Veterinarian


New issues of the following journals are now available online:

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A report in the 6 April issue of Science explains why small dogs are small and large are large. Here’s a news article on the findings. Here’s the abstract.

A British cat won a giant Easter egg.

Tune in online to Heska’s annual shareholder meeting on 4 May 2007. Info about the Webcast is here. (The press release says to “click on the Annual Meeting of Stockholders link on the front page” of the Heska Web site, however when I checked today no such link yet existed; hopefully the PR and IT departments will coordinate a little more closely in the future.)

An editorial in the Times of Malta urges the Maltese to consider setting up their own college of veterinary medicine.

A U.S. military veterinary mission in Djibouti ends up rescuing a young man caught in a flash flood. “With a powerful current of water standing between them and the injured 19 year-old man, three military members, accompanied by a local Djiboutian, tethered themselves together with a rope and made their way into the river.”

A nice story on a Columbus, WI, veterinarian whose husband is reservist serving in Iraq.

A horse in Bakersfield, CA, that got trapped in an overturned, mangled horse trailer (in pouring rain) is rescued. The rescue is caught on camera. (Or you can read a transcript here.)

EquestrianMag.com reports on the end of the most recent outbreak of equine infectious anemia in Ireland.

CIO Asia reports on the Hong Kong Jockey Club’s development and implementation of a veterinary management information system. “With the value of the animals being cared for in excess of US$190 million, the stakes are high.” Indeed.

The San Diego Union-Tribune reports on caprine acupuncture.

K9 Magazine explains how the Petplan Charitable Trust, a charity operated by a British pet insurance company, works.

The Veterinary News Network deems itself newsworthy.

Donations from grateful clients to veterinary colleges (and their teaching hospitals) are climbing.

Go for the title (“Plastic Rats and Disposable Lungs”). Go for the lead image (tandem parachuters, one holding a large gray plastic dog). Go to learn about the new generation of pet mannequins being used to train veterinarians. Just go! This story from Wired has so much going for it!

A profile of Emily Hilscher, a veterinary assistant who was one of the people killed at Virginia Tech last week.

The Royal Canin recall hit us hard. Hypoallergenic is the prescription diet we use second most (after Royal Canin’s Calorie Control). Over fifty of our clients feed it to as many as 100 of our patients. On Friday we sent out thirty-nine sets of bloodwork to Antech, almost what we’d expect to perform in a full month. We had another thirteen cats scheduled to come in for testing on Saturday. We’re performing urinalyses in house and sending out for CBCs and general chemistry profiles. I expect our bill to Royal Canin (who told us they will pay for testing of any cat that has eaten Hypoallergenic in the past six months) to be in the $8,000–$10,000 range, not including treatment costs for those cats showing signs of renal failure (so far, at least two) and not including overtime costs for our staff who have worked extra-long hours the past few days.

Royal Canin’s Handling of the Recall
Catmanager’s wife contacted our Royal Canin representative about three weeks ago to report a cat she had seen in early February with unusual urine crystals. The cat had slightly elevated BUN and creatinine (but still within normal range), had been vomiting, and was generally ADR. Fast forward several weeks and those odd crystals were popping up all over the country, now identified as melamine (Antech has a nice PDF with nine photographs). When my wife realized what she’d likely been seeing, she called our Royal Canin rep. The cat had been eating Hypoallergenic. Our rep said he was unaware of any problems but advised my wife to contact one of the company’s staff veterinarians.

Now that Royal Canin has recalled Hypoallergenic (along with a few other diets) because it contains tainted rice protein, we really wish my wife had made that second call (the birth of our first child got in the way). Had she talked with one of Royal Canin’s vets, would they still have reported “we have no confirmed cases of illness in pets” in their press release announcing the recall?

Probably yes, because a “confirmed” case is worlds away from a “suspected” case. Although I find the semantic game frustrating, it’s a small annoyance in what seems to be an otherwise forthright and responsible response—certainly Royal Canin has outperformed Hill’s in handling the recall. Unlike Hill’s, our Royal Canin rep contacted us immediately about the recall. We also didn’t have to wait for days for them to announce that they’d reimburse for testing. We were simply told that testing would be covered as long as we could show that the client had purchased a bag of recalled food within the last six months.

The response on the two companies’ Web sites is also quite different. Royal Canin’s front page is currently all about the recall. You can’t miss it. If one were unaware that Hill’s products had been recalled and visited the main page of their Web site, one would leave still unaware (unless one read the “Letter to Pet Owners” that is linked to from the main page). The page instead implies that Hill’s foods are unaffected by the recall: “Feed with Confidence.” “Wheat Gluten Free.” “Hill’s products not affected by rice protein concentrate recall.”

(We don’t use any P&G or Purina products, so I haven’t been as aware of their responses. Checking quickly, I don’t see any mention of the recall on Iams’ U.S. page. Purina addresses the recall on its main page.)

For several years now, my wife’s confidence in Hill’s products has steadily declined. For at least the past eighteen months she has refused to carry most of their maintenance diets. She finds that the Royal Canin prescription diets are generally more effective (k/d and z/d are the only Hill’s Prescription Diets we regularly use). Now, after watching them respond poorly over the last month to the pet food recall, her confidence has plumeted to new lows, and we’re seriously considering carrying only k/d and z/d.

Royal Canin, itself not free of warts (we’ve complained loudly in the past about poor communication from them), does at least seem to handle recalls well, admitting the problem in a timely manner and not shying away from their fiscal responsibility.

The FDA’s Center for Veterinary Medicine has posted updated Cumulative Adverse Drug Experiences (ADE) Summaries Reports, containing data from 1987 through 11 April 2007.

More information about the ADE reports can be found here and here (the latter page describes limitations in the ADE reports). An FAQ on the ADE reports is here. The form for submitting an ADE is here.

Reports are arranged by active ingredient (generic drug names are used), species, and route of administration. Some drugs have hundreds or thousands of reports; others have only a handful. Each report includes a list of reported reactions. Unfortunately, reaction types don’t seem to be fully standardized, so one can find the same type of reaction listed several different ways. For example, the report on carprofen administered orally to cats lists eight reports of “K HI, BLD” and one report of “K HI, BLOOD.” Similarly, what is the difference between “HYPOTHERMIA” and “HYPOTHERMIA, BODY,” both of which are reported six times. Some of the reported reactions are puzzling: one cryptic reaction reported for carprofen is “BLD.”

Still, the ADE reports are a wonderful resource for veterinarians who might be wondering if the odd reaction they’re seeing to a drug has been reported by anyone else.

Dr. Elankurmaran Subbiah, a veterinarian and assistant professor at the Virginia-Maryland Regional College of Veterinary Medicine is studying a modified strain of avian Newcastle disease virus (NDV) as a treatment for human prostate cancer. According to the press release here, “Subbiah and his associates are altering the fusion protein of NDV to replicate only in the presence of prostate specific antigen (PSA), which is found exclusively in cancerous prostate cells.”

Eli Lilly and Co. is entereing the veterinary medicine market with a drug for canine separation anxiety, Reconcile (active ingredient appears to be fluoxetine).

A veterinarian’s report led to changes in a controversial Canadian art exhibit. More here.

A Taiwanese veterinarian lost an arm (later reattached) while treating a crocodile at the Shaoshan Zoo. (Warning! The story in the Sydney Morning Herald includes a photograph of the aftermath that some might find too graphic. A shorter version of the story with a nongraphic photo is here.)

India’s lions need more veterinarians.

The BBC reports on Mycobacterium bovis infections in human beings, including cases of human-to-human transmission.

Dr. Nancy Davis, top veterinarian for the Kentucky Horse Racing Authority, is retiring.

Another story of cats attacking humans! This one is surprisingly charming and focuses almost exclusively on the cat rather than the victim.

The New York Times profiles Indonesian governor (and vetceteraVeterinarian of Note“) Irwandi Yusuf.

“Cowboy poet and large animal veterinarian” Baxter Black appeared on NPR’s Talk of the Nation last week.

William Booth, in the Washington Post, asks of his dogs’ wet food, “what, really, is that grayish brown reconstituted lump in the can?”

I assumed it contained lamb lungs and chicken brains. But there’s a lot more. A 99-cent unit of “cuts and gravy” is the signal product of global industrialized food, where nothing is wasted, a brutal efficiency rules and ingredients are assembled from a relentlessly competitive international marketplace. There is no accident in a can of dog food. Just the opposite.

The story pulls quotes from Drs. Tony Buffington and Bonnie Beaver and makes it seem like dogs are the major animal affected (see Dr. Khuly’s comments on this), but then the writer doesn’t admit to owning any cats.

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.

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