Assessing pet supplements

Use widespread in dogs and cats, evidence and regulation lacking

By Katie Burns

A third of all U.S. households with dogs use supplements, as do about a fifth of households with cats, according to a report on pet supplements from market research source Packaged Facts.

Two-thirds of pet owners stated that they purchased at least some of their supplements from a veterinarian, according to the report. How often pet owners consult veterinarians about supplements is another matter.

Then there are the questions about the evidence for the efficacy of supplements in pets and regulation of the market for animal supplements.

Market reports give some sense of how pet owners are using supplements. The AVMA until recently had a policy specifically supporting the availability of glucosamine for nonfood animals but currently offers no guidance about supplements.

The American College of Veterinary Nutrition does not have a position on supplements, but the FAQ section of the ACVN website offers this statement: “If your pet is eating a complete and balanced commercially available pet food, supplements are not recommended unless specifically prescribed by your veterinarian.”

Diplomates of the ACVN suggest veterinarians should be aware that animal supplements fall into a regulatory gray area and should consider what evidence there is for the efficacy of supplements in pets.

Snapshot of pet supplements

The Packaged Facts report “Pet Supplements in the U.S., 5th Edition” came out in February 2015. In 2014, the market for pet supplements reached $541.3 million in sales.

The report states: “Joint health supplements remain the most commonly purchased condition-specific pet supplement according to Packaged Facts' January 2015 survey of pet owners, followed by those supporting heart health and skin and coat health, then digestive health/hairball prevention, and omega fatty acid supplements. Probiotics, senior formula supplements, and omega fatty acid supplements were more popular with cat owners, while more dog owners than cat owners give their pets joint health supplements.”

Also according to the report: “A rising interest in pet supplements with consumers has not translated into significant market gains. Another factor causing sluggish supplement sales is the shift towards functional treats and away from supplements in traditional capsule, tablet, and powder forms. A third factor is the tendency for veterinarians to prescribe medications with clinical evidence supporting their efficacy rather than supplements, which have less scientific support for their health benefits.”

Glucosamine and beyond

The defunct AVMA policy on glucosamine stated the following: “The AVMA encourages enforcement discretion by state and federal officials with respect to the marketing of glucosamine products to non-food producing animals because of their common and long history of use in the management of osteoarthritis and the absence of significant safety concerns.”

The AVMA Board of Directors rescinded the policy in November 2016 on recommendation of the AVMA Council on Biologic and Therapeutic Agents and the AVMA Clinical Practitioners Advisory Committee. According to the background to the recommendation, the council and committee “determined that advocating for enforcement discretion for unapproved drug products based (on) a long history of use without significant safety concerns, but without efficacy data does not reflect the AVMA's science-based perspective.”

Dr. Jennifer L. Buur, who represents clinical pharmacology on COBTA, heads the subcommittee that reviewed the policy. “We've also recognized that there might be a need for a broader policy about the use of nutritional supplements in general,” said Dr. Buur, an associate professor of veterinary pharmacology at Western University of Health Sciences College of Veterinary Medicine in Pomona, California. The subcommittee is looking at drafting such a policy.

Supplements in veterinary medicine

It's important for veterinarians and pet owners to understand that supplements don't have the same oversight as drugs approved by the Food and Drug Administration, Dr. Buur said.

The Dietary Supplement Health and Education Act of 1994 allows supplements to make a statement of nutritional support, including a statement that “describes the role of a nutrient or dietary ingredient intended to affect the structure or function in humans.” The wording must include the following: “This product is not intended to diagnose, treat, cure, or prevent any disease.”

The FDA has taken the position that the act does not apply to animals. An AVMA policy still in effect supports that position and adds that the AVMA does not believe the act should be modified to include animals.

In practice, pet supplements are marketed similarly to human supplements, and pet owners also use human supplements. Dr. Buur said there can be concerns about the safety, efficacy, and quality control of supplements. Nevertheless, she believes, “They are an important part of our integrative veterinary medical care.”

She teaches veterinary students that supplements are like other therapeutics; therefore, veterinarians need to use evidence-based medicine. With the paucity of evidence on supplements, strategies include examining evidence in other species and examining evidence of toxicity.

Dr. Buur tries to impart on students that, as veterinarians, they will need to take the lead in helping clients with supplements. She said, “You can find any information online that you want, and clients won't have the expertise needed to recognize incorrect or misleading information.”

Regulatory gray area

The regulation of animal supplements is quite a confusing arena, said Dr. David A. Dzanis, ACVN secretary and chief executive officer of the consulting firm Regulatory Discretion Inc.

He said most vitamins and minerals and certain oils that deliver fatty acids fall in the realm of food. Many herbs, metabolites, and other substances would be considered unapproved food additives or unapproved animal drugs.

The National Animal Supplement Council, a nonprofit coalition of manufacturers of supplements for companion animals, including horses, has its own labeling system for animal supplements similar to labeling on the human side.

“They are given low priority by regulators,” Dr. Dzanis said. Because they are not labeled as feeds, state feed control officials don't regulate them. He said, “Technically, they're unapproved drugs, and FDA can assert some authority.”

He said the FDA Center for Veterinary Medicine is willing to exercise enforcement discretion, allowing animal supplements on the market as long as the center is comfortable with them. Animal supplements can be subject to action if there is an issue, and the center has access to the NASC Adverse Event Reporting System.

Dr. Dzanis believes better oversight of animal supplements would be ideal, but manufacturers would have to invest a lot of time and money to get a supplement approved as a food additive and even more time and money to get a supplement approved as an animal drug (see page 122, “Supplement companies made changes after facing crackdown.”)

Clinical considerations

“The big picture about dietary supplements is, while there are ones that hold promise, however, there are many more that have absolutely no effect or have potential harm,” said Dr. Lisa M. Freeman, an ACVN diplomate who is a professor of clinical nutrition at Cummings School of Veterinary Medicine at Tufts University. She said the lack of regulation leads to concerns regarding safety, dosage, and quality control.

All these factors make supplements difficult to use, she said. A veterinarian must think about whether a supplement will have a benefit, decide on the correct dosage in a particular animal with a particular condition, and, finally, recommend a specific product with good quality control.

The supplements that hold promise can differ from those that are most used, Dr. Freeman said. Some of the most common are multivitamins, chondroprotectives such as glucosamine, and fatty acids, but multivitamins are not particularly useful if the pet owner is feeding a balanced diet.

Regarding the use of glucosamine, Dr. Freeman said, “There is some evidence in dogs that it may have some modest benefits in the treatment, although not the prevention, of osteoarthritis. However, as a nutritionist, I would say that the effects are much smaller than if an animal (that) is overweight with arthritis loses weight.”

Supplemental resources
  • Consumerlab.com—Site with a small subscription fee that independently evaluates supplements, primarily human supplements but including some pet supplements: www.consumerlab.com.

  • Food and Drug Administration—Regulatory and safety issues of supplements, reporting of adverse events: www.fda.gov/food/DietarySupplements.

  • Mayo Clinic—Fact sheets on human supplements: www.mayoclinic.org/drugs-supplements.

  • United States Pharmacopeia Dietary Supplement Verification Program—Independent testing of human supplements: www.quality-supplements.org.

  • National Institutes of Health's Office of Dietary Supplements—Fact sheets, safety notices, resources on how to evaluate supplements and how to evaluate online health information: http://ods.od.nih.gov.

  • Department of Agriculture's Food and Nutrition Information Center—General supplement and nutrition information with links to a variety of supplement websites: http://fnic.nal.usda.gov/dietary-supplements.

  • World Small Animal Veterinary Association—Nutrition toolkit, including tools for pet owners on selecting the best diet for a pet and tools for veterinarians on taking a pet's diet history: www.wsava.org/nutrition-toolkit.

Long-chain fatty acids from fish oil have some potential benefits in terms of anti-inflammatory effects and might be helpful in heart, kidney, and skin diseases.

Dr. Freeman emphasized that supplements do have potential adverse effects. Adverse effects of glucosamine include gastrointestinal upset and problems with glucose regulation, for example.

Many supplements fail quality tests for potency and contaminants, Dr. Freeman said. She recommends using products with independent quality-control testing, saying the quality control for both human and animal supplements has been shown to be questionable.

Of practitioners, Dr. Freeman said, “A nutritional assessment should be performed on every pet at every visit. In addition to the diet, treats, and other foods, we should also ask owners about dietary supplements to first find out if they're giving them at all, and then to make sure that they're giving ones that have potential benefit and don't have potential harm, that they're giving them in appropriate doses, and are using products with good quality control.”

She said, “What we can do as a profession is to carefully assess the nutritional status of our patients, determine if dietary supplements are warranted, make specific recommendations for products that have had independent testing, and do more research to better understand these supplements.”

Supplement companies made changes after facing crackdown

Feed control officials, FDA had planned enforcement event 15 years ago

By Katie Burns

The availability of glucosamine for animals seemed to be in question 15 years ago. An Aug. 15, 2002, JAVMA News article, “Facing crackdown, dietary supplement companies promise changes,” summarized the situation as follows: “In January, the Association of American Feed Control Officials unveiled a plan for helping states remove unapproved dietary supplements for animals from the market. For several years, products promising therapeutic and nutritional benefits unsubstantiated by the Food and Drug Administration were being sold in pet stores, in catalogs, and on the Internet in increasing numbers.”

According to the article, AAFCO, in cooperation with the FDA, planned on targeting an unspecified ingredient. Many guessed that the ingredient would be glucosamine.

The article goes on to say that, in a letter to AAFCO, “The AVMA stressed the importance of glucosamine products for treating osteoarthritis in companion animals, and encouraged AAFCO to defer to the discretion of state regulators in regard to this particular ingredient.” The National Animal Supplement Council, a nonprofit coalition of companies founded in 2001, “quickly put together a program that it hopes will assuage AAFCO and the FDA's concerns.”

The ongoing program, which applies to supplements for nonfood animals, involves standards for labeling and quality control and a system for reporting adverse events. Under the labeling standards, products cannot promise therapeutic or nutritional benefits but can claim to affect the body's structure or function—such as by claiming that glucosamine supports joint health.

The program seems to have assuaged regulators' concerns. AAFCO dropped its plan, and the FDA exercises enforcement discretion. Glucosamine and other supplements remain on the market for animals.

In 2002, the AVMA passed a policy supporting the availability of glucosamine. The AVMA rescinded the policy last year, however, partly because of a lack of data for the efficacy of glucosamine in management of osteoarthritis.

Feed control officials

The FDA doesn't recognize supplements for animals, just food and drugs. Ben Jones, associate director of the Office of the Texas State Chemist and a past president of AAFCO, said AAFCO “had several task forces that were put together over the years looking at these products and how they might be regulated and never really came up with a successful pathway.”

AAFCO develops model state regulations for animal foods, although it has no enforcement authority. Jones said AAFCO, certain states, the FDA, and the NASC held discussions in 2002 to carve out a means for animal supplements to be marketed. Since then, many states as well as the FDA have applied enforcement discretion, and the same groups continue to meet.

The deliberations resulted in a framework under which companies must follow certain parameters to distribute supplements for animals without interruption. The products must be for nonfood animals—dogs, cats, and horses. The companies cannot make nutritional claims or references on the label or anywhere else.

“What they could do was talk about how this impacted the structure or function of the animal,” such as by helping maintain a healthy skin and coat, Jones said. “In those deliberations, everyone agreed the parameters are that you can't make egregious drug claims. So you can't make statements about curing cancer, preventing arthritis.”

In Texas, companies should register animal supplements with the Department of State Health Services. Also in Texas, if a company incorporates supplements into animal food, other than an approved ingredient such as a vitamin, the food is considered adulterated.

“Safety has always been a concern with these products,” Jones said. There might be a history of safe use in humans, he said, “but that information is generally not available for animals, and then animal species may differ in their reaction to the different products.”

When animal supplements really began to hit the marketplace in Texas 15 to 20 years ago, dealing with the products took up a lot of time and resources for the Office of the Texas State Chemist. Once a framework was developed for the products, most companies stopped making outrageous claims.

Still, Jones would prefer to see the products go through some sort of formal review and approval process for safety and efficacy.

Supplement companies

Bill Bookout, president of the National Animal Supplement Council, has a background as a business executive in human and veterinary medicine. In consultation with his veterinarian, he also gave supplements to his two Labrador Retrievers—joint supplements for the dog with hip dysplasia and multiple supplements for the dog with cancer.

He founded Genesis Ltd., which was acquired by Kemin Industries Inc. in 2012, to sell supplements exclusively to veterinarians. He said, “Supplements are not a magic bullet, but they can be a valuable component of a comprehensive care program. And personally, I believe that the veterinarian was the best person in position to coordinate all aspects of care.”

In April 2002, 26 companies had met in response to the AAFCO strategy to remove animal supplements from the market. Bookout said, “Our objective was to get the majority of the industry together to design and implement a program of self-regulation that was fair, reasonable, responsible, and consistent, with input from the regulatory agencies, both state and federal.”

Eighteen of those companies stayed with the NASC, which as of Dec. 5, 2016, represented 142 members—or about 90 percent of the industry by consumer spending, Bookout said. About half the companies sell equine supplements, and the other half sell supplements for dogs and cats.

To earn the NASC Quality Seal, members must follow standards for good manufacturing practices, participate in the NASC Adverse Event Reporting System, and follow labeling and claims guidelines. Companies that earn the NASC Quality Seal must pass an audit by the NASC every two years.

The NASC also tests members' products randomly from the marketplace to see whether the ingredients meet the label claim. If an issue is identified, corrective action is required.

Why not pursue drug approvals for supplements? For most supplements, Bookout said, there is limited opportunity for the manufacturer to recoup the investment in research and the approval process because courts have held that natural substances cannot be patented.

Bookout said veterinarians can make a statement or speak at a meeting saying “they find a product or ingredient to be beneficial for contributing to curing, diagnosing, preventing, treating, or mitigating a disease process, but when a company uses that information, then that becomes problematic, and that crosses the line. So, is it ideal? No. Is it workable? Absolutely.”

The NASC did submit research for glucosamine and methylsulfonylmethane to be approved as feed ingredients. The FDA declined, saying the ingredients have no demonstrated nutritional purposes.

Bookout said the NASC is working with the FDA to come up with a more formalized policy on animal supplements.

FDA assessment, actions

In a 2016 statement to JAVMA News, the FDA noted that the Dietary Supplement and Health Education Act of 1994 created a new definition and regulatory framework for dietary supplements.

“However, the agency's assessment of the law is that it was not intended (to) and does not apply to animal feed, including pet food,” according to the statement. The AVMA supports that position and does not believe the act should be modified to include animals.

According to the statement, “Thus, products marketed as dietary supplements or ‘feed supplements' for animals remain subject to the same statutory standards as they were prior to DSHEA, i.e., they are considered ‘foods' or ‘new animal drugs' depending on the intended use.”

The FDA has taken regulatory actions against animal supplements in certain situations. The agency noted in an Oct. 7, 2016, warning letter to Buck Mountain Herbs Botanicals Inc. that the company's website made statements such as that bugleweed is for mild hyperthyroid conditions. A Dec. 17, 2015, warning letter noted that Advantage Biosciences Inc. made statements online and on labeling such as that “Resveratrol can be used as a cancer therapy by itself or combined with other therapies.”

In 2015, a court order prohibited sales of RenAvast in the United States, according to the JAVMA News article “Banned in one name, allowed under another” (see JAVMA, Oct. 15, 2015, page 862). According to the FDA complaint, manufacturer Bio Health Solutions LLC had claimed the product could treat or prevent kidney disease in cats and dogs.

Under the court order, the same product could be sold in the United States under a different name and with different marketing.

Board supports dialogue with pharmacies

Association's budget, operating plan also approved at November meeting

By Malinda Larkin


Dr. Rena Carlson-Lammers, District XI representative to the AVMA Board of Directors, listens to discussion at the Board's meeting Nov. 17–19, 2016, at Association headquarters in Schaumburg, Illinois. Board members approved the Association's 2017 budget and three-year operating plan for 2017–2019, among other things. (Photo by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

The AVMA hopes to meet with the National Association of Boards of Pharmacy to collaboratively discuss issues of concern related to pharmaceuticals used in veterinary medicine. To start a dialogue among the leadership of the two organizations, the AVMA Board of Directors approved funding during its meeting Nov. 17–19, 2016, at Association headquarters in Schaumburg, Illinois.

Also during the meeting this past fall, Board members sent a policy on responsible pet breeding (see JAVMA, Jan. 1, 2017, page 20) and other proposed policies to the AVMA House of Delegates for consideration at its regular winter session in January.

In addition, a new AVMA policy approved by the Board supports mitigating the harmful effects of lead exposure on humans, other animals, and ecosystems (see page 129).

Finally, revisions the Board made to the American Board of Veterinary Specialties composition and charge aim to increase transparency and collaboration in the specialty recognition process (see page 127).

Veterinary medication issues

The recommendation for the meeting with the NABP came from the AVMA Council on Biologic and Therapeutic Agents and the AVMA Clinical Practitioners Advisory Committee, both of which are “extremely concerned about health risks to animals resulting from the continued miscommunication and misunderstanding between the veterinary profession and human health care pharmacies as well as erroneous application of allowable modifications within the human healthcare sector being applied to veterinary prescriptions.”

Surveys conducted by five veterinary medical associations in 2012 and 2013 together indicate about a third of respondents knew of occasions when pharmacies dispensed drugs to clients that were different from those that were prescribed or were different in dosage, and they did so without consulting the prescribing veterinarian. Most of those changes occurred without any known harm. However, 10 percent of veterinarians responding said they have had patients harmed when outside pharmacies made substitutions in filling prescriptions (see JAVMA, Sept. 1, 2014, page 462).

The two entities perceive that pharmacists have little awareness of the Animal Medicinal Drug Use Clarification Act of 1994, they wrote in the recommendation background, so including a discussion of it with the NABP is another critical element of the forthcoming meeting.

“Goals of the meeting are to collaboratively gain perspectives, hear concerns, and plan measures to mitigate problems for the common good of the veterinary profession, the pharmacies, and the safety of our patients. Ideally, deliverables would include a joint statement or a basic plan for continued collaboration targeting resolution of the issue and enhanced communication,” the background states.

Strategic priorities

In other Board actions, members approved the three-year strategic operating plan for 2017–2019 along with a 2017 budget. The plan has the Association focusing on four areas determined to best demonstrate and deliver member value. They are as follows:

  • • Advocacy and public policy, with a focus on developing a public policy agenda.

  • • Accreditation and certification, including implementation of an e-accreditation system.

  • • Economics, including development of an economic outreach program.

  • • Delivering membership value, including developing strategies for students and early-career veterinarians as well as investigating and developing a plan to partner on wellness and well-being efforts.

The work in those focus areas will be achieved by improving operational efficiency, with the adoption of best practices in data governance.

Starting in 2017, the AVMA plans to direct much of its advocacy efforts toward educational debt as the Higher Education Act is reauthorized. With regard to economics, the Association will continue its partnership with the graduate veterinary economics program at Colorado State University's Department of Agricultural and Resource Economics, which the Board approved and began funding last April to create a pipeline for economists to work with the AVMA and government agencies. The AVMA Veterinary Economics Division will also work on the AVMA's pet demographic survey and a new series of annual surveys on demand for veterinary services in metropolitan markets.

So far, $1.4 million has been allocated from the AVMA reserves to spend this year on the strategic operating plan, which will focus on the strategic initiatives. Items being funded include the upcoming AVMA Global Summit on food security, taking place Feb. 9–11, at the Grand Hyatt in Washington, D.C. The summit will explore public and private stakeholder partnerships involving national and international relief and development organizations and the veterinary community to promote and enhance global food security. In addition, $75,000 will go to the Veterinary Leadership Experience over the next three years, and $50,000 will go toward Reaching UP, the AVMA's high-quality, high-volume spay-neuter clinic for underserved populations. The AVMA will also contribute funding for four Women's Veterinary Leadership Development Initiative networking events.

The 2017 AVMA budget anticipates $36.8 million in revenue and $36.7 million in expenses, with a net operating revenue of just over $100,000. The 2016 AVMA budget had $35.6 million in revenue and $35.5 million in expenses, resulting in a net operating revenue of just over $100,000.

The Board has chosen to invest in a comprehensive strategic plan based on member feedback to increase member value, said Dr. Janet Donlin, AVMA CEO. “They are accomplishing this by using funds set aside from reserves. The reserves have not decreased since the strategic management process was started three years ago, and in fact, have increased,” she said, thanks to income from investments and other sources of revenue. The total amount in reserves remains within the recommended 50 to 150 percent of the annual operating budget even after investing in the strategic management process from this account for the past three years.

AVMA specialty board to become autonomous

Reforms will make ABVS recognition process more transparent

By R. Scott Nolen

For decades, the AVMA Board of Directors has decided whether a proposed veterinary specialty organization warranted formal AVMA recognition and whether existing veterinary specialty programs met the requirements for continued recognition. Within the next three years, that authority will rest solely with the AVMA American Board of Veterinary Specialties.

That autonomy is one of many reforms outlined in a plan approved by the Board of Directors when it met Nov. 17–19, 2016, that the ABVS developed to align itself with best practices related to accreditation and certification.

“The restructuring, undertaken by veterinary specialists, will expand the recognition process to include non–board-certified veterinarians and public members as well as separate the recognition process from the potential biases of the current voting membership structure,” explained Dr. Robert Murtaugh, ABVS chair and a diplomate of the American College of Veterinary Emergency and Critical Care.

The ABVS currently consists of one voting representative from each of the 22 AVMA-recognized veterinary specialty organizations, with additional nonvoting liaisons from both the AVMA Council on Education and the Association of American Veterinary Medical Colleges.

Under the new scheme, which is expected to be fully implemented in 2019, the ABVS will be reconfigured as an entity of 12 voting members. Four members will be elected from among the recognized veterinary specialty organizations by the new AVMA Veterinary Specialty Organizations Committee, with the remainder representing stakeholders affected by veterinary specialization. These include four noncertified AVMA members chosen by the AVMA Board, one of whom will be an AVMA Board member; an AAVMC representative; a representative of the American Association of Veterinary State Boards; an expert in credentialing and certification activities; and a public member.

“This proactive revision of structure and process for the ABVS spontaneously undertaken by AVMA ABVS–certified specialists reflects a self-recognition that specialized veterinary services have effects beyond specialists themselves,” Dr. Murtaugh said.

“For example,” he continued, “it is a given that referring veterinarians want to be assured that specialists they are working with have been board-certified by specialty organizations and processes that have followed the standards established and upheld by the AVMA ABVS. This is just one of the reasons why it was felt to be important to include nonboarded colleague veterinarians as members on the going-forward version of the ABVS.”

Since its creation by the AVMA House of Delegates in 1959 at the request of the Council on Education, the ABVS—originally the Advisory Board on Veterinary Specialties until 1992, when the current name was adopted—has operated in an advisory capacity, first to the HOD, then to the AVMA Board, which was the arbiter on ABVS recommendations. Once the new plan is fully implemented, the ABVS will make those determinations itself.

The voting membership of the new AVMA Veterinary Specialty Organizations Committee will consist of one representative appointed by each AVMA-recognized veterinary specialty organization. In addition to electing board-certified members to the ABVS, the committee will assist organizations interested in receiving AVMA recognition and advise the Board of Directors on matters related to specialized veterinary medicine.

The reforms can be traced to 2014, when the AVMA Governance Performance Review Committee raised concerns about the composition and function of the ABVS. For instance, the GPRC suggested the ABVS consider separating the certification functions from its other charges and establish a separate group to oversee the certification/recertification process for each specialty. The committee also encouraged the ABVS to examine potential conflicts of interest in its process and procedure. The ABVS created, at the request of the AVMA Board of Directors, a task force to look at the issues.

The task force studied a number of other organizations performing similar recognition or accreditation functions before discussing its findings at the ABVS meeting in February 2016 and presenting the concept of reconfiguring the ABVS to remedy concerns related to the process for recognition of veterinary specialty organizations. At the same time, the task force noted the importance of all specialty organizations remaining engaged in both the ABVS process as well as with the AVMA and other facets related to the specialist segment of its membership.

The concept of a reconfigured ABVS and the formation of a Veterinary Specialty Organizations Committee was presented to, and approved by, the AVMA board during its spring 2016 meeting.

“These changes are transformative for the process of recognition of veterinary specialties,” observed Dr. Ed Murphey, AVMA staff consultant to the ABVS. “They make the process more transparent, give a voice to others affected by recognition of veterinary specialties, and create some interaction between the specialist and nonspecialist facets of the AVMA membership.”

Board makes appointments

The AVMA Board of Directors named the following individuals to the entities indicated, representing the designated areas, while meeting Nov. 17–19, 2016, at Association headquarters in Schaumburg, Illinois. The duration of each term varies.

Animal Welfare Committee

American Association of Small Ruminant Practitioners alternate representative—Dr. Sarah Lowry, Middleport, New York; American Association of Zoo Veterinarians/American Association of Wildlife Veterinarians alternate—Dr. Peregrine Wolff, Reno, Nevada

Clinical Practitioners Advisory Committee

Aquaculture and Seafood Medicine—Dr. Nora Hickey, Olympia, Washington

Early Career Development Committee

Recent graduates—Dr. Stacey Piotrowski, Houston

Legislative Advisory Committee

AVMA Board of Directors—Dr. Rena Carlson-Lammers, Chubbuck, Idaho

Veterinary Leadership Conference Planning Committee

AVMA Board of Directors—Dr. Karen Bradley, Montpelier, Vermont

Liaison to the Association for Assessment and Accreditation of Laboratory Animal Care International

Dr. Katrina Taylor, Yardley, Pennsylvania

Liaison to the National Coalition for Food and Agricultural Research

Dr. Daniel Grooms, Williamston, Michigan

New policy addresses threat of lead toxicosis


The AVMA statement on eliminating harmful lead exposure is a much-needed global policy, said AVMA Board member Dr. Karen Bradley, District I. (Photo by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

The AVMA has adopted a policy supporting efforts to mitigate the harmful effects of lead exposure on people, animals, and the environment. While meeting Nov. 17–19, 2016, at AVMA headquarters in Schaumburg, Illinois, the Board of Directors approved the statement submitted by the AVMA Committee on Environmental Issues.

The policy, which has been endorsed by the American Academy of Veterinary and Comparative Toxicology, American Board of Veterinary Toxicology, and U.S. Animal Health Association/American Association of Veterinary Laboratory Diagnosticians Committee on Environment and Toxicology, reads as follows:


The AVMA recognizes that lead in the environment is a health risk to people, pets, livestock, and wildlife. The AVMA encourages research, education, and actions to mitigate the risk by elimination of lead exposure and continued development and use of alternative products.

“This is a much-needed global policy,” Dr. Karen Bradley, the District I representative on the Board, observed during deliberations.

The AVMA committee noted in its recommendation to the Board that as a founder and participant in the One Health Commission, the Association should be a leader in recognizing health risks posed by lead exposure to people, animals, and ecosystems; in advocating for measures to mitigate these risks; and in urging the development and use of alternatives whenever possible.

Lead toxicosis is a common form of poisoning in cattle, and as of 2014, U.S. taxpayers had spent $1.3 billion for restoration and protection of threatened and endangered species, the committee stated. The veterinary profession is one of many that helped bring the California condor back from the brink of extinction, only to see the recovered condor populations declared unsustainable owing to lead poisoning.

Hundreds and perhaps thousands of bald and golden eagles as well as other scavengers die of lead poisoning annually, the committee added.

Several professional organizations involved in health and management of wildlife have adopted position statements recommending the replacement of lead ammunition by nontoxic alternatives, including The Wildlife Society and the Association of Avian Veterinarians, according to the AVMA committee.

Volunteer projects impact seven communities

Our Oath in Action program now in its eighth year

By Malinda Larkin

Hundreds of volunteers displayed the important work of the profession during the 2016 Our Oath in Action projects this past fall. Held across seven locations, these events gave veterinarians, veterinary students, veterinary technicians, veterinary assistants, and veterinary staff members the opportunity to reach out and connect with the animal-loving public outside the veterinary hospital. The American Veterinary Medical Foundation coordinates the program, with funding and volunteer support from the Banfield Foundation.

“As an organization deeply committed to improving the well-being of pets and communities, we are proud to support the great work of the American Veterinary Medical Foundation,” said Kim Van Syoc, executive director of the Banfield Foundation. “We were pleased to be able to provide 2016 support for AVMF's Our Oath in Action program, which helped to forge valuable connections between veterinarians, veterinary students, and the public.” Details about the 2016 events follow.



Photo courtesy of AVMF

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

The Alabama Veterinary Medical Foundation helped organize the Our Oath in Action event Oct. 1 in Auburn, now in its fourth year. It is held as part of Auburn University's 2016 Fall Roundup and Taste of Alabama Agriculture. Organizers staffed a booth that drew approximately 3,000. Volunteers talked with those visiting the booth about the care of their pets and being ready for emergencies, and distributed posters and candy. Veterinary students along with an Auburn University College of Veterinary Medicine toxicology professor were there to answer questions. The Companion Animal Mobile Equipment Trailer was also on hand; it can provide supplies necessary to house up to 80 pets and can be deployed to care for pets after disaster strikes. The Canine Performance Sciences detector dogs gave a demonstration, too.



Photo courtesy of AVMF

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

At the Animal Adopt-a-Thon, held Oct. 23 in Davis, California, 17 rescue and shelter organizations brought dogs, cats, horses, reptiles, and birds that were up for adoption with reduced or waived fees. In all, 13 animals found homes. The event also had an animal health fair with seven student clubs from the University of California-Davis School of Veterinary Medicine as well as sponsors to educate the public about animal obesity, household toxins, and the human-animal bond. In addition, a free veterinary clinic provided 45 examinations and 20 microchips to owners who brought their animals. Animal demonstrations ran throughout the day, such as disc dog and agility. More than a thousand attended the event.



Photo courtesy of AVMF

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

Volunteers provided a weekend of free veterinary care for less fortunate pet owners Oct. 29–30 in New Britain. Nearly 140 pets were spayed or neutered, and 274 distemper or rabies vaccinations were given, with efforts led by Dr. Gayle Block of Town and Country Veterinary Associates in Vernon. The Connecticut Veterinary Medical Foundation organized the event in collaboration with the local police department.



Photo courtesy of AVMF

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

More than 30 volunteers renovated the Bell County Animal Shelter in Middlesboro on Oct. 22 by adding a fresh coat of paint for all the indoor and outdoor kennels, a fenced-in play yard for the dogs to exercise in, and stainless steel kennels that will allow for more housing and reduce overcrowding. The goal of the remodel was to improve animal welfare for the shelter animals. Many of the helpers hailed from Lincoln Memorial University along with Banfield veterinarians and shelter staff.



Photo courtesy of AVMF

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

The Cummings Community Outreach event took place Oct. 4 in Worcester. Free veterinary care was offered in a community where financial and transportation barriers limit available veterinary services. Animals owned by the homeless and low-income residents of the community received wellness examinations, vaccinations, and spay or neuter procedures while owners were educated on pet care.

The project's volunteers included local veterinarians, veterinary students from Tufts University, veterinary technicians and veterinary technology students, and members of the surrounding community.

New York


Photo courtesy of AVMF

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

The New York State Veterinary Medical Society has run the Hall of Veterinary Health at the New York State Fair in Syracuse since 1970. From Aug. 25-Sept. 5, the organization put on daily presentations, first-aid demonstrations, and exhibits to educate families on the practice of veterinary medicine. The grant from the Banfield Foundation allowed the society to create new exhibits: The Comparative Anatomy exhibit, which featured eight animal skulls and a flipboard game created by Cornell University College of Veterinary Medicine students; the Dress Like a Surgeon exhibit, where children tried on gowns, shoe covers, gloves, and caps; The Teddy Bear Emergency Room, in which veterinarians “performed surgery” on a stuffed teddy bear; and the Journey Through Imaging exhibit, an interactive imaging display using iPads as well as demonstrations on an ultrasound machine, dental imaging machine, and video otoscope and endoscope. In total, more than 15,000 attendees passed through the exhibits.



Photo courtesy of AVMF

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

On Nov. 12, volunteers provided wellness community outreach in Columbus for pet owners in certain homes for the elderly and disabled as well as for homeless residents of the area. The event also offered spay and neuter outreach services to these individuals. It was organized with the support of The Ohio State University College of Veterinary Medicine students, local and OSU veterinarians, and veterinary technician volunteers.

Cat-friendly practices, homes, and shelters

By Katie Burns


Many sessions were full at the 2016 annual conference of the American Association of Feline Practitioners, Nov. 3–6 in Washington, D.C. (Photos courtesy of AAFP)

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

The American Association of Feline Practitioners is trying to make the world a friendlier and healthier place for cats.

The AAFP now has designated more than a thousand practices as cat friendly through its Cat Friendly Practice program. At press time, the association was about to launch an educational website for cat owners, www.catfriendly.com. The 2016 annual conference offered a track on shelter medicine for the first time.

As of Dec. 5, the AAFP had 3,959 members, consisting of 3,802 veterinarians and 157 veterinary technicians and practice managers. The association has been growing by leaps and bounds along with the CFP program, launched in early 2012 as a benefit of membership.

The annual conference, Nov. 3–6 in Washington, D.C., attracted 1,214 attendees. While the focus was on feline behavior and respiratory diseases, the newly offered shelter track proved to be popular.

Friendly to felines

Dr. Elizabeth Colleran, CFP co-chair, said the CFP program is still pretty young. She said, “We've really made tremendous strides in terms of getting people to think about how cats are treated in the veterinary setting and making changes to their practices to accommodate the fact that cats are now the most popular companion animal in North America.

“So people are starting to recognize that if we really do change the way in which we interact with cats and cat owners that we can really change the experience, and, therefore, maybe provide better health care.”

Understanding feline behavior, feline-friendly handling, and reducing stress associated with the visit are core components of the CFP program. The program encompasses the entire well-being of cats, cat caregivers, and the practice team.

In a 2015 survey of practices that had earned the CFP designation, 98 percent of practice respondents were satisfied with achieving the CFP designation. Reasons included less stress for feline patients, higher satisfaction among clients, that the designation demonstrated how much the practice cares about feline patients, that the practice team learned new things about cats, and improved retention of clients.

Almost 80 percent of practice respondents said visits increased because they earned the CFP designation. More than two-thirds thought they gained new patients as a result.

As of Dec. 5, the AAFP had designated 1,050 practices as cat-friendly, and more than 500 practices were in the process of earning the designation.

The CFP program has changed since its beginnings, Dr. Colleran said. Coordinators have refined the process so participants can go online and systematically go through steps for improvements to a practice. Among newer resources is a photo gallery where participants can see solutions to challenges such as space limitations.

In 2015, the program added an advisory council of more than 60 people who are in close contact with cat owners, such as veterinarians, bloggers, and representatives of corporate sponsors.

The new website for cat owners ties into the CFP program. The site provides information in a fun and appealing way, Dr. Colleran said, and the content has been curated by feline practitioners and other experts.

The website covers cat care at home, keeping cats healthy, common diseases, and how to be a cat-friendly caregiver. One section provides answers to frequently asked questions about why a cat does this or that. The site also features a toy box with games and other interactive content to help caregivers learn more about cats.


The AAFP conference included two feline-friendly handling labs.

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

Annual conference

The AAFP annual conference drew 994 veterinary professionals and 220 exhibitors and guests.

Dr. Colleen Currigan, a member of the AAFP Conference Planning Task Force, said the conference task force focused on feline behavior and respiratory diseases because both are problems that veterinarians face on a daily basis in general and referral practice.

“Respiratory disease is a very dynamic area in feline medicine. There are new diagnostics and therapeutics,” she said. “Our knowledge of feline behavior is continuing to grow and evolve. Recognizing both normal and abnormal behavior in cats is important for veterinarians as well as for cat caregivers because that knowledge empowers all of us to have a positive effect on feline welfare in general as well as an impact on an individual cat's physical and mental well-being.”

On the first day of the conference, a combined track offered talks on natural feline behavior, feline emotions, environmental needs, and elimination issues.

Dr. Brenda Griffin, who teaches shelter medicine at the University of Florida and the University of Georgia, presented the shelter track on the second day. She spoke about cat behavior in the shelter, housing, enrichment, differentiating feral from tame cats, and preventing relinquishment.

Dr. Currigan said, “Shelters are a critical part of the puzzle in improving the health and welfare of cats, and that's the core of our AAFP mission. So we felt it was worth it to add in a shelter track, and I think it was very well-received.”

The AAFP partnered with the Association of Shelter Veterinarians to present the shelter track. Dr. Currigan said the AAFP Conference Planning Task Force is considering having the shelter track again at the upcoming meeting in the fall of 2017.

The conference also featured poster sessions for the first time, with seven research posters at the entrance to the exhibit hall. Dr. Currigan said posters more than likely will be part of upcoming conferences.

Young leader becomes AAFP president

By Katie Burns

Dr. Lauren E. Demos is taking the lead as president of the American Association of Feline Practitioners just five years out of veterinary school.

As 2017 AAFP president, Dr. Demos emphasizes the message that any veterinarian who sees a cat is a feline practitioner. As a young leader in the profession, she wants to see every veterinarian get involved in veterinary associations.

Growing up in Green Bay, Wisconsin, she thought about becoming a veterinarian. In 2005, she earned her undergraduate degree from Northern Illinois University in jazz performance and acoustical physics. She moved to Alaska and became a veterinary clinic receptionist, then a veterinary technician. She went overseas to earn her veterinary degree in 2012 from Murdoch University in Perth, Australia.

“I've always liked learning. I like the constant pursuit of making oneself better. So I really like thinking in that scientific mindset, and questioning and challenging things that are handed to you, and looking for inaccuracies,” Dr. Demos said. “And I really want to help people, and I really want to help pets, and I really like teaching.”

When she was in Alaska, she worked in emergency medicine and helped with sled dogs. She didn't see a lot of cats, but she felt drawn to cats. She even took the two cats she had in Illinois with her to Alaska and Australia.

“I've always felt this attraction to cats,” she said. “They're a little bit more of an elusive species to work on. I think they don't like to give up their secrets easily. And there's something that's really appealing about having to really work a little bit harder and think a little bit differently to approach medicine.”

Dr. Demos practiced at a feline clinic in Wisconsin for a year before joining Exclusively Cats Veterinary Hospital in Waterford, Michigan. She is completing a residency in the Feline Practice specialty with the American Board of Veterinary Practitioners.

In 2013, she represented the AAFP as an emerging leader at the AVMA Veterinary Leadership Conference. She helped create an internship on the AAFP board and then served in that position. She stayed on as a board member and then became president-elect.

Among other activities, she serves on a task force for young professionals for the Michigan Veterinary Medical Association. She said, “It's really, really critical that people, not only of any year of graduation from veterinary medicine, but even more so, people that are recent graduates like myself, that we're engaged, because the profession is so much so at the precipice of a lot of issues.”


Dr. Lauren E. Demos

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116


Dr. Paula Monroe-Aldridge

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116


Dr. Colleen Currigan

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116


Dr. Roy B. Smith

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

Dr. Demos said the membership of the AAFP is growing partly as a result of the association's Cat Friendly Practice program and also because the association provides high-quality tools and continuing education.

She said the CFP program is making headway in getting the word out that cats are not small dogs but have their own needs. In another effort, the AAFP offers free toolkits to veterinary and veterinary technology students about working with cats.

Challenges that impact new veterinarians also will impact veterinary associations such as the AAFP, Dr. Demos said. Not the least of these is the increasing student debt, one of the financial challenges that could affect the ability of veterinarians to join associations and attend conferences.

Dr. Demos said, “Whether it's your local VMA or an international or a national organization, I really want to see people being involved. I think that the only way we direct and change our profession is to stick your foot in, stick your hand up, and say, ‘I'm going to do something today to try to find new solutions.”’

Joining Dr. Demos as AAFP officers for 2017 are Drs. Paula Monroe-Aldridge, Tulsa, Oklahoma, president-elect; Colleen Currigan, Chicago, immediate past president; and Roy B. Smith, Round Rock, Texas, treasurer

FDA extends call for treatment limit ideas

Food and Drug Administration authorities have extended a call for ideas on how to limit durations of some approved antimicrobial treatments in livestock.

In another notice, agency officials also confirmed that the agency's rules applied to medicated feed production would change to avoid loss of some antimicrobial treatments for use in sheep, goats, and other minor species as restrictions took effect on uses in major species.

Agency officials are accepting ideas through March 13 on how to establish appropriate and targeted durations of use for antimicrobials that are considered important for human medicine, according to a Nov. 29, 2016, Federal Register notice announcing the 90-day comment period that began Sept. 14 would be extended 90 days.

A notice published at the beginning of the comment period indicates the limits would apply to approved antimicrobial uses in agriculture that lack treatment durations on their labels or provide instructions such as “feed continuously.” The agency has identified such drugs intended for administration to cattle, swine, chickens, turkeys, sheep, and honeybees.

“Establishing defined durations of use for currently approved therapeutics will support FDA's efforts to foster stewardship of medically important antimicrobial drugs in food-producing animals and help preserve the effectiveness of these antimicrobials in animal and human medicine,” September's notice states. “Some examples of defined durations of use on the labeling of currently approved therapeutics are ‘Feed continuously for 5 days,’ ‘Feed continuously for 5 days as the sole ration,’ ‘Feed from weaning up to 120 pounds,’ and ‘Do not feed to chickens over 16 weeks (112 days) of age.”’

The deliberations on treatment duration limits follow agency actions that, at press time, were expected to prohibit agricultural production uses in feed or water of antimicrobials important for human medicine and require veterinarian oversight for remaining uses by Jan. 1. All affected pharmaceutical companies had agreed to implement those changes, according to FDA announcements.

In related news, agency officials published another Federal Register notice the same day confirming a rule that will ensure drugs administered in animal feed for therapeutic purposes would remain available for administration to food-producing minor species—such as sheep, goats, catfish, game birds, and honeybees—after production uses are removed.

An announcement accompanying the notice indicates removing availability of some antimicrobials for production uses in major species—such as pigs or chickens—could have made those drugs less accessible for therapeutic use in minor species because of drug category definitions.

Idaho finds plague in domestic cats

The Idaho Division of Public Health identified Yersinia pestis, the bacterium that causes plague, in six domestic cats in mid-2016.

The Centers for Disease Control and Prevention released notes on the cases in the Dec. 9 issue of the Morbidity and Mortality Weekly Report.

In 2015, Y pestis was identified in dead ground squirrels in Idaho. In mid-2016, Idaho veterinarians reported evaluating five dogs and 12 cats for possible plague. Y pestis was isolated from six cats.

Three cats were treated with antibiotics; two survived, and one was euthanized. The three other cats had died or been euthanized. According to the notes, “All six cats reportedly had contact with ground squirrels and other wild rodents or rabbits before becoming ill.”

No human cases of plague were reported. According to the notes, “Cat-associated human plague cases, including fatalities, have been reported in the western United States since 1977.”

Also according to the notes: “Veterinarians should consider the diagnosis of plague in pets, including cats, with compatible signs and exposure to rodent habitats, rodents, or ill pets in areas where plague is endemic or epizootic. Suspicion of plague should trigger the following actions by veterinary staff: 1) implementation of personal protective measures, including wearing masks and gloves; 2) isolation of the ill pet; 3) assessment of pulmonary involvement; 4) initiation of diagnostic testing for Y pestis; 5) prompt administration of antibiotic therapy; 6) implementation of flea control for affected animals and the hospital environment; 7) provision of advice on household flea control to pet owner; and 8) notification of public health officials.”

The notes state that cats infected with Y pestis usually develop fever, anorexia, lethargy, and lymphadenitis. Approximately 10 percent of infected cats are pneumonic.

Screwworm infestation kills endangered deer

Eradication effort aimed at flesh-eating larvae in Florida Keys

By Greg Cima


A Key deer (Courtesy of U.S. Fish and Wildlife Service)

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

More than 130 endangered deer have been killed by a decades-absent parasite, now a resurgent organism in the Florida Keys.

The deaths from the New World screwworm, a type of fly larvae that eats living flesh of warmblooded animals, had slowed by mid-November 2016. But U.S. Fish and Wildlife Service officials are preparing measures to save the Key deer if their population falls to a critical level.

Prior to the 2016 infestation, the Key deer population was estimated at 800 to 1,000. Found only in the Florida Keys, they are the smallest subspecies of white-tailed deer, the largest males standing 1 meter tall at the shoulder, according to FWS information.

The FWS received increasing reports of sick Key deer, some with maggot-infested wounds, starting in early July 2016. Authorities from the U.S. Department of Agriculture's Animal and Plant Health Inspection Service announced Oct. 3 they had confirmed screwworm infections among deer on Big Pine Key in the National Key Deer Refuge, and some pets in the area may have had infestations over the preceding two months.

Since then, two dogs, two cats, one pig, and one raccoon in the Keys also had positive test results for screwworms. No human infestations have been reported.

Infestations had been confined to the Keys through early December. Dr. Michael Short, Florida state veterinarian, said the state has investigated 15 reports of potential infestations on the mainland in animals ranging from horses to a rat, all with negative test results.

Self-sustaining screwworm populations had been eradicated in the southeastern U.S. by 1959 and the entire U.S. by 1966, although re-infestations occurred until 1982, APHIS information states. Two isolated infestations were identified in two dogs in 2007 and 2010, and both had traveled to or through Florida.

Eradication and re-eradication

FWS officials announced Nov. 24 that Key deer reproductive organs were being collected from roadkill in an effort to preserve the deer's genetic material, which could be used to save the species. Population surveys would be used to decide if and when the remaining deer should be placed in enclosures as a last resort.

Since that announcement, three deer have had confirmed infestations, according to state information.

Key deer are the only large herbivore in the Keys, FWS information states. Poaching and habitat loss reduced the population to a few dozen deer by the 1950s. The Key deer refuge was established in 1957, and the deer were listed as endangered in 1967.

Between Oct. 6 and Dec. 2, 2016, the USDA released more than 45 million sterile screwworm flies in the Keys, according to Tanya Espinosa, an APHIS spokeswoman. A female screwworm fly mates one time, and sterile fly releases have been used to eradicate screwworms in North America and Central America.

U.S. and Panamanian governments together produce and release more than 2 billion sterile pupae each year near the Panama-Colombia border to prevent spread of the flies into Central America. The Panama USDA facility is producing sterilized pupae that are flown to Florida and placed in chambers that are hung from trees in areas where the developed flies can search for mates, Espinosa said in a message.


Screwworm larvae (Courtesy of USDA APHIS)

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116


Screwworm flies (Courtesy of Pam Manns/USDA APHIS)

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

“We will continue eradication efforts until we are assured that screwworm is no longer here in the Florida Keys,” she said. “We will continue releasing sterile flies until we are sure that the only screwworm flies in the Florida Keys are sterile screwworms.”

Dr. Short said he has received no indication how long the eradication program will last, but it would be “months, not weeks.” His department has tentative plans through May, and the state will rely on expert assessment and surveillance findings.

Information from the Florida Department of Agriculture and Consumer Services indicates state and federal authorities were trapping flies to test the extent of infestation, performing surveillance for infested animals, and maintaining a quarantine zone with a checkpoint for inspecting animals leaving the Keys.

About 7,500 animals, mostly dogs, had been examined at the checkpoint by Dec. 19 without any observed signs of infestation. Cats, chickens, parrots, horses, and an ape were among other animals checked.

On the mainland, state agriculture officials are educating animal owners about the risks of screwworm infestation, promoting a hotline for reporting suspected infestations (1–800-HELP-FLA), and conducting surveillance at agricultural markets and other animal concentration points, Dr. Short said.

Cattle live as far south as Miami-Dade County, but Dr. Short said surveillance has indicated those cattle are at low risk of infestation. Far more cattle live to the north in central Florida, according to USDA statistics.

Screwworm development

Espinosa of APHIS said it is important that veterinarians contact their state veterinarian if they see suspicious or unusual clinical signs, including maggots in the tissue of a living animal.

Dr. Charles M. Hendrix, a professor of parasitology at Auburn University, said fly larvae are common in animal wounds, although houseflies, blowflies, and flesh flies tend to lay eggs in contaminated wounds, while screwworms lay eggs in clean and uncontaminated ones and mucous membranes. He teaches his students that screwworms are easily identified by examining the dorsal surface of the posterior end of third-stage larvae, which are distinct for their blackened parallel tubes ending in the spiracular plate.

“If you do see those two tubes—those two tubes with the spiracular plate at the end of them—you do have to report it,” he said.

Screwworm flies are metallic blue, blue-green, or gray, with orange eyes and three dark stripes on their backs, APHIS information states.

Eggs hatch within a day into larvae that feed on the animal for up to one week, APHIS information states. Mature larvae drop to the ground to tunnel and re-emerge as adults.

Screwworms in their early stages can be difficult to see.

“The most obvious sign is a change in the wound's appearance—as larvae feed, the wound gradually enlarges and deepens,” APHIS information states. “An infested wound also gives off an odor and some bloody discharge.

“Even if the actual wound on the skin is small, it could still have extensive pockets of screwworm larvae beneath it.”

Infestation can kill an untreated animal in one or two weeks.

Threatening drug resistance gene found on swine farm

Environmental samples from a U.S. swine farm contained several species of Enterobacteriaceae with carbapenem resistance genes that could be transmitted to other bacteria, a scientific article states.

The article authors, a team from The Ohio State University, wrote that the carbapenem-resistant species of Enterobacteriaceae—such as Escherichia coli and Proteus mirabilis—found in a swine farrowing barn are the first discovered in U.S. livestock to carry the resistance genes on a transmissible plasmid.

The article, published Dec. 5, 2016, in Antimicrobial Agents and Chemotherapy (http://jav.ma/CREplasmid), the American Society for Microbiology's online-only journal, notes that a separate scientific article published in January 2016 described discovery of carbapenem-resistant and carbapenemase-producing bacteria, including species of Enterobacteriaceae, in U.S. dairy cattle. While isolates found in those dairy cattle could transmit resistance genes only to daughter cells, those found on the swine farm are more substantial threats to public health because of their potential for transmission between commensal bacteria and pathogens.

A related announcement from OSU indicates the resistance gene likely was brought onto the farm through an outside source, but use of the antimicrobial ceftiofur in the farrowing barn may have provided selection pressure to help it spread. The scientific article states that pigs in the farrowing barn often receive ceftiofur within the first week of life, and pigs in the nursery and finishing barns receive occasional therapeutic doses.

Information from the Centers for Disease Control and Prevention describes carbapenem-resistant species of Enterobacteriaceae as highly resistant, difficult-to-treat emerging public health threats.

The Ohio State announcement indicates the research team found no evidence carbapenem-resistant species of Enterobacteriaceae or the genes conveying resistance were carried by the farm's pigs into the food supply.

Wellness as an everyday affair

Health and wellness summit emphasizes best practices, activities

By Malinda Larkin


Dr. Mark Stetter, dean of Colorado State University's College of Veterinary Medicine & Biomedical Sciences, demonstrated his own wellness pledge by riding into the crowded conference hall on his mountain bike, wearing cycling gear and a helmet. His entrance was meant to demonstrate that veterinarians must prioritize their own well-being to effectively care for animal patients and their owners. (Photo courtesy of CSU CVMBS)

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

The Association of American Veterinary Medical Colleges' fourth annual Veterinary Health and Wellness Summit focused on a challenging question: How can mental health and well-being be improved within the veterinary profession?

Dr. Michele Gaspar, a feline veterinarian and licensed professional counselor from Chicago, noted during an opening talk that veterinary medicine is physically, emotionally, and intellectually demanding. Practitioners must ably handle the medical needs

These aspects of veterinary work—combined with the traits of introversion and perfectionism shared by many people in the profession—may contribute to depression, anxiety, and even suicide among some veterinary professionals, Dr. Gaspar said. That's according to a press release about the event, which was held Nov. 4–6, 2016, at Colorado State University College of Veterinary Medicine & Biomedical Sciences.

“Our wellness has to be in developing our students and our profession to courageously be able to hold others' pain,” she added.

Dr. Gaspar suggested that veterinary schools consider ways to develop “antidotes to perfectionism,” teaching students the self-compassion that builds confidence, competence, and resilience.

“We need to model service and courage, recognizing that we have the privilege to serve and have to do so courageously,” Dr. Gaspar said, according to the university's release. “Courage doesn't mean we're not afraid. It means that we need to go forward with grace.”

This year's conference, with the theme “Reaching New Heights in Veterinary Well-Being,” was the first to involve veterinary students and practitioners along with educators, social workers, and counselors. It attracted 270 attendees for presentations and workshops meant to raise awareness about factors that may undermine veterinary productivity, career longevity, and enjoyment of practice. Even more, organizers hoped to identify best practices and concrete steps that individuals and the industry may take to improve mental health and a sense of well-being among veterinary students and professionals (see sidebar).

Momentum keeps building for well-being initiatives

Perhaps just as important as the Association of American Veterinary Medical Colleges' Veterinary Health and Wellness Summit, Nov. 4–6, 2016, at Colorado State University College of Veterinary Medicine & Biomedical Sciences, were meetings that took place before and after the event.

Prior to the summit, the Veterinary Mental Health Professionals Group got together. The group comprises about two dozen members who deal with veterinarian well-being, most of whom are based at veterinary colleges, and had its first meeting this past June. These individuals have come together to provide a stronger voice and relevant expertise to help inform decisions being made by veterinary colleges and the profession.

Kathleen Ruby, PhD, a licensed professional counselor at Washington State University College of Veterinary Medicine and a leader of the group, said, “We find veterinarians jumping into the field to do wellness talks, which is wonderful, but it dawned on us that no one knew we were the cardholders of a lot of information because we were so scattered. … Hopefully we can offer support, so as programs come out, we can say whether we think they are the best uses of time and money. Offerings and programs may sound good, but they may not work, based on how veterinarians and schools operate.”

Members have formed working groups looking at developing a comprehensive list of veterinary mental health professionals and their job responsibilities, analyzing research needs, and developing best practices for wellness programs and therapy options at veterinary colleges. The group's hope is to become a committee within the AAVMC.

In addition, the Veterinary Wellness Steering Committee gathered at the conclusion of the summit. The committee formed following the AVMA Wellness Roundtable that took place in March 2016. It has since established the Veterinary Wellness and Well-being Coalition, whose mission is to focus united efforts to advance the well-being of all veterinary professionals. Already, it has four projects underway with assigned working groups.

The first action underway by the coalition is to create a road map for access to resources that veterinary professionals need, to assist their pursuit for information and support. As part of this, this project's working group, which includes a few mental health professionals, will assess wellness resources currently available. Members will also look at state laws regarding the impact on wellness-related issues and then advocate for improvement in any states where there are barriers for seeking help. Yet to be determined is where these resources will be housed.

Plus, this working group will look at the potential for collaboration with the Royal College of Veterinary Surgeons in the U.K. and emulating its Mind Matters Initiative. Launched in December 2014, the initiative seeks to increase the accessibility and acceptance of support, encouraging a culture that is better equipped to talk and deal with stress and related mental health issues, and, ultimately, helping to reduce such triggers within the profession. Mind Matters is supported by a task force comprising eight veterinary organizations that represent students, schools, veterinarians, veterinary nurses, and practice managers in the U.K.

Its main activities are research, a communications program to increase awareness and reduce the stigma associated with mental health issues, financial and other support for existing services such as the Vet Helpline and Veterinary Surgeons' Health Support Programme, training and guidance for those who may be working or living with someone who needs assistance, and identifying aspects of the profession's structure and activities—from veterinary education to retirement—that exacerbate stress and mental health problems and consider how they may be addressed.

The coalition's second project is to look into creating a helpline or other member assistance programs to develop a sustainable model for 24/7 assistance, accessible by veterinary professionals. Right now, this working group is researching the cost and feasibility of providing these programs on a national level.

The third project involves developing model language for implementing effective and barrier-free peer assistance programs. This will require legal research into wellness and peer assistance programs across all states in addition to research into state laws, regulations, and policies relating to confidentiality issues. Initial research was scheduled to be completed by the end of 2016, with continued verification to occur throughout this year.

And finally, the fourth working group's project is to assess existing continuing education opportunities. The group also plans to develop a working list of offerings that state and national organizations can access for wellness programming.

Further updates will be distributed when available or after the next meeting of the Veterinary Wellness Steering Committee, in March during the Western Veterinary Conference. The Veterinary Mental Health Professionals Group plans to meet early this summer.

A focus on listening

One of those concrete steps outlined was promoting the formation of more Finding Meaning in Veterinary Medicine groups. These are discussion groups that provide an ongoing conversation about important experiences, issues, and ideas that emerge from work as a veterinarian that individuals may not have the opportunity to reflect on and discuss with others. The idea is based on a concept that originated more than two decades ago by Rachel N. Remen, MD, a clinical professor of family and community medicine at the University of California-San Francisco School of Medicine.

She first began teaching The Healer's Art course, in which medical students learn how to offer stronger emotional support to their patients, their colleagues, and themselves. From there, she founded the Institute for the Study of Health and Illness at Commonweal, which created Finding Meaning in Medicine. The program has helped hundreds of practicing and teaching physicians nationwide form FMM Conversations at their workplaces, schools, and homes. These self-led groups meet monthly, independent of institutional support or involvement, using a storytelling approach to uncover and deepen a sense of connection and community, and find greater satisfaction and meaning in their daily work and their profession.

Laurie Fonken, PhD, psychological counselor at Colorado State's veterinary college and an organizer of the summit, said one of the guidelines of these groups is that people are encouraged to talk but not necessarily to respond.

“It's not a therapy or support group. Each person shares, and the rest just listen. It's generous listening with an open mind and heart to whatever they're bringing forth,” Dr. Fonken said. “It's not fixing, giving advice, or saying, ‘That happened to me.’ It's holding a space for each to share.”

She started The Healer's Art course at CSU in 2012 for veterinary students and a Finding Meaning in Veterinary Medicine group for faculty and Colorado Springs veterinarians in 2011. Dr. Fonken said groups of practices or students or state VMAs could easily form their own FMVM groups. She encouraged anyone interested in doing so to contact her at Laurie.Fonken@colostate.edu for more information.

Other presenters and topics at the summit included the following:

  • • Veterinary team wellness and the effect of veterinary technician burnout and staff turnover on the well-being of the veterinary team.

  • • The difference between burnout and compassion fatigue.

  • • Tools that can be used to improve self-compliance with well-being activities.

  • • Using technology to teach meditation and stress response.

  • • The emotional roller coaster of working in the veterinary industry and how nonveterinarians can help practitioners they live and work with.

Between sessions, wellness activities such as yoga, breathing techniques, and meditation took place to encourage attendees to learn about them and use the activities at work or at home.

Looking into childhood trauma

The summit also provided a forum for updates on research happening in the field.

Elizabeth Strand, PhD, a clinical assistant professor and director of veterinary social work services at the University of Tennessee colleges of veterinary medicine and social work, gave a presentation on a study she and five other mental health professionals at veterinary colleges conducted. The resulting paper, “Adverse childhood events in veterinary medical students: A multi-site study,” is scheduled for publication in an upcoming issue of the Journal of Veterinary Medical Education. The research explores the presence of adverse childhood experiences in veterinary students at six U.S. veterinary colleges and their relationship with depression, stress, and the desire to become a veterinarian. Sixty-one percent of respondents reported having at least one ACE. The most prevalent ACE reported was living with a household member with a mental illness (31 percent). Students who had experienced four or more ACEs had an approximately threefold increase in signs of clinical depression and higher than average stress when compared with students who had experienced no ACEs. The number of ACEs showed an overall graded relationship with signs of clinical depression and higher than average stress.

That said, there was no statistically significant relationship between age at which a student wanted to become a veterinarian and exposure to ACEs. Veterinary students report being exposed to ACEs before age 18 at a rate similar to subjects in other population-based studies. The findings don't suggest that veterinary students enter the veterinary education system more at risk than the general population for poor mental health due to ACEs.

Dr. Andrew Maccabe, AAVMC chief executive officer, noted during the opening session that veterinary medicine is tackling concerns about practitioner well-being that are shared in related fields, including nursing, dentistry, and human medicine, according to an AAVMC press release. He called on veterinary colleagues to destigmatize mental health problems, to encourage resilience among students and practicing professionals, and to remember that help is available for those suffering with depression, anxiety, and other mental-health concerns.

“This conference is aimed at raising awareness so that we can deal with this problem openly,” Dr. Maccabe said in the release. “We need to turn to our professional colleagues in mental health to solve this issue.”

As the conference closed, students, practitioners, social workers, and industry leaders said they felt energized about the ideas and tools that were shared.

“There is a strong feeling that we have hit a tipping point and that this problem is becoming a top priority,” said Dr. Mark Stetter, dean of CSU's veterinary college. “We are poised to make a difference across the veterinary profession.”

Winn awards grants for feline health studies

The Winn Feline Foundation has awarded $124,495 for feline health studies in partnership with the George Sydney and Phyllis Redman Miller Trust.

The foundation awarded grants for the following studies:

  • • “Characterization of mineralization and expression of osteogenic proteins in feline kidneys with and without calcium oxalate uroliths,” Drs. Jody Lulich and Eva Furrow, University of Minnesota, $12,000.

  • • “The effects of oral anti-inflammatory glucocorticoids on glucose homeostasis and fluid balance in clinically healthy cats,” Dr. Jessica Ward, Iowa State University, $24,975.

  • • “Carboplatin-impregnated calcium sulfate hemihydrate beads: A cost-effective, local treatment for feline injection site–associated sarcoma,” Drs. Heidi Phillips and Elizabeth Maxwell, University of Illinois, $29,169.

  • • “Structure-based design of a novel subunit immunogen for development as a feline infectious peritonitis (FIP) vaccine,” Gary Whittaker, PhD, Cornell University, $30,273.

  • • “Susceptibility to dermatophytes and asymptomatic carrier state in Persian cats,” Dr. Aline Rodriguez Hoffman and William Murphy, PhD, Texas A&M University, $28,078.

Iowa State confers Stange, Switzer awards


Dr. Michael Conzemius

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116


Dr. Vincent Meador

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116


Dr. Donald O'Connor

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116


Dr. James Philip Stein

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

Four alumni of the Iowa State University College of Veterinary Medicine were honored Oct. 29, 2016.

Recipients of the 2016 Stange Award for Meritorious Service were Drs. Michael Conzemius, Vincent Meador, and Donald O'Connor.

The William P. Switzer Award in Veterinary Medicine was presented to Dr. James Philip Stein for his contributions to society and the Iowa State veterinary college.

Dr. Conzemius (Iowa State ‘90), a professor of surgery and director of the Clinical Investigation Center at the University of Minnesota College of Veterinary Medicine, is an internationally recognized researcher in orthopedic biomechanics and joint injury and treatment. He is an expert in osteoarthritis, fracture osteomyelitis, biomechanics of osteonecrosis, and stem cell therapy for cartilage injury and repair. He holds several patents, including two for a canine total elbow implant.

Before joining the University of Minnesota in 2006, he was an associate professor at Iowa State and an assistant professor of surgery at the University of Pennsylvania.

Dr. Meador (Iowa State ‘81), owner of Pacific Tox Path LLC, based in Ellensburg, Washington, and affiliate professor at the University of Washington, is an expert in toxicologic pathology, contributing to the technology transfer of research information and international control programs for preclinical drug safety.

Previously, Dr. Meador was vice president and global head of pathology at Covance Inc., a contract research company. He also was the executive director of comparative biology and safety assessment at Amgen Inc. for three years and director of toxicology and pathology at Eli Lilly and Co. for 12 years.

Dr. O'Connor (Iowa State ‘76) played an important role in Wisconsin's animal disease control efforts for 25 years. After spending 10 years as a dairy practitioner, Dr. O'Connor became an epidemiologist for the state of Wisconsin. He is credited with developing programs to control rabies, chronic wasting disease, avian influenza, Salmonella infection in poultry, and equine infectious anemia.

He was a member of the team of veterinarians that developed the current U.S. Department of Agriculture program to control bovine tuberculosis in cervids. Under his direction, Wisconsin was one of the first states to eradicate pseudorabies.

Dr. Stein (Iowa State 75) and a classmate established a veterinary clinic in a Wisconsin town that lacked veterinary services for pets and livestock. After seven years, he returned home to Muscatine, Iowa. There, along with other community service, he helped develop a shelter for victims of domestic violence, a YMCA/YWCA, and an agricultural learning center.

He is chairman of the board of directors of Central Bancshares. He has worked part time at a veterinary clinic and as a consultant in dairy production. He has been an avid supporter of the Iowa State veterinary college, including by serving on its fundraising advisory council.

Commissioned Corps officers honored

Several U.S. Public Health Service Commissioned Corps officers were honored for their work to improve public health.

The U.S. Public Health Service Ebola Responder Team from 2015 received the 2015 USPHS Veterinary Category's Commissioned Corps Veterinary Responder of the Year Award. The award honors 10 officers for their work on the Ebola epidemic that started in 2014. Previously, the 2014 award also was given to Ebola epidemic responders.

The award honors Lt. Tara Anderson, Cmdr. Stacey Bosch, Capt. Kris Bisgard, Lt. Cmdr. Danielle Buttke, Capt. Kris K. Carter, Cmdr. Mary Anne Duncan, Lt. Lizette O. Durand, Cmdr. Jeff McCollum, Lt. Cmdr. Linda Capewell Pimentel, and Cmdr. Temeri Wilder-Kofie. The award announcement also mentions accomplishments by Cmdr. Bryan Buss and Cmdr. Christa Hale, who were honored in the 2014 award and, therefore, excluded from the 2015 award.

An award announcement describes activities such as research, virus presence testing, deployment coordination, epidemiology, risk evaluation, protocol development, national guidance development and distribution, field team support and management, administration, communication, security coordination, training, and potential contamination monitoring.

One of those award winners, Dr. Buttke, one-health coordinator for the National Park Service, received two more awards. She received the Veterinary Junior Officer of the Year Award from the USPHS and the 2016 Dr. Daniel E. Salmon Award from the National Association of Federal Veterinarians.

The former honored her for accomplishments in prevention and control of zoonotic diseases, among other animal-related human health issues; leadership demonstrating the value of veterinary public health through work in environmental and wildlife health; passion and enthusiasm in promoting veterinary public health; and effort in assuming additional responsibilities in 2015 during an unexpected staffing reduction that coincided with tularemia and plague outbreaks.

The Salmon award honored her for establishing a national one-health program that improved park service employee understanding of, engagement in, and management of infectious diseases affecting humans, wildlife, and the environment. It includes training and education to prevent zoonotic disease in park visitors and employees, a research program, a one-health internship program, and a cross-disciplinary Disease Outbreak Investigation Team that can provide evaluation, investigation, and risk communication on substantial disease concerns in parks.

She also developed a national wildlife morbidity and mortality surveillance system that tracks human and wildlife public health threats and wildlife diagnostics.

Capt. Ronald B. Landy, a regional science liaison for the Environmental Protection Agency, received the 2016 James H. Steele One Health Outstanding PHS Veterinary Career Award for his 33 years with the uniformed services. His work in environmental health has emphasized translation of science into applications for policy and regulation.

Dr. Landy worked as an environmental health officer for the U.S. Air Force and a veterinary medical toxicologist for the Food and Drug Administration before joining the EPA. Before taking his current job, he worked for the EPA as a regional expert toxicologist, senior adviser on pesticide and toxic chemical regulatory development, chief of the Office of Research and Development Regional Scientist Program, regional scientist, and acting director of the regional science program, as well as a member or chair of committees within the department.


Lt. Cmdr. Danielle Buttke

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116


Capt. Ronald B. Landy

Citation: Journal of the American Veterinary Medical Association 250, 2; 10.2460/javma.250.2.116

He championed a program for providing research support to high-priority science needs, and his work helped quadruple resources for the program and raise its profile. He also developed a program that helps technical staff in EPA regional offices travel to ORD laboratories, integrate cutting-edge research into their work, and receive professional development opportunities. And he developed a concept to nurture collaboration among EPA regions and the ORD on research and science delivery during severe budget cuts.

He also developed a novel method for increasing engagement with academic institutions through the Science to Achieve Results program of the National Center for Environmental Research. And he worked to recruit and advise potential new officers for the Public Health Service Commissioned Corps.

Obituaries: AVMA member AVMA honor roll member Nonmember

James A. Bergum

Dr. Bergum (California-Davis ‘82), 61, Herald, California, died July 22, 2016. He owned Jim Bergum Veterinary Service, a mobile equine practice. Dr. Bergum is survived by his wife, Rhonda, and three children.

Neil F. Chapman

Dr. Chapman (Iowa State ‘51), 96, Ruthven, Iowa, died July 5, 2016.

Following graduation, he practiced mixed animal medicine in Algona, Iowa, for several years. Dr. Chapman then rejoined the Air Force as a command veterinarian, having previously served in the Army Air Corps during World War II. During his military service, he was stationed in Japan and the United States. Dr. Chapman retired in 1973 with the rank of colonel. He was a member of the American Legion. Dr. Chapman's son and two daughters, three grandchildren, and a great-grandchild survive him. Memorials may be made to Lost Island Nature Center, 3267 350th Ave., Ruthven, IA 51358.

Charles D. Cooke

Dr. Cooke (Purdue ‘76), 64, Terre Haute, Indiana, died Sept. 2, 2016.

A small animal veterinarian, he co-founded Heritage Animal Hospital in Terre Haute with his wife, Dr. Patricia M. Cooke (Purdue ‘76), in 1976. Dr. Cooke's wife, a daughter and a son, and three grandchildren survive him. His daughter, Dr. Jessica L. Cooke (Purdue ‘07), practices at Heritage Animal Hospital.

Robert L. Maahs

Dr. Maahs (Iowa State ‘59), 81, Solvang, California, died Nov. 9, 2016. Following graduation, he moved to the San Francisco peninsula and established San Carlos Pet Hospital in San Carlos. Dr. Maahs subsequently founded several practices in the San Francisco area. After semiretiring, he practiced in the Palm Springs area for 15 years. In 1974, Veterinary Economics magazine honored the San Carlos Pet Hospital with its annual design award. Dr. Maahs was a past president of the San Carlos Rotary Club. He is survived by a son and a daughter, seven grandchildren, and three great-grandchildren.

John W. Sample Jr.

Dr. Sample (Georgia ‘58), 81, Charleston, South Carolina, died Sept. 2, 2016. Following graduation, he served two years in the Army, including service as post veterinarian at Fort Knox, Kentucky. Dr. Sample then established Ashley River Animal Hospital in Charleston, where he practiced small animal medicine for more than 40 years. He is survived by two sons, two daughters, and five grandchildren. Memorials may be made to Ridge Spring Community Cemetery Fund, c/o Betty Ann Cone, P.O. Box 365, Ridge Spring, SC 29129.

John S. Weems

Dr. Weems (Texas A&M ‘81), 59, Sisters, Oregon, died Oct. 14, 2016.

An equine veterinarian, he owned Sisters Equine since 2013. Dr. Weems began his career practicing in Las Vegas. In 1984, he co-established Weems & Stephens Equine Hospital in Aubrey, Texas. In 2006, Dr. Weems moved to Sisters, where he began an ambulatory equine service serving central Oregon. His wife, Wendy, and two children survive him. Memorials may be made to Shiloh Ranch Cowboy Church, The 1017 Project-Scott Weems, P.O. Box 177, Powell Butte, OR 97753.

Ralph F. Ziegler

Dr. Ziegler (Illinois ‘55), 84, San Antonio, died Oct. 23, 2016.

Following graduation, he served a year as a member of the large animal clinical staff at the University of Illinois. Dr. Ziegler then joined the Air Force, retiring in 1985 as chief of the Veterinary Sciences Division at the Air Force School of Aerospace Medicine in Texas with the rank of colonel.

During his military service, he earned a master's in laboratory animal medicine at Texas A&M University, became a diplomate of the American College of Laboratory Animal Medicine, and was assigned to several biomedical research laboratories for both the Air Force and the Navy. Dr. Ziegler also served in Thailand during the Vietnam War. He received a Legion of Merit. Dr. Ziegler is survived by two sons and three grandchildren. Memorials may be made to The Ralph F. and Norma L. Ziegler Endowment, The Farmhouse Foundation, 11020 NW Ambassador Drive, Suite 330, Kansas City, MO 64153, or Heifer International, P.O. Box 808, Little Rock, AR 72203.