The Canadian Veterinary Journal La Revue Vétérinaire Canadienne Biosecurity Practices in Western Canadian Cow-Calf Herds and Their Association with Animal Health

July/Juillet 2021 The Canadian Veterinary Journal

Vol. 62, No. 07 La Revue vétérinaire canadienne

July/Juillet 2021 Volume 62, No. 07 The Canadian Veterinary Journal La Revue vétérinaire canadienne Biosecurity practices in western Canadian cow-calf herds and their association with animal health

Computed tomographic characteristics of cavitary pulmonary adenocarcinoma in 3 dogs and 2 cats

Bordetella bronchiseptica-reactive antibodies in Canadian polar bears

Evaluation of platelet-rich plasma applied in the coronary band of healthy equine hooves

Diagnosis and outcome of nasal polyposis in 23 dogs treated medically or by endoscopic debridement

Sabulous cystitis in the horse: 13 cases (2013–2020)

Presumed acquired dynamic pectus excavatum in a cat

Computed tomographic diagnosis of necroulcerative reticulorumenitis with portal venous gas in a lamb

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JULY/JUILLET 2021 Contents Table des matières

SCIENTIFIC RUBRIQUE SCIENTIFIQUE

ARTICLES 736 Diagnosis and outcome of nasal polyposis 712 Biosecurity practices in western Canadian in 23 dogs treated medically or by cow-calf herds and their association with endoscopic debridement animal health Enrico Bottero, Emanuele Mussi, Fabiano Raponi, Davide De Lorenzi, Pietro Ruggiero Trent R. Wennekamp, Cheryl L. Waldner, Sarah Parker, M. Claire Windeyer, Kathy Larson, 743 Sabulous cystitis in the horse: 13 cases John R. Campbell (2013–2020) 719 Computed tomographic characteristics Luiza S. Zakia, Diego E. Gomez, Daniel G. Kenney, of cavitary pulmonary adenocarcinoma Luis G. Arroyo in 3 dogs and 2 cats Megan Parry, Laura E. Selmic, CASE REPORTS Sarah Lumbrezer-Johnson, Janis Lapsley, RAPPORTS DE CAS Vincent A. Wavreille, Eric Hostnik 751 Presumed acquired dynamic pectus 725 Bordetella bronchiseptica-reactive excavatum in a cat antibodies in Canadian polar bears Chee Kin Lim, Hock Gan Heng, Lynn F. Guptill John Ellis, Sheryl Gow, Nicholas Pilfold, 755 Computed tomographic diagnosis of Stacey Lacoste, Nicholas J. Lunn, necroulcerative reticulorumenitis with Evan S. Richardson, David McGeachy, portal venous gas in a lamb Megan Owen, Bruce Rideout Alexandra G. Collins-Webb, Robert Bildfell, 729 Evaluation of platelet-rich plasma applied in Lauren Newsom the coronary band of healthy equine hooves Sarah Raphaela Torquato Seidel, 675 QUIZ CORNER Anderson Fernando de Souza, Joice Fülber, TEST ÉCLAIR Paulo Moreira Bogossian, Nubia Nayara Pereira Rodrigues, Raquel Yvonne Arantes Baccarin

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JULY/JUILLET 2021 Contents Table des matières

FEATURES RUBRIQUES

PRESIDENT’S MESSAGE VETERINARY DERMATOLOGY LE MOT DE LA PRÉSIDENTE DERMATOLOGIE VÉTÉRINAIRE 671 What I have learned this year… 771 Cutaneous lymphoma in a Dachshund Ce que j’ai appris cette année… Andrea Lam Enid Stiles NOTICES ANNONCES 673 VETERINARY MEDICAL ETHICS DÉONTOLOGIE VÉTÉRINAIRE 754, Errata 759 687 2020 CVMA ANNUAL REPORT RAPPORT ANNUEL 2020 DE L’ACMV 766 Index of Advertisers Index des annonceurs 762 DIAGNOSTIC OPHTHALMOLOGY 775 Classifieds OPHTALMOLOGIE DIAGNOSTIQUE Petites annonces Danica R. Lucyshyn, Lynne S. Sandmeyer

SPECIAL REPORT RAPPORT SPÉCIAL NEWS | NOUVELLES 765 North Atlantic right whales: 2017–present Ashley L. Powell 677 NEWS NOUVELLES VETERINARY PRACTICE Heather Broughton, Sophie Perreault MANAGEMENT GESTION D’UNE PRATIQUE VÉTÉRINAIRE 767 Positive perceptions: Pet owners’ attitudes towards veterinary medicine/Perceptions positives : opinions des propriétaires d’animaux à l’égard de la médecine vétérinaire 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 2021 L’Association canadienne des médecins vétérinaires détient le droit d’auteur complet L’Association canadienne des médecins vétérinaires 2021 sur tous les articles contenus dans le présent numéro.

The Canadian Veterinary Journal is indexed or abstracted in: Co-Editors-in-Chief/Co-rédacteurs en chef La Revue vétérinaire canadienne est indexée ou ses articles sont Dr. John Kastelic, Calgary, Alberta résumés dans : Dr. Tim Ogilvie, Springbrook, Prince Edward Island AGRICOL, Biological Abstracts, Capsule Report, Current Contents — Agriculture, Derwent Veterinary Drug File, EMBASE/Excerpta Medica, Associate Editors/Rédacteurs associés Index Veterinarius, Index Medicus, Quarterly Index, Science Citation Index, Small Dr. Murray Jelinski, Saskatoon, Saskatchewan Animal Practice, Veterinary Bulletin, Veterinary Reference Service, Veterinary Update. Dr. Wayne McDonell, Guelph, Ontario Feature Editors/Rédacteurs des chroniques Dr. Jangi Bajwa, Burnaby, British Columbia Photo by/Photo de : Donna Kroeger, Lethbridge, Alberta Dr. Tim Blackwell, Fergus, Ontario Dr. Myrna Milani, Charlestown, New Hampshire Typesetting/Typographie Dr. Lynne Sandmeyer, Saskatoon, Saskatchewan AN Design Communications Dr. Debbie Stoewen, Ayr, 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 (2021). Annual: Canada $225 + applicable GST or HST; foreign Dr. Javier Sanchez, Charlottetown, Prince Edwad Island $240 US; institutional $295. 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, Prescott, Ontario Abonnements (2021). Annuel : Canada 225 $ + TPS ou TVH en vigueur; pays étranger 240 $ É-U; prix d’une institution 295 $. 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 62 / JULY 2021 FOR PERSONAL USE ONLY President’s Message Le mot de la présidente

What I have learned this year… Ce que j’ai appris cette année…

et’s be completely frank, this has not exactly been a “fun” oyons honnêtes, la dernière année n’a pas été particulière- L year. I know I am not alone in my thoughts here. The pan- S ment agréable. Je sais que je ne suis pas la seule à arriver à demic is lasting far longer than we thought it would, has affected ce constat. La pandémie, qui persiste beaucoup plus longtemps our everyday lives in ways we could not have imagined, and is qu’on l’aurait pensé, a affecté notre vie quotidienne d’une likely to continue to be part of our world for years to come. manière que nous n’aurions pas pu imaginer et continuera pro- As I look back on this past year as President, I am bombarded bablement de faire partie de notre réalité pour les années à venir. with memories and feelings that may seem contradictory. In En repensant à l’année écoulée à mon poste de présidente, many ways things have changed so very much. In other ways, plusieurs souvenirs et sentiments qui peuvent sembler contra- well, they are pretty much exactly the same: We are home, and dictoires me viennent en tête. D’un côté, tant de choses ont we are staying home. changé sur tellement de plans! Mais de l’autre côté, certaines So what has changed? First, my basement has never seen so choses sont restées exactement les mêmes depuis un an – nous much use! It is set up with a green screen, circular lamp, 2 com- sommes à la maison, et nous restons à la maison. puter screens, a microphone, tripods, oh and my indoor gym. Alors, qu’est-ce qui a tant changé? Premièrement, mon sous- The timing of my meetings is at the forefront of my mind, as sol n’a jamais été autant utilisé! On y trouve un écran vert, une the insanity that ensues when my kids get home from school lampe circulaire, deux écrans d’ordinateur, un microphone, des can be somewhat off-putting. trépieds, et mon gym personnel! L’heure à laquelle mes réunions Second, it’s not just my basement that got a lot of use this sont prévues est devenue un critère important, car le chaos qui year, my brain did too. I am thankful it did, because this s’installe lorsque mes enfants rentrent de l’école doit être pris “Groundhog Day” we have been living through is not what our en considération. brain needs to stay healthy. The good news is that we may not Deuxièmement, il n’y a pas que mon sous-sol qui a été très remember much of what we did during the pandemic in years to sollicité cette année – mon cerveau aussi. Je suis reconnaissante come. The bad news is that our brains need episodic change in que ça ait été le cas, car ce « jour de la marmotte » qui se répète order to hold memories and stave-off cognitive decline. Meeting quotidiennement n’est pas ce dont notre cerveau a besoin pour new people, going to a different park, learning a new language, rester en bonne santé. La bonne nouvelle est que nous oublie- seeing new spaces and places help keep our brains healthy. rons sans doute une partie de ce que nous avons fait pendant Thankfully, I have managed to keep my brain pretty active la pandémie dans les années à venir. La mauvaise est que notre at learning new things this year. My mind was also busy with cerveau a besoin de changements épisodiques pour conserver des the “joy” of learning a multitude of media programs and virtual souvenirs et éviter le déclin cognitif. Rencontrer de nouvelles platforms. I learned how to edit, produce, and film a video in personnes, aller dans un nouveau parc, apprendre une nouvelle order to bring my home-grown “Take 5 with Dr. Stiles” to langue et découvrir de nouveaux endroits aident à garder notre you. It also took me months and finally a new computer just cerveau en santé. to figure out how to have an animated background on Zoom!! Heureusement, j’ai réussi à garder mon cerveau assez actif I recall in my first president’s message I mentioned learning new pour apprendre de nouvelles choses cette année. Mon esprit était lingo and abbreviations. Well, I just kept learning! Long Hauler, aussi occupé par la « joie » de devoir me familiariser avec divers Covidiot, Maskne, Doom Scrolling, Zoombombing, Quarantini, programmes médiatiques et plateformes virtuelles. J’ai appris à

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

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and VoC! And who knew that the general public, and not just on their mental health. We are seeing more and more ethically science people, would use the terms mRNA and herd immunity! challenging situations that, sadly, lead to moral stress. We need On a more serious note, much of my time during the pan- to arm our professionals and support staff with knowledge on demic has been spent watching and listening to the news. What how to deal with these ethically challenging situations as well has become more and more obvious to me is how blatant the as ensure they have people to speak with and professionals to issues are surrounding health inequities. People who work in guide them when they are in need. We also need to do our part precarious and adverse work conditions, experience growing as small businesses and continue to ensure safe environments economic disparities, interlinked with class, ethnicity, gender, for our teams, including more paid sick leave, and mechanisms and education level, are the people who are being most affected to work remotely. and infected by this virus. COVID-19 has exacerbated our exist- As I write these last words of my presidency to all of you, ing social and health vulnerabilities. I know one thing to be true. I have said it all along: Science The issues we are seeing with people around the world living will win and so too will our collective social engagement and in poor socio-economic circumstances, unable to self-isolate, responsibility. I am 24 hours out from my first vaccination and LE MOT DE LA PRÉSIDENTELA DE MOT LE living in close proximity to each other, and unable to work from feel like I am on top of the world! There is a light at the end home or receive paid sick leave can easily be paralleled with what of this tunnel and we will walk through it together. Thank you we experience in production animal medicine. If we cannot give for a year I promise never to forget (brain fog aside)! It was a our animals proper nutrition, better living conditions (space, privilege to serve you all. ■ air quality, and comfort), we know that they will succumb to illness more quickly. If we cannot isolate them and care for them Enid Stiles properly, morbidity and mortality will increase. I worry for our veterinary teams and their safety, both as a direct effect (risk of infection) from COVID-19, and indirectly

produire, à filmer et à monter des vidéos afin de vous présenter résisteront moins longtemps à la maladie. Si nous ne pouvons ma série de capsules « Take 5 avec Dre Enid Stiles ». Il m’a éga- pas les isoler et les soigner correctement, la morbidité et la lement fallu des mois et même un nouvel ordinateur juste pour mortalité vont assurément augmenter. comprendre comment avoir un arrière-plan animé sur Zoom! Je m’inquiète pour nos équipes vétérinaires et leur sécurité, Je me souviens que dans mon premier mot de la présidente, j’ai à la fois pour les effets directs (risque d’infection) et indi- mentionné l’apprentissage de nouveaux termes et acronymes. rects (répercussions sur la santé mentale) de la pandémie de Eh bien, j’ai continué à apprendre – COVID longue, covidiot, COVID-19. Nous voyons de plus en plus de situations difficiles mascné, « doomscrolling », « zoom-bombing », quarantini et sur le plan éthique qui, malheureusement, sont une source de variants préoccupants… Et qui se doutait qu’un jour même le stress moral. Nous devons doter nos professionnels et notre grand public, et pas seulement les scientifiques, utiliserait les personnel de soutien des connaissances nécessaires pour faire termes ARNm et immunité collective! face à ces situations éprouvantes et nous assurer qu’ils ont accès Sur une note plus sérieuse, une grande partie de mon temps à quelqu’un à qui parler ou à des professionnels pour les gui- pendant la pandémie a été consacrée à regarder et à écouter les der lorsqu’ils en ressentent le besoin. Nous devons également nouvelles. Ce qui m’est devenu de plus en plus évident, c’est faire notre part en tant que gestionnaires de petites entreprises à quel point les problèmes entourant les inégalités en matière et continuer à offrir un milieu de travail sécuritaire pour nos de santé sont flagrants. Les personnes qui travaillent dans des équipes, entre autres en offrant davantage de congés de maladie conditions précaires et défavorables et qui sont aux prises avec payés, et en mettant en place des mécanismes pour permettre des disparités économiques croissantes, liées à leur classe sociale, le télétravail. à leur ethnicité, à leur sexe ou à leur scolarité, sont les personnes Au moment où je vous écris ces derniers mots de ma prési- les plus souvent affectées et infectées par le virus. La COVID-19 a dence, je demeure convaincue que, comme je l’ai toujours dit, la exacerbé les vulnérabilités sociales et sanitaires existantes. science triomphera, et notre engagement collectif et notre sens de On peut voir un parallèle entre les problèmes que nous la responsabilité sociale en sortiront grandis. J’aurai ma première constatons autour du monde – là où les gens vivent dans des dose de vaccin dans 24 heures et je suis au comble du bonheur! conditions socioéconomiques désavantageuses, sont incapables On voit la lumière au bout du tunnel, et nous marchons vers elle de s’isoler, cohabitent en promiscuité et n’ont pas la possibilité ensemble. Merci pour une année que je promets de ne jamais de travailler à la maison ou de bénéficier d’un congé de maladie oublier (à l’exception des périodes de « brouillard cérébral »)! payé – et ce que nous constatons en médecine des animaux de Cela a été pour moi un réel privilège de vous servir. ■ production. Si nous ne pouvons pas donner aux animaux une alimentation et des conditions de vie adéquates (en matière Enid Stiles d’espace, de qualité de l’air et de confort), nous savons qu’ils

672 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY Veterinary Medical Ethics Déontologie vétérinaire

Ethical question of the month — Question de déontologie du mois — April 2021 Avril 2021 Selective breeding in agricultural animals has resulted in signifi- L’élevage sélectif des animaux de ferme a entraîné des augmen- cant increases in productivity. These strides in productivity have tations considérables de la productivité. Cette hausse de la been associated with reductions in animal welfare. Laying hens productivité a par contre été associée à une baisse du bien-être face injurious feather pecking and weak, easily fractured bones; animal. Que ce soit le picage et les os fragiles sujets aux fractures broilers experience leg lameness and sudden death syndrome; chez les poules pondeuses, la boiterie due à des problèmes de dairy cattle have shortened longevity, hoof and leg lameness, and pattes et le syndrome de mort subite chez les poulets de chair, increased incidence of mastitis. These welfare reductions result ou encore la baisse de la longévité, la boiterie associée à des from both modern housing and production methods as well troubles des membres et des onglons ou la fréquence accrue de as heritable traits. With a limited pool of production genetics, mammite chez les bovins laitiers, ces impacts sur le bien-être farmers are at the mercy of breeding strategies that they have animal résultent à la fois des méthodes modernes de logement little power to change, forcing them to manage the resulting et de production ainsi que de traits héréditaires. Avec un pool pathologies. Recognizing that welfare-influencing traits are génétique limité, les agriculteurs sont à la merci de stratégies heritable, do genetics companies have a moral duty to select de sélection qu’ils n’ont pas le pouvoir de changer, et qui les for variants that will improve animal welfare? In a free-market obligent à gérer les pathologies qui en découlent. Reconnaissant system, can one expect any genetics company to voluntarily que des traits ayant un impact sur le bien-être sont hérédi- prioritize animal well-being over demands for productivity? taires, les entreprises de génétique ont-elles le devoir moral Submitted by Megan Allore, Montreal, Quebec de sélectionner des variants qui amélioreront le bien-être animal? Dans un système de libre marché, peut-on s’attendre à ce qu’une entreprise de génétique priorise volontairement le bien-être animal par rapport aux demandes en matière de productivité? Question soumise par Megan Allore, Montréal, Québec

An ethicist’s commentary on can genetic companies be expected to ignore productivity for the sake of welfare, when increases in productivity often involve costs in animal welfare? I acknowledge that self-interest is a primary value in business, is a fortiori true of swine, the most intelligent of farm animals. particularly the creation of profit. On the other hand, overzeal- Keeping pigs in small confinement conditions repels the average ous pursuit of profit may backfire, as historically occurred in citizen, especially when keeping animals in natural surroundings the case of worker exploitation. Subjecting workers to oppressive seems to have met or exceeded price as a societal concern, be it conditions led to the rise of unions, which considerably blunted farm animals or zoo animals. corporate power, and put profit at risk. For this reason, it is wise for companies to be perceived as The same is true of animal treatment. As concern for animals sensitive to societal concerns early, without being forced to do has increased rapidly across the western world, pursuit of profit so. The fate of confinement veal operations is an exemplar for has been supplanted by a focus on animal welfare in North industry, even if short-term gain is eroded. America, Europe, and elsewhere. In fact, over the last 20 years, high confinement agriculture has been consistently rejected by Bernard E. Rollin, PhD public opinion. When it comes to social change, it is always wise to be proac- tive, not reactive. This has been patently true of chickens, and

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Ethical question of the month — Question de déontologie du mois — July 2021 Juillet 2021 A veterinarian has a long-term contract with the animal care Un médecin vétérinaire a un contrat à long terme avec le committee of a university in good standing with the Canadian comité de protection des animaux d’une université en règle Council of Animal Care (CCAC). He was informed via e-mail avec le Conseil canadien de protection des animaux (CCPA). by the Dean that 50 healthy research animals would be depopu- Il a été informé par le doyen par courriel qu’une dépopulation lated for management reasons. The directive went against the de 50 animaux en santé serait effectuée pour des raisons de advice of the Animal Care Committee, the primary investigator, gestion. La directive allait à l’encontre des conseils du comité the technicians who cared for the animals, and the approved de protection des animaux, de l’investigateur principal et Animal Use Protocol endpoints for these animals. The veterinar- des techniciens qui s’occupaient des animaux, ainsi que des ian informed the appropriate authorities at the university that paramètres approuvés du protocole d’utilisation des animaux depopulation, in the absence of consultation with the Animal concernant ces animaux. Le médecin vétérinaire a informé Care Committee and veterinarian, would constitute “euthanasia les autorités compétentes de l’université que la dépopulation,

DÉONTOLOGIEVÉTÉRINAIRE of convenience” and that this would jeopardize the veterinary- en l’absence de consultation avec le comité de protection des client-patient relationship upon which a CCAC certificate was animaux et le médecin vétérinaire, constituerait une « eutha- contingent. The technicians, fearing for their jobs, eventually nasie de convenance » et que cela mettrait en péril la relation depopulated the animals and the veterinarian’s contract was ter- vétérinaire-client-patient de laquelle dépend la certification minated. What might be the appropriate next step, and would par le CCPA. Les techniciens, craignant pour leur emploi, ont this be any different if the research animals were primates, finalement procédé à la dépopulation et le contrat du médecin food animals, dogs, companion animals, rodents, or fish? vétérinaire a été résilié. Quelle pourrait être la prochaine étape appropriée, et serait-elle différente selon l’espèce animale en question (p. ex., des primates, des animaux destinés à la production d’aliments, des chiens, des animaux de compagnie, des rongeurs ou des poissons)?

Responses to the case presented are welcome. Please limit your reply to approximately 50 words and forward along with your name and address to: Ethical Choices, c/o Dr. Bettina Bobsien, 4353 Yellowpoint Road, Ladysmith, British Columbia V9G 1G5; e-mail: [email protected] Suggested ethical questions of the month are also welcome! All ethical questions or scenarios in the ethics column are based on actual events, which are changed, including names, locations, species, etc., to protect the confidentiality of the parties involved. Les réponses au cas présenté sont les bienvenues. Veuillez limiter votre réponse à environ 50 mots et nous la faire parvenir par la poste avec vos nom et adresse à l’adresse suivante : Choix déontologiques, a/s de la Dre Bettina Bobsien, 4353 rue Yellowpoint, Ladysmith (Colombie-Britannique) V9G 1G5; courriel : [email protected] Les propositions de questions déontologiques sont toujours bienvenues! Toutes les questions et situations présentées dans cette chronique 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 animal species has kidneys that are lighter in color 1. Laquelle des espèces animales suivantes possède des reins than other domestic animal species because of the presence dont la couleur est plus pâle que les autres espèces domes- of lipid droplets in renal tubular epithelial cells? tiques à cause de la présence de gouttelettes de lipides dans A. Dog les cellules épithéliales tubulaires des reins? B. Cat A. Chien C. Cattle B. Chat D. Horse C. Bovin E. Pig D. Cheval E. Porc 2. Which of the following is the most likely diagnosis for a 6-year-old Labrador retriever with lameness that worsens 2. Lequel des diagnostics suivants est le plus probable chez un after heavy exercise, reduced range of motion, and joint labrador retriever âgé de 6 ans qui présente une boiterie qui effusion with small numbers of mononuclear cells se détériore après un effort soutenu, une réduction de l’ampli- present? tude des mouvements et un épanchement articulaire avec A. Rheumatoid arthritis présence d’une petite quantité de cellules mononucléaires? B. Osteoarthritis A. Arthrite rhumatoïde C. Systemic lupus erythematosus B. Ostéoarthrite D. Type II erosive arthritis C. Lupus érythémateux disséminé D. Arthrite érosive de type II 3. Which of the following is the preferred primary treatment for scapular fractures with minimal displacement? 3. Lequel des traitements suivants est le traitement préféré pour A. Crossed Kirschner wires les fractures de la scapula avec déplacement minimal? B. Angle plates A. Broches de Kirschner croisées C. Lag screws B. Équerres en forme d’angle D. Cage confinement C. Vis à compression D. Confinement en cage 4. An appropriate volume of 2% lidocaine for caudal epidural anesthesia in a 600-kg cow is which of the following? 4. Quel est le volume de lidocaïne à 2 % approprié pour réali A. 2 mL ser une anesthésie épidurale chez une vache de 600 kg? B. 6 mL A. 2 mL C. 8 mL B. 6 mL D. 11 mL C. 8 mL E. 13 mL D. 11 mL E. 13 mL

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5. In equine species, following acute hemorrhage, the number 5. Chez le cheval, combien de jours après une hémorragie aiguë of days after which accelerated bone marrow red cell pro- l’accélération de la production de globules rouges par la duction should be evident is which of the following? moelle osseuse devrait-elle être évidente? A. 3 to 7 A. De 3 à 7 jours B. 7 to 10 B. De 7 à 10 jours C. 11 to 14 C. De 11 à 14 jours D. 14 to 21 D. De 14 à 21 jours

(See p. 735 for answers./Voir les réponses à la page 735.) TESTÉCLAIR

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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676 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY

NEWS | NOUVELLES

Thanks to Our Ethics Team of Drs. Bernard Rollin and Tim Blackwell Merci à notre équipe de déontologie composée des Drs Bernard Rollin et Tim Blackwell rs. Bernard Rollin and Tim Blackwell have been the team e Dr Bernard Rollin et le Dr Tim Blackwell ont constitué Dresponsible for The Canadian Veterinary Journal’s Veterinary Ll’équipe responsable de la chronique sur la déontologie vétéri- Medical Ethics column for over 25 years. Dr. Rollin is a pioneer naire de La Revue vétérinaire canadienne pendant plus de 25 ans. in veterinary medical ethics, and since 1984 he has offered read- Le Dr Rollin est un pionnier de la déontologie vétérinaire et, depuis ers his view of “the profession’s obligation to the animal” and 1984, il offre aux lecteurs son point de vue sur « l’obligation de his assessment of the “conflicting demands from clients, peers, la profession envers l’animal » et son évaluation des « demandes and society.” University Distinguished Professor at Colorado opposées des clients, des pairs et de la société ». Professeur émé- State University, he has authored 17 books and over 600 articles rite de l’Université d’État du Colorado, il est l’auteur de 17 livres and received numerous awards for his contributions to animal et de plus de 600 articles et a reçu de nombreux prix pour ses welfare and bioethics. These awards include the Animal Welfare contributions au bien-être animal et à la bioéthique, y compris le Foundation of Canada Brownlee Award (twice) and the American prix Brownlee de la Fondation du bien-être animal du Canada Veterinary Medical Association Humane Award (2007). (à deux reprises) et le Humane Award de l’American Veterinary On the occasion of Bernie’s receiving a Lifetime Achievement Medical Association (en 2007). Award for Excellence in Research Ethics by the Public Lorsque l’organisation PRIM&R (Public Responsibility in Responsibility in Medicine and Research organization in 2016, Medicine and Research) lui a remis un prix soulignant l’ensemble it was noted that “his friends describe him as extremely intel- de son œuvre en matière d’éthique en recherche en 2016, il a été ligent and sometimes combative, though they also add that he’s dit que « ses amis le décrivent comme un homme extrêmement kind, caring, honest, passionate and thoughtful” and that “he is intelligent et parfois combatif, mais aussi gentil, attentionné, hon- a creative, provocative, engaging, and even confrontational nête, passionné et prévenant », et qu’il est « un philosophe et un philosopher and educator who has shared his perspective and éducateur créatif, intéressant, provocateur et parfois même conflic- stimulated thought and discourse among diverse audiences.” tuel qui a su partager ses points de vue et susciter la réflexion et We have seen all these sides of Bernie through his CVJ column. les discussions dans des auditoires diversifiés ». Nous avons vu We have also seen him as a highly committed contributor who tous ces aspects du Dr Rollin à travers sa chronique dans La RVC. has written over 340 articles for The CVJ over the past 25 years. Il s’est aussi révélé être un contributeur très dévoué, comme en Bernie has had a leadership role and has been enormously témoignent ses quelque 340 articles écrits pour La RVC au cours influential in the development of regulations that reflect our des 25 dernières années. moral and ethical commitment to animals. We have been Le Dr Rollin a joué un rôle de leader et a été très influent dans extremely fortunate to have this world-renowned bioethicist l’élaboration de règlements qui reflètent notre engagement moral share his knowledge, perspective, and experience with our readers. et éthique envers les animaux. Nous avons été extrêmement chanceux que ce bioéthicien de renommée mondiale partage ses connaissances, ses opinions et son expérience avec nos lecteurs. Tout au long de ces nombreuses années, le Dr Rollin a eu le soutien du Dr Tim Blackwell, rédacteur de la rubrique sur la déontologie vétérinaire de La RVC. Le Dr Blackwell est articulé, réfléchi, progressiste et engagé envers le bien-être animal, les pro- ductions animales et la transparence. Il a reçu le Prix humanitaire de l’Association canadienne des médecins vétérinaires (ACMV) en 2015, en récompense de ses décennies de plaidoyer en faveur de systèmes porcins et de pratiques d’élevage qui améliorent le bien-être des porcs. Le Dr Blackwell a apporté un large éventail d’expériences à son poste de rédacteur de chronique et a fait la promotion du bien-être animal dans ses rôles de médecin vétérinaire d’animaux de ferme, de membre du corps professoral de l’Ontario Veterinary College, et de vétérinaire principal de l’Unité des sciences vétérinaires (USV) du Bureau du vétérinaire en chef de l’Ontario. Dans son poste

Dr. Bernie Rollin with baby mule. actuel à l’USV, le Dr Blackwell travaille en étroite collaboration Dr Bernie Rollin avec une jeune mule. avec les producteurs, les médecins vétérinaires, les chercheurs,

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N At every step of the 25 plus years, Dr. Rollin has had the l’industrie et les gouvernements pour élaborer et offrir des pro- support of Dr. Tim Blackwell, Feature Editor of The CVJ’s grammes de sensibilisation et de formation. Il est très apprécié de Veterinary Medical Ethics column. Tim has been articulate, ses collègues et des agriculteurs en raison de sa cordialité, de sa thoughtful, progressive, and committed to animal welfare, live- sincérité et de son profond engagement à améliorer les pratiques stock production, and transparency. He was honored with the de production et le bien-être des animaux. Dans un article qu’il a Canadian Veterinary Medical Association’s (CVMA) Humane co-écrit pour La RVC en 2019, il a dit que lorsque les gens s’en- Award in 2015. This award recognized “his decades of advocacy gagent émotionnellement, plutôt qu’intellectuellement, les compor- work calling for swine systems and husbandry practices that tements appropriés (prendre soin des porcs) deviennent la norme. improve the welfare of pigs.” Nous sommes profondément reconnaissants au Dr Blackwell pour Tim has brought a wide range of experiences to his position la prévenance, l’application et le professionnalisme dont il a fait as Feature Editor and has promoted animal welfare in his roles preuve dans son rôle de rédacteur de la chronique de déontologie as farm animal practitioner, faculty member at the Ontario vétérinaire de La RVC. Veterinary College, and lead veterinarian with the Veterinary (par le Dr Carlton Gyles, ancien rédacteur en chef de La RVC) Science Unit (VSU) of the Office of the Chief Veterinarian for Ontario. In his present position at the VSU, Tim works closely with farmers, veterinarians, researchers, industry and govern- Hommages à Bernard Rollin ments in the development and delivery of outreach and educa- Bernard Rollin est un réel pionnier dans le domaine de l’éthique tion programs. He is well liked by colleagues and farmers because professionnelle vétérinaire. À l’intersection de la philosophie et of his warmth, sincerity, and deep commitment to improving des sciences médicales, il a su les allier de manière équilibrée en production and welfare practices. In a paper he co-authored for tenant compte de l’évolution des mentalités et des connaissances. The CVJ in 2019 he commented that “when stock people are Alors que l’éthique est censée être un guide pour bien agir, il est engaged emotionally, rather than only intellectually, appropriate exceptionnel de trouver des éthiciens aussi informés des données behaviors (caring for pigs) become the norm.” We are deeply probantes et conscients de la réalité du terrain. Ces qualités ont grateful to Tim for the thoughtfulness, caring, and professional- fait en sorte qu’il a pour moi été d’une grande inspiration lorsque ism he has brought to his role as Feature Editor of the Veterinary j’ai moi-même entrepris d’approfondir ma réflexion et d’aider les Medical Ethics column of The CVJ. étudiants et les médecins vétérinaires à le faire. (by Dr. Carlton Gyles, former Editor-in-Chief, The CVJ) Je félicite le Dr Rollin pour tout ce qu’il a fait pour faire progresser la déontologie vétérinaire au Canada et nous l’enseigner grâce à Tributes to Bernard Rollin sa très populaire chronique dans La RVC au cours des 30 der- Bernard Rollin is a true pioneer in the field of veterinary ethics. nières années. Ayant moi-même soumis des scénarios que nous He has been able to combine philosophy and medical sciences rencontrons dans la pratique, j’ai toujours trouvé que les réponses in a balanced way, taking into account the evolution of both du Dr Rollin étaient instructives et qu’elles aidaient à éclairer les understanding and knowledge. Whereas ethics is supposed to « zones grises ». Je pense qu’avoir lu sa chronique a fait de nous be a guide for doing what’s right, it is exceptional to find an de meilleurs médecins vétérinaires, et que ses réflexions étaient ethicist so informed of the evidence, and aware of the reality in particulièrement utiles pour les jeunes vétérinaires. Je sais que the field. Because of these qualities, he was a great inspiration plusieurs scénarios publiés et leurs réponses ont été présentés to me as I undertook to deepen my own thinking and to help dans les cours de déontologie dans les écoles vétérinaires, ce qui students and veterinarians do so as well. prouve l’impact réel qu’il a eu sur notre profession. Les lecteurs de La RVC s’ennuieront de lui. I truly commend Dr. Bernie Rollin for all he has done in advancing and teaching us veterinary ethics in Canada through Je suis membre de l’ACMV depuis 20 ans et je lis toujours La RVC his highly read column in The CVJ over the last 30 years. As avec intérêt. La chronique de déontologie est souvent la première someone that has submitted some real-world scenarios that we que je consulte. Bien que je ne sois pas toujours d’accord avec la encounter in practice, Dr. Rollin’s response was always well- position du Dr Rollin, je respecte son point de vue, en particulier la heeded, and for me he took a lot of the grey out of the situation. façon dont il explique son raisonnement. Il sera, à mon avis, très I believe we are all much better veterinarians for reading his difficile à remplacer. column, and it has been especially helpful for young veterinarians. I know many of the scenarios and responses have been Dans un domaine qu’on sent souvent dominé par un intérêt seu- presented in veterinary ethics courses in veterinary school; a true lement envers la médecine humaine, le Dr Rollin a été un exemple test to the impact he has had on our profession. The CVJ will d’éthicien qui s’intéresse réellement au bien-être animal et qui miss you. souhaite véritablement aider à la fois les humains et les animaux. Sa connaissance approfondie de la production agricole et sa I have been a member of the CVMA for 20 years and am an avid volonté d’échanger avec tout le monde ont permis des discussions reader of The CVJ. The ethical question of the month is often fructueuses avec des médecins vétérinaires, des agriculteurs et the first thing I will read. While I am not always in agreement des étudiants comme moi. En tant que non-vétérinaire, je remer- with Dr. Rollin’s position on certain cases, I respect his point of cie le Dr Rollin d’avoir démontré qu’un intérêt pour la déontologie

678 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY view, specifically how he explains his reasoning. He will, in my vétérinaire est non seulement valable, mais aussi une voie viable N opinion, be very hard to replace. pour aider les autres.

In a field that often feels dominated by interest solely in human J’ai lu pour la première fois la chronique du Dr Rollin dans La Revue medicine, Dr. Rollin has served as an example of an ethicist with vétérinaire canadienne dans les années 1990 alors que je suivais a vested interest in animal wellbeing, and a genuine desire to une formation en évaluation et prise en charge de la douleur help both people and animals. His extensive knowledge of agri- animale. Récemment, nous avons mené une enquête auprès de cultural production and his willingness to engage with everyone praticiens vétérinaires concernant les protocoles d’analgésie pour has allowed for fruitful discussion with veterinarians, farmers, le soulagement de la douleur postopératoire. Environ le tiers des and students such as myself. As a non-veterinarian, I am grateful répondants ont déclaré que l’analgésie postopératoire était offerte to Dr. Rollin for demonstrating that an interest in veterinary en option aux clients. Cela m’a rappelé l’un des commentaires du ethics is not only valid, but a viable path to help others. Dr Rollin (Can Vet J 2010;51:686-688), stipulant que de la même façon que les clients ne dictent pas aux cliniciens les sutures à I was first exposed to Dr. Rollin’s column in The Canadian faire, les types de bandages à utiliser, ni les antibiotiques ou autres Veterinary Journal in the 90s while training in animal pain médicaments à prescrire pour traiter un animal selon les situations, assessment and management. Recently, we conducted a sur- le soulagement de la douleur devrait être une condition préalable vey of veterinary practitioners regarding analgesia protocols au traitement des animaux et non une option laissée à la discrétion for postoperative pain control. Approximately one-third of du client. Nous avons grandement bénéficié du fait qu’une sommité respondents said that postoperative analgesia was offered as visionnaire nous guide dans la pratique vétérinaire. Merci, Dr Rollin. an option to clients. This brought to mind one of Dr. Rollin’s commentaries (Can Vet J 2010;51:686–688): “Clients do not Pour les étudiants, la question de déontologie du mois de La RVC dictate to clinicians what sorts of sutures to use, what sorts of et les réflexions du Dr Rollin ont toujours été intéressantes tout bandages to deploy, or when and what sorts of antibiotics or en portant à réfléchir. Le Dr Rollin a permis d’éclairer certaines other medications to use in treating an animal… Pain control des situations les plus compliquées rencontrées en médecine should be presuppositional to treating animals, not a matter vétérinaire. of client discretion.” We have benefited greatly from having a visionary academician guiding us in veterinary practice. Thank Beaucoup d’étudiants ont été exposés aux idées du Dr Rollin avant you, Dr. Rollin. même leur admission à l’école vétérinaire. En effet, il est souvent recommandé aux étudiants de lire son livre An Introduction to For students, the “ethical question of the month,” and Dr. Rollin’s Veterinary Medical Ethics avant les entrevues de sélection. Cet insights has always been an interesting and thought-provoking ouvrage donne aux lecteurs une nouvelle appréciation de la façon section of The CVJ. Dr. Rollin shed light on some of the most dont les animaux peuvent être vus par différentes personnes et convoluted situations experienced in veterinary medicine. de la complexité déontologique de la profession vétérinaire. Sa chronique dans La RVC a aidé de nombreux étudiants à mieux Many students’ first exposure to Dr. Rollin came before they comprendre la déontologie vétérinaire. were admitted to veterinary school. Students are often recommended to read his book “An Introduction to Veterinary Medical Au nom de tous les étudiants vétérinaires canadiens passés, pré- Ethics” before veterinary school interviews. His book provided sents et futurs, nous remercions le Dr Rollin pour sa contribution a new appreciation for how animals can be viewed by different à notre apprentissage et à notre compréhension de la déontologie people and how ethically complicated the veterinary profession vétérinaire. Ses réflexions nous manqueront énormément. can be. His column in The CVJ has helped many students better understand veterinary ethics. Caroline Kilsdonk, D.M.V., M.A. (bioéthique), Université de Montréal On behalf of all Canadian veterinary students, past, present and Roy Lewis, D.M.V. (WCVM 1981) future, we thank Dr. Rollin for his contributions to our learn- H.J. Rumney, D.M.V., B. Sc. (biologie), B. Sc. (agriculture), ing and understanding of veterinary ethics. His insights will be North Simcoe Veterinary Services greatly missed. Megan Allore, B. Sc., étudiante à la maîtrise, Université McGill Eric Troncy, D.M.V., Ph. D., Université de Montréal Caroline Kilsdonk, DVM, MA (Bioethics), Kelcey King, promotion de 2022 de l’UCVM, et Svetlana Ponsin, University of Montreal promotion de 2022 du WCVM (représentantes du Roy Lewis, DVM (WCVM 1981) Comité des ÉACMV) H.J. Rumney, DVM BSc (Bio), BSc (Agr) North Simcoe Veterinary Services Megan Allore, BSc, MSc student, McGill University Eric Troncy, DVM, PhD, University of Montreal Kelcey King, UCVM Class of 2022 and Svetlana Ponsin, WCVM class of 2022 (SCVMA Representatives)

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N Thank you from the CVMA Merci au nom de l’ACMV As a profession, we are indebted to Bernard (Bernie) Rollin, Notre profession est grandement redevable à Bernard (Bernie) Professor of philosophy, animal sciences, and biomedical sci- Rollin, professeur de philosophie, de sciences animales et de ences at Colorado State University, for years of contributing sciences biomédicales à l’Université d’État du Colorado, pour his thought-provoking monthly column on veterinary ethics sa contribution durant de nombreuses années à l’intéressante to The Canadian Veterinary Journal (The CVJ). Professor Rollin chronique mensuelle sur la déontologie vétérinaire publiée dans is the author of many influential books, the titles of which La Revue vétérinaire canadienne (La RVC). Le Dr Rollin est l’auteur characterise his approach, such as The Unheeded Cry: Animal de nombreux livres influents dont les titres caractérisent son Consciousness, Animal Pain and Scientific Change and Putting approche, comme The Unheeded Cry: Animal Consciousness, Animal the Horse Before Descartes. His philosophically based viewpoints Pain and Scientific Change et Putting the Horse Before Descartes. toward the ethical treatment of animals have often challenged Ses points de vue philosophiques sur le traitement éthique des current veterinary practices as well as traditional scientific animaux ont souvent remis en question les pratiques vétérinaires method. They have motivated the veterinary profession to con- actuelles ainsi que la méthode scientifique traditionnelle. Ils ont sider many ethical dilemmas, and to think about these issues in motivé la profession vétérinaire à revoir de nombreuses questions different ways to those to which we had become accustomed. déontologiques et à y réfléchir différemment. Le Dr Rollin a réussi Bernie has successfully prompted the veterinary community to à inciter la communauté vétérinaire à envisager les dilemmes phi- reflect upon philosophical dilemmas in new ways, often through losophiques sous un nouveau jour, souvent dans une optique plus a broader lens, and his involvement on related committees has large, et sa participation à divers comités a contribué à des normes contributed to more progressive standards of animal care. plus progressives en ce qui concerne les soins aux animaux. Professor Rollin first became involved with the veterinary Le Dr Rollin s’est impliqué pour la première fois dans la pro- profession at a time when many in the profession had less fession vétérinaire à une époque où de nombreux médecins enlightened views on pain control than those currently held. vétérinaires avaient des opinions moins éclairées sur la prise en Over the years, he has enhanced our awareness with his book on charge de la douleur que celles qui prévalent actuellement. Il nous veterinary medical ethics and with his thoughtful contributions a sensibilisés avec son livre sur la déontologie vétérinaire et ses to The CVJ. His responses to the “ethical question of the month” contributions réfléchies à La RVC au fil des ans. Ses réponses were always well-argued, informative, and often provocative. à la « question de déontologie du mois » étaient toujours bien Some of the questions posed, such as can humans infer animal argumentées, informatives et souvent provocatrices. Certaines des emotions from behavior, also need input from a range of disci- questions posées, par exemple à savoir si les humains peuvent plines to marshal the scientific evidence and arguments so as to déduire les émotions des animaux à partir de leur comportement, provide a comprehensive answer. Eventually, however, answers nécessitent l’apport d’intervenants de multiples disciplines pour ras- to these types of questions require the application of philosophy sembler les preuves et les arguments scientifiques afin de fournir and ethics. We may have agreed or disagreed with his commen- une réponse complète. Toutefois, les réponses à ce type de ques- tary and conclusions, but we always should have benefited from tions nécessitent éventuellement l’application de la philosophie et consideration of his analyses and arguments. de l’éthique. Qu’on ait été d’accord ou pas avec ses commentaires Thank you, Bernie, for your many contributions to veterinary et ses conclusions, on pouvait toujours tirer un enseignement de ethics, animal welfare, and the veterinary profession! ses analyses et de ses arguments. r (by Dr. Michael Cockram, Merci à vous, D Rollin, pour vos nombreuses contributions à member Animal Welfare Committee, CVMA) la déontologie vétérinaire, au bien-être animal, et à la profession vétérinaire! (par le Dr Michael Cockram, membre du Comité sur le bien-être animal de l’ACMV)

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Animal Health Week 2021 — Semaine de la santé animale N October 3 to 9, 2021 du 3 au 9 octobre 2021 Animal Health 1 Human Health 1 Santé animale 1 santé humaine 1 Planet Health = One Health santé de la planète = Une seule santé t is time to start planning for Animal Health Week 2021! l est temps de commencer à planifier la Semaine de la santé IAnimal Health Week is an annual, national public aware- Ianimale de 2021! La Semaine de la santé animale est une cam- ness campaign organized by the Canadian Veterinary Medical pagne nationale annuelle de sensibilisation du public organisée Association (CVMA) and hosted by veterinarians across Canada. par l’Association canadienne des médecins vétérinaires (ACMV) et Each year, through Animal Health Week, the veterinary com- présentée par les médecins vétérinaires du Canada. Chaque année, munity draws attention to an important health-related mes- dans le cadre de la Semaine de la santé animale, la communauté sage. During the first week of October, veterinary teams across vétérinaire attire l’attention sur un important message lié à la santé. Canada promote a significant animal health-related message and Pendant la première semaine d’octobre, les équipes vétérinaires du responsible animal ownership as part of Animal Health Week pays font la promotion de ce message et de la propriété respon- celebrations. sable des animaux dans le cadre des célébrations de la Semaine The CVMA is proud to have celebrated Animal Health Week de la vie animale. across the country for 36 years! From October 3–9, 2021, the L’ACMV est fière de célébrer la Semaine de la santé animale CVMA will raise awareness of One Health; the collaborative partout au pays depuis 36 ans! Du 3 au 9 octobre 2021, l’ACMV effort of multiple disciplines — working locally, nationally, and mettra l’accent sur le concept « Une seule santé », soit l’effort globally — to attain optimal health for people, animals, and de collaboration multidisciplinaire – à l’échelle locale, nationale et the environment. This year’s theme Animal Health 1 Human mondiale – visant à atteindre une santé optimale pour les gens, Health 1 Planet Health = One Health will showcase how les animaux et l’environnement. Le slogan de cette année, Santé Canada’s veterinary professionals occupy unique positions within animale 1 santé humaine 1 santé de la planète = Une seule the national One Health community, and how protecting animal santé, met en évidence la position unique de la profession vété- health, protects everyone’s health. This campaign will empower rinaire au sein de la communauté nationale « Une santé » et the national veterinary community through awareness, recogni- comment la protection de la santé animale protège la santé tion, and knowledge of threats, in-turn improving public health de tous. Cette campagne valorisera la collectivité vétérinaire and animal welfare. nationale par la sensibilisation, la reconnaissance, et la prise de Promotional tools, including a social media campaign, infor- conscience des menaces, et améliorera ainsi la santé publique et mation, and articles will be available to promote Animal Health le bien-être animal. Week across the country. A free Animal Health Week poster Des outils promotionnels, y compris une campagne sur les is included in this issue of The Canadian Veterinary Journal. médias sociaux, de l’information et des articles, seront offerts pour Another poster will also be mailed to veterinary hospitals and promouvoir la Semaine de la santé animale d’un bout à l’autre du clinics across the country in August. The CVMA will not be pays. Une affiche gratuite de la Semaine de la santé animale est selling merchandise this year, as we are transitioning Animal incluse dans le présent numéro de La Revue vétérinaire canadienne, Health Week celebrations to an online awareness campaign only. et une autre affiche sera envoyée par la poste aux établissements As Animal Health Week nears, visit the Animal Health Week sec- vétérinaires du pays en août. L’ACMV ne vendra pas de marchan- tion under the Practice & Economics tab of the CVMA website dise cette année, car nous faisons la transition des célébrations de (www.canadianveterinarians.net) to find tips and tools to help la Semaine de la santé animale vers une campagne de sensibili- plan your celebrations. sation en ligne seulement. À l’approche du mois d’octobre, visitez

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N The 2021 Animal Health Week One Health campaign key la section Semaine de la santé animale sous l’onglet Pratique et messages are: finances du site Web de l’ACMV (www.veterinairesaucanada.net) • It is more important than ever for people to understand the pour obtenir des conseils et des outils qui vous aideront à planifier critical links between animal, human, and environmental vos célébrations. health. Les messages clés de la campagne de 2021 sont les • Animals, people, and the environment; keeping one healthy suivants : requires that all be healthy. • Il est plus important que jamais que les gens comprennent • The veterinary profession holds significant roles and respon- les liens fondamentaux entre la santé animale, humaine et sibilities to safeguard One Health. environnementale. • Veterinarians are One Health practitioners by protecting the • L’animal, l’humain et l’environnement – pour que l’un soit en health and safety of animals, and in turn, people, and the santé, les autres doivent l’être aussi. environment. • La profession vétérinaire joue un rôle important et assume des • Veterinarians have critical One Health roles in food safety, responsabilités cruciales dans l’approche « Une seule santé » environmental protection, and public health. pour préserver cette santé globale. Sponsors • Les médecins vétérinaires sont des praticiens « Une seule santé » car ils protègent la santé et la sécurité des animaux et, Generous support of the 2021 Animal Health Week campaign par ricochet, celles des humains et de l’environnement. is provided by Program Sponsors, iFinance Canada (Petcard) • Les médecins vétérinaires jouent des rôles « Une seule santé » and Petsecure. essentiels en innocuité des aliments, en protection de l’environnement et en santé publique. Commanditaires La campagne de la Semaine de la santé animale de 2021 est généreusement soutenue par iFinance Canada (Petcard) et Petsecure.

Digital Success CVMA partner, Moneris provides a step-by-step guide on how veterinary practices can establish an online presence by launching an e-commerce website Succès en ligne Partenaire de l’ACMV, Moneris explique comment les pratiques vétérinaires peuvent établir une présence en ligne en lançant un site Web de commerce électronique

nvesting in e-commerce can be a valuable addition to your nvestir dans le commerce électronique peut vous donner une Irevenue stream. People can order everything online from dog Isource de revenus additionnels. Ainsi, les gens pourront tout food to prescriptions — without leaving the comfort of their commander en ligne, des aliments pour chiens aux médicaments home. The strength of e-commerce lies in its convenience as d’ordonnance – sans quitter le confort de leur foyer. La force du potential clients can find your practice from anywhere with an commerce électronique réside dans sa commodité, car les clients internet connection. potentiels peuvent trouver votre pratique à partir de n’importe où s’ils ont une connexion Internet. Step-by-step e-commerce plan Before anything else, you need to lay the groundwork with Faites un plan some pre-launch preparation. The best way to start involves a Avant toute chose, vous devez faire un travail de préparation avant plan, similar to an overall business plan, specifically focused on le lancement. La meilleure façon de commencer est de faire un e-commerce. It doesn’t need to be complicated; however, it does plan, similaire à un plan d’affaires global, spécifiquement axé sur le need to outline the essentials for getting up and running online. commerce électronique. Ce plan n’a pas à être compliqué; cepen- Now that we laid the groundwork, the next step is to choose dant, il doit décrire les éléments essentiels pour que le projet soit the right e-commerce solution for your practice. Every practice opérationnel en ligne. has specific needs, while various platforms have strengths and L’étape suivante consiste à choisir la bonne solution de com- weaknesses. An essential factor in selecting the best e-commerce merce électronique pour votre pratique. Chaque pratique a des solution is whether it offers the right features for your practice. besoins qui lui sont propres, et toutes les plateformes ont des

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Although you could create a website in minutes, without a forces et des faiblesses. L’un des facteurs essentiels dans le choix N proper launch strategy, you run the risk of losing out on poten- de la meilleure solution de commerce électronique est donc de tial opportunity. With an organized approach to launching savoir si elle offre les bonnes fonctionnalités pour votre pratique. your website, you will set up the online business aspect of your Même s’il est possible de créer un site Web en quelques practice for long-term, scalable success. minutes, sans stratégie de lancement appropriée, vous risquez de ne pas l’exploiter à son plein potentiel. Une approche organisée Accept all the online payment methods du lancement de votre site Web vous aidera à assurer le succès With the expansion of e-commerce and the need for secure modulable à long terme de cet aspect de votre pratique. payment methods, more people are embracing digital wallet payments. Digital wallets have seen a surge in popularity in the Acceptez tous les modes de paiement last few years, not only for the security they provide, but also en ligne for the great convenience involved. Avec l’expansion du commerce électronique et le besoin de pouvoir To meet the changing preferences of customers, it’s important utiliser des méthodes de paiement sécurisées, de plus en plus de to evolve your website and provide a smooth experience. While a gens adoptent les paiements par portefeuille électronique. Les mobile-friendly website is a big part of it, you also have to offer a portefeuilles électroniques ont connu un regain de popularité au seamless checkout experience with alternative payment methods. cours des dernières années, non seulement pour la sécurité qu’ils offrent, mais aussi pour leur grande commodité. Set up curbside pickup Pour répondre aux préférences changeantes des clients, il est Curbside pickup simplifies shopping by allowing customers to important de faire évoluer votre site Web et de fournir une expé- browse through your products safely, whenever and wherever rience fluide. Bien qu’un site adapté aux appareils mobiles soit they want. Allowing customers to order online and pick up essentiel, vous devez également offrir une expérience de paiement at your physical location can help you save on shipping costs, transparente avec différents modes de paiement. utilize in-store inventory, and increase overall sales. Curbside drop-off and pickup are already an integral part of Offrez le ramassage au point de vente the new normal for veterinarians across the country. By giving Le ramassage des commandes au point de vente simplifie les your customers the ability to pick up Fluffy’s favorite food and achats en permettant aux clients de magasiner en toute sécurité, prescription at the same time, you are creating a revenue oppor- quand et où ils le souhaitent. Permettre à vos clients de comman- tunity with minimal effort. der en ligne et de récupérer leur commande à votre établissement Moneris is pleased to offer CVMA members preferred card vétérinaire peut vous aider à économiser sur les frais d’expédition, payment processing rates for your business. Let Moneris sales à écouler vos stocks et à augmenter vos ventes totales. representatives help you meet the needs of your customers today La prise en charge des animaux à l’extérieur de l’établissement and tomorrow. Get in touch at 1-888-552-0341. fait partie intégrante de la nouvelle norme pour les médecins The information in this article is provided solely for infor- vétérinaires partout au pays. En donnant à vos clients la possibilité mational purposes and is not intended to be legal, business, d’obtenir la nourriture préférée de Fluffy en même temps que ses or other professional advice or an endorsement of any of the médicaments, vous créez une opportunité de générer des revenus websites or services listed. avec un effort minime. Moneris est heureuse d’offrir aux membres de l’ACMV des tarifs préférentiels de traitement des paiements par carte pour leur entreprise. Laissez les représentants de Moneris vous aider à répondre aux besoins de vos clients d’aujourd’hui et de demain. Communiquez avec eux au 1-888-552-0341. L’information contenue dans le présent article est fournie uniquement à titre informatif et ne doit pas être interprétée comme des conseils professionnels de nature juridique, commerciale ou autre ni comme une recommandation de l’un des sites ou des services répertoriés.

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N Position Statement on Énoncé de position sur les Service Animals animaux d’assistance ecently the CVMA Council approved a new a position e Conseil de l’ACMV a récemment approuvé un nouvel énoncé Rstatement on service animals. Under federal legislation Lde position sur les animaux d’assistance. En vertu de la légis- in Canada a “service animal” is defined as “an animal that is lation fédérale canadienne, un « animal d’assistance » est défini required by a person with a disability for assistance and is certi- comme un « animal dont une personne ayant une déficience a fied, in writing, as having been trained by a professional service besoin pour l’assister et qui fait l’objet d’un certificat attestant animal institution to assist a person with disability.” qu’il a été dressé à cette fin par un organisme professionnel de Depending on the jurisdiction, an animal identified as a dressage des animaux d’assistance ». “therapy animal,” “emotional support animal” or “working ani- Dans certaines régions, un animal identifié comme un « animal mal” may not be considered a service animal, and therefore, may de thérapie », un « animal de soutien émotionnel » ou un « animal not have the same rights as a service animal to access facilities de travail » peut ne pas être considéré comme un animal d’as- or services such as workplaces, stores, restaurants, and airlines. sistance et, par conséquent, ne pas avoir les mêmes droits qu’un The CVMA’s position states that veterinarians should con- animal d’assistance pour l’accès à des endroits ou à des services tribute to the development of a national standard for service ani- comme les lieux de travail, les magasins, les restaurants ou le mals and work in close collaboration with colleagues in human transport aérien. healthcare and recognized institutions to support the health and La position de l’ACMV stipule que les médecins vétérinaires welfare of service animals, as well as public health and safety. devraient contribuer à l’élaboration d’une norme nationale concernant les animaux d’assistance et travailler en étroite collaboration Service Animals — Position Statement avec les intervenants du secteur de la santé humaine et des institutions reconnues pour soutenir la santé et le bien-être des The Canadian Veterinary Medical Association (CVMA) holds animaux d’assistance, ainsi que la santé et la sécurité du public. that the veterinary profession should contribute to the development and maintenance of a national standard for service ani- Animaux d’assistance – Énoncé de position mals. Furthermore, veterinarians should provide expert advice on the proper care of service animals to support animal health « L’Association canadienne des médecins vétérinaires (ACMV) and welfare, and public health and safety. soutient que la profession vétérinaire devrait contribuer à l’éla- boration et au maintien d’une norme nationale concernant les animaux d’assistance, et que les médecins vétérinaires devraient In December of 2017, the CVMA Council accepted a proposal être appelés à fournir des conseils d’experts sur les soins appro- from the National Issues Committee (NIC) for the development priés à prodiguer aux animaux d’assistance afin de soutenir la of a position statement on Service Animals. Work on the posi- santé et le bien-être de ces animaux ainsi que la santé et la tion statement was put on hold pending the completion of a sécurité du public. » Canadian General Standards Board (CGSB) initiative to develop a national standard for service dogs. A working group comprised En décembre 2017, le Conseil de l’ACMV a accepté une proposition du Comité sur les enjeux nationaux pour la rédaction d’un énoncé de position sur les animaux d’assistance. Le travail sur l’énoncé de position a été suspendu en attendant l’achèvement d’une initiative de l’Office des normes générales du Canada (ONGC) visant à élaborer une norme nationale concernant les chiens d’assistance. Un groupe de travail composé de membres du Comité sur les enjeux nationaux et du Comité sur le bien-être animal s’est donc attelé à la tâche en 2019. Le groupe de travail a effectué une analyse des politiques relatives aux animaux d’assistance des gouvernements et des associations provinciales de médecine vétérinaire au Canada, aux États-Unis, au Royaume-Uni, en Australie et en Nouvelle-Zélande. La recherche a été examinée, et un document a été préparé pour aider à orienter et à justifier l’action de l’ACMV, notamment en précisant l’objectif de l’énoncé de position et le public cible visé. Le groupe de travail a communiqué avec des organisations extérieures, notamment BC & Alberta Guide Dogs et l’American Veterinary Medical Association, pour obtenir des conseils. Une ébauche a été approuvée par le Comité sur les enjeux nationaux et distribuée aux membres de l’ACMV à l’automne 2020.

684 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY of NIC and Animal Welfare Committee (AWC) members com- Des commentaires ont été reçus des membres de l’ACMV ainsi N menced work in 2019. que des associations provinciales de médecine vétérinaire, dont The Working Group conducted an environmental scan of l’Ontario Veterinary Medical Association, l’Alberta Veterinary Medical service animal policies in governments and provincial veterinary Association, la Prince Edward Island Veterinary Medical Association medical associations (VMAs) in Canada, the United States, the et la section SBVC (Society of British Columbia Veterinarians) de United Kingdom, Australia, and New Zealand. The research was l’ACMV. Ces commentaires ont été pris en compte et l’ébauche de reviewed, and a scoping brief was prepared to help determine a l’énoncé de position a été révisée. rationale for CVMA action, including the objective and target La version finale a été présentée au Conseil en mars 2021 et audience that this position statement would reach. Outside a été approuvée; l’énoncé de position et l’information pertinente organizations such as the British Columbia and Alberta Guide sont disponibles sur notre site Web, dans la section des énoncés Dogs, and the American Veterinary Medical Association were de position généraux de l’ACMV. contacted by the Working Group and provided advice. (par Leïa Manin, adjointe aux programmes de l’ACMV) A draft was approved by the NIC and circulated to CVMA members during the fall of 2020. Comments were received from CVMA members as well as VMAs including the Ontario Veterinary Medical Association, Alberta Veterinary Medical Association, Prince Edward Island Veterinary Medical Association, and the CVMA-Society of British Columbia Veterinarians Chapter. The comments received were addressed and a new version of the draft was produced. The final draft was presented to Council in March 2021 and was approved; the position statement and background information are available on our website, under the general position statements section.

(by Leïa Manin, Assistant, Programs, CVMA)

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CVJ / VOL 62 / JULY 2021 685 FOR PERSONAL USE ONLY Whatever and wherever you practice, the CVMA is with you every step of your way.

We speak for you on veterinary issues of We provide resources to help you achieve a national importance and protect the integrity meaningful career and personal wellness. of our profession.

As a CVMA member, you benefit from… As a CVMA member, you benefit from… • Engagement with Government and stakeholders to influence • The Canadian Veterinary Journal policy decisions • The Canadian Journal of Veterinary Research • International relations to provide the Canadian veterinary • CVMA Source Guide perspective • Bi-monthly e-newsletter ‘Online from 339’ • Media/public relations to provide trustworthy information and • CVMA Online Education Portal promote veterinary professionals • CVMA National Issues Forum • Position statements addressing animal welfare and national CVMA Summit veterinary issues • • Emerging Leaders Program • Member consultations on key veterinary issues • CVMA Canadian Veterinary Reserve • Leadership initiatives on antimicrobial stewardship and surveillance, cannabinoids, telemedicine • MyVetStore.ca™ CVMA web store solution for clinics • Administration of national veterinary exams to ensure uniform • Practice Owner’s Economic Survey certification of professional credentials • Individual Practice Diagnostic Report and Practice Value Estimate • Accreditation of veterinary colleges and veterinary technician programs • Provincial Suggested Fee Guides • Associate Compensation and Benefits Report We put money in your pocket to increase • Compensation for Non-DVM Report your profitability. • Report on Veterinarians in Government, Industry and Academe • Practice management articles and career/business resources As a CVMA member, you benefit from… • CVMA specialized group insurance program • GoodLife Fitness (discount) • CVMA Mentoring Program • CVMA Petcard™ Program – financing options for your clients • VetLaw Online™ legal advice column • Moneris™ payment processing services (preferred pricing) • Practical Veterinary Tools and Resources • HRdownloads™ (discount) • Veterinarian Health and Wellness Resources • Mont Tremblant SkiMax/GolfMax (discount) • Early Career DVM Resource Hub • Hotels worldwide discount program • CVMA Guidelines for Veterinary Antimicrobial Use (online • The Personal Insurance for home/auto/travel (preferred pricing) database) • National and Enterprise car rental (discount) • Therapeutic decision cascade poster • Scotiabank® business banking and lending solutions • Animal abuse resources for practitioners • Classified ads in The CVJ (discount) • Preventive healthcare, nutritional assessment and client • Plumb’s Veterinary Drugs™ (subscription discount) education tools and resources • Staples Advantage™ business products • Animal Health Week, National Tick Awareness Month and Mental • Adtel® telephone hold service and digital signage (preferred Health in Vet Med Awareness Week campaigns pricing) Visit our website or contact us to learn how to • Petro-Canada SuperPass™ fuel/diesel discount get more value from your membership. • CVMA Annual Convention (registration discount) • WSAVA World Congress and WVA Congress (registration discount)

CanadianVeterinaryMedicalAssociation StudentsoftheCVMA CANADIAN VETERINARY MEDICAL ASSOCIATION 339 Booth Street, Ottawa (Ontario) K1R 7K1 @CanVetMedAssoc T • 1-800-567-2862 • (613) 236-1162 [email protected] CVMAACMV canadianveterinarians.net @cvma.acmv @scvma.eacmv FOR PERSONAL USE ONLY 2020 Annual Report of the Canadian Veterinary Medical Association Rapport annuel 2020 de l’Association canadienne des médecins vétérinaires

he CVMA sincerely thanks its 7700 plus members, the ACMV remercie sincèrement ses plus de 7700 membres, T 9000 Registered Veterinary Technologists and Technicians L’ 9000 membres affiliés des TTVAC (Technologues et of Canada affiliated members, and more than 600 volunteers for techniciens vétérinaires agréés du Canada) et 600 bénévoles their participation and support. All are party to the identifica- pour leur participation et leur soutien. Toutes ces personnes tion and shaping of the CVMA’s directions, and to providing contribuent à façonner les orientations de l’ACMV et son offre programs and services. de programmes et de services. The last 12 months have been heavily impacted by La pandémie de COVID-19 a eu un impact important en COVID-19. The public have been asked to reduce personal 2020. Le public a dû réduire ses contacts personnels, tandis contact, while veterinarians have adopted safety-inspired prac- que les médecins vétérinaires ont adopté des pratiques sécu- tices such as curb side pick-up, telemedicine appointments, to ritaires telles que la prise en charge des animaux à l’extérieur name but a few. The CVMA went fully virtual, starting with de la clinique et les consultations en télémédecine. L’ACMV the 2020 and 2021 Annual General Meetings, Conventions, and est aussi passée en mode virtuel en 2020 et 2021, notamment Committee Weekends, with staff working remotely from home pour les réunions des comités, les assemblées générales annuelles offices since March 2020. Zoom and other platforms allowed et les congrès, et avec son personnel en télétravail depuis mars the CVMA to conduct business virtually. Although in-person 2020. Zoom et d’autres plateformes ont permis à l’ACMV de contact, relationship-building and social connections took a poursuivre ses activités virtuellement. Bien que les rencontres en

Dr./Dre Melanie Hicks

Dr./Dre Enid Stiles

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backseat, patience will bring opportunities again. The 2 CVMA personne, le développement des relations et les liens sociaux ont Presidents whose terms were affected by these challenges and dû être mis de côté un certain temps, notre patience sera éven- opportunities were Dr. Melanie Hicks (2019–2020) and tuellement récompensée. Les deux présidentes de l’ACMV dont Dr. Enid Stiles (2020–2021). A special thanks to both of you! les mandats ont été affectés par la pandémie sont la Dre Melanie Since the beginning of the pandemic, the CVMA has partici- Hicks (2019-2020) et la Dre Enid Stiles (2020-2021). Un pated in the Public Health Agency of Canada (PHAC)-lead FPT immense merci à vous deux d’avoir relevé ce défi particulier! (Federal/Provincial/Territorial) COVID-19 Advisory Group, Depuis le début de la pandémie, l’ACMV fait partie du enabling the CVMA to have input and obtain timely and cred- groupe fédéral/provincial/territorial de consultation sur la ible information that could be shared with veterinarians on COVID-19 piloté par l’Agence de la santé publique du Canada the CVMA website landing page. The CVMA also initiated (ASPC), ce qui permet à l’ACMV de participer et d’obtenir de and continued its series of COVID townhall sessions featuring l’information fiable en temps opportun qu’elle partage avec RAPPORT ANNUEL Drs. Scott Weese, Melanie Hicks and Enid Stiles, in addition les médecins vétérinaires sur la page d’accueil de son site Web. to other contributors, to address the challenges of COVID in L’ACMV a également lancé et poursuivi une série d’assemblées veterinary practice, on mental health, finances, and on various générales en ligne sur la COVID-19 avec le Dr Scott Weese, la other fronts. Dre Melanie Hicks, la Dre Enid Stiles et d’autres contributeurs Below is an overview of the CVMA’s major programs that invités pour traiter des difficultés imposées par la pandémie, are based on member surveys and needs, strategic plans, and notamment sur la pratique vétérinaire, la santé mentale et les CVMA Council directions. finances. The following are the 2020 reports on CVMA programs. Voici un aperçu des principaux programmes de l’ACMV basés sur les sondages et les besoins des membres, les plans stratégiques et les orientations du Conseil de l’ACMV. Voici des comptes rendus sur les programmes de l’ACMV en 2020.

International Relations Relations internationales

The CVMA represents Canada’s veterinary profession globally; L’ACMV représente la profession vétérinaire du Canada à advocates globally for animal health, welfare, ecosystem health, l’échelle mondiale, fait la promotion de la santé animale, du and the veterinary profession; identifies international trends bien-être des animaux, de la santé des écosystèmes et de la and their impact on Canada; and exchanges knowledge and profession vétérinaire partout dans le monde, identifie les programs internationally. tendances internationales et leur impact au Canada, et échange The CVMA President is a member of the federal gov- des connaissances et des programmes avec des intervenants ernment’s delegation to the World Organisation of Animal d’autres pays. Health’s (OIE) Annual General Assembly of 181 member La présidente de l’ACMV est membre de la délégation countries. The CVMA has a seat on the Council of the World du gouvernement canadien à l’assemblée générale annuelle Veterinary Association (WVA), and on the World Small Animal des 181 pays membres de l’Organisation mondiale de la Veterinary Association (WSAVA); is a partner in the alliance santé animale (OIE). L’ACMV siège aux conseils de la World of the Federation of Veterinarians of Europe (FVE), and the Veterinary Association (WVA) et de la World Small Animal American Veterinary Medical Association (AVMA); has a seat Veterinary Association (WSAVA); est partenaire de l’alliance on the board of directors of the Pan-American Association of de la Federation of Veterinarians of Europe (FVE) et de Veterinary Sciences (PANVET); is a founding member of the l’American Veterinary Medical Association (AVMA); siège au International Veterinary Officers Council (IVOC) that includes conseil d’administration de la Pan-American Association of the veterinary medical associations of the United States, Great Veterinary Sciences (PANVET); est un membre fondateur de Britain, Australia, New Zealand, South Africa, and Canada; and l’International Veterinary Officers Council (IVOC) qui regroupe is a member of the North American Veterinary Leaders Council des associations de médecins vétérinaires des États-Unis, de (NAVL) that includes the veterinary associations of the United Grande-Bretagne, d’Australie, de Nouvelle-Zélande, d’Afrique States, Mexico, and Canada. du Sud et du Canada; et est membre du North American The CVMA is a long-standing partner of the AVMA, includ- Veterinary Leaders Council (NAVL) qui regroupe des associa- ing having an AVMA representative on the CVMA Animal tions vétérinaires des États-Unis, du Mexique et du Canada. Welfare and Veterinary Technician Program Accreditation L’ACMV est un partenaire de longue date de l’AVMA, et ces Committees and vice versa. The CVMA is represented on deux associations maintiennent une représentation mutuelle au the Pet Nutrition Alliance (PNA), and the Council on sein de leurs comités respectifs responsables du bien-être animal Education (CoE) that grants accreditation to veterinary col- et de l’agrément des programmes de formation des techniciens leges. Furthermore, the CVMA is represented on the AVMA’s en santé animale. L’ACMV est représentée au sein de la Pet

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Educational Commission for Foreign Veterinary Graduates Nutrition Alliance (PNA) et du Council on Education (CoE) (ECFVG) and on the board of the International Council for responsable de l’agrément des facultés de médecine vétérinaire. Veterinary Assessment (ICVA), providing the North American En outre, l’ACMV est représentée au sein de la Educational Veterinary Licensing Examination (NAVLE). Commission for Foreign Veterinary Graduates (ECFVG) de l’AVMA et du conseil d’administration de l’International ANNUAL REPORT ANNUAL Council for Veterinary Assessment (ICVA) qui organise l’examen nord-américain d’agrément en médecine vétérinaire (NAVLE).

Corporate Partnership Program 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 bet- l’ACMV est un programme de commandite complet qui a été ter recognize a company’s overall financial contribution to the mis en œuvre afin de mieux reconnaître la contribution finan- Association. Since its inception in 2007, the CPP continues to cière globale d’une entreprise à l’Association. Depuis sa création evolve each year and takes into account the various programs en 2007, le PPE continue d’évoluer chaque année et tient and events that are corporately sponsored, allowing companies compte des divers programmes et événements qui font l’objet that support the CVMA to get better recognition for their de commandites, ce qui permet aux entreprises qui appuient overall contributions. The 3 levels of sponsorship in 2020 were l’ACMV d’obtenir une meilleure reconnaissance pour l’ensemble Platinum (. $80 000), Gold ($48 000–$79 999) and Silver de leurs contributions. Les trois niveaux de commandite en 2020 ($27 000–$47 999). étaient Platine (. 80 000 $), Or (entre 48 000 $ et 79 999 $) The CVMA recognizes the following sponsors for their overall et Argent (entre 27 000 $ et 47 999 $). contributions to the Association for 2020: L’ACMV tient à remercier les commanditaires suivants de Platinum: Merck Animal Health leur soutien en 2020 : Gold: Scotiabank Platine : Merck Santé animale Silver: IDEXX Laboratories Or : Banque Scotia Petsecure Pet Health Insurance Argent : Laboratoires IDEXX Western Financial Group Insurance Solutions P etsecure assurance maladie pour animaux de compagnie HED Courtier en Assurance Inc.

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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) monitors events Le Comité sur le bien-être animal surveille les événements liés au related to animal welfare and prioritizes issues according to bien-être animal et hiérarchise les problèmes selon des critères éta- established criteria. The AWC addresses emerging issues in blis. Il agit en temps opportun pour favoriser une résolution rapide RAPPORT ANNUEL a timely fashion to ensure rapid and effective resolution to et efficace des problèmes liés au bien-être animal. animal welfare-related concerns. Au cours de la dernière année, le Comité a révisé plusieurs During the past year, the AWC reviewed several existing énoncés de position existants et en a rédigé de nouveaux, qui ont position statements, or developed new ones, that have been déjà été publiés ou qui le seront plus tard cette année. Ces énoncés or are anticipated to be published this year. These positions de position portent notamment sur le piégeage des animaux à include: Trapping of Fur-Bearing Animals; Pain Management fourrure, la gestion de la douleur chez les animaux, l’euthanasie, in Animals; Euthanasia of Animals; Humane Destruction la dépopulation de masse d’animaux de manière non cruelle, and Depopulation of Domesticated Animals; Tail Docking l’amputation de la queue des moutons, l’utilisation des animaux à of Sheep; Animals in Science; Humane Killing of Seals in des fins scientifiques, la chasse au phoque dans la région atlantique the Atlantic Seal Hunt; Humane Training Methods for Dogs; du Canada, les méthodes de dressage sans violence des chiens, Humane Slaughter of Farm Animals; Use of Lead Fishing l’abattage sans cruauté des animaux de ferme, l’utilisation du plomb Tackle and Lead Shot in Canada; Castration of Piglets; pour la chasse et la pêche au Canada, la castration des porcelets, Partial Digital Amputation (Onychectomy or Declawing) of l’amputation partielle des doigts (onyxectomie ou dégriffage) des Non-Domestic Felids Kept in Human Care; Devocalization félidés non domestiques gardés par des humains, la dévocalisation of Dogs; Disbudding and Dehorning of Cattle and Goats; des chiens, l’enlèvement des bourgeons et l’écornage du bétail, la Induced Moulting in Poultry; Use of Thermocautery for mue induite de la volaille, l’utilisation de la thermocautérisation the Treatment of Lameness in Horses; and Care of Neonatal pour le traitement de la boiterie chez les chevaux, et les soins aux Calves on Dairy Farms. veaux nouveau-nés dans les fermes laitières. Work continued on CVMA Animal Welfare Codes includ- Les travaux se sont poursuivis sur les codes de pratiques de ing on the Cattery Code, the Small Mammal Code, and l’ACMV en lien avec le bien-être animal, y compris le Code de approval was received to begin work on the Caged Bird pratiques pour les chatteries et le Code de pratiques concernant les Aviary Code (final title may change) in collaboration with petits mammifères, et l’approbation a été reçue pour commencer à the British Columbia Society for the Prevention of Cruelty travailler sur un code de pratiques concernant les oiseaux en cage to Animals. en collaboration avec la SPCA de la Colombie-Britannique. Committee members and staff continue to participate Les membres du Comité sur le bien-être animal et le personnel in working groups with external organizations including: continuent de participer à des groupes de travail avec des organisa- the National Farm Animal Care Council, the National tions externes, telles que le National Farm Animal Care Council, la Companion Animal Coalition, the American Veterinary National Companion Animal Coalition, l’Animal Welfare Judging Medical Association Animal Welfare Judging and Assessment and Assessment Contest de l’AVMA et l’AZAC (Aquariums et zoos Contest, and Canada’s Accredited Zoos and Aquariums. As accrédités du Canada). De plus, le Comité a des représentants au well, the AWC has representatives in the COVID-19 and sein du groupe de travail sur la COVID-19 et les animaux avec Animals Working Group with the Canadian Food Inspection l’Agence canadienne d’inspection des aliments (ACIA), l’ASPC et Agency (CFIA), PHAC, and provincial representatives, and des représentants provinciaux, ainsi dans le groupe de travail qui in the Working Group reviewing the risk of disease introduc- examine le risque d’introduction de maladies par l’importation tion from importation of animals from higher-risk areas. d’animaux en provenance de zones à risque. This year, the AWC responded to events that have or Cette année, le Comité sur le bien-être animal a répondu à des are expected to impact animal welfare. An example is the situations ou à des événements qui ont eu ou qui devraient avoir proposal by Health Canada to remove the consideration of un impact sur le bien-être animal. La proposition de Santé Canada “humaneness” of strychnine and similar compounds in its de ne pas tenir compte de la souffrance animale dans le processus review of compounds used to kill nuisance animals. The d’évaluation de la strychnine et de composés similaires utilisés AWC has also publicly supported provincial efforts to ban pour tuer les animaux nuisibles en est un exemple. Le Comité a certain non-therapeutic surgical procedures and has issued également soutenu publiquement les efforts p rovinciaux visant à a call to action regarding the purchasing and shipping of interdire certaines interventions chirurgicales non thérapeutiques et animals from foreign suppliers due to the health issues and a lancé un appel à l’action concernant l’achat d’animaux auprès de stress-related deaths that have occurred during air transport fournisseurs étrangers et leur expédition en raison des problèmes de

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and after arrival. Further, the AWC lobbied the Government santé et de la mortalité liés au stress survenus pendant le transport of Canada to review the import requirements for these aérien et après l’arrivée. Il a également fait pression sur le gouver- animals. nement du Canada pour qu’il examine les exigences relatives à l’importation de ces animaux. ANNUAL REPORT ANNUAL

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 CVMA, through its National Issues Committee (NIC), L’ACMV, par l’entremise de son Comité sur les enjeux considers a wide range of issues relevant to the veterinary pro- nationaux, examine un large éventail de questions pertinentes fession in Canada. During 2020, CVMA Council approved pour la profession vétérinaire au Canada. En 2020, le Conseil position statements updated by the NIC on Veterinary Surgical de l’ACMV a approuvé les énoncés de position mis à jour par Procedures; Aquatic Animal Veterinary Medicine; Antimicrobial le Comité sur les enjeux nationaux portant sur les interven- Stewardship in Veterinary Medicine (formerly Antimicrobial tions chirurgicales effectuées sur les animaux, sur la médecine Use In Animals); and Extra-Label Drug Use (ELDU) in vétérinaire des animaux aquatiques, sur l’utilisation judicieuse Veterinary Medicine. A new position on Service Animals was des antimicrobiens en médecine vétérinaire (cet énoncé était drafted and working groups were formed to review positions anciennement intitulé « Utilisation des antimicrobiens chez les on Telemedicine; Legislation Concerning Dangerous Dogs; and animaux »), et sur l’utilisation de médicaments en dérogation Microchip Animal Identification. des directives de leur monographie en médecine vétérinaire. The National Issues Forum was not held in 2020 due to the Un nouvel énoncé de position sur les animaux d’assistance a pandemic; however, planning commenced on the 5th Forum été rédigé et des groupes de travail ont été formés pour exami- to be held in July 2021 on the topic of “Veterinarians as ner les énoncés de position sur la télémédecine, la législation Community Leaders on Adaptation to Climate Change.” concernant les chiens dangereux, et l’identification des animaux A major focus continues to be on antimicrobial use (AMU) in par une micropuce. animals and on strategies to support antimicrobial stewardship Le Forum sur les enjeux nationaux n’a pas eu lieu en 2020 en and AMU surveillance. Work is ongoing on the Stewardship raison de la pandémie, mais la planification va bon train pour of Antimicrobials by Veterinarians Initiative (www.savi.vet) le 5e Forum qui aura lieu en juillet 2021 et dont le thème sera through to 2023. Enhancements were made to the functional- « Le rôle des médecins vétérinaires en tant que leaders commu- ity and content of the on-line CVMA Guidelines for Veterinary nautaires sur l’adaptation aux changements climatiques ». Antimicrobial AMU (2018), including an external collaboration L’accent continue d’être mis sur l’utilisation des antimicro- aimed at making content available through an app. Database biens (UAM) chez les animaux et sur les stratégies pour appuyer development for a sustainable data collection and knowledge l’usage prudent et responsable des antimicrobiens et la surveil- transfer system for AMU in animal feed is continuing. The SAVI lance de l’UAM. L’Initiative vétérinaire pour l’usage judicieux project is overseen by CVMA Council, a project management des antimicrobiens (www.ivuja.vet) est en cours jusqu’en 2023. team, and a multi-stakeholder Expert Advisory Group. Des améliorations ont été apportées à la fonctionnalité et au During 2020, the CVMA focused extensively on COVID-19 contenu des Lignes directrices de l’ACMV concernant l’utilisation and its impact on veterinarians. The CVMA participated with des antimicrobiens vétérinaires (2018), y compris une collabo- government agencies on expert working groups on COVID-19 ration externe visant à rendre le contenu disponible au moyen in animals and qualitative risk assessment, and on a communica- d’une application. Le développement d’une base de données tions Working Group with provincial regulators. The CVMA pour un système durable de collecte de données et de transfert continues to work with federal agencies on matters concerning de connaissances en matière d’UAM dans l’alimentation animale pharmaceuticals, including the impact of new Health Canada fee se poursuit. Le projet de l’IVUJA est supervisé par le Conseil de schedules on drug availability, and the impact of the legalization l’ACMV, une équipe de gestion de projet et un groupe consul- of cannabis on veterinarians and their patients. Other initiatives tatif d’experts. with federal agencies include the importation of dogs, tick-borne En 2020, l’ACMV s’est largement concentrée sur la pandé- disease awareness, climate change, and One Health. mie de COVID-19 et son impact sur les médecins vétérinaires. The CVMA will continue to engage on a wide range of L’ACMV a participé avec des organismes gouvernementaux à des national and international issues with stakeholder groups includ- groupes de travail sur la COVID-19 chez les animaux et l’éva- ing the Canadian Food Inspection Agency (CFIA), Public luation qualitative des risques, ainsi qu’à un groupe de travail

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Health Agency of Canada (PHAC), Canadian Animal Health sur les communications avec les organismes de réglementation Institute (CAHI), Canadian Animal Health Surveillance System provinciaux. L’ACMV continue de travailler avec les agences du (CAHSS), Canadian Cattle Identification Agency (CCIA), gouvernement fédéral sur les questions relatives aux produits Canadian Animal Health Products Advisory Committee pharmaceutiques, dont l’impact des nouveaux tarifs de Santé (CAHPRAC), Canadian Council of Veterinary Registrars Canada sur la disponibilité des médicaments et les répercussions (CCVR), National Farmed Animal Health and Welfare Council de la légalisation du cannabis pour les médecins vétérinaires (NFAHWC), the American Veterinary Medical Association et leurs patients. D’autres initiatives avec les agences fédérales (AVMA), among others. portent notamment sur l’importation de chiens, la sensibilisation aux maladies transmises par les tiques, les changements climatiques et l’approche « Une santé ». L’ACMV continuera de s’impliquer pour un large éventail RAPPORT ANNUEL de questions nationales et internationales avec divers groupes d’intervenants, notamment l’Agence canadienne d’inspection des aliments (ACIA), l’Agence de la santé publique du Canada (ASPC), l’Institut canadien de la santé animale (ICSA), le Système canadien de surveillance de la santé animale (SCSSA), l’Agence canadienne d’identification du bétail (CCIA), le Comité consultatif canadien sur la réglementation des produits de santé animale (CCCRPSA), le Conseil canadien des regis- traires vétérinaires (CCRV), le Conseil national sur la santé et le bien-être des animaux d’élevage (CNSBEAE), l’American Veterinary Medical Association (AVMA), et d’autres organismes.

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

Last year was challenging for most people, and for the staff of La dernière année a été difficile pour la plupart des gens, y the CVMA journals it was no exception. We continued to work compris pour le personnel des revues de l’ACMV. Nous avons diligently to ensure all issues of both journals went to press and continué à travailler avec diligence pour nous assurer que tous members/readers on time. COVID-19 brought with it some les numéros des deux revues soient publiés et parviennent aux technological and human/personal challenges, but no apparent membres et aux lecteurs à temps. La COVID-19 a posé des long-lasting consequences on publications have resulted thus far. défis technologiques et humains/personnels, mais n’a pas eu The Canadian Veterinary Journal (The CVJ) and Canadian de conséquence à long terme jusqu’à présent sur la publication Journal of Veterinary Research (CJVR) are the only national, des revues. general or multi-species, peer-reviewed veterinary journals in La Revue vétérinaire canadienne (La RVC ) et la Revue cana- Canada. The number of manuscripts submitted to The CVJ dienne de recherche vétérinaire (RCRV ) sont les seules revues in 2020 was 267; the number submitted to the CJVR in 2020 vétérinaires nationales à contenu général ou multiespèces révisé was 74. Both numbers were slightly lower compared to the par des pairs au Canada. Le nombre de manuscrits soumis en previous year. Efforts to reduce the backlog of manuscripts for 2020 a été de 267 pour La RVC et de 74 pour la RCRV. Ces

692 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY both journals have been successful and it is anticipated that the deux chiffres étaient légèrement inférieurs à ceux de l’année problem should be under control by the end of 2021. Although précédente. Les efforts visant à réduire le retard de traitement the interval from submission to publication for both journals des manuscrits pour les deux revues ont été fructueux et on is slightly lower than last year (10 months for The CVJ and prévoit que le problème devrait être maîtrisé d’ici la fin de 11 for CJVR), measures such as higher rejection rates take time 2021. Bien que l’intervalle entre la soumission et la publication ANNUAL REPORT ANNUAL to yield results. pour les deux revues soit légèrement inférieur à celui de l’année In 2019, a readership survey was sent to members and focus dernière (10 mois pour La RVC et 11 mois pour la RCRV ), groups were conducted in July at the CVMA Convention, certaines mesures telles que des taux de rejet plus élevés mettent with the findings included in an article in the December 2019 du temps à produire des résultats. issue of The CVJ. An extended March Committee weekend to En 2019, un sondage auprès des lecteurs a été envoyé aux discuss future modifications to the journals was unfortunately membres et des groupes de discussion ont été menés en juillet cancelled last year. Virtual editorial meetings were held in lors du Congrès de l’ACMV, et les résultats ont été publiés dans April and November. A visioning meeting, in addition to the le numéro de décembre 2019 de La RVC. La fin de semaine de regular editorial meeting, took place in March 2021 virtually. réunions des comités prévue en mars, durant laquelle on devait Major news for The CVJ in 2020 was the retirement of notamment discuter de modifications à apporter aux revues, a Editor-in-Chief Dr. Carlton Gyles and the introduction of malheureusement été annulée l’année dernière. Des réunions 2 new Co-Editors-in-Chief, Drs. John Kastelic and Tim virtuelles du Comité de la rédaction ont eu lieu en avril et en Ogilvie. The transition was smooth, the only regret being there novembre. Une réunion de vision, en plus de la réunion édito- was no opportunity for an in-person farewell for Dr. Gyles. riale régulière, a eu lieu virtuellement en mars 2021. As a benefit to CVMA members, CVMA authors have lower La grande nouvelle concernant La RVC en 2020 a été le publication fees for The CVJ and lower page charges for CJVR. départ à la retraite du rédacteur en chef, le Dr Carlton Gyles, Advertising revenues, which had been on the decline for the last et son remplacement par nos deux nouveaux corédacteurs en few years due to a combination of variables such as company chef, le Dr John Kastelic et le Dr Tim Ogilvie. La transition mergers, fewer new products, and alternative ways of advertising, s’est déroulée sans heurts; notre seul regret a été de ne pas avoir and of course, COVID-19, are still slow to rebound, except for eu l’occasion de faire nos adieux en personne au Dr Gyles. Classified Advertising, which did well in 2020. En tant qu’avantage de l’adhésion, les auteurs qui sont Readers and CVMA members are reminded that all issues, membres de l’ACMV profitent de tarifs de publication inférieurs except the most recent 6 months (The CVJ) and 3 months pour La RVC ainsi que de frais inférieurs par page pour la RCRV. (CJVR) are available to the public on the PubMed Central Les revenus publicitaires, qui étaient en baisse depuis quelques archive (www.ncbi.nlm.nih.gov/pmc); a link is also available années pour diverses raisons comme des fusions d’entreprises, un through the CVMA website (www.canadianveterinarians.net). nombre moins élevé de nouveaux produits, la possibilité d’utili- CVMA members can view the most recent 6 months of The CVJ ser d’autres moyens promotionnels et, bien sûr, la COVID-19, and most recent 3 months of CJVR on the member-only section continuent d’afficher une reprise lente, à l’exception des petites of the CVMA website. annonces qui ont eu de bons résultats en 2020. Nous rappelons aux lecteurs et aux membres de l’ACMV que 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.ncbi.nlm.nih.gov/pmc); un lien est aussi fourni sur le site Web de l’ACMV (www.veterinairesaucanada.net). 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 planned to L’Association canadienne des médecins vétérinaires prévoyait host the 72nd Annual Convention July 9–12 in Quebec City, tenir son 72e Congrès annuel du 9 au 12 juillet dans la ville Quebec but had to cancel due to the pandemic. The program de Québec, au Québec, mais a dû l’annuler en raison de la was scheduled to host more than 130 continuing education (CE) pandémie. Le programme devait offrir plus de 130 heures de hours with over 30 speakers from Canada and the United States. formation continue présentées par plus de 30 conférenciers du With good intentions, the CVMA planned to host a hybrid Canada et des États-Unis. event this July in beautiful Calgary, Alberta. However, at the Avec de bonnes intentions, l’ACMV avait prévu d’organiser time of writing this report, the program has changed from un congrès hybride en juillet dans la belle ville de Calgary, en

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hybrid to 100% virtual. The virtual program will consist of live Alberta. Cependant, au moment de la rédaction de ce rapport, and pre-recorded sessions, over 80 hours of CE presented from l’événement est passé d’hybride à entièrement virtuel. Le pro- 20 speakers across the globe. gramme comprendra des séances en direct et préenregistrées, We hope to get back to “normal” in 2022 when we host the pour un total de plus de 80 heures de formation continue pré- 74th CVMA Annual Convention in Halifax, Nova Scotia. The sentées par 20 conférenciers à travers le monde. Professional Development Committee is planning an in-person Nous espérons revenir à la « normale » en 2022, pour le event with workshops, social programs, and an interactive con- 74e Congrès annuel de l’ACMV à Halifax, en Nouvelle-Écosse. tinuing education program. Let’s kick things off with a kitchen Le Comité de perfectionnement professionnel planifie un évé- party on the east coast, July 21 to 24, 2022; won’t that be a treat! nement en personne avec des ateliers, des activités sociales et un programme interactif de formation continue. Ce sera bon de se revoir et de célébrer sur la côte Est, du 21 au 24 juillet 2022! RAPPORT ANNUEL

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

The Canadian Veterinary Reserve (CVR), a program of the La Réserve vétérinaire canadienne (RVC) de l’ACMV a été CVMA, has now been in place for 14 years. It provides veteri- constituée il y a maintenant 14 ans. Elle sert à fournir des nary surge capacity in cases of emergencies involving animals, renforts vétérinaires en cas d’urgence impliquant des animaux, be they foreign animal diseases (FADs) or civil emergencies. qu’il s’agisse d’une éclosion de maladie animale exotique ou In the case of civil emergencies or non-reportable diseases, the d’une urgence civile. Dans les cas d’urgences civiles ou de CVR is ready to respond to provincial authorities such as Chief maladies dont la déclaration n’est pas obligatoire, la RVC est Veterinary Officers and/or Emergency Management Officers. In prête à répondre aux autorités provinciales, comme les médecins the case of FADs, the CVR responds to calls from the Canadian vétérinaires en chef ou les agents de gestion des urgences, tandis Food Inspection Agency (CFIA). The CVR consists of 290 vet- que dans les cas de maladie animale exotique, la RVC répond erinarians, mostly private practitioners, from across Canada. aux demandes de l’Agence canadienne d’inspection des aliments In early April of 2020, the CFIA approached the CVMA to (ACIA). La RVC regroupe 290 médecins vétérinaires de partout discuss a possible call up of CVR members to support CFIA au Canada qui œuvrent principalement en pratique privée. veterinarians in circumstances arising due to the COVID-19 Au début d’avril 2020, l’ACIA a contacté l’ACMV pour dis- outbreak. The Call Up Notice was sent to all non-government cuter d’une éventuelle mobilisation de la RVC pour soutenir les employed CVR members (249 members in total). A total of médecins vétérinaires de l’ACIA dans le contexte de la pandémie 56 CVR veterinarians offered to serve. de COVID-19. Un avis a été envoyé à tous les membres de la The CVR continues to offer on-line training courses on RVC n’étant pas à l’emploi du gouvernement (249 membres au incident command and civil emergency response. Furthermore, total), et 56 d’entre eux ont offert de servir. the CVR maintains a detailed database of reservists allowing it La RVC continue d’offrir des cours de formation en ligne sur to reach individuals in critical times, and to identify those with le système de commandement et la réponse aux urgences civiles. the right skills for a given purpose. De plus, la RVC tient à jour une base de données détaillée des Since its inception, the CVR Advisory Board has been chaired réservistes qui lui permet de joindre ces derniers en période cri- by Dr. John Drake. Advisory Board membership includes rep- tique et d’identifier les membres ayant les bonnes compétences resentatives of the CFIA, PHAC, Public Safety Canada, Council pour un objectif donné. of Chief Veterinary Officers, Canadian Council of Emergency Le Conseil consultatif de la RVC est présidé par le Dr John Management Organizations, veterinary regulatory bodies, deans Drake depuis sa création. Il est composé de représentants de of veterinary schools, RVTTC, Red Cross, Veterinarians without l’ACIA, de l’Agence de la santé publique du Canada, de Sécurité Borders, and the CVMA Council. 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.

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Business Management Program Programme de gestion commerciale

In 2020, the CVMA continued its Economic Benchmarking En 2020, l’ACMV a poursuivi son programme d’évaluation ANNUAL REPORT ANNUAL Program (BMP) offering valuable practice management tools comparative du rendement qui offre des outils et des ressources and resources to CVMA members. Resources include: Provincial de gestion utiles à ses membres, comme des guides provin- Suggested Fee Guides; the Compensation and Benefit Report ciaux de tarifs suggérés, le rapport sur la rémunération et les for Associate Veterinarians; the Veterinarians in Government, avantages sociaux des médecins vétérinaires salariés, le rapport Industry, and Academe Report; the Non-DVM Wage Report; sur les médecins vétérinaires du gouvernement, de l’industrie et the National Economic Report; and Individual Practice des milieux collégial et universitaire, le rapport sur les salaires Diagnostic Reports. Each of these reports were produced from des employés non vétérinaires, le rapport économique national, data collected in various surveys administered in partnership et les rapports individuels des pratiques. Chacun de ces rapports with provincial veterinary medical associations. est produit à partir des données recueillies dans le cadre de divers The CVMA and Association des médecins vétérinaires du sondages menés en partenariat avec les associations provinciales Québec en pratique des petits animaux (AMVQ) collaborated de médecins vétérinaires. to deliver the 2020 economic survey of small animal practitio- L’ACMV et l’Association des médecins vétérinaires du ners in Quebec, which provided additional value to CVMA Québec en pratique des petits animaux (AMVQ) ont collaboré members. pour réaliser le sondage économique de 2020 auprès des méde- A workforce study to address the current veterinary shortage cins vétérinaires pour animaux de compagnie du Québec, ce in Canada was conducted, in partnership with Kynetec Canada. qui a apporté une valeur ajoutée pour les membres de l’ACMV. The primary mandate of this study was to examine the supply Une étude sur la main-d’œuvre a été menée en partenariat and demand balance for veterinary services across the Canadian avec Kynetec Canada pour évaluer la pénurie actuelle de méde- companion animal, food animal, and equine sectors, now and cins vétérinaires au pays. L’objectif principal de l’étude était into the future. d’examiner l’équilibre entre l’offre et la demande de services Six veterinary practice management articles, and 4 ads featur- vétérinaires au Canada dans les secteurs des animaux de compa- ing the logo of each partner, were published in The Canadian gnie, des animaux de consommation et des chevaux, maintenant Veterinary Journal in 2020. et à l’avenir. The CVMA thanks its long-standing industry supporters, Six articles sur la gestion d’une pratique vétérinaire et quatre IDEXX Laboratories, Merck Animal Health, Petsecure, and annonces comportant le logo de chaque partenaire ont été Scotiabank for their valuable contributions to the program. Each publiés dans La Revue vétérinaire canadienne en 2020. partner will continue to financially contribute to the program. L’ACMV remercie ses collaborateurs de l’industrie de longue date – Laboratoires IDEXX, Merck Santé animale, Petsecure et Banque Scotia – pour leurs précieuses contributions au programme. Tous ces partenaires continueront de contribuer financièrement au programme.

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Veterinarian Wellness Bien-être des médecins vétérinaires

Veterinarian health and wellness is a high priority at the CVMA. La santé et le bien-être des médecins vétérinaires sont des prio- In 2020 there was much discussion on wellness and mental rités pour l’ACMV. En 2020, il y a eu beaucoup de discussions health in veterinary medicine, and the CVMA is committed sur le thème du mieux-être et de la santé mentale en médecine to offering meaningful and supportive programs and resources vétérinaire, et l’ACMV s’est engagée à offrir des programmes et to members. des ressources utiles pour soutenir ses membres. The CVMA has a section on its website dedicated to Une des sections du site Web de l’ACMV est d’ailleurs inti- Veterinarian Health and Wellness Resources. The resources tulée Santé et bien-être des vétérinaires. Les ressources qui y RAPPORT ANNUEL contained in this section are categorized under 3 key areas: sont proposées sont réparties en trois catégories : santé mentale emotional and mental health; physical health; and veterinarian et émotionnelle, santé physique, et bien-être des vétérinaires. wellness. A rotating banner pointing directly to the web section Pour un accès facile, une bannière rotative menant directement à is permanently placed on the CVMA homepage for easy access. cette section du site a été placée de façon permanente sur la page Resources continue to be added as they are identified. d’accueil du site Web de l’ACMV. Des ressources continuent In 2020, the CVMA published 3 articles in The CVJ in d’être ajoutées au fur et à mesure qu’elles deviennent disponibles. relation to health and wellness. Merck Animal Health and the En 2020, l’ACMV a publié trois articles dans La RVC sur la CVMA offered mental health webinars and videos that lead santé et le mieux-être des médecins vétérinaires. Merck Santé the way to start open and honest conversations about mental animale et l’ACMV ont offert des webinaires et des vidéos sur la health in the veterinary community. These conversations also santé mentale pour entamer des conversations ouvertes et hon- help breakdown social stigma, and to create communities where nêtes sur la santé mentale au sein de la collectivité vétérinaire. members look out for and help one another. Ces conversations aident également à dissiper les préjugés et à Under the CVMA Insurance Program, employees enrolled in créer une communauté dont les membres prennent soin l’un de the group health benefits plan have access to professional refer- l’autre et s’entraident. ral services and employee assistance services offered as optional En vertu du programme d’assurance de l’ACMV, les employés added benefits of the plan. inscrits au régime d’avantages sociaux de groupe ont accès à des To further support the health and wellness of its members, services professionnels et à des services d’assistance aux employés the CVMA offers a corporate discount at GoodLife Fitness. 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 avec GoodLife Fitness.

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

The CVMA Insurance Program offers members and RVTTC Le Programme d’assurance de l’ACMV offre aux membres de ANNUAL REPORT ANNUAL members the opportunity to access Professional Liability, l’ACMV et de l’association TTVAC de l’assurance responsabi- Commercial Insurance, Employee Benefits Insurance, (Affinity) lité professionnelle, de l’assurance commerciale, des avantages Life Insurance, Disability, and Business Overhead Expense cov- sociaux pour les employés, de l’assurance vie, de l’assurance erage at group program rates. Furthermore, through an arrange- invalidité et de l’assurance frais généraux à des tarifs de groupe. ment with The Personal Insurance Co., the Program provides De plus, dans le cadre d’une entente avec La Personnelle, les members with the opportunity to purchase group home, auto, membres peuvent également souscrire des assurances habita- and travel insurance. The CVMA Insurance Program is pro- tion, auto et voyage. Le programme d’assurance de l’ACMV viding, and will continue to provide, members with the latest continuera de fournir aux membres de l’information à jour, des information, guidance, support, and resources as the COVID-19 conseils, du soutien et des ressources à mesure que la pandémie situation evolves. de COVID-19 évolue.

Professional Liability and Commercial “Protected Programme d’assurance responsabilité Self-Insurance” Program (PSIP) professionnelle et « auto-assurance protégée » In 2020, participation in this program increased by 7%. New commerciale participants in the program are provided comprehensive policies En 2020, la participation à ce programme a augmenté de 7 %. tailored to their specific business exposures and receive reduced Les nouveaux participants reçoivent des polices complètes sustainable rates compared to what is available in the insurance conçues pour répondre aux besoins de leur pratique et béné- marketplace. The PSIP model is a unique selling feature and ficient de primes inférieures à celles offertes sur le marché de utilizes a “protected self-insurance” retention fund to enable l’assurance. Le modèle de l’auto-assurance protégée est un avan- participating members to take partial ownership of their insur- tage unique qui fait appel à un fonds de rétention qui permet ance program. Participants are provided with a comprehensive aux membres participants d’assumer une propriété partielle de review of their business operations and a policy tailored to meet leur programme d’assurance. On offre aux participants un exa- the specific needs of the practice. Members also save a minimum men complet de leurs activités et une police adaptée aux risques 10% for equivalent coverage when joining the Commercial or de leur pratique. Les membres économisent également au moins Employee Group Benefits program. 10 % pour une couverture équivalente lorsqu’ils adhèrent au programme d’assurance commerciale ou au programme collectif Employee Group Benefits Program (EGBP) d’avantages sociaux pour les employés. The EGBP offers members the opportunity to provide themselves and their employees with a flexible choice of employee Programme collectif d’avantages sociaux pour les benefits, including health and dental coverage, life insurance, employés (PCASE) accidental death and dismemberment, and disability insurance. Le PCASE offre aux membres la possibilité de choisir et d’offrir Optional wellness benefits such as professional referral and à leurs employés des options flexibles en matière d’avantages counseling services for insured members and family members, sociaux, y compris une assurance maladie et dentaire, une assu- and business assistance and coaching for the practice are also rance vie, une assurance en cas de décès ou de mutilation par available. Insured clinics benefit from the rate stability gener- accident et une assurance invalidité. Des avantages facultatifs ated by spreading claims over the entire TotalGUARDTM/ relatifs au bien-être, comme les services d’aiguillage profession- CVMA pool. nel 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 pratiques 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 « Ma vitrine vétérinaire » de l’ACMV

In 2020, many new clinics continued to be added to the CVMA En 2020, de nombreuses nouvelles pratiques ont adhéré au pro- Web Store Program and sales flowing through the web store gramme de boutique en ligne de l’ACMV et les ventes effectuées across the country have increased. par les boutiques en ligne au pays ont augmenté. The Pet Food Manufacturers’ Rebate Program continues to Le Programme de remise des fabricants d’aliments pour have a significant impact for clinics. A 10% rebate is provided by animaux continue d’avoir un impact important sur les établisse- some pet food manufacturers to clients who purchase the food ments vétérinaires. Certains fabricants offrent un rabais de 10 % through the clinic’s web store AutoOrder, plus volume discounts aux clients qui utilisent la fonction d’autoapprovisionnement RAPPORT ANNUEL at various times throughout the year. de la boutique en ligne de leur clinique, ainsi que des rabais The MyVetStore.ca is a customizable online retail platform en fonction du volume d’achats à divers moments au cours de branded to your practice, offering your clients the ease and l’année. convenience of purchasing their pet’s prescription products and Le site du programme (MyVetStore.ca) est une plateforme dietary recommended products directly from you. You control de vente en ligne qui peut être personnalisée à l’image de votre which products are available and the pricing. You can also set établissement vétérinaire afin d’offrir à vos clients la facilité et up automatic ordering to fulfill recurring orders for those cli- la commodité d’acheter les médicaments et la nourriture de leur ents you have registered to have access to your web store. The animal directement auprès de vous. Vous contrôlez l’offre de web store can improve client compliance, while increasing sales produits et les prix. Vous pouvez aussi établir des commandes without the cost and hassle of stocking inventory. automatiques pour répondre aux commandes récurrentes des The CVMA Web Store Program is configured to meet the clients qui se sont inscrits pour avoir accès à votre boutique respective provincial veterinary regulations and guidelines, and en ligne. La boutique en ligne peut favoriser une meilleure CVMA members benefit from the most favorable financial observance tout en augmentant les ventes sans que vous ayez à terms. 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, helping L’ACMV continue d’appuyer les nouveaux diplômés, en cher- them to meet their personal and professional needs, and assisting chant à répondre à leurs besoins personnels et professionnels et with financial decisions as they settle into their new profession. en les aidant à prendre de bonnes décisions financières tandis qu’ils entreprennent leur carrière. Membership dues reduction To financially assist recent graduates, new graduates receive a Réduction de la cotisation complimentary membership for the remainder of the year in Afin d’appuyer financièrement les finissants, l’ACMV leur which they graduate. Individuals who maintain their member- offre une adhésion gratuite pour le reste de l’année au cours ship after graduation throughout a consecutive 3-year period are de laquelle ils ont obtenu leur diplôme. Ceux qui conservent eligible for a 75% — 50% — 25% tiered fee reduction. Members leur adhésion après la fin de leurs études pendant une période in their first year following graduation also receive a complimen- de trois années consécutives sont admissibles à une réduction tary general registration to the CVMA Convention — a great de leur cotisation de 75 % la première année, de 50 % la opportunity to enhance their skills and knowledge. deuxième année et de 25 % la troisième année. De plus, dans l’année qui suit l’obtention de leur diplôme, les finissants What Can’t Be Taught articles membres obtiennent également une inscription générale gra- A series of articles in The CVJ, written by members of the tuite au Congrès de l’ACMV, ce qui constitue pour eux une CVMA Emerging Leaders Network, provides insight into the excellente occasion de perfectionner leurs compétences et leurs first years in practice, and offers advice from someone “who has connaissances.

698 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY been there.” There were 2 articles published in 2020, and they Articles Ce qui ne s’enseigne pas are posted on the member website in the Mentoring Program Des articles rédigés par les membres du Réseau des futurs lea- Resources section. ders de l’ACMV et publiés dans La RVC permettent d’avoir un aperçu des premières années de pratique et offre des conseils CVMA Emerging Leaders Program (ELP) provenant de personnes qui sont « passées par là ». Deux articles ANNUAL REPORT ANNUAL The Emerging Leader Program incorporates several examples ont été publiés en 2020, et ils sont accessibles à partir de la from every-day private practice that illustrate how, in being the section des ressources du Programme de mentorat du site Web best versions of ourselves as professionals, we can make better, de l’ACMV. more effective clinical care recommendations, practice more medicine, and gain enhanced compliance by our clients for the Programme des futurs leaders (PFL) de l’ACMV benefit of their pets and livestock. Le PFL incorpore un certain nombre d’exemples tirés de la pratique privée quotidienne qui montrent comment, en étant les Early Career DVM Resource Hub meilleures versions de nous-mêmes en tant que professionnels, To support early career DVMs on their path to a successful nous pouvons formuler des recommandations de soins cliniques career, the CVMA created a dedicated website section containing plus efficaces, pratiquer une meilleure médecine, et obtenir une useful information, tools and resources related to financial plan- adhésion accrue de nos clients qui s’avère bénéfique pour leurs ning and budgeting, communications, and career development. animaux de compagnie ou de ferme. Some examples of these tools and resources include student loan repayment estimators, a budgeting app for mobile devices, Carrefour des ressources pour les médecins guidelines for successful employment, video lectures, and per- vétérinaires en début de carrière sonalized self-help programs, guides, and modules. Additional Afin de mieux appuyer les nouveaux médecins vétérinaires et resources continue to be added as they are identified. de les aider à entreprendre une carrière prospère, l’ACMV a créé une section de son site Web contenant des renseignements Mentoring Program et des ressources utiles portant sur la gestion du budget et des The CVMA Mentoring Program was created to facilitate con- finances personnelles, les communications et le cheminement nections among its members and provide support to recent professionnel. On y trouve notamment un outil de calcul de graduates as they transition to professional life, and to early remboursement des prêts étudiants, une application de gestion career veterinarians who may be looking to make a major career du budget pour appareil mobile, des directives en matière change within the profession. d’emploi, des vidéoconférences, des programmes personnalisés The program imparts an enriching experience to mentees who de développement personnel, des guides et des conseils. Des receive personalized feedback, encouragement, and acquire new ressources additionnelles continuent d’être ajoutées au fur et à knowledge and skills. Mentors gain opportunities to provide mesure qu’elles deviennent disponibles. professional nurturing, share knowledge and expertise, and 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 appuyer les nouveaux diplômés tandis qu’ils effectuent la transition à la vie professionnelle ainsi que les 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. Quant à eux, 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 & Public Relations Communications et relations publiques

The CVMA distributed 13 news releases and received 86 media En 2020, l’ACMV a diffusé 13 communiqués de presse et a reçu inquiries in 2020. As expected, media interest centered around 86 demandes de la part des médias. Sans surprise, l’intérêt des the COVID-19 pandemic and how it related to animals, the médias s’est concentré sur la pandémie de COVID-19 et son strain on the veterinary workforce, and the mental health of impact sur les animaux, la pression exercée sur la main-d’œuvre veterinary practitioners. vétérinaire et la santé mentale des vétérinaires praticiens. The CVMA continues to increase its social media activity: L’ACMV continue d’accroître son niveau d’activité dans les • Facebook: 12 093 likes; 13 859 followers médias sociaux : RAPPORT ANNUEL • English & French Twitter: 10 663 followers • Facebook : 12 093 « J’aime »; 13 859 abonnés • Instagram: 1759 followers • Twitter en français et en anglais : 10 663 abonnés • CVMA YouTube: 632 subscribers • Instagram : 1759 abonnés The CVMA continued to promote the value of vet- • Chaîne YouTube de l’ACMV : 632 abonnés erinary healthcare on social media, using the hashtags L’ACMV fait la promotion de la valeur des soins vété- #VetCareEverywhere and #VétérinairesPartenaires. rinaires dans les médias sociaux en utilisant les mots-clics Mass e-mails, social media updates, provincial publications, #VetCareEverywhere et #VétérinairesPartenaires. website and monthly eNewsletters continue to provide members Des courriels de masse, des mises à jour sur les médias with relevant CVMA program updates and general veterinary sociaux, des publications provinciales, l’infolettre mensuelle news. et le site Web de l’ACMV continuent de fournir aux membres The CVMA continues to serve on the Canadian Food les dernières nouvelles sur les programmes de l’Association et les Inspection Agency’s African Swine Fever (ASF) Communications actualités vétérinaires générales. Working Group, providing updates on the CVMA dedi- L’ACMV continue de faire partie du groupe de travail sur les cated landing page featuring ASF information and resources communications concernant la peste porcine africaine (PPA) (www.canadianveterinarians.net/practice-economics/asf). de l’Agence canadienne d’inspection des aliments, et publie The CVMA and Merck Animal Health hosted its 2nd Mental des mises à jour sur la page de son site consacrée à la PPA Health Awareness Week in September 2020. It’s Time to Talk qui propose des ressources et de l’information sur la maladie About Mental Health in Veterinary Medicine kicked off with (www.veterinairesaucanada.net/practice-economics/asf). a live suicide awareness and prevention webinar on National L’ACMV et Merck Santé animale ont organisé la deuxième Suicide Awareness Day. The campaign objective was to initi- Semaine de sensibilisation à la santé mentale en septembre 2020. Ayant pour thème « Il est temps de parler de la santé mentale en médecine vétérinaire », la Semaine a débuté avec un webinaire en direct de sensibilisation et de prévention du suicide qui a eu lieu lors de la Journée nationale de sensibilisation au suicide. L’objectif de la campagne est d’entamer des conversations ouvertes et honnêtes sur la santé mentale au sein de la communauté vétérinaire. L’ACMV continue d’offrir des webinaires trimestriels ainsi que des ressources en santé mentale dans le cadre de cette initiative. Depuis 2016, l’ACMV, en partenariat avec Merck Santé animale, a déclaré le mois de mars comme étant le Mois national

700 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY ate open and honest conversations about mental health in the de la sensibilisation aux tiques. La campagne de 2020 était veterinary community. The CVMA continues to offer quarterly axée sur la saisonnalité prolongée des tiques, pour communiquer webinars, along with mental health resources, as part of this le message que « les saisons passent, les tiques persistent » et initiative. souligner l’importance de la maîtrise des tiques même à des Since 2016, the CVMA, in partnership with Merck Animal périodes de l’année où les propriétaires d’animaux pensent qu’il ANNUAL REPORT ANNUAL Health, declared March National Tick Awareness Month. fait trop froid pour que les parasites soient actifs. The 2020 campaign focussed on extended tick seasonality, Le thème de la Semaine de la vie animale de 2020, particu- highlighting the message that every season can be tick season lièrement approprié compte tenu de la pandémie de COVID-19, and emphasized the importance of tick control, even when pet était « Comprendre les zoonoses : Santé communautaire – Les owners might think it’s too cold for parasites to be active. animaux et vous ». Le thème montrait comment les profession- The 2020 Animal Health Week theme, particularly fitting nels vétérinaires du Canada occupent des positions uniques au given the COVID-19 pandemic, was Understanding Zoonotic sein de la communauté nationale « Une santé » pour soutenir la Diseases: Community Health — Animals and You. The theme lutte contre les maladies zoonotiques, et comment la protection showcased how Canada’s veterinary professionals occupy unique de la santé animale protège la santé de tous. positions within the national One Health community to support the fight against zoonotic diseases — protecting animal health Prix de l’ACMV de 2020 protects everyone’s health. • Dre Suann Hosie, Prix du praticien des petits animaux de l’ACMV (Petsecure assurance maladie pour animaux de 2020 CVMA Awards compagnie) • Dr. Suann Hosie, CVMA Small Animal Practitioner Award • Dre Bettina Bobsien, Prix humanitaire de l’ACMV (Merck (Petsecure Pet Health Insurance) Santé animale) • Dr. Bettina Bobsien, CVMA Humane Award (Merck Animal • Dr Egan Brockhoff, Prix vétérinaire Merck (Merck Santé Health) animale) • Dr. Egan Brockhoff, Merck Veterinary Award (Merck • Delaney Veterinary Services Ltd., Prix de la pratique de Animal Health) l’année de l’ACMV (Banque Scotia) • Delaney Veterinary Services Ltd., CVMA Practice of the • Dr Daniel Venne, Prix de l’industrie de l’ACMV Year Award (Scotiabank) • Dr Eugene Janzen, Membre à vie de l’ACMV • Dr. Daniel Venne, CVMA Industry Award • Dr Jack Wilson, Prix de la présidente de l’ACMV • Dr. Eugene Janzen, CVMA Life Membership • Dr. Jack Wilson, CVMA President’s Award

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The Value of Your Membership La valeur de votre adhésion The Value of Your Membership — Membership Benefits and Services La valeur de votre adhésion – 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 2020, 7769 members supported the CVMA’s work du Canada. En 2020, 7769 membres ont soutenu le travail et le RAPPORT ANNUEL and leadership. Our strength is in guiding policy decisions and leadership de l’ACMV. Notre force consiste à orienter les déci- legislation that affect our profession, today and tomorrow. sions 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, affin- l’information scientifique, l’ACMV est là pour vous. De plus, les ity programs, and a wide array of discounts and savings. A full membres ont accès à un vaste éventail d’avantages, notamment à listing of member benefits and services are included in this issue des outils et à des ressources pour les aider durant leur carrière, of The CVJ and on our website. à de la formation continue, à des programmes collectifs et à une In 2020, the CVMA continued work on a national campaign panoplie de rabais et d’économies. Une liste de tous les avantages to reinforce the value of membership and forge a stronger con- et services offerts aux membres se trouve dans le présent numéro nection with the veterinary community in all provinces. The de La RVC, et sur notre site Web. campaign emphasized that the CVMA was there to protect and En 2020, l’ACMV a poursuivi son travail sur la campagne support the profession during COVID-19. The CVMA provided nationale visant à réitérer la valeur de l’adhésion et à créer des the latest COVID-19 safety guidance to protect veterinarians, liens plus forts avec la communauté vétérinaire dans toutes les their clients, veterinary team, and their families. The Association provinces. La campagne a souligné le fait que l’ACMV était là provided information on government COVID-19 financial pour protéger et soutenir la profession pendant la pandémie and business support programs. Our social media campaign de COVID-19. En effet, l’ACMV a communiqué en temps successfully raised awareness with 1.1 million impressions and opportun les directives de sécurité concernant la COVID-19 23K interactions across Facebook, Instagram, YouTube, and the pour protéger les médecins vétérinaires, leurs équipes, leurs Google network. clients, et leurs familles. Elle a partagé l’information pertinente sur les programmes gouvernementaux de soutien financier et d’aide aux entreprises durant la pandémie. Notre campagne dans les médias sociaux a rehaussé la sensibilisation avec 1,1 million d’impressions et 23 000 interactions sur 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)

Objectives included in the 2020 SCVMA Program Plan were Les objectifs du programme des ÉACMV pour 2020 ont été ANNUAL REPORT ANNUAL achieved by the representatives on the SCVMA Committee, atteints par les représentants du Comité des ÉACMV et le and/or the CVMA SCVMA Liaison Advisory Group. The Groupe consultatif de liaison avec les étudiants de l’ACMV. Le SCVMA Committee is comprised of representatives from each Comité des ÉACMV est composé de représentants étudiants de Canadian veterinary college. chacune des cinq écoles canadiennes de médecine vétérinaire. The Western College of Veterinary Medicine hosted the Le Western College of Veterinary Medicine a accueilli 2020 Symposium, January 17–18. The theme was “The le Symposium de 2020 les 17 et 18 janvier. Le thème était Progressive Future of Veterinary Medicine: Wellness, Welfare, « L’avenir de la médecine vétérinaire, axé sur le bien-être et and Well-being” and over 230 students attended. It featured la santé » et plus de 230 étudiants y ont participé. Il a offert 19 clinical presentations, 14 wet labs, 6 tours, and 3 keynote 19 présentations cliniques, 14 ateliers, 6 excursions et 3 confé- presentations. There was a total of 17 Sponsors including Hill’s, rences principales. L’événement était parrainé par 17 comman- Zoetis, Merck, Purina, Euthabag, and IDEXX. ditaires, dont Hill’s, Zoetis, Merck, Purina, Euthabag et IDEXX. Due to COVID-19, several SCVMA initiatives moved to En raison de la COVID-19, plusieurs initiatives du Comité a virtual platform including lab coat and award ceremonies, des ÉACMV ont eu lieu de façon virtuelle, notamment la céré- and the “One Voice” presentation and hot topic discussion. monie de remise des sarraus et des prix ainsi que la présentation The One Voice provided an overview of CVMA initiatives and « Une voix » et la discussion sur un sujet d’actualité qui l’accom- the hot topic discussion was about veterinary care in Northern pagne. La présentation « Une voix » a renseigné les étudiants sur Communities. les initiatives de l’ACMV et la discussion a porté sur les soins The VetRap annual newsletter was written by students, for vétérinaires dans les collectivités du Nord. students. Le bulletin annuel VetRap a été rédigé par des étudiants, The New Graduate Report was published, providing insight pour les étudiants. from recent grads on the current Canadian veterinary workplace Les résultats du sondage auprès des nouveaux diplômés ont conditions. été publiés pour donner un aperçu des conditions actuelles du Various articles were published in The CVJ including a Year in milieu de travail pour les médecins vétérinaires en début de Review, a Reflection on the SCVMA Symposium, Introduction carrière au Canada. to the Senior Representatives, and one celebrating the recipients Le comité des ÉACMV a publié divers articles dans La RVC, of the Student Leadership Award and Teacher of the Year Award. dont un bilan annuel, une réflexion sur le Symposium, une

Students enjoying the 2020 Symposium. Étudiants profitant du Symposium de 2020.

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Students, Rachel Loppe (UCVM), left, and Emma Bush (AVC) attend the Bee Lab. Les étudiantes Rachel Loppe (UCVM), à gauche, et Emma Bush (AVC) participant à l’atelier sur les abeilles.

présentation des représentants seniors, et un texte pour féliciter les récipiendaires du Prix du leadership étudiant et du Prix de l’enseignant de l’année. Une nouvelle page Facebook des ÉACMV a été créée et le nombre d’abonnés sur Instagram a augmenté de 6 %. L’ACMV représente plus de 1700 étudiants en médecine RAPPORT ANNUEL vétérinaire et 149 étudiants membres du programme d’affiliation (une augmentation de 26 %) qui étudient à l’étranger.

Groupe consultatif de liaison avec les étudiants Le Groupe consultatif de liaison avec les étudiants (GCLE) représente l’ACMV dans chacune des cinq écoles de médecine A new SCVMA Facebook page was created and SCVMA grew vétérinaire canadienne. Composé d’un professeur de chacune its Instagram followers by 6%. des facultés, le GCLE guide les représentants du Comité des The CVMA represents over 1700 veterinary students and ÉACMV et participe aussi aux initiatives annuelles de l’ACMV. 149 international student affiliates (an increase of 26%) study- ing abroad.

Student Liaison Advisory Group The Student Liaison Advisory Group (SLAG) represents the CVMA at each of the 5 Canadian veterinary colleges. The SLAG, comprised of 1 faculty member from each college, guides their college’s SCVMA Committee representative and participates in annual CVMA initiatives.

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

We all experienced the effects of COVID-19 on our families, Nous avons tous subi les effets de la pandémie de COVID-19 ANNUAL REPORT ANNUAL our businesses, our pets and animals. Our Chapter was no differ- sur nos familles, nos entreprises, et nos animaux. Notre section ent and still feels the emotional toll of fielding those calls in the n’a pas fait exception, et nous avons dû répondre aux appels dans first weeks and months from veterinarians who were afraid, but les premières semaines et les premiers mois de la part de méde- who were also determined to provide veterinary care to animals. cins vétérinaires qui avaient peur mais qui étaient déterminés Our Board and Committees continued to focus on their work à continuer de prodiguer des soins vétérinaires aux animaux. and on creating outcomes. Notre conseil d’administration et nos comités ont continué de We provided leadership from the first day, writing to gov- se concentrer sur leur travail et sur la production de résultats. ernment to ensure BC veterinarians were declared essential Nous avons fait preuve de leadership dès le premier jour, en services. We organized e-mail and web support and, once federal écrivant au gouvernement pour nous assurer que les médecins funding became available, we arranged a no-cost session for our vétérinaires de la Colombie-Britannique fassent partie des four- BC members on how to access those funding sources. We swiftly nisseurs de services essentiels. Nous avons organisé du soutien moved our Spring Sunday CE Sessions from in-person to online par courriel et sur le Web et, une fois que le financement fédéral with hardly a glitch. Furthermore, we did all this while ignor- est devenu disponible, nous avons offert une séance gratuite ing the fact that in 2020, we celebrated our 10th anniversary of pour expliquer à nos membres de la Colombie-Britannique being the voice of BC veterinarians. comment accéder aux mesures d’aide économique. Pour les We worked on a new program to assist the animals of those séances de formation continue du printemps, nous avons rapi- fleeing domestic violence, which increased exponentially during dement fait la transition à la prestation en ligne sans problème. the pandemic. Our program launched in April 2021 and will De plus, nous avons accompli tout cela en ignorant le fait match interested members with approved organizations that qu’en 2020, nous avons célébré notre 10e anniversaire en tant work with those fleeing domestic violence. qu’association représentant la voix des médecins vétérinaires de We offered our spring and fall CE including sessions on la Colombie-Britannique. antimicrobial stewardship that were designated “strongly recom- Nous avons travaillé sur un nouveau programme pour aider mended” by our regulatory body in BC. Attendance surpassed les animaux des personnes qui fuient la violence familiale, previous years, proving it was possible to deliver high-quality dont le nombre a augmenté de façon exponentielle pendant la live and interactive continuing education online. pandémie. Notre programme a été lancé en avril 2021 et vise à We began drafting a resiliency program to offer peer support mettre en relation les membres intéressés avec des organismes to members with mental health challenges, and with business, approuvés qui travaillent avec les victimes de violence familiale. personal, or complaint-type issues. We are proceeding carefully Nous avons offert la formation continue prévue au printemps to ensure compliance with our requirements as well as external et à l’automne, dont des séances sur l’utilisation judicieuse des regulatory or legal requirements. antimicrobiens qui ont été « fortement recommandées » par l’or- Finally, in addition to providing personal contact for our ganisme de réglementation provincial en Colombie-Britannique. members, some of whom report feeling isolated or distressed, La fréquentation a été supérieure à celle des années précédentes, we continue to enhance collaborations with our regulatory body, ce qui prouve qu’il est possible d’offrir une formation continue working toward some co-branded materials. We also continue to à distance en direct et interactive de grande qualité. devote significant efforts to trying to convince the BC govern- Nous avons commencé à élaborer un programme de résilience ment to fund an additional 20 seats at the Western College of pour offrir un soutien par les pairs aux membres ayant des Veterinary Medicine, as the labor market shortage continues to problèmes liés à la santé mentale, à leur vie professionnelle ou affect animal health and welfare. personnelle, ou à des plaintes de clients. Nous procédons avec soin pour nous assurer du respect de nos exigences ainsi que des exigences réglementaires ou légales externes. Enfin, en plus d’offrir un contact personnel à nos membres, dont certains disent se sentir isolés ou en détresse, nous pour- suivons le travail en collaboration avec notre organisme de régle- mentation provincial, notamment par la production conjointe de matériel. Nous continuons également de déployer des efforts importants pour tenter de convaincre le gouvernement de la Colombie-Britannique de financer 20 places supplémentaires au Western College of Veterinary Medicine, car la pénurie de main- d’œuvre continue d’affecter la santé et le bien-être des animaux.

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Setting Standards Établissement de normes Veterinary Technicians and Technologists Program Accreditation Agrément des programmes de technologie vétérinaire et de techniques de santé animale

The CVMA’s Animal Health Technologist/Veterinary Technician Le Comité d’agrément des programmes de technologie vétéri-

RAPPORT ANNUEL Program Accreditation Committee (AHT/VTPAC) is respon- naire et de techniques de santé animale est responsable de l’agré- sible for accrediting veterinary technician training programs ment des programmes de formation des techniciens vétérinaires that meet the minimum standards for educating and training qui satisfont aux normes minimales en matière de formation qualified personnel who may join the veterinary healthcare d’employés compétents qui pourront se joindre à l’équipe de team. Graduates of such accredited programs benefit by having soins vétérinaires. Les diplômés de ces programmes agréés their competence recognized and prospects for employment and profitent du fait que leur compétence est reconnue et que leurs mobility enhanced, whereas the veterinary team benefits from perspectives d’emploi et de mobilité sont améliorées et l’équipe well-trained technicians and technologists. vétérinaire profite de techniciens et de technologues bien formés. The CVMA maintains a reciprocity agreement with the L’ACMV maintient une entente de réciprocité avec l’American American Veterinary Medical Association (AVMA) that allows Veterinary Medical Association (AVMA) qui permet la reconnais- for the mutual recognition of our respective accreditation sance mutuelle de nos processus d’agrément respectifs. processes. Au début de 2020, des visites de sites ont eu lieu au Seneca In early 2020, there were site visits to Seneca College and Red College et au Red River College. Cependant, en raison de la River College. However, due to COVID-19, site visits scheduled pandémie de COVID-19, les visites prévues après mars 2020 after March 2020 were suspended for the rest of the year. ont été suspendues pour le reste de l’année. The 19 accredited programs in Canada are: Les 19 programmes agréés au Canada sont ceux des établis- • Algonquin College, Ottawa, Ontario sements d’enseignement suivants : • Dalhousie University (formerly Nova Scotia Agricultural • Algonquin College, Ottawa (Ontario) College), Truro, Nova Scotia • Dalhousie University (anciennement Nova Scotia Agricultural • Douglas College, New Westminster, British Columbia College), Truro (Nouvelle-Écosse) • Georgian College, Orillia, Ontario • Douglas College, New Westminster (Colombie-Britannique) • Grande Prairie Regional College, Fairview Campus, Fairview, • Georgian College, Orillia (Ontario) Alberta • Grande Prairie Regional College, Fairview Campus, Fairview • Lakeland College, Vermilion, Alberta (Alberta) • Maritime Business College, Dartmouth, Nova Scotia • Lakeland College, Vermilion (Alberta) • Northern Alberta Institute of Technology, Edmonton, Alberta • Maritime Business College, Dartmouth (Nouvelle-Écosse) • Northern College, Haileyburg, Ontario • Northern Alberta Institute of Technology, Edmonton (Alberta) • Olds College (on-campus and distance learning), Olds, • Northern College, Haileyburg (Ontario) Alberta • Olds College (sur place et à distance), Olds (Alberta) • Oulton College, Moncton, New Brunswick • Oulton College, Moncton (Nouveau-Brunswick) • Red River College, Winnipeg, Manitoba • Red River College, Winnipeg (Manitoba) • St. Clair College, Windsor, Ontario • St. Clair College, Windsor (Ontario) • St. Lawrence College, Kingston, Ontario • St. Lawrence College, Kingston (Ontario) • Saskatchewan Institute of Science and Technology, Saskatoon, • Saskatchewan Institute of Science and Technology, Saskatoon Saskatchewan (Saskatchewan) • Seneca College, King City, Ontario • Seneca College, King City (Ontario) • Thompson Rivers University (on-campus and distance learn- • Thompson Rivers University (sur place et à distance), Kamloops ing), Kamloops, British Columbia (Colombie-Britannique) • University of Guelph, Ridgetown Campus (on-campus and • University of Guelph, Ridgetown Campus (sur place et à distance learning), Ridgetown, Ontario distance), Ridgetown (Ontario) • Vanier College, Montreal, Quebec • Vanier College, Montréal (Québec)

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National Examining Board Bureau national des examinateurs

National exams Examens nationaux ANNUAL REPORT ANNUAL The National Examining Board (NEB) is the body established Le Bureau national des examinateurs (BNE) est l’organisme établi by the CVMA to administer a veterinary medicine examination par l’ACMV pour gérer le processus d’examen pour les médecins process for foreign- and Canadian-trained veterinarians wishing vétérinaires formés au Canada et à l’étranger qui désirent exer- to practice in Canada. Passing the NEB exams and obtaining cer au Canada. La réussite des examens du BNE et l’obtention a Certificate of Qualification (CQ) allows them to apply for a d’un Certificat de compétence leur permettent de présenter une veterinary license in any Canadian province. demande de permis dans toutes les provinces canadiennes.

NEB examination process Processus d’examen du BNE In 2020, the NEB accepted applications from 474 new candi- En 2020, le BNE a accepté des demandes provenant de dates and issued 406 CQs (317 students from Canadian schools, 474 nouveaux candidats et a émis 406 certificats de compé- 61 graduates from AVMA-accredited veterinary schools and tence (317 à des diplômés des écoles de médecine vétérinaire 28 graduates of non-accredited veterinary schools). This repre- canadiennes, 61 à des diplômés d’écoles de médecine vétérinaire sents a 66% reduction in CQs that were issued to internation- agréées par l’AVMA situées à l’extérieur du Canada, et 28 à des ally trained veterinarians compared to the previous year, due diplômés d’écoles de médecine vétérinaire non agréées). Cela to the practical exams (Preliminary Surgical Assessment [PSA] représente une diminution de 66 % des Certificats de compé- and Clinical Proficiency Examination [CPE]) shutting down tence remis à des médecins vétérinaires formés à l’étranger par for most of the year and travel restrictions due to COVID-19. rapport à l’année précédente, en raison de l’annulation des examens pratiques (évaluation chirurgicale préliminaire et examen de compétences cliniques) pendant la majeure partie de l’année et des restrictions de voyage dues à la pandémie de COVID-19.

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 (AVMA-CoE), Association-Council on Education (AVMA-CoE), procède à grants accreditation to university programs designed to educate l’agrément des programmes universitaires de formation des students to become veterinarians. médecins vétérinaires. In 2020 CVMA/AVMA-CoE virtual or hybrid site visits were En 2020, des inspections virtuelles ou hybrides de l’ACMV/ conducted at: AVMA-CoE ont été effectuées dans les établissements suivants : • University of Arizona • University of Arizona • Texas Tech University • Texas Tech University • University of Illinois • University of Illinois • University College Dublin • University College Dublin • University of Missouri • University of Missouri All 5 Canadian veterinary colleges are accredited. Globally, Les cinq écoles de médecine vétérinaire du Canada sont 54 veterinary schools are accredited. agréées; au total, il y a 54 écoles de médecine vétérinaire agréées dans le monde.

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INDEPENDENT AUDITOR’S REPORT As part of an audit in accordance with Canadian generally accepted auditing RAPPORT ANNUEL standards, we exercise professional judgment and maintain professional skepticism throughout the audit. To the Members, We also: Canadian Veterinary Medical Association: atement of the financial • Identify and assess the risks of material misst Opinion statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is We have audited the financial statements of Canadian Veterinary Medical sufficient and appropriate to provide a basis for our opinion. The risk of not Association (“the Entity”), which comprise the statement of financial position detecting a material misstatement resulting from fraud is higher than for as at December 31, 2020, and the statements of changes in net assets, one resulting from error, as fraud may involve collusion, forgery, intentional operations and cash flows for the year then ended, and notes to the financial omissions, misrepresentations, or the override of internal control. statements, including a summary of significant accounting policies. • Obtain an understanding of internal control relevant to the audit in order In our opinion, the accompanying financial statements present fairly, in all to design audit procedures that are appropriate in the circumstances, but material respects, the financial position of the Entity as at December 31, not for the purpose of expressing an opinion on the effectiveness of the 2020, and the results of its operations and its cash flows for the year then Entity’s internal control. ended in accordance with Canadian accounting standards for not-for-profit organizations. • Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by Basis for opinion management. We conducted our audit in accordance with Canadian generally accepted • Conclude on the appropriateness of management’s use of the ained,going auditing standards. Our responsibilities under those standards are further concern basis of accounting and, based on the audit evidence obt described in the auditor’s responsibilities for the audit of the financial whether a material uncertainty exists related to events or conditions that statements section of our report. We are independent of the Entity in may cast significant doubt on the Entity’s ability to continue as a going accordance with the ethical requirements that are relevant to our audit of concern. If we conclude that a material uncertainty exists, we are required the financial statements in Canada, and we have fulfilled our other ethical to draw attention in our auditor’s report to the related disclosures in the responsibilities in accordance with these requirements. We believe that the financial statements or, if such disclosures are inadequate, to modify our audit evidence we have obtained is sufficient and appropriate to provide a opinion. Our conclusions are based on the audit evidence obtained up to basis for our opinion. the date of our auditor’s report. However, future events or conditions may cause the Entity to cease to continue as a going concern. Responsibilities of management and those charged with governance ation, structure and content of the financial • Evaluate the overall present for the financial statements statements, including the disclosures, and whether the financial Management is responsible for the preparation and fair presentation of these statements represent the underlying transactions and events in a manner financial statements in accordance with Canadian accounting standards for that achieves fair presentation. not-for-profit organizations, and for such internal control as management We communicate with those charged with governance regarding, among determines is necessary to enable the preparation of financial statements other matters, the planned scope and timing of the audit and significant that are free from material misstatement, whether due to fraud or error. audit findings, including any significant deficiencies in internal control that In preparing the financial statements, management is responsible for we identify during our audit. assessing the Entity’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern 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. OUSELEY HANVEY CLIPSHAM DEEP LLP Auditor’s responsibilities for the audit of the financial statements Licensed Public Accountants Ottawa, Ontario Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes 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.

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

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

2020 2019

CURRENT ASSETS ACTIF À COURT TERME Cash $ 846 644 $ 870 074 Encaisse

RAPPORT ANNUEL Accounts receivable 365 908 354 573 Débiteurs Interest receivable 44 943 44 095 Intérêts à recevoir Government remittances receivable 70 323 3 221 Versements gouvernementaux à recevoir Prepaid expenses 207 299 128 405 Frais payés d’avance

1 535 117 1 400 368

INVESTMENTS 3 794 000 3 398 000 PLACEMENTS CAPITAL ASSETS 481 539 492 181 IMMOBILISATIONS

$ 5 810 656 $ 5 290 549

CURRENT LIABILITIES PASSIF À COURT TERME Accounts payable and accrued liabilities $ 561 648 $ 302 927 Créditeurs et charges à payer Deferred revenue 1 041 053 1 277 174 Revenus reportés

1 602 701 1 580 101

NET ASSETS ACTIF NET Invested in capital assets 481 538 492 181 Investi en immobilisations corporelles Internally restricted net assets: Actif net affecté d’origine interne : Operational contingency 1 551 603 1 476 412 Imprévus liés aux opérations Program contingency 2 174 814 1 741 855 Imprévus liés aux programmes Unrestricted — — Non affectés

4 207 955 3 710 448

$ 5 810 656 $ 5 290 549

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, 2020 POUR L’EXERCICE TERMINÉ LE 31 DÉCEMBRE 2020 ANNUAL REPORT ANNUAL

2020 2019

REVENUE REVENUS Communications Program $ 62 562 $ 67 608 Programme de communications Professional development 42 411 120 000 Développement professionnel Journal — CJVR 90 190 83 105 Revue — RCRV Journal — CVJ 674 137 688 370 Revue — RVC Membership services 1 667 022 1 572 447 Services aux membres National Examination Board 1 911 300 2 123 082 Bureau national des examinateurs Canadian Veterinary Reserve 47 899 55 766 Réserve vétérinaire canadienne AHT/VTP Accreditation 45 456 44 564 Agrément TSA Secretariat 666 534 535 403 Secrétariat Students Program 84 058 96 638 Programme pour étudiants Special projects 1 411 047 382 349 Projets spéciaux Interest 70 163 62 659 Intérêts

6 772 779 5 831 991

Inter-departmental revenues Revenus entre services and administration allocations (379 570) (241 517) et frais administratifs

6 393 209 5 590 474

EXPENSES DÉPENSES Communications Program 236 607 248 206 Programme de communications Professional development 144 310 111 583 Développement professionnel Council and committees 145 099 371 074 Conseil et comités Journal — CJVR 96 622 94 572 Revue — RCRV Journal — CVJ 710 616 717 599 Revue — RVC Membership services 590 669 589 059 Services aux membres National Examination Board 1 754 722 1 923 205 Bureau national des examinateurs Canadian Veterinary Reserve 47 899 55 766 Réserve vétérinaire canadienne AHT/VTP Accreditation 16 996 25 075 Agrément TSA Secretariat 919 961 890 704 Secrétariat Students Program 128 495 157 680 Programme pour étudiants Special projects 1 483 276 480 226 Projets spéciaux

6 275 272 5 664 749

Inter-departmental expenses Dépenses entre services and administration allocations (379 570) (241 517) et frais administratifs

5 895 702 5 423 232

NET REVENUE FOR THE YEAR $ 497 507 $ 167 242 REVENUS NETS POUR L’EXERCICE

CVJ / VOL 62 / JULY 2021 711 FOR PERSONAL USE ONLY Article

Biosecurity practices in western Canadian cow-calf herds and their association with animal health

Trent R. Wennekamp, Cheryl L. Waldner, Sarah Parker, M. Claire Windeyer, Kathy Larson, John R. Campbell

Abstract — Biosecurity practices of beef cow-calf herds in western Canada have not been studied extensively nor is there a good understanding of their association with herd health. A survey was sent to 103 cow-calf producers of the Western Canadian Cow-Calf Surveillance Network. Eighty completed questionnaires were returned. Bulls were purchased for all herds during the 2014 to 2017 study period; 54% of herds purchased heifers and 42% purchased cows. The use of standard biosecurity practices was generally low with 30% of producers keeping purchased animals separate and 30% vaccinating new additions. None of the evaluated biosecurity practices were associated with reporting Johne’s disease. The purchase of . 10 bulls, the purchase of cows, not vaccinating animals bought into the herd, and use of community pasture were associated with a bovine respiratory disease outbreak. Outbreaks of calf diarrhea were associated with the purchase of 10 or more bulls, the use of a community pasture, and leasing or sharing bulls.

Résumé — Pratiques de biosécurité dans les troupeaux de vaches-veaux de l’Ouest canadien et leur association avec la santé animale. Les pratiques de biosécurité des troupeaux de bovins de boucherie de l’Ouest canadien n’ont pas fait l’objet d’études approfondies et il n’y a pas de bonne compréhension de leur association avec la santé du troupeau. Un sondage a été envoyé à 103 producteurs de vaches-veaux du Réseau de surveillance vache-veau de l’Ouest canadien. Quatre-vingts questionnaires remplis ont été retournés. Des taureaux ont été achetés pour tous les troupeaux au cours de la période d’étude 2014 à 2017; 54 % des troupeaux ont acheté des génisses et 42 % des vaches. L’utilisation des pratiques de biosécurité standard était généralement faible, 30 % des producteurs gardant les animaux achetés séparés et 30 % vaccinant les nouveaux ajouts. Aucune des pratiques de biosécurité évaluées n’était associée à la déclaration de la maladie de Johne. L’achat de plus de 10 taureaux, l’achat de vaches, et la non-vaccination d’animaux incorporés dans le troupeau, et l’utilisation de pâturages communautaires ont été associés à une épidémie de maladie respiratoire bovine. Les flambées de diarrhée des veaux étaient associées à l’achat de 10 taureaux ou plus, à l’utilisation d’un pâturage communautaire et à la location ou au partage de taureaux. (Traduit par Dr Serge Messier) Can Vet J 2021;62:712–718

Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4 (Wennekamp, Waldner, Parker, Campbell); Department of Production Animal Health, University of Calgary Faculty of Veterinary Medicine, 11877 85th Street NW, Calgary, Alberta (Windeyer); Department of Agricultural and Resource Economics, College of Agriculture and Bioresources, University of Saskatchewan, 51 Campus Drive, Saskatoon, Saskatchewan S7N 5A8, Canada (Larson). Address all correspondence to Dr. Trent Wennekamp; 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 were not purchased incurred lower costs for veterinary services, had a lower average age at first calving, and a higher birth rate lobally there is a recognized need to reduce antimicrobial per 100 dairy cows (23). Laanen et al (24) reported that increased drug usage, making prevention of disease by other means G biosecurity in Belgian pig farms resulted in improvements in daily a top priority, particularly as the worldwide demand for beef weight gain and feed conversion and that as biosecurity improved continues to increase. The objective of biosecurity is to prevent there was a decreased use of antibiotics for prophylaxis. new pathogens from entering a livestock operation and to reduce The objectives of this study were to describe current bio ARTICLE the spread of existing pathogens within premises (1). security practices in cow-calf herds in western Canada and to The beef industry in Canada presents some unique challenges examine the potential association of those practices with animal to implementing and maintaining adequate biosecurity proto- health. Specifically, the association between biosecurity and the cols. As of January 2020 there were 72 700 operations with cows incidence of Johne’s disease, bovine respiratory disease (BRD), and calves in Canada, with the majority concentrated in western and calf diarrhea in those herds were examined. Canada (2). Production in these operations is funneled into a small number of feedlots; in Alberta and Saskatchewan there Materials and methods are 165 feedlots with average annual capacity of 1000 head or This study was approved by the University of Saskatchewan’s higher, and together, they have a one-time capacity of 1.59 mil- Animal Research Ethics Board (#20140003) and the Human lion head of cattle (3). This “funneling” results in extensive Behavioural Research Ethics Board (#14-07). mixing of cattle from various farms as animals are sold through auction markets. This challenge of the industry structure is Herd recruitment coupled with uncertainty regarding the level of knowledge about A biosecurity questionnaire was distributed to 103 cow-calf pro- basic biosecurity practices among beef producers, consistent with ducers in western Canada participating in the Western Canadian that reported in other countries (4–8). In Canada, the Canadian Cow-Calf Surveillance Network (WCCCSN) in July 2017. At Food Inspection Agency has published the Canadian Beef Cattle the time of this study, the WCCCSN consisted of a convenience On-Farm Biosecurity Standard, which has recommendations sample of 103 cow-calf producers in the Canadian provinces for best practices in biosecurity for beef producers (9). It is of Alberta, Saskatchewan, and Manitoba. The 2011 Census uncertain to what extent these practices are followed. There is of Agriculture (25) was used to determine recruitment targets limited information about biosecurity practices in beef cow-calf for herd numbers in various geographic regions representa- farms in Canada (10–13). Previous research relevant to the cur- tive of reported herd density. The distribution was targeted at rent study reported that cows bred on community pastures were moderately sized herds (100 to 300 cow-calf pairs) and larger more likely to be pregnant and less likely to have an abortion if herds (. 300 cow-calf pairs) from these data, although at the they had been vaccinated for bovine viral diarrhea virus (BVDV) time of the survey, some herds had decreased to , 100 cows. and bovine herpesvirus type 1 (BHV-1) (10,12). Local veterinary clinics were asked to assist in the recruitment In the United States, the National Animal Health Monitoring of herds from their clientele. Criteria for recruitment included System (NAHMS) reported . 2/3 of cow-calf ranches added those clients that were interested in participating, herds that new cattle to the herd within the previous 3 y (14). As well, 2/3 had routine pregnancy testing, and producers who kept basic of producers did not quarantine new additions to the herd and production records. Interested producers were paid a yearly , 5% tested new cattle for diseases such as bovine viral diarrhea honorarium to be part of the WCCCSN and were asked to (BVD) and Johne’s (14). complete approximately 3 surveys per year over a 5-year period. Several studies have shown that biosecurity can impact animal health. Cardwell et al (15) reported that cattle in beef herds in Survey content which the producer was given biosecurity advice tailored to them Questions relating to biosecurity included: current beef cattle by their herd veterinarian were less likely to be seropositive to inventory, other animals on the farm (dairy cattle and other BVDV and Leptospira hardjo. Presi et al (16) determined that species), number of cattle purchased, source of cattle purchased, farms that bring in new livestock and use communal summer where cattle were sold, intake procedures applied to cattle pur- grazing are more likely to introduce BVDV infection into the chased (i.e., disease testing, quarantining, and vaccinations), herd. Dias et al (17) reported that buying cattle and renting commingling with other herds, potential risks from exposure pasture from other farmers were risk factors for bovine herpes- to humans and equipment, animal health practices, and general virus infection. Bringing new cattle into the herd is a significant biosecurity within the herd. Questions pertaining to diseases risk factor associated with the presence of bovine tuberculo- within the herd were also included. A copy of the survey is avail- sis (18–20). In 1 western Canadian study, purchased beef cattle able from the corresponding author upon request. had a 2.3 times higher odds of being Mycobacterium avium Before full distribution, the questionnaire was sent to 5 cow- ssp. paratuberculosis (MAP) positive (21). Another study from calf producers who were not study participants for pretesting the same area of Canada determined that the risk of death was and to gather feedback about the questions and suggestions higher in calves from herds in which cattle had been purchased for improvements in wording and clarity. The questionnaires in the months before or during calving (22). were distributed in June 2017 to the WCCCSN participants Similar results have been reported in other areas of animal who could either fill out a paper copy and return it by mail or agriculture. In a study of Dutch dairy farms, farms in which cattle complete the identical questionnaire online.

CVJ / VOL 62 / JULY 2021 713 FOR PERSONAL USE ONLY

Data management and statistical analysis

Data from the biosecurity survey were collected and entered

into a commercial spreadsheet program (Excel 2017; Microsoft,

Redmond, Washington, USA). Data were then imported into a 14) to (1 0 (3 to 40) to (3 0 5 (2 to 387) to (2 5 2 (1 to 543) to (1 2 1 edian (5th to (5th edian umber of cattle of umber roducers urchasing, or those or urchased, 5th percentile) 5th 1 1 3 000) 40 to (8 00 F p p n p m 9 statistical software package (Stata/IC version 15.1; Stata, College 2 verall

Station, Texas, USA) for analysis. The study population was O

described using descriptive statistics. Herd size was categorized

as large (having $ 300 or more cows when completing the

survey in 2017) or moderate (, 300 cows). = 80) = 2 4 2 7

ho purchased ho ercentage f producers f 00 4 5 2 1 ARTICLE attle type attle n %) P o w c ( ( Three health-related outcomes were examined to identify 1

any associated biosecurity factors: the producer answered yes

to “Have you had Johne’s disease diagnosed in your herd?”; the

producer answered yes to “Have you had an outbreak (treated

more than 10%) of animals for shipping fever/pneumonia in (1 to 10) to (1 (1 to 3) to (1 2 400) to (1 8 1 (1 to 73) to (1 1 1

the last 5 years?”; and the producer answered yes to “Have you to (5th edian umber of cattle of umber roducers urchasing, urchased, or those or 5th percentile) 5th 1 1 000) 10 to (2 00 F p p n p m 9 9

had an outbreak (treated more than 10%) of animals for calf 014 2 diarrhea and/or coccidiosis in the last 5 years?” Each outcome

was examined separately using logistic regression, and results are reported as odds ratios (OR) with 95% confidence inter-

= 80) =

vals (95% CI). All potential risk factors were screened using purchased ho ercentage f producers f 1 8 8 6 9 attle type attle n %) P o w c ( ( 9 1 unconditional analysis; factors with P , 0.2 were considered 2

for inclusion in the final multivariable models. Manual stepwise

backward selection was used to develop a main effects model,

retaining only variables with P , 0.05. The final model was checked for confounding by the variable herd size. (1 to 10) to (1 (1 to 3) to (1 6 (3 to 200) to (3 6 2 118) to (1 1 2 edian (5th to (5th edian

umber of cattle of umber roducers urchasing, urchased, or those or 5th percentile) 5th 3 1 000) 10 to (2 00 F p p n p m 9 2

Results 015 2

Herd demographics

Eighty questionnaires were completed, with the last one being returned in May 2018, resulting in a response rate of 78%.

= 80) =

ho purchased ho ercentage f producers f 0 2 3 8 5 attle type attle n Herds ranged in size from 34 cows to 2500, with a median of %) P o w c ( ( 9 2 3 1 312 cows [interquartile range (IQR): 161 to 331]. Participants

reported a median of 11 breeding bulls (IQR: 7 to 21),

49 replacement heifers (IQR: 29 to 83), 193 calves (IQR:

131 to 312), and 22 feeder calves (IQR: 3 to 111). Thirty-one (1 to 10) to (1 herds were large ($ 300 cows) and 49 were moderate in size 5) to (1 1 (1 to 138) to (1 1 0 (1 to 121) to (1 0 3 2 edian (5th to (5th edian

umber of cattle of umber roducers urchasing, urchased, or those or 5th percentile) 5th 1 1 000) 10 to (1 10 F p p n p , m 9 ( 300 cows). A total of 95% of respondents reported having 2 016 2

commercial cows, 22% had purebred cattle, 37% had calves

that were being backgrounded (i.e., fed on a lower energy ration

over the winter before entering the feedlot or summer grazing),

and 9% also had a feedlot. Of the respondents, 38 herds were = 80) =

ho purchased ho ercentage f producers f 9 7 3 6 1 attle type attle n %) P o w c ( ( 8 1 in Alberta, 25 herds were in Saskatchewan, and 17 herds were 4 1

in Manitoba.

Cattle purchases made by producers All producers reported buying at least 1 bull between 2014 and (1 to 12) to (1 (1 to 4) to (1 edian (5th to to (5th edian

7 (1 to 136) to (1 7 3 200) to (1 8 1 000) 10 to (3 2 umber of cattle of umber roducers urchasing, urchased, or those those or 2017 (Table 1). The next most common cattle purchased were percentile) 5th 3 1 4 F p p n p heifers (54% of herds), cows (42% of herds), foster calves (22% m 9

2017

of herds), and feeder calves (17% of herds). Over that same

period, the median number of animals purchased was bulls–10,

heifers–32, cows–15, foster calves–1, and feeder calves–200.

= 80) = ho purchased purchased ho 1 8 8 0 9 ercentage ercentage f producers producers f attle type type attle n %) 9 2 1 ( P o w c Cattle movements (

attle purchases made by producers between 2014 and 2017, reported by 80Canada. by western in reported producers cow-calf 2017, and 2014 between producers by made purchases attle

Producers were asked for the sources from which they purchased C

cattle and the site to which they sold cattle in the previous

12 mo (Tables 2, 3). Three options were given: auction market,

Table 1. Table Cows Foster calves Foster calves Feeder

Bulls another farm (cattle purchased or sold directly from or to a Heifers

714 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY

Table 2. Locations from which cattle were purchased in the 12 mo before the survey reported by 80 cow-calf producers in western Canada. Auction market Another farm Private sale Percentage of For those producers Percentage of For those producers Percentage of For those producers producers who purchasing, number producers who purchasing, number producers who purchasing, number purchased cattle of cattle types purchased cattle of cattle type purchased cattle of cattle types type purchased, median type purchased, median type purchased, median (n = 80) (5th to 95th percentile) (n = 80) (5th to 95th percentile) (n = 80) (5th to 95th percentile) ARTICLE (%) (%) (%) Bulls 0 0 43 2 (1 to 20) 74 3 (1 to 11) Cows 5 20 (11 to 43) 8 29 (1 to 94) 6 2 (1 to 46) Heifers 14 20 (3 to 300) 25 8 (1 to 73) 19 3 (1 to 69) Foster calves 0 0 15 1 (1 to 4) 0 0 Feeder calves 10 121 (1 to 1800) 4 200 (1 to 3066) 0 0

Table 3. Locations to which cattle were sold in the 12 mo before the survey reported by 80 cow-calf producers in western Canada. Auction market Another farm Private sale Percentage of For those producers Percentage of For those producers Percentage of For those producers producers who selling, number of producers who selling, number of producers who selling, number of sold cattle type cattle types sold, sold cattle type cattle types sold, sold cattle type cattle types sold, (n = 80) median (n = 80) median (n = 80) median (%) (5th to 95th percentile) (%) (5th to 95th percentile) (%) (5th to 95th percentile) Bulls 86 3 (1 to 10) 29 6 (1 to 36) 12 42 (1 to 82) Cows 91 24 (6 to 89) 14 21 (1 to 1200) 4 40 (33 to 50) Heifers 35 11 (2 to 67) 27 25 (2 to 70) 12 7 (1 to 57) Foster calves 2.5 3 (1 to 4) 16 3 (1 to 5) 0.0 0 Feeder heifer 70 50 (5 to 175) 12 64 (4 to 1500) 2.5 53 (6 to 100) Feeder steer 72 74 (8 to 300) 19 105 (1 to 600) 2.5 163 (135 to 190)

different farm), and private sale [a sale with a limited number feeding (feeding cattle for a fee) and custom calving (feeding of sellers but could be at any location (i.e., a bull sale)]. Again, and calving cows for a fee), practices which would potentially the most common cattle type purchased was bulls, with 74% of bring new animals into the herd on a yearly basis, were not herds purchasing bulls from private sales and almost half (43%) common, with only 12 and 6% of producers participating in of herds purchasing bulls directly from other farms. Heifers were these activities, respectively. Community pastures, which mix most often purchased from other farms, with 25% of participat- herds for summer grazing, were used commonly (30%), whereas ing herds buying heifers from farms. Fifteen percent of produc- 21% of producers took cattle to livestock shows. As well, 19% ers purchased a foster calf from another farm in the last 12 mo. of producers in the study restricted access of visitors to their The highest percentage of feeder calves were purchased from farm, although 27% of farms had hosted visitors from another auction markets, with 10% of producers purchasing them there. country in the last 3 y, a potential source of foreign animal Most cattle were sold through auction markets; 91% of pro- diseases (Table 4). Most producers used the same equipment ducers sold cows at the auction market, 86% sold bulls, and 72 for handling manure and feeding cattle (79%), and only 22% and 70% sold feeder steers and heifers, respectively. The next reported that they cleaned equipment after handling manure. most common location for selling cattle was directly to another farm; 29% of producers sold bulls to another farm, whereas 27% Health-related outcomes sold heifers to another farm. Sixteen percent of producers sold Interdigital phlegmon of cattle, more commonly known as foster calves to another farm. footrot, was the most common disease in this study, with 86% of producers reporting that they had treated at least 1 case in the Biosecurity practices of cow-calf herds in last 5 y. Almost 1/3 of producers (31%) reported that there had western Canada been a case of Johne’s disease diagnosed in their herd. A total Only 30% of producers kept purchased animals separate from of 72% of producers had treated at least 1 case of BRD (i.e., the herd for some time, and only 30% vaccinated newly pur- pneumonia or shipping fever) and 83% of producers had treated chased animals (Table 4). Few producers asked about disease his- at least 1 case of calf diarrhea (Table 5). Outbreaks were defined tory when purchasing new cattle (16%), but most did ask about as a situation in which a producer treated $ 10% of their cattle vaccination history (78%) before purchase decisions. Custom for a particular disease in a single year; BRD outbreaks were

CVJ / VOL 62 / JULY 2021 715 FOR PERSONAL USE ONLY

Table 4. Responses of cow-calf producers in western Canada Table 5. Health-related outcomes based on the answers regarding survey questions about general biosecurity. producers gave to questions about diseases that they observed in their herds. Under certain Yes No circumstances Percentage of Survey questions (%) (%) (%) herds that Percentage of treated an herds that New animals purchased kept 30 46 24 Health related animal for had an outbreaka separate for a period of time. outcome (n = 80) the disease of the disease New animals are vaccinated prior 30 68 Shipping fever/pneumonia 72 19 to adding them to the herd. Calf diarrhea/scours 83 22 Coccidiosis 58 16

ARTICLE Producer asks about disease history 16 64 17 prior to purchasing new animals. Infectious bovine rhinotracheitis 6 0 Bovine viral diarrhea 6 0 Producer asks about vaccination 78 20 1 Pinkeye 69 16 history prior to purchasing new Footrot 86 12 animals. Trichomoniasis 1 0 Vibriosis 3 1 Producer has custom fed calves 12 85 on their farm in the last 3 years. a Outbreak defined as treating $ 10% of animals in the herd for the specified disease. Producer has custom calved cows 6 93 on their farm in the last 3 years. year. The only variable significant (P , 0.05) in the final model Producer uses community pasture 30 69 for summer grazing. was new animals not being vaccinated before adding them to the herd. However, when herd size was added to the model to Producer has taken cattle to a show 21 78 in the last year. check for confounding, it had a . 20% effect on the exposure variable. When accounting for the effect of herd size, none of Producer had a bull sale on their 6 93 farm in the last year. the variables were associated with a herd having a diagnosis of Johne’s disease. Producer has leased bulls for use 31 67 on their farm in the last 3 years. Factors associated with bovine respiratory Producer restricts access of people 19 63 16 from other farms to their cattle. disease outbreaks in a herd Approximately 1 in 5 producers (20%) reported having had an People from other countries had 27 70 visited the producers farm in the outbreak of BRD in the previous 5 y. Unconditional associa- last 3 years. tions (P , 0.20) with various biosecurity management factors Producer uses the same equipment 79 19 were examined individually with the herd outcome of having for manure handling and feeding a BRD outbreak in the past 5 y. A model was developed in cattle. which herd size was offered as a potential confounder, but it Producer cleans and disinfects 22 57 did not change important effect estimates by . 20% so was loader after handling manure. not retained in the final model. In the final model, producers who purchased . 10 bulls from 2014 to 2017 (OR: 9.70; 95% CI: 1.68 to 56.0, P = 0.011), bought cows in a private sale in reported in 19% of herds, 22% of cow-calf producers reported the last 12 mo (OR: 20.7; 95% CI: 1.25 to 342, P = 0.034), having an outbreak of calf diarrhea in the past 5 y, and coccidio- bought cows from another farm in the last 12 mo (OR: 12.2; sis outbreaks were reported in 16% of herds. Abortion outbreaks 95% CI: 1.11 to 133, P = 0.041), did not vaccinate purchased in which . 5% of the cow herd aborted in a single year over the animals (OR: 10.8; 95% CI: 1.22 to 95.0, P = 0.032), and used last 5 y were only reported in 4% of herds. community pasture grazing in 2017 (OR: 6.2; 95% CI: 1.26 to 30.5, P = 0.025), had greater odds of reporting a BRD outbreak Factors associated with having Johne’s disease in the last 5 y than producers who did not report these factors. diagnosed in a herd Producers were asked, “Have you had Johne’s disease diagnosed Factors associated with an outbreak of calf in your herd?” There is a possibility that some herds may have diarrhea had cows with Johne’s disease but may not have been aware as Several herds had either an outbreak of calf diarrhea (22%) or it had not been diagnosed. There were several factors uncondi- coccidiosis (16%) (Table 5). A final model was developed upon tionally associated (P , 0.20) with reporting that a herd had examining factors unconditionally associated (P , 0.20) with a a previous Johne’s disease diagnosis. They included herd size producer reporting a calf diarrhea and/or coccidiosis outbreak. $ 300 cows, the purchase of $ 10 bulls from 2014 to 2017, Herd size did not change important effect estimates by . 20%, new animals purchased are not kept separate for a period of so it was not retained in the final model as a confounder. In the time, new animals are not vaccinated before adding them to final model, producers who purchased . 10 bulls from 2014 the herd, producer does not ask if Johne’s disease is present in to 2017 (OR: 3.27; 95% CI: 1.16 to 9.21; P = 0.025), used the source herd, producer has taken cattle to a show in the last community pasture for grazing in 2017 (OR: 2.86; 95% CI: year, and the producer had a bull sale on the farm in the last 0.98 to 8.32; P = 0.054), or leased or shared bulls in the last

716 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY

3 y (OR: 2.86; 95% CI: 0.98 to 8.32; P = 0.054) had greater Previous studies have shown that the 2 most significant calf- odds of reporting an outbreak of calf diarrhea and/or coccidiosis hood diseases are BRD and calf diarrhea (11,13). In the current in the last 5 y. study, purchase of cows into the herd had a significant impact on the odds of having a BRD outbreak. Purchasing bulls and Discussion leasing or sharing bulls also had a significant effect on the odds Beef cow-calf herds in western Canada are typically extensively of an outbreak of calf diarrhea. This demonstrates that bring- managed (i.e., cattle predominantly spend their time grazing on ing in adult cattle has an impact on diseases that are of primary ARTICLE pasture) and this type of management does not easily allow for concern in calves, BRD and calf diarrhea. Increasing herd size exclusion biosecurity practices that may be practiced in other and commingling of adults increases the risk of preweaning livestock systems. There is little information in the literature BRD and calf diarrhea in cow-calf herds (11,30,31). The cows regarding the typical biosecurity practices in cow-calf herds in and bulls themselves could be carrying pathogens as commensal North America. Much of the available information for western organisms in their respiratory or gastrointestinal tracts. Careful Canada is from a series of studies by Waldner et al (10,12,26). cow and bull selection based on known disease history and vacci- This research provided insights into biosecurity practices such nation status of the source herd (i.e., not sourcing new additions as the impacts of community pasture and vaccination status on through unknown sources such as auction markets) would be the incidence of abortions and non-pregnancy in these herds. 1 means of reducing disease transmission. How BRD and calf The current study demonstrated the potential negative health diarrhea pathogens are transmitted from adult cattle to calves is effects of practices such as adding new adult cattle into the herd not well-understood and further research in this area is needed. and communal grazing. For example, are some cows and bulls “super shedders” of these Introducing new animals into a herd presents 1 of the highest pathogens and could these animals be culled to reduce disease? risks for introducing disease (27). In this study, all herds pur- Using community pasture was the other factor that increased chased bulls during 2014 to 2017 and over half of the herds also the risk of both BRD and calf diarrhea. Community pasture, purchased heifers, indicating that introduction of new animals involving mixing multiple cow-calf herds together in the same into the herd was a common practice. Most bulls and heifers pasture during the summer grazing period was used by 30% were purchased from either private sales or other farms. This is of producers in western Canada in the years of study. Cows potentially less risky from a biosecurity perspective than pur- sent to community pasture are more likely to mix with herds chases made from an auction market where there is considerable of different biosecurity status. Two Canadian studies reported mixing of cattle from multiple farms. Chi et al (28) investigated that cows grazed on community pastures and not vaccinated disease transmission in dairy cattle and reported that because for BVDV or BHV-1 were more likely to abort and less likely auctions handle cattle from many farms, there is greater contact to be pregnant (10,12). A Brazilian study reported that com- with cattle from multiple sources, and therefore more exposure munal grazing increased the risk of BHV-1 infection (17), and a to various infectious diseases. Swiss study determined that the risk of BVDV introduction was Biosecurity precautions that would be considered standard higher in herds that grazed communally (16). Typically, there is practice in other areas of animal agriculture were not common a substantial lag between when cows are in community pasture in this study. Less than a third of producers kept new additions and the time when BRD in calves (at weaning) or calf diarrhea separate and vaccinated new animals. The survey did not specify (following calving season) is a problem. This would seem to the level of separation (i.e., separated by a significant distance indicate that the cows harbor the pathogens and subsequently versus nose-to-nose contact possible), so the level of contact may pass them onto the calves later; an area for future research. One have been higher than reported. Additionally, many producers potential mitigation measure could be splitting up community used community pasture, thereby mixing their cows with other pastures into smaller areas that have cattle from only 2 to herds in the summer grazing period. There was substantial mix- 3 producers in each area. A step further would be to not allow ing of cattle in other ways as well, such as custom feeding of mixing of herds that have current issues with calf diarrhea and calves and taking cattle to livestock shows. Finally, only 19% of BRD with herds that do not. herds had restricted access for visitors. Interestingly, these results The last factor associated with increased risk of BRD, are similar to those from studies in England (4), Australia (5), although not an increased risk of calf diarrhea, was not vacci- Finland (6), and Belgium (7). This suggests that exclusion bios- nating purchased animals upon arrival. The survey did question ecurity for cattle farms worldwide is not a priority. Partly, this what vaccines were used, but due to many types of vaccines can be attributed to the fact that beef cattle are more commonly being used, results were not included in the analysis. Most raised extensively (on pasture), rather than intensively (in a producers vaccinated for BVDV Types 1 and 2, BHV-1, bovine confined space). Beef cattle in the North American production respiratory syncytial virus (BRSV), and parainfluenza virus 3 system often move from the cow-calf farm where they were born (PI3) (32). The efficacy of vaccinating calves to prevent BRD to a backgrounding operation for post-weaning growth to a is well-established (31,33,34). The questionnaire did not dis- finishing feedlot to be fed to slaughter weight, thereby encourag- tinguish between vaccination of adult new arrivals or calves. ing buying, selling, and mixing of cattle along the production However, because this study did show that purchase of adult chain. Ribble et al (29) in a large Canadian study determined animals increases BRD risk in calves, vaccination of adult new that increased mixing or commingling of calves from different arrivals would seem to be a prudent BRD prevention prac- ranches increased the risk of fatal pneumonia in those calves. tice. Recent work on vaccination practices from herds in the

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WCCCSN showed that 91% of cows and 96% of replacement 11. Waldner C, Jelinski MD, McIntyre-Zimmer K. Survey of western heifers are vaccinated at least once for BVDV and BHV-1(32), Canadian beef producers regarding calf-hood diseases, management practices, and veterinary service usage. Can Vet J 2013;54:559–564. so this practice is already commonplace in western Canada. 12. Waldner CL, Guerra AG. Cow attributes, herd management, and repro- There is potential in this study, as in all survey-based research, ductive history events associated with the risk of nonpregnancy in cow- for recall bias. It may have been difficult for a producer to recall calf herds in Western Canada. Theriogenology 2013;79:1083–1094. 13. Murray CF, Fick LJ, Pajor EA, Barkema HW, Jelinski MD, Windeyer all purchases made and the data on sales of animals over the MC. Calf management practices and associations with herd-level previous 4-year period. This could result in underreporting of morbidity and mortality on beef cow-calf operations. Animal 2015;10: cattle movements within the herds. 468–477. 14. USDA. Biosecurity on U.S. Beef Cow-calf Operations. 2003; (April): Another potential limitation is that the study does not represent 1–4. Available from: https://www.aphis.usda.gov/animal_health/nahms/

ARTICLE a random sample. The WCCCSN has herds recruited through local beefcowcalf/downloads/beef0708/Beef0708_is_Biosecurity_1.pdf Last veterinary practices in western Canada. This could result in selec- accessed May 18, 2021. 15. Cardwell JM, Van Winden S, Beauvais W, et al. Assessing the impact of tion of herds that are more likely to be involved with their local tailored biosecurity advice on farmer behaviour and pathogen presence veterinarian, and subsequently represent producers more likely in beef herds in England and Wales. Prev Vet Med 2016;135:9–16. to implement improvements in biosecurity such as vaccinations. 16. Presi P, Struchen R, Knight-Jones T, Scholl S, Heim D. Bovine viral diarrhea (BVD) eradication in Switzerland-Experiences of the first The odds ratios in these models had wide confidence intervals two years. Prev Vet Med 2011;99:112–121. and should be interpreted with caution as many of the categorical 17. Dias JA, Alfieri AA, Ferreira-Neto JS, Gonçalves VSP, Muller EE. management factors were somewhat open to producer interpreta- Seroprevalence and risk factors of bovine herpesvirus 1 infection in cattle herds in the state of Paraná, Brazil. Transbound Emerg Dis 2013;60: tion (i.e., did animals that were kept separate still have fence line 39–47. contact?) which could affect our estimates within the models. 18. Broughan JM, Judge J, Ely E, et al. A review of risk factors for bovine In conclusion, it is interesting that the introduction of adult tuberculosis infection in cattle in the UK and Ireland. Epidemiol Infect 2016;144:2899–2926. animals into a herd has such a significant association with 19. Gilbert M, Mitchell A, Bourn D, Mawdsley J, Clifton-Hadley R, diseases that are primarily a concern in young calves, namely Wint W. Cattle movements and bovine tuberculosis in Great Britain. BRD and calf diarrhea. The mechanism of how these pathogens Nature 2005;435:491–496. 20. Gopal R, Goodchild A, Hewinson G, de la Rua Domenech R, spread from the newly introduced cattle into calves is an area Clifton-Hadley R. Introduction of bovine tuberculosis to north-east that requires further study. Community pasture grazing was the England by bought-in cattle. Vet Rec 2006;159:265–271. other factor that was associated with both BRD and calf diarrhea 21. Pruvot M, Kutz S, Barkema HW, De Buck J, Orsel K. Occurrence of Mycobacterium avium subspecies paratuberculosis and Neospora caninum outbreaks. Multiple studies from other areas of the world had in Alberta cow-calf operations. Prev Vet Med 2014;117:95–102. similar results (10,12,16,17,23). The purchase of new animals 22. Elghafghuf A, Stryhn H, Waldner C. A cross-classified and mulitple and community pasture grazing are 2 aspects of cow-calf produc- membership Cox model applied to calf mortality data. Prev Vet Med 2014;115:29–38. tion that may compromise biosecurity and affect animal health. 23. Van Schaik G, Dijkhuizen AA, Benedictus G, Barkema HW, Koole JL. CVJ Exploratory study on the economic value of a closed farming system on Dutch dairy farms. Vet Rec 1998;142:240–242. References 24. Laanen M, Persoons D, Ribbens S, et al. Relationship between biosecurity and production/antimicrobial treatment characteristics in pig . 1 Laanen M, Maes D, Hendriksen C, et al. Pig, cattle and poultry farmers herds. Vet J 2013;198:508–512. with a known interest in research have comparable perspectives on dis- 25. 2011 Census of Agriculture [Internet]. [cited 2019 Oct 2]. Available ease prevention and on-farm biosecurity. Prev Vet Med 2014;115:1–9. from: https://www.statcan.gc.ca/eng/ca2011/index Last accessed 2. Cattle and calves statistics, number of farms reporting and aver- February 8, 2021. age number of cattle and calves per farm [Internet]. [cited 2020 26. Waldner CL. Cow attributes, herd management and environmental Feb 16]. Available from: https://www150.statcan.gc.ca/t1/tbl1/en/ factors associated with the risk of calf death at or within 1 h of birth tv.action?pid=3210015101 Last accessed May 18, 2021. and the risk of dystocia in cow–calf herds in Western Canada. Livest 3. Canfax. Canada’s Source for Cattle Market Information Canfax 2018 Sci 2014;163:126–139. Annual Report. Available from: https://ar.cattle.ca/2018/canfax.html 27. Mee JF, Geraghty T, O’Neill R, More SJ. Bioexclusion of diseases from Last accessed May 18, 2021. dairy and beef farms: Risks of introducing infectious agents and risk 4. Brennan ML, Christley RM. Biosecurity on cattle farms: A study in reduction strategies. Vet J 2012;194:143–150. north-west England. PLoS One 2012;7:1–8. 28. Chi J, Weersink A, VanLeeuwen JA, Keefe GP. The economics of 5. Hernández-Jover M, Higgins V, Bryant M, Rast L, McShane C. controlling infectious diseases on dairy farms. Can J Agric Econ 2002; Biosecurity and the management of emergency animal disease among 50:237–256. commercial beef producers in New South Wales and Queensland 29. Ribble CS, Meek AH, Shewen PE, Guichon PT, Jim GK. Effect of (Australia). Prev Vet Med 2016;134:92–102. pretransit mixing on fatal fibrinous pneumonia in calves. J Am Vet Med 6. Sahlström L, Virtanen T, Kyyrö J, Lyytikäinen T. Biosecurity on Finnish Assoc 1995;5:616–619. cattle, pig and sheep farms — Results from a questionnaire. Prev Vet 30. Woolums AR. Risk factors for BRD on cow-calf operations. In: AABP Med 2014;117:59–67. Proceedings 2015:173–176. 7. Sarrazin S, Cay AB, Laureyns J, Dewulf J. A survey on biosecurity and 31. Stokka GL. Prevention of respiratory disease in cow/calf operations. Vet management practices in selected Belgian cattle farms. Prev Vet Med Clin North Am Food Anim Pract 2010;26:229–241. 2014;117:129–139. 32. Waldner CL, Parker S, Campbell JR. Vaccine usage in western Canadian 8. Sayers RG, Sayers GP, Mee JF, et al. Implementing biosecurity measures cow-calf herds. Can Vet J 2019;60:414–422. on dairy farms in Ireland. Vet J 2013;197:259–267. 33. Macartney JE, Bateman KG, Ribble CS. Health performance of feeder 9. Canadian Food Inspection Agency. Canadian Beef Cattle On-Farm calves sold at conventional auctions versus special auctions of vaccinated Biosecurity Standard [Internet]. 2013. 88 p. Available from: https:// or conditioned calves in Ontario. J Am Vet Med Assoc 2003;223: www.inspection.gc.ca/animal-health/terrestrial-animals/biosecurity/ 670–676. standards-and-principles/beef-cattle/eng/1378825897354/137882 34. Step DL, Krehbiel CR, DePra HA, et al. Effects of commingling beef 5940112 Last accessed May 18, 2021. calves from different sources and weaning protocols during a forty-two- 10. Waldner CL. Cow attributes, herd management, and reproductive day receiving period on performance and bovine respiratory disease. history events associated with abortion in cow-calf herds from Western J Anim Sci 2008;86:3146–3158. Canada. Theriogenology 2014;81:840–848.

718 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY Article

Computed tomographic characteristics of cavitary pulmonary adenocarcinoma in 3 dogs and 2 cats

Megan Parry, Laura E. Selmic, Sarah Lumbrezer-Johnson, Janis Lapsley, Vincent A. Wavreille, Eric Hostnik

Abstract — Cavitary pulmonary lesions can result from the localized breakdown of pulmonary parenchyma or be caused by the expulsion of a necrotic part of a mass. The objectives of this study were to describe the clinical and computed tomographic characteristics for cases of cavitary pulmonary adenocarcinoma and find associations between the features and those identified in human pulmonary cavitary soft tissue lesions. Five cases were identified that had a cavitary pulmonary mass on thoracic computed tomography (CT) and histopathology of the lesions. Three dogs and 2 cats had cavitary pulmonary adenocarcinoma. Common features of CT in these cases included lesions in the caudal lung lobes, lobular and spiculated lesion margins, air bronchograms within the mass, pleural tags, heterogeneous contrast enhancement, and ground glass opacity in the surrounding parenchyma. The findings of this case series suggest there are similarities in the CT characteristics of malignancy in human and animal cavitary pulmonary masses.

Résumé — Caractéristiques tomodensitométriques d’adénocarcinome pulmonaire cavitaire chez trois chiens et deux chats. Les lésions pulmonaires cavitaires peuvent résulter de la dégradation localisée du parenchyme pulmonaire ou être provoquées par l’expulsion d’une partie nécrotique d’une masse. Les objectifs de cette étude étaient de décrire les caractéristiques cliniques et tomodensitométriques de cas d’adénocarcinome pulmonaire cavitaire et de trouver des associations entre les caractéristiques et celles identifiées dans les lésions des tissus mous de la cavité pulmonaire humaine. Cinq cas ont été identifiés avec une masse pulmonaire cavitaire par tomodensitométrie (TDM) thoracique et histopathologie des lésions. Trois chiens et deux chats avaient un adénocarcinome pulmonaire cavitaire. Les caractéristiques communes de la tomodensitométrie dans ces cas comprenaient des lésions dans les lobes du poumon caudal, des marges lobulaires et spiculées des lésions, des bronchogrammes aériens dans la masse, des étiquettes pleurales, l’augmentation du contraste hétérogène et une opacité d’apparence de verre dépoli dans le parenchyme environnant. Les résultats de cette série de cas suggèrent qu’il existe des similitudes dans les caractéristiques tomodensitométriques de la malignité dans les masses pulmonaires cavitaires humaines et animales. (Traduit par Dr Serge Messier) Can Vet J 2021;62:719–724

Introduction including neoplasms, granulomas, paragonimus cysts, and abscesses (3,4). The proposed etiology behind these lesions in cavitary pulmonary lesion is defined as a gas-filled space neoplastic disease is vascular inadequacy to the center of the within a zone of pulmonary consolidation or within a A mass, resulting in necrosis followed by central cavitation (5). mass or nodule (1). This lesion is caused by the expulsion of Differential diagnoses for other similarly appearing lesions a necrotic part of the lesion via the bronchial tree (2). There include emphysema, pneumatoceles, bullae, and sub-pleural are both infectious and neoplastic etiologies for the lesions, blebs which can mimic true cavitary pulmonary lesions due to the presence of air-filled areas, but lack the surrounding zone Department of Veterinary Clinical Sciences, College of of pulmonary consolidation (3,4). Veterinary Medicine, Ohio State University, Columbus, Ohio, Although the discussion of cavitary pulmonary lesions usually USA. centers around infectious causes in human medicine, cavitation Address all correspondence to Dr. Laura E. Selmic; e-mail: can also be seen in malignant neoplastic lesions (1–3,5). Primary [email protected] pulmonary neoplasia in dogs and cats is relatively uncommon, Use of this article is limited to a single copy for personal study. with an incidence rate of 4.2 cases per 100 000 dogs and Anyone interested in obtaining reprints should contact the 2.2 cases per 100 000 cats (6,7). In a recent study in 2014, the CVMA office ([email protected]) for additional prevalence of cavitation in primary pulmonary neoplasia in copies or permission to use this material elsewhere. dogs was 11% (1). Across numerous studies of these malignant

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Table 1. Demographic and clinical testing information for 3 dogs and 2 cats with cavitary pulmonary soft tissue lesions. Physical Other Age examination CBC, Abdominal diagnostics Case (y) Gender Breed Clinical signs findings chemistry ultrasound Cytology performed 1 15 FS Domestic Coughing NSF Creatinine: NSF Carcinoma FeLV/FIV: short- 132 mmol/L Negative haired cat 2 12 FS Domestic Weight loss, NSF Mild neutrophilia, Diffuse mild N/A Free T4: Within short- coughing eosinophilia thickening of normal limits haired cat small intestines,

ARTICLE no loss of layering 3 12 MN Basset Weight loss, Grade IV/ NSF N/A N/A N/A Hound coughing, VI heart decreased murmur appetite and activity 4 9 FS Australian Coughing, Mild ocular NSF N/A Atypical cells Fungal urine antigen shepherd lethargy, discharge test: Negative weight loss, Baermann fecal left forelimb examination: lameness Negative 5 11 MN Labrador Coughing, Mild inspiratory HCT: 34.4% N/A N/A N/A retriever weight loss stridor ALP: 564 U/L (diagnosed with (consistent with laryngeal paralysis) prior blood test)

CBC — Complete blood (cell) count; NSF — No significant findings; N/A — Not applicable; FS — Female spayed; MN — Male neutered; HCT — Hematocrit; ALP — Alkaline phosphatase; FeLV/FIV — Feline leukemia virus/Feline immunodeficiency virus.

neoplasms in humans, rates of cavitation were similar, rang- administered intravenous contrast. Cases were excluded if his- ing between 10 and 15% (1,8,9). In a 2015 study of cats with topathology of the lesion(s) was not performed. Medical records primary pulmonary neoplasia, air-containing cavities were for included cases were reviewed, and information recorded identified in 63% of the patients, although there was no dif- included; signalment, clinical history, blood abnormalities, date ferentiation in the type of cavities, such as an air bronchogram of diagnosis, imaging studies and radiographic findings, treat- or cavitation (10). ments, and lesion histopathology. Although cavitary lesions may be seen on thoracic radio- The CT studies were reviewed by a radiology resident graphs, with the increased accessibility of computed tomography (SLJ) at the OSU-VMC, and findings were confirmed by a (CT) in veterinary practice, these cases often undergo CT scans Board-certified radiologist (ETH). The radiology resident to further characterize lesions. The CT appearance of cavitary assessed pulmonary lesions in the CT images for location, wall pulmonary lesions is well-documented in human medicine, and regularity, presence of air bronchograms, characteristics of the lesions can be classified based on CT appearance, shortening the surrounding pulmonary parenchyma, margin characteristics list of possible differential diagnoses. Computed tomographic including the notch sign and spiculations, pleural tags, a ground characteristics of these lesions have yet to be described in dogs glass opacity (focal unstructured interstitial pattern), contrast and cats. The objectives of this study were to describe the enhancement characteristics, mineral attenuation within the clinical and CT characteristics for cases of cavitary pulmonary mass, lesion diameter and location, and presence of tracheobron- adenocarcinoma and to compare CT features identified to those chial lymphadenopathy. Definitions from the human medical described for human pulmonary cavitary soft tissue lesions. literature were used to define features not commonly described in veterinary studies. The notch sign was defined as an abrupt Materials and methods bulging of the contour of the lesion or an indentation in the The diagnostic imaging picture archiving and communication border of a solid lung mass at the location of a blood vessel system (PACS) for the Ohio State Veterinary Medical Center that supplies the tumor (11). A spiculation (also called corona (OSU-VMC) was searched to identify dogs and cats with radiata) was considered a linear opacity that extends from the cavitary pulmonary masses presenting between August 24, mass, and can also be defined as a pleural tag if the linear opacity 2018, and January 6, 2020. Search terms included “cavitary,” extends from the mass to the visceral pleura (12,13). Pleural tags “cavitated,” and “cavity,” and the database was filtered for are linear opacities which extend from the mass to the visceral thoracic CT studies. Criteria for inclusion in the study were pleura and can represent fibrotic tissue that extends from the cases identified by a radiologist as having cavitary pulmonary nodule to the visceral pleura that causes inward retraction of the soft tissue lesions on thoracic CT. All included cases had been visceral pleura (11,12,14). Air bronchograms referred to one or

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Figure 1. Transverse plane CT images of lung parenchyma containing spiculations in A — Case 1 (cat), B — Case 4 (dog), and C — Case 5 (dog). Multiple hyperattenuating linear striations extend from the margins of the mass. In C, there is also a ground glass opacity that partially obscures the appearance of the spiculations. Window width and window level were adjusted to 1500/2600 (lung window), the slice thickness was 1.25 mm, and the images were acquired with 120 kVp (A–C).

Figure 3. Transverse plane CT images of lung parenchyma exhibiting ground glass opacity sign in Case 4 (dog). The Figure 2. Transverse plane CT image of lung parenchyma pulmonary parenchyma dorsal to the cavitated pulmonary mass containing pleural tags in Case 3 (dog). Notice the indentations is hyperattenuating when compared to the parenchyma of the along the pleural surface (black arrows). Two of the 3 pleural contralateral lung. This finding is described as a ground glass tags identified were also classified as spiculations in this image. opacity, and when surrounding a pulmonary mass is referred to Window width and window level were adjusted to 1500/2600 as the halo sign in human literature. Window width and window (lung window), the slice thickness was 1.25 mm, and the image level were adjusted to 1500/2600 (lung window), the slice was acquired with 120 kVp. thickness was 1.25 mm, and the image was acquired with 120 kVp. more linear branching tubular hypoattenuations representing bronchi or bronchioles passing through densely opacified lung detected (Table 1). Additional pre-operative tests are shown in parenchyma or masses (15). Table 1. Three-view thoracic radiographs were taken in all 5 cases, Results with 3 of the 5 cases having imaging completed before presenta- In total, 6 animals were identified as having cavitary pulmo- tion to OSU-VMC by the referring veterinarian. Three of the nary lesions on thoracic CT. Of those 6, 3 dogs and 2 cats met 5 cases were identified as having cavitation, or lucent regions, the criteria for inclusion in the study. Of the 3 dogs, all were within the masses on these radiographs. medium to large breed dogs with ages ranging from 9 to 12 years On thoracic CT, multiple pulmonary cavitary soft tissue of age, 2 were males and 1 was female. The 2 cats were adult lesions were noted in 4 of the 5 cases. The primary (largest) spayed female domestic shorthair cats aged 12 and 15 y old. cavitary lesion was located in the left caudal lobe in 4 cases and in Although 4 of the 5 cases were presented with several clinical the right caudal lobe in 1 case. Two cases (Case 1 and Case 4) had complaints, all 5 cases had experienced coughing. In 4 cases, additional lesions in other lung lobes. Lesion diameters for the decreased appetite and weight loss were present. History and largest cavitary lesion were 2.0 cm and 1.5 cm in the cats and physical examination findings at presentation are summarized 5.6 cm, 6.0 cm, and 4.7 cm in the dogs. The walls were lobular in Table 1. A complete blood (cell) count (CBC) and serum in 4 cases and smooth in 1 case. Spiculations were noted in all chemistry were performed in all 5 animals at presentation, and 5 cases (Figure 1). Pleural tags were seen in all 5 cases (Figure 2). in 4 of the 5 animals no clinically significant abnormalities were In 1 case, multiple masses had a large amount of contact with

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excised at the hilus. Common histopathologic descriptions of the parenchyma adjacent to the mass included alveolar histiocytosis (alveolar macrophages within alveolar spaces) in 4 cases, lymphocytic or neutrophilic inflammation in 3 cases, fibrosis/ fibroplasia in 3 cases, type II pneumocyte hyperplasia in 2 cases, and neoplastic cells in 2 cases. Discussion There has been minimal description and characterization of the

ARTICLE imaging appearance of cavitary pulmonary soft tissue masses in small animal species. Although there are few reports detailing the radiographic findings of cavitary pulmonary masses, there Figure 4. Transverse plane CT image of a pulmonary mass has not been an assessment of cavitary pulmonary soft tissue exhibiting a notch sign in Case 3 (dog). Branches of the caudal lesions with CT findings associated with histopathological pulmonary artery and anomalous pulmonary vein (arrows) diagnosis (1,3,16). In all 5 cases included in this case series, CT course along the mass with an indentation of the margin of the mass along these vessels, indicating a notch sign. A soft tissue of the thorax was performed following radiographic findings of window width and window level were adjusted to 660/230, the pulmonary masses, and all had cavitary pulmonary masses with slice thickness was 1.25 mm, and the image was acquired with similar CT findings. The CT findings in these cases included 120 kVp. lesions present in the caudal lung lobes, lobular and spiculated lesions margins, presence of air bronchograms within the mass, pleural tags, heterogeneous contrast enhancement, and a ground the pleural margin. Air bronchograms were present within the glass opacity in the surrounding parenchyma. mass in all 5 cases. Ground glass opacity (unstructured intersti- On radiographs, pulmonary cavitary neoplastic lesions have tial pattern) was noted in the parenchyma adjacent to the masses characteristic findings including irregular margins, a predisposi- in all 5 cases (Figure 3). The notch sign was present in all dogs tion for the caudal lung lobes, thick walls, and an increase in but could not be accurately evaluated in the 2 cats, because of density of the surrounding parenchyma compared with normal their small size. All 5 cases had mixed heterogeneous contrast pulmonary tissue (3,16). There are similarities between these enhancement of the cavitary pulmonary mass, with 1 case radiograph findings and those seen on CT; including, the containing a non-cavitary metastatic nodule with homogenous irregular margins, lesion location, and increased density of the contrast enhancement. In the case with a non-cavitary metastatic surrounding parenchyma. However, CT is required to identify nodule, this nodule was not within the cavitary mass and was or better visualize some characteristic findings such as pleural in a separate location within the lung parenchyma (right cranial tags, spiculations, intralesional air bronchograms, and contrast lung lobe). Mineral attenuation was present in 4 out of 5 cases. enhancement. Benign lesions in contrast to malignant lesions Tracheobronchial lymphadenopathy was noted in 1 of 5 cases. have, on both plain radiographs and CT, thin walls with smooth, The specific CT findings for each case are outlined in Table 2. regular margins, sharply defined borders, and minimal changes Four out of 5 animals underwent surgery to remove the to the surrounding pulmonary parenchyma (3,17). The char- masses, whereas palliative care was pursued in 1 animal. In 4 out acteristic findings in this case series included caudal lung lesion of 5 cases, histopathologic sampling was via surgical biopsy location, wall irregularity, air bronchograms, pleural indenta- and in 1 case via post-mortem tissue sampling. All 5 cases had tions/tags, contrast enhancement, and the characteristics of the pulmonary adenocarcinoma of varying degrees of differentia- surrounding parenchyma. Upon detailed review of the literature, tion and metastasis. The 2 cats had well-differentiated papillary several findings were not included in this study based on their adenocarcinoma in the right and left caudal lung lobes, respec- subjectivity and lack of specificity. Although these markers are tively, and both had complete surgical excision of these masses. commented on in the human medical literature, they can be One cat had additional sampling from the accessory lung lobe, seen in various types of pulmonary lesions, including those from which had multifocal bronchoalveolar hyperplasia. All 3 dogs benign or infectious causes (5,11,18,19). The markers include showed metastatic disease, and in the 2 surgical cases, incom- mineral attenuation, presence of metastasis, large lesional diam- plete excision of the primary tumors was reported. The cavitary eter, and tracheobronchial lymphadenopathy. In addition, the mass of Case 3 was determined to be pulmonary carcinoma, notch sign was subjective and could not be adequately evalu- whereas additional masses were revealed to be lymphoma. In ated in cats. Case 4, lesions in the left caudal lung lobe as well as the right In this case series, 4 out of 5 cases had an irregular, lobular cranial and caudal lung lobes were excised. All were character- appearance to the walls of the cavitated mass. This finding is ized as aggressive adenocarcinoma, with incomplete excision of similar to malignancy and pulmonary carcinoma in humans, the right cranial lung mass. In Case 4, a biopsy of a cutaneous in whom lobular margins are more commonly identified than carpal lesion was performed at the same time as the thoracic smooth margins, due to an uneven rate of growth (11,12,14). surgery, and this was consistent with carcinoma presumed In addition, spiculations, sometimes referred to as corona to be a metastasis of the pulmonary lesion. Case 5 exhibited radiata, were documented in all 5 cases. Fine spiculations have invasive pulmonary adenocarcinoma, which was incompletely been reported to have a positive predictive value of 90% for

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Table 2. Computed tomography findings for 3 dogs and 2 cats with cavitary pulmonary soft tissue lesions. Case number Lesion location Surrounding parenchyma Contrast (species) (lung lobe) Wall regularity Air bronchograms characteristics enhancement 1 (cat) Right caudal • Lobular margin Present • Ground glass opacity adjacent Heterogeneous • Spiculations to the mass • Pleural tags

2 (cat) Left caudal • Lobular margin Present • Patchy ground glass opacity Heterogeneous ARTICLE • Spiculations adjacent to the mass • Pleural tags 3 (dog) Multiple • Lobular margin Present in both • Patchy ground glass opacity Heterogeneous Largest in left caudal • Spiculations adjacent to both masses. (Smaller in • Notch sign • Pleural tags accessory) 4 (dog) Multiple • Smooth margin (all) Present in the largest • Ground glass opacity Heterogeneous Largest and multiple • Spiculations (one and multiple, but not adjacent to all masses in left caudal smaller mass) smooth, all, masses • Pleural tags present in all, Additional in right internal is irregular. with a lot of pleural contact cranial and caudal • Notch sign 5 (dog) Multiple • Lobular margin Present • Patchy ground glass opacity Heterogeneous (mass), Left caudal mass • Spiculations adjacent to the margin of homogeneous (small nodule) and 2 nodules • Notch sign the mass • Nodules: smooth • Pleural tags margin

primary pulmonary adenocarcinoma in humans (10–12,18). towards a neoplastic rather than benign etiology (25,26). All Spiculations are associated with interlobular septal thickening 5 cases in this series had air bronchograms within their cavitary and fibrosis secondary to the airway, septa, pulmonary vessel, lesions. In cases of primary solitary nodules in humans, an or lymphatic obstruction by neoplastic cells, although they can air bronchogram is more frequently associated with malig- also be associated with benign causes of growth of fibrotic tis- nant nodules and reportedly present in 73% of neoplastic sue (11,12,14,20). In one study evaluating cavitary pulmonary lesions (12,14,17,24). It is thought that in malignant lesions, lesions on CT in humans, 81% of cavitary lesions with an the tumor surrounds the bronchi and invades the bronchial walls irregular wall were malignant, whereas just 19% of cases with causing strangulation and obliteration of the bronchial tracts irregular margins were of a benign etiology (21,22). Benign leading to the presence of air bronchograms which are often lesions typically have inner walls with a smooth, regular mar- torturous or ectatic in appearance (26). gin (3). Another widely accepted explanation for this difference There are additional supportive imaging findings of malig- in appearance between malignant and benign lesions is that the nancy, including changes to the surrounding pulmonary paren- malignant nodules are variable in size, and when they undergo chyma, pleural tags, and contrast enhancement characteristics. necrosis, they do so in a patchy distribution (19). These findings are not specific for a diagnosis of neoplasia, Lesion location is not specific for malignant versus benign but as a group, help to support a diagnosis of malignancy. In neoplasms, although it is documented that pulmonary adeno- a veterinary study, it is well-documented that the surrounding carcinoma has an affinity for the caudal lung lobes, specifically pulmonary parenchyma in malignant cavitary pulmonary lesions the left caudal lung lobe (1). Of the 5 cases included in the has an increased density compared to the normal lung paren- study, all 5 had cavitary lesions in the caudal lung lobes. These chyma (16). On thoracic CT in the human medical literature, results are consistent with the affinity previously described for the presence of ground glass opacity of the surrounding paren- the caudal lung lobes, and more specifically, the left caudal lung chyma of a lesion is a commonly documented finding in patients lobe. In other recent veterinary case reports that evaluated cavi- with primary pulmonary adenocarcinoma and is characterized tary pulmonary lesions due to different underlying etiologies, by an increased attenuation of the lung parenchyma surrounding specifically those associated with Aspergillus fumigatus infection a pulmonary nodule or mass (11). This ground glass opacity is and bronchogenic cysts, the lesions were reported in the cranial associated with various infectious causes, organizing pneumonia, lung lobes of these patients (16,23). Migrating intrathoracic vasculitis, and neoplasia and thought to result from hemorrhage, grass awns have been documented to have an affinity for the inflammation, or the growth of adenocarcinoma (12). All 5 cases caudal and accessory lobes. These are not specifically associ- in this study had ground glass opacity adjacent to the primary ated with cavitary lesions but instead they are associated with mass and, if present, to the secondary masses. Histopathology unstructured interstitial and alveolar patterns, as well as pleural in these cases showed similar results in the surrounding paren- effusion and pneumothorax (24). chyma with alveolar histiocytosis, inflammation, fibrosis, neo- Air bronchograms can be seen in various interstitial pul- plastic invasion, and type II pneumocyte hyperplasia. In human monary diseases. When they are seen, and particularly if they cases of peripheral pulmonary carcinoma, pleural tags have are tortuous or ectatic in appearance and are located within a been reported in 60 to 80% of cases, although they are also pulmonary mass, both solid and cavitated, these findings point associated with granulomas and metastases (12). In this series,

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all 5 cases had an extension of the lesion to the pleural margin, 3. Gafoor K, Patel S, Girvin F, et al. Cavitary lung diseases. Chest and in Case 4, multiple masses had a large amount of contact 2018;153:1443–1465. 4. Vourtsi A, Gouliamos A, Moulopoulos L, et al. CT appearance of with the pleural margin. Heterogeneous contrast enhancement solitary and multiple cystic and cavitary lung lesions. Eur Radiol 2001; is a well-documented finding in malignant masses, likely due 11:612–622. to the variable blood supply within tumors (15). Mixed hetero- 5. Theilen GH, Madewell BR. Tumours of the respiratory tract and thorax. In: Veterinary Cancer Medicine. Philadelphia, Pennsylvania: Lea and geneous enhancement was reported in all 5 cases in this series, Febiger, 1979:341–346. although a non-cavitary nodule in Case 5 was homogenously 6. Dorn CR, Taylor DON, Schneider R, Hibbard HH, Klauber MR. contrast enhancing. Survey of animal neoplasms in Alameda and Contra Costa Counties, California. II. Cancer Morbidity in dogs and cats from Alameda County. Although the maximum wall thickness of the lesion is consid- J Natl Cancer Inst 1968;40:307–318.

ARTICLE ered to be among the best criteria for determining malignancy 7. Barrett LE, Pollard RE, Zwingenberger A, Zierenberg-Ripoll A, in cavitary pulmonary lesions in humans, this finding has not Skorupski KA. Radiographic characterization of primary lung tumors in 74 dogs: Primary lung tumors in dogs. Vet Radiol Ultrasound been used in veterinary medicine (27). In the current series, 2014;55:480–487. lesions had subjectively thickened walls compared to those 8. Ryu JH, Swensen SJ. Cystic and cavitary lung diseases: Focal and diffuse. reported in cysts, bullae, or abscesses, although we did not Mayo Clin Proc 2003;78:744–752. 9. Lee YH, Kwon W, Kim MS, et al. Lung perfusion CT: The differentia- measure wall thickness specifically due to the lack of established tion of cavitary mass. Eur J Radiol 2010;73:59–65. methodology (17,23). These thicker walls surrounding the cav- 10. Aarsvold C, Reetz J, Reichle J, et al. Computed tomographic findings ity give the appearance of a more solid mass, more consistent in 57 cats with primary pulmonary neoplasia. Vet Radiol Ultrasound 2015;56:272–277. with a soft tissue tumor. In the human medical literature, wall 11. Hayashi H, Ashizawa K, Ogihara Y, et al. CT signs of solitary pulmo- thickness is measured at the thickest part of the wall of the nary lesions: Revisited. Published online 2015. Available from: https:// cavity (21,22). In a study of 96 human patients presenting epos.myesr.org/poster/esr/ecr2015/C-1764 Last accessed May 17, 2021. 12. Walker CM, Chung JH. Muller’s Imaging of the Chest E-Book: Expert with cavitary pulmonary lesions, a wall thickness of . 24 mm Radiology Series. 2nd ed. St. Louis, Missouri: Elsevier, 2019. was considered 100% specific for malignancy, whereas a wall 13. Nikolaou K, Bamberg F, Laghi A, Rubin G. Multislice CT. 4th Edition. thickness of # 7 mm was 96.7% specific for non-malignant Manhattan, New York: Springer International Publishing, 2019. 14. Snoeckx A, Reyntiens P, Desbuquoit D, et al. Evaluation of the solitary lesions (27,28). In a follow-up study, 84.2% of patients with pulmonary nodule: Size matters, but do not ignore the power of mor- lesions with a wall thickness of $16 mm had a malignant phology. Insights Imaging 2018;9:73–86. neoplasm on histopathologic follow-up examination following 15. Marolf AJ, Gibbons DS, Podell BK, Park RD. Computed tomographic appearance of primary lung tumors in dogs: CT appearance of primary surgical excision of the masses (21,22). A larger study would lung tumors in Dogs. Vet Radiol Ultrasound 2011;52:168–172. be necessary to create similar guidelines for wall thickness in 16. Silverman S, Poulos PW, Suter PF. Cavitary pulmonary lesions in ani- small animals. Additionally, the protocol for where and how to mals. Vet Radiol 1976;17:134–146. 17. Gadbois J, Blond L, Lapointe C, Collard F. Computed tomographic measure maximal wall thickness would need to be established. In evaluation of a bronchogenic cyst in a German shepherd dog. Can Vet 2 veterinary case reports, 1 detailing the CT findings of a bron- J 2012;53:86–88. chogenic cyst and the other from a solitary pulmonary lesion 18. Iranmanesh A, McDonald R, Absher K, Lowry C, Zagurovskaya M. Peripheral lung lesion: Potential pulmonary adenocarcinoma? Available secondary to Aspergillus fumigatus infection, the walls of these from: https://thoracicrad.org/wp-content/uploads/2016/05/151-Perip lesions were reported to be thin and sharply delineated (17,23). heral-lung-lesion-Potential-Pulmonary-Adenocarcinoma-Compatib In the present case series, the lesions had subjectively thickened ility-Mode.pdf Last accessed May 17, 2021. 19. Honda O, Tsubamoto M, Inoue A, et al. Pulmonary cavitary nodules on walls compared to those routinely seen in cysts or bullae, but computed tomography: Differentiation of malignancy and benignancy. further study would be required to evaluate this characteristic J Comput Assist Tomogr 2007;31:943–949. as a marker of malignancy. 20. Masseau I, Reinero CR. Thoracic computed tomographic interpretation for clinicians to aid in the diagnosis of dogs and cats with respiratory In conclusion, cases presented herein shared some of the disease. Vet J 2019;253:105388. previously identified findings characteristic of malignancy in 21. Woodring J, Fried A, Chuang V. Solitary cavities of the lung: Diagnostic human cavitary pulmonary lesions. The malignant cavitary pul- implications of cavity wall thickness. Am J Roentgenol 1980;135: 1269–1271. monary masses were predominantly present in the caudal lung 22. Woodring H, Fried M. Significance of wall thickness lung: A follow-up lobes and had the following CT findings: lobular and spiculated study. Am J Roentgenol 1983;140:473–474. margins, presence of air bronchograms within the mass, pleural 23. Kulendra E, Halfacree Z, Goggs R, et al. Cavitary pulmonary lesion associated with Aspergillus fumigatus infection in a German shepherd tags, heterogeneous contrast enhancement, and ground glass dog. J Small Anim Pract 2010;51:271–274. opacity in the surrounding parenchyma. These findings can be 24. Schultz RM, Zwingenberger A. Radiographic, computed tomographic, used by clinicians and inform future studies in larger patient and ultrasonographic findings with migrating intrathoracic grass awns in dogs and cats. Vet Radiol Ultrasound 2008;49:249–255. populations to investigate the differentiation of benign and 25. Kuriyama K, Tateishi R, Doi O, et al. Prevalence of air bronchograms in malignant pulmonary lesions. Although thoracic CT findings small peripheral carcinomas of the lung on thin-section CT: Comparison can help narrow the differential diagnosis, histopathology is still with benign tumors. AJR Am J Roentgenol 1991;156:921–924. 26. Kui M, Templeton P, White CS, Zu-Long C, You-Xian B, You-Quan C. necessary for definitive diagnosis. CVJ Evaluation of the air bronchogram sign on CT in solitary pulmonary lesions. J Comput Assist Tomogr 1996;20:983–986. References 27. Nin CS, de Souza VVS, Alves GRT, et al. Solitary lung cavities: CT findings in malignant and non-malignant disease. Clin Radiol 2016; . 1 Gadkowski LB, Stout JE. Cavitary pulmonary disease. Clin Microbiol 71:1132–1136. Rev 2008;21:305–333. 28. Parkar AP, Kandiah P. Differential diagnosis of cavitary lung lesions. 2. Lamb CR, Neiger R. Radiology corner differential diagnosis of pul- J Belg Soc Radiol 2016;100:100. monary cavitary lesions. Vet Radiol Htmlent Glyphamp Asciiamp Ultrasound 2000;41:340–341.

724 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY Article

Bordetella bronchiseptica-reactive antibodies in Canadian polar bears

John Ellis, Sheryl Gow, Nicholas Pilfold, Stacey Lacoste, Nicholas J. Lunn, Evan S. Richardson, David McGeachy, Megan Owen, Bruce Rideout

Abstract — Bordetella bronchiseptica is a promiscuous bacterium that infects a variety of species but has not been reported in free-ranging polar bears (Ursus maritimus). Sera from 385 polar bears from the western Hudson Bay region, 1986 to 2017, were tested for reactivity to B. bronchiseptica with enzyme-linked immunosorbent assays using anti-canine IgG and Streptococcus protein G as secondary reagents. Sera from bears had variable reactivity to B. bronchiseptica antigens, and there was no difference among bears that had a history of coming near the town of Churchill, Manitoba, and bears that did not. Although the sources of exposure were not determined, equivalent results in both groups suggest that potential exposure to humans (aside from handling during sampling) and their animals (dogs) was not an important co-factor in sero-positivity to B. bronchiseptica.

Résumé — Anticorps réactifs à Bordetella bronchiseptica chez les ours polaires du Canada. Bordetella bronchiseptica est une bactérie qui infecte une variété d’espèces mais qui n’a pas été signalée chez les ours polaires en liberté (Ursus maritimus). Les sérums de 385 ours polaires de la région ouest de la baie d’Hudson, de 1986 à 2017, ont été testés pour leur réactivité à B. bronchiseptica par une épreuve ELISA utilisant des anticorps anti-IgG canines et de la protéine G de Streptococcus comme réactifs secondaires. Les sérums d’ours avaient une réactivité variable aux antigènes de B. bronchiseptica, et il n’y avait aucune différence entre les ours qui avaient l’habitude de s’approcher de la ville de Churhill, au Manitoba, et les ours qui n’en avaient pas. Bien que les sources d’exposition n’aient pas été déterminées, des résultats équivalents dans les deux groupes suggèrent que l’exposition potentielle des humains (en dehors de la manipulation pendant l’échantillonnage) et de leurs animaux (chiens) n’était pas un cofacteur important de la séropositivité à B. bronchiseptica. (Traduit par Dr Serge Messier) Can Vet J 2021;62:725–728

Introduction cies ranging from guinea pigs to dogs to humans and including s an ice obligate species, polar bears are adversely affected pinnepeds (6) and lagomorphs (7), the subjects of polar bear A by climate change through loss of habitat and access to predation and scavenging. Therefore, based on the natural his- their primary prey (1–3). In addition, increased use of terrestrial tory of B. bronchiseptica, it is likely that polar bears are exposed environments during ice-free periods (1–3) may lead to closer to this microbe, and that this exposure could be affected by and more frequent contact with humans and their domestic human activity and/or climate change. Moreover, post-exposure animals, notably dogs, and resultant potential exposure to “new,” infection with this recognized pathogen could affect polar bear or at least different, pathogens. respiratory health, especially in the context of co-infections, Bordetella spp. are important respiratory pathogens in human notably with morbilliviruses (8,9), which have been documented and veterinary medicine (4–7). In contrast to B. pertussis, the in this population of bears (9). cause of whooping cough, which only infects primates (4), Our objective was to determine the prevalence of exposure to B. bronchiseptica is promiscuous, naturally infecting many spe- B. bronchiseptica in polar bears in western Hudson Bay, Canada;

Departments of Veterinary Microbiology (Ellis, Lacoste) and Large Animal Clinical Sciences (Gow), Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon Saskatchewan S7N 5B4; Institute for Conservation Research, San Diego Zoo Global, 15600 San Pasqual Valley Road, Escondido California 92027, USA (Pilfold, Owen, Rideout); Wildlife Research Division, Science and Technology Branch, Environment and Climate Change Canada, CW422 Biological Sciences Building, University of Alberta, Edmonton, Alberta T6G 2E9 (Lunn, McGeachy); Wildlife Research Division, Science and Technology Branch, Environment and Climate Change Canada, Suite 150, 123 Main Street, Winnipeg, Manitoba R3C 4W2 (Richardson). Address all correspondence to Dr. John Ellis; 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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this population has been impacted by climate change (1–3) 37°C, washed in 0.85% NaCl (saline solution), resuspended and has potential for exposure to humans and dogs, notably in in saline solution containing 1:1000 formalin, and stored at Churchill, Manitoba, due to their being forced to spend increas- 4°C. Inactivated B. bronchiseptica (50 mL) at a concentration of ing amounts of time onshore. 50 Nephlos units (determined on a colorimeter) were added to

dilutions (log2) of bear sera (in saline solution) to the wells of Materials and methods v-bottom microtiter plates. After 2 h incubation at 37°C, plates Bears and sampling were incubated for a further 20 h at 4°C. A visual determina- Polar bears were immobilized via remote injection from a heli- tion of agglutination (failure to form a distinct button in the copter following standard protocols (10) as part of ongoing, v-bottom well) was then made. Titres were analyzed as geometric ARTICLE long-term research on the ecology of the western Hudson Bay values (log2). subpopulation (1–3). Venous blood was collected from sedated polar bears at the time of examination for health monitoring. Statistical analyses The bears were classified as being of either “greater” or “lower” Statistical analyses were performed using STATA version 15 risk of exposure (to humans and/or dogs) based on capture (Statacorp, College Station, Texas, USA). From a random selec- histories within the town of Churchill. tion of the 385 serum samples available; 50 high- and 50 low- risk bears were selected for testing with the anti-canine IgG and ELISA for B. bronchiseptica-reactive IgG the protein G ELISA. Comparisons of the ELISA results for the An enzyme-linked immunosorbent assay (ELISA) for anti-canine IgG and the protein G (n = 100) were performed B. bronchiseptica-reactive IgG antibodies originally described using kappa to assess the agreement between the 2 test methods. by Boot et al (5) was performed with modifications as The ELISA data were tested using Shapiro-Wilk normality test described (11,12). Briefly, confluent growth of a canine isolate and were determined to not be normally distributed; therefore, a of Bb (Regina-1) was harvested from blood agar plates, washed, comparison of serum B. bronchiseptica IgG, between higher risk and pulse-sonicated on ice (2 3 15 s). Aliquots were frozen at bears (n = 107) and lower risk bears (n = 278) was completed 280°C. Ninety-six-well flat-bottomed micro-titration plates using Kruskal-Wallis equality-of-populations rank test. (Immulon-4; Thermo Fisher Scientific, Waltham, Massachusetts, USA) were coated overnight at 4°C with an optimal dilution of Results B. bronchiseptica antigen (determined in a block titration using To compare the secondary reagents from the full cohort of serum positive and negative control sera) (11,12) in carbonate coating samples (N = 385), 100 randomly chosen greater (n = 50) and buffer, blocked, and then washed before the addition of the sec- lower (n = 50) risk bears were tested in the B. bronchiseptica- ondary reagent. One of the difficulties in assessing the immune specific ELISA using either of the peroxidase conjugates responses of polar bears and other wildlife species as a means of protein G, or the peroxidase-conjugated anti-canine IgG as determining exposure to various microbes, is the lack of available secondary reagents (Figure 1). There was moderate agreement specific reagents to the immunoglobulins of uncommonly stud- (kappa = 0.50) between the 2 tests (16). Of the 100 cases tested, ied species. Streptococcal Protein G (Protein G) has long been 69 samples were classified as positive (ELISA $ 15 optical used as a secondary reagent in various assays due to its binding density units) on the protein G ELISA and 65 were classified of the Fc component of immunoglobulin G from numerous spe- as positive on the anti-canine IgG. In total, 56 were positive on cies (13). More recently it has been documented that antibodies both the protein G ELISA and the anti-canine IgG ELISA tests. against canine IgG have a highly avid cross-reactivity with IgG Twenty-two of 31 negative (ELISA , 15 optical density units) from a range of carnivores, including polar bears (14). Based samples identified by the protein G ELISA and 35 negative on these data, horseradish peroxidase-conjugated sheep anti- samples identified by the anti-canine IgG ELISA were classified canine IgG, heavy chain (Bethyl Laboratories, Montgomery, as negative on both ELISA tests. Texas, USA) and horseradish peroxidase-conjugated Streptococcus Since the protein G test had higher background OD values protein G (protein G; Thermo Fisher) were used as secondary in control wells, the entire bank of sera was tested using the reagents. Optical density from duplicate test wells were com- anti-canine IgG. Bears in both “risk” groups had evidence of pared with B. bronchiseptica-seropositive and seronegative canine exposure to B. bronchiseptica based on the variable reactivity sera to derive ELISA units (11,12). A previously determined of the antibodies in their sera with B. bronchiseptica antigens cut-off value of 15 optical density units based on the testing in the ELISA. Median ELISA units in the high risk population of positive and negative dog sera was used as an indicator of (n = 107) was 24 units (range: 0 to 74 units), and median ELISA a biologically significant antibody response after exposure to units in the low risk (n = 278) population was 25 (range: 0 to B. bronchiseptica antigens (12). 75 units) (Figure 2), with no statistical differences between groups in IgG (P = 0.59). Using 15 optical density units as a Microagglutination test for B. bronchiseptica cut-off value, 67% (72/107) of the bears in the high-risk group antibodies and 74% (205/278) of the bears in the low-risk group were A test of B. bronchiseptica-agglutinating antibodies was per- considered positive for B. bronchiseptica antigens. formed as described using the Regina-1 isolate (11,15). Briefly, Sera from a cohort of 25 bears with a range of low to high B. bronchiseptica was grown in Dulbecco’s modified Eagle’s B. bronchiseptica ELISA units comprising both greater and lower medium supplemented with 10% fetal calf serum for 24 h at risk groups were assessed for B. bronchiseptica agglutinating

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120

100 80 70 80 60 60 50

IgG ELISA units ELISA IgG 40 40 Bb 30 ARTICLE 20 20 Anti- 0

Anti-canine ELSA OD ELSA Anti-canine 10 Low risk High risk 0 Risk category High risk Low risk Protein G Anti-canine IgG Bear risk category

Figure 1. Box and whiskers plot of the anti-Bordetella Figure 2. Box and whiskers plot of the anti-Bordetella bronchiseptica IgG ELISA units using protein G (gray box) or bronchiseptica IgG ELISA units (using anti-canine IgG as the anti-canine IgG (light gray box) as secondary reagents for high secondary reagent) for high (n = 107) and low (n = 278) risk (n = 50) and low (n = 50) risk bear. Each dot represents a bear bears. Each dot represents a bear and the horizontal line in the and the horizontal line in the box represents the median values. box represents the median values. activity. Although bears in both risk groups had serum anti- similar disease sparing immunity compared to a vaccine made bodies that agglutinated B. bronchiseptica (titers ranging from sonicated B. bronchiseptica (5). Nevertheless, given what from # 1:16 to $ 1:512), titers in the agglutination test did is known about the host ranges of these members of the subspe- not agree with the ELISA results. When considering titers of cies, as well other less prevalent Bordetella species, it is unlikely # 1:16 as negative for the agglutination test and an optical that the B. bronchiseptica-reactive antibody responses measured density unit of , 15 as negative for the ELISA tests, the agree- in these bears would be the result of exposure to any Bordetella ment (kappa) between the agglutination test and the ELISA was species except Bb. Whether or not polar bears have a host 20.25 for the agglutination and protein G analysis and 20.16 restricted genotype of B. bronchiseptica, as recently documented for the agglutination and anti-canine analysis. Fourteen samples in seals (6), is a possibility that would require sequencing of were classified as positive by the agglutination test, whereas there samples taken directly from the respiratory tract and cannot be were 17 and 16 samples identified as positive on the streptococ- determined by sero-epidemiological approaches. cal protein G and anti-canine IgG ELISAs, respectively. Eight The lack of agreement between the ELISA and agglutination samples were positive on all 3 tests. These results indicate that tests was somewhat unexpected, at least compared to our previ- there was less agreement between the 2 tests than would be ous studies of acute experimental infections in dogs (11), that expected by chance. had been vaccinated with a feline isolate of B. bronchiseptica and challenged with Regina-1, a canine isolate. However, in a Discussion study examining antibody responses in pigs vaccinated against The precise specificity of the antibody assays used herein B. bronchiseptica, there was little correlation between ELISA and that have been routinely used to assess immune responses to agglutination tests, and the ELISA was reported to be 100 times B. bronchiseptica in dogs (11,12,17), is not known. However, more sensitive than the agglutination assay (19). This disparity, in the original description of the ELISA (5) absorption of which was also reported herein, may relate to differences in the B. bronchiseptica-reactive sera with various other Gram-negative number and types of B. bronchiseptica antigens “exposed” to bacteria, including the genera Acinetobacter, Actinobacillus, antibodies in the 2 tests; a large number of external and internal Alcaligenes, Escherichia, Moraxella, and Pasteurella did not reduce antigens in the sonicated preparation used in the ELISA, com- activity in the assay. Furthermore, young and adult dogs with pared to a relatively smaller constellation of external antigens on low antibody responses as measured in this ELISA have increases “fixed” bacterial cells. Indeed, antibodies in serum from natu- in B. bronchiseptica reactive IgG after vaccination and/or expo- rally exposed and vaccinated dogs recognized numerous proteins sure to B. bronchiseptica, suggesting that this ELISA is not just on immunoblots of the ELISA antigen in addition to those with measuring responses to closely related (commensal) species expected molecular weights of fimbriae and pertactin (18), the of bacteria (11,18). Bordetella bronchiseptica, B. pertussis, and primary (surface) proteins thought to be agglutinins (4,20,21). B. parapertussis comprise an antigenically very closely related It is likely that the same would be the case in B. bronchiseptica- subspecies known as the “Bordetella bronchiseptica cluster,” exposed polar bears. As well, the disparity between the 2 tests with B. bronchiseptica as the apparent progenitor species (4). It could be the result of serotype or strain differences in the is likely that ELISAs using whole sonicated bacteria from any B. bronchiseptica to which the bears had been exposed, versus one of these would not differentiate specific responses to only the canine isolate used in the tests. Intra-specific differences are one of them; polyclonal antibody responses would be expected likely to be manifest in the external proteins, more so than in to be cross-reactive (4). Indeed, in seminal studies of inject- the internal, more conserved proteins/enzymes in the cytosol able B. bronchiseptica vaccines in pigs, it was demonstrated of the bacteria which are shielded from immunological pres- that a vaccine comprising sonicated B. bronchiseptica conferred sure to change. Although there is relatively less known about

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serotype and strain differences in B. bronchiseptica compared to 3. Lunn NJ, Servanty S, Regehr EV, Converse SJ, Richardson E, B. pertussis (4,22), it is interesting that the original reference for Stirling I. Demography of an apex predator at the edge of its range: Impacts of changing sea ice on polar bears in Hudson Bay. Ecol Appl the ELISA used herein reported differences in responses in the 2016;26:1302–1320. ELISA among 11 isolates from guinea pigs, rabbits, and rats; 4. Mattoo S, Cherry JD. Molecular pathogenesis, epidemiology, and clini- 2 had minimal cross-reactivity in ELISAs (5). The implication cal manifestations of respiratory infections due to Bordetella pertussis and other Bordetella subspecies. Clin Microbiol Rev 2005;18:326–381. of those data is that the ELISA using a canine isolate could be 5. Boot R, Bakker RHG, Thuis H, Veenema JL. An enzyme-linked underdiagnosing exposure of polar bears to B. bronchiseptica. immunosorbent assay (ELISA) for monitoring guinea pigs and rabbits Although isolation of B. bronchiseptica from a clinical case for Bordetella bronchiseptica antibodies. Lab Anim 1993;27:342–349. 6. Register KB, Ivanov YV, Harvill ET, Davison N, Foster G. Novel, host- of tracheitis in a captive (zoo) polar bear was reported (23), restricted genotypes of Bordetella bronchiseptica associated with phocine

ARTICLE to our knowledge, this is the first investigation of exposure of respiratory tract isolates. Microbiology 2015;161:580–592. wild polar bears to B. bronchiseptica. It is not surprising, given 7. Pathak AK, Boag B, Poss M, Harvill ET, Cattadori IM. Seasonal breeding drives the incidence of a chronic bacterial infection in a free-living the natural history of B. bronchiseptica, that polar bears can be herbivore population. Epidemiol Infect 2011;139:1210–1219. infected with the bacterium; however, the source of the infec- 8. Cattet MRL, Duignan PJ, House CA, St. Aubin DJ. Antibodies to tion/exposure was not determined. Perhaps B. bronchiseptica canine distemper and Phocine distemper viruses in polar bears from the Canadian Arctic. J Wildl Dis 2004;40:338–342. is endemic in polar bear populations, as it is in some popu- 9. Heje NI, Henriksen P, Aalbaek B. The seal death in Danish waters lations of rabbits, seals, and dogs (4,6,7,12), and that the 1988. Pathological and bacteriological studies. Acta Vet Scand risk of exposure could increase because of commingling of 1991;32:205–210. 10. Stirling I, Spencer C, Andriashek D. Immobilization of polar bears bears and increased population density as occurs in kennelled (Ursus maritimus) with Telazol® in the Canadian Arctic. J Wildl Dis dogs (4,12). It is also possible that bears could have been 1989;25:159–168. exposed to B. bronchiseptica through ingestion of infected 11. Ellis JA, Haines DM, West KH, et al. Effect of vaccination on experimental infection with Bordetella bronchiseptica in dogs. J Am Vet Med seals (6), or even by scavenging rabbits or hares (7). Other host, Assoc 2001;218:367–375. environmental, and infectious co-factors that may be related 12. Ellis J, Anseeuw E, Gow S, et al. Seroepidemiology of respiratory to B. bronchiseptica sero-prevalence in these bears are currently (group 2) canine coronavirus, canine parainfluenza virus, and Bordetella bronchiseptica in urban dogs in a humane shelter and in rural dogs in under investigation. However, the finding of equivalent preva- small communities. Can Vet J 2011;52:861–868. lence of apparent exposure (sero-positivity) did not support the 13. Akerstrom B, Brodin T, Reis L, Bjorck L. Protein G: A powerful tool hypothesis that a higher risk of interaction with humans and for binding and detection of monoclonal and polyclonal antibodies. J Immunol 1985;135:2589–2592. their dogs, at least in town sites, is an important co-factor in 14. Roehl K, Jankowski M, Hofmeister E. Anti-dog IgG secondary antibody the exposure of polar bears to B. bronchiseptica. Regardless, as successfully detects IgG in a variety of aquatic mammals. J Zoo Wildl well-documented in dogs and seals (9,17), these data supported Med 2016;47:970–976. 15. Harris DL, Switzer WP. Immunization of pigs against Bordetella the potential for B. bronchiseptica to have an important role in bronchiseptica infection by parenteral vaccination. Am J Vet Res 1972; clinical respiratory disease in polar bears, especially if they may 33:1975–1984. be co-infected with morbilliviruses. 16. Viera AJ, Garrett JM. Understanding the interobserver agreement: The kappa statistic. Fam Med 2015;37:360–363. 17. Ellis JA. How well do vaccines for Bordetella bronchiseptica work in dogs? Acknowledgments A critical review of the literature 1977–2014. Vet J 2015;204:5–16. Financial and logistical support of field and laboratory 18. Ellis J, Rhoades C, Lacoste S, Krakowka S. Antibody responses to Bordetella bronchiseptica in vaccinated and infected dogs. Can Vet J research was provided by Care for the Wild International, the 2014;55:857–864. Churchill Northern Studies Centre, Earth Rangers Foundation, 19. Venier L, Pothschild MF, Warner CM. Measurement of serum antibody Environment and Climate Change Canada, the Isdell Family in swine vaccinated with Bordetella bronchiseptica: Comparison of agglutination and enyzyme-linked immunosorbent assay. Am J Vet Res Foundation, Manitoba Sustainable Development, Parks Canada 1984;45:2634–2636. Agency, Quark Expeditions, Schad Foundation, Wildlife Media 20. Robinson A, Ashworth LAE, Irons LI. Serotyping Bordetella pertussis. Inc., the McBeth Foundation and World Wildlife Fund Canada. Vaccine 1989;7:491–494. 21. Brennan MJ, Li ZM, Cowell JL, et al. Identification of a 69-kilodalton The primary author thanks Dr. Musangu Ngeleka, Prairie nonfimbrial protein as an agglutinogen of Bordetella pertussis. Infect Diagnostic Laboratory, University of Saskatchewan, for advice Immun 1988;56:3189–3195. 22. Burns EH, Norman JM, Hatcher MD, Bemis DA. Fimbriae and deter- on use of a nephelometer. CVJ mination of host species specificity of Bordetella bronchiseptica. J Clin Microbiol 1993;31:1838–1844. References 23. Lacasse C, Gamble KC. Tracheitis associated with Bordetella bronchi- . 1 Stirling I, Lunn NJ, Iacozza J. Long-term trends in the population septica in a polar bear (Ursus maritimus). J Zoo Wildl Med 2006;37: ecology of polar bears in western Hudson Bay in relation to climatic 190–192. change. Arctic 1999;52:294–306. 2. Regehr EV, Lunn NJ, Amstrup SC, Stirling I. Effects of earlier sea ice breakup on survival and population size of polar bears in western Hudson Bay. J Wildl Manage 2007;71:2673–2683.

728 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY Article

Evaluation of platelet-rich plasma applied in the coronary band of healthy equine hooves

Sarah Raphaela Torquato Seidel, Anderson Fernando de Souza, Joice Fülber, Paulo Moreira Bogossian, Nubia Nayara Pereira Rodrigues, Raquel Yvonne Arantes Baccarin

Abstract — Platelet-rich plasma (PRP) is a widely used hemocomponent that holds great promise in equine medicine due to its feasible production and regenerative therapy potential. Its use has been considered as a treatment for chronic laminitis, mainly in terms of its analgesic properties and because it can induce growth in affected hooves. The aim of this study was to evaluate the effect on hoof growth attributable to PRP applied in the coronary band of clinically healthy horses by comparing the responses to PRP, saline, and trimming alone. After randomization, the forelimbs of 9 horses received specific treatment at intervals of 33 days and were trimmed, measured, and radiographed at the same time. Neither hoof growth nor hoof angles were different between the treatment groups at any time point. The application of PRP in the coronary band of horses may be a safe procedure; however, it had no effect on the growth or conformation of hooves in clinically healthy horses.

Résumé — Évaluation du plasma riche en plaquettes appliqué dans la bande coronaire de sabots équins sains. Le plasma riche en plaquettes (PRP) est un hémo-composant largement utilisé qui est très prometteur en médecine équine en raison de sa production réalisable et de son potentiel de thérapie régénérative. Son utilisation a été considérée comme un traitement de la fourbure chronique, principalement en termes de ses propriétés analgésiques et parce qu’elle peut induire la croissance des sabots atteints. Le but de cette étude était d’évaluer l’effet sur la croissance des sabots attribuable au PRP appliqué dans la bande coronaire de chevaux cliniquement sains en comparant les réponses au PRP, à la solution saline et à la taille seule. Après randomisation, les membres antérieurs de neuf chevaux ont reçu un traitement spécifique à des intervalles de 33 jours et ont été taillés, mesurés et radiographiés au même moment. Ni la croissance ni les angles des sabots n’étaient différents entre les groupes de traitement à aucun moment. L’application de PRP dans la bande coronaire des chevaux peut être une procédure sûre; cependant, il n’a eu aucun effet sur la croissance ou la conformation des sabots chez les chevaux cliniquement sains. (Traduit par Dr Serge Messier) Can Vet J 2021;62:729–735

Introduction tion in locomotor activity, confinement, mechanical support aminitis is a highly debilitating syndrome that affects for the hoof, and induced hypothermia using cryotherapy L equids, has a guarded or poor prognosis, and can result in techniques (3). Among all the treatment possibilities, support euthanasia in many cases. Despite extensive research, laminitis therapies play an important role in attempting to diminish hoof remains a challenge for equine veterinarians. Not only does damage (4). it possess a multifactorial etiopathogenesis, but there is also a Recrudescence of the condition is a common occurrence, scarcity of effective treatments. This fact is mainly attributed to and chronic laminitis usually occurs in response to ineffective uncertainty regarding its pathophysiology (1,2). therapy applied during the acute phase. The signs of the chronic Laminitis must be treated based on its current phase or phase are usually sinking and/or rotation of the third phalanx, on the presented symptomatology. The conventional treat- crushing of the sole and coronet, and anatomical pattern ment commonly involves anti-inflammatory therapy, reduc- changes in hoof structures. As well, there are changes in the

Departamento de Clínica Veterinária (Seidel, Bogossian, Rodrigues, Baccarin), Departamento de Cirurgia Veterinária (de Souza, Fülber) Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, 05508-270, Brazil. Address all correspondence to Dr. Sarah Raphaela Torquato Seidel; e-mail: [email protected]; [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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growth pattern of the hoof itself associated with mild lameness, Table 1. Randomization of the experimental design. continuous severe foot pain, and even recumbency. The chronic Animal Hoof Time point 1 Time point 2 Time point 3 phase often warrants more aggressive treatment, especially 1 R PRP Control Saline regarding pain control (4,5). L Saline PRP Control Trimming and shoeing constitute essential therapy among 2 R PRP Control Saline the treatments providing structural support that are applied in L Saline PRP Control cases of chronic laminitis and are a necessary effort to minimize 3 R PRP Saline Control hoof damage during the progression of this disorder (4,6–8); L Saline PRP Control however, even these procedures cannot ensure restoration of 4 R Saline Control PRP ARTICLE normal anatomical alignment, as functional growth of the L PRP Control Saline coronary band is imperative. 5 R Saline PRP Control Platelet-rich plasma (PRP) is a commonly used autologous L Control Saline PRP hemocomponent that results from platelet enrichment when 6 R Control Saline PRP compared to that of whole blood. This plasma has therapeutic L Control PRP Saline functions mainly due to the presence of growth factors, which 7 R Saline Control PRP are released from platelets after their activation (9,10). There L Control Saline PRP are many centrifugation protocols and commercial systems to 8 R PRP Saline Control obtain PRP (11,12), but it is important to use those that have L PRP Control Saline already been tested and characterized in order to achieve more 9 R Control Saline PRP consistent therapeutic responses. L Control PRP Saline Platelet-rich plasma is widely used in veterinary medicine, R — Right forelimb; L — Left forelimb; PRP — Platelet-rich plasma. especially among equine veterinarians (13,14). Use of PRP in chronic laminitis treatment is anecdotally supported by many veterinarians and farriers, although there are only a few studies that have investigated this application. The injection of day, developed and provided by LABEQUI, and free access to PRP in the coronary band in some cases of chronic laminitis grass pasture and water. secondary to other disorders that are not responsive to treatment has yielded improvements in the growth and quality of Experimental design hooves (15,16). One study demonstrated similar results with Both forelimb hooves were allocated as the experimental units. co-administration of PRP and mesenchymal stem cells (MSCs) The experimental design was 3 (time points) 3 18 (hooves) 3 in a few cases of chronic laminitis, although the treatment was 3 treatments. The randomization was designed using SAS (ver- administered intravenously via the lateral and medial digital sion 9.4; SAS Institute, Cary, North Carolina, USA) (Table 1). veins in this instance (17). The treatment was administered 3 times and consisted of local Although these outcomes presented satisfactory results, administration of 3 mL of PRP or saline solution divided into improving not only the hoof structures but also diminishing 2 points of injection above the coronary band: lateral and pain, more studies are necessary to support further recommen- medial, whereas the third treatment consisted of trimming of dations of this treatment. In addition, these satisfactory results the hooves, with no injections and was designated as control. may encourage the use of PRP in other conditions that require an increase in the hoof growth rate. For this reason, the aim of Trimming and radiography this study was to evaluate the influence that PRP exerts on hoof All hooves were trimmed before initial treatments, and marks growth in clinically healthy horses compared to that associated were made with a hoof rasp approximately 2 cm below the with saline solution and trimming alone. coronary band at 3 sites on the hoof wall: lateral, dorsal, and medial. Digital radiographs with lateromedial (LM) and dor- Materials and methods sopalmar (DP) views of both forelimbs were acquired using a Animals digital radiology system with technical specifications of 60 kVp The present study was approved by the Ethics Committee on and 1.6 mAs with a focus-film distance (FFD) of 1 m. The Animal Use of the School of Veterinary Medicine and Animal images were then archived as digital media for further analysis. Science of the University of São Paulo (FMVZ/USP) (CEUA/ Hooves were trimmed 2 more times at intervals of 33 d, and USP: 1956201219) and was carried out in accordance with radiographic images were acquired 3 more times to document International Guiding Principles for Biomedical Research the treatment response. Involving Animals as issued by the Council for the International Organizations of Medical Sciences. Nine geldings were enrolled, Hoof angles aged 6 to 10 y with an average weight of 392.4 kg. The horses After acquiring the radiographs of all animals in each period of were kept at Centro de Apoio ao Ensino e Pesquisa, CAEP and the study, the angles of the hooves were measured using digital Laboratório de Pesquisa em Alimentos e Fisiologia dos Equinos, radiography and Image J software (Figure 1): dorsal hoof angle LABEQUI (FMVZ/USP). All horses received the same dietary (dorsal surface of the hoof wall 3 solar surface), lateral hoof management, consisting of 1 kg of maintenance concentrate per angle (lateral surface of the hoof wall 3 solar surface), and

730 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY ARTICLE

Figure 1. Illustrative scheme of the angles measured on digital radiographs with lateromedial and dorsopalmar views.

Figure 2. Photograph of needle insertion just above the coronary band. Medial (left) and lateral (right) views are shown. A syringe was attached after needle placement, and 1.5 mL of PRP or saline was injected in each location.

medial hoof angle (medial surface of the hoof wall 3 solar Platelet and leukocyte counts surface). A complete blood (cell) count (CBC) was performed in blood samples from each animal to obtain the baseline values using Platelet-rich plasma preparation a flow cytometry hematology system (ADVIA 2120i; Siemens, The preparation of PRP was individualized for every animal at Erlangen, Germany). Platelet and leukocyte counts in PRP each treatment time point. The protocol used has already been samples were conducted using a Neubauer chamber (19). characterized in equines (18). After clipping and aseptic preparation of the jugular vein, blood was collected using a 21-gauge Treatment administration needle and 7 Vacutainer tubes containing 3.8% sodium citrate To perform the treatment injections, the hooves were washed (Vacuteiner; BD, São Paulo, Brazil). The blood samples were with water and soap and brushed vigorously. The horses incubated at room temperature (25°C) for 25 min and then were sedated with 0.8 mg/kg of 10% xylazine hydrochloride centrifuged at 300 3 g for 5 min, followed by another 25 min (Equisedan; JA Saúde Animal, Patrocínio Paulista, Brazil). The of rest. The supernatant plasma was collected without disturb- circumference above the hoof capsule was clipped. Abaxial ing the leukocyte zone, transferred to a Falcon tube (Cralplast, sesamoid perineural anesthesia was performed with 1.5 mL of Cotia, Brazil), and centrifuged at 700 3 g for 15 min, followed 2% lidocaine hydrochloride (Anestt; Syntec, Barueri, Brazil) at by another incubation period of 45 min at room temperature. each branch. Afterward, the clipped area was aseptically pre- Approximately 70% of the plasma supernatant was removed, pared, and 3.0 mL of PRP or saline solution was injected above and the remaining volume was gently homogenized using a the coronary band using a 24-G needle. The needle was inserted pipette and aliquoted in syringes. The PRP was maintained into the subcutaneous space just above the coronary band and in an aseptic cooler to preserve the temperature (25°C) until distally directed toward the hoof, as shown in Figure 2. This administration, up to 1 h after the production. volume was divided between 2 sites of 1.5 mL each: lateral and

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Table 2. Platelet and leukocyte counts in whole blood, platelet concentrations in PRP. Baseline PLT Baseline WBC PRP PLT PRP WBC PLT Animal (3 10³/mL) (3 10³/mL) (3 10³/mL) (3 10³/mL) concentration 1 154 6.1 1201 0.8 7.8 2 166 4.5 1158 0.5 7.0 3 146 6.1 1169 1.0 8.0 4 175 6.0 1361 1.2 7.8 5 280 6.4 1690 1.1 6.0 6 117 5.8 1043 1.2 8.9 7 281 6.4 1832 1.4 6.5 8 255 5.5 1769 1.5 6.9 ARTICLE 9 238 7.5 1616 1.4 6.8 MEAN 201.33 6.03 1426.33 1.12 7.30 SD 58.80 0.75 284.44 0.29 0.84

Baseline PLT — Whole blood platelet count; Baseline WBC — Whole blood leukocyte count; PRP PLT — Platelet-rich plasma platelet count; PRP WBC — Platelet-rich plasma leukocyte count. PLT concentration — Platelet-rich plasma platelet count/ whole-blood platelet count. SD — Standard deviation.

medial. The control group underwent only trimming of the and 1.02 cm (SD: 0.38) following PRP treatment, respectively; hooves. This procedure was repeated 2 more times at intervals 1.08 cm (SD: 0.24), 1.20 cm (SD: 0.29), and 1.00 cm (SD: of 33 d. 0.28) following saline treatment, respectively; and 1.08 cm (SD: 0.27), 1.21 cm (SD: 0.31), and 1.18 (SD: 0.36) in the control Statistical analysis group, respectively. The variations between animals were negli- A mixed linear model was used for the statistical analysis. gible when compared with the variations between hooves, sug- Group factors were included as fixed factors, and animal and gesting independence among those factors. Statistical differences hoof factors were included as random effects. An autoregressive were not observed between the treatment and control groups covariance structure was used for the superior BIC (Bayesian regarding hoof wall growth in the dorsal (P = 0.90) and medial Information Criterion) value. The Shapiro-Wilk test was con- (P = 0.42) views (Figure 4). When considering only the first ducted to assess whether the data were normally distributed, measurement after treatment, there was a difference in lateral and Bartlett’s test was used for homoscedasticity. Period effects wall growth between the PRP and control groups (P = 0.001), and carryover were tested including the period 3 treatment but this might have been due to a residual effect from the first interaction as a fixed factor. When present, major effects were trimming. Excluding this possibility, hoof growth was similar detailed using Tukey’s test. in all treatment and control groups, including lateral growth All analyses were performed using the RStudio statistical anal- (P = 0.27; Figure 5). ysis software (version 1.2.5001, RStudio, Boston, Massachusetts, USA), with the significance level set at 5% and confidence level Discussion at 95%. The aim of the present study was to evaluate the influence of PRP injections on hoof growth in horses. Platelet-rich plasma Results was produced at the time of each treatment using a double cen- Platelet and leukocyte counts trifugation protocol previously characterized in equines (18). The platelet and leukocyte counts at baseline and in PRP are The platelet concentration achieved was similar to that reported shown in Table 2. The platelet concentration acquired with the in the previous study, which suggests that the growth factors PRP was calculated by dividing the PRP count by the baseline were present at a similar concentration. As expected, the leu- count. kocytes in the final product did not exceed the baseline counts, characterizing the hemocomponent as a pure-PRP (P-PRP) (20). Hoof angles The therapeutic potential of PRP is mainly attributed to The angles measured on radiographs did not show significant the presence of growth factors released by platelets in response differences throughout the treatment course: dorsal [mean: to their activation. Regarding their biological action in hoof 48.1°, standard deviation (SD): 2.7, P = 0.13], medial (mean: structures injured by chronic laminitis, growth factors decrease 75.2°, SD: 5.8, P = 0.42), and lateral (mean: 73.6°, SD: 5.8, the upregulation of nuclear factor kappa B and increase the P = 0.14) hoof angles. The dorsal hoof angle had higher variance proliferation and differentiation of MSCs, collagen I synthesis compared to that of the other angles and occurred in response and deposition, proteoglycan and extracellular matrix synthesis, to greater dorsal wall hoof growth (as observed in the means of endothelial cell mitogenesis and angiogenesis, synthesis of com- hoof measurements) throughout the course of the treatments ponents of the basement membrane, and growth of epidermal (Figure 3). and epithelial tissues (9,21,22). Platelets can also exhibit inflammatory activity in the devel- Hoof measurements opmental phase of laminitis; this response occurs in the early The means of growth as observed in the lateral, dorsal, and stages of the acute phase and is related to the activation of medial views were 1.13 cm (SD: 0.25), 1.17 cm (SD: 0.24), platelets and their sensitivity to endotoxin (23–25). For this

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C P S C P S ARTICLE

C P S

Figure 3. Angles measured on radiographs: lateral, medial, and dorsal hoof angles in response to different treatments.

C — Control; P — Platelet-rich plasma; S — Saline; Thick trace — Mean;  — outlier; (°) — Degrees.

C P S C P S

Figure 4. Growth (cm) presented on medial and dorsal views of hooves in response to different treatments.

C — Control; P — Platelet-rich plasma; S — Saline; Thick trace — Mean;  — outlier.

C P S C P S

Figure 5. Different results obtained for lateral hoof wall growth according to treatment. Left — Without performing carryover and removing residual effects; Right — After removing residual effects.

C — Control; P — Platelet-rich plasma; S — Saline; Thick trace — Mean;  — outlier. reason, hemocomponents such as PRP are unlikely to be an cases. Treatment with allogeneic PRP is not a common practice effective therapy for acute laminitis and may in fact exacerbate in equine medicine on account of possible adverse effects due it. Further study is needed. Of note is that all horses in this to incompatibility between the donor and patient. The authors study were clinically healthy and without a previous history did not find any similar studies using clinical application of of laminitis or any other condition involving their hooves and allogeneic PRP for the same purpose stated here, only a study none of the animals showed any discomfort or clinical signs of involving skin wounds surgically induced but without complica- pain after PRP administration. tions after homologous intralesional injections (26). Only autologous hemocomponent was used in this study; All horses were maintained at pasture, exhibited similar hoof however, homologous products could be an option in some conditions, and had no history of previous laminitis. Trimming

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was an essential step in this study, being performed not only did not cause local pain or discomfort in these animals, this in the beginning, but before each treatment by the same pro- therapy should not be used solely for the purpose of accelerat- fessional. The major intent of the procedure was to obtain ing hoof growth or an aesthetic purpose. The analgesic action functional hooves that enabled homogeneous growth of hoof provided by PRP in chronic laminitis cases was not evaluated structures (27,28). in this study. Further studies are necessary to provide evidence No significant differences in the angles of hooves were for recommendations of treatment for this disease. observed throughout the study. This result reflects not only the uniform growth of the animals’ hooves, but also their homoge- Acknowledgments neity related to body conformation, considering that size and This study was financed in part by the Coordenação de

ARTICLE weight are important factors that influence hoof conformation Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES): and symmetry (29,30). Trimming intervals are another deter- Finance Code 001. The authors thank Professor Rodrigo minant that influence hoof shape, but a hiatus longer than 7 wk Romero Corrêa for the availability of CAEP animals and facili- between trimmings is necessary to result in a decrease in hoof ties and Professor Alexandre Augusto de Oliveira Gobesso for angles (31,32). the availability of LABEQUI animals and personnel support. We A few previous studies have reported positive results regarding are also thankful to Professor Silvana Lima Gorniak and labora- the use of PRP for chronic laminitis. Concerning PRP adminis- tory technician Leonila Ester Reinert Raspantini for granting tration in the coronary band of horses, the case of a mare with us access to the CEPTOX structure. We thank DVM Ângela chronic laminitis secondary to pituitary pars intermedia has Perrone Barbosa for providing language assistance. CVJ been reported in which PRP treatment stimulated hoof growth at a rate of approximately 5 mm/week, with reduced pain and References lameness after 2 applications (15). The same authors revealed . 1 Laskoski LM, Dittrich RL, Deconto I, Faleiros RR. An update on equine laminitis. Ciência Rural 2016;46:547–553. satisfactory results after PRP treatment in 4 other cases of 2. Eades SC. Overview of current laminitis research. Vet Clin Equine Prac. chronic laminitis secondary to different conditions (16). The 2010;26:51–63. association between PRP and MSCs was also used in a study in 3. van Eps AW, Burns TA. Are there shared mechanisms in the pathophysiology of different clinical forms of laminitis and what are the which 9 horses with chronic laminitis and severely compromised implications for prevention and treatment? Vet Clin North Am Equine venograms were enrolled (17). In this study, PRP was used in Pract 2019;35:379–398. association with MSCs and administered in the lateral and 4. Parks A, Grady SEO. Chronic laminitis: Current treatment strategies. Vet Clin North Am Equine Pract 2003;19:393–416. medial digital veins 3 times at monthly intervals. The authors 5. Pollitt CC. Equine laminitis. Clin Tech Equine Pract 2004;3:34–44. observed progressive improvement in the foot’s vascularization, 6. Grady SEO, Parks AH. Farriery options for acute and chronic laminitis. as well as in the structure and function of the hooves. 2008;54:354–363. On analysis of our data, the hooves did not show significant 7. O’Grady SE. Farriery for chronic laminitis. Vet Clin North Am Equine Pract 2010;26:407–423. differences in growth measures collected throughout this study, 8. Oliveira TM, Pereira MMF, da Silva LCLC, Fernandes WR, Baccarin regardless of whether they were in the control or treatment RYA. Relação entre utilização de ferrageamento corretivo com tempo group. This finding may suggest that PRP is not capable of de tratamento e reabilitação de cavalos com laminite crônica. Brazilian J Vet Res Anim Sci 2011;4:355–360. accelerating hoof growth when compared to injections of saline 9. Textor J. Platelet-rich plasma (PRP) as a therapeutic agent: Platelet biol- or even regular trimming. It is important to point out that our ogy, growth factors and a review of the literature. Platelet-Rich Plasma. results reflect a situation in which the horses were healthy and Lecture Notes in Bioengineering. 2014;69:61–94. 10. Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich did not have chronic laminitis or other hoof-related diseases. plasma: A milieu of bioactive factors. Arthroscopy 2012;28:429–439. Considering that these hooves represent normal functionality 11. Vendruscolo CP, Carvalho A de M, Moraes LF, et al. Avaliação da and growth rate, the growth factors released with PRP did not eficácia de diferentes protocolos de preparo do plasma rico em plaquetas para uso em medicina equina. Pesqui Vet Bras 2012;32:106–110. have an injury or pathological event to influence and create a 12. Hessel LN, Bosch G, van Weeren PR, Ionita JC. Equine autologous therapeutic response after treatment. platelet concentrates: A comparative study between different available This study has some limitations. All measures were systems. Equine Vet J 2015;47:319–325. 13. Vendruscolo CP, Alves ALG, Brossi PM, Baccarin RYA. Uso do soro obtained at the times of trimming, providing results of total autólogo condicionado e do plasma rico em plaquetas na terapia orto- growth achieved in approximately a month instead of a week. pédica de equinos. Semin Agrar 2014;35:2607–2624. Platelet-rich plasma administration was performed once for 14. Tambella AM, Martin S, Cantalamessa A, Serri E, Attili AR. Platelet-rich plasma and other hemocomponents in veterinary regenerative medicine. every hoof, without repetition. Each animal received only Wounds 2018;30:329–336. autogenous PRP, which may be reflected in some individual 15. Carmona JU, López C, Samudio IJ. Autologous platelet concentrates as differences; pooled allogeneic PRP may be an option as a more an adjunctive treatment for chronic laminitis in a mare with pituitary pars intermedia dysfunction. J Equine Vet Sci 2013;33:191–195. standardized methodology. Also, the protocol did not include 16. Carmona JU, Gómez WA, López C. Could platelet-rich plasma be a previous activation with agonists. This action may have led to clinical treatment for horses with laminitis? J Equine Vet Sci 2018; the release of growth factors immediately at the time of admin- 61:46–57. 17. Angelone M, Conti V, Biacca C, et al. The contribution of adipose istration and may have produced a different response. tissue-derived mesenchymal stem cells and platelet-rich plasma to the In conclusion, the administration of PRP in the coronary treatment of chronic equine laminitis: A proof of concept. Int J Mol band does not alter the growth pattern or rate in healthy hooves Sci 2017;18:1–17. 18. Seidel SRT, Vendruscolo CP, Moreira JJ, et al. Does double centrifu- compared to that associated with saline injections or trimming gation lead to premature platelet aggregation and decreased TGF-b1 alone. It is important to emphasize that although PRP injections concentrations in equine platelet-rich plasma? Vet Sci 2019;6:68.

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19. O’Shea CM, Werre SR, Dahlgren LA. Comparison of platelet counting 26. Pereira RC da F, De La Côrte FD, Brass KE, et al. Evaluation of technologies in equine platelet concentrates. Vet Surg 2015;44:304–313. three methods of platelet-rich plasma for treatment of equine distal 20. Dohan Ehrenfest DM, Andia I, Zumstein MA, Zhang C-Q, Pinto limb skin wounds. J Equine Vet Sci 2019;72:1–7. NR, Bielecki T. Classification of platelet concentrates (Platelet-Rich 27. O’Grady SE, Poupard DA. Proper physiologic horseshoeing. Vet Clin Plasma-PRP, Platelet-Rich Fibrin-PRF) for topical and infiltrative use North Am Equine Pract 2003;19:333–351. in orthopedic and sports medicine: Current consensus, clinical implica- 28. Ovnicek GD, Page BT, Trotter GW. Natural balance trimming and tions and perspectives. Muscles Ligaments Tendons J 2014;4:3–9. shoeing: Its theory and application. Vet Clin North Am Equine Pract 21. Lubkowska A, Dolegowska B, Banfi G. Growth factor content in PRP 2003;19:353–377.

and their applicability in medicine. J Biol Regul Homeost Agents 29. Melo UP, Ferreira C, Santiago RMFW, Palhares MS, Maranhão RPA. ARTICLE 2012;26:3S–22S. Equilíbrio do casco eqüino. Rev Electron Vet 2006;15:389–398. 22. Sánchez-González DJ, Méndez-Bolaina E, Trejo-Bahena NI. Platelet-rich 30. Lesniák K, Whittington L, Mapletoft S, et al. The influence of body plasma peptides: Key for regeneration. Int J Pept 2012;2012:532519. mass and height on equine hoof conformation and symmetry. J Equine 23. Textor J. Platelets in laminitis. J Equine Vet Sci 2010;30:506–509. Vet Sci 2019;77:43–49. 24. Paes Leme FO, Wurzinger LJ, Vasconcelos AC, Alves GES. Ativação de 31. Malone SR, Davies HMS. Changes in hoof shape during a seven-week plaquetas de eqüinos com laminite induzida e tratados com ketopro- period when horses were shod versus barefoot. Animals 2019;9:1–13. feno, fenilbutazona e flunixin meglumina. Arq Bras Med Vet e Zootec 32. Moleman M, van Heel MC, van Weeren PR, Back W. Hoof growth 2006;58:149–157. between two shoeing sessions leads to a substantial increase of the 25. Bailey SR, Adair HS, Reinemeyer CR, et al. Plasma concentrations moment about the distal, but not the proximal, interphalangeal joint. of endotoxin and platelet activation in the developmental stage of Equine Vet J 2006;38:170–174. oligofructose-induced laminitis. Vet Immunol Immunopathol 2009;129: 167–173.

Answers to Quiz Corner Les réponses du test éclair

1. B) The feline kidney is tan or light brown because of the presence 4. B) Volumes less than 6 mL in this animal will not be effective; of lipids in tubular epithelial cells. volumes greater than 6 mL risk temporary hind limb paresis B) Les reins des chats sont de couleur brun pâle à cause de la or paralysis and recumbency. The dose of 1 mL/100 kg body présence de lipides dans les cellules épithéliales tubulaires. weight is frequently quoted. B) Des volumes de moins de 6 mL chez cet animal ne seront 2. B) Reduced range of motion and joint effusion suggest OA. pas efficaces; des volumes plus grands que 6 mL risquent de B) La réduction de l’amplitude des mouvements et l’épanche- causer une parésie ou une paralysie temporaire des membres ment articulaire suggèrent de l’ostéoarthrite. postérieurs et le décubitus. La dose de 1 mL/100 kg de poids 3. D) Scapula fracture with minimal displacement is usually treated corporel est fréquemment utilisée. with strict cage confinement. 5. A) Accelerated bone marrow RBC production should be evident D) Une fracture de la scapula avec déplacement minimal est by 3 to 7 days after acute hemorrhage. habituellement traitée par un confinement strict en cage. A) L’accélération de la production de globules rouges par la moelle osseuse devrait être évidente de 3 à 7 jours après une hémorragie aiguë.

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CVJ / VOL 62 / JULY 2021 735 FOR PERSONAL USE ONLY Article

Diagnosis and outcome of nasal polyposis in 23 dogs treated medically or by endoscopic debridement

Enrico Bottero, Emanuele Mussi, Fabiano Raponi, Davide De Lorenzi, Pietro Ruggiero

Abstract — This study describes the clinical, diagnostic, and pathological characteristics of canine nasal polyps and how they responded to medical, endoscopic, and surgical treatments. The database of a multi-center veterinary endoscopy group was searched from 2010 to 2018. All dogs with a histological diagnosis of nasal polyposis that were undergoing endoscopic investigation (N = 23), were included. Clinical signs at presentation were sneezing (91%), nasal discharge (83%), stertor (74%), and frontonasal deformation (17%). Skull radiography on 13 dogs had alterations in 77% of cases, including turbinate lysis (6/13), increased radiopacity of one (4/13) or both (6/13) nasal cavities, and lysis of the nasal vomer bone (3/13). Nasal polyposis had a characteristic endoscopic appearance. There were clinical and diagnostic similarities between this cohort of dogs and dogs with nasal neoplasia, although dogs with nasal polyps were often younger and polypoid tissue was external to the nose. Steroid therapy alone was not effective in treating polyposis in dogs; however, endoscopic debulking with a laser and forceps was more effective.

Résumé — Diagnostic et issue de la polypose nasale chez 23 chiens traités médicalement ou par débridement endoscopique. Cette étude décrit les caractéristiques cliniques, diagnostiques et pathologiques des polypes nasaux canins et comment ils ont répondu aux traitements médicaux, endoscopiques et chirurgicaux. La base de données d’un groupe multicentres d’endoscopie vétérinaire a été recherchée de 2010 à 2018. Tous les chiens avec un diagnostic histologique de polypose nasale qui faisaient l’objet d’une investigation endoscopique (N = 23), ont été inclus. Les signes cliniques à la présentation étaient des éternuements (91 %), un écoulement nasal (83 %), un stertor (74 %) et une déformation fronto-nasale (17 %). La radiographie du crâne de 13 chiens présentait des altérations dans 77 % des cas, y compris une lyse du cornet (6/13), une radio-opacité accrue d’une (4/13) ou des deux (6/13) cavités nasales et une lyse du vomer nasal (3/13). La polypose nasale avait un aspect endoscopique caractéristique. Il y avait des similitudes cliniques et diagnostiques entre cette cohorte de chiens et celle de chiens atteints de néoplasie nasale, bien que les chiens atteints de polypes nasaux étaient souvent plus jeunes et que le tissu polypoïde était externe au nez. La thérapie stéroïdienne seule n’a pas été efficace dans le traitement de la polypose chez les chiens; cependant, la réduction endoscopique avec un laser et une pince était plus efficace. (Traduit par Dr Serge Messier) Can Vet J 2021;62:736–742

Introduction The aims of this study were to report the clinical, diagnostic, anine nasal polyps are uncommon and can cause clinical and pathological characteristics of canine nasal polyps and their C signs that include nasal discharge, sneezing, and ster- response to medical, endoscopic (i.e., debulking and laser abla- tor (1–3). The diagnosis is suspected based on imaging studies tion), and surgical treatments. and is confirmed with endoscopy and histological examination of nasal biopsies. The predominant treatment in humans is Materials and methods conservative; surgery is only recommended in cases of persistent A retrospective study was performed. A search was conducted recurrence (4,5). Ventral or dorsal rhinotomy has been reported on the database of a multi-center veterinary endoscopy group for canine nasal polyps, but surgical complications and recur- (Endovet, Rome, Italy) from May 2010 to December 2018. All rence have also been reported (1,6). Endoscopic treatment of dogs undergoing endoscopic investigation with a histological canine nasal polyps has not been reported. diagnosis of nasal polyposis were included in the study.

Endovet Professional Association, Rome, Italy (Bottero, Mussi, Raponi, Ruggiero); I Portoni Rossi Veterinary Hospital, Zola Pedrosa, Bologna, Italy (De Lorenzi). Address all correspondence to Dr. Emanuele Mussi; 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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The histological pattern was considered compatible with nasal polyposis if newly formed exophytic tissue covered with respiratory epithelium was present. This tissue was either hyperplastic or exhibited squamous metaplasia with dysplasia, with underlying fibrillary myxoid to stroma. The stroma had areas of proliferation of the mesenchyme and/or tortuous and dilated

blood vessels, seldom forming lacunar spaces, surrounded by ARTICLE highly variable numbers of serous or mucous glands and sparse inflammatory infiltrates (Figure 1). Dogs diagnosed with nasal polyps received the following treatments: medical (Group 1), endoscopic (Group 2), surgical (Group 3), or no treatment (Group 4). Medical treatment consisted of prednisolone (Prednicortone; Dechra Pharmaceuticals, Northwich, United Kingdom), 1 mg/kg BW, PO, q24h for 2 wk, then a progressively reduced dose for 3 to 6 wk, based on the clinical response. In general, this was achieved by halving the Figure 1. Histological appearance of canine nasal polyposis (Case 1). Exophytic mass is covered by respiratory epithelium dosage every 10 d with a final administration of 0.5 mg/kg BW, that is either hyperplastic or exhibiting squamous metaplasia. PO, q48h. Small cooperative dogs were administered aerosol The stroma is generally edematous and myxoid (arrow) with budesonide (Xavin; Teva Italia, Milan, Italy) 0.25 to 0.5 mg, scant fibrils and surrounded by tortuous and ectatic nasal glands (empty arrow), which are present in highly variable quantities. q12h for 15 d, or fluticasone propionate (Flixotide; Aspen Bad In the lamina propria, mixed inflammatory infiltrates and dilation Oldesloe, Bad Oldesloe, Germany) in a canine aerosol chamber of the vascular system (*) are present. Hematoxylin and eosin, (AeroDawg; BreathEazy, London, Ontario), 125 to 250 mg per 1003 magnification. puff, 1 or 2 times per day for 10 d then the dose was progressively reduced. Endoscopic debulking was performed under direct vision For each patient, we obtained the following information: using an alternating diode laser (400 to 600 mm diameter, breed, body weight (BW), age, sex, reproductive status, clinical continuous wave, 980 mm wavelength; Quanta System, Varese, and pharmacological anamnesis, clinical signs, hematological Italy), an external grasping forceps (Karl Storz), and pressure abnormalities, diagnostic imaging findings, treatment, and washing. The operator used a laser inserted in the working chan- follow-up. With the dog under general anesthesia, ventrodorsal nel of the endoscope. The procedure was carried out using an open-mouth projection radiographs of the skull were taken and immersion in a sterile saline solution, under direct vision, and computed tomography (CT) scans were performed with the by directly contacting the fiber with the polypoid tissue using dog in sternal recumbency, with and without administration of a continuous delivery (power 4 to 8 W) for 5 to 15 s. External intravenous contrast. grasping forceps were used to extract the polypoid tissue and Anterograde rhinoscopy and nasopharyngeal endoscopy fragments of pathological tissue were charred by the laser. In were performed in all cases with a rigid rhinoscope (Hopkins addition, after filling the oropharynx with gauze, pressure washes Forward-Oblique Telescope 30° 64029 BA with diagnostic were performed with a sterile saline solution through a sterile sheath 10.5 Fr 64018 VS or operating sheath 14.5 Fr with work- 60-mL syringe (disposable syringe without needle, catheter tip; ing channel 5 Fr 67065 C; Karl Storz, Tuttlingen, Germany) and Becton, Dickinson and Company, Franklin Lakes, New Jersey, flexible video bronchoscope (Video Bronchoscope EB-530S, dis- USA) inserted medially into the ventral meatus of the nose to tal diameter 4.9 mm, working channel 2 mm, length 600 mm; dislocate the nasal and nasopharyngeal polypoid tissue and the Fujifilm, Tokyo, Japan). For each dog, multiple biopsies of each fragments resulting from debulking. A residual surgical aspira- portion of the grossly abnormal tissue were collected under tor (VORTECO AS 100; Alsa, Bologna, Italy) connected to direct vision with forceps inserted in the working channel of the endoscope was used to eliminate combustion fumes and the endoscope (67161 Z Biopsy Forceps, flexible, oval, diam- washing solution residue. eter 1.7 mm, length 34 cm and 60001 KL Biopsy Forceps, oval All dogs recovered immediately from anesthesia and were cupped jaws, diameter 1.7 mm, length 160 cm; Karl Storz) monitored for complications for 4 to 8 h after endoscopic deb- in dogs weighing , 10 kg and with coaxial external biopsy ulking. The dogs were then discharged with a prescription for a forceps (69133 Biopsy and Grasping Forceps with oval cups broad-spectrum antibiotic for 7 to 10 d and anti-inflammatory 3 mm, sheath diameter, working length 15 cm; Karl Storz) therapy with prednisolone (Dechra Pharmaceuticals), 1 mg/kg in dogs weighing . 10 kg. Biopsies were also performed in BW, PO, q24h, with the dose decreasing over the subsequent cases of nasopharyngeal extension, with forceps inserted in the 3 to 6 wk, based on the clinical response. This protocol was also working channel of the video bronchoscope in the retroversion used in dogs that underwent a second endoscopic debulking. position. The biopsied tissues were fixed in buffered forma- Surgical rhinotomy was performed as described (7). New lin (Formalin 10% with Acetate Buffer; Bio-Optica, Milan, tissue was removed by traction and curettage, and hemorrhage Italy) and sent to a reference laboratory to be analyzed by was controlled with pressure using surgical gauze. After nasal 1 Board-certified pathologist. passages were flushed, a tube was placed into the frontal sinus

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Figure 2. Clinical manifestations of canine nasal polyposis. There is evidence of polypoid tissue in the nostril (A), the zygomatic fistula (B), the periodontal space (C), and the medial canthus of the eye (D).

and secured to the skin and the periosteum. Subcutaneous tissue Skull radiography on 13 dogs showed alterations in 10 cases, and skin were closed in separate layers with single interrupted including turbinate lysis (6/13), increased radiopacity of sutures. 1 (4/13) or both (6/13) nasal cavities, and lysis of the nasal Follow-up data were obtained by telephone interview for at vomer bone (3/13). Three dogs had a normal radiographic least 24 mo. This was done monthly for the first 6 mo and every appearance. A CT scan was performed in 4 dogs. Total or par- 4 mo thereafter. Disease progress was assessed based on the pres- tial turbinate lysis was present in all dogs and nasal septum and ence or absence of clinical signs. For the latter, dogs were con- nasal bone lysis were present in 3. Two dogs had soft tissue with sidered to be without pathology if they were capable of inducing patchy contrast enhancement in 1 or both nasal cavities. Three nasal clinical signs. Clinical symptomatology similar to what was dogs had similar tissue in the choana. One dog had frontal sinus first observed at diagnosis was considered to be a possible relapse involvement (Figure 3). of the nasal polyposis. When possible, this was confirmed with Both anterograde rhinoscopy and nasopharyngeal endoscopy an endoscopic examination and a repeated biopsy. revealed grossly abnormal tissue with a smooth translucent surface, pink color, and elastic consistency. This tissue occupied all Results the meatuses bilaterally in 13 dogs, all the meatuses unilaterally Twenty-three dogs were included in the study, 11 mixed in 7 dogs, and was focally located in 3 dogs. In all subjects with breeds and 12 purebreds. Body weights ranged from 7 to focal lesions, polyposis was unilaterally located in the caudal 39 kg (median = 24.4 kg) and ages ranged from 3 to 12 y nasal portions of the middle meatus and the ethmoturbinates. (median = 9 y). Fourteen dogs were intact males, 5 were spayed In 9 dogs, the polyposis also resulted in complete occlusion of females, and 4 were intact females. The duration of clinical signs the nasopharynx, whereas in 4 dogs, unilateral polyposis derived ranged from 1 to 10 mo (median = 3 mo). from the choana only partially occluded the nasopharynx. The Clinical signs at presentation were sneezing (91.3%), nasal endoscopic appearance of the nasopharyngeal polyposis was discharge [82.6% (56.5% bilateral and 26.1% unilateral)], ster- identical to that of the nasal polyposis (Figure 4). tor (73.9%), and frontonasal deformation (17.4%). Two dogs Histological examination of specimens obtained under direct had clinical evidence of a fistula (1 in the zygomatic region and endoscopic vision identified nasal polyposis in all patients. 1 in the frontal sinus). Translucent tissue was present in the Mild epithelial dysplasia was determined in 3 patients and the nostril of 1 dog and at the end of the nasolacrimal duct in the type of inflammation in the lamina propria was predominantly medial canthus in the eye of 2 other dogs. In 1 dog, the same lymphoplasma cellular in 6 cases and neutrophilic in 4 cases; tissue was also present in the periodontal space of the right there was no inflammation in the remaining cases. maxillary PM2 (Figure 2). One dog had hypoalbuminemia and Of the 23 dogs in the study, 10 were treated medically 2 had neutrophil leukocytosis. None were diagnosed with an (Group 1). Six of these had follow-ups for 24 mo. Clinical signs infectious disease. Cytology of the mandibular lymph nodes of recurred at 6 mo in 4 dogs (Cases 12, 13, 17, and 18) and at the 13 dogs with mild or moderate lymphadenomegaly during 7 mo in 1 dog (Case 14). One dog (Case 22) had no recurrence their physical examination was negative for neoplastic cells in of clinical signs. In 4 dogs with recurrent signs, an endoscopic all cases and reactive in 6 patients. examination and at least 4 biopsies were performed with the

738 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY ARTICLE

A B

A B Figure 3. Transverse CT images (A — Case 1, B — Case 15) of the bone and soft tissue window. In all images, a mass involving the nasal cavity (A and B left) is clearly visible, characterized by patchy contrast enhancement (B) and destruction of turbinates and parts of the bony nasal septum (A and B). Partial lysis of the nasal bone is also present (B). The mass extends into the choanae and the rostral aspect of the nasopharynx (A).

Figure 4. Endoscopic appearance of canine nasal polyposis. Evidence of newly formed tissue with a smooth translucent surface, pink color, and elastic consistency.

Figure 5. Endoscopic debulking with a diode laser of the polypoid tissue of the nasal cavity (A and B) and the removed tissue (C).

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Table 1. Results of follow-up and outcomes of cases. Time to Follow-up relapse State at the end of the study (mo) (mo) (December 2018) Group 1 — Medical treatment Cases 2, 5, 6, 9 N/A N/A N/A 12 26 6 Symptomatic 13 25 6 Symptomatic 14 25 7 Symptomatic

ARTICLE 17 26 6 Symptomatic 18 32 6 Asymptomatic (laser at 6 mo) 22 28 24 Died from cardiac disease Group 2 — Endoscopic debulking Cases 1 96 24 Asymptomatic (laser at 24 mo) 3 36 24 Asymptomatic (laser at 24 mo) 4 24 24 Euthanized for acute necrotizing pancreatitis 7 26 12 Symptomatic 8 24 12 Died from acute renal failure 10 N/A N/A N/A 11 6 0 Euthanized at 6 mo 19 24 24 Died from trauma 20 33 33 Asymptomatic 21 48 8 Asymptomatic (laser at 8 mo) Group 3 — Rhinotomy Case 15 89 89 Died from chronic renal failure Group 4 — No treatment Cases 16 1 0 Euthanized for uncontrollable epistaxis 23 6 0 Died from chronic renal failure

N/A — data not available.

same technique described, with histological confirmation of Laser debulking was repeated in 3 dogs with recurrent the presence of polyposis in all dogs. Endoscopic findings were clinical signs (Case 21 at 8 mo and Cases 1 and 3 at 24 mo). similar to those of the initial examination in all 4 dogs. One Histopathology confirmed the recurrence of polyps in all dog (Case 18) had endoscopic debulking performed and was 3 dogs. These dogs were asymptomatic for 72 mo (Case 1), subsequently treated with aerosolized budesonide, with no 40 mo (Case 21), and 12 mo (Case 3). Two additional dogs recurrence of clinical signs at 24 mo. had recurrent clinical signs 12 mo after laser debulking. One The owners of 4 dogs declined the endoscopic debulking; dog (Case 7) was treated with steroids and had bilateral nasal these dogs continued to have fluctuating clinical signs through- discharge and stertor at the end of the study. The second dog out the study. Clinical signs were mild in 2 dogs and more (Case 8) subsequently died of acute kidney injury. One dog severe in 2 dogs. The 5 dogs that were treated medically were (Case 11) had poor control of clinical signs after laser debulking alive at 24 mo. One dog (Case 18) was asymptomatic. One dog and was euthanized 6 mo after initial treatment. (Case 22) died of cardiac disease. Rhinotomy was performed in 1 dog (Case 15). The procedure Endoscopic debulking was performed in 10 dogs (Group 2). took 70 min. The dog was periodically treated with steroids after Eight dogs had a complete follow-up. One dog had a follow-up surgery and had no clinical signs 89 mo after surgery. Two dogs at 6 mo. The procedure lasted 45 min on average (range: 24 to were not treated (Group 4). One dog (Case 16) was eutha- 71 min), depending on the area covered by the grossly abnormal nized 15 d after diagnosis for uncontrolled epistaxis. One dog tissue (Figure 5). None of the dogs experienced postoperative (Case 23) that had persistent clinical signs of nasal disease was complications. Clinical signs recurred at 12 mo (2 dogs; Cases 7 euthanized after 6 mo due to chronic kidney disease. Data on and 8) and 8 mo (1 dog; Case 21). Five dogs were free of clinical treatments, timing of follow-ups, and outcomes are summarized signs for at least 24 mo (Cases 1, 3, 4, 19, and 20). One dog in Table 1. with worsening clinical signs of nasal disease was euthanized after 6 mo. One dog with focal nasal lesions (Case 20) had Discussion no recurrence for 33 mo. Two other dogs (Cases 1 and 3) had This retrospective multicenter study identified 23 cases of nasal recurrence of clinical signs at 24 mo. Two dogs (Cases 4 and 19) polyposis over an 8-year interval. There were many clinical and remained asymptomatic for 24 mo. diagnostic similarities between this cohort of dogs and dogs

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with nasal neoplasia. However, dogs with nasal polyps were the histological features of polyps that coexist with malignant often younger than those with neoplasia; the median age of our neoplasms with those of idiopathic nasal polyps. patients was 9 y, with 52.2% of dogs , 8 y and 30.4% , 5 y. This is the first study of endoscopic debulking using a laser By contrast, dogs with nasal neoplasms are typically older, with and forceps in combination with appropriate follow-up care an average age of 9 to 11 y in studies conducted over the past in dogs with nasal polyposis. Given the retrospective nature of 15 y (8–12). Based on our data, it is necessary to consider a this study, it was not possible to conduct an adequate statisti- nasal polyposis diagnosis, especially in young dogs with nasal cal analysis of the data. However, 7 of the 10 dogs in Group 2, ARTICLE clinical signs. which were treated with laser debulking and medical therapies, Clinical signs of nasal polyposis are often severe and similar had an average recurrence time of 16.8 mo, and in 5 of these to those of nasal neoplasia. In our study, deformation of the cases, the dogs were without clinical signs for at least 24 mo. We frontonasal profile was present in 17.4% of cases, despite never therefore believe that endoscopic treatment is more appropriate having been reported in the literature on polyposis (1). Epistaxis, than medical therapy alone. Further prospective studies with which is typical of nasal neoplasms (8,10), was not reported at more uniform inclusion criteria are required to confirm this first presentation in any of our cases. hypothesis. Even when it is benign, nasal polyposis is aggres- Another interesting clinical observation was the presence sive in nature. For this reason, surgical therapy is necessary in of polypoid tissue external to the nose, which is not a feature patients with aggressive forms of the disease. This approach of malignant neoplasia. We detected grossly abnormal tissue is also practiced in human medicine in patients with chronic in the medial canthus of the eye (2 cases), in the periodontal rhinosinusitis with polyps, whereby the guidelines recommend space (1 case), and protruding from the nostril (1 case). To the the use of surgery in cases that are relapsing and not responsive best of the authors’ knowledge, this observation has not been to medical treatment (15–17). There is insufficient knowledge reported in a malignant neoplasm. We speculate that after to warrant adopting the same physiopathological, diagnostic, occupying the nasal cavity, polypoid tissue can also occupy histological, and therapeutic considerations in dogs that we do very small free spaces, such as the nasolacrimal canal or the in humans, especially because in humans, the diagnosis is typi- periodontal space. This could be confirmed with a tomographic cally made at an early stage and the response to medical therapy examination to certify the integrity of the periodontal space or is more successful (15–17). the nasolacrimal duct. Another possible explanation is that the Steroid therapy alone was not effective in treating polyposis epithelial tissue of the nasolacrimal duct can be affected in a in dogs. We hypothesize that this ineffectiveness is related to the manner similar to that of the nasal epithelium. extent of the newly formed tissue, which in many dogs, occupied The association of polypoid tissue with fistulae in the zygo- much of the nasal cavity. We speculate that steroid therapy could matic region is another interesting finding. This suggests that be useful in the maintenance phase, after endoscopic treatment, similar to what happens in the course of a malignant neoplasm, in order to delay recurrence. In fact, in our study, 3 dogs in the disease can cause substantial bone erosion, allowing the Group 2 (Cases 1, 20, and 21) that received non-standardized polypoid tissue to extend beyond the nasal cavity through bone. oral and local steroid therapies experienced recurrence after Diagnostic imaging in our study showed the same alterations very long intervals. We cannot rule out that in cases of localized previously described in both polyposis (1) and malignant neo- polyposis at an early stage, steroid therapy may also be effective plasms (9,13). In all cases, endoscopy also revealed the distinct in the long term, which is what we believe happened in Case 22. characteristics of grossly abnormal tissue with a smooth translu- However, we cannot exclude that the small polypoid tissue cent surface, which were pink and had an elastic consistency. In would have regressed even without steroid therapy. Further our opinion, this is an important finding, since these character- studies with a greater number of dogs are needed to define when istics were present in all our cases. The macroscopic appearance and how steroids should be used. of malignant neoplasms can vary substantially. Two dogs in our series (Cases 16 and 11) were euthanized, Although concurrent neoplasia was not reported in any of the 1 due to severe epistaxis and 1 due to a decline in its overall cases in the present study, even on the second biopsy, the authors condition and worsening of nasal signs. Performing a second have observed other cases in which this occurred. In agreement treatment may have led to better results and possibly identi- with Tarrant et al (14), we believe that this concurrence in dogs fied concomitant pathologies. We were not aware of a possible with a caudal nasal neoplasm is not uncommon, especially if clotting disorder in the dog with severe epistaxis (Case 16). In it is epithelial in nature. In the study by Tarrant et al (14), in addition, both dogs may have had a malignant nasal neoplasm 35% of cases in which histological examination of the tissue that was not identified through rhinoscopy. A complete inspec- was repeated, a second biopsy revealed a malignancy. However, tion of the nasal cavities is fundamental, especially when there most of our patients had at least 1 follow-up at 24 mo, yet we are polypoid lesions in the most rostral portions of the nose. did not observe a malignancy. We also believe that in the case of unclear histological results, Tarrant et al (14) hypothesized that the tumor, due to the biopsies should be repeated and a complete exploration of the obstruction of the lymphatic drainage, could lead to regional nasal cavities should be performed. edema and expansion of turbinates until polyps are formed. The main limitation of this study lies in its retrospective In the cases of polyposis that we have described, we cannot nature, as the records did not provide reliable data on progno- make equally valid pathophysiological hypotheses. To better sis and response to therapy for the cases described. This pre- understand this pathology, it would be interesting to compare vented us from comparing the same diagnostic and therapeutic

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strategies among all patients. In addition, the endoscopic 7. Harvey CE. Surgery of the nasal cavity and sinus. In: Bojrab MJ, debulking was performed by 2 operators, which may have Waldron DR, Toombs JP, eds. Current Techniques in Small Animal Surgery. 2nd ed. Philadelphia, Pennsylvania: Lea & Febiger, 1983: influenced the results obtained. 253–257. In conclusion, although canine nasal polyposis may have 8. Avner A, Dobson JM, Sales JI, Herrtage ME. Retrospective review of clinical signs similar to those of nasal neoplasia, it has unique 50 canine nasal tumours evaluated by low-field magnetic resonance imaging. J Small Anim Pract 2008;49:233–239. clinical characteristics, such as the presence of newly formed 9. Malinowsky C. Canine and feline nasal neoplasia. Clin Tech Small Anim tissue in the periodontal space or the medial canthus of the eye. Pract 2006;21:89–94. Nasal polyposis also has a characteristic endoscopic appearance. 10. Mason SL, Maddox TW, Lillis SM, Blackwood L. Late presentation of canine nasal tumours in a UK referral hospital and treatment outcomes. Endoscopic debulking for the treatment of canine nasal polypo- J Small Anim Pract 2013;54:347–353.

ARTICLE sis represents a possible therapeutic option. CVJ 11. Plickert HD, Tichy A, Hirt RA. Characteristics of canine nasal discharge related to intranasal diseases: A retrospective study of 105 cases. J Small References Anim Pract 2014;55:145–152. 12. Cohn LA. Canine nasal disease: An update. Vet Clin North Am Small 1. Holt DE, Goldschmidt MH. Nasal polyps in dogs: Five cases (2005 to Anim Pract 2020;50:359–374. 2011). J Small Anim Pract 2011;52:660–663. 13. Hulse KE, Stevens WW, Tan BK, Schleimer RP. Pathogenesis of nasal 2. Sumner JA, Witham AI, Stent AW, Wightman PF, Mansfield CS. polyposis. Clin Exp Allergy 2015;45:328–346. Emergence of nasal chondrosarcoma in a dog with nasal polyposis. Clin 14. Tarrant JC, Holt DE, Durham AC. Co-occurrence of nasal polyps and Case Rep 2018;6:821–826. neoplasms of the canine nasal cavity. Vet Pathol 2019;56:885–888. 3. Lobetti RG. A retrospective study of chronic nasal disease in 75 dogs. 15. Piromchai P, Kasemsiri P, Laohasiriwong S, Thanaviratananich S. J S Afr Vet Assoc 2009;80:224–228. Chronic rhinosinusitis and emerging treatment options. Int J Gen Med 4. Bachert C, Zhang L, Gevaert P. Current and future treatment options 2013;6:453–464. for adult chronic rhinosinusitis: Focus on nasal polyposis. J Allergy Clin 16. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice Immunol 2015;136:1431–1440. guideline (update): Adult sinusitis. Otolaryngol Head Neck Surg 5. Dietz de Loos DA, Hopkins C, Fokkens WJ. Symptoms in chronic 2015;152:S1–S39. rhinosinusitis with and without nasal polyps. Laryngoscope 2013;123: 17. Rudmik L, Soler ZM. Medical therapies for adult chronic sinusitis: 57–63. A systematic review. JAMA 2015;314:926–939. 6. Fletcher DJ, Snyder JM, Messinger JS, Chiu AG, Vite CH. Ventricular pneumocephalus and septic meningoencephalitis secondary to dorsal rhinotomy and nasal polypectomy in a dog. 2006;229:240–245.

742 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY Article

Sabulous cystitis in the horse: 13 cases (2013–2020)

Luiza S. Zakia, Diego E. Gomez, Daniel G. Kenney, Luis G. Arroyo

Abstract — The objective of this study was to describe the clinical findings, medical management, and outcomes of horses with sabulous cystitis, and to describe a high flow bladder lavage procedure in horses that are standing or under general anesthesia. The medical records of 13 horses diagnosed with sabulous cystitis via cystoscopy between 2013 and 2020 were reviewed. Geldings (92%) and Warmbloods (46%) were overrepresented. The most common presenting complaint was urinary incontinence (69%). Complete blood cell count, serum biochemistry profile and urine cytology results were non-specific. Six (46%) horses had various degrees of erosion, ulceration, and hemorrhage of the bladder mucosa. All horses were treated with bladder lavage either with standing sedation (n = 12) or general anesthesia (n = 2), as well as antimicrobials (54%), anti-inflammatory drugs (62%), bethanechol (15%), and phenazopyridine (15%). Most horses (85%) were discharged from the hospital, but only a small percentage (23%) was reported as having no urinary abnormalities on follow-up communication. Key clinical message: Copious bladder lavage with a high flow rate system could mitigate the acute clinical signs and improve the quality of life of horses with sabulous cystitis, but the prognosis for return to previous level of athletic performance and long-term survival is guarded.

Résumé — Cystite sableuse chez le cheval : 13 cas (2013-2020). L’objectif de cette étude était de décrire les résultats cliniques, la prise en charge médicale et les résultats des chevaux atteints de cystite sableuse, et de décrire une procédure de lavage de la vessie à haut débit chez les chevaux debout ou sous anesthésie générale. Les dossiers médicaux de 13 chevaux diagnostiqués avec une cystite sableuse par cystoscopie entre 2013 et 2020 ont été revus. Les hongres (92 %) et les Warmbloods (46 %) étaient surreprésentés. La plainte la plus fréquente était l’incontinence urinaire (69 %). Un hémogramme complet, le profil biochimique sérique et les résultats de cytologie urinaire n’étaient pas spécifiques. Six chevaux (46 %) présentaient divers degrés d’érosion, d’ulcération et d’hémorragie de la muqueuse de la vessie. Tous les chevaux ont été traités par lavage de la vessie soit avec sédation debout (n = 12) ou anesthésie générale (n = 2), ainsi que des antimicrobiens (54 %), des anti-inflammatoires (62 %), du béthanéchol (15 %) et de la phénazopyridine (15 %). La plupart des chevaux (85 %) sont sortis de l’hôpital, mais seul un petit pourcentage (23 %) a été signalé comme n’ayant aucune anomalie urinaire lors de la communication de suivi. Message clinique clé : Un lavage vésical abondant avec un système à débit élevé pourrait atténuer les signes cliniques aigus et améliorer la qualité de vie des chevaux atteints de cystite sableuse, mais le pronostic du retour au niveau antérieur de performance athlétique et de survie à long terme est réservé. (Traduit par Dr Serge Messier) Can Vet J 2021;62:743–750

Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph Ontario N1G 2W1. Address all correspondence to Dr. Luis Arroyo; 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 of hospitalization, and outcome. Short-term outcome was defined as discharge from the hospital. Long-term outcome was abulous cystitis is an inflammation of the bladder second- established via telephone call. Follow-up time varied between ary to the ventral accumulation of urine sediment, mostly S 1 mo and 2 y after discharge. Owners were asked to report on calcium carbonate crystals (1). The mechanical irritation caused the degree of improvement of the urinary incontinency and/or by the sediment and the accretion of urea result in mucosal dysuria after bladder lavage(s) (none, some improvement, or inflammation and ulceration (1). Sabulous cystitis is usually complete resolution), whether the horse was alive, and the per- associated with bladder dysfunction, which could be caused by formance level compared to before urinary issues. If the horse lower motor neuron (LMN) or upper motor neuron (UMN) was not alive, the reason for death or euthanasia was recorded. disorders. In LMN disorder, pudendal nerve, detrusor muscle, ARTICLE Complete blood (cell) count (CBC), serum biochemistry profile, and external urethral sphincter dysfunctions result in a distended urinalysis, urine bacterial culture, and postmortem findings were and atonic (paralyzed) bladder with consequent dribbling of also recorded. A complete neurological and lameness exami- urine (1). Contrarily, increased urethral resistance despite a full nation was not performed in all cases. Results are presented bladder is present in UMN disorders (1). The mechanisms by descriptively, and numerical values are reported as medians which bladder dysfunction occurs due to neuronal damage are and ranges. well-understood; however, frequently no other neurological abnormalities are detected in horses presenting with sabulous Results cystitis (1–3). Therefore, the term idiopathic bladder paralysis Animals syndrome has been used in these cases (3). It has also been A medical records database search identified 10 299 equids speculated that horses with lumbar pain that do not posture to admitted to the OVC-HSC between May 2013 and March 2020. urinate normally and thus do not completely empty the bladder, Fifteen horses presented sabulous accumulation in the bladder, could also be at a higher risk of developing sabulous cystitis (3). 13 of which fulfilled the inclusion criteria. Two horses were Regardless of the inciting cause, urine accumulation in the excluded as sabulous accumulation was detected on postmor- bladder leads to crystal sedimentation, and ultimately to disten- tem examination but there was no premortem description of tion of the detrusor muscle, which also contributes to bladder urinary tract abnormalities. The cases included 12 geldings dysfunction (1). Treatment options are currently limited to and 1 mare. Six (46%) horses were Warmblood, 3 (23%) repeated bladder lavage, antibiotics, medications that promote Thoroughbred, 3 (23%) Quarter Horse, and 1 (8%) mixed bladder emptying, and anti-inflammatory therapy (1). Bladder breed. The breed distribution at the admitting hospital is pre- dysfunction is usually advanced when horses are presented for dominantly Thoroughbred and Standardbred. The median age evaluation of urine dribbling (3). The prognosis for horses was 12 y (range: 5 to 18 y) (Table 1). affected with sabulous cystitis is usually poor because of the persistence or recurrence of clinical signs (4–6). However, recent History and presenting complaint reports described successful long-term management of some The presenting complaint was urinary incontinence in cases (3,7). Despite the description of the successful long-term 69% (9/13) and dysuria in 31% (4/13) of the cases (Table 1). treatment of 5 cases (7), determining the cause and devising an One horse that was presented for urine dribbling also had para- effective treatment protocol for this disorder remains challeng- phimosis and priapism. The duration of the clinical signs was ing (1,3). The main objectives of this retrospective study were reported in 9 cases, with a median of 21 d (range: 5 to 365 d). to characterize the clinical findings, medical management, and Nine (69%) horses did not receive any treatments before outcomes of horses with sabulous cystitis; and to describe a high presentation, 2 (15%) received trimethoprim-sulfamethoxazole flow bladder lavage procedure to remove the sabulous sediment (TMS), 1 (8%) flunixin meglumine and TMS, and 1 (8%) a while horses are standing or under general anesthesia. dose of phenylbutazone (Table 1). The dosage and duration of Materials and methods treatment on-farm was not specified in the record. History of musculoskeletal, neurological, or additional urinary abnormali- Medical records of horses presented to the Ontario Veterinary ties was not reported in any of the cases. No previous diagnostic College — Health Sciences Centre (OVC-HSC) between 2013 tests were performed to determine the cause of the urinary and 2020 were reviewed. A sabulous cystitis case was defined as alterations before presentation to the hospital. The reproductive a horse presented for evaluation of urinary tract issues, such as history of the mare described in this case series is unknown. urinary incontinence, pollakiuria and stranguria, and diagnosed with abundant sabulous material in the bladder that was not Physical examination removable by emptying the bladder via cystoscopy. The exclu- Physical examination was performed on all 13 horses upon sion criteria were horses diagnosed with sabulous cystitis but admission to the hospital. Twelve horses had all vital parameters without any complaint related to the urinary tract (incidental within normal limits. One horse was considered to have mild finding of sabulous material in the bladder on postmortem dehydration based on the presence of tacky mucous membranes examination). Data recorded included signalment, presenting and a prolonged capillary refill time of 2 to 3 s, but the remain- complaint, duration of clinical signs, previous diagnostic tests ing parameters of the physical examination were within normal and treatments, physical examination, ultrasonography of the limits, including jugular fill and heart rate. Urine scalding of the urinary tract, cystoscopy, treatments, complications, duration distal hind limbs was present in 3 cases. Trans-rectal palpation

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Table 1. Signalment, diagnostic test results, treatments, and outcome of 13 horses diagnosed with sabulous cystitis admitted to the Ontario Veterinary College between 2013 and 2020. Duration of signs before Short-term Long-term Case Breed Age (y) admission Urine culture Cystoscopy Treatments outcome outcome 1 TB 14 # NG Sabulous and Bladder lavage (GA) E mucosal TMS inflammation Flunixin meglumine ARTICLE 2 TB 18 1 mo Enterococcus Sabulous and Bladder lavage DC Euthanized 1 y later, casseliflavus large stone TMS urinary issues Flunixin meglumine 3 WB 12 3 mo NP Sabulous Bladder lavage DC Lost to follow-up 4 Hanov 10 N/R NG Sabulous Bladder lavage DC Lost to follow-up Bethanechol 5 ISH 10 1 wk NG Sabulous Bladder lavage DC 2.5 y of complete resolution 6 CAN 6 5 d NP Sabulous and Bladder lavage DC 2 y partial resolution. mucosal TMS Died of pneumonia hemorrhage 7 TB 7 1 y NP Sabulous, mucosal Bladder lavage E inflammation, and Flunixin meglumine diverticulum 8 SF 10 # Finegoldia Sabulous and Bladder lavage (GA) DC 2 mo of improvement. magna mucosal TMS, enrofloxacin Dribbling persisted inflammation Flunixin meglumine Phenazopiridine Bethanechol 9 Ap-QH 14 3 wk NP Sabulous Bladder lavage DC Lost to follow-up TMS Flunixin meglumine 10 WB 17 N/R NP Sabulous and Bladder lavage DC Euthanized 3 wk later, mucosal TMS urinary issues inflammation Flunixin meglumine Phenazopiridine 11 AQH 12 1 y NG Sabulous Bladder lavage DC Euthanized 3 mo later, TMS urinary issues Flunixin meglumine 12 Paint 20 3 wk NP Sabulous Bladder lavage DC 6 mo of complete Flunixin meglumine resolution 13 MB 5 3 wk NP Sabulous and Bladder lavage DC 1 mo of complete mucosal resolution inflammation

TB — Thoroughbred; WB — Warmblood; Hanov — Hanoverian; ISH — Irish Sport Horse; CAN — Canadian; SF — Selle Français; Ap-QH — Appendix Quarter Horse; AQH — American Quarter Horse; MB — Mixed breed; NP — Not performed; NG — No growth; TMS — Trimethoprim-sulfamethoxazole; E — Euthanized; DC — Discharged from hospital; GA — General anesthesia; # — Records stated several months, exact number is not known; N/R — Not recorded. was performed in 10 horses. No abnormalities were reported range: 4 to 4.6 3 109/L; reference range (RR): 5.1 to in 3 cases, but markedly distended bladder was determined 11 3 109/L], lymphopenia (median: 0.96 3 109/L; range: in 5 cases; one of these had a subjectively thickened bladder 0.4 to 1.06 3 109/L; RR: 1.3 to 4.7 3 109/L), and hypergly- wall and another had a painful response to bladder palpation. cemia (median: 9.7 mmol/L; range: 7.1 to 10.8 mmol/L; RR: Pollakiuria and urinary incontinence was observed in all 9 horses 3.7 to 6.7 mmol/L) were observed in 2/8, 3/8 and 5/8 cases, hospitalized for more than 1 d. Abnormal urination by horses respectively. Eosinophilia (1.08 3 109/L; RR: 0 to 0.7 3 109/L) discharged the same day of presentation was not reported. was detected in 1 case. Serum biochemistry profile performed Neurological examination was performed on 2 horses, 1 horse for 9 horses showed no abnormalities except for mild increased had paresis and grade 2 ataxia of the hind limbs. The neurologi- serum amyloid A in 2 horses (210 and 271 mg/L; RR: 0 to cal examination of the second horse detected no abnormalities. 20 mg/L).

Clinico-pathological findings Urinalysis A CBC was performed in 8 cases; the results were within nor- Urinalysis results were available for 8 cases. All parameters were mal limits in 3 cases. Mild leukopenia [median: 4.3 3 109/L; within the normal reference ranges in 6 horses. One horse had

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reported. Accumulation of sediment in the ventral portion of the bladder was observed in all 13 horses (Figure 1A). Six horses had signs of advanced cystitis, characterized by various degrees of erosions and ulceration with hemorrhage and fibrin deposition covering parts of the ulcerated mucosa (Figure 1B). The degree of cystitis did not appear to be associated with the degree of urinary incontinence reported by the owner, nor with the Figure 1. A — Endoscopic view of the bladder of a horse with treatments performed at the farm. A large urolith was present in large amount of sediment accumulation (yellow slurry) in the 1 horse, and a pseudo-diverticulum (cavity) at the cranio-ventral

ARTICLE ventral aspect and mild mucosal erosion. B — Endoscopic view aspect of the bladder was observed in another. of the bladder of a horse with severe cystitis, characterized by mucosal ulceration and sabulous sediment adhered to ulcerated areas of the mucosa. Treatment Bladder lavage. Bladder lavage with isotonic saline solution isosthenuria (urine specific gravity: 1.009; RR: 1.008 to 1.014); using a pump (Masterflex L/S; model 77201-62, Cole-Parmer this horse was sedated with an alpha-2 agonist sedative before Canada Company, Montreal, Quebec), via sterile endoscope catheterization of the bladder. One horse had increased red (described for cystoscopy) and/or urinary catheter, was per- blood cells [10 to 15 per high-power field (hpf); RR: 0 to 5 per formed in all cases. The procedure was done under seda- hpf] in the urine. Crystalluria due to calcium carbonate was tion (same protocol as described for cystoscopy) in 11 horses present in all 8 cases; subjectively graded as severe in 5/8, mod- (Figure 2). Either standing sedation and general anesthesia or erate in 2/8, and mild in 1 case. No cytological abnormalities general anesthesia were performed in 2 horses (Figure 3). The such as the presence of bacteria or abnormal cells were detected median number of standing lavage procedures performed in each on any of the samples. horse was 2 (range: 1 to 6). For standing bladder lavage, a pump was connected to the endoscope channel with sterile tubing. Urine culture This allowed for a high fluid flow delivery and for subsequent Urine samples were submitted for bacterial culture from reversal of the direction of flow for fast urine and sabulous 6 horses, 5 of which yielded no growth on the first visit sediment removal from the bladder (Figure 2). The endoscope (Table 1). None of these horses were treated with antibiotics was removed in some cases with a large amount of sediment before the initial sample for culture was collected. Enterococcus accumulation, and a urinary catheter (length: 140 cm, diameter: casseliflavus [. 105 colony-forming units (cfu)/mL] was iso- 8 mm) was placed to provide a larger lumen, to allow for a faster lated in 1 case; the isolate was resistant to amikacin, ceftiofur, flush and removal of larger sediment particles, and to prevent gentamicin, kanamycin, rifampin, and TMS, but susceptible damaging the channel of the endoscope. The endoscope was to ampicillin, chloramphenicol, penicillin, and tetracycline. replaced at the end of flushing to verify if the sediment had been Finegoldia magna was isolated from a sample collected during a completely removed and to assess the condition of the mucosa relapse episode in 1 horse; the quantitative growth information of the bladder (i.e., inflammation, ulceration). Trans-rectal was not available, and the minimum inhibitory concentration manipulation of the bladder to enhance dislodgement of the showed resistance to amikacin, gentamicin, rifampin, ceftiofur, sediment was also performed in 2 cases. and erythromycin, but susceptibility to doxycycline, tetracycline, In 2 cases, this procedure was performed under general enrofloxacin, chloramphenicol and imipenem. The method of anesthesia (gas inhalation). One horse was presented with con- collection of the urine sample was not recorded. comitant paraphimosis and severe pain in the penis and prepuce. The second horse underwent 2 standing bladder lavages without Ultrasonography successful removal of all the sediment. This was a large (800-kg) Trans-abdominal ultrasonographic examination (Sonosite edge horse with a severely distended bladder for which trans-rectal II ultrasound system V20680, Bothell, Washington, USA) of the manipulation could not be performed while standing. Due to kidneys and trans-rectal imaging of the bladder were performed the markedly enlarged bladder and large amount of sediment, in 7 cases. No abnormalities were noted in 4 cases, although a an alternative approach was undertaken. For this procedure, the distended bladder containing fluid with increased hyperecho- horse was positioned in dorsal recumbency with a slight caudal genicity was observed in 3 cases. inclination of the surgical table while under general anesthesia. While in this position, the sediment could be dislodged by Cystoscopy gentle manipulation trans-rectally and gravity flow towards All horses were initially sedated with detomidine (Dormosedan; the neck of the bladder (Figure 3). In severe cases, up to 7 kg Zoetis, Kirkland, Quebec), 0.01 mg/kg body weight (BW), IV, of sediment were retrieved from the bladder (Figure 4). This and butorphanol (Torbugesic; Zoetis), 0.01 mg/kg BW, IV; a procedure was successful in achieving complete removal of the similar dose of butorphanol was repeated as needed. Cystoscopy sabulous sediment. The same pump and endoscope were used was performed in all cases using a sterile endoscope 2.5 m in for both types of lavage. A total of 2.5 to 3 L of lavage fluid length and 10 mm in diameter (Olympus EXERA CLV-160 were infused at a speed of 700 mL/min, then the bladder was SIF-Q140 endoscope; Richmond Hill, Ontario) (Table 1). The emptied, and the procedure was repeated until complete removal bladder was distended with air in all cases with no complications of the sediment was achieved. The total volume of fluid used per

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Figure 2. Illustration of a high volume and flow rate bladder lavage procedure in a sedated horse in a standing position. A pump is connected to the endoscope channel, allowing for a fast flow of lavage solution generating efficient sediment dislodgment with subsequent reversal of the flow direction for fast suctioning and sediment removal. lavage varied between 5 and 20 L. The lavage performed under phenazopyridine and at least 4 wk for bethanechol. One horse general anesthesia lasted 45 to 60 min, whereas the median time that was medicated with phenazopyridine was reported to have for the standing lavages was 2 h (range: 1 to 3 h). The lavage orange discoloration of the urine. Flunixin and phenazopyridine was repeated daily until complete removal of the sediment was were administered to horses with dysuria or marked cystitis achieved. No complications occurred during cystoscopy or blad- observed during cystoscopy. der lavage procedures. Outcome and follow-up. Eleven horses (85%) were dis- Antimicrobials. Antibiotic therapy was administered to charged from the hospital and 2 (15%) were euthanized due to 7 horses, including TMS (Apo-Sulfatrim-DS, Apotex, Toronto, poor prognosis for complete resolution of the urine dribbling Ontario) alone, 30 mg/kg BW, PO, q12h in 6 horses. The (Table 1). A follow-up telephone call was conducted between 7th horse was initially treated with TMS without improvement 1 mo to 2 y after hospital discharge. Of the 11 horses that of urine incontinency and subsequently received enrofloxacin were discharged from the hospital, follow-up was available (Chiron Pharmacy, Guelph, Ontario), 7.5 mg/kg BW, PO, in 8 cases. Three owners reported complete resolution of the q24h. This horse had a negative urine bacterial culture at the urinary abnormalities (1 mo, 6 mo, and 2.5 y after the hospital onset but subsequently had a culture positive for a multi- visit). Three horses were euthanized (22 d, 3 mo, and 1 y after resistant strain of Finegoldia magna. Enrofloxacin was the only the hospital visit) due to ongoing urinary issues, and 2 horses antibiotic to which this organism was susceptible in vitro. The improved but still had urinary incontinence (2 mo and 1.5 y median length of antimicrobial treatment was 3 d (range: 1 to after hospital visit). The 3 horses that had complete resolution 21 d). The reasons for administering antimicrobials and the of clinical signs returned to their previous level of performance. length of treatment were unavailable. Two horses improved but were performing at a lower level, which Other treatments. Anti-inflammatory and analgesic ther- was attributed by the owner to the primary bladder disorder. apy with flunixin meglumine (Zoetis), 1.1 mg/kg BW, IV or PO, q24h or q12h, was provided to 8 horses, whereas Postmortem examination 2 horses received phenazopyridine (Galenova, Saint-Hyacinthe, Cystitis was confirmed in all 3 horses submitted for postmor- Quebec), 4 mg/kg BW, PO, q8h. Two horses were treated with tem examination. One horse was diagnosed with suppurative bethanechol (Paladin Labs, Saint-Laurent, Quebec), 0.04 mg/kg and erosive cystitis, whereas a generalized, multifocal necrotiz- BW, PO, q8h. The median duration was 3.5 d (range: 3 to 6 d) ing, neutrophilic cystitis was reported in another horse. The for flunixin meglumine therapy, 9.5 d (range: 5 to 14 d) for third horse had severe, chronic-active, necro-ulcerative cystitis

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Figure 3. Illustration of a high volume and flow rate bladder lavage procedure in a horse under general anesthesia in dorsal recumbency. A pump is connected to the endoscope channel, allowing for a high flow of lavage solution generating efficient sediment dislodgment with subsequent reversal of the flow direction for fast suctioning and sediment removal.

with intralesional mixed populations of bacteria, and fibrous with sabulous cystitis. The disagreement between different case adhesions to the body wall, jejunum, and colon with secondary series may be due to differences in the inciting cause, disease moderate, local chronic-active peritonitis. Histological exami- severity, case selection, or lack of standardized medical manage- nation of sacral spinal cord and spinal nerves was conducted ment guidelines. In addition, differences in breed distribution in only 1 case, and no lesions compatible with cauda equina with associated differences in discipline may be a distinguishing syndrome were observed. A cause for bladder dysfunction could factor when comparing case series as certain disciplines and not be determined in any of these horses. No musculoskeletal competitive events may have lower tolerances for horses with abnormalities were reported. urinary incontinence. The term sabulous urolithiasis has been historically used to Discussion describe what is now known as sabulous cystitis (3–5). Since This case series described the history, clinical signs, clinico- there is no urolith formation, a change of the nomenclature to pathological data, ancillary diagnostics procedures, medical sabulous cystitis has been proposed (7). The natural process of management, and short- and long-term outcome of 13 horses crystal formation and precipitation that ultimately leads to sedi- diagnosed with sabulous cystitis. Although 85% of the horses ment accumulation in some horses is unknown. The tendency were discharged from the hospital, and some horses were lost of particles in suspension to settle is governed by forces such as to long-term follow-up, only 23% (n = 3) were reported by the gravity, acceleration, or electromagnetism (8). The process of owners to have completely recovered from the initial complaint. slurry formation with settling of particles at the bottom of the This suggests the prognosis for complete resolution of sabulous viscus can be explained by Stoke’s Law (8), and it is likely that cystitis, and subsequent return to previous competition and one or more forces of sedimentation act in the horse’s bladder. exercise level is poor, as owners might not be willing to show The settling of particles removed from a horse’s bladder can be or ride a horse with urinary incontinence. The poor progno- demonstrated by allowing the fluid collected from the bladder of sis described in this case series is in agreement with previous an affected horse to settle in a glass flask (Figure 4). As observed publications (4–6); however, is contrary to a recent report (7) in a glass flask, the sediment becomes highly compacted, thick documenting successful long-term management (3 y) of 5 horses and heavy, as seen at the bottom of the bladder (Figure 1A).

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In agreement with previous reports (4,5,7), geldings were overrepresented in this case series, accounting for 92% of the cases. The reason for males to be preferentially affected remains to be determined. A longer urethra compared to females could cause greater difficulty in expelling the crystals leading to accumulation; however, this does not explain why geldings

are more affected than stallions. Additionally, considering ARTICLE 22 previously described cases (4–7), Thoroughbreds (n = 11) accounted for half of the cases, followed by Warmbloods (n = 4). Figure 4. Sedimentation of the sabulous material removed In this study, there were 6 Warmbloods (46%) followed by from a horse’s bladder. A — The glass jar on the left shows the sediment retrieved (7 kg). B — The image shows the 3 Thoroughbreds (23%), which is not biased by the hospital sedimentation that occurred after 7 days. C — After removal of population that is composed mostly of Thoroughbreds and the liquid (urine), the remaining material had a dense, gritty, Standardbred horses (60 to 70%). clay-like appearance. Enterococcus spp. was isolated in 1 case, and this organism has been associated with important nosocomial and community-associated diseases, including urinary tract infec- Different from other species, equine urine is physiologically rich tions in humans (12). Bacterial culture was negative in most of in calcium crystal (9,10), likely due to calcium-rich diets, the the 6 cases submitted in this study; whether these are indeed peculiar regulation of vitamin D, and calcium and phosphorus sterile cystitis or if there are other possible reasons for the lack homeostasis (11). Therefore, the presence of calcium carbonate of bacterial growth is unknown. For example, bacterial biofilm in 100% of the urine samples from horses in this study is an may occur in the bladder wall, in which case urine culture may expected finding. This type of crystal (calcite and/or vaterite) not be an adequate sample for microbiological investigation. The is also the most abundant constituent of sabulous deposits, potential for the presence of fastidious bacteria should also be although calcium oxalate and other compounds (calcium phos- considered. Special culture media and prolonged culture times phates, sulphate, and/or oxalates, and/or silica) can also be may be required for certain organisms (12). Bladder mucosal identified (10). Due to the abundance of crystal in the equine biopsies for bacterial culture and histopathological analysis may urine, the glands in the renal pelvis and proximal ureter secrete better characterize these cases. mucus to lubricate the urinary tract and minimize the adherence Antibiotics, specifically TMS, were used in 54% of these of these crystals to the epithelium (1). When there is bladder cases, which is the most recommended broad-spectrum antibi- dysfunction, urine accumulates enabling the formation of large otic for urinary tract infections, particularly for ascending infec- crystals, leading to the thick sediment accumulation (1) and the tions, since it is eliminated in its active form in the urine (1,13). cloudy appearance of horse’s urine, as observed in the horses Enrofloxacin was used in 1 animal that had a multi-drug described in this report. The mixture of mucus and urine crystals resistant strain of Finegoldia magna after relapse of the urinary forms the clay-like sediment seen in the bladder of these horses. incontinence. The enrofloxacin used was a compounded prod- Bladder dysfunction, as previously described, can be second- uct due to owner’s limited budget; however, it is important to ary to UMN or LMN disorder, with a non-infectious or infec- highlight that compounded drugs should be avoided when there tious etiology (2). A complete neurological examination was is a registered formulation available. Justification for the use performed in only 3 of the 13 cases, and only 1 case had mild of antibiotic is bacterial growth on culture, evidence of severe degree of ataxia and paresis of the hind limbs. This horse was inflammation of the bladder, and potential risk for iatrogenic euthanized 1 y after discharge from the hospital due to urinary infection associated with cystoscopy and/or catheterization. incontinence, but necropsy was not performed. It is presumed Life-long antimicrobial treatment upon the diagnosis of sabulous that no neurological deficits were detected in any of the other cystitis has been advocated (14); however, the reasons behind horses since such information was not recorded in the medical such a recommendation have not been clearly identified or jus- records; however, this remains an assumption. Regardless, our tified by microbiological investigations and could result in the observations are in agreement with previous reports that also emergence of antibiotic-resistant microorganisms. failed to find neurological abnormalities in horses with urinary The efficacy of bethanechol in these cases is unknown. This incontinence (2) or sabulous cystitis (1). If neurological deficits drug was used in only 2 cases, with reportedly clinical response are present in horses with sabulous cystitis, the abnormalities by the owners, judged by a decrease in the frequency and quan- might be subtle and unnoticed by the owners until the onset tity of urine dribbling. The rationale for its beneficial effect of urinary incontinence, which may be indicative of advanced in these cases is that, independently of the inciting cause, the disease (1). sediment accumulation affects the detrusor muscle by directly The horses in this study originated from different farms and impairing the bladder capacity to fully contract. Thus, a drug other animals from the same farms were never reported to be that enhances detrusor muscle contraction could contribute to affected. Sabulous cystitis usually affects only an individual emptying the bladder content and reducing the amount of accu- animal in the herd, suggesting that individual factors such as mulated sediment (1,15). The pharmacokinetic and pharmaco- genetic or acquired disorder (neurological dysfunction) may dynamic aspects of the oral administration of bethanechol in predispose animals to the development of this disorder. horses are unknown as well as its effect on muscarinic receptors

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of the bladder musculature. The use of bethanechol is empirical References and largely based on its documented effects on gastrointestinal . 1 Schott HC, Waldridge B, Bayly WM. Disorders of the urinary system. motility (16,17). In: Reed SM, Bayly WM, Sellon, DC, eds. Equine Internal Medicine, Phenazopyridine hydrochloride, a urinary tract analgesic, is St. Louis, Missouri: Elsevier, 2018:888–889. 2. Schott II HC, Carr EA, Patterson JS, Hines MT. Urinary Incontinence widely used in humans to treat the symptoms of urinary tract in 37 Horses. 50th Annual Conv Am Assoc Equine Pract, Denver, infections. Reported complications in humans, however, include Colorado, 2004;50:345–347. severe acute tubular necrosis, acute interstitial nephritis, met- 3. Schott HC. Urinary incontinence and sabulous urolithiasis: Chicken or egg? Equine Vet Educ 2006;20:23–25. hemoglobinemia, and hemolytic anemia (18). It has been used 4. Keen JA, Pirie RS. Urinary incontinence associated with sabulous in horses with urinary tract disorders (19,20), but its efficacy urolithiasis: A series of 4 cases. Equine Vet Educ 2010;18:11–16.

ARTICLE and safety need to be further investigated. The use and potential 5. Holt PE, Mair TS. Ten cases of bladder paralysis associated with sabulous urolithiasis in horses. Vet Rec 1990;127:108–110. benefit of this drug in sabulous cystitis cases is unknown and 6. Holt PE, Pearson H. Urolithiasis in the horse — A review of 13 cases. anecdotal at best. The pathogenesis of this disease in horses is Equine Vet J 1984;16:31–34. unlike any other disease in humans and other species; therefore, 7. Rendle DI, Durham AE, Hughes KJ, Lloyd D, Summerhays GES. Long-term management of sabulous cystitis in five horses. Vet Rec comparing treatments is challenging. Yet, hyaluronic acid, 2008;162:783–788. chondroitin sulfate, and dimethyl sulfoxide are used to treat 8. Sphere A. Motion of particles in a fluid. Chem Engineering, women with interstitial cystitis (21) and further investigation 2002;2:146–90. 9. Diaz-Espiñeira M, Escolar E, Bellanato J, Rodriguez M. Structure and of the effect of these chemicals in sabulous cystitis cases may composition of equine uroliths. J Equine Vet Sci 1995;15:27–34. be warranted. 10. Diaz-Espineira M, Escolar E, Bellanato J, Medina J. Crystalline As described in the literature (1), and in the authors’ percep- composition of equine urinary sabulous deposits. Scanning Microsc 1995;9:1071–1077. tion, bladder lavages and removal of the sediment appear to 11. Breidenbach A, Schlumbohm C, Harmeyer J. Peculiarities of vitamin D improve the clinical signs of urinary incontinence. This may and of the calcium and phosphate homeostatic system in horses. Vet also prevent further damage to the detrusor muscle and delay Res 1998;29:173–186. 12. Johnson AP. The pathogenicity of enterococci. J Antimicrob Chemother worsening of the condition. Complete removal of the sediment 1994;33:1083–1089. is time-consuming and challenging. As bladder lavage under 13. Wilson WD. Rational Selection of Antimicrobials for Use in Horses. general anesthesia proved to be effective in 2 severely affected AAEP Proc 2001;47:75–93. 14. Schott HC. Urinary tract infection and bladder displacement. In: horses, this approach may be considered for selected cases. Sprayberry KA, Robinson NE, eds. Robinson’s Current Therapy in One horse was presented periodically (every 2 mo) for bladder Equine Medicine. St. Louis, Missouri: Elsevier, 2015:448–450. lavages to reduce accumulation of sediment (1,2). In the authors’ 15. Booth TM, Howes DA, Edwards GB. Bethanechol-responsive bladder atony in a colt foal after cystorrhaphy for cystorrhexis. Vet Rec perception, frequent lavages decreased the amount of sediment 2000;147:306–308. accumulated in the bladder, but did not appear to provide long- 16. Marti M, Mevissen M, Althaus H, Steiner A. In vitro effects of term resolution of the condition. bethanechol on equine gastrointestinal contractility and functional characterization of involved muscarinic receptors subtypes. J Vet Pharmacol The main limitation of this study is its retrospective nature. Therap 2005;28:565–574. Complete information from every patient was not available. 17. Ringger N, Lester G, Neuwirth L, Merritt AM, Vetro T, Harrison J. Follow-up information reported by owners was acquired by Effect of bethanechol or erythromycin on gastric emptying in horses. Am J Vet Res 1996;57:1771–1775. telephone, and reliability of this information could not be 18. Singh M, Shailesh F, Tiwari U, Sharma SG, Malik B. Phenazopyridine verified. Additionally, the small study size constrained use of associated acute interstitial nephritis and review of literature. Ren Fail statistical analyses. 2014;36:804–807. 19. Smith FL, Magdesian KG, Michel AO, Vaughan B, Reilly CM. Equine In summary, although most horses with sabulous cystitis idiopathic hemorrhagic cystitis: Clinical features and comparison with were discharged from the hospital, the prognosis for returning bladder neoplasia. J Vet Intern Med 2018;32:1202–1209. to the previous level of athletic performance and long-term 20. Aleman M, Nieto JE, Higgins JK. Ulcerative cystitis associated with phenylbutazone administration in two horses. J Am Vet Med Assoc survival was guarded. We also propose that copious bladder 2011;239:499–503. lavage with a high flow rate system is indicated in severe cases, 21. Cervigni M, Sommariva M, Tenaglia R, et al. A randomized, open-label, either with the horse standing or while under general anesthesia multicenter study of the efficacy and safety of intravesical hyaluronic acid and chondroitin sulfate versus dimethyl sulfoxide in women and may improve the acute clinical signs of affected horses. with bladder pain syndrome/interstitial cystitis. Neurourol Urodyn However, it is still unknown if copious bladder lavage has an 2017;36:1178–1186. impact on the long-term resolution of the clinical signs or the return to previous athletic performance. CVJ

750 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY Case Report Rapport de cas

Presumed acquired dynamic pectus excavatum in a cat

Chee Kin Lim, Hock Gan Heng, Lynn F. Guptill

Abstract — An 11-year-old, spayed female American domestic shorthair cat was presented with open-mouth breathing and dyspnea due to respiratory tract disease. Radiographically, there was thickening of the retropharyngeal soft tissue and soft palate, focal pulmonary change, and severe pectus excavatum (PE), best seen on the left lateral view. Repeat thoracic radiographs 4 months later showed persistent PE, but only on the right lateral view; PE was absent on the left lateral view. The dynamic component of the observed PE was presumably acquired secondary to chronic upper respiratory disease and/or concurrent increased pliability of the thoracic wall from prolonged prednisolone treatment.

Résumé — Pectus excavatum dynamique acquis présumé chez un chat. Une chatte domestique américaine stérilisée de 11 ans a présenté une respiration à bouche ouverte et une dyspnée due à une maladie des voies respiratoires. Radiographiquement, il y avait un épaississement des tissus mous rétropharyngés et du palais mou, une modification pulmonaire focale et un pectus excavatum (PE) sévère, mieux visible sur la vue latérale gauche. Des radiographies thoraciques répétées 4 mois plus tard ont montré une PE persistante, mais uniquement sur la vue latérale droite; la PE était absent sur la vue latérale gauche. La composante dynamique de la PE observée était vraisemblablement acquise secondaire à une maladie chronique des voies respiratoires supérieures et/ou à une flexibilité accrue concomitante de la paroi thoracique à la suite d’un traitement prolongé à la prednisolone. (Traduit par Dr Serge Messier) Can Vet J 2021;62:751–754

ectus excavatum (PE) is an abnormal sternal conformation mucopurulent bilateral nasal discharge, and obesity. Laboratory P characterized by dorsal deviation of the sternebrae and findings included mild lymphopenia [700 cells/mL; refer- dorsoventral narrowing of the thoracic cavity (1,2). Most PE ence range (RR): 1500 to 7000 cells/mL], left shift (720 band reported in cats and dogs are congenital in origin (2–6), with a neutrophils/mL; RR: 0 to 300 cells/mL, with 12 000 mature possible familial cause suggested in Bengal kittens (6), and are a neutrophils/mL; RR: 3000 to 12 000 cells/mL), hyperglycemia common skeletal manifestation of heritable mucopolysaccharido- (glucose 21.5 mmol/L; RR: 4.2 to 7.4 mmol/L), markedly sis VI in Siamese cats (7). A single case of acquired PE has been increased serum alanine aminotransferase activity (561 IU/L; reported in a dog due to laryngeal obstruction (8). Acquired PE RR: 20 to 108 IU/L), mildly increased serum alkaline phos- with a dynamic or intermittent change in the position of the phatase activity (168 IU/L; RR: 23 to 107 IU/L) and increased sternebrae has not been reported in the veterinary literature. total bilirubin (10.3 mmol/L; RR: 1.7 to 6.8 mmol/L; all delta bilirubin). The cat had been diagnosed with lymphocytic chol- Case description angitis 16 mo earlier, and thoracic radiographs taken at that An 11-year-old, 4-kg spayed female domestic shorthair cat was time were within normal limits. Ongoing medications were presented to Purdue University Veterinary Teaching Hospital prednisolone (Lloyd, Shenandoah, Iowa, USA), 0.8 mg/kg with a 5-day history of progressive oculonasal discharge with body weight (BW), PO, q12h; decreased to q24h following sneezing and dypsnea. Open-mouth breathing was reported at the visit, ursodeoxycholic acid (Fagron, St. Paul, Minnesota, home on the day of presentation. Clinical examination find- USA), 7.5 mg/kg BW, PO, q12h, and cyclosporine (Elanco US, ings included intermittent cyanosis, open-mouth respiration, Greenfield, Indiana, USA), 8 mg/kg BW, PO, q24h, recently stertor, bilateral conjunctivitis, superficial corneal ulceration increased from 4 mg/kg BW, PO, q24h. with marked blepharospasm, and mucopurulent ocular dis- Ventrodorsal, left lateral, and right lateral thoracic radio- charge in the left eye, serous discharge from the right eye, graphs were taken using a digital radiography system (Canon

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA. Address all correspondence to Dr. Chee Kin Lim; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

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Figure 1. A — Left lateral, B — right lateral, and C — ventrodorsal radiographs of the thorax of an 11-year-old, spayed female American domestic shorthair cat at initial presentation. Severe pectus excavatum was present in left lateral view and mild pectus excavatum in right lateral view (solid white arrows). Marked thickening of retropharyngeal soft tissue (star) and the soft palate (asterisk) were noted. Focal soft tissue opacification was present in the right cranial lung lobe (open white arrow).

IP CXDI-80C; Tokyo, Japan; General Electric Advantx; after the diagnosis of acquired PE, the owners reported the Milwaukee, Wisconsin, USA; 55 kVp, 1.6 mAs). Marked dorsal cat’s activity level was reduced. Clinical examination findings deviation of the 2nd to 5th sternebrae was observed on the left included mild icterus, weakness, and weight loss. There was lateral view, with resultant ventrodorsal narrowing of the tho- ongoing intermittent recurrence of respiratory signs including racic cavity (Figure 1A). The frontosagittal index (FSI) was 4.1 upper respiratory congestion and sneezing with ocular and (normal 0.7 to 1.3; severe . 3.0) and vertebral index (VI) was nasal discharge that responded to treatment with addition of 5.5 (normal 12.6 to 18.8; severe , 6.0), indicating severe pec- topical cidofovir (Cidofovir; Heritage Pharmaceuticals, Edison, tus excavatum (PE) (3,9). There was mild caudal displacement New Jersey, USA), 1 drop of 0.5% ophthalmic solution in both of the cardiac silhouette by the dorsally deviated sternum. No eyes, q12h. Repeat thoracic radiographs using the same digital evidence of mediastinal shift was observed on the ventrodorsal radiography system and exposure settings showed persistent view. On the right lateral view, only mild dorsal deviation of marked PE on the right lateral view with FSI of 9.8 and VI of the 2nd to 5th sternebrae was noted (Figure 1B). Additional 2.7 (Figure 2B). However, on the left lateral view, the sternum findings were marked thickening of the retropharyngeal soft was within normal anatomic position and conformation with no tissue and soft palate (Figure 1A) with a small focal soft tissue evidence of PE (Figure 2A). The cardiac silhouette was slightly opacification in the right cranial lung lobe (Figure 1C). displaced caudally by the sternum, with a more upright orienta- The manifested oculonasal and the upper respiratory signs tion on the right lateral view compared to the left lateral view. were consistent with feline herpes virus (FHV) infection (10), The previously identified focal soft tissue opacification in the and this in conjunction with negative bacterial cultures of right cranial lung lobe was absent (Figure 2C), suggesting pos- corneal swabs, and the ongoing treatment with immunosup- sible resolved pneumonia or atelectasis. Based on the dynamic pressive medications, led to a presumptive diagnosis of FHV radiographic changes of the alignment and position of the infection. Based on the history, clinical signs, previous and sternum, a revised diagnosis of presumed acquired dynamic PE current radiological findings, a diagnosis of PE was made, was made. Treatment for the presumptive FHV infection was presumably acquired secondary to the partial obstruction or continued with systemic famciclovir, topical cidofovir, and oral inflammation of the upper respiratory tract from FHV infection. lysine treats (10 to 12 per day). Although the respiratory signs The focal soft tissue opacification in the right cranial lung lobe improved with medication, the cat became more icteric due to may have been due to focal infectious pneumonia or fibrosis or the progressive lymphocytic cholangitis with concurrent bili- atelectasis. ary obstruction secondary to duodenal adenoma. The cat also The cat was treated for presumed FHV infection [famciclovir suffered from recurrent bilateral severe stromal keratitis due to (Famciclovir; MacLeods Pharma USA, Princeton, New Jersey, presumed FHV infection. Six months later, the owner elected USA), 39 mg/kg body weight (BW), PO, q8h, tobramycin euthanasia of the cat. (AK-Tob; Akorn, Lake Forest, Illinois, USA) 0.3% 1 drop, left eye, q6h, buprenorphine (Buprenex; Reckitt Benckiser Discussion Pharmaceuticals, Parsippany, New Jersey, USA), 0.01 mg/kg Dynamic or intermittent sternal retraction has been observed BW, PO, q8h, as needed for pain] and ongoing lymphocytic radiographically in infants with respiratory distress (11). The cholangitis with progressive reduction in clinical signs at revisit current case is the first reported case of an unusual acquired appointments for the subsequent 3 mo. At a revisit 4 mo dynamic PE in a cat in a more cranial sternal location, diagnosed

752 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY CASE REPORT CASE

Figure 2. A — Left lateral, B — right lateral, and C — ventrodorsal radiographs of the thorax of the 11-year-old spayed female American domestic shorthair cat at 4 mo after initial radiographs. Severe pectus excavatum was noted in the right lateral view (solid white arrow) but absent in the left lateral view. Previous focal soft tissue opacification in the right cranial lung lobe was absent.

based on radiographic interpretation of intermittent marked the sternal rigidity was overwhelmed in addition to steroid- deviation of the sternum. induced thoracic muscular weakness, the sternum remained Several theories have been proposed regarding the pathomech- susceptible to deformation even with a minimal change in the anisms of congenital PE, including; i) overgrowth of costal intrathoracic pressure. cartilages; ii) short central diaphragm tendon; iii) thickened It is unknown if, or to what degree PE directly contributed substernal ligament; iv) increased intrauterine pressure; v) con- to recurrent clinical signs of weakness and exercise intolerance nective tissue disorders such as Marfan and Ehlers-Danlos syn- in this cat given the comorbidities. A detrimental effect on the drome; and vi) heritable familial defect (3,5,6,12–14). Acquired cardiac function in humans by PE is controversial but increas- PE is far less commonly reported and has been mostly speculated ingly demonstrated with dynamic computed tomography (CT) to be associated with upper airway obstruction in children and echocardiography (13). Dynamic right ventricular outflow and a dog, leading to abnormal intrathoracic pressure (8,15). stenosis has been reported in dogs (16,17). For the cat in this The dynamic component of PE observed in infants has been report, echocardiography was not pursued due to lack of evi- postulated to be secondary to increased negative intrathoracic dence of cardiac murmur or cardiomegaly on radiographs. It pressure (11). The PE observed in this cat was presumed to is also interesting to note that although lateralized leftward or be acquired due the presence of retropharyngeal and soft pal- rightward dorsal deviation of the sternum with malpositioning ate inflammation and marked upper respiratory signs related of the heart were observed in most reported PE cases in cats and to the presumed FHV infection. As in infants, the increased dogs (2,5,18), these were not observed in our case. This may respiratory effort exhibited by this cat may have led to more be due to the dynamic nature and the more cranial location of vigorous diaphragmatic contraction leading to increased negative the sternal deviation relative to the heart, thereby causing only intrathoracic pressure. When adequate negative intrathoracic slight caudal displacement of the heart. pressure is generated to overwhelm sternebrae rigidity, the Frontosagittal index and VI have been used to classify sternebrae will retract dorsally at their weakest points, causing the severity of PE into mild, moderate, or severe (3,9,19). PE. When the diaphragm is relaxed, the negative intrathoracic Frontosagittal index is the ratio of thoracic cavity width at the pressure is reduced and the sternebrae will return to normal level of the 10th thoracic vertebra to the distance between the anatomic position, hence the dynamic phenomenon of the most dorsal aspect of the sternal deformity and ventral verte- acquired PE. These concepts are similar to the Bell jar model of bral body at that level. Vertebral index is a ratio of the distance mechanics of respiration (11). In infants, dynamic PE has also between the most dorsal aspect of the sternal deformity and been partly attributed to incomplete mineralization of thoracic dorsal vertebral body at that level, to the height of the same ver- osseous structures, resulting in a more pliable anterior thoracic tebral body. Most reported cases of PE in cats and dogs involved wall (11). This pliability may exacerbate the inward deviation of the caudal portion of the sternum (1,6). Cranially located PE is the sternum whenever there is increased negative intrathoracic relatively uncommon, although it has been described in 2 Welsh pressure (11). In our case, it is highly possible that the cat had terrier littermates (20). The usefulness of using the FSI and VI weaker thoracic musculature with resultant more pliable ventral reference ranges for the more cranial location of the PE in this thoracic wall due to prolonged treatment with prednisolone. cat is uncertain. Moreover, the dynamic nature of the PE may Even though the respiratory disease findings were intermittent also underestimate the FSI and VI measured based on still radio- at the time of the follow-up radiographs, it is possible that once graphic images. Although these indices may be useful in caudal

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sternebrae PE, alternative measures or reference ranges may 7. Konde LJ, Thrall MA, Gasper P, et al. Radiographically visualized be needed to assess the cranial sternebrae PE in cats, given the skeletal changes associated with mucopolysaccharidosis VI in cats. Vet Radiol 1987;28:223–228. inherent more narrowed or funneled conformation of the thorax 8. Kurosawa TA, Ruth JD, Steurer J, Austin B, Heng HG. Imaging diag- towards the thoracic inlet. In 1 study, FSI and VI were reported nosis — Acquired pectus excavatum secondary to laryngeal paralysis in to poorly associate with clinical signs in a cat with PE (2). A a dog. Vet Radiol Ultrasound 2012;53:329–332. 9. Yoon HY, Mann FA, Jeong SW. Surgical correction of pectus excavatum larger sample population of cats is required to determine if cra- in two cats. J Vet Sci 2008;9:335–337. nially located PE may be predictive of acquired PE compared 10. Thiry E, Addie D, Belák S, et al. Feline herpesvirus infection: ABCD to congenital PE, or dynamic compared with more static PE. guidelines on prevention and management. J Feline Med Surg 2009;11: 547–555. Although the current case is the first report of dynamic PE 11. Markowitz RI. The radiographic recognition of sternal retraction in in a cat, the authors believe that this condition may possibly be infants. Clin Radiol 1982;33:307–311. underdiagnosed using radiography. Careful thoracic palpation 12. Goretsky MJ, Kelly RE Jr, Croitoru D, Nuss D. Chest wall anomalies:

RAPPORTCAS DE Pectus excavatum and pectus carinatum. Adolesc Med Clin 2004;15: of the sternum during auscultation (2), and fluoroscopic or 455–471. dynamic CT studies in cats presented with respiratory distress 13. Kelly RE Jr. Pectus excavatum: Historical background, clinical picture, may aid in detecting the dynamic component of PE, which may preoperative evaluation and criteria for operation. Semin Pediatr Surg 2008;17:181–193. otherwise be easily overlooked. CVJ 14. Koumbourlis AC. Pectus excavatum: Pathophysiology and clinical characteristics. Paediatr Respir Rev 2009;10:3–6. References 15. Fan L, Murphy S. Pectus excavatum from chronic upper airway obstruction. Am J Dis Child 1981;135:550–552. . 1 Komsta R, Osiński Z, Dębiak P, Twardowski P, Lisiak B. Prevalence 16. Fournier TE. Dynamic right ventricular outflow tract (infundibular) of pectus excavatum (PE), pectus carinatum (PC), tracheal hypo- stenosis and pectus excavatum in a dog. Can Vet J 2008;49:485–487. plasia, thoracic spine deformities and lateral heart displacement in 17. Gifford AT, Flanders JA. External splinting for treatment of pectus thoracic radiographs of screw-tailed brachycephalic dogs. PLoS One excavatum in a dog with right ventricular outflow obstruction. J Vet 2019;14:e0223642. Cardiol 2010;12:53–57. 2. Charlesworth TM, Schwarz T, Sturgess CP. Pectus excavatum: Computed 18. Hassan EA, Hassan MH, Torad FA. Correlation between clinical severity tomography and medium-term surgical outcome in a prospective cohort and type and degree of pectus excavatum in twelve brachycephalic dogs. of 10 kittens. J Feline Med Surg 2016;18:613–619. J Vet Med Sci 2018;80:766–771. 3. Fossum TW, Boudrieau RJ, Hobson HP. Pectus excavatum in eight 19. McAnulty JF, Harvey CE. Repair of pectus excavatum by percutaneous dogs and six cats: A report of 14 cases. J Am Anim Hosp Assoc 1989; suturing and temporary external coaptation in a kitten. J Am Vet Med 25:595–605. Assoc1989;194:1065–1067. 4. Grenn HH, Lindo DE. Case report. Pectus excavatum (funnel chest) 20. Ellison G, Halling KB. Atypical pectus excavatum in two Welsh terrier in a feline. Can Vet J 1968;9:279–282. littermates. J Small Anim Pract 2004;45:311–314. 5. Boudrieau RJ, Fossum TW, Harstfield SM. Pectus excavatum in dogs and cats. Comp Cont Educ Pract 1990;12:341–355. 6. Charlesworth TM, Sturgess CP. Increased incidence of thoracic wall deformities in related Bengal kittens. J Feline Med Surg 2012;14: 365–368.

Erratum Can Vet J 2021;62:503

In this case series, reliable sedation was induced with an initial dose of medetomidine of 0.015 mg/kg BW in many of the smaller horses but had to be increased to approximately 0.2 to 0.3 mg/kg BW.

The dose of 0.2 to 0.3 mg/kg BW is incorrect and should be changed to 0.02 to 0.03 mg/kg BW.

754 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY Case Report Rapport de cas

Computed tomographic diagnosis of necroulcerative reticulorumenitis with portal venous gas in a lamb

Alexandra G. Collins-Webb, Robert Bildfell, Lauren Newsom

Abstract — A 2-month-old, intact male Merino sheep was presented for acute inappetence and pyrexia. Contrast- enhanced abdominal computed tomography identified reticulorumenal intramural gas with suspected ruminal ulceration, arborizing portal venous gas, and mild peritoneal fluid. The lamb was treated medically for presumptive ulcerative reticulorumenitis and non-septic peritonitis. Over 10 days, the lamb initially showed mild improvement before clinical deterioration and was ultimately euthanized. Definitive diagnosis of necrotizing, ulcerative reticulorumenitis was made via necropsy with histopathology. An underlying cause was not determined. Key clinical message: Contrast-enhanced computed tomography was effective in identifying gastric emphysema and portal venous gas associated with reticuloruminal ulceration.

Résumé — Diagnostic par tomodensitométrie d’une réticulo-ruménite nécro-ulcérative avec gaz veineux porte chez un agneau. Un mouton mérinos mâle intact, âgé de 2 mois, a été présenté pour une inappétence aiguë et une pyrexie. La tomodensitométrie abdominale de contraste augmentée a identifié du gaz intramural réticulo- ruménal avec une ulcération ruminale suspectée, du gaz veineux porte arborescent et un léger liquide péritonéal. L’agneau a été traité médicalement pour une réticulo-ruménite ulcéreuse présumée et une péritonite non-septique. Sur une période de 10 jours, l’agneau a d’abord montré une légère amélioration avant une détérioration clinique et a finalement été euthanasié. Le diagnostic définitif de réticulo-ruménite ulcéreuse nécrosante a été posé suite à la nécropsie et l’histopathologie. Une cause sous-jacente n’a pas été déterminée. Message clinique clé : La tomodensitométrie assistée par contraste s’est avérée efficace pour identifier l’emphysème gastrique et le gaz veineux porte associés à l’ulcération réticulo-ruminale. (Traduit par Dr Serge Messier) Can Vet J 2021;62:755–759

he forestomach and abomasum in pre-weaned ruminants Abomasal disorders are relatively common and this may be T are susceptible to physiologic and mechanical dysfunction partially attributed to feeding practices and dietary manage- (esophageal groove reflux failure, obstruction, abomasal reflux) ment: disruption in nursing patterns, large amounts of milk at as well as infectious, caustic, toxic, and metabolic insults. infrequent feedings, poor milk hygiene, and milk replacers with Although gastrointestinal disease is common in small ruminant high concentrations of carbohydrate or protein have all been species, these patients are not commonly evaluated with cross- associated with abomasal bloat (1–3). Decreased gastrointestinal sectional imaging, even though these modalities can provide motility also promotes abomasal bacterial overgrowth and can valuable diagnostic and prognostic information. occur for a number of reasons (1). Numerous reports show an association between ulcerative, emphysematous, or necrotic abomasitis and the presence of Clostridium spp. and Sarcina-like Department of Clinical Sciences (Collins-Webb, Newsom), bacteria, either alone or in combination (4–10). Although less Department of Biomedical Sciences (Bildfell), Oregon State common, abomasal disease with concurrent reticular or ruminal University, 700 SW 30th Street, Corvallis, Oregon 97331, USA. changes, likely due to exuberant fermentation, occurs naturally Address all correspondence to Dr. Lauren Newsom; e-mail: in calves (6,11) and has been experimentally reproduced (11). [email protected] Ruminal acidosis is a similar set of pathologies affecting Use of this article is limited to a single copy for personal study. young ruminants, caused by either failure of closure of the Anyone interested in obtaining reprints should contact the esophageal groove (12,13) with subsequent ruminal fermenta- CVMA office ([email protected]) for additional tion of milk substrates, or by reflux of hydrochloric acid rich copies or permission to use this material elsewhere. abomasal fluids. Failure of esophageal groove closure may

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be secondary to either dietary management or physiologic tachypneic (96 breaths/min, RI: 12 to 24 breaths/min). Results mechanisms: tube or bucket feeding, cold or poor-quality milk of cardiopulmonary auscultation and mucous membrane evalu- replacer, systemic disease, pain, or stress (13). ation were otherwise normal. One rumen contraction was In many veterinary clinics, abdominal ultrasonography is used auscultated over a minute. Abdominal percussion, succession, to evaluate the ruminant gastrointestinal tract. At the authors’ ballottement, and evaluation of abdominal contour were not institution, most small ruminant abdominal diagnostic imaging recorded in the medical record. studies are performed using computed tomography (CT) as it Initial complete blood (cell) count (CBC) showed hemo- is priced competitively with radiography and ultrasonography. concentration (hematocrit 46.9%, RI: 27 to 45%) and neu- Computed tomography is the superior imaging choice in many trophilia (11 948 cells/mL, RI: 2000 to 9000 cells/mL), with cases as ultrasonography is limited by depth and reverberation upper limit of normal fibrinogen (5 g/L, RI: 1 to 5 g/L). artifact associated with the large amount of luminal gas typically Serum chemistry indicated elevated blood urea nitrogen RAPPORTCAS DE seen in the ruminant forestomach. Compared to other modali- (BUN 25.3 mmol/L, RI: 3.6 to 12.5 mmol/L), elevated cre- ties, CT provides a more comprehensive examination of both atinine (221 mmol/L, RI: 79.6 to 176.8 mmol/L), elevated abdominal and musculoskeletal anatomy, has improved contrast creatine kinase (CK 425 U/L, RI: 50 to 150 U/L), elevated resolution, and is unencumbered by summation of structures, gamma-glutamyl transferase (GGT 111 U/L, RI: 30 to 94 U/L), which allows 3-dimensional evaluation of organs and outweighs elevated sorbitol dehydrogenase (SDH 63.1 U/L, RI: 6 to the decrease in spatial resolution (14). The use of intravenous 27 U/L), elevated glucose (5.4 mmol/L, RI: 2.8 to 4.7 mmol/L), positive contrast media in abdominal CT demonstrates differen- elevated phosphorus (4.1 mmol/L, RI: 1.6 to 2.4 mmol/L), and tial perfusion between tissues. This improves margin conspicuity, low magnesium (0.78 mmol/L, RI: 0.91 to 1.15 mmol/L). The helps to differentiate between adjacent organs, detects small total protein (57 g/L, RI: 55 to 75 g/L) and albumin (34 g/L, volumes of non-enhancing peritoneal fluid which may not be RI: 25 to 39 g/L) were within normal limits. The following observable with other modalities, and defines the luminal aspect electrolytes were within the reference limits: sodium, potassium,

of gastrointestinal segments. Published descriptions of CT imag- chloride, calcium. The tCO2 (27 mmol/L, RI: 21 to 28 mmol/L) ing of the ruminant forestomach and abomasum are limited to a and ion gap of 19 mEq/L (no machine specific reference interval few reports of normal anatomy in goats (15,16) and calves (17). provided) were normal. Based on the combination of hemo- This is not surprising, as cross-sectional imaging is not widely concentration with elevated BUN and creatinine, the lamb available and is generally more expensive than both radiography was diagnosed with dehydration and prerenal azotemia, and and ultrasonography. This report describes the clinical presenta- intravenous fluid therapy was initiated. Although the reported tion, diagnostic imaging, treatment, and necropsy findings of a total protein and albumin were within normal reference values, lamb with necrotizing ulcerative reticulorumenitis. there was clinical concern that dehydration was masking an underlying hypoproteinemia. At this time, the primary differ- Case description ential diagnosis for anorexia and fever was abomasitis, possibly A 2-month-old, intact male Merino sheep was presented because complicated by gastrointestinal parasitism. Feces were submitted of a 2-day history of anorexia. Known medical history included for a McMaster test. Unfortunately, ruminal fluid analysis was an abnormal gait since birth and being rejected by the dam. not performed. No diagnostic tests for the ataxia were performed The lamb had been bottle-raised on 18 ounces of milk replacer as it became apparent that this symptom was a static, ongoing 4 times daily and creep fed hay; unfortunately, information on condition that was suspected to be unrelated to the presenting colostrum administration and types of milk replacer was not complaint of anorexia, lethargy, and pyrexia. known. Vaccination for tetanus and Clostridium perfringens The day after presentation, helical multi-slice computed types C and D was performed in the dam 4 wk before lamb- tomography (CT; Toshiba Aquilion 64 Multidetector Row ing and in the lamb at 6 wk of age. During the 2 wk before Computed Tomography; Cannon Medical Systems, Tustin, presentation, the lamb had 2 episodes of self-limiting diarrhea California, USA) of the abdomen was performed before and but continued to urinate normally. The remainder of the sheep after intravenous administration of nonionic, iodinated contrast housed on the property were reported by the owner as healthy. medium [Visipaque 320 mgI/mL; GE Healthcare, Marlborough The day before presentation, the lamb refused milk replacer Massachusetts, USA; 2 mL/kg body weight (BW)]. Image and was lethargic, with a rectal temperature of 40.2°C [reference acquisition parameters consisted of 0.5 mm slice thickness with interval (RI): 38.5 to 39.7°C]. At that time, the owner tube-fed a 0.5 mm reconstruction interval, pitch factor 0.8, tube rota- milk replacer (8 ounces) and administered a combination of tion time 0.75 s, 350 mA, 120 kV, and a 512 3 512 matrix. oxytetracycline, vitamin B complex, flunixin meglumine, and The images were reconstructed in 3 mm slices in the transverse, selenium injection (route unspecified). The following day, the sagittal, and dorsal planes using both soft tissue (kernel FC03) patient remained anorexic and was re-dosed with milk replacer, and bone (kernel FC30) algorithms. Venous sequences were vitamin B complex, and flunixin meglumine. On physical performed after a 65 s delay. Computed tomography images examination, the lamb was bright, alert, and ambulatory, with showed a moderate amount of branching gas within the right adequate body condition score (3/5) but was ataxic and hyper- dorsal intrahepatic portal vasculature; the liver was otherwise metric in the forelimbs with a wide-based stance; no cranial normal in attenuation with uniform parenchymal enhancement. nerve deficits were noted. The lamb remained febrile (40.9°C), Circumferentially and gravity independent, the luminal aspect tachycardic, [216 beats/min (bpm), RI: 70 to 90 bpm], and of the reticulum and rumen were lined by small (up to 1 cm),

756 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY CASE REPORT CASE

Figure 1. Transverse (A) and sagittal (B) post-intravenous contrast computed tomography images of the abdomen. Arborizing gas (black arrow) is within the portal vasculature, and small, gravity-independent gas blebs line the luminal aspect of the reticulum and rumen (white asterisks). Normal abomasal wall (white arrows) for reference.

well-defined, round and oval gas blebs (Figure 1), which was an unexpected finding. Multifocally, the forestomach wall was subjectively thick and decreased in attenuation with gas foci, some of which also silhouetted with the serosal margin of the ruminal folds but were not seen elsewhere in the peritoneal cavity. These findings were interpreted to represent ulceration and emphysema of the reticulorumenal wall. A mild amount of free peritoneal fluid was also present. The remainder of the gastrointestinal structures and the intra-abdominal lymph nodes were unremarkable. After identification via CT, a sample of peritoneal fluid (no quadrant specified) contained 92% neutrophils, 7% large mononuclear cells, and 1% reactive lymphocytes. The neutrophils were nondegenerate, and no microorganisms were identified. The results of the McMaster fecal test returned as gastrointestinal coccidia (750 oocyts/g). While this was classified as Figure 2. Ultrasound image of the liver 7 d after completion of CT images, demonstrating persistent portal vascular gas “unremarkable” by laboratory standards, it remained of clinical (white arrows) with associated reverberation artifact. concern in such a young patient and may have contributed to anorexia. At this time, supportive care for non-septic peritonitis and reticulorumenitis was initiated. Although this lamb was procaine (VetriPen G; Norbrook Laboratories, Newry, UK) previously vaccinated for Clostridium perfringens types C and D, due to cost concerns and feasibility of at-home administra- infection with types A, B, and E as well as Clostridium difficile tion. Following a lack of clinical response, ceftiofur sodium and Sarcina spp. remained possible (1). (Naxcel 1 g, Zoetis) was administered in combination with these Over the next 10 d, the lamb was treated with a combina- penicillin antibiotics. Two days before euthanasia, the lamb tion of Clostridium perfringens types C and D toxoid vac- became progressively neutropenic (744 cells/mL, RI: 2000 to cine (Colorado Serum Company, Denver, Colorado, USA), 9000 cells/mL), and these antibiotics were discontinued in favor antiparasitic medication, initially ponazuril (Marquis, 15% of ampicillin (Polyflex G.C.; Hanford Manufacturing, Syracuse, w/w ponazuril; Merial, Duluth, Georgia, USA), 20 mg/kg New York, USA), 22 mg/kg BW, SC, q12h, in a final attempt BW, PO, due to local resistance to traditional coccidiostats, to provide antibiotic coverage in the face of worsening disease. and subsequently single dose albendazole (Valbazen 11.36%; Other concurrent treatments included lidocaine constant rate Zoetis, Kalamazoo, Michigan, USA), 10 mg/kg BW, PO, infusion (CRI) (Lidocaine 2%; VetOne, Boise, Idaho, USA), for potential liver flukes, thiamine (Thiamine HCl injection 0.05 mg/kg BW per minute, IV, flunixin meglumine (Prevail; 500 mg/mL; Sparhawk Lab, Lenexa, Kansas, USA), 10 mg/kg VetOne), 0.5 to 1 mg/kg BW, IV, q24h, sucralfate (sucralfate BW, SC, q12h, and transfaunation. Antibiotic therapy changed tablets, PLIVA HRVATSKA, Zagreb, Croatia), 1-gram tablet, over the course of hospitalization from potassium G penicillin PO, q12h, and lactated Ringers solution (Vetivex Veterinary (Sandoz, Austria), 44 000 IU/kg BW, IV, q6h, to penicillin G Lactated Ringer’s Injection; Dechra, Overland Park, Kansas,

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USA), supplemented with calcium gluconate, vitamin B complex, and potassium chloride. At 7 d after presentation, focused ultrasonography showed persistent intrahepatic portal venous gas (Figure 2) and remained supportive of reticulorumenal emphysema. Despite initial improvement, the patient continued to have mild pyrexia, variable inappetence, developed the previously mentioned neutropenia (744 cells/mL, RI: 2000 to 9000 cells/mL), and lost 4 kg body weight over the duration of hospitalization. The lamb was ultimately euthanized 12 d after commencement of clinical signs. RAPPORTCAS DE At necropsy, the reticulum and cranioventral aspects of the rumen had extensive fibrous adhesions to the diaphragm and omentum. Grossly, approximately 40% of the reticulorumen mucosa was black and necrotic with underlying areas of ulceration and fibrinosuppurative exudate. Histopathologic Figure 3. Photomicrograph of the rumen wall (stained with full-thickness coagulation necrosis of the forestomach mucosa hematoxylin and eosin at 203 magnification) demonstrating emphysematous bullae (black asterisks) within the necrotic and emphysema of equally necrotic submucosa were identified submucosa and mucosa. Granulation tissue forms the base of (Figure 3). Both granulation tissue and mineral deposits were the lesion. Similar changes were present in the reticulum wall. present, the former indicating severe, chronic multifocal to confluent necroulcerative reticulorumenitis. An initiating cause was not identified. Additional histopathology findings included an intrahepatic trematode with associated focal to multifocal sub- had concurrent rumenitis or reticulitis (11). Emphysematous acute hepatic necrosis, and mild renal tubular dilation. No por- lymphangiectasia of the rumen (25,26) and reticulum of adult tal venous gas was identified. Consistent with the persistent gait cattle has also been reported (27). To the authors’ knowledge, abnormalities and likely unrelated to the presenting complaint, there is no imaging description of draining portal vascular gas cerebellar hypoplasia and cerebral multifocal porencephaly were in ruminant species. also diagnosed; this may have been idiopathic or attributable to Failure to collect a ruminal fluid sample before euthanasia is a in-utero infection, as in Border disease (Pestivirus D). The lamb major limitation in this case and precludes a definitive diagnosis. was negative for bluetongue virus after completion of a cellular As no underlying etiologic agent was identified, 2 mechanisms enzyme-linked immunosorbent assay (cELISA). are proposed: devitalization due to toxic or caustic insult versus the combination of dietary management, forestomach acidosis, Discussion and overgrowth of gas-producing bacteria, such as Clostridium Forestomach mural emphysema and intrahepatic portal vascular spp. Failure of the reticular groove reflex, if present in this case, gas, diagnosed via CT, were unexpected findings in a lamb that may have also contributed to ruminal acidosis. There was no was presented with anorexia, lethargy, and pyrexia. This combi- history of potentially caustic fluids being orally administered, nation of imaging features has not been reported in a ruminant although the widespread character of the damage suggests much species but similar intra-abdominal findings are described in of the forestomach mucosa encountered the insult. Therefore, companion animals as sequelae to conditions of variable severity, an underlying bacterial, metabolic, toxic, or caustic cause for ranging from incidental gastric pneumatosis to life-threatening initial forestomach mucosal injury is possible. In each scenario, emphysematous gastritis (18), gastric necrosis (19), pyogranu- disruption of the reticulorumen mucosa allows for dissection lomatous colitis (20), and necrotizing hemorrhagic enterotyph- of gas along tissue planes of the forestomach wall, which is locolitis (21). The gastrointestinal tract, and in these diseases ultimately drained by tributaries of the gastrosplenic vein (28). the associated mural gas, are drained by the portal vasculature. As the lamb had no previous abdominal surgery, no reported A combination of mechanisms including mucosal damage and trauma, and no imaging signs of gastrointestinal distension, increased wall permeability, gastrointestinal distension, and sep- many causes of portal vascular gas associated with positive sis may be contributing factors in these cases (22). Intrahepatic prognosis were considered unlikely. As no information about portal vascular gas was originally described in humans and asso- colostrum administration was provided, we can only speculate ciated with a high mortality rate but is increasingly recognized as about failure of passive transfer, which may have increased the a sequela of numerous pathologies (23). Similarly, with improve- risk of morbidity and mortality in this lamb. ments in imaging techniques, portal vascular gas is identified in At the authors’ institution, CT is frequently performed with companion animals, and in specific instances, is associated with and without intravenous positive contrast administration in relatively good outcomes: gastric emphysema (18), iatrogenic small ruminants with non-specific abdominal disease. The oral hydrogen peroxide administration (22,24), post-operative findings of forestomach emphysema and portal venous gas gastrointestinal or biliary tract surgery, and trauma (24). were unexpected, and to the authors’ knowledge, this is the first In ruminant species, gastric ulceration and emphysema has imaging description of ulcerative and emphysematous reticulo- been described in calves with abomasitis (6,11), a few of which rumenitis and portal venous gas in a ruminant.

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Acknowledgments 16. Braun U, Irmer M, Augsburger H, Muller U, Jud R, Ohlerth S. Computed tomography of the abdomen in Saanen goats: II. Liver, We are grateful to Kristen Fleming and Susanne Stieger-Vanegas spleen, abomasum, and intestine. Schweiz Arch Tierheilkd 2011; for ultrasound examination, Jason Wiest for technical support, 153:314–320. 17. Braun U, Schnetzler C, Ohlerth S, Hatz L, Augsburger H. Computed and Melissa Von Zup for case consultation. CVJ tomography of the abdomen of calves during the first 105 days of life: I. Reticulum, rumen, omasum, and abomasum. Schweizer Arch References Tierheilkd 2014;156:217–225. REPORT CASE . 1 Simpson KM, Callan RJ, Van Metre DC. Clostridial abomasitis and 18. Thierry F, Ferreira MF, Paterson GK, Liuti T, Del-Pozo J. Canine enteritis in ruminants. Vet Clin Food Anim 2018;34:155–184. and feline emphysematous gastritis may be differentiated from gastric 2. Peters HF, Heaney DP. Factors influencing the growth of lambs reared emphysema based on clinical and imaging characteristics: Five cases. artificially or with their dams. Can J Anim Sci 1974;54:9–18. Vet Radiol Ultrasound 2019;60:136–144. 3. Gorrill ADL, Brisson GJ, Emmons DB, et al. Artificial rearing of young 19. Fischetti AJ, Saunders HM, Drobatz KJ. Pneumatosis in canine gastric lambs. Ottawa: Agriculture Canada; 1990. Available from: https:// dilatation-volvulus syndrome. Vet Radiol Ultrasound 2004;45:205–209. archive.org/stream/artificialrearin00gorr/artificialrearin00gorr_djvu. 20. Cartwright JA, Berheny C, Major AC, Hill TL, Gow AG. Imaging diag- txt Last accessed May 10, 2021. nosis — A case of spontaneous hepatic portal vein gas in an 11-month 4. Vatn S, Tranulis MA, Hofshagen M. Sarcina-like bacteria, Clostridium old West Highland White Terrier. Vet Radiol Ultrasound 2016; fallax and Clostridium sordellii in lambs with abomasal bloat, haemor- 56:E54–57. rhage and ulcers. J Comp Path 1999;122:193–200. 21. Walczak R, Paek M, Suran J, Amory JT, Specci S, Sanchez M. Imaging 5. Edwards GT, Woodger NGA, Barlow AM, et al. Sarcina-like bacteria diagnosis — Radiography and ultrasonography of pneumatosis intesti- associated with bloat in young lambs and calves. Vet Rec 2008;163: nalis in a cat. Vet Radiol Ultrasound 2020;61:E26–E30. 391–393. 22. Faverzani S, Lodi M, Pagetti S. Imaging diagnosis — Portal venous gas 6. Van Kruiningen HJ, Nyaoke CA, Sidor IF, Fabis JJ, Hinckley LS, Lindell in a dog. Vet Radiol Ultrasound 2009;50:312–313. KA. Clostridial abomasal disease in Connecticut dairy calves. Can Vet 23. Iannitti DA, Gregg SC, Mayo-Smith MW, Tomolonis RJ, Cioffi WG, J 2009;50:857–860. Pricolo VE. Portal venous gas detected by computed tomography: Is 7. Melendez P, Poock S. Outbreak of clostridial abomasitis in dairy calves. surgery imperative? Dig Surg 2003;20:306–315. Vet Rec Case Rep 2018;6:e000573. 24. Manfredi S, Fabbi M, Bonazzi M, et al. Ultrasonographic differentiation 8. Songer JG, Miskimins DW. Clostridial abomasitis in calves: Case report between portal venous and parenchymal gas may be important for the and review of the literature. Anaerobe 2005;11:290–294. prognosis of canine and feline hepatic emphysema: 37 cases. Vet Radiol 9. [No authors listed]. Clostridial abomasitis causing deaths of calves in Ultrasound 2019;60:734–744. South-West Scotland. Vet Rec 2012;170:587–590. 25. Ohfuji S. Emphysematous eosinophilic lymphangitis in the ruminal 10. Ellis TM. Acute abomasitis due to Clostridium septicum infection in submucosa of cattle. Vet Pathol 2015;52:1163–1166. experimental sheep. Aust Vet J 1983;60:308–309. 26. Rocha JF, Daoualibi Y, De Lorenzo CD, et al. Emphysematous and 11. Panciera RJ, Boileau MJ, Step DL. Tympany, acidosis, and mural granulomatous submucosal rumenitis in a feedlot Nellore steer. Acta emphysema of the stomach in calves: Report of cases and experimental Sci Vet 2018;46:266. induction. J Vet Diagn Invest 2007;19:392–395. 27. Ohfuji S. Pathology of emphysematous reticulitis in cattle: Report of 12. Kaba T, Abera B, Kassa T. Esophageal groove dysfunction: A cause of two cases and comparative overview of similar or identical conditions. ruminal bloat in newborn calves. BMC Vet Res 2018;14:276. Comp Clin Pathol 2016;25:805–813. 13. Gentile A. Ruminal acidosis in milk-fed calves. Large Animal Veterinary 28. Dyce KM, Sack WO, Wensing CJG. Textbook of Veterinary Anatomy. Rounds 2004;4:9. St. Louis, Missouri: Saunders Elsevier, 2010:680–693. 14. Thrall DE. Textbook of Veterinary Diagnostic Radiology. 7th ed. St. Louis, Missouri: Elsevier, 2018:30. 15. Braun U, Irmer M, Augsburger H, Jud R, Ohlerth S. Computed tomography of the abdomen in Saanen goats: I. reticulum, rumen, and omasum. Schweizer Arch Tierheilkd 2011;153:307–313.

Erratum Can Vet J 2021;62:567

In the Council report published in the June 2021 issue of The CVJ, on page 567, it was stated that the Emerging Leaders Program (ELP) has secured a 3-year funding commitment from Royal Canin and the Atlantic Veterinary College; this is incorrect and should have read Royal Canin and VCA Canada. The Canadian Veterinary Journal apologizes for the error.

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CVJ / VOL 62 / JULY 2021 761 FOR PERSONAL USE ONLY Diagnostic Ophthalmology Ophtalmologie diagnostique

Danica R. Lucyshyn, Lynne S. Sandmeyer

History and clinical signs 13-year-old, 5.0 kg, castrated male domestic short hair cat A was referred to the ophthalmology service at the Western College of Veterinary Medicine (WCVM) for evaluation of chronic superficial corneal ulceration affecting the right eye that was nonresponsive to treatment. The cat had signs of ocular discomfort and a previous history of upper respiratory tract disease. At the time of presentation, the cat was being treated with 1% atropine sulfate ophthalmic solution q12h, 0.1% dexamethasone (Maxidex), ophthalmic suspension q12h, 0.3% ciprofloxacin (Ciloxan), q12h, and 0.1% idoxuridine ophthalmic solution q12h topically in the right eye, and with L-lysine (Enisyl-F), 250 mg, q12h, orally. Neuro-ophthalmic examination revealed normal menace responses and normal palpebral, oculocephalic, and direct and Figure 1. Photograph of the right eye of a 13-year-old castrated consensual pupillary light reflexes bilaterally. Schirmer tear male domestic shorthair cat following application of fluorescein. test 1 (Schirmer Tear Test Strips; Alcon Canada, Mississauga, Ontario) values were 10 mm/min in both eyes. Intraocular Chlamydia felis pressures estimated by rebound tonometry (Tonvet; Tiolat, pesvirus type 1 (FHV-1) and (1,2). Additional Helsinki, Finland) were 16 and 17 mmHg in the right and left differentials include feline eosinophilic keratoconjunctivitis eyes, respectively. Biomicroscopic (Kowa SL-15 Portable Slit (FEK), eyelid or tear film abnormalities, lipogranulomatous con- Mycoplasma Lamp; Kowa Co, Tokyo, Japan) examination of the right eye junctivitis, feline calicivirus (FCV), and potentially felis revealed mild conjunctival hyperemia, a notch defect in the (2,3). Of these, FHV-1 is the predominant cause of ulcer- third eyelid where previously biopsied, and diffusely roughened ative keratitis in cats (2–4). Other causes of ulceration include corneal epithelium with superficial ulceration. Biomicroscopic eyelid or tear film abnormalities and, less likely, trauma (5). examination was unremarkable in the left eye. Indirect oph- The dendritic ulceration, considered pathognomonic for thalmoscopic (Heine Omega 200; Heine Instruments Canada, FHV-1 infection (4,6), revealed the etiologic diagnosis of her- Kitchener, Ontario) examinations were completed bilaterally petic keratoconjunctivitis in this cat. Dendritic and/or punctate and were unremarkable. Fluorescein stain (Fluorets; Bausch & ulcers, however, are seen early in the disease course only, and Lomb Canada, Markham, Ontario) was applied to both eyes have often progressed to larger, more geographic ulcers (3,4,7) and retained OD in a punctate to branching pattern (Figure 1). before affected cats are presented to veterinarians. The diagnosis of FHV-1 keratoconjunctivitis was further supported by the What are your clinical diagnoses, absence of eyelid or tear film abnormalities, corneal inflamma- differential diagnoses, therapeutic plan, tory infiltrates suggestive of FEK (3,5), oral ulceration suggestive and prognosis? of FCV (2,8), and evidence of trauma on routine ophthalmic The clinical diagnoses were conjunctivitis and superficial ulcer- examination and diagnostic testing. Keratitis is rarely present C. felis ative keratitis in the right eye. The most common differentials with infection alone (9) and was therefore considered an for feline conjunctivitis are the infectious agents: feline her- unlikely cause of this cat’s signs. Several diagnostic tests are available for FHV-1 including virus isolation, serology [enzyme-linked immunosorbent assay Department of Small Animal Clinical Sciences, Western College (ELISA) or serum neutralization (SN)], immunofluorescent of Veterinary Medicine, University of Saskatchewan, 52 Campus antibody (IFA) testing, or polymerase chain reaction (PCR) (6). Drive, Saskatoon, Saskatchewan S7N 5B4. Test interpretation, however, can be problematic because clini- Use of this article is limited to a single copy for personal study. cally normal cats can intermittently shed virus detectable by Anyone interested in obtaining reprints should contact the IFA or virus isolation; SN and ELISA antibody titers do not CVMA office ([email protected]) for additional differ significantly between normal and acutely or chronically copies or permission to use this material elsewhere. affected cats; and PCR testing does not differentiate vaccinal

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from wild-type FHV-1 DNA (10), which has been detected density even after resolution of clinical signs (18), treatment in 52.5% of clinically normal shelter-housed kittens (11). with a mucinomimetic tear replacement (e.g., an artificial tear

Given the inherent uncertainty interpreting diagnostic test solution containing hyaluronate), is likely beneficial. Finally, OPHTHALMOLOGYDIAGNOSTIC results for FHV-1, in the absence of pathognomonic dendritic stress reduction is a key component of decreasing incidence of ulcers, additional factors such as history of recurrent keratitis/ recrudescent disease. It is important to remember that frequent conjunctivitis/keratoconjunctivitis or upper respiratory tract medication administration or veterinary visits are stressful for disease, vaccination status, and response to previous treatments many cats (12). Antiviral medications with efficacy against should be considered when diagnosing herpetic disease (12). FHV-1 are available as oral and topical ophthalmic formulations, FHV-1 is a double-stranded DNA alphaherpesvirus ubiqui- although most must be compounded. All are virostatic and tous among cats worldwide (6,12), with a reported seropreva- require frequent administration to be effective (19). Principles lence of up to 97% in some populations (13). During primary of antimicrobial stewardship should be followed when prescrib- infection, FHV-1 replicates rapidly within ocular and upper ing antivirals; administration at subtherapeutic levels, as well as respiratory tract mucosal epithelial cells, in which it causes tapering the dose or dosing frequency, may promote antiviral cell lysis. Clinical signs develop 2 to 6 d after infection and drug resistance (19). include conjunctivitis, epithelial keratitis (12), and — espe- On presentation, the cat in this report was being treated cially in kittens — sneezing, coughing (14), inappetence, and with idoxuridine topically. Idoxuridine is a thymidine analogue pyrexia (13,14). Primary FHV-1 infection is generally self- that non-specifically inhibits DNA-synthesis. This medication limiting within 10 to 20 d (2,6), during which time supportive was formerly available as an FDA-approved 0.1% ophthalmic care for upper respiratory tract disease is often required (6). solution or 0.5% ointment for treatment of herpes simplex Following primary infection, FHV-1 establishes latency virus 1 in humans (19). Although the owners of the cat herein within neurons of the trigeminal ganglia (13) in 82% of infected reported no improvement following treatment with idoxuridine, cats (15). Latent virus can subsequently become reactivated an important consideration is that dosing frequency in this cat and travel peripherally along sensory axons into epithelial tis- was only twice daily, whereas minimum recommended dosing sues (12). Viral reactivation and intermittent shedding either frequencies are approximately every 4 to 6 h (12). spontaneously, following corticosteroid administration, or in Topical antiviral formulations available in Canada are lim- response to stressful situations such as rehousing or parturition, ited and vary depending on the compounding pharmacy. has been observed in 45% of latently infected cats (15). In a Vidarabine (3% ointment) is another topical option that must shelter population of cats in western Canada, FHV-1 shedding be given at least 5 times daily but works via a different mecha- increased with time in the shelter, and all FHV-1 carriers devel- nism than, and therefore may be efficacious in cats that do not oped upper respiratory tract disease within a median of 6 d of respond to idoxuridine (2). Cidofovir compounded as a 0.5% shelter entry (16). Recrudescent clinical disease may be cytolytic solution and given only twice daily was associated with decreased or immunopathologic in nature (2,12). Cytolytic disease often viral shedding and clinical signs of FHV-1 infection in a popula- causes keratoconjunctivitis without signs of upper respiratory tion of experimentally infected cats (20). Despite cidofovir being tract disease (12) or with milder signs of upper respiratory tract virostatic, the lower dosing frequency is possible due to the long disease than are seen in primary disease (2). Chronic stromal tissue half-life of this drug’s metabolites (2). keratitis (immunopathologic disease), results when a cat mounts Famciclovir, a systemically administered antiviral medication, an immune-mediated response to FHV-1 antigens within the has demonstrated clinical efficacy in cats with herpetic disease, corneal stroma (12) and is characterized clinically by stromal and has apparently high safety in vivo (19). Current treatment inflammatory cell infiltrate (3), corneal haziness, and corneal recommendations are oral administration of famciclovir at a vascularization (3,7). Cats treated with corticosteroids topi- dose of 90 mg/kg body weight (BW) twice daily (19). In con- cally, subconjunctivally (3,7), or systemically (17), or those that trast to topical antiviral medications, which are retained only develop secondary bacterial infection (3), are at increased risk transiently on the corneal surface after application, famciclovir of developing stromal keratitis. In the present case, treatment administered at 90 mg/kg BW, PO, q12h can achieve effective . with 0.1% dexamethasone topically may have precipitated or antiviral ( IC50) tear concentrations for up to 53% of the dos- contributed to development of recrudescent cytolytic herpetic ing interval (i.e., for  6 h) (21). The most common adverse disease; the risk of FHV-1 recrudescence should be considered effects reported as potentially associated with famciclovir in prior to corticosteroid administration in any cat. cats are gastrointestinal and are reversible following cessation of Treatment for FHV-1 is not required for cats with spontane- therapy (22). Famciclovir can be particularly appealing for cats ously resolving disease such as transient conjunctivitis. Herpetic that become stressed by application of, or for owners who are ulcers, however, are generally painful and antiviral treatment unable to comply with the frequent dosing intervals required is indicated for cats with ocular pain, corneal ulceration, or for, topically administered antiviral medications. Whether moderate to severe conjunctivitis (3). Topically administered, administered orally or topically, antiviral treatment should be broad-spectrum antibiotics should also be given to any cat with extended for at least 1 wk following resolution of ocular clinical corneal ulceration. Tetracyclines are a logical first choice consid- signs, which can be expected within 2 to 3 wk after initiating ering that co-infection with Mycoplasma and/or Chlamydia can the antiviral medication (2). occur in cats with FHV-1 (2). Given that cats experimentally On presentation to the WCVM, the cat in this report was infected with FHV-1 had decreased conjunctival goblet cell also being adjunctively treated with L-lysine. There are a variety

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of sometimes contradictory data regarding use of this amino 5. Moore PA. Feline corneal disease. Clin Tech Small Anim Pract acid in cats infected with FHV-1 (19). In cats experimentally 2005;20:83–93. 6. Andrew SE. Ocular manifestations of feline herpesvirus. J Feline Med infected with FHV-1, those administered lysine as a bolus had Surg 2001;3:9–16. decreased (23) or unchanged (24) amounts of viral shedding 7. Nasisse M, Guy J, Davidson M, Sussman W, Fairley N. Experimental and decreased conjunctivitis (24) compared to control cats. By ocular herpesvirus infection in the cat. Sites of virus replication, clinical features and effects of corticosteroid administration. Investig contrast, cats in a shelter environment with enzootic FHV-1 Ophthalmol Vis Sci 1989;30:1758–1768. and receiving lysine-supplemented feed had increased FHV-1 8. Walter J, Foley P, Yason C, Vanderstichel R, Muckle A. Prevalence of DNA detected by PCR, and worse clinical signs of herpetic feline herpesvirus-1, feline calicivirus, Chlamydia felis, and Bordetella bronchiseptica in a population of shelter cats on Prince Edward Island. disease (25). However, no toxicity concerns have been reported Can J Vet Res 2020;84:181–188. in cats receiving lysine. If chosen as part of the treatment for 9. Sykes JE. Feline chlamydiosis. Clin Tech Small Anim Pract 2005;20: FHV-1, the recommended lysine dose is 500 mg, PO, q12h 129–134. 10. Maggs DJ, Clarke HE. Relative sensitivity of polymerase chain reaction given as a bolus and not added to food (2). assays used for detection of feline herpesvirus type 1 DNA in clinical Following examination at the WCVM, treatment with dexa- samples and commercial vaccines. Am J Vet Res 2005;66:1550–1555. methasone, idoxuridine, and L-lysine was discontinued, dosing 11. Baumworcel N, Soares AMB, Silva SB, Almeida NKO, de Castro TX. OPHTALMOLOGIE DIAGNOSTIQUE OPHTALMOLOGIE Correlation between clinical signs of feline conjunctivitis and molecular frequency for 0.3% ciprofloxacin (Ciloxan) was increased to detection of felid herpesvirus-1, feline calicivirus, Chlamydophila felis q6h, in the right eye, dosing frequency for 1% atropine sulfate and Mycoplasma felis in cats from shelters in Rio de Janeiro. Braz J Vet ophthalmic solution was decreased to as needed to maintain Res Anim Sci 2017;54:18–26. 12. Gould D. Feline herpesvirus-1: Ocular manifestations, diagnosis and pupil dilation in the right eye, and 0.1% diclofenac ophthal- treatment options. J Feline Med Surg 2011;13:333–346. mic solution q12h and famciclovir 250 mg, PO, q12h were 13. Maggs DJ, Lappin MR, Reif JS, et al. Evaluation of serologic and viral prescribed. Diclofenac was added to reduce keratoconjuncti- detection methods for diagnosing feline herpesvirus-1 infection in cats with acute respiratory tract or chronic ocular disease. J Am Vet Med val inflammation and associated patient discomfort. This cat Assoc 1999;214:502–507. received a lower dose of famciclovir than is currently recom- 14. Contreras ET, Hodgkins E, Tynes V, Beck A, Olea-Popelka F, Lappin mended only because it was examined before the updated dosing M. Effect of a pheromone on stress-associated reactivation of feline herpesvirus-1 in experimentally inoculated kittens. J Vet Intern Med recommendations of 90 mg/kg, BW, PO, q12h were established. 2018;32:406–417. Follow-up examination was performed at the WCVM 1 mo 15. Gaskell R, Povey R. Experimental induction of feline viral rhinotra- later. The owners had observed improvement in clinical signs cheitis virus re-excretion in FVR-recovered cats. Vet Rec 1977;100: 128–133. and therefore discontinued ciprofloxacin, atropine, and fam- 16. Gourkow N, Lawson JH, Hamon SC, Phillips CJ. Descriptive epide- ciclovir 1 week before the recheck. On re-evaluation, neuro- miology of upper respiratory disease and associated risk factors in cats ophthalmic and indirect ophthalmoscopic examinations were in an animal shelter in coastal western Canada. Can Vet J 2013;54:132. 17. Hickman MA, Reubel GH, Hoffman DE, Morris JG, Rogers QR, normal with no retention of fluorescein by the ocular surface Pedersen NC. An epizootic of feline herpesvirus, type 1 in a large spe- tissues in both eyes. Biomicroscopic examination showed mild cific pathogen-free cat colony and attempts to eradicate the infection corneal vascularization and fibrosis under the area of healed by identification and culling of carriers. Lab Anim 1994;28:320–329. 18. Lim CC, Reilly CM, Thomasy SM, Kass PH, Maggs DJ. Effects of ulceration the right eye and was normal in the left eye. All feline herpesvirus type 1 on tear film break-up time, Schirmer tear test remaining medications were discontinued. results, and conjunctival goblet cell density in experimentally infected Although this cat was healed at last recheck and never cats. Am J Vet Res 2009;70:394–403. 19. Thomasy SM, Maggs DJ. A review of antiviral drugs and other com- re-presented to the WCVM, it is important that owners under- pounds with activity against feline herpesvirus type 1. Vet Ophthalmol stand that some cats with FHV-1 may have lifelong viral reac- 2016;19:119–130. tivation with variably persistent/recurrent recrudescent disease 20. Fontenelle JP, Powell CC, Veir JK, Radecki SV, Lappin MR. Effect of topical ophthalmic application of cidofovir on experimentally induced episodes, some of which may require treatment. primary ocular feline herpesvirus-1 infection in cats. Am J Vet Res 2008; 69:289–293. Acknowledgment 21. Sebbag L, Thomasy SM, Woodward AP, Knych HK, Maggs DJ. Pharmacokinetic modeling of penciclovir and BRL42359 in the plasma The authors thank Dr. David Maggs for his comments on this and tears of healthy cats to optimize dosage recommendations for oral report. administration of famciclovir. Am J Vet Res 2016;77:833–845. 22. Thomasy SM, Shull O, Outerbridge CA, et al. Oral administra- References tion of famciclovir for treatment of spontaneous ocular, respiratory, or dermatologic disease attributed to feline herpesvirus type 1: . 1 Hartmann AD, Hawley J, Werckenthin C, Lappin MR, Hartmann K. 59 cases (2006–2013). J Am Vet Med Assoc 2016;249:526–538. Detection of bacterial and viral organisms from the conjunctiva of cats 23. Maggs DJ, Nasisse MP, Kass PH. Efficacy of oral supplementation with with conjunctivitis and upper respiratory tract disease. J Feline Med L-lysine in cats latently infected with feline herpesvirus. Am J Vet Res Surg 2010;12:775–782. 2003;64:37–42. 2. Maggs DJ. Diseases of the conjunctiva. In: Maggs DJ, Miller PE, Ofri 24. Stiles J, Townsend WM, Rogers QR, Krohne SG. Effect of oral admin- R, eds. Slatter’s Fundamentals of Veterinary Ophthalmology. 6th ed. istration of L-lysine on conjunctivitis caused by feline herpesvirus in St. Louis, Missouri: Elsevier, 2018:158–177. cats. Am J Vet Res 2002;63:99–103. 3. Stiles J. Feline ophthalmology. In: Gelatt KN, Gilger BC, Kern TJ, eds. 25. Drazenovich TL, Fascetti AJ, Westermeyer HD, et al. Effects of dietary Veterinary Ophthalmology. 5th ed. Vol. 2. Ames, Iowa: John Wiley & lysine supplementation on upper respiratory and ocular disease and Sons, 2013:1477–1559. detection of infectious organisms in cats within an animal shelter. Am 4. Hartley C. Aetiology of corneal ulcers: Assume FHV-1 unless proven J Vet Res 2009;70:1391–1400. otherwise. J Feline Med Surg 2010;12:24–35.

764 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY Special Report Rapport spécial

North Atlantic right whales: 2017–present

Ashley L. Powell

uring a warm and seemingly uneventful week in June 2017, The North Atlantic right whale is a large baleen whale that D the Canadian Wildlife Health Cooperative (CWHC) can weigh up to 60 000 kg and live up to 70 y. They spend Atlantic and Quebec Regions received a series of telephone calls their winters and calving season near the Florida coast and their from the Marine Animal Response Society and the Department summers thriving in rich feeding grounds in Atlantic Canada’s of Fisheries and Oceans, Canada (DFO) concerning a right waters. Most notably, this species has endured severe hardship whale carcass observed off the coast of Nova Scotia. This was from whaling and other forms of human interactions. They potentially the 5th deceased whale sighted over the past month were the “right” whale to hunt due to their passive behavior and given the critically endangered status of this species, the and tendency to stay near the surface. Although these whales CWHC was committed to recovering and examining this ani- began to make a comeback after the termination of the whal- mal. We kept our e-mail open and cellphones close as arrange- ing industry in the early 20th century, they soon faced another ments were made for the whale to be towed to Norway, PEI, on challenge: unintentional human interactions. There are now an June 26th. With perseverance and coordination among govern- estimated 360 individuals remaining, less than half of which are ment bodies and nonprofit organizations, “Glacier” was brought breeding females (3). An “Unusual Mortality Event” status for to the beach and was waiting for us to uncover the mystery of the North Atlantic right whale was established in 2017 by the his premature death. I had always dreamed of seeing such a rare National Oceanic and Atmospheric Administration (NOAA) and beautiful animal, but not like this. Little did we know when and remains active (4). To date, there have been 34 confirmed we unpacked our gear and started the necropsy, 2 more would mortalities, most from vessel strike and entanglement, and an appear on the beach over the following 3 d. additional 15 severely injured live whales. As we began the necropsy of “Glacier” and the second whale, Even when an encounter with fishing gear or a vessel is not we observed dark red discoloration of the blubber layer and fatal, whales can clearly experience pain. Ropes from fishing underlying muscle. There was evidence of internal bleeding gear can entrench into the skin and blubber, pry open baleen within the thorax and abdomen, consistent with trauma, such plates, and restrict movement. Entanglement prevents the whale as that caused by vessel strike. The third whale, “Starboard,” was from feeding effectively and may cause severe joint degeneration wrapped in a length of rope and her final cause of death was and arthritis, chronic wounds with secondary infections, and determined to be acute entanglement (1,2). scarification. This in turn, can eventually cause a chronic wast- ing syndrome and ultimately death. If a whale is freed, either Dr. Ashley Powell is a 2019 graduate of the Atlantic Veterinary on its own or with the help of dedicated volunteers, it still has College and a certified aquatic animal veterinarian through reduced chances of survival for the next year (5). It is estimated the World Aquatic Veterinary Medical Association (WAVMA). that at least 80% of all North Atlantic right whales have scars She grew up in New York with a strong passion for marine from previous human interactions. Sadly, this is how most biology and received a BSc in Marine Biology and BA in individual right whales are distinguished by researchers. In that Chemistry at Roger Williams University (Rhode Island, USA). regard, we were able to identify “Punctuation” in 2019 due to Her interests in aquatic animal medicine and pathology grew various whimsical marks resembling commas, question marks, throughout her experiences in public aquaria, marine animal and tildes that riddled her body. rescue/rehabilitation centers, and diagnostic laboratories. She Researchers around the globe are determined to understand currently works as an aquatic animal health veterinarian with these whales, improve their welfare, and increase their numbers. the Nova Scotia Department of Fisheries & Aquaculture. The Anderson Cabot Center for Ocean Life at the New England Inspired by this particular experience with the North Atlantic Aquarium and the Woods Hole Oceanographic Institution in right whales, Dr. Powell looks forward to starting an anatomic Massachusetts are 2 major organizations leading the way. The pathology residency and PhD program with aquatic animal New England Aquarium hosts educational programs, sponsors emphasis at the University of Georgia in July 2021. research projects, and maintains an on-line “catalogue” of all Address all correspondence to Dr. Ashley Powell; [email protected] documented right whales and associated names, identifiers, Use of this article is limited to a single copy for personal study. and photographs (6). Studies have been undertaken to monitor Anyone interested in obtaining reprints should contact the behavior, characterize acoustics, and determine potential feed- CVMA office ([email protected]) for additional ing grounds. Researchers are trying to understand normal and copies or permission to use this material elsewhere. stressed states of whales through blubber cortisol concentrations

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and define resident microbial populations in respiratory tract United States, we were able to refine our responses and com- and skin samples. Researchers have also explored methods of plete 12 necropsies (https://www.fisheries.noaa.gov/national/ administering anesthetic and analgesic agents during disen- marine-life-distress/2017-2021-north-atlantic-right-whale- tanglement responses (7–10). unusual-mortality-event). Although we were unable determine By determining potential right whale feeding grounds and cause of death in 2 whales, we attributed 8 to probable blunt identifying migratory patterns, regulations have been promul- force trauma (vessel strike) and 2 to acute entanglement. gated to reduce interactions with humans. Researchers have Recovery of the right whale populations will be a long identified shipping lanes that cross migratory routes and devel- journey. They are long-lived, mature late, and have a year-long oped aerial and acoustic methods for detecting right whales. gestation period. Although the 17 calves born this past year Once a right whale has been identified in a specific area, vessel provide encouragement and hope, we still have a long way to go. speed limits and fishing area restrictions are immediately imple- RAPPORT SPÉCIAL mented. This policy has been successful! There were no North References Atlantic Right Whale deaths in Canada in 2020. However, . 1 North Atlantic Right Whale Incident Report (2018). [Internet] thousands of Canadian citizens rely on the sea for their liveli- Canadian Wildlife Health Cooperative. Available from: http://www. cwhc-rcsf.ca/right_whales.php Last accessed May 25, 2021. hood and shortening the fishing season poses its own limitations 2. Sharp SM, McLellan WA, Rotstein DS, et al. Gross and histopatho- to communities and the fishing industry. Researchers, therefore, logical diagnoses from North Atlantic right whale Eubalaena glacialis are currently challenging conventional fishing methods. By mortalities between 2003 and 2018. Dis Aquat Organ 2019;135:1–31. 3. North Atlantic Right Whale Consortium Annual Meeting 2021 exploring options, such as lineless remote-operated fishing gear Proceedings. and new gear materials, hopefully a mutual solution can be 4. 2017–2021 North Atlantic Right Whale Unusual Mortality Event determined for sharing the sea. Local and global organizations [Internet] National Oceanic and Atmospheric Administration. Available from: https://www.fisheries.noaa.gov/national/marine-life-distress/2017- have also started efforts to recover and recycle “ghost gear,” i.e., 2021-north-atlantic-right-whale-unusual-mortality-event Last accessed long-abandoned lines and traps that are not only harmful to May 25, 2021. right whales but other marine fauna as well (11). 5. Robbins J, Knowlton AR, Landry S. Apparent survival of North Atlantic Right Whales after entanglement in fishing gear. Biol Conserv Working as a veterinary volunteer for the Canadian Wildlife 2015;191:421–427. Health Cooperative to unravel the mystery behind right whale 6. North Atlantic Right Whale Catalogue [Internet] New England mortalities was an invaluable learning opportunity and a sober- Aquarium. Available from: https://rwcatalog.neaq.org/ Last accessed May 25, 2021. ing experience. It was heartbreaking to imagine what these fan- 7. Graham KM, Burgess EA, Rolland RM. Stress and reproductive events tastic creatures had experienced before their death, yet incredibly detected in North Atlantic right whale blubber using a simplified hor- rewarding to know that our findings could improve the welfare mone extraction protocol. Conserv Physiol 2021;9:coaa133. 8. Apprill A, Miller CA, Moore MJ, et al. Extensive core microbiome in and survival rate of this population. It was reassuring to witness drone-captured whale blow supports a framework for heath monitoring. the collaboration among numerous non-profit and government mSystems 2017;2:e00119–17. organizations and the dedication they exhibit in the protection 9. Moore M, Walsh M, Bailey J, et al. Sedation at Sea of Entangled North Atlantic Right Whales (Eubalaena glacialis) to Enhance of these charismatic animals. Disentanglement. PLoS One 2010;5(3). When we first started our examinations, we were working 10. Moore MJ, Rowles TK, Fauquier DA, et al. Assessing North Atlantic in uncharted territory, as Atlantic Canada has never expe- right whale health: threats, and development of tools critical for conservation of the species. Dis Aquat Org 2021;143:205–226. rienced such an undertaking. In the ensuing 3 y, with the 11. Moore MJ. How we can all stop killing wales: A proposal to avoid whale help of numerous specialists from other provinces and the entanglements in fishing gear. ICES J Mar Sci 2019;76:781–786.

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

766 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY Veterinary Practice Management Gestion d’une pratique vétérinaire

Positive perceptions: Pet owners’ attitudes towards veterinary medicine Perceptions positives : opinions des propriétaires d’animaux à l’égard de la médecine vétérinaire

Chris Doherty

he past year has been a bumpy one for many veterinar- a dernière année a été mouvementée pour de nombreux T ians and their teams. Beyond the upheaval and disruption L médecins vétérinaires et leurs équipes. Au-delà des per- caused by the COVID-19 pandemic, veterinary hospitals have turbations et des bouleversements causés par la pandémie de been inundated with patients, short on staff due to self-isolations COVID-19, les établissements vétérinaires sont submergés de and childcare concerns, and seemingly constantly scrambling patients et à court de personnel en raison des périodes d’isole- just to keep up with their ever-expanding workload. ment et des problèmes de garde d’enfants, et les équipes vété- Simultaneously, many pet owners are facing higher stress, rinaires se démènent pour composer avec leur charge de travail which can result in some of them being uncivil and lashing out toujours croissante. while at a veterinary appointment. Though these incidents are Simultanément, de nombreux propriétaires d’animaux sont unfortunate and unacceptable, it is worth remembering that confrontés à un stress plus élevé, ce qui peut amener certains most pet owners are extremely happy with and appreciative of d’entre eux à être impolis et à s’emporter durant une consulta- their veterinary teams, and highly value the services provided. tion. Bien que ces incidents soient malheureux et inacceptables, Each year, the Ontario Veterinary Medical Association il faut se rappeler que la plupart des propriétaires d’animaux sont (OVMA) conducts a Survey of Pet Owners, to assess the atti- extrêmement satisfaits et reconnaissants envers leurs équipes tudes, perceptions, spending patterns, and more, of Ontario’s pet vétérinaires et qu’ils apprécient grandement les services fournis. owning population. Although these results are derived from only Chaque année, l’OVMA (Ontario Veterinary Medical one province, there is little to suggest that a typical pet owner in Association) mène un sondage auprès des propriétaires d’ani- Ottawa is materially different from one in Vancouver, Calgary, maux pour évaluer les opinions, les perceptions, les habitudes de Montreal, Halifax, or elsewhere in the nation. The 2021 survey dépenses et d’autres caractéristiques de la population ontarienne received responses from 1021 pet owners, providing a robust de propriétaires d’animaux. Même si ces résultats ne proviennent dataset to assess. que d’une seule province, on peut présumer que le propriétaire One question from the survey asked pet owners to what d’animal typique d’Ottawa n’est pas tellement différent de celui degree they agreed or disagreed with statements about their de Vancouver, de Calgary, de Montréal, de Halifax ou d’ailleurs veterinarian and veterinary hospitals; the results provide a au pays. Au total, 1021 propriétaires d’animaux ont répondu

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 en tant qu’analyste économique pour l’Ontario Veterinary Medical Association. Le présent article est rédigé dans le cadre du Programme de gestion commerciale de l’ACMV, qui est cocommandité par IDEXX Laboratories, Petsecure 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.

CVJ / VOL 62 / JULY 2021 767 FOR PERSONAL USE ONLY

Strongly agree Agree Disagree Strongly disagree Totalement d’accord D’accord En désaccord Totalement en désaccord

Veterinarian was extremely friendly Mon médecin vétérinaire a été extrêmement sympathique 48% 47% 4% 1%

Hospital staff were extremely friendly 46% 51% 2% 1% Le personnel de mon établissement vétérinaire a été extrêmement sympathique

Veterinarian really cares about my pet(s) 45% 51% 3% 1% Mon médecin vétérinaire se soucie vraiment de mon animal

Veterinarian listened closely to me 43% 51% 5% 1% Mon médecin vétérinaire m’a écouté(e) attentivement

Veterinarian offered clear explanations 42% 53% 5% 0% Mon médecin vétérinaire a donné des explications claires

Hospital staff really care about my pet(s) 41% 55% 3% 1% Le personnel de mon établissement vétérinaire se soucie vraiment de mon animal

Strongly recommend this hospital 39% 53% 7% 1% Je recommanderais fortement mon établissement vétérinaire

Good value for money 24% 60% 14% 2% J’obtiens un bon rapport qualité-prix à mon établissement vétérinaire

Figure 1. Agreement with statements on last veterinary visit from the 2021 Pet Owner Survey. Accord ou désaccord des propriétaires d’animaux avec divers énoncés concernant leur dernière visite

GESTION D’UNE VÉTÉRINAIREPRATIQUE à leur établissement vétérinaire, selon les réponses au sondage de 2021.

Nothing — I’m happy/Rien – Je suis satisfait(e) 58% More payment options/Offrir plus d’options de paiement 17% Review costs before treatment/Passer en revue les coûts des traitements 17% Longer hours/Allonger les heures d’ouverture 11% More explanation/Education/Donner plus d’explications 9% More interaction with veterinarian/Accroître l’interaction avec le médecin vétérinaire 7% Less waiting to see veterinarian/Réduire l’attente avant de voir le médecin vétérinaire 7% Other/Autre 6% Offer telemedicine/Offrir des services de télémédecine 6% More treatment options/Proposer plus d’options de traitements 5% More follow-up after appointments/Améliorer le suivi après les rendez-vous 4% Friendlier staff/Encourager le personnel à être plus sympathique 3%

Figure 2. What else could your veterinarian and/or clinic do to improve you and your pet’s experience at the veterinarian?/Que pourrait faire votre médecin vétérinaire ou le personnel de votre établissement vétérinaire pour améliorer votre expérience et celle de votre animal lors de vos visites?

resoundingly affirmative appraisal. Nearly every respondent au sondage de 2021, et ont ainsi fourni un bon ensemble de strongly agreed or agreed that their veterinarian and team were données à évaluer. extremely friendly, truly cared about their pets, listened atten- Une des questions du sondage demandait aux propriétaires tively, and explained things clearly. Fully 92% stated they would d’animaux dans quelle mesure ils étaient en accord ou en désac- strongly recommend their hospital, and 84% agreed that their cord avec différents énoncés concernant leur médecin vétérinaire veterinarian provided good value for the money spent (Figure 1). et leur établissement vétérinaire, et les résultats sont très positifs. When pet owners were asked to provide suggestions on what Presque tous les répondants étaient d’accord ou totalement could be done to ameliorate their visit to the veterinarian, most d’accord pour dire que leur médecin vétérinaire et les membres simply indicated that nothing came to mind — they were already de leur équipe vétérinaire étaient extrêmement sympathiques, se delighted with the experience. Of those who did have suggestions souciaient vraiment de leurs animaux de compagnie, écoutaient for improvements, many hinged on prices, although primarily attentivement et expliquaient les choses clairement. Au total, around providing options for payment, such as Wellness Plans, 92 % des répondants ont déclaré qu’ils recommanderaient forte- and reviewing the costs of proposed treatments, so as to avoid ment leur établissement vétérinaire, et 84 % ont convenu que leur sticker shock when presented with the bill (Figure 2). médecin vétérinaire offrait un bon rapport qualité-prix (Figure 1). Another encouraging finding was that pet owners hold favor- Lorsqu’on a demandé aux propriétaires d’animaux de don- able opinions not only towards their veterinarians, but also of ner des suggestions sur ce qui pourrait être fait pour améliorer the services and procedures provided. When asked to weigh leur visite chez le médecin vétérinaire, la plupart ont dit que various medical procedures by how important they felt each was rien ne leur venait à l’esprit et qu’ils étaient très satisfaits de to their pet’s health, most pet owners felt that all of them were leur expérience. Ceux qui ont fait des suggestions ont surtout very or somewhat important. Perhaps unsurprisingly, elective mentionné l’aspect des coûts, plus particulièrement offrir des surgeries were regarded as the most important procedure, with options de paiement, comme dans le cadre d’un plan de bien- 86% of pet owners ranking them as such. However, annual vac- être, et passer en revue les coûts des traitements proposés afin cinations, checkups, and parasite prevention were also perceived d’éviter les surprises au moment de se faire présenter la facture as important by most respondents. Pet owners, by and large, et le montant total (Figure 2).

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Very important Somewhat important Somewhat unimportant Very unimportant Très important Plutôt important Peu important Pas important VETERINARY PRACTICE MANAGEMENT VETERINARY

Spay/Neuter 70% 16% 6% 8% Stérilisation

Annual vaccinations 58% 26% 11% 5% Vaccination annuelle

Annual checkup 54% 32% 10% 4% Examen de santé annuel

Tick prevention 55% 26% 11% 8% Protection contre les tiques

Heartworm prevention 48% 27% 14% 11% Protection contre le ver du cœur

Regular heartworm testing 40% 31% 17% 12% Dépistage régulier du ver du cœur

Annual blood test 26% 35% 27% 12% Bilan sanguin annuel

Regular dental cleanings 19% 41% 30% 10% Détartrages réguliers

Figure 3. Importance of various medical procedures to pet(s) health. Importance de divers soins et services médicaux pour la santé des animaux de compagnie.

It was great/Excellente 14% Good, under the circumstances/Bonne dans les circonstances 33%

Satisfied/Acceptable 8% Ok, but prefer in-clinic/Correcte, mais je préfère en clinique 29% Didn’t like it/Je n’ai pas aimé l’expérience 6% NA/Ne s’applique pas 10%

Figure 4. Please rate your curbside visit experience at the veterinarian during this past year. Évaluation de l’expérience de visite vétérinaire sans accès à l’intérieur de l’établissement vétérinaire au cours de la dernière année. seem to understand that these are crucial in maintaining their Un autre constat encourageant est que les propriétaires pet’s health and well-being (Figure 3). d’animaux ont des opinions favorables non seulement à l’égard Finally, a new question added to this year’s survey sought to de leurs médecins vétérinaires, mais aussi à l’égard des soins et examine how pet owners perceived the experience of curbside des services fournis. Lorsqu’on leur a demandé d’évaluer divers veterinary medicine, whereby animals are brought into the soins et services médicaux en fonction de leur importance pour hospital while the pet owner waits outside. This measure was la santé de leur animal, la plupart des répondants ont estimé introduced in response to the pandemic, to minimize contact que tous les soins et services étaient très importants ou plutôt between veterinary teams and their clients. Although obviously importants. Sans surprise, les chirurgies électives étaient consi- beneficial from a public health perspective, having to examine dérées comme les interventions les plus importantes (86 %). their pet while they wait in the parking lot, and communicating L’examen annuel, la vaccination et la protection contre les over the telephone without the benefit of non-verbal cues can parasites sont également perçus comme étant importants par introduce additional friction to the experience. la plupart des répondants. Dans l’ensemble, les propriétaires Despite this, many pet owners had relatively positive things d’animaux semblent comprendre que ces soins et services sont to say about the experience. Some (14%) were very happy with essentiels au maintien de la santé et du bien-être de leur animal it, describing curbside medicine as great, whereas another 33% (Figure 3). felt that it was good given the circumstances. Some were a touch Enfin, une nouvelle question ajoutée au sondage cette année less enthusiastic, feeling that curbside medicine was either satis- visait à examiner comment les propriétaires d’animaux perce- factory, or OK but would prefer in-clinic medicine; this group vaient l’expérience de la médecine vétérinaire durant la pandé- seemingly understood the need for these measures, although mie avec la prise en charge de l’animal à l’extérieur des cliniques would be glad to see normal practice return. Only 6% stated pour réduire les contacts entre les équipes vétérinaires et les that they did not like curbside medicine (Figure 4). clients. Même si ce changement était nécessaire et bénéfique In their recent book, The Power of Bad, social psychologist du point de vue de la santé publique, pour les clients, devoir Roy Baumeister and journalist John Tiernay explained that it attendre dans le stationnement pendant l’examen de leurs typically takes a person 4 positive experiences to outweigh the animaux et communiquer par téléphone en perdant les indices

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impacts of 1 negative experience. For veterinarians, there may non verbaux peut introduire des frictions supplémentaires dans be no way to completely avoid that irate client who dampens l’expérience. the day. But hopefully, with most pet owners holding their Malgré cela, de nombreux propriétaires d’animaux ont eu veterinary teams in high esteem, there will be far more than des commentaires relativement positifs. Certains (14 %) ont été 4 positive interactions against every not so great one. ■ très satisfaits de leur expérience, la qualifiant d’excellente, tandis que 33 % ont dit avoir eu une bonne expérience compte tenu des circonstances. D’autres étaient un peu moins enthousiastes, estimant que leur expérience avait été acceptable ou précisant qu’elle avait été correcte mais qu’ils préfèrent la médecine vété- rinaire en clinique; ainsi, ces gens ont compris la nécessité des mesures mises en place mais seraient heureux de voir revenir la pratique normale. Seulement 6 % des répondants ont déclaré qu’ils n’avaient pas aimé la médecine vétérinaire avec prise en charge des animaux à l’extérieur de l’établissement (Figure 4). Dans leur récent livre intitulé The Power of Bad, le socio- GESTION D’UNE VÉTÉRINAIREPRATIQUE psychologue Roy Baumeister et le journaliste John Tiernay ont expliqué qu’il faut généralement quatre expériences positives pour contrebalancer l’impact d’une expérience négative. Pour les médecins vétérinaires, il n’y a peut-être aucun moyen d’éviter complètement le client mécontent qui gâche la journée. Mais comme la plupart des propriétaires d’animaux tiennent leur équipe vétérinaire en haute estime, on peut s’attendre à ce qu’il y ait bien plus que quatre interactions positives pour faire oublier chaque interaction qui l’est moins. ■

770 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY Veterinary Dermatology Dermatologie vétérinaire

Cutaneous lymphoma in a Dachshund

Andrea Lam

n 11-year-old, 8.6 kg castrated male miniature Dachshund On presentation, the dog was quiet but responsive with A dog was referred for evaluation of acute onset marked normal temperature and slightly elevated heart (140 beats/min) pruritus and dermatitis of the face and trunk of 3-month’s dura- and respiration (50 breaths/min) rates. No peripheral lymph- tion. The dog had no history of pruritus or skin disease before adenomegaly was noted on palpation. No abnormalities were this episode. He was initially treated with oclacitinib (Apoquel; noted on palpation of the abdomen. Except for mild lenticular Zoetis, Kalamazoo, Michigan, USA), 0.61 mg/kg body weight sclerosis affecting both eyes, the general physical examination (BW), PO, q24h for 2 wk with no resolution of clinical signs. was unremarkable. Cyclosporine (Atopica; Elanco, Greenfield, Indiana, USA), Dermatologic examination revealed moderate alopecia with 5.6 mg/kg BW, PO, q24h was then initiated. When the clinical complete depigmentation and mild crusting of the periocular signs did not abate following another 2 wk of therapy, serum region bilaterally. The nasal planum and surrounding muco- allergy testing was performed, and allergen-specific immuno- cutaneous junctions also had hypopigmentation to complete therapy was started. depigmentation (Figure 1). The normal “cobblestone” architecture of the nasal planum was effaced, leaving a smooth, shiny appearance (Figure 1). The hair coat was generally dull with multifocal areas of marked scaling and occasional crusts Address all correspondence to Dr. Andrea Lam; e-mail: (Figure 2). The oral mucosa was markedly erythematous with [email protected] mild erosions on the buccal surface. The surrounding lip mar- Dr. Andrea Lam is a graduate of the Ontario Veterinary gins were completely depigmented and thickened in appearance College and a diplomate of the American College of Veterinary (Figure 3). Marked erythema was noted on the prepuce as well Dermatology. She has worked as a clinical educator and as the perianal region. In addition, mild erosions were noted lecturer at Tufts University, University of California, Davis, perianally. There was complete depigmentation of the margins and St. George’s University. Her research primarily focuses on of the metacarpal, metarsal, and complete to partial depigmenta- investigating novel management strategies for canine allergic tion of digital footpads (Figure 4). dermatitis. Currently, she resides in British Columbia where Given the history of pruritus, in addition to the distribution she enjoys fielding questions and guiding general practitioners and appearance of cutaneous lesions, a differential diagnosis through their challenging cases as a specialist consultant for included: allergic dermatitis with secondary bacterial folliculitis Antech Diagnostics. and mucocutaneous pyoderma. An ectoparasite infestation such Use of this article is limited to a single copy for personal study. as sarcoptic mange was also a consideration for marked pruritus. Anyone interested in obtaining reprints should contact the Differential diagnoses for loss of pigment of the mucocutane- CVMA office ([email protected]) for additional ous junctions included: cutaneous lupus erythematosus and copies or permission to use this material elsewhere. cutaneous lymphoma.

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. Hypo- to complete depigmentation of the nasal Figure 2. Focal area of marked non-adherent scale/crust on the planum and mucocutaneous junctions. The nasal planum also dorsum. lacks a normal architecture.

Deep skin scrapings did not reveal the presence of Demodex. diagnostic tests such as thoracic radiographs and abdominal A Wood’s lamp examination did not reveal any fluorescence ultrasound were also declined. A 4-week course of cefpodox- on the hair coat. Superficial acetate tape cytology yielded 3 to ime proxetil (Simplicef; Zoetis), 5.8 mg/kg BW, PO, q24h was 10 pairs of coccoid bacteria per oil immersion field (10003 prescribed for the secondary bacterial infection, as well as a magnification) with variable degenerate neutrophils, consistent trial of prednisolone (Prednis-Tab; LLOYD, Shenendoah, Iowa, with a bacterial infection. A complete blood (cell) count (CBC) USA), 0.87 mg/kg BW, PO, q24h. Unfortunately, after 2 wk, showed mild non-regenerative anemia, whereas a serum bio- the owner did not note any decrease in the dog’s discomfort chemistry panel was unremarkable, except for a mild elevation in level. Given the refractory nature of the dog’s pruritus as well alkaline phosphatase (110 IU/L; reference range: 14 to 91 IU/L). as progression in severity of skin lesions, the owner opted for For more definitive evidence, 3 affected sites were selected euthanasia. for biopsy; 6-mm punch biopsies were collected from affected Canine cutaneous lymphoma is also known as epitheliotropic skin adjacent to the nasal planum, the mid-dorsal thoracic lymphoma or cutaneous T-cell lymphoma. Earlier literature may region, and the inguinal region and fixed in 10% buffered for- use the borrowed human terminology, mycosis fungoides, to malin, embedded in paraffin, and reviewed by a Board-certified describe this disease. This cutaneous neoplasm is uncommon, pathologist. has no sex predilections, and typically affects older individu- Hematoxylin and eosin-stained sections examined histologi- als. Prior reports suggested that boxers and cocker spaniels are cally had similarities in all samples submitted. The epidermis, predisposed breeds in contrast to a more recent larger-scale follicular walls, glandular epithelium, and superficial dermis retrospective study that did not detect any significant breed were all infiltrated by neoplastic lymphocytes. The neoplastic predilections (1–3). cells had a distinct border with scant amounts of cytoplasm In this dog, histopathologic findings were confirmatory containing a round to indented, hyperchromatic nucleus and of cutaneous lymphoma. Several differential diagnoses were no distinguishable nucleoli. There was mild anisocytosis and considered based on the presenting complaint and examina- anisokaryosis with 5 mitotic figures per 10 high power fields tion findings. The history of marked pruritus did not preclude (HPF; 4003 magnification). Small numbers of small lympho- refractory allergic dermatitis with secondary bacterial folliculitis cytes and occasional plasma cells and mast cells were admixed and mucocutaneous pyoderma; however, it is unusual for allergic in the dermis. There were multifocal areas of orthokeratotic and dermatitis to manifest for the first time this late in life. Of the parakeratotic hyperkeratosis with multifocal serocellular crust- 3 most common canine hypersensitivity reactions, cutaneous ing. A few discrete pyogranulomas were noted in the epidermis, adverse food reaction would be the most likely to occur in older consistent with Pautrier’s microabscesses. individuals. Sarcoptic mange infestations can also present more Immunohistochemistry for CD3 revealed moderate cytoplas- acutely and with intense pruritus. A consideration for hypopig- mic expression throughout most of the neoplastic population. mentation of the nasal planum and mucocutaneous junctions, Immunohistochemistry for CD79a failed to stain the neoplastic and oral erosions was cutaneous lupus erythematosus. However, population. Based on the clinical findings as well as the results of it is unusual for dogs affected with cutaneous lupus erythema- the histopathologic review, a diagnosis of cutaneous lymphoma tosus to exhibit concurrent marked pruritus. was made. Overall, the signalment, late onset of acute pruritic dermatitis Due to the poor prognosis associated with the diagnosis, and progressive clinical lesions, including the coexistence of both the owner declined referral to a veterinary oncologist and mucocutaneous and nasal planum depigmentation, multifocal elected for conservative palliative treatment at home. Additional erythroderma with scaling and crusting, marked inflammation

772 CVJ / VOL 62 / JULY 2021 FOR PERSONAL USE ONLY VETERINARY DERMATOLOGYVETERINARY

Figure 3. Lip margins are completely depigmented and Figure 4. Complete depigmentation of the margins of the thickened. The oral mucosa is markedly erythematous. Note the metacarpal and partial to complete depigmentation of digital and mild irregular erosions on the buccal mucosa. carpal footpads of the right thoracic limb paw.

of the oral mucosa, and depigmentation of the footpad margins In most cases, histopathology will provide a definitive diag- led to cutaneous lymphoma being the top differential diagnosis nosis. Monomorphic, atypical neoplastic lymphocytes have in this case. marked tropism for the epidermal and mucosal epithelium as Cutaneous lymphoma by nature can be difficult for the well as the adnexal structures. These cells may also be in aggre- practitioner to recognize, as the dermatologic features on clini- gates in the upper layers of the epidermis, termed Pautrier’s cal presentation can be quite pleomorphic, often overlapping microabscesses (5,9). Occasionally, early lesions are infiltrated with more common dermatologic conditions. The clinical with other cell types, creating considerable inflammation. This heterogeneity of this disease lends itself to be described as a influx of inflammatory cells can be confounding to pathologists, “great pretender.” Lesions can appear as: i) generalized eryth- often sharing features with cutaneous reactive histocytosis, and roderma with scaling and crusting and pruritus; ii) erythema preventing an accurate diagnosis (9,10). Repeat biopsies may with depigmentation, erosions, and ulcerations of the muco- be required with progression of disease for a more accurate cutaneous regions; iii) single or multiple plaques or nodules; assessment. Additional tests such as immunohistochemistry to or iv) proliferative infiltration causing erosions and ulceration confirm T-cell origin, polymerase chain reaction for antigen of the oral cavity. The footpads may also be hyperkeratotic or receptor rearrangement (PARR) to detect clonality of the cell depigmented (4,5). One case report describes vesiculobullous population, or flow cytometry may also be useful for confirma- lesions, previously not documented in dogs but recognized as a tion or support of diagnosis. clinical presentation of human cutaneous lymphoma (6). If neo- Cutaneous lymphoma has a very poor prognosis, with survival plastic cells are present in peripheral blood, this is termed Sézary rates reportedly ranging from several months to 2 y (2,7,9). The syndrome. Three clinical stages are commonly recognized in survival time of dogs with cutaneous lesions may be shorter than humans: patch, plaque, and tumor. However, in dogs, classifying those presenting solely with mucocutaneous lesions (1). Death lesions into these clinical phases is not useful because of frequent by disease dissemination is rare. More likely, affected dogs are overlap of lesions and lack of prognostic value (1,7). Depending euthanized because of severe non-resolving or recurrent second- on what lesions are noted at presentation, this condition may ary infection and unmanageable pruritus (2,7,9). easily be mistaken for various dermatologic conditions, such as To date, no effective therapies have been identified. In cases allergic dermatitis, ectoparasite infestation, immune-mediated that present with solitary nodules, surgical excision can result disease, cutaneous or mucocutaneous infection, or keratinization in long-term remission; however, frequent monitoring for disorders. local recurrence is recommended (4). Any secondary infections To avoid delays in achieving a definitive diagnosis, any skin should be addressed. Regular use of topical antiseptic therapy disease that does not respond to appropriate therapy as expected can prevent recurrence of infections. Palliation of pruritus is warrants biopsy for histopathology, especially in an older indi- usually achieved with corticosteroids. Oclacitinib and cyclo- vidual. Similarly, if there is a history of late onset of pruritic skin sporine A should be avoided, as both are contraindicated for disease with either no prior history of skin disease or a history use in patients with neoplasia. Malignant T-cells in humans of allergic skin disease that suddenly changes either in degree of with cutaneous lymphoma produce IL-31 (11) a pruritogenic pruritus or distribution or appearance of skin lesions, cutaneous cytokine known to cause pruritus in dogs with atopic dermatitis. lymphoma should be a differential diagnosis. An association Although the role of IL-31 production in dogs with neoplasia between allergic dermatitis and the development of cutaneous has not yet been elucidated, many dermatologists are already lymphoma has been theorized; however, a proven association using lokivetmab (Cytopoint, Zoetis) to manage pruritus asso- has yet to be established (8). ciated with cutaneous lymphoma. It was reported that IL-31

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was not elevated in dogs with non-pruritic mast cell tumors, References multicentric lymphoma, and cutaneous epitheliotropic and . 1 Chan CM, Frimberger AE, Moore AS. Clinical outcome and prognosis non-epitheliotropic lymphoma (12). Further studies are needed of dogs with histopathological features consistent with epitheliotro- to evaluate the role of IL-31 in dogs with pruritic cutaneous pic lymphoma: A retrospective study of 148 cases (2003–2015). Vet Dermatol 2018;29:154–e59. neoplasms. 2. Rook KA. Canine and feline cutaneous epitheliotropic lymphoma and A standard of care protocol has not been established for cutaneous lymphocytosis. Vet Clin Small Anim 2019;45:67–81. 3. Risbon RE, de Lorimier LP, Skorupski K, et al. Response of canine cuta- canine cutaneous lymphoma. Among many treatment options neous epitheliotropic lymphoma to lomustine (CCNU): A retrospective suggested, the most common chemotherapeutic agent recom- study of 46 cases (1999–2004). J Vet Intern Med 2006;20:1389–1397. mended is lomustine (CCNU) as a single-agent or as part of 4. Miller WH, Griffin CE, Campbell KL, et al. Muller & Kirk’s Small Animal Dermatology. 7th ed. St. Louis, Missouri: Elsevier, 2013:918–938. combination therapy (2). However, limited reports with small 5. Gross TL, Ihrke PJ, Walder EJ, Affolter VK. Skin Diseases of the Dog sample sizes have made it difficult to comment on the true and Cat: Clinical and Histopathologic Diagnosis. 2nd ed. Ames, Iowa: efficacy in achieving complete remission using lomustine-based Blackwell Science, 2005:932. 6. Bizikova P, Linder KE, Suter SE, Van Wettere AJ, Olivry T. Canine protocols. A more recent report suggested that despite higher cutaneous epitheliotropic T-cell lymphoma with vesiculobullous DERMATOLOGIE VÉTÉRINAIRE complete remission rates than with other therapies, the median lesions resembling human bullous mycosis fungoides. Vet Dermatol survival time is still only about 6 mo (13). 2009;20:281–288. 7. Fontaine J, Heimann M, Day MJ. Canine cutaneous epitheliotropic Limited studies have evaluated linoleic acid in the form T-cell lymphoma: A review of 30 cases. Vet Dermatol 2010;21:267–275. of safflower oil, oral retinoids, PEGylated L-asparaginase, 8. Santoro D, Marsella R, Hernandez K. Investigation on the association PEGylated doxorubricin, masitinib, rabacfosidine, dacarbazine, between atopic dermatitis and the development of mycosis fungoides in dogs: A respective case-control study. Vet Dermatol 2010;21:267–275. and electron beam therapy (2,4,13). The median survival for 9. Wilcock BP, Yager JA. The behavior of epidermotropic lymphoma in dogs treated with isotretinoin and/or etretinate was the longest 25 dogs. Can Vet J 1989;30:754–756. at 11 mo (14). One case report describes 2 dogs treated with 10. Moore PF, Affolter VK, Keller SM. Canine inflamed nonepitheliotropic cutaneous T-cell lymphoma: A diagnostic conundrum. Vet Dermatol isotretinoin in conjunction with interferon-a, achieving com- 2013;24:204–e45. plete remission with no recurrence or metastasis of disease after 11. Singer EM, Shin DB, Nattkemper LA, et al. IL-31 is produced by the malignant T-cell population in cutaneous T-cell lymphoma and cor- 10- and 27-mo, respectively (15). However, retinoids and other relates with CTCL pruritus. J Invest Dermatol 2013;133:2783–2785. vitamin A derivatives have been associated with neuropsychiatric 12. Ignatenko N, Gonzales AJ, Messamore JE, et al. Serum concentrations signs, such as depression, aggression, and suicide in humans. of IL-31 in dogs with nonpruritic mast cell tumours or lymphoma. Vet Dermatol 2020;31:466–e124. Consequently, it is very difficult for veterinary practitioners 13. Laprais A, Olivry T. Is CCNU (lomustine) valuable for treatment of to acquire these medications. Larger scale clinical trials are cutaneous epitheliotrophic lymphoma in dogs? A critically appraised needed to better evaluate the use of other therapeutic options topic. BMC Vet Res 2017;13:61. 14. White SD, Rosychuk RA, Scott KV, Trettien AL, Jonas L, Denerolle P. in the treatment of cutaneous lymphoma. Other therapies such Use of isotretinoin and etretinate for the treatment of benign cutane- as histone deacetylase (HDAC) inhibitors have been used to ous neoplasia and cutaneous lymphoma in dogs. J Am Vet Med Assoc inhibit tumor growth in humans with CD81 epidermotropic 1993;202:387–391. 15. Lee GA, Song SB, Kang MH, Park HM. Clinical response to isotreti- T-cell lymphoma have promise but are likely cost-prohibitive noin and interferon-a of two dogs with cutaneous epitheliotropic T-cell in veterinary patients (2). lymphoma: A case report. BMC Vet Res 2018;14:382.

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