The Canadian Veterinary Journal La Revue Vétérinaire Canadienne The

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July/Juillet 2016 The Canadian Veterinary Journal

Vol. 57, No. 07 La Revue vétérinaire canadienne

July/Juillet 2016 Volume 57, No. 07

The cost of a case of subclinical ketosis in Canadian dairy herds

Economic value of ionophores and propylene glycol to prevent disease and treat ketosis in Canada

Comparison of intraoperative and postoperative pain during canine ovariohysterectomy and ovariectomy

Evolution of in vitro antimicrobial resistance in an equine hospital over 3 decades

Presumed masitinib-induced nephrotic syndrome and azotemia in a dog

Hypoadrenocorticism mimicking protein- losing enteropathy in 4 dogs

Total laryngectomy for management of chronic aspiration pneumonia in a myopathic dog

Citrobacter freundii induced endocarditis in a yearling colt

Equine motor neuron disease in 2 horses from Saskatchewan

Diagnostic performance of an indirect enzyme-linked immunosorbent assay (ELISA) to detect bovine leukemia virus antibodies in bulk-tank milk samples

Congenital nutritional myodegeneration in a neonatal foal

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JULY/JUILLET 2016 Contents Table des matières

SCIENTIFIC RUBRIQUE SCIENTIFIQUE

ARTICLES 761 Total laryngectomy for management 728 The cost of a case of subclinical ketosis of chronic aspiration pneumonia in in Canadian dairy herds a myopathic dog Khaled Gohary, Michael W. Overton, Karen M. Vernau, Stanley L. Marks, Michael Von Massow, Stephen J. LeBlanc, Maggie A. Kuhn, William T.N. Culp, Kerry D. Lissemore, Todd F. Duffield Tammy J. Owens, G. Diane Shelton, Tausif Siddiqui, Rachel Pollard, 733 Economic value of ionophores and Peter C. Belafsky propylene glycol to prevent disease 767 Citrobacter freundii induced endocarditis and treat ketosis in Canada in a yearling colt Khaled Gohary, Michael W. Overton, Eleonora E.A. Guidi, Aurélie Thomas, Michael Von Massow, Stephen J. LeBlanc, Jean-Luc Cadoré, Agnès Benamou Smith Kerry D. Lissemore, Todd F. Duffield 741 Comparison of intraoperative and 771 Equine motor neuron disease in 2 horses postoperative pain during canine from Saskatchewan ovariohysterectomy and ovariectomy Michelle L. Husulak, Katharina L. Lohmann, Kamal Gabadage, Chris Wojnarowicz, Amanda Tallant, Barbara Ambros, Carol Freire, Fernando J. Marqués Sherisse Sakals 747 Evolution of in vitro antimicrobial resistance BRIEF COMMUNICATION in an equine hospital over 3 decades COMMUNICATION BRÈVE Annie Malo, Caroline Cluzel, Olivia Labrecque, 778 Diagnostic performance of an indirect Guy Beauchamp, Jean-Pierre Lavoie, enzyme-linked immunosorbent assay Mathilde Leclere (ELISA) to detect bovine leukemia virus antibodies in bulk-tank milk samples CASE REPORTS Omid Nekouei, Jean Durocher, Greg Keefe RAPPORTS DE CAS 752 Presumed masitinib-induced nephrotic STUDENT PAPER syndrome and azotemia in a dog COMMUNICATION ÉTUDIANTE Lauren Devine, David J. Polzin 781 Congenital nutritional myodegeneration 757 Hypoadrenocorticism mimicking in a neonatal foal protein-losing enteropathy in 4 dogs Jessie MacQuarrie Janne G. Lyngby, Rance K. Sellon 687 QUIZ CORNER TEST ÉCLAIR

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JULY/JUILLET 2016 Contents Table des matières

FEATURES RUBRIQUES SPÉCIALES

PRESIDENT’S MESSAGE NOTICES ANNONCES LE MOT DE LA PRÉSIDENTE 681 Collaboration/Collaboration 770 New Product Nicole Gallant Nouveaux produit 756 Index of Advertisers 683 VETERINARY MEDICAL ETHICS Index des annonceurs DÉONTOLOGIE VÉTÉRINAIRE 791 Classifieds 703 2015 CVMA ANNUAL REPORT Petites annonces RAPPORT ANNUEL 2015 DE L’ACMV

VETERINARY PRACTICE MANAGEMENT NEWS | NOUVELLES GESTION D’UNE CLINIQUE VÉTÉRINAIRE 785 Veterinary diet pricing: Competing with 689 NEWS the pet food store/Prix des aliments NOUVELLES vétérinaires : comment faire concurrence Heather Broughton, Isabelle Vallières aux animaleries Chris Doherty

789 DIAGNOSTIC OPHTHALMOLOGY OPHTALMOLOGIE DIAGNOSTIQUE Bianca S. Bauer, Bruce H. Grahn, Lynne S. Sandmeyer

BOOK REVIEW COMPTE RENDU DE LIVRE 746 Small Animal Soft Tissue Surgery, 2nd edition Melissa Knowles

Contributors

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

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The Canadian Veterinary Journal Editorial policy: All published articles including editorials and letters reflect the La Revue vétérinaire canadienne opinions of the authors and do not necessarily reflect the opinion of the publisher. Publication of an advertisement does not necessarily imply that the publisher agrees 339 rue Booth Street with or supports the claims therein. Ottawa, Ontario K1R 7K1 Politique de la Rédaction : Tous les articles publiés, y compris les éditoriaux et les Telephone: (613) 236-1162 lettres, représentent l’opinion de l’auteur et non pas nécessairement la position de Fax: (613) 236-9681 l’éditeur. E-mail: [email protected] La publication d’une annonce ne signifie pas nécessairement que l’éditeur est d’accord Website/Site Web: www.canadianveterinarians.net avec son contenu ou qu’il l’appuie. www.veterinairesaucanada.net Editor-in-Chief/Rédacteur en chef © C anadian Veterinary Medical Association 2016 Carlton Gyles, Guelph, Ontario L’Association canadienne des médecins vétérinaires 2016 Associate Editors/Rédacteurs associés Bruce Grahn, Saskatoon, Saskatchewan The Canadian Veterinary Journal is indexed or abstracted in: Wayne McDonell, Guelph, Ontario La Revue vétérinaire canadienne est indexée ou ses articles sont Feature Editors/Rédacteurs des chroniques résumés dans : Stephen Raverty, Abbotsford, British Columbia AGRICOL, Biological Abstracts, Capsule Report, Current Contents — Agriculture, Tim Blackwell, Fergus, Ontario Derwent Veterinary Drug File, EMBASE/Excerpta Medica, Andrew Allen, Saskatoon, Saskatchewan Index Veterinarius, Index Medicus, Quarterly Index, Science Citation Index, Small Animal Practice, Veterinary Bulletin, Veterinary Reference Service, Veterinary Update. Assistant Editors/Rédacteurs adjoints Robert Friendship, Guelph, Ontario Greg Harasen, Regina, Saskatchewan Photo by/Photo de : Shutterstock Jacob Thundathil, Calgary, Alberta Ron Johnson, Guelph, Ontario Typesetting/Typographie Richard Kennedy, Pincher Creek, Alberta AN Design Communications Shawn McKenna, Charlottetown, P.E.I. Printed by/Imprimé par Managing Editor/Directrice de la rédaction The Lowe-Martin Group Heather Broughton, Ottawa, Ontario Ottawa, Ontario Assistant Managing Editor/Directrice adjointe de la rédaction ISSN 0008-5286 Stella Wheatley, Ottawa, Ontario Editorial Coordinator/Coordonnatrice de la rédaction Linda Chow, Ottawa, Ontario Return undeliverable Canadian addresses to: 339 rue Booth Street Advertising Manager/Gérante de la publicité Ottawa, Ontario K1R 7K1 Laima Laffitte, Wendover, Ontario e-mail: [email protected] Published monthly by/ Subscriptions (2016). Annual: Canada $200 + applicable GST or HST; foreign Publication mensuelle de $215 US; institutional $250. Express subscriptions available. Single issue/back issue: Canadian Veterinary Medical Association $25 each + GST or HST, if applicable. (All prices subject to change.) Missing issues will be replaced if the Subscriptions Office is notified within 6 months (for requests within Canada) and 1 year (for requests from abroad) of the issue date. The publisher expects to supply missing issues only when losses have been sustained in transit and when the reserve stock will permit. Telephone (613-236-1162) or (1-800-567-2862) and fax (613-236-9681) orders accepted with a valid Visa or MasterCard number. Please advise the publisher of address changes promptly. Abonnements (2016). Annuel : Canada 200 $ + TPS ou TVH en vigueur; pays étranger 215 $ É-U; prix d’une institution 250 $. Abonnement express disponible. Anciens numéros (chacun) : 25 $ + TPS ou TVH en vigueur. Les prix sont sujets à changement sans préavis. Les numéros qui ne sont pas reçus seront remplacés si l’éditeur en est informée dans les 6 mois (pour les demandes venant du Canada) et 1 an (pour les demandes venant de l’étranger) suivant la date de parution. L’éditeur s’engage à remplacer les numéros manquants seulement lorsque les pertes ont été subies en transit et lorsque ses réserves le permettent. On peut payer son abonnement par téléphone (613-236-1162) 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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Collaboration Collaboration

he world is becoming so much smaller and change con- e monde rétrécit de plus en plus et les changements T tinues to happen. As veterinarians, we must be ready to L continuent de se produire. À titre de vétérinaires, nous be part of these changes and not be left behind. Collaboration devons être prêts à épouser ces changements afin de ne pas within our profession and with other stakeholders is absolutely tirer de l’arrière. À l’avenir, la collaboration au sein de notre necessary going forward. As I think of all the work over the last profession et avec d’autres intervenants sera absolument nécessaire. few years that resulted in the imminent changes in antibiotic Je crois que le travail qui a été réalisé au cours des dernières stewardship, it is obvious that collaboration and communication années et qui a donné lieu à des changements imminents pour among stakeholders must happen to achieve our future goals and l’antibiogouvernance des antibiotiques témoigne du fait que les ensure the voice of our profession is heard. intervenants doivent collaborer et communiquer afin d’atteindre As veterinarians, we tend to be independent and that can leur buts futurs et de veiller à ce que la voix de la profession soit work on a small scale. However, on the larger scale, I have entendue. learned that we must work together for the good of our profes- En tant que vétérinaires, nous avons tendance à être sion and, dare I say, the good of humans also as we think of the indépendants et cela peut fonctionner à petite échelle. Cependant, “One Health” concept. à grande échelle, j’ai appris que nous devons travailler ensemble Last August I attended National Veterinarian Day in Mexico pour le bien de notre profession et, j’oserais même dire, pour le City. This was fascinating to watch. The country brings together bien des humains dans l’optique du concept d’«Une santé». veterinarians and those with whom they work, such as col- En août dernier, j’ai assisté à la Journée vétérinaire nationale leagues in the Department of Agriculture and other government dans la ville de Mexico. C’était un événement fascinant à observer. officials. This large group then proceeds to celebrate all aspects Le pays rassemble les vétérinaires et les personnes avec qui ils of veterinary medicine together. We have work to do to get to travaillent, dont des collègues du ministère de l’Agriculture et this level of interaction in Canada, where things are still a bit d’autres représentants gouvernementaux. Ce grand groupe célèbre fragmented with different veterinary and related groups. We ensuite tous les aspects de la médecine vétérinaire ensemble. must continue to work with other stakeholders, as we have so Nous devons travailler pour parvenir à ce niveau d’interaction successfully done in bringing forward the changes in antibiotic au Canada, où la situation est toujours un peu fragmentée usage. There will be many other issues to collaborate on, such entre les différents groupes vétérinaires et autres regroupements as the evolving problem of rescue groups bringing in dogs from connexes. Nous devons continuer de travailler avec les autres different parts of the world. Foreign diseases that these dogs intervenants, comme nous l’avons fait avec tant de succès lors can potentially introduce to our country, as well as the welfare de la mise en œuvre de changements pour l’utilisation des concern for their transport are issues that require attention. antibiotiques. Il y aura beaucoup d’autres enjeux sur lesquels nous When compared to many countries, we are so fortunate to pourrons collaborer, comme le problème des groupes de secours have the level of organized medicine that we have in Canada, qui amènent des chiens provenant de diverses régions du monde. but we still fall a bit short in some ways. Strong provincial Les maladies exotiques que ces chiens peuvent potentiellement associations are important as is a national voice for the profes- introduire dans notre pays, ainsi que les préoccupations de bien- sion; one doesn’t negate the other. Collaboration and mutual être relatives à leur transport, exigent notre attention. understanding are crucial going forward as we become more Comparativement à de nombreux autres pays, nous sommes involved in the international veterinary community. We can’t vraiment fortunés de posséder le niveau de médecine organisée

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

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continue to compete among ourselves. We all need members to exist but we must reach an understanding and vision of what is going on within and outside of Canada. The fact that Canada is well regarded internationally has become apparent to me in this past year and I thank you for the opportunity to see this international face of Canadian veterinary medicine. We are getting there; let’s work together to make organized veterinary medicine in Canada strong at all levels. ■

Nicole Gallant ADVERSE REACTIONS TO FOOD

LE MOT DE LA PRÉSIDENTELA DE MOT LE Taking purity to the next level que nous avons ici au Canada, mais certains secteurs présentent toujours des lacunes. Il est important de posséder des associations NEW & IMPROVED provinciales fortes et une voix nationale pour la profession et ces deux positions ne sont pas forcément contradictoires. La ® ® Prescription Diet z/d collaboration et la compréhension mutuelle représenteront des éléments cruciaux tandis que nous élargirons notre participation au sein de la collectivité vétérinaire internationale. Nous ne pouvons pas continuer à compétitionner entre nous. Nous avons besoin de la présence de tous les membres, mais nous devons aussi parvenir à une compréhension et à une vision de ce qui se passe à l’intérieur et à l’extérieur du Canada. Au cours de la dernière année, j’ai pu prendre connaissance du fait que le Canada possède une excellente réputation internationale et je vous remercie de l’occasion que vous m’avez accordée de voir ce visage international de la médecine vétérinaire canadienne. Nous nous approchons du but. Travaillons ensemble pour assurer la force de la médecine vétérinaire à tous les niveaux. ■

Nicole Gallant

682 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY Veterinary Medical Ethics Déontologie vétérinaire

Ethical question of the month — July 2016 A nearby successful veterinary practice provides state-of-the-art veterinary medicine and surgery to a large and dedicated clientele. This clinic also offers alternative therapies for conditions that do not respond to conventional treatments. In the past, these therapies were primarily vitamin and herbal products. Owners signed a consent form recognizing that the treatments were unconventional. There is no evidence that these therapies are effective but the clinic has not charged exorbitantly for these services and some of your best clients have gone to this clinic when you have had nothing left to offer but palliative care. A board-certified surgeon at this clinic who performs complex orthopedic surgeries has recently begun to surgically implant special magnets and other “positive energy” devices in patients in which conventional therapies were ineffective. The implants are accompanied by vague claims that they “could help.” The practice charges several thousand dollars for these surgeries, but this deters fewer clients than you would have predicted. You believe this clinician is using the trust created through the success of his conventional treatments to convince clients to try expensive and unproven “alternative” therapies when in desperate straits. You tolerated the selling of false hope when it was low cost and non-invasive, but this new high cost and invasive approach troubles you. Are you justified in your change in attitude towards the unconventional treatments offered by this practice? Question de déontologie du mois — Juillet 2016 Une pratique vétérinaire prospère avoisinante offre de la médecine et des chirurgies à la fine pointe technologique à une clientèle vaste et dévouée. Cette clinique offre aussi des thérapies parallèles pour des affections qui ne répondent pas à des traitements conventionnels. Par le passé, ces thérapies étaient principalement des vitamines et des produits à base de plantes. Les propriétaires signaient un formulaire de consentement pour reconnaître que les traitements n’étaient pas conventionnels. Il n’y avait aucune preuve que ces traitements étaient efficaces, mais la clinique ne facturait pas des tarifs exorbitants pour ces services et certains de vos meilleurs clients s’y rendaient lorsque vous n’aviez rien d’autre à leur offrir que des soins palliatifs. Un chirurgien spécialiste à cette clinique qui effectue les chirurgies orthopédiques complexes a récemment commencé à implanter des aimants spéciaux et d’autres dispositifs à «énergie positive» chez les patients qui ne

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.

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répondent pas aux traitements conventionnels. Les implants sont accompagnés d’allégations vagues stipulant que les traitements «peuvent aider». La pratique facture plusieurs milliers de dollars pour ces chirurgies et ce fait ne décourage pas autant de clients que vous auriez pu le croire. Vous estimez que ce clinicien utilise une réputation bâtie sur le succès de ses traitements conventionnels pour convaincre les clients de tenter des thérapies «parallèles» dispendieuses et non éprouvées lorsque les clients se trouvent dans des situations désespérées. Vous étiez tolérant de la vente de ces faux-espoirs lorsqu’ils étaient peu dispendieux et non invasifs, mais vous êtes perturbé par cette nouvelle approche coûteuse et invasive. Votre changement d’attitude envers les traitements non conventionnels offerts par cette pratique est-il justifié?

Comments/Commentaires :

DÉONTOLOGIEVÉTÉRINAIRE

Name/Nom :

Address/Adresse :

Ethical question of the month — April 2016 You receive a call as clinic hours are ending from someone who is visiting in your area. Their dog has been hit by a car and they are 8 hours from home. The person describes a dog that appears to be seriously injured. You agree to see the dog but since this person is from out of town, you explain your fees and out-of-hours charges and that some form of payment is required at the time of admission. You can hear on the phone that the person is put off by this and says, “Well, I’ll think about it and call you back.” They do not call back and you call them back after an hour and they are still debating what to do and the dog is described as breathing with difficulty. They still say they will call you when they make a decision. You seriously doubt you will hear from them. Are you in any way responsible for this animal’s outcome? Question de déontologie du mois — Avril 2016 Un peu avant la fermeture de la clinique, vous recevez un appel peu d’une personne en visite dans votre région. Son chien a été heurté par une automobile et elle se trouve à huit heures de trajet de la maison. La personne décrit un chien qui semble être gravement blessé. Vous acceptez d’examiner le chien mais, vu que cette personne provient de l’extérieur de la ville, vous expliquez vos tarifs, les frais après les heures d’ouverture et le besoin d’un dépôt au moment de l’admission. Vous pouvez constater au téléphone que la personne est décontenancée par vos propos et elle dit : «Eh bien, je vais y réfléchir et je vous rappellerai.» La personne ne rappelle pas et vous décidez de la contacter après une heure. Elle se demande toujours quoi faire et elle décrit le chien comme ayant une respiration difficile. Elle dit qu’elle vous rappellera quand elle aura pris une décision. Vous doutez sérieusement que vous aurez de nouveau de ses nouvelles. Êtes-vous responsable du sort de cet animal?

An ethicist’s commentary on a dog requiring emergency care after-hours As we have so often done in the past, it is helpful to hark back and only, conceptually, secondarily and derivatively to make to some of the wisdom that may be found in the writings of money. Plato. Two related Platonic points are relevant here. When I am reminded of the story told to me by my dear friend, discussing the wise ruler, Plato makes the point that the job veterinarian Brian Forsgren. Early on in his practice, an impov- of a ruler, or for that matter, a shepherd, or a craftsman, com- erished street person showed up at his clinic with a dog who prises two distinct aspects: first and foremost one is obliged to had been run over by a truck and sustained a crushed pelvis. improve and protect whatever one exercises one’s professional Dr. Forsgren asked when this occurred. The owner replied a few authority over — secondarily, one is functioning as a wage hours ago. Dr. Forsgren then asked why he had waited so long earner. As we pointed out in a recent column, a medical profes- to seek help. The client responded that this had occurred miles sional functions first and foremost to treat, fix, heal, and cure, away, and he had indeed approached the nearest veterinarian,

684 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY who had replied that it would cost many thousand dollars for money after the animal is looked at. And there are also many diagnostics and surgical treatment, and that nothing could be ways of establishing payment protocols as the animal is being done for less. Brian pondered the absurdity of the previous cli- worked on. As a worst-case, the veterinarian can suggest that ETHICS MEDICAL VETERINARY nician’s narrative. He pointed out that he could cast the animal the owner surrender the animal, and then he or she can treat for a few hundred dollars. He did so, and the animal recovered the animal and adopt it out. As Dr. James Wilson has informed well. He then resolved to help financially challenged people treat me, he can then provide the newspapers or other media with a their animals as his life’s work. “After all, who could be myopic touching human interest story that will buy him far more favor- enough to think that a poor person’s animal meant less to them able publicity than he could acquire in any other way. Members than a rich person’s?” Gratifyingly, he built a very successful of the public will be clamoring to adopt the animal! practice. He is currently in semi-retirement, and continues to Giving priority to the payment even as one is told that the stress to his peers the need to place care and empathy before animal is “seriously injured” is hardly the mark of a compas- financial limitations. sionate and committed veterinarian. While I am certainly aware The lesson here should be obvious. As I have said ad nauseam that veterinarians cannot work for nothing, and have repeatedly in this column, the veterinarian’s primary obligation is to the made this point in my writings, one must be wise enough to patient. And it is dogma in veterinary circles to affirm that a recognize exceptional situations and the opportunities they veterinarian is obliged to administer stabilizing care even to an present. To act otherwise is not only unprofessional in the unowned animal brought in by a good Samaritan not willing sense identified by Plato, but is also in the end contrary to the to assume financial responsibility. For the veterinarian in this veterinarian’s interest and is thus imprudent. case to start talking money even before looking at the animal is I am grateful to Drs. Brian Forsgren and James Wilson for teach- at the very least sleazy and borders on obscene. ing me their ways of, as Plato says, “making a virtue of necessity.” First and foremost he or she should insist that the animal be brought to the clinic immediately. There is plenty of time to talk Bernard E. Rollin, PhD

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GLOBAL DIAGNOSTICS

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Quiz Corner Test éclair

1. A 6-year-old boxer dog presents with a skin mass over the 1. Un chien Boxer âgé de 6 ans présente une masse cutanée lateral thorax. The owner notices that it increases and dans la partie latérale du thorax. Le propriétaire mentionne decreases in size regularly and the dog seems to scratch at que la masse augmente et diminue de grosseur de façon the mass. On fine-needle aspiration of the mass, a homog- régulière et que le chien la gratte. À l’aspiration à l’aiguille enous population of round cells containing granules is noted. fine de la masse, on observe une population homogène de The most likely diagnosis is which of the following? cellules rondes renfermant des granules. Lequel des A. Cutaneous mast cell tumor diagnostics suivants est le plus probable? B. Fibrosarcoma A. mastocytome cutané; C. Lymphoma B. fibrosarcome; D. Mammary gland tumor C. lymphome; E. Cutaneous hemangiosarcoma D. tumeur des glandes mammaires; E. hémangiosarcome cutané. 2. The most common cause of urinary incontinence in a 3-month-old female dog is which of the following? 2. Lequel des problèmes suivants constitue la cause la plus A. Ectopic ureter(s) commune d’incontinence urinaire chez une chienne âgée de B. Bladder neoplasia 3 mois? C. Urinary tract infection (UTI) A. uretère(s) ectopique(s); D. Primary sphincter mechanism incompetence (PSMI) B. néoplasie de la vessie; E. Cystic urolithiasis C. infection du tractus urinaire (ITU); D. insuffisance du mécanisme du sphincter primaire (IMSP); 3. Which of the following is a simple technique to determine E. urolithiase vésicale. whether a stray cat has intra-abdominal testicles? A. Measure the length of the canine teeth. 3. Laquelle des procédures suivantes est une façon simple de B. Palpate the abdomen deeply. déterminer si un chat errant possède des testicules C. Examine the base of the penis for androgen-responsive intra-abdominaux? spines. A. mesure de la longueur d’une dent canine; D. Examine the footpads for evidence of hyperkeratosis. B. palpation en profondeur de l’abdomen; E. Measure scrotal thickness. C. examen de la base du pénis pour déceler la présence d’épines due aux androgènes; D. examen des coussinets plantaires pour déceler la présence d’hyperkératose; E. mesure de l’épaisseur du scrotum.

BRAVECTO CVJ - Quiz Corner Question ad.indd 1 2016-03-31 10:45 AM

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4. After unilateral ovariectomy for a granulosa cell theca 4. À la suite d’une ovariectomie unilatérale à cause d’une tumor in a mare, which of the following is correct? tumeur des cellules thécales de l’ovaire chez la jument, lequel A. Surgery should be scheduled to remove the contralateral des énoncés suivants est correct? ovary because these tumors tend to be bilateral. A. On doit planifier une chirurgie pour enlever l’ovaire B. The mare will be unable to conceive and maintain a preg- controlatéral parce que cette tumeur a tendance à être nancy to full term. bilatérale. C. The mare should be carefully observed for any clini- B. La jument sera incapable de concevoir et de maintenir une cal abnormalities because tumor metastasis will have gestation jusqu’à terme. occurred. C. On doit observer attentivement la jument pour détecter des D. The mare can be expected to resume her normal estrus signes d’anomalies à cause des métastases qui peuvent se TESTÉCLAIR cycle, although it may take up to 12 months after surgery. développer. E. The mare can be bred immediately after suture removal, D. On peut penser que la jument reprendra son cycle œstral 2 weeks after surgery. normal bien que cela puisse prendre jusqu’à 12 mois après la chirurgie. 5. Which of the following methods would be most useful for E. La jument peut être accouplée immédiatement après le determining the etiology of an outbreak of BRD in a group retrait des sutures, 2 semaines après la chirurgie. of 550-lb feedlot calves? A. Nasal swab submitted for bacterial culture 5. Laquelle des méthodes suivantes serait la plus utile pour B. Thoracic ultrasound déterminer l’étiologie d’une flambée de maladie respiratoire C. Serum samples from affected calves submitted for viral bovine dans un groupe de veaux à l’engraissement pesant serology chacun 550 lb? D. Necropsy of calves that died of chronic pneumonia or A. écouvillon nasal soumis pour culture bactérienne; were euthanized because of it B. échographie thoracique; E. Transtracheal lavage C. échantillons de sérum provenant de veaux malades soumis pour sérologie virale; D. nécropsie de veaux morts de pneumonie chronique ou euthanasiés à cause de cette affection; E. lavage transtrachéal.

(See p. 788 for answers./Voir les réponses à la page 788.)

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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688 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY

NEWS | NOUVELLES

Special promotion for Promotion spéciale pour your summer getaway! votre escapade estivale! heck out the CVMA hotel discount écouvrez le programme de rabais hôteliers Cprogram! In addition, when you book Dde l’ACMV. De plus, réservez votre your accommodations between May 1st hébergement entre le 1er mai et le 30 septembre and September 30th, you’ll be entered et vous serez inscrit à un tirage pour gagner into a draw to win your booking for free. le remboursement de votre réservation. Pour To start planning your getaway, go to the débuter la planification de votre escapade, allez CVMA website (www.canadianveterinar sur le site Web de l’ACMV (veterinairesaucanada. ians.net) and click on the Hotel Discounts net) et cliquez le lien «Rabais hôtelier» sous link under the tab Value of Membership l’onglet «Avantages et services aux membres» (member log-in required). (les membres devront ouvrir une session).

CVMA’s Emerging Leaders Program Programme des futurs leaders de l’ACMV am a 4th year veterinary student at the Faculté de médecine e suis étudiante de quatrième année en médecine vétérinaire à I vétérinaire, in Saint-Hyacinthe, Quebec, and, last year, I par- Jla Faculté de médecine vétérinaire de l’Université de Montréal à ticipated in one of the veterinary profession’s most enriching Saint-Hyacinthe et, l’année dernière, j’ai participé à l’un des ateliers and informative workshops on leadership, communications and les plus enrichissants et les plus informatifs sur le leadership, teamwork: CVMA’s Emerging Leaders Program (ELP). la communication et le travail d’équipe, le Programme des This workshop took place on July 16, 2015 at the Fairmont futurs leaders (PFL) de l’Association canadienne des médecins Palliser Hotel in Calgary, Alberta, during the CVMA’s Annual vétérinaires (ACMV). Convention. This workshop would not have been possible Cet atelier s’est déroulé le 16 juillet 2015 à l’hôtel Fairmont without the generous support of sponsors Virox, The Personal Palliser à Calgary, en Alberta, à l’occasion du congrès annuel de Insurance Company, Western Financial Group Insurance l’ACMV. Cet atelier n’aurait pas été possible sans le généreux Solutions, and Zoetis. soutien des commanditaires : Virox, laPersonnelle, Western Financial Group Insurance Solutions et Zoetis. Dans le cadre de discussions, de jeux interactifs et de vidéos, le Dr Rick DeBowes a aidé les vétérinaires et les technologues vétérinaires agréés à retrouver le plaisir à travailler et à faire face aux divers défis de la profession. Le Dr Rick DeBowes, professeur de chirurgie et directeur du programme «Personal Life Skills» à l’Université d’État de Washington, est très souvent porte-parole et présentateur de différents programmes de leadership. Il est aussi cocréateur de l’Expérience de leadership vétérinaire de l’American Veterinary Medical Association et de plusieurs autres ateliers de leadership interactifs et pratiques présentés dans de nombreux pays, et ce, sur quatre continents.

Hélène Rembeaux

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Through discussions, interactive games and videos, Dr. Rick Pour les vétérinaires récemment diplômés et les vétérinaires DeBowes helped veterinarians and registered veterinary technol- chevronnés, le PFL a pour objectif de donner les outils essentiels ogists rediscover the joy in working and dealing with the various pour maintenir un équilibre sain entre la vie professionnelle et la challenges of the profession. Dr. DeBowes, a professor of surgery vie personnelle. and director of the Personal Life Skills Program at Washington Cet atelier nous a permis de nous arrêter un instant et de State University, is a highly sought-after moderator and pre- prendre le recul nécessaire pour évaluer sous un autre angle la senter for various leadership programs. He also co-founded the pratique vétérinaire et nos interactions avec les collègues, les American Veterinary Medical Association’s Veterinary Leadership employés, les clients et les patients. Le Dr DeBowes encourage Experience and several other interactive and hands-on leadership les participants à réfléchir et à travailler sur eux-mêmes pour workshops presented in several countries and on 4 continents. développer les qualités qui les aideront à devenir de meilleurs The objective of the ELP is to give recent graduates, as well leaders. as experienced veterinarians and technologists, essential tools Au cours des dernières années, les participants au PFL de that will help them maintain a healthy balance between their l’ACMV ont décrit cette expérience comme étant «revigorante» ou professional and personal life. «rafraîchissante» qui leur permet d’attaquer leur journée en clinique This workshop gave us a moment to step back and see veteri- de façon plus positive et optimiste. nary practice and interactions with colleagues, employees, clients Pour les étudiants en médecine vétérinaire, la précision et la and patients from a different perspective. Dr. DeBowes encour- délicatesse en chirurgie sont des aptitudes bien développées dans ages participants to think and work for themselves to develop le cursus de médecine vétérinaire et elles sont importantes pour qualities that will help them become better leaders. être un bon vétérinaire. Cependant, l’intelligence émotionnelle, In recent years, CVMA’s ELP participants have described this l’empathie et la communication sont toutes aussi importantes mais experience as “energizing” and “refreshing,” allowing them to souvent reléguées en second plan. Le PFL représente un atout look at their clinic workday more positively and optimistically. considérable pour les participants et il leur permet d’être plus For veterinary students, surgical precision and dexterity are efficaces et attentifs lors des travaux d’équipe, des laboratoires et skills that are well developed in the veterinary medicine cur- des exercices chirurgicaux… et bien sûr en stage clinique! riculum and are important in becoming good veterinarians. Le prochain atelier aura lieu lors du congrès 2016 de l’ACMV Emotional intelligence, empathy and communications skills qui se déroulera à Niagara Falls, les 7 et 8 juillet prochains. Cet are just as important, but they often take a back seat. The ELP atelier incomparable est ouvert à tous les membres de l’ACMV et significantly benefits participants and enables them to be more de TTVAC. Pour plus de renseignements et pour vous inscrire, effective and attentive in team projects, labs and surgical exer- visitez le site Web de l’ACMV : (veterinairesaucanada.net/science- cises… and of course during clinical internships! knowledge/emerging-leaders-program) The next workshop will be held at CVMA’s 2016 Convention (par Hélène Rembeaux, représentante sénior sortante et étudiante à in Niagara Falls, Ontario, July 7 and 8. This unparalleled la Faculté de médecine vétérinaire de l’Université de Montréal) workshop is open to all CVMA and RVTTC members. For more information and to register, visit CVMA’s website (www. canadianveterinarians.net/science-knowledge/emerging-leaders- program). (by Hélène Rembeaux, Past SCVMA senior representative and student at the Faculté de médecine vétérinaire de l’Université de Montréal)

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SCVMA President Farewell Adieux du président des ÉACMV N would like to start my farewell by thanking everybody who has aimerais entamer mes adieux en remerciant toutes les I allowed me to hold this position for the last year; all Canadian J’personnes qui m’ont permis d’occuper ce poste au cours de veterinary students for allowing me to be your Students of the la dernière année : tous les étudiants en médecine vétérinaire CVMA (SCVMA) president, my fellow SCVMA Committee canadiens pour m’avoir permis d’être votre président des Étudiants members for your hard work and dedication, and to the CVMA de l’ACMV (ÉACMV), mes collègues membres du Comité des Council, Executive, and staff for being incredibly supportive, ÉACMV de votre travail ardu et de votre dévouement ainsi que le helpful, and informative. Conseil, l’exécutif et le personnel de l’ACMV qui m’ont offert un In my 2 years with the Students of the CVMA I have gained soutien incroyable ainsi que tous les renseignements nécessaires. great insight into the inner workings of our national veterinary Pendant mes deux années passées aux Étudiants de l’ACMV, medical association, the CVMA. The support that the CVMA j’ai découvert les rouages internes de notre association nationale provides to Canadian students is unparalleled; assisting us in de médecins vétérinaires, l’ACMV. Le soutien fourni par l’ACMV aux hosting our annual student Symposium, providing services étudiants canadiens est inégalé : elle nous procure de l’assistance to all students online, and supporting our new graduates as pour l’organisation de notre Symposium étudiant annuel, elle offre they transition into the next stage of their veterinary career. des services en ligne à tous les étudiants et elle appuie tous les I encourage all students to learn more about what the CVMA finissants tandis qu’ils effectuent la transition à l’étape suivante has to offer. Browse the student section of the CVMA website, de leur carrière vétérinaire. J’encourage tous les étudiants à en read the student edition of the CVMA’s e-newsletter “Online apprendre davantage à propos des avantages offerts par l’ACMV. from 339,” contact your college’s SCVMA representatives to Pour en savoir davantage à propos de ce que les ÉACMV et learn more about what the SCVMA, and the CVMA, can do l’ACMV peuvent faire pour vous et votre carrière, consultez la for you and your career. section étudiante du site Web de l’ACMV, lisez l’édition étudiante I will miss working with our SCVMA Committee members du cyberbulletin de l’ACMV «En direct du 339» ou contactez les and I admire their dedication and tireless work to better every représentants des ÉACMV de votre école. Canadian veterinary student’s experience. The endless hours Le travail avec notre Comité des ÉACMV me manquera planning Symposium, writing articles for The CVJ, coordinating car j’admire leur dévouement et leur travail infatigable en vue the New Graduate Survey, publishing our VetRap newsletter, and d’améliorer l’expérience de tous les étudiants en médecine fundraising for our new Student Leadership Workshop (which vétérinaire canadiens. La planification du Symposium, la rédaction will debut this fall at the Faculté de Médecine Vétérinaire in d’articles pour La RVC, la coordination du Sondage auprès des Saint-Hyacinthe, Quebec) are just some of the proud accom- finissants, la publication de notre bulletin VetRap et la cueillette plishments tackled by our Committee every year. de fonds pour notre nouvel Atelier de leadership étudiant (dont la While my time with the SCVMA is ending, I am excited première édition aura lieu cet automne à la Faculté de médecine to leave my position in the very capable hands of our incom- vétérinaire à Saint-Hyacinthe, au Québec) figurent parmi les ing SCVMA president, Elizabeth Hartnett from the Ontario réalisations exceptionnelles auxquelles notre Comité consacre Veterinary College. Elizabeth will lead a capable and motivated d’innombrables heures tous les ans. Committee, with representatives from all 5 Canadian colleges. Même si mon mandat auprès des ÉACMV prend fin, je suis Congratulations to all 2016 graduates, and best of luck to all excité de quitter mes fonctions en sachant que je laisse mon students in your current studies! poste entre les très bonnes mains de notre nouvelle présidente (by Justin R. Kristjansson, Western College of Veterinary Medicine, des ÉACMV, Elizabeth Hartnett, de l’Ontario Veterinary College. Class of 2017, 2015–2016 Students of the CVMA President) Elizabeth dirigera un Comité capable et motivé qui se composera de représentants des cinq collèges de médecine vétérinaire canadiens. Félicitations à tous les diplômés 2016 et, à tous les étudiants, bon succès dans vos études! (par Justin R. Kristjansson, Western College of Veterinary Medicine, promotion 2017, président 2015–2016 des Étudiants de l’ACMV)

Justin R. Kristjansson

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N Meet your 2016–17 SCVMA Rencontrez vos représentants Committee Representatives! 2016–2017 du Comité des ÉACMV! he Students of the Canadian Veterinary Medical Association e Comité des Étudiants de l’Association canadienne des T(SCVMA) Committee represents the CVMA at all Lmédecins vétérinaires (ÉACMV) représente l’ACMV et les cinq 5 Canadian veterinary colleges, strengthening the links between collèges de médecine vétérinaire canadiens afin de renforcer les the Association and its student members. liens entre l’Association et ses membres étudiants. Sarifa Lakhdhir, SCVMA rep- Sarifa Lakhdhir, représentante des ÉACMV à la Faculté de resentative at the University of médecine vétérinaire de l’Université de Calgary (UCVM), Calgary — Faculty of Veterinary est née et a grandi à Calgary, en Alberta. Son amour pour les Medicine (UCVM), was born and animaux s’est manifesté à un très jeune âge et, dans sa jeunesse, raised in Calgary, Alberta. Her love son film favori était Le Roi lion. Pendant qu’elle était à l’école of animals became apparent at a very élémentaire, Sarifa a beaucoup voyagé en Amérique du Nord et young age, as her favorite movie elle a visité plusieurs zoos et parcs d’animaux célèbres, comme growing up was The Lion King. le Zoo de San Diego et le Parc Safari. Durant ses visites, elle While in grade school, Sarifa trav- s’est rendue dans les coulisses et s’est renseignée sur le rôle des elled extensively throughout North vétérinaires afin d’assurer la santé et le bien-être des animaux America where she visited several tout en s’amusant à nourrir des animaux comme des okapis, des Sarifa Lakhdhir world-famous zoos and animal parks rhinocéros et des lions. Durant les deux premières années de such as the San Diego Zoo and Safari Park. During her visits, programme de premier cycle, Sarifa s’est rendue au Costa Rica et she went behind-the-scenes and learned about the role of the en Namibie avec ucalgarycares. Dans le cadre de ces expériences veterinarian in ensuring the health and well-being of the animals, multiculturelles, elle a eu l’occasion de se renseigner à propos all the while enjoying feeding animals such as okapis, rhinos, and du développement international éthique à une échelle locale et lions. During the first 2 years of her undergraduate program, internationale. De plus, elle a fait du bénévolat au Zoo de Calgary Sarifa travelled to Costa Rica and Namibia with ucalgarycares. et dans une clinique pour petits animaux à Calgary. L’été dernier, Through these cross-cultural experiences, she had the opportu- Sarifa a passé dix semaines au Kenya lors d’un internat avec nity to learn about ethical international development on a local Vétérinaires sans frontières Canada afin d’appuyer sa mission and global scale. In addition, she has volunteered at the Calgary en vue d’améliorer la vie des Kényans, de leurs collectivités et de Zoo and at a small animal clinic in Calgary. Last summer, Sarifa leurs animaux. Pendant ce séjour, elle a travaillé avec de petits spent 10 weeks in Kenya interning with Veterinarians without producteurs laitiers afin d’évaluer et d’améliorer le bien-être, le Borders Canada to build on their mission of helping to improve confort, la nutrition et la production des vaches laitières. À titre the lives of Kenyans, their communities, and their animals. de représentante sénior des ÉACMV à l’UCVM pour l’année à While there, she worked with small-holder dairy farmers to assess venir, Sarifa se réjouit à la pensée de présider le Symposium and improve the welfare, comfort, nutrition, and production of des ÉACMV 2017 dont le thème sera «Prenez le taureau par dairy cows. Being the senior SCVMA representative for UCVM les cornes. Soyez responsable de vos actes». Elle espère que le for the upcoming academic year, Sarifa is looking forward to Symposium encouragera les étudiants à assumer la responsabilité chairing the 2017 SCVMA Symposium, themed “Take the bull de leurs actes, particulièrement en ce qui concerne la manipulation by the horns. Take charge of your actions.” She hopes the sym- des animaux, le bien-être animal et la gestion responsable de posium will encourage students to take responsibility for their l’environnement. actions especially when it comes to animal handling, animal Elizabeth Hartnett, représentante des ÉACMV à l’Ontario welfare, and environmental stewardship. Veterinary College (OVC), a décidé qu’elle désirait être vétérinaire Elizabeth Hartnett, SCVMA à l’âge de cinq ans et elle a toujours été fascinée par le monde representative for the Ontario naturel. Elle a grandi dans une famille militaire et a vécu dans Veterinary College (OVC), decided plusieurs endroits différents — allant de l’Allemagne au Manitoba, she wanted to be a veterinarian at en passant par le Québec — avant que sa famille ne s’installe the age of 5 and has always been finalement à Kingston, en Ontario. Ses études de premier cycle à fascinated by the natural world. l’Université Queen’s ont porté sur la biologie environnementale et Growing up in a military family, elle a ensuite obtenu une maîtrise en études environnementales she lived in several different places à l’Université York, où elle s’est concentrée sur l’éducation — from Germany to Manitoba to humanitaire et l’éthique environnementale. Québec — before her family settled Pendant plusieurs années, Elizabeth a travaillé dans le domaine in Kingston, Ontario. She com- des recherches et des politiques environnementales, tout en se Elizabeth Hartnett pleted her undergraduate studies in portant bénévole au Toronto Wildlife Centre les fins de semaine. Environmental Biology at Queen’s University and received a Elle s’est rendue compte que ses intérêts dans l’environnement, Master in Environmental Studies degree from York University, les politiques publiques et la santé faunique étaient compatibles where she focused on humane education and environmental avec une carrière en médecine vétérinaire et elle s’est décidée ethics. à finalement présenter une demande à l’école de médecine

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For several years, Elizabeth worked in environmental research vétérinaire. L’admission à la promotion 2018 de l’OVC était la N and policy, while volunteering at the Toronto Wildlife Centre réalisation d’un rêve. on weekends. Realizing that her interests in the environment, Elizabeth aime participer aux activités de l’OVC et de la public policy and wildlife health were compatible with a career collectivité en générale et elle adore exercer ses compétences in veterinary medicine, she decided to finally apply to veterinary cliniques en faisant du bénévolat avec Community Veterinary school. Being accepted into the OVC Class of 2018 was truly Outreach. Un fait saillant de la dernière année scolaire a été sa a dream come true. contribution à la planification du Symposium 2016 des ÉACMV Elizabeth enjoys being involved at the OVC and in the «L’éléphant dans la pièce» qui a été organisé par l’OVC et qui wider community, and loves to practice her clinical skills by lui a donné l’occasion de rencontrer des collègues étudiants volunteering with Community Veterinary Outreach. A highlight provenant de toutes les régions du Canada. Elizabeth est honorée of this past school year was helping to plan the 2016 SCVMA de représenter les étudiants en médecine vétérinaire canadiens à Symposium “The Elephant in the Room,” hosted by the OVC, titre de présidente 2016–2017 des ÉACMV et elle s’est engagée and having the opportunity to meet fellow students from across à favoriser la collaboration et l’engagement des étudiants à un Canada. Elizabeth is honored to be representing Canadian vet- niveau national. erinary students as the 2016–2017 SCVMA president, and is Mélissa Gohier, représentante de la Faculté de médecine committed to fostering student collaboration and engagement vétérinaire (FMV) de l’Université de Montréal, a déménagé at a national level. à Saint-Hyacinthe après avoir vécu à Montréal pendant toute sa Mélissa Gohier, SCVMA vie et c’était un grand changement qui en valait la peine, car elle representative from the avait toujours rêvé d’étudier à la FMV. Comme plusieurs étudiants Faculté de médecine vété- dans ce domaine, elle envisageait une carrière de vétérinaire rinaire (FMV), moved to depuis un très jeune âge. Toutefois, cela ne l’a pas empêché de Sainte-Hyacinthe after living s’épanouir dans des sphères autres que la science et la santé in Montréal her whole life, et elle a notamment été membre d’un groupe de danse hip-hop and found this to be a big à son Cégep et a organisé le prestigieux spectacle de talent but worthwhile change since «Cégep en spectacle». Mélissa a voyagé dans de nombreux pays she had always dreamed of comme l’Australie et le Costa Rica, qui débordaient de biodiversité studying at FMV. Like many et de ressources culturelles. Ces visites ont consolidé son rêve de devenir médecin vétérinaire. Une fois acceptée à la FMV, Mélissa Gohier students in this field, being a veterinarian was something Mélissa souhaitait continuer de s’impliquer et c’est ainsi qu’elle she wanted from a young age. However, this did not stop her a été choisie pour être la représentante étudiante des ÉACMV, from enjoying fields other than science and health, which un rôle qui lui tient grandement à cœur. Malgré les cinq années include being a member of a hip-hop dance group at her Cégep d’études requises, Mélissa trouve que le temps passe très vite et and by hosting and organizing the annual prestigious national elle est heureuse de travailler fort afin de pouvoir avoir un impact talent show “Cégep en Spectacle.” Mélissa has travelled to several auprès des étudiants durant son passage à la FMV. Elle considère countries such as Australia and Costa Rica, which were full of qu’il s’agit des meilleures années pour développer des amitiés biodiversity and cultural resources. These visits helped cement sincères, découvrir sa propre voie et définir ses futurs rêves et her dream of having a career in veterinary medicine. After ambitions. she was accepted to FMV, Mélissa wanted to continue being Traci Henderson, représentante des ÉACMV à le Western involved in student affairs so she applied and was chosen to be College of Veterinary Medicine (WCVM), a grandi dans une the SCVMA student representative, a role which she holds very ferme d’élevage de bovins dans le sud-est de la Saskatchewan, et dear. Despite the required 5 years of studies, Mélissa is finding c’est de là que provient son intérêt envers la médecine du bétail. that time is flying by and she is happy to work hard in order to Pendant son enfance, Traci participait intensivement au travail have an impact on students during her time at the FMV. She auprès du troupeau et elle savait qu’elle désirait une carrière dans considers that these are the best years to develop true friend- le domaine de l’élevage du bétail. Après avoir constaté l’impact ships, discover her own path, and define her future dreams and que son vétérinaire avait sur le système de production, elle a ambitions. développé un intérêt envers la santé du troupeau et elle a décidé Traci Henderson, SCVMA representative for the Western de poursuivre une carrière en médecine vétérinaire. Après l’école College of Veterinary Medicine (WCVM), was raised on secondaire, Traci a fréquenté le College of Agriculture and Bio a beef farm in southeastern Saskatchewan, from which her Resources de l’Université de la Saskatchewan et elle a obtenu interest in livestock medicine stemmed. Growing up, Traci un diplôme en sciences animales. Après avoir terminé son cours was heavily involved with the herd, and knew that she wanted de trois ans, elle a été acceptée au WVCM et elle entamera sa a career involving livestock production. After realizing the troisième année à l’automne. Au cours des deux dernières années, impact that her veterinarian had on their production system, elle s’est fixée l’objectif de participer aux affaires étudiantes du she developed an interest in herd health, and decided to pursue WCVM et elle s’est portée bénévole pour des postes au sein de a career in veterinary medicine. After high school, Traci attended l’exécutif de la promotion, de l’association étudiante ainsi que the University of Saskatchewan’s College of Agriculture and divers autres postes bénévoles dans les clubs. Traci a vécu une Bio Resources, pursuing a degree in Animal Science. After expérience incroyable l’année dernière en tant que représentante

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N completing her 3-year degree, she junior des ÉACMV au WCVM et elle a hâte d’assumer les fonctions was accepted at the WVCM, and de représentante sénior au cours de la prochaine année! will be entering her 3rd year in the Meredith Versteeg est née et a grandi dans une ferme laitière fall. Over the past 2 years, she has dans une région rurale de la Nouvelle-Écosse et elle a développé made it a goal to become involved in un amour pour les vaches et tous les animaux de ferme à un très WCVM’s student affairs, volunteer- jeune âge. Après avoir terminé son cours secondaire, Meredith a ing for positions on the class execu- fréquenté l’Université Dalhousie en tant qu’étudiante au Programme tive, the student association, and var- de sciences intégrées avant de s’inscrire à l’Université St. Francis ious other volunteer club positions. Xavier à Antigonish, en Nouvelle-Écosse, où elle a terminé son Traci had an amazing experience last cours avec une spécialisation en biologie. Après l’obtention de year as the junior SCVMA represen- son diplôme et tout en faisant du bénévolat auprès de la SPCA, Traci Henderson tative for WCVM, and is looking Meredith a décidé de s’inscrire au programme de médecine forward to stepping into the senior position this coming year! vétérinaire de l’Atlantic Veterinary College (AVC). Elle a été Born and raised on a dairy farm entourée de mentors et de vétérinaires extraordinaires toute sa vie in rural Nova Scotia, Meredith et, vu qu’elle s’intéressait vivement à l’industrie laitière et à la santé Versteeg developed a love for cows des animaux destinés à l’alimentation, elle savait qu’il s’agissait du and all farm animals at a very bon cheminement de carrière pour elle et elle a été ravie d’être young age. After graduating from acceptée à la promotion 2019. En raison de l’esprit communautaire high school, Meredith attended et des expériences extraordinaires qu’elle a pu vivre lors de sa Dalhousie University as a student première année à l’AVC, elle a maintenant vraiment hâte de voir ce in the Integrated Science Program qui l’attend en tant qu’étudiante et de nouvelle représentante sénior before moving to St. Francis Xavier des ÉACMV. Meredith transmet ses meilleurs vœux de succès à University in Antigonish, Nova tous ses camarades de classe, à tous les étudiants en médecine Scotia where she graduated with vétérinaire ainsi qu’à la nouvelle promotion de 2020 pour une Meredith Versteeg an advanced major in Biology. année qui s’avérera assurément excitante. Following graduation and while volunteering at the SPCA, Meredith decided to pursue the Veterinary Medicine program at the Atlantic Veterinary College (AVC). Having been sur- rounded by great mentors and veterinarians her whole life, and with a strong interest in dairy and food animal health, she knew this was the career path for her and was thrilled to be accepted into the class of 2019. The amazing sense of community and the experiences she was able to gain in her 1st year at AVC have only made her more eager to see what lies ahead as both a student and the new AVC senior representative for the SCVMA. Meredith wishes all the best to her classmates, current veterinary students, and the incoming class of 2020 in what she knows will be an exciting year ahead.

Journals Focus Group Outcome Résultats du Groupe de discussion sur les revues n 2015, The CVJ staff held 2 focus groups to tap into Canadian n 2015, le personnel de La RVC a organisé deux groupes Iveterinarians’ thoughts about the 2 peer-reviewed science Ede discussion pour sonder les vétérinaires canadiens à journals, The Canadian Veterinary Journal (The CVJ) and the propos des deux revues scientifiques évaluées par les pairs, Canadian Journal of Veterinary Research (CJVR), published by La Revue vétérinaire canadienne (La RVC) et la Revue canadienne the Canadian Veterinary Medical Association. One discussion de recherche vétérinaire (RCRV), qui sont toutes deux publiées was held in Halifax, Nova Scotia during the Atlantic Provinces par l’Association canadienne des médecins vétérinaires. Une Veterinary Conference and the other was held in Calgary, Alberta discussion s’est déroulée à Halifax, en Nouvelle-Écosse, durant la at the CVMA Convention; there were 10 and 9 participants, Conférence vétérinaire des provinces de l’Atlantique, et l’autre s’est respectively. tenue à Calgary, en Alberta, lors du congrès de l’ACMV; dix et neuf At the March Committee weekend, the Editorial Committee participants ont assisté aux réunions, respectivement. reviewed the comments made at the focus groups and decided Lors de la fin de semaine des comités de mars, le Comité de la to take action on certain recommendations. rédaction a examiné les commentaires faits lors des groupes de

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While participants enjoyed review articles they are difficult discussion et il a décidé d’agir afin de mettre en œuvre certaines N to get; they need to be solicited and focus on a desirable subject des recommandations. as they take up many published pages, which is not good for Même si les participants aimaient lire les articles de the backlog of The CVJ. Dr. Carlton Gyles, editor-in-chief of rétrospective ils sont difficiles à obtenir, car ils doivent être sollicités The CVJ will write to university clinical chairs to invite people et leur sujet doit être souhaitable, car ils occupent plusieurs pages to write review articles after identifying appropriate subjects. de la publication, ce qui nuira à l’arriéré de La RVC. Le Dr Carlton Some people mentioned the usefulness of a journal “app” Gyles, le rédacteur en chef de La RVC écrira aux responsables but this doesn’t seem necessary as the current pdf can easily be cliniques des universités afin d’inviter les personnes à rédiger des downloaded to a phone or computer and forwarded to a tablet. articles de rétrospective après avoir identifié des sujets appropriés. There is demand for practice-based articles but it was noted Certaines personnes ont mentionné l’utilité d’une «appli» de that we can only publish the articles we receive. More practi- la revue, mais cela semble inutile car le format pdf actuel peut tioners need to be encouraged to write, but many find it to be facilement être téléchargé sur un téléphone ou un ordinateur et an onerous job, particularly with the demands on practitioners’ être acheminé à une tablette. time; should CVMA put pressure on educational curriculum to Il existe une demande pour des articles portant sur la pratique, include how to write a scientific article? One current student said mais il a été signalé que nous pouvons seulement publier les articles her class uses The CVJ as an example of how to write an article. que nous recevons. Il faut encourager plus de praticiens à écrire Focus group attendees suggested that the journals provide writ- des articles, mais beaucoup d’entre eux considèrent que c’est un ing mentors to make the process less intimidating. While this travail pénible, particulièrement compte tenu de l’horaire chargé is a good idea it would be difficult to find such people. We will des praticiens. Est-ce que l’ACMV devrait exercer des pressions informally put together a list of retired individuals who might sur le curriculum afin d’inclure des notions sur la rédaction d’un have time and the talent. article scientifique? Une étudiante a dit que sa classe utilise La RVC The need for more disease surveillance articles such as the comme modèle pour la rédaction d’un article. Les participants aux current feature, Cross-Canada Disease Report was also noted, groupes de discussion ont suggéré que les revues fournissent des as well as ask an expert-type feature, and articles on mental mentors de rédaction afin de rendre le processus moins intimidant. health. A new feature titled Veterinary Wellness was started a Même s’il s’agit d’une bonne idée, il sera difficile de trouver de telles few issues ago and we will develop a filler ad that will contain personnes. Nous compilerons une liste informelle de personnes à la provincial/national lab reports and various species-specific disease retraite qui pourraient avoir le temps et les qualifications requises. information/newsletters. This ad could be used in issues when On a aussi signalé le besoin d’articles sur la surveillance space allows. This would ensure existing information is not des maladies comme la rubrique actuelle, Rapport des maladies duplicated and would allow science articles to be more quickly diagnostiquées au Canada, ainsi que d’une chronique et des published as the current backlog would not be increased. articles sur la santé mentale. Une nouvelle rubrique intitulée The use of filler ads was also suggested to attract reviewers, Bien-être vétérinaire a été inaugurée il y a quelques numéros encourage practitioners to write articles, and provide tips on et nous créerons de courtes annonces qui contiendront des how to write and get feedback on an article idea before starting rapports de laboratoires provinciaux et nationaux ainsi que divers to write. bulletins d’information sur les maladies des espèces. Ces annonces Mentorship information would be interesting to include in pourront être utilisées dans les numéros lorsque l’espace le permet. The CVJ, particularly for new graduates; such material could be Cela garantira que les renseignements existants ne sont pas taken from the CVMA Mentorship Program after the program reproduits et permettra aux articles scientifiques d’être publiés plus gets established. rapidement, car l’arriéré actuel n’augmentera pas. The suggestion of including continuing education (CE) Le recours à des annonces a aussi été suggéré pour attirer des components within the journals was mentioned but it was noted évaluateurs, encourager des praticiens à écrire des articles, fournir that there is considerable CE in the journals and veterinarians des conseils sur la façon d’écrire et obtenir de la rétroaction sur une idée d’article afin de commencer la rédaction. Il serait intéressant d’inclure des renseignements sur le mentorat dans La RVC, particulièrement pour les finissants; cette information pourrait être tirée du Programme de mentorat de l’ACMV après l’établissement du programme. On a mentionné la suggestion d’inclure des éléments de formation continue dans les revues, mais il a été signalé qu’il y a déjà beaucoup de formation continue dans les revues et que les vétérinaires obtiennent déjà des crédits de formation auprès des organismes de réglementation en lisant des revues comme la nôtre. On a réitéré lors des deux réunions que les revues sont disponibles en ligne sur le site Web de l’ACMV et qu’elles sont archivées sur PubMedCentral. Les participants aimaient l’utilisation de la couleur, la reliure sans couture, les nouvelles (particulièrement la nouvelle

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N already get CE credit from licensing bodies by reading journals présentation), la question de déontologie, la présentation des such as ours. articles de la RCRV dans La RVC, le test éclair et les sujets traités It was reinforced at both meetings that the journals are dans La RVC (la plupart des participants étaient des praticiens). available online via the CVMA website and are archived on Ils aimaient la publicité, qui est parfois utilisée pour attirer de PubMedCentral. la publicité additionnelle. La valeur et la perception des revues Participants liked the use of color, the perfect binding, the a augmenté et il a été mentionné que l’arriéré n’est pas une news (especially the redesign), ethics, highlighting CJVR articles mauvaise chose s’il est toujours possible de le gérer, ce que nous within The CVJ, the quiz, and topics covered within The CVJ tentons toujours de faire pour La RVC. Ce but a déjà été atteint (most participants were practitioners). They like the advertising, pour la RCRV. which is something that can be used to attract additional adver- La possibilité d’avoir plus de rubriques commanditées, comme tising. The value and perception of the journals have increased, c’est le cas actuellement avec le test éclair, a été recommandée. and it was mentioned that the backlog is not a bad thing if it La directrice de la publicité étudiera la possibilité d’obtenir de can be kept under control, which we are still striving to do for nouveaux commanditaires pour d’autres rubriques. The CVJ and have achieved for CJVR. Des groupes de discussion et des sondages auprès des The possibility of having more sponsored features, such as in lecteurs additionnels seront réalisés pour obtenir la rétroaction des the current case with the quiz, was recommended. The advertis- lecteurs ainsi que de connaître les attentes et les recommandations ing manager will look into the possibility of getting additional des auteurs pour l’orientation future des deux revues. Le personnel sponsors for other features. de la revue et le Comité de la rédaction apprécient le temps et Additional focus groups and readership surveys will be les efforts consacrés à ces réunions et aux sondages et nous forthcoming to get input on reader/author expectations and aimerions remercier tous les participants de leurs commentaires. recommendations for the future direction of both journals. The journal staff and the Editorial Committee appreciate the time and effort these meetings and surveys take and would like to thank each participant for their input.

Animal Health 1 Human Health 1 Planet Health = One Health Working together for the health of all Animal Health Week — October 2 to 8, 2016 Santé animale 1 Santé humaine 1 Santé de la planète = Une santé «Travaillons ensemble pour Une seule santé» Semaine de la vie animale — Du 2 au 8 octobre 2016 he Canadian Veterinary Medical Association has been run- Association canadienne des médecins vétérinaires organise Tning the Animal Health Week campaign for over 30 years L’ la campagne de la Semaine de la vie animale depuis plus de and this year we want to emphasize the importance of One 30 ans et, cette année, nous désirons insister sur l’importance Health. Animal health is intrinsically tied to the health of d’Une santé. La santé animale est inextricablement liée à la humans and that of the environment. This year we want to santé des humains et à celle de l’environnement et, cette année, showcase how important it is that we all work together to protect nous désirons mettre en lumière l’importance de travailler tous the health of animals, people and the planet wholly and globally. ensemble afin de protéger complètement la santé des animaux, During Animal Health Week, from October 2 to 8, 2016, we des personnes et de la planète à l’échelle mondiale. are reminding animal owners that ensuring the health of their Durant la Semaine de la vie animale, qui se déroulera du 2 au animals not only protects their animals, but ensures the health 8 octobre 2016, nous rappellerons aux propriétaires d’animaux of humans and the environment as well. Every step you take to qu’en préservant la santé de leurs animaux, ils protègent non protect the animals in your care contributes to the global health seulement leurs animaux mais aussi la santé des humains et de of the population and the planet: Animal Health 1 Human l’environnement. Tous les gestes que vous posez pour protéger les Health 1 Planet Health = One Health. animaux confiés à vos soins contribuent à la santé mondiale de la We’d like to remind animal owners that: population et de la planète. Santé animale 1 Santé humaine 1 • The concept of ONE HEALTH involves groups of profes- Santé de la planète = Une santé. sionals, including veterinarians, physicians, and scientists, Nous aimerions rappeler aux propriétaires d’animaux que : working together to attain optimal health for animals, people, • Le concept d’UNE SANTÉ nécessite la participation des groupes and the environment. de professionnels, notamment les vétérinaires, les médecins et

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• The health of humans, animals and ecosystems is intercon- les scientifiques, qui travaillent ensemble afin d’assurer la santé N nected. Keeping one healthy requires that all are healthy. optimale des animaux, des humains et de l’environnement. • Everyone can contribute to ONE HEALTH for the better- • La santé des humains, des animaux et des écosystèmes est ment of health in people, animals and the planet. interconnectée. La santé d’un groupe exige la santé de tous • The health of your animal can have an important influence les groupes. on your health and global health. • On peut tous contribuer à UNE SANTÉ pour améliorer la santé • Veterinarians play a critical role in ONE HEALTH as they des personnes, des animaux et de la planète. manage the connection between animal health, human health • La santé de votre animal peut avoir un impact important sur and the state of the environment. votre santé et sur la santé mondiale. • Responsible animal ownership includes regular veterinary • Les vétérinaires jouent un rôle crucial au sein d’UNE SANTÉ, visits, vaccinations, parasite prevention, exercise and optimal car ils gèrent le lien entre la santé animale, la santé humaine nutrition, protecting the health of people and our global et l’état de l’environnement. environment for ONE HEALTH. • Une possession responsable d’animaux de compagnie, qui comprend des visites régulières chez le vétérinaire, la Celebrate Animal Health Week vaccination, la prévention de parasites, l’exercice et une nutrition We invite veterinary health teams to celebrate Animal Health optimale, protège la santé des humains et de l’environnement Week with us. Each year veterinary teams rank waiting room de notre planète pour UNE SANTÉ. displays as the most popular way of celebrating Animal Health Week, followed closely by client contests. In addition to the Célébrez la Semaine de la vie animale official campaign poster, the following items will engage your Nous invitons les équipes vétérinaires à célébrer la Semaine de entire healthcare team and help celebrate Animal Health Week: la vie animale avec nous. Chaque année, les équipes considèrent • Biodegradable Balloons que les expositions dans la salle d’attente sont la façon la plus • Temporary tattoos populaire de célébrer la Semaine de la vie animale, suivies de près • Pet rescue window decals par les concours à l’intention de la clientèle. En plus de l’affiche • CVMA Activity Book “Big or Small, We Help Them All!” officielle de la campagne, les articles suivants inviteront toute • Paws N’ Claws Sports Pack (puppy), which can be used for a l’équipe vétérinaire à célébrer la Semaine de la vie animale : variety of activities like carrying sports gear or beach apparel • Ballons biodégradables • Kid-Friendly Cow-Themed Paper Hat • Tatouages temporaires • T-shirts (available in men’s and women’s sizes) • Décalques de secours pour les fenêtres • V-neck pullover scrub shirts (available in a range of sizes) • Album d’activités de l’ACMV «Petits et grands, ce sont nos Place your order before the early bird deadline on July 22, patients!» 2016 for a chance to win a $100 Subway gift card (enough • Sac à dos sport (chiot) qui peut être utilisé pour toutes sortes to treat the whole team to lunch!) and other fun prizes. d’activités comme le transport d’équipement de sport ou Placing your order online (instead of faxing or mailing it) at d’accessoires de plage (www.canadianveterinarians.net) also gives you a chance to win • Chapeau de papier pour enfants — Vache a $50 Tim Horton’s gift card (treat your hardworking team • T-shirts (disponibles en tailles pour hommes et femmes) to some morning steam)! The last day to place your order for • Blouses chirurgicales avec encolure en V (offertes dans Animal Health Week materials is August 5, 2016. diverses tailles) Placez votre commande avant la date limite hâtive du 22 juillet Our generous supporters 2016 pour courir la chance de gagner une carte-cadeau de Generous support of the 2016 Animal Health Week campaign is 100 $ chez Subway (assez pour sortir toute l’équipe à manger provided by Principal Sponsor Petsecure Pet Health Insurance, le midi!) et d’autres prix épatants. Lorsque vous placez votre and Program sponsors iFinance Canada (Petcard), and Merial. commande en ligne (au lieu d’envoyer le bon de commande par This month, we invite you to learn more about our Principal télécopieur ou par la poste) au veterinairesaucanada.net, vous sponsor, Petsecure Pet Health Insurance. pourrez aussi gagner une carte-cadeau de 50 $ chez Tim Petsecure Pet Health Insurance has embraced the concept Hortons (gâtez les membres de votre équipe travaillante en leur of One Health since its inception over 25 years ago. Petsecure servant une boisson chaude le matin)! La dernière journée pour recognizes the strong bond that exists between owners and pets placer votre commande d’articles de la Semaine de la vie animale and the impact animals have on humans’ daily lives and well- est le 5 août 2016. being. The concept of One Health recognizes that animals affect Nos généreux commanditaires Un généreux soutien de la campagne de la Semaine de la vie animale 2016 est offert par notre commanditaire principal Petsecure assurance maladie pour animaux et par les commanditaires de programmes iFinance Canada (Petcard) et Merial. Ce mois-ci, nous vous invitons à en apprendre davantage à propos de notre commanditaire principal, Petsecure assurance maladie pour animaux.

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N us mentally, emotionally and physically, and that their health and Petsecure assurance maladie pour animaux épouse le the health of our planet are intimately intertwined and directly concept d’Une santé depuis sa création il y a 25 ans. Chez impacts our own health. Petsecure, nous reconnaissons le solide lien qui existe entre les In order to meet the goal of One Health, Petsecure feels we propriétaires et leurs animaux ainsi que l’impact des animaux all have a moral obligation to ensure the health and well-being of sur notre vie quotidienne et notre bien-être. Le concept d’Une all animals under our care. By insuring pets, Petsecure empowers santé reconnaît que les animaux exercent sur nous une influence owners to contribute to One Health by ensuring early diagnosis mentale, émotionnelle et physique et que leur santé et la santé and treatment of zoonotic diseases. Pet health insurance can de notre planète sont intimement liées et ont un impact direct sur help prevent the spread of disease by allowing pet owners to notre propre santé. seek early veterinary attention when needed. As partners in the Afin d’atteindre le but d’Une Santé, Petsecure estime que nous management of a pet’s health, a pet owner and veterinarian can avons tous l’obligation morale d’assurer la santé et le bien-être de prevent certain diseases from occurring and contribute to the tous les animaux confiés à nos soins. En fournissant de l’assurance health of all of us who share this planet. Pet insurance enables pour les animaux de compagnie, Petsecure habilite les propriétaires pet owners to seek medical attention for their pets when they à contribuer à Une santé en assurant un diagnostic précoce ainsi need it and enables veterinarians to choose the optimal medical que le traitement des zoonoses. L’assurance maladie pour animaux treatment a pet needs. de compagnie peut aider à prévenir la propagation des maladies Pets also play a critical role in our own health, especially en permettant aux propriétaires d’animaux de solliciter l’attention when it comes to therapy and service animals. By providing des vétérinaires dès qu’elle devient nécessaire. En tant que physical, mental or emotional support to those who need it, they partenaires dans la gestion de la santé d’un animal de compagnie, contribute to One Health. un propriétaire d’animal et un vétérinaire peuvent prévenir certaines Studies have shown the many positive benefits we derive maladies et contribuer à la santé de toutes les personnes qui from animals. The simple act of petting a dog or cat creates partagent cette planète. L’assurance maladie pour animaux permet a connection that improves blood pressure, heart health and aux propriétaires d’animaux de solliciter des soins médicaux pour overall well-being. Individuals with pets are typically more leurs animaux en cas de besoin et elle permet aux vétérinaires de physically engaged, more active, walk more, and socialize with choisir le traitement médical optimal pour répondre aux besoins other owners. d’un animal de compagnie. Petsecure is heavily involved in community and charitable Les animaux de compagnie jouent aussi un rôle crucial en events. Petsecure supports shelters, breeders, and veterinary clin- ce qui concerne notre propre santé, particulièrement dans le cas ics through fundraisers, trade shows and educational initiatives des animaux de thérapie et d’assistance. En offrant un soutien across Canada. This support also extends to organizations such physique, mental et émotionnel à ceux qui en ont besoin, ils as the Canadian Red Cross and animal welfare programs that contribuent à Une santé. help pets and their owners. Supporting these organizations and Des études ont confirmé les nombreux bienfaits positifs que programs contributes to One Health, as they benefit all people nous dérivons des animaux. Le simple geste de flatter un chien ou and animals involved, in turn creating a healthy environment. un chat crée un lien qui permet d’améliorer l’hypertension, la santé Petsecure Pet Health Insurance can be cardiaque et le bien-être général. Les personnes avec des animaux accessed a number of ways: de compagnie ont habituellement plus d’interactions physiques, • Call 1-800-268-1169 elles sont plus actives, elles marchent plus et elles socialisent avec • Email ([email protected]) d’autres propriétaires. • Chat live at (www.petsecure.com) Petsecure s’implique activement au sein de la collectivité et Petsecure is unique in that there are 12 territory managers dans le cadre d’activités de bienfaisance. Petsecure soutient des who provide customer support and assistance to veterinary refuges, des éleveurs et des cliniques vétérinaires par l’entremise clinics and owners across Canada who carry Petsecure coverage d’activités de financement, de salons d’exposition et d’initiatives for their pets. d’éducation à l’échelle du Canada. Ce soutien est aussi offert à With an award-winning Customer Care Centre, licensed des organisations comme la Croix-Rouge canadienne et à des insurance advisors provide quality support to customers and programmes de bien-être animal qui portent assistance aux partners. Certified animal health technologists in the claims animaux de compagnie et à leurs propriétaires. L’appui de ces and underwriting department adjudicate claims and assist organisations et de ces programmes contribue à Une santé parce veterinarians and veterinary staff through an exclusive Vet Line que ces derniers profitent à l’ensemble des personnes et des phone number. animaux concernés, ce qui crée ensuite un environnement sain. Petsecure offers 4 plans to suit the needs of owners and their On peut accéder à l’assurance maladie pour pets. The advantages of having Petsecure coverage include: up animaux Petsecure de plusieurs façons : to 80% of veterinary bills covered for any accident or illness; • Appelez-nous au 1-800-268-1169 one annual deductible; and coverage of exam fees and taxes, in • Envoyez-nous un courriel à [email protected] addition to prescriptions, hospitalization and much more. • Clavardez avec nous en direct au petsecure.com Petsecure offre un service unique car la compagnie dispose de douze gestionnaires de territoire qui offrent un soutien à la clientèle

698 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY et de l’assistance aux cliniques vétérinaires et aux propriétaires du Petsecure offre quatre régimes pour répondre aux besoins des N Canada possédant une couverture Petsecure pour leurs animaux propriétaires et de leurs animaux de compagnie. Les avantages de compagnie. d’une couverture Petsecure incluent notamment : le remboursement Grâce à un centre de service à la clientèle primé, nos conseillers jusqu’à concurrence de 80 % des factures du vétérinaire pour agréés en assurance offrent un soutien de qualité aux clients et un accident ou une maladie; une seule franchise annuelle; aux partenaires. Les technologues vétérinaires agréés du service et la couverture des frais d’examen et des taxes, en plus des des réclamations et de la souscription règlent les réclamations et prescriptions, de l’hospitalisation et plus encore. portent assistance aux vétérinaires et au personnel vétérinaire sur une ligne téléphonique qui leur est réservée.

CVMA Business Management Programme de gestion commerciale Program de l’ACMV ne of the CVMA’s prime objectives is to help veterinarians un des grands objectifs de l’ACMV consiste à aider les Oachieve “a successful career and a balanced life.” Although L’ vétérinaires à obtenir «une carrière prospère et une vie achieving this state of balance may be considered a luxury by équilibrée». Même si l’atteinte de cet équilibre peut être considérée many practitioners, it is more easily attainable in profitable comme un luxe par beaucoup de praticiens, il est plus facile à practices. The CVMA’s Business Management Program can help atteindre dans les pratiques rentables. Le Programme de gestion all members, regardless of employment type, achieve a successful commerciale de l’ACMV peut aider tous les membres, sans égard career and a balanced life. Here’s how: à leur type d’emploi, à obtenir une carrière prospère et une vie • Data collected from the provincial veterinary economic sur- équilibrée. Voici comment : veys help practices benchmark their financial performance • Les données recueillies dans les sondages économiques and competitiveness, establish fees, and determine com- provinciaux auprès des pratiques vétérinaires aident pensation and benefits levels for associate veterinarians and les pratiques à évaluer leur rendement financier et leur non-DVM staff. compétitivité, à établir des tarifs et à déterminer le niveau de la • Periodic practice management articles and national bench- rémunération et des avantages sociaux des vétérinaires salariés marking reports are published in The Canadian Veterinary et du personnel non-vétérinaire. Journal. • Des articles périodiques sur la gestion commerciale et des • Economic success in private practice translates into higher rapports sur l’évaluation comparative du rendement à l’échelle salaries, which raises the bar for veterinarians employed in nationale sont publiés dans La Revue vétérinaire canadienne. government, academic, or corporate sectors. • Le succès financier des pratiques privées se traduit par des • Economic success also translates into quality medicine by salaires supérieurs, ce qui permet de rehausser la barre pour allowing practices to provide optimal staffing and service, bet- les vétérinaires travaillant au gouvernement, dans les universités ter equipment and facilities, and overall higher level patient et dans le secteur privé. care. • Le succès financier se traduit aussi par une médecine de qualité qui permet aux pratiques d’offrir un personnel qualifié et un service optimal, de l’équipement et des installations améliorées ainsi qu’un meilleur niveau général de soins pour les patients. Le Programme de gestion commerciale aide les propriétaires et les associés des pratiques à l’aide des services suivants : • la communication de normes comparatives de rendement pour les revenus, la production, la dotation en personnel, les dépenses et les tarifs. • la présentation d’un rapport personnalisé, après avoir répondu au Sondage auprès des propriétaires de pratique, qui fournit des recommandations générales afin d’aider à améliorer la rentabilité. • la présentation d’une estimation de la valeur de la pratique, après avoir répondu au Sondage, qui fournit une estimation de la valeur de la pratique basée sur la rentabilité. • l’élaboration des guides tarifaires suggérés provinciaux pour les interventions pour les animaux de compagnie et les grands

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N The Business Management Program helps animaux ainsi que des rapports sur les salaires du personnel practice owners/partners by: non-vétérinaire et des vétérinaires salariés. • providing practice benchmarks for revenue, production, staff- Le Programme de gestion commerciale aide les ing, expenses and fees. vétérinaires salariés en leur offrant les services • giving a detailed personalized report, upon completion of the suivants : Practice Owners Survey, that provides general recommenda- • une étude de tous les aspects de la rémunération et des tions to help improve practice profitability. avantages sociaux dans le cadre du Sondage auprès des • providing a practice value estimate, upon completion of the vétérinaires salariés, qui évalue aussi l’impact d’éléments comme Survey, that provides an estimate of their practice worth based le type de pratique, les années d’expérience, l’emplacement et on profitability. les types de rémunération. • developing Provincial Suggested Fee Guides for Companion • la production du Rapport annuel sur la rémunération et les and Large Animal Procedures, and Wage Reports for Non- avantages sociaux des vétérinaires salariés qui se fonde sur DVM Staff and for Associate Veterinarians. les résultats du sondage et représente un outil important pour The Business Management Program helps l’évaluation comparative des heures travaillées, des bénéfices associate veterinarians by: et des avantages sociaux dans les provinces et à l’échelle du • investigating all aspects of compensation and benefits through Canada. the Associate Survey, which also evaluates the impact of ele- Où pouvez-vous avoir accès à ce service? ments such as type of practice, years in practice, location, and Pour accéder aux plus récents rapports économiques vétérinaires types of compensation. et aux articles qui ont déjà été publiés sur la gestion commerciale : • producing the resulting Annual Report on Compensation • Allez au site Web (www.veterinairesaucanada.net); and Benefits for Associate Veterinarians is an important • Ouvrez une session sur le site Web à l’aide de votre prénom, benchmarking tool to compare hours worked, incomes and nom de famille et mot de passe (si vous ne connaissez pas votre benefits across the province and across Canada. mot de passe, vous pouvez le demander à l’ACMV); Where can you access this service? • Cliquez sur Pratique et finances et ensuite sur Programme de To access the most recent veterinary economic reports and previ- gestion commerciale. ously published practice management articles: Les services du Programme de gestion commerciale sont • Go to the website (www.canadianveterinarians.net); fournis aux membres à l’échelle du pays en collaboration avec • Open a session by logging in using your first name, last les associations provinciales de médecins vétérinaires et les name and password (if you do not know your password, you commanditaires. can request it from the CVMA); • Click on Practice & Economics and then Business Management Program. The CVMA Business Management Program services are provided to members across the country with the collaboration of the provincial veterinary medical associations and corporate sponsors.

Your CVMA Membership Means Votre adhésion à l’ACMV vous offre More. Take Full Advantage. encore plus. Profitez-en pleinement. he Canadian Veterinary Medical Association (CVMA) works Association canadienne des médecins vétérinaires (ACMV) Thard to bring members new, relevant and exclusive benefits, L’ travaille avec diligence pour offrir aux membres de nouveaux discounts and services. In many instances, the savings enjoyed avantages, rabais et services qui sont pertinents et exclusifs. Dans more than cover the cost of your annual membership fee. beaucoup de cas, les économies réalisées dépassent largement le Clinician’s Brief and Plumb’s Veterinary coût de la cotisation annuelle. Drugs Clinician’s Brief et Plumb’s Veterinary Drugs The CVMA has 2 new, exclusive member benefits: Clinician’s L’ACMV offre deux nouveaux avantages aux membres exclusifs : Brief and Plumb’s Veterinary Drugs. Aligned with CVMA’s Clinician’s Brief et Plumb’s Veterinary Drugs. La mission de values, the mission of Clinician’s Brief and Plumb’s Veterinary Clinician’s Brief et Plumb’s Veterinary Drugs, qui correspond à celle Drugs is to provide small animal veterinary teams the tools they de l’ACMV, consiste à fournir aux équipes vétérinaires pour petits need to develop successful practices, build lasting client relation- animaux les outils dont elles ont besoin pour gérer des pratiques ships, and deliver gold-standard patient care. prospères, établir des relations de longue date avec les clients et offrir des soins de calibre supérieur aux patients.

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Dans le cadre de vos avantages de membre de l’ACMV, vous N avez droit gratuitement à une édition mensuelle numérique mondiale de Clinician’s Brief ou à un tarif réduit sur l’abonnement en version imprimée. Voici quelques-uns des avantages de Clinician’s Brief : • Des renseignements pratiques et pertinents sur les actualités en médecine vétérinaire. • Des renseignements présentés dans un format concis pour les praticiens à l’horaire chargé. • La publication classée no 1 et comme étant la plus essentielle par les vétérinaires pour petits animaux pendant neuf ans *. As part of your CVMA member benefits, you are entitled to (2007–2015 PERQ et Essential Media Studies) a free monthly Global Digital Edition of Clinician’s Brief or a • Vous pouvez accéder à Clinician’s Brief en tout temps et special discounted print subscription. Some features and benefits n’importe où — sur votre ordinateur, votre tablette ou votre of Clinician’s Brief include: appareil mobile. • Practical, relevant information on the latest topics in veteri- Pour demander votre abonnement numérique gratuit, allez à la nary medicine. page Web des Avantages et services aux membres de l’ACMV et • Information presented in a brief format for busy practitioners. cliquez sur Clinician’s Brief (il faudra ouvrir une session). • Ranked #1 most essential publication by small animal veteri- De plus, dans le cadre de vos avantages de membre de narians for 9 years*. (2007–2015 PERQ and Essential Media l’ACMV, vous recevez un rabais de 30 % sur l’abonnement en ligne Studies) individuel ou de la pratique ou sur la version imprimée de Plumb’s • Access Clinician’s Brief anytime, anywhere — on your desk- Veterinary DrugsMD. Voici quelques-uns des avantages de Plumb’s top, tablet, or mobile device. Veterinary Drugs : To request your free digital subscription, go to the CVMA • Une ressource numérique conviviale pour accéder à des Member Benefits and Services web page and click on Clinician’s renseignements sur les médicaments vétérinaires. Brief (member log-in required). • Fournit aux vétérinaires à l’horaire chargé des renseignements Also, as part of your CVMA member benefits, you receive a posologiques structurés qui reflètent les dernières 30% discount on the individual or practice online subscription recommandations fondées sur des données probantes ainsi TM or print edition of Plumb’s Veterinary Drugs . Some features qu’une expertise clinique. and benefits of Plumb’s Veterinary Drugs include: • L’appli mobile de Plumb’s vous fournit l’accès instantané et hors • Easy-to-use, digital resource for accessing veterinary drug ligne aux renseignements posologiques des médicaments, en information. tout temps et n’importe où. • Provides busy veterinarians with streamlined dosing informa- Contactez l’ACMV au 1-800-567-2862 ou par courriel (admin@ tion that reflects the latest evidence-based recommendations cvma-acmv.org) pour obtenir votre code de rabais de membre de combined with clinical expertise. l’ACMV dont vous aurez besoin pour profiter du rabais. • Plumb’s mobile app provides you with instant, offline access Plumb’s Veterinary Drugs et Clinician’s Brief représentent deux to the drug dosing information, any time, from any location. autres avantages de l’ACMV qui peuvent aider à positionner votre Contact the CVMA at 1-800-567-2862 or by e-mail pratique à l’avant-garde de la médecine vétérinaire. ([email protected]) to obtain your CVMA member discount code that you will need to provide in order to benefit from the discount. Plumb’s Veterinary Drugs and Clinician’s Brief are 2 more of the CVMA benefits that can help position your practice on the forefront of veterinary medicine.

CVJ / VOL 57 / JULY 2016 701 FOR PERSONAL USE ONLY MORE RESOURCES Practice tools and resources to support you and your practice team.

Early career DVM resource hub

CVMA web store MyVetStore.ca™ Practice owner’s YOUR CVMA MEMBERSHIP economic survey Practice diagnostic and valuation report MEANS … Provincial suggested fee guide MORE Associate compensation and benefits report Compensation report for non-DVM staff MORE Compensation report for DVMs SAVINGS outside private practice MORE Practice management articles KNOWLEDGE CVMA’s national purchase power delivers more CVMA group insurance program Leading-edge research, value to increase your education and profitability CVMA mentoring program information to enhance MORE VetLaw Online™ legal your career and lifelong INFLUENCE Hotel discounts worldwide learning. advice column Advancing your issues, CVMA Green Veterinary Practice your concerns and your National and Enterprise and self-audit tool The Canadian Veterinary Journal Rent-a-Car discounts professional interest. Antimicrobial SmartVet Canadian Journal of The Personal home and auto mobile app Veterinary Research group savings Government relations to Veterinarians health influence policy decisions and wellness resources Clinician’s Brief™ free global Scotiabank® business banking digital edition and lending solutions Guidelines for the successful International relations to employment of new veterinary CVMA national Convention provide the Canadian veterinary graduates perspective The CVJ classified ads discount Sedative, anaesthetic and pain CVMA Veterinary Summit Media and public relations to management protocols posters provide balanced and trustworthy Staples Advantage™ information and promote business products Guidelines for the legitimate CVMA Emerging Leaders Program veterinary professionals use of compounded drugs in veterinary practice Formulation of position Adtel® telephone hold service and CVMA Canadian Veterinary statements on animal welfare and digital signage Antimicrobial prudent use Reserve national veterinary issues guidelines for beef cattle, dairy Petro-Canada SuperPass™ fuel/ cattle, poultry and swine Member e-newsletter diesel/car wash discount Therapeutic decision ‘Online from 339’ Codes of practice for Canadian cascade poster CVMA continuing kennel and cattery operations WSAVA World Congress education portal discounted registration fee Animal abuse resources for practitioners faced with Member consultations and online VetFolio® TM this issue Educational Resource discussions on key veterinary Plumb’s Veterinary Drugs subscription discount issues subscription discount Preventive healthcare, nutritional assessment and client education tools and resources Animal health week annual Learn MORE about your benefits and privileges as a member of the Canadian Veterinary awareness campaign Medical Association. Visit canadianveterinarians.net, or contact the CVMA at 1.800.567.2862, or at [email protected].

03/2016 FOR PERSONAL USE ONLY 2015 Annual Report of the Canadian Veterinary Medical Association Rapport annuel 2015 de l’Association canadienne des médecins vétérinaires

he Canadian Veterinary Medical Association (CVMA) is Association canadienne des médecins vétérinaires (ACMV) T the national and international voice for Canada’s veterinar- L’est la voix nationale et internationale des vétérinaires du ians, providing leadership and advocacy for veterinary medicine. Canada et elle assure le leadership et la défense des intérêts In 2015, the CVMA was comprised of close to 7000 members de la médecine vétérinaire. En 2015, l’ACMV comptait près de plus 6350 affiliate veterinary technicians and technologists 7000 membres ainsi que 6350 techniciens et technologues who are members of the Registered Veterinary Technologists and vétérinaires affiliés qui sont membres de Technologues et Technicians of Canada (RVTTC). techniciens vétérinaires agréés du Canada (TTVAC). To remain relevant to its members, the CVMA continuously Pour demeurer pertinente pour ses membres, l’ACMV doit reviews its value proposition. A framework document entitled continuellement évaluer sa proposition de valeur. Un document “The Future of the CVMA” identified the CVMA’s strengths de travail intitulé «L’avenir de l’ACMV» a identifié les forces and considerations for the future, in light of the environment et les considérations d’avenir de l’ACMV, à la lumière de and feedback obtained from members and non-members. l’environnement et de la rétroaction obtenue auprès des membres et des non-membres. Some of the CVMA’s strengths include: • Canada’s only national veterinary multi-species organization. Les forces de l’ACMV incluent notamment : • Well-recognized national and internationally. • La seule organisation vétérinaire nationale multi-espèces du • A national facilitator. Canada. • The only national multi-species veterinary organization • Une réputation à l’échelle nationale et internationale. engaged in national and international issues, and animal • Un modérateur national. welfare. • La seule organisation vétérinaire nationale multi-espèces • Publishing the only national, general or multi-species, peer- participant aux enjeux nationaux et internationaux ainsi qu’au reviewed veterinary journals in Canada. bien-être animal. • The only national, multi-species Convention offering continu- • La publication des seules revues vétérinaires nationales, générales ing education (CE). ou multi-espèces, au Canada. • The only national student Symposium. • Le seul congrès national et multi-espèces offrant de la formation • Offering national exams to Canadian and international vet- continue. erinary graduates. • Le seul Symposium national des étudiants. • Accrediting veterinary technician & technologists programs • L’administration des examens nationaux aux diplômés en across Canada. médecine vétérinaire canadiens et internationaux. • Large number (close to 500) of dedicated volunteers from • L’agrément des programmes de techniques vétérinaires et de across Canada. technologie en santé animale au Canada. The Future of the CVMA identified the CVMA’s Core • Un nombre important (près de 500) de bénévoles dévoués Competencies: animal welfare, and national and international provenant de toutes les régions du Canada. issues, while the journals, the CVMA Convention, the SCVMA L’avenir de l’ACMV a identifié les compétences fondamentales Symposium and the programs on career & life balance enhance de l’ACMV : le bien-être animal ainsi que les enjeux nationaux these core competencies each in their respective way. The et internationaux, tandis que les revues, le congrès de l’ACMV, national exams, college accreditation and accreditation of le Symposium de ÉACMV et les programmes sur la carrière et veterinary technician programs ensure professional standards. une vie équilibrée rehaussent ces compétences fondamentales. Les examens nationaux, l’agrément des collèges et l’agrément des CVMA’s Core Competencies programmes de techniques vétérinaires garantissent le respect des Some of the many considerations for the CVMA’s future are: normes professionnelles. Continue developing useful practice tools to help veterinarians with decision-making, e.g. Smart Vet app for prudent use of Compétences fondamentales de l’ACMV antimicrobials in companion and food animals; continue tar- Parmi les nombreuses considérations concernant l’avenir geted advocacy according to member needs; increase work with de l’ACMV, citons : La poursuite de la conception d’outils national species associations on key advocacy issues; increase utiles pour la pratique afin de soutenir les vétérinaires dans

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NATIONAL FACILITATOR la prise de décisions, p. ex., l’appli MODÉRATEUR NATIONAL Intelli-Vet pour l’administration judicieuse des antimicrobiens aux NEB JOURNALS BNE REVUES animaux de compagnie et aux animaux destinés à l’alimentation; la poursuite NAT. & INT’L ISSUES de la défense des intérêts ciblée en COLLEGE ACCREDITATION ANIMAL WELFARE CONVENTION & SYMPOSIUM AGRÉMENT DES COLLÈGES ENJEUX NATIONAUX ET CONGRÈS ET SYMPOSIUM fonction des besoins des membres; INTERNATIONAUX BIEN-ÊTRE ANIMAL l’accroissement du travail avec les VET TECH PROGRAM ACCREDITATION CAREER & LIFE BALANCE associations nationales sur les espèces AGRÉMENT DES PROGRAMMES ÉQUILIBRE CARRIÈRE-VIE DE TECHNIQUES VÉTÉRINAIRES en lien avec les principaux enjeux de défense des intérêts; l’augmentation des

RAPPORT ANNUEL COMMUNICATION FOCUSSING ON – Policy & Advocacy activités de défense des intérêts sur les – Science & Knowledge – Practices & Economics enjeux liés aux animaux de compagnie; COMMUNICATION PORTANT SUR : l’élargissement de l’engagement des – Politiques et défense des intérêts – Science et connaissances membres sur les enjeux nationaux – Pratique et finances et l’établissement d’un lien entre les enjeux de défense des intérêts et advocating for companion animal issues; increase engagement of la pratique vétérinaire actuelle et future, p. ex., l’impact de members on national issues and relate advocacy issues to current l’antibiogouvernance sur la pratique vétérinaire; l’intensification and future veterinary practice, e.g. the impact of antimicrobial de l’engagement avec les médias; et l’établissement d’un stewardship on veterinary practice; increase media engagement; lien entre les intervenants nationaux et leurs efforts, p. ex., and connect national stakeholders and their efforts, e.g. on issues relativement aux enjeux liés à la violence envers les animaux. of animal abuse. Représentation et partenariats de l’ACMV : Afin d’accomplir CVMA representation and partnerships: In order to fulfill sa mission à titre de voix nationale et internationale des its mission as the national and international voice of veterinar- vétérinaires, l’ACMV participe officiellement à 27 représentations ians, the CVMA is formally engaged in 27 representations with auprès d’organismes gouvernementaux et de groupes d’intérêts. government agencies and interest groups. The CVMA also L’ACMV représente aussi les vétérinaires canadiens dans plusieurs represents Canadian veterinarians in numerous undertakings projets, notamment en vue de fournir de la rétroaction en whether this is to provide input into government policy or lien avec les politiques gouvernementales et de travailler avec working with other stakeholders. Formal partnerships such as les autres intervenants. Les partenariats officiels, comme celui with the Canadian Council of Veterinary Registrars (CCVR), avec le Conseil canadien des registraires vétérinaires (CCRV), Registered Veterinary Technologists and Technicians of Canada les Technologues et techniciens vétérinaires agréés du Canada (RVTTC), the Federation of Veterinarians of Europe (FVE) and (TTVEC), la Fédération des vétérinaires d’Europe (FVE) et the American Veterinary Medical Association (AVMA), and l’American Veterinary Medical Association (AVMA) ainsi Veterinarians Without Borders (VWB) enhance the Association’s que Vétérinaires sans frontières (VSF) améliorent la force de strength in achieving common goals. l’Association en vue d’atteindre les buts communs. Antimicrobial resistance: For the better part of the last Antibiorésistance : Pendant la majeure partie des vingt 20 years, one of the CVMA’s focal points has been advocacy for dernières années, la défense des intérêts de l’ACMV s’est the prudent use of antimicrobials. The year 2015 was a break- concentrée entre autres sur l’administration judicieuse des through year with Health Canada’s announcement on regulatory antimicrobiens. En 2015, une percée a d’ailleurs été enregistrée lors changes resulting in more veterinary oversight, particularly for de l’annonce des modifications réglementaires de Santé Canada qui the use of antimicrobials in feed and water along with regula- exigeront une surveillance vétérinaire accrue, particulièrement pour tions for own-use importation of drugs and active pharmaceuti- l’utilisation des antimicrobiens dans les aliments et l’eau, ainsi que cal ingredients. On behalf of its members, the CVMA has had de nouveaux règlements pour l’importation des médicaments et a significant stake in this development. In order to prepare des ingrédients pharmaceutiques actifs pour utilisation personnelle. the profession for the regulatory changes, the CVMA, in con- Au nom de ses membres, l’ACMV a joué un rôle important junction with the CCVR, has drafted the document entitled: dans ce projet. Afin de préparer la profession aux modifications “Veterinary Oversight of Antimicrobial Use — A Pan-Canadian réglementaires, l’ACMV, en collaboration avec le CCRV, a rédigé Framework of Professional Standards for Veterinarians.” During le document intitulé : «Surveillance vétérinaire de l’utilisation the 2016 CVMA Summit in Niagara Falls, a broad range of des antimicrobiens — Un cadre de travail pancanadien pour les stakeholders, including CVMA members, will provide input normes professionnelles régissant les vétérinaires». Durant le Sommet to this document. 2016 de l’ACMV qui aura lieu à Niagara Falls, un vaste groupe The following report provides a summary of the main activi- d’intervenants, y compris les membres de l’ACMV, se réunira afin ties undertaken by the CVMA in 2015. de fournir de la rétroaction sur ce document. Le rapport suivant présente un sommaire des principales activités entreprises par l’ACMV en 2015.

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

The CVMA Corporate Partnership Program (CPP) is a compre- Le Programme de commandite par des entreprises (PCE) de ANNUAL REPORT ANNUAL hensive sponsorship program that was implemented in 2007 to l’ACMV est un programme de commandite complet qui a été better recognize a company’s overall financial contribution to the mis en œuvre en 2007 afin de mieux reconnaître la contribution Association. The CPP evolves each year and takes into account financière globale d’une entreprise à l’Association. Le PCE tient the various programs and events that are corporately sponsored, compte des divers programmes et activités qui sont commandités allowing companies that support the CVMA in various aspects par les sociétés et il permet à ces dernières d’appuyer l’ACMV to get better recognition for their overall contributions. The de diverses façons afin d’obtenir une meilleure reconnaissance de 3 levels of sponsorship in 2015 were Platinum (. $80 000), leurs contributions globales. Les trois niveaux de commandite en Gold ($48 000–$79 999) and Silver ($27 000–$47 999). 2015 étaient Platine (. 80 000 $), Or (de 48 000 $ à 79 999 $) The CVMA would like to extend recognition to the follow- et Argent (de 27 000 $ à 47 999 $). ing sponsors for their overall contribution to the Association L’ACMV aimerait reconnaître les commanditaires suivants for 2015: pour leur contribution globale à l’Association en 2015 : Gold: Scotiabank Or : Banque Scotia Silver: IDEXX Laboratories Argent : IDEXX Laboratories Merck Animal Health Merck Santé animale Merial Canada Inc. Merial Canada Inc. Petsecure Pet Health Insurance Petsecure assurance maladie pour animaux

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

The 15 members of the Animal Welfare Committee (AWC) Les 15 membres du Comité sur le bien-être animal (CBA) gèrent deal with a wide range of issues of concern to veterinarians and un vaste éventail d’enjeux qui préoccupent les vétérinaires et the Canadian public in respect to the humane treatment of le public canadien relativement au traitement sans cruauté des animals. Position statements are developed by the AWC through animaux. Des énoncés de position sont élaborés par le CBA en diligently accessing current science and carefully considering the accédant avec diligence à la science actuelle et en considérant ethical dimensions to topics under consideration. The AWC rec- soigneusement les dimensions éthiques des sujets à l’étude. Le ommended a number of positions to CVMA Council that subse- CBA a recommandé plusieurs positions au Conseil de l’ACMV quently received approval including those on Humane Slaughter qui ont subséquemment été approuvées, notamment : Abattage of Animals; Humane Training Methods for Dogs; Humane sans cruauté des animaux; Méthodes de dressage sans violence Mass Depopulation; Seal Hunt in Atlantic Canada; and Use pour les chiens; Dépopulation de masse d’animaux de manière of Animals for Scientific Purposes. Under review by the AWC non cruelle; Chasse aux phoques dans la région atlantique du are position statement statements on Electro-immobilization; Canada; et Utilisation des animaux à des fins scientifiques. Par Induced Molting of Poultry; Castration of Piglets; Cutting ailleurs, les énoncés de position suivants font l’objet d’un examen Canine Teeth in Dogs; Disbudding and Dehorning of Cattle; par le CBA : Électro-immobilisation; Mue forcée de la volaille; Firing of Horses; Tail Docking of Dairy Cattle; Transportation Castration des porcelets; Coupe des canines chez les chiens; of Pets; Use of Animals in Entertainment and Recreation; and Enlèvement des bourgeons et écornage du bétail; Application de

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Onychectomy (Declawing) of the Domestic Feline. The CVMA pointes de feu aux chevaux; Amputation de la queue des bovins is seeking input from members on a position statement on laitiers; Transport des animaux de compagnie; Utilisation des Devocalization of Dogs. The AWC is finalizing the revision of animaux dans le cadre de spectacles et des loisirs; et Onychectomie Code of Practice for Canadian Kennel Operations in consulta- (dégriffage) des félidés domestiques. L’ACMV sollicite aussi la tion with external stakeholders. rétroaction des membres concernant un énoncé de position sur Regarding actions concerning government legislation, the la Dévocalisation des chiens et le CBA procède à la finalisation CVMA continues to monitor various private members bills that de la révision du Code de pratiques à l’intention des chenils du are being tabled to address the need for updated federal animal Canada en consultation avec des intervenants externes. cruelty legislation. New initiatives are expected given the change Quant aux initiatives concernant la législation gouvernementale, in government as a result of the October 2016 federal election. l’ACMV continue de surveiller les divers projets de loi d’initiative The CVMA wrote to the Minister of Agriculture expressing parlementaire qui sont déposés afin d’aborder le besoin de RAPPORT ANNUEL concern regarding the slow progress on the proposed regulatory modernisation de la législation fédérale sur la cruauté envers les amendment of the humane transport requirements of the Health animaux. Nous prévoyons de nouvelles initiatives compte tenu of Animals Regulations. In addition a letter was written to du changement de gouvernement qui a découlé de l’élection Health Canada expressing concern regarding the animal welfare fédérale d’octobre 2016. L’ACMV a écrit une lettre au ministre implications of the use of beta-adrenergic agonist drugs in food de l’Agriculture pour exprimer ses préoccupations face à la animals. Internationally, the CVMA wrote a letter to the World lenteur des progrès relativement au projet de modification de la Veterinary Association and the World Small Animal Veterinary réglementation sur les exigences relatives au transport sans cruauté Association in support of their opposition to the re-scheduling des animaux en vertu du Règlement sur la santé des animaux. of ketamine by the United Nations, which might have meant De plus, une lettre a été écrite à Santé Canada afin d’exprimer reduced availability of this important drug to veterinarians. des préoccupations concernant les répercussions sur le bien-être The CVMA was represented on the National Farmed Animal animal de l’utilisation des médicaments bêta-adrénergiques Care Council (NFACC) Executive and Board and continues to agonistes chez les animaux destinés à l’alimentation. À l’échelle provide representation on the code and scientific committees internationale, l’ACMV a rédigé une lettre à l’Association as well as the Animal Care Assessment Program Committees. mondiale vétérinaire et à la World Small Animal Veterinary Internationally, the CVMA was represented at the annual meet- Association pour appuyer son opposition de la mise à l’annexe ing of the American Veterinary Medical Association (AVMA) de la kétamine par les Nations Unies, qui pourrait se traduire par Animal Welfare Committee. une disponibilité réduite de ce médicament important pour les A number of animal welfare resources continue to be avail- vétérinaires. able on the CVMA website including pain management post- L’ACMV a été représentée au sein du Conseil d’administration ers; Kennel and Cattery Codes; animal abuse information; and et de l’exécutif du Conseil national sur les soins aux animaux animal welfare news items and articles. The CVMA initiated d’élevage (CNSAE) et elle a continué d’assurer une représentation a national working group focused on providing educational au sein des comités des codes et de la science ainsi qu’auprès des material on humane transport of compromised cattle through Comités du programme d’évaluation des soins aux animaux. À the CVMA website. l’échelle internationale, l’ACMV a été représentée à l’assemblée annuelle du Comité sur le bien-être animal de l’American Veterinary Medical Association (AVMA). Plusieurs ressources sur le bien- être animal continuent d’être disponibles sur le site Web de l’ACMV, dont des affiches sur la gestion de la douleur, des codes pour les chenils et les chatteries, des renseignements sur la violence envers les animaux ainsi que des nouvelles et des articles sur le bien-être animal. L’ACMV a aussi formé un groupe de travail national chargé de la présentation de matériel pédagogique sur le transport sans cruauté du bétail fragilisé par l’entremise du site Web de l’ACMV.

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National Issues Enjeux nationaux

The 5 members of the National Issues Committee (NIC) con- Les cinq membres du Comité sur les enjeux nationaux (CEN) ANNUAL REPORT ANNUAL sider a wide range of issues of concern to the veterinary profes- se penchent sur un vaste éventail d’enjeux qui préoccupent la sion in Canada. The NIC revised position statements on issues profession vétérinaire au Canada. Le CEN a révisé les énoncés de including Legislation Concerning Dangerous Dogs; Extra-Label position suivants sur des enjeux qui incluaient notamment : Lois Drug Use (ELDU); and Aquatic Animal Veterinary Medicine, concernant les chiens dangereux; Utilisation des médicaments en all of which were approved by CVMA Council. A new posi- dérogation des directives de l’étiquette (UMDDE); et Médecine tion that is being developed by the NIC on the Transboundary vétérinaire des animaux aquatiques, qui ont tous été approuvés Movement of Dogs will be the focus of the NIC Forum at the par le Conseil de l’ACMV. Une nouvelle position qui est en 2016 Convention. voie d’élaboration par le CEN sur le Mouvement transfrontalier A major focus of NIC deliberations continues to be anti- des chiens sera étudiée lors du Forum du CEN qui aura lieu au microbial stewardship of veterinary drugs given anticipated congrès 2016. changes to federal regulations during 2016. The NIC drafted a Les délibérations du CEN ont continué de se concentrer sur response to the Minister of Health regarding the 2014 Canada l’antibiogouvernance des médicaments vétérinaires compte tenu Federal Framework on Anti-Microbial Resistance (AMR) and is des changements prévus aux règlements fédéraux qui seront mis continuing efforts to urge Health Canada to act on regulatory en œuvre en 2016. Le CEN a rédigé une réponse à la ministre de modernization to address regulatory voids related to active phar- la Santé concernant le Cadre d’action fédéral 2014 sur la résistance maceutical ingredients (API) and own use importation (OUI). aux antimicrobiens au Canada et il poursuit ses efforts afin The CVMA has released a public statement on the findings of d’exhorter Santé Canada à agir pour moderniser la réglementation the Office of the Auditor General on Anti-Microbial Resistance et combler les lacunes réglementaires concernant les ingrédients (AMR). Furthermore, the CVMA represented veterinarians pharmaceutiques actifs (IPA) et l’importation pour utilisation at a roundtable hosted by the Federal Minister of Health that personnelle. L’ACMV a publié une déclaration publique sur brought together 30 human and animal stakeholders to discuss les constatations du Bureau du vérificateur général concernant antimicrobial stewardship. l’antibiorésistance. De plus, l’ACMV a représenté les vétérinaires The CVMA’s Veterinary Pharmaceutical Stewardship lors d’une table ronde organisée par la ministre fédérale de la Santé Advisory Group (VPSAG) developed a draft paper entitled qui a réuni 30 intervenants provenant de la médecine humaine et “Antimicrobial stewardship — A call to action” focusing on devel- vétérinaire afin de discuter de l’antibiogouvernance. oping key questions around stewardship of antimicrobials by Le Groupe consultatif sur l’antibiogouvernance des produits veterinarians in Canada. This led to a paper entitled “Veterinary pharmaceutiques vétérinaires (GCAPPV) de l’ACMV a rédigé oversight of antimicrobial use — A pan-Canadian framework of un document provisoire intitulé «Antibiogouvernance — Un professional standards for veterinarians” that was presented to appel à l’action» qui a porté sur la détermination des principaux stakeholders including Health Canada, Public Health Agency enjeux entourant l’antibiogouvernance des vétérinaires du and the Canadian Food Inspection Agency. The VPSAG pro- Canada. Cette initiative a donné lieu à un document intitulé vided input into the development of communication tools to «Surveillance vétérinaire de l’utilisation des antimicrobiens — highlight the key role veterinarians play in pharmaceutical Un cadre de travail pancanadien pour les normes professionnelles stewardship. The CVMA continues to promote the Prudent régissant les vétérinaires» qui a été présenté aux intervenants, Use Guidelines for anti-microbial use for food animals and the dont Santé Canada, l’Agence de la santé publique du Canada et l’Agence canadienne d’inspection des aliments. Le GCAPPV a fourni de la rétroaction relativement à la mise au point d’outils de communication afin de souligner le rôle crucial des vétérinaires dans la gouvernance des produits pharmaceutiques. L’ACMV continue de promouvoir les Lignes directrices pour l’administration judicieuse des antimicrobiens aux animaux destinés à l’alimentation ainsi que l’appli Intelli-Vet pour les animaux de compagnie et elle prévoit élaborer de nouveaux outils et applications afin d’appuyer l’antibiogouvernance. L’ACMV a assuré une représentation lors des réunions avec l’Institut canadien de la santé animale (ICSA); le Comité consultatif canadien sur la réglementation des produits de santé animale (CCCRPSA); le Conseil canadien des registraires vétérinaires (CCRV); le Comité ad hoc sur la gestion responsable des antimicrobiens vétérinaires; le Conseil national sur la santé et le bien-être des animaux d’élevage (CNSBEAE); le Groupe de travail sur l’importation des chiens du Conseil canadien

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Antimicrobial Smartvet app for companion animals aiming to des médecins vétérinaires en chef (CCMVC); et l’American develop new tools and applications to support antimicrobial Veterinary Medical Association (AVMA). L’ACMV a continué stewardship. d’appuyer la Canadian Global Food Animal Residue Avoidance The CVMA provided representation at meetings with the Databank (CgFARAD) en participant au sous-comité chargé de Canadian Animal Health Institute (CAHI); the Canadian réorganiser la structure du CgFARAD et en siégeant au nouveau Animal Health Products Advisory Committee (CAHPRAC); conseil consultatif du CgFARAD. L’ACMV a communiqué les Canadian Council of Veterinary Registrars (CCVR); Ad Hoc activités de l’Association qui appuient la Stratégie nationale sur la Committee on Veterinary Antimicrobial Stewardship; National santé animale aux participants à l’assemblée du CNSBEAE. Par Farmed Animal Health and Welfare Council (NFAHWC); ailleurs, le CEN continue de surveiller les activités du Conseil du Council of Chief Veterinary Officers (CCVO) Task Force CNSBEAE et il sollicite des occasions de fournir de la rétroaction on Dog Importation; and the American Veterinary Medical sur des enjeux d’importance pour la collectivité vétérinaire (p. ex., RAPPORT ANNUEL Association (AVMA). The CVMA continued supporting the surveillance des maladies, intégration des Codes de pratiques Canadian Global Food Animal Residue Avoidance Databank dans les règlements provinciaux ainsi qu’antibiogouvernance et (CgFARAD) by participating in the sub-committee tasked to antibiorésistance). reorganize the CgFARAD structure and by serving on the new L’ACMV a soumis des questions importantes pour les CgFARAD Advisory Board. The CVMA communicated to vétérinaires du Canada aux candidats à l’élection fédérale attendees at the NFAHWC meeting the Association’s activities d’octobre et elle a ensuite acheminé une lettre aux ministres du that support the National Animal Health Strategy. The NIC Commerce international et des Affaires étrangères afin d’exprimer continues to monitor the activity of the NFAHW Council and la position selon laquelle l’importation des produits en vertu seeks opportunities to provide input on issues that are important des accords commerciaux internationaux doit se produire en to the veterinary community (e.g. disease surveillance, Codes of respectant la pleine protection de la santé et du bien-être des Practice incorporation into provincial regulations, and antimi- animaux, de la santé publique et de la salubrité des aliments à la crobial stewardship/resistance). source et au Canada. The CVMA submitted questions of importance to veterinar- L’ACMV travaille à la préparation d’un plan d’action pour le ians in Canada to political candidates in the October federal Groupe consultatif environnemental afin de miser sur l’Initiative election following which a letter was forwarded to the Minsters d’une pratique vétérinaire écoresponsable de 2014 et d’examiner of International Trade and Foreign Affairs expressing the posi- de nouveaux domaines, y compris la gestion des déchets dans les tion that importation of products under international trade pratiques vétérinaires. agreements must occur under conditions where animal health and welfare, public health and food-safety are fully protected both at source and within Canada. The CVMA is developing a forward action plan for the Environmental Advisory Group aiming to build on the Green Practice Initiative from 2014 and examining new areas of focus including waste disposal in veterinary practices.

International Relations Relations internationales

Veterinary medicine does not have any borders. For example La médecine vétérinaire n’a pas de frontières. Par exemple, importation or exportation of dogs or livestock comes with the l’importation ou l’exportation de chiens ou du bétail comporte des potential risks of disease transmission. Antimicrobial resistance risques potentiels de transmission de maladie. L’antibiorésistance must be addressed globally and by every jurisdiction and every doit être abordée à l’échelle internationale ainsi que par tous veterinary practitioner. The CVMA represents its members by les territoires et les praticiens vétérinaires. L’ACMV représente participating in international networks and organizations with ses membres en participant à des organisations et à des réseaux the goal of sharing expertise and tools, learning from each-other, internationaux dans le but de partager de l’expertise et des and developing joint strategies, positions and actions where outils, d’apprendre l’un de l’autre et d’élaborer des stratégies, des applicable. positions et des actions conjointes au besoin. Here are the groups with which the CVMA has formal Voici les groupes avec lesquels l’ACMV possède des liens ties and examples of the strategies and actions undertaken: officiels ainsi que des exemples des stratégies et des initiatives qui the World Organization for Animal Health (OIE): The ont été entreprises : l’Organisation mondiale de la santé animale CVMA is part of the Canadian Government’s delegation to (OIE) : L’ACMV fait partie de la délégation du gouvernement the OIE’s General Assembly and, last year, participated in the canadien à l’Assemblée générale annuelle de l’OIE et, l’an dernier, OIE annual World Assembly of the Organization for Animal elle a participé à l’Assemblée mondiale annuelle de l’OIE pour Health Delegates, as well as the roundtable on OIE’s coun- les délégués de la santé animale ainsi qu’à la table ronde de l’OIE

708 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY try assessment of veterinary services. The World Veterinary sur l’évaluation des services vétérinaires nationaux. L’Association Association (WVA): The CVMA is represented on the WVA mondiale vétérinaire (AMV) : L’ACMV est représentée au sein Council and has participated in the development of a global du Conseil de l’AMV et elle a participé à l’élaboration d’une AMR position. Furthermore, the CVMA participated in the position mondiale sur l’antibiorésistance. De plus, l’ACMV a WVA’s global initiative on the eradication of rabies. The World participé à l’initiative mondiale de l’AMV sur l’éradication de la ANNUAL REPORT ANNUAL Small Animal Veterinary Association (WSAVA): The CVMA rage. La World Small Animal Veterinary Association (WSAVA) : is represented on the WSAVA Council. Our WSAVA member- L’ACMV est représentée au sein du Conseil de la WSAVA. Notre ship provided significant advantages in negotiating exclusive adhésion à la WSAVA a fourni des avantages importants lors de la terms for the new CVMA member benefits such as VetFolio and négociation de conditions exclusives pour les nouveaux privilèges Clinician’s Brief. The Federation of Veterinarians of Europe/ aux membres de l’ACMV, dont VetFolio et Clinician’s Brief. La American Veterinary Medical Association (FVE/AVMA): Fédération des vétérinaires d’Europe/American Veterinary The CVMA, FVE and AVMA maintain a formal agreement Medical Association (FVE/AVMA) : L’ACMV, la FVE et of collaboration. These associations developed joint position l’AVMA ont conclu des ententes de collaboration officielles. Ces statements on: Global Control of Canine Rabies; The Essential associations ont élaboré des énoncés de position conjoints dans Role of Veterinarians in Protecting Animal, Human, Public les domaines suivants : Le contrôle mondial de la rage canine; & Environmental Health; Responsible and Judicious Use of Le rôle essentiel des vétérinaires dans la protection de la santé Antimicrobials; and Veterinary Education. animale, humaine, publique et environnementale; L’utilisation For decades, the CVMA has had a special, mutually ben- responsable et judicieuse des antimicrobiens et L’enseignement eficial working relationship with the AVMA. The AVMA and de la médecine vétérinaire. the CVMA share the veterinary college accreditation and the Depuis des décennies, l’ACMV entretient une relation de national exams. We enjoy a reciprocity agreement in terms of travail spéciale mutuellement bénéfique avec l’AVMA. L’AVMA recognition of each other’s veterinary technician and technolo- et l’ACMV se partagent l’agrément des collèges de médecine gist program accreditation. We maintain representation on each vétérinaire et les examens nationaux. Nous profitons d’un accord other’s Animal Welfare Committees. The CVMA also holds a de réciprocité pour la reconnaissance mutuelle de l’agrément des seat on the PANVET. The CVMA is a founding member of programmes de techniciens et de technologues vétérinaires. De the International Veterinary Officers Coalition (IVOC), plus, nous maintenons une représentation au sein du Comité comprising the presidents and CEOs of the national veterinary sur le bien-être animal de l’autre association. L’ACMV siège associations of the United States, Canada, Britain, New Zealand, aussi au sein de PANVET. L’ACMV est membre fondateur de Australia and South Africa. Within this group, we share our l’International Veterinary Officers Coalition (IVOC), qui se experience, position, programs and benchmark our organiza- compose des présidents et des présidents-directeurs généraux des tions. The CVMA’s new Mentorship Guide is based on an associations de médecins vétérinaires nationaux des États-Unis, Australian VMA tool. du Canada, de la Grande-Bretagne, de la Nouvelle-Zélande, de l’Australie et de l’Afrique du Sud. Ce groupe nous permet de partager notre expérience, notre position, nos programmes et d’effectuer une évaluation comparative de nos organisations. Le nouveau Guide de mentorat de l’ACMV se base sur l’outil de l’AMV de l’Australie.

Communications & Public Relations Communications et relations publiques

The CVMA received 84 media inquiries during 2015, result- Durant 2015, l’ACMV a reçu 84 demandes de renseignements ing in the Association being highlighted in such stories rang- de la part des médias, ce qui a permis à l’Association d’être ing from Flight Tips for Furry Friends to Antibiotic Resistance: mentionnée dans des reportages portant sur divers sujets, dont des A Growing Problem for Pets. The 2015 CVMA Convention in conseils sur les voyages en avion avec les animaux de compagnie et Calgary saw successful media coverage resulting in a print and la croissance du problème de l’antibiorésistance pour les animaux online article about antibiotic resistance in pets, radio interviews de compagnie. Le congrès 2015 de l’ACMV à Calgary a permis with 2 Convention speakers, as well as 2 TV interviews with d’obtenir une excellente couverture médiatique, dont un article Dr. Nicole Gallant, 2015–16 CMVA president. imprimé et un article en ligne sur la résistance aux antibiotiques The CVMA continues to increase social media channel activ- chez les animaux de compagnie, des entrevues à la radio avec ity. By the end of 2016, the CVMA’s Facebook page is expected deux conférenciers du congrès ainsi que deux entrevues télévisées to hit 5000 likes and its combined English and French Twitter avec la Dre Nicole Gallant, la présidente 2015–2016 de l’ACMV. followers to be over 8500. Its YouTube Channel featured a L’ACMV continue d’accroître ses activités dans les médias number of informative animal health videos, thanks to Dr. Bob sociaux. D’ailleurs, on prévoit que, d’ici la fin de 2016, la page

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Facebook de l’ACMV atteindra 5000 J’aime et que le nombre combiné de suiveurs de Twitter, en français et en anglais, de l’ACMV dépassera 8500 personnes. Son canal YouTube a présenté plusieurs vidéos informatives sur la santé animale, grâce au Dr Bob Bellamy qui a créé les vidéos avec l’aide de Wow Factor Media. En 2015, l’ACMV a mené une campagne de sensibilisation qui a ciblé des publics sur Facebook et Twitter afin de promouvoir la valeur des soins vétérinaires et de rehausser la compréhension quant aux nombreux rôles des vétérinaires. À l’aide de #VétérinairesPartenaires ou #VetCareEverywhere, une RAPPORT ANNUEL série de déclarations sur les soins vétérinaires a attiré l’attention sur divers sujets, dont la santé des animaux de compagnie et des Bellamy who created the videos with the help of Wow Factor grands animaux, la santé publique, l’antibiogouvernance, le lien Media. humain-animal, les options de soins préventifs et plus encore. La The CVMA ran an awareness campaign in 2015 targeting campagne de sensibilisation se poursuit en 2016. public audiences on Facebook and Twitter to promote the value La Semaine de la vie animale s’est déroulée du 4 au 10 octobre of veterinary healthcare and increase the understanding of the 2015 et a marqué le 30e anniversaire de la campagne. Le thème many roles of veterinarians. Using #VetCareEverywhere or de 2015, «Des partenaires hors pair en matière de soins vétérinaires #VétérinairesPartenaires, a series of veterinary healthcare state- préventifs», a insisté sur le fait que, malgré les progrès de la ments drew attention to a variety of topics such as companion technologie médicale et des soins vétérinaires, le lien entre l’équipe and large animal health, public health, antimicrobial steward- vétérinaire et le client demeure l’une des plus importantes facettes ship, the human-animal bond, preventive healthcare options and des soins vétérinaires. L’utilisation du mot-clic #célébronslaSVA a more. The awareness campaign continues in 2016. facilité la promotion et le partage des célébrations des participants Animal Health Week ran from October 4 to 10, 2015 and durant cette semaine. Un généreux soutien a été fourni pour marked the 30th anniversary of the campaign. The 2015 theme, la campagne de la Semaine de la vie animale 2015 par les “The Perfect Pair: Partners in preventive veterinary care,” empha- commanditaires principaux Petsecure assurance maladie pour sized that while medical technology and veterinary care have animaux, le commanditaire de programme plus IDEXX et les advanced, the connection between the veterinary team and the commanditaires de programme iFinance Petcard et Merial. client remains one of the most important facets of veterinary Des bulletins de masse ont été envoyés par courriel et par care. Use of the hashtag #celebrateAHW helped promote and télécopieur et des nouvelles dans les médias sociaux, des articles share participants’ celebrations of the week. Generous support dans les publications provinciales, des renseignements sur le of the 2015 Animal Health Week campaign was provided by site Web de l’ACMV et le cyberbulletin mensuel de l’ACMV Principal Sponsor Petsecure Pet Health Insurance, Program ont fourni aux membres des mises à jour sur les programmes Plus Sponsor IDEXX, and Program Sponsors iFinance Petcard, et l’actualité vétérinaire en général. Des outils pour la pratique, and Merial. comme ceux qui sont disponibles dans le cadre de la collaboration Mass e-mail and fax bulletins, social media updates, articles de l’ACMV avec la Pet Nutrition Alliance, Partners for Healthy in provincial publications, information on the CVMA’s website Pets et Soins des chats, ont aussi été mis en lumière. and the CVMA’s monthly eNewsletter provided members with CVMA program updates and general veterinary news. Practice Prix 2015 de l’ACMV tools, such as those available through the CVMA’s involvement Depuis plus de 20 ans, l’ACMV reconnaît fièrement ses with the Pet Nutrition Alliance, Partners for Healthy Pets and membres pour leurs contributions exceptionnelles à la profession Cat Healthy, were also highlighted. vétérinaire ainsi qu’à la santé et au bien-être des animaux.

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2015 CVMA Awards The CVMA has proudly recognized its members for their exceptional contributions to the veterinary profession and to animal health and welfare for over 20 years. In 2015, the following individuals were honored at the CVMA Awards Ceremony in ANNUAL REPORT ANNUAL Calgary, Alberta, during the 2015 CVMA Convention. Dr. Susan Kilborn — Small Animal Practitioner Award Dr. Yves Tarte — CVMA Industry Award Dr. Timothy Blackwell — CVMA Humane Award En 2015, les personnes suivantes ont été honorées lors de Dr. Doug MacDougald — Merck Veterinary Award la Cérémonie de remise des prix de l’ACMV qui a eu lieu à Veterinary Agri-Health Services Ltd. — CVMA Practice of Calgary, en Alberta, durant le congrès 2015 de l’ACMV. the Year Award Dre Susan Kilborn — Prix du praticien des petits animaux Dr. Michelle Lem — 2015 CVMA President’s Award Dr Yves Tarte — Prix de l’industrie de l’ACMV Dr. Timothy H. Ogilvie — CVMA Life Membership Dr Timothy Blackwell — Prix humanitaire de l’ACMV Recognition was also given to the president of the Students Dr Doug MacDougald — Prix vétérinaire Merck of the CVMA, Ms. Guylene Kheirkhah. The Registered Veterinary Agri-Health Services Ltd. — Prix de la pratique de Veterinary Technologists and Technicians of Canada (RVTTC) l’année de l’ACMV joined the Awards Ceremony to present one of its mem- Dre Michelle Lem — Prix du président de l’ACMV 2015 bers, Ms. Nadine Schueller, with its 2015 Animal Health Dr Timothy H. Ogilvie — Titre de membre à vie de l’ACMV Technologist/Veterinary Technician of the Year Award. On a aussi reconnu la présidente des Étudiants de l’ACMV, Mme Guylène Kheirkhah. Les Technologues et techniciens vétérinaires agréés du Canada (TTVAC) se sont aussi joints à la cérémonie de remise des prix pour décerner le Prix du technologue en santé animale/technicien vétérinaire de l’année 2015 à l’une de leurs membres, Mme Nadine Schueller.

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

The Canadian Veterinary Journal (The CVJ) and Canadian La Revue vétérinaire canadienne (La RVC) et la Revue canadienne Journal of Veterinary Research (CJVR) are the only national, de recherche vétérinaire (RCRV) sont les seules revues vétérinaires general or multi-species, peer-reviewed veterinary journals in nationales, à contenu général ou multi-espèces, évaluées par les Canada. The number of manuscripts submitted to The CVJ pairs au Canada. Le nombre de manuscrits soumis à La RVC in 2015 was 311; the number submitted to the CJVR in 2015 en 2015 a été de 311; le nombre de manuscrits soumis à la was 124. Efforts are ongoing to reduce the backlog of CVJ RCRV en 2015 a été de 124. Les efforts se sont poursuivis afin manuscripts. The CJVR backlog was addressed successfully de réduire l’arriéré des manuscrits de La RVC. L’arriéré de la in 2015 with the installment of $15 000 approved by CVMA RCRV a été corrigé avec succès en 2015 grâce à une subvention Council; the time from submission to publication decreased de 15 000 $ approuvée par le Conseil de l’ACMV. Le délai entre from 16.3 months at the beginning of 2015 to 8.6 months at le moment de la soumission et la publication a été réduit de the beginning of 2016. The extra funds were used to prepare 16,3 mois au début de 2015 à 8,6 mois au début de 2016. Les and publish additional manuscripts for the online issues of the fonds supplémentaires ont été utilisés pour préparer et publier CJVR; policy adjustments are in place to prevent future back- des manuscrits additionnels pour les numéros en ligne de la logs. Both journals will continue to promote the relevance of RCRV; des ajustements ont été apportés aux politiques afin de journal articles to practice, and build demand for the knowledge prévenir de nouveaux arriérés. Les deux revues continueront delivered. de promouvoir la pertinence des articles de la revue pour la Journal staff conducted 2 focus group discussions in 2015 pratique et de miser sur la demande pour les connaissances with the intention of involving veterinarians and getting quali- publiées.

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tative data to aid in improving both journals and ensuring that En 2015, le personnel des revues a tenu deux groupes de they meet the needs of Canadian veterinarians. discussion dans le but de faire participer les vétérinaires et The Editorial Committee is pleased to announce that Dr. Eva d’obtenir des données qualitatives afin d’améliorer les deux revues Nagy has agreed to stay on as editor of the CJVR. Dr. Debbie et de faire en sorte qu’elles répondent aux besoins des vétérinaires Haines has also agreed to continue as an associate editor for canadiens. the CJVR; another veterinarian has also stepped forward to be Le Comité de la rédaction est heureux d’annoncer que la an associate editor and a motion will be going to the CVMA Dre Eva Nagy a accepté de rester en poste en tant que rédactrice Council for approval shortly. de la RCRV. La Dre Debbie Haines a aussi accepté de continuer The journals department sends an annual letter from the en tant que rédactrice associée pour la RCRV et un autre CVMA to the deans of Canadian veterinary schools on behalf of vétérinaire s’est aussi porté bénévole pour travailler en tant que the editors. Editors are recognized by the schools for their work rédacteur associé et une motion sera présentée sous peu au Conseil RAPPORT ANNUEL with the journals in determining academic advancement/tenure. de l’ACMV aux fins d’approbation. As a benefit to CVMA members, CVMA authors have lower Chaque année, le service des revues envoie une lettre aux publication fees for The CVJ and lower page charges for the doyens des écoles de médecine vétérinaire canadienne, de la part CJVR. Both journals will continue to strive toward a break- de l’ACMV, au nom des rédacteurs. Le travail des rédacteurs even budget. auprès des revues est reconnu par les écoles afin de déterminer Readers and CVMA members are reminded that all issues, l’avancement et la permanence dans les universités. except the most recent 6 months, of both The CVJ and the CJVR En tant qu’avantage aux membres de l’ACMV, les auteurs de are available to the public on the PubMed Central archive (www. l’ACMV profitent de tarifs de publication inférieurs pour La RVC pubmedcentral.com); a link is also available through the CVMA ainsi que de frais inférieurs par page pour la RCRV. Les deux website (www.canadianveterinarians.net). CVMA members can revues continueront de travailler en vue d’équilibrer le budget. view the most recent 6 months of the journals on the member- Nous rappelons aux lecteurs et aux membres de l’ACMV que only section of the CVMA website. tous les numéros, sauf pour les six derniers mois, de La RVC et de la RCRV sont disponibles au public dans l’archive de PubMed Central (www.pubmedcentral.com); un lien est aussi disponible sur le site Web de l’ACMV (www.veterinairesaucanada.net). Les membres de l’ACMV peuvent visualiser les six plus récents mois des revues dans la section réservée aux membres du site Web de l’ACMV.

Conventions Congrès

The 2015 CVMA Annual Convention was held from July 16–19 Le congrès 2015 de l’ACMV s’est déroulé du 16 au 19 juillet in Calgary, Alberta attracting 809 attendees. The Convention à Calgary, en Alberta, et a attiré 809 délégués. Le congrès a was organized in cooperation with the Alberta Veterinary été organisé en collaboration avec l’Alberta Veterinary Medical Medical Association (ABVMA) and with the Registered Association (ABVMA) et Technologues et techniciens vétérinaires Veterinary Technicians and Technologists of Canada (RVTTC). agréés du Canada (TTVAC). With over 40 speakers from Canada, the United States and Grâce aux plus de 40 conférenciers provenant du Canada, France, over 100 sessions were offered in the following streams: des États-Unis et de la France, plus de 100 ateliers ont été companion animal, equine, bovine, ruminant, animal welfare, offerts dans les volets suivants : animaux de compagnie, équidés, exotic pets and wildlife, mindfulness and resilience in veteri- bovins, ruminants, bien-être animal, animaux exotiques et faune, nary medicine, and practice management. Topics ranged from pleine conscience et résilience en médecine vétérinaire ainsi que

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dentistry to ophthalmology, from endocrine and metabolic la gestion d’une pratique. Les sujets incluaient la dentisterie, diseases to nutrition and clinical pharmacology. l’ophtalmologie, les maladies endocriniennes et métaboliques ainsi The Convention provided an opportunity for many ancillary que la nutrition et la pharmacologie clinique. groups and organizations to hold meetings onsite including the Le congrès a fourni l’occasion à de nombreux groupes et RVTTC Board, and the Alberta Association of Animal Health organisations de tenir des réunions sur place, dont le Conseil ANNUAL REPORT ANNUAL Technologists (AAAHT), Canadian Council of Veterinary de TTVAC et de l’Alberta Association of Animal Health Registrars, Registered Veterinary Technologists and Technicians Technologists (AAAHT), le Conseil canadien des registraires of Canada (RVTTC), deans of the veterinary medicine facul- vétérinaires, les Technologues et techniciens vétérinaires agréés ties, as well as the Christian Veterinary Missions of Canada. du Canada (TTVACE), les doyens des facultés de médecine The AAAHT hosted a luncheon for almost 100 RVTS with the vétérinaire ainsi que Christian Veterinary Missions of Canada. “Wardens” as entertainment. The Atlantic Veterinary College L’AAAHT a organisé un repas du midi pour près de 100 TVA et le and Western College of Veterinary Medicine held alumni groupe «Wardens» a diverti les participants. L’Atlantic Veterinary receptions. A tour of the Faculty of Veterinary Medicine at College et le Western College of Veterinary Medicine ont tenu the University of Calgary was organized as an evening activity des réceptions pour les anciens, tandis qu’une visite de la Faculté and Vets Without Borders — Canada held a fundraising golf de médecine vétérinaire de l’Université de Calgary a été organisée tournament and dinner. en soirée et Vétérinaires sans frontières — Canada a organisé un For the first time, the CVMA applied to be a RACE (Registry tournoi de golf et un dîner pour recueillir des fonds. of Approved Continuing Education) provider and submitted the Pour la première fois, l’ACMV a présenté une demande Convention program for RACE Approval. As a result, DVMs pour devenir un fournisseur de formation approuvé par RACE were able to earn up to 28 hours of CE from a potential of (Registry of Approved Continuing Education) et elle a soumis le 136 RACE-approved hours. programme du congrès aux fins d’approbation par RACE. Par New in 2015, a one-hour showcase featuring 5 faculty conséquent, les vétérinaires ont pu accumuler jusqu’à 28 heures members from the University of Calgary, Faculty of Veterinary de formation continue parmi 136 heures potentielles de formation Medicine was introduced. This session addressed 5 specific issues approuvée par RACE. allowing for small group, in-depth discussion.

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For the 2nd year, the CVMA Quest game was part of the Pour la première fois en 2015, une présentation d’une heure mobile app. In 2015, 40% of the total delegates participated in présentant cinq professeurs de la Faculté de médecine vétérinaire the challenge and earned from one to 799 points for completing de l’Université de Calgary a été organisée. Cet atelier a abordé activities and winning prizes. Double Dutch, a native (housed cinq enjeux particuliers et a permis une discussion approfondie on your phone) app, had better engagement of attendees as well en petits groupes. as other administrative functions that we wanted to use. App Pour la deuxième année, le jeu de la Quête de l’ACMV faisait ambassadors provided one-on-one demonstrations and funky partie de l’appli mobile. En 2015, 40 % des délégués ont participé animal stickers were given to those who have APPtitude! au défi et ont accumulé de 1 à 799 points en s’adonnant aux The CVMA Professional Development Committee ran a activités et en gagnant des prix. L’appli «Double Dutch», une fundraiser onsite to raise money for a local charity Tails of Help; application native (qui se trouve sur votre téléphone), a suscité a total of $406.70 was raised. une meilleure participation de la part des délégués et offrait aussi RAPPORT ANNUEL On Saturday, July 18, the fun run had 25 runners and the d’autres fonctions administratives que nous voulions utiliser. Les yoga session had 16 participants. The “Western Hoedown” ambassadeurs d’applis ont fourni des démonstrations individuelles attracted 175 attendees who were white-hatted and sworn in as et des autocollants d’animaux cocasses étaient donnés aux délégués honorary Calgarians. The group walked to the casino grounds qui manifestaient de l’APPlitude! where a western-style dinner was served in the Melrose restau- Le Comité de perfectionnement professionnel de l’ACMV a organisé une activité de financement pour recueillir des fonds pour l’organisme de bienfaisance local Tails of Help et des fonds totalisant 406,70 $ ont été amassés. Le samedi 18 juillet, la course folle a réuni 25 coureurs et la session de yoga a rassemblé 16 participants. Quant à elle, la soirée «Western Hoedown» a attiré 175 participants qui portaient le chapeau blanc et ont été assermentés en tant que

714 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY rant. Singer Cort Delano and fiddler Paul Brooks entertained Calgariens honoraires. Le groupe s’est rendu à pied jusqu’au casino the group. Afterwards, everyone was led into Cowboys Dance pour déguster un dîner à la mode de l’Ouest qui a été servi dans Hall via a VIP entrance for a night of dancing to the music of le restaurant Melrose. Le chanteur Cort Delano et le violoneux local band High River. Paul Brooks ont aussi diverti le groupe. Ensuite, tous les invités A video featuring members of the Professional Development se sont dirigés vers la salle Cowboys Dance Hall par une entrée ANNUAL REPORT ANNUAL Committee and others promoted the CVMA Summit, Exhibit VIP pour une soirée de danse au son de la musique du groupe Hall, CE sessions and the destination. The video launched in local High River. April received 363 views for the English version and 45 views Une vidéo présentant les membres du Comité de for the French version. perfectionnement professionnel et d’autres personnes a fait la The CVMA Summit of Veterinary Leaders entitled “Skills promotion du Sommet de l’ACMV, du Salon des exposants, Taught, Skills Needed — the ABC’s of Veterinary Credentials” des ateliers de formation continue et de la destination. La vidéo, was attended by over 140 delegates. Chaired by Dr. Nicole qui avait été inaugurée en avril, a reçu 363 vues pour la version Gallant, 4 guest speakers and several international guests dis- anglaise et 45 vues pour la version française. cussed the importance of veterinary college accreditation espe- Le Sommet des leaders vétérinaires de l’ACMV était intitulé cially to ensure entry level practice skills upon graduation. «Compétences enseignées, compétences nécessaires — l’ABC des titres de compétence vétérinaires» et plus de 140 délégués y ont participé. Le Sommet a été présidé par la Dre Nicole Gallant et quatre conférenciers invités et plusieurs invités internationaux ont discuté l’importance de l’agrément des collèges de médecine vétérinaire, particulièrement dans le but d’assurer des compétences de niveau d’entrée pour la pratique à la fin des études.

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

The purpose of the CVR is to provide veterinary surge capacity La RVC a pour mandat de fournir des ressources vétérinaires resources to first-responders in case of large-scale emergencies d’appoint aux premiers intervenants dans l’éventualité de involving animals, in order to address animal health and welfare. situations d’urgence à grande échelle touchant les animaux et In 2015, there were 474 CVR members in the CVMA data- afin de gérer les enjeux liés à la santé et au bien-être des animaux. base of which 245 have been formally trained. En 2015, il y avait 474 membres de la RVC dans la base Over the past 12 months, some reservists were given the de données de l’ACMV et 245 d’entre eux avaient reçu une opportunity to participate in a provincial exercise and a work- formation officielle. shop: Exercise Angus was organized by Alberta’s provincial gov- Au cours des douze derniers mois, certains réservistes ont eu ernment. The aim of this exercise was to practice the response l’occasion de participer à un exercice provincial et à un atelier. to a serious outbreak of a livestock disease in cattle. En effet, l’exercice Angus a été organisé par le gouvernement The Ontario Livestock & Poultry Council, in conjunction provincial de l’Alberta. Cet exercice avait pour but de pratiquer with the Ontario Equestrian Federation, the Ontario Ministry une intervention lors d’une éclosion grave d’une maladie du bétail. of Agriculture, Food and Rural Affairs, the CFIA and the L’Ontario Livestock & Poultry Council, de concert avec la Animal Health Laboratory at the University of Guelph, held an Fédération équestre de l’Ontario, le ministère de l’Agriculture, Equine Foreign Animal Disease Workshop. The objective was des Aliments et des Affaires rurales de l’Ontario, l’ACIA et to improve the preparedness of the equine sector for an animal le Laboratoire de santé animale de l’Université de Guelph, a disease outbreak. organisé un atelier sur les maladies animales exotiques des équidés. Over the past year, the CVR has liaised with the US L’objectif consistait à améliorer l’état de préparation du secteur Department of Health and Human Services, Office of équin lors de l’éclosion d’une maladie animale. Emergency Management with the goal of enabling CVR mem- Au cours de la dernière année, la RVC a effectué la liaison avec bers to access this department’s 16 online emergency response le Bureau de la gestion des urgences du ministère de la Santé et training modules. This access is planned for early 2016. des Services humains des États-Unis dans le but de permettre aux A broad call-up drill is planned for March 2016. This drill is membres de la RVC d’accéder aux seize modules de formation en designed to test the responsiveness of CVR members to a call ligne sur les interventions d’urgence de ce ministère. Cet accès est up and to test the CVR management and administrative process prévu pour le début de 2016. and procedures. Un vaste exercice de mobilisation est prévu pour mars 2016. Cet exercice est conçu afin de tester la réaction des membres de la RVC lors d’un appel de mobilisation et de mettre à l’épreuve les processus et les procédures de gestion et d’administration de la RVC.

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Practice and Economics Veterinary practice tools and resources that have been developed to support members and their healthcare teams. Pratique et finances Des outils et des ressources pour la pratique vétérinaire qui ont été conçus pour appuyer les membres et leurs équipes de soins vétérinaires. Business Management Gestion commerciale RAPPORT ANNUEL In 2015, the CVMA continued its unique benchmarking pro- En 2015, l’ACMV a continué d’offrir son programme gram that included valuable economic and practice management d’évaluation comparative du rendement unique en son genre tools and resources such as provincial suggested fee guides, qui comprenait des outils et des ressources utiles pour la gestion compensation and benefits reports for associate veterinarians, des finances et de la pratique, comme les guides tarifaires non-DVM wage reports, provincial economic reports, and indi- suggérés provinciaux, les rapports sur la rémunération et les vidual practice reports. The data for these reports come from the avantages sociaux des vétérinaires salariés, les rapports sur les annual economic surveys that the CVMA conducts in partner- salaires des employés non-vétérinaires, les rapports économiques ship with the provincial veterinary medical associations, Idexx provinciaux et les rapports individuels des pratiques. Les Laboratories, Petsecure, Merck Animal Health and Scotiabank données utilisées pour ces rapports proviennent des sondages who co-sponsor this program together with the CVMA. économiques annuels réalisés par l’ACMV en partenariat avec The CVMA and the Association des médecins vétérinaires du les associations provinciales de médecins vétérinaires, Idexx Québec en pratique des petits animaux (AMVQ) collaborated Laboratories, Petsecure, Merck Santé animale et la Banque Scotia to deliver the 2015 economic survey of small animal practitio- qui cocommanditent ce programme de concert avec l’ACMV. ners in Québec, which provided added value to our respective L’ACMV et l’Association des médecins vétérinaires du Québec members. en pratique des petits animaux (AMVQ) ont collaboré pour la In 2015, the CVMA published 6 veterinary practice manage- livraison du sondage économique 2015 auprès des praticiens pour ment articles in The CVJ that can also be found in the Business petits animaux du Québec, ce qui a fourni une valeur ajoutée à Management Program section of the CVMA website. nos membres respectifs. The Business Management track at the 2015 CVMA En 2015, l’ACMV a publié six articles sur la gestion Convention in Calgary, Alberta, “A Successful Career: A Balanced commerciale d’une pratique vétérinaire dans La RVC qui peuvent Life,” was comprised of 6 50-minute sessions. Kelly Lynn aussi être consultés dans la section du Programme de la gestion Cronin tackled practice economics showing how to price shop commerciale du site Web de l’ACMV. competitors and how to get employees on board with pricing, Le volet sur la gestion commerciale du congrès 2015 de and Dr. Jason Coe explored communication skills that can help l’ACMV à Calgary, en Alberta, «Une carrière prospère et une vie you better understand your client’s perspective. équilibrée» comportait six ateliers de 50 minutes. Kelly Lynn Provincial veterinary medical association (VMA) represen- Cronin s’est penchée sur les finances de la pratique en montrant tatives attended the yearly Economic Forum, hosted by the comment déterminer le prix des concurrents et rallier les employés CVMA at the Annual Convention, and were given an overview aux prix établis et le Dr Jason Coe a exploré les aptitudes de of the scheduling and delivery of annual surveys and reports to communication qui peuvent vous aider à mieux comprendre le all members. Mr. Darren Osborne, CVMA’s economic consul- point de vue de votre client. tant, presented national data comparisons and discussed ways Les représentants des associations provinciales de médecins to improve the program and its delivery. vétérinaires (AMV) ont assisté aux Forum économique annuel, qui a été organisé par l’ACMV lors du congrès annuel, et où l’on a présenté un aperçu sur le calendrier et la livraison des sondages et des rapports annuels à tous les membres. M. Darren Osborne, le consultant économique de l’ACMV, a présenté des comparaisons des données nationales et a discuté les façons d’améliorer le programme et sa mise en œuvre.

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Veterinarians Wellness Bien-être des vétérinaires

In May, the CVMA Wellness Advisory Group distributed a En mai, le Groupe consultatif sur le bien-être de l’ACMV a ANNUAL REPORT ANNUAL national survey to the provincial VMAs and veterinary colleges distribué un sondage national aux AMV provinciales et aux to identify the wellness services and programs currently being collèges de médecine vétérinaire afin d’identifier les services et offered to veterinarians and veterinary students in Canada, les programmes de bien-être qui sont actuellement offerts aux measure their utilization, identify gaps, and consider how the vétérinaires et aux étudiants en médecine vétérinaire du Canada, CVMA could fill some of those gaps based on the information de mesurer leur utilisation, d’identifier les lacunes et de considérer gathered. comment l’ACMV pourrait combler certaines de ces lacunes en The Advisory Group recommended the creation of a wellness se fondant sur les renseignements recueillis. microsite, part of the CVMA website, to provide open access to Le Groupe consultatif a recommandé la création d’un microsite a wide range of personal and professional health and wellness sur le bien-être, qui fera partie du site Web de l’ACMV, afin resources. This microsite will be created in 2016. The CVMA d’offrir le libre accès à un vaste éventail de ressources personnelles continues to offer a track in veterinary wellbeing at the CVMA et professionnelles en matière de santé et de bien-être. Ce Convention, maintain an online listing of relevant help lines and microsite sera créé en 2016. L’ACMV continue d’offrir un volet support services, and support the wellness of recent graduates sur le bien-être vétérinaire au congrès de l’ACMV, elle met à through its Mentoring Program. jour une liste pertinente des lignes d’assistance et des services de soutien et appuie le bien-être des diplômés récents dans le cadre de son Programme de mentorat.

CVMA Web Store Program — ‘MyVetStore.ca’ Le programme de boutique Web de l’ACMV — «MaVitrineVeterinaire.ca»

In May, the CVMA introduced its new Web Store Program, En mai, l’ACMV a introduit son nouveau programme de a powerful tool that enables veterinary practices to offer the boutique Web, un puissant outil qui permet aux pratiques ultimate in customer service. With their own branded web vétérinaires d’offrir un service à la clientèle optimal. Grâce à une store, practices can offer their clients the convenience of 24/7 boutique Web à leur image de marque, les pratiques permettent online shopping, enhance the product offering without the cost ainsi à leurs clients d’effectuer des achats en ligne 24 heures sur of carrying inventory, reduce their staff’s administration and 24 et 7 jours sur 7 et elles améliorent aussi l’éventail de produits obtain payment tracking reports for clients who may not be offerts sans assumer le coût d’un inventaire ainsi qu’en réduisant able to pay for the entire amount at the time of its occurrence. l’administration du personnel et en obtenant des rapports de suivi The CVMA Web Store Program is available to practices owned des paiements pour les clients qui ne peuvent payer au moment in whole or in part by CVMA members for whom CVMA has de l’émission de la facture. Le Programme Ma Vitrine Vétérinaire negotiated the most favorable financial terms. The service is de l’ACMV est offert aux pratiques appartenant partiellement ou provided by Acumenex, a Canadian web store provider to the entièrement à des membres de l’ACMV et pour lesquels l’ACMV professional market. a négocié les conditions financières les plus favorables. Le service est fourni par Acumenex, un fournisseur de boutiques Web canadien s’adressant au marché professionnel.

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Group Insurance Program Programme d’assurance de groupe

Professional Liability and Commercial Protected Programme de responsabilité professionnelle et Self-Insurance Program (PSIP) d’assurance auto-protégée commerciale In 2015, 1470 practices were insured. The PSIP model is En 2015, 1470 pratiques étaient assurées. Le modèle de the greatest selling feature for new participants. The average l’assurance auto-protégée est le principal avantage pour les annual rate increased 2% across all practices; this was only the nouveaux participants. Le tarif annuel moyen a augmenté de 2 % 2nd increase in the 9-year history of the program. The proven pour l’ensemble des pratiques et il s’agissait de la deuxième hausse rate stability in comparison to competing products differentiates depuis la création du programme il y a neuf ans. C’est la stabilité RAPPORT ANNUEL the CVMA program from competitors. éprouvée des tarifs qui distingue le programme de l’ACMV de ceux de ses concurrents. Employee Group Benefits Program (EGBP) In 2015, participation increased by 6%.The EGBP offers flexible Programme collectif d’avantages sociaux pour les options for health and dental coverage, life insurance, accidental employés death and dismemberment, and disability. Optional wellness En 2015, la participation a augmenté de 6 %. Ce programme benefits such as professional referral and counseling services for offre des options souples en matière de protection d’assurance insured members and family members, and business assistance maladie et dentaire, d’assurance vie, d’assurance en cas de décès et and coaching for the practice are also available. Insured clinics de mutilation par accident et d’assurance invalidité. Des avantages benefit from the rate stability generated by spreading claims over facultatifs relatifs au bien-être, comme les services d’aiguillage the entire TotalGUARDTM /CVMA pool. professionnel et le counseling pour les membres assurés et les Other insurance solutions available include: Affinity program, membres de la famille admissibles, ainsi qu’une assistance et un Veterinary student & graduate program, Personal automobile, encadrement d’affaires pour l’organisation de l’employeur sont home, and travel insurance. The CVMA Insurance Program is également offerts. Les cliniques assurées profitent de la stabilité available exclusively to CVMA members. des tarifs assurée par l’étalement des réclamations sur l’ensemble du bassin TotalGUARDMD/ACMV. Les autres solutions d’assurance disponibles incluent : le programme Affinité, le programme d’assurance pour étudiants et diplômés et l’assurance automobile, habitation et voyage. Le Programme d’assurance de l’ACMV est offert exclusivement aux membres de l’ACMV.

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

Starting a new career and adjusting to life in private practice can Le début d’une nouvelle carrière et l’ajustement au travail be a very exciting, yet challenging time. The CVMA has devel- en pratique privée peut être une expérience très stimulante oped a number of new initiatives to support new veterinarians qui peut aussi comporter des moments difficiles. L’ACMV and help meet their personal and professional needs. a élaboré plusieurs nouvelles initiatives afin d’appuyer les nouveaux vétérinaires et de répondre à leurs besoins personnels CVMA Mentoring Program et professionnels. Since the launch of this new program in February 2015, 33 mentors and 8 mentees have registered to participate in the Programme de mentorat de l’ACMV program. This program is open to CVMA members. Mentor Depuis le lancement de ce programme en février 2015, profiles are posted in the mentor roster on the CVMA website. 33 mentors et 8 mentorés se sont inscrits pour participer au Mentees can self-search a potential mentor and initiate commu- programme. Ce programme est ouvert aux membres de l’ACMV. nication directly whenever they are ready to do so. A mentoring Les profils des mentors sont affichés dans la liste des mentors guide and FAQ document are also available online. sur le site Web de l’ACMV. Les mentorés peuvent effectuer In July, the CVMA participated in a meeting to learn about eux-mêmes la recherche pour un mentor potentiel et initier la the Western College of Veterinary Medicine’s (WCVM) new communication directement lorsqu’ils sont prêts à le faire. Un Mentee Skills Building Program. The CVMA and WCVM guide de mentorat et un document de FAQ sont aussi disponibles are collaborating to further leverage these 2 programs and en ligne. strengthen the impact of our mentorship efforts to benefit the En juillet, l’ACMV a participé à une réunion pour se renseigner profession. à propos du nouveau programme de création de compétences des

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mentorés du Western College of Veterinary Medicine’s (WCVM). L’ACMV et le WCVM collaborent afin de mettre ces deux programmes à contribution ainsi que d’accroître l’impact de notre travail de mentorat pour renforcer la profession.

Programme des futurs leaders (PFL) de l’ACMV REPORT ANNUAL Le Programme des futurs leaders 2015 de l’ACMV, qui en était à Rick DeBowes, Facilitator sa sixième année, a accueilli 31 participants provenant de toutes of the ELP. les régions du Canada. Les participants incluaient 15 candidats du Rick DeBowes, animateur PFL sélectionnés pour une commandite par l’ACMV et les AMV; du PFL. cinq étudiants commandités par l’ACMV ainsi que la présidente du programme, la Dre Melodie Chan, et dix participants payants. CVMA Emerging Leaders Program (ELP) Comme lors du programme 2014, l’animateur Dr Rick DeBowes In its 6th year, the 2015 CVMA Emerging Leaders Program a puisé dans un répertoire d’approches d’apprentissage didactiques welcomed 31 participants from across Canada. The participants et expérientielles pour aider les participants à découvrir comment included 15 selected ELP candidates sponsored by CVMA/ ils dirigent et communiquent avec les autres et la façon dont VMAs; 5 students sponsored by the CVMA, as well as the ils peuvent devenir de meilleurs leaders. Pour en apprendre program chair, Dr. Melodie Chan, and 10 paid participants. davantage à propos de l’ACMV, les participants au PFL se sont Similar to the 2014 program, facilitator Dr. Rick DeBowes used assis avec un membre du Conseil de l’ACMV durant l’Assemblée didactic and experiential learning techniques to help participants générale annuelle et déjeuner de remise des prix de l’ACMV. À la gain insight into how they lead, communicate with others, and fin de la journée, une session interactive de 30 minutes appelée can become better leaders. To learn more about the CVMA, «Mingle» a été organisée avec le Conseil de l’ACMV. Ce format ELP participants sat with a CVMA Council member during a permis aux membres du Conseil de l’ACMV de recevoir une the CVMA Annual General Meeting and Awards Luncheon. rétroaction directe et personnelle présentée par les participants At the end of the day, a 30-minute interactive “Mingle Mingle” au PFL sur les questions qui avaient été posées. Cette rencontre a session was planned with the CVMA Council. This format été fort appréciée et elle a fourni l’occasion de réseauter dans une allowed CVMA Council members to receive direct and personal ambiance détendue. feedback from the ELP participants to the questions posed. This was well received and provided an opportunity to network in a Carrefour des ressources pour les vétérinaires relaxed and casual atmosphere. en début de carrière En 2015, lorsque l’ACMV a réalisé son sondage annuel auprès des Early Career DVM Resource Hub diplômés récents, les nouveaux vétérinaires ont identifié les trois In 2015, when the CVMA conducted its annual survey of recent défis suivants qu’ils avaient vécus pendant la première année de graduates, the new veterinarians identified the following top pratique : 1) absence de mentorat et manque de confiance envers 3 challenges encountered in their first year in practice: 1) lack leurs compétences cliniques, 2) difficulté à communiquer avec les of mentoring and lack of confidence in their clinical skills, clients et 3) problèmes financiers et remboursement de la dette. 2) difficult client communications, and 3) financial issues and Afin d’appuyer les vétérinaires en début de carrière et de faciliter debt repayment. To support early career DVMs and help set le lancement d’une carrière prospère, l’ACMV a créé une section them on the path to a successful career, the CVMA created a sur son site Web qui contient des renseignements, des outils et dedicated web section on its website that contains useful infor- des ressources utiles. Cette section du site Web comprend trois mation, tools and resources. This web section includes 3 main catégories principales : gestion du budget et finances personnelles, categories: financial planning and budgeting, communications, communications et évolution de carrière. Parmi les outils et and career development. Some of the tools and resources include les ressources offerts dans cette section, citons des calculateurs student loan repayment estimators, a budgeting app for mobile de remboursement des prêts étudiants, une appli de gestion devices, guidelines for successful employment, and instructional du budget pour les appareils mobiles, des directives sur l’emploi communications videos. Over time, more resources will be des finissants et des vidéos de formation sur la communication. added to the hub. De nouvelles ressources seront ajoutées au carrefour à l’avenir.

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VALUE OF MEMBERSHIP VALEUR DE L’ADHÉSION Membership Effectif

As the national professional Association, the CVMA is a power- À titre d’association professionnelle nationale, l’ACMV est une ful, unified voice for Canada’s veterinarians. Our strength is in voix puissante et unie pour les vétérinaires du Canada. Notre sharing veterinary science and knowledge, influencing policy force repose sur le partage de la science et des connaissances decisions that matter most to the profession, and providing vétérinaires, la capacité d’influencer les décisions politiques les services and resources to help meet the needs of veterinarians. plus importantes pour la profession ainsi que la prestation de In 2015, 6799 veterinarians and student members supported services et de ressources afin d’aider à répondre aux besoins des CVMA’s work and leadership by joining as members. vétérinaires. En 2015, 6799 vétérinaires et membres étudiants

RAPPORT ANNUEL The CVMA is always looking to deliver more value to mem- ont appuyé le travail et le leadership de l’ACMV en adhérant en bers to increase their profitability and professional success. tant que membres. Members can take advantage of the broadest suite of benefits L’ACMV recherche toujours de nouvelles façons d’offrir plus available, including practice tools and resources, position state- de valeur aux membres afin d’accroître leur rentabilité et leur ments and research, continuing education, powerful advocacy, succès professionnel. Les membres peuvent profiter du plus vaste and a wide array of discounts and savings on important products éventail d’avantages offerts, dont des outils et des ressources and services to help support veterinarians and the practice team. pour la pratique, des énoncés de position et de la recherche, de In 2015, the CVMA introduced a number of new member la formation continue, une puissante défense des intérêts ainsi benefits and services including: qu’une vaste gamme de rabais et de réductions sur des produits Clinician’s Brief: Members receive a complimentary sub- et des services importants afin d’aider à appuyer les vétérinaires scription to the monthly Global Digital Edition of Clinician’s et l’équipe de la pratique. Brief, which provides practical clinical information to compan- En 2015, l’ACMV a introduit plusieurs nouveaux avantages et ion animal practitioners. Members who prefer the print edition services aux membres qui incluent entre autres : are entitled to a discounted subscription price. Clinician’s Brief : Les membres reçoivent un abonnement Plumb’s Veterinary DrugsTM: Members receive a 30% gratuit à l’édition mensuelle numérique mondiale de Clinician’s discount on the individual or practice online subscription. In Brief, qui offre des renseignements cliniques pratiques aux addition, the Plumb’s mobile app is available exclusively with praticiens pour animaux de compagnie. Les membres qui this subscription. préfèrent l’édition imprimée peuvent se prévaloir d’un tarif VetFolio®: As a benefit of our association membership with d’abonnement réduit. the WSAVA, CVMA members receive a 20% discount on an Plumb’s Veterinary DrugsMD : Les membres reçoivent un individual or practice subscription. In addition, Students of the rabais de 30 % sur l’abonnement en ligne individuel ou de CVMA are eligible for a free subscription. la pratique. De plus, l’appli mobile de Plumb’s est disponible exclusivement avec cet abonnement. VetFolioMD : Dans le cadre des avantages de l’adhésion de notre association à la WSAVA, les membres de l’ACMV reçoivent un rabais de 20 % sur l’abonnement individuel ou de la pratique. De plus, les Étudiants de l’ACMV sont admissibles à un abonnement gratuit.

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

The Students of the Canadian Veterinary Medical Association Les Étudiants de l’Association canadienne des médecins (SCVMA) represent over 1600 student veterinarians from the vétérinaires (ÉACMV) représentent plus de 1600 étudiants en 5 Canadian veterinary colleges. médecine vétérinaire dans les cinq collèges de médecine vétérinaire The student-led 2015 SCVMA Symposium, held January 15 du Canada. and 16 in Guelph at the Ontario Veterinary College, was a huge Le Symposium 2015 des ÉACMV, qui est organisé par les success with over 250 students attending. étudiants et s’est déroulé les 15 et 16 janvier à Guelph à l’Ontario The SCVMA conducted its annual New Graduate Survey to Veterinary College, a remporté un énorme succès et plus de gather useful information for future veterinary graduates and 250 étudiants y ont participé. the profession. Results were published in the March 2016 edi- Les ÉACMV ont réalisé leur sondage annuel auprès des tion of The CVJ and can be found in the SCVMA section of finissants afin de recueillir des renseignements utiles pour les the CVMA website. futurs diplômés en médecine vétérinaire et la profession. Les

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SCVMA members received the annual VetRap student news- résultats ont été publiés dans l’édition de mars 2016 de La RVC letter that showcases articles from each college, as well as et on peut aussi les consulter dans la section des ÉACMV du site 2 student e-newsletters. Throughout the year, the SCVMA sec- Web de l’ACMV. tion of the website and the SCVMA Facebook group provide Les membres des ÉACMV ont reçu le bulletin étudiant annuel updated information. VetRap qui contient des articles provenant de chacun des cinq ANNUAL REPORT ANNUAL First-year students received CVMA-branded lab coats and collèges ainsi que deux cyberbulletins étudiants. Pendant l’année, name badges during each college’s welcome ceremony and la section des ÉACMV du site Web et le groupe Facebook des the CVMA Awards and the Teacher of the Year Awards were ÉACMV présentent aussi des mises à jour. presented. Les étudiants de première année ont reçu leurs sarraus et In the fall, each college hosted the CVMA One Voice des insignes d’identité affichant le logo de l’ACMV. Les Prix Presentation to introduce students to the CVMA and discuss a de l’ACMV et les Prix de l’enseignant de l’année ont aussi été current animal welfare or national veterinary issue. A CVMA décernés à chaque collège. Council member and the SCVMA representative delivered the À l’automne, chaque collège a organisé la présentation «Une presentation and facilitated the discussions. voix» de l’ACMV afin d’introduire les étudiants à l’ACMV et de CVMA’s group insurance partner, Western Financial Group discuter une question de l’heure portant sur le bien-être animal Insurance Solutions, hosted an Insurance presentation at each ou les enjeux vétérinaires nationaux. Un membre du Conseil de college providing an overview of insurance risks that students l’ACMV et le représentant des ÉACMV ont donné la présentation may face in their career and explaining the various insurance et animé les discussions. products and coverages available. Par ailleurs, le partenaire d’assurance de groupe de l’ACMV, In 2015, the CVMA piloted an international student program Western Financial Group Insurance Solutions, a organisé une and welcomed 42 veterinary student affiliate members from présentation sur l’assurance à chaque collège afin de donner aux St. George’s University in Grenada. étudiants un aperçu des risques d’assurance auxquels ils pourront faire face durant leur carrière et d’expliquer les divers produits et Student Liaison Advisory Group couvertures d’assurance offerts. Members of the CVMA Student Liaison Advisory Group rep- En 2015, l’ACMV a organisé un projet pilote avec des resent the CVMA at each of the 5 Canadian veterinary colleges étudiants internationaux et a accueilli 42 membres étudiants and strengthen the link between the CVMA and its student affiliés de l’Université St. George’s à la Grenade. members. The Advisory Group, comprised of 1 faculty member from each college, provides guidance to SCVMA representatives Groupe consultatif de liaison avec les étudiants at their respective colleges. Members also participate in annual Les membres du Groupe consultatif de liaison avec les étudiants CVMA initiatives including the One Voice presentation, lab de l’ACMV représentent l’ACMV à chacun des cinq collèges de coat ceremony, and the SCVMA Symposium. médecine vétérinaire canadiens afin de renforcer le lien entre l’ACMV et ses membres étudiants. Le groupe consultatif, qui se compose d’un professeur provenant de chacun des collèges, fournit des conseils aux représentants des ÉACMV à leur collège respectif. Les membres participent aussi à des initiatives annuelles de l’ACMV dans les collèges vétérinaires incluant la présentation «Une voix», la cérémonie des sarraus et le Symposium des ÉACMV.

The 2015/16 SCVMA Committee reps at the SCVMA Symposium closing banquet. Les représentants du Comité des ÉACMV 2015–2016 au banquet de clôture du Symposium des ÉACMV.

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CVMA-SBCV Chapter Annual Report Rapport annuel de la Section de l’ACMV-SBCV

The CVMA-SBCV Chapter continues to grow its profile among La Section de l’ACMV-SBCV continue de rehausser son profil British Columbia veterinarians and throughout its stakeholder parmi les vétérinaires de la Colombie-Britannique et parmi les base, including media, government, pet owners, and the public. groupes d’intervenants, dont les médias, le gouvernement, les We do this by focusing on providing service to our Chapter propriétaires d’animaux et le public. Nous nous acquittons de members, promoting the veterinary profession, and recogniz- cette tâche en travaillant afin d’offrir des services à nos membres, ing and offering education on human/animal welfare. Despite en faisant la promotion de la profession vétérinaire ainsi qu’en this, we continue to encounter lower than desired membership identifiant et en offrant de l’éducation sur le bien-être des RAPPORT ANNUEL numbers, and we are constantly vigilant about protecting (and humains et des animaux. Malgré cela, nous continuons d’afficher not diluting) our benefits of membership. un effectif inférieur aux attentes et nous sommes constamment The Chapter continually renews and strengthens its beneficial vigilants afin de protéger (et non de diluer) les avantages de relationships with decision-makers and influencers. In addition l’adhésion. to being responsive to media requests, the Chapter consulted La Section renouvelle et renforce constamment ses relations on a pet travelling initiative with BC Ferries and was credited bénéfiques avec les décideurs et les leaders d’opinion. En plus in its release of improved pet policies just recently. The Chapter de répondre aux demandes d’information des médias, la Section is growing its relationship with the College of Veterinarians of a agi comme consultant lors d’une initiative sur le transport des BC through an enhanced sharing program, especially with its animaux de compagnie auprès de BC Ferries et on a reconnu Council. Additionally, the province’s Chief Veterinarian and sa contribution lors de la publication récente de politiques University of BC’s Animal Welfare Program chair both have améliorées sur les animaux de compagnie. La Section travaille à columns in our magazine so our members can be alerted and l’amélioration de sa relation avec le Collège des vétérinaires de la educated on trends, cautions, and new research. Colombie-Britannique dans le cadre d’un programme de partage Last year’s Fall Conference and Trade Show was held at a dif- amélioré, particulièrement avec son Conseil. De plus, le médecin ferent venue and had an intensive 2-day program; all of which vétérinaire en chef de la province et le président du programme was well-received and lauded. We heard from Conference del- de bien-être animal de l’Université de la Colombie-Britannique egates that they want to implement what they learn immediately ont tous deux des rubriques dans notre magazine afin que nos at their practices. We have asked 2016 presenters (in animal membres puissent être informés et sensibilisés à l’égard des behavior, neurology, pet nutrition, and emergency and critical tendances, des mises en garde et de la nouvelle recherche. care) to provide our delegates with new information and ways La Conférence d’automne et Salon des exposants de l’an to immediately implement it. dernier ont eu lieu dans un endroit différent et offraient un Our flagship product, West Coast Veterinarian magazine, programme intensif de deux jours. L’événement a été bien offers both education for our members and economic benefits accueilli et apprécié. Les délégués à la conférence nous ont dit for the Chapter. To enhance our 3rd-largest source of revenue, qu’ils désiraient mettre immédiatement en œuvre les nouveaux we developed a “Prescription for a Subscription” to offer paid apprentissages dans leurs pratiques. Nous avons demandé aux subscriptions to the public and to industry. Our Fall Conference présentateurs 2016 (sur le comportement animal, la neurologie, la and Trade Show included a practice management session, and nutrition des animaux de compagnie ainsi que les soins d’urgence all sessions for 2016 will include a focus on tips to incorporate et critiques) de fournir de nouveaux renseignements et méthodes new knowledge immediately into practice. We continue to be à nos délégués afin qu’ils puissent mettre les apprentissages pleased at the support our Chapter receives from industry at our immédiatement en œuvre. Fall Conference, in terms of sponsorships, and trade show tables Notre produit phare, le magazine West Coast Veterinarian, which, again this year, have already sold out. offre des ressources éducatives et des avantages économiques aux membres de la Section. Afin d’améliorer notre troisième source de revenu, nous avons créé une «Prescription d’abonnement» afin d’offrir des abonnements payants au public et à l’industrie. Notre Conférence d’automne et Salon des exposants incluaient un atelier sur la gestion d’une pratique et tous les ateliers de 2016 incluront des conseils sur la façon d’intégrer immédiatement les connaissances dans la pratique. Nous continuons d’être heureux du soutien offerts par l’industrie à notre Section lors de la Conférence d’automne, car toutes les commandites et les tables du Salon des exposants ont été vendues de nouveau cette année.

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

The CVMA’s Animal Health Technologist/Veterinary Technician Le Comité d’agrément des programmes de technologie en Program Accreditation Committee (AHTVTPAC) is responsible santé animale et de techniques vétérinaires (CAPTSATV) est for accrediting veterinary technician training programs that responsable de l’agrément des programmes de formation des meet the minimum standards for educating and training quali- techniciens vétérinaires qui satisfont aux normes minimales pour fied personnel who may join the veterinary health care team. l’éducation et la formation d’un personnel qualifié qui pourra Graduates of such accredited programs benefit by having their faire partie de l’équipe de soins vétérinaires. Les diplômés de ces competence recognized and prospects for employment and programmes agréés profitent du fait que leur compétence est mobility enhanced and the veterinary team benefits from well reconnue et que leurs perspectives d’emploi et de mobilité sont trained technicians and technologists. améliorées et l’équipe vétérinaire profite de techniciens et de The CVMA maintains a reciprocity agreement with the technologues bien formés. American Veterinary Medical Association that allows for the L’ACMV maintient une entente de réciprocité avec l’American mutual recognition of our respective accreditation processes. Veterinary Medical Association qui permet la reconnaissance In 2015, the CVMA Council approved accreditation for one mutuelle de nos processus d’agrément respectifs. new program, the Maritime Business College in Dartmouth, En 2015, le Conseil de l’ACMV a approuvé l’agrément d’un Nova Scotia. This brings the total number of accredited institu- nouveau programme, celui du Maritime Business College à tions in Canada to 19: Dartmouth, en Nouvelle-Écosse, ce qui fait passer le total des • Algonquin College, Ottawa, Ontario établissements agréés au Canada à 19 : • Dalhousie University (formerly Nova Scotia Agricultural • Algonquin College, Ottawa (Ontario) College), Truro, Nova Scotia • Douglas College, New Westminster (Colombie-Britannique) • Douglas College, New Westminster, British Columbia • Georgian College, Orillia (Ontario) • Georgian College, Orillia, Ontario • Grand Prairie Regional College, Fairview Campus, Fairview • Grand Prairie Regional College, Fairview Campus, (Alberta) Fairview, Alberta • Lakeland College, Vermilion (Alberta) • Lakeland College, Vermilion, Alberta • Maritime Business College, Dartmouth (Nouvelle-Écosse) • Maritime Business College, Dartmouth, Nova Scotia • Northern Alberta Institute of Technology, Edmonton • Northern Alberta Institute of Technology, Edmonton, (Alberta) Alberta • Northern College, Haileyburg (Ontario) • Northern College, Haileyburg, Ontario • Olds College (sur le campus et téléapprentissage), Olds • Olds College (on-campus and distance learning), Olds, (Alberta) Alberta • Oulton College, Moncton (Nouveau-Brunswick) • Oulton College, Moncton, New Brunswick • Red River College, Winnipeg (Manitoba) • Red River College, Winnipeg, Manitoba • St. Clair College, Windsor (Ontario) • St. Clair College, Windsor, Ontario • St. Lawrence College, Kingston (Ontario) • St. Lawrence College, Kingston, Ontario • Saskatchewan Institute of Science and Technology, Saskatoon • Saskatchewan Institute of Science and Technology, (Saskatchewan) Saskatoon, Saskatchewan • Seneca College, King City (Ontario) • Seneca College, King City, Ontario • Université Dalhousie (anciennement Nova Scotia Agricultural • Thompson Rivers University (on-campus and distance College), Truro (Nouvelle-Écosse) learning), Kamloops, British Columbia • Université de Guelph, Campus Ridgetown (sur le campus et • University of Guelph, Ridgetown Campus (on-campus and téléapprentissage), Ridgetown (Ontario) distance learning), Ridgetown, Ontario • Université Thompson Rivers (sur le campus et • Vanier College, St-Laurent, Quebec téléapprentissage), Kamloops (Colombie-Britannique) • Vanier College, Saint-Laurent (Québec)

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National Exams Examens nationaux

The National Examining Board (NEB) is the first point of Le Bureau national des examinateurs (BNE) est le premier point contact for foreign trained veterinarians wishing to practice de contact pour les vétérinaires formés à l’étranger qui désirent veterinary medicine in Canada. Passing the NEB exams and exercer la médecine vétérinaire au Canada. La réussite des examens obtaining a Certificate of Qualification (CQ) allows them to du BNE et l’obtention du Certificat de compétence (CC) leur apply for a license in any Canadian province. permet de présenter une demande de permis dans une province The NEB works closely with its counterparts in the Unites canadienne. States, namely the Educational Commission for Foreign Le BNE travaille en étroite collaboration avec ses homologues RAPPORT ANNUEL Veterinary Graduates (ECFVG) and National Board of aux États-Unis, notamment l’Educational Commission for Veterinary Medical Examiners (NBVME), to ensure that the Foreign Veterinary Graduates (ECFVG) et le National Board of examination process is fair and relevant. Veterinary Medical Examiners (NBVME), afin de veiller à ce que le processus d’examen soit juste et pertinent. NEB examination process The NEB approved a new step in the examination process that Processus d’examen du BNE will become a mandatory step for all candidates taking the Le BNE a approuvé une nouvelle étape dans le processus Clinical Proficiency Examination (CPE) after January 1, 2017. d’examen qui deviendra une étape obligatoire pour tous les The Preliminary Surgical Assessment (PSA) has been developed candidats qui subissent l’Examen de compétences cliniques (ECC) to ensure candidates can demonstrate basic surgical techniques après le 1er janvier 2017. L’Évaluation chirurgicale préliminaire as a prerequisite for CPE registration. A pilot session for the PSA (ÉCP) a été conçue afin d’assurer que les candidats puissent was successfully run for 12 candidates at AVC in Charlottetown, démontrer des techniques chirurgicales de base comme préalable Prince Edward Island on October 3, 2015. à l’inscription à l’ECC. Une séance d’examen pilote pour l’ÉCP In 2015 the NEB accepted applications from 279 new candi- a été tenue avec succès le 3 octobre 2015 pour 12 candidats de dates and issued 494 CQs (338 Canadian students, 18 graduates l’AVC à Charlottetown, à l’Île-du-Prince-Édouard. from AVMA-accredited veterinary schools, 138 graduates of En 2015, le BNE a accepté des demandes provenant de non-accredited veterinary schools). 279 nouveaux candidats et émis 494 CC (338 à des étudiants canadiens, 18 à des diplômés d’écoles de médecine vétérinaire Veterinary college accreditation agréées par l’AVMA, 138 à des diplômés d’écoles de médecine The CVMA, in collaboration with the American Veterinary vétérinaire non agréées). Medical Association — Council on Education (AVMA-COE), is accrediting university programs designed to educate students Agrément des collèges de médecine vétérinaire to become veterinarians. All Canadian veterinary colleges are L’ACMV, en collaboration avec l’American Veterinary Medical AVMA/CVMA-COE accredited. Association — Council on Education (AVMA-COE), procède à In 2015 AVMA/CVMA-COE site visits were conducted at: l’agrément des programmes universitaires conçus pour enseigner la • University of Wisconsin médecine vétérinaire aux étudiants. Tous les collèges de médecine • University of Tennessee vétérinaire canadiens sont agréés par l’AVMA/ACMV-COE. • Montana State University Cooperative En 2015, des inspections de l’AVMA/ACMV-COE ont été • Colorado State University réalisées dans les établissements suivants : • University of Copenhagen • Université du Wisconsin • Midwestern University • Université du Tennessee • University of Florida • Montana State University Cooperative • University of Guelph • Université d’État du Colorado • University of Edinburgh • Université de Copenhague • Texas A&M University • Université Midwestern • Lincoln Memorial University • Université de Floride • Université de Guelph • Université d’Édimbourg • Université Texas A&M • Université Lincoln Memorial

724 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY ANNUAL REPORT ANNUAL

RAPPORT DES AUDITEURS INDÉPENDANTS INDEPENDENT AUDITORS’ REPORT Aux membres de To the Members, L’Association canadienne des médecins vétérinaires Canadian Veterinary Medical Association: Nous avons effectué l’audit des états financiers ci-joints de L’Association We have audited the accompanying financial statements of the Canadian canadienne des médecins vétérinaires, qui comprennent l’état de la situation Veterinary Medical Association, which comprise the statement of financial financière au 31 décembre 2015, les états des revenus et dépenses, position as at December 31, 2015, and the statement of changes in net l’évolution de l’actif net et des flux de trésorerie pour l’exercice terminé à assets, operations and cash flows for the year then ended, and a summary cette date ainsi qu’un résumé des principales méthodes comptables et of significant accounting policies and other explanatory information. d’autres informations explicatives. Management’s responsibility for the financial statements Responsabilité de la direction pour les états financiers Management is responsible for the preparation and fair presentation of these La direction est responsable de la préparation et de la présentation fidèle financial statements in accordance with Canadian accounting standards for de ces états financiers conformément aux normes comptables canadiennes not-for-profit organizations, and for such internal control as management pour les organismes sans but lucratif, ainsi que du contrôle interne qu’elle determines is necessary to enable the preparation of financial statements considère comme nécessaire pour permettre la préparation d’états financiers that are free from material misstatement, whether due to fraud or error. exempts d’anomalies significatives, que celles-ci résultent de fraudes ou d’erreurs. Auditors’ responsibility Our responsibility is to express an opinion on these financial statements Responsabilité de l’auditeur based on our audit. We conducted our audit in accordance with Canadian Notre responsabilité consiste à exprimer une opinion sur les états financiers, generally accepted auditing standards. Those standards require that we sur la base de notre audit. Nous avons effectué notre audit selon les normes comply with ethical requirements and plan and perform the audit to obtain d’audit généralement reconnues du Canada. Ces normes requièrent que reasonable assurance about whether the financial statements are free from nous nous conformions aux règles de déontologie et que nous planifiions material misstatement. et réalisions l’audit de façon à obtenir l’assurance raisonnable que les états financiers ne comportent pas d’anomalies significatives. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures Un audit implique la mise en œuvre de procédures en vue de recueillir des selected depend on the auditor’s judgment, including the assessment of éléments probants concernant les montants et les informations fournis the risks of material misstatement of the financial statements, whether due dans les états financiers. Le choix des procédures relève du jugement to fraud or error. In making those risk assessments, the auditor considers de l’auditeur, et notamment de son évaluation des risques que les états internal control relevant to the entity’s preparation and fair presentation financiers comportent des anomalies significatives, que celles-ci résultent of the financial statements in order to design audit procedures that are de fraudes ou d’erreurs. Dans l’évaluation de ces risques, l’auditeur prend appropriate in the circumstances, but not for the purpose of expressing an en considération le contrôle interne de l’entité portant sur la préparation et opinion on the effectiveness of the entity’s internal control. An audit also la présentation fidèle des états financiers afin de concevoir des procédures includes evaluating the appropriateness of accounting policies used and the d’audit appropriées aux circonstances, et non dans le but d’exprimer une reasonableness of accounting estimates made by management, as well as opinion sur l’efficacité du contrôle interne de l’entité. Un audit comporte evaluating the overall presentation of the financial statements. We believe également l’appréciation du caractère approprié des méthodes comptables that the audit evidence we have obtained is sufficient and appropriate to retenues et du caractère raisonnable des estimations comptables faites par provide a basis for our audit opinion. la direction, de même que l’appréciation de la présentation d’ensemble des états financiers. Nous estimons que les éléments probants que nous avons Opinion obtenus sont suffisants et appropriés pour fonder notre opinion d’audit. In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position of the Canadian Veterinary Medical Opinion Association as at December 31, 2015, and the results of its operations À notre avis, les états financiers donnent, dans tous leurs aspects significatifs, and its cash flows for the year then ended in accordance with Canadian une image fidèle de la situation financière de L’Association canadienne des accounting standards for not-for-profit organizations. médecins vétérinaires au 31 décembre 2015, ainsi que de sa performance financière et de ses flux de trésorerie pour l’exercice terminé à cette date, conformément aux normes comptables canadiennes pour les organismes OUSELEY HANVEY CLIPSHAM DEEP LLP sans but lucratif. Licensed Public Accountants

OUSELEY HANVEY CLIPSHAM DEEP LLP Experts — comptables autorisés Ottawa, Ontario March 29, 2016

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

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CANADIAN VETERINARY MEDICAL L’ASSOCIATION CANADIENNE DES ASSOCIATION MÉDECINS VÉTÉRINAIRES

STATEMENT OF FINANCIAL POSITION ÉTAT DE LA SITUATION FINANCIÈRE AS AT DECEMBER 31, 2015 AU 31 DÉCEMBRE 2015

2015 2014

CURRENT ASSETS ACTIF À COURT TERME Cash $ 378 682 $ 471 921 Encaisse

RAPPORT ANNUEL Accounts receivable 157 293 158 986 Débiteurs Interest receivable 52 829 60 621 Intérêts à recevoir Prepaid expenses 85 955 73 215 Frais payés d’avance

674 759 764 743

INVESTMENTS 2 353 969 2 221 091 PLACEMENTS CAPITAL ASSETS 643 000 665 105 IMMOBILISATIONS

$ 3 671 728 $ 3 650 939

CURRENT LIABILITIES PASSIF À COURT TERME Accounts payable and accrued liabilities $ 117 739 $ 98 506 Créditeurs et charges à payer Government remittances payable 18 497 7 629 Remises gouvernementales à payer Deferred revenue 768 805 708 291 Revenus reportés

905 041 814 426

NET ASSETS ACTIF NET Invested in capital assets 643 000 665 105 Investi en immobilisations corporelles Internally restricted net assets: Actif net affecté d’origine interne : Operational contingency 1 281 713 1 233 280 Éventualité opérationnelle Program contingency 841 974 938 128 Éventualité de programme Unrestricted — — Non affecté

2 766 687 2 836 513

$ 3 671 728 $ 3 650 939

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

President Président

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CANADIAN VETERINARY MEDICAL L’ASSOCIATION CANADIENNE DES ASSOCIATION MÉDECINS VÉTÉRINAIRES

STATEMENT OF OPERATIONS ÉTAT DES RÉSULTATS FOR THE YEAR ENDED DECEMBER 31, 2015 POUR L’EXERCICE TERMINÉ LE 31 DÉCEMBRE 2015 ANNUAL REPORT ANNUAL

2015 2014

REVENUE REVENUS Communications Program $ 58 962 $ 64 408 Programme de communication Professional development 458 130 437 322 Perfectionnement professionnel Journal — CJVR 85 603 73 457 Revue — RCRV Journal — CVJ 646 685 598 921 Revue — RVC Membership services 1 280 151 1 299 209 Services aux membres National Examination Board 1 383 455 1 255 138 Bureau national des examinateurs Canadian Veterinary Reserve 64 051 204 587 Réserve canadienne vétérinaire AHTVTP Accreditation 40 500 46 500 Agrément TSA Secretariat 407 210 424 243 Secrétariat Students Program 71 328 7 855 Programme d’étudiants Special projects 111 135 106 375 Projets spéciaux Interest 43 130 46 317 Intérêts

4 650 340 4 564 332

Inter-departmental revenues Revenus entre services and administration allocations (172 684) (217 311) et frais administratifs

4 477 656 4 347 021

EXPENSES DÉPENSES Communications Program 192 444 187 013 Programme de communication Professional development 449 739 405 514 Perfectionnement professionnel Council and committees 328 376 351 774 Conseil et comités Journal — CJVR 82 660 70 876 Revue — RCRV Journal — CVJ 715 227 702 124 Revue — RVC Membership services 414 313 447 239 Services aux membres National Examination Board 1 346 916 1 283 078 Bureau national des examinateurs Canadian Veterinary Reserve 64 051 204 587 Réserve canadienne vétérinaire AHTVTP Accreditation 29 354 36 622 Agrément TSA Secretariat 806 238 739 219 Secrétariat Students Program 125 977 73 380 Programme d’étudiants Special projects 164 871 153 404 Projets spéciaux

4 720 166 4 654 830

Inter-departmental expenses Dépenses entre services and administration allocations (172 684) (217 311) et frais administratifs

4 547 482 4 437 519

NET EXPENSE FOR THE YEAR $ (69 826) $ (90 498) DÉPENSES NETTES POUR L’EXERCICE

CVJ / VOL 57 / JULY 2016 727 FOR PERSONAL USE ONLY Article

The cost of a case of subclinical ketosis in Canadian dairy herds

Khaled Gohary, Michael W. Overton, Michael Von Massow, Stephen J. LeBlanc, Kerry D. Lissemore, Todd F. Duffield

Abstract — The objective of this study was to develop a model to estimate the cost of a case of subclinical ketosis (SCK) in Canadian dairy herds. Costs were derived from the default inputs, and included increased clinical disease incidence attributable to SCK, $76; longer time to pregnancy, $57; culling and death in early lactation attributable to SCK, $26; milk production loss, $44. Given these figures, the cost of 1 case of SCK was estimated to be $203. Sensitivity analysis showed that the estimated cost of a case of SCK was most sensitive to the herd-level incidence of SCK and the cost of 1 day open. In conclusion, SCK negatively impacts dairy herds and losses are dependent on the herd-level incidence and factors included in the calculation.

Résumé — Coût d’un cas d’acétonémie subclinique dans les troupeaux laitiers canadiens. L’objectif de cette étude consistait à développer un modèle pour estimer le coût d’un cas d’acétonémie subclinique (ASC) dans les troupeaux laitiers canadiens. Les coûts ont été dérivés des valeurs par défaut et comprenaient l’incidence accrue de maladie clinique attribuable à l’ASC, 76 $; un délai plus long avant la gestation, 57 $; la réforme et la mort au début de la lactation attribuable à l’ASC, 26 $; la perte de production laitière, 44 $. Compte tenu de ces chiffres, le coût de 1 cas d’ASC a été estimé à 203 $. Une analyse de sensibilité a montré que le coût estimé d’un cas d’ASC était le plus sensible à l’incidence de l’ASC au niveau du troupeau et au coût d’une journée ouvrable. En conclusion, l’ASC a un impact négatif sur les troupeaux laitiers et les pertes dépendent de l’incidence au niveau du troupeau et des facteurs inclus dans le calcul. (Traduit par Isabelle Vallières) Can Vet J 2016;57:728–732

Introduction (11,12). Therefore, the impacts of SCK on health, reproductive fter calving, all lactating dairy cows go through an inevi- performance, and production can be costly for each affected cow, A table phase of negative energy balance (1) that results from and can affect profitability of a dairy enterprise. the lag of dry matter intake behind milk production, rendering There have been previous attempts to quantify economic cows susceptible to metabolic diseases (2). Ketosis (clinical and losses associated with SCK. One Canadian study estimated a subclinical), a widespread condition in dairy herds across North cost of $78 for a case of SCK (13). This figure might be an America, is one such metabolic disease (3). Subclinical ketosis underestimate of the actual cost of SCK, not only because (SCK) results in reduced milk production (4–6) and decreased the input costs have increased over time, but also because the reproductive performance (4,7) relative to similar cows not diag- authors: i) accounted for only 2 diseases on which SCK can have nosed with the condition. In addition, affected cows are more an impact (DA and CK); ii) did not incorporate the increased likely to develop other diseases including displaced abomasum risk of culling into their calculations; and iii) considered milk (DA), clinical ketosis (CK), and metritis (5,8,9), and are more loss due to SCK for only 2 wk. Another study estimated that a likely to be culled in early lactation (10). As a consequence, the case of SCK can cost €735 ($1031.00 CDN) (14). This figure negative effects of SCK will impact herd performance as a whole might be an overestimation, as some overlapping effects such

Department of Population Medicine, Ontario Veterinary College (Gohary, LeBlanc, Lissemore, Duffield), School of Hospitality, Food and Tourism Management, College of Business and Economics (Von Massow), University of Guelph, Guelph, Ontario N1G 2W1; Department of Population Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia 30602, USA (Overton). Address all correspondence to Dr. Todd F. Duffield; e-mail: [email protected] Dr. Overton’s current affiliation is Elanco Animal Health, Greenfield, Indiana 46140, USA. This study was funded by Elanco Animal Health (Greenfield, Indiana, USA). Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

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Table 1. Inputs used to calculate the cost of 1 case of subclinical Table 2. Inputs used to calculate the cost of 1 case of clinical ketosis (SCK; defined as elevated serum BHBA $ 1400 mmol/L in ketosis (defined as a case of ketosis manifested with clinical signs either of the first 2 weeks following calving in a cow not showing regardless of serum BHBA concentrations) clinical signs) Item Value Reference Item Value Reference Incidence of clinical ketosis (%) 9.6 (3) Price/cost 300 g of propylene glycol for 4 days ($) 12 (26) Average milk price in Canada ($/L) 0.81 (22) Labour wages ($)/hour 15 (27) Cost ($) of 1 kg of TMR (dry matter basis) 0.3 (20) Number of cows drenched/hour 15 ARTICLE to produce 1 L of milk Death due to clinical ketosis (%) 1.3 (28) Average value of a cow in a herd ($) 2100 (20) Culling due to clinical ketosis (%) 5 (28) Cost of pregnant replacement heifer ($)a 2500 (23) Hourly veterinary fee ($) 160 Cull cow value ($)b 1680 (23) Time (hours) to diagnose and treat 0.3 Cost of 1 day open beyond 100 days ($) 3 (21) clinical ketosis by a veterinarian Cases of clinical ketosis examined and 10 (30) Herd/cow data treated by veterinarians (%) Herd annual turnover rate (%) 35 Milk production loss (kg) due to clinical 255 (31) Median time to pregnancy (d) in cows without 108 (7) ketosis SCK Average milk price in Canada ($/L) 0.81 (22) Median time to pregnancy (d) in cows with SCK 124 (7) Dairy efficiencya 2.3 in 1st or 2nd wk postpartum Cost ($) of 1 kg of TMR (dry matter 0.3 (20) Median time to pregnancy (d) in cows with SCK 130 (7) basis) to produce 1 L of milk in 1st and 2nd wk postpartum c Cost of pregnant replacement heifer ($) 2500 (23) Dairy efficiency 2.3 Cull cow price ($) 1680 (23) Milk reduction (kg) for 30 days due to SCK 65 (4,5) Average value of a cow in a herd ($) 2100 (20) a Pregnant replacement heifer price is based on average weight of 454 kg and Cost of 1 day open beyond 100 days ($) 3.0 (21) $250/cwt. Increase in days open for cows with 10 (30) b Cull cow value is based on average weight of 635 kg and $120/cwt. clinical ketosis c Milk yield (kg) produced as a result of a cow consuming 1 additional kg of dry Risk of aspiration pneumonia (%) with 0.003 J.P. Goff, matter above maintenance requirements (24); this calculation accounts only for the drenching Iowa State energy required to produce marginal milk after considering that NEL concentration University, Ames, of 0.75 Mcal/kg of 4% milk and 1.73 Mcal/kg of feed on a dry matter basis (25). Iowa, personal communication, as production loss were double-counted. A recent comprehen- 2015 sive model estimated the average cost of a case of ketosis to be Risk of immediate death after aspiration 0.0024 (32) pneumonia (%) $289 US (15); however, it was based on conditions within the Risk of survival after aspiration 0.0009 (32) US dairy industry. pneumonia (%) Therefore, there is a need for a model that estimates the cost Risk of culling after survival and 0.0003 (32) treatment (%) per case of SCK in Canada as comprehensively as possible, a Milk yield (kg) produced as a result of a cow consuming one additional kg of dry based on currently available information. The objective was to matter above maintenance requirements (24); this calculation accounts only for the

estimate the losses that result from an individual case of SCK in energy required to produce marginal milk after considering that NEL concentration Canadian dairy herds, including a sensitivity analysis to identify of 0.75 Mcal/kg of 4% milk and 1.73 Mcal/kg of feed in dry matter basis (25). influencing input variables. the first test date is at 30 days in milk (DIM). The marginal Materials and methods loss of milk production ($) was calculated by subtracting the A spreadsheet in Excel (Microsoft Office 2010; Microsoft, feed cost (dry matter basis) saved due to the reduction in milk Redmond, Washington, USA) was developed to estimate production caused by SCK from the total loss ($) incurred due the cost of an individual case of SCK. Subclinical ketosis to the reduction in milk production associated with SCK. was defined as elevated serum b-hydroxybutyrate (BHBA) $ 1400 mmol/L in either of the first 2 weeks following calving Losses due to increased disease incidence and in a cow not showing clinical signs. Economic losses due attributable to subclinical ketosis to SCK were calculated by summing the losses resulting from The overall loss due to increased clinical disease (CK, DA, and reduction in milk production, increased risk of clinical diseases metritis) in cows with SCK is a function of the cost of a clinical (DA, CK, and metritis), increased risk of culling and death in case of each disease and the attributable risk (the increment in early lactation, and reduced reproductive performance. The clinical disease incidence attributed to SCK) for the associated price and cost of different variables in addition to herd or cow diseases. data that were used as inputs in the current model are listed in The cost of CK was calculated using inputs listed in Table 2, Table 1. and was $233. The costs of both DA ($707) and metritis ($396) were obtained from McArt et al (15). All disease costs except Losses due to reduction in milk production CK were in US dollars and converted to Canadian dollars using attributable to subclinical ketosis an exchange rate of 1.28. To calculate the attributable risk of The estimate of milk loss due to SCK used in the current study increased disease incidence due to SCK, the lactational incidence was based on the first Dairy Herd Improvement (DHI) test, risk (LIR; the number of cows affected with a certain disease and was 2.15 kg/ketotic cow (4,5). This amounts to a loss of during a lactation divided by the number of cows that calved 65 kg/30 d for a case of SCK when assuming that, on average, in the same time period) of CK (3), DA, and metritis (8), and

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Table 3. Inputs and calculations of epidemiological measures of the contribution of subclinical ketosis (SCK) to subsequent clinical diseases, used to estimate the cost of 1 case of SCK (Average odds ratios references in brackets) Event Measure DA CK Metritis SCK Culling Death Increased odds due to SCK 6.42 5.48 2.51 1.8 — — (5,16,17) (15,16) (5) (10) LIR (%) 4.8 9.6 16.7 40.0 7.53a — (8) (3) (8)

ARTICLE Basal risk (%)b 1.52 3.44 10.41 — 5.7 — Attributable risk (%)c 3.3 6.2 6.3 — 1.82 2.2 Cost of disease/eventd ($) 29.73 14.36 31.88 — 7.48 18.48

DA — Displaced abomasum; CK — Clinical ketosis; LIR — Lactational incidence risk. a Percent of culling by 60 DIM (21.5%) multiplied by annual herd turnover rate (35%). b Event occurrence for cows not affected with SCK. Calculated by solving for x in this formula: LIR of a clinical disease/culling = (percent of cows with SCK 3 increased odds to develop that clinical disease/culling 3 x) 1 (percent of cows without SCK 3 x). c Incremental increase of event attributed to SCK. Calculated using this formula: Attributable risk = (percent of cows with SCK 3 increased odds to develop that clinical disease/culling 3 x) — (percent of cows with SCK 3 x). d Cost of increased disease incidence due to SCK is a function of the cost of a disease and the attributable risk. Cost of increased culling due to SCK is a function of cost of premature culling and the attributable risk. Cost of death due to SCK is a function of average value of a cow in a herd, LIR of SCK and attributable risk.

the increased risk of developing CK (5,16), DA (5,16,17), and metritis (5) due to SCK were obtained from previous studies. The Basal risk (clinical disease incidence for cows not affected with SCK) and the attributable risk (clinical disease incidence for cows affected with SCK) were then calculated (Table 3). Milk Production Reproduction 22% Losses due to culling and death attributable to 28% subclinical ketosis To calculate the loss resulting from culling due to SCK, the following steps were performed. First, the cost of premature culling was calculated based on a culling depreciation model (J. Fetrow, University of Minnesota, St. Paul, Minnesota, USA, Culling and personal communication, 2014) to estimate current predicted Death Disease value of a cow in lactation based on the herd’s parity-specific 13% 37% culling risk and current lactation among other input variables. Second, the turnover rate in the first 60 DIM (LIR of culling in the first 60 DIM) was calculated by multiplying the average culling percent until 60 DIM (18,19) by an assumed annual herd turnover rate of 35%. Third, the risk of culling in early lactation for cows with SCK was obtained (10), and the basal Figure 1. A pie chart showing the breakdown of the cost of and attributable risk of culling due to SCK were calculated. 1 case of subclinical ketosis. Finally, loss resulting from culling due to SCK is a function of the cost of premature culling and the attributable risk of culling between cows diagnosed with SCK and cows without SCK was due to SCK (Table 3). retrieved from a previous report (7). From this, an average cost Considering death associated with SCK, calculations were of days open for cows with SCK was estimated. based on an attributable risk of death due to SCK of 2.2% (J.A. McArt, Cornell University, Ithaca, New York, USA, personal Sensitivity analysis communication, 2015). Assuming an average value of $2100 for Holding all other inputs constant, by changing the value of a lactating cow within a herd (20), loss from death due to SCK is 1 input from its baseline (default) level, the change in the cost a function of attributable risk of death due to SCK, average value of a case of SCK was calculated. In an attempt to standardize of a lactating cow, and the incidence of SCK in a herd. the change in inputs for sensitivity analysis, the following inputs were altered by adding or subtracting 50% of the baseline: cost Losses due to reduced reproductive of 1 d open, cost of 1 kg of feed, labor costs, average value of a performance attributable to subclinical ketosis. cow in a herd, cost of a replacement heifer, price of a cull cow, The cost of 1 d open beyond 100 DIM was assumed to be $3 and the turnover rate. The range used for the incidence of SCK (21). All information on the difference in time to pregnancy was based on Duffield (29), and the range in incidence of CK,

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$130 $150 $170 $190 $210 $230 $250

Subclinical ketosis incidence (40%) 8% 80% 1 day open ($3) $1.5 $4.5 Cost of replacement heifer ($2500) $1250 $5000

Displaced abomasum incidence (4.8%) 2% 7% ARTICLE Average value of cow ($2100) $1050 $4200 Minimum

Cull cow price ($1680) $3360 $840 Maximum Clinical ketosis incidence (9.6%) 7% 18% Metritis incidence (16.7%) 11% 18% Milk price/L ($0.81) $0.71 $0.91 1 kg feed ($0.3) $0.45 $0.15 Turnover rate (35%) 17.5% 52.5%

Figure 2. A Tornado plot to depict sensitivity analysis for estimation of the cost of a case of subclinical ketosis. The plot depicts the change in the cost of a case of SCK due to an increase or decrease of the value of an input. Values in parentheses are baseline values used in building the model while values on the sides of the bars are the minimum and maximum values used for sensitivity analysis. The line in the middle of the plot separating minimum and maximum bars represents loss due to a case of SCK using the baseline (default) values of inputs ($203). metritis, and displaced abomasum was based on Guard (30). of SCK was associated with the increase of the cost of a case of Finally, the range used for milk price was based on adding or SCK due to its direct impact on the basal and attributable risk of subtracting $0.10/L from the baseline used in the analysis. other clinical diseases and culling. However, sensitivity analysis did not show the variation in clinical disease incidences to be Results influential (Figure 2). Loss resulting from SCK in the current model was $203 per The estimate obtained in the current study was lower than case. The breakdown of the cost of 1 case of SCK is shown in the loss of €735 ($1031.00 CDN) for a case of SCK reported Figure 1. The calculated estimate is lower than the $289.00 US in another recent study (14). The current study attempted to ($370.00 CDN) average cost of a case of ketosis reported by limit the overestimation and double counting in cost estimate McArt et al (15). Although milk price in Canada is higher than calculations by accounting only for the attributable risk of clini- in the US, several differences beyond milk price affected the cal disease incidence due to SCK, but there might still have been estimate. For example, reproductive loss due to SCK was based some overlap of costs that were impossible to disentangle from on extended time to pregnancy for subclinically ketotic cows, interrelated diseases in the fresh period. while in the US study it was based on an increased risk of ovar- Loss calculated in the current study, however, is higher than ian dysfunction and pregnancy to first insemination (15). In what was calculated in an earlier Canadian study (13) that addition, our calculations modelled SCK separately from clini- estimated the cost of a case of SCK to be $78. The authors cal ketosis. While McArt et al (15) did not include the cost of of that study only estimated a loss of milk for 2 wk, while in clinical ketosis separately, they still factored treatment costs and the current study milk loss was estimated to be over 30 d. The other downstream impacts in the total cost of ketosis. However, authors also used a lower risk for developing disease than used if the cost of CK and SCK calculated in this study are summed herein; for example, a 3-fold increase in the risk of DA and CK together they will yield a comparable cost of $430.00 CDN to was used, compared to a 6.5 and a 5.5-fold increase in the odds that obtained by McArt et al (15). of developing each disease, respectively, in the current study. In addition, culling was not accounted for and milk price in Discussion Canada now is 2.7 times higher. It is worth mentioning that While there is an association between clinical disease incidence the authors of the older study also overestimated the losses due and SCK (5,8,9), it is not necessarily true in all herds that to developing other diseases, as they included basal disease inci- clinical disease incidence will increase if the incidence of SCK dence in their calculations. This means that losses due to SCK increases. That being the case, in contrast to McArt et al (15) were actually lower than reported. we modelled clinical disease incidence (DA, CK, and metritis) Losses in the current model were based on using a cut-point separately from SCK (i.e., we did not tie the incidence of SCK for blood BHBA concentrations of 1400 mmol/L. The cut-point to the incidence of the associated clinical diseases). Yet, and due was chosen based on the negative impact SCK can have on to the method of calculation used, an increase in herd incidence health and production of lactating dairy cattle (5). Losses will

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vary by changing the cut-point value, whether SCK is diagnosed 12. Ospina PA, Nydam DV, Stokol T, Overton TR. Association between the in the first or second week after calving, or both. Modeling such proportion of sampled transition cows with increased nonesterified fatty acids and beta-hydroxybutyrate and disease incidence, pregnancy rate, thresholds and patterns would have added value to the model; and milk production at the herd level. J Dairy Sci 2010;93:3595–3601. however, this was not done because such a model is prohibitively 13. Geishauser T, Leslie KE, Kelton DF, Duffield TF. Monitoring for sub- complex, and data to support the differential impacts of SCK clinical ketosis in dairy herds. Compend Contin Educ Proc Vet 2001; 23:s65–s71. at that level of detail are sparse. Sensitivity analysis showed that 14. Esslemont JR. The costs of ketosis in dairy cows. Proc 27th World the incidence of SCK was the input to which the estimates were Buiatrics Congress, Lisbon, Portugal, 2012:156. most sensitive (Figure 2). The sensitivity was a result of the wide 15. McArt JA, Nydam DV, Overton MW. Hyperketonemia in early lactation dairy cattle: A deterministic estimate of component and total cost per variation in the incidence of SCK among Canadian dairy herds. case. J Dairy Sci 2015;98:2043–2054.

ARTICLE In conclusion, the average cost of a case of SCK generated by 16. Seifi HA, LeBlanc SJ, Leslie KE, Duffield TF. Metabolic predictors of our model was $203, and varied depending on the herd-level post-partum disease and culling risk in dairy cattle. Vet J 2011;188: 216–220. incidence of SCK. Given previous studies testing cows at least 17. LeBlanc SJ, Leslie KE, Duffield TF. Metabolic predictors of displaced weekly over the first 2 wk postpartum has established a typical abomasum in dairy cattle. J Dairy Sci 2005;88:159–170. cumulative incidence of SCK to be 40%; herd-level costs of 18. Dechow CD, Goodling RC. Mortality, culling by sixty days in milk, and production profiles in high- and low-survival Pennsylvania herds. SCK are substantial. This analysis supports the importance of J Dairy Sci 2008;91:4630–4639. implementing prevention, monitoring, and treatment programs 19. Godden SM, Stewart SC, Fetrow JF, et al. The relationship between herd rBST-supplementation and other factors with risk for removal for cows during the transition period. CVJ in Minnesota Holstein dairy herds. Proc Four-State Dairy Nutrition and Management, Dubuque, Iowa, 2003:55–64. References 20. Guideline for estimating dairy cow production costs in Manitoba. . 1 Herdt TH. Ruminant adaptation to negative energy balance. Influences 2015. Available from: http://www.gov.mb.ca/agriculture/business-and- on the etiology of ketosis and fatty liver. Vet Clin North Am Food Anim economics/financial-management/pubs/cop_dairy_cow.pdf Last accessed Pract 2000;16:215–230. May 3, 2016. 2. Gerloff BJ. Dry cow management for the prevention of ketosis and 21. Groenendaal H, Galligan DT, Mulder HA. An economic spreadsheet fatty liver in dairy cows. Vet Clin North Am Food Anim Pract 2000; model to determine optimal breeding and replacement decisions for 16:283–292. dairy cattle. J Dairy Sci 2004;87:2146–2157. 3. Carson ME. The association of selected metabolites in peripartum dairy 22. Dairy Farmers of Ontario. The Milk Producer magazine. Markets. cattle with health and production [MSc Thesis]. Guelph, Ontario: Available from: https://www.milk.org/Corporate/view.aspx?content= University of Guelph, 2008. aboutus/MilkProducerMagazine Last accessed May 3, 2016. 4. Chapinal N, Carson ME, LeBlanc SJ, et al. The association of serum 23. Ontario Stockyards Inc. 2015. Available from: http://www.ontariostock metabolites in the transition period with milk production and early- yards.on.ca/pages/reports Last accessed May 3, 2016. lactation reproductive performance. J Dairy Sci 2012;95:1301–1309. 24. Britt JS, Thomas RC, Speer NC, Hall MB. Efficiency of converting 5. Duffield TF, Lissemore KD, McBride BW, Leslie KE. Impact of hyperke- nutrient dry matter to milk in Holstein herds. J Dairy Sci 2003;86: tonemia in early lactation dairy cows on health and production. J Dairy 3796–3801. Sci 2009;92:571–580. 25. National Research Council. Nutrient Requirements of Dairy Cattle. 6. Ospina PA, Nydam DV, Stokol T, Overton TR. Associations of elevated 7th revised ed. Washington, DC: Natl Acad Press, 2001. nonesterified fatty acids and beta-hydroxybutyrate concentrations with 26. McArt JA, Nydam DV, Ospina PA, Oetzel GR. A field trial on the effect early lactation reproductive performance and milk production in transi- of propylene glycol on milk yield and resolution of ketosis in fresh cows tion dairy cattle in the northeastern United States. J Dairy Sci 2010; diagnosed with subclinical ketosis. J Dairy Sci 2011;94:6011–6020. 93:1596–1603. 27. OMAFRA. 2015. Dairy Farm Wage Rate. Available from: http:// 7. Walsh RB, Walton JS, Kelton DF, LeBlanc SJ, Leslie KE, Duffield TF. www.omafra.gov.on.ca/english/livestock/dairy/facts/wagerate.htm Last The effect of subclinical ketosis in early lactation on reproductive per- accessed May 3, 2016. formance of postpartum dairy cows. J Dairy Sci 2007;90:2788–2796. 28. Gardner IA, Hird DW, Utterback WW, et al. Mortality, morbidity, 8. Chapinal N, Carson M, Duffield TF, et al. The association of serum case-fatality, and culling rates for California dairy cattle as evaluated metabolites with clinical disease during the transition period. J Dairy by the national animal health monitoring system, 1986–87. Prev Vet Sci 2011;94:4897–4903. Med 1990;8:157–170. 9. Ospina PA, Nydam DV, Stokol T, Overton TR. Evaluation of nonesteri- 29. Duffield TF. Metabolic disorders of ruminants: Subclinical ketosis in fied fatty acids and beta-hydroxybutyrate in transition dairy cattle in the lactating dairy cattle. Vet Clin North Am Food Anim Pract. 2000;16: northeastern United States: Critical thresholds for prediction of clinical 231–253. diseases. J Dairy Sci 2010;93:546–554. 30. Guard CL. The costs of common diseases in dairy cattle. Proc Central 10. Roberts T, Chapinal N, Leblanc SJ, Kelton DF, Dubuc J, Duffield TF. Veterinary Conference (CVC) San Diego, California, 2008. Metabolic parameters in transition cows as indicators for early-lactation 31. Gröhn YT, McDermott JJ, Schukken YH, Hertl JA, Eicker SW. Analysis culling risk. J Dairy Sci 2012;95:3057–3063. of correlated continuous repeated observations: Modelling the effect of 11. Chapinal N, Leblanc SJ, Carson ME, et al. Herd-level association of ketosis on milk yield in dairy cows. Prev Vet Med 1999;39:137–153. serum metabolites in the transition period with disease, milk produc- 32. Braun U, Schweizer G, Feller B, Pospischil A. Aspriation pneumonia tion, and early lactation reproductive performance. J Dairy Sci 2012; in 40 cows after oral treatment. Schweiz Arch Tierheilkd 2007;149: 95:5676–5682. 363–365.

732 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY Article

Economic value of ionophores and propylene glycol to prevent disease and treat ketosis in Canada

Khaled Gohary, Michael W. Overton, Michael Von Massow, Stephen J. LeBlanc, Kerry D. Lissemore, Todd F. Duffield

Abstract — A partial budget model was developed to evaluate the economic value of Rumensin Controlled Release Capsule (CRC) boluses when administered before calving to reduce disease and increase milk production. After accounting for disease incidences in a herd and the percentage by which Rumensin CRC can reduce them, and the increase in milk production attributable to administration of Rumensin CRC, the return on investment (ROI) per lactation was 4:1. Another partial budget model was developed to estimate the economic value of propylene glycol (PG) to treat ketosis when diagnosed by 3 different cow-side tests or when administered to all cows without using any cow-side testing. After accounting for the sensitivity and specificity of each test, ROI per lactation ranged from 2:1 to 4:1. The ROI was 2:1 when no cow-side testing was used. In conclusion, prevention of diseases that occur in the postpartum period and treatment of ketosis after calving yielded a positive ROI that varies based on disease incidence and method of diagnosis.

Résumé — Valeur économique des ionophores et du propylèneglycol pour prévenir la maladie et traiter l’acétonémie au Canada. Un modèle de budget partiel a été développé pour évaluer la valeur économique des bolus de capsules à libération contrôlée (CLC) de Rumensin lors de l’administration avant le vêlage afin de réduire les maladies et d’accroître la production de lait. Après avoir tenu compte de l’incidence des maladies dans un troupeau et du pourcentage par lequel la CLC de Rumensin peut les réduire et de l’augmentation de la production de lait attribuable à l’administration de la CLC de Rumensin, le rendement du capital investi (RCI) par lactation était de 4:1. Un autre modèle de budget partiel a été développé pour estimer la valeur économique du propylèneglycol (PG) afin de traiter l’acétonémie lors du diagnostic par 3 tests différents pour les vaches ou lors de l’administration à toutes les vaches sans le recours à des tests auprès des vaches. Après avoir tenu compte de la sensibilité et de la spécificité de chaque test, le RCI par lactation s’échelonnait de 2:1 à 4:1. Le RCI était de 2:1 lorsqu’aucun test auprès des vaches n’était utilisé. En conclusion, la prévention des maladies qui se produit dans la période postpartum et le traitement de l’acétonémie après le vêlage a donné un RCI positif qui varie selon l’incidence de maladies et la méthode de diagnostic. (Traduit par Isabelle Vallières) Can Vet J 2016;57:733–740 a peak at 10 to 12 wk after calving (3). The peak in DMI is Introduction preceded by the peak in milk production at 7 to 9 wk following he “classic” transition period has been defined as the 3 wk calving, and as a consequence cows will go through a period of T prior to and following calving (1) and is a critical period in negative energy balance (NEB). Cows respond to NEB by mobi- the lactation cycle of a dairy cow. During this phase cows start lizing their body fat to meet the energy requirements, resulting to experience a decrease in dry matter intake (DMI) (2) that in an increase in blood ketones (4). The period of NEB is also reaches its nadir at calving and then gradually increases until associated with depression in immune function (5). As a result,

Department of Population Medicine, Ontario Veterinary College (Gohary, LeBlanc, Lissemore, Duffield), School of Hospitality, Food and Tourism Management, College of Business and Economics (Von Massow), University of Guelph, Guelph, Ontario N1G 2W1, Canada; Department of Population Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia 30602, USA (Overton). Address all correspondence to Dr. Todd F. Duffield; e-mail: [email protected] Dr. Overton’s current affiliation is Elanco Animal Health, Greenfield, Indiana 46140, USA. This study was funded by Elanco Animal Health, Greenfield, Indiana, USA. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

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Table 1. Values of disease costs used in a partial budget model Table 2. Assumptions and inputs used in the partial budget model to evaluate the economic benefit of using Rumensin Controlled to evaluate the economic benefit of using Rumensin Controlled Release Capsule (CRC) to reduce disease incidence and increase Release Capsule (CRC) to reduce disease incidence and increase milk production and to evaluate the economic benefit of using milk production. Value listed for each clinical disease is the propylene glycol (PG) to treat cows with ketosis when diagnosed percentage by which CRC can reduce it whereas values in by different cow-side tests. All values listed are in Canadian dollars parentheses are the median incidences used as a default input for each disease in the model Disease Item Value Reference Cost estimate DA MET MAST RP CK KET Effect of using CRC on disease reduction Total loss 905 507 572 403 233 203 Metritis 16% (16.7%) 17 Losses excluding milk lossc 833a,b — — — — — a a a a,b Ketosis 50% (40%) 20 ARTICLE Losses excluding milk loss, — 271 303 255 53 — Mastitis 9% (40%) 17 veterinary fees, and drugs a Clinical ketosis 25% (9.6%) 17 Losses after excluding the — — — — — 127 Retained placenta 8% (16.7%) 17 cost of clinical disease Displaced abomasum 25% (4.8%) 17 risk (DA, MET, CK) Effect of using CRC on milk production attributable to ketosis a b Increase production in BCS = 3.25 to 3.75 0.85 kg/d 15 Losses after excluding the — — — — — 152 Increase production in BCS $ 4b 1.2 kg/d 15 cost of clinical disease Time period milk is increased 90 days 15 risk (DA, CK) and Price of 1 bolus of CRC $18 culling attributable Milk price $0.81 21 to ketosis Dairy efficiencyc 2.3 DA — displaced abomasum; MET — metritis; MAST — mastitis; RP — retained Cost of 1 kg of TMR (dry matter basis) $0.3 22 placenta; CK — clinical ketosis; cases of ketosis identified by clinical signs regardless Labor wages/h $15 23 of serum BHBA concentrations; KET — ketosis; defined as elevated serum BHBA CRC boluses administered/h 15 $ 1400 mmol/L in either of the first 2 wk following calving and without showing a clinical signs. Cows with BCS between 3.25 and 3.75 are assumed to be 65% of the lactating a Values used in the partial budget model to estimate the economic value of animals in the default inputs used to build the partial budget model. b Rumensin CRC to reduce disease incidence and increase milk production. Cows with BCS $ 4 are assumed to be 10% of the lactating animals in the default b Values used in the partial budget model to estimate the economic value of PG inputs used to build the partial budget model. c to treat cows with ketosis. Milk yield (kg) produced as a result of a cow consuming 1 additional kg of dry c The cost of milk loss only was excluded from the total cost of a DA because matter above maintenance requirements (24); this calculation accounts only for the veterinary fees and drug costs are unique to the surgery. energy required to produce marginal milk after considering a NEL concentration of 0.75 Mcal/kg of 4% milk and 1.73 Mcal/kg of feed in dry matter basis (25).

almost half of the cows in this phase are affected by infectious Table 3. Assumptions and inputs used for each cow-side test to evaluate the economic benefit of using propylene glycol to treat or metabolic diseases (6), which in turn will influence their well- cows with ketosis, and sensitivity and specificity of each cow-side being and the profitability of the dairy enterprise. test used to diagnose ketosis and the number of true positives, One of the management approaches commonly used during false positives, and false negatives within each testing method, assuming a herd size of 1 cow and a cumulative incidence of 40% the entire non-lactating period and extending into lactation for ketosis is the administration of ionophores such as monensin to help reduce health problems and increase milk production (7). Precision XTRA Keto-Test Ketostixa Administration of ionophores to dairy cattle resulted in an b improvement in energy metabolism (8), milk production (9), Sensitivity 0.90 0.8 0.79 Specificityb 0.965 0.94 0.96 and health, including a reduction in the risk of ketosis and True positive 0.360 0.328 0.190 displaced abomasum (DA), but not reproductive performance. False positive 0.021 0.036 0.254 On the treatment side, one of the effective protocols used False negative 0.040 0.072 0.210 Cost of test $3.0 $2.0 $0.25 to treat ketosis is oral administration of propylene glycol (PG) Cows providing urine — — 60% (10,11). However, the number of cows that will or will not Cost of 4 doses of PG $12 $12 $12 receive treatment depends on the underlying risk of hyperketo- Total cost of PG $4.57 $4.37 $5.33 Total cost of labor $0.76 $0.73 $0.89 nemia and the sensitivity and specificity of the cow-side test used a Sensitivity and specificity of Ketostix is only applied to cows from which a urine to diagnose ketosis (6), which in turn can affect the outcome of sample can be obtained. The baseline used in this model was 60% of cows will a treatment program and impact its economic value. provide a urine sample resulting in a sensitivity and specificity of 47.4% and 57.6% respectively, for Ketostix. The objective of this study was to model the economic value b From reference 6. of using Rumensin Controlled Release Capsule (CRC) (Elanco Animal Health, Eli Lilly and Co., Greenfield, Indiana, USA) to help prevent post-parturient diseases in Canada, and to revenues, and increased expenses associated with its administra- estimate the economic value of using PG in treating cows when tion before calving were compared to when not administered. diagnosed with ketosis using different cow-side tests, and when Following the same approach, a different partial budget model administered to all cows without using cow-side testing. was developed to evaluate the economic value of treating ketotic cows with PG when diagnosed using 3 different cow-side tests Materials and methods and when given to all cows without diagnosis with cow-side The economic value of Rumensin CRC to reduce disease testing. For both models, increased revenue was a result of an incidence and increase milk production was estimated using a increase in milk production, decreased revenue was a result of partial budget model in which the increased revenues, decreased an increase in disease incidence, whereas increased expenses were

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Table 4. Assumptions and inputs used in the partial budget model to evaluate the economic benefit of using propylene glycol (PG) to treat cows with ketosis when diagnosed by different cow-side tests Item Value Reference Effect of PG on disease/culling reduction when administered to ketotic cows Clinical ketosis 46% 10 Ketosis 50% 10 ARTICLE Displaced abomasum 37.5% 11 Culling 52.4% 11 LIRa of each event affecting cows with ketosis that PG can impact Clinical ketosis 6.2% 28 Ketosis 40% 26 Displaced abomasum 3.3% 28 Culling 1.8% 27 Effect of PG on milk yield when administered to ketotic cows Increase in milk production 0.69 kg/d 10 Time period milk is increased 30 d 10 Loss due to premature culling $500 28 Milk price $0.81 21 Dairy efficiencyb 2.3 Cost of 1 kg of TMR (dry matter basis) $0.3 22 Labor wages/h $15 23 Number of cows administered with PG/h 15 Number of times PG will be administered 4 10

a Lactational incidence risk = the number of cows affected with a certain event during a lactation divided by the number of cows that calved in the same time period. b Milk yield (kg) produced as a result of a cow consuming 1 additional kg of dry matter above maintenance requirements (24); this calculation accounts only for the energy required to produce marginal milk after

considering a NEL concentration of 0.75 Mcal/kg of 4% milk and 1.73 Mcal/kg of feed in dry matter basis (25).

associated with extra labor used to administer treatments, cost of age by which disease incidence is reduced is listed in Table 2. treatments, and cow-side testing in case of treatment with PG. The reduced disease incidence was multiplied by the respective cost of each disease and then compared to costs when Rumensin Cost of clinical diseases CRC was not administered. Increased revenue due to increased Costs of DA and metritis were obtained from a recent study milk production after administration of Rumensin CRC for (12). The costs of mastitis and retained placenta were obtained cows within each body condition score (BCS) (range: 3.25 to from 2 other studies, respectively (13,14), whereas the costs 3.75 and $ 4 in a 5-point scale) was calculated based on a mar- of ketosis and clinical ketosis (CK) were estimated previously ginal increase in milk production for 90 d (15) by deducting the (28). Costs of clinical diseases retrieved from the literature were cost of extra feed consumed after administration of Rumensin used after excluding milk losses, drug costs, and veterinary fees CRC from the extra revenue obtained from selling more milk from total disease costs to avoid double counting in current after using Rumensin CRC. Total cost of labor to administer calculations. Disease costs used in the current analysis are listed Rumensin CRC was calculated based on hourly wages and the in Table 1. number of Rumensin CRC boluses administered/hour. The net revenue of using Rumensin CRC was compared to not using it Model for estimating the economic value of and then the return on investment (ROI) was calculated using Rumensin CRC for disease reduction the following formula: A partial budget was developed in Excel (Microsoft office 2010; ROI = (net revenue after not using Rumensin CRC 2 net Microsoft, Redmond, Washington, USA) to estimate the eco- revenue after using Rumensin CRC)/increased expenses nomic value of Rumensin CRC boluses administered in the due to using Rumensin CRC close-up period to decrease the incidence of disease after calving and to increase milk production. Inputs and assumptions used Because it is difficult to disentangle how much of the increase in the model are listed in Table 2. in milk production was due to the direct effect of Rumensin The economic benefits of using Rumensin CRC are a func- CRC or to the reduction in ketosis, a sensitivity analysis spe- tion of both the reduction in economic impact of peri-parturient cific to milk production was performed. Hypothetical scenarios disease and an increase in revenue due to more efficient milk starting with an assumption that 100% of the milk increase production during lactation. Reduction in economic impact (i.e., 0.85 kg/d and 1.2 kg/d for cows with a BCS ranging from of peri-parturient disease is achieved by a reduction in disease 3.25 to 3.75 and with a BCS $ 4, respectively) (15) is attributed incidence after administration of Rumensin CRC. The percent- to the direct effect of Rumensin CRC, and then allowing for

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$0 $2 $4 $6 $8 $10

Rumensin CRC price ($18) $27 $9 Ketosis incidence (40%) 8% 80% Cows with BCS 3.25 to 3.75 (65%) 33% 97% Milk price/liter ($0.81) $0.71 $0.91 Displaced abomasum incidence (4.8%) 2% 7% 1 kg feed ($0.30) $0.45 $0.15 Minimum ARTICLE Cows with BCS $ (10%) 5% 10% Maximum Cows administered/hour (15 cows) 8 cows 23 cows Mastitis incidence (40%) 31% 51% Hourly wage ($15) $22.5 $7.5 Metritis incidence (16.7%) 11% 18% Retained placenta incidence (16.7%) 11% 18% Clinical ketosis incidence (9.6%) 7% 18%

Figure 1. A Tornado plot depicting the change in the return on investment after using Rumensin controlled release capsule (CRC) in Canada. Values in parentheses are baseline values used in building the model, while values on the sides of the bars are the minimum and maximum values used for sensitivity analysis. The line in the middle of the plot separating minimum and maximum bars represents the return on investment (indicated by $3.95 of return for $1 invested) resulting from using the baseline values of different inputs.

10% of the increase in milk production to be due to reduction cows. According to this study, control cows were 2.1 times of ketosis (i.e., 90% of milk increase is due to the direct effect more likely to be culled than cows treated with PG. Therefore, of administering Rumensin CRC) until assuming that 100% treated cows will be 0.476 (1/2.1) times less likely to be culled of the milk increase was attributed to reduction of ketosis. than control cows, which means that PG decreases culling by Another sensitivity analysis was performed to evaluate the effect 52.4% (1 2 0.476). Using the same approach, the percentage of of a change of 1 unit of an input at a time on the default ROI DA will decrease by 37.5% after administration of PG to ketotic obtained from the base model. The following inputs were varied cows. The other study (10) reported hazard ratios for developing by adding/subtracting 50% of the default value used: price of CK and resolving ketosis for cows treated with PG. Following Rumensin CRC, cost of 1 kg of feed, proportion of cows with the same approach as above it can be calculated that CK will BCS ranging from 3.25 to 3.75 and with a BCS $ 4, hourly decrease by 46% (1 2 0.54), and ketosis will be resolved by labor wage, and the number of cows treated/hour. The ranges 50% in cows treated with PG. used for the following inputs were based on ranges reported Sensitivity and specificity, in addition to the cost of each previously by 1 study (16) for ketosis and by another study (14) test used to diagnose ketosis, were obtained from a review by for CK, metritis, retained placenta, mastitis, and DA. Finally, LeBlanc (6). Sensitivity and specificity of Ketostix were multi- milk price was varied by adding/subtracting 10 cents to/from plied by the assumed percent of cows from which a urine sample the default value used in the model. can be easily obtained (60%). After assuming a cumulative incidence of ketosis, true positive, true negative, false negative, Model for estimating the economic value of and false positive numbers for each test were calculated. It was propylene glycol for treatment of ketosis assumed that cows will be treated orally with 300 g of PG for Another partial budget model was built to estimate the eco- 4 d (11). Total cost of PG was calculated by summing true posi- nomic value of using oral PG to treat ketosis after being diag- tives and false positives and then multiplying them by the cost nosed using 1 of 3 different cow-side tests, and after treating all of 1.2 kg of PG. Labor costs were calculated based on hourly cows without cow-side testing. The 3 tests used were: Precision wages and the number of cows that can be treated/hour. XTRA (Abbott Laboratories, Abbott Park, Illinois, USA) using The economic value of clinical disease/culling reduction as a a blood sample, Keto-Test (Elanco Animal Health) using a milk consequence of using PG to treat ketosis was calculated for each sample, or Ketostix (Bayer Animal Health, Shawnee Mission, cow-side test by multiplying disease reduction/culling in ketotic Kansas, USA) using a urine sample (Table 3). The sensitivity and cows treated with PG and the respective cost of each clinical specificity of each method of diagnosis of ketosis was incorpo- disease/culling. In addition, the cost of increased disease/culling rated into calculations. Other inputs, assumptions, and calcula- risk in cows diagnosed as false negatives using each cow-side tions used in building the model are listed in Tables 3 and 4. test was calculated by multiplying the number of false negatives Two studies were referenced to evaluate the impact of PG resulting from each cow-side test, the attributable risk of clini- on disease and culling reduction (10,11). One study (11) cal disease/culling due to ketosis, and the cost of each clinical reported risk ratios for culling and developing DA in control disease/culling (28).

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$0 $1 $2 $3 $4 $5 $6 $7

Ketosis incidence (40%) 8% 80% Cost of PG for 4 days ($12) $18 $6 Cost of test ($3) $4.5 $1.5

Cows administered/hour (15 cows) 8 cows 23 cows ARTICLE Minimum Labor wage/hour ($15) $22.5 $7.5 Maximum Milk price/liter ($0.81) $0.71 $0.91 Displaced abomasum incidence (4.8%) 2% 7% 1 kg feed ($0.30) $0.45 $0.15 Turnover rate (35%) 17.5% 52.5% Clinical ketosis incidence (9.6%) 7% 18%

Figure 2. A Tornado plot depicting the change in the return on investment after using propylene glycol (PG) to treat ketosis diagnosed by Precision XTRA due to the change of 1 input at a time from the minimum to the maximum value. Values in parentheses are baseline values used in building the model while values on the sides of the bars are the minimum and maximum values used for sensitivity analysis. The line in the middle of the plot separating minimum and maximum bars represents the return on investment (indicated by $ of return per $1 of investment) resulting from using the baseline values of different inputs.

$0 $1 $2 $3 $4 $5 $6 $7

Ketosis incidence (40%) 8% 80% Cost of PG for 4 days ($12) $18 $6 Cost of test ($3) $3 $1 Cows administered/hour (15 cows) 8 cows 23 cows Minimum Labor wage/hour ($15) $22.5 $7.5 Milk price/liter ($0.81) $0.71 $0.91 Maximum Displaced abomasum incidence (4.8%) 2% 7% 1 kg feed ($0.30) $0.45 $0.15 Turnover rate (35%) 17.5% 52.5% Clinical ketosis incidence (9.6%) 7% 18%

Figure 3. A Tornado plot depicting the change in the return on investment after using propylene glycol (PG) to treat ketosis diagnosed by Keto-Test due to the change of 1 input at a time from the minimum to the maximum value. Values in parentheses are baseline values used in building the model while values on the sides of the bars are the minimum and maximum values used for sensitivity analysis. The line in the middle of the plot separating minimum and maximum bars represents the return on investment (indicated by $ of return per $1 of investment) resulting from using the baseline values of different inputs.

For 1 cow with ketosis both marginal increased (if treated) with ketosis and then ROI was calculated as described for and decreased (if not treated) milk production after administer- Rumensin CRC. Finally, a sensitivity analysis was done to ing (if treated) or not administering (if not treated) PG were study the impact of the change of an input on the ROI of each calculated. These values were multiplied by the number of true diagnostic test. positives and false negatives of each cow-side test, respectively, to calculate the marginal revenue for increased milk production Results when treated and the opportunity cost for milk not produced Model for estimating the economic value of if not treated. Rumensin CRC for disease reduction The net revenue of using PG after diagnosing ketosis with The ROI after using Rumensin CRC was 4:1. Sensitivity analy- each cow-side test was compared to that of not treating cows sis varying how much of the increase in milk production could

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2$1 $0 $1 $2 $3 $4 $5 $6 $7 Ketosis incidence (40%) 8% 80% Cows providing urine (60%) 30% 90% Cost of PG for 4 days ($12) $18 $6 Cows administered/hour (15 cows) 8 cows 23 cows Labor wage/hour ($15) $22.5 $7.5 Minimum

ARTICLE Milk price/liter ($0.81) $0.71 $0.91 Maximum Displaced abomasum incidence (4.8%) 2% 7% 1 kg feed ($0.30) $0.45 $0.15 Turnover rate (35%) 17.5% 52.5% Cost of test ($0.25) $0.38 $0.13 Clinical ketosis incidence (9.6%) 7% 18%

Figure 4. A Tornado plot depicting the change in the return on investment after using propylene glycol (PG) to treat ketosis diagnosed by Ketostix due to the change of 1 input at a time from the minimum to the maximum value. Values in parentheses are baseline values used in building the model while values on the sides of the bars are the minimum and maximum values used for sensitivity analysis. The line in the middle of the plot separating minimum and maximum bars represents the return on investment (indicated by $ of return per $1 of investment) resulting from using the baseline values of different inputs.

be due to the direct effect of Rumensin CRC or the reduction nomic analysis of using Rumensin CRC to help reduce disease in the incidence of ketosis showed an ROI ranging from 4:1 and increase milk production. However, 1 study reported an when 100% of the increase in production is attributed to the increase of $0.39/day per cow in return over feed (milk income administration of Rumensin CRC to 2:1 when 100% of the minus feed cost) when monensin was added to lactating cow increase in production is attributed to the reduction of disease. rations (18). Regarding the general sensitivity analysis, change in the price Return on investment resulting from the sensitivity analysis of Rumensin CRC and the incidence of ketosis had the greatest specific to milk production is positive for all scenarios (rang- impact on ROI, followed by the percent of cows with a BCS of ing from 4:1 to 2:1). However, ROI will be lower if all of the 3.25 to 3.75 (Figure 1). increase in milk production was due to the reduction in incidence of ketosis. In the overall sensitivity analysis (Figure 1), the Model for estimating the economic value of price of Rumensin CRC was the most sensitive input because propylene glycol for treatment of ketosis the capsule is administered to all cows in a herd and there is Returns on investment for treatment based on testing using a wide range of ketosis incidence (8% to 80%) among herds Precision XTRA, Keto-Test, or Ketostix, and for treatment with- (16). The sensitivity of the proportion of cows with a BCS out testing were 4:1, 4:1, 2:1, and 2:1, respectively. Figures 2 between 3.25 and 3.75 can be explained by the larger number to 4 show Tornado plots representing the sensitivity analysis of cows within this BCS range in a dairy herd than cows with for each of the cow-side tests. The incidence of ketosis and the a BCS $ 4. cost of treatment were the most sensitive inputs for the 3 tests. The model used to evaluate the economic benefits of using In addition, the percent of cows providing a urine sample was PG to treat ketosis diagnosed with different cow-side tests among the sensitive inputs for the Ketostix test. Figure 5 shows showed positive values when different scenarios were imple- the results of hypothetical scenarios of different incidences of mented. Diseases included in the model (DA and CK) were ketosis where all cows were treated with PG without being limited by the literature available that studied the effect of tested. using PG to treat ketosis and the impact of this treatment on other diseases. McArt et al (11) found no difference in time to Discussion pregnancy between treated and control cows, hence reproductive The current model for estimating the economic value of performance was not included in the current model. The price Rumensin CRC for disease reduction showed an economic ben- of the Precision XTRA meter was not included in calculations efit due to helping prevent diseases and increase milk production because of its relatively low price ($40) that will be distributed in a dairy herd. The higher the incidence of ketosis in a herd, over hundreds or thousands of cows. the higher the value of using Rumensin CRC is. Reproductive Although the sensitivity of Ketostix is comparable to that of performance and culling were not included as parameters in the Keto-Test (79% and 82%, respectively), the low number of cows model because a meta-analysis showed no impact of monensin that are expected to provide a urine sample resulted in reduction on either parameter (17). There are no previous reports of eco- of both the sensitivity and specificity of Ketostix, resulting in

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$4 ARTICLE

Return on investment $1

2$1 10 20 30 40 50 60 70 80 90 Cumulative incidence of ketosis (%)

Figure 5. Variation in return on investment (ROI) after treating all cows with propylene glycol (PG) without testing them at different herd incidence levels of ketosis. At an average herd incidence of 40% the return on investment is 2:1 which is similar to the ROI of Ketostix when used to diagnose and treat cows with ketosis using PG. the lowest ROI among the 3 cow-side tests evaluated. However, Hypothetical scenarios depicted in Figure 5 (no treatment) when a sensitivity analysis was performed, the percent of cows show that the ROI when herd incidence of ketosis is 40% and providing urine was among the sensitive inputs, indicating that all cows are treated without being tested will be comparable if a urine sample was obtained from a high percentage of cows to the ROI after testing with Ketostix and then treating. As the ROI will be comparable to that of Precision XTRA and the incidence of ketosis increases in a herd the ROI of treating Keto-Test (Figure 4). The lower sensitivity of Ketostix meant without testing will increase. Such a result agrees with a recent that the lowest number of true positive cows would be diagnosed study (19) in which authors found that the strategy of treating among the 3 cow-side tests and therefore losses from diseases all cows without testing is the most cost-effective approach if and culling after using PG will be the least. However, these the incidence of ketosis is . 50%. One can therefore conclude values were offset by the opportunity cost of cows diagnosed as that herd incidence and diagnostic procedures should be con- false negatives and therefore will not benefit from the PG treat- sidered before implementing any monitoring or prevention ments due to the low test sensitivity resulting in the lowest ROI. programs. Return on investment for both Precision XTRA and Keto- In conclusion, return on investment for Rumensin CRC Test were approximately the same. Although the opportunity was positive and its magnitude of impact depends primarily cost of cows diagnosed as false negatives after using Precision on the herd incidence of ketosis. The impact of propylene gly- XTRA was lower than that of Keto-Test (because of the higher col depends on ketosis incidence, and on the method used to sensitivity of Precision XTRA), this difference was not large diagnose ketosis. However, there was no economic difference enough to result in a higher ROI for Precision XTRA. In addi- between treating cows orally with PG after diagnosis of ketosis tion, comparable prices of test strips for Precision XTRA and using either Precision XTRA or Keto-Test. Using PG to treat all Keto-Test ($3 and $2, respectively) (6) contributed to both tests cows without testing for ketosis is comparable to testing with having comparable results. Ketostix and then treating if herd incidence of ketosis is 40%. Sensitivity analysis showed that the incidence of ketosis was Treating without testing should be practiced cautiously as there a common sensitive input among the 3 evaluated tests because are no reports that studied the impact of PG on health when not of the wide range of incidences used in the current model needed. The choice of a diagnostic cow-side test should be based (8% to 80%) to represent North American dairy herds (16). on the herd incidence of ketosis, farm settings that can facilitate Cost of treatment was sensitive for the 3 evaluated tests; for the use of one test of over another, and the farmer’s goal (e.g., both Keto-Test and Ketostix the reason was the higher number presence of headlocks will facilitate the use of Precision XTRA, of false positives diagnosed by both tests compared to Precision whereas testing in the milking parlour allows the efficient use XTRA, while for Precision XTRA the reason was the increase of Keto-Test). CVJ in the number of true positive cows that were treated due to the high test sensitivity. One should consider that the sensitivities References and specificities of different cow-side tests evaluated in the cur- . 1 Grummer RR. Impact of changes in organic nutrient metabolism on rent model were relative to a laboratory measurement of serum feeding the transition dairy cow. J Anim Sci 1995;73:2820–2833. 2. Bertics SJ, Grummer RR, Cadorniga-Valino C, Stoddard EE. Effect b-hydroxybutyrate $ 1400 mmol/L (6) which means that they of prepartum dry matter intake on liver triglyceride concentration and could vary at a different cutoff. early lactation. J Dairy Sci 1992;75:1914–1922.

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. 3 Bauman DE, Currie WB. Partitioning of nutrients during pregnancy 17. Duffield TF, Rabiee AR, Lean IJ. A meta-analysis of the impact of and lactation: A review of mechanisms involving homeostasis and monensin in lactating dairy cattle. Part 3. Health and reproduction. homeorhesis. J Dairy Sci 1980;63:1514–1529. J Dairy Sci 2008;91:2328–2341. 4. Herdt TH. Ruminant adaptation to negative energy balance. Influences 18. McLaren CJ, Lissemore KD, Duffield TF, Leslie KE, Kelton DF, on the etiology of ketosis and fatty liver. Vet Clin North Am Food Anim Grexton B. The association of herd milk production and management Pract 2000;16:215–230. with a return-over-feed index in Ontario dairy herds. J Dairy Sci 2005; 5. Goff JP. Major advances in our understanding of nutritional influences 88:419–425. on bovine health. J Dairy Sci 2006;89:1292–1301. 19. McArt JA, Nydam DV, Oetzel GR, Guard CL. An economic analysis 6. LeBlanc S. Monitoring metabolic health of dairy cattle in the transition of hyperketonemia testing and propylene glycol treatment strategies in period. J Reprod Dev 2010;56 Suppl:S29–35. early lactation dairy cattle. Prev Vet Med 2014;117:170–179. 7. Duffield TF, Bagg RN. Use of ionophores in lactating dairy cattle: 20. Duffield TF, Sandals D, Leslie KE, et al. Efficacy of monensin for the A review. Can Vet J 2000;41:388–394. prevention of subclinical ketosis in lactating dairy cows. J Dairy Sci

ARTICLE 8. Duffield TF, Rabiee AR, Lean IJ. A meta-analysis of the impact of 1998;81:2866–2873. monensin in lactating dairy cattle. Part 1. Metabolic effects. J Dairy 21. Dairy Farmers of Ontario. The Milk Producer Magazine. Markets. Sci 2008;91:1334–1346. Available from: https://www.milk.org/Corporate/view.aspx?content= 9. Duffield TF, Rabiee AR, Lean IJ. A meta-analysis of the impact of aboutus/MilkProducerMagazine Last accessed May 16, 2016. monensin in lactating dairy cattle. Part 2. Production effects. J Dairy 22. Guideline for estimating dairy cow production costs in Manitoba. Sci 2008;91:1347–1360. 2015. Available from: http://www.gov.mb.ca/agriculture/business-and- 10. McArt JA, Nydam DV, Ospina PA, Oetzel GR. A field trial on the effect economics/financial-management/pubs/cop_dairy_cow.pdf Last accessed of propylene glycol on milk yield and resolution of ketosis in fresh cows May 16, 2016. diagnosed with subclinical ketosis. J Dairy Sci 2011;94:6011–6020. 23. OMAFRA. 2015. Dairy Farm Wage Rate. Available from: http:// 11. McArt JA, Nydam DV, Oetzel GR. A field trial on the effect of pro- www.omafra.gov.on.ca/english/livestock/dairy/facts/wagerate.htm Last pylene glycol on displaced abomasum, removal from herd, and repro- accessed May 16, 2016. duction in fresh cows diagnosed with subclinical ketosis. J Dairy Sci 24. Britt JS, Thomas RC, Speer NC, Hall MB. Efficiency of converting 2012;95:2505–2512. nutrient dry matter to milk in Holstein herds. J Dairy Sci 2003;86: 12. McArt JA, Nydam DV, Overton MW. Hyperketonemia in early lactation 3796–3801. dairy cattle: A deterministic estimate of component and total cost per 25. National Research Council. Nutrient Requirements of Dairy Cattle. case. J Dairy Sci 2015;98:2043–2054. 7th revised ed. Washington, DC: Natl Acad Press, 2001. 13. Overton M, Rollin E. Mastitis in the Vital 90TM Days...What’s the Real 26. McArt JA, Nydam DV, Oetzel GR. Epidemiology of subclinical ketosis Cost? Proceedings of The High Plains Dairy Conference, Lubbock, in early lactation dairy cattle. J Dairy Sci 2012;95:5056–5066. Texas, USA 2014:41–49. 27. Roberts T, Chapinal N, Leblanc SJ, Kelton DF, Dubuc J, Duffield TF. 14. Guard CL. The costs of common diseases in dairy cattle. Proc CVC Metabolic parameters in transition cows as indicators for early-lactation Continuous Education Convention, San Diego, California, USA 2008. culling risk. J Dairy Sci 2012;95:3057–3063. 15. Duffield TF. Effects of a monensin controlled release capsule on energy 28. Gohary K, Overton MW, von Massow M, LeBlanc SJ, Lissemore KD, metabolism, health and production in lactating dairy cattle [DVSc Duffield TF. The cost of a case of subclinical ketosis in Canadian dairy Thesis]. Guelph, Ontario: University of Guelph, 1997. herds. Can Vet J 2016;57:728–732. 16. Duffield TF. Subclinical ketosis in lactating dairy cattle. Vet Clin North Am Food Anim Pract 2000;16:231–253.

740 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY Article

Comparison of intraoperative and postoperative pain during canine ovariohysterectomy and ovariectomy

Amanda Tallant, Barbara Ambros, Carol Freire, Sherisse Sakals

Abstract — This study compared physiologic parameters indicating nociception during surgery and pain scores after surgery among dogs undergoing ovariohysterectomy (OHE) and ovariectomy (OVE). Twenty healthy adult female dogs were randomly assigned to either the OHE or the OVE group. Physiologic data collected during surgery included heart rate, respiratory rate, temperature, blood pressure, hemoglobin oxygen saturation, end-tidal

CO2 and isoflurane, and vaporizer settings. Postoperative pain was measured using the short form Glasgow Composite Pain Scale, an interactive visual analog scale, and algometry. There were no clinically relevant differences in intraoperative nociception indices between groups. Duration of surgery for OVE was significantly shorter than for OHE (OVE 15.4 minutes, OHE 17.5 minutes, P = 0.04). There was no significant difference between groups in the use of rescue analgesia after surgery, in the average interactive visual analog scale score over the 24-hour postoperative period (P = 0.12), and in algometer readings (P = 0.34).

Résumé — Comparaison de la douleur peropératoire et postopératoire durant l’ovariohystérectomie et l’ovariectomie canines. Cette étude a comparé les paramètres physiologiques indiquant la nociception durant la chirurgie et la cotation des douleurs après la chirurgie parmi les chiennes subissant une ovariohystérectomie (OHE) et une ovariectomie (OVE). Vingt chiennes adultes en santé ont été réparties au hasard soit au groupe OHE ou au groupe OVE. Les données physiologiques recueillies durant la chirurgie incluaient la fréquence cardiaque, la

fréquence respiratoire, la température, la tension artérielle, la saturation en oxygène de l’hémoglobine le PCO2 et l’isoflurane de fin d’expiration ainsi que les réglages du nébuliseur. La douleur postopératoire a été mesurée à l’aide de la forme abrégée de l’échelle de douleur composée de Glasgow, d’une échelle analogue visuelle interactive et de l’algométrie. Il n’y avait pas de différences pertinentes sur le plan clinique dans les indices de nociception peropératoire entre les groupes. La durée de la chirurgie d’OVE était significativement plus courte que celle d’OHE (OVE 15,4 minutes, OHE 17,5 minutes, P = 0,04). Il n’y avait aucune différence significative entre les groupes pour le recours à un analgésique de secours après la chirurgie, dans la note d’échelle visuelle interactive moyenne pendant la période postopératoire de 24 heures (P = 0,12) et dans les lectures de l’algésimètre (P = 0,34). (Traduit par Isabelle Vallières) Can Vet J 2016;57:741–746

Introduction ovariohysterectomy group) and urinary incontinence (6 of the ovariectomy group and 9 of the ovariohysterectomy group) variohysterectomy (OHE) and ovariectomy (OVE) are were noted between these 2 groups. The authors concluded that common procedures for sterilization of female dogs. In a O there was no indication for removing the uterus (1). A review retrospective study on the long-term effects of OHE and OVE of articles published between 1967 and 2004 revealed no sig- in dogs, no differences were detected in complication rates nificant differences between the 2 techniques in the incidence between the 2 procedures (1). Similar incidences of vaginal of long-term postoperative urogenital complications, including discharge (2 of 69 in the ovariectomy group and 2 of 66 in the endometritis, pyometra, and urinary incontinence (2). The potential advantages of OVE noted were that it is less techni- Department of Small Animal Clinical Sciences, Western College cally complicated, less time consuming, and associated with of Veterinary Medicine, University of Saskatchewan, Saskatoon, less morbidity due to a smaller incision and less intraoperative Saskatchewan S7N 5B4. trauma (2). A 2011 study stated “Ovariectomy has replaced Address all correspondence to Dr. Sherisse Sakals; e-mail: OHE as the preferred procedure for neutering healthy female [email protected] dogs in many European countries” based on the potential advan- Use of this article is limited to a single copy for personal study. tages described above (3). Anyone interested in obtaining reprints should contact the The purpose of our study was to investigate and compare CVMA office ([email protected]) for additional intraoperative physiologic changes and postoperative pain copies or permission to use this material elsewhere. scores in dogs undergoing OHE and OVE. We hypothesized

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that there would be a significant difference in intraoperative tral eye position and absence of a palpebral reflex. Evaluation physiologic parameters indicating nociception (elevated heart of anesthetic depth and adjustment of the vaporizer were per- rate and blood pressure) in dogs undergoing OHE compared to formed by a single board certified anesthesiologist (BA) who was dogs undergoing OVE. We also hypothesized that there would blinded to the surgical procedure being performed. Physiologic not be a significant difference in postoperative pain scores or and instrument setting recordings were performed every 2 min algometry between these 2 procedures. from the time of induction until extubation.

Materials and methods Surgery The study was approved by the institutional animal care com- Ovariohysterectomy was performed through a ventral midline

ARTICLE mittee. Twenty healthy adult female dogs were obtained from celiotomy, centered approximately in the cranial third of the 2 local humane society shelters. Informed consent was obtained distance between the umbilicus and pubis. Each ovary was from the shelter veterinarians of each shelter. Exclusion criteria removed together with the uterus to a level just cranial to the included signs of illness or cardiovascular abnormalities, evi- cervix. The suspensory ligament was torn using digital pressure dence of estrus, and pregnancy as noted on physical examina- during isolation and exteriorization of the ovary. Hemostasis of tion. Body weight ranged from 3.3 to 30.1 kg. The dogs were the ovarian and uterine vasculature, and sealing and division of individually housed in an isolated ward prior to surgery, during the broad ligaments were achieved using a bipolar vessel seal- recovery, and during pain assessment. The dogs were acclima- ing device (LigaSure5 mm blunt tip 20 mm sealer and divider; tized to this ward for a minimum of 24 h before surgery. The Covidien, Minneapolis, Minnesota, USA). The uterine body dogs were fed a maintenance diet within 2 h of extubation and was sealed and divided using the vessel sealing device when walked outside 4 times daily. After recovery from anesthesia and the uterine body was # 9 mm (4). When the uterine body data collection, the dogs were returned to the humane societies exceeded 9 mm, as confirmed by blade handle measurements, a for adoption. single circumferential ligature of 2-0 PDSII (Ethicon; Johnson Randomization software (http://www.graphpad.com/q uickcalcs/ & Johnson, Somerville, New Jersey, USA) was placed prior to randomize1.cfm) was used to assign each dog to 1 of 2 treatment transection of the uterus. The linea alba was closed in a simple groups: OHE or OVE. Prior to surgery a full physical examina- continuous pattern using PDSII with suture sized appropriately tion was performed. Body temperature, heart rate (HR), respira- for each dog. The subcutaneous tissue was closed using 3-0 tion rate (RR), capillary refill time, mucous membrane color and Monocryl (Ethicon; Johnson & Johnson) in a simple continu- body weight for each dog were measured and recorded. Body ous pattern, and the skin was closed with the same suture in an condition scores and American Society of Anesthesiologists intradermal pattern. physical status classifications were assigned and recorded. Blood Ovariectomy was performed through a ventral midline celi- was collected from each dog for measurement of packed cell otomy centered over the umbilicus. The ovaries were removed by volume, total protein, blood urea nitrogen (Azostix Siemens sealing and dividing the proper ligament of the ovary, suspensory Diagnostics; Siemens Canada, Mississauga, Ontario) and blood ligament and the ovarian pedicle using the vessel sealing device. glucose levels (AlphaTrack2; Abbott, Ottawa, Ontario) prior The suspensory ligament was not torn during OVE. Closure was to fasting. identical to that described for OHE. All surgeries were performed by a single board-certified Anesthesia surgeon (SS). The incision length was recorded for each dog. Each dog was administered carprofen (Rimadyl; Pfizer, The duration of each phase of surgery and of the entire surgery Kirkland, Quebec), 4 mg/kg body weight (BW), SC, 30 min was recorded. prior to induction of anesthesia. An IV catheter was placed Anesthesia and surgery were divided into phases. For a base- in the cephalic vein and anesthesia was induced with propo- line measurement, and to achieve a constant plane of anesthesia fol (Diprivan; AstraZeneca, Mississauga, Ontario), 6 mg/kg before surgery, phase 0 began with induction and ended with BW, IV. If insufficient relaxation for intubation was achieved initiation of the skin incision. Phase 1 began with initiation of with this dose, additional propofol was administered IV to the skin incision and ended when one of the ovaries was grasped. effect. Anesthesia was maintained with isoflurane (Forane; Phase 2 began with manipulation of the first ovary and ended at Pharmaceutical Partners of Canada, Richmond Hill, Ontario) initiation of body wall closure. Phase 3 represented abdominal in 100% oxygen delivered via an endotracheal tube. Heart closure and suturing of subcutaneous tissue and skin. rate, RR, systolic blood pressure (SAP), mean blood pressure (MAP), diastolic blood pressure (DAP), hemoglobin oxygen Pain assessment

saturation, end-tidal carbon dioxide (ETCO2), and end-tidal Each dog was assessed at 1, 2, 4, 6, 8, 12, 18, and 24 h isoflurane (ETIso), were measured using a multi-parameter after surgery by 1 blinded observer (AT). Temperature, HR, anesthetic monitoring device (Datex-Ohmeda; General Electric, and RR for each dog was measured at each evaluation. A Little Chalfont, UK), which was routinely calibrated. Isoflurane short form Glasgow Composite Pain Scale (GCPS) assessment vaporizer setting, oxygen flow rate, palpebral reflex, eye position, was performed at each time point (5). The GCPS includes jaw tone, and body temperature were recorded. 30 descriptors in 6 behavioral categories. The descriptors are The isoflurane vaporizer setting was adjusted to provide a ranked numerically according to their associated pain severity. plane of anesthesia that maintained a relaxed jaw tone, a ven- The observer assigns the appropriate descriptor in each category

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and totals the scores. Dogs with a score of 5/24 or greater were Results administered rescue pain medication in the form of buprenor- There were no significant differences in average values of SAP, phine (Vetergesic; Reckitt Benckiser Healthcare, Hull, UK), MAP, DAP in each phase between procedures (Table 1). All 15 mg/kg BW, SC (5). Following this assessment, an interactive blood pressure measurements increased from baseline mea- visual analog scale (IVAS) 10 cm long was also used at each surements in phase 1 and again between phases 1 and 2, but evaluation. Interaction involved removing the dog from the declined between phases 2 and 3 (Table 1). The only statistically kennel, petting the dogs, offering treats, talking to the dogs and ARTICLE significant differences were in the changes of blood pressure noting their responses to the observers. The right side of the line between phases. There was a greater increase in MAP between represented unbearable pain and the left represented no pain. phase 1 and 2 in the OHE group (P = 0.02). The average A mark was made on the line to correspond to the observer’s increase in MAP in the OHE group was 25 mmHg 1/2 14, perception of the pain felt by each dog at each evaluation. The while the average increase of MAP of the OVE group was distance of the mark from the left side of the line was measured 9 mmHg 1/2 15. There was also a greater increase in the DAP and recorded. between phase 1 and 2 in the OHE group (P , 0.01). The aver- An algometer (Topcat Metrology Pressure Rate Onset Device; age increase of DAP in the OHE group was 27 mmHg 1/2 13, Topcat Metrology, Little Downham, UK) was used to measure wound sensitivity. To test the mechanical wound threshold a while the average increase of DAP in the OVE group was 1 2 rounded plastic tip was used (diameter of the rounded head = 6 mmHg / 14. The MAP and DAP changes between phases 2 8 mm) to apply steadily increasing pressure until the animal and 3 were not significant (P = 0.93 and P = 0.23 respectively). showed a response. Any sudden movement of the dog away There were no significant differences between groups in HR from the device, attempting to stand, turning the head towards in phases 1 and 2 or HR changes between phases of surgery. The the device, vocalization, or attempts to bite were considered a HR of the OVE group was greater than that of the OHE group response. Pressure was then instantly released and the applied during phase 0 and during phase 3 (Table 1). force (Newton, N) was read from the display. The algometer The ETIso for the OHE group was lower during phase 1 and provides guidance to the user in the form of red and green lights phase 2 of surgery than for the OVE group. There was no differ- for the application of a constant rate of pressure increase. The ence during phase 3 or between the phases (Table 1). algometer’s technical specification of force range of 0.5 to 20 N The OHE procedure was of significantly greater duration is accurate to 1/2 1 N; all readings above 20 were recorded as than the OVE procedure (P = 0.04). The average OHE proce- 20 N. Dogs were placed in left lateral recumbency and 3 algom- dure was 17.5 1/2 2.4 min and the average OVE procedure was eter readings were obtained 1 cm cranial to the cranial edge of 15.4 1/2 1.7 min. There were no significant differences between the incision on each dog prior to premedication and at each groups in duration of phase 0, phase 1 or phase 2; however, the observation time point after surgery. The average of the values duration of phase 3 was greater in the OHE group compared at each time point was used for statistical analysis. to the OVE group (Table 1). The OHE skin incision lengths were significantly greater Statistical evaluation than the OVE incisions (P = 0.02). The average skin incision A prospective power analysis was performed based on a clini- length of the OHE was 6.4 1/2 0.7 cm, while the average skin cally significant difference of 15 mm for the IVAS, an alpha incision length of the OVE was 5.3 1/2 1.1 cm. of 0.05, and a beta of 0.2. Significance for all tests was set at There was no significant difference between groups in the use P , 0.05. A sample size of 20 animals was sufficient to deter- of rescue analgesia after surgery (1 in each group) as determined mine significant difference between groups. Statistical software by GCPS results (P = 0.37), in the average IVAS score over the (STATA 12; StataCorp LP, College Station, Texas, USA) was 24-hour postoperative period (P = 0.12) or in algometer read- used for analysis. ings (P = 0.34). Average SAP, MAP, DAP, and HR in each phase and blood There were no significant differences between groups in body pressure and HR changes between phases of surgery were com- weight [OHE mean 19.25 kg SD 1/2 7.0, OVE mean 17.53 kg pared using a 2-sample t-test with equal variances between the SD 1/2 6.5 (P = 0.58)]. 2 treatment groups. Following visual inspection the data were There were no complications in any of the dogs during pooled over the 24-hour period for subsequent analysis. surgery or before discharge at 24 h following the conclusion End-tidal averages in each phase and changes between phases of the study. of surgery, total surgery duration and duration of each phase of surgery, and incision lengths were compared with a 2-sample Discussion t-test with equal variance between the 2 treatment groups. The 4 phases for the OHE and OVE procedures were estab- The use of rescue pain medication based on short form GCPS lished by Höglund et al (6) in a comparison of laparoscopic score was compared with a Pearson’s Chi-squared test. Each OVE and open OHE. Division of the procedures into phases patient’s average IVAS score over 24 h and peri-incisional algom- allowed for identification of changes during portions of the eter readings over 24 h were compared between the 2 treatment procedures that were expected to be most relevant in reveal- groups with a two-sample t-test with equal variance. Patients ing differences. It also allowed for steady state anesthesia to be that received rescue pain medication continued to be assessed reached in phase 0 prior to any surgical stimulation. The study and included in the analysis. showed that the differences between the 2 techniques could be

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isolated to phase 2, representing organ removal (6). This study value - .86 .67 .91 .09 also showed that repeated non-invasive blood pressure measure- 0 0 0.03 P 0 0 0.01 ments could be used as an indicator of intraoperative trauma (6).

Our first hypothesis was that there would be a difference 14 15 12 17 0.3 1.2

6 6 6 6 6 between OHE and OVE in intraoperative physiologic param- 7 7 5 6 5 HE .5 .5 .6 .6 8 23 23 03 03 6 hase 3 hase 1 9 O 1 1

P eters. Our data showed only slight differences. The significantly greater increase in MAP and DAP in the OHE group between

phases 1 and 2 may be because the OHE was more stimulat- 13 15 14 12 0.4 1.1

6 6 6 6 ing. However, the average ETIso during phases 1 and 2 was 6 6 6 4 6 4 VE .8 .8 .9 .9 8 26 26 16 16 6 ARTICLE 1 7 -test) are indicated in bold. OVE — — OVE bold. in indicated are -test) O 1 1

t also significantly lower in the OHE group, and could also be

responsible for the greater increase in MAP and DAP in the

OHE group. value - .84 .92 .07 .30 .07 0 0 0 P 0 0.03 0 We suspect that the significantly greater increase in MAP and

DAP in the OHE group between phases 1 and 2 was due to

18 18 12 20 0.3 2.0 increased stimulation during handling of the suspensory liga-

6 6 6 6 8 6 8

8 6 8 ment. For the OHE, the suspensory ligament was torn using HE .9 .9 .0 .0 hase 2 hase 9 34 34 14 14 7 1 6 O P 1 1 digital pressure, whereas for the OVE, a vessel sealing device

was used to divide the ligament. In the OVE procedure the 15 18 14 16 0.4 1.4 incision is more cranially placed, centering the activity directly

6 6 6 6 6 6

VE over the ovaries. This location requires less caudal retraction .3 .3 .5 .5 97 97 33 33 26 26 69 69 2 4 O 1 1 of the ovaries and usually does not require tearing of the sus-

pensory ligaments to ligate the ovarian pedicle. We anticipated

0.02 0.01

value that the manual tearing of the suspensory ligament would be

P ,

more stimulating than use of the vessel sealing device. Manual

rupture of the ligament involves tearing the ligament from its

13 14 cranial attachment sites using tension to the point of failure. HE 7 6 7 5 6 5 2 2 O When sealing and dividing the ligament with the vessel sealing Change from Change hase 1 to Phase 2 Phase to 1 hase

device, there was little to no tension placed on the ligament. It P

14 15 is possible, however, that despite the lack of the tension on the 6 6 VE

6 9

O ligament, division of the ligament with the vessel sealing device was more stimulating than we expected, thereby diminishing a

difference between groups in the response to treatment of the value - .10 .08 .23 .15 .09 0 0 0 0 P 0.02 0 ligament.

Manipulation of the suspensory ligament and removal of the

16 16 14 20 0.2

0.9 ovary has been recognized as the most stimulating portion of

6 6 6 6

the spay and surgical trauma has been noted to result in blood 1 6 1 4 6 4 HE .9 .9 .9 .9 5 7 11 11 16 16 hase 1 hase 1 1 O 1 1 P pressure changes during OHE and OVE procedures (6). We

expected that we would have observed an increase in SAP, as 15 17 21 13 0.4 1.3 was noted between phases 1 and 2 in the study by Höglund

6 6 6 3 6 3 7 6 7 8 6 8 et al (6). The increase in SAP between phases 1 and 2 was also VE .3 .3 6 8 21 21 28 28 2 2 O 1 1 observed by the same researchers in a follow-up study in which a -test was performed on each phase between the OVE and OHE groups and to compare changes between phases. Significant differences ( differences Significant phases. between changes compare to and groups OHE and OVE the between phase each on performed was -test

t pause of 15 min was introduced after the removal of each ovary

in order to ensure a steady state of anesthesia before removal of value - .23 .13 .22 .15 .15 standard deviation) measured during the 4 phases of the surgery the of phases 4 the standard during measured deviation) 0 0 0 0.04 P 0 0

6 the second ovary (7). While a statistically significant increase in

MAP and DAP was noted between phases 1 and 2 in our study,

10 10 9 17 0.3 4.7 there was no statistically significant increase in SAP.

6 6 6

3 6 3 3 6 3 The increase in SAP between phases 1 and 2 in the OHE .9 .9 HE 4 6 03 03 14 14 1 0.4 6 0.4 hase 0 hase 1 1 O 1 P group was 22.8 mmHg and in the OVE group was 12 mmHg

(P = 0.09). This approaches but does not reach statistical 10 13 17 17 0.5 3.0 significance. Transient differences in blood pressure during

6 6 6 6 6 6 9 6 9 the procedures in our study may not have been recognized .1 .1 4 6 08 08 27 27 2 2.3 6 2.3 1 1 OVE 1 with the 2-minute monitoring interval we used. Continuous

monitoring may have allowed us to recognize transient blood

Comparison of parameters (mean (mean parameters of Comparison

pressure changes that occurred within a 2-minute period. Also,

we used non-invasive blood pressure (NIBP) monitoring. While NIBP was used in both studies by Höglund et al (6,7), direct AP (mmHg) AP DAP (mmHg) DAP MAP (mmHg) MAP S HR (bpm) HR Parameter ETIso (%) ETIso Table 1. Table Phase 0 was from induction to skin incision. Phase 1 was from skin incision to manipulation of the first ovary. Phase 2 was from manipulation of the first ovary to body wall closure. Phase 3 was from body wall closure until completion of skin skin of completion until closure wall body from was 3 Phase closure. wall body to ovary first the of manipulation from was 2 Phase ovary. first the of manipulation to incision skin from was 1 Phase incision. skin to induction from was 0 Phase 2-sample A groups. 2 the of each in dogs 10 were There closure. isoflurane. end-tidal — ETIso pressure; diastolic — DAP pressure; blood MAP pressure; systolic — SAP heart — rate; HR group; ovariohysterectomy — OHE group; ovariectomy

Time (min) Time blood pressure monitoring via an arterial catheter may have

744 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY revealed changes that our monitoring equipment did not detect. Algometry was used to increase the objectivity of our post However, since changes in MAP and DAP were found despite operative pain scoring and to quantify superficial pain around intermittent monitoring, we are uncertain as to why SAP did the incision. In this study wound lengths were 1.05 cm dif- not show a similar pattern. ferent in average length. Pain threshold assessments of these The significantly greater increase in MAP and DAP in the wounds were unlikely to be significantly different. Although OHE group between phases 1 and 2 may correspond to this intra-abdominal pain assessment may have been a more accurate group’s significantly lower average ETIso during phase 1 and measure for our study, we are unaware of an effective method ARTICLE phase 2. Higher ETIso is associated with vasodilation, which of quantitatively measuring pain originating from within the could account for the comparatively lower pressures of the peritoneal cavity in dogs. It is possible that the use of the 8-mm OVE group. Differences in duration of the phases between tip diameter may have also obscured differences herein. An groups could potentially contribute as well; however, the dura- inconsistency in patient reactions and higher mechanical thresh- tions of each phase were not significantly different; therefore, olds were noted with larger diameter probes in a recent study the effects of phase duration was likely minimal. These are (12). Also, all dogs quickly became acclimated to the routine of unexpected findings as OVE procedures require less abdominal assessments followed by positive reinforcement and were very organ manipulation; therefore, in theory, the OVE procedure compliant. A high degree of tolerance to both positioning and should require less isoflurane to maintain an adequate plane of use of the algometer was noted in the dogs. This is in agreement anesthesia. with a recent study that found that effect of the individual There was a significantly higher average HR during phase 3 dog is the predominant factor in mechanical threshold testing of the surgery in the OVE group. This difference of 14 beats/ (12). We found immediate acceptance of application of the min may not be clinically relevant. Heart rate in itself cannot algometer. This may be due to the temperament of the dogs, be correlated to intraoperative nociception. This elevation which were obtained from a humane society, similar to another occurred at a time when differences between the procedures are study in which client-owned pets quickly showed avoidance unappreciable, as this phase represents incision closure, which behaviors (13). was performed in identical fashion in both groups. The change in MAP and DAP between phase 1 and phase 2 Incision lengths were statistically significantly shorter by of OHE was significantly greater than for OVE, which may 1.05 cm in the OVE group, and surgery duration was 2.1 min correspond to a greater level of nociception experienced during less for the OVE group. While these results were statistically OHE or may be secondary to the higher levels of isoflurane significant, the clinical relevance is questionable. Achieving in phases 1 and 2 in the OVE group. Follow-up studies will an incision length as short as possible was not an objective of include continuous monitoring of physiologic parameters, our study. especially during manipulation of the suspensory ligament and Our second hypothesis was supported by the data as neither organ removal. There were no differences in postoperative mea- GCPS nor IVAS scores revealed any significant differences in sures of pain between groups. This may be due to an inability post-operative pain between the groups. All dogs were awake of our pain detection methods to ascertain subtle differences, and eating within 2 h of the procedures. Peeters et al (3) also or it may be that there is no difference in postoperative pain found no significant difference in postoperative pain between experienced between the two procedures. Although we did OHE and OVE in dogs. We added algometry to further quantify not find a dramatic difference in our indices of nociception differences after surgery but this did not identify a statistical experienced during these procedures, the frequency with which difference between groups. This suggests that either the dif- they are performed warrants further investigation of the pain ference in pain is too subtle for us to detect with current pain induced. measurement methods or that there truly are no differences in postoperative pain between the 2 procedures. The GCPS Acknowledgment is a behavior-based assessment tool to evaluate acute pain in The authors thank Dr. John Campbell for his direction in our dogs (5). The GCPS is a standardized evaluation system that is statistical analysis. CVJ intended to decrease variation among observers. Wagner et al (8) used GCPS as an assessment tool and showed pain-related References behaviors were mitigated by the administration of analgesics. 1. Okkens AC, Kooistra HS, Nickel RF. Comparison of long-term effects of ovariectomy versus ovariohysterectomy in bitches. J Reprod Fertil All dogs received a preoperative dose of carprofen; therefore, Suppl 1997;51:227–231. potential differences between the groups may have been dimin- 2. Van Goethem B, Schaefers-Okkens A, Kirpensteijn J. Making a rational ished due to the analgesic. In a study evaluating carprofen and choice between ovariectomy and ovariohysterectomy in the dog: A discussion of the benefits of either technique. Vet Surg 2006;35:136–143. buprenorphine in premedication protocols, either one used 3. Peeters ME, Kirpensteijn J. Comparison of surgical variables and short- independently provided adequate analgesia (9). Holton et al term postoperative complications in healthy dogs undergoing ovario- (10) found that while visual analog scales are commonly used in hysterectomy or ovariectomy. J Am Vet Med Assoc 2011;238:189–194. 4. Barrera JS, Monnet E. Effectiveness of a bipolar vessel sealant device human medicine, they show observer variability when assessing for sealing uterine horns and bodies from dogs. Am J Vet Res 2012; dogs. These assessments have shown greater agreement when 73:302–305. patients are in more severe pain (11). It is possible in our study 5. Reid J, Nolan AM, Hughes JML, Lascelles D, Pawson P, Scott EM. Development of the short-form Glasgow Composite Measure Pain Scale that the pain experienced was sufficiently mild to lack a notable (CMPS-SF) and derivation of an analgesic intervention score. Animal significant difference between groups. Welfare 2007;16:97–104.

CVJ / VOL 57 / JULY 2016 745 FOR PERSONAL USE ONLY

6. Höglund OV, Olsson K, Hagman R, et al. Comparison of haemody- 10. Holton LL, Scott EM, Nolan AM, Reid J, Welsh E, Flaherty D. namic changes during two surgical methods for neutering female dogs. Comparison of three methods used for assessment of pain in dogs. J Am Res Vet Sci 2011;91:159–163. Vet Med Assoc 1998;212:61–66. 7. Höglund OV, Hagman R, Olsson K, Olsson U, Lagerstedt AS. 11. Quinn M, Keuler N, Lu Y, Faria M, Muir P, Markel M. Evaluation Intraoperative changes in blood pressure, heart rate, plasma vasopres- of agreement between numerical rating scales, visual analogue scoring sin, and urinary noradrenaline during elective ovariohysterectomy scales, and force plate gait analysis in dogs. Vet Surg 2007;36:360–367. in dogs: Repeatability at removal of the 1st and 2nd ovary. Vet Surg 12. Harris LK, Murrell JC, van Klink E, Whay H. Influence of experimental 2014;43:852–859. protocol on response rate and repeatability of mechanical threshold 8. Wagner A, Worland G, Glawe JC, Hellyer P. Multicenter, randomized testing in dogs. Vet J 2015;204:82–87. controlled trial of pain-related behaviors following routine neutering 13. Coleman K, Schmiedt C, Kirkby K, et al. Learning confounds algo- in dogs. J Am Vet Med Assoc 2008;233:109–115. metric assessment of mechanical thresholds in normal dogs. Vet Surg 9. Shih A, Robertson S, Isaza N, Pablo L, Davies W. Comparison between 2014;43:361–367.

ARTICLE analgesic effects of buprenorphine, carprofen, and buprenorphine with carprofen for canine ovariohysterectomy. Vet Anaesth Analg 2008; 35:69–79.

Book Review Compte rendu de livre

Small Animal Soft Tissue Surgery, modalities and using up-to-date standards of care. This book is 2nd edition part of a series of 22 other question/answer review style books, and is available in a compact soft cover or hard copy, as well as Thieman Mankin KM, ed. 2015. CRC Press, Boca Raton, various electronic formats including a Kindle and pdf format Florida, USA. 224 pp. ISBN: 9781-4822-2538-9. $37.36 US. from the publisher, making it extremely portable. This book has many strengths, and is perhaps a “must have” his book contains 212 scenarios which are the basis for for the earnest intern or the surgical resident approaching his or T over 425 quiz-type questions. The front of every page her Board Exams. I would not, however, recommend this book has 2 scenarios, each case is followed by 2 to 4 questions that to general practitioners, except perhaps to use as a diversion, integrate diagnostic, anesthetic, surgical, and post-operative similar to the CVJ’s Quiz Corner, during a slow point in the day. considerations. The answers, including thorough explanations, The description on the cover, “Self-Assessment Color Review,” are on the back of the page. The front and back page format of sums this book up well. this book is convenient, no holding your place while flipping to the back of the book. The photos used are of exceptional quality Reviewed by Melissa Knowles, BSc, DVM, Associate Veterinarian and add considerable depth and detail to the cases presented. — Northwest Veterinary Services, PO Box 328, Turtleford, The writing is clear, easy, and interesting to follow. The scenarios Saskatchewan S0M 2Y0. and solutions used are current, describing the latest treatment

746 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY Article

Evolution of in vitro antimicrobial resistance in an equine hospital over 3 decades

Annie Malo, Caroline Cluzel, Olivia Labrecque, Guy Beauchamp, Jean-Pierre Lavoie, Mathilde Leclere

Abstract — This study identified antimicrobial resistance patterns of commonly isolated bacteria at the Equine Hospital of the Université de Montréal between 2007 and 2013, and compared the results with the resistance patterns observed in tests performed in previous decades in the same hospital. A total of 396 antimicrobial susceptibility tests were analyzed by the Kirby-Bauer method during the period 2007 to 2013 and compared to 233 and 255 tests completed in 1986 to 1988 and 1996 to 1998, respectively. The most common bacteria were Streptococcus equi subsp. zooepidemicus (S. zooepidemicus) and Escherichia coli. Except for resistance of coagulase- positive staphylococci to trimethoprim-sulfamethoxazole, there was no overall increase in resistance observed between 1986 to 1988 and 2007 to 2013 for antimicrobials reported for all 3 periods. However, between 1996 to 1998 and 2007 to 2013, there was an increase in in vitro resistance to enrofloxacin for E. coli and Enterobacter spp., and to ceftiofur for Enterobacter spp. and coagulase-positive staphylococci. No increase in resistance was observed for S. zooepidemicus and no isolate was resistant to penicillin.

Résumé — Évolution de l’antibiorésistance in vitro dans un hôpital équin pendant 3 décennies. L’objectif était d’identifier les patrons de résistance aux antimicrobiens des bactéries fréquemment isolées à l’Hôpital Équin de l’Université de Montréal de 2007 à 2013, pour ensuite les comparer aux données observées au cours des dernières décennies dans le même hôpital. Trois cent quatre-vingt-seize antibiogrammes faits à l’aide de la méthode Kirby-Bauer ont été analysés et comparés aux 233 et 255 ayant été effectués en 1986–1988 et 1996–1998, respectivement. Les bactéries les plus fréquentes étaient Streptococcus equi subsp. zooepidemicus (S. zooepidemicus) et Escherichia coli. Pour les antibiotiques testés pendant les 3 périodes de l’étude, il n’y pas eu d’augmentation de la résistance observée entre 1986–1988 et 2007–2013, à exception de celle des staphylocoques à coagulase positive au triméthoprime-sulfaméthoxazole. Cependant, entre 1996–1998 et 2007–2013, une augmentation de la résistance à l’enrofloxacin a été observée pour E. coli et Enterobacter spp., ainsi qu’une augmentation de la résistance au ceftiofur pour Enterobacter spp. et les staphylocoques à coagulase positive. Aucune augmentation de résistance n’a été observée pour S. zooepidemicus et aucun isolat n’était résistant à la pénicilline. (Traduit par les auteurs) Can Vet J 2016;57:747–751

Introduction to human health (1). These include third and fourth generation ntimicrobial administration early in the course of severe cephalosporins, aminoglycosides, fluoroquinolones, and mac- A bacterial infections can increase the likelihood of survival. rolides, including antimicrobials highly relevant to the practice Selection of the appropriate antimicrobial is based on multiple of equine medicine such as ceftiofur, gentamicin, amikacin, factors including identification of pathogens, in vitro suscepti- enrofloxacin, and erythromycin. The development of resistance bility, expected in vivo susceptibility, drug disposition, toxicity, against these and other critically important antimicrobials is ease of administration, and cost. The risk of increasing resistance particularly worrisome and has been documented in human and among bacteria should also be taken into account during antimi- equine populations (2–4). As recommended by the American crobial selection, especially when using those critically important College of Veterinary Internal Medicine (ACVIM), decisions on

Department of Clinical Sciences (Malo, Lavoie, Leclere), Department of Pathology and Microbiology (Cluzel), Veterinary Biomedicine Department (Beauchamp), Faculty of Veterinary Medicine, Université de Montréal, 3200 Sicotte, St. Hyacinthe, Quebec J2S 7C6; Laboratoire d’épidémiosurveillance animale, Ministère de l’Agriculture des Pêcheries et de l’Alimentation du Québec, St. Hyacinthe, Quebec (Labrecque). Address all correspondence to Dr. Mathilde Leclere; 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.

CVJ / VOL 57 / JULY 2016 747 FOR PERSONAL USE ONLY

Table 1. Resistance of frequently isolated Gram-negative bacteria from equine patients in 2007 to 2013, compared to previously reported resistance in 1986 to 1988 (6) and 1996 to 1998 (7): Pasteurellaceae and non-lactose fermenters Pasteurellaceae Actinobacillus spp.e Non-lactose fermenters (including Actinobacillus suis) Pseudomonas spp. 1986–1988 1996–1998 2007–2013 1986–1988 1996–1998 2007–2013 % (n) % (n) % (n) % (n) % (n) % (n) Amikacin na 3a (36) 22a (36) 0 (5) 4 (26) 13 (15) Ampicillin 17 (29) 17 (46) 6 (36) 92 (24) 85 (27) 100 (15) ARTICLE Ceftiofur na 0 (47) 0 (36) na 88 (26) 100 (15) Chloramphenicol 25 (4) 0 (19) 0 (36) 87 (23) 57 (14) 79 (14) Enrofloxacin na 0 (47) 0 (36) na 15 (27) 40 (15) Erythromycin 13 (23) 33 (46) 31 (26) Intrinsic resistanced Gentamicin 7 (29) 2 (47) 6 (33) 16 (25) 42 (26) 33 (15) Penicillin 33a,c (30) 73a,b (26) 3b,c (34) Intrinsic resistanced Tetracycline 10 (29) 6 (48) na 83 (24) 63 (27) na TMS 0a (30) 17a (46) 8 (36) 96 (25) 82 (22) 80 (15)

spp. — species; % — percentage of isolates resistant; n — number of isolates; na — data not available; TMS — trimethoprim-sulfamethoxazole. a,b,c For a given bacterium, percentages with the same superscript are significantly different between time periods (P , 0.05). d Intrinsic resistance — in vitro susceptibility cannot be used to predict treatment outcome (15). e Note — changes in guidelines for Pasteurella did not affect Actinobacillus spp.

how to treat bacterial infections should preferably be based on aureus and Staphylococcus intermedius) were retained for analysis. the antimicrobial susceptibility of isolated bacteria. When this Similar criteria were used in 2 previous studies by our group, is not possible, an empirical antimicrobial selection should be except for one bacterium-antimicrobial pair from 1986 to 1988 based on predictable susceptibility patterns and local resistance that was originally reported with less than 5 isolates (6). profiles (5). In order to provide guidance for these empirical choices, the goal of this study was to determine the resistance Antimicrobial resistance testing patterns of frequently isolated bacteria from the equine popula- Following the Clinical and Laboratory Standards Institute tion of a referral hospital from 2007 to 2013. Its secondary goal (CLSI) guidelines (8), isolates were tested for antimicrobial was to identify trends in the variation of resistance by comparing resistance using the Kirby-Bauer disk diffusion method on data with previous studies performed in the same hospital over Mueller-Hinton medium (Mueller-Hinton with 5% sheep blood 2 previous decades (6,7). for Streptococcus spp.). While the Kirby-Bauer method does not determine minimal inhibitory concentrations, qualitative results Materials and methods of bacterial resistance are obtained based on the inhibition zone Selection of bacterial isolates diameter. Based on CLSI breakpoints, isolates were deemed sus- The Clinical Bacteriology Laboratory of the Faculty of ceptible, intermediate, or resistant. Veterinary-specific resistance Veterinary Medicine of the Université de Montréal computer breakpoints were used when available. For this study, and to be system was searched to identify antimicrobial susceptibility consistent with previous reports, intermediate susceptibility was tests performed on aerobic bacterial isolates from patients of considered resistant. Quality control antimicrobial resistance the Equine Hospital of the Centre Hospitalier Universitaire of E. coli ATCC 25922, Staphylococcus aureus ATCC 25923, Vétérinaire between March 1, 2007 and September 1, 2013. In and Streptococcus pneumoniae ATCC 49619 were performed the event that an isolate was cultured more than once (i.e., the monthly. Resistance was compared to the previously reported same bacterial species was recovered from two sites in the same profiles by the same laboratory using the same technique (6,7). patient, or twice from the same site during a hospitalization), Ceftiofur and enrofloxacin were added after 1986 to 1988, and only the first isolate was used for analysis. Bacteria, or groups of tetracycline stopped being included in standard Kirby-Bauer for bacteria with a minimum of 5 isolates were retained for analysis. equine isolates in the 2000s. Additional recorded data included Actinobacillus spp. included bacteria identified as A. equuli, the age of the patients and the sample site. A. equuli subsp. haemolyticus, and A. suis. Pseudomonas spp. included P. aeruginosa and other Pseudomonas spp. Two groups Statistical analysis of Enterobacteriaceae (Escherichia coli and Enterobacter spp.) were Differences among proportions of resistant isolates across 3 time analyzed, whereas in the Streptococcus genus, only Streptococcus periods were compared with the exact Chi-square test using equi subsp. zooepidemicus (S. zooepidemicus) was analyzed. commercial software (SAS 9.4; SAS Institute, Cary, North All coagulase positive staphylococci (including Staphylococcus Carolina, USA). Pair-wise comparisons between time periods

748 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY

Table 2. Resistance of frequently isolated Gram-negative bacteria from equine patients in 2007 to 2013, compared to previously reported resistance in 1986 to 1988 (6) and 1996 to 1998 (7): Enterobacteriaceae Enterobacteriaceae Escherichia coli Enterobacter spp. 1986–1988 1996–1998 2007–2013 1986–1988 1996–1998 2007–2013 % (n) % (n) % (n) % (n) % (n) % (n) ARTICLE Amikacin 11 (9) 0a (58) 12a (57) 0 (5) 9 (22) 34e (29) Ampicillin 63a (46) 34a (58) 53 (57) 90 (20) 91 (22) 97 (29) Ceftiofur na 32 (56) 18 (57) na 21a (24) 52a (29) Chloramphenicol 36 (42) 26 (34) 19 (57) 61 (18) 50 (10) 62 (29) Enrofloxacin na 0a (58) 14a (57) na 5a (22) 41a (29) Erythromycin Intrinsic resistanced Intrinsic resistanced Gentamicin 13 (47) 19 (58) 25 (56) 53 (19) 55 (22) 55 (29) Penicillin Intrinsic resistanced Intrinsic resistanced Tetracycline 62 (48) 45 (58) na 70 (20) 57 (21) na TMS 52 (48) 39 (57) 46 (57) 60 (20) 62 (21) 55 (29)

spp. — species; % — percentage of isolates resistant; n — number of isolates; na — data not available; TMS — trimethoprim-sulfamethoxazole. a,b,c For a given bacterium, percentages with the same superscript are significantly different between time periods (P , 0.05). d Intrinsic in vivo resistance, in vitro susceptibility cannot be used to predict treatment outcome (15). e P = 0.05.

were only performed if there was an overall difference across and 2007 to 2013. An increase in resistance of Actinobacillus time periods. The statistical significance level was set to 0.05. spp. (P = 0.03) and E. coli (P = 0.02) to amikacin was observed between 1996 to 1998 and 2007 to 2013, but resistance from Results 2007 to 2013 did not differ from that in 1986 to 1988 for Patients and sites of sampling E. coli and could not be compared to data from 1986 to 1988 There were 299 samples with bacterial growth on aerobic cul- for Actinobacillus spp. The previously observed increase in ture that had a Kirby-Bauer test performed during the period resistance of coagulase-positive staphylococci to trimethoprim- 2007 to 2013. Seventy-nine samples had multiple isolates, for sulfamethoxazole (TMS) was confirmed, while the increase a total of 396 Kirby-Bauer tests performed. Most (35%) of the observed for Actinobacillus was no longer significant (TMS) or samples originated from the respiratory system and included had again decreased since the years 1996 to 1998 (penicillin). tracheal aspirates, nasopharyngeal swabs, and thoracocentesis. No increase in resistance was observed for S. zooepidemicus and Streptococcus zooepidemicus was isolated from 37% of these no isolate was resistant to penicillin. Additional observations samples. Other frequent sites included wounds and tissue were that, among the 7 E. coli isolates resistant to amikacin in swabs (13%), blood culture (11%), abscesses (7%), and joint the 2007 to 2013 period, 5 were isolated between the end of fluid (6%). Patients (n = 272) from which these bacteria were 2012 and 2013, and 3 were also resistant to fluoroquinolones isolated were between 0 and 29 years of age (median: 3 years (enrofloxacin and marbofloxacin). Furthermore, 15% (4 of old). Eighty-five (31%) of them were foals 8 mo old or less. 26 isolates) of coagulase-positive staphylococci were resistant to cefoxitin, a cephalosporin used to detect methicillin resistance Resistance over time among S. aureus. Among the 4 cefoxitin-resistant isolates, 3 were The 396 resistance patterns were analyzed and compared to confirmed to be S. aureus and were isolated from a lymphangitis, those obtained in 1986 to 1988 (233) and 1996 to 1998 (255). an infected castration site and an infected biopsy wound. Tables 1, 2, and 3 summarize the resistance of frequently isolated bacteria to commonly used antimicrobials during these Discussion 3 periods, and the significant differences between them. For In this study, when comparing the results from the years antimicrobials with data available for all 3 periods, there was no 2007 to 2013 with the ones from 1986 to 1988, we did not overall increase in resistance between 1986 to 1988 and 2007 to observe an overall increase in the antimicrobial resistance of the 2013, except for resistance of coagulase-positive staphylococci most common bacteria isolated from our hospital, except for to trimethoprim-sulfamethoxazole (P = 0.04). However, there coagulase-positive staphylococci’s resistance to trimethoprim- was a significant increase in resistance of E. coli (P = 0.002) sulfamethoxazole. However, not all antimicrobials had data and Enterobacter spp. (P = 0.003) to enrofloxacin, and of for all 3 periods, and we observed a significant increase in Enterobacter spp. (P = 0.03) and coagulase-positive staphylo- resistance between the years 1996 to 1998 and 2007 to 2013 cocci (P = 0.02) to ceftiofur between the years 1996 to 1998 for 3 antimicrobials considered to be critically important to

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Table 3. Resistance of frequently isolated Gram-positive bacteria from equine patients in 2007 to 2013, compared to previously reported resistance in 1986 to 1988 (6) and 1996 to 1998 (7): Streptococcus equi subsp. zooepidemicus and coagulase-positive staphylococci Streptococcus equi subsp. zooepidemicus Coagulase-positive staphylococci 1986–1988 1996–1998 2007–2013 1986–1988 1996–1998 2007–2013 % (n) % (n) % (n) % (n) % (n) % (n) Amikacin Low-level intrinsic resistanced na 4 (24) 0 (42) Ampicillin 8 (12) 0 (6) 8 (37) na 25 (20) 43 (42) Ceftiofur na 0 (9) 2 (86) na 11a (46) 40a (42) ARTICLE Chloramphenicol 0 (5) 0 (5) 10 (10) 0 (19) 6 (16) 0 (42) Enrofloxacin na 33 (9) na na 2 (45) 2 (42) Erythromycin 0 (7) 22a (9) 0a (60) 0 (23) 11 (46) 9 (34) Gentamicin Low-level intrinsic resistanced 4 (23) 15 (46) 19 (42) Penicillin 0 (18) 0 (12) 0 (86) 70 (23) 41 (46) 41 (41) Tetracycline 53 (17) 44 (9) 86 (7) 0a (22) 28a (46) na TMS 18 (17) 25 (12) 35 (84) 0a,b (24) 33a (46) 17b (42)

subsp. — subspecies; % — percentage of isolates resistant; n — number of isolates; na — data not available; TMS — trimethoprim-sulfamethoxazole. a,b,c For a given bacteria, percentages with the same superscript are significantly different between time periods (P , 0.05). d Low-level resistance of streptococci to aminoglycosides (17).

human health by the World Health Organization (WHO) (1). microbials used in the equine population. Previously observed In addition to the increase in resistance to ceftiofur (Enterobacter increase in resistance between 1986 to 1988 and 1996–1998 spp.), enrofloxacin (Enterobacter spp. and E. coli), and ami- for Actinobacillus (penicillin and TMS) was not observed again kacin (E. coli), there was a trend (P = 0.05) for an increase of and there was even a decrease in the resistance to penicillin Enterobacter spp.’s resistance to amikacin. A similar increase in (7). It can be speculated that this is in part due to a decrease in resistance of Enterobacteriaceae isolated from equine patients to the use of penicillin in our area in the past decade, but this is ceftiofur and other antimicrobials was also recently described certainly not the case for TMS, since its ease of administration by others (2,4), and at least 1 other study observed this change and observed rarity of side effects make it a widely used antimi- for enrofloxacin (9). crobial in our area. These fluctuations highlight the importance The pressure of selection due to the widespread use of antimi- of long-term studies to evaluate trends over multiple decades. crobials in veterinary and human patients is an important cause Drugs designated as critically important antimicrobials by the of acquired bacterial resistance and could have played a role in WHO should be reserved for use after appropriate susceptibil- the observed development of resistance to ceftiofur, enrofloxacin, ity testing or when no alternative is available (1). The ACVIM and amikacin. The former (ceftiofur, enrofloxacin) became avail- guidelines recommend that practitioners sort antimicrobials able in the late 1980s and 1990s, respectively, and have since used in their practice into Primary, Secondary, and Tertiary become widely used by equine practitioners. Amikacin has been categories, and to favor Primary Use drugs (such as penicil- on the market for longer, but its use in the equine population lin, tetracycline, potentiated sulfonamides) over Secondary or (mainly in neonates) has increased in North America since the Tertiary Use drugs when choosing an antimicrobial for first line 1990s (2). However, since Enterobacteriaceae are not typically treatment (5). A similar classification is recommended by the species-specific and numerous mobile genetic elements confer- British Equine Veterinary Association Protect ME program (12). ring resistance (plasmids, bacteriophages, transposons) can be Some clinical implications can be drawn from the results of this transferred between bacteria and across species (10), an increase study, particularly regarding respiratory infections. As previously in resistance is not necessarily only a consequence of increased reported (6), S. zooepidemicus was the most commonly isolated use of antimicrobials in the species of interest. Furthermore, bacterium from respiratory samples. None of these isolates even if resistance appears to be most common to the older were resistant to penicillin, which confirms that this antimi- antimicrobials such as tetracycline, streptomycin, penicillin, crobial could be the Primary Use drug of choice for horses with and sulfonamides (5), there are many exceptions and one cannon-life-threatening respiratory tract infections, unless culture not assume that increased resistance is always correlated with and sensitivity testing suggests otherwise. It should be noted increased use. that, in addition to the relatively low frequency of in vitro activ- This study also confirmed the continuing susceptibility of ity of TMS against S. zooepidemicus (65% in 2007 to 2013), S. zooepidemicus to penicillin, also reported by others (11). this antibiotic is unlikely to have appropriate in vivo activity The lack of resistance to penicillin and the few variations against S. zooepidemicus, even in the face of apparent suscep- observed for other antimicrobials over time is notable because tibility in vitro, making it a poor choice of Primary Use drug S. zooepidemicus is considered a mucosal commensal of the upper for respiratory infections. Indeed, it was suggested that TMS airways of horses and is therefore widely exposed to all anti- efficacy decreases in purulent exudates due to low pH and high

750 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY concentrations of p-aminobenzoic acid (13,14). When treating in individual patients, routine culture and susceptibility testing non-respiratory infections, in the presence of life-threatening should always be attempted for non-respiratory infections, or infections (respiratory or not), or in cases of poorly responding respiratory infections responding poorly to penicillin alone. CVJ respiratory infections, it becomes even more important to base therapeutic decisions on culture and sensitivity testing, because References the second most commonly isolated bacteria (Enterobacteriaceae) . 1 World Health Organization. Critically Important Antimicrobials for Human Medicine. 3rd Revision 2011. WHO Document Production have unpredictable resistance patterns. Services, Geneva, Switzerland, 2011. Available from: http://apps. ARTICLE Resistance should be interpreted with caution when spe- who.int/iris/bitstream/10665/77376/1/9789241504485_eng.pdf Last cies and organ-specific breakpoints are not available. Such accessed May 10, 2016. 2. Theelen MJ, Wilson WD, Edman JM, Magdesian KG, Kass PH. breakpoints are designed to predict the therapeutic outcome Temporal trends in prevalence of bacteria isolated from foals with sepsis: of a bacterial infection based on the expected antimicrobial 1979–2010. Equine Vet J 2014;46:169–173. concentrations that can be achieved in a patient, and ideally in 3. European Food Safety Authority and European Centre for Disease Prevention and Control. The European Union Summary Report on a specific organ, depending on pharmacodynamics and recom- antimicrobial resistance in zoonotic and indicator bacteria from humans, mended dosages (15). Only a limited number of breakpoints animals and food in 2012. Available from: http://www.efsa.europa.eu/ had been determined for equine pathogens at the time of the en/efsajournal/pub/3590 Last accessed October 29, 2015. 4. Johns IC, Adams EL. Trends in antimicrobial resistance in equine bacte- study and these include the following combinations: gentamicin rial isolates: 1999–2012. Vet Rec 2015;176:334. for Enterobacteriaceae, Pseudomonas aeruginosa, Actinobacillus 5. Morley PS, Apley MD, Besser TE, et al. Antimicrobial drug use in spp. (no organ specified), and ampicillin and ceftiofur for veterinary medicine. J Vet Intern Med 2005;19:617–629. 6. Lavoie JP, Couture L, Higgins R, Laverty S. Aerobic bacterial isolates in S. zooepidemicus (respiratory disease) (8). Because of this, while horses in a university hospital, 1986–1988. Can Vet J 1991;32:292–294. a therapeutic failure can most likely be predicted by the use of 7. Peyrou M, Higgins R, Lavoie JP. Evolution of bacterial resistance to an antimicrobial in a patient infected by an organism deemed certain antibacterial agents in horses in a veterinary hospital. Can Vet J 2003;44:978–981. “resistant,” its “susceptibility” should be interpreted with caution 8. Clinical and Laboratory Standards Institute. Performance Standards in clinical settings. Another point to consider when interpret- for Antimicrobial Disk and Dilution Susceptibility Tests for Bacteria ing the results of this study is that bacterial isolates obtained Isolated From Animals; Approved Standard — 4th ed. CLSI document VET01-A4: Clinical and Laboratory Standards Institute 2013. Available in referral centers might not represent infections treated in the from: http://shop.clsi.org/c.1253739/site/Sample_pdf/VET01A4_sam field, but rather cases seen for a second opinion, which could ple.pdf Last accessed May 10, 2016. have received prior antimicrobial treatment. Referral center 9. Sanchez LC, Giguère S, Lester GD. Factors associated with survival of neonatal foals with bacteremia and racing performance of surviving cases could also include nosocomial infections, which could Thoroughbreds: 423 cases (1982–2007). J Am Vet Med Assoc 2008; falsely increase resistance compared to community-acquired 233:1446–1452. infections or first line cases. In fact, it has been shown that prior 10. Dahmen S, Haenni M, Chatre P, Madec JY. Characterization of blaCTX-M IncFII plasmids and clones of Escherichia coli from pets in administration of antimicrobial drugs and sampling of hospital- France. J Antimicrob Chemother 2013;68:2797–2801. ized patients after their admission can influence susceptibility 11. Erol E, Locke SJ, Donahoe JK, Mackin MA, Carter CN. Beta-hemolytic patterns (16). Unfortunately, it was not possible to extract from Streptococcus spp. from horses: A retrospective study (2000–2010). J Vet Diagn Invest 2012;24:142–147. the available data the percentage of cases that had received prior 12. British Equine Veterinarians Association. PROTECT ME — Respon antimicrobial treatment. Finally, tetracycline was removed from sible antimicrobial use policy. Available from: http://www.beva.org. our routine susceptibility testing of equine bacterial isolates in uk/_uploads/documents/beva-antimicrobial-policy-template-2012.1.pdf Last accessed May 10, 2016. the 2000s and data are therefore missing for 2007 to 2013. 13. Ensink JM, Bosch G, van Duijkeren E. Clinical efficacy of prophylactic In conclusion, the results of this study show little overall administration of trimethoprim/sulfadiazine in a Streptococcus equi increase in resistance of common pathogens encountered in the subsp. zooepidemicus infection model in ponies. J Vet Pharmacol Ther 2005;28:45–49. equine species between the periods of 1986 to 1988 and 2007 14. Ensink JM, Smit JA, van Duijkeren E. Clinical efficacy of trimethoprim/ to 2013 for antimicrobials with data available for all 3 periods. sulfadiazine and procaine penicillin G in a Streptococcus equi subsp. However, a significant and worrisome increase in resistance was zooepidemicus infection model in ponies. J Vet Pharmacol Ther 2003; 26:247–252. observed for some bacteria to aminoglycosides, fluoroquino- 15. Rubin JE. Antimicrobial susceptibility testing methods and interpreta- lones, and third generation cephalosporins between the periods tion of results. In: Giguère S, Prescott JF, Dowling T, eds. Antimicrobial 1996 to 1998 and 2007 to 2013. Since S. zooepidemicus is the Therapy in Veterinary Medicine. 5th ed. Ames, Iowa: John Wiley & Sons, 2013. most commonly isolated pathogen from the respiratory tract 16. Dunowska M, Morley PS, Traub-Dargatz JL, Hyatt DR, Dargatz DA. and it appears to be consistently susceptible to penicillin, this Impact of hospitalization and antimicrobial drug administration on anti- should be the drug of choice for non-life-threatening respiratory microbial susceptibility patterns of commensal Escherichia coli isolated from the feces of horses. J Am Vet Med Assoc 2006;228:1909–1917. infections, unless culture and sensitivity testing suggests other- 17. Leclercq R, Canton R, Brown DF, et al. Clin Microbiol Infect 2013;19: wise. Since Enterobacteriaceae, Pseudomonas spp., and coagulase- 141–160. positive staphylococci have unpredictable susceptibility patterns

CVJ / VOL 57 / JULY 2016 751 FOR PERSONAL USE ONLY Case Report Rapport de cas

Presumed masitinib-induced nephrotic syndrome and azotemia in a dog

Lauren Devine, David J. Polzin

Abstract — Masitinib mesylate is a tyrosine-kinase inhibitor approved for the treatment of nonresectable or recurrent, Grade 2 or 3 mast cell tumors in dogs. This report describes nephrotic syndrome and acute kidney injury attributed to masitinib and illustrates the need for regular monitoring of serum creatinine concentration, urinalysis, and urine protein:creatinine ratio during its use.

Résumé — Présomption de syndrome néphrotique et d’azotémie induits par le masitinib chez un chien. Le mésylate de masitinib est un inhibiteur de la tyrosine-kinase homologué pour le traitement des mastocytes non résécables ou récurrents de grade 2 ou 3 chez les chiens. Ce rapport décrit le syndrome néphrotique et une blessure aiguë au rein attribués au masitinib et illustre le besoin d’une surveillance régulière de la concentration sérique de créatinine, des analyses d’urine et du ratio protéine:créatinine urinaire durant son utilisation. (Traduit par Isabelle Vallières) Can Vet J 2016;57:752–756

asitinib mesylate (Kinavet, AB Science, Short Hill, (VMC) for evaluation of acute onset of vomiting and abdominal M New Jersey, USA) is a tyrosine-kinase inhibitor that has distension of 1 wk duration. A mass had been noted on the left been approved for the treatment of nonresectable or recurrent, cheek 217 d prior to presentation. A Grade 1 mast cell tumor Grade 2 or Grade 3 mast cell tumors in dogs (1–10). The was diagnosed through incomplete surgical debulking with primary effect of masitinib is selective and potent inhibition histopathology on day 292. Several weeks later (Day 277), of c-KIT-dependent cell proliferation. Masitinib plays a role treatment was initiated with masitinib at a dose of 4.4 mg/kg in the inhibition of platelet-derived growth factor receptor body weight (BW), PO, q12h. (PDGFR)-dependent cell proliferation and Src family kinases A complete blood (cell) count (CBC) and serum chemistry such as LYN, a contributor to IgE-induced mast cell degranula- performed by the referring veterinarian for an unrelated sur- tion in vitro (2,5,7,11). The effect of masitinib on renal func- gery prior to beginning the masitinib therapy (Day 2337), tion is theorized to be a direct inhibition of c-KIT on the renal revealed abnormalities that were consistent with mild dehydra- tubules or on the glomerular cells that express PDGF receptors tion (Table 1). A CBC and serum chemistry performed 1 mo (1,7). Reported renal-related side effects of masitinib include (Day 230) after initiation of the medication revealed no sig- proteinuria, nephrotic syndrome, and renal failure (2). To the nificant abnormalities. The day before presentation (Day 21) authors’ knowledge, this is the first report describing a severe to the VMC, the dog had been examined by her referring vet- case of Masitinib-related nephrotic syndrome (NS) and acute erinarian for lethargy, inappetance, polydipsia, and abdominal kidney injury (AKI) with complete recovery of renal function distension of 1 wk duration. At that time, the serum chemistry based on biochemistry and urinalysis parameters. results indicated panhypoproteinemia (Table 1) on an in-house chemistry analyzer and the referring veterinarian discontinued Case description masitinib and recommended a high protein diet. A 3-year-old, 29.8 kg, intact female Weimaraner dog was pre- The following day (Day 0), the dog was presented to the sented to the University of Minnesota Veterinary Medical Center University of Minnesota emergency service for vomiting and lethargy of 6 h duration. Physical examination revealed moderate submandibular edema and profound abdominal distension. North Carolina State Veterinary Hospital — Internal Medicine, As a consequence, packed cell volume, total plasma protein, 1060 William Moore Drive, Raleigh, North Carolina 27607, point-of-care chemistry analysis (Chem81 iStat; Abaxis, Union USA (Devine); University of Minnesota — Internal Medicine, City, California, USA), 4DX SNAP test (IDEXX, Westbrook, St. Paul, Minnesota, 55108, USA (Polzin). Maine, USA), abdominal radiographs, abdominal FAST scan Address all correspondence to Dr. Lauren Devine; email: (Focused Assesment with Sonography for Trauma Scan) and [email protected] abdominocentesis were performed. The total plasma protein Use of this article is limited to a single copy for personal study. was low at 48 g/L; however, the limited chemistry panel was Anyone interested in obtaining reprints should contact the unremarkable. Serological tests for Diroflaria immitis, Anaplasma CVMA office ([email protected]) for additional phagocytophilum, Ehrlichia canis, and Borrelia burgdorferi were copies or permission to use this material elsewhere. negative. Abdominal radiographs revealed poor serosal detail due

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Table 1. Changes in biochemistry values over time CREA BUN TP Albumin Sodium Chloride Phosphorus Bicarbonate Cholesterol 53 to 3.2 to 50 to 27 to Globulin 145 to 109 to 1.07 to 15 to 3.7 to Day 141 mmol/L 11.0 mmol/L 69 g/L 37 g/L 17 to 35 g/L 153 mmol/L 118 mmol/L 2.2 mmol/L 25 mmol/L 9.66 mmol/L 2337 61.88 3.93 78 45 32 138 NA 1.26 NA NA 230a 61.88 4.28 68 42 26 142 NA 1.42 NA NA CASE REPORT CASE 21b 97.24 6.78 34 21 13 130 NA 2.45 NA NA 1c 114.92 7.14 35 9 26 144 120 1.65 11.8 11.99 3 150.28 17.14 25 , 15 NDd 140 126 2.07 7.6 9.14 4e 256.36 25.35 38 10 27 141 122 3.13 6 10.08 5 344.76 32.84 36 11 24 140 120 2.71 9.8 8.62 6 362.44 32.48 36 11 24 142 122 2.68 10.8 8.81 9 316.24 26.76 37 12 25 141 122 2.61 9.5 10.77 16 97.24 9.28 44 16 28 143 111 1.65 22.9 12.71 30 70.72 4.64 58 27 31 145 112 1.20 24 9.19 44 70.72 5.71 60 30 30 145 111 1.20 22.7 6.99 196 70.72 6.07 63 35 28 145 111 1.03 22.4 5.96

Masitinib was initiated on day 277. a A CBC and serum chemistry were performed within 1 mo of initiation of therapy (day 230). b Masitinib was discontinued on day 21. c The subcutaneous mass on the left check was noted in the same location as the previously incompletely excised mast cell tumor. d The globulin value was not detectable on the chemistry analyzer. e The catheter site infection was observed. CREA — creatine; BUN — blood urea nitrogen; TP — total protein; NA — not available.

to abdominal effusion, and the FAST scan confirmed a moder- dexamethasone-SP were administered to minimize increased ate to severe abdominal effusion. Cytology of the abdominal vascular permeability secondary to histamine from the mast fluid revealed a transudate with protein (, 25 g/L), and a total cell tumor. Maropitant was continued throughout the course nucleated cell count of 680 cells/mL. Systolic blood pressure of hospitalization. was 120 mmHg. Upon admission into the Intensive Care Unit, On the third day, a moderate amount of a subcutaneous a colloid osmotic pressure was determined to be decreased at edema of the vulva, perianal region, and hind limbs was pres- 6.5 mmHg [reference interval (RI): 19.95 to 22.05 mmHg], and ent. Pyrexia of 40.6°C and a mild catheter site inflammation a metoclopramide (Reglan; Hospira, Lake Forrest, Illinois, USA) were discovered that afternoon. Purulent debris exuded from constant rate infusion (CRI) and a subcutaneous injection of the catheter site during removal and the body temperature Maropitant (Cerenia; Zoetis, Madison, New Jersey, USA) were returned to normal (37.9°C) several hours after removal of the administered to address the vomiting. catheter and addition of antibiotics. Cytologic examination The next morning (Day 1), physical examination revealed of the purulent debris revealed a marked septic neutrophilic an approximately 2 cm diameter movable, soft, subcutaneous inflammation with cocci bacteria. A serum chemistry, urine mass on the left cheek, a mild amount of dependent subcuta- sodium, and Rocky Mountain spotted fever titer revealed pan- neous edema on the ventral thorax, and abdominal distension. hypoproteinemia, progressive hypobicarbonemia, and azotemia The subcutaneous mass on the left cheek was consistent with (Table 1). Urine sodium concentration determined on a urine recurrence of the previously diagnosed mast cell tumor. A sample obtained on Day 3 was elevated at 59 mmol/L (prer- CBC, serum chemistry, abdominal ultrasound, and thoracic enal: , 20 mmol/L) possibly indicating active renal tubular radiographs were performed. A serum chemisty panel revealed dysfunction or a physiologic response post hetastarch therapy hypoalbuminemia, hypobicarbonemia, and hypercholesterol- (14). The Rocky Mountain spotted fever titer was negative. emia (Table 1). The urine sample obtained on admission was Ampicillin sublactam (Pfizer, New York, New York, USA), not evaluated and reported until Day 3. This urinalysis revealed 22 mg/kg body weight (BW), q8h, and enrofloxacin (Bayer, isothenuria, hematuria, proteinuria, pyuria, and bacteruria Shawnee Mission, Kansas, USA), 10 mg/kg BW, q24h, were (Table 2). The urine protein:creatinine ratio (UPC) was sig- initiated and Prednisone (Prednisone; Teva Parenteral Medicines, nificantly elevated at 36.3 (normally , 0.2). Abdominal ultra- Irvine, California, USA), 0.5 mg/kg BW, q24h was continued sound revealed marked abdominal effusion, edema of the gall to prevent mast cell degranulation. Hetastarch was discontinued bladder wall, and subcutaneous edema. Thoracic radiographs due to the progression of the subcutaneous edema and poor and a CBC were unremarkable. Colloid osmotic pressure on colloid osmotic pressure response suggesting possible overfill. Day 2 remained low at 7.6 mmHg (RI: 19.95 to 22.05 mmHg). Ondansetron (Zofran; Wockhart, Mumbai, India) and famoti- Treatment for Days 1 and 2 included Hetastarch (Hydroxyethyl dine (Pepcid; Westward Pharmaceutical, Eatontown, New Jersey, starch; Teva Parenteral Medicines, Irvine, California, USA) and a USA) were administered for the vomiting prior to presentation. proton pump inhibitor (Pantoprazole; Protonix, Pfizer, Madison, The catheter site became severely inflamed and painful on New Jersey, USA). Dexamethasone-SP (Dexamethasone Sodium Day 4. An ultrasound of the limb revealed 3 separate pock- Phosphate; Vedco, St. Joseph, Missouri, USA) and diphen- ets of fluid; culture and sensitivity testing of the fluid grew hydramine (Benadryl; Parkedale Pharmaceuticals, Rochester, Staphylococcus intermedius group resistant to ampicillin and Michigan, USA) were administered once intravenously fol- penicillin, but susceptible to enrofloxacin. Three separate blood lowed by oral diphenhydramine. Diphenhydramine and cultures revealed no bacterial growth after 5 d. A CBC revealed

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Table 2. Urinalysis and urine protein:creatinine values over time Occult Day USG pH blood Protein WBC Bacteria UPC 0a 1.013 7.5 21 31 5 to 20/HPF Many rods/HPF 36.3 4 1.021 6.5 11 31 occasional none NA 6 1.017 6.5 21 31 5 to 20/HPF none 23.7 16 1.013 6.5 11 21 occasional none 8.3 30 0.1 44 0.1 196 1.025 7.5 Trace Negative Negative Negative 0.1

a The day 0 sample was not reported until day 3. USG — urine specific gravity; WBC — white blood cells; UPC — urine protein:creatinine ratio, which is normally , 0.2, urine samples were collected by cystocentesis on days 4 to 196; HPF — high-powered RAPPORTCAS DE field; NA — not available.

an inflammatory leukogram and a mild nonregenerative anemia: (Table 1). The UPC ratio remained elevated (Table 2). The dog’s leukocytosis 22 470/mL (RI: 3880 to 14 570/mL), neutrophilia clinical signs appeared to be improving, and she was discharged 20 220/mL (RI: 2100 to 11 200/mL), with a regenerative left shift from the hospital the same afternoon. 220/mL (RI: 0 to 130/mL), lymphopenia 450/mL (RI: 780 to The dog was monitored closely on an outpatient basis and 3360/mL), and a monocytosis 1570/mL (RI: 0 to 1200/mL). renal profiles were repeated on days 9, 16, 30, and 44. The A nonrengenerative anemia was present with a hematocrit UPC ratio values were repeated on days 16, 30, and 44 and of 34% (37.5% to 60.3%), red blood cell concentration of a urinalysis was performed on day 16. Three days after dis- 4.96 3 106/mL (RI: 5.44 to 8.79 3 106/mL), and a hemoglobin charge (Day 9), a renal profile revealed mild improvement in concentration of 118 g/L (RI: 133 to 207 g/L) were noted. The serum creatinine, urea nitrogen, phosphorus, and bicarbonate serum chemistry revealed progression of the renal dysfunction concentrations while serum albumin concentration remained with progressive elevations in blood urea nitrogen (BUN), cre- static. Hypercholesterolemia worsened, most likely attribut- atinine, and phosphate, worsened hypobicarbonemia, and static able to recent feeding (Table 1). One week later (Day 16), the serum albumin concentration (Table 1). Urinalysis revealed a azotemia had completely resolved and both hypoproteinemia, persistent proteinuria with occasional white blood cells, but no and hypoalbuminemia had improved. The UPC ratio was mark- bacteria (Table 2). A urine culture was sterile. The prothrom- edly improved but proteinuria persisted (Table 2). By day 30, bin time (PT) was within normal limits, but the activated the renal and electrolyte values had returned to pre-masitinib partial thromboplastin time (aPTT) was slightly prolonged levels and the UPC ratio was normal (Table 1). These values at 21.3 s (RI: 9.8 to 14.6 s). Venous blood gas (EC71 iStat; were similar on days 44 and 196. Abaxis) revealed a metabolic acidosis with respiratory compensation: pH of 7.095 (RI: pH 7.3 to 7.47), hypobicarbonatemia Discussion 10 mmol/L (RI: 17.8 to 27.2 mmol/L), pCO, 32.5 mmHg The Weimaraner dog in this case report had laboratory and

(RI: 28.9 to 44.4 mmHg), and total CO2 11 mmol/L (18.6 to physical examination findings consistent with nephrotic syn- 28.4 mmol/L). Metabolic acidosis was treated with sodium drome (NS) and concurrent acute kidney injury (AKI) presumed bicarbonate (Hospira). Massage and warm compresses were initi- secondary to masitinib administration. Masitinib mesylate is ated to improve blood and lymphatic circulation to the affected labeled for use in dogs for Grades 2 or 3 nonresectable mast cell limb. A fentanyl patch (Duragesic Patch; Noven Pharmaceutical, tumors at a dose of 12 mg/kg BW per day (2,4). In this case, Miami, Florida, USA) was applied for the pain, and clinicare masitinib was used at a dose lower than recommended, and in an liquid diet (CliniCare; Abbott, Abbott Park, Illinois, USA) was extralabel fashion in that the mast cell tumor was Grade 1. The administration through a nasoesophageal feeding tube. noteworthy and not previously reported aspect of this case is the Clinical improvement of the catheter site infection was recovery of normal kidney function with no apparent long-term noted on Day 5. A serum chemistry profile revealed further sequellae despite masitinib-associated severe nephrotic syndrome progression of the azotemia, and a relatively static hyper- and concurrent IRIS AKI Grade II. This case demonstrates that phosphatemia, hypoalbuminemia, and hypobicarbonatemia dogs affected by severe masitinib-associated nephrotic syndrome (Table 1). The point-of-care venous blood gas analysis revealed with concurrent AKI can recover and return to normal levels of improvement in the metabolic acidosis with a pH 7.137, hypo- kidney function without long-term complications when treated bicarbonatemia 10.2 mmol/L (RI: 17.8 to 27.2 mmol/L), and by withdrawal of masitinib and supporting therapy.

pCO2 37.1 mmHg (RI: 28.9 to 44.4 mmHg). Pantoprazole Nephrotic syndrome is defined as the presence of hypo- and Trimethoprim sulfamethoxazole (SMX-TMP; Amneal albuminemia, proteinuria, extravasulcar fluid accumulation, Pharmaceutical, Hauppauge, New York, USA) were added to the and hypercholesterolemia. Nephrotic syndrome is seemingly treatment protocol, and ampicillin sulbactam was discontinued uncommon in dogs, with the median number of dogs diag- based on the culture and sensitivity results of the catheter site nosed with NS at tertiary institutions reported to be 0.5 every infection. 12 mo (12). Hypoalbuminemia and proteinuria occur due to On Day 6, the serum creatinine concentration continued to the loss of selective permeability of the glomerulus. The hypo- rise; however, the other blood values remained relatively stable albuminemia may cause secondary hypercholesterolemia due to

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hepatic b iosynthesis upregulation, changes in plasma viscosity, villous transformation. Patchy interstitial inflammation and or as a compensatory mechanism to low plasma oncotic pres- multiple microthrombi were noted upon cross section of the sure (12,13). Ascites occurs in approximately 75% of canine Labrador’s kidney. While the Schnauzer’s nephrotic syndrome NS cases. Pitting edema and subcutaneous fluid, the most clinically resolved, the Labrador was ultimately euthanized due common finding in people with NS, is noted in 60% of dogs. to increasing renal dysfunction (1,7).

The ascites fluid is characterized as a pure transudate with a Interpretation of the UPC ratio in this case is complicated by REPORT CASE nucleated cell count of less than 1500 cells/mL and a protein the bacteriuria and pyuria detected in the first urine sample. The concentration , 25 g/L (12,13). It is possible that masitinib has urinary tract infection (UTI) is a possible cause for proteinuria. an undescribed direct effect on peripheral blood vessels. Edema, In our case, the method of the first urine collection was unclear primarily periorbital, was noted in 26% of humans during a and, while it was collected on day 1, it was not analyzed for 3 d. masitinib trial for rheumatoid arthritis. In a sizable proportion A meta-analysis of 80 human studies examining associations of patients, the edema persisted and was thought to be secondary between proteinuria and asymptomatic UTI found that in only to PDGFR inhibition in the periorbital region (11). Periorbital 10 studies did UTI have a significant effect on proteinuria (16). edema has been described as a possible complication of masitinib Although significantly elevated UPC ratio values have been in humans and it may be a contributing factor to the subcutane- reported in several dogs with experimentally induced cystitis ous edema in the dog in the present case. (17), a prospective study of the effect of pyuria and bacteriuria The progressive azotemia in this case is consistent with AKI, in dogs revealed no correlation between the degree of pyuria which may be attributable to the drug’s effect on the glomerulus, and the magnitude of increase in UPC ratio. For 39 dogs with renal tubules, or both. Other causes of AKI such as pyelone- 6 to 20 white blood cells/high-powered field (HPF), similar to phritis and hypoperfusion are less likely, given the continued this dog, the UPC ratio ranged from 0 to 0.55 (median: 0.16). progressive azotemia despite adequate volume support and broad The UPC ratio values in 26 dogs with observed bacteriuria spectrum antibiotics. In the safety and efficacy study published ranged from 0 to 1.4 (median: 0.2) (18). Similar to our case, the by Hahn et al (4), renal disorders were reported in 12 out of Labrador reported to have masitinib-associated minimal change 161 dogs (7.5%) following treatment with masitinib, compared nephropathy had 5 to 10 WBC/HPF, 41 protein, 31 blood, and to 2 dogs (4.9%) in the placebo group. Renal dysfunction in a UPC ratio of 12 prior to euthanasia (1). Therefore, it is likely this population of dogs was characterized as glomerulonephritis, that the markedly elevated UPC ratio observed in the current renal failure, nephrotic syndrome, and/or proteinuria. Renal case was not a consequence of bacterial UTI. It is possible that biopsy with electron microscopy was not performed in any this dog’s AKI may be a consequence of pyelonephritis; how- of the dogs with noted renal disorders; therefore, the type of ever, pyelonephritis does not adequately explain the nephrotic glomerular or tubular lesion was not definitively diagnosed in syndrome in this dog. Further, the association between AKI this study. All of the dogs affected with renal dysfunction had and masitinib is well-established in the efficacy and safety study baseline BUN and creatinine values that were high/normal to and previous case reports. In addition, there was no evidence of mildly elevated (1,2). Three of the 12 dogs were euthanized pyelonephritis in this dog. and 6 dogs recovered without sequelae (1). In contrast with The catheter site infection observed in this case is likely the findings in the safety and efficacy study, the dog in the attributed to immunosuppression secondary to kidney dysfunc- current case had a normal creatinine prior to the development tion and/or administration of corticosteroid therapy to prevent of AKI. A safety trial of masitinib mesylate in cats documented mast cell degranulation. However, secondary infections have significant elevations in serum creatinine concentrations and been well-documented in humans with NS. Humans have an a corresponding drop in serum albumin concentrations from up to 13-fold increase in risk for the development of bacterial baseline levels (15). Although changes in creatinine and serum infections and sepsis (19,20). However, this complication has albumin concentrations were noted from baseline, neither value yet to be clearly associated with NS in the veterinary literature. appeared outside reference ranges in the population of study Most dogs in the study by Hahn et al (4) and the dog in the cats. Furthermore, 10% of the cats in this study experienced minimal change nephropathy case report (7) recovered fully reversible proteinuria (15). with no long-term sequelae. Despite the severity of the azotemia Renal complications associated with masitinib have been and NS, the dog in this case report recovered rapidly, and with- reported in the veterinary literature. Minimal change nephropa- out relapse or long-term sequelae after discontinuation of the thy secondary to masitinib administration was described in a medication. Based on the number of dogs noted to have eleva- giant schnauzer (7) and in a Labrador retriever (1). Clinical find- tions in renal values and/or proteinuria in the study by Hahn ings in the schnauzer included progressive panhypoproteinemia, et al (4), it seems prudent to recommend serial monitoring of and proteinuria without azotemia. The Labrador presented with serum chemistry, urinalysis, and UPC ratio for all dogs receiv- vomiting, and abdominal pain, which progressed to severe sub- ing masitinib mesylate. Significant elevations in renal values cutaneous edema and oligouric renal failure. Light microscopy and/or proteinurina dictate discontinuation of the medication on both dogs’ kidneys postmortem revealed podocyte enlarge- and subsequent monitoring of renal function. Serial UPC ratio ment, mild thickening or splitting of the basement membrane may be an early marker for renal dysfunction in dogs treated in the Bowman’s capsule, and slight swelling of the proximal with masitinib (6). When this dog was initially presented to tubular epithelium. Lesions observed by electron microscopy the referring veterinarian, she had a serum creatinine above her in both dogs confirmed podocyte effacement, swelling, and previously observed values but not greater than the reference

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range. Elevations in serum creatinine above baseline may war- 10. Procoli F. Clinical trial on the efficacy of masitinib in canine IBD. Vet rant discontinuation of masitinib, or at the very least increased Rec 2010;167:760. 11. Walker UA. More about masitinib. Arthritis Res Ther 2009;11:120. monitoring, even if the serum creatinine concentration remains 12. Klosterman ES, Pressler BM. Nephrotic syndrome in dogs: Clinical within reference range. CVJ features and evidence-based treatment considerations. Top Companion Anim Med 2011;26:135–142. References 13. Klosterman ES, Moore GE, de Brito Galvao JF, et al. Comparison of signalment, clinicopathologic findings, histologic diagnosis, and 1. Brown MR, Cianciolo RE, Nabity MB, Brown CA, Clubb FJ, prognosis in dogs with glomerular disease with or without nephrotic Lees GE. Masitinib-associated minimal change disease with acute syndrome. J Vet Intern Med 2011;25:206–214. tubular necrosis resulting in acute kidney injury in a dog. J Vet Intern 14. Waldrop JE. Urinary electrolytes, solutes, and osmolality. Vet Clin North Med 2013;27:1622–1626. Am Small Anim Pract 2008;38:503–512, ix. 2. Gentilini F. Letter to the editor: “Masitinib is safe and effective for the 15. Daly M, Sheppard S, Cohen N, et al. Safety of masitinib mesylate in treatment of canine mast cell tumors.” J Vet Intern Med 2010;24:6; healthy cats. J Vet Intern Med 2011;25:297–302. author reply 7. RAPPORTCAS DE 16. Nicolle LE. Asymptomatic urinary tract infection is unlikely to 3. Daigle J, Moussy A, Mansfield CD, Hermine O. Masitinib for the cause proteinuria or microalbuminuria. Nat Clin Pract Nephrol treatment of canine atopic dermatitis: A pilot study. Vet Res Commun 2007;3:242–243. 2010;34:51–63. 17. Bagley RS, Center SA, Lewis RM, et al. The effect of experimental cys- 4. Hahn KA, Legendre AM, Shaw NG, et al. Evaluation of 12- and titis and iatrogenic blood contamination on the urine protein/creatine 24-month survival rates after treatment with Masitinib in dogs with ratio in the dog. J Vet Intern Med 1991;5:66–70. nonresectable mast cell tumors. Am J Vet Res 2010;71:1354–1361. 18. Vaden SL, Pressler BM, Lappin MR, Jensen WA. Effects of urinary tract 5. London CA. Tyrosine kinase inhibitors in veterinary medicine. Top inflammation and sample blood contamination on urine albumin and Companion Anim Med 2009;24:106–112. total protein concentrations in canine urine samples. Vet Clin Pathol 6. Smrkovski OA, Essick L, Rohrbach BW, Legendre AM. Masitinib 2004;33:14–19. mesylate for metastatic and non-resectable canine cutaneous mast cell 19. Wei CC, Yu IW, Lin HW, Tsai AC. Occurrence of infection among tumours. Vet Comp Oncol 2015;13:314–321. children with nephrotic syndrome during hospitalizations. Nephrology 7. Sum SO, Hensel P, Rios L, et al. Drug-induced minimal change (Carlton) 2012;17:681–688. nephropathy in a dog. J Vet Intern Med 2010;24:431–435. 20. Wu HM, Tang JL, Cao L, Sha ZH, Li Y. Interventions for prevent- 8. Takeuchi Y, Fujino Y, Fukushima K, et al. Biological effect of tyrosine ing infection in nephrotic syndrome. Cochrane Database Syst Rev kinase inhibitors on three canine mast cell tumor cell lines with various 2012;4:CD003964. KIT statuses. J Vet Pharmacol Ther 2012;35:97–104. 9. Thamm DH, Rose B, Kow K, et al. Masitinib as a chemosensitizer of canine tumor cell lines: A proof of concept study. Vet J 2012;191: 131–134.

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756 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY Case Report Rapport de cas

Hypoadrenocorticism mimicking protein-losing enteropathy in 4 dogs

Janne G. Lyngby, Rance K. Sellon

Abstract — Four dogs referred for suspected protein-losing enteropathy based on clinical signs, severe hypoalbuminemia, and hypocholesterolemia, and in 2 dogs, abdominal effusion or peripheral edema, were diagnosed with hypoadrenocorticism. Dogs with hypoadrenocorticism may have features of protein-losing enteropathy, including ascites or peripheral edema, which have not been described in dogs with hypoadrenocorticism.

Résumé — Hypoadrénocorticisme imitant l’entéropathie avec perte de protéines chez 4 chiens. Quatre chiens recommandés pour une entéropathie suspectée avec perte de protéines fondée sur les signes cliniques, accompagnée d’une hypoalbuméniémie grave et de l’hypocholestérolémie et, chez 2 chiens, d’une effusion abdominale ou d’un œdème périphérique, ont reçu un diagnostic d’hypoadrénocorticisme. Les chiens atteints d’hypoadrénocorticisme peuvent présenter des signes d’entéropathie avec perte de protéines, y compris de l’ascite ou de l’œdème périphérique, qui n’ont pas été décrits chez les chiens atteints d’hypoadrénocorticisme. (Traduit par Isabelle Vallières) Can Vet J 2016;57:757–760

ome clinicopathologic abnormalities of hypoadrenocorti- On hematologic evaluation performed 4 d before referral, S cism, such as hypoalbuminemia, hypoglycemia, and hypo- there was a mild hypochromic anemia. Mean corpuscular cholesterolemia (1) could be misinterpreted as liver disease or volume (MCV), reticulocyte count, and blood smear exami- gastrointestinal disease from protein-losing enteropathy (PLE), nation were not performed. There was no evidence of a stress potentially leading to inappropriate diagnostic and treatment leukogram. Serum biochemical abnormalities included hypopro- interventions. To the authors’ knowledge, there are no published teinemia, hypoalbuminemia, and hypoglobulinemia (Table 1). reports in the veterinary literature of hypoadrenocorticism A post-prandial bile acid concentration was normal. No abnor- resulting in hypoalbuminemia severe enough to cause abdomi- malities were noted on urinalysis. nal effusion or edema. The purpose of this report is to describe On examination at the referral hospital 4 days later, the dog 4 dogs with PLE-like features, including abdominal effusion and was quiet, alert, and responsive. The dog was underweight with peripheral edema, that were attributed to hypoadrenocorticism. a body condition score (BCS) of 2/5. The rectal temperature was 38.7°C. There was mild to moderate generalized muscle Case descriptions atrophy. Abdominal effusion made abdominal palpation chal- Case 1 lenging. Heart and lung sounds were normal. Peripheral lymph A 5-year-old spayed female Labrador retriever (dog 1) weighing nodes appeared normal. There was no information regarding 35.1 kg was referred with a 6- to 8-week history of worsen- rectal examination noted in the medical record. The remainder ing lethargy, decreased appetite, chronic anemia, ascites, and of the physical examination was normal. panhypoproteinemia. There was no history of vomiting or Abdominal ultrasound showed marked ascites and mild diarrhea, but there were 3 episodes of regurgitation. The dog enlargement of medial iliac (1.5 cm) and mesenteric lymph had developed melena at the time of presentation. The dog was nodes (1.4 cm). No abnormalities were noted in the stomach, up-to-date on vaccinations had not travelled outside the Pacific or small or large intestine. The adrenal glands were not visual- Northwest, and was not on any medications prior to referral. ized. Results of peritoneal fluid analysis were consistent with a pure transudate (protein: 15 g/L, nucleated cell count/mL: 1430 with 46% non-degenerate neutrophils, 38% small lym- Department of Veterinary Clinical Sciences, College of phocytes, 12% macrophages, and 4% eosinophils) attributed Veterinary Medicine, Washington State University, 205 Ott to hypoalbuminemia. Road #1002, Pullman, Washington 99164, USA. Serum biochemical abnormalities included hypocholesterol- Address all correspondence to Dr. Janne Lyngby; e-mail: emia, hypoalbuminemia, hypoglobulinemia, and hypocalcemia [email protected] (Table 1); ionized calcium was not determined. The diagnosis Use of this article is limited to a single copy for personal study. of hypoadrenocorticism was confirmed on adrenocorticotropic Anyone interested in obtaining reprints should contact the hormone (ACTH) stimulation test (Table 1). CVMA office ([email protected]) for additional The dog was treated with prednisone (PredniSONE Tablets copies or permission to use this material elsewhere. USP; Boehringer Ingelheim Roxane Laboratories, Columbus,

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Table 1. Hematologic and biochemical abnormalities in 4 dogs with hypoadrenocorticism and signs of gastrointestinal disease Dog 1a Dog 2b Dog 3c Dog 4c Neutrophils/mL (2000 to 12 000) 4256 7300 1014 11 070 Lymphocytes/mL (1500 to 6000) 2508 1500 2496 2160 Monocytes/mL (0 to 800) 304 300 156 135 Eosinophils/mL (0 to 1200) 532 0 0 135 Total protein g/L (54 to 82) 33 50 32 22 Albumin g/L (29 to 38) 13 9 12 11 Cholesterol mmol/L (3.5 to 9.2) 2.8 0 1.5 0.9 Glucose mmol/L (3.6 to 6.9) 3.9 3.8 2.4 6.2 Sodium mmol/L (149 to 158) 149 145 154 153 Potassium mmol/L (3.7 to 5.3) 4.1 4.2 4.4 4.2 RAPPORTCAS DE Total calcium mmol/L (2.3 to 2.8) 2.1 2.4 2.1 1.9 Resting cortisol nmol/L , 27.6 , 27.6 , 27.6 , 27.6 Post ACTH cortisol nmol/L (. 2)d , 27.6 , 27.6 , 27.6 , 27.6

Reference ranges are in parentheses. a Results from the CBC were obtained 4 d before presentation to the VTH; the biochemistry results are from the day of presentation. b Results obtained 1 d before referral. c Results obtained on day of presentation to the VTH. d ACTH stimulation tests were performed after presentation to the VTH.

Ohio, USA), 0.28 mg/kg body weight (BW), PO, q24h and palpation. Peripheral lymph nodes were normal. No abnormali- discharged to follow-up with the regular veterinarian. Two weeks ties were noted on rectal examination. after discharge there was improvement in the laboratory abnor- Abnormal results of a complete blood (cell) count (CBC) malities and all had resolved 2 mo after discharge. The ascites, included a microcytic, non-regenerative anemia [reticulocyte regurgitation, and melena had reportedly resolved and the dog count 0.025 3 106/mL, reference interval (RI): . 0.1 3 106/mL had a good appetite and energy level. The patient was continued for regeneration]. There was still no evidence of a stress leuko- on the same dose of predisone. gram and abnormalities of the biochemical profile persisted. The diagnosis of hypoadrenocorticism was confirmed on ACTH Case 2 stimulation test (Table 1). A 5-year-old castrated male great Dane (dog 2) weighing 52.4 kg The dog was treated with prednisone, 0.29 mg/kg BW, PO, was referred for endoscopic examination and biopsy of the q24h, and discharged to follow-up with the regular veterinarian. gastrointestinal tract for hypoproteinemia presumed secondary All laboratory abnormalities had resolved at examination 4 wk to gastrointestinal disease. Three days prior to presentation to after discharge, and the dog had gained weight. At this time the the referral hospital the dog was seen for acute gastric dilation prednisone dose was decreased to 0.19 mg/kg, BW PO, q24h, at an emergency clinic, at which time laboratory abnormalities and the dog was reported to do well on this dose. included hypoalbuminemia, hypoglycemia, hypocholesterolemia, and anemia. Clinical signs resolved after orogastric tube Case 3 decompression. The dog had been losing weight over the last A 10-year-old spayed female husky (dog 3) weighing 37.6 kg was 6 mo, despite a good appetite. There was no history of vomiting referred for an 8- to 12-week history of colitis. Initially, colitis or diarrhea. The dog was up to date on vaccinations and had was treated with an unspecified dose of metronidazole resulting not travelled outside the Pacific Northwest. in weakness that resolved after discontinuation of metronidazole. Two days before referral the dog had mild to moderate One week before presentation to the referral hospital the dog anemia; a reticulocyte count was not performed. There was developed hematochezia. At the time of presentation the dog no evidence of a stress leukogram. Abnormalities on a limited also had hematemesis. The dog was up-to-date on vaccinations. serum chemistry panel included hypoproteinemia, severe hypo- Travel history was not noted in the medical record. albuminemia, hypoglycemia, and no measureable cholesterol on On examination the dog was quiet, alert, and responsive. repeated tests (Table 1). The only abnormality on urinalysis was Heart and lung sounds were normal. There were no abnor- mild hyperbilirubinuria. On abdominal ultrasound the liver, malities noted during abdominal palpation. Mucous membranes gastrointestinal tract, spleen, kidneys, bladder, and pancreas were were pale pink with a capillary refill time of 3 s. Peripheral unremarkable. The adrenal glands were small with the right and lymph nodes appeared normal. The dog had pitting edema of left measuring 5 mm and 4.1 mm, respectively. the peripheral limbs, ventral abdomen, and thorax. There was At the referral hospital the dog was quiet, alert, responsive, no information regarding rectal examination recorded in the and underweight with a BCS of 1.5/5. There was severe gen- medical record. eralized muscle atrophy. Mucous membranes were pale pink On a CBC there was no evidence of a stress leukogram, with a capillary refill time of 2 s. Heart and lung sounds were but there was moderate neutropenia. Abnormal serum chem- apparently normal. No abnormalities were noted on abdominal istry panel results (Table 1) included hypocholesterolemia,

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hypoproteinemia, hypoalbuminemia, hypoglycemia, and hypo- Discussion calcemia attributed to hypoalbuminemia; ionized calcium was All 4 dogs in this report were referred for evaluation of what not determined. The diagnosis of hypoadrenocorticism was was believed to be primary gastrointestinal (GI) disease; all were confirmed on ACTH stimulation test (Table 1). The CBC diagnosed with hypoadrenocorticism. Although the presence was repeated the following day and the neutrophil count had of a primary enteropathy was not definitively excluded in any normalized. REPORT CASE of these dogs, resolution of both clinical signs and laboratory An abdominal ultrasound showed fluid-filled and hypomotile abnormalities of hypoproteinemia, hypoalbuminemia, and small and large bowels and a scant amount of free peritoneal hypocholesterolemia following therapy with physiologic replace- fluid. The remaining abdomen was normal; however, there was ment doses of prednisone supports the likelihood that all of the no specific mention of the adrenal glands in the ultrasound clinical features of these dogs were a consequence of untreated report. The thoracic radiographs were unremarkable except for hypoadrenocorticism and not a concurrent enteropathy. evidence of hypovolemia. The dogs in this report were suspected of having PLE, a The patient was administered prednisolone sodium succinate spectrum of GI diseases characterized by loss of serum proteins (Zoetis, Kalamazoo, Michigan, USA), 0.5 mg/kg BW, IV, q12h, into the GI tract. Dogs with PLE are often seen for chronic for 1 d until she regained her appetite. With resumption of food consumption the dog was discharged to follow-up with or relapsing diarrhea and/or vomiting, and commonly exhibit the regular veterinarian with prednisone, at 0.53 mg/kg BW, weight loss. They may have ascites, pleural effusion, or periph- PO, q24h for 1 wk and then decreased to 0.13 mg/kg BW, PO, eral edema, usually as a consequence of hypoalbuminemia and q24h. Four weeks after discharge all previously documented low oncotic pressure (2). Common laboratory findings include clinical and biochemical abnormalities had normalized. hypoalbuminemia, hypocholesterolemia, and potentially hypoglobulinemia, lymphopenia, hypocalcemia, hypomagnesemia, Case 4 and hypocobalaminemia (1–2). The diagnostic approach to A 5-year-old neutered male Labrador retriever (dog 4) weighing a dog suspected of having PLE commonly involves exclusion 28 kg was evaluated for a 2-day history of lethargy, vomiting, of other causes of hypoalbuminemia including protein-losing diarrhea, and hematochezia. Previous history included an avul- nephropathy, liver failure, and third space losses, but hypoadre- sion of the right front dew claw 2 wk earlier, and an episode of nocorticism is not routinely mentioned as a differential diagnosis vomiting and diarrhea 8 mo prior. (2–3). The 4 cases described here highlight the importance of On examination, the dog was quiet, alert, and responsive, considering hypoadrenocorticism as a differential diagnosis for but shortly became obtunded and laterally recumbent. The dog a PLE-like presentation in dogs with hypoalbuminemia and/or had a BCS of 3/5. Mucous membranes were pink and capillary hypocholesterolemia, even when such dogs exhibit clinical refill time was , 1 s. The rectal temperature was 36.8°C. Heart consequences of enteric protein loss, such as peripheral edema rate was 156 beats/min and respiratory rate was 16 breaths/min. or ascites. Femoral pulses were hypokinetic but synchronous. There were The pathophysiologic mechanism driving hypoalbuminemia normal breath sounds and no arrhythmia, but there was a left- in hypoadrenocorticism is unknown. Loss of albumin into the sided grade I/VI systolic murmur loudest over the left apex. The GI tract or decreased intake/assimilation of proteins, is the dog seemed uncomfortable with abdominal palpation, but there main suspected cause (4). The human literature suggests that were no other abnormalities. Peripheral lymph nodes apeared glucocorticoids enhance barrier function of epithelial cells due normal. Hematochezia was noted on rectal examination. The to suspect epithelial-specific properties, but more research is remainder of the physical examination was normal. needed in this area (5). Abdominal radiographs were taken at the time of presenta- Two of the 4 dogs had fluid accumulation (abdominal effu- tion to the referral hospital. There was good serosal detail, but sion, dog 2; peripheral edema, dog 3) attributed to hypoalbu- the small and large bowels were fluid-filled with no evidence minemia. It is well-known that hypoadrenocorticism can mimic of obstruction. There was no stress leukogram on a CBC. gastrointestinal disease; however, to our knowledge there is no Abnormal results of a serum chemistry panel (Table 1) included literature describing ascites or peripheral edema secondary to hypocholesterolemia, hypoproteinemia with both hypoalbu- hypoadrenocorticism-induced hypoalbuminemia (4,6). Effusions minemia and hypoglobulinemia, and hypocalcemia attributed and edema are, however, relatively common in dogs with PLE, to hypoalbuminemia. An ionized calcium test performed the potentially increasing the likelihood that a clinician erroneously following day (day 2) was normal (1.32 mmol/L, RI: 1.12 to suspects PLE as the cause of the clinical features in dogs affected 1.40 mmol/L). The diagnosis of hypoadrenocorticism was con- by hypoadrenocorticism. firmed on ACTH stimulation test (Table 1). Hypocholesterolemia is common in dogs with what has been After establishing a diagnosis of hypoadrenocorticism, pred- historically referred to as atypical, or glucocorticoid-deficient, nisone, 0.27 mg/kg BW, PO, q12h, was given for 1 wk and hypoadrenocorticism. A recent paper (7) found that dogs with then decreased to 0.27 mg/kg BW, PO, q24h. The dog was “atypical” hypoadrenocorticism had mineralocorticoid deficien- clinically normal at the time of discharge on day 3, with no cies despite having normal electrolyte concentrations, but for lethargy, vomiting, or diarrhea. At a 4-week follow-up the dog the sake of this discussion, we will retain the atypical hypoad- was clinically normal except for mild polyuria/polydipsia. All renocorticism designation. In one study, 13/17 (76.5%) dogs biochemical abnormalities had resolved. with atypical hypoadrenocorticism had hypocholesterolemia

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(6). In a study by Thompson et al (8), dogs with glucocorticoid- had unspecified electrolyte abnormalities, and Hoerauf and deficient hypoadrenocorticism had significantly lower albumin Reusch (12) did not describe laboratory results/abnormalities for and cholesterol concentrations than dogs with typical hypo- their patients. Adrenal ultrasonography may be of value in dogs adrenocorticism. The diagnostic challenge posed by atypical with clinical signs otherwise suggestive of PLE as small adrenal hypoadrenocorticism, and often the more prolonged course glands could enhance the suspicion of hypoadrenocorticism. of disease before diagnosis, could contribute to the increased In conclusion, the challenge of diagnosing atypical hypoadre- frequency of hypocholesterolemia in affected dogs (8,9). All the nocorticism resides in generating clinical suspicion. The absence dogs of our report had hypocholesterolemia, and in dog 2, the of a stress leukogram in dogs with hypoalbuminemia and/or hypocholesterolemia was severe. The mechanism for hypocho- hypocholesterolemia, even with ascites or peripheral edema, lesterolemia in hypoadrenocorticism is not known. It has been should warrant a resting cortisol, and ACTH stimulation testing suggested that glucocorticoids play a role in fat absorption from if indicated, before pursuing causes of primary GI disease. CVJ RAPPORTCAS DE the GI tract; decreased mobilization or increased utilization of fatty acids secondary to high ACTH concentrations has also References been proposed (1,6,9). 1. Stockham SL, Scott MA. Lipids. In: Stockham SL, Scott MA, eds. Fundamentals of Veterinary Clinical Pathology. 2nd ed. Ames, Iowa: Dogs with hypoadrenocorticism often have no stress leuko- Blackwell Publishing, 2008:770–771. gram because of cortisol deficiency. In the study by Thompson 2. Dossin O, Lavoué R. Protein-losing enteropathies in dogs. Vet Clin et al (8), all dogs had normal lymphocyte, monocyte, and North Am Small Anim Pract 2011;41:399–418. 3. Willard MD. Small intestine — Malabsorption. In: Washabau RJ, eosinophil counts, and Scott-Moncrief (9) reported that 97% of Day MJ, eds. Canine & Feline Gastroenterology. 1st ed. St. Louis, dogs with hypoadrenocorticism lacked a stress leukogram. Since Missouri: Saunders, 2013:678–683. hyperkalemia and/or hyponatremia often prompt suspicion of 4. Langlais-Burgess L, Lumsden JH, Mackin A. Concurrent hypoadrenocorticism and hypoalbuminemia in dogs: A retrospective study. J Am hypoadrenocorticism and subsequent testing for the disease, rec- Anim Hosp Assoc 1995;31:307–311. ognition that a patient lacks a stress leukogram becomes critical 5. Fischer A, Gluth M, Weege F, et al. Glucocorticoids regulate barrier to generating suspicion of atypical hypoadrenocorticism even function and claudin expression in intestinal epithelial cells via MKP-1. Am J Physiol Gastrointest Liver Physiol 2014;306:G218–2128. when none of the classic electrolyte abnormalities are present 6. Lifton SJ, King LG, Zerbe CA. Glucocorticoid deficient hypoadrenocor- (8–9). None of the dogs in this report had a stress leukogram. ticism in dogs: 18 cases (1986–1995). J Am Vet Med Assoc 1996;209: In a retrospective study, pre- and post-ACTH serum corti- 2076–2081. 7. Baumstark ME, Sieber-Ruckstuhl NS, Müller C, Wenger M, Boretti FS, sol concentrations were below 27.6 nmol/L in 37/42 of dogs Reusch CE. Evaluation of aldosterone concentrations in dogs with with hypoadrenocorticism, whereas the remaining 5/42 had hypoadrenocorticism. J Vet Intern Med 2014;28:154–159. pre- and post-ACTH serum cortisol levels between 27.6 and 8. Thompson AL, Scott-Moncrieff JC, Anderson JD. Comparison of classic hypoadrenocorticism with glucocorticoid-deficient hypoadreno- 55.2 nmol/L (8). Thus, a resting cortisol can be a useful and corticism in dogs: 46 cases (1985–2005). J Am Vet Med Assoc 2007; relatively inexpensive tool in ruling out hypoadrenocorticism. 230:1190–1194. It could be argued that an ill patient without a stress leukogram 9. Scott-Moncrief JC. Hypoadrenocorticism. In: Ettinger EC, Nelson RW, Reusch CE, Scott-Moncrieff JC, Behrend EN, eds. Canine and Feline should have a basal cortisol concentration measured before more Endocrinology. 4th ed. St. Louis, Missouri: Saunders, 2015:485–520. invasive and expensive diagnostics are performed. If the basal 10. Lennon EM, Boyle TE, Hutchins RG, et al. Use of basal serum or cortisol is less than 55.2 nmol/L the sensitivity and specificity plasma cortisol concentrations to rule out a diagnosis of hypoadrenocorticism in dogs: 123 cases (2000–2005). J Am Vet Med Assoc 2007; for detecting hypoadrenocorticism are 100% and 63% to 78%, 231:413–416. respectively, and obtaining post-ACTH cortisol concentration 11. Bovens C, Tennant K, Reeve J, Murphy KF. Serum cortisol concentra- is recommended to confirm the diagnosis (10–11). tion as a screening test for hypoadrenocorticism in dogs. J Vet Intern Med 2014;28:1541–1545. Three dogs in this report had small or non-detectable adrenal 12. Hoerauf A, Reusch CE. Ultrasonographic evaluation of the adrenal glands during abdominal ultrasonography. It has previously been glands in six dogs with hypoadrenocorticism. J Am Anim Hosp Assoc described that dogs with hypoadrenocorticism had significantly 1999;35:214–218. 13. Wenger M, Mueller C, Kook PH, Reusch CE. Ultrasonographic evalu- thinner adrenal glands than those of healthy dogs, but dogs with ation of adrenal glands in dogs with primary hypoadrenocorticism or atypical hypoadrenocorticism were not well-represented in these mimicking diseases. Vet Rec 2010;167:207–210. reports (12,13). All patients in the paper by Wenger et al (13)

760 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY Case Report Rapport de cas

Total laryngectomy for management of chronic aspiration pneumonia in a myopathic dog

Karen M. Vernau, Stanley L. Marks, Maggie A. Kuhn, William T.N. Culp, Tammy J. Owens, G. Diane Shelton, Tausif Siddiqui, Rachel Pollard, Peter C. Belafsky

Abstract — A 5-month-old female pit bull terrier dog evaluated for ataxia, progressive regurgitation, and recurrent aspiration pneumonia had markedly elevated creatine kinase activity, non-inflammatory generalized myopathy, and severe esophageal dysmotility. A narrow-field total laryngectomy was performed. The dog is doing well 30 months after surgery, and no longer has episodes of aspiration pneumonia, despite intermittent regurgitation. This case represents the first application of total laryngectomy for the prevention of chronic recurrent aspiration pneumonia in the dog.

Résumé — Laryngectomie totale pour la gestion d’une pneumonie par aspiration chronique chez un chien myopathique. Une chienne Pit Bull Terrier âgée de 5 mois évaluée pour de l’ataxie, de la régurgitation progressive et une pneumonie par aspiration récurrente présentait une activité de la créatine kinase particulièrement élevée, une myopathie généralisée non inflammatoire et un trouble de motilité de l’œsophage grave. Une laryngectomie totale à champ étroit a été réalisée. La chienne se porte bien 30 mois après la chirurgie et n’a plus d’épisodes de pneumonie par aspiration, malgré une régurgitation intermittente. Ce cas représente la première application d’une laryngectomie totale pour la prévention d’une pneumonie par aspiration chronique récurrente chez un chien. (Traduit par Isabelle Vallières) Can Vet J 2016;57:761–766

ince Theodor Billroth performed the first human laryngec- closure (9–13). Conservative measures are generally preferred for S tomy for laryngeal carcinoma in 1873, the procedure has concerns of voice preservation in humans. However, when medi- been modified and improved many times (1–6). Total laryngec- cal management fails, total laryngectomy is the gold standard tomy has been used to prevent chronic aspiration in 4 human treatment of chronic and life-threatening aspiration pneumonia patients (7); however, application of the procedure for treatment in humans (7). Experimental laryngectomy was first performed of chronic aspiration in humans was limited due to complete in the dog in the early 19th century (6,14), and was exclusively loss of phonation and naso-laryngeal breathing, hyposmia, and used for the surgical management of laryngeal cancer in dogs atrophy of nasal mucosa (7,8). Various medical and surgical (15–17). To the best of our knowledge, a total laryngectomy has alternatives to laryngectomy have been used for chronic aspira- not been performed for the treatment and prevention of chronic tion in humans, including dietary and behavioral modification, recurrent aspiration pneumonia in the dog. oral care and sitting posture, levodopa to improve swallow and This report documents the successful management via total cough reflex, tracheostomy with gas bag, laryngeal diversion, laryngectomy of a 5-month-old female pit bull terrier with tracheoesophageal diversion, laryngeal diversion with a speech progressive regurgitation and recurrent aspiration pneumonia fistula, dynamic laryngotracheal closure, and a paced glottis secondary to a severe non-inflammatory congenital myopathy.

Department of Surgical and Radiological Sciences (Vernau, Culp, Pollard), Department of Medicine and Epidemiology (Marks), William R. Pritchard Veterinary Medicine Teaching Hospital (Owens), University of California, Davis, School of Veterinary Medicine, Davis, California, USA; Department of Otolaryngology (Belafsky, Siddiqui, Kuhn), School of Medicine, Sacramento, California, USA, and Department of Pathology, School of Medicine (Shelton), University of California, San Diego, La Jolla, California, USA. Address all correspondence to Dr. Stanley L. Marks; e-mail: [email protected] This work was completed at the William R. Pritchard Veterinary Medical Teaching Hospital (VMTH), University of California, Davis and the University of California, San Diego. The study was not supported by any grants or other funding. 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 57 / JULY 2016 761 FOR PERSONAL USE ONLY RAPPORTCAS DE

Figure 1. Cryosections from the adductor, diaphragm, cranial tibial, and pharyngeal muscles stained with hematoxylin and eosin (H&E). Excessive variability in myofiber size is evident in the adductor, diaphragm, and pharyngeal muscles with marked endomysial fibrosis separating individual muscle fibers in the adductor and diaphragm muscles consistent with a severe degenerative myopathy. The cranial tibial muscle is relatively spared. Bar = 50 mm for all images.

Case description increased (97 IU/L, RR: 14 to 91 IU/L). The elevated CK and AST were consistent with a myopathy, and the elevated ALP A 5-month-old female pit bull terrier dog was referred to the activity and increased phosphorus were associated with osteo- William R. Pritchard Veterinary Medical Teaching Hospital blastic activity during growth. A complete blood (cell) count (VMTH), University of California, Davis, for evaluation of an abnormal gait. The dog was rescued 1 mo previously, and the (CBC) and urinalysis were unremarkable. Infectious disease previous medical history was unknown. At presentation, the titers for Neospora (direct fluorescent antibody) and Toxoplasma dog weighed 16 kg with a body condition score (BCS) of 4/9. (latex agglutination test) were negative. The pelvic limbs were held in an adducted position, and the The dog was placed under general anesthesia for an electro- pelvic limb musculature was palpably firm, with limited range diagnostic evaluation by electromyography (EMG) and biopsies of motion and apparent pain on gentle manipulation of the were collected from the cranial tibial, vastus lateralis, triceps, and coxofemoral (CF) joints. The thoracic limbs had a wide-based adductor muscles. In addition, the dog underwent a bilateral stance with elbow abduction, but normal range of motion in femoral head ostectomy (FHO) and tenotomies of the pectineus all joints. On neurological examination, abnormalities were muscle to improve the CF pain and ability to ambulate. The restricted to a short-strided gait in all 4 limbs, reduced flexor pectineus muscle was also biopsied during the FHO. The EMG reflexes and delayed proprioception in the pelvic limbs. Bilateral was abnormal and characterized by diffuse complex repetitive CF luxation was noted on pelvic radiographs. A serum chemistry discharges in the distal and proximal thoracic and pelvic limb, profile revealed hyperphosphatemia [2.2 mmol/L, reference epaxial, head, and tongue muscles. All muscle biopsies revealed range (RR): 0.84 to 1.68 mmol/L], hypercalcemia (3 mmol/L, a non-inflammatory generalized myopathy with dystrophic RR: 2.4 to 2.8 mmol/L), and marked elevation of creatine kinase features, most severe in the adductor (Figure 1) and pectineus (CK) activity (74 272 IU/L, RR: 55 to 257 IU/L) with elevated muscles. alanine aminotransferase (ALT) (295 IU/L, RR: 21 to 72 IU/L) Following adoption, the dog was noted to have progressive and aspartate aminotransferase (AST) (1339 IU/L, RR: 20 to dysphagia and regurgitation. Thoracic radiographs revealed a 49 IU/L). The alkaline phosphatase (ALP) activity was mildly fluid-filled caudal thoracic esophagus and a videofluoroscopic

762 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY CASE REPORT CASE

A B

C D Figure 2. A, B, C — Videofluoroscopic swallow study with liquid barium documenting evidence of aspiration characterized by barium coating the trachea and severe esophageal dysmotility with retrograde movement of the bolus in the proximal esophagus prior to movement of the bolus in an aborad direction. D — Videofluoroscopic swallow study with barium-soaked kibble documenting displacement of the cardia cranially to the diaphragmatic crus (sliding hiatal hernia) with gastroesophageal reflux.

swallow study revealed evidence of severe esophageal dysmotil- gus. Liquid barium was subsequently refluxed through the upper ity in the cranial esophagus characterized by retention of large esophageal sphincter into the pharynx and nasopharynx, and volumes of liquid barium and retrograde motility of the bolus a large amount of barium was subsequently aspirated into the into the pharynx (Figure 2A–C). In addition, the dog had trachea. Persistence of gastroesophageal reflux and hiatal hernia- multiple episodes of gastroesophageal reflux and a sliding tion was noted. Progression of the underlying myopathy with (Type I) hiatal hernia (Figure 2D). Persistent regurgitation was concurrent esophagitis secondary to reflux was considered the managed with famotidine (Famotidine; Major Pharmaceuticals, likely etiology. Esophagoscopy revealed that the proximal half of Livonia, Michigan, USA), 1 mg/kg body weight (BW), PO, the esophagus was abnormally dilated and the gastroesophageal q24h, sucralfate (Carafate; Nostrum Laboratories, Kansas City, junction had rugal folds protruding above the diaphragmatic Missouri, USA), 1 g PO, q8h, and omeprazole (Omeprazole pinch. Significant reflux was observed with the application of delayed release tablets; Dexcel Pharma Technologies, Yokneam, gastric pressure. A 24-French percutaneous endoscopic gas- Israel), 1 mg/kg BW, PO, q24h. Feedings were changed to a trostomy (PEG) tube (EndoVive PEG tube; Boston Scientific, commercial complete and balanced puppy food fed in small Marlborough, Massachusetts, USA) was placed to facilitate volumes 3 times daily. Although the dog was fed in a dog sitting feeding, and this was replaced with a 24-Fr low-profile button position, regurgitation persisted. The dog underwent correc- (Bard Button; Bard Access Systems, Salt Lake City, Utah, USA) tive surgery for the hiatal hernia characterized by a left-sided after 2 mo. gastropexy, esophagopexy, and esophageal hiatal plication 2 mo Progressive regurgitation and recurrent aspiration pneumonia later. The dog’s diaphragm was found to be markedly thickened necessitated frequent visits and hospitalizations at the VMTH, secondary to the severe myopathy and the diaphragmatic defect with antimicrobial therapy consisting of ampicillin/sulbactam was reduced. Two biopsies were obtained from the left crura of (Unasyn; Pfizer), 50 mg/kg BW, IV, q8h and enrofloxacin the diaphragm and the muscle was found to be severely affected (Baytril; Bayer Healthcare, Shawnee Mission, Kansas, USA), with a dystrophic process similar to that observed in the other 10 mg/kg BW by PEG tube q24h, with nebulization and coup- muscles (Figure 1). The frequency of regurgitation decreased age necessary to manage the pneumonia. The dog’s quality of for approximately 3 mo; however, clinical signs progressed life was poor with frequent episodes of regurgitation, nasal shortly thereafter and the dog developed aspiration pneumonia reflux of ingesta, and difficulty sleeping due to partial airway that was treated with ampicillin/sulbactam (Unasyn; Pfizer, obstruction. The dog lost 3 kg body weight and had a BCS of New York, New York, USA), 50 mg/kg BW, IV, q8h. A repeat 2/9. Regurgitation persisted despite administration of cisapride videofluoroscopic swallow study revealed severe segmental (Cisapride, compounded product; Road Runner Pharmacy, esophageal dysmotility characterized by the absence of primary Phoenix, Arizona, USA), 0.5 mg/kg BW, PO, q12h. A cus- peristaltic waves and pooling of barium in the proximal esopha- tomized calorie-dense complete and balanced home-prepared

CVJ / VOL 57 / JULY 2016 763 FOR PERSONAL USE ONLY RAPPORTCAS DE A B Figure 3. A — Fully healed uncovered tracheostoma following laryngectomy in a pit bull terrier. B — The tracheostoma is kept patent with a soft, flexible silicon tracheostoma vent (Bivona; Smiths Medical ASD, Gary, Indiana, USA) that is secured in place with a foam tracheal tie (Posey Company, Arcadia, California, USA).

diet of liquid consistency was formulated for the dog. Despite cranial trachea was then brought into apposition with the skin to the administration of prokinetics and the liquid diet via the form a permanent tracheostomy. The severed end of the trachea low profile gastrostomy device (LPGD), the dog continued to was rotated to allow the entire circumference to be sutured to regurgitate and had 3 episodes of airway obstruction with loss the skin edges forming an airtight seal. The trachea was sutured of consciousness, requiring emergent intervention to re-establish to the skin with 3-0 silk (Perma-Hand Silk Suture; Ethicon) airway patency. In light of the frequent episodes of regurgitation because of its braided and non-absorbable features and optimal and subsequent aspiration with airway obstruction, a narrow knot security qualities. Two closed-suction drains (Jackson-Pratt field laryngectomy was elected when the dog was 14 mo of age. drain; Cardinal Health, Dublin, Ohio, USA) were placed in the A narrow-field total laryngectomy was performed under surgical wound and the rest of the cervical incision was closed general anesthesia by 2 otolaryngologists and a board-certified with staples. A light compression dressing was placed around veterinary surgeon. The dog was placed in dorsal recumbency, the neck. The dog recovered uneventfully from anesthesia in the fur was clipped, and the skin was prepared with aseptic the intensive care unit (ICU) and was discharged from the unit technique. A cushion was placed under the neck to elevate the the following morning. cervical region into the surgical field. A 5-cm horizontal cur- The dog was unable to swallow immediately following surgery vilinear incision was made 2 cm below the level of the cricoid secondary to the pharyngeal and esophageal myopathy, but cartilage. The sternohyoideus and sternothyroideus muscles otherwise did well in the post-operative period. The stoma was were bluntly separated on the ventral midline and retracted to cleaned with sterile saline after nebulization with sterile water for expose the larynx. Blunt and sharp dissection was utilized to 10 min 3 times daily for 10 d and a size #8 tracheostoma vent expose the cricoid and thyroid cartilage of the larynx as well as (Bivona; Smiths Medical ASD, Gary, Indiana, USA) was applied the cranial aspect of the trachea (1st and 2nd tracheal rings). 14 d after surgery and held in place with a Posey foam tracheal The entire circumference of the cranial trachea was dissected tie (Posey Company, Arcadia, California, USA). The drains were free from all surrounding tissues. The pharyngeal constrictor removed on postoperative day 3 and the staples were removed on muscles (hyopharyngeus, thyropharyngeus, and cricopharyn- postoperative day 7. The dog is doing well 30 mo after surgery geus) were separated from their attachments on the larynx as with a weight of 25 kg and a BCS of 8/9. There have been no were the sternothyroideus and thyrohyoideus muscles. The cuff episodes of aspiration pneumonia, even though the dog con- of the endotracheal tube was deflated, and the endotracheal tinues to regurgitate. The dog is managed with glycopyrrolate tube was pulled cranially, to allow for a tracheal incision. A (Par Pharmaceutical, Woodcliff Lake, New Jersey, USA), 1 mg #15 blade was utilized to enter the trachea between the 2nd q8h to reduce saliva production, acid suppressants (famotidine, and 3rd tracheal rings. This incision was continued around the omeprazole), and gastrointestinal protectants (sucralfate) admin- entire circumference of the trachea; a sterile endotracheal tube istered via PEG tube for the chronic gastroesophageal reflux and was introduced into the open end of the trachea, and the cuff esophagitis, and lactated Ringer’s solution (500 mL SQ, q12h) was inflated to allow for a tight seal. Cranially, the larynx was to maintain hydration status. The dog has frequent episodes of freed from its attachments to the hyoid apparatus (disarticulated regurgitation and nasal reflux of saliva and refluxed food due bilaterally) as well as the attachments to the tongue and hyoid to her pharyngeal and esophageal myopathy. She wears the bone, which were preserved. The larynx and cranial trachea tracheostoma vent continuously to maintain a patent tracheal were then removed. The pharyngeal mucosa was closed with 3-0 stoma. In addition, the dog is heat intolerant secondary to the polydioxanone (PDS Suture; Ethicon, Somerville, New Jersey, inability to thermoregulate by panting; however, quality of life is USA) in a simple continuous pattern, followed by closure of the considered excellent by the owners and clinicians. Neurological paired thyropharyngeal and cricopharyngeal muscles with 3-0 status has minimally progressed since initial presentation with polydioxanone (Ethicon) in a simple continuous pattern. The increased muscle rigidity in the thoracic limbs.

764 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY

Discussion with less severe dysphagia may be able to eat and drink orally after laryngectomy, without the previous risk of aspiration. By Aspiration pneumonia is a common clinical problem in dogs removing the larynx and separating the respiratory and digestive with neurological disease, particularly neuromuscular disor- tracts, the risk of aspiration pneumonia is eliminated. ders such as myasthenia gravis, polymyopathies, and polyneu- Chronic regurgitation and recurrent life-threatening aspira- ropathies affecting the swallowing reflex (18–20). In 1 report, tion pneumonia are challenging conditions to treat and result REPORT CASE aspiration pneumonia was most frequently noted in dogs with in death or euthanasia in many dogs, particularly in those with esophageal disease, vomiting, and neurological disorders (21). In esophageal and neuromuscular disorders. Currently there is no that study, 22 of 88 dogs died or were euthanatized, and 3 of the established surgical management available for this disorder and 22 dogs (14%) were euthanized because of continual or refrac- many dogs are euthanized. This case report suggests that a nar- tory aspiration pneumonia (21). Most dogs with myasthenia row field laryngectomy can be safely and effectively performed gravis have esophageal weakness and dysfunction, in addition for management of chronic aspiration in the dog, and should to generalized weakness. In 1 study, 12 of 25 dogs (48%) with be considered as a viable alternative treatment for dogs with myasthenia gravis died or were euthanized shortly after admis- profound oropharyngeal dysphagia, chronic regurgitation, and sion to the hospital due to aspiration pneumonia (18). Given the aspiration pneumonia. high incidence of spontaneous remission of myasthenia gravis The ethical considerations and importance of comprehensive in dogs (22), a laryngectomy procedure should be reserved for client communications surrounding the surgical management those animals with the most intractable pneumonia and an of a dog with a progressive myopathy cannot be overempha- irreversible primary disease that is refractory to medical therapy, sized. The dog in this report did not have an obviously clini- regardless of cause. Currently, there is no established surgical cally progressive myopathy other than the involvement of the treatment for prevention of chronic or recurrent aspiration pharynx and esophagus. Prior to the laryngectomy procedure, pneumonia in dogs. the dog suffered 3 episodes of airway obstruction secondary In humans, it has been suggested that surgery is indicated to aspiration of regurgitated material with consequent loss of for those cases with chronic aspiration and severe associated consciousness. Without the laryngectomy procedure, the dog medical problems, whereby a total laryngectomy is the only would have undergone elective euthanasia as it was deemed justifiable surgical intervention which can improve patient inhumane for her to continue to aspirate and suffer respiratory quality of life (7). We utilized this approach to prevent recurrent obstruction. The internists and surgeons met with the owners on aspiration pneumonia in a dog and prevented chronic aspira- several occasions to discuss the ramification of the laryngectomy tion, markedly improved quality of life, and obviated the need procedure as well as potential complications. The owners were for euthanasia. Documented complications of laryngectomy in given ample opportunity to discuss the options with their family dogs include collapse of the laryngeal stoma, tracheoesopha- members and elected to move forward with the procedure rec- geal fistula formation, pharyngeal dehiscence, megaesophagus, ognizing that euthanasia would be indicated if the dog’s quality hypocalcemia secondary to iatrogenic hypoparathyroidism, of life was not dramatically improved. The dog has continued pneumonia, and death (15–17). Two of these reports describe to thrive and its quality of life is deemed to be excellent by the significant post-laryngectomy morbidity in dogs while another owners and clinicians. report demonstrated no significant complications during 18 mo of follow-up (15–17). Other complications related to permanent Acknowledgments tracheostomy include skin fold occlusion of a tracheal stoma, The authors thank John Doval for assistance with the images hyposmia and olfactory mucosal changes, loss of thermoregula- and Robin Fisher and Paula Howell for their technical support. tion through panting, and increased CNS temperature (23–25). CVJ Postoperative activity of such dogs should be limited, as upper respiratory ventilation is required for normal thermoregulation References and restriction of outdoor activities in warm weather should be 1. Weir NF. Theodore Billroth: The first laryngectomy for cancer. J Laryngol Otol 1973;87:1161–1169. considered in some cases as well (17). These dogs are also unable 2. Stell PM. The first laryngectomy. J Laryngol Otol 1975;89:353–358. to swim due to the risk of drowning. 3. Rizzotto G, Succo G, Lucioni M, Pazzaia T. Subtotal laryngectomy Although this dog was cured of recurrent aspiration pneu- with tracheohyoidopexy: A possible alternative to total laryngectomy. Laryngoscope 2006;116:1907–1917. monia, it remains unable to swallow because of the progressive 4. Majer EH. 100 Years of laryngectomy. Laryngol, Rhinol, Otol 1975;54: myopathy. The dog has also developed hyposmia as reported 3–9. by the owners because the dog can no longer smell the family 5. Bron L, Brossard E, Monnier P, Pasche P. Supracricoid partial laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and cat entering the family room, and the dog used to chase the cat supraglottic carcinomas. Laryngoscope 2000;110:627–634. out of the room as soon as she was aware of its presence. The 6. Schwartz AW, Devine KD. Some historical notes about the first laryn- myopathy in this case is congenital and no specific treatments gectomies. Laryngoscope 1959;69:194–201. 7. Cannon CR, McLean WC. Laryngectomy for chronic aspiration. Am or cures are available, thus the necessity for the laryngectomy J Otolaryngol 1982;3:145–149. to prevent aspiration pneumonia. She is maintained on inter- 8. Wei X, Fan X, Zhang J. [The long-term morphology of the nasal cavity mittent tube feedings administered through a PEG tube and after total laryngectomy] Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. J Clin Otorhinolaryngol, 2010;24:785–787. subcutaneous fluids, and maintains an excellent quality of life 9. Sasaki H, Sekizawa K, Yanai M, Arai H, Yamaya M, Ohrui T. New according to her owners and clinicians. It is plausible that dogs strategies for aspiration pneumonia. Intern Med 1997;36:851–855.

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10. Wang H, Shen Z, Yao Z, Qiu H. [Surgical treatment for the chronic 18. Dewey CW, Bailey CS, Shelton GD, Kass PH, Cardinet GH, 3rd. severe aspiration]. Lin Chuang Er Bi Yan Hou Ke Za Zhi. J Clinical Clinical forms of acquired myasthenia gravis in dogs: 25 cases (1988–1995). Otorhinolaryngol 2003;17:732–733. J Vet Intern Med 1997;11:50–57. 11. De Vito MA, Wetmore RF, Pransky SM. Laryngeal diversion in the 19. Ryckman LR, Krahwinkel DJ, Sims MH, Donnell RL, Moore PF, treatment of chronic aspiration in children. Int J Pediatric Otorhinolar Shelton GD. Dysphagia as the primary clinical abnormality in two dogs yngol 1989;18:139–145. with inflammatory myopathy. J Am Vet Med Assoc 2005;226:1519–23. 12. Wang D, Dulguerov P. Laryngeal diversion and tracheotracheal 20. Khorzad R, Whelan M, Sisson A, Shelton GD. Myasthenia gravis in speech fistula for chronic aspiration. Ann Otol Rhinol Laryngol dogs with an emphasis on treatment and critical care management. J Vet 2000;109:602–604. Emerg Crit Care 2011;21:193–208. 13. Broniatowski M, Grundfest-Broniatowski S, Tyler DJ, et al. Dynamic 21. Kogan DA, Johnson LR, Sturges BK, Jandrey KE, Pollard RE. Etiology laryngotracheal closure for aspiration: A preliminary report. Laryngo and clinical outcome in dogs with aspiration pneumonia: 88 cases scope 2001;111:2032–2040. (2004–2006). J Am Vet Med Assoc 2008;233:1748–1755. 14. Lapidot A, Catalfumo F, Gelot R, Liskow A. Total laryngectomy and 22. Shelton GD, Lindstrom JM. Spontaneous remission in canine myasthe- autogenous reconstruction observations in an experimental series in nia gravis: Implications for assessing human MG therapies. Neurology

RAPPORTCAS DE canines. J Surg Oncol 1973;5:259–266. 2001;57:2139–2141. 15. Block G, Clarke K, Salisbury SK, DeNicola DB. Total laryngectomy and 23. Baker MA, Chapman LW, Nathanson M. Control of brain temperature permanent tracheostomy for treatment of laryngeal rhabdomyosarcoma in dogs: Effects of tracheostomy. Resp Physiol 1974;22:325–333. in a dog. J Am Anim Hosp Assoc 1995;31:510–513. 24. Hedlund CS, Tangner CH, Montgomery DL, Hobson HP. A procedure 16. Crowe DT, Goodwin MA. Total laryngectomy for laryngeal mast cell for permanent tracheostomy and its effects on tracheal mucosa. Vet Surg tumor in a dog. J Am Anim Hosp Assoc 1986;22:809–816. 1982;11:13–17. 17. Henderson RA, Powers RD, Perry L. Development of hypoparathyroid- 25. Hedlund CS, Tangner CH, Waldron DR, Hobson HP. Permanent ism after excision of laryngeal rhabdomyosarcoma in a dog. J Am Anim tracheostomy: Perioperative and long-term data from 34 cases. J Am Hosp Assoc 1991;198:639–643. Anim Hosp Assoc 1988;24:585–591.

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766 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY Case Report Rapport de cas

Citrobacter freundii induced endocarditis in a yearling colt

Eleonora E.A. Guidi, Aurélie Thomas, Jean-Luc Cadoré, Agnès Benamou Smith

Abstract — Endocarditis is a rare pathology in horses and the clinical signs can be misleading. We describe the clinical, echocardiographic, and pathological features of Citrobacter freundii induced bacterial endocarditis in a horse. This bacterium has never been reported before as an agent of vegetative endocarditis in the horse.

Résumé — Endocardite induite par Citrobacter freundii chez un poulain âgé d’un an. L’endocardite est une pathologie rare chez les chevaux et les signes cliniques peuvent être trompeurs. Nous décrivons les caractéristiques cliniques, échographiques et pathologiques d’une endocardite bactérienne induite par Citrobacter freundii chez un cheval. Cette bactérie n’a jamais été signalée auparavant comme un agent d’endocardite végétante chez un cheval. (Traduit par Isabelle Vallières) Can Vet J 2016;57:767–770

acterial endocarditis is a rare disease in horses, compared Intervet, Igoville, France), 1 mg/kg BW, PO, q12h for 6 d with- B to other species, and is associated with a high mortality out any improvement. Serological tests for Streptococcus equi, rate (1). Infection of the endothelial layer of the heart results in Borrelia spp., and Anaplasma phagocytophilum were all negative. vegetation and valve regurgitation. Most commonly the mitral valve is affected, followed by aortic, tricuspid, and pulmonary Clinical findings valves (1). Persistent regurgitation in the left side can lead to The colt was in moderately poor body condition [weight 308 kg, heart failure even if infection has been treated. Actinobacillus body condition score 3/9 (3)] and lethargic. A warm, painful, spp. and Streptococcus spp. are the microorganisms most com- soft edematous swelling was present at the dorsal surface of the monly cultured, but a wide range of other bacterial and fungal left carpus and the horse had a 4/5 grade lameness. He had pale pathogens have been implicated (2). mucous membranes, normal capillary refill time, and no fever. This report describes the clinical, echocardiographic, and Cardiac auscultation revealed a markedly elevated and irregu- pathological findings in a yearling with a Citrobacter freundii lar heart rate with 72 beats/min [reference range (RR): 28 to induced endocarditis. 40 beats/min], and a harsh pansystolic heart murmur, loudest over the mitral valve area, graded as 4/5 on the left side of the Case description chest and 3/5 on the right side. Respiratory rate was increased A 10-month-old French saddlebred colt was presented at the (36 breaths/min, RR: 8 to 14 breaths/min). Auscultation with Veterinary Teaching Hospital of the University of Lyon, with a rebreathing bag revealed some crackles in the cranio-ventral a 2-week history of weakness, hyperthermia, and intermittent- areas of both lungs but did not induce cough or nasal discharge. shifting lameness (right hind limb, right frontlimb). Hematology showed a marked neutrophilia and a mild anemia. Prior to refer- Other examinations ral the horse had been treated with trimethoprim sulphadiazine Hematology indicated a moderate anemia (red blood cells (Avemix; Vétoquinol, Magny, Vernois, France), 30 mg/kg body 6.46 3 1012/L, RR: 6 to 9 3 1012/L; hemoglobin 71 g/L, weight (BW), PO, q24h for 8 d and vedaprofene (Quadrisol; RR: 110 to 190 g/L; hematocrit 22.8%, RR: 32% to 50%), leukocytosis at 18.9 3 109/L (RR: 7 to 10 3 109/L) with a marked neutrophilia (84%). Total serum protein concentration Département Hippique, VetAgro-Sup, Campus vétérinaire de was 69 g/L (RR: 65 to 83 g/L) with severe hypoalbuminemia Lyon, 1, avenue Bourgelat — 69280 Marcy l’étoile — France (11 g/L, RR: 25 to 39 g/L) and hyperglobulinemia (58 g/L, (Thomas, Cadoré, Smith); Dipartimento di Scienze Veterinarie, RR: 20 to 44 g/L; albumin/globulin ratio 0.19, RR: 0.9 to 1.6). Università degli Studi di Torino, Largo Braccini 2-5-10095 A base-apex (4) electrocardiogram revealed a sinus tachycardia Grugliasco — Italia (Guidi). and occasional atrial premature complexes (Figure 1). Cardiac Address all correspondence to Dr. Eleonora Guidi; e-mail: troponin I concentration in serum was moderately increased at [email protected] 0.31 ng/mL (RR: 0 to 0.2 ng/mL). Blood culture wasn’t per- Use of this article is limited to a single copy for personal study. formed since the colt was already under antibiotic treatment. Anyone interested in obtaining reprints should contact the An echocardiographic examination was performed without CVMA office ([email protected]) for additional sedation using an Aloka alpha 10 sonographic unit (Hitachi copies or permission to use this material elsewhere. Medical Systems Europe Holding AG, CH-6300 Zurich,

CVJ / VOL 57 / JULY 2016 767 FOR PERSONAL USE ONLY RAPPORTCAS DE

Figure 1. Base-apex electrocardiogram displaying a sinus Figure 2. Two-dimensional real-time, right parasternal long- tachycardia (atrial premature contractions, black arrows). Paper axis echocardiographic image. Notice that right heart chambers speed: 25 mm/s; amplitude: 10 mm/mV. on the top of the image are barely visible. White arrows point towards the nodular thickening of the mitral valve. Black arrows indicate the enlargement of the left ventricle (rounded apex) and left atrium.

Figure 3. Two-dimensional real-time right parasternal short axis Figure 4. Two-dimensional real-time, right parasternal long-axis view (M-mode). Right ventricle is barely visible (white arrow). echocardiographic image with color flow Doppler showing the Note the increased fractional shortening (FR: 67.7%) (normal severe mitral valve regurgitation. range: 34, 2 to 43, 4%). LA — left atrium. LV — left ventricle.

Switzerland) and a 2.5 to 3 MHz sectorial probe. A prominent The pulmonary hypertension was also supported by the enlarged change in the anatomic shape of the mitral valve was evident pulmonary artery diameter at 3.9 cm (almost equating the size on B- mode and M-mode echocardiography (Figure 2). Severe of the aorta at 4.1 cm) seen on echocardiography. Cardiomegaly nodular thickening of the valve, with at least 2 echogenic masses was also noted on radiographs, with a marked enlargement and on the leaflets was present and pathognomonic for mitral valve a rounded appearance of the cardiac silhouette. endocarditis. The nodules ranged from 2 to 3 cm in diameter. Considerable left atrial and ventricular dilation was also present Diagnosis and outcome (left ventricle internal diameter in diastole = 9.25 6 1.05 cm, The clinical, laboratory, and ultrasonographic findings were left atrium internal diameter in systole = 10.85 6 0.45 cm, nor- consistent with a diagnosis of bacterial endocarditis of the mitral mal for reference range in adult horses so increased for a year- valve. The foal was treated with broad-spectrum antibiotics: ling), with a large and rounded left ventricular apex (Figure 2). procaine penicillin (Depocilline; Intervet), 25 000 IU/kg BW, The chambers of the right heart were barely visible from the left IM, q12h, and gentamicin (G4; Virbac Group, Carros, France), and right sides (Figures 2, 3), because of compression by the 6.6 mg/kg BW, IV, q24h and provided intensive care (IV fluid enlarged left heart. Left cardiac chamber dilatation, in addition therapy, nasal oxygen and diuretics). to an increased fractional shortening (Figure 3), indicated left The animal was euthanized 3 d later because of worsening heart volume overloading. Color flow Doppler echocardiography of heart failure signs (severe respiratory distress, foamy nasal was also performed and revealed severe holosystolic mitral valve discharge, increased jugular pulse, and ventricular extra systoles) regurgitation due to a loss of leaflets coaptation (Figure 4). No (Figure 5) and a necropsy was performed. other valvular regurgitation was detected. Thoracic X-rays were obtained because of the abnormali- Postmortem findings ties noted during thoracic auscultation. Both interstitial and At necropsy the mitral valve had large nodular masses (Figure 6) alveolar patterns were present caudally to the heart, indicating that were aseptically biopsied for histology and bacteriological pulmonary cardiogenic edema and pulmonary hypertension. culture. One of the chordae tendinae was ruptured explaining

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Figure 5. Base-apex electrocardiogram revealing ventricular tachycardia with runs of abnormal and premature QRS complexes (black arrows). Paper speed: 25 mm/s; amplitude: 10 mm/mV. Figure 6. Gross appearance of the mitral valve during necropsy. Three vegetative masses are evident on the leaflets of the mitral the acute worsening of heart failure. The lungs showed signs of valve (black circles). Black arrows point towards the ruptured secondary pulmonary edema and the kidneys had an infarcted chordate tendinae. area (probably resulting from septic emboli) and signs of glomerulonephritis. Bacterial culture lead to a pure and heavy mia, synovial distension, and lameness associated with blood growth of Citrobacter freundii and histology of the mitral valve parameters revealing hyperglobulinemia, hypoalbuminemia, confirmed an active endocarditis. hyperfibrinogenemia, and leukocytosis significantly increase Discussion the probability of diagnosing vegetative endocarditis. In human medicine, the criteria used to diagnose an endocarditis are Endocarditis following C. freundii infection has never been divided into major criteria (oscillating intracardiac masses, reported before in a horse and is also an uncommon find- abscesses, persistently positive blood culture) and minor criteria ing in humans in whom infectious endocarditis is more fre- (fever, predisposing heart conditions, emboli, infarcts, petechiae, quently encountered than in equids. Citrobacter freundii is glomerulonephritis, rheumatoid factor, microbiologic evidence). an aerobic, Gram-negative bacillus that belongs to the family Thus, evidence of 2 major criteria or 1 major with 2 minor Enterobacteriaceae. Its habitats include the environment, food, criteria leads to a definitive diagnosis of infectious endocarditis and animal and human intestinal tracts (5). (22). In the case described herein 3 of these minor signs were In humans C. freundii represents up to 29% of all opportu- present: glomerulonephritis and an infarcted area on the kidneys nistic hospital infections (6) and is typically found in neonates, as evidenced in the necropsy as well as a shifting lameness due debilitated aged ($ 65 y) or immunocompromised patients (7). to synovitis because of immune-complex deposition. Systematic Citrobacter species is responsible for a wide variety of nosocomial use of those parameters in veterinary medicine could improve infections such as urinary tract and hematological infections, the sensitivity of the diagnostic procedure. intra-abdominal sepsis, brain abscesses, pneumonia in adults This report describes the clinical and echocardiographic (8,9) and neonatal infections, such as meningitis, neonatal signs presented by a colt presenting with endocarditis caused sepsis, joint infection, or bacteremia (10–12). There is only by C. freundii. This bacterium has never been reported before 1 report of C. freundii endocarditis in a human: the patient also as a causative agent of endocarditis in the horse, and although had chronic and advanced liver disease that contributed to the ubiquitous in the environment, it is not a common pathologi- fatal infection and the bacterium was resistant to most first line cal finding. Infection by Citrobacter spp. should therefore be antimicrobials as commonly reported for Citrobacter spp. (13). considered as a possible differential diagnosis in young, old, or In horses, Citrobacter spp. has been found occasionally as an immunocompromised animals particularly those not responding agent of neonatal septicemia (14), endometritis (15), ulcerative to first line antimicrobial treatment. CVJ keratitis (16), and arthritis (17). Citrobacter freundii has been reported to be resistant to several broad-spectrum antibiotics References (18) and may act as a reservoir of antimicrobial resistance genes 1. Maxson AD, Reef VB. Bacterial endocarditis in horses: Ten cases in soils (19). (1984–1995). Equine Vet J 1997;29:394–399. In the present case, the diagnosis of endocarditis was based 2. Buergelt CD, Cooley AJ, Hines SA, Pipers FS. Endocarditis in on echocardiographic findings of oscillating intracardiac het- six horses. Vet Pathol 1985;22:333–337. 3. Henneke DR, Potter GD, Krieder J, Yeates BF. Relationship between erogenic masses on the mitral valves. Echocardiography is a condition score, physical measurements, and body fat percentage in non-invasive technique that usually provides sufficient evidence mares. Equine Vet J 1983;15:371–372. to substantiate the diagnosis of bacterial endocarditis. When 4. Menzies-Gow N. ECG interpretation in the horse. In Practice 2001;23: 454–459. interpreted in combination with relevant clinical signs and 5. Wang JT, Chang SC, Chen YC, Luh KT. Comparison of antimicrobial concurrent volume overload, echocardiographic examination susceptibility of Citrobacter freundii isolates in two different time peri- of valve regurgitation or ruptured chordae tendinae is helpful ods. J Microbiol Immunol Infect 2000;33:258–262. 6. Whalen JG, Mully TW, English JC, 3rd. Spontaneous Citrobacter freun- in establishing the prognosis for the animal (20). According dii infection in an immunocompetent patient. Arch Dermatol 2007; to a study by Porter et al (21) clinical signs such as hyperther- 143:124–125.

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7. Chen YS, Wong WW, Fung CP, Yu KW, Liu CY. Clinical features and 16. Moore CP, Fales WH, Whittington P, Bauer L. Bacterial and fungal iso- antimicrobial susceptibility trends in Citrobacter freundii bacteremia. lates from Equidae with ulcerative keratitis. J Am Vet Med Assoc 1983; J Microbiol Immunol Infect 2002;35:109–114. 182:600–603. 8. Marco Sanchez F, Turabian Fernandez JL, Duran Perez-Navarro A. Fatal 17. Schneider RK. Common bacteria encountered in septic arthritis. Proc Citrobacter freundii bronchopneumonia acquired in the community in of the Annual Convention of the American Association of Equine an uncompromised patient. Revi Clin Esp1985;176:320. Practitioners, Baltimore, Maryland. AAEP 1998;44:152–158. 9. Pepperell C, Kus JV, Gardam MA, Humar A, Burrows LL. Low- 18. Nada T, Baba H, Kawamura K, Ohkura T, Torii K, Ohta M. A small virulence Citrobacter species encode resistance to multiple antimicrobi- outbreak of third generation cephem-resistant Citrobacter freundii infec- als. Antimicrob Agents Chemother 2002;46:3555–3560. tion on a surgical ward. Jpn J Infect Dis 2004;57:181–182. 10. Doran TI. The role of Citrobacter in clinical disease of children: Review. 19. Srinivasan V, Nam H-M, Sawant AA, Headrick SI, Nguyen LT, Oliver SP. Clin Infect Dis 1999;28:384–394. Distribution of tetracycline and streptomycin resistance genes and 11. Badger JL, Stins MF, Kim KS. Citrobacter freundii invades and repli- class 1 integrons in Enterobacteriaceae isolated from dairy and nondairy cates in human brain microvascular endothelial cells. Infect Immun farm soils. Microb Ecol 2008;55:184–193. 1999;67:4208–4215. 20. Verdegaal EJMM, van Oldruitenborgh-Oosterbaan MMS. Endocarditis

RAPPORTCAS DE 12. Drelichman V, Band JD. Bacteremias due to Citrobacter diversus and in the horse. Equine Vet Educ 2006;18:196–198. Citrobacter freundii. Incidence, risk factors, and clinical outcome. Arch 21. Porter SR, Saegerman C, van Galen G, et al. Vegetative endocarditis in Intern Med 1985;145:1808–1810. equids (1994–2006). J Vet Intern Med 2008;22:1411–1416. 13. Reyes CV, Folwarkiw O. Endocarditis due to Citrobacter freundii. Tex 22. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infec- Heart Inst J 1984;11:216–217. tive endocarditis: Utilization of specific echocardiographic findings. Am 14. Wilson WD, Madigan JE. Comparison of bacteriologic culture of blood J Med 1994;96:200–209. and necropsy specimens for determining the cause of foal septicemia: 47 cases (1978–1987) J Am Vet Med Assoc 1989;195:1759–1763. 15. Hinrichs K, Spensley MS, McDonough PL. Evaluation of progester- one treatment to create a model for equine endometritis. Equine Vet J 1992;24:457–461.

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770 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY Case Report Rapport de cas

Equine motor neuron disease in 2 horses from Saskatchewan

Michelle L. Husulak, Katharina L. Lohmann, Kamal Gabadage, Chris Wojnarowicz, Fernando J. Marqués

Abstract — Two horses from Saskatchewan were presented with signs of sweating, muscle fasciculations, weight loss, and generalized weakness. The horses were diagnosed with equine motor neuron disease (EMND), by histological assessment of a spinal accessory nerve or sacrocaudalis dorsalis medialis muscle biopsy. This is the first report of EMND in western Canada.

Résumé — Maladie équine des motoneurones chez 2 chevaux de la Saskatchewan. Deux chevaux de la Saskatchewan ont été présentés avec des signes de sudation, de fibrillations musculaires, de perte de poids et de faiblesse généralisée. On a diagnostiqué la maladie équine des motoneurones (MEMN) chez les chevaux en effectuant une évaluation histologique d’un nerf accessoire de la colonne vertébrale ou une biopsie du muscle sacrocaudalis dorsalis medialis. Il s’agit du premier rapport de MEMN dans l’Ouest canadien. (Traduit par Isabelle Vallières) Can Vet J 2016;57:771–776

quine motor neuron disease (EMND) is an acquired radicals (7). Deficient plasma a-tocopherol concentrations E neurodegenerative disorder, which sporadically affects have been linked with neurologic disease in several species horses that have limited access to pasture for long periods of (7). Experimental models in which animals have been fed time (1). It was first described in 1990 by Cummings et al (2), vitamin E-deficient diets have resulted in degenerative lesions who compared the clinical signs and the neuronal degenera- in the central and peripheral nervous systems. In Rhesus mon- tive changes to sporadic amyotrophic lateral sclerosis (ALS) in keys (8) and rats (9) these lesions have been found primarily in humans. Common clinical signs in horses with EMND include sensory neurons. Experimental models with adult horses fed weight loss, muscle wasting, muscle trembling (fasciculations), vitamin E-deficient diets have resulted in degenerative changes prolonged recumbency, shifting weight while standing, a short- to motor neurons, typical of EMND (10,11). In naturally occur- strided gait, and a base-narrow stance (3,4). Other findings may ring cases, affected horses have degenerative changes in their include elevated tail head carriage, low head and neck carriage, somatic motor neurons and axonal degeneration of the ventral profuse sweating, a ravenous appetite, and a brown pigment horns of the spinal cord, ventral roots, and peripheral nerves retinopathy due to ceroid-lipofuscin accumulation within the (2). These lead to neurogenic muscle atrophy, which is grossly retinal pigment epithelium (3,5,6). Affected horses may have present in severely affected cases. Muscles containing high num- mildly to moderately elevated muscle enzymes (creatine kinase bers of type I fibers, such as the sacrocaudalis dorsalis medialis and aspartate aminotransferase) and deficiency in serum or muscle, have high oxidative requirements and therefore undergo plasma concentration of a-tocopherol (1,3), an isoform of the most damage due to oxidative stress (12), leaving them vitamin E. appearing pale, soft, and with a yellow-red discoloration (13). One of the main roles of vitamin E in the body is preven- Equine motor neuron disease was first reported in Canada in tion of oxidant injury to cell membranes by scavenging of free Nova Scotia (14) and Prince Edward Island (15) in 1994. Since then, additional cases have been reported in Ontario (1) but to the authors’ knowledge there are no previously published reports Department of Large Animal Clinical Sciences, Western College from western Canada. This report describes 2 cases of EMND in of Veterinary Medicine, University of Saskatchewan (Husulak, horses that resided in different parts of Saskatchewan and had no Lohmann, Gabadage, Marqués), Prairie Diagnostic Services history of travel outside of the province. Veterinarians practicing (Wojnarowicz), 52 Campus Drive, Saskatoon, Saskatchewan in western Canada need to be aware of EMND and be familiar S7N 5B4. with the clinical signs in order to proceed with the appropriate Address all correspondence to Dr. Michelle L. Husulak; e-mail: diagnostic tests and treatment for these cases. [email protected] Use of this article is limited to a single copy for personal study. Case descriptions Anyone interested in obtaining reprints should contact the Case 1 CVMA office ([email protected]) for additional A 3-year-old Quarter Horse stallion (Figure 1) was referred to copies or permission to use this material elsewhere. the Western College of Veterinary Medicine, Veterinary Medical

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EMG — Left extensor carpi radialis RAPPORTCAS DE

Figure 1. A 3-year-old Quarter Horse stallion (Case 1) displaying a base narrow stance, low head carriage, elevated tail head carriage, and profuse sweating.

Center (VMC) with a 7-day history of lethargy, muscle fasciculations, profuse sweating, and prolonged frequent periods 100 (mV) 10 (ms) of recumbency. His owners estimated that the stallion had lost Figure 2. Electromyogram reading demonstrating fibrillation 100 kg in the previous 2 wk, despite a normal appetite. He had potentials in the left extensor carpi radialis muscle, which is been housed in a paddock with no access to pasture for most of consistent with the muscle fiber denervation that occurs with his life. His diet consisted of mixed alfalfa-grass hay, with oats EMND. Each line represents the recording from an electrode within a muscle and the wave forms indicate spontaneous firing and corn provided as supplements. The horse was up-to-date of the muscle due to loss of innervation. on vaccinations and did not have any previous history of disease prior to the onset of clinical signs. He was the only affected horse in a herd of 40 horses. bency and made exertional rhabdomyolysis a less likely diag- On presentation to the VMC, the stallion was quiet and nosis. Serum magnesium concentration was low at 12 mg/mL responsive, and exhibited generalized muscle atrophy. He had [RR: 18 to 35 mg/mL (16)]. Examination by a board-certified continuous muscle fasciculations, especially of the triceps and ophthalmologist revealed an incipient posterior capsular cataract quadriceps muscles. He was tachycardic (heart rate: 60 beats/ of the right eye. The fundi of both eyes were normal and no min), hyperthermic (rectal temperature: 38.7°C), had decreased pigment retinopathy was noted. Hair samples from the stallion’s borborygmi on abdominal auscultation, and was sweating mane were collected to test for HYPP. Results indicated that the profusely throughout the examination. Thoracic auscultation stallion was homozygous normal (NN), and therefore negative revealed no abnormalities. His head and neck carriage was low for the sodium channel a-subunit gene mutation responsible with muscle wasting of the cervical musculature and his tail for HYPP (17). Serum selenium concentration was normal at head was elevated. The horse stood with a base-narrow stance 0.227 mg/mL, while a-tocopherol concentration was deficient and shifted his weight continuously on both forelimbs and hind at 0.41 mg/mL [normal . 2 mg/mL (18)]. A nerve biopsy limbs. At a walk, his gait appeared labored and weak, but no was obtained from the left distal branch of the spinal acces- ataxia or proprioceptive deficits were noted. His digital pulses sory nerve (19) while the horse was restrained with xylazine were within normal limits. Based on the history and physical hydrochloride (Rompun; Bayer Animal Health, Mississauga, examination findings the initial differential diagnoses included Ontario), 0.5 mg/kg body weight (BW), IV, and butorphanol colic, laminitis, exertional rhabdomyolysis, hyperkalemic peri- (Torbugesic; Zoetis, Kirkland, Quebec), 0.01 mg/kg BW, IV to odic paralysis (HYPP), and EMND. induce standing sedation and the site was infiltrated with 2% Evaluation for colic included nasogastric intubation, which lidocaine hydrochloride (Zoetis) as local anesthesia. The sample yielded no reflux, and a rectal examination that revealed no was then fixed in formalin and stained with hematoxylin and abnormalities. An abaxial sesamoid nerve block was performed eosin (H & E) for histological evaluation. Histopathological on all 4 limbs in order to help rule out foot pain causing extreme analysis revealed significant Wallerian degeneration and a few discomfort. The nerve blocks did not dramatically improve the bundles of unmyelinated nerves, which were interpreted as horse’s stance or gait, ruling out laminitis. Büngner’s bands [cords of proliferating Schwann cells (2)]. These Blood work included a venous blood gas analysis and com- findings supported a diagnosis of EMND. plete blood (cell) count (CBC), which revealed no abnormali- The stallion was treated by his owners with dl-a-tocopherol ties. The serum biochemistry profile revealed a mild elevation capsules (10 000 IU/day, PO, brand unknown) (18) for 3 mo in creatine kinase [450 U/L, reference range (RR): 88 to and housed on pasture during the summer. Repeat evaluation 439 U/L] and aspartate aminotransferase activity (477 U/L, of the stallion’s serum a-tocopherol levels would have been ideal RR: 6 to 347 U/L), which was attributed to prolonged recum- following 3 to 6 mo of treatment, but was not possible in this

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Figure 3. Right extensor carpi radialis muscle (Case 2). Figure 4. Left accessory nerve (Case 2). The chain of digestion Multiple fibers are hypereosinophilic, homogeneous (arrows) chambers (arrows) is filled with axonal debris and activated and vacuolated (arrowhead), representing degenerative lesions. macrophages. Such examples of Wallerian degeneration were Hematoxylin and eosin (H&E) stain. abundant in both the left and right accessory nerves. H&E stain.

case. A follow-up conversation with the owner 1 y later indicated that the stallion’s gait and stance had improved, and the muscle fasciculations and profuse sweating had subsided.

Case 2 A 17-year-old Thoroughbred gelding was referred to the VMC for evaluation and treatment of suspected colic. The horse had a history of weight loss and behavioral changes over the last 2 mo. The owners reported that he had recently become the subor- dinate horse in the herd; while he was formerly dominant over the other horses. He was up-to-date on vaccinations and had no previous medical problems. The gelding had a good appetite and was fed a diet of grass hay, occasionally supplemented with pelleted complete feed following exercise. He was housed in a dirt paddock with no pasture access. The horse presented with generalized muscle fasciculations, Figure 5. Spinal cord, cervical intumescence (Case 2). This profuse sweating, and stood with a hunched back and base- ventral motor neuron (arrow) shows advanced degenerative change of peripheral chromatolysis, accumulation of eosinophilic narrow stance. His head carriage was low and his tail head inclusions and swollen nucleus. H&E stain. carriage was elevated. He was tachycardic (heart rate: 60 beats/ min), tachypneic (respiratory rate: 32 breaths/min), and had increased borborygmi on abdominal auscultation. Tacky mucous Once he was placed in a stall and allowed to lie down, his tachy- membranes and a slightly elevated packed cell volume (45%) cardia resolved and the profuse sweating stopped. The muscle were consistent with dehydration; however, the concentration fasciculations were present only when the horse was standing. of total solids (75 g/L) was normal. The referring veterinarian As no further colic signs were observed, the primary differential had performed a CBC and serum biochemistry, which revealed a diagnosis was EMND. Other differentials included laminitis, mild elevation of aspartate aminotransferase activity at 366 U/L exertional rhabdomyolysis, and pheochromocytoma, but all (RR: 175 to 340 U/L) as the only abnormality. A nasogastric were considered less likely than EMND based on monitoring tube was passed and no gastric reflux was obtained. Rectal exam- of physical examination findings and the serum biochemistry ination revealed no abnormalities. An abdominocentesis yielded results from the referring veterinarian. peritoneal fluid that was normal based on cytological analysis. Examination by a board-certified ophthalmologist revealed Following the initial examination, the horse was treated with incipient posterior cataracts bilaterally and normal fundi with flunixin meglumine (Flunixin injection; Zoetis), 1.1 mg/kg no apparent pigment retinopathy. A serum vitamin and mineral BW, IV, once for pain control and intravenous fluids (Lactated panel revealed deficient levels of both serum magnesium at Ringer’s Solution; Baxter, Mississauga, Ontario), 90 mL/kg BW 10.10 mg/mL [RR: 18 to 35 mg/mL (16)] and a-tocopherol per day to replace fluid deficits and to provide maintenance fluid at 0.86 mg/mL [normal . 2 mg/mL (18)]. A muscle biopsy needs. The horse was monitored overnight for signs of colic. for histopathological evaluation was obtained from the left

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sacrocaudalis dorsalis medialis (SCDM) muscle (19) under stand- when the horse was able to lie down. Botulism and equine grass ing sedation with xylazine hydrochloride (Bayer Animal Health), sickness are other differential diagnoses that could also have 0.5 mg/kg BW, IV, and butorphanol (Zoetis), 0.01 mg/kg BW, been considered for these cases. Equine grass sickness is a poly- IV, and local anesthesia with 2% lidocaine hydrochloride neuropathy, which results in clinical signs similar to EMND, (Zoetis). The SCDM muscle contained muscle fibers with as well as dysphagia and ptosis. Grass sickness has only been moderate size variation, anguloid atrophy, angular atrophy, reported once in North America to date (26), and in contrast centrally displaced nuclei, and sarcoplasmic masses, which is to horses with EMND, horses with grass sickness are commonly consistent with neurogenic atrophy that occurs in EMND cases kept on pasture (27). Botulism should also be considered in (20). Electromyography (EMG) was performed under general cases of muscle weakness; however, the lack of dysphagia in the anesthesia (21). Spontaneous fibrillation potentials consistent presented cases put it lower on the differential list (28). The low with muscle fiber denervation were detected in several muscles magnesium in both cases was considered to be an incidental RAPPORTCAS DE on the left side of the horse including the extensor carpi radia- finding and not the primary cause of the clinical signs. Primary lis (Figure 2), gluteal, quadriceps, triceps, and neck muscles. hypomagnesemia is rare in horses (29) and causes mineralization Complete examination of the right side was not undertaken of several body tissues (30). Low serum magnesium has been due to the positioning of the horse in right lateral recumbency. associated with severe illness and endotoxemia in hospitalized Given the results of the muscle biopsy examination and horses (31), which was not present in either of these cases. EMG, an antemortem diagnosis of EMND was established. Different diagnostic techniques were used to confirm a diag- The horse was given a guarded to poor prognosis for return to nosis of EMND in the 2 cases reported here. Histopathology his previous level of function and the owners elected euthanasia. of the spinal accessory nerve was the first reliable antemortem On postmortem examination, there were no gross abnormalities. diagnostic test for definitive diagnosis of EMND (32). When Histologic examination revealed minimal degenerative lesions interpreted by an experienced pathologist, this test has a specific- in the extensor carpi radialis muscle (Figure 3). Abundant ity of 94% and a sensitivity of 92% (32). In Case 1, the spinal lesions of Wallerian degeneration in both spinal accessory nerves accessory nerve biopsy was obtained by an experienced board- (Figure 4) and degenerative lesions of ventral motor neurons in certified equine surgeon, with the horse restrained under stand- both cervical (Figure 5) and lumbar intumescences of the spinal ing sedation and local anesthetic infiltration at the surgical site. cord confirmed the diagnosis of EMND (13). This procedure is technically challenging and in some cases may require general anesthesia (32). In Case 2, antemortem diagnosis Discussion of EMND was made by evaluation of frozen and formalin-fixed The 2 cases of EMND presented with similar clinical signs of SCDM muscle biopsy specimens. Frozen specimens are thought muscle fasciculations and sweating, history of recent weight loss to yield higher test sensitivity than formalin-fixed samples (20). and no access to pasture (3). Interestingly, fundic examination The SCDM muscle biopsy procedure is technically easier than in both horses showed no evidence of a pigment retinopathy, the spinal accessory nerve biopsy (19) and therefore is preferred which has been reported commonly in cases of EMND (5). The by many clinicians. The SCDM muscle is used for diagnosis breeds of the horses in this report are not unusual as Quarter because it is easily accessible and it contains a high percentage Horses are reportedly the most commonly affected breed and of type 1 muscle fibers, causing it to be more severely affected Thoroughbreds are overrepresented amongst reported EMND by denervation atrophy than other muscles (19). Denervation cases (1,3). Equine motor neuron disease has been diagnosed atrophy of the SCDM muscles ultimately leads to fibrotic in adult horses as young as 3 y old (3), but the risk of develop- contracture and elevation of the tail head. The sensitivity and ing the disease peaks at 16 y (1,22). Experimental models have specificity of the SCDM muscle biopsy for diagnosing EMND demonstrated that the disease can be reproduced after 18 (11) to is approximately 90% (19). 21 mo (10) of feeding a diet completely deficient in vitamin E. The neurodegeneration that occurs in EMND is associated In order for this disease to occur in a 3-year-old horse, as in with a deficiency in plasma a-tocopherol levels (3). Alpha- Case 1, his diet would likely have had very low or no vitamin E tocopherol is a potent anti-oxidant and has several important for most of his life. roles in the body including immune function, gene transcrip- Several differential diagnoses were considered during initial tion, and neuromuscular function (18). When a deficiency of examination of the horses described here. Colic, laminitis, and vitamin E manifests itself as EMND, neurodegeneration occurs exertional rhabdomyolysis were considered in both cases, as in the areas of the body that have high oxidative requirements, they are common differential diagnoses in horses presenting such as the motor neurons supplying the type I muscle fibers with tachycardia, profuse sweating, and occasionally, muscle (12,13). A neuronal loss of approximately 30% is required fasciculations (23). Equine hyperkalemic periodic paralysis before clinical signs will manifest as EMND (33). It has been (HYPP) was included as a differential diagnosis in Case 1 as it hypothesized that both neuronal loss and dysfunctional motor mainly occurs in Quarter Horses and one of the most common neurons may be present in the diseased state (6). The affected clinical signs is muscle fasciculations (24). Pheochromocytoma horses that recover may be those with a higher proportion of is a catecholamine secreting adrenal medullary tumor, which neuronal dysfunction, rather than neuronal loss, and the dys- results in clinical signs such as prolonged tachycardia, tachypnea, functional motor neurons may be capable of recovery (6). In profuse sweating, muscle tremors, and anxiety (25). This was cases in which the horse is able to continue to eat and remain considered in Case 2 until the tachycardia and sweating resolved mobile, treatment may be beneficial.

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Treatment usually involves supportive care, which may assessment. Dr. Sara Higgins and members of the WCVM class include administration of corticosteroids in acute cases, and of 2013 were instrumental in the management of the horse in increasing dietary vitamin E through supplementation and the Case 2 during his hospitalization. CVJ addition of fresh green forage in the diet (4,12). The recommended dose for supplementation is 5000 to 7000 IU of vita- References min E/horse per day, with the highest safe level being 10 000 IU . 1 DeLaRuaDomenech R, Mohammed HO, Cummings JF, Divers TJ, REPORT CASE DeLahunta A, Summers BA. Association between plasma vitamin E of vitamin E/horse per day (18), which was the dose used in concentration and the risk of equine motor neuron disease. Vet J 1997; Case 1. This dose is expected to increase the serum a-tocopherol 154:203–213. concentration to normal levels within 2 to 4 wk of initiation (4). 2. Cummings JF, de Lahunta A, George C, et al. Equine motor neuron disease; A preliminary report. Cornell Vet 1990;80:357–379. It is important to consider the type of vitamin E in the supple- 3. Divers TJ, Mohammed HO, Cummings JF, et al. Equine motor neuron ment, as vitamin E in its natural form (RRR-a-tocopherol) is disease: Findings in 28 horses and proposal of a pathophysiological up to twice as bioavailable as the synthetic formulations (all-rac- mechanism for the disease. Equine Vet J 1994;26:409–415. a a 4. Divers TJ, Lahunta A de, Hintz HF, Riis RC, Jackson CA, Mohammed -tocopherol and dl- -tocopherol) (18). Clinical improvement HO. Equine motor neuron disease. Equine Vet Educ 2001;13:63–67. is noticeable in 40% of cases within 6 wk of treatment and of 5. Riis RC, Jackson C, Rebhun W, et al. Ocular manifestations of equine these, some will appear normal within 3 mo (4). However, it motor neuron disease. Equine Vet J 1999;31:99–110. 6. Divers TJ, Mohammed HO, Hintz HF, de Lahunta A. Equine motor should be considered that improvement of clinical signs at rest neuron disease: A review of clinical and experimental studies. Clin Tech can be deceiving and owners should be warned that the horse Equine Prac 2006;5:24–29. may deteriorate if it is put back into work, potentially lead- 7. Sokol RJ. Vitamin E deficiency and neurologic disease. Annu Rev Nutr 1988;8:351–373. ing to injury of both the horse and the rider (4). In 20% of 8. Nelson JS, Fitch CD, Fischer VW, Broun GO, Chou AC. Progressive EMND cases clinical signs progress to prolonged recumbency neuropathologic lesions in vitamin E-deficient rhesus monkeys. and debilitation, which often leads to euthanasia (4). The stal- J Neuropathol Exp Neurol 1981;40:166–186. 9. Pentschew A, Schwarz K. Systemic axonal dystrophy in vitamin E lion in Case 1 was expected to be a breeding animal and due to deficient adult rats. Acta Neuropathol 1962;1:313–334. the severity of his clinical condition, the highest safe dose was 10. Divers TJ, Cummings JE, de Lahunta A, Hintz HF, Mohammed HO. used in an attempt to promote his recovery. In Case 2 the horse Evaluation of the risk of motor neuron disease in horses fed a diet low in vitamin E and high in copper and iron. Am J Vet Res. 2006;67: was to be used for riding, and due to the unpredictability of his 120–126. recovery, he was euthanized. 11. Mohammed HO, Divers TJ, Summers BA, de Lahunta A. Vitamin E Equine motor neuron disease occurs sporadically and the deficiency and risk of equine motor neuron disease. Acta Vet Scand 2007;49:17–25. etiology has not been fully determined. It is still unknown why 12. Divers TJ, Mohammed HO, Cummings JF. Equine motor neuron some horses are affected and others are not when they are on the disease. Vet Clin North Am Equine Pract 1997;13:97–105. same farm and fed the same diet. One study evaluated vitamin E 13. Valentine BA, de Lahunta A, George C, et al. Acquired equine motor levels in clinically normal horses kept on the same property and neuron disease. Vet Pathol 2009;31:130–138. 14. Loftstedt J, Ikede BO. Motor neuron disease in a quarter horse from in the same housing conditions as EMND-affected horses. This Nova Scotia. Can Vet J 1994;35:507. study showed that clinically normal horses had low vitamin E 15. Moore A, Collatos C, Ortenburger A, Illanes O, Ikede B. Prince Edward concentrations, but the EMND-affected horses from these farms Island: Motor neuron disease in a horse. Can Vet J 1994;35:522. 16. Puls R. Mineral Levels in Animal Health. 2nd ed. Clearbrook, British had significantly lower plasma vitamin E concentrations than Columbia: Sherpa International, 1994. the clinically normal controls (3). Genetic factors have been 17. Rudolph JA, Spier SJ, Byrns G, Hoffman EP. Linkage of hyperkalaemic considered and based on the genetic mutation responsible for periodic paralysis in quarter horses to the horse adult skeletal muscle sodium channel gene. Anim Genet 1992;23:241–250. human familial ALS, the coding sequence of the equine copper/ 18. Finno CJ, Valberg SJ. A comparative review of vitamin E and associated zinc superoxide dismutase (SOD1) gene was evaluated in a equine disorders. J Vet Intern Med 2012;26:1251–1266. group of affected horses, but no similar mutations were detected 19. Divers TJ, Valentine BA, Jackson CA, Van Metre DC, Mohammed HO. Simple and practical muscle biopsy test for equine motor neuron (34). A heritable component of EMND has not been completely disease. Am Assoc Equine Pract Conf Proc 1996;42:180–181. ruled out, however, and it could be argued that the stallion in 20. Bedford HE, Valberg SJ, Firshman AM, Lucio M, Boyce MK, Case 1 should not be used as a breeding animal. Trumble TN. Histopathologic findings in the sacrocaudalis dorsalis medialis muscle of horses with vitamin E — responsive muscle atrophy Veterinarians in western Canada need to be aware of EMND and weakness. J Am Vet Med Assoc 2013;242:1127–1138. as horse husbandry during long winters typically involves feed- 21. Podell M, Valentine BA, Cummings JF, et al. Electromyography ing stored hay, which contains less vitamin E than fresh forage in aquired equine motor neuron disease. Prog Vet Neurol 1995;6: 128–134. (35), and therefore may predispose those horses to dietary vita- 22. Mohammed HO, Cummings JF, Divers TJ, la Rua-Domenech de R, min E deficiency. By familiarizing themselves with the clinical de Lahunter A. Epidemiology of equine motor neuron disease. Vet Res signs of EMND, veterinarians can proceed with appropriate 1994;25:275–278. 23. Reed SM, Bayly WM, Sellon DC. Equine Internal Medicine. 3rd ed. diagnostics and treatment. St. Louis, Missouri: Elsevier Health Sciences, 2010. 24. Naylor JM. Equine hyperkalemic periodic paralysis: Review and implica- Acknowledgments tions. Can Vet J 1994;35:279–285. 25. Yovich JV, Horney FD, Hardee GE. Pheochromocytoma in the The authors thank the equine surgeons who assisted with the horse and measurement of norepinephrine levels in horses. Can Vet J cases and performed the biopsies, including Drs. David Wilson, 1984;25:21–25. Joe Bracamonte, Holly Sparks, and Keri Thomas. Drs. Bianca 26. Wright A, Beard L, Bawa B, Bras J. Dysautonomia in a six-year-old mule in the United States. Equine Vet J 2010;42:170–173. Bauer and Lynne Sandmeyer were the consulting ophthal- 27. Pirie RS, Jago RC, Hudson NPH. Equine grass sickness. Equine Vet J mologists. Dr. Gillian Muir performed the electromyography 2014;46:545–553.

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28. Johnson AL, McAdams-Gallagher SC, Aceto H. Outcome of adult 33. Polack EW, King JM, Cummings JF, de Lahunta A, Divers TJ, horses with botulism treated at a veterinary hospital: 92 cases Mohammed HO. Quantitative assessment of motor neuron loss in (1989–2013). J Vet Intern Med 2015;29:311–319. equine motor neuron disease (EMND). Equine Vet J 1998;30:256–259. 29. Stewart AJ. Magnesium disorders in horses. Vet Clin North Am Equine 34. la Rua-Domenech de R, Wiedmann M, Mohammed HO, Cummings Pract 2011;27:149–163. JF, Divers TJ, Batt CA. Equine motor neuron disease is not linked to 30. Harrington DD. Pathologic features of magnesium deficiency in young Cu/Zn superoxide dismutase mutations: Sequence analysis of the equine horses fed purified rations. Am J Vet Res 1974;35:503–513. Cu/Zn superoxide dismutase cDNA. Gene 1996;178:83–88. 31. Johansson AM, Gardner SY, Jones SL, Fuquay LR, Reagan VH, 35. Bruhn JC, Oliver JC. Effect of storage on tocopherol and carotene Levine JF. Hypomagnesemia in hospitalized horses. J Vet Intern Med concentrations in alfalfa hay. J Dairy Sci 1978;61:980–982. 2003;17:860–867. 32. Jackson CA, de Lahunta A, Cummings JF, et al. Spinal accessory nerve biopsy as an ante mortem diagnostic test for equine motor neuron disease. Equine Vet J 1996;28:215–219. RAPPORTCAS DE

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

Articles from the April 2016 issue of CJVR that might Les articles suivants du numéro d’avril 2016 de la be of interest to practitioners include: RCRV pourraient intéresser les praticiens : Farm-level prevalence and risk factors for detection Farm-level prevalence and risk factors for detection of hepatitis E virus, porcine enteric calicivirus, and of hepatitis E virus, porcine enteric calicivirus, and rotavirus in Canadian finisher pigs on page 95 rotavirus in Canadian finisher pigs à la page 95 Breed- and age-related differences in canine mammary Breed- and age-related differences in canine mammary tumors on page 146 tumors à la page 146 The effects of intravenous alfaxalone with and without The effects of intravenous alfaxalone with and without premedication on intraocular pressure in healthy dogs premedication on intraocular pressure in healthy dogs on page 156 à la page 156

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CVMACVMA CONVENTIONCONVENTION welcomeswelcomes everyoneeveryone "from"from away"away" FOR PERSONAL USE ONLY Brief Communication Communication brève

Diagnostic performance of an indirect enzyme-linked immunosorbent assay (ELISA) to detect bovine leukemia virus antibodies in bulk-tank milk samples

Omid Nekouei, Jean Durocher, Greg Keefe

Abstract — This study assessed the diagnostic performance of a commercial ELISA for detecting bovine leukemia virus antibodies in bulk-tank milk samples from eastern Canada. Sensitivity and specificity of the test were estimated at 97.2% and 100%, respectively. The test was recommended as a cost-efficient tool for large-scale screening programs.

Résumé — Performance diagnostique d’un test ELISA indirect pour détecter les anticorps contre le virus de la leucémie bovine dans des échantillons prélevés dans les réservoirs à lait. Cette étude a évalué la performance diagnostique d’un test ELISA commercial pour détecter les anticorps contre le virus de la leucémie bovine dans des échantillons prélevés dans des réservoirs à lait provenant de l’Est du Canada. La sensibilité et la spécificité du test ont été estimées à 97,2 % et à 100 %, respectivement. Le test a été recommandé comme un outil rentable pour les programmes de dépistage à grande échelle. (Traduit par Isabelle Vallières) Can Vet J 2016;57:778–780

nzootic bovine leukosis (EBL), caused by bovine leuke- formance in large-scale surveillance programs (8,9). However, E mia virus (BLV), is an economically important disease of applying commercial ELISA tests, particularly to pooled samples dairy cattle. The virus is transmitted through infected blood (e.g., BTM), could lead to variable levels of uncertainty in the lymphocytes. Premature culling, death, and condemnation of results. Several factors, including study region, herd (pool) size, carcasses at slaughter due to lymphosarcoma, as well as restric- sampling procedures, and transferring process can potentially tions on international trade of infected cattle and their products contribute to the variable test results. Therefore, it has been are among the most significant economic losses attributed to recommended that the validity of diagnostic tests should be the disease (1,2). evaluated in different populations before integrating the tests Many European countries are now officially free from EBL, in large-scale control and eradication programs (10,11). The whereas prevalence of the infection in North America has been objective of this study was to assess the diagnostic performance high and appears to have a rising trend (2,3). For instance, in (sensitivity and specificity) of a commercially available ELISA the Maritime region of Canada, herd-level prevalence of the for detecting BLV antibodies in BTM samples from eastern infection has increased from 70% in 1998 (4) to over 90% in Canada, in order to validate the routine application of this test 2013 (5). to the BLV surveillance programs implemented in the region. Using bulk-tank milk (BTM) samples has become one of The study population consisted of 133 dairy herd improve- the most convenient and economically efficient procedures for ment (DHI)-registered dairy herds, including 8358 lactating screening for important diseases in dairy herds, including EBL cows, from 4 eastern provinces of Canada [Prince Edward Island (6,7). Among available commercial tests for detection of BLV (PE), New Brunswick (NB), Nova Scotia (NS), and Quebec antibodies, milk enzyme-linked immunosorbent assay (ELISA) (QC)]. During 2013, 30 farms were randomly selected from has been documented as a desirable method with good per- each of PE, NB, and NS (a total of 90 farms) based on a wide range of BLV within-herd prevalences (5). In 2014, a similar study was carried out on 43 purposively selected dairy farms Department of Health Management, Atlantic Veterinary in Quebec. These herds were selected from a pool of volunteer College, University of Prince Edward Island, Charlottetown, herds with a wide range of expected prevalences (according to Prince Edward Island, C1A 4P3 (Nekouei, Keefe); R&D Team, the available data from historic BLV surveys in Quebec). One Valacta, Sainte-Anne-de-Belevue, Quebec H9X 3R4 (Durocher). BTM sample was obtained from every selected farm, and on the Address all correspondence to Dr. Omid Nekouei; e-mail: same day of the BTM sampling, all lactating cows that contrib- [email protected] uted milk to the BTM were also individually sampled via the Use of this article is limited to a single copy for personal study. corresponding milk meters. Anyone interested in obtaining reprints should contact the Bulk-tank milk and individual cow milk samples (30 mL CVMA office ([email protected]) for additional each) from PE, NB, and NS were transferred to the Maritime copies or permission to use this material elsewhere. Quality Milk (MQM) laboratory in the University of Prince

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Table 1. Descriptive summary for 133 study dairy herds that had all their lactating cows tested for bovine leukemia virus milk antibodies, from eastern provinces of Canada Lactating herd size Tested Tested Positive Proportion

Province herds Min Median Max cows cowsa (%)b BRIEF COMMUNICATION New Brunswick 30 23 51 287 2232 845 37.8 Nova Scotia 30 30 65.5 214 2281 460 20.2 Prince Edward Island 30 28 52 126 1598 555 34.7 Quebec 43 14 56 145 2247 801 35.6 All 4 provinces 133 14 52 287 8358 2661 32.1

a Positive in individual milk ELISA test (percent positivity . 45). b Number of positive cows/number of tested cows.

Edward Island, Charlottetown to be tested for BLV antibodies. 25 All Quebec samples were submitted to the Valacta central laboratory (Sainte-Anne-de-Bellevue, Quebec) for BLV testing. All 20 samples were preserved with BROTAB (Sierra Court, California,

USA) and tested within a maximum of 7 d from the original 15 sampling dates using a commercial indirect ELISA (Svanovir BLV gp51-Ab, Svanova, Uppsala, Sweden). The test results were 10 reported as percent positivity (PP) values: Number of herds 3 [PP = (ODcorrected sample/ODcorrected positive control) 100] 5 Where: OD = optical density. 0 The statistical analyses were conducted in Stata 13.1 (StataCorp, 0 0 , 10 , 20 , 30 , 40 , 50 , 60 , 70 , 80 , 90 , College Station, Texas, USA). Within-herd prevalence (%) To determine the apparent within-herd prevalence of BLV- antibodies (AP), number of positive cows (PP . 45) was Figure 1. Frequency distribution of the within-herd prevalence of infection with bovine leukemia virus for 133 study herds from divided by the number of lactating (tested) cows for every herd. the eastern provinces of Canada. The black bar represents True within-herd prevalence of BLV infection (TP) was then uninfected herds (25/133). estimated for each of the selected herds using the following formula (12): respectively. Hence, the midpoint of 5 was considered as our practical cut-point value. At this cut-point, sensitivity and specificity of TP = (AP 1 Sp 2 1)/(Se 1 Sp 2 1) the BTM ELISA were estimated at 97.2% [95% confidence inter- Where: AP is the apparent prevalence of BLV infection within val (CI): 92.1% to 99.4%] and 100% (95% CI: 86.3% to 100%), the study herds; sensitivity (Se) and specificity (Sp) of the indi- respectively. vidual ELISA test at the applied threshold of 45 were 95.5% and According to our established reference standard, 3 truly 98.4%, respectively (13). The true within-herd prevalence was infected herds were negative by the BTM ELISA (defined as false regarded as the reference standard for evaluating the diagnostic negative herds). Each of those 3 herds harbored only 1 infected performance of the pooled-level application of the BTM ELISA. cow: 1 herd from NS (including 53 lactating cows), and 2 herds If the true within herd prevalence was zero (i.e., all cows were from QC (including 37 and 47 lactating cows). In stringent negative), the herd was considered as uninfected; and if it was eradication programs, repeated sampling from bulk-tank over above zero (i.e., at least 1 positive cow was present), the herd was appropriate time intervals has been recommended in order to considered as infected with BLV. A two-graph receiver operating compensate for the imperfect sensitivity of the BTM tests, and characteristic (TG-ROC) analysis was carried out to determine to capture as many positive animals in a herd as possible (12). the optimal cut-point on BTM ELISA values using the defined Addition or elimination of some cows can be influential on dichotomized reference standard. the BTM titers, such as those at advanced stages of BLV infec- Based on the true within-herd prevalence of BLV, 81.2% tion (e.g., cows with persistent lymphocytosis), because they (108/133) of the study herds were found to be infected (i.e., often produce high levels of virus and circulating antibodies true positive herds). Of 8358 cows tested (90% Holstein), (14). However, it is generally believed that the prevalence of BLV 2661 (31.8%) were positive to BLV milk-antibodies in the in herds from endemic areas (e.g., North America) remains fairly individual cow tests. Descriptive statistics for the study herds, steady over time (15); this characteristic supports the credibility by province, are presented in Table 1. The mean of BLV true of the current testing strategies (BTM ELISA) used in detecting within-herd prevalence for the 108 infected herds was 0.39 BLV infection. (SD = 0.27). Figure 1 displays the distribution of BLV true We were not able to apply more sophisticated statistical analy- within-herd prevalence for the study herds. ses to our data in order to include some potentially important From the TG-ROC analysis, maximum accuracy for BTM herd-level factors such as lactating herd size (representing the ELISA titers was achieved at 2.1 and 7.2 (percent positivity), potential dilution effect of BTM) because there were only 3 false

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diagnoses by the BTM test. However, this issue should not 3. Nekouei O, VanLeeuwen J, Sanchez J, Kelton D, Tiwari A, Keefe G. lead to any substantial bias since the selected herds were fairly Herd-level risk factors for infection with bovine leukemia virus in canadian dairy herds. Prev Vet Med 2015;119:105–113. representative of the herds in eastern Canada with regards to 4. VanLeeuwen JA, Keefe GP, Tremblay R, Power C, Wichtel JJ. the main characteristics, including herd size. For instance, the Seroprevalence of infection with Mycobacterium avium subspecies average lactating herd size in our study was 62.8, which was very paratuberculosis, bovine leukemia virus, and bovine viral diarrhea virus in maritime Canada dairy cattle. Can Vet J 2001;42:193–198. close to the average of lactating herd size in all 4 study provinces 5. Nekouei OA, Stryhn H, VanLeeuwen J, Kelton D, Hanna P, Keefe G. (approximately 60). Predicting within-herd prevalence of infection with bovine leukemia Applying a cut-point of 5 as the criterion for a negative herd virus using bulk-tank milk antibody levels. Prev Vet Med 2015; 122:53–60. test, when using the ELISA for BTM samples, generated reason- 6. Sargeant JM, Kelton DF, Martin SW, Mann ED. Evaluation of a bulk- ably valid results. Farmers whose farms are free from BLV and milk ELISA test for the classification of herd-level bovine leukemia virus would desire to maintain their negative status or those who wish status. Prev Vet Med 1997;31:211–221. 7. Sorge US, Lissemore K, Cantin R, Kelton DF. Milk ELISA status for to monitor their decreasing trend of BLV prevalence on their bovine leukosis virus infection is not associated with milk production COMMUNICATIONBRÈVE farms (due to taking control measures) could efficiently adopt in dairy cows. J Dairy Sci 2011;94:5062–5064. ongoing monitoring using the BTM ELISA test over appropriate 8. Gutierrez SE, Ferrer JF, Esteban EN, Rodriguez Dubra C, Dolcini GL, Arroyo GH. Development and evaluation of a highly sensitive and time-intervals. Application of the BTM ELISA in other regions specific blocking enzyme-linked immunosorbent assay and polymerase (particularly with large herds) should be validated before use in chain reaction assay for diagnosis of bovine leukemia virus infection in future surveillance programs. cattle. Am J Vet Res 2001;10:1571–1577. 9. Erskine RJ, Bartlett PC, Byrem TM, Render CL, Febvay C, Houseman JT. Using a herd profile to determine age-specific preva- Acknowledgments lence of bovine leukemia virus in Michigan dairy herds. Vet Med Int The authors gratefully acknowledge the contribution of 2012;2012:350–374. 10. Christensen J, Gardner IA. Herd-level interpretation of test results for all parties to this project, including study farmers, person- epidemiologic studies of animal diseases. Prev Vet Med 2000;45:83–106. nel at the MQM laboratory (Charlottetown, PE), Natasha 11. Greiner M, Gardner IA. Epidemiologic issues in the validation of vet- Robinson, Shereen Hassan and other Valacta personnel erinary diagnostic tests. Prev Vet Med 2000;45:3–22. 12. Dohoo IR, Martin SW, Stryhn H. Veterinary Epidemiologic Research. (Sainte-Anne-de-Bellevue, QC). This study was funded by the 2nd ed. Charlottetown, Prince Edward Island: VER Inc., 2009:91–133. MQM laboratory, Valacta, Dairy Farmers of Prince Edward 13. Nekouei OA, Sanchez J, Keefe GP, Carryover of bovine leukemia virus Island, New Brunswick, and Nova Scotia, the New Brunswick antibodies in samples from shared milk meters. J Dairy Sci 2015; 98:5274–5279. Department of Agriculture, and Agriculture and Agri-Food 14. Juliarena MA, Gutierrez SE, Ceriani C. Determination of proviral load Canada through the Agricultural Adaptation programs in Prince in bovine leukemia virus-infected cattle with and without lymphocytosis. Am J Vet Res 2007;68:1220–1225. Edward Island and Nova Scotia. CVJ 15. Radostits OM, Gay CC, Hinchcliff KW, Constable PD. Veterinary Medicine: A Textbook of the Diseases of Cattle, Horses, Sheep, Pigs References and Goats. 10th ed. New York, New York: Elsevier Saunders, 2006: . 1 Sandev N, Kostadinova N, Zarkov I. Economic problems concerning 1209–1221. enzootic bovine leukosis. Agric Econ Manag 2000;45:38–41. 2. Bartlett PC, Sordillo LM, Byrem TM, et al. Options for the control of bovine leukemia virus in dairy cattle. J Am Vet Med Assoc 2014; 244:914–922.

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780 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY Student Paper Communication étudiante

Congenital nutritional myodegeneration in a neonatal foal

Jessie MacQuarrie

Abstract — A 2-day-old Quarter Horse colt was presented to the Atlantic Veterinary College for recumbency and diarrhea. Dietary history of the dam, serum biochemistry findings, and whole blood selenium levels were consistent with nutritional myodegeneration. The patient was treated successfully with fluid therapy and broad-spectrum antimicrobials. Recovery was uneventful, and the patient was discharged with a favorable prognosis.

Résumé — Myodégénérescence nutritionnelle congénitale chez un poulain néonatal. Un poulain Quarter Horse âgé de deux jours a été présenté à l’Atlantic Veterinary College pour un décubitus et de la diarrhée. L’anamnèse nutritionnelle de la mère, les résultats de la biochimie sérique et les taux de sélénium dans le sang total étaient conformes à la myodégénérescence nutritionnelle. Le patient a été traité avec succès à l’aide d’une fluidothérapie et d’antimicrobiens à large spectre. Le rétablissement a été sans incident et le patient a reçu son congé avec un pronostic favorable. (Traduit par Isabelle Vallières) Can Vet J 2016;57:781–784

Quarter Horse colt was examined by a veterinarian at At the time of presentation to AVC, the foal was recumbent, A 1 day of age for diarrhea and recumbency with an inabil- unable to rise, and had a dull mentation. The patient had a ity to rise. Clinical signs were noted by the owner following body weight of 67 kg and rectal temperature of 37.0°C. Heart IM administration of selenium and tetanus toxoid. The owner rate was 108 beats/min, and pulse quality was poor. Distal did not observe urination following onset of clinical signs, and extremities were cold to the touch. Oral mucous membranes it was unclear if the foal had voided urine prior to recumbency. were dark pink and tacky, with a capillary refill time of 2 s, The veterinarian administered IV flunixin meglumine that eve- suggestive of dehydration and poor perfusion. Respiratory rate ning, followed by IV flunixin meglumine and IM trimethoprim was 25 breaths/min, accompanied by increased respiratory sulfa the following morning (all doses unknown). Clinical effort and normal lung sounds. Ecchymoses were noted on the signs did not improve, and the foal was referred to the Atlantic inner surface of both pinnae, but were not present on any other Veterinary College’s (AVC’s) Veterinary Teaching Hospital for mucosal surfaces. A weak suckle reflex was present, and abdomi- further evaluation. nal auscultation revealed decreased intestinal borborygmi in all The dam was pastured with the sire for 1 mo from July 2014 4 quadrants. No heat or swelling was detected in the umbilicus to August 2014, so the expected foaling date of the mare was or joints. The patient was assumed to be full-term, as no signs uncertain. The mare was observed at 4-hour intervals overnight of prematurity were noted on physical examination. on July 13th, 2015, and was not in labor when observed at Problems identified from the clinical history and physical 2 am. When the owners returned at 6 am on July 14th, the foal examination were recumbency with an inability to rise, dull was standing and nursing. The mare was fed locally sourced hay mentation, diarrhea, dehydration, and a shock-like state. and haylage ad libitum without grain supplementation through- Differential diagnoses initially considered included failure of out gestation, but was started on a mare and foal concentrate passive transfer, neonatal septicemia, hypoxic ischemic encepha- ration shortly after parturition. lopathy, and uroabdomen or uroperitoneum. Initial diagnostic evaluation included a complete blood (cell) count (CBC), serum biochemical profile, arterial blood gas, Department of Health Management, University of Prince blood culture, serum lactate, and gluteraldehyde coagulation Edward Island, 550 University Avenue, Charlottetown, Prince test. The CBC revealed mild leukocytosis [white blood cells, Edward Island C1A 4P3. 17.6 3 109/L; reference interval (RI): 5.5 to 12.5 3 109/L] Address all correspondence to Ms. Jessie MacQuarrie; e-mail: characterized by moderate mature neutrophilia, consistent with [email protected] inflammation or stress. Ms. MacQuarrie will receive 50 copies of her article free of Abnormalities on the serum biochemistry included highly charge courtesy of The Canadian Veterinary Journal. elevated creatine kinase (CK, 38 4073 U/L; RI: 0 to 500 U/L) Use of this article is limited to a single copy for personal study. and aspartate aminotransferase (AST, 9478 U/L; RI: 197 to Anyone interested in obtaining reprints should contact the 429 U/L), suggestive of acute muscle cell injury. Moderate CVMA office ([email protected]) for additional azotemia (urea 11.6 mmol/L; RI: 3.5 to 7.0 mmol/L and cre- copies or permission to use this material elsewhere. atinine 317 mmol/L; RI: 78 to 143 mmol/L) could be attributed

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to a pre-renal cause such as decreased renal perfusion, a renal lar casts were present, indicative of renal tubular degeneration. cause such as acute renal injury, or to a post-renal cause such These findings led to a tentative diagnosis of myoglobinuric as uroabdomen. Severe hyperkalemia (potassium 9.1 mmol/L; nephropathy, potentially associated with congenital nutritional RI: 3.0 to 5.0 mmol/L) was attributed to decreased renal excre- myodegeneration. Concurrent sepsis could not be ruled out at tion potentially caused by uroabdomen, urinary obstruction, this time. Blood was collected from both the mare and foal to or acute renal failure. Shifting of potassium from intracellular assess serum and whole blood selenium levels. A stall side EKG fluid to extracellular fluid as a result of muscle cell leakage was detected no abnormalities of heart rate or rhythm. another possible cause for hyperkalemia. Severe hyponaturemia Initial medical therapy focused primarily on correcting elec- (sodium 112 mmol/L; RI: 135 to 148 mmol/L) and severe trolyte abnormalities and dehydration. Following diagnostic hypochloremia (chloride 71 mmol/L; RI: 98 to 110 mmol/L) testing and placement of a jugular catheter, a continuous rate were attributed to increased loss (such as renal loss or third infusion of IV fluids (0.9% NaCl with 5% dextrose solution) space sequestration) or shifting from intracellular to extracellular was initiated at a rate of 200 mL/h. Antimicrobial therapy was fluid due to myopathy or uroabdomen. Mild hyperphosphate- also instituted; Ceftiofur (Zoetis Canada, Kirkland, Quebec), COMMUNICATIONÉTUDIANTE mia (phosphorus 2.39 mmol/L; RI: 1.0 to 1.8 mmol/L) was 5 mg/kg body weight (BW), IV, q12h and Penicillin G Sodium attributed to decreased renal excretion or leakage from injured (Pharmaceutical Partners of Canada, Richmond Hill, Ontario), myocytes. Hypocalcemia (calcium 1.91 mmol/L; RI: 2.8 to 22 000 IU/kg BW, IV, q6h, were administered for 7 d. A naso- 3.44 mmol/L) and hypoalbuminemia (albumin 21 g/L; RI: 25 to gastric feeding tube was placed to provide enteral nutrition. 36 g/L) were attributed to increased renal loss or normal varia- Urine output was monitored for a 24-hour period. tion in a neonatal patient. Mildly elevated alkaline phospha- The patient made attempts to stand within 12 h of hospital- tase (ALP) was consistent with normal variation in a neonatal ization, and his suckle reflex gradually returned. The foal was patient. standing, nursing from the mare, and urinating within 24 h. Hyperlactatemia (3.77 mmol/L; RI: 0.55 to 1.11 mmol/L) Over the first 5 d, repeated blood samples were submitted was suggestive of tissue hypoxia. Arterial blood gas results approximately every 24 h for serum biochemistry to monitor the revealed a mild respiratory acidosis. The gluteraldehyde coagula- efficacy of fluid therapy. Biochemical derangements progressively tion test showed a serum IgG concentration greater than 8 g/L, returned to normal reference ranges. As these imbalances stabi- suggesting adequate colostral transfer of maternal antibodies. lized, fluid therapy was modified accordingly, and the patient The foal had a negative sepsis score of 9, based on the University was weaned off IV fluids completely after 5 d of hospitalization. of Florida scoring system. A sample of blood was collected and The foal was nursing, ambulating, and urinating independently submitted for bacterial culture. at the time of discharge. Blood culture results were negative, The clinical presentation, biochemical abnormalities, and with no growth of organisms. clinical signs were consistent with acute muscle cell injury. Some Seven days after admission, the patient was discharged on a findings were also suggestive of decreased renal excretion. Other 5-day course of Trimethoprim sulfa tablets (Apo Sulfatrim-DS; differential diagnoses included nutritional myodegeneration, Apotex, Toronto, Ontario), 25 mg/kg BW, PO, q12h. The uroabdomen or uroperitoneum, renal or post-renal azotemia, mare was given an IM injection of selenium and vitamin E and myoglobinuric renal insufficiency. Transabdominal ultra- prior to discharge to treat a suspected deficiency. The owners sonography and urinary catheter placement were performed were advised to subject the foal to 2 wk of stall confinement to determine the likelihood of uroabdomen and post-renal followed by 6 to 8 wk of turnout in a small paddock, and to azotemia. provide both the mare and foal with a concentrate ration suit- Transabdominal ultrasonography (iU22 Ultrasound Sytem; ably supplemented with selenium, as well as a trace mineral Philips Healthcare, Andover, Massachusetts, USA) using a 5 to block supplemented with selenium. Continued monitoring of 8 mHz curvilinear transducer determined that the bladder con- the foal’s serum selenium status by the referring veterinarian tained a significant amount of urine and was severely distended. was also recommended. To prevent future cases of congenital Hyperechoic foci were visible within the bladder. The bladder nutritional myodegeneration, adequate selenium supplementa- wall appeared intact, and no free abdominal or retroperitoneal tion for all broodmares on the farm during gestation and after fluid was noted. A cystic lesion was noted within the cortex of parturition was recommended. the right kidney as an incidental finding. These ultrasonographic Results of whole blood and serum selenium levels received findings ruled out uroperitoneum. following discharge confirmed that both the mare and foal were Since no urination had been observed, a urinary catheter was selenium deficient. The foal had a serum selenium concentration passed to determine if an obstruction was present and to col- of 0.05 ppm, while the mare’s serum selenium concentration was lect a sample of urine for urinalysis. The catheter passed easily, 0.031 ppm (RI: 0.14 to 0.25 ppm). This confirmed the tentative making a diagnosis of post-renal obstruction unlikely. A sample diagnosis of congenital nutritional myodegeneration leading to of turbid, dark yellow urine was collected following catheter myoglobinuric nephropathy in the foal. placement and submitted for urinalysis. Proteinuria and large Three months after discharge the foal was doing well and numbers of hyaline casts were noted, suggestive of myoglo- growing at a normal rate. A serum sample collected by the refer- binuria. The absence of red blood cells on urinalysis provided ring veterinarian 60 d after discharge yielded a serum selenium additional support for myoglobinuria, which was confirmed concentration of 0.14 ppm, indicating that proper nutrition was using the Differential Solubility Test. Large numbers of granu- helping to restore selenium levels in the patient.

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Discussion the lack of bacterial growth on blood culture, and the inability to identify a post-renal obstruction made nutritional myo- Nutritional myodegeneration is a disease of rapidly growing degeneration the likely cause of the foal’s acute recumbency. neonatal foals due to a congenital deficiency of selenium and Confirming the presence of myoglobinuria provided further vitamin E. The disease is more common in geographic areas support for nutritional myodegeneration (8). where soil is known to be selenium deficient, such as Atlantic PAPER STUDENT Initial fluid therapy consisted of 0.9% NaCl with 5% dex- Canada (1). Both vitamin E and selenium act as antioxidants in trose solution, based on initial biochemical derangements. circulation; deficiency leads to the presence of circulating free The 0.9% NaCl was selected to correct hyponatremia, and 5% radicals, which damage muscle cell membranes and disrupt the dextrose solution was added to correct hyperkalemia by driving barrier between intracellular and extracellular compartments potassium back into cells (6). Broad-spectrum antimicrobial (2,3). therapy was instituted to treat a potential underlying sepsis, Affected foals exhibit weakness, recumbency, and difficulty and as prophylaxis against a possible secondary pneumonia rising with the subacute form of the disease affecting skeletal (5,6). Ceftiofur and penicillin G sodium were chosen to provide muscles. Myoglobinuria due to skeletal muscle destruction, and broad-spectrum coverage against Gram-positive and Gram- secondary pneumonia due to respiratory muscle weakness are negative bacteria (9). Gentamicin, although efficacious against common sequelae of the disease (4). Pathogen inhalation dur- Gram-negative bacteria, was contraindicated in this patient ing recumbency can also contribute to pneumonia (5). White due to the patient’s compromised renal function and the risk of streaking of skeletal muscles due to calcium deposition is a com- nephrotoxicity associated with aminoglycosides (9). monly reported postmortem finding, giving rise to the common The low serum selenium concentrations confirmed the tenta- name of “White Muscle Disease” (6). Although the subacute tive diagnosis that poor broodmare nutrition led to inadequate form of the disease affecting skeletal muscle is more common, placental and colostral transfer of selenium to the foal. A recent a peracute form affecting cardiac muscle can also occur. Foals study comparing dietary treatments in multiparous broodmares affected with the cardiac form of nutritional myodegeneration found higher levels of colostral selenium in mares supplemented typically have a rapid irregular heartbeat, although many are with selenium from organic sources (10). Concentration of found dead. In cases in which the diaphragm and intercostal selenium in red blood cells in foals, an indicator of placental muscles are concurrently affected, cardiomyopathy can result transfer, was also higher when dams were supplemented with (4). Treatment involves strict rest, significant supportive care, selenium from an organic source (10). Colostral transfer of and supplementation of vitamin E and selenium by IM injec- selenium had a short-term effect, whereas selenium obtained tion. Despite aggressive therapy, disease prognosis is generally transplacentally resulted in elevated red blood cell concentra- guarded to grave (4). tions for up to 1 mo after foaling. These studies suggest that Biochemical disturbances seen in the patient on initial selenium supplementation during gestation is imperative for diagnostic evaluation included hyperkalemia, hyponaturemia, establishing adequate selenium levels in the fetus and newborn hypochloremia, hyperphosphatemia, hypocalcemia, and azo- foal. temia. Taking into account the patient’s age at presentation, The clinical presentation of the foal combined with the inability to rise, and suspected anuria, the electrolyte profile dietary history of the mare led to a diagnosis of congenital was suggestive of uroabdomen or uroperitoneum (7). These nutritional myodegeneration. This case report emphasizes the electrolyte abnormalities may also occur, however, as a result importance of proper broodmare nutrition in selenium-deficient of severe muscle damage (8). Nutritional myodegeneration was areas as a means of preventing nutritional myodegeneration in high on the differential diagnosis list, given the nutritional his- neonatal foals. tory of the mare and the fact that the mare and foal were from an area known to be selenium deficient. Acknowledgments Skeletal muscle is the largest intracellular fluid compartment I thank Drs. Maureen Wichtel and Emily John, the senior clini- in the body and thus a major reservoir for potassium (5,6). cian and resident on the case, for their guidance and support. Severe muscle cell injury, as seen with nutritional myodegen- I also acknowledge my rotation mates (Jessica Eisnor, Bethany eration, leads to disruption of the barrier between intracellular Holliday, Maria Kearney, Jamie Linthorne) and 2 visiting veteri- and extracellular fluid compartments and altered electrolyte nary students from Kasetsart University in Bangkok, Thailand composition of serum. Potassium and phosphorus move from (Nance Duangkamol and Ana Prommarit) for their assistance damaged muscle cells into the bloodstream. Sodium, chloride, with patient care. CVJ and calcium follow a concentration gradient from serum to damaged muscles, leading to the electrolyte abnormalities described References in the patient. . 1 Gupta UC, Gupta SC. Selenium in soils and crops, its deficiencies in Evaluating serum CK and AST, and performing abdominal livestock and human: Implications for management. Commun Soil Sci Plant Anal 2000;31:1791–1807. ultrasound are the most reliable methods of differentiating 2. Paradis MR, ed. Equine Neonatal Medicine: A Case-Based Approach. uroabdomen from nutritional myodegeneration (6). Markedly Philadelphia, Pennsylvania: Elsevier Saunders, 2006:153. elevated levels of serum CK and AST have been associated with 3. Wilson DA. Clinical Veterinary Advisor: The Horse. St. Louis, Missouri: Elsevier Saunders, 2012:406. selenium deficiency and resulting oxidative stress to skeletal 4. McAuliffe SB, Slovis NM. Color Atlas Diseases and Disorders of the muscle (6). The absence of free fluid on abdominal ultrasound, Foal. Philadelphia, Pennsylvania: Elsevier Saunders, 2008:218.

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. 5 Valberg SJ. A Review of the Diagnosis and Treatment of Rhabdomyolysis 8. Sonnenwirth AC, Reitman S, Frankel S, eds. Gradwohl’s Clinical in Foals. AAEP Proceedings, Orlando, Florida, December 4–8, 2002; Laboratory Methods & Diagnosis. 7th ed. Vol 1. St. Louis, Missouri: 48:117–121. Mosby, 1970:603. 6. Perkins G, Valberg SJ, Madigan JM, Carlson GP, Jones SL. Electrolyte 9. Lees P, Aylifee TR, Baggot JD, et al. Toxicology and pharmacology. disturbances in foals with severe rhabdomyolysis. J Vet Intern Med In: Higgins AJ, Snyder JR, eds. The Equine Manual. 2nd ed. St. Louis 1998;12:173–177. Missouri: Elsevier Saunders, 2013:236–243. 7. Kablack KA, Embertson RM, Bernard WV, et al. Uroperitoneum 10. Montgomery JB, Wichtel JJ, Wichtel MG, et al. The effects of selenium in the hospitalised equine neonate: Retrospective study of 31 cases, source on measures of selenium status of mares and selenium status and 1988–1997. Equine Vet J 2000;32:505–508. immune function of their foals. J Equine Vet Sci 2012;32:352–359. COMMUNICATIONÉTUDIANTE

784 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY Veterinary Practice Management Gestion d’une clinique vétérinaire

Veterinary diet pricing: Competing with the pet food store Prix des aliments vétérinaires : comment faire concurrence aux animaleries

Chris Doherty, DVM/D.M.V.

espite its importance, nutrition is routinely given only algré son importance, la nutrition est un sujet qui est D a cursory mention during veterinary appointments. M habituellement mentionné seulement de passage lors Veterinarians may brush over the conversation, not wishing to des rendez-vous vétérinaires. Les vétérinaires peuvent passer seem like pushy salespersons, and believing that their clients rapidement sur le sujet parce qu’ils ne désirent pas donner perceive veterinary diets as too expensive. l’impression qu’ils forcent le client à acheter le produit et qu’ils The reality, however, is that veterinary exclusive diets are croient que ces derniers perçoivent les aliments vétérinaires highly competitive in price when compared to premium pet comme étant trop dispendieux. Cependant, dans la réalité, le food store diets, and in some cases can result in the pet owner prix des aliments vétérinaires exclusifs est hautement compétitif saving hundreds of dollars per year. lorsqu’on le compare à celui des diètes de qualité supérieure For the average pet owner, it can be exceedingly difficult to vendues en magasin et, dans certains cas, les propriétaires accurately compare the cost of a diet as variable bag sizes and d’animaux de compagnie peuvent même économiser des centaines caloric densities can confuse the assessment. The key figure that de dollars par année. needs to be determined is the consumption cost, or the cost of Pour le propriétaire d’animal moyen, il peut être très difficile feeding per day. Calculating this will allow for an “apples to de comparer le coût d’une diète, car les dimensions des sacs et apples” analysis of prices among diets. les densités caloriques peuvent compliquer l’évaluation. Il est When the consumption costs are calculated, veterinary important de déterminer le coût de la consommation ou le coût exclusive diets are found to be in close competition. Tables 1 des aliments par jour. Ce calcul permettra une analyse de données and 2 outline the consumption cost of a number of veterinary comparables relativement au prix des diverses diètes. exclusive diets, as well as premium pet food store diets. The Or, en calculant les coûts de consommation, on constate veterinary exclusive diets (highlighted in blue) all have a daily que les aliments vétérinaires exclusifs sont très concurrentiels. cost to feed that is either lower than, or close to these common Les tableaux 1 et 2 présentent le coût de la consommation de premium foods sold in pet stores. Indeed, some of the most plusieurs aliments vétérinaires exclusifs ainsi que de diètes pour popular premium diets are significantly more expensive in pet animaux de qualité supérieure vendues en magasin. Les aliments stores on a cost per day basis. vétérinaires exclusifs (surlignés en bleu) présentent tous un coût

Dr. Doherty completed his BSc at the University of Guelph and his DVM at the Ontario Veterinary College. He works as an economic analyst for the Ontario Veterinary Medical Association and does some voluntary and locum veterinary work in his spare time. 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 a obtenu son B.Sc. à l’Université de Guelph et son D.M.V. à l’Ontario Veterinary College. Il travaille en tant qu’analyste économique pour l’Ontario Veterinary Medical Association et œuvre comme vétérinaire bénévole et remplaçant dans ses temps libres. Le présent article est rédigé dans le cadre du Programme de gestion commerciale de l’ACMV, qui est cocommandité par IDEXX Laboratories, Petsecure Insurance, Merck Santé Animale et la Banque Scotia. Veuillez adresser toute correspondance au Comité de la gestion commerciale de l’ACMV; courriel : [email protected] L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs.

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Table 1/Tableau 1. Name, size of bag, amount fed, and cost per Table 2/Tableau 2. Name, size of bag, amount fed, and cost per day of canine maintenance and dental diets/Nom, taille du sac, day of feline maintenance and dental diets/Nom, taille du sac, quantité consommée et coût par jour des diètes canines de quantité consommée et coût par jour des diètes félines de maintien maintien du poids et de soins dentaires du poids et de soins dentaires Grams Grams fed/day fed/day (11 kg dog) (4.5 kg cat) (g) (g) Gramnes Size of Grammes/ Cost/ Size of d’aliments/ Cost/ bag (kg) jour (chat day bag (kg) jour (chien day Diet name Taille du de 4,5 kg) Coût/ Diet name Taille du de 11 kg) Coût/ Nom de la diète sac (kg) (g) jour Nom de la nourriture sac (kg) (g) jour Hill’s Science Diet Optimal Care 3.2 62 $0.70 Royal Canin Medium Adult 2.7 177 $1.50 Original Royal Canin — Adulte Moyen Royal Canin Adult 4.5 60 $0.75 Hill’s Science Diet Adult — 2.3 200 $1.56 Royal Canin — Adulte Light Original Hill’s Science Diet Adulte — Acana Wild Prairie 2.3 68 $0.75 GESTION D’UNECLINIQUE VÉTÉRINAIRE Légère Originale Purina Essential Care Adult 3.6 78 $0.85 Purina Veterinary Dental Health 2.7 184 $1.60 Purina Essential Care — Adulte Purina Vétérinaire — Formule dentaire BLUE Wilderness Chicken 2.3 60 $0.87 Royal Canin Dental 3.5 170 $1.66 BLUE Wilderness — Poulet Royal Canin — Formule dentaire Hill’s Healthy Advantage Adult 1.4 62 $0.88 Now Fresh Grain Free — Adult 2.7 163 $1.75 Hill’s Healthy Advantage — Adulte Now Fresh Sans Grains — Adulte Royal Canin Dental 3.5 60 $0.92 Orijen Canine Adult 2.3 160 $1.90 Royal Canin — Soins dentaires Orijen Canine — Adulte Orijen Cat and Kitten 2.3 68 $0.97 Acana Grasslands — Grain Free 2.3 175 $2.08 Orijen — Chat et chaton Acana Grasslands — Sans Grains Royal Canin Feline Indoor Cat 3.2 77 $1.00 Hill’s T/D 2.2 197 $2.15 Royal Canin — Formule Chats d’intérieur BLUE Wilderness Chicken 2.0 199 $2.63 BLUE Wilderness — Poulet Performatrin Indoor Formula 2.7 102 $1.01 Performatrin — Formule d’intérieur Hill’s T/D 3.9 72 $1.09 Purina Veterinary Dental Health 2.7 82 $1.10 To make this as relevant as possible for clients, after making Purina Vétérinaire — Soins dentaires a dietary recommendation during the examination, provide the consumption cost of the pet’s current diet compared to the veterinary exclusive diet that has been proposed. This will assist in removing any hesitation based on cost, so the discussion can de consommation quotidien qui est inférieur ou est très près de focus on other relevant benefits. celui des diètes de qualité supérieure les plus populaires vendues Determining the cost per day of feeding a diet is relatively dans les animaleries. En effet, le coût quotidien de certaines des straightforward, requiring only a few key pieces of information: diètes de qualité supérieure les plus populaires est beaucoup plus • Divide the price of the bag of food by the weight of the bag dispendieux dans les animaleries. to determine the price per kilogram; Afin d’assurer la plus grande pertinence possible pour • Consult the feeding guide to determine how many grams les clients, après la communication d’une recommandation to feed the individual animal per day (based on weight, age, alimentaire durant l’examen, fournissez le coût de la etc.), and divide by 1000 to convert to kilograms; consommation de la diète actuelle de l’animal par rapport à • Multiply the kilograms fed per day by the price per kilogram, celui des aliments vétérinaires exclusifs qui ont été proposés. resulting in cost to feed per day. Cette comparaison vous aidera à dissiper les doutes à propos du To really drive the point home for pet owners, the savings coût et la discussion pourra ensuite porter sur les autres bienfaits per year can also be illustrated. As an example, take the Purina pertinents. Veterinary Dental Health and BLUE Wilderness diets from Il est relativement facile de déterminer le coût quotidien d’une Table 1. Feeding the veterinary exclusive diet to a 25 lb dog diète et vous avez besoin uniquement de quelques données : would result in an annual savings of over $375. • Divisez le prix du sac d’aliments par le poids du sac pour With this competitive pricing, veterinary hospitals are in an déterminer le prix par kilogramme; excellent position to discuss the foods they recommend based • Consultez le guide de nutrition afin de déterminer combien on nutritional and safety merits alone. de grammes l’animal individuel doit consommer par jour Consider assigning the role of nutritional expert to one staff (selon le poids, l’âge, etc.) et divisez par 1000 pour convertir person in the clinic. Provide them access to proper training, and en kilogrammes;

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have them educate the rest of the practice on current trends and Notes: Grams fed per day are based on the manufacturer’s knowledge on pet foods. Make a point of asking your clients recommended feeding guide for a dog weighing 11 kg, and a PRACTICE MANAGEMENT VETERINARY what they are feeding and how it is working for them. Help cat weighing 4.5 kg. The actual amount required to be fed per them better understand the ingredient list. Discussing the day may vary for an individual animal, affecting consumption topic of nutrition during appointments or offering a nutritional cost. The costs of veterinary exclusive diets were determined by consultation with your resident “expert,” making a dietary taking the cost from veterinary suppliers for an individual diet recommendation, and comparing the consumption cost of the and applying a markup of 1.43 (the national average determined current and recommended diets will position veterinary clinics through the Practice Owners Economic Survey). ■ as experts in nutritional advice. Through these strategies, you can provide your clients with higher quality pet food, promote pet health, and grow your sales of pet food.

• Multipliez les kilogrammes d’aliments consommés par jour mieux comprendre la liste d’ingrédients. Afin de positionner les par le prix par kilogramme, ce qui vous donnera le coût des cliniques vétérinaires comme des experts en nutrition, vous pouvez aliments par jour. discuter ce sujet durant les rendez-vous ou offrir une consultation Afin de vraiment convaincre les propriétaires, on peut aussi nutritionnelle avec votre «expert» interne pour présenter une illustrer les économies réalisées annuellement. À titre d’exemple, recommandation d’aliments tout en comparant le coût de la on peut comparer les diètes Purina — Formule Dentaire et consommation des diètes actuelles et recommandées. BLUE Wilderness du tableau 1. Dans ce cas, l’achat des aliments Grâce à ces stratégies, vous pourrez fournir à vos clients des vétérinaires exclusifs pour un chien de 25 lb produirait des aliments pour animaux de qualité supérieure, promouvoir la santé économies annuelles de plus de 375 $. des animaux et augmenter vos ventes d’aliments pour animaux. Avec ces prix concurrentiels, les cliniques vétérinaires se trouvent dans une excellente position pour discuter des aliments Nota : Les grammes de nourriture par jour se fondent sur qu’ils recommandent en fonction des mérites nutritionnels et de le guide nutritionnel recommandé par le fabricant pour un l’innocuité. chien pesant 11 kg et un chat pesant 4,5 kg. La quantité réelle Envisagez l’attribution d’un rôle d’expert nutritionnel à une de nourriture requise par jour peut varier pour un animal personne de la clinique. Donnez-lui accès à une formation individuel, ce qui affectera le coût de la consommation. Le coût appropriée, puis demandez à cette personne de former le reste des aliments vétérinaires exclusifs a été déterminé en prenant le des employés sur les tendances et les connaissances actuelles coût des fournisseurs vétérinaires pour une diète individuelle et en relativement aux aliments pour animaux. Rappelez-vous de appliquant une marge commerciale de 1,43 (la moyenne nationale demander à vos clients quel type de nourriture ils donnent à déterminée dans le Sondage économique auprès des propriétaires leurs animaux et quel est leur niveau de satisfaction. Aidez-les à de pratique). ■

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Answers to Quiz Corner Les réponses du test éclair

1. A) This is a typical presentation for a mast cell tumor. et la formation de pierres chez les jeunes est possible Fibrosarcomas and hemangiosarcomas can occur in the secondairement à une ITU ou à un problème métabolique. skin, but are spindle cell tumors and not round cell tumors. Cependant, ce type d’incontinence est encore moins fréquent Mammary gland tumors typically occur within the mammary que celui résultant d’une maladie congénitale, dont la plus chain and only rarely have the appearance of round cells. fréquente est l’uretère ectopique. Lymphoma is a round cell tumor but the granules and varia- 3. C) Spines on the base of a cat’s penis are responsive to andro - tion in size of the mass over time make a mast cell tumor a genic stimulation; thus, their presence in a cat devoid of more likely diagnosis. any scrotal testes is an indication that androgenic stimula- A) Il s’agit d’une présentation caractéristique d’un mastocytome. tion continues to occur and may be due to retained intra- Les fibrosarcomes et les hémangiosarcomes peuvent affecter abdominal testicles. la peau, mais ce sont des tumeurs à cellules fusiformes et C) Les épines à la base du pénis du chat sont responsables de la non à cellules rondes. Les tumeurs des glandes mammaires se stimulation par les androgènes. Ainsi, leur présence chez un retrouvent de façon caractéristique dans la chaîne mammaire chat qui ne possède pas de testicules dans le scrotum est un et elles ont seulement rarement l’apparence de cellules rondes. indice que la stimulation androgénique continue à se produire Le lymphome est une tumeur à cellules rondes, mais la et peut être due à la rétention de testicules dans l’abdomen. présence de granules et la variation de grosseur de la masse font en sorte que le mastocytome constitue un diagnostic plus 4. D) Because of the elevated hormone levels in these horses, the probable. contralateral ovary can take a prolonged period of time to resume normal activity. 2. A) Bl adder neoplasia is considerably more likely in the older dog. D) À cause des taux hormonaux élevés chez ces juments, l’ovaire Urge incontinence is possible with UTI; however, UTI in the controlatéral peut prendre beaucoup de temps avant de revenir young rarely occurs as a separate entity but rather occurs à une activité normale. in addition to a congenital anomaly. PSMI is very uncom - mon in very young dogs. Urge incontinence is possible with 5. E) Nasal swabs will pick up bacteria that are normally found in urolithiasis, and stone formation in the young is possible the upper respiratory tract. Serology is difficult to interpret, secondary to a UTI or to a metabolic problem. However, especially in the face of vaccine titers and previous pathogen this is still less common than incontinence resulting from exposure. Necropsy of calves with chronic pneumonia often congenital anomaly, the most common of which is ectopic reveals secondary and tertiary pathogens, and not the incit- ureter. ing pathogens. A) Une néoplasie de la vessie est considérablement plus probable E) Les écouvillons nasaux prélèvent les bactéries qui sont chez les vieux chiens. L’incontinence est possible avec une normalement présentes dans le tractus respiratoire supérieur. ITU. Toutefois, il est rare de rencontrer une ITU chez les La sérologie est difficile à interpréter, spécialement en présence jeunes chiens en tant qu’entité séparée, car elle se produit de titres vaccinaux et d’exposition à des agents pathogènes surtout accompagnée d’une anomalie congénitale. Il est peu antérieurs. La nécropsie de veaux souffrant de pneumonie commun de retrouver une IMSP chez les très jeunes chiens. Il chronique révèle souvent des agents pathogènes secondaires est possible d’observer de l’incontinence avec une urolithiase ou tertiaires et non les agents pathogènes causaux.

BRAVECTO CVJ - Quiz Corner Answer ad.indd 1 2016-03-31 10:47 AM

788 CVJ / VOL 57 / JULY 2016 FOR PERSONAL USE ONLY Diagnostic Ophthalmology Ophtalmologie diagnostique

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

History and clinical signs What are your clinical diagnosis, 6-year-old, neutered male miniature poodle dog was differential diagnoses, therapeutic plan, A referred to the ophthalmology service at the Western and prognosis? College of Veterinary Medicine (WCVM) for evaluation of acute Discussion blindness. The neuro-ophthalmologic examination revealed The ophthalmic diagnosis was bilateral complete rhegmatog- absent menace responses bilaterally with normal pupillary enous retinal detachments with vitreal degeneration. In the clini- light, palpebral, and oculocephalic reflexes. Schirmer tear test cal photographs (Figure 1) the retina is hanging ventrally in the (Schirmer Tear Test Strips; Alcon Canada, Mississauga, Ontario) vitreous over the optic nerve head due to a giant dorsal periph- values were 21 and 19 mm/min in the right and left eyes, respec- eral retinal tear at the ora ciliaris retinae. The grey membrane tively. The intraocular pressures were estimated with a rebound is the neurosensory retina hanging from and obscuring direct tonometer (Tonvet; Tiolat, Helsinki, Finland) and were 11 and visualization of the optic nerve head. A physical examination, 13 mmHg in the right and left eyes, respectively. Fluorescein complete blood (cell) count (CBC), serum biochemical profile, staining (Fluorets; Bausch & Lomb Canada, Markham, Ontario) urinalysis, and blood pressure measurements were performed was negative bilaterally. The pupils were dilated with 0.5% trop- and no abnormalities were noted. Routine chest radiographs icamide (Mydriacyl; Alcon Canada, Mississauga, Ontario) and were also performed and were unremarkable. Bilateral vitrec- biomicroscopic examination (Osram 64222; Carl Zeiss Canada, tomy with retinal reattachment surgery was recommended Don Mills, Ontario) and indirect ophthalmoscopic (Heine but declined by the owner. Annual examinations to monitor Omega 200; Heine Instruments Canada, Kitchener, Ontario) for inflammation secondary to the retinal detachments were examinations were completed bilaterally. Biomicroscopic exami- recommended and 6 mo following initial presentation the dog nation was within normal limits, bilaterally, and fundic photo- re-presented to the WCVM for blepharospasm and hyphema graphs are provided for your assessment (Figure 1). in the left eye. Due to the presence of discomfort and chronic

Figure 1. Photographs of the right and left fundi of a 6-year-old miniature poodle.

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.

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uveitis in the face of blindness, evisceration and placement of return of vision but in animals, the timeline of events is often an intrascleral prosthesis was performed on the left eye with unknown. This case presented with a history of acute bilateral continued annual examinations for the right eye. blindness; however, it is important to note that in many cases of Retinal detachments occur as the neurosensory retina sepa- bilateral rhegmatogenous retinal detachments the detachments rates from the underlying retinal pigment epithelium (RPE). do not happen simultaneously in both eyes. Astute owners may They can develop in one of 3 ways: i) exudative, in which effu- notice acute unilateral vision loss in their pet; however, most sions, exudations, or solid accumulations of cells push off the cases presenting with acute bilateral retinal detachments have neurosensory retina; ii) rhegmatogenous retinal detachments, in one retina that has been detached long-term and it is only when which a tear or hole in the retina causes disinsertion allowing the retina detaches in the fellow eye that the owner is aware of liquefied vitreous to accumulate under the tear; and iii) trac- a visual disturbance (2). It has been demonstrated that if the tion detachments, in which proliferation of pre-retinal (i.e., retina is reattached within 4 wk, there is a reasonable chance of vitreal) membranes pulls the neurosensory retina away from its return of some functional vision (3). Obviously, the sooner the underlying RPE (1). Causes of retinal detachment are variable repair, the better the odds of good vision. and include infectious disease (including bacterial, rickettsial, Without surgical correction, chronic retinal detachments OPHTALMOLOGIE DIAGNOSTIQUE OPHTALMOLOGIE and mycotic infections), systemic hypertension, trauma, and release vascular endothelial growth factors, which induce vascu- congenital ocular disease (1). Rhegmatogenous retinal detach- lar membranes that predominate on the anterior and posterior ments are most common in the shih tzu, whippet, and Italian iris surfaces and extend into the vitreous. These membranes are greyhound breeds in which a primary vitreal degeneration and fragile, and often leak serum and blood, resulting in chronic liquefaction predisposes to peripheral retinal tears and sudden, uveitis and secondary glaucoma (4). In cases of chronic retinal total detachment. The diagnosis of rhegmatogenous retinal detachment there is a 90% chance that a dog will develop detachment is confirmed by ophthalmoscopic examination secondary complications such as chronic uveitis and secondary unless opacification of the anterior segment (cornea, anterior glaucoma within the animal’s lifetime (4). In this particular chamber, lens) precludes fundic examination. In such cases case, the dog developed hyphema and pain from chronic uveitis ultrasonographic examination can often confirm the diagnosis. necessitating an evisceration and intrascleral prosthesis in the left Ophthalmic examination by a veterinary ophthalmologist is eye 6 mo after initial presentation. Owners with dogs suffering often helpful in confirming the diagnosis. Further diagnostic from retinal detachment who are unable to arrange for surgi- testing in cases of retinal detachment should include a systemic cal correction should be made aware of the risk of secondary work-up consisting of a physical examination, CBC, serum complications necessitating enucleation or evisceration. Annual biochemical profile, blood pressure, urinalysis, and chest radio- complete ophthalmic examinations including Schirmer Tear graphs to rule out any systemic disease resulting in the retinal Tests, intraocular pressures, and fluorescein staining are recom- detachment. In this particular case all diagnostics were within mended in patients affected with chronic retinal detachment. normal limits. Vitreal degeneration and liquefaction resulting in vitreal traction bands and a retinal tear were the suspected References cause of retinal detachments. 1. Narfstrom K, Petersen Jones SM. Diseases of the canine ocular fundus. In: Gelatt KN, Gilger BC, Kern TJ, eds. Veterinary Ophthalmology. Complete rhegmatogenous retinal detachment results in Vol 2. Ames, Iowa: John Wiley & Sons, 2013:1303–1392. blindness in the affected eye(s). Once the retina is detached 2. Vainisi S, Wolfer J, Hoffman A. Surgery of the canine posterior segment. there is rapid degradation of the photoreceptors when they are In: Gelatt KN, Gilger BC, Kern TJ, eds. Veterinary Ophthalmology. Vol 2. Ames, Iowa: John Wiley & Sons, 2013:1393–1431. detached from the RPE. The recommended treatment in cases 3. Vainisi SJ, Wolfer JC. Canine retinal surgery. Veterinary Ophthalmology with rhegmatogenous retinal detachments is vitrectomy with 2004;7:291–306. retinal reattachment surgery. In such cases, reattachment surgery 4. Grahn BH, Barnes LD, Breaux CB, Sandmeyer LS. Chronic retinal detachment and giant retinal tears in 34 dogs: Outcome comparison is the patient’s only chance to restore vision. The duration of the of no treatment, topical medical therapy, and retinal reattachment after retinal detachment is important in predicting any anticipated vitrectomy. Can Vet J 2007;48:1031–1039.

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