September/Septembre 2020 September/Septembre The Canadian Veterinary Journal La Revue vétérinaire canadienne

Vol. 61, No. 09

September/Septembre 2020 Volume 61, No. 09 The Canadian Veterinary Journal La Revue vétérinaire canadienne Osteosarcoma of the proximal tibia in a dog 6 years after tibial tuberosity advancement Concurrent bullous emphysema, bronchointerstitial pneumonia with necrosis, and tension pneumothorax in an 8-week-old puppy Leishmania infantum infection in a dog imported from Morocco Pathology associated with ophidiomycosis in wild snakes in Ontario, Canada Missing in action: Sustainable climate change adaptation evidence for animal health Radiographic tracheal dimensions in brachycephalic breeds before and after surgical treatment for brachycephalic airway syndrome Detection of DNA from undeclared animal species in commercial canine and feline raw meat diets using qPCR Compliance with the Code of Practice for the Care and Handling of Equines on 50 horse farms in Prince Edward Island Characterization of the use of shock wave therapy among equine veterinarians Sertoli cell tumor/mixed germ cell-stromal cell tumor as separate neoplasms in a bilaterally cryptorchid dog FOR PERSONAL USE ONLY FOR PERSONAL USE ONLY

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SEPTEMBER/SEPTEMBRE 2020 Contents Table des matières

SCIENTIFIC RUBRIQUE SCIENTIFIQUE

CASE REPORTS 977 Detection of DNA from undeclared animal RAPPORTS DE CAS species in commercial canine and feline 946 Osteosarcoma of the proximal tibia in a dog raw meat diets using qPCR 6 years after tibial tuberosity advancement Allison Cox, Vincent E. Defalque, Tyler J. Udenberg, Samantha Barnum, Cara Wademan Surabhi Sharma, Sarah E. Boston, Douglas Riddle, Kevin Isakow 985 Compliance with the Code of Practice for the 951 Concurrent bullous emphysema, Care and Handling of Equines on 50 horse bronchointerstitial pneumonia with farms in Prince Edward Island necrosis, and tension pneumothorax Kathleen M. MacMillan, Lisa J. Millican, in an 8-week-old puppy Jennifer J. Burns, J. Trenton McClure, Raphael Vanderstichel Emily M. Brand, Chee Kin Lim, Ethan Biswell, Yava Jones-Hall, Hock Gan Heng BRIEF COMMUNICATION 963 Leishmania infantum infection in a dog COMMUNICATION BRÈVE imported from Morocco 990 Characterization of the use of shock wave Victoria Wagner, Noélie Douanne, therapy among equine veterinarians Christopher Fernandez-Prada Angela V. MacKay, Rebecca C. McOnie, Lea P. Riddell, Katherine A. Robinson ARTICLES 957 Pathology associated with ophidiomycosis STUDENT PAPER in wild snakes in Ontario, Canada COMMUNICATION ÉTUDIANTE Christina M. McKenzie, Paul T. Oesterle, 994 Sertoli cell tumor/mixed germ cell-stromal Brian Stevens, Leonard Shirose, Brandon N. Lillie, cell tumor as separate neoplasms in a Christina M. Davy, Claire M. Jardine, bilaterally cryptorchid dog Nicole M. Nemeth Teagan L. DeForge 966 Missing in action: Sustainable climate change adaptation evidence 925 QUIZ CORNER for animal health TEST ÉCLAIR Craig Stephen, Joy Wade 971 Radiographic tracheal dimensions in brachycephalic breeds before and after surgical treatment for brachycephalic airway syndrome Penny J. Regier, Federico Vilaplana Grosso, Hannah K. Stone, Edzard van Santen

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SEPTEMBER/SEPTEMBRE 2020 Contents Table des matières

FEATURES RUBRIQUES

PRESIDENT’S MESSAGE VETERINARY PRACTICE MANAGEMENT LE MOT DE LA PRÉSIDENTE GESTION D’UNE CLINIQUE VÉTÉRINAIRE 921 Let’s do this Canada! COVID-19, you can’t 1009 The response across Canada: Highlights get rid of us without a fight!/On ne lâche of the National COVID-19 Survey pas, Canada! En ce qui concerne la Faits saillants du sondage national COVID-19, on n’a pas dit notre dernier mot! sur la COVID-19 au Canada Enid Stiles Chris Doherty

923 VETERINARY MEDICAL ETHICS NOTICES ANNONCES DÉONTOLOGIE VÉTÉRINAIRE 1008 Index of Advertisers SPECIAL REPORT Index des annonceurs RAPPORT SPÉCIAL 997 Comparing the prevalence of 1014 Classifieds tetrahydrocannabinol (THC) toxicities Petites annonces in dogs before and after legalization of cannabis in Canada NEWS | NOUVELLES Molly Joffe, Daniel Joffe

VETERINARY DERMATOLOGY 929 NEWS DERMATOLOGIE VÉTÉRINAIRE NOUVELLES 1001 Can equine urticaria be cured? Heather Broughton, Sophie Perreault Frédéric Sauvé

COMMENTARY COMMENTAIRE 1005 The final gift Lisa Skentelbery

1007 DIAGNOSTIC OPHTHALMOLOGY OPHTALMOLOGIE DIAGNOSTIQUE Shayna Levitt, Stephanie Osinchuk, Lynne Sandmeyer

Contributors

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

CVJ / VOL 61 / SEPTEMBER 2020 917 FOR PERSONAL USE ONLY

The Canadian Veterinary Journal Editorial policy: All published articles including editorials and letters reflect the La Revue vétérinaire canadienne opinions of the authors and do not necessarily reflect the opinion of the publisher. Publication of an advertisement does not necessarily imply that the publisher agrees 339 rue Booth Street with or supports the claims therein. Ottawa, Ontario K1R 7K1 The Canadian Veterinary Medical Association holds complete copyright of all articles Telephone: 613-236-1162 within this issue. Fax: 613-236-9681 Politique de la Rédaction : Tous les articles publiés, y compris les éditoriaux et les E-mail: [email protected] lettres, représentent l’opinion de l’auteur et non pas nécessairement la position de Website/Site Web: www.canadianveterinarians.net l’éditeur. www.veterinairesaucanada.net La publication d’une annonce ne signifie pas nécessairement que l’éditeur est d’accord avec son contenu ou qu’il l’appuie. © C anadian Veterinary Medical Association 2020 L’Association canadienne des médecins vétérinaires détient le droit d’auteur complet L’Association canadienne des médecins vétérinaires 2020 sur tous les articles contenus dans le présent numéro.

The Canadian Veterinary Journal is indexed or abstracted in: Editor-in-Chief/Rédacteur en chef La Revue vétérinaire canadienne est indexée ou ses articles sont Dr. Carlton Gyles, Guelph, Ontario résumés dans : AGRICOL, Biological Abstracts, Capsule Report, Current Contents — Agriculture, Associate Editors/Rédacteurs associés Derwent Veterinary Drug File, EMBASE/Excerpta Medica, Dr. Bruce Grahn, Saskatoon, Saskatchewan Index Veterinarius, Index Medicus, Quarterly Index, Science Citation Index, Small Dr. Wayne McDonell, Guelph, Ontario Animal Practice, Veterinary Bulletin, Veterinary Reference Service, Veterinary Update. Dr. Murray Jelinski, Saskatoon, Saskatchewan Feature Editors/Rédacteurs des chroniques Dr. Jangi Bajwa, Burnaby, British Columbia Photo by/Photo de : Jim McLane, Battleford, Saskatchewan Dr. Bruce Grahn, Saskatoon, Saskatchewan Dr. Myrna Milani, Charlestown, New Hampshire Typesetting/Typographie Dr. Debbie Stoewen, Ayr, Ontario AN Design Communications Dr. Tim Blackwell, Fergus, Ontario Printed by/Imprimé par Assistant Editors/Rédacteurs adjoints Dollco Print Solutions Group Dr. Aylin Atilla, Calgary, Alberta Ottawa, Ontario Dr. Marcio Costa, Saint-Hyacinthe, Quebec ISSN 0008-5286 Dr. Robert Friendship, Guelph, Ontario Dr. Luis Gaitero, Guelph, Ontario Dr. Emily John, Charlottetown, Prince Edward Island Report undeliverable Canadian addresses to: Dr. Ron Johnson, Guelph, Ontario e-mail: [email protected] Dr. Shawn McKenna, Charlottetown, Prince Edward Island Dr. Shannon Martinson, Charlottetown, Prince Edward Island Subscriptions (2020). Annual: Canada $220 + applicable GST or HST; foreign Dr. Javier Sanchez, Charlottetown, Prince Edwad Island $235 US; institutional $290. Express subscriptions available. Single issue/back issue: Managing Editor/Directrice de la rédaction $25 each, institutional single issue = $50.00 + GST or HST, if applic­able. (All prices Heather Broughton, Ottawa, Ontario subject to change.) Missing issues will be replaced if the Subscriptions Office is Assistant Managing Editor/Directrice adjointe de la rédaction notified within 6 months (for requests within Canada) and 1 year (for requests from Stella Wheatley, Ottawa, Ontario abroad) of the issue date. The pub­lisher expects to supply missing issues only when Editorial Coordinator/Coordonnatrice de la rédaction losses have been sustained in transit and when the reserve stock will permit. Telephone Kelly Gray-Sabourin, Ottawa, Ontario (613-236-1162) or (1-800-567-2862) and fax (613-236-9681) orders accepted with a valid Visa or MasterCard number. Please advise the publisher of address changes Advertising and Sponsorship Consultant/Consultante, publicité et commandites promptly. Laima Laffitte, Wendover, Ontario Abonnements (2020). Annuel : Canada 220 $ + TPS ou TVH en vigueur; pays étranger 235 $ É-U; prix d’une institution 290 $. Abonnement express disponible. Published monthly by/ Anciens numéros (chacun) : 25 $, ancien numéro d’institution 50 $ + TPS ou TVH Publication mensuelle de en vigueur. Les prix sont sujets à changement sans préavis. Les numéros qui ne sont pas Canadian Veterinary Medical Association reçus seront remplacés si l’éditeur en est informée dans les 6 mois (pour les demandes venant du Canada) et 1 an (pour les demandes venant de l’étranger) suivant la date de parution. L’éditeur s’engage à remplacer les numéros manquants seule­ment lorsque les pertes ont été subies en transit et lorsque ses réserves le permettent. On peut payer son abonnement par téléphone (613-236-1162) ou (1-800-567-2862), par télé­copieur (613-236-9681) ou par carte de crédit (Visa ou MasterCard). Veuillez aviser le bureau de l’éditeur de tout ­changement d’adresse.

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

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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 • Member e-newsletter ‘Online from 339’ perspective • CVMA national convention and CE • Media/public relations to provide trustworthy information and • CVMA National Issues Forum promote veterinary professionals • CVMA Summit • Position statements addressing animal welfare and national • CVMA Emerging Leaders Program veterinary issues • CVMA Canadian Veterinary Reserve • Member consultations on key veterinary issues • LifeLearn products (preferred pricing) • 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 and valuation report • Accreditation of veterinary colleges and veterinary technician • Provincial suggested fee guide programs • Associate compensation and benefits report • Compensation report for non-DVM staff • Compensation report for DVMs outside private practice We put money in your pocket to increase • Practice management articles and career/business resources your profitability. • CVMA specialized group insurance program • CVMA mentoring program As a CVMA member, you benefit from… • VetLaw Online™ legal advice column • GoodLife Fitness (discount) • CVMA Green Veterinary Practice and self-audit tool • CVMA Petcard™ Program – financing options for your clients • Veterinarian health and wellness resources • Moneris™ payment processing services (preferred pricing) • Early career DVM resource hub • HRdownloads™ (discount) • Guidelines for the successful employment of new graduates • Mont Tremblant SkiMax/GolfMax (discount) • Guidelines for the legitimate use of compounded drugs • 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 • Clinician’s Brief™ (free global digital edition) education tools and resources • Plumb’s Veterinary Drugs™ (subscription discount) • Animal Health Week, National Tick Awareness Month and Mental • Staples Advantage™ business products Health in Vet Med Awareness Week campaigns • Adtel® telephone hold service and digital signage (preferred pricing) • Petro-Canada SuperPass™ fuel/diesel discount • CVMA Annual Convention (registration discount) Visit our website or contact us to learn how to get • WSAVA World Congress and WVA Congress (registration discount) more value from your membership.

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Go ahead... tell them they can afford to! 1-888-689-9876 petcard.ca FOR PERSONAL USE ONLY President’s Message Le mot de la présidente

Let’s do this Canada! COVID-19, you can’t get rid of us without a fight! On ne lâche pas, Canada! En ce qui concerne la COVID-19, on n’a pas dit notre dernier mot!

efore I begin my first President’s Message, which in the vant de commencer mon premier mot de la présidente B present circumstances may well be a somewhat uncon- A (qui, dans les circonstances actuelles, pourrait bien livrer ventional message, I want to say THANK YOU. I have never un message quelque peu non conventionnel), je tiens à vous dire been so proud to be Canadian and part of such a committed MERCI. Je n’ai jamais été aussi fière d’être Canadienne et de and caring community of professionals. Our now past-president faire partie d’une communauté de professionnels aussi engagés Dr. Melanie Hicks, aka “COVID-time president” and our et dévoués. Notre présidente sortante, la Dre Melanie Hicks, CEO Jost Am Rhyn have demonstrated the truth in the say- alias « présidente COVID », et notre PDG, M. Jost Am Rhyn, ing, “In times of crisis, true leaders emerge.” In collaboration ont démontré que c’est bien vrai que les temps de crise révèlent with the tireless efforts of the CVMA staff and the COVID-19 les vrais leaders. Appuyés par les efforts colossaux du personnel working group, they have brought, and continue to bring, our de l’ACMV et du groupe de travail sur la COVID-19, ils ont members the most relevant and vital materials, in the form of transmis, et continuent de transmettre, à nos membres l’infor- webinars and direct guidance to Canadian veterinary teams. mation la plus utile et pertinente sous la forme de webinaires The continued collaborations with Canadian veterinary regis- et de conseils directs aux équipes vétérinaires canadiennes. trars, provincial associations, federal government agencies, and Leur collaboration constante avec les registraires vétérinaires industry are once again a testament to our core belief that we canadiens, les associations provinciales, les agences du gouver- are stronger as One Voice. nement fédéral et l’industrie témoigne une fois de plus de notre I can tell you in all honesty that in February of 2020, when conviction profonde que nous sommes plus forts lorsque nous I first began jotting down my possible subjects for the upcoming unissons nos voix. President’s Messages, I barely knew what COVID-19 was. As Je peux vous dire en toute honnêteté qu’en février 2020, we planned the many events and activities for the CVMA this lorsque j’ai commencé à noter mes idées de sujets pour les coming year, I never imagined that most, or all, of these activi- prochains mots de la présidente, c’est à peine si j’avais entendu ties would be cancelled/rescheduled for some unknown date in parler de la COVID-19. Alors que nous nous affairions à pla- the future. My year of presidency went from hotel rooms and nifier les nombreux événements et activités de l’ACMV pour airports and speaking engagements, to tripods, microphones la prochaine année, je n’aurais jamais imaginé que la plupart, and laptops for a seemingly endless stream of web-based meet- voire la totalité, de ces activités seraient annulées ou reportées ings. Finding the right spot in my home, where I am often à une date ultérieure inconnue. Mon année de présidence est surrounded by 3 kids, 2 cats and a lovely but high-pitched bark- passée d’un enchaînement de chambres d’hôtel, d’aéroports et ing dog, has been a challenge to say the least. You may see my d’allocutions aux trépieds, microphones et ordinateurs portables locations change over the year! Fear not, I promise to wear pants! pour ce qui semble être une série infinie de réunions virtuelles. Admittedly, it has been extremely difficult maintaining a posi- Trouver le bon endroit dans ma maison, où je suis souvent tive attitude these past months, and I certainly hope that by the entourée de trois enfants, de deux chats et d’un chien (adorable time this message is printed, we will be seeing far fewer cases of mais bruyant!), a été tout un défi! Vous risquez de voir mon COVID-19 and that our world would have started to “open up.” arrière-plan changer au cours de l’année, mais n’ayez crainte, je Just as I knew little of COVID-19 only a few months ago, I still promets de toujours porter un pantalon! have no certain idea of what “opening up” will mean. New terms Je dois reconnaître qu’il a été très difficile de garder une atti- like PPE, social-distancing, covidiot, quarantini, drivecation, tude positive ces derniers mois, et j’espère sincèrement qu’au Zoom-bombing, or just Zooming have become common usage moment où ce texte sera publié, nous verrons beaucoup moins

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

CVJ / VOL 61 / SEPTEMBER 2020 921 FOR PERSONAL USE ONLY

in only a short time! And then there is my all-time favorite new I have always been a strong believer that, “It’s not the mistake acronym, WWSWD (What Would Scott Weese Do)! that matters. It’s how you deal with it, what you learn from it, The COVID-19 pandemic has given us time to reflect on and how you apply that lesson to your life.” COVID-19 was a who we are and what was important to us before the pandemic giant global mistake. We are certainly learning from it, perhaps struck. Was it that pat on the shoulder from your colleague in an involuntary fashion at times. Personal mentors from when you were having a bad day? Was it a heartfelt hug from my old alma mater such as Dr. Scott Weese and Dr. David your mom? Was it seeing the happy, smiling faces of your clients Waltner-Toews, have been instrumental in the past months when they bring in their new kitten? Was it shaking the hand as I try to “make sense” of what COVID-19 is and how it has of the farmer after a successful caesarean? Was it being able turned our global community upside-down. I believe we have to hold closely that client you have known for 20 years when the “learning” part down pat. Now, my question to myself and she says goodbye to her dog? Was it going out to have drinks to you is “how are we going to apply this lesson to our lives?” with your co-workers after a long week? Was it getting excited I do not know if I will have a personal answer to this question about that upcoming family trip? Was it knowing your family before the end of my term as president of the CVMA but for LE MOT DE LA PRÉSIDENTELA DE MOT LE is healthy and safe? now what I can say is: Be ready for the unexpected and be ready What is likely happening here is that some, and probably to switch gears fast! most of us, are grieving over the losses of our “ordinary” life and I am proud to walk this arduous walk with you, Canadian concerned about what the future will bring. We are likely going animal health team members! It may not be what we expected, through all 5 of the steps of grief. Denial: this won’t affect ME. but it certainly will be one we will never forget. Dear Anger: making me stay home, how could you! Bargaining: in COVID-19, you can’t get rid of us that easily! ■ a few weeks, everything will be all right. Sadness: I don’t know when this will end. And last, but not least, Acceptance: I have Enid Stiles to learn to live with this. Perhaps it is time to stock up on COMPASSION for others, including our colleagues and clients, because we simply don’t know what stage of grieving they are in at any moment.

de cas de COVID-19 et que nous aurons amorcé un certain Il est peut-être temps de faire le plein de COMPASSION « retour à la normale ». Cela dit, tout comme j’en savais bien peu pour les autres, y compris nos collègues et nos clients, car sur la COVID-19 il y a quelques mois, à ce stade-ci, je n’ai pas nous ne pouvons pas toujours savoir à quel stade du deuil ils d’idée claire de quoi cette « normale » sera faite. De nouveaux se trouvent. termes comme EPI, distanciation sociale, covidiot, quarantaine, J’ai toujours cru fermement que ce n’est pas l’erreur qui aplatir la courbe, et « zoomer » sont devenus bien connus en compte, mais plutôt la façon dont on y fait face, ce qu’elle nous très peu de temps! Sans oublier mon nouvel acronyme préféré : apprend et comment on met cet apprentissage en pratique dans QFSW (pour « que ferait Scott Weese? »)! notre vie. La COVID-19 était une énorme erreur mondiale. La COVID-19 nous a donné le temps de réfléchir à qui nous Nous en tirons certainement des leçons, peut-être même de sommes et à ce qui était important pour nous avant la pandémie. façon involontaire parfois. Mes mentors personnels de mon Était-ce cette tape sur l’épaule de votre collègue lorsque vous ancienne alma mater, comme le Dr Scott Weese et le Dr David passiez une mauvaise journée? Était-ce un câlin réconfortant de Waltner-Toews, ont joué un rôle déterminant au cours des der- votre maman? Était-ce voir les visages heureux et souriants de niers mois alors que j’essayais d’assimiler ce qu’est la COVID-19 vos clients qui vous emmènent un nouveau chaton? Était-ce la et comment elle a viré le monde à l’envers. Je crois que nous poignée de main sincère de l’agriculteur après une césarienne avons appris. Maintenant, la question que je me pose, et que réussie? Était-ce la possibilité de prendre dans vos bras cette je vous pose à vous tous, est comment allons-nous mettre cet cliente que vous connaissez depuis 20 ans lorsqu’elle a dû dire apprentissage en pratique dans nos vies? Je ne sais pas si j’aurai au revoir à son chien? Était-ce pouvoir sortir prendre un verre trouvé une réponse à cette question d’ici la fin de mon mandat avec vos collègues à la fin d’une longue semaine? Était-ce l’exci- à la présidence de l’ACMV, mais pour l’instant, ce que je peux tation ressentie à l’approche de votre prochain voyage en famille? dire est qu’il faut toujours être prêt à faire face aux imprévus et Était-ce savoir que votre famille est en santé et en sécurité? à s’adapter rapidement! Nous sommes probablement peinés en raison de toutes ces Durant cette période difficile, je suis fière d’être à vos côtés, petites choses de notre vie « normale » dont nous sommes privés, chers membres de la grande équipe vétérinaire canadienne! Ce et préoccupés par l’incertitude de ce que l’avenir nous réserve. n’est peut-être pas ce à quoi nous nous attendions, mais ce sera Nous traversons probablement les cinq étapes du deuil. Le choc certainement quelque chose que nous n’oublierons jamais. Chère et le déni : cela ne m’arrivera pas à MOI. La colère : comment COVID-19, tu n’arriveras pas à te débarrasser de nous aussi osez-vous me dire que je dois rester à la maison? Le marchan- facilement! ■ dage : dans quelques semaines, tout ira bien. La tristesse : je ne sais pas quand tout cela va finir. Et enfin l’acceptation : je dois Enid Stiles apprendre à composer avec la situation.

922 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY Veterinary Medical Ethics Déontologie vétérinaire

Ethical question of the month — Question de déontologie du mois — June 2020 Juin 2020 A farmer, who is not one of your regular clients and who lives Un agriculteur, qui n’est pas l’un de vos clients réguliers et qui relatively distant from your clinic, started calling you to talk vit relativement loin de votre clinique, a commencé à vous appe- about difficulties on his farm. He appears to have both animal ler pour parler des difficultés de sa ferme. Il semble confronté health and financial problems. You encourage him to call the à la fois à des problèmes de santé animale et à des problems veterinarians at his local clinic so that they can work out his financiers. Vous l’encouragez à appeler les médecins vétérinaires animal health problems. He continues to call, often at odd de sa clinique locale afin qu’ils puissent l’aider à résoudre ses hours, leaving rambling and often incoherent messages to the problèmes de santé animale. Il continue de vous appeler, sou- point that you are concerned for his well-being. You contact vent à des heures indues, et vous laisse des messages décousus the local ministry of agriculture about mental health resources et parfois incohérents, ce qui vous amène à vous inquiéter de for farmers. They assure you that resources are available but sa santé à lui. Vous contactez le ministère de l’Agriculture de that the farmer must initiate the process. You believe that this votre province pour vous renseigner sur les ressources en santé would be a difficult topic to introduce to the farmer. If this was mentale offerte aux agriculteurs. On vous assure qu’il y a des an animal welfare situation, you would be obliged to report it, ressources disponibles, mais que l’agriculteur doit entreprendre but with human welfare, you are limited by legal requirements lui-même le processus de demande d’aide. Vous estimez que of confidentiality. What is my best ethical action here? c’est un sujet délicat et difficile à aborder avec l’agriculteur. S’il s’agissait d’une situation de bien-être animal, vous auriez l’obligation de la signaler, mais en ce qui concerne le bien-être humain, vous êtes limité par des exigences légales en matière de confidentialité. Quelle est la façon la plus éthique d’agir dans une telle situation?

An ethicist’s commentary on response to case of a farmer with suspected mental health concerns Veterinarians by nature of their professional experience recog- is often one of the rare individuals a livestock producer interacts nize abnormal behavior in a variety of species including other with over extended periods of time. humans. As members of a caring profession, it is understandable What, then, should a veterinarian do if she/he suspects that veterinarians wish to ensure that optimal care is provided to a problem is developing in a client? There is a moral imperative all those they contact who suffer from ailments of any descrip- to intercede on behalf of a farmer who is not addressing his tion. In rural areas where there may be a shortage of physicians, animal health and financial problems and may be drifting into veterinarians may feel a greater obligation to intercede in matters a state of mental ill health. The solution begins with establish- related to human health. ing communication. In the case described, a first step would be Although laudable in intention, a veterinarian should resist for the farmer’s regular veterinarian to be contacted for advice. the urge to directly intervene if he or she suspects a client may The producer’s herd veterinarian may have more information on be suffering from physical or mental ill health. The best course of the farmer’s current state based on direct contact or conversations action in such cases is to encourage the individual to seek profes- with neighbors or personnel such as feed or equipment suppliers. sional medical attention appropriate for the malady. This sug- If this is not the case, the herd veterinarian out of professional gestion, however, may not always produce the desired outcome. courtesy, may agree to stop by the farm to check on animal health Mental health disorders are now increasingly diagnosed among while assessing the farmer’s mental state at the same time. those working in agriculture. Long hours working alone, physi- If the herd veterinarian observes animal health concerns cally demanding work, and financial insecurity likely all contrib- (perhaps related to the producer’s mental state) she/he can ute to this. The isolation that results from living and working begin by engaging the producer in addressing those problems. in one place means that deteriorating mental health in a farmer This will provide the regular veterinarian additional opportuni- may be observed by very few outside the family. A veterinarian ties to interact with and assess the farmer’s mental state.

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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If animal health appears adequate but the veterinarian notes mental health resources that are available in most rural jurisdic- instances of unusual behavior on the part of the farmer, the tions. Unfortunately, these resources must be accessed by the herd veterinarian may be able to engage neighbors and friends farmer directly. The only exception is in cases in which the indi- of the client to stop by and visit. This would provide additional vidual has demonstrated that he is a threat either to himself or perspectives on the farmer’s condition. If the producer is under to others. In such cases, police may intervene directly. However, some mental strain, he may be more willing to share his con- if the livestock are adequately cared for and the producer has cerns with a friend or fellow farmer than with his veterinarian. not demonstrated threatening behavior nor is willing to seek Another option that can be both effective and non-threatening is professional help, options to assist such individuals are limited. to ask an appropriate religious leader to approach the producer. If it is concluded by all involved that the producer is not well Bernard E. Rollin, PhD and is behaving increasingly irrationally, there are many excellent DÉONTOLOGIEVÉTÉRINAIRE

Ethical question of the month — Question de déontologie du mois — September 2020 Septembre 2020 Farmers and human nutritionists complain that food is too Les agriculteurs et les nutritionnistes affirment que le prix des cheap. Others claim that there is a “cheap food” policy in west- aliments est trop bas. D’autres croient qu’il existe une politique ern countries that adversely affects the competitiveness of local de « nourriture bon marché » dans les pays occidentaux qui producers while benefiting large corporate agriculture. Many affecte négativement la compétitivité des producteurs locaux of the least expensive foods available are convenient but nutri- tout en bénéficiant aux grandes entreprises agricoles indus- tionally deficient. Nevertheless, cheap food is seen as a benefit trielles. Beaucoup d’aliments parmi les moins chers offerts sont for those on limited incomes and politicians are reluctant to pratiques, mais peu nutritifs. Néanmoins, les aliments abor- support policies that lead to higher food costs. Accepting that dables sont considérés comme un avantage pour les gens ayant many animal welfare improvements will increase the costs of des revenus modestes et les politiciens sont réticents à appuyer production, how does one balance the welfare of livestock des politiques qui entraînent une augmentation des coûts liés à with that of people on limited incomes? l’alimentation. Étant donné que plusieurs améliorations du bien-être animal s’accompagnent d’une augmentation des coûts de production, comment peut-on trouver un équilibre entre le bien-être des animaux destinés à la production d’ali- ments et celui des personnes à faible revenu?

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

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Quiz Corner Test éclair

1. Which of the following statements is NOT correct regarding 1. Lequel des énoncés suivants N’EST PAS exact à propos de exocrine pancreatic insufficiency (EPI)? l’insuffisance pancréatique exocrine? A. The most common cause in dogs is pancreatic acinar A. La cause la plus commune chez le chien est l’atrophie des atrophy. acini pancréatiques. B. Serum trypsin-like immunoreactivity is more sensitive and B. L’immunoréactivité de la trypsine et du trypsinogène (TLI) specific for EPI compared with fecal proteolytic activity. est plus sensible et spécifique pour l’insuffisance pancréa- C. Serum cobalamin is frequently increased. tique exocrine par comparaison à l’activité protéolytique D. Pancreatic enzyme replacement therapy is required for life. fécale. C. La concentration sérique de cobalamine est fréquemment 2. Which of the following is NOT true regarding canine augmentée. dystrophin-deficient muscular dystrophy? D. Un traitement de remplacement des enzymes pancréa- A. Clinical signs occur in older animals. tiques est nécessaire durant toute la vie. B. It is most common in male dogs. C. It is similar to Duchenne muscular dystrophy of humans. 2. Lequel des énoncés suivants N’EST PAS vrai à propos de la D. Serum creatine kinase is markedly elevated. dystrophie musculaire canine avec déficit en dystrophine? E. Clinical signs include weakness and muscle atrophy. A. Les signes cliniques apparaissent chez les vieux animaux. B. Elle est plus commune chez les chiens mâles. 3. Cardiomyopathy in dogs has been associated with deficiency C. Elle est semblable à la dystrophie musculaire de Duchenne of which of the following nutrients? chez les humains. A. Carnitine D. Le taux sérique de créatine kinase est élevé de façon B. Vitamin A marquée. C. Taurine E. Les signes cliniques comprennent de la faiblesse et de D. Magnesium l’atrophie musculaire. E. Linoleic acid 3. Chez le chien, la cardiomyopathie a été associée à une 4. A 3-year-old Thoroughbred gelding is being evaluated for carence en lequel des éléments nutritifs suivants? respiratory noise and exercise intolerance. Upper respiratory A. Carnitine endoscopy reveals incomplete abduction of the left cornicu- B. Vitamine A late process. The diagnosis is which of the following? C. Taurine A. Laryngeal hemiplegia D. Magnésium B. Dorsal displacement of the soft palate E. Acide linoléique C. Epiglottic entrapment D. Arytenoid chondrosis 4. Un hongre Thoroughbred âgé de 3 ans est examiné à cause de bruits respiratoires et d’intolérance à l’effort. L’endoscopie des voies respiratoires supérieures révèle l’abduction incom- plète du processus corniculé gauche. Quel est le diagnostic? A. Hémiplégie laryngée B. Déplacement dorsal du palais mou C. Entrappement épiglottique D. Chondrose aryténoïdienne

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5. A 3-year-old Holstein has severe and rapidly progressive 5. Une Holstein âgée de 3 ans présente un ballonnement du rumen bloat after engorgement on lush alfalfa pasture. The rumen sévère à progression rapide après s’être empiffrée tuber coxae are barely visible, oral and vaginal mucosae are sur un pâturage de luzerne luxuriant. Les tubérosités coxales blue, and the animal is severely dyspneic and staggering. sont à peine visibles et les muqueuses orale et vaginale sont Which of the following is an appropriate intervention? bleutées; la vache est gravement dyspnéique et elle chan- A. Observation celle. Laquelle des interventions suivantes est appropriée? B. Oral surfactants A. Observation C. Emergency rumenotomy B. Administration orale de surfactants D. Percutaneous intraruminal surfactants C. Ruminotomie d’urgence E. Elevation of forequarters and mild exercise D. Administration intraruminale de surfactants TESTÉCLAIR E. Élévation des membres antérieurs et exercice léger

(See p. 956 for answers./Voir les réponses à la page 956.)

Questions and answers were derived from Review Questions and Answers Les questions et les réponses sont extraites de Review Questions and for Veterinary Boards 2nd ed., a 5-volume series including Basic Sciences, Answers for Veterinary Boards 2nd ed., une série de cinq ­volu­mes qui Clinical Sciences, Small Animal Medicine and Surgery, Large Animal ­comprend Basic Sciences, Clinical Sciences, Small Animal Medicine and Medicine and Surgery, and Ancillary Topics, by kind permission of the Surgery, Large Animal Medicine and Surgery, et Ancillary Topics, avec publisher, Mosby–Year Book, Inc., St. Louis, Missouri. l’aimable permission de ­l’éditeur, Mosby–Year Book, Inc. de St. Louis (Missouri).

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NEWS | NOUVELLES

Farewell Letter to My Fellow Lettre à mes camarades étudiants Veterinary Students en médecine vétérinaire hat a year 2019–2020 has been! Congratulations to the uelle année qui s’achève! Un immense bravo aux cohortes Wgraduating class of 2020, especially given the exceptional Q2020 des cinq facultés de médecine vétérinaire cana- circumstances that the world and our profession has faced. diennes qui terminent leur parcours dans des circonstances plus I would like to first acknowledge the efforts of all personnel qu’exceptionnelles. who ensured completing the academic year was possible and Je me dois de souligner les efforts colossaux du personnel who are currently working hard to ensure a safe back-to-school de nos écoles vétérinaires qui a rendu cet exploit possible et qui season. It’s been remarkable to see such resilience within our poursuit son travail afin de permettre une rentrée sécuritaire pour veterinary community and, I believe, this will inspire veterinary tous. La résilience dont fait preuve la communauté vétérinaire en students for the upcoming school year. Rest assured that the ces temps incertains est exemplaire et inspirera, je l’espère, les Students of the CVMA (SCVMA) will continue to support you étudiants à continuer de s’adapter à ce contexte particulier. Soyez through your academic progress. assurés que votre Comité des étudiants de l’ACMV (ÉACMV) It has been a privilege to serve as SCVMA president and hav- restera attentif à vos préoccupations et continuera à vous épauler ing the opportunity to sit on the Canadian Veterinary Medical tout au long de votre parcours académique. Association (CVMA) Council. Thank you to the members of Ce fut un immense privilège pour moi de représenter l’ensemble the CVMA Council for their warm welcome. des étudiants canadiens en médecine vétérinaire au Conseil de Now more than ever, veterinary medicine is relevant to public l’Association canadienne des médecins vétérinaires (ACMV) pour health decisions and current events. The importance to unite the l’année 2019-2020. Je suis extrêmement reconnaissante de cette voice of animal health professionals has taken on a whole new opportunité d’apprentissage unique et je remercie les membres du meaning and I have been lucky, through the CVMA, to witness Conseil de l’ACMV pour leur accueil chaleureux. how Canadian veterinarians pulled together in times of adversity. Plus que jamais, le rôle des médecins vétérinaires en matière Before I sign off, I would like to take this opportunity de santé publique est au cœur de l’actualité. L’importance d’unifier to acknowledge and thank my fellow 2019–2020 SCVMA la voix des membres de la communauté des professionnels de la Committee. Senior representatives Rachel Loppe (University santé animale prend tout son sens et ce fut pour moi une chance of Calgary — Faculty of Veterinary Medicine), Vanessa Fussell incroyable de voir, à travers l’ACVM, comment les médecins vété- (Western College of Veterinary Medicine), Meredith Garcia rinaires canadiens se serrent les coudes face à l’adversité. (Ontario Veterinary College) and Emma Bush (Atlantic En terminant, je souhaite souligner le travail du Comité des Veterinary College); and junior representatives, it has ben an étudiants 2019-2020 de l’ACMV. À mes collègues représentantes absolute pleasure working alongside you. I feel we also owe a tre- Rachel Loppe (University of Calgary – Faculty of Veterinary mendous thanks to Natalie Morrissey, student CVMA liaison, Medicine), Vanessa Fussell (Western College of Veterinary for her support in helping with the various SCVMA initiatives. Medicine), Meredith Garcia (Ontario Veterinary College) et Emma The upcoming year will require resourcefulness from our Bush (Atlantic Veterinary College) ainsi qu’aux représentantes Canadian student community to maintain and develop the juniors, ce fut un réel plaisir de travailler avec vous. Un immense important relationships between the 5 veterinary colleges. I am merci également à Natalie Morrissey, agente de liaison des confident that with Svetlana Ponsin (WCVM) taking over as étudiants de l’ACMV, pour son support essentiel à la réalisation SCVMA president, veterinary students will be well represented de nos projets. on a national level and will keep on taking part in the continu- L’année scolaire qui s’amorce promet de mettre de l’avant ous growth of our wonderful profession. l’ingéniosité de notre communauté étudiante canadienne afin Welcome back to school one and all! de maintenir et développer les liens qui se sont créés à travers (by Audrey Roy, SCVMA President 2019–2020) les facultés. Avec l’arrivée de Svetlana Ponsin à la présidence des ÉACMV, les étudiants en médecine vétérinaire seront sans l’ombre d’un doute très bien représentés à l’échelle nationale et continueront de contribuer à la progression constante de notre belle profession. Bonne rentrée à tous! (par Audrey Roy, présidente des ÉACMV 2019-2020)

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N Students of the CVMA (SCVMA): Étudiants de l’ACMV (ÉACMV) : A Year in Review Bilan annuel his past year has been a big one for the veterinary profession ette dernière année a été importante pour la profession vété- Tin Canada. As a veterinary student finishing my 2nd year of Crinaire au Canada. En tant qu’étudiante en fin de deuxième study, while also completing my 2nd and final year as a SCVMA année du programme de médecine vétérinaire et de représentante representative for the Atlantic Veterinary College (AVC), I have des étudiants de l’ACMV pour l’Atlantic Veterinary College (AVC) been privileged to experience this both at my school and on the terminant la deuxième et dernière année de son mandat, j’ai eu national level. le privilège d’en faire l’expérience à la fois dans mon école et à I have wanted to be a veterinarian for as long as I can l’échelle nationale. remember, inspired from an early age by the stories of British Je veux être vétérinaire depuis aussi longtemps que je me veterinarian James Herriot and by my family’s motley assort- souvienne, inspirée dès mon plus jeune âge par les histoires du ment of hobby farm animals. Throughout the years I have been vétérinaire britannique James Herriot et par l’assortiment hété- passionate about animal health, welfare, and sport, being an roclite d’animaux de ferme de ma famille. Au fil des ans, j’ai été active participant in leadership roles in my local 4-H club and passionnée par la santé et le bien-être des animaux ainsi que competing in dressage horse shows throughout North American le sport – je me suis engagée activement et j’ai fait preuve de with my mare Sophie. leadership au sein de mon club 4-H local et j’ai participé à des I was overjoyed to realize my life-long goal and start at the concours de dressage un peu partout en Amérique du Nord avec Atlantic Veterinary College in the fall of 2018 and knew right ma jument Sophie. away that I wanted to be involved in the larger veterinary com- C’est avec bonheur que j’ai commencé ma formation à l’AVC à munity. The opportunity to write, travel, network and make my l’automne 2018, et j’ai tout de suite su que je voulais m’impliquer voice heard nationally made work with the SCVMA incredibly dans la communauté vétérinaire. L’opportunité d’écrire, de voyager, appealing and I was thrilled to be accepted to the 2-year term as de réseauter et de faire entendre ma voix à l’échelle nationale a the AVC’s SCVMA representative. rendu le travail avec les ÉACMV très attrayant, et j’ai été ravie qu’on I started my 2nd year as the AVC SCVMA representative me confie un mandat de deux ans en tant que représentante de by attending the Annual CVMA Convention in Toronto in l’AVC au sein du Comité des ÉACMV. July 2019. This was an amazing opportunity to continue build- La deuxième année de ce mandat a débuté par ma participa- ing relationships with other incoming senior representatives and tion au Congrès annuel de l’ACMV à Toronto en juillet 2019, qui allowed me to engage with other students and network with lead- a été pour moi une occasion incroyable de nouer des relations, ers in the veterinary field. Having the chance to meet so many d’échanger avec d’autres représentants et étudiants et de réseauter

Rachel Loppe (left) and Emma Bush Rachel Loppe (à gauche) et Emma Bush

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avec des leaders dans le domaine vétérinaire. Avoir eu la chance N de rencontrer autant de professionnels influents et passionnés a été très inspirant. Cela m’a également permis d’assister à des discussions d’experts, à des conférences, à des réunions, et aussi de participer au programme des futurs leaders. Ces activités m’ont aidée à développer ma voix et à préciser mes objectifs liés à la profession vétérinaire en discutant avec les membres de l’ACMV et des ÉACMV. Ces expériences m’ont incitée à m’impliquer davan- tage dans ma communauté vétérinaire scolaire. De retour à l’école à l’automne, j’ai établi un partenariat avec la Dre Karen MacMillan, représentante du groupe consultatif de l’ACMV de liaison avec les étudiants pour l’AVC, dans le but d’orga- niser la conférence « Une voix ». Cette conférence donne aux étu- diants un aperçu de l’ACMV et de ses initiatives et comprend une Emma Bush discussion sur un sujet d’actualité, qui était cette année l’utilisation des animaux pour les sports et la compétition, en particulier dans influential and passionate people in the profession was incredibly les rodéos, ce qui a généré des échanges animés et intéressants inspiring. It also allowed me to participate in panels, lectures, entre les présentateurs et les étudiants. meetings and the Emerging Leaders Program. Through this I fur- Le semestre d’hiver a été encore plus excitant alors que ther developed my voice and goals as they relate to the veterinary plusieurs étudiants en médecine vétérinaire se sont rendus à profession by active participation in discussions with members of Saskatoon, en Saskatchewan, pour assister au Symposium annuel. the CVMA and SCVMA. From these experiences I was inspired Cet événement est spécial et important, car il est organisé pour to get further involved in my vet school community. les étudiants, par les étudiants. Le Symposium de cette année, Returning to school in the fall, I partnered with Dr. Karen dont le thème était axé sur le bien-être et la santé, a réuni plus MacMillan, CVMA Student Liaison Advisory Group representa- de 200 étudiants. J’ai assisté à des conférences sur des sujets tive from AVC, to organize the One-Voice lecture. This lecture allant du bien-être des animaux et du mieux-être des médecins gives students an overview of the CVMA and its initiatives and vétérinaires à la recherche sur les chevaux de l’île de Sable en includes a “hot topic” discussion. This year’s “hot topic” was passant par la santé des abeilles et un atelier sur l’insémination Animals for Use in Sport and Competition, specifically rodeos, artificielle chez les bovins. À ce stade de mes études, il s’agissait which allowed for a lively and engaging discussion between pour moi d’une exploration de différentes facettes de la formation presenters and students. et de nouvelles expériences pratiques, qui a piqué mon intérêt The winter semester was even more exciting as veterinary concernant les possibilités de recherche au Canada et ce que je students travelled to Saskatoon, Saskatchewan to attend the peux anticiper au cours de mes prochaines années d’études. annual Symposium conference. This conference is particularly Mon point culminant personnel de l’événement a été « l’expé- important as it is organized for students, by students. The theme rience culturelle » vécue à Saskatoon par des activités hors de was “Wellness, Welfare, and Well-being” and was attended by l’ordinaire, comme faire de la raquette à 240 °C et en apprendre over 200 students. I participated in lectures on topics ranging davantage sur la culture autochtone au Wanuskewin Heritage from animal and veterinary welfare to current research on Sable Park. Un grand merci à Vanessa Fussell et à Svetlana Ponsin, Island horses, honey-bee health, and bovine artificial insemina- représentantes du WCVM au Comité des ÉACMV, d’avoir organisé tion labs. At this stage in my studies these were new facets of ce Symposium très attendu! education and hands-on experiences and, as such, made me Après ces moments forts, l’année scolaire s’est terminée de excited about research opportunities in Canada, as well as for manière inattendue et difficile avec la COVID-19 qui a provoqué what I can anticipate in my coming years of study. une transition subite vers l’apprentissage virtuel en ligne. Ce n’était My personal highlight from the conference was the “cultural pas la façon dont j’avais prévu de terminer ma deuxième année, et experience” in a few true Saskatoon pursuits including snow je sympathise avec tous les étudiants qui commencent leurs stages shoeing in 240°C weather and learning about indigenous ou terminent leur formation d’une façon aussi déconcertante. culture at Wanuskewin Heritage Park. Considerable thanks are Cependant, malgré la tristesse du deuil des remises de diplômes due to WCVM SCVMA representatives Vanessa Fussell and et des adieux, j’ai eu la chance d’être témoin du dévouement de Svetlana Ponsin for organizing this highly anticipated event! nombreux professionnels, professeurs et étudiants. Même si nous Despite the many highs, the school year ended in an unex- sommes déçus, nous devons garder espoir que nous serons bientôt pected and challenging way with COVID-19 sparking change to de nouveau réunis et trouver du réconfort dans le fait que nous online virtual learning. This was not the way I had anticipated nous soutenons tous les uns les autres. completing my 2nd year and my heart goes out to my fellow Je tiens à remercier l’ACMV et le Comité des ÉACMV du fond students as they enter and exit their rotations and years respec- du cœur pour les expériences incroyables que j’ai vécues grâce tively in completely unforeseen ways. However, through the au poste de représentante que j’ai occupé durant deux ans. Les sadness of lost graduations and goodbyes, I have witnessed the relations que j’ai tissées sont inestimables et seront à jamais ché- dedication of many professionals, faculty and students. Despite ries. Merci à mes consœurs représentantes des ÉACMV Audrey

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N disappointment, hope has risen that we will be together again Roy (FMV), Meredith Garcia (OVC), Vanessa Fussell (WCVM) soon and that, even apart, we are supported by one another. et Rachel Loppe (UCVM) pour leur amitié et leur dévouement I would like to thank the CVMA and SCVMA from the partagé pour la reconnaissance et l’amélioration de notre future bottom of my heart for the incredible experiences through profession. volunteering for this 2-term position. The opportunities and J’encourage toute personne intéressée à s’impliquer – si c’est relationships I have made are invaluable and will be forever votre cas, communiquez avec votre représentant actuel. Je suis cherished. Thank you to my fellow SCVMA senior representa- reconnaissante pour les souvenirs impérissables, les amitiés à vie tives Audrey Roy (FMV), Meredith Garcia (OVC), Vanessa et les nombreuses opportunités que ma participation au Comité Fussell (WCVM), and Rachel Loppe (UCVM) for their friend- des ÉACMV m’a apportés. ship and shared dedication to the appreciation and betterment (par Emma Bush, représentante de l’AVC au of this profession. Comité des ÉACMV, promotion de 2022) I encourage anyone interested in getting involved, please reach out to your current SCVMA representative. I am grateful for the amazing memories, life-long friendships, and the many opportunities given to me through the SCVMA. (by Emma Bush, AVC SCVMA Sr. Representative, Graduating class of 2022)

Get to know the 2020–2021 Rencontrez les représentants des Students of the CVMA (SCVMA) étudiants auprès de l’ACMV pour Senior Representatives! l’année 2020-2021! he Students of the Canadian Veterinary Medical Association e Comité des étudiants de l’Association canadienne des T(SCVMA) was established to provide a student forum in Lmédecins vétérinaires (ÉACMV) a été créé pour regrouper les veterinary medicine and to allow for the exchange of students’ étudiants en médecine vétérinaire et permettre l’échange d’idées ideas and information with the profession, the CVMA, and et d’information entre les étudiants et la profession, l’ACMV et other relevant organizations. The SCVMA facilitates the com- d’autres organisations pertinentes. Le Comité des ÉACMV facilite munication between the CVMA Council and students at the la communication entre le Conseil de l’ACMV et les étudiants des 5 Canadian Veterinary Colleges. cinq écoles de médecine vétérinaire canadiennes. Introducing Svetlana Ponsin, SCVMA Svetlana Ponsin, présidente des ÉACMV president, representing the Western et représentante du Western College of College of Veterinary Medicine (WCVM) Veterinary Medicine (WCVM) Growing up on her family’s grain Ayant grandi dans la ferme de céréales et de pommes de terre de and potato farm in St. Eustache, sa famille à St. Eustache, au Manitoba, Svetlana a approfondi ses Manitoba, Svetlana gained an appre- connaissances et s’est découvert une passion durant sa formation ciation for agriculture and devel- en productions animales à la faculté d’agriculture de l’Université du oped a passion for animal produc- Manitoba. Elle a d’ailleurs profité de cette période pour travailler et tion while attending the University faire du bénévolat dans plusieurs fermes et établissements vétéri- of Manitoba where she pursued naires, y compris à la station de recherche Glenlea de l’Université, an Animal Systems degree in the à l’Anderson Animal Hospital et au Veterinary Diagnostic Services Faculty of Agriculture. While in uni- Laboratory pour acquérir de l’expérience et élargir ses connais- versity, she worked and volunteered sances sur les animaux et la médecine vétérinaire. on various livestock operations and En 2018, Svetlana a franchi une étape importante vers la Svetlana Ponsin at veterinary clinics including the concrétisation de son rêve d’enfance de devenir vétérinaire university’s Glenlea Research Station, Anderson Animal Hospital, ­lorsqu’elle a été admise au WCVM. Actuellement, Svetlana est la and the Veterinary Diagnostic Services Lab to gain experience représentante de VetPrep pour sa promotion, et fait partie de divers and broaden her knowledge of animals and veterinary medicine. groupes, dont le club équin et le comité des articles promotionnels In 2018, Svetlana realized her childhood dream of pursu- de sa classe. Elle est également membre étudiante de l’American ing veterinary medicine when she was accepted to WCVM. Association of Swine Veterinarians et de l’Association canadienne Currently, Svetlana is the VetPrep representative for her class, and des vétérinaires porcins. Pendant ses temps libres, elle aime participates in a variety of clubs, including the equine club and jouer de la flûte (elle est d’ailleurs joueuse de piccolo au sein de her class’s Merch (merchandise) Committee. She is also a student l’orchestre de chambre du WCVM) et passer ses vacances d’été

932 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY member of the American Association of Swine Veterinarians and avec des chevaux en faisant de la randonnée et en participant à N of the Canadian Association of Swine Veterinarians. In her free des courses de barils. time, she enjoys playing the flute and is a piccolo player in the Elle a acquis une expérience précieuse au cours des deux WCVM Chamber Orchestra, and over summer break enjoys derniers étés en travaillant pour Swine Health Professionals, une spending time with horses, barrel racing and trail riding. pratique vétérinaire exclusivement porcine, et plus récemment à She has gained valuable experience over the last 2 summers la Woodlands Veterinary Clinic, une pratique mixte, et elle prévoit working for Swine Health Professionals, an all-swine veteri- retourner au Manitoba pour travailler dans une pratique mixte nary practice, and more recently in a mixed animal practice at offrant un accès aux soins vétérinaires dans les communautés Woodlands Veterinary Clinic, and plans to return to Manitoba rurales. to work in mixed practice, providing access to veterinary care Svetlana est honorée de représenter les étudiants en médecine for rural communities. vétérinaire et d’être la présidente des ÉACMV pour l’année scolaire Svetlana is honored to be your SCVMA president and repre- 2020-2021. sent veterinary students for the 2020–2021 school year. Pour communiquer avec Svetlana, envoyez-lui un courriel To contact Svetlana, please e-mail her ([email protected]). ([email protected]). Next, meet Kelcey King, SCVMA Kelcey King, représentante des ÉACMV de representative for the University of la Faculty of Veterinary Medicine de Calgary — Faculty of Veterinary l’Université de Calgary (UCVM) Medicine (UCVM) Kelcey a grandi dans une petite ferme de Spruce Grove, en Alberta, Kelcey grew up on a small acreage avec plusieurs animaux, dont des chats, des chiens, des lapins, farm in Spruce Grove, Alberta with des hamsters, des cochons d’Inde, des chevaux et un cochon viet- a variety of animals including cats, namien. Elle a eu la chance de pouvoir avoir tous les animaux de dogs, rabbits, hamsters, guinea pigs, compagnie qu’elle voulait, à condition d’être responsable de leurs horses, and a potbelly pig. She was soins. Elle a reçu son premier cheval à son huitième anniversaire, fortunate to have whatever pet she et a ensuite joint le club 4-H et le Poney-club canadien. wanted, under the condition that Kelcey s’est impliquée dans le saut d’obstacles et les Jeux she was responsible for its care. She du prince Philip comme cavalière et comme entraîneuse d’autres was given her first horse on her participants au niveau national. Tout en obtenant son baccalauréat 8th birthday and from there jumped en sciences de l’Université MacEwan, elle est restée active dans into the horse world by joining 4-H la communauté équine en faisant du bénévolat à la Little Bits Kelcey King and the Canadian Pony Club. Therapeutic Riding Association et a été cavalière d’entraînement Kelcey became involved in show jumping and the Prince dans une écurie de chasse lors d’un échange éducatif en Irlande. Philip Games where she competed and coached at the national Après avoir obtenu son baccalauréat, Kelcey a déménagé à level. While earning her Bachelor of Science (BSc) degree at Saint John’s, à Terre-Neuve, pour terminer sa maîtrise en microbio- MacEwan University, she remained active in the horse com- logie portant sur la résistance aux antibiotiques. C’était la première munity by volunteering at Little Bits Therapeutic Riding fois que Kelcey n’avait pas d’animaux pour lui tenir compagnie. Association and became an exercise rider at a hunting barn Comme elle s’en ennuyait beaucoup, elle a commencé à faire du while on an educational exchange in Ireland. bénévolat à la SPCA locale et a travaillé comme aide-vétérinaire After completing her BSc, Kelcey moved to St. John’s, dans une clinique vétérinaire. Avant longtemps, elle avait deux rats Newfoundland to complete her Master of Science (MSc) degree de compagnie, un chat de la SPCA, un beagle de Beagle Paws… in microbiology with a focus on antibiotic resistance. It was the et une nouvelle passion pour la médecine vétérinaire! Kelcey a first time Kelcey didn’t have pets to keep her company. Missing obtenu son diplôme de maîtrise et a ensuite été admise à l’UCVM. them greatly, she started volunteering at the local SPCA and Kelcey retourne à Terre-Neuve durant l’été pour travailler dans worked as a veterinary assistant at a vet clinic. Before long, une clinique vétérinaire pour petits animaux. Elle s’est récemment she had 2 pet rats, a cat from the SPCA, a beagle from Beagle découvert un nouvel amour pour les vaches, donc elle passe aussi Paws, and a love for veterinary medicine. Kelcey completed her quelques semaines à aider un ami de la famille durant la saison MSc degree and was accepted into UCVM. des vêlages dans son ranch de 3000 têtes. Kelcey travels back to Newfoundland in the summer to work Depuis qu’elle a rejoint la cohorte de 2022 de l’UCVM, Kelcey at a small animal veterinary practice and has developed a new- est devenue membre de nombreux clubs. Elle est à la fois heureuse found love of cows. She spends a couple weeks helping a family et honorée d’avoir été choisie comme représentante des étudiants friend during calving season on their 3000-head cattle ranch. de l’UCVM au sein du Comité des ÉACMV. Since joining the UCVM Class of 2022, Kelcey has become Vous pouvez joindre Kelcey par courriel ([email protected]). a member of numerous clubs and is excited and honored to be Katie McQueen, représentante des ÉACMV chosen for her role as the SCVMA committee representative de l’Atlantic Veterinary College for UCVM. Katie vient de Burlington, en Ontario. Bien qu’elle n’ait pas grandi To contact Kelcey, please e-mail her ([email protected]). sur une ferme, Katie a passé une grande partie de son enfance et de son adolescence dans une écurie, à travailler et à monter à

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N Then there’s Katie McQueen, SCVMA cheval. Après avoir terminé un stage coopératif durant ses études representative for the Atlantic Veterinary secondaires dans un centre de référence pour la chirurgie et les College (AVC) urgences équines dans le sud de l’Ontario, elle a continué à travail- Katie grew up in Burlington, ler à cet endroit pendant huit mois supplémentaires avant de partir Ontario. Although she did not grow étudier à l’université. Katie a fréquenté l’Université Dalhousie, au up on a farm, Katie spent much of campus agricole à Truro, en Nouvelle-Écosse, où elle a obtenu un her childhood and teenage years in baccalauréat en sciences (agriculture) avec majeure en sciences a barn, working and riding horses. animales. After completing a high school co-op Au cours de ces années, son amour et son intérêt pour l’agri- placement at an Equine Surgical culture et le bétail ont grandi. Elle a travaillé dans une ferme and Emergency Referral Center laitière et a participé à un projet de recherche sur l’amélioration in Southern Ontario, she went de la fertilité des moutons. Katie a également équilibré le côté on to work for them for an addi- académique de ses études universitaires avec le sport, en étant athlète universitaire dans les équipes de rugby et d’équitation et Katie McQueen tional 8 months before leaving for University. Katie attended Dalhousie entraîneuse de CrossFit. University at their Agricultural campus in Truro, Nova Scotia, Après avoir obtenu son diplôme, Katie a déménagé à Sydney, obtaining a BSc (Agriculture) with a major in Animal Science. en Nouvelle-Écosse, où elle a travaillé comme aide-vétérinaire dans During these years, her love and interest for agriculture and une clinique pour petits animaux afin de pouvoir obtenir le statut livestock animals grew. She worked on a dairy farm and assisted de résidente des Provinces de l’atlantique pour pouvoir faire une with a research project on improving fertility in sheep. Katie demande d’admission à l’AVC de l’Île-du-Prince-Édouard. En 2019, also balanced her academics as a varsity athlete on the rugby and Katie a été admise à l’AVC dans la promotion de 2023. equestrian teams and as a CrossFit coach. Elle est actuellement coprésidente par intérim du club de After graduation, Katie moved to Sydney, Nova Scotia where médecine intégrative et trésorière du club de thériogénologie. Ses she worked as a veterinary assistant at a small animal clinic so she intérêts en médecine vétérinaire incluent la médecine sportive could obtain her Atlantic residency to apply to AVC in Prince équine, la thériogénologie et la pathologie; elle aime apprendre et Edward Island. In 2019 Katie was delighted to be accepted to n’a aucun doute que son cheminement de carrière anticipé chan- AVC as part of their incoming Class of 2023. gera plusieurs fois au cours des prochaines années. Currently, she is acting co-president for the Integrative Pour communiquer avec Katie, n’hésitez pas à lui envoyer un Medicine Club and treasurer for the Theriogenology Club. Her courriel ([email protected]). interests in veterinary medicine include equine sports medi- Peyton Tam, représentante des ÉACMV cine, theriogenology and pathology; she loves learning and has de l’Ontario Veterinary College (OVC) no doubt her desired career path will change multiple times Originaire de Toronto, en Ontario, Peyton sait qu’elle veut être throughout the next few years. vétérinaire depuis toujours. Son amour des animaux et de l’envi- To contact Katie, please e-mail her ([email protected]). ronnement l’a inspirée à se porter volontaire pour des organisations And meet Peyton Tam, SCVMA comme Community Veterinary Outreach et à exceller sur le plan representative for the Ontario Veterinary académique. Elle voulait fréquenter l’Université de Guelph pour des College (OVC) études de premier cycle afin de se rapprocher de la réalisation de Peyton is from Toronto, Ontario son rêve d’être admise à l’OVC. and has wanted to be a veterinarian En 2016, elle a entrepris ses études universitaires en biologie for as long she can remember. Her animale en recevant la bourse Lincoln Alexander – l’une des love for animals, and the environ- bourses les plus prestigieuses de l’Université. Cette bourse est ment, inspired her to volunteer for décernée à un étudiant qui obtient d’excellentes notes et qui fait organizations such as Community preuve de leadership en ayant une présence importante au sein de Veterinary Outreach, as well as excel la communauté. Cette bourse lui a ouvert de nombreuses portes academically. She knew she wanted au cours de ses années d’études de premier cycle, telles que des to attend the University of Guelph assistanats de recherche, la représentation de l’Université lors for undergraduate studies to get one d’événements publics et l’accès à du mentorat. Peyton a travaillé sur des projets de recherche allant de la santé des petits ruminants Peyton Tam step closer to realizing her dream of attending OVC. à l’oncologie comparative. Elle a été admise à l’OVC après avoir In 2016, she began her academic career as an Animal Biology terminé trois années de son programme de premier cycle, et est major by receiving the Lincoln Alexander Scholarship — one of reconnaissante envers les gens et les enseignants merveilleux the University’s most prestigious scholarships. This scholarship qu’elle a rencontrés. is awarded to a student with high academics and a significant Bien qu’elle l’ait trouvée intimidante au début, Peyton s’est leadership presence within his/her community. It opened many adaptée à la vie d’étudiante en médecine vétérinaire, et elle doors during her undergraduate years such as research assistant- a pu apprécier diverses activités parascolaires comme siéger ships, representing the university at public events, and mentoring à la Central Veterinary Student Association (CVSA) et être la

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guidance. Peyton worked on research projects ranging from small ­représentante des ÉACMV de l’OVC. Peyton est également la N ruminant health to comparative oncology. She was accepted to présidente du Symposium des ÉACMV qui se tiendra à l’OVC en OVC after completing 3 years of her undergraduate degree and 2021. Quand elle n’est pas sur le campus de l’OVC, elle aime pas- is grateful for the wonderful people and teachers she met. ser du temps avec ses amis, sa famille, son chien et son chat. Elle Although overwhelming at first, she settled into veterinary reste active en jouant au hockey dans l’équipe mixte de l’école et school life and has enjoyed extracurricular activities such as sit- en faisant des activités de plein air. Peyton est très reconnaissante ting on the Central Veterinary Student Association (CVSA), and d’avoir l’opportunité de représenter l’OVC en tant qu’ambassadrice being the SCVMA representative for OVC. Peyton is also the de l’ACMV. SCVMA Symposium Chair for the upcoming 2021 Symposium Vous pouvez communiquer avec Peyton en lui envoyant un to be held at OVC. When she is not on the OVC campus, she courriel ([email protected]). enjoys spending time with her friends, family, and her dog and Charlotte Nury, représentante des ÉACMV cat. She stays active by playing hockey on the co-ed school team pour la seule école vétérinaire canadienne and doing outdoor activities. Peyton is very grateful for the francophone, la Faculté de médecine opportunity to represent OVC as a CVMA ambassador. vétérinaire (FMV) de l’Université de To contact Peyton, please e-mail her ([email protected]). Montréal Finally, meet Charlotte Nury, SCVMA Ayant grandi à la campagne près de Québec, Charlotte a passé la representative for the only French-speaking majeure partie de son enfance à l’extérieur à découvrir la grande Canadian veterinary school, the Faculté de biodiversité de sa cour arrière. Sa famille et elle ont accueilli leur médecine vétérinaire (FMV) de l’Université juste part d’animaux divers – des lapins et lièvres aux faisans de Montréal en passant par les bernaches et les canards – en plus de leur Born and raised in the country- Labrador. Charlotte a décidé de poursuivre sa passion pour la side near Quebec City, Charlotte nature en obtenant un diplôme technique en gestion de l’environ- spent most of her childhood out- nement et de la faune du Cégep de Sainte-Foy. doors discovering the great biodi- Après avoir obtenu son diplôme, Charlotte a décidé de faire versity in her backyard. Growing une pause de deux ans pour évaluer ce qu’elle voulait faire ensuite up, her family fostered their fair et, après avoir passé un an dans le magnifique territoire du Yukon share of animals, from rabbits and à travailler en tant que monitrice de français, Charlotte a trouvé hares to pheasants, Canada geese sa véritable vocation : la médecine vétérinaire. Admise à la FMV and ducks — in addition to their en 2018, elle souhaite combiner sa formation en biologie avec la family Labrador. Charlotte decided médecine vétérinaire pour éventuellement se concentrer sur la to pursue her passion for nature santé de la faune et la médecine zoologique, ainsi que pour par- Charlotte Nury by pursuing a Technical Diploma ticiper à la recherche transdisciplinaire en accord avec l’approche in Environmental and Wildlife Management at Cégep de « Une santé ». Sainte-Foy. Actuellement, elle fait du bénévolat à la Clinique des oiseaux After graduation, Charlotte decided to take 2 gap years to de proie, fait partie de l’association étudiante et du club sur l’envi- figure out what she wanted to do next and after spending a year ronnement et copréside le club de médecine zoologique, en plus in the beautiful Yukon Territory working as a French assistant, de travailler comme assistante de recherche. Pendant ses temps Charlotte found her true calling: veterinary medicine. She was libres, elle aime le cinéma et les activités de plein air comme la accepted to FMV in 2018 with hopes to combine her biology randonnée, le camping, le ski de fond et le canot. background with veterinary medicine to eventually focus on Charlotte est ravie de représenter ses camarades au sein du Wildlife Health and Zoological Medicine, as well as collaborate in Comité des ÉACMV, ce qui lui donne l’occasion d’encourager transdisciplinary research in tune with the One Health approach. la collaboration interuniversitaire et d’aborder les problèmes à Currently, she volunteers at the Bird of Prey Clinic, partici- l’échelle nationale. pates in the student association and the Environmental Club, Pour joindre Charlotte, envoyez-lui un courriel (charlotte.nury@ and co-chairs the Zoological Medicine Club, in addition to gmail.com). working as a research assistant. During her free time, she enjoys Si vous aimeriez vous impliquer, veuillez communiquer avec cinema and outdoor activities such as hiking, camping, cross- le Comité des ÉACMV par courriel ([email protected]). country skiing, and canoeing. Charlotte is excited to represent her fellow students on the SCVMA Committee, giving her the opportunity to encourage inter-university collaboration, as well as addressing issues on the national level. To contact Charlotte, please e-mail her (charlotte.nury@ gmail.com). If you are interested in getting involved, please contact ([email protected]).

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N Future Veterinarian Support La Banque Scotia, partenaire Continues from Scotiabank: privilégié de l’Association A Preferred Partner of the Canadian canadienne des médecins Veterinarian Medical Association vétérinaires (ACMV), continue (CVMA) d’appuyer les futurs vétérinaires cotiabank is proud to continue to support the efforts of a Banque Scotia est fière de continuer à soutenir les efforts de SThe Canadian Veterinary Journal (The CVJ) to keep students LLa Revue vétérinaire canadienne (La RVC) visant à informer les informed about the industry during their studies. Since 2015, étudiants de ce qui se passe dans l’industrie pendant leurs études. Scotiabank has supported the program, offering veterinary Depuis 2015, la Banque Scotia soutient le programme en offrant students across Canada a subscription to The CVJ at no cost. aux étudiants en médecine vétérinaire de partout au Canada un Scotiabank understands the importance of staying informed abonnement à La RVC sans frais. about current issues and topics for professionals within the vet- La Banque Scotia comprend l’importance de se tenir au courant erinary community across the country, especially during these des enjeux et des sujets d’actualité pour la communauté vétérinaire unusual and unprecedented times. By providing access to issues partout au pays, surtout en ces temps inédits et sans précédent. of The CVJ, Scotiabank demonstrates an ongoing commitment En fournissant La RVC aux étudiants, la Banque Scotia démontre to the profession. un engagement continu envers la profession. As the CVMA’s preferred financial services provider, En tant que fournisseur de services financiers privilégié de Scotiabank designed the Scotia Professional Student Plan program l’ACMV, la Banque Scotia a conçu le programme Professions to meet the unique needs and goals of professional students. For libérales Scotia pour étudiants afin de répondre aux besoins et practicing professionals, the Scotia Professional Plan provides objectifs uniques des étudiants inscrits à certains programmes everything needed to help them become financially better off, universitaires. Pour les professionnels en pratique, le programme both personally and professionally. Professions libérales Scotia offre tout ce dont vous avez besoin pour Additional resources are provided to veterinary students réussir financièrement, tant sur le plan personnel que professionnel. at each faculty across Canada under Scotiabank’s Faculty Des ressources supplémentaires sont fournies aux étudiants en Representative Program; this program ensures a dedicated advi- médecine vétérinaire du Canada dans le cadre du programme des sor is assigned to address the needs of veterinary students at each représentants de la Banque Scotia, qui fait en sorte qu’un conseiller university. The Scotiabank faculty representatives are listed below dédié est affecté aux besoins des étudiants en médecine vétéri- for your convenience. Scotiabank wishes to thank the CVMA naire de chaque université. Les représentants de la Banque Scotia student representatives who are distributing the journal to their pour chaque école vétérinaire canadienne sont listés ci-dessous. La fellow students on campus. Banque Scotia souhaite remercier les représentants des étudiants For more information about Scotiabank’s services for profes- de l’ACMV qui distribuent La RVC sur le campus. sional students, please visit: (https://www.scotiabank.com/ca/en/ Pour en savoir plus sur les services offerts par la Banque small-business/business-banking/industries/student-professionals. Scotia aux étudiants professionnels, visitez le site Web de la html). Banque Scotia (https://www.scotiabank.com/ca/fr/petites-entre Or meet with a Scotiabank advisor today. prises/bancaires-dentreprises/secteurs-dactivit/solutions-pour- etudiants.html) ou rencontrez un conseiller de la Banque Scotia dès aujourd’hui.

Faculty representative University/Université Représentant E-mail/Courriel Telephone/Téléphone Calgary Inder Arora [email protected] 403-801-6509 Ahmed El-Dani [email protected] 403-880-4867 Saskatchewan Thomas Jackson [email protected] 306-717-7613 Jordan Vandriel [email protected] 306-717-1748 Guelph Josh Campbell [email protected] 519-835-2611 Vivian Contonis [email protected] 519-766-7663, ext./poste 4200 Montreal Hida Hirbod [email protected] 514-499-5511, ext./poste 3004 Montréal Bouchra Essafi [email protected] 438-225-8199 PEI Erica Bustard [email protected] 506-440-1661 Île-du-Prince-Édouard Shelley Wilson [email protected] 902-802-4296

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2020 World Rabies Day N World Rabies Day is September 28 of Each Year Journée mondiale contre la rage 2020 La Journée mondiale contre la rage est célébrée chaque année le 28 septembre

orld Rabies Day is the first and only global day of action a Journée mondiale contre la rage est la seule et unique Wand awareness for rabies prevention. It is an opportu- Ljournée d’action et d’éducation sur la prévention de la rage à nity to unite as a community — helping individuals, NGOs, l’échelle mondiale. Elle est une occasion de s’unir en tant que com- and governments connect and share their work. The Canadian munauté, et d’aider les individus, les ONG et les gouvernements à Veterinary Medical Association (CVMA) joins countries from se concerter et à partager leur travail. L’Association canadienne des around the world to promote rabies awareness and prevention. médecins vétérinaires (ACMV) se joint aux intervenants d’autres This year’s theme focuses on vaccination and collaboration. pays du monde pour promouvoir la sensibilisation à la rage et la In brief, the theme reminds us of key current issues in rabies prévention de cette maladie. elimination, namely: Le thème de cette année est axé sur la vaccination et la col- • the goal of Zero by 30, laboration. Il nous rappelle les points clés de l’élimination de la • the importance of dog vaccination and post-exposure pro- rage, c’est-à-dire : phylaxis; and • l’objectif « zéro d’ici 2030 »; • the need for a united effort towards achieving elimination of • l’importance de la vaccination des chiens et de la prophylaxie this transboundary disease. post-exposition; et The 2020 World Rabies Day theme is “End Rabies: • la nécessité d’un effort commun pour parvenir à éliminer cette Collaborate, Vaccinate.” Every year, the Global Alliance for maladie transfrontalière. Rabies Control (GARC) team develops the annual theme with Le thème de la Journée mondiale contre la rage 2020 est consideration of significant events, major milestones, and the « Finissons-en avec la rage : collaborons et vaccinons ». primary needs to move the world towards achieving rabies Chaque année, l’équipe de la Global Alliance for Rabies Control elimination. (GARC) élabore le thème annuel en tenant compte des événe- • End rabies: a reminder that we have 10 years to end human ments importants, des jalons majeurs et des principaux besoins deaths from dog rabies and that we can raise awareness pour faire avancer le monde vers l’élimination de la rage. at the global level through the End Rabies Now (https:// • Finissons-en avec la rage : Cet élément nous rappelle que endrabiesnow.org) campaign. nous avons 10 ans pour mettre fin aux décès humains dus • Collaborate: The United Against Rabies coalition was à la rage canine et que nous pouvons sensibiliser le public formed and subsequently launched the Global Strategic du monde entier grâce à la campagne « End Rabies Now » Plan. We need to continue collaboration at the international, (https://endrabiesnow.org). national and local levels to eliminate rabies — especially • Collaborons : La coalition United Against Rabies a été formée keeping in mind that it’s a disease that knows no borders. et a ensuite élaboré un plan stratégique mondial. Nous devons • Vaccinate: A massive breakthrough was recently made in the poursuivre la collaboration locale, nationale et internationale rabies world — GAVI, The Vaccine Alliance, has included pour éliminer la rage – surtout en gardant à l’esprit qu’il s’agit rabies into its portfolio of vaccines. This means with their d’une maladie qui ne connaît pas de frontières. support, 181 000 more human deaths from rabies can be • Vaccinons : Une percée massive a récemment été réalisée prevented. We also need to remember to vaccinate dogs to dans le monde de la rage – GAVI, l’Alliance du vaccin, a inclus prevent rabies at its source so that we can reach elimination. la rage dans sa gamme de vaccins. Cela signifie qu’avec le Visit the GARC website (https://rabiesalliance.org/world- soutien de cette organisation, 181 000 décès humains sup- rabies-day) to find information on how to organize a World plémentaires dus à la rage peuvent être évités. Nous devons Rabies Day event. You will find event toolkits, awareness également nous rappeler de vacciner les chiens pour prévenir resources, and free downloadable logos in multiple languages. la rage à sa source si on veut réussir à l’éliminer. Use #WorldRabiesDay to promote your event. Visitez le site Web de la GARC (https://rabiesalliance.org/ world-rabies-day) pour obtenir de l’information sur la façon d’orga- niser un événement dans le cadre de la Journée mondiale contre la rage. Vous y trouverez des outils pour l’organisation d’activités, des ressources pour la sensibilisation du public, et des logos à télécharger gratuitement dans plusieurs langues. Utilisez les mots- clics #JournéeMondialeContreLaRage et #WorldRabiesDay pour promouvoir votre événement. La GARC propose également des cours en ligne gratuits pour améliorer les compétences et les connaissances des personnes

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N GARC also offers free online courses to improve the skills and qui travaillent dans le domaine de la sensibilisation à la rage et de knowledge of people working in rabies awareness and prevention. la prévention de cette maladie. World Rabies Day Awards 2020 Prix de la Journée mondiale contre la The annual World Rabies Day Awards recognizes Community rage 2020 Rabies Champions from across the world. The 2020 Awards Les prix annuels associés à la Journée mondiale contre la rage provide even more opportunities to share the stories of people récompensent des champions de la lutte contre la rage du monde and organizations to prevent rabies in their communities. entier. Les prix de 2020 offrent encore plus d’occasions de parta- The main aim of the World Rabies Day Awards is to recog- ger les histoires de personnes et d’organisations qui travaillent à nize and reward extra-ordinary individuals and people for their prévenir la rage dans leurs communautés. efforts towards rabies elimination. The awards focus on giving L’objectif principal des prix de la Journée mondiale contre la recognition to those who may not be receiving suitable recog- rage est de reconnaître et de souligner le travail de personnes nition for their efforts. Nominations close on September 11, extra­ordinaires visant à éliminer la rage. Les prix visent à récom- 2020. Find more information on the GARC website. penser ceux qui ne reçoivent peut-être pas une reconnaissance appropriée pour leurs efforts. Les candidatures sont acceptées CVMA offers information for pet owners jusqu’au 11 septembre 2020. Pour obtenir de plus amples ren- The CVMA offers a Rabies Fact Sheet and Rabies Prevention seignements, consultez le site Web de la GARC. Tips for Pet Owners under its animal owner section (www.animal healthcare.ca). Feel free to share this information with your L’ACMV offre de l’information aux clients or through your social media channels. propriétaires d’animaux de compagnie Working together against rabies helps people and animals live L’ACMV propose une fiche d’information sur la rage et des conseils safely together, free from rabies. de prévention de la rage à l’intention des propriétaires d’animaux de compagnie dans la section de son site Web destinée aux proprié- taires d’animaux (www.santeanimale.ca). N’hésitez pas à partager cette information avec vos clients ou par le biais de vos comptes de médias sociaux. Le travail concerté contre la rage aide les gens et les animaux à vivre ensemble en sécurité, à l’abri de la rage.

Mental Health Awareness Week Semaine de sensibilisation à la 2020 — It’s Time to Talk About santé mentale 2020 – Il est temps Mental Health in Veterinary de parler de santé mentale en Medicine médecine vétérinaire Warning: This article talks about suicide. Please decide if you feel Avertissement : Cet article parle de suicide. Prenez un moment pour safe reading it. Please reach out for help if you feel overwhelmed or réfléchir et décider si vous devriez le lire ou non. Demandez de l’aide distressed as you read this. You are not alone. Contact the Canadian si vous vous sentez bouleversé(e) ou en détresse en le lisant. Vous Suicide Support line at 1-833-456-4566 or find a call centre near n’êtes pas seul(e). Contactez le Service de prévention du suicide du you (https://www.suicideprevention.ca/Need-Help). Canada au 1-833-456-4566 ou trouvez une ressource près de chez vous (https://www.suicideprevention.ca/Need-Help). n important mental health awareness day is on the hori- Azon. Thursday, September 10, 2020 is World Suicide ne importante journée de sensibilisation à la santé mentale Prevention Day — “Working Together to Prevent Suicides.” Use profile à l’horizon. Le jeudi 10 septembre 2020 est la The International Association for Suicide Prevention works Journée mondiale de prévention du suicide, qui aura pour thème together with the World Health Organization to promote this cette année « Travaillons ensemble pour prévenir le suicide ». annual event (1). We must work together to prevent suicide, a L’Association internationale pour la prévention du suicide (IASP) significant public health problem across the world. An average of collabore avec l’Organisation mondiale de la santé pour promouvoir cet événement annuel (1). Nous devons travailler ensemble pour prévenir le suicide, un problème de santé publique important dans le monde entier. En moyenne, 10 personnes se suicident chaque jour au Canada, ce qui fait du suicide la 9e plus importante cause de décès au pays (2). Pour chaque décès par suicide, il y a 5 hos- pitalisations pour blessures auto-infligées, de 25 à 30 tentatives de suicide, et de 7 à 10 personnes dont la vie est changée à jamais (2). Bien que quiconque puisse être touché par le suicide,

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10 people die by suicide each day in Canada, making suicide the certaines populations sont plus à risque, y compris les profes- 9th leading cause of death (2). For every 1 suicide death there sionnels vétérinaires. Une étude récente a révélé que 26,2 % des are 5 self-inflicted injury hospitalizations, 25 to 30 attempts and médecins vétérinaires canadiens ont eu des pensées suicidaires au 7 to 10 people’s lives are forever changed (2). Although anyone cours des 12 derniers mois, une proportion significativement plus can be impacted by suicide, some populations are at higher risk, élevée (p , 0,001) que les 12,2 % de Canadiens qui ont déclaré including veterinary professionals. In a recent study, 26.2% of avoir sérieusement envisagé le suicide au cours de leur vie (3). Canadian veterinarians have had thoughts of suicide in the last Même si la prévention des idées suicidaires n’est pas néces- 12 months, significantly higher (p , 0.001) than the 12.2% sairement possible, la prévention des actes de suicide, elle, l’est. of Canadians reported to have seriously considered suicide in Et c’est porteur d’espoir. La prévention du suicide a de multiples their lifetime (3). facettes. Nous devons tirer parti de notre capacité individuelle à Although thoughts of suicide can’t necessarily be prevented, améliorer notre littératie en santé mentale, comprendre réellement acts of suicide can. And that is hopeful. Suicide prevention ce qu’est la santé mentale, trouver comment promouvoir une bonne is multi-faceted. We need to leverage individual capacity to santé mentale dans notre vie personnelle et professionnelle, et improve our mental health literacy, truly understand what men- vaincre la stigmatisation entourant la maladie mentale et le sui- tal health is, figure out how to promote good mental health in cide. L’une des façons d’y parvenir est de suivre des ateliers en our personal and work lives, and conquer stigma around mental personne, comme la formation de premiers soins en santé men- illness and suicide. One such way is to take face-to-face skills tale (4,5), la formation de sensibilisation au suicide safeTALK (6) training courses like Mental Health First Aid (4,5), safeTALK et la formation appliquée en techniques d’intervention face au Suicide Awareness Training (6), and Applied Suicide Intervention suicide (ASIST) (6). D’autres options, particulièrement viables Skills Training (ASIST) (6). Other options, particularly viable pendant la pandémie de COVID-19, sont des cours sur la préven- during COVID-19, are online suicide prevention courses, such tion du suicide en ligne, comme START (6), et des webinaires sur as START (6) and webinars on suicide prevention in the work- la prévention du suicide en milieu de travail conçus par le Centre place developed by the Centre for Suicide Prevention together de prévention du suicide de la Commission de la santé mentale with the Mental Health Commission of Canada (7). These du Canada (7). Ces cours nous donnent les connaissances et les courses equip us with the knowledge and skills to intervene compétences nécessaires pour intervenir auprès d’une personne with someone at risk of suicide, either in our personal life or à risque de suicide, soit dans notre vie personnelle, soit dans in our veterinary work environments. These courses make a notre milieu de travail vétérinaire. Ces cours font une différence. difference. For example, a study with veterinary students and Par exemple, une étude menée en Écosse auprès d’étudiants en staff in Scotland demonstrated that safeTALK increased their médecine vétérinaire et de personnes travaillant dans des éta- knowledge, willingness and confidence to help someone with blissements vétérinaires a démontré que la formation safeTALK a thoughts of suicide get the help they need (8). An additional augmenté leurs connaissances, leur volonté et leur confiance en way is to come together as a veterinary community to promote eux pour aider une personne aux prises avec des idées suicidaires action to prevent suicide. à obtenir l’aide dont elle a besoin (8). Une autre façon consiste à Merck Animal Health and the Canadian Veterinary se réunir en tant que communauté vétérinaire pour promouvoir des Medical Association’s (CVMA’s) annual It’s Time to Talk About actions concernant la prévention du suicide. Mental Health in Veterinary Medicine campaign features a La campagne annuelle Il est temps de parler de santé 1-hour webinar at 12 p.m. EDT on Tuesday, September 10, mentale en médecine vétérinaire de Merck Santé animale 2020 in recognition of World Suicide Prevention Day. This et de l’Association canadienne des médecins vétérinaires webinar will help us better understand risk factors for suicide (ACMV) présentera un webinaire d’une heure, à 12 h (HAE) le in veterinary medicine and increase awareness about training mardi 10 septembre 2020, pour souligner la Journée mondiale opportunities for suicide prevention. The registration link is de prévention du suicide. Ce webinaire nous aidera à mieux com- available on the CVMA website and will be shared with all prendre les facteurs de risque de suicide en médecine vétérinaire members. Suicide can be prevented, and help is available. Let’s et à accroître la sensibilisation aux possibilités de formation sur work together with a sense of shared responsibility as a v­ eterinary la prévention du suicide. Le lien pour s’inscrire est accessible sur

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N community to find hope in a suicide prevention strategy. Be le site Web de l’ACMV et sera partagé avec tous les membres. well and stay safe. Le suicide peut être évité, et de l’aide est disponible. Travaillons This article was written by Dr. Kathy Keil. Dr. Keil studied ensemble en tant que communauté vétérinaire avec un sentiment cognitive and neuropsychology in her undergraduate and graduate de responsabilité partagée pour trouver de l’espoir dans une psychology degrees prior to attending veterinary school at the Ontario stratégie de prévention du suicide. Prenez soin de vous et restez Veterinary College. She is not a licensed psychologist. She has train- en sécurité. ing in Mental Health First Aid, safeTALK suicide awareness, Cet article a été écrit par la Dre Kathy Keil. La Dre Keil a étudié la ASIST suicide intervention, Mindful Self-Compassion and Stress psychologie cognitive et la neuropsychologie durant ses programmes Reduction, and is licensed to teach safeTALK suicide awareness and d’études de premier cycle et d’études supérieures en psychologie instruct yoga. She regularly teaches mental and psychological safety avant de s’inscrire en médecine vétérinaire à l’Ontario Veterinary skills to veterinary professionals. She is a member of the Alberta College. Elle n’est pas détentrice d’un permis de psychologue. Elle and Canadian Veterinary Medical Association Member Wellness a suivi des formations sur les premiers soins en santé mentale, la Committees. Dr. Keil is a technical services veterinarian with Merck sensibilisation au suicide (safeTALK), les techniques d’intervention Animal Health and the leading force behind the Merck Animal face au suicide (ASIST), ainsi que l’autocompassion en pleine Health-Canadian Veterinary Medical Association’s “It’s Time to conscience et la réduction du stress. Elle est aussi autorisée à Talk about Mental Health in Vet Med” Awareness Campaign. donner la formation safeTALK et enseigne le yoga. Elle donne régulièrement des ateliers sur les compétences en sécurité mentale 1. Available from: https://suicideprevention.ca/WSPD Last accessed et psychologique à des professionnels vétérinaires. Elle est membre June 30, 2020. des comités sur le bien-être des médecins vétérinaires de l’Alberta 2. Available from: https://www.canada.ca/en/public-health/services/ publications/healthy-living/suicide-canada-infographic.html Last Veterinary Medical Association et de l’Association canadienne des accessed June 30, 2020. médecins vétérinaires. Médecin vétérinaire des Services techniques 3. Perret JL, Best CO, Coe JB, Greer AJ, Khosa DK, Jones-Bitton A. de Merck Santé animale, la Dre Keil est la force motrice de la cam- Prevalence of mental health outcomes among Canadian veterinar- pagne de sensibilisation « Il est temps de parler de santé mentale ians. J Am Vet Med Assoc 2020;256:365–375. en médecine vétérinaire » de l’Association canadienne des médecins 4. https://www.mhfa.ca/ During COVID MHFA offers some mini- vétérinaires et de Merck Santé animale. virtual courses online. Face-to-face MHFA courses are postponed as of June 4, 2020. 1. Disponible au : https://suicideprevention.ca/WSPD (dernière consul- 5. https://www.livingworks.net/ During COVID Living Works is offer- tation le 30 juin 2020). ing START, 1–2 hour online suicide prevention course for only $20. 2. Disponible au : https://www.canada.ca/en/public-health/services/ Face-to-face courses such as safeTALK and ASIST are postponed as publications/healthy-living/suicide-canada-infographic.html (dernière of June 4, 2020. consultation le 30 juin 2020). 6. Keil K. Mental health first aid. Can Vet J 2019;60:1289. 3. Perret JL, Best CO, Coe JB, Greer AJ, Khosa DK, Jones-Bitton A. 7. Available from: https://www.suicideinfo.ca/resource-type/webinar/ Prevalence of mental health outcomes among Canadian veterinarians. Last accessed June 30, 2020. J Am Vet Med Assoc 2020;256:365-375. 8. Mellanby RJ, Hudson NP, Allister R, et al. Evaluation of suicide 4. https://www.mhfa.ca/ (Durant la pandémie de COVID-19, MHFA pro- awareness programmes delivered to veterinary undergraduates and pose des mini-cours virtuels en ligne. En date du 4 juin, tous les cours academic staff. Vet Rec 2010;167:730–734. en personne de premiers soins en santé mentale étaient reportés à une date ultérieure non déterminée.) 5. https://www.livingworks.net/ (Pendant la pandémie de COVID-19, Living Works propose START, un cours en ligne de prévention du suicide d’une à deux heures pour seulement 20 $. En date du 4 juin 2020, les formations en personne telles que safeTALK et ASIST étaient reportées à une date ultérieure non déterminée.) 6. Keil K. Mental health first aid. Can Vet J 2019;60:1289. 7. Disponible au : https://www.suicideinfo.ca/resource-type/webinar/ (dernière consultation le 30 juin 2020). 8. Mellanby RJ, Hudson NP, Allister R, et al. Evaluation of suicide aware- ness programmes delivered to veterinary undergraduates and academic staff. Vet Rec 2010;167:730-734.

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Animal Health Week 2020 — Semaine de la vie animale du N October 4 to 10, 2020 4 au 10 octobre 2020 Understanding Zoonotic Diseases: Comprendre les zoonoses : Santé Community Health — Animals and You communautaire – Les animaux et vous nimal Health Week is an annual national public awareness a Semaine de la vie animale est une campagne nationale Acampaign organized by the Canadian Veterinary Medical Lannuelle de sensibilisation du public organisée par l’Associa- Association (CVMA) and hosted by veterinarians across Canada. tion canadienne des médecins vétérinaires (ACMV) et mise en The CVMA is proud to have celebrated Animal Health Week œuvre par les médecins vétérinaires du Canada. L’ACMV est fière across the country for 35 years! From October 4–10, 2020, de célébrer la Semaine de la vie animale partout au pays depuis the CVMA will showcase how Canada’s veterinary profession- 35 ans! Cette année, la Semaine de la vie animale aura lieu du 4 au als occupy unique positions within the national One Health 10 octobre 2020, et l’ACMV montrera comment les professionnels community to support the fight against zoonotic diseases and vétérinaires du Canada occupent des positions uniques au sein how protecting animal health, protects everyone’s health. This de la communauté nationale « Une santé » pour soutenir la lutte year’s theme, Understanding Zoonotic Diseases: Community contre les zoonoses et comment la protection de la santé animale Health — Animals and You, will empower the national veteri- protège la santé de tous. Le thème de cette année, Comprendre nary community through awareness, recognition, and knowledge les zoonoses : Santé communautaire – Les animaux et vous, of threats, in-turn improving public health and animal welfare. valorisera la collectivité vétérinaire nationale par la sensibilisation, The 2020 Animal Health Week campaign key messages are: la reconnaissance, et la prise de conscience des menaces, en plus • Zoonotic diseases may be transmitted from animals to people, d’améliorer la santé publique et le bien-être animal. but they can be easily prevented. Les points clés de la campagne de la Semaine de la vie ani- • Regular veterinary wellness checks can help protect you, your male 2020 sont les suivants : family, and your pet from zoonotic diseases. • Les maladies zoonotiques peuvent être transmises des animaux • Always wash your hands after being around animals, even if aux humains, mais elles peuvent aussi être facilement évitées. you did not touch them. • Des examens vétérinaires préventifs réguliers peuvent aider • Talk to your veterinary team for information on zoonotic à protéger votre animal et votre famille contre les maladies diseases. zoonotiques. Our 2020 Animal Health Week campaign key messages will • Lavez-vous toujours les mains après avoir été près d’animaux, be supplemented with the following proof points in the form même si vous ne les avez pas touchés. of prewritten shareable social media posts: • Parlez à votre équipe vétérinaire pour vous renseigner sur les 1. Travelling to areas where specific zoonotic diseases are preva- zoonoses. lent may require extra precautions. Speak with your veteri- Les points clés de notre campagne de la Semaine de la vie nary team about your travel plans for more information and animale 2020 seront appuyés par les messages suivants sous advice on how to protect yourself and your pets. forme de publications rédigées à l’avance et prêtes à partager sur 2. Regular veterinary wellness checks and a deworming program les réseaux sociaux : for your pets protect you, your family, and your pet. Speak 1. Voyager dans des régions où certaines maladies zoonotiques with your veterinary team for more information and advice sont répandues peut nécessiter des précautions supplémen- on zoonotic diseases. taires. Discutez avec votre équipe vétérinaire de vos projets de 3. Children under 5 years of age, adults over 65 years of age, voyage pour obtenir de l’information et des conseils sur la façon and anyone with a weakened immune system should not have de vous protéger et de protéger vos animaux de compagnie. contact with rodents, reptiles, amphibians, and poultry. Speak 2. Des examens vétérinaires préventifs réguliers et un programme with your veterinary team for more information and advice de vermifugation pour vos animaux protègent à la fois vos on zoonotic diseases. animaux et votre famille. Parlez à votre équipe vétérinaire pour obtenir de l’information et des conseils concernant les zoonoses. 3. Les enfants de moins de 5 ans, les adultes de plus de 65 ans et toutes les personnes dont le système immunitaire est affaibli ne devraient pas être en contact avec des rongeurs, des reptiles, des amphibiens, ni des volailles. Parlez à votre équipe vétéri- naire pour obtenir de l’information et des conseils concernant les zoonoses. 4. Surveiller les enfants autour des animaux, ne pas embrasser les animaux et empêcher les animaux de nous lécher sur le visage sont des moyens faciles d’aider à prévenir les zoonoses. Parlez à votre équipe vétérinaire pour obtenir de l’information et des conseils.

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N 4. Easy ways to help prevent zoonotic diseases include super- 5. Vous pouvez aider à prévenir les maladies zoonotiques en vising children around animals, not kissing animals, and gardant vos animaux et leurs choses hors de la cuisine et preventing animals from licking faces. Speak with your des autres endroits où vous préparez, servez ou mangez de veterinary team for more information and advice. la nourriture. Parlez à votre équipe vétérinaire pour obtenir de 5. Help prevent zoonotic diseases by keeping pets and their l’information et des conseils. supplies out of the kitchen or other areas where you prepare, 6. Vous pouvez aider à prévenir les zoonoses en restant à une serve, or eat food. Speak with your veterinary team for more distance sécuritaire des animaux de la faune. Parlez à votre information and advice. équipe vétérinaire pour obtenir de l’information et des conseils. 6. Help prevent zoonotic diseases by enjoying wildlife from 7. Ce qu’on ne sait pas PEUT nous faire mal. La rage, la teigne et a safe distance. Speak with your veterinary team for more la grippe ne sont que quelques exemples de maladies partagées information and advice. entre les animaux et les humains. Parlez à votre équipe vétéri- 7. What you don’t know CAN hurt you. Rabies, ringworm, and naire pour obtenir de l’information et des conseils concernant certain strains of the flu are just a few of the diseases shared les zoonoses. between animals and humans. Speak with your veterinary 8. Votre animal de compagnie peut-il vous rendre malade, ou team for more information and advice on zoonotic diseases. pouvez-vous le rendre malade? Parlez à votre équipe vétérinaire 8. Can your pet make you ill? Can you make your pet ill? Speak pour obtenir de l’information et des conseils concernant les with your veterinary team for more information and advice zoonoses. on zoonotic diseases. 9. Les animaux font partie de notre communauté, et garder les 9. Our community includes animals and keeping animals animaux en santé garde aussi les humains en santé. Parlez à healthy, which keeps humans healthy. Speak with your vet- votre équipe vétérinaire pour obtenir de l’information et des erinary team for more information and advice on zoonotic conseils concernant les zoonoses. diseases. Ces publications prêtes à diffuser sur les médias sociaux, des These prewritten social media posts, additional promotional outils promotionnels supplémentaires et d’autres renseignements tools, and more information are available to help clinics across sont disponibles pour aider les cliniques de partout au Canada Canada promote the importance of understanding zoonotic à souligner l’importance de comprendre les zoonoses. Visitez la diseases. Visit the Animal Health Week section under the section de la Semaine de la vie animale sous l’onglet Pratique et Practice & Economics tab of the CVMA website (www.canadian finances du site Web de l’ACMV (www.veterinairesaucanada.net) veterinarians.net) to find tips and tools to help plan your pour obtenir des conseils et des ressources qui vous aideront à celebrations. planifier vos célébrations. Sponsors Commanditaires Generous support of the 2020 Animal Health Week campaign is La campagne de la Semaine de la vie animale 2020 est géné- provided by Program Plus Sponsors, IDEXX and Merck Animal reusement soutenue par les commanditaires principaux IDEXX Health, and Program Sponsors, iFinance Canada (Petcard), et Merck Santé animale et les commanditaires de programme Petsecure, and Virbac. iFinance Canada (Petcard), Petsecure et Virbac. This month we highlight one of our Ce mois-ci, nous saluons l’un de nos Program Plus Sponsors, Merck commanditaires principaux, Merck Animal Health: Santé animale. An estimated 59 000 people worldwide die from rabies annu- On estime que 59 000 personnes dans le monde meurent de ally and children under the age of 15 account for 40% of these la rage chaque année, et les enfants de moins de 15 ans repré- deaths. Outbreaks can be controlled when more than 70% of an sentent 40 % de ces décès. Les épidémies peuvent être contrôlées area’s canine population is vaccinated since 99% of human rabies lorsqu’une proportion de plus de 70 % de la population canine cases are caused by rabid dogs. Merck Animal Health donated d’une région est vaccinée, étant donné que 99 % des cas de rage over 3 million vaccines to date to help deliver mass canine vac- humaine sont associés à des chiens enragés. À ce jour, Merck cinations in high-risk world regions. These mass vaccination Santé animale a fait don de plus de 3 millions de doses de vaccin campaigns are a proven, effective way to eliminate the disease in pour appuyer la vaccination de masse des chiens dans les régions addition to creating a safe and healthy dog population. du monde à haut risque. Ces campagnes de vaccination de masse sont un moyen éprouvé et efficace d’éliminer la maladie, en plus de créer une population de chiens qui sont en sécurité et en santé.

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Merck Animal Health has supported research on rabies con- Merck Santé animale soutient la recherche sur la lutte contre la N trol, mass canine vaccination in high-risk regions of the world, rage, la vaccination canine de masse dans les régions du monde and education initiatives raising awareness in high-risk regions à haut risque et les initiatives de sensibilisation dans les régions à of Africa and India for more than 20 years. risque d’Afrique et d’Inde depuis plus de 20 ans. Merck Animal Health also contributes to protecting against Merck Santé animale contribue également à la protection the important zoonotic disease Influenza A in swine. Influenza contre l’importante zoonose qu’est la grippe porcine A. La grippe (flu) is a respiratory illness in humans caused by 2 main types (influenza) est une maladie respiratoire chez l’homme causée par of viruses: Influenza Type A and Type B. Influenza B circulates deux principaux types de virus : les virus de la grippe de type A et only among humans, Influenza A viruses are found in many dif- de type B. La grippe B ne circule que parmi les humains, tandis ferent animals, including pigs. Influenza A viruses are constantly que les virus de la grippe A se retrouvent chez de nombreuses evolving through mutations (antigenic drift) and/or reassortment espèces animales, dont les porcs. Les virus de la grippe A évoluent (exchange of gene segments during coinfection). New influenza constamment par mutations (glissement antigénique) et/ou réas- viruses affecting humans can be created by mutations and anti- sortiment (échange de segments de gènes lors d’une co-infection). genic shift when infecting pigs. De nouveaux virus grippaux affectant les humains peuvent être The bidirectional transmission between humans and swine, créés par des mutations et des glissements antigéniques lors de and occasionally pig infections with avian viruses, facilitates the l’infection des porcs. origin of new influenza viruses. The 4 pandemics in the last La transmission bidirectionnelle entre les humains et les porcs 100 years that occurred in humans were related to antigenic et parfois l’infection des porcs par des virus aviaires facilitent le drift. Antigenic drifts occur when the virus’s genetic structure développement de nouveaux virus grippaux. Les quatre pandémies changes and the virus that infects animals causes disease in survenues au cours des 100 dernières années chez l’humain humans and vice versa. Infections in humans and pigs are highly étaient liées au glissement antigénique. Les glissements anti­ related, the human seasonal H3N2 and the pandemic H1N1 géniques se produisent lorsque la structure génétique du virus were introduced by humans into pig populations. Preventing change et que le virus qui infecte les animaux provoque des mala- swine influenza infections reduces the possibility of creating a dies chez l’humain, et vice versa. Les infections chez l’humain et new strain that could infect humans. In addition, swine influenza le porc sont très apparentées, et le virus H3N2 saisonnier humain virus is part of the respiratory disease complex affecting grow- et le virus H1N1 pandémique ont été introduits par l’humain dans ing pigs, a disease that impacts pork production costs and is the les populations porcines. La prévention des infections par la grippe main driver for antibiotic usage. porcine réduit la possibilité de créer une nouvelle souche qui pour- Furthermore, influenza is costly for human healthcare. The rait infecter les humains. De plus, le virus de la grippe porcine fait average case cost in Canada of patients admitted to the ICU with partie du complexe respiratoire affectant les porcs en croissance, influenza during 2018, was $14 000. The National Institute une maladie qui a un impact sur les coûts de production du porc et on Ageing (NIA), a new policy and research centre based at qui est la principale raison de l’utilisation des antibiotiques. Toronto’s Ryerson University, estimates human respiratory ill- De plus, la grippe coûte cher en soins de santé pour les nesses costs around $2.8 billion. Influenza is the 7th leading humains. Le coût moyen d’un cas de patient admis aux soins cause of death in Canada and the leading cause among prevent- intensifs pour cause de grippe au Canada en 2018 était de able diseases. Its economic impact on work productivity leads 14 000 $. Le National Institute on Ageing (NIA), un nouveau centre to 1.5 million workdays lost each year. de recherche basé à l’Université Ryerson de Toronto, estime les Veterinary preventive medicine is also important to Merck coûts des maladies respiratoires humaines à environ 2,8 milliards Animal Health. Reducing infections in sows and protecting pig- de dollars. La grippe est la septième cause de décès au Canada, lets against pathogens that could be zoonotic such as rotaviruses, et la plus importante cause de décès parmi les maladies évitables. E. coli, Salmonella, and parasites are part of the solution. Son impact économique sur la productivité au travail entraîne la Merck Animal Health products are available directly from perte de 1,5 million de jours de travail chaque année. Merck Animal Health Customer Service team at (vet.customer. La médecine vétérinaire préventive est également importante [email protected]). You can also contact Merck pour Merck Santé animale. La réduction des infections chez les Animal Health staff at 1-866-683-7838 or simply order through truies et la protection des porcelets contre les agents pathogènes your preferred distributors. qui pourraient être zoonotiques, comme les rotavirus, E. coli, Salmonella et les parasites, font partie de la solution. Les produits de Merck Santé animale sont disponibles directement auprès de l’équipe du Service à la clientèle ([email protected]). Vous pouvez également communiquer avec le personnel de Merck Santé animale au 1-866-683-7838, ou simplement commander leurs produits auprès de vos distributeurs habituels.

CVJ / VOL 61 / SEPTEMBER 2020 943 FOR PERSONAL USE ONLY

N CVMA Partner, Petcard asks “Vet Bills During a Pandemic... Can Financing Help?” « Factures de soins vétérinaires durant une pandémie… le financement peut-il aider? » demande Petcard, partenaire de l’ACMV or many pet owners, the financial obligations of owning a our de nombreux propriétaires d’animaux, les obligations Fpet can well exceed the means they have available for veteri- Pfinancières liées à la possession d’un animal peuvent dépas- nary bills. During the time of COVID-19, this has never been ser leur budget pour les factures vétérinaires, à plus forte raison truer. Providing a financing option to your clients can eliminate en cette période de pandémie de COVID-19. Offrir une option many of the barriers to providing pets with the care they need. de financement à vos clients peut éliminer de nombreux obsta­ With a worldwide pandemic on our hands, many pet owners cles à la prestation de soins aux animaux qui en ont besoin. En are left struggling, and without immediate resources to care for contexte de pandémie mondiale, de nombreux propriétaires d’ani- their pet. However, this should not mean your veterinary clinic maux éprouvent des difficultés et se retrouvent sans ressources should be burdened with unpaid veterinary bills and outstanding immédiates pour prendre soin de leur animal. Toutefois, cela ne balances with no commitment of ever having them being paid. signifie pas que votre établissement vétérinaire devrait assumer Financing options alleviate the pressure on both parties with full le fardeau de factures impayées sans engagement d’acquitter les payment for the clinic and an affordable monthly installment soldes dus. Les options de financement atténuent la pression sur plan for the client. les deux parties, grâce au paiement intégral de la facture pour For pet owners, applying for financing is as simple as contact- l’établissement vétérinaire et à un plan de versements mensuels ing the financing company directly from the veterinary office, abordables pour le client. or from home via an online application. Similar to a standard Pour les propriétaires d’animaux, demander un financement credit application, the financing company will review the client’s est aussi simple que de contacter la société de financement information to determine their eligibility for approval. The client directement depuis l’établissement vétérinaire ou chez eux par will need to provide basic information, as well as submit to a une application en ligne. Comme lors d’une demande de crédit credit check. This can all be done immediately, therefore avoid- standard, la société de financement examinera le dossier du ing the need to delay the start of treatment. Once the contract client pour déterminer son admissibilité. Le client devra fournir is signed and submitted to the financing company, the payment des renseignements de base et se soumettre à une vérification is sent directly to the veterinary clinic. de crédit. Tout cela peut être fait immédiatement, ce qui évite de Getting setup to offer financing for veterinary clinics is retarder le début du traitement. Une fois le contrat signé et soumis quite simple. Typically, rudimentary paperwork is asked to be à la société de financement, le paiement est envoyé directement completed along with direct deposit information. Although à l’établissement vétérinaire. offering a financing option to pet owners may seem like extra La mise en place pour offrir du financement est assez simple work added to an already busy schedule, the majority of the pour les établissements vétérinaires. En règle générale, il suffit financing is handled between the finance company and the pet de remplir quelques formulaires et de fournir les coordonnées owner. As previously mentioned, after the pet owner has been bancaires pour les dépôts directs. Bien qu’offrir une option de approved, a final contract is signed by the owner, and payment financement aux propriétaires d’animaux puisse sembler être une is sent to the veterinary clinic. Unlike having an in-house financ- tâche supplémentaire à ajouter à un horaire déjà chargé, la majeure ing option, once the veterinary clinic has been paid, there is no partie du processus est géré entre la société de financement et need to worry about having to chase down payments or cover le propriétaire de l’animal. Comme on l’a mentionné précédem- outstanding costs. ment, après l’approbation du dossier du propriétaire de l’animal, The priority of veterinary clinics has always been the health un contrat final est signé par le propriétaire et le paiement est and well being of the animals in their care. Outstanding and envoyé à l’établissement vétérinaire. Contrairement à une option unpaid bills should not be a result of that commitment. Offering de financement interne, une fois que l’établissement vétérinaire a a financing option can eliminate those uncomfortable conversa- été payé, le personnel n’a plus à se soucier de faire le suivi pour tions about finances and veterinary clinics can feel confident that obtenir les versements ni d’avoir à couvrir les frais impayés. La priorité des établissements vétérinaires a toujours été la santé et le bien-être des animaux qui sont leurs patients. Cet enga- gement ne devrait pas se solder par des comptes en souffrance ou des factures impayées. Offrir une option de financement peut éliminer les conversations inconfortables concernant les paiements, en plus de vous donner la certitude que vos honoraires soient payés sans que vous ayez à réduire les coûts des procédures ou à retarder les traitements. Nous n’aurions jamais pu prédire qu’une pandémie telle que celle que nous vivons actuellement frapperait notre pays d’une manière aussi préjudiciable. Comme beaucoup de gens n’étaient

944 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY the office is being paid, without having to settle on lowering pas préparés à la crise financière que cette pandémie a provoquée, N procedures costs or delaying treatment. plusieurs propriétaires d’animaux n’ont pas les fonds nécessaires We could never have predicted a pandemic such as pour payer les imprévus comme les factures vétérinaires. De COVID-19 to hit our country in such a detrimental way. With nombreux propriétaires d’animaux ont subi une baisse importante many unprepared for the financial backlash that this pandemic de leur revenu régulier, ce qui les prive de la stabilité financière has brought, it has left pet owners without surplus funds to pay à laquelle ils étaient habitués. Une option de financement leur for emergencies such as veterinary bills. Many pet owners have permet de continuer d’avoir accès aux services vétérinaires dont had a drastic change to their regular income, depleting access to leurs animaux ont besoin, sans avoir à y consacrer la totalité de the same financial stability to which they were accustomed. A leurs économies possiblement limitées. financing option allows pet owners to still have access to veteri- Pour en savoir plus, visitez le site de l’ACMV (www.veterinaires nary services their pets’ need, without the burden of using the aucanada.net) ou composez le 1-888-689-9876. entirety of their possibly limited funds all at once. To find out more, visit (www.canadianveterinarians.net) or call 1-888-689-9876.

CVJ / VOL 61 / SEPTEMBER 2020 945 FOR PERSONAL USE ONLY Case Report Rapport de cas

Osteosarcoma of the proximal tibia in a dog 6 years after tibial tuberosity advancement

Surabhi Sharma, Sarah E. Boston, Douglas Riddle, Kevin Isakow

Abstract — A 9-year-old spayed female Cane Corso dog was presented with a 1-week history of an acute right hind limb non-weight-bearing lameness. Six years previously, a right tibial tuberosity advancement (TTA) procedure had been performed. Orthogonal radiographs of the right pelvic limb taken before presentation revealed a comminuted displaced mid-diaphyseal tibial fracture. An aggressive bone lesion with osteolysis and periosteal reaction of the proximal tibia were evident that were most consistent with a primary bone tumor. The owner elected to have the dog euthanized. After euthanasia a fine-needle aspirate of the right proximal tibia was submitted for clinical pathology. Cytology and alkaline phosphatase staining of the fine-needle aspirate were consistent with osteosarcoma. Key clinical message: To the authors’ knowledge, this is only the second reported case of osteosarcoma at the site of a TTA. Implant- associated osteosarcoma has been associated with tibial plateau levelling osteotomy (TPLO) and fracture repair.

Résumé — Ostéosarcome du tibia proximal chez un chien six ans après l’avancement de la tubérosité tibiale. Une femelle Cane Corso stérilisée âgée de 9 ans fut présentée avec une histoire d’une boiterie sans appui de la patte arrière droite apparue de manière aiguë depuis 1 semaine. Six ans auparavant, une chirurgie d’avancement de la tubérosité tibiale droite (TTA) avait été réalisée. Des radiographies orthogonales du membre pelvien droit prises avant la présentation ont révélé une fracture comminutive déplacée du tibia au niveau mi-diaphysaire. Une lésion osseuse agressive avec ostéolyse et réaction du périoste du tibia proximal étaient évidentes et considérées compatibles avec une tumeur osseuse primaire. Le propriétaire opta pour l’euthanasie du chien. À la suite de l’euthanasie une aspiration à l’aiguille fine du tibia proximal droit fut soumise pour examen en pathologie clinique. La cytologie et une coloration à la phosphatase alcaline de l’aspiration à l’aiguille fine étaient compatibles avec un ostéosarcome. Message clinique clé : À la connaissance de l’auteur, ceci est seulement le deuxième cas rapporté d’un ostéosarcome au site d’une TTA. Les ostéosarcomes associés aux implants ont été associés avec l’ostéotome de nivellement du plateau tibial (TPLO) et la réparation de fracture. (Traduit par Dr Serge Messier) Can Vet J 2020;61:946–950

steosarcoma at the site of an orthopedic implant has been been associated with comminuted fractures with a history of O previously reported in dogs (1,2), although direct causal complicated healing, implant loosening, or infection (3). One relationship between the orthopedic implant and bone neoplasia of the theories implicates corrosion of the implant as a casual has not been established. Fracture-associated osteosarcoma has factor (3,4). Orthopedic implants are mostly made of either stainless steel or titanium. A titanium implant is used for the tibial tuberosity advancement (TTA) procedure. About 100 000 Surgical Oncology Department (Sharma, Boston), Emergency TTA procedures have been performed since the procedure’s Department (Riddle), Surgery Department (Isakow), VCA 404 introduction in 2004 (5) and only 1 case report exists implicat- Veterinary Emergency and Referral Hospital, 510 Harry Walker ing a titanium implant as a causal factor for osteosarcoma. Parkways South, Newmarket, Ontario. Address all correspondence to Dr. Surabhi Sharma; e-mail: Case description [email protected] A 9-year-old spayed female Cane Corso dog was presented to Use of this article is limited to a single copy for personal study. the emergency service at our hospital with a 1-week history of Anyone interested in obtaining reprints should contact the a non-weight-bearing right hind limb lameness. Two weeks CVMA office ([email protected]) for additional before presentation, the dog had an episode of right hind limb copies or permission to use this material elsewhere. lameness which resolved with administration of meloxicam.

946 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY CASE REPORT CASE

Figure 2. Right pelvic limb radiograph (lateral and anteriopalmer view) showing comminuted, closed, cranially displaced mid- diaphyseal fracture of the tibia and evidence of osteolysis at proximal tibia.

radiographic appearance was most consistent with a primary bone tumor and secondary pathological fracture. Based on the presumptive diagnosis of a primary bone tumor, likely osteosarcoma, further diagnostic testing, including cytol- ogy of the bone lesion and staging with thoracic radiographs were recommended but declined by the owner. Treatment options such as amputation and chemotherapy, or euthanasia were discussed. The owners elected to have the dog euthanized and pentobarbital sodium injection (Euthanyl 240 mg/mL; Bimeda-MTC, Cambridge, Ontario), 40 mg/kg body weight, IV, was administered. After euthanasia and with informed consent, a fine-needle aspirate from the proximal tibia and more detailed radiographs were taken which confirmed a pathological fracture and aggres- sive bone lesion of the mid tibial diaphysis at the site of the previous TTA (Figure 2). The aspirates were submitted to a clinical pathologist for cytology and alkaline phosphatase (ALP) staining (Figures 3, 4). The cytology revealed well-differentiated osteoblasts in low to moderate numbers with individual, scat- tered, atypical spindle-shaped cells in moderate numbers. The nuclei of these cells were round or oval, and contained clumped Figure 1. Right pelvic limb radiograph (lateral view) showing comminuted, closed, cranially displaced mid-diaphyseal fracture to granular chromatin, as well as 1 to 8 small, round, prominent of the tibia and evidence of osteolysis and osteoproduction at nucleoli. Large cells containing a large nucleus were regularly the proximal tibia. observed, as well as mitotic figures, macro nucleoli, and bi- and tri-nucleated cells. Osteoclasts and well-differentiated osteoblasts Six years previously, the dog was diagnosed with right cranial were indicative of reactive bone and the presence of atypical cruciate ligament rupture and a tibial tuberosity advancement stromal cells was compatible with sarcoma. The neoplastic cells (TTA) was performed. The stifle joint was stabilized using a were positive for ALP-staining, suggesting that they were of 7-hole titanium plate and 12/24-mm titanium cage. osteoblastic origin. Therefore, the cytology was suspicious for On presentation, the dog was noted to be bright and alert osteosarcoma (6,7). with normal vital signs. The dog was non-weight-bearing on the right pelvic limb. A splint had been applied to the limb by the Discussion primary care veterinarian just before referral. Radiographs taken Osteosarcoma is the most common primary malignant tumor of by the primary care veterinarian showed that the previously the skeletal system in dogs (8). It is locally aggressive with high placed TTA implant was in place with no evidence of implant metastatic potential (9). Spontaneously occurring ­osteosarcoma failure (Figure 1). There was a comminuted, closed, cranially is most commonly seen in older large breed dogs with the distal displaced mid-diaphyseal fracture of the tibia and evidence radius and proximal humerus shown to be the most common of osteolysis and osteoproduction of the proximal tibia. The sites (8).

CVJ / VOL 61 / SEPTEMBER 2020 947 FOR PERSONAL USE ONLY RAPPORTCAS DE

Figure 3. Cytology of the fine-needle aspirate of the proximal Figure 4. Alkaline phosphatase (ALP) staining of the fine-needle tibia showing stained osteoblast cells and spindle cells aspirate from the proximal tibia showing neoplastic cells stained (© IDEXX Laboratories, Markham, Ontario. Used by permission) with ALP, suggestive of osteoblasts (© IDEXX Laboratories. [Hematoxylin and eosin (H&E) staining]. Used by permission).

Osteosarcoma has previously been reported secondary to a neoplastic process. It has been hypothesized that chronic fracture fixation in dogs (3,4). Fracture-associated osteosarcoma inflammation and necrosis can lead to cancer as a result of has been associated with comminuted fractures with a history processes such as uncontrolled cell growth, cell transformation, of complicated healing, implant loosening, or infection (3). It and immunosuppression leading to lack of response from the has also been reported that fracture-associated osteosarcomas growing cells (20). Chronic inflammation leads to production of tend to occur on average 5 to 6 y after the primary fracture in reactive oxygen, nitrogen species, cytokines, metalloproteinases dogs (3,10). Implant-associated osteosarcomas have been previ- and PGE2, which amplify and perpetuate the inflammatory ously reported both in human (11) and animal studies (2,12,13). cascade (20). These inflammatory mediators can lead to trans- It was previously believed that Jonas pins, the spring-loaded formation of normal cells via activation of oncogenes or lack of pins used for intramedullary fixation, which are known to be anti-oncogenic activity. Some inflammatory mediators such as corrosion susceptible, were related to implant associated osteo- reactive oxygen and nitrogen species primarily attack infectious sarcoma (1). The Jonas pins are no longer available, but implant agents and foreign bodies by nitration and oxidation. However, associated osteosarcoma continues to be reported in dogs (2,13). these mediators can induce DNA damage and mutations in It has been hypothesized that chronic inflammation, corrosion of the host cells by the same mechanism (20). Inflammation also implants, and decreased vascularity of bone after fracture might results in the production of angiogenic factors such as vascular contribute to the formation of fracture-associated or implant- endothelial growth factor which can lead to tumor growth and associated osteosarcoma (4,10). progression (20). The exact pathway leading to cancer develop- Tibial plateau levelling osteotomy (TPLO) is a common pro- ment, however, remains poorly understood. cedure for the treatment of ruptured anterior cruciate ligament Early-generation TPLO plates had inhomogeneous structure in dogs (14,15) and has been implicated as a potential cause with differences in chemical composition, not only between of implant-associated OSA (2). Primary bone tumors affect- plates but also between regions of the plate (17,20). Cast plates ing the tibia and fibula are rare (9). In a large study of about have larger grain boundaries than the wrought counterparts and 400 000 insured Swedish dogs, the incidence of primary proxi- are more prone to intergranular corrosion (17). Previous case mal tibial or fibular neoplasia was only 0.017% (9). The preva- reports have mostly implicated Slocum TPLO plates in relation lence of TPLO-associated osteosarcoma is noted to be about to the development of neoplasia. Two contradicting studies 4 times higher than the frequency of spontaneous bone tumor are available regarding corrosion of the Slocum plate (21,22). affecting the proximal tibia and fibula (13). In preceding studies, One study found evidence of corrosion at the implant site osteosarcoma at the previous TPLO site has been shown to occur and postulated that compounds produced secondary to corro- 5 to 6 y after the procedure (2,13,16). There is limited evidence sion can incite neoplastic change (21). The other study found to prove the causal relationship between the orthopedic implant no evidence of corrosion at the implant site (22). However, and the development of osteosarcoma, but the association has TPLO-associated osteosarcomas have also been associated with been noted in both humans and dogs (8). Several theories have newer generation TPLO plates (13,16). Another case report been postulated such as metal implants inciting chronic inflam- showed osteosarcoma at the TPLO implant site, but the bone mation leading to neoplasia development (10) or corrosion at plate in that report was manufactured from 316LVM surgical the implant site leading to a neoplastic process (17). Corrosion steel rather than the Slocum TPLO plate (13). Tibial tuberos- at the implant site can incite chronic inflammation and tissue ity advancement (TTA), another surgical procedure used to necrosis (18) and can negatively affect osteoblast proliferation stabilize a cranial cruciate deficient knee joint (23), was also and differentiation (19) which hypothetically could result in associated with osteosarcoma in a single case report (24). The

948 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY report herein is the second case report to document presence osteosarcoma at the site of a previous TTA. Implant-associated of osteosarcoma at the site of a previous TTA. The first case osteosarcoma is rare but may occur after TTA. Although, in was reported in an Alaskan malamute that underwent the TTA contrast to a TPLO, the TTA procedure utilizes a titanium plate, procedure to stabilize a stifle joint with a deficient cranial cruci- implant-associated osteosarcoma remains possible. CVJ ate ligament (24). The dog made an excellent recovery and no post-operative complications were reported. Twenty months References REPORT CASE after the procedure, the dog was diagnosed with osteosarcoma . 1 Sinibaldi KR, Pugh J, Rosen H, Liu SK. Osteomyelitis and neoplasia associated with use of the Jonas intramedullary splint in small animals. at the site of the TTA implants. J Am Vet Med Assoc 1982;181:885–890. The TTA procedure is not performed as often as the TPLO, 2. Selmic LE, Ryan SD, Ruple A, Pass WE, Withrow SJ. Association of likely because of surgeon preference and experience (25) as well tibial plateau leveling osteotomy with proximal tibial osteosarcoma in dogs. J Am Vet Med Assoc 2018;253:752–756. as initially TTA could not be used in the large breed dogs as 3. Stevenson S, Hohn RB, Pohler OE, Fetter AW, Olmstead ML, Wind AP. tuberosity advancement was limited to 12 mm (25,26). This Fracture-associated sarcoma in the dog. J Am Vet Med Assoc 1982;180: may be part of the reason that TTA-associated osteosarcoma is 1189–1196. 4. Burton AG, Johnson EG, Vernau W, Murphy BG. Implant-associated so rarely reported in the literature. A recent study showed that neoplasia in dogs: 16 cases (1983–2013). J Am Vet Med Assoc 2015; the TTA procedure has a worse outcome than TPLO (27), which 247:778–785. may further reduce its popularity and therefore the incidence of 5. KYON Veterinary Surgical Products. Tibial Tuberosity Advancement. Available from: https://www.kyon.ch/current-products/tibial-tuberosity- TTA-associated osteosarcoma. advancement-tta. Published 2009 Last accessed June 15, 2020. In in-vitro studies (28), animal models (29) and human stud- 6. Barger A, Graca R, Bailey K, et al. Use of alkaline phosphatase stain- ies (30) titanium implants have been shown to be less prone ing to differentiate canine osteosarcoma from other vimentin-positive tumors. Vet Pathol 2005;42:161–165. to biofilm formation compared with stainless-steel implants. 7. Ryseff JK, Bohn AA. Detection of alkaline phosphatase in canine cells Titanium alloy is also more inert than stainless steel, causing less previously stained with Wright–Giemsa and its utility in differentiating soft tissue reaction and less bone loss during the remodelling osteosarcoma from other mesenchymal tumors. Vet Clin Pathol 2012; 41:391–395. phase of fracture healing (31). It is, therefore, possible that the 8. Withrow SJ. Withrow and MacEwen’s Small Animal Clinical Oncology. titanium implant itself, as opposed to the stainless steel implant, Elsevier Health Sciences; 2007. is less likely to cause chronic inflammation and subsequent 9. Egenvall A, Nødtvedt A, von Euler H. Bone tumors in a population of 400 000 insured Swedish dogs up to 10 y of age: Incidence and survival. transformation to a sarcoma. Can Vet J 2007;71:292–299. In the present report, the fracture was at the mid-diaphysis 10. Stevenson S. Fracture-associated sarcomas. Vet Clin North Am Small at the junction of the tumor and non-tumor bone. This is Anim Pract 1991;21:859–872. 11. Kavalar R, Fokter SK, Lamovec J. Total hip arthroplasty-related osteo- likely due to a stress-riser created at the transition between genic osteosarcoma: Case report and review of the literature. Eur J Med lytic tumor bone and normal density bone. In contrast to the Res 2016;21:8. usual metaphyseal location in cases of spontaneously occurring 12. Marcellin-Little DJ, DeYoung BA, Doyens DH, DeYoung DJ. Canine uncemented porous-coated anatomic total hip arthroplasty: Results of osteosarcoma, an implant-associated osteosarcoma can occur at a long-term prospective evaluation of 50 consecutive cases. Vet Surg diaphyseal locations (4). 1999;28:10–20. A histopathological diagnosis was not available in this case. 13. Atherton MJ, Arthurs G. Osteosarcoma of the tibia 6 years after tibial plateau leveling osteotomy. J Am Anim Hosp Assoc 2012;48: In human medicine, fine-needle aspirate is becoming more 188–193. common for diagnosis of bone tumors (32,33). Although his- 14. Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of topathology is the gold standard for diagnosing bone neoplasia, cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993;23:777–795. 1 human study reported a sensitivity of 86% and a specificity of 15. Slatter DH. Textbook of Small Animal Surgery. Vol 1. St. Louis, 94.7% for cytology of bone tumors (33). A recent canine study Missouri: Elsevier Health Sciences; 2003. has shown that accuracy of diagnosis of a malignant bone tumor 16. Selmic LE, Ryan SD, Boston SE, et al. Osteosarcoma following tibial plateau leveling osteotomy in dogs: 29 cases (1997–2011). J Am Vet is similar between cytology and histology (34). Cytology offers Med Assoc 2014;244:1053–1059. faster results with less complications but there are limitations 17. Boudrieau RJ, McCarthy RJ, Sprecher CM, Künzler TP, Keating JH, such as difficulty in differentiating reactive bone from neoplastic Milz S. Material properties of and tissue reaction to the Slocum TPLO plate. Am J Vet Res 2006;67:1258–1265. bone or differentiating osteosarcoma from other sarcomas such 18. Steinemann SG. Metal implants and surface reactions. Injury. 1996; as chondrosarcoma or fibrosarcoma (35). Furthermore, this 27:S–C16. case was positive for ALP staining, which is noted to be 100% 19. Uo M, Watari F, Yokoyama A, Matsuno H, Kawasaki T. Tissue reaction around metal implants observed by X-ray scanning analytical micro­ sensitive and 89% specific for the diagnosis of osteosarcoma (7). scopy. Biomaterials 2001;22:677–685. Other tumors such as amelanotic melanoma, multilobular tumor 20. Baniyash M. Chronic inflammation, immunosuppression and cancer: of bone, and chondrosarcoma occasionally also express ALP, but New insights and outlook. Semin Cancer Biol 2006;16:80–88. 21. Charles AE, Ness MG. Crevice corrosion of implants recovered after this is uncommon (6). In this case report, in addition to the tibial plateau leveling osteotomy in dogs. Vet Surg 2006;35:438–444. positive ALP staining, cytologic evidence supported sarcoma. 22. Lackowski WM, Vasilyeva YB, Crooks RM, Kerwin SC, Hulse DA. Although not 100% confirmatory it is considered likely that Microchemical and surface evaluation of canine tibial plateau leveling osteotomy plates. Am J Vet Res 2007;68:908–916. this is a case of osteosarcoma. 23. Lafaver S, Miller NA, Stubbs WP, Taylor RA, Boudrieau RJ. Tibial Tibial plateau leveling osteotomy associated osteosarcoma tuberosity advancement for stabilization of the canine cranial cruciate has been repeatedly reported in the literature (13,16,36), but ligament-deficient stifle joint: Surgical technique, early results, and complications in 101 dogs. Vet Surg 2007;36:573–586. TTA-associated osteosarcoma has only been reported once (24). 24. Dunn AL, Buffa EA, Hanshaw DM, Farrell M. Osteosarcoma at the site This case report documents a pathological fracture due to of titanium orthopaedic implants in a dog. Aust Vet J 2012;90:39–43.

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25. Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity 31. Uhthoff HK, Bardos DI, Liskova-Kiar M. The advantages of titanium advancement? Vet Surg 2009;38:1–22. alloy over stainless steel plates for the internal fixation of fractures. An 26. Burns CG, Boudrieau RJ. Modified tibial tuberosity advancement pro- experimental study in dogs. J Bone Joint Surg Br 1981;63:427–484. cedure with tuberosity advancement in excess of 12 mm in four large 32. Fröstad B, Tani E, Brosjö O, Skoog L, Kogner P. Fine needle aspiration breed dogs with cranial cruciate ligament-deficient joints. Vet Comp cytology in the diagnosis and management of children and adolescents Orthop Traumatol 2008;21:250–255. with Ewing sarcoma and peripheral primitive neuroectodermal tumor. 27. Moore EV, Weeren R, Paek M. Extended long-term radiographic and Med Pediatr Oncol 2002;38:33–40. functional comparison of tibial plateau leveling osteotomy vs tibial 33. Agarwal S, Agarwal T, Agarwal R, Agarwal PK, Jain UK. Fine needle tuberosity advancement for cranial cruciate ligament rupture in the aspiration of bone tumors. Cancer Detect Prev 2000;24:602–609. dog. Vet Surg 2019;49:146–154. 34. Sabattini S, Renzi A, Buracco P, et al. Comparative assessment of the 28. Harris LG, Meredith DO, Eschbach L, Richards RG. Staphylococcus accuracy of cytological and histologic biopsies in the diagnosis of canine aureus adhesion to standard micro-rough and electropolished implant bone lesions. J Vet Intern Med 2017;31:864–871. materials. J Mater Sci Mater Med 2007;18:1151–1156. 35. Dodd LG, Scully SP, Cothran RL, Harrelson JM. Utility of fine-needle 29. Arens S, Schlegel U, Printzen G, Ziegler WJ, Perren SM, Hansis M. aspiration in the diagnosis of primary osteosarcoma. Diagn Cytopathol

RAPPORTCAS DE Influence of materials for fixation implants on local infection: An 2002;27:350–353. experimental study of steel versus titanium DCP in rabbits. J Bone Joint 36. Selmic LE, Ryan SD, Ruple A, Pass WE, Withrow SJ. Association of Surg Br 1996;78:647–651. tibial plateau leveling osteotomy with proximal tibial osteosarcoma in 30. Clauss M, Graf S, Gersbach S, Hintermann B, Ilchmann T, Knupp M. dogs. J Am Vet Med Assoc 2018;253:752–756. Material and biofilm load of K wires in toe surgery: Titanium versus stainless steel. Clin Orthop Relat Res 2013;471:2312–2317.

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950 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY Case Report Rapport de cas

Concurrent bullous emphysema, bronchointerstitial pneumonia with necrosis, and tension pneumothorax in an 8-week-old puppy

Emily M. Brand, Chee Kin Lim, Ethan Biswell, Yava Jones-Hall, Hock Gan Heng

Abstract — An 8-week-old, male, mixed breed puppy was presented because of progressive respiratory distress. Thoracic radiographs revealed innumerable coalescing pulmonary bullae throughout the lungs with increased soft tissue opacity of the remaining pulmonary parenchyma and tension pneumothorax. Necropsy and histopathological findings were compatible with bullous emphysema and marked neutrophilic to histiocytic bronchointerstitial pneumonia with necrosis, bronchiectasis, fibrosis, dystrophic mineralization, and vasculitis with thrombosis. Tests for agents of infectious disease did not reveal an underlying etiological agent. This case highlights the radiographic, gross necropsy, and histopathologic features of a puppy with bullous emphysema and severe bronchointerstitial pneumonia with necrosis.

Résumé — Emphysème bulleux, pneumonie broncho-interstitielle avec nécrose et pneumothorax de tension concomitants chez un chiot de 8 semaines. Un chiot mâle croisé âgé de 8 semaines fut présenté à cause de détresse respiratoire progressive. Des radiographies thoraciques ont révélé un nombre incalculable de bulles pulmonaires coalescentes à travers les poumons avec augmentation de l’opacité des tissus mous du parenchyme pulmonaire restant et un pneumothorax de tension. La nécropsie et les trouvailles histopathologiques étaient compatibles avec de l’emphysème bulleux et une pneumonie broncho-interstitielle neutrophilique et histiocytaire marquée avec nécrose, de la bronchiectasie, de la fibrose, une minéralisation dystrophique et une vasculite avec thrombose. Des tests pour agents infectieux de maladie n’ont pas permis de mettre en évidence un agent étiologique sous-jacent. Ce cas met en évidence les trouvailles radiographiques, de nécropsie et histopathologiques chez un chiot avec emphysème bulleux et pneumonie broncho-interstitielle avec nécrose. (Traduit par Dr Serge Messier) Can Vet J 2020;61:951–955

ithin the lung, there are 2 broad categories of emphy- Case description sema: interstitial or alveolar (1). Interstitial emphysema W An 8-week-old, 2 kg, male, mixed breed puppy was obtained refers to presence of gas within the connective tissues of the lung from a breeder and the puppy’s vaccination status, prior history, while alveolar emphysema is caused by enlargement of the alve- and information regarding any littermates were unknown. Once oli due to destruction of the alveolar septa (1). If the enlarged home, the puppy was noted to be constantly panting and was air spaces in the alveoli coalesce, they can result in a pulmonary presented the following day to the Purdue University Veterinary bulla. The term bullous emphysema has been used to describe Teaching Hospital in severe respiratory distress. Harsh lung the presence of pulmonary bullae secondary to congenital or sounds, severe tachypnea, and mild tachycardia were noted on acquired causes. There have been no reports describing multi- thoracic auscultation. A rectal temperature was not recorded. lobar bullous emphysema (congenital or acquired) in puppies The mucous membranes were pale with a capillary refill time with concurrent bronchointerstitial pneumonia and necrosis. of less than 2 s. The puppy was hypotensive with an indirect systolic blood pressure of 60 mmHg [reference range (RR): 90 to Department of Veterinary Clinical Sciences (Brand, Lim, 140 mmHg] and had moderate hyperglycemia (12 mmol/L, Heng) and Department of Comparative Pathobiology (Biswell, RR: 4.4 to 7.8 mmol/L) (2). A test for parvovirus (SNAP Jones-Hall), College of Veterinary Medicine, Purdue University, Parvovirus Antigen Test Kit; IDEXX Laboratories, Westbrook, West Lafayette, Indiana, USA. Maine, USA) was negative. During the initial attempt to Address all correspondence to Dr. Emily Brand; e-mail: take thoracic radiographs, the puppy went into cardiac arrest. [email protected] Cardiopulmonary resuscitation (CPR) with manual thoracic Use of this article is limited to a single copy for personal study. compressions and intubation with supplemental oxygen therapy Anyone interested in obtaining reprints should contact the were performed and return of spontaneous circulation was CVMA office ([email protected]) for additional achieved. Radiographs were taken after the puppy was stabilized, copies or permission to use this material elsewhere. while still intubated.

CVJ / VOL 61 / SEPTEMBER 2020 951 FOR PERSONAL USE ONLY RAPPORTCAS DE

Figure 1. A — Ventrodorsal view of the thorax. Innumerable pulmonary bullae are seen with increased soft tissue opacity of the remaining parenchyma (white arrows). There is moderate tension pneumothorax with scalloping of the parietal pleura margins (white dashed arrows). The thymus (black arrowheads) is normal. An endotracheal tube is present. B — Right lateral view of the thorax. There is moderate tension pneumothorax with flattening of the diaphragm (black dashed arrows). The thymus (black arrowheads) is normal. An endotracheal tube is present.

Thoracic radiographs revealed innumerable coalescing pul- organs were fixed in 10% neutral buffered formalin, processed monary bullae throughout all lung lobes with increased soft routinely, and embedded in paraffin wax. Sections (3-mm thick) tissue opacity of the remaining pulmonary parenchyma. Severe were stained with hematoxylin and eosin (H&E). tension pneumothorax was present with scalloping of the pari- Histologically, there was severe multifocal effacement of the etal pleural margins and flattening of the diaphragm (Figure 1). normal pulmonary parenchymal architecture in all examined The diameter of the thoracic trachea was subjectively small. The lung lobes. The grossly described bullae consisted of clear spaces, normal thymus was identified. The initial differential diagnoses most of which expanded from recognizable bronchiolar lumens for these findings included congenital bullous or cystic emphy- partially lined by respiratory epithelia (Figure 2C–E). However, sema, with potential rupture of the pulmonary bulla(e) leading some of the bullae were also noted to arise from the bronchi. to tension pneumothorax. Saccular or cystic bronchiectasis was A few bullae expanding bronchioles/bronchi had microscopic considered a less likely differential diagnosis given the severity areas with respiratory epithelium which was multifocally attenu- of the changes and varied appearance compared with previous ated, with the rest of the wall replaced by abundant numbers of studies (3). Immediately following radiography, another episode macrophages, neutrophils (commonly degenerate), and fewer of cardiac arrest occurred, and resuscitation was unsuccessful. A lymphocytes and plasma cells. The bullae compressed adjacent necropsy was performed. parenchyma with marked fibrosis and heavy infiltrates of foamy The most severe gross necropsy findings were observed in the and fewer epithelioid macrophages, scattered neutrophils, and lungs and reflected the lesions seen on radiographs. Bilaterally, variably sized areas of necrosis and/or dystrophic mineralization all lung lobes had numerous random multifocal to coalescing (Figure 2C, D, F). Bronchiectasis was also present and associated pulmonary nodules ranging from pinpoint to 2 cm diameter with the inflammation and necrosis; however, there was no evi- and, on cut section, consisted of either air (bullae), solid tan dence of bronchial dysplasia or hypoplasia. Few scattered bron- firm tissue, or a mixture of purulent to caseous material and/or chioles that were less affected were lined by columnar epithelium small amounts of granular debris (necrosis) (Figure 2A, B). The with microscopic aggregates of macrophages, lymphocytes, and thymus was grossly normal in size and appearance. The abdo- fewer neutrophils multifocally expanding the lamina propria. men was distended, and the peritoneal cavity contained approxi- In less affected areas, the alveolar septa were markedly thick- mately 10 mL of clear, amber-colored fluid with scattered fibrin. ened by variable amounts of fibrosis admixed with edema fluid Samples from lung were submitted for aerobic, anerobic, and and mixed inflammation (mainly macrophages, neutrophils, fungal cultures and liver samples were submitted for aerobic and lymphocytes). There was occasional hyperplasia of type 2 and Salmonella cultures. Lung samples were also submitted for pneumocytes. Scattered vessels were thrombosed and infiltrated canine distemper virus fluorescent antibody detection. All major by similar inflammation, mostly lymphocytes, ­macrophages,

952 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY CASE REPORT CASE

Figure 2. Gross images and histopathology of the puppy’s pulmonary lesions. A — Lateral view shows variably sized tan nodules within the left cranial and caudal lung lobes surrounded by collapsed consolidated parenchyma. B — Magnified image of the right lung lobes shows multiple bullae (black arrows) surrounded by firm consolidated tissue. C — Low magnification of the variably sized bullae (B) distended mainly by clear space indicating air, and which are surrounded by collapsed fibrotic parenchyma (black arrowheads). H&E, bar = 1 mm, 13. D — Bullae (B) located within a discernable bronchiolar lumen partially lined by respiratory epithelia (black arrow), adjacent to a bronchus (Br). The remaining pulmonary parenchyma is collapsed (black asterisk) with multifocal areas of necrosis. H&E, bar = 750 mm, 23. E — Higher magnification of the partially lined bullae from figure D. The epithelial cells (black arrow) are tall columnar and ciliated, with erosion of the epithelium over areas of necrosis. There are numerous infiltrates of macrophages and fewer neutrophils within the parenchyma and luminal cavity. H&E, bar = 50 mm, 103. F — There is a focus of necrosis (N) with dystrophic mineralization (white arrow) surrounded by collapsed parenchyma (black asterisk) infiltrated by numerous macrophages. H&E, bar = 100 mm, 83. and rare neutrophils (vasculitis). No fibrinoid necrosis within hepatic granulomas with vasculitis extending from portal vessels, vessel walls was observed. The histopathologic diagnosis was and multifocal, histiocytic splenitis (limited to the red pulp). bullous emphysema and marked neutrophilic to histiocytic Lung tissue was further evaluated using special stains, includ- bronchointerstitial pneumonia with necrosis, bronchiectasis, ing periodic acid–Schiff (PAS), Gram stain (Brown & Hopps), fibrosis, dystrophic mineralization, and vasculitis with thrombo- Ziehl-Neelsen acid fast, and mucicarmine. Liver and spleen were sis. Additional histopathologic abnormalities were identified in additionally evaluated with PAS and Ziehl-Neelsen acid fast. the liver and spleen with morphologic diagnoses of multifocal, All stains on lung, liver, and spleen as well as testing of the lung

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for canine distemper virus were negative for detection of infec- 10-week-old puppy (12). These authors described a puppy tious agents. All bacterial and fungal cultures of lung and liver with congenital bullous emphysema that acutely developed were negative. By means of immunohistochemistry, pulmonary, dyspnea; on thoracic radiographs, multiple thin-walled bullae hepatic, and splenic macrophages were CD18 positive (histiocytic and regions of consolidation were present (12). These changes cell marker) and E-cadherin negative (Langerhans cell marker). are similar to our puppy’s radiographs; however, our case had Polymerase chain reaction (PCR) was performed on lung tissue a greater number of bullae. Histopathologically, the previous for Neospora caninum, Toxoplasma gondii, and canine respiratory case had thickening of the alveolar septa with edema, but coronavirus; all tests were negative. Finally, fungal PCR testing lacked the bronchiectasis, necrosis, vasculitis, and thrombosis was performed on lung tissue using a universal panfungal PCR seen in our case (12). Additionally, both these puppies lacked primer to detect fungal RNA and specific PCR primers to detect bronchial dysplasia or malformation which were described in Pythium insidiosum DNA (4–6). Fungal RNA and Pythium DNA reports of congenital lobar emphysema (7–9,12,13). A study of RAPPORTCAS DE were not detected. An etiological agent was not identified. experimentally induced pulmonary emphysema in aged dogs reported that the presence of inflammation in addition to hyper- Discussion inflation led to greater severity of emphysema, alveolar septal Of the 2 types of pulmonary emphysema in dogs, alveolar and thickening, and varying degrees of necrosis (14). Given the interstitial, the former is more common. This can take the concurrent changes in the spleen and liver, a systemic immune- form of bullous or lobar emphysema, which occurs second- mediated vasculitis or sterile granulomatous disease may have ary to coalescing air spaces or obstruction of a lobar bronchus been the inciting factor for progression of the bullous disease usually due to abnormalities of the bronchial cartilage, respec- to bronchointerstitial pneumonia with necrosis. Alternatively, tively (1,7–9). As there was no evidence of bronchial obstruction the bullous lesions may have caused increased pressure within or abnormal cartilage, the emphysema present in the current the pulmonary parenchyma which could result in hypoxia or patient was considered to be bullous emphysema. The term ischemia in other regions of the lung. The subsequent inflam- bullous emphysema has been used to describe pulmonary bullae mation may have initiated progression to bronchointerstitial secondary to both congenital and acquired causes, leading to pneumonia with necrosis. confusion within the literature due to lack of clear distinction The second theory is that the puppy was exposed to an between congenital and acquired forms of this disease. We con- undetected infectious agent (bacterial, viral, protozoal, or fun- sider use of the term congenital bullous emphysema to describe gal) which led to the development of pneumonia. As has been pulmonary bullae development in young dogs (, 1 y of age) reported in humans, pneumonia could have progressed second- without bronchial dysplasia, and acquired bullous emphysema ary to vasculitis induced by the infectious organism leading to describe the presence of pulmonary bullae incidentally found to activation of the coagulation cascade and development of in aged dogs or developing secondary to pneumonia (10). thrombi (15,16). Alternatively, the infectious agent may have The inciting cause for the development of the lung pathology contained toxins that acted directly on the pulmonary tissues to in this patient was not elucidated despite extensive post-mortem cause inflammation and subsequent necrosis (16). The lesions testing. Several pathogeneses for the histopathological findings in the liver and spleen could also be suggestive of fungal disease, in the lungs were considered. Diffuse necrosis of such sever- viral infection, or bacteria. Infection by any of these agents ity occurs more commonly secondary to aspiration of foreign could have led to progression to bronchointerstitial pneumonia material, but such extensive bullae formation is not a common with necrosis. In children and adults, a severe complication finding with aspiration pneumonia. Furthermore, no foreign of pneumonia is the progression to necrotizing pneumonia material was noted on histopathology, making this etiology with the development of thin, gas-filled cavities or pulmonary unlikely. E-cadherin testing was performed to evaluate for the abscesses (15). In veterinary medicine, the development of gas- presence of Langerhans cells in the pulmonary parenchyma as filled cavities or bullae has been described secondary to pneumo- our patient’s radiographs had a slightly similar imaging appear- nia without pulmonary necrosis in a chinchilla, a dog, and a cow, ance to Langerhans cell histiocytosis in humans (11). However, but only the cow had extensive bullous emphysema (10,17,18). the positive CD18 and negative E-cadherin results identified Given the rapid decline when radiographs were taken, cardiac these cells as histiocytic and inflammatory in origin, and not of arrest was presumed to be due to severe tension pneumothorax, Langerhans cell origin. Two possible pathophysiologic theories likely caused by rupture of a bulla and less likely caused by the remain that could have led to this combination of pulmonary initial CPR attempt. Differentiation between congenital versus pathology: the patient had congenital bullous emphysema that acquired bullous emphysema with concurrent bronchointerstitial progressed to bronchointerstitial pneumonia with necrosis, pneumonia with necrosis was challenging in this case. Based on or the patient had severe bronchointerstitial pneumonia with the young age of the puppy, the acute and rapid decline, the necrosis that progressed to acquired bullous emphysema. radiographic appearance, the severity of the bullous changes, The first theory is that the patient had a severe form of and the lack of identification of an infectious cause, we suspect congenital bullous emphysema that progressed to bronchoin- the patient most likely had congenital bullous emphysema that terstitial pneumonia with necrosis. End-stage congenital bul- progressed to bronchointerstitial pneumonia with necrosis lous emphysema was first suspected on radiographs given secondary to an underlying vasculitis or immune-mediated the patient’s young age and a similar radiological appearance disease. Although the history with the breeder is unknown, the to a previous report of congenital bullous emphysema in a mild clinical signs when he was obtained were likely the start of

954 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY the puppy’s acute decline. We expect that a puppy with necro- References sis this severe, if secondary to an infectious cause, would have . 1 Caswell JL, Williams KJ. Respiratory system. In: Maxie MG, ed. Jubb, shown more significant clinical signs at the time the puppy was Kennedy & Palmer’s Pathology of Domestic Animals. 6th ed. Vol 2. obtained from the breeder. Additionally, the thymus was grossly St. Louis, Missouri: Elsevier, 2016:486–487. 2. Barton L. Daily assessment of the critically ill patient. In: Silverstein normal in size and appearance suggesting that this puppy was DC, Hopper K, eds. Small Animal Critical Care Medicine. St. Louis, likely immunocompetent, making common viral diseases less Missouri: Saunders/Elsevier, 2009:853. REPORT CASE likely. As every infectious disease could not be tested for, we can- 3. Hawkins EC, Basseches J, Berry CR, Stebbins ME, Ferris KK. 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The greatest limitation to 1986;23:83–84. radiographs is that fluid-filled cavities or bullae could be missed 9. Ruth J, Rademacher N, Ogden D, Rodriguez D, Gaschen L. Imaging diagnosis — Congenital lobar emphysema in a dog. Vet Radiol due to superimposition of lung pathology or silhouetting of Ultrasound 2011;52:79–81. fluid-filled lesions with soft tissues of the thorax (15). In these 10. Trempala CL, Herold LV. Spontaneous pneumothorax associated with cases, computed tomography (CT) may be advantageous as it is Aspergillus bronchopneumonia in a dog. J Vet Emerg Crit Care 2013; 23:624–630. more sensitive in detection of cavitary lesions and the extent of 11. Odev K, Guler I, Altinok T, Pekcan S, Batur A, Ozbiner H. Cystic and pulmonary changes (15), but CT references in veterinary medi- cavitary lung lesions in children: Radiologic findings with pathologic cine for these diseases are scarce (10,22). Computed tomography correlation. J Clin Imaging Sci 2013;3:60. 12. Tennant BJ, Haywood S. Congenital bullous emphysema in a dog: features of congenital bullous emphysema in dogs have not been A case report. J Small Anim Pract 1987;28:109–16. reported. In the dog with acquired bullous emphysema and con- 13. Hoover JP, Henry GA, Panciera RJ. Bronchial cartilage dysplasia with current Aspergillus bronchopneumonia, CT showed a large bulla multifocal lobar bullous emphysema and lung torsions in a pup. J Am Vet Med Assoc 1992;201:599–602. with multiple smaller bullae in the affected lobe (10). In a dog 14. Anderson AE, Azcuy A, Batchelder TL, Foraker AG. Experimental with pneumonia and necrosis, CT revealed collapse of the right analysis in dogs of the relationship between pulmonary emphysema, middle, and caudal lung lobes with air bronchograms, irregular- alveolitis, and hyperinflation. Thorax 1964;19:420–432. 15. Masters IB, Isles AF, Grimwood K. Necrotizing pneumonia: An emerg- ity of the pleural surface of the lung, and pneumothorax (22). ing problem in children? Pneumonia 2017;Jul 25:9–11. Due to the obvious severity of pulmonary abnormalities seen on 16. Tsai Y-F, Ku Y-H. Necrotizing pneumonia: A rare complication of radiographs in our case, a CT was not performed. pneumonia requiring special consideration. Curr Opin Pulm Med 2012; 18:246–252. In conclusion, this case highlights the common endpoint of 17. Bezek DM, Williams J, Rings DM. What is your diagnosis? Broncho­ 2 possible primary pathophysiologic processes — congenital pneumonia with unilateral pneumothorax, pneumomediastinum, and bullous emphysema leading to bronchointerstitial pneumonia pulmonary bullae. J Am Vet Med Assoc 1995;206:955–956. 18. Huynh M, Pingret J-L, Nicolier A. Disseminated Mycobacterium with necrosis versus bronchointerstitial pneumonia with necrosis genavense infection in a Chinchilla (Chinchilla lanigera). J Comp Pathol progressing to acquired bullous emphysema. The appearance 2014;151:122–125. of the radiographs is striking, with pulmonary bullae admixed 19. Breitschwerdt EB, DebRoy C, Mexas AM, Brown TT, Remick AK. Isolation of necrotoxigenic Escherichia coli from a dog with hemorrhagic with regions of increased soft tissue opacity. The presence of pneumonia. J Am Vet Med Assoc 2005;226:2016–2019. radiographic changes as severe as seen here should prompt a cli- 20. Chvala S, Benetka V, Möstl K, Zeugswetter F, Spergser J, Weissenböck nician to consider both congenital disease and infectious causes H. Simultaneous canine distemper virus, canine adenovirus type 2, and Mycoplasma cynos infection in a dog with pneumonia. Vet Pathol which could have implications for the health of a young puppy’s 2007;44:508–512. littermates. If similar changes are seen in a puppy, examination 21. Kumar S, Driskell EA, Cooley AJ, et al. Fatal canid herpesvirus 1 of the littermates with radiography or infectious disease testing respiratory infections in 4 clinically healthy adult dogs. Vet Pathol 2015;52:681–687. (including viral, bacterial, protozoal, or fungal diseases) may 22. Garber JB, Saile K, Rademacher N, Wignall JR, McLaughlin LD, allow detection of disease in these puppies before clinical signs Ryan KA. Pneumothorax in a dog caused by necrotizing pneumonia arise and allow for earlier implementation of treatment. secondary to heatstroke. J Vet Emerg Crit Care 2015;25:759–764. Acknowledgments We thank Dr. Andrea Pires dos Santos and Nelly Elshafie for their performance of pan-fungal PCR testing on lung samples. CVJ

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Answers to Quiz Corner Les réponses du test éclair

1. C) Serum cobalamin is frequently decreased. The other answers 5. C) This animal will die in minutes if bloat is not relieved. are correct. Rumenotomy is the only method to achieve this. Surgical C) La concentration sérique de cobalamine est fréquemment preparation time will be short, and the rumen will not be diminuée. Les autres réponses sont bonnes. pexied to the skin as it is in an exploratory procedure, but packing off the area and using an assistant will reduce 2. A) Clinical signs usually occur in young animals. abdominal contamination. Oral administration of surfactants A) Les signes cliniques apparaissent habituellement chez les is effective, but takes approximately 10 to 20 minutes to jeunes animaux. cause eructation. Percutaneous administration of surfactants 3. C) Cardiomyopathy has been associated with taurine deficiency. is not recommended. Elevation of forequarters and mild exer- C) La cardiomyopathie a été associée à une carence en taurine. cise may accelerate eructation, particularly after surfactant administration, but is inappropriate in an emergency. 4. A) Clinical signs of laryngeal hemiplegia include exercise intol- C) Cet animal va mourir en quelques minutes si le ballonnement erance and inspiratory respiratory stridor. Grade 3 laryngeal n’est pas éliminé. La ruminotomie est la seule intervention hemiplegia is characterized by asynchronous movement pour y parvenir. Le temps de préparation chirurgicale doit of one arytenoid, with that arytenoid being unable to fully être court et le rumen ne sera pas fixé à la peau comme c’est abduct on endoscopic examination. le cas lors d’une procédure exploratrice, mais le paquetage A) Les signes cliniques de l’hémiplégie laryngée comprennent de la région et l’aide d’un assistant diminueront la contami- une intolérance à l’effort et un bruit de cornage à l’inspira - nation abdominale. L’administration orale de surfactants est tion. L’hémiplégie laryngée de grade 3 est caractérisée par un efficace, mais prend environ 10 à 20 minutes pour provoquer mouvement asynchrone de l’un des cartilages aryténoïdes, l’éructation. L’administration intraruminale de surfactants qui est incapable de faire une abduction complète à l’examen n’est pas recommandée. L’élévation des membres antérieurs endoscopique. et l’exercice léger peuvent accélérer l’éructation, particuliè- rement après l’administration de surfactants, mais ne sont pas appropriés en situation d’urgence.

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956 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY Article

Pathology associated with ophidiomycosis in wild snakes in Ontario, Canada

Christina M. McKenzie, Paul T. Oesterle, Brian Stevens, Leonard Shirose, Brandon N. Lillie, Christina M. Davy, Claire M. Jardine, Nicole M. Nemeth

Abstract — Ophidiomycosis (snake fungal disease) is the most common cause of skin lesions in free-ranging snakes in North America. Naturally infected snakes with ophidiomycosis (9 carcasses, 12 biopsies) were examined grossly and histologically. These cases comprised 32% of the 66 snake cases submitted to the Canadian Wildlife Health Cooperative-Ontario/Nunavut Node in 2012 through 2018. Affected species included the eastern foxsnake (Pantherophis vulpinus; n = 15), gray ratsnake (Pantherophis spiloides; n = 3), eastern massasauga (Sistrurus catenatus; n = 2), and queensnake (Regina septemvittata; n = 1). Severity of disease varied widely from mild microscopic skin lesions to fatal, necrotizing, and ulcerative facial lesions. Key clinical message: Ophidiomycosis should be the primary differential diagnosis for skin lesions in wild snakes, particularly in southern Ontario.

Résumé — Pathologie associée avec l’ophidiomycose chez des serpents sauvages en Ontario, Canada. L’ophidiomycose (maladie fongique du serpent) est la cause la plus fréquente de lésions cutanées chez les serpents en liberté en Amérique du Nord. Les serpents infectés naturellement avec l’ophidiomycose (9 carcasses, 12 biopsies) furent examinés macroscopiquement et histologiquement. Ces cas comprenaient 32 % des 66 cas de serpents soumis au Réseau canadien pour la santé de la faune – Centre régional de l’Ontario et du Nunavut entre 2012 et 2018. Les espèces affectées incluaient la couleuvre fauve de l’est (Pantherophis vulpinus; n = 15), la couleuvre obscure (Pantherophis spiloides; n = 3), la massasauga (Sistrurus catenatus; n = 2) et la couleuvre royale (Regina septemvittata; n = 1). La sévérité de la maladie variait grandement allant de lésions cutanées microscopiques à une forme fatale, nécrosante et lésions faciales ulcératives. Message clinique clé : L’ophidiomycose devrait être le diagnostic différentiel primaire pour les lésions cutanées chez les serpents sauvages, particulièrement dans le sud de l’Ontario. (Traduit par Dr Serge Messier) Can Vet J 2020;61:957–962

Introduction been documented in over 30 species, encompassing 6 families phidiomycosis, also known as snake fungal disease, is of wild snakes across North America and in some areas of O caused by the fungus Ophidiomyces ophiodiicola and can Europe (1,3–5). Furthermore, O. ophiodiicola is thought to be cause facial swelling, granulomatous dermatitis, and death in the most common cause of skin lesions in free-ranging snakes both captive and free-ranging snakes (1–3). The disease was first in the eastern United States (3,6). The observed prevalence described in a free-ranging population of timber rattlesnakes and severity of ophidiomycosis lesions vary seasonally in some (Crotalus horridus) in 2011 in New Hampshire, and has since species. Clinical disease in snakes often corresponds to their

Canadian Wildlife Health Cooperative — Ontario/Nunavut, Department of Pathobiology, University of Guelph, Guelph, Ontario N1G 2W1 (McKenzie, Oesterle, Stevens, Shirose, Jardine); Department of Pathobiology, University of Guelph, Guelph, Ontario N1G 2W1 (McKenzie, Lillie, Jardine); Environmental and Life Sciences Program, Trent University, Environmental Science Building, Suite A211, 1600 West Bank Drive, Peterborough, Ontario K9L 0G2 (Davy); Wildlife Research and Monitoring Section, Ontario Ministry of Natural Resources and Forestry, 300 Water Street, Peterborough, Ontario K9J 8M5 (Davy); Southeastern Cooperative Wildlife Disease Study, University of Georgia, 589 D.W. Brooks Drive, Athens, Georgia, 30602, USA (Nemeth). Address all correspondence to Dr. Christina McKenzie; 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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­emergence from brumation, a time of severe energy restric- Table 1. Grading scheme for Ophidiomyces ophiodiicola tion and communal behavior in snakes (1,7,8). In free-ranging microscopic skin lesions in snakes. snakes, the development of ophidiomycosis is likely multifacto- Skin histologic feature score rial, and the mechanisms by which it causes mortality are cur- Feature Description Points rently unknown (1,8). Thirteen of Ontario’s native, free-ranging Inflammation • None 0 snake species are considered species at risk (9), 4 of which have • Heterophils in epidermis 1 been found with ophidiomycosis as discussed in this study. • Mixed inflammation, dermal involvement 2 They are subject to numerous threats, including habitat loss and • Mixed inflammation, muscle involvement 3 degradation, vehicular trauma, and deliberate persecution by Necrosis • None 0

ARTICLE humans, in addition to the potential threat posed by infectious • Minimal 1 • Coalescing areas, , 1 scale width 2 diseases, such as ophidiomycosis (9). We sought to describe the • Coalescing areas, . 1 scale width 3 pathology of ophidiomycosis in naturally infected free-ranging Other • Serocellular crust 1 snakes in Ontario, Canada, at the northern limit of the currently • Ulceration 1 recognized range of O. ophiodiicola. Skin grade determination Materials and methods Total Histologic grade points All snake cases diagnosed with ophidiomycosis at the Canadian Wildlife Health Cooperative (CWHC) Ontario/Nunavut node 0 0 I 1–3 from 2012–2018 (including whole carcasses and snake skin II 4–5 biopsies) that met the following criteria were reviewed: available III 6–8 formalin-fixed, paraffin-embedded tissues, a positive quantitative polymerase chain reaction (qPCR) result for O. ophiodiicola, and microscopically visible fungal elements. For each snake, the species, sample submission type, diagnosed cause of death, and Figure 1a), II (i.e., moderate; Figure 1b), and III (i.e., severe; gross lesions were recorded. Before 2012, no snakes submitted to Figure 1c). In many biopsy samples, deep muscle involvement the CWHC in Ontario were reported to have lesions consistent could not be assessed due to superficial sampling; thus, the with ophidiomycosis. Before 2015, qPCR for O. ophiodiicola maximum number of points for skin inflammation in these was not available at the provincial diagnostic laboratory (Animal cases was 2. Health Laboratory, University of Guelph, Guelph, Ontario) Nucleic acid (DNA) was extracted from fresh-frozen skin and thus, frozen skin samples collected from 2012 and 2014 swabs, fresh-frozen skin, and formalin-fixed paraffin-embedded were retrospectively tested by qPCR. Whole carcasses were samples using a commercially available kit (DNeasy Plant mini typically frozen before submission. After thawing, the skin Kit; Qiagen, Valencia, California, USA) following the manu- over the dorsal, ventral, and lateral body walls was swabbed, as facturer’s instructions. A TaqMan qPCR assay was performed well as any grossly visible skin lesions, with a polyester-tipped using primers and probe from IDT (Coralville, Iowa, USA) applicator and a standard necropsy was performed. A common and master mix from Roche (Laval, Quebec) to amplify the alternative to carcass submission was field collection of a skin internal transcribed spacer between the 18S and 5.8S ribosomal biopsy sample from live snakes along with an additional section RNA gene specific for O. ophiodiicola as described in Allender of fresh skin or a skin swab for the qPCR test. Biopsy samples et al (10). All histology processing and staining and qPCR were submitted in lysis buffer were placed in 10% neutral-buffered performed at the Animal Health Laboratory (Guelph, Ontario). formalin for at least 24 h before processing for histopathology. Formalin-fixed samples were routinely processed, embedded in Results paraffin, sectioned at 5 mm, and stained with hematoxylin and Of the 66 snake cases submitted to the CWHC from 2012 to eosin (H&E), as well as Gomori’s methenamine silver (GMS) 2018, 21 (32%) met the criteria of having both histological stain. When a fresh skin or swab sample was not available, the lesions consistent with ophidiomycosis and a positive qPCR lysis buffer fluid that contained the skin biopsy was tested by result for O. ophiodiicola (9 carcasses, 12 skin biopsies; Table 2). qPCR. In 1 case, formalin-fixed paraffin-embedded tissue was Species included the eastern foxsnake (Pantherophis vulpinus; deparaffinized and used for qPCR analysis. When multiple tis- n = 15), gray ratsnake (P. spiloides; n = 3), eastern massasauga sues were submitted for qPCR from the same snake, the sample (Sistrurus catenatus; n = 2), and queensnake (Regina septemvit- with the greatest amount of fungal DNA, as indicated by the tata; n = 1). lowest cycle threshold value, was used for analysis. The cause of death was attributed to ophidiomycosis in 3 of Histopathology scoring was performed on the most affected the 21 (14%) snakes (W.C.05, W.C.08, and W.C.09), 2 of skin section from each snake, based on estimated percentage which were eastern massasaugas. The 2 rattlesnakes had severe of the section with a lesion. Inflammation and necrosis were gross lesions with brown crusting over the head, affecting the subjectively scored based on depth and amount of tissue affected spectacles and nasolabial pits, and swelling of the rostrum as 0, 1, 2, or 3. The presence or absence of serocellular crusting (Figure 1d). Caudal to the crusted areas, there was loosely and ulceration was also scored. A histologic grade (Table 1) was adhered, unshed skin, indicating dysecdysis. The ventral and then assigned to each snake skin as 0 (i.e., absent), I (i.e., mild; dorsal subcutis of both snakes had approximately twelve, 1- to

958 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY ARTICLE

Figure 1. Natural Ophidiomyces ophiodiicola infections in snakes from Ontario, Canada. a — Skin, Pantherophis vulpinus, grade I lesion with heterophilic inflammation limited to the epidermis and serocellular crusting with intralesional fungal hyphae, antemortem biopsy sample, snake W.B.01. Hematoxylin and eosin (H&E) stain. Scale bar = 50 mm. b — Skin, P. vulpinus, grade II lesion with heterophilic and granulomatous inflammation extending into the dermis, with a small amount of necrosis, serocellular crusting and ulceration, postmortem specimen, snake W.C.02. H&E stain. Scale bar = 100 mm. c — Skin, P. vulpinus, grade III lesion with heterophilic and granulomatous inflammation extending into the skeletal muscle, with extensive necrosis, serocellular crusting and ulceration, antemortem biopsy sample, snake W.B.05. H&E stain. Scale bar = 500 mm. d — Head, Sistrurus catenatus, severe, locally extensive swelling, crusting and ulceration with oral and ocular involvement, postmortem specimen, snake W.C.08. e — Head, S. catenatus, severe, heterophilic and granulomatous, necroulcerative dermatitis, cellulitis, and myositis (black arrowhead), stomatitis (black chevron), with serocellular crusts over the head and eyes (asterisk), postmortem specimen, snake W.C.09. There is also osteomyelitis and encephalitis in this specimen, not visible at this low magnification. H&E stain. Scale bar = 2 mm. f — Scale, S. catenatus, a large number of O. ophiodiicola hyphae (black arrowhead) and arthroconidia (black chevron) in the keratin of a scale overlying necrotic tissue, postmortem specimen, snake W.C.09. Gomori’s methenamine silver stain. Scale bar = 20 mm. g — Lung, S. catenatus, heterophilic and granulomatous fungal pneumonia, postmortem specimen, snake W.C.08. H&E stain. Scale bar = 200 mm. h — Skin, Pantherophis spiloides, thickened, irregular and dull scales on the lateral body wall (white asterisk), postmortem specimen, snake W.C.07.

3-mm diameter, raised, firm, nodules randomly scattered along septate, and had undulating walls and acute angle branching the length of the body. Snake W.C.09 had 2, firm, 5-mm consistent with O. ophiodiicola. Conidia were rectangular and diameter nodules within the caudal lung. Both snakes were approximately 3 to 8 3 3 mm. The fungus stained positive with in good nutritional condition with abundant intracoelomic GMS (Figure 1f). Both snakes had extensive, # 150-mm deep and pericardial adipose tissue, as these 2 snakes were held in a foci of serocellular crusting and necrosis of the epidermis and rehabilitation facility and force fed for 5 wk before submission. dermis, affecting approximately 20% to 80% of the skin over the Microscopically, these lesions corresponded to severe granulo- head. In the snout of snake W.C.09, there was extensive necrosis matous and heterophilic, necroulcerative dermatitis, cellulitis, with aggregates of fungal hyphae that effaced the epidermis, myositis, keratitis, stomatitis, and osteomyelitis with intrale- dermis, skeletal muscle, bone, and nasal turbinates. In the sional fungal hyphae and conidia consistent with O. ophiodiicola more caudal portions of the head, fungal hyphae and associated (Figure 1e). Fungal hyphae were amphophilic, 4 to 6 mm wide, inflammation extended from the skin into underlying bone and,

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Table 2. Summary of gross and microscopic lesions and qPCR results from carcasses and biopsy samples of wild snakes naturally infected with Ophidiomyces ophiodiicola in Ontario, Canada, 2012–2018. Skin qPCR Gross Histologic Cycle Submission Case Species Year lesions Inflammation Necrosis Crust Ulceration grade Sample threshold Carcass W.C.01 Pantherophis 2012 2 1 0 1 0 Ia fresh skin 38.69 vulpinus Carcass W.C.02 P. vulpinus 2014 1 2 1 1 1 IIa fresh skin 23.35 Carcass W.C.03 P. vulpinus 2016 2 1 1 1 0 IIa skin swab 34.42 Carcass W.C.04 P. vulpinus 2016 2 1 1 1 0 Ia skin swab 26.85 a ARTICLE Carcass W.C.05 P. vulpinus 2017 1 3 2 1 0 III skin swab 34.62 Carcass W.C.06 P. vulpinus 2018 1 3 3 1 1 IIIa skin swab 36.83 Carcass W.C.07 P. spiloides 2018 1 2 2 1 0 IIa skin swab 30.46 Carcass W.C.08 Sistrurus 2018 1 3 3 1 1 IIIa skin swab 30.79 catenatus Carcass W.C.09 S. catenatus 2018 1 3 3 1 1 IIIa skin swab 29.71

Biopsy W.B.01 P. vulpinus 2015 1 1 0 1 0 Ia shed skin 21.48 Biopsy W.B.02 P. vulpinus 2016 1 2 3 1 1 IIIa fresh skin 33.61 Biopsy W.B.03 P. vulpinus 2016 1 2 1 1 1 IIa FFPE 23.10 Biopsy W.B.04 Regina 2016 1 2 1 1 0 IIa skin swab 33.95 septemvittata Biopsy W.B.05 P. vulpinus 2017 1 3 3 1 1 IIIa skin swab 27.69 Biopsy W.B.06 P. spiloides 2018 1 NA NA 1 NA NAa skin swab 22.65 Biopsy W.B.07 P. spiloides 2018 1 NA NA 1 NA NAa skin swab 33.66 Biopsy W.B.08 P. vulpinus 2018 1 2 3 1 1 IIIa lysis buffer 24.27 Biopsy W.B.09 P. vulpinus 2018 1 2 3 1 1 IIIa lysis buffer 20.49 Biopsy W.B.10 P. vulpinus 2018 1 2 3 1 1 IIIa lysis buffer 19.49 Biopsy W.B.11 P. vulpinus 2018 1 2 3 1 1 IIIa lysis buffer 24.68 Biopsy W.B.12 P. vulpinus 2018 1 3 3 1 1 IIIa lysis buffer 24.73

NA — not applicable; 1 — present; 2 — absent; FFPE — formalin-fixed paraffin-embedded tissue. a Fungal hyphae observed in affected tissue.

to a lesser extent, the brain (Figure 1e). In the epidermis, fungal anesthetic complications during transmitter implantation sur- hyphae and conidia most often formed dense aggregates within gery were considered the proximate cause of death. Gross the keratin and serocellular crust, underlain by a layer of hetero- lesions attributed to ophidiomycosis included three, 1- to 2-mm phils and epithelioid macrophages. In the deeper tissues, fungal diameter crusts over the caudodorsal head, which corresponded hyphae were most often found in a central area of necrosis, sur- to grade III skin lesions with dermal and skeletal muscle granu- rounded by a ring of epithelioid macrophages with interspersed lomas, ulceration and crusting with intralesional fungi. The heterophils that increased in number towards the periphery. The proximate cause of death in snake W.C.07, a gray ratsnake, pulmonary nodules in snake W.C.09 were fungal granulomas, was determined to be septicemia secondary to traumatic tail which were also seen in the lung of snake W.C.08, although they amputation. There were two, 1.5 3 1.0 cm foci of crusting and were not recognized grossly. Inflammation, hyphae and debris irregular scales in the skin over the lateral body wall (Figure 1h), extended from the faveolar septa into airspaces and the central which corresponded to skin lesions with a histologic grade of lumen (Figure 1g). II with inflammation in the dermis, and a moderate amount of The third snake in which mortality was directly attributed to necrosis and serocellular crusting. ophidiomycosis was an eastern foxsnake (W.C.05). The cause of Two snakes (eastern foxsnakes, W.C.01 and W.C.03) had death was determined to be emaciation (i.e., empty gastrointes- microscopic lesions compatible with ophidiomycosis and tested tinal tract, no fat bodies, and reduced muscle mass) secondary qPCR positive for O. ophiodiicola, but the fungal infection to facial ophidiomycosis lesions. There was an opaque, right, was considered incidental due to lack of gross lesions and mild ocular spectacle and a 5-mm diameter, firm swelling at the cau- (grade I) histologic lesions. Snake W.C.01 was egg bound with dal aspect of the right mandible. Microscopically, a heterophilic, resulting sepsis. Microscopically, W.C.01 had serocellular crust- serocellular crust containing fungal hyphae and conidia covered ing affecting half of a single scale on the head, with rare fungal the corneal surface, with a granuloma in the adjacent eyelid and hyphae, and a few heterophils in the underlying dermis with extraocular connective tissue. Over the mandibular skin, there no necrosis. Snake W.C.03 had extensive damage to the cranial was serocellular crusting and a 2-mm diameter granuloma in portion of the body, attributed to vehicular-induced trauma. the underlying dermis, with heterophils and macrophages in Microscopically, W.C.03 had a very similar lesion on the head, the subjacent skeletal muscle. with a small amount of necrosis. In 2 additional snakes (W.C.06 and W.C.07), ophidiomy- The cause of death was not determined in 2 snakes (W.C.02 cosis was considered to be an incidental finding or potentially and W.C.04, both eastern foxsnakes) with microscopic ophid- contributing to death. In snake W.C.06, an eastern foxsnake, iomycosis lesions that were considered subclinical (i.e., mild

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and of limited distribution) and positive qPCR results. In snake cosis was considered the cause of death was an eastern foxsnake, W.C.02, there were a few thickened scales grossly over the dorsal which was emaciated, presumably secondary to facial ophid- aspect of the head, which microscopically correlated to grade II iomycosis. Lesions involving the head are thought to decrease skin lesions with primarily heterophilic inflammation. In snake the snake’s ability to obtain food and lead to a negative caloric W.C.04 there were no gross lesions of ophidiomycosis, but the balance and subsequent immunosuppression (1,14). The func- snake was in poor nutritional condition and had numerous tion of the innate immune system could also be compromised

nematodes in the lungs, and a transmitter had been previously by direct fungal damage to the physical barrier of the skin and ARTICLE implanted in the coelomic cavity. Microscopically, there was a dysecdysis. Ophidiomycosis can also lead to behavioral changes grade I skin lesion with heterophilic inflammation. (e.g., increased time spent basking), which may predispose to Of the 12 snakes for which skin biopsy samples were submit- other mortality causes (e.g., vehicular trauma, predation). This ted, all were reported by the submitter to have had gross lesions. may have been the case with an eastern massasauga, which had All samples had serocellular crusting with heterophils and visible multiple ophidiomycosis skin lesions, but died from sepsis due fungal hyphae. Samples from 2 snakes (W.B.06 and W.B.07) to a traumatic tail amputation. Affected snakes of some species were limited to crusts removed from the skin (presumed supra- are often observed basking in the open more often than unin- epidermal), with no epidermis or dermis for evaluation; these fected snakes in both experimental and natural settings (4,15). samples could not be graded. Among the remaining 10 samples, This behavior may in part be an adaptation toward combatting 1 had grade I skin lesions, 2 had grade II skin lesions, and 7 had pathogens, as basking increases body temperature and metabolic grade III skin lesions. Only 2 skin samples (snakes W.B.05 and rate (15–17). W.B.12) were sufficiently deep to assess the underlying skeletal Skin from biopsied snakes in the present study displayed muscle for involvement, which included inflammation in both a wide range of lesion severity. Although the samples that cases (Figure 1c). consisted only of supraepidermal crusts were sufficient for demonstrating fungus in the lesion, the deeper sections allowed Discussion for assessment of skeletal muscle involvement, which may have All snakes in this study displayed varying degrees of hetero- been prognostically significant. When collecting biopsy samples philic and granulomatous dermatitis, cellulitis, and myositis, from snakes for ophidiomycosis assessment, the benefits of a as well as additional lesions potentially attributable to invasive deeper, more complete biopsy sample must be weighed against or disseminated O. ophiodiicola infection, consistent with the negative effects of a more invasive procedure that may be previous reports of ophidiomycosis in the United States and detrimental to the snake. Europe (1,5). The ophidiomycosis microscopic skin lesion grading scheme Lesion severity associated with O. ophiodiicola infection described in the present study proved a useful tool to create varied greatly among individual snakes. Previous studies have semi-quantitative data based on lesion characteristics and sever- suggested that species within the family Viperidae may be more ity. The scheme allowed us to compare skin lesions in both susceptible to the effects of ophidiomycosis (4,11,12). Indeed, carcasses and biopsy samples. This grading scheme provides a 2 of the 3 snakes we observed with fatal ophidiomycosis were template for future assessments of ophidiomycosis, allowing for viperids. The potential population-level impacts of ophid- more consistent lesion comparisons across studies. It may also iomycosis on free-ranging snakes were first recognized in a prove useful as a prognostic indicator, but this would require population of eastern massasaugas in Illinois (11). The eastern further studies (e.g., a prospective study). massasauga is Ontario’s only extant, native species in the family Although the population-level impacts of ophidiomycosis Viperidae (13). However, many other snake species, including are unclear, snake species in Ontario are subject to various colubrids, also can develop severe infections (1). Both eastern significant threats, primarily due to human activity, and it is massasaugas in this study had extensive facial lesions, including essential that all risk factors, including disease, be considered fungal stomatitis, keratitis, osteomyelitis, and encephalitis. This in conservation initiatives (9). Ophidiomycosis is a complex most likely led to fungal pneumonia in both snakes through disease, especially in natural settings in which season, stress, either inhalation or direct extension, rather than hematogenous food availability and habitat degradation play a role in pathogen- embolization, given the presence of fungal hyphae and debris esis (1,7,15,18–20). Further targeted studies as well as ongoing in the central airspaces. All of the other snakes diagnosed with surveillance, including population monitoring, are required to naturally acquired ophidiomycosis in this study were species determine the potential impacts of ophidiomycosis on snakes within the family Colubridae, which encompasses the majority in Ontario, as well as in the rest of Canada. of native, free-ranging snake species in Ontario. Lesions in these snakes were primarily confined to the superficial skin. Eastern Acknowledgments foxsnakes are overrepresented among the naturally infected We are indebted to Doug Campbell, recently retired from the species in this study, as many samples came from a single, free- Canadian Wildlife Health Cooperative (CWHC), for con- ranging population that is intensively monitored and sampled ducting the initial examination of all naturally infected snakes as part of a research initiative. prior to August 2018. We are grateful to the CWHC Ontario/ In the colubrids in the present study, ophidiomycosis was usu- Nunavut staff and to those who submitted case material. We ally considered an incidental finding, or potentially contributing thank the Animal Health Laboratory, especially Hugh Cai, as to the cause of death. The only colubrid in which ophidiomy- well as the histotechnology team. CVJ

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References 10. Allender MC, Bunick D, Dzhaman E, Burrus L, Maddox C. Develop­ ment and use of a real-time polymerase chain reaction assay for the . 1 Lorch JM, Knowles S, Lankton JS, et al. Snake fungal disease: An emerg- detection of Ophidiomyces ophiodiicola in snakes. J Vet Diagn Invest ing threat to wild snakes. Philos Trans R Soc Lond B Biol Sci 2016; 2015;27:217–220. 371:ID2015045. 11. Allender MC, Dreslik M, Wylie S, et al. Chrysosporium sp. infection in 2. Rajeev S, Sutton DA, Wickes BL, et al. Isolation and characterization of eastern massasauga rattlesnakes. Emerg Infect Dis 2011;17:2383–2384. a new fungal species, Chrysosporium ophiodiicola, from a mycotic granu- 12. McBride MP, Wojick KB, Georoff TA, et al. Ophidiomyces ophiodiicola loma of a black rat snake (Elaphe obsoleta obsoleta). J Clin Microbiol dermatitis in eight free-ranging timber rattlesnakes (Crotalus horridus) 2009;47:1264–1268. from Massachusetts. J Zoo Wildl Med 2015;46:86–94. 3. Sigler L, Hambleton S, Paré JA. Molecular characterization of reptile 13. Powell R, Conant R, Collins JT. Peterson Field Guide to Reptiles and pathogens currently known as members of the chrysosporium anamorph Amphibians of Eastern and Central North America (Vol 12). Boston, of Nannizziopsis vriesii complex and relationship with some human- Massachusetts: Houghton Mifflin Harcourt, 2016.

ARTICLE associated isolates. J Clin Microbiol 2013;51:3338–3357. 14. Bouma HR, Carey HV, Kroese FGM. Hibernation: The immune system 4. Clark RW, Marchand MN, Clifford BJ, Stechert R, Stephens S. at rest? J Leukoc Biol 2010;88:619–624. Decline of an isolated timber rattlesnake (Crotalus horridus) popula- 15. Lorch JM, Lankton J, Werner K, Falendysz EA, McCurley K, Blehert tion: Interactions between climate change, disease, and loss of genetic DS. Experimental infection of snakes with Ophidiomyces ophiodiicola diversity. Biol Conserv 2011;144:886–891. causes pathological changes that typify snake fungal disease. mBio 5. Franklinos LHV, Lorch JM, Bohuski E, et al. Emerging fungal pathogen 2015;6:e01534–15. Ophidiomyces ophiodiicola in wild European snakes. Sci Rep 2017 Jun 16. Dorcas ME, Hopkins WA, Roe JH. Effects of body mass and tempera- 19;7(1):3844. ture on standard metabolic rate in the eastern diamondback rattlesnake 6. Allender MC, Raudabaugh DB, Gleason FH, Miller AN. The natural (Crotalus adamanteus). Copeia 2004;1:145–151. history, ecology, and epidemiology of Ophidiomyces ophiodiicola and its 17. Graham SP, Fielman KT, Mendonça MT. Thermal performance and potential impact on free-ranging snake populations. Fungal Ecol 2015; acclimatization of a component of snake (Agkistrodon piscivorus) innate 17:187–196. immunity. J Exp Zool A Ecol Integr Physiol 2017;327:351–357. 7. Guthrie AL, Knowles S, Ballmann AE, Lorch JM. Detection of snake 18. Allender MC, Dreslik MJ, Wylie DB, Wylie SJ, Scott JW, Phillips CA. fungal disease due to Ophidiomyces ophiodiicola in Virginia, USA. J Ongoing health assessment and prevalence of Chrysosporium in the east- Wildl Dis 2016;52:143–149. ern massasauga (Sistrurus catenatus catenatus). Copeia. 2013;1:97–102. 8. Lind C, Moore IT, Akçay Ç, Vernasco BJ, Lorch JM, Farrell TM. 19. Lind CM, McCoy CM, Farrell TM. Tracking outcomes of snake fungal Patterns of circulating corticosterone in a population of rattlesnakes disease in free-ranging pigmy rattlesnakes (Sistrurus miliarius). J Wildl afflicted with snake fungal disease: Stress hormones as a potential media- Dis 2018;54:352–356. tor of seasonal cycles in disease severity and outcomes. Physiol Biochem 20. McCoy CM, Lind CM, Farrell TM. Environmental and physiological Zool 2018;91:765–775. correlates of the severity of clinical signs of snake fungal disease in a 9. COSEWIC Annual Report 2007–2008. Committee on the status of population of pigmy rattlesnakes, Sistrurus miliarius. Conserv Physiol endangered wildlife in Canada [homepage on the Internet]. Committee 2017;5:1–10. on the Status of Endangered Wildlife in Canada c2019. Available from: http://publications.gc.ca/collections/collection_2013/ec/CW70-18- 2008-eng.pdf Last accessed June 29, 2020.

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962 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY Case Report Rapport de cas

Leishmania infantum infection in a dog imported from Morocco

Victoria Wagner, Noélie Douanne, Christopher Fernandez-Prada

Abstract — A mixed breed dog rescued from Morocco was presented at a Quebec veterinary practice for facial lesions. Leishmaniosis, an exotic disease caused by the zoonotic protozoan Leishmania infantum, was suspected. Genomic DNA extraction from blood samples and polymerase chain reaction (PCR) were used to confirm L. infantum parasitemia. Parasites were successfully cultured from lesion biopsies, and dose-response assays demonstrated susceptibility to miltefosine, a drug that requires importation from Europe. Twenty-eight days of treatment led to the disappearance of lesions, but relapse occurred several months later (consistent with persistent parasitemia on post-treatment analysis). Further treatment would require importation of drugs and significant delays, offering a poor prognosis. Key clinical message: Diagnosis of tropical diseases in Canada will likely become more common in the near future. Having proper diagnostic tools, effective drugs, and stricter control of animal importation are essential to preventing the spread of these dangerous and frequently zoonotic diseases.

Résumé — Infection par Leishmania infantum chez un chien importé du Maroc. Un chien de race croisée réchappé du Maroc fut présenté dans une pratique vétérinaire du Québec pour des lésions faciales. La leishmaniose, une maladie exotique causée par le protozoaire zoonotique Leishmania infantum, fut suspectée. L’extraction d’ADN génomique d’échantillons sanguins et la réaction d’amplification en chaine par la polymérase (PCR) furent utilisées pour confirmer la parasitémie à L. infantum. Les parasites furent cultivés avec succès à partir de biopsies des lésions et des essais dose-réponse ont démontré une sensibilité au miltefosine, un médicament devant être importé d’Europe. Vingt-huit jours de traitement ont mené à la disparition des lésions, mais une rechute se produisit plusieurs mois plus tard (compatible avec une parasitémie persistante lors d’analyses post-traitement). Des traitements supplémentaires nécessiteraient l’importation de médicaments et des délais significatifs, offrant ainsi un pronostic peu optimiste. Message clinique clé : Le diagnostic de maladie tropicale au Canada devrait devenir plus fréquent dans un avenir rapproché. Il est essentiel d’avoir les outils diagnostiques appropriés, des médicaments efficaces et un contrôle plus sévère des importations d’animaux afin de prévenir la propagation de ces dangereuses et fréquentes maladies zoonotiques. (Traduit par Dr Serge Messier) Can Vet J 2020;61:963–965

eishmaniosis is a serious disease transmitted by sandflies (1). alone (6). Leishmaniosis in humans can manifest in several L The etiologic agent of canine leishmaniosis is the zoo- ways, including a disfiguring cutaneous form, mucocutaneous notic protozoan species Leishmania infantum, and dogs serve form, and fatal visceral form (1). In dogs, L. infantum infections as a reservoir for this infectious agent (2,3). Leishmaniosis in typically lead to cutaneous lesions with lymphadenomegaly, humans is a neglected tropical disease, affecting the eastern lethargy, and weight loss, sometimes progressing to deposition Mediterranean region, southeast Asia, and parts of Africa, of immune complexes and corresponding immune-mediated Europe, and Central and South America, with an estimated signs such as glomerulonephritis, keratoconjunctivitis sicca, and 1.3 million new cases annually (4,5). Conservative estimates vasculitis (3,7,8). Diagnosis of canine leishmaniosis can be chal- based on serological data indicate that approximately 2.5 million lenging due to a number of factors, including the high percent- dogs are affected in endemic western Mediterranean countries age of apparently healthy carriers, nonspecific nature of clinical

Département de Pathologie et Microbiologie and Groupe de recherche sur les maladies infectieuses des animaux de production “GREMIP,” Faculté de Médecine Vétérinaire Université de Montréal, Saint-Hyacinthe, Québec J2S 2M2. Address all correspondence to Dr. Christopher Fernandez-Prada; 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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signs, and lack of accessible diagnostic tools in non-endemic 0.5 mM of each primer, 0.2 mM of dNTPs, and 1 U of Phusion areas (1,3). This disease poses a serious public health risk, and DNA Polymerase (New England Biolabs, Ipswich, Massachusetts, prevention is based on vector control, reducing sandfly/human USA). Amplification was performed in 25 cycles: denaturation contact, and control of the animal reservoir (dogs), among oth- at 98°C for 10 s, annealing at 60°C for 30 s, and extension at ers (4). While the phlebotomine vector of this protozoan parasite 72°C for 1 to 2 min (depending on the size of the PCR ampli- is not present in Canada, certain indigenous species may be con). A final extension was performed at 72°C for 5 min. PCR competent vectors of Leishmania (9). Moreover, recent studies products were electrophoresed on 0.7% agarose gels, purified have shown the potential role of ticks in the infectious cycle of with the Monarch DNA Gel Extraction Kit (New England leishmaniosis (10,11). Given predictions that climate change Biolabs, USA) and sequenced. Cell culture, considered the gold may lead to expansion of Leishmania to North America, surveil- standard method for Leishmania diagnosis (15), was also car- lance for this important zoonosis (among other exotic diseases) ried out with samples from the affected dog’s lesions in 5 mL of RAPPORTCAS DE should be implemented and enforced (12). Current rules for M199 medium (Gibco, ThermoFisher, Waltham, Massachusetts, importing animals into Canada require only that the animal be USA) supplemented with 10% fetal bovine serum (Wisent, Saint- rabies-free (vaccinated or accompanied by a certificate of health Jean-Baptiste, Quebec), 5 mg/mL of hemin at pH 7.0 (Sigma, from a licensed veterinarian) and appear healthy at inspec- St. Louis, Missouri, USA), 100 IU of penicillin/mL (Sigma, tion (13). Here we describe the case of a dog imported from USA), and 100 mg of streptomycin/mL (Sigma). Preliminary Morocco to Quebec, with lesions on the face and muzzle that pathological testing of biopsies did not allow visualization of were later diagnosed to be infection with Leishmania infantum. Leishmania, which can often be found inside macrophages. Case description However, Sanger sequencing of DNA extracted from the blood sample (performed at the FMV sequencing service) detected the A mixed breed dog was presented to a private clinic in Quebec presence of Leishmania infantum. The veterinarian, therefore, for lesions on the muzzle and medial canthus of the left eye. The instituted therapy with allopurinol (Jamp Pharma Boucherville, dog had recently arrived in Quebec from a shelter in Morocco Quebec), 100 mg, PO, q24h, a leishmaniosis treatment avail- and had an unknown history. The lesions were granulomatous able in Canada, until the lengthy process of importing milt- and weeping and were originally thought to be wounds from efosine (Virbac, Carros, France), a more effective drug, could a fight. The dog was treated with Cefaseptin (Vétoquinol, be completed. Miltefosine was received 1 mo later and therapy Lavaltrie, Quebec), 12.5 mg/kg body weight (BW), PO, q12h was initiated at a dose of 2 mg/kg BW, PO, q24h for 28 d for 15 d. Three months later, the dog was again presented while awaiting final parasitological results. Parasites were suc- because the lesions had not disappeared; however, they were cessfully cultivated from skin samples after approximately 3 wk stable (granulomatous without purulent secretions) and no of growth. The culture was then separated into 2 aliquots; the new lesions had appeared. The veterinarian suspected pos- first was subjected to genomic DNA extraction using DNAzol sible autoimmune disease and implemented treatment with (Invitrogen, ThermoFisher, USA) as described by the manufac- Prednisolone (Rafter 8; Calgary, Alberta) at an anti-inflamma- turer. Polymerase chain reactions were performed as described. tory dose (0.5 mg/kg BW, PO, q12h for 7 d, q24h for 10 d, The resulting sequences were aligned against Leishmania ref- then q48h). Inflammation receded, but the lesions persisted. erence genomes using TriTryp.DB (16). Results once again Approximately 1 mo later, the lesions began to spread to the confirmed L. infantum. The second aliquot was used for dose- limbs of the dog. Leishmaniosis was suspected. response tests (in comparison with standard L. infantum wild The veterinarian consulted with the Faculté de médecine type strain MHOM/MA/67/ITMAP-263) to determine the drug vétérinaire — Université de Montréal (FMV). Biopsies (both susceptibility profile of the isolate by monitoring the growth of fresh and in formalin) of lesions on the lateral face of the right parasites after 72 h of incubation in the presence of increasing tarsus and medial face of the left carpus (firm, alopecic masses drug concentrations by measuring absorbance at 600 nm (17) with dry, red skin), and muzzle (where lesions had progressed (Cytation 5 multimode reader; BioTek, Winooski, Vermont, to become ulcerated and crusty), as well as a biopsy of the right USA). EC50 values were calculated based on dose-response submandibular lymph node were sent to the FMV Pathology and curves analyzed by non-linear regression with Prism 8.2. soft- Microbiology department. Blood and serum samples were sent to ware (GraphPad, San Diego, California, USA). Final results the FMV Molecular Parasitology department, where they were of dose-response assays indicated that the dog was infected by processed by our team. DNA was extracted from whole blood L. infantum susceptible to antimonial drugs and miltefosine, using the QIAmp DNA Blood Mini Kit (Qiagen, Germantown, confirming the relevance of the already instituted drug therapy. Maryland, USA). The pteridine reductase 1 gene (PTR1), which After approximately 1 mo of miltefosine treatment, lesions had allows for the identification of Leishmania species, was ampli- completely disappeared, and new blood samples were sent to the fied using compatible primers (14). Two additional Leishmania FMV for analysis. DNA extraction followed by standard PCR genes, LINF_230008200 (Fw: 59-ATGCGCTTCAAGGCG-39; still allowed detection of Leishmania infantum in the blood. Rv: 59-CTACACCCTTGCGGGG-39) and LINF_230007700 Consistent with these results, the dog relapsed 6 mo later. (Fw: 59-ATGCTCAACGAGGTGC-39; Rv: 59-CTAAATAC CAACCAGA-39), were amplified and sequenced to further Discussion corroborate L. infantum as causative agent. Polymerase chain Leishmania infantum is a zoonotic parasite of worldwide impor- reactions (PCRs) were performed in 50 mL volumes using tance, and is responsible for severe illness in humans and the compatible primers and contained 100 ng of total gDNA, dogs (18). Canada is not currently a Leishmania-endemic

964 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY country. That said, importation of animals into Canada requires References no quarantine and no serological testing; all that is required is . 1 Ribeiro RR, Michalick MSM, da Silva ME, Dos Santos CCP, Frezard proof that an animal is rabies-free (13). With countless owners FJG, da Silva SM. Canine leishmaniasis: An overview of the current status and strategies for control. Biomed Res Int 2018;2018:3296893. traveling with their pets and numerous organizations rescuing 2. Pineda C, Aguilera-Tejero E, Morales MC, et al. Treatment of canine dogs from other countries, leishmaniosis, along with other exotic leishmaniasis with marbofloxacin in dogs with renal disease. PLoS One diseases, presents a risk to public health in Canada. Despite the 2017;12:e0185981. REPORT CASE fact that the phlebotomine vector of L. infantum is not present 3. Miro G, Lopez-Velez R. Clinical management of canine leishmaniosis versus human leishmaniasis due to Leishmania infantum: Putting “One in this country, similar indigenous insects may well prove to be Health” principles into practice. Vet Parasitol 2018;254:151–159. competent vectors of the disease (9). Ticks have recently been 4. Gradoni L, Lopez-Velez R, Mokni M. Manual on case management demonstrated to have a possible role in the infectious cycle of and surveillance of the leishmaniases in the WHO European Region. Geneva, Switzerland: World Health Organization, 2017. Leishmania; this is noteworthy considering the rapidly spread- 5. Fernández-Prada C, Douanne N, Minguez-Menendez A, et al. Repur­ ing tick populations in Canada (10,11,19). Certain articles posed molecules: A new hope in tackling neglected infectious diseases. have also documented transmission of leishmaniosis through In: Roy K, ed. In Silico Drug Design. Cambridge, Massachusetts: Academic Press, 2019:119–160. dog bite wounds or transplacentally; these types of dog-to-dog 6. Moreno J, Alvar J. Canine leishmaniasis: Epidemiological risk and the transmission may contribute to maintaining disease in North experimental model. Trends Parasitol 2002;18:399–405. America (20,21). Furthermore, Canadian veterinarians are not 7. Ciaramella P, Oliva G, Luna RD, et al. A retrospective clinical study of canine leishmaniasis in 150 dogs naturally infected by Leishmania equipped to diagnose and treat many of the diseases of concern infantum. Vet Rec 1997;141:539–543. in imported animals due to a lack of available tests and appropri- 8. Pumarola M, Brevik L, Badiola J, Vargas A, Domingo M, Ferrer L. ate therapeutic drugs. For example, the recommended first step Canine leishmaniasis associated with systemic vasculitis in two dogs. J Comp Pathol 1991;105:279–286. in diagnosing a dog with clinical leishmaniosis is a quantitative 9. Duprey ZH, Steurer FJ, Rooney JA, et al. Canine visceral leishmani- serology enzyme-linked immunosorbent assay (ELISA) that is asis, United States and Canada, 2000–2003. Emerg Infect Dis 2006; unavailable in Canada (18). It is not always possible to identify 12:440–446. Leishmania through pathological analysis of lesion biopsies; 10. Campos JH, Costa FA. Participation of ticks in the infectious cycle of canine visceral leishmaniasis, in Teresina, Piaui, Brazil. Rev Inst Med there may be low parasite burden or lack of migration to the Trop Sao Paulo. 2014;56:297–300. lymph nodes. In such cases, without available serological tests, 11. Dantas-Torres F. Ticks as vectors of Leishmania parasites. Trends specialized PCRs and/or lengthy parasite cultures are necessary. Parasitol 2011;27:155–159. 12. Gonzalez C, Wang O, Strutz SE, Gonzalez-Salazar C, Sanchez-Cordero An additional consideration is that many of the drugs necessary V, Sarkar S. Climate change and risk of leishmaniasis in north america: to treat Leishmania, such as miltefosine, require an onerous Predictions from ecological niche models of vector and reservoir species. importation process to obtain the medication from L. infantum- PLoS Negl Trop Dis 2010;4:e585. 13. Importing or Travelling with Domestic Dogs [Internet]. Government endemic countries. Due to the complexity of Leishmania diagno- of Canada. 2018. Available from: https://www.inspection.gc.ca/animal- sis, the difficulties in obtaining appropriate treatments, and the health/terrestrial-animals/imports/import-policies/live-animals/pet- vast number of infected but clinically healthy dogs in endemic imports/dogs/eng/1331876172009/1331876307796 Last accessed June 16, 2020. areas, managing this neglected infectious disease presents a sub- 14. Hadighi R, Mohebali M, Boucher P, Hajjaran H, Khamesipour A, stantial challenge for doctors, veterinarians, and public health Ouellette M. Unresponsiveness to Glucantime treatment in Iranian officials. It is worth noting that even with appropriate treatment, cutaneous leishmaniasis due to drug-resistant Leishmania tropica para- it can be difficult to obtain complete clearance of Leishmania sites. PLoS Med 2006;3:e162. 15. Sundar S, Rai M. Laboratory diagnosis of visceral leishmaniasis. Clin because the parasite is capable of harboring within macrophages Diagn Lab Immunol 2002;9:951–958. and “hiding” in different organs and tissues such as the spleen, 16. Aslett M, Aurrecoechea C, Berriman M, et al. TriTrypDB: A func- liver, and bone marrow. Dogs serve as a reservoir for this disease, tional genomic resource for the Trypanosomatidae. Nucleic Acids Res 2010;38(Database issue):D457–462. and therefore control of canine infection is a fundamental pillar 17. Fernandez-Prada C, Vincent IM, Brotherton MC, et al. Different muta- of disease prevention and needs to be prioritized (3,18). tions in a P-type ATPase transporter in leishmania parasites are associ- In conclusion, veterinarians should be vigilant when examining ated with cross-resistance to two leading drugs by distinct mechanisms. PLoS Negl Trop Dis 2016;10:e0005171. animals with a travel history. Given the significant public health 18. Solano-Gallego L, Miro G, Koutinas A, et al. LeishVet guidelines for risk posed by many exotic diseases, relevant diagnostic tests and the practical management of canine leishmaniosis. Parasit Vectors therapeutic molecules should be made available in Canada, and 2011;4:86. 19. Leighton PA, Koffi JK, Pelcat Y, Lindsay LR, Ogden NH. Predicting stricter animal importation control measures are imperative. Delays the speed of tick invasion: An empirical model of range expansion in diagnosis as well as the lengthy process of drug importation are for the Lyme disease vector Ixodes scapularis in Canada. J Appl Ecol detrimental to affected patients’ prognoses. As demonstrated by 2012;49:457–464. 20. Boggiatto PM, Gibson-Corley KN, Metz K, et al. Transplacental the current case, exotic diseases may not be so exotic anymore. transmission of Leishmania infantum as a means for continued disease incidence in North America. PLoS Negl Trop Dis 2011;5:e1019. Acknowledgments 21. Naucke T, Amelung S, Lorentz S. First report of transmission of canine Christopher Fernandez-Prada is supported by an NSERC leishmaniosis through bite wounds from a naturally infected dog in Discovery Grant (RGPIN-2017-04480). This research was Germany. Parasit Vectors 2016;9:256. also supported by the Canada Foundation for Innovation (www.innovation.ca), grant number 37324 awarded to Christopher Fernandez-Prada. CVJ

CVJ / VOL 61 / SEPTEMBER 2020 965 FOR PERSONAL USE ONLY Article

Missing in action: Sustainable climate change adaptation evidence for animal health

Craig Stephen, Joy Wade

Abstract — Health impacts of climate change are now inevitable. The objective of this study was to see if animal health climate change adaptation was a subject of scholarly inquiry, advice, or discussion and if there was an evidence base from which to make adaptation recommendations. A scoping review of English-language literature over the past 10 years was undertaken and the top findings related to animal health adaptation and climate change were inventoried on Google. Documents found in the search focussed predominantly on hypothesizing what hazards might occur with climate change, describing their spread or proposing possible impacts. Scant evidence was found of scholarship related to sustainable animal health climate change adaptation planning or action. Investment and attention to adaptation planning and research are needed to increase confidence in climate change recommendations in the face of continuing uncertainty about the breadth of effects on animal health and the best actions to take in preparing and responding to them.

Résumé — Portée disparue : Évidence d’adaptation durable aux changements climatiques pour la santé des animaux. Les impacts sur la santé des changements climatiques sont maintenant inévitables. L’objectif de la présente étude était de voir si l’adaptation de la santé animale aux changements climatiques était un sujet d’enquête savante, un avis ou une discussion et s’il y avait une base factuelle à partir de laquelle faire des recommandations d’adaptation. Une recension de la littérature de langue anglaise des 10 dernières années fut entreprise et les principales trouvailles reliées à l’adaptation de la santé animale et des changements climatiques furent inventoriées sur Google. Les documents retrouvés dans la recension focussaient principalement en émettant des hypothèses sur quels risques peuvent survenir avec les changements climatiques, décrivant leur propagation ou proposant des impacts possibles. Peu d’évidences furent trouvées liées à la planification ou l’action relativement à l’adaptation durable aux changements climatiques en matière de santé animale. Des investissements et une attention à la planification de l’adaptation et de la recherche sont requis pour augmenter la confiance dans les recommandations liées aux changements climatiques compte tenu de l’incertitude persistante à propos de l’étendue des effets sur la santé animale et les meilleures actions à prendre pour s’y préparer et y répondre. (Traduit par Dr Serge Messier) Can Vet J 2020;61:966–970

Introduction well as in the future. Decision-makers are confronted with the challenge of allocating resources to protect human, animal, and limate change transcends species and geographical bound- ecosystem health in the face of scientific and social debate on aries. The frequencies of nations, cities, and states declar- C the anticipated effects of climate change and the best ways to ing climate change emergencies is accelerating. How we respond respond. Climate change will amplify existing health problems, or adapt to climate change will have profound implications alter global food production and consumption patterns, dimin- for humans, biodiversity, economies, and ecosystems today as ish the availability and quality of ecological services, and create unanticipated threats (1). International organizations such as Canadian Wildlife Health Cooperative, Western College of the Intergovernmental Panel on Climate Change (IPPC), the Veterinary Medicine, University of Saskatchewan, Saskatoon, World Health Organization (WHO), the Food and Agriculture Saskatchewan S7N 5B4 (Stephen); Fundy Aqua Services, Organization (FAO), and the World Organisation for Animal Nanoose Bay, British Columbia V9P 9B3 (Wade). Health (OIE) have all reminded us that the health impacts of Address all correspondence to Dr. Craig Stephen; e-mail: climate change are now inevitable and will become some of the [email protected] greatest challenges to societies. Health stewardship in the face of Use of this article is limited to a single copy for personal study. climate change means promoting a continuum of care that will Anyone interested in obtaining reprints should contact the prevent anticipated impacts, resist unanticipated impacts, and CVMA office ([email protected]) for additional ensure recovery without persistent and irreversible harm. A pre- copies or permission to use this material elsewhere. vious commentary opined that, despite being arguably the most

966 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY important challenges of the 21st century, veterinary engagement if the conversation recognized some core concepts of sustainable and leadership on climate change response and adaptation have adaptation action including the recognition that: been hard to find (2). The goal of this paper was to further test i) there are multiple concurrent stressors and acknowledgment that declaration by characterizing the conversation on animal that adaptation against one harm can affect adaptation for health and climate change adaptation seen in peer-reviewed another; literature and online. ii) differing values and interests will affect adaptation outcomes;

The 2018 special report of the IPCC emphasized the neces- iii) local knowledge is needed for effective adaptation action; ARTICLE sity of limiting global warming to 1.5°C to reduce risk to health, iv) adaptation actions should not add to climate change, limit biodiversity, fisheries, food security, water supply, and ecosys- the ability to respond or negatively impact other parts of tems (3). The world was not on target to meet that goal in 2020 society, the economy, or the natural environment; and nor did it seem there was consensus on the path to do so. In this v) adaptation actions should be effective, efficient, equitable, study, we were interested to see if the animal health sector was and evidence-based (7,8). investigating or evaluating strategies, technologies, policies, or other tools to help animals sustainably adapt to what seems now Materials and methods to be the inevitable health impacts of climate change. Climate A scoping literature review was undertaken using PubMed and change adaptation involves reducing risk and predisposition Google Scholar as search engines. PubMed was selected because to be adversely affected by climate change by building capac- it indexes about 110 veterinary and laboratory animal journals ity to cope with climate impacts and mobilizing that capacity and we wanted to focus our search on journals likely to be used by implementing decisions and actions (4). Climate change and read by animal health professionals. Google Scholar was adaptation requires adjustments in natural and human systems added to increase the likelihood of finding other peer-reviewed in response to actual or expected effects of climate change, in scholarly publications, such as research theses. PubMed has been order to moderate harm or exploit beneficial opportunities (5). assessed as the optimal tool for searching biomedical electronic Our focus on adaptation does not reflect a lack of interest in research while Google Scholar is well-suited to retrieving more or importance of climate change mitigation. Taking tangible obscure online information (9). Only English-language papers steps to reduce further climate change by managing activities from the past 10 y were included in order to characterize the and policies that lead to global warming must still be a priority. most recent conversation. The words animal, cat, feline, dog, However, the climate will be slow to respond to any new initia- wildlife, livestock, and aquaculture were searched in combina- tives and the trajectory back to climate conditions to which tions with the words climate change, health, and adaptation. species, ecosystems, and societies have evolved will take untold Duplicates were identified by viewing titles, authors, and dates years, even if we could eliminate all drivers of adverse climate of publication. All papers were initially screened by looking change today. It has been estimated that anthropogenic climate at the title and abstract to ensure there was some relevance to change will be irreversible on centennial to millennial timescales animal health and climate change. If the paper’s relevance was even after a complete cessation of CO2 emissions (6). Adaptation still uncertain, a key word search of the paper using the term action will, therefore, be a pressing issue for several generations “climate change” was done to establish the context in which of animal health professionals. animal health was associated with climate change. Papers were Stephen et al (2) scanned websites of selected veterinary placed into broad thematic categories based on the subjects and associations and government agencies in the global north and context of the discussion of climate change and animal health. international animal health organizations such as the OIE and The relevance screening was done by both authors and the initial FAO as part of their commentary on the social relevance of thematic categorization done by 1 reviewer (CS). This thematic veterinary medicine in climate change action. Acknowledgment categorization was assessed by the second author (JW) who of climate change as a priority issue was not widespread, but reviewed the title and abstract of each paper in each category. there was a suggestion of a growing conversation about the Where disagreements were found, the 2 reviewers came to a need for the animal health sector to be engaged in climate consensus on the appropriate categorization of a paper. Based change research and action. When these authors inserted “ani- on this initial screening, CS nominated initial themes within mal health climate change adaptation” in an Internet search each category that could be used to further describe the focus bar, they found few “hits” in relation to the magnitude of of papers within each category. Both reviewers used the initial risk that climate change is posing to natural ecosystems, food list of themes as a starting point to assess each paper and were production systems, and societies. Stephen et al (2) asserted able to add new themes as they emerged when papers were read. that climate change is part of the animal health dialogue but The categories discovered by both reviewers were discussed to with little tangible evidence that the dialogue is focussing on find a common set of descriptors for papers within each broader what actions animal health professionals can undertake now theme. Papers were not reviewed for methodological quality to better prepare wild and owned animals from future climate or rigor of their conclusions as the purpose of the study was change harm. to explore if sustainable adaptation was a subject of interest or The objective of this study was to see if animal health adap- discussion in the extracted literature. tation was a subject of scholarly inquiry, advice, or discussion Our inclusion criterion was any paper that included dis- and if there was an evidence base from which to make climate cussion of a determinant of animal health or animal disease action recommendations. More specifically, we were interested or an animal health outcome with respect to climate change.

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Table 1. Exclusion criteria used in a 2019 scoping review of peer- Table 2. General themes of 446 documents included in a scoping reviewed, English-language literature on animal health and climate review of animal health and climate change using PubMed and change found in PubMed and Google Scholar. Google Scholar and the number (percent) of documents that occurred in each theme. This included peer-reviewed and non- Exclusion criteria peer-reviewed documents such as summaries of conferences Dealt primarily with human health impacts from climate change but or meetings and research theses. mentioned animals such as noting how new public health hazards, such Number of as pathogens or toxins, could arise from animals or animal-based foods. documents Noted climate change as one of several future threats but then generically Theme (primary concern) (% of the total) discussed future preparedness for a suite of impending threats or simply Threats or hazards that might emerge, spread 283 (63%) stated that climate change was a concern. and/or cause harm to animals as a result of ARTICLE Mentioned animal production as a cause of climate change with minor climate change. reference to animal health management or risks. How agriculture or aquaculture production needs 53 (12%) Generic calls for climate action without specific reference to animal to or could adapt to climate change. health. Ways animals might adapt to climate change or 36 (8%) Impacts on ecosystems or natural resource management, but the how management steps could be taken to help implications for animal health or an animal health perspective were animals adapt to climate change. not present or were only mentioned in passing/general terms. How animal management could help agriculture 36 (8%) Examined the climate change perceptions of agriculture or aquaculture mitigate its contributions to climate change. producers. How ecosystem or natural resource management 28 (6%) Was concerned with changing human behaviour for agriculture/ might benefit animal climate change adaptation. aquaculture sectors without references to animal health or management Other topics. 10 (2%) of determinants of animal health. Examined or mentioned the role of weather on a health outcome, hazard or determinant without reference to a climate change. of animal health and climate change, 446 documents were left to be reviewed. These 446 documents fell into 6 themes (Table 2). Only 388 of the 446 documents extracted were from peer- reviewed journals. The remaining documents were either Determinants of health are specific categories of factors that research theses, edited but not reviewed documents, compila- cumulatively impact the capacity of an individual or population tions of meetings or workshops abstracts, or technical reports to be healthy. They include an individual’s biological endow- from international organizations. Only 8% of the documents ment as well as social and environmental factors that provide the (n = 36) directly discussed animal health adaptations to climate capacity and resources to remain healthy. Determinants of health change: of these 36 papers, 15 (3% of the total papers extracted) are well-studied in humans and have been adapted for animals in described innate evolved characteristics, including genetic attri- Wittrock et al, 2009 (10). Exclusion criteria are listed in Table 1. butes, that could help some species, strains or breeds adapt to or Our second method involved examining the contents of cope with climate change; 9 papers (2%) dealt with ecosystem the first 10 pages of hits emerging from the Google search in or natural resource management to help animals adapt to the November 2019 for the term “sustainable climate change adap- impacts of climate change; 6 papers (1%) were concerned with tation for animal health.” What people are searching for from animal husbandry to help animals cope. The remaining papers Google can provide insight into what the public are concerned in this theme either provided generic statements on the need about or interested in (11). We first determined if animal health for adaptation or focussed on the harms to which animals or outcomes or determinants were the subject of the webpage. If animal health service providers should be prepared to respond. they were, we assessed if they dealt with or discussed methods There was insufficient information in the extracted papers to for adaptation and if those methods met the criteria for sustain- identify best practices for adaptation or to assess if a proposed able adaptation action described in the introduction [in brief action(s) was effective due to the small number of papers for they recognize that: i) there are multiple, concurrent, interacting each recommendation. Papers in this theme either proposed or stressors; ii) differing values and interests will affect adaptation hypothesized actions or tried them on a pilot scale or limited outcomes; iii) local knowledge is needed for effective adaptation basis rather than systematically evaluating their effectiveness. action; iv) actions should not add to climate change, limit the Papers in this section tended to look at 1 harm or 1 species ability to respond or negatively impact other parts of society, or rather than multiple species or harms. There was little discussion the natural environment; and v) adaptation actions should be of how action in one setting could affect adaptation in another effective, efficient, equitable and evidence-based]. Google search or on the need for equitable adaptation actions. “hits” that included papers encountered in the literature review Papers that focussed on adaptation of the agriculture or were not assessed a second time. aquaculture industry predominantly discussed how the sec- tor could adapt as opposed to a focus on how to adapt food Results production for animals’ benefits apart from some recognition The initial PubMed search yielded 1341 papers and Google that changing disease situations could harm animals. The pro- Scholar yielded an additional 342 documents. After relevance posed, non-economic-based recommendations paid attention screening was done to ensure documents involved some aspect to animals’ determinants of health, such as housing conditions,

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environmental quality, and feed availability. Only 7 papers agriculture adaptation, or in the context of sustaining ecosys- emphasized animal health. Sixteen papers (4% of the total tems in the face of climate change but usually from an anthro- extracted papers) in this theme were reviews that gave little pocentric perspective. None emphasized the need to develop detail on specific adaptation actions. The 36 papers interested adaptation plans for the sake of the animals themselves apart in how animal management could mitigate climate change from one concerned with ecosystem management for wildlife dealt exclusively with reducing greenhouse gas emissions either conservation. The remaining 80 online documents either had

through animal husbandry or with reduced meat consumption the search key words on the page in ways unrelated to sustain- ARTICLE by humans. The former focussed more on describing the harms able adaptation for animal health or spoke of animal health in from agriculture-related greenhouse gas emissions than propos- passing as something to consider or spoke of animal-based risk ing actions to effectively, equitably and sustainably reduce those factors for human outcomes. emissions. As with papers on how agriculture and aquaculture could adapt to climate change, papers examining ecosystem or Discussion natural resource management actions rarely mentioned specific Our project found scant evidence of scholarship or activities actions to protect animal health. Although adaptation was a related to sustainable climate change adaptation action for search term, most papers mentioned the need for adaptation animal health. Few papers or websites were explicitly concerned but then either discussed harms that might occur or provided a with adaptation action. Many of those that were concerned high-level overview of adaptation issues. discussed adaptation in very general terms rather than evaluat- General science journals provided 16% of the 388 peer- ing the effectiveness, efficiency, equity, or evidence upon which reviewed papers based on our search criteria. Journals concerned to base action recommendations. Documents that met our primarily with hazards (such as vectors, parasites, pathogens, inclusion criteria generally did not explore differing values and or pollutants), journals concerned with biology, and journals interests or examine the implications of actions on other harms concerned with ecology or the environment each provided or other sectors of society. Some of the papers we excluded did approximately 14% of the peer-reviewed papers. Other health describe varying social values linked to animal production or journals (including public health and environmental health) aquaculture but didn’t incorporate those findings into animal provided 13%; general animal health journals provided 9%; health adaptation planning. Adaptation for the sake of animal and journals concerned with food production (such as animal health was more commonly a concern for wildlife. Companion science and aquaculture journals) provided 7% of the extracted animal papers were more focussed on harm detection and peer-reviewed papers. Only 4% of the papers found on animal response. Livestock and aquaculture papers dealt more with health and climate change were from journals dedicated to adaptation actions to ensure sustainable farming activities in the climate change science. The remaining 9% were from miscel- face of climate change. Engineered and technological adapta- laneous journals categories. tion are common adaptive responses in other sectors, including Papers and other documents concerned with possible threats human health, but there is growing experience of the value for could be placed into 7 categories: infectious diseases (n = 63), ecosystem-based, institutional, and social measures (4). Our vector-borne diseases (n = 60), parasites (n = 32), ecological findings indicate that there is an important gap in scholarly changes (n = 31), heat stress or thermal tolerance (n = 17), pol- inquiry into an adequate scope of actions needed to sustain- lutants or toxins (n = 12), and others (n = 85). As some papers ably help animals adapt to and maintain health in the face of dealt with more than one issue, the number provided in the climate change. last sentence exceeds the total number of papers in this theme. There was a high level of awareness of the importance of Twenty-four percent (n = 68) of the documents in this theme climate change within the papers we reviewed, which was to be were reviews or perspectives papers. Topics included in the expected given our search criteria. The literature we found pre- category of “other” were: impacts on productivity or reproduc- dominantly hypothesized what hazards might occur, described tion, food quality effects, access to biotic determinants of health the spread of putative climate sensitive hazards, or proposed or (e.g., habitat, pasture), ocean acidification and implications for documented disease impacts from unusual or extreme weather food production. conditions that could be expected with climate change. Most Our Google search using the phrase “sustainable climate papers were found in journals without explicit foci on animal change adaptation for animal health” yielded 97 hits; 2 were health such as general science journals, natural resource or explicitly concerned with adaptation efforts for animal health environment journals, or journals targeting the agriculture or and 15 mentioned animal health or management of animal aquaculture sectors. The veterinary journals were almost exclu- health determinants as a part of broader climate change adapta- sively concerned with describing possible harms or the effects tion efforts. Nine were found in our aforementioned literature of climate change on hypothesized climate change sensitive search. All the 17 sites with some relevance to animal health hazards. Papers dealing with possible threats looked primarily acknowledged that animals face multiple concurrent climate at infectious, parasitic, and vector-borne diseases with little change stressors or threats but only 1 mentioned all the elements attention to non-infectious diseases, non-carbon pollution, or of sustainable adaptation action described in our methods. The natural toxins. This occurred despite our purposeful exclusion need for better or more evidence was a common refrain but with of the term disease or disease-associated words in our search sparse details. Animals were either discussed as a risk factor, as terms. Papers dealing with changes to determinants of health a strategy for human community climate resilience, as part of were largely found in agriculture, aquaculture, ecology, and

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­environment journals. The experience in human health to References date shows that non-infectious diseases, such as heat stress and 1. IPCC. Summary for policymakers. In: Field CB, Barros VR, Dokken impacts of respiratory and cardiovascular disease are having DJ, et al. eds. Climate Change 2014: Impacts, Adaptation, and significant social impacts (12), giving rise to a recommendation Vulnerability. Part A: Global and Sectoral Aspects. Contribution of Working Group II to the Fifth Assessment Report of the Inter­ for animal health researchers to expand their areas of interest governmental Panel on Climate Change. 2014. New York, New York: when investigating animal health harms from climate change. Cambridge University Press, 2014:1–32. Attention on climate change continues to rapidly grow but, at 2. Stephen C, Carron M, Stemshorn B. Climate change and veterinary medicine: Action is needed to retain social relevance. Can Vet J 2019; government, inter­national, and scientific levels, attention seems 60:1356–1358. more focussed on speculating the course of known climate- 3. IPCC. Global Warming of 1.5°C. An IPCC Special Report on the

ARTICLE sensitive infectious and parasitic diseases rather than on building impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of adaptable wild and domestic animal populations able to cope strengthening the global response to the threat of climate change, sus- with a wide suite of known and unknow harms that will come tainable development, and efforts to eradicate poverty. 2018: Available from climate change. from: https://www.ipcc.ch/sr15/ Last accessed June 30, 2020. 4. Noble IR, Huq S, Anokhin YA, et al. Adaptation needs and options. A collaborative report prepared by the Auditors General of In: Field CB, Barros VR, Dokken DJ, et al. eds. Climate Change 2014: all Canadian provinces, territories, and the federal government Impacts, Adaptation, and Vulnerability. Part A: Global and Sectoral concluded in 2018 that leadership, guidance, and tools to inte- Aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. New York, grate climate change issues into government operations were New York: Cambridge University Press, 2014:833–868. lacking (13). We feel that the combination of the arguments 5. IPCC. Summary for policymakers. In: Solomon S, Qin D, presented in Stephen et al (2), with our review of 446 scientific Manning M, eds. Climate change 2007: The physical science basis. Contribution of working group I to the fourth assessment report of documents and an overview of the conversation on Google the Intergovernmental Panel on Climate Change. New York, New York: allows us to propose that climate change adaptation leadership Cambridge University Press, 2007:1–34. and innovation is similarly missing in the animal health world. 6. Thorne PW, Willett K M, Allan RJ, et al. Guiding the creation of a comprehensive surface temperature resource for twenty-first-century This suggests a critical void that will make animal populations, climate science. Bull Am Meteor 2011;92:ES40–ES47. and the humans and communities that depend on them, highly 7. Eriksen S, Aldunce P, Bahinipati CS, et al. When not every response vulnerable to the effects of climate change. We acknowledge that to climate change is a good one: Identifying principles for sustainable adaptation. Climate Develop 2011;3:7–20. the parameters of our search precluded an international assess- 8. Prutsch A, Grothmann T, Schauser I, Otto S, McCallum S. Guiding ment of research and limited the scope of papers we reviewed principles for adaptation to climate change in Europe. ETC/ACC to those covered by 2 literature databases. However, our process technical paper 2010:1–32. 9. Falagas ME, Pitsouni EI, Malietzis GA, Pappas G. Comparison of of comparing concurrently collected qualitative findings allows PubMed, Scopus, web of science, and Google scholar: Strengths and us to triangulate our and Stephen et al (2) findings to propose weaknesses. FASEB J 2008;22:338–342. there is a critical gap in scholarship on sustainable climate 10. Wittrock J, Duncan C, Stephen C. A determinants of health conceptual model for fish and wildlife health. J Wildl Dis 2019;55:285–297. change adaptation action for animal health. Triangulation in 11. Scharkow M, Vogelgesang J. Measuring the public agenda using search research allows investigators to explore if examining a phe- engine queries. Int J Public Opin Res 2011;23:104–113. nomenon in different ways supports or contradicts a finding 12. U.S. Global Change Research Program. Populations of concern. In: Crimmins A, Balbus, JL, Gamble JL et al. eds. The Impacts of Climate or conclusion (14). Change on Human Health in the United States: A Scientific Assessment. Climate change vulnerability is determined by a population’s Washington, DC: U.S. Global Change Research Program 2016:1–332. exposure to the impacts of climate change and its adaptive 13. Auditors General of Canada. Perspectives on Climate Change Action in Canada — A Collaborative Report from Auditors General — capacity (15). Building adaptive capacity is, therefore, critical March 2018. Available from: https://www.oag-bvg.gc.ca/internet/ to any population’s health in the face of climate change. Animal English/parl_otp_201803_e_42883.html Last accessed June 30, 2020. health adaptation planning will need extraordinary investment 14. Mathison S. Why triangulate? Educ Res 2008;17:13–17. 15. Yohe GW. Mitigative capacity — The mirror image of adaptive capacity and attention to adaptation research to increase confidence in on the emissions side. Clim Change 2001;49:247–262. adaptation recommendations in the face of continuing uncer- tainty about the breadth of impacts and the best actions to prepare for and respond to them. CVJ

970 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY Article

Radiographic tracheal dimensions in brachycephalic breeds before and after s­ urgical treatment for brachycephalic airway syndrome

Penny J. Regier, Federico Vilaplana Grosso, Hannah K. Stone, Edzard van Santen

Abstract — The objective of this retrospective study was to compare preoperative and postoperative tracheal measurements in brachycephalic dogs undergoing surgical treatment of brachycephalic airway syndrome (BAS) using 2 radiographic methods (TD:TI and TT:3R). Medical records of 24 brachycephalic dogs with surgically corrected BAS were reviewed. Represented breeds included English bulldogs (n = 9), French bulldogs (n = 9), pugs (n = 5), and a Japanese chin (n = 1). Dogs with BAS that had postoperative thoracic radiographs # 1 week after surgery showed no significant difference in the mean TD:TI ratios (P = 0.06) or mean TT:3R ratios (P = 0.19) when comparing preoperative to postoperative ratios. Dogs that had postoperative thoracic radiographs  1 week after surgery showed no significant difference in the mean TD:TI ratios (P = 0.06) or mean TT:3R ratios (P = 0.32) when comparing preoperative to postoperative ratios. According to these findings, surgical correction for BAS does not resolve or improve tracheal hypoplasia in brachycephalic breeds.

Résumé — Dimensions trachéales radiographiques chez des races brachycéphales avant et après le traitement chirurgical pour le syndrome des voies respiratoires brachycéphales. L’objectif de cette étude rétrospective était de comparer les mesures trachéales préopératoire et postopératoire chez des chiens brachycéphales soumis à un traitement chirurgical pour le syndrome des voies respiratoires brachycéphales (BAS) en utilisant deux méthodes radiographiques (TD:TI et TT:3R). Les dossiers médicaux de 24 chiens brachycéphales avec un BAS corrigé chirurgicalement furent examinés. Les races représentées incluaient les bulldogs anglais (n = 9), les bulldogs français (n = 9), les carlins (n = 5) et l’épagneul japonais (n = 1). Les chiens avec BAS qui ont eu des radiographies thoraciques postopératoires # 1 semaine après la chirurgie ne montraient aucune différence significative dans les ratios moyens TD:TI (P = 0,06) ou ratios moyens TT:3R (P = 0,19) lors de la comparaison des ratios préopératoire et postopératoire. Les chiens avec BAS qui ont eu des radiographies thoraciques postopératoires . 1 semaine après la chirurgie ne montraient aucune différence significative dans les ratios moyens TD:TI (P = 0,06) ou ratios moyens TT:3R (P = 0,32) lors de la comparaison des ratios préopératoire et postopératoire. En fonction de ces trouvailles, la correction chirurgicale pour le BAS ne résout pas ou n’améliore pas l’hypoplasie trachéale chez les races brachycéphales. (Traduit par Dr Serge Messier) Can Vet J 2020;61:971–976

Introduction Clinical signs often reported by owners include heat stress, and rachycephalic airway syndrome (BAS) is a cause of exercise intolerance, snoring, inspiratory dyspnea, and occasion- B ­respiratory distress in brachycephalic breeds. Breeds most ally cyanosis and syncopal episodes in severe cases. commonly affected are English bulldogs, French bulldogs, pugs, Tracheal hypoplasia is a congenital trait (5–8) and is a and Boston terriers (1,2). This syndrome is comprised of a ­concurrent finding in many patients with BAS (1,5,6,9,10). number of components. Primary components of BAS include Affected dogs have small tracheal cartilage rings with overlap- the following: stenotic nares, elongated soft palate, hypoplastic ping ends and a narrow or absent dorsal tracheal membrane trachea, redundant pharyngeal tissue, and possible aberrant (6,7). Tracheal hypoplasia typically involves the whole ­trachea, nasal conchae (1,3,4). Secondary components include everted with a uniformly narrowed lumen from the larynx to the carina. laryngeal saccules, pharyngeal edema, and laryngeal collapse (4). English bulldogs are more commonly affected by ­tracheal

Department of Small Animal Clinical Sciences, College of Veterinary Medicine (Regier, Grosso, Stone), and Agronomy Department and Statistical Consulting Unit, Institute of Food and Agricultural Sciences (van Santen), University of Florida, Gainesville, Florida, USA. Address all correspondence to Dr. Penny Regier; 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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A B

C D Figure 1. Preoperative (A) and postoperative (B) right lateral thoracic radiographs demonstrating TD:TI (tracheal lumen diameter and thoracic inlet distance) ratio measurements on a single English bulldog patient. Preoperative (C) and postoperative (D) right lateral thoracic radiographs demonstrating TT:3R (thoracic tracheal luminal diameter and the width of the proximal third of the third rib) ratio measurements on the same English bulldog patient.

­hypoplasia than are other breeds (6–8). In the absence of tion in the literature about TD:TI or TT:3R ­tracheal measure- ­concurrent pulmonary disease, tracheal hypoplasia is usually ments in dogs before and after surgical ­treatment of BAS. not associated with clinical signs (5–7). Tracheal hypoplasia may Tracheal diameters are not necessarily static and were shown exacerbate the respiratory signs associated with BAS because of to improve in 6 bulldog puppies after resolution of broncho- increased resistance to airflow, but it was not associated with pneumonia (14). Another study showed a change in the tracheal worse outcomes after surgical correction of BAS (1,10,11). diameter during phases of respiration in healthy dogs as detected Tracheal hypoplasia has been considered a negative prognostic via computed tomography (CT) (15). There is speculation that indicator when it occurs in association with BAS or broncho- the size of the trachea may change with age and patient growth; pneumonia (5). however, no studies proving this are available in the literature. Palpation, radiography, tracheobronchoscopy, and fluo- Although tracheal hypoplasia is considered a congenital trait, roscopy have been used to diagnose tracheal hypoplasia there has been no prior investigation on whether or not tracheal (5–8,11,12). Two radiographic methods have been described to dimensions would increase by decreasing airway resistance and evaluate the dimensions of the tracheal diameter in dogs and to improving airflow with surgical correction of BAS. distinguish between hypoplastic and non-hypoplastic tracheas: The purpose of this study was to compare preoperative and the tracheal lumen diameter to thoracic inlet distance ratio postoperative tracheal measurements in brachycephalic dogs (TD:TI) (11) and the ratio between the thoracic tracheal lumi- undergoing surgical treatment of BAS using 2 radiographic nal diameter and the width of the proximal third of the third rib methods (TD:TI and TT:3R) and to evaluate for changes (TT:3R) (13). Although neither method has been shown to be in tracheal­ dimensions and possible resolution of tracheal superior (5), the most commonly used method is TD:TI with ­hypoplasia. We hypothesized that the tracheal dimensions would the benefits including that it is independent of the size of the not change either # 1 week or  1 week after brachycephalic patient and phase of respiration (11,12). There is no informa- airway surgery using either the TD:TI or TT:3R method.

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Materials and methods graphically as recommended by Kozak and Piepho (16). Means of interest and associated standard errors were calculated using Medical records from an academic, referral veterinary the LSMEANS statement of the above-named procedure. ­hospital (University of Florida) were searched to identify ­brachycephalic dogs that received surgical treatment for BAS Results between July 1, 2008 and July 1, 2018. Brachycephalic breeds Twenty-four brachycephalic dogs were identified that met the with surgically corrected brachycephalic airway syndrome and study criteria. ARTICLE both preoperative and postoperative thoracic radiographs were retrospectively collected. Signalment Surgical treatment may have included any one of the Females (n = 13) and males (n = 11) were diagnosed with ­following treatments or a combination of the following: and treated for BAS during the study period. Represented ­stenotic nares resection, staphylectomy, and surgical excision of breeds included English bulldogs (n = 9; 37.5%), French everted saccules. Right and left lateral recumbent radiographs bulldogs (n = 9; 37.5%), pugs (n = 5; 20.8%), and a Japanese from 24 brachycephalic dogs were evaluated by a single Board- chin (n = 1; 4.2%). Median age at presentation was 38 mo certified radiologist using the 2 different ratios. (mean: 41.4  30.7 mo, range: 3 to 110 mo; N = 24). Three-view thoracic radiographs were taken before and after surgery for each dog. TD:TI and TT:3R ratios were Surgical treatment and findings calculated and correlated on preoperative and postoperative Surgical data were available for all 24 dogs in this study. (Figure 1) right and left lateral thoracic radiographs. When A total of 23/24 (95.8%) staphylectomies or folded flap using the TD:TI ratio for tracheal dimensions, the thoracic ­palatoplasties were performed. Nares resection was per- inlet (TI) was measured from the first thoracic vertebra to the formed in 20/24 (83.3%) cases, and laryngeal sac- manubrium, and the tracheal diameter (TD) was measured cules were excised in 19/24 (79.1%) cases. The most where the TI line intersects the trachea (11). The TD:TI common surgical treatment performed for BAS was ratio for hypoplastic trachea was defined as , 0.16 in non- a combination of a nares resection, staphylectomy/ bulldog brachycephalic dogs and , 0.12 in English bulldogs. palatoplasty, and laryngeal saccule excision in 13/24 cases The TT:3R method used the ratio between the thoracic (54.1%). A combination of nares resection, staphylectomy/ ­tracheal luminal diameter and the width of the proximal third palatoplasty, and laryngeal saccule excision with a temporary of the third rib, and a TT:3R ratio of , 2.0 was used to define tracheostomy was performed in an additional 2/24 cases (8.3%), tracheal hypoplasia (6–8). and 1/24 cases (4.2%) had this c­ombination with a permanent Each radiographic method was used both before and after tracheostomy performed. Nares resection and staphylectomy/ surgery to determine the number of hypoplastic and non-­ palatoplasty were performed in 4/24 cases (16.7%). hypoplastic dogs. Preoperative and postoperative thoracic Staphylectomy/palatoplasty and lar­ yngeal saccule excision were ­radiographs were evaluated in both left and right lateral performed in 2/24 cases (8.3%). One isolated case (4.2%) had ­positions and compared using both radiographic methods. laryngeal saccule excision alone, and 1 isolated case (4.2%) had The cases were further subdivided into 2 groups. Group A a staphylectomy performed alone. (n = 12) consisted of cases in which thoracic radiographs were taken before surgery, and postoperative radiographs were taken Radiographic dimensions # 1 wk after surgery. Group B (n = 15) consisted of cases in Orientation (left versus right lateral) was considered in the analy- which thoracic radiographs were taken before surgery, and sis by including it as a factor in the analysis. Neither the main postoperative radiographs were taken  1 wk after surgery. effect nor any interaction with the other factors was significant Three patients were included in both Groups A and B, as for TT:3R measurements (P = 0.63) and TD:TI measurements they had postoperative radiographs taken # 1 wk and  1 wk (P = 0.92). after surgery. TD:TI dimensions Statistical analysis Group A (Postoperative radiographs # 1 wk) The following fixed effect linear model was used to ­analyze each When brachycephalic airway cases that had postoperative response variable using the SAS procedure MIXED (SAS/ STAT thoracic radiographs # 1 wk were evaluated, there was no 14.1; SAS Institute, Cary, North Carolina, USA): ­significant difference (P = 0.06) in the mean TD:TI ratios Response = Orientation  Group  Orientation  when comparing preoperative [mean  standard error (SE): 0.13  0.01] to postoperative (mean  SE: 0.11  0.01) ratios Group  Time (Group)  Orientation*Time (Group), of lateral thoracic radiographs. where: Orientation (L, R) refers to the aspect from which the radiographs were taken after surgery, Group (A, B) was Group B (Postoperative radiographs  1 wk) explained in the last paragraph, and Time (Pre, Post) refers to When brachycephalic airway cases that had postoperative the time the radiographs were taken. The nested approach for ­thoracic radiographs  1 wk were evaluated, there was no the time factor was chosen because the post time was the basis ­significant difference (P = 0.06) in the mean TD:TI ratios for the group assignment. Normality of residuals was ­evaluated when comparing preoperative (mean  SE: 0.12  0.01)

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Table 1. Number of dogs (English bulldog versus other breeds) for group A (postoperative radiographs # 1 week after surgery) that were diagnosed with tracheal hypoplasia before and after surgery using the TD:TI measurement method and TT:3R measurement method both before and after surgery. TD:TI method for diagnosis TT:3R method for diagnosis of hypoplasia of hypoplasia English bulldog Other breeds English bulldog Other breeds (n = 5) (n = 7) (n = 5) (n = 7) Group A TD:TI , 0.12 TD:TI , 0.16 TT:3R , 2.0 TT:3R , 2.0 Pre right lateral 4 5 3 2

ARTICLE Pre left lateral 3 5 3 2 Post right lateral 3 6 2 3 Post left lateral 2 6 2 3

to postoperative (mean  SE: 0.14  0.01) ratios of lateral within the upper respiratory system, and stenotic nares are ­thoracic radiographs. the most common primary manifestation of BAS, found in 17% to 77% of brachycephalic breeds (4,18,19). Despite this, TT:3R dimensions the overlong soft palate has also been considered the main cause Group A (Postoperative radiographs # 1 wk) of BAS clinical signs. More recently, aberrant n­ asopharyngeal When brachycephalic airway cases that had postoperative turbinates, which have been found in 21% of brachycephalic thoracic radiographs # 1 wk were evaluated, there was no dogs (18), have been postulated to play a major role in BAS ­significant difference (P = 0.19) in the mean TT:3R ratios and have also been shown to be present in clinically healthy when comparing­ preoperative (mean  SE: 2.36  0.14) English bulldogs (3). However, this needs to be more thor- to ­postoperative (mean  SE: 2.11  0.14) ratios of lateral oughly ­evaluated and was beyond the scope of this study ­thoracic radiographs. (20–22). A recent study using computational fluid dynamics showed that the rostral third of the nasal passage exhibited a Group B (Postoperative radiographs  1 wk) larger airflow resistance than the caudal and middle regions of When brachycephalic airway cases that had postoperative the nasal passage (23). Hypoplastic trachea is a less common thoracic radiographs  1 wk were evaluated, there was no finding (13% of all dogs with BAS; 1,18) and also ­contributes ­significant difference (P = 0.32) in the mean TT:3R ratios to increased airway resistance, owing to the decreased tracheal when comparing­ preoperative (mean  SE: 2.42  0.12) diameter. Hypoplastic trachea has been diagnosed­ in 53.9% to ­postoperative (mean  SE: 2.60  0.12) ratios of lateral of English bulldogs surgically treated for BAS in previous ­thoracic radiographs. ­studies (1); this is similar to an ­average of 70% of English bull- dogs before surger­ y in this study using the TD:TI method and Tracheal hypoplasia 50% of English bulldogs using the TT:3R method. In this study tracheal hypoplasia was diagnosed using both the English bulldogs (61%), pugs (21%), and Boston terriers­ TD:TI and TT:3R methods (, 0.12 in bulldogs and , 0.16 (9%) are the most common breeds with BAS (19). The most in non-bulldog brachycephalic breeds for the TD:TI; and common components of BAS were elongated soft palate , 2.0 for the TT:3R method). Table 1 shows the number of (94%), stenotic nares (77%), everted laryngeal saccules (66%), dogs (English bulldog versus other breeds) for group A that and everted tonsils (56%) in a study by Fasanella et al (19). were diagnosed with tracheal hypoplasia using the TD:TI Dogs most commonly had 3 or 4 components of BAS, with measurement method both before surgery (17/24) and after the most common combination being stenotic nares, elongated surgery (17/24). This table also shows the number of dogs for soft palate, everted laryngeal saccules, and everted tonsils (19). group A that were diagnosed with tracheal hypoplasia before Riecks et al (1) concluded that surgical treatment of BAS in surgery (10/24) and after surgery (10/24) using the TT:3R dogs appeared to have a favorable long-term outcome, regardless measurement method. Table 2 shows the number of dogs for of age, breed, specific diagnosis, or number and combination group B that were diagnosed with tracheal hypoplasia before of diagnoses, including hypoplastic trachea. surgery (25/30) and after surgery (7/30) using the TD:TI In the present study, an elongated soft palate was s­urgically measurement method. This table also shows the number of treated either by a traditional staphylectomy or a folded dogs for group B that were diagnosed with tracheal hypoplasia flap ­palatoplasty (FFP) and was the most common before surgery (7/30) and after surgery (5/30) using the TT:3R ­procedure per­ formed (23/24 cases). This was determined by measurement method. ­surgeon preference with the traditional cut and sew staphy lectomy performed to address the elongation of the soft ­palate Discussion (17,24). The FFP has been used to address the soft palate Brachycephalic airway syndrome is comprised of a n­ umber of hyperplasia and e­xcessive length, but there is no information anatomic changes which lead to increased inspiratory ­resistance demonstrating that one technique is superior to another as far (17). The nose is the greatest source of airway ­resistance as clinical outcome (25,26).

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Table 2. Number of dogs for group B (postoperative radiographs  1 week after surgery) that were diagnosed with tracheal hypoplasia before surgery and after surgery using the TD:TI and TT:3R measurement methods. TD:TI method for diagnosis TT:3R method for diagnosis of hypoplasia of hypoplasia English bulldog Other breeds English bulldog Other breeds (n = 5) (n = 10) (n = 5) (n = 10) Group B TD:TI , 0.12 TD:TI , 0.16 TT:3R , 2.0 TT:3R , 2.0 ARTICLE Pre right lateral 4 9 2 1 Pre left lateral 3 9 2 2 Post right lateral 2 6 2 1 Post left lateral 2 8 2 0

In this study, everted laryngeal saccules, a secondary during phases of respiration, and with patient growth, dem- component of BAS, were excised in 19/24 cases. Whether or onstrating that tracheal diameter may not be static (14,15). not resection of everted laryngeal saccules (ELS) is needed still However, based on the present retrospective study, surgical remains to be determined. In recent studies in which stenotic correction of BAS does not change the incidence of tracheal nares and elongated palates were corrected and ELS were not hypoplasia after surgery compared to before surgery. addressed, outcomes appeared to be similar to studies in which The 2 methods most widely referred to for evaluation of ELS were excised (25,27). Recent studies have also suggested tracheal dimensions are the tracheal diameter to thoracic inlet that sacculectomy may increase morbidity following brachyce- (TD:TI) ratio (11) and the thoracic trachea diameter to width phalic airway surgery (28). of the third rib (TT:3R) ratio described by Suter et al (7) and Tracheal hypoplasia is a congenital abnormality often identi- subsequently modified by Coyne and Fingland (6). The TD:TI fied in BAS patients, and the English bulldog has the highest ratio is used most commonly to define tracheal hypoplasia and incidence of tracheal hypoplasia among brachycephalic breeds is defined as , 0.16 in non-bulldog brachycephalic dogs and (1,6,14,18,27,29–31). Tracheal hypoplasia is a primary com- , 0.12 in English bulldogs. For non-brachycephalic dog breeds, ponent of BAS (18) along with other abnormalities including normal radiographic tracheal dimensions have been described stenotic nares, elongated soft palate, redundant pharyngeal tis- as TD:TI ratio of  0.2 (11). Previously reported definitions sue, and aberrant nasal conchae. With canine tracheal hypoplasia of tracheal hypoplasia using TT:3R ratios were either , 2.0 or the tracheal cartilages are small and rigid and the ends are closely , 3.0 (6–8). apposed or overlapping with shortening of the dorsal elastic Ingman et al (13) evaluated both the TD:TI and TT:3R membrane and the trachealis muscle (7,10,11,14,30,32). Unlike methods and concluded that there was poor agreement in tracheal collapse, the trachea luminal diameter is reduced with ­classification of English bulldogs as tracheal hypoplastic or non- tracheal hypoplasia but does not vary with dynamic pressure hypoplastic depending on measuring method, cut-off value and changes during respiration (6,30,33). observer (13). In our study, we used both methods for tracheal Although tracheal hypoplasia is considered a significant find- measurements as both methods are commonly referred to and ing in dogs with clinical BAS, there may be normal variation used in clinical practice. We had a single Board-certified radiolo- in tracheal dimensions in healthy dogs of different breeds with gist (FVG) perform all measurements to eliminate variability in BAS (15). There is currently no information on what degree interobserver agreement. In this study, there was no significant of hypoplasia is tolerated or what degree may cause respiratory difference in incidence or diagnosis of tracheal hypoplasia symptoms in brachycephalic breeds. Tracheal hypoplasia has when comparing preoperative versus postoperative thoracic been reported to not cause clinical signs and, in fact (1,6,10) radiographs when using either radiographic measurement at may be an incidental finding (14). any time point. Tracheal hypoplasia has historically been thought to contrib- Limitations of this study include the retrospective nature with ute to respiratory symptoms in BAS dogs, but studies have not a small number of patients included. These patients had a wide been able to associate tracheal hypoplasia with worse outcomes range of ages, which was a variable in the study and may account following surgical treatment of nasal, pharyngeal, and laryngeal for changes in tracheal dimensions as tracheal size may change abnormalities in dogs. In the absence of concurrent pulmonary with growth. Information was gathered from medical records, disease or cardiovascular disease, tracheal hypoplasia is well toler- and due to the relatively small study population, it may be chal- ated and is not a contraindication for surgery (6). A recent study lenging to reach conclusions regarding findings. Along with the revealed partial resolution of hypoplastic trachea in 6 English retrospective nature, the surgical procedures performed for each bulldog puppies with bronchopneumonia and determined that patient were variable and were dependent on surgeon preference, tracheal hypoplasia might partially or completely resolve with which may be a limitation for outcome assessment. Three of growth to mature body size (14). Although tracheal hypoplasia these patients also had a tracheostomy performed, which has is considered a congenital trait, there is evidence that tracheal the potential to impact long-term tracheal diameter. Prospective, diameters can change with resolution of bronchopneumonia, controlled studies are warranted to further investigate whether

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tracheal hypoplasia persists or improves after surgical correction 13. Ingman J, Naslund V, Hansson K. Comparison between tracheal ratio of BAS. Tracheal dimensions were obtained from radiographs to methods used by three observers at three occasions in English bulldogs. Acta Vet Scand 2014;56:79–85. diagnose tracheal hypoplasia. Tracheoscopy is likely more sensi- 14. Clarke DL, Holt DE, King LG. Partial resolution of hypoplastic trachea tive for making a definitive diagnosis and also permits gradation in six English Bulldog puppies with bronchopneumonia. J Am Anim of tracheal hypoplasia. A recent study (34) concluded that CT Hosp Assoc 2011;47:329–335. 15. Leonard CD, Johnson LR, Bonadio CM, Pollard RE. Changes in tra- and radiographic tracheal diameter measurement were compa- cheal dimensions during inspiration and expiration in healthy dogs as rable in English bulldogs; however, diameters for both imaging detected via computed tomography. Am J Vet Res 2009;70:986–991. techniques were not comparable with tracheoscopy scores, and 16. Kozak M, Piepho H-P. What’s normal anyway? Residual plots are more telling than significance tests when checking ANOVA assumptions. tracheoscopy identified hypoplastic changes in all study dogs. J Agronomy Crop Sci 2018;204:86–98.

ARTICLE Montgomery et al (35) compared radiography and CT for 17. Koch DA, Arnold S, Hubler M, Montavon PM. Brachycephalic syn- determining tracheal diameter and length in canine cadavers for drome in dogs. Comp Cont Ed 2003;25:48–55. 18. Ginn JA, Kumar MSA, McKiernan BC, Powers BE. Nasopharyngeal tur- the purpose of tracheal stent size selection and results revealed binates in brachycephalic dogs and cats. J Am Anim Hosp Assoc 2008; that tracheal measurements via CT were on average 1 mm 44:243–249. larger compared with radiographic measurements, which may 19. Fasanella FJ, Shivley JM, Wardlaw JL, Givaruangsawat S. Brachycephalic airway obstructive syndrome in dogs: 90 cases (1991–2008). J Am Vet be important for the determination of stent size but is likely Med Assoc 2010;237:1048–1051. minimal in regards to diagnosis of tracheal hypoplasia. Another 20. Oechtering GU, Pohl S, Schlueter C, et al. A novel approach to limitation of this study is that radiographic measurements for brachycephalic syndrome. 1. Evaluation of anatomical intranasal airway obstruction. Vet Surg 2016;45:165–172. Group B included a wide time period for  1 wk postoperative 21. Oechtering GU, Pohl S, Schlueter C, Schuenemann R. A novel radiographs, and tracheal dimensions may have changed given approach to brachycephalic syndrome. 2. Laser-assisted turbinectomy more time after surgical treatment. (LATE). Vet Surg 2016;45:173–181. 22. Liu NC, Genain MA, Kalmar L, Sargan DR, Ladlow JF. Objective In conclusion, there was no difference in the incidence effectiveness of and indications for laser-assisted turbinectomy in of tracheal hypoplasia before surgery compared to after surgery, brachycephalic obstructive airway syndrome. Vet Surg 2019;48:79–87. based on tracheal dimensions measured on thoracic radio- 23. Hostnik ET, Scansen BA, Zielinski R, Ghadiali SN. Quantification of nasal airflow resistance in English bulldogs using computed tomogra- graphs. According to these findings, surgical correction for BAS phy and computational fluid dynamics. Vet Radiol Ultrasound 2017; does not resolve or improve tracheal hypoplasia in brachyce- 58:542–551. 24. Monnet E. Brachycephalic airway syndrome. In: Slatter D, ed. Textbook phalic breeds. CVJ of Small Animal Surgery. Philadelphia, Pennsylvania: Saunders; 2003:808–813. References 25. Findji L, Dupré GP. Folded flap palatoplasty for treatment of elon- 1. Riecks TW, Birchard SJ, Stephens JA. Surgical correction of brachyce- gated soft palates in 55 dogs. Vet Med Austria/Wien Tiera¨rztl Mschr phalic syndrome in dogs: 62 cases (1991–2004). J Am Vet Med Assoc 2008;95:56–63. 2007;230:1324–1328. 26. Findji L, Dupré G. Folded flap palatoplasty for treatment of elongated 2. Dupre G, Heidenreich D. Brachycephalic syndrome. Vet Clin North soft palates in 55 dogs. Eur J Companion Anim Pract 2009;19:125–132. Am Small Anim Pract 2016;46:691–707. 27. Poncet CM, Dupré GP, Freiche VG, Estrada MM, Poubanne YA, Bouvy 3. Vilaplana Grosso F, ter Haar G, Boroffka SAEB. Gender, weight, and BM. Prevalence of gastrointestinal tract lesions in 73 brachycephalic age effects on prevalence of caudal aberrant nasal turbinates in clinically dogs with upper respiratory syndrome. J Small Anim Pract 2005;46: healthy English Bulldogs: A computed tomographic study and classifica- 273–279. tion. Vet Radiol Ultrasound 2015;56:486–493. 28. Hughes JR, Kaye DM, Beswick AR, Ter Haar G. Complications fol- 4. Harvey CE. Soft palate resection in brachycephalic dogs. J Am Anim lowing laryngeal sacculectomy in brachycephalic dogs. J Small Anim Hosp Assoc 1982;18:538. Pract 2018;59:16–21. 5. Hendricks JC. Brachycephalic airway syndrome. In: King LG, ed. 29. Trappler M, Moore K. Canine brachycephalic airway syndrome: Surgical Textbook of Respiratory Disease in Dogs and Cats. Philadelphia, management. Compend Contin Educ Vet 2011;33:E1–E5. Pennsylvania: Saunders; 2004:310–318. 30. Hammond G, Geary M, Coleman E. Radiographic measurements of 6. Coyne BE, Fingland RB. Hypoplasia of the trachea in dogs: 103 cases the trachea in domestic shorthair and Persian cats. J Feline Med Surg (1974–1990). J Am Vet Med Assoc 1992;201:768–772. 2011;13:881–884. 7. Suter PF, Colgrove DJ, Ewing GO. Congenital hypoplasia of the canine 31. Huck JL, Stanley BJ, Hauptman JG. Technique and outcome of nares trachea. J Am Anim Hosp Assoc 1972;8:120–127. amputation (Trader’s technique) in immature Shih tzus. J Am Anim 8. Ettinger SJ, Kantrowitz B. Diseases of the trachea. In: Ettinger SJ, Hosp Assoc 2008;44:82–85. Feldman EW, eds. Textbook of Veterinary Internal Medicine. 6th ed. 32. Reed SD, Evans DE. Tracheal hypoplasia with a discrete subaortic septal St. Louis, Missouri: Elsevier; 2005:1217–1232. ridge in a Rottweiler puppy. J Vet Diagn Invest 2009;21:117–119. 9. Poncet CM, Dupre GP, Freiche VG, Bouvy BM. Long-term results 33. Stadler K, Hartman S, Matheson J, O’Brien R. Computed tomographic of upper respiratory syndrome surgery and gastrointestinal tract imaging of dogs with primary laryngeal or tracheal airway obstruction. medical treatment in 51 brachycephalic dogs. J Small Anim Pract Vet Radiol Ultrasound 2011;52:377–384. 2006;47:137–142. 34. Kaye BM, Boroffka SAEB, Haagsman AN, Ter Haar G. Computed 10. Pink JJ, Doyle RS, Hughes JML, Tobin E, Bellenger CR. Laryngeal tomographic, radiographic, and endoscopic tracheal dimensions in collapse in seven brachycephalic puppies. J Small Anim Pract 2006;47: English bulldogs with grade 1 clinical signs of brachycephalic airway 131–135. syndrome. Vet Radiol Ultrasound 2015;56:609–616. 11. Harvey CE, Fink EA. Tracheal diameter: Analysis of radiographic mea- 35. Montgomery JE, Mathews KG, Marcellin-Little DJ, Hendrick S, surements in brachycephalic and nonbrachycephalic dogs. J Am Anim Brown JC. Comparison of radiography and computed tomogra- Hosp Assoc 198;18:570–576. phy for determining tracheal diameter and length in dogs. Vet Surg 12. Kneller SK. Larynx, pharynx, and trachea. In: Thrall DE, ed. Textbook 2015;44:114–118. of veterinary diagnostic radiology. 5th ed. St. Louis, Missouri: Saunders; 2007:489–492.

976 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY Article

Detection of DNA from undeclared animal species in commercial canine and feline raw meat diets using qPCR

Allison Cox, Vincent E. Defalque, Tyler J. Udenberg, Samantha Barnum, Cara Wademan

Abstract — The best diagnostic test for cutaneous adverse food reactions (CAFR) in companion animals is an elimination diet and subsequent provocation trials. Many commercial diets contain novel protein ingredients used in elimination diets, and selection is based on label ingredients. Raw meat-based diets (RMBD) have become increasingly commercially available, gaining popularity despite potential health risks. Reliability of RMBD based on label ingredients has not been investigated. Using quantitative polymerase chain reaction (qPCR), 9 canine and 9 feline commercial RMBD were assessed for reliability of species-specific animal DNA. Two separate batches of each diet were assessed for content consistency. The DNA of 1 or more unlisted animal species was identified in  60% of diets, as was discrepancy between batches. The unlisted DNA most frequently detected was lamb in canine diets and turkey in feline diets. Based on these findings, use of commercially available RMBD cannot be recommended as an elimination diet in clinical diagnosis of CAFR.

Résumé — Détection par qPCR d’ADN d’espèces animales non-déclarées dans des aliments crus pour chien et chat. Le meilleur test diagnostique pour les réactions cutanées adverses aux aliments (CAFR) chez les animaux de compagnie est une diète d’élimination et des essais subséquents de provocation. Plusieurs diètes commerciales contiennent des ingrédients protéiques nouveaux utilisées dans les diètes d’élimination, et la sélection est basée sur la liste des ingrédients sur l’étiquette. Les diètes à base de viande crue (RMBD) sont devenues de plus en plus disponibles commercialement, gagnant en popularité malgré les risques potentiels pour la santé. La fiabilité des RMBD basée sur les ingrédients listés n’a pas été examinée. En utilisant la réaction d’amplification en chaîne par la polymérase quantitative (qPCR), neuf RMBD canines et neuf RMBD félines commerciales furent évaluées pour la fiabilité de l’ADN spécifique d’espèces animales. Deux préparations séparées de chaque diète furent évaluées pour l’uniformité du contenu. L’ADN d’une ou plus d’espèces animales non-listées fut identifié dans . 60 % des diètes, ainsi que des différences entre les préparations. L’ADN non-listé le plus fréquemment détecté était de l’agneau dans les diètes canines et de dinde dans les diètes félines. Sur la base de ces trouvailles, l’utilisation de RMBD commercialement disponible ne peut être recommandée comme une diète d’élimination dans le diagnostic clinique de CAFR. (Traduit par Dr Serge Messier) Can Vet J 2020;61:977–984

Introduction lupoid onychodystrophy, conjunctivitis, sneezing, and anaphy- n adverse food reaction (AFR) is defined as any abnormal laxis have been associated with AFR in dogs; gastrointestinal and A clinical response that occurs following ingestion of a food respiratory signs, conjunctivitis, and hyperactive behavior have or food component (1). It is often unclear if the pathologic also been reported in cats (4). Of these clinical signs, diarrhea mechanisms of AFR represent a specific immune-mediated and frequent defecation were most often diet-responsive in dogs; response (i.e., type I hypersensitivity) to food antigens, or if the in the cat, diet-responsive clinical signs included vomiting and mechanism is related to non-immune intolerance to a compo- diarrhea (4). Among dogs and cats presented to their veterinar- nent in the food (2). When manifested as dermatological signs, ian for pruritus, the median prevalence of CAFR is estimated an AFR is termed a cutaneous adverse food reaction (CAFR) (3). to be between 15% and 20% (5). In dogs in Australia, Europe, In addition to cutaneous signs, gastrointestinal signs, symmetric and North America, the most common food antigens causing

North West Veterinary Dermatology Services, Vancouver, British Columbia (Cox, Defalque, Udenberg); Department of Medicine and Epidemiology, University of California Davis, Davis, California, USA (Barnum, Wademan). Address all correspondence to Dr. Allison Cox; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

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Table 1a. Diet, brand, and declared composition of canine CAFR are beef, dairy products, chicken, wheat, and lamb (6). commercial raw meat diets in analysis. In cats, the most common food antigens that are incriminated Diet are beef, fish, and chicken (6). number Brand Composition as declared The best diagnostic procedure for identifying CAFR in 1 A Lamb (muscle meat, hearts, livers, bone), fruits/ companion animals is an elimination diet with subsequent vegetables (kale, carrot, squash, broccoli, apples, provocation trials (7). To reliably diagnose CAFR in more cranberries, blueberries), seeds (pumpkin, sunflower), montmorillonite clay, parsley, apple than 90% of dogs and cats, elimination diet trials should last cider vinegar, oils (salmon, coconut), quinoa at least 8 wk (8) and can be either homemade or commercially powder, kelp, alfalfa, Vitamin E produced (9). Although veterinary dermatologists often consider

ARTICLE 2 A Turkey (muscle meat, necks, hearts, livers), homecooked diets as their first choice, many pet owners prefer whole sardines, fruits/vegetables (collard greens, the convenience of commercial “novel” or “hydrolyzed” pro- squash, cranberry, blueberry, celery), seeds (pumpkin, sunflower), montmorillonite clay, tein diets, and rely on package labels to select diets that do not apple cider vinegar, cilantro, ginger, coconut contain previously fed ingredients (9). There are concerns that oil, quinoa powder, alfalfa, kelp, Vitamin E these diets may contain unlisted food sources, and that unidenti- 3 A Duck (muscle, necks, wings, hearts, gizzards, fied ingredients might cause clinical reactions in hypersensitive livers), fruits/vegetables (kale, carrots, squash, patients (10). Unidentified dietary allergens could preclude a broccoli, apples, blueberries, cranberries), seeds (pumpkin, sunflower), montmorillonite clay, resolution of clinical signs in CAFR-affected patients, yielding parsley, apple cider vinegar, oils (salmon, misleading results for the elimination diet trial. Inadvertent coconut), quinoa powder, kelp, alfalfa, cross-contamination of pet foods appears common, even in those Vitamin E with “limited ingredients” proposed for elimination diets (10). 4 B Muscle meat from pork chops/ribs, beef (heart, Rigorous quality control to screen for accidental contamina- marrow, bone), pumpkin, vitamins/minerals tion using real-time or quantitative polymerase chain reaction 5 A Rabbit (muscle meat, bone, liver, heart), fruits/ (qPCR) has been used in both human and animal food manu- vegetables (collard greens, squash, celery, cranberry, blueberry), seeds (pumpkin, facturing as a rapid and sensitive point-of-care application to sunflower), montmorillonite clay, apple cider screen for food-borne bacteria, viruses, or allergens, which can vinegar, cilantro, ginger, oils (sardine, coconut), be identified at low concentrations (11). This screening method quinoa powder, alfalfa, kelp, Vitamin E has also been used in the production of veterinary prescription 6 C Duck (muscle meat, ground bone), turkey diets to validate their contents in order to avoid inadvertent (heart, liver, bone), yeast culture, pumpkin seeds, montmorillonite clay, fruits/vegetables allergen exposures for sensitized pets (12). Of the quality control (apples, broccoli, butternut squash, carrots, analysis methods available, DNA-based protocols are considered spinach, blueberries) salt, cod liver oil, kelp, most reliable for detecting animal species in processed pet food dried, chicory root manufacturing (13). 7 D Beef (muscle meat, heart, liver, bone), ground A subset of commercially available diets includes raw meat- salmon, turkey (muscle meat, liver), fruits/ vegetables (cranberries, spinach, broccoli, based diets (RMBD). Historically, these diets were fed to racing beets, carrots, squash, apples, blueberries), greyhounds and sled dogs; this feeding practice began to be vitamins/minerals, dried fermentation extended to pets and became increasingly popular in the 1990’s products­ as probiotics (Pediococcus acidilactici, Lactobacillus acidophilus, Bifidobacterium (14). Despite evidence of nutritional deficiencies or excesses and longum, Enterococcus faecium) potential health risks of feeding raw or undercooked animal- 8 D Beef (muscle meat, liver, kidney, heart, tripe, source proteins, advocates of RMBD claim anecdotal health bone), pumpkin seed, fruits/vegetables benefits, such as improvement in coat and skin, and a reduc- (cranberries, spinach, broccoli, beets, carrots, tion in medical conditions such as allergies (15). The increasing squash, apples, blueberries), vitamins/ minerals, dried fermentation products as popularity of RMBD has been demonstrated in multiple studies. probiotic (Pediococcus acidilactici, Lactobacillus A 2008 telephone survey revealed approximately 30% of dogs acidophilus, Bifidobacterium longum, and 15% of cats in the United States and Australia consumed a Enterococcus faecium) combination of “unconventional” diets (i.e., homemade diets, 9 E Chicken meat, eggs, brown kelp, flaxseed, table scraps, and/or RMBD) and commercial pet foods (16). fruits/vegetables (cabbage, broccoli, chard, carrot, cauliflower, kelp, apple, pear), green A more recent anonymous Internet-based American survey mussel, vitamins/minerals, selenium yeast, indicated that 46% of dog owners and 38% of cat owners had sunflower oil fed RMBDs to their pets (17). Additionally, sales of RMBD 10 Royal Corn starch, hydrolyzed poultry by-products have increased annually by as much as 15% in recent years Canin aggregate, coconut oil, soybean oil, natural (18). Over the past decade, this feeding practice has continued Ultamino flavors, vitamins/minerals, chicory, L-tyrosine, fructooligosaccharides, fish oil, marigold to increase, and market locations have expanded to include extract, histidine, rosemary extract, mixed grocery stores, mass merchandisers, pet specialty stores, and tocopherols, citric acid veterinary clinics (19). A 2019 Italian-based survey shed light on dog owners’ motivations for adopting this feeding method (20). About 80% of respondents reported that they abandoned feed- ing commercial diets due to distrust in the clarity of ingredients

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Table 1b. Diet, brand, and declared composition of feline ­commercial prescription veterinary diet, veterinarians may commercial raw meat diets in analysis. acquiesce to such requests. However, the reliability of RMBD Diet for this purpose has not been evaluated. number Brand Composition as declared The primary aim of this study was to use PCR to test com- 1 D Duck (muscle meat, bone, gizzard), turkey mercially available RMBD for the presence of DNA of animal (muscle meat, liver), goose, pumpkin seed, origin (beef, chicken, duck, turkey, salmon, lamb, rabbit, kan- vitamins/minerals, dried ­fermentation products as probiotics (Pediococcus acidilactici, garoo, pork) other than that declared on the labels. A secondary ARTICLE Lactobacillus acidophilus, Bifidobacterium objective was to determine the consistency of DNA presence longum) between different batches of the same diets. The hypothesis 2 C Rabbit (muscle meat, bone, liver, kidney, was that the diets would contain unlisted protein ingredients, lung), pork (liver, heart, bone, fat), yeast and that these unlisted proteins would vary between batches. culture, pumpkin seeds, montmorillonite clay, fruits/vegetables (apples, broccoli, butternut To the authors’ knowledge, no previous studies have examined squash, carrots, kelp, spinach, blueberries), these issues. salt, cod liver oil, taurine, dried chicory root 3 A Beef heart, beef liver, ground beef bone Materials and methods 4 A Turkey (muscle meat, necks, hearts, livers), Diets fruits/vegetables (collard green, squash, celery, Nine commercial canine and feline RMBD (Tables 1a, 1b) c ranberries, blueberries, cilantro), seeds were selected for analysis. All diets (with the exclusion of feline (pumpkin, sunflower), almonds, apple cider vinegar, oils (sardine, cod liver, coconut), diet 3) were marketed as balanced for complete feeding. The vitamins/minerals, quinoa powder, kelp, ginger selected diets included a variety of commonly available North 5 A Chicken (muscle meat, necks, gizzards, livers), American RMBD, some formulated with novel (less commonly salmon, fruits/vegetables (kale, yams, carrots, fed) ­animal source proteins (e.g., rabbit), or limited ingredients apples, broccoli, cranberries, blueberries), seeds (e.g., single protein diets), or grain-free diets which may be (pumpkin, sunflower), vitamins/ minerals, apple cider vinegar, oils (salmon, coconut, cod potentially selected for use as an elimination diet. The diets liver), quinoa powder, kelp evaluated were not specifically marketed for feeding as elimina- 6 A Rabbit (muscle meat, bone, livers, hearts), tion diets, but contained ingredients which may be considered fruits/vegetables (collard greens, squash, by pet owners for this feeding purpose. Two lot numbers of celery, cranberries, blueberries), seeds RMBD representing separately prepared batches of each diet (pumpkin, sunflower), montmorillonite clay, apple cider vinegar, oils (sardine, coconut, were selected for analysis in order to assess for consistency of any cod liver), vitamins/minerals, quinoa powder, ingredient contamination between the 2 batches. One canine kelp, ginger and one feline veterinary prescription extensively hydrolyzed 7 F Chicken (muscle meat, heart, liver, gelatin), poultry feather-based diet (Royal Canin Ultamino; labelled as water, dried egg yolk, dulse powder, egg shell Anallergenic in Canada) were used as negative controls. powder, organic psyllium husk powder, Vitamin E, manganese gluconate Nucleic acid preparation 8 F Beef (muscle meat, heart, liver, gelatin), water, organic dried egg yolk, dulse powder, egg shell A 100-mg sample of pet food was added to a 96-well deep well powder, psyllium husk powder, Vitamin E, grinding block (Greiner Bio-One; Monroe, North Carolina, manganese gluconate USA) with 600 L of ATL Buffer, 60 L of Proteinase K 9 F Lamb (muscle meat, heart, liver, gelatin), (Qiagen, Valencia, California, USA), and 2 stainless-steel beads water, dried egg yolk, dulse powder, egg shell (Fisher Scientific, Waltham, Massachusetts, USA). The grind- powder, psyllium husk powder, Vitamin E, manganese gluconate ing block was sealed and the pet food pulverized in a 2010 Geno/Grinder homogenizer (SPEX SamplePrep, Metuchen, 10 Royal Corn starch, hydrolyzed poultry by-products Canin aggregate oils (coconut, vegetable, fish) New Jersey, USA) at 1750 rpm for 2.5 min. Lysate was incu- Ultamino powdered cellulose, natural flavors, dried bated for 15 min at 56°C before 200 L of lysate were removed chicory root, vitamins/minerals, fructo-­ and used for total nucleic acid (TNA) extraction. Total nucleic oligosaccharides, marigold extract, rosemary extract, glycine, mixed tocopherols, citric acid acid extraction was performed on a semi-automated extrac- tion s­ystem (QIAamp 96 DNA, QIAcube HT Kit; QIAcube, Qiagen) according to manufacturer’s instructions and eluted in used, and 94% reported that they believed in the absolute safety 100 L of diethylpyrocarbonate (DEPC)-treated water. of this feeding method (20). Of the meats selected for canine RMBD, the most frequently purchased were beef, chicken, and qPCR assay design and validation turkey (20). Nine species-specific qPCR assays were designed to detect beef, Although feeding RMBD to dogs and cats is discouraged chicken, duck, turkey, salmon, sheep, rabbit, kangaroo, and by veterinary organizations and governmental public health pig DNA (Table 2). Sequences for each species were found in organizations (21,22) up to 1/3 of pet owners may choose to the National Institute of Biotechnology Information (NCBI) use RMBD for the purpose of an elimination diet (23). When database. Two primers and an internal hydrolysis probe (5 end, a pet owner categorically declines to feed a homecooked or reporter dye FAM, 6-carboxyfluorescein), 3 end, quencher dye

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Table 2. qPCR assay and sequence information for DNA of each of 9 targeted species. Forward primer name/ Reverse primer name/ Probe name/ Gene GenBank Amplicon size Species Sequence Sequence Sequence with labeling location accession number (bp) Beef B.taurusHBB-1084f B.taurusHBB-1147r B.taurusHBB-1103p FAM- HBB X00376 64 GTTGTGCTGGCT CCTTCTGAAAGT TGGCAAGGAATTCA- CGCAAT CAGCCTGCA MGB Chicken GallusBactin-3323f GallusBactin-3419r TGGCAGAG TGF-BETA3 X60091 97 CAGCTGGCCTG AAAGGACCAGGA CCGG CCAGTATTGC

ARTICLE Duck CairinaBactin-1588f CairinaBactin-1710r CairinaBactin-1656p FAM- beta actin NM_001310421 123 CTTTGATTTGTT TCAGTGTACAGG CCTGCCTAGGAGAGGT- CAGCGAGCG TAGCCCCTCTCT MGB Turkey Meleagris-303f Meleagris-398r Meleagris-354p FAM- cytochrome b L08381 96 CGGCCTATATTA ACATAGCCTACA AGTCTTACTTCTCA TGGTTCGTACCT AAGGCTGTTGC CCCTC-MGB Salmon Oncorhynchus-1453f Oncorhynchus-1534r Oncorhynchus-1479p FAM- growth hormone 1 X61938 82 CCCTGTTGCCTG ATTGGGCTCACG CTGAACAAGATATTCCTG- ATGAACG ATGGAGTC MGB Sheep O.ariescytoB-513f O.ariescytoB-642r O.ariescytoB-573p FAM- cytochrome b KY110724 130 CAAAGCTACCCT GTCCGATGGAAT CCTCGCCATAGTTCA CACCCGATT TCCTGTGG CCT-MGB Rabbit LeporidaeBactin-74f LeporidaeBactin-150r LeporidaeBactin-99p FAM- beta actin NM_001101683 77 CCATGGATGACG ATCGTCGCCCG CGTGGTCGACAATGG- ATATCGCC CGAA MGB Kangaroo MacropusNADH-118f MacropusNADH-237r MacropusNADH-177p FAM- NADH JN003396.1 120 GTAGGCCCCTAC GAGGGCTAGGAT ACCCCTACGACCTTT- GGACTCCT TGGGGC MGB Pig SusBactin-297f SusBactin-406r SusBactin-352p FAM- Beta actin DQ452569 110 GACGAGGCTGCC TGCAAGGAACAC TCTGACGTGACTCCCCGA- GTAAAGG GGCTAAGTG MGB

NFQMGB (Non-Fluorescent Quencher Minor Grove Binding) automated fluorometer (ABI PRISM 7900 HT FAST; Thermo were designed using Primer Express Software (Thermo Fisher Fisher Scientific). The following amplification conditions were Scientific, Carlsbad, California, USA) for all species, with the used: 2 min at 50°C, 10 min at 95°C, 40 cycles of 15 s at 95°C, exception of chicken which used a locked nucleic acid probe and 60 s at 60°C. Fluorescent signals were collected during the (Roche Molecular Systems, Pleasanton, California, USA). annealing phase and cycle quantification values (Cq) extracted A Basic Local Alignment Search Tool (BLAST, NCBI) of the with a threshold of 0.1 and baseline values of 3 to 10. A no amplicons confirmed unique species detection. To ensure these template control (DEPC-treated water) was run with all assays assays did not cross-react with DNA of other species, a cross- to ensure absence of non-specific binding of the primers and reactivity evaluation was performed by running all assays with probes. Positive controls (extracted DNA from animal tissue or control DNA from each species (Table 3). A housekeeping gene, blood) were run with their respective assay to ensure the assay eukaryotic 18S assay (Hs99999901_s1, Applied Biosystems, was working properly. Thermo Fisher Scientific), was run with each sample to con- firm successful DNA extraction. All assays were validated for Results efficiency and sensitivity by running 10-fold standard curves in Of the 9 species of animal DNA tested, 8 species, including triplicate from serial dilutions of control DNA. Each assay was pork, chicken, duck, rabbit, lamb, beef, salmon, and turkey, 90% to 100% efficient and sensitive enough to detect as few as were detected in at least 1 sample of the canine and feline 10 copies of the target gene. RMBD tested. Only kangaroo DNA was not detected in any of the RMBD. qPCR reaction The 2 extensively hydrolyzed poultry feather-protein based Each qPCR reaction contained 20 primers and probe with a diets (negative controls) contained either trace amounts of final concentration of 400 nM for each primer and 80 nM for chicken DNA (canine) or no detectable DNA (feline). the probe, commercial PCR master mix (TaqMan Universal In the canine RMBD, DNA of 1 or more animal species not PCR Master Mix; Thermo Fisher Scientific) containing 10 mM indicated on the label was identified in 9 out of 9 diets, in either Tris-HCl (pH 8.3), 50 mM KCl, 5 mM MgCl2, 2.5 mM deoxy- 1 or both of the tested batches (Table 4a). Of the 18 batches nucleotide triphosphates, 0.625 U AmpliTaq Gold DNA poly- tested, 89% tested positive for unlisted animal-source DNA. merase per reaction, 0.25 U AmpErase UNG per reaction, and An average of 4.4 unlisted proteins was detected in each diet. A 5 L of diluted extracted TNA. qPCR was performed using an total of 2 batches (test diets 1a and 4a) were found to contain

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Table 3. Results of cross-validation qPCR assay. qPCR assay (Cq) Beef Chicken Duck Turkey Salmon Sheep Rabbit Kangaroo Pig Controls (DNA obtained from tissue or other biological material)

Beef 20.45 — — — — — — — — ARTICLE Chicken — 21.40 — — — — — — — Duck — — 28.66 — — — — — — Turkey — — — 25.55 — — — — — Salmon — — — — 27.08 — — — — Sheep — — — — — 22.90 — — — Rabbit — — — — — — 25.58 — — Kangaroo — — — — — — — 19.44 — Pig — — — — — — — — 24.41

Quantification cycle (Cq) values out of 40 cycles reported in positive circumstances, ‘—’ indicates no amplification detection (qPCR negative).

DNA consistent with the stated label ingredients. The diet with Due to cost limitations restricting the analysis to only 2 batches the greatest number of unlisted proteins was a single batch (2a), of each RMBD, a statistically significant batch contamina- labeled as containing turkey and sardine. It contained a total tion rate could not be determined. However, the finding of of 6 unlisted proteins (pork, chicken, duck, lamb, beef, and ­discrepancy among batches represents yet another variable which salmon). The unlisted DNA most frequently detected was lamb could impact interpretation of an ED trial in a patient fed a (n = 12). Discrepancy in the unlisted DNA between batches was commercially prepared RMBD. noted in 78% of batches. While no particular manufacturer’s diets were found to be In the feline RMBD, DNA of 1 or more animal species not more likely to contain unlisted proteins, brand F, the producer indicated on the label was identified in 7 of 9 diets, in either of feline diets 7 to 9, had the least number of contaminants, as 1 or both of the tested batches (Table 4b). Of the 18 batches well as the most consistent agreement between each batch. It is tested, 61% were positive for unlisted animal-source DNA. An possible that this finding is due to the nature of the processing average of 2.6 unlisted proteins was detected in each diet. A total practices of this particular manufacturer, the production of of 7 batches (test diets 3a, 6a and b, 8a and b, 9a and b) were smaller batch sizes to minimize opportunity for contamination, found to contain DNA consistent with the stated label ingredi- or more limited sourcing of ingredients to restrict the potential ents. The diet with the highest number of unlisted proteins was for supplier cross-contamination. Overall, the number of animal a single batch (7a), labeled as containing chicken and salmon. protein ingredients included in each diet was not a predictor of It contained 5 unlisted proteins (pork, rabbit, lamb, beef, and the number of unlisted proteins isolated in the analysis. Even turkey). The unlisted DNA most frequently detected was ­turkey diets restricted to single proteins were as likely to contain 1 or (n = 7). Discrepancy between batches was noted in 56% of more sources of unlisted animal DNA as those with multiple batches. All of the canine and feline RMBD included in the animal proteins and batch contamination was unpredictable. analysis were found to contain the proteins listed on their labels. Previous studies have shown that in rare cases, ingredients listed on product packaging were found to be missing from Discussion the analysis (10). Our study showed that no animal DNA was Contamination of one or both batches in all canine RMBD missing from that declared on the packaging of any RMBD and most of the feline RMBD tested was detected in this study, included in the analysis. Due to the target DNA of the qPCR which supports the hypothesis that cross-contamination would assay, the study was unable to validate the presence of sardine be found in many RMBD. Numerous independent studies have (listed in canine test diet 2) or goose (listed in feline test diet 1) also demonstrated significant discrepancies between label claims to confirm the inclusion of these ingredients. This was again and actual contents of dry or canned over-the-counter (OTC) due to cost limitations precluding the addition of these proteins commercial diets, including those marketed for the management in the analysis. of CAFR (24–28). While this finding may have been expected Some diets also contained animal fat sources such as salmon in RMBD due to the prevalence of unlisted DNA detected in oil, cod oil, or sardine oil. Through purification processes, fish other such studies, diet purity could theoretically have been oils undergo refinement to remove proteins from the oil to improved in RMBD as they are purported to undergo less render them free of proteins (29). While cod and sardine were processing before distribution, allowing less opportunity for not included in the analysis, our study did evaluate for salmon protein contamination. An additional finding of this study was DNA. Both canine diets 1 and 3 contained salmon oil and tested that unlisted animal source proteins varied among batches in negative for salmon DNA. Feline diet 5 contained salmon oil, most batches tested, including both canine and feline RMBD but also contained salmon meat, and tested positive for salmon that were analyzed. Discrepancy among batches has not been DNA as would be expected. If extrapolating from the finding previously studied for comparison, but these results showed that that salmon DNA was not found in the diets containing salmon differences in unlisted ingredients were common in RMBD. oil, it may be expected that the other diets containing fish

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Table 4a. Results of analyses of canine diets. Animal species DNA detected in samples “” = present, “” = not detected in 40 cycles of amplification Diet Animal proteins Animal fats number in ingredients in ingredients list Batch Pork Chicken Duck Rabbit Lamb Beef Salmon Kangaroo Turkey 1 Lamb — a          b          2 Turkey, sardine — a          b          3 Duck — a          ARTICLE b          4 Pork, beef — a          b          5 Rabbit — a          b          6 Duck, turkey — a          b          7 Beef, salmon, turkey — a          b          8 Beef — a          b          9 Chicken — a          b          10 Hydrolyzed poultry — a          feather protein

sources of oil did not contain cod or sardine DNA as potential in chicken feathers (33). Additionally, the manufacturer is aware allergens. In general, plant- and animal-based oils are not consid- that cross-contamination needs to be avoided in a therapeutic diet ered allergenic when highly purified (30). and has developed and clinically validated calibration curves to Of additional note was the finding that no diet contained the prevent contamination (12). These calibration curves correspond DNA of kangaroo. The commercial RMBD tested were obtained to a known DNA level that was clinically tolerated based on in California due to the proximity to the testing ­facility (­Real-time Global Skin Scores (GSS) in feeding trials in order to set a toler- PCR Research and Diagnostics Core Facility, University of ance level for ancillary proteins known as the NPPI (no protein California, Davis, California, USA). Since kangaroo meat is not pollution index %), which is strictly monitored in each diet prior used by any of the manufacturers in their RMBD, this finding to allowing market release (12). Based on the manufacturer’s serves as an additional negative control for this study to validate quality control data, 72.3% of these extensively hydrolyzed diets that no DNA of kangaroo origin was detected in the analysis, as contain DNA below the limit of detection (LOD = 0.003 g/g), would be expected. and 25.7% may have DNA above the LOD but below a safety Analysis of the 2 extensively hydrolyzed poultry feather- threshold of 1.2 g/g (12). However, no diet released to market based diets (Royal Canin Ultamino) revealed no detection of will exceed the established cut-offs of the NPPI based on the unlisted animal DNA. This is consistent with previous reports pre-established calibration curves (12). Therefore, trace copies that contaminants are detected less commonly and in lower of chicken DNA may be expected on PCR in some of the diets numbers in hydrolyzed diets (10,24). The extensive hydrolysis released to market, as was found in our study. The DNA in the of poultry feather proteins into component amino acids or very feline extensively hydrolyzed diet in this study was below the short ­oligopeptides is intended to avoid inducing IgE-mediated LOD, and no animal DNA was detected in the assay. mast cell activation that can occur with proteins 10 kDa in size Based on the sensitivity of qPCR, it can be argued that these or greater (12,31). Extensive hydrolysis to reduce poultry allerge- assays, being sensitive enough to detect as few as 10 copies of the nicity has been validated in both serum IgE and feeding trials to target gene, are of greater sensitivity than that required to detect show the clinical benefits for CAFR (32). These negative control clinically meaningful contamination that would trigger CAFR. diets were selected because of the rigorous quality control methods There is no established maximum tolerable level of a contaminat- undertaken by the manufacturer to ensure cross-­contamination ing protein that may elicit a pruritic reaction in a food sensitized does not occur before market release (12). While the canine pet. In humans, soy protein concentration as low as 10 ppm diet did test positive for chicken DNA, the manufacturer (0.01 g/mg) may evoke a reaction in a soy-sensitized individual does list the feathers of chicken, turkey, and duck as their sourced (34). Additionally, dose distribution has been demonstrated to raw materials (12). The target gene of the analysis for chicken vary between different food allergens in sensitized humans, show- DNA, transforming growth factor beta 3, is a protein expressed ing that a tolerance range may exist for different food antigens

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Table 4b. Results of analyses of feline diets. Animal species DNA detected in samples “” = present, “” = not detected in 40 cycles of amplification Diet Animal proteins Animal fats number in ingredients in ingredients list Batch Pork Chicken Duck Rabbit Lamb Beef Salmon Kangaroo Turkey 1 Duck, turkey, goose — a          b          ARTICLE 2 Rabbit, pork Pork fat a          b          3 Beef — a          b          4 Turkey Cod-liver oil a          b          5 Chicken, salmon — a          b          6 Rabbit — a          b          7 Chicken — a          b          8 Beef — a          b          9 Lamb — a          b          10 Hydrolyzed poultry — a          feather protein

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14. Lee E. Raw dog food: Dietary concerns, benefits, and risks. Available 26. Ricci R, Granato A, Vascellari M, et al. Identification of undeclared from: https://pets.webmd.com/dogs/guide/raw-dog-food-dietary-­ sources of animal origin in canine dry foods used in dietary elimination concerns-benefits-and-risks#1 Last accessed June 30, 2020. trials. J Anim Physiol Anim Nutr (Berl) 2013;97:32–38. 15. Freeman LM, Chandler ML, Hamper BA, Weeth LP. Current knowledge 27. Okuma TA, Hellberg RS. Identification of meat species in pet foods about the risks and benefits of raw meat-based diets for dogs and cats. using a real-time polymerase chain reaction (PCR) assay. Food Control J Am Vet Med Assoc 2013;243:1549–1558. 2015;50:9–17. 16. Laflamme DP, Abood SK, Fascetti AJ, et al. Pet feeding practices of 28. Horvath-Ungerboeck C, Widmann K, Handl S. Detection of DNA dog and cat owners in the United States and Australia. J Am Vet Med from undeclared animal species in commercial elimination diets for Assoc 2008;232:687–694. dogs using PCR. Vet Dermatol 2017;28:1–6. 17. Morgan SK, Willis S, Shepherd ML. Survey of owner motivations and 29. Yin, H. Purification of fish oils and production of protein powders veterinary input of owners feeding diets containing raw animal products. with EPA and DHA enriched fish oils. LSU Doctoral Dissertations Peer J 2017;5:e3031. 2011. Available from: https://digitalcommons.lsu.edu/gradschool_­

ARTICLE 18. Wall T. Raw pet food sales growing despite health warnings. Available dissertations/2084 Last accessed June 30, 2020. from: https://www.petfoodindustry.com/articles/6928-raw-pet-food- 30. Health Canada’s position on highly refined oils derived from food sales-growing-despite-health-warnings Last accessed June 30, 2020. allergen sources. Health Canada c2013. Available from: https://www. 19. Parr JM, Remillard RL. Handling alternative dietary requests from canada.ca/en/health-canada/services/food-nutrition/food-labelling/ pet owners. Vet Clin North Am Small Anim Pract 2014;44:667–688. allergen-labelling/position-highly-refined-oils-derived-food-allergen- 20. Morelli G, Bastianllo S, Catellani P, Ricci R. Raw meat-based diets for sources.html Last accessed June 30, 2020. dogs: Survey of owners’ motivations, attitudes and practices. BMC Vet 31. Verlinden A, Hesta M, Millet S, Janssens GPJ. Food allergy in dogs and Res 2019;15:74. cats: A review. Crit Rev Food Sci Nutr 2006;46:259–273. 21. Raw meat based diets for pets — position statement. Canadian 32. Olivry T, Bexley J, Mougeot I. Extensive protein hydrolyzation is indis- Veterinary Medical Association c2018. Available from: https://www. pensable to prevent IgE-mediated poultry allergen recognition in dogs canadianveterinarians.net/documents/raw-meat-based-diets-for-pets and cats. BMC Vet Res 2017;13:251. Last accessed June 30, 2020. 33. Jakowlew SB, Ciment G, Tuan RS, Sporn MB, Roberts AB. Expression 22. Raw or undercooked animal-source protein in cat and dog diets. of transforming growth factor-beta 2 and beta 3 mRNAs and proteins American Veterinary Medical Association c2012. Available from: in the developing chicken embryo. Differentiation 1994;55:105–118. https://www.avma.org/policies/raw-or-undercooked-animal-source- 34. Koppelman SJ, Lakemond CM, Wlooswijk R, Hefle SL. Detection of protein-cat-and-dog-diets Last accessed June 30, 2020. soy protein in processed foods: Literature overview and new experimen- 23. Tiffany S, Parr JM, Templeman J, et al. Assessment of dog owners’ tal work. J AOAC Int 2004;87:1398–1403. knowledge relating to the diagnosis and treatment of canine food 35. Ballmer-Weber BK, Rivas-Fernandez M, Beyer K, et al. How much is allergies. Can Vet J 2019;60:268–274. too much? Threshold dose distributions for 5 food allergens. J Allergy 24. Ricci R, Conficoni D, Morelli G, et al. Undeclared animal species in dry Clin Immunol 2015;135:964–971. and wet novel and hydrolyzed protein diets for dogs and cats detected by microarray analysis. BMC Vet Res 2018;14:209. 25. Raditic DM, Remillard RL, Tater KC. ELISA testing for common food antigens in four dry dog foods used in dietary elimination trials. J Anim Physiol Anim Nutr (Berl) 2011;95:90–97.

984 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY Article

Compliance with the Code of Practice for the Care and Handling of Equines on 50 horse farms in Prince Edward Island

Kathleen M. MacMillan, Lisa J. Millican, Jennifer J. Burns, J. Trenton McClure, Raphael Vanderstichel

Abstract — The objective of this study was to determine the proportion of horse farms on Prince Edward Island, Canada that comply with the requirements of the Code of Practice for the Care and Handling of Equines (Code). An investigator performed on-farm assessments while administering a questionnaire to owners of 50 horse farms. The percentage of farms in compliance with specific requirements in the Code ranged from 20% to 100% per requirement. The largest areas of non-compliance regarding facilities and housing were the lack of the ability to segregate sick or injured animals and the lack of an emergency action plan. It was determined that 72% of farms were in compliance with body condition scores and 54% reported to have taken corrective action when required. Farm owners who were aware of the Code were more likely to have good quality air in their barns as well as an emergency action plan in place.

Résumé — Conformité avec le Code de pratiques pour les soins et la manipulation des chevaux sur 50 fermes équines à l’Île-du-Prince-Édouard. L’objectif de la présente étude était de déterminer la proportion de fermes équines sur l’Île-du-Prince-Édouard, Canada qui se conforme aux exigences du Code de pratiques pour les soins et la manipulation des chevaux (Code). Un enquêteur effectua des évaluations à la ferme tout en procédant à un questionnaire auprès des propriétaires de 50 fermes équines. Le pourcentage de fermes en conformité avec des exigences spécifiques du Code variait de 20 % à 100 % selon l’exigence. Les secteurs les plus importants de non- conformité en regard des facilités et de logement étaient l’absence de la capacité à isoler les animaux malades ou blessés et l’absence d’un plan d’action d’urgence. Il fut déterminé que 72 % des fermes étaient en conformité pour les pointages d’état de chair et 54 % rapportèrent d’avoir pris les actions correctives lorsque requises. Les propriétaires de ferme qui étaient au courant du Code étaient plus susceptibles d’avoir un air de bonne qualité dans leurs fermes ainsi qu’un plan d’action d’urgence en place. (Traduit par Dr Serge Messier) Can Vet J 2020;61:985–989

Introduction Canada in 2010 (1). There were approximately 4000 horses on 720 properties in Prince Edward Island (PEI) (1). Previous here has been increasing interest in the welfare of horses as studies were carried out to assess the welfare of non-racing horses they have evolved from working animals to animals used T in PEI; however, no studies included the overall equine popula- primarily for sport and companionship. Results from a 2010 sur- tion on PEI or equine owner compliance with the revised Code vey by Equine Canada determined that horses in Canada are of Practice for the Care and Handling of Equines (Code) (2,3). primarily used for sport and recreation (1) and donkeys are The Code is a document created by the National Farm predominantly used for companionship. Based on this survey, Animal Care Council which was last updated in 2013 (4). approximately 963 500 horses resided on 145 000 premises in It serves as our national understanding of the minimum care requirements for horses and donkeys living in Canada and Department of Health Management, Atlantic Veterinary makes recommendations to enhance the welfare of equids. The College, University of Prince Edward Island, 550 University Code development process ensures credibility and scientific Avenue, Charlottetown, Prince Edward Island C1A 4P3, rigor by thoroughly vetting empirical evidence for validity Canada. and applicability to ensure the Code is scientifically informed, Address all correspondence to Dr. Kathleen MacMillan; e-mail: practical, and reflective of societal expectations for responsible [email protected] farm animal care (2). Use of this article is limited to a single copy for personal study. The Code is divided into 10 sections covering 123 require- Anyone interested in obtaining reprints should contact the ments in the following areas: duty of care, facilities and hous- CVMA office ([email protected]) for additional ing, feed and water, health management, feedlot management, copies or permission to use this material elsewhere. husbandry practices, reproductive management, transportation,

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change or end of career, and euthanasia. The Code serves as it difficult to interpret an answer from the participant as either an educational tool, providing guidance to horse owners and compliant or non-compliant. The questionnaire was created professionals on how to make informed decisions for the equids methodically to not lead respondents to a correct answer in in their care. The Code also provides reference material for order to minimize response bias associated with question- regulations and serves as the foundation for animal assessment naires (10). After multiple revisions, questions developed in programs. relation to specific requirements in the Code were asked in mul- On-farm welfare assessment has been used primarily for tiple choice format with 1 or more correct answers. An example farm owner education or to qualify for voluntary welfare- of such a question would be “If winter blankets are used, how assurance programs rather than for regulatory purposes (5). In often are they removed in order to evaluate the condition of

ARTICLE Canada the use of the Code for regulatory purposes remains the horse.” The requirement in the Code states “If blankets are a provincial decision. When the PEI Animal Welfare Act was used, the condition of the horse beneath the blankets must be revised in 2017, a section pertaining to the Codes of Practice examined at least weekly;” therefore, the correct answers are: for Commercial Animals was included in the Animal Welfare daily, 4 to 6 times/wk, 2 to 3 times/wk, once/wk, or blankets Regulations. Regulation 26 of this Act states: “Every owner of a are not used. Alternatively, incorrect answers for the question commercial animal shall comply with the codes of practice listed include: every 10 to 14 d, once/mo, and occasionally. in Schedule B in respect of the commercial animal to which the A total of 57 questions were asked in the questionnaire with code applies” (6). When inspectors with the PEI Department of the first 7 questions addressing demographics of the owners Agriculture and Land investigate equine welfare complaints, they and their awareness of the Code as previously reported (7). use the Code of Practice for the Care and Handling of Equines as Fifty questions addressed 51 of 95 requirements within 6 of a guideline to ensure that the minimum care requirements are the sections in the Code. These sections included: facilities and being met on farm. housing (15 questions), feed and water (10 questions), health The purpose of this study was to assess compliance with management (11 questions), husbandry practices (8 questions), specific requirements in the Code on 50 horse farms in PEI reproductive management (3 questions), and euthanasia (3 ques- and to use these results to educate farm owners about the Code tions). The questionnaire did not address sections pertaining to and how they may use this important document to meet and duty of care, feedlot management, transportation, and change enhance the welfare of the horses under their care. Information or end of career, as they did not pertain to all farms included on the demographics of the owners and the overall estimate of in the study nor were we able to develop questions that would the proportion of awareness of the Code by owners on PEI was suitably assess their requirements. collected during this study and reported separately (7). Clients of the Atlantic Veterinary College were not solicited directly by the principal investigator due to potential conflict Materials and methods of interest arising from veterinarian-client relationships and This study was approved by the University of Prince Edward research ethics guidelines. Volunteers were recruited to par- Island Research Ethics Board (REB# 6007056) and the Animal ticipate in the study primarily through social media. Requests Care Committee (AUP# 16-021) of the University of Prince for participation were placed on social media websites, the Edward Island in accordance with the Canadian Council on University of Prince Edward Island website, and an inter- Animal Care. A questionnaire was designed to investigate horse view with the principal investigator was aired on CBC Radio. farm owners’ level of awareness of the Code, demographics of Recruitment for the study occurred from June to August, 2017 the farms and their owners as well as their compliance with the until 50 farms were enrolled (approximately 7% of the equine requirements as outlined in the Code. On farm, an investigator farms on PEI) (1). The equine population on PEI is estimated (who was a licensed veterinarian) questioned the owner and to be approximately 4000 (1). Including 50 farms as a sample surveyed the property to answer additional questions which were size in this study produced a maximum 95% confidence inter- based on observation rather than owner response. Ammonia val (CI) of 0.27 (Binomial Exact method), which was deemed levels were considered above 20 ppm if the investigator was acceptable for this pilot study. able to detect ammonia either by smell or irritation to the eyes For statistical analyses, all responses were dichotomously as described in the Code. The Investigator also performed body coded as either yes (1 = compliant with the code) or no (0 = non- condition scores on all horses based on the Henneke horse body compliant), and descriptive statistics were used to describe these condition scoring system and donkeys based on the body con- proportions. Fisher’s exact test was used to find associations dition scoring chart as outlined in the Code (4,8,9). The same between all pairwise dichotomous responses (compliant versus investigator performed all 50 farm visits to provide continuity non-compliant) in the questionnaire. For these pairwise analyses, and eliminate potential inter-investigator bias. questions needed a minimum of 40 non-missing responses with During development of the questionnaire the intent was to the presence of at least 1 “no” response — no statistical adjust- ask questions directly from the Code; however, this proved chal- ments were made for the multiple pairwise comparisons (see lenging as it is human nature to want to be in compliance and discussion herein); statistical significance was set at P , 0.05. not admit to wrongdoing, thus potentially creating question- naire bias and yielding inaccurate results. Another challenge in Results using the requirements from the Code verbatim was that the A total of 50 equine farms consisting of 248 horses from wording of many requirements is vague in detail, thus making multiple disciplines were included in this study. Most farms

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were private (n = 42) with 8 farms used as boarding facilities. if the horse or pony was not within the recommended range Most farms had primarily riding horses (n = 29), followed by for body condition; however, only 20% of farm owners (95% Standardbred racehorses (n = 8), retired horses (n = 6), breeding CI: 1% to 72%) sought veterinary advice if the horse or pony horses (n = 2), pulling horses (n = 1), and other (n = 4). The failed to respond to corrective actions. Corrective actions taken first part of the study addressed the proportion of owners who by respondents included increasing the daily amount of hay or were aware of the Code, along with their related demographic grain fed, having a veterinarian examine and perform dentistry descriptions of the farms (7). It was determined that 38% if needed and deworming or performing fecal egg counts. With ARTICLE (n = 19) of the farms were not aware of the Code, 48% (n = 24) respect to dental care, 82% (95% CI: 69% to 91%) of respon- were aware of the Code but unfamiliar with its content, and dents have their horse’s teeth floated at least once per year or only 14% (n = 7) used the Code regularly when making deci- when the horse is showing signs of dental problems; 6% (95% sions on caring for their horses (7). Further results related to CI: 1% to 17%) had never had a dental examination performed the demographic descriptions of the farms have been previously on their horse. In 78% of cases, respondents who had a dental published (7). examination and float, had it performed by a veterinarian (95% The average age of the horses in this study was 11 y, rang- CI: 64% to 88%). ing from 2 mo to 32 y. The average body condition score was The section pertaining to husbandry practices found that 5.3 out of 9, ranging from 2 to 8 out of 9 for the horses. Of farms were generally in compliance with the requirements we the 248 equids there were 4 (1.6%, 95% CI: 0.4% to 4.1%) examined (range: 98% to 100%). Only 1 (2%, 95% CI: 0.1% horses with a BCS below the recommended range of 4 to 6 out to 10.6%) of 50 farms used tethering as a form of restraint of 9. These horses with low BCS were all geriatrics (ages 20, while grazing, although the horses were monitored at all times 32, and 35) with the exception of 1 yearling. In contrast, there while tethered. While 84% (95% CI: 69% to 91%) of respon- were 39 (15.7%, 95% CI: 11.4% to 20.9%) horses above the dents reported having their horses’ feet trimmed at least 5 to recommended BCS. Three donkeys from 2 farms were enrolled 10 times per year, 16% (95% CI: 7% to 29%) had their horses in the study. The average age of the 3 donkeys was 8 y, ranging feet trimmed 2 to 5 times per year. The condition of the hooves from 2 to 22 y. These donkeys had an average BCS of 3.3 out was not evaluated by the investigator. of 5 with 2 of the donkeys having an appropriate BCS of 3 and The section pertaining to reproductive management applied 1 donkey scoring above the recommended BCS with a BCS of 4. to 11 (22%, 95% CI: 12% to 36%) of the 50 farms, and these Based on the results of the questionnaire, the percentage of were 91% to 100% in compliance. Of the 11 farms, 10 (91%) farms in compliance with specific requirements investigated observed their pregnant mares which were close to foaling at from the Code ranged from 20% to 100%. The questions per- least twice per day for health, well-being, and signs of foal- taining to facilities and housing showed 50% to 100% compli- ing. All 11 (100%) farms monitored the mare and foal post- ance. The question which identified 50% compliance applied foaling until the foal was standing and successfully nursing. to only 2 farms, 1 of which had indoor group housing with Supplemental colostrum or intravenous plasma was provided insufficient space for a subordinate horse to escape aggression. as needed. Sixty-three percent of farms had an area within the facility to The last section to be examined was euthanasia; here, 54% segregate sick or injured animals (95% CI: 47% to 77%), while to 100% of respondents were compliant with the requirements 91% of farms provided access to shelter to protect their horses of the Code. Of the 50 respondents, 43 (86%, 95% CI: 73% from the harmful effects of extreme weather conditions (95% to 94%) had had a horse euthanized in the past, with 33 (77%, CI: 77% to 97%). With regard to air quality and humidity, 95% CI 61 to 88%) of those euthanasias performed by a vet- 84% of the farms had air quality maintained below the level erinarian and 10 (23%, 95% CI: 12% to 39%) performed by a of detection of excess ammonia (95% CI: 71% to 94%). Only skilled individual using a free bullet or penetrating captive bolt. 58% of the farms had an emergency action plan (95% CI: 43% With respect to disposal, 54% (95% CI: 37% to 71%) complied to 72%). with provincial guidelines. The underground burial of livestock The percentage of farms in compliance with the questions on farms is not permitted in PEI, yet burial of a dead horse related to specific requirements on feed and water ranged from had occurred on 16 of 35 (46%, 95% CI: 29% to 63%) farms. 70% to 100%. Seventy percent (95% CI: 55% to 82%) of Of the total 57 questions included in the questionnaire, respondents took an appropriate course of action such as soak- 50 were directly related to specific aspects of the Code and could ing the hay in water or obtaining a new hay source when the be further dichotomized as compliant “yes” or “no.” Of the hay appeared to be dusty, and 92% (95% CI: 81% to 98%) of 50 dichotomous questions, 30 had at least one “no-compliant” farms provided their horses with access to safe, palatable, and response and were further included in the multiple pairwise clean water in quantities to maintain health and vigor. analyses using Fisher’s exact test. It is important to note that no The percentage of farms in compliance with the questions adjustments were made for these reported P-values which were pertaining to health management was 20% to 100%. The lowest derived from 435 pairwise comparisons. Two requirements in compliance was in reference to body condition scoring. Seventy- the Code were significantly positively correlated with aware- two percent (95% CI: 58% to 84%) of farms had their equids ness of the Code: having indoor air quality in the barn that was within the recommended range of 4 to 6 out of 9 for horses and maintained to prevent the buildup of noxious gases, dust, and ponies and 3 out of 5 for donkeys and mules (4,8,9). Fifty-four moisture (P = 0.008) and having an emergency action plan for percent of respondents reported that they took corrective action emergencies that may occur such as fire and flood (P = 0.022).

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Discussion the weight loss was simply a natural process of aging in geriatric horses. The average body condition score of the 243 horses was It was our intent to establish a baseline for how equine farm 5.3 out of 9, which is 0.4 lower than previously reported in a owners in PEI currently care for their horses and how closely study on non-racing horses in PEI (2). The lower score in this they were in compliance with the requirements of the Code study may have resulted from including horses as young as 2 mo even when unaware of the content. Several factors may come old in the study population and racing Standardbreds which into play when failing to provide adequate welfare for animals. tend to be fitter and have a lower body condition score. While In particular, multiple factors associated with poor equine only a few horses were below the recommended BCS, many had welfare have been reported in the literature. One commonly excessive body condition which may reflect overfeeding and lack suggested factor is the general lack of awareness of owners on ARTICLE of exercise. Obesity in the horse population is a concern due to issues that compromise equine welfare (3,11,12). When owners association with insulin resistance, oxidative stress/inflammation, lack resources, whether financial or knowledge-based, they are and laminitis (15). Eighty-two percent of respondents had their more likely to be unable to meet the care of their horses, result- horse’s teeth examined and floated annually, and in 78% of cases ing in less than desirable welfare. When insufficiencies in care this procedure was performed by a veterinarian. In the province are identified, the Code can be used to educate horse owners on of PEI performing dental procedures falls under the Veterinary how to improve the welfare of their horses by meeting minimum Profession Act and legally these procedures are required to be care requirements and recommended practices. performed by a veterinarian. Proper dental care helps horses n As previously described, 62% ( = 31) of respondents on eat more effectively, maintain an appropriate body weight, and farms were aware of the Code (7). Of these 31 farms, respon- perform better; therefore, not maintaining good dental health dents on 24 of the farms were aware of the Code but not famil- provided by a properly trained individual may have a negative iar with its contents and 7 used the Code regularly when making impact on the horse’s welfare. decisions on the care of their horses (7). An unpublished online With respect to facilities and housing, the biggest areas of survey (obtained in writing from the Horse Welfare Alliance of non-compliance were the lack of the ability to segregate sick Canada on April 23, 2019) found that 58% of 2800 respondents or injured animals and the lack of an emergency action plan. were aware of the Code. Another online survey conducted across Segregating sick animals is an important part of an effective Canada found similar results of 53.9%, n = 486/901 (13). A biosecurity plan to help minimize the spread of disease within study conducted in southern Ontario found that 50% (13/26) the herd and to neighboring farms. Emergency action plans of operators of farms were aware of the Code (14). Our study are essential during fires, floods, and natural disasters. These found a higher awareness than in these 3 studies. The higher plans should be available to all individuals who have access awareness of the Code in PEI may be because the province is to the facility to result in the best outcome possible during an small and the dissemination of information such as the con- emergency. A recent pilot project in southern Ontario using tents of the Code to horse owners is less challenging. Another an on-farm assessment tool found that 78% of 26 farms in the potential contributing factor to the higher awareness in PEI is project had an emergency action plan, which is higher than that the province has a strong agricultural base and Codes of that reported in the study herein (14). The higher prevalence of Practice are used extensively in many other areas of the agricul- emergency action plans in the southern Ontario study may have tural sector. Based on our findings, compliance was higher than been the result of stronger educational efforts, higher incidence expected given that only 14% of respondents reported that they of emergencies in this region, or a reflection of demographics. used the Code regularly when making decisions regarding the Air quality was one of the most important requirements and care of their horses. Two requirements were positively correlated was positively correlated with awareness of the Code. Good air with awareness of the Code; indoor air quality and having an quality and ventilation are important in the prevention and emergency action plan. Individuals who were aware of the Code, management of respiratory diseases in horses. Many horses therefore, were more likely to comply with the requirement spend a significant part of their day in stalls, and as such, may of having good quality air in the stable as well as having an have a higher exposure to particulate matter and noxious gases emergency action plan in place. It is possible that respondents such as ammonia which may contribute to airway inflamma- aware of the Code sought educational resources and used these tion and resulting disease (16). Detection of poor air quality tools to improve their facilities and management of the equids in this study was limited by the ability of the investigator to under their care. It is difficult to speculate why other require- detect ammonia via smell or irritation to the eyes which sug- ments were not positively correlated with awareness of the Code. gests the ammonia concentration in the air is above 20 ppm. Studies examining the relationship between compliance and To fully assess air quality and obtain an accurate measure of awareness are warranted. the concentration of ammonia in the air would have required In the section on health management, 72% of the farms were calibrated equipment. in compliance with body condition score. The lowest compli- With respect to disposal of horses after euthanasia, 54% of ance was 20%; only 1 in 5 respondents sought veterinary advice respondents were in compliance with provincial guidelines. The when their horse or pony did not respond to corrective actions Department of Agriculture and Land in PEI recommends that to increase body condition score. The lack of veterinary con- a carcass removal service be used as best practice for disposal sultation may be due to financial constraints or the perception of carcasses. The guidelines are designed to protect the public that the owner had tried everything within their means and that and animal health and to reduce the risk of contamination of

988 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY drinking water supplies and surface water resources. The lack of References compliance with this requirement could have legal and environ- . 1 Equine Canada [homepage on the Internet] c2010 Canadian horse mental implications. This suggests that there is a lack of aware- industry profile survey. Available from: https://www.equestrian.ca/ ness or a disregard for proper disposal of dead livestock within industry/about Last accessed July 6, 2020. 2. Christie JL, Hewson CJ, Riley CB, McNiven MA, Dohoo IR, Bate LA. the equine community. However, many horse owners view their Management factors affecting stereotypies and body condition score in horse as a companion animal rather than livestock and without nonracing horses in Prince Edward Island. Can Vet J 2006;47:136–143. 3. Christie JL, Hewson CJ, Riley CB, McNiven MA, Dohoo IR, Bate LA. knowledge of the implications, may prefer a more traditional ARTICLE Demographics, management, and welfare of nonracing horses in Prince form of disposal such as underground burial. Improving efforts Edward Island. Can Vet J 2004;45:1004–1011. to educate horse owners and veterinarians may be helpful in 4. National Farm Animal Care Council [homepage on the Internet] c2013 developing better compliance for disposal of horse carcasses. The Code of Practice for the Care and Handling of Equines. Available from: https://www.nfacc.ca/codes-of-practice/equine-code Last accessed Perhaps the greatest limitation of this study was the potential July 6, 2020. for bias within the volunteer population. As such, this study 5. Sørensen JT, Fraser D. On-farm welfare assessment for regulatory pur- may not offer a true representation of the horse farm owner poses: Issues and possible solutions. Livest Sci 2010;131:1–7. 6. Government of Prince Edward Island [homepage on the Internet] population of PEI, but it does provide a baseline from which c2019 Animal Health Act and Regulations EC194/17. Available from: future studies on equine welfare issues can be developed both https://www.princeedwardisland.ca/en/legislation/animal-welfare-act/ regionally and nationally. The results herein will be used to animal-welfare-regulations. 2017 Last accessed July 6, 2020. 7. Millican L, Vanderstichel R, McClure J, MacMillan K. Demographic direct educational efforts in the form of presentations and writ- factors associated with Prince Edward Island horse farm owner awareness ten articles provided to the public and to stakeholders. There of the Code of Practice for the Care and Handling of Equines. J Appl is a concern that individuals who would benefit most from the Anim Welf Sci 2020;23:378–384. 8. Henneke DR, Potter GD, Kreider JL, Yeates BF. Relationship between knowledge gained from the questionnaire are individuals who condition score, physical measurements and body fat percentage in may not have volunteered for the study. It is easier to educate mares. Equine Vet J 1983;15:371–372. individuals who want to improve the welfare of their horses, as 9. The Donkey Sanctuary [homepage on the Internet] c2013 Condition scoring and weight estimation of the donkey [Updated November they are more likely to seek advice from appropriate resources. 2018]. Available from: https://www.thedonkeysanctuary.org.uk Last As an educator and animal welfare advocate it is a challenge to accessed July 6, 2020. have a positive impact on individuals who are resistant to acquir- 10. Choi BC, Pak AW. A catalog of biases in questionnaires. Prev Chronic Dis 2005;2:A13. ing additional information or who do not seek information from 11. Hitchens PL, Hultgren J, Frössling J, Emanuelson U, Keeling LJ. An appropriate resources. One of the greatest challenges is how to epidemiological analysis of equine welfare data from regulatory inspec- identify individuals who would most benefit from additional tions by the official competent authorities. Animal 2017;11:1237–1248. 12. Collins JA, Hanlon A, More SJ, Wall PG, Kennedy J, Duggan V. information and then empower them with the knowledge Evaluation of current equine welfare issues in Ireland: Causes, desir- necessary to make a meaningful improvement in welfare of the ability, feasibility and means of raising standards. Equine Vet J 2010;42: horses under their care. 105–113. 13. DuBois C, Nakonechny L, Derisoud E, Merkies K. Examining Canadian equine industry participants’ perceptions of horses and their welfare. Animals (Basel) 2018;8:201. Acknowledgments 14. DuBois C, DeVries T, Haley DB, Lawlis P, Merkies K. Putting an The authors thank Dr. Jennifer MacLean for her help in devel- on-farm welfare assessment tool into practice in the Canadian equine industry — A pilot study. J Equine Vet Sci 2018;63:35–40. oping the questionnaire and Dr. Colleen Hughes and Alex 15. Thatcher C, Pleasant R, Geor R, et al. Prevalence of obesity in mature Stavert for the collection of data. horses: An equine body condition study. J Anim Physiol Anim Nutr Funding for this project was provided by Growing Forward 2 (Berl) 2008;92:222–222. 16. Millerick-May ML. How to manage air quality in stables. In: Sprayberry and the Atlantic Veterinary College Veterinary Student Research KA, Robinson NE, eds. Robinson’s Current Therapy in Equine Award. CVJ Medicine. 7th ed. St. Louis, Missouri: WB Saunders, 2015:243–247.

CVJ / VOL 61 / SEPTEMBER 2020 989 FOR PERSONAL USE ONLY Brief Communication Communication brève

Characterization of the use of shock wave therapy among equine veterinarians

Angela V. MacKay, Rebecca C. McOnie, Lea P. Riddell, Katherine A. Robinson

Abstract — Extracorporeal shock wave therapy (ESWT) research has prioritized mechanism of action and efficacy. Data regarding frequency of use and clinical opinion are not available. A web-based survey was offered to members of the American Association of Equine Practitioners; 144 responses were obtained. Frequency of ESWT use by respondents was as follows: daily by 8.3% (12/144), at least once weekly by 36.8% (53/144), at least once per month by 22.9% (33/144), less than once per month by 19.4% (28/144), and never by 12.5% (18/144) of respondents. The most common reason for use was to treat ligamentous injuries. Opinion of efficacy was variable.

Résumé — Caractérisation de l’utilisation de la thérapie par ondes de choc parmi les vétérinaires équins. La recherche sur la thérapie extra-corporelle par ondes de choc (ESWT) a priorisé le mécanisme d’action et l’efficacité. Les données concernant la fréquence d’utilisation et l’opinion clinique ne sont pas disponibles. Un sondage sur le web fut offert aux membres de l’American Association of Equine Practitionners; 144 réponses furent obtenues. La fréquence d’utilisation d’ESWT par les répondants était la suivante : quotidiennement par 8,3 % (12/144), au moins une fois semaine par 36,8 % (53/144), au moins une fois par mois 22,9 % (33/144), moins d’une fois par mois par 19,4 % (28/144) et jamais par 12,5 % (18/144) des répondants. La raison la plus fréquente pour son utilisation était pour traiter des blessures aux ligaments. Les opinions sur son efficacité étaient variables. (Traduit par Dr Serge Messier) Can Vet J 2020;61:990–993

hock wave therapy (extracorporeal shock wave therapy, veterinarians. The survey was then offered to the 7787 members S ESWT) was originally developed for dissolution of urinary of the American Association of Equine Practitioners (AAEP). calculi in humans, but has evolved into a treatment modality for An advertisement and a link for the survey were e-mailed by the musculoskeletal injuries in animals and humans. Research has AAEP to members on behalf of the authors. The University of concentrated on the mechanism of action of ESWT and efficacy Saskatchewan Research Ethics Board reviewed the survey and of treatment for both experimentally induced and naturally determined that ethics approval was not required. The survey occurring musculoskeletal diseases in rats, dogs, horses, and was available between April 25 and June 6, 2016. E-mail remind- humans (1–3). Types of ESWT generators, treatment protocols, ers were circulated 1 and 3 wk after release of the survey by the indications for use, and evidence and definition of efficacy vary AAEP. Respondents could choose to remain anonymous and in the scientific literature (1). Data regarding the use of ESWT could exit the survey at any time. A reward was not offered for in equine veterinary clinical practice are not available. participation. Frequency of ESWT use, machine type, conditions The objective of this survey was to characterize the use of treated, opinion of efficacy and tolerance, use of sedation, and ESWT among equine veterinary practitioners regarding: frequency practice demographics were evaluated. Demographic information of use, conditions treated, and clinical opinion of treatment included: type of practice, percentage of work that was equine, efficacy. A 21-question web-based survey (surveymonkey.com, complementary therapies offered, and types of horses worked on Portland, Oregon, USA) was initially pre-tested by 10 equine (grouped by discipline). Frequency of ESWT use was classified as daily, at least once per week, at least once per month, less than once per month, Department of Large Animal Clinical Sciences, Western College and never. The brands of ESWT machines used were elicited of Veterinary Medicine University of Saskatchewan, 52 Campus to determine which types of shock wave generators were being Drive, Saskatoon, Saskatchewan S7N 5B4. used. Responses were classified as focused, radial, or dual Address all correspondence to Dr. Angela MacKay; e-mail: (focused and radial) machines based on information freely [email protected] available from the manufacturers. Respondents were asked Use of this article is limited to a single copy for personal study. which 5 common conditions they treated with ESWT (desmitis, Anyone interested in obtaining reprints should contact the tendinitis, muscle pain, osteoarthritis, navicular syndrome) and CVMA office ([email protected]) for additional were provided with space for comments. Opinion of how well copies or permission to use this material elsewhere. equine patients tolerate application of ESWT to various body

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Table 1. Number and percent of responses to the possible Respondents were asked to identify the type of practice in choices from key survey questions regarding ESWT use and demographic information.a,b which they worked. Based on distribution, responses were cat- egorized into 4 distinct types of practice: general/ambulatory Number of equine practice, specialist/referral equine practice, racetrack/ BRIEF COMMUNICATION responses Variable explored Possible response # (%) sport horse practice, and mixed practice. Types of horses seen were divided by generic discipline, and respondents could select Frequency of ESWT use Daily 12 (8.3) (N = 144) At least once weekly 53 (36.8) all that applied. Reporting the percentage of work in the veteri- At least once per month 33 (22.9) nary practice that was on horses was recategorized into 2 groups: Less than once per month 28 (19.4) 100% equine work (equine-only), or all other responses (not Never 18 (12.5) equine-only). Type of ESWT used Focused 92 (73.6) All surveys that were received were reviewed for completion (N = 121) Radial 17 (13.6) Both or dual 6 (4.8) and errors. All available responses were included in the analysis. Unsure 10 (8.0) Numerical data were tested for normality using Shapiro-Wilks Common conditions treated Desmitis 118 (94.4) test for normality. Responses were summarized and percentages with ESWT Tendon injuries 96 (76.8) were calculated for all questions. Associations were assessed (N = 125) Muscle pain 79 (63.2) using Fisher’s exact test for binary outcome variables, and Respondents could select Osteoarthritis 64 (51.2) all that applied Navicular syndrome 34 (27.2) 95% confidence intervals (CI) were calculated for proportions. Predictors included amount of equine work and if complemen- Opinion of ESWT efficacy (N = 133) tary therapies, such as acupuncture, were offered by the practice. Ligament injuries Highly effective 77 (57.9) The outcome variable examined was frequency of ESWT use Somewhat effective 36 (27.1) recategorized into a binary variable based on the previously Ineffective 20 (15.0) described options: do not use ESWT (never, less than once Muscle pain Highly effective 62 (46.6) Somewhat effective 39 (29.3) per month) and use ESWT (daily, at least once per week, at Ineffective 32 (24.1) least once per month). Statistical analysis was performed using Tendon injuries Highly effective 51 (38.3) Stata version 14.2 (StataCorp LP, College Station, Texas, USA). Somewhat effective 44 (33.1) Significance was set at P , 0.05. Ineffective 38 (28.6) One-hundred-and-forty-four (144/7787) responses were col- Osteoarthritis Highly effective 27 (20.3) lected (1.8% response rate). Thirteen surveys were incomplete; Somewhat effective 43 (32.3) Ineffective 63 (47.4) available responses from incomplete surveys were included in the Navicular syndrome Highly effective 19 (14.3) analysis. The data were not normally distributed. Most respon- Somewhat effective 36 (27.0) dents indicated that their practice was equine-only (108/131; Ineffective 78 (58.7) 82.4%). Practice demographics are detailed in Table 1. English Practice type General/ambulatory 60 (45.8) performance horses were the most common type of horses (N = 131) equine practice seen by respondents (Table 1). Most respondents (92/131, Specialist/referral equine 22 (16.8) practice 70.2%) offered complementary therapies for their clients; only Racetrack/sport horse 40 (30.5) 39/131 (29.8%) respondents did not. Many respondents offered practice more than one type of complementary therapy. Mixed practice 9 (6.9) Frequency of ESWT use and type of machine used by Types of horses seen English performance 103 (78.6) respondents are listed in Table 1. Respondents who never used (N = 131) Companion/pleasure 86 (65.7) Respondents could select Western performance 77 (58.8) ESWT indicated that a lack of scientific evidence supporting all that applied Thoroughbred/Quarter 59 (45.0) its use and a lack of access to the technology were their primary Horse racing reasons. Multiple respondents commented that ESWT is now Rodeo 43 (32.8) Breeding 39 (29.8) available to lay people, which may result in use without veteri- Halter 33 (25.2) nary supervision and allow for the misuse and abuse of ESWT Standardbred racing 26 (19.9) in equine patients. Extracorporeal shock wave therapy was used a ESWT — extracorporeal shock wave therapy. more frequently if the practice was 100% equine [0.75 (95% b If not stated, respondents could only choose 1 option. CI: 0.66, 0.83) versus 0.52 (95% CI: 0.31, 0.73); P = 0.04] and if complementary therapies were also offered by the veterinarian [0.8 (95% CI: 0.71, 0.88) versus 0.49 (95% CI: 0.32, 0.65); regions was rated on a scale of 1 to 4, with 1 being intolerable P = 0.001]. and 4 being completely tolerable. Clinical opinion of the efficacy Respondents reported their use of ESWT for 5 common of ESWT as a single treatment option for various musculo- conditions (Table 1). Other indications for ESWT use reported skeletal conditions was rated on a scale of 1 to 5, with 1 being by respondents included wounds, proximal sesamoiditis, non- completely ineffective and 5 being highly effective. Based on a healing fractures, periostitis of the third metacarpal bone, sac- clustered response distribution, this scale was condensed into a roiliac pain, generalized back pain, sclerosis of the third carpal 3 point descriptive scale: ineffective (ratings 1 and 2), somewhat bone, cervical vertebral pain, injury to the second and fourth effective (rating 3), and highly effective (ratings 4 and 5). metacarpal or tarsal bones, and digital cushion pain. Most

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­respondents (110/118, 93.2%) indicated that they prefer to highlights the need to provide defined, concrete, endpoints in use ESWT in conjunction with other medically appropriate both surveys and equine scientific literature. therapies, depending on the injury. Sedation was always used to The low survey response rate (1.8%) and undetermined administer ESWT to horses by 50% (59/118) of respondents. possible biases were important limitations of this study. A Of the 50% that did not always use sedation, 16/59 (27%) rarely previous survey of a similar population elicited 831 responses, or never used sedation to administer ESWT. Most respondents or a 7.6% response rate (14). The pool of respondents was indicated that equine patients were moderately to completely tol- limited to those with access to e-mail and Internet. In addition, erable of ESWT, regardless of the body region (data not shown). voluntary surveys can produce non-response bias, which poses Extracorporeal shock wave therapy was viewed as a highly a significant risk to the accuracy of the results, given the pos- effective treatment option for ligament injuries and ineffective sibility that the responses of the respondents could differ from for the treatment of navicular syndrome by most respondents. those that would be provided by non-respondents (15). In this Opinion on effectiveness for muscle pain, osteoarthritis, and survey, ESWT users may have been more likely to voluntarily

COMMUNICATIONBRÈVE treatment of tendon injuries was mixed (Table 1). More than participate. However, based on demographic responses, our one respondent commented that they were unsure of the true population was similar to that of a previous survey investigating efficacy of ESWT for healing of musculoskeletal injuries, but intra-articular injection practices of equine veterinarians. Ferris the clinically observed reduction in pain was a useful benefit. et al (14) reported that 80.3% of their respondents worked in a Descriptive information regarding ESWT use among equine practice that saw 100% equine cases. This is similar to our result practitioners was previously not available. This survey outlines of 82.4%, indicating that our population of respondents may the clinical use of ESWT in the equine veterinary field. There represent the entire population sampled. However, the AAEP is conflicting evidence supporting the use of ESWT in equine published demographic information for 2016 stated that 45.4% veterinary practice. Multiple studies have shown that treatment of their 7787 members worked in a practice that saw 100% with ESWT alleviated pain and lameness in horses while being equine cases (16), suggesting that non-response bias could be used to treat different diseases (4–6). Experimental studies have present. It is possible that non-response bias existed both due to demonstrated a potential benefit of ESWT for improving the the conflicting scientific evidence supporting ESWT, and due healing process of suspensory desmitis (7,8) and wounds (9). to the interests of equine-only practitioners. Both the subject of However, other studies have failed to show a positive effect on the current survey and the previous survey of the same popula- disease modulation (5,10) or analgesia (11), and some groups tion were more likely to be of interest to veterinarians who were have even demonstrated that ESWT can damage normal tis- equine-only practitioners. sues in experimental situations (12). It has been shown that the The current survey attempted to gather a large volume of effects on cells are dose-dependent, with lower energy doses information regarding ESWT use and had a small number stimulating growth factor production and high energy doses of respondents. Further work on this topic should attempt causing cell damage (13). Despite this information, optimal to improve response rate and decrease potential non-response dosage ranges for specific injuries in horses have not been estab- bias. Methods to achieve this include mailing out surveys, lished, and it is not known if treatment with ESWT improves conducting phone surveys, offering a small reward for survey final outcomes for musculoskeletal injuries compared to negative completion, decreasing the length of the survey, increasing the controls or other available treatments (3). Difficulties exist in duration that the survey is available, or establishing the statisti- interpretation of the current literature and are beyond the scope cal difference between responses of early and late respondents of this paper, in part because the studies are widely varied in to estimate the amount of sampling bias (17). Information that design, use of appropriate blinding and negative controls, and would improve the available body of literature regarding ESWT sample size. include therapy protocols used for defined injuries (includ- The current survey established that equine veterinary practi- ing frequency, dose, and duration of therapy), type of ESWT tioners have a positive view regarding the efficacy of ESWT for generator used, and specific outcome measures used to indicate treating ligament injuries in horses. However, respondents were treatment success. Expanding the survey population to a wider simply asked to provide a rating; a definition of efficacy was not range of veterinarians may improve response rate, and expand- provided or allowed to be stated by the respondent. Efficacy ing the survey topic to include other species may result in a could have been interpreted in multiple ways. For example, more accurate assessment of ESWT use by the entire veterinary one practitioner could have deemed ESWT to be efficacious population. in treating osteoarthritis if the patient’s lameness was alleviated In conclusion, ESWT was commonly used by the equine with no change in radiographic evidence of disease. Another practitioners who participated in this survey. The therapy was practitioner could conclude that ESWT was efficacious in treat- used to treat a diverse range of injuries in the horse. Respondents ing a tendinopathy based on improvement in ultrasonographic had variable opinions of the efficacy of ESWT, depending on appearance, regardless of the degree of lameness improvement. the condition being treated. Practitioners in equine-only prac- This survey was a tool to examine practitioner use and opinion tice were more likely to use ESWT than those who worked in of ESWT and provides a starting point for more precise inves- mixed practice. Non-response bias likely affected the results of tigations. However, this lack of a definition of efficacy as used this survey. Further work should include efforts to reduce non- in this survey may not have allowed for an accurate evaluation response bias. Future surveys of practitioners regarding ESWT of respondents’ opinions; it simply provided an estimate. This should focus on the clinical use of the technology.

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Acknowledgments histologic appearance of collagenase-induced equine forelimb suspensory ligament desmitis. Ultrasound Med Biol 2004;30:461–467. The authors thank Dr. Sheryl Gow for her assistance with sur- 9. Morgan DD, Mcclure S, Yaeger MJ, Schumacher J, Evans RB. Effects vey design and data management, and Dr. Sarah Parker for her of extracorporeal shock wave therapy on wounds of the distal portion

of the limbs in horses. J Am Vet Med Assoc 2009;234:1154–1161. BRIEF COMMUNICATION assistance with statistical analysis. CVJ 10. Waguespack RW, Burba DJ, Hubert JD, et al. Effects of extracorporeal shock wave therapy on desmitis of the accessory ligament of the deep References digital flexor tendon in the horse. Vet Surg 2011;40:450–456. . 1 Chung B, Wiley JP. Extracorporeal shockwave therapy: A review. Sport 11. Brown KE, Nickels FA, Caron JP, Mullineaux DR, Clayton HM. Med 2002;32:851–865. Investigation of the immediate analgesic effects of extracorporeal shock 2. Leeman JJ, Shaw KK, Mison MB, Perry JA, Carr A, Shultz R. Extra­ wave therapy for treatment of navicular disease in horses. Vet Surg 2005; corporeal shockwave therapy and therapeutic exercise for supraspinatus 34:554–558. and biceps tendinopathies in 29 dogs. Vet Rec 2016;179:385. 12. Bosch G, de Mos M, van Binsbergen R V, van Schie HTM, van de Lest 3. Yocom AF, Bass LD. Review of the application and efficacy of extra- CHA, van Weeren PR. The effect of focused extracorporeal shock wave corporeal shockwave therapy in equine tendon and ligament injuries. therapy on collagen matrix and gene expression in normal tendons and Equine Vet Educ 2019;31:271–277. ligaments. Equine Vet J 2009;41:335–341. 4. Dahlberg JA, McClure SR, Evans RB, Reinertson EL. Force platform 13. Zhang X, Yan X, Wang C, Tang T, Chai Y. The dose-effect relation- evaluation of lameness severity following extracorporeal shock wave ship in extracorporeal shock wave therapy: The optimal parameter for therapy in horses with unilateral forelimb lameness. J Am Vet Med Assoc extracorporeal shock wave therapy. J Surg Res 2014;186:484–492. 2006;229:100–103. 14. Ferris DJ, Frisbie DD, Mcilwraith CW, Kawcak CE. Current joint 5. Frisbie DD, Kawcak CE, McIlwraith CW. Evaluation of the effect of therapy usage in equine practice: A survey of veterinarians 2009. Equine extracorporeal shock wave treatment on experimentally induced osteoar- Vet J 2011;43:530–535. thritis in middle carpal joints of horses. Am J Vet Res 2009;70:449–454. 15. Dargatz DA, Hill GW. Analysis of Survey Data. Prev Vet Med 1996;28: 6. Crowe OM, Dyson SJ, Wright IM, Schramme MC, Smith RKW. 225–237. Treatment of chronic or recurrent proximal suspensory desmitis using 16. Chopra A. Ideas Into Action. AAEP Annual Report 2016. Vol. 59, radial pressure wave therapy in the horse. Equine Vet J 2004;36:313–316. AAEP. 2016. Available from: https://issuu.com/americanassocequine- 7. Caminoto EH, Alves ALG, Amorim RL, Thomassian A, Hussni CA, practioners/docs/2016ar-flpbk?e=5951787/47764187 Last accessed Nicoletti JLM. Ultrastructural and immunocytochemical evaluation of July 2, 2020. the effects of extracorporeal shock wave treatment in the hind limbs of 17. Sax LJ, Gilmartin SK, Bryant AN. Assessing response rate and non­ horses with experimentally induced suspensory ligament desmitis. Am reponse bias in web and paper surveys. Res High Educ 2003;44:409–432. J Vet Res 2005;66:892–896. 8. McClure SR, VanSickle D, Evans R, Reinertson EL, Moran L. The effects of extracorporeal shock-wave therapy on the ultrasonographic and

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CVJ / VOL 61 / SEPTEMBER 2020 993 FOR PERSONAL USE ONLY Student Paper Communication étudiante

Sertoli cell tumor/mixed germ cell-stromal cell tumor as separate neoplasms in a bilaterally cryptorchid dog

Teagan L. DeForge

Abstract — An 11-year-old miniature poodle dog was presented with bilateral flank alopecia, gynecomastia, severe thrombocytopenia, and preputial edema. Based on characteristic clinical and hematological findings of hyperestrogenism and the presence of a caudal abdominal mass, a Sertoli cell tumor (SCT) was diagnosed. After a platelet concentrate transfusion, the SCT was surgically removed in addition to an atrophied contralateral testicle containing a mixed germ cell-stromal cell tumor. Recovery was uneventful. This combination of different neoplasms in separate testicles has yet to be documented. Key clinical message: This case of a SCT/mixed germ cell-stromal cell tumor combination in a bilaterally abdominal cryptorchid dog highlights common clinical signs associated with hyperestrogenism and the management of estrogen-induced myelotoxicity causing severe thrombocytopenia.

Résumé — Tumeur à cellules de Sertoli/tumeur mixte à cellules germinales-cellules stromales comme néoplasmes séparés chez un chien cryptorchide bilatéral. Un caniche miniature âgé de 11 ans fut présenté avec alopécie bilatérale des flancs, gynécomastie, thrombocytopénie sévère et œdème préputial. Sur la base des trouvailles cliniques et hématologiques caractéristiques d’hyperœstrogénisme et la présence d’une masse abdominale caudale, une tumeur à cellules de Sertoli (SCT) fut diagnostiquée. À la suite d’une transfusion d’un concentré de plaquettes, la SCT fut retirée chirurgicalement en plus d’un testicule controlatéral atrophié contenant une tumeur mixte à cellules germinales-cellules stromales. La guérison s’est passée sans problème. Cette combinaison de néoplasmes différents dans des testicules séparés n’avait jamais été documentée. Message clinique clé : Ce cas de combinaison de SCT/tumeur mixte cellules germinales-cellules stromales chez un chien cryptorchide abdominal bilatéral met en lumière les signes cliniques fréquents associés avec l’hyperœstrogénisme et la gestion de myélotoxicité induite par les œstrogènes causant une thrombocytopénie sévère. (Traduit par Dr Serge Messier) Can Vet J 2020;61:994–996

n 11-year-old miniature poodle dog, which was reported Abdominal radiography confirmed the presence of a soft tis- A by the rescue organization to be neutered, was presented sue mass in the caudal abdomen, near the cranial margin of the because of bilaterally symmetric flank alopecia, gynecomastia, bladder (Figure 1). No thoracic metastasis was detected on tho- and edematous preputial enlargement of unknown duration. racic radiographs. Hematological analysis revealed a mild, non- Upon physical examination, the dog was in poor body condition regenerative, normocytic, hypochromic anemia, and a marked (BCS 1.5/5), had diffuse brown, flaky seborrheic dermatitis, an thrombocytopenia (Table 1). The leukogram was normal. There enlarged soft prostate, and no petechiae or ecchymosis. Upon was a mild hyperproteinemia with a mild hypoalbuminemia and palpation, a firm, smooth, freely movable mass measuring hyperglobulinemia [total protein: 78 g/L, reference range (RR): approximately 7 3 7 cm was detected in the caudal abdomen. 50 to 74 g/L; albumin: 22 g/L, RR: 27 to 44 g/L; globulin: 56 g/L, RR: 16 to 36 g/L]. Urinalysis revealed a marked pyuria Western College of Veterinary Medicine, 52 Campus Drive, and moderate hematuria [WBC: . 100/high power field (hpf); Saskatoon, Saskatchewan S7N 5B4. RBC: 20 to 30/hpf] but no bacteria were observed micro- Address all correspondence to Teagan L. DeForge; e-mail: scopically or cultured. The dog was treated with pradofloxacin [email protected] (Veraflox; Bayer Animal Health, Mississauga, Ontario), 15 mg, Use of this article is limited to a single copy for personal study. PO, q24h, for 10 d. Based on these findings, a Sertoli cell tumor Anyone interested in obtaining reprints should contact the was suspected; however, surgery was delayed due to the severe CVMA office ([email protected]) for additional thrombocytopenia. Further blood analysis was completed the copies or permission to use this material elsewhere. following day. The anemia was relatively unchanged, there was

994 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY now a mild leukocytosis and neutrophilia, and the platelets were still markedly decreased (Table 1). The prothrombin time (PT) and partial thromboplastin time (PTT) were within normal ranges (PT: 6.9 s; PTT: 15.6 s). Blood typing and crossmatching were completed to prepare a blood transfusion in the event of STUDENT PAPER STUDENT uncontrolled hemorrhage during the surgical procedure. Due to the severe thrombocytopenia and risk for spontaneous hemor- rhage during surgery, a concentrated platelet transfusion was administered the day before surgery and a follow-up complete blood (cell) count (CBC) the day of surgery showed the platelets were now only moderately decreased (Table 1). The dog was premedicated with midazolam (Midazolam; Sandoz, Boucherville, Quebec), 0.3 mg/kg body weight (BW), IV, and hydromorphone (HYDROmorphone HP 10; Figure 1. Abdominal radiograph of an 11-year-old miniature Sandoz), 0.1 mg/kg BW, IV, induced with IV alfaxolone poodle dog showing the cryptorchidic enlarged left testicle (Alfaxan; Multidose; Jurox, North Kansas City, Missouri, USA), (arrows). 3 mg/kg BW, IV, and maintained on isoflurane. The abdomen was clipped and aseptically prepared. A 7-cm midline inci- sion was made into the abdomen. The abdomen was explored having an increased risk for cryptorchidism (5). Cryptorchidism and an enlarged, vascular left abdominal testicle measuring was found to be a significant risk factor for the development 5 cm 3 4 cm was visualized. Using a 3-hemostat clamp tech- of both MGCSCTs and SCTs (4). Cryptorchid testes are nique with 2 Miller’s knots as ligation, the spermatic cord was approximately 13 to 14 times more likely to develop a neoplasm transected. Upon further exploration, an atrophied right testicle compared with scrotal testes, suggesting that cryptorchidism measuring 1 cm 3 1 cm was also identified within the abdo- contributes to testicular tumorigenesis (4,6). men and the spermatic cord was transected in a similar manner. This case is unique in that both retained testes had separate The incision was closed in 3 layers with 2-0 PDS (Ethicon, and different neoplasms. While there have been previous reports Somerville, New Jersey, USA) (rectus sheath) and 3-0 PDS of SCT/interstitial and SCT/seminoma combinations (26% and (subcutaneous and skin). 21% of reported combinations, respectively), the author could On histopathologic examination, the larger left testicle was not find any reports of an SCT/MGCSCT combination (3,7). diagnosed as containing a Sertoli cell tumor. The neoplastic This case also highlights common characteristic presenting cells showed moderate anisocytosis and anisokaryosis, and an signs associated with a SCT. These include an enlarged pros- increased mitotic rate (23 per 10 hpf). The smaller right testicle tate, non-pruritic symmetrical alopecia, thinning of the skin, was diagnosed as containing a mixed germ cell-sex cord stro- hyperpigmentation, gynecomastia, and a pendulous edematous mal tumor with moderate anisocytosis and anisokaryosis and prepuce (7,8). In affected male dogs, 25% to 50% with a SCT frequent mitotic figures. experience this feminization syndrome due to estrogens secreted The dog was rechecked daily for 3 d after surgery for evidence by the tumor (8). Feminization syndrome appears more com- of spontaneous hemorrhage. No petechiae or ecchymosis were mon for abdominal SCTs (8). observed. A repeat CBC was performed at 3 and 7 d after sur- Along with feminization syndrome, the estrogens secreted gery and showed the beginning of recovery in the thrombogram by a SCT can also affect the bone marrow (9). Typical hemato- and hemogram. Two and a half months later, all values had logical changes associated with estrogen-induced myelotoxicity returned to normal (Table 1). The preputial swelling, alopecia, include a non-regenerative anemia, thrombocytopenia, and and gynecomastia gradually resolved over these months. No leukocytosis followed by a leukopenia. Prognosis is guarded further clinical problems have been reported. when all elements are present (9). The mechanism of estrogen- induced myelotoxicity appears to involve the production of Discussion myelopoiesis-inhibitory factor by thymic stromal cells in the Primary testicular neoplasms are the most common testicular presence of high estrogen levels. However, the exact mechanism tumors in dogs (1). Testicular tumors are histologically classified is unknown (10,11). into sex cord-stromal tumors [Sertoli cell tumors (SCTs) and While the anemia and leukocytosis in this dog were mild, Leydig/interstitial cell tumors], germ cell tumors (seminomas), the thrombocytopenia was severe. Both pre-transfusion plate- and mixed germ cell-sex cord stromal tumors (MGCSCTs) (1,2). let counts were below the range in which spontaneous clinical Multiple retrospective studies have found that MGCSCTs and hemorrhage can occur (12). A platelet concentrate transfusion SCTs are the 2 least prevalent testicular tumors while interstitial was administered as it is thought to be useful for prophylactic (Leydig) cell tumors and seminomas are most common (3,4). therapy when the thrombocytopenia is due to decreased platelet Although this dog was presented as neutered, being a rescued production (12). animal, there was no documentation to confirm this claim. Only Another interesting feature of this case was the increased 15% of cryptorchid dogs have bilaterally retained abdominal mitotic activity seen on histology, suggesting an increased pos- testicles and miniature poodles have previously been identified as sibility for malignancy. Typically, mitotic figures are rare in

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Table 1. Hematological data before and after surgery. 7 days 5 days 3 days 7 days 2.5 months Reference before before Day of after after after Parameter range surgery surgery surgerya surgery surgery surgery Platelets (3109/L) 143 to 448 13 34 58 30 63 314 RBC (31012/L) 5.4 to 8.7 5.1 5.0 4.7 5.1 5.3 7.9 Hematocrit (L/L) 0.38 to 0.57 0.37 0.34 0.34 0.37 0.40 0.56 Hemoglobin (g/L) 134 to 207 116 117 114 125 126 172 Reticulocytes (103/ mL) 10 to 110 15.3 15.0 18.8 15.6 15.6 36.3 WBC (3109) 4.9 to 17.6 11.7 18.2 10.5 7.8 7.0 5.1 Neutrophils (3109) 2.9 to 12.7 9.5 15.4 7.7 5.6 5.0 2.56

a Platelet rich transfusion the previous day.

SCTs, averaging 0 to 1 per hpf, versus the 23 per 10 hpf reported 4. Liao AT, Chu PY, Yeh LS, Lin CT, Liu CH. A 12-year retrospective COMMUNICATIONÉTUDIANTE here (3). Only about 10% to 20% of SCTs are malignant with study of canine testicular tumors. J Vet Med Sci 2009;71:919–923. 5. Yates D, Hayes G, Heffernan M, Beynon R. Incidence of cryptorchidism metastasis occurring most commonly to the inguinal, iliac, and in dogs and cats. Vet Rec 2003;152:502–504. sublumbar lymph nodes, as well as lungs, liver, and spleen (13). 6. O’Keefe DA. Tumors of the genital system and mammary glands. In: Thoracic radiographs showed no sign of metastasis in this dog Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 4th ed. Philadelphia, Pennsylvania: WB Saunders, 1994:1699–1700. at the time of surgery; however, lymph node aspirates were not 7. Post K, Kilborn SH. Canine sertoli cell tumor: A medical records search taken. and literature review. Can Vet J 1987;28:427–431. 8. Scott DW, Miller WH, Griffin CE. Endocrine and metabolic diseases. Acknowledgments In: Scott DW, Miller WH, Griffin CE, eds. Muller and Kirk’s Small Animal Dermatology. 5th ed. Philadelphia, Pennsylvania: Saunders, I am deeply grateful to Dr. Bruce Wobeser for his exceptional 1995:682–686. support and assistance while writing this case report. I also wish 9. Sontas HB, Dokuzeylu B, Turna O, Ekici H. Estrogen-induced myelo- toxicity in dogs: A review. Can Vet J 2009;50:1054–1058. to thank Dr. Vanessa Scanlan and Dr. Suzanne Misiaszek for 10. Farris GM, Benjamin SA. Inhibition of myelopoiesis by conditioned their clinical mentorship throughout this case and many others. medium from cultured canine thymic cells exposed to estrogen. Am J Vet Res 1993;54:1366–1373. CVJ 11. Sontas HB, Dokuzeylu B, Turna O, Ekici H. Estrogen-induced myelo- toxicity in dogs: A review. Can Vet J 2009;50:1054–1058. References 12. Abrams-Ogg AC. Triggers for prophylactic use of platelet transfusions 1. Nødtvedt A, Gamlem H, Gunnes G, Grotmol T, Inderbø A, Moe L. and optimal platelet dosing in thrombocytopenic dogs and cats. Vet Breed differences in the proportional morbidity of testicular tumours Clin North Am Small Anim Pract 2003;33:1401–1418. and distribution of histopathologic types in a population-based canine 13. Feldman EC, Nelson RW. Canine male reproduction. In: Feldman, EC, cancer registry. Vet Comp Oncol 2011;9:45–54. Nelson RW, eds. Canine and Feline Endocrinology and Reproduction. 2. D’Angelo AR, Vita S, Marruchella G, Di Francesco G. Canine testicular Philadelphia, Pennsylvania: WB Saunders, 1987:702–705. tumours: A retrospective investigation in Abruzoo and Molise, Italy. Vet Ital 2012;48:329–339. 3. Grieco V, Riccardi E, Greppi GF, Teruzzi F, Iermanò V, Finazzi M. Canine testicular tumours: A study on 232 dogs. J Comp Pathol 2008; 138:86–89.

996 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY Special Report Rapport spécial

Comparing the prevalence of tetrahydrocannabinol (THC) toxicities in dogs before and after legalization of cannabis in Canada

Molly Joffe, Daniel Joffe

Introduction with typical signs associated with such a toxicity, but the owner did not see the pet ingest the drug, or denied they had access n October 17, 2018, the Canadian government legalized to a THC-containing substance. Confirmed cases were those the recreational use of cannabis, becoming the second O in which the owner was able and willing to tell veterinarians country globally to do so (1). Statistics Canada conducted that they or someone else had seen the dog ingest cannabis in a National Cannabis Survey (NCS) in November 2019, to some form. identify post-legalization changes in cannabis use in Canadian residents over 15 y of age (2). The NCS found that the num- The date of presentation at the hospital was recorded for both ber of Canadians using recreational cannabis after legalization testing periods, as well as dog breed and age. With consent from had increased from 4.5 million reported users before legaliza- the owner, further demographics were recorded during the post- tion (2018) to 5.1 million (1). These 0.6 million new users legalization investigation, yielding information regarding the age represent 1.9% of the Canadian population (1). and gender of the clients. When known, the type of cannabis While cannabis is generally touted as a safe product when product (edible or marijuana leaf) was recorded. It should be used appropriately, it may pose a health risk to pets since canna- noted that during the post-legalization period, the consumption binoids are metabolized differently in each species (3). Previous of “edibles” was not yet legal. studies have identified that dogs are more sensitive than humans Data were entered into a number spreadsheet, which was to tetrahydrocannabinol (THC), the psychoactive compound converted to a .csv file to enable statistical analysis using the in cannabis (4,5). Studies comparing the excreted metabolites ‘R’ statistics software (R Foundation for Statistical Computing, of cannabis in urine samples taken from various species have Vienna, Austria. https://www.R-project.org). As all data were provided strong evidence for a different mechanism of cannabis count data, the log-likelihood ratio test (G-test) was used to catabolism in dogs than in humans (5). There is thought to be a perform the statistical analysis. Significance was set at P , 0.05. link between metabolic route and toxicity, which likely accounts Results for the higher sensitivity of dogs to THC (6). There is also evi- dence that the canine brain has a larger number of cannabinoid There was no significant difference in the total number of dogs receptors than the human brain, which may also play a role in presenting with signs of THC toxicity in a 12-month period the increased sensitivity of dogs to THC (7). following cannabis legalization compared with the number The purpose of this study was to investigate whether there in a 12-month period before the legislation (G = 0.21632, was a significant increase in the number of dogs presenting at P = 0.6419, Figure 1). There was also no evidence of a cor- a large referral hospital (VCA Canada Calgary Animal Referral relation between the legality of cannabis and whether or not and Emergency Centre) with suspected and confirmed cases presented toxicities were classified as “confirmed” or “suspected” of cannabis toxicity following the legalization of cannabis in (G = 1.8181, P = 0.1775, Figure 1). Canada. Twelve months of data obtained 3 y before cannabis When analyzing the prevalence of toxicities with respect legalization were compared to 12 mo of data collected immedi- to age, dogs were grouped into 4 age categories. These were ately following cannabis legalization. , 1 y of age, 1 to 4.9 y, 5.0 to 8.9 y, and 9 and older. Of these groups, dogs , 1 y of age (n = 15) were classified as puppies, Materials and methods and all dogs . 1 y were considered adults (n = 20). Puppies were For each period of investigation, suspected and confirmed disproportionately represented in the toxicities, significantly cannabis toxicities were recorded by emergency doctors at the exceeding the predicted number of cases if dogs of all age classes referral and emergency hospital. Each case was classified as either were equally likely to be presented with THC toxicity symptoms suspected cannabis toxicity, meaning the dog was presented (G = 5.2925, P = 0.02142, Figure 2).

VCA Canada Calgary Animal Referral and Emergency Centre, 7140 12 Street SE, Calgary, Alberta T2H 2Y4. Address all correspondence to Dr. Daniel Joffe; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

CVJ / VOL 61 / SEPTEMBER 2020 997 FOR PERSONAL USE ONLY

Cases by age Puppies (*) Total cases 40 Suspected Confirmed

30 , 1 year

20 Number of cases

RAPPORT SPÉCIAL 1–4.9 years 91 years 10 Adults (*) 5–8.9 years

0 Pre-legalization Post-legalization Study period

Figure 1. Comparison of number of cases in the 12-month Figure 2. Distribution of cases in the post-legalization study period pre-legalization (n = 39) with the number of cases in among puppies (black, n = 15) and adults (gray, n = 20). The the 12-month period post-legalization (n = 35). The cases adult group was further subdivided into age groups of 1 to pre-legalization consisted of 25 suspected and 14 confirmed 4.9 y (n = 8), 5 to 8.9 y (n = 6), and 91 y (n = 5). There was a cases; the cases post-legalization consisted of 17 confirmed significant difference in prevalence between puppies and adults. and 18 suspected cases.

In homes with a single owner, there was no significant rela- have been an increased number of cases of canine THC toxicity tionship between owner gender and prevalence of THC toxicity during that same period (9). This is likely due to 1 of 2 factors. in their dog (G = 1.0957, P = 0.2952). First, owners may be reluctant to admit to cannabis use. Owner age, breed of dog, and type of drug were recorded, According to the 2019 Canadian Cannabis Survey, 23% of but due to limitations of the data collection chart, and occa- survey respondents reported that despite the legalization of can- sional inconsistent collection of data, these results could not nabis, they would not disclose cannabis usage (10). Additionally, be analyzed. despite the legalization of cannabis, not all users are purchasing it through legal means. The 2019 Canadian Cannabis Survey Discussion reported just 52% of cannabis users were purchasing the drug Our findings revealed no significant change in the number of from a legal source (10). Those who purchased cannabis from dogs presenting with signs of toxicity associated with cannabis an illegal source may be hesitant to disclose usage due to fear consumption 1 y after legalization compared with the number of legal repercussions. It is crucial to keep in mind that medical from a similar survey performed 3 y before legalization. This records and information collected by a veterinarian during a result is in contrast to the reported 0.6 million person increase consultation with a client are confidential (11). Veterinarians in cannabis usage among the Canadian human population in cannot alert authorities of the suspected use of illicit drugs the same time frame (1). However, in the United States, in states unless they suspect they were purposefully used in an attempt that have legalized recreational cannabis, an increase in calls to to harm an animal and constitute an animal welfare concern. the Pet Poison Helpline has been observed (7). Furthermore, A second possibility for the findings in this study is the there was no change in the number of confirmed THC toxicities misidentification of the toxic substance involved. Signs of (cases in which the owner could confirm the dog had consumed THC toxicity in dogs are relatively general in presentation and a THC-containing product) compared to those suspected may be wrongly attributed to another type of toxic product. (dogs presenting with classic symptoms of THC toxicity in Dogs that have ingested ethanol-containing substances, such as which ingestion of a THC-containing product could not be alcoholic beverages, exhibit central nervous system depression confirmed by the owner). Suspected cases were not confirmed similar to that observed in the case of THC toxicity (7,12,13). using drug tests. It is possible to test for THC in canine urine, Ataxia, lethargy, and vomiting observed secondary to THC but the extensive amount of time between testing the urine and consumption can also be seen in cases of grape, ethanol, and receiving results makes it an impractical option (8). Although NSAID ingestion (7,12,13). Ataxia and cardiac arrhythmias are results are more rapid, human drug tests are often not accurate characteristic of both chocolate and THC toxicity (7,13). One for testing in dogs (8). distinguishing feature of THC toxicity is urinary incontinence, Given that 320 000 more Canadians reported trying can- and THC toxicity would be a more likely differential diagnosis nabis for the first time between January 1 and March 31 of in a dog that is dribbling urine and has the other symptoms (7). 2019 (post-legalization) than in the same period a year earlier Despite data from the 2019 Canadian Cannabis Survey (pre-legalization), it seems counterintuitive that there would not indicating that 8% more males than females reported use of

998 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY cannabis products (10), the results of this study did not find a References significant difference in the number of THC toxicities in homes . 1 Rotermann M. What has changed since cannabis was legalized? with female versus male owners. [monograph on the Internet]. Ottawa, Canada: Her Majesty the Puppies (classified as dogs , 1 y of age) were significantly Queen in Right of Canada as represented by the Minister of Industry, c2020. Available from: https://www150.statcan.gc.ca/n1/pub/82- more likely than adult dogs to present with signs of marijuana 003-x/2020002/article/00002-eng.htm Last accessed July 13, 2020. REPORT SPECIAL toxicity. According to the literature, dogs are most commonly 2. National Cannabis Survey-metadata [database on the Internet]. Ottawa, exposed to THC via the ingestion of homemade or commercial Canada: Statistics Canada Open License. Available from: http://www23. statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5262 Last edibles, with these cases comprising 66% of marijuana exposures accessed July 7, 2020. reported to the Pet Poison Helpline (7). Puppies typically use 3. Vaughn D, Kulpa J, Paulionis L. Preliminary investigation of the their mouths to explore and tend to eat flavored or malodor- safety of escalating cannabinoid doses in healthy dogs. Front Vet Sci 2020;7:51. ous substances, making them more susceptible to ingesting 4. Cavanagh K, Kyes J. Veterinarians caution: Medical cannabis exposure THC than adult dogs (14). The importance of keeping THC- in pets [monograph on the Internet]. Ottawa, Canada. Canadian containing products away from pets cannot be overstated. The Veterinary Medical Association, c2020. Available from: https://www. canadianveterinarians.net/documents/veterinarians-caution-medical- literature cites the ingestion of plant material as the second-most marijuana-exposure-in-pets Last accessed July 7, 2020. common route of THC exposure (7). Puppies are more likely 5. Harvey DJ, Samara E, Mechoulam R. Comparative metabolism than adult dogs to explore their surroundings by taste, leaving of cannabidiol in dog, rat and man. Pharmacol Biochem Behav 1991;40:523–532. them vulnerable to accidental consumption of the leaves of the 6. Sullivan HR, Hanasono GK, Miller WM, Wood PG. Species specific- Cannabis sativa plant (14). Ingestion of this toxic substance can ity in the metabolism of nabilone. Relationship between toxicity and be prevented by home growers keeping their C. sativa out of metabolic routes. Xenobiotica 1987;17:458–468. 7. Brutlag A, Hommerding H. Toxicology of marijuana, synthetic can- reach of pets and keeping a close eye on dogs during walks to nabinoids, and cannabidiol in dogs and cats. Vet Clin North Am Small try and ensure that they are not consuming suspicious materi- Anim Pract 2018;48:1087–1102. als. These measures should be considered to mitigate the risk 8. Gollakner R, Buzhardt L. Cannabis (Marijuana) Intoxication in Cats and Dogs. [monograph on the Internet]. Los Angeles, United States: of accidental THC exposure in both puppies and adult dogs. LifeLearn Inc., c2018. Available from: https://vcahospitals.com/know- This study is limited by results coming from only 1 veteri- your-pet/marijuana-intoxication-in-dogs-and-cats Last accessed July 7, nary hospital in Calgary, Alberta. As such, it is possible that the 2020. 9. Zafar A. First-time cannabis use up after legalization, StatsCan reports. results do not apply to the general population. Further research [monograph on the Internet]. Toronto, Canada: CBC/Radio-Canada, and data collection from numerous animal hospitals across c2020. Available from: https://www.cbc.ca/news/health/cannabis-use- Canada would be required to ensure the results and implications statistics-canada-1.5121125 Last accessed July 7, 2020. 10. Canadian Cannabis Survey 2019. [database on the Internet]. Ottawa, of the study are more widely applicable. Another limitation of Canada: Statistics Canada Open License. Available from: https://www. the study is that the authors relied on busy emergency doctors to canada.ca/en/health-canada/services/publications/drugs-health-products/ document the toxicities. It is quite conceivable that some cases canadian-cannabis-survey-2019-summary.html#s1 Last accessed July 7, 2020. were missed due to a lack of documentation. As the same data 11. Canadian Veterinary Medical Association [homepage on the Internet] collection method was used in the toxicity study performed 3 y c2020 Principles of Veterinary Medical Ethics of the CVMA [updated before the present study, any “missed cases” could be expected 2016]. Available from: https://www.canadianveterinarians.net/ documents/principles-of-veterinary-medical-ethics-of-the-cvma Last to occur at similar frequencies. accessed July 7, 2020. 12. Khan SA, McLean MK. Toxicology of frequently encountered nonste- Acknowledgments roidal anti-inflammatory drugs in dogs and cats. Vet Clin North Am Small Anim Pract 2012;42:289–306. The authors acknowledge Brett Joffe for allowing them to use 13. Cortinovis C, Caloni F. Household food items toxic to dogs and cats. data he collected as part of a 2015 Calgary Youth Science Fair Front Vet Sci 2016;3:26. project. They also acknowledge the emergency team at the VCA 14. The Spruce Pets [homepage on the Internet] c2017 How to Stop Your Puppy From Eating Everything [updated 2019]. Available from: https:// Canada Calgary Animal Referral and Emergency Centre for their www.thesprucepets.com/why-your-puppy-eats-everything-2804589 Last recording of THC toxicity data for this study. accessed July 7, 2020.

CVJ / VOL 61 / SEPTEMBER 2020 999 PRELIMINARY PROGRAM CONFERENCE VETERINARY CANWEST FOOD ANIMAL EQUINE COMPANION ANIMAL www.canwestconference.ca Speakers: onlineat Soundness andRuminants. Antimicrobial Resistance,Breeding Pharmacology, PracticeManagement, Emerging Diseases,Pathology, This year’stopicswillinclude: Lameness, Dr. SherryJohnson Radiology, Dr. SarahPuchalski Anesthesia andanalgesia(tentative) Respiratory Medicine,Dr. JuliaMontgomery Nephrology andUrinaryTract Disease, Gastroenterology, Dr. KatieTolbert Neurology, Dr. LeahCohn Dr. CatherineLangston 2020 OCTOBER 17–20 REGISTRATION NOW OPEN. VISIT: ATCE OPPORTUNITIES, RATE”. AN APPEALING “VIRTUAL THE 2020PROGRAM WILLPROVIDE THESAMEGREAT OFYOUR HOME! FROM THECOMFORT CANWEST WILLBEHOSTED VIRTUALLY THISYEAR. Clinical Education,Communication andPracticeManagementSkills… FOR

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FOR PERSONAL USE ONLY Veterinary Dermatology Dermatologie vétérinaire

Can equine urticaria be cured?

Frédéric Sauvé

Introduction administered necessitate stopping the horse’s activities (such as competitions, shows, training, riding), or cause adverse effects. quine veterinary practitioners and horse owners are familiar Finding an easy way to manage hives in horses could allevi- with hives as common skin eruptions in horses. Although E ate frustrations for both veterinarian and owner, and improve urticaria is reported in other species, it is more frequently the quality of life of the animal. The question is: can we cure reported in horses (1). Urticarial eruptions are not life threat- urticaria in horses? ening, except in the presence of a severe angioedema obstruct- ing the upper respiratory tract, which is rare in horses (2,3). Although fatalities are rare in horses suffering from urticaria, this Understanding urticaria skin reaction pattern has a major negative impact on the ani- To properly answer this question, it’s important to under- mal, owner, and veterinarian. This dermatosis is often chronic, stand that urticaria is a cutaneous reaction pattern that is not demands time and patience to find the underlying cause, and specifically associated with one etiology. Indeed, urticaria is requires long-term management. The veterinarian might be not a dermatological disease by itself, rather a clinical mani- frustrated by not finding the cause of the hives, as well as the festation initiated by various etiopathological processes (1–4). owner having to spend money for laboratory tests, veterinary Hives have been commonly associated with immunologic fees, and therapeutics. Both veterinarian and owner may be reactions against allergens in contact with the skin, inhaled, affected by compassion fatigue due to the chronic management ingested or injected parenterally (4,5). The classical immuno- of this skin problem. The quality of life of the horse might logic hypersensitivity reaction leading to urticarial lesions is also be affected if the severity of the disease or the treatments the type 1 hypersensitivity reaction involving the formation of

Département de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal, 3200, rue Sicotte, Saint-Hyacinthe, Québec J2S 2M2. Address all correspondence to Dr. Frédéric Sauvé; e-mail: [email protected] Dr. Sauvé is a Board-certified Veterinary Dermatologist and Grant Chair of the Canadian Academy of Veterinary Dermatology (CAVD). In the last 5 years, Frédéric Sauvé has received honoraria, consulting fees and/or collaborated with Royal Canin, Zoetis, and Elanco. The Veterinary Dermatology column is a collaboration of The Canadian Veterinary Journal with the Canadian Academy of Veterinary Dermatology (CAVD). The CAVD invites veterinarians, veterinary technicians and technologists, and students with a professional interest in dermatology to join us (www.cavd.ca) to stay current with the advances and challenges in this dynamic field. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

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

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type E immunoglobulins (IgE). Type E immunoglobulins are molecules that attach to cutaneous mast cells and stimulate the release of mast cell granules, particularly the vasoactive amines, in the presence of an allergen. The release of cytokines from basophils is also involved, usually within hours of mast cell degranulation. Type 3 hypersensitivity reactions, which involve the formation and deposition of immune complexes (antigens- antibodies), have also been described in the pathogenesis of urticaria in horses (1–3,6,7). The ultimate results of these hypersensitivity reactions is the release of a storm of inflammatory mediators, which increase the permeability of blood vessels and thereby extravasation of plasma. Clinically, this inflammatory wave initiates the forma- DERMATOLOGIE VÉTÉRINAIRE tion of edematous papules or plaques and/or angioedema (2,4). A part of the complexity of this disease resides in various mechanisms causing mast cell degranulation. Immunological Figure 1. Papules and plaques representing classical and non-immunological (physical, genetic, drug, or chemical appearance of hives. triggers) mechanisms have been described as potent causes for the release of mast cell granules (1,3,4). Unfortunately, it is impossible to determine whether the reaction is immunological or not, by relying solely on examination of the affected horse. The answer to the initial question is partially explained by the complexity of the pathogenesis of equine urticaria.

Many causes reported The dermatological challenge is not in making the diagnosis of urticaria. In most cases, the diagnosis is straightforward, because the clinical findings are usually highly suggestive of urticaria (4). Different patterns of urticaria have been described in horses, including localized or generalized papules or plaques (Figure 1), and giant, linear, exudative, and gyrate (arciform, serpiginous, annular) patterns (Figures 2, 3) (1–9). A common finding in Figure 2. Generalized gyrate pattern of urticaria. these patterns is pitting edema and blanching of the skin upon pressure (1,2,8). Hives are variably pruritic. They are often acute and short-lived (24 to 48 h). However, if hives persist beyond 6 to 8 wk the condition is considered chronic. When chronic, it is particularly important to try to find the putative trigger since chronic urticaria represents a major therapeutic challenge (1,2,9). We may assume that by finding the putative trigger it will be possible to cure urticaria; this is partially true. In fact, if a specific etiology can be found and removed from or controlled within the environment of the horse, then a cure is possible. The potential causes reported for equine urticaria may be divided into 5 main categories. Authors have reported etiologies in different manners, but essentially, they are classified as immunological causes, physi- cal insults, infectious and parasitic diseases, stress or psychogenic disorders, and chronic idiopathic cases (1–4,8). Immunological etiologies are associated with a large num- Figure 3. Serpiginous and annular hives. Erythema multiforme ber of horses suffering from urticaria. This group of disor- may mimic this pattern of urticaria. ders includes atopic dermatitis, insect hypersensitivity (e.g., Culicoides spp., flies, chiggers), adverse food reaction (vitamin substances (e.g., morphine, atropine, dextran, polymyxin B, and mineral supplements, hay, cereals, pastures), adverse drug strawberries, cobra venoms) may also induce hives. In such cases, reactions (e.g., antibiotics, phenylbutazone, flunixin, narcotics, the substance ingested, injected, or in contact with the animal anthelmintics), vaccine or bacterin reactions, serotherapy or induces wheals due to the chemical properties of the agent (12). blood transfusion adverse reactions, vasculopathies, sweat hyper- Less commonly, physical reactions may be the culprit. Physical sensitivity, and snake bites (1–4,10–12). Some urticariogenic urticaria has been associated with temperature variations (such

1002 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY

Table 1. Common symptomatic treatments for urticaria in horses (2,3,4,5,11,12,14,16). Therapeutic classes Drugs and dosages

Glucocorticoids (17) Predniso(lo)ne: 0.5 to 2 mg/kg body weight (BW) PO, q24h DERMATOLOGYVETERINARY Dexamethasone: 0.02 to 0.1 mg/kg BW, PO, q24h Administer for 3 to 10 d (until resolution of the hives), and then every 48 h [predniso(lo)ne: # 0.5 mg/kg BW] or 72 h (dexamethasone: # 0.02 mg/kg BW) if treatment is required over a longer period. Antihistamines Hydroxyzine: 0.5 to 2 mg/kg BW, PO, q8h to q12h Chlorpheniramine: 0.2 to 20.5 mg/kg BW, PO, q12h Diphenhydramine: 1 to 2 mg/kg BW, PO, q8h to q12h Cetirizine: 0.2 to 0.4 mg/kg BW, PO, q12h (18) Can be combined with glucocorticoids to reduce the exposure to steroids. Tricyclic antidepressants Doxepin: 0.5 to 0.75 mg/kg BW, PO, q12h Trimeprazine: 1 to 2 mg/kg BW, PO, q12h Amitriptyline: 1 mg/kg BW, PO, q12h Used for their antihistaminic potencies. Methylxanthine derivative Pentoxifylline: 8 to 10 mg/kg BW, PO, q8h to q12h Fatty acid supplementation Flaxseed or flaxseed oil. Several commercial products are available, e.g., EO-3TM (KER), Formulas Platinum Performance Equine and Platinum Skin & Allergy (Platinum Performance), Herbs for horses herring oil (Selected BioProducts).

as cold pack compress or hot shower), skin pressure (dermog- example, perennial (year-round) hives that were initially seasonal raphism), exercise, or following sun exposure (1–4,12). Many might be the result of atopy, or hives first noted recently and cutaneous infections (viral, fungal, protozoal) and parasitic concomitantly to guttural pouch infection might be secondary disorders (endoparasites and ectoparasites) have been reported to an infectious disease or its treatment. It is also important to as potential causes of equine urticaria (1–3,12). Always difficult question the owner on the management of the stable, the history to diagnose and to clearly explain, hives have been associated of the drugs and vaccines administered, the deworming pro- with psychogenic stresses such as the arrival of a new horse at gram, and travel. Such questions may be helpful in identifying the stable or a close pet friend leaving, or just before a horse an adverse drug reaction or a disease transmitted during travel. race (1–3,12). Stress caused by travelling should also be kept in mind. Adverse The numerous etiologies of equine urticaria reflect the com- drug reactions can occur quickly following the administration of plexity of its pathogenesis. It becomes clearer that equine urti- the offending drug only if the horse has already been sensitized caria might be cured, or at least controlled, but not in all cases. to this drug in the past. If the drug hasn’t been given in the past, most reactions will occur 1 to 3 wk after starting the treat- Is there a therapy to cure urticaria? ment (3). If a vasoactive or urticariogenic agent is administered, The short answer to the question “is there a therapy to cure the eruptions may occur following the first administration (12). urticaria in horses?” is no. In cases of mild acute eruptions, Simple tests may help define the origin of hives when a physi- observation of the patient may be sufficient (benign neglect). cal cause is suspected based on the history. Dermatographism However, if the horse shows severe manifestations, such as may be induced within 15 min after drawing any pattern on facial angioedema, even if the episode subsides within 24 to the skin of the horse with the blunt tip of a pencil. Wheals may 48 h, treatment with glucocorticoids, antihistamines, and/or also be induced by the application of ice or heat on the skin for epinephrine is recommended (1–3). 5 to 15 min. In chronic cases, if the underlying cause can be identified, When an infectious disease or a parasitic infestation is identi- elimination of the trigger is the treatment of choice, and the fied concomitant with urticarial eruptions, the next step is to sole treatment that cures the disease. A thorough approach is treat this infection or infestation properly (1,3,4,10). key in order to identify the underlying cause. First, the patient’s Obviously, equine urticaria may be cured if its origin is one history is an important step in the dermatological investigation. of the etiologies discussed, and removal or treatment of the The trigger might be known, but not yet identified. Several offending trigger is possible. questions regarding the history of the skin disease and general Hives associated with stress or psychogenic causes pose a health status (age of onset, seasonality, other horses affected, challenge, and some of these cases are probably classified as pruritus, response to previous treatments) must be asked. For idiopathic. Consulting with an animal behaviorist may be

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­beneficial in recognizing subtle behaviors that reveal anxiety. If The therapeutic approach chosen by the veterinary practitioner the anxiety-provoking situation can be managed, then a cure to should be based on the severity of the clinical signs, the chronic- the urticaria may be expected. ity of the condition, the underlying cause, the general health Among the common immunologic disorders, the most chal- status of the animal, and the potential side effects. The main lenging ones are atopic dermatitis, insect hypersensitivity, goal is to relieve pain, discomfort, or pruritus without causing and adverse food reaction. Allergy testing is available, but further health issues. reliable only in allergies associated with the environment. In conclusion, returning to the initial question; unfortunately, Intradermal testing or serological tests are not considered diag- in most instances, equine urticaria is an incurable lifelong dis- nostic per se. Diagnosis of atopic dermatitis should be based on ease. In a few cases, the underlying cause can be identified and medical history, dermatological findings, and the elimination addressed, which leads to a cure for the hives. It is important of other causes of urticaria (3,4). Allergy testing is recom- for veterinary equine practitioners to be aware of this fact. The mended once the elimination process is completed, in order to recommendations can then be appropriate for the horse, and initiate allergen-­specific immunotherapy (desensitization vac- realistic expectations can be set for the owner. DERMATOLOGIE VÉTÉRINAIRE cine) (3,13). Once offending allergens are identified, the removal of these allergens represents the ideal therapeutic approach. References However, this option is rarely possible given the environment 1. Diesel A. Equine urticaria: A clinical guide to management. In Practice 2014;36:295–300. of the horses and the fact that they are often polysensitized. 2. White SD, Yu AA. Equine dermatology. AAEP Proceedings, San Immunotherapy is considered an effective long-term therapeutic Antonio, Texas, USA. 2006;52:457–500. approach, especially for horses with perennial symptoms (1,9). 3. Scott DW, Miller WH. Skin system and allergic skin diseases. In: Equine Dermatology. 2nd ed. St. Louis, Missouri: Elsevier Saunders, Concomitant symptomatic treatment might be required, espe- 2011:314–359. cially within the first months after starting immunotherapy. 4. von Tscharner C, Yager J, Kunkle G. Immunologic diseases. In: Insect hypersensitivity, especially to Culicoides spp, is the most Stannard’s Illustrated Equine Dermatology Notes. Vet Dermatol 2000; 11:163–178. common cause of equine allergy (2). Since insect desensitiza- 5. Lloyd DH, Littlewood JD, Craig JM, Thomsett LR. Practical Equine tion is not always possible, various measures can be taken to Dermatology. Oxford, UK: Blackwell Science, 2003:23–24. minimize exposure to insects (insect repellents, modification 6. Hinden S, Klukowska-Rötzlert J, Janda J, Marti EI, Gerber V, Roosje PJ. Characterization of the inflammatory infiltrate and cytokine of hours on pasture, use of fans and mosquito nets suitable for expression in the skin of horses with recurrent urticaria. Vet Dermatol the stable, face or full protection net for horses) (14). Adverse 2012;23:503–e99. food reaction represents significant diagnostic and therapeutic 7. Wagner B. Editorial: Immunoglobulin E and allergy. Equine Vet J 2016; 48:13–14. challenges. Only a change in the diet over a period of 4 to 6 wk 8. Marsella R. Manual of Equine Dermatology. Oxfordshire, UK: CABI, can give a clue to a possible food allergy. A first step would be to 2019:32–46. remove all treats and oral supplements. If required, the second 9. Lorch G, Hilier A, Kwochka KW, Saville WA, LeRoy BE. Results of intradermal tests in horses without atopy and horses with atopic step would be to change the diet. For example, if the horse’s dermatitis or recurrent urticaria. Am J Vet Res 2001;62:1051–1059. ration contains a mixture of grains, the horse can be fed with 10. Lorch G, Calderwood Mays MB, Roberts HA, Isler KK. Sweat only one type of grain. Likewise, new unmixed hay (for example, hypersensitivity-­induced urticaria and sebaceous adenitis in an American saddlebred. J Vet Intern Med, 2013;27:1627–1632. hay containing only alfalfa) may be an option to consider. 11. Rodriguez-Palacios A, Quesada R, Baird J, Stalker M, McGurrin K. However, dietary changes in horses can be a major source of Presumptive fluphenazine-induced hepatitis and urticaria in a horse. concern as certain nutrient intakes are essential for horse activi- J Vet Intern Med 2007;21:336–339. 12. White SD. Urticaria. In: Smith B, Van Metre D, Pusterla N, eds. Large ties and colic can also occur. Moreover, the food trial might not Animal Internal Medicine. 6th ed. St. Louis, Missouri: Elsevier Mosby, be strict considering that horses have access to different plants 2019:1318–1319. on pasture. If an adverse reaction to a food or supplement can 13. Wagner B. IgE in horses: Occurrence in health and disease. Vet Immunol Immunopathol 2009;132:21–30. be proven by a provocative challenge following the food trial, 14. Marsella R. Equine allergy therapy. Vet Clin North Am Equine Pract a cure may be possible if the triggers can be removed from the 2013;29:551–557. environment or the ration of the horse (1–4,14–16). 15. Fadok V. Update on equine allergies. Vet Clin North Am Equine Pract 2013;29:541–550. Idiopathic urticaria is diagnosed when no underlying cause 16. Rashmir-Raven AM. Disorders of the skin. In: Reed S, Bayly W, Sellon can be found (1–3). Idiopathic cases also encompass horses for D, eds. Equine Internal Medicine. 4th ed. St. Louis, Missouri: Elsevier which hives are not investigated. Overall, it could potentially Saunders 2017:1159–1162. 17. Leclerc M, Lefebvre-Lavoie J, Beauchamp G, Lavoie J-P. Efficacy of represent 75% of the cases (3). oral prednisolone and dexamethasone in horses with recurrent airway The therapeutic management of horses suffering from urti- obstruction in the presence of continuous antigen exposure. Equine caria without identified triggers, or when the known triggers Vet J 2010;42:316–321. 18. Olsén L, Bondesson U, Broström H, et al. Pharmacokinetics and cannot be avoided or treated, relies on symptomatic ther- effects of cetirizine in horses with insect bite hypersensitivity. Vet J apy (1,2). The therapeutic modalities are summarized in Table 1. 2011;187:347–351.

1004 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY Commentary Commentaire

The final gift

Lisa Skentelbery

uthanasia can be a gift you give your pet, the final gift. tingly leaving their pet to spend their last days and nights in E I know that may seem like a strange present, but, in many pain or senility, which causes them distress. Animals are hard- instances, it can be the most humane, selfless thing to do for wired not to show weakness as it makes them more vulnerable them. in the wild, so they are very good at disguising pain. Limping Often, as pets age, they begin to have issues with mobility, and avoiding activities can be signs of discomfort that are subtle house soiling, dementia, and organ failure, which can make their enough that we may not recognize them as such. lives difficult and even painful. They know something is wrong; Some feel that it is a blessing to help your pet to die while they’re uncomfortable, they can’t keep up with their human and it is still more like itself, still able to enjoy a few last pleasures animal friends like they used to, and they may be confused and rather than wait until a crisis happens and then have to make a upset, both by disorientation or by their humans’ reactions. Pets painful decision in haste. are exceptionally good at reading our body language. You’ve It takes a good deal of courage to help a loved one to let go probably observed that they know when you’re unhappy or not and be there to comfort your pet in its last moments, but it feeling well. In the same way, they can probably sense your sad- likely gives them a good deal of solace to feel your presence. ness over their failing health, their inability to get around like I’ve read many passages that suggest that you try to make their they used to, or when they have accidents in the house. last minutes as joyful and normal as possible. For instance, Imagine if, as you become very old and infirm, you had a don’t take their collar off beforehand as, often in life, their faithful friend who could see what was happening to you and collar being removed starts something they may not like, like loved you so much that they would do anything to ease your suf- a bath or brushing. Feed them their absolute favorite thing to fering, even to the point of helping you to end your life if that eat and bring along blankets and toys that smell like home. If was what you really wanted. That idea can be very comforting. it’s at all possible, some people are able to have the euthanasia Depending on what your beliefs are for what happens after done at home, under a familiar tree or in a room that the pet death, it can be soothing to think that once their physical body loved to be in. is released here on earth, their soul can be free to return to a It’s important to celebrate the life you shared by doing some- creator or come back again in another form to experience a new thing to remember the pet, like a book or shadowbox about life in a young, and healthy body. them and the things your pet treasured. Let yourself feel sad I have often heard pet owners say “I’m just going to let afterward, but recognize that you did what you could to make him/her pass away at home because that’s the most natural your animal companion feel loved and cared for until it was thing,” but the owners may not realize that they may be unwit- time for them to go.

Lisa Skentelbery is a Registered Veterinary Technician and a Board member of the Ontario Association of Veterinary Technicians. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

CVJ / VOL 61 / SEPTEMBER 2020 1005 FOR PERSONAL USE ONLY Save the Date! 2021 CVMA CONVENTION, JULY 22 —25, 2021 Calgary, Alberta

IN COLLABORATION WITH:

canadianveterinarians.net FOR PERSONAL USE ONLY Diagnostic Ophthalmology Ophtalmologie diagnostique

Shayna Levitt, Stephanie Osinchuk, Lynne Sandmeyer

History and clinical signs 4-year-old spayed female bulldog was referred to the A ophthalmology service at the Western College of Veterinary Medicine for evaluation of a right conjunctival mass noted 2 months earlier and a history of chronic irritation of the right eye. Upon admission, the menace responses, palpe- bral, oculocephalic, and direct and consensual pupillary light reflexes were present bilaterally. Schirmer tear test (Schirmer Tear Test Strips; Alcon Canada, Mississauga, Ontario) values were 22 mm/min and 21 mm/min in the right and left eyes, respectively. The intraocular pressures were estimated with a rebound tonometer (Tonovet; Tiolat, Helinski, Finland) and were 16 mmHg and 24 mmHg in the right and left eyes, respectively. Biomicroscopic examination (Kowa SL-17; Kowa Figure 1. Photograph of the right eye of a 4-year-old bulldog Ophthalmic and Medical Equipment, Tokyo, Japan) of the right that was presented for a conjunctival mass. eye and lid revealed a 5-mm firm, pink raised mass (Figure 1) at the lateral limbus, and superficial corneal vascularization, mild scarring of the ­dorsal third of the cornea, mild blephari- tis, and multiple distichia. The left eye had a mild, lymphoid conjunctivitis. Following application of 0.5% tropicamide (Mydriacyl; Alcon Canada, Mississauga, Ontario), biomicro- scopic examination revealed no further abnormalities. Indirect ophthalmoscopic (Heine Omega 200; Heine Instruments Canada, Kitchener, Ontario) examinations were completed bilaterally and no further abnormalities were detected. An inci- sional biopsy was performed under sedation and submitted for histopathology. What are your clinical diagnosis, differential diagnoses, therapeutic plan, and prognosis? Discussion Differential diagnoses for the mass included inflammatory (­parasitic, granuloma, immune-mediated disease, foreign Figure 2. Light microscopy revealed non-keratinized hyperplastic epithelium encasing multiple fibrovascular cores body reaction) or neoplastic [squamous cell carcinoma (SCC), of a papillomatous tumor. Each frond contained a mild diffuse neutrophil infiltration with occasional lymphocytes. Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Rd E, Guelph, Ontario N1G 2W1 (Levitt); Department of Small Animal Clinical ­papilloma (viral or squamous), adenoma, lymphoma, mast cell Sciences, Western College of Veterinary Medicine, University tumor, histiocytoma]. The histopathology of the incisional of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan biopsy confirmed a diagnosis of bulbar conjunctival squamous S7N 5B4 (Osinchuk, Sandmeyer). papilloma (Figure 2). Use of this article is limited to a single copy for personal study. Conjunctival papillomas are considered primary epithelial Anyone interested in obtaining reprints should contact the neoplasms (1). Although most of these masses are benign (2), CVMA office ([email protected]) for additional malignant transformation has been reported in cases of eyelid copies or permission to use this material elsewhere. and oral papillomas (3–5). There are 2 categories of papillomas

CVJ / VOL 61 / SEPTEMBER 2020 1007 FOR PERSONAL USE ONLY

that can affect the conjunctiva: viral and squamous papillomas References (non-viral). The papilloma types are distinct in the popula- 1. Sansom J, Barnett KC, Blunden AS, Smith KC, Turner S, Waters L. tions they affect, their outcomes, and their light microscopic Canine conjunctival papilloma: A review of five cases. J Small Anim characteristics. Viral papillomas, commonly associated with Pract 1996;37:84–86. 2. Gwin RM, Gelatt KN, Williams LW. Ophthalmic neoplasms in the dog. papillomavirus infection, can be present on both skin and muco- J Am Anim Hosp Assoc 1982;18:853–866. sal surfaces including the oral cavity, conjunctiva and cornea, 3. Wiggans KT, Hoover CE, Ehrhart EJ, Wobeser BK, Cohen LB, penis, vulva, and lips (6–8). Viral papillomas occur in younger Gionfriddo JR. Malignant transformation of a putative eyelid papilloma to squamous cell carcinoma in a dog. Vet Ophthalmol 2013;16:105–112. dogs, and often spontaneously regress (1,5,9,10). Under light 4. Watrach AM, Small E, Case MT. Canine papilloma: Progression of oral microscopy, they exhibit hyperkeratosis, and cytopathic effects papilloma to carcinoma. J Natl Cancer Inst 1970;45:915–920. including koilocytes, intranuclear inclusions, and thickened 5. Thaiwong T, Sledge DG, Wise AG, Olstad K, Maes RK, Kiupel M. Malignant transformation of canine oral papillomavirus (CPV1)- stratum granulosum (9). associated papillomas in dogs: An emerging concern? Papillomavirus Squamous papillomas, or non-viral papillomas, are tumors Res 2018;6:83–89. of squamous epithelium that are slow growing (2) and typi- 6. Brandes K, Fritsche J, Mueller N, et al. Detection of canine oral papil- lomavirus DNA in conjunctival epithelial hyperplastic lesions of three cally occur in older dogs (1,9). Clinically they are often well-

OPHTALMOLOGIE DIAGNOSTIQUE OPHTALMOLOGIE dogs. Vet Pathol 2009;46:34–38. demarcated, have variable amounts of pigment, and have a 7. Tokita H, Konishi S. Studies on canine oral papillomatosis: II. frond-like appearance and a feeder vessel at their base (1,2,6). Oncogenicity of canine oral papilloma virus to various tissues of dog with special reference to eye tumor. Jpn J Vet Sci 1975;37:109–120. Light microscopic descriptions of squamous papillomas reveal 8. Bonney CH, Koch SA, Confer AW, Dice PF. A case report: A conjunc- numerous delicate fronds covered by hyperplastic epithelium tivocorneal papilloma with evidence of a viral etiology. J Small Anim connected with a fine fibrovascular core. Hyperkeratosis and Pract 1980;21:183–188. 9. Beckwith-Cohen B, Teixeira LBC, Ramos-Vara JA, Dubielzig RR. viral cytopathic affects, which are seen in viral papillomas, are Squamous papillomas of the conjunctiva in dogs: A condition not not present in squamous papillomas (9). Polymerase chain reac- associated with papillomavirus infection. Vet Pathol 2015;52:676–680. tion (PCR), immunohistochemistry, and in-situ hybridization 10. Nicholls PK, Moore PF, Anderson DM, et al. Regression of canine oral papillomas is associated with infiltration of CD4 and CD8 have also been used to differentiate between squamous and viral lymphocytes. Virol 2001;283:31–39. papillomas (6,9,11). 11. Teifke JP, Lohr CV, Shirasawa H. Detection of canine oral papillomavirus- Squamous papillomas have been associated with chronic oph- DNA in canine oral squamous cell carcinomas and p53 overexpressing skin papillomas of the dog using the polymerase chain reaction and thalmic inflammatory conditions such as keratoconjunctivitis non-radioactive in situ hybridization. Vet Microbiol 1998;60:119–130. sicca (1,12–14) and traumatic external stimuli; the etiology is 12. Brandes K, Leuzinger K, Rogge G, Müller B, Teifke J. Conjunctival otherwise considered idiopathic (15). Additional risk factors papillomas and corneal squamous cell carcinomas after long-term ciclosporin treatment in four brachycephalic dogs with chronic keratitis. include brachycephalic breeds (12,14) and prolonged topical J Comp Pathol 2020;174:198. immunosuppressive therapy (12). In contrast to dogs with 13. Kim MS, Kweon DH, Yi NY, et al. Corneal papilloma in a dog. Vet Rec lesions caused by papillomavirus (10), dogs with squamous 2005;156:454. 14. Bernays ME, Flemming D, Peiffer RL Jr. Primary corneal papilloma papillomas do not typically experience spontaneous regression and squamous cell carcinoma associated with pigmentary keratitis in (15). Surgical excision is recommended for improved cosmesis four dogs. J Am Vet Med Assoc 1999;214:215–217. or when there is irritation and secondary ocular disease (2,6). 15. Cornegliani L, Vercelli A, Abramo F. Idiopathic mucosal penile squa- mous papillomas in dogs. Vet Dermatol 2007;18:439–443. The prognosis is good following complete excision (2,15), with 16. Bonney CH, Koch SA, Dice PF, Confer AW. Papillomatosis of con- no recurrence after 6 to 8 months in multiple studies (6,13,16). junctiva and adnexa in dogs. J Am Vet Med Assoc 1980;176:48–51.

Index of Advertisers Index des annonceurs

Boehringer Ingelheim Animal Health Canada, Inc...... IFC, OBC Lebalab, Inc...... IBC Borden Ladner Gervais LLP...... 1024 Merck Animal Health Canada...... 916, 928 Canadian Veterinary Medical Association...... 919, 1006, 1013 Moneris...... 950 CanWest Veterinary Conference...... 1000 Scotiabank...... 913 Chiron Compounding Pharmacy...... 1024 Simmons & Associates Canada, Inc...... 1024 Dechra Veterinary Products...... 993 University of Saskatchewan...... 1022 Hill’s Pet Nutrition Canada, Inc...... 914 UXR, Inc...... 1024 iFinance Canada...... 920 VetCare Canada, Inc...... 1024 Kane Veterinary Supplies...... 926 Western Financial Group Insurance Solutions...... 927

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

1008 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY Veterinary Practice Management Gestion d’une clinique vétérinaire

The response across Canada: Highlights of the National COVID-19 Survey Faits saillants du sondage national sur la COVID-19 au Canada

Chris Doherty

he COVID-19 pandemic, which began to take hold in a pandémie de COVID-19, qui a commencé à prendre de T Canada in mid-March, drastically altered many aspects L l’ampleur au Canada à la mi-mars, a radicalement modifié of life for nearly everyone. Events were cancelled, businesses de nombreux aspects de la vie de pratiquement tout le monde. closed, and gatherings prohibited, to name but a few of the L’annulation d’événements, la fermeture d’entreprises et l’inter- repercussions. The pandemic, and need for physical distanc- diction des rassemblements ne sont que quelques exemples de ing, also reshaped the way that veterinarians across the country ses nombreuses répercussions. La pandémie a également trans- practiced medicine. formé la façon de travailler des médecins vétérinaires du pays, In an effort to quantify the steps that veterinary hospitals notamment en raison de la consigne de distanciation physique took in the interest of public health, as well as the impacts to imposée pour freiner sa propagation. their businesses, the CVMA and OVMA partnered with Merck Afin de quantifier les mesures prises par les établissements Animal Health, Associated Veterinary Purchasing Co. Ltd., vétérinaires pour protéger la santé publique et les impacts de Purina Pro Plan Veterinary Diets, Royal Bank of Canada, and ces mesures sur les entreprises vétérinaires, l’ACMV et l’OVMA Veterinary Purchasing and Western Drug Distribution Center ont établi un partenariat avec Merck Santé animale, Associated Limited to conduct a national survey of veterinarians. Veterinary Purchasing Co. Ltd., Purina Pro Plan Veterinary Running from June 22 to July 3, 2020, the survey received a Diets, la Banque Royale du Canada, Veterinary Purchasing et total of 1126 responses, providing much insight into exactly how Western Drug Distribution Center Limited pour mener un veterinarians were dealing with the changing world they faced. sondage national auprès des médecins vétérinaires. Please note that Prince Edward Island and Newfoundland and Réalisé du 22 juin au 3 juillet 2020, le sondage a reçu un Labrador are excluded from tables due to insufficient completed total de 1126 réponses fournissant beaucoup d’information surveys from these provinces. sur la façon dont les médecins vétérinaires composent avec la One of the most encouraging findings from the survey situation en constante évolution à laquelle ils sont confrontés. was the extent to which veterinarians across the nation had Veuillez noter que les provinces de l’Île-du-Prince-Édouard taken seriously the pandemic and adjusted their operations in et de Terre-Neuve-et-Labrador sont exclues des tableaux des response. When asked which measures they or their hospital résultats en raison du nombre insuffisant de répondants de had taken at any point over the course of the pandemic, most ces provinces.

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 61 / SEPTEMBER 2020 1009 FOR PERSONAL USE ONLY

Table 1/Tableau 1. Over the course of the pandemic, which measures did you and/or your hospital implement at any point?/Au cours de la pandémie, quelles mesures ont été mises en œuvre à quelque moment que ce soit, par vous ou dans votre établissement vétérinaire? AB BC MB NB NS ON QC SK Canada Alb. C.-B. Man. N.-B. N.-É. Ont. Qc Sask. Emergency care only/Prestation de soins urgents seulement 61% 27% 40% 36% 56% 81% 79% 65% 34% Postponing immature animal examinations/vaccines 20% 11% 12% 14% 11% 54% 21% 41% 15% Report des examens et de la vaccination des animaux immatures Postponing mature animal examinations/vaccines 79% 59% 73% 78% 78% 91% 87% 73% 61% Report des examens et de la vaccination des animaux matures Postponing elective surgeries/Report des chirurgies électives 81% 56% 76% 64% 100% 93% 91% 69% 56% Curbside animal drop-off 87% 88% 84% 86% 67% 89% 91% 55% 78% Prise en charge de l’animal à l’extérieur de l’établissement Utilizing telemedicine/Utilisation de la télémédecine 70% 56% 55% 56% 67% 76% 81% 55% 61% Curbside pickup of diets/pharmaceuticals 90% 85% 89% 86% 100% 93% 95% 51% 83% Service de cueillette à l’auto pour la nourriture et les médicaments

GESTION D’UNECLINIQUE VÉTÉRINAIRE Home delivery of diets/pharmaceuticals 32% 20% 31% 25% 11% 33% 38% 20% 20% Livraison à domicile de la nourriture et des médicaments Limiting Client Entry to Hospital 90% 88% 88% 92% 89% 91% 92% 67% 85% Restriction de l’accès des clients à l’intérieur de l’établissement Increasing cleaning/disinfecting 95% 96% 98% 89% 100% 94% 96% 76% 90% Augmentation du nettoyage et de la désinfection Contactless payments/Paiement sans contact 89% 84% 92% 83% 100% 91% 93% 67% 76% Screening clients for illness/travel 77% 72% 81% 72% 89% 69% 80% 51% 83% Questions aux clients concernant les voyages ou les symptômes de maladie Asking clients to wear masks 60% 59% 51% 67% 67% 67% 64% 55% 39% Port du masque exigé pour les clients Use of personal protective equipment by veterinary team 84% 79% 84% 75% 67% 85% 88% 71% 61% Utilisation d’équipement de protection individuelle par l’équipe vétérinaire Minimizing contact during farm/mobile calls 17% 22% 20% 25% 11% 20% 12% 16% 41% Réduction des contacts pendant les visites à la ferme/chez les clients Utilizing lowest risk client on farm/mobile calls 10% 14% 10% 8% 11% 15% 8% 6% 15% Aide du client le moins à risque lors des visites à la ferme/chez les clients None of the above/Aucune de ces mesures 1% 0% 0% 3% 0% 2% 0% 2% 0% Other/Autre 6% 10% 6% 6% 22% 7% 4% 6% 10%

AB — Alberta; BC — British Columbia; MB — Manitoba; NB — New Brunswick; NS — Nova Scotia; ON — Ontario; QC — Quebec; SK — Saskatchewan. Alb. – Alberta; C.-B. – Colombie-Britannique; Man. – Manitoba; N.-B. – Nouveau-Brunswick; N.-É. – Nouvelle-Écosse; Ont. – Ontario; Qc – Québec; Sask. – Saskatchewan.

respondents indicated that they had implemented dramatic L’une des conclusions les plus encourageantes du sondage est changes (Table 1). que les médecins vétérinaires du pays ont pris la pandémie au Nearly all veterinary respondents undertook increased clean- sérieux et ajusté leurs activités en conséquence. Lorsqu’on leur ing, limited entry to their hospital, utilized contactless payment a demandé quelles mesures avaient été prises par eux-mêmes ou methods, and implemented curbside animal drop-off. Many oth- dans leur établissement vétérinaire à quelque moment que ce soit ers took steps such as postponing appointments and surgeries, au cours de la pandémie, la plupart des répondants ont indiqué providing curbside pick-up of dietary and pharmaceutical prod- que des changements majeurs avaient été effectués (tableau 1). ucts, or limiting their practice to emergency or urgent care only. Presque tous les répondants ont augmenté le nettoyage, It should also be noted that, when limited to mixed, large, restreint l’entrée des clients dans leur établissement, utilisé des and mobile veterinarians, the percentage of those minimizing méthodes de paiement sans contact et pris en charge les animaux contact and using the lowest risk client for restraint during farm/ à l’extérieur de la clinique. Beaucoup ont aussi pris d’autres mobile calls was significantly higher; these figures are artificially mesures, comme le report des consultations et des interventions decreased (Table 1) due to the high number of small animal chirurgicales, le service de cueillette à l’auto pour la nourriture veterinarians who responded to the survey. et les médicaments et la prestation de soins urgents seulement. Staffing during the pandemic was another challenge many Il convient également de noter que, si on ne tient compte veterinary hospitals faced. At first, the worry was over busi- que des vétérinaires en pratique mixte, en pratique des grands ness slowdowns and potential layoffs or terminations, but the animaux ou en pratique mobile, le pourcentage de répondants introduction of government programs, such as the Canada qui veillaient à réduire les contacts avec les clients ou à obtenir Emergency Wage Subsidy (CEWS) helped to quell these con- l’aide du client le moins à risque pour les contentions lors des cerns (Table 2). visites à la ferme ou à domicile était significativement plus Across Canada, only 14% of veterinarians indicated that they élevé; les pourcentages pour ces mesures sont artificiellement had laid off staff over the course of the pandemic. Of the 12% diminués (tableau 1) en raison du nombre élevé de médecins

1010 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY

Table 2/Tableau 2. Have you and/or your hospital altered staffing?/La pandémie a-t-elle eu un impact sur la gestion du personnel dans

votre établissement vétérinaire? PRACTICE MANAGEMENT VETERINARY AB BC MB NB NS ON QC SK Canada Alb. C.-B. Man. N.-B. N.-É. Ont. Qc Sask. No — All staff healthy/working as normal 36% 39% 30% 47% 44% 19% 36% 31% 41% Non. Tout le personnel est en bonne santé/travaille normalement. Lost staff to self-isolation/illness/child-care responsibilities, etc. 46% 36% 53% 33% 11% 43% 50% 38% 44% On a perdu du personnel pour des raisons d’auto-isolement, de maladie, de garde d’enfants, etc. Laid off staff due to business slowdown Du personnel a dû être mis à pied en raison du ralentissement des activités. 14% 17% 13% 11% 11% 46% 10% 26% 0% Reduced staff hours due to business slowdown 19% 18% 18% 14% 33% 44% 16% 36% 10% Les heures du personnel ont dû être réduites en raison du ralentissement des activités. Split staff into separate teams 21% 22% 11% 25% 22% 52% 19% 33% 22% Le personnel a été divisé en équipes distinctes. Staff working from home/remotely 15% 14% 15% 11% 0% 11% 16% 13% 24% Le personnel a travaillé à domicile ou à distance. Other/Autre 12% 13% 20% 11% 22% 11% 10% 13% 12%

AB — Alberta; BC — British Columbia; MB — Manitoba; NB — New Brunswick; NS — Nova Scotia; ON — Ontario; QC — Quebec; SK — Saskatchewan. Alb. – Alberta; C.-B. – Colombie-Britannique; Man. – Manitoba; N.-B. – Nouveau-Brunswick; N.-É. – Nouvelle-Écosse; Ont. – Ontario; Qc – Québec; Sask. – Saskatchewan.

who indicated an “other” response, many specified that they vétérinaires en pratique des animaux de compagnie qui ont had actually hired additional staff to allow for greater distancing répondu au sondage. from clients on farm calls, or to assist with the increased time La gestion du personnel pendant la pandémie a été un autre requirements of many of the measures they had implemented défi auquel de nombreux établissements vétérinaires ont été to deal with the pandemic. Rather, the concern that arose was confrontés. Au début, les principales préoccupations concer- with the 46% of veterinarians who indicated that they had lost naient le ralentissement des activités et les mises à pied et les staff because of self-isolation, illness, and particularly child-care licenciements, mais l’introduction de programmes gouverne- responsibilities. With schools and daycares closed, camps can- mentaux, comme la Subvention salariale d’urgence du Canada celled, and people supposed to be isolating from others as much (SSUC), a contribué à apaiser ces inquiétudes (tableau 2). as possible, many veterinary staff were left with few alternatives Seulement 14 % des répondants ont indiqué que du personnel but to remain out of work so they could supervise their children. de leur établissement a dû être mis à pied au cours de la pandé- It was unavoidable that the pandemic and measures to miti- mie. Parmi les 12 % qui ont indiqué « Autre » comme réponse, gate its spread would have repercussions on veterinarians’ busi- beaucoup ont précisé qu’ils avaient en fait embauché du person- nesses. While April marked the depths of the lockdown, things nel supplémentaire pour permettre une plus grande distanciation were certainly not back to normal by May. avec les clients lors des visites à la ferme ou pour compenser le Over half of all respondents indicated that their revenues temps consacré à l’application des nombreuses mesures mises en would be down in May 2020, compared to May 2019 (Table 3). œuvre pour faire face à la pandémie. La statistique plus préoc- Despite this, reassuringly, another 16% had a May this year that cupante concernait les 46 % de médecins vétérinaires qui ont was consistent with last year, while 20% indicated their revenues indiqué avoir perdu du personnel en raison de l’auto-isolement, had grown year over year. Of the 12% who indicated an “other” de la maladie et, souvent, des responsabilités de garde d’enfants. response, nearly all explained that they did not know what the Comme de nombreuses écoles et garderies étaient fermées, des revenue of their hospital was in May 2020. camps de jour étaient annulés et les gens devaient s’isoler autant The picture continued to improve in June, with only a quar- que possible des autres, de nombreux médecins vétérinaires ont ter of respondents indicating that revenues would be down from dû cesser de travailler pour pouvoir s’occuper de leurs enfants. June 2019 (Table 4). Well over half, at 66%, expressed that their Il était inévitable que la pandémie et les mesures visant à revenues in June 2020 would be consistent, or increased, from atténuer sa propagation aient des répercussions sur les entreprises 2019. While some of this is without doubt due to demand for vétérinaires. Même si le mois d’avril a marqué l’apogée du confi- veterinary services that has been pushed back from the more nement, les choses n’étaient pas revenues à la normale en mai. sweeping lockdowns in March and April, it is nonetheless Plus de la moitié des répondants ont indiqué que leurs encouraging to see veterinary hospitals rebound so rapidly. revenus avaient baissé en mai 2020 par rapport à mai 2019 Finally, veterinarians were asked if they had, at any point ­(tableau 3). Malgré cela, de manière rassurante, 16 % ont connu during the pandemic, qualified for the CEWS (Table 5). This un mois de mai 2020 équivalent à celui de l’année dernière, program would cover up to 75% of an employee’s wage, to a tandis que 20 % ont indiqué que leurs revenus avaient augmenté maximum of $847 per week (approximately $44 000 per year, or cette année par rapport à l’an dernier. Parmi les 12 % qui ont

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Table 3/Tableau 3. How do you anticipate your and/or your hospital’s revenues will be for May?/Quelles sont vos prédictions concernant vos revenus ou les revenus de votre établissement vétérinaire pour mai? AB BC MB NB NS ON QC SK Canada Alb. C.-B. Man. N.-B. N.-É. Ont. Qc Sask. Consistent with May 2019 16% 23% 17% 29% 0% 4% 13% 8% 35% Comme en mai 2019 Increased from May 2019 20% 34% 22% 23% 33% 11% 14% 15% 30% Augmentation par rapport à mai 2019 Decreased from May 2019 by 30% or less 40% 22% 42% 31% 56% 55% 46% 59% 10% Diminution de 30 % ou moins par rapport à mai 2019 Decreased from May 2019 by 30% or more 12% 5% 11% 6% 0% 11% 16% 10% 0% Diminution de 30 % ou plus par rapport à mai 2019 Other/Autre 12% 16% 8% 11% 11% 19% 11% 8% 25%

AB — Alberta; BC — British Columbia; MB — Manitoba; NB — New Brunswick; NS — Nova Scotia; ON — Ontario; QC — Quebec; SK — Saskatchewan. Alb. – Alberta; C.-B. – Colombie-Britannique; Man. – Manitoba; N.-B. – Nouveau-Brunswick; N.-É. – Nouvelle-Écosse; Ont. – Ontario; Qc – Québec; Sask. – Saskatchewan.

GESTION D’UNECLINIQUE VÉTÉRINAIRE Table 4/Tableau 4. How do you anticipate your and/or your hospital’s revenues will be for June?/Quelles sont vos prédictions concernant vos revenus ou les revenus de votre établissement vétérinaire pour juin? AB BC MB NB NS ON QC SK Canada Alb. C.-B. Man. N.-B. N.-É. Ont. Qc Sask. Consistent with June 2019 30% 35% 34% 34% 11% 25% 27% 24% 44% Comme en juin 2019 Increased from June 2019 36% 36% 31% 23% 56% 38% 37% 29% 38% Augmentation par rapport à juin 2019 Decreased from June 2019 by 30% or less 21% 13% 23% 32% 22% 26% 22% 37% 3% Diminution de 30 % ou moins par rapport à juin 2019 Decreased from June 2019 by 30% or more 4% 3% 6% 0% 11% 0% 6% 0% 0% Diminution de 30 % ou plus par rapport à juin 2019 Other/Autre 9% 13% 6% 11% 0% 11% 8% 10% 15%

AB — Alberta; BC — British Columbia; MB — Manitoba; NB — New Brunswick; NS — Nova Scotia; ON — Ontario; QC — Quebec; SK — Saskatchewan. Alb. – Alberta; C.-B. – Colombie-Britannique; Man. – Manitoba; N.-B. – Nouveau-Brunswick; N.-É. – Nouvelle-Écosse; Ont. – Ontario; Qc – Québec; Sask. – Saskatchewan.

Table 5/Tableau 5. Have you qualified for the Canada Emergency Wage Subsidy (75% wage subsidy) at any point during the pandemic?/Votre établissement vétérinaire a-t-il été admissible à la Subvention salariale d’urgence du Canada (subvention salariale de 75 %) à un moment quelconque de la pandémie? AB BC MB NB NS ON QC SK Canada Alb. C.-B. Man. N.-B. N.-É. Ont. Qc Sask. Yes/Oui 33% 24% 26% 20% 50% 30% 41% 25% 17% No/Non 67% 76% 74% 80% 50% 70% 59% 75% 83%

AB — Alberta; BC — British Columbia; MB — Manitoba; NB — New Brunswick; NS — Nova Scotia; ON — Ontario; QC — Quebec; SK — Saskatchewan./Alb. – Alberta; C.-B. – Colombie-Britannique; Man. – Manitoba; N.-B. – Nouveau-Brunswick; N.-É. – Nouvelle-Écosse; Ont. – Ontario; Qc – Québec; Sask. – Saskatchewan.

75% of the annual salary of an employee making approximately répondu « Autre », presque tous ont expliqué qu’ils ne savaient $59 000 per year). pas quels étaient les revenus de leur établissement en mai 2020. In order to qualify for this program, veterinarians had to La situation a continué de s’améliorer en juin : seulement show that their revenues had declined by at least 15% in le quart des répondants ont indiqué que les revenus seraient March 2020 from either March 2019 or the average of January en baisse par rapport à juin 2019 (tableau 4). La majorité des and February 2020, and by at least 30% in April, May, and répondants (66 %) ont déclaré que les revenus en juin 2020 June 2020 from the same month in 2019 or the average of seraient équivalents ou supérieurs à ceux de juin 2019. Même January and February 2020. si cela s’explique sans doute en partie par la demande de services Despite physical distancing, urgent-care only provisions, vétérinaires qui a été repoussée en raison des restrictions plus curbside drop-off, missing staff, and all the other difficulties importantes en mars et en avril, il est néanmoins encourageant faced, only 1/3 of veterinarians across Canada ended up qualify- de voir les établissements vétérinaires rebondir si rapidement. ing for CEWS throughout the pandemic. Enfin, on a demandé aux médecins vétérinaires si leur éta- Overall, the results of this survey paint a picture of a profes- blissement avait été, à un moment quelconque de la pandémie, sion that took immediate and appropriate action in response to a admissible à la SSUC (tableau 5). Ce programme visait à couvrir public health emergency and has overcome significant disruption jusqu’à 75 % du salaire des employés, pour un maximum de without suffering grievous damage to revenue and businesses. 847 $ par semaine par employé (environ 44 000 $ par année ou

1012 CVJ / VOL 61 / SEPTEMBER 2020 FOR PERSONAL USE ONLY

While COVID-19 is not yet entirely in the rear-view mirror, Diets, Royal Bank of Canada, Veterinary Purchasing and this should provide a great deal of confidence in the resilience Western Drug Distribution Center Limited, and all the veteri- PRACTICE MANAGEMENT VETERINARY of the Canadian veterinary profession. narians and veterinary staff who responded to the survey. ■ Thank you again to Merck Animal Health, Associated Veterinary Purchasing Co. Ltd., Purina Pro Plan Veterinary

75 % du salaire annuel d’un employé gagnant environ 59 000 $ Dans l’ensemble, les résultats de ce sondage indiquent que la par année). profession vétérinaire a pris des mesures immédiates et appro- Pour être admissible à ce programme, l’établissement vétéri- priées en réponse à l’urgence de santé publique et a surmonté des naire devait prouver que ses revenus avaient diminué d’au moins perturbations importantes sans trop de dommages aux revenus 15 % en mars 2020 par rapport à mars 2019 ou à la moyenne ni aux entreprises. Bien que la COVID-19 ne soit pas encore de janvier et février 2020, et d’au moins 30 % en avril, mai et derrière nous, ces résultats suscitent une grande confiance envers juin 2020 par rapport au même mois en 2019 ou à la moyenne la résilience de la profession vétérinaire canadienne. de janvier et février 2020. Nous remercions encore Merck Santé animale, Associated Malgré la distanciation physique, la prestation de soins Veterinary Purchasing Co. Ltd., Purina Pro Plan Veterinary urgents seulement, la prise en charge des animaux à l’extérieur Diets, la Banque Royale du Canada, Veterinary Purchasing et de l’établissement, le manque de personnel et toutes les autres Western Drug Distribution Center Limited, ainsi que tous les difficultés rencontrées, seulement le tiers des répondants ont eu médecins vétérinaires et membres du personnel vétérinaire qui droit à la SSUC durant la pandémie. ont répondu au sondage. ■

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