technique under general anesthesia between January CVMA office ([email protected]) for additional 2007 and June 2014 at the ONIRIS Nantes equine clinic were copies or permission to use this material elsewhere. retrospectively reviewed. Intact males with 2 descended testes as

466 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY well as unilateral cryptorchid horses in which both testes could Statistical analysis be retrieved via an inguinal approach were included. Horses in Only horses with complete medical records were reviewed. Data which a laparoscopic or a parainguinal cryptorchidectomy was were recorded and analyzed on Excel 2007. Descriptive statis- performed were excluded. Collected data included signalment tics were used for relevant variables, in particular to report the of the horse (breed, age), presence of cryptorchidism, periopera- incidence of short- and long-term complications. To determine tive treatments (type of antimicrobials and anti-inflammatory risk factors associated with complications, Fisher’s exact test was drugs received), experience of the surgeon (resident versus board- used and odds ratio (OR) with 95% confidence intervals (CI) ARTICLE certified surgeon), and surgical technique (inguinal approach were calculated for each variable using BiostaTGV (http://marne. versus scrotal approach with scrotal ablation, use of electrocau- u707.jussieu.fr/biostatgv/?module=tests/fisher). Differences were tery, ligation of the scrotal ligament, ligation of the cremaster considered significant at P , 0.05. Significant parameters were muscle, emasculator applied to the cremaster muscle, ligation also tested for hematoma formation. For long-term complica- of the spermatic cord, type of emasculator used, size of suture tions, horses lost to follow-up were excluded from the analysis. material for spermatic cord ligation, twisting and attaching the In order to evaluate the incidence of general postoperative vaginal tunic to the femoral fascia, closure of the superficial complications (colic and fever), a control group of horses that inguinal ring, technique of closure). Concurrent surgical pro- underwent elective surgical procedures at our hospital during cedures during the same anesthetic period were recorded, as the same study period was evaluated. Incidence of postoperative well as complications and subsequent treatments. Hematoma complications were compared with Fisher’s exact tests. and edema formation, signs of digestive pain or disturbance, and fever (. 38.8°C) occurring during hospitalization were all Results considered as short-term post-operative complications. In the During the study period, 159 horses aged 1 to 21 y old [mean 6 authors’ hospital, peri-incisional seroma and edema smaller than standard deviation (SD) 4.2 y 6 2.6 y] were castrated using a a testis in size were considered acceptable and thus were not primary closure technique under general anesthesia. There were reported as complications. Moreover, catheter related complica- 64 Selle Français, 23 German horses (Hanoverian, Holsteiner, tions and other postoperative abnormalities not related to the Oldenburg), 12 Thoroughbreds, 9 French trotters, and 51 horses surgical procedure were not taken into account. Edema, weight of 19 other breeds. Cryptorchidism was present in 40 horses loss, castration adhesions, hydrocele, and infection of the surgi- (25%). Location of retained testis was inguinal in 25 horses and cal site occurring after hospital discharge were all considered as abdominal in 15 horses. long-term complications. All horses received prophylactic antimicrobials. Penicillin (Depocilline; MSD, Beaucouzé, France) was given to 126 horses Perioperative protocol (79.2%), whereas a third (Excenel, Zoetis, Paris, France) or Horses were fasted for 8 to 12 h before surgery and admin- fourth generation (Cobactan, MSD, Beaucouzé, France) cepha- istered an antimicrobial drug. The anesthetic protocol losporin was given to 33 horses (20.8%). Six horses (3.8%) were included acepromazine (Vetranquil; CEVA, Libourne, France), given postoperative gentamicin (Forticine; Vétoquinol, Lure, 0.02 mg/kg body weight (BW), IV or 0.04 mg/kg BW, IM, France), either because of a concurrent surgical procedure, or administered 20 to 60 min before sedation with romifidine because of a complication. All horses received either flunixin (Sedivet; Boehringer-Ingelheim, Reims, France), 0.08 mg/kg meglumine (Meflosyl; Zoetis), 1.1 mg/kg BW, IV, or phenyl- BW, IV, and butorphanol (Torbugesic; Zoetis, Paris, France), butazone (Equipalazone; Dechra, Northwich, UK), 2.2. mg/kg 0.02 to 0.04 mg/kg BW, IV. Induction was performed with diaz- BW, IV or PO, before and after surgery. All but 5 horses (97%) epam (Valium; Roche, Basel, Switzerland), 0.05 mg/kg BW, IV, had postoperative anti-edema drugs consisting of a combina- and ketamine (Imalgene; Mérial, Lyon, France), 2.2 mg/kg BW, tion of dexamethasone, 0.01 to 0.02 mg/kg BW, IV or PO, and IV. Horses were positioned in dorsal recumbency and anesthesia thiazide diuretic hydrochlorthiazide (Diurizone, Vétoquinol), was maintained with isoflurane (Vetflurane; Virbac, Carros, 2 to 3 mg/kg BW, IV or PO q24h for 4 d. France) in oxygen in a semiclosed circle system. After recovery, Regarding the surgical techniques used, 145 of 159 horses water was available as the horses were returned to their box stall, (91.2%), including those with retained testes, had an incision and food was gradually reintroduced according to auscultable performed over each superficial inguinal ring. The remaining gut motility, generally 4 to 6 h later. 14 horses had a scrotectomy that allowed access to both testes Horses were generally discharged 48 h after surgery. Owners with 1 large incision. Electrocautery was used for skin incision were asked to walk and trot their horse for 20 min for 10 d and coagulation of small vessels in 47 horses (29.6%). After before resuming work. incising the inguinal fascia, the testis, covered by its vaginal tunic, was exteriorized. The scrotal ligament was ligated and sev- Follow-up ered in 60 cases (37.7%) or bluntly separated in the others. The Owners were contacted by telephone by 1 of the authors cremaster muscle was isolated and ligated in 135 cases (84.9%) (R.J.J.C.) to determine whether complications occurred after with either USP 1 or 2 polyglactin 910 and/or emasculated in discharge from the hospital and to grade their level of satisfac- 77 cases (48.4%). The parietal tunic was incised, allowing the tion regarding the surgery. A dedicated form specifically men- testicle to be pulled out from the vaginal cavity. The ligament of tioning possible complications was used during this telephone the tail of the epididymis was sharply transected and the vaginal interview. tunic bluntly separated from the mesorchium. All horses had

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Table 1. Postoperative complications in a control population of Table 2. Long-term complications reported by owners of 376 horses operated on for several elective procedures from 105 horses among 159 castrated using a primary closure January 2007 to June 2014 technique Cases reviewed Colic Fever Slight edema 15 14.3% Moderate to severe edema 9 8.6% Umbilical hernia 14 0 1 Weight loss 5 4.8% Laryngoplasty 12 0 0 Adhesions 1 1.0% Tenoscopy 25 1 0 Hydrocele 1 1.0% Enucleation 21 3 1 Inguinal abscess requiring euthanasia 1 1.0% Splint bone surgery 14 1 0 Tie-forward 13 0 0 Arthroscopy 277 13 7 ARTICLE Total (percentage) 376 (100%) 18 (4.8%) 9 (2.4%)

their spermatic cord and vaginal tunic ligated during surgery Four horses (2.5%) had postoperative fever, which resolved to prevent hemorrhage and evisceration, respectively (3). Cord with the administration of antipyretic drugs (dipyrone, flunixin ligation was done with either USP 1 (13.4%) or USP 2 (86.6%) meglumine) and/or modification of the antimicrobial therapy. polyglactin 910. An emasculator was subsequently applied The incidence of postoperative fever was not significantly differ- 2 cm distal to the ligature for 5 min. The vaginal tunic was ent from what was observed in the control population (P = 1). transected and its stump closed either by a transfixation liga- Owners of 105 horses were contacted successfully from 3 mo ture (USP 1 or USP 2 polyglactin 910) or a simple continuous to 7 y following castration of their horse. Long-term complica- suture (2-0 absorbable suture material). On several occasions tions are reported in Table 2. Eleven horses (10.5%) required (40 horses), it was twisted twice and sutured to the femoral additional medical care, mainly diuretics and antimicrobials, fascia. The superficial inguinal ring was closed in only 5 cases because of persistent edema. Two horses underwent a second and exclusively in cryptorchid horses. Then, the inguinal fascia surgery, 1 because of scrotal adhesions and the other because of and the subcutaneous tissue were closed in 136 (85.5%) and a hydrocele. One horse had recurring preputial edema every 3 71 horses (44.6%) respectively. Finally, the skin was closed in to 4 mo. He was euthanized 18 mo after being castrated because a continuous pattern, either simple (72.4%) or intradermal of a suspected inguinal abscess. No additional diagnostic pro- (27.6%). Monofilament absorbable USP 2-0 suture material cedures or treatment were requested from the ONIRIS equine was generally used for the 3 latter layers. For retained testicles, clinic to confirm this suspicion before euthanasia and no nec- the inguinal approach described by Schumacher (1) was suc- ropsy information was available. The overall clients’ satisfaction cessfully used in all cases. with castration with primary wound closure technique was excel- Seventeen horses (10.7%) underwent another surgical proce- lent (98%). The effects of different variables on complications dure during the same anesthetic episode. Eight had an arthros- of castration are reported in Table 3. copy performed (1 to 4 joints), 2 had a prosthetic laryngoplasty, French trotters and horses aged 3 to 6 y appeared at a higher 2 had an umbilical herniorrhaphy, 2 had a platelet rich plasma risk of developing complications following primary closure injection, 2 had sarcoids removed, and 1 had a subchondral castration, with an odds ratio exceeding 4. In particular, French cystic lesion in the middle phalanx curetted. In the short-term trotters were at a higher risk of developing a postoperative hema- postoperative period, 26 (16.4%) horses experienced 1 or more toma than were other horses (P = 0.02; OR = 7.6). complications attributed to the surgical procedure. Intraoperative use of electrocautery (P = 0.02; OR = 0.3) and Hematoma in the scrotal sac was the most common compli- ligation of the cremaster muscle (P = 0.03; OR = 0.3) appeared cation. Among the 12 horses (7.6%) in which it occurred, only to significantly reduce complication rates. Ligation of the cre- 1 required a second surgery under general anesthesia in order master muscle had a significant protective effect on the occur- to stop the hemorrhage originating from the spermatic cord. rence of hematoma (P = 0.02; OR = 0.21). Other variables did Nine horses were treated with a scrotal incision under standing not show any significant effect on complication rates. sedation and local anesthesia to remove the hematoma, 1 was treated via ultrasound-guided needle aspiration of the blood, Discussion and 1 resolved over time. This study confirms that castration is not risk-free even when Six horses (3.8%) experienced postoperative colic. All resolved performed as a clean surgical procedure in a fully equipped with medical treatment consisting of a combination of dipyrone surgical theater with a primary closure technique under general (Calmagine; Vétoquinol), 25 mg/kg BW, IV (4 horses), omepra- anesthesia. More than 16% of horses developed complication zole (Gastrogard; Mérial, Lyon, France) (2 horses), nasogastric in the short-term postoperative period. These results are worse laxatives [magnesium sulfate (1 horse) or mineral oil (2 horses)], than those previously reported. Indeed, complication prevalence or flunixin (1 horse). Additionally, 1 horse showed temporary as low as 2% had previously been reported for primary closure bruxism after surgery which resolved after administration castration (8). However, direct comparison between studies is of omeprazole. The incidence of postoperative colic was not difficult because of differences in horse populations, surgical different from what was observed in a control population of techniques, and definition of complications. 376 horses (mean age 5.2 y 1/2 3.5 y) operated on for elective In our study, hemorrhage leading to hematoma formation in procedures during the study period (P = 0.82) (Table 1). the scrotal sac was the most frequent short-term complication,

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Table 3. Effect of different variables on short-term castration complications in 159 horses sustaining a primary closure technique 95% Confidence Variable P-value OR interval Age 3 to 6 y (n = 98) versus other age categories (n = 61) 0.008 4.3 1.373 to 18.202

Cryptorchidism (n = 40) 0.47 0.6 0.173 to 1.890 ARTICLE Type of cryptorchidism Abdominal (n = 15) versus inguinal (n = 25) 0.63 0.4 0.007 to 4.429 Surgeon’s experience Resident versus board-certified 0.82 1.78 0.442 to 2.988 Electrocautery (n = 47) 0.02 0.3 0.046 to 0.898 Scrotectomy (n = 14) 1 0.8 0.082 to 3.952 Ligation of scrotal ligament (n = 60) 0.83 1.2 0.449 to 2.921 Ligation of cremaster muscle (n = 135) 0.03 0.3 0.113 to 1.019 Emasculation of the cremaster muscle (n = 77) 0.09 0.5 0.174 to 1.204 Suture of fascia (n = 136) 0.55 1.4 0.377 to 4.598 Suture of subcutaneous tissue (n = 71) 0.09 0.5 0.163 to 1.204 Skin suture Cutaneous (n = 113) versus intradermal (n = 43) 1 1 0.377 to 3.181 Type of emasculator on spermatic cord Reimers (n = 149) versus serra (n = 8) 0.35 Size of suture material for cord ligation USP 1 (n = 20) versus USP 2 (n = 129) 1 0.9 0.157 to 3.569 Closure of superficial inguinal ring (n = 5) 0.59 Concurrent surgical procedure (n = 17) 0.50 1.7 0.034 to 16.695 Perioperative antimicrobial Penicillin (n = 126) versus cephalosporin (n = 33) 0.3 0.6 0.203 to 1.645 Breed Selle français (n = 64) 0.83 0.9 0.322 to 2.145 French trotter (n = 9) 0.04 4.4 0.803 to 21.983 German breeds (n = 23) 0.55 1.4 0.377 to 4.598

OR — Odds ratio. Significant values appear in bold. occurring in 7.6% of horses. In previous studies, a prevalence of elective surgeries performed in the authors’ clinic. The surgical 1% to 4.8% has been described for hemorrhage (7,9–11). The site is a possible cause of pain, but gastrointestinal assessment testicular artery is the likely source of severe hemorrhage, but the is essential to exclude other problems such as cecal impaction. most common sources of “dripping” are the richly vascularized Fever was observed in 2.5% of the horses and is considered skin and tunica dartos (2). Because the skin is closed at the end as a normal postoperative response to soft tissue trauma in the of surgery it is sometimes necessary to anesthetize the horse a first 48 h (10). second time to locate the source of bleeding when a fast grow- Surprisingly, peri-incisional edema had a low prevalence (2%) ing scrotal hematoma occurs and to prevent life-threatening within the short-term postoperative period compared to other hemorrhage, as observed once in our study (8). In cases in which studies in which it could affect up to 38% of the horses (10). no source of hemorrhage is found, it is advisable to ligate the This difference could be explained by the systematic use of non- spermatic cord and the cremaster muscle again because they are steroidal anti-inflammatory and anti-edema drugs during the the most likely sources of bleeding (3). However, most scrotal perioperative period in the present study and by the different hematomas are managed by incising the scrotum to allow drain- criteria used to define swelling in others. However, 23% of the age once the clot has collected (10,11). Ultrasound-guided owners described scrotal or preputial swelling after discharge aspiration of blood from the scrotum was used successfully in and discontinuation of anti-inflammatory drugs, which is more 1 case of this study. This procedure appears useful for mild to comparable to published results, and in accordance with the moderate hematomas before clotting occurs. If the hematoma mean reported delay of 6 d between castration and the time of recurs regardless, incising the scrotum is advised. maximal edema (12). Postoperative signs of colic that resolved medically were Interestingly, 5% of horses lost some weight according to observed in about 4% of our cases, which is in accordance with their owner. The link with castration is questionable and none other authors (10) and with the general horse population having of the horses had been re-evaluated in our clinic to ­quantitatively

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assess this problem. It is possible that some of the horses devel- contains the cremasteric artery, which branches from the exter- oped a low grade and undiagnosed infection of the surgical nal iliac artery and measures 0.5 to 1 mm in diameter. It is part site, or even a low-grade hemorrhage (13). Given that all horses of the complex vascular blood supply of the testis, anastomosing survived and owners were satisfied with the technique, such with other arteries at the caudal epididymal ligament and in the pathologic processes seem unlikely. A postoperative catabolic mesorchium (17,18). We suggest that the cremasteric artery state could be another possible explanation. plays a major role in postoperative bleeding and hematoma One horse was euthanized because of a suspected inguinal formation when the cremaster muscle is not properly ligated abscess. This was not confirmed at the clinic and thus no infor- (3). It is possible that this artery dilates after ligation of the mation regarding a possible surgical treatment was available. spermatic cord, as suggested previously (17,19). Furthermore, it

ARTICLE This horse represents the only case of surgical site infection has been stated that a single ligature around both the cremaster (1%) in the study, which is comparable to other studies (7,8). and spermatic cord can loosen upon cremaster contractions. As No evisceration occurred during the study period, probably a consequence, it has been advised to isolate the cremaster from because of systematic closure of the vaginal tunic (3). Despite the spermatic cord and to ligate it separately (1). the relatively low number of cases in our study, these results The second protective factor identified was intraoperative use are in accordance with previously published data. Indeed, this of electrocautery. We are not aware of any study showing simi- life-threatening complication appears rarely using a primary lar protective effects of electrocautery regarding complications closure castration technique. Only 1 case was reported out of in equine surgery. Conversely, in human literature, it appears 951 horses when summing cases from 4 studies (7,8,10,11). In that electrocautery induces more postoperative seroma, and a comparison, up to 4.8% of draught horses castrated with a field significantly higher inflammatory response than regular scalpel second intention healing technique sustained evisceration (14). or ultrasonic dissector in patients undergoing mastectomy (20). It seems reasonable to recommend primary closure castration In equine castration, its protective effect would be a consequence to prevent postoperative evisceration, particularly for high risk of its direct hemostatic properties. Without electrocautery, small individuals or breeds. subcutaneous and inguinal vessels can be inadvertently severed Overall, client satisfaction was excellent despite some compli- using scalpel and scissors. Because of the relative hypotension cations, a higher cost compared to an open wound scrotal castra- induced by general anesthesia, bleeding can be minimal during tion (7), and the need to ship their horse to a clinic with surgical surgery but increased during and after recovery. This could lead facilities. Most of the owners considered this technique as safer to a scrotal hematoma due to primary skin closure and therefore than a scrotal castration for valuable horses aged more than 3 y. an inability for the blood to drain out of the scrotal sac (1). Horses aged 3 to 6 y develop 4 times more complications Other parameters did not show any significant effect with than other horses. A relationship between age categories and respect to complications. Among them, concurrent surgery complications has already been proposed. Kummer et al (10) did not increase the incidence of complications, even if a trend found a higher rate of seromas and edema in horses older than had been shown previously (7). However, when post-castration 10 y as well as a tendency for fever to develop in horses less than complications occur, they can impede convalescence after a 10 y. In the same study, middle-aged horses (5 to 10 y old) were concurrent procedure, often an orthopedic one. Similarly, Barber prone to develop hematomas, a finding similar to the present (21) and Mason et al (7) pointed out the importance of elimi- study. A possible explanation of this age-related risk factor is the nating dead space during closure to limit subsequent hematoma high proportion of young horses in our study population, 62% development. Yet, we did not find any association between the of them being in the 3 to 6 y category. The mean age of our closure method and complications. Another interesting point population was 4.2 y and this may account for the differences is that ligation of the scrotal ligament did not seem to influ- observed with the complication rates of other studies. ence complications although it contains a small artery (18). It French trotters seem to be prone to postoperative complica- is probably because, when not ligated, the scrotal ligament had tions in the present study, and particularly to hematoma for- been bluntly dissected and the artery might have been stretched, mation. Breed sensitivity to castration complications has been allowing some form of hemostasis. reported previously. Standardbreds, Dutch warmbloods, and Cryptorchid horses represented 25% of the population. The draft horses have been pointed out to be at greater risk com- inguinal approach we used is one of the preferred methods of pared to other breeds, especially regarding evisceration (14–16). castration for cryptorchids because it is considered noninvasive However, to the best of our knowledge, a direct relationship (1). However, inguinal removal of abdominal testis sometimes between postoperative bleeding and Trotters (or Standardbred) requires dilation of the vaginal ring and subsequent closure of has not been established. This could reflect a relative hypertro- the superficial inguinal ring (4). This procedure may result in phy of the vascular network, similar or even related to the larger profuse bleeding due to insufficient visualization and the pres- inguinal rings observed in this breed (16). ence of large vessels in that area. However, neither the presence This study also identified protective factors for the devel- of a retained testis nor its location had a significant effect on opment of post-castration complications. The first one was the occurrence of complications. ligation of the cremaster muscle, which appeared to play a role One of the limitations of this study is its retrospective nature. in decreasing hematoma formation. The cremaster is a striated Records might have been incomplete or at least imprecise, muscle coming from the internal oblique abdominal muscle and have influenced some of the results. Furthermore, the low running along the caudolateral aspect of the parietal tunic. It number of complications might have biased the statistical power

470 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY of the analysis. Finally, long-term complications were based on 7. Mason BJ, Newton JR, Payne RJ, Pilsworth RC. Costs and compli- telephone conversations with the owners, introducing some cations of equine castration: A UK practice-based study comparing ‘standing nonsutured’ and ‘recumbent sutured’ techniques. Equine Vet subjectivity on the outcome. J 2005;37:468–472. We conclude that castration of horses with primary closure 8. Riemersma D. Complication rate of castration of the horses using an technique under general anesthesia results in some complica- inguinal approach in 554 cases. Proc European College of Veterinary Surgeons, Marcy l’Étoile, France 2005:162–165. tions, scrotal hematoma being the most common in the short- 9. Cox JE. Castration of horses and donkeys with first intention healing. term postoperative period. The risk of evisceration was low. It Vet Rec 1984;115:372–375. ARTICLE is reasonable to advise owners to elect a primary closure method 10. Kummer M, Gygax D, Jackson M, Bettschart-Wolfensberger R, Furst A. Results and complications of a novel technique for primary castration of castration under general anesthesia in a surgical theater in with an inguinal approach in horses. Equine Vet J 2009;41:547–551. order to prevent this life-threatening complication, particularly 11. Sedrish S, Leonard J. How to perform a primary closure castration using in horses known to be at a particular risk and/or of high value. an inguinal incision. Proc American Association of Equine Practitioners, San Diego, California, 2001:423–425. Attention has to be given to horses aged 3 to 6 y and to French 12. Kilcoyne I, Watson JL, Kass PH, Spier SJ. Incidence, management, trotters which appeared more prone to develop postopera- and outcome of complications of castration in equids: 324 cases tive complications. However, intraoperative measures can be (1998–2008). J Am Vet Med Assoc 2013;242:820–825. 13. Holmes JM, Nath LC, Muurlink MA. Laparoscopic cauterisation of the undertaken to limit their incidence. These assessments need to testicular arteries to manage haemoperitoneum in a gelding. Equine Vet be confirmed by a multicentric study on a larger population. Educ 2013;25:297–300. 14. Shoemaker R, Bailey J, Janzen E, Wilson DG. Routine castration in 568 draught colts: Incidence of evisceration and omental herniation. Acknowledgments Equine Vet J 2004;36:336–340. The authors thank Drs. Marianne Depecker and Emma Steel 15. Rutgers LJ, Kersjes AW. [Towards a veterinary-professional standard concerning castration in stallions]. Tijdschr Diergeneeskd 1989;114: for their careful review of this article, the referring veterinarians 493–498. for providing these cases, and the other clinicians of ONIRIS 16. Moll HD, Pelzer KD, Pleasant RS, Modransky PD, May KA. A survey who dealt with them. CVJ of equine castration complications. J Equine Vet Sci 1995;15:522–526. 17. Jantosovicova J, Jantosovic J. [Topographico-anatomic data on the testicular artery, ductus deferens artery and cremaster artery in the stal- References lion]. Gegenbaurs Morphol Jahrb 1983;129:467–482. . 1 Schumacher J. Testis. In: Auer JA, Stick JA, eds. Equine Surgery. 4th ed. 18. Voermans M, Rijkenhuizen AB, van der Velden MA. The complex blood St. Louis, Missouri: Elsevier, 2012:804–840. supply to the equine testis as a cause of failure in laparoscopic castration. 2. Coomer R. Drip, drip, drip. Equine Vet Educ 2013;25:301–303. Equine Vet J 2006;38:35–39. 3. Embertson RM. Selected urogenital surgery concerns and complications. 19. Hennau A, Collin B. La vascularisation artérielle du testicule chez le Vet Clin North Am Equine Pract 2008;24:643–661. cheval. Anat Histol Embryol 1973;2:46–53. 4. Searle D, Dart AJ, Dart CM, Hodgson DR. Equine castration: Review 20. Yilmaz KB, Dogan L, Nalbant H, et al. Comparing scalpel, electro- of anatomy, approaches, techniques and complications in normal, cautery and ultrasonic dissector effects: The impact on wound com- cryptorchid and monorchid horses. Aust Vet J 1999;77:428–434. plications and pro-inflammatory cytokine levels in wound fluid from 5. Wilson JF, Quist CF. Professional liability in equine surgery. In: Auer JA, mastectomy patients. J Breast Cancer 2011;14:58–63. ed. Equine Surgery. 1st ed. St. Louis, Missouri: Saunders, 1992:13–35. 21. Barber SM. Castration of horses with primary closure and scrotal abla- 6. Lowe JE, Dougherty R. Castration of horses and ponies by a primary tion. Vet Surg 1985;14:2–6. closure method. J Am Vet Med Assoc 1972;160:183–185.

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CVJ / VOL 58 / MAY 2017 471 FOR PERSONAL USE ONLY Article

Treatment rates for injectable tiamulin and lincomycin as an estimate of morbidity in a swine herd with endemic swine dysentery

Krysia Walczak, Robert Friendship, Egan Brockoff, Amy Greer, Zvonimir Poljak

Abstract — Treatment can be used as an indirect measure of morbidity, and treatment records can be used to describe disease patterns in a population. The aim of this study was to describe the rates of treatments with tiamulin and lincomycin by the intramuscular route in cohorts of pigs affected by swine dysentery. Data from treatment records from 19 cohorts of a 1500-head grower-finisher barn were analyzed using Poisson regression to determine factors associated with rates of treatment. Serial interval and reproductive numbers were extracted. Treatment rates displayed marked seasonality. The mean serial interval was estimated at 17 d with variability among batches. In the early period of most cohorts, the effective reproductive number did not exceed 1, and the highest estimate was 2.15 (95% CI: 1.46, 3.20). The average days-to-first treatment was 4.8 which suggests that pigs could have been infected at time of entry. The information about possible sources of infection and likely seasonality should be considered when developing disease and infection control measures in affected barns.

Résumé — Taux de traitement pour la tiamuline et la lincomycine injectables en tant qu’estimation de la morbidité dans un troupeau porcin atteint de dysenterie porcine. Le traitement peut servir de mesure indirecte de la morbidité et les dossiers de traitement peuvent être utilisés pour décrire les profils pathologiques au sein d’une population. Le but de cette étude consistait à décrire les taux de traitement à l’aide de la tiamuline et de la lincomycine par voie intramusculaire dans des cohortes de porcs affectées par la dysenterie porcine. Les données des dossiers de traitement provenant de 19 cohortes d’une porcherie de 1500 porcs d’engraissement ont été analysées en utilisant la régression de Poisson pour déterminer les facteurs associés aux taux de traitement. Des données sur les intervalles sériels et la reproduction ont été extraites. Les taux de traitement ont affiché une saisonnalité marquée. L’intervalle sériel moyen était estimé à 17 jours avec de la variabilité entre les groupes. Au début de la période de la plupart des cohortes, le nombre effectif de reproductions n’a pas dépassé 1 et l’estimation la plus élevée était de 2,15 (IC de 95 % : 1,46, 3,20). Le nombre moyen avant le premier traitement était de 4,8 jours, ce qui suggère que les porcs auraient pu être infectés au moment de l’arrivée. Les renseignements sur les sources possibles d’infection et la saisonnalité probable devraient être considérés lors de l’élaboration de mesures de contrôle de la maladie et de l’infection dans les porcheries affectées. (Traduit par Isabelle Vallières) Can Vet J 2017;58:472–481

Introduction has re-emerged in some North American swine populations. Diagnostic investigations have revealed that outbreaks of swine wine dysentery is characterized by mucohemorrhagic dysentery clinical disease were caused by either Brachyspira diarrhea in individual pigs, mostly in the grower-finisher S hyodysenteriae, a causative agent of swine dysentery, or the stage resulting in high morbidity and mortality (1), with a sig- newly recognized “Brachyspira hampsonii” (2). Control strategies nificant impact on welfare and productivity. Once thought to include: thorough cleaning and disinfection, strict age separa- be controlled by good husbandry practices, the clinical disease tion when possible, rodent control, feed interventions when applicable, and use of antimicrobials to reduce the incidence or Department of Population Medicine, University of Guelph, severity of clinical disease (1). The detection of severe clinical Guelph, Ontario N1G 2W1 (Walczak, Friendship, Greer, disease is accompanied by rapid implementation of control strat- Poljak); Prairie Swine Health, Red Deer, Alberta T4P 2T4 egies which ultimately have an impact on the circulation of the (Brockoff). pathogen. This could be one of the reasons why observational Address all correspondence to Dr. Zvonimir Poljak; e-mail: studies of swine dysentery at the individual pig level continue [email protected] to be rare. However, production records in many swine herds Use of this article is limited to a single copy for personal study. are becoming more comprehensive and detailed. The patterns Anyone interested in obtaining reprints should contact the of treatment usage over time in well-defined closed popula- CVMA office ([email protected]) for additional tions are indicative of the development of general morbidity copies or permission to use this material elsewhere. in a herd. Under certain restrictive assumptions, the treatment

472 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY

records could have the potential to be utilized for studying Manitoba), ceftiofur hydrochloride (Excenel, 50 mg/mL; Zoetis the spread of specific infectious diseases within a herd. In this Canada, Kirkland, Quebec), ampicillin [Polyflex, 25 g/250 mL; study, we used treatment records in multiple cohorts of pigs to Boehringer Ingelheim (Canada), Burlington, Ontario], lincomy- gain insight into the epidemiology of swine dysentery. The first cin hydrochloride (Lincomix 100, 100 mg/mL; Zoetis Canada), objective was to describe the rates of treatments with tiamulin and isoflupredone (Predef 2X, 2 mg/mL; Zoetis Canada). and lincomycin by intramuscular injection in cohorts of pigs Water medications used in at least some of these batches

affected by swine dysentery. The second objective was to extract were penicillin (Pot Pen, 500 000 000 IU/pouch; Vétoquinol ARTICLE parameters of importance for describing the transmissibility of N.-A., Lavaltrie, Quebec), amoxicillin trihydrate (Paracillin swine dysentery disease using treatment records as a proxy for SP, 800 mg/g; Merck Animal Health, Kirkland, Quebec), and morbidity due to the disease. tetracycline (Tetracycline 250, 25 g/100 g; Vétoquinol N.-A.). Feed medications used in at least some of the batches included Materials and methods lincomycin hydrochloride (Lincomix 110 Premix; 110 g/kg, Inclusion criteria in this study were a grower-finish population Zoetis Canada) and tiamulin hydrogen fumerate (Denagard with the: i) existence of mucohemorrhagic diarrhea, and diagnostic 10% GF Premix, 100 g/kg; Novartis Animal Health Canada). confirmation of an agent of swine dysentery — B. hyodysenteriae In this study, IM treatments with tiamulin and lincomycin or an emerging species of Brachyspira, such as “B. hampsonii,” and were used as indication of clinical cases of the disease that ii) availability of detailed medication records and mortality on a required injectable treatment (i.e., morbidity). Tiamulin was day-to-day basis in multiple production batches. used exclusively to treat clinical disease associated with swine dysentery signs, whereas lincomycin was used to treat swine Farm description dysentery disease, as well as lameness due to M. hyosynoviae One grower-finisher site with detailed treatment records available when used in combination with isoflupredone. During the in an electronic form over multiple cohorts (batches) was selected. study period, injectable tiamulin ceased to be commercially The study site consisted of 3 swine barns located on the same available and consequently, only lincomycin was used to treat premises in western Canada. The first barn (i.e., grower barn) both swine dysentery disease and disease due to M. hyosynoviae had a capacity of 1500 pigs, and was the barn in which pigs were in more recent groups of pigs. Intramuscular application of first housed when moved to the site. The barn had fully-slatted these 2 antimicrobials was used to calculate 2 types of statistics. concrete floors. Animals stayed in the grower barn for 6 wk, and For the first set of statistics, treatment rates were calculated for were then moved to 1 of 2 larger finisher barns. The finisher both tiamulin and lincomycin directly from the farm records barns had solid concrete floors and used straw bedding. Pigs were by summing all of the respective treatments over the duration housed in finisher barns for approximately 12 wk until the last of a specific cohort. For the second set of statistics, adjustment pigs were shipped to market. There was an additional room to in the use of lincomycin was done in an attempt to account allow for overflow. The grower barn and each of the finisher barns for lincomycin treatment used specifically for swine dysentery. was thoroughly cleaned, washed, dried, and disinfected, with more The difference between the total number of lincomycin treat- thorough disinfection being conducted during warmer months. ments and the total number of isoflupredone treatments was Different batches of pigs were affected by diseases consistent with calculated for each day in each batch. We assumed that this swine dysentery-like disease, lameness consistent with Mycoplasma difference would remove treatments due to M. hyosynoviae and hyosynoviae, and clinical conditions consistent with infection with would provide a more accurate number of treatments of lin- Streptococcus suis as identified by the barn managers. comycin used specifically for swine dysentery. We refer to this statistic as adjusted lincomycin count. Finally, the sum of the Records total number of treatments due to any tiamulin and adjusted Detailed close-out data between June 2011 and December 2013 lincomycin was calculated, in an attempt to calculate statistics were obtained from the study farm. Data contained informa- which will account for all antimicrobial usage likely due to swine tion from 19 cohorts including the shipping dates onto and dysentery disease in one variable. The incidence of treatment off the farm, number of animals shipped, unique batch ID, rates per pig-day was calculated with the numerator as the total and quantity of different types of feed medication delivered number of treatments (contributions more than once are pos- to sequential production phases. All types of feed were barley- sible) and the denominator as the sum of the total number of soybean meal based, and did not change in a substantial manner pig-days. Pig-days were obtained as the total number of days over the study period. Records on the medication type, date of that the given number of animals in a batch spent in a barn. application, dosage, and number of pigs treated were available This incidence rate was then multiplied by 1000 to give the for medications delivered through feed, water, and as inject- average number of treatments per 1000 pig-days. Therefore, able (IM) treatment. Data on the date of mortality, the likely 4 outcomes obtained for treatment rates were: tiamulin, linco- reason for mortality, and the number of animals affected were mycin, adjusted lincomycin (for use of swine dysentery alone), also available. Day-to-day records were provided for 19 batches. and combined tiamulin and adjusted lincomycin. Injectable medications used included tiamulin hydrogen fumer- Both of these antimicrobials are labeled for treatment of ate (Denagard, 100 mg/mL; Novartis Animal Health Canada, clinical disease due to swine dysentery. Injectable tiamulin is Mississauga, Ontario), penicillin (Procaine Penicillin G, labeled to treat animals showing clinical signs of swine dysen- 300 000 IU/mL; Dominion Veterinary Laboratories, Winnipeg, tery with the dose of 11 mg/kg body weight (BW) given once

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Table 1. Risk factors considered for the univariable analysis for Disease transmission parameters injectable treatments with tiamulin and lincomycin In this study, 3 parameters of importance for the natural history Covariate Explanation of disease in this population were estimated: i) serial interval, Season (start) The season the batch spent most of its time on the ii) reproductive number, and iii) minimum time between intro- site. This is a categorical variable. duction of animals into the barn and the first treatment with Season (batch) The season when the batch first entered the site. IM treatment suggestive of swine dysentery. For all 3 parameters, This may or may not be the same as the season treatment with tiamulin was used with a rationale that this treat- of the batch. This is a categorical variable. ment in this population was most reflective of clinical swine Lag (lincomycin) Comparison of lincomycin treatment rates between dysentery, and was implemented in the early stages of growth

ARTICLE previous, 2nd previous, and 3rd previous batches. and potential outbreaks of swine dysentery. Lag (tiamulin) Comparison of tiamulin treatment rates between A series of serial intervals was generated from the raw data previous, 2nd previous, and 3rd previous batches. using the following approach. The data for serial interval were Feed (lincomycin) Feed medication of lincomycin used in one of the extracted from tiamulin use first by displaying the daily count 3 grower barns, the finisher barn, or any of these of tiamulin treatments within the first 45 d for each batch barns. This is a categorical variable. separately. The day of the first peak (i.e., the mode) of cases in Feed (tiamulin) Feed medication of tiamulin used in one of the the early period served as a baseline day for the calculation of 3 grower barns, the finisher barn, or any of these barns. This is a categorical variable. the serial interval. Then, cases in the second wave of treatments were identified and the baseline day was subtracted from the days that each case in the second wave occurred. Although more daily until clinical signs disappear or for a maximum of 4 d and data were available, we only considered batches in which the with a withdrawal period of 9 d before slaughter (3). Injectable 2 waves could clearly be separated, and did not extend beyond lincomycin is labeled in Canada for the treatment of swine dys- that due to any discrepancies that may occur with subsequent entery especially in moribund animals (3). The recommended waves. The best fitting parametric distribution was fit to the treatment is 1 mL of solution/10 kg BW for a period between observed series of serial interval using functionality provided 3 and 7 d, with a withdrawal period of 2 d before slaughter (3). in R (Version 3.03; University of Auckland, New Zealand), package R0 (4). Following that, in the package R0, the effective

Statistical analysis reproductive number (Re) was estimated from the exponential Analysis of treatment rates growth rate of the outbreak as previously reported in a study A statistical program (Stata Version 10; STATA, College Station, done examining how serial intervals affect growth rates and Texas), was used to determine treatment rates of the recom- reproductive numbers (5). The observed number of treatments mended uses of tiamulin, lincomycin, and adjusted lincomycin. with tiamulin over the first 45 d was used to generate the growth The combination of tiamulin and lincomycin was described rate of the epidemic, and from parametric distribution (Weibull) using descriptive statistics and was compared against the season estimated from the series of serial intervals. The effective repro-

at the start of the cohort and the season in which the majority ductive number (Re) is the average number of secondary infec- of growth occurred for each cohort. Seasons were determined tions resulting from a single infection per unit of time in a given based on calendar time (e.g., the winter season is December 21 heterogeneous population (i.e., some animals are immune), and to March 20). Season of the batch at the start was determined on is also known as the net reproductive number (R) (6). The time the basis of the start date for each batch, whereas season of the to first treatment with injectable tiamulin in the grower barn batch was assigned on the basis of the season which comprised was calculated for each batch. the majority of the growth period for each batch. A mixed Poisson regression with batch as a random effect was Literature search used to determine factors associated with the treatment rates. An ad-hoc literature search was performed to determine the Count of treatments was used as the outcome and the total ani- duration of some important periods which were summarized mal time-at-risk per pig-day was used as the exposure. Because either using descriptive statistics, such as averages, or by using of the nature of the dataset, animals could be treated multiple random-effect meta-analysis if the quality of reported data times. Each treatment count was considered for analysis. Table 1 allowed for that. For the current purposes, a random effects contains description of factors that were considered in the initial meta-analysis was conducted to estimate the incubation time analysis. Treatment rates in the previous batches (lag = 1, 2, of swine dysentery from experimental challenge studies with and 3) were determined by treatment use in the preceding, the confirmed infection of the bacteria in swine. Incubation time is second preceding, and the third preceding batch. defined as the time from being infected to the time when clinical Each covariate was evaluated in a univariable analysis. Factors signs first start to show. associated with treatment rates with P , 0.20 were considered for inclusion in the multivariable model. Multivariable models Results were fit using manual forward selection approach. Biologically Only 11 cohorts had information on tiamulin usage (excluding plausible interactions of feed medication and injectable treat- batch 2) and batch 13 onwards did not have record informa- ments were evaluated. Residuals and influence statistics were tion on injectable tiamulin. The mean number of the maxi- examined and models were refit. mum pigs in a cohort was 1493 pigs with a standard deviation

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90 A 800 B

80 700 70 600 60 50 500

40 400 ARTICLE 30 * 300 20 * 200 10 Number of tiamulin treatments Number of lincomycin treatments 0 100 * Winter Spring Summer Fall Winter Spring Summer Fall

500 C 550 D

450 500 400 450 350 400 350 300 300 250 250 200 200 150 tiamulin treatments 150 100 100 Number of lincomycin (adj) and Number of lincomycin (adj) and 50 50 Number of lincomycin (adj) treatments * Winter Spring Summer Fall Winter Spring Summer Fall Season Figure 1. Box plot of total count of intramuscular treatments with tiamulin (A), lincomycin (B), adjusted lincomycin (C), and tiamulin and adjusted lincomycin combined (D). Counts represent total count of treatments in each batch stratified by the season when the batch was introduced to the farm. For each plot, the whiskers represent the values that are within 1.5*IQR of the nearest quartile, the median treatment use is represented by the white line within each box. The lower edge of the boxes represent the 25th percentile, and the upper edge of the boxes represent the 75th percentile. The asterisks displayed outside the error bars represent outlier values.

(SD) 6 23.3 pigs. The average weight of the pigs when entering of several Brachyspira species, including B. hyodysenteriae and the site was 24.1 kg (6 2.5 kg). The minimum average weight “B. hampsonii.” However, clinical cases were predominantly was 20.0 kg and the maximum average weight of entering detected with “B. hampsonii.” The underlying clinical issue with pigs was 29.7 kg. Barn turnover for this site was an average of M. hyosynoviae was confirmed through diagnostic testing based 144.4 d (6 6.3 d), minimum of 131 d and maximum of 150 d. on polymerase chain reaction (PCR), and with S. suis through On the basis of entry and exit date for each cohort, animals from bacteriological culture of appropriate samples. All tests were between 3 and 4 cohorts were present on-site at the same time. conducted at the herd-level and not every affected pig or batch The mean risk of mortality (calculated by the number of deaths was sampled for diagnostic testing. in each batch over the number of pigs that started) was 3.78% (6 0.82%) and ranged between a minimum of 2.5% and a Intramuscular treatments with tiamulin and maximum of 5.33%. Most deaths (89%) were due to septicemia, lincomycin as defined by the herdsperson, followed by deaths, as listed in The mean number of injectable treatments in this dataset the production data, caused by S. suis (2.8%), and being a poor- was 0.17 per 1000 pig-days (6 0.20, min = 0, max = 0.50), doer (i.e., a pig with slow growth) (1.7%). The most common 1.58 per 1000 pig-days (6 1.01, min = 0.53, max = 3.69), proportional causes for euthanasia included lameness (62.9%), 1.08 per 1000 pig-days (6 0.66, min = 0.22, max = 2.52), and being a poor-doer (18.9%), and being a downer pig (i.e., a pig 1.24 per 1000 pig-days (6 0.72, min = 0.22, max = 2.84) for that is not able to stand before being taken to slaughter) (6.9%). tiamulin, lincomycin, adjusted lincomycin, and tiamulin and The cause of mortality on a farm was determined by a herd- adjusted lincomycin combined, respectively. Figure 1 depicts sperson and did not include any diagnostics; therefore, it was the total number of treatments per cohort for all 4 outcomes syndromic, aimed to capture major clinical problems, and could of interest when stratified by the calendar season when the pigs include different clinical signs with the same etiology. Results entered a barn for the first time. Total number of treatments for of diagnostic testing during the study period indicated presence tiamulin was, on average, the lowest if the batch started in the

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90 A 800 B

80 700 70 600 60 * 50 500 40 400 30 300 20

ARTICLE 200 10 Number of tiamulin treatments 0 Number of lincomycin treatments 100

Winter Spring Summer Fall Winter Spring Summer Fall

500 C 550 D

450 500 * 400 * 450 350 400 350 300 300 250 250 200 200 * 150 tiamulin treatments 150 100 100 Number of lincomycin (adj) and Number of lincomycin (adj) and 50 50 Number of lincomycin (adj) treatments Winter Spring Summer Fall Winter Spring Summer Fall Season Figure 2. Box plot of total count of intramuscular treatments with tiamulin (A), lincomycin (B), adjusted lincomycin (C), and tiamulin and adjusted lincomycin combined (D). Counts represent total count of treatments in each batch stratified by the calendar season during which most of the growth occurred for each batch. For each plot, the whiskers represent the values that are within 1.5*IQR of the nearest quartile, the median treatment use is represented by the white line within each box. The lower edge of the boxes represent the 25th percentile, and the upper edge of the boxes represent the 75th percentile. The asterisks displayed outside the error bars represent outlier values.

winter, although there seemed to be considerable variability in highest in the winter and spring when season of the batch was the number of tiamulin treatments in each season (Figure 1A). considered. In contrast, treatment with lincomycin showed a different pat- Lincomycin treatment was used in the later parts of growing tern (Figure 1B). Batches that started in the fall had on average for the earlier batches, but for the later cohorts, lincomycin the highest number of lincomycin treatments, followed by the treatments were administered earlier as a result of the cessation winter batches; and batches that started in spring had on aver- of the use of tiamulin. The highest count of lincomycin treat- age the lowest number of treatments. Adjustment of lincomycin ment used across the batches ranged from Day 19 to Day 119 treatment counts with isoflupredone, accounting for treatment in the dataset. The mean total number of lincomycin treatments reflective of swine dysentery disease, did not change the overall used was 191.9 (6 127.8, min = 49, and max = 494). In com- pattern (Figure 1C). A similar pattern was observed for the sum parison, the maximum tiamulin treatments administered ranged of tiamulin and lincomycin treatment (Figure 1D). from Day 4 to Day 38 in the provided dataset. The mean total Figure 2 depicts the summary of the number of treatments number of tiamulin treatments across the batches was 28.5 with tiamulin and lincomycin by the season in which most of (6 33.6, min = 0, and max = 86). the growth occurred (i.e., season of growing). Batches in which pigs grew predominantly in winter continued to have the low- Risk factors for tiamulin and adjusted est number of treatments with tiamulin, followed by cohorts in lincomycin usage which pigs predominantly grew in summer (Figure 2A). The Results from the univariable and the final multivariable mixed number of treatments with lincomycin, adjusted lincomycin, Poisson regression for the tiamulin and the adjusted lincomycin and adjusted lincomycin and tiamulin combined were on aver- rates are shown in Tables 2 and 3, respectively. According to the age highest in the winter, followed by the spring (Figures 2B, multivariable model, the use of in-feed lincomycin was associ- C, D). Overall, lincomycin treatment counts were highest in ated with the lower rates of IM tiamulin usage (Table 3). For the fall and winter when season of the start was considered and the tiamulin treatment rates, compared with a batch starting in

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Table 2. Mixed Poisson regression univariable analysis of factors associated with IM treatment rates for tiamulin and lincomycin (adjusted for treatment with corticosteroid) in multiple batches of growing pigs affected by swine dysentery in 1 Canadian pig farm Tiamulin Lincomycin (adjusted) Covariate IRR P-value 95% CI IRR P-value 95% CI Season (start) 0.15a 0.001a

Referent (winter) ARTICLE Spring 2.16 0.56 0.16 to 28.37 0.47 , 0.001 0.30 to 0.71 Summer 1.56 0.72 0.14 to 16.81 0.63 0.03 0.42 to 0.95 Fall 2.79 0.47 0.17 to 46.06 1.73 0.02 1.11 to 2.70 Season (batch) 0.02a 0.03a Referent (winter) Spring 8.11 0.04 1.08 to 61.11 0.74 0.36 0.38 to 1.42 Summer 1.12 0.90 0.19 to 6.82 0.40 0.002 0.22 to 0.72 Fall 6.17 0.04 1.05 to 36.31 0.63 0.15 0.34 to 1.17 Lag (lincomycin) 1 0.84 0.67 0.38 to 1.87 1.13 0.38 0.86 to 1.47 2 0.74 0.21 0.45 to 1.19 0.99 0.95 0.75 to 1.31 3 1.40 0.18 0.86 to 2.29 0.78 0.07 0.60 to 1.02 Lag (tiamulin) 1 18.24 0.22 0.17 to 1927.57 1.32 0.70 0.32 to 5.40 2 0.28 0.41 0.01 to 5.82 2.38 0.23 0.57 to 9.89 3 1.11 0.95 0.04 to 33.11 2.01 0.37 0.44 to 9.08 Feed (lincomycin) 0.05 , 0.001 0.01 to 0.25 0.68 0.37 0.29 to 1.58 Feed (tiamulin) 0.05 , 0.001 0.01 to 0.25 1.24 0.5 0.66 to 2.35 Lincomycin (IM) 1.89 0.31 0.56 to 6.34 — — — Tiamulin (IM) — — — 1.86 0.37 0.48 to 7.14

a Indicated by a likelihood ratio test; CI — confidence interval; IRR — incidence rate ratio.

Table 3. Final mixed Poisson regression multivariable models for factors associated with IM (intramuscular) treatment rates for tiamulin and lincomycin (adjusted for treatment with corticosteroid) in multiple batches of growing pigs affected by swine dysentery in 1 Canadian pig farm Tiamulin Lincomycin Covariate IRR P-value 95% CI IRR P-value 95% CI Season (start) Winter (Referent) Spring (1) — — — 0.47 , 0.001 0.30 to 0.71 Summer (2) — — — 0.63 0.03 0.42 to 0.95 Fall (3) — — — 1.73 0.02 1.11 to 2.70 Season (batch) Winter (Referent) Spring (1) 6.40 0.02 1.99 to 20.52 — — — Summer (2) 2.32 0.05 1.00 to 10.45 — — — Fall (3) 4.88 0.003 1.73 to 13.79 — — — Feed (lincomycin) any 0.06 , 0.001 0.02 to 0.25 — — —

CI — confidence interval; IRR — incidence rate ratio. the winter, there was a higher use of tiamulin in batches that association and statistical significance for the spring season did grew in spring, summer, or fall compared with batches that not change. These 2 potential outliers represented early batches mostly grew in winter (Table 3). Nonetheless, no statistically and were kept in the model. significant difference could be detected in the rates of tiamulin For the final adjusted lincomycin model, the start of the use for batches that grew in spring compared with summer season for the batch was more statistically significant than the (P = 0.22), or to fall (P = 0.57). Similarly, no difference in primary season of growth of the batch. Including both the tiamulin treatment rates were observed between summer and fall season of the start of the batch and the season of the batch (P = 0.39). Residual diagnostics identified 2 potential outliers. would cause collinearity issues; therefore, only the start of the Their joint omission from the model resulted in a decrease in season for the batch was included in the final model. Batches the incidence risk ratios for all seasons. The summer (P = 0.48) that started in the spring and summer had less lincomycin usage and fall (P = 0.06) seasons were not statistically significant any than batches that started in the winter. In contrast, batches more when compared with winter. Nonetheless, the direction of that started in the fall season had greater lincomycin usage

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3 0.150 2.75 2.5 2.25 0.075 2 1.75 1.5 0.000 1.25

Probability density function Probability 0 2 4 6 8 10 14 18 22 26 30 1 * * Serial interval (days) .75

ARTICLE .5 Figure 3. Histogram representing a series of serial intervals number reproductive Effective .25 extracted from early growing phase on the basis of treatments 0 with tiamulin. The X-axis represents the serial interval measured in days. The multiple modes represent the variability of serial 1 2 3 4 5 6 7 8 9 10 11 12 intervals. The mean serial interval was calculated to be 17.2 days. Batch

Figure 4. Effective reproductive number (Re) for each batch approximated using intramuscular tiamulin treatments. Each circle indicates the mean R and the error bars are the 95% confidence than those that started in the winter. Batches that started in the e intervals of the estimate. Re indicates transmissibility of the spring had less lincomycin usage than those that started in the disease and the dashed line on this figure represents the summer, but this was not statistically significant (IRR = 0.74, epidemic threshold (Re=1). Any number above this threshold 95% CI = 0.50 to 1.09, P = 0.13). Batches that started in the theoretically results in an outbreak or indicates sustained transmission of disease. spring and summer had less lincomycin usage than cohorts that started in the fall; both were statistically significant (IRR = 0.27, 95% CI = 0.18 to 0.41, IRR = 0.36, 95% CI = 0.24 to 0.55; Estimates of incubation time respectively P , 0.001). Residual analysis of the best linear The incubation time of this disease based on the literature search unbiased predictions (BLUPs) identified one potential nega- was an average of 11.2 d (95% CI = 10.4 to 12.3) (7–17). More tive outlier, but its omission did not change the direction or specifically, B. hyodysenteriae and “B. hampsonii” had incubation significance when compared to the full adjusted lincomycin periods averaging 11.9 d (95% CI = 10.4 to 13.3) (7–14,17) model. Therefore, this outlier was kept in the final model for and 8.1 d (95% CI = 7.2 to 9.1) (16–18), respectively. adjusted lincomycin. Discussion Disease transmission parameters The median time to first treatment with adjusted lincomycin Based on the tiamulin treatments of the data and the early was much shorter (7.5 d) when tiamulin was no longer avail- grower phase of production (45 d), the distribution of the able as a treatment option compared to when tiamulin was used observed serial intervals is depicted in Figure 3, together with (39 d), and was similar to the first treatment with tiamulin the best fitting parametric distribution, which was determined (4.25 d). This shorter time to the first treatment is expected to be Weibull distribution with mean of 17.2 d (6 5.25 d). The as lincomycin was used as the only choice for swine dysentery histogram representing the series of serial intervals extracted in later batches and for treatment of pigs in early production from all eligible cohorts showed 3 distinct modes at 9, 15, and stages that would otherwise be treated with tiamulin. However, 21 d (Figure 3). as this is a dynamic disease it is difficult to speculate whether The effective reproductive number found using the serial descriptively longer time to the first treatment with adjusted interval ranged from 0.07 to 2.15. The only cohorts when the lincomycin than with tiamulin is a consequence of the choice

Re was greater than 1 and statistically significant were batches related to the administration of a specific treatment, a change in 4 and 9 as indicated by asterisks on Figure 4 showing the effec- disease dynamics (e.g., later onset of clinical signs), or inaccuracy tive reproductive number for each batch. The average time to in adjusting the lincomycin treatment rates. first treatment with tiamulin was 4.2 d (6 1.7 d, min = 2, and Patterns of tiamulin and lincomycin usage were different max = 7) and the average time to first treatment with lincomy- between seasons, but this could be more due to treatment cin was 17.4 d (6 21.7 d, min = 0, and max = 63), whereas protocols and procedures for the use of the 2 antibiotics in for adjusted lincomycin the mean time to first treatment was different production phases, than to the disease itself. The fact 24.6 d (6 21.6 d, min = 2, and max = 63). In order to evaluate that a clear association between the treatment rates in sequential time to first treatment with adjusted lincomycin, we compared cohorts could not be identified could be a result of sanitation descriptively time to first treatment with adjusted lincomycin and other infection control measures that were applied between in batches that used tiamulin (n = 11), and batches that did not different batches. These measures were perhaps not sufficient to use tiamulin (n = 8). The mean times to the first treatment with completely eliminate the infection, but were adequate to remove adjusted lincomycin in batches that did and did not use tiamulin most of the environmental contamination and remove temporal were 31.7 d (6 21.4 d) and 14.7 d (6 18.8 d), respectively. autocorrelation in treatment rates. The median times were 39 d and 7.5 d, respectively and the Seasonality of lincomycin usage was more in line with the minimum was 2 d in both types of batches. epidemiology of the disease, expected to be more frequent

478 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY during colder temperatures, as a previous report showed that there was straw bedding, which could have changed the infec- B. hyodysenteriae could survive in pig feces for 112 d, in a mix- tion dynamics with consequent impact on transmissibility. We ture of pig feces and soil for 78 d, and in soil for 10 d at 10°C did not consider lincomycin usage data to estimate Re, in part under laboratory settings (19). Others reported that B. hyodysen- because it was more difficult to determine what represented teriae is able to survive in pig feces for 48 d at a temperature the starting point of the outbreak, and partly because there between 0°C and 10°C (20). This is in line with longer surviv- was higher variability in the number of possible treatments per ability of the causative agent at colder temperatures which could individual case under labeled use. Regardless of this, the fact ARTICLE contribute to higher environmental contamination and increased remains that this disease has a strong environmental component, opportunity for fecal-oral transmission. Thorough cleaning is and because of that, measuring transmissibility through the use also generally harder to achieve during colder months, and of reproductive number could be limited. However, such an this could increase the level of initial contamination and con- approach has been used previously for infections with similar sequently influence the pattern of transmission and the total transmission routes (21). Thus, although we can expect that treatment rate. It is also possible that pigs are more susceptible estimates of transmissibility could change in different studies to clinical swine dysentery during colder months due to higher and under different conditions, together with the approaches incidence of other diseases, either gastrointestinal or immuno- to evaluate transmissibility, we believe that current estimates suppressive. Interestingly, the use of lincomycin in the previous could represent useful initial estimates of this source popula- cohorts was not predictive of the rates of lincomycin usage in tion — and of similar populations. These initial estimates could a current cohort. allow studying some aspects of epidemiology of swine dysentery The seasonal pattern of tiamulin usage was different. At first using disease modelling approaches. The serial interval is another glance, it would appear that tiamulin usage was a more reli- essential parameter in studying infectious diseases at the popula- able indicator of swine dysentery disease because it was used tion level, rarely utilized in animal health. It is defined as the just for the treatment of swine dysentery. However, this has time “between successive infections in a chain of transmission” to be considered in the light of the following facts. First, this (6). In this study it was estimated at approximately 17 d, but it treatment was used only over the first 40 d of the growing varied between cohorts. This serial number is essential for the period, which is not sufficient to fully depict the burden of estimation of Re, and on its own suggests that successive waves swine dysentery and could be influenced by other interventions of infections could be expected to occur in a little over a 2-week such as in-feed antimicrobials. In fact, implementation of feed window — with some variability among cohorts. antimicrobials significantly decreased the rate of tiamulin usage The average time to first treatment in this study from these before and after adjusting for season, but had no impact on production data was 4.2 d and 24.6 d for tiamulin and adjusted the use of lincomycin. This farm was transitioning towards an lincomycin treatments, respectively. This result is shorter than antibiotic-free program which could further influence the shape the average incubation time of 11.5 d published in the literature. of this association. Second, seasonality in the use of tiamulin was Consequently, this suggests that first clinical cases of swine dys- influenced by 2 influential cohorts. Once they were removed entery disease were due to infection that was introduced from a from the model, season was not statistically associated with the source herd before arrival of the pigs on-site. However, it is diffi- rate of tiamulin usage. Thus, the idea that tiamulin usage was cult to determine the level of clinical signs of swine dysentery and most indicative of the swine dysentery morbidity could indeed whether some animals treated with tiamulin were misdiagnosed. be valid, but only for the early stage of growing. In fact, this The estimate obtained from meta-analysis of a limited num- feature has been utilized in this analysis to extract parameters ber of published reports indicated that the incubation time important for understanding of natural history of disease, such was 11.2 d (95% CI = 10.4 to 12.3), suggesting that time to as the effective reproductive number. first treatment was shorter than the average incubation time.

The effective reproductive number, Re, estimated in this study However, this estimate should be used with care for several based on tiamulin treatments in the initial stage was relatively reasons. The 95% CI relates to the expected mean of studies, low and did not exceed a value of 1 in many of the batches in not of individual animals. It is expected that variability among this study. This could be because the pigs spent the first 6 wk in individual animals would be much higher, and therefore some an environment in which it is easier to implement biosecurity animals could have much shorter incubation times. In the latter measures such as disinfection and more efficient manure removal case, it is possible that animals are infected in the barn itself. through fully slatted floors. In-feed antimicrobials could possibly Secondly, most of the estimates used for meta-analysis were decrease the likelihood of expressing classic clinical signs of the obtained under experimental conditions, and the incubation disease, and change the overall infection dynamics. But the Re time could be linked to dosage, strain, environmental condi- continued to be low even in cohorts that did not have in-feed tions, feed, and age of animals. For example, Wilberts et al (17) antibiotics. A combination of a low number of clinical and pos- reported an average incubation time of 12.2 d, with a minimum sibly infectious animals during this early stage, a high sensitivity of 7 d, when pigs were fed standard diet with 0% corn DDGS of case definition and therefore early detection, and an effective and challenged with B. hyodysenteriae, and an average incubation intramuscular treatment which reduces morbidity and duration time of 6.8 d, with a minimum of 5 d when the pigs were fed of shedding could also have contributed to a low estimate of with 30% of corn-based DDGS. Composition of feed also had the reproductive number in this early stage. The second barn substantial impact on incidence and severity of clinical disease environment to which the pigs were moved was different in that and other parameters in other studies (22–24). In this study,

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feed was barley and soybean-meal based and did not change Partnership (Emergency Management Research theme). The substantially over the study period. Hence, it should not be a authors greatly appreciate the assistance of the producer who major source of confounding bias for associations detected in provided valuable data for this analysis. CVJ this study. The nature of measurements herein does not allow us to make strong conclusions about the incubation time. References Nonetheless, 2 points are worth considering. First, in the early . 1 Hampson DJ, Fellstrom C, Thomson J. Swine dysentery. In: Straw B, Zimmerman J, D’Allaire S, Taylor D, eds. Diseases of Swine. 9th ed. phases of recurrent outbreaks of diseases such as swine dysen- Ames, Iowa: Blackwell Publishing, 2006:785–805. tery, extra effort should be made to estimate the time until the 2. Chander Y, Primus AE, Oliveira S, Gebhart CJ, Olivera SR, Gebhart CJ. first set of confirmed cases. Secondly, the infection status of Phenotypic and molecular characterization of a novel strongly hemolytic Brachyspira species, provisionally designated “Brachyspira hampsonii.” ARTICLE the source herds is worth investigating as a part of the overall J Vet Diag Invest 2012;24:903–910. infection control strategy, despite anticipated challenges such as 3. North American Compendiums. Compendium of Veterinary Products- possible low prevalence of infection in the source herds. Swine Medications Formulary [Internet]. Available from: https:// swinemeds.naccvp.com/ Last accessed January 17, 2017. This study is subject to some limitations, the most severe of 4. Boelle P-Y, Obadia T. R0: Estimation of R0 and real-time reproduction which is the possibility of misclassification bias. Tiamulin was number from epidemics [Internet]. 2013. Available from: http://cran.r- used exclusively for swine dysentery clinical signs and lincomy- project.org/package=R0 Last accessed January 17, 2017. 5. Wallinga J, Lipsitch M. How generation intervals shape the relationship cin was used for swine dysentery diseases and for other condi- between growth rates and reproductive numbers. Proc Biol Sci 2007; tions such as lameness due to M. hyosynoviae. We attempted 274:599–604. to adjust lincomycin treatment used only for swine dysentery 6. Vynnycky E, White RG. An Introduction to Infectious Disease Modelling. New York, New York: Oxford University Press, 2010: by subtracting the isoflupredone treatments. The pattern of 364. lincomycin usage did not change in a qualitative way after this 7. Tiege J, Tollersrud S, Lund H, Larsen J. Swine dysentery: The influ- adjustment. Validity of results would have been greatly enhanced ence of dietary vitamin E and selenium on the clinical and patho- logical effects of Treponema hyodysenteriae infection in pigs. Res Vet Sci if the reason for treatment was recorded. This is done in many 1982;32:95–100. herds and would create little additional work. Results of this 8. Olson LD. Induction of swine dysentery in swine by the intravenous study represent only 1 farm, hence external validity is limited. injection of filtered Treponema hyodysenteriae. Can J Comp Med 1981; 45:371–376. We also used treatments as if they were measures of individual 9. Raynaud J, Brunault G, Patterson E. A swine dysentery model for morbidity, but labelled treatment for tiamulin is to be used evaluation of drug prophylaxis: Development of a model involving oral until clinical signs ceased and for lincomycin is between 3 and infection plus pen contamination. Am J Vet Res 1981;42:49–50. 10. Jensen TK, Boye M, Møller K, Leser TD, Jorsal SE. Association of 7 d. This is one of the reasons why only tiamulin was used for Serpulina hyodysenteriae with the colonic mucosa in experimental estimation of disease parameters, but it is far from a perfect swine dysentery studied by fluorescent in situ hybridization. APMIS approach. The study should be repeated prospectively and across 1998;106:1061–1068. multiple systems or farms. 11. Jacobson M, Lindberg R, Jonasson R, Fellström C, Jensen Waern M, Waern MJ. Consecutive pathological and immunological alterations Despite these limitations, some important insights into during experimentally induced swine dysentery — A study performed the patterns of circulation of swine dysentery under current by repeated endoscopy and biopsy samplings through an intestinal conditions were gained. Although there was endemic pres- cannula. Res Vet Sci 2007;82:287–298. 12. Tiege J, Larsen HJ, Tollersrud S. Swine dysentery: The influence of ence of swine dysentery in this system the overall mortality dietary selenium on clinical and pathological effects of Treponema did not seem to be driven by acute cases of swine dysentery, hyodysenteriae infection. Acta Vet Scand 1984;25:1–9. which is not reflective of historical reports. More age separa- 13. Jonasson R, Essén-Gustavsson B, Jensen-Waern M. Blood concentrations of amino acids, glucose and lactate during experimental swine dysentery. tion, disinfection protocols, and overall environment quality Res Vet Sci 2007;82:323–331. are possible contributing factors. Under the assumption that 14. Kruse R, Essén-Gustavsson B, Fossum C, Jensen-Waern M. Blood the rate of adjusted lincomycin usage was the most reflective concentrations of the cytokines IL-1beta, IL-6, IL-10, TNF-alpha and IFN-gamma during experimentally induced swine dysentery. Acta Vet of the burden of swine dysentery over the entire period, the Scand 2008;50:32. average morbidity could also be considered relatively low. As 15. Rubin J, Harms N, Fernando C, et al. Isolation and characterization an example, with a treatment rate of 1.08 per 1000 pig-days, a of Brachyspira spp. including “Brachyspira hampsonii” from lesser snow geese (Chen caerulescens caerulescens) in the Canadian Arctic. Microb population of 1500 animals and a 120-day finisher period, one Ecol 2013;66:813–822. could expect 194.4 treatments in this population. With the 16. Costa MO, Hill JE, Fernando C, et al. Confirmation that “Brachyspira additional assumption that each animal received 3 injections, hampsonii” clade I (Canadian strain 30599) causes mucohemorrhagic diarrhea and colitis in experimentally infected pigs. BMC Vet Res 2014; we could expect 65 treated animals (4.3% swine dysentery 10:129. morbidity). Although of concern for animal health and welfare, 17. Wilberts BL, Arruda PH, Kinyon JM, et al. Investigation of the impact such estimates are far lower than historical descriptions of the of increased dietary insoluble fiber through the feeding of distillers dried grains with solubles (DDGS) on the incidence and severity of disease. Nonetheless, the rate of treatment with lincomycin — Brachyspira-associated colitis in pigs. PLoS One 2014;9:e114741. and thus morbidity — is expected to vary substantially among 18. Rubin JE, Costa MO, Hill JE, et al. Reproduction of mucohaemorrhagic seasons with the highest rate for animals raised in winter months diarrhea and colitis indistinguishable from swine dysentery following experimental inoculation with “Brachyspira hampsonii” strain 30446. and the lowest rate for animals raised during summer. PLoS One 2013;8:e57146. 19. Boye M, Baloda SB, Leser TD, Møller K. Survival of Brachyspira hyo- Acknowledgments dysenteriae and B. pilosicoli in terrestrial microcosms. Vet Microbiol 2001;81:33–40. This study was funded by the University of Guelph-Ontario 20. Chia S, Taylor D. Factors affecting the survival of Treponema hyodysen- Ministry of Agriculture, Food and Rural Affairs Research teriae in dysenteric pig faeces. Vet Rec 1978;103:68–70.

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21. Lanzas C, Brien S, Ivanek R, et al. The effect of heterogeneous infectious 23. Hansen CF, Hernández A, Mansfield J, et al. A high dietary concentra- period and contagiousness on the dynamics of Salmonella transmission tion of inulin is necessary to reduce the incidence of swine dysentery in dairy cattle. Epidemiol Infect 2008;136:1496–1510. in pigs experimentally challenged with Brachyspira hyodysenteriae. Br J 22. Siba PM, Pethick DW, Hampson DJ. Pigs experimentally infected Nutr 2011;106:1506–1513. with Serpulina hyodysenteriae can be protected from developing swine 24. Jacobson M, Fellström C, Lindberg R, Wallgren P, Jensen-Waern M. dysentery by feeding them a highly digestible diet. Epidemiol Infect Experimental swine dysentery: Comparison between infection models. 1996;116:207–216. J Med Microbiol 2004;53:273–280. ARTICLE

Book Review Compte rendu de livre

Current Therapy in Avian Medicine and an example. The pain management chapter does include a Surgery useful drug formulary, however, with differences among avian species noted. Speer BL. Elsevier, St. Louis, Missouri, USA. 2016. 908 pp. The section on surgery contains less detail about individual ISBN: 9781-4557-4671-2. procedures than most general practitioners would probably require. There are a few photographs but hardly any diagrams, he most comprehensive volume of its kind to date. This so this is not a text to use if you want, for example, a step-by- T first edition encompasses the most up-to-date informa- step approach for performing your first avian castration. There tion on the subject, including a wealth of new information not are some useful photos in the orthopedics section that would included in other texts. aid in applying external coaptation. This book is an in-depth, evidence-based discussion on avian Pattern Recognition is a brief section primarily of charts and therapy, including sections on medicine, anesthesia, analgesia, tables to aid the practitioner in making a diagnosis. It includes and surgery, welfare, conservation, and practice management, tables of diseases found in common species, and indicates which and pattern recognition. While definitely not a quick refer- conditions are likely to be found in that species depending on ence to be used in emergency situations, this book offers the which part of the world they are kept as pets. veterinarian an opportunity to become well-versed in the most An appendix is included for common drugs and approximate current information on avian illness and injury. Subjects such doses, divided by class (e.g., antibacterial, antifungal) and listed as infectious disease, oncology, nutrition, behavior, cardiology, alphabetically, making it easier to select a treatment compared to neurology, and endocrinology are covered in depth. There are using a general veterinary drug formulary. The text also includes individual chapters on specific anatomical regions, including up-to-date tables for hematology and biochemistry, with dif- the cloaca, coelomic cavity, and endocrine system. Sections on ferent values for individual species of birds, which provides hematology and cytology include photographs and tables to aid a more diagnostic value than most other discussions of avian in-house diagnostics when an immediate answer is required. clinical pathology, which seem to include only one value for There is a chapter devoted specifically to management and medi- all avian species. cine of backyard poultry, which is useful even in urban practice This book is highly recommended for mixed practitioners given the current popularity of having a small backyard flock. with an avian component to their practice, and for those looking Information on pain management goes beyond the usual to specialize into avian and exotic medicine exclusively. pharmacology discussion found in most avian texts, to include a discussion on recognition and assessment of pain in birds. The one omission to this chapter that would be useful is a pain Reviewed by Lynn Smart-Ridgway, DVM, Cascade Veterinary scale; the author discusses their usefulness but fails to include Clinic, Princeton, British Columbia.

CVJ / VOL 58 / MAY 2017 481 FOR PERSONAL USE ONLY Article

Information needs, sources, and decision-making by hatching egg and broiler chicken producers: A qualitative study in Alberta, Canada

R. Michele Anholt, Margaret Russell, Tom Inglis, Darko Mitevski, David Hall

Abstract — Understanding the sources and use of information from hatching egg and broiler chicken producers, their constraints, and unmet information needs can help define future research agendas. This report presents the results from a qualitative study using interviews of 11 hatching egg producers and 12 broiler producers in Alberta, Canada. Patterns were reported and described using thematic analysis. Producers recognized that there were numerous sources of information available to them for managing disease in their flocks. Complex disease issues such as early mortality were discussed, but many producers did not believe they had any influence over the outcomes and did not see a benefit from additional information to improve outcomes. Producers described their experience, trust in the information source, and the usefulness of the information for decision-making as necessary for information uptake.

Résumé — Besoins et sources d’information et prise de décisions par les producteurs d’œufs d’incubation et de poulets à griller : une étude qualitative en Alberta, au Canada. La compréhension des sources et de l’utilisation de l’information par les producteurs d’œufs d’incubation et de poulets à griller ainsi que des contraintes et des besoins d’information non comblés pourrait aider à définir les programmes de recherche futurs. Ce document présente les résultats provenant d’une étude qualitative se basant sur des entrevues réalisées auprès de 11 producteurs d’œufs d’incubation et de 12 producteurs de poulets à griller en Alberta, au Canada. Nous avons utilisé une analyse thématique pour signaler et décrire les tendances. Les producteurs ont reconnu qu’il y avait plusieurs sources d’information qui étaient mises à leur disposition pour la gestion des maladies dans leurs troupeaux. Des problèmes de maladie complexes, comme une mortalité précoce, ont été discutés, mais beaucoup de producteurs ne croyaient pas qu’ils exerçaient une influence sur les résultats et ils n’envisageaient pas d’avantages provenant de renseignements additionnels afin d’améliorer les résultats. Ils ont décrit que l’expérience, la confiance envers la source d’information et l’utilité de l’information pour la prise de décisions étaient nécessaires pour l’assimilation de renseignements. (Traduit par Isabelle Vallières) Can Vet J 2017;58:482–487

Introduction disease prevention strategies by food animal producers (5–7). This study examined how hatching egg (broiler breeder) produc- cquiring and using information is the foundation ers (HEP) and broiler (chicken) producers (BP) acquire and use for decision-making. The goal of production animal A information in their decision-making. research is often to provide evidence-based advice to produc- In Alberta, day-old broiler breeder chicks are imported from ers. However, producers may not apply the new information the United States, and HEPs raise the chicks and continue to (1–4). Increasingly, attention has focused on how to promote own them throughout production of hatching eggs, which are the uptake and implementation of agricultural innovation and then delivered to a hatchery. The hatchery pays the HEP for each viable chick hatched from the delivered eggs. The day-old University of Calgary — Ecosystem and Public Health, Faculty broiler chicks are then sold to BPs to be raised until processing. of Veterinary Medicine, 3280 Hospital Drive NW, Calgary, Hatching egg and broiler chicken production is supply man- Alberta T2N 1N4 (Anholt, Hall); University of Calgary aged in Canada and commercial producers are required to hold Cumming School of Medicine — Community Health Sciences, quota to produce and sell their products. The HEPs and the Calgary, Alberta (Russell); Poultry Health Services, Airdrie, BPs in Alberta are serviced by field staff provided by the agri- Alberta T4B 2A3 (Inglis, Mitevski). food corporation (hatchery), veterinarians (who may also be Address all correspondence to Dr. Michele Anholt; e-mail: under contract to an agri-food corporation), feed suppliers and [email protected] nutritionists, and a poultry diagnostic laboratory. Veterinarians, Use of this article is limited to a single copy for personal study. nutritionists, and hatchery advisors together develop flock Anyone interested in obtaining reprints should contact the health programs for their producers. The programs include CVMA office ([email protected]) for additional flock management, feeding, vaccination protocols, and disease copies or permission to use this material elsewhere. management protocols.

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The purpose of this study was to inform future research proj- agement of flocks. The third section asked about their experi- ects and provide evidence-based advice to the Alberta poultry ence managing disease in the flocks. Our aim was to understand industry. Our objectives were to explore how HEPs and BPs when the producers sought additional information, sources of currently make decisions about routine flock management, their information, why consultation was or was not sought, and moti- approaches to disease challenges in their flocks, their motiva- vation for responding to changes in flock health. Producers were tions for responding to problems, sources of information, and asked specifically if there were any gaps in available information neglected information needs. that would be useful for decision-making. The final section ARTICLE asked what methods of communication worked best for them, Materials and methods if they were willing to share data about flock performance with This was a qualitative study. Data were collected by telephone other parties, and under what circumstances they would be less interview and then thematically analyzed. willing to share this information. The producers’ responses were recorded using handwritten Participant recruitment notes, which were transcribed by the interviewer immediately Participants were identified by using the client database from following the interview. a poultry diagnostic service in the province of Alberta. Poultry submissions to this diagnostic service come from producers Thematic analysis serviced by 3 veterinary practices and under contract to 1 of Qualitative analysis was performed using QDA Miner 3.2.6 soft- 3 agri-food corporations or producing broilers for their own ware (Provalis Research, Montreal, Quebec) to manage the data use. All quota HEPs (n = 26) in the province were identified as files. Our analytic approach was an applied thematic analysis as potential participants. Broiler producers were selected using a described by Guest et al (9). Broad, general themes were devel- random sample (n = 40), stratified by region, of the 200 produc- oped which largely mirrored questions in the interview guide. ers in the client list. With the expectation of a 25% response Through careful reading of the transcripts, meaningful text rate, the sample size was judged to provide a sufficient number was segmented and the content was coded using a hierarchical of participants so as to reach informational redundancy and still coding structure. The lower level codes under each theme rep- allow sufficient time for thorough analysis (8). The 66 producers resented more specific ideas or beliefs. Word searches and key- were initially contacted by e-mail, facsimile, or mail depending words-in-context were used to provide more detail in selected on available contact information. The letter requesting their codes. A codebook was developed that described the relationship participation introduced the investigators, and the objectives and of the key words to the code and its associated theme, provided methods of the project. In the month following, attempts were detailed definitions of each code, and provided explicit textual made to contact each producer by telephone; 2 attempts were clues to help differentiate the code from similar codes. made for each producer. When telephone contact was estab- To refine the codebook, 6 randomly selected interviews were lished, the project was again described and informed consent independently coded by 2 analysts. The 2 analysts reviewed was obtained. A time for the interview was then scheduled. No the results together. Where they disagreed, they discussed the remuneration, or other incentive, was provided. discrepancy and alternative interpretations, recoded the segment with an agreed-upon code, and revised the codebook and the Ethics code definitions if necessary. The remaining interviews were This research was approved by the University of Calgary coded by 1 analyst using the refined codebook. Conjoint Faculties Research Ethics Board. Potential partici- Participant attributes were summarized using descriptive sta- pants were assured that their data would be anonymous and tistics. The frequencies of codes and co-occurrences of selected they were informed of their right to refuse to answer any or all codes were examined to identify and explore relationships in of the questions. the data.

Interview method Results Interviews were conducted by the lead author (RMA) using a Producer characteristics semi-structured interview guide. An initial interview guide was Twenty-three producers (HEP, n = 11; BP, n = 12) were inter- developed with input from practicing poultry veterinarians and viewed from April 29, 2014 to June 9, 2014. Of the 15 HEPs poultry marketing board members. The interview was piloted who did not participate, there was no response from 11 of the with a poultry board member. After the piloting interview and producers, we had the wrong contact information for 3, and the 2 initial interviews, the questionnaire was changed slightly 1 producer declined to participate due to time constraints. There to improve the logical order and coherence of the questions. The was no response from 18 of the 28 BP’s we attempted to contact, final interview guide was composed of 4 parts. 2 were no longer raising chickens, we had incorrect contact The first section, “Description of Participant,” gathered information for 3 producers, and 6 producers declined to par- demographic information about the producer, his/her back- ticipate. The reasons for not participating were time constraints ground in the poultry industry, and the rewards and concerns (n = 1) and lack of interest (n = 5). The number of participating they described working in the poultry industry. The second producers was sufficient to meet our targeted sample size. section identified whether there were additional decision-makers The duration of the HEP interviews averaged 32.5 min on-farm and how decisions were made regarding routine man- [standard deviation (SD) = 8.4 min] and averaged 19.8 min

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Table 1. Demographic and farm characteristics of poultry producers who participated in this study HEPa BPb n = 11 n = 12 Variable Result (%) (%) Male Yes 10 (91) 12 (100) Married/children Yes 10 (91) 12 (100) Age [mean 6 SD (y)] 47.9 6 12.3 44.2 6 9.5 Education High school not completed 0 6 (50) High school completed 3 (27) 3 (25) ARTICLE High school and technical training 2 (18) 1 (8) Some post-secondary 4 (36) 1 (8) University degree, college diploma 2 (18) 1 (8) Hutterite Yes 0 4 (33) Years in industry 18.4 6 8.5 18.8 6 12.7 [mean 6 SD (y)] Location in province North 3 (27) 5 (42) North-central 1 (9) 3 (25) South-central 6 (55) 1 (8) South 1 (9) 3 (25) Hatchery Hatchery A 4 (36) 5 (42) Hatchery B 2 (18) 5 (42) Hatchery C 5 (45) 2 (17) Flock Size (per cycle) , 15 000 4 (36) 2 (17) 15 000 to 25 000 4 (36) 1 (8) 25 000 to 50 000 3 (27) 3 (25) . 50 000 0 6 (50)

a Hatching egg producer. b Broiler producer. SD = Standard deviation.

(SD = 5.5 min) for the BP interviews. The demographic char- and their responses to the interview questions. However, there acteristics of the HEPs and the BPs were similar except for their were differences between the HEPs and the BPs in the codes levels of education (Table 1). and key words that emerged from responses to some questions. All participants indicated that they were responsible for Rewards. The HEPs and the BPs responded alike to the making decisions regarding the care of their flocks. Twelve of question about what they perceived as the rewarding aspects the producers involved their spouse or other family members of working in the poultry industry (Table 2). Most producers in the decision-making, 7 were the sole decision-makers, and identified the industry as being profitable and stable, providing 4 discussed concerns and plans with other men on the Hutterite a preferred lifestyle and/or rewarding work. colony. Concerns. The BPs had few concerns for themselves or their families working in the poultry industry now and in the future. Themes and codes Concerns about a poor work/life balance and the difficulty Nine themes, which reflected the interview questions, were finding the workers necessary to meet their labor needs were developed: Rewards, Concerns, Disease Experience, Problem unique to the HEPs. Recognition, Information Sources, Motivation, Response, Gaps, Both groups of producers identified the prospect of disman- and Sharing. Under each theme there were 2 to 6 codes derived tling the supply management system as a concern. Producers also directly from the data (Table 2). described the consequences of high quota values on their debt Two crosscutting concepts were identified. These were rel- load and the difficulty selling quota to young people hoping evant to several themes and provided some degree of integration to start in the industry. The poor quality of the broiler breeder and coherence between themes. The crosscutting concepts were: chicks provided by the American hatcheries was identified as a i) role of experience, and ii) importance of trust (Table 3). concern by the HEPs. The data were examined by cross-tabulating themes with Disease experience. Responses to the question about the demographic data and comparing the results to determine the producers’ experiences with disease in their flocks were if there were any relationships between the demographic char- coded as No major disease problems, Problems that were solved, acteristics of the producers and the codes derived from their and Challenging disease problems (Table 2). Some produc- interviews. There was no evidence of a relationship between ers responded to questions about disease experiences with a the producers’ age, level of education, time in the industry, description of an acute disease associated with severe morbidity location in the province, the hatchery with which they were or mortality, but which had since been managed (e.g., infec- under contract, flock size, membership in a Hutterite colony, tious laryngotracheitis). They may not identify the losses due

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Table 2. Frequencies of themes, codes, and key words derived from an applied thematic analysis of producers’ responses Breeder Grower Themes Codes Key Words n (%) n (%) Rewards Profitable/stable 3 (27) 3 (25) Lifestyle 6 (55) 6 (50) Rewarding work 6 (55) 6 (50) Concerns Work life balance 4 (36) 0 ARTICLE Meeting labor needs 2 (18) 0 Loss of supply management 8 (73) 3 (25) Other struggles Inadequate revenues 3 (27) 1 (8) High quota value 2 (18) 1 (8) Poor bird quality 3 (27) 0 No concerns 0 5 (42) Disease experience Problems solved 3 (27) 3 (25) Challenging problems Early mortality, bird quality 10 (91) 9 (75) Cocci and/or Staphylococcus 3 (27) 2 (17) No major disease 4 (36) 9 (75) Problem recognition Flock observation Mortality, behavior 11 (100) 10 (83) Processing Trim, condemnations 0 2 (17) Facility improvement 3 (27) 4 (33) Compare other flocks 0 3 (25) Information sources Experience 8 (73) 4 (33) Personal networks Other producers 10 (91) 10 (83) Veterinarian 7 (64) 5 (42) Hatchery agent 4 (36) 8 (67) Nutritionist 1 (9) 1 (8) Feed salesman 2 (18) 6 (50) Other experts/suppliers 3 (27) 4 (33) Other sources Newsletters 1 (9) 6 (50) Online 8 (73) 9 (75) Courses 2 (18) 2 (17) Magazines/journals 1 (9) 2 (17) Motivation to address health issues Financial 8 (73) 6 (50) Feeling frustrated 3 (27) 4 (33) Responsible for flock 6 (55) 7 (58) Response Manage on own with products on hand Experience 10 (91) 9 (75) Conduct postmortems 2 (18) 1 (8) Facility cleaning/maintenance 3 (27) 5 (42) Vitamins, probiotics 5 (45) 5 (42) OTC antibiotics 8 (73) 4 (33) Prescription antibiotics 2 (18) 0 Consultation Veterinarian 10 (91) 10 (83) Feed salesman 3 (27) 10 (83) Nutritionist 1 (9) 0 Hatchery agent 2 (18) 9 (75) Other 1 (9) 1 (8) No treatment Watchful waiting 1 (9) 5 (42) Cull 1 (9) 3 (25) Barriers to consultation Familiar with problem 5 (45) 5 (42) Time/distance to lab 5 (45) 0 Cost of diagnostics 5 (45) 4 (33) Time to results 3 (27) 1 (8) Useful results 3 (27) 2 (17) Other 1 (9) 1 (8) Gaps No gaps identified 5 (45) 8 (67) Information to manage challenging problems Early mortality/chick quality 5 (45) 6 (50) Cocci/Staphylococcus 2 (18) 0 Antibiotics available 0 2 (17) Service Lack of farm visits 4 (36) 1 (8) Not 24/7 service 1 (9) 1 (8) Poor lab services 5 (45) 4 (33) Poor support from hatcheries 4 (36) 0 Trusting relationships Sharing all flock data 3 (27) 0 Trust in hatcheries 7 (64) 0 No sense of common good 2 (18) 0 Poor communication With hatcheries 3 (27) 0 Among producers 3 (27) 2 (17) Research knowledge transfer 3 (27) 0 Sharing Willing to share 10 (91) 12 (100) Careful to share 7 (64) 10 (83)

OTC — Over the counter (non-prescription).

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Table 3. Relationship of crosscutting concepts to themes An equal proportion of HEPs and BPs would supplement the identified in the interviews flock with vitamins when faced with poor health issues in their Crosscutting concepts birds. More HEP’s than BPs indicated that they would initiate Theme Experience Trust treatment with over-the-counter non-prescription antibiotics that they had on hand or prescription antibiotics provided by a Rewards X Concerns X X veterinarian with a protocol for use (Table 2). Disease experience X For challenging disease problems they looked for advice and Problem recognition X ideas from other producers, searched the Internet, and sought Information sources X X Response X X consultation from experts within their personal networks.

ARTICLE Gaps X X Veterinarians were the people most frequently contacted for Sharing X X consultation but producers needed to be able to justify the time and cost of investigating and responding to a problem. Broiler producers indicated that they consulted with feed suppliers and to complex and recurring diseases such as early mortality as a their hatchery more frequently than did HEPs. “disease problem,” although these were discussed later in the When producers were asked to describe the barriers to interview by most producers. All 4 HEPs and 7 of the 10 BP seeking a consultation for their flocks’ health problems, the interviews that reported No major disease problems also described discussion focused on the challenges of submitting birds to the Challenging disease problems. laboratory, the costs of diagnostic testing, and the usefulness of Problem recognition. All producers relied on experience to the information received. The HEPs described greater barriers recognize problems in their flocks. Producers described walk- to submitting birds for postmortem examination than did the ing the barns daily to observe the birds, looking for clues in BPs; the time and distance needed to travel to submit birds was behavior, feed and water consumption, and mortality levels to a problem for 45% of the HEPs. No BPs indicated that this determine how birds were doing. Any deviation from expected was an issue. The cost of diagnostic work was identified as a would alert producers to a problem. barrier to submission by both groups. Some producers did not Information sources. Producers trusted their experience as a find the information from diagnostic testing helpful for mak- source of information (Table 2). When additional information ing management changes. In addition, the producers would be was sought, producers relied on personal networks. Relationships compensated by the hatchery for increased early mortality, and with members of their personal networks were often based on this discouraged submission. trust and respect and were the product of experience over time. Producers also needed the information to be relevant to them Within their personal networks, many producers (n = 18, and any recommendations to be feasible within their manage- 78%) preferred talking face-to-face to other producers when ment system. Could it be implemented in their barns, was it managing challenging problems. However, those who were right for them? Perhaps they would experiment with a new geographically more isolated found meetings difficult to attend. approach for 1 cycle and monitor the results. Some producers Work required the HEPs to remain on-farm and made it dif- described waiting to hear the results from other producers who ficult to attend meetings. E-mail was the next preferred method had adopted a new management technique before considering of communicating information (n = 12, 52%), especially time- it for themselves. sensitive information, but others favored telephone or cell Gaps. Producers were asked when they consider all the infor- phones (n = 9, 39%); multiple methods of communication were mation sources that are available to them and the challenges necessary to reach all producers. they had in raising poultry, what they would identify as the gaps Motivation. Producers were motivated to find a solution to in information or service. Managing challenging problems, in disease challenges in their flocks. They were financially moti- particular bird quality, was identified by 8 (73%) of the HEPs vated but frustration and a sense of obligation to animal care and 6 (50%) of the BPs. Five (45%) of the HEPs and 8 (67%) was also described when faced with an unhealthy flock. of the BPs indicated that from their perspective there were no Response. Producers relied on their experience when man- gaps. Replies were often inconsistent with previous responses. aging disease or problems with poor production. Faced with Each of the 5 HEPs and 6 of the 8 BPs who indicated that there a health problem in their flocks many producers described were no gaps in their information sources had also described spending more time watching the birds and investigating their experiences managing challenging disease problems that were management. To manage disease problems, the producers not readily solved, the most frequently cited problem being described implementing strategies that had worked in the past. early mortality. If probed to clarify this inconsistency, 3 HEPs Initially they may cull symptomatic birds and monitor others and 2 BPs blamed the recent introduction of the Ross 308 bird closely if improvement was expected (Table 2). Some producers and the chicks it produces for early mortality. conducted their own postmortem examinations to determine if Hatching egg producers were more likely to discuss other per- they were dealing with an infectious disease problem. Decisions ceived gaps in service. More on-farm visits by either a hatchery were case-specific and included management changes, investing agent or veterinarian were desired by 7 (64%) of the HEPs but more time cleaning, changing the type of bedding used, sourc- only 1 (8%) of the BPs. Many admitted that the cost of these ing chicks from a different hatchery, mixing their own feed, and services could be a deterrent (Table 2). Trust in the hatcheries correcting equipment issues. was an important issue for the HEPs. Concerns were raised

486 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY about the objectivity of the information they received from the improve their uptake of research-based knowledge; this study hatcheries. indicates that producers would support research examining early Sharing. Most producers were willing to share detailed infor- chick mortality. mation about their flocks with other producers and agencies but Producer participation in identifying information gaps and it was important that there would be no negative consequences developing research questions supports integration of sci- for themselves or their farms and that the group requesting the ence with their knowledge into the decision-making processes information was legitimate and could be trusted. (12–14). This study revealed some opportunities for enhanced ARTICLE collection of diagnostic data to enhance disease surveillance Discussion or to understand the epidemiology of disease. For example, While the HEPs and the BPs responded alike to many questions, reducing the cost and inconvenience of laboratory submissions there appeared to be greater challenges raising breeder birds and demonstrating the value of laboratory results may remove compared with broiler birds. The HEPs had more concerns and some of the barriers to submission of samples. The producers identified additional gaps in the resources available compared expressed a willingness to share data so it may also be feasible with the BPs. to integrate production data with clinical laboratory data for Most of the producers in this study had low levels of formal improved disease detection and study. education but abundant practical knowledge borne of experi- This study had limitations. It is unknown if the views ence. Once they had detected a change and characterized a expressed by the participants in this study are representative of problem they again relied on their experience to determine the all broiler bird producers in Alberta. The producers in this study next steps. Knowledge was personal, context specific, subjective, may have modified their responses during the interview due to and goal-oriented. To assimilate new information it needed to social desirability bias. In addition, hand-written recording of be incorporated with existing experience so as to be understood responses to interview questions may have resulted in errors and and to give meaning to the information. Learning from the recorder bias. CVJ experience of trial and error and from observing the results of innovation implemented by other producers has been described References by Bandura (10). The producers wanted to understand what was . 1 Garforth C, Rehman T, McKemey K, et al. Improving the design of knowledge transfer strategies by understanding farmer attitudes and going on and to find a solution to complex disease problems but behaviour. J Farm Manag 2004;12:17–32. described a perception that their actions may not have much 2. Garforth C, Bailey A, Tranter R. Farmers’ attitudes to disease risk man- impact on the outcomes. The flock placed in the next cycle agement in England: A comparative analysis of sheep and pig farmers. Prev Vet Med 2013;110:456–466. could be better or more of the same. Within their personal 3. Llewellyn RS. Information quality and effectiveness for more rapid networks other producers were describing similar challenges, adoption decisions by farmers. Field Crops Res 2007;104:148–156. which re-enforced their belief that not much could be done; 4. Fraser RW, Williams NT, Powell LF, Cook AJC. Reducing Campylobacter and Salmonella infection: Two studies of the economic cost and attitude it was beyond their control. Some described feeling powerless to adoption of on-farm biosecurity measures. Zoonoses Public Health but they were not indifferent. 2010;57:e109–e115. Producers recognized that numerous sources of information 5. Thysen I. Agriculture in the information society. J Agric Eng Res 2000;76:297–303. were available to them but looked toward trusted sources and 6. Alarcon P, Wieland B, Mateus ALP, Dewberry C. Pig farmers’ percep- institutions for guidance. Previous work has demonstrated the tions, attitudes, influences and management of information in the importance of trust for effective communication (11). The decision-making process for disease control. Prev Vet Med 2014;116: 223–242. producers talked extensively about the value of the trusting rela- 7. Nuthall PL. Farm Business Management: The Human Factor. tionships within their networks and the components of industry Wallingford, UK: CABI, 2011. that they did not trust. Specifically, we identified the lack of 8. Sandelowski M. Sample size in qualitative research. Res Nurs Health 1995;18:179–183. confidence of the HEPs in the hatcheries as a very important 9. Guest G, MacQueen KM, Namey EE. Applied Thematic Analysis. barrier to sharing information. Los Angeles, California: Sage, 2011. The producers described information needs that were met and 10. Bandura A. Social Learning Theory. New York, New York: General Learning Press, 1977. information needs that were known but not met. The contra- 11. Zeffane R, Tipu SA, Ryan JC. Communication, commitment & trust: dictory responses by some producers around unsolved complex Exploring the triad. Intl J Bus Manag 2011;6:77–87. disease issues but satisfied information needs suggest there 12. Farrington J, Martin AM. Farmer participatory research: A review of concepts and recent fieldwork. Agric Adm Exten 1988;29:247–264. were also information needs that were either not recognized or 13. Fountas S, Wulfsohn D, Blackmore BS, Jacobsen HL, Pedersen SM. they believed that there were no solutions within their control. A model of decision-making and information flows for information- Further producer consultation would be required to ensure a intensive agriculture. Agric Syst 2006;87:192–210. 14. Lawrence D, Christodoulou N, Whish J. Designing better on-farm participatory, problem-orientated evaluation of the information research in Australia using a participatory workshop process. Field Crops needs. A meaningful participatory approach could allow produc- Res 2007;104:157–164. ers to define their priorities in applied agricultural research and

CVJ / VOL 58 / MAY 2017 487 FOR PERSONAL USE ONLY Article

Congenital nuclear cataracts in a Holstein dairy herd

Stephanie Osinchuk, Lyall Petrie, Marina Leis, Fritz Schumann, Bianca Bauer, Lynne Sandmeyer, Kayla Madder, Fiona Buchanan, Bruce Grahn

Abstract — This report describes congenital nuclear cataracts and posterior lenticonus in a closed purebred Holstein dairy herd in Canada. Ophthalmic examinations were completed on 30 male and 249 female cattle aged newborn to 10 years old. Nutritional, infectious, and toxic etiologies were investigated. Necropsies of 3 affected calves were performed and eyes of 2 additional affected calves were examined with light microscopy. Bilateral nuclear cataracts were identified in 53/279 (19%) animals. Additional congenital anomalies observed included posterior lenticonus, iris to lens persistent pupillary membranes (n = 7), and lenticular colobomata (n = 1). Heifers did not give birth to calves with congenital nuclear cataracts (0/105), whereas the incidence of affected calves born to multiparous cows was 31% (53/171). The animals with nuclear cataracts ranged from newborn to 8 years old. The cataracts appeared to be non- or minimally progressive. Light microscopic examination of 10 affected globes confirmed nuclear cataract with posterior lenticonus (n = 10). Pedigree analysis was inconclusive. Polymerase chain reaction and sequence analysis for the NID1 gene deletion were negative. The etiology of the congenital lenticular anomalies was not determined.

Résumé — Cataractes nucléaires congénitales dans un troupeau laitier Holstein. Cette étude rapporte les résultats d’une enquête sur des cataractes nucléaires congénitales et des lenticônes postérieurs dans un troupeau laitier fermé Holstein pur-sang au Canada. Des examens ophtalmiques ont été réalisés sur 30 bovins mâles et 249 bovins femelles qui étaient âgés de nouveau-né à 10 ans. Les étiologies nutritionnelles, infectieuses et toxiques ont été étudiées. Des nécropsies ont été effectuées pour trois veaux touchés et les yeux de deux veaux affectés additionnels ont été examinés à l’aide de microscopie photonique. Des cataractes nucléaires bilatérales ont été identifiées chez 53/279 (19 %) des animaux. Les anomalies congénitales additionnelles observées incluaient le lenticône postérieur, des membranes pupillaires persistantes de l’iris à la lentille (n = 7) et le colobome lenticulaire (n = 1). Les taures n’ont pas donné naissance à des veaux avec des cataractes nucléaires congénitales (0/105), tandis que l’incidence des veaux affectés nés de vaches multipares était de 31 % (53/171). Les animaux avec des cataractes nucléaires étaient âgés de nouveau-né à 8 ans. Les cataractes semblaient être non progressives ou minimalement progressives. Un examen à l’aide d’un microscope photonique de 10 globes affectés a confirmé la cataracte nucléaire avec un lenticône postérieur (n = 10). L’analyse du pedigree a été non-concluante. Une réaction d’amplification en chaîne par la polymérase et une analyse de séquence pour la suppression du gène NID1 ont été négatives. L’étiologie des anomalies lenticulaires congénitales n’a pas été déterminée. (Traduit par Isabelle Vallières) Can Vet J 2017;58:488–492

Introduction 45 d of gestation (2). Reported etiologies for bovine congenital ataracts are focal to generalized opacities within the lens. cataracts include infection with bovine viral diarrhea virus C Their influence on vision varies from inconsequential to (BVDV) (3), hypovitaminosis A (4,5), and genetic mutations blinding. Cataracts manifest unilaterally or bilaterally and can (6–9). Recently, oxidative stress has been speculated to play a be congenital, developmental, or acquired; they have multiple role (10). etiologies (1). Congenital nuclear cataracts develop as a result of Infection with BVDV between 75 and 150 d gestation ocular insults occurring during early ocular organogenesis (1). has been associated with congenital equatorial and subcap- In the cow, lens organogenesis occurs at approximately 17 to sular cataracts (3). Affected calves have mucosal disease and

Department of Small Animal Clinical Sciences (Osinchuk, Leis, Bauer, Sandmeyer, Grahn), Large Animal Clinical Sciences (Petrie, Schumann), Western College of Veterinary Medicine; Department of Animal and Poultry Science, College of Agriculture and Bioresources (Madder, Buchanan), University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan. Address all correspondence to Dr. Stephanie Osinchuk; 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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Figure 1. A small central nuclear cataract representative Figure 2. A larger cataract in a 3-year-old Holstein cow that of a less severe presentation of the disease in a 3-year-old was likely visually impairing when this animal was young. As this Holstein cow. animal grew, clear cortical lens fibers were laid down around the opaque nucleus allowing for improved vision.

the primary ocular manifestations can include uveitis, retinal was reviewed carefully with the owner. Distance to the nearest degeneration, and optic neuritis, although cataracts are also MPBS was calculated. reported (3). Inherited congenital cataracts in the Holstein, Light microscopic examinations were completed on Jersey, and Romagnola have been reported as an autosomal 10 formalin-­fixed globes from 5 affected calves. Complete nec- recessive condition (6–9). In Romagnola cattle, the mutation has ropsy examinations were completed on 3 affected calves. Fresh been identified as a deletion in the NID1 gene (9). Congenital liver samples were submitted for vitamin A, iron, copper, and ocular anomalies and cataracts also develop following prolonged selenium levels. Blood samples were collected through coccygeal maternal hypovitaminosis A (4,5). Primary vitamin A deficiency venipuncture and DNA was harvested from white blood cells. can develop when cattle are fed a ration containing little or no The DNA from affected and non-affected animals was evalu- green forage without supplementation (11) and when expired ated for a deletion mutation in the NID1 gene, using previously supplements are fed (4). Congenital nuclear cataracts have also published methods (8). been reported in cattle on farms with a history of vitamin E deficiency or with low levels of selenium in their feed (12). Results An increase in congenital nuclear cataracts was reported on Ophthalmic examinations a Swiss dairy farm following the installation of a mobile phone Nuclear cataracts were confirmed in 53/279 (19%) animals. In base station (MPBS) in the vicinity (13). Distance to MPBS animals with smaller nuclear cataracts, biomicroscopic examina- has been associated with increased markers for oxidative stress tion allowed for visualization of posterior lenticonus. Extensive in aqueous humor of globes collected from Swiss veal calves at nuclear to posterior cortical cataracts prevented visualization slaughter (14). Globes with cataract had increased oxidative of the posterior lens in many cases, precluding the establish- stress (14). It has not been shown that mobile telephone anten- ment of an n value for posterior lenticonus. Other abnormal nas affect stress or cause congenital nuclear cataract (14). ophthalmic findings in the herd included: iris to lens persistent This is the first report describing congenital nuclear cataracts pupillary membranes with associated anterior capsular cataract and posterior lenticonus in a closed purebred Holstein dairy (PPMs, n = 7), incipient capsular cataracts (n = 8), and lenticular herd in Canada. colobomata (n = 1). The nuclear cataracts varied in size and opacity (Figures 1, 2). Materials and methods The anomalies were present in animals that were examined In November 2014 a dairy farmer reported the birth of 3 calves at birth. Younger animals were the most visually impaired as with “white eyes” to a field service veterinarian at the Western the cataract occupied most of the lens and extended to the College of Veterinary Medicine who diagnosed congenital periphery. Affected older cows had clear cortical fibers around cataracts. The herd (n = 279) was screened by a veterinary the affected nucleus. Most animals were bilaterally affected ophthalmologist in scotopic conditions with a transillumina- although the lesions were not always symmetrical. Only bull tor. Complete ophthalmic examinations were conducted on all calves from the current year were examined. The use of arti- animals with leucocoria (n = 56) following dilation with 0.5% ficial insemination in this herd precluded examination of any Tropicamide (Mydriacyl; Alcon Canada, Mississauga, Ontario). herd sires. These included neuro-ophthalmic examinations, biomicros- copy, and indirect ophthalmoscopy. The only bull calves that Prevalence/incidence were examined were those born since January 2015. Data from The prevalence of congenital nuclear cataracts in the herd was birth month and cow parity were collected and analyzed using 19%. Heifers did not produce calves with cataracts (0/105; 95% confidence intervals (CI). Feed samples were submitted Figure 3). The incidence in calves born to cows in their second for analysis and testing for mycotoxins. Water was submit- or higher parity was 31% (53/171; Figure 3). Examination of ted for analysis. Skin biopsies of affected animals were submitted the breeding records demonstrated use of the same bulls in both for immunohistochemical detection of BVDV. The vaccine and heifers and multi-parity cows. Bull calves and heifer calves were medical histories for the herd were reviewed. Teratogen exposure equally affected. The average number of affected calves born per

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80 80 70 70 60 60 50 50 40 40 30 30 Incidence (%) Incidence (%) 20 20

10 10 ARTICLE 0 0 1st 2nd 3rd 4th 5th 6th Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Parity Month

Figure 3. The incidence of cataracts in calves based on dam Figure 4. Incidence of cataracts according to month with a parity with a 95% confidence interval (represented by error bars). 95% confidence interval (represented by error bars)

Table 1. Analyses of total mixed ration (TMR) demonstrating prior to calving they were fed a total mixed ration with a cus- nutrient values were within recommended limits tom close-up supplement formulated by Dairy Smart. Calves Maximum were fed a milk-based diet. After weaning, heifers were fed a Current Recommended tolerable silage-based diet supplemented with a custom 16% protein Nutrient analysis minimuma level (19) heifer grower pellet made by Dairy Smart. Near infrared spec- Calcium (% DM) 1.03 0.67 Not listed troscopy and wet chemical analysis was completed for the total Phosphorus (% DM) 0.41 0.36 1.00 Magnesium (% DM) 0.35 0.2 0.4 mixed ration fed to the lactating and pregnant cows. Nutrients Potassium (% DM) 1.69 1.06 3 were within normal limits (Table 1). Water was sourced from Sulfur (% DM) 0.31 0.2 0.4 a well and analysis was within normal limits (data not shown). Sodium (% DM) 0.43 0.22 1.6 Chloride (% DM) 0.66 0.28 4 Mycotoxin analysis was within normal limits (data not shown). Iron (mg/kg) 356 17 1000 Manganese (mg/kg) 68 13 1000 History Zinc (mg/kg) 107 52 300 to 1000 Copper (mg/kg) 39 11 40 The average milk production was 37 kg/cow per day. Selenium (mg/kg) 0.52 0.3 5b Vaccinations for clostridia, infectious bovine rhinotracheitis c Vitamin A (IU/kg) 26 154 2780 66 000 and BVDV were provided annually over the preceding 10 y. a Based on 45 kg milk production (19). Historical review of the medical record revealed no associated b Level at which chronic selenium toxicity may occur. c Presumed safe limit for vitamin A. medical disorders and no previous incidents of any other con- genital anomalies.

month in 2015 was 2 (range: 0 to 5). Analysis of birth month Other tests for all affected animals demonstrated an increased incidence of Immunohistochemistry tests for BVDV in skin biopsies from affected animals born in June; however, when analyzed using a 7 affected animals were negative. Discussion with the herd 95% CI the incidence overlapped with other months (Figure 4). manager and examination of the premise revealed no sources The oldest affected animal in the herd was born in 2008. of teratogens. Polymerase chain reaction and sequence analysis for the NID1 deletion were negative. Ten globes from 5 affected Environment calves were submitted for histological analysis. All calves had The herd consisted of approximately 280 Holstein cattle. bilateral posterior lenticonus, and nuclear and posterior cortical Approximately 100 milking cows were housed in a tie stall cataracts (Figure 5). barn and the remaining cows and bred heifers were housed in a dry lot. The barns were bedded with straw. Calves were housed Postmortem examination in individual pens in a calf barn. Heifer calves were retained Three affected calves were submitted for complete necropsy. One in the herd and bull calves were sold at a few months of age. calf had mild omphalitis and another calf had a patent foramen Artificial insemination was used exclusively. The nearest MBPS ovale, both of which were considered incidental. The third calf was 11.6 km away. had no systemic abnormalities. The liver values for vitamin A, magnesium, manganese, cobalt, zinc, molybdenum, selenium, Diet and feed/water analysis copper, and iron in all 3 calves were within normal limits. Lactating cows were fed a total mixed ration which consisted of barley silage, canola meal, soybean meal, corn distillers, canola Pedigree analysis oil, monensin, and a custom vitamin/mineral premix (Dairy Pedigree analysis was conducted for the cows and calves in the Smart, Saskatoon, Saskatchewan). Dry cows and heifers were herd. Ocular phenotypes of the sires were unknown. Dams of fed a hay-based diet until 3 wk before calving. In the 3 wk 43 affected animals were available for examination, 37 were

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Figure 5. Posterior lenticonus (arrows) and associated posterior cortical and nuclear cataracts in gross sections the eye of an affected Holstein calf. normal and 6 were affected. There were 6 incidences in which There was a higher incidence of affected animals born in the 3 consecutive generations were examined. In 2 of these inci- month of June (conceived in September), but a 95% CI over- dences the grand dam was normal and the cow and calf were lapped with intervals from other months. Two reports identi- affected. In the remaining 4 incidences the grand dam and fied an increase in incidence of affected calves conceived and dam were normal and the calf was affected. There were 6 sets undergoing organogenesis in the fall and winter months (12,16); of twins in the herd, 4 sets in which both calves were affected, however, no statistical analyses were done on these herds. The 1 set in which both calves were normal and 1 set in which 1 was herds were managed on grass in spring and summer and were affected and the other was normal. Both male and female calves switched to winter feed in the fall. The change from grazing were equally affected in 2015. Affected animals were sired by to winter feed early in lactation coincided with an increased 27 different bulls and could be traced back to the same ancestral incidence of cataracts in calves (12,16). Ellis and Bilsson (12) bull (not shown in herd pedigree). In most cases this bull was did, however, note that the silage used in the winter feed was present in both the maternal and paternal lineage and was typi- unlikely the problem as it was also fed to the heifers which did cally 5 to 8 generations prior to the affected animal. Pedigrees not have affected calves. The cows in our investigation were fed with this level of inbreeding would typically suggest a recessive TMR year-round with no access to pasture. Further investiga- inheritance; however, at the time of publication an inheritance tion into the relationship between grazing and disease incidence pattern could not be clearly demonstrated. is required. Hereditary congenital cataracts have previously been reported Discussion in Jerseys, Holstein-Friesians, and Romagnola cattle (6,8,9,18). Congenital nuclear and posterior cortical cataracts and poste- Reports of hereditary congenital cataracts in Holstein-Friesians rior lenticonus are reported in a Canadian Holstein dairy herd. and Jerseys included microphakia and buphthalmos (6,8), which These cataracts were similar to those observed in other reports were not observed in our investigation. The lesions caused in which etiologies were not determined (10,12,13,15). Similar by a NID1 deletion mutation described in Romagnola cattle to our findings, previous authors also reported a lower incidence (9) were phenotypically similar to the lesions observed in our of lesions in calves born to heifers (10,12,15). These authors herd; however, the NID1 deletion mutation was not present in speculated that lactation plays a role in the development of our herd. Pedigree analysis revealed a high level of inbreeding, cataracts. Derom (10) reported butyric acid was elevated and which is reflective of common industry practices. There was a total protein was decreased in dams of affected calves. Blood similar distribution of affected animals between male and female butyric acid can originate from rumen fermentation of feed, calves. On one occasion a cow gave birth to twins and 1 calf or directly from silage, or is produced as a byproduct of fat was affected while the other was normal. The lack of affected metabolism (17). A difference in butyric acid level would be calves born to heifers despite shared sire use with multiparous expected between lactating multiparous cows and non-lactating cows makes a simple autosomal inheritance less likely, and a heifers. A comparison of these variables between multiparous multifactorial etiology more likely. cows with normal calves and multiparous cows with affected Prolonged maternal hypovitaminosis A is associated with calves was not reported. Low serum selenium and glutathione outbreaks of severe congenital ocular anomalies in calves (4,5). peroxidase were also reported (10). In 1 report a history of These include ocular dermoids, microphthalmias, and retinal vitamin E and feed selenium deficiencies were identified (12). dysplasia but not cataracts (4,5). In this study, hypovitaminosis The authors speculated that low antioxidants (selenium and A was ruled out as feed and liver levels of vitamin A were within vitamin E) contributed to a reduction/oxidation imbalance normal limits. Liver and blood levels of vitamin A in gestating leaving the developing lens vulnerable to oxidative damage. In cows were not evaluated. our investigation, the selenium levels in the total mixed ration In this investigation PPM’s in 7 animals and lenticular (TMR) fed to lactating cows, and selenium levels measured in colobomata in 1 cow were considered incidental findings. the livers of 3 affected calves were within normal limits. Serum Previous authors did not report either of these anomalies in selenium and glutathione were not measured. their investigations.

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Teratogenic and other infectious etiologies for congenital 3. Bistner SL, Rubin LF, Saunders LZ. The ocular lesions of bovine viral nuclear cataracts and posterior lenticonus were excluded based diarrhea-mucosal disease. Pathol Vet 1970;7:275–286. 4. Mason CS, Buxton D, Gartside JF. Congenital ocular abnormalities in on the high health of the herd, examination of the premise, and calves associated with maternal hypovitaminosis A. Vet Rec 2003;153: questioning of the farmer. No other congenital anomalies were 213–214. observed in the herd throughout the course of the investigation. 5. Millemann Y, Benoit-Valiergue J-P, Bonnin J, Fontain JJ, Maillard R. Ocular and cardiac malformations associated with maternal hypovita- The distance between the farm and the nearest mobile phone minosis A in cattle. Vet Rec 2007;160:441–443. antenna made it unlikely that the antennas contributed to the 6. Detlefson J, Yapp W. The inheritance of congenital cataract in cattle. incidence of cataract. The animals were housed either in a tie Am Nat 1920;54:277–280. 7. Saunders LZ, Fichner MG. Hereditary multiple eye defects in grade stall stanchion or in a dry lot with limited environmental varia- Jersey calves. Cornell Vet 1951;41:351–356.

ARTICLE tion. Sources of teratogens would be limited to feed contami- 8. Gregory PW, Mead G, Regan W. A congenital hereditary eye defect of nation or be iatrogenic from undocumented treatments. These cattle. J Hered 1943;34:125–128. 9. Murgiano L, Jagannathan V, Calderoni V, Joechler, Gentile A, sources were considered unlikely. These methods do allow for a Drogemuller C. Looking the cow in the eye: Deletion in the NID 1 margin of error and it is impossible to conclusively rule out all gene is associated with recessive inherited cataract in Romagnola cattle. teratogens or infectious agents. PLos ONE 2014;9:e110628. Doi:10.1371/journal.pone.0110628. 10. Derom H. Studies on repeated cases of congenital cataract on a dairy In conclusion, congenital nuclear cataracts and posterior farm. Summa Anim Reddito 2007;7:57–64. lenticonus were observed in a Canadian Holstein dairy herd. 11. Booth A, Reid M, Clark T. Hypovitaminosis A in feedlot cattle. J Am Known nutritional, infectious, and toxic causes were ruled out. Vet Assoc 1987;10:1305–1308. 12. Ellis K, Billson FM. An investigation into a herd outbreak of congenital We suggest that these particular abnormalities could be due to cataracts. Cattle Practice 2001;9:29–32. genetics, oxidative stress, or possibly a combination of the 2; 13. Hässig M, Jud F, Spiess B [Increased occurrence of nuclear cataract however, the etiology remains undetermined. in the calf after erection of a mobile phone base station]. [Article in German] Schweiz Arch Tierheilkd. 2012;154:82–86. 14. Hässig M, Jud F, Naegeli H, Kupper J, Spiess BM. Prevalence of nuclear Acknowledgment cataract in Swiss veal calves and its possible association with mobile telephone antenna base stations. Schweiz Arch Tierheilkd. 2009; Funding for this project was provided through Saskatchewan 151:471–478. Agriculture. CVJ 15. Krump L, O’Grady L, Lorenz I, Grimes T. Congenital cataracts in an Ayrshire herd: A herd case report. Ir Vet J 2014;67:72. 16. Ashton N, Barnett KC, Clay CE, Clegg FC. Congenital nuclear cata- References racts in cattle. Vet Rec 1977;100:505–508. 1. Grahn BH, Peiffer RL. Veterinary ophthalmic pathology. In: Gelatt KN, 17. Beever DE, Sutton JD, Reynolds CK. Increasing the protein content of Gilger BC, Kern TJ, eds. Veterinary Ophthalmology. 5th ed. Vol 1. cow’s milk. Aust J Dairy Technol 2001;56:138–149. Ames, Iowa: Wiley-Blackwell, 2013:457–458. 18. Small CP. Hereditary cataracts in calves. Am J Ophthal 1919;2:681. 2. Bistner SL, Rubin L, Aguirre G. Development of the bovine eye. Am 19. National Research Council. Nutrient Requirements of Dairy Cattle. J Vet Res 1973;34:7–12. 7th revised ed. Washington, DC: The National Academies Press, 2001.

492 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY Case Report Rapport de cas

Ovarian carcinomatosis in a dog managed with surgery and intraperitoneal, systemic, and intrapleural chemotherapy utilizing indwelling pleural access ports

Matthew P. Best, Angela E. Frimberger

Abstract — A 3-year-old Weimaraner dog was presented with bilateral papillary ovarian carcinoma and abdominal carcinomatosis. Treatment included ovariectomy, intraperitoneal cisplatin, and systemic carboplatin. Pleural carcinomatosis 473 days following surgery was treated with intrapleural cisplatin through indwelling pleural access ports. Euthanasia occurred 1154 days following surgery due to malignant pleural effusion without peritoneal effusion.

Résumé — Carcinomatose ovarienne chez une chienne gérée par chirurgie et chimiothérapie intrapleurale, systémique et intrapéritonéale en utilisant des ports d’accès à demeure. Une chienne Weimaraner âgée de 3 ans a été présentée avec un carcinome papillaire bilatéral et une carcinomatose abdominale. Le traitement a inclus l’ovariectomie, de la cisplatine intrapéritonéale et de la carboplatine systémique. Une carcinomatose pleurale 473 jours après la chirurgie a été traitée avec de la cisplatine intrapleurale par des ports d’accès pleuraux à demeure. L’euthanasie a été réalisée 1154 jours après la chirurgie en raison d’une effusion pleurale maligne sans épanchement péritonéal. (Traduit par Isabelle Vallières) Can Vet J 2017;58:493–497

varian neoplasia is rare in modern companion canine thickness followed by the use of combination chemotherapy O populations due to the high incidence of ovariectomy/ with a platinum compound and paclitaxel (6–8). ovariohysterectomy (1). In populations of entire female dogs it has been estimated that the prevalence of ovarian neoplasia is Case description 6.25% (2). Of these cases approximately 50% are epithelial in A 3-year, 3-month-old female intact Weimaraner dog was origin and 64% of those that are epithelial in origin are malig- presented with a 5- to 6-day history of abdominal distension nant (3). In 1 study, 10 of 18 dogs with ovarian adenocarcino- without change in demeanor or appetite. On examination, mas had metastatic disease, with local carcinomatosis being the there was marked abdominal distension with a fluid wave and most common metastatic manifestation (3). the rest of the examination was unremarkable. Abdominal There is no established standard treatment for canine ovar- sonography revealed a large volume effusion and bilateral ovar- ian carcinoma with regional metastasis (carcinomatosis) (1) ian masses. The left ovary was partially cavitated and measured and in many cases dogs are euthanized due to a perceived poor 5.3 3 2.6 cm (Figure 1) while the right was homogenous and prognosis (4,5). In humans ovarian neoplasia is the second most smaller, measuring 3.9 3 2.0 cm (Figure 2). Cytology of both common gynecological cancer and most patients have a high the abdominal fluid and the ovarian masses was consistent with clinical stage of disease at presentation and a poor prognosis for carcinoma. Thoracic radiographs were unremarkable as was an long-term survival (6). The standard of care for human ovarian echocardiogram. A comprehensive biochemistry panel and a adenocarcinoma is cytoreduction of gross disease to , 1 cm complete blood cell count were within normal limits. On exploratory laparotomy 5 L of serosanguinous fluid Brisbane Veterinary Specialist Centre and Australian Animal were drained from the abdomen. The peritoneum was grossly Cancer Foundation, Corner of Old Northern and Keong Roads, thickened with widespread erythematous and nodular changes. Albany Creek, QLD 4035, Australia (Best); Veterinary Oncology The uterus was adhered to the colon and there was marked Consultants Pty Ltd, 379 Lake Innes Drive, Wauchope, NSW mesenteric lymphadenopathy, with the largest nodes estimated 2446, Australia (Frimberger). to have a maximum cross-sectional thickness of 10 to 20 mm. Address correspondence to Dr. Matthew Best; e-mail: The bilaterally enlarged ovaries were removed via ovariectomy [email protected] but rigorous resection of the generalized regional metastatic Use of this article is limited to a single copy for personal study. disease was not anatomically feasible. Histopathology confirmed Anyone interested in obtaining reprints should contact the bilateral ovarian papillary carcinoma with extensive vascular CVMA office ([email protected]) for additional and lymphatic infiltration. The diagnosis of carcinomatosis was copies or permission to use this material elsewhere. based on the clinical presentation, the gross appearance, the

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Figure 1. Sonographic image of the partially cavitated left Figure 2. Sonographic image of the right ovarian mass. Note ovarian mass. the surrounding echogenic free fluid.

presence of carcinoma cells within the effusion, and extensive Three doses of IV carboplatin (DBL Carboplatin; Hospira vascular infiltration on histology. Australia) were given at 3-weekly intervals starting 26 d after Three weeks following surgery urine culture was negative the last intracavitary chemotherapy. Complete blood cell counts and serum creatinine was normal; further urinalysis was not and serum creatinine levels were monitored before each dose performed. A blood smear was evaluated at this time with no and at 1 and 2 wk after treatment. Following 300 mg/m2 abnormalities noted in abundance or morphology of any cell carboplatin an uncomplicated VCOG-CTCAE grade 4 neu- line. Abdominal sonography showed small amounts of gener- tropenia (0.45 3 109/L) was identified on day 16. Further alized free fluid and a mildly irregular renal outline while the doses were reduced to 225 mg/m2 without further neutropenia. residual disease seen at surgery could not be identified. For 4 h Uncomplicated VCOG-CTCAE grade 2 thrombocytopenia was prior to intraperitoneal (IP) treatment saline diuresis was per- noted at 16 d following the first treatment (75 3 1012/L; RI: formed with 18.3 mL/kg body weight (BW) per hour of intra- 175 to 500 3 1012/L) and 14 d following the second treatment venous saline (0.9% NaCl) solution. Pretreatment antiemetics (92 3 1012/L). No platelet count was done after the third dose. were administered with maropitant (Cerenia; Zoetis, Silverwater, Brief abdominal sonograms at the time of the third dose of NSW, Australia), 1 mg/kg BW, SC 4 h prior to chemotherapy peritoneal cisplatin as well as the second and third doses of sys- and 2 doses of butorphanol (Torbugesic; Zoetis) 0.4 mg/kg temic carboplatin showed no evidence of free abdominal fluid. BW, IM, 4 h and 10 min prior to chemotherapy. An 18 G Monthly comprehensive abdominal sonography was performed rigid IV catheter was placed through the surgically prepared for 3 mo following completion of the course of carboplatin and ventral midline with the dog in lateral recumbency. A solution showed a very small volume of free abdominal fluid (on both of cisplatin (DBL Cisplatin; Hospira Australia, VIC, Australia) occasions a single pocket of fluid measuring less than 1 3 1 cm) was prepared in 1 L of room temperature 0.9% NaCl, using a initially, which was undetectable by 3 mo following chemother- closed system transfer device (PhaSeal, Becton, Dickinson and apy. In total, 15 abdominal sonograms were performed follow- Company, New Jersey, USA) to a total dose of 70 mg/m2. No ing completion of the initial course of chemotherapy, with the fluid was removed before instillation of this solution into the maximum period between imaging being 207 d. No sonograms peritoneal space over 5 to 10 min. The dog was rolled back and identified peritoneal-free fluid or mesenteric lymphadenopathy forth repeatedly, to distribute the fluid, then was briskly walked for the remainder of the patient’s life, with the last abdominal before a further 2 h of saline diuresis. On all occasions the imaging performed 1112 d after surgery. intracavitary chemotherapy was tolerated without any apparent At 473 d post-surgery the dog was presented with a recent discomfort or nausea. history of expiratory wheeze. While an abdominal sonogram Complete blood cell counts showed a normal leukogram on was normal at this time a bilateral pleural effusion was identi- day 7, and uncomplicated Veterinary Co-operative Oncology fied sonographically and was confirmed radiographically. No Group — Common Terminology Criteria for Adverse Events mass effect or nodular pattern was identified with either imag- (VCOG-CTCAE) grade 3 (9) neutropenia [0.84 3 109/L; ing modality. Thoracocentesis was performed and 560 mL of reference interval (RI): 2.0 to 12.0 3 109/L] on day 14. Three serosanguinous fluid was obtained. Fluid submitted for cytology further doses of cisplatin were given at 3-weekly intervals follow- showed malignant epithelial cells similar in morphology to cells ing the same protocol but with a reduced dose of 52.5 mg/m2. in the previous carcinomatosis and consistent with a high prob- These were tolerated well, and VCOG-CTCAE grade 1 neutro- ability of progressive disease. penia (1.77 3 109/L) was noted at day 20 following the fourth Thirty-two days later intrapleural cisplatin therapy was initiated. dose. Prior to each dose serum creatinine levels were evaluated, Serum creatinine was within normal limits and urine sediment was and remained within the reference interval. No gastrointestinal inactive with a negative culture and a specific gravity of 1.026. toxicities were observed. Treatment with saline diuresis and ­maropitant was ­performed,

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as previously, while butorphanol was not administered. Bilateral tively. Uncomplicated VCOG-CTCAE grade 3 neutropenia indwelling pleural access ports (Canine PleuralPort; Norfolk Vet (1.07 3 109/L) and uncomplicated VCOG-CTCAE grade 4 Products, Illinois, USA) were placed under general anesthesia. thrombocytopenia (17 3 109/L) were identified on day 15. Effusion was drained through the ports; the volume was not After 3 wk, a second dose of carboplatin was given in the recorded but was sonographically similar to the initial pleural left hemithorax at a reduced dose of 180 mg/m2. The effusion

effusion. Intrapleural chemotherapy was then performed under recurred after 1 wk and the patient was euthanized 1154 d after REPORT CASE the same general anesthesia with a total dose of 52.5 mg/m2 cis- the date of the ovariectomy. platin divided into 2 volumes of 125 mL/m2 of 0.9% NaCl each instilled into 1 hemithorax, using Huber needles (PosiGrip 22G Discussion Huber needle; Norfolk Vet Products, Skokie, Illinois, USA) to Previously reported treatments for canine ovarian carcinoma access the indwelling pleural ports. The patient was rocked fol- are mostly limited to surgical resection of gross tumor tissue lowing drug instillation and, following recovery from anesthesia, (1,3,4,10,11). Treatment of high-stage ovarian carcinoma in was taken outside for a brisk walk to aid drug distribution within dogs with IP chemotherapy has been reported very rarely the thoracic cavity. (10,12), with reports of only 3 cases of carcinomatosis treated VCOG-CTCAE grade 1 inappetence occurred during the first in this way, only 1 of which was confirmed ovarian adenocar- week after intrapleural cisplatin. Complete blood cell counts cinoma (10). were monitored at weekly intervals for 3 wk with no myelosup- In 1 case a multi-agent systemic chemotherapy protocol pression noted. Two further doses of intrapleural cisplatin were containing cyclophosphamide, chlorambucil, and nitrosurea, given at 3-week intervals, without anesthesia but otherwise fol- resulted in at least 10 mo remission (13). In the single case of lowing the same protocol. Thoracocentesis was also performed IP cisplatin as a treatment of canine ovarian carcinoma a second on these occasions with 310 mL and 410 mL removed from the look celiotomy soon after 5 treatments of IP cisplatin suggested left hemithorax and no effusion noted on the right. While no a complete remission, but the dog died acutely of hemoabdomen adverse effects were noted, a self-limiting episode of presumed 2 mo later (10). Another study retrospectively reviewed the use unrelated infectious tracheitis was diagnosed at an emergency of intracavitary carboplatin and/or mitoxantrone in dogs with clinic 10 d after the second dose. carcinomatosis, sarcomatosis, or mesothelioma; however, there A fourth dose of intrapleural cisplatin was intended but were no cases of ovarian carcinoma or peritoneal effusion (14). VCOG-CTCAE grade 1 azotemia developed (creatinine While the evidence in veterinary medicine regarding intra- 172 mmol/L RI: , 159 mmol/L), with concurrent urine cavitary chemotherapy is sparse, this treatment remains part of specific gravity of 1.027, after a total cumulative cisplatin the standard of care for high stage ovarian carcinoma in human dose of 385 mg/m2. As thoracic and abdominal sonograms medicine and accordingly there has been extensive research demonstrated no evidence of disease at this time, cisplatin was into maximizing its efficacy. Experimental animal research discontinued. Consideration was given to using further cycles of (15,16) and human trials (6,7,17,18) demonstrate the benefits IV carboplatin as had been done previously. The dog tolerated of IP cisplatin therapy over IV chemotherapy in abdominal IV carboplatin well at that time and renal function was normal; carcinomatosis. Cisplatin has been demonstrated to penetrate however, as carboplatin is renally excreted, it was considered that into the tissue to a greater depth than carboplatin when given risk of side effects was now higher. Therefore considering the as an IP dose (19) and for this reason cisplatin was selected remission status, the potential for risk was considered greater for intracavitary chemotherapy in this case. Despite this, the than the potential for benefit and no further chemotherapy was penetration of cisplatin is only a few millimeters (15) limiting administered at this time. its use as a sole therapy. Several techniques have been developed Monitoring by thoracic and abdominal sonography and aspi- to combat this problem including cytoreductive surgery prior ration via the ports showed no evidence of disease at rechecks to chemotherapy (6,8,20), the use of IV chemotherapy fol- 231 and 438 d following the first dose of intrapleural cisplatin. lowing IP treatment including cisplatin (21), and measures to At 607 d following the first pleural cisplatin the patient was increase the penetration of the cisplatin including hypotonic presented with a 2-week history of lethargy, increased respiratory carrier fluids (22), instillation of adrenaline in the carrier effort, reduced appetite, and coughing. Abdominal sonography fluids (23), regional hyperthermia (23–25), use of IV sodium showed no evidence of malignancy but thoracic radiographs thiosulfate to reduce systemic side effects and so allow the use showed left-sided effusion. Aspiration yielded 450 mL of fluid of a higher IP dose (26), and high pressure abdominal lavage from the left hemithorax which cytologically revealed large (27). To date none of these have been investigated in dogs. numbers of neoplastic epithelial cells consistent with metastatic Reducing disease to , 1 cm rather than , 2 cm would intui- ovarian carcinoma. Repeated aspiration was required at 2- to tively be expected to be more efficacious; however, while this 7-day intervals with similar volumes returned. is suggested in some studies, a conclusive benefit has not been Twelve days following recurrence, creatinine was 164 mmol/L demonstrated (8). and 225 mg/m2 carboplatin was administered into the left In our case cytoreduction was performed but residual disease hemithorax in 250 mL of 0.9% NaCl through the indwell- exceeded the recommended maximum thickness in human ing pleural access port. Following a short improvement in medicine of 1 cm, although it was less than a previously used clinical signs thoracocentesis was required at 15 and 18 d with cut-off of 2 cm for optimal cytoreduction (7,8). In 1 random- 520 mL and 548 mL removed from the left hemithorax, respec- ized study in humans there was a significant benefit to the use

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of IV cisplatin with cytoreduction to a maximum diameter of References 2 cm (18). For this reason a combination of IP cisplatin followed 1. Saba SF, Lawrence JA. Tumours of the female reproductive system. by carboplatin IV was used to address the need for deeper tissue In: Withrow SJ, Vail DM, Page RL, eds. Withrow & MacEwen’s penetration resulting from suboptimal cytoreduction. It was not Small Animal Clinical Oncology. 5th ed. St. Louis, Missouri: Elsevier Saunders, 2013:532–537. clear whether the addition of IV therapy was necessary and it is 2. Dow C. Ovarian abnormalities in the bitch. J Comp Pathol 1960;70: possible that the IP cisplatin reduced the tumor burden to the 59–69. extent that complete penetration became possible during later 3. Patnaik AK, Greenlee PG. Canine ovarian neoplasms: A clinico- pathological study of 71 cases, including histology of 12 granulosa cell treatments. Previous studies in humans have suggested that 5 or tumors. Vet Pathol 1987;24:509–514. 6 cycles of platinum chemotherapy may be as effective as 10 or 4. Diez-Bru N, Garcia-Real I, Martinez EM, Rollan E, Mayenco A, 12 cycles (28,29). In this case the initial protocol of 7 cycles Llorens P. Ultrasonographic appearance of ovarian tumours in 10 dogs. Vet Radiol Ultrasound 1998;39:226–233. allowed a short course of each IP and IV chemotherapies and 5. Petterino C, Modesto P, Ratto A. A bilateral ovarian psammomatous RAPPORTCAS DE kept the total number of treatments similar to these studies papillary cystic adenocarcinoma in a German shepherd bitch. Comp (28,29). Indeed the presumed recurrence of disease within Clin Pathol 2010;19:389–395. 6. Zeimet AG, Reimer D, Radl AC, et al. Pros and cons of intraperitoneal the pleural space was controlled for 607 d with just 3 doses of chemotherapy in the treatment of epithelial ovarian cancer. Anticancer intracavitary cisplatin, although it is not known whether this Res 2009;29:2803–2808. would have been the best possible outcome. The protocols used 7. Cannistra SA, Gershenson DM, Recht A. Ovarian cancer, fallopian tube carcinoma, and peritoneal carcinoma. In: Devita VT, Lawrence TS, were tolerated extremely well clinically, though dose reductions Rosenberg SA, DePinho RA, Weinberg RA, eds. DeVita, Hellman, were required for both drugs due to asymptomatic neutropenia and Rosenberg’s Cancer: Principles & Practice of Oncology. 9th ed. with cisplatin and asymptomatic neutropenia and thrombocy- Philadelphia, Pennsylvania: Lippincott, Williams and Wilkins, 2011: 1368–1384. topenia with carboplatin. This is of particular interest because 8. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. a perceived high morbidity of intracavitary cisplatin in humans Survival effect of maximal cytoreduction surgery for advanced ovarian has reduced its uptake by oncologists (7). carcinoma during the platinum era: A meta-analysis. J Clin Oncol 2002; 20:1248–1259. This case also highlights potential use of pleural access 9. Veterinary Co-operative Oncology Group. Veterinary co-operative devices for chemotherapeutic drug administration as well as oncology group — common terminology criteria for adverse events symptomatic/­palliative thoracocentesis with the ports remain- (VCOG-CTCAE) following chemotherapy or biological antineoplastic therapy in dogs and cats v1.0. Vet Comp Oncol 2004;2:194–213. ing fully functional and without adverse effects for 649 d. The 10. Olsen J, Komtebedde J, Lackner A, Madewell BR. Cytoreductive treat- use of pleural access ports has previously been described in the ment of ovarian carcinoma in dog. J Vet Intern Med 1994;8:133–135. veterinary literature (30) and these ports are reported by the 11. Yotov S, Simeonov R, Dimitrov F, Vassilev N, Dimitrov M, Georgiev P. Papillary ovarian cystadenocarcinoma in a dog. J S Afr Vet Assoc 2005; manufacturer to be indicated for administration of chemo- 76:43–45. therapy agents (31). To our knowledge functional ports have not 12. Moore AS, Kirk C, Cardona A. Intracavitary cisplatin chemotherapy been reported for this duration in dogs and their use for intra- experience with six dogs. J Vet Intern Med 1991;5:227–231. 13. Greene JA, Richardson RC, Thornhill JA, Boon GD. Ovarian papillary pleural chemotherapy has not been described in peer-reviewed cystadenocarcinoma in a bitch: Case report and literature review. J Am veterinary literature prior to this article. Anim Hosp Assoc 1979;15:351–356. There is no well-established survival time for ovarian carci- 14. Charney SC, Bergman PJ, McKnight JA, et al. Evaluation of intra- cavitary mitoxantrone and carboplatin for treatment of carcinomatosis, noma in dogs, though the prognosis is considered poor in cases sarcomatosis and mesothelioma, with or without malignant effusions: with metastatic disease (1). The outcome in this case compares A retrospective review of 12 cases (1997–2002). Vet Comp Oncol 2005; favorably with average survival times for high-stage ovarian 3:171–181. 15. Los G, Mutsaers PHA, Lenglet WJM, Baldew GS, McVie J. Platinum carcinoma in humans (6,17,18,20). This case demonstrates distribution in intraperitoneal tumors after intraperitoneal cisplatin long-term resolution of a peritoneal malignant effusion with treatment. Cancer Chemother Pharmacol 1990;25:389–394. surgery and intracavitary and systemic chemotherapy and a 16. Pretorius RG, Petrilli ES, Kean CK, Ford LC, Hoeschele JD, Lagasse LD. Comparison of the IV and IP routes of administration of long-term (607 d) remission from a malignant pleural effusion cisplatin in dogs. Cancer Treat Rep 1981;11–12:1055–1062. with intracavitary chemotherapy alone. It can only be speculated 17. Armstrong DK, Bundy B, Wenzel L, et al. Intraperitoneal cisplatin and as to whether or not longer remission of the thoracic component paclitaxel in ovarian cancer. New Engl J Med 2006;354:34–43. 18. Alberts DS, Liu PY, Hannigan EV, et al. Intraperitoneal cisplatin plus of the disease could have been achieved if renal compromise had intravenous cyclophosphamide versus intravenous cisplatin plus intra- not curtailed the course of intrapleural cisplatin. venous cyclophosphamide for stage III ovarian carcinoma. New Engl J This case demonstrates the potential for long-term responses Med 1996;335:1950–1955. 19. Los G, Verdegaal EME, Mutsaers PHA, McVie JG. Penetration of car- to intracavitary chemotherapy and may provide encouragement boplatin and cisplatin into rat peritoneal tumor nodules after intraperi- to clinicians in the face of otherwise sparse information in the toneal chemotherapy. Cancer Chemother Pharmacol 1991;28:159–165. literature regarding the management of ovarian carcinomatosis. 20. Sugarbaker PH. Intraperitoneal chemotherapy and cytoreductive sur- gery for the prevention and treatment of peritoneal carcinomatosis and Canine ovarian carcinoma with carcinomatosis should be con- sarcomatosis. Semin Surg Oncol 1998;14:254–261. sidered a disease for which there may be reasonable palliative 21. Nicoletto MO, Dalla Palma M, Donach ME, et al. Positive experience options. Further study is needed to define case selection and of intraperitoneal chemotherapy followed by intravenous chemotherapy in heavily pretreated patients with suboptimal residual ovarian cancer treatment protocols to optimize the role of intracavitary chemo- and primary peritoneal cancer. Tumori 2010;96:918–925. therapy in canine carcinomatosis. This case report also highlights 22. Tsujitani S, Oka A, Kondo A, et al. Administration in a hypotonic the potential for indwelling pleural access ports to be used as solution is preferable to dose escalation in intraperitoneal cisplatin che- motherapy for peritoneal carcinomatosis in rats. Oncol 1999;57:77–82. a convenient and safe method to administer chemotherapeutic 23. Facy O, Radais F, Ladoire S, et al. Comparison of hyperthermia and agents. CVJ adrenaline to enhance the intratumoral accumulation of cisplatin in

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a murine model of peritoneal carcinomatosis. J Exp Clin Cancer Res 28. Hakes TB, Chalas E, Hoskins WJ, et al. Randomized prospective trial 2011;30:4–12. of 5 versus 10 cycles of cyclophosphamide, doxorubicin, and cisplatin 24. Barnes AP, Miller BE, Kucera GL. Cyclooxygenase inhibition and in advanced ovarian carcinoma. Gynecol Oncol 1992;45:284–289. hyperthermia for the potentiation of the cytotoxic response in ovarian 29. Bertelsen K, Jakobsen A, Strøyer I, et al. A prospective randomized cancer cells. Gyn Oncol 2007;104:443–450. comparison of 6 and 12 cycles of cyclophosphamide, adriamycin, and 25. Roviello F, Pinto E, Corso G, et al. Safety and potential benefit of cisplatin in advanced epithelial ovarian cancer: A Danish ovarian study hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal group trial (DACOVA). Gynecol Oncol 1993;49:30–36. carcinomatosis from primary or recurrent ovarian cancer. J Surg Oncol 30. Brooks AC, Hardie RJ. Use of the PleuralPort device for management REPORT CASE 2010;102:663–670. of pleural effusion in six dogs and four cats. Vet Surg 2011;40:935–941. 26. Abe R, Akiyoshi T, Baba T. ‘Two-route chemotherapy’ using cisplatin 31. Norfolk Vet Products. PleuralPortTM designed to simplify pleural drain- and its neutralizing agent, sodium thiosulfate, for intraperitoneal cancer. age [Product information on the internet]. Norfolk Vet Products, Illinois Oncol 1990;47:422–426. 2011. Available from: http://www.norfolkvetproducts.com/pleuralport. 27. Esquis P, Consolo D, Magnin G, et al. High intra-abdominal pres- html Last accessed February 15, 2017. sure enhances the penetration and antitumor effect of intraperito- neal cisplatin on experimental peritoneal carcinomatosis. Ann Surg 2006;244:106–112.

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Purina Launches Neurologic Breakthrough in Canine Nutrition Thousands of dogs with idiopathic epilepsy Glucose serves as the primary fuel for the brain; however, may soon benefit from Purina’s introduc- brain glucose metabolism is compromised in patients with tion of the first and only therapeutic diet epilepsy, creating a need for an alternate source of brain energy. indicated to help nutritionally manage dogs According to Dr. Gagné, adding ketones as an energy source with this condition as an adjunct to veteri- for the brain is an approach that has been used for decades in nary therapy. children with epilepsy;6 however, the human “ketogenic” diet, Purina® Pro Plan® Veterinary Diets NC which is high in fat and low in protein and carbohydrates, has NeuroCareTM is formulated with medium yet to be shown to significantly improve seizures in dogs as it chain triglyceride (MCT) oil to help nutri- does in humans.7 tionally manage dogs with epilepsy that Fortunately, dogs can readily metabolize medium chain tri- are also being administered anti-epilepsy glycerides (MCTs) to produce ketones.8 Experts also believe that drugs (AEDs). The diet is enhanced with a unique blend of dietary MCTs may have direct antiseizure effects via blocking nutrients — eicosapentaenoic acid (EPA), docosahexaenoic acid the Alpha-Amino-3-Hydroxy-5-Methyl-4Isoxazolepropionic (DHA), antioxidants and B vitamins, as well as MCT oil — to Acid (AMPA) receptors in the brain.9 help nutritionally manage dogs with cognitive dysfunction A six-month randomized placebo-controlled, double-blinded syndrome (CDS). crossover study conducted in dogs with idiopathic epilepsy at Idiopathic epilepsy is the most commonly diagnosed neuro- the Royal Veterinary College in London, in partnership with logical disorder in dogs.1 Unfortunately, the reality for many Purina, demonstrated for the first time that a diet with MCT affected dogs — and owners — is living with debilitating, oil can have positive effects on reduction of seizure frequency uncontrolled seizures and/or unpleasant medication side effects. when fed as an adjunct to veterinary therapy.8 Results included: “More than two-thirds of dogs with epilepsy continue to • 71% of dogs showed a reduction in seizure frequency have seizures long-term, despite treatment,2 and 20–30 per- • 48% of dogs showed a 50% or greater reduction in seizure cent of affected dogs remain poorly controlled,”3,4,5 explains frequency Jason Gagné, DVM, DACVN, Director, Veterinary Technical • 14% of dogs achieved complete seizure freedom Marketing for Purina Pro Plan Veterinary Diets. Meanwhile, Based on this information, Purina developed its NeuroCare diet, medications such as phenobarbital and potassium bromide formulating it with MCT oil. Dr. Gagné notes that NeuroCare is are commonly associated with such side effects as polyphagia, formulated with lower amounts of fat and higher proportions of weight gain, polydipsia, polyuria, sedation, restlessness, lethargy protein and carbohydrates than the traditional human ketogenic and ataxia. The result: only four percent of veterinarians sur- diet. “This provides for a complete and balanced diet — which is veyed reported being either “totally” or “mostly” satisfied with important, given that epileptic dogs need to be on this specialized current treatment options.1 diet for the remainder of their lives,” he explains.

CVJ / VOL 58 / MAY 2017 497 FOR PERSONAL USE ONLY Case Report Rapport de cas

Femoral head ostectomy and medial patellar ligament desmotomy to treat a pregnant miniature horse with coxofemoral joint luxation and upward fixation of the patella

Elsa K. Ludwig, Christopher R. Byron

Abstract — A 2-year-old, 8-weeks pregnant, non-weight bearing miniature horse mare was treated for a 6-day-old left coxofemoral joint luxation with a femoral head ostectomy. The procedure had no negative effects on pregnancy or parturition and 23 months following surgery the horse had minimal lameness.

Résumé — Ostectomie de la tête fémorale et desmotomie du ligament patellaire médial pour traiter une jument miniature gravide atteinte d’une luxation de l’articulation coxofémorale et d’une fixation supérieure de la rotule. Une jument miniature non portante gravide de 8 semaines et âgée de 2 ans a été traitée pour une luxation de l’articulation coxofémorale gauche datant de 6 jours à l’aide d’une ostectomie de la tête fémorale. L’intervention n’a pas eu d’effets négatifs sur la gestation ou la parturition et 23 mois après la chirurgie, la jument présentait une boiterie minime. (Traduit par Isabelle Vallières) Can Vet J 2017;58:498–502 Case description mechanical lameness caused by the upward fixation of the patella made assignment of the lameness grade difficult, but it 2-year-old, 113 kg, miniature horse mare that was approxi- was estimated at AAEP grade 4/5 (1). The left hind limb was mately 8 wk pregnant was referred to the large animal hos- A rotated externally and there was moderate edematous swelling of pital at the Virginia-Maryland College of Veterinary Medicine the hock and mild distal limb edema. The cause of the moderate (VMCVM) Veterinary Teaching Hospital (VTH) because of limb swelling was unknown, but could have been attributed to non-weight bearing left hind limb lameness. The owners found prior limb manipulation or dependent edema secondary to the the mare non-weight bearing on that limb in a paddock 6 d coxofemoral joint luxation. The right and left hip joint regions before presentation at the VMCVM hospital. Initially, the mare were asymmetric in appearance and the greater trochanter of the had been admitted to another large animal hospital, where the left femur was displaced proximally (as determined via palpa- horse was diagnosed with a luxated left coxofemoral joint. Four tion). No crepitus was palpated when the left coxofemoral joint days before the mare arrived at the VMCVM hospital, 5 unsuc- was manipulated. The remainder of the physical examination cessful attempts at closed reduction of the left coxofemoral joint was unremarkable. A transabdominal ultrasound examination under general anesthesia had been performed at the other large revealed no abnormalities of the pregnancy. Standing radio- animal hospital. The mare’s lameness did not improve following graphs of the pelvis (laterolateral and lateral-oblique projec- attempted closed reduction of the coxofemoral joint, and the tions) were obtained with the mare unsedated and a diagnosis owners elected to bring the horse to the VMCVM hospital for of craniodorsal luxation of the left coxofemoral joint was made further assessment. (Figure 1). Physical examination at the time of arrival at the VMCVM Due to the 6-day duration of the coxofemoral joint luxation VTH revealed that the mare had a non-weight bearing lame- and previous failure at closed reduction, the owners elected to ness of the left hind limb with upward fixation of the patella have a femoral head ostectomy procedure performed for the in that limb. The mare would not place the foot down when mare. Financial limitations of the owners dictated the need for ambulating, and would toe-touch when non-ambulatory. The a surgical procedure that could be performed relatively rapidly and did not require extensive follow-up care. Additionally, Department of Large Animal Clinical Sciences, Virginia- left medial patellar ligament desmotomy was planned for the Maryland College of Veterinary Medicine, Blacksburg, Virginia correction of upward fixation of the patella. Perioperative and 24061, USA. postoperative antimicrobial and anti-inflammatory medications Address all correspondence to Dr. Elsa Ludwig; e-mail: were administered. Potassium penicillin G (Pfizerpen; Pfizer, [email protected] New York, New York, USA), 22 000 IU/kg body weight (BW), Use of this article is limited to a single copy for personal study. IV, q6h, and gentamicin (Sparhawk Laboratories, Lenexa, Anyone interested in obtaining reprints should contact the Kansas, USA), 6.6 mg/kg BW, IV, q24h were administered for CVMA office ([email protected]) for additional 3 d, followed by sulfamethoxazole-trimethoprim (Aurobindo copies or permission to use this material elsewhere. Pharma USA, Cranbury, New Jersey, USA), 30 mg/kg BW, PO,

498 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY CASE REPORT CASE

Figure 1. Perioperative standing lateral-oblique radiograph of Figure 2. Photograph of the mare trotting with her foal a luxated left coxofemoral joint in a 2-year-old female miniature 10 months after surgery. horse. The left femoral head is luxated craniodorsally. q12h for 14 d. Phenylbutazone liquid (MWI/VetOne, Boise, ciate pattern. The subcutaneous tissue was closed using No. 0 Idaho, USA), 4.4 mg/kg BW, IV, q12h was also administered polygalactin 910 in a simple continuous pattern. The skin was for 5 d, then phenylbutazone 1-g tablets (First Priority, Elgin, closed using No. 2-0 polypropylene suture (Prolene; Ethicon, Illinois, USA), 2.2 mg/kg BW, PO, q12h for 5 d. San Lorenzo, Puerto Rico) in an interrupted cruciate pattern. A After sedation with acepromazine (MWI/VetOne), 0.02 mg/kg stent bandage was applied over the closed incision. Total surgi- BW, IV and xylazine (MWI/VetOne), 0.5 mg/kg BW, IV, gen- cal time was 135 min. The horse’s recovery from anesthesia was eral anesthesia was induced with tiletamine/zolazapam (Telazol; hand-assisted and without complications. Immediately following Zoetis, Exton, Pennsylvania, USA), 2.0 mg/kg BW, IV and pro- recovery, the horse received a dose of butorphanol (Turbogesic; pofol (Zoetis), 0.4 mg/kg BW, IV, and maintained with balanced Zoetis), 0.04 mg/kg BW, IM, once. The mare bore full weight inhalation anesthesia using isoflurane (Isoflo; Zoetis) in oxygen on the left hind limb and ambulated with minimal discomfort. in a semiclosed circle system. The mare was positioned in right The mare was hospitalized for 4 d following surgery, during lateral recumbency and the surgical sites were clipped, aseptically which time she seemed comfortable and was able to bear full prepared, and surgically draped. weight on the left hind limb. The stent bandage was removed The left medial patellar ligament desmotomy was performed 3 d after surgery, and the incision appeared to be healing appro- first, as previously described (2). Following the left medial priately. The mare walked with a moderate lameness (AAEP patellar ligament desmotomy, the left femoral head ostectomy grade 4/5) (1) that gradually improved during hospitalization. was performed by use of a craniolateral approach to the coxo- Transrectal ultrasonography was performed prior to the mare’s femoral joint. A 30-cm curvilinear skin incision was made over discharge from the hospital; a moving fetus was visualized and the craniolateral aspect of the left coxofemoral joint, extending a fetal heartbeat was detected. Due to the owners’ financial over the cranial aspect of the greater trochanter and continuing limitations, post-operative radiographs were not taken. At the parallel to the long axis of the femur. The superficial gluteal time of discharge the mare weighed 116 kg. muscle over the greater trochanter was incised and retracted Clinicians recommended to the owners that they house the caudodorsally. The tensor fascia latae and vastus lateralis muscle mare in a small paddock for a minimum of 2 mo, allowing were separated via blunt and sharp dissection and retracted the mare to ambulate in a quiet environment. The mare was caudally. The caudal part of the greater trochanter was palpated rechecked by the referring veterinarian and the skin sutures were and used as a guide for the approach to the femoral head in its removed 14 d after surgery. Passive range of motion exercises craniodorsally displaced location. The middle and deep gluteal of the left hind limb were performed by the owners for 10 min muscles were partially transected and retracted cranially and several times each day. caudally to obtain access to the femoral head. The ilium was The mare returned to the VMCVM VTH 10 wk after sur- palpated axial to the head of the femur. Hohmann bone eleva- gery for examination of the fetus and assessment of surgical site tors were used to rotate and elevate the femoral head from the healing. The mare was housed in a pasture at this time and the surrounding tissue. Femoral head ostectomy was performed owners were continuing left hind limb passive range of motion using an oscillating bone saw to establish a cutting plane along exercises. The owners reported that the patient was fully weight the neck of the femoral head, and an osteotome was used to bearing on the affected limb and seemed comfortable, but they complete the femoral head transection. The transected surface had not observed the horse to lie down. The mare had a moder- of the femur was smoothed with a bone rasp and the surgical site ate hip hike when ambulating (AAEP lameness grade 4/5) (1) was copiously lavaged with sterile saline (0.9% NaCl) solution. and a shorter stride of the left hind limb compared with the No. 0 polygalactin 910 (Vicryl; Ethicon, Somerville, New Jersey, right hind stride. The left hind limb seemed to be mildly shorter USA) was used to close the muscle layers in an interrupted cru- than the right hind limb and there was moderate muscle atrophy

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of the left gluteal muscles. The surgical sites had healed appro- the ileum is more likely to fracture than the coxofemoral joint priately without complications. Transabdominal ultrasonography luxating as a result of trauma (6). Additionally, coxofemoral lux- was performed and a viable fetus with a heartbeat was detected. ations can occur during recovery from anesthesia, due to a hind Approximately 6 mo after surgery, the mare was re-evaluated limb cast or previous injury, or secondary to upward fixation at the VMCVM hospital. At that time, the mare weighed 121 kg of the patella (5–7,13–15). Some authors have speculated that and was housed in a stall at night and on pasture during the day. upward fixation of the patella can cause a strong contraction of The horse was reported to ambulate with ease, but still had not the quadriceps femoris muscle as the horse attempts to flex the been observed to lie down. The owners continued to perform locked stifle, resulting in coxofemoral joint luxation (3,6,9,16). passive range of motion exercises of the affected limb. The left Alternatively, a luxated coxofemoral joint may cause external hind limb remained slightly shorter than the right hind limb. rotation of the hind limb: the rectus femoris muscle is unable to Lameness examination at the walk revealed a mild hip hike of release the patella and the mechanics of the femoropatellar joint RAPPORTCAS DE the left hind limb and shorter stride compared with the right are altered, resulting in upward fixation of the patella (5,7,9,11). hind limb, which was improved from the previous assessment. The inciting cause of coxofemoral joint luxation in the horse A hoof pad was conformed to the shape of the horse’s left hind of this report was unknown, as the mare was found lame in hoof and applied to the sole with elastic tape to elevate the limb the paddock. After the horse was diagnosed with the luxation to the same height as the right hind. Following application of and the upward fixation of the patella, the owners reported the the hoof pad, the mare immediately walked with a longer left mare might have had previous episodes of a locked left stifle. hind stride, matching the stride length of the right hind limb. Therefore, it is possible that upward fixation of the patella may The owners were advised to continue with the passive range of have resulted in the coxofemoral joint luxation in this mare. motion exercises and keep the left hind hoof pad in place. Alternatively, the mare could have suffered an unseen trauma Follow-up telephone communication with the owners was which resulted in the coxofemoral joint luxation. regularly obtained weekly and multiple visits of one author Horses affected with coxofemoral joint luxation have severe (EKL) were performed to the horse’s farm. The mare’s comfort lameness, with the affected limb rotated externally (the toe improved dramatically following the application of the left hind and stifle point away from the horse) (3,6–11). The pelvis may hoof pad. The horse was noted to trot in the pasture, and get appear asymmetric and the affected limb may be shorter than up and down from recumbency with ease. Nine months after the contralateral limb (8,10,16). The shortened limb length can surgery, the mare successfully foaled, after which the left hind result in a decreased cranial stride length of the affected limb hoof pad was no longer applied and passive range of motion when ambulating (3,7). Manipulation of the affected hind limb exercises were discontinued. Immediately post-parturition, the may result in detection of crepitus or signs of pain (3,7,10,16). mare became substantially more active in the pasture, trotting The mare in this report had external rotation of the left hind and cantering with minimal lameness (Figure 2). The mare was limb and asymmetry of the pelvis, but no crepitus when the successfully re-bred via live cover and foaled with no complica- limb was manipulated. Diagnosis of coxofemoral joint luxa- tions. Lameness examination performed by one author (EKL) tion can be made on the basis of patient history, clinical signs, 17 mo after surgery revealed the mare’s hind limbs to be similar and diagnostic imaging. Radiography can be performed for a lengths, with the left hind limb very mildly shorter than the standing or anesthetized patient to confirm the diagnosis and right hind limb, and there was no atrophy of muscles of the rule out other potential injuries (3,9). Ventrodorsal radiographic left hind limb. There was minimal lameness (AAEP grade 1/5) views of the pelvis are typically obtained for patients during (1) observed at the walk, trot, and canter, and the left hind general anesthesia; however, ventrodorsal radiographic views limb flexed and extended normally. At the time of most recent have been obtained in standing animals (9,11,15,17,18). The follow-up, 23 mo following surgery, the owners were extremely use of general anesthesia to facilitate radiographic imaging is satisfied with the mare’s comfort level and minimal lameness. an added expense, and carries risks associated with anesthetic use and patient recovery (9,19). Laterolateral and lateral- Discussion oblique radiographic views performed for standing horses are We treated a coxofemoral joint luxation in a large, pregnant adequate for diagnostic imaging of coxofemoral joint luxation miniature horse with a femoral head ostectomy. The mare and were performed on the horse in this report (6,9,16,20,21). recovered from the procedure with relative ease, successfully Ultrasonography can also be used to diagnose coxofemoral joint foaled, and has remained comfortable with minimal lameness luxation and subluxation for standing horses (3,10,18,19). after surgery. Coxofemoral joint luxation is an uncommon injury Treatment options for coxofemoral joint luxations include in horses (3–7). The heavy musculature, round ligament, and closed reduction, open reduction, greater trochanter trans- accessory ligament of the femoral head, and transverse acetabular position, augmentation of the lateral joint capsule, toggle ligament that surrounds the acetabulum provide strength and pinning, total hip arthroplasty, or femoral head ostectomy stability to the hip (3,5,7–9). Equine coxofemoral joint luxa- (3,4,6–8,10,11,15,16,20,22,23). Closed reduction is often tions, therefore, are frequently caused by a traumatic event, such not successful or re-luxation can occur quickly (3 8). Failure of as a kick or fall (3–8,10–12). Coxofemoral joint luxation is closed coxofemoral joint luxation reduction is often attribut- typically unilateral with the femoral head oriented craniodorsal able to blood clots, granulation tissue, joint capsule, tissue, or to the acetabulum; foals, ponies, and miniature horses are most ligamentous debris in the acetabulum and the contraction of commonly reported (4,5,7,8,12). In full sized horses, however, surrounding musculature (3–5,8,11,21,22). Results of 1 study

500 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY reported 4 of 5 horses with coxofemoral luxation treated via following surgery and continued to improve during the follow- closed reduction re-luxated (7) and for patients in which closed ing 23 mo. Previously published reports described a range of reduction was successful, osteoarthritis, and persistent lame- post-operative lameness, with the AAEP lameness scale used in ness developed (6). Greater trochanter osteotomy provides only 2 cases, and these cases involved AAEP grades 2/5 and 3/5 good exposure of the coxofemoral joint and increases ease of (15–17,20,21,24). The mare in this report was AAEP grade 1/5 manipulation (21,24). Also, a greater trochanter transposition at the last examination. Left hind limb passive range of motion REPORT CASE procedure provides further support to the reduced luxation (4). exercises and the addition of a hoof pad to the left hind hoof Joint capsule augmentation and toggle pinning have been used may have contributed to the horse’s minimal lameness. The successfully in combination or alone in several cases (4,10,11). gradual postoperative recovery resulted in the horse having Total hip arthroplasty has been attempted for 3 patients, but similar hind limb lengths and no obvious atrophy of the left these animals did not survive to hospital discharge (22,23). gluteal muscles. Femoral head ostectomy is generally considered to be a Femoral head ostectomy for the treatment of a chronic salvage procedure for horses with coxofemoral joint luxation coxofemoral joint luxation was successful in this large, preg- (4,8,22,24). During this procedure, the head of the femur is nant miniature horse, with no negative effects on postoperative excised; after surgery, a pseudoarthrosis forms that provides pain parturition and re-breeding. Additionally, the mare was able to relief to the horse (15,16,20). Rasping the transected end of the return to near-baseline soundness (AAEP grade 1/5 lame), an femur smoothes the bone, helping to prevent osteochondral improvement over previous reports of femoral head ostectomy in fragmentation and postoperative lameness (16,24). Authors of horses (1,16,17,21,24). Femoral head ostectomy can result in an previous studies have concluded that patient prognosis following excellent outcome for treatment of coxofemoral joint luxations femoral head ostectomy is mainly dependent on patient weight, in large miniature horses and ponies. CVJ with a favorable prognosis for patients weighing less than 100 kg (21,24,25). In a report on femoral head ostectomies in 9 horses, References 6 horses weighed 100 kg or greater (range: 100 to 225 kg) at . 1 American Association of Equine Practitioners. Guide for veterinary service the time of surgery, and 4 of these 6 horses were euthanized and judging of equestrian events. Lexington, Kentucky: AAEP 1991. after surgery (24). Overall, the prognosis following treatment 2. Walmsley JP. Medial patellar desmotomy for upward fixation of the patella. Equine Vet Educ 1994;6:148–150. of coxofemoral joint luxations is guarded, with 50% or fewer 3. Baxter GM. The femur and coxofemoral joint. In: Baxter GM, Adams of horses surviving (7,8,10,17,24). If reduction of the femoral OR, eds. Adams and Stashak’s Lameness in Horses. 6th ed. Ames, Iowa: head in the acetabulum is maintained, most horses are sound Wiley-Blackwell, 2011:827–829. 4. Garcia-Lopez JM, Boudrieau RJ, Provost PJ. Surgical repair of coxo- enough for breeding, with a small number of horses returning femoral luxation in a horse. J Am Vet Med Assoc 2001;219:1254–1258. to complete soundness (3). 5. Bennett D, Campbell JR, Rawlinson JR. Coxofemoral luxation compli- The 6-day duration of the coxofemoral joint luxation and cated by upward fixation of the patella in the pony. Equine Vet J 1977; 9:192–194. failures at closed reduction resulted in the decision to perform 6. Clegg PD, Butson RJ. Treatment of a coxofemoral luxation secondary femoral head ostectomy for the mare of this report. Our treat- to upward fixation of the patella in a Shetland pony. Vet Rec 1996;138: ment goal was to improve the mare’s comfort to a level that 134–137. 7. Malark JA, Nixon AJ, Haughland MA, Brown MP. Equine coxofemoral would allow breeding and a high quality of life during pasture luxations: 17 cases (1975–1990). Cornell Vet 1992;82:79–90. activity. This horse was pregnant; to our knowledge, this surgi- 8. Ducharme NG. Pelvic fracture and coxofemoral luxation. In: Nixon AJ, cal technique has not been reported for a pregnant mare. Other ed. Equine Fracture Repair. Philadelphia, Pennsylvania: Saunders, 1996: 295–298. mares have been reported to successfully foal following femoral 9. Amitrano FN, Gutierrez-Nibeyro SD, Joslyn SK. Radiographic diagnosis head ostectomy, but the surgical procedure was performed for of craniodorsal coxofemoral luxation in standing equids. Equine Vet these mares when they were foals (1-week-old, 1-month-old, Educ 2014;26:255–258. 10. Richardson DW. Femur and pelvis. In: Auer JA, Stick JA, eds. Equine and 4-months-old), allowing for prolonged postoperative heal- Surgery. 4th ed. St. Louis, Missouri: Elsevier/Saunders, 2012:1451. ing prior to maturation, pregnancy, and parturition (17,24). 11. Kuemmerle JM, Fürst AE. Treatment of a coxofemoral luxation in a Additionally, this horse weighed 113 kg at the time of surgery, pony using a prosthetic capsule technique. Vet Surg 2011;40:631–635. 12. Barr ARS, Fairburn AJ. Aspects of coxofemoral luxations in the horse. which was heavier than most horses for which femoral head Equine Vet Educ 2014;26:259–261. ostectomy procedures had been previously reported, and the 13. Portier K, Walsh CM. Coxofemoral luxation in a horse during recovery mare was gaining weight due to pregnancy (15–17,20,21,24). from general anaesthesia. Vet Rec 2006;159:84–85. 14. Trotter GW, Auer JA, Arden W, Parks A. Coxofemoral luxation in two We were uncertain as to whether the mare in this study would foals wearing hindlimb casts. J Am Vet Med Assoc 1986;189:560–561. be able to carry a fetus to term, support the additional weight 15. Platt D, Wright IM, Houlton JEF. Treatment of chronic coxofemoral of the foal, and foal successfully following the femoral head luxation in a Shetland pony by excision arthroplasty of the femoral head: A case report. British Vet J 1990;146:374–379. ostectomy. The mare was able to foal with no complications, 16. Toth F, Adair HS, Holder TE, Schumacher J. Femoral head ostectomy was rebred via live-cover, showing no signs of discomfort from to treat a donkey for coxofemoral luxation. Equine Vet Educ 2007; the weight of the stallion during breeding, and was able to foal 19:478–481. 17. Gracia Calvo LA, Martín-Cuervo M, Peña E, Fruto J, Jiménez J, a second time successfully. Ezquerra LJ. Femoral head excision after coxofemoral luxation in an While there are other published reports on successful femoral Arab filly: Four years follow-up. Equine Vet Educ 2011;23:346–352. head ostectomies in equines, few have the detailed follow-up 18. Brenner S, Whitcomb MB, Green EM, eds. How to diagnose equine coxofemoral subluxation with dynamic ultrasonography. Proc of this report (15–17,20,21,24). The comfort level and lame- 53rd Annual Convention of the American Association of Equine ness for the patient of this report were improved immediately Practitioners, Orlando, Florida, USA, 1–5 December, 2007.

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19. Brenner S, Whitcomb MB. Ultrasonographic diagnosis of coxofemoral 23. Huggons N, Andrea R, Grant B, Duncan C. Total hip arthroplasty in subluxation in horses. Vet Radiol Ultrasound 2009;50:423–428. the horse: Overview, technical considerations and case report. Equine 20. Field JR, McLaughlin R, Davies M. Surgical repair of coxofemoral Vet Educ 2010;22:547–553. luxation in a miniature horse. Can Vet J 1992;33:404–405. 24. Squire KRE, Fessler JF, Toombs JP, van Sickle DC, Blevins WE. Femoral 21. van den Boom R, Rijkenhuizen ABM, Meij BP. Femoral head ostectomy head osteotomy in horses and cattle. Vet Surg 1991;20:453–458. following osteotomy of the greater trochanter in a pony with chronic 25. Clegg PD, Comerford EJ. Coxofemoral luxation — How does our coxofemoral luxation. Pferdeheilkunde 2003;19:246–252. knowledge of treatment in other species help us in the horse? Equine 22. Garcia-Lopez JM. Coxofemoral luxations in the horse: Surgical options Ve Educ 2007;19:482–483. and challenges. Equine Vet Educ 2010;22:554–556.

RAPPORTCAS DE Answers to Quiz Corner Les réponses du test éclair

1. A) Exogenous steroids can cause the clinical signs of hyper- 4. A) Adrenal insufficiency is seen in horses just off the track, just adrenocorticism and suppress adrenal function. Clinical back from extensive training, or in those with a history of signs suggest hyperadrenocorticism, yet there is a poor exogenous glucocorticoid administration. cortisol response to the administration of ACTH. In naturally A) Une insuffisance surrénalienne est observée chez les chevaux occurring hyperadrenocorticism, the ACTH response test de retour d’une course ou de retour d’un entraînement is typically exaggerated. These results suggest iatrogenic intense ou encore chez les chevaux présentant une anamnèse hyperadrenocorticism. d’administration de corticoïdes exogènes. A) Les stéroïdes exogènes peuvent causer les signes 5. B) Subclinical coliform infections usually clear within a few cliniques d’hyperadrénocorticisme et supprimer la hours, so culture based on somatic cell counts are unreward- fonction surrénalienne. Les signes cliniques suggèrent de ing. Problem-solving should point-source fecal contamina- l’hyperadrénocorticisme, bien qu’il y ait une mauvaise tion of teat and udder skin, and lack of removal prior to réponse de cortisol à l’administration d’ACTH. Lors milking. Although contamination can occur at any time in d’hyperadrénocorticisme qui se produit naturellement, le the daily cycle, infections are introduced around the time of test de réponse à l’ACTH est typiquement exagéré. Ces milking, when the teat sphincter muscle is relaxed. For this résultats suggèrent de l’hyperadrénocorticisme iatrogène. reason, cows should stand (e.g., eating at the feed bunk) for 2. C) FIV is most prevalent in cats 6 years of age or older. Ocular 30 minutes after milking. Escherichia coli bacterins reduce disorders are associated with FIV. Cats exhibit clinical signs the prevalence and severity of coliform mastitis. within 4 to 6 weeks after exposure. Most infections occur B) Les infections subcliniques à coliforme disparaissent via bite wounds. habituellement après quelques heures, de sorte qu’une culture C) Le virus de l’immunodéficience féline est le plus prévalent basée sur la numération des cellules somatiques est peu chez les chats âgés de plus de 6 ans. Les problèmes oculaires satisfaisante. La résolution du problème doit être dirigée sont associés au virus de l’immunodéficience féline. Les chats vers une contamination fécale de la peau des trayons et du présentent des signes cliniques dans un délai de 4 à 6 semaines pis et l’absence de retrait du lait avant la traite. Bien que la après l’exposition. La plupart des infections font suite à des contamination puisse se produire en tout temps du cycle plaies de morsure. quotidien, les infections ont lieu au moment de la traite, lorsque le muscle sphincter du trayon est relâché. Pour cette 3. B) Virus is shed about 10 days before the onset of clinical signs. raison, les vaches doivent se tenir debout (par exemple, B) Le virus est libéré environ 10 jours avant l’apparition des signes lorsqu’elles mangent à la mangeoire) durant 30 minutes cliniques. après la traite. Les bactérines d’Escherichia coli réduisent la prévalence et la sévérité des mammites à coliforme.

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502 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY Case Report Rapport de cas

Frontal and caudal maxillary sinus lipoma in a horse

Elsa K. Ludwig, Christopher R. Byron, Kevin K. Lahmers, Marcos P. Santos

Abstract — An adult horse was diagnosed with a frontal and caudal maxillary sinus lipoma, which was surgically removed. This is the first known report of a sinus lipoma in a horse. Lipomas should be considered in the differential diagnoses of equine sinus masses; complete surgical excision appears to be curative.

Résumé — Lipome du sinus maxillaire frontal et caudal chez un cheval. Un cheval adulte a été diagnostiqué avec un lipome du sinus maxillaire frontal et caudal qui a été enlevé par chirurgie. Il s’agit du premier rapport d’un lipome de sinus chez un cheval. Les lipomes devraient être considérés dans les diagnostics différentiels des masses des sinus chez les équidés; l’excision chirurgicale complète semble être curative. (Traduit par Isabelle Vallières) Can Vet J 2017;58:503–507

Case description 17-year-old American Warmblood mare was referred to A the large animal hospital at the Virginia-Maryland College of Veterinary Medicine (VMCVM) for evaluation because of a 5-month history of right-sided mucopurluent nasal discharge. Prior to referral, the mare had been treated with a 7-day course of oral sulfamethoxazole-trimethoprim, which did not resolve or ameliorate the nasal discharge. At the time of admission, the mare was bright and alert and weighed 564 kg with a body condition score of 7/9. Pulse, respiratory rate, and rec- tal temperature were all within normal limits (40 beats/min; 12 breaths/min; 37.9°C). No abnormal findings were detected during pulmonary and cardiac auscultation, and capillary refill time was , 2 s. A moderate amount of pale yellow, purulent discharge was evident in the right naris. Xylazine (MWI/ VetOne, Boise, Idaho, USA), 0.3 mg/kg body weight (BW), IV, was administered to facilitate dental examination by use of an oral speculum, dental mirror, and dental pick. A diastema was detected between teeth 108 and 109, and when probed with a dental pick, tooth 109 was suspected to have infundibular caries. During upper respiratory tract endoscopy, moderate pha-

Figure 1. Lateral oblique radiograph of the skull showing Department of Large Animal Clinical Sciences (Ludwig, Byron) increased soft tissue opacity within the right maxillary sinus Department of Biomedical Sciences and Pathology (Lahmers), (arrow). Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia 24061, USA; Blue Ridge Equine Clinic, Earlysville, ryngeal hyperemia and swelling over the pharyngeal recess were Virginia 22936, USA (Santos). detected in addition to a mild pharyngeal lymphoid hyperplasia. Address all correspondence to Dr. Elsa Ludwig; e-mail: A moderate amount of serous discharge was present within the [email protected] trachea and there was a significant amount of purulent material Use of this article is limited to a single copy for personal study. emanating from the right nasomaxillary aperature. Both guttural Anyone interested in obtaining reprints should contact the pouches were free of abnormalities. CVMA office ([email protected]) for additional Skull radiography revealed increased soft tissue opacity copies or permission to use this material elsewhere. within the right maxillary sinus (Figure 1) and a soft tissue

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Figure 3. Endoscopic image of a soft tissue mass (arrow) within the right common nasal meatus.

aseptically prepared. A 1.5-cm diameter, semi-circular skin inci- sion was made on the mid-dorsal aspect of the right rostral max- illary sinus. Muscle and connective tissue below the skin incision were bluntly separated, and a 1-cm diameter Galt trephine was used to create the sinus opening. The rostral maxillary sinus was lavaged with 3 L of sterile saline (0.9% NaCl) solution, and the trephination site was left open to facilitate future sinus lavage. Figure 2. Dorsoventral radiograph of the skull showing soft The empty 109 tooth alveolus was then dried and packed with tissue projection of axial border of the right maxillary sinus (arrow) and mild deviation of the nasal septum. vinyl polysiloxane impression material via an oral approach. Following tooth extraction and sinus trephination, the horse was discharged with instructions advising the owner to continue projection of the axial border of the maxillary sinus into the the oral sulfamethoxazole-trimethoprim, 30 mg/kg BW, q12h right oral cavity resulting in mild deviation of the nasal septum for 14 d. Phenylbutazone (1 g tablets; First Priority, Elgin, (Figure 2). Additionally, there was mild lysis of periapical bone Illinois, USA), 2.2 mg/kg BW, PO, was to be administered and blunting of the mesial root tips of teeth 107 to 109. Based q12h for 3 d, then q24h for 3 d. The sinus was to be lavaged on the results of the dental examination, upper respiratory with 1 mL of 10% povidone-iodine solution in 1 L sterile saline endoscopy, and radiographs; apical root infection of tooth 109 (a 1% povidone-iodine solution) q12h for 7 to 10 d, and then with suspected secondary right maxillary sinusitis was diagnosed. q24h for 7 to 10 d. The vinyl polysiloxane impression material Extraction of tooth 109 per os and right rostral maxillary sinus was to be removed 4 wk following tooth extraction. Follow-up trephination were elected for treatment of the suspected apical communication with the owners was obtained monthly via tooth root infection and maxillary sinusitis. telephone. Following discharge from the VMCVM, the mare’s Prior to tooth extraction and sinus trephination, the mare right-sided nasal discharge resolved and the trephination site received phenylbutazone (MWI/VetOne), 4.4 mg/kg BW, healed with no complications. The mare returned to her original IV, and sulfamethoxazole-trimethoprim (Aurobindo Pharma level of performance with no complications. USA, Cranbury, New Jersey, USA), 30 mg/kg BW, PO. The Six months after the initial evaluation, the horse was returned patient was then sedated with detomidine (Dormosedan; Zoetis, to the VMCVM with a 1-week history of right-sided nasal Kalamazoo, Michigan, USA) and butorphanol (Turbogesic; discharge. At presentation, the patient weighed 545 kg, had Zoetis, Exton, Pennsylvania, USA) both at 0.01 mg/kg BW, IV, a heart rate of 36 beats/min, a respiratory rate of 18 breaths/ and sedation was maintained with an IV detomidine constant min, and a rectal temperature of 38°C. A moderate amount of rate infusion (0.04 mg/kg BW per hour). A right maxillary nerve tan, mucopurulent discharge was present in the right naris. No block was given with 15 mL of 2% mepivicaine (Carbocaine-V other abnormalities were noted during physical examination. 20 mg/mL; Zoetis) and the 109 tooth was extracted per os with The mare was sedated with detomidine (0.01 mg/kg BW, IV) the horse standing. Following the tooth extraction, the trephi- and a dental examination was performed. The alveolus of the nation site for the right rostral maxillary sinus was clipped and 109 tooth was filled with healthy granulation tissue. Upper

504 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY CASE REPORT CASE

Figure 5. Dorsoventral radiograph of the skull showing moderate deviation of the nasal septum due to increased soft tissue opacity in the right caudal maxillary sinus (arrow). Note the Figure 4. Lateral oblique radiograph of the skull showing soft 109 tooth had been extracted. tissue opacity in the right caudal maxillary sinus (arrow). Note the 109 tooth had been extracted. sinus lining was removed and the sinus was copiously lavaged airway endoscopy revealed a rounded, soft tissue mass within with sterile 0.9% NaCl solution. A Foley catheter was passed the right common nasal meatus, rostral to the nasomaxillary through the right naris and into the right frontal sinus to facili- aperture (Figure 3). A moderate amount of mucopurulent tate future lavage of the sinus. The sinus flap was then replaced material was draining from the nasomaxillary aperture. Skull and the periosteum was closed in a simple continuous pattern radiography identified a soft tissue opacity in the right caudal using No. 2-0 polyglactin 910 (Vicryl; Ethicon, Somerville, maxillary sinus (Figure 4) and moderate deviation of the nasal New Jersey, USA) suture material. The subcutaneous tissue was septum (Figure 5). The patient’s history of right maxillary sinus- closed in a simple continuous pattern using No. 2-0 polyglactin itis, recurrence of nasal discharge following 109 tooth extraction, 910 suture material, and the skin was closed with No. 2-0 poly- and findings on endoscopy and radiography were suggestive of propylene (Prolene; Ethicon, San Lorenzo, Puerto Rico) suture a right caudal maxillary sinus mass. material in a simple interrupted pattern. The mare received procaine penicillin G (Pfizerpen; Pfizer, The patient recovered uneventfully from sedation. Following New York, New York, USA), 22 000 IU/kg BW, IM, gentamicin surgery the mare received oral sulfamethoxazole-trimethoprim (Sparhawk Laboratories, Lenexa, Kansas, USA), 6.6 mg/kg BW, (30 mg/kg BW, PO), q12h for 14 d and phenylbutazone IV, and phenylbutazone (4.4 mg/kg BW, IV) prior to standing (2.2 mg/kg, PO) was to be administered orally q12h for 3 d, surgery. Detomidine (0.01 mg/kg BW) was administered IV to then q24h for 3 d. The surgical site was lavaged q12h with sedate the horse for surgical site preparation. The dorsal aspect 1 mL of 10% povidone-iodine solution in 1 L sterile saline for of the horse’s head was clipped and cleaned. A supraorbital nerve 3 d using the Foley catheter. The catheter was removed before block was given using 3 mL of 2% mepivacaine (20 mg/mL) and the horse was discharged from the hospital. The mare was to be a line block along the proposed skin incision was done using stall rested for 14 d, then transitioned to a small paddock for 2% mepivacaine (20 mg/mL). The surgical site was aseptically 14 d before returning to work. Skin sutures were to be removed prepared and the mare was started on an intravenous continu- 14 d following the standing surgical procedure and the mare ous rate infusion of detomidine (0.01 mg/kg BW per hour). A was to return to the VMCVM after 30 d for reassessment and right-sided frontonasal bone flap was created by use of routine diagnostic imaging. methods using an osteotome. Once the frontonasal bone flap Results of histopathologic examination of the sinus mass was elevated, a 9 3 11 cm smooth mass of lipid consistency were unusual. The large, tan, soft mass (Figure 7) was entirely was seen in the frontal sinus and extended into the caudal composed of large cells in sheets subdivided by mature fibrous maxillary sinus (Figure 6). The mass was digitally separated tissue and small amounts of hemorrhage. The cells were polygo- from the surrounding sinus walls, removed, and submitted for nal with large, clear, discrete cytoplasmic vacuoles that displace histopathologic examination. The caudal maxillary and frontal and compress nuclei (Figure 8). The space occupying mass was

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Figure 7. Photograph of the large, tan, soft mass removed from the right frontal and caudal maxillary sinus.

progressive ethmoid hematomas, sinus cysts, or neoplasia (1–5). Equine sinonasal neoplasia is rare, comprising 8% to 19% of sinonasal disorders (2,5). Reported equine sinonasal neoplasms include squamous cell carcinoma, fibroma, adenocarcinoma, Figure 6. Photograph of the elevated right frontonasal sinus flap. Note the soft tissue mass (arrow). fibrosarcoma, myxoma, osteoma, carcinoma, mast cell tumor, hemangioma, hemangiosarcoma, adenoma, lymphosarcoma, melanoma, and sarcoma (2,6–9). interpreted as a lipoma based on the normal appearing adipo- Most reports indicate that lipomas constitute about 3% of cytes. Biweekly telephone communication with the owner was all equine neoplasms (10–12), but one survey found that 13% established. The mare’s skin incision healed appropriately, and of 151 equine tumors were mesenteric lipomas (13). In horses, there was no nasal discharge following the surgical procedure. lipomas are most frequently located in the abdomen, and The mare returned to the VMCVM 16 wk after the surgical may be the most common equine intra-abdominal neoplasm procedure for reassessment. The horse was not reported to have (10,11,14). Rarely, lipomas may develop at other anatomic nasal discharge by the owner, and a mild boney callus was pres- locations; such masses have been detected in paraurethral, ent at the distal margin of the right-sided frontonasal bone flap. meningeal, subcutaneous, intramuscular, intrathecal, pericar- The patient’s vital parameters were within normal limits. The diac, and nuchal ligament locations (14–21). To the authors’ horse was sedated with xylazine (0.3 mg/kg BW, IV) for skull knowledge, this is the first report of a paranasal sinus lipoma in radiography. Examination of the radiographs indicated there a horse. There are limited reports of nasal, paranasal sinus, and was no recurrence of the soft tissue mass, and smooth periosteal nasopharyngeal lipomas in humans (22–30). Since 1915, only proliferation was present on the level of the rostral frontal and 5 human cases of paranasal sinus lipomas have been reported caudal maxillary bone. Repeat endoscopy was declined by the (22–24,26,29). Lipomas are rarely detected in the nasal cavity, owner due to financial limitations. The mare was discharged paranasal sinuses, and nasopharynx due to the lack of adipose from the hospital with the recommendation to return in 6 mo tissue in these regions (26). for repeat assessment to ensure the sinus lipoma was not recur- Lipomas are most often benign, slow-growing tumors with ring. Follow-up communication with the owner 16 mo after the uncertain etiology that arise from lipocytes (10,29,31). Trauma mare’s initial assessment indicated that the mare had returned or chronic tissue irritation has been proposed as causes of oral to full work and had had no known episodes of nasal discharge lipomas in humans (31). In horses, lipomas grossly appear as since the surgical procedure. soft and fatty masses, and may or may not be encapsulated (10). Histopathologically, lipomas are composed of mature adipocytes Discussion supported by vascular connective tissue (10,27,28). The sinus Diseases affecting the equine sinuses can result in the produc- mass removed from the mare in this report matched both the tion of nasal discharge and decreased nasal airflow, which can gross and histopathologic description of a lipoma. Surgical exci- progress to cause facial swelling or deformity (1–5). Sinus disease sion of lipomas is the treatment of choice, and lipomas usually can be due to primary infections or secondary to dental disease, do not recur following complete excision (10,27,30,31). Surgical

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3. Lane J, Longstaffe J, Gibbs C. Equine paranasal sinus cysts: A report of 15 cases. Equine Vet J 1987;19:537–544. 4. O’Leary J, Dixon P. A review of equine paranasal sinusitis. Aetiopatho­ genesis, clinical signs and ancillary diagnostic techniques. Equine Vet Educ 2011;23:148–159. 5. Tremaine W, Dixon P. A long-term study of 277 cases of equine sino- nasal disease. Part 1: Details of horses, historical, clinical and ancillary diagnostic findings. Equine Vet J 2001;33:274–282. REPORT CASE 6. Madewell B, Priester W, Gillette E, Snyder S. Neoplasms of the nasal passages and paranasal sinuses in domesticated animals as reported by 13 veterinary colleges. Am J Vet Res 1976;37:851–856. 7. Head K, Dixon P. Equine nasal and paranasal sinus tumours. Part 1: Review of the literature and tumour classification. Vet J 1999;157: 261–279. 8. Scarratt WK, Crisman MV. Neoplasia of the respiratory tract. Vet Clin North Am Equine Pract 1998;14:451–473. 9. Witte T, Perkins J. Early diagnosis may hold the key to the successful treatment of nasal and paranasal sinus neoplasia in the horse. Equine Vet Educ 2011;23:441–447. 10. Knottenbelt DC, Patterson-Kane JC, Snalune KL. Clinical Equine Figure 8. Low power photomicrograph (hematoxylin and Oncology. Edinburgh, Scotland: Elsevier, 2015:294–295. eosin stain at 2003 magnification) shows normal adipocytes. 11. Priester WA, McKay FW. The occurrence of tumors in domestic animals. The cells are large and polygonal with large, clear, discrete Natl Cancer Inst Monogr 1980;54:1–210. cytoplasmic vacuoles that displace and compress nuclei. 12. Sundberg J, Burnstein T, Page E, Kirkham W, Robinson F. Neoplasms Scale bar = 100 mm. of Equidae. J Am Vet Med Assoc 1977;170:150–152. 13. Cotchin E, Baker-Smith J. Correspondence: Tumours in horses encoun- tered in an abattoir survey. Vet Rec 1975;97:339–339. excision of the sinus lipoma in the mare of this report resulted 14. Hammer EJ, Chope K, Lemire TD, Reef VB. A lipoma of the extensor in a successful outcome. tendon sheaths in a horse. Vet Radiol Ultrasound 2002;43:63–65. Interestingly, 2 of the reported paranasal sinus lipomas in 15. Sertich P, Hamir A, Orsini P, Kenney R. Paraurethral lipoma in a mare humans occurred following Caldwell-Luc procedures (26,29). associated with frequent urination. Equine Vet Educ 1990;2:121–122. 16. Anderson WI, King JM. Incidental meningeal lipoma in a horse. Vet The Caldwell-Luc procedure is a surgical procedure that creates Pathol 1988;25:530–531. an opening into the maxillary sinus via the sublabial area over 17. Erkert R, Moll H, MacAllister C, Confer A, Ritchey J. Infiltrative the canine fossa (32). This opening provides excellent sinus lipoma in an American Quarter Horse gelding. Equine Vet Educ 2007;19:380–383. visualization and the procedure is used for cases of chronic 18. Owens C, Young A, Loukopoulos P, Hilbert B. Lipoma of the long maxillary sinusitis or the removal of sinus masses (32,33). It has digital extensor tendon sheath in a horse. Equine Vet Educ 2015. been suggested that the Caldwell-Luc procedure may stimulate 19. Dunkerley S, Williams A, Gillis J. Lipoma in a foal. J Am Vet Med Assoc 1997;210:332–333. the development of a lipoma, or that the tumor may develop as 20. Blackwell J. Unusual adipose tissue growth in a colt. J Am Vet Med a result of perioperative diversion of lipocytes (29). Maxillary Assoc 1972;161:1141. sinuses in horses can be surgically approached via rostral maxil- 21. Baker D, Kreeger J. Infiltrative lipoma in the heart of a horse. Cornell Vet 1987;77:258–262. lary sinus trephination, a procedure similar to the Caldwell-Luc 22. Lawson H. Lipoma of the maxillary antrum. J Laryngol Otol 1942;57: procedure (34). The mare of this report had rostral maxillary 382–384. sinus trephination performed at the time of initial presentation. 23. Silbernagel CE. Lipoma of the maxillary antrum. Laryngoscope 1938; 48:427–428. Lipomas have been reported following tooth extractions in 24. Goldstein MA. Lipoma of the maxillary antrum. Laryngoscope 1915; humans (22,35). A 1942 case report described the discovery 25:142–144. of a lipoma in a patient’s maxillary sinus following the failure of 25. Fagan J, Learmonth G, Garb M, Bowen R. Nasopharyngeal lipoma — A rare clinico-pathological entity. J Laryngol Otol 1996;110:275–276. an empty tooth alveolus to heal after removal of the tooth (22) 26. Fu YS, Perzin KH. Non-epithelial tumors of the nasal cavity, paranasal and a 2004 paper that reviewed the clinicopathologic features sinuses and nasopharynx. A clinicopathologic study. VIII. Adipose tissue of 125 lipomas of the oral and maxillofacial region reported that tumors (lipoma and liposarcoma). Cancer 1977;40:1314–1317. 27. Oddie JW, Applebaum EL. Lipoma of the nasopharynx. Arch Otolaryngol 1 patient associated the tumor with a previous tooth extraction 1982;108:57–57. (35). Regarding the mare of this report, the surgical procedure 28. Preece JM, Kearns DB, Wickersham JK, Grace AR, Bailey CM. Nasal performed at the time of the patient’s initial hospitalization may lipoma. J Laryngol Otol 1988;102:1044–1046. have resulted in lipoma formation. Alternately, it is possible that 29. Schwentner I, Schmutzhard J, Krugmann J, Sprinzl GM. Lipoma of the paranasal sinus: A rare but noticeable entity. J Otolaryngol Head Neck the sinus lipoma was present at the time of the initial treatment. Surg 2008;37:E133–134. Lipomas of the paranasal sinus are rare in humans, and have 30. Takasaki K, Yano H, Hayashi T, Kobayashi T. Nasal lipoma. J Laryngol not been reported in horses. This is the first report of a sinus Otol 2000;114:218–220. 31. de Visscher JG. Lipomas and fibrolipomas of the oral cavity. J Maxillofac lipoma in a horse. Lipomas should be considered in the dif- Surg 1982;10:177–181. ferential diagnoses of equine sinus masses; complete surgical 32. Kim E, Duncavage J. Caldwell-Luc procedure. Op Tech Otolaryngol 2010;21:163–165. excision seems to be curative. CVJ 33. Defreitas J, Lucente FE. The Caldwell-Luc procedure: Institutional review of 670 cases: 1975–1985. Laryngoscope 1988;98:1297–1300. References 34. Ruggles AJ, Ross MW, Freeman DE. Endoscopic examination of normal . 1 Beard W, Hardy J. Diagnosis of conditions of the paranasal sinuses in paranasal sinuses in horses. Vet Surg 1991;20:418–423. the horse. Equine Vet Educ 2001;13:265–273. 35. Furlong MA, Fanburg-Smith JC, Childers EL. Lipoma of the oral and 2. Boulton C. Equine nasal cavity and paranasal sinus disease: A review of maxillofacial region: Site and subclassification of 125 cases. Oral Surg 85 cases. J Equine Vet Sci 1985;5:268–275. Oral Med Oral Pathol Oral Radiol Endod 2004;98:441–450.

CVJ / VOL 58 / MAY 2017 507 FOR PERSONAL USE ONLY Student Paper Communication étudiante

Idiopathic glaucoma in an 11-year-old crossbred mare

Daniella Rizzo

Abstract — An 11-year-old crossbred mare was presented with left eye buphthalmia, a mydriatic minimally responsive pupil, locally extensive ventral corneal edema, and corneal striae. Intraocular pressures exceeding 80 mmHg lead to a presumptive diagnosis of glaucoma. Following several days of treatment there was no improvement and enucleation was performed.

Résumé — Glaucome idiopathique chez une jument de race croisée âgée de 11 ans. Une jument de race croisée âgée de 11 ans a été présentée avec une buphtalmie de l’œil gauche, une pupille mydriatique minimalement réactive, un œdème cornéen ventral important localement et une strie cornéenne. Les pressions intraoculaires dépassant 80 mmHg ont donné lieu à diagnostic présomptif de glaucome. Après plusieurs jours de traitement, il n’y avait aucune amélioration et l’énucléation a été réalisée. (Traduit par Isabelle Vallières) Can Vet J 2017;58:508–510

previously healthy 11-year-old gray Arabian-Quarter (Banamine; Merck AH, Toronto, Ontario) given IV initially, A Horse crossbred mare was presented to the veterinarians of then PO, q12h. Two days after initial presentation, intraocular Springer Animal Hospital with complaint of a “swollen left eye” pressures were measured with a tonometer (Tono-Pen; Reichert of 1 day duration. On neuro-ophthalmic examination of the Technologies, New York, New York, USA) while the horse was left eye there was a diminished direct dazzle and pupillary light lightly sedated with 0.7 mg of xylazine (Xylamax; Bimeda, reflex. The indirect pupillary light reflex was normal. Palpebral Cambridge, Ontario) given IV, and 2 drops of topical propara- reflexes of the left eye were normal, the eye was fluorescein stain caine hydrochloride, 0.5% (Alcaine; Alcon Canada, Missisauga, negative with a positive Jones test, and the mare appeared to Ontario) were applied, with intraocular pressures averaging be visual with a positive menace response. Ocular lesions noted 88 mmHg (left eye) and 22 mmHg (right eye). On neuro- in the left eye were buphthalmia, brown pigmentation of the ophthalmic examination, the edematous area in the cornea was sclera, mild episcleral injection, a 5-mm diameter semi-circular now almost completely encircling the pupil, measuring approxi- area of edema located ventrally within the cornea, linear corneal mately 7 mm in diameter, the linear corneal band opacities were band opacities extending from limbus to limbus, and the pupil more prominent, and the pupil had become fixed and minimally appeared dilated with a diminished response to light (Figure 1). responsive to light stimulus. The horse had minimal tearing No other ocular abnormalities were noted in the left eye but it and did not appear to be in pain. Working with a presumptive was difficult to perform a thorough fundic examination due to diagnosis of glaucoma, 1 to 2 drops of 20 mg/mL dorzolamide the presence of obscuring edema; what we were able to evaluate hydrochloride and 5 mg/mL timolol maleate (Cosopt; Merck appeared normal. No anomalies were noted in the right eye. AH) applied topically to the left eye q8h was added to the treat- Initially, the patient was treated with a 1-cm strip of sodium ment protocol to control intraocular pressure (IOP). chloride, 5% (Muro 128; Bausch & Lomb, Vaughan, Ontario) Three days later, on re-check examination, the corneal edema applied topically q6h, and 500 mg of flunixin meglumine had dissipated by approximately 1/3, leaving a 5-mm circular area in the ventrum of the cornea. Intraocular pressures were averaging 86 mmHg (left eye) and 22 mmHg (right eye). Ontario Veterinary College, University of Guelph, 50 Stone All further treatment options were discussed with the owner Road East, Guelph, Ontario N1G 2W1. including long-term medical management, referral, surgical Address all correspondence to Daniella Rizzo; e-mail: treatment, and enucleation as a salvage procedure. One week [email protected] later, the owner elected to enucleate. On pre-operative exami- Ms. Rizzo will receive 50 copies of her article free of charge nation of the eye, it was noted that there were several centrally courtesy of The Canadian Veterinary Journal. located pinpoint areas of fluorescein stain uptake, implying Use of this article is limited to a single copy for personal study. micro-ulceration of the cornea. The eye was enucleated using a Anyone interested in obtaining reprints should contact the standing subconjunctival surgical approach. The eye was fixed CVMA office ([email protected]) for additional in formalin solution and sent to the Animal Health Laboratory, copies or permission to use this material elsewhere. University of Guelph for histopathological evaluation.

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congenital, primary, and secondary. Congenital glaucoma is associated with developmental abnormalities of the anterior segment (4). Primary glaucoma is seen with acquired, but often inherited ICA degeneration (2). Secondary glaucoma is the type most commonly diagnosed in horses with primary uveitis, with STUDENT PAPER STUDENT some hypothesized links to equine recurrent uveitis (ERU), along with neoplasia, lens luxation, and trauma (4). Diagnosis of glaucoma in equine patients is challenging, as horses tend to exhibit the initial clinical signs of glaucoma more subtly than other species. Diagnosis can be confirmed if elevated intraocular pressure (anything exceeding normal pressures which range from 17 to 28 mmHg) can be documented in the pres- ence of clinical signs of glaucoma, as described for the present case (2). This may prove difficult if the horse is concurrently afflicted with equine recurrent uveitis, as intraocular pressure may not be consistently elevated and a diseased globe can expe- rience large diurnal fluctuations (1). For accurate diagnosis, an auriculopalpebral nerve block can be performed to reduce the chances of a false positive secondary to manipulation of the Figure 1. Generalized corneal edema, scleral pigmentation, and eye and eyelids. Variation among different devices and normal linear band opacities noted in the glaucomatous eye. diurnal pressure fluctuations should be taken into account when taking IOPs for diagnostic purposes. Comparing IOPs with the normal or unaffected eye can also help confirm the diagnosis The histopathology report included a diagnosis of glauco- as there should not be large IOP differences between the right matous retinal atrophy along with axonal depletion from the and left eyes, as occurred in this case. optic nerve, with no histologic evidence of an underlying cause. During the acute or active phase of glaucoma, a mydriatic Superficial peripheral corneal stromal vascularization was also pupil may be seen along with mild to moderate corneal edema, noted with no other evidence of intraocular inflammation or mild to severe blepharospasm, aqueous flare, corneal striae, granulation tissue. uveitis, and lens luxation (1). When glaucoma becomes chronic, Discussion corneal edema may be severe or permanent, corneal striae are Glaucoma is a disease affecting aqueous humor outflow path- often seen along with extensive posterior synechia, optic nerve ways in the eye that result in phasic elevations of intraocular atrophy with the lamina cribrosa exposed, hydrophthalmos, pressure to levels incompatible with eye health (1,2). This condi- inconsistent aqueous flare, lens luxation (typically posterior), tion is not commonly diagnosed in horses and its mechanisms and blindness. Horses may display a range of none to all of these are poorly understood. Glaucoma occurs in stages; initially clinical signs, and tend to remain somewhat visual even in the there is an event that leads to the hindrance of aqueous outflow late stages of disease, making detection and diagnosis of glau- systems, followed by the system becoming fully obstructed coma even more challenging. In the current case, we suspected through morphological changes and intraocular pressures begin the horse to be in the acute/active stage of glaucoma, which was to increase (1). High intraocular pressures are what lead to the further supported by the histological analysis of the eye. clinical signs associated with glaucoma, including scleral blood A histopathological retrospective study done by Curto vessel congestion, corneal edema, and fixed pupils. The intraocu- et al (3), found that the most common histological lesions found lar pressure eventually exceeds a level at which the optic nerve in glaucomatous eyes included corneal stromal vascularization, and retinal ganglion cells can function, leading to optic nerve multiple breaks in Descemet’s membrane, loss of nerve fibers axon degeneration, progressive loss of vision, and eventually, and ganglion cells from the inner retina, optic disc cupping, blindness (1). gliosis, and axonal loss from the optic nerve. This study also In a normal eye, aqueous outflow exits the globe through determined that there appeared to be no sex predilection for the iridocorneal angle (ICA) and the uveoscleral pathway (3). development of glaucoma, that horses over the age of 15 are at Obstruction of the pathways can result from the development the highest risk for development of secondary glaucoma, and of pre-iridal fibrovascular membranes, blockage of the ICA with Appaloosas (a breed susceptible to ERU) are highly susceptible inflammatory debris, pupillary block resulting from posterior to developing glaucoma (3). synechia and development of iris bombé, trabecular compres- Treatment for glaucoma involves both medical and surgical sion, and angle closure (1). It has also been proposed that uveal management. Several factors including the vision status of the atrophy after an inflammatory event may predispose the ICA eye, the presence of concurrent disease, the horse’s activity, to collapse, along with blockage of the ICA by a tumor or other economic factors, and ease with which the owner can apply pathologic processes (1). treatments will determine which treatment protocols are rec- While all glaucomas occur secondary to a causative mecha- ommended and optimally used (2). Treatment should focus on nism, equine glaucoma is frequently categorized into 3 types: reducing intraocular pressure to levels compatible with optic

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nerve and retinal health (levels # 20 mmHg are suggested as other species such as the dog (3). There are several features of acceptable in a glaucomatous eye), decreasing aqueous humor the anatomy of the iridocorneal angle in the horse that account production, and increasing outflow via conventional and uncon- for these differences (1,3). This is thought to account for the ventional pathways (1). To reduce aqueous humor production, perceived resistance of equine eyes to glaucoma and lower topical b-adrenergic blockers such as timolol maleate and topical prevalence seen in the population (7). However, it is also pos- carbonic anhydrase inhibitors such as dorzolamide hydrochlo- sible that lack of diagnostic equipment could also contribute ride have proven effective in lowering IOPs (5). Some sources to infrequent diagnosis in the early stages (7). In this case, it recommend topical atropine treatment to prevent glaucoma in was difficult to assess which causative mechanism lead to the cases of uveitis; however, this is only recommended for use when secondary development of glaucoma. We hypothesized that it tonometry is consistently available and uveitis is the underly- may have been a rare form of primary glaucoma that presents ing cause of the glaucoma (1). Anti-inflammatory therapy with in aged horses, due to the sudden onset of clinical signs with topical corticosteroids such as prednisolone acetate and sys- no previous history of ocular pathology and lack of histological temic administration of non-steroidal anti-inflammatory drugs evidence of causation. Throughout the investigation and man- COMMUNICATIONÉTUDIANTE (NSAIDs) such as phenylbutazone or flunixin meglumine can agement of this case it became apparent that there is a general control uveitis and provide pain control (1). With long-term lack of literature exploring the pathophysiology of equine glau- NSAID use, it is recommended that the horse be carefully coma. Increased understanding of how horses maintain vision observed for signs of common complications such as kidney in the face of chronically elevated intraocular pressures and the disease or right dorsal colitis. connection between glaucoma and ERU will be paramount When medical management is no longer controlling glau- in controlling the disease in the future. This is an area that coma, one of several surgical interventions should be consid- needs to be explored further for us to understand and treat this ered. Laser transscleral cyclophotocoagulation or ablation is debilitating disease. the current surgical treatment of choice; it uses laser energy to preferentially destroy ciliary body epithelium and the stroma of Acknowledgments the pars plicata, thereby reducing the amount of aqueous humor The author thanks Drs. Emily Vellekoop, Marcie Ninness, and produced (2). Transscleral cyclocryosurgery is another option the team at Springer Animal Hospital, and Drs. Maria Spinato, involving cryodestruction of the ciliary body using nitrous Brian Wilcock, and Chantale Pinard from the University of oxide (1). This method is associated with more severe ocular side Guelph for their help and guidance. CVJ effects, and has been limited to use in blind eyes (1). Chemical ablation of the ciliary body with gentamicin may also be used References in blind eyes to reduce pain and hydrophthalmos (1). A recent 1. Utter ME, Brooks DE. Glaucoma. In: Gilger BC, Rudolph P, Harms L, report by Lassaline (6) introduced a new surgical technique eds. Equine Ophthalmology. 2nd ed. Maryland Heights, Missouri: that involved placing a Baerveldt glaucoma shunt in an equine Elsevier Saunders, 2011:357–373. eye that had become refractory to treatment, resulting in the 2. Wilkie DA. Equine glaucoma: State of the art. Equine Vet J 2010;42: 2042–3306. reduction of intraocular pressures and retention of vision (7). 3. Curto EM, Gemensky-Metzler AJ, Chandler HL, Wilkie DA. Equine Finally, salvage procedures including enucleation or eviscera- glaucoma: A retrospective study (1999–2012). Vet Ophthalmol tion should be considered if the eye cannot be managed with 2013;17:334–342. 4. Cullen CL, Grahn BH. Equine glaucoma: A retrospective study of either technique or if the eye is severely painful or buphthalmic. 13 cases presented at the Western College of Veterinary Medicine from Silicone implants can be placed for a more esthetically pleasing 1992 to 1999. Can Vet J 2000;41:470–480. look, but as in all surgeries complications need to be discussed. 5. Willis AM, Robbin TE, Hoshaw-Woodard S. Effect of topical administra- tion of 2% dorzlamide hydrochloride or 2% dorzlamide hydrochloride- In the present case, a combination of economic factors, feasibil- ­0.5% timolol maleate on intraocular pressure in clinically normal horses. ity of long-term treatment, and failure to respond to treatment Am J Vet Res 2001;62:709–713. lead to the decision to enucleate the affected eye. 6. Lassaline M. A promising surgical approach to equine glaucoma. Equine Vet Educ 2015;27:352–354. With respect to aqueous outflow, the uveoscleral pathway 7. Wilcock BP, Brooks DE, Latimer CA. Brief communications and case in the horse may be just as important as the ICA pathway is in reports: Glaucoma in horses. Vet Pathol 1991;28:74–78.

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

Bouncing back across the board: Results of the 2016 CVMA Practice Owners Economic Survey Rétablissement généralisé : résultats du Sondage économique 2016 de l’ACMV auprès des propriétaires de pratique

Chris Doherty

verall, 2016 was a strong year for Canadian veterinarians. ans l’ensemble, 2016 a été une excellente année pour les O Companion animal hospitals experienced small increases in D vétérinaires canadiens. Les cliniques pour animaux de revenue, net income, and both current and new clients. On the compagnie ont observé de légères hausses de leurs revenus, du mixed and large animal side, a stagnation of revenue was overcome bénéfice net et du nombre de clients actuels et nouveaux. Du by prudent expense control, allowing for a jump in net income. côté de la pratique mixte et pour grands animaux, une stagna- Companion animal hospitals enjoyed a healthy 3.5% increase tion des revenus a été surmontée en faisant preuve d’un contrôle in gross revenue per full-time equivalent (FTE) DVM in 2016 prudent des dépenses, ce qui a permis un bond du bénéfice net. (Figure 1). The gross revenue figure of $538 281 sets a new Les cliniques pour animaux de compagnie ont connu une national high water mark. Over the same time frame, net bonne hausse de 3,5 % du revenu brut par vétérinaire équivalent income ticked upwards by 1.7%, to $162 589. This does not temps plein (ETP) en 2016 (figure 1). Le chiffre du revenu brut quite reach the record high attained in 2014, but does reverse de 538 281 $ établit d’ailleurs un nouveau record national. the downturn seen last year. Pendant la même période, le bénéfice net a crû de 1,7 % pour These Canada-wide figures, however, can obscure regional s’établir à 162 589 $. Ce chiffre n’atteint pas tout à fait le niveau differences. Despite the national averages climbing upwards, record de 2014, mais il renverse la tendance à la baisse observée some provinces experienced downturns. Alberta, Manitoba, and l’an dernier. Newfoundland and Labrador veterinary hospitals all suffered Cependant, ces données nationales peuvent obscurcir les declines in both gross revenue and net income. Meanwhile, différences régionales car, malgré la hausse des moyennes Ontario, New Brunswick, and Nova Scotia hospitals enjoyed nationales, certaines provinces ont connu des replis. Les growth above the national averages. cliniques vétérinaires de l’Alberta, du Manitoba et de Terre- After years of decline, current and new client numbers are Neuve-et-Labrador ont toutes connu des déclins au niveau du finally showing not only resilience, but even noticeable growth. revenu brut et du bénéfice net. Entre-temps, les cliniques de The number of current clients (defined as a client seen within l’Ontario, du Nouveau-Brunswick et de la Nouvelle-Écosse ont the past 12 months) per FTE DVM climbed by 4.6% in 2016, profité d’une croissance supérieure aux moyennes nationales.

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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Gross Revenue Net Income Revenu brut Bénéfice net $600 000 $538 318 $529 202 $519 934 $500 761 $514 296 $500 000

$400 000

$300 000

$170 033 $200 000 $154 892 $158 603 $159 900 $162 589

$100 000 GESTION D’UNECLINIQUE VÉTÉRINAIRE $0 2012 2013 2014 2015 2016

Figure 1. Average gross revenue and net income per full-time equivalent DVM for companion animal hospitals in Canada from 2012 to 2016./Revenu brut et bénéfice net moyens par vétérinaire équivalent temps plein pour les cliniques pour animaux de compagnie au Canada de 2012 à 2016.

Current Clients/FTE New Clients/FTE Clients actuels/ETP Nouveaux clients/ETP

1000 909 916 864 900 845 826 800 700 600 500 400 262 300 225 198 194 198 200 100 0 2012 2013 2014 2015 2016

Figure 2. Average current and new clients per full-time equivalent DVM for companion animal hospitals in Canada from 2012 to 2016./Moyenne des clients actuels et nouveaux par vétérinaire équivalent temps plein pour les cliniques pour animaux de compagnie au Canada de 2012 à 2016.

above the numbers achieved in both 2014 and 2015. The Après des années de déclin, le nombre de clients actuels number of new clients per FTE DVM did not rebound quite et nouveaux montre finalement des signes non seulement de as strongly, yet still grew by 2.1%, back to levels seen in 2014 résilience, mais il affiche même une croissance notable. Le (Figure 2). nombre de clients actuels (qui sont définis comme des clients Again, the national average masks differences among the qui ont fréquenté la clinique au cours des douze derniers mois) provinces. Saskatchewan and Nova Scotia veterinary hospitals par vétérinaire ETP a augmenté de 4,6 % en 2016 et a dépassé had above average increases in the numbers of current and new les chiffres atteints en 2014 et en 2015. Le nombre de nouveaux clients per FTE DVM. British Columbia hospitals, by contrast, clients par vétérinaire ETP n’a pas connu un rebondissement witnessed a decline in their client numbers. aussi convaincant, mais il a toujours augmenté de 2,1 %, pour Setting 2012 as a baseline, it is obvious that the typical effectuer un retour aux niveaux observés en 2014 (figure 2). Canadian veterinarian continues to do more with fewer clients. De nouveau, la moyenne nationale masque les différences The cumulative change in companion animal current active entre les provinces. Les cliniques vétérinaires de la Saskatchewan clients had fallen 5% below 2012 in 2016; yet the annual et de la Nouvelle-Écosse ont affiché des hausses supérieures à

512 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY

Current Clients Revenue per Client VETERINARY PRACTICE MANAGEMENT VETERINARY 25% Clients actuels Revenu par client 22%

20% 18% 15% 15% 12%

10%

5% 0% 1% 0% 2012 2013 2014 2015 2016

25% 25% 27% 210% 29%

Figure 3. Cumulative change in current clients per full-time equivalent DVM and annual revenue per client for companion animal hospitals in Canada from 2012 to 2016./Changement cumulatif du nombre de clients actuels par vétérinaire équivalent temps et du revenu annuel par client pour les cliniques pour animaux de compagnie au Canada de 2012 à 2016.

Gross Revenue Net Income Revenu brut Bénéfice net

$500 000 $459 792 $442 770 $456 701 $450 000 $403 946 $407 570 $400 000 $350 000 $300 000 $250 000

$200 000 $159 032 $137 384 $146 636 $138 157 $139 751 $150 000 $100 000 $50 000 $0 2012 2013 2014 2015 2016

Figure 4. Gross revenue and net income per full-time equivalent DVM for mixed and large animal hospitals from 2012 and 2016./Revenu brut et bénéfice net par vétérinaire équivalent temps plein pour les cliniques mixtes et pour grands animaux de 2012 à 2016.

­revenue per client reached a cumulative increase over the same la moyenne pour le nombre de clients actuels et nouveaux par time period of 22% (Figure 3). vétérinaire ETP. Par contraste, les cliniques de la Colombie- Mixed and large animal veterinary hospitals experienced Britannique ont observé un déclin du nombre de clients. a very slight drop in gross revenue, falling 0.7% in 2016 Si l’année 2012 sert d’année de référence, il est évident que (Figure 4). However, despite this obstacle, these hospitals le vétérinaire canadien type continue de faire plus avec moins were able to realize a stunning 13.8% jump in net income. de clients. Le changement cumulatif du nombre de clients Transforming stagnating revenue into a climbing net income is actifs actuels pour animaux de compagnie a chuté en deçà des done through only one method: expense control. niveaux de 2012 en 2016; pourtant, le revenu annuel par client At $159 032, mixed and large animal hospitals have set a atteint une hausse cumulative de 22 % au cours de la même a new high point in 2016 for net income. Gross revenue is période (figure 3). only slightly below the record high seen in 2015. Regionally, Les cliniques vétérinaires mixtes et pour grands animaux Saskatchewan and Ontario hospitals had above average growth ont connu une très légère chute du revenu brut, qui a baissé in 2016. Manitoba hospitals, unfortunately, suffered declining de 0,7 % en 2016 (figure 4). Cependant, malgré cet obstacle, revenue and net income. ces cliniques ont pu réaliser un bond spectaculaire de 13,8 %

CVJ / VOL 58 / MAY 2017 513 FOR PERSONAL USE ONLY

In 2016, many hospitals saw bounce backs in a number of Finally, wellness plans, which allow clients to pay for their their key metrics. Revenue, net income, and client numbers pet’s veterinary care in more manageable monthly installments, were all holding steady or climbing. In order to ensure success are gaining in popularity. In urban areas, with young popula- in 2017, hospitals may be best served by implementing strategies tions and high costs of living, this type of plan can be a fantastic to control expense and increase client loyalty. way for the millennial pet owner to provide their animal with It is apparent that many mixed and large animal hospitals are the level of care it requires, without breaking the bank. already employing the expense control strategy. Setting a budget, With these strategies, and some co-operation from the econ- sticking to it, and regularly re-assessing goals can allow a practice omy as a whole, veterinarians can ensure that 2017 is even more to convert more gross revenue to flow into net income. successful than 2016. While client numbers are climbing, strong communication remains important to continue this trend. Pre-booking remains Notes: Data for the CVMA Practice Owners Economic Survey a highly recommended strategy; preliminary research and anec- are derived from the 2016 Provincial Practice Owner’s Economic dotal evidence show that, when done properly, this can increase Surveys. Provincial averages are weighted based on relative popu- client visits and compliance, and decrease the amount of time, lation size to calculate a national average for all metrics. For the money, and effort that hospitals spend trying to re-establish purposes of this research, a full-time equivalent veterinarian is GESTION D’UNECLINIQUE VÉTÉRINAIRE contact with clients to book their next visit. assumed to work 1750 hours annually. ■

pour le revenu net. La transformation d’un revenu stagnant en de rendez-vous à l’avance demeure une stratégie fortement un bénéfice net croissant s’effectue seulement à l’aide d’une recommandée, car la recherche préliminaire et les observations méthode : le contrôle des dépenses. permettent de croire que lorsque cette technique est employée À 159 032 $, les cliniques mixtes et pour grands animaux de manière appropriée, elle peut accroître les visites des clients ont établi un nouveau record en 2016 pour le bénéfice net. et l’observance ainsi que réduire le temps, l’argent et les efforts Signalons que le revenu brut se situe légèrement en deçà du investis par les cliniques qui tentent de rétablir le contact avec record observé en 2015. Sur le plan régional, les cliniques de les clients pour prendre le prochain rendez-vous. la Saskatchewan et de l’Ontario ont affiché une croissance Enfin, les régimes de bien-être, qui permettent aux clients de supérieure à la normale en 2016. Mais les cliniques du Manitoba payer pour les soins vétérinaires de leur animal de compagnie ont malheureusement souffert d’une chute du revenu et du selon des mensualités abordables, gagnent en popularité. Dans bénéfice net. les régions urbaines, où il y a de jeunes populations et un coût En 2016, beaucoup de cliniques ont assisté à un de la vie élevé, ce type de régime peut être une excellente façon rétablissement pour plusieurs de leurs indicateurs de rendement pour le propriétaire d’animal millénial de fournir le niveau de importants. Le revenu, le bénéfice net et le nombre de clients soins requis à son animal sans faire sauter la banque. étaient tous stables ou à la hausse. Afin d’assurer le succès en Grâce à ces stratégies, et avec une certaine coopération de 2017, il pourrait être préférable pour les cliniques de mettre l’économie dans son ensemble, les vétérinaires peuvent faire en œuvre des stratégies qui visent à contrôler les dépenses et à en sorte que l’année 2017 soit encore plus prospère que 2016. accroître la loyauté des clients. Il est apparent que beaucoup de cliniques mixtes et pour Notes : Les données pour le Sondage économique de l’ACMV grands animaux emploient déjà des stratégies de contrôle des auprès des propriétaires de pratique sont dérivées des Sondages dépenses. L’établissement et le respect d’un budget ainsi que économiques provinciaux 2016 auprès des propriétaires de la réévaluation régulière des cibles peuvent permettre à une pratique. Les moyennes provinciales sont pondérées en fonction pratique de convertir une plus grande part du revenu brut pour de la taille de la population afin de calculer une moyenne l’acheminer vers le bénéfice net. nationale pour tous les paramètres. Pour les besoins de cette Même si le nombre de clients augmente, la communication recherche, on présume qu’un vétérinaire équivalent temps plein demeure importante afin de maintenir cette tendance. La prise travaille 1750 heures par année. ■

514 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY Diagnostic Ophthalmology Ophtalmologie diagnostique

Lynne S. Sandmeyer, Jerome Gagnon, Bianca S. Bauer

History and clinical signs flare, incipient cortical cataract, and a lateral aphakic crescent were present in the left eye. Additionally, white infiltrates were 13-year-old spayed female domestic shorthaired cat was visible adjacent to the ciliary body and posterior to the lens examined at the ophthalmology service at the Western A bilaterally. Indirect ophthalmoscopic (Heine Omega 200; Heine College of Veterinary Medicine. This cat was presented for eval- Instruments Canada, Kitchener, Ontario) examination was uation of pink masses in the right eye, and uveitis and secondary completed and did not reveal further abnormalities in either glaucoma in the left eye. She was being treated with topical eye. A photograph of the right and left eyes at presentation is prednisolone acetate 1% (Sandoz Prednisolone; Sandoz Canada, provided for your assessment (Figure 1). Boucherville, Quebec), q6h in both eyes and dorzolamide hydrochloride 2%/timolol maleate 0.5% combination (Cosopt; What are your clinical diagnosis, Merk Frosst Canada, Kirkland, Quebec), q12h in the left eye. differential diagnoses, therapeutic plan, The menace responses, and palpebral, occulocephalic, direct and consensual pupillary light reflexes were present bilaterally. and prognosis? Schirmer tear test (Schirmer Tear Test Strips; Alcon Canada, Discussion Mississauga, Ontario) values were 35 and 31 mm/min in the The clinical diagnoses were iris masses in the right eye, bilat- right and left eyes, respectively. The intraocular pressures were eral uveitis, and lens subluxation in the left eye. Historically estimated with a rebound tonometer (Tonvet; Tiolat, Helsinki, documented elevated intraocular pressure in the left eye also Finland) and were 13 and 19 mmHg in the right and left eyes, suggested secondary glaucoma in the left eye. The differential respectively. Fluorescein staining (Fluorets; Bausch & Lomb diagnoses for iris masses include primary intraocular tumors Canada, Markham, Ontario) was negative bilaterally. On direct such as iridociliary adenocarcinoma, post-traumatic sarcoma, examination there was mild bilateral conjunctival hyperemia; leiomyosarcoma, and poorly pigmented melanocytic tumors; the right eye had 2 pink, nodular masses extending from the as well as secondary tumors such as lymphosarcoma, histiocytic iris, and hypopyon was present. Following application of 0.5% sarcoma, metastatic carcinoma, hemangiosarcoma, and osteosar- tropicamide (Mydriacyl; Alcon Canada) biomicroscopic exami- coma (1–5). Bilateral uveitis is most often secondary to endog- nation (Osram 64222; Carl Zeiss Canada, Don Mills, Ontario) enous causes and differential diagnoses include systemic infec- revealed moderate aqueous flare in the right eye. Mild aqueous tions with agents such as feline leukemia virus (FeLV), feline

Figure 1. Photograph of the right and left eyes of a 13-year-old domestic shorthaired cat.

Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

CVJ / VOL 58 / MAY 2017 515 FOR PERSONAL USE ONLY

immunodeficiency virus (FIV), feline coronavirus, Toxoplasma pathology (14–16). Canine and feline intraocular lymphomas gondii, fungi, and Bartonella henselae. Other etiologies of uve- are frequently of B-cell lineage (17,18). However, knowledge itis include neoplasia, immune-mediated inflammation, and of therapeutic response of specific lymphoma subtypes in idiopathic (6). Lens subluxation and glaucoma were most likely cats is limited (14,15,19). Testing for FeLV and FIV may also secondary to chronic uveitis in the left eye. Chronic uveitis is be important in determining potential cause and prognosis. the most common cause of lens subluxation in the feline as it FeLV-antigenemic cats have significantly shorter remission and leads to zonular degeneration (7). Glaucoma is also commonly survival times than FeLV-negative cats (16). Histologic grade is associated with lens luxation. Glaucoma may occur due to a one of the most reliable prognostic factors and is the main fac- change in aqueous humor dynamics associated with a shift in tor used to develop a treatment (20). Low grade lymphoma is lens position; however, glaucoma is also a common sequela to often referred to as small cell lymphoma and is associated with feline anterior uveitis and thus, lens luxation and glaucoma may prolonged survival. be coincident endpoints of chronic inflammation (8,9). Chemotherapy is the mainstay of treatment for cats with Ocular neoplasia can be suggested based on appearance and lymphoma. Combination chemotherapy protocol such as COP confirmed with cytology of aqueous humor or biopsy of tissue (cyclophosphamide, vincristine, and prednisolone) or CHOP OPHTALMOLOGIE DIAGNOSTIQUE OPHTALMOLOGIE followed by light microscopic examination. Both aqueocentesis (cyclophosphamide, doxorubicin, vincristine, and prednisolone) and intraocular biopsy are invasive procedures requiring special- are considered standard of care for cats with high grade lympho- ized techniques and should only be completed by a veterinary mas (lymphoblastic lymphoma). Approximately 50% to 70% ophthalmologist. When the tumor is extensive and affecting of cats are expected to achieve a remission with such protocols. ocular comfort and/or function, enucleation and submission for Achieving a complete remission is a reliable prognostic factor. histopathology is a reasonable means of making a diagnosis. The Cats achieving a complete remission may live 1 year or longer, diagnostic evaluation for bilateral uveitis should include a com- while partial responders and non-responders will usually only plete physical examination, complete blood cell count (CBC), live a few months (21–23). Cats with low grade lymphoma serum biochemistry profile, urinalysis, thoracic radiographs, (small cell lymphoma) are usually treated with a combination abdominal ultrasound, and select serology. In this cat, a CBC of chlorambucil and prednisolone and are expected to have a and urinalysis were within normal limits. Serum biochemistry prolonged survival (20). Extranodal lymphomas represent a revealed mild panhyperproteinemia with a total protein of therapeutic challenge as the disease is localized at the time of 90 g/L (reference range: 53 to 84 g/L) but was otherwise nor- diagnosis. Some cats may be cured with local therapies such mal. Testing for FeLV/FIV was negative. Thoracic radiographs as surgery and radiation, while others will go on to develop showed no significant abnormalities. Abdominal ultrasound systemic disease. Nasal lymphoma in cats is a common form of revealed the liver to be thickened and hyperechoic and the extranodal lymphoma. Treatment with radiation (with or with- spleen to have mottled parenchyma. Fine-needle aspiration of out chemotherapy) yields survival times close to 3 years (24). the liver and spleen was performed and the cytology was not Biologic behavior with other forms of extranodal lymphomas is consistent with neoplasia. Aqueous centesis was performed and largely unknown in cats so that a combination of local therapy cytology revealed neoplastic round cells most consistent with a (such as surgery) to control the primary disease in combina- lymphoid tumor. For therapeutic purposes and to confirm the tion with systemic therapy (chemotherapy) to prevent systemic diagnosis, the right eye was enucleated the following day and progression of the cancer is often recommended. submitted for light microscopic examination; the diagnosis was In this case chemotherapy was recommended; however, the confirmed as intraocular B-cell lymphoma. owner elected not to pursue this treatment. As the left eye was Lymphoma is the most common hematopoietic neoplasm still visual and comfortable we continued symptomatic therapy and the most common secondary intraocular tumor in cats (10). with topical diclofenac, prednisolone acetate, and dorzolamide/ Although there are a few case reports of solitary conjunctival and timolol, q8h. Unfortunately, the cat died 5 months after initial ocular lymphoma, solitary ocular lymphoma is believed to be presentation and no postmortem examination was completed to rare in dogs and cats (11–13). Intraocular lymphoma is generally confirm the cause of death. Although multicentric lymphoma considered to be part of multicentric disease. The anterior uvea was not confirmed by our initial diagnostic evaluation in this is the most common tissue involved and intraocular lymphoma cat, it is likely that systemic progression of the lymphoma may often mimics anterior uveitis. The uveitis in the left eye of this have resulted in death. cat was likely a manifestation of systemic lymphoma rather than idiopathic or immune-mediated inflammation. Nodular iris References lesions, as seen in this case, are the most common ocular mani- 1. Grahn BH, Peiffer RL, Cullen C, Haines DM. Classification of feline festations of intraocular lymphoma in cats (3). Interestingly, intraocular neoplasms based on morphology, histochemical staining, ocular manifestations are often the presenting lesions and the and immunohistochemical labelling. Vet Ophthalmol 2006;9:395–403. precursor to detection of systemic disease (3,11). 2. Labelle P, Holmberg BJ. Ocular myxoid leiomyosarcoma in a cat. Vet Ophthalmol 2010;13:58–62. Establishing the immunologic phenotype and histologic clas- 3. Corcoran KA, Peiffer RL, Koch SA. Histopathologic features of feline sification is important for determining therapeutic strategies and ocular lymphosarcoma 49 cases (1978–1992). Vet Comp Pathol 1995;5: prognosis for dogs with lymphoma. In cats, immunophenotyp- 35–40. 4. Giordano C, Guidice C, Bellino C, Borrelli A, D’Angelo A, Gianella P. ing does not provide prognostic information, but is useful to A case of oculo-cerebral B-cell lymphoma in a cat. Vet Ophthalmol 2013; confirm a diagnosis of lymphoma in conjunction with histo- 16:77–81.

516 CVJ / VOL 58 / MAY 2017 FOR PERSONAL USE ONLY

5. Scurrell E, Trott A, Rozmanec M, Belford CJ. Ocular histiocytic sarcoma 16. Vail DM, Moore AS, Ogilvie GK, Volk LM. Feline lymphoma in a cat. Vet Ophthalmol 2013;16:173–176. (145 cases): Proliferation indices, cluster of differentiation 3 immu- 6. Powell C, Lappin MR. Causes of feline uveitis. Comp Cont Ed Small noreactivity, and their association with prognosis in 90 cats. J Vet Int Anim Pract 2001;23:128–140. Med 1998;12:349–354. OPHTHALMOLOGYDIAGNOSTIC 7. Olivero D, Riis R, Dutton A, Murphy C, Nasisse M, Davidson M. 17. Malmberg JL, Garcia T, Dubielzig RR, Ehrhart EJ. Canine and feline Feline lens displacement: A retrospective analysis of 345 cases. Progr retinal lymphoma: A retrospective review of 12 cases. Vet Ophthalmol Vet Comp Ophthalmol 1991;1:239–244. 2016:1–6. DOI:10, 1111/vop.12356. 8. Wilcock BP, Peiffer RL, Davidson MG. The causes of glaucoma in cats. 18. Ota-Kuroki J, Ragsdale JM, Bawa B, Wakamatsu N, Kuroki K. Vet Pathol 1990;27:34–40. Intraocular and periocular lymphoma in dogs and cats: A retrospective 9. Davidson MG, Nasisse MP, English RV, Wilcock BP, Jamieson VE. review of 21 cases (2001–2012). Vet Ophthalmol 2014;17:389–396. Feline anterior uveitis: A study of 53 cases. J Am Anim Hosp Assoc 19. Collette SA, Allstadt D, Chon Em, et al. Treatment of feline 1991;27:77–83. ­intermediate- to high-grade lymphoma with a modified university 10. Stiles J. Feline ophthalmology. In: Gelatt KN, Gilger BC, Kern TJ, of Wisconsin-Madison protocol: 119 cases (2004–2012). Vet Comp eds. Veterinary Ophthalmology. 5th ed. Ames, Iowa: Wiley-Blackwell, Oncol 2016;14:136–146. 2013:1511–1514. 20. Lingard AE, Briscoe K, Beatty JA, et al. Low-grade alimentary lym- 11. Wiggins TK, Skorupski KA, Reilley CM, Frazier SA, Dubielzig RR, phoma: Clinicopathological findings and response to treatment in Maggs DJ. Presumed solitary intraocular or conjunctival lymphoma in 17 cases. J Feline Med Surg 2009;11:692–700. dogs and cats: 9 cases (1985–2013). J Am Vet Med Assoc 2014;244: 21. Ettinger SN. Principles of treatment for feline lymphoma. Clin Tech 460–470. Small Anim Pract 2003;18:98–102. 12. Radi ZA, Miller DL, Hines ME, II. B-cell conjunctival Hodgkin’s-like 22. Teske E, van Straten G, van Noort R, Rutteman GR. Chemotherapy lymphoma in a cat. Vet Ophthalmol 2004;7:413–415. with cyclophosphamide, vincristine, and prednisolone (COP) in cats 13. Holt E, Goldschmidt MH, Skorupski K. Extranodal conjunctival with malignant lymphoma: New results with an old protocol. J Vet Hodgkin’s-like lymphoma in a cat. Vet Ophthalmol 2006;9:141–144. Intern Med 2002;16:179–186. 14. Patterson-Kane JC, Kugler BP, Francis K. The possible prognostic sig- 23. Milner RJ, Peyton J, Cooke K, et al. Response rates and survival times nificance of immunophenotype in feline alimentary lymphoma: A pilot for cats with lymphoma treated with the University of Wisconsin- study. J Comp Pathol 2004;130:220–222. Madison chemotherapy protocol: 38 cases (1996–2003). J Am Vet Med 15. Wolfesberger B, Skor O, Hammer SE, et al. Does categorization of Assoc 2005;227:1118–1122. lymphoma subtypes according to the World Health Organization clas- 24. Sfiligoi G, Theon AP, Kent MS. Response of nineteen cats with sification predict clinical outcome in cats? J Fel Med Surg 2016;1–10. nasal lymphoma to radiation therapy and chemotherapy. Vet Radiol DOI: 10.1177/1098612X16666119. Ultrasound 2007;48:388–393.

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518 CVJ / VOL 58 / MAY 2017 VET-2K Allowing customers to check their pets for diabetes at home.

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