Mental Health & Veterinarians

SEPTEMBER 2016 | No 24

THE ELEPHANT NATURE PARK IN CHIANG MAI

MENTAL HEALTH & VETERINARIANS

EXTRACORPOREAL BLOOD PURIFICATION THERAPY NEW APPROACHES TO REGULATING ANIMAL RESEARCH VETERINARY MEDICAL RECORDS DATA COLLECTION ERRORS AND OMISSIONS

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FROM THE EDITOR

all has always been my favourite time of the year, likely because I am inspired by the colour orange, and the riot of reds and yellows that goes with it. It is also, for me, a time to reflect on the very early death of my mom, in September, when I KNOWING was 12. FSo the issue of medical assistance in dying article touches a nerve with me and brings MAKES ALL THE back so many memories of loss and sadness. I can well imagine the hurt involved with having a loved one die; I cannot imagine what it would be like if that death were by choice. I was DIFFERENCE not surprised, however, to see that even in this arena of human suffering, there is a role for An early diagnosis could save my life. veterinarians to play. My great love for animals and their unselfish acceptance of us humans with all our faults is mirrored over and over again by generous, thoughtful, considerate veterinarians who act with grace and candour and knowledge to help another person, not COREY VAN’T HAAFF EDITOR solely an animal. On a different level altogether is our story of mental illness and mental wellness, and the terrible tragedy of suicide. The story opens with the suicide of Dr. Sophia Yin, which shocked so many of us who followed her words of caring wisdom about animal welfare. I will never understand what drives people to such a state of utter hopelessness that they end their lives, TO THE EDITOR but I do hope that, through this story, anyone who recognizes signs of mental unwellness in >> Letters from members themselves or their colleagues will have a bit more knowledge of how to help and where to go are welcome. They may C for help. For a certainty, help is always available. In fact, by simply following this link, www. be edited for length and clarity. Email us at canadianveterinarians.net/documents/mental-health-support-resources, you will find a list of M

[email protected]. resources that are available to each of you. Veterinarians in BC should know that specific help Y through Homewood Health is fully confidential, and neither the College of Veterinarians of BC CM nor your CVMA-SBCV Chapter will ever know you called. ON THE COVER MY >> Elephants in Chiang Mai. CY CMY Email: [email protected] K

LETTER TO THE EDITOR

Dear Editor,

I thought I would share a photo with you. Our daughter will not let go of the March edition of West Coast Veterinarian magazine. Her grandpa is a retired veterinarian, and she is currently a very big fan of dogs (her first word!). She has been picking the magazine up every day since March and You can be the dierence between “I wish we could have done looks at all the dogs. Thanks for providing something” and “I’m so glad we caught this soon enough...” her with hours of entertainment! Visit IDEXX.ca/preventivecare to learn more Best wishes, Heather Brekke (Anika’s mom) IN-HOUSE DIAGNOSTICS  DIGITAL IMAGING AND TELEMEDICINE  REFERENCE LABORATORIES  CLIENT AND PRACTICE MANAGEMENT ABOVE Anika and her grandpa Dr. Ron Lewis.

© 2016 IDEXX Laboratories, Inc. All rights reserved. • 108602-00 All ®/TM marks are owned by IDEXX Laboratories, Inc. or its aliates in the United States and/or other countries. The IDEXX Privacy Policy is available at idexx.ca. 4 WCV

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SEPTEMBER 2016

CVMA-SOCIETY OF BC VETERINARIANS 22 CARSTEN BANDT, DVM, DAVID LANE, DVM, ACVSMR, CHAPTER 2016 BOARD OF DIRECTORS DACVECC, earned his DVM is a 1992 OVC graduate. He PRESIDENT MENTAL HEALTH from Humboldt University, recently earned Diplomate sta- Sarah Armstrong, DVM Berlin, in 1997 and became tus with the American College MENTORSHIP LIAISON & VETERINARIANS Diplomate of the American of Veterinary Sports Medicine VICE PRESIDENT College of Veterinary and Rehabilitation (Canine). Al Longair, DVM Emergency and Critical Care He is the owner of Points East CE COMMITTEE LIAISON in 2007. From 2007 to 2014, West Veterinary Services, a TREASURER he was Clinical Assistant specialty practice focused Rob Ashburner, DVM Professor of Emergency exclusively on resolving condi- CVMA LIAISON Critical Care at the University tions that cause lameness, DIRECTORS of Florida. He is part of the chronic pain, and /or paresis Christiane Armstrong, DVM ER + Critical Care team at in pets. MAGAZINE COMMITTEE LIAISON Canada West Veterinary Koharik Arman, DVM Specialists. DAVID PATON, DVM, an 1978 MEMBERSHIP COMMITTEE LIAISON WCVM graduate, is a partner Paul Kennedy, DVM REGIONAL REPRESENTATIVE, NORTHERN BC LINDA CREWS, BScH, DVM, in Paton and Martin Veterinary Jessica Robertson, DVM graduated from Ontario Services. A former president DOG IMPORTATION INITIATIVE LIAISON Veterinary College in 1997. of the BCVMA and a CVMA executive committee member, Marco Veenis, DVM She is involved in reviewing, PAST-PRESIDENT investigating, and teach- he began his international ing the benefits of medical experience with the Canadian CVMA-SBCV CHAPTER records to veterinarians—pre- International Development CONTACT INFORMATION viously with the CVO for nine Agency. He is the CVMA-SBCV PUBLISHER years, and for the past five Chapter Delta Equine Seminar CVMA-SBCV CHAPTER Chair. Email: [email protected] FROM THE EDITOR 04 years with the CVBC. She is Telephone 604.406.3713 the founder of Advise a Vet PO Box 21088 Maple Ridge Square RPO LETTER TO THE EDITOR 04 DANIEL WEARY, D.Phil., is a Services which helps teach Maple Ridge BC V2X 1P7 professor and NSERC Research veterinarians the benefits of www.canadianveterinarians.net/SBCV WCV CONTRIBUTORS 06 18 Chair at UBC. He studied biol- good quality medical records. ogy at McGill and Oxford, and WEST COAST VETERINARIAN FROM THE CVMA PRESIDENT 08 SPECIALIST went on to co-found UBC’s ISSUE 24 VERONICA GVENTSADZE, COLUMN Animal Welfare Program where FROM THE CVMA-SBCV 10 MA, PhD, DVM, graduated EXTRACORPOREAL he still works and co-directs West Coast Veterinarian is the quarterly CHAPTER PRESIDENT from Ontario Veterinary BLOOD PURIFICATION this active research group. He magazine of the CVMA-SBCV Chapter College in 2008. She moved THERAPY was recently awarded UBC’s EDITOR FROM THE CHIEF VETERINARY 12 to Squamish, BC where she Killam Research Prize. Corey Van’t Haaff OFFICER FOR THE PROVINCE OF BC worked for two years as an Email: [email protected] associate veterinarian in a THE CVMA-SBCV CHAPTER WCVM 14 KATHRYN WELSMAN, DVM, COPY EDITOR small animal practice. She STUDENT LIAISON COLUMN graduated from OVC in 2007 Clélie Rich currently travels across BC as GLOBAL VETS IN AFRICA and practised emergency med- ART DIRECTOR a locum and enjoys learning icine in the Lower Mainland Paula Grasdal, CGD ANIMAL RESEARCH COLUMN 16 something new from each until moving to the Interior AD SALES NEW APPROACHES TO REGULATING ANIMAL RESEARCH practice. of BC and starting work as a Inga Liimatta september small animal locum. Email: [email protected] VETERINARY MEDICAL RECORDS 32 SUSAN HUGHSON, DVM, Phone: 604.420.0663 DATA COLLECTION ERRORS & OMISSIONS 28 practices small animal medi- CAROLINE YEUNG, RVT, gradu- MAGAZINE EDITORIAL COMMITTEE FALLOUT FROM THE QUEST FOR GOLD 34 RVT COLUMN cine in Vancouver and is a ated from Douglas College’s board member of Dying With Rick Stanley, DVM, Chair THE ELEPHANT Veterinary Technology program Sarah Armstrong, DVM A MULTIMODAL APPROACH TO 35 Dignity Canada. NATURE PARK IN in 2012. Since graduation, she Kathryn Welsman, DVM TREATING OSTEOARTHRITIS IN DOGS has worked at Eagle Ridge CHIANG MAI Animal and Bird Hospital in EQUITARIAN INITIATIVE IN COSTA RICA 38 Coquitlam, dealing with a variety of companion animals. MEDICAL ASSISTANCE IN DYING 40 She is currently indulging her CLASSIFIED ADS 41 travel bug working as an RVT in Australia. VETERINARY CONTINUING EDUCATION 42

FIND US ON FACEBOOK © 2016 CVMA-SBCV Chapter. No part of this publication may be duplicated or reproduced in any manner without CVMA-SOCIETY OF BC VETERINARIANS CHAPTER the prior written permission of the CVMA-SBCV Chapter. All efforts have been made to ensure the accuracy of information in this publication; however, the CVMA-SBCV Chapter accepts no responsibility for errors or omissions. #VetCareEverywhere

6 WCV WCV 7 FROM THE CVMA PRESIDENT

his year’s Animal Health Week will be celebrated from Octo- The National Examining Board (NEB) is providing ber 2 to 8 and will focus on One Health, showcasing that we DVM candidates with an opportunity to assess their are working together for the health of all. The CVMA invites skills prior to undertaking a live surgery during the veterinary clinics and hospitals across the country to cel- Clinical Proficiency Examination (CPE). The NEB, with Tebrate and share the message of Animal Health + Human Health + Planet the collaboration of subject experts from CPE sites, has Health = One Health with their clients. developed a process to ensure candidates can demon- In June 2016, as part of the Federal Action Plan on Antimicrobial Resis- strate basic surgical techniques as a prerequisite for tance and Use in Canada, the CVMA joined other like-minded stakeholders CPE registration. at the first Federal, Provincial, Territorial Antimicrobial Resistance (AMR) Each year, CVMA Provincial Practice Owners Eco- Steering Committee meeting held in Ottawa. The meeting responded to nomic Surveys are distributed to veterinary practices the need to engage stakeholders in human health and agri-food sec- across Canada. The 2015 survey gathered data in each tors (e.g., government, industry, health professionals, veterinarians, and province on revenue, expenses, fees, employee wages, licensing bodies) on efforts to develop a pan-Canadian framework and etc. Read the full article in the Business Management action plan on AMR. The CVMA presented its draft document “Overview of section under the Practice & Economics tab of the CVMA Veterinary Oversight of Antimicrobial Use—A Pan-Canadian Framework of website. Professional Standards for Veterinarians,” which provides a template for I, and the staff of the CVMA, value your continued veterinary oversight of the use of antimicrobials. support as a CVMA-SBCV Chapter member so we may The CVMA’s Animal Welfare Committee has formed a working group to continue to provide a voice for Canadian veterinarians. explore and address issues arising from the review of Bill C-246, the Mod- ernizing Animals Protection Act. Acting on advice from the working group, the CVMA sent a letter expressing support for the Bill to each Member of Parliament. The House of Commons debated this Bill in May 2016. More debate time will likely be allocated, where a vote will be required to move Troy Bourque, DVM, originally from it to Committee hearings. The CVMA hopes its letter to Members will aid Fredericton, NB, graduated from the in the passage of the Bill through the second reading, so our voice can be Atlantic Veterinary College in 2000. heard at the resulting Committee hearings. Dr. Bourque was a mixed animal X® DELIVEReS The World Small Animal Veterinary Association developed the veterinarian for 14 years in Okotoks, O coverag “Ketamine Campaign” to give its members the opportunity to stop until 2014, when he began work- rum . — VERAFLad-spect our mind the international rescheduling of ketamine. Called an “essential vet- ing as an emergency veterinarian 1,2 and bro ll ease y erinary medicine,” it is often the only agent available for anesthesia/ y wi at Fish Creek 24-Hour Pet Hospital ASSUREaDr safet eraf ox® analgesia and the principal agent used to facilitate feral dog/cat popu- in Calgary. He now also works at REST ocul e, V proven lients lov lation control via spay/neutering. The international rescheduling of Big Rock Animal Clinic in Okotoks, practicing small animal With s your c ketamine would effectively eliminate its clinical use in both veteri- medicine. Dr. Bourque was involved in the Alberta Veterinary form y-to-use nary and human medicine. The CVMA has asked its members to sign Medical Association (ABVMA) for 14 years and served on in eas the petition to secure the future of ketamine at www.change.org/p/ council from 2006 to 2012, and as president in 2010. He has ketamine-is-an-essential-medicine-and-should-not-be-re-scheduled. been involved with the CVMA for over five years on various The CVMA has updated position statements on Keeping Native or Exotic committees including the Executive Committee, the Commu- Wild Animals; and Partial Digital Amputation (onychectomy, declawing) of nications Advisory Group, and most recently as the Chair of Non-Domestic Felids and Other Carnivores Kept in Captivity. the Veterinary Pharmaceutical Stewardship Advisory Group.

Please join us in welcoming Dr. Troy Bourque as the 68th national president of the Canadian Veterinary Medical Association (CVMA). Dr. Bourque succeeds Dr. Nicole Gallant whose term came to an end in July 2016. LEAVE SECOND GUESSES BEHIND. YOUR 2016–2017 CVMA EXECUTIVE MEMBERS Dr. Troy Bourque, President Dr. Michelle Hicks, Executive Member Choose Veraflox® for treating skin infections and wounds in your canine and feline patients. Dr. Troye McPherson, President-Elect Dr. Nicole Gallant, Immediate Past-President Contact your Bayer representative or email [email protected] for more information. Dr. Terri Chotowetz, Vice-President Dr. Barry Stemshorn, Treasurer

1Freedom of Information Summary, 2012. NADA: 141-344. 2Messias A, Gekeler F, Wegener A, et al. (2008). Retinal safety of a new fluoroquinolone, pradofloxacin, ©2016 Bayer Inc., Mississauga, Ontario L4W 5R6, Canada TM 8 WCV in cats: assessment with electroretinography. Doc Ophthalmol. 116(3):177-191. ® see www.bayer.ca/tm-mc FROM THE CVMA-SBCV CHAPTER PRESIDENT Because worms shouldn’t be

ummer has come and gone in the blink of an eye, and a lot has At the end of the discussion, it became apparent that happened. I went to the CVMA convention in July in Niagara the solution to this dilemma rests mainly with border in the picture Falls and attended a few inspiring and thought-provoking control, and that the CVMA will have to tread lightly, meetings, the CVMA-SBCV Chapter is looking to develop an as enforcing such guidelines could have tremendous Sanimal welfare committee to support the work of the CVMA-run National backlash from the public who might see our actions as Animal Welfare committee, our own Jess Robertson attended the highly indications that we are not caring for rescue animals. talked-about and successful Emerging Leaders Program, and the Chapter is This is one topic which the CVMA-SBCV Chapter working hard to increase its social media platforms. hopes to discuss with our new Animal Welfare com- The hot topics at the CVMA convention were antimicrobial stewardship mittee alongside the CVMA National Animal Welfare and the importation of dogs into Canada. The CVMA Summit focused on committee this year. a discussion between veterinarians and stakeholders on the impact of Every year, the Chapter sends two veterinarians regulatory changes in antimicrobial use. In February, the CVMA created who have graduated in the past 10 years to the CVMA’s a document to act as a template of professional standards to be used extremely successful Emerging leaders Program—a by provincial veterinary licensing bodies when developing their own highly interactive program which seeks to bring joy regulations or bylaws pertaining to the use and oversight of antimicrobials. back into the workplace by teaching recent graduates The review of the document and discussion at the Summit was heated and how to cope with a variety of challenges encountered a good reminder to us all how important a topic this is. If our privileges of in veterinary practice. This year, our candidates were prescribing and dispensing antimicrobials are taken away, our patients will Jessica Robertson and Horace Yeung, and you can read suffer. The CVMA-SBCV Chapter is trying to help raise awareness of this their reports on the program in our winter issue. via social media and, in the coming months, we hope to be able to share Please don’t forget to register for the Chapter’s an- an antimicrobial stewardship video put together by the SVMA, which they nual convention on November 5 and 6. We promise have kindly allowed us to use for our members. you will have a great experience and hear from a list of The CVMA Convention’s first National Issues Forum focused on the wonderful, top-notch speakers. I hope to see you there. CVMA’s draft position statement on the issues surrounding importation of dogs into Canada. Importation of “rescue” dogs into Canada is at an all-time high. There is a certain ethical feel-good mentality to rescuing an animal which the public finds appealing. Unfortunately, this is accompa- Sarah Armstrong, DVM, graduated from OVC in 2007. Following nied by a public lack of education on the dangers and cost associated with graduation, she worked full time in rescuing one of these dogs from other countries. Several expert panelists Bayer · Drontal · Brands + additives examples general practice and worked part spoke about the dangers surrounding the lackadaisical border efforts on June 2012 time at a local emergency practice in monitoring entry of companion animals into Canada and the direct ef- Southern Ontario before moving to fect on animal and public health. At this time, there is limited regulatory Vancouver, BC, where she currently control of importation of dogs into Canada, and current requirements are works at the Vancouver Animal Brand additives no more than a health certificate and a current rabies vaccine certificate. Emergency Clinic. DE: Hund, Katze EN: Puppy, Dog, Cat FR: Chiot, Chien, Chat Drontal Drontal Drontal Drontal Drontal IT: Cucciolo, Cane, Gatto ES: Cachorro, Perro, Gato 230/20 mg Cat Cat XL Chat Gatos PT/BR: Filhote, Cão, Gato

DE: Fleischaroma CORRECTION EN: Flavour FR: Arôme Boeuf IT: Sapore Carne ES: Sabor Carne PT/BR: Sabor Carne IN RESPONSE TO THE CVMA-SBCV CHAPTER PRESIDENT’S REPORT IN THE JUNE 2016 ISSUE OF WEST COAST VETERINARIAN. Droncit Droncit Droncit I am on the board of Dying With Dignity Canada and have been working on the assisted dying file for several years. There has been some Intestinal parasites often go untreated in dogs and cats. In fact, ½ of dogs and ²⁄3 of cats seen within the past year by media coverage of the role veterinarians can play in normalizing end-of-life choice based on our experience in practice. I would like to Spot-on 50 mg 9 % make an important distinction with respect to terminology. The new legislation being formulated from Bill C-14, which passed June 17, is their veterinarian have not received a deworming treatment,* making zoonotic transmission a real threat to families. not human euthanasia legislation. It is legislation covering MAID — medical assistance in dying. The terminology is key on this issue. Recommending routine deworming with Drontal® protects pets against the most common types of intestinal worms—so families can stay close without unnecessary risk of disease. Susan Hughson, DVM Director, Dying With Dignity Canada

Please see the story on MAID on page 40 of this issue. Protect pets, protect their families. Drontal Drontal Drontal Drontal Drontal Drontal Drontal Plus Plus Plus XL Plus XL Large Dog Large Dog Comp. vet. tabl. *VetRx, 2014. [email protected] ©2015 Bayer Inc., Mississauga, Ontario L4W 5R6, Canada flavour1-888-663-5326 flavour flavour töflur 10 WCV Bayer, the Bayer Cross and Drontal are registered trademarks of Bayer AG, used under license by Bayer Inc.

BNYBOEF58293_West Coast Vet_Sept_Full Page Ad_8.5x11.indd 1 Drontal 5/19/16P 10:08 AM Drontal P Chien Chien Arôme boeuf Welpan Dronstop Drontal Drontal Drontal Chiot Chiot Puppy Pup FROM THE CHIEF VETERINARY OFFICER FOR THE PROVINCE OF BC

AVIAN INFLUENZA TRAINING SESSION

ritish Columbia has had to mount a response to an outbreak of Notifiable Avian Influenza (NAI) four times in the ten-year span between 2004 and 2014. Our poultry industry is centered in the OBESITY ARTHRITIS Fraser Valley, which is also where multitudes of migrating and + Bnon-migrating waterfowl, the carriers of this disease, spend time. It is clear A B that we need to be prepared to face the possibility of another outbreak. The response to the most recent outbreak in the winter of 2014–15 demonstrated how far we’ve come in our response preparation and The only way to treat both actions since the first outbreak in 2004. The province has focused on building stronger relationships between the industry, the CFIA, and the BC Ministry of Agriculture, on improved and faster NAI testing at the Animal is to work together Health Centre, and on training in the operation of the Joint Emergency C Operations Centre functions. Improvements have also been made by A. Stand-up planning meeting to start the process. the industry with higher mandatory audited biosecurity and mandatory B. Destruction team in biocontainment protective personal clothing premises ID, and with training in the operation of the Joint Emergency taking to the barn the manifold that distributes the gas. Operations Centre functions. C. Manifold set up in the barn. REDUCES BODY WEIGHT A Rapid Response working group was formed after the most recent BY 13% IN 60 DAYS1 outbreak. This group has focused on instituting changes to try to This training allowed for a practical test of sharing shorten the time from the first diagnosis of NAI to the containment and roles with other agencies. The training of local, diverse depopulation of that first barn. After each outbreak here in BC and also in groups of individuals who are prepared to support an IMPROVES MOBILITY the USA last year, exercises in lessons learned have indicated this to be emergency response will greatly assist in the contain- IN AS LITTLE AS 21 DAYS2 critical for containing the spread of NAI. Due to the nature of the disease, ment of this disease in future outbreaks. it has also been seen as supporting animal welfare to shorten the time The BC government also purchased new mobile that the birds are suffering from NAI. The Rapid Response working group equipment to support a timely disease containment targeted 48 hours from submission of birds to the destruction process. response through the efficient depopulation of barns For changes in this process to reach that kind of efficiency, training and with infected birds. practice are required. In May 2016, the BC Ministry of Agriculture partnered The exercise, though complicated and intense, did with the Poultry Industry and the CFIA to carry out such training in show that we have made great improvements and biocontainment and destruction on a Fraser Valley Poultry Farm to test resulted in additional people trained in critical tasks. ourselves. We hope that we never have to demonstrate this in a real outbreak and only continue to train and get better. THE PURPOSE AND SCOPE OF THE EXERCISE WERE TO: 1. Review the complexities of the processes required to control an outbreak of NAI. 2. Expand knowledge of destruction, biocontainment, and OSH Jane Pritchard, DVM, MVetSc, procedures. graduated from OVC in 1977, and 3. Develop a team of trained BC AGRI and BC Industry personnel on completed a Masters in Anatomic Pathology at WCVM in 2000, the use of CO2 destruction equipment. 4. Develop a team of trained BC AGRI and BC Industry personnel on continuing as an Associate Profes- PRESCRIPTION DIET® biocontainment procedures. sor in the Department of Pathology 5. Review and implement procedures for biocontainment, PPE, and for two years before embarking safety for all personnel involved in on-farm depopulation. on a career with the BC Ministry Metabolic +Mobility 6. Review and implement the logistics of setting up and managing an of Agriculture in 2004. With the Meet the world’s only proven single solution for both. on-farm depopulation. exception of a two-year international development project in 7. Increase local capacity to respond to a foreign animal disease. China from 2007–2009, she has remained with the BC Gov- Together we can help all of your patients at risk. ernment. In 2013, she was appointed to the role of Director of the Plant and Animal Health Branch, and Chief Veterinary For more information, talk to your Officer for the Province of British Columbia. Hill’s Veterinary Account Manager.

1Data on file. Hill’s Pet Nutrition, Inc. 2Data on file. Hill’s Pet Nutrition, Inc. 12 WCV ©2016 Hill’s Pet Nutrition Canada, Inc. ®/™ Trademarks owned by Hill’s Pet Nutrition, Inc. HillsVet.ca CVMA-SBCV CHAPTER WCVM STUDENT LIAISON COLUMN GLOBAL VETS IN AFRICA ADVERSE REACTIONS TO FOOD PHOTOS BY AMBER BACKWELL BY PHOTOS Taking purity to the next level aving recently returned home from two months of settings are as well-equipped and stocked as we are LEFT Lion in the Ngorongoro Crater, Tanzania; ABOVE Operating on an injured serval cat at the volunteering in Africa, I thought my first article should used to in Canada, due either to a lack of funding or NEW & IMPROVED Lilongwe Wildlife Rehabilitation Centre in Malawi. showcase that trip as the best way to introduce myself perhaps the scarcity of certain supplies or medications. Prescription Diet® z/d® as the CVMA-SBCV Chapter’s new student liaison. I There were many occasions where we simply had to am part of the WCVM Global Vets club, whose aim is make do with what was available; for instance, clinics an impact as fully fledged veterinarians, and in some situations we could Clinically proven to improve GI signs to send students who have just completed their second year of the DVM stocked only with surgical gloves that were much too only hope to watch and learn, but there were many times on this trip that in 21 days and derm signs in 30 days Hdegree to volunteer their time in developing countries. Members of the large for our hands, or not having the drug we were I felt we were having a positive impact on the animals and communities Crafted with highly hydrolyzed club spend their school year fundraising and planning what ultimately taught in school to use for certain situations. As frus- we were working with. What stands out in my mind is the time we spent chicken protein and a single purified amounts to an incredible, perhaps once-in-a-lifetime experience abroad. trating as experiences like these can be at times, they volunteering at the ZAASO animal rescue centre in Zanzibar. Upon our carbohydrate source There were eleven members of Global Vets this past year. Six of us challenge our skills and allow us to develop a resource- arrival, our host veterinarian expressed how grateful he was that we were Rich aroma, colour and new planned projects in Africa while the other five organized projects in India. I fulness and adaptability that will ultimately help us there because, with our help, the centre would now be able to sterilize a kibble shape dogs can’t resist cannot speak for the students who went to India, but I imagine their expe- become more confident veterinarians. It is important great number of animals on the island where over-population—and thus riences were equally as interesting and rewarding as ours. The Africa group to remember that, even as veterinarians in Canada, we hunger and poor health—is a serious issue. Similarly, ZAASO provides volunteered their time in four locations: 1) the Champion Wildlife veteri- won’t always have access to all of the resources that community clinics each week where farmers in the surrounding area nary practice in Rooiberg, South Africa; 2) the Lilongwe Wildlife Rehabilita- we had, say, at our university’s teaching hospital, but can bring their animals in for free or low-cost care and treatment. As the tion Centre in Lilongwe, Malawi; 3) the Zanzibar Animal Affections Society making the best choices with the resources that are livelihood of these farmers greatly depends on the few animals that they (ZAASO), an animal rescue and welfare centre in Tanzania; and 4) the available is what will be most important. have, it was very rewarding to be able to assist these people in helping Sokoine University of Agriculture veterinary school in Morogoro, Tanzania. Another benefit of volunteering abroad is, of course, their animals and in turn, these farmers and their families. During my time volunteering, I got to thinking about how fortunate we the opportunity to collaborate with and learn from In conclusion, I can say with confidence that all of us in Global Vets will all were to have such an experience and about the benefits that we, as well others in the veterinary profession. The exchange of develop into more competent and confident veterinarians because of our as those we were working alongside, accrued during our time in Africa. knowledge and ideas with students and professors experiences abroad. Personally, I will always be grateful for having had The most obvious benefit for veterinary students is gaining knowledge at Sokoine University is a prime example of this, and this opportunity and would urge both students and veterinarians alike to and skills related to veterinary medicine. From learning about anesthesia provided opportunities for both sides to gain a greater consider similar volunteer projects themselves. in wild game in South Africa, to trying our hands at spays and neuters in understanding of various aspects of animal health and Tanzania, the opportunities for learning were endless. To be able to gain welfare. Learning from each other’s experiences, and such practical, hands-on experience during our initial years of veterinary navigating the differences in opinions and ways of do- Amber Backwell was born and raised in London, ON, and school, when lectures and classwork predominate, helps us to fully grasp ing things, is beneficial for all involved. Likewise, there moved to BC in 2009 to pursue a Masters of Public Health. the concepts taught in the classroom and increases our confidence as vet- is no telling how professional connections made may She is looking forward to returning to BC upon gradua- erinary students. I know that numerous things I experienced during this benefit those involved in future endeavours. tion from WCVM to work in a mixed animal practice and trip will greatly benefit me in my final two years of veterinary school and Finally, I feel that the most rewarding aspect of our hopes to be involved in wildlife medicine one day. When in the development of my career as a veterinarian. time in Africa was that we were able to make a positive not in school, she likes to hike, camp, ride horses, and do HillsVet.ca ©2016 Hill’s Pet Nutrition Canada, Inc. ®/™ Trademarks owned by Hill’s Pet Nutrition, Inc. Spending time in Africa also gave us greater insight into working in contribution doing something we are passionate about. anything else involving the outdoors. She is currently in low-income settings, and brought home to us that not all veterinary Of course, as students, we can’t expect to have as great her third year of the DVM program at the WCVM.

14 WCV WCV 15 YOUR PURCHASINGAVAILABLE NOW GROUP! FROM ANIMAL WELFARE COLUMN

NEW APPROACHES TO REGULATING ANIMAL TREAT RESEARCH THEM RIGHT! BY DANIEL WEARY, D. Phil

sing animals in research has always been But even if committees had access to much better data on harms and contentious. The existence of a regulatory benefits, making a meaningful comparison may be impossible. For ex- framework, such as that provided by the ample, how can the harm (e.g., the suffering of 30 rats) really be compared Canada Council on Animal Care (CCAC), with the benefits (e.g., a 50 per cent chance of publishing a scientific paper, Uallows practices under certain constraints, and this a 10 per cent chance of contributing to basic biological knowledge, or a framework helps to legitimate animal experimentation 0.01 per cent chance of contributing to a new clinically relevant therapy)? socially, as well as legally. But how solid is our frame- In practice, almost every study proposed by researchers is currently per- work, and how might this be improved? mitted to proceed. The CCAC requires that all studies using animals One alternative to this utilitarian approach would be a simple prohibi- go through review by local Animal Care Commit- tion on certain types of studies that fall sharply out of step with commu- tees, and that these committees should only allow a nity values. Some elements of this approach are reflected in the current study to proceed if the harms caused to the animals European Union prohibitions on studies involving great apes and severe are less than the expected benefits of the research. harm to animals. By abandoning the pretense of a utilitarian analysis, we Unfortunately, the committees charged with making could also free Animal Care Committees to focus on the task that they this assessment struggle to assess both the real harms currently do best—implementing refinements that reduce harms that the caused to the animals and the potential benefits of the research animals experience. research. The current process relies upon the research- More fundamentally, perhaps the time has come to more radically er’s claims regarding both the harms and benefits. But re-examine our approach to the use of animals in research. For example, researchers, however well intentioned, are in an obvi- could some innovative and socially aware research institutions, such as ous conflict of interest given that their careers depend the University of British Columbia, move to end all studies that harm upon the study’s approval. animals? The entire debate about animal use in research is based upon One way around this conflict would be to ask for the idea that the projects are at least somewhat harmful to the animals, assessments from an independent third party, but in but what if living conditions provided to animals were such that their lives practice this does not occur. Animal Care Committees were as good as or better than that of a well-cared-for pet? What if the could also demand more explicit assessments of the only studies permitted were those in which animals freely participated, actual harms; for example, by using data on morbidity such as in learning studies where animals choose to participate to earn and mortality from similar studies completed by the food rewards or other treats? Or if research animals were actually pets same researchers. Similarly, independent, scholarly from good homes with the animals’ caregivers providing informed con- assessments of potential benefits (such as systematic sent, much like is required now for the parents of children participating in reviews that show which types of animal research have research studies? This would mean that certain types of harmful experi- and have not been helpful in the development of treatments would no longer occur, but the results from these better cared-for ments for human diseases) would provide a stronger animals might also better translate to applications that benefit science BECAUSE EVERY PET basis for evaluating the merit of future work. and our larger society. DESERVES A HEALTHY REWARD. 16 WCV © Royal Canin SAS 2016. All Rights Reserved. WCV 17 SPECIALIST COLUMN

EXTRACORPOREAL CASE STUDY 1 A one-year-old neutered male mixed breed dog presented to xtracorporeal blood purification therapy (ECT) is Small Animal Emergency service for ibuprofen toxicity. The Ethe circulation of blood through an external arti- patient and his housemate got into the owner’s bathroom ficial circuit connected to a hemofilter that performs BLOOD and chewed a bottle that contained 15 tablets of 800 mg blood purification (removal of toxins, gas exchange, Motrin. The owners did not find any tablets left. The owners or correction of metabolic abnormalities). The various contacted the pet poison control hotline and were instructed ECT modalities include intermittent hemodialysis (IH), PURIFICATION to give hydrogen peroxide to both dogs. The patient vomited hemoperfusion (HP), hemofiltration (HF), continuous once at home and twice on the way to the emergency hospi- renal replacement therapy (CRRT), peritoneal dialysis, tal. The time elapsed between the ibuprofen and presenting and plasmapheresis (PE). THERAPY to the emergency room was about two hours. The types of ECT system most utilized in both hu- Upon presentation, the patient was ataxic and unaware man and veterinary medicine are IH and CRRT for the BY CARSTEN BANDT, DVM, DACVECC of his surroundings. Within five minutes of his arrival, he treatment of acute and chronic kidney diseases. began oscillating between a hyperactive state and a later- In human medicine, ECT has been recommended ally recumbent state. About five minutes later, the patient for many decades as a treatment option for serious became semi-comatose. His temperature on presentation intoxications with drugs (e.g., salicylates, lithium, eth- was 102.3F, heart rate was 69 beats per minute, and his ylene glycol, methanol, and theophylline). As a general respiratory rate 96 breaths per minute. His capillary refill rule, ECT is considered in cases of intoxications when time was less than 2 seconds, and his systolic blood pressure there is a history of ingestion of a highly toxic (poten- was 120 mmHg. tially lethal) dose, and when the toxin can efficiently be A peripheral IV catheter was placed, and he was given removed with one of the modalities of ECT. fluids (LRS) as well as oxygen support. Blood was collected Whether extracorporeal removal of toxins is pos- for a complete blood count (CBC), serum biochemistry, and sible or not depends on the characteristics of the toxin blood gas analysis. The CBC revealed a mild leukocytosis itself and the technique used. There are several differ- (9.2 K/uL). Serum biochemistry revealed increased AST ent modalities of ECT that can be used in cases of in- (57 U/L) and increased phosphorus (6.3 mg/dL). The blood toxication (e.g., IH, HF, CRRT, and PE). Factors effecting gas did not reveal any significant abnormalities. He did not the removal of toxins are protein binding, lipid binding, respond consistently to supportive treatment, so char- molecular weight, and volume of distribution. coal hemoperfusion was elected in an effort to remove the In general, toxins or drugs with a small molecular ibuprofen from his circulation. A hemodialysis catheter was weight, low protein binding, and a low volume of dis- placed, and charcoal hemoperfusion was performed. The tribution can be removed with a conventional hemo- patient’s weight before dialysis was 32.8 kg, and after treat- dialyzer. A good example is ethylene glycol, which is ment it was 25.3 kg. The patient remained stable through hydrophilic and has a small molecular weight, allowing the procedure. The treatment lasted 4 hrs, and samples were it to be removed very effectively from the blood stream obtained at 15, 30, 60, and 90 minutes during the procedure with a conventional hemodialyzer. Toxicities from for LC-MS. After treatment was completed, the patient was substances with high protein or lipid binding require bright, alert, and responsive, and had a normal physical a different approach. A typical example would be an examination. He was continued on LRS at 50 ml/kg/day with overdose with naproxen, which is rapidly absorbed in added 16 mEq of KCl overnight. While in the hospital, he re- dogs after oral ingestion. It is highly protein-bound ceived Pantoprazole IV (1mg/kg) every 24 hrs, Famotidine IV and has a very low volume of distribution. It cannot (0.5 mg/kg) every 12 hrs, and Sucralfate 1 gram in slurry by be removed by a conventional hemodialyzer due to its mouth every 6 hrs. The patient was discharged the next day. high protein binding in dogs. Charcoal HP is a modality

18 WCV WCV 19 20

WCV THROUGH CHARCOALGRANULES

CONTINUOUSLY CIRCULATED “ DURING THEPROCEDURE, treatment ofibuprofen intoxication indogs. the first reported useof charcoal HPas asuccessful sive fluidtherapy. Thefollowing casestudy describes emesis, activated charcoal administration, andaggres nary medicineare decontaminationby inductionof methods oftreating ibuprofen intoxication inveteri perimentally toproduce acuterenal failure. The typical 50-100mg/kg, andadoseof 300mg/kgisrequired ex also increased. The reported toxic doseofibuprofen is andintoxication ofsmallanimals has tal ingestion increased inthehumanpopulation, andtheacciden nary medicine. Conversely, theuseofthisNSAIDhas in dogs; therefore, itisnotcommonly usedinveteri hepatic toxicity. Ibuprofen hasanarrow safetymargin over-dosagesingest ofNSAIDSare gastric, renal, and most commonsideeffectsseenincaninepatientsthat gastro-protection, andrenal blood flow. Someofthe physiologic functionssuch asplateletaggregation, mediate inflammationandpainas well asother ing theproduction ofprostaglandins. Prostaglandins by inhibitingcyclooxygenase (COX), thusdecreas ties. Non-steroidal anti-inflammatories(NSAIDs)act andanti-inflammatoryused foritsanalgesic proper the countersince1984. Inhumans, inflammatory thathasbeen agent available over Ibuprofen isanon-steroidal, non-narcotic anti IBUPROFEN TOXICITY charcoal aswell asthetoxins. mia, asthesecellsandmoleculestendtobindthe cytopenia, leucopenia, hypocalcemia, andhypoglyce associated totheuseofcharcoal HPinclude thrombo because ithasfewer complications. Complications IH orHP, then IHshouldbethemodalityofchoice, toxins. Ifasubstanceisequally well removed by either as protein-bound and, toalesserdegree, lipid-bound removes moleculesinthe1000–1500kDarange aswell in circuit withthedialysis filter. Charcoal efficiently common typeoffilterusedinHP, canbeusedaloneor systemic circulation. Charcoal hemofilters, themost ing tothefiltermaterialandeliminateitfrom the is able toadsorbthetoxin from theblood by bind containing asorbentmaterial(e.g., charcoal), which protein-bound toxins. This methoduses ahemofilter of ECTindicatedforcasesintoxication withhigh THE PATIENT’S BLOODIS

it iscommonly ” ------HP treatment. recovered wellandwas senthometheday afterthecharcoal HP didnotshowany significantabnormalities. The patient laboratory for evaluation. after startingtreatment. Those sampleswere alsosenttothe filter andrightafterat30, 60, 120, 180, and 240 minutes were alsocollectedfrom bloodbefore reaching thecharcoal significant concentration ofibuprofen at478ug/mL. Samples concentrations ofacetaminophenor Aspirin, butthere was a to thelaboratory. Inthissample, there were nosignificant (collected from thepatientwhen first presented) was sent phy—mass spectroscopy (LC-MS). The pre-treatment sample levels. The sampleswere by analyzed liquidchromatogra Racing Laboratory for Aspirin, ibuprofen, andacetaminophen to theUniversity ofFloridaCollege Veterinary Medicine and afterinitiationoftreatment. These sampleswere sent continued for four hours afterpresentation totheemergency room and HP was performed. Treatment withcharcoal HPstarted large dosagesofibuprofen andacetaminophen, charcoal received 250mlofLRS. Given thehistoricalingestionof the incisionsite. Duringtheanestheticperiod, thepatient 0.1 mgIVofGlycopyrrolate and10mgofLidocaine SQat was maintainedwithSevoflurane; thepatientalso received and theninducedwith100mgofPropofol. Gasanesthesia the patientwas pre-medicated with 5mgIVofButorphanol placed intherightjugularvein. To placethedialysiscatheter, hours for acetaminopheningestion. A dialysiscatheterwas mg diluted1:3withD5W)was administered IVevery eight and then0.9%NaClat100ml/hr. N-acetylcysteine (250 nation, thenIVfluidsconsistinginitiallyoflactatedringers, by mouthimmediatelyuponpresentation for oral decontami total solids6.3g/dL. The patientreceived activated charcoal and ahyperlactatemia of3.6mmol/L. The PCVwas 56%and acidemia at7.38, amildlydecreased pCO and bloodchemistry. Venous bloodgasrevealed amild a bloodsamplesubmittedfor PCV/TS, bloodgasanalysis, malities observed. An intravenous catheterwas placed, and as more quietanddepressed. the vomit thenbecamefoamy. The ownerdescribedthedog colour andcontainedaboutfive pillsandsome food material; vomited alarge volume afterwards. Initially, itwas dark in was otherwisehealthy withnootherhistory ofillness. He ingested oneDoans(magnesiumsalicylate, 850mgtabs). He proximately 50ibuprofen tablets(200mgeach). Healso (500 mgacetaminophenand65caffeineeach) andap after ingestingaboutfour Excedrintensionheadache tablets terrier presented totheEmergency andCriticalCare service A nine-month-old, 17.8kilogram, neutered male Wheaten CASE STUDY On physical examination, there were nosignificantabnor Blood gasanalysisandserumbiochemistry aftercharcoal

four hours. 2

Serum was collectedbefore, during, 2 at28.5mmHg, - - - - mulation ofthedruginthird spacessuch asfat. After the liver, toexhaustion ofthecharcoal filter, oraccu the entero concentration ofibuprofen thatcanbeattributedto 60 minutes to120minutes, there isanincrease inthe plasma concentration from 90ug/mLto25ug/mL. At hour oftreatment. There isasignificantdrop inthe creased aftercharcoal HP, especially duringthefirst how theconcentration ofibuprofen inplasmade and about 25%excreted inbile. Figure 1demonstrates fen slowly withmore than50%excreted intheurine of thedrugisprotein bound. Dogs metabolize ibupro and,3 hourspost-ingestion afteroral ingestion, 96% plasma concentration occursbetween 30minutes to is rapidly absorbed afteroral administration. The peak Ibuprofen isanon-selective COX inhibitorNSAIDthat DISCUSSION before (diamond) andafter (square) charcoal HP. Figure 2 Pre- andPost-Charcoal Hemoperfusion CASE 2Concentration of Ibuprofen before (diamond) andafter (square) charcoal HP. Figure 1 Pre- andPost-Charcoal Hemoperfusion CASE 1Concentration of Ibuprofen hepatic recycling thatthisdrugundergoes in

Plasmaconcentration-time profile of ibuprofen Plasma concentration-time profile of ibuprofen

- - - before treatment andabsorbed lessthan thepatient patient inCaseStudy 2 vomited most of theibuprofen higher thaninCaseStudy 2. Itispossible thatthe tion inplasmaofibuprofen inCaseStudy 1was much paring Figures 1and2, we can seethattheconcentra more significantclinicalsignsatpresentation. Com on thehistory thanthepatientinCaseStudy 2buthad patient appeared lessoftheibuprofen toingest based Study about 1ingested 366mg/kgofibuprofen. This the 600mg/kgreported lethaldose. The patientinCase dose thatcancauseacuterenal failure andjustbelow mg/kg, well beyond thepreviously cited300mg/kg treatment. the plasmaconcentration ofibuprofen before andafter 120 minutes, inCaseStudy 2, there isnodifference in The patientinCaseStudy around 2ingested 560 cases ofibuprofen toxicity. a first-lineprotocol insevere ment shouldbeconsidered as tration ofibuprofen. This treat reducing theplasmaconcen to beaneffective methodat cases presented, itproved from theplasma. Inthetwo membrane andare adsorb stances easily pass through the the granules, buttoxic sub protect theblood encapsulates coal granules. A membrane to ously circulated through char the patient’s blood iscontinu cations. Duringtheprocedure, helpful incasesofdrugintoxi capacity ofactive carbon. Itis that usestheadsorption points forCaseStudy 1. cases, andthere are fewer time different timesinboththese the sampleswere collectedat It’s importanttonotethat was saturated withibuprofen. for thiswould bethatthefilter in CaseStudy 2, andareason did notdecrease asmuch as Study 1, theconcentrations absorption ofthedrug. InCase this may have decreased the vated charcoal aswell, and Case Study 2received acti in CaseStudy 1. The patientin Charcoal HPisamethod - ed ------

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WCV WCV

MENTAL HEALTH AND VETERINARIANS

BY KATHRYN WELSMAN, DVM

ental health and veterinarians. What a topic. When I offered to write an article about it, I obvi- Mously didn’t think it through as I don’t have any expertise in this area except for the fact that I’m a veterinarian. And apparently, because I’m a veterinarian, I’m at a higher risk of suicide and other mental health concerns such as compassion fatigue. Consistently, papers and reviews indicate that veterinarians have a higher suicide rate compared to the general population. Nobody told me that when I dreamed of becoming James Herriot.

WCV 23 The recent suicide of Dr. Sophia Yin, who was well known for her work animals or seeing dead animals that I had turned that com), he is an expert in emergency psychiatric care, There is no one to unload on, as many veterinarians would be very reluc- around less stressful veterinary care, pushed the topic of suicide and men- part of my brain off. This police officer made me look and he has treated many veterinarians in his lengthy tant to discuss emotions or problems with their technical staff. I remem- tal health into the spotlight among veterinary professionals. It coincides at what I do in a different way. It made me realize that career—usually at a time when they are in acute crisis. ber, early on in my career, euthanizing an elderly dog. I calmly explained with a growing discussion among Canadians in general about mental what we do can be difficult, emotionally draining, and I asked him why veterinarians are at a high or higher the process to the owner and euthanized the dog. Afterwards, the assistant health. Despite this growing awareness, there is still a stigma attached traumatizing to ourselves and colleagues. risk for mental health crises than many other pro- asked me why I wasn’t crying. She was crying and was honestly perplexed. to these discussions as well as a lack of knowledge and understanding. I The house fire had expected tragedy attached to it. fessionals. He said it is a chicken-and-egg scenario. It made me feel like a bad person because I hadn’t cried. In hindsight, definitely fell into the ignorant category until more recently. However, I’ve also learned over the years that some- The profession demands and attracts high-achieving she was grieving, as she had known the dog for much longer than I had, My husband is a police officer who sees some terrible things, and I times, when you least expect it, an emotional curveball perfectionists who jump through many hoops not only and I didn’t have the same emotional attachment. Did I think she was worry constantly about mental well-being for him and his co-workers. comes your way. I was examining an elderly golden to get into vet school, but also to succeed until gradu- weak because of her tears? I probably did, just like maybe she thought I But I never really worried about myself, nor did I understand why veterin retriever for fairly non-specific signs. She looked quite ation. Those exact same traits can be our downfall was cold-hearted for not crying. Had we taken a moment to talk about it, arians would be at risk for such workplace occupational stress. In my healthy outwardly, but there was just something about as we ourselves can be our biggest critics and expect maybe there would have been a greater understanding of where each of us mind, what we do doesn’t fall into the same category as responding to a her that made my Spidey sense tingle. I asked the perfection from ourselves once we set out into the was coming from, instead of judging each other. car crash fatality, having to shoot someone to protect someone else, or owner, a man in maybe his mid-40s, some questions, fast-paced world of veterinary medi- having to investigate and delve into so many other unsavoury topics that and finally he said, “Do you think stress could cause cine. I remember one occasion when a the general population shies away from. So, even though I had been told in this?” I said, “Sure. Why do you ask?” He said, “Well, technician came up to me after a dog, vet school that veterinarians are the second highest professionals to com- my son is dying, and he was admitted to hospice to who had been hit by a train, died dur- “IT DOES TAKE A LOT OF STRENGTH AND mit suicide, I didn’t really “get” it. die this morning.” I sat there speechless, and I just ing a blood transfusion. She felt like Because of my ignorance or lack of understanding, I remember won- couldn’t get my brain to re-engage. I had been thinking she’d been responsible for the dog’s RESILIENCE TO CONTINUE TO FACE DEATH dering how someone like Dr. Yin could commit suicide when, from an that this dog probably had cancer, and that’s bad luck, death as she was the one monitor- outsider’s view, she had a flourishing and respected career in something and wondering how to open that discussion. After that ing the dog. I remember thinking it AND MAKING THE DECISIONS TO END LIFE” she obviously loved. So, I asked Dr. Sally Foote, a long-time friend and bombshell of an announcement, there was just no way, was absurd of her to worry, as it was co-worker of Dr. Yin’s, what caused her to commit suicide. She said, “No absolutely no way, that dog could have a bad diagno- ultimately my fault the dog died. In one can say what was going on in Sophia’s life that was a deciding factor sis. She had to live. I asked the owner if he wanted to hindsight, I should have been open to for her to choose death over life. Only she knows that. I feel we all want leave her with me for care if that might alleviate some her concerns, but at the time I brushed her off and said I used to work in an emergency practice. I loved the fast pace and type a logical or causal explanation for a suicide. We look at their life through stress. His response was that she had to come back not to worry about it. What was probably equally ab- of medicine and thought I was well suited to the job. But after several years our own experiences to find an answer that is actually dismissing their with him, as the dog had work to do at home. I as- surd was thinking I was responsible for the dog’s death, of euthanizing as many animals as the hours I worked, I started to not look personal story.” I would agree. I know that when I hear about tragedies, sumed he meant the dog was a comfort to the family. seeing as I wasn’t the train that ran over the dog. You forward to my shifts. We talk about death a lot as veterinarians and even whether it’s suicide or a horrific accident, I always want to know why it His son died the next day of brain cancer, and the dog can’t save them all, and that is a hard lesson to learn. more so in emergency practice, probably. Here are some interesting figures happened, because I want to assure myself it won’t happen to me. It is a died several weeks later of cancer. I mean—really—you Dr. Furlong thinks that, in addition to our own per- for one of those emergency shifts. Euthanizing 12 animals + 4 discussions protective measure. But to understand suicide and the continuum of other can’t make this up. Our jobs demand us to be emotion- fectionism, society puts enormous pressure on us to about the possibility of death + 2 CPR events + 2 DNR forms signed = 20 mental health concerns such as compassion fatigue, I realized I had to be ally involved in our cases even if we just don’t have be perfect as well, as society today is less accepting of discussions about death. Seriously, who talks about death that much, day open to the idea that there might not be a simple, straightforward answer. the desire or energy. We are being asked to listen to the errors. He relayed a story to me of when he was doing in and day out? It certainly isn’t the norm in most people’s jobs. I asked Dr. I look back on an event from a few years ago when I had a bit of an human story behind the animal and to feel so many his residency, and he met a young female veterinarian Furlong about this issue and whether veterinarians see death in a more aha moment. We were living in a very rural community, and my husband human emotions. If I hadn’t known the story of the in her mid-30s who was in the ICU in a very compro- sterile way than the general population, which could lead to an easier called me in the middle of the night to come to a house fire, as there were son, maybe I wouldn’t have felt such intense pressure mised state after a suicide attempt. He remembers justification for suicide. He says that the way veterinarians perceive death two dogs that had been trapped in the fire. Unfortunately, one of the dogs to play God and make that dog better no matter what. wondering what would drive a person, with such high is something addressed in the literature, but he doesn’t know of a concrete had died, and the other was probably in the worse respiratory distress I Anything short of fixing the dog was going to be a fail- standards and obvious intelligence, to suicide. It came answer that says our exposure to death leads us to a mental health crisis. had ever seen. I had a discussion with the surviving family members about ure, which is a pretty heavy burden to carry. to light that this veterinarian had just been going He indicated that it is very rare for someone to suffer an acute mental getting the one dog to the local clinic for treatment or euthanasia and This is likely not news to Dr. Brian Furlong. As chief through a complaint to her College, and it had been the health crisis because of one factor; it is usually multi-factorial, with issues about the aftercare for the deceased dog. I remember a moment later one of staff for Homewood Health (www.homewoodhealth. breaking point for her. He went on to say that, through- in both personal and professional realms, but there is often a tipping point of the other police officers saw me lift the dead dog out his career, a common theme for veterinarians in that moves us from coping to not coping. Already long hours now exacer- into the back of my truck. He looked at me and said, crisis has been the stress of a College complaint, and bated by technology, demanding clients, the ever-present and annoying Dr. “How can you do that? Doesn’t it bother you?” At first among professional groups, veterinarians are particu- Google, clients with unrealistic expectations, financial burdens from em- I didn’t understand what he meant. Then, I realized larly reluctant to reach out for help during a complaint ployers or clients, trying to juggle family and work, not taking time away he was asking how I could handle the dead dog along “AFTER SEVERAL YEARS process as we don’t want anyone to know what we are from the job, managing employee conflict, lack of resources to do your with the currently suffering dog and the remaining going through. We are ashamed to show our perceived job properly, poor management, feeling trapped in this profession—take family. I was truly astonished. Here was a police officer OF EUTHANIZING AS imperfection. This can be very isolating and can your pick. Whatever the issues may be, you also then need to factor in the who had just come out of a house where two people increase someone’s stress level to the point of depres- personal side of things that might tip the scales such as being a new par- were dead, and he was having trouble with the dog’s MANY ANIMALS AS THE sion and, potentially, suicide. This isn’t to say, however, ent, dealing with a sick family member, financial concerns, student debt, death. It was in that moment, standing in the dark that every veterinarian who receives a complaint is divorce, or previous medical conditions. with the smell of smoke and the sound of a weeping HOURS I WORKED, I suffering from mental health issues, but the complaint Dr. Foote added her opinion to these risk factors, saying, “Shame is a person, that it really hit home; as veterinarians, we becomes another risk factor. huge factor. If we are not the highest producing, most intelligent, en- do things that other people wouldn’t dream of doing STARTED TO NOT LOOK Dr. Furlong also believes that because we operate in ergetic, loyal, generous with our time and expertise at the cost of our and would consider difficult. That moment is etched very small teams with little support, compared to phy- personal life, we are not good veterinarians and that is shameful. If we into my brain. I had become so used to euthanizing FORWARD TO MY SHIFTS” sicians in big hospital settings, this can be isolating. have money problems, that is shameful. If we have addiction problems,

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support-resources documents/mental-health- www.canadianveterinarians.net/ resources available at: is also alist of mental wellness (604.243.8996).Health There narian inBC can call Homewood and itisconfidential. Any veteri some help, there isplenty available, who thinks heorshemightneed information orfor any veterinarian For veterinarians seeking more attempt. or leading upto anactualsuicide term for suicidal thoughts priorto Suicidal ideation any workplace. due to work, whichcan happenin tionally overextended anddrained Burnout suffering be empathetic to theperson whois reduces thecaregiver’s ability to exceed your personal resources. It curs whenthedemandsof caring of others. Compassion fatigue oc experiences thepain orsuffering veterinarians, where thecaregiver acting incaregiver roles, suchas natural consequence for those situations. Itissomewhat of a tive exposure to highlyemotional emotional resources dueto repeti Compassion fatigue TERMINOLOGY SOME BASIC is defined asbeingemo isageneral . is theloss of

- - - interested inlearningabout otherpeople. However, suicideisnotsomething sion fatigueattimes. ButIamanemotionalpersontobegin withandam I definitely have afew thoughtsonthematter;” and “Icansay Ifeelcompas ate personwhoiscurrently battlingsomeburnoutandcompassionfatigue, spectrum reflected personal experiences: “As apossibly overly compassion the range ofattitudestoward mentalillness. Answers from oneendofthe coworkers, whodidgive meaninteresting mixofresponses, which reflect to bethefirstspeakup? Then, Ipostedamessage toallof my friendsand dered ifthetopicwas taboo, goingback tothatissueofstigma. Who wanted the low response, from simpledisinterest tobeingtoobusy. Part ofmewon around 70people—only two responded. There are many possible reasons for graduating classonFacebook, andofallwhosaw thepost—which was I broached thistopic. Itwas aninteresting mix. Ipostedaquestiontomy bad vet? So, I hadtowonder whatmy friendsandcolleagues would say if health issues. Will Ibeperceived asweak? LikeIcan’t hack it? That I’ma still amajorfactorforveterinarian consideringseekinghelpformental that makestheproblem worse.” change ourcareer, thatisshameful. From thatshame, there issilenceand that isshameful. Ifwe have mentalhealthproblems, thatisshameful. Ifwe help isthatthey reach outtotheright resources it. andget help someonewhenyou leastexpect it. And my hopeforthosewhoneed hope isthatthisarticlesparks aconversation inyour practice asitmight deals withthingsdifferently, andthat nooneisweak orcan’t hack it. My create amentalhealthcrisis. To beopenmindedtothefactthateveryone understand how theperfectstormofissues, sometimes outoftheblue, can while consideringthistopic—andIhopeyou willconsiderit, too—isto profession asablessing indisguise. The pointoftheexercise Iwent through mental illness, I’mlooking at my “forced” slowdown from theveterinary stay-at-home momthesedays. could. This hasmademedoubtmy abilities andmy decisiontobeamostly because I’munable andunwillingtostay forextended hoursasIpreviously because neitherisbeingdone “perfectly.” Ifeellikealessvaluable employee its own setofstressors. Ifeelthatcan’t beagoodvet andagoodmother my skillsandknowledge were slippingthrough my fingers, which created backanxious toget towork fulltime, back andget tothegrind. Ifeltlike has created stress atwork thatInever thoughtwould exist. At first, I was I am, however, arelatively new motherwithtwo young children, andthis person, noonementionedsuicide. Stigma? comfortable talkingabout compassionfatiguebut, withtheexception ofone I thoughtwas equally interesting was thatthosewho responded seemed tigue doesn’t exist, you eithermakeitinthisprofession oryou don’t.” What pretty goodatkeeping my jobandemotionsseparate;” and “Compassion fa as “I don’t considermyself compassionate, soIcan’t fatiguefrom it. I’m away atself-worth.” At theotherendofspectrumwere statementssuch industry draws incertainhighly emotionalindividuals. Over time, itchips Certainly notaprofession forthefaintofheart;” and “I would say thatour resilience tocontinue to facedeathandmakingthedecisionstoendlife. but seemedtobeaware oftheconcerns: “It doestakealotofstrength and I worry about personally.” Somedidnot, perhaps, have issuesthemselves Dr. Furlongsays thateven thoughwe have comealongway, stigmais However, afterimmersingmyself inthetopicsofcompassionfatigueand Personally, I’mnotsufferingfrom compassionfatigueoramentalillness. - - - -

IMAGES BY VALENTINA PHOTOS & HAVER / SHUTTERSTOCK.COM VetPen adENOVMA.indd 1 of differentdosingincrements/maximum dose: MERCK® isaregisteredtrademark ofMerckCanadaInc.©2016IntervetCorp. Allrightsreserved. CANINSULIN® andVETPEN® areregisteredtrademarksofIntervetInternationalB.V. Usedunderlicense. • 1IU/16IUwhenalargerdose isneeded • 0.5IU/8IUwhenafinerdose adjustmentisneeded VetPen that drivesconvenienceandcompliance Innovative andaccurateinsulin delivery VetPen ® isavailableintwosizesprovidingaconvenientchoice When accuracyandprecision matter mosttoyourclients ® IsonTarget 2016-01-21 2:04 PM RVT COLUMN

THE ELEPHANT NATURE PARK IN CHIANG MAI

BY CAROLINE YEUNG, RVT

28 WCV WCV 29 t is 6 am on a balmy November morning in Northern Thailand. My If an elephant survives Phajaan, it becomes a shell of legs have wrestled themselves out from underneath my blanket, what it once was. Tourists who ride elephants, watch “HER LOVE FOR ELEPHANTS and I can hear the gentle whirring of the oscillating ceiling fan. them play soccer, buy paintings done by elephants, or BEGAN WHEN HER My state of mind is a jetlag-induced fog, and suddenly I’m startled go to the circus, do not realize the pain and agony ele- awake by the powerful trumpets of a herd of elephants. How is that phants go through to allow these activities to happen. GRANDFATHER, A TRADITIONAL for an alarm clock? ENP founder Sangduen “Lek” Chailert is small in HEALER, RECEIVED A BABY IThat was my first morning of two weeks volunteering in November 2015 stature, but big in heart and determination. Born in at Elephant Nature Park (ENP) in Chiang Mai, Thailand. ENP is a rescue and 1962 in a small hill-tribe village in the mountains of ELEPHANT AS PAYMENT FOR rehabilitation centre for abused, neglected, and distressed Asian elephants Northern Thailand, her love for elephants began when SAVING A MAN’S LIFE” who have been rescued from all over Thailand from industries such as log- her grandfather, a traditional healer, received a baby ging, trekking, street begging, and tourism. Founded in 1996 by Lek Chailert, elephant as payment for saving a man’s life. Lek de- ENP is now home to 68 elephants, 400 dogs, 200 cats, water buffalo, cattle, veloped a close bond with this elephant, and a lifelong horses, and myriad other animals. passion dedicated to the welfare of Asian elephants The Asian elephant is considered an endangered species by the Interna- was born. Being an advocate for change in an industry related to obesity. Some of the elephants are land-mine victims tional Union for Conservation of Nature. At the beginning of the 20th cen- steeped in tradition has been an uphill battle, but with and need daily foot care for the rest of their lives. tury, over 100,000 elephants roamed across Asia, but that number has fallen hard work and determination, her voice is now glob- The veterinarian and trainer work together with the el- by more than 50 per cent. It is estimated there are fewer than 30,000 Asian ally recognized. She was named one of Time maga- ephants in both protected and free contact. Protected contact is elephants remaining—with 4,000 of those living in Thailand where they zine’s Heroes of Asia for her work in conservation in when there is a physical barrier between the elephant and the are the country’s national symbol and a cultural icon. Threats to the Asian 2005. She rescued her first elephant named Mae Perm person, so they do not share the same space. All behaviours in elephant population include habitat loss and fragmentation, human-wildlife in 1992 and founded ENP in 1996. protected contact are completely voluntary, and it is up to the conflict, and poaching. Developmental projects, agricultural plantations, and elephant to participate. Free contact is when the person and an ever-expanding human population encroach on the elephant’s remain- I have always loved travelling and experiencing new elephant share the same space. This can be more dangerous ing habitat. As Asia’s population increases, more of the elephant’s habitat cultures, so I started looking into volunteer opportuni- as the person is more vulnerable. The mahout, the elephant’s is transformed into farmland, leading to human-wildlife interactions and ties abroad that I had access to as an RVT. ENP sparked caretaker, is more relied on to be able to control their elephant conflicts. These confrontations are now considered to be the leading cause my interest because they have a program specific for and keep them calm. of elephant deaths in Asia. Poaching is not as severe a threat as it is to their veterinary professionals. This program is open to qual- My days at the park would start around 7:30 am and end at African counterparts, but Asian elephants are still hunted for their tusks, ified veterinarians, veterinary technicians, and veteri- 4:30 pm. I spent the day shadowing one of the veterinarians meat, and skin. They are also captured in the wild to be used in the live nary students. Applicants must commit a week’s worth and assisting with the daily treatments. Treatments would be done in the elephant trade. of time to the park, and stays can be up to four weeks. morning before the elephants were allowed out of their shelters, and again Elephants are social animals. They’re capable of feeling love, happiness, ENP employs three elephant/large animal veterinari- in the afternoon when they came back. Some treatments were done on site pain, and sorrow, and they depend on their family and friends for support. ans and one small animal veterinarian. They also have at the park and some off site at a neighbouring camp. If the veterinarian It is not in a wild elephant’s nature to listen to people, obey commands, a small animal clinic on site for cats and dogs, as they needed to perform a treatment on an elephant in a family group, I would perform tricks, or allow strangers to ride them. To accomplish these feats, have a dog rescue sanctuary where dogs are adopted work with the trainer and other park staff to distract the other elephants a wild elephant is captured as a baby, taken away from its mother, and put out all over the world. Every dog and cat at the park is with food so the veterinarian could isolate and work on that one elephant. through a torturous process called Phajaan. The elephant’s spirit is broken, also spayed or neutered. Each elephant veterinarian is Team work and a game plan were the keys to our success. Luckily for us, and it is taught to fear and obey people. It is tied down and beaten for responsible for 20 or so elephants, and a visual health elephants are very food-motivated. They eat nearly 400 lbs of food a day! days or weeks on end with bull hooks, bamboo sticks, and metal spikes. It check is performed at the start of every day. The most I was also involved in helping treat an ear injury on an elephant named is struck on the ears and trunks (the most sensitive areas), not allowed to common ailments are abscesses, foot conditions, colic, Khampaan. Almost half of her ear had become necrotic and sloughed off, sleep, and not given food or water. The pain and deprivation are constant. eye conditions/injuries, various wounds, and problems so she required wound treatments twice a day. Other procedures I observed were blood draws, enemas, X-rays, various wound treatments on skin and feet, eye treatments, and rectal exams. The technical skills I developed in companion animal general practice did not come into play very much working with elephants, but I expected that going in. Being an RVT, however, allowed me to have access to a unique experience working directly with the elephants. I take great pride in being an RVT, and for me it goes beyond my job description at my workplace. It means giving back to the community, locally or globally, and donating my time, skills, and money to animal welfare causes. ENP provided an enlightening and eye-opening experience that I will hold close to my heart for the rest of my life. Elephants are such beautiful beings that have been mistreated for far too long. While it was ABOVE (FROM TOP) Treating heartbreaking to see the lasting damage firsthand, I am very thankful that an ear wound; the author poses with an elephant resident at ENP. Elephant Nature Park exists where they are now free to just be. PAGE 30 (FROM LEFT) A nursing To learn more about the park, how to donate, or how to volunteer, visit elephant; feeding time. www.elephantnaturepark.org.

30 WCV WCV 31 “IT IS CRUCIAL TO REMEMBER THAT THE MEDICAL RECORD IS LEAST OF ALL FOR THE VETERINARY VETERINARIAN WHO WROTE IT” MEDICAL

įį Many have no assessment, +/- no rule-outs, or dif- RECORDS ferentials that support the GPE and findings. įį Treatment plans with insufficient details: concen- DATA COLLECTION tration, frequency, dosage, route, location, method, ERRORS & OMISSIONS volume. įį No indication of informed consent: what was discussed, do the owners understand, have the BY LINDA CREWS, BScH, DVM prognoses and costs been explained, are the owners in agreement? Have they been given appropriate options? įį Verbal recommendations made but not recorded: insufficient details to prove what was said by whom and when. here was a time when patients THE MOST COMMON OMISSIONS IN THESE AREAS ARE: įį Suggested tests and treatment options offered, had surgery without any thermo but no record that they were declined or why. įį Many elements are incomplete or too brief: not regulatory support, but continuing įį Test results not interpreted, or interpretation education has taught us that pa- enough detail to have a clear understanding. not recorded, leaving it open for critiques and į tients recover faster, process drugs į Variations in measurement: date format; lbs/kgs; errors. 0 better, bleed less, and have fewer adverse events when DOB/age; C/F, all of which allow for confusion įį Inconsistency between the way staff and vet- Tthey are kept warm throughout surgery. As a profes- among staff and others with regards to dosing, chro- erinarians at the same clinic manage the case, sion, we tried blankets, then came warming with oats, nology, risk of diseases, etc. the meds, or the recommendations. Standard and now we have circulating warm water blankets and įį Inadequate description of presenting complaint: operating protocols can often resolve these Bair huggers! Medical knowledge is evolving, and we timeframe—quantify and qualify—number of days, issues. need to continue our education in how to meet the when it began, first signs, progressive or static, įį Inadequate follow-up: what was done with increasing needs for evolved medical records. frequency, colour, consistency, composition, current the fecal sample? What did it look like? In the fictitious ABC Animal Hospital medical history. Submitted in-house? To lab? Discarded? record shown above, there are 25 errors or omissions įį Initials of staff who admitted the patient, who Conclusions made from it? Owner approved in the Data Collected section—the body of the medi- talked to owner, who recorded the data, who sug- or declined costs? cal record. This section is the meat and potatoes of a gested options. įį Supporting documents missing or out of medical record. Most owners do not see this portion of įį Inadequate history: past history of vet care, vac- order. the record, nor are they qualified to assess its content, cinations, adverse events, seizures, trauma, toxins, įį Communication details: did the person and because the veterinarian is present during this meds, diet. who took the message, or gave the advice, portion, it is often missing adequate description, detail, įį Inadequate PE findings: NAF and WNL are not quan- recognize the severity of the concerns, un- or specifics of technique, as the veterinarian is acutely titative but subjective; a GPE needs numeric values derstand the client’s limitations, have the What’s missing? How aware of what happened. It is crucial to remember that and objective data. Use of a template or PE proto- knowledge to extrapolate the important can we improve it? the medical record is least of all for the veterinarian col or sticker/stamp will capture this data more How can we capture details, and provide an accurate portrayal more information while who wrote it. It is the specific details of history, data, accurately. of the urgency and risks involved? observations, assessment, interpretation, treatment įį Illegible: often cannot read the writing or under- writing less? plans, and response to treatment that are needed for stand the abbreviations. Does it say FB or PB, and Stay tuned for the hospitalized patient, the IV Tune in next time for any other competent medical personnel to compre- does that stand for foreign body, lead poisoning, or fluids patient, and the anesthesia-monitored patient. the answers... hend exactly what did and did not take place, so that phenobarb toxicity? What train of thought is the Learn how to have your staff capture many of the they might be able to help the patient further. practitioner following? details for you. FALLOUT FROM THE QUEST FOR GOLD BY VERONICA GVENTSADZE, MA, PhD, DVM

century after gold fever changed the infrastructure of the entire put out of his suffering relatively quickly, but likely A MULTIMODAL Pacific Northwest, the lust for this metal continues to kill. This because he was found in close proximity to an estab- time, it’s galvanized iron that’s doing the deadly work. lished trail. Likewise, the issue of moose and caribou AA network of telegraph lines spanning BC and Yukon was built at the turn entrapment in abandoned wire has been known for of the 20th century by what was then the Dominion Government Telegraph years in the Northwest Territories, where the federal APPROACH Service using wire that does not corrode or crumble. The telegraph lines government has finally made plans to remove the wire TO TREATING OSTEOARTHRITIS IN DOGS were abandoned, but not removed, in the 1940s and 1950s. The sad irony along the Canol Trail (which, although not part of the of the wire’s durability is that when it sags to the ground, either from trees Yukon Telegraph, is a post-war addition to telegraph falling on it or due to collapse of the original poles, it ends up in a perfect lines in place at that time). BY DAVID LANE, DVM, ACVSMR position to snag and trap moose (and caribou further north). My husband My research brought me mixed feelings of sorrow came upon this silent tragedy as he foraged for lobster mushrooms east of and relief—sorrow to realize how widespread and Sand Lake in the Nass Valley north of Terrace, BC, where we spend much neglected this problem is, and relief to know that ef- of our summer and fall. Trained as an forts, albeit on a local scale, are being electrician, he recognized the type of wire “WHEN AN ANIMAL DEPRIVED OF made to correct it. When an animal right away: number 8 galvanized wire A FIGHTING CHANCE DIES IN THE deprived of a fighting chance dies about 5 mm thick. On a one-kilometre in the wilderness with no one to stretch of abandoned telegraph line, he WILDERNESS WITH NO ONE TO WITNESS witness its suffering, it suffers just found three moose skeletons tangled in ITS SUFFERING, IT SUFFERS JUST THE the same, and its death is no more the wire, some older and covered in moss SAME, AND ITS DEATH IS NO MORE acceptable than deliberate and obvi- and others more fresh. He wanted to cry, ACCEPTABLE THAN DELIBERATE AND ous acts of animal cruelty. With our and was glad I was not with him to see OBVIOUS ACTS OF ANIMAL CRUELTY” new federal government’s increased adie is an 11-year-old Rotti cross that originally presented for arthritis pain that the devastation. attention to the environment, this was manifesting as irritability, decreased mobility, and rapidly escalating aggression In our research aided by Bill Miller’s problem needs to become front page toward dogs. The owner perceived the right forelimb to be the most affected, with the book Wires in the Wilderness (Heritage House Publishing Co. Ltd., 2009), we news rather than reports of merely local interest here lameness worsening after only a 20-minute leash walk. identified this stretch of telegraph line as part of the Stewart branch of the and there, and its solution requires consistent effort On physical exam, Sadie was found to have bilaterally painful and arthritic elbows, reduced mobil- “OA IS BEST Yukon Telegraph, built in 1910–1911. Its name refers not to the location of on the part of the federal government to remove all of Sity and comfort of the lumbar musculature, and bilateral stifle arthritis with greater pain on the right. TACKLED the lines but to their destination: from Ashcroft, BC, towards Yukon where the wire, not only segments of it close to established Sadie had previously received surgical care for bilateral cruciate disease, with the right side never fully the line extends to the north of Dawson City. From this book, I was shocked trails. As much as I am tempted to organize a vol- recovering. There was also evidence of arthritis and sesamoiditis of the MCP and MTP joints, but no USING A to learn that the problem of wildlife entrapment in abandoned wire has unteer campaign to go into the bush and remove as pain was elicited on palpation of these structures. MULTIMODAL been known at least since 1941. The wire, a small segment of which I saw much wire as possible, such an effort would be a drop The lumbar pain was treated with combined acupuncture and manual therapy, and the owner closer to the highway, shows no sign of corrosion. The metal used to galva- in the bucket as well as setting a precedent for letting reported immediate and significant improvement. A week later, both elbows and stifles were each APPROACH” nize it is toxic enough to cut an inch-wide swatch of bare soil through the the government off the hook. To get the attention it injected with 1ml of Platelet Rich Plasma (PRP). This resulted in further improvement in Sadie’s mood mossy forest floor. needs, a successful project will benefit greatly from the and mobility. Her aggression toward dogs disappeared, and she was able to go for longer walks without My research brought another sad find: news of a similar situation in influence and involvement of veterinarians in BC and triggering lameness. These benefits lasted for 10 months before a repeat PRP injection was required. Yukon and Northwest Territories. A moose trapped in wire in Yukon was all of Canada. Sadie responded equally well to the repeat injection.

34 WCV WCV 35 steoarthritis (OA) is a common source of chronic pain and the perception of pain. Walking is the primary mecha- PAGE 35 & LEFT X-ray of Humphrey’s hips. reduced quality of life, affecting 80 per cent of dogs over nism for circulating joint fluid and bringing nutrients PAGE 36 (FROM LEFT) PRP being processed; eight years of age. Although NSAIDs are a popular and to chondrocytes. Too much exercise is bad, but too little Sadie receiving PRP elbow injection. effective treatment for OA, they are only small part of a is worse. Avoid sudden changes in velocity (jackrabbit complete arthritis treatment program. starts, hard braking). Flat or slightly undulating ground OAs with any chronic pain condition, OA is best tackled using a multi with soft give, like grass or forest floor, is generally modal approach. Treatment should be directed towards not only the the best terrain. More frequent but shorter duration affected joint itself, but the rest of the body also, so that the dog can better exercise is better than being a weekend warrior. Any mobilizations, and massage. Manual therapy triggers compensate for the affected joint(s). Some treatments should be applied exercise that increases stiffness after rest or that the spinal reflexes to relax muscle. Acupuncture needles to every patient with arthritis, while others can be selected based on a dog is too tired to repeat the next day was too much. can be placed in acupoints, which are associated with number of factors, including access to equipment, patient co-morbidities, Exercise that does not result in stiffness or excessive neural structures, or into regions of focal irritated owner compliance and/or financial restrictions, and owner preference. fatigue benefits both comfort and life expectancy. muscle (also known as myofascial trigger points). Swimming is usually contra-indicated for shoulder is- Acupuncture stimulates central endorphin production TREATMENTS TO BE APPLIED FOR ALL CASES OF OA sues but helpful for other forms of arthritis. and descending pain inhibition. Blinded research has Research consistently shows that Omega 3 essential fatty acids (EFA) are shown that CAMT provides immediate improvement an effective treatment—more so than any other oral nutritional product. NON-PHARMACEUTIC OPTIONS TO TARGET AFFECTED JOINT(S) in ability to walk, trot, jump, descend stairs, and rise If you are going to recommend only one supplement to OA patients, this There are a number of non-pharmaceutic options from a lying position, and it reduces stiffness after is the one to suggest. Research further shows that concurrent use of EFAs to reduce pain by directly targeting arthritic joint(s), either rest or exercise. with NSAIDs allows for a reduction in NSAID dosing. Use products of fish including extracorporeal shockwave (ESWT), laser, and Therapeutic exercise can be used to strengthen origin; avoid products containing flax or other plant origin EFAs. Dose at pulsed electromagnetic field therapy (PEMF). These specific muscles, increase stability, and improve 100mg/kg, which often exceeds the label dose, or feed a prescription diet options are particularly useful for those patients who Intra-articular (IA) injections reduce OA pain in 80 coordination. Research from the Penn Vet Working Dog Center found that containing at least 3.5 per cent EFA on a dry matter basis. For better ab- are cannot tolerate NSAIDs, or for owners reluctant per cent of patients. Corticosteroids are commonly therapeutic exercise programs increased the average retirement age of sorption, select products that are triglycerides, not ethyl esters, which may to utilize daily medication as a first-line approach. used, either alone or concurrently with HA. Some cor- police dogs from 8 years to 11. mean contacting the supplier directly to gain this information. Intra-articular injections are another effective option. ticosteroids can damage cartilage, while others have

Research results for glucosamine and chondroitin (GSACh) have been ESWT inhibits pain transmission and increases been shown to be chondroprotective. Duration of effect umphrey is a Clumber Spaniel with severe hip dysplasia (see radio- mixed, but the current consensus is that there is moderately strong the production of anti-inflammatory growth factors. is typically 3–4 months. HA can be used on its own for graph) who benefited from just such therapy. When Humphrey was evidence that it increases patient comfort, with a small percentage of Shockwaves are sudden mechanical impulses, not mild cases, but a series of injections is required. PRP H originally presented at four years of age, his owner was interested in pur- patients showing dramatic improvement. GSACh works by stimulating electrical therapy. Three applications of ESWT have is as effective as combined HA and steroids, and the suing hip replacement surgery. However, it was determined that second- the chondrocytes to produce more extracellular matrix. As arthritis pro- been shown to improve mobility in dogs for 98 days. effects typically last nine months. It is my preferred IA ary lower back pain was a significant contributor to his discomfort, and gresses, cartilage thins, and chondrocytes die. Therefore, GSACh may be of Typical prescriptions are q7d x3, followed by q3m prn. injection. Mesenchymal stem cells can also be given IA, surgery was postponed until the lower back pain could be resolved. His greatest value as a preventative treatment or early in the course of disease Meta-analysis of laser therapy has shown its ef- with a typical duration of effect of 11 months; however, response to treatment was so profound that he never did require surgery. when there are more viable chondrocytes. For injectable products such as fectiveness in treating arthritis, although the strength it is more invasive and costly than PRP. Humphrey’s ongoing treatment includes EFAs, regular CAMT, strict weight Cartrophen and Adequan, the research behind these products, similar to and duration of effect can vary widely between control (much to his chagrin), therapeutic exercise, and a single round of EFA, shows more consistent results than it does for GSACh products. Tur- patients. Although I treat OA with laser, I personally TREAT THE ENTIRE BODY IA PRP. Today, he is 11 years old, has earned multiple tracking titles, hikes meric has anti-inflammatory action, but is poorly absorbed, and its in-vivo find it more useful as a tool for addressing secondary Treating the whole body and not just the affected joints comfortably for over an hour a day with no discernable lameness or pain, effectiveness is uncertain. Hyaluronic acid (HA) is beneficial when it is muscular pain. is key to successful multimodal management. Dogs and aside from EFAs, takes no oral medication. injected directly into the joint, but its oral effectiveness is debated because Research indicates that PEMF is effective as an with hind-limb OA frequently exhibit painful latissimus its large molecular weight prevents direct absorption. adjunctive therapy. PEMF triggers increased extracel- dorsi, paraspinal, and/or trapezii muscles, as well as The importance of a weight loss program cannot be overstated. Excess lular matrix production and nitrous oxide release to secondary lower back (lumbosacral or sacroiliac) pain Prescription pharmaceutics are the remaining option available to ad- body weight increases the mechanical stress on joints. Adipocytes produce decrease inflammation, pain, and edema. Owners that can be more painful than the OA that triggered it. dressing OA pain. NSAIDs remain the first line drug of choice, and are as pro-inflammatory mediators including interleukins and TNF. Research on typically purchase a PEMF device (e.g., a wire loop that Dogs with hind-end paresis are more likely to have ilio- effective as injectable opioids for pain management of OA in dogs. How- obese dogs demonstrates that a loss of 11 per cent excess body weight emits a 10″ EMF) and administer the 15-minute treat- costalis pain. Elbow or carpal arthritis frequently leads ever, their effectiveness can often be improved by the addition of other produces benefits approaching that of daily NSAID administration. ment at home, QID initially, then tapering to every few to thoracic paraspinal, trapezius, and rhomboid pain. medications, particularly in patients with chronic OA. The response to dif- Exercise helps maintain muscle bulk and neural function, and reduces days as needed. Shoulder arthritis likely reflects tendon or ligament ferent medications can vary between patients, and different practitioners injury that requires additional diagnostic evaluation. have different opinions on what the best second or third line medication Muscles are the shock absorbers of the body. Having should be. NSAIDs, followed by amantadine, are my personal favourites. robust musculature with normal tone, good flexibil- Amantadine is ineffective on its own, but is a good adjunctive choice when ity, and fast reaction times can provide vital sup- combined with NSAIDs, especially for chronic OA. It’s worth noting that port to joints, and therefore reduce pain. This is why if a dog fails to respond to NSAID brand A, brand B may still be effective. well-muscled dogs with hip dysplasia are less likely However, if NSAIDs fail to yield a satisfactory clinical result, then concur- to manifest pain than breeds with thinner muscling. rent muscle pain is the most likely reason. Some degree of muscle pain can be detected in virtu- Gabapentin produces variable results and is not living up to its original ally every chronic OA dog. Combined acupuncture and hype. Better results are achieved when it is employed for cases of mal- manual therapy (CAMT) and laser therapy are the pri- adaptive and neuropathic pain. Tramadol has been shown to be ineffective mary tools I use to tackle muscle pain, followed by ther- in treating chronic arthritis. Absorption of oral opioids varies widely be- apeutic exercise to maintain strength and flexibility. tween patients, but is generally poor. Codeine has the best oral absorption Manual therapy is an umbrella term that includes availability. Corticosteroids can help with pain but are chondrotoxic and chiropractic-style manipulations, physiotherapy-style generally not recommended for OA.

36 WCV WCV 37 PAGE 38 Horses waiting for treatment. FROM LEFT A Honduras vet student performing a dental exam; treating an ear tick infestation. EQUITARIAN KORNATOWSKI MATT BY PHOTOS and handlers then went to a triage team where han- are not luxuries but a vital part of the economic well-being of the family. dlers received a physical exam and were vaccinated for The owners know that if they take better care of the working animals, rabies, tetanus, and sleeping sickness. The horses were they will live longer and be healthier, happier, and more productive. The INITIATIVE all treated for ticks and worms, and dental, reproduc- Equitarian Initiative is similar to other worldwide programs involving tive, and lameness exams were performed as required. volunteer veterinarians. These initiatives require not only boots on the Then they were moved on to other stations to have ground but financial support to help expand these worthwhile projects. IN COSTA RICA hooves trimmed, castration if required, reproductive I am proud that some of the profits from the Delta Equine Seminar held examination, dental work performed, and saddle fit- each fall will be supporting a student to attend next year’s project in ting consultation when needed. Costa Rica. I hope that this experience might lead to a “made in Canada” BY DAVID PATON, DVM The trip was very rewarding on so many levels. I project to help benefit these working equids and their owners. was able to observe how important these horses are to the owner, their family, and community. These are working animals important to economic survival. I aving been fortunate enough to have had the opportunity food and transport, as well as locations for us to work saw no evidence of animal abuse and, in general, the “THESE TRIPS (NOT FOR THE FAINT OF HEART) to visit and work in many parts of the world, it seemed on the animals from the local area. The region where horses were in good condition. Costa Rica is rich in INVOLVED SLEEPING ON THE FLOOR IN CHURCH an easy fit to get involved in the Equitarian Initiative. The we were working did not have any veterinary care for vegetation, but we were told that the economy was motto of this organization is “Veterinarians Helping Work- their horses and donkeys, and we needed to take with poor at the moment, hence the horses were not work- CLASSROOMS, TRAVELLING UP TO TWO HOURS IN ing Equids Around the World.” Equitarian Initiative is a us all the necessary equipment, vaccines, medications, ing as much as usual. Economic realities were soon THE BACK OF A CATTLE TRUCK ON ROADS THAT Hnon-profit organization established by equine veterinarians to sustainably and supplies. Appropriate permits, transportation, ac- obvious. Medications that we take for granted, farrier improve working equid health by harnessing the passion and expertise of commodation, meals, and ground organization all had equipment, and other professional services were basi- WOULD MAKE MOUNTAIN GOATS NERVOUS” volunteer veterinarians. This is a North American veterinary organization to be coordinated ahead of arrival. A vital cog in the cally non-existent. Certainly, there was no veterinary with the majority of its efforts focused in Central America. It is a group wheel is an on-the-ground contact who can organize care available for humane castrations or prevention of veterinarians and caregivers looking to provide education, leadership, all vital in-country details, including the coordination or treatment of routine diseases. It was very reward- I would encourage all veterinarians who might be interested in this and assistance to the working equid and, by extension, their families. It of local horse owners. ing to be able to get back to the roots of veterinary sort of endeavour to go www.equitarianinitiative.org and join the Face- is estimated that there are 100 million working equids in the developing These trips (not for the faint of heart) involved medicine, providing basic veterinary care to animals in book page. You will not only be notified of the various workshops available world—a working equid is defined as a horse, mule, or donkey that is used sleeping on the floor in church classrooms, travel- need. This is really what is close to the heart of most but also receive postings of various opportunities to join with a group, primarily for family income, agriculture, and/or transportation. ling up to two hours in the back of a cattle truck on veterinarians. sometimes large, often small, that requires and is looking for help. Work I was able to attend an Equitarian workshop in southern Costa Rica in roads that would make mountain goats nervous, and A young female veterinarian student from Honduras is being done throughout Central America including Honduras, Nicara- January 2016. We were a group of 30 volunteers including veterinarians, working in a hot humid climate. After the workshop, was sponsored through an Equitarian scholarship. It gua, Haiti, and Costa Rica as well as many other countries. I am hoping to veterinary students and interns, veterinary technologists, animal health we spent four days at four different locations and was very rewarding to see her learn many important travel to Ethiopia this winter with a contact who is working on a com- specialists, farriers, saddle fitters, and interpreters. After overnighting treated about 350 horses and donkeys. We learned veterinary skills that she will be able to take back and munity project and has recognized the need for veterinary involvement in at a guest house in the capital city of San José, we travelled by bus nine the importance of being well organized. Envision 100 apply in her home country. We also had several North developing sustainable agriculture in the region. It is my hope that we can hours south to the small town of Puerto Jiménez on the Osa Peninsula, horses arriving at a local soccer or farm field for a free American veterinary students and new graduate vet- develop some made in Canada projects in the future. Although the need is close to Panama. The first two days were spent learning about all issues veterinary clinic! Horses arrived early in the morning, erinarians on our trip. They too learned many valuable primarily for those with equine practice experience, we had several small relating to working in this environment, including dealing with foreign having been walked or ridden for up to two hours. Our practical and life skills which will help them become animal practitioners with us on our trip who were well able to contrib- tropical diseases, socioeconomic issues, and the logistics of organizing invaluable and intrepid interpreter processed every leaders and contribute to this sort of work in the future. ute and work alongside the seasoned veterans. AHTs, students, and new and implementing such a trip. The workshop included lectures in internal horse, obtaining important information and history It is important to know that this sort of work should graduates are encouraged to participate. Anyone fluent in Spanish, even medicine, dermatology, and surgery from experts, all volunteers, and oth- about each horse, no different than what we would do not be seen as charity without contribution. The horse without veterinary training, could be a real asset to a project. Scholarship ers experienced in working in Third World countries. The lectures focused here. He also ensured that there was no cutting in line owners that we were working with are eager to provide funding may be available for students and new graduates. If you or any of on the practical aspects of disease identification and treatments. It is no or preferences given to those who felt they were more good horse care—they just lack not only the finances your staff are interested in this sort of activity, feel free to contact me at small feat to coordinate importation of supplies, local accommodation, important than the person ahead of them! The horses but also the skills and resources needed. These horses [email protected] or 604.856.3351.

38 WCV WCV 39 MEDICAL ASSISTANCE IN DYING NOVEMBER BY SUSAN HUGHSON, DVM 5–6 2016 PINNACLE HOTEL Proud sponsor of the CVMA. HARBOURFRONT ® ne of the most important duties and privileges we Scotiabank can assist you in all stages of your veterinary career. VANCOUVER, BC Ohave as veterinarians is provision of euthanasia. Ask me how I can help. Euthanasia of non-human animals can be implemented in a gentle and rapid manner. For those of us in companion animal practice, this may be the final service we provide to a patient we have known since near birth. We often have a deep bond with the patient and client, and while we are JOIN THE FUN THIS NOVEMBER! Shaun East sometimes relieved to allow a life to end, it is most often a November 11 & 12 • Calgary AB • www.hockeyorama.com Scotia Professional Plan Phone: (604) 619-4699 time of solemnity, dignity, and grief. As veterinarians, we Open to veterinarians and veterinary students email: [email protected] ® Registered trademarks of The Bank of Nova Scotia. also know that the end of a human-animal bond may evoke other losses and emotional trauma for the person who is saying goodbye. An additional, unspoken aspect of the euthanasia process is being witness to the suffering of the VetAdvise.com Your specialists for digital human animal. veterinary X-ray software, So it should come as no surprise that many veterinarians, equipment & service. myself included, sighed with relief when the Supreme Court of Canada ruled on February 6, 2015 to lift the absolute CVMA-SBCV CHAPTER prohibition on physician-assisted death. The unanimous All About Veterinarians decision of the Carter ruling established medical assistance Consulting, Coaching, Valuations, Negotiations, Purchase / Sale Digital Imaging Equipment & Software in dying (MAID) as a Charter right for competent adult X-ray Accessories & Supplies FALL CONFERENCE Full Service & Support Canadians who are suffering intolerably as a result of TERRY JACKSON, C.P.A. - C.G.A. & TRADE SHOW “grievous and irremediable” illness. The decision was open, Phone: 604.939.2323 [email protected] 1.866.455.3050 | nuonimaging.ca compassionate, and patient-centred in tone. Bill C-14, however, the new federal assisted dying law, is much more restrictive and paternalistic in its approach. Despite the recommendations of its own Special Joint Parliamentary Committee, an independent provincial ANNUAL and territorial panel, top constitutional experts, and the Senate—yes, the Senate—the government opted to DELTA introduce language stipulating that eligibility for assisted death would only be available for those Canadians whose EQUINE “natural death is reasonably foreseeable.” In practice, this rule will exclude entire classes of chronically ill individuals SEMINAR who are suffering intolerably but who don’t find themselves, for better or worse, near death’s door. The ink is barely OCTOBER 24 – 25, 2016 dry on this new legislation, and already we have court challenges to this restriction. Organized by the Equine Committee As a veterinarian, I cannot help but think about what of the CVMA-SBCV Chapter, the 45th would happen if similar unfair restrictions were imposed on Annual Equine Seminar at the Town and my practice. Imagine being told that it is illegal to euthanize Country Inn, Delta, BC, will feature Prac- a dog with degenerative myelopathy that has progressed to tical Approach to Lameness Diagnosis & paralysis, and that your only option would be to withdraw Treatment with Dr. Tracy Turner and A her food, water, and medication, and then watch her die Potpourri of Current and Practical Medi- cal Topics with Dr. Joe Bertone. slowly. This is what some Canadians with non-terminal illnesses that cause unbearable suffering will face as a PRACTICE FOR SALE NICOLA VALLEY VETERINARY CLINIC LTD. FOR SALE For more information, contact Dr. David result of our new legislation. This is not what the Supreme Vancouver Lower Mainland (Surrey, BC) Small Animal Hospital. Minimal investment needed to own this established turnkey Paton at 604.856.3351 or Dr. Marian Court of Canada intended. Well-established, 25 years, personable practice with consistent profitable practice in Interior BC. Multiple options. Enjoy sun- Dobson at 604.888.2323 or email Veterinarians are uniquely positioned to provide guidance loyal clientele. Great potential for expansion in this rapidly shine & recreation year round. Seller motivated by retirement [email protected]. and compassion around the topic of assisted death. It is not growing area. Owner wishing to retire, and motivated to help age. Can transition. Visit www.nicvet.com new owner phase into practice. Great opportunity to have Contact [email protected] easy to end life, but it can be done well. These are things we www.deltaequineseminar.com your OWN clinic. Contact Sharon Prus at 604-837-3078 or can say to Canadians, as we move away from a culture that [email protected] To place a classified ad in West Coast Veterinarian please contact Inga fears death, and begin to look profoundly at when it is best Liimatta at [email protected]. Deadline for ad booking is October 22, to assist someone to die. 2016 for the Winter issue.

40 WCV WCV 41 604.879.ERER (3737) | 604.734.5104

OCTOBER

ACVS Surgery Summit 6–8 Seattle, WA www.acvs.org/surgery-summit

Pacific Northwest Veterinary Conference CALL FOR 7–9 Spokane, WA www.wsvma.org/pacific-northwest-veterinary- conference/ SUBMISSIONS 15–18 2016 CanWest Veterinary Conference Banff, AB Every issue of West Coast www.abvma.ca/calendar-listing.asp?ID=184 Veterinarian features articles Cruciate Extracapsular Repair by RVTs and Board-certified 22–23 Calgary, AB www.focusandflourish.com Specialists. If you have a story you would like to tell us, please The 45th Annual DELTA EQUINE SEMINAR 24–25 features Practical Approach to Lameness email Corey Van’t Haaff at Diagnosis & Treatment with Dr. Tracy Turner; and A Potpourri of Current and Practical [email protected] with Medical Topics with Dr. Joe Bertone. details of your speciality and Town and Country Inn, Delta, BC www.deltaequineseminar.com your idea. For more information, contact Dr. David Paton at 604-856-3351 or Dr. Marian Dobson at 604-888- 2323 or email [email protected]. 2016

NOVEMBER

The CVMA-SBCV CHAPTER FALL 5–6 CONFERENCE & TRADE SHOW features Critical & Emergency Care with Dr. Marie Kerl; Behaviour & Pharmacology with Dr. Kenneth ANIMAL HEALTH WEEK Martin; Neurology with Dr. Peter Gordon; OCTOBER 2 TO 8, 2016 Pet Nutrition with Dr. Tammy Owens. Also, NOW OPEN at 2303 Alberta St the Conference features LVT Debbie Martin N A DA speaking to RVTs on Fear Free—Creating a C A ’ S V E B Y T E D R I Veterinary Spaw and Fear Free—Prevention T E N N A E R is Easier than Treatment. S I A E N R S P OCTOBER–DECEMBER Pinnacle Hotel Harbourfront, Vancouver, BC www.canadianveterinarians.net We have expanded services including 2nd Ave. DECEMBER board-certified specialists who are

Dental Radiology & Positioning Yukon St. Yukon Columbia St. Columbia 4 Alberta St. Victoria, BC available for referral. As always, our www.scilvet.ca

8–11 CVC Convention San Diego ANIMAL HEALTH + HUMAN HEALTH + PLANET HEALTH ER department is open 24/7. Come San Diego, CA CANADIANVETERINARIANS.NET www.thecvc.com/dates-and-locations/ St. Cambie cvc-san-diego-2/ see us at our new facility. 7th Ave. W L O L R A K F IN EVENTS TO NOTE IN EARLY 2017 INCLUDE: G O T TH OG AL ET HE 2017 OVMA Conference & Trade Show, January 2–28 HER FOR THE Toronto, ON www.ovma.org Call us to book a tour today! 8th Ave. Central Canadian Veterinary Conference, February 3–5

Winnipeg, MB www.mvma.ca PRINCIPAL SPONSOR PROGRAM SPONSORS IN PARTNERSHIP WITH Broadway To publicize your continuing education event in West Coast Veterinarian, 604.879.ERER (3737) please email the following details to [email protected] with CE Event in the subject. List the date, event title, location, sponsor, and website. Two blocks north of Broadway & two blocks east of Cambie @ 7th & Alberta VETERINARY CONTINUING EDUCATION CONTINUING VETERINARY

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