Medicine


New issues of the following journals are now available online:

Advertisements

The arrival of a new baby in the house has made it a bit more difficult for catmanager to keep up with the steady stream of new journal issues. I’d love to be providing my usual summaries of articles I find notable, but time (or the lack of it) leaves me no choice but to cut back somewhat.

The following veterinary journals have new issues available online:

    Also now available online are the following individual articles (half are from forthcoming issues of veterinary journals; half are from journals that are not veterinary-specific):

    • An article on feline leishmaniasis appears in the American Journal of Tropical Medicine and Hygiene, Vol. 76, No. 4 (2007).
    • A study accepted for publication in the Journal of Applied Physiology (available online now) finds that ” the role of the vestibular system in the control of breathing is to modify baseline respiratory parameters in proportion to the general intensity of ongoing movements, and not to rapidly alter ventilation in accordance with body position.”
    • A study forthcoming in the Journal of Microbiology (available as an OnlineEarly Article now) “demonstrate[s] that rumen fungi can biohydrogenate fatty acids.”
    • A study in the Proceedings of the National Academy of Sciences, Vol. 104, no. 15 (April 10, 2007) finds that Toxoplasma causes highly specific changes in the brains of rats (previous studies have shown brain changes but not such specifically targeted changes as this study claims).
    • A study forthcoming in Animal Genetics (available as an OnlineEarly Article now) finds that as in mice and dogs mutations in the fibroblast growth factor 5 (FGF5) gene are responsible for differing hair length in cats.
    • A paper forthcoming in the Journal of Small Animal Practice (available as an OnlineEarly Article now) reports on a case of canine sinus arrest caused by atrial myocarditits.
    • A study forthcoming in the Journal of Veterinary Pharmacology and Therapeutics (available as an OnlineEarly Article now) looks at the use of morphine in dogs.
    • A study forthcoming in Veterinary Anaesthesia and Analgesia (available as an OnlineEarly Article now) compares “two anaesthetic protocols using lidocaine or medetomidine in horses.”

    Catmanager saw this AVMA news item the other day: “How to submit samples, report cases related to adulterated pet food.”

    The story explains that “the American Association of Veterinary Laboratory Diagnosticians, in consultation with the Food and Drug Administration, was refining a working definition” of what consitutes a “case” of food-recall-related illness. As part of their effort, the AAVLD has set up an online survey (available on the AAVLD Web site and conducted by Michigan State University and the University of Guelph on behalf of the AAVLD) to collect incidents that diagnostic laboratories or veterinarians suspect are related to the food recall.

    The AAVLD will share data with the FDA and will present an analysis of the data at the October 2007 AAVLD meeting.

    Catmanager was excited to hear about the AAVLD survey, but after checking it out I was somewhat confused.

    First
    What is the purpose of the survey? Veterinarians have already been encouraged to report incidents to the FDA, their state veterinarian, and (if they are members) to VIN. Now they need to submit to another organization? Already taxed for time, why would they contribute to AAVLD?

    According to the AVMA, the primary goal of the survey

    is to distinguish true cases of nephropathy unique to this recall, hopefully resulting in a set of criteria defining a true case.

    Other survey objectives are to characterize the spectrum of lesions; the temporal and geographic distributions of the suspected intoxications; the species, breeds, and ages of affected animals; and when possible, the brands, lot numbers, and UPC numbers of pet food involved in the toxic exposure, and results of chemical analyses.

    Catmanager interprets this to mean that the AAVLD isn’t in the business of counting cases. They aren’t trying to create an authoritative tally (that’s up to the FDA). Instead, they’re trying to figure out how one should go about counting cases. In an e-mail responding to my questions, survey coordinator Dr. Wilson Rumbeiha seemed to confirm this interpretation.

    The main objective is to define a true case of pet-food-induced nephrotoxicity derived from several criteria including history of ingestion of contaminated pet foods, documentation of renal failure by chemistry assays and urinalysis, histopathologic signs consistent with pe-food-induced nephrotoxicity and chemistry tests for markers of contaminants found in food, tissues and/or urine. Everyday animals fall sick or die of acute renal faliure and so our job is to come up with criteria that decide what is in and what is out.

    Second
    Who should be submitting data to the survey? The survey is publicly accessible and doesn’t require registration or passwords. According to Dr. Rumbeiha, the openness of the survey “is meant to encourage participation rather than discourage.” However, some of the

    information asked for in the survey is not what you would expect regular veterinarians to have. That information would be gathered at diagnostic laboratories or selfstanding commercial labs like IDEXX. Hence we expect that only terminal diagnosticians will complete the survey as primary practitioners will not have the information handy.

    Looking over the survey questions, catmanager suspects primary practitioners could answer all of the questions (in fact, many of the questions about patient history will be more easily answered by the primary practitioner unless they provide extremely detailed histories to the labs) but might not be able to fully answer question 9, which asks about crystal composition. The average practitioner will need to rely on labs to confirm the presence of melamine in the pet’s food or tissues, for example.

    Still, I wondered about the openness of the survey. I can without difficulty imagine pet owners attempting to complete the survey. Would the researchers screen out data submitted by laypersons? Dr. Rumbeiha indicated that they will, and he pointed to the unique animal ID (such as a case number assigned by a lab) and contact information asked by the survey. Dr. Rumbeiha and three other pathologists will contact “each and every case entered” using that contact info. Any unauthenticated cases will be discarded from the survey.

    Third
    Will the survey, which was released on April 4, be updated to include the foods subsequently added to the recall? Dr. Rumbeiha said no, they’ll rely on people using the spot for “other” in the list of foods. This holds open the possibility that the survey could identify new foods in need of recall, although it’s not certain whether that information would be identified soon enough to have a practical effect.

    Fourth
    When can we expect to see results of the survey? After one or two months, the survey will close so that the team contacting the cases, reviewing slides, and checking the data has enough time to complete their work before the fall presentation to the AAVLD. Because the AAVLD commissioned the survey, they get to decide when and how they’ll release the data to the public. Dr. Rumbeiha wasn’t sure when that might be. He also wasn’t sure when or how the data would be shared with the FDA, but he did say they wouldn’t be sharing data in real time.

    Our job is to define criteria of what is a real case of pet food poisoning and what is not. . . . the real work will follow the survey where pathologists will come up with these criteria defining what is in and what is out. That requires time and good scientific review.

    So, check with your diagnostic lab to see whether they’re submitting reports to the AAVLD survey. If they’re not, consider submitting them yourself. (Pet owners, please save yourself and the researchers conducting the survey some time and don’t try to submit data yourself. You might, however, want to check that your veterinarian is aware of survey—many veterinarians aren’t members of AAVLD, and the AVMA news story announcing the survey won’t be published in print until the May 1 issue of JAVMA.)

    As Pet Connection noted last week, this survey could serve as a model for a future reporting mechanism. One thing that struck catmanager was how simple setting up the survey appeared to be. It’s hosted at SurveyMonkey.com, which is one of many online survey companies that make it surprisingly easy—and inexpensive—to create your own survey. Of course, someone has to review the data (which presumes people have taken the time to submit data), and as Dr. Rumbeiha noted in his e-mail to me, the real work doesn’t start until the data are all in.

    Still, from a technological standpoint, setting up a national adverse-events database for veterinary medicine should be doable with existing, commericially available software. Finding money for the real work of reviewing all the data is where the political will is needed.

    With spring upon us, veterinarians might once again be asked to operate on that sweetest of avian critters, Peepsis mallowis. Need a refresher? Catmanager recommends this excellent article on Peep surgery from the venerable Peep Research Organization. The article makes clear that operations on this species, while carrying their own special set of complications, are not necessarily restricted to the avian specialist. From the “Introduction”:

    One of the great mysteries of the Peep species is that these creatures are always born as conjoined quintuplets. Some scientists have theorized that this arrangement, much like pack behavior in other species, serves as a natural protection against predators. . . .

    Nevertheless, as Peeps integrate into modern society, there is no ethical reason they should be denied the benefits of individualism.

    In addition to describing the surgery itself, the article offers tips on patient prep, anesthetic protocols, how to handle emergencies, and advanced reconstructive surgical technique. Enjoy!

    The University of Guelph Laboratory Services department has posted images of crystals taken from a cat suspected to have ingested melamine-tainted food. Guelph hasn’t been able to identify the cystals yet, but mass spectrometry shows them to be 30 percent melamine and to have a different spectrum than ammonium urate or xanthine. Several veterinarians on VIN are reporting seeing crystals similar to those posted by Guelph.

    The current issue of the Journal of Veterinary Medical Association (Vol. 230, No. 7, 1 April 2007) arrived at the office recently. Of note:

    • An interesting “What Is Your Diagnosis” (995–996) offers a novel presentation of M. haemofelis (although the report does not note any genetic confirmation, only cytologic).
    • An article discusses “Sexual Harassment Issues in Veterinary Practice” (1007–1010), providing a review of sexual harassment law, a series of practical steps to avoid sexual harassment liability (have a written sexual harassment policy, provide training, handle complaints promptly, etc.), and tips for employees who are being sexually harassed.
    • A study (1011–1017; abstract) finds little significant difference between feline blood glucose curves done at home and those done in clinic settings and confirms that for in-home curves “there is significant day-to-day variability . . . even when factors such as insulin dose and meal size remain constant and the cat is at home in a stress-free environment.”
    • A study (1018–1023; abstract) reports on a rare case of Histoplasma capsulatum affecting the nervous system of a cat. Treatment included not only itraconazole but physical therapy, which the authors believe played a significant role in the positive outcome of the case.
    • Two anemia case studies are presented. One, another feline case study (1024–1027; abstract), tells of a cat that presented for acute lethargy and was ultimately diagnosed with immune-mediated erythroid and megakaryocytic aplasia. The other (1028–1031; abstract) tells of a parrot that presented with progressive lethargy (among other symptoms) and was ultimately diagnosed with immune-mediated hemolytic anemia.
    • A retrospective case series (1032–1037; abstract) looks at chronic nasal discharge in cats and concludes that it’s difficult to obtain an etiologic diagnosis in many cases. The article reviews standard laboratory tests, imaging, rhioscopy, and biopsy and finds that a combination of the latter three offers “the best chance of diagnosis.”

    Vet student Megan Watland offers her own thoughtful analysis of the most recent turns in the pet food recall.

    Cabezalana wonders what happened to his Saturday. The latest updates in the food recall played a part:

    As you might imagine, this ratcheted up the general hysteria and our poor receptionist was nearly in tears trying to keep up with all the phone calls from panicked people who decided that we must have some special insider knowledge. Because we manufacture the foods ourselves in our spare time, of course.

    T.J. at dogscatskidslife offers a thoughful commentary about the pet food recall. He sees problems with the anecdotal reports of pet deaths. For one, how many pets that have died had undetected illness before ingesting tainted pet food?

    There are many pet owners who do not seek medical care for their pets at the first onset of their symptoms. Either they simply ignore the symptoms, believe that it is a passing malady, or just don’t pay enough attention to their pets to notice the symptoms, until they are pointed out to them by news reports, mass hysteria and fear.

    (My own observations from my wife’s practice support this point, although I’d add a cat-specific reason pet owners don’t seek veterinary care soon enough: cats are experts at hiding symptoms of illness. Combine that with the difficulty of observing gradual changes in a pet you see every day, and you have a recipe for cats becoming severely ill before their owners notice. That’s why we recommend all cats be seen twice a year for physical exams—or any time owners notice a change in sleep pattern, vocalization, bad breath, grooming, weight, food and water intake, urination/defecation, or behavior.)

    T.J. also makes a point that catmanager had been thinking about:

    I began to think about contaminants that are probably present in all of our foods. Foods that we eat every day.

    Let’s say we took a food product off of the shelf at our local grocery store. Any product would do, just pick one. And let’s say we sent it to a toxicology lab and tested it for every known toxin possible.

    How do you think that final report would read?

    I think we would be very surprised.

    Indeed. I think it’s important to remember, though, that our food supply today is (in general) much safer than at any time in human history. We might hear more about food poisonings and contaminated batches of food, but, as one researcher argues, “This trend . . . is essentially an artefact, whose significance is reduced if considered in its broader historical context.”

    Dr. Khuly at the Dolittler blog appears to have been inspired by the latest AVMA-PLIT newsletter (“a self-serving tool for the insurance industry”? Oh, the synicism!) to write about veterinary professional liability issues.

    We vets are not used to being hauled in front of lawyers and judges to defend the way we do our jobs—not yet, anyway. Increasingly, though, we’re forced to practice medicine as if we might be in that position with each and every case.

    In some ways that’s good. It makes us careful in our record-keeping, more willing to consider diagnostics before treatment, and conscientiously detailed when securing consent from our clients. In other ways, it’s kind of depressing.

    And that’s because we have to practice more defensively. This finds us thinking about clients in an different way, adhering to hard-and-fast protocols with less regard to our patients’ needs, and generally driving the cost of pet healthcare through the roof.

    This post from Alexander Wilkas, a Realtor with “20+ years in quality Assurance for a major consumer products company,” bothers catmanager. Mr. Wilkas

    • refers to “the corn gluten used in the recent pet food recall”;
    • makes unsupported claims about nonexistent regulation in the pet food industry. Yes, I’d like to see more or different regulation, but to call it “almost nonexistent” and imply that the human food supply is significantly more regulated is simply wrong (“The Pet food industry is subject to the same regulation as the human food industry,” the FDA’s Stephen Sundloff said at last Friday’s FDA press conference);
    • claims that “Most companies spend very little on testing, since . . . ‘it’s only pet food,'” again without offering any evidence. Has Mr. Wilkas seen the testing budgets of Menu Foods, Hill’s, Purina, Royal Canin? Is he familiar with their QC protocols? Or is he just speculating?

    I hate to be in the position of defending pet food manufacturers, but as Ohio State’s Dr. Tony Buffington has pointed out: we see far fewer recalls of pet foods than we do of human foods; and unlike most human foods, the majority (if not all) of pet foods are formulated by board-certified nutritionists to meet specific nutritional requirements (whether they are successful or pressured by corporations in their formulations is another matter). Are the makers of Twinkies, Doritos, and Big Macs formulating their products to meet the nutritional needs of human beings?

    Changes are needed in the pet food industry, to be sure. PetConnection has made some excellent recommendations (here and here). Congress is (I hope) finally starting to pay attention. The FDA’s Sundloff has promised that his agency is looking at ways of preventing similar problems in the future. Things can and will get better, but that doesn’t mean they are currently bankrupt, as Mr. Wilkas’s post implies.

    The Blog Pound catches an interesting—and confusing—story from the Toronto Sun.

    Next Page »