WSAVA Nov 2021 Proceedings

hours immediately after the injection. Very rarely anaphylactic reactions 0170 are observed, such asangioedema or collapse. No such reaction occur with sublingual immunotherapy, the only side effects described are oral FELINE LOW-GRADE INTESTINAL T-CELL erythema and irritation or increased pruritus. LYMPHOMA OR CHRONIC INFLAMMATORY ENTEROPATHY ? A CHALLENGE FOR CLINICIANS Concurrent therapies V. Freiche During the initial phase of immunotherapy, symptomatic treatment, includ- Maisons Alfort/France ing the use of oclacitinib, lokivetmab, ciclosporin, may be needed in the first 6-9 months, if the ASIT is effective, these can be slowly tapered and/ Qualifications: or withdrawn. If the treatment is effective, vaccine maintenance therapy is Dr Valérie FREICHE. DVM, PhD, DESV-IM given for the rest of the patient’s life. Only a minority of cases (about one Internal medicine Department third) will be controlled by immunotherapy alone. The majority of cases Hospital Practitioner will require adjunct symptomatic therapy, for at least part of the year. [email protected] FELINE LOW-GRADE INTESTINAL T-CELL LYMPHOMA OR CHRONIC INFLAMMATORY ENTEROPATHY? A CHALLENGE FOR CLINICIANS. Feline chronic enteropathies include both inflammatory and neoplastic lesions. Gastrointestinal lymphoma is by far the most frequent digestive tract neoplasia in cats. Among the different lymphoma subtypes, low- grade intestinal T-cell lymphoma (LGITL) is an indolent disease, affecting elderly cats, and its incidence has significantly increased over the two past decades. LGITL was first compared to monomorphic epitheliotropic T cell lymphoma (MEITL, previously named EATL2), in view of the associat- ed infiltration of the lamina propria and epithelium by medium-sized mono- morphic neoplastic T cells1. However, LGITL has recently be validated as a relevant spontaneous model of human indolent T-cell lymphoprolifera- tive disorders of the GI tract (GI-TLPD)2. 1.Differentiating low-grade intestinal T-cell lymphoma from lymphoplas- macytic enteritis in cats. A challenge for both veterinary clinicians and pathologists is to distin- guish lymphoplasmacytic enteritis (LPE) from LGITL: in fact, clinical signs, laboratory results, diagnostic imaging findings, histology, immunohis- tochemistry and clonality features are known to overlap, particularly in elderly cats3. However, differentiating these two entities is important as prognostic and treatment are different. Moreover, some indolent cases are known to progress towards more aggressive forms in both human and feline cases. As for now, several unanswered questions are still pending concerning the etiopathogenesis of both diseases. Compared to its human counterpart, histopathology and immunohistochemistry of LGITL cases lacks detailed characterization. Furthermore, clonality testing has been considered as a key step to ultimately differentiate LGITL from LPE4. In order to better de- fine the frontiers between intestinal inflammation and indolent intestinal lymphoma in cats, a recent study included 22 cats ultimately diagnosed with a LGITL and 22 cats suffering from LPE5. The epidemiologic results showed an over representation of males. Clinical signs duration prior to diagnosis were statistically different between the groups. No laboratory results were different excepting cobalamin dosage (lower in the LGIL group). The histologic analysis included a separate assessment of the epithelium and the lamina propria. More detailed histopathologic, pheno- typic, and molecular criteria have been established. Concerning clonality results, if the LGITL cases were monoclonal, 40% of LPE cases showed clear monoclonality, while 30% showed monoclonality in a polyclonal background. Given the clonality results, the current gold-standard tests should still be a combination of conventional histopathology and immuno- histochemistry and no equivocal case should be reclassified according to the clonality results. 251

13–15 NOVEMBER, 2021 2.Frontier between inflammatory and indolent low-grade T-cell lymphoma 0171 in cats6. THE END OF ANIMAL LIFE AS THE START FOR Concurrent LPE has been evoked in up to 60% of LGITL cases and it has ETHICS: ON EUTHANASIA AND THE ROLE OF THE also been suggested that LGITL might develop from LPE3. Several argu- VETERINARIAN ments were pointed out to support a continuum between LPE and LGITL2: F. Meijboom - The duration of clinical signs is statistically longer in cats diagnosed with LGITL compared with LPE cases. UTRECHT/Netherlands - A significant epitheliotropism may be identified in both LPE and LGITL Qualifications: - LGITL small lymphocytes invade the mucosa according to an “api- Franck L.B. Meijboom cal-to-basal” gradient suggesting a chronic endoluminal antigenic stimula- tion2. No LGITL case emerge from the depth of the mucosa. Associate professor and Head of Centre - “Patchy lesions” and nests are hallmarks of LGITL, even in a polymorphic [email protected] background #125 The end of animal life as the start for ethics: on euthanasia and the role of the veterinarian - Persistent cellular polymorphism infiltrates are regularly found in some TLGIL cases Franck L.B. Meijboom - Only minimal differences are seen between LPE and LGITL intestinal All over the world we keep animals for many purposes and in different microbiome and there is high similarity with the microbiome dysbiosis contexts. As veterinarian you are trained to protect and improve the health seen in human IBD. and wellbeing of these animals. It is also reflected in the WSAVA mission to “advance the health and welfare of companion animals worldwide”. A new model of lymphomagenesis has thus emerged and suggests a From this perspective the death of animals is often perceived as a sen- continuum between inflammatory enteropathy towards low-grade T-cell sitive and uncomfortable theme. At the same time, making decisions at intestinal lymphoma. In this model, the immunohistochemical study has the end of animal life and killing animals are for most veterinarians part highlighted the JAKSTAT pathway activation. Targeted therapy may result of their daily practice. As a result, euthanasia and animals are a central from these findings. theme in veterinary medicine that raises many questions. These are not limited to technical questions about diagnoses and best methods but References include a clear ethical component. This has been widely acknowledged (e.g., Cholbi, 2017; Rollin, 2011; Yeates, 2010). Nonetheless, it is import- • Moore PF, Rodriguez-Bertos A, Kass PH. Feline gastrointestinal lympho- ant to keep reflecting on this for two reasons. ma: mucosal architecture, immunophenotype, and molecular clonality. Vet Pathol. 2012; 49:658-68. First, euthanasia still leads to moral distress. Recent publications (e.g., Quain, 2021; Hartnack et al 2016) and research in our own group show • Freiche V, Cordonnier N, Paulin MV et al. Feline low-grade intestinal T that veterinarians feel confronted with problems and dilemmas in case of cell lymphoma: a unique natural model of human indolent T cell lymph- euthanasia. This moral stress is not only a matter of individual wellbeing oproliferative disorder of the gastrointestinal tract. Lab Invest. 2021 ; but also a potential moral problem. Veterinarians are professionals who 101(6):794-804. are capable of making autonomous moral decisions. This is the basis for the professional autonomy in moral matters that is often entrusted to • Paulin MV, Couronné L, Beguin J et al. Feline low-grade alimentary veterinarians. If, however, a veterinarian due to moral distress is compro- lymphoma: an emerging entity and a potential animal model for human mised in his or her ability to make well-informed and free moral assess- disease. BMC Vet Res. 2018 Oct 11;14(1):306. ments that is an ethical issue as such. It threatens both the professional position of the veterinarian and the quality of the ethical assessment. • Kiupel M, Smedley RC, Pfent C et al. Diagnostic algorithm to differ- entiate lymphoma from inflammation in feline small intestinal biopsy A second reason to focus on euthanasia starts in the hypothesis that samples. Vet Pathol. 2011 Jan;48(1):212-22. problems in the context of euthanasia are not stand-alone issues, but touch upon broader questions in veterinary ethics that are linked to deal- • Freiche V, Paulin MV, Cordonnier N, et al. Histopathologic, phenotypic, ing with moral uncertainty. This can be recognized on three levels. The and molecular criteria to discriminate low-grade intestinal T-cell lymphoma first level is the uncertainty linked to making decisions about euthanasia. in cats from lymphoplasmacytic enteritis. J Vet Intern Med. 2021 Aug 10. In many situations the decision is made under uncertainty: based on a di- Epub ahead of print. agnosis and an assessment of available treatments one assesses whether euthanasia is the best option. This assessment always takes place • Bernard P, Cordonnier N, Abadie J et al. Comparative analysis of the before the actual killing. This raises the question how much uncertainty distribution and severity of the lesions within the gastrointestinal tract in is acceptable. Another level at which uncertainty plays a role links to the feline low-grade intestinal T-cell lymphoma or lymphoplasmacytic enteri- moral position of animals. Despite trends that can be recognized world- tis: a prospective study. 2021 Online ECVIM Congress. wide to acknowledge animal as having moral standing, there still is a lot diversity in whether and why animals are considerable for their own sake. This leaves veterinarians often with uncertainty and has a direct impact on the evaluation of the act of euthanasia. Finally, there is uncertainty of what can be reasonably expected of a veterinarian. In combination with the diversity of views on the value of animals, expectations start to shift as well. This is not only about the expectation of animal owners, but also those of societal organizations or the general public. This further compli- cates answers to the question when euthanasia of an animal is the right 252 WSAVA GLOBAL COMMUNITY CONGRESS

thing to do and whether it fits to the moral ideal of the good professional. 0172 Finding a balance in this situation is important to navigate between the PET POPULATION CONTROL: ADVANTAGES AND extremes of getting paralyzed if no uncertainty is allowed and an anything DISADVANTAGES OF SURGICAL VS MEDICAL goes situation if the problems of uncertainty are ignored. Finding such a STERILIZATION balance depends on ethical assumptions and will benfit from a reference to principles such as the precautionary principle. In the lecture, this anal- M. Kutzler ysis will be further elaborated and some steppingstones to deal with the ethical dimensions of euthanasia will be presented. Corvallis/United States of America References Qualifications: Cholbi, M. (2017) The Euthanasia of companion animals. In Pets and Michelle Anne Kutzler, MBA, DVM, PhD, DACT People: The Ethics of Our Relationships with Companion Animals; Overall, C., Ed.; Oxford University Press: New York, NY, USA, 2017; pp. 264–278. [email protected] PET POPULATION CONTROL: ADVANTAGES AND DISADVANTAGES OF S. Hartnack, S. Springer, M. Pittavino and H. Grimm (2016). Attitudes SURGICAL VS MEDICAL STERILIZATION of Austrian veterinarians towards euthanasia in small animal practice: impacts of age and gender on views on euthanasia. BMC Veterinary Overpopulaton of unowned dogs and cats is a world-wide problem. In the Research (2016) 12:26 United States, surgical sterilization is commonly performed in pets as young as six weeks old to reduce pet overpopulation. Throughout much Rollin, B.E. (2011). Euthanasia, Moral Stress, and Chronic Illness in Veteri- of the world, surgical sterilization of dogs and cats (owned or unowned) nary Medicine, Veterinary Clinics of North America: Small Animal Practice, is neither available nor desirable for several reasons. The purpose of this 41/3, 651-659, review is to discuss the advantages and disadvantages of surgical and medical sterilization in dogs and cats. Quain, A. (2021). “The Gift: Ethically Indicated Euthanasia in Compan- ion Animal Practice” Veterinary Sciences 8, no. 8: 141. https://doi. The most common method for surgically sterilizing female dogs and org/10.3390/vetsci8080141 cats is for a veterinarian to perform an ovariectomy (which removes the ovaries) or to perform an ovariohysterectomy (spay; which removes the Yeates, J. (2010). Ethical aspects of euthanasia of owned animals. Prac- ovaries and part of all of the uterus) (Table 1). The most common method tice 2010, 32, 70–73. for surgically sterilizing male dogs and cats is to perform an orchiectomy (castration or neutering; which removes the testicles). These sterilization methods have the added benefit of eliminating the risk of future reproduc- tive tract diseases. However, because of the lack of gonadal hormones (estrogen and testosterone), there is a loss of negative feedback to the hypothalamic-pituitary axis, resulting in a sustained, supraphysiologic secretion of luteinizing hormone. Gonadectomized dogs have a higher tendency to develop obesity, abnormal hair growth/shedding, urinary incontinence, musculoskeletal diseases (cruciate ligament tears, hip dysplasia, intervertebral disc herniation), endocrine diseases ((hypothyroidism, hyperadrenocorticism, diabetes mellitus), behavioral abnormalities (fear, aggression, anxiety), and cognitive dysfunction, as well as hematologic, bone, prostatic and bladder neoplasia. There is mounting evidence supporting the long-term health complications associated with canine gonad removal are related to luteinizing hormone hypersecretion.1 It is necessary to consider the important functions the gonads play in regulating an animal’s health. Gonads are not merely gamete-producing or ancillary sex/reproductive organs but rather they are necessary endocrine glands for normal metabolic, behavioral, musculoskeletal, and anti-neo- plastic health. For this reason, surgical sterilization of dogs can also be performed in ways to spare the gonads.2,3,4 At this time, there is not enough evidence to support gonad-sparing sterilization in cats. An ovary-sparing hysterectomy is method of surgical sterilization that removes the entire uterus and all (or most) of the uterine tubes and cervix but leaves the ovaries intact and functional (Table 2). The surgi- cal approach is like an ovariohysterectomy and has been performed by veterinarians in the United States for nearly fifty years.5 Because the entire uterus is removed, there is no future risk for developing a pyo- metra. However, because the ovaries are spared, the risk future risk for developing ovarian and mammary cancer remains. In male dogs and cats, surgical sterilization can be performed by vasectomy.6 However, just as in females, because the testicles are still present, reproductive behaviors will persist and the risk for reproductive diseases remains (Table 2). 253

13–15 NOVEMBER, 2021 Regardless of which surgical sterilization method is used, surgery must be • Fossum TW. Surgery of the Reproductive and Genital Systems. Small performed under anesthesia and using sterile techniques. In many parts Animal Surgery Textbook. 3rd ed. St. Louis, USA: Elsevier; 2007. p 719. of the world, the availability of safe anesthetic protocols and sterile equip- ment is non-existent. For this reasons, non-surgical (medical) options for • Alliance for Contraception in Cats and Dogs. Contraception and fertility sterilizing dogs and cats are needed. The advantages and disadvantages control in dogs and cats. 2013. Available from: https://www.acc-d.org/ of intratesticular injections and deslorelin implants are provided in this re- resources/accd-e-book [Accessed 1st October 2021]. view. Other medical options for contracepting dogs and cats may require daily administration or are still considered experimental.7 • Kutzler M, Wood A. Non-surgical methods of contraception and steriliza- tion. Theriogenology. 2006;66(3):514-525. Available from doi:10.1016/j. Intratesticular injections have been investigated as a method of non- theriogenology.2006.04.014. surgical sterilization in dogs and cats for more than six decades.8,9 An FDA-approved proprietary zinc gluconate solution for intratesticular • Kutzler MA. Intratesticular and intraepididymal injections to sterilize injection labeled for sterilizing dogs is no longer manufactured. However, male cats: From calcium chloride to zinc gluconate and beyond. Journal calcium chloride dihydrate (CaCl2) is sold worldwide (CaClCa, Edmonton, of Feline Medicine and Surgery 2015;17(9):772-776. Available from: Canada). Intratesticular injection with CaCl2 induces sterilization via two doi:10.1177/1098612X15594991. mechanisms: 1) intratesticular edema following the injection leads to necrosis and fibrosis, which causes testicular degeneration; and 2) free • Goericke-Pesch S. Long-term effects of GnRH agonists on fertility and radicals produced within testicular tissue following the injection leads to behaviour. Reproduction in Domestic Animals. 2017;52 Suppl 2:336-347. lipid peroxidation and destruction of other cellular structures, which also Available from: doi:10.1111/rda.12898. directly impairs spermatogenesis. Sterility is accomplished within 4-6 weeks following the injection. Table 1. Advantages and Disadvantages of Gonadectomy in Dogs and Cats1 CaCl2 intratesticular injections should be performed using a sterile 27-gauge 12-mm needle directed from the caudal aspect of each testis ap- Advantages Disadvantages proximately 0.5 cm from the epididymal tail towards the cranial aspect of that testis. The CaCl2 should be carefully deposited along the entire route Permanent sterilization, Surgical complications, Obesity, by linear infiltration while withdrawing the needle from the proximal to Decreased risk of mammary Abnormal hair growth/shed- distal end. Care should be taken to prevent seepage of the CaCl2 solution Female Dog neoplasia if performed prepu- ding, Increased risk of urinary from the injection site. If the CaCl2solution is spilled on the scrotal skin bertally, Eliminates possibility of incontinence, Increased risk of and remains there, a skin lesion will develop because of tissue necrosis. reproductive tract diseases hematologic, bone, prostatic and But if the solution is immediately wiped away, then complications can be bladder neoplasia, Increased avoided. risk of musculoskeletal diseases (cruciate ligament tears, hip Intratesticular CaCl2 injection is well tolerated, with mild discomfort dysplasia, intervertebral disc occurring 1 to 5 min after injection. Testicular swelling is evident by 24 herniation) and endocrine hours, which peaks 2 to 4 days following injection and then decreases diseases ((hypothyroidism, over a period of 3 to 4 weeks. Scrotal skin necrosis can also occur if an hyperadrenocorticism, diabetes excessive volume is injected or leakage occurs outside of the tunic. mellitus), Increased risk for developing abnormal behaviors Deslorelin is a gonadotropin-releasing hormone agonist. When adminis- (fear, aggression, anxiety) and tered as an implant to male and female dogs and cats, there is an initial cognitive dysfunction stimulation of gonadotropin and gonadal hormone secretion followed by long-term infertility (Table 3). However, there is wide variability in the Male Dog Permanent sterilization, Surgical complications, Obesity, onset and duration of infertility.10 Infertility-inducing effects are fully Decreased urine marking and Abnormal hair growth/shedding, reversible, which limits the application of this method of sterilization when male reproductive behaviors, Increased risk of hematologic, working with unowned animal populations. Decreased risk of reproductive bone, prostatic and bladder tract diseases (except prostate neoplasia, Increased risk of mus- References cancer) culoskeletal diseases (cruciate ligament tears, hip dysplasia, in- • Kutzler MA. Possible relationship between long-term adverse health ef- tervertebral disc herniation) and fects of gonad-removing surgical sterilization and luteinizing hormone in endocrine diseases (hypothy- dogs. Animals. 2020;10(4):599. Available from: doi:10.3390/ani10040599. roidism, hyperadrenocorticism, diabetes mellitus), Increased risk • American Veterinary Medical Association. Spaying and neutering. for developing abnormal behav- Available from: https://www.avma.org/resources/pet-owners/petcare/ iors (fear, aggression, anxiety) spaying-and-neutering [Accessed 1st October 2021]. and cognitive dysfunction • Brent L, Kutzler M. Alternatives to traditional spay and neuter – evolving Permanent sterilization, best practices in dog sterilization. Innovative Veterinary Care. 2018. Avail- Decreased risk of mammary neo- Surgical complications, Obesity, able from: https://ivcjournal.com/spay-neuter-alternatives/ [Accessed Female Cat plasia if performed prepubertally, Increased risk of diabetes 1st October 2021]. Eliminates possibility of ovarian/ mellitus uterine disease • Kutzler MA. Gonad-sparing surgical sterilization in dogs. Fron- tiers in Veterinary Science. 2020;7:342. Available from: doi:10.3389/ Male Cat Permanent sterilization, Obesity, Increased risk of diabe- fvets.2020.00342. Decreased spraying and male tes mellitus reproductive behaviors • Belfield WO. For a more normal life for a pet: a partial spay (hysterecto- my). Veterinary Medicine Small Animal Clinician. 1972;67:1223–1224. 254 WSAVA GLOBAL COMMUNITY CONGRESS

0173 Table 2. Advantages and Disadvantages of Gonad-Sparing Sterilization THE CANINE PROSTATE: ITS ROLE IN FERTILITY Surgery in Dogs3,4 AND MANAGEMENT OF HYPERPLASTIC CONDITIONS Advantages Disadvantages S. Schaefer-Somi Surgical complications, Potential Vienna/Austria Female Dog Permanent sterilization, Decreasedfor developing mammary cancer risk of pyometra or reproductive tract diseases Qualifications: (except for pyometra) Sabine Schäfer-Somi Male Dog Permanent sterilization Surgical complications, Potential A.Prof.Dr.Dipl ECAR for developing reproductive tract diseases (except prostate cancer) [email protected] The prostate gland in very young dogs, is situated in the pelvis, is shifted Table 3. Advantages and Disadvantages of Deslorelin Implant Sterilization into the abdomen when the dog grows and can be palpated in the pelvis in Dogs and Cats10 again, when the size is increased due to a disease. The normal consisten- cy is firm but elastic, the dorsal sulcus can be palpated rectally, allowing Advantages Disadvantages to examine for symmetry. The growth is strongly regulated mainly by the active metabolite of testosterone (T), 5a-Dihydrotestosterone (DHT). Reversible (may also be disad- Induction of estrus with ovulation After diffusion into the prostate gland, more than 95% of testosterone are Female Dog vantage), No special training or if administered during anestrus, converted to DHT by the enzyme 5α-reductase which binds stronger to the Induction of abortion if adminis- receptors than T. Estradiol-17ß supports the effects of DHT and induces equipment needed tered during pregnancy, Increased the upregulation of DHT-receptors. The prostate secrections provide >90% risk of forming ovarian follicular of the ejaculate, they substitute the sperm cell function and transport. cysts, Potential for developing Recently, the composition was unscrambled in a proteomic study (1). The mammary cancer or reproductive proteins mainly consist of the Serin-Protease Canine-Prostate-Specific-Es- tract diseases terase (CPSE) and the Lactotransferrin-Precursor. The CPSE has a proteo- lytic effect and after binding influences the spermatozoa uptake of zink; Male Dog Reversible (may also be disad- Increase in intensity of male it furthermore induces cholesterol efflux. Like the prostate secretions, the vantage), No special training or reproductive behaviors for 7-14 secretion of CPSE is regulated by androgens. equipment needed, Decreased days following implant administra- urine marking and male repro- tion; Increased risk of reproductive The most common disease of the prostate in aging dogs is the Benign ductive behaviors, Decreased tract diseases (except for prostatic Prostate Gland Hyperplasia (BPH) accounting for 50% of all prostate dis- risk of prostatic hyperplasia and hyperplasia and prostatitis) eases. The BPH seldom occurs in 2-3 year old dogs, the incidence increas- prostatitis es with age. At the age of 5 years, first sonographical changings can be seen in 80% of dogs. Causes for the BPH are among others an increased Reversible (may also be disad- Increased risk of forming ovarian ratio of estrogen : testosterone, a change in the intraprostatic receptor Female Cat vantage), No special training or follicular cysts; Potential for expression and an increased concentration of Dihydrotestosteron (DHT) in developing mammary cancer or re- the epithelial gland tissue. A genetic predisposition is discussed; recently, equipment needed productive tract diseases (except an increased risk to develop BPH was found in Rhodesian Ridgebacks (2). for pyometra) First clinical signs are bloody preputial discharge and erythrocytes in the Male Cat Reversible (may also be disad- urine. In stud dogs, the disease is frequently recognized during semen vantage), No special training or collection because of erythrocyte admixtures in the prostate secretions. equipment needed, Decreased When the centrifugal growth advances, disturbed urination and defecation spraying and male reproductive can result, and even urinary retention and acute constipation (3). The com- behaviors position of the prostate secretions may be changed, causing a decrease in semen quality; a significant increase in CPSE and pH, increased choles- terol concentrations and decreased concentrations of Zn and Cu in the prostate secretions were reported (4), furthermore higher concentrations of glucose and triglycerides than in healthy dogs (1). The changed composition of the prostate secretions and decreased se- men quality can cause a temporary impaired fertility and freezability of the semen. In one study, 32.8% of dogs with infertility had BPH. The semen parameters were mostly changed, especially motility, progressive motility and the percentage of live sperm (5). Significantly more spermatozoa with DNA fragmentation were found than in healthy dogs, which was reversible (4), furthermore lower concentration of spermatozoa and defective mem- brane functions (1). The bacteriological examination is often negative. The CPSE concentration in the semen is among others dependant on the age. Meanwhile, tests are commercially available and cut-off values have been published. However, any value should be interpreted in relation to the 255

13–15 NOVEMBER, 2021 clinical findings. In stud dogs, further diagnostics should be performed fitness. This can be achieved by regular clinical and sonographical exam- after semen collection and comprise a clinical-andrological examination inations, when the dog reached 40% of its life expectance (10). Beginning inclusive digital-rectal palpation of the gland and sonography of the testi- signs of BPH can then be treated in time preventing infections and chron- cles. Prostate secretions can be collected for cytological and bacteriolog- ical diseases of the gland. ical examination; for this purpose, the urinary bladder has to be emptied, then a catheter is inserted in the urethra and positioned under the gland. Literature Cited The prostate gland must be digitally massaged via the rectum, then the prostate secretions can be aspirated. 1. Aquino-Cortez A, Pinheiro BQ, Lima DBC, Silva HVR, Mota-Filho AC, Martins JAM et al. Proteomic characterization of canine seminal plasma. During sonographical examination, the examiner should recognize the Theriogenology 2017; 95:178–86. size, structure, echogenicity and abnormal structurs like cysts, abscess, mineralisation. Advanced techniques like Doppler sonography and the 2. Werhahn Beining F, Urhausen C, Wolf K, Schmicke M, Rohn K, Schuler use of ultrasound contrast agents (UCA) improve the diagnostic value. An G et al. Rhodesian Ridgebacks have an increased risk to develop benign x-ray indicates the size and position of the gland; in healthy dogs, the max- prostatic hyperplasia. Reprod Domest Anim 2020; 55(3):283–92. imum size corresponds to 70% of the distance between the cranial margin of the os pubis and the promontorium of the os sacrum. Retrograde 3. Gobello C, Corrada Y. Noninfectious prostatic disease in dogs. Com- urethrocystography simplifies the evaluation of the urethra diameter. pend Contin Educ Vet 2002; (24):99–107. A blood picture usually reveals normal findings; in the urine, seminal plas- 4. Krakowski L, Wąchocka A, Brodzki P, Wrona Z, Piech T, Wawron W et ma and prostate secretion, admixture of erythrocytes is a frequent finding. al. Sperm quality and selected biochemical parameters of seminal fluid in dogs with benign prostatic hyperplasia. Animal Reproduction Science Theoretically, the diagnosis BPH should be verified by using fine needle 2015; 160:120–5. aspiration (FNA), which can be done in the sedated dog by performing ultrasound guided, transcutaneous puncture of the gland. However, this 5. Domosławska A, Zdunczyk S. Clinical and spermatological findings in is seldom necessary since the clinical findings usually are sufficient to male dogs with acquired infertility: A retrospective analysis. Andrologia initiate the therapy. 2020; 52(11):e13802. The therapy can be initialized with the 5α-Reductase-Inhibitor Finasteride 6. Sirinarumitr K, Johnston SD, Kustritz MV, Johnston GR, Sarkar DK, or an anti-androgenic compound, and prolonged with a long-acting Memon MA. Effects of finasteride on size of the prostate gland and Gonadotropin-Releasing-Hormone (GnRH)-agonist such as deslorelin. semen quality in dogs with benign prostatic hypertrophy. J Am Vet Med In case of low grade BPH, the 5α-Reductase-Inhibitor Finasteride is the Assoc 2001; 218(8):1275–80. medicament of choice (6). It does not influence semen quality, libido or the health of resulting puppies and side effects have not been described 7. Socha P, Zduńczyk S, Tobolski D, Janowski T. The effects of osaterone so far. Finasteride tablets have to be applied daily for 1-4 month, different acetate on clinical signs and prostate volume in dogs with benign prostat- dosages were described (0.1-1 mg/kg/day). In higher grades of BPH, ic hyperplasia. Pol J Vet Sci 2018; 21(4):559–66. especially when urination and defaction are disturbed, a quicker effect of treatment is important. Anti-androgens like cyproterone acetate (3 mg/ 8. Niżański W, Levy X, Ochota M, Pasikowska J. Pharmacological kg s.c.) or osaterone acetate (0,25-0,5 mg/kg SOD for 7 days) significantly treatment for common prostatic conditions in dogs - benign prostatic decrease the size of the gland within 1-2 weeks by competitively blocking hyperplasia and prostatitis: an update. Reprod Domest Anim 2014; 49 testosterone receptors; even intraprostatic cysts < 3 cm can be effectively Suppl 2:8–15. treated. After this time, the treatment can be repeated with the same dos- age. Duration of effectiveness is 3-6 months, dependant on dosage and 9. Hatamoto LK, Baptista Sobrinho CA, Nichi M, Barnabe VH, Barnabe RC, age of the dog. Osaterone acetate (Ypozane®, Virbac, F) decreases the Cortada CNM. Effects of dexamethasone treatment (to mimic stress) uptake of dihydrotestosterone (DHT) in the prostate gland, decreases the and Vitamin E oral supplementation on the spermiogram and on seminal expression of DHT-receptors and reduces the activity of the 5α-reductase. plasma spontaneous lipid peroxidation and antioxidant enzyme activities Oral application of 0,25 mg/kg SOD for 7 days significantly reduced the in dogs. Theriogenology 2006; 66(6-7):1610–4. prostate gland volume to 64.3% within 14 days (7). The semen quality is decreased during therapy, the volume being decreased for up to 4 months 10. Mantziaras G. Imaging of the male reproductive tract: Not so easy as it and more morphologically changed spermatozoa can be found in the ejac- looks like. Theriogenology 2020. ulate. However, after 3 months of therapy, the size of the prostate gland and semen quality will be normal; even semen quality after freezing and thawing will be improved. Since the libido is only low grade decreased, collection of semen is possible any time. Long acting GnRH agonists like Deslorelin (Suprelorin® 4.7 oder 9.4 mg, Virbac, F) can significantly re- duce the volume, however, they affect slowly. The volume of the prostate gland decreased after application of a 4.7 mg implant within 6 weeks by 50% (8). The effect starts after approximately one month. The initial flare- up can be overcome by initial use of an anti-androgen. During each therapy and thereafter, reconstitution of semen quality can be supported by food additives like vitamin E and fatty acids. In one study (9), 500 mg of vitamin E was applicated once daily to 18 dogs for 10 weeks to neutralize the detrimental effect of dexamethasone treatment. Ejaculate volume, progressive motility and total sperm pathology were significantly improved thereafter. BPH has a high recidive quote; in stud dogs, the goal should be to decrease the frequency of recidives and to preserve their reproductive 256 WSAVA GLOBAL COMMUNITY CONGRESS

0174 stage, presence or not of comorbidities, and the clinical conditions of the patients. PALLIATIVE TREATMENT IN VETERINARY ONCOLOGY As a rule, in some cancers that rise from inflammatory cells and are by nature “inflammatory” (often produce cytokines release form the cancer) A. Giuliano it is better to use prednisolone (es; lymphoma, multiple myeloma, mast cell tumours). For other cancers that often carry overexpression of COX-2 Kowloon/Hong Kong PRC (main target of many NSAIDs, especially selective COX-2 inhibitors,eg; piroxicam and meloxicam) like urinary TCC, oral SCC, Lung carcinomas Qualifications: and others, NSAID are the drugs of choice. Antonio Giuliano, DVM, MS, GpCert(SAM), PgCert(CT), ECVIM (onc), Other variables to keep in mind before deciding to chose prednisolone MRCVS versus NSAID are the clinical conditions of the pet, presence of comorbid- ities (like renal disease) and the expectation of life with the consequent [email protected] duration of the treatment and possible related long term side effects that could affect the QOL. PALLIATIVE TREATMENT IN VETERINARY ONCOLOGY As an example, a dog with urinary TCC that have a reasonably long-term Palliative care is defined “as the approach that improves quality of life expectation of life, in the absence of severe renal/liver disease, will ben- (QOL) of patients and their families facing the problem associated with efit more of a long-term treatment with NSAID, while a dog with advanced life threatening illness thorough prevention and relief of pain, suffering unresectable and metastatic MCT will benefit from prednisolone. An old and other physical and psychosocial problems”(1). cat with anorexia and CKD and an advanced oral SCC, will probably benefit more of prednisolone rather than NSAID treatment. Strictly speaking, most of the cancer treatments used in veterinary oncolo- gy are mainly palliative. This is due to the fact that he quality of life of the Various pain management strategies can be used to treat cancer pain and pets is more important than increasing the life span. combinations of various drugs are often needed to achieve the best result. While prednisolone or NSAID can be used for pain control, often are not However sometimes more aggressive treatments are recommended enough in controlling significant or severe cancer pain. A classic example hence the term “curative/definitive” intent treatments. is the severe pain caused by bone tumours like osteosarcoma. There is a significant difference between curative intent or definitive treat- In this scenario combination of various drugs like NSAID, bisphosphonate, ment versus palliative treatment. gabapentin, tramadol, amantadine amitriptyline and/or other is recom- mended. Curative or definitive treatments are used with the intent of a higher gain, like a cure or long-term survival (one year or longer). In this scenario, Recently a new drug for pain relief called bedinvetmab in dogs and frun- some temporary reduction of patient quality of life can be considered evetmab in cats have been approved in the EU (2). These are specie-spe- acceptable, in view of a possible cure or a long-term survival. cific monoclonal antibodies directed against NGF (nerve growth factor), that inhibit signalling through sensory neurons and pain. Despite it has A classic example of this approach could be an aggressive surgery like a been approved only for the treatment of pain related to osteoarthritis, it is maxillectomy for a stage I-II oral squamous cell carcinoma in a dog. As likely that these new drugs will be beneficial in the control of cancer pain the metastatic rate for this type of tumour is low and a complete resection especially when related to primary or secondary bone cancer (3). can be curative, then a curative intent treatment is preferred. Various nautriceutical products present in the market have been claimed On the other hand, a large oral melanoma with metastasis to the regional to have pain killer effects. Probably one of the most used by owners of lymph node can be treated with a palliative surgical resection (debulking dogs and cats with cancer is cannabis oil or cannabidiol (CBD). The real of the mass) or palliative radiotherapy treatment. Despite a cure or a long- efficacy of this drug in the clinical setting is not known. The pharmacoki- term survival are very unlikely to be achieved, the reduction in size of the netic and pharmacodynamic of CBD present in various formulations found mass will increase the comfort and the quality of life of the dog. in the market for pet are also largely unknown. However, in some pain models in rodents some efficacies have been found and some anecdotical We can divide cancer palliative treatment in dogs and cats in primary benefits are reported by people that use CBD oil. It seems extremely safe treatments (directed towards the tumour), that involve the use of palliative in dogs and cats, but due to the inhibition of various CYPs in the liver, surgery, radiotherapy, electrochemotherapy, conventional chemotherapy clinically relevant drugs interactions are possible (4). and targeted therapy versus secondary or supportive medical treatment, directed to control the pain and the clinical signs related to the cancer. In the palliative treatment of our oncological patients, we need to remem- ber that pets are part of the family, and it is very important discussing Secondary/supportive medical treatments are considered all the drugs clearly with the owner the patient prognosis, assessment of parameters of that are used to reduce pain and/or the various clinical signs associated quality of life and pain and managing owner expectations. with cancer, including; inflammation, infection, anorexia, cachexia, nausea, vomiting or even paraneoplastic conditions like hypercalcemia, hypogly- It is also important to discuss when, how and why euthanasia is recom- caemia. mended. Various drugs are used for this purpose, like NSAID, gluco-corticoids, Advice on counselling and psychologic support should also be consid- opioid, and non-opioid pain killers, appetite stimulants, gastro-protectants ered. amongst many others. References NASAID and prednisolone are probably the most used drugs in palliative cancer management and often veterinarians are unsure when to use one 1)Kelley AS, Morrison RS. Palliative care for the seriously ill. New England or the other. Journal of Medicine. 2015 Aug 20;373(8):747-55. It is difficult to give clear guidelines on when to choose NSAID or gluco- 2) M. Krautmann, R. Walters, P. Cole, J. Tena, L.M. Bergeron, J. Mes- corticoids, as it will depend on many variables including the cancer type, 257

13–15 NOVEMBER, 2021 samore, D. Mwangi, S. Rai, P. Dominowski, K. Saad, Y. Zhu, M. Guillot, 0175 L. Chouinard. Laboratory safety evaluation of bedinvetmab, a canine anti-nerve growth factor monoclonal antibody, in dogs, The Veterinary DOC, WHAT HAPPENS IF I DON’T TREAT MY PET’S Journal, 2021; 276, TUMOR? 3)Bimonte, S., Cascella, M., Forte, C. A., Esposito, G., & Cuomo, A. The N. Ignatenko Role of Anti-Nerve Growth Factor Monoclonal Antibodies in the Control of Chronic Cancer and Non-Cancer Pain. Journal of pain research, 2021;14, Feldkirchen/Germany 1959–1967. Qualifications: 4)Mlost J, Bryk M, Starowicz K. Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action. Int J Mol Sci. 2020;21(22):8870 Ignatenko Nataliia phD, resident ECVIM-Ca oncology [email protected] DOC, WHAT HAPPENS IF I DON`T TREAT MY PET WITH TUMOR? resident ECVIM-Ca -oncology [email protected] Question: “Doctor, what might happen if I do not medicate my pet with a tumor?” is one of the very first questions that a doctor gets asked in daily praxis once a neoplasm was visualized. In order to answer this question, two components are important: 1. com- prehensive information about the process (localization of the neoplasm, growth rate, tumor type, degree of aggressiveness and the presence of a metastatic process) and 2. sincere communication with the owner of the pet. So, question number one: What do we know about the enemy (tumor) in order to assume the power of its destructiveness? The presence of a neo- plasm does not automatically mean cancer. And the presence of a benign neoplasm may not affect the duration and quality of life of a pet with a neoplasm. If we know absolutely nothing about the tumor, then our rec- ommendations will not be accurate. Knowing the diagnosis, it is important to discuss both scenarios: What can be gained by providing therapy and what are the prospects if further treatment is abandoned? Some of the most common dogs skin lesions are histiocytomas, papil- loma’s and lipomas. Here, the observation regime is fully justified. In the first two cases of neoplasms, spontaneous disappearance is possible. Lipomas, if they do not increase in size and do not cause concern to the pet, cannot be removed. But mast cell tumors - the most common skin neoplasms in dogs - are large imitators and may look like all three harmless tumors (they may look like “strawberry” histiocytomas, like soft lipomas, or be dense like papilloma’s). Therefore, just by the type of neoplasm, we cannot offer anything by understanding that neoplasms such as mast cell tumors, soft tissue sarcomas or post-injection sarcomas in the early stages - can only be cured through surgery. Let´s please consider a second example: Mammary gland tumors are the second most common tumors. In this case, a waiting period will be disastrous for patients who are admitted at the first stage of mammary malignant tumors - they can be cured only with the help of surgery. A misconception here is: if the tumor does not interfere, then you can do nothing until the moment when discomfort appears. The situation however is different for a systemic tumor process: we still cannot defeat cancer, but we can successfully treat it and offer our pa- tients with diffuse round cell lymphoma at least 12-18 months of age. What does a doctor need to determine as a first component? The exact localization, the size of the neoplasm, morphological (cytological or histological diagnosis), the presence of regional or distant metastasis, the patient’s general well-being and minimal tests (biochemistry, general 258 WSAVA GLOBAL COMMUNITY CONGRESS

blood count). 0176 Moving on to the second part, it is very important to understand why the PAIN MANAGEMENT FOR REPTILE PATIENTS - owner of the animal is asking this question. Is there a desire to escape WHAT WE REALLY KNOW! from the problem behind? Until the diagnosis is announced, you should not think about the fear of a serious illness or a separation. T. Plangsangmas1, R. Boonyarittichaikij2, P. Ratanakorn1 Perhaps the fear of not coping with the financial burden is the reason for 1Bangkok/Thailand, 2Nakornpathom/Thailand refusing further therapy. Comprehensive information about the diagnosis, possibilities, complications and side effects of therapy, prognosis and Qualifications: costs are important for the owner decision. In case of insufficient funds, it is possible to discuss the owner’s appeal to animal assistance funds, or Tithipong Plangsangmas information on how to create a fundraising platform. DVM MS Another important reason for refusing therapy is the fear of additional suffering that may be caused by the treatment within the tumor process. [email protected] Chemotherapy treatment is more frightening than surgery, because The definition of pain by the International Association for the Study of negative personal experience (someone from close or distant relatives Pain (IASP) is “An unpleasant sensory and emotional experience associ- who underwent chemotherapy) forces them to refuse treatment without ated with, or resembling that associated with, actual or potential tissue discussing its advantages and disadvantages. The owners do not want to damage”. “Nociception” is the process of refining information from the prolong the suffering of their four-legged family member. This is nowa- peripheral and central nervous system (CNS) when stimulated by external days the opinion of anti-cancer therapy: as a period in which a pet will or internal ques. As veterinarians, it is our duty to deal with pain to suc- experience all the hardships of the side effects of chemotherapy: nausea, cessfully treat our patients. However, reptiles are commonly doubted if weakness, apathy, vomiting, diarrhea, systemic alopecia. Few people they experience pain like mammals or have responses to noxious stimuli. know that 80% of patients tolerate chemotherapy well - without severe Reptiles are also known to hide signs of illness and pain as well. Their sto- side effects requiring medical intervention. ic presentation brings up the question “Can reptiles feel pain?”. Scientific evidence shows that reptiles possess all anatomical attributes essential The degree of attachment to the pet and the willingness to experience the for experiencing pain as in other vertebrates. Therefore, it is reasonable stress associated with treatment also influences the decision to withdraw for veterinarians to stand by that reptiles feel pain for the best interest of from therapy. When the owner doesn’t decide for cancer therapy, it´s their welfare. Pain management is an important part of medical manage- important to realize there is an understanding of the awareness of the ment. Due to more than 10,000 species of reptiles, the reptile patient is a decision made and the missed opportunities. After a decision was taken, challenging case with different responses to analgesic drugs. Adapting it is not possible to start at different stages with other possibilities or recommended doses from different species of reptiles should be done different prognosis. with caution. Occasionally, the owner might not prefer a cancer therapy, but will not One reason efficacy studies of different analgesic drugs in reptiles are refuse palliative care. scarce is because the measurement of pain in reptiles is difficult. To be able to recognize abnormal behavior or presentation from pain, one must We also cannot ignore the special personal circumstances of the owners: understand the normal species-specific behavior displayed within the pregnancy, existing or planned, breastfeeding, the presence of small environmental context. Apart from behavioral indicators, physiological children in the family, which should exclude any possible contact with indicators are useful for assessing pain in reptiles as well. The combina- four-legged family members receiving chemotherapy. After all, we are still tion of appropriate behavioral and physiological parameters used for pain doctors “treating humans”. measurement include absence of normal behavior, hunched posture, in- creased aggression, rubbing/scratching painful area, change of skin color The suffering that comes from caring for a seriously ill pet can also be (usually darkening), head extension (especially in chelonians), lameness, a huge burden for owners. Oncologists with a heavy heart are afraid to decreased food intake, decreased activity, heart rate, and respiration rate. communicate to owners a euthanasia in order to help them make the right decision. Opioids are often used for acute pain in reptiles. They are classified ac- cording to the receptor’s subtypes: mu (μ), kappa (κ), and delta (δ). For ex- We veterinarians often feel that we know the best way out, but it is very ogenous opioids to be effective, the reptiles must have opioid receptors. important to give the owner the right to decide whether or not to run a The three receptor subtypes are highly conserved in vertebrates. However, cancer therapy. However, we still have the important task of maximum studies have shown that butorphanol commonly used as a reptile anal- information. gesic do not have analgesic properties in certain reptile species. While morphine and hydromorphone which are mu-opioid receptor agonists have demonstrated analgesic effects in a range of reptiles. Fentanyl, another μ-opioid receptor agonist which is 75 to 100 times more potent than morphine has been developed to be administered transcutaneously as a patch or intravenously. Fentanyl patches has been proved effective in ball pythons and other snakes. As for other species, more studies should be investigated. Tramadol has increasingly been used in reptiles due to the reduced opioid side effects of respiratory depression and can be given per oral as well. However, when using all types of opioids veterinarians should be aware of the possible side effects, mainly respiratory depression, and monitor the reptile patient continuously. Nonsteroidal antiinflammatory drugs (NSAIDs) are also widely used as an- algesics for reptiles. Even though they are not as potent as opioids, they 259

13–15 NOVEMBER, 2021 are considered in conjunction with their anti-inflammatory effects. Studies 0177 on the efficacy of NSAIDs are scarce. Meloxicam has shown to be an effective analgesic in red eared sliders and several reptile species. More JUVENILE AND SENIOR BIRDS - WHAT’S SPECIAL - studies on the efficacy of NSAIDs should be done. Veterinarians should al- WHAT’S DIFFERENT? ways be aware of the side effects documented in other species (e.g., renal impairment, gastrointestinal ulceration, hematological abnormalities) and C. Hochleithner, M. Hochleithner consider administering lower reference ranges of species without studies. Vienna/Austria Managing pain in the reptile patient requires a great deal of caution. Since there are limited literature on reptile analgesia and the variety of species Qualifications: with different responses, a fixed plan or approach is not applicable to all reptile species. Combining groups of analgesics as a multimodal Dr. Manfred Hochleithner, Dipl. ECZM approach may be the best way to manage pain in reptiles. In conclusion, analgesics used in reptiles all have the potential to reduce pain, especially Head of Tierklinik Strebersdorf Hochleithner GmbH when given preemptively and combined in a multimodal approach. [email protected] REFERENCES Cardiovascular diseases have long been described and treated in psittacines. However, there is little data available on effective dosages in 1. Hawkins MG, Guzman DS-M, Paul-Murphy J. General Principles of different species. Analgesia and Anesthesia in Wildlife. In: Medical Management of Wildlife Species. John Wiley & Sons, Ltd; 2019. p. 45–73. As part of the routine ambulance, birds are always presented in different general conditions. Especially with parrots with cardiac insufficiencies, 2. Longley L, Fiddes M, O’Brien M. Anaesthesia of exotic pets. Edinburgh ; which often present shortly before or while already in decompensation, it New York : Elsevier Saunders; 2008. is important to quickly diagnose and start the optimal therapy. 3. Olsson A, Simpson M. Analgesia and Anaesthesia. In: Doneley B, Monks Dilated cardiomyopathy in psittacids D, Johnson R, Carmel B, editors. Reptile Medicine and Surgery in Clinical Practice. John Wiley & Sons, Ltd; 2017. p. 369–81. Up to now, psittacids have been presented in the literature in addition to the more common arteriosclerosis cardiomyopathies, mitralis infusion, 4. Perry SM, Nevarez JG. Pain and Its Control in Reptiles. Veterinary Clin- hypertrophic cardiomyopathy and conduction disorders. Dilated cardiomy- ics of North America: Exotic Animal Practice. 2018 Jan;21(1):1–16. opathy, as described in dogs, (especially in the Doberman, has never been described in birds, nor has successful therapy with Pimobendan been 5. Sladky KK. Reptile and Amphibian Analgesia. In: Miller RE, Lamberski N, published. In a genetic study of histopathology results, an African penguin Calle PP, editors. Fowler’s Zoo and Wild Animal Medicine Current Therapy, was diagnosed with atrial and vetricular dilatation due to congenital Volume 9. W.B. Saunders; 2019. p. 421–31. tricuspidalis valve dysplasia on the right. The authors also describe a con- nection with the avian leukosis virus in broilers with right heart dilatations 6. Sladky KK, Mans C. Clinical Analgesia in Reptiles. Journal of Exotic Pet and in the statistical evaluation of section results. In a retrospective study Medicine. 2012 Apr;21(2):158–67. of post mortem examinations from 144 psittacids, right heart dilatation was found in 6 animals. 7. Sladky KK, Mans C. Analgesia. In: Divers SJ, Stahl SJ, editors. Mader’s Reptile and Amphibian Medicine and Surgery (Third Edition). Third Edition. Ultrasound is used as a routine diagnostic in veterinary cardiology. In St. Louis (MO): W.B. Saunders; 2019. p. 465-474.e3. dogs and cats, standardized measurements in B and M mode are carried out to measure the ratios of the chambers and draining vessels as well as the contractility of the heart muscle. Furthermore, Doppler examina- tions are used to examine the blood flow velocities, which gives detailed information about the pressure conditions, the valve tightness and the performance of the chambers. Standardized examination protocols in B-mode are also available for birds. Due to the small size of the patients, high-frequency transducers of at least 7.5 MHz are required. Furthermore, due to the small sonic window in the ventral area caudal from the sternum above the liver, the coupling differs for the individual species, since the transducer must be tilted strongly cranially towards the heart to be able to represent the heart that lies on the sternum. In order to be able to carry out all measurements in B-mode in both cutting planes (horizontal and vertical), the examiner needs time and, above all, a stable patient 260 WSAVA GLOBAL COMMUNITY CONGRESS

0178 Performing corneal collagen crosslinking CORNEAL COLLAGEN CROSS LINKING- USEFUL IN Corneal collagen crosslinking requires a device that emits a continuous GENERAL PRACTICE? wave of UV light at a wavelength of 365nm with an adjustable aperture and illumination intensities of 3-45mW/cm2 and Riboflavin (Vitamin B2) M.-C. Fischer solution. After a serial application of riboflavin (Vitamin B2) eye drops over 30minutes the ocular surface in illuminated with ultraviolet light. Hatfield/United Kingdom Different protocols have been used and vary in length (between 2- 30min- utes) and total energy delivered/ fluence (5.4 -16.4 J/cm2). The routine Qualifications: 30 minutes, 5.4 J/cm2 single energy dose Dresden protocol used to treat keratoconus in humans may be insufficient in treating infectious keratitis Maria-Christine Fischer and higher UV fluences increase the bacterial killing rate (14). Further general anesthesia is required for these long protocols to ensure patient Dr.med.vet. DipECVO MRCVS immobilization and focus of the UV light beam during the photoactivation process. Subsequently, accelerated protocols using high-energy over [email protected] shorter periods of time are gaining popularity. A standard protocol for treatment of infectious keratomalacia has not yet been published. Concept of corneal collagen crosslinking (CXL) PACK-CXL should only be used in patients with corneal stromal ulcers Corneal collagen crosslinking has been the gold standard treatment for with stromal loss of no more than 50% due to its potential to damage the keratoconus in physician-based ophthalmologyfor over two decades. New endothelial cells when the stroma is insufficiently thick. ophthalmic indications evolved based on the use of photoactivation of riboflavin in transfusion medicine to reduce the microbial load, killing both Antibiotic resistance in veterinary medicine and potential future impact of bacteria and viruses. To distinguish CXL treatment for keratoconus from photo-activated chromophore for keratitis corneal cross-linking (PACK- CXL for infectious keratitis the term photo-activated chromophore for CXL) keratitis corneal cross-linking (PACK- CXL). The emergence of antimicrobial resistance in both human and veterinary CXL works by combining ultraviolet A light and a chromophore (Vitamin medicine has called for increased attention on how antimicrobials are B2, Riboflavin). The photoactivation of the chromophore is acting as a used. This is of special importance when considering that the bacterial disinfectant, reducing the microbial load of a liquid of tissue, killing bac- species causing infectious keratomalacia (predominantly Pseudomo- teria, viruses and fungi. Its disinfectant effect has been attributed to three nas aeruginosa, Escherichia coli and Staphylococcus spp.; unpublished mechanisms: 1. Damage to the microorganisms cell walls by creation data from authors’ group) are being found in increasing numbers with of a large number of reactive oxygen species during the photochemical multidrug-resistant profiles in veterinary medicine (15–17). All antimicro- reaction 2. Intercalation of the chromophore with the nucleic acids of bial use can select for resistant pathogens, and those contained within the microorganism, inhibiting DNA replication 3. Steric hinderance for licensed eye-drops for dogs are featured on the World Health Organisa- collagenases by changing the tertiary structure of the corneal collagen tion’s list of Highly Important and Critically Important Antimicrobials (HI/ lamellar (1). This increases the cornea’s resistance to digestion. Further CIAs), such as fluoroquinolones, gentamicin, chloramphenicol and fusidic the weakened cornea is biomechanically stiffened by more than 300%. All acid (WHO, 2019). Previously it has been shown that topical fluoroquino- four effects occur simultaneously when CXL is performed. lone use may result in higher concentrations required to inhibit subse- quent growth of ulcer-derived pathogens and may even result in a need Application of corneal collagen crosslinking (CXL) in to change to an alternative therapy (15). There is also extensive concern veterinary ophthalmology of the side-effect of antimicrobial use on the resident flora of the skin and mucosae, especially when considering the potential for subsequent In veterinary ophthalmology it is mainly used in form of photo-activat- long-term carriage of multidrug-resistant bacteria, including methicillin-re- ed chromophore for keratitis corneal cross-linking (PACK-CXL) to treat sistant S. pseudintermedius (MRSP), and its implication for human health corneal infection with keratomalacia. Corneal infection with keratomalacia and veterinary infection control (18). represent a serious, vision-threatening condition that is mainly caused by bacterial infections. The microorganisms together with the resident The disinfectant effect of corneal collagen crosslinking has the potential inflammatory cells lead to collagenolysis, a rapidly progressing corneal to become a game changer in treating infectious keratitis in patients and melting process which can result in perforation of the cornea and loss addressing antibiotic resistance. It is equally effective against antibiotic of sight. The standard care protocol involves intensive treatment with resistant and non- resistant bacteria. topical antimicrobials and anticollagenases. Results of medical treatment are variable with surgical intervention being required in 45% of cases (2). Conclusion During the last decades several groups have published studies on the use of PACK-CXL for humans and veterinary patients with keratomalacia PACK-CXL is a minimal invasive, simple, and relatively inexpensive therapy with very promising results. Some of these cases were non-responsive to for patients with melting corneal ulcers and infectious keratitis. Due to its medical therapy and in the majority (74-100%), PACK-CXL has led to arrest disinfecting properties independent of antimicrobial resistance pattern of melting due to its effect on the collagen digesting enzymes (3–9). is addresses a crucial issue: emerging antimicrobial resistance. It has proven to be a successful ulcer treatment even in cases non-responsive to The antimicrobial effect has been shown in numerous in vitro experiments standard medical therapy and is currently used in adjunction to conven- and meta-analysis of individual physician-based ophthalmic studies tional antimicrobial treatment. The ability to reduce eye drop application (5,10–13). A multicenter, randomized, and blinded study with the aim to frequency after PACK-CXL treatment is another positive aspect. It can determine whether PACK-CXL is a viable alternative to conventional inten- improve owner and patient compliance and reduce the treatment related sive state-of-the-art medical therapy for stromal corneal ulcer treatment in stress. If PACK-CXL proves to be a superior ulcer treatment by sufficient- dogs is currently being conducted. ly powered clinical trials it might be used as a replacement therapy for medical treatment in future. 261

13–15 NOVEMBER, 2021 References antimicrobial resistance and emergence of major international high-risk clonal lineages in dogs and cats with urinary tract infection: 16 year retro- 1. Hafezi, F, Knyazer B. Rising to the challenge. Pack-CXL for bacterial, spective study. J Antimicrob Chemother. 2018;73(2):377–384. fungal and mixed infection keratitis. Cataract Refract Surg Today Eur. 2017;60–3. 18. Morris D, Loeffler A, Davis M, Guardabassi L, Weese J. Recommen- dations for approaches to meticillin-resistant staphylococcal infections 2. Guyonnet A, Desquilbet L, Faure J, Bourguet A, Donzel E, Chahory S. of small animals: diagnosis, therapeutic considerations and preventative Outcome of medical therapy for keratomalacia in dogs. J Small Anim measures.: Clinical Consensus Guidelines of the World Association for Pract. 2020;61(4):253–8. Veterinary Dermatology. . 28(3). Vet Dermatol. 2017;28(3):304–69. 3. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-A-induced col- lagen crosslinking for the treatment of keratoconus. Am J Ophthalmol. 2003;135(5):620–7. 4. Spoerl E, Wollensak G, Seiler T. Increased resistance of crosslinked cornea against enzymatic digestion. Curr Eye Res. 2004;29(1):35–40. 5. Alio JL, Abbouda A, Valle DD, del Castillo JMB, Fernandez JAG. Corneal cross linking and infectious keratitis: A systematic review with a me- ta-analysis of reported cases. J Ophthalmic Inflamm Infect. 2013;3(1):1– 7. 6. Spiess BM, Pot SA, Florin M, Hafezi F. Corneal collagen cross-linking (CXL) for the treatment of melting keratitis in cats and dogs: A pilot study. Vet Ophthalmol. 2014;17(1):1–11. 7. Pot SA, Gallhöfer NS, Matheis FL, Voelter-Ratson K, Hafezi F, Spiess BM. Corneal collagen cross-linking as treatment for infectious and noninfec- tious corneal melting in cats and dogs: Results of a prospective, nonran- domized, controlled trial. Vet Ophthalmol. 2014;17(4):250–60. 8. Famose F. Evaluation of accelerated collagen cross-linking for the treat- ment of melting keratitis in eight dogs. Vet Ophthalmol. 2014;17(5):358– 67. 9. Famose F. Evaluation of accelerated collagen cross-linking for the treat- ment of melting keratitis in ten cats. Vet Ophthalmol. 2015;18(2):95–104. 10. Martins SAR, Combs JC, Noguera G, Camacho W, Wittmann P, Walther R, et al. Antimicrobial efficacy of riboflavin/UVA combination (365 nm) in vitro for bacterial and fungal isolates: A potential new treatment for infec- tious keratitis. Investig Ophthalmol Vis Sci. 2008;49(8):3402–8. 11. Richoz O, Kling S, Hoogewoud F, Hammer A, Tabibian D, Francois P, et al. Antibacterial efficacy of accelerated photoactivated chromophore for keratitis-corneal collagen cross-linking (PACK-CXL). J Refract Surg. 2014;30(12):850–4. 12. Kunt Z, Yağmur M, Kandemir H, Harbiyeli I, Erdem E, Kalkancı A, et al. In Vitro Efficacy of Chlorhexidine and a riboflavin/UVA Combination on Fungal Agents of Keratitis. Curr Eye Res. 2020;45(1):7–11. 13. Papaioannou L, Miligkos M, Papathanassiou M. Corneal collagen cross-linking for infectious keratitis: A Systematic Review and Meta-Analy- sis. Cornea. 2016;35(1):62–71. 14. Kling S, Hufschmid FS, Torres-Netto EA, Randleman JB, Willcox M, Zbinden R, et al. High Fluence Increases the Antibacterial Efficacy of PACK Cross-Linking. Cornea. 2020;39(8):1020–6. 15. Jinks M, Miller E, Diaz-Campos D, Mollenkopf D, Newbold G, Ge- mensky-Metzler A, et al. Using minimum inhibitory concentration values of common topical antibiotics to investigate emerging antibiotic resistance: A retrospective study of 134 dogs and 20 horses with ulcerative keratitis. Vet Ophthalmol. 2020;23(5):806–13. 16. Couto N, Monchique C, Belas A, Marques C, Gama, LT Pomba C. Trends and molecular mechanisms of antimicrobial resistance in clinical staphylococci isolated from companion animals over a 16 year period. J Antimicrob Chemother. 2016;71(6):1479–1487. 17. Marques C, Belas A, Franco A, Aboim C, Gama L, Pomba C. Increase in 262 WSAVA GLOBAL COMMUNITY CONGRESS

0179 between breeds is also becoming clearer. GENETICS OF PROGRESSIVE RETINAL ATROPHY; Details of all known retinal disease mutation, listed by breed, can be MORE COMPLEX THAN MEETS THE EYE? downloaded from the link below or the QR code included in these proceed- ings; C. Mellersh https://canine-genetics.org.uk/criedd/retinal-mutations-breed Cambridge/United Kingdom Cone-Rod Degeneration in the Miniature Longhaired Dachshund – a genet- Qualifications: ically complex form of PRA Cathryn Mellersh Most forms of PRA that have been characterised at the molecular level appear to be monogenic, recessive diseases but at least one form of a PhD more complex PRA has been described for which at least two independent variants have been identified that contribute to the clinical phenotype. [email protected] This form of retinal degeneration was originally described in the Miniature Genetics of progressive retinal atrophy; more complex than longhaired dachshund (MLHD)as an early-onset, autosomal recessive meets the eye? PRA with all affected dogs within an inbred research colony displaying ophthalmologic abnormalities that were detectable by ERG by six weeks Inherited forms of retinal disease are arguably among the best described of age and 25 weeks by fundoscopy and becoming blind by the time they and best characterized of all inherited diseases in the dog, at both the were 2 years of age [1]. A subsequent ERG study led to the disease being clinical and molecular level. re-classified as a cone-rod dystrophy (CRD) and the disease was termed cord1 for cone-rod degeneration 1 [2]. Using the same colony of dogs a Retinal disorders can be categorized in various ways, depending on wheth- variant in the gene RPGRIP1 was identified that co-segregated completely er the disorder is degenerative, where the retina develops normally and with cord1 in the research colony [3]. then degenerates during the dog’s lifetime or dysplastic, where the retina develops abnormally and whether the cone or rod photoreceptor cells A DNA test for the RPGRIP1 variants was made widely available and it degenerate first (cone-rod or rod-cone degenerations respectively). soon became apparent that outside of the colony there was not complete correlation between the RPGRIP1 genotype and phenotype [4] with con- Clinically, progressive retinal atrophy (PRA) is the umbrella term that is siderable variation observed in the age of onset of retinal degeneration in used to describe observed widespread retinal degeneration suspected to dogs homozygous for the RPGRIP1 variant. Nevertheless dogs that were be of inherited aetiology, regardless of the developmental stage at which homozygous for the RPGRIP1 mutation demonstrated reduced or absent signs might have become apparent or which photoreceptors were initially ERG cone responses, even in the absence of ophthalmoscopic abnormal- affected. PRA is characterised by distinctive changes to the fundus that ities, a finding that was corroborated by Busse and co-workers [5]. These are visible upon ophthalmoscopic investigation. Typical changes include findings suggested that additional variants were likely involved which attenuation of the blood vessels of the retina, increased reflectivity of modify the age of onset of ophthalmoscopic abnormalities associated the tapetal layer as a result of retinal thinning and atrophy of the optic with the RPGRIP1 variant. Because the original research colony used was disc. Secondary cataracts develop in many dogs, which might become developed from a very small number of dogs it was hypothesised that the extensive enough to obscure the retina and require the use of electro- colony was fixed for this additional modifier which had therefore gone retinography (ERG) for diagnosis. As the term progressive retinal atrophy undetected until the more outbred pet population was investigated. A sub- implies, most inherited forms of retinal degeneration are progressive and sequent association study using MLHDs that had either early or late onset invariably lead to significant visual impairment or blindness. cord1 did indeed reveal a second locus that segregated with early-onset retinal degeneration [6] and work by Forman and co-workers demonstrated Genetic heterogeneity between and within breeds that the underlying modifier was in fact a deletion across the tandemly duplicated MAP9 gene in the canine genome [7]. It is now understood that There are numerous genetically distinct forms of PRA and other retinal the MLHDs that are homozygous for both the RPGRIP1 and MAP9 variants diseases that have different underlying causal variants. Details of the ge- develop early onset retinal degeneration, and dogs that are homozygous netic variants that have been reported to cause all forms of retinal disease for the RPGRIP1 variant alone probably have cones that do not function in dogs can be downloaded using the link below or the QR code included normally, but they do not develop the early onset, progressive disease that in these proceedings; was described by Curtis and Barnett nearly 30 years ago [1]. https://canine-genetics.org.uk/criedd/inherited-retinal-diseases Several other breeds, including the Beagle [4] as well as Chihuahuas, English Springer Spaniels, English Toy Terriers, Lowchens, Swedish Because age of onset is not clearly defined for many forms of PRA, and Elkhounds and Chinese Crested Dogs [8] are known to segregate the fundus changes are broadly similar regardless of the causal mutation, it is RPGRIP1 variant but it is unclear which, if any of these breeds also seg- not possible to distinguish different genetic forms of PRA from ophthal- regate the MAP9 deletion, which is technically challenging to screen for. moscopic examination alone, and genetic analysis is usually required. The cone photoreceptors of dogs that are homozygous for the RPGRIP1 mutation probably do not function normally, but the extent to which vision Most forms of PRA that have been characterised at the molecular level is impaired is largely unknown and if they do not also carry the MAP9 de- result from single, high impact genetic variants that give rise to autoso- letion that is associated with early onset disease it is possible that many mal recessive forms of disease, although a small number of X-linked and will retain near-normal vision for most, if not all their lives. More research dominant forms have also been described. A general tenet is that PRA is is required to determine which breeds co-segregate the MAP9 modifying genetically heterogeneous between breeds, but that within a breed PRA variant so that fully informed breeding advice can be provided to those will exhibit breed-specific characteristics such as age of onset and rate of breeds that segregate the RPGRIP1 and/or MAP9 mutations. progression and be genetically homogeneous. However, as DNA sequenc- ing technologies become ever cheaper and more accessible it is becom- ing easier to tease apart the genetics of inherited canine diseases, and the extent to which PRA can be genetically heterogenous within as well as 263

13–15 NOVEMBER, 2021 Advice for breeders and veterinarians It is crucial that all dogs used for breeding should be DNA tested for all known disease-associated mutations that are relevant to their breed, being sure that breed-appropriate DNA tests are selected based on the variant(s) that have been demonstrated to cause disease in the breed in question. But DNA tests should never replace routine eye examinations, which will detect novel, genetically distinct forms of the same disease as well as other ocular disorders. Veterinarians should also remain aware that clinically similar, genetically different forms of disease can exist within a breed and both veterinarians and owners should readily engage with researchers if dogs that have tested clear of a known PRA mutation go on to develop a clinically similar condition – such cases provide important information about newly emerg- ing conditions in a breed. Acknowledgements The two linked tables that detail all reported variants associated with inherited canine eye diseases, were generated from the CRIEDD (Consor- tium to Research Inherited Eye Diseases in Dogs) database – an interdis- ciplinary project funded by Dogs Trust Consortium to Research Inherited Eye Diseases in Dogs (CRIEDD) – Kennel Club Genetics Centre (canine-ge- netics.org.uk) References 1. Curtis, R. and K.C. Barnett, Progressive retinal atrophy in miniature longhaired dachshund dogs. Br Vet J, 1993. 149(1): p. 71-85. 2. Turney, C., N.H. Chong, R.A. Alexander, et al., Pathological and elec- trophysiological features of a canine cone-rod dystrophy in the miniature longhaired dachshund. Invest Ophthalmol Vis Sci, 2007. 48(9): p. 4240-9. 3. Mellersh, C.S., M.E. Boursnell, L. Pettitt, et al., Canine RPGRIP1 muta- tion establishes cone-rod dystrophy in miniature longhaired dachshunds as a homologue of human Leber congenital amaurosis. Genomics, 2006. 88(3): p. 293-301. 4. Miyadera, K., K. Kato, J. Aguirre-Hernandez, et al., Phenotypic variation and genotype-phenotype discordance in canine cone-rod dystrophy with an RPGRIP1 mutation. Mol Vis, 2009. 15: p. 2287-305. 5. Busse, C., K.C. Barnett, C.S. Mellersh, et al., Ophthalmic and cone derived electrodiagnostic findings in outbred Miniature Long-haired Dachshunds homozygous for a RPGRIP1 mutation. Veterinary Ophthalmol- ogy, 2011. 14(3): p. 146-52. 6. Miyadera, K., K. Kato, M. Boursnell, et al., Genome-wide association study in RPGRIP1 (-/-) dogs identifies a modifier locus that determines the onset of retinal degeneration. Mammalian Genome, 2012. 23(1-2): p. 212-23. 7. Forman, O.P., R.J. Hitti, M. Boursnell, et al., Canine genome assembly correction facilitates identification of a MAP9 deletion as a potential age of onset modifier for RPGRIP1-associated canine retinal degeneration. Mamm Genome, 2016. 27(5-6): p. 237-45. 8. Pettinen, I.-T., J. Donner, J.A. Turunen, et al., Gene Panel Screening Across Canine Eye Disorders Highlights Genetic Heterogeneity and the Need for Molecular Discoveries. 2021: Research Square. https://www. researchsquare.com/article/rs-417922/v1. 264 WSAVA GLOBAL COMMUNITY CONGRESS

0180 routes of administration. Dose intervals vary from 1 to 4 hours depending on the dose. They can be combined with sedatives (e.g. dexmedetomi- PERIOPERATIVE PAIN RECOGNITION AND dine or acepromazine) to maximize sedation and analgesia. Fentanyl, a MANAGEMENT short-acting mu-agonist opioid, is available as an injectable agent or as a transdermal patch. Fentanyl can be used as constant rate infusion (CRI) P. Larenza intra and postoperatively at doses starting from 2.5−10 mcg/kg/h using a syringe pump. Fentanyl patches (i.e. 2−4 mcg/kg/h) may be applied on Camperdown/Australia the patient’s skin to provide postoperative analgesia. Buprenorphine is a partial mu-receptor agonist which produces minimal side effects and se- Qualifications: dation, although it is less useful for severe pain. Doses of 10–30 mcg/kg intravenously or intramuscularly usually provide 6 to 8 hours of analgesia. M. Paula Larenza Menzies The injectable form of buprenorphine can be applied in the oral mucosa as well. Butorphanol is a mixed kappa-receptor agonist and a mu-receptor DVM, Dr.Med.Vet., PhD, EBVS® European Specialist in Veterinary Anaes- antagonist which provides a relatively short-lived (40 minutes - 2 hours) thesia and Analgesia analgesia. Butorphanol provides fair-to-good visceral analgesia but poor somatic analgesia. Both, buprenorphine and butorphanol can be used to [email protected] reverse side effects caused by mu agonists. PERIOPERATIVE PAIN ASSESSMENT PERIOPERATIVE CRI OF NON-OPIOID ANALGESICS such as lidocaine, ketamine and dexmedetomidine can be used in the perioperative period. Currently, there is no gold standard for assessing perioperative pain in Ketamine is an N-Methyl-D-aspartic acid (NMDA) receptor antagonist dogs and cats, but some tools exist. Multimodal pain scales normally commonly used in combination with other analgesics at subanesthetic include the evaluation of the animal posture, vocalization, attention to doses (0.6 – 2.5 mg/kg/hr) to improve the control of orthopedic and wound, facial expressions, response to people and wound area palpa- neuropathic pain. Lidocaine can be used intravenously (0.02 – 0.1 mg/ tion and overall demeanor. Examples of multimodal scales to evaluate kg/min) to enhance visceral analgesia. Lidocaine has anti-inflammatory pain in dogs and cats include the UNESP-BOTUCATU MCPS (http://www. properties, which may be helpful in patients with endotoxemia. Caution animalpain.com.br/en-us/), the GLASGOW COMPOSITE MEASURES should be exercised with cats as lidocaine infusions may reduce the car- PAIN SCALE-FELINE (RCMPS-FELINE; (http://www.newmetrica.com/ diovascular function in these species. If sedation is required together with acute-pain-measurement/) and the GLASGOW SHORT-FORM COMPOS- analgesia, infusions of α2-adrenoceptor agonists (i.e. medetomidine or ITE SCALE FOR DOGS (http://www.newmetrica.com/wp-content/up- dexmedetomidine) may be a valid option. These agents are potent visceral loads/2016/09/Reid-et-al-2007.pdf). analgesics, although they may affect the cardiovascular system causing severe bradycardia, vasoconstriction and reductions in cardiac output. To PERIOPERATIVE PAIN MANAGEMENT minimize these adverse side effects, small doses are usually infused (i.e. 0.0005- 0.002 mg/kg/hr). Multimodal approaches to pain management are often used which allow for combining low doses of different analgesic agents and techniques TRAMADOL has been incorporated to treat mild to moderate pain in the maximizing their analgesic actions and reducing side effects. postoperative period. It is generally used in conjunction with NSAIDs, as its efficacy as the sole agent has not been yet demonstrated. In dogs, NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) are one of the doses of 2−5 mg/kg every 12 hours are recommended, although more most commonly and effective analgesic agents used in the perioperative frequent administration (every 8 or 6 hours) may be used if required. Cats period. The most commonly used NSAIDs before or after surgery are car- are given 2−4 mg/kg every 12 hours. Side effects may include sedation profen (2 mg/kg BID) and meloxicam (0.2 mg/kg on day 1, then 0.1 mg/ and vomiting. Currently available formulations are bitter and may cause kg SID in subsequent days). NSAIDs should be avoided in patients with salivation. Gelatin capsules can be used to administer tramadol liquid for- renal or hepatic dysfunction, coagulopathies, gastrointestinal disorders, mulation. Generally, cats tolerate the bitterness poorly and peanut butter shock, hypotension, hypovolemia, hypoalbuminemia or pregnancy. Caution can be used to mask the unpleasant flavor. A growing body of evidence should be exercised when employing NSAIDs in cats. Meloxicam appears demonstrates that MAROPITANT (1 mg/kg SQ or IV), a neurokinin (NK1) to be well tolerated in cats (0.1–0.2 mg/kg SID), although some veterinar- receptor antagonist, may be useful when given during the perioperative pe- ians would recommend reducing the dose to 0.05 mg/kg or administer it riod to prevent emesis and as an analgesic for surgically induced visceral every 2−3 days for long-term treatment. Other NSAIDs such as robenacox- pain in dogs and cats. Drugs used for treatment of chronic pain such as ib, deracoxib, cimicoxib may be used in the perioperative period. AMANTIDINE (3−5 mg/kg SID) and GABAPENTIN (1.25 to 10 mg/kg BID) may also be included in the perioperative period, particularly in patients in OPIOIDS are widely used analgesics for controlling perioperative pain. which the development of chronic pain is expected (e.g. leg amputation, They are classified according to their actions on mu- and kappa-opioid invasive orthopedic surgery, cancer patients, hemilaminectomies). receptors and their duration of action (short, intermediate or long). Mu-opioid receptor agonists provide very good analgesia and are indi- LOCAL ANESTHETICS agents are one of the most effective drugs to treat cated for major trauma, orthopedic and invasive thoracic and abdominal perioperative pain as they block pain transmission by interacting with the surgeries. However, they have the potential to produce significant side function of the neural axons. Currently used local anesthetic agents for effects (bradycardia, excessive sedation, respiratory depression, urinary nerve blocks are from the “amide group” (e.g. lidocaine, bupivacaine and retention, vomiting, regurgitation and subsequent aspiration, defecation, ropivacaine. constipation) when used at large doses. High doses of mu-opioids in dogs and even lower doses in cats may cause dysphoria (i.e. howling, vocalization, pacing, excitement, dilated pupils). Cats, in addition, may show a short-lived hyperthermia after the administration of a mu-opioid agent. Concomitant administration of anticholinergics (e.g. atropine), anti-emetics (e.g. metoclopramide) and sedatives may prevent for bradycardia, emesis and dysphoria, respectively. Morphine (0.1−0.5 mg/ kg), methadone (0.1−0.5 mg/kg) and levo-methadone (0.1−0.3 mg/kg) are intermediate acting mu-opioid agonists that can be used via various 265

13–15 NOVEMBER, 2021 Table 1.- Pharmacological aspects of amide local anesthetics. 0181 Local anesthetic Onset Duration Maximal dose Maximal dose ANESTHESIA FOR EMERGENCY PATIENTS - CASE SCENARIOS - Dog - Cat P. Larenza Lidocaine 2 % 2 – 5 minutes 60 – 90 6 mg/kg 3 mg/kg minutes (0.3 mL/kg) (0.15 mL/kg) Camperdown/Australia Bupivacaine 0.5% 20 – 30 6 hours 2 mg/kg 2 mg/kg Qualifications: minutes (0.4 mL/kg) (0.4 mL/kg) M. Paula Larenza Menzies Ropivacaine 0.5% 15 – 20 4 hours 3 mg/kg 2 mg/kg minutes (0.6 mL/kg) (0.4 mL/kg) DVM, Dr.med.vet, PhD, EBVS® European Specialist in Veterinary Anaes- thesia and Analgesia Local anesthetics are injected into the target tissues using aseptic tech- niques. Local anesthetics can simply be applied by infiltrating them into [email protected] the site to be desensitized (e.g. subcutaneous “line” blocks, intratesticular Anesthesia carries some risks, however, these risks are accentuated blocks, interfacial blocks, intra-articular blocks) or “splashed” into small when anesthesia is performed as an emergency procedure. Some of the wounds or on incisions before closing. In addition, nerves can be localized commonly encountered problems in these situations include a full stom- and blocked using a nerve stimulator. The nerve stimulator emits electri- ach (the stomach of dogs and cats usually empties in approximately 6–8 cal impulses that are transmitted down an insulated needle. If the tip of hours and 4–6 hours, respectively), limited time for patient’s preparation, the insulated needle is close to a nerve with motor function, it will elicit a hypovolemia (hemorrhage or fluid loss from diarrhea or vomiting), pain, muscle twitch with every electrical impulse. Ultrasound imaging can also and co-existing medical diseases. Preanesthetic physical examination be used as an alternative or a complimentary method to localize nerves. should determine the cardiovascular and pulmonary function and the This technique helps to identify the distribution of the local anesthetic and risk of regurgitation/aspiration as well as ease of tracheal intubation. prevent for intraneural injections. Once the nerve is located with either The patient should be fluid-resuscitated and any electrolyte imbalances technique, 0.2 mL/kg of lidocaine 2%, bupivacaine 0.5% or ropivacaine corrected prior to the induction of anesthesia. It may be necessary to 0.5% are applied. Attention is paid not to inject maximal (“toxic”) doses of administer some drugs or fluids for the treatment of hypotension prior to the individual agents. anesthesia. In some cases (e.g. decompensated cardiac disease), fluid restriction may be required together with the administration of diuretic Local anesthetics can also be injected into the epidural space of dogs agents. All anesthesia equipment, drugs and emergency agents should be and cats to provide caudal abdomen, hindquarters and perineal analgesia. made ready for use. Intravenous access should be ensured using a large The patient can be positioned sternally with the rear legs pulled cranially bore cannula. Bleeding cases should have another line for rapid infusion or in a flexed lateral position. The thumb and middle finger of one hand of fluid or blood. are placed on the iliac crests and the index finger is used to locate the lumbosacral space on the midline. A spinal/Tuohy needle is inserted The anesthetic choice for emergency procedures is guided by the nature exactly on the midline, perpendicular to the skin in the L7-S1 depression of the diagnostic or surgical technique and the preferences of the anes- and advanced until it “pops” through the ligamentum flavum and enters thetist. The advantages of using local anesthetics vs. systemic analgesics the epidural space. Usually, 0.1-0.2 ml/kg of preservative-free bupivacaine like opioids should be considered (e.g. less bradycardia, faster recovery). 0.5% is injected together with 0.1 mg/kg of preservative free morphine. A rapid sequence induction of general anesthesia may be preferred in If blood of cerebrospinal fluid is encounter, the injection is aborted. some cases, although its impact on the cardiovascular system should For prolonged analgesia using local anesthetics, epidural or perineurial be considered. Induction agents that minimally affect the hemodynamic catheters may be used (e.g. ropivacaine 0.1 – 0.2 mL/kg, with the addition status of the patient may be preferred for the induction of anesthesia. of morphine 0.05 mg/kg, tramadol (0.5 mg/kg) or dexmedetomidine 0.003 mg/kg every 8 or 12 hours). CASE EXAMPLES Often patients may be distressed, although pain has been excluded as the CESAREAN SECTION IN DOGS cause for anxiety. In these cases, sedatives (acepromazine or dexmedeto- midine) or simple human interaction and tender loving care (TLC) will help The selection of anesthetic drugs and techniques for the emergency Ce- in reducing the stress. A calm room and comfortable bedding will also sarean section aims at maximizing the survival of mum and pups, ensur- alleviate patient discomfort. In addition, re-evaluate bandage tightness ing high neonate Apgar scores, providing efficacious maternal analgesia and position of the body in the postoperative period, as these factors and allowing for early suckling and bonding with the neonates. Ideally, no may be the source for stress or pain. Other adjunctive therapies such as more than 15 minutes should pass from induction until the removal of the acupuncture and physiotherapy may also alleviate perioperative pain. puppies. Therefore, it is important to stabilize mum and, if possible, clip and do the initial scrubbings of the surgical site before induction holding References the dam in sitting position or in lateral recumbency to avoid an aortocaval compression by the uterus. Full-term gestation causes significant changes Flecknell P. & Waterman-Pearson A. Pain management in animals. London, in the respiratory system which lead to an increase in oxygen consumption UK; W.B. Saunders publishers; 2000. and a decrease in oxygen reserve. A 5-minute long pre-oxygenation before anesthesia may be efficient in minimizing desaturation during induction. Otero P. & Portela D. Manual of Small Animal Regional Anesthesia: Illus- Since most anesthetic and analgesic drugs cross the placental barrier, trated Anatomy for Nerve Stimulation and Ultrasound-Guided Nerve Blocks agents with a short duration of action, minimal cardio-respiratory side - Second edition. Buenos Aires, Argentina; Inter-Medica publisher; 2019. effects and with a fast elimination profile or that can be reversed should be selected. Due to the release of progesterone, the dose requirements of anesthetic agents in pregnant patients can be reduced by 20-40%. As an example, induction can be achieved with low dose propofol (e.g. 1-3 mg/ 266 WSAVA GLOBAL COMMUNITY CONGRESS

kg) or alfaxalone (e.g. 1-3 mg/kg). Premedication is often not be required an adequate lung ventilation are obtained, the cat should be placed in for emergency Cesarean section, however a low dose of fast acting opioid sternal recumbency with the head and chest elevated over the abdominal (i.e. fentanyl, 2 mcg/kg) may be given slowly IV before administering the line by using towels or a padded board to avoid further lung compression induction agents. Maropitant may be given (1 mg/kg IV over 5 minutes of the herniated abdominal organs. Commonly used induction agents while monitoring blood pressure) before induction to minimize the risks of include ketamine (2-5 mg/kg IV) and alfaxalone (1-3 mg/kg) associated regurgitation. Anesthesia can be maintained with a constant rate infusion with a benzodiazepine (midazolam or diazepam, 0.2 mg/kg IV) or propofol (CRI) or boli of propofol or alfaxalone or volatile agents such as isoflurane (1-4 mg/kg). Assisted ventilation should be applied after induction using (1-1.5%) and sevoflurane (2-3%). Close monitoring of anesthetic depth, lung protective strategies with lower tidal volumes (e.g. 10 instead of 15 electrocardiogram, blood pressure, pulse oximetry and end-tidal carbon ml/kg) and higher respiratory rates (e.g. 20 instead of 12 breaths/min) dioxide is recommended to ensure adequate anesthetic plane, oxygen- than usual, as re-expansion pulmonary edema develops when forceful ation, ventilation and perfusion in the dam. Analgesia may be provided ventilations are used to rapidly expand the lungs. Positive end-expiratory with an incisional line block with lidocaine 2% and opioids after delivery of pressure (2-5 cm/H2O) may be indicated to ensure an adequate hemoglo- the puppies. An epidural block with low doses of local anesthetics and/or bin saturation (above 95%). Inspiratory pressure should be limited to less opioids may also be suitable option for the skilled anesthetist. Neonatal than 20 cm H2O to avoid barotrauma. Maintenance of anesthesia may resuscitation equipment, drugs and (ideally) one assistant per neonate be carried out with isoflurane (1-1.5%) or sevoflurane (2-3%) in oxygen. delivered should be organized before anesthesia. Fentanyl CRI (2-10 mcg/kg/h) can be used to provide antinociception. In addition, locoregional techniques help to improve analgesia (line blocks, GASTRIC DILATION -VOLVULUS SURGERY IN DOGS inter pleural instillation of local anesthetics, epidural blocks). Intraopera- tive blood pressure, electrocardiogram, pulse oximetry, capnography and Management of hypovolemia to prevent or treat shock is crucial in the body temperature should be monitored. In addition, arterial blood gas preanesthetic period. Two large bore catheters (ideally 16g or 18g) should analysis may help deciding the ventilation strategies. Severe hypotension be placed in a cephalic or jugular vein and blood taken for hematocrit, may occur when the abdominal organs are retrieved from the thoracic total proteins (TP) and electrolyte measurement (e.g. K+). Fluid therapy cavity. Treatment with a large bolus of fluids is not advisable as hyper- should be started at a rate of 90 ml/kg/h using a balanced electrolyte volemia may later induce pulmonary edema. Management of low blood solution. Synthetic colloid administration may be also necessary (e.g. pressure in this situation is best with a CRI of dopamine (2-10 mcg/kg/ hydroxyethyl starch 5 ml/kg bolus). Continuous electrocardiogram should min). Postoperatively, the patient is extubated if vital parameters allow. be monitored before induction. Gastric decompression should only be Hemodynamically and respiratory unstable patients may require mechan- attempted once correction of the intravascular volume deficit is well ical ventilation postoperatively. Adequate analgesia in the postoperative underway. For sedation, a combination of fentanyl (2-4 micrograms/kg) or period can help with early recoveries. butorphanol (0.2 mg/kg IV) followed by diazepam or midazolam (0.2-0.5 mg/kg IV) can be used. Oxygen should be provided via a face mask. Anes- REFERENCES thesia induction can be achieved by injecting slowly (over 2 – 5 minutes) lidocaine 1-2 mg/kg IV, followed by a combination of ketamine 2-4 mg/kg Campbell VL. Anesthetic protocols for common emergencies. Vet Clin and a benzodiazepine (diazepam or midazolam) 0.2 mg/kg IV. Alfaxalone North Am Small Anim Pract. 35:435-53; 2005. (1-2 mg/kg) may be used instead of ketamine. Propofol (1-2 mg/kg) may be used as an induction agent in least severe cases as it may cause a Grubb T. et al. 2020 AAHA Anesthesia and Monitoring Guidelines for Dogs significant drop in blood pressure. Inhaled anesthesia (e.g. isoflurane in and Cats. JAAHA; 56:2; 2020. oxygen) can be used for maintenance. A fentanyl CRI (2-5 mcg/kg/h) may be used to supplement analgesia. Alternatively, butorphanol 0.1-0.2 mg/ kg every 1-2 hours may be used. A lidocaine CRI (25-50 mcg/kg/min) can be administered to enhance visceral analgesia and to diminish ventricular dysrhythmias. Intraoperative monitoring should consist of blood pressure, electrocardiogram, urine production, pulse oximetry and capnography. Evaluation of hematocrit, TP and K+ should be performed intraoperative- ly at 30 to 60-minute intervals. Intravenous fluid type and composition should be tailored to each individual patient’s needs. Persistent hypoten- sion (mean blood pressure below 65mmHg) can be treated with crystal- loid boli (5-10 ml/kg) or a dopamine CRI (2-10 mcg/kg/min). After surgery, metoclopramide (1-2mg/kg/day IV) may be used to promote gastrointes- tinal motility. TRAUMATIC DIAPHRAGMATIC HERNIA IN CATS Anesthetic management of these patients is challenging in view of an emergency surgery with inadequate time to patient stabilization, unsta- ble hemodynamics, high probability of hypoxemia and desaturation and need for lung ventilation. Fluid therapy should be tailored to stabilize the cardiovascular status of the patient and replace potential ongoing losses such as hemorrhage. Oxygen therapy is indispensable and preoxygen- ation should be carried out for about 5 minutes before induction. In some cases, it may be recommended to induce the cat in an oxygen cage to minimize the stress associated with transporting or using a tight-fit- ting mask. Sedation may not be recommended because of the risk of further respiratory depression. If needed, buprenorphine (0.01 mg/kg) or butorphanol (0.2-0.4 mg/kg) may be administered as they cause minimal respiratory depression. Throughout induction and until a patent airway 267

13–15 NOVEMBER, 2021 0182 such as collapse of the trachea, collapse of the left lobar bronchus from the left atrium or other airway disease. Cats pose a challenge as differ- CARDIOVASCULAR RADIOLOGY entiating between asthma and peribronchial edema can be challenging in some instances. Correlation with heart rate and respiratory rate are most R. Appleby1,2 valuable to differentiate coughing with pulmonary edema from coughing without pulmonary edema. 1Guelph/Canada, 2guelph/Canada References: Qualifications: • Ferasin, L. and Linney, C. (2019), Coughing in dogs: what is the evidence Ryan Appleby for and against a cardiac cough?. J Small Anim Pract, 60: 139-145. https://doi.org/10.1111/jsap.12976 DVM DACVR • Bahr R. Chapter 35 - Canine and Feline Cardiovascular System. In: Thrall [email protected] DE, ed. Textbook of Veterinary Diagnostic Radiology (Seventh Edition). Patients in small animal practice frequently present with both coughing Seventh Ed. W.B. Saunders; 2018:684-709. doi:https://doi.org/10.1016/ and a heart murmur. Coughing for many years has been considered a B978-0-323-48247-9.00047-4 clinical sign associated with heart failure. It is common as a radiologist to receive radiographs of a coughing dog who has been started on a diuretic ​ due to concern for congestive heart failure. While this is sometimes the cause coughing, often a separate cause is present. Drs. Ferasin and Linney published recently in the Journal of Small Animal Practice on the concept of the cardiac cough. They argue that most often, the term cardiac cough is a misnomer and coughing patients with cardiac disease is often due to respiratory disease. As they describe, coughing is a physiologic response to clear the airway and commonly a primary presenting complaint of many respiratory diseases.​ It is characterized by deep inspiration and forceful expiration against closed glottis.​ There is subsequent opening of the glottis and a sound​is made. Coughing occurs through stimulation of cough receptors in the pharynx, larynx and bronchi.​ It is not stimulated by smaller airways​and therefore should not be caused by pulmonary edema. In many patients under diseased states there is an increased cough sensitivity. Coughing in patients with heart disease should be classified as coughing with pulmonary edema and coughing without pulmonary edema. In cases without pulmonary edema small dogs may cough due to tracheal collapse, chronic bronchitis and chondromalacia. Larger dogs may have coughing due to chronic bronchitis or gastroesophageal reflux. Thoracic radiographic evaluation should occur through the same process every time. I advocate either an outside to in approach or an inside to out approach. When going outside to in, one starts with skeletal structures, abdomen and anything extrathoracic. Then the pleural space, lungs, medi- astinum, and finally the cardiac structures. When evaluating the heart, the main question one must answer is whether the right or the left side is enlarged. Signs of left sided enlargement include dorsal elevation of the trachea and a flattened caudodorsal margin in the lateral projections. The heart is often wide in both lateral adn dorso- ventral/ventrodorsal projections. The left atrium at the 6 o’clock position and left auricle and the 2-3 o’clock position is often enlarged. Common causes of left sided enlargement in dogs include myxomatous mitral valve degeneration, dilated cardiomyopathy and congenital causes such as sub-aortic stenosis and patent ductus arteriosus. In cats hypertrophic cardiomyopathy is the common cause and the heart is usually generally enlarged or valentine shape in the DV projections rather than the common appearance in dogs. Right sided cardiomegaly is characterized by increased sternal contact and a rounded cranial margin in the lateral projections. In the dorsoventral projection there is a reversed D appearance. Sometimes the right atrium (9-11 o’clock) and main pulmonary artery (1-2 o’clock) are enlarged. Common causes in dogs are pulmonic stenosis, tricuspid dsyplasia and heartworm disease. Cases evaluated in this presentation show a variety of dogs and cats with heart disease. In many instances the coughing is due to other causes 268 WSAVA GLOBAL COMMUNITY CONGRESS

0183 considering a wide variety of differentials will ensure that one does not miss an important cause. PULMONARY RADIOLOGY R. Appleby The cases presented in this presentation demonstrate a variety of pulmo- nary patterns with a variety of underlying causes. guelph/Canada References: Qualifications: 1. Thrall DE. Chapter 36 - Canine and Feline Lung. In: Thrall DE, ed. Ryan Appleby Textbook of Veterinary Diagnostic Radiology (Seventh Edition). Seventh Edition. W.B. Saunders; 2018:710-734. doi:https://doi.org/10.1016/B978- DVM DACVR 0-323-48247-9.00048-6 [email protected] Coughing is a common presenting complaint in small animals species. Radiographs are an important initial diagnostic step. Radiographs of the thorax should include all three views (right lateral, left lateral and either dorsoventral or ventrodorsal). Evaluation of the thorax should occur in a systematic approach as describe in the proceedings for the presentation on cardiovascular radiology. Evaluating the lungs often takes one of two forms. The first is pattern recognition, which categorized abnormalities as to whether they occur in the alveoli, bronchi or the intersitium. This is the most common method, however, it oversimplifies the process. It fails to recognize that multiple compartments of the lung are affected, not just the compartment corre- sponding to the pattern name​. A second approach is considering an airway vs. non-ariway pattern. This relates to the next diagnostic step. Increases in opacity which involve the airway (corresponding with bronchial or alveolar components) will respond to airway wash. Interstitial patterns, masses and nodules do not involve the airway and require aspirates of the lung. Interpreting radiogrpahs using a component of both may be of value. Patterns: Unstructured Interstitial Pattern - increase in pulmonary opacity which partially obscures vessel margin. Ill defined and without shape. Structured interstitial pattern - increase in pulmonary opacity, with defined margins, which partially obscures vessel margins (nodules, small mass- es). Alveolar pattern - increase in pulmonary opacity completely obscuring vessel margins, forming air bronchograms and lobar signs. Bronchial pattern - increase in opacity along airways, often appears as lines and rings. Mnemonic Device for Differential diagnoses: V - vascular​ I - infectious/inflammatory​ T - traumatic/toxic​ A - autoimmune​ M - metabolic​ I - idiopathic/iatrogenic​ N - neoplastic​ C - congenital​ D - degenerative/developmental​ E - endocrine​ W​ hile it is important to remember that common things occur commonly, 269

13–15 NOVEMBER, 2021 0184 lenging. Also go through all the possible complications and the possible scenarios post-surgery, including giving a realistic median survival time LUMPS IN TRICKY PLACES and explaining clearly that there are some dogs that will have recurrence or metastatic spread before this time. For major resections it is often J. Ladlow1,2 useful to have a consultation and then ask the owners to consider their decision for a few days before proceeding so they have time to consult 1High Wycombe/United Kingdom, 2Cambridge/United Kingdom family and reflect. Decide together with the owner prior to surgery what the aim of the surgery is – palliative or curative surgery. For palliative Qualifications: surgery I aim to have the animal out of the hospital swiftly, trying to avoid any complications. With curative intent surgery it is reasonable to have a Jane Frances Ladlow longer recovery period as a longer survival time is probable, providing the post-operative quality of life is high. For tumours in difficult locations or MA VetMB Cert VR CertSAS FHEA DipECVS MRCVS those that are likely to metastasise it is very sensible to talk to an oncolo- gist prior to starting treatment so the owner is aware of possible adjuvant [email protected] treatments or alternative treatments prior to making a decision. Lumps in Tricky Places Animal temperament Tricky places? Some animals are very stressed by a hospital environment or may not be amenable to post-operative medication. Whilst anxiolytic medications may A mass on or adjacent to any essential body structure be helpful for some cases, the treatment process may still be distressing. These are difficult cases and whether treatment is not just possible but Approach desirable/ ethical should be considered on a case-by-case basis. Surgical planning is aided by adequate information- type of tumour, Surgery and Closure pre-operative imaging of local tumour and staging if indicated. We have a limited knowledge of margin requirements in most small ani- Diagnosis mal tumours. Rough guidelines are: A diagnosis is necessary in oncology cases to determine tumour type and 1cm; small grade 1/low grade mast cell tumours, oral basal cell carci- grade, plan appropriate treatment and provide the owner with an idea of noma, oral fibromatous epulides, well-differentiated skin squamous cell the prognosis. carcinoma The type of biopsy performed is dependent on site, condition of the 2cm; Most mast cell tumours, oral fibroscarcoma, oral squamous cell patient, vet preference and diagnosis versus treatment. carcinoma and intermediate grade squamous cell carcinoma The ideal biopsy technique should safely and simply provide an adequate 3cm; Soft tissue sarcomas, injection- associated soft tissue sarcomas (as tissue sample for correct diagnosis. Biopsies can also be used to monitor a minimum), osteosarcomas that have invaded soft tissues, high grade/ response to therapy. Biopsy techniques include fine needle aspirates- grade 3 mast cell tumours cytology, incisional, tru cut, excisional. Cytology yields better results for discrete cell tumours, such as mast cell tumours1, plasmacytomas, When discussing margins it is useful to look at the tissue concerned- fat lymphomas and is reasonably good for epithelial cell tumours. Mesenchy- is a poor barrier to tumour cells, fascia, cartilage and bone are good bar- mal cells tend to have poor exfoliation and thus cytology is less useful. riers to tumour cells. Ideally try and have one biological margin as a deep The exception to this is bone tumours where ultrasound guided fine needle margin. The excised mass should be submitted for histopathology to give aspirates of bone tumours can provide a diagnostic sample. an idea of prognosis5 and if further treatment is required. The biopsy report should provide the following information: type of Plan the closure prior to surgery so that adequate margins can be taken tumour, grade of tumour- degree of differentiation, mitotic index, amount with confidence, ideally have a couple of closure options available and of necrosis, pleomorphism, lymphoid response and invasiveness. The type clip sufficiently wide. Measure the margins required and mark them on the and grade of the tumour together provide an idea of the likely behaviour skin with a sterile marker. Excise previous biopsy tract and aim for early of the tumour and can be used to advise the owner on prognosis and vascular ligation. Gentle tissue handling is required (use stay sutures pref- treatment options2,3. erentially to manipulate the tumour or atraumatic debakey forceps). Avoid contaminating clean tissue with tumour cells and use lavage of surface If the biopsy results do not correlate with the clinical picture discuss the wounds. On distal limbs, an esmarch bandage or sterile vet wrap used to case with the pathologist, ask for a second opinion and if still in doubt exsanguinate the limb makes surgery much easier. If it is not possible to rebiopsy as a proportion of biopsy results are not clinically accurate. close a limb wound it is reasonable to leave it open to heal by secondary intention healing6. Staging depends on the type and grade of the tumour and also whether the owner is likely to consider multimodality treatment or would not treat Multimodality treatment if distant metastases are present. Staging involves assessment of the sentinel lymph nodes with cytology, CT/ radiography or ultrasound and Although a lot of tumours are amenable to radiotherapy when there is depending on tumour type, evaluation of thoracic and abdominal me- gross disease (nasal tumours, brain tumours, osteosarcoma) certain tastases. Any positive nodes on cytology or imaging should be removed tumours such as soft tissue sarcomas and mast cell tumours are more for accurate staging, this can be aided by marking the lymph nodes on sensitive to radiotherapy if the majority of the tumour is debulked. It ultrasound imaging4. is preferable to talk to a radiation oncologist prior to surgery and have radiotherapy as part of the initial plan if the owner is amenable and has Owner expectations the budget rather than using radiotherapy as a sticking plaster for dirty margins. Plan the surgery carefully and for RT if possible mark the subcu- For any radical surgery, preoperative owner counselling is essential. I often give the owners pictures of surgeries that are cosmetically chal- 270 WSAVA GLOBAL COMMUNITY CONGRESS

taneous tissue with staples PMID: 15238564. The objective in cytoreductive treatment of tumours is to have microscop- ic disease with minimal wound complications or morbidity. Aim for rapid wound healing heal in order to gain benefit from radiotherapy or chemo- therapy as radiotherapy is usually started 2-3 weeks post-surgery. In some cases this will mean skin-sparing and peeling the skin off the underlying tumour in order to have uncomplicated healing. For certain tumours (osteosarcoma, haemangiosarcoma) chemotherapy is likely to reduce/ slow metastatic spread. We typically start chemother- apy 7-10 days post-surgery. Some tumours will shrink with pre-surgical medical treatment, with mast cell tumours reducing in volume by 50-70% after a short course of prednisolone7. Innovative treatment In some cases, tumour treatment may be possible endoscopically or novel treatments such as photodynamic therapy (PDT) or brachytherapy may be available. If the owner has the inclination and budget it may be worth what options are available at other institutions. Redundancy Some structures can be removed and function is maintained, though this may not be normal function. These surgeries include amputations, total glossectomy8, epiglottectomy, total penile amputation with scrotal ure- throstomy, nasal planectomy. In these cases, the quality-of-life post-sur- gery should be carefully considered, both before and after surgery. References • Camus MS, Priest HL, Koehler JW, Driskell EA, Rakich PM, Ilha MR, Krimer PM. Cytologic Criteria for Mast Cell Tumor Grading in Dogs With Evaluation of Clinical Outcome. Vet Pathol. 2016 Nov;53(6):1117-1123. doi: 10.1177/0300985816638721. • Perry JA, Culp WT, Dailey DD, Eickhoff JC, Kamstock DA, Thamm DH. Diagnostic accuracy of pre-treatment biopsy for grading soft tissue sarcomas in dogs. Vet Comp Oncol. 2014 Jun;12(2):106-13. doi: 10.1111/j.1476-5829.2012.00333.x. • Shaw T, Kudnig ST, Firestone SM. Diagnostic accuracy of pre-treatment biopsy for grading cutaneous mast cell tumours in dogs. Vet Comp Oncol. 2018 Jun;16(2):214-219. doi: 10.1111/vco.12346. Epub 2017 Aug 31. PMID: 28857446 • Pierini A, Marchetti V, Rossanese M, Finotello R, Cattai A, Pisani G. Ultrasound-Guided Hook-Wire Localization for Surgical Excision of Non-Palpable Superficial Inguinal Lymph Nodes in Dogs: A Pilot Study. Animals (Basel). 2020 Dec 7;10(12):2314. doi: 10.3390/ani10122314. PMID: 33297352; • Scarpa F1, Sabattini S, Marconato L et al. Use of histologic margin evaluation to predict recurrence of cutaneous malignant tumors in dogs and cats after surgical excision. J Am Vet Med Assoc. 2012 May 15;240(10):1181-7 • Prpich CY, Santamaria AC, Simcock JO et al. Second intention healing after wide local excision of soft tissue sarcomas in the distal aspects of the limbs in dogs: 31 cases (2005-2012). J Am Vet Med Assoc. 2014 Jan 15;244(2):187-94. • Stanclift RM1, Gilson SD. Evaluation of neoadjuvant prednisone admin- istration and surgical excision in treatment of cutaneous mast cell tumors in dogs. J Am Vet Med Assoc. 2008 Jan 1;232(1):53-62 • Dvorak LD, Beaver DP, Ellison GW, Bellah JR, Mann FA, Henry CJ. Major glossectomy in dogs: a case series and proposed classification system. J Am Anim Hosp Assoc. 2004 Jul-Aug;40(4):331-7. doi: 10.5326/0400331. 271

13–15 NOVEMBER, 2021 0185 is pulse oximetry (normal intestine remains within 1 cm of a normal pulse oximetry reading) and fluorescein dye which is highly accurate in detect- GI FOREIGN BODIES ing nonviable tissue and reasonable in detection of viable tissue. If in doubt take remove dubious intestine as up to 70% of the canine intestine J. Ladlow can be resected without development of short bowel syndrome. Cambridge/United Kingdom If the intestines are judged to be viable a longitudinal anti-mesenteric enterotomy should be made in healthy intestine distal to the foreign Qualifications: body. Enterotomy incisions should be closed in a single layer with a full thickness appositional suture pattern. The submucosa is the suture Jane Frances Ladlow holding layer, therefore full thickness sutures through the mucosa are not necessary. However, full thickness sutures are easier with no reported MA VetMB, CertVR, CertSAS FHEA DipECVS MRCVS complications in comparison to the partial thickness sutures. A monofila- ment, synthetic, absorbable suture material should be used. A swaged-on [email protected] taper-cut or reverse cutting needle is preferable to a cutting needle to reduce leakage from the suture hole6. For linear foreign bodies, the site GI foreign bodies of attachment is released. An enterotomy is made at the centre of the foreign body and as much of the foreign body is removed as possible. Pathophysiology and Diagnosis Multiple further enterotomies may be required. Intestinal resection and end-to-end anastomosis is indicated for removal of ischaemic or perforat- Solid foreign bodies of many types have been reported in cats and dogs ed intestine. If hand sutured, two continuous appositional sutures reduce and may cause a partial or complete obstruction. Often younger animals surgical time. Alternatively, simple interrupted sutures can be placed. A are affected. Linear foreign bodies are commonly reported in cats but are continuous approximating pattern results in less mucosal eversion and also found in dogs. One end of the string often becomes lodged at the less post-operative adhesions compared to the simple interrupted pattern. base of the tongue or the pylorus. The intestines then become gathered Disparity in luminal size between the two ends can be corrected by into accordion like pleats around the remainder of the string. The string spacing sutures further apart on the larger side or transecting the smaller may cut through the mesenteric border of multiple sections of intestines side at an angle to match the diameter of the larger side. Anastomosis resulting in multiple perforations. can also be achieved with specialised stapling equipment. For small intestinal surgery a linear cutter (GIA) staplers and thoracoabdominal The history with a foreign body is dependent on whether the obstruction (TA) stapler can be used to create a functional end to end anastomosis. is complete in which case there is usually frequent projectile vomiting, Stainless steel sutures result in less inflammatory reaction with compared whereas partial obstruction of the distal intestine results in intermittent, to suture. The reported dehiscence rate for stapled anastomosis is 12.5 less profuse vomiting. Anorexia, depression and weight loss may also %, higher than that reported for sutured anastomosis (1.5-7 %) however occur. Cases that require enterectomy generally have a higher heart rate the stapled anastomosis is safer if there is pre-operative peritonitis or on presentation and increased severity of vomiting1. On clinical exam- previous enterotomy/enterectomy leakage6. After any intestinal surgery it ination dehydration and abdominal pain may be evident and sometimes is sensible to leak test with saline or air to check for any surgical errors. an intra-abdominal mass is clearly palpable. Although palpation may be Reinforcement of intestinal sutures can be achieved by omentalisation or diagnostic, in most cases, imaging confirmation of gastrointestinal for- serosal patching. Post intestinal repair, the drape that was added to limit eign bodies is required. On radiographs, signs consistent with obstruction contamination should be removed, clean gloves and kit should be used include masses (soft tissue or radio-opaque), distended loops of small and lavage of the abdomen is recommended, with 2-300ml/kg of warm intestine and plication. Serial radiographs have not found to be helpful in crystalloid solution. Lavage decreasesthe number of bacterial contami- diagnosis2 and linear foreign bodies often do not cause intestinal dilata- nants and the chance of multi-resistant organisms being cultured. tion. Ultrasound can be very useful in the hands of a skilled operator, often giving location of obstruction and any evidence of peritoneal effusion with Post-operative Care high sensitivity and specificity 3. CT is also very sensitive and specif- ic. Once the diagnosis has been established, rapid surgical removal is Post-operative management is crucial, with early enteral feeding import- advised once the animal is stable. Pre-operative stabilisation includes re- ant and careful monitoring and management of pain and ileus. It takes hydration and correction of any blood abnormalities. Usual blood profiles about 72 hours for normal intestinal function to return, and this can be changes include hypochloraemia, metabolic alkalosis, hyperlactaemia promoted by offering water when fully recovered and then enteral feeding and hypokalaemia. These changes are not lesion site dependent4 and, as if no vomiting occurs. It is not unusual for animals to have post-opera- yet, the initial lactate levels have not correlated with outcome. For foreign tive nausea in which case a metoclopramide infusion and maropitant or body removal and/or resection & anastomosis antibiotics should be given ondansetron may be beneficial. peri-operatively and for 24 hours post-surgery. Common intestinal patho- gens include E Coli, Enterococcus, Staphylococcus aureus and suitable Post-operative analgesics include opiates and paracetamol in dogs. antibiotic regimens include 2nd generation cephalosporin or amoxicillin & Non-steroidal anti-inflammatories have been linked to increased dehis- clavulanate. cence in human colorectal surgery (little evidence in animals) and thus their use should be judicious. Surgical Treatment Prognosis Exploratory laparotomy with enterotomy or intestinal resection and end- to-end anastomosis as appropriate is indicated for most intestinal foreign The prognosis for discrete foreign bodies is good with appropriate atten- bodies. tion to surgical technique (90% recovery). The prognosis for linear foreign bodies is similar though morbidity and cost of treatment is often higher The use of a surgical checklist and separate drape to limit abdominal as these cases have an increased incidence of intestinal perforation and contamination reduced surgical site infection after foreign body removal peritonitis. from 20% to 12% in one study5. Intestinal viability around discrete foreign bodies should be assessed carefully by colour, pulsation, bleeding when Dehiscence occurs in 7-20% cases of foreign body removal and results incised and peristalsis. All these are subjective. Somewhat more objective 272 WSAVA GLOBAL COMMUNITY CONGRESS

in a septic peritonitis with reduced survival (50% survival). Factors that 0186 increase the risk of dehiscence include a longer duration of clinical signs, pre-operative sepsis, pre-operative inflammatory bowel disease, linear ALL YOU NEED TO KNOW ABOUT FELINE foreign bodies, multiple enterotomies and hypotensive episodes during LEUKEMIA VIRUS INFECTION DIAGNOSTICS the surgery. R. Hofmann-Lehmann References Zurich/Switzerland • Hobday MM, Pachtinger GE, Drobatz KJ, Syring RS. Linear versus non-linear gastrointestinal foreign bodies in 499 dogs: clinical presen- Qualifications: tation, management and short-term outcome. J Small Anim Pract. 2014 Nov;55(11):560-5. doi: 10.1111/jsap.12271. PMID: 25352109. Prof. Dr. med. vet. Regina Hofmann-Lehmann • Elser EB, Mai W, Reetz JA, Thawley V, Bagshaw H, Suran JN. Serial Professor of Laboratory Medicine, University of Zurich abdominal radiographs do not significantly increase accuracy of diagnosis of gastrointestinal mechanical obstruction due to occult foreign bodies Head Dept. of Clinical Diagnostics and Services and Center for Clinical in dogs and cats. Vet Radiol Ultrasound. 2020 Jul;61(4):399-408. doi: Studies 10.1111/vru.12870. Epub 2020 Apr 30. PMID: 32350994. [email protected] • Sharma A, Thompson MS, Scrivani PV, Dykes NL, Yeager AE, Freer Feline leukemia virus (FeLV) is a retrovirus that affects domestic and SR, Erb HN. Comparison of radiography and ultrasonography for diag- small wild cats worldwide. Like all retroviruses, FeLV is a RNA virus. It nosing small-intestinal mechanical obstruction in vomiting dogs. Vet carries an enzyme, the reverse transcriptase, which transfers viral RNA Radiol Ultrasound. 2011 May-Jun;52(3):248-55. doi: 10.1111/j.1740-826 into DNA once a cell is infected. The DNA is integrated into the host’s cell 1.2010.01791.x. Epub 2010 Dec 28. PMID: 21554473. genome in the form of proviral DNA (provirus). FeLV-infection may cause fatal illnesses, including neoplasia, bone marrow suppression, and immu- • Boag AK, Coe RJ, Martinez TA, Hughes D. Acid-base and electrolyte ab- nodeficiency. Thereby, FeLV poses a problem to the infected individual normalities in dogs with gastrointestinal foreign bodies. J Vet Intern Med. but also to unprotected cat populations if the infection is not recognized 2005 Nov-Dec;19(6):816-21. doi: 10.1892/0891-6640. PMID: 16355674. promptly. This presentation focuses on the diagnosis of FeLV infection as well as on certain aspects of the pathogenesis that are essential for • Launcelott ZA, Lustgarten J, Sung J, Samuels S, Davis S, Davis GJ. Ef- the comprehension of an optimal diagnostic workup. It provides current fects of a surgical checklist on decreasing incisional infections following recommendations for diagnostic testing of FeLV infection and addresses foreign body removal from the gastrointestinal tract in dogs. Can Vet J. potential diagnostic pitfalls and limitations of the different tests. 2019 Jan;60(1):67-72. PMID: 30651653; PMCID: PMC6294029. There are four different outcomes of FeLV infection: progressive (least • Mitsou K, Papazoglou LG, Savvas I, Tzimtzimis E. Investigation of favorable for the cat), regressive, abortive (most favorable for the cat), leakage holes created by four needle types used for closure of canine and the probably rarely occurring focal (atypical) infection (Figure 1). It is enterotomies. Open Vet J. 2018;8(4):411-414. doi: 10.4314/ovj.v8i4.10. important to understand what happens over time after FeLV infection; in Epub 2018 Nov 2. PMID: 30538932; PMCID: PMC6243210. clinics, we usually only see one or few time points after the infection. • Snowdon KA, Smeak DD, Chiang S. Risk Factors for Dehiscence of Stapled Functional End-to-End Intestinal Anastomoses in Dogs: 53 Cases (2001-2012). Vet Surg. 2016 • Ji C, Xiong Y, Pan X, Guo X, Li Z, Qian S, Xu C, Yu DH, Liao WQ. Effect of non-steroidal anti-inflammatory drugs on the increasing the incidence of colonic anastomosis in rats. Int J Clin Exp Pathol. 2015 Jun 1;8(6):6126- 34. PMID: 26261490; PMCID: PMC4525824. • Hayes G. Gastrointestinal foreign bodies in dogs and cats: a retrospec- tive study of 208 cases. J Small Anim Pract. 2009 Nov;50(11):576-83. doi: 10.1111/j.1748-5827.2009.00783.x. Epub 2009 Oct 8. PMID: 19814770. • Hoffman CL, Mastrocco A, Drobatz KJ. Retrospective evaluation of gastrointestinal foreign bodies and presurgical predictors for enterectomy versus enterotomy in dogs (2013-2016): 82 cases. J Vet Emerg Crit Care (San Antonio). 2021 Sep 23. doi: 10.1111/vec.13139. PMID: 34555866. Fig. 1. Outcomes of FeLV infection (time course). Adapted from (1). The outcome of FeLV infection is not always a fixed situation. This is true particularly in the early phase of infection, usually over the first 12 weeks after exposure, when in most cats the course the infection will take is determined (2). However, also later on either the virus or the cat’s immune system might gain the upper hand. Therefore, it can be helpful to think of the outcomes of FeLV infection also in terms of a set of balance scales, with the cat’s immune response on one side and the virus on the other (Figure 2). Depending on who wins the fight, FeLV or the cat’s immune sys- 273

13–15 NOVEMBER, 2021 tem, the balance can tip to one or the other side, e.g. should the immune pose an infection risk to naive cats. system be compromised, and the outcome can either be beneficial for the cat or not. Indeed, the balance between host and virus can be altered by In case of low FeLV prevalence (many countries nowadays) and if the different factors, such as immunosuppression, coinfections, or change in cat does not belong to a risk group (FeLV-associated disease, history of environment, leading to a change in the outcome of FeLV infection. recent FeLV exposure), antigen-positive results should be confirmed, since the predictive value positive in these cases is low. Fig. 2: Balance between the cat’s immune system and FeLV. It is important to note that the outcome is not always a fixed situation; under certain A negative test result occurs in cats that are not FeLV-infected, in cats circumstances the balance can tip to one side or the other. Immunosup- with regressive or abortive infection and in FeLV-infected cats in the very pression for any reason can lead to shift in the balance, and the virus can early infection phase (see also Figure 1 and Table 1). gain the upper hand (balance on the far right; shift towards progressive infection). Protective immunity, e.g. vaccine-induced immune response, FeLV Provirus: suppresses virus replication, and spread and leads to a situation that is more beneficial for the cat (situations on the left; regressive or ideally Provirus detection in blood by PCR is useful for confirming positive or abortive infection). Adopted from (1). questionable antigen test results. Distinction between progressive and regressive infection: To differentiate Provirus PCR also detects regressive infection. between the two clinically and epidemiologically most relevant forms of FeLV infection (progressive/regressive infection), a repeated examination FeLV RNA: of FeLV antigen-positive cats is necessary to determine whether the cat is able to fight the virus and become antigen-negative (Figure 1). This usual- FeLV RNA detection in the blood is seldomly performed. ly happens within a few weeks, but seldom can take several months. FeLV RNA detection in saliva can be used instead of the FeLV p27 antigen The methodology to diagnose FeLV infection has been refined over the test. Sample collection is less invasive. Multiple samples can be pooled years. However, from a clinical point of view, it is still most important to to test multi-cat households for freedom of FeLV shedders with minimal determine whether a cat is viremic/antigenemic in the first place and then costs. In cats with abortive infection, antibodies can be found as the sole whether regressive or progressive infection prevails. What has changed in parameter of exposure to FeLV. recent years is the spectrum of methods available to reach this goal. The availability of the tests may vary depending on the country of residence. Antibodies to FeLV: Of epidemiological importance are FeLV antigen-positive FeLV shedders; i.e. any cat with progressive FeLV infection or cats with regressive infec- Detection of antibodies against FeLV p15E proved effective for the detec- tion as long as they are antigen-positive (Figure 1). FeLV shedders can tion of a previous FeLV exposure. The test is not yet evaluated for the field be detected by testing for soluble FeLV p27 antigen in blood or by testing sitaiton. for viral RNA in saliva using RT-PCR; there is a strong correlation between these two parameters (3). However, RT-PCR is positive earlier than FeLV Table 1: FeLV Test Characteristics p27 antigen testing (Table 1). DNA PCR from whole blood can be used to detect FeLV provirus integration. This test detects also regressively infect- Test Material Time point at which test ed cats that are FeLV p27 antigen negative. Therefore, the PCR is more is usually positive, if cat is sensitive than the antigen test for detecting a previous FeLV exposure FeLV p27 Antigen Testing Serum, Plasma infected (Figure 1). FeLV provirus remains latently integrated in the cats genome of regressively infected cats. However, the infection may be reactivated, FeLV Provirus PCR Whole blood Not before week 3 (!) e.g. due to severe immunosuppression and the cat becomes antigenemic/ viremic again (Figure 2); at this time point the cats are also shedding virus Viral RNA RT-PCR Blood/Saliva Week 2 (some cats in again. FeLV vaccination and the presence of maternal antibodies do not week 1) interfere with FeLV testing. Week 1 / Week 1-2 Soluble FeLV p27 antigen: The screening of all cats for FeLV infection is recommended with the A positive result indicates that the cat is most likely FeLV positive and exception of cats that certainly have never been exposed to FeLV. (www. viremic. In most cases, antigen-positivity is equivalent to presence of abcdcatsvets.org) viremia (replicating virus). Antigen-positive cats are shedding FeLV and Kittens can be tested anytime for antigenemia – maternal antibodies do not interfere with the p27 testing. Each kitten should be tested individual- ly. The European Advisory Board on Cat Diseases ( ABCD; www.abcd- catsvets.org) has developed a diagnostic tree that guides through all steps of FeLV testing (Figure 3). It takes into account the different test characteristics, the duration when a test will be positive, the predictive val- ue positive (the tree is designed for areas with low infection prevalence), the necessary confirmation of positive results as well as repeated testing to determine the different outcome of FeLV infections. 274 WSAVA GLOBAL COMMUNITY CONGRESS

0187 AN UPDATE ON FELINE CALICIVIRUS INFECTION R. Hofmann-Lehmann Zurich/Switzerland Fig. 3: FeLV diagnostic tree (adapted from the ABCD FeLV diagnostic tool). Qualifications: Conclusion: Appropriate testing for FeLV infection requires in-depth knowl- Prof. Dr. med. vet. Regina Hofmann-Lehmann edge of the infection pathogenesis, the prevalence of the infection as well Professor of Laboratory Medicine, University of Zurich as of the clinical presentation. In addition, it necessitates experience with Head Dept. of Clinical Diagnostics and Services and Center for Clinical available tests and their characteristics as well as with the interpretation Studies of the results. [email protected] This presentation gives an update on feline calicivirus (FCV) infection; the The text was partially adapted from (2, 4-9). different topics are illustrated using research from our laboratory. 1. Hofmann-Lehmann R, Hartmann K. Feline leukemia virus infection: A Occurrence and clinical presentation: FCV is a highly contagious pathogen practical approach to diagnosis. JFMS. 2020;22:831-46. and one of the most common pathogens in domestic cats. Infected cats often show painful erosions in the mouth (especially the tongue and pal- 2. Hofmann-Lehmann R, Cattori V, Tandon R, Boretti FS, Meli ML, Riond ate) and mild cold signs (Fig. 1). In addition, FCV infections are detectable B, et al. How molecular methods change our views of FeLV infection and in a large proportion of cats with chronic gingivostomatitis and faucitis. vaccination. Veterinary immunology and immunopathology. 2008;123(1- In a recent study, cats with FCV infection had more frequently gingivitis, 2):119-23. stomatitis, caudal stomatitis, salivation, oral and tongue ulcers, but less frequently the classic signs of upper respiratory illness, such as nasal and 3. Gomes-Keller MA, Tandon R, Gonczi E, Meli ML, Hofmann-Lehmann R, ocular discharge or sneezing (1). Especially in juvenile cats, FCV-induced Lutz H. Shedding of feline leukemia virus RNA in saliva is a consistent pneumonia can lead to death. feature in viremic cats. Veterinary microbiology. 2006;112(1):11-21. Fig 1: a) FCV infection causes problems particularly in cat groups; b) 4. Hofmann-Lehmann R, Tandon R, Boretti FS, Meli ML, Willi B, Cattori V, Feline faucitis; c) FCV erosions on the tongue of an FCV-infected cat © et al. Reassessment of feline leukaemia virus (FeLV) vaccines with novel Clinical Laboratory, Clinic for Small Animal Medicine, Vetsuisse Faculty, sensitive molecular assays. Vaccine. 2006;24(8):1087-94. UZH. 5. Hofmann-Lehmann R, Cattori V, Tandon R, Boretti FS, Meli ML, Riond FCV infections are more common in multi-cat environments and in sick B, et al. Vaccination against the feline leukaemia virus: outcome and re- cats. But also healthy cats can be FCV shedders. We found FCV infection sponse categories and long-term follow-up. Vaccine. 2007;25(30):5531-9. in 45% of FCV suspect cases but also in 8% of healthy cats (1). Forty percent of the diseased cats had co-infections with other pathogens, 6. Hartmann K, Hofmann-Lehmann R. Consult the expert: Diagnosing mainly with Mycoplasma felis and feline herpesvirus-1; less commonly different courses of FeLV infection. Clin Brief. 2020;68 12-9. with Chlamydophila felis or Bordetella bronchiseptica. But also in 14% of the healthy cats co-infections with several upper respiratory pathogens 7. Hartmann K, Hofmann-Lehmann R. What’s New in Feline Leukemia Virus were found. Infection. The Veterinary clinics of North America Small animal practice. 2020;50(5):1013-36. High mutation rate of the virus: Like human Norovirus, feline Caliciviruses have a high mutation rate and are constantly changing. Despite the great 8. Lutz H, Addie D, Belak S, Boucraut-Baralon C, Egberink H, Frymus T, et genetic variability, the viruses have antigenically so much in common that al. Feline leukaemia. ABCD guidelines on prevention and management. vaccine strains were identified (e.g. F9 and 255) that have broad neutraliz- Journal of feline medicine and surgery. 2009;11(7):565-74. ing activity against many field strains. 9. Little S, Levy J, Hartmann K, Hofmann-Lehmann R, Hosie M, Olah G, Tenacity: Also like human Noroviruses, FCV are highly contagious and et al. 2020 AAFP Feline Retrovirus Testing and Management Guidelines. survive in the environment for up to one month. Thus, very good hygiene Journal of feline medicine and surgery. 2020;22(1):5-30. and disinfectant with effectiveness against FCV are needed (look for disinfectant that are labeled effective against Norovirus). To kill FCV on clothes, a wash cycle with a temperature of at least 60°C is required. Vaccination: The FCV vaccine is a so-called core vaccine. Every cat should be vaccinated against FCV. The vaccine usually protect against FCV-in- duced disease, but not against infection. It has been discussed whether the use of broadly neutralizing vaccine strains for many years has led 275

13–15 NOVEMBER, 2021 to an “immune escape”. This question is difficult to answer universally Fig. 3: Clinical presentation of cats with highly aggressive FCV infections. by in vitro studies, as they each relate to certain FCV isolates and virus a) skin ulceration head; b) skin ulceration ear; c) cutaneous edema pinna. neutralization assays only test part of the immune protection. Particularly © Clinical Laboratory, Vetsuisse Faculty, UZH. when using live virus vaccines, the cellular immune response plays also an important role. In a recent study, we found that cats vaccinated with The highly aggressive viruses (VS-FCV) develop locally. Viruses from a live FCV F9 vaccine had less severe clinical signs, less inflammation different outbreaks show no genetic similarity. It is therefore not possible and lower virus loads (RNA) than control cats and the vaccine elicited to predict whether a vaccine will protect against a VS-FCV outbreak. neutralizing and cellular immunity against the Swiss field strains used for Mostly FCV vaccines provide only partial or no protection against VS-FCV. challenge infection (2, 3). An ideal vaccine should probably contain both, Depending on the virus, different vaccine viruses (FCV G1 / 431, FCV F9) broadly neutralizing FCV strains as well as current local FCV variants. have been able to result in a milder course of the disease in the infected However, the latter are unknown for most geographic areas. cats. During a large VSD outbreak in Switzerland in 2016 most cats were not or only insufficiently vaccinated against FCV. Detection of FCV shedders: FCV-RNA can best be detected by RT-PCR in oral cytobrush. The sample is ideally placed in virus transport medium (in- Diagnosis of VS-FCV outbreaks: Per definition the diagnosis of virulent quire laboratory) and analyzed within three days. Due to the variability of systemic disease (VSD) is based on clinical signs, the epizootic spread FCV false negative results may occur; in case of strong clinical suspicion and the fatal outcome as well as the same FCV isolate in all affected cats. and a negative result, a second RT-PCR with a different specificity (ask Some of the outbreaks we observed were localized, not all infected cats laboratory) and/or resampling is recommended. showed involvement of the inner organs, and no high mortality was found (6). The syndrome resembled the “paw and mouth disease” (7), which has Risk and protective factors: The number of cats per group (multicat envi- an initial clinical presentation similar to VSD, but lacked high mortality, ronment) was identified as a risk factor for FCV infection (Fig. 2). Groups obvious organ involvement and epizootic spread. Some other outbreaks with ≥ 4 cats had an increased risk of FCV infection. Additionally, sexually we observed included inner organ involvement and the cats died from the intact cats had a higher risk of FCV infection. FCV vaccination was found infection, but no epizootic was observed (Table 1). to be a protective factor (1). Table 1: Comparison of different forms of FCV-induced disease resem- bling (at least initially) virulent systemic disease (VSD) Disease Multicat Clinical Same virus Systemic epizootic environment sings of in all cats infection, high mor- spread VSD inner organ tailty involvement Fig 2: Number of cats/group and FCV infection. a) ill cats; b) healthy cats \"paw&mouth yes yes yes no no no (1). disease\" The genetic analysis of 66 Swiss FCV isolates confirmed a very high non-epizootic yes yes yes yes no genetic variability (4). In some veterinary practices closely related viruses form resem- yes yes yes yes yes were found in several cats; the reason for the latter may be the high te- bling VSD nacity of the virus and thus persistence of these isolates within the clinic. This observation emphasizes the importance of effective disinfection. VSD yes yes The study was not designed to investigate a possible immune escape, but currently used FCV vaccine strains (FCV F9; FCV 255; FCV 431/G1) were The “paw and mouth disease” and the non-epizootic forms resem- within the phylogenetic distribution of the field isolates. bling VSD cannot not be distinguished from VSD in the early stages of infection. It is therefore important to take precautionary mea- Highly aggressive FCV variants: Highly aggressive, virulent-systemic sures whenever the first characteristic signs appear. FCV (VS-FCV) have first been described in the US (5) and then in Europe. These viruses can lead to virulent systemic disease (VSD) characterized Measures in cat groups with more frequent FCV problems: FCV is almost by severe systemic inflammatory reactions with fever and greatly reduced always a problem in cat groups. The question is to what extent FCV general health, skin edema and ulcerations, especially on the head and induced disease is acceptable. The European Advisory Board on Cat paws, infection of the inner organs and subsequent multi-organ failure Diseases (ABCD; www.abcdcatsvets.org) has designed a tool to help and peracute death (Fig. 3). The outbreaks usually occur in multi-cat veterinarians in rehabilitating multicat environments with FCV problems environments and have been characterized by rapid onset and spread of (www.abcdcatsvets.org/wp-content/uploads/2020/02/FCV-in-multi-cat- the disease and high mortality. communities.pdf). A vaccine change is indicated if all cats are already optimally kept and annually vaccination in place. This text was partially adapted from (1, 4, 6, 8). 1. Berger A, Willi B, Meli ML, Boretti FS, Hartnack S, Dreyfus A, et al. Feline calicivirus and other respiratory pathogens in cats with Feline calicivi- rus-related symptoms and in clinically healthy cats in Switzerland. BMC 276 WSAVA GLOBAL COMMUNITY CONGRESS

Vet Res. 2015;11(1):282. 0188 2. Spiri AM, Novacco M, Meli ML, Stirn M, Riond B, Fogle JE, et al. Modi- TRAP-NEUTER-VACCINATE-RELEASE: ETHICAL fied-Live Feline Calicivirus Vaccination Elicits Cellular Immunity against a PERSPECTIVES IN THE PHILIPPINES. Current Feline Calicivirus Field Strain in an Experimental Feline Challenge Study. Viruses. 2021;13(9). R. Del Napoles 3. Spiri AM, Riond B, Stirn M, Novacco M, Meli ML, Boretti FS, et al. Modi- Quezon City/Philippines fied-Live Feline Calicivirus Vaccination Reduces Viral RNA Loads, Duration of RNAemia, and the Severity of Clinical Signs after Heterologous Feline Qualifications: Calicivirus Challenge. Viruses. 2021;13(8). Rey Camuta del Napoles, DMV 4. Spiri AM, Theze J, Meli ML, Cattori V, Berger A, Steinrigl A, et al. Genetic diversity and phenotypic associations of feline caliciviruses from cats in Head - Veterinary and Emergency Services , Animal Kingdom Foundation Switzerland. J Gen Virol. 2016;97(12):3253-66. Council on Technical Standards for Companion Animals - Philippine Veter- 5. Pedersen NC, Elliott JB, Glasgow A, Poland A, Keel K. An isolated epizo- inary Medical Association otic of hemorrhagic-like fever in cats caused by a novel and highly virulent strain of feline calicivirus. Vet Microbiol. 2000;73(4):281-300. [email protected] Trap-Neuter-Vaccinate-Release: Ethical Perspectives In The Philippines 6. Willi B, Spiri AM, Meli ML, Samman A, Hoffmann K, Sydler T, et al. Molecular characterization and virus neutralization patterns of severe, For the longest time, destruction of roaming dogs has remained the most non-epizootic forms of feline calicivirus infections resembling virulent popular dog population management in the Philippines. Spay and Neuter/ systemic disease in cats in Switzerland and in Liechtenstein. Vet Microbi- TNVR was introduced through efforts of local and international NGO’s ol. 2016;182:202-12. earning dislike from the national regulatory bodies. 7. Cooper LM, Sabine M. Paw and mouth disease in a cat. Aust Vet J. Despite the growing studies on the importance of vaccinating the roaming 1972;48(11):644. population to prevent the transmission of rabies, impounding and eventual euthanasia has remained the prime dog population management em- 8. ABCD. European Advisory Board for Cat Diseases (ABCD): Managing ployed by most local operated pounds. FCV outbreaks in multi-cat communities 2019 [Available from: http://www. abcdcatsvets.org/wp-content/uploads/2020/02/FCV-in-multi-cat-commu- While cat TNVR has gained tolerance in most local government units, the nities.pdf. program is highly opposed almost by everyone because of the fear of dog bites (based on a KAP survey made in 2017). Ninety eight (98%) of dog bites and rabies incidence according to the same study was identified to have been due to owned dogs. Only 2% was reported from stray/roaming dog population. 277

13–15 NOVEMBER, 2021 0189 possible paralysis. Deformed legs are more prone to osteoarthritis as the joint surfaces are incongruent. We also need to consider the behavioural THE ETHICS OF BREEDING FOR EXTREME aspects for these animals. Do they experience frustration at the inability CONFORMATION IN COMPANION ANIMALS to move freely and especially for cats that are incapable of climbing, descending or in some cases even scratching? E. Milne Abnormal ears. Perpignan/France Dogs, cats and rabbits have all been affected by this. In the case of fold Qualifications: cats, like the Scottish fold, the cartilage deformity responsible for the fold- ed ears can cause crippling arthritis at a young age. Dogs such as bassets Dr Emma Goodman Milne with very long ears, poodles with very hairy ear canals, and spaniels with very hairy, heavy ears are all prone to various welfare problems from ear BVSc FRCVS infections to trauma. Lop-eared rabbits account for around 50% of the UK population. They are prone to wax build- up and ear base abscesses as [email protected] well as trauma. For breeds like the English lop with ears that can top 50cm it can even adversely affect their mobility as well as their thermoregula- The Ethics of Breeding for Extreme Conformation in tion. Companion Animals Abnormal coats. We are all well aware of the concept of evolution and survival of the fit- test. Although it may seem obvious, I believe it is important to always bear Hairless animals such as the Sphinx cat and the Chinese crested dog this in mind when we consider extreme conformation. As vets we too have often require human clothes to protect their skin from trauma and sun become used to seeing and sometimes normalising these body shapes damage or help keep them warm. Cats may need to be kept in because and the associated health issues. of the risk of trauma. Cats being kept indoors is a cause of stress and stress-related disease in itself. This talk will focus on dogs, cats and rabbits but the problems extend to horses, fish, birds and many other species. Evolution has produced canids On the other end of the spectrum we have breeds like the Angora rabbit and felids across the world that tend to have long, straight legs, erect and Persian cat. These animals have coats that are untenable both by the ears, long muzzles, open, unobstructed eyes and short fur. Even in very animal and owner. For animals like this that are fastidious groomers the cold climates fur tends to grow thicker, not longer. matting and soilng of these coats must have some behavioural impacts. Rabbits have an increased risk of fly strike and both species of hairball ob- The process of domestication started because animals were helpful to struction. Angora rabbits can have problems mating and nursing because us. Dogs for herding, hunting and guarding, cats for pest control, horses of excess hair. for heavy work. In the late 1800s the Victorians started to really change the shapes of dogs and cats and the concept of breeds and the breed Excessively hairy dogs such as the Old English sheepdog and the puli standard took off. 19 breeds of dog were recognised then, now we have have lost the ability to communicate, especially if docked. They can’t raise over 200 – all based on morphology alone. their hackles, change their facial expression or change their tail position if docked. This can draw aggression from other dogs or cause behavioural Breed standards are, in my view, a major cause of unnecessary suffering. issues. They are an arbitrary, man-made concept. A knitting pattern for sentient beings. Breeder priorities are looks, temperament and health. In 2008 a Brachycephaly. BBC Panorama programme, Pedigree Dogs Exposed, caused a storm in the UK and many vets felt that real change would begin. The UK Kennel This is the epitome of shape change and gets much more coverage than Club set out to do an overhaul of the standards to make them healthier. the other issues might. Please feel free to sign up to www.vetsagainst- Allegedly. We’ll look at some examples of extreme conformation and what brachycephalism.com if you feel as strongly as I do that it is indefensible the impact on the animals are. on welfare grounds to breed these animals. Excessive Skin. There are entire conferences devoted to this and BOAS is a major cause of unnecessary suffering. BUT we need to remember that it’s not just Many breeds of dog have been bred to have wrinkled skin on various parts about BOAS. These animals are afflicted with multiple GI diseases, heat of the body. The Shar-pei is the most well-known but the same applies to intolerance, exophthalmos, corneal trauma, dry eye, skin fold pyoderma, faces, lips and legs of many breeds such as brachycephalics, mastiffs, hemivertebrae, IVDD, myelopathies, chondrodystrophy, obesity, 100% den- bassets, spaniels etc. tal malocclusion, cardiac disease, CM/SM and fundamentally a profound inability to reproduce. Skin is usually a well-balanced, self-regulating organ. Folds are unnatural and alter the microclimate of the skin in those areas. Skin fold pyoder- If a breed is only existing through veterinary intervention, then we need to ma is a major welfare issue and many dogs require rigorous daily skin ask some very basic ethical questions of ourselves. routines to keep them under control. Facial folds can cause entropion, ec- tropion, diamond eye, ocular trauma and dysfunctional lips; all conditions Inherited disease and abnormalities. that frequently require surgical intervention. In some breeds like the ridgeback we select for the genetic defects in the Long backs and short legs. litter and in some cases actually cull the ‘normal’ litter mates. Added to this is the fact that keeping narrow gene pools to keep breeds ‘pure’ we Some breeds of dog and cat, such as the dachshund and Munchkin, have inadvertently select for inherited disease such as OCD, urate disease in almost effectively had their legs amputated through selective breeding. dalmatians, hip and elbow dysplasia, mitral valve disease and many more. The UK KC recently made changes to the dachshund breed standard to assure ground clearance. The altered cartilage in chondrodystrophic ani- Breeds are a man-made concept and do not occur in nature. When we mals, combined with overly long backs is a well-known cause of IVDD and 278 WSAVA GLOBAL COMMUNITY CONGRESS

breed for looks we, by definition, are not breeding for health and temper- are happy, healthy, family pets that are capable of living a good life and ament. Some breed enthusiasts say we can’t change breeds but we have extreme conformation quite simply is not compatible with this. already changed many of them beyond recognition. What should we be doing? Governments. - Laws must be enforced and extended to all breeders and all species. - Confusion resolved over whose responsibility it is to prosecute. - Money for training of those who are responsible for prosecution/licenc- es. - Stop illegal trade and close loopholes in puppy imports. - Mandatory use of AWF/RSPCA puppy contract and PIP (or similar out- side the UK) for all breeders. - Proof of knowledge prior to pet ownership. - Mutilations? Ear-cropping and tail docking must be properly outlawed. - Ban breeding of certain breeds eg sphinx and extreme brachys? A taboo subject but a good ethical discussion should ensue. Kennel Clubs and other show organisations. - Halt showing and registration of worst affected breeds until health issues have been addressed. - No new breeds added unless bred for health and temperament. - Complete, independent veterinary review of breed standards across all species. - Use of the AWF/RSPCA puppy contract and PIP (or similar outside UK) for all breeders wanting to register. - Open the stud books and allow outcrossing. - Mandatory, rational health testing for all breeding animals and all show animals. Veterinary profession. - Governing bodies – tighter guidelines for professional misconduct e.g reproductive services and mutilations. - Practice ethical policies and meetings. Mental health. - No elective c-sections. - Mandatory neutering with c-sections? - No assisted reproduction apart from extenuating circumstances. - No more normal for breed. All deformities should be noted as such. - Social media. Absolutely no sharing of extreme conformation as cute or funny. - Pre-purchase advice. - Stop being part of the problem. - Collaborate with insurance companies. Which conditions should not be covered? - Research into maximum healthy variations. Why Not Mongrels and Moggies? What is driving the current trend for more and more extreme animals? Why are we no longer happy true crossbreeds and hybrid vigour? WE HAVE to start breeding for health and temperament above all else. What we want 279

13–15 NOVEMBER, 2021 0190 with inadequate protection against these deadly diseases. For this reason, vaccination of all dogs immediately upon admission with vaccines that VACCINATION OF DOGS IN SHELTERS: WHO, WHAT, induce the most rapid immune response is paramount to control of the WHEN AND WHY most common diseases in shelters. A delay of even a day can significantly increase the risk for infection and spread of disease within the population. C. Crawford Delays in vaccination have greater consequences for animals in shelters than in homes. Gainesville/United States of America The core vaccines that every shelter dog must receive starting at admis- Qualifications: sion include CDV, CPV, CAV-2, CPiV, and Bordetella bronchiseptica. Mod- ified-live vaccines are the vaccines of choice because they provide the Cynda Crawford fastest onset of immunity and break through maternal antibody interfer- ence sooner than inactivated vaccines, important factors when exposure DVM, PhD is likely to occur soon after admission. The core vaccines typically include a combination of modified- live CDV, CPV, CAV2, and CPiV administered [email protected] parenterally in addition to an intranasal vaccine containing modified-live Vaccination of Dogs in Shelters: Who, what, when and why Bordetella and CPiV. This vaccine induces a rapid mucosal immune response against both pathogens within 3 to 7 days and significantly Cynda Crawford, DVM, PhD reduces clinical disease and pathogen shedding.4-6 Maddie’s Shelter Medicine Program Vaccination of all dogs on admission with the modified-live core vaccines includes strays, owner-surrendered pets, animals impounded for rabies University of Florida quarantine or a cruelty case, pregnant or lactating animals, animals with a mild illness or injury, and community dogs admitted for trap-neuter-re- Gainesville, FL USA lease or return-to-field programs. While vaccination of pregnant, sick, or injured pets in homes with modified-live vaccines is not advised, the rapid [email protected] protection afforded by these vaccines in a shelter outweighs the risk for harm to fetuses and neonates or for an impaired immune response. For There are two basic types of shelters for housing homeless dogs: tradi- financial reasons, shelters may be tempted to vaccinate only those dogs tional shelters that provide temporary housing pending placement into likely to be adopted. Restricting vaccination to adoptable animals creates homes, and sanctuaries where dogs remain for life. The traditional shelter a large pool of susceptible animals with subsequent development of population has a higher turnover rate and shorter residence time with the endemic disease and disease outbreaks that are costlier than vaccines. continual admission and leaving of dogs. Sanctuaries have a more stable population based on long term residence and low turnover. Both types ad- Vaccination of puppies entering shelters starts at 1 month of age with mit dogs from random sources in the community, most of which have no the modified-live CDV/CPV/CAV2/CPiV parenteral vaccine and the prior veterinary care, substantially increasing the risk for introduction and modified-live Bordetella/CPiV intranasal vaccine. Vaccination with the spread of contagious diseases and establishment of endemic disease. parenteral CDV/CPV/CAV2/CPiV combination is repeated every 2 weeks to break through maternal antibody interference as quickly as possible. A The high risk for disease exposure in shelters requires a robust vacci- small proportion of puppies can have maternal antibody interference with nation program that not only protects each dog but the population as a core vaccine response after 4 months of age.7,8 Therefore, vaccination of whole. What best serves individual animals in lower exposure risk home puppies in the shelter should extend to 5 months of age to ensure that all environments is not ideal for the high-risk shelter environment. According puppies have been successfully immunized. to the Association of Shelter Veterinarians Guidelines for Standards of Care in Animal Shelters1, “Vaccination protocols used for individual pets Adult dogs 5 months of age and older receive the modified-live CDV/CPV/ in homes are not adequate in most population settings. Strategies must CAV2/CPiV parenteral vaccine and the modified-live Bordetella/CPiV in- be specifically tailored for shelters because of the higher likelihood of tranasal vaccine on admission into the shelter. The CDV/CPV/CAV2/CPiV exposure to infectious disease, the likelihood that many animals entering parenteral vaccine is repeated 2 weeks later as a safety net for dogs that the shelter are not immune and the potentially life-threatening conse- did not respond well to the first vaccine or received a vaccine that was quences of infection.” improperly handled. Dogs in sanctuaries should be re-vaccinated with the intranasal modified-live Bordetella/CPiV intranasal vaccine annually9 and For dogs in shelters, determining what vaccines to administer, who the modified-live CDV/CPV/CAV2/CPiV parenteral vaccine every 3 years receives them and when, and why these factors are important is based on as recommended by the WSAVA Guidelines for Vaccination of Dogs and risk assessment for the entire population, not just the individual animal. Dogs.10 There are three components of a best practice shelter vaccination pro- gram critical to protection of both the individual and the population: Rabies virus is a core vaccine for dogs in shelters in rabies-endemic locations and should be administered according to local regulations. For • Vaccinate all dogs at admission with core vaccines shelters where animals stay for a short period of time, vaccination at the time of adoption is advisable to help ensure compliance with local rabies • Use modified-live vaccines that induce the most rapid immune response vaccination requirements. Dogs in sanctuaries should be vaccinated against rabies at the time of admission and re-vaccinated at intervals • Start primary vaccination of puppies at 1 month of age and repeat every required by local regulations. 2 weeks while in shelter care until 5 months old The Borrelia burgdorferi (Lyme) vaccine, leptospirosis vaccines, and Canine distemper virus (CDV), canine parvovirus (CPV), canine adenovi- H3N8/H3N2 canine influenza vaccines are non-core vaccines with rus-2 (CAV2), canine parainfluenza virus (CPiV), and Bordetella bronchi- restricted use for dogs in shelters. If the exposure risk is high based septica commonly cause life-threatening or debilitating illness in dogs in on documented cases in the local community or even within the shelter shelters. Every shelter is a high-risk environment for exposure to these population, the primary vaccination series should be started for every dog highly contagious pathogens and most have been affected by very costly in the shelter and every new dog on admission according to manufacturer outbreaks with animal suffering and death. Most puppies <6 mo old and 30 to 50% of adult dogs have little or no little antibody to CDV and CPV on admission into shelters2,3, indicating that many animals enter shelters 280 WSAVA GLOBAL COMMUNITY CONGRESS

instructions. In short-term-stay shelters, many dogs leave the shelter 0191 before finishing the primary vaccination series and adopters should be encouraged to pursue follow-up vaccination with their veterinarian. Where VACCINATION OF CATS IN SHELTERS: WHO, WHAT, indicated by substantial risk for exposure, the Borrelia, leptospirosis, or WHEN AND WHY CIV vaccines should be included in the vaccination program for dogs in C. Crawford sanctuaries. References Gainesville/United States of America • Newbury S, Blinn M, Bushby PA, Cox CB, Dinnage J, Griffin B, Hurley Qualifications: KF, Isaza N, Jones W, Miller L, O’Quin J, Patronek G, Smith-Blackmore M, Cynda Crawford Spindel M. Association of Shelter Veterinarians Guidelines for Standards DVM, PhD of Care in Animal Shelters 2010;p.19. [email protected] Vaccination of cats in shelters: Who, what, when and why • Litster A, Wu CC, Leutenegger CM. Detection of feline upper respiratory Cynda Crawford, DVM, PhD tract disease pathogens using a commercially available real-time PCR Maddie’s Shelter Medicine Program test. Vet J 2015 Nov;206(2):149-153 University of Florida • Lechner ES, Crawford PC, Levy JK, Edinboro CH, Dubovi EJ, Caligiuri R. Prevalence of protective antibody titers for canine distemper virus and canine parvovirus in dogs entering a Florida animal shelter. J Am Vet Med Assoc 2010 Jun 15;236(12):1317-1321 • Ellis JA, Gow SP, Waldner CL, Shields S, Wappel S, Bowers A, Lacoste S, Gainesville, FL USA Xu Z, Ball E. Comparative efficacy of intranasal and oral vaccines against Bordetella bronchiseptica in dogs. Vet J 2016;212:71–77. [email protected] • Larson LJ, Thiel BE, Sharp P. A comparative study of protective immunity There are two basic types of shelters for housing homeless cats: tradi- provided by oral, intranasal and parenteral canine Bordetella bronchisepti- tional shelters that provide temporary housing pending placement into ca vaccines. International J Applied Res Vet Med 2013;11:153–160. homes, and sanctuaries where cats remain for life. The traditional shelter population has a higher turnover rate and shorter residence time with the • Scott-Garrard MM, Chiang Y-W, David F. Comparative onset of immu- continual admission and leaving of cats. Sanctuaries have a more stable nity of oral and intranasal vaccines against challenge with Bordetella population based on long term residence and low turnover. Both types bronchiseptica. Veterinary Record Open 2018;5:e000285. doi:10.1136/ admit cats from random sources in the community, most of which have no vetreco-2018-000285 prior veterinary care, substantially increasing the risk for introduction and spread of contagious diseases and establishment of endemic disease. • Pollock RV, Carmichael LE. Maternally derived immunity to canine parvovirus infection: transfer, decline, and interference with vaccination. J The high risk for disease exposure in shelters requires a robust vacci- Am Vet Med Assoc 1982 Jan 1;180(1):37-42. nation program that not only protects each cat but the population as a whole. What best serves individual animals in lower exposure risk home • Carmichael LE. Immunization strategies in puppies-why failures? Com- environments is not ideal for the high-risk shelter environment. According pend Cont Ed Pract Vet 1983;5:1043-1051 to the Association of Shelter Veterinarians Guidelines for Standards of Care in Animal Shelters1, “Vaccination protocols used for individual pets • Jacobs AA, Theelen RP, Jaspers R, Horspool LJ, Sutton D, Bergman JG, in homes are not adequate in most population settings. Strategies must Paul G. Protection of dogs for 13 months against Bordetella bronchisepti- be specifically tailored for shelters because of the higher likelihood of ca and canine parainfluenza virus with a modified live vaccine. Vet Record exposure to infectious disease, the likelihood that many animals entering 2005 Jul 2;157(1):19-23. the shelter are not immune and the potentially life-threatening conse- quences of infection.” • Day MJ, Horzinek MC, Schultz RD, Squires RA; Vaccination Guidelines Group (VGG) of the World Small Animal Veterinary Association (WSAVA). For cats in shelters, determining what vaccines to administer, who WSAVA guidelines for the vaccination of dogs and dogs. J Small Anim receives them and when, and why these factors are important is based on Pract. 2016 Jan;57(1):E1-E45. risk assessment for the entire population, not just the individual animal. There are three components of a best practice shelter vaccination pro- gram critical to protection of both the individual and the population: • Vaccinate all cats at admission with core vaccines • Use modified-live vaccines that induce the most rapid immune response • Start primary vaccination of kittens at 1 month of age and repeat every 2 weeks while in shelter care until 5 months old Feline parvovirus (panleukopenia) (FPV), feline herpesvirus (FHV), and feline calicivirus (FCV) commonly cause life-threatening or debilitating illness in cats in shelters. Every shelter is a high-risk environment for exposure to these highly contagious pathogens and most have been affected by very costly outbreaks with animal suffering and death. Most kittens <6 mo old and 30 to 50% of adult cats have little or no little antibody to FPV, FHV, and FCV on admission into shelters2, indicating that many animals enter shelters with inadequate protection against the 281

13–15 NOVEMBER, 2021 most common diseases. For this reason, vaccination of all cats immedi- cats is then based on length of stay. This vaccine is not recommended ately upon admission with vaccines that induce the most rapid immune for group-housed cats in short-term stay shelters - adopters can decide response is paramount to disease control in shelters. A delay of even a whether to vaccinate based on each cat’s lifestyle in the new home.7 Vac- day can significantly increase the risk for infection and spread of disease cination is recommended for group-housed kittens and cats in sanctu- within the population. Delays in vaccination have greater consequences aries with repeat vaccination at intervals recommended by the vaccine for animals in shelters than in homes. manufacturer. 7 The core vaccines that every cat must receive starting at admission Bordetella bronchiseptica and Chlamydia felis vaccines are non-core include FPV, FHV, and FCV. Modified-live FPV, FHV, and FCV vaccines are vaccines for cats in shelters because these bacterial infections are less the vaccines of choice because they provide the fastest onset of immunity common causes of respiratory infections. For shelters with confirmed Bor- and break through maternal antibody interference sooner than inactivated detella cases, the intranasal modified-live vaccine can be given once to all vaccines, important factors when exposure is likely to occur soon after cats at least 1 month old on admission with continuation of this policy for admission. The core vaccines typically include a combination of FPV, FHV, several months to build up population immunity and stop transmission. and FCV administered parenterally. For shelters struggling with a high The Chlamydia felis vaccine can be used in a similar manner in shelters incidence of respiratory disease, the modified-live FHV + FCV vaccines giv- where disease caused by C. felis infection has been confirmed. en intranasally can be used for rapid onset of immunity in 4 to 6 days. In this case, the parenteral vaccine for FPV must also be given because the References intranasal FPV does not induce protective immunity against this deadly disease. • Newbury S, Blinn M, Bushby PA, Cox CB, Dinnage J, Griffin B, Hurley KF, Isaza N, Jones W, Miller L, O’Quin J, Patronek G, Smith-Blackmore M, Vaccination of all cats on admission with the modified-live FPV + FHV Spindel M. Association of Shelter Veterinarians Guidelines for Standards + FCV core vaccines includes strays, owner-surrendered pets, animals of Care in Animal Shelters 2010;p.19. impounded for rabies quarantine or a cruelty case, pregnant or lactating animals, animals with a mild illness or injury, and community cats admit- • DiGangi BA, Levy JK, Griffin B, McGorray SP, Dubovi EJ, Dingman PA, ted for trap-neuter-release or return-to-field programs. While vaccination Tucker SJ. Prevalence of serum antibody titers against feline panleukope- of pregnant, sick, or injured pets in homes with modified-live vaccines is nia virus, feline herpesvirus 1, and feline calicivirus in cats entering a Flori- not advised, the rapid protection afforded by these vaccines in a shelter da animal shelter. J Am Vet Med Assoc 2012 Nov 5;241(10):1320-1325. outweighs the risk for harm to fetuses and neonates or for an impaired immune response. For financial reasons, shelters may be tempted to • DiGangi B, Levy JK, Griffin B, Reese MJ, Dingman PA, Tucker SJ, Dubovi vaccinate only those cats likely to be adopted and not vaccinate those at EJ. Effects of maternally-derived antibodies on serologic responses to risk for euthanasia. Restricting vaccination to adoptable animals creates vaccination in kittens. J Feline Med Surg 2012;14(2):118–123. a large pool of susceptible animals with subsequent development of endemic disease and disease outbreaks that are costlier than vaccines. • Jakel V, Cussler K, Hanschmann KM, Truyen U, König M, Kamphuis E, Duchow K. Vaccination against feline panleukopenia: implications from a Vaccination of kittens entering shelters starts at 1 month of age with field study in kittens. BMC Veterinary Research 2012; 8:62-70 re-vaccination every 2 weeks to break through maternal antibody interfer- ence as quickly as possible. Up to one-third of kittens can have maternal • Reese MJ, Patterson EV, Tucker SJ, Dubovi EJ, Davis RD, Crawford PC, antibody interference with core vaccine response after 4 months of Levy JK. Effects of anesthesia and surgery on serologic responses to age.3-5 Therefore, primary vaccination of kittens in the shelter with core vaccination in kittens. J Am Vet Med Assoc 2008;233: 116–121. vaccines should extend to 5 months of age to ensure that all kittens have been successfully immunized. • Day MJ, Horzinek MC, Schultz RD, Squires RA; Vaccination Guidelines Group (VGG) of the World Small Animal Veterinary Association (WSAVA). Adult cats 5 months of age and older receive the modified-live FPV + FHV WSAVA guidelines for the vaccination of dogs and cats. J Small Anim + FCV vaccine on admission into the shelter and again 2 weeks later. The Pract. 2016 Jan;57(1):E1-E45. second dose serves as a safety net for cats that did not respond well to the first vaccine or received a vaccine that was improperly handled. Cats • Little S, Levy J, Hartmann K, Hofmann-Lehmann R, Hosie M, Olah G, De- in sanctuaries should be re-vaccinated with the modified-live FPV + FHV nis KS. 2020 AAFP Feline retrovirus testing and management guidelines. J + FCV core vaccines every 3 years as recommended by the WSAVA Guide- Feline Med Surg. 2020 Jan;22(1):5-30. lines for Vaccination of Dogs and Cats.6 Rabies virus is a core vaccine for cats in shelters in rabies-endemic locations and should be administered according to local regulations. For shelters where animals stay for a short period of time, vaccination at the time of adoption is advisable to help ensure compliance with local rabies vaccination requirements. Cats in sanctuaries should be vaccinated against rabies at the time of admission and re-vaccinated at intervals required by local regulations. The FeLV vaccine is a non-core vaccine for cats in shelters. According to the 2020 AAFP Feline Retrovirus Testing and Management Guidelines7, all cats should be tested for FeLV infection prior to FeLV vaccination: “If a vaccinated cat’s status is unknown and the cat is later determined to have a FeLV infection, vaccine efficacy would be questioned, and vaccine failure suspected. Cats should be tested for FeLV infection before initial vaccination” FeLV testing and vaccination is not necessary for individu- ally housed cats in shelters due to the low risk of viral transmission.7 In shelters that group-house cats, FeLV testing is essential for identifying uninfected cats to place in the group. FeLV vaccination of group-housed 282 WSAVA GLOBAL COMMUNITY CONGRESS

0192 MUC2, develop spontaneous colitis and are at higher risk for developing colorectal cancer6. In human UC patients, it is postulated that a defective COMPARATIVE GASTROENTEROLOGY inner mucus layer allows for increased bacterial contact with the epitheli- um +/- bacterial colonization of the normally sterile crypts7. Studies of the A. Manchester mucus barrier in CE dogs are lacking. Additional chemical components of the intestinal barrier include antimicrobial peptides (AMP) which also Fort Collins/United States of America exclude bacteria from the epithelial surface. Paneth cells are the primary source of AMPs in humans and mice yet have not been identified in the Qualifications: canine gastrointestinal tract. Alison C. Manchester Environmental factors are critical to the pathogenesis of intestinal inflammation. Directly adjacent to the IE are a multitude of microbes DVM, MS, DACVIM-SAIM increasing in density travelling aboard in the GI tract. Sometimes referred to as the “forgotten organ”, the intestinal microbiota is largely beneficial [email protected] to host health. It promotes normal barrier function, helps the host obtain Chronic gastrointestinal (GI) symptoms manifest in many species. nutrients from otherwise undigestible fibers and provides competitive Although the names and subcategories of disease differ, the ensuing exclusion against enteropathogens. Germ-free mice have underdeveloped clinical signs of diarrhea, vomiting, weight loss, and abdominal discom- gut-associated lymphoid tissues and are at much higher risk of succumb- fort, are the same. In humans, dogs, and other species, these signs are ing to enteric infection, yet the dysbiosis accompanying IE disruptions often linked to intestinal inflammation. Inflammatory bowel diseases can allow for bacterial translocation into subepithelial regions, inciting (IBD) in people are subdivided into Crohn’s disease (CD) and ulcerative microinflammation5. When germ-free mice are colonized with microbiota colitis (UC). Irritable bowel syndrome (IBS) is the diagnosis ascribed to from IBD humans, their colitis worsens with concomitant with increased the subset of people with chronic GI symptoms who have no identifiable Th17 and Th2 cells and reduction in anti-inflammatory regulatory T cells8. intestinal inflammation. Dogs with ongoing signs referrable to GI distress Similar alterations in gut microbial composition have been documented for which obvious causes have been ruled out are considered to have in humans and dogs with IBD: decreases in Firmicutes and Bacteroidetes chronic enteropathy (CE). This is currently the preferred term in canine phyla, increases in Proteobacteria. Modulation of the intestinal microbi- patients given the dissimilarities from human IBD and the infrequency with ota is therefore an attractive therapeutic target. Probiotics have proven which intestinal inflammation is documented1. Mice are used as models benefit in human patients with acute infectious and antibiotic-associ- for human IBD, and consequently, most research of the immunopathology ated diarrhea, UC, IBS, and necrotizing enterocolitis9. Fecal microbiota underpinning intestinal inflammation emanates from these two species. transplantation is widely accepted as a therapy for humans with refractory These proceedings will review existing knowledge of chronic intestinal Clostridioides difficile enteritis and may benefit individuals with UC10. Its inflammation in dogs, humans, and mice, toward the aim of improved utility in canine patients remains unclear. understanding of this common condition. A delicate balance thus exists between host and gut microbiome. Eluci- Why individuals develop and maintain intestinal inflammation is incom- dating the complex relationships between these entities requires further pletely understood. Decades of study have converged on contributions large-scale functional analyses, but modulation of the gut microbiome has from the intestinal epithelial, environmental triggers, and dysregulated clear therapeutic promise for treatment (and exacerbation) of intestinal immune responses. Diagnoses of IBD and IBS in people and CE in dogs inflammation. are on the rise. A comparative perspective of chronic intestinal disease is a worthwhile endeavor. Diet is another environmental factor able to provoke or quell intestinal inflammation. As with the intestinal microbiota, the normal host response The intestinal epithelium (IE) may appear as a simple row of columnar to food antigens is tolerance. Loss of tolerance results in inappropriate cells, but it is far from an inert, impenetrable wall. This barrier is multilay- inflammatory reactions to innocuous compounds. Humans with Celiac ered, more akin to a transnational boundary with numerous scanning sta- disease have CD4+ T cells specific for deamidated gluten; they incite tions, ports of entry, and exchanged goods. Physically, adjacent intestinal inflammation and tissue damage upon exposure to gluten, and disease epithelial cells are knit together by multiprotein complexes that form tight remission can be achieved with a gluten-free diet. Non-immune mediated junctions (TJ). Connections between TJs and intracellular cytoskeletal net- adverse food reactions (food intolerances) also occur. Dogs and humans works create a stratified barrier. Disruption of IE cytoskeletal organization with primary intestinal lymphangiectasia can improve dramatically with and subsequent TJ breakdown has been correlated with disease activity ingestion of an ultra-low-fat diet. In many cases, though, it is not clear in human CD2. Dogs with lymphoplasmacytic colitis have increased ex- whether favorable responses are due to inclusion or lack of certain food pression of the pore-forming tight junction protein claudin-2 as compared components. Long-term, strict diet adherence is certainly less realistic for to healthy ones3. Mice with defective TJ-associated proteins, however, do human as opposed to canine patients. Achievement of clinical remission not spontaneously develop colitis but manifest compensatory increases in and mucosal healing in pediatric CD patients treated with elemental diet IgA expression4. This lends weight to a multi-hit IBD pathogenesis. monotherapy exhibit the potential for nutritional strategies. Diet offers a readily modifiable environmental factor that could obviate the need for The intestinal barrier is more permable in animals with intestinal inflam- potent immunomodulatory drugs and have substantial positive impacts on mation, but it is not known whether this is a cause or effect of disease. individuals with intestinal signs. Much attention has been given to barrier-breaking events with the theory that a “leaky gut” precipitates increased antigen-immune cell contacts The GI tract is home to the largest number of immune cells in the body. with ensuing immune cell recruitment5. Gut permeability is challenging to Together, they are tasked with the supreme challenge of ignoring the accurately and repeatably assess in clinical patients. Improved means of vast majority of microbes and antigens they encounter while rapidly and evaluation are needed and would benefit veterinary and human patients. effectively fending off harmful pathogens. Epithelial disruption and envi- ronmental triggers may converge in predisposed individuals to provoke Intestinal epithelial cells are blanketed by highly glycosylated mucins, inappropriate intestinal immune responses. Overzealous inflammation secreted by goblet cells. This mucus layer increases in thickness along results in bystander tissue damage with symptomatic, nutritional, and the length of the intestinal tract and insulates the host from the multitude even neoplastic consequences. On the other hand, ineffective immune of luminal microbial organisms, mechanical irritants, and endogenous responses allow pathogens to persist, as is the case in dogs with E. digestive enzymes. Mice unable to produce the primary colonic mucin, 283

13–15 NOVEMBER, 2021 coli-associated granulomatous colitis. Here, bacteria persist and replicate 0193 within host macrophages; this disease was often fatal until antimicrobial therapy aiding eradication of intramucosal E. coli was employed. SALMONELLA AND OTHER GASTROINTESTINAL ZOONOSIS IN EXOTICS In human IBDs, suppression of the immune system is the cornerstone of therapy. Targeted approaches including anti-TNF monoclonal antibod- R. Boonyarittichaikij ies and Janus kinase inhibitors can help individuals achieve remission. However, up to 30% of people with IBD are non-responsive to these drugs, Nakornpathom/Thailand and about half lose responsiveness over time. Dogs with CE that have not improved clinically with diet and/or antibiotics are often treated with Qualifications: broad-spectrum immunosuppressants. These are not consistently effec- tive and are associated with numerous side effects which can limit quality Roschong Boonyarittichaikij of life. Comparative studies of chronic intestinal inflammation to expand understanding of disease pathogenesis are needed to enable more DVM, MSc, PhD individualized treatment strategies. Collaboration between basic science, veterinary, and human medical researchers will be paramount in achieving [email protected] these one health goals. Exotic pet is regularly defined as unusual pets other than dogs, cats, and livestock. There is an increasing trend towards keeping exotic pet such as References: small mammals, reptiles, and birds. Approximately one third of the pets in the US and Europe are exotic animals1. Although most of them are unique 1. Dandrieux, JRS. Inflammatory bowel disease versus chronic enteropa- and endearing, some of them can carry and transmit zoonotic patho- thy in dogs: are they one and the same? J Sm Anim Pract. 2016;57:589- gens2. Concerning that 75% of known emerging infectious diseases are 599. zoonoses3. Zoonotic pathogens should be considered when dealing with these exotic pets. Enteric pathogens are among the important zoonotic 2. Blair SA, et al. Epithelial myosin light chain kinase expression and agents. Veterinarians treating exotic pets should concern the potential activity are upregulated in inflammatory bowel disease. Lab Invest. risks of zoonoses and dedicate themselves to public health. Here an over- 2006;86(2):191-201. view of Salmonellosis and other selected enteric zoonoses associated with common exotic pets is summarized. 3. Ridyard AE, Brown JK, Rhind SM, et al. Apical Junction Complex Protein Expression in the Canine Colon: Differential Expression of Claudin-2 in Enteric zoonoses in exotic pets the Colonic Mucosa in Dogs With Idiopathic Colitis. J Histochemistry & Cytochemistry. 2007;55(10):1049-1058. Zoonotic agents are including bacteria, fungi, virus, parasite, and proto- zoa. Bacteria is the most common zoonotic pathogen. Table 1 showed the 4. Khounlotham, M. et al. Compromised intestinal epithelial barrier induc- some of the zoonotic pathogens involved with exotic pets.4 es adaptive immune compensation that protects from colitis. Immunity. 2012; 37, 563–573. Group Zoonotic pathogen Exotic pet species Bacteria Campylobacter amphibian, reptile, bird, mammal 5. Akdis, CA. Does the epithelial barrier hypothesis explain the increase Citrobacter amphibian, reptile, bird, mammal in allergy, autoimmunity and other chronic conditions?. Nat Rev Immunol fish, amphibian, reptile, bird, 2021. Clostridium mammal amphibian, reptile, bird 6. Peterson, LW, and Artis D. Intestinal epithelial cells: regulators of barrier Corynebacterium amphibian, reptile, bird function and immune homeostasis. Nat Rev Immunol. 2014;14:141-153. Enterococcus amphibian, reptile, bird, mammal E. coli amphibian, reptile, mammal 7. Johansson ME. Mucus layers in inflammatory bowel disease. Inflamm Fusobacterium amphibian, reptile, bird Bowel Dis. 2014 Nov;20(11):2124-31. Proteus fish, amphibian, reptile, bird, mammal 8. Britton GJ, Contijoch EJ, Mogno I, et al. Microbiotas from Humans Salmonella amphibian, reptile, primate with Inflammatory Bowel Disease Alter the Balance of Gut Th17 and RORγt+ Regulatory T Cells and Exacerbate Colitis in Mice. Immunity. Shigella 2019;50(1):212-224.e4. 9. Wilkins T, Sequoia J. Probiotics for Gastrointestinal Conditions: A Sum- mary of the Evidence. Am Fam Physician. 2017;96(3):170-178. 10. Paramsothy S, Kamm MA, Kaakoush NO, Walsh AJ, van den Bogaerde J, Samuel D, Leong RWL, Connor S, Ng W, Paramsothy R, Xuan W, Lin E, Mitchell HM, Borody TJ. Multidonor intensive faecal microbiota transplan- tation for active ulcerative colitis: a randomised placebo-controlled trial. Lancet. 2017;389(10075):1218-1228. Staphylococcus amphibian, reptile, bird, mammal Yersinia amphibian, reptile, bird, mammal Fungi Candida bird, primate Cryptococcus amphibian, reptile, bird 284 WSAVA GLOBAL COMMUNITY CONGRESS

Baylisascariasis mammal ● Wash hands before and after handling of exotic pets fish, amphibian, reptile, bird Cryptosporidium amphibian, reptile, mammal ● Check the hygiene of the habitat of exotic pets mammal Parasite and Entamoeba mammal ● Do not eat/drink while handling exotic pets protozoa Giardia bird, mammal ● Do not use kitchen sink/bathtub to bath exotic pets Toxocara ● Proper dispose the waste from exotic pets Schistosoma ● Isolate new exotic pets with a quarantine period determined by the Salmonellosis in exotics pets veterinarian. Salmonellosis is one of the most common zoonosis causing by Salmo- ● Acquire exotic pets from credible sources. nella species. Salmonella spp. are gram-negative belonging to the family Enterobacteriaceae. Currently 2 species within the genus Salmonella ● Regularly veterinary visit for health checkup and deworming. were recognized, Salmonella bongori and Salmonella enterica. Salmonel- la enterica have a wide host range including humans, mammals, birds, ● Limit contact yourself and exotic pets to other exotic pets owing by reptiles, amphibians and insects. Up to 90% of reptiles carry of one or other people and wild animal. more serovars of Salmonella without demonstrating clinical signs. A large number of reports of human salmonellosis has been linked to pet reptiles. ● Wearing gloves when handling carcass The term reptile-exotic-pet associated salmonellosis (REPAS) is used as salmonellosis often caused by the contact with captive species than with References wild species5. This results in the ban on selling turtles less than 4 inches in the US. Many Salmonella infections in humans are self-resolving within 1. Lenzi C, Grasso C, Rizzolo JB. Are exotics suitable pets?. The Veterinary a week; however, the disease can sometimes progress to sepsis and pos- Record. 2020 Apr 18;186(14):459. sibly death. Immunocompromised individuals such as infants, the elderly, and those with immunosuppressive disorders are at a higher risk. 2. Souza MJ. Bacterial and parasitic zoonoses of exotic pets. Veterinary Clinics: Exotic Animal Practice. 2009 Sep 1;12(3):401-15. Recent outbreaks of salmonella infection in humans in the US have been associated with owning pet hedgehogs with more than 10 human cases. S 3. Taylor LH, Latham SM, Woolhouse ME. Risk factors for human disease typhimurium have been involved with the out breaks6. emergence. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences. 2001 Jul 29;356(1411):983-9. Campylobacteriosis 4. Warwick C, Arena PC, Steedman C, Jessop M. A review of captive exotic Campylobacter spp. together with Salmonella spp. are the 2 most animal-linked zoonoses. J Environ Health Res. 2012;12(1):9-24. common zoonotic pathogens. Campylobacter is a gram-negative bacteria found in the digestive tract of wide host range. The most important spe- 5. Bjelland AM, Sandvik LM, Skarstein MM, Svendal L, Debenham JJ. Prev- cies is C. jejuni. In human the disease generally self-limiting gastroenteri- alence of Salmonella serovars isolated from reptiles in Norwegian zoos. tis. Studies have been reported the prevalence of Campylobacter spp. in Acta Veterinaria Scandinavica. 2020 Dec;62(1):1-9. pet birds including canaries and psittacines7. 6. Keeble E, Koterwas B. Salmonellosis in Hedgehogs. Vet Clin North Am Reptile such as lizards and snakes could also play an important role in Exot Anim Pract. 2020 May 1;23:459-70. transmitting the disease8. 7. Boseret G, Losson B, Mainil JG, Thiry E, Saegerman C. Zoonoses in pet Antimicrobial resistance (AMR) birds: review and perspectives. Veterinary Research. 2013 Dec;44(1):1-7. One of the most recent concerns is the antimicrobial resistance (AMR), 8. Masila NM, Ross KE, Gardner MG, Whiley H. Zoonotic and Public Health which may cost high mortality and cost rates. There have been studies on Implications of Campylobacter Species and Squamates (Lizards, Snakes AMR in Enterobacteria from urban wildlife such as birds. Although limited and Amphisbaenians). Pathogens. 2020 Oct;9(10):799. studies have been reported isolation of AMR in exotic pets. The role of exotic pets in transmitting AMR should not be overlooked. 9. Marin C, Lorenzo-Rebenaque L, Laso O, Villora-Gonzalez J, Vega S. Pet reptiles: a potential source of transmission of multidrug-resistant Salmo- A study in pet reptiles in Spain showed that 48% of the pet reptiles carry nella. Frontiers in Veterinary Science. 2021 Jan 6;7:1157. Salmonella spp. All the strains showed resistance to at least one antibiot- ic with 72% were multidrug-resistant strains9. 10. Kotze A, Dalton DL, Strinden M, Sauther ML, Cuozzo FP, Stone AC. An evaluation of the oral microbiome and potential zoonoses of the southern Multidrug resistant E. coli was also recovered from pet budgerigar in thick-tailed or treater galago (Otolemur crassicaudatus). African Primates. Nigeria10. 2016;11(1):19-26. Microbiome The novel next generation sequencing (NGS) and shot gun sequencing technology in gut microbiome study will gain more knowledge on the zoonotic pathogens and AMR of exotic pets. Prevention guideline 285

13–15 NOVEMBER, 2021 0194 Making a pet-specific nutrition recommendation for healthy pets can be done quickly, by recommending the amount and type of a high-quality WHY NUTRITION MATTERS - THE KEY ROLE OF food that matches the pet’s nutritional life stage requirements. Use every NUTRITION IN HELPING PETS THRIVE visit as an opportunity to educate pet owners about how to check their J. Churchill pet’s body condition score and emphasize what the pet owner is doing right. Verify and clearly document the current feeding plan. St Paul/United States of America Opportunities to Impact pet health Qualifications: Primary care providers can positively influence a pet’s “health span” or Julie A. Churchill DVM, PhD, DACVIM (Nutrition), period of life spent in good health through nutrition. As mentioned, the VHCT should have, and provide the expertise to help debunk nutritional Board Certified Veterinary Nutritionist® myths for pet owners help them select appropriate life stage pet foods and include recommendations about how to feed these foods properly. Professor, Veterinary Nutrition The primary care providers are uniquely positioned to monitor a pet’s transition through various life stages and make new recommendations Associate Medical Director to meet those needs and to maintain healthy body and muscle condition. WHY NUTRITION MATTERS-THE KEY ROLE OF NUTRITION IN HELPING These are key features of preventive care. If disease conditions arise, the PETS THRIVE veterinarian can recommend a therapeutic diet in the care plan. Julie Churchill DVM, PhD DACVIM (Nutrition) LIFESTAGE NUTRITION University of Minnesota College of Veterinary Medicine By explaining the need for different foods as life stages change the VHCT creates a culture of individualized nutrition for each pet in the household. Veterinary Clinical Science Department 1352 Boyd Ave. Saint Paul Minnesota 55108 USA Right from the Start-Pediatric Nutrition Email: [email protected] The goal of feeding plans for puppies and kittens is to support healthy im- mune systems and growth. In dogs, the length of time and rate of growth The Power of Food- nurturing through nutrition differ between small, medium, large and giant breed dogs. Because of this, pet food companies are formulating products differently to meet the One of the most important decisions a pet owner makes is what to feed needs for the correct period of growth. Pets should eat a product formu- their pet each day. The idea that great or even ‘optimal’ nutrition positive- lated for growing animals until they reach at least 80% of their mature ly contributes to an animal’s health is well accepted by pet owners and height. Specific objectives of a feeding plan for growing animals are:1) to veterinary professionals alike. Nutrition is strongly linked to ways a pet achieve healthy growth, 2) to optimize immune function and behavioral owner nurtures, loves and cares for their pet. Increasingly, pet owners development (training), 3) minimize developmental orthopedic disease want the veterinary health care team to be the nutritional experts advising and 4) minimize risk of unhealthy weight gain and obesity. and answering questions about pet foods. When members of the veter- inary healthcare team (VHCT) address pet owners’ questions, they have Feeding management the opportunity to educate, and clarify many of the popular myths and misperceptions surrounding pet food. In addition, when the VHCT makes Counsel owners about the importance of maintaining controlled growth a specific individualized feeding recommendation, they engage clients in rather than feeding for maximal growth. Preventing unhealthy weight gain the care of their pets. while pets are growing reduces risks of obesity and associated health risks. Teach owners to perform a BCS at least every two weeks and Nutrition can be the cornerstone of preventive care programs in clinical adjust the amount of growth food to maintain 4.5-5/9 BCS (9-point scale). practice. Meeting a pet’s optimal nutritional needs requires simple tools Validate when pets are ideal BCS. Reiterate the feeding recommendations to assess each pet and adjust nutritional recommendations at each mile- at each visit and include 1) the specific type of food(s), 2) the amount and stone in development to maintain health and delay or prevent diseases. frequency of feeding 3) a monitoring plan such as BCS checks. Avoid ad Integrating nutrition protocols will help develop a partnership between libitum feeding which contributes to unhealthy weight gain. owner, veterinary healthcare team and lead to healthier pets. In this way, pet owners develop enduring and trusted relationships with their veteri- Large Breed Puppies Need Special care nary care team and feel empowered by providing individualized care. Make Nutrition Recommendations a Part of Every Pet’s Visit Large breed puppies are defined as breeds that will weigh approximately 25 or more kg at adult healthy weight. These breeds are particularly at The WSAVA Global Nutrition Committee has developed a suite of practical risk for developmental orthopedic disease (DOD)4 such as hip dysplasia, tools and resources1-2 to help the VHCT make nutritional assessments osteochondrosis as well as increased risk of osteoarthritis. There are 3 and recommendations more efficiently. The toolkit also contains excellent nutritional factors known to increase risk of DOD: client education materials for the team to share with pet owners. The Pet Nutrition Alliance (PNA; www.petnutritionalliance.org) developed practical 1. Increased calories and rapid rate of growth. tools for the veterinary healthcare team to assist them in implementing these nutritional guidelines for every pet. One tool, Implementing the WSA- 2. Excess calcium. Select foods formulated specifically for large breed VA Nutritional Assessment Guidelines can be downloaded from the WSA- puppies that meet the growth requirement but are more modest levels of VA Global Nutrition Guidelines1, 2 page listed in the reference section. calcium than many puppy foods. Evidence suggests this process is most successful when the veterinary team develops easy protocols for each team member to follow. 3. Nutritional Balance. Commercial pet foods are formulated to meet the nutritional needs for growth when fed as the majority (90-95%) of the pet’s 286 WSAVA GLOBAL COMMUNITY CONGRESS

intake.Minimize additional foods and supplements which can imbalance Guidelines. https://wsava.org/wp-content/uploads/2020/01/Implement- the nutrient profile needed for proper growth and development. ing-the-WSAVA-Nutrition-Guidelines.pdf. accessed October 9, 2021 • Gonadectomy 4. Hazewinkel H. Nutritional management of orthopedic diseases. In: Fascetti AJ, Delaney SJ (eds). Applied Veterinary Clinical Nutrition. West Gonadectomy reduces caloric requirement by as much as 25%5. This is Sussex: Wiley-Blackwell, 2012: 125-155. an important time to and adjust the feeding recommendation to meet the new requirements while maintaining ideal BCS. If they are still growing, 5. Jeusette I, Detilleux J, Cuvelier C, et al. Ad libitum feeding following use a lower calorie growth product and vigilantly monitor the pet’s BCS. ovariectomy in female Beagle dogs: effect on maintenance energy require- ment and on blood metabolites. J Anim Physiol Anim Nutr (Berl). 2004 Maintaining Adult health Apr;88(3-4):117-21. Once a pet finishes growing, nutritional needs are usually better met with 6. Churchill JA, Eirmann L. Senior Pet Nutrition and Management. In: pet food products formulated for adult maintenance. Prevention, early Laflamme DP, editor. Vet Clin Small Anim. Vol 51,(3) May 2021:. detection, and early intervention are the first line. Use the WSAVA nutrition assessment checklist to identify nutritional risk factors2. Once identified, they should be addressed with a revised nutritional recommendation and follow up. Meeting Unique needs of Seniors Senior pets represent an increasing percentage of the population visiting veterinary clinics and the goal of pet owners and veterinary care teams alike is to maintain health and quality of life for pets with advancing age. Nutritional needs change in healthy elder pets compared to the young adult life stage. Veterinary healthcare teams must provide nutritional assessments and individual recommendations, recognizing there is no defined nutrient profile for seniors. Aging is a continuum and individual variation prevents a “one size fits all” approach. Advancing age places pets at risk for developing medical conditions. Early detection can lead to earlier nutritional intervention to support recovery, health and quality of life. Despite a somewhat arbitrary categorization of aging, physiologic changes that occur in middle-aged and seniors make them less tolerant of nutritional deficiencies or excesses. Middle-aged pets should be consid- ered “at risk” or more vulnerable to age-related health and nutrition-sensi- tive problems. Middle age is the stage of life when there is an increasing incidence of an onset or progression of chronic diseases, many of which can be influenced by nutritional management. Conduct the same nutri- tional assessment at every wellness visit that has occurred throughout the lifelong care of the pet, but with advancing age, an extended evalua- tion is more likely to be needed. Comorbidities may present a nutritional conundrum, requiring prioritization of problems and nutritional triage to balance needs. Nutrients worth highlighting6 when evaluating a senior pet’s needs include energy, water, protein and antioxidants and lipids to optimize body and muscle conditions, cognitive function, mobility, and quality of life. Summary Nutrition plays an integral role in maintaining health and preventing diseases. Use nutrition-screening tools to identify changing needs of pets throughout life and address nutritional concerns early to improve the pet’s quality of life and health span. When the veterinary team addresses nutrition, not only does the pet benefit, but pet owners develop enduring and trusted relationships with their veterinary care team. References and website links 1. Global Nutrition Guidelines. https://wsava.org/global-guidelines/glob- al-nutrition-guidelines/ Accessed October 9, 2021. 2. WSAVA Global Nutrition toolkit. https://wsava.org/wp-content/up- loads/2021/04/WSAVA-Global-Nutrition-Toolkit-English.pdf accessed October 9, 2021 3. Pet Nutrition Alliance/WSAVA. Implementing Nutrition Assessment 287

13–15 NOVEMBER, 2021 0195 rendering) can have different nutritional characteristics compared to the raw material of origin3, but they can be used safely and effectively as long SEPARATING FACT FROM FICTION: NAVIGATING as the quality control is good, and the formulation takes those changes THE INTERNET AND THE PET FOOD AISLE into account. The ingredient list only provides one type of information, and that is the ingredients used in the formulation (in the EU, sometimes C. Villaverde not even that, since they can be declared as categories; EU regulation EC 767/2009). Fermoy/Ireland The nutritional analysis is not useful for quality assessment either. Of the Qualifications: approximately 40 essential nutrients for pets, the label mandates only two (protein and fat), and, in the case of the US, this is only a minimum Cecilia Villaverde level, not an average value. This number does not provide information on protein or fat quality (i.e., amino acid/fatty acid profile, digestibility, BVSc, PhD, DACVIM (Nutrition), DECVCN bioavailability, freshness, etc.). [email protected] The price point or terms such as “premium” are also not a good indica- Choosing a pet food is an important task: an adequate diet (nutritious and tor of quality, because more expensive does not mean better. There are safe) will promote health and well-being. While there is not one single diet expensive foods where the manufacturer does not invest that money on best for all dogs or for all cats, and multiple diets can be adequate for research, expert personnel, or advanced testing. each case, it is important to choose a product that it is both adequate for the patient and of good quality. How to choose a quality pet food The veterinary team will have to perform a nutritional assessment1 to While pet food is regulated (differently depending on the country), there identify the nutritional characteristics that are desirable for the pet, is a high component of self-regulation in this industry, and since label mainly, find a diet complete and balanced for the species and life-stage information is limited, that has to be complemented with assessment of that better fits the needs of the patient. For example, a pet with multiple the manufacturer. The WSAVA has developed a document with a list of obesity risks factors (spayed/neutered, middle aged, low activity level, items to identify on the label and questions to ask manufacturers mainly breed) will benefit from a lower calorie product, whereas a very active dog regarding expertise and quality control (https://wsava.org/wp-content/ will do better on a “performance” type diet. uploads/2021/04/Selecting-a-pet-food-for-your-pet-updated-2021_WSA- VA-Global-Nutrition-Toolkit.pdf). Even after the assessment, multiple products might fit the bill, especially for healthy pets, and choosing the brand and variety can be a daunting Label information that is useful includes the nutritional adequacy state- task for the pet caretakers, given the thousands of options and the con- ment (which, in the US, also clarifies how has the diet been determined fusing and even contradictory marketing messages. Choosing a quality to be complete, for some other countries this will have to be asked), the pet food among all these options is not easy, which is why it is important calorie content (mandatory in the US, for example, but not in the EU), and for the veterinary team to be a source of reliable nutrition information to the contact information of the manufacturer. Some companies manufac- help consumers navigate the pet food aisle and choose a quality product: ture their own foods, but not all. While quality can be good in both cases, that is, a food that is nutritious and safe2. the level of control over the process is different. How is quality defined Questions to ask the manufacturer include asking about the credentials of the formulators, if they employ animal nutritionists (and veterinary nutri- Quality can be a subjective term. Regarding pet food and ingredients, tionists if they develop therapeutic diets), and what type of quality control quality should address both nutritional value and safety. Nutritional value measures are in place, including ingredient and final product testing (both will vary depending on the ingredient itself, for example, amino acid profile lab and in vivo). It is also interesting to ask if they invest in research, what and digestibility are important quality indicators of protein sources, but type, and if this is published. digestibility is not important in fibre sources (by definition, undigestible). Each ingredient will also have associated safety risks (such as micro- How to navigate marketing terms biological contamination, micotoxins, oxidation products, heavy metal contamination, etc). Manufacturers must develop protocols to identify The WSAVA also has a document to help pet caretakers navigate the in- those risks in their raw materials. ternet, where they read/see a lot of the pet food marketing (https://wsava. org/wp-content/uploads/2020/01/The-Savvy-Dog-Owner-s-Guide-to-Nutri- The quality of a pet food, however, is more than the quality of each ingre- tion-on-the-Internet.pdf), and the recommendation is to check the source dient: the quality of the final product itself will also be affected by nutrient of the information, date, etc, and the veterinary team should encourage interactions, effect of processing (such as heat and storage), and the discussion about it. knowledge of the formulator(s) in ensuring that the specific combination of ingredients results in a complete product. Moreover, products that work Ingredient based marketing is common but does not provide information for one pet might not work as well for others (which is why the nutritional on quality (many claims such as natural, organic, grain free, “evolutionary assessment is an important part of the process for choosing a pet food). correct”, human grade, “holistic” are ingredient focused, and in many cases not legally defined, which makes them non-informative). Negative Some tings that do not inform quality: ingredient list and guaranteed (or marketing towards other companies/feeding philosophies (instead of typical) analysis showing positive effects of their own product) is also a red flag, as is the abundance of testimonials, or the use of vague, sciency-sounding The ingredient list and the typical/guaranteed analysis are sometimes language (e.g. “boosts the immune system”). If it sounds too good to be used by pet food ranking websites or others to determine the quality of true, it likely is. a food. However, the name of an ingredient and/or its position within the list do not provide us with any information on its nutritional profile/safety 1. WSAVA Nutritional Assessment Guidelines Task Force Members, or that of the final product. The inclusion of ingredients like by products, Freeman L, Becvarova I, Cave N, MacKay C, Nguyen P, Rama B, Takashima cereals (or other starch sources), or meals does not mean that the final G, Tiffin R, Tsjimoto H, van Beukelen P. WSAVA Nutritional Assessment product is not complete and balance and safe. Meals (obtained through 288 WSAVA GLOBAL COMMUNITY CONGRESS

Guidelines. J Small Anim Pract. 2011 Jul;52(7):385-96. 0196 2. Eirmann L, Cowell C, Thompson L. Pet food safety: the roles of govern- CONSIDERATIONS FOR YOUR VETERINARY CLINIC ment, manufacturers, and veterinarians. Compend Contin Educ Vet. 2012 TO IMPROVE THE COMFORT OF YOUR PATIENTS Jan;34(1):E4. M. Petty 3. Cramer KR, Greenwood MW, Moritz JS, Beyer RS, Parsons CM. Protein Canton/United States of America quality of various raw and rendered by-product meals commonly incorpo- rated into companion animal diets. J Anim Sci. 2007 Dec;85(12):3285-93. Qualifications: Michael C Petty, DVM DVM, certified in medical acupuncture, rehabilitation, pain management [email protected] Considerations for your veterinary clinic to improve the comfort of your patients Our duty toward animals; the Five Freedoms Freedom from hunger and thirst Freedom from discomfort Freedom from pain, injury and disease* Freedom to express normal behavior Freedom from fear and distress* Its not just about drugs: Comfort Emotional support Nausea and vomiting Low stress handling Physical environement Nursing care Post-operative nutrition Pain scores Are you assessing pain? Only 17% of veterinary practices routinely use a pain assessment tool But over 80% of veterinary nurses and technicians agree that they are useful Choose a validated tool that you like and that you and your staff will use Assessing pain in cats and dogs is mostly about behavior What are normal behaviors Look for loss of normal behaviors Look for development of new behaviors. The plan starts at home Motion sickness Maripotant Sedation can help with motion sickness in cats Gabapentin 50 mg to 100 mg per cat Warn owner of sleepiness and ataxia 289

13–15 NOVEMBER, 2021 Give one dose the night before and one the morning of travel 0197 Sedation for dogs Trazodone 2-3 mg per kg EFFECTS OF PAIN ON THE HEALTH, EMOTIONAL Gabapentin 5-10 mg kg WELLBEING & QUALITY-OF-LIFE IN DOGS AND The plan continues at the hospital CATS Treatment of pain: How long do we treat? M. Petty Orthopedic, maybe weeks Soft tissue, maybe days Canton/United States of America We want to avoid the development of persistent post operative pain Remember to assess, then treat, then re-assess Qualifications: Fear:Fear and stress makes pain worse. Fear and stress makes it difficult Michael C Petty to give nursing care Look at your clinic through your patient’s eyes: DVM, certified in acupuncture, rehabilitation and pain management What do they see that might scare them? What do they hear that might scare them? [email protected] Social Isolation There are people in the world that are born with the inability to feel pain. Keep animals from the same family together One woman in particular has never felt pain and has never felt fear or Take the time to comfort animals anxiety in her life. This lecture explores this relationship between pain Nursing Care: Give your staff the time to watch over animals in your care perception and emotional response, all controlled within the limbic system Assess for pain and anxiety of the brain. Additionally we take a look at how pain interferes with basic Assess what might be in their surroundings that might be bothering them bodily functions, which can have a negative impact on the health of the Certain techniques can make them more comfortable for procedures patient in pain. And finally, we will learn about a validated online tool for Towel technique for cats the evaluation of quality-of-life in our patients. Flooring that is easy to walk on Music Effects of pain on fear and anxiety Jo Cameron is a Scot who was born Cages with the inability to feel painIn her life, among other things she experi- They need cages to be able to stretch out and exhibit normal behavior enced: Cats need a space away from their litter box Cats like to have a space to hide A broken arm Positioning for surgery Enough people to move large animals Child birth Tables that are large enough Heat and padding Losing her front teeth after falling on concrete Surgical restraint – often they are tied into uncomfortable positions Make sure they eat Burns she could not feel until she smelled burning flesh Treat nausea as needed Going home:The decision for “when” to send them home can be difficult Cuts How much pain medication do they need? Is it an injectable like buprenorphine or tramadol that must be given in the Etc. hospital? Is it an oral NSAID that can be given at home? None of the above things hurt She described liking to weed stinging nettles because of the pleasant tingling feeling on her hands and arms Jo Cameron has never felt anxiety Jo Cameron has never felt fear Could all fear and anxiety stem from knowing the experience of pain? Pain Behaviors Diagnosing and monitoring of pain is commonly done by looking at chang- es in behavior This look at behavior is best done by metrics that look at pain Chronic pain surveys for dogs or catsDogs Canine Brief Pain Inventory Cincinnati Orthopedic Disability Index Liverpool Osteoarthritis in Dogs Helsinki Chronic Pain Index Cats Feline Musculoskeletal Pain Index All rely in part or in whole on changes in behavior to measure pain 290 WSAVA GLOBAL COMMUNITY CONGRESS

Behavioral Changes ExamplesCats Learned fear Reluctance to play Anxiety House soiling Depression Reluctance to groom Has emerged as an important brain center for the emotional-affective Reluctance to climb stairs dimension of pain and for pain modulation Using furniture to jump up or down from a height Painful stimuli to the limbic system activates the Amygdala Dogs This in turn affects the medial prefrontal cortex causing cortical deactiva- Reluctance to play tion and cognitive deficits House soiling Effects on HealthMobilityGrooming Reluctance to climb stairs or into vehicles Increased dermatologic disorders, which may be a new source of pain Reluctance to walk on slippery or uneven surfaces Especially true in cats Cognitive changes Elimination Besides behavioral changes we need to look at emotional and cognitive Posturing to eliminate becomes difficult changes It is common in practice to see dogs with both cognitive and Constipation chronic pain issues. How many of those cognitive issues are happening Incomplete bladder emptying leading to UTI because of the pain? This is a known issue in human medicine. Are we Decrease in Exercise toleranceDecrease in muscle mass missing something? Joint support is lost Emotional changes associated with the pain of OA Strength is lost Irritability Mobility is further affected Aggression: Other animals, People Increase in weight Whimpering Added load on joints Decreased Social Interaction Inflammatory mediatiors Attention seeking Physiologic effects Emotional changes secondary to the pain of inflammatory bowel disease Not as well studied are the following: Restlessness Impact on organ systems Irritability Cardiac Night walking Renal Confusion Respiratory Loss of interest in food Immune system Vocalizing Effects on Quality of Life and the measurement of chronic pain through its Emotional changes secondary to CNS and PNS pain states impact on health-related quality of life in companion animals Self-mutilation Pain: Its not just about how it feels, it’s about how it makes you feel Vocalization Link between chronic pain and QOLIn humans with chronic pain they Decreased Activity report Decreased appetite Most aspects of their life affected Aggression Loss of enjoyment of life Emotional changes secondary to dermatologic conditions Poor emotional well-being Irritability Fatigue Self-mutilation Weakness Increased sensitivity Sleep issues Aggression Health-related Quality of life (HRQL) is concerned with those aspects of The limbic systemAmygdalaKey role in emotional responses and affective QOL that change as a result of ill health and medical interventionsThere states and disorders are many HRQL scales out there 291

13–15 NOVEMBER, 2021 Not all are equal 0198 Not all have science behind them HOW I TREAT FRACTURES IN YOUNG PUPPIES (< 5 MONTHS OF AGE) Check the literature R. Palmer Key properties of HRQL Fort Collins/United States of America Validity: measure what it is supposed to Qualifications: Ross H. Palmer, DVM, MS, DACVS Reliability: repeatable results Professor, Orthopedics Colorado State University Responsiveness: Ability to measure a clinically significant change Fort Collins, Colorado USA Vetmetrica has a dog and cat instrument delivered to the owner online Abstract Body: Bone in immature animals is biomechanically, anatomical- and completed in about 5 minutes ly, and physiologically distinct from mature bone. Failure to recognize the unique features of immature bone when treating fractures increases the Dog: 22 simple behavior questions for the dog owner risk of complications that may cause years of patient morbidity. Mature bone’s inorganic mineral content accounts for 65 to 70% of its dry weight Cat : 20 simple behavior questions for the cat owner and gives bone its solid consistency and rigidity. The organic extracellular matrix, composed primarily of collagen, gives bone its flexibility and Can be used to not only measure quality of life but to monitor therapeutic resiliency. The mineral content of bone rapidly increases during skeletal efficacy growth such that its stiffness increases up to 20-fold in the first 6 months. Compared to mature bone, immature bone is more ductile, absorbs more Humane endpoints for end of life decision making energy, and tolerates more strain and elastic deformation prior to fracture. Accordingly, incomplete “greenstick” fractures and bent (plastically https://www.vetmetrica.com/ deformed) bones are almost exclusively seen in growing dogs. The brittle nature of adult bone causes it to fracture with little plastic deformation References/Suggested Reading such that anatomic reconstruction of bony segments is feasible when indicated. The more ductile nature of immature bone, however, can Treatment and Care of the Geriatric Veterinary Patient, Ed: Gardner, M. plastically deform quite significantly prior to fracture. Additionally, the soft McVety, D. Wiley Blackwell 2017 nature of immature bone makes implants more prone to premature loosening, especially when the fixation is comparatively stiff. Understanding Fibromyalgia and its related disorders Prim Car Companion J Clin Psychiatry 2008 Fractures in the growing dog often occur in the region of the physis. Unfortunately, rather than occurring in the hypertrophic zone as is typical Beal BS. Orthopedic problems in Geriatric dogs and cats Vet Clin NA 2005 in humans, naturally occurring physeal fractures in the canine often occur in the proliferative zone.1 This may account for the relatively high risk of Epstein, M. Kuehn, NF Senior care Guidelines Task Force for dogs and physeal dysfunction following injury in dogs. The effect of gonadectomy cats. AAHA on physeal function should also be considered. Gonadectomy delays normal physeal closure and the earlier gonadectomy is performed, the Handb Exp Pharmacol 2015;227: 261-84 more prolonged is the delay.2 Melzack R and Katz J (1992) in Handbook of Pain Assessment (Eds Turk The periosteum of growing dogs and cats is relatively thick and vascular DC and Melzack) and contributes dramatically to appositional bone growth and the rapid development of callus fracture healing. However, excessive emphasis on Turk DC, Dworkin RH, Revicki D, Harding G, Burke LB, Cella D, Cleeland the fracture healing potential of growing dogs often distracts veterinary CS, Cowan P, Farrar JT, Hertz S, Max MB. Identifying important outcome attention from the goal of rapid restoration of normal limb function. domains for chronic pain clinical trials: an IMMPACT survey of people with pain. PAIN®. 2008 Jul 15;137(2):276-85. Several general treatment strategies are applicable to growing puppies: Focus upon rapid, full restoration of limb function in treatment selection Cook, J. L. (2014). Veterinary Surgery, 43(3), 229–231 rather than on fracture healing. Be cautious with coaptation that alters normal limb contours / usage and Wiseman-Orr ML, Nolan AM, Reid J, Scott EM. Development of a ques- minimize its duration. Altered limb usage may lead to abnormal bone tionnaire to measure the effects of chronic pain on health-related quality shaping due to abnormal biomechanical forces applied to the soft of life in dogs. American journal of veterinary research. 2004 Aug collagen-rich bone (example: a puppy with a tibial fracture coapted in 1;65(8):1077-84. stifle extension may develop patellar luxation due poor femoral sulcus formation due to reduced retropatellar pressure) Noble CE, Wiseman-Orr LM, Scott ME, Nolan AM, Reid J. Development, Healing time in weeks is usually less than the puppies age in months (i.e., initial validation and reliability testing of a web-based, generic feline a 2- month old puppy would be expected to heal in 2 weeks or less) health-related quality-of-life instrument. Journal of feline medicine and Frequent convalescent recheck examinations with attentive observation of surgery. 2019 Feb;21(2):84-94 limb use and joint mobility and function. Do not span physes with implants that prevent longitudinal bone growth Reid J, Wright A, Gober M, Nolan AM, Noble C, Scott EM. Measuring chron- (including cross-pin fixation).3 ic pain in osteoarthritic dogs treated long-term with carprofen, through its Pins spanning a physis should be non-threaded, relatively perpendicular to impact on health-related quality of life (HRQL). Vet Comp Orthop Trauma- tol. 2018; 31(S 01): A1-A6.. 292 WSAVA GLOBAL COMMUNITY CONGRESS

the physis, and of as small a diameter as possible to achieve proper patellar luxation. Elastic plate or external skeletal fixation may be stability. When these principles are achieved, pin removal following advantageous in many cases. healing is debated as bony bridging forming in the transphyseal void may result in disturbed physeal growth (especially for pin diameters > 3mm).3 1. Johnson JM, Johnson AL, Eurell JA. Histological appearance of Plate fixation should relatively elastic by using smaller, thinner plates that naturally occurring canine physeal fractures. Vet Surg 1994;23:81-86. span from metaphysis to metaphysis and clustering fixation screws at the 2. Salmeri KR, Bloomberg MS, Scruggs SL, et al. Gonadectomy in proximal and distal ends of the plate.4,5 immature dogs: effects on skeletal, physical, and behavioral development. J Am Vet Med Assoc 1991;198:1193-1203. Femoral fractures in growing dogs and cats often occur at the physes, but 3. Campbell CJ, et al. The effects produced in the cartilagenous epiphyse- also occur in the diaphysis. Slipped capital femoral epiphysis (SCFE) al plate of immature dogs by experimental surgical trauma. J Bone Joint occurs in both dogs and cats. In cats, this condition often develops in Surg 1959;41-A;1221-1242. overweight, neutered males between 1.5 and 2.5 years of age despite the 4. Cabassu JP. Elastic plate osteosynthesis of femoral shaft fractures in lack of a traumatic incident and is theorized to be the result of chronic young dogs. Vet Compar Orthop Traumatol 2001;14:40-45. mechanical overload of the physis that is delayed on closure because of 5. Sarrau S, Meige F, Autefage A. Treatment of femoral and tibial fractures early gonadectomy.6 This condition may involve one or both hips. If only in puppies by elastic plate osteosynthesis: a review of 17 cases. Vet one hip is involved, the contralateral hip should be closely evaluated on Comp Orthop Traumatol 2007;20:51-58. radiographs and the pet owner informed that delayed development of the 6. McNicholas WT, Jr., Wilkens BE, Blevins WE, et al. Spontaneous femoral condition in the contralateral hip is not uncommon. In cats, SCFE can be capital physeal fractures in adult cats: 26 cases (1996-2001). J Am Vet effectively treated with internal fixation or femoral head/neck excision. In Med Assoc 2002;221:1731-1736. dogs, SCFE is most commonly the result of trauma, but nontraumatic 7. Moores AP, Owen MR, Fews D, et al. Slipped capital femoral epiphysis in cases have been identified.7 The risk of coxofemoral osteoarthritis is dogs. J Small Anim Pract 2004;45:602-608. increased when SCFE develops in dogs < 4 months of age because 8. Belkoff SM, Millis DL, Probst CW. Biomechanical comparison of three physeal closure results in a shortened femoral neck. Normal femoral neck internal fixations for treatment of slipped capital femoral epiphysis in length and limb use are important in the normal development of the immature dogs. Am J Vet Res 1992;53:2136-2140. coxofemoral joint. Fixation of SCFE with multiple Kirschner wires is more 9. Belkoff SM, Millis DL, Probst CW. Biomechanical comparison of 1-screw stable than a single wire.8 Fixation with a lag screw is even more stable, and 2-divergent pin internal fixations for treatment of slipped capital but should be avoided if preservation of physeal growth is desired.9 Distal femoral epiphysis, using specimens obtained from immature dogs. Am J femoral physeal fractures are common in dogs and cats. Cats often Vet Res 1993;54:1770-1773. develop Salter-Harris I fractures and dogs most commonly have Salt- 10. Sukhiani HR, Holmberg DL. Ex vivo biomechanical comparison of pin er-Harris II fractures. Internal fixation of these fractures is easily per- fixation techniques for canine distal femoral physeal fractures. Vet Surg formed with cross-pinning or dynamic pinning techniques. Cross-pinning 1997;26:398-407. provides superior to resistance to rotational forces, but either fixation provides adequate stability.10 A single intramedullary pin can be used if the interdigitation of the unique “four pegs in four cups” contour of the distal femoral physis provides adequate rotational stability. Femoral diaphyseal fractures often involve the distal half of the bone. While the prognosis for fracture union is excellent in properly treated fractures, the risk of quadriceps contracture should be assessed. Risk factors for quadriceps contracture include distal femoral fracture, extensive comminution or soft tissue injury, unstable fracture fixation, reduced stifle flexion upon fracture reduction/alignment, surgical stabilization combined with external coaptation. When there is increased risk of quadriceps contracture, a 90º/90º flexion sling should be used during the first 48-72 hours after surgery followed by passive/active physical therapy each day for the first 3-4 weeks after surgery. Attentive convalescent care should include recheck examinations every 2-3 days during the first two weeks following surgery. Tibial fractures are relatively common in growing dogs and may occur at the physes or within the diaphysis. The tibial tubercle develops from a separate ossification center from the proximal tibial epiphysis. Avulsion fracture of the tibial tubercle may occur as an isolated injury or in combination with Salter-Harris I or II fractures of the proximal tibial physis. Tibial tubercle fractures may be treated with Kirschner wires or tension band fixation, though the latter is more likely to permanently close the physis. Salter-Harris fractures of the proximal tibial physis are often treated with multiple Kirschner wires. Radiographs are often made in 2-week intervals and implants are removed, if feasible, at the earliest sign of fracture union. Greenstick (incomplete) and minimally displaced fractures of the tibial diaphysis are relatively common in growing dogs. While coaptation is frequently effective in achieving bony union of such fractures, maintaining the stifle in some flexion, encouraging slow, controlled limb use and keeping the duration of coaptation to a minimum helps maintain retropatellar pressure and avoid the complication of 293

13–15 NOVEMBER, 2021 0199 0200 HOW I TREAT MY CLIENTS ON SOCIAL MEDIA HOW I PERFORM FULL THICKNESS GI BIOPSIES J. Kirpensteijn K. Thieman Topeka/United States of America College Station/United States of America Qualifications: Dr. Jolle Kirpensteijn DVM PhD Qualifications: Diplomate ACVS & ECVS Chief Veterinary Officer Hill’s US Kelley Thieman [email protected] How you can be the next veterinary social media star on whatever plat- DVM, MS, Diplomate ACVS (Small Animal) form you choose [email protected] Full thickness intestinal biopsies are performed with some frequency in small animal surgery. Although this is a common procedure, it can be technically difficult. Pitfalls of the procedure and tips for success will be discussed. Objectives: Know technique for biopsy of the intestine Know appropriate suture patterns for intestinal biopsy site closure Know the importance of gentle tissue handling Preparation Patient preparation: Prior to determining that full thickness biopsies are necessary, a full GI work up is performed. Depending on the clinical signs, this likely includes bloodwork and abdominal imaging including radiographs and ultrasound. The results and clinical signs of the patient are used to determine which organs must be biopsied. Commonly, the small intestines (duodenum, jejunum and ileum) are biopsied. The liver and stomach may also need to be biopsied, as well as bile sampling. Once the patient has been deemed a surgical patient (following an appro- priate work up – not detailed here), it should be prepared for an abdominal exploratory. The shave of the patient should extend several centimeters cranial to the xiphoid to several centimeters caudal to the brim of the pu- bis. This includes the caudal thorax and inguinal area. The skin is shaved lateral to the nipples. The skin is then prepared – prepping the entire shaved area and allowing adequate contact time. The entire prepared area should be draped with quarter drapes (drapes placed just cranial to the xiphoid and just caudal to the pubis). Most com- monly, the incision is made on the ventral abdomen and through the linea alba. Other incisional options for performing GI biopsies are discussed below. The abdomen is entered and the surgeon verifies there are no adhesions to the ventral midline before extending the incision. The edges of the incision are protected using moistened lap sponges. Abdominal self-retaining retractors are placed (ie. Balfour retractors). Visualization of the cranial abdomen is facilitated by removal of the falciform fat. An abdominal exploration is performed. Intestinal biopsy: Intestinal biopsy is performed similarly regardless of the section of intes- tine. The duodenum, jejunum, and ileum should each be biopsied. Multiple samples of jejunum are likely to be required. If abnormalities are detected during the abdominal exploration, the abnormal section is biopsied (or resected). Resection and anastomosis (R&A) is indicated for removal of ischemic, necrotic, neoplastic, granulomatous, stenotic, or occasionally ulcerated / traumatized segments of intestine. The segment of intestine to be biopsied should be isolated and packed 294 WSAVA GLOBAL COMMUNITY CONGRESS

off with moistened laparotomy sponges. My preference is to identify the 0201 site to be biopsied. I take a 4-0 PDS on an RB-1 needle and take a full thickness bite of intestine at the antimesenteric border perpendicular to HOW I PERFORM CYSTOTOMY/ the long axis of the intestines. The bite is approximately 3 mm of tissue. I UROHYDROPULSION FOR A URETHRAL STONE place this suture as a stay suture. This suture should be manipulated gen- tly as it will be your biopsy sample. I apply gentle upward traction on the K. Thieman stay suture. With a new blade (11 blade or 15 blade) I make an incision on each side of the stay suture angling toward each other. The incisions each College Station/United States of America must penetrate the lumen and connect with each other to remove a small segment of intestine. A slight sawing motion is sometimes necessary. Qualifications: Be careful with your incisions – you wish to keep your biopsy to approxi- mately 25% or less of the intestine, although larger biopsy samples do not Kelley Thieman seem to cause a problem. DVM, MS, Diplomate ACVS (Small Animal) Suturing: [email protected] The incision is sutured together using an appositional suture pattern. Key Points: Slowly absorbable monofilament suture in 4-0 or 3-0 size is appropriate. A small taper point needle (such as RB-1) is often useful. Commonly used · Urohydropulsion should be used to dislodge stones in the urethra suture patterns are simple interrupted, simple continuous or modified Gambee. Regardless of the suture technique, it is imperative that the · Be sure to empty the bladder / monitor the bladder to prevent rupture tissues be handled gently and that each suture bite engages the submu- during the urohydropulsion cosa. Bites are taken to include approximately 3mm of submucosa back from the cut border and spaced approximately 3mm apart. Keep in mind Urinary stones are a common problem in dogs. Urethral obstruction can that the intestinal mucosa will evert, billowing out of the intestinal inci- occur when small stones move down the urethra. This is more common in sion. This mucosa can be encouraged back into the lumen with suturing male dogs but can occur in either males or females. techniques (modified Gambee), encouraging it back in with a mosquito or cotton tipped applicator, or it can be excised. When suturing the incision, Urohydropulsion / Retrohydropulsion suturing commences just past the incision when using a continuous suture pattern or at the start of the incision when using an interrupted pat- Retrohydropulsion should be performed in dogs with urethral stones. The tern. I find placing a simple interrupted suture in the middle of the biopsy urethra of the lumen narrows at the base of the os penis and it is common site first is helpful. Then, I either finish closing by dividing each segment for stones to become lodged in this area. Prior to cystotomy, it is common with a new suture or place a simple continuous suture pattern. to relieve urinary obstruction and flush the stones back to the bladder so they can all be removed. Retrohydropulsion should be the mainstay Postoperative Care: in returning urethral stones to the bladder for removal. Urethrotomy is almost never utilized for removal of urethral stones (only in incredibly rare Following intestinal biopsy, the patient is fed small frequent amounts. instances). Eating is encouraged to promote healing of the enterocytes and to prevent ileus. Procedure (male dogs): The dog is commonly under general anesthesia (as appropriate based on the condition of the patient). The patient is prepped as is typical for urinary cathetherization. The tip of the penis is prepared with betadine solution or dilute chlorhexidine solution. A urinary catheter is introduced in the distal urethra. I usually start with a red rubber catheter that is undersized for the patient. Apply a large amount of sterile water based lubricant and attempt to slide the small catheter past the obstructing stone and evacuate the urinary bladder so you are starting with an empty bladder. Next, introduce a red rubber catheter of a size that is appropriate for the size of dog (fills the urethra). Try to continue advanc- ing the catheter proximally with gentle pressure. Occasionally, the stones will move easily back into the urinary bladder. If the catheter does not move into the urinary bladder, flush with a mixture of sterile water based lubricant, sterile saline, and lidocaine. I usually use a few milliliters of lidocaine but base it on the size of the dog – you can calculate their safe dose. You can flush vigorously with this solution trying to flush the stones back into the bladder. Pay attention to the volume of fluid that you are instilling and make sure that the bladder is not becoming over distended. Evacuate the bladder as needed. If the stone has not moved, distal to the obstruction and sterile saline is instilled under pressure. High intraluminal urethral pressure is created by occluding the distal end of the penis (around the catheter) and having an assistant digitally occlude the urethra per rectum over the pubic symphysis. When high pressure is sensed by the assistant’s finger, digital pressure is released. The flushing of saline continues as the assistant releases pressure from the more proximal urethra. This causes the pressurized saline and the stones in the urethra to flow rapidly into the bladder. ****Always check the size of the bladder prior to retropulsing stones, as the addition of fluid to the bladder may overextend the bladder to the point of rupture**** 295

13–15 NOVEMBER, 2021 Procedure (female dog): The procedure is similar when performed in a 0202 female dog. The procedure is more successful when the dog is under general anesthesia (as appropriate based on the condition of the patient). NEW OPTIONS FOR TREATMENT OF FIP In females, the length of the urethra can be palpated rectally. Digital manipulation of the stone is useful in female dogs. While the dog is J. Dear sedated or anesthetized, a rectal examination is performed. The stones are palpated in the urethra and gently digitally manipulated cranially. A Davis/United States of America urinary catheter can be passed to help push the stones into the bladder as described above. Qualifications: Following retrohydropulsion, the stones can be removed by cystotomy. Jonathan D. Dear, DVM, MAS, DACVIM (SAIM) In the unstable dog (hyperkalemia, severe azotemia, etc), this procedure should be delayed and an indwelling urinary catheter left in place until the Associate Professor of Clinical Internal Medicine patient is stable (often 24-48 hours). [email protected] Cystotomy is the most common urinary surgery performed in dogs. It is most commonly performed to remove cystic calculi. Other indications are NEW OPTIONS FOR TREATMENT OF FIP to remove or biopsy masses, remove congenital abnormalities (urachal diverticulum), or repair ureteral ectopia. Most cystotomies for stone Despite the incidence of feline infectious peritonitis (FIP), until recently removal are done near the apex of the bladder on the ventral surface of there have existed no effective vaccines or treatment for cats afflicted by the bladder. Cystotomy incisions heal quickly and with minimal adhesions this fatal disease. The last decades, however, has given rise to encourag- regardless of the site. ing developments in antiviral treatment options for infected cats. Before making the cystotomy incision, place one stay suture to immobilize Coronaviruses are single-stranded, enveloped RNA viruses that infect a the bladder. This should be placed at the apex of the bladder. Placing two wide range of mammals. The now infamous spike protein is critical to more stay sutures – one on either side of the proposed incision, can facil- allowing viral invasion as it is the primary binding receptor and determines itate inspection of the inside of the bladder. Make a stab incision and use the host and cell specificity of the virus. Following fusion of the viral en- a suction tip (Poole) to remove the urine within the bladder. Stones should velope with the host cell membrane, viral RNA acts as mRNA to initiate a be removed and submitted for analysis and possibly culture. cascade of events that result in RNA-dependent RNA polymerase allowing viral RNA to serve as the template that is used both in viral genome repli- Suture Material cation and translation into viral proteins.1 It is best to keep the suture material out of the lumen. Exposure of the Feline infectious peritonitis is caused by the virulent feline enteric coro- suture to the bladder lumen can result in stone formation on the sutures. navirus (FECV), an alphacoronavirus. Wild type or avirulent FECV primarily This makes non-absorbable suture a poor choice for the urinary bladder. targets intestinal epithelial cells and generally results in mild, self-limiting, Absorbable suture material is a better choice in case the bladder lumen or clinically inapparent diarrhea. Mutations to FECV result in a shift in host is penetrated. Polyglycolic acid loses its tensile strength more quickly in cell tropism to allow dissemination via macrophages. Spontaneous muta- urine and should be avoided in the bladder. Poliglecaprone 25, polydiox- tions in the gene encoding the spike protein are thought to play the main anone and polyglyconate are better choices. In general, a monofilament role in facilitating the change in tropism. Virulent FECV is often referred to absorbable suture is a good choice for the urinary bladder. as feline infectious peritonitis virus (FIPV), though it’s the same virus with single or multiple single point mutations. Fortunately, when FIPV gains Suture Pattern its ability to infect macrophages, it loses its ability to infect epithelial cells and, thus, is not shed in the feces, making natural transmission of Simple interrupted and simple continuous suture patterns are used in the FIP from cat to cat impossible. FECV is highly transmissible, however, urinary bladder. and long periods of shedding from subclinical carriers increases disease The urinary bladder is elastic and continuous patterns are performed by prevalence in cat populations, increasing the risk of de novo mutation many surgeons because it can be performed quickly and can provide a wa- which might result in FIP. ter tight seal. A one-layer closure with an appositional pattern (including the submucosa) has been shown to provide adequate closure. A two-layer Following the SARS and MERS epidemics, drug discovery targeting coro- closure with inverting pattern will decrease the bladder lumen size more naviruses was pursued and led to the development of both protease inhibi- than a one-layer closure. tors and nucleoside analogues. Protease inhibitors inhibit viral replication by interfering with the virus’ ability to process polyproteins into functional viral proteins. Nucleoside analogues result in premature termination of RNA transcription. GC376 is a 3C-like protease inhibitor that was shown to have remarkable effects in reversing the course of experimental FIP infection in 6 of 8 cats.2 Unfortunately, this drug was found to be less ef- fective in cats with naturally occurring disease with many cats developing recurrence or progression of disease following cessation of treatment.3 Following these trials, work continued to identify a treatment that con- veyed a long-lasting cure for FIP. GS-441524, a nucleoside analogue, was found to be an effective treatment of experimentally and naturally infected cats with FIP.4-6This drug is structurally related to Remdesivir (GS-5734), the commercially available treatment for COVID-19. Remdesivir was selected over GS-441524 based on its increased potency and its ability to avoid viral resistance.7 In the initial clinical trial of cats naturally infected with FIP, GS-441524 effectively cured 25 of 26 cats who completed treatment cycles. This 296 WSAVA GLOBAL COMMUNITY CONGRESS

study found that cats with CNS disease related to FIP were more likely to 0203 relapse on the initial (2 mg/kg SQ q24) dose. A subsequent study using higher dose therapy (5-10 mg/kg SQ q24) led to resolution of disease in 3 GASTRIC DILATION VOLVULUS of 4 cats with neurologic or ophthalmic manifestations of FIP.6 E. Monnet An oral nucleoside analogue, Mutian X, produced by a Chinese phar- maceutical firm, has been shown to reduce FECV shedding but no peer Fort Collins/United States of America reviewed clinical trials have evaluated its use in cats with FIP.8 A preprint available online describes its use in cats with effusive FIP and a single Qualifications: case report discusses its use along with feline interferon-omega for a cat with uveitis associated with FIP.9,10 Eric Monnet, Despite the evidence of clinical cure in these cats, there remain no DVM, PhD, FAHA commercially available products licensed for the treatment of FIP in the US. Gilead, the patent holder for both remdesivir and GS-441524, despite Diplomate ACVS and ECVS being a collaborator in these research studies, has not pursued approval for use in cats and will not relinquish its rights to the drug. Anivive, a Colorado State University, Fort Collins, Colorado veterinary therapeutics company acquired the rights to GC376 and is currently pursuing approval for its use in cats with FIP and humans with [email protected] COVID-19. Hopefully GC376 doesn’t find the same fate as GS-441524. Gastric dilatation volvulus syndrome is an acute medical and surgical con- dition due to several pathophysiological effects occurring secondary to References gastric distention and mal-positioning. It occurs most commonly in large, deep chested dogs. Large and giant breed dogs appear to have a 7% risk 1. Haake C, Cook S, Pusterla N, et al. Coronavirus Infections in Companion of death from GDV throughout their lifetime. Great Danes, however, have a Animals: Virology, Epidemiology, Clinical and Pathologic Features. Viruses 42.4% chance of developing GDV, and a 12.6% chance of dying from GDV 2020;12. in their lifetimes. 2. Kim Y, Liu H, Galasiti Kankanamalage AC, et al. Reversal of the Progres- As gastric dilatation progresses, the normal means of relief, such as eruc- sion of Fatal Coronavirus Infection in Cats by a Broad-Spectrum Coronavi- tation, vomiting, or pyloric emptying fail to occur. Pyloric function seems rus Protease Inhibitor. PLoS Pathog 2016;12:e1005531. to be normal in dog treated for gastric dilatation volvulus. Acute gastric dilatation volvulus has been recognized for many years in dogs however 3. Pedersen NC, Kim Y, Liu H, et al. Efficacy of a 3C-like protease inhibitor its exact cause is still not clearly understood in dogs. Only risk factors in treating various forms of acquired feline infectious peritonitis. Journal have been identified. Diet, the amount of food ingested, the frequency of of feline medicine and surgery 2018;20:378-392. feeding, behavior, exercise and stress after a meal are contributing factors for the development of gastric dilatation-volvulus. Large breed dogs , dogs 4. Murphy BG, Perron M, Murakami E, et al. The nucleoside analog GS- with large thoracic depth-to-width ratio, dogs with history of GI disease, 441524 strongly inhibits feline infectious peritonitis (FIP) virus in tissue dogs with family history of GDV, underweight dogs, and older animals are culture and experimental cat infection studies. Veterinary microbiology at higher risk to develop a gastric dilatation-volvulus. 2018;219:226-233. The pyloric antrum rotates in a clockwise fashion and the pyloric ends up 5. Pedersen NC, Perron M, Bannasch M, et al. Efficacy and safety of the in the dorsal part of the abdominal cavity on the left side. The displace- nucleoside analog GS-441524 for treatment of cats with naturally occur- ment of the spleen may vary from the degree of volvulus. The spleen is ring feline infectious peritonitis. Journal of feline medicine and surgery usually engorged or can undergo torsion on its own pedicle. Thrombosis 2019;21:271-281. of the splenic artery can also occur. Most commonly 1800 degree of rotation is seen but 3600 rotation is possible. 6. Dickinson PJ, Bannasch M, Thomasy SM, et al. Antiviral treatment using the adenosine nucleoside analogue GS-441524 in cats with clinically Gastric dilatation causes hypovolemic shock followed by a septic shock if diagnosed neurological feline infectious peritonitis. Journal of veterinary not treated quickly internal medicine / American College of Veterinary Internal Medicine 2020;34:1587-1593. CLINICAL SIGNS 7. Agostini ML, Andres EL, Sims AC, et al. Coronavirus Susceptibility to the Dogs with gastric dilatation-volvulus are presented with progressive dis- Antiviral Remdesivir (GS-5734) Is Mediated by the Viral Polymerase and tension and tympanic cranial abdomen. They are restlessness, retching, the Proofreading Exoribonuclease. mBio 2018;9. and hyper salivating. 8. Addie DD, Curran S, Bellini F, et al. Oral Mutian(R)X stopped faecal Dogs with a gastric dilatation-volvulus are presented with a weak femoral feline coronavirus shedding by naturally infected cats. Res Vet Sci pulse, increased heart rate, pale mucous membrane, decreased capillary 2020;130:222-229. refill time, and tachypnea. Dogs present clinical signs similar to hypovole- mic shock because their venous return is limited by the stomach dilation. 9. Addie DD, Covell-Ritchie J, Jarrett O, et al. Rapid Resolution of Non-Effu- If decompression is not performed rapidly they can develop septic shock sive Feline Infectious Peritonitis Uveitis with an Oral Adenosine Nucleo- during to congestion and ischemia of the gastrointestinal tract. side Analogue and Feline Interferon Omega. Viruses 2020;12. DIAGNOSIS 10. Katayama M, Uemura Y. Pharmacological Therapy of 141 Client-Owned Cats with Feline Infectious Peritonitis with Mutian ® Xraphconn Ade- Very often the diagnosis is made from the history, the signalment, and the nosine Nucleoside Analogue and Prognostic Prediction of Their Clinical physical examination. Radiographic evaluation is rarely required for the Outcomes. In: 2021. diagnosis of gastric dilatation-volvulus. Dogs are usually presented for unproductive vomiting, retching and hyper- salivation. The abdomen is distended and as the severity increases the 297

13–15 NOVEMBER, 2021 animal can become weak, lateral recumbent with tachypnea. an ultrasound probe to make sure the spleen is not between the stomach wall and right abdominal wall. Signalment Cardiac rhythm needs to be evaluated before surgery. Supraventricular Gastric dilatation-volvulus is most commonly seen in large and giant tachycardia and ventricular tachycardia are the most common arrhythmias breed dogs. It also can be seen in small dogs and cats. Dogs from 10 associated with a gastric dilatation-volvulus. Atrial fibrillation has been month to 14 years old have been diagnosed with gastric dilatation-volvu- reported in some dogs with GDV without cardiomyopathy. lus. Surgical intervention is required after medical stabilization of the patient. Physical examination Surgical intervention is recommended as soon as possible. Delayed surgery increased the potential for gastric wall edema and necrosis, and On physical examination is classic to find a large distended abdomen. On venous stasis. It has also been shown that dogs with more than 5 or 6 percussion, a tympanic sound is produced. Abdominal palpation could hours of clinical signs related to GDV have a poor prognosis. be uncomfortable. Animals hypersalivate and are retching. Very often the dogs are showing pain on abdominal palpation. SURGICAL TREATMENT First, the animals are presented with clinical signs similar to hypovolemic The purpose of the surgery is to derotate the stomach, evaluate the stom- shock because most of their blood volume is restricted in the caudal vena ach wall and the spleen for ischemic injury, and perform a gastropexy. cava and the portal vein. Therefore, the animals are going to be tachycar- Gastropexy decreases the chances of recurrence from 80% to 5%. Dogs dic and tachypnic with a normal femoral pulse, a slow capillary refill time, after a gastropexy can still dilate but not rotate their stomach. pale mucous membrane, and cold extremities. With progression of the syndrome, the patients are going to go in septic shock with tachycardia, The dogs are placed on dorsal recumbency and a midline celiotomy is tachypnea, weak femoral pulse, injected mucous membrane, fever, slow performed. The surgeon stays on the right side of the dog. Upon opening capillary refill time. Finally the patients are going to decompensate with the abdominal cavity, the omentum is covering the stomach which con- severe hypotension, bradychardia, hypothermia, white mucous membranes firmed the diagnosis of gastric dilatation-volvulus. The stomach can be and cold extremities. decompressed again before derotation with a large orogastric tube. After identification of the pylorus and the fundus with a clockwise rotation, The severity of the presentation is indicator of survival for the patients. the pylorus is grasped with the right hand and pulled ventrally toward the Dogs that are presented bright and alert have better prognosis than dogs abdominal incision while the left hand pushed the fundus dorsally into that lateral recumbent. the abdominal cavity. The spleen follows the motion of the stomach. If a splenic torsion is present a splenectomy is performed without untwisting Blood work the vascular pedicle. Lactate level needs to be evaluated too. Since dogs with GDV are in some After derotation, the stomach and spleen are evaluated for ischemic degree of shock, very often they are presented with an elevated lactate injuries. Usually, the spleen shows signs of venous congestion that resorb level. It is important to evaluate the level of lactate at the time of presen- quickly after derotation of the stomach. Splenectomy is indicated if throm- tation and after initiation of fluid-therapy. Response to medical treatment bosis of the splenic artery is present. Evaluation of gastric wall perfusion is an important prognosis indicator. If the lactate level decreased by 50% is difficult. Approximately 10% of dogs have a devitalized gastric wall after initiation of medical treatment the prognosis is better. requiring gastrectomy. Gastrectomy is required to resect the necrotic stomach wall. Two options are available: gastrectomy with either tradition- Radiographs al suture technique or stapling suture. Radiographs help to differentiate between gastric dilation, gastric dilation The stomach is packed off from the abdominal cavity with multiple moist- volvulus syndrome ,and mesenteric volvulus. Since the pylorus is dis- ened laparotomy sponges. The healthy stomach is retracted with stay su- placed on the left side of the abdominal cavity in a dorso-cranial position tures to prevent gastric spillage.gastrectomy can be performed with hand to the fundus, right lateral recumbency radiographs are required to be able sutures or stapling equipment. Hand suture technique was associated to have a double bubble image. Free gas is present in the abdomen when with a 60% mortality. The mortality rate with the autostapling equipment the stomach has ruptured. Also accumulation of gas within the wall of the is close to 10%. Stomach rupture at the time of surgery is associated with stomach is another sign of gastric wall necrosis. peritonitis. Placement of a close suction drain is recommended to help control the peritonitis. TREATMENT After gastrectomy, a gastropexy is required. A belt loop gastropexy, a Emergency treatment circumcostal gastropexy and an incisional gastropexy are the most com- monly performed with similar outcome. Emergency medical treatment of the hypovolemic shock and gastric decompression is required before surgical treatment for gastric dilatation POSTOPERATIVE COMPLICATIONS volvulus. Venous catheters of the largest size possible are placed in the cephalic or jugular vein to deliver 1/4 shock dose of intravenous fluid. Several complications can occur after surgical treatment of gastric The rate and volume of fluids administered can be adjusted according to dilatation-volvulus. They result from the pathophysiology of the gastric the assessment of several clinical parameters: heart rate, pulse, mucous dilatation-volvulus syndrome. Shock after surgery results usually from membrane, capillary refill time. Colloids at the dose of 4 ml/kg are recom- inappropriate treatment prior to surgery, surgical blood loss, anesthetic mended during hypovolemic shock treatment. Blood gas and electrolyte depression, and fluid sequestration due to ileus. Septic shock can result evaluations are required before acid-base and electrolyte imbalances from toxins and bacterial absorption from gastric mucosa necrosis and corrections are attempted. peritonitis. Gastric decompression is attempted first with an orogastric tube after Prognostic indicators are gastrectomy with splenectomy, hypotension, initiation of fluid therapy or with a large percutaneous catheter. Percutane- DIC, arrhythmias, and peritonitis. Gastrectomy alone is not a prognostic ous gastrocenthesis is performed on the right side. It is important to use indicator for survival, however it increases the risk of complications: peritonitis, arrhythmias, and hypotension. 298 WSAVA GLOBAL COMMUNITY CONGRESS

Ventricular premature contractions that require medical treatment and 0204 ventricular tachycardia at a rate faster than 140 beats per min, R on T, and multiform.Lidocaine will be used to control the arrhythmias. Sotalol will FELINE PNEUMONIA - AN UNDER DIAGNOSED then be administered for 2 weeks. DISEASE? J. Dear Davis/United States of America Qualifications: Jonathan D. Dear, DVM, MAS, DACVIM (SAIM) Associate Professor of Clinical Internal Medicine [email protected] FELINE PNEUMONIA – AN UNDER DIAGNOSED DISEASE? Pneumonia is defined as acute inflammation of the bronchioles and alveoli that results in injury to the gas exchange mechanism of the lungs. The etiopathogenesis can be classified by the organism responsible for the insult or by clinical features of the process (i.e., aspiration or foreign body related). Considering these two etiopathogenic categories can help narrow differential diagnoses during the clinical reasoning process. The first considers the microorganism responsible for the infection. Bacteria are the most common microorganisms that cause pneumonia. Howev- er, pneumonia can also be caused by fungi, viruses, protozoa, atypical bacteria and parasites. In addition to considering which microorganisms may be involved, it is also helpful to consider potential underlying causes for pneumonia. Beyond recurrent aspiration events or a foreign body that is a nidus for recrudescing infection, underlying immunosuppression and diseases that impair mucociliary clearance (e.g., bronchiectasis and ciliary dyskinesia) should be considered in cats with recurrent cough and pneumonia. Aspiration pneumonia is generally considered to be uncommon in cats, likely because of the propensity for laryngospasm in this species. Aspira- tion pneumonia is most common in cats with laryngeal and esophageal disease. Like AP, viral are also less commonly diagnosed in cats possibly due to less environmental exposure. That said, a review of cases seen at Davis revealed a host of cases of pneumonia in cats diagnosed at necrop- sy including 35 cats with idiopathic interstitial pneumonia, 25 cats with pneumonia due to FIP, 23 with lipid pneumonia, 6 with FHV-1 pneumonia and 5 with fungal disease. A comprehensive study of airway disease in cats published in 2004 found that 19 out of 80 cats undergoing bronchoscopy had a definitive diagno- ses of lower respiratory tract infections (LRTI).1 Meanwhile, a previous but larger study retrospectively evaluated necropsy findings from cats and kittens with lung lesions in Switzerland.2 In the kittens, viral pneumonias were confirmed in 4 kittens (2.5%) and suspected in 16 (10%). Viral pneu- monia was also suspected in 4 adult cats (4.6%). Bacterial pneumonia was diagnosed in 25 kittens (16%), suspected in 4 (2.5%) and diagnosed in 14 adult cats. Coinfections (diagnosed bacterial, suspected viral) were found in 16 kittens (10%) and 4 adult cats (4.6%). In 2019, a retrospective study of AP in cats was published. This study found risk factors for AP in cats were similar to dogs. Gastrointestinal dis- ease, recent anesthesia, neurologic and laryngeal disease were identified in all but 1 cat. Many cats had multiple identified risk factors. Radiograph- ically, these cats typically had cranioventral pulmonary infiltrates and 57% had multilobar disease.3 Eighty-nine percent of these cats survived to discharge and median duration of hospitalization was 3 days. Unfortu- nately, only 1 cat had airway sampling in this study, so information about the nature of inflammation and microbial cultures was limited. Finally, we recently completed a study recently completed at UC Davis was 299

13–15 NOVEMBER, 2021 published that set out to better define characteristics of cats with both with bronchopneumonia, aerobic bacterial cultures were positive in 25/26 AP and bronchopneumonia.4 Cats with inflammatory airway disease were (96%), anaerobic cultures were positive in 16/24 (67%) cats, and Myco- included as a control group.4 Cough was the most common presenting plasma cultures were positive in 11/26 (42 %). After Mycoplasma spp., sign (63/103 cats; 61%) and was significantly more common in cats with Pasteurella spp. (9/26; 34%) were isolated most commonly. bronchopneumonia or inflammatory airway disease compared to AP. Dura- tion of clinical signs was longer in cats with inflammatory airway disease Considering both types of pneumonia, aerobic gram-negative organisms (median 180 days) and bronchopneumonia (median 270 days) compared were cultured more often than aerobic gram-positive organisms. Pasteu- to cats with AP (median 12 days). Age did not differ among groups. rella multocida was the gram-negative bacterial species isolated most frequently, and Streptococcus spp. were the gram-positive organisms On physical examination, cats diagnosed with AP were significantly more isolated most frequently. likely to be hypothermic at presentation. Cats with AP also had significant- ly lower body weight and body condition score that both other groups. The Table 2 - Culture results from airway lavage or necropsy samples in cats presence of a risk factor for aspiration was an inclusion criterion for this diagnosed with aspiration pneumonia (AP) and bronchopneumonia (BP). diagnosis, and like the 2019 study, our findings were similar to what has Numbers in parentheses indicate the number of cats with a single bacteri- been reported in dogs. um cultured. Cats with bronchopneumonia had significantly higher neutrophil counts Aerobic culture AP BP than cats with inflammatory airway disease and cats with AP were signifi- Gram-positive n=9 n=26 cantly more likely to have a left shift than cats with inflammatory airway disease. Corynebacterium spp. 0 2 Enterococcus spp. 2 (1) 2 Radiographs were reviewed retrospectively using a previous schema Streptococcus spp. 1 7 (2) whereby the radiographic pattern was categorized as bronchial, alveolar Staphylococcus spp. 1 (1) 1 or interstitial and the severity of each pattern was scored on a scale of 0-3 resulting in a total score of 0-9 for each case. Table 1 – Radiograph scoring rubric used in masked, case-controlled, retrospective review. A total radiographic score was provided for each cat by adding the cumulative scores from each radiographic pattern. Alveolar Bronchial Interstitial Gram-negative Enterics 0 – absence of pattern 0 – absence of pattern 0 – absence of pattern E. coli 1 – mild (slight, localized 1 – mild (primary bronchi 1 – mild (mild interstitial Klebsiella pneumoniae 1 1 Non-enterics 1 0 alveolar pattern) visible) framework visible) Acinetobacter spp. Bordetella bronchiseptica 0 1 2 – moderate (moderate, 2 – moderate (secondary 2 – moderate (interstitial Myroides spp. 0 1 bilateral signs of alveolar bronchi visible) framework distinguishable Pasteurella spp. 1 (1) 1 pattern) from a bronchial pattern) Pseudomonas aeruginosa 2 8 (1) Unclassified non-enteric 1 2 (2) 3 – severe (clearly apparent 0 1 (1) Mycoplasma culture bilateral signs of alveolar 3 – severe (tertiary bronchi 3 – severe (clearly apparent Mycoplasma spp. n=8 n=26 0 11 (2) pattern or lobar consoli- visible) interstitial pattern) Anaerobic culture Actinomyces spp. n=9 n=24 dation) Peptostreptococcus spp. 1 (1) 2 Clostridium spp. 1 (1) 2 Total score = alveolar + bronchial + interstitial score 1 1 Diagnoses were classified as AP, bronchopneumonia, and inflammatory airway disease. Total radiographic score was significantly different be- tween cats with AP and those with inflammatory airway disease [median (range) scores: AP 4 (3-6), bronchopneumonia 4 (2-6), inflammatory airway disease 3 (1-4)]. Cats with inflammatory airway disease were more likely to have a diffuse radiographic pattern while cats with AP were more likely to have a multifocal distribution of disease. Cats diagnosed with AP were more likely to have an alveolar pattern compared to cats with inflammatory airway disease. Cats with bronchopneumonia had higher bronchial scores compared to cats with AP. Bronchiectasis was observed in all groups and prevalence did not differ between them. Septic inflammation was observed cytologically in 3/5 BAL samples from cats with AP and in 25/25 BAL samples from cats with bronchopneumo- nia. Positive aerobic culture results were obtained in 7/9 cats with AP and yielded mixed growth in three. Mycoplasmacultures were negative in 8/8 cats with AP. Anaerobic cultures were positive in 4/9 cats with AP. In cats 300 WSAVA GLOBAL COMMUNITY CONGRESS