The Canadian Veterinary Journal La Revue Vétérinaire Canadienne Imaging and Clinical Features of a True Gastrogastric Intussusception in a Dog

July/Juillet 2020 The Canadian Veterinary Journal

Vol. 61, No. 07 La Revue vétérinaire canadienne

July/Juillet 2020 Volume 61, No. 07 The Canadian Veterinary Journal La Revue vétérinaire canadienne Imaging and clinical features of a true gastrogastric intussusception in a dog

The outcome for feline non-hypersecretory thyroid carcinoma after thyroidectomy

Septic fibrinous pericarditis in 4 horses in Saskatchewan following an outbreak of forest tent caterpillars in 2017

Acute hyperkalemia as anesthetic complication in a diabetic dog undergoing tumor excision

Glucagon therapy in canines with an insulinoma: A retrospective descriptive study of 11 dogs

Evaluation of 1,2-o-dilauryl-rac-glycero- 3-glutaric acid-(69-methylresorufin) ester lipase concentrations in cats with kidney disease and with normal SNAP fPL

Evaluation of radiographs for the detection of sublumbar lymphadenopathy in dogs

Gap between producers and veterinarians regarding biosecurity on Quebec dairy farms

Descriptive epidemiology of companion animal dermatophytosis in a Canadian Pacific Northwest animal shelter system

Isolation of Histophilus somni and Trueperella pyogenes from a 2-month-old calf with chronic fibrosing and suppurative epididymitis FOR PERSONAL USE ONLY

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JULY/JUILLET 2020 Contents Table des matières

SCIENTIFIC RUBRIQUE SCIENTIFIQUE

CASE REPORTS ARTICLES RAPPORTS DE CAS 743 Evaluation of 1,2-o-dilauryl-rac-glycero-3- 715 Imaging and clinical features of a true glutaric acid-(69-methylresorufin) ester gastrogastric intussusception in a dog lipase concentrations in cats with kidney Lindsey T. Graham, Mylène Auger, disease and with normal SNAP fPL Allison M. Watson, Christian Folk, Anne-Sophie Bua, Carolyn Grimes, Adrien-Maxence Hespel Guy Beauchamp, Marilyn E. Dunn 719 The outcome for feline non-hypersecretory 749 Evaluation of radiographs for the detection thyroid carcinoma after thyroidectomy of sublumbar lymphadenopathy in dogs Alberto Oramas, Sarah Boston, Vincent Wavreille Megan C. Murphy, Martin Sullivan, Barbara J. Gomes, Ada Kaczmarska, 724 Septic fibrinous pericarditis in 4 horses Gawain J.C. Hammond in Saskatchewan following an outbreak of forest tent caterpillars in 2017 757 Gap between producers and veterinarians Ronan J.J. Chapuis, Valentina M. Ragno, regarding biosecurity on Quebec dairy farms Cristian A. Ariza, Ahmad R. Movasseghi, José Denis-Robichaud, David F. Kelton, Soraya Sayi, Fabienne D. Uehlinger, Cathy A. Bauman, Herman W. Barkema, Julia B. Montgomery Gregory P. Keefe, Jocelyn Dubuc 731 Acute hyperkalemia as anesthetic 763 Descriptive epidemiology of companion complication in a diabetic dog undergoing animal dermatophytosis in a Canadian tumor excision Pacific Northwest animal shelter system Chiara Hampton, Jon Fletcher, Mika Fitzgerald, Emilia Gordon, Amanda Idle, Lena DeTar R. Avery Bennett STUDENT PAPER 737 Glucagon therapy in canines with an COMMUNICATION ÉTUDIANTE insulinoma: A retrospective descriptive study of 11 dogs 776 Isolation of Histophilus somni and Megan E. Harris, Linda Weatherton, Trueperella pyogenes from a 2-month-old Christopher P. Bloch calf with chronic fibrosing and suppurative epididymitis Rachel Dobberstein

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CVJ / VOL 61 / JULY 2020 667 FOR PERSONAL USE ONLY

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For more fetches, prescribe Galliprant from the first diagnosed stages of canine osteoarthritis. FOR MORE INFORMATION *Grapiprant is a non-steroidal, non-cyclooxygenase inhibiting anti-inflammatory drug in the piprant class. Grapiprant is a selective antagonist of the EP4 receptor. ABOUT GALLIPRANT, INDICATION FOR USE CONTACT YOUR ELANCO Galliprant is indicated for the treatment and control of pain and inflammation associated with osteoarthritis in dogs.1 SALES REPRESENTATIVE. IMPORTANT SAFETY INFORMATION The label contains complete use information, including cautions, and warnings. Always read, understand and follow the label.

REFERENCES 1. Galliprant Canadian product label. 2. Kirkby Shaw K, Rausch-Derra L, Rhodes L. Grapiprant: an EP4 prostaglandin receptor antagonist and novel therapy for pain and inflammation. Vet Med Sci. 2015;2:3-9. 3. Rausch-Derra L, Huebner M, Wofford J, et al. A prospective, randomized, masked, placebo-controlled multi-site clinical study of grapiprant, an EP4 prostaglandin receptor antagonist (PRA), in dogs with osteoarthritis. J Vet Intern Med. 2016;30(3):756-763. Galliprant, Elanco and the diagonal bar logo are trademarks of Elanco or its affiliates. © 2019 Elanco or its affiliates. PM-CA-19-0220 FOR PERSONAL USE ONLY

JULY/JUILLET 2020 Contents Table des matières

FEATURES RUBRIQUES

PRESIDENT’S MESSAGE 789 DIAGNOSTIC OPHTHALMOLOGY LE MOT DE LA PRÉSIDENTE OPHTALMOLOGIE DIAGNOSTIQUE 673 Navigating through COVID-19 Shayna Levitt, Stephanie Osinchuk, Composer avec la COVID-19 Lynne Sandmeyer Melanie Hicks BOOK REVIEWS 677 VETERINARY MEDICAL ETHICS COMPTE RENDU DE LIVRES DÉONTOLOGIE VÉTÉRINAIRE 742 That sheep may safely graze: Rebuilding animal health care in war-torn Afghanistan 689 2019 CVMA ANNUAL REPORT Barry Stemshorn RAPPORT ANNUEL 2019 DE L’ACMV 775 Language Signs & Calming Signals of Horses: Recognition and Application VETERINARY WELLNESS Kristine Torske BIEN-ÊTRE VÉTÉRINAIRE 771 Managing change in a changing world NOTICES ANNONCES Part 2: The power to choose Debbie L. Stoewen 774 Industry News Nouvelles de l’industrie VETERINARY DERMATOLOGY DERMATOLOGIE VÉTÉRINAIRE 791 Index of Advertisers 781 Twenty years of pyodermas: How Index des annonceurs antimicrobial resistance has changed 792 Classifieds the way I practice Petites annonces Kinga Gortel

VETERINARY PRACTICE MANAGEMENT NEWS | NOUVELLES GESTION D’UNE CLINIQUE VÉTÉRINAIRE 785 Surviving a downturn: How to keep 681 NEWS your practice afloat/Survivre à un NOUVELLES ralentissement : comment maintenir votre pratique à flot Heather Broughton, Sophie Perreault Chris Doherty

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 The Canadian Veterinary Medical Association holds complete copyright of all articles Telephone: 613-236-1162 within this issue. Fax: 613-236-9681 Politique de la Rédaction : Tous les articles publiés, y compris les éditoriaux et les E-mail: [email protected] lettres, représentent l’opinion de l’auteur et non pas nécessairement la position de Website/Site Web: www.canadianveterinarians.net l’éditeur. www.veterinairesaucanada.net La publication d’une annonce ne signifie pas nécessairement que l’éditeur est d’accord avec son contenu ou qu’il l’appuie. © C anadian Veterinary Medical Association 2020 L’Association canadienne des médecins vétérinaires détient le droit d’auteur complet L’Association canadienne des médecins vétérinaires 2020 sur tous les articles contenus dans le présent numéro.

The Canadian Veterinary Journal is indexed or abstracted in: Editor-in-Chief/Rédacteur en chef La Revue vétérinaire canadienne est indexée ou ses articles sont Dr. Carlton Gyles, Guelph, Ontario résumés dans : AGRICOL, Biological Abstracts, Capsule Report, Current Contents — Agriculture, Associate Editors/Rédacteurs associés Derwent Veterinary Drug File, EMBASE/Excerpta Medica, Dr. Bruce Grahn, Saskatoon, Saskatchewan Index Veterinarius, Index Medicus, Quarterly Index, Science Citation Index, Small Dr. Wayne McDonell, Guelph, Ontario Animal Practice, Veterinary Bulletin, Veterinary Reference Service, Veterinary Update. Dr. Murray Jelinski, Saskatoon, Saskatchewan Feature Editors/Rédacteurs des chroniques Dr. Jangi Bajwa, Burnaby, British Columbia Photo by/Photo de : Shutterstock Dr. Bruce Grahn, Saskatoon, Saskatchewan Dr. Myrna Milani, Charlestown, New Hampshire Typesetting/Typographie Dr. Debbie Stoewen, Ayr, Ontario AN Design Communications Dr. Tim Blackwell, Fergus, Ontario Printed by/Imprimé par Assistant Editors/Rédacteurs adjoints Dollco Print Solutions Group Dr. Aylin Atilla, Calgary, Alberta Ottawa, Ontario Dr. Marcio Costa, Saint-Hyacinthe, Quebec ISSN 0008-5286 Dr. Robert Friendship, Guelph, Ontario Dr. Luis Gaitero, Guelph, Ontario Dr. Emily John, Charlottetown, Prince Edward Island Report undeliverable Canadian addresses to: Dr. Ron Johnson, Guelph, Ontario e-mail: [email protected] Dr. Shawn McKenna, Charlottetown, Prince Edward Island Dr. Shannon Martinson, Charlottetown, Prince Edward Island Subscriptions (2020). Annual: Canada $220 + applicable GST or HST; foreign Dr. Javier Sanchez, Charlottetown, Prince Edwad Island $235 US; institutional $290. Express subscriptions available. Single issue/back issue: Managing Editor/Directrice de la rédaction $25 each, institutional single issue = $50.00 + GST or HST, if applicable. (All prices Heather Broughton, Ottawa, Ontario subject to change.) Missing issues will be replaced if the Subscriptions Office is Assistant Managing Editor/Directrice adjointe de la rédaction notified within 6 months (for requests within Canada) and 1 year (for requests from Stella Wheatley, Ottawa, Ontario abroad) of the issue date. The publisher expects to supply missing issues only when Editorial Coordinator/Coordonnatrice de la rédaction losses have been sustained in transit and when the reserve stock will permit. Telephone Kelly Gray-Sabourin, Ottawa, Ontario (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 Advertising and Sponsorship Consultant/Consultante, publicité et commandites promptly. Laima Laffitte, Wendover, Ontario Abonnements (2020). Annuel : Canada 220 $ + TPS ou TVH en vigueur; pays étranger 235 $ É-U; prix d’une institution 290 $. Abonnement express disponible. Published monthly by/ Anciens numéros (chacun) : 25 $, ancien numéro d’institution 50 $ + TPS ou TVH Publication mensuelle de en vigueur. Les prix sont sujets à changement sans préavis. Les numéros qui ne sont pas Canadian Veterinary Medical Association 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.

670 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY Whatever and wherever you practice, the CVMA is with you every step of your way.

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CanVet2020_F.indd 1 5/4/20 5:19 PM FOR PERSONAL USE ONLY President’s Message Le mot de la présidente

Navigating through COVID-19 Composer avec la COVID-19

s I sit down to write my last President’s Message, the last lors que je m’installe pour écrire mon dernier « mot de A of the snow is melting in New Brunswick and the spring A la présidente », les dernières neiges fondent au Nouveau- migration of Merganser ducks and Canada geese have appeared Brunswick et je vois des canards et des bernaches en migration in my pond. Creating a message in May that will be relevant printanière sur mon étang. Rédiger un texte en mai qui sera when published in July unfortunately doesn’t provide much flex- publié en juillet ne donne malheureusement pas beaucoup ibility to write meaningful dialogue about a current event, which de flexibilité pour livrer une analyse pertinente sur le sujet de in this case is obviously COVID-19, caused by the SARS-CoV-2 l’heure, c’est-à-dire la pandémie de COVID-19 causée par le virus. My previous President’s Message discussed One Health virus SARS-CoV-2. Mon dernier article parlait de l’approche and bacterial zoonosis, at the time of writing it in the winter, « Une santé » et des zoonoses bactériennes; au moment de COVID-19 was more of a “trendy” discussion because it hadn’t l’écrire durant l’hiver, la COVID-19 ne revêtait pas autant reached our borders and affected our daily lives. d’importance car elle n’avait pas encore franchi nos frontières Unfortunately, we now know that shifted dramatically by ni affecté notre vie quotidienne. early March, and the flurry of changes in our profession to Malheureusement, nous savons tous maintenant que la keep our colleagues, animals and clients safe and healthy has situation a radicalement changé au début de mars, et à quel been a momentous undertaking. Initial concerns that our point la multitude de modifications que nous avons dû appor- services would not be deemed essential passed quickly, to be ter à notre profession pour assurer la sécurité et la santé de nos replaced by strict measures in every province. Most of us have collègues, de nos patients et de nos clients a été une entreprise never experienced this kind of situation before, and it has capitale. Les craintes initiales que nos services ne soient pas certainly created mixed feelings that move like a rollercoaster. considérés comme essentiels se sont dissipées rapidement, pour Being attuned to our wellbeing has been of utmost importance être remplacées par des mesures strictes imposées dans chaque throughout this situation. The emotional, physical and financial province. La plupart d’entre nous n’avons jamais connu ce genre toll of CO VID-19 is not a short-term difficulty, it’s something de situation auparavant, et cela a certainement suscité chez nous we, along with the rest of society, will need to grapple with for des sentiments mitigés en montagnes russes. Être attentif à notre many months to come. bien-être est de la plus haute importance dans ces circonstances. When any new pathogen emerges, there tends to be more Les répercussions émotionnelles, physiques et financières de la questions than answers, and this situation has proven to be no COVID-19 seront non pas des ennuis passagers, mais bien des different. I’m proud of the leadership role that the CVMA has difficultés auxquelles nous, ainsi que le reste de la société, aurons taken since COVID-19 became a daily reality in Canada. We à faire face pendant de nombreux mois à venir. have endeavored to support veterinarians, paraprofessionals, Lorsqu’un nouvel agent pathogène émerge, il y a générale- and the animals we serve. We have collaborated with provincial ment plus de questions que de réponses, et la situation actuelle and federal organizations to ensure that the veterinary industry ne fait pas exception. Je suis fière du rôle de leadership que and the public have the most relevant information, and provide l’ACMV a joué depuis que la COVID-19 est devenue une réalité the most current resources via our website, webinars, and social quotidienne au Canada. Nous nous sommes efforcés de soutenir media. I cannot thank our hardworking CVMA staff, Council les médecins vétérinaires, les paraprofessionnels, et les animaux members and our COVID-19 task force enough. Their efforts que nous servons. Nous avons collaboré avec diverses organisa- in navigating through this pandemic should be commended. tions provinciales et fédérales pour offrir à l’industrie vétérinaire

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

CVJ / VOL 61 / JULY 2020 673 FOR PERSONAL USE ONLY

The CVMA had to make the difficult decision to cancel emerged from this situation. Many have had tremendous oppor- the CVMA Convention in July, and many other veterinary tunity to spend more quality time with immediate family, and conventions worldwide have followed suit. Although this was virtual time with extended family and friends. On a professional the only choice available, it was still a disappointing one. Our front, social media has been exploding with veterinarians and Convention has always been an exciting week of collaboration their teams posting supportive messages, dancing to songs and with provincial regulatory and membership bodies, species sending words of strength to their peers, clients, other essential groups, international guests, and colleagues. Old friends are re- workers, and the general public. Veterinary businesses have discovered, and new friends are made during the numerous net- embraced telemedicine in situations where it can be used, to working and social events. I hope that all CVMA members will ensure that animals receive the care they need. Veterinary hospi- make the effort to attend the virtual Annual General Meeting tals have donated respirators and personal protective equipment this year, as well as to mark the calendar for our Convention for the human medical system, and some have donated their next year, being held in beautiful Calgary, Alberta. time to assist with public health endeavors. These are merely a Throughout this time, I also don’t want to overlook a sub-set few examples, there are so many more. LE MOT DE LA PRÉSIDENTELA DE MOT LE in the profession — the new veterinary graduates and veterinary I’m hoping that at the time of publication of my last message technician/technologist graduates. They should be proud of their as President of the CVMA, life will be settling into a routine achievement and eager to begin their career. Understandably, of the new norm. We’ll certainly need to remain flexible and missing key aspects of the curriculum was unavoidable and it adapt as the situation continues to change, and the CVMA will may create additional challenges (and anxieties) when they enter be there every step of the way to support you. As we continue practice. As we slowly enter a phased return to a new normal, to navigate through COVID-19, I wish all CVMA members they will have a unique introduction into the workforce. The health, safety, and prosperity in the upcoming months. ■ need for a strong onboarding program with consistent mentor- ship has never been so vital. Melanie Hicks No matter how dire a situation is, I always try to find a positive element. Let’s look at some of the positivity that has

et au public l’information la plus pertinente et pour fournir les sera unique et inusitée. La nécessité d’un bon programme d’inté- ressources les plus récentes par l’intermédiaire de notre site Web, gration avec un mentorat soutenu n’aura jamais été aussi grande. de webinaires et des médias sociaux. Je tiens à remercier sincère- Peu importe la gravité d’une situation, j’essaie toujours de ment le personnel dévoué de l’ACMV, les membres du Conseil trouver un élément positif. Quels ont été les aspects positifs et notre groupe de travail sur la COVID-19. Ils n’ont ménagé de cette pandémie? Beaucoup de gens ont eu une formidable aucun effort pour nous aider à composer avec la pandémie. opportunité de passer plus de temps de qualité avec leur famille L’ACMV a dû prendre la difficile décision d’annuler son immédiate, et du temps virtuel avec la famille élargie et les amis. Congrès annuel prévu en juillet, et les organisateurs de nom- Sur le plan professionnel, les médias sociaux ont explosé – on breux autres congrès vétérinaires dans le monde ont emboîté a vu des médecins vétérinaires et des membres de leurs équipes le pas. Même si c’était la décision à prendre, elle n’en était pas publier des messages de soutien, danser sur des chansons, et moins crève-cœur. Notre Congrès a toujours été une semaine encourager leurs pairs, leurs clients, les autres travailleurs essen- passionnante de collaboration avec les associations provinciales tiels et le grand public. Les entreprises vétérinaires ont adopté la et les organismes de réglementation, les groupes vétérinaires télémédecine dans les cas où elle peut être utilisée, pour que les consacrés aux différentes espèces, des invités internationaux et animaux reçoivent les soins dont ils ont besoin. Des hôpitaux nos collègues. Les nombreuses activités sociales et occasions de vétérinaires ont donné des respirateurs et de l’équipement de réseautage offertes nous permettent de reprendre contact avec protection individuelle pour appuyer le système de soins de de vieux amis et de nouer de nouvelles amitiés. J’espère que tous santé pour humains, et des gens ont donné de leur temps pour les membres de l’ACMV assisteront tout de même à l’assemblée contribuer aux efforts de santé publique. Ce ne sont là que générale annuelle, qui sera virtuelle cette année, et noteront à quelques exemples, il y en a beaucoup d’autres. leur calendrier les dates de notre Congrès de l’an prochain, qui J’espère qu’au moment de la publication de mon dernier mes- se tiendra dans la belle ville de Calgary, en Alberta. sage à titre de présidente de l’ACMV, la vie aura un peu repris En cette période inédite, j’ai une pensée spéciale pour les son cours et une certaine routine conforme à la nouvelle norme nouveaux diplômés du doctorat en médecine vétérinaire et de la se sera installée. Nous devrons certainement rester flexibles et technique en santé animale. Ils peuvent être fiers de leur réussite nous adapter à mesure que la situation évoluera, et l’ACMV sera et ont sûrement hâte d’entreprendre leur carrière. Naturellement, là à chaque étape pour vous soutenir. Alors que nous continuons le fait que certains aspects clés de leur programme de formation à composer avec la COVID-19, je souhaite à tous les membres n’aient pas pu être couverts pourrait créer des défis (et des de l’ACMV la santé, la sécurité et la prospérité au cours des angoisses) supplémentaires lors de leurs premiers pas en pra- prochains mois. ■ tique. Alors que nous amorçons lentement un retour progressif à une nouvelle normalité, leur arrivée sur le marché du travail Melanie Hicks

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Ethical question of the month — Question de déontologie du mois — April 2020 Avril 2020 The Coronavirus disease 2019 (COVID-19) is suspected to La maladie à coronavirus 2019 (COVID-19) est présumée have originated in a wet market in China. Recent evidence dem- provenir d’un marché de fruits de mer et d’animaux vivants en onstrates that similar coronaviruses may cross species barriers. Chine. Des données récentes démontrent que des coronavirus This has raised concerns at animal research institutions that a similaires peuvent traverser la barrière des espèces. Cette person unknowingly infected with COVID-19 could infect the situation soulève des inquiétudes dans les centres de recherche : research animals in the facility. Without established tests for this on se demande si une personne infectée sans le savoir par infection in various animal species, an infected animal popula- la COVID-19 pourrait infecter les animaux utilisés pour la tion may be difficult to identify. Not only could a subclinical or recherche dans l’établissement. Sans tests établis pour détecter clinical infection affect experimental outcomes, but it potentially l’infection chez diverses espèces animales, il peut être difficile de could serve as a reservoir of infection for students and staff déterminer si une population animale est infectée ou non. Une working in the facility. Essentially quarantining the animals in infection subclinique ou clinique pourrait affecter les résultats the facility would result in a significant loss of time and money expérimentaux, mais aussi potentiellement servir de réservoir invested in research projects currently underway or planned. At d’infection pour les étudiants et le personnel travaillant dans the same time, infecting a population of research animals would l’établissement. La mise en quarantaine des animaux entraînerait have its own serious consequences. Is there an ethically sound une perte importante de temps et d’argent investi dans les approach to this dilemma given all the unknowns that cur- projets de recherche en cours ou prévus. De plus, l’infection rently exist regarding this new coronavirus epidemic? d’une population d’animaux de recherche aurait ses propres conséquences importantes. Existe-t-il une approche éthique de ce dilemme compte tenu de tout ce qui demeure inconnu à l’heure actuelle concernant cette épidémie de nouveau coronavirus?

An ethicist’s commentary on coronavirus in a laboratory animal facility Were the answer to this question unequivocally affirmative, we we witnessed the emergence of solid scientific data. Beyond that, would have solved a lot of questions dealing with the coronavi- we are whistling in the dark. rus in humans. The truth is, currently we do not know enough The emerging virus pandemic teaches us a valuable les- to come out on one side. Thus, it is difficult to respond to the son — we don’t know as much as we think we do. Under such question posed, as we are lacking the relevant information. circumstances, we need to fly by the seat of our pants. As such, In an interview with Science Magazine, two eminent labora- I would recommend staying with established procedures and tory animal veterinarians freely admitted that, short of common- not trying radical departures from proven protocols. I would sense strategies, such as keeping research animals separated from certainly urge authorities in my university to avoid undertaking one another, there is no body of accepted scientific knowledge novel research projects. on how to handle laboratory animals under pandemic condi- I realize that this is a far from satisfactory response, but such tions. So, what does one do? Were I running a laboratory animal is the nature of an emerging epidemic. The best one can do is facility, I would follow the dictates of common sense, by separat- roll the dice and hope for a satisfactory outcome. ing the animals as much as possible. In addition, my procedures would be guided by my extensive experience until such time as Bernard E. Rollin, PhD

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Ethical question of the month — Question de déontologie du mois — July 2020 Juillet 2020 Some posit that zoos provide a unique opportunity for people Certains estiment que les zoos offrent au public une occasion to observe and appreciate wild animals. They believe that zoos unique d’observer et d’apprécier les animaux sauvages. Ils croient create a deeper appreciation of the natural world and the ani- que les zoos favorisent une meilleure compréhension du monde mals that live there. Displaying animals in zoologic parks may naturel et des animaux qui y vivent, et peuvent inspirer le public also inspire the public to work to conserve and protect wild à faire des efforts pour protéger les animaux sauvages, en parti- animals, especially those that are endangered. Others argue that culier ceux qui sont menacés d’extinction. D’autres soutiennent there can never be any justification for keeping wild animals in qu’aucune raison ne peut justifier de garder des animaux sau- captivity for public enjoyment. Do zoos provide a net benefit vages en captivité pour le simple plaisir des humains. Les zoos to wild animals as a result of their educational value or is offrent-ils un avantage net aux animaux sauvages en raison de their only benefit one of providing human entertainment at leur valeur éducative, ou leur seul avantage est-il de servir de the animals’ expense? divertissement pour les humains au détriment des animaux? DÉONTOLOGIEVÉTÉRINAIRE

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

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Quiz Corner Test éclair

1. Which of the following is FALSE regarding feline respiratory 1. Lequel des énoncés suivants est FAUX à propos du syndrome disease? respiratoire félin? A. Cats that recover from feline herpesvirus (FHV) or feline A. Les chats qui récupèrent de l’herpèsvirus félin ou du cali- calicivirus (FCV) become subclinical carriers. civirus félin deviennent des porteurs subcliniques. B. FCV survives 8 to 10 days outside the host. B. Le calicivirus félin peut survivre de 8 à 10 jours à l’exté- C. Chlamydophila felis causes chronic conjunctivitis. rieur de l’hôte. D. Bordetella bronchiseptica does not cause respiratory dis- C. Chlamydophila felis cause une conjonctivite chronique. ease in cats. D. Bordetella bronchiseptica ne cause pas de maladie respi- E. FHV may cause abortion in pregnant cats. ratoire chez les chats. E. L’herpèsvirus félin peut causer un avortement chez les 2. Which of the following is NOT a common side effect of chattes gestantes. phenobarbital therapy for the treatment of epilepsy? A. Weight gain 2. Laquelle des manifestations suivantes N’EST PAS un effet B. Polyuria and polydipsia secondaire courant du phénobarbital dans le traitement de C. Elevation of serum creatinine levels l’épilepsie? D. Elevation of serum alkaline phosphatase levels A. Gain de poids E. Suppression of thyroid hormones B. Polyurie et polydipsie C. Élévation du taux de créatinine sérique 3. Which of the following is most correct concerning treat- D. Élévation du taux de phosphatase alcaline sérique ment for brachial plexus avulsion? E. Suppression des hormones thyroïdiennes A. Amputation should be performed immediately as function to the limb rarely returns. 3. Lequel des énoncés suivants est le plus exact à propos du B. Amputation should be performed if there is self-mutilation traitement de l’avulsion du plexus brachial? or if there is little return to function after 6 months. A. L’amputation devrait être réalisée immédiatement puisque C. Amputation is never indicated. la récupération de la fonction du membre est rare. D. Amputation should be performed if there is no return to B. L’amputation devrait être réalisée s’il y a automutilation function after 1 month because function usually returns ou s’il y a peu de récupération de la fonction du membre quickly. après 6 mois. C. L’amputation n’est jamais indiquée. D. L’amputation devrait être réalisée s’il n’y a pas de récu - pération de la fonction du membre après 1 mois puisque la récupération de la fonction est habituellement rapide.

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4. An 11-year-old Quarter horse bay gelding has a unilateral, 4. Un hongre Quarter Horse bai âgé de 11 ans présente une firm, nontender thyroid enlargement; the gelding is other- tuméfaction unilatérale, ferme et indolore de la thyroïde; wise healthy. Thyroid function levels are normal, and a le cheval est autrement en santé. Les paramètres de la biopsy shows thyroid adenoma. Which of the following is fonction thyroïdienne sont normaux et une biopsie révèle the best treatment plan? un adénome thyroïdien. Laquelle des interventions suivantes A. Surgical excision est la meilleure? B. Monitoring of the horse A. Excision chirurgicale C. Radiation therapy B. Surveillance du cheval D. Intralesional chemotherapy C. Radiothérapie D. Chimiothérapie intralésionnelle TESTÉCLAIR 5. Which of the following is true of neosporosis in cattle? A. Cattle are the definitive host of the causative agent. 5. Lequel des énoncés suivants est vrai à propos de la néospo- B. It presents as neurological disease in adults. rose chez les bovins? C. Most calves born with congenital infection show clinical A. Les bovins sont l’hôte définitif de l’agent étiologique. signs. B. Elle se présente comme une maladie neurologique chez D. Abortion is best diagnosed by fetal histopathology. les adultes. E. Horizontal transmission predominates. C. La plupart des veaux qui naissent avec une infection congénitale présentent des signes cliniques. D. En cas d’avortement, le meilleur moyen d’établir le diagnostic est l’histopathologie du fœtus. E. La transmission horizontale prédomine.

(See p. 778 for answers./Voir les réponses à la page 778.)

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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680 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY

NEWS | NOUVELLES

Exciting! Inspiring! Motivating! 2020 CVMA Convention — July 9 to 12 A Special Message from the CVMA Regarding the CVMA Annual Convention in Quebec City Excitant! Inspirant! Motivant! Congrès de l’ACMV du 9 au 12 juillet 2020 Message spécial de l’ACMV concernant le Congrès annuel de l’ACMV à Québec iven the continuing concerns over COVID-19 and in keep- n raison des préoccupations persistantes au sujet de la Ging with the recommendations of public health officials ECOVID-19 et conformément aux recommandations des res- and provincial authorities to restrict large gatherings and non- ponsables de la santé publique et des autorités provinciales d’éviter essential travel, the CVMA will no longer host the 2020 CVMA les grands rassemblements et les voyages non essentiels, l’ACMV Annual Convention scheduled to take place in Quebec City this a décidé d’annuler son Congrès annuel de 2020 qui devait avoir July. Given what the Annual Convention means to the CVMA, lieu en juillet à Québec. Comme il s’agit d’un événement majeur its members and volunteers, this has been a disappointing but pour l’ACMV, ses membres et ses bénévoles, cette décision a été necessary decision. extrêmement difficile à prendre, mais elle était nécessaire vu la When making this difficult choice, the CVMA considered pandémie mondiale et ses répercussions. social responsibility, and government directions and actions Il s’agit d’une décision crève-cœur pour l’ACMV, qui a été prise on the federal, provincial and municipal levels (such as the par souci de responsabilité sociale et respect des orientations Quebec government not allowing certain events up to the end et actions des gouvernements à l’échelle fédérale, provinciale et of August 2020). municipale (comme l’interdiction par le gouvernement du Québec As a concession in the negotiations with the Convention de tenir certains types d’événements jusqu’à la fin d’août 2020). hotels and the Quebec City Convention Centre, the CVMA En guise de concession dans les négociations avec les hôtels has committed to host its 2023 Convention from July 6–9 in partenaires et le Centre des congrès de Québec, l’ACMV s’est beautiful Quebec City and will continue with plans to host engagée à tenir son congrès de 2023 du 6 au 9 juillet dans la its 2021 Convention in Calgary, Alberta (July 22–25) and its belle ville de Québec. Nos plans actuels d’organiser le Congrès 2022 Convention in Halifax, Nova Scotia (July 21–24). de 2021 à Calgary, en Alberta (du 22 au 25 juillet), et le Congrès The CVMA would like to thank the volunteers on the de 2022 à Halifax, en Nouvelle-Écosse (du 21 au 24 juillet), Professional Development Committee (PDC), especially demeurent inchangés. Dr. Marie-Claude Blais, 2020 Local Chair, for all the hard work L’ACMV tient à remercier les bénévoles du Comité de perfec- and dedication in preparing for the 2020 Annual Convention. tionnement professionnel, en particulier la Dre Marie-Claude Blais, The PDC is working on the scientific program for the présidente locale du Congrès de 2020, pour leur travail acharné et 2021 Annual Convention in Calgary, Alberta and is hoping to leur dévouement dans la préparation du Congrès annuel de 2020. bring forward speakers and topics originally scheduled this July Le Comité de perfectionnement professionnel planche actuel- in Quebec City. lement sur le programme scientifique du Congrès annuel de 2021 We appreciate your understanding during these unprec- à Calgary, en Alberta, et espère présenter des conférenciers et des edented times. Should you have any questions, please contact sujets initialement prévus cette année à Québec. Sarah Cunningham ([email protected]). Nous vous remercions de votre compréhension en cette période Thank you and we hope to see you at our 2021 CVMA sans précédent. Si vous avez des questions, n’hésitez pas à com- Convention in Calgary! muniquer avec Sarah Cunningham ([email protected]). Merci encore, et nous espérons vous voir au Congrès de l’ACMV (by Sarah Cunningham, Manager, Conventions, CVMA) de 2021 à Calgary! (par Sarah Cunningham, responsable du Congrès de l’ACMV)

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N Animal Health Week 2020 — Semaine de la vie animale du October 4 to 10, 2020 4 au 10 octobre 2020 Understanding Zoonotic Diseases: Comprendre les zoonoses : Community Health — Animals and You Santé communautaire – Les animaux et vous t’s time to start planning for Animal Health Week 2020! l est temps de commencer à planifier la Semaine de la vie ani- IAnimal Health Week is an annual national public aware- Imale de 2020! La Semaine de la vie animale est une campagne ness campaign organized by the Canadian Veterinary Medical nationale annuelle de sensibilisation du public organisée par Association (CVMA) and hosted by veterinarians across Canada. l’Association canadienne des médecins vétérinaires (ACMV) et Each year, through Animal Health Week, an important health- mise en œuvre par les médecins vétérinaires du Canada. Chaque related message is highlighted. During the first week of October, année, un message important lié à la santé est mis de l’avant dans veterinary teams across Canada promote this carefully chosen le cadre de la Semaine de la vie animale et, pendant la première specific theme and celebrate responsible animal ownership. semaine d’octobre, le personnel des établissements vétérinaires Many veterinary hospitals and clinics host open houses, hold de partout au Canada fait la promotion de ce message soigneu- photo contests, offer clinic tours, and organize various events sement choisi et célèbre la propriété responsable des animaux. for the community. De nombreux hôpitaux et cliniques vétérinaires organisent des The CVMA is proud to have celebrated Animal Health Week journées portes ouvertes, des concours de photos, des visites across the country for 35 years! From October 4–10, 2020, de leurs installations et divers événements pour la communauté. the CVMA will raise awareness of Zoonotic Diseases. This L’ACMV est fière de célébrer la Semaine de la vie animale year’s theme Understanding Zoonotic Diseases: Community partout au pays depuis 35 ans! Cette année, la Semaine de la Health — Animals and You will showcase how Canada’s veteri- vie animale aura lieu du 4 au 10 octobre 2020 et l’accent sera nary professionals occupy unique positions within the national mis sur les maladies zoonotiques. Le thème de cette année, One Health community to support the fight against these Comprendre les zoonoses : Santé communautaire – Les ani- diseases and how protecting animal health, protects everyone’s maux et vous, montrera comment les professionnels vétérinaires health. This campaign will empower the national veterinary du Canada occupent des positions uniques au sein de la commu- community through awareness, recognition, and knowledge nauté nationale « Une santé » pour soutenir la lutte contre ces of threats, subsequently improving public health and animal maladies, et comment la protection de la santé animale protège la welfare. Promotional tools, information, and merchandise will santé de tous. Cette campagne valorisera la collectivité vétérinaire be available to promote activities across the country. nationale par la sensibilisation, la reconnaissance, et la prise de A free Animal Health Week poster was included in June’s conscience des menaces, dans le but d’améliorer la santé publique issue of The Canadian Veterinary Journal. Another poster was et le bien-être animal. De l’information ainsi que des outils et mailed to veterinary hospitals and clinics across the country in articles promotionnels seront offerts pour promouvoir les activités June. As Animal Health Week nears, visit the Animal Health de la Semaine de la vie animale d’un bout à l’autre du pays. Week section under the Practice & Economics tab of the CVMA Une affiche gratuite de la Semaine de la vie animale était website (www.canadianveterinarians.net) to find tips and tools incluse dans le numéro de juin de La Revue vétérinaire canadienne. to help plan your celebrations. Une autre affiche a été postée en juin. Pensez également à visi- Order your Animal Health Week ter la section du site de l’ACMV (www.veterinairesaucanada.net) merchandise online consacrée à la Semaine de la vie animale sous l’onglet Pratique et finances pour trouver des conseils et du matériel pour vous aider You can conveniently order your Animal Health Week mer- à planifier vos célébrations. chandise online through CVMA’s website and don’t forget to take advantage of the Early Bird deadline, for a chance win a Commandez vos produits de la Semaine $100 Subway gift card! de la vie animale en ligne Vous pouvez commander facilement vos produits de la Semaine de la vie animale en ligne sur le site Web de l’ACMV. Si vous le faites avant la date limite pour les commandes hâtives, vous pourriez gagner une carte-cadeau de 100 $ chez Subway! Commanditaires La campagne de la Semaine de la vie animale de 2020 est géné- reusement soutenue par les commanditaires principaux IDEXX et Merck Santé animale et les commanditaires de programme iFinance Canada (Petcard), Petsecure et Virbac.

682 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY

Sponsors Ce mois-ci, nous saluons deux de nos N Generous support of the 2020 Animal Health Week campaign is commanditaires de programme, iFinance Canada provided by Program Plus Sponsors, IDEXX and Merck Animal (Petcard) et Virbac : Health and Program Sponsors, iFinance Canada (Petcard), iFinance Canada (Petcard) Petsecure, and Virbac. Petcard, la plus importante entreprise de financement d’interven- This month we highlight 2 of our Program tions vétérinaires au Canada, soutient fièrement l’ACMV et des Sponsors, iFinance Canada (Petcard) and Virbac: initiatives comme la Semaine de la vie animale depuis longtemps. L’expertise de Petcard en tant qu’entreprise de financement d’in- iFinance Canada (Petcard) terventions vétérinaires lui permet de soutenir les équipes de soins Petcard, Canada’s premier veterinary procedure financing com- vétérinaires dans leur travail essentiel de lutte contre les zoonoses. pany, has proudly supported the CVMA and initiatives, like En plus de commanditer l’événement, Petcard soutient également Animal Health Week, for considerable time. Petcard’s expertise l’ACMV et La Revue vétérinaire canadienne par d’autres moyens, as a veterinary procedure financing company, allows it to support allant de la publicité à l’élaboration conjointe de programmes tels veterinary care teams as they engage in their critical work of bat- que le Programme Petcard de l’ACMV, et offre aux membres de tling zoonotic diseases. On top of its sponsorship, Petcard also l’ACMV des avantages exclusifs pour appuyer leurs pratiques. supports the CVMA, and The Canadian Veterinary Journal, in Petcard offre des options de financement aux Canadiens depuis other ways, ranging from advertising, to co-developing programs 1996 pour leur donner accès aux meilleurs soins vétérinaires. such as the CVMA Petcard Program, providing CVMA members Cela permet aux médecins vétérinaires de se concentrer sur le exclusive benefits to support their businesses. traitement des animaux de compagnie, que ceux-ci souffrent d’une Petcard has provided financing options to Canadians since blessure ou d’une maladie zoonotique. La pratique de la médecine 1996, allowing access to the best in veterinary care. This allows vétérinaire est à la fois une passion et une vocation. Petcard veterinarians to focus on treating companion animals, whether permet de réduire les coûts liés aux traitements vétérinaires en it be an injury or zoonotic disease. The practice of veterinary offrant aux propriétaires d’animaux de compagnie des options de medicine is a passion as well as a vocation. Petcard helps reduce paiement flexibles. the cost concerns related to veterinary treatment by providing Petcard est fière de proposer à tous les membres de l’ACMV companion animal owners with flexible payment options. le Programme Petcard de l’ACMV! Les membres peuvent main- CVMA Petcard is proud to offer all CVMA members the tenant s’inscrire pour offrir Petcard dans leur établissement et Petcard Program! Members can now register to offer Petcard bénéficier d’une inscription gratuite (d’une valeur de 250 $). Le at their clinics or offices with complimentary registration Programme Petcard de l’ACMV offre de nombreux avantages inté- (a $250 value). The CVMA Petcard Program comes with many ressants, notamment des programmes de récompenses exclusifs exciting benefits including exclusive reward programs and et des occasions d’amélioration de l’optimisation pour les moteurs increased search engine optimization (SEO) opportunities. If you de recherche. Si vous souhaitez vous inscrire ou en savoir plus would like to take part or learn more about the unique CVMA sur le Programme Petcard de l’ACMV, envoyez un courriel à Petcard Program, please contact us by calling 1-888-689-9876 [email protected] ou composez le 1-888-689-9876. or email ([email protected]). Virbac Virbac Virbac Canada a récemment mis sur le marché un médicament à Virbac Canada recently brought to market a selamectin drug base de sélamectine qui aide à lutter contre plusieurs menaces product that helps tackle several potential zoonotic threats. zoonotiques potentielles. En effet, la solution topique EVICTO® ® The product, EVICTO Topical Solution, contains the active contient de la sélamectine, un parasiticide à large spectre d’action. ingredient selamectin, a broad-spectrum parasiticide drug. The La gamme de produits de Virbac comprend également la solution Virbac portfolio also includes ECTOSHIELD Topical Solution topique ECTOSHIELD et la solution topique PREVENTIC. and PREVENTIC Topical Solution. Chez les chats, la solution topique EVICTO® traite les infesta- ® For cats, EVICTO Topical Solution treats flea infestations, tions de puces, les vers ronds et les vers en crochet intestinaux, et intestinal roundworms and hookworms, ear mites, and prevents les mites d’oreilles, et prévient la dirofilariose. Parmi ces parasites heartworm disease. Of these important diseases, fleas and round- importants, les puces et les vers ronds représentent une pré worms are of particular zoonotic concern. occupation zoonotique. Chez les chiens, la solution topique EVICTO® traite les infestations de puces, les mites d’oreilles, les mites de la gale sarcoptique

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N For dogs, EVICTO® Topical Solution treats flea infestations, et les infestations de tiques Rhipicephalus sanguineus. De plus, elle ear mites, sarcoptic mange mites and Rhipicephalus sanguineus aide au traitement des vers ronds intestinaux et des infestations tick infestations. Furthermore, it aids in the treatment of intes- de tiques Dermacentor variabilis. tinal roundworm and Dermacentor variabilis tick infestations. Chez les chats, la solution topique ECTOSHIELD traite les For cats, ECTOSHIELD Topical Solution treats flea infestations de puces. infestations. Chez les chiens, la solution topique ECTOSHIELD offre une For dogs, ECTOSHIELD Topical Solution provides dual double protection contre les infestations de puces et de poux. protection against flea and lice infestations Chez les chiens, la solution topique PREVENTIC maîtrise les For dogs, PREVENTIC Topical Solution will control fleas, puces, les tiques, les poux et les moustiques. ticks, lice and mosquitoes. La maladie des griffures de chat est une infection bacté- Cat Scratch Disease is a bacterial infection spread by cats to rienne transmise par les chats aux humains. L’agent qui la cause, people. The causative agent, Bartonella henselae, is acquired by Bartonella henselae, est transmis aux chats par les piqûres de cats from flea bites. While cats are often asymptomatic, the bac- puces. Bien que les chats infectés soient souvent asymptoma- teria have the potential for significant disease when transmitted tiques, les bactéries peuvent causer une maladie importante to people. People become infected most often when an infected lorsqu’elles sont transmises aux humains. Le plus souvent, la cat bites or scratches them, introducing saliva into broken skin. transmission s’effectue par la griffure d’un chat ou une morsure Days later regional lymph nodes become swollen and painful. et l’introduction de salive dans la peau lésée. Quelques jours plus Affected individuals have also reported fevers, headaches, lack tard, les nœuds lymphatiques régionaux deviennent enflés et of appetite and lethargy. If infection is suspected, it is advised douloureux. Les personnes touchées ont également signalé de la to contact your doctor. fièvre, des maux de tête, un manque d’appétit et une léthargie. Si Toxocariasis is a roundworm infection transmitted from dogs une infection est suspectée, il est conseillé de communiquer avec or cats to humans. Toxocara canis and Toxocara cati eggs can be un médecin. shed in the feces of dogs and cats, respectively. While anyone La toxocarose est une infection par des vers ronds transmis can potentially become infected by these roundworms, younger des chiens ou des chats aux humains. Les œufs de Toxocara canis children have a higher chance of becoming infected because et de Toxocara cati sont excrétés dans les selles des chiens et des they are not as diligent with hand washing after playing outside chats, respectivement. Alors que n’importe qui peut potentiellement or handling pets. Clinical manifestations of Toxocara infections être infecté par ces vers ronds, le risque d’infection est plus élevé include ocular toxocariasis and visceral toxocariasis. Mild toxo- chez les jeunes enfants, car ils ne sont pas aussi diligents que les cariasis can cause vague symptoms such as fever, nausea, cough, adultes avec le lavage des mains, notamment après avoir joué à behavioral and sleep disturbances. It is common for puppies l’extérieur ou manipulé un animal. Les manifestations cliniques and kittens to be infected by intestinal roundworms and as such des infections par Toxocara comprennent la toxocarose oculaire routine, frequent deworming from an early age is paramount. et la toxocarose viscérale. Une légère toxocarose peut provoquer Hookworms are well documented zoonotic disease agents de vagues symptômes tels que fièvre, nausées, toux, troubles and are the most common cause of cutaneous larva migrans du comportement et perturbations du sommeil. Les chiots et les in people. Ancylostoma spp. larvae can penetrate human skin, chatons sont souvent infectés par des vers ronds intestinaux et, producing intensely pruritic serpentine lesions par conséquent, une vermifugation systématique fréquente dès le The good news with tick-borne pathogens, such as the caus- jeune âge est primordiale. ative agent of Lyme disease, is that they are not directly zoonotic Les vers en crochet sont des agents zoonotiques documentés from pets to people. Tick bites are required to pass on disease et sont la cause la plus fréquente de larva migrans cutanées chez and humans and animals are both at risk. Due to increasing les humains. Les larves d’Ancylostoma peuvent pénétrer la peau public health concerns it is imperative to protect pets and people humaine et causer des lésions serpigineuses très prurigineuses. from tick bites. La bonne nouvelle concernant les agents pathogènes transmis Virbac Canada supports Canadian veterinarians. All Virbac par les tiques, comme la bactérie qui cause la maladie de Lyme, est products are available solely through your chosen veterinary dis- qu’ils ne sont pas directement zoonotiques des animaux de com- tributor partner. To obtain more information about EVICTO® pagnie aux humains. Il faut une piqûre de tique pour transmettre Topical Solution, specifically our “Buy a Dose, Give a Dose” ces agents, et tant les humains que les animaux sont à risque. En program, please contact your Territory Sales Manager or call raison des préoccupations croissantes de santé publique, il est 1-866-458-3350. impératif de protéger les animaux de compagnie et les humains contre les piqûres de tiques. Virbac Canada appuie les médecins vétérinaires canadiens. Tous les produits de Virbac sont disponibles uniquement par l’intermé- diaire de votre distributeur de produits vétérinaires. Pour obtenir de plus amples renseignements sur la solution topique EVICTO®, ou sur le programme de don de doses pour chaque dose vendue, communiquez avec votre représentant de Virbac ou composez le 1-866-458-3350.

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CVMA Partner, Moneris Provides Partenaire de l’ACMV, Moneris offre N Advice on How to Navigate Your des conseils pour composer avec la Practice During this Difficult Time situation actuelle difficile o help veterinarians survive the repercussions of this unprec- oneris, l’un des partenaires commerciaux de l’ACMV, a Tedented time, one of the CVMA’s business partners, Moneris Msoumis cet article dans l’espoir d’aider les médecins vétéri- submitted this article in the hope of making circumstances a naires à composer avec les répercussions de cette période sans little improved. précédent. We won’t sugarcoat it: it’s a tough time for businesses. Across Disons-le franchement : la période actuelle est éprouvante pour Canada, many have shut their doors for the foreseeable future les entreprises. Partout au Canada, plusieurs commerces ont dû in response to the pandemic. It’s the right thing to do to slow fermer leurs portes temporairement en réponse à la pandémie. the spread of this virus, but it has left business owners uncertain C’était la bonne chose à faire pour ralentir la propagation du virus, about their future, wondering when they’ll get back to normal mais plusieurs propriétaires d’entreprises sont incertains de leur again. avenir et se demandent quand la situation reviendra à la normale. There may not be a definitive answer to this question, Même si on ne connaît pas encore la réponse définitive à cette but that doesn’t mean you can’t maintain your practice. question, cela ne signifie pas que vous ne pouvez pas poursuivre Communicating with your clients, and getting creative about votre pratique. Communiquer avec vos clients et vous adapter en how you can adapt, can help you navigate these rapidly chang- fonction de l’évolution de la situation sont des mesures qui vous ing times. aideront à faire face à cette période difficile. Get realistic — then get creative Soyez réalistes – et créatifs As an essential service, closing your office may not be an option. Comme vous êtes un fournisseur de services essentiels, la ferme- But it might mean that you’ll have to rethink how it operates. ture de votre établissement n’est peut-être pas une option. Mais Setting up contactless pick up can help your patients get food vous devrez sans doute repenser son fonctionnement. or recurring medication when they need it. Offering contactless La mise en place d’un service de collecte sans contact peut delivery on essential items can help your clients practice social faire en sorte que vos patients obtiennent la nourriture ou les distancing. médicaments dont ils ont besoin. La livraison sans contact d’articles Sharing free tips and support over Instagram Live can help essentiels peut aussi aider vos clients à respecter les consignes you stay connected to your community. And enabling phone or de distanciation sociale. video conferencing appointments can help you interact with a Envisagez des façons de rester en contact avec les pro- pet parent, while you examine their pet. priétaires d’animaux, par exemple en donnant gratuitement des Communicate with your clients conseils ou en offrant de l’assistance sur Instagram en direct. Et n’oubliez pas que les rendez-vous par téléphone ou par vidéoconfé- Once you’ve decided how your practice is going to handle the rence peuvent vous aider à interagir avec vos clients pendant que next few months, you’ll need to loop in your clients. Be as vous examinez leurs animaux. upfront and informative as possible. Have a client newsletter? Send out an update with informa- Communiquez avec votre clientèle tion on any changes to practice hours or closures, purchase or Une fois que vous aurez décidé de la façon dont votre établisse- return policies, and anything else that will impact clients. ment va gérer les prochains mois, vous devrez en informer vos clients. Soyez aussi directs et informatifs que possible. Avez-vous une infolettre destinée à vos clients? Envoyez une mise à jour avec de l’information sur les modifications des heures d’ouverture, les politiques d’achat ou de retour, et tout autre élé- ment qui a un impact sur les clients. Publiez la même information sur vos comptes de médias sociaux. Le fait de communiquer votre plan de façon claire et aussi largement que possible éliminera la confusion et aidera tout le monde à regarder vers l’avenir. Amenez votre pratique en ligne Vous vendez de la nourriture, des gâteries et des jouets pour animaux, mais vous n’avez pas de boutique en ligne? C’est une excellente occasion d’y voir. Vous n’avez pas à créer une boutique en ligne à partir de zéro. De nombreuses options sont disponibles, de la conception d’un site de commerce électronique en quelques minutes avec Bookmark au traitement des paiements en ligne à l’aide d’un terminal virtuel. La clé est d’avoir une solution de paiement en ligne sécurisée.

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N Echo this on your social media accounts. Making your plan Prévenez la fraude pendant que votre as clear and widely available as possible will eliminate confusion établissement est vulnérable and help everyone to start looking to the future. Le fait de permettre davantage d’achats en ligne peut vous rendre Take your practice online plus vulnérable à la fraude, ce qui est la dernière chose dont toute entreprise a besoin. Sell specialty pet food, treats and toys, but don’t have an online Il est essentiel de connaître les différents types de fraude en storefront? This is a great opportunity to change that. ligne. L’utilisation d’une solution de paiement de commerce élec- You don’t have to build an entire online store from scratch. tronique fiable conçue pour prévenir la fraude et activer les outils There are many options available, from setting up an e-com- de prévention de la fraude en ligne est le moyen le plus simple de merce site in minutes with Bookmark to processing payments protéger votre entreprise. online using a virtual terminal. The key — having a secure online payment solution in place. Rappelez-vous que c’est temporaire Prevent fraud while your practice is at its Vous pouvez vous sentir dépassés par l’ampleur du changement most vulnerable auquel vous devez vous adapter en ce moment. N’oubliez pas que, bien qu’il y ait beaucoup de choses que vous ne pouvez pas Allowing more online purchases can leave you vulnerable to contrôler, vous pouvez réduire l’impact négatif de la pandémie sur fraud — which is the last thing any business needs. votre pratique. It’s essential to stay informed about the different kinds of Une chose est sûre : lorsque tout cela sera terminé, vous online fraud out there. Using a trusted e-commerce payment aurez beaucoup appris sur ce que signifie être résilient face à solution built to prevent fraud and enable online fraud preven- l’incertitude. tion tools, is the easiest way to keep your business safe. Visitez le site moneris.com/lesassociations ou composez le Remember, this is temporary 1-888-552-0341 pour en savoir plus sur nos services. You may feel overwhelmed by the amount of change you have to adapt to right now. Remember, while there’s a lot you can’t control, you can minimize the negative impact on your practice. One thing’s for sure — you’ll come out of this having learned a great deal about what it means to be agile in the face of uncertainty. Call 1-888-552-0341 or visit (moneris.com/associations) for more information.

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Obituary Nécrologie N Dr. Donald Stewart MacDonald Dr Donald Stewart MacDonald Dr. Donald Stewart MacDonald passed away peacefully on Le Dr Donald Stewart MacDonald est décédé paisiblement le Friday, April 24, 2020, at home surrounded by his family after vendredi 24 avril 2020, chez lui et entouré de sa famille, après a lengthy battle with cancer. His is lovingly remembered by his une longue bataille contre le cancer. Il laisse dans le deuil son best friend and wife Judy (Gerred) and his 3 children Meredith épouse et meilleure amie Judy (Gerred) ainsi que ses trois enfants (Marc), Gavin (Marina), and David (Kerrie). He was much Meredith (Marc), Gavin (Marina) et David (Kerrie). Il était très loved by his grandchildren Alexa, Jessica, Natalie, Kelly and aimé de ses petits-enfants Alexa, Jessica, Natalie, Kelly et Sean. He will be missed by many other members of his family Sean. Il manquera également aux nombreux autres membres de as well. sa famille. After graduating Upper Canada College in 1952, Don Après avoir obtenu un diplôme de l’Upper Canada College en continued in his father’s footsteps and became a veterinarian 1952, Don a suivi les traces de son père et a reçu son diplôme de graduating in 1957 from the Ontario Veterinary College at the médecine vétérinaire en 1957 de l’Ontario Veterinary College de University of Guelph. He had a passion for all types of animals l’Université de Guelph. Il avait une passion pour tous les animaux but also believed in growing his profession. He owned and mais croyait aussi fermement à l’évolution de la profession. Il pos- operated the oldest animal hospital in Ontario, MacDonald sédait et exploitait le plus ancien hôpital vétérinaire de l’Ontario, le Animal Hospital, taking over from his father who opened the MacDonald Animal Hospital, fondé par son père en 1932. doors in 1932. Il a fait partie de nombreux comités provinciaux et nationaux – il He served on many committees both provincially and a entre autres été président de la Toronto Academy of Veterinary nationally including president, Toronto Academy of Veterinary Medicine en 1962, président de l’Ontario Veterinary Association Medicine (1962); president, Ontario Veterinary Association (maintenant appelée Ontario Veterinary Medical Association) en (now the Ontario Veterinary Medical Association) (1967), and 1967, et président de l’Association canadienne des médecins president, Canadian Veterinary Medical Association (1994). He vétérinaires en 1994. Il a également participé à la construction was also dedicated to building the Equine Research Centre serv- de l’Equine Research Centre en tant que directeur et membre du ing as a director and a member of the Board of Governors at the conseil des gouverneurs de l’Université de Guelph. En 1962, Don University of Guelph. In 1962, Don spearheaded Vetascope at a dirigé Vetascope à l’Exposition nationale canadienne où le grand the Canadian National Exhibition where the general public were public a pu assister à une intervention chirurgicale et interagir avec able to watch a surgery and interact with over 300 veterinarians. plus de 300 médecins vétérinaires. He was a founding member of the Veterinary Emergency Il a été membre fondateur de Veterinary Emergency Clinics et Clinics and served on the executive for 18 years. Through his a siégé au comité exécutif pendant 18 ans. Dans le cadre de son work with the Ontario Veterinary Association, he was respon- travail avec l’Ontario Veterinary Association, il a été responsable de sible for the creation and implementation of the first Animal la création et de la mise en œuvre du premier programme de tech- Health Technician program in Ridgetown, Ontario. He was niques de santé animale à Ridgetown, en Ontario. Il a également also a Rotarian for 25 years in the Toronto West and Downtown été Rotarien pendant 25 ans dans les clubs de Toronto-Ouest et clubs. Don had many other passions in his life his faith, travel- du centre-ville de Toronto. Don a eu beaucoup d’autres passions ling with friends and family, Windsong and Glendyer, jazz, his dans sa vie, comme sa foi, les voyages avec la famille et des amis, motorcycles, and corvettes. He was a man who lived life on his Windsong et Glendyer, le jazz, ses motos et les corvettes. C’était own terms and loved to make others laugh. un homme qui vivait sa vie comme il l’entendait et qui aimait faire rire les autres.

CVJ / VOL 61 / JULY 2020 687 VETERINARY PROCEDUREFOR PERSONAL USE ONLY FINANCING PETCARD THE CLEAR CHOICE

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Canadian Veterinarian Journal-May 2020.indd 1 2020-04-14 11:48 AM FOR PERSONAL USE ONLY 2019 Annual Report of the Canadian Veterinary Medical Association Rapport annuel 2019 de l’Association canadienne des médecins vétérinaires

he CVMA is the national and international voice for Association canadienne des médecins vétérinaires (ACMV) T Canada’s veterinarians, providing leadership and advocacy L’ est la voix nationale et internationale des médecins vétéri- for veterinary medicine. As of December 2019, the CVMA com- naires canadiens, assurant le leadership et la défense des intérêts prised close to 7600 members, plus 8800 affiliated Registered de la médecine vétérinaire. En décembre 2019, l’ACMV comp- Veterinary Technologists and Technicians of Canada (RVTTC) tait près de 7600 membres, ainsi que 8800 techniciens affiliés veterinary technicians (both are record high numbers). The membres de l’association TTVAC (Technologues et techniciens CVMA’s governance and diverse programs are supported by vétérinaires agréés du Canada), deux nombres records. La gou- more than 600 volunteers and 20 staff positions. What are the vernance et les divers programmes de l’ACMV sont appuyés par CVMA’s focal points? plus de 600 bénévoles et 20 employés. Quelles sont les priorités Advocate on behalf of the profession: The CVMA’s core com- de l’ACMV? petencies are Animal Welfare, National Issues, and International Défendre les intérêts de la profession : Les principales Relations. The CVMA, with its elected delegates from all prov- compétences de l’ACMV sont le bien-être animal, les enjeux inces, colleges and students, speaks on behalf of the profession, nationaux et les relations internationales. L’ACMV, avec ses formulates position statements, and develops tools in the area of délégués élus représentant toutes les provinces, les écoles de national issues, animal welfare and international issues. médecine vétérinaire et les étudiants en médecine vétérinaire, Protect integrity of the profession: By administering the s’exprime au nom de la profession, rédige des énoncés de posi- national exams for Canadian and internationally trained vet- tion et développe des outils relativement aux enjeux nationaux erinarians and accrediting all Canadian veterinary colleges and et internationaux et au bien-être animal. veterinary technician/technologist programs, the CVMA fosters Protéger l’intégrité de la profession : En administrant the highest standards of veterinary medicine across Canada. les examens nationaux aux médecins vétérinaires formés au Foster wellness and career development: The CVMA helps Canada et à l’étranger et en participant à l’agrément des écoles to advance the career and wellness of veterinary students and vétérinaires canadiennes et des programmes de techniciens et veterinarians. The Students of the CVMA (SCVMA) provides technologues vétérinaires, l’ACMV voit au respect des normes an annual Student Symposium and hot topic sessions. The les plus élevées en médecine vétérinaire au Canada. CVMA hosts an annual Emerging Leaders Program (ELP) for Favoriser le bien-être et la réussite d’une carrière fruc- recent graduate veterinarians. Mental wellbeing is of utmost tueuse : L’ACMV contribue à faire progresser la carrière et importance. In addition to posting valuable information on its le mieux-être des étudiants en médecine vétérinaire et des website, the CVMA has started an annual Wellness Awareness médecins vétérinaires. Le Comité des étudiants de l’ACMV Campaign followed by quarterly wellness webinars. Economic (ÉACMV) organise un symposium étudiant annuel et des wellness is equally important; the CVMA continues its annual séances thématiques. L’ACMV propose chaque année aux practice benchmarking surveys and publishes annual suggested médecins vétérinaires en début de carrière de participer au fee guides, compensation and benefits reports for associate Programme des futurs leaders (PFL). Le bien-être mental est de veterinarians, non-DVM wage reports, provincial economic la plus haute importance – en plus d’afficher de l’information reports, and individual practice reports. utile sur son site Web, l’ACMV a lancé une campagne annuelle Act as facilitator: Part of CVMA’s leadership in veterinary de sensibilisation à la santé mentale, suivie de webinaires trimes- issues is accomplished by serving as a national and international triels sur le mieux-être. Le bien-être économique est tout aussi facilitator. The CVMA maintains formal, ongoing representa- important – l’ACMV poursuit ses sondages annuels auprès des tion on 21 national and 8 international organizations. The propriétaires d’établissements vétérinaires et publie des guides CVMA facilitates formal, ongoing contact with provincial annuels sur les tarifs suggérés, des rapports sur la rémunéra- and national veterinary associations through the organization tion et les avantages sociaux pour les vétérinaires salariés et les of regular meetings such as the CVMA/Provincial Veterinary employés non vétérinaires, des rapports économiques provin- Medical Association (VMA) and Regulatory Presidents’ Meeting; ciaux et des rapports sur les pratiques individuelles. Provincial Forum including CEOs/registrars and communica- Agir à titre d’intermédiaire : Une partie du leadership de tions staff of all provinces and the CVMA; CVMA meetings l’ACMV concernant les enjeux vétérinaires s’accomplit en servant with national species presidents; regular teleconferences with d’intermédiaire à l’échelle nationale et internationale. L’ACMV

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provincial communications managers; formal meetings with the maintient une représentation officielle et constante auprès de RVTTC; and formal meetings with the veterinary college deans. 21 organisations nationales et 8 organisations internationales. The following report features the most important 2019 L’ACMV garde un contact continu avec les associations vétéri- CVMA program achievements. naires provinciales et nationales par l’organisation de divers évé- nements, notamment des réunions avec les groupes vétérinaires provinciaux et les directeurs d’organismes de réglementation, des forums provinciaux avec les dirigeants/registraires et le personnel des communications des différentes provinces, des réunions avec les présidents des groupes vétérinaires nationaux par espèces, des téléconférences avec les gestionnaires des communications dans les différentes provinces, des réunions officielles avec l’association RAPPORT ANNUEL TTVAC et des réunions officielles avec les doyens des facultés de médecine vétérinaire. Le présent rapport présente les plus importantes réalisations de l’ACMV en 2019.

International Relations Relations internationales

Many aspects of veterinary medicine are international. The De nombreux aspects de la médecine vétérinaire sont inter CVMA’s objective is to represent Canada’s veterinary profession nationaux. L’ACMV a pour objectif de représenter la profession globally; advocate globally for animal health, welfare, ecosystem vétérinaire du Canada à l’échelle mondiale; de faire la promotion health, and the veterinary profession; identify international de la santé animale, du bien-être, de la santé des écosystèmes trends and their impact on Canada; and exchange knowledge et de la profession vétérinaire partout dans le monde; d’iden- and programs internationally. tifier les tendances internationales et leur impact au Canada; OIE: The CVMA president is a member of the Canadian et d’échanger des connaissances et des programmes avec des government’s delegation to the World Organization of Animal intervenants d’autres pays. Health’s annual General Assembly of 181 member countries. OIE : La présidente de l’ACMV est membre de la délégation WVA: The World Veterinary Association represents more du gouvernement canadien à l’assemblée générale annuelle than 500 000 veterinarians worldwide. Dr. Troye McPherson des 181 pays membres de l’Organisation mondiale de la santé represents the CVMA on the WVA Council and Canada’s animale (OIE). Dr. Patricia Turner became WVA president in April 2020. As WVA : La World Veterinary Association (WVA) représente an example of activities, the WVA Zoonotic Disease working plus de 500 000 médecins vétérinaires dans le monde. La group is drafting a position statement on climate change and the Dre Troye McPherson représente l’ACMV au Conseil de la role/responsibility of the veterinary profession regarding climate WVA et la Dre Patricia Turner, une Canadienne, est devenue change and/or environmental protection. présidente de la WVA en avril 2020. À titre d’exemple d’activi- WSAVA: Dr. Jim Berry was the representative of the tés, le groupe de travail de la WVA sur les zoonoses est en train CVMA on the Council of the World Small Animal Veterinary de rédiger un énoncé de position sur les changements clima- Association. Dr. Terri Chotowetz has since succeeded Dr. Berry tiques et le rôle et la responsabilité de la profession vétérinaire en as CVMA representative. In 2019, the CVMA and WSAVA ce qui a trait aux changements climatiques et/ou à la protection co-hosted the combined Convention in Toronto. One of the de l’environnement. many WSAVA deliverables is the Global Companion Animal WSAVA : Le Dr Jim Berry était le représentant de l’ACMV Welfare Guidelines. au sein du conseil d’administration de la World Small Animal FVE: The Federation of Veterinarians of Europe, comprised Veterinary Association. C’est maintenant la Dre Terri Chotowetz of 38 member country associations including the American qui joue ce rôle. En 2019, l’ACMV et la WSAVA ont organisé Veterinary Medical Association (AVMA) and the CVMA, ensemble leur congrès conjoint qui a eu lieu à Toronto. L’une maintains an association of approximately 400 000 veterinar- des nombreuses réalisations de la WSAVA est la publication de ians, with the objective of working together on matters of lignes directrices mondiales sur le bien-être animal. common interest. Dr. Enid Stiles is the CVMA’s representative. FVE : La Federation of Veterinarians of Europe, qui regroupe Examples of joint position statements include veterinary educa- les associations de 38 pays membres y compris l’American tion, responsible and judicious use of antimicrobials, roles of Veterinary Medical Association (AVMA) et l’ACMV, compte veterinarians in promoting animal welfare, the benefits of animal environ 400 000 médecins vétérinaires désireux de travailler vaccination programs, and global control of canine rabies. ensemble sur des questions d’intérêt commun. La Dre Enid PANVET: Dr. Theresa Bernardo represents the CVMA Stiles est la représentante de l’ACMV à la FVE. Les énoncés de on the Board of the Pan American Association of Veterinary position conjoints portent notamment sur la formation vétéri- Sciences. PANVET promotes the development of veterinary naire, l’utilisation responsable et judicieuse des antimicrobiens,

690 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY science in the areas of animal and human health, animal le rôle des médecins vétérinaires dans la promotion du bien-être welfare, animal production and productivity, and contributes animal, les avantages des programmes de vaccination des ani- to the protection of the environment and sustainability for the maux et le contrôle mondial de la rage canine. benefit of society. PANVET : La Dre Theresa Bernardo représente l’ACMV au IVOC: The CVMA’s president and the CEO represent the sein du conseil d’administration de la Pan-American Association ANNUAL REPORT ANNUAL CVMA on the International Veterinary Officers Council com- of Veterinary Sciences. PANVET fait la promotion du dévelop- prising the USA, Canada, Great Britain, Australia, New Zealand pement de la science vétérinaire dans les domaines de la santé and South Africa. The CVMA conducts an annual benchmark- animale et humaine, du bien-être animal, des productions ing survey and compiles an annual report, comparing some animales et de la productivité des animaux, et contribue à la key data of the participating VMAs. The IVOC encourages its protection de l’environnement et au développement durable au members to learn from each other and share experience and profit de la société. programs where applicable. IVOC : La présidente et le président-directeur général NAVL: The CVMA president and CEO represent the CVMA de l’ACMV représentent l’ACMV au sein de l’International on the North American Veterinary Leaders group consisting of Veterinary Officers Council regroupant les États-Unis, le the VMAs of the USA, Mexico and Canada. Canada, la Grande-Bretagne, l’Australie, la Nouvelle-Zélande AVMA: The CVMA and the AVMA have maintained a close et l’Afrique du Sud. L’ACMV effectue une enquête annuelle relationship since the CVMA’s inception. For many decades, the et produit chaque année un rapport dans lequel elle compare CVMA has been part of the Council on Education; all Canadian certaines données clés des associations vétérinaires participantes. Colleges are CVMA/AVMA-COE accredited; we maintain the L’IVOC encourage ses membres à apprendre les uns des autres same national exams; and we maintain representation on each et à partager leurs expériences et leurs programmes. other’s animal welfare and veterinary technician accreditation NAVL : La présidente et le président-directeur général program committees. de l’ACMV représentent l’ACMV au sein du groupe North PNA: Dr. Jim Berry is the CVMA’s representative on the Pet American Veterinary Leaders, composé des associations vétéri- Nutrition Alliance. The PNA’s role is to promote the importance naires des États-Unis, du Mexique et du Canada. of nutrition as an integral and essential component of provid- AVMA : L’ACMV et l’AVMA entretiennent des relations ing optimal health care for healthy, sick and injured pets. In étroites depuis la création de l’ACMV. Depuis plusieurs décen- May 2019, PNA launched its newest nutrition tool for veteri- nies, l’ACMV fait partie du Council on Education (COE) de nary teams: “Dare to Ask — Manufacturer Report.” l’AVMA; toutes les facultés de médecine vétérinaire canadiennes COE: Dr. David Scammel represents the CVMA on the sont agréées par l’ACMV/AVMA-COE, nous administrons les Council on Education, which accredits 50 DVM programs in mêmes examens nationaux, et nous maintenons une représenta- North America and internationally. tion mutuelle au sein de nos comités respectifs responsables du ECFVG: Dr. Bev Baxter is the National Examining Board bien-être animal et de l’agrément des programmes de formation (NEB) representative on the Educational Commission for des techniciens vétérinaires. Foreign Veterinary Graduates, which oversees the AVMA’s PNA : Le Dr Jim Berry est le représentant de l’ACMV à la certification of graduates of non-accredited veterinary schools. Pet Nutrition Alliance. Le rôle de la PNA est de promouvoir ICVA: Dr. Jack Wilson represents the NEB on the l’importance de la nutrition en tant que composante intégrale International Council for Veterinary Assessment, which is the et essentielle de la prestation de soins de santé optimaux pour NEB’s provider of the North American Veterinary Licensing les animaux de compagnie en bonne santé, blessés ou malades. Examination (NAVLE). En mai 2019, la PNA a lancé son plus récent outil pour les équipes vétérinaires : le rapport sur les fabricants d’aliments pour animaux « Dare to Ask ». COE : Le Dr David Scammel représente l’ACMV au Council on Education, responsable de l’agrément de 50 programmes de doctorat en médecine vétérinaire en Amérique du Nord et ailleurs dans le monde. ECFVG : La Dre Bev Baxter est la représentante du Bureau national des examinateurs (BNE) au sein de l’Educational Commission for Foreign Veterinary Graduates qui supervise l’agrément par l’AVMA des médecins vétérinaires diplômés des écoles vétérinaires non agréées. ICVA : Le Dr Jack Wilson représente le BNE au International Council for Veterinary Assessment, qui fournit au BNE le NAVLE (North American Veterinary Licensing Examination).

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Corporate Partnership Program (CPP) Programme de partenariats avec des entreprises

The CVMA Corporate Partnership Program (CPP) is a com- Le Programme de partenariats avec des entreprises (PPE) de prehensive sponsorship program that was implemented to l’ACMV est un programme de commandite inclusif qui a été mis better recognize a company’s overall financial contribution to en œuvre afin de mieux reconnaître la contribution financière the Association. Celebrating its 12th year in 2019, the CPP globale d’une entreprise à l’Association. Le PPE, qui célébrait sa continues to evolve each year and takes into account the various 12e année en 2019, continue d’évoluer chaque année en tenant programs and events that are corporately sponsored, allowing compte des divers programmes et événements qui font l’objet companies that support the CVMA in various aspects to get de commandites, ce qui permet aux entreprises qui appuient RAPPORT ANNUEL better recognition for their overall contributions. The 3 levels l’ACMV dans divers domaines d’être mieux reconnues pour of sponsorship in 2019 were Platinum (. $80 000), Gold leurs contributions globales. En 2019, les trois niveaux de ($48 000–$79 999) and Silver ($27 000–$47 999). commandite étaient Platine (. 80 000 $), Or (de 48 000 $ à The CVMA would like to extend recognition to the follow- 79 999 $) et Argent (de 27 000 $ à 47 999 $). ing sponsors for their overall contribution to the Association L’ACMV tient à remercier les commanditaires suivants de leur for 2019: contribution générale à l’Association en 2019 : Platinum: Merck Animal Health Platine : Merck Santé animale Gold: Scotiabank Or : Banque Scotia Virox Animal Health Virox Animal Health Silver: IDEXX Laboratories Argent : Laboratoires IDEXX Petsecure Pet Health Insurance Petsecure assurance maladie pour animaux Western Financial Group Insurance Solutions Western Financial Group Insurance Solutions

We Speak for You on Animal Welfare Nous parlons en votre nom afin d’appuyer le bien-être animal Animal Welfare Bien-être animal

The Animal Welfare Committee (AWC) is comprised of mem- Le Comité sur le bien-être animal (CBA) est composé de bers who represent a range of animal health and welfare exper- membres qui représentent un vaste éventail d’expertises en santé tise. These dedicated volunteers make significant contributions animale et en bien-être des animaux. Ces bénévoles dévoués to animal welfare related initiatives that have been identified as apportent une contribution importante aux initiatives liées priority issues by CVMA members and stakeholder organiza- au bien-être animal qui ont été identifiées comme des enjeux tions. Committee members include those from companion and prioritaires par les membres de l’ACMV et les organisations food animal practice as well as equine, animal research, wildlife concernées. Les membres du comité proviennent de la pratique and zoo animal medicine, and laboratory animal medicine. des animaux de compagnie, des chevaux et des animaux de The membership also includes delegates from the Canadian consommation, du secteur de la recherche sur le bien-être ani- Food Inspection Agency (CFIA), Humane Canada (HC), mal, et de la médecine des animaux de la faune, des animaux Ontario Veterinary Medical Association (OVMA), the Canadian de zoo et des animaux de laboratoire. Le comité comprend éga- Association of Laboratory Animal Medicine (CALAM), the lement des représentants de l’Agence canadienne d’inspection Canadian Council on Animal Care (CCAC), the Society of des aliments (ACIA), de la Fédération des sociétés canadiennes

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British Columbia Veterinarians (SBCV), and the Registered d’assistance aux animaux (FSCAA), de l’Ontario Veterinary Veterinary Technologists and Technicians of Canada (RVTTC). Medical Association (OVMA), de l’Association canadienne de During 2019, the AWC revised or initiated several progressive la médecine des animaux de laboratoire (ACMAL), du Conseil position statements and animal welfare-based Codes includ- canadien de protection des animaux (CCPA), de la Society of ing Elective and Non-Therapeutic Veterinary Procedures for British Columbia Veterinarians (SBCV) et de Technologues et ANNUAL REPORT ANNUAL Cosmetic or Competitive Purposes, Free Roaming Owned, techniciens vétérinaires agréés du Canada (TTVAC). Abandoned and Feral Cats, Trapping of Fur-Bearing Animals, En 2019, le CBA a révisé ou proposé plusieurs énoncés de Use of Lead Fishing Sinkers and Lead Shot in Canada, Pest position progressistes liés au bien-être animal, y compris ceux Control, Castration of Cattle, Sheep, and Goats, Neutering of portant sur les interventions vétérinaires non urgentes et non Dogs and Cats, Animals in Sport and Competition, Animals in thérapeutiques à des fins esthétiques ou compétitives, sur les Entertainment and the Arts, Electroejaculation of Ruminants, chats en liberté appartenant à des propriétaires, abandonnés ou Dog Breeding, and The Care and Transport of Neonatal Dairy féraux, sur le piégeage des animaux à fourrure, sur l’utilisation Calves. In addition, the AWC along with external experts and des plombs pour la chasse et la pêche au Canada, sur la lutte reviewers completed the drafting of the Cattery Code and com- contre les animaux nuisibles, sur la castration des bovins, des menced work on the Small Mammal Code. The AWC considers moutons et des chèvres, sur la stérilisation des chiens et des both the scientific evidence as well as the ethical parameters of chats, sur l’utilisation des animaux dans les sports et les compé- a given issue in its deliberations and the format of the informa- titions ainsi que dans les divertissements et le domaine des arts, tion it provides. sur l’électroéjaculation des ruminants, sur l’élevage des chiens, During 2019, the AWC considered and consulted with et sur les soins et le transport des veaux laitiers nouveau-nés. De experts to conceptualize an End of Life decisional framework, plus, le CBA, en collaboration avec des experts et des examina- met with corporate sponsors regarding the design and imple- teurs externes, a terminé la rédaction de l’ébauche du Code de mentation of a Pain Management Initiative, and supported pratiques pour les chatteries et a commencé à travailler sur le externally derived programs such as Link Training (addressing Code de pratiques concernant les petits mammifères. Le CBA the link between domestic violence and animal abuse: a Humane tient compte à la fois des preuves scientifiques et des paramètres Canada initiative) and Co-Sheltering of Animals (for animals of éthiques d’une question donnée dans ses délibérations et le choix domestic abuse victims: a Vet-Outreach initiative). du format dans lequel il fournit l’information. Members of the AWC contribute to various external animal En 2019, le CBA a consulté des experts pour conceptualiser welfare-related associations and working groups including un cadre décisionnel de fin de vie, a rencontré des commandi- the National Farm Animal Care Council (NFACC) Board of taires pour la conception et la mise en œuvre d’une initiative Directors, the NFACC Transport Code Species working groups, de prise en charge de la douleur, et a soutenu des programmes and the NFACC (on farm) Code Development Committees externes, tels qu’une initiative de formation de la Fédération des and Code Scientific Committees. In addition, AWC represen- sociétés canadiennes d’assistance aux animaux sur le lien entre la tatives participate on the Board of Directors of the National violence familiale et la maltraitance des animaux et une initiative Companion Animal Coalition (along with the Canadian de l’organisme Community Veterinary Outreach visant à ce que Kennel Club, The Canadian Federation of Humane Societies, les victimes de violence familiale puissent avoir accès aux centres Agriculture and Agri-Food Canada, and The Pet Industry d’hébergement avec leurs animaux de compagnie. Joint Advisory Council) and the Animal Welfare Judging and Les membres du CBA participent à diverses associations et Assessment Competition (AWJAC) in affiliation with the divers groupes de travail externes sur le bien-être des animaux, American Veterinary Medical Association. notamment au sein du conseil d’administration du Conseil Communications with various levels of government to reflect national pour les soins aux animaux d’élevage (CNSAE), des members’ concerns included providing comments further to the groupes de travail par espèce pour la révision du Code de posting of the amendment to the Health of Animals Regulations pratiques sur le transport du CNSAE et des comités d’éla- Part XII: Animal Transport as well as supporting a call for a boration des Codes de pratiques à la ferme et des comités provincial ban on elective surgeries. scientifiques du CNSAE. De plus, des représentants du CBA siègent au conseil d’administration de la Coalition nationale sur les animaux de compagnie (avec le Club canin canadien, la Fédération canadienne des sociétés d’assistance aux animaux, Agriculture et Agroalimentaire Canada et le Pet Advisory Joint Advisory Council) et participent à l’Animal Welfare Judging and Assessment Competition (AWJAC) en collaboration avec l’American Veterinary Medical Association. Les communications avec divers paliers de gouvernement pour refléter les préoccupations des membres comprenaient des commentaires à la suite de la publication de la modification du Règlement sur la santé des animaux (partie XII : Transport des animaux), ainsi qu’un appui à un appel en faveur d’une interdiction provinciale des chirurgies électives.

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We Help Shape National Policy and Legislation that Affect You Nous aidons à façonner les politiques et les lois nationales qui vous concernent National Issues Enjeux nationaux

The National Issues Committee (NIC) considers a wide range of Le Comité sur les enjeux nationaux (CEN) se penche sur

RAPPORT ANNUEL issues of concern to the veterinary profession in Canada. During diverses questions qui préoccupent la profession vétérinaire au 2019 the NIC revised and CVMA Council approved position Canada. En 2019, le CEN a révisé les énoncés de position sur la statements on Complementary and Alternative Veterinary médecine vétérinaire complémentaire et parallèle et sur la vacci- Medicine, and Vaccination of Animals. Work continued on nation des animaux, qui ont ensuite été approuvés par le Conseil a new position statement on Service Animals and a review de l’ACMV. Le travail de rédaction d’un nouvel énoncé de and revision of the Telemedicine position. Working groups position sur les animaux d’assistance et de révision de l’énoncé were formed to review position statements on Veterinary de position sur la télémédecine s’est poursuivi. Des groupes de Surgical Procedures, Antimicrobial Use in Animals, Extra- travail ont été formés pour réviser les énoncés de position sur Label Drug Use (ELDU), Aquatic Animal Veterinary Medicine, les interventions chirurgicales vétérinaires, l’utilisation des anti- Legislation Concerning Dangerous Dogs, and Microchip Animal microbiens chez les animaux, l’utilisation des médicaments en Identification. dérogation des directives de l’étiquette, la médecine vétérinaire The 4th National Issues (NI) Forum was held at the CVMA des animaux aquatiques, les lois concernant les chiens dangereux Convention in Toronto in 2019 on Telemedicine. The event et l’identification des animaux à l’aide d’une micropuce. involved presentations from 3 panelists, discussion and live poll- Le quatrième Forum sur les enjeux nationaux, qui portait ing and was attended by 150 veterinarians. A working group was sur la télémédecine, s’est tenu durant le Congrès de l’ACMV de formed to develop plans for the 2020 Quebec City Convention 2019 à Toronto. Le Forum proposait aux 150 médecins vétéri- (since cancelled due to COVID-19) on the topic of Veterinary naires qui y ont assisté des présentations de trois panélistes, des Medicine and Natural Disasters. discussions et des sondages en direct. Un groupe de travail a A major focus of NIC activities continued to be antimi- également été formé pour entamer la planification du Congrès crobial use (AMU) and strategies to support antimicrobial de 2020 à Québec (qui a dû être annulé en raison de la pandé- stewardship and AMU surveillance. A funding contribution mie de COVID-19) sur la médecine vétérinaire en situation de was approved by Agriculture and Agri-Food Canada for the catastrophe naturelle. 4-year National Veterinary Oversight System for Antimicrobial Un sujet important des activités du CEN a continué d’être Use (NVOS-AMU) initiative (2019–2023). The objective is l’utilisation des antimicrobiens et les stratégies pour appuyer to build on recent initiatives and enhance veterinary steward- l’antibiogouvernance et la surveillance de l’utilisation des anti- ship and decision-making via the enhancement of the new microbiens. Agriculture et Agroalimentaire Canada a approuvé on-line CVMA Guidelines for Veterinary Antimicrobial Use (AMU) (2018) and the implementation of a sustainable data une contribution financière pour le projet du Système national collection and knowledge transfer system for AMU in animal de surveillance vétérinaire (SNSV) de l’utilisation des antimi- feed. The NVOS project will be overseen by CVMA Council, crobiens étalé sur 4 ans (2019–2023). Le projet vise à soutenir CVMA’s Veterinary Pharmaceutical Stewardship Advisory Group l’utilisation responsable et la prise de décisions judicieuses en (VPSAG), a project management team, and a multi-stakeholder médecine vétérinaire par l’amélioration des nouvelles Lignes Expert Advisory Group. directrices de l’ACMV sur l’utilisation des antimicrobiens (2018) NIC continues to work with federal government agencies on et la mise en œuvre d’un système durable de collecte de données matters concerning pharmaceuticals including the impact of et de transfert de connaissances sur l’utilisation des antimicro- new Health Canada fee schedules and monitoring the impact biens dans les aliments pour animaux. Le projet du SNSV sera of legalization of cannabis on veterinarians and veterinary supervisé par le Conseil de l’ACMV, le Groupe consultatif sur patients, and taking action accordingly in their interest. la gouvernance des produits vétérinaires pharmaceutiques de During 2019, CVMA provided representation at meetings l’ACMV, une équipe de gestion de projet et un groupe consul- with the Canadian Food Inspection agency (CFIA), Canadian tatif d’experts multipartite. Animal Health Coalition (CAHC), Canadian Animal Health Le CEN continue de travailler avec les agences du gouverne- Institute (CAHI), Canadian Animal Health Surveillance System ment fédéral sur des questions concernant les produits pharma- (CAHSS), Canadian Cattle Identification Agency (CCIA), ceutiques, comme l’impact des nouveaux tarifs de Santé Canada Canadian Animal Health Products Regulatory Advisory et le suivi des répercussions de la légalisation du cannabis pour Committee (CAHPRAC), Canadian Council of Veterinary les médecins vétérinaires et leurs patients, et de prendre des Registrars (CCVR), Canadian Lyme Disease Roundtable, mesures pour veiller aux intérêts de la profession.

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National Farmed Animal Health and Welfare Council Au cours de l’année 2019, l’ACMV a assuré une représen- (NFAHWC), Animal Health Canada (AHC), the American tation à des réunions avec l’Agence canadienne d’inspection Veterinary Medical Association (AVMA), among others. des aliments (ACIA), la Coalition canadienne pour la santé The NIC continues to monitor the activity of the NFAHW des animaux (CCSA), l’Institut canadien de la santé animale Council and seeks opportunities to provide input on issues that (ICSA), le Système canadien de surveillance de la santé ani- ANNUAL REPORT ANNUAL are important to the veterinary community (e.g. disease surveil- male (SCSSA), l’Agence canadienne d’identification du bétail lance, animal welfare, One Health, antimicrobial stewardship/ (CCIA), le Comité consultatif canadien sur la réglementation resistance). des produits de santé animale (CCCRPSA), le Conseil canadien des registraires vétérinaires (CCRV), la Table ronde canadienne sur la maladie de Lyme, le Conseil national sur la santé et le bien-être des animaux d’élevage (CNSBEAE), Santé animale Canada, l’American Veterinary Medical Association (AVMA), et d’autres organismes. Le CEN continue de suivre les activités du CNSBEAE et saisit les occasions de fournir de la rétraction sur les enjeux qui sont importants pour la communauté vétérinaire (comme la surveillance des maladies, le bien-être animal, l’approche « Une santé » ainsi que l’antibiogouvernance et la résistance aux antimicrobiens).

We Have Resources to Help You Throughout Your Career Nous avons des ressources pour vous appuyer pendant votre carrière Journals Revues

The Canadian Veterinary Journal (The CVJ) and the 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 multiespèces révisé par les pairs Canada. The number of manuscripts submitted to The CVJ au Canada. Le nombre de manuscrits soumis en 2019 a été de in 2019 was 285; the number submitted to the CJVR in 2019 285 pour La RVC et de 84 pour la RCRV. Ces deux chiffres was 84. Both numbers were slightly lower compared to the étaient légèrement inférieurs à ceux de l’année précédente. Des previous year. Efforts are ongoing to reduce the backlog of CVJ efforts sont déployés afin de réduire le délai de traitement des manuscripts; the time from submission to publication is under manuscrits de La RVC; le temps écoulé entre la soumission et 12 months, at 11. For CJVR the time for the same progression la publication est actuellement de moins d’un an, c’est-à-dire is just over one year at 13 months. Both journals will continue 11 mois. Pour la RCRV, ce délai est de 13 mois. Les deux publi- to promote the relevance of journal articles to practice and build cations continueront de promouvoir la pertinence des articles demand for the knowledge delivered. pour la pratique et d’accroître la demande pour les connaissances Of those articles submitted in 2019 to The CVJ, 88 out of qu’elles transmettent. 285 came from Canadian authors. Last year 120 articles were Parmi les 285 articles soumis en 2019 à La RVC, 88 pro- published, an increase from 2018. Of those published, approxi- venaient d’auteurs canadiens. L’an dernier, 120 articles ont mately 65 articles covered small companion animal content, été publiés, ce qui représente une augmentation par rapport à and 35 large animal content; similar numbers to 2018. The 2018. Des articles publiés, environ 65 traitaient des animaux de

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remainder was a combination of articles on pigs, sheep, goats, compagnie et 35 portaient sur les grands animaux; ces chiffres exotic and other less common species. sont semblables à ceux de 2018. Le reste du contenu se compo- Last year, a readership survey was sent to members and focus sait d’articles sur les porcs, les moutons, les chèvres, les animaux groups were conducted in July at the CVMA Convention. An exotiques et d’autres espèces moins courantes. article in the December 2019 issue of The CVJ explains the L’an dernier, un sondage a été envoyé aux membres et des results. A note on the polybags used to mail copies of The CVJ groupes de discussion ont été organisés durant le Congrès was added to indicate the bags are recyclable. Research continues de l’ACMV en juillet. Un article publié dans le numéro de on a compostable option. décembre 2019 de La RVC en explique les résultats. Une note As a benefit to CVMA members, CVMA authors have lower sur les enveloppes en polyéthylène utilisées pour expédier les publication fees for The CVJ and lower page charges for the exemplaires de La RVC a été ajoutée pour indiquer que ces enve- CJVR. Advertising revenues, which had been on the decline loppes sont recyclables. La recherche se poursuit pour trouver RAPPORT ANNUEL for the last few years due to a combination of variables such as une option compostable. company mergers, fewer new products, and alternative ways En tant qu’avantage de l’adhésion, les auteurs qui sont of advertising, are still slow to rebound, except for Classified membres de l’ACMV profitent de tarifs de publication infé- Advertising, which did well in 2019. rieurs pour La RVC ainsi que de frais inférieurs par page pour la Readers and CVMA members are reminded that all issues, RCRV. Les recettes publicitaires, qui avaient diminué au cours except the most recent 6 months (The CVJ) and 3 months des dernières années pour diverses raisons comme des fusions (CJVR) are available to the public on the PubMed Central d’entreprises, un nombre moins élevé de nouveaux produits et la archive (www.pubmedcentral.com); a link is also available possibilité d’utiliser d’autres moyens promotionnels, continuent through the CVMA website (www.canadianveterinarians.net). d’afficher une reprise lente, à l’exception des petites annonces CVMA members can view the most recent 6 months of The CVJ qui ont eu de bons résultats en 2019. and most recent 3 months of CJVR on the member-only section Nous rappelons aux lecteurs et aux membres de l’ACMV que of the CVMA website. tous les numéros, sauf ceux des six derniers mois pour La RVC et des trois derniers mois pour la RCRV, sont accessibles à tous par l’intermédiaire de PubMed Central (www.pubmedcentral); un lien est aussi fourni sur le site Web de l’ACMV. Les membres de l’ACMV peuvent consulter les plus récents numéros (six derniers mois pour La RVC et trois derniers mois pour la RCRV ) dans la section réservée aux membres du site de l’ACMV.

Conventions Congrès

The Canadian Veterinary Medical Association held its L’Association canadienne des médecins vétérinaires a tenu son 71st Annual Convention in partnership with the World Small 71e Congrès annuel en partenariat avec la WSAVA (World Animal Veterinary Association (WSAVA) to bring delegates Small Animal Veterinary Association) afin d’offrir aux quelque a dynamic program, showcasing Canadian and international 2000 participants un programme dynamique mettant en vedette experts who were primed to share their knowledge with over des experts canadiens et étrangers heureux de partager leurs 2000 delegates. connaissances.

Emerging Leaders Program Programme des futurs leaders

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The WSAVA/CVMA Congress started off with the Opening Le Congrès de l’ACMV/ Ceremony and Welcome Reception, where all delegates were WSAVA a commencé par la céré- welcomed with live entertainment, including a First Nations monie d’ouverture et la réception hand drummer, Celtic fiddlers and steel drums performer, all de bienvenue, où tous les partici- while having photos, submitted by Canadian veterinarians and pants ont été accueillis avec des ANNUAL REPORT ANNUAL their teammates, showcased in a video backdrop. The enter- prestations en direct, notamment tainment was followed by welcoming speeches by the WSAVA d’un joueur de tambour à main president, Dr. Shane Ryan, and the CVMA president, Dr. Terri des Premières nations, de violo- Chotowetz. nistes celtiques et d’un joueur The CVMA Global Summit, which focused on The Gold de tambours en acier, avec en Standard of Animal Welfare — Positive and Negative Impact on toile de fond un diaporama de Animals and Veterinarians; and the CVMA Global Forum titled photos soumises par des vétéri- Telehealth and Animal Welfare — Pros, Cons and Implications for naires canadiens et leurs équipes. Veterinary Patients; and finally the CVMA Emerging Leaders Susan Aglukark L’animation a été suivie du dis- Program in its 10th year, took place on the first day of the cours de bienvenue du président Congress. de la WSAVA, le Dr Shane Ryan, et de la présidente de l’ACMV, With a great variety of continuing education (CE) sessions la Dre Terri Chotowetz. presented by top-notch speakers, attendees had the opportu- Trois événements importants ont eu lieu le premier jour du nity to gain over 31 hours of CE over the course of the 4-day Congrès : le Sommet mondial de l’ACMV, dont le thème était congress. The CVMA was pleased to incorporate some large La norme d’excellence en matière de bien-être animal – Impact animal topics into the CE program, including equine welfare positif et négatif sur les animaux et les médecins vétérinaires, le and equine diagnostic imaging, rounding out the CE. Forum mondial de l’ACMV, intitulé Télésanté et bien-être ani- The CVMA was excited to work with WSAVA to bring the mal – Avantages, inconvénients et conséquences pour les patients social evening of a lifetime. The Canadian Street Party, held at vétérinaires, et la 10e édition du Programme des futurs leaders the Evergreen Brick Works, gave attendees a chance to enjoy de l’ACMV. local food and beverages, while being entertained by local busk- Avec une grande variété de séances de formation continue ers. With the generous sponsorship from Elanco, guests were présentées par des conférenciers de renom, les participants ont invited into the main event space where one of Canada’s most eu l’occasion d’acquérir plus de 31 heures de formation au cours unique artists and a leading voice in Canadian music, Susan des quatre jours du Congrès. L’ACMV était ravie d’avoir ajouté Aglukark, performed to over 350 guests. des sujets relatifs aux grands animaux, y compris le bien-être Under the direction of the Professional Development des chevaux et l’imagerie diagnostique équine, pour compléter Committee, with the creativity of the 2019 CVMA Convention le programme de formation continue. local chair, Dr. Jim Berry, and with the assistance of CVMA L’ACMV a eu le plaisir de travailler avec la WSAVA pour staff, the 2019 world congress was an exhilarating success! offrir une soirée sociale inoubliable. Le « Canadian Street Mark your calendars for the 2021 CVMA Convention to be Party », qui a eu lieu à Evergreen Brick Works, a permis aux held in Calgary, Alberta from July 22–25. participants de savourer de la nourriture et des boissons locales tout en étant divertis par des amuseurs publics de la région. Grâce au généreux parrainage d’Elanco, les convives ont été invi- tés dans l’espace principal de l’événement où Susan Aglukark, une artiste canadienne unique et exceptionnelle, a réjoui plus de 350 invités. Sous la direction du Comité de perfectionnement professionnel, avec la créativité du pré- sident local du Congrès de l’ACMV de 2019, le Dr Jim Berry, et l’aide du personnel de l’ACMV, le Congrès mondial de 2019 a été un immense succès! Marquez vos calendriers pour le Congrès de l’ACMV de 2021 qui se tiendra à Calgary, en Alberta, du 22 au 25 juillet.

CVMA Council Conseil de l’ACMV

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

The CVR, a program of the CVMA, has now been in place La RVC de l’ACMV a été constituée il y a maintenant 13 ans. for 13 years. It provides veterinary surge capacity in cases of Elle sert à fournir des renforts vétérinaires en cas d’urgence emergencies involving animals, be they foreign animal diseases impliquant des animaux, qu’il s’agisse d’une éclosion de mala- or civil emergencies. In the case of civil emergencies or non- die animale exotique ou d’une urgence civile. Dans les cas reportable diseases, the CVR is ready to respond to provin- d’urgences civiles ou de maladies dont la déclaration n’est pas cial authorities such as the Chief Veterinary Officers and/or obligatoire, la RVC est prête à répondre aux autorités provin- Emergency Management Officers. In the case of FADs, the ciales, comme les médecins vétérinaires en chef ou les agents de RAPPORT ANNUEL CVR responds to calls from the CFIA. The CVR consists of gestion des urgences, tandis que dans les cas de maladie animale 300, mostly private practice veterinarians from across Canada. exotique, la RVC répond aux demandes de l’ACIA. La RVC As part of its life cycle, the CVR has conducted a review of regroupe 300 médecins vétérinaires de partout au Canada qui its services, hosting 2 individual workshops with first respond- œuvrent principalement en pratique privée. ers, the first one including provincial authorities, the 2nd one, Dans le cadre de son cycle de vie, la RVC a procédé à une the CFIA. The findings will be addressed in future plans of the réévaluation de ses services, et a organisé deux réunions avec CVR and will adapt the CVR to new needs. les premiers répondants – la première avec les autorités provin- The CVR continues offering on-line training courses on ciales et la deuxième avec l’ACIA. Les conclusions seront prises incident command and civil emergency response. Furthermore, en compte dans les futurs plans de la RVC pour l’adapter aux the CVR maintains a detailed database of reservists that allows nouveaux besoins. it to reach individuals in critical times and to identify the right La RVC continue d’offrir des cours de formation en ligne sur skills for a given purpose. le système de commandement et la réponse aux urgences civiles. The CVR Advisory Board has since inception been chaired De plus, la RVC tient à jour une base de données détaillée des by Dr. John Drake. Membership of the Advisory Board consists réservistes qui lui permet de joindre ces derniers en période cri- of representatives of the CFIA, PHAC, Public Safety Canada, tique et d’identifier les membres ayant les bonnes compétences Council of Chief Veterinary Officers, Canadian Council of pour un objectif donné. Emergency Management Organization, veterinary regula- Depuis sa création, le Conseil consultatif de la RVC est pré- tory bodies, deans of veterinary schools, RVTTC, Red Cross, sidé par le Dr John Drake. Le Conseil consultatif est composé Veterinarians without Borders, and the CVMA Council. de représentants de l’ACIA, de l’Agence de la santé publique du Canada, de Sécurité publique Canada, du Conseil des médecins vétérinaires en chef, du Conseil canadien des organisations de gestion des urgences, des organismes de réglementation vétérinaire, des doyens des facultés de médecine vétérinaire, de l’association TTVAC, de la Croix-Rouge, de Vétérinaires sans frontières, et du Conseil de l’ACMV.

Business Management Gestion commerciale

In 2019, the CVMA continued its economic benchmarking pro- En 2019, l’ACMV a continué d’offrir son programme d’éva- gram, which included valuable practice management tools and luation comparative du rendement qui comprenait des outils et resources such as provincial suggested fee guides, compensation des ressources utiles pour la gestion des finances de la pratique, and benefits reports for associate veterinarians, non-DVM wage comme les guides tarifaires suggérés par province, les rapports reports, provincial economic reports, and individual practice sur la rémunération et les avantages sociaux des médecins reports. Data for these reports come from the annual economic vétérinaires salariés, les rapports sur les salaires des employés surveys the CVMA conducts in partnership with provincial non vétérinaires, les rapports économiques provinciaux et les veterinary medical associations and program co-sponsors, Idexx rapports individuels des établissements. Les données utilisées Laboratories, Merck Animal Health, Petsecure, and Scotiabank. pour créer ces rapports proviennent des sondages économiques The CVMA and Association des médecins vétérinaires du annuels réalisés par l’ACMV en partenariat avec les associations Québec en pratique des petits animaux (AMVQ) collaborated to provinciales de médecins vétérinaires et les commanditaires du deliver the 2019 economic survey of small animal practitioners programme, c’est-à-dire Idexx, Merck Santé animale, Petsecure in Québec, which provided added value to CVMA members. et la Banque Scotia. In 2019, the CVMA published 6 veterinary practice manage- L’ACMV et l’Association des médecins vétérinaires du ment articles in The CVJ, which are also posted on the CVMA Québec en pratique des petits animaux (AMVQ) ont col- website’s Business Management Program section. laboré pour réaliser le sondage économique de 2019 auprès

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In Toronto, Ontario, the 2019 CVMA Convention’s Business des médecins vétérinaires pour animaux de compagnie du Management track had 2 speakers, Mr. Terry Jackson and Québec, ce qui a apporté une valeur ajoutée pour les membres Dr. Stacee Santi. Mr. Jackson, CPA and CGA at VetAdvise, de l’ACMV. gave 3 lectures including “Increasing Practice Revenue through En 2019, l’ACMV a publié six articles sur la gestion com- Perceived Value (Part 1 and Part 2),” and “Employee Incentive merciale d’une pratique vétérinaire dans La RVC, qui peuvent ANNUAL REPORT ANNUAL Programs.” Dr. Santi, DVM and CEO and founder of Vet2Pet, aussi être consultés dans la section du Programme de gestion led lectures including “The Rewards of a Reward Program,” commerciale du site Web de l’ACMV. “Creative Ways to Use Technology to Drive Compliance,” Le volet sur la gestion commerciale du Congrès de l’ACMV “The Secret to Bonding Millennials to Your Practice,” and de 2019 qui a eu lieu à Toronto, en Ontario, avait deux confé- “Team Collaboration Tools.” renciers, M. Terry Jackson et la Dre Stacee Santi. M. Jackson, Provincial veterinary medical association representatives CPA et CGA chez VetAdvise, a donné des conférences sur attended the annual Economic Forum, held during the CVMA’s l’augmentation des revenus de la pratique par la valeur per- Convention, and were provided with the scheduling and deliv- çue et sur les programmes d’incitatifs pour les employés. La ery of annual surveys and reports to all members. National Dre Santi, D.M.V. et fondatrice et présidente-directrice générale data comparisons were presented and discussed, and potential de Vet2Pet, a parlé des avantages des programmes de récom- improvements to the program and its delivery were considered. penses, de moyens créatifs d’utiliser la technologie pour favoriser l’observance, du secret pour fidéliser les milléniaux à votre pratique et de différents outils pour faciliter le travail d’équipe. Des représentants des associations provinciales de médecins vétérinaires ont assisté au Forum économique annuel, qui s’est tenu durant le Congrès de l’ACMV, pendant lequel on a pré- senté un aperçu du calendrier des sondages et de la transmission des rapports à tous les membres. Les participants du Forum ont pu discuter des données nationales et proposer des améliorations au programme et à sa mise en œuvre.

Veterinarian Wellness Bien-être des médecins vétérinaires

The CVMA has a section on its web- Une section du site Web de l’ACMV est site dedicated to Veterinarian Health consacrée à la santé et au bien-être des and Wellness Resources. The resources médecins vétérinaires. Les ressources pro- contained in this section are categorized posées sont réparties en trois catégories : under 3 key areas: Emotional and Mental santé mentale et émotionnelle, santé Health, Physical Health, and Veterinarian physique, et bien-être des vétérinaires. Wellness. A rotating banner pointing Pour un accès facile, une bannière rota- directly to the web section is permanently tive menant directement à la section placed on the CVMA homepage for easy du site sur le bien-être a été placée de access. Resources continue to be added façon permanente sur la page d’accueil as they are identified. du site Web de l’ACMV. Des ressources The Canadian Veterinary Journal (The CVJ) is the voice of continuent d’être ajoutées au fur et à mesure qu’elles deviennent veterinary medicine in Canada. In 2019, the CVMA published disponibles. 4 articles in The CVJ in relation to health and wellness. Under La Revue vétérinaire canadienne (La RVC ) est la voix de la the CVMA Insurance Program, employees enrolled in the group médecine vétérinaire au Canada. En 2019, l’ACMV a publié health benefits plan have access to professional referral services 4 articles dans La RVC sur la santé et le mieux-être des médecins and employee assistance services offered as optional added vétérinaires. benefits of the plan. En vertu du programme d’assurance de l’ACMV, les employés To further support the health and wellness of its members, inscrits au régime d’avantages sociaux de groupe ont accès à the CVMA offers a corporate discount at GoodLife Fitness. des services professionnels et à des services d’assistance aux employés offerts en tant qu’avantages supplémentaires du régime. Afin de promouvoir encore plus la santé et le bien-être de ses membres, l’ACMV a négocié un rabais d’entreprise chez Énergie Cardio/Goodlife.

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CVMA Group Insurance Program Programme d’assurance de groupe de l’ACMV

The CVMA Insurance Program offers members the opportu- Le Programme d’assurance de l’ACMV offre aux membres de nity to access Professional Liability, Commercial Insurance, l’assurance responsabilité professionnelle, de l’assurance com- Employee Benefits Insurance, (Affinity) Life Insurance, merciale, des avantages sociaux pour les employés, de l’assurance Disability and Business Overhead Expense coverage at group vie, de l’assurance invalidité et de l’assurance frais généraux à program rates. Furthermore, through an arrangement with des tarifs de groupe. De plus, dans le cadre d’une entente avec The Personal Insurance Co., the Program provides members La Personnelle, les membres peuvent également souscrire des with the opportunity to purchase group Home, Auto and assurances habitation, auto et voyage. Nouveauté en 2019, RAPPORT ANNUEL Travel Insurance. New in 2019, the CVMA and the Registered l’ACMV et l’association TTVAC (Technologues et techniciens Veterinary Technologists and Technicians of Canada (RVTTC) vétérinaires agréés du Canada) ont convenu de permettre aux agreed to allow locum technicians/technologists access to cover- techniciens/technologues remplaçants d’accéder à la couverture age through the CVMA Insurance Program. par le biais du programme d’assurance de l’ACMV.

Professional Liability and Commercial ‘Protected Programme d’assurance responsabilité Self-Insurance’ Program (PSIP) professionnelle et « auto-assurance protégée » In 2019, the Program insured 1637 participants. Participation commerciale in this program increased by 11%. The PSIP model is a unique En 2019, le programme a assuré 1637 participants, une hausse selling feature and utilizes a ‘protected self-insurance’ retention de 11 % par rapport à l’année précédente. Le modèle de l’auto- fund to enable participating members to take partial ownership assurance protégée est un avantage unique qui fait appel à un of their insurance program. Participants are provided with a fonds de rétention qui permet aux membres participants d’assu- comprehensive review of their business operations and a policy mer une propriété partielle de leur programme d’assurance. On tailored to meet the specific needs of the practice. Members also offre aux participants un examen complet de leurs activités et save a minimum 10% for equivalent coverage when joining the une police qui est conçue spécifiquement pour répondre aux Commercial or Employee Group Benefits program. risques de leur pratique. De plus, les membres économisent au moins 10 % pour une couverture équivalente lorsqu’ils adhèrent Employee Group Benefits Program (EGBP) au programme d’assurance commerciale ou au programme col- In 2019, the Program had 280 accounts participating in the lectif d’avantages sociaux pour les employés. CVMA Employee Benefits Program. The EGBP offers flexible options to clinics for comprehensive life, health and dental Programme collectif d’avantages sociaux pour les plans, accidental death and dismemberment, and disability. employés (PCASE) Optional wellness benefits such as professional referral and En 2019, le PCASE de l’ACMV comptait 280 participants. counseling services for insured members and family members, Le PCASE offre des options flexibles aux cliniques en matière and business assistance and coaching for the practice are also de protection d’assurance vie, d’assurance maladie et dentaire, available. Insured clinics benefit from the rate stability gener- d’assurance en cas de décès ou de mutilation par accident et ated by spreading claims over the entire TotalGUARDTM/ d’assurance invalidité. Des avantages facultatifs relatifs au CVMA pool. bien-être, comme les services d’aiguillage professionnel et le counseling pour les membres assurés et les membres de leur famille, ainsi qu’une assistance et un encadrement d’affaires pour la pratique, sont également offerts. Les cliniques assurées profitent de la stabilité des tarifs garantie par l’étalement des réclamations sur l’ensemble des participants du programme TotalGUARDMC/ACMV.

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CVMA Webstore Program — “MyVetStore.ca” Programme MaVitrineVétérinaire de l’ACMV

In 2019, new clinics continued to be added to the CVMA Web En 2019, de nouvelles cliniques ont continué de s’ajouter au ANNUAL REPORT ANNUAL Store Program and sales flowing through the web store across Programme MaVitrineVétérinaire de l’ACMV et les ventes the country increased by 24%. effectuées au pays ont augmenté de 24 %. The Pet Food Manufacturer’s Rebate Program continues to Le Programme de remise des fabricants d’aliments pour ani- have a significant impact for clinics. A 10% rebate is provided maux continue d’avoir un impact significatif pour les cliniques. by some pet food manufacturers to clients who purchase the Certains fabricants offrent un rabais de 10 % aux clients qui food through the clinic’s web store AutoOrder, plus volume utilisent la fonction d’autoapprovisionnement de la boutique discounts at various times throughout the year. The AutoOrder en ligne de leur clinique, ainsi que des rabais en fonction du rebate has resulted in an increase in AutoOrders, but not at the volume d’achats à divers moments au cours de l’année. Le rabais expense of one-time sales. associé à la fonction d’autoapprovisionnement a entraîné une The MyVetStore.ca is a customizable online retail platform augmentation des commandes effectuées au moyen de cette branded to your practice, offering your clients the ease and fonction, sans toutefois avoir d’impact négatif sur les ventes convenience of purchasing their pet’s prescription products and uniques. dietary recommended products directly from you. You control Le site du programme (MyVetStore.ca) est une plateforme what products are available and the pricing. You can also set up de vente en ligne qui peut être personnalisée à l’image de votre automatic ordering to fulfill recurring orders for those clients établissement vétérinaire afin d’offrir à vos clients la facilité et you have registered to have access to your web store. The web la commodité d’acheter les médicaments et la nourriture de leur store can help promote better client compliance, while increas- animal directement auprès de vous. Vous contrôlez l’offre de ing sales without the cost and hassle of stocking inventory. produits et les prix. Vous pouvez aussi établir des commandes The CVMA Web Store Program is configured to meet the automatiques pour répondre aux commandes récurrentes des respective provincial veterinary regulations and guidelines, and clients qui se sont inscrits pour avoir accès à votre boutique en CVMA members benefit from the most favorable financial ligne. MaVitrineVétérinaire peut favoriser une meilleure obser- terms. vance, tout en augmentant les ventes sans avoir à assumer les coûts et les tracas liés à la gestion des stocks. Le programme de boutique en ligne de l’ACMV est configuré de manière à respecter la réglementation vétérinaire provinciale, et les membres de l’ACMV profitent des conditions financières les plus avantageuses.

Early Career DVM Initiatives Initiatives pour les médecins vétérinaires en début de carrière

The CVMA continues to support new veterinarians, help meet L’ACMV continue d’appuyer les nouveaux vétérinaires, de their personal and professional needs, and help make financial chercher à répondre à leurs besoins personnels et professionnels decisions as they settle into their new profession. et de les aider à prendre de bonnes décisions financières tandis qu’ils entreprennent leur carrière. Membership dues reduction To financially support recent graduates, new graduates receive Réduction de la cotisation a complimentary membership for the remainder of the year in Afin d’appuyer financièrement les finissants, l’ACMV leur offre which they graduate. Individuals who maintain their member- une adhésion gratuite pour le reste de l’année au cours de laquelle ship after graduation throughout a consecutive 3-year period are ils ont obtenu leur diplôme. Ceux qui conservent leur adhésion eligible for a 75%-, 50%-, 25%-tiered fee reduction. Members après la fin de leurs études pendant une période de trois années in their first year following graduation also receive a complimen- consécutives sont admissibles à une réduction de leur cotisa- tary general registration to the CVMA Convention — a great tion de 75 % la première année, de 50 % la deuxième année opportunity to enhance their skills and knowledge. et de 25 % la troisième année. De plus, dans l’année qui suit

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What Can’t Be Taught articles l’obtention de leur diplôme, les finissants membres obtiennent A series of articles published in The CVJ, written by members également une inscription générale gratuite au Congrès de of the CVMA Emerging Leaders Network, provides insight into l’ACMV, ce qui constitue pour eux une excellente occasion de the first years in practice and offers advice from someone “whose perfectionner leurs compétences et leurs connaissances. been there.” The articles are also posted on the member website in the Mentoring Program Resources section. Articles Ce qui ne s’enseigne pas Une série d’articles rédigés par les membres du Réseau des futurs CVMA Emerging Leaders Program (ELP) leaders de l’ACMV et publiés dans La RVC permet d’avoir un In its 10th year, the 2019 CVMA Emerging Leaders Program, aperçu des premières années de pratique et offre des conseils which took place during the 2019 WSAVA/CVMA World provenant de personnes qui ont déjà vécu des situations simi- Congress, welcomed 31 participants from across Canada, the laires. Les articles sont aussi accessibles à partir de la section des RAPPORT ANNUEL United States and internationally. ressources du Programme de mentorat du site Web de l’ACMV. The Emerging Leaders Program incorporates a number of examples from every day private practice that illustrate how, by Programme des futurs leaders (PFL) de l’ACMV being the best versions of ourselves as professionals, we can make La 10e édition du Programme des futurs leaders de l’ACMV, better, more effective clinical care recommendations, practice qui a eu lieu durant le Congrès mondial de l’ACMV/WSAVA more medicine, and gain enhanced compliance by our clients en 2019, a accueilli 31 participants de partout au Canada, aux for the benefit of their pets and livestock. États-Unis et ailleurs dans le monde. Le PFL incorpore un certain nombre d’exemples tirés de la Early Career DVM Resource Hub pratique privée quotidienne qui montrent comment, en étant les To support early career DVMs on their path to a successful meilleures versions de nous-mêmes en tant que professionnels, career, the CVMA created a dedicated website section containing nous pouvons formuler des recommandations de soins cliniques useful information, tools and resources related to financial plan- plus efficaces, pratiquer une meilleure médecine, et obtenir une ning and budgeting, communications, and career development. adhésion accrue de nos clients qui s’avère bénéfique pour leurs Some examples of these tools and resources include student animaux de compagnie ou de ferme. loan repayment estimators, a budgeting app for mobile devices, guidelines for successful employment, video lectures, person- Carrefour des ressources pour les médecins alized self-help programs, guides, and modules. Additional vétérinaires en début de carrière resources continue to be added as they are identified. Afin de mieux appuyer les médecins vétérinaires en début de carrière et de les aider à entreprendre une carrière prospère, Mentoring Program l’ACMV a créé une section de son site Web contenant des The CVMA Mentoring Program was created to facilitate con- renseignements et des ressources utiles portant sur la gestion nections among its members and provide support to recent du budget et des finances personnelles, les communications et graduates as they transition to professional life, and to early le cheminement de carrière. On y trouve notamment un outil career veterinarians who may be looking to make a major career de calcul de remboursement des prêts étudiants, une applica- change within veterinary medicine. tion de gestion du budget pour appareil mobile, des directives The program imparts an enriching experience to mentees who en matière d’emploi, des conférences vidéo, des programmes receive personalized feedback and encouragement, and acquire personnalisés de développement personnel, des guides et des new knowledge and skills. Mentors gain opportunities to provide conseils. Des ressources additionnelles continuent d’être ajoutées professional nurturing, share their knowledge and expertise, and au fur et à mesure qu’elles deviennent disponibles. further develop their own communication and leadership skills. Programme de mentorat Le programme de mentorat de l’ACMV a été mis sur pied pour faciliter l’établissement de liens entre les membres et fournir de l’appui aux nouveaux diplômés tandis qu’ils effectuent la transition à la vie professionnelle, ainsi qu’aux médecins vétérinaires en début de carrière qui envisagent d’effectuer un changement de carrière majeur en médecine vétérinaire. Le programme offre une expérience enrichissante aux men- torés qui reçoivent des commentaires et des encouragements personnalisés en plus d’acquérir de nouvelles connaissances et compétences. Les mentors ont la possibilité de fournir un encadrement professionnel, de partager leurs connaissances et leur expertise et de développer davantage leurs propres compétences en communication et en leadership.

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Communications and Public Relations Communications et relations publiques

The CVMA distributed 17 news releases and received 115 media En 2019, l’ACMV a diffusé 17 communiqués de presse et a reçu ANNUAL REPORT ANNUAL inquiries in 2019. One of the biggest media interests was around 115 demandes de la part des médias. Les médias se sont parti- cannabis exposure and/or use in pets. culièrement intéressés à l’exposition des animaux de compagnie The CVMA continues to increase its social media channel au cannabis et à son utilisation chez ces derniers. activity: L’ACMV continue d’accroître son activité dans les médias • Facebook: 9683 likes sociaux : • English & French Twitter: 10 499 followers • Facebook : 9683 J’aime • Instagram (@cvma.acmv): 1410 followers • Twitter en français et en anglais : 10 499 abonnés • CVMA YouTube: highlighted the 2019 Animal Health Week • Instagram (@cvma.acmv) : 1410 abonnés animated video, the 2019 National Tick Awareness Month • Chaîne YouTube de l’ACMV : La chaîne a présenté la vidéo video, and the CVMA Council’s Convention promotional animée de la Semaine de la vie animale de 2019, la vidéo du videos. Mois national de sensibilisation aux tiques de 2019 et les The CVMA continued to promote the value of vet- vidéos promotionnelles du Congrès de l’ACMV. erinary healthcare on social media, using the hashtags L’ACMV a continué de faire la promotion de la valeur des #VetCareEverywhere and #VétérinairesPartenaires. soins vétérinaires dans les médias sociaux en utilisant les mots- Mass email and fax bulletins, social media updates, articles clics #VetCareEverywhere et #VétérinairesPartenaires. in provincial publications, information on the CVMA’s website Des courriels de masse, des bulletins par télécopieur, des mises and in the CVMA’s monthly eNewsletter continue to provide à jour sur les médias sociaux, des articles dans des publications members with relevant CVMA program updates and general provinciales, l’infolettre mensuelle et l’information sur le site veterinary news. Web de l’ACMV continuent de transmettre aux membres les The CVMA served on the Canadian Food Inspection dernières nouvelles sur les programmes de l’ACMV et les actua- Agency’s (CFIA) African Swine Fever (ASF) communications lités vétérinaires générales. working group and created a dedicated landing page fea- L’ACMV a fait partie du groupe de travail sur les communi- turing up-to-date information and resources related to ASF cations concernant la peste porcine africaine (PPA) de l’Agence (www.canadianveterinarians.net/practice-economics/asf). canadienne d’inspection des aliments (ACIA) et a créé une page The CVMA and Merck Animal Health launched an inaugural Web consacrée à la PPA où trouver des ressources et de l’infor- Mental Health Awareness Week in September 2019. It’s Time to mation à jour sur cette maladie (www.veterinairesaucanada.net/ Talk About Mental Health in Veterinary Medicine kicked off with practice-economics/asf). a live suicide awareness and prevention webinar on National L’ACMV et Merck Santé animale ont organisé la première Suicide Awareness Day. The objective of the campaign is to start Semaine de sensibilisation à la santé mentale en septembre 2019. having open and honest conversations about mental health in the Ayant pour thème « Il est temps de parler de santé mentale en veterinary community. We continue to offer quarterly webinars, médecine vétérinaire », la Semaine a débuté avec un webinaire along with mental health resources, as part of this initiative. en direct de sensibilisation et de prévention du suicide qui a eu The CVMA, in partnership with Merck Animal Health, lieu lors de la Journée nationale de sensibilisation au suicide. once again declared March National Tick Awareness Month. L’objectif de la campagne est d’entamer des conversations

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ouvertes et honnêtes à propos de la santé mentale au sein de la communauté vétérinaire. Nous continuons d’offrir des webinaires trimestriels ainsi que des ressources en santé mentale dans le cadre de cette initiative. L’ACMV, en partenariat avec Merck Santé animale, a de nouveau déclaré le mois de mars comme étant le Mois national de sensibilisation aux tiques. La campagne de 2019 prévoyait aussi le lancement de TiqueTocCanada.com, un nouveau site Web éducatif pour les propriétaires RAPPORT ANNUEL d’animaux de compagnie canadiens. Le matériel produit pour la campagne de 2018 intitulée « Que savez-vous vraiment au sujet des tiques? », comprenant une animation vidéo et une série de 12 vidéos de réponses aux questions sur les tiques, est accessible sur le nouveau site Web. The 2019 campaign launched TickTalkCanada.com (a new Bien que la campagne de 2019 demeurait axée sur l’éducation educational website for Canadian pet owners). Material pro- des clients, nous en avons aussi profité pour transmettre directe- duced for the 2018 “What do you really know about ticks?” ment des messages aux propriétaires d’animaux comme l’avaient campaign, including a video animation and a series of 12 share- souvent demandé les médecins vétérinaires lors des campagnes able “The truth about ticks” videos is prominently featured on précédentes. the new website. While client education remained the 2019 Le thème de la Semaine de la vie animale de 2019 était campaign’s focus, we took things up a notch by bringing the « Nutrition optimale = Santé optimale : Consultez votre équipe message directly to pet owners, a common request from veteri- vétérinaire pour vous renseigner sur les besoins alimentaires de narians during past campaigns. votre animal », ce qui nous a donné l’occasion de rappeler aux The 2019 Animal Health Week theme was “Optimal propriétaires d’animaux qu’il est important d’obtenir des conseils Nutrition for Optimal Health: Talk to Your Veterinary Team vétérinaires professionnels concernant quels aliments et quelle about Your Animal’s Dietary Needs,” giving us an opportunity quantité donner à leur compagnon en fonction de son espèce, to remind animal owners about the importance of seeking de son âge et de son état de santé général. L’Agence canadienne professional veterinary advice regarding what and how much to d’inspection des aliments (ACIA) a distribué des affiches dans feed their animals based on species, age, and overall health. The les diverses régions du Canada et a invité l’ACMV à donner une Canadian Food Inspection Agency (CFIA) distributed posters présentation en personne. through departments across Canada and invited the Association to provide an in-person presentation. Prix de l’ACMV 2019 En juillet, la cérémonie de remise des prix de l’ACMV 2019 2019 CVMA Awards a honoré des membres exceptionnels de la communauté The July 2019 CVMA Awards Ceremony honored exceptional vétérinaire : individuals of the veterinary community: • Dre Kate Lupton, Prix du praticien des petits animaux de • Dr. Kate Lupton, CVMA Small Animal Practitioner Award l’ACMV (Petsecure assurance maladie pour animaux) (Petsecure Pet Health Insurance) • Dr Dennis Will, Prix humanitaire de l’ACMV (Merck Santé • Dr. Dennis Will, CVMA Humane Award (Merck Animal animale) Health) • Dre Karin Orsel, Prix vétérinaire Merck (Merck Santé animale) • Dr. Karin Orsel, Merck Veterinary Award (Merck Animal • Veterinary Specialty Centre of Newfoundland and Health) Labrador, Prix de la pratique de l’année de l’ACMV (Banque • Veterinary Specialty Centre of Newfoundland and Scotia) Labrador, CVMA Practice of the Year Award (Scotiabank) • Dr Jim Brackett, Membre à vie de l’ACMV • Dr. Jim Brackett, CVMA Life Membership • Dr Lloyd Keddie, Prix de la présidente de l’ACMV • Dr. Lloyd Keddie, CVMA President’s Award. L’ACMV tient aussi à féliciter Mme Ivana Novosel qui a reçu The CVMA extends congratulations to Ms. Ivana Novosel le Prix du technologue/technicien vétérinaire agréé canadien de who received the 2019 Canadian Registered Animal Health l’année 2019. L’ACMV a publié des communiqués de presse Technologist/Veterinary Technician of the Year Award. The individuels pour chaque lauréat. CVMA issued individual news releases on each award recipient.

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The Value of Your Membership La valeur de votre adhésion

Membership Benefits and Services REPORT ANNUAL Avantages et services aux membres

As your national professional Association, the CVMA supports À titre d’association professionnelle nationale, l’ACMV appuie and advances the interests and priorities of Canada’s veterinar- et défend les intérêts et les priorités des médecins vétérinaires ians. In 2019, 7599 members supported the CVMA’s work du Canada. En 2019, 7599 membres ont soutenu le travail et and leadership. Our strength is in guiding policy decisions and le leadership de l’ACMV. Notre force consiste à orienter les legislation that affect our profession today and tomorrow. décisions politiques et les lois susceptibles d’affecter la profession The CVMA is always looking to deliver more value to mem- aujourd’hui et à l’avenir. bers and to support you throughout your career. From helping L’ACMV recherche toujours de nouvelles façons d’offrir plus shape animal welfare legislation, to creating public awareness of de valeur à ses membres et de les appuyer tout au long de leur the role of veterinarians, to supporting your personal health and carrière. Que ce soit en contribuant à l’élaboration des lois en wellness, to providing scientific knowledge and resources, the matière de bien-être animal, en sensibilisant le public au rôle CVMA is here for you. In addition, members have access to a des médecins vétérinaires, en vous aidant à veiller à votre santé broad suite of benefits, including practice tools and resources to et à votre mieux-être, ou en vous fournissant des ressources et de help you throughout your career, continuing education, affinity l’information scientifique, l’ACMV est là pour vous. De plus, les programs, and a wide array of discounts and savings. A full list- membres ont accès à un vaste éventail d’avantages, notamment ing of member benefits and services can be found in this issue des outils et des ressources pour vous aider durant votre carrière, of The CVJ (page 671). à de la formation continue, à des programmes collectifs et à une In 2019, the CVMA developed a national campaign to panoplie de rabais et d’économies. Une liste de tous les avantages help reinforce the value of membership and forge a stronger et services offerts aux membres se trouve dans le présent numéro connection with the veterinary community in all provinces. de La RVC (page 671). Some of the main elements of this campaign were the creation En 2019, l’ACMV a conçu une campagne nationale visant of an English and French 30-second video, “We’re with you à réitérer la valeur de l’adhésion et à créer des liens plus forts every step of your way.” (“Nous sommes avec vous à chaque avec la communauté vétérinaire dans toutes les provinces. étape de votre parcours.”), and new videos that have council Certains des principaux éléments de cette campagne ont été la representatives speak to provincial colleagues about the value production d’une vidéo de 30 secondes, en français et anglais, of the CVMA. After 4 months, the 2 new YouTube videos intitulée « Nous sommes avec vous à chaque étape de votre received over 25 000 views. Also, our social media campaign parcours » (« We’re with you every step of your way »), et de successfully raised awareness with 1.8 million impressions and nouvelles vidéos mettant en vedette les représentants du Conseil 33 000 interactions across Facebook, Instagram, YouTube, and expliquant aux médecins vétérinaires de leur province la valeur the Google network. de l’ACMV. Après quatre mois, les nouvelles vidéos ont été visionnées plus de 25 000 fois sur YouTube. Par ailleurs, notre campagne dans les médias sociaux a rehaussé la sensibilisation avec 1,8 million d’impressions et 33 000 interactions dans Facebook, Instagram, YouTube et le réseau Google.

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

The SCVMA kicked off 2019 with the highly anticipated, Les ÉACMV ont donné le coup d’envoi à l’année 2019 avec student-organized, Symposium, held on January 18 and 19 at le très attendu Symposium organisé par les étudiants, qui a eu the Faculté de médecine vétérinaire de l’Université de Montréal, lieu les 18 et 19 janvier à la Faculté de médecine vétérinaire de attended by 258 students. The theme was “One Health, One l’Université de Montréal et auquel 258 étudiants ont participé. Symbiosis,” and focused on the important role veterinarians play Le thème était « Une santé, la symbiose ultime » pour mettre in ensuring the health of the environment, people, and animals. l’accent sur le rôle important que jouent les médecins vétéri- VetRap, a newsletter that brings together our national naires pour assurer la santé de l’environnement, des humains RAPPORT ANNUEL and international student communities, features articles and et des animaux. stories from Canadian veterinary students, was published Le bulletin VetRap, une infolettre qui rassemble la commu- in February. To read the 2019 edition, visit the website nauté étudiante au pays et à l’étranger et qui présente des articles (www.canadianveterinarians.net/membership/scvma-newsletter). d’étudiants vétérinaires canadiens, a été publié en février. Pour Moving into April, the CVMA’s insurance partner, Western lire l’édition de 2019, visitez notre site Web (www.veterinaires Financial Group Insurance Solutions, travelled to each of the aucanada.net/membership/scvma-newsletter). 5 veterinary colleges and presented an overview of career insur- En avril, le partenaire d’assurance de l’ACMV, Western ance risks students could face and explained available products Financial Group Insurance Solutions, a organisé dans cha- and coverages. Each college reported the session was informative cune des cinq écoles vétérinaires du pays une présentation sur and feedback was positive. l’assurance afin de donner aux étudiants un aperçu des risques The fall school year began with the welcome ceremonies for auxquels ils pourraient faire face durant leur carrière et d’expli- first-year students. During this ceremony, students were pre- quer les divers produits et couvertures d’assurances offerts. Les sented with a CVMA-branded lab coat and name badge. It is organisateurs de chacune des écoles ont indiqué que la présen- also during this ceremony that the Teacher of the Year Award is tation était informative et que les commentaires étaient positifs. given to a teacher, selected by 3rd-year veterinary students, who L’année scolaire a commencé par les cérémonies d’accueil des inspired them most with their approach to the subject, teaching étudiants de première année, pendant lesquelles ces derniers methods, and enthusiasm. ont reçu un insigne d’identité et un sarrau de l’ACMV. C’est Moving into October, each college hosted a One Voice également lors de la cérémonie d’accueil que le Prix de l’ensei- presentation. The One Voice presentation gives students an gnant de l’année est remis au professeur qui, selon les étudiants overview of the CVMA and its initiatives, and includes a “hot de 3e année, a été une source d’inspiration par son approche du topic” discussion. This year’s “hot topic” discussion was Animals sujet, ses méthodes d’enseignement et son enthousiasme. for Use in Sport and Competition, specifically rodeos. Each col- En octobre, chaque école a organisé une présentation Une voix, lege reported the presentation was well attended and received. qui donne aux étudiants un aperçu de l’ACMV et de ses initiatives

Welcome ceremony at the Western College of Veterinary Medicine for the Class 2023. Cérémonie de bienvenue au Western College of Veterinary Medicine pour la promotion de 2023.

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In November, the CVMA distributed the New Graduate et comprend une discussion sur un sujet d’actualité. Cette année, Survey to help better understand the current Canadian la discussion a porté sur l’utilisation des animaux pour les sports veterinary workplace conditions, specifically for new graduates. et la compétition, en particulier dans les rodéos. La présentation The survey had 216 respondents, with a 68% response rate. a attiré beaucoup de participants et a été bien reçue dans toutes The survey was published in the April edition of The Canadian les écoles. ANNUAL REPORT ANNUAL Veterinary Journal and is currently available online at (www. En novembre, l’ACMV a distribué le sondage annuel canadianveterinarians.net/membership/scvma-survey-new- auprès des nouveaux diplômés afin de mieux comprendre graduates). The year concluded with the CVMA representing les conditions actuelles du marché du travail vétérinaire over 1700 DVM students, a slight increase from last year. canadien, particulièrement pour les nouveaux diplômés. Au total, 216 personnes ont répondu au sondage, pour un taux de Student Liaison Advisory Group réponse de 68 %. Les résultats ont été publiés dans l’édition The CVMA Student Liaison Advisory Group (SLAG) rep- d’avril de La RVC et l’article peut être lu en ligne sur notre resents the CVMA at each of the 5 Canadian veterinary col- site Web (www.veterinairesaucanada.net/membership/scvma- leges, strengthening the CVMA and veterinary student link. survey-new-graduates). À la fin de l’année, l’ACMV représentait The SLAG, comprised of one faculty member from each plus de 1700 étudiants en médecine vétérinaire, soit une légère college, guides their college’s SCVMA Committee representa- augmentation par rapport à l’année précédente. tive and participates in annual CVMA initiatives including the One Voice presentation, lab coat ceremony, and the SCVMA Groupe consultatif de liaison avec les étudiants Symposium. Le Groupe consultatif de liaison avec les étudiants (GCLE) de l’ACMV représente l’ACMV dans chacune des cinq écoles de médecine vétérinaire canadiennes afin de renforcer le lien entre l’ACMV et ses membres étudiants. Le GCLE, qui se compose d’un professeur provenant de chacune des écoles, guide le représentant du Comité des ÉACMV dans chaque école et participe aussi aux initiatives annuelles de l’ACMV, dont la présentation Une voix, la cérémonie des sarraus et le Symposium des ÉACMV.

SCVMA 2019 Symposium Planning Committee Comité de planification du Symposium des ÉACMV de 2019

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CVMA-Society of British Columbia Veterinarians Chapter Section ACMV-Society of British Columbia Veterinarians

The Chapter, at 10 years old, can begin looking at expanding its La Section ACMV-SBCV, qui célèbre ses 10 ans d’existence, programs to include a peer-support service, enhanced regional peut commencer à envisager d’élargir ses programmes pour spring continuing education (CE) sessions, an expanded Fall inclure un service de soutien par les pairs, des sessions régionales Conference to include wet labs, and antimicrobial stewardship améliorées de formation continue au printemps, un congrès training. The Chapter continued to explore emerging issues with d’automne élargi pour inclure des ateliers pratiques, et une its provincial regulator, and to further develop its relationship formation sur la gestion responsable des antimicrobiens. Elle with its regional veterinary college, the Western College of a continué d’explorer les nouveaux enjeux avec son organisme RAPPORT ANNUEL Veterinary Medicine (WCVM). de réglementation provincial et de développer davantage ses relations avec son école de médecine vétérinaire régionale, le Policy Western College of Veterinary Medicine (WCVM). In 2019, the Chapter was involved with the issue of Dangerous Dog legislation, specifically being successful in being declared Politique an intervenor in the British Columbia Court of Appeal case of En 2019, la Section ACMV-SBCV a été impliquée dans la the dog “Punky” who was slated for destruction. Our argument question de la législation sur les chiens dangereux, notamment rested solely on the fact that a veterinarian must be involved en réussissant à être déclarée comme intervenant dans l’affaire before a dog is designated as dangerous (and before destruction). de la Cour d’appel de la Colombie-Britannique concernant le While Punky lost the appeal, its owner applied for leave before chien « Punky » qui devait être euthanasié. Son argument repo- the Supreme Court of Canada, which was dismissed by that sait uniquement sur le fait qu’un médecin vétérinaire devrait Court. As a result of our profile in this issue, the Chapter then être consulté avant qu’un chien soit désigné comme dangereux played a vital role in getting the City of Vancouver to include (et avant son euthanasie). Bien que Punky ait perdu en appel, the requirement for a veterinarian consult, prior to a designa- son propriétaire a déposé une requête auprès de la Cour suprême tion, in its motion regarding dangerous dogs. The Chapter du Canada, laquelle a été rejetée. En raison de sa participation (pre-COVID) hopes to continue to actively educate the city and dans cette affaire, la Section ACMV-SBCV a ensuite joué un rôle the province about the necessity for a veterinarian examination essentiel pour amener la Ville de Vancouver à inclure l’obligation and opinion in dangerous dog designations, as per the CVMA de consulter un médecin vétérinaire dans sa motion concernant position statement. les chiens dangereux. La Section ACMV-SBCV prévoyait avant la pandémie de continuer à éduquer activement les autorités Animal Welfare municipales et provinciales sur la nécessité d’une évaluation In addition to providing substantial input into each CVMA effectuée par un médecin vétérinaire dans le cadre du processus draft position statement, the Animal Welfare Committee is de désignation des chiens dangereux, conformément à l’énoncé attending conferences on animal abuse, animal health and de position de l’ACMV. welfare, and the link between animal and human violence, and is investigating activities in support of animal welfare for those Bien-être des animaux escaping domestic violence. En plus de fournir une rétroaction substantielle pour chaque ébauche d’énoncé de position de l’ACMV, le Comité sur le bien- Veterinarian support être animal de la Section ACMV-SBCV assiste à des conférences Much of the year was spent on the Sector Labour Market sur la maltraitance des animaux, la santé et le bien-être des Partnership program, a well-supported study that demonstrated animaux, et le lien entre la violence envers les animaux et la vio- there was a shortage of veterinarians in British Columbia, esti- lence envers les humains, et évalue des initiatives pour appuyer mated at 100 per year for each of the next 5 years. The Chapter le bien-être des animaux des victimes de violence familiale. lobbied the government to take the available 20 seats at WCVM and was successful at getting the support of the Minister of Soutien des médecins vétérinaires Agriculture but not the Minister of Advanced Education. Pre- Une grande partie de l’année a été consacrée au programme sec- COVID, the Chapter had completed its media program’s first toriel de partenariat avec le marché du travail, qui démontre une stage and was about to launch its public education program. pénurie de médecins vétérinaires en Colombie-Britannique estimée This will be revisited when possible. à 100 par année pour chacune des 5 prochaines années. La Section ACMV-SBCV a fait des démarches auprès du gouvernement pour obtenir les 20 places disponibles au WCVM. Elle a réussi à obtenir le soutien de la ministre de l’Agriculture mais pas celui de la ministre de l’Enseignement supérieur. Avant la pandémie, elle avait terminé la première étape de son programme médiatique et était sur le point de lancer son programme d’éducation publique. Elle reprendra ces activités lorsque cela sera possible de le faire.

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Setting Standards Établissement de normes

Animal Health Technologist/Veterinary Technician Program Accreditation REPORT ANNUAL Agrément des programmes de technologie et de techniques vétérinaires

The CVMA’s Animal Health Technologist/Veterinary Technician Le Comité d’agrément des programmes de technologie et de Program Accreditation Committee (AHTVTPAC) is respon- techniques vétérinaires (CAPTTV) de l’ACMV est responsable sible for accrediting veterinary technician training programs de l’agrément des programmes de formation des techniciens that meet the minimum standards for educating and training vétérinaires qui satisfont aux normes minimales en matière de qualified personnel who may join the veterinary health care formation d’employés compétents qui pourront se joindre à team. Graduates of such accredited programs benefit by having l’équipe de soins vétérinaires. Les diplômés de ces programmes their competence recognized and prospects for employment agréés profitent du fait que leur compétence est reconnue et and mobility enhanced, and the veterinary team benefits from que leurs perspectives d’emploi et de mobilité sont améliorées well-trained technicians and technologists. et l’équipe vétérinaire profite de techniciens et de technologues The CVMA maintains a reciprocity agreement with the bien formés. American Veterinary Medical Association that allows for the L’ACMV maintient une entente de réciprocité avec l’Ame- mutual recognition of our respective accreditation processes. rican Veterinary Medical Association (AVMA) qui permet la In 2019, site visits to Vanier College and Georgian College reconnaissance mutuelle de nos processus d’agrément respectifs. took place. En 2019, des inspections ont eu lieu au Vanier College et au The 19 accredited programs in Canada are: Georgian College. • Algonquin College, Ottawa, ON Les 19 programmes agréés au Canada sont ceux des établis- • Dalhousie University (formerly Nova Scotia Agricultural sements d’enseignement suivants : College), Truro, NS • Algonquin College, Ottawa (Ontario) • Douglas College, New Westminster, BC • Dalhousie University (anciennement Nova Scotia • Georgian College, Orillia, ON Agricultural College), Truro (Nouvelle-Écosse) • Grand Prairie Regional College, Fairview Campus, • Douglas College, New Westminster Fairview, AB (Colombie-Britannique) • Lakeland College, Vermilion, AB • Georgian College, Orillia (Ontario) • Maritime Business College, Dartmouth, NS • Grand Prairie Regional College, Fairview Campus, Fairview • Northern Alberta Institute of Technology, Edmonton, AB (Alberta) • Northern College, Haileyburg, ON • Lakeland College, Vermilion (Alberta) • Olds College (on-campus and distance learning), Olds, AB • Maritime Business College, Dartmouth (Nouvelle-Écosse) • Oulton College, Moncton, NB • Northern Alberta Institute of Technology, Edmonton • Red River College, Winnipeg, MB (Alberta) • St. Clair College, Windsor, ON • Northern College, Haileyburg (Ontario) • St. Lawrence College, Kingston, ON • Olds College (sur place et à distance), Olds (Alberta) • Saskatchewan Institute of Science and Technology, • Oulton College, Moncton (Nouveau-Brunswick) Saskatoon, SK • Red River College, Winnipeg (Manitoba) • Seneca College, King City, ON • St. Clair College, Windsor (Ontario) • Thompson Rivers University (on-campus and distance • St. Lawrence College, Kingston (Ontario) learning), Kamloops, BC • Saskatchewan Institute of Science and Technology, • University of Guelph, Ridgetown Campus (on-campus and Saskatoon (Saskatchewan) distance learning), Ridgetown, ON • Seneca College, King City (Ontario) • Vanier College, Montreal, QC • Thompson Rivers University (sur place et à distance), Kamloops (Colombie-Britannique) • University of Guelph, Ridgetown Campus (sur place et à distance), Ridgetown (Ontario) • Vanier College, Montréal (Québec)

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National Examining Board Bureau national des examinateurs

National exams Examens nationaux The National Examining Board (NEB) is the body established Le Bureau national des examinateurs (BNE) est l’organisme by the CVMA to administer a veterinary medicine examination établi par l’ACMV pour gérer le processus d’examen pour les process for foreign- and Canadian-trained veterinarians wishing médecins vétérinaires formés au Canada et à l’étranger qui to practice in Canada. Passing the NEB exams and obtaining désirent exercer au Canada. La réussite des examens du BNE a Certificate of Qualification (CQ) allow them to apply for a et l’obtention d’un Certificat de compétence leur permettent license in any Canadian province. de présenter une demande de permis dans toutes les provinces RAPPORT ANNUEL canadiennes. NEB examination process In 2019, the NEB accepted applications from 406 new candidates Processus d’examen du BNE and issued 632 CQs (355 Canadian students, 187 graduates from En 2019, le BNE a accepté des demandes provenant de AVMA-accredited veterinary schools, and 90 graduates of non- 406 nouveaux candidats et a émis 632 certificats de com- accredited veterinary schools). This means that in 2019, 277 or pétence (355 à des étudiants canadiens, 187 à des diplômés 44% of CQs were issued to internationally trained veterinarians. d’écoles de médecine vétérinaire agréées par l’AVMA et 90 à des diplômés d’écoles de médecine vétérinaire non agréées). Cela signifie qu’en 2019, 277 ou 44 % des certificats de compétence ont été remis à des médecins vétérinaires formés à l’étranger.

Veterinary College Accreditation Agrément des facultés de médecine vétérinaire

The CVMA, in collaboration with the American Veterinary L’ACMV, en collaboration avec l’American Veterinary Medical Medical Association — Council on Education, is accrediting Association – Council on Education (AVMA-COE), procède university programs designed to educate students to become à l’agrément des programmes universitaires de formation des veterinarians. All Canadian veterinary colleges are CVMA/ médecins vétérinaires. Toutes les écoles de médecine vétérinaire AVMA-COE accredited. du Canada sont agréées par l’ACMV/AVMA-COE. In 2019 CVMA/AVMA-COE site visits were conducted at: En 2019, des inspections de l’ACMV/AVMA-COE ont été • Bristol Veterinary School réalisées dans les établissements suivants : • Western University of Health Sciences College of • Bristol Veterinary School Veterinary Medicine • Western University of Health Sciences College of • University of Calgary Faculty of Veterinary Medicine Veterinary Medicine • University of Arizona College of Veterinary Science • University of Calgary Faculty of Veterinary Medicine • University of Sydney Faculty of Veterinary Science • University of Arizona College of Veterinary Science • Michigan State University College of Veterinary Medicine • University of Sydney Faculty of Veterinary Science • Louisiana State University School of Veterinary Medicine • Michigan State University College of Veterinary Medicine • Auburn University College of Veterinary Medicine • Louisiana State University School of Veterinary Medicine • Université de Montréal Faculté de médecine vétérinaire • Auburn University College of Veterinary Medicine All 5 Canadian veterinary colleges are accredited. Globally, • Faculté de médecine vétérinaire de l’Université de Montréal 51 veterinary schools are accredited. Les cinq écoles de médecine vétérinaire du Canada sont agréées; au total, il y a 51 écoles de médecine vétérinaire agréées dans le monde.

710 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY ANNUAL REPORT ANNUAL

INDEPENDENT AUDITOR’S REPORT As part of an audit in accordance with Canadian generally accepted auditing standards, we exercise professional judgment and maintain professional To the Members, skepticism throughout the audit. Canadian Veterinary Medical Association: We also: atement of the financial Opinion • Identify and assess the risks of material misst We have audited the financial statements of Canadian Veterinary Medical statements, whether due to fraud or error, design and perform audit Association (“the Entity”), which comprise the statement of financial position procedures responsive to those risks, and obtain audit evidence that is as at December 31, 2019, and the statements of changes in net assets, sufficient and appropriate to provide a basis for our opinion. The risk of not operations and cash flows for the year then ended, and notes to the financial detecting a material misstatement resulting from fraud is higher than for statements, including a summary of significant accounting policies. one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. In our opinion, the accompanying financial statements present fairly, in all material respects, the financial position of the Entity as at December 31, • Obtain an understanding of internal control relevant to the audit in order 2019, and the results of its operations and its cash flows for the year then to design audit procedures that are appropriate in the circumstances, but ended in accordance with Canadian accounting standards for not-for-profit not for the purpose of expressing an opinion on the effectiveness of the organizations. Entity’s internal control. • Evaluate the appropriateness of accounting policies used and the Basis for opinion reasonableness of accounting estimates and related disclosures made by We conducted our audit in accordance with Canadian generally accepted management. auditing standards. Our responsibilities under those standards are further • Conclude on the appropriateness of management’s use of the ained,going described in the auditor’s responsibilities for the audit of the financial concern basis of accounting and, based on the audit evidence obt statements section of our report. We are independent of the Entity in whether a material uncertainty exists related to events or conditions that accordance with the ethical requirements that are relevant to our audit of may cast significant doubt on the Entity’s ability to continue as a going the financial statements in Canada, and we have fulfilled our other ethical concern. If we conclude that a material uncertainty exists, we are required responsibilities in accordance with these requirements. We believe that the to draw attention in our auditor’s report to the related disclosures in the audit evidence we have obtained is sufficient and appropriate to provide a financial statements or, if such disclosures are inadequate, to modify our basis for our opinion. opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may Responsibilities of management and those charged with governance cause the Entity to cease to continue as a going concern. for the financial statements ation, structure and content of the financial Evaluate the overall present Management is responsible for the preparation and fair presentation of these • statements, including the disclosures, and whether the financial financial statements in accordance with Canadian accounting standards for statements represent the underlying transactions and events in a manner not-for-profit organizations, and for such internal control as management that achieves fair presentation. determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. We communicate with those charged with governance regarding, among In preparing the financial statements, management is responsible for other matters, the planned scope and timing of the audit and significant assessing the Entity’s ability to continue as a going concern, disclosing, as audit findings, including any significant deficiencies in internal control that applicable, matters related to going concern and using the going concern we identify during our audit. basis of accounting unless management either intends to liquidate the Entity, or to cease operations, or has no realistic alternative but to do so. Those charged with governance are responsible for overseeing the Entity’s financial reporting process.

Auditor’s responsibilities for the audit of the financial statements OUSELEY HANVEY CLIPSHAM DEEP LLP Our objectives are to obtain reasonable assurance about whether the Licensed Public Accountants financial statements as a whole are free from material misstatement, Ottawa, Ontario whether due to fraud or error, and to issue an auditor’s report that includes March 25, 2020 our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with Canadian generally accepted auditing standards will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

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RAPPORT DE L’AUDITEUR INDÉPENDANT considérées comme significatives lorsqu’il est raisonnable de s’attendre RAPPORT ANNUEL à ce que, individuellement ou collectivement, elles puissent influer sur les décisions économiques que les utilisateurs des états financiers prennent Aux membres de en se fondant sur ceux-ci. l’Association canadienne des médecins vétérinaires Dans le cadre d’un audit réalisé conformément aux normes d’audit Opinion généralement reconnues du Canada, nous exerçons notre jugement Nous avons effectué l’audit des états financiers de l’Associationat de lacanadienne situation professionnel et faisons preuve d’esprit critique tout au long de cet audit. l’Entité »), qui comprennent l’ét des médecins vétérinaires (« En outre : financière au 31 décembre 2019, et les états de l’évolution de l’actif net, • Nous identifions et évaluons les risques que les états financiers comportent des résultats et des flux de trésorerie pour l’exercice clos à cette date, des anomalies significatives, que celles-ci résultent de fraudes ou ainsi que les notes complémentaires, y compris le résumé des principales d’erreurs, concevons et mettons en œuvre des procédures d’audit en méthodes comptables. réponse à ces risques, et réunissons des éléments probants suffisants À notre avis, les états financiers ci-joints donnent, dans tous leurs aspects et appropriés pour fonder notre opinion. Le risque de non-détection significatifs, une image fidèle de la situation financière de l’Entité au d’une anomalie significative résultant d’une fraude est plus élevé que 31 décembre 2019, ainsi que de sa performance financière et de ses flux celui d’une anomalie significative résultant d’une erreur, car la fraude peut de trésorerie de l’exercice clos à cette date, conformément aux normes impliquer la collusion, la falsification, les omissions volontaires, de fausses comptables canadiennes pour les organismes sans but lucratif. déclarations ou le contournement du contrôle interne. • Nous acquérons une compréhension des éléments du contrôle interne Fondement de l’opinion pertinents pour l’audit afin de concevoir des procédures d’audit Nous avons effectué notre audit conformément aux normes d’audit appropriées aux circonstances, et non dans le but d’exprimer une opinion généralement reconnues du Canada. Les responsabilités qui nous sur l’efficacité du contrôle interne de l’Entité. ables incombent en vertu de ces normes sont plus amplement décrites dans • Nous apprécions le caractère approprié des méthodes compt la section « Responsabilités de l’auditeur à l’égard de l’audit des états retenues et le caractère raisonnable des estimations comptables faites par financiers » du présent rapport. Nous sommes indépendants de l’Entité la direction, de même que des informations qui y sont afférentes fournies conformément aux règles de déontologie qui s’appliquent à l’audit des par cette dernière. états financiers au Canada et nous nous sommes acquittés des autres ation responsabilités déontologiques qui nous incombent selon ces règles. • Nous tirons une conclusion quant au caractère approprié de l’utilis Nous estimons que les éléments probants que nous avons obtenus sont par la direction du principe comptable de continuité de l’exploitation et, suffisants et appropriés pour fonder notre opinion d’audit. selon les éléments probants obtenus, quant à l’existence ou non d’une incertitude significative liée à des événements ou situations susceptibles Responsabilités de la direction et des responsables de la de jeter un doute important sur la capacité de l’Entité à poursuivre son gouvernance à l’égard des états financiers exploitation. Si nous concluons à l’existence d’une incertitude significative, La direction est responsable de la préparation et de la présentation fidèle nous sommes tenus d’attirer l’attention des lecteurs de notre rapport des états financiers conformément aux normes comptables canadiennes sur les informations fournies dans les états financiers au sujet de cette pour les organismes sans but lucratif, ainsi que du contrôle interne qu’elle incertitude ou, si ces informations ne sont pas adéquates, d’exprimer considère comme nécessaire pour permettre la préparation d’états une opinion modifiée. Nos conclusions s’appuient sur les éléments financiers exempts d’anomalies significatives, que celles-ci résultent de probants obtenus jusqu’à la date de notre rapport. Des événements ou fraudes ou d’erreurs. des situations futurs pourraient par ailleurs amener l’Entité à cesser son exploitation. Lors de la préparation des états financiers, c’est à la direction qu’il ation d’ensemble, la structure et le contenu incombe d’évaluer la capacité de l’Entité à poursuivre son exploitation, de • Nous évaluons la présent communiquer, le cas échéant, les questions relatives à la continuité des états financiers, y compris les informations fournies dans les notes, l’exploitation et d’appliquer le principe comptable de continuité d’exploi et apprécions si les états financiers représentent les transactions et tation, sauf si la direction a l’intention de liquider l’Entité ou de cesser son événements sous-jacents d’une manière propre à donner une image fidèle. activité ou si aucune autre solution réaliste ne s’offre à elle. Nous communiquons aux responsables de la gouvernance notamment Il incombe aux responsables de la gouvernance de surveiller le processus l’étendue et le calendrier prévus des travaux d’audit et nos constatations d’information financière de l’Entité. importantes, y compris toute déficience importante du contrôle interne que nous aurions relevée au cours de notre audit. Responsabilités de l’auditeur à l’égard de l’audit des états financiers Nos objectifs sont d’obtenir l’assurance raisonnable que les états financiers pris dans leur ensemble sont exempts d’anomalies significatives, que celles-ci résultent de fraudes ou d’erreurs, et de délivrer un rapport de l’auditeur contenant notre opinion. L’assurance raisonnable correspond à un OUSELEY HANVEY CLIPSHAM DEEP LLP niveau élevé d’assurance, qui ne garantit toutefois pas qu’un audit réalisé Experts-comptables autorisés conformément aux normes d’audit généralement reconnues du Canada Ottawa, Ontario permettra toujours de détecter toute anomalie significative qui pourrait 25 mars 2020 exister. Les anomalies peuvent résulter de fraudes ou d’erreurs et elles sont

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

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CANADIAN VETERINARY MEDICAL ASSOCIATION CANADIENNE DES ASSOCIATION MÉDECINS VÉTÉRINAIRES

STATEMENT OF FINANCIAL POSITION ÉTAT DE LA SITUATION FINANCIÈRE AS AT DECEMBER 31, 2019 AU 31 DÉCEMBRE 2019 ANNUAL REPORT ANNUAL

2019 2018

CURRENT ASSETS ACTIF À COURT TERME Cash $ 870 074 $ 246 663 Encaisse Accounts receivable 354 573 497 349 Débiteurs Interest receivable 44 095 29 737 Intérêts à recevoir Government remittances receivable 3 221 40 639 Versements gouvernementaux à recevoir Prepaid expenses 128 405 94 396 Frais payés d’avance

1 400 368 908 784

INVESTMENTS 3 398 000 2 804 850 PLACEMENTS CAPITAL ASSETS 492 181 513 654 IMMOBILISATIONS

$ 5 290 549 $ 4 227 288

CURRENT LIABILITIES PASSIF À COURT TERME Accounts payable and accrued liabilities $ 302 927 $ 150 770 Créditeurs et charges à payer Deferred revenue 1 277 174 533 312 Revenus reportés

1 580 101 684 082

NET ASSETS ACTIF NET Invested in capital assets 492 181 513 654 Investi en immobilisations Internally restricted net assets: Actif net affecté d’origine interne : Operational contingency 1 476 412 1 397 135 Imprévus liés aux opérations Program contingency 1 553 140 1 632 417 Imprévus liés aux programmes Unrestricted 188 715 — Non affectés

3 710 448 3 543 206

$ 5 290 549 $ 4 227 288

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

President Présidente

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CANADIAN VETERINARY MEDICAL ASSOCIATION CANADIENNE DES ASSOCIATION MÉDECINS VÉTÉRINAIRES

STATEMENT OF OPERATIONS ÉTAT DES RÉSULTATS FOR THE YEAR ENDED DECEMBER 31, 2019 POUR L’EXERCICE TERMINÉ LE 31 DÉCEMBRE 2019

2019 2018

REVENUE REVENUS

RAPPORT ANNUEL Communications Program $ 67 608 $ 86 549 Programme de communications Professional development 120 000 687 024 Perfectionnement professionnel Journal — CJVR 83 105 91 332 Revue — RCRV Journal — CVJ 688 370 752 815 Revue — RVC Membership services 1 572 447 1 487 936 Services aux membres National Examination Board 2 123 082 1 786 885 Bureau national des examinateurs Canadian Veterinary Reserve 55 766 69 213 Réserve vétérinaire canadienne AHTVTP Accreditation 44 564 43 691 Agrément des programmes de techniques vétérinaires Secretariat 535 403 549 724 Secrétariat Students Program 96 638 39 660 Programme pour étudiants Special projects 382 349 417 999 Projets spéciaux Interest 62 659 49 288 Intérêts

5 831 991 6 062 116

Inter-departmental revenues Revenus entre services and administration allocations (241 517) (261 128) et frais administratifs

5 590 474 5 800 988

EXPENSES DÉPENSES Communications Program 248 206 241 531 Programme de communications Professional development 111 583 533 551 Perfectionnement professionnel Council and committees 371 074 401 343 Conseil et comités Journal — CJVR 94 572 91 900 Revue — RCRV Journal — CVJ 717 599 761 715 Revue — RVC Membership services 589 059 523 772 Services aux membres National Examination Board 1 923 205 1 610 877 Bureau national des examinateurs Canadian Veterinary Reserve 55 766 69 213 Réserve vétérinaire canadienne AHTVTP Accreditation 25 075 37 612 Agrément des programmes de techniques vétérinaires Secretariat 890 704 858 621 Secrétariat Students Program 157 680 109 156 Programme pour étudiants Special projects 480 226 473 015 Projets spéciaux

5 664 749 5 712 306

Inter-departmental expenses Dépenses entre services and administration allocations (241 517) (261 128) et frais administratifs

5 423 232 5 451 178

NET REVENUE FOR THE YEAR $ 167 242 $ 349 810 REVENUS NETS POUR L’EXERCICE

714 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY Case Report Rapport de cas

Imaging and clinical features of a true gastrogastric intussusception in a dog

Lindsey T. Graham, Mylène Auger, Allison M. Watson, Christian Folk, Adrien-Maxence Hespel

Abstract — An 18-month-old male mixed breed dog was evaluated for acute vomiting and hematemesis. Clinical signs and initial radiographic findings shared commonalities with reported cases of pylorogastric intussusception in dogs. However, unlike previously reported cases, additional imaging [including ultrasound and computed tomography (CT)] revealed invagination of the gastric fundus into the gastric body, consistent with true gastrogastric intussusception. These findings were confirmed with histopathology and on necropsy. Key clinical message: Although extremely rare, gastrogastric intussusception should be included as a differential diagnosis for any patient presenting with acute vomiting, abdominal pain, dehydration, or tachycardia in combination with the diagnostic imaging findings described in this report.

Résumé — Caractéristiques cliniques et d’imagerie d’une intussusception gastro-gastrique vraie chez un chien. Un chien mâle de race croisée âgé de 18 mois fut évalué pour des vomissements aigus et de l’hématémèse. Les signes cliniques et les trouvailles radiographiques initiales partageaient des similarités avec des cas rapportés d’intussusception pyloro-gastrique chez des chiens. Toutefois, contrairement aux cas rapportés précédemment, des examens d’imagerie supplémentaires [incluant l’échographie et la tomodensitométrie (CT)] ont révélé une invagination du fundus gastrique dans le corps de l’estomac, compatible avec une intussusception gastro-gastrique vraie. Ces données furent confirmées lors de l’examen histopathologique et de la nécropsie. Message clinique clé : Bien qu’extrêmement rare, l’intussusception gastro-gastrique devrait être incluse dans le diagnostic différentiel pour tout patient présenté avec des vomissements aigus, de la douleur abdominale, de la déshydratation ou de la tachycardie en combinaison avec les trouvailles en imagerie diagnostique décrites dans le présent rapport.

(Traduit par Dr Serge Messier) Can Vet J 2020;61:715–718

ntussusceptions are characterized by the prolapse of one gastrointestinal tract, but most are most commonly found at I gastrointestinal segment into the lumen of an immediately the ileocolic junction (1,3,7–18). adjacent segment (1–6). Intussusceptions are named based on In this report, we describe the clinical signs, imaging find- their location within the gastrointestinal tract, starting with the ings, and necropsy findings in a dog with a true gastrogastric intussusceptum followed by the intussuscipiens (5,7–11). Most intussusception. intussusceptions in dogs and cats occur in patients younger than 1 y (1,3,5,10–14), and may occur anywhere along the Case description A 21.1-kg, 18-month-old, intact male, mixed breed dog was Department of Small Animal Clinical Sciences (Graham, Auger, presented because of a 3-hour history of hematemesis, progress- Folk, Hespel), Department of Anatomic Pathology (Watson), ing from pink foam to large quantities of dark fluid and frank University of Tennessee College of Veterinary Medicine, blood. The patient had a life-long history of not gaining weight, 2407 River Drive, Knoxville, Tennessee 37996, USA. despite a normal appetite, and a recent history of lethargy. Address all correspondence to Dr. Adrien-Maxence Hespel; On presentation, the dog was quiet, alert, and responsive. e-mail: [email protected] Physical examination revealed a body condition score of 3/9, Use of this article is limited to a single copy for personal study. muscle wasting, 5% to 7% dehydration, and mild tachycardia. Anyone interested in obtaining reprints should contact the The results of the remainder of his examination were unremark- CVMA office ([email protected]) for additional able. Blood analysis detected no abnormalities other than an copies or permission to use this material elsewhere. increased hematocrit (62%).

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Abdominal radiographs (Figure 1) (Super 80CP; Philips, Bothell, Washington, USA) revealed a well-defined, ovoid, soft- tissue opaque structure with a convex dorsal margin outlined by gas within the gastric fundus. The pylorus and descending duodenum were not identified. The remainder of the small intestine was normal. Additionally, the caudal vena cava was small. Based on these findings and the clinical presentation, a pyloroduodenal intussusception was suspected. A gastric foreign body was considered less likely based on the imaging findings but could not be excluded. An abdominal ultrasound was performed using a curvilinear RAPPORTCAS DE and a high frequency linear transducer (9 MHz and 12–18MHz, Epiq 5; Philips, Bothell, Washington, USA) which revealed invagination of the dorsal aspect of the gastric fundus into the gastric body immediately adjacent to the cardia (Figure 2). The invaginated gastric wall was markedly thickened, measuring up to 1.9 cm, with an altered ratio of wall layering due to severe hypoechoic and heterogeneous submucosal thickening but without loss of wall layering. The outer gastric wall was mildly thickened, measuring up to 0.6 cm and mainly associated with submucosal thickening without loss of the normal wall layers. There was no evidence of disruption of blood flow. The pyloric antrum, pylorus, and duodenum were in a normal anatomic position and were normal. Findings were most consistent with a true gastrogastric intussusception. The changes to the gastric wall were attributed to edema or inflammation, although an underlying neoplasm could not be excluded. An exploratory laparotomy was recommended; however, the owners elected for euthanasia. The body was conserved in a refrigerated environment. The following morning (12 h after euthanasia), computed tomography (CT) of the abdomen (Brilliance; Philips, Cleveland, Ohio, USA) was performed (Figure 3). Post-mortem CT revealed invagination of a large portion of the greater curvature of the stomach immediately adjacent to the cardia into the lumen of the gastric fundus and body. There was heterogeneously hypoattenuating thickening of the invaginated gastric wall. A focal linear region of fat attenuation with a centrally positioned thin, elongated soft tissue attenuating structure con- Figure 1. Right lateral (A) and ventrodorsal (B) abdominal sistent with mesenteric fat and a mesenteric blood vessel were radiographs revealing a well-defined, ovoid, soft tissue seen extending from the adjacent mesentery into the invaginated opacity with a convex dorsal margin outlined by gas within the gastric fundus (black arrows) with fluid dilation of the caudal portion of gastric wall. The pyloric antrum, pylorus, and duode- intrathoracic esophagus (white arrows). The caudal vena cava is num were in a normal anatomic position. These findings further small (asterisk), likely due to dehydration or hypovolemia. supported the diagnosis of a true gastrogastric intussusception. On necropsy, a 10 3 6 cm area of hemorrhage was present on the gastric serosa extending from the greater curvature to the mid-body. The serosa was markedly indented at the middle expanded by lakes of hemorrhage and proteinaceous fluid. The of the greater curvature, causing folding of the gastric serosa serosa was edematous and lined by hypertrophic mesothelium, (Figure 4). This indentation corresponded to a serpiginous area and lymphatics within the submucosa and muscularis were of raised mucosa that was expanded by hemorrhage and edema dilated. The gross indentation of the serosa and the imaging on the cut section. Approximately 50% of the gastric mucosa findings are consistent with a gastrogastric intussusception, was dark red and roughened, with a sharp line of demarcation which led to vascular compromise, ischemia, and infarction. between normal and affected mucosa, consistent with a gastric The antemortem imaging findings were more severe than those infarct. Histopathology of the stomach showed regionally at necropsy, suggesting that the intussusception was partially extensive necrosis of the mucosa, with many neutrophils and reduced following euthanasia. karyorrhectic debris, and mixed bacterial colonies throughout Hookworms were found in the distal small intestine, as well the lamina propria. The underlying submucosa was markedly as within the colon.

716 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY CASE REPORT CASE

Figure 2. Ultrasound images (linear transducer, 12 MHz) of the gastric fundus and body revealing invagination of the dorsal aspect of the gastric fundus into the gastric body. The invaginated gastric wall (intussusceptum; asterisks) is markedly thickened with an altered ratio of wall layering due to severe hypoechoic and heterogeneous submucosal thickening, but without loss of the normal pattern of wall layers. The outer gastric wall (intussuscipiens, white arrows) is mildly thickened, mainly associated with submucosal thickening without loss of the normal pattern of wall layers. The stomach contains a small amount of echogenic fluid within its lumen (white arrowheads). A distal acoustic shadow artefact is visible on the right side of the image due to poor probe contact.

there is only 1 post-mortem report in the non-peer reviewed veterinary literature (18). All documented cases of a true gastro-gastric intussusception in humans have occurred in older adults, ranging from 65 to 83 y of age. Clinical signs included abdominal pain, vomiting, and weight loss (2,4,19–22). All cases but one were associated with benign or malignant neoplasms (2,4,19–22). There have been few veterinary case reports identifying pylorogastric/duodenogastric intussusceptions in which the pylorus alone, or in conjunction with the duodenum, has invaginated into the stomach (1,7,8,12,13,15,16). More than 50% of the documented cases were in dogs older than 1 y and most were large breed (1,7–9,15,18). Contrary to reports in human medicine, most of the previously reported pylorogastric and duodenogastric intussusceptions Figure 3. Dorsal oblique multiplanar reconstruction of the in dogs were idiopathic (1,8,13) and concurrent gastric neoplasia computed tomographic study (soft tissue kernel and window has yet to be reported. Of the published case reports for which an WW 60, WL 360). There is invagination of a large portion of underlying cause was identified, etiologies included dietary indis- the greater curvature of the stomach (*), immediately adjacent to the cardia, into the lumen of the gastric fundus and body (white cretion (1,7), a gastric foreign body (12), prior laparotomies (16), arrows) with heterogeneously hypoattenuating thickening of the and uremia (15). Based on this small number of cases, underlying invaginated gastric wall. The pyloric antrum and pylorus are in gastritis, foreign body ingestion, and previous surgery have been a normal anatomic position (black arrow). There is fluid dilation of the caudal intrathoracic esophagus (white asterisk). Ground considered as potential predisposing factors (3). glass attenuation within the left lungs likely represents post- Similar to the current case, all patients with pylorogastric and mortem atelectasis. duodenogastric intussusceptions presented with severe vomiting, and while this is most likely a result of the intussusception, the Discussion alteration of gastric motility secondary to severe emesis should To the authors’ knowledge, this is the first report of true gastro also be considered a risk factor for development of intussuscep- gastric intussusception diagnosed antemortem. In veterinary tion (1,3,7,8,15). medicine, gastrogastric intussusception has been used in the There was documentation in a non-peer reviewed journal of past interchangeably with pylorogastric and duodenogastric a midbody true gastrogastric intussusception, identified during intussusception. True gastrogastric intussusceptions, defined as dissection of a canine cadaver (18), in which the gastric body invagination of the gastric fundus into the gastric body, have was invaginated into the gastric body without involvement of been rarely reported in the human literature (19–22). Similarly, the duodenum, pylorus, pyloric antrum, or fundus. However,

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Figure 4. Gross images of the stomach at necropsy. The serosa is indented at the greater curvature (arrow, A), and there is a 10 3 6 cm area of hemorrhage on the serosa (A,*). The serosal indentation corresponds to a serpiginous area of raised mucosa (B).

ante-mortem information describing clinical signs and diagnos- 3. Levitt L, Bauer MS. Intussusception in dogs and cats: A review of tic imaging was not available in this case. 36 cases. Can Vet J 1992;33:660–664. 4. Shanbhogue A, Walsh C, Fasih N. Education and imaging. Gastro Imaging in our patient had features in common with the intestinal: Gastrogastric intussusception. J Gastroenterol Hepatol 2009; reported findings of pylorogastric and duodenogastric intussus- 24:169. ceptions (1,7,8,12,15,16). Radiographs revealed a well-defined, 5. Welch FT. Small Animal Surgery Textbook. 4th ed. St. Louis, Missouri: Elsevier, 2013. soft tissue opaque structure within the lumen of the gastric fun- 6. Wang N, Cui XY, Liu Y, et al. Adult intussusception: A retrospective dus and a poorly visualized pylorus and descending duodenum. review of 41 cases. World J Gastroenterol 2009;15:3303–3308. In addition, ultrasound highlighted the presence of a mass-like 7. Marks D. Pylorogastric intussusception. Vet Med Small Anim Clin 1983;78:677–680. lesion with concentric rings extending into the lumen of the 8. de Brito Galvao JF, Johnson SE, Sherding RG, Baan M, Ball RL, Ben- stomach as well as gastric wall thickening. Amotz R. Endoscopic diagnosis of a pylorogastric intussusception with In humans, abdominal CT is the test of choice for evaluating spontaneous resolution. J Am Anim Hosp Assoc 2011;47:e156–e161. 9. Applewhite AA, Cornell KK, Selcer BA. Diagnosis and treatment of gastrogastric intussusceptions (4,6,14,19–21). In our case, CT intussusceptions in dogs. Compend Contin Educ Pract Vet 2002;24: was performed post-mortem and contrast could therefore not 110–127. be administered; however, it is unlikely that the gastric changes 10. Lewis DD EG. Intussusception in dogs and cats. Compend Contin Educ Pract Vet 1987;9:523–532. were significantly affected as all findings across modalities and 11. Wilson GP, Burt JK. Intussusception in the dog and cat: A review of necropsy were in agreement. Computed tomography was useful 45 cases. J Am Vet Med Assoc 1974;164:515–518. in confirming the exact diagnosis, but the recommendation for 12. Allman DA,Pastori MP. Duodenogastric intussusception with concurrent gastric foreign body in a dog: A case report and literature review. J Am surgery was based on the radiographic and sonographic findings. Anim Hosp Assoc 2013;49:64–69. The necropsy findings of edematous gastric mucosa and hem- 13. Lideo L, Mutinelli F, Milan R. Pylorogastric intussusception in a orrhage are consistent with what has been previously reported Chihuahua puppy. A case report. J Ultrasound 2010;13:175–178. 14. Levien AS, Baines SJ. Histological examination of the intestine from during laparotomy and endoscopy in humans; gastric wall edema dogs and cats with intussusception. J Small Anim Pract 2011;52: was likely secondary to compromised venous and lymphatic 599–606. return (5,8,10,12). Hookworms found within the distal small 15. Huml R, Konde LJ, Sellon RK, Forrest LJ. Gastrogastric intussusception in a dog. Vet Radiol Ultrasound 1992;33:150–153. and large intestine in our patient may have been incidental but 16. Choi J, Keh S, Kim T, Jang J, Kim H, Yoon J. Ultrasonographic find- may have been a contributing factor to the intussusception. ings of pylorogastric intussusceptions in two dogs. J Vet Sci 2012;13: To the authors’ knowledge, this is the first report in which 215–217. 17. Rallis TS, Papazoglou LG, Adamama-Moraitou KK, Prassinos NN. a true gastrogastric intussusception was diagnosed in a canine Acute enteritis or gastroenteritis in young dogs as a predisposing factor patient ante-mortem. This is also the sole report describing the for intestinal intussusception: A retrospective study. J Vet Med A Physiol pathology and associated changes using 3 diagnostic imaging Pathol Clin Med 2000;47:507–511. 18. Sharma A GR, Holladay S. First report of a persistent mid-gastric intus- modalities. Although extremely rare, gastrogastric intussuscep- susception in the dog. Jacobs Journal of Anatomy and Physiology. 2015. tion can occur in dogs and should be considered as a differential Available from: https://pdfs.semanticscholar.org/0a6e/9f9a7eabe4264f4 diagnosis for any patient presenting with acute vomiting, abdomi- ae10d65b10bb242bd2fb7.pdf Last accessed May 8, 2020. 19. Vikram R, McCulloch AS, Zealley IA. True gastrogastric intussuscep- nal pain, dehydration, or tachycardia in combination with the tion: A rare radiologic diagnosis with surgical correlation. AJR Am J diagnostic imaging findings described in this report. CVJ Roentgenol 2006;186:585–586. 20. Karegowda LH, Rajagopal K, Shastry P, Deevi HK. Imaging appearance of malignancy associated gastrogastric intussusception in an elderly References woman. BMJ Case Rep 2018;2018. . 1 Applewhite AA, Cornell KK, Selcer BA. Pylorogastric intussusception 21. Behrooz A, Cleasby M. Gastrogastric intussusception in adults: A case in the dog: A case report and literature review. J Am Anim Hosp Assoc report with review of the literature. BJR Case Rep 2018;4:20180006. 2001;37:238–243. 22. Eom BW, Ryu KW, Lee JH, et al. Gastrogastric intussusception sec- 2. Grundy A, Rayter Z, Shorthouse AJ. Gastrogastric intussuscepting ondary to a gastric carcinoma: Report of a case. Surg Today 2011;41: leiomyomas. Gastrointest Radiol 1984;9:319–321. 1424–1427.

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The outcome for feline non-hypersecretory thyroid carcinoma after thyroidectomy

Alberto Oramas, Sarah Boston, Vincent Wavreille

Abstract — A 14-year-old neutered male cat was presented because of a left ventral cervical mass. Based on imaging, the mass was suspected to have a thyroid origin. There was no evidence of gross metastatic disease or hyperthyroidism. Left thyroidectomy alone was the treatment for this patient and a thyroid carcinoma was diagnosed on histopathology. At last follow-up, 831 days after surgery, there was suspicion of metastasis to the lungs and the cat had developed a right thyroid mass and hyperthyroidism. Key clinical message: This case report identifies a non-hypersecretory thyroid carcinoma. This is a rare diagnosis. The outcome with surgery alone was comparable to that reported for treatment with iodine131.

Résumé — Issue à la suite d’une thyroïdectomie pour un carcinome thyroïdien non-hypersecréteur félin. Un chat mâle castré âgé de 14 ans fut présenté concernant une masse ventro-cervicale gauche. Basé sur l’imagerie, la masse était suspectée être d’origine thyroïdienne. Il n’y avait pas d’évidence macroscopique de métastases ou d’hyperthyroïdisme. Une thyroïdectomie gauche fut l’unique traitement pour ce patient et un carcinome thyroïdien fut diagnostiqué lors de l’examen histopathologique. Lors de la dernière visite de suivi, 831 jours après la chirurgie, il y avait un doute de métastases aux poumons et le chat avait développé une masse thyroïdienne droite et de l’hyperthyroïdisme. Message clinique clé : Ce rapport de cas identifie un carcinome thyroïdien non-hypersecrétoire. Il s’agit d’une condition rarement diagnostiquée. L’issue à la suite de seulement une chirurgie était comparable à ce qui est rapporté pour un traitement avec de l’iode131. (Traduit par Dr Serge Messier) Can Vet J 2020;61:719–723

ats with thyroid masses typically have functional adeno- adenoma and carcinoma in cats (4–8). The metastatic rate for C mas and are presented with hyperthyroidism (1–3). In thyroid carcinoma in cats is as high as 71%. Thyroid carcinoma 1 retrospective study that evaluated the histopathologic find- most frequently metastasizes to regional lymph nodes (4,7). ings of thyroid masses in 101 cats, adenomatous hyperplasia Most often thyroid carcinomas in cats are functional; rarely was diagnosed in 96% of the cases (1). It is rare that cats with are they non-hypersecretory (NHS) (7–9). The first report of hyperthyroidism will have a malignant tumor and thyroid car- NHS thyroid carcinoma involved 1 cat in a retrospective study cinoma made up 3% of the cases in that study (1). Radioactive of thyroid carcinoma in 14 cats (7). Thyroidectomy, I131, and iodine (I131) is often the recommended treatment for thyroid external radiotherapy with cobalt-60 was the reported treatment for that case (7). Unfortunately, the survival time for that patient was not stated; however, the overall median survival time University of Florida Ringgold standard institution — ECC, (MST) for the 14 thyroid carcinomas in that study was 270 d. 2015 SW 16th Ave, Gainesville, Florida 32610, USA (Oramas); Guptil et al (8) also described a single case of NHS thyroid VCA Canada, 404 Veterinary Emergency & Referral — Surgical carcinoma in a study of 7 cats with thyroid carcinoma treated Oncology, 510 Harry Walker Parkway South, Newmarket, with high-dose I131 after thyroidectomy. The MST in that study Ontario L3Y 0B3 (Boston); The Ohio State University, College was 615 d, but again, the survival time of the 1 cat with NHS of Veterinary Medicine — Department of Veterinary Clinical thyroid carcinoma was not reported. An NHS thyroid carcinoma Sciences, Columbus, Ohio, USA (Wavreille) was mentioned in a retrospective study performed by Hibbert Address all correspondence to Dr. Alberto Oramas; e-mail: et al (9) in 8 cats. The cat was first treated with thyroidectomy, [email protected] and then with I131, after 6 mo regrowth was noted, and surgical Use of this article is limited to a single copy for personal study. resection of the deep musculature in this region was performed. Anyone interested in obtaining reprints should contact the The survival time for that cat was 428 d. CVMA office ([email protected]) for additional Thyroid carcinoma is a rare diagnosis in cats, with NHS thy- copies or permission to use this material elsewhere. roid carcinoma being even more rare. There are 3 cases of this

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Figure 1. A — Left lateral thoracic radiograph. A cranial mediastinal mass is noted, the mass (arrow) is soft tissue opaque and not well-circumscribed. B — Ventrodorsal thoracic radiograph. A cranial mediastinal soft tissue opacity (arrow) is noted in the same region previously described in the lateral view.

syndrome in cats in the veterinary literature, all of which were gravity was 1.021 with glycosuria (5.5 mmol/L) and moderate treated with a combination of surgery, I131, and external beam hematuria. The hematuria was suspected to be due to the cysto- radiation therapy. We present an atypical case of a thyroid mass centesis, the glycosuria was not further investigated but was not in a cat that was both non-secretory and a thyroid carcinoma noted in future or previous urinalyses. and was treated effectively with surgery alone. Three-view thoracic radiographs showed a possible cranial mediastinal mass (Figures 1A, B). An abdominal ultrasound Case description showed a heterogeneous nodular pancreas; a 5.1 3 10 mm A 14-year-old neutered male Tonkinese cat was presented to heterogeneous nodule dorsal to the splenic head and moderate the University of Florida Small Animal Teaching Hospital for bilateral pyelectasis. Ultrasound-guided aspirates of the nodule evaluation of a left, ventral, cervical mass near the thoracic inlet. adjacent to the spleen, thought to be splenic lymph node, were The mass was first noted as an incidental finding the previous consistent with extramedullary hematopoiesis. The liver aspirates month during a routine examination by the family veterinarian. had no cytological abnormalities, and aspirates of the pancreas At that time, the serum total and free thyroxine were within the were nondiagnostic. Cervical ultrasound showed a 3.1 3 1.9 cm reference range at 28.3 nmol/L [reference range (RR): 10.3 to cystic mass in the region of the left thyroid gland (Figure 2). 51.5 nmol/L], and 27 pmol/L (RR: 10 to 50 pmol/L), respec- Ultrasound-guided fine-needle aspirates of the cervical mass tively. At the time of presentation to our hospital, the cat had were consistent with cystic fluid with mildly atypical epithelium. an 3 cm subcutaneous, mobile, nonpainful mass in the area Differential diagnoses included thyroid or parathyroid neoplasm. of the left thyroid gland and was asymptomatic. Computed tomography (CT) of the head, neck, and thorax Complete blood (cell) count (CBC) was performed and was performed. The left ventral cervical mass was seen extending was considered clinically unremarkable or within the reference from the second cervical vertebra to the fifth vertebra. The mass intervals for the laboratory (Advia 120; Siemens Healthineers, was mildly heterogeneous and appeared to be well-circumscribed Malvern, Pennsylvania, USA). The serum biochemical profile with a differentiated capsule (Figures 3A, B, C). The previously revealed a mild hyperproteinemia (90 g/L) (RR: 62 to 81 g/L); observed pulmonary abnormalities described on thoracic radi- mild hyperglobulinemia (60 g/L) (RR: 3.4 to 5.3 g/L); mild ography were not observed in the CT study. Based on the CT, hypercreatininemia (274.0 mmol/L) (RR: 88.4 to 185.5 mmol/L); no evidence of gross metastatic disease was identified. and mild hypermagnesemia (1.06 mmol/L) (RR: 0.78 to Left thyroidectomy was recommended. The following day, the 0.9 mmol/L) (Dimension Xpand plus; Siemens Healthineers). patient was anesthetized using methadone (Mylan Institutional, Urine was obtained by cystocentesis for urinalysis. The specific Rockford, Illinois, USA), 0.48 mg/kg body weight (BW), IM,

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Figure 2. A well-vascularized, large, cystic mass is present in cervical ultrasound. The mass is well-circumscribed.

midazolam (Athenex, Schaumburg, Illinois, USA), 0.22 mg/kg BW, IV, and propofol (Zoetis, Kalamazoo, Michigan, USA), 5.5 mg/kg BW, IV. Anesthesia was maintained with isoflurane (Piramal Enterprises, Telangana, India) via endotracheal intuba- tion during surgery. The ventral neck was aseptically prepared for surgery. A standard ventral medial approach to the thyroid gland was used (Figure 4A). The mass was 3.7 3 2.0 3 1.9 cm and mobile, with evidence of neovascularization cranially and caudally (Figure 4B). The mass was bluntly dissected from the surrounding tissues using cotton swabs and bipolar electro- surgery for hemostasis. Vascular clips (Surgiclip; Medtronic, Minneapolis, Minnesota, USA) were used to manage the larger C vessels encountered at the cranial and caudal poles of the thyroid mass. A nodule (3 3 3 3 1.5 mm) that was grossly consistent with a lymph node in appearance was noted cranial to the mass and was removed. There were no complications during surgery and the cat recovered well from surgery and anesthesia. During and after surgery, the cat was treated with Lactated Ringer’s solution (Dechra Veterinary Products, Overland Park, Kansas, USA) IV at a maintenance rate. Buprenorphine (Par Pharmaceutical, Chestnut Ridge, New York, USA), 0.02 mg/kg BW, IV, q6h, was administered for pain management. The cat was discharged 1 d after surgery, with buprenorphine at the same dose to be given sublingually every 6 to 8 h for 5 to 7 d. Histopathology was consistent with thyroid carcinoma. The thyroid gland was largely replaced by tumor which consisted of solid sheets of cells forming nests, packets, and clumps. Occasionally, the cells from the follicles were filled with colloid. Figure 3. A — On the reconstructed sagittal view of the Cells were pleomorphic, round, and had prominent nuclei. computed tomography study the left ventral cervical mass Mitotic figures were approximately 1 per high-powered field extends from C3-C5 (arrow). The mass is heterogeneous, well-circumscribed with no obvious invasion of the surrounding (hpf). The mass was slightly invading the surrounding tissues in tissues. B — The transverse view of the computed tomography different areas, with 1 mm of normal tissue around the mass. study at the level of the 4th cervical vertebra. A large, ventral The sample was multifocally moderately obscured by streaming and left-sided cervical mass (arrow) is heterogeneous and hypoattenuating to surrounding soft tissues and muscles with a nuclear debris (Figure 5). The adjacent nodule was confirmed to rim of contrast enhancement. C — No cranial mediastinal mass be lymphatic tissue, with no evidence of metastasis. (arrow) is seen on the reconstructed dorsal plane CT image.

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Figure 4. A — Intraoperative image of the standard ventral cervical approach. B — Intraoperative image shows a well-vascularized left thyroid mass (arrow).

Figure 5. Histopathologic image of the thyroid mass, there are Figure 6. The transverse view of thoracic computed tomography solid sheets of cells forming nests, packets, and clumps with study. There is a well-defined, soft-tissue attenuating mass occasional follicles present. measuring 1.5 mm in diameter in the caudodorsal aspect of the right caudal lung lobe.

The cat was monitored regularly at our hospital for possible At last follow-up, 831 d after surgery, the cat was presented recurrence or progression of distant disease at 1, 4, 8, and 15 mo to our hospital for a right-sided thyroid mass after a diagnosis after thyroidectomy. During those appointments a physical of hyperthyroidism by the family veterinarian. The serum examination, CBC, serum biochemistry, measurements of total total thyroxine was 82.4 nmol/L (RR: 10.3 to 51.5 nmol/L). thyroxine, 3-view thoracic radiographs, and ultrasound of the Computed tomography of the head, neck, and thorax was neck were performed. There was no evidence of distant metas- performed. The right thyroid gland was noted to be enlarged, tasis, or recurrence of the previous mediastinal structure noted measuring 16 3 5 3 9 mm. Associated with the left ventral in the first radiographs during the follow-up period and the cat subcutaneous tissue where the left thyroid mass was previously remained euthyroid. The mild hypercreatininemia persisted dur- excised, there was a mildly homogenously contrast-enhancing ing the follow-up appointment (203.0 to 229.8 mmol/L; RR: nodule measuring 9 3 5 3 4 mm; this nodule was surrounded 88.4 to 185.6 mmol/L), but the hyperglobulinemia resolved. by a hyperattenuating rim. On the study of the thorax, the

722 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY craniodorsal aspect of the right caudal lung lobe was noted that had recurred seemed to be well-demarcated. All options to have 2 oval, well-defined, contrast-enhancing structures for treatment were declined by the owner. measuring up to 3 mm in maximum dimension. Another well- In conclusion, based on this case report, thyroidectomy defined, soft tissue attenuating structure measuring 1.5 mm in alone can result in a good clinical outcome for NHS thyroid diameter was noted in the caudodorsal aspect of the same lung carcinoma. The survival time of this cat is comparable to what lobe (Figure 6). These pulmonary nodules were suspected to be is expected in dogs with thyroid carcinomas receiving the same REPORT CASE metastatic disease. type of treatment (10–12). NHS thyroid carcinoma is a pathol- A fine-needle aspirate of the left ventral cervical nodule was ogy that is amenable to thyroidectomy and should be treated as performed. The aspirate revealed neuroendocrine neoplastic cells a separate entity from hyperthyroid disease in feline patients. with a prominent proteinaceous background consistent with Chemotherapy could also be recommended to slow progression recurrence of the previously excised thyroid carcinoma. After of the disease but the lack of data proving its effectiveness makes the last follow-up, the owners decided for medical management it difficult to recommend this treatment (10). and did not pursue further treatment. Acknowledgment Discussion The authors thank the UF oncology, pathology, and radiol- This report describes a case of NHS thyroid carcinoma in a cat. ogy services and the Colorado State University Diagnostic There is limited information regarding the expected biological Laboratory for their assistance with this case. CVJ behavior of this tumor type, with only 3 cases in the veterinary literature. The 3 cats reported in the literature were treated with References thyroidectomy, radioiodine, or a combination of both (7–9). 1. Naan EC, Kirpensteijn J, Kooistra HS, Peters ME. Results of thyroidectomy in 101 cats with hyperthyroidism. Vet Surg 2006;35:287–293. The cat herein was still alive at last follow-up 831 d after 2. Flanders JA. Surgical options for the treatment of hyperthyroidism in surgery. The clinical behavior, staging, surgery, and progression the cat. J Feline Med Surg 1999;1:127–134. of the disease in this case seem to be comparable to that seen 3. Peterson ME. Feline hyperthyroidism: An animal model for toxic nodular goiter. J Endocrinol 2014;223:T97–T114. in dogs with a noninvasive thyroid carcinoma, treated by uni- 4. Barber L. Thyroid tumors in dogs and cats. Vet Clin North Am Small lateral extracapsular thyroidectomy (2,4,6). It is unclear if the Anim Pract 2007;37:755–773. development of hyperthyroidism was related to recurrence of the 5. Scott-Moncrieff JC. Thyroid disorders in the geriatric veterinary patient. Vet Clin North Am Small Anim Pract 2012;42:707–725. previous NHS thyroid carcinoma or if it was the product of a 6. Feeney DA, Anderson KL. Nuclear imaging and radiation therapy in de novo functional adenoma in the right thyroid gland. Further canine and feline thyroid disease. Vet Clin North Am Small Anim Pract biopsies and scintigraphy might have been useful to differentiate 2007;37:799–821. 7. Turrel JM, Feldman EC, Nelson RW, Cain GR. Thyroid carcinoma between the 2 possibilities. The owner of this patient declined causing hyperthyroidism in cats: 14 cases (1981–1986). J Am Vet Med further diagnostics or treatment. Assoc 1988;193:359–364. Based on the lack of evidence of metastasis to the adjacent 8. Guptill L, Scott-Moncrieff CR, Janovitz EB, Blevins WE, Yohn SE, DeNicola DB. Response to high-dose radioactive iodine administration lymph node or lungs and the fact that histologically the tumor in cats with thyroid carcinoma that had previously undergone surgery. appeared to be low-grade (1 mitotic figure per hpf, non-vascular J Am Vet Med Assoc 1995;207:1055–1058. invasion, and the lack of metastatic disease at presentation), 9. Hibbert A, Gruyffydd-Jones T, Barrett E, Day MJ, Harvey AM. Feline thyroid carcinoma: Diagnosis and response to high-dose radioactive chemotherapy was not recommended in this case. The mass iodine treatment. J Feline Med Surg 2009;11:116–124. was well-encapsulated and grossly was removed completely 10. Nadeau ME, Kitchell BE. Evaluation of the use of chemotherapy and other prognostic variables for surgically excised canine thyroid with marginal excision, so external beam radiotherapy and/or carcinoma with and without metastasis. Can Vet J 2011;52:994–998. 131 I were not recommended. The information gathered in the 11. Liptak JM. Canine thyroid carcinoma. Clin Tech Small Anim Pract last follow-up showed evidence of recurrence and metastatic 2007;22:75–81. 131 12. Klein MK, Powers BE, Withrow SJ, et al. Treatment of thyroid carci- disease. At this point I and chemotherapy were recommended noma in dogs by surgical resection alone: 20 cases (1981–1989). J Am in order to prolong survival, and as potential treatment for the Vet Med Assoc 1995;206:1007–1009. hyperthyroidism. Surgery was also recommended as the mass

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Septic fibrinous pericarditis in 4 horses in Saskatchewan following an outbreak of forest tent caterpillars in 2017

Ronan J.J. Chapuis, Valentina M. Ragno, Cristian A. Ariza, Ahmad R. Movasseghi, Soraya Sayi, Fabienne D. Uehlinger, Julia B. Montgomery

Abstract — In the summer of 2017, 4 horses were diagnosed with septic fibrinous pericarditis at the Western College of Veterinary Medicine, Saskatoon. This case series occurred after a significant outbreak of forest tent caterpillars (Malacosoma disstria) in the province during that spring. Three horses were immediately euthanized, and treatment was attempted in 1 mare. This is the first case series of pericarditis possibly associated with the ingestion of forest tent caterpillars to be reported in western Canada. Although cause-effect is not proven, it is prudent to prevent the ingestion of caterpillars by horses. Key clinical message: Septic fibrinous pericarditis, a rare condition in horses, has previously been linked to outbreaks of eastern tent caterpillars. A similar link might exist in this case series.

Résumé — Péricardites fibrineuses septiques chez quatre chevaux saskatchewanais consécutive à une infestation de chenilles de livrée des forêts en 2017. Au cours de l’été 2017, quatre chevaux ont été diagnostiqués avec une péricardite fibrineuse septique au Western College of Veterinary Medicine de Saskatoon. Ces cas ont été présentés après une sévère infestation printanière de chenilles de livrée de forêts (Malacosoma disstria) dans la province de la Saskatchewan, reportée au printemps. Trois chevaux ont été immédiatement euthanasiés et une jument a été hospitalisée pour traitement. Ceci est le premier rapport décrivant la possible association entre des cas de péricardite chez des chevaux et l’ingestion de chenilles de livrée de forêts dans l’Ouest canadien. Même si le lien de cause à effet n’est pas prouvé, il est prudent d’éviter l’ingestion de ces chenilles processionnaires par les chevaux. Message clinique clé : La péricardite fibrineuse septique, une condition rare chez les chevaux, a précédemment été liée à des flambées de livrées des forêts. Un lien similaire pourrait exister dans la présente série de cas. (Traduit par les auteurs) Can Vet J 2020;61:724–730

Case descriptions infested by forest tent caterpillars within the past 2 springs. n the spring of 2017, Saskatchewan experienced an outbreak It was suspected that they ingested caterpillars as previously I of forest tent caterpillars (Malacosoma disstria) (1). That reported (2). summer, 4 horses from Saskatchewan were presented to the Western College of Veterinary Medicine (WCVM), University Case 1 of Saskatchewan, and were diagnosed with right-sided conges- A 3-year-old Quarter Horse stallion was referred at the end of tive heart failure due to septic fibrinous pericarditis. All horses June for evaluation of suspected pleuropneumonia of 11 days’ were housed on pasture with other apparently healthy horses. duration. He had been bought as a yearling and had not received According to the owners, all 4 horses had their environment any vaccines since he was purchased but was dewormed that

Clinical Sciences, Ross University School of Veterinary Medicine, PO Box 334, Basseterre, St. Kitts, West Indies (Chapuis); Large Animal Clinical Sciences (Chapuis, Ragno, Ariza, Uehlinger, Montgomery) and Prairie Diagnostic Services (Sayi), Western College of Veterinary Medicine, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4; Washington State University, College of Veterinary Medicine, Veterinary Teaching Hospital, 205 Ott Road Pullman, Washington 99164-7060, USA (Ariza); Charles River Laboratories, 445 Boulevard Armand-Frappier, Laval, Quebec H7V 4B3 (Movasseghi). Address all correspondence to Dr. Ronan J.J. Chapuis; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

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spring (unknown product). No previous medical history was Table 1. Clinical findings obtained at presentation of 4 horses with septic fibrinous pericarditis referred to the Western College reported. The horse was initially treated by the referring veteri- of Veterinary Medicine, University of Saskatchewan, between June narian for lethargy and fever with 5 d of penicillin switched to and September 2017, following an environmental infestation with ceftiofur and phenylbutazone (unknown products and dosages) forest tent caterpillars. Abnormalities are highlighted in bold. until the day before presentation when the horse was deteriorat- Case 1 Case 2 Case 3 Case 4 Normal values

ing, developing ventral edema, signs of respiratory difficulty, REPORT CASE Rectal temperature and colic. On presentation, muffled heart sounds led to the °C 38.1 38.8 38.7 36.4 37.2 to 38.5 suspicion of pericardial effusion; the jugular vein distension, °F 100.5 101.8 101.6 97.5 98.9 to 101.3 weak peripheral pulse, and pitting edema led to the suspicion Heart rate/pulse 68a 76 60a 52a 26 to 44 of right-sided constrictive cardiomyopathy. These cardiovascular (beats/min) abnormalities suggested right-sided congestive heart failure. The Respiratory rate 36 34 28 20 8 to 16 abnormalities of the respiratory system associated with decreased (breaths/min) lung field auscultation led to the suspicion of pleural effusion a The heart rate/pulse was assessed by palpation of the facial artery because heart (Tables 1 and 2), which could also have contributed to muffle sounds were not audible on auscultation. the heart sounds. Ultrasonographic examination was consistent with tri-cavitary effusion (pericardial, pleural, and peritoneal) collected following euthanasia and analysis was consistent with with fibrinous pericarditis (Figure 1). Results from venous blood suppurative inflammation. Culture of this sample was negative, gas, electrolytes and L-lactate, were overall unremarkable. The contrary to the post-mortem sample (Table 3). horse was euthanized due to financial constraints and grave prognosis. Case 3 An 18-year-old Appaloosa mare was presented in early July for Case 2 evaluation of lethargy and acute diarrhea. She had been with the An 8-year-old Quarter Horse gelding was presented 3 d after current owner since she was 2 y old, not up-to-date on vaccina- Case 1, for evaluation of lethargy, ongoing for a week. The horse tions but had been regularly dewormed (unknown protocol). had been owned for 3 y with no previous medical history, was She previously was presented in early June for lethargy and colic up-to-date on vaccinations (unknown product) and dewormed of undetermined cause. She had been managed symptomatically with ivermectin paste in the spring and fall. Sheath edema was but had never fully recovered. noticed a few days before presentation; the horse started to pass On presentation, the mare had lost body condition (BCS loose manure and ventral edema appeared the day of presenta- from 5 to 4/9) since the previous visit. On physical examination, tion. Penicillin (unknown dosage and time of administration) right-sided congestive heart failure and pleural effusion were sus- was administered by the owner. On presentation, right-sided pected (Tables 1 and 2). Thoracic ultrasound suggested fibrinous congestive heart failure was suspected (Tables 1 and 2). Thoracic effusive pericarditis (Figure 1) and pleural effusion. Abdominal ultrasound was consistent with pleural effusion and fibrinous ultrasound revealed ascites and colonic edema suspected to be effusive pericarditis (Figure 1). Abdominal ultrasound revealed secondary to portal hypertension. Despite a poor to grave prog- ascites and suggested edema of the mesentery. Venous blood gas nosis, the owner pursued further work-up and treatment. Blood was overall unremarkable except for electrolyte abnormalities, analysis (venous blood gas, biochemistry, and CBC) results were confirmed on the biochemistry panel, including hyponatremia comparable to Case 2. Cardiac troponin was 11 ng/L (RR: 0 to [119.5 mmol/L; reference range (RR): 132 to 142 mmol/L], 60 ng/mL). Ultrasound-guided pericardiocentesis was performed and hypochloremia (81 mmol/L; RR: 92 to 103 mmol/L). before initiation of antimicrobial therapy and revealed septic On biochemistry, the other relevant abnormalities included suppurative inflammation (Table 3). low total calcium (2.26 mmol/L; RR: 2.39 to 3.38 mmol/L), The mare received intravenous fluids including lactated hyperphosphatemia (1.93 mmol/L; RR: 0.53 to 1.19 mmol/L), Ringer’s solution (Baxter Corporation, Mississauga, Ontario) and hypoproteinemia due to hypoalbuminemia (17 g/L; RR: 27 and 0.9% saline, started at maintenance rate [2 mL/kg body to 36 g/L). These findings were consistent with third space weight (BW) per hour] and adapted based on hydration status. syndrome or free water excess attributed to hypotension sec- Deficits were not addressed aggressively to avoid fluid overload, ondary to congestive heart failure. Low total with normal ion- worsening edema, and third space losses. Broad spectrum anti- ized calcium was due to hypoalbuminemia, attributed to the microbials included sodium penicillin G (Penicillin G for injec- combination of either free water excess, protein loss in the tion; Fresenius Kabi Canada, Toronto, Ontario), 22 000 IU/kg effusion, and/or decreased synthesis due to chronic inflamma- BW, IV, q6h, and gentamicin (Gentocin; Intervet Canada, tion. Complete blood (cell) count (CBC) revealed leukocy- Kirkland, Quebec), 6.6 mg/kg BW, IV, q24h. Therapeutic drug tosis (17.8 3 109/L; RR: 5.1 to 11.0 3 109/L), neutrophilia monitoring was submitted for gentamicin on day 4. Gentamicin (14.7 3 109/L; RR: 1.8 to 8.0 3 109/L) with regenerative left concentrations were 18.1 mg/mL 1 h and 3.9 mg/mL 8 h after shift (bands of 0.5 3 109/L; RR: 0.0 3 109/L) and monocytosis administration, resulting in a gentamicin concentration less than (0.7 3 109/L; RR: 0.0 to 0.4 3 109/L), consistent with chronic 2 mg/mL about 11 h after administration, which is desirable to active inflammation. Abdominal fluid analysis suggested non- avoid nephrotoxicity. The target peak of 8 to 10 times the mini- septic neutrophilic inflammation. The horse was euthanized due mum inhibitory concentration was also reached: 2 mg/mL was to financial constraints and grave prognosis. Pericardial fluid was considered for the isolate of Actinobacillus (Table 3), reported

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Table 2. Problem list following the physical examination of 4 horses with septic fibrinous pericarditis referred to the Western College of Veterinary Medicine, University of Saskatchewan, between June and September 2017, following an environmental infestation with forest tent caterpillars. Case 1 Case 2 Case 3 Case 4 General condition Loss of body condition Body condition score 4/9 Loss of body condition Lethargy Lethargy Lethargy, anorexia Lethargy, anorexia Hyperthermia Hyperthermia Hyperthermia Colic Cardiovascular system Tachycardia Tachycardia Tachycardia Tachycardia Muffled heart sounds Muffled heart sounds Muffled heart sounds Muffled heart sounds Weak peripheral pulse Weak peripheral pulse Jugular vein distension Jugular vein distension Jugular vein distension Jugular vein distension

RAPPORTCAS DE Retrograde jugular pulse Retrograde jugular pulse Retrograde jugular pulse Ventral pitting edema Ventral pitting edema Ventral pitting edema Ventral pitting edema Congested gingival mucous Congested gingival mucous membranes membranes Respiratory system Tachypnea Tachypnea Tachypnea Tachypnea Nostril flaring Nostril flaring Nostril flaring Dull thoracic percussion Dull thoracic percussion Decreased lung field Decreased lung field Decreased lung field auscultation auscultation auscultation Pain reaction at palpation Abdominal expiratory effort of intercostal spaces Gastrointestinal system Loose stool Soft stool Diarrhea Soft stool Hypermotile borborygmi Decreased borborygmi

(0.9% saline, 2 L, on day 2) and intrapericardial antimicrobial infusions (10 million IU penicillin G and 1 g gentamicin, twice on day 3) were performed. Stall side analysis (total solids, lactate) of the recovered pericardial fluid suggested response to treatment. Twelve hours after the second antimicrobial instillation, no fluid could be recovered. Either the drain was plugged by the accumulation of fibrin or there was not enough fluid accumulation to be drained; the drain was left in place for monitoring. No pericardial fluid had accumulated over 24 h, therefore, the drain was removed. Subsequent ultrasound examinations during hospitalization revealed no significant accumulation of Figure 1. Right parasternal long-axis 4-chamber pericardial fluid. echocardiographic view of an 18-year-old Appaloosa mare On day 3, the mare showed respiratory distress. Arterial blood (Case 3) diagnosed with fibrinous pericarditis. Dorsal is to the right. Villonodular fibrin (*) was adhering to the epicardium and gas analysis revealed hypoxemia (PO2: 61.0 mmHg) and hyper- visceral layer of pericardium, moderate pericardial effusion (ff) capnia (PCO2: 50.7 mmHg). Intranasal oxygen therapy was was present. RA — right atrium; LA — left atrium; RV — right administered (5 L/min). A thoracic drain (24G French trocar ventricle; LV — left ventricle. catheter; Argyle, Covidien) connected to a Heimlich valve was placed under ultrasound guidance. The same IV fluid plan as for susceptible to gentamicin. An anti-inflammatory drug (Flunixin the placement of the pericardial drain was used. Fifty liters of injection; Norbrook Laboratories, Newry, Northern Ireland), fluid were drained from the thoracic cavity. Thoracic ultrasound 1.1 mg/kg BW, IV, q12h, was administered. The fever sub- revealed bilateral resolution of the effusion. Stall side analysis sequently subsided and the respiratory rate normalized at the (total solids, lactate) of the fluid recovered suggested less severe following physical examination 1 h later. inflammation compared with the pericardial fluid. The sample On day 2, a pericardial drain (24G French trocar catheter, for cytology was lost during processing. Respiratory parameters length 40 cm; Argyle, Covidien, Mansfield, Massachusetts, USA) returned to the normal range and oxygen therapy was discon- attached to a 3-way valve was placed under ultrasound guidance tinued. Fluid was drained for 3 d; when it stopped, the drain and concurrent electrocardiogram monitoring (Televet 100; was clamped and removed 6 h after the absence of further fluid Kruuse, Marlev, Denmark). Sixteen liters of fluid were drained. accumulation. During the procedure, hypertonic saline (7.2% saline, 4 mL/kg The mare returned to normal mentation and appetite. Fecal BW) and colloids (6% hydroxyethyl starch, Voluven; Fresenius consistency normalized. Abdominal ultrasound revealed resolu- Kabi Canada, Toronto, Ontario), 5 mL/kg BW, were admin- tion of ascites and suggested resolution of colonic edema. Blood istered and the rate of IV polyionic fluid was increased (4 to analysis suggested a response to treatment. Rebreathing exami- 5 mL/kg BW per hour). Jugular distension and retrograde pulse nation was performed to confirm the absence of an underlying resolved, and arterial pulse strength improved. Pericardial lavages respiratory disease.

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Table 3. Bacterial culture results from 4 horses with septic fibrinous pericarditis referred to the Western College of Veterinary Medicine, University of Saskatchewan, between June and September 2017, following an environmental infestation with forest tent caterpillars. Sample Bacteria isolated Case 1 Necropsy: Liver, lung, pericardium Enterococcus faecalis, Escherichia coli

Case 2 On presentation: Pericardiocentesis Negative REPORT CASE Necropsy: Liver, pericardium Escherichia coli Necropsy: Pericardium Actinobacillus suis Case 3 On presentation: Pericardiocentesis Actinobacillus suis, Actinobacillus equuli Necropsy: pericardial and pleural fluid Negative (post treatment with antimicrobials) Case 4 On presentation: Pericardiocentesis following euthanasia Negative Necropsy: Pericardium Actinobacillus suis, Escherichia coli

Due to financial constraints, the mare was discharged on hypercreatinemia (146 mmol/L; RR: 52 to 126 mmol/L), day 8. She was switched to phenylbutazone (Phenylbutazone hypoalbuminemia (21 g/L), and hyperglobulinemia (51 g/L; tablets 1000 mg; Dominion Veterinary Laboratories, Winnipeg, RR: 26 to 41 g/L). Prerenal azotemia was suspected due to Manitoba), 2.2 mg/kg BW, PO, q12h, and trimethoprim/ decreased renal perfusion secondary to congestive heart failure. sulfamethoxazole (Apo-Sulfatrim-DS; Apotex, Toronto, Hyperglobulinemia was attributed to antigenic stimulation Ontario), 30 mg/kg BW, PO, q12h, based on the susceptibility from chronic inflammation. A CBC showed mild neutrophilia results. Vitamin E (3000E Vitamin E; Dominion Veterinary (9.1 3 109/L) with regenerative left shift (bands of 0.2 3 109/L) Laboratories), 6000 IU PO, q24h, was initiated for its poten- consistent with mild inflammation. The mare was euthanized tial myocardial antioxidant properties and pentoxifylline based on a poor to grave prognosis. (Pentoxifylline SR; AA Pharma, Toronto, Ontario), 10 mg/kg BW, PO, q12h, was administered for its potential inhibitor effect Necropsy findings of extracellular matrix proliferation which might decrease the Postmortem examination indicated severe fibrinous pericarditis incidence of constrictive pericarditis as previously reported (3). and epicarditis with large amounts of pericardial effusion in Even though these treatments have no proven efficacy, they were all 4 cases (Figure 2). The pericarditis was classified as septic included for additional support in the context of the premature based on bacteriology results with evidence of bacteremia in discharge of the horse from the hospital, at the owner’s request. Cases 1 and 2 (Table 3). There were variable amounts of thoracic Follow-up included weekly physical examinations, CBC, and and abdominal effusions in all affected horses. Histopathology ultrasound examination. Eleven days after discharge, the mare revealed severe diffuse fibrinous pericarditis, granulation tis- had tachycardia, muffled heart sounds, jugular distension with sue formation, and variable fibroplasia in all cases. There were retrograde pulses, coughing, thoracic and pericardial effusions, multifocal to coalescing foci of eosinophilic, lymphohistiocytic suggestive of a relapse of right-sided congestive heart failure. inflammation in the colon in 2 horses. Refractile yellowish Euthanasia was elected. Cytology of pericardial fluid showed no brown foreign material was noted in the center of a few lesions evidence of inflammation and pleural fluid suggested mild septic in Case 2, which raised the suspicion of involvement of tent inflammation. Based on the necropsy findings and the negative caterpillar setae (Figure 3). culture of the fluid samples (Table 3), the relapse was attributed to the accumulation of fibrin on the epicardium which had Farm follow-up likely caused a constrictive cardiomyopathy. None of the pen mates of Cases 2 and 3 had abnormalities on echocardiography. Two years later, all remaining horses were Case 4 reported to be healthy. A 15-year-old Quarter Horse mare was referred in late September for evaluation of persistent lethargy of approximately 3 weeks’ Discussion duration. She had developed anorexia, mild colic, teeth grinding, Congestive heart failure is a rare condition in horses and has and increased respiratory effort during the 3 d before referral. a grave prognosis. The most common cause is valvular dis- She had been owned for 7 y and had no previous health concerns ease. Other causes include congenital disease, myocarditis, or other than suspected pituitary pars intermedia dysfunction. She pericarditis, which have a low prevalence (4). Three forms of was not up-to-date on vaccinations and had been last dewormed pericarditis are reported including effusive, fibrinous, and con- the week before presentation (unknown product). strictive (5). The effusive form lacks the presence of fibrin in the On presentation, right-sided congestive heart failure was pericardial space and the constrictive form includes fibrosis of suspected (Tables 1 and 2). Ultrasonographic examination the pericardium (5), which was lacking in this case series. The revealed tri-cavitary effusion with fibrinous pericarditis such present cases were all classified as septic fibrinous pericarditis. as that found in Case 3 (Figure 1). Arterial blood gas analysis Pericarditis is most often idiopathic (5–9). Identified causes

revealed hypoxemia (PO2: 72.9 mmHg) and hyponatremia. of pericarditis include immune-mediated conditions (5,6,10), Other significant abnormalities on biochemistry panel included which may be associated with viral disease (11), neoplasia

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A B C Figure 2. Post-mortem examination of the left side of the thorax from horses diagnosed with fibrinous pericarditis. Cranial is to the left. The pericardia have been opened and thick fibrinous material adhere to the epicardium. A — 3-year-old Quarter Horse. B — 8-year-old Quarter Horse. C — 18-year-old Appaloosa.

200 mm A B 50.0 mm Figure 3. Eosinophilic lymphohistiocytic colitis with the cross section of a birefringent material from an 8-year-old Quarter Horse diagnosed with fibrinous pericarditis. B: is the zoom of the red square from picture A, arrow is the material.

(12–14), trauma including external trauma and foreign body It is still unclear if the ingestion of tent caterpillars induces an (15,16), or vessel rupture (3). Bacterial infections (11,17–22) immune reaction due to an antigen or a toxin from the setae (3), are reported and can be associated with mare reproductive loss or facilitates a direct hematologic spread of bacteria secondary syndrome (MRLS) (3,23–25). to bacterial translocation from setae penetration through the The ingestion of eastern tent caterpillars (Malocosoma colonic wall (29). A syndrome similar to MRLS, associated with americanum) was associated with MRLS in Kentucky, Ohio, the ingestion of processionary caterpillars (Ochrogaster lunifer), Indiana, Illinois, West Virginia, and Tennessee in 2001 and has been described in Australia and named equine amnionitis 2002 (23,26,27). The syndrome has been reproduced experi- and fetal loss (EAFL) (30). This syndrome differs from MRLS mentally (27,28). The main bacteria recovered from tissues by the period of abortion, the predominant bacteria isolated, following abortion were non-hemolytic streptococci and actino- and the absence of reported cases of pericarditis and uveitis. bacilli which constitute part of the normal gastrointestinal flora Therefore, it seems possible that pathogenicity can differ with of horses (28). Escherichia coli and Enterococcus spp. were also the different species of caterpillars. An increased rate of abor- isolated in some cases, but seemed less frequent (28). Fibrinous tions was not recognized in Saskatchewan during the forest tent pericarditis was associated with some cases of MRLS (24). Other caterpillar outbreak in 2017. This may have several explanations. conditions associated with MRLS include unilateral uveitis and First, the forest tent caterpillars may not be able to induce abor- rare cases of Actinobacillus meningoencephalitis (23). However, tion in mares. Second, the breeding season period is delayed even if MRLS and pericarditis shared the same risk factor of in Saskatchewan compared to the United States and Australia caterpillar ingestion, a different pathophysiologic mechanism because of the long winters and short daylight hours. In MRLS, between the 2 conditions cannot be excluded (24). the window of abortions has been suggested to be between

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40 to 120 d of pregnancy (27). Therefore, it is possible that the The main support for a possible association between the exposure of pregnant mares to caterpillars in Saskatchewan was 2017 forest tent caterpillar outbreak in Saskatchewan and the at a different time of the gestational period than the potential occurrence of several cases of fibrinous pericarditis includes window of abortion. Third, a breed factor cannot be excluded as the exposure to forest tent caterpillars, the number of cases of most of the horses in Saskatchewan are Quarter Horse-related, this rare condition presented only in 2017 (since 1996), the

whereas in Kentucky and Australia the breeds involved in the homogeneity of the clinical signs, and pathological findings. The REPORT CASE 2 syndromes were Thoroughbred-related. Finally, it is probable presence of granulomatous colitis was reported in experimental that abortions were simply not reported by owners and/or horses models of mares fed eastern tent caterpillars (2) and procession- suffering from abortion, pericarditis, or uveitis were not referred ary caterpillars (34). In these reports, setae were also found on to our hospital. histology of the intestinal walls. They had a similar appearance The clinical signs and clinicopathological abnormalities to the birefringent material described in the histology of Case 2. reported with pericarditis associated with MRLS are overall simi- However, this foreign body could not be further analyzed, and lar to the case series presented (3). The main difference is that all other types of foreign bodies could not be ruled out. of the cases here were diagnosed with a septic process, whereas In previous reports, pericarditis was successfully treated 67% of the cases of pericarditis reported in 2001 had sterile in 67% to 70% of cases (9). Only the owner of the horse in pericardial effusion (3). When septic effusions were present, Case 3 elected to pursue treatment. The mare relapsed follow- Actinobacillus equuli, Streptococcus spp., Pasteurella multocida, ing initial response to treatment, but post-mortem examination Staphylococcus aureus, Pseudomonas spp., or Acinetobacter spp. suggested that the initial treatment had successfully resolved were isolated (3). In another report, 40% of the pericarditis the pericardial infection. The relapse was attributed to the associated with caterpillar ingestion yielded predominantly mechanical constrictive effect from the fibrin accumulated on Actinobacillus spp., but also E. coli and Enterococcus faecalis the epicardium. Further treatment options could have included (25). In addition, Cases 2 and 4 highlighted the fact that some fibrinolytic agents (streptokinase, tissue plasminogen activator), pericarditis can be falsely classified as idiopathic when solely corticosteroids, heparin, and hyaluronic acid (3). These were not pericardiocentesis is used for analysis. This previously lead some initiated due to the cost of such treatments. authors to recommend more invasive diagnostic tests such as To the authors’ knowledge, this is the first report of a sus- pericardial or myocardial biopsy to decrease the number of false pected association between an outbreak of forest tent caterpillars diagnoses of idiopathic cases (31). In human medicine, recom- and equine fibrinous pericarditis in western Canada. Based on mendations for diagnostic tests include physical examination, the information available, it seems prudent to avoid, as much blood analysis, imaging and, electrocardiography, followed by as possible, the exposure and accidental ingestion of caterpillars analysis of fluid from pericardiocentesis. Biopsy should only by horses. Interestingly, in Kentucky, co-grazing with cattle has be considered in suspected cases of tuberculosis and neoplasia been reported as being protective (24). Some pesticides are also when previous tests did not reach a final diagnosis; it has a lower effective in controlling the infestation of eastern tent caterpillars recommendation status then the first tests listed (32). (35). This report can serve as a starting point for prospective Outbreaks of forest tent caterpillars are unpredictable and epidemiologic research on pathology caused by forest tent cat- lack periodicity in Saskatchewan compared to the outbreaks in erpillars in horses or for a clinical trial. eastern Canada (33). Records from the last 20 y at the WCVM were reviewed by the authors to investigate the frequency of Acknowledgments pericarditis diagnosed at our hospital. Horses were included if Case 3 was presented by Gillian Davies (WCVM class of 2020), they presented signs of heart failure or if they were diagnosed supervised by Drs. Ronan Chapuis and Julia Montgomery, with pericarditis on necropsy. From 1996 to 2018, 35 horses as part of a student case report competition on a French vet- were presented with signs of heart failure. Final diagnoses were erinary website. Ms. Davies received a student report award available for only 17 horses, and only the 4 horses presented in (www.vetofocus.com). CVJ this case series had a final diagnosis of fibrinous pericarditis. There is little information available about the severity of the References outbreak of caterpillars in 2017 compared with previous out- . 1 “They just keep coming”: Tent caterpillar invasion coats Sask. home breaks to confirm with certainty that the infestation was more in insects — and feces. CBC News (updated May 31, 2017). Available from: https://www.cbc.ca/news/canada/saskatchewan/tent-caterpillars- severe than usual. Based on Internet and social media searches, rm-dundurn-1.4139552 Last accessed April 9, 2020. the years 2016 and 2017 seemed to have a particular abundance 2. McDowell KJ, Webb BA, Williams NM, et al. Invited review: The of caterpillars compared to previous years (1). However, no role of caterpillars in mare reproductive loss syndrome: A model for environmental causes of abortion. J Anim Sci 2010;88:1379–1387. further conclusion can be drawn about an association between 3. Slovis N. Pericarditis: A clinical perspective during an epidemic of fibrin- the 2017 outbreak of forest tent caterpillars and this case series ous pericarditis in central Kentucky. Equine Vet Educ 2011;23:69–72. of pericarditis. It is also very likely that even if a real cause-effect 4. Davis JL, Gardner SY, Schwabenton B, Breuhaus BA. Congestive heart failure in horses: 14 cases (1984–2001). J Am Vet Med Assoc 2002;220: relationship existed, not all cases were referred to the WCVM. 1512–1515. Based on the economics of the horse industry in Saskatchewan, 5. Worth LT, Reef VB. Pericarditis in horses: 18 cases (1986–1995). J Am the severity of the clinical signs of heart failure and the poor Vet Med Assoc 1998;212:248–253. 6. Freestone JF, Thomas WP, Carlson GP, Brumbaugh GW. Idiopathic prognosis, it is likely that most horses, once diagnosed, are effusive pericarditis with tamponade in the horse. Equine Vet J 1987;19: euthanized on farm without a necropsy performed. 38–42.

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. 7 Malalana F, Bardell D, McKane S. Idiopathic aseptic pericardial effusion 24. Seahorn JL, Slovis NM, Reimer JM, Carey VJ, Donahue JG, Cohen with cardiac tamponade in a horse. Equine Vet J 2011;23:64–68. ND. Case-control study of factors associated with fibrinous pericarditis 8. Dill SG, Simoncini DC, Bolton GR, et al. Fibrinous pericarditis in the among horses in central Kentucky during spring 2001. J Am Vet Med horse. J Am Vet Med Assoc 1982;180:266–271. Assoc 2003;223:832–838. 9. Reimer J. Management of equine pericarditis. Equine Vet Educ 2013; 25. Bolin DC, Donahue JM, Vickers ML, et al. Microbiologic and patho- 25:334–338. logic findings in an epidemic of equine pericarditis. J Vet Diagn Invest 10. Robinson JA, Marr CM, Reef VB, Sweeney RW. Idiopathic, aseptic, 2005;17:38–44. effusive, fibrinous, nonconstrictive pericarditis with tamponade in a 26. Dwyer RM, Garber LP, Traub-Dargatz JL, et al. Case-control study of standardbred filly. J Am Vet Med Assoc 1992;201:1593–1598. factors associated with excessive proportions of early fetal losses associ- 11. Jesty SA, Reef VB. Septicemia and cardiovascular infections in horses. ated with mare reproductive loss syndrome in central Kentucky during Vet Clin North Am Equine Pract 2006;22:481–495. 2001. J Am Vet Med Assoc 2003;222:613–619. 12. Carnine BL, Schneider G, Cook JE, Leipold HW. Pericardial mesothe- 27. Bernard WV, LeBlanc MM, Webb BA, Stromberg AJ. Evaluation of early lioma in a horse. Vet Pathol 1977;14:513–515. fetal loss induced by gavage with eastern tent caterpillars in pregnant 13. Stoica G, Cohen N, Mendes O, Kim HT. Use of immunohistochemi- mares. J Am Vet Med Assoc 2004;225:717–721.

RAPPORTCAS DE cal marker calretinin in the diagnosis of a diffuse malignant metastatic 28. Webb BA, Barney WE, Dahlman DL, et al. Eastern tent caterpillars mesothelioma in an equine. J Vet Diagn Invest 2004;16:240–243. (Malacosoma americanum) cause mare reproductive loss syndrome. 14. Hargreaves L, Gosling L, Dixon JJ. Pericardial effusion and congestive J Insect Physiol 2004;50:185–193. heart failure in a horse with multicentric lymphoma. Vet Rec Case Rep 29. Donahue JM, Sells SF, Bolin DC. Classification of Actinobacillus spp. 2018;6:e000631. isolates from horses involved in mare reproductive loss syndrome. Am 15. Bertone JJ, Dill SG. Traumatic gastropericarditis in a horse. J Am Vet J Vet Res 2006;67:1426–1432. Med Assoc 1985;187:742–743. 30. Cawdell-Smith AJ, Todhunter KH, Perkins NR, Bryden WL. Exposure 16. Voros K, Felkai C, Szilagyi Z, Papp A. Two-dimensional echocardio- of mares to processionary caterpillars (Ochrogaster lunifer) in early graphically guided pericardiocentesis in a horse with traumatic pericar- pregnancy: An additional dimension to equine amnionitis and fetal ditis. J Am Vet Med Assoc 1991;198:1953–1956. loss. Equine Vet J 2013;45:755–760. 17. Benson CE, Sweeney CR. Isolation of Streptococcus pneumoniae type 3 31. Sage A. Fever: Endocarditis and pericarditis. In: Marr C, Bowen M, eds. from equine species. J Clin Microbiol 1984;20:1028–1030. Cardiology of the Horse. 2nd ed. Philadelphia, Pennsylvania: Saunders, 18. Perkins SL, Magdesian KG, Thomas WP, Spier SJ. Pericarditis and 2011:217–225. pleuritis caused by Corynebacterium pseudotuberculosis in a horse. J Am 32. Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the Vet Med Assoc 2004;224:1133–1138. diagnosis and management of pericardial diseases: The Task Force for 19. May KA, Cheramie HS, Howard RD, et al. Purulent pericarditis as the Diagnosis and Management of Pericardial Diseases of the European a sequela to clostridial myositis in a horse. Equine Vet J 2002;34: Society of Cardiology (ESC) Endorsed by: The European Association for 636–640. Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015;36:2921–2964. 20. Morley PS, Chirino-Trejo M, Petrie L, Krupka L, Schwab M. Pericarditis 33. Cooke BJ, Lorenzetti F. The dynamics of forest tent caterpillar outbreaks and pleuritis caused by Mycoplasma felis in a horse. Equine Vet J 1996; in Québec, Canada. Forest Ecol Manag 2006;226:110–121. 28:237–240. 34. Todhunter KH, Cawdell-Smith AJ, Bryden WL, Perkins NR, Begg AP. 21. Alcott C, Howard J, Wong D, Haynes J. Fibrinous pericarditis and Processionary caterpillar setae and equine fetal loss: 1. Histopathology of cardiac tamponade in a 3-week-old pony foal. Equine Vet Educ experimentally exposed pregnant mares. Vet Pathol 2014;51:1117–1130. 2013;25:328–333. 35. Potter DA, Foss L, Baumler RE, Held DW. Managing Eastern tent 22. Armstrong SK, Raidal SL, Hughes KJ. Fibrinous pericarditis and peri- caterpillars Malacosoma americanum (F) on horse farms to reduce risk cardial effusion in three neonatal foals. Aust Vet J 2014;92:392–399. of mare reproductive loss syndrome. Pest Manag Sci 2005;61:3–15. 23. Sebastian MM, Bernard WV, Riddle TW, Latimer CR, Fitzgerald TD, Harrison LR. REVIEW paper: Mare reproductive loss syndrome. Vet Pathol 2008;45:710–722.

730 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY Case Report Rapport de cas

Acute hyperkalemia as anesthetic complication in a diabetic dog undergoing tumor excision

Chiara Hampton, Jon Fletcher, Mika Fitzgerald, R. Avery Bennett

Abstract — A mixed-breed dog with a history of diabetes mellitus underwent surgical removal of multiple colonic adenocarcinomas. The dog acutely developed electrocardiographic changes compatible with hyperkalemia during manipulation of the tumors, which was confirmed and treated. Although it was not possible to confirm clinical tumor lysis syndrome in this dog, the hyperkalemia and resultant arrhythmia that occurred during tumor manipulation were suggestive of acute tumor lysis syndrome. Key clinical message: Hyperkalemia is a serious anesthetic and intraoperative complication that should be considered in dogs undergoing solid tumor resection due to the potential risk of developing acute tumor lysis syndrome. Diabetic patients may also be at increased risk of developing hyperkalemia. Both the potassium concentration and ECG should be routinely monitored during these procedures.

Résumé — Hyperkaliémie aiguë comme complication lors de l’anesthésie d’un chien diabétique subissant une excision tumorale. Un chien de race croisée avec une historique de diabète mellitus a subi une chirurgie pour retirer de multiples adénocarcinomes coloniques. Le chien développa de manière aiguë des changements électrocardiographiques compatibles avec une hyperkaliémie durant la manipulation des tumeurs, ce qui fut confirmé et traité. Bien qu’il ne soit pas possible de confirmer un syndrome clinique de lyse des tumeurs chez ce chien, l’hyperkaliémie et l’arythmie qui en résulta durant la manipulation des tumeurs étaient suggestives du syndrome aigu de lyse des tumeurs. Message clinique clé : L’hyperkaliémie est une complication sérieuse lors de l’anesthésie et de la chirurgie qui devrait être considérée chez les chiens subissant la résection d’une tumeur solide dû au risque potentiel de développer le syndrome aigu de lyse des tumeurs. Les patients diabétiques pourraient également présenter un risque plus grand de développer une hyperkaliémie. La concentration de potassium et l’ECG devraient être surveillés de routine durant ces procédures. (Traduit par Dr Serge Messier) Can Vet J 2020;61:731–736

Case description were performed, as well as colonoscopy under general anesthesia. n 11-year-old, 11.7 kg (BCS 8/9) neutered male, mixed Two adjacent, pale pink, irregular, ulcerated masses occlud- A breed dog was presented to the Louisiana State University ing approximately 80% of the colonic lumen were identified Veterinary Teaching Hospital for evaluation of chronic tenes- approximately 12 cm orad to the anus. Histopathology of mus and hematochezia of 1-year duration. The dog had a the endoscopic biopsies was consistent with colonic adeno- 2-year history of diabetes mellitus controlled with twice daily carcinoma. The computed tomography (LightSpeed 16 slice SC administration of 10 IU of NPH insulin [0.85 IU/kg body CT Scanner; GE Healthcare, Waukesha, Wisconsin, USA) weight (BW); Novolin N, Novo Nordisk, West Princeton, scan for surgical planning revealed 2 masses measuring New Jersey, USA]. Complete blood (cell) count (CBC), chem- 2.8 3 0.6 3 2 cm, and 1.1 3 0.6 3 0.6 cm. The anesthetic istry panel, thoracic radiographs, and abdominal ultrasound episode and recovery were uneventful with the exception of

Louisiana State University School of Veterinary Medicine Ringgold standard institution — Skip Bertman Drive #2313, Baton Rouge, Louisiana 70803, USA. Address all correspondence to Dr. Chiara Hampton; 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 61 / JULY 2020 731 FOR PERSONAL USE ONLY RAPPORTCAS DE Figure 1. Pre-anesthetic lead II electrocardiogram tracing showing sinus rhythm at a rate of 149 bpm (paper speed = 25 mm/s; 1 mV = 10 mm).

Figure 2. Lead II ECG tracing showing bradycardia, sinus arrest, and atrial standstill (Paper speed = 25 mm/s; 1 mV = 10 mm) at the moment of surgical manipulation. Serum K1 = 6.2 mmol/L.

hyperglycemia noted after premedication (19.7 mmol/L; refer- Pennsylvania, USA) was administered by IV infusion at a rate of ence interval: 4.4 to 6.4 mmol/L) and during maintenance of 5 mL/kg BW/h. A multiparameter monitor (VetTrends V Vital anesthesia (28.0 mmol/L), which was treated with SC adminis- Signs Monitor; VetTrends, Tampa, Florida, USA) was used to tration of 5 IU of regular insulin (Novolin R; Novo Nordisk). monitor heart rate and rhythm, hemoglobin oxygen saturation,

Preanesthetic evaluation the day before surgery was unremark- pulse rate, end-tidal partial pressure of CO2, and direct blood able with the exception of mild elevation in body temperature pressure monitoring. A veterinary-specific glucometer (Alpha (rectal temperature: 39.3°C), hyperglycemia (14.4 mmol/L), Trak 2; Zoetis, Kalamazoo, Michigan, USA) validated for use and mildly increased alkaline phosphatase [ALP; 276 U/L, in dogs was used to monitor peripheral blood glucose every reference range (RR): 23 to 212 U/L]. Food was withheld for 30 min. Cefoxitin (Cefoxitin for injection USP; West-Ward approximately 8 h before induction of anesthesia. The patient Pharmaceuticals, Eatontown, New Jersey, USA), 30.8 mg/kg had access to water ad libitum before anesthesia. On the morn- BW, IV, was administered every 90 min over a 10-minute ing of surgery, the blood glucose was 14.4 mmol/L and the dog period beginning right after induction. Mechanical ventila- received 5 IU (0.4 IU/kg BW) of NPH insulin (Novolin N, tion (Model 2002 Pro Anesthesia Ventilator; Hallowell EMC, Novo Nordisk) by SC injection. A lead II ECG tracing per- Pittsfield, Maryland, USA) was initiated (tidal volume 200 mL,

formed as part of the routine pre-anesthetic evaluation prior to peak inspiratory pressure 14 cm H2O, I:E ratio 1:2.5, and premedication revealed sinus rhythm with a rate of 163 beats/ respiratory rate 10 breaths/min) to target end-tidal CO2 value min (bpm) (Figure 1). between 35 and 45 mmHg. A dobutamine (Hospira) CRI was The anesthetic plan included premedication with mor- initiated at 5 mg/kg BW/min, IV to correct hypotension (mean phine (Morphine Sulfate; Hospira, Lake Forest, Illinois, USA), arterial pressure 56 mmHg) once the patient was in the operat- 0.5 mg/kg BW, IM, induction with ketamine (Ketamine hydro- ing room. Cardiac rhythm was confirmed to be sinus on lead II. chloride; Hospira), 0.3 mg/kg BW, IV, followed by propo- A ventral midline celiotomy approach was elected for this fol (Gensia Sicor, Irvine, California, USA), 4.1 mg/kg BW, case. A physiologic response to nociception which included IV, maintenance with isoflurane (Fluriso; Vet One, Boise, purposeful movement of the head, increase in heart rate, and Idaho, USA) delivered via circle system in 98% to 99% oxygen increase in mean arterial pressure was observed when the titrated to effect (range of vaporizer setting 0.8% to 2.1%; peritoneum was incised. Propofol (0.85 mg/kg BW, IV) was range of fresh gas flow 1 to 2 L/min), a constant rate infusion administered and purposeful movement ceased. Fentanyl (CRI) of ketamine (10 mg/kg BW/min, IV) and a lumbosacral (Hospira), 5 mg/kg BW, IV and lidocaine (Hospira), 2 mg/kg epidural injection (morphine; 0.1 mg/kg BW; bupivacaine BW, IV loading doses followed by CRI (fentanyl, 15 mg/kg 0.5%; 0.5 mg/kg BW; total volume administered 1.3 mL). BW/h, IV; lidocaine, 50 mg/kg BW/min, IV) were adminis- Correct placement of the tip of the insulated spinal needle tered over a 5-minute period along with an increase in ket- was confirmed via electrostimulation (motor movement of the amine CRI to 20 mg/kg BW/min to provide additional anti- tail and pelvic limbs at 0.3 mA). Lactated Ringer’s solution nociception and sparing effect on isoflurane requirements. (LRS) (Lactated Ringers Inj. USP; Braun Medical, Bethlehem, Two units (0.17 IU/kg BW) of regular insulin (Novolin R; Novo

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Table 1. Parameters from blood gas analysis during atrial 36 min after the onset of ECG changes consistent with hyper- standstill (11:15 AM) and after treatment of hyperkalemia and resolution of atrial standstill (11:40 AM). kalemia (Table 1). The remainder of the surgery and anesthetic period were 11:40 AM uncomplicated, and the patient was extubated 60 min after (after treatment 11:15 AM and resolution Reference discontinuation of isoflurane. Fentanyl, lidocaine, and ketamine a b Parameters (during AS ) of AS) range CRI doses were decreased during recovery (5 mg/kg BW/h, REPORT CASE pH 7.328 7.384 7.36 to 7.46 25 mg/kg BW/min, and 2 mg/kg BW/min, respectively), and

PaCO2 (mmHg) 41.7 34.4 35 to 41 continued during the postoperative period. The heart rate and PaO (mmHg) 334.8 252.2 89 to 104 2 rhythm were monitored via telemetry in the intensive care unit HCO 2 (mmol/L) 21.9 20.5 20 to 25 3 and remained within normal limits as did the plasma electro- cSO2 (%) 99.9 99.9 90 to 100 Na1 (mmol/L) 141 145 140 to 151 lyte concentrations during the subsequent 24 h (measured 2 Cl (mmol/L) 110 113 106 to 127 every 6 h). The patient began receiving maintenance insulin K1 (mmol/L) 6.2 4.3 3.5 to 5 Ca11 (mmol/L) 1.2 1.29 1.13 to 1.42 therapy and was discharged from the hospital 3 d after surgery. Glucose (mmol/L) . 38.8 29.5 3.5 to 6.9 Histopathology confirmed the diagnosis of colonic adenocar- Lactate (mmol/L) 2.61 2.43 0.6 to 3 cinoma with metastasis to the caudal mesenteric lymph nodes. Creatinine (mmol/L) 54.8 50.4 35.4 to 132.6 HCT (%) 41 42 36 to 55 cHb (g/L) 140 141 120 to 190 Discussion 2 2 2 1 BE (mmol/L) 4.1 4.5 5 to 5 Potassium is the major intracellular cation (140 mmol/L) and Anion gap (mmol/L) 15 16 5 to 22 is only present in small quantities in the extracellular fluid ASa — Atrial standstill. b As provided by manufacturer for this species (Heska, Loveland, Colorado, USA). (approximately 4 mmol/L) (2). Homeostasis of potassium in the body is maintained by 3 main mechanisms: i) enteral or parenteral potassium intake; ii) extracellular-intracellular transloca- Nordisk) were administered by SC injection due to progressive tion; and iii) renal potassium excretion. Enteral potassium intake hyperglycemia (30.7 mmol/L). The administration of a second is provided by the diet, whereas parenteral potassium typically dose of cefoxitin over 10 min coincided with initial manipula- comes from the administration of potassium-containing crys- tion of the colon and colonic masses which were adhered to talloid solutions and the addition of potassium salts (i.e., KCl,

the urinary bladder and peritoneum. During this time, brady- KPO4) to these solutions. Internal homeostasis is maintained cardia (average heart rate 29 bpm; range: 16 to 75 bpm) with by mechanisms that tightly regulate the potassium concentra- progressive loss of P-waves and tenting of T-waves was noted tion, such as movement into and out of the intracellular and on lead II of the ECG tracing (Figure 2) without changes in extracellular compartments and endogenous insulin secretion mean arterial pressure. Administration of cefoxitin was dis- and b-adrenergic activation by epinephrine which increases continued and a tentative diagnosis of sinus arrest and atrial the activity of the Na-K-ATPase pump. About 90% to 95% of standstill was made based on the electrocardiographic wave- the extracellular potassium is excreted by the kidney, while the form. Glycopyrrolate (Glycopyrrolate injection, USP; Amneal remainder is secreted passively by the small intestine and actively Pharmaceuticals, Bridgewater, New Jersey, USA), 6.8 mg/kg secreted by the colon through Na-K-ATPase activity (3). BW, IV, was administered and arterial blood sample analysis Hyperkalemia is defined as an increased concentration of (Element Point of Care Rapid Blood Analyzer; Heska, Loveland, potassium in the extracellular compartment and can develop due Colorado, USA) revealed a mild organic acidosis (pH: 7.328, to alterations in the aforementioned homeostatic mechanisms. lactate 2.61 mmol/L; RR: 7.35 to 7.45, and 0.6 to 3 mmol/L, Although electrocardiographic alterations have been observed respectively), hyperglycemia (. 38.8 mmol/L), and hyperkale- in healthy dogs with experimentally induced hyperkalemia mia (6.2 mmol/L; RR: 3.5 to 5 mmol/L) (Table 1). Ventilatory greater than 5.5 mmol/L, they are not consistently observed in settings were changed to temporarily induce respiratory alkalosis patients with naturally occurring hyperkalemia at similar plasma and 10 IU (0.85 IU/kg BW) of regular insulin were admin- potassium concentrations (4). The plasma potassium concentra- istered IV in an attempt to resolve the hyperkalemia. The tion of the patient (6.2 mmol/L) presented in this case report dobutamine infusion was momentarily discontinued to allow is not commonly associated with arrhythmias in the clinical for administration of 10% calcium chloride (18.8 mg/kg BW, setting. In fact, atrial standstill was not observed in dogs with IV, over a 30-minute period), as some sources have reported experimentally induced hyperkalemia until plasma potassium incompatibility of these 2 solutions if administered in the same concentrations exceeded 8.5 mmol/L (5) and in ill cats until line (1). Concomitantly, a bolus of LRS (10 mL/kg BW, IV) was concentrations exceeded 9 mmol/L (6). It is possible that the administered over 10 min to promote excretion of potassium patient’s low-normal calcium concentration (1.2 mmol/L; in the urine. The heart rate increased to 79 bpm with persis- RR: 1.2 to 1.5 mmol/L) during the hyperkalemic episode content atrial standstill and sinus arrest (Figure 3). Subsequently, tributed to the patient’s cardiotoxic sensitivity to hyperkalemia. P-waves reappeared, the T-wave amplitude decreased, and the Although the ability of hypocalcemia to enhance the cardiotoxic heart rate increased to 114 bpm maintaining a mean arterial effects of potassium remains a debated phenomenon (7), calcium pressure of 90 mmHg. Lead II ECG tracing showed sinus tachy- is known to antagonize the effects of hyperkalemia on the cell cardia at a rate of 145 bpm (Figure 4), and the blood gas analysis membrane so a reduction in the calcium concentration could revealed a normal plasma potassium concentration (4.2 mmol/L) lead to less tolerance to increases in the potassium concentration.

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Figure 3. Lead II ECG tracing showing atrial standstill and sinus arrest (Paper speed = 25 mm/s; 1 mV = 10 mm) after initial treatment with glycopyrrolate, dobutamine, and hyperventilation. RAPPORTCAS DE

Figure 4. Lead II ECG tracing after successful treatment of acute hyperkalemia showing sinus tachycardia (Paper speed = 25 mm/s; 1 mV = 10 mm). Serum K1 = 4.2 mmol/L.

Commonly recognized causes of hyperkalemia in small ani- patients. Although there is no consensus on what constitutes mals during the perioperative period include administration of the best practice for the management of insulin therapy in the potassium-containing fluids, translocation of potassium from perioperative period, a clinically accepted practice is to fast the the intracellular to the extracellular compartment, malignant animal and administer half of the maintenance insulin dose hyperthermia, and decreased urinary excretion (e.g., acute before surger y (12). Insulin deficiency and hyperosmolarity can kidney injury) (2). Administration of fluids supplemented result in hyperkalemia by reducing the activity of the Na1-H1 with potassium chloride and decreased urinary excretion can antiporter which is needed for Na1-K1 ATPase activation and be excluded as this patient received LRS and did not show the movement of potassium into the cell (13) and via a phe- biochemical abnormalities consistent with acute kidney injury nomenon called “solvent drag” whereby potassium accompanies before, during, or after surgery. Furthermore, the maximum core water as it moves down a concentration gradient from the intra- body temperature before and during the anesthetic period was cellular to extracellular space. Diabetic patients typically have a 35.9°C. Therefore, we concluded that the acute hyperkalemia total body deficit of potassium which makes hypokalemia (43% was the result of translocation from the intracellular to the prevalence) more common than hyperkalemia (10% prevalence) extracellular compartment. in diabetic dogs (14). This patient received half of his mainte- Causes of potassium translocation in the surgical patient nance dose (5 IU; 0.4 IU/kg BW) of NPH insulin the morning include use of succinylcholine, extensive muscle dissec- of surgery and was moderately hyperglycemic (23.4 mmol/L) tion, severe acidosis, insulin deficiency, and tumor lysis syn- at the time of induction. Although marked hyperglycemia and drome (2,5). This patient did not receive succinylcholine and hyperkalemia were documented simultaneously, the patient had did not have extensive muscle dissection during the surgical pro- received NPH insulin (0.4 IU/kg BW) prior to surgery and a

cedure. Acidosis of mineral (e.g., NH4Cl and HCl) and respira- supplemental dose of regular insulin (0.17 IU/kg BW) prior tory (e.g., CO2), but not organic (e.g., lactic acid and ketoacids) to documentation of hyperkalemia which makes an absolute origin can cause changes in membrane stability due to shifting insulin deficiency unlikely. It is possible that insulin deficiency of potassium from the intracellular to the extracellular compart- and hyperosmolarity may have contributed to the hyperkale- ment in exchange for protons that will enter the cell to allow for mia in this patient but were unlikely to be the primary cause. buffering (2,7,8), as well as changes in membrane excitability Intravenous administration of regular insulin resulted in cor- due to the decreased availability of b-adrenergic receptors in rection of the hyperkalemia and a reduction in blood glucose nodal tissue (9). At the time of documented hyperkalemia, the concentration. Handling, storage, and administration issues were patient had only a mild organic acidosis (pH: 7.328, lactate excluded as possible causes of the lack of response to the SC dose 2.46 mmol/L, reference point , 2.5 mmol/L) and a negligible of insulin. The dose and route of administration (0.17 U/kg BW,

respiratory acidosis (PaCO2 41.7 mmHg, RR: 36 to 40 mmHg). SC) are likely the reason a detectable response was not observed. Since plasma potassium has been shown to increase by 0.16 to Although it is possible to see a response to subcutaneous regular 1.67 mmol/L per 0.1 unit decrease in pH (10), it is unlikely that insulin within 10 min of administration, it more commonly acidemia was the primary cause or contributed significantly to takes 30 min or more before a response is observed, and the the hyperkalemia in this patient. hyperkalemia and marked hyperglycemia were first documented Severe hyperglycemia is a frequent occurrence in diabetic 18 min after administration. patients undergoing general anesthesia and surgery, and it has Acute tumor lysis syndrome (ATLS) is a life-threatening been recently reported to be associated with life-threatening oncologic emergency characterized by the variable presence of hyperkalemia in a diabetic dog undergoing phacoemulsifica- hyperkalemia, hyperuricemia, lactic acidosis, hyperphosphatemia, tion (11). Anesthesia- and surgery-induced stress, alteration and hypocalcemia (15). Acute tumor lysis syndrome has been in patient’s insulin/feeding regimen, and use of drugs that can reported following induction chemotherapy for lymphoid neo- alter insulin and glucagon secretion (i.e., a-adrenergic ago- plasms (16) and other types of tumors in humans (17,18), and in nists) are the most common causes of hyperglycemia in these dogs with lymphoma (19). Intraoperative ATLS following surgical

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manipulation of solid tumors has also been reported in the human of lidocaine and bupivacaine used in this patient were inves- and veterinary medical literature (15,20,21). Although the patho- tigated and excluded. Opioid administration could also have physiology of this syndrome is unclear (22), ATLS is thought to been the cause of the bradyarrhythmia, although the concurrent occur due to a massive release of intracellular compounds such as hyperkalemia seems to be the most likely cause of the observed purines and electrolytes after damage to malignant cells. Since the atrial standstill.

renal excretory capacity is overwhelmed, metabolic and electrolyte Lastly, as reported in the case description, IV administration REPORT CASE disturbances are often the cause of death in patients suffering of cefoxitin was occurring at the same time that the ECG abnor- ATLS if these are not promptly recognized and treated (19). malities were observed and the tumor and colon were being Known risk factors for ATLS are high tumor burden, aggressive manipulated. It is important to recognize that this was the sec- cancerous behavior, high degree of necrosis, abdominal involve- ond dose of cefoxitin administered and that ECG abnormalities ment, and adhesions to other organ structures (15,19,23). In the did not occur during administration of the initial dose or with case presented here, multiple adhesions were found between the subsequent doses administered during the postoperative period. colon, urinary bladder, and peritoneum. It has been suggested that Therefore, we believe that the administration of cefoxitin and manipulation of the tumor during dissection may contribute to development of hyperkalemia were not associated. massive release of intracellular substances that translocate to the Intraoperative hyperkalemia is an established complication blood stream causing complications associated with ATLS (20). of ATLS in people associated with solid tumor removal. To our Interestingly, there are also reports of tumor lysis syndrome after knowledge, this is the second report of this type of complication the administration of chemotherapy for the treatment of colonic in the veterinary literature and the first in a dog with diabetes cancer in humans (24,25). mellitus as a potential confounding issue. Hyperkalemia is a Laboratory and clinical criteria used to classify tumor lysis serious anesthetic and intraoperative complication that should syndrome have been established in humans (26). Laboratory be considered in dogs undergoing resection of solid tumors, tumor lysis syndrome (LTLS) is defined as an increase in especially if the dogs are diabetic as they may be at increased plasma uric acid (. 476 mmol/L), potassium (. 6 mmol/L), risk of developing cardiotoxicity at a lower plasma potassium and phosphorus (. 1.45 mmol/L), and a decrease in calcium concentration. Given the inconsistency between ECG abnor- (, 1.75 mmol/L). These criteria also include a 25% or greater malities and the degree of hyperkalemia, both parameters should increase or decrease from baseline of these parameters. To meet be routinely monitored. The integration of the information the criteria for clinical tumor lysis syndrome (CTLS), a patient provided by these diagnostic tools best reflects the patient’s must have at least 2 criteria of LTLS and at least 1 of the fol- clinical picture and leads the clinician through the appropriate lowing signs: increase in creatine kinase greater than 1.5 times therapeutic intervention. CVJ the upper limit of the reference interval, a cardiac arrhythmia, seizure not attributable to administered medications, or sudden References death. Although it was not possible to confirm CTLS based . 1 Trissel LA. Pocket Guide to Injectable Drugs. Bethesda, Maryland: American Soc Health-System Pharmacists, 2011. on these criteria in the dog presented in this case report, the 2. Dibartola S, Morais AD. Disorders of potassium: Hypokalemia and hyperkalemia and resultant arrhythmia that occurred during hyperkalemia. In: DiBartola SP, ed. Fluid Therapy in Small Animal tumor manipulation met 2/3 of the criteria and were sugges- Practice. Philadelphia, Pennsylvania: WB Saunders 2011, 92–115. 3. Batlle D, Boobés K, Manjee KG. The colon as the potassium target: tive of CTLS. It is also worth noting that borderline hypocal- Entering the colonic age of hyperkalemia treatment? EBio Med 2015; cemia (1.2 mmol/L; RR: 1.2 to 1.5 mmol/L) was also present, 2:1562–1563. and we speculate would have progressed to overt hypocalcemia 4. Ettinger PO, Regan TJ, Oldewurtel HA. Hyperkalemia, cardiac con- duction, and the electrocardiogram: A review. Am Heart J 1974;88: if calcium chloride had not been administered. 360–371. The purpose of the treatments administered to this patient 5. Kogika MM. A quick reference on hyperkalemia. Vet Clin North Am was to induce a temporary increase in the rate of nodal depolar- Small Anim Pract 2017;47:223–228. 6. Tag TL, Day TK. Electrocardiographic assessment of hyperkalemia in ization (glycopyrrolate), stabilize the myocardial cell membrane dogs and cats. J Vet Emerg Crit Care 2008;18:61–67. (calcium chloride), and reduce the plasma potassium concentra- 7. Surawicz B. Relationship between electrocardiogram and electrolytes. tion by increasing translocation (insulin and dobutamine), and Am Heart J 1967;73:814–834. 8. Dreifus L, Pick A. A clinical correlative study of the electrocardiogram promoting urinary potassium excretion (IV fluid bolus), since in electrolyte imbalance. Circulation 1956;14:815–825. hyperkalemia should be treated if ECG changes are present 9. Adrogué HJ, Madias NE. Changes in plasma potassium concentration during acute acid-base disturbances. Am J Med 1981;71:456–467. regardless of the degree of hyperkalemia. Additional treatments 10. Rose B, Post T. Hypokalemia. Clinical Physiology of Acid-base and used in humans include the administration of allopurinol or Electrolyte Disorders. 5 ed. New York, New York: McGraw Hill, rasburicase and dialysis, with the goal being elimination of 2001:836–887. 11. Monticelli P, Dawson C, Adami C. Life-threatening hyperkalaemia in metabolic compounds such as calcium phosphate, purines, a diabetic dog undergoing anaesthesia for elective phacoemulsification. uric acid, and other waste products which are known to cause Vet Anaesth Analg 2018;45:881–882. nephropathy (27). The lidocaine CRI was not discontinued at 12. Fischer BL. Endocrine disease. In: Snyder LBC, Johnson RA, eds. Canine and Feline Anesthesia and Co-existing Disease. Hoboken, New the time of the hyperkalemic episode because local anesthetic Jersey: Wiley-Blackwell, 2014:151. toxicity was not suspected to be a cause of the observed ECG 13. DeFronzo RA, Felig P, Ferrannini E, Wahren J. Effect of graded doses changes. Local anesthetic toxicity could have contributed to of insulin on splanchnic and peripheral potassium metabolism in man. Am J Physiol Endocrinol Metab 1980;238:E421–E427. the observed ECG changes, although it is unlikely at the dose 14. Feldman EC. Nelson RW. Diabetes Mellitus. 2nd ed. Philadelphia, being administered. Furthermore, incorrect dosing and dilution Pennsylvania: WB Saunders, 1996.

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15. Lobe TE, Karkera MS, Custer MD, Shenefelt RE, Douglass EC. Fatal 22. Lee M, Cheng K, Jang R, Hsu J, Dai Z, Wu J. Tumour lysis syndrome refractory hyperkalemia due to tumor lysis during primary resection for developing during an operation. Anaesthesia 2007;62:85–87. hepatoblastoma. J Ped Surg 1990;25:249–250. 23. Del GT, Morris E, Cairo M. Tumor lysis syndrome: Pathophysiology, 16. Cohen LF, Balow JE, Magrath IT, Poplack DG, Ziegler JL. Acute tumor definition, and alternative treatment approaches. Clin Adv Hematol lysis syndrome: A review of 37 patients with Burkitt’s lymphoma. Am J Oncol 2005;3:54–61. Med 1980;68:486–491. 24. Tseng R-H, Wu C-H, Wu K-L, Lai G-M, Lin J-T. Tumor lysis syndrome 17. Stark ME, Dyer MC, Coonley CJ. Fatal acute tumor lysis syndrome in a patient with metastatic colon cancer after treatment with oxaliplatin with metastatic breast carcinoma. Cancer 1987;60:762–764. and 5-Fu. J Cancer Res Pract 2016;3:124–127. 18. Vogelzang NJ, Nelimark RA, Nath KA. Tumor lysis syndrome after 25. Agrawal A, Jain D, Morginstin M. Tumor lysis syndrome in metastatic induction chemotherapy of small-cell bronchogenic carcinoma. J Am colon cancer after single FOLFOX cycle. Intl J Case Reports Images Med Assoc 1983;249:513–514. 2016;7:445–448. 19. Vickery KR, Thamm DH. Successful treatment of acute tumor lysis 26. Coiffier B, Altman A, Pui C-H, Younes A, Cairo MS. Guidelines for the syndrome in a dog with multicentric lymphoma. J Vet Int Med management of pediatric and adult tumor lysis syndrome: An evidence- 2007;21:1401–1404. based review. J Clin Oncol 2008;26:2767–2778.

RAPPORTCAS DE 20. Chohan AS, Greene SA. Anesthesia case of the month. J Am Vet Med 27. Sallan S. Management of acute tumor lysis syndrome. Semin Oncol Assoc 2009;234:746–749. 2001;28:9–12. 21. Baeksgaard L, Sørensen J. Acute tumor lysis syndrome in solid tumors — A case report and review of the literature. Cancer Chemother Pharmacol 2003;51:187–192.

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736 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY Case Report Rapport de cas

Glucagon therapy in canines with an insulinoma: A retrospective descriptive study of 11 dogs

Megan E. Harris, Linda Weatherton, Christopher P. Bloch

Abstract — Canine insulinomas are uncommon neoplasms, which often result in refractory hypoglycemia. Glucagon is one readily available treatment for insulin-induced hypoglycemia. The primary objective of this study was to evaluate blood glucose trends and outcome (survival to discharge versus death or euthanasia) for dogs with insulinoma that were treated with glucagon. Secondary objectives included the description and influence of other variables such as abnormalities on diagnostic tests, physical examination abnormalities, concurrent administration of dextrose and/or glucocorticoids, and seizures. The median glucagon constant rate infusion dose was significantly higher for the non-survivors than for survivors. No other correlation was found between any of the independent variables evaluated when comparing blood glucose trends, length of hospitalization, and outcome. The main conclusion of the study is that glucagon therapy in insulinomas is an effective treatment to manage hypoglycemia.

Résumé — Thérapie au glucagon de chiens avec un insulinome : étude rétrospective descriptive de 11 chiens. Les insulinomes canins sont des néoplasmes peu fréquents, qui résultent souvent en hypoglycémie réfractaire. Le glucagon est un traitement facilement disponible pour l’hypoglycémie induite par l’insuline. L’objectif primaire de la présente étude était d’évaluer les tendances du glucose sanguin et l’issu (survie jusqu’au congé versus décès ou euthanasie) de chiens avec insulinome qui furent traités avec du glucagon. Les objectifs secondaires incluaient la description et l’influence d’autres variables telles que des anomalies lors des tests diagnostiques et des examens physiques, l’administration concomitante de dextrose et/ou de glucocorticoïdes, et des convulsions. La dose médiane de perfusion à taux constant de glucagon était significativement plus élevée pour les non-survivants que pour les survivants. Aucune autre corrélation ne fut trouvée entre l’une ou l’autre des variables indépendantes évaluées lors de comparaisons avec les tendances du glucose sanguin, la durée de l’hospitalisation, et l’issu. La principale conclusion de cette étude est que la thérapie au glucagon lors d’insulinomes est un traitement efficace pour gérer l’hypoglycémie. (Traduit par Dr Serge Messier) Can Vet J 2020;61:737–742

Introduction secrete glucagon (1). Beta cells account for 60% of the islet cells and secrete insulin (1). nsulinoma is a beta cell neoplasm of the pancreas that In healthy dogs, insulin secretion is inhibited once the blood results in insulin-induced hypoglycemia (1,2). The func- I glucose levels reach 4.44 mmol/L (3). Insulinomas secrete tion of the endocrine pancreas is to secrete hormones directly insulin independently from the circulating blood glucose levels into the circulation. The hormones originate from the Islets of and are relatively uncommon in dogs (1,2). Most canine insu- Langerhans, which contain 3 cell types: alpha, beta, and delta linomas are malignant, commonly spreading to regional lymph cells (1). Alpha cells account for 25% of total islet cells and nodes and the liver. Metastasis to the lung is rare (1,3). The average age in dogs with insulinomas is 9 y (1). Veterinary Emergency and Critical Care, 8650 W. Tropicana Insulinomas tend to occur in large breed dogs with golden Avenue, Ste b107, Las Vegas, Nevada 89147, USA (Harris, retrievers, Labrador retrievers, boxers, German shepherds, Irish Weatherton); Department of Biological Sciences, Bridgewater setters, standard poodles, and mixed breed dogs being over State University, Bridgewater, Massachusetts 02325, USA represented (1,4). Clinical signs are variable, but include weak- (Bloch). ness, collapse, ataxia, disorientation, and seizures (1). Clinical Address all correspondence to Dr. Megan Harris; e-mail: signs are associated with neuroglycopenia, as the central nervous [email protected] system uses glucose as its sole energy source (1). Use of this article is limited to a single copy for personal study. Suspicion of insulinoma is raised when a patient has fasting Anyone interested in obtaining reprints should contact the hypoglycemia (blood glucose , 3.33 mmol/L) with concurrent CVMA office ([email protected]) for additional hyperinsulinemia (. 138.9 nmol/L) (5). Complete blood (cell) copies or permission to use this material elsewhere. count (CBC), serum chemistry, and radiographic imaging are

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largely non-specific (1). The CBC is typically normal (6). In • additional therapies such as glucocorticoids and/or dextrose, addition to hypoglycemia, serum chemistry may show elevations histopathology or cytology (if available), in alkaline phosphatase (ALP) and alanine aminotransferase • length of hospitalization and outcome. (ALT) (6). Abdominal and thoracic radiographs often show Descriptive statistics were calculated for all clinical and labo- no significant abnormalities in the absence of metastasis (6). ratory data. Statistical analyses were conducted using SPSS v.24 Abdominal ultrasound has been shown to identify pancreatic software (IBM Statistics for Windows Version 24.0; IBM Corp, masses in less than 50% of cases (6). Other diagnostic tools Armonk, New York, USA). Binary logistic regression was used include advanced imaging such as computed tomography (CT), to assess the relationship of initial blood sugar, duration of time or magnetic resonance imaging (MRI) to identify a pancreatic on glucagon, highest glucagon CRI dose, elevations in ALP and nodule (3). ALT, and the presence of seizures on the likelihood of survival to Medical management of insulinomas is aimed at increasing discharge. Pearson’s product-moment correlation coefficient was RAPPORTCAS DE blood glucose levels and include the use of glucagon, gluco- used to test for an association between initial blood glucose and corticoids, and dextrose supplementation (2,4). Other medical time on a glucagon CRI as well as elevations in ALP and ALT interventions include treatment with diazoxide and strepto- and length of time on a glucagon CRI. Fisher’s exact test was zotocin (4). In an acute hypoglycemic crisis dextrose can be used to assess correlation between ALP and ALT and metastasis administered (1,6,7). However, a complication of administering to the liver. A least squares linear regression was used to assess dextrose is rebound release of insulin from the pancreas causing for a relationship between highest blood glucose concentration worsening hypoglycemia (6). and dose of glucagon. A Mann-Whitney U-test compared time Prognosis varies and depends on the clinical stage of the to euglycemia between patients that received dextrose and glu- disease, with higher stages of metastatic disease having a poorer cagon versus patients that just received glucagon. A P , 0.05 prognosis compared to patients without signs of metastatic was considered statistically significant. changes (6). Medical therapy alone is reported to result in a median survival time of 196 d (8). Almost 50% of dogs with Results metastatic changes typically succumb to the disease within A total of 13 dogs met the inclusion requirements. Two patients 6 mo (6). were excluded due to incomplete records. Of the remaining The primary objective of this study was to evaluate blood 11 patients, 6 were spayed females and 5 were castrated males. glucose trends and outcome (survival to discharge versus death The average age was 9.9 y (range: 7 to 13 y). Breeds represented or euthanasia) for insulinoma patients that were treated with included mixed breed dogs (n = 3), American pitbull (n = 2), glucagon. Secondary objectives included the description and and 1 each of bullmastiff, Boston terrier, Kerry blue terrier, influence of other variables such as concurrent administra- bichon frise, Labrador retriever, old English bulldog, and golden tion of dextrose and/or glucocorticoids, physical examination retriever. There was no gender or breed predilection. abnormalities, seizures, and abnormalities on diagnostic tests. The most common presenting complaints were seizures We hypothesized that administration of glucagon continuous (n = 7), weakness (n = 3) and referral for confirmed hypogly- rate infusion (CRI) would improve systemic blood glucose cemia (n = 2). Seizure activity was reported in 8/11 patients. concentration in the current patient population. All seizure activity had started within 72 h of presentation. A total of 7/11 patients had at least 1 seizure during treatment Materials and methods (range: 0 to 9 seizures). Seizures did not correlate with patient Electronic medical record databases of 2 veterinary referral spe- outcome (P . 0.21). cialty hospitals were used to search for medical records between All patients had normal heart rate, temperature, and respira- December 2011 and September 2017 which contained the tory rate on arrival (defined as heart rate 80 to140 beats/min, keywords glucagon, insulin:glucose (I:G) pair, and insulinoma. respiration rate 24 to 46 breaths/min, and rectal temperature Inclusion criteria were dogs with hypoglycemia (defined as a 37.6°C to 38.8°C). Abnormalities found on examination were blood glucose , 3.33 mmol/L), a recorded I:G pair consistent weakness (n = 5), a mammary mass (n = 1), and airway stertor with an insulinoma (defined as blood glucose , 3.33 mmol/L (n = 1). Examination was reported as normal in 3/11 patients. with concurrent hyperinsulinemia . 138.9 nmol/L) and treat- On presentation, no patients had active seizures nor were they ment with glucagon. The following data were collected from in the postictal period. medical records for patients that met the inclusion criteria: All patients had an I:G pair which was consistent with an • signalment, insulinoma (Table 1). The average serum insulin level was • presenting complaint(s), 638.04 pmol/L (reference range: 52.09 to 138.9 pmol/L; • presence of seizures, range: 354.2 to 1024.39 pmol/L). The average glucose mea- • examination findings, surement during submission of the I:G pair was 1.81 mmol/L • results of biochemical parameters, (range: 1.22 to 2.16 mmol/L) (Table 1). • I:G pair, Initial CBC and serum chemistry parameters were available • blood glucose concentrations (Accu-check glucometer; Roche for all patients. Complete blood (cell) count was within refer- Diagnostics, Indianapolis, Indiana, USA) prior to and during ence ranges for all patients. The most common abnormality on treatment, serum chemistry was hypoglycemia. The median presenting • doses of glucagon CRI, blood glucose concentration was 1.82 mmol/L (range: 1.27 to

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Table 1. Summary of blood glucose (BGt = 0) values on presentation, serum insulin values and insulin glucose pair results. Glucagon Duration of Insulin CRI starting administration

BGt = 0 values dose (ng/kg BGmax G B min of glucagon Patient (mmol/L) (pmol/L) BW/min) (mmol/L) (mmol/L) CRI (hours) Outcome CASE REPORT CASE 1 1.77 424.3 15 6.33 1.33 47 D 2 1.83 563.2 10 12.34 1.77 40 D 3 1.88 354.1 4.4 5.71 1.83 150 E 4 1.94 708.3 6.0 5.44 1.61 60 D 5 1.94 379.8 15 10.06 1.77 154 E 6 2.66 645.2 15 3.33 1.51 8 E 7 1.28 375.0 10.4 11.83 2.27 82 D 8 2.22 711.8 25 12.22 1.78 36 D 9 1.66 729.9 13.8 7.94 1.44 46 E 10 2.00 1024.3 10 8.83 2.28 64 D 11 1.55 972.3 9.4 9.16 1.44 84 D

BW — body weight; BGmax — highest blood glucose concentration recorded during glucagon administration; BGmin — lowest blood glucose concentration recorded during glucagon administration; CRI — constant rate infusion; E — euthanasia; D — survival to discharge.

2.67 mmol/L) detected by handheld glucometer. No significant , 3.33 mmol/L), while 10/11 patients experienced hyperglyce- association was found between the presenting blood glucose mia (defined as a blood glucose concentration . 6.67 mmol/L) reading and the likelihood of survival (P . 0.21). after initiation of glucagon CRI (average: 8.95 mmol/L, range: A total of 3/11 patients had elevated ALP (. 140 IU/L) 5.44 to 12.3 mmol/L). There was no significant linear associa- (median: 131 IU/L; range: 226 to 365 IU/L). There was no tion between highest recorded blood glucose reading and cor- correlation between elevated ALP and number of hours receiving responding glucagon CRI dose (P = 0.353). The mean length glucagon (P = 0.312). All 3 patients with elevated ALP had liver of time from initiation to euglycemia and highest blood glucose histopathology performed. No correlation was found between from initiation of the glucagon CRI was , 1 and 22 h, respec- the ALP and metastasis to the liver. Elevation in ALP did not tively. The average frequency of blood glucose monitoring was correlate with survival to discharge (P = 0.9). 1.8 h (range: 1 to 6 h). A total of 3/11 patients also had an elevated ALT (. 120 IU/L) The starting glucagon CRI average dose was 11.8 ng/kg body on initial serum chemistry (median: 105.5I U/L; range: 121 to weight (BW) per minute (range: 4.4 to 25 ng/kg BW per min- 336 IU/L). There was no correlation between elevated ALT and ute) and this dose did not correlate with survival to discharge number of hours receiving glucagon (P = 0.837). All 3 patients (P = 0.953). The median maximum rate of infusion of the glu- with elevated ALT had liver histopathology performed. Of those cagon CRI was 10 ng/kg BW per minute (range: 6 to 34 ng/kg patients, 2/3 had evidence of metastatic changes to the liver on BW per minute and was significantly higher for non-survivors histopathology. There was no correlation between elevated ALT (P = 0.042). The mean length of time on the glucagon CRI was and metastasis to the liver (P . 0.99). The ALT value also did 70.18 h (range: 9 to 150 h). There was no correlation between not correlate with survival to discharge (P = 0.63). duration of time on the glucagon CRI and outcome (P = 0.21) Thoracic radiographs were taken in 9/11 patients. Of A total of 4/11 patients had dextrose supplementation (range: those 9, 1 had an enlarged sternal lymph node and another had 2.5% to 5.0% solution) in addition to glucagon CRI. The a cranial thoracic mass. An abdominal ultrasound examination average blood glucose concentration of the patients which had was completed in 9/11 patients. Of those, 3 identified the a dextrose CRI at any time during their glucagon infusion was presence of a pancreatic nodule. Other abnormalities seen on 4.16 mmol/L, while for patients which never received dextrose ultrasound included enlarged lymph node, hepatomegaly, and during their glucagon infusion this value was 3.95 mmol/L. cystoliths (n = 1 each). There was no difference in the time to euglycemia (P . 0.99) Six patients underwent an exploratory laparotomy with or duration of glucagon CRI (P = 0.573) between those patients subsequent histopathology. All of the patients had pancreatic receiving glucagon alone versus those receiving glucagon and biopsies submitted and 4/6 included liver samples. One patient dextrose. had a fine-needle aspirate of the liver. All of the histopathol- Prednisone was administered to 7/11 patients. The average ogy or cytology results from liver and pancreatic samples were dose of prednisone administered was 0.91 mg/kg BW per day compatible with islet cell carcinoma (insulinoma). (0.3 to 2.0 mg/kg BW per day). There was no significant dif- All patients were placed on a glucagon CRI. The average ference between use of prednisone when comparing time to blood glucose concentration at the time of glucagon administra- euglycemia (P = 0.601) or dose of glucagon CRI (P = 0.573). tion was 2.36 mmol/L (range: 1.3 to 4.88 mmol/L). No correla- There was no significant difference between prednisone use tion was identified between initial blood glucose reading and and duration of glucagon infusion for groups which received duration of glucagon CRI (P = 0.716). The lowest blood glucose glucagon and dextrose supplementation (P = 0.601). reading after initiation of the glucagon CRI was 1.85 mmol/L The average number of days in hospital for all patients was (range: 1.33 to 2.77 mmol/L). All patients had at least 1 epi- 5.5. A total of 4/11 patients were euthanized. The reasons for sode of hypoglycemia (defined as blood glucose concentration euthanasia included post-surgical complications (1 with diabetes,

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1 with aspiration pneumonia), lack of response to treatment an insulinoma. All patients in the current study had an insulin (refractory hypoglycemia, n = 1), and identification of more level . 139 pmol/L. than 1 type of neoplasia (mammary mass, n = 1). No patients In this study, elevations in ALT and/or ALP (1,5,6) did not died of natural causes. No adverse reactions pertaining to glu- correlate with survival to discharge or length of time of glucagon cagon administration were noted for any patients. The average CRI. There are no studies with which to compare this finding. hospitalization time for survival versus non-survival groups was Unlike in the present study, a correlation between elevations in 4.71 d (range: 3 to 10 d) and 3.5 d (range: 1 to 6 d), respec- ALP and ALT with metastasis to the liver has been reported in tively. Hospitalization time between survivors and non-survivors 1 study (5). The most common areas of metastasis include the did not differ significantly (P = 0.222). regional lymph nodes and liver, with 46% to 75% having signs of metastatic changes seen on exploratory laparotomy (9,14). Discussion Metastatic spread can hinder gluconeogenesis and glycogenoly- RAPPORTCAS DE Glucagon infusion was successful in raising blood glucose con- sis (10,15). However, the duration and dose of glucagon CRI centrations in patients diagnosed with insulinoma. Consistent can be altered to maintain euglycemia. This was not found with other publications, the average age of patients herein was herein possibly due to the small sample size. 9.9 y and there was no breed or gender predilection (1,3,6,9). Radiographs are of limited diagnostic value for diagnosis The duration of clinical signs prior to diagnosis has been doc- of insulinomas (1,10). Beta cell secreting tumors typically are umented to be variable with ranges between 1 d and 3 y (3,6). In , 3 cm in diameter at the time of diagnosis, do not produce our study, clinical signs were reported to be more acute (typically a mass effect within the cranial abdomen, and rarely will within 72 h), possibly because some clinical signs of insulinomas cause pulmonary metastatic changes until much later in the are mild and gradual. Owners may rationalize initial symptoms disease course (1,10). No patients in this study had evidence as age-related. The most common presenting complaint in this of metastatic spread on thoracic radiographs but the sensitiv- study was the presence of new seizures, which has been docu- ity of radiographic detection of metastatic changes to visceral mented to occur in 63% of patients (1). Owners may perceive organs is only 18% (9). Therefore, patients in this study may the sudden onset of seizures as the only clinical sign, and there- have had metastatic spread that was not evident on radiographs. fore report a more acute onset of symptoms. Weakness was the No patients underwent advanced imaging such as CT or MRI. second most common presenting complaint which has also been In this patient population abdominal ultrasound may visu- noted to occur in up to 40% of patients (10). This exemplifies alize a mass(es) within the pancreas and also determine if the effects of hypoglycemia including neuroglycopenia and there are metastatic changes in other organs. Three of nine peripheral polyneuropathy (1,3,6). Interstitial brain glucose pancreatic nodules were identified on abdominal ultrasound. concentrations are 20% to 30% less than that of plasma, but the Ultrasonography for detection of insulinomas has reported low brain has 3 times the metabolic rate of peripheral tissues, mak- specificity, detecting insulinomas in 46% to 75% of cases (9). ing the central nervous system prone to hypoglycemia-induced Detection of pancreatic nodules was reported in only 5/13 and cellular damage (11). Initial clinical signs include weakness and 12/16 dogs in 2 prior studies (16,17). Limitations of transab- tremors (11). As hypoglycemia progresses to 1.0 mmol/L severe dominal ultrasound include user experience, patient body con- signs such as seizure activity, brain damage, and even death dition score, patient cooperation, and size of the tumor (1,5). occur (11). Compensatory pathways to increase peripheral blood Abdominal ultrasound is useful and a recommended diagnostic glucose levels occur by increasing endogenous levels of glucagon, tool to rule out other causes of hypoglycemia and can be used catecholamines, and cortisol with suppression of endogenous to determine if there is metastatic spread (1,10). insulin (11). Intracranial compensation arises from changes Glucagon is an insulin antagonistic hormone that causes an in cerebral blood flow and glucose delivery by upregulation of increase in blood glucose by increasing glycogenolysis, promot- glucose transporters (11). ing gluconeogenesis, increasing ketogenesis, increasing lipolysis, The peripheral polyneuropathy is possibly due to the effects and decreasing glycogenesis (2,5,18). Once in circulation, the of hyperinsulinemia on the peripheral nerves (1,10). Elevated peak plasma concentration of glucagon occurs within 20 min insulin levels prevent the nerves from utilizing fatty acids and of administration (19). Previous studies show that maximum amino acids as energy and make them reliant on glucose as the glucose levels occur within 40 to 80 min after glucagon admin- sole energy source (12). However, the extent of the peripheral istration (1,6). In the current study, euglycemia was achieved neuropathy and duration or severity of the hypoglycemia are in , 1 h after initiation of the glucagon CRI. not correlated (1,9,11). Side effects of glucagon infusion in humans include dizziness Diagnosis of an insulinoma can be established by an I:G and nausea. In a study in dogs, subcutaneous administration pair that shows hypoglycemia with inappropriately elevated of glucose caused mild sedation (19). Other side effects of insulin levels. During hypoglycemia, endogenous pancreatic glucagon administration include diarrhea, ataxia, and tachy- insulin concentrations should be low or non-detectable due to pnea (19,20,27). The current study did not show any side effects negative feedback (1). A previous study has documented that an of glucagon administration. insulin level . 417 pmol/L was sufficient to confirm an insu- In the current study, the average glucagon CRI dose was linoma in dogs (13). Laboratory interpretation guidelines state higher in non-survivors. High serum insulin levels at the time normal (reference range: 7 to 139 pmol/L) or elevated insulin of initiation of glucagon and a delay in glucagon administration concentration in the presence of hypoglycemia is supportive of have been shown to decrease the efficacy of glucagon (21,22).

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In addition, prolonged hyperinsulinemia can lead to a deple- In conclusion, the current retrospective observational study tion of glycogen storage in the liver, inhibiting glycogenoly- shows that glucagon CRI is an effective medication to stabilize sis (15,21,23). Furthermore, dogs with normal or elevated blood glucose concentrations in patients with an insulinoma. glucose concentrations have a significantly better prognosis Due to the small sample size, further conclusions could not compared with dogs that had persistent hypoglycemia (24). be made pertaining to the more effective dosing of glucagon,

Our data showed that a much lower glucagon CRI dosing concurrent prednisone administration, dextrose administration, REPORT CASE range was needed to maintain euglycemia compared with that in and outcome. Further studies are warranted with a larger patient a previous study (25). This led the clinician to consider starting population and standardization of the glucagon therapy to make the glucagon CRI at a lower dose. Also, refractory hyperglyce- definitive recommendations. CVJ mia that can be seen with higher glucagon CRI doses may be avoided (2). References Dextrose can be administered for short-term use and initial 1. Goutal CM, Brugmann BL, Ryan KA. Insulinoma in dogs: A review. stabilization if the patient is showing signs of hypoglycemia J Am Anim Hosp Assoc 2012;48:151–163. 2. Fischer JR, Smith SA, Harkin KR. Glucagon constant-rate infusion: such as seizures, trembling, weakness, or abnormal menta- A novel strategy for the management of hyperinsulinemic- hypoglycemic tion (1,9,16,24). Dextrose can stimulate further insulin secre- crisis in the dog. J Am Anim Hosp Assoc 2000;36:27–32. tion resulting in rebound hypoglycemia and should therefore 3. Hess R. Insulin secreting islet cell neoplasia. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Small Animal Medicine. 7th ed. be used with caution (1,2,9,24). In the current study a lack of Philadelphia, Pennsylvania: Elsevier Saunders, 2010:1779–1782. refractory hyperglycemia could have been due to the concurrent 4. Greene SN, Bright, RM. Insulinoma in a cat. J Small Anim Pract 2008; administration of glucagon. 49:38–40. 5. Caywood DD, Klausner JS, O’Leary TP. Pancreatic insulin-secreting Most patients in the current study were administered gluco- neoplasms: Clinical, diagnostic and prognostic features in 73 dogs. corticoids concurrently. Glucocorticoids increase blood glucose J Am Anim Hosp Assoc 1988;24:577–584. levels by antagonizing insulin at a cellular level, increasing 6. Lunn KF, Page RL. Tumors of the endocrine system. In: Withrow SJ, Vail DM, eds. Small Animal Clinical Oncology. St. Louis, Missouri: hepatic gluconeogenesis, elevating glucose 6-phosphate activity, Elsevier Saunders, 2013:519–521. decreasing tissue uptake of glucose, and stimulating endogenous 7. Cunningham JG, Klien BG. Endocrine glands and their function. In: glucagon release (24). In a previous retrospective study, there Textbook of Veterinary Physiology. 4th ed. Philadelphia, Pennsylvania: Elsevier Saunders, 2007:448–463. was no significant increase in blood glucose levels in patients 8. Polton GA, White RN, Brearley MJ, Eastwood JM. Improved survival receiving prednisone until a glucagon CRI was instituted, which in a retrospective cohort of 28 dogs with insulinoma. J Small Anim Pract is consistent with the current findings (25). 2007;48:151–156. 9. Housley D, Tappin S. Canine insulinoma: Part 1. Diagnosis. Compan All non-survivors herein were euthanized at owners’ request Animal 2014;19:138–142. due to other comorbidities including post-surgical complica- 10. Feldman EC, Nelson RW. Beta-cell neoplasia. In: Feldman EC, Nelson tions, lack of response to treatment, and identification of more RW. Canine and Feline Endocrinology and Reproduction. 2nd ed. Philadelphia, Pennsylvania: WB Saunders, 1996:616–644. than one type of neoplasia. Long-term outcome could not be 11. Loose NL, Rudloff E, Kirby R. Hypoglycemia and its effect on the assessed due to lack of follow-up, as only the medical records brain. J Vet Emerg Crit Care 2008;18:223–234. were reviewed. Most patients were seen several years before data 12. Braund KG, Steiss JE, Amling KA, et al. Insulinoma and subclinical peripheral neuropathy in two dogs. J Vet Intern Med1987;1:86–90. collection and long-term communication with the owners or 13. Madarema H, Kayanuma H, Shida T. Retrospective study of canine referring veterinarians was not documented within the medical insulinomas: Eight cases (2005–2008). J Vet Med Sci 2009;71:905–911. records, limiting long-term evaluations. 14. McDermott L, Swainson S, Howard M. Canine insulinoma: A case report and review of the current literature. Iowa State Univ Vet 1999;61: Due to the retrospective descriptive nature of this study many 60–66. limitations are noted. Keyword search of the medical record 15. Hawdon JM, Anynsley-Green A, Ward Platt MP. Neonatal blood glucose database may have missed patients that were coded incorrectly. concentrations: Metabolic effects of intravenous glucagon and intra- gastric medium chain triglyceride. Arch Dis Child 1993;68:255–261. Many patients had to be excluded due to incomplete records or 16. Lamb CR, Simpson KW, Boswood A, Matthewman LA. Ultra lack of inclusion criteria. These exclusions can lead to type II sonography of pancreatic neoplasia in the dog: A retrospective review error, making it difficult to draw any statistical conclusions. of 16 cases. Vet Rec 1995;137:65–68. 17. Robben JH, Pollak YW, Kirpensteijn J, et al. Comparison of ultrasonog- Furthermore, insulinomas are an uncommon neoplasm mak- raphy, computed tomography, and single-photon emission computed ing acquisition of a large population of patients difficult. The tomography for the detection and localization of canine insulinoma. blood glucose monitoring devices also varied among hospitals J Vet Intern Med 2005;19:15–22. 18. Hall JE. Insulin, Glucagon, and diabetes mellitus. In: Guyton and Hall and hematocrit values were not taken into consideration when Textbook of Medical Physiology. 12th ed. Philadelphia, Pennsylvania: measuring spot blood glucose readings (26). Abnormally low or Elsevier Saunders, 2011:939–951. high hematocrit readings can affect blood glucose values with 19. Zeugswetter FK, Schornsteiner E, Haimel G, Schwendenwein I. Metabolic and hormonal responses to subcutaneous glucagon in healthy anemic patients having a falsely higher blood glucose reading beagles. J Vet Emerg Crit Care 2012;22:558–563. and patients with hemoconcentration reading falsely low glu- 20. Fall T, Holm B, Karlsson A, Ahlgren KM, Kämpe O, von Euler H. cose values (26). Another limitation to the study is that nearly Glucagon stimulation test for estimating endogenous insulin secretion in dogs. Vet Rec 2008;163:266–270. half of the patients were euthanized. Treatment regimens were 21. Blauw H, Wedl I, DeVires JH, Heise T, Jax T. Pharmacokinetics and variable and based on doctor discretion. Limitations related to pharmacodynamics of various glucagon doses at different glucose levels. treatments include the use and timing of adjunctive therapies Diabetes Obes Metab 2015;18:34–39. 22. Castle JR, Engle JM, El Youssef J, Massoud RG, Ward WK. Factors (glucocorticoids, dextrose, and chemotherapeutic agents), start- influencing the effectiveness of glucagon for preventing hypoglycemia. ing dose, and time to initiation of the glucagon CRI. J Diabetes Sci Technol 2010;4:1305–1310.

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23. Hoff AO, Vassilopoulou-Selllin R. The role of glucagon administration 26. Tang Z, Lee JH, Louie RF, Kost GJ. Effects of different hematocrit in the diagnosis and treatment of patients with tumor hypoglycemia. levels on glucose measurements with handheld meters for point-of-care Cancer 1998;82:1585–1892. testing. Arch Pathol Lab Med 2000;124:1135–1140. 24. Housley D, Tappin S. Canine insulinoma: Part 2. Treatment. Compan 27. Graf CJ, Woodworth JR, Seger ME. Pharmacokinetic and glucodynamic Animal 2014;19:453–457. comparisons of recombinant and animal-source glucagon after IV, IM, 25. Datte K, Guillaumin J, Barrett S, Monnig A, Cooper E. Retrospective and SC injection in healthy volunteers. J Pharm Sci 1999;88:991–995. evaluation of the use of glucagon infusion as adjunctive therapy for hypoglycemia in dogs: 9 cases (2005–2014). J Vet Emerg Crit Care 2016;26:775–781. RAPPORTCAS DE Book Review Compte rendu de livre

That sheep may safely graze: development professionals and others, whether working for Rebuilding animal health care in non-governmental organizations, national veterinary authorities, war-torn Afghanistan donor organizations or in a private capacity. These lessons span the training of animal health workers, provision of basic equip- Sherman DM. Purdue University Press, West Lafayette, Indiana, ment and transportation, and the procurement and handling of USA. 2019. 307 pp. ISBN: 978-1-55753-862-8. medicines and vaccines under extremely challenging conditions. Most importantly, these lessons address the development of sus- s a consultant to OIE (The World Organisation for tainable revenue streams based on community engagement and A Animal Health) I’ve had the pleasure of working with the development of demands for animal health services from a David Sherman of OIE’s Capacity Building Department, paying clientele of subsistence farmers. where he manages programs on veterinary education, veterinary A key foundation of this successful network of private veteri- paraprofessionals, veterinary legislation, and other activities nary field units lies in an understanding of the needs of these related to strengthening the veterinary services of OIE mem- farmers and the importance of their strategies for diversification ber countries. Dr. Sherman’s support for the development of of livestock to produce food, transport, clothing, and marketable leadership and management skills and his innovative thinking products such as cashmere. about the role and training of community-based veterinary para- Dr. Sherman’s experiences also underline the importance of professionals are amongst his important contributions. developing teamwork, leadership, and management skills at When I heard that Dr. Sherman had undertaken an OIE local, institutional, and national levels to overcome rivalries, mission to Afghanistan not long ago, I wondered what he was foster inter-agency collaboration, and counter corruption. thinking given the security risks. His excellent book, That Sheep The book concludes with a summary of 5 key development May Safely Graze answers that question for me, as it provides factors that contributed to the lasting success of the field net- extraordinary insights into a society of “decent hard-working work, namely: 1. direct community engagement; 2. effective people” who are “generous, hospitable, good-humored, trust- training; 3. fostering economic independence; 4. maintaining worthy and devoted to family and community.” His story demand for services; and 5. promoting personal responsibility. undermines many prejudices about Afghanistan while honestly As important as these are, the lasting image in my mind is documenting the great challenges posed by many years of con- Dr. Sherman’s portrayal of the people of Afghanistan, especially flict, not to mention poor governance in the country and the those with deep and personal commitment to rebuilding their performance of some key donor organizations. society. I will not forget his exemplary empathy and respect for Starting with his initial Afghanistan experience in 1993, but the people of Afghanistan and his contributions to their well- focusing mainly on the period from 2004 to 2019, Dr. Sherman being. May their sheep safely graze — in good health! describes the successful development and nation-wide delivery of practical field veterinary services through a program established by an NGO, the Dutch Committee for Afghanistan, in Reviewed by Barry Stemshorn, BSc, DVM, PhD, Honorary collaboration with many partners. His story provides hard- Senior Fellow, Graduate School of Public and International learned lessons for veterinarians, para-professionals, students, Affairs, University of Ottawa, Ottawa, Ontario.

742 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY Article

Evaluation of 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(69-methylresorufin) ester lipase concentrations in cats with kidney disease and with normal SNAP fPL

Anne-Sophie Bua, Carolyn Grimes, Guy Beauchamp, Marilyn E. Dunn

Abstract — Measuring 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(69-methylresorufin) ester (DGGR) lipase activity is a cost-effective test for diagnosing pancreatitis compared to the feline pancreas-specific lipase (Spec fPL) test. However, little is known about the influence of renal insufficiency on DGGR lipase in cats. This study evaluated the influence of renal function on serum DGGR lipase in the cat. Serum samples from 49 cats with normal pancreas-specific lipase immunoreactivity were analyzed for DGGR lipase activity and serum creatinine. Median serum DGGR lipase activity for cats with kidney disease (KD1) was 22 IU/L (range: 9 to 29 IU/L), whereas for cats without kidney disease (KD2) and healthy cats, the medians were 16 IU/L (range: 6 to 32 IUI/L), and 15 IU/L (range: 9 to 23 IU/L), respectively. The KD1 group had significantly higher DGGR lipase concentrations compared to the healthy group (P = 0.030), but most results were within the reference range. There was a weak positive correlation between creatinine and DGGR lipase values (R2 = 19.6%; P = 0.0014) and no significant correlation between symmetric dimethylarginine (SDMA) and DGGR lipase. Key clinical message: Although cats with kidney disease had significantly higher serum DGGR lipase concentrations than the healthy controls, the difference was small and does not appear to be clinically relevant.

Résumé — Évaluation de la concentration de la lipase de l’ester de l’1,2-o-dilauryl-rac-glycero-3-acide glutarique-(69-methylresorufine) chez les chats présentant une maladie rénale et un SNAP fPL normal. La lipase d’ester 1,2-o-dilauryl-rac-glycero-3-glutarique ester (69-méthylrésorufine) (DGGR) semble être utile pour le diagnostic ante-mortem de pancréatite et s’avère également une méthode économique par rapport au dosage de la lipase féline spécifique du pancréas (Spec fPL). Toutefois, l’influence de l’insuffisance rénale sur la lipase DGGR, est encore méconnue chez le chat. Le but de cette étude prospective est d’établir l’influence de la fonction rénale sur la lipase DGGR chez les chats. Du sérum a été prélevé chez 49 chats ayant un test semi-quantitatif normal pour l’estimation de l’immunoréactivité pancréatique féline (SNAP fPL) et a été analysé pour déterminer l’activité sérique de la DGGR lipase et de la créatinine. La médiane sérique de la lipase DGGR chez les chats atteints de maladie rénale (groupe KD1) était de 22 (intervalle : 9-29) UI/L, tandis que celle des chats sans maladie rénale (groupe KD2) et celle des chats sains était de 16 (6-32) UI/L et 15 (9-23) UI/L, respectivement. Le groupe KD1 présentait des concentrations sériques de lipase DGGR significativement plus élevées que le groupe de chats sains (P = 0,030), mais la plupart des résultats se situaient dans les valeurs de référence. Il y avait une corrélation positive statistiquement significative, mais faible, entre les valeurs de la créatinine et de la lipase de DGGR (R2 = 19,6 %; P = 0,0014). Il n’y avait pas de corrélation significative entre la symétrique diméthylarginine (SDMA) et la lipase DGGR.

Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, 3200 rue Sicotte, Saint-Hyacinthe, Québec J2S 2M2. Address all correspondence to Dr. Anne-Sophie Bua; e-mail: [email protected] Dr. Bua’s current address is Clinique Vétérinaire Rive-Sud, 7415 Boulevard Taschereau, Brossard, Québec J4Y 1A2. Dr. Grimes’ current address is Ethos Diagnostic Science, 10455 Sorrento Valley Rd., Suite 100, San Diego, California 92121, USA. This study was supported by the Interdepartmental Research Grants Program (Fond en santé des animaux de compagnie and Fond du Centenaire), Faculty of Veterinary Medicine, Université de Montréal. 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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Message clinique clé : Ainsi, les chats atteints d’une maladie rénale présentent des concentrations sériques de lipase DGGR signifi cativement plus élevées que celles des chats sains. Cependant, la différence est légère et ne semble pas être cliniquement pertinente. (Traduit par les auteurs) Can Vet J 2020;61:743–748

Introduction kidney function in azotemic cats (8). However, in this study it was not established whether the cats were suspected of having ARTICLE ancreatitis is a common disease and the most common dis- pancreatitis. order of the exocrine pancreas in cats (1). Accurate clinical P The aim of this prospective study was to evaluate serum diagnosis of pancreatitis remains challenging because no single DGGR lipase concentrations in cats with and without kidney non-invasive diagnostic method is completely reliable. Although disease, in which pancreatitis was considered unlikely based on feline pancreas-specific lipase (Spec fPL) is generally regarded a normal SNAP fPL. It was hypothesized that kidney disease as the most accurate blood test for the diagnosis of pancreatitis would lead to an increase in serum DGGR lipase concentration. in cats, its high cost, limited availability and relatively long turnaround time are major drawbacks in its clinical utility (2). A recent comparison of Spec fPL and SNAP fPL (rapid point-of- Materials and methods care semiquantitative assay for the estimation of feline pancreas- Animals and study design specific immunoreactivity), revealed an agreement of 97.5% Client-owned cats older than 1 y of age were prospectively when Spec fPL concentration was , 3.5 mg/L (normal) (3). recruited from the patient population at the Faculty of Veterinary Recently, a catalytic assay for the determination of serum Medicine, University of Montreal, between January 2017 and lipase activity using the substrate 1,2-o-dilauryl-rac-glycero- December 2018. For all cats enrolled in the study, a physical 3-glutaric acid-(69-methylresorufin) ester (DGGR) was validated examination, a complete routine serum biochemistry panel, total for use in feline serum, and substantial agreement between thyroxine concentration, SNAP fPL test, quantitative serum this assay and the Spec fPL assay has been established (4). The lipase DGGR activity, and urinalysis were performed. sensitivity and specificity for the DGGR assay (cutoff value Sick cats were defined as cats with a wide variety of diseases, . 26 IU/L) were 66.7% and 78.6%, respectively (5) for histo- for which pancreatitis was deemed unlikely based on a normal logically diagnosed pancreatitis, when the histological diagnosis SNAP fPL (i.e., fPL , 3.5 mg/L). Additional testing was left to is defined as lymphocytic inflammation in . 10% of a section the discretion of the clinician overseeing the case. Sick cats were of pancreas. Both the Spec fPL and DGGR lipase assays per- further divided into 2 groups based on the diagnosis of concur- formed similarly well in this study. In cats, the reported sensi- rent kidney disease. A diagnosis of kidney disease (group KD1) tivity and specificity of serum 1,2-diglyceride lipase (1,2-DiG) was based on the presence of urine specific gravity (USG) activity for pancreatitis are low and have no value in the diag- # 1.035 and a serum creatinine concentration $ 140 mmol/L. nosis of spontaneous feline pancreatitis. The DGGR method, Cats were considered not to have kidney disease (group KD2) however, may be more specific than the older traditionally used if the USG was . 1.035 and the serum creatinine concentration 1,2-DiG method for the detection of pancreatitis in cats. was , 140 mmol/L. Sick cats were excluded from the analysis There is little published information about the influence if they had either a USG # 1.035 with a concurrent serum cre- of comorbidities on lipase assays in cats. Pancreatic lipase atinine concentration , 140 mmol/L, or a USG . 1.035 with (48 kDa) has a lower molecular size than serum albumin a concurrent serum creatinine concentration $ 140 mmol/L, and is therefore considered to be of low molecular weight. or if they had received fluid therapy within a wk or glucocorti- As a result, the filtration rate of this biomarker is relatively coids 2 mo before blood sampling. If an abdominal ultrasound high (6). A reduction in glomerular filtration associated with was performed, pancreatic and peripancreatic abnormalities renal dysfunction should, therefore, reduce its relative filtration suspected to be associated with pancreatitis were recorded as and increase its serum concentration. However, the relationship follows: hypoechoic or heteroechoic pancreatic parenchyma, between pancreatitis and kidney disease has been investigated pancreatic enlargement, hyperechoic mesentery, and peritoneal in cats with experimentally induced kidney disease and the effusion. results indicated that all cats had a serum Spec fPL concentra- Healthy cats were all student-owned animals and were defined tion within their respective reference intervals (7). Furthermore, as healthy based on history, physical examination, complete there was no significant correlation between serum creatinine blood (cell) count (CBC), complete routine serum biochemistry concentrations and Spec fPL concentrations. These results sug- panel, total thyroxine concentration, urinalysis, and SNAP fPL. gest that Spec fPL is not affected by kidney disease. A more These cats were also considered to not have kidney disease if the recent retrospective study evaluated the effect of creatinine on USG was . 1.035 and the serum creatinine concentration was DGGR lipase and Spec fPL in 1314 cats and demonstrated an , 140 mmol/L. Cats were excluded if the USG was # 1.035, overall weak association between creatinine and DGGR lipase, serum creatinine concentration was $ 140 mmol/L, or if they and creatinine and Spec fPL, suggesting that elevated DGGR had received any medication, except for prophylactic antiparasit- lipase or Spec fPL should not be attributed solely to decreased ics, within the last 6 mo.

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Table 1. Descriptive variables and median ranges for DGGR lipase, serum creatinine, and SDMA for sick cats with kidney disease (KD1 group; n = 16), sick cats without kidney disease (KD2; n = 15) and healthy cats (healthy; n = 18). Group Variable KD1 KD2 Healthy Number of cats 16 15 18 a b b Age (y) 10 (2 to 16) 5 (1 to 15) 5 (1 to 11) ARTICLE Gender 9 FN 1 M 6 MN 9 FN 0 M 6 MN 9 FN 1M 8 MN Serum DGGR lipase (IU/L) 22 (9 to 29)a 16 (6 to 32)b 15 (9 to 23)b Serum creatinine (mmol/L) 211 (144 to 630)a 92 (54 to 134)b 107 (60 to 133)b SDMA (mg/dL) 18.5 (9 to 30)a 8.5 (6 to 14)b 10 (6 to 18)b

a,b Within a row, values with different superscripts differ significantly (P , 0.05). Values represent the mean (range) unless otherwise specified. FN — Female neutered; M — Male intact; MN — Male neutered; SDMA — symmetric dimethylarginine.

This study was approved by the ethics and animal welfare Statistical analysis committee of the Faculty of Veterinary Medicine, University Demographic characteristics among the 3 study groups were of Montreal. compared with a general linear model with group as a factor (KD1, KD2, healthy) for age and body weight and with an SNAP fPL and measurement of DGGR lipase exact Chi-square test for sex distribution. Normality of the dis- and serum SDMA tributions was examined using the Anderson-Darling test (4). Approximately 3 to 4 mL of blood was collected from each DGGR lipase activity, SDMA, and creatinine (required loga- cat by jugular or medial saphenous venipuncture. Each sample rithmic transformations to normalize their distributions) were was placed in a serum tube and centrifuged within 1 h of col- compared among groups with a general linear model followed by lection. The blood sample was analyzed on the collection day. Tukey’s post-hoc tests to compare pairs of group means. A linear A complete routine serum biochemistry panel (UniCel DxC regression was used to examine the association between log-10 600 Synchron; Beckman Coulter, Fullerton, California, USA), transformed DGGR lipase results with the following variables: SNAP fPL test (SNAP fPL Test; IDEXX, Westbrook, Maine, creatinine, SDMA, bilirubin, alanine aminotransferase (ALT), USA), and quantitative DGGR lipase activity (Lipase colorimet- alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT). ric Synchron LX; Beckman Coulter) were performed. Hemolysis For hemolysis, an ordinal variable, Spearman’s rank correlation index and bilirubin concentration were also reported. Remaining was used instead. Statistical significance was assigned at P , 0.05. serum was stored at 220°C and was submitted to an external reference laboratory (IDEXX Laboratories. Lachine, Quebec) Results for symmetric dimethylarginine (SDMA) measurement the day Study population after sample collection. The selected population consisted of 79 cats. Thirty cats were The individual performing the SNAP fPL test was blinded excluded (19 of which were excluded because of an abnormal to the results of the clinical examination, the clinicopathologic SNAP fPL), leaving a study population of 49 cats. results, and the results of the abdominal ultrasound. The SNAP The KD1 group consisted of 16 cats and included 9 spayed fPL test was performed in accordance with the manufacturer’s females, 6 neutered males, and 1 intact male, ranging in age instructions. This rapid, in-clinic, semi-quantitative test uses from 2 to 16 y (median: 10 y). The mean weight was 4.5 kg monoclonal antibodies, as used for the quantitative reference (range: 2.3 to 6.6 kg). Breeds represented in this group included Spec fPL, for estimation of feline pancreatic lipase immuno- domestic shorthair (n = 13) and domestic longhair, Maine Coon, reactivity in serum. The SNAP fPL assay utilizes a reference and Siamese (1 each). spot result that corresponds to the upper limit of the reference The KD2 group consisted of 15 cats and included 9 spayed interval in cats (3.5 mg/L for cats) and a patient sample spot females and 6 neutered males, ranging in age from 1 to 15 y that is visually compared with the reference spot. All cats with (median: 5 y). The mean weight was 5.1 kg (range: 3.4 to an abnormal result were excluded from this study. 7.4 kg). Breeds represented in this group included domestic Measurement of quantitative DGGR lipase activity was per- shorthair (n = 13) and domestic longhair, Persian, and Bengal formed using an in-house assay with the use of 1,2-o-dilauryl- (1 each). rac-glycero-3-glutaric acid-(69-methylresorufin) ester as the The healthy group consisted of 18 cats and included 9 spayed substrate. A reference interval for DGGR lipase activity females, 8 neutered males, and 1 intact male, ranging in age (8 to 26 IU/L) was previously established using 80 clinically from 1 to 11 y (median: 5 y). The mean weight was 4.9 kg healthy male and female cats of various breeds (3). However, (range: 3.3 to 6.9 kg). Breeds represented in this group included the chemistry analyzer used in this study differed from the one domestic shorthair (n = 14), and domestic longhair (n = 4). used to develop the reference interval. Consequently, compari- Cats in the KD1 group were significantly older than the cats son of results between the KD1, KD2, and healthy groups in in the KD2 and healthy groups (P = 0.017). The sex distribu- this study was performed independent of this reference interval. tion (P = 0.95) and mean body weight (P = 0.45) did not differ

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Lipase and creatinine KD2 (n = 12/15) and healthy groups (n = 17/18), the median values were 8.5 mg/dL (range: 6 to 14 mg/dL) and 10 mg/dL

1. 4 (range: 6 to 18 mg/dL), respectively. The KD1 group had significantly higher SDMA concentrations compared to the KD2 (P = 0.001) and healthy (P = 0.003) groups. No significant

1. 2 difference was found between the KD2 and healthy groups for SDMA concentration (P = 0.73). Linear regression indicates nlipase that DGGR lipase was positively associated with serum creati- 2 1. 0 nine (P = 0.0014) but this association was weak (R = 19.6%)

ARTICLE (Figure 1). Linear regression also suggests that DGGR lipase was positively associated with serum SDMA, but this association was 0.8 not statistically significant (P = 0.25).

1.8 2.0 2.2 2.4 2.6 2.8 ncreat Hepatic enzymes and interfering substances Linear regression results indicate that DGGR lipase was positively Figure 1. Correlation of the serum DGGR lipase activity (nlipase) with the creatinine concentration (ncreat) for all associated with ALP, ALT, and GGT but these associations were cats. The data has undergone a logarithmic transformation not statistically significant: ALP (P = 0.57), ALT (P = 0.52), and (P = 0.014). GGT (P = 0.48). The same was true for interfering substances: bilirubin (P = 0.28) and hemolysis index (P = 0.60). significantly among the 3 groups. Demographic data for each group are presented in Table 1. An abdominal ultrasound exami- Discussion nation was performed in 12/31 sick cats. None of them had The aim of our study was to investigate the influence of kidney ultrasonographic evidence of pancreatitis. Comorbidities were disease on serum DGGR lipase in cats. In our study, cats with noted as follows: enteropathy (KD1 group, n = 5; KD2 group, kidney disease had serum DGGR lipase concentrations signifi- n = 9), hepatopathy or cholangiohepatopathy (KD1 group, cantly increased compared to those of younger healthy controls. n = 6; KD2 group, n = 2), cardiomyopathy (KD1 group, n = 2; However, kidney disease had a small effect on DGGR lipase and KD2 group, n = 0), respiratory tract disease (KD1 group, did not appear to be clinically relevant. n = 0; KD2 group, n = 3), diabetes mellitus (KD1 group, Pancreatic lipase (48 kDa) has a lower molecular size n = 1; KD2 group, n = 0), hyperthyroidism (KD1 group, than serum albumin and, as a result, the filtration rate of this n = 0; KD2 group, n = 1), feline immunodeficiency virus (FIV) biomarker is relatively high (7). A reduction in glomerular (KD1 group, n = 1; KD2 group, n = 0), and polycythemia vera filtration associated with renal dysfunction should therefore (KD1 group, n = 0; KD2 group, n = 1). In some cases, a cat reduce its relative filtration and increase its serum concentra- had multiple comorbidities. tion. Studies in dogs have shown that 1,2-DiG lipase is increased in experimentally induced and spontaneous kidney disease DGGR lipase assay results (9,10). However, no correlation could be established between The median serum DGGR lipase for the KD1 group was increased 1,2-DiG lipase in kidney disease and inulin clearance, 22 IU/L (range: 9 to 29 IU/L), for the KD2 and healthy creatinine concentration, or serum urea concentration in these groups, the median values were 16 IU/L (range: 6 to 32 IU/L) studies. Thus, a decrease in renal excretion of 1,2-DiG lipase and 15 IU/L (range: 9 to 23 IU/L), respectively (Table 1). The did not appear to be the main cause of the increase in serum KD1 group had significantly higher DGGR lipase concentra- 1,2-DiG lipase concentration (10). However, more recent stud- tions than the healthy group (P = 0.030), although ranges ies in dogs with experimentally induced kidney disease have overlapped substantially. No significant difference was found for not supported this and have demonstrated that decreased renal DGGR lipase between the KD1 and KD2 groups (P = 0.21) excretion did not cause consistent increases in serum lipase nor for the KD2 and control groups (P = 0.68). 1,2-DiG activity (11,12). It should be noted, however, that the stability of 1,2-DiG lipase in serum was not addressed in one Creatinine and SDMA of these studies, although serum samples were analyzed nearly The median serum creatinine concentration for the KD1 20 y after storage at 280°C (12). It is suggested that, in addi- group was 211 mmol/L (range: 144 to 630 mmol/L). For the tion to a filtration defect, renal tubular damage often observed KD2 and healthy groups, the median concentrations were in kidney disease patients may lead to a decrease in the tubular 92 mmol/L (range: 54 to 134 mmol/L) and 107 mmol/L (range: reabsorption of lipase, causing a decrease in its concentration in 60 to 133 mmol/L), respectively (Table 1). The KD1 group had blood. Oppliger et al (5) stated that both the DGGR lipase and significantly higher creatinine concentrations compared to the Spec fPL assays are similarly affected by concurrent azotemia in KD2 (P , 0.001) and healthy (P , 0.001) groups. There was cats, and that catalytic lipase activity seems no more influenced no significant difference in creatinine concentrations between by azotemia than Spec fPL. However, the impact of concur- the healthy and KD2 groups (P = 0.23). The median serum rent azotemia cannot be definitively assessed because only the SDMA concentration for the KD1 group (results available agreement between the 2 lipase assays was determined in the for n = 8/16) was 18.5 mg/dL (range: 9 to 30 mg/dL). For the azotemic and nonazotemic cats. In a more recent retrospective

746 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY

study that evaluated the effect of creatinine on DGGR lipase tion (16). For this reason, cats with corticosteroid treatment and Spec fPL in 1314 cats, there was an overall weak association were excluded from our study. Similarly, it may have been between concentrations of creatinine and lipase, and creatinine interesting to exclude the comorbidities mentioned in cats with and Spec fPL, suggesting that elevated lipase or Spec fPL should kidney disease. However, our purpose was to evaluate a popu- not be attributed solely to decreased kidney function in azotemic lation of cats with kidney disease in a clinical situation. Not cats (13). However, in this study it was not established whether surprisingly, many of our cats, mostly geriatric, had concurrent

the cats were suspected of having pancreatitis. Our study illnesses. For this reason, a control group of sick cats without ARTICLE demonstrated that cats with kidney disease had significantly kidney disease was used. The number of cats with enteropathy higher serum DGGR lipase concentrations than did the healthy and/or hepatopathy or cholangiohepatopathy, which were the controls. However, this difference was minimal and does not most frequently observed comorbidities, was similar among appear to be clinically relevant, especially since DGGR lipase sick cats whether they had kidney disease or not. In addition, was not significantly associated positively with serum SDMA. DGGR lipase was not significantly associated with hepatic It would have been interesting to evaluate glomerular filtration enzymes (ALP, ALT, GGT). It therefore appears unlikely that rate. Studies on experimentally induced azotemia in cats without these comorbidities played a significant role in DGGR lipase pancreatic disease would likely be necessary to directly assess concentration. Healthy cats were younger than KD1 cats and the influence of concurrent azotemia on serum lipase activity, this could be one of the reasons for the minimal differences although ethically this would be difficult to justify. Factors, between DGGR lipase results. other than creatinine, explaining the variation of DGGR lipase There were several limitations to our study. The relatively between groups remain undetermined. small number of cases may have limited statistical evaluation. It is possible that cats with chronic pancreatitis were included Also, the effect of concurrent treatment and comorbidities on in this study, as false-negative results may occur due to the limi- DGGR lipase is unknown. Although cats in the healthy control tations of laboratory assays and ultrasonographic examination group and the sick cats without kidney disease were nonazo- for diagnosis of pancreatitis, especially in cases of subclinical temic, some may have had early kidney disease. Healthy cats or inactive disease. When comparing the results of lipase assays were younger than sick cats. Furthermore, although this study with those of standardized histologic examination of the pan- employed several clinically available noninvasive tests to rule creas in cats, the sensitivity of the Spec fPL assay with a cutoff out pancreatitis, histopathology may have been helpful in ruling value of $ 5.4 mg/L for the diagnosis of pancreatitis ranged out pancreatic pathology. Finally, the reference interval used for from 42.1% to 61.1%, while the DGGR lipase assay had a statistical analysis for the DGGR assay was based on the healthy sensitivity of 36.8% to 66.8% (6). These values depended upon control group in the study, a relatively small number, rather than whether up to 10% lymphocytic inflammation was considered a population-based reference interval specifically established for normal or abnormal. However, this distinction is controversial this laboratory. So, it is reasonable to assume that this prelimi- as the relevance of mild lymphocytic pancreatic inflammation nary reference interval would expand by several U/L if more in cats is currently unknown. In a recent study, the comparison cats had been included, making our conclusion quite different. of Spec fPL and SNAP fPL revealed an agreement of 97.5% Our study concluded that cats with kidney disease had sig- when Spec fPL was , 3.5 mg/L (normal) (3). Given this, having nificantly higher serum DGGR lipase concentrations than did a normal SNAP fPL makes it less likely that a cat would have the healthy controls. However, the minimal difference does not pancreatitis. It would have been ideal to exclude pancreatitis by appear to be clinically relevant. CVJ performing a Spec fPL, an abdominal ultrasound on all patients, and pancreatic biopsy for histopathology. However, only slight References to fair agreement between ultrasonography and serum lipase 1. Xenoulis PG. Diagnosis of pancreatitis in dogs and cats. J Small Anim Pract 2015;56:13–26. (Spec fPL and DGGR lipase) has been described, with the 2. Xenoulis PG, Steiner JM. Canine and feline pancreatic lipase immuno- following criteria used to diagnose pancreatitis: combined reactivity. Vet Clin Pathol 2012;41:312–324. hypoechoic and mixed-echoic pancreas; hypoechoic pancreas; 3. Schnauß F, Hanisch F, Burgener IA. Diagnosis of feline pancreatitis with SNAP fPL and Spec fPL. J Feline Med Surg 2019;21:700–707. and enlarged pancreas (14). One explanation for the poor agree- 4. Anderson TW, Darling DA. Asymptotic theory of certain “goodness of ment between ultrasonography and serum lipase results could be fit” criteria based on stochastic processes. Ann Math Statist 1952;23: a high false-positive rate of diagnosis based on ultrasonographic 193–212. 5. Oppliger S, Hartnack S, Riond B, Reusch CE, Kook PH. Agreement findings. Moreover, there is accumulating evidence that pan- of the serum Spec fPLTM and 1,2-o-dilauryl-rac-glycero-3-glutaric creatic histopathology is associated with several and important acid-(69-methylresorufin) ester lipase assay for the determination of limitations and, therefore, should not be considered the gold serum lipase in cats with suspicion of pancreatitis. J Vet Intern Med 2013;27:1077–1082. standard (15). The 2 main limitations of histopathology are 6. Oppliger S, Hilbe M, Hartnack S, Zini E, Reusch CE, Kook PH. the possibility of false negative results because of missed lesions Comparison of serum spec fPLTM and 1,2-o-dilauryl-rac-glycero-3-glutaric and the unknown clinical significance of certain histopathologic acid-(69-methylresorufin) ester assay in 60 cats using standardized assessment of pancreatic histology. J Vet Intern Med 2016;30:764–770. findings. There is currently no gold standard for ruling out 7. Fabris C, Basso D, Naccarato R. Urinary enzymes excretion in pancreatic pancreatitis in cats. diseases. Clinical role and pathophysiological considerations. J Clin Non-pancreatic conditions associated with increased serum Gastroenterol 1992;14:281–284. 8. Xenoulis PG, Finco DR, Suchodolski JS, Steiner JM. Serum fPLI and 1,2-DiG lipase activities include renal, hepatic, intestinal, Spec fPL concentrations in cats with experimentally induced chronic and neoplastic diseases, as well as corticosteroid administra- renal failure (abstr). J Vet Intern Med 2009;250:786.

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. 9 Wagner AE, Macy DW. Nephelometric determination of serum amylase 13. Everson E, Abrams-Oggs A, Kocmarek H, Ruotsalo K. Effect of serum and lipase in naturally occurring azotemia in the dog. Am J Vet Res creatinine on feline serum DGGR-lipase and serum pancreatic lipase 1982;43:697–699. immunoreactivity (abstr). J Vet Intern Med 2016;30:1463. 10. Polzin DJ, Osborne CA, Stevens JB, Hayden DW. Serum amylase and 14. Oppliger S, Hartnack S, Reusch CE, Kook PH. Agreement of serum lipase activities in dogs with chronic primary renal failure. Am J Vet feline pancreas–specific lipase and colorimetric lipase assays with pan- Res 1983;44:404–410. creatic ultrasonographic findings in cats with suspicion of pancreatitis: 11. Hulsebosch SE, Palm CA, Segev G, Cowgill LD, Kass PH, Marks SL. 161 cases (2008–2012). J Am Vet Med Assoc 2014;244:1060–1065. Evaluation of canine pancreas-specific lipase activity, lipase activity, and 15. Bazelle J, Watson P. Pancreatitis in cats: Is it acute, is it chronic, is it trypsin-like immunoreactivity in an experimental model of acute kidney significant? J Feline Med Surg 2014;16:395–406. injury in dogs. J Vet Intern Med 2016;30:192–199. 16. Washabau RJ. Pancreas. In: Washabau RJ, Day MJ, eds. Canine and 12. Steiner JM, Finco DR, Williams DA. Serum lipase activity and canine Feline Gastroenterology. St. Louis, Missouri: Saunders, 2013:799–848. pancreatic lipase immunoreactivity (cPLI) concentration in dogs with

ARTICLE experimentally induced chronic renal failure. Vet Res 2010;3:58–63.

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748 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY Article

Evaluation of radiographs for the detection of sublumbar lymphadenopathy in dogs

Megan C. Murphy, Martin Sullivan, Barbara J. Gomes, Ada Kaczmarska, Gawain J.C. Hammond

Abstract — The purpose of this study was to evaluate radiographs for the detection of sublumbar lymph node (SLN) enlargement. Ultrasound was used to determine SLN size. Twenty-two dogs with anal gland adenocarcinoma or lymphoma were prospectively included, with 16/22 having SLN enlargement on ultrasound. Twenty-one dogs without enlargement were retrospectively included as controls. Three blinded observers evaluated 43 right lateral abdominal radiographs for the presence of SLN enlargement. Sensitivity and specificity of radiographs for the detection of SLN enlargement were 81%/70%, 94%/81%, and 75%/100% for a general practitioner, imaging resident, and radiologist, respectively. Ventral displacement of the colon, a soft tissue opacity in the caudal retroperitoneal space and loss of conspicuity of the ventral margin of the iliopsoas muscle were radiographic findings significantly associated with identification (P-values , 0.05). Markedly enlarged SLNs (. 21.5 mm) were consistently detected radiographically by observers with specialist imaging training. Key clinical message: Radiographic visualization should raise suspicion of neoplastic infiltration of SLN but lack of visualization does not exclude mild to moderate enlargement. Additional imaging such as ultrasound or computed tomography remains important to confirm or exclude sublumbar lymphadenopathy.

Résumé — Évaluation de radiographies pour la détection de lymphadénopathie sub-lombaire chez des chiens. Le but de la présente étude était d’évaluer des radiographies pour détecter l’augmentation de taille des ganglions sub-lombaires (SLN). L’échographie fut utilisée pour déterminer la taille des SLN. Vingt-deux chiens avec un adénocarcinome des glandes anales ou un lymphome furent inclus prospectivement, avec 16/22 ayant des SLN augmentés lors de l’échographie. Vingt-et-un chiens sans augmentation de taille furent inclus rétrospectivement comme témoins. Trois observateurs ont évalué à l’aveugle 43 radiographies abdominales latérales droites pour la présence d’augmentation des SLN. La sensibilité et la spécificité des radiographies pour la détection d’augmentation des SLN étaient de 81 %/70 %, 94 %/81 % et 75 %/100 % pour un praticien généraliste, un résident en imagerie et un radiologiste, respectivement. Un déplacement ventral du côlon, une opacité des tissus mous dans l’espace rétropéritonéal caudal et une perte de visibilité de la bordure ventrale du muscle iliopsoas furent des trouvailles radiographiques associées significativement avec l’identification (P , 0,05). Des SLN avec une forte augmentation de taille (. 21,5 mm) étaient constamment détectés radiographiquement par des observateurs avec une formation spécialisée en imagerie. Message clinique clé : La visualisation radiographique devrait soulever des soupçons d’infiltration néoplasique des SNL mais le manque de visualisation n’exclu pas une augmentation de taille de légère à modérée. Des analyses en imagerie additionnelles, telles que l’échographie ou la tomodensitométrie, demeurent importantes pour confirmer ou exclure une lymphadénopathie sub-lombaire.

(Traduit par Dr Serge Messier) Can Vet J 2020;61:749–756

Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom. Address all correspondence to Dr. Megan C. Murphy; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

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Introduction general practice may be limited by a lack of equipment availability and operator experience. Radiography is rapid, low cost, he sublumbar lymph nodes (SLNs) include the medial iliac, non-invasive, and readily available, having the added value of internal iliac (previously termed hypogastric), and sacral. In T allowing evaluation of the lumbar vertebrae, sacrum, and pelvis the dog, the SLNs drain the perineal and pelvic regions, which for evidence of neoplastic infiltration. There has been limited include the reproductive organs, anus, rectum, colon, ureters, investigation into the use of radiography for detecting sublum- and lower urinary tract (1). The medial iliac lymph nodes bar lymphadenopathy. Only 1 article could be found that briefly (MILNs) are consistently present, the largest of the group, and commented on the use of abdominal radiography to evaluate located ventral to the 5th or 6th lumbar vertebrae adjacent to for metastasis in dogs with AGAAS (11). the caudal vena cava and aorta, between the external iliac and ARTICLE The aim of this study was to evaluate the use of radiography caudal circumflex arteries (2,3). The internal iliac lymph nodes for identifying SLN enlargement in dogs using ultrasonography (IILNs) are located at the level of the 6th and 7th lumbar ver- as a comparator. Objectives were to: i) evaluate intra-observer tebrae in the angle between the median sacral and internal iliac agreement with regards to radiographic interpretation; ii) deter- arteries (2). The sacral lymph nodes (SALNs) are located ventral mine the size at which the SLNs become conspicuous radio- to the sacrum and adjacent to the median sacral artery (3). The graphically; and iii) evaluate easily recognizable radiographic SLNs are typically paired; however, variations have been docu- features that could aid in detecting SLN enlargement. We mented (3,4). These lymph nodes are not palpable rectally or hypothesized that enlarged SLNs would be identified on lateral abdominally unless markedly enlarged and therefore imaging is abdominal radiographs and that having specialist imaging train- essential for evaluation (5). ing would influence identification. In canine patients with apocrine gland adenocarcinoma of the anal sac (AGAAS), the SLNs are the most common site of Materials and methods metastasis (6). Lymphoma, a common canine neoplasia with the Client-owned dogs presented to the Glasgow University Small multicentric form seen most frequently, may also affect these Animal Hospital oncology service for staging of lymphoma or nodes (7). The SLNs are routinely evaluated in both of these AGAAS between September 2015 and July 2017 were prospec- types of neoplasia, and in other diseases affecting the perineal tively recruited. Ethical approval of the study was granted by the or pelvic regions, as knowledge of their involvement may affect University of Glasgow Research Ethics Committee. Inclusion therapeutic planning and prognostic determination. Apocrine criteria included dogs with lymphoma or AGAAS having tho- gland adenocarcinoma of the anal sac has been extensively racic imaging (CT or radiographs) and abdominal ultrasonog- studied and is well-recognized due to its highly invasive nature raphy performed under sedation on the same date. Exclusion and metastatic potential, with patients often having SLN criteria included history of surgical removal of the SLNs prior metastasis at the time of presentation (8–15). Identification of to imaging and changes on abdominal radiographs that could SLN involvement is essential considering the negative impact limit or prevent evaluation of the sublumbar region, such as on survival and documented increased survival times associated peritoneal or retro-peritoneal effusion. Informed written owner with removal of metastatic SLNs (16–19). Staging of patients consent was obtained for performance of a single right lateral with AGAAS typically includes thoracic and abdominal imag- radiograph of the abdomen, which was taken while the patient ing using radiographs, ultrasound, or computed tomography was under sedation for routine staging. The sedation protocol (CT) (2,6,14). for each dog varied and was chosen by the attending clinician. Various imaging modalities have been studied for the purpose All abdominal radiographs were acquired at the time of tho- of evaluation of the SLNs. Computed tomography (CT) is racic imaging by an experienced radiographer, using the same becoming more widely used, especially when surgery or radia- computed radiography (CR) machine (AGFA CR35-X; AGFA tion therapies are considered. Recent work has found that CT Healthcare, Greenville, South Carolina, USA). Ultrasonography was able to distinguish more SLNs than ultrasonography (6,20); was performed by a European College of Veterinary Diagnostic however, it has not been proven superior in the ability to detect Imaging (ECVDI) Board-certified radiologist or diagnostic abnormal lymph nodes (20). A comparison of magnetic reso- imaging resident under direct supervision. A single ultrasound nance imaging (MRI) with ultrasonography, for the detection machine with a 6–10 MHz curvilinear transducer was used of sublumbar lymphadenopathy in dogs with AGAAS, found (LOGIQ 9; GE Healthcare, Solingen, Germany). The entire that MRI was more sensitive and that ultrasonography failed abdomen was imaged; however, particular attention was paid to detect 67% of abnormal lymph nodes (2). Despite the to the SLNs. Size (height) and appearance of the MILNs were advantages of CT and MRI, ultrasonography remains the most recorded during each abdominal ultrasound and the images were commonly used modality for evaluation of the SLNs due to stored. If the IILN or SALNs could be identified on ultrasound, the increased cost and need for sedation or general anesthesia their size and appearance were also recorded. associated with cross-sectional imaging. Upon completion of prospective case recruitment, 21 con- Ultrasound is widely available, non-invasive, and has been trol cases were selected from the same study time period to documented to be effective as a screening tool for SLN involve- minimize observer bias. Inclusion criteria for controls were ment in dogs with AGAAS (20). It has been noted to be superior as follows: dogs with abdominal ultrasound and abdominal to radiography and more sensitive for detection of sublumbar radiographs performed on the same date, well-positioned right lymphadenopathy (14,21). Unfortunately, use of ultrasound in lateral view, good quality ultrasound images of the MILNs,

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visible SLNs measuring , 8 mm on ultrasound with normal Observers were asked to review the right lateral abdominal appearance, a detailed ultrasound report containing no reported radiographs in a single session and in the order provided, with- abnormalities involving any of the SLNs, and no history of ill- out returning to previously viewed images. To allow calculation ness which would be expected to involve the SLNs. Having an of intra-observer agreement, all radiographs were reviewed SLN . 8 mm in height on ultrasound or overt pathology on 1 mo later and randomization was repeated to help remove the right lateral abdominal radiograph, which could distract the recall bias. Observers were provided with a data collection sheet observer or limit evaluation of the SLNs, were exclusion criteria. and asked to note the presence or absence of 4 radiographic ARTICLE Both criteria were applied at the same time while searching for features (yes = 1/no = 0) and to classify the presence or absence appropriate control cases and therefore the number of cases (yes = 1/no = 0) of SLN enlargement. Enlargement of the SLNs that met inclusion criteria but not exclusion criteria, was not on radiographs was defined as having a visible soft tissue struc- determined. All radiographs from both the control and disease ture in the anatomic area of the SLNs, ventral to the 5th lumbar groups were reviewed by 1 author (M.M.) to ensure these crite- vertebra to the sacrum, and dorsal to the colon. This definition ria were met. Radiographs and ultrasound examinations of the was provided to the observers for clarity. The 4 radiographic control dogs were performed using the same equipment as the features were: ventral displacement of the colon, a soft tissue prospectively enrolled dogs. opacity in the caudal retroperitoneal space, loss of the ventral The medical records for all dogs included in the study were margin of the iliopsoas muscle, and narrowing of the colon from reviewed and the following information recorded: breed, age, the 5th lumbar vertebrae to the sacrum. weight, sex, neutered status, disease (lymphoma versus AGAAS), confirmation of disease (cytology and/or histology), and confirma- Statistical analysis tion of SLN metastasis (cytology and/or histology), if available. Statistical analysis was performed by a Diplomate in Veterinary An SLN was considered enlarged on ultrasound if it mea- Epidemiology (T.P.), using commercially available software sured . 8 mm in height (22), and subjectively abnormal (Minitab, version 17.1.0.0; Minitab, Coventry, United Kingdom in appearance if it demonstrated 1 or more of the following and Excel; Microsoft Office). All demographic data were found imaging characteristics: an abnormal shape, irregular margin, to be normally distributed. Two sample t-tests were performed hypoechoic or heterogeneous parenchyma compared to the to compare age and body weights of control and study groups. surrounding fat (6,21). Lymph node height was considered the Cohen’s Kappa was used for determining intra-observer agree- greatest ventral to dorsal dimension in the sagittal plane at the ment and the Landis-Koch method was used to classify the maximum diameter of the lymph node (20). Height (mm) was K-values (23). For statistical analysis, cases were divided into recorded for all MILNs and any visible IILNs or SALNs. For 2 groups: those with SLNs # 8 mm on ultrasound (21 healthy statistical purposes, a binary classification of SLN enlargement controls 1 6 disease cases without sublumbar lymphadenopa- on ultrasound (yes = 1/no = 0) was given if there was enlarge- thy for a total of 27) and those with at least 1 SLN . 8 mm ment (. 8 mm height) of any 1 SLN (medial iliac, internal iliac, on ultrasound (disease cases with SLN enlargement, n = 16). or sacral), unilateral or bilateral. Sensitivity and specificity of radiographs as a diagnostic test for Following compilation of study cases, 3 reviewers with the detection of SLN enlargement were calculated by comparing varying levels of image interpretation experience individually the lymph node classification determined by each observer from evaluated the right lateral abdominal radiographs: a general the radiographs (yes = 1/no = 0) to the classification determined practitioner (A.K., observer A), a second-year diagnostic imag- on ultrasound (yes = 1/no = 0). Pearson Chi-Square tests were ing resident (B.J.G., observer B) and an ECVDI diplomate used to test for association between the 4 radiographic features (G.J.C.H., observer C) with 14 y of experience. Abdominal and patients with at least 1 SLN measuring . 8 mm in height radiographs from both study groups were included and case on ultrasound. P-values , 0.05 were considered significant. numbers were randomized using an Excel random number gen- Sensitivity and specificity of the radiographic features for the erator (Excel; Microsoft Office, Redmond, Washington, USA). detection of SLN enlargement were also calculated by comparing Observers were provided with the case number, date, and time the presence of each finding with the lymph node classification of imaging to ensure the correct image was retrieved from the on ultrasound. Receiver operating characteristic (ROC) curves hospital’s picture archiving and communication system (PACS), were generated for each observer, to identify the lymph node and images were reviewed using digital imaging and communi- size which corresponded to the best combination of sensitivity cations in medicine (DICOM) viewing software (Clear Canvas; and specificity for radiographic visualization. The height of the Synaptive Medical, Toronto, Ontario). Observers were blinded largest SLN was used if more than 1 was enlarged. to patient details such as age, breed, neutered status, disease status (neoplasia versus control), disease category (lymphoma Results versus AGAAS) as well as lymph node category (neoplasia & Twenty-four dogs met the inclusion criteria for the prospec- enlarged versus neoplasia & not enlarged versus control & not tive disease group. Two dogs were excluded; 1 due to the enlarged). As the study objective was known to the observers, presence of a moderate volume of peritoneal effusion causing they were made aware that control and diseased dogs without reduced serosal detail, which may have limited the ability to SLN enlargement were included, to help remove observer bias. evaluate the sublumbar region. The second exclusion was due Abdominal ultrasound images were not available to the observ- to documentation in the medical record of having the MILNs ers, nor were the imaging reports. surgically removed. A total of 22 cases remained; including

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5 with lymphoma (4 multicentric and 1 involving the bladder) and 17 cases with AGAAS. There were 8 females (7 spayed) and 14 males (12 neutered). Breeds included 6 Labrador retrievers, 4 cocker spaniels, 2 German shepherds, 2 springer spaniels, 2 Labradoodles, 1 Cavalier King Charles spaniel, 1 golden retriever, 1 border collie, 1 Japanese spitz, and 2 cross breeds. Mean [6 standard deviation (SD)] body weight was 26 6 11.1 kg (range: 12 to 55 kg). Mean age was 9.2 6 2.3 y (range: 4 to 13 y). Thirteen of the 17 dogs with anal gland

ARTICLE masses had anal sacculectomy and AGAAS was confirmed histologically. Two dogs with AGAAS had cytological confirmation of the primary tumor with fine-needle aspiration (FNA) and the diagnosis was highly suspected but not confirmed in 2 dogs. The dogs having a high suspicion of AGAAS had an anal gland mass and sublumbar lymphadenopathy. All dogs with lymphoma had cytological confirmation. There was variation in the time between confirmation of diagnosis and imaging due to referral at different stages of the diagnostic process (some cases were not confirmed until referral, while others had a diagnosis confirmed prior to referral). Of the 21 retrospective control dogs, 11 were female (8 spayed) and 10 were male (6 neutered). Breeds included 9 Labrador retrievers, 4 cross breeds, 2 cocker spaniels, 2 golden retrievers, and 1 each German shepherd, bearded collie, Staffordshire bull terrier, red setter. Mean (6 standard deviation) body weight was 22.3 6 9.3 kg (range: 2.8 to 36.8 kg). Mean age was 8.5 6 3.5 y (range: 3 to 13 y). There were no significant differences between the age or weights of the control and study groups (P = 0.44 for age, P = 0.24 for weight). Ultrasound identified enlargement of at least 1 SLN in 16/22 of the prospectively enrolled cases; 5/5 of the lymphoma cases, and 11/17 dogs with AGAAS. More than 1 SLN was enlarged in 4/5 lymphoma cases and 9/17 AGGAS cases. Lymph nodes found to be enlarged were also abnormal in appearance in all cases, except for 1 AGAAS patient in which enlargement was very mild (right MILN 10.2 mm). Besides this exception, enlarged SLNs in patients with AGAAS consistently demon- * strated a heterogeneous and/or hypoechoic appearance with most having undulating margins (Figures 1A–B and 2A). In the lymphoma group, all SLNs identified as enlarged were also hypoechoic with a rounded shape. None of the lymph nodes measuring , 8 mm on ultrasound had an abnormal appearance. Enlarged SLNs were confirmed to have metastatic spread, with either cytology or histopathology, in 1/5 patients with Figure 1. Radiographic and ultrasound images of a 7.5-year-old lymphoma and 6/17 dogs with AGAAS after abdominal imag- Labradoodle dog with AGAAS and SLN enlargement. The ing but before observers reviewed the abdominal radiographs. right IILN and right MILN measure 51.8 mm and 16.8 mm, respectively. The left MILN was normal (5 mm). All observers Intra-observer agreement was determined to be fair for agreed on enlargement. A — Ultrasonographic image of the observer A (Kappa 0.35), moderate for observer B (Kappa 0.53) right IILN (outlined by the cursors) demonstrating enlargement, and almost perfect (Kappa 0.89) for observer C. hypoechoic heterogeneity, cystic regions (asterisk) and irregular margination. B — Ultrasonographic image of the right MILN Sensitivity and specificity of radiographs for the detection (outlined by the cursors) demonstrating enlargement and mild of SLN enlargement, using ultrasound as the comparator, heterogeneity. Note the descending abdominal aorta near the were calculated for each observer. For observer A, sensitivity level of the bifurcation (asterisk). C — Right lateral abdominal radiograph demonstrating ventral displacement of the colon was 81% and specificity was 70%. For observer B, sensitiv- (dashed arrow), narrowing of the colon at the level of the ity was 94% and specificity was 81%, and for observer C sensi- sacrum (short arrow), loss of the ventral margin of the iliopsoas tivity was 75% and specificity was 100%. muscle (long arrow), and a soft tissue opacity in the caudal retroperitoneal space (asterisk) indicating radiographically visible Four radiographic features were evaluated to determine if SLN enlargement. their presence was useful in identifying SLN enlargement.

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Table 1. Reason for presentation of retrospective control cases. Retrospective control cases Weight Case Breed (kg) Reason for imaging 25 Cocker spaniel 9.4 Addison’s disease 26 Labrador 26.5 Non-regenerative anemia

27 Labrador 25.8 Adrenal mass ARTICLE 28 Bearded collie 18.3 Urinary incontinence 29 Terrier 2.8 Kidney stones 30 Cross breed 8.6 Intervertebral disc disease 31 Labrador 32.7 Pyloric foreign body 32 Staffordshire bull terrier 19 Gastric neoplastic 33 Labrador 19.1 Anorexia and weight loss 34 Cocker spaniel 16.1 Lethargy 35 German shepherd 36.8 Irritable bowel disease 36 Labrador 24.8 Cystitis 37 Labrador cross 16.3 Vomiting B 38 Golden retriever 21.4 Vomiting 39 Terrier cross 37 Insulinoma 40 Red setter 25.4 Polydipsia * 41 Poodle cross 11.8 Steroid responsive meningitis 42 Labrador 29.9 Gastritis 43 Retriever 30.8 Hepatopathy 44 Labrador 26.2 Pancreatitis 45 Labrador cross 28.7 Gastritis

least 1 SLN measuring . 17 mm, except for 1 patient with an SLN measuring 18.5 mm which was missed by observer C (Table 1). All observers correctly identified SLN enlargement in patients with at least 1 SLN . 38 mm (n = 3), whereas Figure 2. Radiographic and ultrasound images of a 4-year-old only those with specialist imaging training (B and C) correctly cocker spaniel dog with AGAAS and SLN enlargement. The right identified SLN enlargement in patients having at least 1 SLN IILN is enlarged, measuring 25 mm. The left and right MILNs measuring . 21.5 mm (n = 9). were normal. Metastasis was confirmed with histopathology in the IILN. Enlargement was only identified by experienced observers. A — Ultrasonographic image of the IILN demonstrating Discussion enlargement, irregular margination, and heterogeneity. B — Right Our study is the first to document radiographic visualization lateral abdominal radiograph demonstrating a soft tissue opacity in the caudal retroperitoneal space (asterisk), ventral of SLNs confirmed to be enlarged with ultrasound. Sublumbar displacement of the colon (dashed arrow), and loss of visibility of lymph node enlargement can be identified radiographically and the ventral margin of the iliopsoas muscle (arrow). Radiographic several radiographic findings aid in identification. Dogs with visibility of IILN enlargement in the absence of MILN enlargement has not been previously documented. AGAAS and multicentric lymphoma were selected for the study given that enlargement of the SLNs would be more prevalent in these groups. Although MRI and CT have been reported to be Findings were as follows: ventral displacement of the colon more sensitive for the detection of sublumbar lymphadenopa- (sensitivity: 94%, specificity: 63%, P , 0.001), narrowing of thy (2,6), ultrasound is widely used for evaluation of the SLNs the colon from L5-sacrum (sensitivity: 44%, specificity: 74%, for staging purposes (2,6,17,24), and was therefore chosen as P = 0.228), loss of the ventral margin of the iliopsoas muscle the comparator in this study. (sensitivity: 81%, specificity: 78%, P , 0.001), abnormal soft In general practice, radiographs are often used as an initial tissue opacity in the caudal retroperitoneal space (sensitivity: screening tool for suspected neoplasia, and, in some practices, 81%, specificity: 96%, P , 0.001). The radiographic features it may be the only available imaging modality. Information on are shown in Figures 1c and 2b. radiographic identification of SLN enlargement would be useful For ease of calculation when multiple SLNs were enlarged, in these situations as pre-treatment knowledge of SLN involve- the maximum SLN height was used in the generation of the ment may have implications for the patient, including changes ROC curves. Receiver operating characteristics curve analysis in prognosis, surgical planning, and treatment. identified that an SLN height on ultrasound of . 21.5 mm Results from the general practitioner (observer A) suggest resulted in the best combination of sensitivity and specificity poorer detection than those with specialist imaging training, for radiographic detection for observers B and C (sensitiv- supporting our hypothesis. For observer B, the sensitivity was ity: 53% and 75%, respectively, with 100% specificity for high at 94% but the specificity was lower at 84%, indicating both). No informative conclusions could be drawn from the that most enlarged SLNs were detected radiographically; how- ROC curves generated from observer A’s data due to poor ever, there were some cases falsely identified with enlargement. intra-observer agreement. Observers with specialist imaging Observer C had a lower sensitivity of 75%, but a specificity training (B and C) correctly identified all patients with at of 100%. It is possible that due to experience, observer C was

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reluctant to give a diagnosis without having a high confidence of the parietal lymph nodes, usually only MILN enlargement is in the findings. Observer B may have been influenced by bias, substantial enough to be visualized radiographically (26). This knowing the objective was to identify SLN enlargement, lead- is the first study to demonstrate radiographic visualization of ing to overinterpretation of the images. However, this careful IILN enlargement. scrutiny may have led to the high sensitivity of this observer. While radiography may detect lymph node enlargement due Intra-observer agreement was poor for the general practitio- to an increased lymph node height, it cannot detect changes in ner compared to the observers with specialist imaging training. appearance as ultrasound can. The ultrasonographic appearance Although the imaging resident and general practitioner had of lymph nodes has been found to help differentiate between spent a similar amount of time practicing veterinary medicine, neoplastic and benign nodes. Neoplastic lymph nodes in dogs

ARTICLE the resident had more experience with image interpretation and have been documented to be round and hypoechoic (4,27,28) daily exposure to a high number of images, along with daily as well as heterogeneous (21,29). All SLNs with confirmed feedback from an experienced radiologist, which likely led to AGAAS metastasis in our study had these characteristics on improved performance. Future studies with a larger number of ultrasound. All nodes confirmed to have lymphoma had a round observers in each group would be needed to further evaluate and hypoechoic appearance. The intention of this study was not the effect of interpretation experience. Given the improved to evaluate radiography for imaging of the SLNs instead of other performance of those with specialist training, referring images more proven modalities but to evaluate the use of radiography to a veterinary radiologist could be considered. when other modalities are not an option. Imaging of the SLNs Sublumbar lymph node size was important for radiographic should be performed with ultrasound or cross-sectional imaging identification and a size at which they become conspicuous was when available, especially if identification of lymphadenopathy identified. Having at least 1 SLN with a height $ 21.5 mm would change the treatment plan such as in cases of AGAAS. on ultrasound produced the best sensitivity and specificity Our study had several limitations. The study population for radiographic detection by observers with specialist imag- was small with a low number of patients included in the study ing training. Due to the poor intra-observer agreement for having SLN enlargement. Not all enlarged SLNs were con- observer A, the ROC curves generated very different results for firmed to have neoplastic infiltration. However, the aim of this their first and second data sets. Because of this, no conclusions study was not to identify neoplastic nodes, but to determine if could be made and the results were not reported. All SLNs with SLN enlargement could be detected on radiographs. Control confirmed metastasis measured above . 20.1 mm in height; cases were chosen to avoid patients with sublumbar lymph- however, larger lymph nodes are more likely to be sampled adenopathy and although the SLNs were ultrasonographically and it is possible that lymph nodes smaller in size contained normal, lack of histopathologic confirmation is a limitation. metastasis. Lymph node size, however, has been documented to A sonographic SLN height of 8 mm was chosen as the cut- be significantly associated with neoplastic versus benign lymph off above which SLNs were considered enlarged in our study. nodes (21,25); therefore, radiographic visualization should raise This was based on reference ranges for canine and feline lymph suspicion of neoplastic infiltration. nodes provided in Penninck’s textbook, which notes that the All radiographic features evaluated were significantly associated adult canine MILNs may measure up to 7 to 8 mm (22). There with a diagnosis of SLN enlargement on ultrasound, except a is a wide range of reported values for the size of normal SLNs. finding of narrowing of the colon from the 5th lumbar vertebra Palladino et al (6) found the mean normal MILN size to be to the sacrum. Ventral displacement of the colon was associated between 4.3 mm and 8.9 mm. Anderson et al (2) considered any with a good sensitivity, but surprisingly a poor specificity, indicat- SLN . 10 mm enlarged in their study. The veterinary oncology ing it could be associated with a false diagnosis of enlargement. response evaluation criteria in solid tumors (RECIST) considers Knowledge of these radiographic signs may be useful to aid in normal lymph node size to be , 10 mm in short axis (30,31). identifying SLN enlargement on radiographs. The radiographic Considering the RECIST criteria and articles published after the features could also be useful to help identify SLN enlargement in start of our study (2,6), a cutoff . 10 mm may have been more patients undergoing abdominal radiography without prior knowl- appropriate and could be used in future studies. Interestingly, edge of a primary tumor. If SLN enlargement is detected on a there were no lymph nodes in our study measuring between lateral abdominal radiograph, screening for a primary tumor can 8 and 10 mm; therefore, a cutoff size . 10 mm would not have be recommended. For example, in a case of AGAAS in which an changed our results or conclusions. anal gland mass has yet to be identified, abdominal radiography In our study, height was chosen as the measurement for deter- may be performed due to clinical signs such as tenesmus and a mining SLN enlargement on ultrasound. The RECIST criteria finding of SLN enlargement could prompt the veterinarian to recommend using the width or height to measure lymph nodes perform a rectal examination, identifying the mass. rather than the length (30). For retrospective cases, height was Interestingly, a patient with only a single IILN enlarged recorded for lymph node size and because only still images were (25 mm) on ultrasound and no MILN enlargement was identi- available, it would be difficult to ascertain whether the node fied as having SLN enlargement on radiographs by both observ- was displayed in its maximum length in the image. Height best ers with specialist training. The IILN was surgically removed and represented what would be seen on radiographs, as length could confirmed to have AGAAS metastasis. In our experience, and in be misrepresented due to summation of the SLNs (the MILN the experience of others (2), it is unusual to see IILN enlarge- are more cranially positioned than the IILN and these nodes ment without MILN enlargement. It has been mentioned that could appear as one).

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Although the general practitioner in our study demonstrated marked enlargement and should raise concern for neoplastic poorer performance than the observers with specialist imaging infiltration. Lack of radiographic visualization does not exclude training, it is important to note that there was only one general mild to moderate enlargement and further imaging is warranted practitioner in this study. Therefore, a conclusion cannot be in such cases. Referral of abdominal radiographs to a veterinary drawn that all general practitioners would perform similarly. radiologist could be considered to increase detection; however, The interpretation abilities of a general practitioner could be additional imaging such as ultrasound or CT remains important influenced by an interest in diagnostic imaging, additional train- to confirm or exclude sublumbar lymphadenopathy, especially ARTICLE ing through continuing education, or years spent in practice. in cases in which treatments such as radiation therapy and/or This could be addressed by repeating the current study using surgery are being considered. multiple general practitioners as observers. Similar to a study by Palladino et al (6), the ultrasound data Acknowledgments for the retrospective controls relied on the written radiologist The authors sincerely thank Timothy D. H. Parkin for statisti- report and the saved images taken at the time of examination. In cal analysis of the data, Dr. Henrik Stryhn for statistical advice, some cases, reports noted the SLNs to be within normal limits and Dr. Lynne O’Sullivan for advice and assistance during the but did not specify if the radiologist visualized the lymph node editorial process. CVJ and deemed it to be normal or if the node was not identified and assumed to be normal. This was the case for IILN and References SALNs; however, clear images allowing measurement of the . 1 Ganesan S, Mohindroo J, Verma P, Saini NS. Ultrasonographic features right and left MILNs were available for all control cases. As our of medial iliac and jejunal lymph nodes in apparently healthy dogs. Turk J Vet Anim Sci 2016;40:225–228. study aimed to evaluate the identification of enlarged SLNs on 2. Anderson CL, Mackay CS, Roberts GD, Fidel J. Comparison of radiographs, it was most relevant to determine if enlargement abdominal ultrasound and magnetic resonance imaging for detection was present or absent on ultrasound. It was assumed that IILN of abdominal lymphadenopathy in dogs with metastatic apocrine gland adenocarcinoma of the anal sac. Vet Comp Oncol 2015;13:98–105. enlargement would have been detected on ultrasound and 3. Bezuidenhout A. The lymphatic system. In: Evans HE, de Lahuna A, documented; however, sacral lymphadenopathy may not have eds. Miller’s Anatomy of the Dog. 4th ed. St. Louis, Missouri: Elsevier been recognized and this is a limitation of the current study. Saunders, 2013:550–562. 4. Pugh CR. Ultrasonographic examination of abdominal lymph nodes in It is possible that some cases, especially those with AGAAS, the dog. Vet Radiol Ultrasound 1994;35:110–115. had SALN enlargement without MILN or IILN enlargement. 5. Mayer MN, Lawson JA, Silver TI. Sonographic characteristics of pre- Such cases could have had lymph nodes correctly identified as sumptively normal canine medial iliac and superficial inguinal lymph nodes. Vet Radiol Ultrasound 2010;51:638–641. enlarged on radiographs but given a false diagnosis of being 6. Palladino S, Keyerleber MA, King RG, Burgess KE. Utility of computed normal on ultrasound. This study could be repeated using CT tomography versus abdominal ultrasound examination to identify ilio- as the comparator instead of ultrasound, given its advantage in sacral lymphadenomegaly in dogs with apocrine gland adenocarcinoma of the anal sac. J Vet Intern Med 2016;30:1858–1863. identification of the SALN (6,20). 7. Mortier F, Daminet S, Vandenabelle S, Van de Maele I. Canine lym- Another potential limitation of our study is observer bias phoma: A retrospective study (2009–2010). Vlamms Diergeneeskundig when evaluating radiographs. To help control this, observers Tijdschrift 2012;81:341–351. 8. Berrocal A, Vos J, Van Den Ingh T. Canine perineal tumours. Zentralbl were blinded to patient status (diseased versus healthy) but made Veterinarmed A 1989;36:739–749. aware that diseased and control patients with normal abdominal 9. Goldschmidt MH, Schofer, FS. Anal sac tumors. In: Goldschmidt radiographs were added to the image set. Despite this, and the MH, Schofer FS, eds. Skin Tumours of the Dog and Cat. Oxford, UK: Pergamon Press, 1992:103–108. fact that the image set was randomized, observers were given the 10. Williams LE, Gliatto JM, Dodge RK, et al. Carcinoma of the apocrine task of determining the presence or absence of SLN enlargement glands of the anal sac in dogs: 113 cases (1985–1995). J Am Vet Med and this increased awareness may have contributed to observer Assoc 2003;223:825–831. 11. Ross J, Scavelli T, Matthiesen D. Adenocarcinoma of the apocrine glands overinterpretation. This may have occurred with our less expe- of the anal sac in dogs: A review of 32 cases. J Am Anim Hosp Assoc rienced observers (A and B), as several cases were incorrectly 1991;27:349–355. identified as having enlargement, possibly supporting over- 12. Goldschmidt MH, Zoltowski C. Anal sac gland adenocarcinoma in the dog: 14 cases. J Small Anim Pract 1981;22:119–128. interpretation. Although the patient name was not included in 13. Bennett PF, DeNicola DB, Bonney P, Glickman NW, Knapp DW. the list of cases to be reviewed, the patient name could be seen Canine anal sac adenocarcinomas: Clinical presentation and response on the images. It is possible the observers had seen the patient to therapy. J Vet Intern Med 2002;16:100–104. 14. Turek MM, Forrest LJ, Adams WM, Helfand SC, Vail DM. Postoperative and/or the images in the past and this may have introduced radiotherapy and mitoxantrone for anal sac adenocarcinoma in the dog: bias. It was not evaluated whether it could be determined on 15 cases (1991–2001). Vet Comp Oncol 2003;1:94–104. radiographs if more than one SLN was enlarged. This concept 15. Emms SG. Anal sac tumours of the dog and their response to cytoreduc- tive surgery and chemotherapy. Aust Vet J 2005;83:340–343. could be considered in future studies with a larger number of 16. Hobson HP, Brown MR, Rogers KS. Surgery of metastatic anal sac patients and using CT as a comparator to better differentiate adenocarcinoma in five dogs. Vet Surg 2006;35:267–270. the SLNs from each other. 17. Polton GA, Brearley MJ. Clinical stage, therapy, and prognosis in canine anal sac gland carcinoma. J Vet Intern Med 2007;21:274–280. In conclusion, radiographic findings of an abnormal soft 18. Majeski SA, Steffey MA, Fuller M, Hunt GB, Mayhew PD, Pollard RE. tissue opacity in the caudal retroperitoneal space, loss of the Indirect computed tomographic lymphography for iliosacral lymphatic ventral margin of the iliopsoas muscle, and ventral displacement mapping in a cohort of dogs with anal sac gland adenocarcinoma: Technique description. Vet Radiol Ultrasound 2017;58:295–303. of the colon can be used to help identify SLN enlargement on 19. Potanas CP, Padgett S, Gamblin RM. Surgical excision of anal radiographs. Radiographic visualization was associated with sac apocrine gland adenocarcinomas with and without adjunctive

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chemotherapy in dogs: 42 cases (2005–2011). J Am Vet Med Assoc 27. Nyman HT, Kristensen AT, Skovgaard IM, McEvoy FJ. Characterization 2015;246:877–884. of normal and abnormal canine superficial lymph nodes using gray-scale 20. Pollard RE, Fuller MC, Steffey MA. Ultrasound and computed tomog- B-mode, color flow mapping, power and spectral Doppler ultrasound: raphy of the iliosacral lymphatic centre in dogs with anal sac gland A multivariate study. Vet Radiol Ultrasound 2005;46:404–410. carcinoma. Vet Comp Oncol 2017;15:299–306. 28. Sato AF, Solano M. Ultrasonographic findings in abdominal mast cell 21. Llabrés-Díaz FJ. Ultrasonography of the medial iliac lymph nodes in disease: A retrospective study of 19 patients. Vet Radiol Ultrasound the dog. Vet Radiol Ultrasound 2004;45:156–165. 2004;45:51–57. 22. d’Anjou MA, Carmel EN. Abdominal cavity, lymph nodes, and great 29. Kinns J, Mai W. Association between malignancy and sonographic vessels. In: Penninck D, d’Anjou MA, eds. Atlas of Small Animal heterogeneity in canine and feline abdominal lymph nodes. Vet Radiol Ultrasonography. 2nd ed. Ames, Iowa: Wiley Blackwell, 2015:455–479. Ultrasound 2007;48:565–569 23. Landis JR, Koch GG. The measurement of observer agreement for 30. Nguyen SM, Thamm DH, Vail DM, London CA. Response evaluation categorical data. Biometrica 1977;33:159–174. criteria for solid tumours in dogs (v1.0): A Veterinary Comparative

ARTICLE 24. Wouda RM, Borrego J, Keuler NS, Stein T. Evaluation of adjuvant Oncology Group (VCOG) consensus document. Vet Comp Oncol carboplatin chemotherapy in the management of surgically excised anal 2015;13:176–183. sac apocrine gland adenocarcinoma in dogs. Vet Comp Oncol 2013;14: 31. Vail DM, Michels GM, Khanna C, Selting KA, London CA. Response 67–80. evaluation criteria for peripheral nodal lymphoma in dogs (v1.0) — A 25. De Swarte M, Alexander K, Rannou B, d’Anjou M, Blond L, Veterinary Cooperative Oncology Group (VCOG) consensus document. Beauchamp G. Comparison of sonographic features or benign and Vet Comp Oncol 2010;8:28–37. neoplastic deep lymph nodes in dogs. Vet Radiol Ultrasound 2011;52: 451–456. 26. Frank PM. The peritoneal space. In: Thrall DE, ed. Texbook of Veterinary Diagnostic Radiology. 6th ed. St. Louis, Missouri: Saunders Elsevier, 2013:659–678.

756 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY Article

Gap between producers and veterinarians regarding biosecurity on Quebec dairy farms José Denis-Robichaud, David F. Kelton, Cathy A. Bauman, Herman W. Barkema, Gregory P. Keefe, Jocelyn Dubuc

Abstract — As part of the ProAction on-farm program to implement national biosecurity requirements on dairy farms, Canadian veterinarians are called upon to complete biosecurity risk assessments. The objective of the present study was consequently to understand veterinarians’ perceptions of biosecurity, and to compare perceptions among producer-veterinarian pairs. Questionnaires were administered to 106 producers from Quebec and their veterinarians (n = 82), and the answers of the producer-veterinarian pairs were compared. While most veterinarians reported it was easy to discuss biosecurity with their clients, most veterinarians and producers did not report discussing biosecurity. Moreover, when producers or veterinarians reported discussing biosecurity topics, there was no agreement amongst pairs. Veterinarians also misjudged how their clients perceived the importance and usefulness of biosecurity. Finally, veterinarians reported they had the knowledge and opportunity to assess and discuss biosecurity on dairy farms but lacked skills for evaluating farms and communicating their knowledge.

Résumé — Différences entre les producteurs et les vétérinaires en matière de biosécurité dans les fermes laitières du Québec. Dans le cadre du programme à la ferme ProAction visant à mettre en œuvre les exigences nationales de biosécurité dans les fermes laitières, les vétérinaires canadiens sont appelés à effectuer l’évaluation des risques reliés à la biosécurité. L’objectif de cette étude était, par conséquent, de comprendre la perception qu’ont les vétérinaires de la biosécurité et de comparer cette perception entre les paires producteurs-vétérinaires. Des questionnaires ont été administrés à 106 producteurs québécois et à leurs vétérinaires (n = 82). Les réponses des paires producteurs-vétérinaires ont été comparées. Alors que la plupart des vétérinaires ont déclaré qu’il était facile de discuter de biosécurité avec leurs clients, la plupart des vétérinaires et des producteurs n’ont pas déclaré en avoir discuté dans l’année précédant l’étude. De plus, lorsque les producteurs ou les vétérinaires ont rapporté avoir discuté de sujets liés à la biosécurité, il n’y avait pas d’accord entre les paires. Les vétérinaires ont également mal évalué la façon dont leurs clients percevaient l’importance et l’utilité des mesures de biosécurité. Enfin, les vétérinaires ont indiqué qu’ils avaient les connaissances et la possibilité d’évaluer et de discuter de la biosécurité dans les exploitations laitières, mais manquaient de compétences pour évaluer les exploitations et communiquer leurs connaissances. (Traduit par Dr José Denis-Robichaud) Can Vet J 2020;61:757–762

Introduction practices have a beneficial impact on animal and herd heath, n animal production industries, infectious diseases have a their adoption is relatively limited in dairy herds in Canada (4) I major impact on animal health and productivity, and also and worldwide (5–7). To address this issue, the Canadian dairy have the potential to make a broader impact on human health industry has included biosecurity as one of the main pillars of and the economy. Biosecurity is defined as the set of manage- the Canadian dairy producer Quality Assurance Program, the ment practices implemented to avoid the introduction and proAction initiative (8). The overall objective of proAction is to spread of infectious diseases (1–3). Although it is clear that these implement a national on-farm program to maintain consistently

Independent researcher, Amqui, Quebec G5J 2N5 (Denis-Robichaud); Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1 (Kelton, Bauman); Department of Production Animal Health, University of Calgary, Alberta T2N 1N4 (Barkema); Department of Health Management, University of Prince Edward Island, Charlottetown, Prince Edward Island C1A 4P3 (Keefe); Département de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal, 3200, rue Sicotte, St-Hyacinthe, Quebec J2S 2M2 (Dubuc). Address all correspondence to Dr. Denis-Robichaud; e-mail: [email protected] This study was funded by the Dairy Cluster 2 Research program through the Canadian Agri-Science Clusters Initiative (Dairy Farmers of Canada, Agriculture and Agri-Food Canada, Canadian Dairy Commission, and Natural Sciences and Engineering Research Council). 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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high quality standards, which include biosecurity requirements, ness and importance of biosecurity (multiple choice question). namely the completion of a biosecurity risk assessment with a Veterinarians were also asked if they considered that they had veterinarian. the knowledge, skills, and opportunity to evaluate and discuss Veterinarians have been identified as the main source for biosecurity with producers (yes/no questions). Finally, they were health management knowledge for livestock producers (9–11), asked why it was difficult to discuss biosecurity and why they but many do not consider themselves as the main provider of thought producers did not adopt biosecurity practices (open- biosecurity information (9,12). In a recent study, few Canadian ended questions). dairy producers reported having discussed specific biosecurity practices with their veterinarian (1% to 20%, depending on the Statistical analysis

ARTICLE practice; 13), but it is unclear why. Veterinarians have reported Statistical analyses were conducted using R version 3.6.0 (17). the barriers to promoting biosecurity were the lack of financial Producers from Quebec were compared to the other Canadian resources, interest, and time from their clients, but also the lack NDS producer respondents by comparing their farms’ character- of their own interest, knowledge, and trust in the efficacy of the istics and answers to biosecurity questions using the Wilcoxon measures, which could reflect an issue in knowledge transfer rank-sum test for the herd size variable (comparing medians) between the researchers and the industry actors who need to and using a Chi-square test for equal proportions for categori- implement the results of the research (9,12,14). In order to opti- cal variables. Descriptive analyses for the questions of interest mize the implementation of the biosecurity component of the were computed as proportions for categorical data, and as proAction initiative on Quebec dairy farms, the objective of this frequencies for qualitative data. Proportions were compared study was to determine veterinarians’ perceptions of biosecurity, using a Chi-square test for equal proportions. Some questions and to compare perceptions among producer-veterinarian pairs. to the producers were collapsed into 2 categories, or combined to be comparable to the questions the veterinarians were asked Materials and methods (Table 1). Agreement among producer-veterinarian pairs was This study was conducted on Quebec dairy farms, follow- assessed using a Cohen’s kappa statistic for binary questions ing the Canadian National Dairy Study (NDS) 2015, which (yes/no) and using a Monte Carlo symmetry test for paired con- surveyed dairy producers about multiple aspects of dairy farm tingency tables for multiple choice questions (rcompanion pack- management across the country, and was approved by Human age). The interpretation of kappa was done as follows: 0 to 0.20: Ethics and Animal Care Committees of the University of none, 0.21 to 0.39: minimal; 0.40 to 0.59: weak; 0.60 to 0.79: Montreal (15-007-CE-RES-D, 15-Rech-1786). To determine moderate; 0.80 to 0.90: strong; . 0.90: almost perfect (18). and compare the perceptions of producers and veterinarians, Statistical significance was determined at a P-value , 0.05. data were collected in 2 steps. First, as part of the NDS (15), 374 farms across all 10 provinces in Canada were visited Results between May 10 and August 30, 2015. The sample size for this A total of 121 producers from Quebec, Canada, were visited part of the project was calculated to estimate the prevalence of during the NDS, 106 (88%) of whom shared their veterinar- common endemic diseases in Canadian herds (allowable error: ian’s name and contact information, and consented to their 5%, confidence: 95%, and expected prevalence: 40%) (15). The participation. The producers included in the present study had farms were selected using a stratified random sampling strategy a median of 61 milking cows (range: 14 to 250) which did not from all the respondents who participated in the first phase of differ from the NDS (median = 54 milking cows; P = 0.17). the NDS (all voluntary participants, non-random). At the visit, Their cows were housed in freestall (29%) and tiestall (71%) farmers were interviewed by 2 interviewers (4 different ones barns, which differed from the respondents of the NDS (42% across the province) using a questionnaire covering 5 subcatego- freestall, 58% tiestall; P = 0.01). The producers included in the ries: biosecurity, antimicrobial use, calf health, down cow man- present study also reported discussing general biosecurity more agement, and the role of veterinarians on the farm. The present than all respondents from the NDS (Quebec = 60%, NDS = study used a subset of these questions (Table 1). Producers were 47%, P = 0.02), but there was no difference for specific topics also asked if they would allow the research team to contact their (P . 0.10). All 82 veterinarians agreed to answer the questions herd veterinarian. From April 20 to June 10, 2016, all veteri- by telephone, which resulted in 106 producer-veterinarian narians identified by the participating Quebec dairy producers pairs (1 to 5 producers per veterinarian; median = 1). were contacted by 1 interviewer (different from the NDS) and While the same proportion of veterinarians and producers asked to answer a brief questionnaire by telephone (16). These reported discussing general biosecurity (59% and 60%, respec- questions referred to the same period of time during which tively; P = 1.0), there was no agreement amongst producer- the producers completed their NDS questionnaires. The vet- veterinarian pairs for reporting discussing general biosecurity erinarians were asked if general biosecurity, closed versus open (kappa = 0.11, did not differ from 0; Table 2). Producer- herd, visitor management, and visitors’ clothing, footwear, and veterinarian pairs also had discordant answers (kappa did not equipment (yes/no questions) were discussed at the visits to this differ from 0) for reporting discussing management of the herd farm (Table 1). Veterinarians were also asked if they thought the as closed versus open, management of visitor access to the farm, producer understood the importance of biosecurity and if (s)he and management of visitors’ clothes, boots, and equipment was interested in the topic (yes/no questions), and what they (Table 2). The proportion of veterinarians who reported discuss- thought their client answered to the question addressing useful- ing these specific practices was also greater than the proportion

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Table 1. Corresponding questions asked, in French, to 106 producer-veterinarian pairs from Quebec, Canada, concerning their interaction regarding biosecurity practices. Producers Veterinarians Au cours de la dernière année, Dans l’année précédent le 1er septembre 2015, Avez-vous eu une discussion avec votre vétérinaire au sujet de la gestion Avez-vous eu une ou des discussions avec le producteur sur la biosecurite de la biosécurité sur votre fermea? en général? • Non, nous n’en avons jamais parlé • Oui, mon vétérinaire m’a parlé de certains éléments de la biosécurité ARTICLE • Oui, j’ai posé des questions à mon vétérinaire au sujet de certains éléments de la biosécurité • Oui, nous avons eu une discussion au sujet d’un plan complet de biosécurité pour ma ferme

Avez-vous parlé avec un vétérinaire de ne pas introduire d’animaux de Avez-vous eu une ou des discussions sur la gestion de son troupeau source externe? ouvert vs fermé? Avez-vous parlé avec un vétérinaireb : Avez-vous eu une ou des discussions sur la gestion de ses visiteurs? • de réduire le plus possible l’accès des visiteurs aux zones d’accès restreint? • de réduire le plus possible le contact entre les visiteurs et les animaux? • d’avoir un registre des visiteurs?

Avez-vous parlé avec un vétérinaire deb : Avez-vous eu une ou des discussions sur la gestion des bottes, salopettes • demander aux employés et aux professionnels en visite d’enfiler des et équipement des visiteurs? vêtements de protection fournis par la ferme • de fournir aux professionnels en visite des bottes de plastique?

Selon vous, quelle a été la réponse du producteur à la question : En quoi la biosécurité est-elle importante pour votre ferme? « En quoi la biosecurite est-elle importante pour votre ferme? ». • Elle est utile et importante pour la gestion au quotidien de ma ferme • Elle est utile et importante pour la gestion au quotidien de ma ferme • Elle pourrait être utile pour ma ferme, mais pas suffisamment réalisable • Elle pourrait être utile pour ma ferme, mais pas suffisamment réalisable ou importante pour l’inclure dans ma gestion au quotidien ou importante pour l’inclure dans ma gestion au quotidien • Elle est importante pour ma gestion au quotidien, mais pas utile à • Elle est importante pour ma gestion au quotidien, mais pas utile à mettre en place mettre en place • La biosécurité n’est ni utile ni importante pour la gestion au quotidien • La biosécurité n’est ni utile ni importante pour la gestion au quotidien de ma ferme de ma ferme

Table 1. English translation. Producers Veterinarians In the past year, In the year preceding September 1, 2015, Have you had a discussion with your veterinarian about biosecurity Did you have one or more discussions with the producer on biosecurity management on your farma? in general? • No, we never talked about it • Yes, my veterinarian told me about some elements of biosecurity • Yes, I asked my veterinarian questions about some aspects of biosecurity • Yes, we had a discussion about a complete biosecurity plan for my farm

Did you speak with a veterinarian about not introducing animals from Did you have one or more discussions on the management of its open vs external sources? closed herd? Did you speak with a veterinarian aboutb: Did you have one or more discussions on the management of its visitors? • reducing visitor access to restricted areas as much as possible? • minimizing contact between visitors and animals? • having a visitor log?

Did you speak with a veterinarian aboutb: Did you have one or more discussions on the management of boots, • asking employees and visiting professionals to wear protective clothing overalls and visitor equipment? provided by the farm • providing visiting professionals with plastic boots?

In your opinion, what was the producer’s response to the question: How is biosecurity important for your farm? “How is biosecurity important for your farm?”. • It is useful and important to the daily operation of my farm • It is useful and important to the daily operation of my farm • It might be useful for my farm, but not feasible or important enough • It might be useful for my farm, but not feasible or important enough to implement into my daily management to implement into my daily management • It is important for my daily management, but not useful to implement • It is important for my daily management, but not useful to implement • It is neither useful nor important for the daily management of my farm • It is neither useful nor important for the daily management of my farm a The answers to this question were collapsed into binary yes/no answers. b These questions were combined in parallel, if a producer answered yes to at least one of the questions, the answer was categorized as yes. If the producer answered no to all the questions, the answer was categorized as no.

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Table 2. Number (%) of agreeing and disagreeing producer-veterinarian pairs for reporting discussing general biosecurity and biosecurity practices in Quebec dairy herds, the proportion of agreeing pairs, and the agreement beyond chance (Cohen’s kappa). Veterinarians reported yes Veterinarians reported no Producers Producers Producers Producers In the year prior to September, reported reported reported reported Cohen’s 2015, did you discuss: n yes (%) no (%) yes (%) no (%) %-agree kappa P-valuea General biosecurity? 104 39 (64) 22 (36) 23 (53) 20 (47) 57 0.11 0.29 Management of the herd as 105 5 (8) 55 (92) 5 (11) 40 (89) 43 20.02 0.63 closed versus open?

ARTICLE Management of visitors on 105 0 (0) 17 (100) 2 (2) 86 (98) 82 20.04 0.53 the farm? Management of visitors’ 106 1 (7) 13 (93) 3 (3) 89 (97) 85 0.06 0.48 clothes, boots, and equipment on the farm?

a H0: the Cohen’s kappa is 0.

Table 3. Number of agreeing and disagreeing producer-veterinarian pairs for the perception of general biosecurity by producers. Producers’ perception Might be useful for my farm, but not Is important for my Is useful and important feasible or important daily management, Is neither useful nor to the daily operation enough to implement but not useful to important for the daily Veterinarians’ perception of my farm. into my daily management. implement. management of my farm. General biosecurity: Is useful and important to the 22 23A 4 0B daily operation of my farm. Might be useful for my farm, 8A 10 2 1C but not feasible or important enough to implement into my daily management. Is important for my daily 4 6 0 1 management, but not useful to implement. Is neither useful nor important for 8B 16C 1 0 the daily management of my farm.

Gray-shaded areas — agreeing cells. A–C Discordant cells with the same uppercase letter were pairs with a significant asymmetry difference (P , 0.03).

of pr oducers (closed herd: 57 and 10%, P , 0.01; visitors: (P = 0.02; Table 3). However, veterinarians wrongly perceived 16 and 2%, P , 0.01; visitors’ apparel: 13 and 4%, P = 0.03). that producers considered general biosecurity as “neither useful Most veterinarians thought it was easy to discuss biosecurity nor important” when their producers indicated that they con- with producers (59%), and the ones who found it was difficult sidered general biosecurity as “useful and important” (P = 0.02) reported there was no interest from the producers (n = 15) or or “useful, but not feasible” (P = 0.01; Table 3). Veterinarians the producers were not receptive to the discussion (n = 7), there thought producers did not adopt biosecurity recommendations was no opportunity or time (n = 13), there were no biosecurity because they had not had any biosecurity related problems on related problems on the farm (n = 4), or biosecurity was not a their farm (n = 23), because their farm were at low risk for dis- priority (n = 3). eases (n = 7), because they were not interested (n = 6), because Most veterinarians thought producers understood the impor- the changes were too expensive (n = 5) or required too much tance of biosecurity (65%), were interested in the subject (51%), time (n = 3), or because they were not relevant (n = 5), impor- and adopted recommendations the veterinarians made (53%). tant (n = 3), or were difficult to implement (n = 2). Seventy percent (74/106) of the veterinarians, however, wrongly Most veterinarians perceived that they had sufficient knowl- perceived how the producer clients considered the usefulness and edge and opportunities to evaluate biosecurity management importance of general biosecurity. Some thought the producer on-farm (67 and 62%, respectively), but not many thought they perceived biosecurity as “useful and important” when the pro- had sufficient skills (22%). Similarly, veterinarians perceived ducers considered general biosecurity as “useful, but not feasible” they had sufficient knowledge and opportunities to discuss

760 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY biosecurity with the producers (70% and 68%, respectively), producers to implement changes (24–26). This was, however, but not the skills to deliver their biosecurity knowledge in a not directly mentioned by veterinarians in the present study as convincing form to elicit positive change (32%). a reason for the non-adoption of their recommendations. The most frequently reported item was the absence of a perceived Discussion biosecurity (infectious disease) threat by their clients. Other The goal of this study was to identify important differences in studies have reported that veterinarians considered their clients the perceptions of biosecurity by veterinarians compared to their would not adopt on-farm biosecurity practices due to lack of ARTICLE clients. Addressing these differences would help improve the knowledge or understanding, and unwillingness/incapacity to veterinarian’s role as a biosecurity advisor working to encour- invest (9,27). Perhaps these reasons are reflecting veterinarians’ age the implementation of biosecurity practices on Canadian struggles to communicate the appropriate knowledge on bio dairy farms. security to their client, which prevents them from understanding While general biosecurity had been discussed by more than the risks associated with poor biosecurity practices. half of the veterinarians, a lesser proportion reported discuss- This study used a convenience sample in the province of ing specific biosecurity practices. The barriers to discussing Quebec, which might have influenced the results. Indeed, the biosecurity were similar to those identified in previous studies farms in Quebec are smaller than those in the rest of Canada, and included the perception that producers have no interest or particularly western Canada, and a greater proportion are tie- time for biosecurity (9,12). stall barns. However, more respondents from Quebec reported The results, however, show that many veterinarians under they had discussed biosecurity with their veterinarian than estimate the producer’s perception of the importance and useful- respondents from other provinces, similar to what was found ness of biosecurity. Other studies have indeed shown a lack of for biosecurity practices adoption (4), but it is unclear how veterinarians’ awareness of producers’ goals and attitude, except this would have influenced the disagreement among producer- for general herd management topics (19). As previously observed veterinarian pairs. This should, however, be taken into con- by Hall and Wapenaar (20), there is an opportunity for veteri- sideration for the external validity of the present study if, for narians to be more proactive in addressing biosecurity on farms. example, strategies would be implemented to address the limited Moreover, the present study found that more veterinarians proportion of veterinarians who reported discussing biosecurity reported discussing biosecurity topics (closed herd, visitors, and practices, the lack of agreement among producer-veterinarian visitors’ apparel) than producers, similar to what was previously pairs, and the self-reported lack of skills to evaluate and discuss observed for topics other than biosecurity (20). Interestingly, biosecurity across the country or in another country. there was an absence of agreement among producer-veterinarian In conclusion, this study revealed that while general bio pairs for biosecurity-specific topics, but also for general bio security was reported to be discussed by more than half of the security, for which the proportion of veterinarians and produc- producers and veterinarians, specific biosecurity practices were ers who reported discussing it did not differ. This result could seldom discussed between them. Moreover, when producers or have been influenced by the social desirability (respondents veterinarians reported biosecurity practices were discussed, there behave accordingly to what they think is expected from them) was a lack of agreement between producer-veterinarian pairs on and acquiescence biases, and suggests that there could be more whether they discussed them. Veterinarians also misjudged how disagreement than previously reported. These differences could important and useful producers perceived biosecurity. Finally, partly be explained by the time lag between the producer and most veterinarians perceived they lacked effective knowledge veterinarian questionnaire and the period they were asked translation and communication skills, while most considered about (recall bias; 21). We believe, however, that the potential they had sufficient knowledge and opportunities to evaluate biases of this study (social desirability, acquiescence, and recall) and discuss biosecurity. If the dairy industry aims to promote have most likely resulted in overestimating the prevalence of veterinarians as biosecurity advisors on dairy farms, the present veterinarians and producers discussing biosecurity matters and study supports development of communication and assessment underestimating the disagreement among producer-veterinarian skills for the veterinarians as key biosecurity advisors. pairs. Another design limitation was the non-independence Acknowledgments of the data (repeated measures for some veterinarians). This could have resulted in an underestimated kappa, or variance, or The authors acknowledge the technical staff and students from both (18). As we already found there was no agreement among the University of Montreal for their contribution to question- pairs, we suspect the minimal non-independence structure of naire building and data collection. The authors thank the par- our data would not influence our conclusions. ticipating dairy farmers and veterinarians for their willingness The gap observed between producer-veterinarian pairs could to contribute to the study. CVJ suggest a lack of effective communication skills, as previously References identified in herd health veterinary visits (22). As mentioned 1. Dargatz DA, Garry FB, Traub-Dargatz JL. An introduction to biosecu- by the veterinarians in the present study, their knowledge rity of cattle operations. Vet Clin North Am Food Anim Pract 2002; and opportunity did not limit their ability to evaluate and 18:1–5. discuss biosecurity, but skills did. Studies have already dem- 2. Department for Environment, Food and Rural Affairs. Biosecurity guidance to prevent the spread of animal diseases. c2003. Available onstrated that communication skills of veterinarians were sub from: www.nonnativespecies.org/downloadDocument.cfm?id=615 Last optimal (19,22,23), which could affect their ability to motivate accessed May 25, 2020.

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3. Brennan ML, Christley RM. Cattle producers’ perceptions of biosecurity. 15. Bauman CA, Barkema HW, Dubuc J, Keefe GP, Kelton DF. BMC Vet Res 2013;9:71. Canadian National Dairy Study: Herd-level milk quality. J Dairy Sci 4. Denis-Robichaud J, Kelton DF, Bauman CA, Barkema HW, Keefe 2018;101:2679–2691. GP, Dubuc J. Biosecurity and herd health management practices on 16. National Dairy Study. Veterinarian perceptions questionnaire. c2015. Canadian dairy farms. J Dairy Sci 2019;102:9536–9547. Available from: https://www.nationaldairystudy.ca/biosecurity Last 5. Moore DA, Leach DA, Bickett-Weddle D, et al. Evaluation of a biologi- accessed May 25, 2020. cal risk management tool on large Western United States dairies. J Dairy 17. R Core Team. A language and environment for statistical computing. Sci 2010;93:4096–4104. Foundation for Statistical Computing, Vienna, Austria c2015. Available 6. Sarrazin S, Cay AB, Laureyns J, Dewulf J. A survey on biosecurity and from: http://www.R-project.org Last accessed May 25, 2020. management practices in selected Belgian cattle farms. Prev Vet Med 18. McHugh ML. Interrater reliability: The kappa statistic. Biochemia 2014;117:129–139. Medica 2012;22:276–282. 7. Emanuelson U, Sjöström K, Fall N. Biosecurity and animal disease 19. Derks M, van Woudenbergh B, Boender M, Kremer W, van Werven T,

ARTICLE management in organic and conventional Swedish dairy herds: A ques- Hogeveen H. Veterinarian awareness of farmer goals and attitudes to tionnaire study. Acta Vet Scand 2018;60:23. herd health management in The Netherlands. Vet J 2013;198:224–228. 8. Dairy Farmers of Canada. ProAction — Biosecurity. c2018. Available 20. Hall J, Wapenaar W. Opinions and practices of veterinarians and dairy from: https://www.dairyfarmers.ca/proaction/resources/biosecurity Last farmers towards herd health management in the UK. Vet Rec 2012; accessed May 25, 2020. 170:441. 9. Gunn GJ, Heffernan C, Hall M, McLeod A, Hovi M. Measuring and 21. Dohoo IR, Martin SW, Stryhn H. Veterinary epidemiologic research. comparing constraints to improved biosecurity amongst GB farmers, 2nd ed. Charlottetown, Prince Edward Island: VER Inc., 2009. veterinarians and the auxiliary industries. Prev Vet Med 2008;84: 22. Ritter C, Adams CL, Kelton DF, Barkema HW. Clinical communication 310–323. patterns of veterinary practitioners during dairy herd health and produc- 10. Ellis-Iversen J, Cook AJC, Watson E, et al. Perceptions, circumstances tion management farm visits. J Dairy Sci 2018;101:1–14. and motivators that influence implementation of zoonotic control 23. Cipolla M, Zecconi A. Short communication: Study on veterinarian programs on cattle farms. Prev Vet Med 2010;93:276–285. communication skills preferred and perceived by dairy farmers. Res 11. Frössling J, Nöremark M. Differing perceptions — Swedish farmers’ Vet Sci 2015;99:60–62. views of infectious disease control. Vet Med Sci 2016;2:54–68. 24. Kleen J, Atkinson O, Noordhuizen JPTM. Communication in pro- 12. Sayers RG, Good M, Sayers GP. A survey of biosecurity-related practices, duction animal medicine: Modelling a complex interaction with the opinions and communications across dairy farm veterinarians and advi- example of dairy herd health medicine. Ir Vet J 2011;64:8. sors. Vet J 2014;200:261–269. 25. Jansen J, Lam TJGM. The role of communication in improving udder 13. Denis-Robichaud J, Kelton DF, Bauman CA, Barkema HW, Keefe GP, health. Vet Clin North Am Food Anim Pract 2012;28:363–379. Dubuc J. Canadian dairy farmers’ perception of the efficacy of biosecu- 26. Ritter C, Adams CL, Kelton DF, Barkema HW. Factors associated with rity practices. J Dairy Sci 2019;102:10657–10669. dairy farmers’ satisfaction and preparedness to adopt recommendations 14. Garforth C, Rehman T, McKemey K, et al. Improving the design of after veterinary herd health visits. J Dairy Sci 2019;102:4280–4293. knowledge transfer strategies by understanding farmer attitudes and 27. Pritchard K, Wapenaar W, Brennan ML. Cattle veterinarians’ awareness behaviour. J Farm Manag 2004;12:17–32. and understanding of biosecurity. Vet Rec 2015;176:546.

762 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY Article

Descriptive epidemiology of companion animal dermatophytosis in a Canadian Pacific Northwest animal shelter system

Emilia Gordon, Amanda Idle, Lena DeTar

Abstract — This study investigated the frequency of false positive dermatophyte cultures, dermatophyte prevalence, and dermatophytosis risk factors in an animal sheltering system in British Columbia. Records for 80 471 incoming shelter animals over 3.5 years were accessed retrospectively. For 831 high-risk animals cultured, the false positive rate was 28% [N = 229; 95% confidence interval (CI): 25% to 31%]. Microsporum canis was diagnosed in 201 cases (0.25%, 95% CI: 0.22% to 0.29%) and Trichophyton was diagnosed in 43 cases (0.055%, 95% CI: 0.040% to 0.072%). Microsporum canis cases occurred only in cats and rabbits, but not in dogs. Cats were twice as likely to be diagnosed with Trichophyton as dogs. Puppies and kittens (versus adults) and animals from cruelty investigations (versus other sources) were significantly more likely to be diagnosed with dermatophytosis. Animals seized from 4 cruelty cases with enzootic dermatophytosis did not follow overall prevalence or population risk patterns. Understanding patient and population risk factors can help expedite diagnosis, treatment, and recovery, and reduce contagious risk to humans and animals.

Résumé — Épidémiologie descriptive de la dermatophytose des animaux de compagnie dans un système de refuges animaliers du Nord-Ouest Pacifique canadien. Cette étude descriptive cherchait à déterminer la fréquence de faux positifs (contaminant) dans les cultures de dermatophytes, la prévalence de dermatophytes, ainsi que les facteurs de risque de dermatophytose dans un système de refuge pour animaux en Colombie-Britannique. Les archives d’arrivées aux refuges de 80 471 animaux sur une période de 3,5 ans ont été inspectées rétrospectivement. Pour les cultures de 831 animaux à haut risque, le taux de faux positifs était de 28 % (N = 229; IC 25–31 %). Microsporum canis a été diagnostiqué dans 201 cas (0,25 %; IC 0,22–0,29 %) et 43 cas de dermatophytes Trichophyton ont été diagnostiqués (0,055 %; IC 0,040–0,072 %) chez quatre espèces d’animaux. Les cas de M. canis n’ont été identifiés que chez le chat et le lapin, mais pas chez le chien. Les chats étaient diagnostiqués deux fois plus souvent avec Trichophyton que les chiens. Les chiots et les chatons (vs adultes), ainsi que les animaux arrivant au refuge à la suite d’enquêtes pour maltraitance (vs autres sources) étaient significativement plus souvent diagnostiqués avec une dermatophytose. Les animaux avec dermatophytose enzootique saisis dans quatre cas de maltraitance n’étaient conformes ni avec la prévalence générale, ni avec les schémas de population à risque. Comprendre les facteurs à risque chez le patient et dans la population peut permettre d’accélérer le diagnostic, le traitement et la guérison, tout en réduisant le risque de contagion aux humains et aux animaux. (Traduit par Emeline Nogues) Can Vet J 2020;61:763–770

Introduction which are not part of the normal fungal microbiota (1,5,6). The ermatophytosis is a zoonotic fungal infection of the super- incubation period is 2 to 4 wk (7). Healthy individuals typi- D ficial skin common in humans and animals. Globally, cats cally experience mild, self-limiting disease, but dermatophytosis are the most commonly affected companion animal species (1), can be challenging to manage in a shelter or cattery setting (8) but dogs and small companion mammals are also at risk. The and can become enzootic in poorly cared-for confined popula- most important dermatophyte species in companion animals are tions (9). Variable clinical signs make screening and diagnosis Microsporum canis, M. gypseum, and Trichophyton species (2–4), complicated. In particular, subclinical infections and fomite

British Columbia Society for the Prevention of Cruelty to Animals Ringgold standard institution, Vancouver, British Columbia (Gordon, Idle); Cornell University Ringgold standard institution — Maddie’s Shelter Medicine Program, Cornell University College of Veterinary Medicine, Ithaca, New York, USA (DeTar). Address all correspondence to Dr. Emilia Gordon; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

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Table 1. BC SPCA regions — climate and precipitation data (19). Winter Spring Summer Autumn Average Average Average Average Average Average Average Average temperature precipitation temperature precipitation temperature precipitation temperature precipitation Region (°C) (mm) (°C) (mm) (°C) (mm) (°C) (mm) Northa 26.6 73.9 4.4 57.5 14.4 75.5 4.2 97.4 Interiorb 24.9 31.7 7.6 31.2 18.6 44.5 6.4 36.4 Islandc 3.5 167.3 9.1 80.4 17 37.0 10 119.9 Lower Mainlandd 3.7 221.7 9.6 141.3 17.1 66.9 10.4 194.4

ARTICLE Branch locations: Fort St. John, Prince George, Prince Rupert, Dawson Creek, Williams Lake. b Branch locations: Kamloops, Nelson, Penticton, Shuswap, Vernon. c Branch locations: Campbell River, Nanaimo, Salt Spring Island. d Branch locations: Abbotsford, Burnaby, Chilliwack, Maple Ridge, Port Coquitlam, Sunshine Coast, Surrey, Vancouver, West Vancouver.

carriage of M. canis is common in cats (1,2,8), so clinicians often Columbia (BC) shelter system, and to investigate dermatophy- rely on risk factors to influence diagnostic suspicion. tosis risk factors in incoming shelter animals. Risk factors for dermatophytosis identified in individual animals include species, breed, young age, poor body condition, Materials and methods concurrent disease, physiological stress, poor grooming and Shelter data and regions hygiene, and microtrauma to the skin (1,7). Animals with skin The British Columbia Society for the Prevention of Cruelty to lesions are more likely to test positive than those without (10). Animals (BC SPCA) operates a unique sheltering system with Dermatophytosis is more common in warm or humid climates 34 branches across 4 regions of the northwestern Canadian prov- and in shelter, group-housed, and free-roaming cats (11–13) ince (Table 1). Annual intake ranges from 139 to 1952 animals and is a concern in animal hoarding cases (14). In shelters, per branch. Shelter intake policies include open and limited risk factors identified include intake source (stray, transfer), admission formats depending on the presence of municipal and positive Wood’s lamp examination findings in siblings or contracts. housemates (8,15). Rapid diagnosis and treatment of dermato- From June 1, 2015 to March 27, 2019, 80 471 canine, phytosis are desirable in both private practice and shelter settings feline, and small domestic mammal species entered BC SPCA to reduce contagious risk to humans and animals. shelters. Incoming data were retrieved retrospectively from the Clinical dermatophytosis is typically diagnosed via a com- shelter software database used across all facilities (Shelter Buddy; bination of physical and Wood’s lamp examination findings The Animal Shelter Database System, RSPCA, Queensland, and diagnostic testing [direct hair examination, fungal culture, Australia) in April 2019. The BC SPCA Animal Welfare polymerase chain reaction (PCR)] (1,8,10). One standard test Committee approved the study protocol and gave permission for detection and species identification of dermatophytes is to use shelter data. fungal culture of hair (1,7,8). In shelter settings, the number of colony-forming units (cfu) have been used to guide Screening and diagnosis diagnosis, treatment, and monitoring (7,8,10). Clinical and Trained BC SPCA staff members performed standardized physi- manufacturer recommendations include daily checks for color cal examinations on all companion animals at intake including change for 14 to 21 d, macroscopic examination of colony determining species, breed, and age and noting any problems morphology, and microscopic examination of any suspicious requiring follow-up by a veterinarian. The skin and coat were growth (1,8,10,16). It is important to differentiate between checked carefully for lesions consistent with possible derma- M. canis and Trichophyton species because this knowledge guides tophytosis in room light, followed by an examination under a treatment and further testing protocols (2). Contaminant sap- Wood’s lamp. rophyte growth is also common and can cause delayed derma- Animals with identified lesions and animals associated with tophyte test media (DTM) color change, which may be falsely them (e.g., potentially sharing a contaminated environment) interpreted as a positive result (8,17). When macroscopic and were defined as high risk and sampled for culture using the microscopic examinations of suspected dermatophyte colonies toothbrush technique (1,2). Toothbrushes were placed in new are not performed, there can be a 1 in 5 chance of a false posi- Ziploc bags labelled with the date. Sample bags were mailed, tive result (17). couriered, or hand-delivered to the BC SPCA Hospital in There is little published work on dermatophytosis prevalence Vancouver. Upon arrival, toothbrushes were inoculated onto in companion animals in Canada, with 1 study in Quebec from DTM/Enhanced Sporulation Agar bi-plates (Sensor Health the 1980s (18). To date, there is no published research on risk RW2 Culture System, Cambridge, Ontario) using standard factors or epidemiology of shelter animal dermatophytosis technique (7,10). Monitoring of the plates and microscopic in Canada. The objectives of this retrospective study were to examination occurred in a secure area by trained professionals. investigate culture results by fungal species including frequency Plates were maintained in an incubator (Quincy Lab, Model 12E of false positives, to determine the prevalence of dermatophyte Incubator, Chicago, Illinois, USA) between 25°C and 30°C at species isolated from companion animals in a large British 42% to 46% humidity.

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Table 2. Prevalence of all cases of dermatophytosis diagnosed in companion animals at BC SPCA shelters between June 2015 and March 2019. Species/Diagnosis Cat (%) Dog (%) Rabbit (%) Guinea pig (%) Total (%) M. canis 180 (0.35) 15 (0.06) 6 (0.4) 0 201 (0.25) M. canis carrier 14 (0.03) 9 (0.04) 7 (0.4) 0 30 (0.04) Trichophyton 35 (0.06) 8 (0.04) 0 0 43 (0.05) Trichophyton carrier 8 (0.02) 6 (0.03) 0 1 (1.4) 15 (0.02) Dermatophyte species 29 (0.06) 2 (0.01) 0 0 31 (0.04) ARTICLE not identified Culture negative 322 (0.6) 167 (0.7) 11 (0.7) 8 (0.7) 511 (0.6) Not tested 50 275 (99.2) 23 337 (99.3) 1538 (98.5) 1117 (99.9) 79 640 (99.0) Total 50 699 23 494 1562 1119 80 471

Bold text indicates total animals testing P2 or P3 positive for each dermatophyte species.

Plates were examined every 1 to 3 d for 14 d, and results Table 3. P-scores of all diagnostic cultures with growth and were recorded on day 7 and day 14. Nonpigmented, fluffy species identification. colonies associated with media color change within 24 h of Species/P-scorea Cat Dog Rabbit Guinea pig initial growth were coded as positive. Results were recorded M. canis P1 19 11 7 0 as negative (no growth), contaminant (negative for dermato- M. canis P2 10 2 1 0 phytosis), or positive using P-scores to describe colony count M. canis P3 167 10 5 0 Trichophyton P1 11 8 0 1 [NG (No Growth) = 0, P1 = 1 to 4 cfu/plate, P2 = 5 to 9 cfu/ Trichophyton P2 11 1 0 0 plate, P3 = 101 cfu/plate] (7,8,10). All P2 and P3 plates were Trichophyton P3 21 6 0 0 coded as “positive” (15). P1 plates with subsequent positive a P2 and P3 are considered “infected;” some P1 animals with subsequent positive follow-up cultures (taken after treatment initiation) were also cultures after treatment initiation are coded as “infected” for the purposes of this study. coded as “positive,” as repeat cultures on fomite carriers should be negative (10). P1 plates with negative follow-up cultures were coded as fomite carriers (10) and grouped with nega- spring (March to May). In the final analysis, exclusion of all cats tive and “not tested” animals in risk factor analysis. Positive with no region of origin as well as cats admitted after May 31, plates were sampled with clear cellophane tape and stained 2018 resulted in a count of 39 995 cats. Further exclusion of with lactophenol cotton blue for microscopic examination. 94 cats from enzootic dermatophytosis investigation cases which White fluffy contaminant colonies were sampled and stained to had not already been excluded resulted in a final population of identify dermatophyte species and rule out non-dermatophyte 39 901 cats. growth. Pigmented contaminant colonies were not microscopi- cally examined (8). Plates with growth that could not be clearly Statistical analysis identified as dermatophyte or saprophyte were sent to an outside We chose prevalence to describe the frequency of dermatophy- laboratory for further fungal identification (Idexx Reference tosis because animals were assumed to be infected, incubating Laboratories, Delta, BC). infection, or carriers at intake. Since the risk factors were categorical, we used the x2 test to assess association with each factor Risk factors and exclusion criteria and the diagnosis of species of dermatophyte. Proportional con- Risk factors were selected a priori based on previous find- fidence intervals were calculated using the EpiTools proportion ings in the literature and the data available for each animal in confidence interval utility (20) set to a 95% CI employing the the shelter database. Shelter software assigned cats and dogs Wilson method. Regression coefficients were exponentiated to 6 mo and under as “juvenile,” and over 6 mo as “adult.” For obtain odds ratios (OR), and those significant at P , 0.20 were analysis of intake source, categories included Stray (stray, aban- further evaluated. Unconditional logistic regression (21) was doned, and animal control intakes), Owner Surrender, Cruelty used to assess joint effects and control confounding. Those with Investigations (humane officer-surrendered and seized animals P , 0.05 were retained in the final model. x2 tests and logistic with active cruelty files), Shelter Offspring, Returns, Transfer regression were performed in SPSS (IBM SPSS v.26, Armonk, In, and Emergency Boarding (boarding for wildfire evacuees and New York, USA). Significance was set at P , 0.05. other temporary boarding for owners in crisis). Owner requested euthanasia cases and animals arriving deceased were excluded. Results Amongst cats (N = 50 699), only those with a region of origin Culture results specified were retained in regional analyses (N = 50 428). Only Of the 80 471 companion animals entering BC SPCA shel- cats admitted to the shelter during the first 3 full years of the ters between June 2015 and February 2019, 831 dogs, cats, study period were retained for seasonal analyses (N = 40 205); rabbits, rats, and guinea pigs from 22 branches were considered those admitted after May 31, 2018 were excluded. Intake high-risk and received initial fungal cultures. Of these, 320 or seasons were defined as summer (June to August), autumn 38.5% (95% CI: 35.2% to 41.9%) were positive for dermato- (September to November), winter (December to February), and phyte growth (Tables 2, 3). Of the positives, 31 did not have

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Table 4. Prevalence and odds ratios of risk factors for companion animals diagnosed with M. canis (enzootic cruelty cases excluded). Prevalence Risk factor x (%) 95% CI (%) N OR 95% CI P-value Species Feline 111 0.22 0.18 to 0.26 50 699 — — — Canine 0 0.00 0.00 to 0.00 23 367 — — — Age Adult cat 23 0.08 0.05 to 0.1 28 372 Referent — — Kitten 68 0.31 0.23 to 0.38 22 207 3.98 2.6 to 6.2 , 0.001 ARTICLE Total 196 0.24 0.21 to 0.28 80 208

x — Number of affected animals in the category. N — Total population in the category. OR — Odds ratio; CI — Confidence interval. Bold text indicates statistically significant finding.

Table 5. Prevalence and odds ratios of risk factors for companion animals diagnosed with Trichophyton (enzootic cruelty cases excluded). Prevalence Risk factor x (%) 95% CI (%) N OR 95% CI P-value Species Feline 34 0.07 0.04 to 0.09 50 699 2.62 1.1 to 6.2 0.029 Canine 6 0.03 0.01 to 0.05 23 367 referent — — Age Cat 4 0.01 0.00 to 0.03 28 372 referent — — Kitten 30 0.14 0.09 to 0.19 22 207 9.6 3.4 to 27.0 , 0.001 Dog 2 0.01 0.00 to 0.02 19 270 referent — — Puppy 4 0.1 0.02 to 0.19 4097 9.4 1.7 to 52.6 , 0.001 Total 44 0.05 0.04 to 0.07 80 208

x — Number of affected animals in the category. N — Total population in the category. OR — Odds ratio; CI — Confidence interval. Bold text indicates statistically significant finding.

recorded microscopic species and were excluded from analysis Epidemiology of dermatophyte species; 3 of these were P1. Of the P1 samples Two hundred and one cases (0.25%, 95% CI: 0.22% to 0.29%) with microscopic species identification, 9 animals were con- of M. canis and 43 (0.055%, 95% CI: 0.040% to 0.072%) cases sidered infected due to clinical signs and subsequent positive of Trichophyton dermatophytosis were diagnosed in 4 companion cultures taken after initiation of treatment, and 45 animals animal species (Table 2). There were no cases of M. gypseum were determined to be fomite carriers and were excluded from or any other dermatophyte species in any companion animal prevalence and risk factor analysis. Contaminant fungal growth during the study period. A small number of incoming animals with no dermatophyte growth was recorded for 229 plates, for a (n = 263) were admitted as part of hoarding/cruelty cases false positive rate of 28% (95% CI: 25% to 31%). The overall in which dermatophytosis was found to be enzootic in the combined dermatophytosis prevalence in this population was population. 0.48% (n = 244/50 699; 95% CI: 0.42% to 0.54%) in cats and Excluding enzootic cruelty cases, for the general population 0.11% (n = 25/23 494; 95% CI: 0.06% to 0.15%) in dogs. Pet of animals entering shelters in the BC system during this period, rat cultures (n = 3) were all negative. there were no M. canis cases in dogs (x2 P , 0.001 versus cats) and cats were more than twice as likely as dogs to be diagnosed Time to recognition with Trichophyton (Tables 4, 5). Kittens were significantly more Amongst all culture-positive animals, initial cultures were taken likely to be diagnosed with M. canis and Trichophyton than adult 0 to 132 d after shelter intake. There were 790 cultures that cats; puppies were significantly more likely to be diagnosed with were taken within 30 d of intake, and 41 cultures that were Trichophyton than adult dogs. There were too few canine cases taken more than 30 d after intake. Eighteen of these were from to evaluate any risk factors besides age. animals which were likely exposed during foster care or time Cats entering the sheltering system from the Northern and spent off-site after shelter intake. When these 18 animals were Lower Mainland regions of British Columbia were significantly excluded, initial cultures were all taken between 0 and 91 d after more likely to be diagnosed with both M. canis and Trichophyton shelter intake, with a median of 2 d after intake. than those from the Interior and Island regions of the province.

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Table 6. Prevalence and odds ratios of risk factors for cats diagnosed with M. canis (enzootic cruelty cases excluded). Prevalence Risk factor x (%) 95% CI (%) N OR 95% CI P-value Season Winter 12 0.2 0.05 to 0.23 7072 referent — — Spring 16 0.2 0.09 to 0.25 9460 0.997 0.471 to 2.1 0.99 Summer 30 0.2 0.16 to 0.33 12 174 2.3 1.2 to 4.4 0.009 Autumn 25 0.2 0.13 to 0.31 11 393 1.2 0.65 to 2.5 0.46 ARTICLE Total 91 0.2 0.18 to 0.27 40 099 Region North 38 0.4 0.24 to 0.46 10 852 referent — — Interior 2 0.01 0.00 to 0.03 17 230 0.23 0.13 to 0.41 , 0.001 Island 5 0.04 0.01 to 0.08 11 865 0.10 0.04 to 0.26 , 0.001 Lower Mainland 46 0.4 0.32 to 0.57 10 373 1.1 0.72 to 1.7 0.67 Total 91 0.2 0.14 to 0.22 50 320 Source Stray 45 0.2 0.13 to 0.25 23 616 referent — — Investigations 0 0.0 0.00 to 0.00 1928 — — — Owner surrender 40 0.2 0.14 to 0.26 20 281 0.89 0.6 to 1.3 0.55 Born in care 0 0.0 0.00 to 0.00 1575 — — — Transfer 0 0.0 0.00 to 0.00 206 — — — Returns 2 0.08 0.00 to 0.20 2430 0.49 0.15 to 1.5 0.23 Emergency boarding 0 0.0 0.00 to 0.00 543 — — — Total 91 0.2 0.14 to 0.22 50 579 x — Number of affected animals in the category. N — Total population in the category. OR — Odds ratio; CI — Confidence interval. Bold text indicates statistically significant finding.

Table 7. Prevalence and odds ratios of risk factors for cats diagnosed with Trichophyton (enzootic cruelty cases excluded). Prevalence Risk factor x (%) 95% CI N OR 95% CI P-value Season Winter 1 0.01 0.00 to 0.04 7072 referent — — Spring 0 0.00 0.00 to 0.00 0.00 — — — Summer 7 0.06 0.01 to 0.110 12 174 4.0 0.5 to 33.1 0.19 Autumn 20 0.18 0.10 to 0.25 11 393 12.4 1.7 to 92.7 0.014 Total 29 0.07 0.05 to 0.1 40 099 Region North 8 0.07 0.02 to 0.12 10 852 referent — — Interior 7 0.04 0.01 to 0.07 17 230 0.63 0.2 to 1.8 0.38 Island 3 0.03 0.00 to 0.05 11 865 0.39 0.1 to 1.5 0.17 Lower Mainland 17 0.16 0.09 to 0.24 10 373 2.5 1.1 to 6.1 0.038 Total 35 0.07 0.05 to 0.09 50 320 Source Stray 10 0.04 0.02 to 0.07 23 616 referent — — Investigations 16 0.83 0.42 to 1.23 1928 21.9 9.7 to 49.7 , 0.001 Owner surrender 9 0.04 0.02 to 0.07 20 281 1.2 0.46 to 2.9 0.75 Born in care 0 0.00 0.00 to 0.00 1575 — — — Transport 0 0.00 0.00 to 0.00 206 — — — Returns 0 0.00 0.00 to 0.00 2430 — — — Emergency boarding 0 0.00 0.00 to 0.00 543 — — — Total 35 0.07 0.05 to 0.09 50 579 x — Number of affected animals in the category. N — Total population in the category. OR — Odds ratio; CI — Confidence interval. Bold text indicates statistically significant finding.

Those entering the shelter in the summer showed significantly For cats diagnosed with Trichophyton, intake source and higher levels of M. canis than those entering in the winter. Age, intake season were also significant risk factors (Table 7). Those region, and season were the only risk factors found to be signifi- entering through cruelty investigations were significantly more cant for M. canis diagnosis in this population of cats (Table 6). likely to have Trichophyton than stray cats, and those entering

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Table 8. Final model for cats diagnosed with M. canis (enzootic Table 10. Dermatophyte prevalence in enzootic cases (n = 4), cruelty cases excluded). combined. Risk factor OR 95% CI P-value Total by Rabbit dermatophyte Age Cat (%) Dog (%) (%) (%) Adult referent — — Kitten 4.2 2.7 to 6.6 , 0.001 M. canis 96 (80) 16 (12.7) 6 (33.3) 118 (44.7) Trichophyton 0 3 (2.4) 0 3 (1.1) Region Negative 24 (20) 106 (84.1) 12 (66.7) 142 (53.8) North referent — — Interior 0.22 0.13 to 0.4 , 0.001 Total by species 120 126 18 263 Island 0.12 0.05 to 0.3 , 0.001

ARTICLE Lower Mainland 1.4 0.95 to 2.2 0.09 Season Winter referent — — population, even though enzootic cases were excluded from Spring 0.87 0.4 to 1.8 0.71 this analysis. Summer 1.6 0.8 to 3.0 0.16 Autumn 0.9 0.5 to 1.9 0.82 Intake source and enzootic cases OR — Odds ratio; CI — Confidence interval. Bold text indicates statistically significant findings. When animals from the 4 investigation cases in which dermatophytosis was found to be enzootic were included in the analysis of intake source, cruelty investigation intakes of cats, dogs, and Table 9. Final model for cats diagnosed with Trichophyton rabbits had an overall M. canis prevalence of 2.5% (118/4787, (enzootic cruelty cases excluded). 95% CI: 2.1% to 2.9%) and were 15.4 (95% CI: 11.3 to 21.2, , Risk factor OR 95% CI P-value P 0.001) times more likely to be diagnosed with M. canis than those entering by the next most prevalent category, strays Age Adult referent — — (prevalence 59/36 114 or 0.2%). Dogs and cats entering via Kitten 11.2 3.9 to 32.3 , 0.001 cruelty investigations had an overall Trichophyton prevalence Season of 0.4% (19/4787, 95% CI: 0.2% to 0.6%) and were 16.4 Winter referent — — (CI: 7.4 to 36.2, P , 0.001) times more likely to be diagnosed Summer 2.0 0.24 to 16.7 0.52 with Trichophyton than animals entering as strays (prevalence Autumn 1.8 1.02 to 58.5 0.048 9/36 114 or 0.02%). Region North referent — — Interior 0.6 0.2 1 to 1.7 0.35 Enzootic cases Island 0.5 0.12 to 01.8 0.37 A total of 263 cats, dogs, and rabbits were seized as part of 2 Lower Mainland 1.9 0.72 to 4.98 0.20 related and 2 unrelated animal hoarding/cruelty investigation Source cases in which dermatophytosis was found to be enzootic in Stray referent — — the animal population. These 4 investigations brought in 40 to Investigations 29.8 12.0 to 73.4 , 0.001 Owner surrender 1.1 0.44 to 2.8 0.83 98 animals per case (2 related cases with cats and dogs, 1 with dogs only, 1 with cats, dogs and rabbits). The overall preva- OR — Odds ratio; CI — Confidence interval. Bold text indicates statistically significant findings. lence of M. canis in these cases ranged from 8.2% to 66.7% (n = 66/98, n = 14/40, n = 6/73, n = 32/52) for a combined average of 44.9% (118/263). Eighty percent of cats (range: 72% to 100%) and 33.3% of rabbits involved were diagnosed with the shelter in the autumn showed significantly higher levels of M. canis. Only 3 dogs from 1 investigation (4.1%, n = 3/73), Trichophyton than those entering in the winter. No other season were diagnosed with Trichophyton (Table 10). or intake type was significantly different from the referent. In these enzootic case populations, risk factors observed in the A multivariate regression model was created to control for general shelter population were not represented. For example, interactions of age, season, and region for cats diagnosed with in all of the cases involving cats, adult cats had an equal or M. canis (Table 8), and to control for interactions of age, sea- greater prevalence of M. canis than juveniles (adult: n = 39/49, son, region, and source for cats diagnosed with Trichophyton n = 5/5, n = 19/19 vs. juvenile: n = 20/33, n = 9/9, n = 4/5). (Table 9). In this model, kittens were 4 times more likely to be Regionally, all of the cases originated in the Lower Mainland. presented with M. canis and 11 times more likely to be presented Three cruelty investigation interventions occurred in winter with Trichophyton than adults. Cats from the Northern and and spring, with only 1 case occurring in autumn. One of four Lower Mainland regions remained most at risk for M. canis. cases involved dogs with Trichophyton; in this case, dogs in the However, season was no longer significant, likely explained by population were diagnosed with both Trichophyton and M. canis, high summer kitten intake. Cats with Trichophyton were nearly though no individual animal was diagnosed with more than twice as likely to be presented to the shelter in the autumn than 1 species of dermatophyte. The only rabbits diagnosed with any the winter, but this finding was barely significant. Cats taken dermatophyte during the study period were those with M. canis in through cruelty investigations had a 30 times greater chance associated with infected cats in 1 of the 4 cases. Given the of presenting with Trichophyton than the general incoming unique nature of each case, statistical analysis was not pursued.

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Discussion termates, poor hygiene, microtrauma from external parasites, and reduced grooming tendencies (2,8,15); all of these factors This study represents a large number of companion animals could describe animals in hoarding situations. Three of the four entering 34 shelters in coastal western Canada. While all enzootic cruelty cases, all of which involved hoarding, had a animals were screened for signs of dermatophytosis, only high- commercial component including breeding and/or boarding ani- risk animals were cultured. This organization performs cruelty mals. These facilities had a net outflow of kittens and puppies, prevention work provincially, and cruelty case animals (both in which may have been infected when sold into the community. ARTICLE general, and from enzootic cases) were overrepresented among The initial finding that cats from the Lower Mainland were those cultured and infected. Thus, results from this study may at higher risk for M. canis than those from other regions is con- not be applicable to all shelters or communities. sistent with previous studies and references indicating that der- The 28% contaminant growth rate in this study was large but matophytosis is more common in areas with higher temperatures lower than in previously published reports. One study in healthy and humidity (2,10–12). When enzootic cases were excluded, cats reported contaminant rates of 78/100 in Florida and 63/100 however, cats from both the North and Lower Mainland regions in the northern US (11). A study of healthy shelter cats from were more likely than cats from the Island and Interior regions California found saprophyte growth in 117/209 samples (12). to have dermatophytosis. This finding was unexpected, because Reasons for differences in culture specificity may relate to cli- the Island and Lower Mainland regions have similar mild climate, culture technique, or patient selection. This highlights mates, while the North and Interior have the coldest winter the importance of performing microscopic examination of temperatures. This finding could be related to the relatively low suspicious fungal colonies. human population in Northern BC [5% of the human popula- The overall combined dermatophytosis prevalence in BC tion, compared to 60% in the Lower Mainland (27)], with many , SPCA intakes ( 0.5% in cats) was much lower than previ- remote and rural communities in which veterinary care is less ously reported. Recent studies of shelter populations found accessible. Shelter intake was approximately 10 000 animals over frequencies of 5.5% (feline, n = 11/200; 10/200 M. canis; the study period in both regions, indicating a higher per capita 1/200 Trichophyton) in California (12); 4.5% (feline, n = 9/200; shelter intake in the North. 8/200 M. canis; 1/200 T. mentagrophytes) in Florida and several Dermatophytosis is often regarded as a seasonal disease in cats Northern US states (11); and 1.8% (feline, n = 202/11 214 with more cases in summer and autumn; some studies support M. canis; 2/11 214 Trichophyton) in Oregon (15). Possible this (23) while others do not (15,24,26). Excluding enzootic reasons for this difference include population, geographic or cruelty cases, the highest numbers of cats with dermatophytosis climactic factors. A prevalence range of 8.2% to 66.7% for entered BC SPCA shelters in summer and autumn. When the M. canis in our enzootic cruelty cases is consistent with other effect of age (kitten season) was controlled in the final model, studies of enzootic dermatophytosis populations which found however, the significance of summer intake for M. canis dropped frequencies of 9.9% (n = 69/696 (14), 33% (n = 46/140) (22), out and only a barely significant increase in Trichophyton and 66% (n = 204/309) (9). cases in autumn remained. No seasonal pattern was noted The finding that cats were significantly more likely than dogs for dogs. to have dermatophytosis of any type is also consistent with pre- The most important risk factor for dermatophytosis, besides vious studies (23–25) except for 1 report in which dogs had a animal species, was entering the shelter through cruelty inves- higher rate of Trichophyton (23). Cats are the primary M. canis tigations. One other dermatophytosis study included a specific reservoir (1,2) and Trichophyton species have been associated analysis of humane officer intakes and did not find an associa- with rodents (1,2); many cats entered BC shelters from barns tion (15), but had no enzootic cases represented. Other studies and outbuildings where rodent populations thrive. This pat- have suggested that stray/free-roaming (11,28,29) and trans- tern may also be related to the tendency of cats to arrive at the fer (15) cats are more likely to have dermatophytosis than owner shelter in litters or in larger groups, while dogs usually arrive surrender or pet cats; however, results from this study did not as individuals. support either finding. Possible reasons include the generally low This study found an association for dermatophytosis with prevalence of dermatophytosis in BC, or that owner-surrendered young age in dogs and cats when enzootic cruelty cases were cats in BC may have similar lifestyles to free-roaming cats. The excluded. Previous studies have generally found that younger number of cats transferred in by the BC SPCA was 206/50 age is a risk factor for dermatophytosis in both cats and 699 (0.4%), extremely low. dogs (15,23–25) but some studies found no association with This study identified a much lower prevalence of dermato- age (12,26). In our enzootic cases, older cats were paradoxically phytosis in shelter animals in British Columbia than reported but consistently more affected. In these cases, animals were elsewhere, but supported previously published risk factors, such living in close contact with one another in conditions of poor as young cats from warmer areas presenting the highest risk. hygiene and physiological stress while continually being exposed New findings in this report suggest that companion animals of to a contaminated environment. Furthermore, case animals any age entering shelters from cruelty investigations present a which had contracted dermatophytosis when young may not much higher risk for both M. canis and Trichophyton dermato- have yet self-cured, though they were now over 6 mo old. In phytosis. When private practitioners encounter an animal with normal situations, younger animals are thought to be at higher dermatophytosis, a detailed history should be taken in case the risk due to inadequate immune system, close contact with lit- patient can be traced to an enzootic population.

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These findings shed light on dermatophytosis risk in western 14. Polak KC, Levy JK, Crawford PC, Leutenegger CM, Moriello KA. Canada and can be used by both shelters and general prac- Infectious diseases in large-scale cat hoarding investigations. Vet J 2014; 201:189–195. titioners to understand factors that determine prevalence of 15. DeTar LG, Dubrovsky V, Scarlett JM. Descriptive epidemiology and common fungal infections in shelter and community animals. test characteristics of cats diagnosed with Microsporum canis derma- Understanding which patients are at highest risk can help expe- tophytosis in a Northwestern US animal shelter. J Feline Med Surg 2019. Available from: https://doi.org/10.1177/1098612X19825519 dite dermatophytosis recognition, diagnosis, and treatment and Last accessed May 12, 2020. reduce contagious risk to people and animals. 16. Newbury S, Moriello K. Feline dermatophytosis: Steps for investigation of a suspected shelter outbreak. J Feline Med Surg 2014;16:407–418. Acknowledgment 17. Kaufmann R, Blum SE, Elad D, Zur G. Comparison between point- of-care dermatophyte test medium and mycology laboratory culture

ARTICLE The authors thank Emeline Nogues for providing a French for diagnosis of dermatophytosis in dogs and cats. Vet Dermatol 2016; 27:284–e68. translation of the abstract. CVJ 18. Scott DW, Paradis M. A survey of canine and feline skin disorders seen in a university practice: Small Animal Clinic, University of Montreal, References Saint-Hyacinthe, Quebec (1987–1988). Can Vet J 1990;31:830–835. . 1 Frymus T, Gruffydd-Jones T, Pennisi MG, et al. Dermatophytosis in 19. Canadian Climate Normals 1981–2010 Station Data [homepage on the cats. J Feline Med Surg 2013;15:598–604. Internet]. Government of Canada c2019 Available from: http://climate. 2. Moriello KA, Deboer DJ. Dermatophytosis. In: Sykes JE, Greene CE, weather.gc.ca/climate_normals/results_1981_2010_e.html?searchType eds. Infectious Diseases of the Dog and Cat. 4th ed. St. Louis, Missouri: =stnProv&lstProvince=BC&txtCentralLatMin=0&txtCentralLatSec= Elsevier, 2012:588–602. 0&txtCentralLongMin=0&txtCentralLongSec=0&stnID=145&disp 3. Overgaauw PAM, van Avermaete KHA, Mertens CARM, Meijer M, Back=0 Last accessed May 12, 2020. Schoemaker NJ. Prevalence and zoonotic risks of Trichophyton menta- 20. Seargent ESG, 2019. EpiTools Epidemiological Calculators, Ausvet PTY grophytes and Cheyletiella spp in guinea pigs and rabbits in Dutch pet LTD. Available from: https://epitools.ausvet.com.au/ciproportion Last shops. Vet Microbiol 2017;205:106–109. accessed May 14, 2020. 4. Kraemer A, Mueller RS, Werckenthin C, Straubinger RK, Hein J. 21. Kleinbaum DG, Kupper LL, Chambless LE. Logistic regression analysis Dermatophytes in pet Guinea pigs and rabbits. Vet Microbiol 2012;157: of epidemiologic data: Theory and practice. Commun Stat Theory 208–213. Methods 1982;11:485–547. 5. Moriello KA, Deboer DJ. Fungal flora of the coat of pet cats. Am J Vet 22. Carlotti DN, Guinot P, Meissonier E, Germain PA. Eradication Res 1991;52:602–606. of feline dermatophytosis in a shelter: A field study. Vet Dermatol 6. Meason-Smith C, Diesel A, Patterson AP, et al. What is living on your 2009;21:259–266. dog’s skin? Characterization of the canine cutaneous mycobiota and fun- 23. Cafarchia C, Romito D, Sasanelli M, Lia R, Capelli G, Otranto D. The gal dysbiosis in canine allergic dermatitis. FEMS Microbiol Ecol 2015; epidemiology of canine and feline dermatophytosis in southern Italy. 91:pii; fiv139. Mycoses 2004;47:508–513. 7. Moriello KA, Newbury S. Dermatophytosis. In: Miller K, Hurley K, 24. Lewis DT, Foil CS, Hosgood G. Epidemiology and clinical features eds. Infectious Disease Management in Animal Shelters. Ames, Iowa: of dermatophytosis in dogs and cats at Louisiana State University: Blackwell Publishing, 2009:243–273. 1981–1990. Vet Dermatol 1991;2:53–58. 8. Moriello K. Feline dermatophytosis: Aspects pertinent to disease man- 25. Seker E, Dogan N. Isolation of dermatophytes from dogs and cats with agement in single and multiple cat situations. J Feline Med Surg 2013; suspected dermatophytosis in Western Turkey. Prev Vet Med 2011;98: 16:419–431. 46–51. 9. Newbury S, Moriello K, Coyner K, Trimmer A, Kunder D. Management 26. Proverbio D, Perego R, Spada E, Bagnagatti de Giorgi G, Della Pepa of endemic Microsporum canis dermatophytosis in an open admission A, Ferro E. Survey of dermatophytosis in stray cats with and without shelter: A field study. J Feline Med Surg 2015;17:342–347. skin lesions in northern Italy. Vet Med Int 2014 Article ID 565470. 10. Moriello KA, Coyner K, Paterson S, Mignon B. Diagnosis and treatment Available from: http://dx.doi.org/10.1155/2014/565470 Last accessed of dermatophytosis in dogs and cats. Clinical Consensus Guidelines of May 12, 2020. the World Association for Veterinary Dermatology. Vet Dermatol 2017; 27. BC Atlas of Wellness: Population Distribution Within the Province, 28:266–e68. University of Victoria. Available from: http://www.geog.uvic.ca/wellness/ 11. Moriello KA, Kunkle G, Deboer DJ. Isolation of dermatophytes from wellness2011/Ch4_1.pdf Last accessed May 12, 2020. the haircoats of stray cats from selected animal shelters in two different 28. Duarte A, Castro I, Pereira da Fonseca I, et al. Survey of infectious and geographic regions of the United States. Vet Dermatol 1994;5:57–62. parasitic diseases in stray cats at the Lisbon Metropolitan area, Portugal. 12. Boyanowski KJ, Ihrke PJ, Moriello KA. Isolation of fungal flora from J Feline Med Surg 2010;12:441–446. the hair coats of shelter cats in the Pacific coastal USA. Vet Dermatol 29. Romano C, Valenti L, Barbara R. Dermatophytes isolated from asymp- 2000;11:143–150. tomatic stray cats. Mycoses 1997;40:471–472. 13. Mignon BR, Losson BJ. Prevalence and characterization of Microsporum canis carriage in cats. J Vet Med Mycol 1997;35:249–256.

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Managing change in a changing world Part 2: The power to choose

Debbie L. Stoewen

Introduction The power to choose s stated in Part 1, we find ourselves in extraordinary Choose how you want to carry yourself forward! There are steps you A times (1). We’re facing what we have never faced before, can take to support yourself, your family, and your community a global pandemic. Nobody knows how long it will last or how as we move through this pandemic. Maybe it is just following long it will be until we can resume our usual lives — whenever the hygiene recommendations, maintaining social distance, and that will be. Nobody knows what life will be like on the other curbing travel. But it can be so much more. Just as social distanc- side. For now, all we have is today, and for today, we can, and ing has its limits — on your life, so to say — it doesn’t have to should, do all we can, individually and collectively, to carry us limit you. There are many things you can do to keep you, and through these times in the best ways possible — for ourselves, those you care about, well. our families, and our communities. Change doesn’t come easy, even at the best of times. Before Lean into self-care we knew what was happening, social (aka physical) distanc- Self-care is vital for the resilience needed to manage the stressors ing was put in place and our lives changed overnight with in life that can’t be changed (4). It’s important to assess how the gargantuan effort to slow the spread, i.e., “flatten the you’re caring for yourself at this critical time. Eating a balanced curve” (2) — gatherings on pause, schools shut down, public diet, getting plenty of sleep, balancing movement with rest, and spaces closed, and many working from home. For so many, engaging in leisure activities are always key to staying physically life has virtually ground to a halt, isolated at home, while for and psychologically healthy during stressful times. Good self- others, it has ramped up in ways unimaginable. Certainly the care also keeps your immune system robust. veterinary profession has much to be proud of, from deftly Customize your self-care to your needs. Self-care isn’t a one- restructuring services for companion animal care and livestock size-fits-all strategy. Assess which areas of your life need more management, to providing personal protective equipment, attention. And remember, as your circumstances change, your ventilators, and anesthetic gas machines to hospitals, to calling needs may change. Lean into your self-care more than ever out — again — for a One Health approach with research and before, even if it is hard to find the time and space. It’s impera- response to zoonoses (3). The COVID-19 pandemic marks the tive. When you care for your body, mind, and spirit, you’ll be third novel coronavirus outbreak of the 21st century. With a able to live your best life. One Health approach, veterinarians may one day play a vital role in preventing the next pandemic. Mind your attitude For all of us, there is a call for resilience. The ability to flex Choose optimism. Catastrophic predictions aren’t helpful. with the times, move with the change, to recover quickly from Create a positive future story. The way you think and the things difficulties. Part 1 of Managing change in a changing world that you fill your mind with greatly influence your psychologi- focused on “moving” with the change, which referred, paradoxi- cal well-being. If you’re constantly thinking things like, “I can’t cally, to doing quite the opposite. Pausing, pulling out from the stand this,” or “Things will never be the same,” you’ll stress chaos, the upheaval of our lives, to reflect, take perspective, and yourself out. Positive thoughts will help you develop a healthier regain balance, so we can, from a balanced mindset, choose how outlook. Choose to have optimistic conversations with yourself. to carry ourselves through the pandemic. As Victor Frankl said, They will help you manage your emotions and take positive “Between stimulus and response there is a space. In that space is our action (5). What you say to yourself matters. power to choose our response.”

Dr. Debbie Stoewen is the Director of Veterinary Affairs for LifeLearn Animal Health, Guelph, Ontario. With a passion for lifelong learning, she contributes to designing innovative continuing education to help veterinarians and their teams address the challenges of modern veterinary practice. 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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Express gratitude Where and how everyone works and plays at home should be Gratitude is empowering. It not only helps you recognize all the planned, recognizing the need for flexibility. Design your life things you have to be thankful for, but reminds you of all the with an emphasis on control and continuity. resources that you have to cope with this (5). Whether you’re grateful for a sunny day or a child in your arms, think about all Connect with others the good things that you have in your life. Consider keeping a Social distancing doesn’t mean social isolation. Connection is journal on the things you are grateful for or that are going well. essential, especially during challenging times. When we can’t Share what you’re grateful for and what is going well with as gather in person, “gather” virtually — with gratitude that we many people as you can. Let gratitude show up in conversations. live in a time when that’s possible. Leverage technology to stay Make gratitude a habit. As Melodie Beattie said, “Gratitude in touch. Phone, e-mail, text, and use social media to connect unlocks the fullness of life… makes sense of our past, brings peace with friends, family, and those in your community. Play online for today, and creates a vision for tomorrow.” games, form a digital supper club! Talk “face-to-face” with Skype

BIEN-ÊTREVÉTÉRINAIRE or FaceTime. Likewise, be sure to disconnect from technology Be creative to spend face-to-face time with your family. Taking the time Immersing yourself in a creative activity helps you to temporar- to savor heart-to-heart conversations can bring about stronger ily forget your troubles and worries. As you become engrossed in social connectedness going forward. There are many ways to what you’re doing, you enter an almost meditative state, an inner maintain the social ties that bind us (9). focus that distracts you from what’s happening in the world around you. Creative expression, whether through art, drawing, Be of service coloring, reading, or writing; or through crafts, pottery, carpen- Ask yourself, “What can I do to help?” Helping others is good try, knitting, or sewing; or through photography, music, danc- for everyone, including yourself (!), because service is an anti- ing, gardening, or cooking; and so much more, makes us feel dote to fear. So every day — and especially when you’re caught better (6). Creativity can even boost the immune system! When up in fear and worry — ask yourself what you can do to help. was the last time you danced in the kitchen, sang in the shower, Providing urgent care is service. Beyond this front-line work, or sat at the piano? How long has it been since you curled up to is there something else that you can do? Is there someone you read a good book? If you aren’t into drawing or painting, why can call who might be feeling particularly worried, afraid, or not try coloring? It’s a great stress reliever (5). Love to cook? Or lonely? Can you “Zoom” a friend with your pet, bringing extra want to start? Take advantage of the time saved with not going smiles? Can you get groceries for the next-door neighbor? Can to restaurants to create new dishes. Take-out is riskier than you support a restaurant or retailer by purchasing an online making food at home, given the links between the people who gift certificate to use later on? What about a donation to a food prepare and deliver it and you. It’s hard to know what that is, bank? What about donating blood — naturally there are protec- but it is certainly higher than making meals at home. tive protocols, and the need never goes away. Think about acts of kindness. The smallest acts often go the farthest. And when Get outdoors we each do our turn, and the kindnesses circulate, we quickly Barring a complete lockdown, one thing that is still available realize just how much we are in this together. to us is the outdoors. Spending time outside, even if just in the backyard, is good for the body, mind, and spirit. Catch some Seek help when needed sunshine. Take in the green. Listen to the birds. And don’t In times like these, tuning in to mental health is important (10). forget to look up. There’s that vast sky above us. When was the Some will experience mental health problems for the first last time you followed the clouds or looked for the big dipper? time, while others find that their symptoms worsen (11). It’s The outdoors offers the chance to enjoy a change of scenery, not unusual to feel more on edge than usual, angry, sad, or which gets you into a different frame of mind. Walking is a even helpless. You may notice that you’re impatient and eas- simple but effective way to rejuvenate both mind and body. If ily irritated. You may want to avoid any reminders of what is you have kids, join them in a game of catch, soccer, hide-and- happening. For those who struggle with mental health, you seek, or tag. Although they can’t play with other kids, surely may feel more anxious or depressed, and less motivated to do there’s still the kid in you! Go bicycling together. Plant a garden. the things you usually do. The physical isolation, the closure Enjoy a picnic. And if you can’t get outdoors, even looking out of community-based mental health programs, and the move the window or at the photo of a landscape can make you hap- to virtual counselling can make the adjustments needed at this pier, healthier, and less stressed (7). time more difficult. Those with severe anxiety may increase their use of substances. Those in recovery may become more Maintain routines likely to relapse. With social distancing, we’re doing less of the things we nor- If your mental health is impacted by the stress of COVID-19, mally do. Amid these changes, try to keep up with regular then you may want to seek professional help. A licensed mental routines, as it will lend the sense of normalcy and control. And health professional can help you manage your fears. If you’re as you develop new routines, stick to them. It’s important to feeling alone and struggling, you can reach out to the Crisis maintain structure, predictability and a sense of purpose in each Text Line (12) by texting 741741 or Crisis Services Canada by day. Stick to regular wake-up, grooming and meal times (8). calling 1-833-456-4566 or the National Suicide Prevention

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Lifeline by calling 1-800-273-TALK. Help is always available. action for the common good. What will life be like on the other You may also contact SAMHSA’s Disaster Distress Helpline at side? Maybe we’ll feel a greater sense of community. Maybe 1-800-985-5990 (13). we’ll know our neighbors a little better. For sure we’ll see the

outcomes of the choices we’ve made. WELLNESS VETERINARY Stay informed, within reason It’s natural to feel anxious when missing information, so stay References informed. Learn all that you can about COVID-19 and what 1. Stoewen DL. Managing change in a changing world Part 1: Moving you can do to protect yourself, and your family, coworkers, and with the change. Can Vet J 2020;61:651–652. 2. Kristof N, Thompson SA. How Much Worse the Coronavirus Could clients, and prevent the spread. Watch, listen to, or read the Get, in Charts. Available from: https://www.nytimes.com/interactive/ news for updates from trustworthy sources and officials. And 2020/03/13/opinion/coronavirus-trump-response.html?action=click& be aware of the rumors that spread, especially on social media. module=Opinion&pgtype=Homepage-- Last accessed May 13, 2020. 3. Nolen RS. Can veterinarians prevent the next pandemic? JAVMAnews Avoid media outlets that build hype or dwell on things that can’t April 15, 2020. Available from: https://www.avma.org/javma-news/ be controlled. Check your sources and turn to reliable sources of 2020-04-15/can-veterinarians-prevent-next-pandemic Last accessed information, like your government authorities and the Centers May 13, 2020. 4. Scott E. 5 Self-Care Practices for Every Area of Your Life. Available for Disease Control and Prevention (CDC) (14). from: https://www.verywellmind.com/self-care-strategies-overall-stress- Just as it’s natural to feel anxious when missing information, if reduction-3144729 Last accessed May 13, 2020. you have too much information or are inundated with the news, 5. Scott E. Effective Stress Relievers for Your Life. Available from: https:// www.verywellmind.com/tips-to-reduce-stress-3145195 Last accessed you can feel quite the same — or worse. Too much informa- May 13, 2020. tion can be confusing and overwhelming, making it difficult to 6. Benayon C. How Creativity Improves Mental Health And Wellness. make sense of it. Repeated exposure to troubling news can be Available from: https://www.huffingtonpost.ca/charles-benayon/how- creativity-improves-mental-health-and-wellness_a_23016111/ Last traumatic. This is where media distancing comes in. accessed May 13, 2020. Set limits on your media consumption (11). Tuning into 7. Williams F. Call to the Wild: This Is Your Brain on Nature. Available stories that incessantly talk about how fast the virus is spread- from: https://www.nationalgeographic.com/magazine/2016/01/call-to- wild/ Last accessed May 13, 2020. ing, how many people are getting sick, and the death tolls, only 8. Kecmanovic J. A psychologist’s science-based tips for emotional increases anxiety. It can even cause you to overestimate the risks resilience during the coronavirus crisis. Available from: https://www. of contracting the infection. Take breaks from the news, includ- washingtonpost.com/lifestyle/wellness/anxiety-coronavirus-mental- wellness-tips/2020/03/16/f187faf2-67b8-11ea-9923-57073adce27c_ ing social media. Follow your regular daily routines as much as story.html Last accessed May 13, 2020. possible, checking in for updates as seems reasonable. Just as we 9. Pajer N. 40 Ways to Maintain Social Ties During the Coronavirus absolutely need to stay informed, we absolutely need to avoid Quarantine. Available from: https://parade.com/1011597/nicolepajer/ ways-to-stay-social-coronavirus/ Last accessed May 13, 2020. too much exposure. 10. Marshall D. Taking Care of Your Mental Health in the Face of Uncertainty. Available from: https://afsp.org/taking-care-of-your-mental- Carrying on, moving forward health-in-the-face-of-uncertainty/ Last accessed May 13, 2020. 11. Morin A. How to Cope With Anxiety About Coronavirus (COVID-19). It is what it is — we are in a pandemic. We can’t change that. Available from: https://www.verywellmind.com/managing-coronavirus- But we can choose how to carry ourselves “in” and “through” anxiety-4798909 Last accessed May 13, 2020. this. To do this, we need to first pull out from the chaos, the 12. Crisis Text Line. Available from: https://www.crisistextline.org/texting-in Last accessed May 13, 2020. upheaval of our lives, to reflect, take perspective, and regain bal- 13. SAMHSA (Substance Abuse and Mental Health Services Administra ance, so we can, from a balanced mindset, choose how to carry tion) Disaster Distress Helpline. Available from: https://www.samhsa. ourselves forward. These choices will hold us in good stead. gov/find-help/disaster-distress-helpline Last accessed May 13, 2020. 14. CDC (Centers for Disease Control and Prevention) Coronavirus It’s clear that we’ve never faced a situation like this before. (COVID-10). Available from: https://www.cdc.gov/coronavirus/2019- However, this shouldn’t mean that we’ll fall apart. Quite the ncov/index.html Last accessed May 13, 2020. contrary. We are in this together and can join in collective

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Industry News Nouvelles de l’industrie

NAVC Conducts Landmark Research on Opportunities and Challenges Facing the Veterinary Profession The North American Veterinary Community (NAVC) released Initial plans NAVC will undertake to address the challenges the Voice of the Veterinary Community, a landmark study reported in this study include: conducted to better understand and respond to the needs of • Provide a stronger community and support wellbeing among veterinary professionals and help shape the future of the vet- veterinary teams, encourage balance, raise awareness of signs erinary profession. associated with burnout, compassion fatigue and mental ill- The Voice of the Veterinary Community uniquely examines ness, and increase acceptance of wellbeing assistance. the key intersections of the veterinary practice experience, • Provide more tools and training to improve management including the patient/provider relationship and how veterinar- and communication skills for veterinary professionals. The ians and veterinary nurses/technicians feel about their work NAVC will continue to advocate for improved utilization of overall. The research also probes what is important to pet owners trained veterinary paraprofessionals to better distribute the when it comes to their pets’ healthcare. workloads, which will, in turn, improve job satisfaction and “The Voice of the Veterinary Community study will help retention among the entire veterinary team. guide the NAVC in planning and implementing programs and • Increase the types of educational resources available to vet- services to ensure the future vibrancy of the veterinary field erinary team members while striving to provide free and and those who work in it,” said Gene O’Neill, NAVC CEO. low-cost options whenever possible. “NAVC is engaging leaders across the profession to support us • Advocate the importance of veterinary care and showcase the and the industry in this endeavor. With the coronavirus further expertise and experience of veterinary professionals to pet exacerbating the financial and emotional stresses our veterinary owners while increasing the recognition of the importance community faces, the timing couldn’t be more important,” of the human-animal bond. O’Neill said. According to the study, helping animals on a daily basis is Other survey findings what veterinary professionals cite as their favorite part of their In looking at the attitudes of the pet owners, the study found job (77%), followed by doing meaningful and purposeful pet owners feel their vets acknowledge and understand the love work (65%). When it comes to stress, the study shows student and importance they have for their pets. Ninety percent of pet and/or practice debt is the leading stressor for veterinarians fol- owners identify strongly with their pets and 87% say that their lowed by the pressure to adhere to appointment time restrictions pet is a core part of their overall happiness and well-being. and balancing work life with family. For veterinary technicians/ Veterinarians and pet owners both recognize effective com- nurses, staff turnover, compassion fatigue and burnout were the munications as an important quality. Pet owners also want top stressors cited. The research also found that, like many other their veterinary team to stay on top of the latest techniques and professions, including human medicine, more than one-quarter developments in diagnosis and treatment. of veterinarians and veterinary technicians/nurses, plan to leave “This is a very rewarding field where veterinary care profes- the field in the next five years, though the survey did not address sionals get to work with what they’re most passionate about — the driving force behind that sentiment. animals. With pet ownership at an all-time high and, unique When it comes to pet owners’ experiences and feelings about stressors facing the veterinary profession, research like this is their veterinarians, the survey found that an overwhelming 83% important for shaping the future of the industry,” said O’Neill. of clients are very or extremely satisfied with their veterinarian. The study was conducted by data and analytics consultancy They also gave very high marks to their overall clinic experience LRW on behalf of the NAVC: 293 veterinarians, 277 veterinary when it comes to a caring, clean, safe and secure environment. nurses/technicians and 501 pet owners were surveyed. The pre- Interestingly, 98% of veterinary professionals surveyed agree cision in the report varies with responses and sample sizes for that preventative care is an important aspect of a pet’s health each question with an overall accuracy rate of 1/2 4–6%. The and well-being, but the number one reason pet owners cited for full survey is available upon request. not going to the vet is that they believe that their pet is healthy. “We want pet owners to understand the importance of pre- Contact: NAVC, 622 E Washington St Suite 300, Orlando, ventative care and early disease detection for their pets,” said FL 32801, USA; website: NAVC.com Dana Varble, NAVC Chief Veterinary Officer. “Early detection alone can save pet owners hundreds of dollars in the long term when it comes to animal healthcare.”

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Book Review Compte rendu de livre

Language Signs & Calming Signals of therefore requires less time and repetition in learning.” This not Horses: Recognition and Application only benefits the well-being of the horse but also helps avoid conflicts thus improving handler safety and enjoyment of their Draaisma R. CRC Press, Boca Raton. Florida, USA. 2018. interactions with the horse. 182 pp. ISBN: 9781-1380-7015-8. Overall, I think that this book is a good catalogue of equine body language and calming signals. I would highly recommend his book is divided into an introduction; a section that lists it for horse owners, riders, handlers, and veterinary care givers T and describes various equine calming signals; a section on with an interest in developing a better understanding of equine stress and body responses to stress, including stereotypies and behavior. withdrawal as a reaction to stress; and lastly a section on how to implement this information in our interactions with horses. Reviewed by Kristine Torske, DVM, DVSc, Winnipeg, Manitoba. The text is easy-to-read and is aimed at horse owners, riders, and handlers. This would also be a good text for first year veterinarians or veterinary technology students wishing to familiarize themselves with horse behaviors. Text descriptions are supplemented with color photos that clearly depict the behaviors and expressions described in the text. The different sections of the Attention Practitioners text are conveniently highlighted by colored page tabs, which make it easy to look for specific information. You may not have the time, facilities, or experience While the initial reaction of experienced horse people may to write scientific articles for review by experts. be that the material described is obvious or intuitive, the author does an excellent job of breaking down the most subtle changes But you have interesting and valuable experiences in expressions and behaviors and showing how they relate into that are worth sharing. We encourage you to communication ladders. She has accomplished this by observing, share by submitting articles to Practitioners’ photographing, and videotaping horses interacting in various Corner, The Canadian Veterinary Journal. Simply settings and then carefully recording calming signals or behaviors e-mail your article to Ms. Heather Broughton that horses display in response to aversive stimuli in order to ([email protected]). We will edit avoid conflict. By being aware of and observing and respond- to ensure the format is correct then we will ing to these signals, the handler may be able to recognize stress publish your article in The CVJ. in the horse earlier and adjust their handling in order to avoid escalating tension. One potential shortcoming of this book is the relatively small number of horses and situations that were observed in this study. The owner used 200 video recordings and a calming signal must have been observed at 35 times to be included. Most of this work was done in Europe where horses are more intensely managed and housed. It would be interesting to see these finding supported by a similar study in horses raised and living in various types of management conditions. In summary, to quote the author, “If a rider or handler interprets the horse’s body signals more precisely, makes sure to recognize calming signals and adapts the learning circumstances in order to avoid high tension, they will be dealing with a horse who feels better, learns and remembers more easily and

CVJ / VOL 61 / JULY 2020 775 FOR PERSONAL USE ONLY Student Paper Communication étudiante

Isolation of Histophilus somni and Trueperella pyogenes from a 2-month-old calf with chronic fibrosing and suppurative epididymitis

Rachel Dobberstein

Abstract — A 2-month-old red Angus crossbred calf was evaluated for a severely swollen scrotum, approximately 30 cm in diameter. Culture of the lesion isolated both Trueperella pyogenes and Histophilus somni. A final diagnosis based on the histopathology report was chronic fibrosing epididymitis with testicular atrophy and mild orchitis.

Résumé — Isolement d’Histophilus somni et de Trueperella pyogenes d’un veau âgé de 2 mois avec une épididymite suppurative et fibrosante chronique. Un veau croisé Angus rouge âgé de 2 mois fut évalué pour un scrotum sévèrement enflé, mesurant approximativement 30 cm de diamètre. Une culture de la lésion a permis d’isoler Truepurella pyogenes et Histophilus somni. Le diagnostic final basé sur le rapport de l’examen histopathologique était une épididymite fibrosante chronique avec atrophie testiculaire et orchite modérée. (Traduit par Dr Serge Messier) Can Vet J 2020;61:776–778

n May 17, 2019 a 2-month-old red Angus crossbred calf chlorhexidine gluconate soap before a 5 cm vertical incision O was initially seen at the Paris Veterinary Clinic in Paris, was made through the scrotal skin. A large amount of white Ontario for a urogenital evaluation. The birth was uncompli- suppurative liquid drained from the incision site. The vaginal cated; however, when an attempt was made to band the calf at tunic was located fused to the overlying skin and noted to be 3 d of age the producer noticed that the scrotum was abnormally thick and irregular. During the procedure, only 1 vaginal tunic large and they could not get the band over the scrotum. At was found. A single incision was made into the vaginal tunic and re-evaluation at 1 mo of age, the calf’s scrotum was noticeably more suppurative white liquid drained from the site. Inside the enlarged, but otherwise the calf was healthy. The differential vaginal tunic there was no clearly visible testis and the tissues diagnoses included a scrotal hernia, testicular torsion with sec- present were small and shriveled in appearance with multifocal ondary venous congestion, orchitis, scrotal hematoma, and/or areas of purulent liquid within the epididymis. Additionally, a spermatic granuloma. there were multifocal areas of dilation of the deferent duct along The producer was asked to monitor the calf and call the its length. The testicular vessels were ligated with 2-0 chromic clinic if anything changed. The producer called 1 mo later, and catgut suture (Ethicon, Somerville, New Jersey, USA) using the calf was seen for a second time on June 4. The scrotum had 1 circumferential ligature. The scrotal contents were removed, increased in size significantly since the last visit and was now along with the vaginal tunic. All the tissues were gathered into approximately 30 cm in diameter. Other than the large swollen a sterile wrapping. The skin was left open to allow for drain- scrotum, the calf was healthy on physical examination, includ- age and for healing by second intention. The patient recovered ing a temperature of 38.7°C. The calf had normal weight gain uneventfully with no post-operative complications. The calf since birth, and was bright, alert, and responsive. However, due was treated with penicillin (Penicillin G Procaine; Teva Canada, to the size of the scrotum potentially affecting the quality of life Markham, Ontario), 1 500 000 units, IM, once. A swab was for the calf, surgical excision was attempted. taken from the suppurative liquid that was found inside the The patient was sedated with xylazine (Rompun; Bayer, vaginal tunic and was sent for bacterial culture. The remain- Mississauga, Ontario), 1.0 mg/kg body weight (BW), IV and ing tissues were placed in a jar of formalin for histopathology. placed in dorsal recumbency. The scrotum was washed with a Both samples were submitted to the Animal Health Laboratory (University of Guelph, Guelph, Ontario). The bacterial culture result was 31 growth for both Ontario Veterinary College, University of Guelph, Guelph, Trueperella pyogenes and Histophilus somni. The histopathol- Ontario N1G 2W1. ogy report indicated that there were 2 protruding firm white Address all correspondence to Rachel Dobberstein; e-mail: masses that were comprised predominantly of mature organizing [email protected] fibrovascular stroma that surrounded several variably sized col- Use of this article is limited to a single copy for personal study. lapsed tubules lined by pseudostratified epithelium (Figure 1). Anyone interested in obtaining reprints should contact the The tubular cross-sections were filled with degenerate neutro- CVMA office ([email protected]) for additional phils, several of which were ruptured (Figure 2). The stroma copies or permission to use this material elsewhere. contained large lakes of degenerate neutrophils admixed with

776 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY STUDENT PAPER STUDENT

0.6 mm 120 mm

Figure 1. Variably sized epididymal tubules, some markedly Figure 2. Epididymal tubule filled with degenerate neutrophils, dilated (arrows) and others collapsed (thick arrow). some of which are ruptured (arrow), and a few vacuolated macrophages (thick arrow).

fewer vacuolated macrophages. The diagnosis was chronic-active Typically, Histophilus somni is considered part of the normal epididymitis with extensive fibrosis. The histologically examined genital and respiratory tract flora (4). It causes disease processes testis showed closely packed seminiferous tubules lined by intact such as myocarditis, thrombotic meningoencephalomyelitis, Sertoli cells. The interstitium contained numerous dispersed pneumonia, polyarthritis, and vasculitis (4–7). Histophilus somni erythrocytes and rare neutrophils. The second testis could not has both virulent and avirulent strains that are antigenically and be identified. The pathologist considered the chronic fibros- biochemically similar (7). Many clinically healthy bulls, and a ing epididymitis to be a post-natal inflammatory process that smaller proportion of cows/heifers, harbor the bacterium in originated from a navel infection that tracked up the urachus to their reproductive tracts because H. somni can be retained in the bladder, into the urethra, and then into the deferent duct. neutrophils, monocytes, macrophages, and epithelial and endo- thelial cells (5,6). Trueperella pyogenes is a Gram-positive, non- Discussion motile, opportunistic, rod-shaped bacterium that can often be This report documents a case of epididymitis in a newborn calf. found on the skin, oropharynx, urogenital, and gastrointestinal A similar case was documented in 1984, involving an appar- tracts (8). Culturing Trueperella pyogenes from bovine chronic ently healthy calf that was presented with an abnormally large suppurative lesions is common, particularly in mastitis and scrotum prior to orchiectomy (1). Multifocal areas of purulent abscesses (8). liquid were cultured and Histophilus somni was isolated (1). The exact pathogenesis of epididymitis in the calf described The similarities between these 2 cases are striking. Infectious herein cannot be determined. Infection of the epididymis was epididymitis is commonly reported in post-pubertal animals, by hematogenous or ascending infection (2). Because of the including rams, bucks, dogs, and bulls (2,3). rarity of epididymitis in newborns and the lack of other signs Infectious epididymitis in regions free of Brucella abortus is rare of bacteremia in this case, ascending infection was considered in bulls; however, in rams, epididymitis is more common, occur- the most likely route of infection (2,3). Ascending infection of ring either by hematogenous or ascending bacterial infection, with the epididymis in post-pubertal males is from preputial organ- Brucella ovis as a frequent cause (2). Histophilus somni is one cause isms (3). The preputial and penile epithelium of newborns is of ascending bacterial epididymitis (2). Grossly and microscopi- fused, so ascending infection through the urethra would not be cally, Histophilus somni causes epididymal enlargement and the from the prepuce, but by direct contamination of the urethral formation of spermatic granulomas (2,3). The epididymal epi- opening (2). Umbilical and urachal infection is common in thelium transitions from simple, ciliated columnar epithelium to calves, so ascending infection of the urachus to the bladder and pseudostratified, columnar epithelium, and ultimately to cuboidal then to the seminal colliculus may be an alternate explanation with focal hyperplasia (2,3). The interstitial tissues are distended as to why this rare disease occurs in newborn calves (9). with edema and fibrin, and then neutrophils predominantly. With This case report documents a rare disease in a young calf, time, many lymphocytes and plasma cells are found. Spermatic and practitioners should include epididymitis as a differential granulomas are comprised of a mixture of neutrophils, macro- diagnosis in a newborn calf with scrotal swelling. phages, and spermatozoa in the interstitium (2,3). Eventually, fibrosis develops, appearing at the outset with granulation tissue, Acknowledgments and ultimately forming mature fibrous tissue (2,3). Interstitial I thank the staff at the Paris Veterinary Clinic, specifically abscesses and spermatic granulomas develop upon death of the Dr. Rick Healey for his guidance on this case. As well, I thank the tissue or once the duct has ruptured and a spermatocele has owners of the calf for allowing me to publish this report. Finally, developed (2,3). Spermatoceles may then rupture into the vaginal I sincerely thank Drs. Robert Foster and Maria Spinato for their tunics and result in severe periorchitis (2,3). insights, encouragement, and scientific contributions. CVJ

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References 5. Van Donkersgoed J, Janzen ED, Potter AA, Harland RJ. The occurrence of Haemophilus somnus in feedlot calves and its control by postarrival 1. Metz AL, Haggard DL, Hakomaki MR. Chronic suppurative orchiepi- prophylactic mass medication. Can Vet J 1994;35:573–580. didymitis associated with Haemophilus somnus in a calf. J Am Vet Med 6. Inzana TJ. Current topics in microbiology and immunology: Histophilus Assoc 1984;184:1507–1508. somni. Cham, Switzerland: Springer International Publishing, 2016: 2. Foster RA. Male reproductive system. In: Zachary J, ed. Pathologic 109–129. Basis of Veterinary Disease Expert Consult. 6th ed. St. Louis, Missouri: 7. Siddaramppa S, Inzana TJ. Haemophilus somnus virulence factors and Elsevier, 2017:1198–1218. resistance to host immunity. Anim Health Res Rev 2004;5:79–93. 3. Foster RA. Male genital system. In: Maxie MG, ed. Jubb, Kennedy and 8. Ribeiro MG, Risseti RM, Bolaños CAD, et al. Trueperella pyogenes Palmer’s Pathology of Domestic Animals. 6th ed. St. Louis, Missouri: multispecies infections in domestic animals: A retrospective study of Saunders, 2015:486–490. 144 cases (2002 to 2012). Vet Q 2015;35:82–87. 4. Hubbard RD, Kaeberle ML, Roth JA, Chiang YW. Haemophilus somnus- 9. Bauer SB, Retik AB. Urachal anomalies and related umbilical disorders. induced interference with bovine neutrophil functions. Vet Microbiol Urol Clin North Am 1978;5:195–211. 1986;12:77–85. COMMUNICATIONÉTUDIANTE

Answers to Quiz Corner Les réponses du test éclair

1. D) Bordetella bronchiseptica can cause respiratory disease in 5. D) Neospora caninum causes abortion in cattle, and is best cats. diagnosed by histopathology on the fetal tissues, especially D) Bordetella bronchiseptica peut causer une maladie respiratoire brain and heart. Most congenitally infected calves appear chez le chat. normal but some of those affected show neurological signs, are unable to rise, or are underweight. The only clinical sign 2. C) The elevation of serum creatinine levels is not a common in cattle older than 2 months is abortion. The dog is the side effect. definitive host. Horizontal transmission does not occur in C) L’élévation du taux de créatinine sérique n’est pas un effet cattle: transmission is vertical, or direct from the definitive secondaire courant. host (dog). 3. B) Amputation should be performed if there is little return to D) Neospora caninum cause des avortements chez les bovins function after 6 months or if there is self-mutilation. et le meilleur moyen d’établir le diagnostic est par l’histo - B) L’amputation devrait être réalisée s’il y a peu de récupé- pathologie sur les tissus du fœtus, en particulier l’encéphale ration de la fonction du membre après 6 mois ou s’il y a et le cœur. La plupart des veaux infectés de façon congéni - automutilation. tale semblent normaux, mais certains montrent des signes neurologiques, sont incapables de se lever ou ont un poids 4. B) The horse does not require any treatment at this time. The insuffisant. Le seul signe clinique chez les bovins âgés de plus mass should be monitored in case it grows large enough to de 2 mois est l’avortement. Le chien est l’hôte définitif. La interfere with normal function. transmission horizontale ne se produit pas chez les bovins; B) Le cheval n’a pas besoin de traitement à ce stade-ci. La masse la transmission est verticale ou directe à partir de l’hôte doit être surveillée au cas où elle grossirait jusqu’à nuire au définitif (chien). fonctionnement normal.

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The Canadian Veterinary Medical Association may not be having its Annual Convention this summer, but we do wish to thank the companies that had signed up to support the convention prior to the pandemic. Although you are not able to visit their booths in person this year, you can still get information on their products and services on the Convention site (https://pheedloop.com/cvma20/site/) or download the Convention App (https://pheedloop.com/cvma20/) to have their information at your fingertips! Here is a listing of the companies: Même si le Congrès n’aura pas lieu cet été, l’Association canadienne des médecins vétérinaires tient quand même à remercier les entreprises qui s’étaient engagées à appuyer le Congrès avant la pandémie. Vous ne pourrez pas visiter leurs kiosques en personne, mais vous pouvez consulter le site du Congrès (https://pheedloop.com/cvma20/site/) pour obtenir des renseignements sur leurs produits et services ou encore télécharger l’application du Congrès (https://pheedloop.com/cvma20/) pour avoir l’information à portée de main en tout temps! Voici la liste de ces entreprises :

Aesculight Fondation Aide Vétérinaire Multi Radiance Serona Animal Health Alpha Vet Science Internationale (FAVI) National Dosimetry Services (NDS) Simmons & Associates Canada Inc. Boehringer Ingelheim Animal Health Georgian Anesthesia and Medical Corp. Nestle Purina Sound Imaging Canada Inc. Grey Wolf Animal Health Neuronix Inc. SpectraVET Therapeutic Lasers Brief Media Hill’s Pet Nutrition Canada Inc. Nova Biomedical Summit Veterinary Pharmacy Inc. Canadian Animal Blood Bank Inc. HK Medical Instruments NVA TD Canada Trust Canopy Animal Health IDEXX Canada ON2 Solutions Universal Imaging, Inc. CDMV iFinance Canada Inc./Petcard Pets Plus Us UXR Inc. Central Sales Ltd. JAAPHARM Canada Inc. pi Veterinary Consultants VetCare Canada Champion Alstoe Animal Health KVP International Inc. Probiotech International Inc. Veterinarians without Borders Clarius Mobile Health LifeLearn Animal Health Reflex Integrated Inc. Veterinary Orthopedic Implants Christian Veterinary Mission Canada Login Canada Registered Veterinary Technicians and VetMedSolutions Dechra Veterinary Products McCarthy & Sons Service Technologists of Canada (RVTTC) VetStrategy Digatherm, LLC Merck Animal Health Ritmed Virbac Canada Ltd. Dispomed Ltd. Millpledge Veterinary ROI Corporation Western Financial Group Insurance Dragon Veterinary Milo Rose Micro Solutions Solutions Elimedical, Inc. MNP LLP scil animal care company Zoetis Canada Esaote North America Modern Veterinary Therapeutics Scotiabank ezyVet Moneris Sensor Health Veterinary Diagnostics

CVMA Corporate Partnership Program Programme de Partenariats de L’ACMV The CVMA would like to extend recognition to the following sponsors for their overall contribution to the Association for 2020. L’ACMV tient à remercier les commanditaires suivants de leur contribution générale au travail de l’Association en 2020.

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CVJ / VOL 61 / JULY 2020 779 FOR PERSONAL USE ONLY Save the Date! 2021 CVMA CONVENTION, JULY 22 —25, 2021 Calgary, Alberta

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canadianveterinarians.net FOR PERSONAL USE ONLY Veterinary Dermatology Dermatologie vétérinaire

Twenty years of pyodermas: How antimicrobial resistance has changed the way I practice

Kinga Gortel

e was a routine dermatology patient: a senior neutered ians. This term identifies a broad resistance to beta-lactam drugs H male Jack Russell terrier referred for chronically relaps- including the potentiated penicillins and cephalosporins typi- ing superficial pyoderma. He was presented with widespread cally prescribed for skin infections. Methicillin-resistant staphy- superficial bacterial folliculitis; epidermal collarettes and crusts lococci (MRS) can express co-resistance to any combination of with abundant cocci on skin surface cytology (examples of these other drug classes and this makes antibiotic therapy very dif- lesions are shown in Figures 1 and 2). He was moderately pru- ficult to nearly impossible for some strains (1). The prevalence ritic, and other than his skin disease, very healthy. I prescribed of methicillin resistance in Staphylococcus pseudintermedius, the oral cephalexin and scheduled a recheck examination after 3 wk organism typically involved in canine pyoderma, had increased to investigate underlying causes for the pyoderma. But at the to . 30% of isolates in dogs from the United States within a recheck, his infection remained stubbornly unchanged. decade of being reported in 1999 (2,3). In the last decade, the I treated this patient during my veterinary dermatology prevalence of methicillin-resistant isolates from Canadian dogs residency in the late 1990s, when pyoderma typically presented with pyoderma has ranged from 12.1% of all staphylococcal few therapeutic challenges. This dog’s refractory infection was species in primary practice (4), to 45% of coagulase-positive highly unusual and thus memorable. But things were beginning staphylococci in a referral practice (5). to change. I encountered increasing numbers of similar cases as How did they become so common? Staphylococci comprise a newly minted dermatologist and see them frequently today. part of the normal skin and mucosal microbiota, with several Resistant staphylococcal infections are now common enough species serving dual roles as commensals and opportunistic that the term “methicillin-resistant” is well-known to veterinar- pathogens (1). Staphylococcus pseudintermedius is part of the

President of the Executive Committee of the Canadian Academy of Veterinary Dermatology, Westbank Animal Care Hospital, West Kelowna, British Columbia. Address all correspondence to Dr. Kinga Gortel; e-mail: [email protected] Conflicts of interest: in the last 5 years, Kinga Gortel has received honoraria, consulting fees, and/or has collaborated with Royal Canin, Zoetis, and Elanco. The Veterinary Dermatology column is a collaboration of the Canadian Veterinary Journal with the Canadian Academy of Veterinary Dermatology (CAVD). The CAVD invites veterinarians, veterinary technicians and technologists, and students with a professional interest in dermatology to join us (www.cavd.ca) to stay current with the advances and challenges in this dynamic field. 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.

the dermatology feature is generously sponsored by royal canin. la rubrique sur la dermatologie est généreusement commanditée par royal canin.

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Figure 1. Epidermal collarettes. Figure 2. Widespread superficial folliculitis resembling urticaria. Both dogs responded to topical antimicrobial therapy and treatment for the underlying condition. Photo credit: Kinga Gortel.

commensal skin microbiota of most dogs and the most com- to practice antimicrobial stewardship is in the management of mon species causing infections, followed much less frequently canine pyoderma. by S. aureus and the coagulase-variable S. schleiferi (1,6,7). As a result of AMR, my approach to pyoderma has changed Commensal bacteria are subjected to selection pressure any since I treated this terrier more than 20 years ago. Some of the time their host is treated with systemic antibiotics, regardless key points are listed here, and published guidelines with more of whether they are the target of treatment. Resistant strains of detailed recommendations are included below. staphylococci are not created de novo when an animal is treated with an antibiotic. Rather, treatment can obliterate the existing 1. Topical therapies are now my first-line treatments for pyo- susceptible commensal populations and allow re-colonization derma. The World Association for Veterinary Dermatology by a strain resistant to these drugs. Over the last 2 decades, this recommends that “topical therapy should be used as the sole lateral transmission has allowed MRS to spread through canine on-animal antibacterial treatment for surface and superficial populations (1,5). Unfortunately, even after successful treatment infections whenever a pet and owner can be expected to be of pyoderma caused by MRS, these organisms can continue to compliant” (1). This works because most cases of canine colonize dogs (5) and cause future resistant infections. pyoderma are indeed superficial, limited to the epidermis The emergence of MRS in dogs is not surprising, as decades and superficial portion of the hair follicles. A “deeper” earlier S. aureus trod the same path in humans. The role of anti- treatment with systemic antibiotics is usually not neces- microbial use as a risk factor was well-known. More surprising sary and in my practice, it is now the exception. Topical is how long it has taken our approach to pyoderma to change. monotherapy was previously recommended chiefly for I was far from alone in relying on systemic antibiotics as a key localized infections. But when using shampoos, does it really treatment. A study of UK primary care practices showed that matter if the patient has 1 lesion, or a few dozen? Various 92% of canine pyoderma cases received systemic antimicrobials, topical therapies have been studied and found to be effec- over half without concurrent topical therapy. Fewer than 5% of tive for pyoderma. The best evidence exists for the use of dogs were treated with topical therapy alone (8). Due to the high chlorhexidine shampoos (1,9). Chlorhexidine has a broad frequency of pyoderma in dogs, skin infections are the primary spectrum of antibacterial activity and there is a relative lack reason for antibiotic treatment in this species and account for of resistance to this drug despite more than 60 years of use up to 30% of prescriptions (6,9). The lengthy courses of therapy in health care settings. It is nonirritating, rarely sensitizing, used for skin infections compound the large number of doses and can remain bactericidal for many days after applica- used worldwide. tion (12). Chlorhexidine-based products can be as effective The toll of antimicrobial resistance (AMR) on humans and as systemic antibiotics in dogs with superficial pyoderma: the health care systems is already staggering (10). In veterinary efficacy of twice-weekly 4% shampoo (with 3 to 5 minutes medicine, the principles of antimicrobial stewardship and the of contact time) and daily 4% solution was equal to 4 weeks One Health Initiative have gained prominence as we recognize of oral antibiotics in 1 study, whether infection was caused that efforts to combat AMR must encompass all species. Three by methicillin-susceptible or methicillin-resistant staphylo- key approaches recommended for limiting AMR include pre- cocci (13). This is a common protocol that I use for active venting disease occurrence, reducing overall antimicrobial drug infections, with reduced frequency for prevention. In the use, and improving antimicrobial drug use (11). In small animal last 5 years, the selection of chlorhexidine-based products practice, one of the most practical and frequent opportunities available in Canada has grown substantially and includes

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2% to 4% chlorhexidine shampoos, sprays, mousses, solu- to preventing recurrences. Allergic skin disease tops the list tions, and wipes. In addition to an antiseptic effect, sham- of underlying conditions and may be responsible for 74% pooing removes organisms and debris from the skin surface to 90% of cases (5,15). Despite their complex and chronic VETERINARY DERMATOLOGYVETERINARY and improves the dog’s odor and appearance. It also spares nature, allergies in most dogs can be successfully managed. bystander organisms in other organ systems unnecessary Interventions including systemic and topical therapies exposure to antimicrobial drugs, reducing the risk of select- to reduce inflammation and pruritus, allergen-specific ing for resistant strains (9). immunotherapy , dietary and topical treatments to improve 2. I help clients implement topical therapies effectively. This the skin barrier, and elimination diet trials can all be useful means providing a topical therapy handout, and instructions in preventing infections. It may take some time to find a on the frequency, volume, and duration of application of regimen that is most effective for each dog, particularly now prescribed products. that we have many choices for antipruritic/anti-inflamma- 3. I still prescribe systemic antibiotics for pyoderma when tory therapies. The use of bacterins and other preventative necessary. This includes dogs with deep or severe pyo- therapies warrants further investigation. Staphage lysate derma, dogs responding poorly to topical therapy within (SPL) (Delmont Laboratories, Swarthmore, Pennsylvania, 3 to 4 weeks, or when patient or client factors make topical USA) bacterin injections can be considered for dogs with therapy impractical. Follow-up is key for assessing the effi- recurrent pyoderma that is idiopathic, or continues despite cacy of treatments for infection. I aim to re-examine patients treatment of the primary disease (16,17). (including cytologic examination) within 2 weeks if using 6. I try to be more patient with skin infections. Unlike with systemic antibiotics, and within 2 to 4 weeks if using only sepsis or pneumonia, we can delay starting systemic anti- topical therapy. I base my decision about whether to use biotics with most cases of superficial pyoderma, and we systemic antibiotics on clinical and patient/client factors, can tolerate a more gradual improvement. Since pyoderma rather than on whether the isolate is resistant or susceptible represents a dysbiosis, rather than infection with an external on culture. Methicillin-resistant S. pseudintermedius (MRSP) pathogen, complete eradication of the causative organ- are no more virulent than susceptible strains and the disease ism is unlikely even using aggressive systemic therapy (5). they cause is clinically indistinguishable. It is only when we Treatment should thus aim to restore a more balanced use systemic antibiotics that a difference becomes apparent. microbiota. This takes time. Treating the dog’s pruritus Thus the mere isolation of MRSP on culture should not allows for an acceptable quality of life as we strive to return prompt an escalation to systemic therapy. the skin to a more normal state. 4. When selecting systemic therapy, I rely on culture and sus- 7. I recognize the potential for inter-animal transmission of ceptibility testing whenever MRS is suspected. Empirical resistant staphylococci. Although pyoderma is not consid- antibiotic selection is contraindicated in these cases due to ered “contagious,” the lateral movement of resistant strains, the high prevalence of multidrug resistance among these especially within a clinic setting, is possible and impacts how strains (1). In addition to severe infections, I collect cultures I examine patients. Recommendations for hand hygiene, from patients with recurrent infections and when empirical personal protective equipment, and cleaning/disinfection therapy fails to resolve an infection as expected. Practically, are discussed in published guidelines (1). I might collect a bacterial culture from a patient with 8. I am careful with how I present information about resistant superficial pyoderma while commencing topical therapy infections to clients. I avoid the term “superbug” and the and treating the primary condition with the aim of adding erroneous label “MRSA” (methicillin-resistant S. aureus) a systemic antibiotic, if needed, once results are reported. A when speaking about MRSP. I reiterate that topical therapy follow-up call to the client to relay the culture results often is usually very effective for treating these infections. I discuss indicates sufficient improvement that antibiotics are not the low potential for zoonotic transmission and provide a prescribed (I call this the “antibiotic cooling-off period”). balanced client handout. When interpreting cultures, it is critical to evaluate not just the antimicrobial resistance pattern but also the spe- Some of the questions that remain to be answered pertain to cies isolated. Notably, the significance of the uncommonly the appropriate duration of systemic antibiotic therapy. These pathogenic coagulase-negative staphylococci (aside from questions are particularly relevant when treating resistant infec- S. schleiferi) should be interpreted with caution, even if tions with drugs that carry a considerable risk of serious adverse methicillin-resistant (1). Key indications and techniques effects (e.g., rifampin or amikacin). A 21- to 28-day course of for bacterial culture and susceptibility testing are available systemic therapy, extending at least 1 week past the resolution in open-access resources (9,14) along with guidelines for of lesions, is a standard recommendation for treating superficial culture interpretation (1). bacterial folliculitis in order to prevent relapses (11,12). This is 5. I attempt to address the cause of pyoderma, knowing that based on experience but not yet on a scientific foundation, and repeated antibiotic therapy is likely to become ineffective. the effect of concurrent topical therapy on treatment duration Preventing disease is arguably the most important com- has not been explored. Since administering antibiotics for longer ponent of antimicrobial stewardship and one that is often than is necessary can increase the risk of resistance, evidence- overlooked (11). Staphylococcal pyoderma in dogs is second- based recommendations in human and veterinary medicine have ary to an underlying condition and addressing this is critical often moved to shorter courses of therapy than were previously

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prescribed (11,18). In light of the quantities of antibiotics 4. Joffe D, Goulding F, Langelier K, et al. Prevalence of methicillin- prescribed to dogs with pyoderma, it is critically important to resistant staphylococci in canine pyoderma cases in primary care veterinary practices in Canada: A preliminary study. Can Vet J 2015;56: re-examine treatment duration for pyoderma using clinical trials. 1084–1086. When I recall patients like this Jack Russell terrier, what 5. Beck KM, Waisglass SE, Dick HL, Weese JS. Prevalence of methicillin- seems most surprising is that his treatment was once considered resistant Staphylococcus pseudintermedius (MRSP) from skin and carriage sites of dogs after treatment of their methicillin-resistant or methicillin- standard or appropriate. As you can imagine, I would treat him sensitive staphylococcal pyoderma. Vet Dermatol 2012;23:369–375. quite differently today. This is partly due to an improved selec- 6. Larsen RF, Boysen L, Jessen LR, Guardabassi L, Damborg P. Diversity tion of treatments to control his underlying disease, but largely of Staphylococcus pseudintermedius in carriage sites and skin lesions of dogs with superficial bacterial folliculitis: potential implications for as a response to antimicrobial resistance. A silver lining of the diagnostic testing and therapy. Vet Dermatol 2018;29:291–295. dissemination of MRS has been learning that we can and should 7. Rubin J, Chirino-Trejo M. Prevalence, sites of colonization, and anti- treat skin infections differently, providing a key opportunity for microbial resistance among Staphylococcus pseudintermedius isolated from healthy dogs in Saskatoon, Canada. J Vet Diagn Invest 2011; antimicrobial stewardship in small animal practice. 23:351–354. 8. Summers JF, Hendricks A, Brodbelt DC. Prescribing practices of

DERMATOLOGIE VÉTÉRINAIRE Resources: primary-care veterinary practitioners in dogs diagnosed with bacterial pyoderma. BMC Vet Res 2014;10:240. Guidelines for the diagnosis and antimicrobial therapy of canine 9. Hillier A, Lloyd DH, Weese JS, et al. Guidelines for the diagnosis superficial bacterial folliculitis (Antimicrobial Guidelines and antimicrobial therapy of canine superficial bacterial folliculi- Working Group of the International Society for Companion tis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases). Vet Dermatol Animal Infectious Diseases). Open Access: https://doi.org/ 2014;25:163–e43. 10.1111/vde.12118 10. Interagency Coordination Group on Antimicrobial Resistance. No Time Recommendations for approaches to meticillin-resistant to Wait: Securing the future from drug-resistant infections. [Report on the Internet] Available from: https://www.who.int/antimicrobial- staphylococcal infections of small animals: Diagnosis, thera- resistance/interagency-coordination-group/final-report/en/ Last accessed peutic considerations and preventative measures.: Clinical May 25, 2020. Consensus Guidelines of the World Association for Veterinary 11. Weese JS, Giguère S, Guardabassi L, et al. ACVIM consensus statement on therapeutic antimicrobial use in animals and antimicrobial resistance. Dermatology. This comprehensive document addresses many J Vet Intern Med 2015;29:487–498. questions including less frequently isolated species, such as 12. Miller WH, Griffin CE, Campbell KL. Muller & Kirk’s Small Animal MRSA. Open Access: https://doi.org/10.1111/vde.12444 Dermatology. 7th ed. St. Louis, Missouri: Elsevier, 2013. 13. Borio S, Colombo S, La Rosa G, De Lucia M, Damborg P, Guardabassi CVMA Guidelines for Veterinary Antimicrobial Use: https:// L. Effectiveness of a combined (4% chlorhexidine digluconate shampoo www.canadianveterinarians.net/AMU-UAM and solution) protocol in MRS and non-MRS canine superficial pyo- The Canadian Academy of Veterinary Dermatology website derma: a randomized, blinded, antibiotic-controlled study. Vet Dermatol 2015;26:339–344. contains open access and member resources including clini- 14. Beco L, Guaguère E, Lorente Méndez C, Noli C, Nuttall T, Vroom M. cal guidelines, client handouts, and lists of topical therapies Suggested guidelines for using systemic antimicrobials in bacterial skin available in Canada: www.cavd.ca infections (1): diagnosis based on clinical presentation, cytology and culture. Vet Rec 2013;172:72–78. Client handouts for MRSP and MRSA: www.wormsandgerms 15. Bensignor E, Germain PA. Canine recurrent pyoderma: A multicenter blog.com prospective study (Scientific Abstract from the Fifth World Congress of Veterinary Dermatology). Vet Dermatol 2004;15:42. References 16. Solomon SEB, Farias MR, Pimpão ST. Use of Staphylococcus aureus Phage Lysate Staphage Lysate (SPL)® for the control of recurrent pyo- 1. Morris DO, Loeffler A, Davis MF, Guardabassi L, Weese JS. derma eczema in dogs with atopic dermatitis. Acta Sci Vet 2016;44: Recommendations for approaches to methicillin-resistant staphylococ- 1382. cal infections of small animals: diagnosis, therapeutic considerations 17. DeBoer DJ, Moriello KA, Thomas CB, Schultz KT. Evaluation of a and preventative measures: Clinical Consensus Guidelines of the commercial staphylococcal bacterin for management of idiopathic recur- World Association for Veterinary Dermatology. Vet Dermatol 2017;28: rent superficial pyoderma in dogs. Am J Vet Res 1990;51:636–639. 304–e69. 18. Llewelyn MJ, Fitzpatrick JM, Darwin E, et al. The antibiotic course has 2. Loeffler A, Lloyd DH. What has changed in canine pyoderma? A nar- had its day. BMJ 2017;358:j3418. rative review. Vet J 2018;235:73–82. 3. Gortel K, Campbell KL, Kakoma I, Whittem T, Schaeffer DJ, Weisiger RM. Methicillin resistance among staphylococci isolated from dogs. Am J Vet Res 1999;60:1526–30.

784 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY Veterinary Practice Management Gestion d’une clinique vétérinaire

Surviving a downturn: How to keep your practice afloat Survivre à un ralentissement : comment maintenir votre pratique à flot

Chris Doherty

fter continuous growth in revenue and net income from a pandémie de COVID-19 menace de mettre un terme à A 2015 through 2019, COVID-19 is threatening to spoil L la période de croissance continue des revenus bruts et du the streak Canadian veterinarians have been enjoying. While the revenu net des établissements vétérinaires constatée de 2015 à progression of the pandemic is beyond the control of any one 2019. Bien que l’évolution de la pandémie soit indépendante de person, there are steps that veterinarians can take to help ensure notre volonté, il y a des mesures que les médecins vétérinaires their business weathers this storm, and rebounds as quickly as peuvent prendre pour aider leur entreprise à tenir le coup et à possible once it abates. rebondir le plus rapidement possible une fois la tempête passée. Reduce expenses Réduire les dépenses The first step that any business should take in the face of La première chose que toute entreprise devrait faire en cas de a downturn is to perform some belt tightening and reduce ralentissement est de réduire ses dépenses dans la mesure du expenses where possible. Some of this will occur automatically, possible. Une certaine réduction se fera naturellement à mesure as revenues decline; drug and supply costs, bank fees, and que les revenus diminuent – en effet, les dépenses liées aux laboratory expenses would all be expected to fall if a hospital is médicaments et aux fournitures, aux frais bancaires et aux frais seeing fewer clients. Given that drug and supply costs are the de laboratoire devraient baisser lorsqu’un établissement vétéri- single largest expense that a veterinary hospital incurs, this alone naire voit moins de patients. Étant donné que les médicaments can make a significant difference. et les fournitures représentent les dépenses les plus importantes The next area to look for savings is on rent or mortgage des établissements vétérinaires, cette catégorie peut à elle seule expenses. For those veterinarians who rent their facilities, the faire une différence significative. federal government recently announced that they will work with On peut ensuite examiner les dépenses liées au loyer ou à landlords and provincial governments to cover 75% of the rental l’hypothèque. Pour les médecins vétérinaires qui louent leur expense for businesses that have seen revenues decline by 70% local, le gouvernement fédéral a récemment annoncé qu’il or more. While it is unlikely that too many veterinary hospitals travaillerait avec les propriétaires d’immeubles et les gouverne- will have seen their revenues fall quite so precipitously, it may ments provinciaux pour couvrir 75 % du loyer des entreprises still be worthwhile to open a dialogue with the landlord, to dont les revenus ont diminué de 70 % ou plus. Bien qu’il soit

Dr. Doherty is a graduate of the Ontario Veterinary College and he works as an economic analyst for the Ontario Veterinary Medical Association. This article is provided as part of the CVMA Business Management Program, which is co-sponsored by IDEXX Laboratories, Petsecure Pet Health Insurance, Merck Animal Health, and Scotiabank. Address all correspondence to the CVMA Business Management Advisory Group; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. Le Dr Doherty est diplômé de l’Ontario Veterinary College et travaille comme analyste économique pour l’Ontario Veterinary Medical Association. Le présent article est rédigé dans le cadre du Programme de gestion commerciale de l’ACMV, qui est cocommandité par IDEXX Laboratories, Petsecure assurance maladie pour animaux, Merck Santé animale et la Banque Scotia. Veuillez adresser toute correspondance au Groupe consultatif de la gestion commerciale de l’ACMV ([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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explore the possibility of a rent reduction or deferral, to assist peu probable qu’un grand nombre d’établissements vétérinaires with cash flow. For those who own their building, the chartered aient vu leurs revenus chuter de façon aussi importante, il n’en Canadian banks have been offering mortgage deferrals of up to demeure pas moins possible de discuter avec le propriétaire et 6 months. Note that this is not mortgage forgiveness, and thus d’explorer la possibilité d’envisager une réduction ou un report will incur interest and likely result in higher payments, but it de loyer, afin de conserver les liquidités de l’entreprise. Pour ceux is an option for businesses that require the cash to see them qui sont propriétaires, les institutions financières canadiennes through the next few months. offrent de reporter les paiements des prêts hypothécaires pour In the same vein, for veterinary hospitals that have business une période allant jusqu’à 6 mois. Notez que ces paiements ne loans or lines of credit, there is an opportunity to work with sont pas annulés mais bien remis à plus tard, et qu’ils entraîne- the lender to defer payments or make “interest only” payments. ront des intérêts supplémentaires et probablement des paiements Again, this will invariably incur more interest over the life of plus élevés, mais c’est une option pour les entreprises qui ont the loan but can aid in managing cash flow in the short-term. besoin de liquidités pour continuer à fonctionner au cours des Finally, there are several expenses that can be pushed off until prochains mois. better days. Repairs and maintenance, continuing education, Dans la même veine, pour les établissements vétérinaires qui and advertising should be scaled back as much as possible, until ont des prêts ou des marges de crédit, il est possible de négocier GESTION D’UNECLINIQUE VÉTÉRINAIRE things return to a semblance of normal. avec le prêteur pour différer les paiements ou payer seulement While payroll, for both DVM and non-DVM staff is a sub- les intérêts. Encore une fois, cette mesure fera invariablement stantial expense, in most cases it should be one of the last areas augmenter les intérêts payés pendant la durée du prêt, mais peut in which savings are pursued, particularly as the federal govern- aider à gérer les liquidités à court terme. ment has introduced the Canada Emergency Wage Subsidy. Enfin, plusieurs dépenses peuvent être repoussées à plus tard. Layoffs, work-sharing (reduced hours), and other means should Les frais liés aux réparations et à l’entretien, à la formation conti- be explored only after consulting with an employment lawyer, nue et à la publicité devraient être réduits autant que possible, to ensure that provincial labor laws and employment contracts jusqu’à ce que les choses redeviennent plus normales. are adhered to. Furthermore, before the onset of COVID-19, Bien que la masse salariale, pour les vétérinaires salariés et le many veterinary hospitals were struggling to attract and retain personnel non vétérinaire, représente une dépense substantielle, associate veterinarians and RVT/AHTs; once the pandemic dans la plupart des cas, elle devrait être l’une des dernières recedes, it is likely these people will again be highly sought after. catégories où chercher des économies, d’autant plus que le gouvernement fédéral offre la Subvention salariale d’urgence Maintain revenues du Canada. Les mises à pied, le travail partagé (réduction des Despite veterinarians in many parts of the country postponing heures) et d’autres moyens impliquant le personnel ne devraient elective procedures, only providing urgent care, or reducing the être envisagés qu’après avoir consulté un avocat en droit du number of cases they see, it is still both possible and advisable travail, afin de s’assurer que les lois provinciales et les contrats to maintain revenues as much as is feasible. d’emploi sont respectés. En outre, avant le début de la pandé- One route to accomplish this is to continue the selling of mie, de nombreux établissements vétérinaires avaient du mal à dietary and pharmaceutical products, which are a considerable attirer et à retenir des vétérinaires salariés et des techniciens en source of revenue in many hospitals. This can be accomplished santé animale; il est probable que ces professionnels seront à with physical distancing from the pet owner, as products can nouveau très recherchés une fois la pandémie maîtrisée. typically be picked up curbside with little to no in-person interaction, or in some cases products can be delivered to the Maintenir les revenus pet owner’s home. Même si les médecins vétérinaires dans de nombreuses régions Telemedicine provides another means for veterinarians to du pays reportent les interventions électives, ne prodiguent que earn revenue. Using phone, e-mail, video conferencing, or a des soins urgents ou réduisent le nombre de cas qu’ils voient, veterinary telemedicine platform can allow veterinarians to man- il est souhaitable de maintenir les revenus autant que possible. age non-urgent cases, triage potential emergencies, and provide Une façon d’y parvenir est de poursuivre la vente de sacs de advice and guidance to their clients, while adhering to physical nourriture et de produits pharmaceutiques, qui sont une source distancing. However, if providing this service, it is important importante de revenus dans de nombreux établissements vétéri- to remember to charge for it. naires. Ces ventes peuvent se faire en respectant les consignes de distanciation sociale, car les clients peuvent venir chercher leurs Utilize government programs achats avec peu ou pas d’interaction en personne (ramassage In response to the COVID-19 pandemic, the federal govern- sans contact), ou les produits peuvent être livrés au domicile du ment has announced a myriad of initiatives, many of which propriétaire de l’animal. are relevant to veterinarians. Perhaps the most impactful is La télémédecine est un autre moyen par lequel les méde- the Canada Emergency Wage Subsidy (CEWS), in which cins vétérinaires peuvent continuer à générer des revenus. the government will cover 75% of all employee wages, up L’utilisation du téléphone, du courriel, de la vidéoconférence ou to $847 per week, from March 15 to August 29. In order to d’une plateforme de télémédecine vétérinaire peut permettre aux qualify, a business must have seen their March revenue fall by médecins vétérinaires de prendre en charge les cas non urgents, 15% from last year, or their April and May revenue fall by 30%. de trier les urgences potentielles et de fournir des conseils et des

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Table 1/Tableau 1. Example of how expenditures may be recommandations à leurs clients, tout en respectant la distan- managed to respond to reduced income in a veterinary practice PRACTICE MANAGEMENT VETERINARY with 1 owner, 1 full-time associate, and 1 part-time associate. ciation physique. Cependant, si vous fournissez ce service, il est Exemple de la façon dont les dépenses peuvent être gérées pour important de ne pas oublier de le facturer. répondre à la baisse des revenus dans un établissement vétérinaire ayant un médecin vétérinaire propriétaire, un médecin vétérinaire Avoir recours aux programmes salarié à temps plein et un médecin vétérinaire salarié à gouvernementaux temps partiel. En réponse à la pandémie de COVID-19, le gouvernement fédé- April May June Avril Mai Juin ral a annoncé diverses mesures d’aide dont plusieurs s’appliquent aux médecins vétérinaires. L’une des plus importantes est sans Revenue/Revenus $109 357 $121 318 $95 687 Drugs and supplies $30 073 $33 362 $26 314 doute la Subvention salariale d’urgence du Canada (SSUC), par Médicaments et fournitures laquelle le gouvernement s’engage à couvrir 75 % du salaire de Non-DVM wages $6736 $6736 $6736 tous les employés, jusqu’à concurrence de 847 $ par semaine, Salaires des employés non vétérinaires du 15 mars au 29 août. Pour être admissible, l’entreprise doit DVM wages $8053 $8053 $8053 avoir vu ses revenus de mars baisser de 15 % par rapport à Salaires des vétérinaires Specialists/Spécialistes $656 $728 $574 l’an dernier, ou ses revenus d’avril et de mai baisser de 30 %. Rent/Loyer $7229 $7229 $7229 Comme on l’a mentionné précédemment, étant donné que la Office/Frais de bureau $1640 $1820 $1435 masse salariale est une dépense considérable dans presque tous Accounting and legal $0 $0 $0 les établissements vétérinaires, ce programme gouvernemental Services comptables et juridiques peut vraiment changer la donne. Bank charges/Frais bancaires $2078 $2305 $1818 Les établissements qui ne sont pas admissibles à la SSUC Utilities/Services publics $1577 $1577 $1577 peuvent demander la subvention salariale temporaire de 10 %, Repairs & maintenance $394 $394 $394 Réparations et entretien qui fournira jusqu’à 1375 $ par employé ou 25 000 $ par Laboratory/Laboratoire $2734 $3033 $2392 employeur. Professional dues $657 $657 $657 Enfin, le gouvernement fédéral propose le Compte d’urgence Cotisations professionnelles pour les entreprises canadiennes, qui offre un prêt sans intérêt Other expenses/Autres frais $131 $131 $131 de 40 000 $ aux entreprises qui ont payé entre 20 000 $ et Advertising/Publicité $1052 $1052 $1052 1 500 000 $ en masse salariale en 2019. De plus, une partie du Equipment rental $789 $789 $789 prêt (jusqu’à 10 000 $) sera radiée si le prêt est remboursé d’ici Location d’équipement Continuing education $0 $0 $0 la fin de 2022. Formation continue Insurance/Assurances $789 $789 $789 Exemple d’application de ces mesures Net Income/Revenu net $44 768 $52 663 $35 746 Prenons comme exemple un établissement ayant un médecin vétérinaire propriétaire, un médecin vétérinaire salarié à temps plein et un médecin vétérinaire salarié à temps partiel. D’après les moyennes nationales pondérées de l’enquête éco- As mentioned, given that payroll is a sizable expense in nearly nomique auprès des propriétaires d’établissements vétérinaires all hospitals, this government program can be a game changer de 2019, cette pratique aurait un revenu annuel d’un peu moins if a veterinarian’s business has declined. de 1 600 000 $. Cette somme peut être répartie tout au long de For those hospitals that do not qualify for the CEWS, they l’année en utilisant les données de l’indice d’activité vétérinaire are still able to access the Temporary 10% Wage Subsidy, which de l’Ontario, car certains mois sont plus occupés que d’autres. will provide up to $1375 per employee or $25 000 per employer. Le propriétaire se paie à lui-même et verse au médecin Finally, the federal government has launched the Canada vétérinaire salarié à temps plein un salaire annuel de 91 510 $ Emergency Business Account (CEBA), which provides a (moyenne nationale pondérée du salaire des médecins vétéri- $40 000 interest free loan to businesses with payroll between naires à temps plein) et paie 45 755 $ par an au médecin vété- $20 000 and $1 500 000 in 2019. In addition, up to $10 000 rinaire salarié à temps partiel; les trois salaires sont admissibles of this will be forgiven, if repaid by the end of 2022. à la SSUC. Les dépenses liées aux médicaments et aux fournitures, Putting it all together aux spécialistes, aux frais bancaires et aux frais de laboratoire As an example, consider a DVM practice with 1 practice owner, évoluent en fonction des revenus. Les réparations et l’entretien 1 full-time associate, and 1 part-time associate. sont réduits de 75 %, en supposant que seules les réparations Using national weighted average figures from the 2019 essentielles sont effectuées. Les dépenses liées à la formation Practice Owners Economic Survey, this hospital would have continue et aux services comptables et juridiques sont réduites an annual revenue just shy of $1 600 000. This can be spread à zéro et reportées à plus tard (tableau 1). through the year using Veterinary Activity Index data from Comme les revenus de l’entreprise ont baissé de 35 % en avril, Ontario, as some months will be busier than others. mai et juin, les salaires peuvent être couverts par la SSUC. La The practice owner pays both herself/himself and full-time masse salariale mensuelle était légèrement supérieure à 46 000 $, associate an annual salary of $91 510 (the national weighted mais elle baisse à moins de 15 000 $ avec la subvention. Cette

CVJ / VOL 61 / JULY 2020 787 FOR PERSONAL USE ONLY

average full-time associate compensation), and the part-time somme comprend le salaire que le propriétaire se verse à lui- associate $45 755 annually; all 3 salaries would be eligible for même, qui est admissible à la SSUC sous réserve des dispositions CEWS. relatives aux employés avec lien de dépendance. Drug and supply, specialist, bank charges, and laboratory Malgré une forte baisse des revenus, en réduisant les dépenses, expenses will all scale with revenue. Repairs and maintenance are en tentant de maintenir autant que possible les revenus et en reduced by 75%, with the assumption that only critical repairs ayant recours aux programmes gouvernementaux offerts, cet are performed. Accounting/legal and continuing education are établissement vétérinaire canadien moyen hypothétique est reduced to zero and deferred until later (Table 1). toujours en mesure de générer un revenu net positif chaque This hospital has seen revenues decline by 35% for April, mois. La mise en œuvre de ces stratégies devrait permettre à la May, and June, and thus qualifies for CEWS. Prior to the sub- plupart des établissements vétérinaires de traverser avec succès sidy, monthly payroll was just above $46 000; with the subsidy, la période creuse provoquée par la pandémie. it falls to almost $15 000. Note that this includes the salary that the practice owner pays himself/herself, which is eligible Remarques : Les moyennes nationales pondérées des revenus et for CEWS, subject to the non-arm’s length employee provisions. des dépenses proviennent des résultats de l’enquête économique Despite suffering a steep decline in revenues, by managing menée par l’ACMV auprès des propriétaires d’établissements GESTION D’UNECLINIQUE VÉTÉRINAIRE their expenses, maintaining revenues as much as possible, and vétérinaires en 2019. Les données sur la rémunération des méde- utilizing the government programs available, this hypothetical cins vétérinaires salariés sont tirées des enquêtes provinciales de average Canadian veterinary hospital is still able to generate a 2019 sur la rémunération et les avantages sociaux des médecins positive net income through each month. For most veterinar- vétérinaires salariés. Les moyennes provinciales sont pondérées ians, implementing all these strategies should allow them to en fonction de la population relative pour calculer une moyenne successfully navigate the slow months brought upon by the nationale pondérée. ■ pandemic as well.

Notes: National weighted average revenue and expenses were derived from CVMA 2019 Practice Owners Economic Surveys. Associate compensation data were derived from 2019 Provincial Surveys of Associate Compensation and Benefits. Provincial averages are weighted based on relative population to calculate a national weighted average. ■

788 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY Diagnostic Ophthalmology Ophtalmologie diagnostique

Shayna Levitt, Stephanie Osinchuk, Lynne Sandmeyer

History and clinical signs 10-year-old Welsh pony cross gelding was examined at the A ophthalmology service at the Western College of Veterinary Medicine for evaluation of a change of color of the right bulbar conjunctiva from black to pink (Figure 1). The menace response, palpebral, oculocephalic, and direct and consensual pupillary light reflexes were present bilaterally. Schirmer tear test (Schirmer Tear Test Strips; Alcon Canada, Mississauga, Ontario) values were 25 and . 35 mm/min in the right and left eyes, respectively. The intraocular pressures were estimated with a rebound tonometer (Tonovet, Tiolat, Helinski, Finland) and were 26 mmHg bilaterally. On direct examination, there was an irregularly shaped area of depigmentation with a mottled surface affecting the lateral bulbar conjunctiva. Following application Figure 1. Photograph of the right eye of a 10-year-old Welsh of 0.5% tropicamide (Mydriacyl; Alcon Canada, Mississauga, pony cross gelding. There was an irregularly shaped area of depigmentation on the bulbar conjunctiva. Ontario), biomicroscopic examination (Osram 64222; Carl Zeiss Canada, Don Mills, Ontario) revealed no further abnormalities bilaterally. Indirect ophthalmoscopic (Heine Omega 200; Heine Instruments Canada, Kitchener, Ontario) examinations were completed bilaterally and no further abnormalities were detected. What are your clinical diagnosis, differential diagnoses, therapeutic plan, and prognosis? Discussion Differential diagnoses for the depigmented lesion included neoplasia (squamous cell carcinoma (SCC), papilloma, adenoma, lymphoma, mast cell tumor) or an inflammatory lesion (parasitic, granuloma, immune-mediated disease, foreign body reac- Figure 2. A light microscopic image of the depigmented lesion. There is an increase in epithelial layers, undulating epithelial tion). An excisional biopsy was submitted for histopathology. basement membrane, and multiple nests of epithelial cells in Light microscopy revealed an undulating basement membrane of the substantia propria below the basement membrane of the the epithelium with packets of epithelial cells invading into the epithelium. There are also scattered lymphocytes and plasma cells within the substantia propria. Image collected at 53, substantia propria consistent with a diagnosis of SCC (Figure 2). Bar = 0.2 mm.

Department of Clinical Studies, Ontario Veterinary College, Squamous cell carcinoma is the most common neoplasm of University of Guelph, 50 Stone Road East, Guelph, Ontario, ocular tissue in horses, affecting the eyelids, conjunctiva, limbus, N1G 2W1 (Levitt); Department of Small Animal Clinical cornea, and nictitans (1,2). An increased prevalence has been Sciences, Western College of Veterinary Medicine, University reported in Haflingers (3,4), Appaloosas, Paint horses, Quarter of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan horses, draft horses, Belgians, and Percherons (4). Prevalence S7N 5B4 (Osinchuk, Sandmeyer). increases with age (2), with horses between 8 and 13 years most Use of this article is limited to a single copy for personal study. affected (5). A predisposition for ocular and adnexal SCCs has Anyone interested in obtaining reprints should contact the been reported in geldings (5). Horses with a lighter coat color CVMA office ([email protected]) for additional are overrepresented, likely due to a lack of photoprotective pig- copies or permission to use this material elsewhere. ment in the skin and conjunctiva (4).

CVJ / VOL 61 / JULY 2020 789 FOR PERSONAL USE ONLY OPHTALMOLOGIE DIAGNOSTIQUE OPHTALMOLOGIE

Figure 3. Photograph of the right eye of a 10-year-old Welsh Figure 4. Strontium-90 beta-irradiation was applied to the Pony cross gelding after the excisional biopsy had healed. There surgical site under standing sedation. was a focal area of conjunctival thickening and cobblestone texture of 1 mm in diameter at the junction of the pigmented and non-pigmented conjunctiva.

Although the pathogenesis has not been fully elucidated, it is frequently than limbal SCC, possibly due to the sclera and cor- likely that several factors play a role, including prolonged expo- nea acting as barriers to the penetration of cells (13). sure to sunlight and genetics (2–4). Ultraviolet radiation causes Surgical excision is the most common treatment option mutations in the tumor suppressor gene p53, a gene that codes for ocular SCC and can be adequate when a wide margin is for a protein involved in cell cycle and tumor suppression (6). excised (13). Cryotherapy, radiofrequency hyperthermia, photo- This protein is overexpressed in SCC of multiple species, dynamic therapy, immunotherapy, chemotherapy with cisplatin, including horses (6). Damage-specific DNA binding protein 2 mitomycin C, radiotherapy, and beta-irradiation have all been (DDB2) is another gene important for the repair of ultraviolet- described as adjunctive therapies (1,2,5,8,10,13–16). induced mutations as it is involved in the excision and repair Beta-irradiation is applied to the neoplastic tissue using a of ultraviolet damaged DNA (3,4). Bellone et al (4) identified strontium probe (Figure 4) and is an effective treatment of a mutation in this gene that was strongly associated with SCC ocular SCC with a local control rate of 64% to 100% with range of the limbus and third eyelid in the Haflinger and Belgian, of follow-up varying between studies of 1 to 3 years after treat- and to a lesser extent in the Percheron (3,4). Genetic testing is ment (14–16). Beta-irradiation has been reported to be effica- available for screening Belgians and Halflingers for the DDB2 cious in cases of superficial SCC of the cornea and limbus after mutation (https://vgl.ucdavis.edu/services/HaflingerSCC.php). keratectomy (2,10). It is a safer adjunctive therapy for corneal Other factors such as papillomavirus (7), changes in estrogen and limbal lesions due to its limited range of penetration into and androgen levels in the blood (5), and parasitic irritation of soft tissue ( 2 mm) (13). tissues (2) have been suggested to play a role in the pathogenesis. In this case, the leading edge of the biopsy had neoplastic cells Early limbal SCC may appear clinically as an area of con- extending to the tissue margin. Upon re-examination 3 months junctival depigmentation or hyperemia, which can progress to later, the right eye revealed a focal area of conjunctival thicken- become ulcerated, raised, or multilobulated (2). It will often ing and cobblestone texture of 1 mm in diameter (Figure 3). begin at the lateral limbus and extend into the adjacent cornea A resection including a peripheral superficial keratectomy and conjunctiva (8). Affected eyes may have concomitant con- was completed to allow a 1 cm margin around the abnormal junctivitis and ocular discharge (9). tissue. Beta-irradiation was applied at a dose of 20 000 rads Ocular SCCs can be locally invasive, exhibit metastatic using a strontium probe (Figure 4) positioned directly over potential, and are prone to recurrence (10). Local invasion can the surgical site and repositioned as needed to expose the involve the sclera, intraocular structures, orbit, nasal cavity, gut- entire surgical site. Application of topical antibiotic therapy tural pouch, and sinuses (8). Metastases are reported in 6% to (BNP ointment; Vétoquinol, Lavaltrie, Quebec) was initiated 18% (5,8,11) of cases and most commonly involve the regional postoperatively, every 6 hours for 10 days. Administration of lymph nodes, salivary glands, or thorax (11). The recurrence rate phenylbutazone (Phenylbutazone tablets; Dominion Veterinary following treatment has been reported to be between 11.1% Laboratories, Winnipeg, Manitoba) was initiated, 1 g, per os for to 66.7% depending on completeness of surgical excision and 3 to 5 days. The excised tissue was submitted for histopathology, adjunctive therapy (5,8). Recurrences are more common in which revealed no evidence of neoplastic cells. The owner was eyelid SCC than the limbal form of the tumor (12), and third instructed to monitor for recurrence and a recheck was recom- eyelid and eyelid tumors tend to spread and metastasize more mended in 6 months, or earlier if there were concerns.

790 CVJ / VOL 61 / JULY 2020 FOR PERSONAL USE ONLY

References 9. Millichamp NJ. Conjunctiva. In: Auer JA, Stick JA, eds. Equine Surgery. Philadelphia, Pennsylvania: Saunders, 1999:465–471. 1. Dugan SJ. Ocular neoplasia. Vet Clin N Am Equine Pract 1992;8: 10. Plummer CE, Smith S, Andrew SE, et al. Combined keratectomy, 609–626. strontium-90 irradiation and permanent bulbar conjunctival grafts OPHTHALMOLOGYDIAGNOSTIC 2. Rebhun WC. Tumors of the eye and ocular adnexal tissues. Vet Clin for corneolimbal squamous cell carcinomas in horses (1990–2002): North Am Equine Pract 1998;14:579–606. 38 horses. Vet Ophthalmol 2007;10:37–42. 3. Singer-Berk M, Knickelbein KE, Vig S, et al. Genetic risk for squamous 11. Eversole TG, Lavach JD. Primary ocular squamous cell carcinoma with cell carcinoma of the nictitating membrane parallels that of the limbus metastasis in a horse. Vet Med Small Anim Clin 1978;73:287–290. in Haflinger horses. Anim Genet 2018;49:457–460. 12. Dugan SJ, Roberts SM, Curtis CR, Severin GA. Prognostic factors 4. Bellone RR, Liu J, Petersen JL, et al. A missense mutation in damage- and survival of horses with ocular/adnexal squamous cell carcinoma: specific DNA binding protein 2 is a genetic risk factor for limbal 147 cases (1978–1988). J Am Vet Med Assoc 1991;198:298–303. squamous cell carcinoma in horses. Int J Cancer 2017;141:342–353. 13. Hendrix DVH. Equine ocular squamous cell carcinoma. Clin Tech 5. Mosunic CB, Moore PA, Carmichael KP, et al. Effects of treatment with Equine Pract 2005;4:87–94. and without adjuvant radiation therapy on recurrence of ocular and 14. Théon AP. Radiation therapy in the horse. Vet Clin North Am Equine adnexal squamous cell carcinoma in horses: 157 cases (1985–2002). Pract 1998;14:673–688. J Am Vet Med Assoc 2004;225:1733–1738. 15. Frauenfelder HC, Blevins WE, Page EH. 90Sr for treatment of periocular 6. Sironi G, Riccaboni P, Mertel L, Cammarata G, Brooks DE. p53 pro- squamous cell carcinoma in the horse. J Am Vet Med Assoc 1982;180: tein expression in conjunctival squamous cell carcinomas of domestic 307. animals. Vet Ophthalmol 1999;2:227–231. 16. Walker MA, Goble D, Geiser D. Two-year non-recurrence rates for 7. Sykora S, Samek L, Schönthaler K, et al. EcPV-2 is transcriptionally equine ocular and periorbital squamous cell carcinoma following radioactive in equine SCC but only rarely detectable in swabs and semen therapy. Vet Radiol 1986;4:146. from healthy horses. Vet Microbiol 2012;158:194–198. 8. Kafarnik C, Rawlings M, Dubielzig RR. Corneal stromal invasive squamous cell carcinoma: A retrospective morphological description in 10 horses. Vet Ophthamol 2009;12:6–12.

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Grey Wolf Animal Health...... 675 Vetoquinol North America, Inc...... IFC

IDEXX Laboratories, Inc...... 666 Western Financial Group Insurance Solutions...... 665

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

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