Letters to the Editor

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CAABs lend helping hand

I want to thank JAVMA News for its recent story1 highlighting the importance of animal behavior in veterinary medicine and describing how collaboration with other professionals can be of benefit both to animals and to their owners.1 The American Animal Hospital Association behavior management guidelines list several possible collaborators but neglect to mention Certified Applied Animal Behaviorists (CAABs), who have been working with veterinarians for many years. The Animal Behavior Society (ABS) began developing criteria for a certification process in 1985 and began certifying individuals as CAABs in 1991. Fully certified CAABs are required to have received a PhD in a biological or behavioral science from an accredited college or university or completed a veterinary degree plus two years in a university-approved residency program in animal behavior. In addition, CAABs are required to document coursework pertaining to animal behavior; demonstrate work experience in applied animal behavior; submit case reports for review; present case studies, posters, or research-based papers at a specified number of annual ABS meetings; regularly comply with recertification procedures; and adhere to the ethical standards set forth by the ABS. Certified Applied Animal Behaviorists are frequently invited by local, regional, and national veterinary medical associations to present papers and continuing education programs. Veterinary practitioners should be aware of the existence of these well-qualified professionals and potential collaborators.2

Victoria L Voith, dvm, phd, dacvb

College of Veterinary Medicine Western University of Health Sciences Pomona, Calif

Reflecting on 100 years of JAVMA

I want to thank JAVMA News for including notice of my honorary degree from Helsinki University in its September 15, 2015, issue.1 At least part of my success can be attributed to what I learned while serving terms on the AVMA's councils on Biologic and Therapeutic Agents and Education. That experience gave me better insight into things that need to be accomplished in our profession.

I found the 100-year celebration of the JAVMA very interesting, especially since from 1958 until now, I have been part of the veterinary profession as a graduate veterinarian. Reading the October 1, 2015, issue brought back memories of people I knew and events I saw happen.

I was pleased to see that Dr. Janis Audin was featured in the 2005–2015 decade summary, given all the wonderful things she did for our profession, but disappointed that same summary featured a photograph of marijuana. Although we have made amazing progress in anesthesia and analgesia over the years, marijuana has not played a role, although I recognize that it could in the future. Given that there are excellent new analgesics on the market and others under development, I recommend that we refrain from putting any emphasis on marijuana until a lot more science is completed and legal guidelines for use in veterinary medicine are well established.

Charles E. Short, dvm, phd, dr.h.c.

Emeritus Professor, Anesthesiology & Pain Management College of Veterinary Medicine Cornell University Ithaca, NY

1. Short awarded honorary degree by Helsinki University. J Am Vet Med Assoc 2015;247:586.

Importance of self-awareness in development of veterinary leaders

We enjoyed the commentary “A renewed call for veterinary leaders” by Bradley et al1 on leadership and the emerging need for leadership training in veterinary medicine. Given the current gender shift in the veterinary profession, the authors make an important point about the need to focus on preparing more women veterinarians to assume leadership roles.

We come from a background of participating in, teaching, and leading an experiential and self-reflective leadership development program with a 46-year history and more than 1,200 alumni. The California Agricultural Leadership Foundation2 has established effective cooperative programs with four universities and is, we believe, among the longest-standing such collaborative programs in the country.

Instructions for Writing a Letter to the Editor

Readers are invited to submit letters to the editor. Letters may not exceed 500 words and 6 references. Letters to the Editor must be original and cannot have been published or submitted for publication elsewhere. Not all letters are published; all letters accepted for publication are subject to editing. Those pertaining to anything published in the JAVMA should be received within one month of the date of publication. Submission via email (JournalLetters@avma.org) or fax (847-925-9329) is encouraged; authors should give their full contact information, including address, daytime telephone number, fax number, and email address.

Letters containing defamatory, libelous, or malicious statements will not be published, nor will letters representing attacks on or attempts to demean veterinary societies or their committees or agencies. Viewpoints expressed in published letters are those of the letter writers and do not necessarily represent the opinions or policies of the AVMA.

Our experience leads us to believe that effective, transformational leadership training requires deliberate effort, extended cultivation, and a means of accountability checking to create necessary dynamic changes. The program offered by the California Agricultural Leadership Foundation is a 12-seminar course provided over a period of 18 months with cohorts of 24 individuals selected for high leadership potential. We believe this extended program is more impactful than short courses or intermittent lectures integrated into already rigorous academic programs.

Paul Wieand, founder of the Center for Advanced Emotional Intelligence, has suggested that “strong leadership begins with self-awareness: knowing who you are and what your values are.”3 However, self-awareness may be uncommon among technical professionals such as veterinarians who have not prioritized this capacity. Additionally, the personality profile of persons interested in veterinary medicine may not naturally lend itself to self-reflection. Thus, it may take substantial effort to develop self-awareness in veterinary students.

Our program begins with readings and targeted discussions that help participants understand themselves. Using three personality assessment tools and a 360° review, we then provide feedback on personality preferences, how participants interact with others in areas such as conflict resolution, and how others perceive them. We have found personal coaching is vital to stimulate personal change and growth, helps participants develop specific goals and the vital behaviors needed to achieve those goals, and ultimately holds participants accountable for integrating their goals into their real-life situations at home and at work.

Leadership development certainly involves didactic competencies such as vision development and effective communication and organizational skills. However, leadership development is also about establishing the behaviors required to effectively lead others, such as modeling the way, inspiring a shared vision, challenging the process, enabling others to act, and encouraging the heart.4

Leadership development requires continued effort within a controlled trial-and-error process to learn what is needed to bring about genuine transformational growth. Our advice is to find a way to establish such a program specifically for the veterinary profession. It will take time, patience, money, and sustained effort before observable results are noticed. But it will be well worth the effort, and our profession needs it.

Michael Thomas, dvm

Department of Animal Sciences California State University Fresno, Calif

Director of Education California Agricultural Leadership Foundation Salinas, Calif

Robert Cherenson, dvm

Lander Veterinary Clinic Turlock, Calif

Board Director California Agricultural

Leadership Foundation Salinas, Calif

  • 1. Bradley KM, Charles EM, Hendricks JC. A renewed call for veterinary leaders. J Am Vet Med Assoc 2015;247:592–594.

  • 2. California Agricultural Leadership Foundation. Available at: www.agleaders.org. Accessed Oct 5, 2015.

  • 3. Positive People. Leadership development. Available at: http://www.positive-people.net.au/leadership-development.html. Accessed October 5, 2015.

  • 4. Posner B, Kouzes J. The leadership challenge. 5th ed. San Francisco: Jossy-Bass Publishing, 2012.

Questioning conclusions involving cats with suspected chronic small bowel disease

I read with anticipation the report by Norsworthy et al1 on histologic abnormalities in cats suspected to have chronic small bowel disease because it deals with a topic that commonly causes diagnostic concerns among veterinarians. However, I am not certain the authors could have reached their conclusions solely on the data presented in the article.

First, the authors indicated that they used an impedance analyzer to perform CBCs but did not mention whether they did differential cell counts by hand or evaluated how well their analyzer performed for individual samples on the basis of the graphics. Thus, their leukocyte differential counts may not have been accurate, particularly for cats with toxic neutrophil changes, a left shift, or abnormal lymphocytes or nucleated RBCs in the circulation. Although cats in the study had chronic disease, median lymphocyte count was 2.6 × 109 cells/L (the authors reported leukocyte counts in units of 103 cells/mL, but counts should have been reported in units of 103 cells/μL or 109 cells/L) among cats with lymphoma (n = 52) and 2.1 × 109 cells/L among cats with chronic enteritis (65), and the highest reported lymphocyte counts for these groups were 14.7 × 109 cells/L and 40.0 × 109 cells/L, respectively. In contrast, sick cats typically have lymphopenia, and a lymphocyte count > 15 to 20 × 109/L in a sick cat would most likely be neoplastic in origin. Certain RBC indices, such as mean corpuscular volume and RBC distribution width, may be useful in determining whether cats have chronic gastrointestinal bleeding, but the authors did not provide these values. Also, it would have been helpful to know the prevalence of various other hematologic and serum biochemical abnormalities, such as the prevalence of anemia in cats with lymphoma, compared with the prevalence in cats with enteritis.

Second, in the Materials and Methods section, the authors discussed performing immunophenotyping and a PCR assay for antigen receptor rearrangement on some intestinal biopsy specimens, but the number of specimens on which these tests were performed or their results were not described in the Results section.

Third, the authors did not provide information on the ultrasonographic appearance of the intra-abdominal lymph nodes. Lymph node size, the bidimensional ratio, and the resistive index frequently assist in categorizing lymph nodes as reactive or neoplastic.2 Cytologic findings for abnormal lymph nodes should also have been provided.

Fourth, I was interested in how often ambiguous results were obtained with histopathology alone and how often immunophenotyping with or without the PCR assay for antigen receptor rearrangement was useful when ambiguous results were obtained after histopathologic evaluation, but no results were provided. Also, because four pathologists evaluated the specimens, it would have been ideal to provide a statement as to how often they reached a consensus. This is a common issue when evaluating histopathologic samples3,4 and should have been addressed.

Guillermo Couto, dvm

Couto Veterinary Consultants Hilliard, Ohio

  • 1. Norsworthy GD, Estep JS, Hollinger C, et al. Prevalence and underlying causes of histologic abnormalities in cats suspected to have chronic small bowel disease: 300 cases (2008–2013). J Am Vet Med Assoc 2015;247:629635.

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  • 2. Prieto S, Gómez-Ochoa P, De Blas I, et al. Pathologic correlation of resistive and pulsatility indices in canine abdominal lymph nodes. Vet Radiol Ultrasound 2009;50:525529.

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  • 3. Regan RC, Rassnick KM, Balkman CE, et al. Comparison of first-opinion and second-opinion histopathology from dogs and cats with cancer: 430 cases (2001–2008). Vet Comp Oncol 2010;8:110.

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  • 4. Renshaw MA, Renshaw AA, Gould EW. Should pathologists send all or only selected slides for patient-requested interlaboratory second opinion? Am J Clin Pathol 2009;132:763766.

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The authors respond:

Although we greatly respect Dr. Couto's comments, we disagree with his statement that conclusions in our report are not supported by the data.

In response to Dr. Cuoto's questions about hematologic testing of patients included in our study, the Alamo Feline Health Center routinely reviews graphical displays from the impedance analyzer used for CBCs and, when necessary, blood films. The authors appreciate two minor mistakes Dr. Cuoto identified. The leukocyte unit was inadvertently changed during revision, and the highest reported lymphocyte concentration of 40.0 × 103 cells/μL was an error that resulted from a manual entry in the patient's record. Use of the accurate concentration, 4.0 × 103 cell/μL, results in maximum and median concentrations for the chronic enteritis group of 11.0 × 103 cells/μL and 2.0 × 103 cells/μL, respectively. Although undesirable, neither of these mistakes affected conclusions. There was overlap and no significant difference in lymphocyte concentration between cats with chronic enteritis and those with lymphoma. Although evaluation of erythrocyte indices would have extended the hemogram assessment, these data were not collected. Percentages of cats with various analyte values above and below reference limits were not included owing to manuscript length, but results paralleled those reported, in that diagnostically useful differences between cats with chronic enteritis versus intestinal lymphoma were not apparent.

A previously proposed definition of ambiguous histologic findings1 was used in our study to determine when immunophenotyping and the PCR assay for antigen receptor rearrangement would be performed. The number of times these tests were performed was not presented for brevity.

Early in our study series, enlarged mesenteric lymph nodes were routinely biopsied, and discordance between small intestinal and lymph node biopsy results was noted. Because veterinarians may perform fine-needle aspiration of enlarged lymph nodes instead of biopsies, we compared results of lymph node cytology with histopathologic findings for intestinal samples. In eight cats, 22-gauge needles were used to aspirate enlarged mesenteric lymph nodes and ≥ 3 intestinal biopsy specimens were obtained. Results of lymph node cytology correlated with histopathologic findings for only 1 of the 8 cats, and many cats had intestinal lymphoma but only inflammatory changes in the lymph nodes. Thus, lymph node aspiration appeared of little value in diagnosis, and lymph node aspiration alone was unreliable. In addition, 6 of the 8 cats had periods of anorexia lasting up to two weeks after the procedure, contrasting with > 100 cats that underwent biopsy without aspiration and did not have anorexia. Therefore, we elected to discontinue this phase of our study. A recent study2 found that biopsy of intra-abdominal lymph nodes in cases of intestinal wall thickening offers no diagnostic advantage and that biopsy of affected intestinal segments is more important for correct diagnosis. These findings are in agreement with our clinical observations. Finally, four pathologists viewed samples simultaneously on a multiheaded scope and reached a consensus on the basis of previously agreed diagnostic criteria. Diagnostic categories were normal, lymphoma, chronic enteritis, or ambiguous, with all ambiguous cases subjected to additional testing.

We realize our conclusion that definitive diagnosis of chronic small bowel disease in cats requires full-thickness biopsy after examination of the entire intestine to determine proper biopsy sites may not be accepted by all readers. However, we believe this approach is most likely to lead to a correct diagnosis and permits sampling of the liver and pancreas. We stand firmly committed to the belief that this approach should be recognized as the diagnostic gold standard.

Gary D. Norsworthy, dvm

Alamo Feline Health Center San Antonio, Tex

  • 1. Norsworthy GD, Estep JS, Kiupel M, et al. Diagnosis of chronic small bowel disease in cats: 100 cases (2008–2012). J Am Vet Med Assoc 2013;243:14551461.

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  • 2. Daniaux LA, Laurenson MP, Marks SL, et al. Ultrasonographic thickening of the muscularis propria in feline small intestinal small cell T-cell lymphoma and inflammatory bowel disease. J Fel Med Surg 2014;16(2):8998.

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