Dr. Gordon Theilen: on one former student's “Mount Rushmore” of veterinarians

I read with appreciation the comments reflecting on the career of Dr. Gordon Theilen,¹ one of the grandparents of small animal veterinary medicine and specialization (I was 8 years old when he graduated from veterinary school). At the beginning of my third year of veterinary training, I transferred to the University of California-Davis School of Veterinary Medicine, joining the class of 1973. One of my first lecturers there was Dr. Theilen. My memories of his enthusiasm and obvious desire for each of us to share his joy of caring for animals remain clear. His lectures and recommendations always carried references to his research or that of others to support his messages; he was a proponent of evidence-based medicine before the term became popular. His slide carousels were guaranteed to include a few photos from a pack trip into the Sierra Nevada mountains with friends and family or some other outdoor activity (a strategy to help maintain audience attention I later adopted). He encouraged students to seek balance between work, family, and other activities. He was insightful.

It was later in my career that I learned of Dr. Theilen's well-deserved reputation as an outstanding scientist. Of key importance, he had a phenomenal ability to bridge basic and clinical research, translating laboratory results into improved patient care. Dr. Theilen was one of dog and cat veterinary medicine's first specialists, a true pioneer. His success in having veterinarians refer cancer cases to him was a surprise to many colleagues at the time. He improved the care of cancer patients; developed a large following of devoted pet owners, former students, and colleagues; and served regional practitioners by offering a service not previously available. He was among the first to demonstrate that a veterinary specialist's opinions and assistance would be sought by veterinary general practitioners and owners of dogs and cats. A piece of every small animal specialist's board certification can be traced to Dr. Theilen's legacy.

Some years after graduation, I returned to the University of California-Davis as a junior faculty member. Dr. Theilen, an internationally recognized virologist, oncologist, clinician, and educator, would occasionally stop by my office to see how I was doing! I was no one, and he was an icon. Leading the list of Dr. Theilen's many attributes? He was a super nice person whose smile would fill a room. His sage observations and advice were always appreciated. Our conversations usually ended with talk of family, life trials, his much-loved dogs, backcountry experiences with gorgeous high mountain lakes (the bears and trout grew larger with each telling), and spirituality. He was a phenomenal role model, mentor, colleague, and friend; I shall miss him.

Edward C. Feldman, dvm

Emeritus Professor of Small Animal Internal Medicine School of Veterinary Medicine University of California-Davis Davis, Calif

Rethinking feline coronavirus infection outcomes

Feline coronavirus (FCoV) is a common pathogen of domestic and nondomestic felids. Although most cats infected with FCoV have only mild to inapparent gastrointestinal disease, a small subset develops the lethal disease feline infectious peritonitis (FIP).¹ Feline infectious peritonitis was first described by Holzworth² as chronic fibrinous peritonitis before it gained its current name,³ and since then, the disease has often been further subdivided into effusive (so-called wet) and noneffusive (dry) forms, with a mixed form sometimes included.¹

In parallel, the related coronavirus, SARS-CoV-2, is the etiologic agent of COVID-19 in people, and similar to the case of cats infected with FCoV, a large portion of people infected with SARS-CoV-2 are asymptomatic or only mildly symptomatic. However, cough, fever, shortness of breath, malaise, headaches, and anosmia have been reported for those who do develop the disease. More severe presentations of COVID-19 include acute respiratory distress syndrome and multisystem inflammatory syndrome in children.⁴ Additionally, numerous other organ systems may be involved, manifesting as acute kidney injury, high liver enzyme activities, gastrointestinal abnormalities, deep vein thromboses, cardiomyopathies, hyperglycemia, and cutaneous lesions.⁵ Despite the range of clinical outcomes, each of these clinical scenarios has been considered a part of the COVID-19 spectrum. In addition, because the initial cases of SARS-CoV-2 infection were reported less than a year ago, its long-term effects have not yet been fully described. However, concerns for the development of diabetes mellitus, heart disease, and even Alzheimer disease in COVID-19 patients have been raised.

Endotheliitis and vasculitis underlie disease development following infection with either SARS-CoV-2 or FCoV.^1,5 From a one-health perspective, it is possible that cats with subclinical FCoV infection may provide clues to the future impacts of SARS-CoV-2 infection. Investigating previous FCoV exposure in cats with various diseases may help provide insight into the diseases that we might expect to result from SARS-CoV-2.

By the same token, however, information regarding SARS-CoV-2 infection in people may provide insights into FCoV infection in cats. In particular, the variety of long-term disease outcomes in people with COVID-19 raises the question of whether we should rethink the dichotomous outcome of FCoV infection in cats (ie, lethal FIP vs mild disease with no long-term consequences). Feline infectious peritonitis may not be the only consequential disease outcome resulting from FCoV infection, and FCoV infection may in fact be represented by a spectrum of outcomes.

Veterinarians, physicians, and basic researchers addressing coronavirus disease may benefit from thinking more broadly about the impacts of FCoV infection in cats. We believe that the clinical signs of FCoV infection exceed those of classic FIP and that understanding the long-term implications of FCoV infection in cats may inform our understanding of SARS-CoV-2 infection in people. This prompts careful consideration of diseases caused by coronavirus infections from a one-health perspective.

Alison E. Stout, dvm

Nicole M. Andre, bs

Beth N. Licitra, dvm, phd

Department of Microbiology and Immunology College of Veterinary Medicine Cornell University Ithaca, NY

Gary R. Whittaker, phd

Department of Microbiology and Immunology Feline Health Center College of Veterinary Medicine Cornell University Ithaca, NY

Declawing of cats

I recently read a commentary¹ in dvm 360 in which the Humane Society Veterinary Medical Association applauded the AVMA for amending its position statement to reflect disapproval of feline declawing (onychectomy). I was not pleased with the change or with the commentary. I am a rural practitioner with 28 years of experience. This is a procedure I perform weekly, and I do not believe that our profession should discourage procedures that can be done with little pain and distress by a knowledgeable and skilled surgeon.

Such decisions, in my mind, are best left to the veterinarian and the owner of the animal within the framework of the veterinarian-client-patient relationship that is the foundation of our profession. I have declawed my own cats and will declaw the next one. These cats walk, eat, drink, and act normally the day after surgery and often spend considerable time removing the bandages from their feet, which I would not expect them to do if they were in extreme pain. I cannot remember the last cat that developed complications. Perhaps we should put our focus on correctly performing the procedure and leave the judgment of whether it needs to be done to the owner and the veterinarian performing the procedure. Discouraging something as simple as onychectomy is, in my opinion, not acting in the best interests of clients and patients.

Nolan Keith Beech, dvm

Washington County Veterinary Clinic Chatom, Ala

AVMA responds:

I appreciate the opportunity to respond to Dr. Beech's questions about the AVMA policy on declawing of domestic cats. This policy was recently revised to clarify the AVMA's support for both feline welfare and veterinarians’ professional judgment.¹ Scratching is a normal behavior for cats, and declawing should only be undertaken if it is medically necessary or if alternatives to eliminate harmful or destructive scratching have failed. As an amputation, declawing is a major surgical procedure. Welfare concerns include acute and chronic maladaptive pain, surgical complications, impairment of normal behavior, and an increased incidence of problem behavior.² In discouraging declawing as a routine elective procedure, the AVMA urges veterinarians to help clients explore and implement nonsurgical alternatives, including routine nail trimming, providing a variety of scratching surfaces, and positive reinforcement training, prior to considering onychectomy.

The AVMA agrees with Dr. Beech that veterinarians need to be able to exercise their professional judgment when deciding how to best protect their individual patients’ health and welfare.¹ Veterinarians and pet owners must work together to make a decision that will provide optimal health and welfare for their pet and family. Therefore, it is incumbent on veterinarians to counsel pet owners about the natural scratching behavior of cats, alternatives to surgery, and details of the procedure itself and subsequent potential complications.¹

The AVMA provides resources to assist with client education and support the decision-making process at avma.org/declaw.

Jyothi V. Robertson, dvm

Chair, AVMA Animal Welfare Committee