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IN SHORT

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Boehringer Ingelheim's manufacturing site in Barceloneta, Puerto Rico (Courtesy of BI)

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

SCIENTISTS DISCOVER HOW PARVOVIRUS LEARNED TO INFECT DOGS

Parvovirus infected cats and other animals long before it acquired a few mutations and started a worldwide epizootic among dogs in the late 1970s. Now, a team led by Cornell University's Colin Parrish, PhD, has worked with the laboratory of Susan Hafenstein, PhD, at Pennsylvania State University to discover how parvovirus enters cells in dogs.

In a paper published Oct. 8, 2019, in the Proceedings of the National Academy of Sciences, the researchers reported that the virus attaches to the pointy end of the transferrin receptor, a protein that all cells use normally to take in iron. Once attached to the receptor, the virus sways back and forth. It's possible that this rock-and-roll action causes the virus to change shape and be transported inside the cell, which is the first step on the pathway to infection.

Heather Callaway, PhD, a former graduate student in Dr. Parrish's laboratory, worked with postdoctoral researcher Hyunwook Lee, PhD, in Dr. Hafenstein's group to visualize the interaction using cryo-electron microscopy. This technique allowed the researchers to freeze the purified virus and receptor together, catching them in the act of binding, so that the researchers could see exactly how the attachment occurred.

In the future, researchers will look for a drug or antibody to block receptor binding in infected dogs, particularly puppies that are too young to be vaccinated.

BOEHRINGER INGELHEIM EXPANDS SITE TO MEET DEMAND

Boehringer Ingelheim announced Nov. 13, 2019, a nearly $50 million expansion of its manufacturing site in Barceloneta, Puerto Rico, to meet growing demand for its products.

Headquartered in Duluth, Georgia, Boehringer Ingelheim Animal Health USA Inc. has invested more than $220 million to expand sites in Georgia, Missouri, and Puerto Rico in the last few years.

Secretary Manuel A. Laboy Rivera of the Puerto Rico Department of Economic Development and Commerce noted that the pharmaceutical industry in Puerto Rico accounts for 29.9% of the territory's gross domestic product, according to a BI press release.

The Barceloneta plant has been in operation for 48 years; it manufactures Heartgard Plus, a combination heartworm preventive and intestinal wormer. The $49.9 million expansion will allow the site to start manufacturing NexGard, a flea and tick preventive. The Barceloneta site already packages NexGard manufactured in Brazil for shipment to the United States and Canada.

This fall, Boehringer Ingelheim plans to donate the first of 60,000 doses of rabies vaccine and tens of thousands of dollars to fight rabies in Puerto Rico.

RESCUES IMPLICATED IN CANADIAN OUTBREAK OF DOG FLU

Imported dogs likely spread canine influenza to Canada, causing outbreaks in 2017–18, according to health investigators.

Investigators found links between clusters of illnesses in Ontario and dogs that had arrived from South Korea and China, according to findings published in the October issue of Emerging Infectious Diseases. One of the article authors—Dr. Scott Weese, veterinary internist at the University of Guelph and associate editor for EID—also described the findings in a November podcast.

The article indicates an H3N2 canine influenza A virus sickened at least 104 dogs in Ontario from December 2017 through October 2018. One died, and another was euthanized.

Investigations linked the imported dogs with rescue organizations. Dr. Weese said people with rescue organizations bring dogs into North America from Asia to remove them from meat production.

The article is available at jav.ma/emergingH3N2, and the podcast is at jav.ma/H3N2podcast.

FDA describes legal limits of drug compounding

Agency says few uses allowed for raw active ingredients

Greg Cima

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The Animal Medicinal Drug Use Clarification Act, passed in 1994, lets veterinarians administer approved drugs outside their labeled indications, and that allowance applies to compounded drugs made from approved products. But it doesn't allow administration of drugs compounded from raw pharmaceutical ingredients, even if the compounded products contain the same active ingredients as approved drugs.

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

Federal authorities plan to affirm that veterinarians and pharmacists can compound animal drugs from raw active ingredients, which the Food and Drug Administration refers to as bulk drug substances, but only under narrow circumstances.

They also plan to focus enforcement efforts against those who sell copies of approved drugs.

In November, FDA officials published draft guidance that describes which animal drug compounding methods are legal, illegal and subject to enforcement, or illegal but allowed by policy because they benefit patients. The guide, Compounding Animal Drugs from Bulk Drug Substances, is available at jav.ma/Guide256.

Citing the Food, Drug, and Cosmetic Act, agency officials said an animal drug compounded from raw active ingredients is a new product that needs FDA review, whether that's reflected in full approval, conditional approval, or the indexing that allows administration to non–food-producing species with small populations. But they acknowledge some animals benefit from exceptions.

A cat allergic to a drug ingredient may need a specially compounded formulation. Cattle that have eaten poisonous plants may need a compounded antidote. Office stock of compounded apomorphine hydrochloride could induce a dog to vomit in time to save its life.

Veterinarians and pharmacists still should dispense an approved drug when possible and, when none is, should consider extralabel use of an approved or indexed animal-use or human-use drug, the draft guidance states. If none meet the patient's needs, a compounder should try to use an approved drug, a conditionally approved drug, or an indexed drug as the source of active ingredients before resorting to raw active ingredients.

NARROW EXCEPTIONS

Dr. Amber McCoig, deputy director of the FDA Center for Veterinary Medicine's Division of Compliance, said in a video presentation in November that the Animal Medicinal Drug Use Clarification Act, passed in 1994, lets veterinarians administer or authorize approved drugs outside their labeled indications, and that allowance applies to compounded drugs made from approved products. But it doesn't allow administration of drugs compounded from raw active ingredients, even if the compounded products contain the same active ingredients as approved drugs.

FDA officials have received reports of illnesses and deaths associated with compounded drugs made from bulk ingredients that were too potent, contained incorrect ingredients, or contained contaminants, Dr. McCoig said. She cited three examples since 2009 of compounded equine-use drugs that contained too much selenium or pyrimethamine and killed at least 28 ponies and horses.

Dr. McCoig also noted that improper compounding can discourage investment in new animal drugs and undermine approved drugs.

Janice Steinschneider, regulatory counsel for the FDA CVM, said during the same presentation that veterinarians who prescribe or make a compounded animal drug need to work within a veterinarian-client-patient relationship. They also should report adverse events to the FDA.

Steinschneider said FDA policy will, under the draft guidance, let veterinarians and pharmacists use raw active ingredients to make drugs for specific, identified, non–food-producing animals when the final products need to differ from existing drugs on the basis of contents or administration route. If the compound and an approved or indexed drug have the same active ingredients, same routes of administration, and similar strength, the veterinarian should say in the prescription why the animal needed a product compounded from raw active ingredients.

The draft guidance allows making office stock of certain compounded substances that may be needed more quickly than compounding allows; those drugs are included in a list from the FDA. Plus, the bulk substances on the list can be used to make antidotes for food-producing animals, provided veterinarians tell clients how long the animals need to be held or their products discarded to keep the drugs out of the human food supply.

The list of stock compounds can be found at jav.ma/compoundstock. FDA officials are accepting nominations to the list.

CONCERNS FROM COMPOUNDERS

Soon after the draft's publication, AVMA volunteers started reviewing it with plans to send comments to the FDA, according to a Nov. 19, 2019, post on the AVMA@Work blog. The post states that the AVMA is committed to preserving veterinarians' access to compounded drugs and the FDA drug approval process.

Leaders of the Alliance for Pharmacy Compounding, formerly the International Academy of Compounding Pharmacists, said they disagree with the FDA's interpretation that the law restricts compounding animal drugs from raw active ingredients and with the agency's plan to apply policy through guidance rather than regulations. David Pore, governmental affairs counsel for the APC, said in late November the organization was studying details of the policy ahead of submitting comments.

Under the draft guidance, compounders would rely on enforcement discretion, he said.

Anthony Grzib, who is chair of the APC's legislative committee and a compounding pharmacist for Wedgewood Pharmacy in Swedesboro, New Jersey, noted that the FDA's list of approved compounds for office stock started with eight active pharmaceutical ingredients and a call to nominate more. Wedgewood uses such raw active pharmaceutical ingredients in about 2,000 animal products that account for half the company's veterinary-use compounding, he said.

“It's difficult to imagine how we're going to be able to serve patients with only being able to use eight APIs,” he said.

Grzib said the guidance language also would limit compounding that modifies only the flavor or dosage form of a drug. A liquid and a chewable treat, for example, could deliver a drug in different forms but the same route of administration.

An FDA spokeswoman clarified that, while such a product would be considered a copy, a pharmacist can compound such a product when a veterinarian determines the change would be a clinical benefit for the veterinarian's patient. The veterinarian needs to explain that decision in the prescription, and the pharmacist needs to document why the drug could not be compounded from an approved product.

Grzib said having office stocks of compounded medicines available also benefits veterinarians who travel to animals.

“The veterinarians don't always know which animals are going to need what medication when they visit a barn or a zoo,” he said. “And so that's why office use is much more prevalent in animal health than in human health.”

The FDA also maintains lists of bulk drug substances that can be used in compounding human medicines to address shortages or unmet clinical needs. Pore said adding drugs to those lists involves a restrictive nomination and approval process, and he expects similar scrutiny of compounded animal drugs.

FDA officials published another draft guide on compounding in May 2015 and withdrew it in November 2017 in response to comments. In that document, FDA officials described compounding animal drugs from raw ingredients as manufacturing but said they would allow limited uses for patient care.

At the time, AVMA leaders responded that they thought the proposed guidance could limit treatment options and harm animals. In an 18-page letter from then–AVMA CEO Dr. W. Ron DeHaven, the AVMA criticized provisions that would have restricted administration of drugs compounded from raw drug substances to individually identified animals, which would exclude populations in zoos and aquariums; limited veterinarians' abilities to stock emergency-use doses of compounded drugs; and required a clinical benefit from compounding from raw ingredients over approved products, which would have prevented compounding of drugs that were approved but unavailable.

ASSOCIATION STRENGTHENS POLICY ON EXTRACTIVE INDUSTRIES

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Bison graze at dusk near a hydraulic fracturing rig. Fracking is a technique to extract oil and gas from rock by injecting high-pressure mixtures of water, sand or gravel, and chemicals.

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

The AVMA has bolstered its policy on extraction of gas, oil, and minerals to support responsible practices that minimize negative impacts on animals, humans, and the environment.

The previous policy on “Extractive Industries” stated only this: “AVMA supports objective scientific research on extractive industries' impacts on animal health, foods of animal origin, and the environment.”

The AVMA Committee on Environmental Issues recommended strengthening the policy, with an emphasis on industry transparency. The committee believes that it is appropriate for the AVMA to weigh in when evidence suggests that the conduct of human activities is impacting the health and welfare of animals, according to background materials.

In late 2017, the United States withdrew as one of more than 50 implementing countries of the Extractive Industries Transparency Initiative, although the U.S. remains a supporting country of the initiative. The EITI has established a global standard to promote the open and accountable management of oil, gas, and mineral resources.

The AVMA Board of Directors, while meeting in November 2019, revised the AVMA policy on “Extractive Industries” to read as follows:

Extractive Industries

AVMA supports objective scientific research on extractive industries' impacts on animal health, foods of animal and plant origin, and the environment. The AVMA also supports responsible extractive industry practices that minimize negative impacts on animals, humans, and the environment and believes that industry transparency is critical to achieve this goal.

AVMA LAUNCHES NEW VERSION OF WEBSITE

The AVMA has spent a year and a half developing a new version of the Association's website at avma.org. The new site went live Dec. 4, 2019.

“After several years of service from our previous AVMA website, we recognized that it was time for a new model, one that would enhance our members' experience with reorganized content, improved searchability, and dynamic design and visuals—ultimately helping us share the important work the profession does,” said Dr. Janet Donlin, AVMA chief executive officer.

“Throughout the project, we put a strong focus on collecting member feedback and incorporating insights gleaned from website surveys and analytics. This is an exciting time for the AVMA as we work to continue supporting our members and the public through a new and improved web experience.”

Members of the AVMA and other users of the AVMA website will be able to take advantage of the following features and functionality:

  • • A new dashboard for AVMA members, upon login, that engages them with their representatives on the AVMA Board of Directors and AVMA House of Delegates and provides direct access to membership links and the latest in AVMA news and policies.

  • • Navigation and search tools that help users more easily find the specific information they are looking for, while broadening awareness of AVMA offerings, advocacy, and policy initiatives.

  • • Clear visual distinction of member-only content to convey member value for current and prospective members.

  • • Landing pages that organize complex topics into content that is easy to scan for specific information.

  • • An improved search tool that allows users to sort and filter content on the basis of multiple criteria.

A major goal of the redesign is to improve the findability of information through a re-engineered and user-tested menu system, an updated search function, and new page layouts.

The new website also was built to meet modern guidelines for accessibility of web content, ensuring the site is fully accessible for everyone, including people with disabilities or limited browsing devices.

In the weeks after the December launch, the AVMA continued to update content, address bugs, and refine the organization of information across the site. On an ongoing basis, the AVMA will update content and add technical enhancements to keep the site fresh and relevant for members and the public.

CONTEST PUTS STUDENTS' ANIMAL WELFARE KNOWLEDGE TO THE TEST

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The 19th annual AVMA Animal Welfare Assessment Contest hosted this past November by Colorado State University drew the highest number of participants since the contest began in 2001.

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

The AVMA Animal Welfare Assessment Contest has been around for nearly 20 years and is one way undergraduates, graduate students, and veterinary students can learn more about the important topic of animal welfare.

Participants must conduct live and computer-based assessments of the welfare of animals in various settings. Those decisions and how well the participants present and justify their positions are scored by a panel of judges.

Started at Michigan State University in 2001, the Animal Welfare Assessment Contest—formerly known as AWJAC for Animal Welfare Judging/Assessment Contest—was modeled on traditional livestock, horse, and meat judging competitions to encourage students to learn about welfare while competing with students from universities across North America. The competition teaches students to assess the welfare of animals in a variety of settings using science-based methods and reasoning. Contestants also learn communication skills to help them clearly share information. Aside from alumni's positive reviews of the event, now there is further evidence that the event benefits participants by not only increasing their aptitude for animal welfare, but also helping them hone other skills.

The “Special Reports” section of this issue of JAVMA features the findings from a survey of veterinary students who participated in the contest. Overall, students reported coming away from the experience with a heightened awareness of animal welfare science. Moreover, they saw the contest as an opportunity to expand their professional networks and to expand their communication and critical thinking skills (J Am Vet Med Assoc 2020;256:239–244).

A record 244 participants representing 25 universities competed in the 19th annual AVMA Animal Welfare Assessment Contest, Nov. 23–24, 2019, at Colorado State University. The event included keynote addresses from Temple Grandin, PhD, professor of animal science at Colorado State, and Ruth Woiwode, PhD, a livestock auditor with Food Safety Net Services. Results of the 2019 competition are as follows:

  • • Veterinary Student Division: Live Assessment High Scoring Individual—Brittany Senecal, University of Illinois; Live Assessment High Scoring Team—Michigan State University; Overall Individual—Caleb Brezina, Iowa State University; and Overall Team—University of Guelph.

  • • Graduate Student Division: Live Assessment High Scoring Individual—Shannon Kelley, The Ohio State University; Live Assessment High Scoring Team—Colorado State University; Overall Individual—Emma Heuchan, University of Guelph; and Overall Team—University of Guelph.

  • • Undergraduate Division: Live Assessment High Scoring Individual—Samantha Likar, University of Minnesota; Live Assessment High Scoring Team—Texas A&M University; Overall Individual—Ashley Dunn, Michigan State University; and Overall Team—Michigan State University Team 1.

“We're excited that this event continues to draw more and more participants every year. It's a great indication of the leadership role veterinarians play—and will continue to play—in protecting animals' welfare,” said AVMA President John Howe.

“These dedicated future veterinarians and animal scientists have worked hard to prepare for this contest, and the things they've learned and the connections they've made this past weekend will help position them for great success in their future careers,” he said.

The next two Animal Welfare Assessment Contests will be held at North Carolina State University, followed by contests in 2022 and 2023 at the University of Wisconsin-River Falls.

Learn more about the Animal Welfare Assessment Contest at AWJAC.org.

WHO: VACCINE MAKES EBOLA PREVENTABLE

A vaccine against the most deadly strain of Ebola virus meets international agencies' standards, giving hope it could reduce the toll of outbreaks.

World Health Organization officials said Nov. 12, 2019, that Merck's injectable human-use vaccine against Ebola Zaire virus meets the organization's standards for quality, safety, and efficacy. That determination lets United Nations' agencies and the organization Gavi, the Vaccine Alliance, buy it for use in at-risk countries.

One day earlier, Merck officials announced that the European Commission had granted a conditional marketing authorization for the vaccine, which allows its use in European Union countries.

In an announcement, WHO Director-General Tedros Adhanom Ghebreyesus called the WHO's declaration a historic step.

“Five years ago, we had no vaccine and no therapeutics for Ebola,” he said. “With a prequalified vaccine and experimental therapeutics, Ebola is now preventable and treatable.”

Kenneth C. Frazier, chairman and CEO of Merck, said in a company announcement that the vaccine, Ervebo, is a product of unprecedented collaboration and should be a global source of pride. He noted that the vaccine is under review by other agencies, including the U.S. Food and Drug Administration.

“We at Merck are honored to play a part in Ebola outbreak response efforts and we remain committed to our partners and the people we serve,” he said. “We also look forward to continuing to work with the FDA and the African countries on their regulatory reviews over the coming months and with the World Health Organization on vaccine prequalification, which will help broaden access to this important vaccine for those who need it most.”

Merck will make the vaccine at a plant in Germany, and licensed doses will be available starting in the third quarter of 2020, the company announcement states.

Pandemic prevention program ending after 10 years

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Members of a Predict Rwanda team collect samples from rodents. (Photos courtesy of the University of California-Davis One Health Institute)

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

USAID Predict led virus discovery, health training, risk education

Greg Cima

After an Ebola epidemic, disease experts spent 2 1/2 years searching in three West African countries for viruses that endanger people.

Partners in the U.S. Agency for International Development's Predict program trained local teams on biological safety and collected tens of thousands of diagnostic samples in Guinea, Liberia, and Sierra Leone, especially from bats. They found a new Ebola strain—Bombali—in free-tailed bats and found the deadly Marburg virus in the region for the first time. In one bat, they found a Zaire ebolavirus, the type that caused the 2014–16 epidemic and killed 11,000 people.

David Wolking, senior manager of global programs for the One Health Institute at the University of California-Davis and global operations manager for Predict, said Predict teams in those countries used the findings to teach people in nearby villages how to reduce their risk and connected them with government and health care workers who could use Predict's training to help them stay safe.

“I think that's a really great encapsulation of Predict's mission and our achievements as a whole,” Wolking said.

The Predict project is winding down after 10 years of work that identified 1,100 unique viruses, provided aid to 60 disease detection laboratories, and trained 6,200 people in 30 countries. The project, led by the UC-Davis One Health Institute, is part of the USAID Emerging Pandemic Threats program.

Wolking said Predict's second five-year term ended Sept. 30, 2019, although USAID provided a six-month extension for studies that use the project's accumulated evidence to learn about virus spillover, spread, and countermeasures. He knows USAID officials want to continue the type of work conducted by Predict: reducing pandemic threats, increasing laboratory capacity, and learning what dangerous viruses threaten people, especially those circulating in wildlife.

Dr. William Karesh is executive vice president for health and policy at EcoHealth Alliance, one of the founding organizations in Predict. He said Predict's 10-year run was a success, and it makes sense to move on.

“The project's been so productive and so successful, at some point, you need to take those lessons and move forward expanding into other areas,” he said.

Dr. Karesh said the project built nations' cross-disciplinary health platforms. It also helped people in those countries set health policies and priorities.

Building those platforms took cooperation across environmental and public health sectors, as well as a little money and a lot of trust, Dr. Karesh said. But local government agencies are better able to keep developing the platforms, and partner organizations are better at writing grant proposals and seeking funding. The European Union, World Bank, and private foundations see the wisdom of investing in these disease prevention efforts, he said.

In a 2018 article in the journal Science, leaders of the Global Virome Project announced a 10-year effort to discover hundreds of thousands of viruses from the same families as known zoonoses, with funding from governmental and nongovernmental organizations. Project information cites the Predict program as proof such a virus discovery program is feasible.

A USAID spokesperson provided a statement that the agency continues its commitment to work with countries on reducing spillover, amplification, and spread of zoonoses and becoming self-reliant in fighting disease. Predict provided a wealth of data and analyses that will aid new projects as USAID officials keep working to detect pathogens with pandemic potential and reduce that risk.

“The Agency looks forward to building upon the lessons learned and the significant contributions made by the consortium to the global knowledge base to protect Americans and people around the world from future infectious threats,” the statement says.

The project's one-health approach, Wolking said, helped build international coalitions that could send people into the field and conduct difficult sampling and data collection work, especially in tropical regions known as hot spots for disease emergence.

The project's data will remain available to all, which Wolking thinks will be a huge benefit and a legacy of Predict.

Predict's legacy also includes Living Safely with Bats, a picture book designed to help people understand that bats have important environmental roles but can host viruses that cause diseases in people.

Dr. Karesh said Predict's teams worked with academic and government partners in Jordan, as well as Bedouins who breed camels, to identify the Middle East respiratory syndrome coronavirus in camels and report the finding to international health authorities. A university-based Predict partner in Thailand tested for unknown viruses among boys who had been trapped 18 days in a cave, finding no novel viruses and reassuring families and government officials.

The local partners from Predict are staying in their home countries, where they can teach others and build defenses against emerging disease, Dr. Karesh said.

“At some point, when we do foreign aid and when we do development projects, they're supposed to become self-sustaining or sustainable,” he said. “That'll never happen if you continue projects for hundreds of years.”

Canadian veterinary colleges teach access to care

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Predict team members examine wild birds following a large die-off in August 2018 at Sangiin Dalai Lake in Mongolia.

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

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Dr. Shane Bateman, associate professor of emergency and critical care medicine at the University of Guelph Ontario Veterinary College, works with veterinary students at the Guelph Humane Society. (Photos courtesy of University of Guelph)

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

Funding supports curriculum changes at Ontario, Atlantic veterinary colleges

Students at two Canadian veterinary colleges will graduate with a better understanding of how to remove barriers to clients accessing care, thanks to funding meant to revolutionize veterinary education and services.

Last November, the University of Guelph Ontario Veterinary College announced it had received an $11 million donation—the largest in the college's history—from Kim and Stu Lang through their Angel Gabriel Foundation.

University President Franco Vaccarino said OVC will work with community partners to ensure its veterinary students graduate with the skills and knowledge to support and lead programs that expand animal health care for underserved populations, including identifying and removing barriers to access.

“This generous gift will bring together professionals serving vulnerable animal and human populations to allow us to learn from each other, address social inequities and share knowledge using an interdisciplinary One Health approach,” Vaccarino said in a Nov. 4, 2019, press release.

The donation will create the Kim and Stu Lang Community Healthcare Partnership Program, the first academic program of its kind in Canada. It will expand initiatives such as OVC's community outreach and spay-neuter programs that provide veterinary services for shelters and underserved and remote communities.

The CHPP will enhance and develop partnerships with humane societies, veterinary outreach organizations, and social service agencies already doing important work in community health care. The CHPP will drastically expand opportunities for student experiential learning, including a clinical rotation where OVC will partner with northern indigenous communities.

The program also will include graduate training and specialization in community or shelter medicine to educate future specialists and help establish evidence-based best practices. Previously, such training was available only outside of Canada.

Capital improvements on campus will enhance clinical facilities to accommodate the expanded medical and surgical offerings. Operational funding will support equipment, supplies, and personnel to deliver programs at the university, in surrounding communities, and remotely, according to the release.

Further, the gift will support a full-time veterinary director, an academic professorship, staff, and student scholarships as well as intern and resident training programs in community medicine. Remy's Fund, named for one of the Langs' rescue dogs that received life-saving cancer treatments at OVC, will be created to subsidize medical care for animals in need.

“This gift will allow us to catalyze one of the most significant developments in clinical training we have seen in recent decades,” said Dr. Jeff Wichtel, dean of Ontario Veterinary College, in the release.

Meanwhile, the University of Prince Edward Island Atlantic Veterinary College in November announced it had received a $50,000 grant from the U.S.-based Stanton Foundation's program to develop courses on canine care.

Dr. Michelle Evason, an associate professor of small animal internal medicine, is using the funding to develop a new third-year elective course that will teach veterinary students to identify and define the spectrum of care and give them the tools they need to address the issue.

The spectrum of care is defined as the availability and accessibility of veterinary medical care regardless of the socioeconomic status of the pet owner.

The course, thought to be the first of its kind to be taught at a veterinary college in Canada, will be offered in the winter 2020 semester.

Using the knowledge and skills they have gained in their veterinary education, third-year students will learn to develop diagnostic and treatment options that span the full spectrum of care for common clinical conditions, determine the likelihood of success of the options, and design communication plans to help clients make informed and shared decisions. Local veterinarians in private practice will be involved in teaching and evaluating the course, sharing their experiences, and mentoring the students.

FIP DRUGS CONTINUE TO SHOW PROMISE WHILE BEING SOLD ON BLACK MARKET

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Bubba was a participant in the field trial of the antiviral drug GS-441524 for treatment of feline infectious peritonitis and is still doing very well two years later. (Courtesy of Dr. Niels C. Pedersen)

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

Katie Burns

Two antiviral drugs have shown promise in the past few years for the treatment of cats with feline infectious peritonitis, which has been almost always fatal. Some desperate cat owners have turned to the black market to buy the unapproved drugs.

In April, the Journal of Feline Medicine and Surgery published the latest study on the antiviral drugs, evaluating the efficacy and safety of the nucleoside analog GS-441524 for cats with naturally occurring FIP. Treatment was successful in 25 of 31 cats, and the researchers described the safety profile of the drug as impressive.

Efficacy against naturally occurring FIP appeared greater with GS-441524 than with the viral protease inhibitor GC376, the first antiviral drug evaluated for treatment of cats with FIP. When given to younger kittens, GC376 interfered with the development of permanent teeth. Nevertheless, the researchers wrote in the April paper, “GC376 should be further studied using a minimum of 12 weeks with a higher dosage and a larger number of cats before making any final comparisons.”

In 2018, Kansas State University licensed GC376 to Anivive Lifesciences Inc. of California for commercial development.

A number of entities, largely in China, are manufacturing unapproved versions of GS-441524 and GC376 for sale to owners of cats with FIP, according to a June update from Dr. Niels C. Pedersen, FIP researcher and professor emeritus at the University of California-Davis School of Veterinary Medicine.

“Veterinarians, who are under more legal and ethical constraints, may view the black market quite differently from owners of cats suffering from FIP,” Dr. Pedersen wrote. “Some may refuse to participate beyond making the initial diagnosis of FIP, some may help with drug administration and monitoring as long as the owners provide the drug, and some may require signed waivers freeing them of any legal or ethical obligations.”

UC-Davis has compiled a list of general FIP resources, available at jav.ma/FIP. The resources include updates from Dr. Petersen, studies, literature reviews, and information about treatment.

As for prevention of FIP, researchers at Colorado State University, funded by Morris Animal Foundation, are working on a vaccine for the feline enteric coronavirus, which can mutate into the FIP virus. If successful, the vaccine will control pervasive FECV infection in animal shelters and other multicat environments while also protecting individual cats against FIP. Vaccination against FIP itself has so far been unsuccessful.

In a second study funded by the foundation, Colorado State researchers are working to develop a new diagnostic test for FIP. They have identified 18 proteins in the blood of cats, among thousands, that appear to be common in cats with the disease. The team aims to prove that the proteins are indeed markers for FIP and determine which ones can be detected easily and developed into a diagnostic test.

Keeping veterinary services tax-free

State VMAs fight efforts that would raise veterinary care costs

R. Scott Nolen

In their perennial search for new revenue sources, governors and state legislators often propose taxing professional services.

These are services provided by veterinarians, physicians, architects, attorneys, engineers—basically anyone requiring special certification, education, and licensing to practice in a state. Just four states currently tax veterinary services—Hawaii, Kentucky, New Mexico, and South Dakota—but not for a lack of trying.

“For us, it typically comes up during the budget cycle,” said Jack Advent, executive director of the Ohio VMA, about legislative proposals to tax professional services. “It didn't come up at all in our last budget cycle, but it did during each of the previous three.”

Reasons for opposing a service tax vary. One argument is such taxes are regressive and would disproportionally impact low-income residents. Another is small businesses are less competitive against larger retailers that are better able to absorb the costs. The objection raised by veterinarians is the subsequent increase in the cost of veterinary services would ultimately harm animals.

“It is important to keep veterinary services tax-exempt in our state because Vermont has a very high cost of living relative to incomes,” explained Kathryn Finnie, executive director of the Vermont VMA. “If services are taxed, people may view veterinary care as discretionary, and the health of Vermont animals would suffer.”

FROM GOODS TO SERVICES

The first state sales tax laws were enacted during the 1930s when the U.S. was primarily a manufacturing economy. States started collecting taxes on sales of tangible goods, such as food and houses, but exempted fees charged for professional services.

Then, during the 1960s, the services portion of the economy began to expand and continued to grow to a point where it now contributes almost half of the nation's GDP, according to the federal Bureau of Economic Analysis.

Five states—Alaska, Delaware, Montana, New Hampshire, and Oregon—impose no general, statewide sales tax on either goods or services.

Given the shift from a manufacturing to service-based economy, state officials often describe sales tax laws that exempt professional services as antiquated. In a 2017 budget message, former Oklahoma Gov. Mary Fallin said, “The way we impose taxes and collect revenue no longer reflects the current economy, but an outdated system that has not changed much since its inception.”

Attempts to amend sales tax laws to reflect the new economic reality are rarely successful as they are met with strong opposition from coalitions comprising diverse professional organizations. The three times Ohio's former governor attempted to tax professional services, the state VMA joined with organizations representing auto dealers, accountants, and lawyers to defeat the initiative each time.

“They loved us,” Advent recalled. “While we were certainly not the biggest organization in the coalition, they loved us because the average consumer holds veterinarians in high regard. And our message was simple: The governor wants to tax the health care of your pet.”

Even when legislators tried “cherry picking” a handful of services to tax, the coalition returned in force. “It's like Benjamin Franklin said, ‘Either we hang together, or we hang separately.‘ We understand that it may not be us today, but in a few more years it might be,” Advent said.

THE FINE PRINT

No two states have the same tax laws, which can be so nuanced as to be confusing. For instance, some states exempt animal products from sales tax when purchased by a livestock producer or used in food animals. Last year, the Vermont VMA successfully advocated the passage of legislation clarifying a 50-year-old law exempting veterinary supplies from sales tax.

“The tax department wanted to strictly interpret the existing language to only allow exemptions for supplies for agricultural animals,” Finnie explained. “Passage of clarifying legislation was necessary to preserve our exemption, and veterinarians actively lobbied their legislators and testified in House and Senate committee hearings.”

The legislation that passed exempted veterinary supplies and pharmaceuticals, including vaccines, as well as durable medical equipment but not over-the-counter medicines.

“At a time when the legislature was looking to find money under any rock, this was considered a big accomplishment for our members,” Finnie said.

DISCOVERY MAY LEAD TO NEW RABIES VACCINES

Researchers have reportedly found a way to prevent the rabies virus from shutting down vital defense responses in the immune system.

The discovery, published in early November 2019 in Cell Reports, could lead to the development of new rabies vaccines, including oral vaccines for dogs, which are responsible for most of the 60,000 human rabies deaths reported worldwide each year.

Scientists at Monash University and the University of Melbourne believe they are the first to observe how a particular protein made by the rabies virus binds to a critical cellular protein known as signal transducer and activator of transcription 1, halting key parts of the immune response.

What wasn't understood was how P-protein—the main immune antagonist of lyssaviruses, including the rabies virus—takes hold of STAT1, because of a lack of direct structural data on STAT1 complexes with viral proteins.

The researchers brought the two proteins together and, using nuclear magnetic resonance spectroscopy, showed the precise regions where the viral protein sticks to STAT1 and holds on to it to keep it away from locations in the cell where it needs to be to activate the immune response.

“We were able to find new regions and new sites for mutations and so could target these in a virus, completely preventing it from being able to grab hold of STAT1,” said Paul Gooley, PhD, an associate professor of biochemistry and molecular biology at the University of Melbourne and a senior author of the study, in a press release.

Using a wild strain of rabies virus, collaborators at the Pasteur Institute in France showed that by disabling this binding, they could weaken even a highly pathogenic virus. Oral vaccines can be more immunogenic with attenuated live virus than with killed virus.

In up to 99% of cases of rabies in humans, domestic dogs are responsible for transmitting the virus, according to the World Health Organization. In 2018, the WHO announced a global strategy to eliminate dog-mediated rabies by 2030.

Methods such as culling dogs have not worked to control rabies, and while mass vaccination is effective, catching and injecting animals is problematic, explained Greg Moseley, PhD, a microbiologist at Monash University and also a senior author of the study, in the press release. There are several candidates for oral vaccines for dogs.

“The development of a new safe and highly effective rabies vaccine that can be given orally or as ‘baits’ would be a major step forward,” Dr. Moseley said.

RESEARCHERS LOOK FOR IBDV–AVIAN FLU LINK

A million-dollar grant from the U.S. Department of Agriculture is helping a coalition of international researchers better understand how infectious bursal disease virus affects the transmission of disease caused by influenza A virus in chickens.

The $1,025,000 award, announced by the USDA National Institute of Food and Agriculture this past November, will be shared among researchers at the University of Minnesota College of Veterinary Medicine, the University of Oxford, and the Pirbright Institute. Located in Surrey, England, the Pirbright Institute studies infectious diseases of farm animals.

“Understanding transmission and evolution of infectious diseases is really important not just for chickens, but for any population, be it humans or animals,” said Dr. Marie Culhane, an associate professor in the Department of Veterinary Population Medicine at Minnesota's veterinary college and co-investigator on the project, in a press release.

Dr. Culhane has spent her career studying influenza viruses in all species. She said the study “could have broader implications, such as how the immune status of an individual in the flock, herd, or group affects disease spread.”

Infectious bursal disease virus weakens the immune system in chickens. Researchers suspect IBDV may be a key player in the spread of avian influenza, prolonging the period during which birds can shed viruses into their environment and reducing vaccine efficacy.

Moreover, IBDV has been identified in wild bird species in Europe, and because wild birds are natural hosts for avian influenza, it's quite likely that wild birds with both IBDV and avian influenza will be better at spreading the viruses to domestic poultry. The study is investigating the genetic code of IBDV and how differences in that code change the way the viruses move.

Data collected from the study will be used in transmission and surveillance simulation models to help determine the impact of IBDV exposure and spread of disease. The models will also attempt to capture the effect of IBDV exposure on the time it takes to detect avian influenza virus shedding from infected birds to other birds in the same environment.

Researchers hope their findings will raise awareness of the need to maintain good immune status in a flock to benefit animal welfare. It could also influence policy on the management of avian influenza by revealing a need for either increased surveillance for IBDV in both wild and domestic birds or screenings of the immune status of chicken flocks to help identify at-risk flocks sooner.

“A major advantage of this project is the combination of studies in both poultry and aquatic waterfowl populations,” said Dr. Carol Cardona, one of the lead investigators and chair in avian health in the veterinary college's Department of Veterinary and Biomedical Sciences, in the press release.

“This allows for a more holistic, integrated approach,” Dr. Cardona explained, “that combines field studies and metagenomic sequencing with experimental challenge studies in order to answer fundamental questions regarding the ecology and evolution of IBDV and avian influenza virus, which are both economically important pathogens for the poultry industry.”

Culture shift needed to enhance veterinary well-being

Summit explores individual, group efforts to achieve this shift, as well as suicide prevention

Malinda Larkin

Well-being isn't just an individual effort—it takes a village. Workplaces can play a substantial role in promoting health and well-being by reducing barriers to emotional and physical health (see page 150).

In addition, a collaborative and inclusive approach is essential for promoting healthy work environments that welcome all members of the team—not just those within the majority group (see page 158). All individuals need to be accepted for who they are versus how well they fit in, said Jen Brandt, PhD, director of well-being and diversity initiatives at the AVMA.

“It's up to teams, practices, and organizations to actively create space for individuals and groups who have traditionally been marginalized,” she said. “Creating inclusive environments requires intentional organizational commitment. It can no longer be the sole burden of the individual who has been marginalized to attempt to carve out a space where they can be accepted.”

These were the central themes that came out of the 2019 Veterinary Wellbeing Summit, held Nov. 17–19 in Rosemont, Illinois. The event attracted 263 attendees, who heard from industry experts and colleagues how to make individual and organizational well-being an everyday part of their personal life and professional practice.

The event, now in its sixth year, was hosted by the AVMA, Association of American Veterinary Medical Colleges, and Zoetis, with additional support from Hill's Pet Nutrition and Banfield Pet Hospital. The first four years of the well-being summits were aimed primarily at those who work in academic settings. For the 2018 and 2019 summits, the AVMA expanded the scope to include practitioners as well. The summit brings together veterinarians, veterinary students, educators, and mental health professionals to explore and identify individual, community, and systemic actions that can be taken to foster well-being and inclusivity in the workplace.

A number of sessions also focused on best practices in suicide prevention or post-vention, including a talk from Christine Moutier, MD, chief medical officer of the American Foundation for Suicide Prevention.

She mentioned that stigma reduction is a core component of any successful suicide prevention program, with a particular focus on vulnerable populations.

“You might be in the most enlightened school or practice, where you're shedding stigma and talking about mental health, but when you become distressed, your perception changes,” Dr. Moutier said. “Whether it's cognitive distortion or shame or fear or primal instinct of withdrawal, when we're not feeling ourselves or are weakened in some way, we have to keep in mind that it's OK to seek help.”

The summit builds on the AVMA's Workplace Wellbeing Certificate Program, which comprises five modules that connect veterinary team members with critical resources for group and individual problem-solving focused on creating a culture of well-being.

Participants in the certificate program must complete the first module—“Creating a Culture of Wellbeing”—before moving on to the remaining modules, which may be completed in any order. Participants who complete all modules will earn an AVMA Workplace Wellbeing Certificate of Completion in addition to four continuing education credit hours. The certificate program is free to all AVMA and Student AVMA members; the cost for other veterinary professionals to register is $75. See the AVMA's other well-being resources at avma.org/Wellbeing.

Prioritizing well-being at the institutional level

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Makenzie Peterson, well-being program director at Cornell University College of Veterinary Medicine, said working toward better well-being for all requires culture change. She gave the talk “Developing a Strategic Organizational Plan for Wellbeing” during the 2019 Veterinary Wellbeing Summit, held Nov. 17–19 in Rosemont, Illinois. (Photos by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

Self-care can only do so much for individuals in a toxic environment

Malinda Larkin

Jeremiah Grissett was hired last year as counselor and wellness coordinator at Oklahoma State University College of Veterinary Medicine. He's already gotten a counseling program set up for students. He's now working with a team lead by Dr. Margi Gilmour, associate dean for student and academic affairs, to create a better environment for everyone at the veterinary teaching hospital.

“There's so much stress for everyone over there. There's stress for veterinarians in general, but faculty have to teach, do research, and maintain client care. It's difficult for them,” Grissett said. “It's also not just a typical teaching position—you teach students as they come through on rotations. And students are growing and stretching during that time. It's long hours and difficult work.”

Grissett, the hospital director, and others in leadership have formed a team to approach culture change through a strategic plan. They will send a survey at the beginning of this semester to figure out what faculty, staff, and residents want to see changed.

He attended the session “Developing a Strategic Organizational Plan for Wellbeing” during the 2019 Veterinary Wellbeing Summit, held Nov. 17–19 in Rosemont, Illinois, to get ideas for how to make a plan happen.

The speaker for the session, Makenzie Peterson, well-being program director at Cornell University College of Veterinary Medicine, said working toward better well-being for all requires culture change. That's because individual efforts can't take root if the culture isn't open to them in the first place.

“Culture eats strategy for breakfast. There's the stuff we (organizations) put on our marketing materials, and then there's the boots-on-the-ground experience—that's culture. And it is a monster,” she said.

And while intimidating, culture change is necessary for many parts of the profession, Peterson said, citing results from the Merck Animal Health Veterinary Wellbeing Study, which showed that overall only 40% of veterinarians would recommend the profession. And of those with serious psychological distress, only 17% would recommend the profession (J Am Vet Med Assoc 2018;252:1231–1238).

“We're not doing well-being to be nice anymore; it's not a fluffy luxury. We're doing it to save lives at this point. We want everyone who participates in veterinary medicine to be in the profession as long as they want to be—not as long as they can stand it,” Peterson said.

She outlined the following five steps to create a culture of well-being at any workplace.

1. ESTABLISH ENOUGH LEADERSHIP BUY-IN.

Studies have shown that well-being programs reduce health costs and lead to higher engagement, improved productivity, higher retention, easier recruiting, reduced absenteeism, better company culture, and higher job satisfaction.

2. CONDUCT A NEEDS ASSESSMENT.

The needs assessment can look at resource allocation; the current culture, including values, and the hidden culture; and what is currently being offered for well-being as well as whether employees are happy with those offerings. Conduct a survey open to all members and departments. Collecting demographics is a good idea, too.

The second part of this step is data analysis. Identify stress points for the community, whether those are individual factors such as skills or competencies, systemic factors such as organizational communication or processes, or external factors such as clients, the economy, or industry trends. Also, look at capacity to see what well-being offerings can feasibly be made available and what can be outsourced or done as a partnership.

“The essence of strategy is determining what not to do,” Peterson said. “What national and community organization can you partner with to fill in the gaps?”

Finally, assign people or ask for volunteers in the organization for a further deep dive to develop suggested solutions based on the needs assessment.

3. CHOOSE YOUR OWN ADVENTURE.

Based on the needs assessment data, leaders should determine which change management and well-being approaches they'd like to take.

The three top models for organizational culture change are the Lewin Change Management Model, meant for large shifts and deep analysis; the McKinsey 7S Model, which is good for small organizations to analyze how coherent or in sync an organization is; and Kotter's Theory, a top-down approach that generates momentum and drive toward change. This last option helps implement either of the first two models, Peterson said.

Culture change should touch everything from recruiting, hiring, and orientation to performance evaluations, staff training, and support.

As for drafting the well-being approach, Peterson recommends designing the program for the marginalized, the people who have to navigate the most barriers and need the most support. This way, the program will automatically cover those who need less support.

Further, let the needs assessment be a road map, have defined roles and responsibilities for action steps, and don't subscribe to the thinking that you have to offer it all. Don't offer gym memberships when people can't even take a lunch break or programming that people don't want or won't use.

Above all else, “we need to see modeled behavior to have culture change,” especially leadership modeling behavior that promotes well-being, Peterson said. “Maybe being the best team player is going home and taking care of yourself instead of staying 12 hours when you only needed to be there eight hours.”

4. CONDUCT A STAKEHOLDER ASSESSMENT.

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More than 260 people attended the 2019 Veterinary Wellbeing Summit. They heard from industry experts and colleagues how to make individual and organizational well-being an everyday part of their personal life and professional practice.

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

Who are the stakeholders? Are they donors, leadership, veterinarians, technicians, staff, clients, students, or alumni?

Once the groups are determined, sort them by who is supportive, on the fence, unsupportive, and unknown. Consider what the groups value and who influences them.

5. ADDRESS BARRIERS TO CHANGE.

Barriers to change can involve closed attitudes, not accounting for differences among departments or divisions, unclear culture goals, bias or stigma, poor communication strategy around changes, or lack of employee engagement, expertise, or data.

To manage resistance is to expect it and plan for it. Addressing resistance formally, identifying the root causes of resistance, and being able to answer “What's in it for me?” can all go a long way, Peterson said.

Grissett, the wellness coordinator at Oklahoma State's veterinary college, encounters resistance to change frequently in his work as a licensed therapist. When a client is resistant, he takes a step back and reassesses.

“The process of feedback with a client is the same as what we might go through with the teaching hospital,” he said. “If we encounter that (resistance to change), we'll make sure we have a core group, not necessarily the ones heading up the initiative, but the ones guiding it, that will be open to feedback, which will be vital for us so we can address and move forward with changes in the most effective way possible.”

When there is resistance, he said, it's important to not push through, but to think of why there is resistance. Is it an obstacle to go around? Is there another way to get through it better? Or do we need to rethink the plan in general because it's not going to work?

“You can learn a lot from resistance; you just have to listen to it,” Grissett said.

DEFINING WELL-BEING

Kaitlyn Mattson

Dr. Julie Ducoté argues that moving to a culture of well-being will help the veterinary industry. She has been working to change the culture in her own practice since she lost two veterinarian friends to suicide a few years ago.

“In my shock … I had to start questioning everything that I believed about my personal and professional life,” Dr. Ducoté said. “What I discovered was up to this point, I had lived and worked every day refusing to acknowledge the truth about the struggles I faced in my work.”

Dr. Ducoté gave the presentation “Transforming from a Culture of Competition and Self-Sacrifice into a Culture of Wellbeing” at the 2019 Wellbeing Summit.

She is CEO and staff neurologist at the Center for Veterinary Specialty Emergency Care in Lewisville, Texas.

Well-being is defined as the way individuals think and feel about their lives, compared with the best and worst possible lives they can imagine, according to the 2017 Merck Animal Health Veterinary Wellbeing Study. The study shows that veterinarians scored only slightly lower in well-being than the general population, with the percentage of veterinarians classified as “flourishing” (58.3%) approximately 3 percentage points lower than the percentage of the U.S. employed general population with that classification (61.2%). Factors contributing to low well-being include educational debt, working long hours, low income, and lack of healthy activities.

Dr. Ducoté has worked hard to define and implement a culture of well-being at her practice by doing some of the following:

  • • Emphasizing collaboration instead of competition.

  • • Caring for others within healthy boundaries.

  • • Practicing self-care instead of self-sacrifice.

  • • Releasing perfectionism.

  • • Being present with each other.

  • • Remembering it's a journey.

  • • Developing empathy.

  • • Following instincts.

  • • Speaking up and talking with team members about mental health.

  • • Hiring a veterinary social worker.

Access to lethal means looked at to lower veterinary suicide rate

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Dr. Julie Ducoté is the CEO and staff neurologist at the Center for Veterinary Specialty Emergency Care in Lewisville, Texas. She has worked hard to define and implement a culture of well-being at her practice. (Courtesy of Dr. Ducoté)

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

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Jen Brandt, PhD, director of well-being and diversity initiatives at the AVMA, lectures on QPR training, which helps in identifying and aiding individuals who may be at risk for suicide. QPR stands for question, persuade, and refer. (Photos by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

Researchers say changes needed to prevent diversion of euthanasia drug

Malinda Larkin

Veterinarians have a higher rate of suicide than does the general population, research says. But according to the most recent study, if suicides associated with pentobarbital, a drug commonly used for euthanasia of animals, were not counted, veterinarians would mirror the general population in terms of suicide rates.

Researchers and veterinarians are calling for change, but there's a lack of consensus as to the best steps to take. Some within the profession have advocated for controlling access to the means—that is, changing how pentobarbital is stored. Others say better policies need to be in place to avoid the risk of the drug leaving the clinic for potential use at home.

MEANS TO AN END

Researchers from the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health looked at mortality rates from suicide among 11,620 veterinarians who died from 1979–2015. They concluded that male veterinarians were 2.1 times as likely and female veterinarians were 3.5 times as likely to die from suicide as were members of the U.S. general population, and these higher suicide mortality rates extended the entire 36-year period (J Am Vet Med Assoc 2019;254:104–112).

When looking at methods of suicide, the researchers found notable differences.

Fifty-one percent of male veterinarians who died by suicide used firearms, and 33% overdosed, compared with 18% of female veterinarians who used firearms and 64% who overdosed.

For both male and female veterinarians, those in clinical positions more often used pharmaceuticals than did those in nonclinical positions.

Tracy Witte, PhD, a professor in the Auburn University psychology department, then built on the CDC's work by looking more specifically at methods of suicide.

Dr. Witte's research, published in September, showed not only that overdoses were the most common suicide means for veterinarians, but also that pentobarbital was the most common substance used, which is different from what's seen in the general population (J Am Vet Med Assoc 2019;255:595–608).

“In some ways, this isn't a shocking finding because people have speculated for a while, and there was indirect evidence that veterinarians are more likely to overdose. And reading between the lines, people assumed they overdosed on pento,” Dr. Witte said.

Further, 89% of the pentobarbital-caused deaths did not occur at work—most of the time they were at home (72%).

Taking it one step further, the researchers reanalyzed their data after excluding those veterinarians who used pentobarbital, and they found that suicide rates for male and female veterinarians were no different from those for the general population.

“So, the idea is the people who used pentobarbital, theoretically, if that had been prevented, we would have a similar suicide rate in vets as we do in the general population,” Dr. Witte said. “This gives credence to the idea that if we made it a little more difficult for veterinarians to die by suicide, we could prevent suicide, not just make them switch to something else.

“Moreover, our finding that most of the suicides involving pentobarbital occurred outside the workplace suggests any new policies should consider guidelines for when and how pento can be removed from a clinical setting.”

ONE DAY AT A TIME

On average, 129 Americans died by suicide each day in 2017, and upwards of 90% of those individuals had a diagnosable mental health condition at the time of their death, according to the American Foundation for Suicide Prevention.

There is no single cause of suicide, but a convergence of biological, psychological, social, and environmental factors contribute, and all of these factors interact with external life events every day. Suicide most often occurs when stressors exceed the current coping abilities of someone suffering from a mental health condition, the AFSP states.

Christine Yu Moutier, MD, chief medical officer for the AFSP, gave a talk during the 2019 Veterinary Wellbeing Summit, held Nov. 17–19 in Rosemont, Illinois, on preventing suicide and building resilience.

People experience negative life events all the time, she said, from bullying to crises, and the rule is resilience, not suicide. The latter happens when “those natural ways of resilience and protective factors are temporarily dismantled. In those moments, you don't have access to a sense of connectivity, for example. That cognitive constriction lasts for a short period of time, but if you can allow a person to get through moments to hours of that high acute period and keep them away from lethal means, you don't just save their life for a moment” but possibly for a lifetime, Dr. Moutier said.

Limiting access to lethal means is effective, as the data show that most people don't opt for another method. Dr. Moutier cited a 2010 study that examined rates of suicide after a policy change in the Israeli Defense Forces that reduced adolescents' access to firearms. Following the policy change, suicide rates decreased by 40%.

TOOLKIT TO HELP VETERINARY COLLEGES DEAL WITH SUICIDE

To help support veterinary colleges in the aftermath of a student's death by suicide, the American Foundation for Suicide Prevention, AVMA, and Association of American Veterinary Medical Colleges have released a new resource, “After a Suicide: A Toolkit for Colleges of Veterinary Medicine.”

The toolkit provides a best-practices approach to effectively managing the impact of suicide in academic communities, said Dr. Andrew T. Maccabe, AAVMC CEO, in a Nov. 18, 2019, press release. The launch coincided with the 2019 Veterinary Wellbeing Summit (see page 148).

Developed by experts in veterinary medicine and suicide prevention as well as survivors of suicide loss in the veterinary community, this free toolkit includes the following:

  • • Best practices for how school administrators and staff should respond in the immediate aftermath of a suicide.

  • • Guidance on helping students, faculty, and staff cope in the short and long term.

  • • Tips on working with the media and community partners such as the coroner's office, local police departments, funeral directors, faith leaders, and mental health professionals.

  • • Tools for deciding how to safely memorialize students.

  • • Information on how to identify and support members of the community who may be vulnerable and reduce the risk of suicide contagion.

“This toolkit addresses many of the questions that schools have following a suicide death, while also giving them a framework through which to effectively respond to students' questions and needs,” said AVMA President Dr. John Howe in the release. “Collaborating with AFSP provided the expertise and insight necessary in the development of these tools, and AAVMC's reach within the colleges and schools gives us confidence that they will make a significant difference in the future of veterinary medicine.”

Christine Moutier, MD, AFSP chief medical officer, said in the release: “Because suicide loss survivors can develop elevated risk of suicide if not appropriately supported, postvention is a critical component of suicide prevention. The appropriate handling of the aftermath of a suicide often paves the way for effective prevention strategies to be developed and employed at the next phase after the grief period.”

To view the toolkit, go to afsp.org/veterinarians.

Further, a 2017 study in the online journal BMC Psychiatry found that people in jobs with access to firearms, medicines or drugs, or carbon monoxide more frequently used these methods to end their lives than those without access to lethal means.

Women in jobs with access to lethal means had suicide rates that were 3.02 times the rates for those without access at their work. Men in jobs with access had suicide rates that were 1.24 times the rates for those without access.

“The findings of this study suggest the importance of controlling access to lethal methods in occupations where these are readily available,” the authors concluded.

KEEPING TABS

All health professionals licensed to dispense, administer, or prescribe controlled drugs, such as pentobarbital, must register with the Drug Enforcement Administration. Registrants must comply with regulatory requirements relating to drug security and record keeping. Prescription drugs should be stored separately from over-the-counter drugs and in a secure manner, with access limited to key personnel. But that's not always the case, said Dr. Suzanne E. Tomasi, an epidemiologist at NIOSH and lead researcher on the CDC study.

“Once staff gets in for the day, they're constantly in and out of the drug box,” said Dr. Tomasi, a former practicing veterinarian. “You have the morning appointments while the surgery technician is prepping for surgery and hope to get one done in time for lunch. As the vet, you unlock the controlled box so the tech can start dosing meds and calculating surgery meds. Usually, I would double-check doses before giving to patients, but you're running around and doing your stuff, and the box is basically open.” She says the profession needs to come up with ways to look at better administrative controls in various situations, from a small rural clinic to a big multidoctor practice to an ambulatory clinic.

“That's where the paper in September was driving that point home. We're working on the mental health part—changing stigma, looking at the business model, improving work-life balance, and educating the public when they say these things that are a form of bullying and hurting the profession—but that's going to take time,” Dr. Tomasi said. “Changing administrative controls that change how clinics view and access the drug box could be an immediate lifesaving change for a certain percentage of the profession.”

FINDING WHAT WORKS

Of course, the devil lies in the details.

There are the quick and easy solutions, such as putting a sticker on drug boxes with the phone number of a suicide prevention lifeline. But other solutions will take greater effort to thwart veterinarians from diverting pentobarbital.

Dr. Andy Roark, a practicing veterinarian at Cleveland Park Animal Hospital in Greenville, South Carolina, and an author and speaker, started the Four Eyes campaign last year. He's advocating that accessing controlled drugs should require two people in every clinic possible.

But the campaign has seen pushback. For example, solo mobile practitioners have said they wouldn't have a second person around to sign off.

“And my response is, if you have something great for 90–95% of the profession, and 5–10% percent can't do it, it doesn't mean 90–95% can't,” he said.

Other criticisms include that a two-person system wouldn't work as quickly as veterinarians would need access to drugs in some cases or that implementing a new system would be expensive. Dr. Roark says he doesn't buy the quickness argument because human emergency rooms have been able to make the same system work. And drug management systems range in cost, from those that require thumbprint recognition from two approved people before allowing access to just having two locks on a drug box, which the DEA already requires, and committing to a key management system.

Regarding the latter, Dr. Roark said, “It has to come from leadership. You can't have doctors hiding keys. I think a lot of people think it (suicide) can't happen in their practice. The truth is you don't know what's going on in the mind of colleagues.”

He thinks the hesitation he's seen about his idea is that veterinarians worry they will lose access to important drugs they need to do their job.

“That's why us choosing to do this (voluntarily) and do it well is important to get people on board,” he said.

Meanwhile, Dr. Witte's research group is planning to get feedback from practitioners on a variety of ideas on how to implement better controls and seeing whether they work.

“We shouldn't have one solution for everybody,” she said. “What needs to be done is a bottom-up approach to identify things that might work and be viewed as acceptable by people who would need to use them.”

Talk is tricky

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The theme of the 2019 Veterinary Wellbeing Summit was “Putting the ‘We’ in Wellbeing.” The event brings together veterinarians, veterinary students, educators, and mental health professionals each year.

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

Veterinary professionals may unknowingly be using microaggressions when communicating

Kaitlyn Mattson

Garnetta Santiago, a licensed veterinary technician, stresses that the way people communicate has a direct impact on well-being.

In particular, she suggests that microaggressions—brief, subtle statements, miscommunications, actions, or incidents that are hostile or derogatory—create stress that inhibits well-being for veterinary professionals and may contribute to feelings of isolation.

“When we talk about diversity, we don't consider the impact of the diverse environment around us and how that affects our communication trends,” Santiago said. “The country is a rich tapestry of cultures, languages, traditions, and backgrounds. There is a huge disconnect, and there is a huge problem, when we are a profession that serves an entire country, and we are not representative of the people and populations that we serve.”

Santiago, manager of academic and professional affairs for Zoetis Inc., spoke about communication and microaggressions during the session “Did She Really Just Say That? The Impact of Unconscious Communication Patterns on Wellbeing in the Veterinary Profession” at the 2019 Veterinary Wellbeing Summit, Nov. 17–19 in Rosemont, Illinois.

WHEN WORDS CAN HURT

“Culture shapes a lot of the lenses that we operate through,” Santiago said. “We know what we know, but what happens when you encounter people that are different? … Our cultural lenses help us navigate the world, but they are also a source of some blind spots, and a lot of the mismatches or miscues in communication come out of our blind spots.”

For example, a person may be trying to communicate and connect with someone, but because of his blind spots, he may inadvertently be harming that individual, Santiago said.

Elements of culture include nationality, ethnicity, religion, sexual orientation, and language.

Lisa Greenhill, EdD, senior director for institutional research and diversity at the Association of American Veterinary Medical Colleges, discussed microaggression in an AAVMC DiVersity Matters podcast in 2017 with Kathleen Wong, PhD, chief diversity officer at San Jose State University.

It is important to inform and educate people about microaggressions because they are difficult to deal with, and they're not necessarily seen as very severe from outside observers or perpetrators, Dr. Wong said.

“They are so micro,” she said. “But we know from research that microaggressions take a huge psychological toll and contribute a lot to organizational culture and perceptions of safety, welcomeness, or warmness. … We generally don't talk to people about them, and so you have this other whammy, where people have no idea that they have done something wrong.”

Dr. Wong said that some examples of microaggressions for someone in veterinary medicine might be: So do you guys get to do any real doctoring? Did you really study medicine? Are you a real doctor?

BE POLITE

“Not all insults are the same,” Santiago said. “A microaggression is an equal opportunity offender. They're not limited to race.” There are microaggressions related to religion and sexual orientation, among others.

Santiago broke microaggressions into the following three categories:

  • • Microassaults: An insult that is overt, conscious, and with a goal to hurt someone's feelings and to further marginalize or isolate an individual. For example: “It's a shame you decided to have kids in veterinary school; you could have gone far.”

  • • Microinsults: A “bless your heart” insult or a statement that is not intentionally mean or demoralizing. For example: “Wow, you speak good English” or “You graduated from that veterinary school? There's probably a lot I'm going to have to teach you here in the practice.”

  • • Microinvalidations: An insult that negates or nullifies the thoughts or experiences of a certain group of people. For example: “Why is everything about race with you?”

“I have experienced my share of microaggressions, and a lot of times I experience them in the rearview mirror,” Santiago said. “So, someone will say something. Something doesn't feel right about it, but I'll process it later. When you think about it, every time an individual experiences something like this and they have to go back and look at it, it builds what I call a callus because you are not able to process or address it in real time.”

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Attendees at the 2019 Veterinary Wellbeing Summit, Nov. 17–19, in Rosemont, Illinois (Photo by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

Dr. Stacie Gallenstein, an anatomy professor at North Carolina State University College of Veterinary Medicine who is white, knows she has implicit bias.

“I made an unfortunate comment that President Obama was an amazing speaker,” Dr. Gallenstein said at the summit. “What I meant was that he is one of the best speakers I have ever seen, period. But what I learned was that a lot of my African-American students read that as, ‘He's one of the best speakers; he speaks so well as a black person.‘ My intent was completely different than what they had interpreted.”

Dr. Gallenstein said she is on the committee for diversity and inclusion at the veterinary college, and she is working to be a good ally, but it's a learning process.

Santiago argues that you can't control an individual's response, but you can be vulnerable and open to feedback. “My personal belief is that as long as you don't stop trying, as long as you open yourself to be vulnerable—and that goes for the dominant culture as well as members of underrepresented groups—as long as your goal is constantly moving towards better understanding through communication, and you don't shut yourself off and retreat into your tribe, then you'll get closer than where you were before,” to being more aware of microaggressions.

People

VETERINARY EMERGENCY, CRITICAL CARE GROUPS HOLD SYMPOSIUM

EVENT

25th International Veterinary Emergency and Critical Care Symposium, Sept. 6–10, 2019, Washington, D.C.

PROGRAM

This year's symposium focused on the critical kidney in veterinary emergency and critical care. The symposium was conducted jointly by the Veterinary Emergency & Critical Care Society, American College of Veterinary Emergency and Critical Care, Academy of Veterinary Emergency and Critical Care Technicians and Nurses, American College of Veterinary Anesthesia and Analgesia, Academy of Veterinary Technicians in Anesthesia and Analgesia, International Veterinary Academy of Pain Management, and Association of Veterinary Hematology and Transfusion Medicine. The symposium also served as the venue for the annual meeting of the Veterinary Emergency and Critical Care Foundation. Dr. Cynthia Otto, Philadelphia, presented the Knowles Memorial Keynote Lecture, discussing the vital role that dogs in the military and law enforcement play in saving lives.

AWARDS

Ira M. Zaslow VECCS Distinguished Service Award

Dr. Elizabeth Rozanski (Illinois '92), Norwalk, Connecticut. Dr. Rozanski serves as an associate professor of respiratory disease, hematology, and emergency and critical care at the Cummings School of Veterinary Medicine at Tufts University. She is a past president of the ACVECC and a diplomate of the American College of Veterinary Internal Medicine.

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Dr. Elizabeth Rozanski

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

Hill's Dr. Jack Mara ACVECC Achievement Award

Drs. Daniel J. Fletcher, Ithaca, New York, and Manuel Boller, Werribee, Australia. A 2002 veterinary graduate of the University of California-Davis,

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Dr. Daniel J. Fletcher

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

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Dr. Manuel Boller

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

Dr. Fletcher serves as an associate professor in the Section of Emergency and Critical Care and is associate chair for the Department of Clinical Sciences at Cornell University College of Veterinary Medicine. He is president of the ACVECC and a co-chair of the Reassessment Campaign on Veterinary Resuscitation initiative, a nonprofit, volunteer-based program within the ACVECC and VECCS dedicated to conducting high-quality education, evidence review, and guideline creation. A 1997 veterinary graduate of the University of Zurich in Switzerland, Dr. Boller is a senior lecturer in small animal emergency and critical care at the University of Melbourne, Melbourne Veterinary School. He is a co-chair of the RECOVER initiative and the SnakeMap project in Australia. The project aims to better predict, prevent, diagnose, and treat snakebites in animals as well as people. Dr. Boller is a diplomate of the ACVECC.

T. Douglas Byars Boehringer Ingelheim Equine Emergency & Critical Care Educator of the Year

Dr. Pamela Wilkins (Cornell '86), Urbana, Illinois. Dr. Wilkins is a professor of veterinary clinical medicine at the University of Illinois College of Veterinary Medicine. Her clinical interests include cardiovascular and respiratory problems of critically ill foals and horses and bacterial blood cultures in foals and horses as indicators of disease severity and prognosis. Dr. Wilkins is a diplomate of the ACVIM and ACVECC.

Hill's-VECCS Distinguished Award and VECCS Presidential Award

Dr. Gary L. Stamp (see obituary, Sept. 1, 2019, JAVMA, page 517), was posthumously honored for his years of commitment to advancing emergency medicine and critical care worldwide. Dr. Stamp was a founding member and a past president of the VECCS and ACVECC and a co-founder of the IVECCS. Dr. Stamp served as executive director of the VECCS from 1999 until his death.

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Dr. Gary L. Stamp

Citation: Journal of the American Veterinary Medical Association 256, 2; 10.2460/javma.256.2.133

Gary L. Stamp Award

Dr. Dennis Burkett (Pennsylvania '84), Malvern, Pennsylvania, was honored for his years of commitment to advancing emergency medicine and critical care worldwide. Dr. Burkett is a veterinary cardiologist and an emergency and critical care specialist at Hope Veterinary Specialists in Malvern. He is a diplomate of the ACVIM and ACVECC.

VECCS Practice Manager of the Year, sponsored by Nationwide Insurance

Kate Parker, Arvada, Colorado. Parker is the hospital manager at Animal Urgent Care in Arvada.

ACVECC Research Grant Award ($9,990)

Dr. Galina Hayes, Cornell University, for “Before and after parallel group controlled trial investigating the effects of a bundled anti-burnout intervention measure on burnout severity in veterinary technicians”

ACVECC CPR Research Grant Award ($7,250)

Dr. Karin Unger, Washington State University, for “The effect of the use of an impedance threshold device on end-tidal carbon dioxide partial pressure and return of spontaneous circulation in dogs undergoing cardiopulmonary resuscitation after in-hospital cardiac arrest”

VECCF Research Grant Award ($6,700)

Dr. Michael Kato, North Carolina State University, for “Comparison of platelet function between canine fresh whole blood, cold whole blood, and platelet concentrate”

Small Animal Resident Abstract Award

A $500 stipend was awarded to Dr. Christiana Fischer, Philadelphia, for “Evaluation of subcutaneous versus intravenous apomorphine for emesis induction in dogs.”

Large Animal Resident Abstract Award

A $500 stipend was awarded to Dr. Jamie Kopper, Washington State University, for “The effect of proximal gastrointestinal conditions and storage on viability of fecal microbiota transfaunation.”

ACVAA Resident Abstract Award, sponsored by Smiths Medical/SurgiVet

First place, small animal—Dr. Marta Garbin, University of Florida, for “Injectate spread following ultrasound-guided lateral quadratus lumborum block in dogs: A cadaveric study;” first place, large animal: Dr. Nicole Trenholme, University of Georgia, for “Effects of a 5-degree head-up incline on arterial oxygenation in anesthetized horses”

Case Report Award

A stipend of $300 was awarded to Dr. Kaila Rizzo, University of Pennsylvania, for “Trippin topiramate.”

Technician Case Report Award, sponsored by Animal Blood Resources International

A stipend of $300 was awarded to Bonnie Lockridge, University of Georgia, for “Spontaneous atrial fibrillation in an anesthetized patient for PDA ligation.”

IVAPM Case Report Award

Mylissa Fitzpatrick, Gansevoort, New York, for “Managing osteoarthritis and severe elbow dysplasia after an acute ITP event.”

Royal Canin Nutritional Case Report Award

Dr. Lisa Gretebeck, Alexandria, Virginia, for “But it is grain free!”

Poster Abstract Award, sponsored by Abaxis

A stipend of $500 was awarded to Dr. Marcelle Hon, Honolulu, for “Cryopreservation of feline red blood cells in liquid nitrogen using glycerol and hydroxyethyl starch.”

VETERINARY EMERGENCY AND CRITICAL CARE SOCIETY

Business

It was announced that membership numbers are almost the same as the previous year, and finances are strong. The society has moved to a true accrual system. This year, $79,000 in additional scholarships were given to veterinary students and to certified facilities to provide pro bono services. The Journal of Veterinary Emergency and Critical Care has an additional copy editor to assist with journal backlog. Online continuing education offerings to membership have risen and will continue to expand. Participation in social media has increased visibility and exposure for the society. A task force with the ACVECC to address the shortage of veterinary emergency and critical care staff, announced last year, has resulted in a three-prong approach, with the task force working on new certification for veterinary technicians, separate from that of the AVECCTN; mentorship for young veterinarians with experienced emergency room doctors; and increased knowledge and career advancements.

Officials

Dr. Linda Martin, Pullman, Washington, president; Dr. Elisa Mazzaferro, Norwalk, Connecticut, president-elect; Dr. Chris Gray, East Lansing, Michigan, treasurer; Kenichiro Yagi, Ithaca, New York, recording secretary; Dr. Robert Messenger, Charlotte, North Carolina, immediate past president; P.J. Andrus, Chicago, chief executive officer; and members-at-large—Drs. Julie Dechant, Davis, California, and Steven Epstein, Davis, California

AMERICAN COLLEGE OF VETERINARY EMERGENCY AND CRITICAL CARE

Program

The ACVECC conducted its certification examination and held its annual business meeting.

New diplomates

Fifty-three individuals passed the certification examination

They are as follows:

Rachel Acciacca, U.S. armed forces

Maia Ramirez Aitken, Kennett Square, Pennsylvania

Daniel Avenick, Santa Barbara, California

Amy Bell, Redwood City, California

Steven Todd Berkowitz, Hamilton, New Jersey

Alexander “Alex” Bluntinger, Washington, D.C.

Heike Botha, San Diego

Laura A. Cagle, Davis, California

Dana J. Caldwell, Gilbert, Arizona

Laura Cole, London

Emma Lindsey Deane, Rocklin, California

Samuel Avram Dicker, Great Neck, New York

Liam R. Donaldson, Newstead, Australia

Rebekah E. Donaldson, Aspley, Australia

Kerry Doolin, Paisley, Scotland

Emily T. Dozeman, Chicago

Brittany Enders, Cary, North Carolina

Katherine K. Gerken, Opelika, Alabama

Clayton David Greenway, Lewisville, Texas

Simon Paul Hagley, Manchester, England

Jeanette Hendricks, Woodland Hills, California

Aubrey Lynn Hnatusko, Edmond, Oklahoma

Marcelle Hon, Honolulu

Jennifer A. Hoose, Chino, California

Danielle M. Hundley, Omaha, Nebraska

Claudia Iannucci, Bern, Switzerland

Christopher R. Kennedy, Vancouver, British Columbia

Jessica Kielb, Cary, North Carolina

Terence Krentz, Los Gatos, California

William G. Lane, Boston

Hendrik Lehmann, Giessen, Germany

PenTing Liao, Ames, Iowa

Bridget M. Lyons, Columbia, Missouri

John Michael Mallard, Los Angeles

Ingrid O. Manhart, Deerfield, Illinois

Hannah Rose Marshall, Portland, Oregon

Pia Martiny, Salt Lake City

Rebecca McQuitty, San Jose, California

Emiliana Rose Meroni, Philadelphia

Jennifer Lynne Morris, Philadelphia

Michael R. Nystorm, Durham, North Carolina

Laura Osborne, Calgary, Alberta

Kirsty L. Royle, Vancouver, British Columbia

Jonathan Schaefer, Columbia, Missouri

Katherine Maria Scotti, Greenville, South Carolina

Susanna Solbak, Guildford, England

Stanley Sowy, Houston

Jessica L. Wallis, Calgary, Alberta

Jessica Marie Weeks, Brandon, Florida

Elodie Yam, Morley, Washington

Igor Yankin, College Station, Texas

Xiu Ting Yiew, Guelph, Ontario

Kristin Marie Zersen, Fort Collins, Colorado

Officials

Drs. Daniel Fletcher, Ithaca, New York, president; Ken Drobatz, Philadelphia, president-elect; Beth Davidow, Seattle, vice president; Scott Shaw, Oxford, Massachusetts, treasurer; Armelle de Laforcade, North Grafton, Massachusetts, executive secretary; Elisa Mazzaferro, Norwalk, Connecticut, immediate past president; and regents—Drs. Kira Epstein, Athens, Georgia; Erica Reineke, Devon, Pennsylvania; Lisa Powell, Golden Valley, Minnesota; Greg Lisciandro, Spicewood, Texas; Maurine Luschini, East Syracuse, New York; and Deborah Silverstein, Philadelphia

ACADEMY OF VETERINARY EMERGENCY AND CRITICAL CARE TECHNICIANS

Program

The academy conducted its 22nd certification examination and held a pinning ceremony and reception for the class of 2018. Louise O'Dwyer was posthumously honored as Technician of the Year.

Business

Committee reports were presented and ratified.

Officials

Megan Brashear, Portland, Oregon, president; Trisha Farry, Brisbane, Australia, president-elect; Kenichiro Yagi, Ithaca, New York, treasurer; Andrea Steele, Guelph, Ontario, executive secretary; Amy Newfield, Tewksbury, Massachusetts, immediate past president; and members-at-large—Justin Chandler, Matawan, New Jersey; Jess Kerr, Clifton, New Jersey; and Katy Waddell, College Station, Texas

AMERICAN COLLEGE OF VETERINARY ANESTHESIA AND ANALGESIA

Program

Forty abstracts were presented. A review day was held for residents enrolled in ACVAA programs with a focus on respiratory physiology and pathophysiology. Lectures for the review day were presented by Drs. John Dodam, University of Missouri, and Peter Pascoe, University of California-Davis. Also on offer were two days of special-focus lectures, with Drs. Michael Walsh of McMaster University, Michael Seneff of The George Washington University Hospital, Carrie Palm of the University of California-Davis, and Pascoe speaking on perioperative management of the patient with renal insufficiency; Dr. Luis Campoy, Cornell University, lecturing on the use of perioperative maropitant and local anesthetic techniques; and Dr. Manuel Martin-Flores, Cornell University, speaking on recent information on the recovery from neuromuscular blocking agents. The 2019 ACVAA Career Achievement Award was given to Dr. Thomas J. Doherty, Knoxville, Tennessee. A 1974 veterinary graduate of the University College Dublin in Ireland, Dr. Doherty serves as a professor of large animal clinical sciences at the University of Tennessee College of Veterinary Medicine. He is a diplomate of the ACVAA. Drs. Lawrence R. Soma (Pennsylvania ‘57), Glenn Mills, Pennsylvania, and Robert Bruce Heath (Iowa State ‘62), Fort Collins, Colorado, received the 2019 President's Award for Meritorious Service. Dr. Soma is an emeritus professor of anesthesia and clinical pharmacology at the University of Pennsylvania School of Veterinary Medicine. He is charter president of the ACVAA. Dr. Heath is professor emeritus at Colorado State University College of Veterinary Medicine & Biomedical Sciences. He is a charter diplomate of the ACVAA.

New diplomates

Eighteen individuals passed the certification examination. They are as follows:

Sarah Bigby, Elanora, Australia

Katherine Bennett, Knoxville, Tennessee

Joana Chagas, Palmerston North, New Zealand

Renata Costa, North Grafton, Massachusetts

Graeme Doodnaught, Sainte Hyacinthe, Quebec

Kimberly Hassen, Raleigh, North Carolina

Teela Jones, Saskatoon, Saskatchewan

Krista Mitchell, Athens, Georgia

Ashley Mitek, Urbana, Illinois

Kirk Munoz, East Lansing, Michigan

Vaidehi Paranjape, Gainesville, Florida

Marco Ruffato, Boca Raton, Florida

Adrianna Sage, Urbana, Illinois

Stefania Scarabelli, Montecalvo Versiggia, Italy

Chia Tseng, Ames, Iowa

Raphaël Vézina-Audette, Philadelphia

Keely Wilson, Stratford-upon-Avon, England

Kathryn Zatroch, Ithaca, New York

Business

Discussions were held on changes to the language of ACVAA bylaw amendments that need to be voted on by the end of 2019. Also discussed were updates on requirements for maintenance of certification and the North American Veterinary Anesthesia Society. Nominees for the 2020 Region 1 and at-large board of director positions were announced, with additional nominations welcomed.

Officials

Drs. Christine Egger, Knoxville, Tennessee, president; Colin Dunlop, Gladesville, Australia, president-elect; Lynne Kushner, Portsmouth, Rhode Island, executive secretary; and Lesley Smith, Madison, Wisconsin, immediate past president

ACADEMY OF VETERINARY TECHNICIANS IN ANESTHESIA AND ANALGESIA

Program

The academy celebrated its 20th anniversary at the symposium and conducted its certification examination.

Business

The academy met with the ACVAA and discussed issues facing both organizations. Katy Waddell, the president of the academy, outlined short- and long-term goals for the AVTAA.

Officials

Katy Waddell, College Station, Texas, president; Jennifer Sager, Gainesville, Florida, president-elect; Lynette DeGouff, Cortland, New York, treasurer; Darci Palmer, Auburn, Alabama, executive secretary; Brenda Feller, Fort Myers, Florida, immediate past president; and members-at-large—Jody Nugent-Deal, Davis, California; Brynn Schmidt, Los Angeles; and Amanda Shelby, Avon, Indiana

VETERINARY EMERGENCY AND CRITICAL CARE FOUNDATION

Program

The foundation partnered with the Society for the Prevention of Cruelty to Animals/Humane Society of Prince George's County to provide preventive services and basic medical care for 150 pets in an underserved community. It also hosted its sixth annual K9 ER Care and CPR Course. More than 30 first responders attended the all-day course, which included hands-on instruction and lectures on anatomy, wound management, CPR in the field, exposure to toxins, and common traumas. The foundation raised more than $25,000, some of which was donated to the Prince George's SPCA and a portion of which will be directed toward the Dougie Fund for Disaster Relief, to help veterinary practices and animal caregivers impacted by natural disasters.

Officials

Alyce D'Amato, Appleton, Wisconsin, president; Dr. Deborah Silverstein, Philadelphia, secretary; Dr. Robert Messenger, Charlotte, North Carolina, treasurer; Dr. Bill Smith, Seale, Alabama, immediate past president; and board members—Dr. Susan Barnes, Leesburg, Virginia; Chris Kotnaur, Crystal Lake, Illinois; Dr. Lorna Lanman, Sun City West, Arizona; and Deanne Pawlisch, Schaumburg, Illinois

Obituaries: AVMA MEMBER | AVMA HONOR ROLL MEMBER | NONMEMBER

JOHN MICHAEL BARNES

Dr. Barnes (Ohio State '73), 72, New Martinsville, West Virginia, died Aug. 20, 2019. He owned Riverside Animal Clinic in New Martinsville, where he initially practiced mixed animal medicine, focusing later on small animals. Dr. Barnes also made farm calls in neighboring Ohio during that time. He retired in 2016.

Dr. Barnes was a member of the Ohio and West Virginia VMAs. He was also a member of the Rotary Club and Brooks Bird Club. Dr. Barnes is survived by his wife, Jeanne; a daughter; and two grandchildren. Memorials, toward West Virginia

Scholarship Fund #315329, benefiting a West Virginia student attending The Ohio State University College of Veterinary Medicine, may be sent c/o The Ohio State University Office of Advancement, 1480 West Lane Ave., Columbus, OH 43221.

JAMES D. ELMORE

Dr. Elmore (Texas A&M '70), 72, Evans, Georgia, died July 24, 2019. A diplomate of the American College of Veterinary Preventive Medicine, he served in the Army for 30 years prior to retirement with the rank of colonel. Dr. Elmore also worked in adult education at Augusta Technical

College in Augusta, Georgia, for several years.

He is survived by his wife, Roberta; two daughters; four grandchildren; and a brother.

LINDSAY B. FRUGE

Dr. Fruge (Louisiana State '13), 31, Baton Rouge, Louisiana, died Aug. 31, 2019. A small animal veterinarian, she owned Crowley Veterinary Hospital in Crowley, Louisiana. Dr. Fruge was a member of the Crowley Rotary Club. Her husband, Adam; two sons; her mother; and three sisters, three stepbrothers, and a stepsister survive her.

SAMUEL A. GILMORE

Dr. Gilmore (Texas A&M '64), 82, Amarillo, Texas, died July 5, 2019. He worked for the Department of Agriculture for 30 years prior to retirement in 1994, serving as a circuit supervisor for New Mexico and southwest Texas. Dr. Gilmore was a veteran of the Army. He volunteered with Meals on Wheels, English as a Second Language, and Snack Pak 4 Kids.

Dr. Gilmore is survived by his wife, Martha; a son, two daughters, a stepson, and a stepdaughter; three grandchildren; and two brothers and two sisters. Memorials may be made to South Georgia Baptist Church, 5209 S. Georgia St., Amarillo, TX 79110.

ROBERT B. HANCOCK JR.

Dr. Hancock (Mississippi State '01), 43, Madisonville, Louisiana, died June 16, 2019. A diplomate of the American College of Veterinary Surgeons, he owned South Paws Veterinary Surgical Specialists in Mandeville, Louisiana. Dr. Hancock's wife, Jennifer; two daughters; and his parents survive him. Memorials may be made to South Paws Healing Hands Fund, 2631 N. Causeway Blvd., Mandeville, LA 70471, or Dr. Robert “Bob” Hancock Memorial Scholarship Fund, Mississippi State University College of Veterinary Medicine, Mississippi State, MS 39762.

WILLIAM H. HERBOLD III

Dr. Herbold (Cornell '62), 83, West Islip, New York, died May 9, 2019. He practiced small animal medicine in West Islip for 40 years. Dr. Herbold is survived by his wife, Dianne; three sons and three daughters; 11 grandchildren; two great-grandchildren; and two brothers. Memorials may be made to St. Luke's Lutheran Church, 3 Lawrence Lane, Bay Shore, NY 11706, or Remington Fund, Cornell University, Box 39, 930 Campus Road, Ithaca, NY 14853.

WENDELL H. NIEMANN

Dr. Niemann (Minnesota '57), 86, Tucson, Arizona, died Aug. 13, 2019. Following graduation, he served in the Army, attaining the rank of captain. During his military service, Dr. Niemann worked in research at the Walter Reed National Military Medical Center in Bethesda, Maryland. He later continued a career in research, working at Hoffmann-La Roche Pharmaceutical Co. in Nutley, New Jersey; Columbia University; New York University; and what was known as the University of Medicine and Dentistry in New Jersey.

Dr. Niemann was a member of the Tucson Cactus and Succulent Society, served on the advisory board of the Pima County Library, and volunteered with homeless services, including Casa Maria in Tucson. His wife, Rosemary; three sons, two stepsons, and a stepdaughter; nine grandchildren; and two sisters and a brother survive him.

GLENN F. SEXTON

Dr. Sexton (Auburn '70), 78, Guntersville, Alabama, died May 22, 2019. From 1985–2005, he served as director, program coordinator, and professor for the veterinary technology program at Snead State Community College in Boaz, Alabama. Dr. Sexton later served as a consultant for the veterinary technology program at Alabama's Jefferson State Community College.

Earlier in his career, he was in private practice in Mississippi at Greenville and Cleveland. Dr. Sexton's wife, Charlene; a daughter, a son, a stepson, and a stepdaughter; six grandchildren; a great-grandchild; and a brother survive him.

LARRY J. WISEMAN

Dr. Wiseman (Washington State '66), 77, Colorado Springs, Colorado, died June 29, 2019. Following graduation, he served two years as a captain in the Army Veterinary Corps. Dr. Wiseman subsequently founded Pikes Peak Veterinary Clinic in Colorado Springs, where he practiced until retirement. He later joined Simmons & Associates, a veterinary consulting company.

Dr. Wiseman was a past president of the Colorado VMA and a past editor of its newsletter, Voice. In 2001, he was a recipient of the CVMA President's Award. Dr. Wiseman's wife, Sue; a daughter and a son; three grandchildren; and a brother and a sister survive him. Memorials may be made to Project Healing Waters Fly Fishing Inc., P.O. Box 695, LaPlata, MD 20646.

Please report the death of a veterinarian promptly to the JAVMA News staff via a toll-free phone call at 800–248–2862, ext. 6754; email at news@avma.org; or fax at 847-925-9329. For an obituary to be published, JAVMA must be notified within six months of the date of death.

  • Boehringer Ingelheim's manufacturing site in Barceloneta, Puerto Rico (Courtesy of BI)

  • The Animal Medicinal Drug Use Clarification Act, passed in 1994, lets veterinarians administer approved drugs outside their labeled indications, and that allowance applies to compounded drugs made from approved products. But it doesn't allow administration of drugs compounded from raw pharmaceutical ingredients, even if the compounded products contain the same active ingredients as approved drugs.

  • Bison graze at dusk near a hydraulic fracturing rig. Fracking is a technique to extract oil and gas from rock by injecting high-pressure mixtures of water, sand or gravel, and chemicals.

  • The 19th annual AVMA Animal Welfare Assessment Contest hosted this past November by Colorado State University drew the highest number of participants since the contest began in 2001.

  • Members of a Predict Rwanda team collect samples from rodents. (Photos courtesy of the University of California-Davis One Health Institute)

  • Predict team members examine wild birds following a large die-off in August 2018 at Sangiin Dalai Lake in Mongolia.

  • Dr. Shane Bateman, associate professor of emergency and critical care medicine at the University of Guelph Ontario Veterinary College, works with veterinary students at the Guelph Humane Society. (Photos courtesy of University of Guelph)

  • Bubba was a participant in the field trial of the antiviral drug GS-441524 for treatment of feline infectious peritonitis and is still doing very well two years later. (Courtesy of Dr. Niels C. Pedersen)

  • Makenzie Peterson, well-being program director at Cornell University College of Veterinary Medicine, said working toward better well-being for all requires culture change. She gave the talk “Developing a Strategic Organizational Plan for Wellbeing” during the 2019 Veterinary Wellbeing Summit, held Nov. 17–19 in Rosemont, Illinois. (Photos by R. Scott Nolen)

  • More than 260 people attended the 2019 Veterinary Wellbeing Summit. They heard from industry experts and colleagues how to make individual and organizational well-being an everyday part of their personal life and professional practice.

  • Dr. Julie Ducoté is the CEO and staff neurologist at the Center for Veterinary Specialty Emergency Care in Lewisville, Texas. She has worked hard to define and implement a culture of well-being at her practice. (Courtesy of Dr. Ducoté)

  • Jen Brandt, PhD, director of well-being and diversity initiatives at the AVMA, lectures on QPR training, which helps in identifying and aiding individuals who may be at risk for suicide. QPR stands for question, persuade, and refer. (Photos by R. Scott Nolen)

  • The theme of the 2019 Veterinary Wellbeing Summit was “Putting the ‘We’ in Wellbeing.” The event brings together veterinarians, veterinary students, educators, and mental health professionals each year.

  • Attendees at the 2019 Veterinary Wellbeing Summit, Nov. 17–19, in Rosemont, Illinois (Photo by R. Scott Nolen)

  • Dr. Elizabeth Rozanski

  • Dr. Daniel J. Fletcher

  • Dr. Manuel Boller

  • Dr. Gary L. Stamp

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