April/Avril 2017 The Canadian Veterinary Journal La Revue ... · 396 Mosby’s Comprehensive Review for Veterinary Technicians, 4th edition Shannon Wheatley 396 Review Questions and

Use of an elastic transarticular external fixator construct for immobilization of the elbow joint

Determining bovine viral diarrhea and infectious bovine rhinotracheitis infections in dairy cattle using precolostral blood

Pregnancy per AI in Holstein heifers inseminated with sex-selected or conventional semen after estrus detection or timed-AI

Hematology and biochemistry reference intervals for Ontario commercial nursing pigs close to the time of weaning

Cuttable plate fixation for small breed dogs with radius and ulna fractures: Retrospective study of 31 dogs

Pneumatosis coli in a domestic ferret (Mustela putorius furo)

Complete longitudinal patellar fracture in a cat: A rare case

Primary intranasal melanoma with brain invasion in a dog

Prevalence and risk factors for Coxiella burnetii seropositivity in small ruminant veterinarians and veterinary students in Ontario, Canada

A case of feline ectopic abdominal fetuses secondary to trauma

The Canadian Veterinary Journal La Revue vétérinaire canadienneThe Canadian Veterinary Journal La Revue vétérinaire canadienne

April/Avril 2017 Vol. 58, No. 04

April/Avril 2017 Volume 58, No. 04

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CVJ / VOL 58 / APRIL 2017 323

SCIENTIFIC RUBRIQUE SCIENTIFIQUE

ARTICLES

353 Use of an elastic transarticular external fixator construct for immobilization of the elbow jointBertrand Vedrine

360 Determining bovine viral diarrhea and infectious bovine rhinotracheitis infections in dairy cattle using precolostral bloodPaul Baillargeon, Juan C. Arango-Sabogal, Vincent Wellemans, Gilles Fecteau

365 Pregnancy per AI in Holstein heifers inseminated with sex-selected or conventional semen after estrus detection or timed-AIMarcos G. Colazo, Reuben J. Mapletoft

371 Hematology and biochemistry reference intervals for Ontario commercial nursing pigs close to the time of weaningAmanda M. Perri, Terri L. O’Sullivan, John C.S. Harding, R. Darren Wood, Robert M. Friendship

377 Cuttable plate fixation for small breed dogs with radius and ulna fractures: Retrospective study of 31 dogsGwyneth K. Watrous, Noel M.M. Moens

CASE REPORTS RAPPORTS DE CAS

383 Pneumatosis coli in a domestic ferret (Mustela putorius furo)Cédric B. Larouche, Marion R. Desmarchelier, Swan Specchi, Isabelle Langlois

387 Complete longitudinal patellar fracture in a cat: A rare caseGregory D. Herndon

391 Primary intranasal melanoma with brain invasion in a dogJulie Lemetayer, Ahmad Al-Dissi, Kim Tryon, Valerie MacDonald-Dickinson

BRIEF COMMUNICATION COMMUNICATION BRÈVE

397 Prevalence and risk factors for Coxiella burnetii seropositivity in small ruminant veterinarians and veterinary students in Ontario, CanadaShannon L. Meadows, Andria Jones-Bitton, Scott A. McEwen, Jocelyn Jansen, Samir N. Patel, Catherine Filejski, Paula Menzies

STUDENT PAPER COMMUNICATION ÉTUDIANTE

400 A case of feline ectopic abdominal fetuses secondary to traumaAndrew Chong

337 QUIZ CORNER TEST ÉCLAIR

Contents Table des matières

APRIL/AVRIL 2017


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CVJ / VOL 58 / APRIL 2017 325

Contents Table des matièresFEATURES RUBRIQUES SPÉCIALES

APRIL/AVRIL 2017

EDITORIAL ÉDITORIAL

329 Journal impact/Impact des revuesCarlton Gyles

333 VETERINARY MEDICAL ETHICS DÉONTOLOGIE VÉTÉRINAIRE

VETERINARY HISTORY HISTOIRE VÉTÉRINAIRE

403 The creation of the Department of Population Medicine at the Ontario Veterinary CollegeKevin Woodger, Elizabeth Stone, Cate Dewey

THE ART OF PRIVATE VETERINARY PRACTICE L’ART DE LA PRATIQUE VÉTÉRINAIRE PRIVÉE

411 Cold-call communicationMyrna Milani

WHAT CAN’T BE TAUGHT CE QUI NE S’ENSEIGNE PAS

413 Recognize valueDr. Marc Philippot

BOOK REVIEWS COMPTES RENDUS DE LIVRES

396 Mosby’s Comprehensive Review for Veterinary Technicians, 4th editionShannon Wheatley

396 Review Questions and Answers for Veterinary Technicians, 4th editionShannon Wheatley

Contributors

“Instructions for authors” are available online (www.canadianveterinarians.net).

Les «Directives à l’intention des auteurs» sont disponibles en ligne (www.veterinairesaucanada.net).

382 Books Available for Review Livres disponibles pour compte rendu

402 Index of Advertisers Index des annonceurs

414 Classifieds Petites annonces

NOTICES ANNONCES

339 NEWS NOUVELLESHeather Broughton, Isabelle Vallières

N E W S | N O U V E L L E S


326 CVJ / VOL 58 / APRIL 2017

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Editorial policy: All published articles including editorials and letters reflect the opinions of the authors and do not necessarily reflect the opinion of the publisher.Publication of an advertisement does not necessarily imply that the publisher agrees with or supports the claims therein.Politique de la Rédaction : Tous les articles publiés, y compris les éditoriaux et les lettres, représentent l’opinion de l’auteur et non pas nécessairement la position de l’éditeur.La publication d’une annonce ne signifie pas nécessairement que l’éditeur est d’accord avec son contenu ou qu’il l’appuie.

Editor-in-Chief/Rédacteur en chef Carlton Gyles, Guelph, OntarioAssociate Editors/Rédacteurs associés Bruce Grahn, Saskatoon, Saskatchewan Wayne McDonell, Guelph, OntarioFeature Editors/Rédacteurs des chroniques Jangi Bajwa, Burnaby, British ColumbiaBruce Grahn, Saskatoon, SaskatchewanMyrna Milani, Charlestown, New HampshireDebbie Stoewen, Ayr, OntarioTim Blackwell, Fergus, OntarioAssistant Editors/Rédacteurs adjoints Robert Friendship, Guelph, Ontario Greg Harasen, Regina, Saskatchewan Jacob Thundathil, Calgary, Alberta Ron Johnson, Guelph, Ontario Richard Kennedy, Pincher Creek, Alberta Shawn McKenna, Charlottetown, P.E.I.Managing Editor/Directrice de la rédaction Heather Broughton, Ottawa, OntarioAssistant Managing Editor/Directrice adjointe de la rédaction Stella Wheatley, Ottawa, OntarioEditorial Coordinator/Coordonnatrice de la rédaction Linda Chow, Ottawa, OntarioAdvertising Manager/Gérante de la publicité Laima Laffitte, Wendover, Ontario

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and to promote veterinary professionals• Position statements on animal welfare and national veterinary issues• Codes of practice for Canadian kennel and cattery operations, and for the

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CVJ / VOL 58 / APRIL 2017 329

Editorial Éditorial

L es chercheurs et les éditeurs surveillent le facteur d’impact annuel des revues. On détermine le facteur d’impact d’une

année en établissant le nombre de citations pour l’année en cours des articles publiés au cours des deux années antérieures et en le divisant par le nombre total d’articles publiées au cours des deux années antérieures. Par exemple, si, en 2016, il y avait 400 citations d’articles qui avaient été publiées dans la Revue X en 2014 et en 2015 et que le nombre total d’articles publiés par la Revue X en 2014 et en 2015 était de 200, alors le facteur d’impact pour 2016 serait 400 divisé par 200 = 2,0. En moyenne, les articles publiés il y a un ou deux ans étaient cités deux fois durant une période d’un an. Ce chiffre pourrait être atteint si un article était cité 400 fois et que le reste des 199 articles n’étaient jamais cités ou si chaque article avait été cité deux fois. Habituellement, il se produit une distribution biaisée des citations (1,2) : «Le soi-disant phénomène 80/20 s’applique car 20 % des articles peuvent représenter 80 % des citations» (2).

Il y a aussi un facteur d’impact de cinq ans qui a tendance à afficher moins de variations annuelles. Le facteur d’impact de cinq ans d’une revue est le nombre de citations observées dans une année pour des articles publiés au cours des cinq années antérieures qui est divisé par le nombre total d’articles publiés au cours des cinq années antérieures.

Le facteur d’impact porte principalement sur l’utilisation par les chercheurs des articles publiés. Il ne tient pas compte de l’impact qu’ont les chercheurs cliniciens lorsqu’ils transposent leurs articles afin d’améliorer la pratique clinique.

Le Dr Eugene Garfield (1, 3), l’un des créateurs du facteur d’impact des revues, a mis en garde que «le facteur d’impact ne devrait pas être utilisé sans porter une attention particulière aux nombreux phénomènes qui influencent les taux de citation …». Par exemple, il signale qu’aucun effort n’est déployé pour différencier les études cliniques de celles de laboratoire ni des articles fondés sur la pratique de ceux axés sur la recherche. Il poursuit en signalant que l’inclusion des articles de compte rendu peut affecter le facteur d’impact parce que ces articles sont souvent

R esearchers and publishers keep an eye on the annual impact factor of journals. The impact factor for a year

is the number of current year citations of articles published in the 2 previous years divided by the total number of articles published in the 2 previous years. For example, if in 2016 there were 400 citations of articles that were published in Journal X in 2014 and 2015 and the total number of articles published by Journal X in 2014 and 2015 was 200, the impact factor for 2016 would be 400 divided by 200 = 2.0. On average, the articles published 1 or 2 years ago were cited 2 times in the 1-year time frame. This could be achieved if 1 article was cited 400 times and the remaining 199 articles were never cited, or if each article had been cited 2 times. Typically, there is a skewed distribution of citations (1,2): “The so-called 80/20 phenomenon applies, in that 20% of articles may account for 80% of the citations” (2).

There is also a 5-year impact factor that tends to suffer less year-to-year variation. The 5-year journal impact factor is the number of previous 5-year citations in the year divided by the total number of articles published in the preceding 5 years.

The impact factor is all about usage of published articles by researchers. It does not take into account the impact clini-cian researchers make through translation of their articles into improved clinical practice.

Dr. Eugene Garfield (1,3), one of the creators of the journal impact factor has warned that “the impact factor should not be used without careful attention to the many phenomena that influence citation rates…” He notes, for example, that “no effort is made to differentiate clinical vs laboratory studies or, for that matter, practice-based vs research based articles.” He goes on to point out that inclusion of review articles can affect the impact factor because these articles are often used in place of earlier literature and are usually cited more frequently than are research articles. Not surprisingly, journals that publish reviews only are among those with the highest impact factors. He notes, however, that mediocre review papers are not likely to improve a journal’s impact factor (3).

Journal impact

Impact des revues

Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs.


330 CVJ / VOL 58 / APRIL 2017

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Currency and accessibility of articles to researchers may also influence impact factor. If an article is delayed for too long in the refereeing/processing stages it will be less current when it does appear and also may lose out in citations to related articles that were published while it was being processed. In this regard, online only journals that provide open access to everyone within days or weeks of accepting an article have an advantage over print journals.

Other factors that influence the likelihood of an article being cited in a research journal include quality of research, area of research (popular areas are more likely to be cited than areas with a small research following), local/international relevance (articles that relate specifically to a country or region are less likely to be cited widely than articles with a broader relevance), reputation of the authors, and reputation of the journal. Case reports that describe rare conditions or procedures are candidates for low citation rates.

Unfortunately, impact factor is now being used to not only judge journals but also to evaluate authors. “The misuse of the Impact Factor has become institutionalized in the research assessment methods of many universities and national evaluation panels, leading to a perverse incentive system” (2). Researchers are under pressure to publish in high impact journals and we

now have a system in which papers work their way down the impact factor ladder, with rejections until they find a rung of the ladder where the article is accepted. “Ultimately, the culture will only change when the institutions responsible for oversee-ing the assessment of researchers and those who constitute the evaluation panels take active steps to change how they assess scientists” (2). Why do we care? We care because, although the impact factor is a measure of impact on researchers and not of impact on practicing veterinarians, the impact factor influences the decisions of clinical researchers engaged in high quality research with regard to where they submit their articles.

References1. Garfield E. The history and meaning of the journal impact factor. J Am

Med Assoc 2006;295:93.2. Kiermer V, Larivière V, MacCullum C. 2016. Measuring Up: Impact

Factors Do Not Reflect Article Citation Rates. Available from: http://blogs.plos.org/plos/2016/07/impact-factors-do-not-reflect-citation-rates/ Last accessed February 15, 2017.

3. Garfield E. 1994. The Thompson Reuters Impact Factor — Clarivate Analytics. Available from: http://wokinfo.com/essays/impact-factor/ Last accessed February 15, 2017. ■

Carlton Gyles

utilisés au lieu d’articles antérieurs et qu’ils sont habituellement cités plus fréquemment que les articles de recherche. Il n’est donc pas surprenant de constater que les revues qui publient seulement des comptes rendus figurent parmi celles affichant les facteurs d’impacts les plus élevés. Cependant, il signale que des comptes rendus médiocres n’amélioreront probablement pas le facteur d’impact d’une revue (3).

L’actualité et l’accessibilité des articles pour les chercheurs peuvent aussi influencer le facteur d’impact. Si la publication d’un article est retardée pendant trop longtemps lors des étapes de lecture et de traitement, il sera moins actuel lorsqu’il paraîtra et il pourra perdre des citations vers des articles connexes qui ont été publiés pendant le traitement. À cet égard, les revues publiées exclusivement en ligne, qui offrent un accès ouvert à toutes les personnes dans un délai de quelques jours ou semaines après l’acceptation, jouissent d’un avantage par rapport aux revues en format imprimé.

Les autres facteurs qui influencent la probabilité qu’un article soit cité dans une revue de recherche incluent la qualité de la recherche, le domaine de recherche (il est plus probable que les domaines populaires soient cités que ceux intéressant un petit groupe de chercheurs), la pertinence locale et internationale (il est moins probable que les articles portant sur un pays ou une région en particulier soient généralement cités comparativement aux articles ayant une pertinence plus vaste), la réputation des auteurs et la réputation de la revue. Les rapports de cas qui décrivent des affections ou des interventions rares sont des candidats à des faibles taux de citation.

Malheureusement, le facteur d’impact est maintenant utilisé non seulement pour juger les revues mais aussi pour

évaluer les auteurs. «Le mauvais usage du facteur d’impact s’est institutionnalisé dans les méthodes d’évaluation de la recherche de beaucoup d’universités et de groupes d’évaluation nationale, ce qui a donné lieu à un système d’incitatifs pervers» (2). Les chercheurs subissent des pressions afin de publier dans des revues qui ont un facteur d’impact élevé et nous avons maintenant un système où les articles se fraient un chemin vers le bas de l’échelle du facteur d’impact en subissant des refus jusqu’à ce qu’ils trouvent un échelon où l’article est accepté. «En fin de compte, la culture ne changera que lorsque les institutions responsables de la supervision de l’évaluation des chercheurs et des membres de groupes d’évaluation prendront activement des mesures pour changer la façon dont ils évaluent les chercheurs» (2). Pourquoi nous préoccupons-nous de cette situation? Parce que, même si le facteur d’impact est une mesure de l’impact des chercheurs et non de l’impact sur les vétérinaires praticiens, il influence la décision des chercheurs cliniques réalisant une recherche de haute qualité quant au choix des publications lors de la soumission de leurs articles.

Renvois1. GARFIELD, E. «The history and meaning of the journal impact factor»,

J Am Med Assoc, 2006, vol. 295, p. 93.2. KIERMER, V., V. LARIVIÈRE et C. MACCULLUM. 2016. Measuring

Up: Impact Factors Do Not Reflect Article Citation Rates. Disponible au : http://blogs.plos.org/plos/2016/07/impact-factors-do-not-reflect-citation-rates/ Dernière consultation le 15 février 2017.

3. GARFIELD, E. 1994. The Thompson Reuters Impact Factor — Clarivate Analytics. Disponible au : http://wokinfo.com/essays/impact-factor/ Dernière consultation le 15 février 2017. ■

Carlton Gyles



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Veterinary Medical Ethics Déontologie vétérinaire

Ethical question of the month — April 2017Recent studies have shown that taking urban visitors on tours of carefully chosen and well-run livestock operations does not always produce a positive response regarding the care of farm animals. For example, when members of the public visit free stall dairy barns with robotic milking machines where cows are clean and comfortable with only rare cases of lameness and other “production diseases,” the response of the urban visitor is not always positive. Standard farm practices such as the removal of the calf at birth from its mother and the inability of cows to graze at pasture are considered both unnatural and disturbing to many urban visitors. Is educating the public regarding modern livestock production practices the correct approach to convincing the public that current industry practices ensure the welfare of farm animals?

Question de déontologie du mois — Avril 2017Des études récentes ont montré que l’organisation de visites guidées dans des exploitations d’élevage soigneusement choisies et bien exploitées à l’intention des citadins ne suscite pas toujours une réaction positive à l’égard des soins des animaux d’élevage. Par exemple, lorsque des membres du public visitent des logettes laitières avec des systèmes de traite automatisée où les vaches sont propres et confortables et que seulement quelques rares cas de boiterie et d’autres «maladies de production» sont observés, la réponse du visiteur urbain n’est pas toujours positive. Les pratiques normalisées des fermes, comme la séparation du veau et de la mère à la naissance et l’incapacité des vaches de brouter dans les prés, sont considérées comme n’étant pas naturelles et dérangeantes pour de nombreux visiteurs urbains. L’éducation du public à propos des pratiques d’élevage modernes représente-elle l’approche appropriée pour convaincre la population que les pratiques actuelles de l’industrie garantissent le bien-être des animaux d’élevage?

Comments/Commentaires :

Name/Nom :

Address/Adresse :

Responses to the case presented are welcome. Please limit your reply to approximately 50 words and forward along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, 6486 E. Garafraxa, Townline, Belwood, Ontario N0B 1J0; telephone: (519) 846-3413; fax: (519) 846-8178; e-mail: [email protected] ethical questions of the month are also welcome! All ethical questions or scenarios in the ethics column are based on actual events, which are changed, including names, loca-tions, species, etc., to protect the confidentiality of the parties involved.

Les réponses au cas présenté sont les bienvenues. Veuillez limiter votre réponse à environ 50 mots et nous la faire parvenir par la poste avec vos nom et adresse à l’adresse suivante : Choix déontologiques, a/s du Dr Tim Blackwell, 6486, E. Garafraxa, Townline, Belwood (Ontario) N0B 1J0; téléphone : (519) 846-3413; télécopieur : (519) 846-8178; courriel : [email protected] propositions de questions déontologiques sont toujours bienvenues! Toutes les questions et situations présentées dans cette chronique s’inspirent d’événements réels dont nous modifions certains éléments, comme les noms, les endroits ou les espèces, pour protéger l’anonymat des personnes en cause.


L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs.


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Ethical question of the month — January 2017Welfare audits are becoming a common component of quality assurance programs. In addition, welfare audits are demanded by processors and retailers when videos are released that imply animal welfare abuse on farms supplying products to these processors or retailers. Should welfare audits be performed by the herds’ own veterinarians? If a third party audit is specifically requested by a processor or retailer, does a veterinarian need to be licensed in the province where they perform the third party welfare audit? Are there advantages to having all welfare audits performed by non-veterinarians?

Question de déontologie du mois — Janvier 2017Les vérifications de bien-être deviennent un élément courant des programmes d’assurance de la qualité. De plus, des vérifications de bien-être sont exigées par les transformateurs et les détaillants lorsque des vidéos publiées laissent sous-entendre qu’il s’est produit de la violence envers les animaux dans des fermes fournissant des produits à ces transformateurs ou à ces détaillants. Ces vérifications devraient-elles être réalisées par les vétérinaires affectés aux troupeaux? Si une vérification par un tiers est spécifiquement demandée par un transformateur ou un détaillant, un vétérinaire devrait-il détenir un permis dans la province où il effectue la vérification de bien-être de tierce partie? Enfin, y aurait-il des avantages à la réalisation de ces vérifications de bien-être par des non-vétérinaires?

Welfare audits on farms — A commentIn the event of an incident where there is credible evidence of animal cruelty (e.g., Chilliwack dairy abuse case, June 2014), the dairy processing industry would require that a 3rd party welfare audit be conducted by a trained veterinary auditor to restore consumer and customer confidence.

The Canadian dairy processing industry has been collaborat-ing with veterinary associations and regulators to establish a

national roster of trained veterinarians to conduct such audits; including provisions for emergency licensure should there be a need for a veterinarian to come from out-of-province (e.g., con-flict of interest).

Warren Skippon, DVM, Director, Animal Welfare, Governmental Affaires, Saputo, St-Léonard, Quebec.

An ethicist’s commentary on welfare audits on farmsThe creation of the Pew Commission as a result of a collabora-tion between the Pew Charitable Trusts and the Bloomberg School of Public Health at Johns Hopkins University repre-sented a world-historic event. For the first time since indus-trial agriculture (a.k.a. factory farms) crowded out traditional husbandry-based agriculture in the 20th century, an eminent group of experts took a critical look at the effects of confine-ment agriculture on many areas of concern — animal welfare, environmental despoliation, human and animal health, loss of small family farms, domination of agriculture by giant mega-corporate entities, and numerous other issues. I was privileged to serve on this commission, along with some of the brightest minds I ever encountered, with expertise ranging from human health, animal health, environmental preservation, animal wel-fare, sustainability, government, and numerous other relevant areas. The commission’s work involved two years of thorough investigation of the issues, as well as multiple meetings held around the country listening to all relevant stakeholders, rang-ing from people living near confined animal feeding operations (CAFOS) to experts in infectious disease, to medical and vet-erinary school administrators, to environmentalists and animal welfare advocates, to regulators. In 2008, the report of the commission, the first ever account of the costs and benefits of industrial agriculture, was published, with all recommendations requiring unanimous approval of all commissioners.

Initially, many commissioners were quite naive about the animal welfare issues raised by the sort of animal production being examined. Eventually however, they came to realize that it was probably the most problematic and pressing issue emerging from our study. None of us knew of a good way to assure that the abysmal welfare experienced by animals in CAFOS could be significantly improved. We considered federal legislation, but immediately came up against the question of who would enforce such laws. Though some people suggested the United States Department of Agriculture (USDA), we quickly realized that the job of USDA was to promote agriculture, and that USDA over-sight over animals used in biomedical research and teaching was of extremely limited effectiveness. We were particularly reluctant to create yet another government bureaucracy. In the end, it was decided that independent third-party audits were probably the most efficacious mechanism for ensuring farm animal welfare.

With societal concern about farm animal welfare increasing exponentially worldwide (witness recent stirrings in the United States regarding environments suitable for the natures of poultry, and the thrust for slow-growing birds which are less susceptible to musculoskeletal problems), a wide range of corporate entities have begun to use third-party auditors. These entities include restaurant chains, grocery chains, catering industries, food ser-vices in universities, etc. And in my experience, this approach works extremely well.


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I believe that auditors must be trained to know what to look for, both good and bad. But I certainly do not believe that they need to be veterinarians. Furthermore, they should not work for the entity they are inspecting — I can hardly imagine a greater conflict of interest! The issue of licensure is irrelevant. What is required is a genuine and deep concern for the well-being of the animals, and an ability to be diplomatic yet firm when dealing with farm workers and owners.

It probably helps to have some background in agriculture as well, although that is by no means necessary. In some cases, in fact, having in agricultural background can be a disadvantage, particularly if one has worked in an operation that is far from exemplary, and where, in Temple Grandin’s mot juste, “bad has

become normal.” Indeed, some of the best auditors I have met grew up in an urban context. It is also essential that the auditor not be easily intimidated, and possesses a superb BS detector. Above all, the auditor must have the solid backing of the man-agement of the entity for whom she/he works.

Gender does not matter. Some first-rate auditors are females totally devoid of macho swagger. What is essential is a commit-ment to the animals and a deep and powerful sense of honor, which is unfortunately not as widespread and pervasive as it used to be.

Bernard E. Rollin, PhD

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1. Which of the following is the most appropriate treatment plan for a cat with a mass in the left second mammary gland and a second mass in the right third mammary gland?A. No direct intervention is needed; measure the masses

monthly to monitor for changes.B. Simple lumpectomy.C. Chemotherapy with a cisplatin-based protocol.D. Mammectomy of the affected glands.E. Bilateral radical mastectomy of both mammary chains.

2. A 9-year-old castrated male cocker spaniel has a history of polyuria and polydipsia and has an elevated alkaline phos-phatase (ALP) concentration. Morning urine is collected at home, and the urine cortisol:creatinine ratio (UCCR) is determined to be 36 (reference range: 8 to 24). Which of the following is the best interpretation of these results?A. This dog has hyperadrenocorticism, and treatment should

be initiated.B. This dog may have hyperadrenocorticism, and further

adrenal function testing is indicated.C. This dog does not have hyperadrenocorticism.D. The elevation of the UCCR is due to stress.E. This dog has hypoadrenocorticism.

3. Which of the following is most correct concerning chocolate toxicity in the dog?A. Milk chocolate is more toxic than dark chocolate.B. Clinical signs are mild, and treatment is not necessary.C. Large quantities of chocolate must be consumed for toxic-

ity to occur.D. Clinical signs include tachycardia, vomiting, ataxia, muscle

tremors, and seizures.

1. Lequel des traitements suivants est le plus approprié pour une chatte qui présente une masse dans la seconde glande mammaire gauche et une autre masse dans la troisième glande mammaire droite?A. aucune intervention directe n’est nécessaire; on devrait

mesurer les masses tous les mois pour surveiller les changements;

B. lumpectomie simple;C. chimiothérapie avec un protocole à base de cisplatine;D. mastectomie des glandes atteintes;E. mastectomie radicale bilatérale des deux chaînes de glandes

mammaires.

2. Un Épagneul cocker mâle castré âgé de 9 ans souffre de polyurie et de polydipsie et présente une concentration de phosphatase alcaline élevée. On prélève l’urine du matin à la maison et on détermine que le rapport créatinine : cortisol urinaire est de 36 (étendue de référence 8 à 24). Quelle est la meilleure interprétation des résultats?A. Ce chien souffre d’hyperadrénocorticisme et on doit

débuter un traitement.B. Ce chien peut souffrir d’hyperadrénocorticisme et un

examen de la fonction surrénalienne plus poussé est indiqué.

C. Ce chien ne souffre pas d’hyperadrénocorticisme.D. L’élévation du rapport créatinine : cortisol urinaire est due

au stress.E. Ce chien souffre d’hypoadrénocorticisme.

3. Lequel des énoncés suivants est le plus juste à propos de la toxicité du chocolat chez le chien?A. Le chocolat au lait est plus toxique que le chocolat noir.B. Les signes cliniques sont peu marqués et un traitement

n’est pas nécessaire.C. Une grande quantité de chocolat doit être ingurgitée pour

qu’il y ait toxicité.D. Les signes cliniques comprennent de la tachycardie, du

vomissement, de l’ataxie, des tremblements musculaires et des convulsions.

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4. A 2-year-old quarter horse mare is being evaluated for an acute onset of neurological signs (circling, stumbling, depression, tremors). A serum chemistry panel reveals severe hepatic dysfunction. A liver biopsy shows hepatocy-tomegaly, biliary hyperplasia, and fibrosis, with a minimal inflammatory component. Which of the following is the most likely cause of the condition?A. CopperB. Pyrrolizidine alkaloidsC. ZincD. LeadE. Maple

5. A 3-year-old cow, lame in the right hind limb, with striations in the white line of the outer claw and soft, focal swelling at the coronary band proximal to this striation, probably has which of the following?A. Foot rotB. Hairy heel wartC. LaminitisD. Sole abscessE. Sole ulcer

4. On fait l’examen d’une jument Quarter horse âgée de 2 ans à cause de l’apparition soudaine de signes neurologiques (tournis, trébuchement, abattement, tremblements). Un profil biochimique sérique révèle une dysfonction hépatique grave. Une biopsie hépatique montre de l’hépatocytomégalie, de l’hyperplasie biliaire et de la fibrose avec une composante inflammatoire minimale. Laquelle des causes suivantes est la plus probable?A. cuivre;B. alcaloïdes de type pyrrolidizine;C. zinc;D. plomb;E feuilles d’érable.

5. Une vache âgée de 3 ans boite du membre postérieur droit et présente des stries dans la ligne blanche de l’onglon externe et de l’enflure molle au niveau de la bande coronaire proximalement aux stries. Elle souffre probablement de quel problème?A. piétin;B. dermatite digitale;C. fourbure;D. abcès de la sole;E. ulcère de la sole.

Questions and answers were derived from Review Questions and Answers for Veterinary Boards 2nd ed., a 5-volume series including Basic Sciences, Clinical Sciences, Small Animal Medicine and Surgery, Large Animal Medicine and Surgery, and Ancillary Topics, by kind permission of the publisher, Mosby–Year Book, Inc., St. Louis, Missouri.

Les questions et les réponses sont extraites de Review Questions and Answers for Veterinary Boards 2nd ed., une série de cinq volu mes qui comprend Basic Sciences, Clinical Sciences, Small Animal Medicine and Surgery, Large Animal Medicine and Surgery, et Ancillary Topics, avec l’aimable permission de l’éditeur, Mosby–Year Book, Inc. de St. Louis (Missouri).

(See p. 410 for answers./Voir les réponses à la page 410.)


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Symposium 2017 des ÉACMV«Prenez le taureau par les cornes, assumez la responsabilité de vos actes»

Il n’est pas facile de résumer le Symposium 2017 des Étudiants de l’ACMV (ÉACMV) dans un court article, car nous avons

vraiment vécu une fin de semaine extraordinaire! Les 20 et 21 janvier, la Faculté de médecine vétérinaire de l’Université de Calgary (UCVM) a accueilli plus de 200 étudiants en médecine vétérinaire au Symposium 2017 des ÉACMV «Prenez le taureau par les cornes, assumez la responsabilité de vos actes». D’abord, au nom de tous les participants étudiants, j’aimerais transmettre mes chaleureux remerciements aux organisateurs étudiants de l’UCVM. Cet événement exige beaucoup de planification et il était évident pendant la fin de semaine que les organisateurs avaient effectué un énorme travail au cours de la dernière année. J’aimerais aussi remercier les étudiants de l’UCVM qui ont accueilli des étudiants de l’extérieur de la ville dans leur foyer et qui ont facilité leurs déplacements à Calgary pendant la fin de semaine. Votre

2017 SCVMA Symposium“Take the Bull by the Horns, Take Charge of your Actions”

Summarizing the 2017 Students of the CVMA (SCVMA) Symposium in one short article is not easy considering how

amazing the weekend was! On January 20 and 21 the University of Calgary — Faculty of Veterinary Medicine (UCVM) hosted over 200 Canadian veterinary students at the 2017 SCVMA Symposium “Take the Bull by the Horns, Take Charge of your Actions.” First, on behalf of all student attendees, I would like to extend a huge thank you to the UCVM student organizers. This event takes a lot of planning and the hard work the orga-nizers put in over the past year definitely showed throughout the weekend. In addition to thanking the organizers, I would also like to thank the UCVM students who welcomed students from out of town into their homes and helped them navigate Calgary for the weekend. Your hospitality was greatly appreciated by all. My last thank you is for the 2017 Symposium sponsors;

Basic Alpaca Handling and Skills wet lab.

Laboratoire sur la manipulation et les soins de base des alpagas.

A hippopotamus having his teeth brushed during the Calgary Zoo tour.

Un hippopotame qui se fait brosser les dents durant la visite du Zoo de Calgary.

The SCVMA Committee representatives with Dr. Temple Grandin (far left), CVMA President Dr. Troy Bourque (back row with tie), CVMA Vice-President Dr. Terri Chotowetz (front row in white) and SCVMA Coordinator Alexandra

Schlesiger (back row in orange).

Les représentants du Comité des ÉACMV avec la Dre Temple Grandin (extrême gauche), le président de l’ACMV Dr Troy Bourque (dernière rangée portant une cravate), la vice-présidente de l’ACMV Dre Terri Chotowetz (rangée avant en blanc) et la coordonnatrice des ÉACMV Alexandra Schlesiger (dernière rangée en orange).


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The winners of the 2017 CPR Competition, Team Owl Save You.

Les gagnants de la compétition de RCR 2017, l’équipe Owl Save You.

Second-year WCVM students, from the left, Shawna Ellis, Fiona Hooch-Antink, Jason Johnson, Garrett Fraess, Bailie Ericson, Kaitlyn Brown, Lauren Bonnell and Krista Davis, enjoying the SCVMA Symposium closing banquet.

Les étudiants de deuxième année du WCVM, de gauche à droite, Shawna Ellis, Fiona Hooch-Antink, Jason Johnson, Garrett Fraess, Bailie Ericson, Kaitlyn Brown, Lauren Bonnell et Krista Davis, s’amusant lors du banquet de clôture des ÉACMV.


CVJ / VOL 58 / APRIL 2017 341

Nhospitalité a été grandement appréciée par tous les participants. Enfin, j’aimerais remercier les commanditaires du Symposium 2017, car c’est votre générosité qui permet la tenue de cet événement. Les commanditaires Platine, Or et Argent du Symposium 2017 des ÉACMV incluaient l’Association canadienne des médecins vétérinaires, l’Union des étudiants de l’Université de Calgary, l’Agence canadienne d’inspection des aliments, Merial et Royal Canin.

Le coup d’envoi du Symposium 2017 des ÉACMV a eu lieu le jeudi soir lors d’une compétition de RCR entre les écoles. Travaillant en équipes, les étudiants ont réanimé des patients simulés en puisant dans leurs compétences de RCR, leurs connaissances en médecine d’urgence ainsi que leurs compétences de communication professionnelle. C’est l’équipe Owl Save You qui a remporté la palme et une mention honorable a été décernée à l’équipe Cardiopulménagerie, à l’équipe Less Compassion : More Compression, à l’équipe Get Your Heart On, à l’équipe Fibrillicious et à l’équipe Sleep Apnea a.k.a. Dream Team. Vous avez tous été sensationnels!

Le vendredi a été une journée remplie de conférences et de laboratoires de travaux pratiques. Parmi les faits saillants, citons la conférence du Dr Cody Creelman sur l’utilisation de la technologie mobile sur le terrain et dans les plates-formes des médias sociaux, la conférence de la Dre Emma Read sur les femmes en médecine vétérinaire et les avantages des résidences ainsi que de nombreuses autres conférences intéressantes sur le bien-être animal, la médecine de zoo et plus encore. Dans l’après-midi, les étudiants ont pu acquérir de l’expérience pratique tout en assistant aux laboratoires de travaux pratiques, dont la manipulation des alpagas, les techniques pour les onglons bovins, l’imagerie des petits animaux, la dystocie bovine, la cardiologie équine et l’anesthésie de la faune ainsi que beaucoup d’autres. Après une journée bien remplie de conférences et de laboratoires, les participants se sont réunis au Ranchman’s Cookhouse and Dancehall pour déguster un dîner barbecue suivi d’une soirée de rencontres, de réseautage, de danse à deux pas et même d’un taureau mécanique.

Lors de la dernière journée, les étudiants choisissaient soit d’assister à des ateliers sur les techniques d’urgence ou de participer à diverses excursions. Les excursions incluaient une visite dans les coulisses au Zoo de Calgary, l’Unité canine du service de police de Calgary, le Moore Equine Veterinary Centre, le parc d’engraissement Cattleland ou la colonie huttérite de Wheatland. Le samedi après-midi, les étudiants ont eu le plaisir d’assister à la conférence de la Dre Temple Grandin, «Comportement animal : comprendre comment les animaux parlent et ce qu’ils ressentent». Pour clôturer la fin de semaine, les étudiants ont assisté à un banquet au Zoo de Calgary qui présentait un jeu de Jeopardy, de la musique et de la danse!

Le Symposium 2017 des ÉACMV a été une expérience fantastique et j’encouragerais tous les étudiants à assister à la conférence de l’an prochain, qui sera organisée par l’Atlantic Veterinary College à Charlottetown, à l’Île-du-Prince-Édouard. Nous espérons vous y rencontrer en grand nombre!

(par Traci Henderson, WCVM, représentante sénior des ÉACMV)

your generosity makes this event possible. The 2017 SCVMA Symposium’s platinum, gold and silver sponsors include the Canadian Veterinary Medical Association, the University of Calgary Students’ Union, the Canadian Food Inspection Agency, Merial, and Royal Canin.

The 2017 SCVMA Symposium kicked off Thursday night with a CPR Competition between the colleges. Working in teams, students resuscitated simulated patients while utiliz-ing their CPR skills, medical emergency knowledge, as well as their professional communication skills. Team Owl Save You came out on top with honorable mentions going out to Team Cardiopulmenagerie, Team Less Compassion: More Compression, Team Get Your Heart On, Team Fibrillicious, and Sleep Apnea a.k.a. Dream Team. You were all amazing!

Friday was full of educational lectures and wet labs; highlights were Dr. Cody Creelman’s lecture on using mobile technology in the field and social media platforms, Dr. Emma Read’s lecture about women pursuing veterinary medicine and the advantages of residencies, as well as many other interesting lectures on ani-mal welfare, zoo medicine and more. In the afternoon, students gained hands on experience while attending wet labs, includ-ing Alpaca Handling, Bovine Hoof Techniques, Small Animal Imaging, Bovine Dystocia, Equine Cardiology, and Wildlife Anesthesia, along with many others. After the busy day of lec-tures and labs, attendees gathered at Ranchman’s Cookhouse and Dancehall for a barbeque dinner followed by a fun night of socializing, networking, 2-stepping, and even bull riding.

On the last day, students chose to either attend workshops on emergency techniques or professional skills or go on various tours. The tours included going behind the scenes at the Calgary Zoo, the Calgary Police K9 Unit, Moore Equine Veterinary Centre, Cattleland Feedlot, or the Wheatland Hutterite Colony. Saturday afternoon students had the pleasure of listening to Dr. Temple Grandin’s keynote speech, “Animal Behavior; Understanding How Animals Talk and Feel.” To close the week-end, students attended a banquet at the Calgary Zoo involving an intercollege game of jeopardy, music, and dancing!

The 2017 SCVMA Symposium was a fantastic experi-ence, and I would encourage all students to attend next year’s conference, hosted by the Atlantic Veterinary College in Charlottetown, Prince Edward Island. Hope to see you all there!

(by Traci Henderson, WCVM, Senior SCVMA Representative)


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La Semaine nationale de l’action bénévole offre une excellente occasion d’honorer les médecins vétérinaires, les techniciens et

technologues vétérinaires ainsi que les autres bénévoles qui donnent de leur temps et offrent leur expertise aux divers projets entrepris par l’Association canadienne des médecins vétérinaires (ACMV) afin d’appuyer la profession vétérinaire au Canada.

Le thème de la Semaine nationale de l’action bénévole de cette année est «Les bénévoles enrichissent notre société». Chaque activité bénévole enrichit les collectivités où nous vivons. Les nombreuses heures investies par les bénévoles dans de nombreuses causes permettent non seulement aux collectivités de survivre mais de s’épanouir. Les bénévoles rehaussent le succès des organisations et aident à cultiver des liens forts au sein des collectivités. L’ACMV compte sur les contributions de ses bénévoles dévoués à l’échelle du Canada qui aident notre association à atteindre ses divers buts et objectifs et veillent à faire entendre la voix de la profession vétérinaire partout au pays et dans le monde.

Plus de 600 bénévoles appuient l’Association, dans le cadre de leur travail au sein de notre exécutif, du Conseil, des divers comités permanents, des groupes consultatifs, des groupes de travail et en révisant des articles pour nos revues. Les bénévoles de l’ACMV consacrent du temps, malgré leur horaire chargé, pour agir à titre d’ambassadeurs lors d’entrevues avec les médias ainsi que pour représenter l’ACMV et la profession vétérinaire au sein de plus de 25 conseils externes, associations ainsi que de groupes législatifs et stratégiques différents tant au Canada qu’à l’étranger.

Voici un aperçu des nombreux exemples de la façon dont les bénévoles ont récemment contribué aux efforts de l’ACMV :

Les bénévoles du Comité sur le bien-être des animaux (CBA) travaillent à la défense et à la promotion du bien-être animal au sein de l’industrie animale, du gouvernement et du public. Le Comité a

National Volunteer Week provides a wonderful opportunity to honor the veterinarians, veterinary technicians/technologists,

students and other volunteers who donate their time and expertise to the various projects undertaken by the Canadian Veterinary Medical Association (CVMA) in support of Canada’s veterinary profession.

This year’s National Volunteer Week theme is “Volunteers: Enriching Our Society.” Every volunteer activity enriches the communities in which we live. Communities not only survive because of the enormous amount of time volunteers dedicate to various causes, but they thrive. Volunteers enhance the success of organizations and help cultivate strong relationships within communities. The CVMA depends on the contributions of our devoted volunteers across Canada to help our Association achieve a variety of goals and objectives, and ensure the voice of the Canadian veterinary profession is heard across the country and around the world.

Over 600 volunteers support the work of the Association, through their work on our Executive, Council, various standing committees, advisory groups, and task forces, and by reviewing articles for our journals. CVMA’s volunteers take time from their busy schedules to act as ambassadors in media interviews and represent the CVMA and the veterinary profession on 25 differ-ent external boards, associations, legislative and policy-making groups, both in Canada and abroad.

Here is a glimpse into the many examples of how volunteers have recently contributed to CVMA efforts:

Volunteers on the Animal Welfare Committee (AWC) advocate and promote animal welfare within the animal industry, to gov-ernment, and the public. The Committee has updated a number of Position Statements, including: Thermocautery for Lameness in Horses, Induced Moulting of Poultry, Tail Docking of Dairy

Volunteers: Enriching Our SocietyNational Volunteer Week — April 23 to 29, 2017

Les bénévoles enrichissent notre sociétéSemaine nationale de l’action bénévole — Du 23 au 29 avril 2017

Members of the National Issues Committee discussing current issues in the veterinary community. (Top left: Dr. Duane Landals, Dr. Enid Stiles, CVMA CEO, Mr. Jost am Rhyn, Dr. Leigh Rosengren, Dr. Randy Bagg. Bottom left: Dr. Christiane Armstrong, Dr. Joanne Dias, Dr. Jaspinder Komal, and National Issues and Animal Welfare manager, Dr. Shane Renwick).

Les membres du Comité sur les enjeux nationaux discutent des enjeux d’actualité dans la collectivité de la médecine vétérinaire. (En haut, de gauche à droite : D r Duane Landals, Dre Enid Stiles, le PDG de l’ACMV, M. Jost am Rhyn, Dre Leigh Rosengren, Dr Randy Bagg. En bas, de gauche à droite : Dre Christiane Armstrong, Dre Joanne Dias, Dr Jaspinder Komal et le gestionnaire des Enjeux nationaux et du Bien-être animal, Dr Shane Renwick).


CVJ / VOL 58 / APRIL 2017 343

Nmis à jour plusieurs énoncés de position, notamment : l’utilisation de la thermocautérisation pour le traitement de la boiterie chez les chevaux, la mue induite de la volaille, l’amputation de la queue des bovins laitiers, la castration des porcelets et l’enlèvement des bourgeons et l’écornage du bétail. Le Comité a aussi passé du temps à défendre le projet de loi C-246, la Loi sur la modernisation des mesures de protection des animaux, qui a malheureusement été défait à la Chambre des communes à l’automne 2016. Le CBA et l’ACMV appuient fortement la mise à jour des lois fédérales entourant la cruauté envers les animaux.

Pour les bénévoles œuvrant au sein du Comité sur les enjeux nationaux (CEN), la profession vétérinaire occupe le devant de la scène dans son travail de leadership et de défense des intérêts à l’égard des enjeux vétérinaires nationaux qui touchent la profession. En 2016, pour la première fois, l’ACMV a tenu un Forum sur les enjeux nationaux durant son congrès annuel qui se penchait sur l’importation des chiens au Canada. Le CEN utilise actuellement la rétroaction reçue durant le forum pour la finalisation de l’énoncé de position sur l’importation des chiens au Canada. Dans le cadre du Plan d’action fédéral sur la résistance et le recours aux antimicrobiens au Canada, les membres du CEN se sont joints à d’autres intervenants partageant les mêmes objectifs pour la première réunion du Comité d’orientation fédéral, provincial et territorial (FPT) sur l’antibiorésistance. Le CEN a aussi travaillé à la défense des intérêts au nom de la World Small Animal Veterinary Association contre la mise à l’annexe internationale de la kétamine, un agent anesthésique et analgésique important en médecine vétérinaire. Le CEN procède aussi à la révision de l’énoncé de position sur le transport des chiens et des chats.

Le Groupe consultatif sur la gouvernance des produits pharmaceutiques vétérinaires a consacré beaucoup de temps à l’élaboration du document «Surveillance vétérinaire de l’utilisation des antimicrobiens — Un cadre de travail pancanadien pour les

Cattle, Castration of Piglets, and Disbudding and Dehorning of Cattle. The Committee also spent time advocating in support of Bill C-246, the Modernizing Animal Protections Act, which was unfortunately defeated in the House of Commons in the fall of 2016. The AWC, and the CVMA as a whole, strongly supports the updating of federal legislation surrounding animal abuse.

The veterinary profession is top of mind for the volunteers on the National Issues Committee (NIC), which provides leadership and advocacy on national veterinary issues affecting the profes-sion. For the first time, in 2016, the CVMA held a National Issues Forum during its Annual Convention highlighting the importation of dogs into Canada. The NIC is using the feedback received during the forum to help finalize the Importation of Dogs into Canada Position Statement. As part of the Federal Action Plan on Antimicrobial Resistance and Use in Canada, members of the NIC joined other like-minded stakeholders for the first meeting of the Federal, Provincial, Territorial (FPT) Antimicrobial Resistance (AMR) Steering Committee. The NIC also advocated on behalf of the World Small Animal Veterinary Association against the international rescheduling of ketamine, an important anesthesia/analgesia agent in veterinary medicine. The NIC is also revising the Transportation of Dogs and Cats Position Statement.

The Veterinary Pharmaceutical Stewardship Advisory Group has dedicated much time to developing the, “Veterinary Oversight of Antimicrobial Use — A Pan-Canadian Framework for Professional Standards for Veterinarians,” in collaboration with the Canadian Council of Veterinary Registrars (CCVR).

The Environmental Advisory Group continues to work on the CVMA Green Veterinary Practice Initiative, providing a web-based source of information on how to improve the envi-ronmental impact of veterinary practices and infrastructure. The group continues to encourage practices to share their success

On March 4, 2017, the CVMA held a Volunteer Appreciation Dinner during the 2017 CVMA Committee Weekend in Ottawa, Ontario.

Le 4 mars 2017, l’ACMV a organisé un dîner d’appréciation des bénévoles durant la Fin de semaine des comités 2017 de l’ACMV qui s’est tenue à Ottawa, en Ontario.

We thank the veterinarians, registered veterinary technicians/technologists, students, and other volunteers who donate their time and expertise to the CVMA. (Left to right: NL Council rep, Dr. Margaret Brown-Bury,

AHT/VT Program Accreditation member, Ms. Tammy McLeod, RVTTC Council rep, Ms. Lois Ridgway, AHT/VT Program Accreditation member, Ms. Gail Cooper, CVMA President-Elect, Dr. Troye McPherson,

and 2017 Convention Chair, Dr. Kathleen MacMillan).

Nous remercions les médecins vétérinaires, les techniciens et les technologues vétérinaires agréés, les étudiants et les autres bénévoles qui donnent de leur temps et communiquent leur expertise à l’ACMV. (De gauche à droite : la représentante du Conseil de Terre-Neuve-Labrador, Dre Margaret Brown-Bury, la membre du Comité d’agrément

des programmes de TVA/TV, Mme Tammy McLeod, la représentante du Conseil de TTVAC, Mme Lois Ridgway, la membre du Comité d’agrément des programmes de TVA/TV, Mme Gail Cooper, la présidente désignée de l’ACMV,

Dre Troye McPherson, et la présidente du congrès 2017, Dre Kathleen MacMillan).


344 CVJ / VOL 58 / APRIL 2017

N normes professionnelles régissant les médecins vétérinaires», en collaboration avec le Conseil canadien des registraires vétérinaires (CCRV).

Le Groupe consultatif environnemental continue de travailler à l’Initiative de l’ACMV pour une pratique vétérinaire écoresponsable afin de fournir une source d’information sur le Web sur la façon d’atténuer l’impact environnemental des pratiques et de l’infrastructure vétérinaires. Le groupe continue d’encourager les pratiques à communiquer leurs histoires de réussites avec l’ACMV et d’inciter les autres à suivre leur exemple sur le plan écologique. Le groupe sert aussi de ressource au Comité sur les enjeux nationaux qui le consulte sur des enjeux environnementaux particuliers.

Le Groupe consultatif sur la gestion commerciale (GCGC) appuie l’ACMV afin d’atteindre l’un de ses trois objectifs stratégiques, soit celui «d’aider les vétérinaires à obtenir une carrière prospère et à atteindre une vie équilibrée». Ces bénévoles supervisent la livraison des initiatives annuelles d’analyse comparative du rendement de l’ACMV, comme les guides tarifaires suggérés des provinces, les rapports sur la rémunération et les avantages sociaux des vétérinaires salariés et les rapports sur la rémunération des employés autres que les vétérinaires. En 2016, le GCGC a collaboré au lancement de la Trousse d’outils pour la carrière et les affaires de l’ACMV qui se trouve sur le site Web, afin de permettre aux vétérinaires d’accéder facilement à des ressources pertinentes en ligne ainsi qu’à des renseignements portant sur la gestion des finances personnelles, la gestion d’une entreprise vétérinaire et la gestion de la clientèle.

Chaque année, les bénévoles du Groupe consultatif des communications aident à choisir le thème et le slogan de la campagne annuelle de la Semaine de la vie animale. De plus, le Groupe continue de fournir de l’expertise et des conseils sur la vaste campagne de sensibilisation dans les médias sociaux afin de rehausser la sensibilisation. Chaque mois, l’ACMV partage un message et un graphique dans les médias sociaux afin de rehausser la sensibilisation à l’égard des enjeux auxquels sont confrontés les animaux et d’informer les propriétaires sur les mesures qu’ils peuvent prendre pour guérir ou prévenir des maladies.

Le Comité du perfectionnement professionnel (CPP) contribue à améliorer la formation continue et professionnelle de ses membres et de tous les vétérinaires. Les programmes scientifiques, les ateliers et les activités présentés lors du congrès annuel de l’ACMV permettent aux vétérinaires et aux autres membres de l’équipe de la pratique d’améliorer la pratique professionnelle et d’entrer en contact avec leurs pairs des autres régions du Canada. Pour la première fois, le congrès 2016 de l’ACMV s’est tenu à Niagara Falls, en Ontario. En conséquence, un nombre record de vétérinaires de l’Ontario (241) ont assisté au congrès. Signalons aussi que, pour la première fois depuis la création du programme en 2009, deux représentants commandités de chacune des dix provinces ont assisté au Programme des futurs leaders.

Les bénévoles du Bureau national des examinateurs facilitent l’administration des examens d’agrément vétérinaire du Canada, ils participent au processus d’agrément des collèges de médecine vétérinaire et examinent et évaluent les titres de compétence au nom de certains organismes de réglementation provinciaux. En 2016, le Bureau national des examinateurs a émis 472 Certificats de compétence aux diplômés des cinq facultés de médecine

stories with the CVMA and entice others to follow in their environmental footsteps. The Group also remains a resource for the NIC to consult on specific environmental issues.

The Business Management Advisory Group (BMAG) helps the CVMA with one of its 3 strategic objectives; “helping vet-erinarians achieve a successful career and a balanced life.” These volunteers oversee the delivery of the CVMA’s annual economic benchmarking initiatives such as the Provincial Suggested Fee Guides, Compensation and Benefits Reports for Associate Veterinarians, and Non-DVM Wage Reports. In 2016, the BMAG helped launch CVMA’s online Career and Business Toolkit, providing veterinarians easy access to pertinent online resources and information on personal financial management, veterinary business management, and client management.

Each year volunteers on the Communications Advisory Group help choose the theme and slogan for the annual Animal Health Week campaign. As well, the Group is once again providing expertise and insight into the extended social media awareness campaign. Each month the CVMA shares a social media message and graphic aimed at creating more awareness of issues animals may face and what owners can do to help or prevent illness.

The Professional Development Committee (PDC) helps advance the continuous, professional growth of its members and all veterinarians. The scientific program, workshops and activities offered at the annual CVMA Convention enable veterinarians and other members of the practice team to enhance professional practice and connect with peers from across Canada. For the first time in convention history, the 2016 CVMA Convention was held in Niagara Falls, Ontario. As a result, a record-breaking number (241) of Ontario DVMs attended the convention. Also noteworthy, the Emerging Leaders Program had 2 sponsored representatives from each of the 10 provinces for the first time since its inception in 2009.

Volunteers of the National Examining Board assist with the administration of Canada’s veterinary licensing examinations, participate in the veterinary college accreditation process, and review and evaluate credentials on behalf of some of the provin-cial licensing bodies. In 2016 the National Examining Board issued 472 Certificates of Qualification to graduates from the 5 Canadian veterinary colleges, as well as to internationally trained veterinarians who completed the NEB exams.

Volunteers of the Animal Health Technology/Veterinary Technician Program Accreditation Committee (AHTVTPAC) work to identify and promote standards and accreditation for animal health technologist and veterinary technician programs. The AHTVTPAC constantly reviews accreditation standards in collaboration with the 19 accredited programs in Canada and partners like the American Veterinary Medical Association to keep up with rapidly changing requirements and evolving needs in veterinary practice. In 2016, accreditation site visits were made at 4 AHT programs across Canada.

The Canadian Veterinary Medical Association’s Canadian Veterinary Reserve (CVR) is a national, volunteer group of quali-fied Canadian veterinarians who make themselves available to rapidly assist governments in responding to outbreaks of foreign animal disease and other large-scale emergencies and disasters affecting animals.


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346 CVJ / VOL 58 / APRIL 2017

N vétérinaire du Canada ainsi qu’à des médecins vétérinaires formés à l’international qui avaient réussi les examens du BNE.

Les bénévoles du Comité d’agrément des programmes de technologie en santé animale et de techniques vétérinaires travaillent afin d’identifier et de promouvoir des normes et l’agrément des programmes de technologie de la santé animale et de techniques vétérinaires. Pour suivre l’évolution rapide des exigences et des besoins en pratique vétérinaire, le CAPTSATV passe constamment en revue les normes d’agrément en collaboration avec les 19 programmes agréés au Canada et avec des partenaires comme l’American Veterinary Medical Association. En 2016, des inspections ont été réalisées pour quatre programmes de technologie de la santé animale au Canada.

La Réserve vétérinaire canadienne (RVC) de l’Association canadienne des médecins vétérinaires est un groupe national de vétérinaires autorisés bénévoles qui peuvent porter assistance rapidement aux gouvernements lors d’interventions en cas d’éclosions de maladies animales exotiques et d’autres urgences et catastrophes à grande échelle qui touchent les animaux.

Les bénévoles du Comité de la rédaction supervisent le fonctionnement et le contenu éditorial de La Revue vétérinaire canadienne et de la Revue canadienne de recherche vétérinaire. Ces deux publications ne pourraient pas exister sans la contribution des bénévoles et des nombreux rédacteurs et examinateurs.

Le Comité des étudiants de l’ACMV (ÉACMV) et le Groupe consultatif de liaison avec les étudiants créent un lien entre l’ACMV et les étudiants en médecine vétérinaire et les professeurs des cinq facultés de médecine vétérinaire du Canada. En janvier, le Comité des ÉACMV a accueilli plus de 200 étudiants au Symposium 2017 des ÉACMV, qui a été organisé par la Faculté de médecine vétérinaire de l’Université de Calgary et, en novembre 2016, la première édition annuelle de l’Atelier de leadership étudiant s’est tenue à la Faculté de médecine vétérinaire (FMV) de l’Université de Montréal.

L’objectif du Groupe consultatif sur le bien-être vétérinaire consiste à élaborer et à promouvoir des initiatives et des programmes de bien-être vétérinaire à l’échelle nationale afin de servir de complément aux programmes provinciaux ainsi que d’aider les groupes et les provinces à élargir leurs propres initiatives de bien-être. En 2016, le Groupe consultatif a conçu une nouvelle section sur le site Web de l’ACMV qui est consacrée à la santé et au bien-être des médecins vétérinaires. La section offre l’accès à des ressources externes pertinentes, à des outils et à des renseignements dans les catégories de la santé émotionnelle et mentale, la santé physique et le bien-être des vétérinaires. On continuera d’ajouter des ressources au fur et à mesure qu’elles seront identifiées.

L’ACMV a aussi réalisé un sondage auprès de toutes les associations provinciales de médecins vétérinaires et des organismes de réglementation afin d’obtenir des renseignements sur les programmes de bien-être et de counseling qu’ils offrent à leurs membres, les services de counseling spécifiques qui sont fournis, le coût de ces programmes et de compiler des statistiques sur l’utilisation des services. Les résultats du sondage ont été compilés et partagés avec toutes les AMV provinciales à titre d’information.

C’est grâce au dévouement des nombreux bénévoles que les réalisations de l’ACMV sont mises en œuvre. Nous vous remercions sincèrement de faire don de votre temps et de votre expertise.

The volunteers of the Editorial Committee oversee the opera-tion and editorial content of The Canadian Veterinary Journal and the Canadian Journal of Veterinary Research. These 2 publica-tions could not exist without the volunteer contribution of the numerous editors, peer reviewers and writers.

The Students of the CVMA Committee (SCVMA) and the Student Liaison Advisory Group (SLAG) link the CVMA with stu-dent veterinarians and faculty members at Canada’s 5 veterinary colleges. In January, the SCVMA Committee welcomed over 200 students to the 2017 SCVMA Symposium, hosted by the University of Calgary — Faculty of Veterinary Medicine and in November 2016 the first annual Student Leadership Workshop debuted at the Faculté de médecine vétérinaire (FMV).

The Veterinary Wellness Advisory Group’s objective is to develop and promote veterinary wellness initiatives and pro-grams at a national level to complement provincial programs, and help groups and provinces in expanding their own wellness initiatives. In 2016, the Advisory Group developed a new sec-tion on the CVMA website dedicated to the health and wellness of veterinarians. The section provides easy access to relevant external resources, tools, and information categorized under emotional and mental health, physical health, and veterinarian wellness. Resources continue to be added as they are identified.

The CVMA also undertook a survey of all the provincial vet-erinary associations and regulatory bodies to obtain information about their respective wellness/counselling programs available to members; the specific counselling services being offered; the cost to offer such programs; and some aggregate usage statistics. The survey results were compiled and shared with all the provincial VMAs for their information.

The CVMA’s achievements are due to the devotion of our many volunteers. We sincerely thank you for donating your time and expertise.


CVJ / VOL 58 / APRIL 2017 347

NLa Journée mondiale vétérinaire aura lieu le 29 avril 2017L’antibiorésistance — De la sensibilisation à l’action

La Journée mondiale vétérinaire se déroulera le 29 avril 2017 à l’échelle mondiale sous le thème

«L’antibiorésistance — De la sensibilisation à l’action».À l’Association canadienne des médecins

vétérinaires (ACMV), nous passons de la sensibilisation à l’action après l’élaboration du document Surveillance vétérinaire de l’utilisation des

antimicrobiens — Un cadre de travail pancanadien pour les normes professionnelles régissant les

médecins vétérinaires. Le cadre de travail est un modèle de normes professionnelles qui sera utilisé par les organismes de réglementation de la médecine vétérinaire lors de l’établissement de leurs propres règlements, lignes directrices ou statuts concernant les responsabilités professionnelles des médecins vétérinaires dans le cadre de la surveillance de l’utilisation des antimicrobiens vétérinaires. Il vise à appuyer l’élaboration de règlements uniformes à l’échelle du pays. Le cadre de travail peut être téléchargé sur le site Web de l’ACMV, sous l’onglet Politiques et défense des intérêts.

L’ACMV facilite les préparatifs pour la mise sur pied de la surveillance nationale de l’utilisation des antimicrobiens par la collectivité vétérinaire. Un atelier financé en vertu du Programme d’assistance fédérale du gouvernement du Canada a réuni les principaux partenaires de la santé animale et humaine à Ottawa le 28 février et le 1er mars 2017. L’objectif consistait à établir une compréhension commune de l’état actuel de la surveillance de l’utilisation des antimicrobiens dans le contexte vétérinaire, à identifier des lacunes en matière d’information et à considérer les exigences en vue de la conception de méthodes et d’approches efficaces pour la collecte des données. L’atelier constituait la première phase de ce qui s’annonce comme un projet pluriannuel.

Dans un projet distinct portant sur l’amélioration de l’antibiogouvernance, et avec l’appui de Cultivons l’avenir 2 d’Agriculture et Agroalimentaire Canada, l’ACMV a entamé le renouvellement des Lignes directrices de l’ACMV sur l’administration judicieuse des médicaments antimicrobiens vétérinaires. Ce projet invitera la participation de la collectivité vétérinaire en vue d’identifier les besoins et de concevoir de nouveaux outils, lignes directrices et stratégies de communication dans le but d’aider les médecins vétérinaires à prendre des décisions informées à propos de l’utilisation des médicaments antimicrobiens vétérinaires.

Le cadre de travail et les nouvelles initiatives qui en découleront aborderont les responsabilités changeantes des médecins vétérinaires en lien avec la mise en œuvre, par le gouvernement fédéral, d’une surveillance vétérinaire accrue qui est prévue à la fin de 2017.

Le travail de l’ACMV appuiera l’engagement du Canada en vue d’établir et de renforcer les systèmes de surveillance afin d’identifier les nouvelles menaces ou l’évolution des tendances du recours et de la résistance aux antimicrobiens, dans les contextes humains et animaux, tel qu’il a été décrit dans le Plan d’action fédéral sur la résistance et le recours aux antimicrobiens au Canada : Prolongement du cadre d’action fédéral.

World Veterinary Day Takes Place on April 29, 2017Antimicrobial Resistance — From Awareness to Action

World Veterinary Day takes place globally on April 29, 2017 under the theme, “Antimicrobial

Resistance — from Awareness to Action.”At the Canadian Veterinary Medical

Association (CVMA), we are shifting from aware-ness to action following the development of the document Veterinary Oversight of Antimicrobial Use — A Pan-Canadian Framework for Professional Standards for Veterinarians. The Framework is a tem-plate of professional standards for provincial and territo-rial veterinary regulatory bodies to use when developing their own regulations, guidelines, or bylaws relating to veterinarians’ professional responsibilities in providing oversight of veterinary antimicrobial use. It is intended to support the development of consistent regulations across the country. The Framework can be downloaded from the CVMA website, under the Policy & Advocacy tab.

The CMVA is facilitating the foundational work for building national surveillance of antimicrobial use (AMU) in animals by the veterinary community. Funded under the Canadian government’s Federal Assistance Program, a workshop gathered key partners in animal and human health in Ottawa, Ontario on February 28 and March 1, 2017. The objective was to build a collective understanding of the existing state of AMU surveillance in the veterinary context, and to identify informa-tion gaps and requirements to design efficient and effective data/information gathering methods. The workshop was Phase 1 of what is expected to be a multi-year project.

In a separate project focused on enhancing stewardship, and with the support of Agriculture Canada’s Growing Forward 2, the CVMA has commenced the renewal of the CVMA Guidelines for the Prudent Use of Veterinary Antimicrobial Medications. This project will engage the veterinary community in identifying needs for, and the development of, new tools, guidelines and communication strategies to assist veterinarians in making informed decisions about the use of veterinary anti-microbial drugs.

The Framework and resulting new initiatives address the changing veterinary responsibilities that accompany the federal government implementation of increased veterinary oversight of antimicrobials slated for the end of 2017.

The CVMA’s work will help Canada’s commitment to estab-lish and strengthen surveillance systems to identify new threats or changing patterns in antimicrobial resistance and use, in human and animal settings, as described in the Federal Action Plan on Antimicrobial Resistance and Use in Canada: Building on the Federal Framework for Action.


348 CVJ / VOL 58 / APRIL 2017

N Promotion 2017 : Votre adhésion à l’ACMV est GRATUITE jusqu’en décembre!

Félicitations à la promotion 2017 pour l’obtention du D.M.V.! Tandis que vous entamez votre carrière et que vous renforcez vos

compétences, l’ACMV vous encourage à rencontrer les leaders de votre profession, à garder le contact avec vos pairs et à vous tenir au courant des enjeux qui touchent les médecins vétérinaires canadiens.

L’ACMV désire assurer votre succès lors de cette transition à votre nouvelle carrière et elle vous offre l’adhésion gratuite à l’ACMV jusqu’en décembre 2017. Vous recevrez bientôt votre premier Guide des ressources de l’ACMV et vous continuerez à recevoir des mises à jour régulières par courriel, les numéros mensuels du cyberbulletin de l’ACMV ainsi qu’une version imprimée de La Revue vétérinaire canadienne par la poste et l’accès aux initiatives de l’ACMV pour les vétérinaires en début de carrière, dont le Programme de mentorat de l’ACMV.

Continuez de profiter des avantages de l’adhésion à l’ACMV en vous assurant que nous possédions bien vos adresses actuelles pour votre résidence et votre courriel dans la base de données vétérinaires nationale de l’ACMV. Voici ce qu’il faut faire :1. Allez au (www.veterinairesaucanada.net).2. Cliquez sur l’onglet Connexion au haut de la page Web.3. Choisissez Modification de profil et ouvrez une session en

utilisant votre prénom et nom de famille et votre mot de passe personnel (si vous avez oublié votre mot de passe, vous pouvez le demander dans la section de connexion du site Web ou communiquer avec le bureau de l’ACMV).De plus, veuillez noter que l’ACMV a mis en place des réductions

annuelles de la cotisation pour les diplômés récents. Après votre adhésion gratuite à l’ACMV pendant le reste de l’année d’obtention du diplôme, vous recevrez un rabais de 75 % pour l’année civile suivante, un rabais de 50 % la deuxième année après la fin du cours et un rabais de 25 % pour la troisième année.

L’ACMV a été heureuse de vous compter parmi ses membres étudiants durant vos études et nous vous offrons nos meilleurs vœux de succès pendant votre nouvelle carrière!

Pour en savoir davantage à propos de l’adhésion à l’ACMV et pour de plus amples renseignements sur les initiatives de l’ACMV pour les médecins vétérinaires en début de carrière, contactez notre équipe des Services aux membres par téléphone au 1-800-567-2862, poste 110, ou par courriel ([email protected]).

Class of 2017: Your CVMA Membership is FREE Until December!

Class of 2017, congratulations on earning your DVM! As your career begins and your skills strengthen, the CVMA

encourages you to meet your profession’s leaders, stay connected with your peers and be aware of Canadian issues affecting veterinarians.

The CVMA wants to help you excel as you transition into your new career and is offering free CVMA membership until December 2017. You’ll soon receive your first CVMA Source Guide and you will continue to receive regular e-mail updates, CVMA’s monthly e-newsletter, a print copy of The Canadian Veterinary Journal by mail and access to CVMA’s early career DVM initiatives, including CVMA’s Mentoring Program.

Continue enjoying your CVMA membership benefits by ensuring your current home and e-mail addresses are reflected in CVMA’s national veterinary database. Here’s how:1. Go to (www.canadianveterinarians.net).2. Click on the My Profile tab at the top of the web page.3. Choose Update Profile and log in using your first and last

name and personal password (if you forget your password, you can request it through the login section of the website or contact the CVMA office).Also, please note the CVMA has annual membership due

reductions for new graduates. After your free CVMA member-ship for the balance of your graduating year, you’ll receive a 75% discount for the calendar year following graduation, a 50% discount for year 2 post-graduation and a 25% reduction for year 3 post-graduation.

The CVMA enjoyed counting you among its student mem-bers over the course of your studies and wishes you success in your new career!

For more information about your CVMA membership and to learn more the CVMA’s early career DVM initiatives to help you in your career, contact our Member Services team by phone at 1-800-567-2862, ext. 110, or by e-mail ([email protected]).


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Le Jour de la Terre aura lieu le 22 avril 2017. Veuillez envisager ces dix changements simples que vous pouvez mettre en œuvre

dans votre pratique afin d’avoir un impact positif sur l’environnement : 1. La mise hors tension de l’équipement le soir produira une

réduction de 25 à 50 % de l’utilisation d’énergie. Ordinateurs/Imprimantes/Écrans/Télévisions/Ventilateurs/Climatiseurs type fenêtre.

2. Utilisation du papier — n’utilisez pas de papier lorsque vous le pouvez! — Utilisez la communication électronique au lieu du service des postes. Choisissez du papier recyclé post-consommation.

3. Lavez et stérilisez de nouveau les seringues de plastique de grand format pour pouvoir les réutiliser plusieurs fois.

4. Utilisation de l’eau — choisissez des toilettes à faible débit d’eau ou un réducteur de volume d’eau. Utilisez des bouteilles d’eau potable réutilisables ou de l’eau filtrée — pas de bouteilles jetables!

5. Affichez des panonceaux «Pas de marche au ralenti» dans votre stationnement.

6. Exercez des pressions sur les représentants de l’industrie vétérinaire afin qu’ils procèdent à des améliorations pour concevoir des emballages écologiques et de l’équipement médical à haut rendement énergétique. Utilisez des fournisseurs qui récupèrent l’emballage et les contenants pour réutilisation.

7. Les lumières — fermez-les! — Utilisez des détecteurs de mouvement et des minuteries. Le soir, allumez un nombre minimal de lumières pour des raisons de sécurité. Le Jour de la Terre devrait être tous les jours!

8. Débarrassez-vous des ampoules incandescentes — remplacez-les par des lampes fluocompactes ou des ampoules DEL.

9. RECYCLEZ, RECYCLEZ, RECYCLEZ!10. Utilisez des produits «écologiques»

toutes les fois que vous en avez l’occasion. Minimisez l’utilisation de produits à forte teneur en phosphates, eau de Javel, etc.

Vis i tez la sect ion Pra t ique e t finances du site Web de l’ACMV (www.veterinairesaucanada.net) afin d’accéder à l’initiative d’une Pratique vétérinaire écoresponsable.

Earth Day takes place on April 22, 2017. Consider these 10 simple changes you can implement in your practice that

will make a positive impact on the environment: 1. Power down equipment (computers, printers, monitors,

television, fans, window A/C units) at night for a 25% to 50% reduction in energy use.

2. Paper use — go paperless where you can! Use electronic communication rather than mail. Choose 100% post-consumer recycled paper.

3. Wash and re-sterilize larger sized plastic syringes for multiple use.

4. Water use — choose low-flow toilets or use a toilet dam. Utilize refillable drinking water bottles or filtered water — no throwaways!

5. Post “No Idling” signs in your parking area. 6. Put pressure on veterinary industry representatives for

improvements in environmentally friendly packaging and energy efficient medical equipment. Use suppliers who take back packaging/totes for reuse.

7. Lights — turn them off! Use motion detectors and/or timers. Leave minimal lighting on at night for security purposes. Earth Day should happen every day!

8. Get rid of incandescent bulbs — switch to CFL or LED. 9. RECYCLE, RECYCLE, RECYCLE!10. Use “green” products at every opportunity. Minimize the

use of high phosphate products such as bleach.Visit the Practice & Economics section of CVMA’s website

(www.canadianveterinarians.net) to access the Green Veterinary Practice initiative.

Top 10 Changes Veterinarians Can Make that Impact the EnvironmentLes dix changements les plus importants que les vétérinaires peuvent apporter afin d’avoir un impact sur l’environnement


350 CVJ / VOL 58 / APRIL 2017

N Congrès 2017 de l’ACMV Charlottetown, du 13 au 16 juilletLibérez votre potentiel!

Le congrès de l’ACMV à Charlottetown (du 13 au 16 juillet 2017) aura lieu dans moins de trois mois. Lorsque nous consultons

les évaluations du congrès 2016 de l’ACMV, nous constatons que c’est l’emplacement du congrès qui est le facteur le plus important lorsque les médecins vétérinaires prennent la décision d’assister au congrès de l’ACMV.

Nous espérons que les anciens de l’Atlantic Veterinary College (AVC) éprouveront de la nostalgie et planifieront une visite dans cette charmante ville. L’AVC organisera une réunion des anciens de toutes les promotions le vendredi 15 juillet à l’AVC. Il s’agira d’une merveilleuse occasion de reprendre contact avec des camarades de classe. Et, pour les autres, Charlottetown illustre l’exemple par excellence d’une capitale maritime animée, grâce à son cachet historique et à sa fierté locale. On peut y retracer des liens avec le passé et la ville maintient la tradition d’hospitalité et de sentiments d’appartenance pour lesquels toute l’Île-du-Prince-Édouard est reconnue. C’est une destination estivale à découvrir!

L’évaluation du congrès 2016 a aussi identifié que les ateliers de formation continue représentaient le deuxième facteur qui influençait la décision d’assister au congrès de l’ACMV. L’article du mois dernier décrivait les divers laboratoires de travaux pratiques qui seront offerts et les ateliers parallèles commenceront le 14 juillet et se termineront le dimanche 16 juillet. Ces ateliers porteront sur les animaux de compagnie, les équidés, les bovins, les ruminants et la santé des petits troupeaux de volaille et ils présenteront plus de 40 conférenciers provenant du Canada et des États-Unis. Les sujets incluront la dentisterie, la chirurgie des tissus mous, les animaux exotiques et les animaux de poche, la gestion de la douleur, la dermatologie, le bien-être animal, l’ophtalmologie, l’imagerie diagnostique et plus encore.

2017 CVMA Convention Charlottetown, July 13–16Unleash Your Potential!

The CVMA Convention in Charlottetown (July 13–16, 2017) is less than 3 months away. Looking at the evaluations of the

2016 CVMA Convention, the location of the Convention is the number one factor to influence DVMs whether they will attend the CVMA Convention.

We are hoping that Atlantic Veterinary College (AVC) alumni will feel nostalgic and plan a return visit to this charming city. The AVC is hosting an all-year alumni reunion on Friday, July 15 at the college; a wonderful opportunity to reconnect with classmates. And for others, Charlottetown is an excellent example of a vibrant seaside capital city with historic charm and pride of place. It provides links to the past and carries on the tradition of hospitality and the sense of belonging that the entire province of Prince Edward Island is noted for. A summer destination to be enjoyed!

The 2016 Convention evaluation also identified that con-tinuing education (CE) sessions are the 2nd factor to influence whether to attend the CVMA Convention. Last month’s article described the diverse wet labs that will be offered. The concur-rent sessions begin on Friday, July 14 and run through Sunday, July 16. These sessions cover companion animals, equine, bovine, ruminant, and small flock poultry health with over 40 speakers from Canada and the United States. Topics include dentistry, soft-tissue surgery, exotics, and pocket pets, pain management, dermatology, animal welfare, ophthalmology, diagnostic imag-ing, and much more.

On Thursday, July 13, Dr. Ernie Ward from North Carolina will present 6 sessions in the Practice Management stream —


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NLe jeudi 13 juillet, le Dr Ernie Ward de la Caroline du Nord présentera six ateliers dans le volet sur la gestion d’une pratique — «Une carrière prospère : une vie équilibrée». Le Dr Ward discutera de la façon d’améliorer l’exactitude du diagnostic et de la communication, comment gérer les conflits et il révélera des conseils qui permettront à toute l’équipe de créer un environnement plus heureux et plus sain à la clinique. Il discutera aussi la pratique innovatrice de l’introduction d’une visite de 9 mois pour les animaux de compagnie.

Le Sommet de l’ACMV, qui s’intitulera «L’avenir de la médecine vétérinaire : Adopter les changements et l’innovation», aura lieu le jeudi 13 juillet et présentera trois conférenciers inspirants. Nick Stace, du Royal College of Veterinary Surgeons au Royaume-Uni, discutera des résultats d’un rapport portant sur l’avenir des vétérinaires. Le Dr Caleb Frankel de la Pennsylvanie se penchera sur «L’innovation dans la pratique vétérinaire» et les nouvelles technologies émergentes. Enfin, le Dr Adam Little, de l’Université Texas A&M, examinera l’«Uber de la médecine vétérinaire». Le Sommet de cette année sera présidé par la Dre Troye McPherson, la présidente désignée de l’ACMV.

Le jeudi 13 juillet, de 14 h à 17 h, le Forum sur les enjeux nationaux, qui est commandité par Wood Wyant, se penchera sur la médecine parallèle et explorera le sujet pour déterminer s’il s’agit toujours d’une médecine parallèle. Le Dr Jim Berry abordera cette question à titre de praticien pour petits animaux qui fait appel à des traitements d’acupuncture; la Dre Christine Savidge examinera la question du point de vue d’une universitaire et spécialiste en médecine interne des petits animaux et la Dre Laura Taylor présentera des commentaires du point de vue de la pratique équine holistique privée.

Une discussion et la participation de l’auditoire avec des sondages en direct contribueront à l’examen formel de la position officielle de l’ACMV sur la médecine complémentaire et parallèle qui se déroulera cette année.

Ces ateliers de formation continue devraient intéresser la plupart des médecins vétérinaires et des techniciens vétérinaires agréés (TVA) et ils permettent de justifier la participation au congrès. Les ateliers du congrès 2017 de l’ACMV ont été évalués et approuvés par le programme RACE de l’AAVSB afin d’offrir un total

de 125 crédits de formation continue (maximum de 27) qui sont disponibles aux médecins vétérinaires et de 72 crédits pour les techniciens vétérinaires (maximum de 27) qui sont proposés aux TVA. C’est une excellente occasion d’accumuler des crédits de formation continue.

Si vous n’êtes pas encore inscrit, rendez-vous sur le site Web (www.veterinairesaucanada.net). Inscrivez-vous dès aujourd’hui pour cette occasion exceptionnelle de formation continue qui est offerte dans l’Est du Canada. Au plaisir de vous rencontrer à Charlottetown!

(par Ruta Klicius, CMP, gestionnaire des congrès de l’ACMV)

“A Successful Career: A Balanced Life.” Dr. Ward will discuss how to improve diagnostic accuracy and communication, how to deal with conflict, and reveal tips for the entire team on how to make your clinic happier and healthier. He will also discuss an innovative practice of introducing a 9-month pet visit.

The CVMA Summit entitled “The Future of Veterinary Medicine: Embracing Change and Innovation” will be held on Thursday, July 13 with 3 thought-provoking speakers. Nick Stace, with the Royal College of Veterinary Surgeons in the United Kingdom, will discuss the results of a report dealing with veterinary futures. Dr. Caleb Frankel from Pennsylvania will look at “Innovation in the Veterinary Practice” and the new technologies that are emerging. Dr. Adam Little, with Texas A&M University, will look at the “Uber in Veterinary Medicine.” This year’s Summit will be chaired by Dr. Troye McPherson, CVMA president-elect.

On Thursday, July 13 from 2 to 5 pm, the National Issues Forum, sponsored by Wood Wyant, will look at alternative medicine and discuss whether it’s still an alternative. Dr. Jim Berry will discuss the issue as a small animal practitioner who uses some acupuncture; Dr. Christine Savidge will view the issue through the lens of an academic and a small animal internal medicine specialist, and Dr. Laura Taylor will provide insight from an equine holistic private practice.

A discussion and audience participation with live polling will help contribute to the formal review of CVMA’s official posi-tion on complementary and alternative medicine that is taking place this year.

These CE offerings should be of interest to most DVMs and RVTs and provide the rationale for attending the conven-tion. The 2017 CVMA Convention program was reviewed and approved by the AAVSB RACE program to offer a total of 125 CE credits (27 maximum) being available to any one DVM and 72 veterinary technician credits (27 maximum) being avail-able to any one RVT. It’s a great opportunity to earn CE.

If you haven’t registered, go to the website (www.canadian veterinarians.net). Register today for an exceptional CE oppor-tunity in eastern Canada. See you in Charlottetown!

(by Ruta Klicius, CMP, CVMA Manager, Conventions)


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La Communauté des maladies émergentes et zoonotiques (CMEZ) est un réseau virtuel qui intègre les outils automatisés

d’extraction d’information d’aujourd’hui avec la capacité analytique multidisciplinaire des humains. Ce système automatisé en temps réel collecte, collige, analyse et dissémine des renseignements portant sur les maladies infectieuses et les zoonoses émergentes provenant de sources d’information ouvertes et traditionnelles.

Pourquoi la CMEZ a-t-elle été mise sur pied?Ce réseau virtuel a été conçu afin d’appuyer les besoins des capacités de dépistage précoce, de préparatifs et d’intervention du Canada en lien avec les maladies émergentes et les zoonoses. Par la collecte de renseignements, la production et la distribution de rapports de renseignement opportuns, le Canada est maintenant plus apte à prévoir, à gérer et à atténuer les menaces de maladies pour sa société, son économie, son environnement et les ressources animales.

La CMEZ sollicite votre participation!Tous les partenaires et les intervenants membres des collectivités de la santé animale, publique et environnementale sont encouragés à s’engager, à participer à la mise en œuvre de ce réseau virtuel et à profiter de ses capacités de dépistage précoce. Les participants des diverses collectivités de pratique possédant des qualifications et/ou de l’expertise dans le domaine de la santé agricole, publique et environnementale sont invités à s’engager en tant qu’analystes de la CMEZ pour assurer la prestation de sa capacité d’analyse multidisciplinaire.

Pour en savoir davantage, allez sur le site Web (www.cahss.ca) du Système canadien de surveillance de la santé animale (SCSSA) (www.cahss.ca) et sous l’onglet Groupes, cliquez sur Communauté des maladies émergentes et zoonotiques afin de :• Lire un résumé portant sur la CMEZ qui présente ses

avantages et des renseignements sur la façon de vous joindre à la collectivité.

• Télécharger l’affiche de la CMEZ qui décrit le but et le processus suivis par la collectivité pour les maladies émergentes et zoonotiques.La CMEZ est un groupe de réseau au sein du Système

canadien de surveillance de la santé animale (SCSSA), une initiative du Conseil national sur la santé et le bien-être des animaux d’élevage (CNSBAE), doté d’un vaste soutien collaboratif de l’industrie et des gouvernements. Le SCSSA a été conçu pour combler le besoin d’une surveillance accrue de la santé animale

au Canada tel qu’il a été identifié dans le rapport du CNSBAE, «Surveillance in a Time of Transition in Farmed Animal Health».

The Community for Emerging and Zoonotic Diseases (CEZD) is a virtual network that integrates today’s auto-

mated information-mining tools with a human-based multi-disciplinary analytical capability. This real-time automated system collects, collates, analyzes, and disseminates intelligence information related to zoonotic and emerging infectious diseases from both open and traditional information sources.

Why was CEZD developed?This virtual network was developed to support Canada’s animal early-warning, preparedness and response capabilities needs regarding emerging and zoonotic diseases. Through the gathering of information, generation and distribution of timely intelligence reports, Canada is now better able to anticipate, manage, and mitigate pending disease threats on its society, economy, environ-ment, and animal resources.

CEZD would like your participation!All partner and stakeholder members of the animal, public and environmental health communities are encouraged to participate, be involved in the implementation of this virtual network, and benefit from its early-warning capabilities. Various community of practice participants with agricultural, public and environ-mental health-related qualifications and/or expertise are invited to participate as CEZD analysts in order to deliver on its multi-disciplinary analytical capability.

For more information, go to the Canadian Animal Health Surveillance System (CAHSS) website (www.cahss.ca) and under the Groups tab, click Community for Emerging and Zoonotic Diseases to do the following:• Read a summary of CEZD, its benefits and information

on how to join the community.• Download the CEZD poster that describes the purpose

and process followed by the community for emerging and zoonotic disease.CEZD is a network group within the Canadian Animal

Health Surveillance System, which is an initiative of the National Farmed Animal Health and Welfare Council (NFAHWC), with broad-based collaborative support of industry and governments. CAHSS has been designed to fill the need for strengthened animal health surveillance in Canada, as identified in the NFAHWC’s report, “Surveillance in a Time of Transition in Farmed Animal Health.”

Join the Community for Emerging and Zoonotic Diseases to Support Canada’s Animal Early Warning CapabilitiesJoignez-vous à la Communauté des maladies émergentes et zoonotiques afin d’appuyer les capacités de dépistage précoce des animaux du Canada


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Article

Use of an elastic transarticular external fixator construct for immobilization of the elbow joint

Bertrand Vedrine

Abstract — Transarticular external skeletal fixation usually involves rigid bars that result in a stable but stiff joint. This study describes the technique and the outcome of an elastic transarticular external fixator (ETEF) applied to the elbow joint. Four cases of elbow luxation with collateral ligament injuries were managed with closed reduction and application of an ETEF to maintain the reduction. A triceps tendon avulsion was surgically managed before applying an ETEF. The clinical outcome was considered excellent in 2 cats, good in 2 dogs (1 elbow luxation and the avulsion of the triceps tendon), and poor in 1 dog presented for elbow luxation and a permanent neurological defect. The procedure was rapid, easy to perform, and inexpensive. All animals except the one with a neurological defect had an early return to weight bearing. This method maintains extension of the joint while permitting its motion thereby promoting rehabilitation.

Résumé — Utilisation d’un fixateur externe élastique en pontage articulaire pour immobiliser le coude. Un pontage articulaire est généralement réalisé avec des barres métalliques aboutissant à une articulation stable mais rigide. Cette étude décrit la technique et le suivi d’un pontage articulaire par fixateur externe elastique (FEE) appliqué au coude. Quatre cas de luxation du coude avec lésions ligamentaires associées ont été gérés par réduction manuelle et application d’un FEE pour maintenir la réduction. Une avulsion du tendon du triceps a été opérée avant application d’un FEE. Le résultat a été considéré excellent pour 2 chats, bon pour 2 chiens (1 luxation du coude et l’avulsion du triceps), et mauvais pour un chien présenté pour luxation du coude avec un déficit neurologique permanent. La procédure était rapide, facile à réaliser et peu onéreuse. Tous les animaux à l’exception de celui avec le déficit neurologique ont repris rapidement un appui. Le FEE maintient l’articulation en extension tout en permettant son mouvement ce qui favorise sa rééducation.

(Traduit par Docteur Bertrand Vedrine)

Can Vet J 2017;58:353–359

Introduction

T ransarticular stabilization is designed to restrict joint movement by the placement of an external skeletal fixa-

tion device above and below a joint, connected by rigid bars. It has been developed to manage joint instability (1–3), protect tendon repair such as patellar tendon (4–6), common calcaneal tendon (7,8), triceps tendon (9,10), and juxta-articular fractures

(2,5,11). Rigid transarticular external fixators (RTEFs) have been employed to restore joint alignment and stability while healing of supporting structures and articular cartilage surface takes place.

Joint immobilization, however, causes a decrease in synovial fluid production, cartilage stiffness and thickness, and range of motion (ROM). It also leads to cartilage fibrillation, cleft formation, intra-articular adhesions, periarticular contractures, the development of degenerative joint disease, a loss of muscle mass, and bone mineral content and density (1–8,11). Some of the changes present after joint immobilization appear to be per-manent even if rapid remobilization after removal of the fixator helps to reverse the negative consequences of immobilization.

Controlled motion of ligamentous structures has been reported to be beneficial since intermittent joint compression serves as a pump mechanism for solute exchange in the cartilage (4). Motion has been shown to stimulate neochondrogenesis, promoting differentiation of mesenchymal cells toward a chon-drogenic lineage, especially during the first few weeks of the healing process. As little as 10º of movement in a joint promotes

Clinique Vétérinaire Seinevet — 5, place Cauchoise 76000 Rouen, France.Address all correspondence to Dr. Bertrand Vedrine; e-mail: [email protected] in abstract form at the 43rd Veterinary Orthopedic Society Annual Conference, March 1, 2016, Big Sky, Montana, USA.Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.


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preservation of articular cartilage health, so an ideal balance between motion and immobilization is required for the best outcome after surgical ligamentous repair (4).

Non-rigid transarticular external fixator (N-RTEF) has been proposed to reduce the stiffness of the immobilization and promote an early controlled motion of the joint after surgery. Hinged transarticular external fixator (HTEF) restricts motion to a single plane parallel to the joint’s plane of motion (2,4). Elastic transarticular external fixator (ETEF) replaces connective rigid bars with an elastic band (3). The goals of N-RTEF are to prevent joint instability and promote healing of supportive structures while minimizing the impact of immobilization on articular homeostasis and cartilage metabolism.

The elbow is particularly prone to decreased range of motion (ROM) and development of periarticular fibrosis when immo-bilized for any length of time (12). Recommendations for immobilizing the joint after reduction of elbow dislocation vary from 7 d to 2 wk (13–16). Protection of an avulsed triceps tendon repair needs an immobilization of 3 to 6 wk to allow the tendon to regain sufficient tensile strength and healing at the osseo-tendinous junction (9,10,17–20).

The purpose of this study was to describe the placement of an ETEF in clinical cases and to evaluate its ability to maintain the reduction of unstable elbows, and to protect repair of an avulsed triceps tendon.

Materials and methodsHospital records from the veterinary clinic Seinevet, Rouen-Boos, France, were searched for cases in which ETEF was used to immobilize elbow joints. Between May 2013 and December 2014, 5 animals (3 dogs, 2 cats) presented for elbow luxation (2 dogs, 2 cats) and avulsion of the triceps muscle (1 dog) were managed by application of an ETEF.

Elastic transarticular external fixator (ETEF) techniqueThe technique employed herein was the same as described by Schwartz and Griffon in 2008 (3). One pin was placed in the

distal quarter of the humerus, proximal to the supratrochlear foramen and perpendicular to the long axis of the bone. A second pin was placed parallel to the first in the center of the olecranon, at the proximal aspect of the bone (Figure 1). When both pins were in place, the elbow was moderately extended to an angle of 140°. The pins were then clamped to rigid bars for 2 d until postoperative swelling had decreased. Then, the con-nective bars were replaced with tight elastic bands on the medial and lateral aspects of the elbow to allow ROM. A commercial regular elastic band was used on each side of the fixator and was twisted several times around each pin until there was enough

Figure 1. Medio-lateral radiograph of an elbow illustrating the placement of the pins in the distal humerus and olecranon (black circles).

Figure 2. Photograph (A) and radiographs in orthogonal views (B) of the ETEF after placement of the elastic bands. Blood sampling tube stoppers were used to prevent migration of the band.

A

B


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tension to allow the patient to keep the elbow in extension and allow good ROM. Blood sampling tube stoppers were placed over the pins before and after placement of the elastic bands to prevent migration of the bands (Figure 2).

Elbow luxation (cases 1 to 4)Description, history, and duration of luxation at the time of consultation were recorded (Table 1). Diagnosis of elbow luxation was made upon clinical and radiographic examination (Figure 3). All the cases were managed with closed reduction. A Campbell test was carried out to evaluate collateral ligament integrity and residual instability after reduction. Stable elbows after closed reduction were excluded from the study. An ETEF was applied as described. Animals were discharged from the clinic after replacement of the rigid connective bars with elastic bands. They received anti-inflammatory drugs for 5 to 7 d. Instructions were given to owners to confine animals to a small room, dogs were allowed to have short leash walks for toilet-ing purposes. Re-examination and removal of the ETEF were scheduled 2 wk after its application in all cases.

Triceps avulsion (case 5)A 1-year-old female border collie, weighing 17 kg, was referred 11 d after being hit by a car. Initial consultation had allowed localization of the lameness to the elbow. Radiographs showed

osseous fragments proximal to the olecranon. Anti-inflammatory drugs were given to the dog for 1 wk without improvement. At the time of referral, the dog carried the limb flexed without bear-ing weight, loss of muscle mass was already noticed compared to the contralateral forelimb. Swelling in the region of the triceps tendon and the presence of osseous fragments in the region of the tendon on radiographs already taken were indicative of a triceps tendon avulsion. A computed tomography (CT) scan was made and showed a partial avulsion of the tendon (Figure 4). The triceps tendon was reattached to the olecranon using a modified three-loop pulley pattern. An ETEF was applied to protect the suture and allow the tendon to heal at the osseo-tendinous junction. The dog received anti-inflammatory drugs for 10 d and antimicrobial protection for 5 d. Instructions were given to confine the dog for 1 mo.

ResultsElastic transarticular external fixator (ETEF) techniquePin diameters were chosen based on body weight: 2 mm for animals weighing , 10 kg, and 2.5 mm for the dog weighing 17 kg. The mean duration of the procedure was approximately 15 min (the elbow luxations were reduced and the surgery of the avulsed triceps was performed beforehand). No peri-operative complication was noticed when applying ETEF. Elastic tension was estimated subjectively to allow the patient to keep the elbow extended and allow good ROM (Figure 5).

Pin tract drainage or infection and pin loosening were not seen in the study. The only complication seen with the ETEF application was cutaneous irritation by the blood sampling tube stoppers (Figure 6). This complication was observed in all the cases of the study. This was considered as a minor complication and was successfully managed with local treatment in case of irritation or with stitches at the time of the ETEF removal in case of ulceration.

Elbow luxationAll the elbows were laterally luxated. Closed reduction was suc-cessfully managed in all cases. The reduced joint was assessed for collateral stability by the Campbell test. Normal range of motion is around 45° in pronation and 70° in supination in dogs; normal supination is around 110° in cats. If the collateral lateral ligament is avulsed or ruptured supination is expected to increase, if the collateral medial ligament is injured, prona-tion is expected to increase. In cases 1, 2, and 4 both collateral ligaments seemed to be ruptured. In case 3, only the lateral

Table 1. Description and history of the 4 cases of elbow luxation

Duration of Origin of lameness at Stability of the Duration Range of motion at Age Weight elbow the time of elbow after of ETEF time of removal of Case Species Breed Gender (y) (kg) luxation surgery (d) closed reduction (d) the ETEF

1 Cat Common breed F 4 3.5 Unknown 1 Mildly unstable 28 30°2 Dog Spitz F 5 7 Dog bite 8 Highly unstable 15 25°3 Cat Common breed M 0.5 3 Kicked by owner 6 Mildly unstable 16 75°4 Dog Jack Russell terrier F 11 7.5 Hit by car 1 Mildly unstable 12 75°

F — Female; M — Male.

Figure 3. Cranio-caudal and medio-lateral radiographs of the elbow of the dog of case 4. Lateral luxation of the elbow without concomitant fracture are noted.


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collateral ligament seemed to be injured. In case 2, the dog was presented several days after being bitten by another dog and had multiple cutaneous lacerations and severe injury of nerves in the limb. In case 4, the dog was presented with concomitant pelvic fractures that were surgically managed with the elbow luxation.

Removal of the ETEF was initially scheduled for 2 wk after surgery. In case 1, the owner forgot the appointment and the ETEF was removed 28 d after surgery. The cat had intermit-tent weight-bearing with a limited ROM (30°) at this time on account of a severe ankylosis. The owner reported that the lameness had worsened during the presence of the ETEF, the cat had normal weight-bearing at the beginning of the period. Active physiotherapy was performed after removal of the fixator that allowed rapid improvement of the ROM and the lameness. The cat was examined during a consultation 5 mo later: there was no lameness, ROM was normal in extension but decreased in flexion as compared to the other forelimb (angle of flexion of 80° in the operated limb and of 30° in the contralateral limb) without clinical consequence. The clinical result was considered excellent.

Case 2 had a poor outcome on account of a permanent neu-rologic defect as a consequence of the dog bite (limb paralysis with loss of deep pain perception). Nearly 2 y after surgery, the dog still does not use his limb. The owner declined amputation. Case 3 was considered to have an excellent outcome. The cat walked without lameness with the ETEF and was immediately free of lameness after its removal. The cat was lost to follow-up 1 mo after the removal of the ETEF. Case 4 was considered to have a good outcome. The postoperative period was difficult on account of the concomitant pelvic fractures. At the removal of the ETEF the dog was lame in the hind limbs and the operated forelimb. Control evaluation was made 6 wk after surgery and revealed weight-bearing without lameness. A mild lameness was reported after activity, but the owners had difficulties identifying the lame limb. The ROM of the elbow was 90° (140° on the other elbow) with normal extension and limited flexion.

There was no case of reluxation after removal of the ETEF in the study.

Triceps avulsionRemoval of the stitches and the ETEF were made 14 d after surgery. It was assumed that the partial nature of the avulsion enabled a rapid removal of the fixator with decreased risk of complete rupture of the tendon. The ROM was decreased in flexion (90° of flexion) but normal in extension (170°). The dog had weight-bearing with persistent lameness. Active physiotherapy was done by the owner and the angle of flexion decreased to 60° 1 mo after removal of the ETEF. Clinically, the dog was intermittently lame, he was pain-free, and had returned to normal activity. He was lost to further follow-up.

DiscussionThis study describes the placement of an ETEF in clinical cases, and its ability to maintain the reduction of unstable elbows and to protect repair of an avulsed triceps tendon. To the author’s knowledge, this is the first report on clinical cases involving the use of ETEF (21).

The ETEF was successfully applied in 5 elbows. The pro-cedure was rapid (about 15 min), easy to perform, and not expensive for the pet owners. The bilateral frame of the ETEF was well-tolerated by the animals because of its light weight and absence of friction against the thorax. All the animals except the one with a neurological defect had an early return to weight-bearing. An N-RTEF such as HTEF or ETEF has been proposed to reduce the stiffness of the immobilization and promote an early controlled motion of the joint after surgery (2–4). Post-traumatic stiffness of the elbow joint is a frequent result of rigid immobilization leading to severe ankylosis. The tendency to stiffness leads to the assumption that the strong self-healing forces of the capsule and ligament apparatus convert the initial instability of the joint after ligament rupture, into a high-grade undirected stability following immobilization. Directed

Figure 4. Computed tomography scan of the elbow of the dog of case 5 in parasagittal sections. Heterogeneous soft tissues and swelling are noticed at the triceps tendon insertion. A hypodense area of 1 cm in diameter (double white arrow) is seen at the level of the caudal and the lateral bellies of the triceps (A). Several “flake” fractures are seen approximately 1.5 cm proximally from the olecranon (B).

A B


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stability, as produced by the natural ligament apparatus of the joint, on the other hand produces a guided movement of the joint in one direction. These theoretical considerations lead to the idea that the self-healing forces of the ligament apparatus under continuous guided movement of the joint will result in a stable and movable joint to allow healing of the compromised soft tissue envelope (1–8,11). Comparison between stiffness of the elbow joint at the time of removal of RTEF, HTEF, and ETEF is lacking. Three dogs (2 with elbow luxation and 1 with avulsed triceps tendon) had a ROM of 75° to 80° at the time of removal of the ETEF. The 2 other dogs with elbow luxation had ROM of only 25° to 30° on account of the length of time of the presence of the ETEF in 1 case, and the impossibility of weight-bearing with the ETEF secondary to a neurologic defect for the other. External coaptation is an alternative to transarticular external skeletal fixation in limiting elbow joint flexion. Robert-Jones bandage, light bandage, Spica splint, and orthosis are employed after reduction of elbow luxation to prevent recurrence (12–16,22), or to protect tendon repair in several joints (9,10,17–20).

Lateral elbow luxation was seen in the 4 cases described here, which is consistent with other studies that reported 92% to 100% of elbow luxations were lateral (13–16,22–24). In our study, luxations were caused by a traffic accident, dog bite, kick, and an unknown origin for the 4th case. Other reports described other causes such as falling from a height or getting

Figure 6. Photograph of the medial aspect of the elbow of the dog of case 5 after removal of the ETEF showing cutaneous ulceration secondary to friction by the blood sampling tube stoppers.

A

Figure 5. Photographs of the ETEF applied to the dog of case 4. ETEF maintains the elbow in extension because of the tension of the elastic bands (A) and allows ROM of the joint without reluxation (B).

B


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the leg caught, with indirect rotational forces rather than from direct traumatic forces (13,15). Closed and open reductions have been proposed to manage elbow luxation (13–16,22,25). Closed reduction often leads to successful reduction if the luxation is recent and without severe swelling. The reduced joint is assessed for collateral stability by the Campbell test: the elbow is held in a flexed position and the carpus is rotated. If the collateral ligaments are ruptured or avulsed, the paw is expected to rotate through a greater ROM than normal (16,23,26). Some authors have reported that collateral ligament injuries occur in 18% to 100% of the cases of elbow luxation (13–15,22). All the cases in our study had collateral ligament injury. An in vitro study has shown that the canine elbow could luxate after transection of the lateral collateral ligament or after transection of both the lateral and medial collateral ligaments, and the feline elbow could only luxate after transection of both (26). Closed reduction leads to periarticular fibrosis that provides sufficient stability of the elbows even if collateral ligament injuries are present at the time of surgery. Open reduction and stabilization should be considered if the joint cannot be reduced, if gross instability is present following closed reduction, or if a fracture is associated with the luxation. Some authors consider surgery immediately after closed reduction to decrease long-term stiffness of the joint and lameness (24) but this is controversial (13–15,22). External coaptation by Robert-Jones bandage, light bandage, or Spica splint is warranted for 7 d to 2 wk to avoid post-reduction reluxation (12–16,22). Duration of bandaging varies according to the resultant stability and subjective assessment of soft tissue damage (16).

Rigid transarticular external fixators (RTEF) have not been described to immobilize the elbow after luxation. Elastic trans-articular external fixators (ETEF) have been briefly mentioned in veterinary medicine (3), but no clinical reports have been published. We subjectively decided to maintain the ETEF for 2 wk (1 case had a removal at 28 d because the owner forgot the appointment). The absence of reluxation in the postopera-tive period now leads us to believe that this duration may be reduced to limit ankylosis. In the 4 cases described here, we did not notice any reluxation with an ETEF. The results were excel-lent for the 2 cats, good for 1 dog, and poor for the second dog on account of nerve injury. The cats had better postoperative results than dogs as previously described: an excellent result was encountered in 47.6% to 100% of cases following closed reduction in dogs (13,15,16), and in 100% in cats (16), which suggests that cats tolerate elbow luxation better than dogs. Joint stability following closed reduction is thought to be a positive prognostic indicator (13). All of the cases included in the study were unstable after reduction. In our practice we do not use complementary coaptation in case of elbows that are stable following reduction.

Triceps tendon rupture/avulsion is a rare injury. Rupture most commonly occurs from the osseous tendon insertion in the olecranon or, rarely, through the muscle or its myotendi-nous junction. The rupture can be complete or partial with or without associated fracture of the olecranon insertion of the tendon [i.e “flake” fracture avulsed from the olecranon (9,18)]. The rupture is often traumatic, although chronic degenera-

tion after repeated local infiltration of steroids has also been described (19). Swelling of the olecranon region can mask the palpation of the gap in the acute stage. A second examination after a few days, when the swelling has reduced, could be useful in doubtful cases. In our case, the referral consultation took place 11 d after the initial injury and offered an easy clinical diagnosis. Moreover, radiographs have shown osseous fragments proximal to the olecranon that were predictive of an avulsion of the triceps (9,18). Ultrasound examination (19) and magnetic resonance imaging (MRI) (10,20) allow a better intramuscular and myotendinous examination than do radiographs. Computed tomography (CT) has never been described for a diagnosis of a triceps avulsion. Reattachment of the triceps tendon to the olec-ranon via drill holes within the olecranon is usually successful. Various tension-relieving suture patterns have been described for repair of tendon ruptures such as the three-loop pulley (27,28) and its modified configuration that was employed in our case (18,19,29), locking-loop patterns (9,21), or double Krackow sutures (28). Augmentation of repair with a graft, as described for tendon rupture in dogs (10,30), was not necessary in our case on account of the partial rupture and the limited retrac-tion of the ruptured bellies of the triceps even though the initial trauma had happened 11 d earlier. The avulsed flakes of bone were too small to attempt their fixation. A postoperative immo-bilization of 3 to 6 wk is warranted to allow the tendon to regain sufficient tensile strength and healing at the osseo-tendinous junction (9,10,17–20). We chose to remove the fixator sooner than previously recommended because the rupture was partial with limited retraction. Transarticular external skeletal fixator offers a complete immobilization of the elbow with good protec-tion of the tendon repair (9,10). Nevertheless, it is well-known that a gradual increase in tendon activity increases healing strength over the maturation, organization, and differentiation phase (17). Therefore a regular passive ROM of the elbow after temporary removal of the connecting bars of the fixator is war-ranted to assist healing of the tendon. The N-RTEF (HTEF, ETEF) enables a limited active ROM during the weight-bearing phase that promotes healing of the tendon and reduces the risk of elbow ankylosis. Alternative strategies such as bandage, Spica splint (18,20) or orthosis (19) have the advantage of being less rigid than a transarticular external fixator, but need to be regu-larly monitored to prevent negative dermal effects of padding.

Care was required to control cutaneous irritation by the rub-ber stoppers. This complication was observed in all cases of the study and could be avoided by the placement of “olives” on the pins to prevent the rubber stoppers slipping and irritating the skin. Pin tract drainage or infection and pin loosening were not seen in the study on account of the rapid removal of the external fixator and the limited stiffness of the frame.

Duration of immobilization by transarticular external fix-ator plays a major role in ankylosis of the joint. Rigid joint immobilization can have harmful effects on connective tis-sue, and results in decreased ROM of the joint (1,2,4–8,11). All methods of elbow stabilization are associated with serious drawbacks; any method that prevents elbow motion delays rehabilitation and may result in stiffness. An ETEF could not prevent a reduced ROM at the time of removal of the fixator in


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our study. Comparison of residual ROM between RTEF and N-RTEF (HTEF and ETEF) applied to the elbow is warranted in another study to determine effectiveness of ETEF. A study reported a mean loss in ROM of 21% for the stifle and 16% for the tarsus after removal of an HTEF, but there was no case of application of HTEF on the elbow joint in this study (2).

This study has several limitations. Our sample size is small (4 cases of elbow luxation and 1 case of triceps avulsion), this was a retrospective study, and the procedures were performed by only 1 surgeon. The results will need to be confirmed in a larger series to verify the possibility of its generalization. Further research will be needed to determine the appropriate duration of immobilization by ETEF, and the appropriate tension of the elastic band depending upon species and body weight.

In conclusion, ETEF is an alternative for elbow stabilization that maintains extension of the joint while permitting its motion thereby promoting rehabilitation. Surgeons may consider this device to manage elbow luxation and triceps avulsion to facili-tate early weight-bearing. CVJ

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external skeletal fixation. J Small Anim Pract 1999;40:482–488.2. Jaeger GH, Wosar MA, Marcellin-Little DJ, Lascelles BDX. Use of

hinged transarticular external fixation for adjunctive joint stabilization in dogs and cats: 14 cases (1999–2003). J Am Vet Med Assoc 2005;227: 586–591.

3. Schwartz Z, Griffon DJ. Nonrigid external fixation of the elbow, coxofemoral, and tarsal joints in dogs. Compend Contin Educ Pract Vet 2008;30:648–660.

4. Lauer S, Hosgood G, Ramirez S, Lopez M. In vivo comparison of two hinged transarticular external skeletal fixators for multiple ligamentous injuries of the canine stifle. Vet Comp Orthop Traumatol 2008;21:25–35.

5. Kulendra E, Grierson J, Okushima S, Cariou M, House A. Evaluation of the transarticular external skeletal fixator for the treatment of tarsocrural instability in 32 cats. Vet Comp Orthop Traumatol 2011;24:320–325.

6. Das S, Thorne R, Lorenz ND, et al. Patellar ligament rupture in the dog: Repair methods and patient outcomes in 43 cases. Vet Rec 2014;175: 370.

7. Norton J, DeCamp C, Yu J, Rooks RL. Use of a single-ring transarticu-lar fixator construct for immobilization of the talocrural joint following common calcaneal tenorrhaphy. Vet Comp Orthop Traumatol 2009;22: 430–435.

8. Cervi M, Brebner N, Liptak J. Short- and long-term outcomes of primary Achilles tendon repair in cats: 21 Cases. Vet Comp Orthop Traumatol 2010;23:348–353.

9. Clarke SP, Jermyn J, Carmichael S. Avulsion of the triceps tendon inser-tion in a cat. Vet Comp Orthop Traumatol 2007;20:245–247.

10. Ambrosius L, Arnoldy C, Walker KR, Little JP, Bleedorn JA. Reconstruction of chronic triceps tendon avulsion using synthetic mesh graft in a dog. Vet Comp Orthop Traumatol 2015;28:220–224.

11. Higgins B, Coughlam A, Pettitt R, et al. The use of transarticular exter-nal skeletal fixation in the management of failed tibial tuberosity trans-position in five dogs. Vet Comp Orthop Traumatol 2010;23:109–113.

12. Piermattei DL, Flo GL, DeCamp DL. Handbook of Small Animal Orthopaedics and Fracture Repair. 4th ed. St. Louis, Missouri: Saunders, 2006.

13. O’Brien M, Boudrieau R, Clark G. Traumatic luxation of the cubital joint (elbow) in dogs: 44 cases (1978–1988). J Am Vet Med Assoc 1992; 201:1760–1765.

14. Billings L, Vasseur P, Todoroff R, Johnson W. Clinical results after reduction of traumatic elbow luxations in nine dogs and one cat. J Am Anim Hosp Assoc 1992;28:137–142.

15. Schaeffer I, Wolvekamp P, Meij B, Theijse LFH, Hazewinkel HAW. Traumatic luxation of the elbow in 31 dogs. Vet Comp Orthop Traumatol 1999;12:33–39.

16. Mitchell KE. Traumatic elbow luxation in 14 dogs and 11 cats. Aust Vet J 2011;89:213–216.

17. Dueland R, Quentin J. Triceps tenotomy: Biomechanical assessment of healing strength. J Am Anim Hosp Assoc 1980;16:507–512.

18. Liehmann L, Lorinson D. Traumatic triceps tendon avulsion in a cat. J Small Anim Pract 2006;47:94–97.

19. Garcia-Fernandez P, Quero Martin P, Mayenco A, Gardoqui M, Calvo I. Surgical management and follow-up of triceps tendon avulsion after repeated local infiltration of steroids: Two cases. Vet Comp Orthop Traumatol 2014;27:405–410.

20. Yoon HY, Jeong SW. Traumatic triceps tendon avulsion in a dog: Magnetic resonance imaging and surgical management evaluation. J Vet Med Sci 2013;75:1375–1377.

21. Vedrine B. Use of elastic transarticular external fixator construct for immobilization of the elbow joint: 4 cases of elbow luxation and 1 case of avulsion of the triceps tendon. 43rd Veterinary Orthopedic Society Annual Conference, March 1, 2016. Big Sky, Montana, USA.

22. Bordelon JT, Reaugh HF, Rochat MC. Traumatic luxations of the appendicular skeleton. Vet Clin Small Anim 2005;35:1169–1194.

23. Campbell JR. Luxation and ligamentous injuries of the elbow in the dog. Vet Clin North Am 1971;1:429–440.

24. McCartney W, Kiss K, McGovern F. Surgical stabilisation as the primary treatment for traumatic luxation of the elbow joint in 10 dogs. Intern J Appl Res Vet Med 2010;8:97–100.

25. Farrell M, Thomas DG, Carmichael S. Surgical management of trau-matic elbow luxation in two cats using circumferential suture prostheses. Vet Comp Orthop Traumatol 2009;22:66–69.

26. Farrell M, Draffan D, Gemmill T, Mellor D, Carmichael S. In vitro validation of a technique for assessment of canine and feline elbow joint collateral ligament integrity and description of a new method for collateral ligament prosthetic replacement. Vet Surg 2007;36:548–556.

27. Berg RJ, Egger EL. In vitro comparison of the three loop pulley and locking loop suture patterns for repair of canine weightbearing tendons and collateral ligaments. Vet Surg 1986;15:107–110.

28. Wilson L, Banks T, Luckman P, Smith B. Biomechanical evaluation of double Krackow sutures versus the three-loop pulley suture in a canine gastrocnemius tendon avulsion model. Aust Vet J 2014;92:427–32.

29. Moores AP, Comerford EJ, Tarlton JF, Owen MR. Biomechanical and clinical evaluation of a modified 3-loop pulley suture pattern for reattachment of canine tendons to bone. Vet Surg 2004;33:391–397.

30. Morton MA, Thomson DG, Rayward RM, Jimenez-Pelaez M, Whitelock RG. Repair of chronic rupture of the insertion of the gastrocnemius tendon in the dog using a polyethylene terephthalate implant. Vet Comp Orthop Traumatol 2015;28:282–287.


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Article

Determining bovine viral diarrhea and infectious bovine rhinotracheitis infections in dairy cattle using precolostral blood

Paul Baillargeon, Juan C. Arango-Sabogal, Vincent Wellemans, Gilles Fecteau

Abstract — The objective of this study was to determine if precolostral blood samples are useful to detect apparent fetal infections with bovine viral diarrhea (BVD) and infectious bovine rhinotracheitis (IBR) viruses. A convenience sample of 317 sera from 50 Canadian herds was used in the study. Antibody level was measured using 2 commercial IBR and BVD ELISA kits. Precolostral status of sera was confirmed on 304 samples using serum gamma-glutamyl transferase activity. Postcolostral serum samples yielded a higher proportion of positive results to IBR (OR = 86; 95% CI: 17.8 to 415.7) and BVD (OR = 199.3; 95% CI: 41.7 to 952.3) than did precolostral samples. All positive precolostral serum samples (n = 7 of 304) originated from calves born to vaccinated cows. Postcolostral positive serum samples (n = 11 of 13) originated mostly (60%) from calves born to non-vaccinated cows. Precolostral serum sampling can detect apparent fetal infections in a herd.

Résumé — Utilisation du serum précolostral pour le dépistage de la diarrhée virale bovine (BVD) et rhinotracheite infectieuse bovine (IBR) dans les troupeaux laitiers. L’objectif de cette étude était d’évaluer l’utilité du prélèvement de sérum précolostral de nouveaux nés pour détecter des infections fœtales apparentes par IBR et BVD dans un troupeau. Un échantillonnage de convenance de 317 sérums, prélevés de 50 troupeaux canadiens, a été utilisé. Les niveaux d’anticorps des sérums ont été mesurés en utilisant 2 trousses ELISA (IBR et BVD). Le statut précolostral a été confirmé pour 304 échantillons par la mesure de l’activité sérique des gamma glutamyl transférases. Une plus grande proportion de résultats positifs à IBR (RC = 86; IC 95%: 17,8 à 415,7) et BVD (RC = 199,3; IC 95 %: 41,7 à 952,3) a été observée parmi les échantillons postcolostraux que parmi les précolostraux. Tous les échantillons précolostraux positifs (n = 7/304) provenaient de veaux nés de mères vaccinées. Les échantillons postcolostraux positifs (n = 11/13) étaient majoritairement (60 %) prélevés à partir de veaux nés de mères non vaccinées. Le prélèvement de sérum précolostal peut détecter des infections fœtales apparentes dans les troupeaux.

(Traduit par les auteurs)

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Introduction

O ver the last 30 y, bovine viral diarrhea (BVD) and infec-tious bovine rhinotracheitis (IBR) have been associated

with epidemics causing severe losses, most often involving respi-ratory diseases and abortions (1–3). In Canada, a retrospective study reported that 12% of 84 aborted fetuses were positive for IBR as indicated by a fluorescent antibody technique (4). Based on the presence of at least 1 seropositive (. 1:64) unvaccinated

animal, the herd-level prevalence of BVD in dairy herds in Canada has been estimated to be between 28.1% and 53.4% (5).

Commercial modified live (MLV) (6,7) and killed (K) vac-cines (8) are available with indications to prevent reproductive consequences of BVD or IBR infections as well as to provide fetal protection (9,10). In North America, enzyme-linked immunosorbent assay (ELISA) testing to detect antibodies as an indicator of ongoing infection in a herd is not widely used since use of K or MLV vaccine would complicate interpretation (11). One approach to detect endemic BVD virus infection involves demonstrating seroconversion in a subset of animals by testing paired acute and convalescent sera. However, seroconversion in a subset of animals is difficult to demonstrate due to the slow within-herd spread of BVD virus, making it hard to select the exposed animals that seroconvert (12). Moreover, once again, vaccination could complicate the interpretation of results from this approach (11).

Serological analysis of precolostral serum samples is an effec-tive method to demonstrate fetal exposure to pathogens such as Neospora caninum (13–15) and BVD (9,12,16) during the last trimester of pregnancy. Some studies suggest that precolostral

Zoetis, 16740 Trans-Canada Highway, Kirkland, Québec H9H 4M7 (Baillargeon); Département de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal, 3200 rue Sicotte, Saint-Hyacinthe, Québec J2S 2M2 (Arango-Sabogal, Wellemans, Fecteau).Address all correspondence to Dr. Gilles Fecteau; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.


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serum antibody detection cannot be confounded by vaccination and would be an interesting screening method as an alterna-tive to bulk-tank milk reverse transcriptase-polymerase chain reaction (RT-PCR) and non-vaccinated sentinel calf strategies (12,16).

Fetal infections occurring after the development of a com-petent immune system could lead to the birth of a normal calf with precolostral antibodies (17,18). Therefore, detecting fetal infections constitutes evidence of virus infection within the herd, as was suggested previously for BVD (12). The objective of this study was to determine if precolostral blood samples can be used to detect apparent fetal infections with BVD and IBR viruses.

Materials and methodsOrigin of the samplesA convenience sample of 317 precolostral calf sera from 50 Quebec herds was used in this study. Of these, 236 samples were taken between February 2005 and March 2008 by veterinarians and dairy producers who participated on a voluntary basis. The remaining 81 samples originating from a previous study (13) were collected between August 1999 and October 2000 and were stored at 270°C. At the time of the visit, herd informa-tion (vaccination strategy adopted in the farm and veterinarian’s perception of reproductive performance for each farm) and dam individual information (last calving date, number of lactations, date of last vaccination, and type of last vaccine administered to the dam) were recorded. Samples were collected either by a veterinarian or by a trained producer prior to observed colos-trum intake. Jugular vein puncture using a vacutainer tube was used to collect blood.

Laboratory analysesWhole blood samples were centrifuged after clot formation. A subsample of at least 2 mL of serum was stored at 270°C.

Samples were submitted to the laboratory (Biovet, Saint-Hyacinthe, Quebec). Antibody detection was achieved using the BVD virus ELISA Kit (Bio-X Diagnostics, Jemelle, Belgium) and the SVANOVIR IBR-Ab assay (Boehringer Ingelheim Svanova, Uppsala, Sweden). Samples were treated and inter-preted according to the instructions of the manufacturers. A sample was considered positive for BVD if its optical density ratio was . 0.15. For IBR an optical density ratio . 0.20 was used as the cutoff to declare a sample positive. In order to confirm that the blood samples were collected before colostrum intake, gamma-glutamyl transferase (GGT) activity in serum was measured at the laboratory of the Faculté de médecine vétéri-naire at Université de Montréal in Saint-Hyacinthe, Quebec. As suggested previously (15), a serum sample with a GGT value , 50 U/L was considered to be precolostral.

Statistical analysisDescriptive statistics were used to determine the distribution of the samples by farm, vaccination strategy, and type of vaccine administered to the dams. The difference between pre- and post-colostral samples positive for IBR and BVD was evaluated using the Fisher’s exact test. Results were considered to be statistically significant if P , 0.05.

ResultsHerd characteristicsA total of 346 samples from 50 herds were obtained. Herds were distributed within 9 Quebec and 1 Ontario administrative regions. All herds were dairy except for 1 beef herd. A total of 20 veterinarians submitted samples for the analysis. A mean of 6 samples per herd (95% CI: 4.5 to 9.1) was collected, ranging from 1 sample to 52 samples. The number of collected samples per herd is shown in Figure 1. Most of the samples (n = 224) were collected in 2005 and 2006. Twenty-nine samples were

Figure 1. Number of samples per herd collected for the detection of antibodies to infectious bovine rhinotracheitis and bovine viral diarrhea in precolostral sera from Canadian herds.

Herd ID

Num

ber

of s

ampl

es c

olle

cted

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

55

50

45

40

35

30

25

20

15

10

5

0


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excluded because a GGT result was not available. On average, dams of the calves included in the study were in their second lactation (ranging from 1 to 8 lactations).

Types of vaccineInformation about the most recent vaccination of the dams was available for all samples. Samples were grouped into 3 categories according to the type of vaccine administered to the dam: “K” if an inactivated vaccine was administered (n = 196); “MLV” if a modified live virus vaccine was administered (n = 97); and “Not vaccinated” if, to the best of our knowledge, no vaccine was administered to the dam (n = 53).

Precolostral samplesOut of the 317 serum samples, 13 were considered to be post-colostral (GGT . 50 U/L) (Table 1). Overall, more positive results for either IBR (OR = 86; 95% CI: 17.8 to 415.7) or BVD (OR = 199.3; 95% CI: 41.7 to 952.3) were obtained from the postcolostral samples than from the precolostral samples. Among the precolostral samples, 1 was positive for both IBR and BVD, 2 were positive for IBR only, and 4 were positive for BVD only. Positive samples originated from 5 herds.

All positive precolostral samples (n = 7) were collected from calves born to vaccinated dams (Table 2). Five samples were col-lected from calves born to cows vaccinated with a K vaccine and 2 samples were collected from calves born to dams vaccinated with an MLV vaccine within the last year. Of the 304 confirmed precolostral samples, 259 were collected from calves born to vaccinated cows: 176 cows with a K vaccine and 83 cows with a MLV vaccine (Table 2).

Positive postcolostral samplesOf the 13 samples confirmed to be postcolostral (GGT . 50 U/L) (Table 1), 5 were positive for both IBR and BVD, 1 was positive for IBR only and 5 were positive for BVD only. These samples originated from 8 herds.

Among positive postcolostral samples (n = 11), 7 were collected from calves born to non-vaccinated cows while the remaining 4 were collected from calves born to cows vaccinated with either an MLV vaccine (3 cows) or a K vaccine (1 cow) (Table 3). There was no difference in the number of positive results for IBR between the samples of calves born from vac-

cinated and non-vaccinated cows (Table 3). The 2 postcolostral negative samples came from cows that received a K vaccine.

Historical reproductive herd problemsNo history of reproductive problems was reported in 3 of the herds from which the positive precolostral samples for IBR or BVD originated, whereas in 2 herds, historical reproductive problems were reported. Seven of the herds from which posi-tive non-precolostral samples were collected had no history of reproductive problems, whereas in 1 herd, historical reproduc-tive problems were reported.

DiscussionThe primary objective of this study was to determine if pre-colostral blood samples can be used to detect apparent fetal infections with BVD and IBR viruses as a means to demonstrate viral transmission in a herd. The number of herds, the total number of samples collected, and the number of veterinarians who submitted samples from different regions demonstrated the practicality of this monitoring tool under field conditions. Our experience with this project and with another field study (4) is that properly instructed producers can satisfactorily collect blood samples from calves before colostrum intake. A high percentage of samples were confirmed to be precolostral. Confirmation of precolostral status by GGT activity concentration provides additional confidence in this strategy.

The overall number of positive samples for IBR or BVD was lower than expected. However, postcolostral samples yielded significantly more positive results for either IBR or BVD than

Table 1. ELISA test results for serum samples collected from newborn calves for the diagnosis of infectious bovine rhinotracheitis and bovine viral diarrhea in Canadian herds

Number of GGTa result IBRb BVDc samples (%)

, 50 (Precolostral; n = 304) 1 1 1 (0.3) 1 2 2 (0.7) 2 1 4 (1.3) 2 2 297 (97.7)

. 50 (Postcolostral; n = 13) 1 1 5 (38.5) 1 2 1 (7.7) 2 1 5 (38.5) 2 2 2 (15.3)a GGT — gamma-glutamyl transferase (U/L).b IBR — infectious bovine rhinotracheitis.c BVD — bovine viral diarrhea.

Table 2. Serum samples positive for infectious bovine rhinotracheitis and bovine viral diarrhea antibodies by type of vaccine administered to the dams for precolostral serum samples (GGTa , 50 U/L)

Number of

Positive samples (%)

Type of vaccine samples IBRb BVDc

Inactivated 176 3d (1.7) 3d (1.7)Modified live virus 83 0 (0) 2 (2.4)Not vaccinated 45 0 (0) 0 (0)Total 304 3 (0.9) 5 (1.6)a GGT — gamma-glutamyl transferase.b IBR — infectious bovine rhinotracheitis.c BVD — bovine viral diarrhea.d One of these 3 samples was positive for both viruses.

Table 3. Postcolostral serum samples from newborn calves that tested positive by ELISA for infectious bovine rhinotracheitis and bovine viral diarrhea by type of vaccine administered to the dams

NumberType of vaccine IBRa BVDb of samples

Inactivated 1 1 1Modified live virus 1 1 2Modified live virus 2 1 1No vaccine 2 1 4No vaccine 1 1 2No vaccine 1 2 1Total 11a IBR — infectious bovine rhinotracheitis.b BVD — bovine viral diarrhea.


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did precolostral samples. The GGT levels in these samples confirmed calf colostrum intake before sampling. These calves proved that antibodies against both viruses were present in the source herds; however, it is not possible to know if they were present due to vaccination or infection. More than 60% of these samples originated from calves born to non-vaccinated dams, which favors the circulating virus hypothesis.

Positive results for either IBR or BVD were observed among precolostral samples, indicating fetal exposure to the viruses. All these samples were collected from calves born from vaccinated dams. The presence of one or more seropositive calves at birth before colostrum intake provides evidence of dam’s exposure to the viruses after 125 days of gestation (17). This confirms that precolostral blood samples can be used to detect exposure to IBR and BVD viruses, as was suggested previously (12).

Newborn calves sampled before colostrum intake can be used as sentinels for IBR and BVD. In larger herds, replacement heifers may be housed in a different environment from the milking herd, making them less suitable for establishing herd status. Also, in an increasing number of herds, calves are vac-cinated during the neonatal period and are no longer useful as potential sentinels. Thus, the precolostral monitoring strategy presented here is more likely to reflect viral transmission in the reproductive portion of the adult herd compared to the sampling strategies described previously (19,20).

Precolostral serological status has been proven to be an effective way of monitoring transmission of Neospora caninum (13). It appears that the strategy may similarly be valuable for monitoring BVD transmission. For example, in 1 study (9), 10 non-vaccinated pregnant heifers delivered live calves after natural exposure to 3 strains of BVD type 2a during their last trimester of pregnancy. Precolostral serology revealed that 9 of these calves were seropositive. The only seronegative calf was determined to be persistently infected (PI).

The percentage of calves with precolostral BVD virus serum antibodies may be significantly higher than the proportion of PI animals. In 1 study (12), the authors found that approxi-matively 8 BVD seropositive calves were born for every BVD PI calf. For this reason, a precolostral BVD virus antibody screening strategy should have a higher sensitivity than searching for PI animals to detect viral transmission.

Regarding IBR, little is known about the survival of bovine fetuses exposed to bovine herpes virus (BHV)-1 in utero. Experimental challenge during the last trimester of pregnancy in susceptible seronegative pregnant females has resulted in very high rates of abortions or stillbirths of fetuses exhibiting lesions of BHV-1 infection (18). Precolostral serology may not be as sensitive for monitoring BHV-1 as it is for BVD and Neospora infections where fetuses have a much higher chance of surviving in utero infection.

Fetal immunocompetence allows detection of infection, as demonstrated in other reports (9,13) and in our results (18/317 seropositive for IBR or BVD), and reflects viral exposure during the last trimester of pregnancy. Almost 15% of the precolostral samples were collected from calves born to non-vaccinated dams. Among them, no positive results for IBR or BVD were observed. The samples collected from calves born to dams vac-

cinated with the K vaccine tended to yield more positive results to both viruses. However, we observed 2 positive results to BVD among precolostral samples collected from calves born to dams vaccinated with an MLV vaccine without fetal protection. The MLV vaccines providing fetal protection against BVD and IBR became available after 2004 in Canada. A previous study also evidenced a lack of protection of calves born to dams which were given a BVD MLV vaccine (21). The authors suggested that this result may be explained by an inadequate host response to vac-cination or a vaccine failure (21). The detection of seropositive calves in precolostral blood samples supports the pertinence of including this fetal protection for reproductive animals.

A completely different situation was observed in postcolostral samples in which samples collected from calves born from dams vaccinated with an MLV vaccine tended to yield more positive results to either IBR or BVD virus. Surprisingly, more positive results to both viruses were observed in postcolostral samples collected from calves born from non-vaccinated dams. We would expect that postcolostral samples from calves fed colostrum from vaccinated dams would more often be antibody positive. One explanation for this observation may be that non-vaccinated dams living in a herd with endemic infection have higher colos-tral antibody titers compared with vaccinated dams.

The results of this study support the inclusion of precolostral serology for the monitoring of circulating IBR and BVD viruses in cattle herds when alternatives are not possible (e.g., vaccinated young calves) or are more cumbersome. This information could be helpful to demonstrate exposure to these disease agents and to monitor compliance with recommended vaccination programs.

AcknowledgmentThe authors gratefully acknowledge Dr. Julie Paré who critically reviewed this manuscript. CVJ

References 1. Newcomer BW, Givens D. Diagnosis and control of viral diseases of

reproductive importance: Infectious bovine rhinotracheitis and bovine viral diarrhea. Vet Clin North Am Food Anim Pract 2016;32:425–441.

2. Grissett GP, White BJ, Larson RL. Structured literature review of responses of cattle to viral and bacterial pathogens causing bovine respiratory disease complex. J Vet Intern Med 2015;29:770–780.

3. Miller JM, Van der Maaten MJ. Early embryonic death in heifers after inoculation with bovine herpesvirus-1 and reactivation of latent virus in reproductive tissues. Am J Vet Res 1987;48:1555–1558.

4. Khodakaram-Tafti A, Ikede BO. A retrospective study of sporadic bovine abortions, stillbirths, and neonatal abnormalities in Atlantic Canada, from 1990 to 2001. Can Vet J 2005;46:635–637.

5. VanLeeuwen JA, Keefe GP, Tremblay R, Power C, Wichtel JJ. Sero-prevalence of infection with Mycobacterium avium subspecies para-tuberculosis, bovine leukemia virus, and bovine viral diarrhea virus in maritime Canada dairy cattle. Can Vet J 2001;42:193–198.

6. Fairbanks KK, Rinehart CL, Ohnesorge WC, Loughin MM, Chase CC. Evaluation of fetal protection against experimental infection with type 1 and type 2 bovine viral diarrhea virus after vaccination of the dam with a bivalent modified-live virus vaccine. J Am Vet Med Assoc 2004;225:1898–1904.

7. Ficken MD, Ellsworth MA, Tucker CM, Cortese VS. Effects of modi-fied-live bovine viral diarrhea virus vaccines containing either type 1 or types 1 and 2 BVDV on heifers and their offspring after challenge with noncytopathic type 2 BVDV during gestation. J Am Vet Med Assoc 2006;228:1559–1564.

8. Zimmerman AD, Buterbaugh RE, Herbert JM, et al. Efficacy of bovine herpesvirus-1 inactivated vaccine against abortion and stillbirth in pregnant heifers. J Am Vet Med Assoc 2007;231:1386–1389.


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9. Ellsworth MA, Fairbanks KK, Behan S, et al. Fetal protection following exposure to calves persistently infected with bovine viral diarrhea virus type 2 sixteen months after primary vaccination of the dams. Vet Ther 2006;7:295–304.

10. Leyh RD, Fulton RW, Stegner JE, et al. Fetal protection in heifers vaccinated with a modified-live virus vaccine containing bovine viral diarrhea virus subtypes 1a and 2a and exposed during gestation to cattle persistently infected with bovine viral diarrhea virus subtype 1b. Am J Vet Res 2011;72:367–375.

11. Saliki JT, Dubovi EJ. Laboratory diagnosis of bovine viral diarrhea virus infections. Vet Clin North Am Food Anim Pract 2004;20:69–83.

12. Schefers J, Munoz-Zanzi C, Collins JE, Goyal SM, Ames TR. Serological evaluation of precolostral serum samples to detect Bovine viral diarrhea virus infections in large commercial dairy herds. J Vet Diagn Invest 2008;20:625–628.

13. Baillargeon P, Fecteau G, Paré J, Lamothe P, Sauvé R. Evaluation of the embryo transfer procedure proposed by the International Embryo Transfer Society as a method of controlling vertical transmission of Neospora caninum in cattle. J Am Vet Med Assoc 2001;218:1803–1806.

14. Staubli D, Sager H, Haerdi C, Haessig M, Gottstein B. Precolostral serology in calves born from Neospora-seropositive mothers. Parasitol Res 2006;99:398–404.

15. Paré J, Thurmond MC, Hietala SK. Congenital Neospora caninum infection in dairy cattle and associated calfhood mortality. Can J Vet Res 1996;60:133–139.

16. Schefers JM, Collins JE, Goyal SM, Ames TR. Detection, character-ization, and control of bovine viral diarrhea virus infection in a large commercial dairy herd. Can Vet J 2009;50:1075–1079.

17. Tizard IR. Veterinary Immunology. 9th ed. St. Louis, Missouri: Elsevier/Saunders, 2013.

18. Miller RB, Smith MW, Lawson KF. Some lesions observed in calves born to cows exposed to the virus of infectious bovine rhinotracheitis in the last trimester of gestation. Can J Comp Med 1978;42:438–445.

19. Rush DM, Thurmond MC, Munoz-Zanzi CA, Hietala SK. Descriptive epidemiology of postnatal bovine viral diarrhea virus infection in intensively managed dairy heifers. J Am Vet Med Assoc 2001;219: 1426–1431.

20. Waldner CL, Campbell JR. Use of serologic evaluation for antibodies against bovine viral diarrhea virus for detection of persistently infected calves in beef herds. Am J Vet Res 2005;66:825–834.

21. Cortese VS, Grooms DL, Ellis J, Bolin SR, Ridpath JF, Brock KV. Protection of pregnant cattle and their fetuses against infection with bovine viral diarrhea virus type 1 by use of a modified-live virus vaccine. Am J Vet Res 1998;59:1409–1413.

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CVJ / VOL 58 / APRIL 2017 365

Article

Pregnancy per AI in Holstein heifers inseminated with sex-selected or conventional semen after estrus detection or timed-AI

Marcos G. Colazo, Reuben J. Mapletoft

Abstract — This study compared pregnancy per AI (P/AI) of heifers inseminated with sex-selected or conventional semen after estrus detection (ED) or timed-AI (TAI). Heifers in the ED group received 2 treatments with prostaglandin F2a 14 d apart and those in the TAI group received a modified 5-day Co-synch protocol plus an intravaginal progesterone releasing insert device (PRID) and were inseminated 72 h after PRID removal. Overall P/AI were 69.2% (74/107) and 64.1% (75/117) for conventional and sex-selected semen (P . 0.05). Although P/AI in ED heifers following the use of conventional semen were numerically higher (75.0% versus 63.6%), P/AI with sex-selected semen were almost identical (65.0% versus 63.2%) for ED and TAI heifers. Pregnancy losses from first pregnancy diagnosis to term did not differ between ED and TAI heifers (6.0% versus 11.3%). In summary, heifers subjected to TAI with sex-selected semen following the application of a modified 5-day Co-synch plus PRID protocol had acceptable P/AI.

Résumé — Gestation par IA chez les génisses Holstein inséminées avec du sperme déterminant le sexe ou un sperme conventionnel après la détection de l’œstrus ou l’IA à temps prédéterminé. Cette étude a comparé la gestation par IA (G/IA) des génisses inséminées avec du sperme déterminant le sexe ou du sperme conventionnel après la détection de l’œstrus (DŒ) ou l’IA à temps déterminé (IATD). Les génisses dans le groupe DŒ ont reçu 2 PGF à un intervalle de 14 jours et celles dans le groupe IATD ont reçu un protocole modifié 5-d Co-synch et PRID et ont été inséminées 72 heures après l’enlèvement de PRID. Dans l’ensemble, le taux de G/IA était de 69,2 % (74/107) et de 64,1 % (75/117) pour le sperme conventionnel et celui déterminant le sexe (P . 0,05). Même si le taux de G/IA chez les génisses DŒ après l’utilisation de sperme conventionnel était numériquement supérieur (75,0 % c. 63,6 %), le taux de G/IA avec le sperme déterminant le sexe était presque identique (65,0 % c. 63,2 %) pour les génisses DŒ et IATD. La perte de gestations entre le premier diagnostic de gestation jusqu’à la parturition ne différait pas entre les génisses DŒ et TAI (6,0 c. 11,3 %). En résumé, les génisses soumises à l’IATD avec du sperme déterminant le sexe après l’application d’un protocole modifié 5-d Co-synch et PRID avaient une G/IA acceptable qui confirmait notre hypothèse.

(Traduit par Isabelle Vallières)

Can Vet J 2017;58:365–370

IntroductionThe use of sex-selected semen to inseminate heifers might increase the profitability of the dairy herd, as it provides an opportunity to increase the proportion of calves that are heif-ers (1). This has 2 main advantages: a 28% reduction in the

incidence of dystocia (2) and more replacements from the genetically improved group in the herd (3). However, the use of sex-selected semen results in reduced pregnancy per AI (P/AI) compared with the use of conventional semen. In this regard, Seidel et al (4) reported that among dairy farms P/AI of Holstein heifers inseminated with sex-selected semen varied from 40% to 68%, while with conventional semen the P/AI varied from 67% to 82%. Others have concluded that the fertility of sex-selected semen was compromised as P/AI remained different even when number of sperm per insemination dose was equal-ized between sex-selected and conventional semen (5,6). In an attempt to increase P/AI with sex-selected semen, Sá Filho et al (7) evaluated different intervals from onset of estrus to AI using the Heat Watch system (CowChips, Manalapan, New Jersey, USA) in Jersey heifers. They reported that the greatest P/AI was obtained when inseminations were done between 16.1 and 20 h after onset of estrus, which is somewhat longer than the interval recommended for conventional semen.

Livestock Research Branch, Alberta Agriculture and Forestry, Edmonton, Alberta T6H 5T6 (Colazo); Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B4 (Mapletoft).Address all correspondence to Dr. Marcos Colazo; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.


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The implementation of timed-AI (TAI) protocols has allowed for increased use of AI in beef and dairy cattle. However, P/AI with sex-selected semen has been inconsistent in studies that evaluated estradiol and progesterone-based TAI protocols (8). As a result, sex-selected semen is often not recommended for use in dairy cattle that are subjected to TAI (3). Therefore, optimization of TAI protocols that consistently yield high P/AI in heifers inseminated with sex-selected semen would increase the adoption of these technologies.

Recently, a 5-day Co-synch TAI protocol that incorpo-rates a progesterone releasing device resulted in 39.3% P/AI in Holstein heifers inseminated with sex-selected semen (9). Moreover, Colazo and Ambrose (10) modified this protocol by eliminating the first gonadotropin-releasing hormone (GnRH) injection in dairy heifers inseminated with conventional semen and obtained an overall conception rate of 70%. Two follow-up studies with larger numbers of Holstein (n = 605) and beef (n = 1062) heifers confirmed that administration of GnRH at progesterone device insertion was not necessary to achieve high P/AI with conventional semen (11,12). In our earlier study (10), we observed that more than 75% of the heifers ovulated within 24 h following insemination, which might be favorable for the use of sex-selected semen. In addition, this protocol called for heifers to be handled only 3 times, which would be more acceptable to producers. Therefore, the objective of the present study was to compare P/AI of heifers inseminated with sex-selected or conventional semen after estrus detection or TAI. We hypothesized that a modified 5-day Co-synch plus an intravaginal progesterone releasing insert device (PRID) protocol, without the first GnRH, would result in acceptable P/AI in Holstein heifers inseminated with sex-selected semen.

Materials and methodsThis study was carried out in a large commercial dairy herd in Wetaskiwin, Alberta, Canada. All procedures were conducted in accordance with the guidelines of the Canadian Council on Animal Care (13).

Animals and dietsThis study was conducted with cyclic (determined by transrectal ultrasonography) Holstein heifers between 13 and 16 mo of age. Heifers were housed in free-stalls, had unrestricted access to water, and were fed a total mixed ration once daily. The diet was designed to meet the nutritional requirements of Holstein heifers weighing 350 kg and gaining 1.0 kg/d (14). The diet (DM/kg per day) was based on barley silage (16.0), alfalfa silage (4.0), haylage grass (4.0), hay (4.0), brewer’s grain (4.0), barley grain (0.75), and a mineral and vitamin supplement. The dry matter and crude protein content of the ration were 41.6% and 14.3%, respectively.

Experimental designA group of 131 cyclic Holstein heifers were given 2 treatments with 500 mg cloprostenol [prostaglandin F2a (PGF); Estroplan, Vétoquinol Canada, Lavaltrie, Quebec] 14 d apart (ED group) (Figure 1). Another group of 112 cyclic Holstein heifers received a modified 5-day Co-synch protocol which involved the inser-tion of an intravaginal progesterone releasing device (PRID; Vétoquinol Canada) for 5 d without GnRH treatment at the time of insertion and single treatment with PGF at PRID removal (TAI group; 10) (Figure 1). Heifers in the ED group received the second PGF treatment and those in the TAI group had the PRID removed and PGF administered on the same

Table 1. Effect of synchronization treatment and type of semen on pregnancy per AI (P/AI), calving rate and pregnancy loss in Holstein heifers subjected to estrus detection and AI (ED group) or a modified 5-day Co-synch plus PRID protocol (TAI group)

Conventional semen Sex-selected semen

ED group TAI group ED group TAI group

Number 52 55 60 57P/AI, % (n) 75.0 (39) 63.6 (35) 65.0 (39) 63.2 (36)Calving rate, % (n) 71.2 (37) 58.2 (32) 63.3 (38) 61.4 (35)Preg loss, % (n)a 7.1 (3) 10.3 (4) 4.9 (2) 12.2 (5)a Pregnancy losses from first pregnancy diagnosis (27 to 33 d after AI) to term.

Seven heifers had a non-viable embryo at first pregnancy diagnosis.

Figure 1. Illustration of activities and treatments during the study. Two-hundred-forty-three cycling Holstein heifers (13- to 16-months-old) were assigned to one of two treatment groups. The ED group received two 500 mg of cloprostenol (PGF) treatments 14 d apart. Detection of estrus was carried out for 6 d after the second administration of PGF and the heifers were inseminated 12 h after onset of estrus. The TAI group received a progesterone-releasing intravaginal device (PRID) containing 1.55 g of progesterone for 5 d. At PRID removal, PGF was given im. Heifers received 100 mg GnRH and TAI 72 h after PRID removal. Ultrasonographic (U/S) examinations were done at different times during the study to determine the response to treatments and at 27 to 33 d after TAI for confirmation of pregnancy. Pregnant heifers were re-examined by ultrasonography at 42 to 48 d after TAI.

EDGroup

TAIGroup

14 d

PGFU/S

PGFU/S

PGFU/SU/S

GnRH TAIU/S

U/S U/S U/S

U/S U/SEstrus detection 1 AI 1 U/S

PRID 5 d 3 d 1 d 1 d 30 d

6 d 27 d


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day. Detection of estrus was carried out 3 times/d for 30 min for 6 d after the second administration of PGF and the heifers were inseminated 12 h after onset of estrus (ED group) or TAI 72 h after PRID removal (TAI group) with sex-selected or conventional semen from 4 sires available commercially. Heifers assigned to TAI received 100 mg GnRH (Fertiline; Vétoquinol Canada) at the time of AI. All heifers were inseminated by the same technician.

SemenThe semen used in this study was available commercially (Alta Genetics, Balzac, Alberta). The 4 sires used in the study and type of semen (sex-selected versus conventional) were equally distributed between estrus synchronization protocols. The sperm concentrations of sex-selected and conventional semen were 2.1 3 106 and 20 3 106 cells/dose, respectively. The overall post-thaw motility varied from 50.0% to 70.0% and the post-thaw viability from 42.0% to 65.1%.

Ultrasonographic examinationsTransrectal ultrasonography (MicroMAXX, color Doppler scanner equipped with a multifrequency 5–10 MHz linear transducer; SonoSite, Bothell, Washington, USA) was performed and ovarian maps were drawn for each heifer, which included the diameter and location of follicles and corpora lutea as previ-ously described by Pierson and Ginther (15). Cycling status was determined at the initiation of the study as previously described by Colazo et al (16). Ovaries were scanned at AI and every 12 h thereafter until ovulation to determine ovulation time. Heifers in the ED groups that were not inseminated were also examined 6 d after the second PGF to determine ovulation. Pregnancy status was determined by transrectal ultrasonography between 27 and 33 d after AI. Presence of a viable embryo (positive heart beat) was used as a determinant of pregnancy. Heifers diagnosed pregnant at the first examination were re-examined between

42 and 48 d after AI to confirm pregnancy. Throughout the manuscript, the term pregnancy loss (unless otherwise noted) denotes all losses, embryonic mortality determined at first exam-ination plus pregnancy losses from 27 to 33 d after AI to term.

Statistical analysisAll data were analyzed using SAS (Statistical Analysis System, Version 9.3 for Windows; SAS Institute, Cary, North Carolina, USA). Binomial data were analyzed using general estimat-ing equations (GEE) in the GENMOD procedure. Model specifications included a binomial distribution, logit link func-tion, repeated statement with subject equal to heifer, and an exchangeable correlation structure. Continuous data were ana-lyzed by 1-way analysis of variance (ANOVA) in the General Linear Model (GLM) procedure. Bartlett’s test of equal variance was used to analyze variance, and the LSD test was used to compare means. A probability of 0.05 or less was considered statistically significant, and a probability between 0.051 and 0.1 was considered a tendency.

A power analysis (17) of previously published data on the use of sex-selected semen (4,6) suggested that fewer than 107 heif-ers per group would be required to demonstrate a statistically significant difference in P/AI with sex-selected versus conven-tional semen.

ResultsPregnancy per AI (P/AI) did not differ between synchronization treatments nor between types of semen used to inseminate heif-ers (Table 1). As expected, insemination risk was greater in the TAI group compared to the ED group (P , 0.01; 100.0% versus 85.5%). The distribution of estrus in both groups is shown in Figure 2. Of the 19 (14.5%) heifers not seen in estrus in the ED group, 52.6% (10/19) did not ovulate within 6 d following the second PGF administration. In the TAI group, 77.7% of heifers were observed in estrus from 36 to 96 h following PRID

Figure 2. Distribution of interval to estrus (hours) in Holstein heifers in both synchronization groups. Heifers in the ED group received two 500 mg of cloprostenol (PGF) treatments 14 d apart. Heifers in the TAI group were subjected to a modified 5-day Co-synch plus PRID TAI protocol.

Num

ber

of h

eife

rs

Interval (hours) after second PGF (ED group) or PRID removal (TAI group)

ED group

TAI group

0 24 36 48 60 72 84 96 108 120 132 144

35

30

25

20

15

10

5

0


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removal. Two of 25 heifers not seen in estrus did not ovulate. Heifers subjected to TAI that showed estrus had higher P/AI, regardless of type of semen (Table 2).

Interval from AI to ovulation was longer and more variable (P , 0.05) in the TAI group (21.1 h 6 1.3 h) compared to the ED group (16.1 h 6 0.7 h). The number of heifers by ovulation time with reference to AI for each group is shown in Figure 3. When timing of ovulation was analyzed in TAI heifers, P/AI tended (P = 0.1) to be affected by interval from AI to ovulation and type of semen (Table 3).

Seven heifers had a non-viable embryo at first pregnancy diag-nosis; 5 of the 7 had been inseminated with sex-selected semen. No further pregnancy loss occurred between first and second pregnancy diagnosis in either group of heifers. However, 7 more heifers lost the pregnancy between second pregnancy diagnosis and term; 5 of the 7 had been inseminated with conventional semen (Table 1).

Overall, 91.8% (67/73) of heifers pregnant with sex-selected semen delivered a female calf. Sire did not affect the female/male ratio (ranging from 86.7% for Bull C to 95.2% for Bull D), while 52.2% of heifers inseminated with conventional semen delivered a female calf (ranging from 50% for Bulls A and D to 52.9% for Bull C).

DiscussionIn the current study, the overall P/AI with sex-selected semen in TAI heifers was 63.6% at 32 d and the calving rate was 58.2%,

which supported our hypothesis that a modified 5-day Co-synch plus an intravaginal progesterone releasing insert device (PRID) protocol, without the first GnRH, would result in acceptable P/AI in Holstein heifers inseminated with sex-selected semen. In this study, P/AI was greater than that reported in previous TAI studies. In a large field study, Holstein heifers were syn-chronized with the 5-day Cosynch 1 CIDR (controlled internal drug release) with 1 injection of PGF and assigned randomly to be inseminated with conventional or sex-selected semen from 2 sires (9). Pregnancy per AI with sex-selected semen was 39.3% at 32 d and 35.9% at 60 d after TAI, while P/AI with conventional semen were 59.8% and 59.2%, respectively. Low P/AI with sex-selected semen has been also reported in studies that used estradiol and progesterone based-TAI protocols (8). In Jersey heifers that received 2 mg of estradiol benzoate (EB) and a CIDR for 8 d and were inseminated with sex-selected semen at 54 or 60 h following CIDR removal and PGF treatment (30 or 36 h after a second treatment with EB 24 h after CIDR removal), P/AI ranged from 16.2% to 31.4%, while P/AI was 46.5% with conventional semen (8). In the current study, P/AI obtained with sex-selected semen in TAI heifers was almost identical to that obtained with conventional semen, indicating that the modified 5-day Co-synch plus PRID protocol used in this study is a feasible option for attaining high P/AI in Holstein heifers inseminated with sex-selected semen.

Interestingly, P/AI obtained with sex-selected semen in estrus detected heifers was somewhat lower (86.6% of that obtained with conventional semen). Although the reason for this difference is unclear and needs to be elucidated in future studies, results are in agreement with previous studies in which estrus detec-tion was done. In this regard, Seidel et al (4) summarized data from the insemination of 1000 heifers with sex-selected semen over several experiments; overall P/AI in heifers receiving 1 of 4 estrus synchronization methods was 90.0% of that obtained with conventional semen. In a more recent study, De Jarnette et al (6) compared P/AI in Holstein heifers from 51 dairy herds in USA that were inseminated with sex-selected or conventional semen from 8 Holstein sires. Across herds and sires, P/AI for sex-selected semen (2.1 3 106, n = 2319) was 38% compared to 60% for conventional semen (10 3 106, n = 2292). In these studies, P/AI in heifers inseminated with sex-selected semen following estrus detection ranged from 63% to 90% of that obtained with conventional semen. Factors other than type of semen such as herd, sire, sperm dosage and service number were identified as affecting P/AI (6). In the present study, other variables, except for sperm dosage, were not confounding factors that could have affected the outcome. Interestingly, the P/AI

Table 2. Effect of estrus expression and type of semen on pregnancy per AI (P/AI) after timed-AI in Holstein heifers subjected to a modified 5-day Co-synch plus PRID protocol

P/AI P-value

Conventional Sex-selected EstrusExpression semen semen Estrus Type of expression byof estrus n/n (%) n/n (%) expression semen type of semen

Yes 28/41 (68.3) 32/46 (69.6)No 7/14 (50.0) 4/11 (36.4) 0.02 0.57 0.40

Figure 3. Distribution of interval to ovulation (hours) after AI in Holstein heifers in both synchronization groups. Heifers in the ED group received two 500 mg of cloprostenol (PGF) treatments 14 d apart. Heifers in the TAI group were subjected to a modified 5-day Co-synch plus PRID TAI protocol.

Num

ber

of h

eife

rs

Interval (hours) after AI

ED group

TAI group

0 12 24 36

70

60

50

40

30

20

10

0


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obtained in ED heifers inseminated with sex-selected semen was 65.0%, which is comparable to the P/AI usually achieved with conventional semen in well-managed commercial dairy herds.

It has been reported that inseminations with sex-selected semen in the uterine horn ipsilateral to the presumed ovulation could improve conception rate of estrus synchronized heifers (18). However, in the current study, all inseminations were performed in the uterine body by the same technician, sug-gesting that placement of sex-selected semen deeper into the uterine horn or ipsilateral to the ovulation site is not necessary to achieve acceptable P/AI.

In an attempt to improve P/AI with sex-selected semen, Sá Filho et al (7) evaluated different intervals from onset of estrus to AI in Jersey heifers. Estrus was detected with a HeatWatch system and heifers were inseminated from 12 to 16, 16.1 to 20, or 20.1 to 24 h after onset of estrus. Inseminations between 16.1 to 24 h after the onset of estrus resulted in greater P/AI than inseminations between 12 and 16 h, indicating that inseminations with sex-selected semen done closer to the time of ovulation should be recommended. In agreement, another study with a small number of Angus heifers subjected to GnRH-based plus CIDR TAI inseminations with sex-selected semen at 67 to 68 h after CIDR removal resulted in numerically higher pregnancy rates than inseminations done at 55 to 56 h after CIDR removal [46.6% versus 34.4% (5)].

In the present study the interval from AI to ovulation affected P/AI, especially in TAI heifers inseminated with sex-selected semen. Ovulations occurring within 12 h following TAI resulted in numerically higher P/AI, while ovulations occurring between 24 and 36 h after TAI tended to result in lower P/AI in heifers inseminated with sex-selected semen compared to conventional semen. It appears that fertility of sex-selected semen is reduced after 24 h in the female reproductive tract. Conversely, fertility seemed to be unaffected in heifers inseminated with conven-tional semen if ovulation occurred within 36 h following insemi-nation. Therefore, our observations are in agreement with the suggestion that timing of AI for sex-selected semen should be delayed compared to that recommended for conventional semen. In an earlier study (10), more than 75% of the heifers subjected to the modified 5-day Co-synch plus PRID protocol ovulated within 24 h following insemination, while only 64.3% ovulated during the same interval of time in the current study. Decreasing

the proportion of heifers with later ovulations would further improve P/AI following TAI with sex-selected semen. Hence, future studies should examine strategies to enhance synchrony of ovulation in heifers subjected to the modified 5-day Co-synch plus PRID protocol.

Expression of estrus in heifers subjected to the TAI protocol affected P/AI, regardless of type of semen used. Although not significant, heifers that were observed in estrus before TAI with sex-selected semen were twice as likely to become pregnant than those that were not observed in estrus. Thus, the use of estrus detection aids (e.g., patches or tail chalk) to determine which animals were in estrus might enhance P/AI with sex-selected semen used in TAI protocols. For example, sex-selected semen could be used in females determined to be in estrus before TAI, while conventional semen could be used in those not observed in estrus. Another option, if only sex-selected semen was being used, would be to delay the timing of AI in those females not observed in estrus. This strategy has been explored by Thomas et al (19) in heifers subjected to another TAI protocol and inseminated with conventional semen. Delaying insemination of heifers that had not expressed estrus before scheduled TAI by 20 h resulted in increased P/AI [from 46% to 54% (18)].

There is little published information concerning pregnancy loss in heifers following insemination with sex-selected semen. Seidel et al (20) reported that 3/11 (27.3%) and 2/11 (18.2%) heifers inseminated with X- or Y-bearing, non-frozen semen, respectively, lost their pregnancies between 1 and 2 mo post-insemination. Bodmer et al (21) compared pregnancy rate and loss in 54 heifers inseminated with either X-bearing, frozen-thawed semen or conventional semen. Pregnancy loss between first (30 to 40 d after AI) and second (70 to 90 d after AI) pregnancy diagnosis was 11.1% and 0.0% for sex-selected and conventional semen, respectively. Based on these reports, preg-nancy loss in heifers following insemination with sex-selected semen would appear to be higher than with conventional semen. Although, no differences in the overall pregnancy loss between sex-selected and conventional semen were found in the present study, the majority of pregnancy losses following the use of sex-selected semen occurred early during gestation. Interestingly, all heifers in the TAI group that experienced pregnancy loss had a non-viable embryo at the time of first pregnancy diagnosis and no further pregnancy loss occurred between first (27 to 33 d

Table 3. Effect of time of ovulation relative to timed-AI and type of semen on pregnancy per AI (P/AI) in Holstein heifers subjected to a modified 5-day Co-synch plus PRID protocol

P/AI

Conventional Sex-selected Time of semen semen Overall n/novulation (h) N (%) n/n (%) n/n (%) (%)

0 20 (17.9) 5/11 (45.4) 4/9 (44.4) 9/20 (45.0)12 27 (24.1) 6/9 (66.6) 15/18 (83.3) 21/27 (77.7)24 25 (22.3) 10/13 (76.9) 8/12 (66.6) 18/25 (72.0)36a 38 (33.9) 14/20 (70.0) 9/18 (50.0) 23/38 (60.5)No ovulation 2 (1.8) 0/2 (0.0) — 0/2 (0.0)a P/AI tended to differ (P = 0.1) between sex-selected and conventional semen.


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after AI) and second (42 to 48 d after AI) pregnancy diagnosis. All other pregnancy losses occurred in both groups between the second pregnancy diagnosis and term.

As indicated, the objective of using sex-selected semen is to obtain offspring of the preferred gender (female calves in our study) in a selected group of females. The proportion of female offspring born from heifers inseminated with sex-selected semen was 91.8%, while the proportion of female offspring in heifers inseminated with conventional semen was 52.2%. There was no effect of sire on the proportion of female calves born, which is in agreement with reports by others (3,5,20).

In conclusion, the modified 5-day Co-synch plus PRID pro-tocol, without an injection of GnRH at PRID insertion, resulted in acceptable P/AI in Holstein heifers inseminated with sex-selected semen, which supported our stated hypothesis. Results suggest that sex-selected semen can be used with the TAI pro-tocol used in this study to eliminate the inconvenience of estrus detection and increase the proportion of female calves born.

AcknowledgmentsThe research was supported by Livestock Research Branch, Alberta Agriculture and Forestry. The authors thank Mr. Darren Hipkin from Alta Genetics (Balzac, Alberta) and Vétoquinol (Lavaltrie, Québec) for their in-kind support and the de Goeij family (Breevliet Ltd; Wetaskiwin, Alberta) for their cooperation during the study. CVJ

References 1. de Vries A. The economics of using sexed semen. Adv Dairy Technol

2010;22:357–370. 2. Norman HD, Hutchinson JL, Miller RH. Use of sexed semen and its

effect on conception rate, calf sex, dystocia, and stillbirth of Holstein in the United States. J Dairy Sci 2010;93:3880–3890.

3. Seidel GE, Jr. Update on sexed semen technology in cattle. Animal 2014;8:160–164.

4. Seidel GE, Jr, Schenk JL, Herickhoff LA, et al. Insemination of heifers with sexed sperm. Theriogenology 1999;52:1407–1420.

5. Schenk JL, Cran DG, Everett RW, Seidel GE, Jr. Pregnancy rates in heifers and cows with cryopreserved sexed sperm: Effects of sperm numbers per inseminate, sorting pressure and sperm storage before sorting. Theriogenology 2009;71:717–728.

6. De Jarnette JM, Leach MA, Nebel RL, Marshall CE, McCleary CR, Moreno JF. Effects of sex-sorting and sperm dosage on conception rates of Holstein heifers: Is comparable fertility of sex-sorted and conven-tional semen plausible? J Dairy Sci 2011;94:3477–3483.

7. Sá Filho MF, Ayres H, Ferreira RM, et al. Strategies to improve preg-nancy per insemination using sex-sorted semen in dairy heifers detected in estrus. Theriogenology 2010;74:1636–1642.

8. Sales JNS, Neves KAL, Souza AH, et al. Timing of insemination and fertility in dairy and beef cattle receiving timed artificial insemination using sex-sorted sperm. Theriogenology 2011;76:427–435.

9. Risco CA. Reproductive management of dairy heifers. Adv Dairy Technol 2011;23:233–237.

10. Colazo MG, Ambrose DJ. Neither duration of progesterone insert nor initial GnRH treatment affect pregnancy per timed-insemination in dairy heifers subjected to a Co-synch protocol. Theriogenology 2011;76:578–588.

11. Lima FS, Ayres H, Favoreto MG, et al. Effects of gonadotropin releas-ing hormone at initiation of the 5-d timed artificial insemination (AI) program and timing of induction of ovulation relative to AI on ovarian dynamics and fertility of dairy heifers. J Dairy Sci 2011;94:4997–5004.

12. López-Helguera I, Whittaker P, Behrouzi A, Colazo MG. Initial gonadotropin-releasing hormone treatment increased pregnancy per timed insemination only in acyclic beef heifers subjected to a 5-day Co-synch protocol. Reprod Fertil Dev 2015;28:135–136.

13. Canadian Council on Animal Care. Guide to the care and use of experimental animals. Second Edition, vol. 1. Ottawa, Ontario: Canadian Council on Animal Care. Available from: http://www.ccac.ca/Documents/Standards/Guidelines/Experimental_Animals_Vol1.pdf; 1993 Last accessed February 6, 2017.

14. National Research Council. Nutrient requirements of dairy cattle, 7th rev. ed., Washington, DC: The National Academies Press, 2001.

15. Pierson RA, Ginther OJ. Ultrasonography of the bovine ovary. Therio-genology 1984;21:495–504.

16. Colazo MG, Gordon MB, Rajamahendran R, Mapletoft RJ, Ambrose DJ. Pregnancy rates to timed-AI in dairy cows treated with gonadotropin releasing hormone or porcine luteinizing hormone. Theriogenology 2009;72:262–270.

17. Win Episcope 2000. Win Episcope 2.0: Software for quantitative veterinary epidemiology. Facultad de Veterinaria, Zaragoza, Spain; Agricultural University Wageningen, The Netherlands; University of Utrecht, The Netherlands; University of Edinburgh, UK.

18. Hunter RHF. New breeding opportunities with deep corneal insemi-nation: Exploiting modern sperm technologies in cattle. Reprod Dom Anim 2011;36:217–222.

19. Thomas JM, Poock SE, Ellersieck MR, Smith MF, Patterson DJ. Delayed insemination of non-estrus heifers and cows when using conventional semen in timed artificial insemination. J Anim Sci 2014; 92:4189–4197.

20. Seidel GE, Jr, Allen CH, Johnson LA, et al. Uterine insemination of heifers with very low numbers of nonfrozen and sexed spermatozoa. Theriogenology 1997;48:1255–1264.

21. Bodmer M, Janett F, Hässig M, den Daas N, Reichert P, Thun R. Fertility in heifers and cows after low dose insemination with sex-sorted and non-sorted sperm under field conditions. Theriogenology 2005;64:1647–1655.


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Article

Hematology and biochemistry reference intervals for Ontario commercial nursing pigs close to the time of weaning

Amanda M. Perri, Terri L. O’Sullivan, John C.S. Harding, R. Darren Wood, Robert M. Friendship

Abstract — The evaluation of pig hematology and biochemistry parameters is rarely done largely due to the costs associated with laboratory testing and labor, and the limited availability of reference intervals needed for interpretation. Within-herd and between-herd biological variation of these values also make it difficult to establish reference intervals. Regardless, baseline reference intervals are important to aid veterinarians in the interpretation of blood parameters for the diagnosis and treatment of diseased swine. The objective of this research was to provide reference intervals for hematology and biochemistry parameters of 3-week-old commercial nursing piglets in Ontario. A total of 1032 pigs lacking clinical signs of disease from 20 swine farms were sampled for hematology and iron panel evaluation, with biochemistry analysis performed on a subset of 189 randomly selected pigs. The 95% reference interval, mean, median, range, and 90% confidence intervals were calculated for each parameter.

Résumé — Intervalles de références de l’hématologie et de la biochimie pour des porcelets à l’allaitement vers le moment du sevrage dans des élevages commerciaux de l’Ontario. L’évaluation des paramètres hématologiques et biochimiques des porcs est rarement réalisée surtout en raison des coûts associés aux tests de laboratoire ainsi qu’à la main-d’œuvre et à la disponibilité limitée d’intervalles de référence requis pour l’interprétation. La variation de ces valeurs au sein de troupeaux et entre les troupeaux complique l’établissement des intervalles de référence. Néanmoins, des intervalles de référence de base sont importants pour appuyer les vétérinaires dans l’interprétation des paramètres sanguins pour le diagnostic et le traitement des porcs malades. Cette recherche avait pour objectif de fournir des intervalles de référence pour les paramètres hématologiques et biochimiques des porcelets commerciaux à l’allaitement âgés de 3 semaines en Ontario. Des échantillons ont été prélevés pour un total de 1032 porcs ne présentant pas de signes cliniques de maladie provenant de 20 fermes porcines pour une évaluation du profil d’hématologie et du fer et une analyse biochimique a été réalisée pour un sous-groupe de 189 porcs choisis au hasard. L’intervalle de référence de 95 %, la moyenne, la médiane, l’étendue de référence et les intervalles de confiance de 90 % ont été calculés pour chaque paramètre.

(Traduit par Isabelle Vallières)Can Vet J 2017;58:371–376

Introduction

There are many important reasons for performing blood analy-ses in pigs. Firstly, the assessment of these parameters can be

used as a component of determining the health status of a herd (1). Hematology and biochemistry reference intervals can also contribute to the early identification of disease or poor growth

performance, aiding clinicians and researchers in interpreting the results of tests on blood samples (2–5). However, despite the importance of analyzing these parameters, hematology and biochemistry assessments are rarely used in the swine industry. This may be due to the dearth of information on reference intervals for commercial pigs, the costs associated with labor and laboratory testing, especially in comparison to the low economic value of an individual pig (1), or the perception that hematology and blood biochemistry will provide little useful information. Additionally, it is possible for the results to be biased by factors such as improper blood collection and handling techniques (i.e., not properly mixing the blood with the anticoagulant), which may result in poor sample quality, or the effects of animal stress or excitement from the handling and collection process (1).

Many within-herd variables can influence hematology and biochemistry parameters. These include environmental and physiological factors such as age, breed, gender, diet, and hous-ing, as well as pathogen challenge, and stress (1,3). Between-herd differences can include the same reasons mentioned, as well as variables associated with management practices, biosecurity, and

Department of Population Medicine (Perri, O’Sullivan, Friendship), Department of Pathobiology (Wood), University of Guelph, Guelph, Ontario N1G 2W1; Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon S7N 5B4 (Harding).Address all correspondence to Dr. Terri O’Sullivan; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.


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overall health status of the herd. Hematology and biochemistry parameters from a particular animal or herd are typically com-pared to reference intervals that have been previously deter-mined from a similar group of animals using similar laboratory techniques. Additionally, some previously published studies that developed reference intervals have used small sample sizes, breeds that are uncommon, or have combined data from differ-ent age categories of pig or different stages of production (6–8). However, there are limited studies that have published such reference intervals for nursing commercial piglets. Reference intervals are influenced by analytical factors such as instrumenta-tion and technology, time or temperature of a chemical reaction, or the substrate used (5). Many laboratories have been updated with advanced automated and computerized systems to improve the overall accuracy and precision of analytical measurements. Thus, it is important to report updated reference intervals that reflect current analytical methods/automation, and advance-ments in genetics and pig production practices. The objective of this study was to develop reference intervals for hematology and biochemistry parameters for Ontario commercial nursing piglets close to the time of weaning at approximately 21 d of age.

Materials and methodsThe animal care committee at the University of Guelph, follow-ing the guidelines of the Canadian Council for Animal Care, reviewed and approved this study. The blood samples were taken from pigs from 20 southern Ontario swine farms and had been used in a previous study (9). Briefly, the farms sampled varied in production type, management practice, and sow-herd size, and were representative of the variation and types of herds operat-ing in Ontario at the time. A questionnaire was administered to each producer from the participating farms to collect reference population information including age of piglets at weaning, management practices, and the size of the sow herd. All animals used in this study were raised according to the current Canadian Code of Practice for the Care and Handling of Pigs (10). Hence, all pigs received a 200-mg IM iron injection, either gleptofer-ron or iron dextran, within the first 7 d of life (9). Litters were not used if they were treated with any pharmacological agents (i.e., antibiotics). Thus, all participating farms were considered to have healthy pigs without any current health challenges or disease outbreaks. Creep feed was given to suckling pigs on some of the farms; however, the number of farms and contents of the feed were not recorded. Each farm was visited 1 to 2 d before the routine weaning day, and litters were systematically selected at this time by beginning with the initial crate in the farrow-ing room until a maximum of 20 litters were sampled. From each litter, a small, medium, and large piglet were purposely selected to account for size variation across litters. All male piglets enrolled in this study were barrows. Pigs were excluded if they had any health concerns such as the visible presence of an abscess, hernia, thin body condition, or lameness (9).

A technician and a veterinarian took blood samples from the selected piglets by the orbital sinus bleeding technique (11,12) using a Monoject Standard Hypodermic needle 16 G 3 10 (Covidien; Mansfield, Massachusetts, USA). Blood for serum biochemistry and iron profile was collected in 8.5-mL plain

tubes containing no additive (BD Vacutainer; BD, Franklin Lakes, New Jersey, USA). Blood for hematology was collected in 6-mL tubes containing ethylenediamine tetraacetic acid (EDTA) (BD Vacutainer; BD). The EDTA tubes were imme-diately inverted 5 to 10 times after the sample was collected to mix the anticoagulant with the blood. The blood samples were immediately placed on ice packs in a cooler and transported from the farm to the laboratory.

Hematology evaluationThe blood samples (n = 1095) collected by Perri et al (9) were used for hematology analysis of individual piglets just prior to weaning at approximately 21 d of age. Within approximately 3 h of sampling on-farm, the whole blood samples were analyzed at the Animal Health Laboratory (AHL), University of Guelph, Guelph, Ontario. Standard hematology techniques using the ADVIA 2120/2120i Hematology system (Siemens Healthcare Diagnostics, Deerfield, Illinois, USA) were used to determine the red blood cell (RBC) count, white blood cell (WBC) count, hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), platelets, and mean platelet volume (MPV). Platelet counts were measured photometrically. For further details on the hematology analytical methods and automation procedures, please contact the corresponding author.

Biochemistry evaluationBlood samples (n = 1095) were centrifuged at the AHL, the serum was removed and then stored at 220°C until the time of analysis. Due to the cost associated with the biochemical analysis a subset of 200 samples was randomly chosen by using a random generator in STATA 12.0 (Stata 12 Statacorp LP, College Station, Texas, USA). A total of 10 serum samples, representing 10 individual pigs, were randomly selected from each of the participating farms and were analyzed using a Roche Cobas 6000 c501 biochemistry analyzer (Roche Diagnostics USA, Indianapolis, USA), as per standard protocols at the AHL. For further details on the biochemistry analytical methods and automation, please contact the corresponding author.

Statistical analysisReference intervals were statistically evaluated using a computer program (Analyze-It Version 3.0; Analyze-It Software, Leeds, UK). This software program works within Microsoft Excel. Data were examined using non-parametric methods as recommended by the American Society for Veterinary Clinical Pathology (ASVCP). Non-parametric methods are recommended when using $ 120 samples for the determination of reference intervals and when the data do not follow a normal distribution (13).

Five blood samples were omitted from the datasets due to small clots. Additionally, the authors decided a priori to exclude any pigs from the study if they were considered anemic. Anemia was defined as a pig having a HGB value # 90 g/L. The decision tree indicating whether a pig should be included or excluded in the statistical analysis to define reference intervals for the hema-tology and biochemistry parameters is displayed in Figure 1.


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After the removal of anemic pigs, 1032 pigs (from the original 1095) were used for hematology reference interval determina-tion. From the original 1095 pigs, 200 were randomly selected for biochemical analysis. However, of these 200 pigs selected 11 were removed because they were anemic, leaving a total of 189 pigs available for biochemistry reference interval determina-tion. Each hematology and biochemistry parameter was initially screened visually using histograms and boxplots to assess the distribution. Box plots illustrate a sample distribution using the 25th, 50th, and 75th percentiles, which are also referred to as the lower quartile (Q1), median (m or Q2), and upper quartile (Q3), respectively (14). The interquartile range (IQR) is equal to Q3 2 Q1 and this range covers the central 50% of the data (14). The 95% reference intervals, mean, median, minimum, maximum, and 90% CI’s for the lower and upper reference limits were calculated for each hematology and biochemistry

parameter. The statistical examination of outliers is not recom-mended for reference interval analysis since large values from a skewed population (non-Gaussian) may be mislabeled as an outlier(s) (15). Since nonparametric methods establish refer-ence limits by trimming the most extreme values, outliers have less of an effect on the reference intervals than with parametric methods (13). Thus, outlier detection was not performed.

ResultsThe mean age of piglets sampled was 21.8 6 4.2 d. The 95% reference intervals, mean, median, minimum, maximum, and 90% CI’s for the lower and upper reference limits for the hema-tology parameters are presented in Table 1. The 95% reference intervals, mean, median, minimum, maximum, and 90% CI’s for the lower and upper reference limits for the biochemistry parameters are displayed in Table 2.

Figure 1. Decision tree used for the inclusion and exclusion criteria of piglet data for statistical analyses of hematology and biochemistry parameters in commercial nursing piglets at the time of weaning.

Select a parameter of interest

Is the parameter selected a hematology parameter?

Remove piglets with an HGB# 90 g/L as established a priori and

any samples that have clotted

Use a histogram and box plot to visually assess the

distribution

Determine the mean, median, minimum, and maximum for

each parameter

Determine the interquartile range using

the box plots

Determine the 95% reference intervals and 90% confidence

intervals for the upper and lower reference limits

Use the random generator (STATA12.0 Statacorp LP,

College Station, Texas, USA) to select 10 pigs

per farm (n = 200)

Yes

No

NoYes

Is the parameter selected a biochemistry parameter?


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DiscussionThe establishment of hematology and biochemistry reference intervals in nursing piglets is important for veterinarians and researchers. Reference intervals can be used to interpret labora-tory results in order to better understand the health status of

either an individual pig or the entire herd. The interpretation of these parameters is often difficult due to the variation within individual pigs and herds, as well as between herds. There are many animal-related pre-analytical factors such as age, gender, breed, growth rate, nutritional and health status, season, physical

Table 1. Hematology reference valuesa and reference intervals for Ontario piglets (n = 1032) sampled 1 to 2 days prior to weaningb on 20 commercial farms

95% Reference 90% CI 90% CI Variable Mean Median Min–Max IQR interval Lower limit Upper limit

WBC (3 109/L) 11.2 10.1 4.3–53.9 5.0 6.0–21.7 5.8–6.2 20.7–22.8RBC (3 1012/L) 6.0 5.9 3.9–8.0 0.9 4.8–7.3 4.6–4.9 7.2–7.4HGB (g/L) 115.0 115.0 91.0–144.0 15.0 93.0–136.0 92.0–94.0 135.0–137.0HCT (L/L) 0.4 0.4 0.3–0.5 0.05 0.3–0.5 0.32–0.33 0.45–0.46MCV (10215 L) 66.0 66.0 48.0–87.0 9.0 53.0–79.0 53.0–54.0 78.0–80.0MCH (10212 g) 19.5 20.0 13.0–27.0 3.0 15.0–23.0 15.0–15.0 23.0–24.0MCHC (g/L) 295.0 294.0 262.0–397.0 14.0 275.0–317.2 274.0–276.0 316.0–319.0RDW (%) 18.2 17.4 10.0–31.1 3.6 14.3–26.0 14.2–14.5 25.3–26.9Platelets (3 109/L) 487.0 474.5 49–1498 201.0 171.8–833.2 156.0–196.0 795.0–857.0MPV 10.5 10.0 6.6–22.7 2.8 7.4–16.5 7.4–7.5 15.7–16.8a Reference values were determined using Analyze-It Software (Analyze-It Version 3.0; Leeds, UK) and based on non-parametric analyses.b Average age of piglets (1 to 2 d prior to weaning) was 21.8 6 4.2 d.IQR — interquartile range, which is equal to the upper quartile (Q3) minus the lower quartile (Q1) (Q3–Q1) and this range covers the central 50% of the data; CI — confidence interval; WBC — white blood cells; RBC — red blood cells; HGB — hemoglobin; HCT — hematocrit; MCV — mean corpuscular volume; MCH — mean corpuscular hemoglobin; MCHC — mean corpuscular hemoglobin concentration; RDW — red blood cell distribution width; MPV — mean platelet volume.

Table 2. Biochemistry reference valuesa and reference intervals for Ontario piglets (n = 189) sampled 1 to 2 days prior to weaningb on 20 commercial farms

95% Reference 90% CI 90% CI Variable Mean Median Min-Max IQR interval Lower limit Upper limit

Calcium (mmol/L) 2.8 2.9 1.70–3.2 0.19 2.4–3.1 2.0–2.6 3.1–3.2Phosphorus (mmol/L) 3.3 3.3 2.3–3.9 0.33 2.6–3.8 2.4–2.7 3.7–3.8Magnesium (mmol/L) 1.2 1.1 0.9–1.5 0.1 0.9–1.5 0.9–0.9 1.4–1.5Sodium (mmol/L) 138.3 140.0 94–150 6.0 122.0–145.3 107.0–128.0 144.0–147.0Potassium (mmol/L) 5.0 5.0 3.6–7.2 0.6 3.9–6.2 3.8–4.2 6.0–6.4Chloride (mmol/L) 97.2 98.0 64–106 4.0 86.8–103.3 75.0–88.0 102.0–104.0Serum carbon dioxide (mmol/L) 25.3 26.0 18–32 3.0 19.0–31.0 18.0–20.0 30.0–32.0Anion gap (mmol/L) 20.9 21.0 15–29 4.0 16.0–28.3 15.0–16.0 27.0–29.0Na/K ratio (mmol/L) 27.8 28.0 18–36 4.0 22.8–33.3 22.0–23.0 33.0–36.0Serum iron (mmol/L) 19.4 17.0 2–85 17.0 4.0–45.0 4.0–5.0 43.0–47.0UIBC (mmol/L) 60.0 61.0 0–143 42.0 7.0–116.0 6.0–9.0 114.0–118.0TIBC (mmol/L) 80.0 79.0 23–149 28.6 37.0–122.2 36.0–40.0 121.0–125.0Prop saturation (%) 28.0 24.0 2–100 29.0 4.0–82.0 4.0–4.0 77.0–86.0Total protein (g/L) 48.0 48.1 31.0–61.0 4.0 40.8–55.3 34.0–42.0 53.0–59.0Albumin (g/L) 36.9 38.0 23–46 6.0 24.9–46.0 22.0–27.0 43.0–46.0Globulin (g/L) 11.2 11.0 4–33 3.0 5.0–24.5 5.0–6.0 18.0–28.0A/G ratio 3.8 3.5 0.7–10.5 1.8 1.2–8.4 1.0–1.5 7.0–9.2Urea 2.5 2.2 0.7–9.3 1.2 0.9–4.9 0.7–1.1 4.5–6.2Creatinine (mmol/L) 89.7 88.0 36.0–141.0 24.0 54.3–127.0 50.0–65.0 120.0–140.0Glucose (mmol/L) 6.5 6.5 2.7–8.9 1.0 4.98–8.05 3.9–5.3 7.8–8.5Cholesterol (mmol/L) 4.7 4.6 1.74–9.76 1.9 2.2–8.4 1.9–2.8 8.0–9.2Total bilirubin (mmol/L) 6.0 5.0 1–22 3.0 2.0–18.0 1.0–2.0 11.0–16.0Conjugated bilirubin (mmol/L) 2.9 3.0 0–10 1.0 1.0–6.0 1.0–1.0 5.0–7.0Free bilirubin (mmol/L) 3.1 3.0 0–15 2.0 0.0–8.3 0.0–0.0 7.0–10.0Alkaline phosphatase (U/L) 589.3 552.0 160–2119 326.7 233.0–1332.0 224.0–276.0 1077.0–1400.0GGT (U/L) 35.0 35.0 0–75 20.0 14.0–64.0 6.0–15.0 61.0–68.0AST (U/L) 38.3 35.0 3–130 14.0 18.0–83.5 13.0–20.0 73.0–98.0CK (U/L) 365.0 302.0 111–4918.0 144.7 146.0–869.8 133.0–174.0 569.0–2885.0GLDH (U/L) 5.1 2.0 0–65 3.0 0.0–9.0 0.0–0.0 11.0–61.0BHBA (mmol/L) 3.2 0 0–58 0 0.0–34.0 0.0–0.0 36.0–37.0Haptoglobin (g/L) 0.6 0.4 0.2–3.7 0.2 0.26–2.59 0.24–0.26 1.71–3.69Calculated osmolality (mmol/L) 278.0 278.0 188–297 11.0 243.5–288.1 212.0–259.0 287.0–293.0a Reference values were determined using Analyze-It Software (Analyze-It Version 3.0, Leeds, United Kingdom) and based on non-parametric analyses. b Average age of piglets at (1 to 2 d prior to weaning) was 21.8 6 4.2 days. IQR — interquartile range, which is equal to the upper quartile (Q3) minus the lower quartile (Q1) (Q3–Q1) and this range covers the central 50% of the data. CI — confidence interval; UIBC — unsaturated iron-binding capacity; TIBC — total iron-binding capacity; GGT — gamma-glutamyl transferase; AST — aspartate transaminase, CK — creatine kinase; GLDH — glutamate dehydrogenase; BHBA — blood b-hydroxybutyrate.


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activity and stress that can affect both hematology and biochem-istry parameters (16).

Nursing piglets undergo rapid growth and immune system changes, which may result in variation in hematology and biochemistry parameters. It is therefore essential to develop reference intervals for this age group to aid in the diagnosis of disease and to enable timely intervention to prevent further health-challenge issues in subsequent stages of production. There are only a few published manuscripts containing refer-ence intervals for hematology and biochemistry parameters for 3-week-old nursing piglets. Thus, contributions to the literature on reference intervals for these parameters are needed.

All pigs selected for sampling lacked any visible outward clini-cal signs or physical abnormalities. However, subclinical disease and/or marginal nutritional deficiencies may have been present in some of the pigs included in this study. This further high-lights the importance of assessing hematology and biochemistry parameters. The decision to omit anemic pigs from the study was based on both the authors’ previous work on pig anemia and iron deficiency (9) as well as on other studies that have published accepted values for pig hemoglobin (HGB) concentra-tion (17,18). The work conducted by Perri et al (9) established that iron deficiency and anemia are present in a proportion of Ontario pigs at weaning, despite their healthy physical appear-ance. Hence, anemic pigs were identified and removed from the current study in order to establish hematology and biochemistry parameters for healthy pigs. It was hypothesized that the timing of iron administration would contribute to the number of ane-mic pigs found in the herds. However, Perri et al (9) found no statistically significant difference in the number of anemic pigs when comparing pigs administered an iron injection at # 1 d of age, 2 to 4 d, or 5 to 7 d of age.

The values reported in the current study are similar to values reported in 2 previous publications (19,20). Gong et al (19) evaluated hematology values for 368 piglets that were 20 d of age and the values were similar to the hematology values from the current study. Egeli et al (20) conducted a study on bio-chemistry and hematology values of pigs at 1 d, 21 d, and 35 d of age. The study compared values from pigs (n = 60) that were defined as having a normal hemoglobin concentration (HGB . 80 g/L) to pigs (n = 42) that were anemic (HGB # 80 g/L). When comparing our hematology parameters to those of Egeli et al (20), the current study reports higher HGB and HCT values. The minor variation in these parameters may be due to differences in the iron supplementation protocols, such as timing of injection and dosage. Egeli et al (20) administered 180 mg of iron dextran at 1 d of age, compared to 200 mg of either iron dextran or gleptoferron at 1 to 7 d of age from the current study. Egeli et al (20) reported slightly lower reference intervals for AST, magnesium, cholesterol, and similar reference intervals for total protein and albumin compared with the cur-rent study. The larger sample size herein and different analytical methods may explain the dissimilarities in these parameters. The disparities in cholesterol and total iron may be a result of nutritional variations due to access to milk and creep feed. Also, variations in the amount of protein in milk and creep feed might also affect urea and creatinine concentrations (21).

It is inappropriate to compare hematology and biochemis-try reference intervals of nursing piglets to those of other age groups because nursing pigs undergo significant physiological changes such as bone development which will lead to differ-ences in parameters (i.e., elevated phosphorus concentration and alkaline phosphatase activity) compared to older growing pigs (22). There are also nutritional variances between pigs from different age groups, which can affect values such as phospho-rus, cholesterol, total bilirubin, conjugated bilirubin, and free bilirubin (21).

A general limitation for assessing reference intervals for hematology and biochemistry parameters is the large variation in biological features found within pigs on a single farm as well as an even larger variation when comparing pigs from different farms. However, a strength of this study was the large sample size for both hematology evaluation (n = 1032) and biochemis-try evaluation (n = 189).

The results from this study fill an important gap in the lit-erature by providing reference intervals for hematology and bio-chemistry parameters in nursing piglets from Ontario commer-cial herds. The herds selected appeared to be in good health and the pigs chosen lacked clinical signs or physical abnormalities on physical examination, thus the variation in parameters may reflect what is expected in Ontario commercial pigs at weaning. Since the nursing period is a critical stage of development for pigs, it is important to continue to assess and publish hemato-logical and biochemical blood parameters for these animals, as well as for other stages of production, to aid veterinarians and researchers in the identification of clinical or subclinical disease or metabolic and nutritional problems.

AcknowledgmentsThis study was funded by the Saskatchewan Ministry of Agriculture and Food, Saskatchewan Pork Development Board, the Canadian Swine Health Board, and the Ontario Ministry of Agriculture Food and Rural Affairs-University of Guelph Research Partnership. CVJ

References 1. Evans RJ. Porcine haematology: Reference ranges and the clinical value

of the haematological examination in the pig. Pig J 1994;32:52–57. 2. Klem TB, Bleken E, Morberg H, Thoresen SI, Framstad T. Hematologic

and biochemical reference intervals for Norwegian crossbreed grower pigs. Vet Clin Path 2010;39:221–226.

3. Friendship R, Lumsden JH, McMillan I, Wilson MR. Hematology and biochemistry reference values for Ontario swine. Can J Com Med 1984; 48:390–393.

4. Lumsden JH, Mullen K. On establishing reference values. Can J Com Med 1978;42:293–301.

5. Lumsden JH, Mullen K, McSherry BJ. Canine hematology and bio-chemistry reference values. Can J Com Med 1979;43:125–131.

6. Elbers ARW, Geudeke MJ, van Rossem H, Kroon MC, Counotte GHM. Haematology and biochemistry reference values for sows kept under modern management conditions. Vet Q 1994;16:127–130.

7. Miller ER, Ullrey DE, Ackerman I, Schmidt DA, Luecke RW, Hoefer JA. Swine haematology from birth to maturity. II. Erythrocyte population, size and haemoglobin concentration. J Anim Sci 1961;20: 890–897.

8. Ullrey DE, Miller ER, Brent BE, Bradley BL, Hoefer JA. Swine hae-matology from birth to maturity. IV. Serum calcium, magnesium, sodium, potassium, copper, zinc and inorganic phosphorus. J Anim Sci 1967;26:1024–1029.


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9. Perri AM, Friendship R, Harding J, O’Sullivan TL. An investiga-tion of iron deficiency and anemia in piglets and the effect of iron status at weaning on post-weaning performance. J Swine Health Prod 2016;24:10–20.

10. National Farm Animal Care Council. [Code of practice for the care and handling of pigs]. Ottawa, Canada: Canadian Pork Council; 2014.

11. Huhn RG, Osweiller GD, Switzer WP. Application of the orbital sinus bleeding technique to swine. Lab Animal Care 1969;19:403–405.

12. Dove CR, Alworth LC. Blood collection from the orbital sinus of swine. Lab Animal 2015;44:383–384.

13. ASVCP Quality Assurance and Laboratory Standards Committee (QALS) Guidelines for the Determination of Reference Intervals in Veterinary Species and other related topics: SCOPE. American Society for Veterinary Clinical Pathology (ASVCP). [18 October 2010]. Available from: https://www.asvcp.org/pubs/pdf/RI%20Guidelines%20For%20ASVCP%20website.pdf Last accessed August 28, 2015.

14. Krzywinski M, Altman N. Points of significance: Visualizing samples with box plots. Nature Methods 2014;11:119–120.

15. Horn PS, Pesce AJ, Copeland BE. A robust approach to reference inter-val estimation and evaluation. Clinical Chemistry 1998;44:622–631.

16. Humann-Ziehank E, Ganter M. Pre-analytical factors affecting the results of laboratory blood analyses in farm animal veterinary diagnos-tics. Animal 2012;6:1115–1123.

17. Bhattarai S, Nielsen JP. Early indicators of iron deficiency in large piglets at weaning. J Swine Health Prod 2015;23:10–17.

18. Nielsen JP, Busch ME, Friendship R, Martineau G-P, Framstad T. Herd diagnosis of iron deficiency in piglets. Proc European Symposium Porcine Health Management, Edinburgh, 2013:168.

19. Gong YF, Lu X, Wang ZP, et al. Detection of quantitative trait loci affecting haematological traits in swine via genome scanning. BMC Genetics 2010;11:56–81.

20. Egeli AK, Framstad T, Morberg H. Clinical biochemstry, haematology and body weight in piglets. Acta Vet Scand 1998;39:281–393.

21. Wilson GD, Harvey DG, Snook CR. A review of factors affecting blood biochemistry in the pig. Br Vet J 1972;128:596–609.

22. Boyd RD, Hall D, Wu JF. Plasma alkaline phosphatase as a criterion for determining biologically available phosphorus for swine. J Anim Sci (Suppl 1) 1982;55:263.


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Article

Cuttable plate fixation for small breed dogs with radius and ulna fractures: Retrospective study of 31 dogs

Gwyneth K. Watrous, Noel M.M. Moens

Abstract — This retrospective study evaluated complication rates for radius and ulna fractures in small breed dogs in which 1.5 mm to 2.7 mm cuttable bone plates were used for internal fixation. The medical records of all cases from 2004 to 2011 that were presented to our clinic were reviewed. Inclusion criteria were: dogs with body weight , 9 kg, fracture of the radius and ulna with open reduction, and internal fixation utilizing a cuttable bone plate. Thirty-four fractures in 31 dogs met the inclusion criteria. Of 25 dogs that were available for follow-up, all achieved union, minor complications occurred in 9, and major complications occurred in 8. External coaptation was responsible for complications in 8 cases and the need for coaptation needs to be investigated. Excluding minor complications, 32% of patients required at least 1 additional surgery or additional hospitalization. All but 2 of the dogs returned to full function. The 1.5 mm straight plate was successfully used in all dogs with a body weight of 0.9 to 2.6 kg.

Résumé — Fixation à l’aide d’une plaque taillable chez les chiens de petites races pour les fractures de radius et de cubitus : étude rétrospective de 31 chiens. Cette étude rétrospective a évalué les taux de complication pour les fractures de radius et de cubitus chez les chiens de petites races pour lesquels des plaques vissées taillables de 1,5 mm à 2,7 mm ont été utilisées pour la fixation interne. Les dossiers médicaux de tous les cas de 2004 à 2011 présentés à notre clinique ont été examinés. Les critères d’inclusion étaient les suivants : chiens avec un poids corporel de , 9 kg, la fracture de radius et de cubitus avec une réduction ouverte et une fixation interne utilisant une plaque vissée taillable. Trente-quatre fractures de 31 chiens ont satisfait aux critères d’inclusion. Parmi les 25 chiens qui étaient disponibles pour le suivi, on a observé une union réussie, des complications mineures se sont produites dans neuf cas et des complications majeures ont eu lieu dans huit cas. La coaptation externe a été responsable des complications dans huit cas et le besoin de coaptation doit être étudié. En excluant les complications mineures, 32 % des patients ont requis au moins une chirurgie additionnelle ou une hospitalisation additionnelle. Tous les chiens sauf deux sont retournés à une fonction complète. La plaque de 1,5 mm a été utilisée avec succès chez tous les chiens ayant un poids corporel de 0,9 à 2,6 kg.


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Introduction

R adius and ulna fractures represent the third most com-mon fractures in dogs and account for approximately

17% of all fractures in dogs, with many of these occurring in small breeds (1). Although various techniques can be used for the treatment of radius and ulna fractures in small breed dogs, bone plating remains one of the most frequent methods of sta-bilization for these fractures. In a retrospective study of 22 small and miniature dogs with radial and ulna fractures treated with bone plates, 89% successfully returned to function. However, complication rates were high and reported to affect 54% of the

cases with 18% considered major complications and 36% minor complications (2).

Bone size and small bone fragments are always significant challenges in miniature breeds and the surgeon must choose the most appropriate plate for each dog. Several types of plate are available for the repair of radial fractures in small and miniature dogs and the results for several of these types of plate have been described in the literature (2–4). Cut-to-length plates provide unique characteristics that make them appealing for the treat-ment of radial fractures in miniature breeds. They are versatile and economical; they come in multiple small sizes and generally

Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1.Address all correspondence to Dr. Gwyneth Watrous; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.


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offer a short hole-to-hole distance, allowing the placement of several screws in relatively short bone segments (5,6). On the other hand, their small size and high hole-to-plate ratio make them subjectively flexible and weak. Results associated with the use of these cut-to-length plates have not been reported.

It has been over 15 y since any literature has been published reviewing the complication rate and long-term outcome of radius and ulna fractures repaired by internal fixation in small breed dogs. The purpose of this retrospective study was to determine the current complication rate over an 8-year period treating small breed dogs with internal fixation for radial and ulna fractures using cut-to-length plates.

Materials and methodsInclusion criteriaThe medical records of all cases from 2004 to 2011 in which a 1.5 mm, 2.0 mm, or 2.7 mm cuttable bone plate was used were reviewed and totaled 97 cases. The criteria for inclusion of cases in the study were: fracture of the radius and ulna with open reduction and internal fixation utilizing a cuttable bone plate [1.5 mm straight plate; 2.0 mm straight plate; 2.0 mm/1.5 mm Cut-To-Length Plate; formerly known as Veterinary Cuttable Plates (VCP) or 2.7 mm/2.0 mm Cut-To-Length Plate] (DePuy-Synthes, Paoli, Pennsylvania, USA) in dogs with body weight less than 9 kg.

Data pertaining to breed, gender, age, body weight, clinical history, time from injury to surgery, fracture description, previ-ous repair attempts, duration of surgical repair, plate size and configuration, utilization of cancellous bone graft, postoperative fracture alignment, postoperative management, postoperative complications, lameness outcome, and time from fracture fixation until last follow-up radiographs were recorded. Owner compliance was not recorded.

Complications were classified into major and minor based on criteria proposed by Cook et al (7). Major complications were defined as complications that required further treatment based on current standards of care (implant failure, surgical interven-tion, or hospitalization for bandage complications). Minor complications were defined as complications not requiring additional surgical or medical treatment to resolve (long-term lameness, bandage complications not requiring specific treat-ment or hospitalization) (7).

All referring veterinarians were contacted to determine if the patient was still living at the time of the survey. A questionnaire was created and mailed to all owners for long-term follow-up, excluding those clients whose dogs were known to have died. A $10 gift card incentive was offered and mailed to every client who completed and returned the questionnaire.

ResultsThirty-one dogs were included in the study. Pomeranians con-stituted 10 of the 31 dogs; other breeds were poodle (n = 7), Yorkshire terrier (n = 4), mixed breed (n = 3), Chihuahua (n = 3), Chinese crested hairless (n = 2), Jack Russell terrier (n = 1), and Italian greyhound (n =1). The mean (median) age at fracture repair was 14.9 mo (7.0 mo). Bilateral fractures occurred in 2 of 31 dogs and 1 dog was presented for fracture of

the contralateral radius 7 mo following the first repair for a total of 34 fractures in 31 dogs. There were 14 females and 17 males. Clinical history for all cases included minimal trauma: falling (n = 12), jumping a short distance (n = 11), unknown trauma (n = 5), playing with other dogs (n = 2), or being stepped on (n = 1).

All fractures consisted of complete fracture of the radius and ulna. Of the 34 fractures that were treated initially, 20 were located in the distal diaphysis of the radius, 10 in the mid-diaphysis, 1 in the proximal diaphysis and the location was not recorded in 3 cases. All recorded fractures were either a short oblique or transverse fracture except for 3 cases: 1 case of bilat-eral fractures (both comminuted) which went on to experience implant failure and 1 mid-diaphyseal fracture (mild comminu-tion) which was lost to follow-up (Table 1).

Most dogs had their fracture(s) treated within 3 d after the injury; 8 fractures were repaired between 4 to 10 d after injury. One dog had been treated unsuccessfully with a splint for 9 wk before presentation.

All fractures were repaired at our clinic. A total of 45 surger-ies were performed on 31 dogs. Bilateral fractures were pres-ent in 3 dogs, 1 of which had bilateral radial fractures 7 mo apart. Implant failure requiring plate replacement occurred in 4 dogs (Table 1). Seven additional surgeries were performed to provide additional bone graft and/or to remove or replace screws during the healing process (n = 4) or to remove the plate following complete healing because of perceived ongoing complication associated with the implant (n = 3). Excluding the surgeries for bilateral fractures, 5 dogs required 2 surgeries and 3 dogs required 3 surgeries. Among the 4 dogs that suffered catastrophic implant failure, 2 were repaired using a plate other than a cuttable plate (2.0 mm DCP; DePuy-Synthes). For these 2 cases, the revision surgeries were counted as a complication but excluded from our analysis of plates.

Of the initial fracture fixation (34 fractures in 31 dogs), 21 fractures were stabilized with a 1.5 mm straight plate, 4 frac-tures with a 2.0 mm straight plate, 5 with a 2.0/1.5 mm VCP, and 4 with the 2.7/2.0 mm VCP. The average (median) weight of the dogs treated with each type of plate were 2.2 (2.2) kg for the 1.5 mm straight plate, 2.4 (2.8) kg for the 2.0 mm straight plate, 2.9 (2.0) kg for the 2.0/1.5 VCP, and 5.4 (4.9) kg for the 2.7/2.0 VCP. All fractures were initially repaired using a single plate. The 2 plate revision surgeries included were revised with a 1.5 mm straight plate (from a 2.0 mm straight plate) on a 0.94-kg dog and a stacked 2.0 mm straight plate (from a single 2.0 mm straight plate) on a 2.8-kg dog.

Either a cancellous or cortico-cancellous bone graft (autograft or allograft) was used in 8 of the initial 34 fractures. Three additional bone grafts were performed on 3 dogs during revision surgery (Table 1). Two of the bilateral fractures and the fracture that had been splinted for 9 wk before presentation were grafted at the time of initial surgery.

Immediately after surgery for the initial 34 fractures, 23 cau-dal splints were placed, including both of the bilateral fracture repairs. Caudal splints generally consisted of spoon splint, caudal splint made of fiberglass casting material, or a portion of a tongue depressor, at the discretion of the clinician. Splints


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or bandages were rechecked weekly. Three limbs had a soft pad-ded bandage placed after surgery for an undetermined period of time (Table 1). Eight cases had either no bandage after surgery or only a soft padded bandage placed for a short time thereafter (1 to 5 d) (Table 1). Of these 8 cases, 4 were lost to follow-up immediately after surgery. One dog required bandage removal because of skin irritation and was lost to follow-up after 27 d. The other 3 were followed a minimum of 101 d after surgery and all 3 had healed fractures.

Of the 31 dogs, 6 were lost to follow-up after the initial surgery (Table 1). The remaining 25 dogs had at least 1 set of recheck radiographs with a follow-up range of 27 to 169 d. The mean (median) follow-up time was 64 (57) d. Complete fracture healing was recorded for 17 cases with the remaining 8 cases having evidence of progression of bony healing. The number

of follow-up visits ranged from 2 to 15 and included 2 patients that were hospitalized for 4 d and 10 d each, to address severe bandage complications and associated wounds. Of the 25 cases with at least 27 d of follow-up, major postoperative complica-tions were recorded in 8 patients and minor complications occurred in 9 patients (Table 1).

Major complicationsFour dogs suffered a catastrophic plate failure (9 to 58 d follow-ing initial surgical repair) (Table 1, dogs 1 to 4). Two (dogs 1 and 2) were in the group repaired with the 1.5 mm mini straight plate and had a splint or padded bandage following surgery. The dogs weighed 3.5 and 5 kg and were the largest dogs in the 1.5 mm plate group. Both were successfully repaired with a 2.0 mm DCP and were censored from the study. The 2 other

Table 1. Summary of treatments, configuration of fractures, and complications in the 31 cases in this study

Case Postoperative number Bandage placed complications Fracture configuration Nature of complication

1 Soft padded Major Transverse Implant failure, repaired with 2-0DCP, censored. 2 Splint Major Transverse Implant failure, repaired with 2-0DCP, bandage, censored. 3 2 Splints Revision splint Major Comminuted (2) Implant failure. Bandage — pressure sores — requiring

hospitalization, intermittent lameness. 4 Splint Revision splint Major Oblique Implant failure following screw removal, osteopenia, revised with

smaller plate, healed without complications. 5 Splint Revision splint Major Transverse Splinted for 9 wk before referral. Osteopenia, bone grafting, screw

failure, and disuse osteopenia of carpus and manus. 6 No Major Transverse Implant removal due to synostosis and cold sensitivity. 7 Splint Major Oblique Implant removal for osteopenia, bandaged — olecranon wound.

Hospitalized for 4 d for wound management. Valgus deformity. 8 Soft padded , 5 d Major Oblique Mild decrease in range of motion of carpus/elbow. Osteopenia,

staged plate removal. 9 Splint Minor Transverse Bandage — pressure sores. Ulnar osteopenia.10 Splint Minor Oblique Bandage — olecranon wound.11 Splint Minor Oblique Bandage, osteopenia.12 Soft padded , 5 d Minor Oblique Bandage, chewing sutures.13 Splint Minor Transverse Bandage, osteopenia, lameness.14 Splint Minor Oblique Carpal swelling; non-weight-bearing lameness 8 wk after surgery,

ulnar osteopenia.15 Splint Minor Oblique Valgus deformity16 Splint Minor Oblique Lameness17 No Minor Transverse Lameness18 Splint None Transverse None19 2 Splints None Transverse/oblique (2) None20 2 Splints None Transverse (2) None, contralateral radial fracture 7 mo following first fracture.21 Splint None Oblique None22 Splint None Oblique None23 Splint None Oblique None24 Soft padded None Oblique None25 Soft padded , 5 d Lost Transverse NA26 Soft padded , 5 d Lost Transverse NA27 Soft padded , 5 d Lost Comminuted NA28 Splint Lost Transverse NA29 Soft padded Lost Transverse NA30 No Lost Oblique NA31 Splint None Oblique None

NA = not applicable.


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failures happened with the 2.0 mm straight plate. Dog 3 had a bilateral comminuted fracture with postoperative splints. One of the plates broke and the dog developed pressure sores requiring additional hospitalization. The surgery was revised with a stacked 2.0 mm straight plate and no coaptation. Bone graft was used for both the initial and revision surgeries. The fourth dog (#4) failed after a bone screw was removed because of delayed healing and progressive osteopenia. The dog was a 0.94-kg Chihuahua and the smallest dog in the series. The plate and screws were considered oversized and the surgery was revised successfully with a 1.5 mm straight plate. Bone graft and coaptation were used for both initial and revision surgeries.

Dog 5, which had been treated initially with a splint before a 2.0 mm straight plate was applied, developed a delayed union and required 2 additional surgeries, 1 for bone grafting, the other to replace failing screws. Healing was confirmed 151 d following surgery and required 15 hospital visits in total.

Three dogs (dogs 6,7,8) healed uneventfully but required the implant to be removed because of progressive osteopenia or cold sensitivity. One of these dogs was a 1-kg dog treated with a 1.5 mm straight plate and no coaptation, one was a 3-kg dog treated with a 2.0/1.5 mm VCP and no coaptation, and the third (dog 8) was a 4.6-kg dog treated with a 2.7/2.0 VCP and coaptation. This dog was also hospitalized for 4 d because of a deep olecranon ulcer. Two of these plates were removed in a single staged procedure and the third plate was removed in 2 stages.

Minor complicationsNine dogs suffered only minor complications; some dogs suf-fered more than 1 complication. Minor complications included: bandage complications that did not require specific treatment other than bandage change or removal (5 cases), premature suture removal by the animal (1 case), carpal swelling (l case), valgus deformity (1 case), intermittent lameness (3 cases), and 1 non-weight bearing lameness at 8 wk.

Long-term lameness outcome among the 25 cases with follow-up was as follows: full return to function in 15, accept-able function in 5, unacceptable function with continued lame-ness in 2 dogs, and undocumented lameness status in 3 dogs. One of the dogs with unacceptable function was the dog which had the fracture splinted before treatment and required multiple surgeries due to delayed union (Table 1, dog 5). This dog was also diagnosed with elbow incongruity. The other dog with unacceptable function was non-weight-bearing 8 wk following fracture fixation despite bone healing on radiographs (Table 1, dog 14). This dog had mild swelling of the carpal joint; how-ever, no further follow-up was available. Of the 3 dogs that had undocumented lameness status; 2 had mild decrease in carpal and elbow range of motion.

Twenty-nine questionnaires were mailed to owners, exclud-ing 5 whose dogs had died. Six questionnaires were returned. All owners were satisfied with the surgery and only 1 dog had residual lameness after strenuous activity. The overall use of the limb was satisfactory for all owners. Two of the 6 patients had implants removed. The long-term complications noted from surgery included a scar from a bandage sore and a little tender-

ness after running too hard, resulting in favoring of the leg for a brief period with a mild lameness. A third owner reported the leg to be sensitive and become cold easily. The questionnaire answers were factored into the overall complication rate.

DiscussionSmall breed dogs appear to be predisposed to radial fractures with approximately 85% of radius and ulna fractures occur-ring in the distal third (1,8). Morphological differences in the antebrachium of small breed dogs compared to larger breeds are believed to be responsible for this predisposition (9). Radius and ulna fractures in small breed dogs have been associated with a high complication rate and a high incidence of delayed and non-unions (2,10). One study reported up to 54% of small breed dogs treated with plate osteosynthesis developed postoperative complications (2). The complication rate is approximately 83% if the radial fractures are treated with cast fixation (2). The reasons for this high rate of complication likely include the size and shape of the bones, technical difficulties associated with the size of the bone fragments, and the paucity of soft tissues surrounding the distal antebrachium.

Our retrospective study on radius and ulna fractures in small breed dogs treated with cuttable plates showed similar trends to previous studies but a higher complication rate with 8 major and 9 minor complications in 25 cases. The overall complication rate of 68% is higher than the previously reported overall complica-tion rate of 54% (2). However, unlike previous publications, we adopted a stringent definition of complications as suggested by Cook et al (7). Furthermore, complications associated with coaptation were also counted as if they resulted in alteration of the original postoperative plan (such as premature bandage removal), even though they may not have influenced the final outcome.

In our study, coaptation was used in 23 of the 31 cases following the initial repair of the radius and ulna. External coaptation accounted for complications in 8 cases and resulted in prolonged hospitalization in some cases. A high complica-tion rate associated with coaptation (up to 63%) has also been observed by others following the application of bandages, splints, or casts in small animals (11–14). External coapta-tion has the potential for causing pressure sores, swelling, and dermatitis (13,14) and in this study, all of these were observed within the minor complication category. Extensive lesions and a deep olecranon ulcer were observed in the major complica-tion category.

The need for external coaptation following internal stabi-lization is controversial. The decision to apply postoperative coaptation was made by the surgeon, based on their evaluation of the surgical repair and the implant strength. In this study, out of the 21 fractures in which the smallest 1.5 mm straight plate was used, 16 had external coaptation placed after surgery. Four minor and 2 major complications were at least partially attrib-uted to the bandage in that group. Bandages were also used with all other types of plate and complications occurred in all groups. There are, however, too few cases of other types of plate and our ability to make comparisons between groups was limited. One would expect that postoperative coaptation would be used


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in cases deemed at risk for implant failure and that coaptation would protect against plate breakage. Surprisingly, all 4 implant failure cases had postoperative coaptation. Two of those dogs were in the 1.5 mm straight plate group. Two of those dogs had body weights of 3.5 and 5 kg, well above the average weight of the dogs in that group (2.2 kg). Although there are no published guidelines for the use of these plates, it is likely that those dogs were too heavy for the plate. All dogs which had successful frac-ture repair with the 1.5 mm straight plate had an average body weight of 1.9 kg (range: 0.9 to 2.6 kg) and we therefore suggest that this plate be used for dogs within that body weight range. The other 2 cases that underwent catastrophic failure were in the 2.0 mm straight plate group and both had bone graft and postoperative coaptation. The failure of 1 of the cases remains unexplained as the dog weight (2.8 kg) was in the range of the other dogs in that group and no predisposing factor could be identified other than the fact that this dog had bilateral com-minuted fractures. The last case that suffered implant failure was the smallest dog of the cohort and weighed only 0.94 kg. The fracture was initially stabilized with a 2.0 mm straight plate and 2.0 mm screws. In the face of progressing osteopenia and delayed healing, concerns of overly rigid fixation prompted the removal of 2 of the central screws and precipitated the implant failure and fracture of the bone. Fixation with a smaller plate and smaller screws, a bone graft and coaptation resulted in healing of the fracture.

Eight dogs did not have external coaptation following surgery or had coaptation for 5 d or less. Four of those dogs were imme-diately lost to follow-up. Interestingly, none of the remaining 4 dogs for which follow-up was available experienced implant failure, suggesting that postoperative coaptation may not always be required.

Osteopenia was diagnosed in several dogs. The degree of osteopenia was subjectively considered significant in 3 cases, prompting surgical removal of all or some of the implants. Self-limiting osteopenia not requiring treatment was not counted as a complication. Concerns about osteopenia, delayed healing, or non-union in small and miniature dogs are often raised fol-lowing radius and ulna fractures (2,4,10). Although the causes of osteopenia following plate fixation have been extensively debated, it is generally accepted that vascular impairment to the bone cortex plays a larger role than stress protection in the development and progression of osteopenia (8,15).

Determination of the degree of osteopenia is often subjec-tive and the need for the removal of the implant could be questioned. In 1 dog, the plate was believed to be oversized and although stress protection cannot be totally ruled out in this dog, vascular impairment caused by the oversized plate and screws was likely to also be a contributing factor.

In addition to the effect of the implant, vascular insufficiency of the distal radius has also been suggested as a cause of healing impairment in small and miniature breeds. Decreased vascular density of the intraosseous blood supply to the distal diaphyseal-metaphyseal junction of the radius has been demonstrated compared to large breeds (16). Although vascular density is not necessarily synonymous with blood flow, decreased vascular density may contribute to the decreased prognosis for fracture

healing in small breed dogs and an increased frequency of delayed union and non-union compared to similar fractures in large breed dogs or compared to fractures in other bones (16). To the best of our knowledge, true vascular insufficiency has not been demonstrated. All fractures for which follow-up was available healed and non-union was not observed in this series. Because of the retrospective nature of the study, accurate time to healing was not available.

The lack of long-term follow-up, inability to compare risk factors due to small group sizes, inability to compare time to healing with or without external coaptation, and the retrospec-tive nature of the study present significant limitations of this study. Because of institutional policy regarding client communi-cation, we were not allowed to contact owners of pets that had died. Furthermore, the response rate to the long-term survey was low. These factors reduced our ability to collect long-term data on several of the dogs. It is possible that these limitations have biased our results. The direction of the bias is, however, unknown.

Our study on radial and ulna fracture fixation using 1.5 mm to 2.7 mm “cut-to-length” plates demonstrated a higher overall rate of complication than previously reported in the literature for other types of plate. The high complication rate may have been, at least in part associated with the strict definition of com-plications used in this publication. Despite the high complica-tion rate, the results were similar to those reported for different plates in a similar population of dogs. All fractures that we could follow achieved clinical union and we believe “cut-to-length” plates remain a good choice for fracture repair. Bandages and splints were used in most cases and were responsible for a large number of complications. The fact that all catastrophic failures occurred despite the splint raises questions about the efficacy of coaptation or the need for coaptation. Perhaps more empha-sis should be placed on strict exercise restriction and external coaptation reserved only for tenuous repairs; however, owner compliance could not be assessed and may have played a role. The retrospective nature of the study and the small number of cases that were treated without coaptation limit the strength of this conclusion and additional studies should be conducted. The 1.5 mm straight plate was successfully used in all dogs with a body weight between 0.9 and 2.6 kg. We suggest that this range is appropriate for use of this plate although plate selection and the decision to apply coaptation will remain subjective until stronger guidelines can be developed.

References 1. Phillips IR. A survey of bone fractures in the dog and cat. J Small Anim

Pract 1979;20:661–674. 2. Larsen LJ, Roush JK, McLaughlin RM. Bone plate fixation of distal

radius and ulna fractures in small- and miniature-breed dogs. J Am Anim Hosp Assoc 1999;35:243–250.

3. Voss K, Kull MA, Haessig M, Montavon PM. Repair of long-bone fractures in cats and small dogs with the Unilock mandible locking plate system. Vet Comp Orthop Traumatol 2009;22:398–405.

4. Hamilton MH, Langley-Hobbs SJ. Use of the AO veterinary mini ‘T’-plate for stabilisation of distal radius and ulna fractures in toy breed dogs. Vet Comp Orthop Traumatol 2005;181:18–25.

5. Fruchter A, Holmberg D. Mechanical analysis of the veterinary cuttable plate. Vet Comp Orthop Traumatol 1991;4:10–13.

6. Hammel SP, Elizabeth PG, Novo RE. Fatigue analysis of plates used for fracture stabilization in small dogs and cats. Vet Surg 2006;35:573–578.


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7. Cook JL, Evans R, Conzemius MG, et al. Proposed definitions and cri-teria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010;39:905–908.

8. Gauthier CM, Conrad BP, Lewis DD, et al. In vitro comparison of stiffness of plate fixation of radii from large- and small-breed dogs. Am J Vet Res 2011;728:1112–1117.

9. Brianza SZ, Delise M, Ferraris MM, et al. Cross-sectional geometrical properties of distal radius and ulna in large, medium and toy breed dogs. J Biomech 2006;39:302–311.

10. Hunt J, Aitken M, Denny H, Gibbs C. The complications of diaphy-seal fractures in dogs: A review of 100 cases. J Small Anim Pract 1080; 212:103–119.

11. Bristow PC, Meeson RL, Thorne RM, et al. Clinical comparison of the hybrid dynamic compression plate and the castless plate for pancarpal arthrodesis in 219 dogs. Vet Surg 2015;44:70–77.

12. Weinstein J, Ralphs C. External coaptation. Clin Tech Small Anim Pract 2004;19:98–104.

13. Meeson RL, Davidson C, Arthurs GI. Soft-tissue injuries associated with cast application for distal limb orthopaedic conditions. Vet Comp Orthop Traumatol 2011;24:126–131.

14. Anderson DM, White RAS. Ischemic bandage injuries: A case series and review of the literature. Vet Surg 2000;29:488–498.

15. Perren SM. Evolution of the internal fixation of long bone fractures. J Bone Joint Surg Br 2002;84B:1093–1110.

16. Welch JA, Boudrieau RJ, DeJardin LM, Spodnick GJ. The intraosseous blood supply of the canine radius: Implications for healing of distal fractures in small dogs. Vet Surg 1997;26:57–61.

Books Available for Review Livres disponibles pour compte rendu

The following books are yours to keep free of charge in exchange for a book review that will be published in The CVJ. To order a book and receive suggestions on how to do a book review, please contact Kelly Gray-Sabourin, Editorial Coordinator, Journals, Canadian Veterinary Medical Association, at [email protected]

1. Papich MG. Saunders Handbook of Veterinary Drugs, 4th edition. Elsevier. St. Louis, Missouri, USA. 2016. 900 pp. ISBN 9780-3232-4485-5.

2. Fubini SL, Ducharme NG. Farm Animal Surgery, 2nd edi-tion. Elsevier. St. Louis, Missouri, USA. 2017. 662 pp. ISBN 9780-3233-1665-1.

3. Samour J. Avian Medicine, 3rd Edition. Elsevier. St. Louis, Missouri, USA. 2016. 699 pp. ISBN 9780-7234-3832-8.

4. Boyle JE. Crow & Walshaw’s Manual of Clinical Procedures in Dogs, Cats, Rabbits & Rodents, 4th edi-tion. Wiley-Blackwell. Ames, Iowa, USA. 2016. 408 pp. ISBN 9781-1189-8570-0.

5. Hnilica KA, Patterson AP. Small Animal Dermatology: A Color Atlas and Therapeutic Guide. Elsevier. St. Louis, Missouri, USA. 2017. 663 pp. ISBN 9780-3233-7651-8.

6. Schrey CF. Examination and Treatment Methods in Dogs and Cats, 2nd edition. 5m Publishing, Sheffield, UK. 2016. 575 pp. ISBN 9781-9104-5516-6.

7. Cork S, Hall D, Liljebjelke K, eds. One Health Case Studies: Addressing Complex Problems in a Changing World. 5m Publishing, Sheffield, UK. 2016. 378 pp. ISBN 9781-9104-5555-5.



CVJ / VOL 58 / APRIL 2017 383

Case Report Rapport de cas

Pneumatosis coli in a domestic ferret (Mustela putorius furo)

Cédric B. Larouche, Marion R. Desmarchelier, Swan Specchi, Isabelle Langlois

Abstract — A 4-year-old spayed female ferret was presented with acute diarrhea and partial anorexia. Pneumatosis coli and segmental enteropathy were identified by ultrasonography and radiography. Fecal culture did not identify any pathogenic bacteria. Medical management of concurrent diseases and antibiotic therapy resulted in resolution of clinical signs and pneumatosis coli.

Résumé — Pneumatose chez un furet domestique (Mustela putorius furo). Un furet femelle stérilisé âgé de 4 ans a été présenté avec une diarrhée aiguë et de l’anorexie partielle. Une pneumatose et une entéropathie segmentaire ont été identifiés par échographie et radiographie. Une culture fécale n’a pas permis de mettre en évidence une bactérie pathogène. La gestion médicale de maladies concomitantes et d’une thérapie antibiotique ont produit une résolution des signes cliniques et de pneumatose.


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F errets are frequently affected by gastrointestinal diseases of various origins (1). Pneumatosis coli (PC) is an uncommon

medical condition characterized by the presence of gas within the intestinal wall, usually in the submucosal or subserosal layer. The condition is most commonly known as pneumato-sis cystoides intestinalis or pneumatosis intestinalis when the intestines are affected. It is also reported as intestinal emphy-sema, cystic lymphopneumatosis, and abdominal or intestinal gas cysts (2). The term gastric pneumatosis is used when the stomach is affected. These conditions are considered physical or radiographic findings and reflect the presence of an underlying condition, including trauma as well as gastrointestinal, systemic, pulmonary, autoimmune, and iatrogenic diseases (3,4).

Case descriptionA 4-year-old, spayed female domestic ferret was presented to the Zoological Medicine Service of the Centre Hospitalier

Universitaire Vétérinaire, Université de Montréal, with a 3-day history of diarrhea and partial anorexia. The animal had been adopted 5 mo before presentation. Previous medical history was unknown. The owner reported recent loss of fur on the tail and generalized pruritus.

On physical examination, the ferret was thin and mildly lethargic. Clinical findings included a 3-mm rectal prolapse, mucoid diarrhea, generalized pruritus, and hypotrichosis of the tail. The rectal mucosa was erythematous and moderately swol-len. On abdominal palpation, multiple small firm mobile masses were identified in the mid-abdomen. The right adrenal gland was suspected to be enlarged. Blood glucose measured with a portable glucometer (AlphaTrak, Abbott Laboratories, Illinois, USA; using a canine setting) after a 3-hour fasting period was 3.4 mmol/L [reference range (RR): 4.4 to 6.5 mmol/L] (5).

Abdominal ultrasonography showed moderate to severe mesenteric lymphadenomegaly (up to 15 mm in thickness) with hypoechoic parenchyma and hyperechoic fat surrounding the lymph nodes. Segmental asymmetrical wall thickening of the jejunum was also observed. There was gas dissecting the colonic wall with parallel disposition compared to the wall layering, consistent with pneumatosis coli (Figure 1). The right adrenal gland was moderately enlarged (thickness: 6.5 mm; RR: 1.3 to 3.7 mm) (6) with heterogeneous parenchyma and hyperechoic speckles casting acoustic shadowing within it. Abdominal radiographs revealed linear radiolucency within the colonic wall, confirming the presence of pneumatosis coli (Figure 2). This section of the colon was severely dilated and mainly filled with gas and a small amount of fecal material.

Differential diagnoses for segmental enteropathy included lymphoma, bacterial enteritis, inflammatory bowel disease, eosinophilic enteritis, proliferative bowel disease, coccidiosis, and epizootic catarrhal enteritis with concomitant pneumatosis coli. Presumptive diagnosis of adrenal gland disease was also

Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec J2S 7C6.Address all correspondence to Dr. Isabelle Langlois; e-mail: [email protected]. B. Larouche’s current address is Department of Pathobiology, Ontario Veterinary College, University of Guelph, Ontario N1G 2W1.Dr. Specchi’s current address is Diagnostic Imaging Service, Istituto Veterinario di Novara, Granozzo con Monticello, NO 28060, Italy.Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.


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established based on hypotrichosis and ultrasonographic find-ings. Despite the absence of pancreatic nodules visualized on ultrasonographic examination, an insulinoma was suspected based on the cut-off value of 3.3 mmol/L and the use of the AlphaTrack with a canine setting, which can overestimate blood glucose in hypoglycemic ferrets (7,8). A blood glucose concentration value remained to be measured using a validated laboratory analyzer to confirm hypoglycemia (8).

A therapeutic plan was established based on the presumptive diagnoses and was to be modified if needed in light of forthcom-ing bacterial culture results. The plan included leuprolide acetate (Lupron Depot; Abbvie, Saint-Laurent, Quebec), 100 mg/kg body weight (BW), IM, q1mo, prednisolone (Pediapred; Sanofi-Aventis, Laval, Quebec), 1 mg/kg BW, PO, q12h until re-evaluation, cephalexin (Novo-Lexin; Teva Canada, Toronto, Ontario), 25 mg/kg BW, PO, q12h for 14 d, and sucralfate (Sulcrate; Aptalis Pharma Canada, Mont-St-Hilaire, Quebec), 100 mg/kg BW, PO, q12h for 30 d.

Aerobic and anaerobic bacterial cultures of the stools were sub-mitted during the initial examination. Sensitivity testing on aero-bic bacteria was performed. Enterococcus spp., Enterobacteriaceae,

and Clostridium perfringens were identified. Fecal flotation was planned but could not be performed following a laboratory error.

Upon re-evaluation 5 wk later, diarrhea had resolved. The owner reported that the animal was more active, fur was grow-ing back, and pruritus had resolved following the first visit. However, a decrease in general activity and a relapse of the generalized pruritus had been noted 4 d prior to the recheck examination. Treatment recommendations had been followed except for prednisolone that was discontinued by the owner after 3 wk of administration and for leuprolide acetate injection that should have been administered a week earlier. Abdominal ultra-sound showed a less pronounced abdominal lymphadenomegaly and resolution of the segmental jejunal enteropathy and pneu-matosis coli (Figure 2). The size of the right adrenal gland was decreased compared to the first evaluation, but the gland was still enlarged. Abdominal radiograph confirmed resolution of the pneumatosis coli. On repeated aerobic and anaerobic bacterial cultures, Enterococcus spp., Enterobacteriaceae, C. perfringens, and Bacillus spp. were identified. No parasites were observed on fecal flotation.

Considering the resolution of diarrhea, rectal prolapse, and segmental enteropathy, no antibiotic treatments were initiated despite the bacterial culture results. Further treatment with prednisolone was declined by the owner. Leuprolide acetate injections were continued as prescribed on initial presentation.

The ferret was presented for re-evaluation 10 wk after initial presentation. Hair was growing back, pruritus had

Figure 1. Abdominal ultrasonography of the ferret. Longitudinal (A) and transverse (B) ultrasonographic evaluations of the colon revealed hyperechoic lines within the colonic wall (arrows) consistent with pneumatosis coli.

Figure 2. Abdominal radiography of the ferret. These images were acquired in right lateral recumbency on the day of presentation (A) and on first re-evaluation 5 wk later (B). Arrows show linear radiolucency within the colonic wall consistent with pneumatosis coli (A). Similar findings were absent on re-evaluation (B).


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resolved, and general activity was back to normal. No gas-trointestinal clinical signs were reported. The results of an ultrasonographic examination were similar to those of the first re-evaluation. Aerobic and anaerobic bacterial cultures revealed Lactobacillus spp., C. perfringens, and an unidentified coliform bacterium.

DiscussionPneumatosis cystoides intestinalis is uncommon in veterinary medicine. It is occasionally seen in swine (9). It has been previ-ously described in a gnotobiotic pigs inoculated with an entero-pathogenic Escherichia coli (9), in a single rabbit doe (Oryctolagus cuniculus) (2), and in horse neonates (10). There have been several reports of pneumatosis coli in dogs (11–14). Gastric pneumatosis has been described in a red ruffed lemur (Varecia variegata rubra) with non-specific gastrointestinal signs (15), in 4 black and white ruffed lemur (Varecia variegata variegata) associated with eosinophilic gastritis (16), in a Bengal slow loris (Nycticebus coucang bengalensis) with a hepatocellular carcinoma and an esophageal leiomyosarcoma (17), in dogs with gastric dilatation-volvulus syndrome (18), and in a domestic cat fol-lowing gastrointestinal surgery (19). To the authors’ knowledge, this is the first report of pneumatosis coli in a domestic ferret.

Three mechanisms have been described concerning the origin of pneumatosis cystoides intestinalis in humans: gas translocation from the lumen to the intestinal wall, intrusion of gas- producing bacteria within the intestinal wall, and intrusion of gas from lung alveolar rupture, tracking through the medias-tinum to the retroperitoneum and mesentery (3,4). Alteration of the intestinal mucosal or immune barrier integrity eases the transfer of gas or bacteria into the mural compartment, poten-tially leading to pneumatosis cystoides intestinalis. Increased intraluminal pressure can also lead to the passage of gas through the mucosal barrier, even in the absence of mucosal or immune compromise, though a combination of both situations is com-mon. A theory called “counterperfusion supersaturation” has been proposed, hypothesizing that the increased intraluminal hydrogen tension in patients affected by some bacteria exceeds the blood nitrogen tension, leading to the diffusion of hydrogen toward the submucosal vessels (20). It has also been proposed that fluctuations in intra-abdominal pressure in patients affected by pulmonary diseases could lead to the formation of pneuma-tosis cystoides intestinalis instead of alveolar rupture and gas movement through the mediastinum (21).

A wide variety of underlying conditions have been reported in humans affected by pneumatosis cystoides intestinalis. Although many mechanical or traumatic causes have been described, multiple inflammatory, autoimmune, infectious, pulmonary, iatrogenic, and oncologic conditions have been associated with pneumatosis cystoides intestinalis (3,4). Approximately 15% of human cases are idiopathic, while 85% are considered second-ary (3). Humans with this condition are most commonly asymp-tomatic, but clinical signs can include abdominal pain, diarrhea, nausea/vomiting, hematochezia, melena, constipation, tenesmus, and excessive mucus or gas production (16,22). Complications directly associated with pneumatosis cystoides intestinalis occur in 16.3% of cases according to a study in human medicine (22).

They are usually the result of gastrointestinal obstruction by intestinal wall dilatation (22).

The exact cause of pneumatosis coli was not determined in this case, but multiple etiologies are possible. Ulcerative coli-tis, as well as Clostridium spp. infections, have been reported as possible causes for pneumatosis cystoides intestinalis in humans (3,4). In this patient, Enterococcus spp., C. perfringens, and Enterobacteriaceae were identified on initial presentation. These bacteria were still present on the first re-evaluation despite resolution of gastrointestinal signs and pneumatosis coli. These findings were expected considering the weak efficacy of cepha-lexin against most of these bacteria and the time lapse between the end of the treatment and the re-evaluation. C. perfringens, as well as several Enterobacteriaceae, have been previously described as part of the fecal microbiota of healthy ferrets (23). Their role in this case is probably minimal considering their continued presence after the resolution of clinical signs. However, no distinction was made among the different bacteria of the family Enterobacteriaceae and some of them could have been susceptible to cephalexin. Determination of toxin status via enzyme-linked immunosorbent assay (ELISA) would have been required to link the presence of C. perfringens with the diarrhea (24). Infection by another bacterium, not identified on routine aerobic and anaerobic bacteriology, remains pos-sible. Bacterial enteritis was unlikely to be the primary cause of pneumatosis coli in this patient. However, the use of antibiot-ics may have contributed to reduction of bacterial overgrowth, leading to resolution of pneumatosis coli (25). Cephalexin, though uncommonly prescribed in cases of diarrhea in ferrets, was used while we awaited the results of bacterial culture. The ferret’s poor general condition and several client-associated constraints led to the choice of this antibiotic. The treatments were not modified when bacterial culture results were available due to the improvement in the animal’s condition and refusal of the owner to try another medication. As inflammatory bowel disease and eosinophilic enteritis were part of the differential diagnoses, prednisolone could have played a role in the resolu-tion of pneumatosis coli as well.

Insulinoma was highly suspected in this ferret because of the low blood glucose (3.4 mmol/L) following a 3-hour fast. The AlphaTrak with a canine setting has been shown to be the portable glucometer with the best agreement to a validated laboratory analyzer for the evaluation of ferrets’ blood glucose, although results can be overestimated (9,26). Hypoglycemia is usually defined as a blood glucose value of , 3.3 mmol/L, although different reference ranges have been described in fer-rets (5). Thus, hypoglycemia was likely but not confirmed and evaluation by a validated laboratory analyzer was recommended, but declined by the owner.

In this case, pneumatosis coli was diagnosed using both ultrasonography and radiography. The condition is characterized by linear, curvilinear or cystic-shaped radiolucency within the colonic wall on radiography (27). Barium enema can occasion-ally be helpful for the diagnosis of pneumatosis coli, though the condition can be confused with intestinal polyposis (4). The diagnosis can also be made using ultrasonography by identifying bright echoes casting acoustic shadowing within the


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colonic wall (28). Computed tomography is now considered the most sensitive diagnostic technique in the identification of pneumatosis coli, allowing the distinction of gas in the bowel wall from intraluminal gas (3). Histopathological examination of gas cysts usually reveals granulomatous inflammation charac-terized by eosinophils, lymphocytes, multinucleated giant cells, macrophages, and plasma cells (4,16). Endoscopy has been used in human medicine to confirm the presence of pneumatosis cystoides intestinalis, but the distinction between gas cysts and other structures is often impossible without aspiration (4).

Treatment of pneumatosis coli relies mainly on resolution of the primary condition responsible for the accumulation of submucosal gas. It has been suggested that oxygen therapy by facemask, head tent, hyperbaric means, or mechanical ventila-tion to maintain an arterial oxygen partial pressure higher than 300 mmHg was effective in treating pneumatosis cystoides intestinalis (3). It is uncertain whether this therapy acts by direct effect on anaerobic bacteria or by diffusion of oxygen into the bowel wall, increasing the gas partial pressure and thus forcing the accumulated gas into the intestinal lumen. Radiographic cri-teria supportive of a surgical intervention in human include the presence of pneumoperitoneum or portal venous gas (29). Other criteria include blood pH , 7.3, bicarbonate level , 20 mEq/L, lactate level . 2 mmol/L, amylase level . 200 U/L, and dissem-inated intravascular coagulation (3). Complete blood cell count and biochemistry were not performed in this ferret because of budget limitations and the absence of criteria supportive of a surgical intervention.

In conclusion, radiography and ultrasonography were useful in establishing a diagnosis when pneumatosis cystoides intestina-lis was suspected in a ferret. The exact cause of pneumatosis coli was not identified in this ferret, but a multifactorial enteropathy is deemed likely.

References 1. Lennox AM. Gastrointestinal diseases of the ferret. Vet Clin North Am

Exot Anim Pract 2005;8:213–225. 2. Peris B, Garcia V, Blas E, Segura P, Martinez J, Corpa JM. Pneumatosis

cystoides intestinalis in a rabbit doe (Oryctolagus cuniculus). J Vet Diagn Invest 2005;14:256–258.

3. Feuerstein JD, White N, Berzin TM. Pneumatosis intestinalis with a focus on hyperbaric oxygen therapy. Mayo Clin Proc 2014;89:697–703.

4. St Peter SD, Abbas MA, Kelly KA. The spectrum of pneumatosis intes-tinalis. Arch Surg 2003;138:68–75.

5. Quesenberry KE, Orcutt C. Basic approach to veterinary care. In: Quesenberry KE, Carpenter JW, eds. Ferrets, Rabbits, and Rodents: Clinical Medicine and Surgery. 3rd ed. Philadelphia, Pennsylvania: WB Saunders, 2012:13–26.

6. Kuijten AM, Schoemaker NJ, Voorhout G. Ultrasonographic visualiza-tion of the adrenal glands of healthy ferrets and ferrets with hyperadre-nocorticism. J Am Anim Hosp Assoc 2007;43:78–84.

7. Chen S. Advanced diagnostic approaches and current medical man-agement of insulinomas and adrenocortical disease in ferrets (Mustela putorius furo). Vet Clin North Am Exot Anim Pract 2010;13:439–452.

8. Petritz OA, Antinoff N, Chen S, Kass PH, Paul-Murphy JR. Evaluation of portable blood glucose meters for measurement of blood glucose con-centration in ferrets (Mustela putorius furo). J Am Vet Med Assoc 2013; 242:350–354.

9. Meyer RC, Simon J. Intestinal emphysema (Pneumatosis cystoides intestinalis) in a gnotobiotic pig. Can J Comp Med 1977;41:302–305.

10. de Solis CN, Palmer JE, Boston RC, Reef VB. The importance of ultrasonic pneumatosis intestinalis in equine neonatal gastrointestinal disease. Equine Vet J Suppl 2012;41:64–68.

11. Anderson GR, Greary JC. Canine pneumatosis coli (interstitial emphy-sema of colon): A case report. J Am Anim Hosp Assoc 1973;9:354–357.

12. Degner DA. Pneumatosis coli in a dog. Can Vet J 1992;33:609–611.13. Aste G, Boari A, Guglielmini C. What is your diagnosis? Pneumatosis

coli. J Am Vet Med Assoc 2005;227:1407–1408.14. Russell NJ, Tyrrell D, Irwin PJ, Beck C. Pneumatosis coli in a dog. J Am

Anim Hosp Assoc 2008;44:32–35.15. Calle PP. Gastric pneumatosis in a red ruffed lemur. J Am Vet Med Assoc

1986;189:1212–1214.16. Niederwerder MC, Stalis IH, Campbell GA, Backues KA. Gastric

pneumatosis with associated eosinophilic gastritis in four black and white ruffed lemurs (Varecia variegata variegata). J Zoo Wildl Med 2013; 44:79–86.

17. Bicknese E, Jones MEB. Gastric pneumatosis in a Bengal slow loris (Nycticebus coucang bengalensis). Proc Annu Conf Am Assoc Zoo Vet 2013:156–157.

18. Fischetti AJ, Saunders HM, Drobatz KJ. Pneumatosis in canine gastric dilatation-volvulus syndrome. Vet Radiol Ultrasound 2004;45:205–209.

19. Lang LG, Greatting HH, Spaulding KA. Imaging diagnosis — Gastric pneumatosis in a cat. Vet Radiol Ultrasound 2011;52:658–660.

20. Florin TH, Hills BA. Does counterperfusion supersaturation cause gas cysts in pneumatosis cystoides coli, and can breathing heliox reduce them? Lancet 1995;345:1220–1222.

21. Gagliardi G, Thompson IW, Hershman MJ, Forbes A, Hawley PR, Talbot IC. Pneumatosis coli: A proposed pathogenesis based on study of 25 cases and review of the literature. Int J Colorectal Dis 1996;11: 111–118.

22. Wu LL, Yang YS, Dou Y, Liu QS. A systematic analysis of pneumatosis cystoides intestinalis. World J Gastroenterol 2013;19:4973–4978.

23. Nizza S, Rando F, Fiorito F, Pagnini U, Iovane G, De Martino L. Fecal microbiota and antibiotic resistance in ferrets (Mustela putorius furo) from two captive breeding facilities in Italy. Res Vet Sci 2014;96: 426–428.

24. Marks SL, Kather EJ, Kass PH, Melli AC. Genotypic and phenotypic characterization of Clostridium perfringens and Clostridium difficile in diarrheic and healthy dogs. J Vet Intern Med 2002;16:533–540.

25. Azzaroli F, Turco L, Ceroni L, et al. Pneumatosis cystoides intestinalis. World J Gastroenterol 2011;17:4932–4936.

26. Summa NM, Eschar D, Lee-Chow B, Larrat S, Brown DC. Comparison of human portable glucometer and an automated chemistry analyzer for measurement of blood glucose concentration in pet ferrets (Mustela putorius furo). Can Vet J 2014;55:865–869.

27. Pear BL. Pneumatosis intestinalis: A review. Radiology 1998;207:13–19.28. Vernacchia FS, Jeffrey RB, Laing FC, Wing VW. Sonographic recogni-

tion of pneumatosis intestinalis. AJR Am J Roentgenol 1985;145:51–52.29. Duron VP, Rutigliano S, Machan JT, Dupuy DE, Mazzaglia PJ.

Computed tomographic diagnosis of pneumatosis intestinalis: Clinical measures predictive of the need for surgical intervention. Arch Surg 2011;146:506–510.


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Complete longitudinal patellar fracture in a cat: A rare case

Gregory D. Herndon

Abstract — Longitudinal patellar fractures in cats are extremely rare with only 1 other report of a comminuted longitudinal fracture for which pins and wires were placed in the patella for stabilization. This report describes the surgery and outcome of a strictly longitudinal patellar fracture in a cat.

Résumé — Fracture patellaire longitudinale complète chez un chat : un cas rare. Les fractures patellaires longitudinales chez les chats sont extrêmement rares et seulement un autre rapport de fracture longitudinale fragmentée a été publié pour lequel des broches et fils ont été placés dans la rotule afin de la stabiliser. Ce rapport décrit la chirurgie et les résultats d’une fracture patellaire strictement longitudinale chez un chat.


Can Vet J 2017;58:387–390

F ractures of the long bones make up a significant portion of an orthopedic caseload; however, patellar fractures are

an uncommon occurrence in veterinary surgery. The incidence that has been reported in the veterinary literature is as low as 0.1% in dogs and only 0.25% of fractures in small animals (1,2). Most patellar fractures seen in veterinary practice are transverse in configuration thus leading to a strong tensile force across the fracture line due to the quadriceps mechanism of the knee. It is this tensile force that leads to a high complication rate with patellar fractures, including implant failure, re-fracture of the patella, implant loosening, and delayed or non-union of the patella. Although there are reports of comminuted fractures of the patella in cats, the literature is sparse on longitudinal patel-lar fractures. This report describes the presentation, surgical fixation, and 8-month postoperative outcome of a longitudinal patellar fracture in a cat.

Case descriptionA 2-year-old spayed female ocelot cat was referred to our hospi-tal because of a 3-week history of right hind limb lameness and traumatic lateral patellar luxation after falling from a third story window. Conservative management, consisting of rest, was not associated with significant improvement. Upon examination, the cat exhibited a moderate lameness of the right hind limb. Orthopedic examination findings included pain on palpation

of the right stifle and lateral patellar luxation that could not be reduced through a full range of motion. No cranial cruciate associated instability was noted on examination. A cranial-caudal radiograph from the referring veterinarian demonstrated a lateral patellar luxation; however, the patella was not of a normal size or shape and there was a radiopaque structure still in the troch-lear groove (Figure 1A). Additional radiographs were acquired and confirmed the presence of a closed, laterally displaced, mid-body longitudinal fracture of the right patella with a small non-displaced chip fracture on the distal aspect of the patella (Figure 1B). Based on the degree of clinical lameness, failure of conservative treatment, the presence of a laterally luxated portion of the patella, and pain on manipulation of the stifle joint, surgical correction was recommended to repair the patellar fracture and restore normal function to the limb.

Pre-operative hematological and biochemical evaluations revealed no significant anomalies. The cat was premedicated with a standard protocol of ketamine (Vetalar; Vétoquinol, Lavaltrie, Quebec), 3 mg/kg body weight (BW), IM, hydro-morphone (Sandoz Canada, Boucherville, Quebec), 0.1 mg/kg BW, IM, and dexmedetomidine hydrochloride (Dexdomitor; Zoetis, Kirkland, Quebec), 0.005 mg/kg BW, IM. Anesthesia was induced with alfaxalone (Alfaxan; Central Sales, Bramton, Ontario), 0.5 mg/kg BW, IV, and maintained with isoflurane (PPC Vet Isoflurane; Fresenius Kabi Canada, Richmond Hill, Ontario). Once induced, an epidural injection of bupivacaine (Marcaine; Hospira, St. Laurent, Quebec), 0.5 mg/kg BW, and preservative-free morphine (Morphine LP Epidurale; Sandoz Canada), 0.1 mg/kg BW, was used to help control pain during anesthesia and after surgery.

A lateral parapatellar skin incision was made over the right stifle. After subcutaneous dissection, the laterally luxated patellar fragment and the medial patellar fragment located in the troch-lear groove were identified. The patellar tendon was examined and was noted to be partially torn in the same plane as the

Faculty of Veterinary Medicine, University of Montreal, 3200 Rue Sicotte, C.P. 5000, St-Hyacinthe, Quebec J2S 2M2.Address all correspondence to Dr. Gregory Herndon; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.


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fracture (Figure 2). A medial arthrotomy was then performed to examine the articular surface of the medial fragment. The articu-lar cartilage was normal in appearance. The cruciate ligaments and menisci were examined at this time and found to be normal. A lateral desmotomy was performed to facilitate reduction of the lateral patella fragment. Once the lateral fragment was reduced, its cartilage was examined and found to be normal. There was a significant amount of fibrous tissue present on both fracture surfaces, which was debrided using a #15 surgical blade and a Freer elevator (Johnson & Johnson, Markham, Ontario). Once the fibrous tissue was removed and the fracture ends were clearly identified, the fracture was reduced.

Initial stabilization was attempted using an encircling suture with 20-lb test leader line. Although adequate reduction was achieved there was significant instability noted in the patella when it was placed through a range of motion. Due to the instability the suture was removed and an alternative fixation was used. At the midpoint of the patella, a 0.054-inch K-wire was inserted through the medial fragment in a lateral to medial direction; the fracture was reduced using pointed reduction forceps to maintain reduction while placing the pin. The pin was then inserted into the lateral fragment. A 22-gauge encircling cerclage wire was placed around the pin ends and tightened to facilitate compression of the fracture. The pin ends were then cut, leaving approximately 2-mm ends (Figure 3). The articular surface of the patella and the fracture reduction were visualized by externally rotating the patella from the medial arthrotomy site. The reduction was found to be adequate and there was no evidence of the pin penetrating the articular surface (Figure 4). The distal fragment was visualized and found to be non-displaced and no attempt at stabilization was made. Once the repair had been completed the stifle was placed through a range of motion and no crepitus or instability was noted. The lateral desmotomy was closed with 2 simple interrupted sutures using 2-0 Polydioxane (PDS; CDMV, St. Hyacinthe, Quebec), leaving most of the lateral desmotomy open to prevent lateral luxation after surgery. Two simple interrupted sutures using 3-0 PDS were placed to repair the tear in the patella tendon. The medial joint capsule was closed using 2-0 PDS in a vest over pants

and simple interrupted pattern. A medial fabellopatellar suture using #2 Polypropolene (Prolene; CDMV) was place to further stabilize the patella and prevent lateral luxation from occurring after surgery. The subcutaneous closure was completed using 3-0 Monocryl in a simple continuous pattern, and the skin was closed with 4-0 Nylon in a simple continuous pattern.

Postoperative radiographs were taken and revealed a mild medial patella subluxation, likely secondary to the medial fabel-lopatellar suture and the vest over pants sutures. The cat was returned to the operating room and the medial fabellopatellar suture and the vest over pants sutures were removed. The medial arthrotomy was then closed with 2-0 PDS in a simple continu-ous pattern. The remaining subcutaneous and skin closure was performed as stated previously. Radiographs were repeated and the patella was properly positioned (Figure 5). Recovery was uneventful and the cat was discharged 3 d after surgery on the following medications: buprenorphine (Vetergesic multidose; Champion Alstoe, Whitby, Ontario), 0.01 mg/kg BW, PO, q8h for 7 d, meloxicam (Metacam; Boehringer Ingelheim Canada, Burlington, Ontario), 0.1 mg/kg BW, PO, q24h for 5 d, and amoxicillin/clavulanate (Clavamox; Zoetis), 13.75 mg/kg BW, q12h for 7 d.

The cat was returned to his referring veterinarian after 2 wk for suture removal and was clinically doing well at that time. The cat was returned to our hospital 8 wk after surgery. The owner reported that there was no evidence of lameness noted when the cat walked, ran, or jumped. During gait analysis the cat was placed in a closed examination room and observed at a walk for 5 min with no obvious lameness noted. Upon palpation of the right stifle, no pain was detected nor elicited through a

Figure 1. A, B — Cranial/caudal view and lateral radiographs showing 2 distinct fragments of the patella with a small non-displaced fragment on the distal aspect of the medial fragment.

A B

Figure 2. Intraoperative image of the patella ligament torn in the same plane as the fracture.


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normal range of motion. Radiographs were taken under sedation (Figure 6). Alignment and reduction were adequate and there was no evidence of loosening or migration of the implants. The patella exhibited signs of healing, as the fracture line was becom-ing less distinct. The non-displaced fracture distally was healed at this time. Mild stifle effusion was noted but this was an improvement compared to the postoperative radiographs. The owner was instructed to continue exercise restriction for another 2 wk and slowly increase activity to normal over another 4 wk. Communication with the owner 8 mo after surgery revealed that the cat was doing well with no obvious lameness noted at a walk. The owner mentioned, however, that when the cat sat, the right limb seemed to be slightly externally rotated.

DiscussionPatellar fractures are uncommon in dogs and cats. The majority of patellar fractures have been reported in the dog, with only a small number of cases reported in the cat (7 articles with a total of 87 fractures involving the patella; 3–9). Most patellar fractures in the cat are described as transverse in configuration and typically are not associated with trauma. These fractures appear to be associated with stress as opposed to direct trauma as is typically seen in dogs (3). Since the majority of patellar fractures in cats, regardless of the cause, appear to be trans-verse, the literature on longitudinal patellar fractures in cats is sparse. There are only 6 patellar fractures in cats reported in the literature that were considered to be longitudinal or to have a longitudinal component (4–6). Of these 6 cases, 5 had one side of the fracture that was too small for repair using an implant and was either removed at the time of surgery or was stabilized with an encircling suture. The remaining case was described as a comminuted longitudinal fracture that was stabilized with multiple pins and cerclage wires (6). The outcome of these frac-tures has been good to excellent, which is not surprising since many of them involved removing the fragment and preventing patella luxation from occurring. The outcome of the single case that was repaired with pins and cerclage wires was good with the only complication being a recurrent patellar luxation (6); however, it was unclear if this complication required a second surgery for correction.

When presented with a patellar fracture in a cat, determining the best method of treatment can be difficult. In a review of the literature, one article compared the outcome of transverse patellar fractures repaired surgically versus those treated non-surgically. Of 9 transverse patellar fractures that were evaluated, 6 were treated surgically and 3 were treated non-surgically. The outcome was good with a return to normal activity whether surgery was performed or not (7). However, none of these cases involved luxation of a patellar fragment, which typically results in chronic lameness and, when present, surgery should be considered. Although only a few cases of longitudinal patel-lar fractures have been reported, complications seemed to be infrequent and included a persistent mild lameness in 1 case, intermittent lameness in cold weather in 1 case, and 2 recur-rences of a patella luxation in another case (6). It is interesting to note, when we consider that only one other case in the literature involved internal fixation of a longitudinal patellar fracture in a cat, that neither of these cases suffered complications typically seen with transverse patella fractures such as implant failure or re-fracture of the patella. The most likely explanation for the difference in outcomes for surgical repair between longitudinal and transverse fractures probably lies in the differences between the forces that act on these fractures.

The extensor mechanism of the stifle is composed of the vastus muscle group (lateralis, medialis, and intermedius) and rectus femoris, which form the quadriceps tendon that attaches to the patella, which in turn attaches to the patellar tendon. The contraction of the vastus muscle group and rectus femo-ris leads to the exertion of a tensile force through the patella and patellar tendon leading to extension of the stifle. When a transverse fracture of the patella is present, this tensile force will lead to distraction between the 2 fracture fragments. The internal fixation used in cases of patellar fractures has historically been pin and tension band wires. All cases in which implants are placed, especially in areas of high motion, are susceptible to cyclical forces that can lead to loosening and even failure of the implants (3). In a longitudinal patellar facture, the forces acting on the implants are likely diminished because the forces acting

Figure 3. Patella repaired with a 0.54-mm pin and encircling 22-gauge wire.

Figure 4. Patella rotated laterally to view the articular surface and reduction of the fracture.


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on the fracture line are parallel rather than perpendicular as in a transverse fracture. The anatomic structures that would provide tensile forces in a longitudinal patellar fracture would come from the parapatellar ligaments, which were transected in this case during the medial and lateral arthrotomy. Since the patellar frag-ment was luxated laterally, most of the tensile force would have come from the lateral aspect of the stifle due to the contracture of the soft tissues. Therefore, the lateral arthrotomy was left open to reduce lateral tensile forces from acting on the repair. By reducing the tensile forces acting on the 2 fracture fragments, the amount of stress and strain on the implant should lead to a reduction in the cyclical forces acting on the implants. This decrease in stress and strain on a longitudinal fracture should lead to a more stable fixation and a decrease in complications such as implant failure. The main force to then overcome in stabilizing this type of patellar fracture would be shear. In this case, the fracture was adequately reduced using pin and cerclage wire, which provided sufficient stability to overcome shear force.

In conclusion, cats that suffer a longitudinal patellar fracture and have a concurrent patellar luxation of 1 of the fragments should be considered surgical candidates. Surgical repair of a longitudinal fracture will likely have a better outcome with fewer complications than occur with a transverse fracture due to the difference in configuration of the fracture and how the anatomic forces act upon that fracture. This is only the second report of a successful internal fixation of a patellar fracture with a longitudinal configuration. Although both cases had a good

outcome, the case presented here was not associated with any complications 8 mo after surgery. More such cases are needed before we can definitively comment on prognosis and outcome of these cases.

AcknowledgmentsThe author thanks Dr. Bertrand Lussier and Dr. Carolyn Grimes for their help and advice on preparation of this manuscript. CVJ

References1. Carb A. A partial patellectomy procedure for transvers patellar fracture

in the dog and cat. J Am Anim Hosp Assoc 1975;11:649–657.2. Harari JS, Person M, Berardi C. Fractures of the patella in dogs and cats.

Compend Contin Educ Pract Vet 1990;12:1557–1563.3. Langley-Hobbs SJ. Survey of 52 fractures of the patella in 34 cats. Vet Rec

2009;164:80–86.4. Guillaumot P, Scotti S, Carozzo C, Bouvy B, Genevois J-P. Two cases of

surgically treated feline patellar fractures. Vet Comp Orthop Traumatol 2008;21:156–158.

5. Cusack L, Johnson M. Arthroscopic assessment for patellar injuries and a novel suture repair of patellar fracture in cats. J Am Anim Hosp Assoc 2013;49:267–272.

6. Langley-Hobbs SJ, Brown G, Matis U. Traumatic fracture of the patella in 11 cats. Vet Comp Orthop Traumatol 2008;21:427–433.

7. Salas N, Popovitch C. Surgical versus conservative management of patella fractures in cats: A retrospective study. Can Vet J 2001;52:1319–1322.

8. Palierne S, Palissier F, Raymone-Letron I, Autefage A. A case of bilateral patellar osteochondrosis and fracture in a cat: Clinical and histological findings. Vet Comp Orthop Traumatol 2010;2:128–133.

9. Langley-Hobbs SJ, Ball S, McKee WM. Transverse stress fractures of the proximal tibia in 10 cats with non-union patellar fractures. Vet Rec 2009; 164:425–430.

Figure 5. Lateral and cranial caudal views of the patella immediately after surgery.

Figure 6. Lateral and cranial caudal views of the patella 8 wk after surgery. There is no change in the implants and the fracture line has become less distinct. The small distal fragment also shows signs of healing.


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Primary intranasal melanoma with brain invasion in a dog

Julie Lemetayer, Ahmad Al-Dissi, Kim Tryon, Valerie MacDonald-Dickinson

Abstract — A 6-year-old castrated male boxer dog with right-sided dark purulent nasal discharge and acute bilateral blindness was diagnosed on magnetic resonance imaging (MRI) and then on necropsy with primary nasal malignant melanoma that extended into the brain, as well as concurrent ocular melanosis. There was no evidence of metastasis in other organs.

Résumé — Un cas de mélanome primitif des fosses nasales avec invasion cérébrale chez un chien. Un boxer mâle castré de 6 ans a été présenté pour écoulement nasal purulent et de couleur foncée à droite et perte de vision bilatérale aiguë. Un mélanome malin nasal primaire qui s’étendait dans le cerveau, ainsi qu’une mélanose oculaire, ont été diagnostiqués par imagerie à résonnance magnétique (IRM) puis nécropsie. Il n’y avait pas d’évidence de métastases dans les autres organes.

(Traduit par les auteurs)

Can Vet J 2017;58:391–396

I n human and veterinary medicine, melanoma is one of the few neoplasms for which location is an important prognostic

indicator. While oral melanoma, the most common form of melanoma in dogs, and melanoma of the digit, foot pad, and mucocutaneous junction are usually aggressive malignant tumors with high potential for local invasiveness and metastasis, 95% of the haired-skin melanomas and most intraocular melanocytic tumors are benign (1).

In humans, sinonasal melanoma is invariably malignant and aggressive (2–7). Contrary to its human counterpart for which sinonasal melanoma is more common than oral melanoma, pri-mary malignant intranasal melanoma has been rarely reported in dogs, and only 2 cases are fully described (8,9). The tumor was limited to the nasal vestibule in 1 case based only on surgical findings and to 1 nasal cavity in a second case based on magnetic resonance imaging (MRI) of the head. There was no metastasis based on repeated thoracic radiographs for both cases and lymph node aspirations for the second case (8,9).

Ocular melanosis, on the other hand, is a benign lesion of the melanocytic system that is known to occur mainly in cairn terriers, although similar lesions have been described in boxers and Labrador retrievers (10).

To the authors’ knowledge, this is the first case of primary nasal melanoma with brain invasion and concurrent ocular melanosis in a dog. Clinical presentation was interesting as the dog presented for both signs of nasal and neurological diseases.

Case descriptionA 6-year-old castrated male boxer dog was referred to the Western College of Veterinary Medicine, Saskatoon, Saskatchewan because of a 3-week history of unilateral nasal discharge from the right nostril, progressive lethargy, and blind-ness over 2 d. The nasal discharge was dark brown/purple and purulent but became hemorrhagic on the day of presentation. No pain was detected on palpation of the nose or retropulsion of the eyes, and submandibular lymph nodes were normal in texture and size. A neurological examination showed bilateral absence of menace response and marked bilateral mydriasis with poor direct and consensual pupillary light reflexes. The remain-der of the neurological and physical examinations was normal. An ophthalmological examination showed very myelinated and prominent optic nerves that were interpreted as possible individual variation. The marked mydriasis prevented a good evaluation of the irises. An electroretinogram was found to be normal. The origin of the blindness was therefore suspected to involve the proximal portion of the visual pathway, from the optic nerves to the lateral geniculate nuclei, and more likely the optic chiasma.

Complete blood cell count, serum biochemistry, and urinaly-sis were unremarkable. Thoracic radiographs and abdominal ultrasound were performed to look for metastasis since a nasal

Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1 (Lemetayer); Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4 (Al-Dissi, Tryon, MacDonald-Dickinson).Address all correspondence to Dr. Julie Lemetayer; e-mail: [email protected]. Lemetayer and Al-Dissi are co-first authors.Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.


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tumor was the most likely diagnosis. Findings were mild and non-specific. A mild bronchial pattern and possible mild sternal lymphadenomegaly were seen on the thoracic radiographs and splenomegaly was seen on abdominal ultrasound examina-tion. A magnetic resonance image of the brain showed a large (8 3 4 3 2.5 cm) contrast-enhanced mass of mixed intensity that filled the entire right nasal passage and extended into the left nasal passage and caudally through the cribiform plate into the olfactory and likely the frontal lobes of the rostral right brain (Figures 1A, B). The nasal mass was isointense to hyperintense on T2 sequences, isointense and moderately hyperintense on T1 sequences, and enhanced on the post-contrast T1 sequences. There was also a focal lesion in the left frontal lobe, immedi-ately rostral to and displacing the left lateral ventricle, as well as bilateral symmetrical lateral ventriculomegaly. This lesion was hyperintense on T2 sequences, hypointense on T1 sequences, did not contrast enhance and was considered to be a fluid-filled lesion. The right frontal sinus was fluid-filled, likely secondary to the obstruction from the mass. Differential diagnoses for the mass included primary neoplasia and less likely fungal infec-tion. Due to the poor prognosis, the dog was euthanized and a postmortem examination was conducted.

Grossly, a black firm mass measuring 8 3 4 3 2.5 cm filled the right nasal cavity, destroyed the cribiform plate and extended into the cranium. The ventral and rostral aspect of the right frontal lobe of the brain contained a solitary, round, dark grey, soft mass which replaced the olfactory bulb area (Figures 2A, B). A focal round area was found on the spleen. Microscopically, expanding and infiltrating the submucosa, destroying the nasal bone and multifocally elevating or ulcerating the nasal mucosa, there was an unencapsulated, poorly demarcated, highly infiltrative, and densely cellular neoplastic mass that

was composed of cells arranged in interlacing bundles, whorls and dense clusters and that was supported by a fine fibrovas-cular stroma. Neoplastic cells were pleomorphic, ranging from round to polygonal to spindloid, with variably distinct cell borders and a variable amount of eosinophilic cytoplasm, often obscured by dark brown melanin pigment. Nuclei were round to oval to spindloid with moderately stippled chromatin, and had 1 to 3 distinct nucleoli. There was marked anisocytosis and anisokaryosis, and mitotic figures ranged from 3 to 10 per high power field (403). Areas of nasal bone invasion and necrosis were also seen. Similar neoplastic cells were seen infiltrating and effacing the brain (Figures 2C, D, E). These tumor cells infiltrated the olfactory nerve fibers and the olfactory bulb of the brain but did not infiltrate the optic chiasm. There was no evidence of metastasis in any of the other organs examined including draining lymph nodes and the spleen. Based on gross and histological findings a diagnosis of malignant melanoma was made and was confirmed by immunohistochemistry. Tumor cells were positive for Melan A (Figure 2F) and S100, two melanoma associated antigens.

In both eyes, the iris was diffusely infiltrated by a dense popu-lation of highly pigmented round cells which obscured the iris architecture and extended into the filtration angle, ciliary body, choroid and around the optic disc. A bleached section revealed the cells to be round to polygonal with indistinct cell borders. Nuclei were polygonal to spindle and no mitotic figures were seen (Figures 2G, H).

DiscussionWe describe a case of primary nasal melanoma with brain infiltration, along with ocular melanosis, in a boxer dog. To the authors’ knowledge, this is the first description of these 2 lesions

Figure 1. Post-contrast sagittal (A) and dorsal (B) T1-weighted post contrast magnetic resonance images of a 6-year-old boxer dog with an intranasal melanoma with brain invasion. The large hyperintense area (star) indicates the tumor originating in the right nasal passage with extension into the cranial cavity and into the region of the olfactory and frontal lobes. The arrows designate the caudal borders of the main part of the tumor. Tendrils of invasion into the brain tissue are delineated by the arrowheads. (Post contrast T1* sequences (A) TR = 413, TE = 12, 3.5 mm slice thickness, 200 3 200 (B) TR = 516, TE = 12, slice thickness 3.5 mm).


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Figure 2. A — Cross section of the head. A dark black nasal mass was found occupying most of the nasal cavity and extending into the cranium. B — Brain, ventral view. Solitary, round, dark black, soft mass replaced the olfactory bulb area. Inset: Dorsal view: the mass extended dorsally. C — Nose: A large neoplastic mass replaced the nasal epithelium and underlying bone. Hematoxylin and eosin stain (H&E), 1003. D — Closely packed neoplastic cells invaded the brain. (H&E), 4003. E — Round to polygonal neoplastic cells, some of them containing intracytoplasmic dark brown pigment. (H&E), 4003. F — Positive immunohistochemistry for melan A. Brown pigment is present within the cytoplasm of tumor cells. ABC diaminobenzidine method, hematoxylin counterstain; 2003. Inset: Omission control. G — A bleached histology section of the eye displaying melanocytes occupying the iris and ciliary body. 203. Inset: The iris is expanded by many round to polygonal cells with variably distinct cell borders and moderate to abundant amount of cytoplasm. Nuclei were mostly polygonal, rarely had prominent nucleoli with no mitotic figures. H — A large population of melanocytes expanding the iris and ciliary body. (H&E), 203. Inset: Pigmented melanocytes with expanding iris stroma. H&E.


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combined in a dog and the first description of brain invasion by a primary nasal melanoma. Nasal melanoma in dogs has only been described twice previously (8,9).

Extensive local invasiveness and infiltration of surrounding tissues is a characteristic common to all types of malignant melanoma and is attributed to submucosal lymphatic spread of the disease (2). The case of primary nasal malignant melanoma presented herein had a very aggressive local behavior, as seen by the extensive bone and brain invasion.

In contrast to this case, the 2 previously described cases of malignant nasal melanoma had a longer duration of clinical disease and did not progress to brain invasion. In the first report, malignant melanoma was diagnosed within the ventral left nasal vestibule of a 14-year-old intact male miniature schnauzer 1 mo after the mass was treated with topical hydrocortisone. The tumor extended to the upper lip caudally and ventrally. Three months after complete surgical excision, there were no clini-cal signs of tumor recurrence and no evidence of metastasis in repeated thoracic radiographs (8). The second case occurred in a 10-year-old, spayed female, Newfoundland-cross dog which was presented to the referring veterinarian for intermittent left epistaxis and sneezing of 6 to 8 months’ duration (9). Magnetic resonance imaging of the head revealed a mass in the middle portion of the left nasal cavity which was locally destructive and histologically diagnosed as epithelioid melanoma. The tumor was cytoreduced surgically via a rhinotomy followed by radia-tion. Complete resection was not possible because of the tumor location. Clinical signs improved after surgery; however, the dog was presented for a gingival mass on the right side of the oral cavity, which was contralateral to the location of the original mass. A second MRI showed no evidence of a nasal mass. The gingival mass was diagnosed as malignant melanoma and was treated with radiation 3 mo later. No evidence of metastasis was found on repeated radiographs and submandibular lymph node aspirations, and the dog was still alive after 12 mo (9).

Sinonasal melanoma occurs rarely in humans, representing approximately 4% to 8% of malignant tumors of the nasal cavity and paranasal sinuses (5). Comparable to other forms of malignant melanoma, sinonasal melanoma in humans is characterized by extensive local invasion. Humans with primary nasal melanoma usually present with one-sided nasal obstruction and/or epistaxis (4,11). Due to the non-specific nature of the symptoms experienced by humans with sinonasal melanoma, delay in diagnosis is frequent, patients having symptoms for months to years before diagnosis (5,11). Therefore the tumor is often advanced at the time of diagnosis. However, brain invasion is very rarely reported (4,7).

Studies in humans have reported high rates of local recur-rence of primary nasal melanoma after surgical removal (31% to 85%); low rates of invasion of regional lymph nodes (10% to 30%); high rates of distant metastasis (25% to 50%), which occurs late in the disease process; and often poor 3- and 5-year survival rates (19% to 62.5%) (2,3,6). Since these tumors are invariably aggressive in humans, the classification of mucosal melanoma of the head and neck (70% of which are sinonasal melanoma) by the American Joint Committee on Cancer does not include stages T1 and T2 (5). The tumor is classified stage

T3 when it only invades the mucosa and stage T4 for deeper invasion, with 2 sub-stages a and b for moderately advanced disease and very advanced disease, such as brain invasion, respectively. The absence of distant metastasis in this case based on necropsy and in the 2 previously described reports based on repeated thoracic radiographs, and submandibular lymph node aspirations in 1 of the 2 cases, could suggest that nasal malignant melanoma in dogs, unlike humans, is a locally invasive tumor with lower metastatic potential, but a higher number of cases would be necessary to investigate this hypothesis.

The tumor is suspected to originate from melanocytes within the nasal mucosa and less likely within meninges or brain. It has been previously thought that melanocytes were not present within the nasal mucosa, thus, malignant nasal melanomas in humans were suspected to arise after squamous metaplasia of nasal epithelium (12). Later studies in humans have confirmed the presence of nasal melanocytes within the nasal mucosa. The clinical course of this tumor with epistaxis preceding the develop-ment of neurological signs as well as the presence of a larger mass within the nasal cavity are consistent with a nasal origin (12). Although studies confirming the presence of melanocytes within the nasal mucosa in dogs are lacking, the clinical presentation in this case and the absence of squamous metaplasia within the nasal mucosa suggests their existence within the canine nasal mucosa.

The origin of the blindness in this dog was suspected to be due to swelling and compression around the optic chiasm, as opposed to an infiltration by the tumor as the tumor was not seen microscopically.

Interestingly, this dog presented with another lesion involv-ing the melanocytic system. Ocular melanosis, a non-neoplastic condition in which pigmented cells proliferate in several tissues of the eyes, occurs mainly in cairn terriers, less commonly in other breeds, and is thought to be inherited (13). Diffuse over-pigmentation of the uvea is typically seen histologically resulting from an increase in the number and size of round and heavily pigmented cells. Two cell types are present within the lesion, i.e., melanocytes and melanophages. Melanocytes are thought to predominate in the cairn terrier while melanophages are thought to be predominant in other breeds (13). A few consider ocular melanosis to be a variant of melanocytoma while others make a distinction between the 2 lesions (13). Melanocytomas typically form a regional mass (i.e., are not diffuse), and contain heavily pigmented round and spindle cells. This is unlike most cases of ocular melanosis in which only a single population of round and heavily pigmented cells is present diffusely. In this case, only a single population of round and heavily pigmented cells was seen histologically in both eyes which is consistent with a diagnosis of ocular melanosis. It is possible that the lesions in both eyes represent a site of distant metastasis; however, this possibility is less likely given the organized nature of this lesion, the benign cellular morphology and the lack of local invasion or mitotic figures.

Gross and histological findings were consistent with malig-nant melanoma in this case, but because malignant melanoma can be amelanotic and highly pleomorphic, the histological diagnosis may need to be confirmed by immunohistochem-istry. Tests for Melan-A, an antigen present on the surface of


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melanocytes; PNL2, an antigen of melanocytes and granulo-cytes; and tyrosinase-related proteins 1 and 2 were found to be highly sensitive and 100% specific in a study evaluating canine oral amelanotic melanocytic neoplasms (14). S-100, a calcium-binding protein that is widely distributed in the central and peripheral nervous systems, as well as in other cells including melanocytes, is considered a less reliable marker because tests for this protein are less specific but sensitive. Melan A and the S-100 proteins were used in our case, both showing positive staining. The dog in this report had poor short- and long-term prognoses, regardless of the type of tumor diagnosis; therefore, nasal biopsies and treatments were declined by the owners, and the diagnosis of primary nasal malignant melanoma was made on postmortem examination.

Available treatments for malignant melanomas in dogs include wide surgical resection, radiation therapy, and adjunc-tive systemic therapies such as melanoma vaccine and vari-ous chemotherapy protocols (15–19). Wide surgical excision remains the treatment of choice if complete resection is feasible (15,16,19). External beam radiotherapy can also be used for local tumor control, despite older data which suggested that melanoma was radioresistant (2,8,19). However, given the high metastatic rate of malignant melanoma, systemic therapy is often added. No consensus has been established on the optimal systemic management of mucosal malignant melanoma in dogs and humans (15,16).

Studies investigating the chemotherapeutic agents carbopla-tin, cisplatin, both in association with piroxicam, melphalan, lomustine, dacarbazine, doxorubicin, or temozolomide showed response in a small subset of dogs with malignant oral mela-noma; and the combination of adjunctive systemic therapies to surgery and/or radiation does not seem to improve the survival time compared to loco-regional control alone (16,20–25). However, type II errors were possible in these studies due to the small number of dogs studied.

Various immunotherapy strategies have been developed, some of them showing promising results, but the development of these products is expensive, time-consuming, and difficult to reproduce or commercialize (15). The development and commercialization of a vaccine containing xenogeneic plasmid DNA encoding human tyrosinase represents a leap forward, but its efficacy has recently been questioned (17). Despite initial data indicating promising results of the vaccine (26), a more recent study failed to show greater progression-free survival, disease-free interval, or median survival time in dogs receiving the vaccine compared with control dogs (17). Other promising strategies are under development such as the xenogeneic elec-trovaccination against the human chondroitin sulfate proteogly-can-4 (hCSPG4) DNA for dogs with oral malignant melanoma expressing CSPG4 (27).

Regardless of the treatment strategy chosen, early diagnosis and treatment are important to improve the outcome of patients with primary nasal malignant melanoma and, although very rare, primary malignant nasal melanoma is a possible cause of nasal discharge in dogs.

In conclusion, this report describes a case of primary nasal malignant melanoma with brain invasion and concurrent ocu-

lar melanosis in a 6-year-old castrated male boxer dog. Signs of neurological involvement, acute bilateral blindness with marked mydriasis, and poor direct and consensual pupillary light reflexes, were seen 3 wk after the development of unilateral dark purulent nasal discharge. Due to the poor prognosis based on MRI findings, euthanasia was elected and the diagnosis of primary intranasal malignant melanoma with brain invasion was made at necropsy. CVJ

References 1. Smith SH, Goldschmidt MH, McManus PM. A comparative review of

melanocytic neoplasms. Vet Pathol 2002;39:651–678. 2. Vandenhende C, Leroy X, Chevalier D, Mortuaire G. Sinonasal mucosal

melanoma: Retrospective survival study of 25 patients. J Laryngol Otol 2012;126:147–151.

3. Clifton N, Harrison L, Bradley PJ, Jones NS. Malignant melanoma of nasal cavity and paranasal sinuses: Report of 24 patients and literature review. J Laryngol Otol 2011;125:479–485.

4. Going JJ, Kean DM. Malignant melanoma of the nasal cavity. J Laryngol Otol 1989;103:231–233.

5. Gilain L, Houette A, Montalban A, Mom T, Saroul N. Mucosal melanoma of the nasal cavity and paranasal sinuses. Eur Ann Otorhinolaryngol Head Neck Dis 2014;131:365–369.

6. Mahalingappa YB, Khalil HS. Sinonasal malignancy: Presentation and outcomes. J Laryngol Otol 2014;128:654–657.

7. Gasparyan A, Amiri F, Safdieh J, Reid V, Cirincione E, Shah D. Malignant mucosal melanoma of the paranasal sinuses: Two case pre-sentations. World J Clin Oncol 2011;2:344–347.

8. Holt D, Prymak C, Evans S. Excision of tumors in the nasal vestibule of two dogs. Vet Surg 1990;19:418–423.

9. Hicks DG, Fidel JL. Intranasal malignant melanoma in a dog. J Am Anim Hosp Assoc 2006;42:472–476.

10. Van de Sandt RR, Boeve MH, Stades FC, Kik MJ. Abnormal ocular pigment deposition and glaucoma in the dog. Vet Ophthalmol 2003; 6:273–278.

11. Lund VJ, Howard DJ, Harding L, Wei WI. Management options and survival in malignant melanoma of the sinonasal mucosa. Laryngoscope 1999;109:208–211.

12. Zak FG, Lawson W. The presence of melanocytes in the nasal cavity. Ann Otol Rhinol Laryngol 1974;83:515–519.

13. Dubielzig RR, Ketring KL, McLellan GJ, Albert DM. Veterinary Ocular Pathology: A Comparative Review. 1st ed. Edinburgh, UK: Saunders 2010:280–282.

14. Smedley RC, Lamoureux J, Sledge DG, Kiupel M. Immunohisto-chemical diagnosis of canine oral amelanotic melanocytic neoplasms. Vet Pathol 2011;48:32–40.

15. Bergman PJ. Canine oral melanoma. Clin Tech Small Anim Pract 2007; 22:55–60.

16. Boston SE, Lu X, Culp WT, et al. Efficacy of systemic adjuvant thera-pies administered to dogs after excision of oral malignant melanomas: 151 cases (2001–2012). J Am Vet Med Assoc 2014;245:401–407.

17. Ottnod JM, Smedley RC, Walshaw R, Hauptman JG, Kiupel M, Obradovich JE. A retrospective analysis of the efficacy of Oncept vac-cine for the adjunct treatment of canine oral malignant melanoma. Vet Comp Oncol 2013;11:219–229.

18. Proulx DR, Ruslander DM, Dodge RK, et al. A retrospective analysis of 140 dogs with oral melanoma treated with external beam radiation. Vet Radiol Ultrasound 2003;44:352–359.

19. Tuohy JL, Selmic LE, Worley DR, Ehrhart NP, Withrow SJ. Outcome following curative-intent surgery for oral melanoma in dogs: 70 cases (1998–2011). J Am Vet Med Assoc 2014;245:1266–1273.

20. Dank G, Rassnick KM, Sokolovsky Y, et al. Use of adjuvant carboplatin for treatment of dogs with oral malignant melanoma following surgical excision. Vet Comp Oncol 2014;12:78–84.

21. Rassnick KM, Ruslander DM, Cotter SM, et al. Use of carboplatin for treatment of dogs with malignant melanoma: 27 cases (1989–2000). J Am Vet Med Assoc 2001;218:1444–1448.

22. Brockley LK, Cooper MA, Bennett PF. Malignant melanoma in 63 dogs (2001–2011): The effect of carboplatin chemotherapy on survival. N Z Vet J 2013;61:25–31.

23. Page RL, Thrall DE, Dewhirst MW, et al. Phase I study of melphalan alone and melphalan plus whole body hyperthermia in dogs with malignant melanoma. Int J Hyperthermia 1991;7:559–566.


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24. Boria PA, Murry DJ, Bennett PF, et al. Evaluation of cisplatin combined with piroxicam for the treatment of oral malignant melanoma and oral squamous cell carcinoma in dogs. J Am Vet Med Assoc 2004;224: 388–394.

25. Cancedda S, Rohrer Bley C, Aresu L, et al. Efficacy and side effects of radiation therapy in comparison with radiation therapy and temozolo-mide in the treatment of measurable canine malignant melanoma. Vet Comp Oncol 2014.

26. Grosenbaugh DA, Leard AT, Bergman PJ, et al. Safety and efficacy of a xenogeneic DNA vaccine encoding for human tyrosinase as adjunc-tive treatment for oral malignant melanoma in dogs following surgical excision of the primary tumor. Am J Vet Res 2011;72:1631–1638.

27. Riccardo F, Iussich S, Maniscalco L, et al. CSPG4-specific immunity and survival prolongation in dogs with oral malignant melanoma immunized with human CSPG4 DNA. Clin Cancer Res 2014;20:3753–3762.

Mosby’s Comprehensive Review for Veterinary Technicians, 4th edition

Tighe MM, Brown M. St. Louis, Missouri, USA. 2015. ISBN: 9780-3231-7138-0.

M osby’s Comprehensive Review for Veterinary Technicians was one of the most useful tools I had to help me review

for the Veterinary Technician National Examination (VTNE). This book is packed with an incredible amount of information including many aspects of the skills and subjects I studied in school, as well as new information that allowed me to expand my knowledge. The information is provided in a layout that

made it easy to find specific topics and areas of interest. This helped me to quickly find and review certain subjects I was struggling to remember or understand while studying for the VTNE. It is well-written and easy to understand, which is important for anyone having difficulty understanding certain concepts. Another benefit of this book, is that it provides review questions for each topic, and a complete review test at the end. I believe that this book would be a great tool for any veterinary technician, whether they are using it to study for exams at school, the VTNE, or even just as a book to look to from time to time for review while in practice.

Reviewed by Shannon Wheatley, RVT, Ottawa, Ontario.

Book Reviews Comptes rendus de livres

Review Questions and Answers for Veterinary Technicians, 4th edition

Colville T. Mosby Elsevier, St. Louis, Missouri, USA. 2010. ISBN: 9780-3233-4143-1.

I ntended as a companion to Mosby’s Comprehensive Review for Veterinary Technicians, 4th edition, this book provides a

large selection of review questions and answers for veterinary technicians who are preparing to write the Veterinary Technician National Examination (VTNE), or any other exam. There is a wide variety of questions covering every aspect of registered veterinary technician (RVT) skills, from emergency triage to

large animal care, as well as pharmacy and anatomy. I found this book incredibly useful as a tool to not only review all the skills and important information I learned in school, but also a source of new information that I did not cover in my stud-ies. When studying for the VTNE, the book allowed me to improve my method of studying by taking the quizzes provided and getting an idea of which sections I needed to study more to better prepare for the exam. This is something that I would have found helpful to have in school as well as after school and I would recommend it to any new veterinary technician looking for another tool to help them progress to becoming an RVT.

Reviewed by Shannon Wheatley, RVT, Ottawa, Ontario.


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Brief Communication Communication brève

Prevalence and risk factors for Coxiella burnetii seropositivity in small ruminant veterinarians and veterinary students in Ontario, Canada

Shannon L. Meadows, Andria Jones-Bitton, Scott A. McEwen, Jocelyn Jansen, Samir N. Patel, Catherine Filejski, Paula Menzies

Abstract — Coxiella burnetii is a zoonotic pathogen that causes Q fever in humans. Serological and questionnaire data on C. burnetii were obtained from 32 small ruminant veterinarians and veterinary students in Ontario, Canada, in February 2012. Overall, 59% of participants were seropositive; advanced stage of career and increased age were associated with seropositivity.

Résumé — Prévalence et facteurs de risques pour la séropositivité à Coxiella burnetii chez les vétérinaires des petits ruminants et les étudiants en médecine vétérinaire en Ontario, au Canada. Coxiella burnetii est un agent pathogène zoonotique qui cause la fièvre Q chez les humains. Des données sérologiques et provenant de réponses à un questionnaire portant sur C. burnetii ont été obtenues auprès de 32 vétérinaires et étudiants en médecine vétérinaire en Ontario, au Canada, en février 2012. Globalement, 59 % des participants étaient séropositifs; un stade de carrière avancé et un âge supérieur étaient associés à la séropositivité.

(Traduit par Isabelle Vallières)Can Vet J 2017;58:397–399

C oxiella burnetii is a zoonotic bacterium that causes Q fever in humans (1). Human infection has most frequently been

attributed to indirect or direct contact with infected ruminants, pri-marily sheep, goats, and cattle (1). Therefore, by the nature of their occupation, veterinarians have been identified as having a higher risk of C. burnetii exposure than the general population (2,3).

The presence of C. burnetii specific antibodies in serum is used to indicate past exposure to the bacterium. Immunofluorescence assay (IFA) is the reference serological test used to diagnose human Q fever (4). The IFA detects the immunoglobulin G (IgG) antibody response to phase I and phase II C. burnetii antigens (5). A phase II titer . phase I titer is suggestive of

recent exposure, while phase I titer $ phase II titer is suggestive of past exposure (5).

The objectives of this study were to: i) determine the preva-lence of C. burnetii seropositivity in Ontario small ruminant veterinarians and veterinary students; and ii) investigate demo-graphic, hygiene, biosecurity and lifestyle factors for association with seropositivity. A convenience sampling procedure was used; all attendees at the Small Ruminant Veterinarians of Ontario (SRVO) Annual General Meeting (AGM), which took place in Orangeville, Ontario, on February 24, 2012, were invited to participate. The SRVO is a voluntary professional organization of veterinarians and veterinary students with an interest in the health of ovine, caprine, and camelid species. Informed writ-ten consent was obtained from all 32 participants (18 males, 14 females). The University of Toronto Research Ethics Board (Certification of Ethical Acceptability of Research Involving Human Participants: Reference 27340) approved the study.

Blood samples were collected on-site by a certified phle-botomist via venipuncture into 10-mL red top serum BD vacu-tainer tubes (Becton, Dickson and Company, Franklin Lakes, New Jersey, USA). Serological analysis was performed at the Public Health Ontario Laboratory in Toronto using the Focus Diagnostic IFA (Cypress, California, USA), according to manu-facturer instructions. Serum samples were stored at 4°C if tested within 48 h, or stored at 220°C if tested beyond 48 h. Samples were considered seropositive when either the phase I or phase II IgG titer was $ 1:16, as per manufacturer’s guidelines (5).

Univariable exact logistic models were constructed in Stata Intercooled Version 10.1 (StataCorp, 2007; College Station, Texas, USA) to assess putative risk factor associations with the outcome of seropositivity. Univariable exact logistic regression

Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1 (Meadows, Jones-Bitton, McEwen, Menzies); Veterinary Science and Policy, Ontario Ministry of Agriculture, Food and Rural Affairs, 6484 Wellington Road 7, Unit 10, Elora, Ontario N0B 1S0 (Jansen); Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario M5G 1V2 (Patel); Department of Laboratory Medicine and Pathobiology, University of Toronto, Medical Sciences Building, 6th floor, 1 King’s College Circle, Toronto, Ontario M5S 1A8 (Patel); Ontario Ministry of Health and Long-Term Care, 393 University Avenue, 21st floor, Toronto, Ontario M7A 2S1 (Filejski).Address all correspondence to Dr. Shannon Meadows; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.


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modelling was used in place of standard asymptotic logistic regression, as the former is ideal for analyzing small, skewed, or sparse datasets (6). Associations were considered significant at confidence level of a , 0.05. If a covariate predicted sero-positivity perfectly, an estimate of the coefficient was calculated using a median unbiased estimates procedure to give a reason-able estimate of the covariate of interest (6). The dataset was considered too small for the development of a multivariable model.

At the time of sampling, 5 participants indicated in the ques-tionnaire that they suspected they had had Q fever at some point in the past. Two of these individuals sought medical attention but had negative serological tests for C. burnetii at that time. The reported symptoms attributed to Q fever by the 5 individu-als were: fever (n = 5), headache and muscle ache (n = 3), fatigue (n = 2), cough (n = 1), and sore throat (n = 1). All 5 of these individuals were seropositive for C. burnetii at the time of sam-pling for the current study. None of the 14 female participants were pregnant at the time of sampling. Of the 4 women who reported having been pregnant in the previous 2 y, all tested seropositive; none reported an adverse pregnancy outcome.

Serosurvey results indicated that 59.4% [19/32, 95% confi-dence interval (CI): 40.6% to 76.3%] of participating veteri-narians and veterinary students were seropositive to C. burnetii. Practicing veterinarians had a seroprevalence of 76.2% (16/21, 95% CI: 52.8% to 91.8%) compared to 50.0% (2/4, 95% CI: 6.8% to 93.2%) in veterinarians not active in clinical practice at the time of sampling, and 14.3% (1/7, 95% CI: 0.3% to 57.9%) in veterinary students. Table 1 demonstrates the distribution of phase I and phase II antibodies to C. burnetii antigens among the study population; 9.4% (3/32) and 50.0% (16/32) were considered to have recent and past exposures, respectively.

The exact logistic univariable analysis identified 2 covariates significantly associated with seropositivity. Being a veterinary student had a sparing effect, as students had 0.06 times (95% CI: 0.0011 to 0.65) the odds of seropositivity compared to practicing veterinarians; the odds of seropositivity among vet-

erinarians not active in clinical practice were not significantly different from the odds for either practicing veterinarians or veterinary students. In addition, participants aged 30 to 39 y and 40 to 49 y had 15 times (95% CI: 1.01 to 1059.64) and 13 times (95% CI: 1.26 to +Infinity) the odds of seropositivity, respectively, compared to those aged 18 to 29 y.

This is the first investigation examining C. burnetii sero-positivity among veterinarians and veterinary students in the province of Ontario, and the second in Canada (2). The sero-prevalence (59.4%, 19/32) indicates that exposure to C. burnetii was common. Coxiella burnetii has been identified as an occu-pational hazard for veterinarians and veterinary students else-where (3,7,8). For the present research, an IFA IgG titer cut-off of $ 1:16 was used, as this is the cut point recommended by manufacturers, and the low cut-point maximizes case capture of those who have been previously exposed to C. burnetii (6). Although an IFA titer cut-point analysis using past C. burnetii exposure as the outcome has not been published, manufactur-ers reported a high specificity (100%) using the cut-off of $ 1:16 (5). Due to the high specificity, false positives are not anticipated, though cross-reactivity to non-specific antibodies cannot be excluded (9).

Within our study group, there was an increased risk of C. burnetii seropositivity among practicing veterinarians com-pared to veterinary students. While veterinary students perform similar activities as veterinarians, particularly in upper years of study (7), they typically do not have as much opportunity for exposure to potentially infected animals as do veterinarians. Other risk factors for seropositivity previously identified and consistent with dose-response relationships between degree of animal exposure and human seropositivity include age, num-ber of hours with animal contact per week, number of years graduated as a veterinarian, and number of years lived on a farm (3,7,8). Young participants (aged 18 to 29 y) had decreased odds of seropositivity compared to those who were 30 to 39 y and 40 to 49 y; however, all 7 of the participating veterinary students, and 3 of the practicing veterinarians, were between 18 and 29 y

Table 1. Number of individuals (percentage of total samples) with specific serum titers for immunoglobulin G to Phase I and Phase II Coxiella burnetii antigens, among 32 small ruminant veterinarians and veterinary students as determined by the immunofluorescence assay (Focus Diagnostics) (February 24, 2012, Ontario, Canada)

Phase I

NR 1:16 1:32 1:64 1:128 $ 1:256 Total

Phase II

NR 13 (40.6) 2 (6.3) 1 (3.1) 1 (3.1) 0 (0) 0 (0) 17 (53.1)

1:16 1 (3.1) 0 (0) 1 (3.1) 0 (0) 0 (0) 0 (0) 2 (6.2)

1:32 0 (0) 0 (0) 2 (6.3) 3 (9.4) 2 (6.3) 0 (0) 7 (22.0)

1:64 0 (0) 0 (0) 0 (0) 2 (6.3) 0 (0) 0 (0) 2 (6.3)

1:128 0 (0) 0 (0) 2 (6.3) 0 (0) 2 (6.3) 0 (0) 4 (12.6)

$ 1:256 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)

Total 14 (43.7) 2 (6.3) 6 (18.8) 6 (18.8) 4 (12.6) 0 (0) 32 (100.0)

With the exception of non-reactive titers, titers above the dashed line are suggestive of a chronic infection and those below, suggestive of an acute infection.NR — Not reactive.40.6% (13/32) Unexposed (phase I and phase II IgG not reactive).9.4% (3/32) Titers suggestive of recent exposure (phase II titer . phase I titer).50.0% (16/32) Titers suggestive of past exposure (phase I titer $ phase II titer).


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of age. When students were excluded from the analysis, age was no longer associated with seropositivity. Age may therefore be an explanatory antecedent of position (practicing veterinarian/student) (6), since age can largely explain the participants’ stage of career. Due to the small sample size of our dataset, we were unable to determine whether age confounded the relationship between stage of career and seropositivity.

We hypothesized that the percent of a veterinarian’s practice dedicated to sheep, goats, or to a lesser extent cattle, would have had an association with seropositivity, as up to 1 3 109 organisms may be shed in the sheep/goat placenta (10) and these animal species have been linked to human cases of Q fever (1); however, this study failed to demonstrate any relationship. The potential animal source of C. burnetii exposure among seroposi-tive veterinarians and veterinary students remains unclear. While sheep and goats have high seroprevalences in Ontario (11,12), C. burnetii could have been transmitted to participants from cows, cats, or other animals.

By the nature of their occupations, small ruminant veteri-narians and veterinary students may be exposed to C. burnetii frequently throughout their career. The animal Q fever vaccine (Coxevac; CEVA Animal Health, Libourne, France) is now avail-able for use in Ontario in sheep and goats. However, since vet-erinarians potentially have contact with animals on many farms, use of the vaccine in sheep and goats may not infer veterinarian protection unless use was widespread. Therefore, vaccinating unexposed veterinary students and veterinarians, particularly those at high risk of developing chronic Q fever (e.g., those with pre-existing heart disease), with a human C. burnetii vac-cine (Q-Vax; CSL Biotherapies, Melbourne, Australia), merits future consideration. The Q-Vax vaccine is currently used in Australia, and research has demonstrated that it induces a long-lived immune response to C. burnetii (13).

Several limitations of the study should be noted. While 1/3 of all SRVO members were sampled for this study, the sample size was nevertheless small. The exact logistic regression models served to limit the bias of the coefficients and P-values obtained from small sample sizes (6); however, our sample size, and an expected proportion C. burnetii exposure of 59% (as observed here), means the statistical power is low (calculated at 16.5%). Larger sample sizes may be required to further elucidate the relationship between risk factors and veterinarian seropositivity in Ontario, and to increase the precision of identified associa-tions. This study may also have been subject to selection bias. Our sampling frame of SRVO members is not an exhaustive list of all veterinarians and veterinary students who work with small ruminants in Ontario. As previously noted, SRVO is a voluntary organization and is involved in the continuing education of veterinarians in the health and welfare of small ruminants. The SRVO members may therefore be more engaged in learning about small ruminants and consider small ruminants as a more important part of their caseload or anticipated caseload, than non-members. In addition, research has identified a number of other barriers to participation in continuing education events among veterinarians including: ownership of a solo practice, stage of career, and family demands (14). These factors may have influenced attendance at the AGM, and thus, subsequent par-

ticipation. Most participants had not been tested for C. burnetii exposure before participating in our study and most did not suspect that they have had Q fever.

Overall, Coxiella burnetii seropositivity was common among SRVO members, particularly among veterinarians, presumably due to their contact with infectious animals. Veterinarians should be alert to the signs and symptoms of Q fever, and should ask their physician for the appropriate tests should these signs and symptoms appear. Hygiene and biosecurity practices, while not statistically associated with seropositivity here, are encouraged for their utility in preventing occupational exposure to not only C. burnetii, but also several other zoonotic disease agents (8).

AcknowledgmentsThe authors thank: the Ontario Ministry of Agriculture, Food and Rural Affairs-University of Guelph Agreement through the Animal Health Strategic Investment fund (AHSI) managed by the Animal Health Laboratory of the University of Guelph; the Ontario Ministry of Health and Long-Term Care; the Natural Sciences and Engineering Research Council of Canada; and Public Health Ontario. The authors also acknowledge the cooperation of the SRVO and the small ruminant veterinarians and veterinary student members who participated in this study. CVJ

References 1. Maurin M, Raoult D. Q fever. Clin Microbiol Rev 1999;12:518–553. 2. Marrie TJ, Fraser J. Prevalence of antibodies to Coxiella burnetii among

veterinarians and slaughterhouse workers in Nova Scotia. Can Vet J 1985;26:181–184.

3. Whitney EAS, Massung RF, Candee AJ, et al. Seroepidemiologic and occupational risk survey for Coxiella burnetii antibodies among US vet-erinarians. Clin Infect Dis 2009;48:550–557.

4. Anderson A, Bijlmer H, Fournier PE, et al. Diagnosis and Management of Q Fever — United States, 2013: Recommendations from CDC and the Q Fever Working Group. MMWR. 2013;62:1–30.

5. Q Fever IFA IgG [Internet]. Focus Diagnostics. 2011. p. 2–5. Available from: www.focusdx.com/pdfs/pi/OUS/IF0200G.pdf Last accessed January 16, 2017.

6. Dohoo I, Martin W, Stryhn H. Veterinary epidemiologic research. Prince Edward Island, Canada: AVC Incorporated; 2003.

7. de Rooij MMT, Schimmer B, Versteeg B, et al. Risk factors of Coxiella burnetii (Q fever) seropositivity in veterinary medicine students. PLoS One 2012;7:e32108.

8. Van den Brom R, Schimmer B, Schneeberger PM, Swart WA, van der Hoek W, Vellema P. Seroepidemiological survey for Coxiella burnetii antibodies and associated risk factors in Dutch livestock veterinarians. PLoS One 2013;8:e54021.

9. Musso D, Raoult D. Serological cross-reactions between Coxiella burnetii and Legionella micdadei. Clin Diagn Lab Immunol 1997;4:208–212.

10. Sánchez J, Souriau A, Buendía AJ, et al. Experimental Coxiella burnetii infection in pregnant goats: A histopathological and immunohisto-chemical study. J Comp Pathol 2006;135:108–115.

11. Meadows S, Jones-Bitton A, McEwen S, Jansen J, Menzies P. Coxiella burnetii seropositivity and associated risk factors in goats in Ontario, Canada. Prev Vet Med 2015;121:199–205.

12. Meadows S, Jones-Bitton A, McEwen S, Jansen J, Menzies P. Coxiella burnetii seropositivity and associated risk factors in sheep in Ontario, Canada. Prev Vet Med 2015;122:129–134.

13. Kersh GJ, Fitzpatrick KA, Self JS, Biggerstaff BJ, Massung RF. Long-term immune responses to Coxiella burnetii after vaccination. Clin Vaccine Immunol 2013;20:129–133.

14. Moore DA, Klingborg DJ, Brenner JS, Gotz AA. Perspectives in profes-sional education in continuing veterinary medical education. J Am Vet Med Assoc 1998;217:1001–1006.


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Student Paper Communication étudiante

A case of feline ectopic abdominal fetuses secondary to trauma

Andrew Chong

Abstract — A multiparous adult cat with a history of prior trauma but no presenting clinical signs was admitted for routine ovariohysterectomy. Uterine abnormalities indicative of trauma were found in addition to 2 ectopic fetuses wrapped in omentum. The ovariohysterectomy was completed and the ectopic fetuses were removed. Recovery was uneventful.

Résumé — Cas de fœtus abdominaux ectopiques félins secondaires à un traumatisme. Une chatte adulte multipare ayant une anamnèse de traumatismes antérieurs mais ne présentant aucun signe clinique a été admise pour une ovario-hystérectomie de routine. Des anomalies utérines indiquant un traumatisme ont été trouvées en plus de deux fœtus ectopiques enveloppés dans l’omentum. L’ovario-hystérectomie a été réalisée et les fœtus ectopiques ont été enlevés. Le rétablissement s’est effectué normalement.


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A female, domestic, short-haired, adult calico cat of unknown age was presented to Norwich Veterinary Service for a spay

surgery on May 17, 2016. The cat primarily lived outdoors in the owner’s barn, and so a detailed history could not be obtained. The owner noted that the cat had previously given birth to 3 healthy litters each of 3 to 4 kittens, but she was unsure whether the cat was currently pregnant. Approximately 3 to 4 mo earlier, the cat had been stepped on by a cow, but continued to be ambulatory and appeared to be healthy after-wards. The owner was not sure if the cat had been pregnant at the time of the incident. During the preoperative examination, it was not possible to determine pregnancy by palpation and no abnormalities were discovered.

Upon incising into the abdominal cavity, a moderate amount of serosanguinous fluid was found. Gauze was used to soak up most of the fluid and the surgery was continued. After ligation of the left ovarian pedicle, an attempt was made to visualize the right ovarian pedicle and numerous abnormalities were found. First, the right uterine horn was found to have ruptured into 2 sections with a 3-cm gap filled with hemorrhagic tissue (Figure 1). Second, there was an adhesion between the gap and body wall with 3 to 4 circular, soft, fat-like nodules of

approximately 1 cm diameter contained within. The adhesion was vascularized and may have attached to a portion of the small intestines, but it was difficult to confirm without more invasive manipulation. The adhesion was ligated and the surgery was continued. Interestingly, the uterus itself was not distended and beyond the abnormalities listed, appeared normal. The right ovarian pedicle and uterine body were then ligated as per standard spay protocols.

Prior to closing, the abdomen was thoroughly searched and 2 dead fetuses were found wrapped in well-vascularized omen-tum in the cranial abdomen (Figure 2). Additionally, there was evidence of blood supply between the spleen and fetuses. Ligations of 3 large omental vessels and 1 splenic vessel were made to remove the fetuses. The fetuses were each approximately 10 cm from crown to rump, had fine hair covering most of the body, and their limbs were bent in abnormal angles. The lighter-colored fetus was especially abnormal, with the caudal half of the body rotated nearly 180°, and a 3-cm crater-like lesion in

Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1.Address all correspondence to Andrew Chong; e-mail: [email protected]. Chong will receive 50 copies of his article free of charge courtesy of The Canadian Veterinary Journal.Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

Figure 1. Right uterine horn rupture with approximately a 3-cm gap of hemorrhagic tissue and an adhesion to the ventral body wall containing soft, fat-like nodules of approximately 1 cm diameter.


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the abdominal area with an absence of abdominal organs. The patient’s omentum also contained a yellow/tan, amorphous, soft-tissue mass that was 3 to 4 cm in diameter with a ridged surface. None of the fetuses were found with placenta. Additionally, fine dark hairs were found throughout the abdomen. The abdomen was lavaged with sterile saline and 5 mL of a penicillin solu-tion (penicillin G; Fresenius Kabi, Richmond Hill, Ontario) reconstituted to 100 mg/mL before closing the surgical site. The patient was kept in hospital for 3 d and placed on clavulanic acid and amoxicillin tablets (Clavaseptin; Vétoquinol, Lavaltrie, Quebec), 62.5 mg, PO, q12h, for the duration of the cat’s stay.

At 3 d post-surgery, ventral-dorsal and right lateral abdominal radiographs were taken. A medially displaced healing fracture was identified in the midsection of the wing of the left ilium. No additional fetuses or other abdominal abnormalities were observed on radiographs. Despite this fracture, the patient showed no gait abnormalities at admittance and after surgery. Since the surgery, the patient has returned to the owner’s barn and has had no complications.

DiscussionEctopic pregnancies are defined as pregnancies that occur outside of the uterus. They are traditionally classified as either abdominal or tubal pregnancies, depending on the site of implantation. There have been no cases of tubal pregnancies in non-primate animals, possibly because of factors inhibit-ing implantation in the uterine tube and/or lack of maternal recognition of pregnancy (1). However, abdominal pregnancies in cats and other domestic animals have been reported in the literature, albeit uncommonly.

Abdominal pregnancies can be categorized into 2 forms: primary and secondary. Primary abdominal ectopic pregnancies occur when a fertilized oocyte is expelled into the abdomen and implants itself on an abdominal organ such as the omentum or spleen. These have been theorized to occur if a fertilized ovum was present during a spay surgery and excessive handling during surgery allowed the ovum to escape into the abdomen

(2). In order to diagnose a primary abdominal ectopic preg-nancy, histology is required to show extrauterine placentation onto an abdominal organ. To date, there have been no reports documenting this phenomenon with sufficient histological evi-dence. Secondary abdominal ectopic pregnancies occur if the oocyte matures into a fetus while it is still in the uterus, then is expelled into the abdominal cavity due to uterine wall rup-ture and continues its development there. In the available case reports, the diagnosis of these have been based on a history of trauma, evidence of uterine trauma, and gross findings of mum-mified fetuses in the abdomen (3,4). However, for a confirmed diagnosis, there must be evidence of continued development or viability while in the abdomen (5). In humans, evidence of development in secondary abdominal pregnancy often takes the form of life-threatening hemorrhage caused by the developing fetus. This hemorrhage results from the increase in fetal size within a substitute organ which has a relatively low expansion potential compared to the uterus (6). In cats, although clinical signs are reported in some cases of secondary ectopic pregnan-cies, none of the case reports have associated intra-abdominal hemorrhage (3–5,7). A possible explanation for this lack of development may be that there is a difference in placental inva-sion, which describes the degree of fetal trophoblast contact and infiltration into maternal tissues. While humans have the most invasive type, called hemochorial placentation, cats have endotheliochorial placentation, which has only a slight degree of maternal tissue invasion. Thus, from a comparative anatomy perspective, cats are less likely to have ectopic pregnancies due to a difference in their placentation (5,8).

Unfortunately, this case also lacks the histological evidence needed to definitively diagnose an abdominal ectopic pregnancy. Therefore, an ectopic fetus may be a more appropriate diagnosis. Since an ectopic fetus is characterized by its abnormal location, the only requirement for diagnosis is locating the fetus. Since there is lack of evidence to support fetal implantation onto the omental tissues in this patient, the tentative diagnosis is ectopic fetuses. A macroscopic inspection of the fetuses and

Figure 2. Ectopic fetuses ex-situ. The fetuses were 10 cm from crown to rump, fully-haired, and had abnormal body and limb positions. A yellow/tan amorphous mass of approximately 3 to 4 cm with undulating margins was found beside the black and white-haired fetus. Additionally, the black and white-haired fetus’ abdomen had a crater-like lesion and contained no abdominal contents.


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analysis of the history provides evidence for this diagnosis. Gross inspection of the yellow/tan amorphous mass found in the omentum suggested that it could have been intestinal contents undergoing autolysis. It is possible that the sudden increase in intra- abdominal pressure during the traumatic incident not only caused a uterine rupture, but also directly damaged the fetuses themselves leading to expulsion of one of the fetus’ abdominal contents. Moreover, the fine hairs tracked throughout the abdo-men may have been due to the traumatic passage of the fetus from the uterus to the cranial abdomen. These observations all support a diagnosis of ectopic fetuses secondary to trauma.

There has been a wide variety of clinical signs associated with ectopic fetuses. Some reports have described non-specific signs such as fever and vomiting, while others have found the ectopic fetuses incidentally during routine spay surgery or abdominal radiographs (3–5,7). It is unknown if ectopic fetuses directly cause clinical signs due to obstruction, or if initial rupture of the uterus itself causes peritonitis due to release of bacteria from the uterine microflora (3). In this case, the patient was presented with no clinical signs yet had a moderate amount of fluid upon opening its abdomen. It is possible that the ruptured uterine horn remained open to the abdomen, and thus during every estrus cycle, the normal fluid accumulation in the uterus was deposited in the abdomen. Whether this may eventually cause clinical signs is unknown, but given that the patient has had no clinical signs 3 to 4 mo after the incident and the recovery itself was uneventful, it is highly likely that the ectopic fetuses were incidental.

Based on the gross findings, history of the patient, and lit-erature analysis, this patient had an ectopic fetus secondary to abdominal trauma. It is also likely that previous cases diagnosed as secondary abdominal ectopic pregnancies may also be in fact, ectopic fetuses secondary to trauma. However, there are no

experimental studies attempting to replicate secondary abdomi-nal ectopic pregnancies in cats or other domestic animals. Non-primate animal models of tubal ectopic pregnancies have been made with some success (9), but currently there are no models of secondary abdominal ectopic pregnancies in domestic animals. This case adds to the database of ectopic fetuses and further illustrates their incidental nature.

AcknowledgmentsI thank Dr. Kathi Kirby for her guidance and support through-out the management of this case and Drs. Cowbrough and Barnes for hosting me during my externship. Special thanks are due to the Norwich Veterinary Services staff for their continued support during my veterinary education. CVJ

References1. Corpa JM. Ectopic pregnancy in animals and humans. Reproduction

2006;131:631–640.2. Kustritz MV. Clinical management of pregnancy in cats. Theriogenology

2006;66:145–150.3. Dzięcioł M, Niżański W, Ochota M, et al. Two separate cases of extrauter-

ine pregnancy in queens. Electr J Pol Agric Univ 2012;15(2).4. Osenko A, Tarello W. A 7-Year-Old Extrauterine Pregnancy in a Cat.

Case Report Vet Med 2014. Available from: https://www.hindawi.com/journals/crivem/2014/145064/ Last accessed February 14, 2017.

5. Nack RA. Theriogenology question of the month. J Am Vet Med Assoc 2000;217:182–184.

6. Agarwal SS, Chavali KH, Kumar L, Kumar S, Sheikh I. Secondary abdominal ectopic pregnancy: Diagnosis at autopsy. J Ind Acad Forensic Med 2007;29:5–7.

7. Rosset E, Galet C, Buff S. A case report of an ectopic fetus in a cat. J Feline Med Surg 2011;13:610–613.

8. Furukawa S, Kuroda Y, Sugiyama A. A comparison of the histological structure of the placenta in experimental animals. J Toxicol Pathol 2014; 27:11–18.

9. Wang H, Guo Y, Wang D, et al. Aberrant cannabinoid signaling impairs oviductal transport of embryos. Nat Med 2004;10:1074–1080.

The participation of advertisers in the CVJ is an indication of their com-mitment to the advancement of veterinary medicine in Canada. We encourage our readers to give their products and services appropriate consideration. — Ed.

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Veterinary History Histoire vétérinaire

The creation of the Department of Population Medicine at the Ontario Veterinary College

Kevin Woodger, Elizabeth Stone, Cate Dewey

I n 1987 the Ontario Veterinary College (OVC), University of Guelph, inaugurated the Department of Population

Medicine, beginning a new era in the College’s approach to veterinary medical education, research and health care. The creation of the Department was the product of wider changes in the nature of livestock agriculture, the growing importance of population level health management in veterinary practice in Canada and elsewhere, and strong support from within the College. Population level preventive medicine became increas-ingly important over the second half of the 20th century as the intensification of livestock production combined with tightening profit margins for producers made the prevention of disease and increased productivity vital to the success of livestock agricul-ture. Outbreaks of new production limiting diseases among livestock populations can wreak havoc on agricultural economies and cause substantial financial losses for producers. Within OVC a number of influential faculty members, including Drs. Wayne Martin, Bob Curtis, Alan Meek, Bob Friendship, Ken Leslie, Bill Mitchell, and Dean Ole Nielsen helped lay the foundation for, and/or were the driving forces behind the creation of the Department. Their work helped put OVC in a leadership posi-tion in terms of the growth of population medicine in North America. Several of these faculty members were interviewed and their thoughts have been incorporated into this paper.

As a consequence of these developments OVC reconsidered its approach to livestock animal medicine and created the Department of Population Medicine to systematically teach and perform research and extension work in farm animal health management and welfare, epidemiology, public health, food protection, and theriogenology.

The intensification of livestock production, especially from the 1960s onwards, meant that food animal veterinarians needed to re-orient their practices to serve the new focus on herd health,

which emphasized preventive medicine as an effective response to tight profit margins for producers. Producers were forced to increase productivity to keep pace with the increasing costs of agricultural production, as the intensification of agriculture led to increased costs of farm machinery and land, due in part also to rapid urbanization and the spread of human populations over agricultural lands in places such as Ontario. Such tight profit margins meant that veterinarians needed to provide services that would be economically beneficial to producers as they changed their focus from individual animals to the herd as a whole (1). Many veterinarians recognized the financial constraints facing large-scale livestock producers and throughout the 1960s and 1970s began to advocate herd health management as a way to provide cost-effective veterinary services to livestock producers.

Beginning in the early 1960s, the Ontario Veterinary College, with the assistance of the Livestock Branch of the Ontario Department of Agriculture, began a Specific Pathogen-Free (SPF) pig program to “create a nucleus of high quality pure-bred certified herds from which other secondary herds can be established easily and economically” (2).These pigs were seen as potentially able to “break the cycle of infection at the moment of birth.” While there were high start-up costs, long-term sav-ings would accrue from decreased drug costs and mortality rates compared to conventional herds (3). Specific Pathogen-Free researcher M.K. Abelseth noted that “the practicing veterinar-ian should be closely associated with the SPF programme” (4). Veterinarians provided farmers with advice on topics such as sanitation and nutrition, and by 1964 it was reported that veterinarians with SPF herd clients “have co-operated to the fullest extent in endeavoring to keep the herd health status at a high level” (3).

In 1974 Dr. O.M. Radostits (a faculty member at the OVC in the early 1960s before moving to the Western College of Veterinary Medicine at the University of Saskatchewan in 1964) noted that the modern livestock producer is “business oriented and applies the principles of agricultural economics to his every-day task of allocating resources to achieve optimum returns.” He argued that the high cost of raising stock such as cattle and pigs meant that “progressive” producers would increasingly demand high quality herd health services from their veterinarians. In addition, Canadian and American veterinary colleges, which traditionally focused on individual animals, would need to teach herd level medicine to meet this new demand (5).

A mid-1970s report in Ontario recommended a simi-lar approach. William A. Stewart, the Ontario Minister of Agriculture and Food, commissioned Dr. E.H. Botterell to

Department of Population Medicine (Dewey), Department of Clinical Studies (Stone), Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1; Department of Historical Studies, University of Toronto, 100 St. George Street, Room 2074, Toronto, Ontario M5S 3G3 (Woodger).Address all correspondence to Dr. Cate Dewey; e-mail: [email protected] of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.


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study the state of livestock animal health management. The Botterell Report (6) concluded that “the food animal industry and veterinary medicine are entering the era of Maintenance of Health Programs in support of intensive production of food-producing farm animals (herd health).” Botterell found that the intensive production of livestock animals was making “new and heavy demands” for preventive medicine programs and for services to help producers manage such things as nutrition, fertility, and humane housing (5). While Botterell found that the emergency, or “fire-engine” approach to veterinary farm practice was well taken care of in Ontario, due in large part to the long hours worked by livestock veterinarians, “relatively little has been achieved in the direction of a comprehensive system of Maintenance of Health Programs for food producing animals” (6).

The result of this was “substantial economic loss due to disease in livestock and poultry” (6). The Ontario Ministry of Agriculture and Food estimated that animal diseases cost the Ontario economy over $100 million in 1973. These losses could be reduced through health management and preventive veterinary medicine programs. For example, veterinarians could assist swine producers in managing and preventing or reducing potentially devastating outbreaks of diarrhea due to Escherichia coli, especially among newborn pigs. One way of doing this was through an E. coli vaccine developed by OVC faculty member Dr. Michael R. Wilson in the early 1970s (7). This vaccine remains in use and its administration has become standard practice for all sows prior to farrowing.

Herd health was a lesson that Martin, one of the founders of population medicine at OVC, learned in the 1970s from pioneering veterinary epidemiologist Dr. Calvin Schwabe at the University of California Davis (UCD). Schwabe argued that “preventive veterinary medicine of the future will largely be a form of on-going on-farm research, based upon surveil-lance” (Interview with Wayne Martin by Kevin Woodger and Cate Dewey, March 2, 2015). Often referred to as the “father of veterinary epidemiology,” Dr. Schwabe founded the UCD Department of Epidemiology and Preventive Medicine (the first of its kind in any veterinary school) in the late 1960s and was a strong advocate of the concept of one medicine. Schwabe believed that animal and human medicine are intimately linked and veterinarians could make meaningful contributions to the field of human health and public health (9). Indeed, the growth of veterinary epidemiology mirrored a similar trend in human health. In human medicine in the 1970s and 1980s an increased emphasis was placed on epidemiological methods, health promo-tion and preventive medicine (10).

The OVC introduced a dairy herd health program in 1960 when 2 Clinical Studies faculty members, Drs. Jack Cote and Bob Curtis, began enrolling herds. Twenty years into the program, Cote reported that “herd health practice has been a very satisfying aspect of veterinary medicine and a profit-able and valued service to our clients.” Aspects of OVC’s herd health program included monthly visits to participating farms for physical examinations, implementing good recordkeeping practices which would allow the veterinarian to quickly find necessary information, immunizations against viral diseases,

and supplying farmers with and advising them on the use of veterinary drugs. Cote concluded that for farmers who took full advantage of the program, returns on investment were as high as 300% to 500% (11).

Curtis was himself an early and influential advocate for herd health and preventive medicine. In 1971, Curtis argued that preventive medicine programs, especially if subsidized by the government, could be of great benefit to agricultural produc-tion and allow the large animal veterinarian to move beyond the “emergency service approach” (12). He noted that the veteri-narian, “by his unique training which enables him to diagnose disease has the broadest background to implement preventive medicine programs” (12). While the veterinarian may not be an expert in fields such as nutrition, agricultural engineering, or animal science, Curtis believed that “he is the man best qualified to recognize disease as a cause of lost production and to pinpoint the contributing factors such as inadequate nutri-tion, faulty housing and management” (12). For these reasons, Curtis believed that veterinarians would be the perfect liaisons “between the producers and the experts in the various disciplines mentioned” (12). Although he would leave OVC in 1985 for the Atlantic Veterinary College at the University of Prince Edward Island, Curtis was “at the forefront” of fostering relations with associated producer groups, industry partners, and commodity boards,” in support of preventive medicine (13). According to Meek, Curtis influenced the changing philosophy of veterinary medicine, which created a climate amenable to a Department of Population Medicine (Interview with Alan Meek by KW, March 2, 2015).

The 1976 Botterell Report, faculty advocates such as Curtis and Cote, Martin’s experiences at UCD, and the growing OVC herd health program led to discussions at OVC about creating a department focused on population level medicine. Dr. Bill Mitchell, a faculty member in the Department of Veterinary Microbiology and Immunology (VMI) was also influential. Throughout the 1960s and 1970s Mitchell taught a Public Health course in the Doctor of Veterinary Medicine (DVM) program, which incorporated aspects of applied epidemiology. He also stressed to his colleagues in VMI that “there was more to understanding and controlling disease than the microbe,” and was an advocate for the use of epidemiology in public health and in government efforts at controlling diseases such as bovine tuberculosis and brucellosis (Interview with Wayne Martin by Kevin Woodger and Cate Dewey, March 2, 2015). Furthermore, Mitchell helped convince Schwabe to take on Wayne Martin as a PhD student in 1970 and he was instrumental in supporting the hiring of both Martin and Alan Meek (after he completed a PhD in epidemiology at the University of Melbourne) into VMI in the mid-1970s, changing the “face” of OVC, as Wayne Martin put it (Interview with Wayne Martin by Kevin Woodger and Cate Dewey, March 2, 2015).

By the 1980s, OVC had 4 departments; Biomedical Sciences, Pathology, Clinical Studies and VMI. In the summer of 1981, the OVC Dean, Dr. D.C. Maplesden, appointed a committee of OVC faculty, which was chaired by Dr. Gordon Ball, Associate Dean of the Ontario Agricultural College, with a member-ship of Curtis, Meek, W.H. Harris, and J.O.D. Slocombe, to


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investigate what the College should do in the area of preventive medicine. Settling on the term health management rather than preventive medicine, the committee sought to “assess the needs of the profession and society in general in the area of health management,” and to “recommend how these needs might be best fulfilled by OVC in its responsibilities for teaching, research and extension” (14). The committee defined health management as a concern for the health of animal populations and with the development of programs to maintain health in order to opti-mize production efficiency and produce high quality animal food products under humane conditions (14).

Over the course of its investigation, the Committee decided that the creation of a Department of Health Management would be the best way to generate producer awareness of the importance of preventive medicine, and to facilitate teaching, research, and extension work in health management. They envisioned faculty joining the new department from relevant areas across the College, including reproduction and swine, ruminant, and poultry medicine (from Clinical Studies) as well as epidemiology and public health (from VMI). They also called for computer scientists and biometricians, as it was perceived that the new department would need to manipulate large volumes of data concerning the health of client herds. It was recognized that information management on herd health was becoming increasingly important. This was reflected in the Committee’s recommendations for the potential department’s teaching program which would include an emphasis on epide-miology and the statistical analysis of the wealth of information (including nutrition, genetics, and housing) needed to determine the cause of disease outbreaks and production concerns among animal populations (14).

Data generation and collection would also be key to the department’s research program. The Committee noted that the general absence of health management programs in Ontario resulted in a dearth of data on which OVC researchers could base technical health management advice. They noted that pro-duction diseases were increasingly prominent and that veterinary services should be tailored to treating and controlling these. With that in mind, the Committee outlined a research program for the department that would center around “the interrelation-ships between the various components and levels of livestock production including husbandry/management, production, producer objectives and disease” (14).

According to Martin, the findings of the Committee on Health Management supported the general desire amongst faculty to act on the recommendations of the Botterell Report and “do things differently” (Interview with Wayne Martin by Kevin Woodger and Cate Dewey, March 2, 2015). In the late 1970s, Martin and Meek (who was Chair of VMI in the early 1980s) were becoming increasingly aware that their work study-ing populations was an awkward fit in the VMI department that focused mainly on diseases of individual animals and, according to Meek, in many cases “not even…the individual animal,” but more on the cellular level (15).

After the Committee released its report in April 1982, a faculty vote was taken on the motion to create a Department of Health Management. According to Martin, the mood among

his colleagues at the time was, “oh yea this will pass and we’ll move ahead with this” (Interview with Wayne Martin by Kevin Woodger and Cate Dewey, March 2, 2015). Dr. Friendship, who was at that time a faculty member specializing in swine diseases in the Department of Clinical Studies, recalled in an interview that the proposed department was “sort of the domi-nant talk in the coffee room.” He had seen the proposed depart-ment as a way to secure the place of food animals in the College in the face of the growing popularity of small animal medicine (Interview with Bob Friendship by KW, March 2, 2015). Even with this support, the motion to create the department failed. Martin notes that the failure of the Department of Health Management motion came as a surprise to most of his col-leagues, although not to him because he had voted against the creation of the department. Despite the growing calls for a more herd-oriented approach to livestock medicine, Martin believed that the concept of herd health management was too narrow, with the connotation that public health and zoonoses would not be incorporated into the department’s work (Interview with Wayne Martin by Kevin Woodger and Cate Dewey, March 2, 2015). Martin would take a leading role in advocating for a broader definition of population medicine during the years between the vote on a Department of Health Management and a vote on the founding of the Department of Population Medicine.

Both Martin and Friendship agree that there was a good deal of misunderstanding within OVC about the concept of health management, especially among individual animal-oriented fac-ulty members. Friendship recalls that within Clinical Studies, many of the proponents of individual animal medicine did not understand that it “was ridiculous to bring a cow or a pig into the clinic and have the students do a big workup on it the way you would a pet.” In the context of intensive livestock operations, “if you’re going to bring the animal in to diagnose the situation you would take them straight to the postmortem room and try to make a diagnosis as quickly as you can because there’s another thousand of them out in the barn that are dying of the same thing” (Interview with Bob Friendship by KW, March 2, 2015).

After the 1982 vote that rejected the creation of a Department of Health Management, conversations and initiatives continued to advance population level health management. Particularly important was creation of a coursework Master of Science pro-gram in epidemiology by Martin, with the assistance of Meek, within VMI in 1982. The program was designed to “prepare students for participation in the organization of animal disease control programs at the farm and provincial and federal gov-ernment levels” (15). Over the next several years, this program would become internationally renowned and was matched only by Dr. Calvin Schwabe’s veterinary epidemiology program at UCD. Martin’s program attracted some of the best students from OVC and around the world to study epidemiology. The success of Martin’s graduate program in epidemiology was a key factor in convincing OVC faculty to support population medi-cine in 1987. For a list of all epidemiology-focused graduate students between 1979 and 1998 (including those from VMI in the coursework MSc in epidemiology and those who were


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Table 1. Epidemiology-focused Graduate Students, 1979–1998

Name Yeara Degreeb Position/Institution or Agencyc Country

Hollis Erb 1979 PhD Professor/Cornell University USAIan Dohoo 1982 PhD Professor/University of Prince Edward Island CanadaScott McEwen 1985 DVSc Professor/University of Guelph CanadaDavid Waltner-Toews 1985 PhD Professor/University of Guelph CanadaNonie Smart 1987 MSc Senior Scientist/Canada Food Inspection Agency CanadaKenneth Bateman 1988 MSc Professor/University of Guelph CanadaBrenda Bonnett 1988 PhD CEO, International Partnership for Dogs CanadaNeil Anderson 1989 MSc Lead Veterinarian, Bovine Health and Welfare, OMAFRAd CanadaHelen Drolia 1989 MSc Veterinary Practitioner/Greece GreeceGary Halbert 1989 MSc Analyst and Scientific Advisor/CFIAe CanadaDavid Sandals 1989 MSc Professor/University of Guelph CanadaDavid Alves 1990 PhD Deputy Chief Veterinarian of Ontario/OMAFRA CanadaJohn McDermott 1990 PhD Director/CGIARf Research Program on Agriculture for Nutrition and Health, USA International Food Policy Research InstituteW. Bruce McNabb 1990 PhD Senior Scientist/Animal Health and Welfare Branch, OMAFRA CanadaJonathan Morgan 1990 MSc Manager/CFIA CanadaCord Heuer 1991 MSc Professor/EpiCentre, Massey University New ZealandJeff Wilson 1991 PhD President/Novometrix Research Inc CanadaCate Dewey 1992 PhD Professor and Department Chair/University of Guelph CanadaGordon Doig 1992 MSc Senior Lecturer/University of Sydney AustraliaPilar Donado-Godoy 1992 MSc Scientist/CORPOICA, CBBg ColombiaArmin Elbers 1992 MSc Senior Scientist/Central Veterinary Institute NetherlandsGeorge Gitau 1992 MSc Professor/University of Nairobi KenyaCarol Mulder 1992 MSc Provincial Lead, Quality Improvement Decision Support Program, AFHTOh CanadaCarl Ribble 1992 PhD Professor/University of Calgary CanadaDominique Baronet 1993 MSc Director of Development & Regulations, MAPAQi CanadaJohn Deen 1993 PhD Professor/University of Minnesota USAAndrea Ellis 1993 MSc Scientist/CFEZIDj, PHACk CanadaPatrick Hearne 1993 MSc Co-owner, Hearn Veterinary Services CanadaGeorge Hillis 1993 MSc Veterinarian/East Oshawa Animal Hospital CanadaJulia Keenliside 1993 MSc Epidemiologist/Alberta Agriculture and Rural Development CanadaJohn Griffin 1994 MSc SSVIj/Department of Agriculture and Food IrelandMutsuyo Kadohira 1994 PhD Professor/Obihiro University of Agriculture and Veterinary Medicine JapanRonny Mudigdo 1994 MSc Director for Animal Diseases Investigation Center Maros IndonesiaFrank Pollari 1994 PhD Senior Epidemiologist/CFEZID, PHAC CanadaBambang Sumiarto 1994 MSc Professor/Gadjah Mada University IndonesiaAndré Busato 1995 MSc Professor/University of Bern SwitzerlandAbdelhamid Elfadil 1995 PhD Professor/Sudan University of Science and Technology SudanGeorge Gunn 1995 MSc Professor/Scotland’s Rural College ScotlandJack Halip 1995 MSc President/Professional Animal Behavior Associates Inc. CanadaDavid Kelton 1995 PhD Professor/University of Guelph CanadaDean Middleton 1995 MSc Senior Public Health Epidemiologist/Public Health Ontario CanadaParminder Raina 1995 PhD Professor/McMaster University CanadaSonja Saksida 1995 MSc CEO/British Columbia Centre for Aquatic Health Sciences CanadaNathaniel Tablante 1995 MSc Professor/University of Maryland USAPaul Valle 1995 MSc Professor/Norwegian School of Veterinary Science NorwayCindy Adams 1996 PhD Professor/University of Calgary CanadaPeter Buck 1996 MSc Senior Public Health Epidemiologist, PHAC CanadaHugo Dunlop 1996 PhD Veterinarian, Chris Richards Associates Swine Veterinary Consultants AustraliaMuhamad Sopian Johar 1996 MSc Epidemiologist/Ministry of Agriculture MalaysiaGeorge Nasinyama 1996 PhD Deputy Vice-Chancellor, Research Innovation and Extension/KIUl UgandaRita Nespeca 1996 MSc Associate Director Data Management/ProNAi Therapeutics CanadaChristine Power 1996 MSc Professor/Institute of Child Health, University College London EnglandAsep Saefuddin 1996 PhD Rector/Trilogi University IndonesiaJan M. Sargeant 1996 PhD Director, Centre for Public Health & Zoonoses, University of Guelph CanadaNathalie Bruneau 1997 PhD National Manager Aquatic Surveillance & Epidemiology, CFIA CanadaAbdunaser Dayhum 1997 MSc Professor/University of Tripoli LibyaAlmabrouk Fares 1997 MSc Professor/University of Tripoli LibyaCarolyn Hewson 1997 PhD Professor/University of Prince Edward Island Canada


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graduate students in the Department of Population Medicine during its first 10 years of operation) see Table 1.

In addition, a number of Clinical Studies faculty, such as Leslie, Curtis, and Friendship, were demonstrating how epi-demiology could be integrated into health management. They worked to convince veterinarians, veterinary students, and pro-ducers of the value of this approach. For example, Leslie, often alongside Curtis, carried out research evaluating the efficacy of treatments and determining the sensitivity and specificity of diagnostic tests and measuring production parameters in dairy cattle.

They were joined by Martin and Meek from VMI, who had become increasingly assertive in their opinion that a more for-malized approach to population medicine was necessary. Despite the freedom to pursue their own research, the epidemiologists were more likely to work with food animal faculty members in Clinical Studies, such as Leslie and Curtis, than the microbi-ologists, virologists, and immunologists of their own depart-ment (8). As Friendship recalled, the food animal faculty and epidemiologists increasingly recognized the complementarity of their work. Food animal clinicians noted that proper feeding, ventilation, and proper sanitation and hygiene practices could prevent many of the diseases found in their patients. They began to see many livestock diseases as “multi-vectoral” and multi-factorial and opened up space for epidemiologists to “do their very structured studies and prove [what] the risk factor for [a] disease was,” and demonstrate “the value of epidemiology to point out what…the clinicians were observing in the field, that the two went rather well together” (Interview with Bob Friendship by KW, March 2, 2015).

In 1982 and 1983, faculty responsible for swine health in Clinical Studies, including Drs. Bob Friendship and Mike Wilson, carried out a large “Wintario” study to examine swine herd productivity in Ontario and provide a pool of data from

which other producers and veterinarians could draw to compare their own herds’ productivity. Reporting in 1986, the study provided an early demonstration of the value and importance of many of the tools and methods on which the Department of Population Medicine would later rely. The researchers noted that “records of productivity are essential for efficient (or cost effective) health management” (16). They found that “in the absence of clinical disease, and where suboptimal productivity is the problem, productivity data and corresponding reference val-ues are effective means for identifying problem areas” (16). The researchers undertook weekly and biweekly farm visits in order to collect the data recorded by participating producers. The study also provides an early example of the use and importance of computer technology, including the use of computerized production records, in health management work. The research-ers typed the data collected on the farm into a “hand-held, programmed data logger and transmitted through a modem (via telephone) to a central microcomputer,” for statistical analysis (16). The researchers concluded that “a wide range in swine productivity…exists between Ontario farms,” with “a significant number of pork producers…operating at a level far below their productivity potential” (16). However, they also found that there was “great potential…in the industry for increasing the efficiency of farms,” especially if producers made wider use of existing health management techniques (16).

In 1986, noting the increasing collaborations between the epidemiologists and the food animal faculty, the newly appointed Dean, Dr. Ole Neilsen, supported by the Dean’s Council, appointed a steering committee co-chaired by popu-lation medicine advocates Martin and Leslie, to investigate the creation of a Department of Population Medicine. The committee believed that “clinical veterinary medicine can be divided…into two broad streams; one that is primarily oriented to individual patients and one to populations” (17). They found

Table 1. Epidemiology-focused Graduate Students, 1979–1998 (continued)

Name Yeara Degreeb Position/Institution or Agencyc Country

Paul Innes 1997 MSc Manager, Veterinary Science and Policy, OMAFRA CanadaPascal Michel 1997 PhD Chief Science Officer, PHAC CanadaCarol Poland 1997 MSc Professional Development Veterinarian/Hill’s Canada CanadaSiti Ramanoon 1997 MSc Senior Lecturer/Universiti Putra Malaysia MalaysiaJohn VanLeeuwen 1997 PhD Professor/University of Prince Edward Island CanadaPatrick Boerlin 1998 MSc Professor/University of Guelph CanadaJoseph Mallia 1998 PhD Professor/Institute of Agriculture, University of Malta MaltaChris O’Callaghan 1998 PhD Sr. Investigator/Canadian Clinical Trials Group; Professor, Queen’s University CanadaH. Morgan Scott 1998 PhD Professor/Texas A&M University USAGary Teare 1998 PhD Saskatchewan’s Health Quality Council CanadaMarieke Wevers 1998 MSc Owner/Foothills Veterinary Services Canadaa Year degree was awarded.b Highest degree received from Department of Population Medicine.c Current position or last position before retirement based on publicly available information.d OMAFRA — Ontario Ministry of Agriculture, Food and Rural Affairs.e CFIA — Canadian Food Inspection Agency.f CGIAR — Consultative Group on International Agricultural Research.g CORPOICA, CBB — Corporación Colombiana de Investigación Agropecuaria, Centro de Biotecnologia y Bioindustria.h AFHRP — Association of Family Health Teams of Ontario.i MAPAQ — Le ministère de l’Agriculture, des Pêcheries et de l’Alimentation du Québec.j CFEZID — Centre for Foodborne, Environmental and Zoonotic Infectious Diseases.k PHAC — Public Health Agency of Canada.l KIU — Kampala International University.


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that at OVC individual patient medicine “has flourished” (17). Population medicine, however, had been slower to develop due to the relatively recent recognition of the importance of veterinary epidemiology, particularly to “modern food animal production and regulatory medicine” (17). Whereas the previ-ously proposed Department of Health Management carried the implication of having a focus strictly limited to livestock, from the beginning, Martin, Leslie, and the committee sought to outline a department with a broader scope. For example, they extended the benefits of veterinary epidemiology to wild-life, laboratory animals, environmental toxicology and public health (17).

The committee used a definition of population medicine that incorporated health management, but also the broader concept championed by Martin. They defined population medicine as the “study of the frequency, distribution, and cost of disease, and the interrelationships between and among disease, management, environment and productivity” (18). Reflecting the importance of health management, the definition incorporated “directed action (i.e., applied prevention and control strategies) for the management of health and control of disease in animal popula-tions” (18). By contrast, the earlier health management approach focused more on preventive medicine, with less consideration given to the relationships between disease and the other factors outlined by the committee (14).

As outlined by Martin, Leslie, and the rest of the commit-tee, the proposed Department of Population Medicine’s main responsibility would be the collection of “data on the distribu-tion, causes, and costs of disease (including abnormal behavior) in animal populations and to develop control strategies based on that knowledge.” They foresaw a department that would empha-size the key roles played by environment, population structure, animal behavior and animal husbandry and management in determining health and disease. To do this, the department would take epidemiology as a key discipline (18). The commit-tee envisioned a department that would “bring together those who are, or desire to be, involved in a population-based, quan-titative, holistic approach to studies of health and disease” (18).

An OVC faculty vote on the creation of a new Department of Population Medicine was taken in the spring of 1987, with faculty members voting in favor of the new department, and Martin was appointed as the first Department Chair (14). Faculty involved in the Department’s founding, such as Martin, Meek, and Friendship, now generally agree that the proposals and debates that preceded and surrounded the initial proposal for a Department of Health Management helped lay the ground-work for the approved Department of Population Medicine and convinced faculty of the need for a new approach to food animal medicine (Interview with Wayne Martin by Kevin Woodger and Cate Dewey, March 2, 2015).

While there was some caution on the part of the wider Canadian veterinary profession to not lose sight of the individual animal in favor of the herd, population medicine was cited as a necessity given the reality of the intensive livestock economy (19,20). For example, Martin and Drs. John McDermott, and David Alves argued that there was a lack of expertise in herd health within the Canadian veterinary profession. They noted

that when dealing with livestock at the population level, “the risk of disease or treatment success, for an individual in a herd, isn’t independent of risks for the other animals in the herd.” Management decisions, such as vaccination programs must be made based on how it will benefit the herd as a whole. Furthermore, such decisions can only be made after comparing data from similar herds so treated. They noted, however, that “our track record as a profession, in scientifically testing these herd level decisions, is rather poor” (21).

The Department of Population Medicine initially had 23 fac-ulty, 16 staff, and 23 graduate students. It was divided into 5 primary research areas: farm animal health management, epidemiology and biometrics, public health and food protec-tion, theriogenology (reproduction), and ethology (animal behavior) (22). Some individuals questioned the inclusion of the theriogenologists because of their focus on individual ani-mals. However, their efforts to improve production efficiency by improving reproduction efficiency “without compromising the welfare of the animal,” fit with the Department’s overall goals (14,22).

Health management was a core discipline of the new depart-ment (as enshrined in the department’s mission statement), and most faculty who joined at the beginning worked in health man-agement. The farm animal health management section worked with dairy and beef cattle, sheep, goats, and pigs, divided into separate subsections for ruminants and swine. The College’s poultry specialists chose not to join the department, in part because of the importance of pathology to the poultry industry (14). However 2 poultry epidemiologists later joined Population Medicine, Dr. Jean Pierre Vaillancourt, from 1990 to 1996, and then Dr. Michele Guerin from 2007 to the present. The farm animal health management section was tasked with carrying out teaching as well as the practical work of health management and disease prevention, examining the factors that affected farm animal health, and devising tools to control them.

In general, the health management group was responsible for teaching, including the health management areas of the DVM curriculum. This consisted of lectures, laboratories, and practical exercises in herd health and population medicine. There was also a 2-week clinical rotation in ruminant field service plus a 1-week clinical rotation in swine field service for all final year veterinary students (23). According to Leslie, the group’s extension educa-tion work, which included faculty talks to breeders’ and produc-ers’ associations, helped fulfill the Department’s “responsibility to the large animal community in Ontario.” Furthermore, as with dairy, the swine area emphasized the importance of eco-nomics in the DVM curriculum so that upon entering practice, veterinarians could “make a valuable contribution to swine producers” (Interview with Kerry Lissemore by KW, March 2, 2015). Through the department’s DVM teaching, generations of veterinarians have graduated into health management practice, making a huge impact on the health, welfare, and productivity of livestock on Canadian farms.

Epidemiology was primarily concerned with the “study of the distribution and determinants of health and disease in animal populations,” using the quantitative tools of biometrics (22). Computer technologies were key to the epidemiology


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and biometrics group. Computers and epidemiology were seen as essential for the Department to be able to collect, manage, manipulate, and interpret herd health data in support of fac-ulty research and producer-clients. Computers were also seen as important veterinary student teaching tools, as they helped students learn “how to evaluate a herd on a population basis and how to interpret data as a first step in making proper recommendations about health management to their clients” (18). This included setting goals in collaboration with clients and measuring whether they achieved the targets. This was done before and during each herd health visit. In 1989 Kerry Lissemore explained that computers had greatly enhanced vet-erinarians’ ability to monitor herd health. He noted that as a key part of herd health and the “continual assessment of devia-tions of actual herd performance from targets of performance,” computers have “reduced the labour required by the veterinarian and the farmer in the repetitive tasks related to data preparation and analysis” (24).

The research emphasis within the new department was firmly on the population level. For example, researchers including Drs. Cate Dewey, Martin, Wilson, and Friendship examined computerized swine records from 1987 to 1991. Recognizing that litter size “is an important production parameter in swine herds,” they examined 66 525 computerized individual sow-level records from 112 Ontario swine farms in order to analyze “the relationships between sow-level management factors and litter size” (25). In 1991 Drs. McDermott, Alves, Neil Anderson (OMAF) and Martin published a study examining the produc-tivity of Ontario cow-calf herds, using a sample of 180 separate breeding herds. One of their aims was to provide farmers, veterinarians, and agricultural extension personnel with data with which they could “compare a specific herd’s health and productivity to productivity measures and disease rates of other herds kept under the same conditions” (26).

Through its research and extension work, such as Leslie’s internationally recognized Dairy Health Management Certificate program, the Department of Population Medicine quickly established itself as a leader in the field of population health and epidemiology. The creation of the Department of Population Medicine allowed OVC to effectively respond to the needs of the intensive livestock agriculture economy and train veterinar-ians to provide services that would be of maximum benefit to producers. By 2012, OVC faculty and students were conduct-ing over 800 farm visits for health management and teaching purposes per year, impacting 1.3 million livestock animals and were providing continuous health management services to more than 70 Ontario farms, accounting for over 55 000 animals. A 2014 study of the economic impact of OVC concluded that the College, “as one of the largest and most well respected programs of its kind in the world, is an essential link in the development and maintenance of health management standards and proto-cols in an ever-evolving landscape” (27). As the Dean’s Council concluded in 1989, “the creation of [the] new department of Population Medicine was a critically important step that has brought the Institution to the cutting edge in the population-based veterinary health disciplines” (28). CVJ

References1. Jones Susan D. Valuing Animals: Veterinarians and their Patients in

Modern America. Baltimore, Maryland: Johns Hopkins University Press, 2003:111.

2. Alexander TJL, Roe CK. Attempts at establishing swine herds free from atrophic rhinitis and virus pneumonia II: Repopulation with specific pathogen-free pigs. Can Vet J 1962;3:2992302.

3. McDermid KA. Ontario certified herd policy for swine. Can Vet J 1964; 5:95299.

4. Abelseth MK. The application of specific pathogen-free animals to research and production. Can Vet J 1963;3:52.

5. Radostits OM. Specialization in large animal practice. Can Vet J 1974;15:3402341.

6. Botterell EH. Maintenance of Animal Health for Food Production: Report of the Study of Animal Health Services in Ontario for the Minister of Agriculture and Food, December 1976:2234.

7. Wilson MR, Brown P, Svendson J. Immunity to Escherichia coli in pigs: Antibody secretion by the mammary gland after intramammary or intramuscular vaccination with an E. coli vaccine. Can J Comp Med 1972;36:44248.

8. Schwabe C. The current epidemiological revolution in veterinary medi-cine part I. Prev Vet Med 1982;1:5215.

9. Nolan SR. Legends: The accidental epidemiologist, Dr. Calvin W. Schwabe fathered a generation of veterinary epidemiologists. J Am Vet Med Assoc 2013;243:27229.

10. Rutty C, Sullivan SC. This is Public Health: A Canadian History. Ottawa, Ontario: The Canadian Public Health Association, 2010:8.128.10.

11. Côté JF. Twenty years of experience with dairy herd health in Ontario. Can Vet J 1980;21:3402342.

12. Curtis RA. A proposal for large animal practice in the seventies. Can Vet J 1971;12:2162217.

13. Ogilvie T. A tribute to Dr. Robert A. Curtis: Teacher, scholar, and clini-cian. Can Vet J 1996;37:4072408.

14. Ball AG, Curtis RA, Harris WH, Meek AH, Slocombe JOD. “Report on Health Management by the Ad Hoc Committee of Ontario Veterinary College,” April 1982. CAV Barker Museum of Canadian Veterinary History, University of Guelph.

15. Annual Report of the University of Guelph, 1982. RE1 UOG A0086, University of Guelph Archival and Special Collections.

16. Wilson MR, Friendship RM, McMillan I, Hacker RR, Pieper R, Swaminathan S. A survey of productivity and its component inter-relationships in Canadian swine herds. J Anim Sci 1986;62:5762582.

17. Ontario Veterinary College Inter-Departmental Memorandum, Proposed Department of Population Medicine, 11 November 1986, CAV Barker Museum of Canadian Veterinary History, University of Guelph.

18. A Proposal for a Department of Population Medicine in the Ontario Veterinary College. CAV Barker Museum of Canadian Veterinary History, University of Guelph.

19. Maxie G. The continuing evolution of veterinary education. Can Vet J 1987;28:627.

20. Ribble CS. The use of modern marketing strategies for the promotion of preventive medicine and herd health. Can Vet J 1987;28:406.

21. McDermott JJ, Martin SW, Alves DM. Marketing vs. training in herd health programs. Can Vet J 1987;28:629.

22. Tho D. Department of Population Medicine. At Guelph. 19 April 1989:4.23. Wilcock BP. The Ontario Veterinary College. Can Vet J 1987;28:638.24. Lissemore K. The use of computers in dairy herd health programs:

A review. Can Vet J 1989;30:632.25. Dewey CE, Martin SW, Friendship RM, Kennedy BW, Wilson MR.

Associations between litter size and specific sow-level management fac-tors in Ontario swine. Prev Vet Med 1995;23:1012102.

26. McDermott JJ, Alves DM, Anderson NG, Martin SW. Measures of herd health and productivity in Ontario cow-calf herds. Can Vet J 1991;32: 4132417.

27. Deloitte. Economic impact study on the Ontario Veterinary College at the University of Guelph: Final Report. July 9, 2014.

28. OVC Dean’s Council Meeting, 25 October, 1989. CAV Barker Museum of Canadian Veterinary History, University of Guelph.


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1. E) A majority of feline mammary masses are malignancies; therefore, a “wait and see” attitude would clearly not be appropriate. With feline mammary masses it is typically recommended to remove the entire mammary chain, and with this cat having bilateral involvement, this procedure would be the best choice. Lumpectomy and mammectomy are procedures to be used on occasion in canine patients, but not typically in cats. The response of mammary tumors to chemotherapeutic agents has been frustratingly poor, and cisplatin administration is contraindicated in cats as it can cause fatal pulmonary edema.

E) La majorité des masses mammaires des chats sont malignes et une attitude «d’attendre avant d’agir» n’est clairement pas appropriée. Avec les masses mammaires félines, il est fortement recommandé de faire l’ablation des chaînes mammaires au complet et, chez cette chatte qui a une atteinte bilatérale, cette intervention est le meilleur choix. La lumpectomie et la mastectomie sont des chirurgies qui peuvent être réalisées à l’occasion chez la chienne mais non chez la chatte. La réponse des tumeurs mammaires à la chimiothérapie est mauvaise de façon frustrante et l’administration de cisplatine est contre-indiquée chez la chatte puisqu’elle peut causer de l’œdème pulmonaire fatal.

2. B) This dog could have hyperadrenocorticism based on these results. Further testing is necessary. Elevation of the UCCR may be caused by hyperadrenocorticism, but may also be elevated as a result of stress or other nonadrenal ill-ness. The clinical signs and elevated UCCR do not suggest hypoadrenocorticism.

B) Ce chien peut souffrir d’hyperadrénocorticisme si on en croit les résultats. D’autres examens sont nécessaires. L’élévation du rapport créatinine : cortisol urinaire peut être causée par de l’hyperadrénocorticisme mais elle peut aussi être le résultat d’un stress ou d’autres maladies non surrénaliennes. Les signes cliniques et le rapport créatinine : cortisol élevé ne suggère pas d’hypoadrénocorticisme.

3. D) Dark chocolate is more toxic than milk chocolate, and even small quantities of chocolate can be quite toxic. Treatment is usually necessary because clinical signs are severe.

D) Le chocolat noir est plus toxique que le chocolat au lait et même de petites quantités peuvent être vraiment toxiques. Un traitement est habituellement nécessaire parce que les signes cliniques sont sévères.

4. B) Pyrrolizidine-alkaloid-containing plants can cause severe hepatic dysfunction in horses, and exposures are generally chronic. Wilted maple leaves can cause a hemolytic ane-mia, zinc and copper can cause hemolytic changes (though horses are very resistant to the toxic effects of copper), and lead toxicosis in horses typically causes more neurological changes.

B) Les alcaloïdes de type pyrrolidizine des plantes peuvent causer des dysfonctions hépatiques sévères chez le cheval et les expositions sont généralement chroniques. Les feuilles d’érable fanées peuvent causer une anémie hémolytique; le zinc et le cuivre peuvent causer des changements hémolytiques (bien que les chevaux soient très résistants aux effets toxiques du cuivre) et la toxicose au plomb chez les chevaux cause de façon caractéristique plus de changements neurologiques.

5. D) These symptoms are common with sole abscesses. Infection begins at compromised white line, and proceeds under the sole horn, into the corium, or under the wall horn (as in this case). Abscesses of this type will rupture at the coro-nary band directly proximal to the site of initial infection. Abscesses that track under the sole will rupture at the heel, or axial wall. Sole ulcers are present at the heel-sole junc-tion, away from the white line. Foot rot and hairy heel wart are diseases of the skin, and the symptoms of laminitis are numerous and non-specific, but inconsistent with focal coronary band swelling.

D) Ces symptômes sont communs lors d’abcès de la sole. L’infection commence à la ligne blanche et se poursuit sous la corne de la sole jusqu’au corium ou sous la corne de muraille (comme c’est le cas ici). Les abcès de ce type vont éclater à la bande coronaire directement proximalement au site de l’infection initiale. Les abcès qui ont un trajet fistulaire sous la sole vont s’ouvrir au talon ou à la paroi axiale. Les ulcères de la sole sont présents à la jonction talon-sole, loin de la ligne blanche. Le piétin et la dermatite digitale sont des maladies de la peau et les symptômes de fourbure sont nombreux et non spécifiques, mais incompatibles avec une enflure de la bande.

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The Art of Private Veterinary Practice L’art de la pratique vétérinaire privée

W hen Dr. Bogart arrives home more than an hour later than she told her family to expect her, it is difficult to tell

who is more upset: the veterinarian or her family. Her daughter is annoyed that her carefully prepared casserole is overbaked. Her son complains because he could have stayed longer at his friend’s home working on a school project. Her partner gives her “the look” that translates, “Another unscheduled phone call or walk-in?”

Because quality communication skill plays such an important role in successful practice, veterinarians who master it soon become aware of the costs of this skill as well as its benefits. During her scheduled office hours, Dr. Bogart has minimal trouble taking time to talk to clients she knows will a) concisely describe the animal’s problem, b) carefully listen to her recom-mendations, and c) reliably implement them. Although she sometimes may feel put out by such calls when these negatively impact her other activities, for the most part she can justify any inconvenience because these people are good clients.

It is the rambling, unscheduled calls that wear Dr. Bogart down. While her family becomes increasingly irritated by her tardiness, she finds herself on an emotional roller coaster as she listens to Ms. Gabrieli talk about her 19-year-old cat, Fidelio. The veterinarian fully understands that her geriatric client is terrified of losing her only companion even as Ms. Gabrieli faces failing health herself. But Dr. Bogart also knows that Fidelio’s many complex and overlapping problems make it impossible to give his owner the kind of definitive answers she wants in response to her random phone calls. Furthermore, she knows that Ms. Gabrieli knows this because they have discussed this

many times — providing the client’s memory remains reliable. Although the woman seems lucid enough when she calls, the practitioner cannot rule out the possibility that her client’s memory might not be as good as it used to be.

Unsolicited or cold-calls from clients like Ms. Gabrieli can be stressful for practitioners because they may elicit all kinds of conflicting emotions. Dr. Bogart appreciates that her client loves Fidelio and cannot bear the thought that he could die. She also recognizes that Ms. Gabrieli is very lonely. Consequently, the veterinarian does not feel that she can refuse to take the client’s calls. But at the same time, Dr. Bogart knows that doing this reinforces the client’s behavior. It also means taking time away from other clients and patients, as well as sometimes denying herself the necessary restorative benefits of interactions with family and friends.

In situations like this, repeatedly asking the client to set up specific phone appointments often does not work because doing so does not address the client’s loneliness. Compare this to Dr. Bogart asking Ms. Gabrieli to keep a journal of Fidelio’s daily activities. This includes how often and how much he eats and drinks, what he eats, how often he uses the litter box, details about his urine and stool, his sleep patterns, how much interest he shows in his surroundings, including his interest in play. At that time, the practitioner also sets up a specific time for Ms. Gabrieli to call “so that we can go over what you’ve discovered and make any changes necessary to help Fidelio.”

Although playing a more active role in her animal’s health hopefully will add more meaning to the client’s life, this is not mere busywork to keep the client from bothering the veteri-narian. It also guarantees that when the practitioner talks to the client, the client will be able to provide more meaningful information about the animal.

Cold-calls from long-standing clients like Ms. Gabrieli can stress even the most patient and saintly practitioner. At their worst, they may drive frustrated veterinarians to make com-ments to the client that they later regret. Or they may take out their frustration on colleagues, staff, or family members after-the-fact. But be that as it may, at least the veterinarian has the consolation of knowing that these clients genuinely care about their animals and want to do their best to help them, regardless how little that may be.

Cold-call communication

Myrna Milani

Dr. Milani is a behavior and bond practitioner, teacher, and author of several books on the interaction of animal behavior, health, and the human-animal relationship.Cold-call: Calling or visiting a prospect (who may not know the visitor/caller) without a prior appointment. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.


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“True,” admits Dr. Bogart. “Even if Ms. Gabrieli’s current willingness to keep a journal and call at specific times to dis-cuss Fidelio wanes over time, it’s impossible to deny how much he means to her. Plus once I know this approach has merit, I can adjust her ‘assignments’ to keep her busy and me better informed.”

Another group of cold-callers create even greater communica-tions challenges for practitioners. Unlike the Ms. Gabrielis of the world, these people are not clients, never have been clients, and often vanish as soon as they get the service they want from the veterinarian. Like most practitioners, Dr. Bogart would not refuse to see an animal experiencing a true emergency, regardless how demanding or inconsiderate the owner might be. But when someone she does not know calls or drops in and expects her to immediately provide some non-emergency service strictly for that person’s own convenience, she flounders.

“No matter how I look at it, I consider it a no-win situation for me,” she acknowledges. “Before I even open my mouth I have to dissipate all kinds of negative emotions and assume a reasonably professional demeanor. I also know that, if I give these people what they want, I can’t rationalize denying that same service to them or others in the future. That makes me feel even more abused. But even if I never see them again, I worry that they may tell others in the area that I refused to help them and their animals. That could hurt my business. Regardless what I do, I never feel like I’m in control of the situation.”

Whereas Dr. Bogart inevitably gives in to the unknown call-ers’ demands even if she hates herself for doing so afterward, her colleague, Dr. Yanover, takes a more impulsive approach. How he responds depends on his mood and what he is doing when the call occurs. If he is in a good mood and has time, he treats a cold-caller the same way he would one of his regular clients. But if he is in a bad mood for any reason, e.g., facing a packed schedule or in dire need of some sleep after a series of legitimate night emergencies, these people will feel the full force of his anger.

Obviously neither of these responses is optimal. Allowing strangers to treat her like a doormat eventually will take its toll on Dr. Bogart as well as her family. Whereas her established

relationship with clients like Ms. Gabrieli enables her to ratio-nalize giving in to their demands, she feels no such allegiance to unknown cold-callers. Consequently, each such interaction leaves her feeling frustrated and angry for hours afterward. And although Dr. Yanover’s venting may make him feel better, his staff members and others around during his angry outbursts or those who hear about them may wonder if he treats animals the same way.

In these situations, preparation pays big dividends. Preparing a basic response to unknown cold-callers and then practicing it to the point that it flows naturally when these situations arise places the veterinarian in a position of authority from the begin-ning. In this scenario, Dr. Bogart’s first response to a request for immediate non-emergency care is to thank the person for their interest in the clinic. Then without giving the other time to respond, she continues with, “We work on an appointment-only basis to ensure that all of our patients and clients get the best care. Because this isn’t an emergency, may I set up an appoint-ment for you and your dog so the staff and I can give you the benefit of our full attention?”

In addition to enabling the practitioner to respond in a professional manner, the essence of a carefully crafted response can be repeated as many times as necessary for the cold-caller to get the message. Admittedly there may be those self-absorbed individuals who become angry and frustrated when they can-not manipulate the practitioner. But because the practitioner truthfully defines ensuring optimal care for the animal as the reason for the policy, it is easier for her to stand firm and politely terminate the conversation.

In The Temple of Glas, 15th century monk John Lydgate wrote, “You can please some of the people all of the time, you can please all of the people some of the time, but you can’t please all of the people all of the time.” Accepting this reality will enable practitioners bedeviled by known and unknown cold-callers to prepare strategies that, at best, will re-educate and, at worst, discourage these people in a professional manner. This will enable those in private practice to sustain quality patient and client care, as well as their own well-being.


CVJ / VOL 58 / APRIL 2017 413

What Can’t Be Taught Ce qui ne s’enseigne pas

Dr. Philippot graduated from the Western School of Veterinary Medicine in 2001. He is a mixed animal practitioner and owner/operator of Rolling Plains Veterinary Consultants who operate the St. Claude Veterinary Clinic in St. Claude, Manitoba; South Central Veterinary Clinic in Notre Dame de Lourdes, Manitoba; and the Carman Veterinary Clinic in Carman, Manitoba.Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.

Recognize value

Dr. Marc Philippot

A fter graduating from veterinary school, I moved back to my home province of Manitoba to begin, I hoped, my career

as a mixed animal practitioner. Now as I sit in my office, trying to write this article, I have to remind the reader and myself that I graduated 16 years ago. What possibly can I offer to new grads in advice about my first year, or years, in practice? Can I even remember that long ago? Sure, I had some difficult cases then, like now: a horse with immune-mediated thrombocytopenia, the first outbreaks of West Nile virus in Manitoba, the BSE crisis in cattle, an iguana with a fractured mandible and certainly being fooled by a sick golden retriever with Addison’s disease; just to name a few.

As well, I certainly cannot forget my other life choices during this time. Falling in love, getting married, having kids. There is also agreeing to buy my first mixed animal practice in my home town, a month prior to BSE. I convinced myself that things would be okay, I had dairy farms and the PMU industry in the area to fall back on. LOL! But 10 years later, I was back at it, buying another mixed animal practice and its satellite clinic to complement my first business.

But why stop there — how about volunteering with local community groups or becoming president of the Manitoba Veterinary Medical Association.

So, the advice I give today, comes more from these past 16 years, instead of my first year. Recognize value — the value you give to your clients, the value your employees or coworkers or employer bring to the team, the value of time with loved ones.

We as employers often hear about or discuss value. If clients feel that they got more out of you, compared to what they paid for, they got value. I believe this to be true; I’ve seen it and I

preach it. If you charge a client $50 for something, make them feel they got $100 worth. One way to achieve this, in my opin-ion, is through good communication. Do not feel you have to educate clients; far too many times the client smiles and nods and walks away. You feel good, but they left confused. Therefore, don’t educate, communicate! Through communication, both sides are talking, asking questions and getting to the point. Clients do value this time, and remember, you still have to sound knowledgeable.

The same goes to your staff and/or coworkers. If you cannot communicate effectively with them, nothing gets done right. You end up with upset people, and worse, a toxic environment. Don’t forget to say hello or goodbye — you never know if that’s the last time you’ll see them. We lost an employee a few years ago. She was driving to work and died in an automobile acci-dent. You just never know. Give praise where praise is due. Even for the little things. Thank you or great job can go a long way.

My wife has three plaques with quotes above the toilet, I read them every day. Her favorite is… “Life is not measured by the number of breaths we take, but by the moments that take our breath away.” Now, I don’t care what generation you may belong to. All I know is that I was raised to work hard, be kind and respectful, and do the job right the first time. Therefore I like to think I work hard, and in our career, that sometimes involves long hours. So, I do the task at hand; however, this may sacrifice family time. If it was not for my wife, I probably would miss even more things. I see my younger colleagues try-ing to enjoy life and value their time with their loved ones. I see my older colleagues wondering what the younger ones are doing (and I admit, I question them too). Maybe its envy. But as I write this, I remember a conference I was at recently and overheard an older colleague say to another that he was a terrible father, always working, never seeing his kids grow up and that he hoped to be a better grandfather. Now I hope his kids don’t feel that way, many of us had parents who worked a lot. But if this is how we as a profession feel, then value your time with your loved ones. Don’t forget to try and take that time when available with them and make some memories. Work does not always allow me to be there with my family, they understand that and they appreciate that I try.

So there you have it, something that was not taught to me at school, at least not directly. Someone once said… “Try not to become a man of success, but rather try to become a man of value.” Something to live by…


414 CVJ / VOL 58 / APRIL 2017

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