Letters to the Editor

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Experiences with passive restraint of cats

The recent JAVMA News story “Study looks at which method proves best to restrain cats”1 describes results of a study examining cat welfare during handling. The authors concluded that passive restraint was less stressful and caused less struggling than did full-body restraint for cats undergoing routine physical examinations.

I have advocated for this approach since the mid-1960s when Dr. James Beckley, a private practitioner in Fairbanks, Alaska, introduced me to his method. For this method, a short (approx 2 feet in length) soft cord was prepared with loops at each end. One loop was loosely put around the cat's neck; the other was put around the handler's wrist. No physical restraint was used, and the only purpose of the cord was to regain control of the cat in the event that it tried to bolt from the examination table.

Using this method, I estimate that I was able to conduct thorough physical examinations on, collect blood samples from, and administer vaccines and simple injections to > 85% of the cats with which I worked. In every instance, the most important factor was using the absolute minimum amount of restraint, and in many instances, I was able to perform these tasks without an assistant.

Note that for collecting a blood sample, I would use a manual clipper to remove the fur over the vessel, because the noise and feel of an electric clipper are stressful for most cats. For vaccine administration and IM or SC injections in the caudal part of the body, I would place the cat head first at one end of the examination table and, using a back leg, gently and slowly pull the cat backward toward the other end of the table while making the injection. For injections in more cranial locations, I would place the cat tail first at one end of the table and then gently grab the scruff of the cat's neck and slowly push it toward the other end of the table while making the injection. In most instances, the cat was so interested in trying to stop its movement that it didn't even realize it was getting an injection.

Obviously, some degree of physical or chemical restraint will be required for uncooperative cats and cats with sufficient trauma that are in substantial pain. But, in my career, I typically found that less restraint was more than enough.

Richard C. Simmonds, dvm, ms

Director, Laboratory Animal Medicine, Emeritus

Nevada System of Higher Education, Professor of Physiology, Emeritus, University of Nevada, School of Medicine, Reno, Nev

1. Study looks at which method proves best to restrain cats. J Am Vet Med Assoc 2019;254:564.

Setting expectations for animal behavior cases

As members of the board of the American College of Veterinary Behaviorists, we want to thank Dr. Dunphy for her letter1 highlighting concerns regarding treatment of dogs with aggressive behavior discussed in recent reports in the Animal Behavior Case of the Month feature in JAVMA. The board fully agrees that all veterinarians, including diplomates of the American College of Veterinary Behaviorists, should set realistic expectations for clients to protect people from dog bites. As veterinary behaviorists, we take our role in educating the public and protecting public health very seriously. Studies2–4 have demonstrated that most dog bites are preventable. Nevertheless, safety and management recommendations are the first and most important part of every treatment plan for aggressive animals. In most cases, clients who follow the treatment and management recommendations can prevent future bites. However, in those instances when management recommendations are unrealistic or do not sufficiently reduce the risk of serious bites, a poorer prognosis should be given and a frank discussion should be had with the owner.5

Readers should bear in mind that the purpose in presenting these case reports, many of which have been used by their authors in partial fulfillment of the requirements for board certification, is to highlight the treatment from a specialist's point of view, much like the reports in the “What Is Your Neurologic Diagnosis?,” “ECG of the Month,” and “Theriogenology Question of the Month” features. The intention is to share cases that are informational and demonstrate success in difficult circumstances. Our intent is to allow veterinarians who do not see these cases regularly or do not have extensive training in animal behavior to see the potential for aggressive dogs to be successfully managed with appropriate evaluation, treatment, and follow-up. We consistently find that owners will go to great lengths to ensure the well-being of their pets, which is an important factor in the success of treatment.

Veterinary behaviorists are acutely aware that dog bites and other aggressive behaviors pose a complex public health risk and animal welfare issue. These important topics are frequently discussed by diplomates during veterinary student education, veterinary continuing education courses, and outreach to other animal care professionals and the pet-owning public. Many diplomates are happy to consult with general practitioners when they have questions regarding the suitability of treating a particular aggressive patient. As veterinary behaviorists, we believe that by featuring these cases, we are fully invested in upholding the Veterinarian's Oath, which includes “the protection of animal health and welfare, the prevention and relief of animal suffering, … the promotion of public health, and the advancement of medical knowledge.”

Ellen M. Lindell, vmd

President

Carlo Siracusa, dvm, phd

President-Elect

Valerie V. Tynes, dvm

Immediate Past President

E'Lise Christensen Bell, dvm

Secretary

Lisa Radosta, dvm

Treasurer

Lore I. Haug, dvm, ms

Member at Large

Kelly C. Ballantyne, dvm

Member at Large

American College of Veterinary Behaviorists, Gainesville, Fla

  • 1. Dunphy C. Setting reasonable expectations for animal behavior cases (lett). J Am Vet Med Assoc 2019;254:1040.

  • 2. De Keuster T, Lamoureux J, Kahn A. Epidemiology of dog bites: a Belgian experience of canine behaviour and public health concerns. Vet J 2006;172:482487.

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  • 3. Reisner IR, Shofer FS. Effects of gender and parental status on knowledge and attitudes of dog owners regarding dog aggression toward children. J Am Vet Med Assoc 2008;233:14121419.

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  • 4. Shuler CM, DeBess EE, Lapidus JA, et al. Canine and human factors related to dog bite injuries. J Am Vet Med Assoc 2008;232:542546.

  • 5. Reisner IR, Hollis NE, Houpt KA. Risk factors for behavior-related euthanasia among dominant aggressive dogs: 110 case (1989–1991) J Am Vet Med Assoc 1994;205:855863.

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Maintaining our commitment to our clients and patients

During my first week in veterinary college, the dean told us that veterinarians were one of the most trusted bodies of professionals, more so than human doctors. Hearing that sentiment convinced me I was on the right track in life. Now, after only seven years in practice, I worry that it may be outdated.

The AVMA has been lobbying Congress against the Fairness to Pet Owners Act of 2019 (HR 1607), which would establish a requirement that, when a veterinarian prescribes a drug for a companion animal, the owner must be given a copy of the prescription. In my opinion, if we want to maintain our commitment to our clients and patients, putting them first instead of our bottom line, and want to uphold our integrity and trustworthiness to our clients and communities, then we should allow this legislation to pass. We have more important things we could be focusing our lobbying efforts on.

Leslie Brooks, dvm, mph

Indianapolis, Ind

1. AVMA. AVMA opposes prescription mandate legislation. Available at: www.avma.org/Advocacy/National/Congress/Pages/just-ask-oppose-unnecessary-prescription-writing-mandates-for-veterinarians.aspx. Accessed Jun 27, 2019.

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The AVMA responds:

We always appreciate the opportunity to talk with members about important issues you feel passionate about. The high level of public trust held by the veterinary profession has been built by generations of ethical veterinary practice that puts clients and patients first. Veterinarians adhere to a code of ethical conduct known as the Principles of Veterinary Medical Ethics, and those principles are grounded in maintaining that public trust.

In terms of mandatory prescription writing, the AVMA has long opposed this legislation for very good reasons. To begin, we believe it's simply unneeded. When clients request written prescriptions, veterinarians provide them, and pet owners have the flexibility to take those prescriptions to the pharmacy of their choice. We do this not only because it is a long-standing ethical obligation, but also because in the vast majority of states—including Indiana where Dr. Brooks practices—it is a legal requirement defined in the state veterinary medical practice act or in a policy set by the state board of veterinary medicine.

Veterinarians and their clients shouldn't have unnecessary federal mandates inserted between them. The proposed legislation would make it federal law that a veterinarian must always and immediately provide a prescription to a companion animal client before offering either to dispense the medication or provide a prescription, regardless of the client's wishes and whether the prescription is filled off-site or the medication is ultimately dispensed by the veterinarian. Failure to perform that cumbersome, unnecessary, and additional step would be deemed an unfair or deceptive practice in violation of the Federal Trade Commission Act. To demonstrate compliance in this scenario, veterinarians would be required to create elaborate record-keeping systems to prove they provided a prescription to a client prior to offering to dispense a medication. This would place an astounding and needless burden on veterinary practices.

It also poses hazards to animal and human health. Veterinarians cannot both dispense a medication and provide a copy of a prescription that can be filled elsewhere. Clients often desire to have their veterinarian dispense medication because there is a need to start treatment immediately, it is convenient, or the medication is not available elsewhere. For many medications, however, dispensing the medication and also providing a prescription would be dangerous.

To be clear, the AVMA supports a client's choice to have medication dispensed by their veterinarian or to receive a prescription they can have filled at the pharmacy of their choice. The choices and options available to pet owners in today's highly competitive marketplace are plentiful, and we welcome the level of choice and flexibility that is currently available. But a federal law requiring a veterinarian to write a prescription, whether a client asks for it or not, is unnecessary, unworkable, and potentially dangerous.

We are fortunate as a profession to have a long history of working together with our clients to provide quality care within clients' budgets. The public's trust in veterinarians is well placed, and we will continue to work to earn it.

John Howe, dvm

AVMA President, Grand Rapids, Minn

John de Jong, dvm

AVMA Immediate Past President, Weston, Mass

Veterinary reporting of animal abuse and neglect

We were dismayed to read that the Association's Board of Directors recently revised the AVMA policy “Animal Abuse and Animal Neglect,” which provides veterinarians guidance on responding to cases of suspected animal abuse or neglect.1 The previous version of this policy stated that “The AVMA considers it the responsibility of the veterinarian to report such cases to appropriate authorities, whether or not reporting is mandated by law.” This sentence was removed from the new version, and instead, the policy now states that “The AVMA encourages state legislation providing immunity from liability … to any veterinarian who reports, in good faith, a suspected case of animal abuse or neglect to the proper authorities.” It further states that “The AVMA encourages veterinarians to … familiarize themselves with relevant laws and the appropriate authorities to whom they should report suspected cases of animal abuse or neglect within their jurisdiction.”

We recognize that veterinary reporting requirements and immunity laws differ by state. However, we believe that national guidance for reporting of suspected animal abuse and neglect should be governed by the overarching principles of veterinary medical ethics. As stated in the Principles of Veterinary Medical Ethics of the AVMA, “A veterinarian shall be influenced only by the welfare of the patient, the needs of the client, the safety of the public, and the need to uphold the public trust vested in the veterinary profession….”

Animal abuse and neglect is an important one-health issue. A sizeable body of literature2–6 suggests that links exist between abuse or neglect of animals and domestic violence and child abuse. Failure on the part of veterinarians to make appropriate authorities aware of animal abuse or neglect carries the risk that humans and other animals living in households where animal abuse occurs could incur serious and even life-threatening consequences.

The former policy prompted state veterinary medical associations to work with their state governments to change client confidentiality exceptions and provide immunity for reporting. In some states, it is still problematic for veterinarians to report suspected animal abuse or neglect. Still, we believe that reporting such cases should be considered an important responsibility of veterinarians. We urge the AVMA to consider restoring the previous language to its policy on animal abuse and neglect.

Joann M. Lindenmayer, dvm, mph

Chair, Leadership Council

Barry Kipperman, dvm, msc

President, Board of Directors, Humane Society Veterinary Medical Association, Gaithersburg, Md

Melinda Merck, dvm

Veterinary Forensics Consulting LLC, Austin, Tex

  • 1. Burns K. AVMA addresses animal abuse, research cats and dogs, outdoor housing of pets. J Am Vet Med Assoc 2019;254:1364.

  • 2. Barrett BJ, Fitzgerald A, Stevenson R, et al. Animal maltreatment as a risk marker of more frequent and severe forms of intimate partner violence [published online ahead of print Jul 14, 2017]. J Interpers Violence 2017 doi: 10.1177/0886260517719542.

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  • 3. Campbell JC, Webster D, Koziol-McLain J, et al. Risk factors for femicide in abusive relationships: results from a multisite case control study. Am J Public Health 2003;93:10891097.

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  • 4. Flynn CP. Women-battering, pet abuse, and human-animal relationships. In: Linzey A, ed. The link between animal abuse and human violence. Eastbourne, England: Sussex Academic Press, 2009.

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  • 5. Krienert JL, Walsh JA, Matthews K, et al. Examining the nexus between domestic violence and animal abuse in a national sample of service providers. Violence Victims 2012;27:280295.

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  • 6. National Link Coalition. The link between violence to people and violence to animals. Available at: animaltherapy.net/animal-abuse-human-violence/link-bibliography/#domesticviolence. Accessed Jul 8, 2019.

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The AVMA responds:

On behalf of the AVMA Animal Welfare Committee (AWC), we would like to respond to Lindenmayer et al.

During the review period of the AVMA policy “Animal Abuse and Animal Neglect,” the House of Delegates requested that the AWC consider language to address a fundamental impediment to reporting of suspected animal abuse and neglect: the need for state laws and regulations to include immunity provisions so that veterinarians could report suspected abuse with protection and without fear of jeopardizing their licenses because of violations of client confidentiality. The AWC agreed that the policy would be strengthened by encouraging action to establish immunity protections and responded to the House's request with the proposed revisions, which were approved by the AVMA Board of Directors in April 2019.

Lindenmeyer et al suggest that these changes mean that the current policy no longer adequately conveys the important responsibility of veterinarians to report animal abuse and neglect. The authors cite language from both the previous and current policies. However, it should be noted that both versions state that “Prompt disclosure of abuse is necessary to protect the health and welfare of animals and people.” The AWC is fully aware of the importance of reporting abuse and neglect and believes the current policy continues to support veterinary reporting of such cases to appropriate authorities.

Lindenmeyer et al correctly cite the statement from the Principles of Veterinary Medical Ethics of the AVMA that underlies the policy on animal abuse and neglect. However, the Principles also state that, “A veterinarian shall respect the law and also recognize a responsibility to seek changes to laws and regulations which are contrary to the best interests of the patient and public health.” For this reason, the current policy now includes language to encourage state legislatures and regulatory bodies to adopt legislation and policy that removes known impediments to veterinary reporting of animal abuse and neglect (ie, “The AVMA encourages state legislation providing immunity from liability in any civil, criminal, or state licensing action to any veterinarian who reports, in good faith, a suspected case of animal abuse or neglect to the proper authorities.”).

Lindenmeyer et al also suggest that the previous policy prompted state veterinary medical associations to work with their state governments to implement changes. However, the previous policy did not address legislation or regulation, whereas the current policy directly addresses this issue.

In sum, the current policy on animal abuse and neglect does not withdraw AVMA support for veterinarians reporting animal abuse. Rather, it continues to recommend prompt disclosure, while adding needed language that supports the removal of impediments to reporting.

Emily McCobb, dvm, ms, dacvaa

Immediate Past Chair, Animal Welfare Committee

Clinton, Mass

Leanne Alworth, dvm, ms, daclam

Chair-Elect, Animal Welfare Committee, Athens, Ga

Lori Teller, dvm, dabvp, cvj

AVMA Board of Directors, Houston, Tex

Ingestion of Sophora secundiflora by dogs

Sophora secundiflora, commonly known as the Texas mountain laurel or mescal bean, is a member of the Fabaceae (pea) family that is native to Texas and New Mexico and also used as a landscape plant in various states. Sophora secundiflora is a multi-stemmed evergreen tree or shrub that can grow 1 to 10 m (3.3 to 32.8 feet) in height. It has dark green, glossy, 10- to 15-cm-long (3.9- to 5.9-inch-long) compound leaves comprised of 5 to 13 leaflets. In February through March, the plant produces violet flowers in 5- to 12-cm-long (2.0- to 4.7-inch-long), drooping, terminal racemes and releases a sweet, grapelike aroma. One to five bright-red, hard seeds or beans are produced in silvery 2- to 13-cm-long (0.8- to 5.1-inch-long) pods constricted between the seeds.1,2

Native Americans of the American southwest and Mexico used S secundiflora seeds (also known as mescal or red beans) in ceremonies because the seeds were considered to have divinatory, oracular, and hallucinogenic properties. The seeds do not contain mesca-line but do include the alkaloid cytisine (also known as sophorine). Cytisine is similar in action to nicotine and binds to both nicotinic and muscarinic receptors.3–5

There is limited published information on the effects of S secundiflora ingestion by dogs.6 Although its primary activity is to manage human exposures, the Texas Poison Center Network received 20 calls about canine ingestion of S secundiflora from 2000 to 2018. By comparison, there were 805 reported cases of S secundiflora ingestion by humans during the same period. The part of the plant involved in these ingestions was the seed (12 [60%]), flower (1 [5%]), or root (1 [5%]), or was unknown (6 [30%]). Fifteen (75%) of the ingestions occurred at the home of the dog's owner or caregiver, 1 (5%) at another residence, and 4 (20%) at an unknown location.

Nine (45%) of the dogs were managed outside of a health-care facility, 1 (5%) was referred to a veterinary facility by the poison center, 5 (25%) were managed at a veterinary facility, and 5 (25%) were managed at an unspecified or unknown location. The most commonly reported initial sign was vomiting (4 [20%]). Other clinical signs reported in association with ingestion were blood in the rectum, ataxia, drowsiness or lethargy, and hyperventilation or tachypnea. Thirteen (65%) of the ingestions were not considered to be potentially serious, and 6 (30%) were considered to be potentially serious. In the remaining case, the ingestion was considered to have probably not been responsible for the reported signs. No deaths were reported, but the Texas Poison Center Network generally does not follow animal exposures to determine final outcome.

These cases suggest that ingestion of S secundiflora by dogs might result in gastrointestinal or neurologic signs. Thus, pet owners and caregivers should take care when dogs are in environments where S secundiflora can be found.

Mathias B. Forrester, bs

Austin, Tex

  • 1. Lady Bird Johnson Wildflower Center. Sophora secundiflora. 2011. Available at: www.wildflower.org/plants/result.php?id_plant=sose3. Accessed Jan 2, 2019.

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  • 2. Vines RA. Trees, shrubs, and woody vines of the Southwest. Austin, Tex: University of Texas Press, 1960.

  • 3. Erowid. Sophora secundiflora. 2015. Available at: www.erowid.org/plants/mescal/mescal.shtml. Accessed Jan 2, 2019.

  • 4. Wiegand TJ, Smollin CG. Ingestion of mescal beans (Sophora secundiflora) causing agitation in an adolescent—a new intoxicant. Clin Toxicol (Phila) 2007;45:344.

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  • 5. Izaddoost M, Harris BG, Gracy RW. Structure and toxicity of alkaloids and amino acids of Sophora secundiflora. J Pharm Sci 1976;65:352354.

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  • 6. Knauer KW, Reagor JC, Bailey EM, et al. Mescalbean (Sophora secundiflora) toxicity in a dog. Vet Hum Toxicol 1995;37:237239.

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